Information

  • Document No.

  • Audit Title

  • Client / Site

  • Conducted on

  • Prepared by

  • Location
  • Personnel

Fire Zone

Ansuls

  • Ansul Inspection in date range?<br>

  • Date of last Inspection?(Kimbrough) Semi-Annual<br>

  • Select date

  • Ansuls above grill zone fryer clear/maintained?<br>

  • Ansuls above grill clear/maintained?<br>

  • Ansuls above French Fry fryer clear/maintained?<br>

Fire Extinguishers

  • All fire extinguisher inspections within date range?<br>

  • Last Date of Fire Extinguisher Inspection?<br>

  • Select date

  • Fire extinguishers clearly marked?<br>

  • Fire extinguishers are in easy to reach location?<br>

Fryers

  • Are fryers in good working condition?<br>

  • (Pull Out) Build up on the back/sides of the fryers?<br>

  • (Under) Well maintained under the fryers, wheels, etc?<br>

  • Wall behind fryers well maintained?<br>

  • Drip pan on side of fryers emptied often?<br>

  • Basket hangs are free of build up?<br>

  • Gas lines and cords clear of debris and build up?<br>

Grills

  • Date of last Grill Certification? In Range?<br>

  • Select date

  • Grills are in good repair and properly working?<br>

  • Grills are clean with little to no bulidup on the platens or behind the platens?<br>

  • (Pull Out) Back side and sides of the Grills are being maintained?<br>

  • (Under) Well maintained under the Grills, wheels, etc?<br>

  • Walls behind grill are clear of build up?<br>

Vent Hoods

  • Date of last Vent Hood Cleaning? In Range?<br>

  • Select date

  • Vent hood covers clean and maintained?<br>

  • All Vent Hoods are functioning properly?<br>

Detex Alarms

  • Back door Detex alarms working properly and in use?<br>

  • Play Place Detex Alarms are working properly and in use?<br>

Emergency Evacuation Plan

  • Emergency evacuation plan is posted in lobby?<br>

Emergency Exit Signs

  • All emergency exit signs are above exits and lit?<br>

  • Fire Zones General Notes

Beverage System

Coke

  • R/O filters are with in date?<br>

  • Date of last QMC? (COKE)<br>

  • Select date

  • Main CO2 tank is properly bolted to the floor or wall?<br>

  • Back-up CO2 tank is full and properly secured to the wall?<br>

  • Muliplex is functioning properly?<br>

  • Muliplex is clean and free of debris and build up?<br>

  • ABS is functioning properly?<br>

  • Automated Beverage System(ABS) is clean and maintained?<br>

  • Control panel of ABS is working properly?<br>

  • Peripherals of ABS are functioning properly? Arm, Turret, Belt System, Etc?<br>

  • Ice Dispenser above the ABS is functioning Properly?<br>

  • Self Serve Beverage Station is clean, well maintained and working properly?<br>

  • Lighted sign on the beverage station is in good repair and light up?(if no type of replacement bulb)<br>

  • Ice Dispencer above the beverage station is in functioning properly and maintained?<br>

Orange Juice Dispenser

  • OJ Dispenser is in good repair?<br>

  • OJ Dispenser is well maintained?<br>

Blended Ice Machine

  • BIM has 2 functioning pitchers? (Note cracks, chips, etc.)<br>

  • BIM Lid is in good repair?<br>

  • BIM is well maintained?<br>

Melitta Machine

  • Melitta machine is in good repair?<br>

  • Melitta Machine is well maintained?<br>

Creamer Machine

  • Creamer Machine is in good repair?<br>

  • Creamer Machine is well maintained?<br>

Ice Dispensers

Back of Restaurant

  • Manitowoc large ice dispenser is in good repair?<br>

  • Manitowoc large ice dispenser is well maintained?<br>

Drive Thru

  • Manitowoc ABS ice dispenser is in good repair? <br>

  • Manitowoc ABS ice dispenser is well maintained?<br>

Lobby

  • Manitowoc beverage station ice dispenser is in good repair?<br>

  • Manitowoc beverage station ice dispenser is well maintained?<br>

Coffee Brewers

  • Coffee brewers are in good repair?<br>

  • Coffee brewers are well maintained?<br>

Shake Machine

  • Shake machine is in good repair?<br>

  • Shake machine is well maintained?<br>

  • Beverage General Notes

General Kitchen Maintenance

Walk-In Freezer

  • Walk in freezer is well lit? (if No note the type of bulb needing replacement)<br>

  • Walk in freezer curtians are in good repair?<br>

  • Walk in freezer is well maintained?<br>

  • Walk in freezer is free of any ice build up?<br>

Walk-In Refrigerator

  • Walk in refrigerator is well lit? (if No note the type of bulb needing replacement)<br>

  • Walk in refrigerator curtians are in good repair?<br>

  • Walk in refrigerator is well maintained?<br>

Grill Area Freezers

  • All grill area freezers are in good repair?<br>

  • All grill area freezers are well maintained?<br>

  • All grill area freezers are free of ice build up internally?<br>

Grill Area Refrigerators

  • All grill area refrigerators are in good repair?<br>

  • All grill area refrigerators are well maintained?<br>

Q-ing Oven

  • Qing ovens are in good repair?<br>

  • Qing ovens are well maintained?<br>

Oven

  • Oven is in good repair?<br>

  • Oven is well maintained?<br>

Toaster

  • Toaster is in good repair?<br>

  • Toaster is well maintained?<br>

UHC

  • UHC Controls are in working condition?<br>

  • UHCs are well maintained?<br>

French Fry Dispenser

  • French fry dispenser is in good repair?<br>

  • French fry dispenser is well maintained?<br>

Grill Hand Wash Sink

  • Grill hand wash sink is properly affixed to the wall?<br>

  • Grill hand wash sink is clean and used for hand washing only?<br><br>

  • Grill hand wash sink is stocked for proper hand washing?<br>

Back Sink

  • Sink chemicals are functioning properly and dispensers are well maintained?<br>

  • Drain under sink is free of build up and debris?<br>

  • Tanks are clear of build up?<br>

  • Kitchen Maintenance General Notes

Guest Areas

Lobby

  • Lobby tables are stable and well maintained? (No lose feet or wobbling)<br>

  • Floors are clean of build up? (Under tables/booths/chair legs)<br>

  • Door signage is clear? (hours of operation/ events/ etc)<br>

  • Walls are clean and free of build up, holes, and tears?<br>

  • All lighting in the lobby is working? (list bulbs if needed)<br>

  • Trash cans are clear of build up and in working order?<br>

  • Lobby A/C vents are free of dust build up?<br>

Playplace

  • Playplace tables are stable and well maintained? (No lose feet or wobbling)<br>

  • Playplace are clean of build up? (Under tables/booths/chair legs)<br>

  • Playplace walls are clean and free of build up, holes, and tears?<br>

  • Playplace Toy is in good condition?<br>

  • Interior of playplace toy is clean and free of build up?<br>

  • Exterior of playplace toy is clean and in good repair?<br>

  • All playplace netting is secure and free of rips or tears?<br>

  • Date of last Playplace Sanitization?<br>

  • Select date

  • Playplace lights are working? (list bulbs if needed)<br>

  • Playplace A/C vents are free of dust build up?<br>

  • Trash cans are clear of build up and in working order?<br>

Restrooms

  • Restrooms are in general good condition?<br>

  • Restroom mirrors are free of graffiti and clear of build up?<br>

  • Restroom sinks are clean and functioning properly?<br>

  • Restroom hand dryers are secure to wall and functioning properly?<br>

  • Restroom changing station is in good repair and straps are functioning properly?<br>

  • Toilets are in working order and free of leaks?<br>

  • Toilets are secure to the floor and caulked all the way around?<br>

  • Restroom doors and signage are in good repair?<br>

Maintenance Closet

  • Is closet clean and free of build up on floors, baseboards, and walls?<br>

  • Are the mop sinks clean and free of build up?<br>

  • Are chemicals being stored properly?<br>

  • Guest Area General Notes

Front Counter

Refrigerator

  • F/C Refrigerators are in good repair?<br>

  • F/C refrigerators are well maintained?<br>

Front Counter - Hand Wash Sink

  • F/C hand wash sink is properly affixed to the wall?<br>

  • F/C hand wash sink is clean and used for hand washing only?<br>

  • F/C hand wash sink is stocked for proper hand washing?<br>

HLZ

  • HLZs are free of build up?<br>

  • HLZ cords are in good condition?<br>

  • Front Counter General Notes

Building Exterior

Roof

  • Is roof clean and free of debris? Is cleaning routine in place?<br>

  • A/C air filters are clean? A maintenance routine is in place and executed?<br>

  • A/C Condensers are well maintained and functioning properly? Maintenance Routine in place?<br>

  • Roof ladder is in compliance and is accessible?<br><br>

Trash Corral

  • Ground around trash dumpsters is clean and free of build up?<br>

  • Trash dumpsters are well maintained and lids are in place and closed?<br>

  • Walls around the trash corral are free of equipment and well maintained?<br>

Storage Unit

  • Storage unit is clean and well maintained?<br>

  • All lights and light fixtures are in proper working order?<br>

  • Lot is clear of oil spots and parking lot lines are clearly visible?<br>

  • Building Exterior General Notes

Safety

First Aid Kit

  • Supplies are full and First Aid kit is accessible? (List what is needed if No)<br>

OSHA Safety Sign Off

  • OSHA sign off is completed by all employees for the current month?<br>

Safety Sign Off Sheet

  • Safety sign off sheet has been signed by all employees for the current month?<br>

Safety Equipment

  • Is safety equipment (i.e. Face shield, Gloves, apron, etc.) available and utilized?<br>

  • Safety Section General Notes

Miscellaneous

Grease Trap

  • Date of last grease trap maintenance?<br>

  • Select date

Technology

CDP

  • CDP is functioning properly and up to date?<br>

  • All peripheral are attached an in good condition?<br>

POS

  • All registers are functioning properly?<br>

  • All registers are well maintained?<br>

Cash Drawers

  • All cash drawers are working properly?<br>

  • All cash drawers are well maintained?<br>

Coin Changer

  • Coin changer is functioning properly?<br>

  • Coin changers is well maintained?<br>

KVS Monitors

  • All KVS monitors are functioning properly?<br>

  • All KVS monitors are well maintained?<br>

KVS Controllers

  • All KVS controllers are functioning properly and updated to nest NewPOS Version?<br>

KVS Bump Bars

  • Bump bars are in good condition and functioning properly? (buttons, cords, mounts, etc) <br>

  • Bump bars are wrapped to avoid grease and build up?<br>

POS/Grill Printers

  • Printers are functioning properly?<br>

  • Printers are well maintained and free of build up? (Inside and out)<br>

PED

  • F/C Printers are functioning properly?<br>

  • F/C Printers are well maintained and free of build up? (Inside and out)<br>

  • Technology General Notes

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.