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Daily Checklists _ Monthly Workplace Inspection Form

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Daily Checklists _ Monthly Workplace Inspection Form Powered By Docstoc
					This DAILY inspection must be completed before opening.

Location: ___________________________________________________

Date:_____________________        Time:____________________

Name of person completing inspection: ____________________________________
                                                  (Print full name)

Maintenance / Restaurant Appearance
  Exterior Garbage can is empty and free of debris.
  Windows and doors are free of debris and smears.
  Side walk is free of debris.
  Parking lot and surrounding area is free of debris.
  Front and rear vestibules swept and free of debris.
  All products 6” off floor.
  All ceiling tiles are free of debris / stains.
  Ceiling diffusers are free of debris and dust.
  Floors are swept and free of debris.
  “Wet Floor” sign available and cleaned.
  Mop bucket is clean / hung to dry.
  Walls and baseboards are clean and not in need of repair.
  All Stainless trim clean and in good repair.
  Stairs and hallways are kept free of obstructions, debris or grease.
  Rear door access is free of impediments and locked.
  No pests present or mice droppings

Health and Safety
   All staff know the location of the Health and Safety Bulletin Board.
   MSDS Sheets are available for every chemical.
   MSDS Sheets are poster on the Health and Safety Bulletin Board.
   Emergency telephone numbers posted & location of nearest Hospital.
   First Aid Box organized and stocked.
   First Aid log completed.
   Eye Wash Station in working order.
   WSIB and Employment Standards Act information is posted.
   WSIB booklets are available for every employee.
   Fire Extinguishers are available, charged and certified.
   All staff has knowledge on how to use Fire Extinguisher.
   Litmus paper available.
   All staff aware of Litmus paper dilution.


Cleaning Products
   Hand Sanitizer available at front counter.
   Sanitizer formulated with spray bottles available.
   Red J-cloths available.
   Blue J-cloths available.
   All sinks have hot running water.
   All sinks equipped with Anti Bacterial Soap.
   All sinks equipped with paper towels.
   No Cleaning Chemicals stored in Kitchen/food prep. Areas.

HVAC – (Heating, Ventilation, and Air Conditioning)
  Exhaust Unit set to correct settings.
  Make up Air unit in working order.

Walk-In Cooler
  Doors kept closed.
  Seals/latches are in working order.
  Walls / Ceilings / Floors clean.
  Temperatures recorded.
  Working Thermometer available.
      All ingredients are covered, dated and proper lids
      All Food 6” off the floor.
      Shelves clean and free of debris.
      Dough trays clean – no cracks.
      Dough tray lids clean – no cracks.

Make Line
  Temperatures recorded.
  Working Thermometer available.
  Pizza Paddles clean and available.
  Shelves clean and free of debris.
  Under counter refrigerator seals/latches and drawers are in working order.
  Under counter refrigerator has working thermometer.
  All food in under counter refrigerator covered.

Fryer Area
   Fire Extinguishers are available, charged and certified.
   Access to Fire Extinguishers is free of impediments.
   All staff has knowledge on how to use Fire Extinguisher.
   Fryers are in proper working order.
   Fryer clean and filled to minimum levels.
   Fryer Operations Manual available.
   Fryer break on and unit secure.
   Fryer hood filters are free of debris and grease.
   Personal Protective equipment available (goggles, oven gloves, mesh gloves)
   All staff has knowledge on how to use Personal Protective Equipment.
   Working Lights above fryer and heat lamp.

Oven Area
   Ovens are in proper working order (springs, dials, etc)
   Oven hood filters are free of debris and grease.
   Oven faces free of debris, grease, and dust.
   Clean dry oven mop available.
   Clean Oven scraper available.
   Oven’s not used to store equipment.

Pop Coolers
   Doors kept closed.
   Temperatures recorded.
   Working Thermometer available.
   Shelves clean of debris.
   Operations manual available.

Washrooms
  Soap dispensers are filled with soap.
  Paper towel dispensers filled.
  Toilet paper available.
  Toilet bowl clean and free of debris.
  All fixtures in working order.
  Floors free of debris, dirt, moisture or graffiti.
  Walls free of debris, dirt, moisture or graffiti.
  Cleaning schedule posted.
  Toilet plunger available.
  Fragrance packs are in working order.
  Garbage cans free of debris, dirt, moisture or graffiti.
  No pests present or mice droppings



Signature of person completing daily inspection:

______________________________________________________________
                                                          Workplace Inspection Recording Form
Daily/Monthly
 Inspection Location(s)                                                                                         Time of Inspection:

 Department/Areas Covered:                                                                                      Date of Inspection:

                                                                                                                                            FOR FOLLOW UP
                                            Hazard                                                                      By
       Item                Hazards          Class      Repeat Item                                                                                                         Date            Authorized
                                                                               Recommended Action                                                Action Taken
   (and location)          Observed         (see                                                                                                                         Completed         Signature
                                            below)                                                              Whom       When
                                                       Yes     No




 Copies To (For Action):                                                                                                   Inspected By:

                                                                                                                           Worker Rep: ______________________________________
 Copies To (For Information): Therese Sousa, Human Resources
                                                                                                                           Management Rep:___________________________________


Class “A” Hazard:             A condition or practice with the potential for permanent disability, loss of life or body part, and/or extensive loss of structure, equipment or material.

Class “B” Hazard:             A condition or practice with the potential for serious injury or illness (resulting in serious or temporary disability) or property damage that is
                              disruptive but less so than Class “A”.

Class “C” Hazard:             A condition or practice with the potential for injury or illness, or disruptive (non-disabling) property damage.

				
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posted:10/25/2011
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