Information

  • Restaurant Number

  • Restaurant Manager

  • PIC

  • Reason for visit

  • Conducted on

  • Prepared by

  • Kitchen waste material stored in containers with tight fitting lids and kept in designated areas and removed by carts to compactors, dumpster, and/or oil tank?

  • Grill/fryer wheels in good condition. Grill/fryer easy to pull and easy to maneuver?

  • Floors adjacent to fryers dry and free of grease?

  • Floors around sink area free of debris and mopped dry?

  • Main shut-off valves (water, gas) free from obstruction & properly identified?

  • Floors around ice machine area free of debris and ice and mopped dry?

  • First aid kit accessible and filled properly?

  • Fire extinguishers properly wall mounted and accessible for hazard involved?

  • Fire extinguishers properly charged?

  • Flammable and combustible liquids (solvents, paint, etc.) stored properly?

  • Storage of combustible not permitted within 30 feet of furnaces, hot water heathers, and/or other heat sources?

  • Does the store has keys to the electrical room and/or hot water heater room?

  • All electrical equipment properly grounded, portable electrical equipment & extension cords have a ground prong?

  • Extension cords not laying in walk ways?

  • Breaker switches properly labeled & open breakers are properly capped? (No open spaces on breaker box)

  • Electrical panel boxes have doors closed and clear area of 30 inches in front of box?

  • Store has proper safety equipment/gear on hand and it is in good condition? (Face shield and/or googles, gloves, back support belt, neoprin apron)

  • Stock properly & securely stacked; stored on racks and/or shelves; bread racks stacked and secured properly? (No empty bread racks laying around).

  • Good housekeeping maintained, aisles clear, storage room orderly, floors free of debris, storage has proper clearances from hot-water heater and sprinkles?

  • Shelving and racks in good repair?

  • Storage racks anchored properly to walls if against wall and together if free standing?

  • Walk-in cooler & freezer doors provided with operable interior release mechanism system?

  • Floors free for spillage, loose mats, broken/loose floor tiles or other hazards?

  • Portable signs indicate wet-mopped floors or temporary hazards?

  • Wet floor signs are picked up after floor is dry?

  • Stair treads equipped with abrasive strips or other nonskid surface?

  • Stairs and/or stair railings are free of debris (cups, purses, jackets, etc.)?

  • Secure handrails on all stairs and step?

  • Stairs properly illuminated?

  • No -exit doors (to restroom area, kitchen, closets, etc.) identified properly?

  • Exits properly marked, illuminated & unobstructed; doors kept untucked during hours of operation or equipped with panic bars?

  • Exterior paths & parking lot well illuminated?

  • Steps, ramps, grounds, parking lot in good repair, free of holes or obstruction and well illuminated?

  • Snow and ice promptly removed from parking lot and walkway surfaces?

  • Car stops (bumper strips) painted with contrasting colors so they are clearly visible (Concrete ok as long as there is contrast)?

  • Dumpster & grease deposit areas are clean, secured & maintained?

  • Dumpster door are able to be secured properly when opened?

  • Changes is elevations are properly marked to visibly show changes in elevations and/or illuminated properly?

  • Patio furniture is in good repair?

  • Patio outlets are properly covered and in working order?

  • Patio area is clean and well illuminated?

  • No ice build-up in the walk-in freezer? (Check also for ice build coming from evaporator).

  • Employee break area free of hazards?

  • No leaning objects such as ladders, pallets, etc. in front of doors or access to roof ladders?

  • Back door is equipped with a panic lock so it can be kept lock at all times?

  • If back door has an alarm system, is it operational?

  • Spot check videos by shift (6-2, 2-10 & 10-6) for any safety and security violations.

  • Comments/Notes

  • PIC signature:

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