Title Page
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Site conducted
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Frequency
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Date
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Inspector
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Location
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YES if safe. Note HAZARD IDENTIFIED/COMMENTS & WORK ORDERS SUBMITTED
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GENERAL CLEANLINESS & PRACTICES<br>Floors, ceilings, tables, work areas, lighting, pest control, food holding, temperatures, food protected, wet mops stored outside to dry (or hung properly), free from graffiti.
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FOOD STORAGE AREA<br>Clean, no food on floor, labels, no pests, no leaks, no toxins, food protected.
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REFRIGERATORS AND FREEZERS<br>Clean, thermometers, correct temperature, labels, lighting, food protected.
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Temp on Milk Fridge
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Did you have to remove any milk?
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Date on Freezer Foods:
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Are any lights out in the freezer?
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EMPLOYEES<br>Clean clothes, hair covers, good hygiene, no smoking, no unauthorized personnel.
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EQUIPMENT<br>Clean, in good repair, protected.
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DISHES/POTS WASHING FACILITIES/DISHWASHING<br>Clean, protected in storage & dispensing, correct temperature air drying.
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RESTROOMS <br>Clean, paper towels, hot & cold water, antibacterial soap, toilet tissue, waste cans.
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GARBAGE AREAS<br>Cans cleaned & covered, surrounding area clean, no pests.
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FIRE PROTECTION <br>Portable fire extinguishers, fire alarm systems and emergency lighting operational.
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CLEANING SUPPLIES/SDS BOOKS<br>Properly stored and labeled.
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LIGHTING<br>Cafeteria, kitchen, storage rooms and restroom adequate lighting.
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PLUMBING<br>Pipes, faucets, drains, traps, toilets, urinals, water temps.
Sign Off
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Inspected by
