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TECH EXH 1C
TE-1c
DAILY INSPECTION FORM
Date:_____________ Inspectors:______________________
Contractor Rep:__________________
| MAJOR AREAS |
| REFERENCE |
| Satisfactory |
| Unsatisfactory |
| COMMENTS |
| Hygiene & Sanitation (2) |
| 1.5.6 |
| A. Clean uniforms & aprons |
| 1.5.5.1-1.5.5.4 |
| B. Hair restraints |
| 1.5.5.6 |
| D. Proper hand washing |
| 1.5.6.1 |
| E. Gloves-direct contact w/food |
| 1.5.6.1 |
| F. No jewelry (except wed. band) |
| 1.5.6.2 |
| G. Fingernails short/clean/polish |
| 1.5.6.3 |
| H. Beards covered |
| 1.25.6.5 |
Additional Comments:
| Safety (8) |
| 1.5.5.4, 4.5.1.1 |
| A. Safety shoes in scullery |
| 1.5.5.4 |
| B. Ear plugs in scullery |
| 1.5.5.4 |
| C. Non-skid/closed toe shoes in all other areas |
| 1.5.5.4 |
| D. MSDS sheets posted & visible |
| 4.5.1.1 |
| E. Cleaning chemicals will be stored in the appointed store room |
| 4.5.1.1 |
F. Cleaning chemicals will be stored in their original containers.
All contains shall be labeled with the contents.
4.5.1.1
| G. Any other safety violations noted |
| 4.5.1 |
Additional Comments:
| Contractor Furnished Items (9) |
| 4.0, 4.5 |
| B. Antibacterial soap |
| 4.3.3 |
| D. Hats for contract employees |
| 1.5.5.8 |
| E. Cleaning supplies |
| 4.3.1, 4.3.2, 4.5 |
| F. Cleaning equipment |
| 4.2.2, 4.5.3 |
Additional Comments:
| Patient Trayline (17) |
| 5.3.4 |
| A. 30 minutes prior to inpatient meal plating, supply dishes, carts, etc and continue to resupply |
| 5.3.4.1, 5.3.4.2 |
| Serving Area (11, 17 & 15) |
| 5.1.3. |
AFTER EACH MEAL, 1 HOUR
AFTER LINE CLOSES
| A. Steam tables drained & cleaned |
| 5.1.3.2 |
| B. Entire serving line-cleaned sanitized /dried/polished |
| 5.1.3.2 |
C. Toaster/food warmers cleaned after each use
5.1.3.2
| D. Shelves under serving line clean |
| 5.1.3.2 |
| E.. Tables/dispenser cleaned |
| 5.1.3.2 |
F. Clean/polish line, employee & bulk milk refrigerators
5.1.3.2
| G. Clean/polish warmer doors |
| 5.1.3.2 |
| H. Clean stainless steel doors |
| 5.1.3.2 |
I. Drains are cleaned after each meal (15)
AFTER EACH MEAL, 2 HOURS
5.1.3.3
| A. Clean beverage island/dispensers |
| 5.1.3.3 |
| B. Wipe down surfaces |
| 5.1.3.3 |
| C. Clean glass doors |
| 5.1.3.3 |
| D. Clean all bars & sneeze guards |
| 5.1.3.3 |
| E. Clean coffee urn |
| 5.1.3.3 |
| F. Defrost milk dispenser with more than 1/8 inch ice |
| 5.1.3.3 |
| G. Weekend descale serving line |
| 5.1.3.3 |
| H. Monthly disassemble and toasters clean |
| 5.1.3.3 |
| I. Serving Line walls kept clean of smudges, marks, dust or streaks (15) |
| 5.1.3, 5.1.10 |
| Dining Room, Plants, Furniture (10) |
| 5.1.4, 5.1.13, 5.1.14 |
AFTER EACH MEAL, 2 HOURS
| A. Wash & sanitize tables |
| 5.1.3.2 |
| B. Damp-wipe chairs |
| 5.1.3.3 |
C. Sweep/mop/dry tile decks, spot clean carpets & vacuum 5.1.3.3
D. Clean/replace salt/pepper, vases, turntables, condiment bottles 5.1.3.3
| E. Wash/dry tray return belt |
| 5.1.3.3 |
| F. Clean microwaves |
| 5.1.3.3 |
| G. Move furniture as needed back to original design |
| 5.1.14 |
Weekly-Dining Room/ Serving area
| A. Wash pipes, window sills, venetian blinds & columns and dust furniture |
| 5.1.3.3 |
| B. Wash legs & bottoms of chairs and tables |
| 5.1.3.3 |
| C. Strip deck, scrub tile and grout, mop, dry, finish and buff |
| 5.1.3.3 |
| D. Wash glazed tile wainscoting in serving area & dining room, reseal |
| 5.1.3.3 |
| A. Daily remove trash from plants |
| 5.1.13.1 |
| B. Weekly dust plants & water live plants |
| 5.1.13.2 |
| C. Every six months-wash plants |
| 5.1.13 |
| D. As needed clean plants with silk flower cleaner |
| 5.1.13 |
Additional Comments:
Staging Area, Beverage Storage, Chemical/Cleaning Gear Area and Patient Cart Storage Area (12 & 15) 5.1.4
| A. Decks are swept, scrubbed, sanitized, rinsed, and dried each day |
| 5.1.4 |
B. Drains are cleaned after each meal
| C. Ice scoop is sanitized each day when in use |
| 5.1.4 |
| D. Cleaned weekly walls & baseboards, more often if needed |
| 5.1.4 |
| E. Weekend – ice machine is cleaned & sanitized on a monthly basis |
| 5.1.4 |
| F. As required: police these areas to clean spills |
| 5.1.4 |
Additional Comments:
Rear Platform, Trash Removal, and Area Maintenance (13)
5.1.4, 5.1.15
| A. Rear platform – after Breakfast sweep & mop, after lunch scrub platform and stairs. Clean spills on stairs as required |
| 5.1.4 |
| B. Clean drains daily |
| 5.14 |
| C. Police area around platform and dumpster daily or as required |
| 5.1.4, 5.1.15 |
| D. Steam clean once per quarter or more if needed. |
| 5. 1.4 |
| A. Garbage shall be removed from cafeteria, scullery, & pot & pan area |
| 5.1.15.1 |
| B. Trash sorted– food waste, cardboard, recyclables and trash are separated into their perspective bins and transferred to the loading dock. |
| 5.1.15.2 |
| C. Garbage cans are cleaned before returning to point of use, wheel bases are cleaned once per day |
| 5.1.15.3 |
D. Garbage is loaded into trash dumpster, cardboard loaded into recycle bin, food and paper waste loaded into compost bin and recyclable trash (aluminum, plastic) loaded into recycle bin
5.1.15.4
Additional Comments:
| Passageways, Lavatories & Offices(14 &15) |
| 5.1.7, 5.1.8, 5.1.9 |
Passageways
A. Sweep, and damp mop after every meal and scrub & dry once/day 5.1.5.1
| B. Clean spilled food as required |
| 5.1.5.3 |
Lavatories – DAILY
Lavatories
A. Cleaned daily – including showers, lockers, benches, ceilings, walls, doors 5.1.6
B. Toilets & urinals washed inside & out with no rust or scale deposits 5.1.6.1
C. Lockers, walls, doors washed and wiped so no streaks remain 5.1.6
| D. Decks mopped & sanitized |
| 5.1.6 |
| E. All surfaces free of dust |
| 5.1.6.2 |
| F. Supplied with and towels, toilet tissue, antibacterial hand soap, seat covers. (9) |
| 5.1.6.3 |
| G. Trash containers emptied & washed as needed. |
| 5.1.6.4 |
| H. Mirrors and glass shall be cleaned and polished |
| 5.1.6.5 |
| I. Sinks & faucets cleaned sanitized |
| 5.1.6.6 |
| J. Drains are cleaned (15) |
| 5.1.9.1 |
| A. Empty trash & recycle cans |
| 5.1.7.1 |
| B. Clean decks and doors |
| 5.1.7.1 |
| C. Vacuum and spot clean carpet |
| 5.1.7.1 |
| E. Dust files, furniture and blinds |
| 5.1.7.1 |
F. Thoroughly clean venetian blinds – Monthly 5.1.7.2
| G. Shampoo carpet-Quarterly |
| 5.1.7.2 |
Additional Comments:
Walls, Baseboards, Ceiling, Partitions, Doors, Wood & Bright Work, Louvers, Vents, Fans and Drains (15) 5.1.8, 5.1.9
A. Walls, doors, baseboards, ceilings, woodwork, & partitions kept clean of smudges, marks, dust or streaks 5.1.8.1
B. All metal surfaces are polished & kept clean, shinning & free of tarnish or corrosion 5.1.8.2
C. Walls, doors & vertical surfaces are cleaned as needed, but at least once per week 5.1.8.1
D. Deck drain covers & strainers are cleaned after each meal 5.1.9.1, 5.1.9.2
| E. Louvers, vent covers & fans are cleaned at least monthly or more often. |
| 5.1.9.3 |
Additional Comments:
Windows/Glass, Light Fixtures, Water Fountains, Sinks & Eyewash Station (16) 5.1.10, 5.1.11, 5.1.12
A. Daily & as required: all windows, glass walls, diamond cut windows and glass doors clean of smudges, marks, dust or other dirt streaks inside and out
5.1.10.1
B. Weekly: windows, diamond windows and sills are thoroughly cleaned inside & out 5.1.10.2
| C. Monthly light fixtures cleaned |
| 5.1.11 |
D. Water fountains, sinks & eye wash station clean & sanitized daily 5.1.12
Additional Comments:
Scullery Program 18 & 15
Inspect scullery at 1010-1025 or 1510-1525, scullery should be inspection ready at these times.
5.4
A. Dishes are properly washed and air dried
5.4.1.1 -5.4.1.3
| C. Hand sanitize patient carts |
| 5.4.1.6 |
D. Clean dish dispensers, dollies, tray racks, lowerators, & carts daily 5.4.1.7
E. Clean special event mess equipment as required 5.4.1.7
F. Tables, sinks, counters, shelves and trough is scrubbed & rinsed 5.4.1.8
| G. Garbage grinder is clean |
| 5.4.1.9 |
| H. Decks cleaned & mopped dry |
| 5.4.1.10 |
I. Vents and walls are clean(15)
A. Temperatures recorded 3 times per day at 0530,1115 &1615 5.4.2.1
B. After each meal the dishwashing machine is cleaned 5.4.2.2
C. Weekly: dishwashing machine and pot & pan machine are descaled 5.4.2.3
| A. Equipment is air dried |
| 5.4.3.1 |
| B. Equip returned to point of use |
| 5.4.3.2 |
| C. Washing accomplished rapidly |
| 5.4.3.3 |
D. Left clean after each use, sweep, scrub, rinsed mop dry
5.4.3.4
| E. All pan racks washed and dried |
| 5.4.3.5 |
| F. Garbage grinder cleaned after each meal |
| 5.4.3.7 |
| G. Cafeteria tray return cleaned |
| 5.4.3.8 |
H. Tables, sinks, counter & shelves cleaned & sanitized daily 5.4.3.9
I. Dust & clean light fixtures, vents and fans weekly 5.4.3.10
| J. Water on deck immediately mopped. |
| 5.4.3.11 |
Additional Comments:
