Marshall County Health Department Food Service Establishment Plan Review Form

Transcription

1 Sectin I Infrmatin: Marshall Cunty Health Department Fd Service Establishment Plan Review Frm A full set f plans, the equipment list (including the methd f equipment installatin), the menu, and the plan review must be submitted. Any changes in plans r n this frm must receive advance apprval. Establishment Name: Owner: Phne: FAX: Cell Phne: Prject Cntact: Phne: FAX: Cell Phne: Architect: Phne: FAX: Cntractr: Phne: FAX: Equipment Supplier: Phne: FAX: Signature f Owner r Authrized Agent: Date: Marshall Cunty Health Department th St. PO Bx 156 Lacn, IL / Office Use Only: Type f Menu: Catering:... Yes... N Seating Capacity: Dry Fd Strage Area: Sq. Ft. Kitchen Area: Sq. Ft. Refrigeratin Area: Sq. Ft.

2 Sectin II Refrigeratin: (please mark yur respnse t each belw) Yes N N/A 1. Are yur walk-in clers and walk-in freezers accessible frm inside the establishment? Have yu specified a refrigerated meat cutting rm fr trimming raw meats? Have yu prvided an ice machine? Are yu installing a buffet r salad bar? If YES, Is the buttet r salad bar mechanically refrigerated? Have yu designated refrigeratin space fr: Cling large quantities f fd? Marinating fd prduct? Separating meat, pultry, fish, and ther fd items? Have yu made prvisins fr refrigeratin and freezer strage invlving the six majr areas? Shrt-term refrigeratin (reach-in), explain: Lng-term refrigeratin which includes frzen prducts and deliveries (walk-ins), explain: Cling prduct (blast chiller, additinal walk-in cler) space, explain: Assembly r preparatin f prduct, explain: Display f prduct, explain: Prduct fr custmer service, explain: Sectin III Strage Facility: Specify the type f shelving unit that will be prvided in the fllwing areas Dry Strage: Manufacturer: Mdel Number: Walk-in Freezers: Manufacturer: Mdel Number: Walk-in Cler(s): Manufacturer: Mdel Number: Beer Cler: Manufacturer: Mdel Number: Kitchen Utensils: Manufacturer: Mdel Number: Sectin III Strage Facility cntinued n next page.

3 Sectin III Strage Facility (cntinued) Strage Calculatins: Ttal kitchen area Sq. Ft. (wall t wall dimensins) Kitchen area X 0.25 = Required dry fd strage Ttal dry strage area Sq. Ft. (wall t wall dimensins) Ttal bar area Sq. Ft. (wall t wall dimensins) Bar area X 0.1 = Required bar strage Ttal Bar strage area Sq. Ft. (wall t wall dimensins) 1. Have yu included the strage areas fr fd, utensils and beverages? Have yu prvided a strage area fr yur cleaning supplies separate frm the fd and fd service peratins? Have yu specified a heavy-duty-mp-rack capable f hlding wet mps abve the mp basin? Are yu using firewd as a fuel surce fr cking equipment? If YES, specify the lcatin f firewd strage: Reminder: Firewd must be stred separate frm the fd strage and fd service peratins. Additinal measures must be taken t prevent rdent and insect infestatins. Sectin IV Emplyee Areas, Restrms, and Handwashing Sinks: Emplyee Areas: 1. Indicate the ttal number f emplyees: 2. Have yu shwn the lcatin fr persnal belngings strage n the plans?... Yes... N... N/A 3. Have yu prvided fr each emplyee? Cat hks Lckers Other Reminder: Break area, ffice area, dressing rms an persnal belnging strage areas cannt be lcated in areas f fd and/r utensil strage, preparatin, fd service r dish areas. Restrms: 1. Have yu prvided the number f tilets/facilities as required by the Illinis State Plumbing Cde and verified with the lcal Sanitary District r lcal Building Department? Can the public access the restrms withut ging thrugh kitchen, strage area, r utensil-washing area? Are the rms mechanically vented t the utside? Have yu prvided garbage cntainers with lids fr sanitary items and als diapers? Sectin IV Emplyee Areas, Restrms, and Handwashing Sinks cntinued n next page.

4 Sectin IV Emplyee Areas, Restrms, and Hand Washing Sinks (cntinued) Hand Washing Sinks: 1. Hw many hand washing sinks (excluding bathrm lavatries) are yu prviding? 2. Indicate the lcatins f the hand sinks: 3. Are all hand washing sinks supplied with dispensed sap?... Yes... N 4. Are all hand washing sinks supplied with dispensed sap?... Yes... N Sectin VI Plumbing: 1. Type f water supply:... Public... Private 2. Public Sewer will be prvided?... Yes... N... N/A 3. Is grease interceptr required by lcal Building Department r lcal Sanitary District?... Yes... N... N/A If YES, hw will it be installed... Outdr... Indr 4. Type f Janitrial Sink? 5. Will yu install a garbage grinder?... Yes... N... N/A Ptable Water Backflw prtectin is required n the fllwing pieces f equipment Please mark the pieces f equipment that apply t yur facility: Chemical Mixing System Tilet(s) Urinal(s) Dishwashing Machine(s) Garbage Grinder(s) Carbnatr(s) Water Faucets with Hse Attachments Pre-rinse Sprayer(s) Other: Indirect Opensite Waste Cnnectins are required n the fllwing pieces f equipment Please mark the pieces f equipment that apply t yur facility: Deli Cler Clean Out Drain(s) Refrigeratr/Freezer Cndensatin Line(s) Ice Maker/Ice Bin(s) Fd Preparatin Sink(s) Dipper Wells(s) Salad Bar(s) Steam Kettle Walk-in Refrigeratr Drain(s) Steam Tables(s) Three Cmpartment Sink Fd Service Three Cmpartment Sink Bar Service Dishwashing Machine(s) Sda Dispenser(s) Buffet Line Other: Sectin VII Sanitizing Equipment and Facilities: Ht Water System: 1. Specify the water heater strage capacity in gallns: 2. Specify the water heater recver rate: GPA F, if mechanical (chemical r ht water) sanitizing machine is being prpsed. Sectin VII Sanitizing Equipment and Facilities cntinued n next page.

5 Sectin VII Sanitizing Equipment and Facilities (cntinued) Manual Utensil Washing: 1. Have yu specifiec a standard fd service three-cmpartment sink with tw integral drain bards? Is yur largest item able t be submerged int the three-cmpartment sink? D yu have a clean-in-place prcedure fr statinary equipment? Have yu prvided additinal space fr the strage f clean utensils, glassware, etc.? If YES, where? Mechanical Utensil Washing: (If nt applicable, prceed t next sectin) 1. Are yu installing a dishwashing machine? If YES, Manufacturer: Dishwashing machine demand f rinse water: Mdel Number: 20 PSI flw pressure 2. Have yu included a siled-dish table? Have yu included a pre-rinse sink? Did yu prvide mechanical ventilatin at dishwashing machine? Have yu included a clean-dish table? Where is the lcatin fr yur clean utensil and dish strage? Chemical Sanitizing Machine: (If nt applicable, prceed t next sectin) 1. Are yu prviding a chemical sanitizing machine? Have yu prvided an audible and visual warning indicatr n the sanitizer dispenser? Have yu prvided a lcatin fr air drying utensils after being sanizited? If YES, where? Ht Water Sanitizing Machine: (If nt applicable, prceed t next sectin) 1. Are yu installing a ht water sanitizing machine? If YES, Manufacturer (Bster Heater): Bster Heater recvery rate: Mdel Number: GPH 2. Have yu prvided fr a temperature guage befre bster heater?......

6 Sectin VIII Lighting: (please mark yur respnse t each belw) Yes N N/A 1. Are yur fd preparatin and utensil washing areas lighted accrding t specificatins? Are yur fd strage rms lighted accrding t specificatins? Are yur restrms lit accrding t specificatins? Have yu prvided dimmer switches r n/ff switches in bar areas fr clean-up purpses? Have yu supplied flurescent lights with vapr-prf fixtures r additinal incandescent light kits fr yur walk-in refrigeratr and freezer units? Are all f yur light fixtures ver fd preparatin, display, service, strage, and utensil-washing areas shielded with explsin tubes and end caps, shatterprf lenses, r shatterprf bulbs? Sectin IX Laundry Facility: (If nt applicable, prceed t next sectin) 1. D yu have a washer? If YES, a dryer is als required. 2. Is yur laundry facility separated by a dr frm the fd service peratin? Is shelving prvided t keep clean linens stred separately frm siled linens? Sectin X Insect and Rdent Cntrl: (please mark yur respnse t each belw) Yes N N/A The type f prtectin prvided fr yur building: 1. Are all the vents cvered with screening? Are all the vids and gaps arund utility lines, pipes, etc. sealed? Are penable windws prperly sealed? Is the garbage area mre than 20 feet frm the facility s dr(s)? Did yu specify an air curtain? If YES, Manufacturer: Mdel Number: D yu have: Drive-thrugh Windw Carry Out Windw Walk-up Windw(s) The type f prtectin prvided fr yur windws: Spring laded bump pad Electric eye pener Air curtain Self-clsing screen/windw Fly fan Reminder: A cmbinatin is strngly recmmended. Sectin X Insect and Rdent Cntrl cntinued n next page.

7 Sectin X Insect and Rdent Cntrl (cntinued) The type f prtectin prvided fr yur delivery and entrance drs: Self-clsing device Threshld and threshld sweep 1. If yu have a garage-type dr, have yu prvided an air curtain? If YES, Manufacturer: Mdel Number: Other: Reminder: Daylight is NOT t be bserved arund the dr. Sectin XI Garbage and Refuse Dispsal: (please mark yur respnse t each belw) 1. The type f dispsal prvided: Dumpster(s) Cmpactr Exterir grease cntainer(s) Interir self-cntained system fr grease Recycling cntianer(s) 2. The type f surface fr strage f dispsal cntainers: Cncrete pad Machine-laid asphalt 3. Will an enclsure be installed fr the strage f cntainers?... Yes... N... N/A If YES, Describe: