PFM - Store Inspection - V1

• Audit Title

• Contact Name

• Conducted on

  Date

• Prepared by

• Location
  Address

Parking Lot

Conditions

• Painted crosswalk?

  Yes

  No

  N/A

• Painted curbs?

  Yes

  No

  N/A

• Crosswalk contains stop signs?

  Yes

  No

  N/A

• Minimal debris in parking lot? (glass, trash, ect.)

  Yes

  No

  N/A

• Other?

  Safe

  At Risk

  N/A

Behaviors

• Employees wearing high visibility vests?

  Yes

  No

  N/A

• Employees push max of 5 carts at a time?

  Yes

  No

  N/A

• No horseplay/employees not "riding on carts"?

  Safe

  At Risk

  N/A

• Other?

  Safe

  At Risk

  N/A

Department Grade

• Overall Grade

  Excellent

  Good

  Fair

  Needs Improvement

  Failed

• Department manager or shift supervisor signature.

  Sign

Produce Department

Conditions

• Floor mats under grapes and cherries?

  Yes

  No

  N/A

• Floor mats under all sources of water spray? Veg sprayers, asparagus, flowers.

  Yes

  No

  N/A

• Floor mats in good condition?

  Yes

  No

  N/A

• Floor is free from debris?

  Yes

  No

  N/A

• Produce bag stand is stable on floor/overhead?

  Yes

  No

  N/A

• Temperature of Produce Cooler

• Time of Temperature Check

  Date

• Other?

  Safe

  At Risk

  N/A

Behaviors

• Employees wearing slip resistant shoes?<br>

  Yes

  No

  N/A

• Employee using hand cart to stock merchandise?

  Yes

  No

  N/A

• Boxes on hand carts do not exceed height of shoulders on employee.

  Yes

  No

  N/A

• Employees demonstrating good behaviors (not horsing around)?

  Yes

  No

  N/A

• Employees observed picking up debris off floor?

  Yes

  No

  N/A

• Hazard cones on display only when hazards exist at that time?

  Yes

  No

  N/A

• Other?

  Safe

  At Risk

  N/A

Department Grade

• Overall Grade

  Excellent

  Good

  Fair

  Needs Improvement

  Failed

• Department manager or shift supervisor signature.

  Sign

Deli Department

Conditions

• Floor mats on floor?

  Yes

  No

  N/A

• Floor mats in good condition?

  Yes

  No

  N/A

• Floor is free from debris?

  Yes

  No

  N/A

• Slicer contains proper guarding?

  Yes

  No

  N/A

• Slicer contains proper hand piece?

  Yes

  No

  N/A

• Slicer cords contain ground plug?

  Yes

  No

  N/A

• Slicer cords contain no exposed wiring?

  Yes

  No

  N/A

• Knife storage available by magnets or holders?

  Yes

  No

  N/A

• Other?

  Safe

  At Risk

  N/A

Behaviors

• Employees wearing slip resistant shoes?<br>

  Yes

  No

  N/A

• Employees using a cut resistant glove any time a knife is being used?

  Yes

  No

  N/A

• Employees wearing cut resistant gloves when cleaning slicer?

  Yes

  No

  N/A

• Employees using slicer properly?

  Yes

  No

  N/A

• Employees "0" out slicer hand dial.

  Yes

  No

  N/A

• Knives are put away when not in use, not lying around on tables?

  Yes

  No

  N/A

• Other?

  Safe

  At Risk

  N/A

Department Grade

• Overall Grade

  Excellent

  Good

  Fair

  Needs Improvement

  Failed

• Department manager or shift supervisor signature.

  Sign

Meat Department

Conditions

• Floor mats on floor?

  Yes

  No

  N/A

• Floor mats in good condition?

  Yes

  No

  N/A

• Floor is free from excess debris/blood?

  Yes

  No

  N/A

• Meat grinder contains guard?

  Yes

  No

  N/A

• Band saw contains guard?

  Yes

  No

  N/A

• Temperature of Meat Cooler

• Time of Temperature Check

  Date

• Other?

  Safe

  At Risk

  N/A

Behaviors

• Employees wearing slip resistant shoes?<br>

  Yes

  No

  N/A

• Employees wearing cut resistant gloves?

  Yes

  No

  N/A

• Employees NOT wearing gloves when using band saw?

  Yes

  No

  N/A

• Guard on band saw adjusted above meat when in use?

  Yes

  No

  N/A

• Guard on band saw completely down when not in use?

  Yes

  No

  N/A

• Employees not using milk crates to stand on?

  Yes

  No

  N/A

• Floors are free from cardboard?

  Yes

  No

  N/A

• Other?

  Safe

  At Risk

  N/A

Department Grade

• Overall Grade

  Excellent

  Good

  Fair

  Needs Improvement

  Failed

• Department manager or shift supervisor signature.

  Sign

Bakery Department

Conditions

• Floor is free from debris?

  Yes

  No

  N/A

• Mixers contain guards?

  Yes

  No

  N/A

• Other?

  Safe

  At Risk

  N/A

Behaviors

• Employees wearing slip resistant shoes?<br>

  Yes

  No

  N/A

• Employees wearing cut resistant gloves?

  Yes

  No

  N/A

• Employees use guards on mixers?

  Yes

  No

  N/A

• Other?

  Yes

  No

  N/A

Department Grade

• Overall Grade

  Excellent

  Good

  Fair

  Needs Improvement

  Failed

• Department manager or shift supervisor signature.

  Sign

Hot Foods

• Temperature of Hot Foods

• Time of Temperature Check

  Date

Back of House / Housekeeping

Conditions

• Step stools/ladders available in each walk-in coolers?

  Yes

  No

  N/A

• Step stools/ladders are clean with minimal food debris in steps?

  Yes

  No

  N/A

• Squeegee readily available in produce/meat coolers?

  Yes

  No

  N/A

• Wheels on carts in good condition.

  Yes

  No

  N/A

• Coolers free from excess water?

  Yes

  No

  N/A

• Freezers free from ice?

  Yes

  No

  N/A

• Milk crates stored no more than 6 high?

  Yes

  No

  N/A

• Aisles clear from trip hazards?

  Yes

  No

  N/A

• Ample lighting and visibility?

  Yes

  No

  N/A

• Floor mats under sinks and ice makers?

  Yes

  No

  N/A

• 15 minute flow eye wash station near forklift charging station?

  Yes

  No

  N/A

• Other?

  Safe

  At Risk

  N/A

Behaviors

• Employees practice proper lifting techniques?

  Yes

  No

  N/A

• Employees wearing seatbelt on forklifts.

  Yes

  No

  N/A

• Employees engage parking brake when not in use.

  Yes

  No

  N/A

• Employees lower forks to the floor when not in use.

  Yes

  No

  N/A

• Employees observed driving slowly on forklifts?

  Yes

  No

  N/A

• Employees not standing on storage racks?

  Yes

  No

  N/A

• Fire exits free from obstructions?

  Yes

  No

  N/A

• Electrical panels free from obstructions?

  Yes

  No

  N/A

• Extension cords are:<br>- Used for temporary basis<br>- Are contained into one room, not extending into multiple areas<br>- In good condition - no frayed wiring<br>- Not daisy chained (linking multiple extension cords/power strips)

  Safe

  At Risk

  N/A

• Floors are free from cardboard?

  Yes

  No

  N/A

• No overhead storage on top of walk-ins, mezzanines, ect?

  Yes

  No

  N/A

• All fire extinguishers are mounted to a wall and not placed on floor?

  Yes

  No

  N/A

• Fire extinguishers contain current year on tag (2014/2013) with monthly signatures on back of tag?

  Yes

  No

  N/A

• Other?

  Safe

  At Risk

  N/A

Department Grade

• Overall Grade

  Excellent

  Good

  Fair

  Needs Improvement

  Failed

• Department manager or shift supervisor signature.

  Sign

Store Manager Acknowledgement

Overall Store Grade

• Overall Grade

  Excellent

  Good

  Fair

  Needs Improvement

  Failed

• Store Manager Signature

  Sign