Safety Survey

• Conducted on

  Date

• Prepared by

• Location
  Address

JACK IN THE BOX SAFETY SURVEY

• MANAGER

A. EXTERIOR GUEST & SERVICE AREA

• Lot & Driveways free of potholes, slip and trip hazards; free of water subject to icing?

  Yes

  No

  N/A

• Lot striping & handicapped graphics are visible

  Yes

  No

  N/A

• Internal, external and emergency lighting operational?

  Yes

  No

  N/A

• Dumpster enclosure orderly; clean and free of grease build-up & spillage?

  Yes

  No

  N/A

• Walkways, rails, ramps and stairs in good repair?

  Yes

  No

  N/A

• Restrooms are clean & sanitary

  Yes

  No

  N/A

B. INTERIOR GUEST AREAS

• Doors and locks in good repair? (Interior/Exterior, cabinet doors, etc.)

  Yes

  No

  N/A

• Tables, chairs, highchairs, booths, & other fixtures in good condition?

  Yes

  No

  N/A

• "Wet Floor" signs (min.2) available and in good condition; used when floor is wet?

  Yes

  No

  N/A

• Floors in good repair and free of slip, trip and fall hazards?

  Yes

  No

  N/A

C. ADMINISTRATION, EQUIPMENT & ELECTRICAL

• Only the approved box-cutter is present in the restaurant.

  Yes

  No

  N/A

• 2 bodily fluid kits are available, employees know where to locate & how to use

  Yes

  No

  N/A

• Are all operating license and permits posted where customers can view?

  Yes

  No

  N/A

• Has all cash been secured and not left out or unattended?

  Yes

  No

  N/A

• Is the safe locked when not in use?

  Yes

  No

  N/A

• Is restaurant cash within $2 of the expected amount?

  Yes

  No

  N/A

• Where applicable, is there only one cashier per cash drawer?

  Yes

  No

  N/A

• Is there an acceptable amount of cash in each drawer?

  Yes

  No

  N/A

• Are all cash drawers operating properly?

  Yes

  No

  N/A

• Are register keys / swipe cards controlled by Management at all times?

  Yes

  No

  N/A

• Are petty cash receipts available for all purchases made in the last quarter?

  Yes

  No

  N/A

• Is the CCTV fully functional?

  Yes

  No

  N/A

• Is the date and time correct on the CCTV?

  Yes

  No

  N/A

• Are all CCTV cameras presenting a clear image on the monitor?

  Yes

  No

  N/A

• Is the SmartSafe fully operational?

  Yes

  No

  N/A

• Have fire extinguishers been serviced within the last 12 months?

  Yes

  No

  N/A

• All employees instructed in proper use of hood extinguishing systems?

  Yes

  No

  N/A

• All electrical outlets & cords UL approved, in good condition and protected from grease and water?

  Yes

  No

  N/A

• All ladders and hand trucks in good working order and free of defects?

  Yes

  No

  N/A

• Are all employees aware of proper floor cleaning procedures? (proper amount of degreaser, wet floor signs, separate mops, daily deep cleaning & deck brush scrubbing)

  Yes

  No

  N/A

• Personal Protective Equipment (gloves, apron, face shield, etc,) available and in good condition

  Yes

  No

  N/A

• First Aid Kit available and maintained per Reference Manual specifications

  Yes

  No

  N/A

• Is the monthly safety discussion guide posted current and signed by all employees? (first week of each month)

  Yes

  No

  N/A

• Are safety and security policies and procedures readily available to all workers?

  Yes

  No

  N/A

• Is the current Federal labor poster properly displayed at eye-level?

  Yes

  No

  N/A

• Is the current state labor poster properly displayed at eye-level?

  Yes

  No

  N/A

• Is the "Right to know board" displaying all standard and current information including MSDS and IPP

  Yes

  No

  N/A

• Are all employees wearing approved footwear and are the required # of crew guards available? (5 pair)

  Yes

  No

  N/A

• Are the three approved floor cleaning job-aids posted in plain view? (TDC-1216, 9218, 9217)

  Yes

  No

  N/A

• Fire extinguishers available, mounted in the proper place, charged and accessible; employees instructed on proper use of extinguishers and ansul? Serviced with the last 12 months

  Yes

  No

  N/A

• Are fire exit lights illuminated and affixed to the ceiling?

  Yes

  No

  N/A

• Is the emergency evacuation job aid posted?

  Yes

  No

  N/A

• Does the emergency evacuation job aid include all required information?

  Yes

  No

  N/A

• Medical Provider Poster in Right to Know shows nearest clinic/hospital

  Yes

  No

  N/A

• Have injuries been reported?

  Yes

  No

  N/A

• Only certified employees conducting filtering and oil replacement

  Yes

  No

  N/A

D. COOKING AND PREP AREAS

• Floor in good condition; clean, no loose grout; free of grease and obstructions?

  Yes

  No

  N/A

• Aisles & passageways are kept clear and free from clutter and tripping hazards

  Yes

  No

  N/A

• All exits are kept free of obstructions

  Yes

  No

  N/A

• Is drainage adequate and functional? All floor drains have covers

  Yes

  No

  N/A

• Back door closed and locked when not in use?

  Yes

  No

  N/A

• Is the back door policy posted on the back door?

  Yes

  No

  N/A

• Does the back door alarm work?

  Yes

  No

  N/A

• Has the key been removed from the alarm box?

  Yes

  No

  N/A

• Is trash only taken out during daylight hours?

  Yes

  No

  N/A

• Are employees aware of the procedure for letting someone behind the counter?

  Yes

  No

  N/A

• CO2 and Helium cylinders chained; unused and empty cylinders capped? Clearly labeled

  Yes

  No

  N/A

• Fryer shortening changing & cleaning done by certified/trained persons only, utilizing the required personal protective equipment?

  Yes

  No

  N/A

• Drainage adequate; no standing water; drain caps/guards in place and secure?

  Yes

  No

  N/A

• Only approved chemicals/cleaning agents in use?

  Yes

  No

  N/A

• Chemicals stored away from food items and in properly labeled containers?

  Yes

  No

  N/A

• Heavy items stored at waist level or below?

  Yes

  No

  N/A

• All ladders and step-stools maintained in good condition - joints between steps and side rails are tight, all hardware and fittings securely attached

  Yes

  No

  N/A

• All work areas properly illuminated

  Yes

  No

  N/A

• Dispensing equipment working and maintained

  Yes

  No

  N/A

STORAGE, WALK-INS & OTHER AREAS

• Walk-in floors free of ice deposits and obstructions? Door latches operable from inside?

  Yes

  No

  N/A

• Ladder steps have anti-slip treads, clean (free of grease/oil) and unobstructed? Not stored in front of doors or electrical breakers

  Yes

  No

  N/A

• Water heaters operating properly; no fire hazards nearby?

  Yes

  No

  N/A

• Is the back office clean and well organized?

  Yes

  No

  N/A

F. SAFETY BEHAVIOR AND CORRECTIVE ACTION TAKEN

• List corrective action taken on any item checked no.

• Note any unsafe behavior and what corrective action was taken.

• Other items / Comments