Safety checklist

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

Dining Room/Restrooms

• Tables and Chairs in good shape ( including high chairs)

  Yes

  No

  N/A

• Floors Dry(wet floor signs in use when not)/ Carpets not torn/tiles not loose

  Yes

  No

  N/A

• No loose fixtures

  Yes

  No

  N/A

• No leaks

  Yes

  No

  N/A

Service Area/Bakery/Line

• Equipment in safe working condition, doors, wheels

  Yes

  No

  N/A

• Counters/equipment have no sharp edges

  Yes

  No

  N/A

• Kevlar gloves used with knife and bread bowl knife at both line and bakery

  Yes

  No

  N/A

• Neoprene glove used when cleaning Panini Press

  Yes

  No

  N/A

BOH

• Floors dry (wet floor and fan used if necessary)

  Yes

  No

  N/A

• Chemicals stored on bottom of designated shelf (not within 3 feet of heat source)

  Yes

  No

  N/A

• Goggles used for chemicals

  Yes

  No

  N/A

• MSDS sheets up to date

  Yes

  No

  N/A

• Fire alarms not blocked/ fire exits clear

  Yes

  No

  N/A

• Exits signs well lit

  Yes

  No

  N/A

• Emergency lighting works and is not blocked

  Yes

  No

  N/A

• Back door locked & alarmed & sign posted to not open after dark

  Yes

  No

  N/A

• Mops, brooms, dust pans hung up; floor free of clutter and trip hazzards

  Yes

  No

  N/A

• Shelving in good repair

  Yes

  No

  N/A

• Shelves/counters no sharp edges

  Yes

  No

  N/A

• Kevlar glove used with knife and all hand slicers

  Yes

  No

  N/A

• Neoprene glove used when reaching into soup rethermolizer

  Yes

  No

  N/A

• Pans stored safely in dish area/ cooler

  Yes

  No

  N/A

• Broken glass/ china bucket in use

  Yes

  No

  N/A

• Knives stored in knife rack only

  Yes

  No

  N/A

• No leaks (pipes/ceiling/sinks/equipt)

  Yes

  No

  N/A

• Water temp not scalding

  Yes

  No

  N/A

• Oven mitts in use/ hot racks being called out

  Yes

  No

  N/A

• Safety Manager in place

  Yes

  No

  N/A

• New hires has safety policy signed off? List hires

• Committee members and meeting notes

• Injuries this past month # and description

• Corrective actions / Safety training needed for prevention

• Add signature

  Sign