Attachment_3_Weekly_Inspection.docx
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Weekly Inspection Report.
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Attachment 3 Weekly Inspection Weekly Inspection
| Completed By: _______________________ | Date: ___________________ | |
| Company: ___________________________ | Location: ____________________________ | |
| Life Safety Issues | ||
| Satisfactory | ||
| Not Satisfactory |
Corrective Action/Date
Walkways maintained, aisles defined, uncluttered
Emergency exits clearly identified, adequate number
Egress routes marked and accessible
Unapproved doors clearly marked “NOT AN EXIT
Stairs/aisleways free from material storage and debris
| Emergency Medical |
| Satisfactory |
| Not Satisfactory |
Corrective Action/Date
Emergency contact information posted.
Bloodborne pathogens exposure potential adequately addressed
First aid supplies adequate and available
Transportation available for injured workers/plan in place
| Fire Safety |
| Satisfactory |
| Not Satisfactory |
Corrective Action/Date
Portable fire extinguishers of proper type are mounted properly, accessible, and inspected
Approved safety containers are used for flammable liquids
Fire Sprinkler Inspection:
Date of Last inspection: ________________
Bonding and grounding used with storage of flammable materials
Combustible debris disposed of regularly
No Smoking” areas designated
Sprinkler system functional/inspected/documented
Smoke/heat detectors functional and inspected;
Date of last inspection:________________
Minimum 18” of clearance below sprinkler heads
Sprinkler valves locked in the open position.
| Mobile Equipment |
| Satisfactory |
| Not Satisfactory |
Corrective Action/Date
Observed operating at safe speeds
Equipped with back-up alarms
Operators qualified/trained
Seat belt worn by operator
Equipment Inspected regularly
Vehicle operator inspections performed prior to dispatch
Bus barn inspection conducted
Vehicles washed and cleaned as needed
| Chemicals |
| Satisfactory |
| Not Satisfactory |
Corrective Action/Date
Hazardous materials containers labeled
MSDS available
Hazard Communication Training program in place
Smoking and eating prohibited in work areas where chemicals are used
Eyewash/emergency shower available and functional
| Facilities Management Tasks |
| Satisfactory |
| Not Satisfactory |
Corrective Action/Date
Inspect premises to check whether employees have adequate supplies
Inspect office rooms, bathrooms, etc. to check their workability;
Inspection of daily procedures to ensure operating capability of work equipment (bus barn, IT equipment, audio/video equipment)
Inspect the building interior & exterior
Maintenance - technical, cleaning and repair services
Maintenance - exterior services: lawn care, trimming, painting, etc.
Seasonal building preparations (e.g. winterizing the building) & emergency preparedness
Pest control routine and disinfestations (Qtrly) Date of Last service call: _____________
Lighting and electricity: burned-out light bulbs are replaced, etc.;
Inspect electric cables, outlets, appliances and fixtures for proper operation.
Test emergency lighting fixtures are functional
Check heating and AC controls for temperature
Preventive maintenance tasks scheduled and completed are noted.
Number of PM’s issued for the Week_________ Number of PM’s completed for the Week__________ Number of PM’s issued year to date: ______________ Number of PM’s completed year to date:___________
Number of corrective work orders issued for the week_________ Number of corrective work orders issued completed for the week___________ Number of corrective work orders issued year to date:______________ Number of corrective work orders completed year to date______________
| Janitorial Services |
| Satisfactory |
| Not Satisfactory |
| Corrective Action/Date |
Bathrooms
Toilets, urinals cleaned daily
Sinks and Mirrors cleaned daily
Paper towel dispensers filled as needed
Exhaust fans cleaned as needed
Classrooms/Common Areas/Offices
Carpet vacuumed as needed
Windows cleaned as needed
Interpreters offices vacuumed and dusted
Floors mopped as needed
Furniture cleaned as needed
Clean water fountains
| Security |
| Satisfactory |
| Not Satisfactory |
| Corrective Action/Date |
Inspect Visitor Sign in/Sign out log reviewed
Inspect CCTV operational status
Inspect electro magnetic locks for front entrance
Inspect UPS systems
| Food Service |
| Satisfactory |
| Not Satisfactory |
| Corrective Action/Date |
Inspect weekly menu – compliance with USDA dietary requirements
Employees wear proper uniform including proper shoes
· Hair restraints
· Gloves when serving food
Check food serving temperatures _________________
Food is handled with utensils, clean gloved hands
Food properly labeled
Utensils are handled to avoid touching parts that will come into direct contact with food
All surfaces and floor clean
Chemicals are stored away from food and other food related supplies
Food is protected from contamination
Work surfaces are clean to sight and touch
Work areas are washed and sanitized between uses
Kitchen garbage cans are clean
Garbage cans are emptied as necessary
No evidence of pests is present.
Clean and sanitized dinnerware, utensils and trays are available to diners without delay during the scheduled meal period.
Ensure Service Provider does not leave ice utensils in ice machine
Ensure Service Provider effectively protects ice that is used for human consumption and it must be potable and covered
Ensure gloves are worn when dispensing ice.
Ensure Service Provider does not use ice for human consumption that has been used for cooling stored food and food containers
Serving lines are set up no earlier than 15 minutes prior to the scheduled start of the meal period.
Ensures set temperatures of all equipment are in accordance with recipe during cooking/preparation at Service Provider’s facility and at Government facility during serving periods.
Ensure salad bar and all other cold food is kept to a temperature of 40 degrees F prior to being placed on the serving line.
Ensure all raw fruits and vegetables are thoroughly washed with potable water before being cooked or served.
Ensure temperature monitoring devices are utilized in all cooking, roasting, and baking of food items at the Service Provider’s Facility as well as during scheduled meal serving periods at Government facility to ensure compliance with proper specified temperature controls.
Ensure the serving line is properly replenished to ensure availability to all patrons throughout the serving period.
Ensure empty serving line containers are promptly removed and full containers are placed back on serving line.
Ensure personnel serving food is courteous and presents a helpful attitude toward each patron being serviced.
Ensure personnel serving food is in a clean, well fitted and proper uniform daily.
Breakdown of the serving lines begins within 15 minutes after the conclusion of the scheduled meal period, including any authorized extensions, and completed within 60 minutes after the end of the meal period.
Ensure Contractor cleans serving/steam line equipment and all other equipment in the serving or dining area, or on which
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