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Self Inspection - East District
Please fill out the form and click "Submit" at the end.
Lodge Information
Please enter your Lodge and requested contact info below
Your Lodge
Select Your Lodge
Apache Junction #2349
Casa Grande Valley #1957
Chandler #2429
Coolidge-Florence #2350
Fountain Hills #2846
Gilbert #2848
Kearny #2478
Mesa-Buckhorn #2656
Pinal Mountain #2809
Tempe #2251
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Name
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Access Roads, Walkways, & Parking Areas
Free of debris, cracks, & broken paving
YES
NO
N/A
Different elevations between adjacent walkways provided with guards or well marked
YES
NO
N/A
Walkways flat, well drained, & without holes
YES
NO
N/A
Fences & barricades secured & in good condition
YES
NO
N/A
Pathways & parking areas well lighted
YES
NO
N/A
Walkways have safe clearance from motorized equiptment
YES
NO
N/A
Signs indicating "Park at Your Own Risk"
YES
NO
N/A
Stairs & Ramps
Standard stair rails or handrails provided on stairways with four or more stairs & ramps
YES
NO
N/A
Handrails well secured with no sharp or rough parts
YES
NO
N/A
Stair tread & riser free of chips, cracks, & uneveness
YES
NO
N/A
Stair treads & ramps slip resistent
YES
NO
N/A
Stairways & ramps well lighted
YES
NO
N/A
Do stairs have at least 6½' overhead clearance?
YES
NO
N/A
Elevators/lifts inspected as required by local law?
YES
NO
N/A
Floor & Wall Openings
Large glass areas subject to human impact well marked
YES
NO
N/A
Floor opening provided with guard rail or cover
YES
NO
N/A
Grate type covers designed not to affect foot traffic
YES
NO
N/A
Safe floors - Non Skid
YES
NO
N/A
Exiting & Egress
Emergency lighting provided in corridors & stairways
YES
NO
N/A
All exits marked & properly illuminated
YES
NO
N/A
All doors, passages, & stairs that aren't exits properly marked
YES
NO
N/A
All exits & passageways free of obstructions
YES
NO
N/A
There are at least 2 means of egress provided from upper floors
YES
NO
N/A
Exit Doors
All exit doors opening the direction of exit
YES
NO
N/A
Cold storage room doors provided with inside release
YES
NO
N/A
Doors opening into street provided with warnings or barriers to prevent stepping into path of vehicles
YES
NO
N/A
Doors opening into street provided with warnings or barriers to prevent stepping into path of vehicles
YES
NO
N/A
Storage Areas
Storage areas clean, dry, & free of refuse
YES
NO
N/A
Entrance to area lock when unattended
YES
NO
N/A
Flammables & combustibles stored away from heating devices & open flames
YES
NO
N/A
Trash & debris in metal covered containers & regularly removed
YES
NO
N/A
Emergency & First Aid
Emergency numbers posted at each phone
YES
NO
N/A
Employees instructed on reporting emergencies
YES
NO
N/A
Employees instructed on use of portable exstinguishers
YES
NO
N/A
First aid kits clean & fully stocked
YES
NO
N/A
Outdoor Fixtures & Playgrounds
Benches & tables free of cracks, slivers, & broken parts
YES
NO
N/A
Water fountain & taps in good repair without broken parts
YES
NO
N/A
BBQ free of sharp edges & have no missing parts
YES
NO
N/A
Playground equipment clean & in good repair
YES
NO
N/A
Swimming Pool
Appropriate caution signs posted
YES
NO
N/A
Proper enclosure to prevent falling into pool or access to children
YES
NO
N/A
Glass cups & plates not allowed in pool area
YES
NO
N/A
Remove diving board
YES
NO
N/A
Certified Lifeguard on duty when pool is open
YES
NO
N/A
Kitchen, Bar, & Restaurant
Metal container with cover provided for greasy rags
YES
NO
N/A
Knives stored in holders when not in use
YES
NO
N/A
Electrical cords & plugs of appliances in good condition
YES
NO
N/A
Food processing equipment properly guarded & in good repair
YES
NO
N/A
Glass stored away from open ice storage & food storage areas
YES
NO
N/A
Gas & beverage concentrate cylinders secured against tipping
YES
NO
N/A
Drain & other floor openings covered
YES
NO
N/A
Non-skid mats provided in line of sinks, ice machine, range, etc...
YES
NO
N/A
Are mats clean, & without grease or other build-up?
YES
NO
N/A
Foods stored off the floor
YES
NO
N/A
Food covered & stored in refrigerator when not being prepared. Proper temperatures being maintained.
YES
NO
N/A
Hoods & filters over range clean & not laden with grease
YES
NO
N/A
Suppression system in hood(s) inspected in the last 6 months
YES
NO
N/A
Chairs, stools, & tables in good condition
YES
NO
N/A
Board of Health certified server and inspection
YES
NO
N/A
Restrooms, Locker Rooms, Showers, & Saunas
Maintained dry, clean, sanitized & free of debris
YES
NO
N/A
Well illuminated, burned out bulbs promptly replaced
YES
NO
N/A
Hand towel, soap, toilet paper, & sink fixtures secured & in good repair
YES
NO
N/A
Toilet stall & locker walls, doors, & latches secure & in good repair
YES
NO
N/A
Walking surfaces of non-skid materials
YES
NO
N/A
Appropriate warning signs posted, e.g. "CAUTION-SLIPPERY WHEN WET" / "DO NOT USE FOR MORE THAN 15 MINUTES", etc...
YES
NO
N/A
Personal Protection Devices
Appropriate protective devices provided for chemicals on site such as respirators for gas leaks, gloves, goggles, etc...
YES
NO
N/A
Compliance with "Right to Know" requirements where applicable
YES
NO
N/A
Protection Devices
All automatic fire sprinkler system supply valves wide open
YES
NO
N/A
All heat/smoke detection systems in operation
YES
NO
N/A
Portable extinguishers serviced in last 12 months & tagged
YES
NO
N/A
Pressures in appropriate range on gauge
YES
NO
N/A
Extinguishers properly mounted at stations
YES
NO
N/A
Extinguishers recharged as required
YES
NO
N/A
All sleeping quarters provided with smoke detectors unless provided with automatic sprinklers and carbon monoxide detectors
YES
NO
N/A
Optional Notes
Add anything you deem prudent here in this field
