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CHECKLIST CONTENT: 1. Ambient Storage Facilities 2. Cold Storage Facilities 3. Frozen Storage 4. Food Establishments 5. Catering Personnel 6. Locker Room & Personnel Toilets 7. Premises & Layout 8. Camps and Communal Living Facilities 9. Pest Control 10. Sewage Water 11. Solid Waste 12. Potable Water Supply
DATE: FOREMAN: LIAISONMAN: NUMBER OF PEOPLE LIVING IN THE RIG CAMP: RIG NAME: WELL NAME: LOCATION:
REMARKS
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D&WO DOE&CD EPA CHECKLIST Rev.01: 02 Jan 2012
Name 1 2 3 4 5 6 7 8 9 10
Job Title
Department
Acknowledgments: Name/Signature 1 2 3 4
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D&WO DOE&CD EPA CHECKLIST Rev.01: 02 Jan 2012
Partial
Yes Yes
Remarks
Is the temperature in dry goods and non refrigerated ambient food stores maintained at below 30 oC? (SASC-S04[20.1.4]) Is adequate space provided to accommodate orderly, off-the-floor storage of all the dry goods? (SASC-S-04[20.1.1]) Is an easily distinguishable FIFO procedure carried out to avoid the usage of outdated stock? (SASC-S-04[20.2.3]) Are all stored items examined regularly for signs of damage, pest infestation and expiry dates? (SASC-S-04[20.2.4]) Are damaged and outdated stock removed from the premises expeditiously to avoid mixing with regular stock? (SASC-S04[20.2.4]) Are bulk storage containers and container covers labeled to identify stored foods by their common names? (SASC-S04[20.2.5.1]) Are there any rejections of material/product due to unacceptable temperature or condition? (SASC-S05[12.8.3])
No
Partial
HYGIENE :
Remarks
Is there a cleaning schedule program displayed? Are the cleaning records available on site for inspection? (SASC-S04[24.2/24.3]) 3
D&WO DOE&CD EPA CHECKLIST Rev.01: 02 Jan 2012
Are raw materials and vegetables washed as needed to remove dust and 6 contamination prior to being placed in chillers? (SASC-S-05[12.3]) Are thermometers available and are temperatures recorded? Are the 7 thermometers properly calibrated? (SASCS-04[21.1.1/21.2.3]) Are any crushed/spoiled fruits and 8 vegetables or broken/cracked eggs kept in storage? (SASC-S-04[29.1/30.6]) Are the meat and vegetables kept/stored 9 on same racks/shelves? (SASC-S04[21.2.10]) Are the milk products/eggs, fruits/vegetables and meat 10 products/cooked products stored at below +5oC? (SASC-S-04[21.2.1/30.6.2]) Is the cold storage temperature average at 11 +5oC throughout transportation, delivery and serving? (SASC-S-04[26.4])
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D&WO DOE&CD EPA CHECKLIST Rev.01: 02 Jan 2012
Yes Yes
HYGIENE :
No
Remarks
Is a calibrated thermometer that displays the temperature present on the frozen storage door? Is a temperature reading record available? (SASC-S04[21.1.1/21.2.3]) Does the freezer temperature average -18 degree C always? (SASC-S-04[21.2.1]) Are all items stored in an orderly, uncluttered, off-the-floor manner on shelves or racks? (SASC-S-04[21.2.4]) Are there product names, dates of manufacture, packing and expiry details on the tag? (SASC-S-05[12.8.5]) Are frozen foods well covered and protected? (SASC-S-04[21.2.5/21.2.9]) Are stored items stored away from the cooling units such that free circulation of air is maintained? (SASC-S-04[21.2.5])
4 5 6
Partial
HYGIENE :
No
Remarks
Is an accessible hand wash basin provided for food handlers to wash hands? (SASCS-04[18.1]) Is the hand wash area clean? Are hot water, liquid soap, disinfectants and hand drying facilities available? (SASC-S04[38.9/24.7])(SASC-S-05[11.11]) Are the work tables, work areas, service areas and tops disinfected before and after work? (SASC-S-04[27.1.1/27.1.2/27.1.3]) Is hot food held at a minimum 63oC at all times? (SASC-S-04[31.7]) 5
D&WO DOE&CD EPA CHECKLIST Rev.01: 02 Jan 2012
3 4
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
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30
31
32
33
34 35
Partial
Yes
HYGIENE:
No
Remarks
Are catering employees suffering from any cuts or scabs on their hands? (SASC-S04[4.3]) Do employees wash and disinfect their hands before and after work and after coughing or sneezing? (SASC-S-04[4.7]) Do the catering personnel wear protective clothing (caps, gloves) and personal protective equipment when dealing with food? (SASC-S-04[4.10/4.11]) 8
D&WO DOE&CD EPA CHECKLIST Rev.01: 02 Jan 2012
4 5 6
Partial
HYGIENE :
SASC-S-04 & SASC-S-07: Locker Room & Personnel Toilets No
Yes
Remarks
4 5
Are there separate locker rooms and toilets for Catering Personnel? (SASC-S04[19.3]) Are the toilets/wash hand basins in good working order and clean? (SASC-S07[8.1]) Is the ventilation in the toilet area adequate and exhausts are directed to outside of the building? Are the ventilation equipment in a good working condition? (SASC-S07[3.4.3/8.9] Are toilets clean and free from odors? (SASC-S-07[8.1] Are soap dispensers, soaps, paper hand towels and hot water provided? (SASC-S07[10.3]- SASC-S-04[38.9]) 9
D&WO DOE&CD EPA CHECKLIST Rev.01: 02 Jan 2012
Are the floors, walls and ceiling clean? (SASC-S-07[2.1] Are the doors and windows tightly fitted and are door closers working effectively? (SASC-S-07[3.3.2]) Is a pest control program in place for locker rooms and toilets? Are records regarding pest control completed and available? (SASC-S-07[14.10])
Yes
No
Partial
HYGIENE:
Remarks
Is there a hand wash basin nearby? (SASC-S-07[10.1]) Is the hand wash basin provided with hot water, soap dispenser and hand drying facilities? (SASC-S-07[10.3]) Is there adequate sign display in terms of hygiene / standards and general recommendations? (SASC-S-07[8.10]) Are the walls, window panes, ceiling fan/air conditioner kept clean? Are they made of materials that are easy to clean? (SASCS-07[3.2.1/3.2.7/3.3.6]) Are the doors and windows tightly fitted and are door closers working effectively? (SASC-S-07[3.3.2])
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D&WO DOE&CD EPA CHECKLIST Rev.01: 02 Jan 2012
Yes
No
Partial
HYGIENE:
Remarks
Are all habitable rooms and service buildings maintained in a clean condition? Is a master-cleaning schedule developed and implemented? (SASC-S-07[2.1]) Are a bed, mattress, mattress pad and pillow provided for each occupant? (SASCS-07[7.3.1]) Are bedding and linen maintained in a clean, sanitary and good condition? (SASC-S-07[7.3.1]) Is the floor space allocated in sleeping rooms a minimum of 4.6 m2 or equivalent of 50 ft2? (SASC-S-07[7.2]) Are carpets maintained in a good condition? (SASC-S-07[7.3.3]) Are occupants provided with a full locker that can be locked (cupboard)? (SASC-S07[7.4]) Are all the lights outside the accommodation in a good functioning order and not damaged? Is adequate illumination provided? (SASC-S-07[3.5]) Is proper ventilation provided (e.g. windows placed on opposite sides)? (SASC-S-07[3.4.2])
4 5 6
Are all air conditioners in the accommodations functioning efficiently? (SASC-S-07[3.4.1/3.4.2]) Are walls and ceilings clean and free from 10 flaking paint? (SASC-S-07[2.1]) Are bins provided with tight-fitting lids and lined with heavy duty plastic bags? (SASC11 S-07[13.2.2/13.2.3/13.2.5])
9
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HYGIENE:
Pest Control SASC-S-17 G.I. 0151.006 SASC-S-10 SASC-S-07 1 Partial Yes No
Remarks
Is there a robust and complete pest control program in place? Are the records complete and available? (SASC-S07[14.10/14.7/2.6] Are only trained personnel allowed to handle spraying equipment and pesticides? (SASC-S-17[7.5]) Are protective clothing/ personal protective equipment (coverall, rubber gloves, goggles, respirator) available and are they used by pest controllers? (G.I. 0151.006[4.3]) Are pesticides and equipment stored at a dedicated area under lock and key? (SASC-S-17[7.3]) Are Chemical Data Sheets (CHB) or Hazardous Material Summary Data Sheets (MSDS) of the pesticides available in the clinic? (SASC-S-10[2.6.22])
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D&WO DOE&CD EPA CHECKLIST Rev.01: 02 Jan 2012
Remarks
Do potable and black water pipeline networks cross each other? (SASC-S07[4.6.3]) If yes, is the potable water pipe always above the sewage one? (SAES-S010[5.2.14]) Is the sewage water treated prior to its discharge? (SASC-S-02[5.1.3]) Is the discharged water periodically tested? (SASC-S-02[5.1.3]) How often is the discharged water tested? (SASC-S-02[4.11.3-Table 5])
3 4 5
HYGIENE:
No SASC-S-07: Solid Waste Partial
Remarks
1 2 3 4
Are there sufficient refuse containers for solid wastes? (SASC-S-07[13.2.4]) Are the provided refuse containers properly lined? (SASC-S-07[13.2.3]) Do they have tight- fitting covers? (SASCS-07[13.2.2]) Are the refuse containers regularly/periodically emptied to avoid accumulation? (SASC-S-07[13.3.1]) Is the final disposal of the wastes located at a safe distance from the living place? Are open dumps or burn pits used for dumping? (SASC-S-07[13.3.3]) Are lugger boxes properly covered? (SASC-S-07[13.2.2.1]) 13
D&WO DOE&CD EPA CHECKLIST Rev.01: 02 Jan 2012
Partial
HYGIENE:
No SASC-S-07: Potable Water Supply
Yes
Remarks
4 5
7 8 9
Is potable water obtained from an approved source and is adequate chlorine added to the water in the bulk water transport (conveyance) system to create a 0.5 mg/L to 1.5 mg/L concentration? Inspector shall take a sample from the bulk water supply and verify chlorine residual. (SASC-S-07[4.1/4.2/4.4]) Is sufficient amount of chlorine added to water to maintain a chlorine residual of at least 0.5 mg/L and maximum of 3 mg/L at all points of the distribution system from which water will be withdrawn? Are records of sample testing complete and robust? (SASC-S-07[4.3/4.4]) Are tanks designed with openings that permit visual inspection of the tank and provide access for cleaning and disinfection? (SASC-S-07[4.5]) Are all the openings covered? Is any leakage, spilling or ponding observed in the location? (SASC-S-07[4.5]) Are the covers properly sealed? (SASC-S07[4.5]) Are openings in the top of the tank flanged upward to prevent surface water from entering through the openings? (SASC-S07[4.5]) Do vents and overflows terminate in a downward direction? (SASC-S-07[4.5]) Are vents screened to prevent the entry of birds and other animals? (SASC-S-07[4.5]) Are water storage tanks provided with sampling taps? Are records of sampling
SASC-S-04 & SASC-S-05
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D&WO DOE&CD EPA CHECKLIST Rev.01: 02 Jan 2012