Title Page
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Conducted on
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Prepared by
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Location
POTENTIAL HAZARDS AND SAFETY MEASURES
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Floor is free of wet spots or debris.
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Appropriate use of “wet floor” signing in use if needed.
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Exits or walkways throughout restaurant patio or dining room are free of obstruction.
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Back door exit(s) are free of obstruction, and no boxes are blocking the pathway.
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Chairs and tables are in safe condition for use by the customer. No tables appear wobbly.
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Fire extinguisher(s) and ansul system are all serviced and current, with tags up to date.
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ADDITIONAL COMMENTS :
EMPLOYEE ACTIONS
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Employee's carrying a reasonable amount of weight, and no observed over-lifting seen.
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Employee's are wearing protective mesh gloves (as instructed by management) when cutting product.
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Filling of ice dispenser done in a safe manner, and any ice spilled picked up immediately as to avoid wet spots.
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Wet spots or grease spills are handled immediately and in a safe manner.
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Debris is picked up or swept immediately; boxes are broken down immediately.
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Areas being mopped is no longer than 4ft x 4ft area.
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Employees are practicing proper lifting techniques.
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Employees are calling out “behind you, corner, hot foods,” etc.
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Workstations are being kept neat, clean, and organized.
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ADDITIONAL COMMENTS :
EQUIPMENT CHECK AND USE
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All observed employees are wearing their proper uniform, including the use of non-slip shoes.
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Knives, cutting boards, mixing collars and shake spindle is being cleaned and sanitized between uses.
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Cooking equipment is in safe and good working order.
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Hot and cold holding equipment is in safe and good working order.
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Equipment electrical cords are in safe condition, properly guarded and covered.
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Personal Protective Equipment (PPE) provided, and located in an employee accessible area. This includes cutting gloves, fryer gloves, fryer apron.
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The 3 compartment sink is kept clean, dry and organized. There are no dirty dishes or knives in the sink, and there is no sitting water being held in the sink.
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Can opener(s) sanitized and in good working order.
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Onion dicer, vegetable slicer, and knife blades are not dull, and equipment is in good working condition.
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Ladder(s) in safe and good working condition
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ADDITIONAL COMMENTS :
STORAGE AND COOLER AREAS
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Product is stored at least 6” off floors and 6” away from the walls.
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Heavy containers stored closer to the floor, and light items stored higher.
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Proper rotation of product – LABEL – DATE – ROTATE
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All product is properly covered.
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Chemicals are not being stored in food storage areas, and are clearly marked on their packaging as to what they are.
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No ice build-up is present in the Walk-In Cooler and the area presents no danger.
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ADDITIONAL COMMENTS :
GUEST RESTROOMS
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Floors free of wet spots or debris.
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Sink/vanity areas are dry and clean.
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Restrooms are adequately stocked with toilet tissue and seat liners.
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Toilet seats are tightened and in safe condition.
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Restroom is well lit, and exterior door locked at all times.
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Sinks is adequately stocked with hand soap, sanitizer and paper towels.
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Overall the restrooms are being maintained in a safe and sanitary condition.
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ATTACH PHOTO OF THE RESTROOM :
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ADDITIONAL COMMENTS :
OFFICE AND COMMUNICATION BOARD
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Emergency phone numbers and list of approved industrial injury clinic displayed.
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“Right to Know” MSDS Binder accessible to employees and signed.
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Safety Calendar / Lesson Plan Program posted for employees to see, and in use.
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First Aid box adequately stocked.
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BBSC observations being done and observations are being sent to office.
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ADDITIONAL COMMENTS :
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SAFETY SUPPLIES NEEDED TO BE ORDERED :
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COMPLETED BY :
