Value Added Kitchen Entry and Exit Form

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Please complete this form at the beginning and end of every use of the facility.

Name *

Date *

YYYY

Time *

Time

Is this an Entry or Exit form? *

Entry Form

Exit Form

All equipment is cleaned, sanitized and in its proper place?

Specifications:
1. Equipment is cleaned using Dawn in the first sink, rinsed in the same sink.
2. Equipment is completely submerged in sanitized solution in the second sink. Sanitized solution = 1 tablespoon of bleach/gallon of water.
3. Equipment is air dried.

4. Electrical equipment (food processors, mixer) are cleaned, sanitized and returned to their proper place under the counter.

Yes

Counter tops are cleaned and sanitized?
Specifications:
1. Use the 2 separate and premixed spray bottles to clean and sanitize.
2. Use a clean paper towel for each. *

Yes

Shelves below counter tops are cleaned and organized? *

Yes

Sinks, including the hand sink, are cleaned, sanitized, dried with a paper towel? Please pour boiling water down each sink to help eliminate fruit flies. *

Yes

Stove and microwave are cleaned, sanitized? This means the sides of these pieces of equipment are also cleaned. *

Yes

The outside and inside of the refrigerator is wiped down? This includes the sides and front of the refrigerator. *

Yes

Walls behind and around workspaces and behind the stove are cleaned? *

Yes

Kitchen garbage cans are emptied and cleaned? *

Yes

Floors in kitchen are swept and mopped?

Specifications:

1. Sweep.

2. Use the mop bucket right outside the VAK door. Fill with warm water in the kitchen.

3. Mop solution: warm water + tablespoon of bleach

4. Be sure to also mop under the sinks, shelves, move and mop under the work tables.

4. Clean/rinse mop and mop bucket by the mop bucket sink outside and drain on the back patio through the floor grate.

5. Return mop and bucket right outside the doors to the Value Added Kitchen.

6. Turn the fan on and leave it on when you leave to help eliminate moisture.

Yes

Personal items are removed from the refrigerator and VAK? *

Yes

Additional comments *

If a User fails to leave the facility in the proper condition, the User will receive a warning. Upon a second such failure, the User shall pay a fine of $50. Upon a third such failure, this Agreement may be terminated.

If you documented in your Entry Form that equipment or areas of the kitchen were not clean when you arrived or personal items were not removed, please send a picture(s) of this and email it to jjmollet@ncsu.edu

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