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13F-OEHS /Tulane (Rev. 8/03) Inspection & Compliance
FOOD SERVICES Health & Safety Inspection Report
Instructions: Checklist items should be circled “Y” for Yes, “N” for No, or “N/A” for Not Applicable. For every item circled
“N” (No), provide the “Corrective Action.” Once corrected, provide date correction completed.
Items not listed in this report may be included under Item V “Additional Notes” at the end of this form.
Distribution: On completion of the INSPECTION, the inspection report should be signed, the original retained by the
department, and a copy provided to the Departmental Safety Representative (DSR) in charge of the area.
The DSR will take responsibility for forwarding the copy to the Office of Environmental Health & Safety.
INSPECTION CONDUCTED BY (print): ______________________________________________ Phone: ________________
E-mail: ___________Campus: ______________ Building: ______________ Dept: _____________ Floor/Rm Nos:__________
Date of Inspection: ____________________________
CHECKLIST ITEMS CORRECTIVE ACTION Correction Date
I. KITCHEN (General)
1. Floors and work boards are free from
grease and debris Y N N/A ______________________________________ _____________
2. Steampipes are insulated Y N N/A ______________________________________ _____________
3. Knives, saws, cleavers are in appropriate
racks (or drawers) when not in use Y N N/A ______________________________________ _____________
4. Walk in refrigerator boxes are equipped
with operable safety latches and safety
guards on light fixtures Y N N/A ______________________________________ _____________
5. Sufficient disposal containers are
available Y N N/A ______________________________________ _____________
6. Powered meat and food processing
equipment is provided with proper guards Y N N/A ______________________________________ _____________
7. Electrical connections and cords are in
good condition Y N N/A ______________________________________ _____________
8. The floor is free of standing water Y N N/A ______________________________________ _____________
9. Smoking is not allowed except in
designated areas Y N N/A ______________________________________ _____________
10. All equipment and utensils are clean Y N N/A ______________________________________ _____________
11. Plumbing is in good repair, (vacuum
breakers in place on submerged inlets
and hose bibs) Y N N/A ______________________________________ _____________