Information
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Restaurant Number
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Restaurant Manager
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PIC
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Reason for visit
- Routine Visit
- Follow up Visit
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Conducted on
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Prepared by
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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?
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Grill/fryer wheels in good condition. Grill/fryer easy to pull and easy to maneuver?
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Floors adjacent to fryers dry and free of grease?
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Floors around sink area free of debris and mopped dry?
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Main shut-off valves (water, gas) free from obstruction & properly identified?
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Floors around ice machine area free of debris and ice and mopped dry?
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First aid kit accessible and filled properly?
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Fire extinguishers properly wall mounted and accessible for hazard involved?
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Fire extinguishers properly charged?
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Flammable and combustible liquids (solvents, paint, etc.) stored properly?
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Storage of combustible not permitted within 30 feet of furnaces, hot water heathers, and/or other heat sources?
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Does the store has keys to the electrical room and/or hot water heater room?
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All electrical equipment properly grounded, portable electrical equipment & extension cords have a ground prong?
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Extension cords not laying in walk ways?
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Breaker switches properly labeled & open breakers are properly capped? (No open spaces on breaker box)
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Electrical panel boxes have doors closed and clear area of 30 inches in front of box?
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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)
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Stock properly & securely stacked; stored on racks and/or shelves; bread racks stacked and secured properly? (No empty bread racks laying around).
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Good housekeeping maintained, aisles clear, storage room orderly, floors free of debris, storage has proper clearances from hot-water heater and sprinkles?
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Shelving and racks in good repair?
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Storage racks anchored properly to walls if against wall and together if free standing?
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Walk-in cooler & freezer doors provided with operable interior release mechanism system?
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Floors free for spillage, loose mats, broken/loose floor tiles or other hazards?
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Portable signs indicate wet-mopped floors or temporary hazards?
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Wet floor signs are picked up after floor is dry?
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Stair treads equipped with abrasive strips or other nonskid surface?
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Stairs and/or stair railings are free of debris (cups, purses, jackets, etc.)?
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Secure handrails on all stairs and step?
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Stairs properly illuminated?
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No -exit doors (to restroom area, kitchen, closets, etc.) identified properly?
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Exits properly marked, illuminated & unobstructed; doors kept untucked during hours of operation or equipped with panic bars?
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Exterior paths & parking lot well illuminated?
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Steps, ramps, grounds, parking lot in good repair, free of holes or obstruction and well illuminated?
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Snow and ice promptly removed from parking lot and walkway surfaces?
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Car stops (bumper strips) painted with contrasting colors so they are clearly visible (Concrete ok as long as there is contrast)?
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Dumpster & grease deposit areas are clean, secured & maintained?
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Dumpster door are able to be secured properly when opened?
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Changes is elevations are properly marked to visibly show changes in elevations and/or illuminated properly?
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Patio furniture is in good repair?
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Patio outlets are properly covered and in working order?
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Patio area is clean and well illuminated?
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No ice build-up in the walk-in freezer? (Check also for ice build coming from evaporator).
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Employee break area free of hazards?
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No leaning objects such as ladders, pallets, etc. in front of doors or access to roof ladders?
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Back door is equipped with a panic lock so it can be kept lock at all times?
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If back door has an alarm system, is it operational?
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Spot check videos by shift (6-2, 2-10 & 10-6) for any safety and security violations.
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Comments/Notes
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PIC signature: