HAZARD IDENTIFICATION CHECKLIST
Hazard Identification Checklist /Dining & Kitchen Areas
Surveyor Name:______Survey Date:______
Work Unit:______Room:______
If “No” is selected, please correct the hazard and note the date.
Yes
/ No / n/a / Date CorrectedADMINISTRATIVE
1. / Is current signage present and accurate? Post if missing.
· UCI or UCIMC Emergency Procedures Flipchart (all blue or multi-colored)
· UC Irvine Injuries & Medical Treatment (08/2009)
· CAL/OSHA poster “Safety and Health Protection on the Job”
2. / Is there a work unit emergency call list available?
3. / Does staff know how to report an incident/injury/safety concern?
4. / Has staff reviewed the content of the UCI Emergency Procedures Flipchart?
FIRST AID
5. / Are the first aid kits located in an easy to see location
and unobstructed?
6. / Is first aid kit adequately stocked with the approved
items only?
7. / Are the first aid kits located in an easy to see location
and unobstructed?
KITCHEN
8. / Are sink drains clear and free flowing?
9. / Are taps free from drips?
10. / Is equipment secured?
11. / Are aerosol containers stored away from cooking
equipment.
12. / Are exhaust hoods and suction/ventilation ducts over
equipment cleaned as necessary.
13. / Are blades on slicing equipment covered with the
blade guard or protected?
EQUIPMENT
Is the equipment listed below in good working condition, clean and not missing any parts?
14. / Can openers
15. / Deep fryers
16. / Grills
17. / Flat top
18. / Mixers
19. / Ovens
20. / Wok
21. / Pizza Oven
22. / Range Top
23. / Steamer
24. / Slicers
25. / Steam Kettles
26. / Broiler
27. / Heat Lamps
HAZARD IDENTIFICATION CHECKLIST
Hazard Identification Checklist /Dining & Kitchen Areas
Yes / No / n/a / Date Corrected28. / Soup Wells
29. / Fountain Drink Machines
30. / Toaster
31. / Microwave
32. / Coffee machine
33. / Ice Machine
34. / Tilt Kettle
35. / Heated Shelves
36. / Rice Cooker
37. / Milk Dispensers
38. / Salad Bars
FACILITIES CLEANLINESS
39. / Floors are clean, including underneath tables and
equipment
40. / Floor drains are clean and free of debris, floor sink
baskets are in place
41. / Air gaps maintained on all water sources
42. / Shelves are clean and organized
43. / Empty boxes are removed from production areas
44. / Garbage cans are properly lined and not overflowing
45. / Chemicals are stored away from food preparation areas
46. / Ceiling is clean and free of holes, no missing tiles
47. / Fans are free of dust
LOADING DOCK/DUMPSTER
48. / Dock is clean
49. / Boxes are broken down, crates neatly stacked
50. / Grease bin is accessible for grease disposal
51. / Propane tanks are locked
DISH ROOM/ DISH MACHINE
52. / Floors are free of excess water
53. / Dish machine is clean and working properly
54. / Garbage disposal is clean and working properly
55. / Employees use safety goggles when changing dish
chemicals.
ELECTRICAL
56. / Are sockets or switches in good order (not broken)?
57. / Are all plugs, cords, electrical panels, and receptacles in good condition (no exposed conductors
or broken insulation)?
58. / Are extension cords being used correctly? (They must not be run through walls, doors, ceilings; not represent a trip hazard running across aisle ways; not to be used as a permanent source of electrical supply have additional outlets installed; not be linked together. (No “thin zip cords.”)
59. / Is clear access (36” clearance) provided to
electrical panels?
60. / Are lamps well clear of drapes, papers and other
combustible materials?
61. / Are there any adapters/piggyback appliances being used?
HAZARD IDENTIFICATION CHECKLIST
Hazard Identification Checklist /Dining & Kitchen Areas
Yes / No / n/a / Date Corrected62. / All equipment is properly grounded?
LIGHTING
63. / Is there adequate lighting for the work being
carried out?
64. / Is the area’s lighting steady (no flickering lights)?
ENVIRONMENT
65. / Is furniture in good repair?
66. / Is there adequate lighting?
67. / Is there adequate ventilation?
FIRE LIFE SAFETY
1. / Does staff know evacuation assembly location?
2. / Does staff know how to respond to emergencies?
3. / Does staff know where 1st aid supplies are located?
4. / Are exit corridors and doors free from obstruction (potentially created by improper storage or arrangement of furniture)?
5. / Do fire doors and doors to hazardous areas self-close and latch properly?
6. / Are evacuation plan posted near elevators or stairs?
7. / Are exits properly marked and unobstructed (not locked)?
8. / Are fire extinguishers provided and are physically and visually accessible, fully charged, pin and security seal in place, and up-to-date maintenance tag?
9. / Are trash receptacles and paper located away heat sources?
10. / Do portable space heaters have protected heating elements?
11. / Are fire alarm bells/horns/strobes free from obstructions that would hamper the operation or reduce the sound?
12. / Are there strobe lights in conference rooms and are they in good condition?
13. / Are refrigerators in good condition and not leaking?
14. / Are counter top appliances in working order?
ELECTRICAL / MECHANICAL
15. / Are electrical cords and plugs in good repair, not cracked, broken, or frayed?
16. / Does staff follow procedures in manufacturers’ maintenance and operations manuals?
17. / Are wall outlets & switches in good repair (not broken, covers in place, etc.)?
18. / Is the area free of multi-plug outlet adapters?
19. / Does office avoid “daisy-chaining” power strips?
20. / Are extension cords being used only on a temporary or emergency basis?
21. / Are there fixed or portable Ground Fault Circuit Interrupter (GFCI) devices used in areas that are frequently wet (within 6 feet of a water source)?
22. / Are office machines and equipment guarded and grounded (grounding pin intact and 3-pin to 2-pin adaptors not in use)?
23. / Do all electrical panels have a 3-foot clearance?
HAZARD IDENTIFICATION CHECKLIST
Hazard Identification Checklist /Dining & Kitchen Areas
Yes / No / n/a / Date Fixed1. / Are unneeded electrical items disposed of through Peter’s Exchange?
2. / Other?
Signature of Surveyor:______
Updated: 08/08/2016