SHORT CAFE LOBEN INSPECTION CHECKLIST

• FORM NPC-1188 (9-28-2012) Draft 1 U.S DEPARTMENT OF COMMERCE Economics and Statistics Administration U.S. CENSUS Bureau

• SHORT CAFE LOBEN INSPECTION CHECKLIST

EQUIPMENT AND FURNISHINGS

• 1. Drip trough

  Satisfactory

  Unsatisfactory

• 2. Trash cabinets

  Satisfactory

  Unsatisfactory

• 3. Trash bags/cans

  Satisfactory

  Unsatisfactory

• 4. Dispensers

  Satisfactory

  Unsatisfactory

• 5. Cutting boards

  Satisfactory

  Unsatisfactory

• 6.<br>...<br>49. Cashier stand

  Satisfactory

  Unsatisfactory

• 7 th question

  Yes

  No

  N/A

GLASS SURFACES

• 1. Windows

  Satisfactory

  Unsatisfactory

• 2. Doors

  Satisfactory

  Unsatisfactory

• 3. Dessert unit

  Satisfactory

  Unsatisfactory

• ... 7. Tile wall cleaning

  Satisfactory

  Unsatisfactory

STAINLESSS STEELSURFACES

• 1. Serving line counter

  Satisfactory

  Unsatisfactory

• 2. Refrigerator, 2D, kitchen

  Satisfactory

  Unsatisfactory

• ... 15. Other

  Satisfactory

  Unsatisfactory

Other Controls

• Checkbox: Are Floormats Clean?

• Draw here:

  Drawing

• Information: You may add text/media/link here
  Caution: Floors may be slippery
  

• Multiple choice responses

  Select dirty slippery cracks

  • dirty
  • slippery
  • cracks

• Is Toaster clean? Use Slider bar to Indicate how clean the toaster is. 0 = Filthy, 10 = Sparkling clean

• Fire Extinguisher: Slide to ON position if pressure is in acceptable range

  Off

  On

• Single line text

• Multiple line text

AUDITOR

• Location of Inspection Site
  Address

• Inspector Name

• Signature

  Sign

• Date/Time of Inspection

  Date