Title Page
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Name of Restaurant
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Inspector
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Date of Inspection
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Location
STORAGE AREAS, ATTIC
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Are floors clean, dry and in good condition?
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Are aisles free of boxes or clutter?
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Are electrical panels accessible and properly labeled?
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Are doors and latches working properly?
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Are products or supplies properly stored? (Light items on top, arranged to avoid toppling.)
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Is shelving in good condition?
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Are combustibles kept away from heat sources? (Heating unit, hot water, tank, electrical boxes, etc.)
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Are outlets, switches and electrical components working properly?
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Are ladders in good condition and properly stored?
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Are chemicals separated from foodstuffs?
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Is trash compactor in good repair?
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Is first aid kit adequately stocked and accessible?
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Are lights working properly?
FOOD PREPARATION AND COOKING AREA
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Are floors clean, dry and in good condition?
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Are aisles free of clutter?
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Are drain screens being cleaned regularly?
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Are doors and latches working properly?
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Is food preparation and storage equipment in good repair?
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Is the grill and fryer exhaust system clean and in good repair?
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Has Ansul extinguishing system been inspected and serviced within the last 6 months?
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Have portable fire extinguishers been inspected and serviced within last year?
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Are combustibles kept away from heat sources? (Ovens, grill, fryer, toaster, etc.)
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Are outlets, switches and electrical components working properly?
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Are lights working properly?
DINING AND RESTROOM AREAS
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Are floors clean, dry and in good condition?
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Are highchairs, tables and seating in good condition?
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Are floor mats in good condition? (Lay flat, smooth edges)
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Is product display equipment in good repair? (½ gallon cases, shelving, cooler doors, etc.)
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Are exit signs illuminated?
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Are outlets, switches and electrical components working properly?
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Are fixtures in restrooms in good condition?
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Are lights working properly?
OUTSIDE SEATING AREAS/ PLAYGROUND
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Are walking surfaces clean, dry and in good condition?
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Are tables and seating in good condition?
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Are gates and access passage locked?
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Is playground equipment in good condition? (No missing parts, holes or tears, sharp objects, clean, etc.)
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Is playground equipment inspected on a daily basis?
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Is playground area clean and free of debris or clutter? (Balls returned to pit area)
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Are proper signs in place?
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Are lights working properly?
EXTERIOR (WALKWAYS AND PARKING LOT) OK Needs Improvement Date of Correction
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Are sidewalks and curbs in good repair?
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Is landscaping trimmed away from walks and to eliminate possible hiding places?
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Is the parking lot free of potholes or tripping hazards?
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Is the dumpster area in good condition?
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Is the garden hose properly stored?
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Are outside lights working properly?
SAFE WORKING PRACTICES
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Do employees demonstrate a team approach to preventing accidents?
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Are spills or dropped items cleaned up promptly?
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Are “Wet Floor” warning signs displayed when needed?
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Are employees wearing proper footwear?
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Are floors thoroughly cleaned at closing?
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Are employees instructed in proper lifting techniques?
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Do employees “practice” proper lifting techniques?
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Is cooking oil at room temperature before changing or straining?
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Are knives cleaned safely? (Not left in soapy water)
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Are slicers cleaned and stored properly?
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Are employees instructed in the proper use of slicers?
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Are all cleaning supplies properly labeled?
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Do employees know where Material Safety Data Sheets are kept?
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Do employees practice safe ladder usage?
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Do employees use a mechanical hand when changing marquee?
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Are proper posters displayed? (OSHA, Workers’ Compensation, etc.)
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For ice-cream dipping restaurants:
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Are squares “tempered” before placed in dip cabinets?
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Are squares “rotated” as needed?
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Do employees place hip against dip cabinet for leverage when dipping?
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Is ice cream temperature in dip cabinets kept in the proper temperature range?
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Have all maintenance issues been reported as required?
FOLLOW-UP
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Have the hazards that were identified last month been corrected? (If “NO”, specify which hazards by adding a note)
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Have maintenance-related items been reported, called in or entered on the restaurant computer?
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Have unsafe practices been addressed with all employees?
COMPLETION
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Recommendations or Overall Assessment
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Name & Signature of Inspector/ Responsible Personnel