PROJECT NAME: __________________________

LUNCHROOM INSPECTION CHECKLIST

LOCATION LUNCHROOM No. MONTH

LEGEND OK – ACCEPTABLE, NOT - NOT ACCEPTABLE, ELM– EQUIPMENT LOST OF MISSING, REP – EQUIPMENT BEING REPAIRED, N/A – NOT APPLICABLE
RAISE THE ISSUES THROUGH CORRECTION REPORT (BEFORE & AFTER PHOTO) FOR ACTION TAKEN

Date

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

29

30

31
1

9
Time
Floor Clean

Table Clean

Lunch Box Rack

Air Condition

Adequate Ventilation

Adequate Lighting

Conditions of Door

Trash bin lid

Trash Removal

Drinking Water

Cleaner Signature

Supervisor Signature

Safety Officer Name: _______________________________ Signature: _____________________ Date: _____________________

(Reviewed By)

Site Manager Name: _______________________________ Signature: _____________________ Date: _____________________

(Accepted By)