LAKE COUNTY SCHOOLS
Monthly Serving Line / Kitchen Inspection Form
Location: Choose School Date ______
General Conditions / Premises and Maintenance / INSPECTION / If Failed please explain in comments below.Comments:
Pass / Failed
Authorized Personnel Only Signage (Kitchen entrance)
Restrooms (Lighting, ceiling, floor, fixtures, housekeep)
Serving Lines (Clear of obstructions )
Serving Lines / Tray Slides, (Sanitation / free of damage)
General Conditions / Premises and Maintenance – Kitchen Area
Air Curtain at Outside Exit Doors
Chemical / Storage Policy Followed / MSDS
Debris / Trash / Trip Hazards / Pest Control
Delivery Area (Clear of obstructions)
Electrical Panels - Labeled Closed / 3’ Clearance
Emergency Exit Plan
Exit Doors (Panic hardware)
Exit Doors Properly Marked With Sign/ Lighting
Exits (Clear of obstructions)
Fire Alarm
Fire Extinguishers (ABC and K type extinguisher / properly mounted / inspected / tagged / within 75 feet of equipment / 3' clearance around)
Fire Sprinkler Heads (No objects within 18")
Floor Drains (Proper operation / flush with floor)
Floors Dry
GFCI Installed With 6” Of Water Source
Hood Annual Inspection Certification (On file)
Hood / Duct Exhaust (Filters clean / system clean)
Ice Machines (Sanitary / free of mold / no ice around machines)
Mats (Clean and flat on floor)
Meat Slicing / Mixing Equipment (Guards)
Office (Lighting / ceiling / floor / housekeep) [i]
PPE In Place / Adequate Inventory
Preparation Tables (No damage / clean and sanitary)
Refrigeration / Freezers (Proper temperature records / sanitary and clean / doors have interior release mechanism or alarm / textured floors / floors free of water, ice, trip hazards / proper storage of food items)
Safety Signage (Posted and current)
Storage / Maintenance (Sanitary and clean / proper lighting / floors free of water and trip hazards / racks and shelving secure / supplies securely and properly stacked)
Utensils / Knives (Proper use and storage)
MIS 79 008 7/10/17 REV
Submitted by Risk Management Signature ______Title______
[i]