Title Page

  • Conducted on

  • Prepared by

  • Location

Equipment

  • Are all Gaskets Well-Maintained and Easy to Clean? (Check Cooler, Freezer, Thaw Cabinets, all Lowboys)

  • Describe Corrective Action

  • Are Cutting Boards in Good Condition, Without excessive Cracks?

  • Describe Corrective Action

  • Are Handles on Thaw Cabinets and Lowboys Clean and Free of Debris?

  • Describe Corrective Action

  • Are Beverage Nozzles are Clean and Free of Mold? (Take multiple nozzles off, put on glove, and run finger through the inside)

  • Describe Corrective Action

  • Do We have a Bodily Fluid Kit Available?

  • Describe Corrective Action:

  • Are there any cracks in Ice Machine?

  • Describe Corrective Action

  • Are all Dishes free of cracks?

  • Describe Corrective Action

Floors

  • Are all Tiles in Good Repair?

  • Describe Corrective Action

  • Are Walls and Wall/Floor Junctions clean and free of mold?

  • Describe Corrective Action

Walls

  • Is there mold in any grouting? (Check behind 3 compartment sink, mop sink, front hand washing sink?)

  • Describe Corrective Action

  • Are walls free of holes?

  • Describe Corrective Action

Ceiling

  • Are Vents, Fanguards, and Filters clean?

  • Describe Corrective Action

  • Are all Lights Working and in Good Repair?

  • Describe Corrective Action

Water

  • Is Water hitting 100 Degrees within 60 seconds in Men's Restroom?

  • Describe Corrective Action

  • Is Water hitting 100 Degrees within 60 seconds in Women's Restroom?

  • Describe Corrective Action

  • Does Water in the 3-compartment sink meet 171 degrees?

  • Describe Corrective Action

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.