Sanitation Inspection

• Document No.

• Client / Site

• Conducted on

  Date

• Prepared by

• Personnel

Rest Rooms (Women's)

• Orderly Appearance?

  Yes

  No

  N/A

• Fixtures clean?

  Yes

  No

  N/A

• Hot, cold or tepid water available?

  Yes

  No

  N/A

• Hand soap or sanitizer available for cleansing?

  Yes

  No

  N/A

• Hand towels or air blower available?

  Yes

  No

  N/A

• Partitions in good repair?

  Yes

  No

  N/A

• Floor in good condition with no leaks?

  Yes

  No

  N/A

• Outlets protected by GFCI?

  Yes

  No

  N/A

• Adequate ventilation?

  Yes

  No

  N/A

• Air vents clean?

  Yes

  No

  N/A

• Adequate lighting?

  Yes

  No

  N/A

Rest Rooms (Men's)

• Orderly appearance?

  Yes

  No

  N/A

• Fixtures clean?

  Yes

  No

  N/A

• Hot, cold or tepid water available?

  Yes

  No

  N/A

• Hand soap or sanitizer available for cleansing?

  Yes

  No

  N/A

• Hand towels or air blower available?

  Yes

  No

  N/A

• Partitions in good repair?

  Yes

  No

  N/A

• Floor in good condition with no leaks?

  Yes

  No

  N/A

• Outlets protected by GFCI?

  Yes

  No

  N/A

• Adequate ventilation?

  Yes

  No

  N/A

• Air vents clean?

  Yes

  No

  N/A

• Adequate lighting?

  Yes

  No

  N/A

Sanitation

Employee Work Area

• Under counter areas clean?<br>

  Yes

  No

  N/A

• Work area free of visible insects or evidence of pests?

  Yes

  No

  N/A

• Limited or no plants present?

  Yes

  No

  N/A

• Furniture in good repair?

  Yes

  No

  N/A

• Food stuffs stored appropriately?

  Yes

  No

  N/A

• Pest control records available?

  Yes

  No

  N/A

Break Room

• Orderly and clean in appearance?

  Yes

  No

  N/A

• Free of visible insects or evidence of pests?

  Yes

  No

  N/A

• Furniture in good repair?

  Yes

  No

  N/A

• Garbage cans have lids?

  Yes

  No

  N/A

• No storage within 24 inches of ceiling?

  Yes

  No

  N/A

• Food stuffs stored appropriately?

  Yes

  No

  N/A

Customer Wait Area

• Orderly and clean in appearance?

  Yes

  No

  N/A

• Furniture in good repair?

  Yes

  No

  N/A

• Water fountain clean?

  Yes

  No

  N/A

First Aid Supplies

• Identification sign present?

  Yes

  No

  N/A

• AED functional?

  Yes

  No

  N/A

• Adequate supplies available?

  Yes

  No

  N/A

Additional Information