Self Inspection - South District
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Lodge Information
Please enter your Lodge and requested contact info below
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Your Lodge
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Street Address
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City, State, & ZIP
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Phone *
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Date *
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MM
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DD
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YYYY
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Name *
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Email
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Confirm Email
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Access Roads, Walkways, & Parking Areas
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Free of debris, cracks, & broken paving
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YES
NO
N/A
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Different elevations between adjacent walkways provided with guards or well marked
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YES
NO
N/A
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Walkways flat, well drained, & without holes
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YES
NO
N/A
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Fences & barricades secured & in good condition
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YES
NO
N/A
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Pathways & parking areas well lighted
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YES
NO
N/A
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Walkways have safe clearance from motorized equiptment
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YES
NO
N/A
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Signs indicating "Park at Your Own Risk"
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YES
NO
N/A
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Stairs & Ramps
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Standard stair rails or handrails provided on stairways with four or more stairs & ramps
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YES
NO
N/A
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Handrails well secured with no sharp or rough parts
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YES
NO
N/A
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Stair tread & riser free of chips, cracks, & uneveness
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YES
NO
N/A
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Stair treads & ramps slip resistent
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YES
NO
N/A
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Stairways & ramps well lighted
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YES
NO
N/A
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Do stairs have at least 6½' overhead clearance?
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YES
NO
N/A
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Floor & Wall Openings
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Large glass areas subject to human impact well marked
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YES
NO
N/A
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Floor opening provided with guard rail or cover
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YES
NO
N/A
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Grate type covers designed not to affect foot traffic
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YES
NO
N/A
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Safe floors - Non Skid
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YES
NO
N/A
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Exiting & Egress
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Emergency lighting provided in corridors & stairways
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YES
NO
N/A
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All exits marked & properly illuminated
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YES
NO
N/A
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All doors, passages, & stairs that aren't exits properly marked
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YES
NO
N/A
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All exits & passageways free of obstructions
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YES
NO
N/A
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There are at least 2 means of egress provided from upper floors
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YES
NO
N/A
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Exit Doors
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All exit doors opening the direction of exit
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YES
NO
N/A
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Cold storage room doors provided with inside release
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YES
NO
N/A
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Doors opening into street provided with warnings or barriers to prevent stepping into path of vehicles
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YES
NO
N/A
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Doors opening into street provided with warnings or barriers to prevent stepping into path of vehicles
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YES
NO
N/A
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Storage Areas
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Storage areas clean, dry, & free of refuse
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YES
NO
N/A
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Entrance to area lock when unattended
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YES
NO
N/A
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Flammables & combustibles stored away from heating devices & open flames
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YES
NO
N/A
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Trash & debris in metal covered containers & regularly removed
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YES
NO
N/A
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Emergency & First Aid
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Emergency numbers posted at each phone
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YES
NO
N/A
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Employees instructed on reporting emergencies
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YES
NO
N/A
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Employees instructed on use of portable exstinguishers
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YES
NO
N/A
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First aid kits clean & fully stocked
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YES
NO
N/A
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Outdoor Fixtures & Playgrounds
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Benches & tables free of cracks, slivers, & broken parts
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YES
NO
N/A
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Water fountain & taps in good repair without broken parts
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YES
NO
N/A
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BBQ free of sharp edges & have no missing parts
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YES
NO
N/A
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Playground equipment clean & in good repair
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YES
NO
N/A
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Swimming Pool
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Appropriate caution signs posted
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YES
NO
N/A
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Proper enclosure to prevent falling into pool or access to children
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YES
NO
N/A
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Glass cups & plates not allowed in pool area
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YES
NO
N/A
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Remove diving board
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YES
NO
N/A
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Certified Lifeguard on duty when pool is open
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YES
NO
N/A
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Kitchen, Bar, & Restaurant
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Metal container with cover provided for greasy rags
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YES
NO
N/A
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Knives stored in holders when not in use
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YES
NO
N/A
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Electrical cords & plugs of appliances in good condition
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YES
NO
N/A
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Food processing equipment properly guarded & in good repair
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YES
NO
N/A
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Glass stored away from open ice storage & food storage areas
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YES
NO
N/A
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Gas & beverage concentrate cylinders secured against tipping
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YES
NO
N/A
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Drain & other floor openings covered
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YES
NO
N/A
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Non-skid mats provided in line of sinks, ice machine, range, etc...
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YES
NO
N/A
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Are mats clean, & without grease or other build-up?
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YES
NO
N/A
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Foods stored off the floor
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YES
NO
N/A
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Food covered & stored in refrigerator when not being prepared. Proper temperatures being maintained.
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YES
NO
N/A
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Hoods & filters over range clean & not laden with grease
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YES
NO
N/A
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Suppression system in hood(s) inspected in the last 6 months
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YES
NO
N/A
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Chairs, stools, & tables in good condition
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YES
NO
N/A
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Board of Health certified server and inspection
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YES
NO
N/A
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Restrooms, Locker Rooms, Showers, & Saunas
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Maintained dry, clean, sanitized & free of debris
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YES
NO
N/A
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Well illuminated, burned out bulbs promptly replaced
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YES
NO
N/A
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Hand towel, soap, toilet paper, & sink fixtures secured & in good repair
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YES
NO
N/A
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Toilet stall & locker walls, doors, & latches secure & in good repair
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YES
NO
N/A
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Walking surfaces of non-skid materials
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YES
NO
N/A
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Appropriate warning signs posted, e.g. "CAUTION-SLIPPERY WHEN WET" / "DO NOT USE FOR MORE THAN 15 MINUTES", etc...
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YES
NO
N/A
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Personal Protection Devices
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Appropriate protective devices provided for chemicals on site such as respirators for gas leaks, gloves, goggles, etc...
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YES
NO
N/A
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Compliance with "Right to Know" requirements where applicable
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YES
NO
N/A
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Protection Devices
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All automatic fire sprinkler system supply valves wide open
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YES
NO
N/A
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All heat/smoke detection systems in operation
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YES
NO
N/A
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Portable extinguishers serviced in last 12 months & tagged
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YES
NO
N/A
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Pressures in appropriate range on gauge
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YES
NO
N/A
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Extinguishers properly mounted at stations
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YES
NO
N/A
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Extinguishers recharged as required
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YES
NO
N/A
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All sleeping quarters provided with smoke detectors unless provided with automatic sprinklers and carbon monoxide detectors
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YES
NO
N/A
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Image Verification
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