Restaurant Site Safety Inspection Report Form
Date and Time
-
Month
-
Day
Year
Date
Hour Minutes
AM
PM
AM/PM Option
Restaurant Branch Location
Please Select
ABC Restaurant Branch 1
ABC Restaurant Branch 2
ABC Restaurant Branch 3
ABC Restaurant Branch 4
ABC Restaurant Branch 5
Inspector Name
First Name
Last Name
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Email Address
example@example.com
Inspection Type
Routine
Re-inspection
Complaint
Storage Rooms/Freezers
Rows
Yes/Good
No/Poor
N/A
Remarks
Storage rack good condition
1
2
3
Heavy equipment can be handled by the rack?
4
5
6
Floor surfaces prevent slips or floor?
7
8
9
Maintenance of gas systems
10
11
12
Is the cooler or freezer closed properly?
13
14
15
Floors and Surfaces
Rows
Yes/Good
No/Poor
N/A
Remarks
Are the floor is good condition?
16
17
18
Is there a floor mat or carpet in the floor?
19
20
21
Is the floor or carpet being cleaned and maintained in a regular basis?
22
23
24
Are the floor regularly being cleaned?
25
26
27
Does everyone have a footwear that is slip-resistant?
28
29
30
Are the necessary pathways clear from any obstruction?
31
32
33
Is the lighting enough on all sections?
34
35
36
Ladder Safety
Rows
Yes/Good
No/Poor
N/A
Remarks
Is it stored properly and securely?
37
38
39
Is it in good condition?
40
41
42
Is it being checked and maintained in a regular basis?
43
44
45
Are there any cracks or issues with the ladder?
46
47
48
Does the store have enough ladders they needed?
49
50
51
Equipment and Tool Safety
Rows
Yes/Good
No/Poor
N/A
Remarks
Are there available PPE (Personal protective equipment) for employees?
52
53
54
Is the filtration of the grease system in good condition?
55
56
57
Are the tools and equipments working properly?
58
59
60
Are face masks, face-shields, and safety googles available when required?
61
62
63
Are there clothing requirements when cooking?
64
65
66
Does the kitchen have pot holder and other related tools for safety when cooking?
67
68
69
Does the employee remove jewelry and rings inside the store or kitchen?
70
71
72
Are the hair tied and are the employees wearing hairnets?
73
74
75
Fire Safety
Rows
Yes/Good
No/Poor
N/A
Remarks
Are there enough fire extinguisher in the store?
76
77
78
Are the fire extinguisher inspected properly in a regular basis?
79
80
81
Are the fire extinguisher working?
82
83
84
Are entrance and exits labeled properly in the store?
85
86
87
Is there a sprinker system?
88
89
90
Is there a smoke detector?
91
92
93
Are there emergency lights?
94
95
96
Is the first aid kit available and stored properly?
97
98
99
Electrical Safety
Rows
Yes/Good
No/Poor
N/A
Remarks
Does light fixtures that has bulb properly covered?
100
101
102
Are the switches in the circuit breaker labeld correctly?
103
104
105
Are there any obstacles in circuit breaker boxes?
106
107
108
Does the power cord have ground prong?
109
110
111
Does the extension have ground prong?
112
113
114
Chemical Safety
Rows
Yes/Good
No/Poor
N/A
Remarks
Are PPEs available when managing these chemicals?
115
116
117
Chemical containers are labeled correctly?
118
119
120
Chemical agents are stored properly?
121
122
123
Observations
What are the things that needs corrective actions?
Please upload a photo for reference
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Inspector Signature
Date Signed
-
Month
-
Day
Year
Date
Manager's Name
First Name
Last Name
Manager Signature
Date Signed
-
Month
-
Day
Year
Date
Submit
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