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THIS FORM SHOULD BE FILLED IN BY THE RESTAURANT MANAGER
Name
*
First Name
Last Name
Restaurant 530
Date
*
MM
DD
YYYY
Section 1: TRAINING
Please walk through the restaurant as you look at the areas outlined, please check Safe or Not Safe to mark your restaurant's compliance. If any areas are Not Safe please fill out the comment section to explain why and outline the plan to get it to Safe.
Copy of Workplace Safety Policy posted where it is visible to employees?
*
SAFE
NOT SAFE
Copies of job aids/safe work procedures are available in the restaurant
*
SAFE
NOT SAFE
WHMIS: All employees are educated about hazardous material and safe use of cleaning products. WHMIS training is completed and recorded within 1 week of hiring. Employees are retrained in WHMIS near each one year anniversary of employment.
*
SAFE
NOT SAFE
Are employees aware of reporting and response procedures for incidents such as first aid or workplace violence?
*
SAFE
NOT SAFE
COMMENT
Please comment on any NOT SAFE areas
Section 2: KITCHEN
Floor (must be free of slipping hazards)
*
SAFE
NOT SAFE
Vents working properly
*
SAFE
NOT SAFE
Lights working properly
SAFE
NOT SAFE
Refuse facilities not overflowing
SAFE
NOT SAFE
Fire Equipment - Auto / Portable
*
SAFE
NOT SAFE
Date Checked - WHMIS labels satisfactory
*
SAFE
NOT SAFE
Exit signs working
*
SAFE
NOT SAFE
Hand Washing Facility (dispensing soap / single use towels)
*
SAFE
NOT SAFE
COMMENT
Section 3 : DINING ROOM
Entrance Area/Doors Vestibules (must have good visibility to deter intruders/assailants)
*
SAFE
NOT SAFE
Floor (must be free of slipping hazards)
*
SAFE
NOT SAFE
Vents working properly
*
SAFE
NOT SAFE
Lighting (lighting must be sufficient to discourage use as a hiding place)
*
SAFE
NOT SAFE
Exit Signs (lights) working properly
*
SAFE
NOT SAFE
COMMENT
Section 4 : GUEST WASHROOMS - MENS
If windows, they must prevent potential intrusions
*
SAFE
NOT SAFE
NO WASHROOMS
Floor (must be free of slipping hazards)
*
SAFE
NOT SAFE
NO WASHROOMS
Lights - all working and bright enough to deter intruders
*
SAFE
NOT SAFE
NO WASHROOMS
Toilet Seats - all firmly attached to toilet bowls
*
SAFE
NOT SAFE
NO WASHROOMS
COMMENT
Section 4 : GUEST WASHROOMS - WOMENS
If windows, they must prevent potential intrusions
*
SAFE
NOT SAFE
NO WASHROOMS
Floor (must be free of slipping hazards)
*
SAFE
NOT SAFE
NO WASHROOMS
Lights - all working and bright enough to deter intruders
*
SAFE
NOT SAFE
NO WASHROOMS
Toilet Seats - all firmly attached to toilet bowls
*
SAFE
NOT SAFE
NO WASHROOMS
COMMENT
Section 5 : EXTERIOR
Garbage Area (where possible, seen from inside restaurant)
*
SAFE
NOT SAFE
NOT VISIBLE FROM RESTAURANT
Landscaping (free from unmarked tripping hazards)
*
SAFE
NOT SAFE
NO LANDSCAPING
Lot Cleanliness and Appearance (no hiding places for intruders/assailants)
*
SAFE
NOT SAFE
NO LOT
Building Lights/Lot Lights (well-lit to deter intruders/assailants)
*
SAFE
NOT SAFE
Condition of Fence (must be intact)
*
SAFE
NOT SAFE
Shed or Outside Storage Area (well-lit access from restaurant)
*
SAFE
NOT SAFE
Curbs/Sidewalks (free from unmarked tripping hazards)
*
SAFE
NOT SAFE
COMMENT
Section 6 : STORAGE/BASEMENT
Floors must be free of tripping hazards
*
SAFE
NOT SAFE
NO STORAGE/BASEMENT
CO2 tanks secured
*
SAFE
NOT SAFE
NO STORAGE/BASEMENT
"Materials stored for safe lifting and handling (no bag-in-box above shoulder height)"
*
SAFE
NOT SAFE
NO STORAGE/BASEMENT
Stairs must be free of tripping hazards
*
SAFE
NOT SAFE
NO STORAGE/BASEMENT
Furnace Room must be clean and free from tripping hazards
*
SAFE
NOT SAFE
NO STORAGE/BASEMENT
COMMENT
Section 7 : STAFF MANAGEMENT AREAS
First Aid Kit contents meets provincial requirements
*
SAFE
NOT SAFE
First Aid Kit / Accidental Record Book complete and up-to-date
*
SAFE
NOT SAFE
"Staff Room : (appearance and cleanliness) must be free of tripping hazards"
*
SAFE
NOT SAFE
Office : (appearance and cleanliness) must be free of tripping hazards
*
SAFE
NOT SAFE
"Staff Washroom : (cleanliness: soap/single use towels) must be free of tripping hazards"
*
SAFE
NOT SAFE
COMMENT
Section 8 : WHMIS
All controlled products are labelled
*
SAFE
NOT SAFE
Staff have access of MSDS for all products
*
SAFE
NOT SAFE
"All controlled products and other chemicals are inventoried"
*
SAFE
NOT SAFE
"Cleaning supply storage (away from food, on lower shelves)"
*
SAFE
NOT SAFE
"Appropriate personal protective equipment available & being used"
*
SAFE
NOT SAFE
Chemicals from Approved National Supplier
*
SAFE
NOT SAFE
COMMENT
Thank you!