TANEY COUNTY HEALTH DEPARTMENT FOOD ESTABLISHMENT PLAN REVIEW APPLICATION 320 Rinehart Rd., Branson, MO EXT FAX

Transcription

1 TANEY COUNTY HEALTH DEPARTMENT FOOD ESTABLISHMENT PLAN REVIEW APPLICATION 320 Rinehart Rd., Bransn, MO EXT FAX Applicatin must be cmpleted and submitted t TCHD a minimum f 10 days prir t pening. Establishment Name: FOR OFFICE USE ONLY High Medium Lw City f Bransn Cunty City f Hllister BUSINESS CONTACT INFORMATION Categry Restaurant Grcery Cncessin Other Establishment Phne: Establishment Fax: Date: Establishment Owner Name: Owner Phne: Establishment Address: Owner Owner Fax: Billing Address: Plans/applicatins have been submitted t the fllwing authrities n the fllwing dates: City f Bransn Cunty Planning & Zning Culd this ptentially be a seasnal establishment? City f Hllister Cunty Fire District Yes N Seasnal Dates: t Number f seats: Number f staff: (Max per shift) Ttal square feet f facility: Number f flrs n which peratins are cnducted: Maximum meals t be served: Breakfast (apprximate number) Lunch Dinner Type f service: Sit dwn meals Take ut Caterer Prpsed menu Other Hurs f Operatin: New Cnstructin Prpsed pening date: Re-pening/Remdel Lcatin Change In additin t cmpleting this applicatin it is necessary t cntact the City f Bransn t btain a business license. If yur establishment is in the cunty, please cntact yur fire department regarding a fire inspectin. Western: Central: Mnday am/pm t am/pm Tuesday am/pm t am/pm Wednesday am/pm t am/pm Thursday am/pm t am/pm Friday am/pm t am/pm Saturday am/pm t am/pm Sunday am/pm t am/pm PLEASE ENCLOSE THE FOLLOWING DOCUMENTS: Manufacturer specificatin sheets fr each piece f equipment shwn n the plan A HACCP plan fr specialized prcessing methds such as vacuum packaged fd items prepared n-site r therwise required by the regulatry authrity Site plan shwing lcatin f business in building: lcatin f building n site including alleys, streets, and lcatin f any utside equipment (dumpster, well, septic system-if applicable) Plan drawn t scale f fd establishment shwing lcatin f equipment, plumbing, electrical services, and mechanical ventilatin Equipment schedule Page 1

2 FOOD PREPARATION REVIEW Check categries f Ptentially Hazardus Fds (PHF S) t be handled, prepared, and served. Categry Raw meats (hamburger, chicken, seafd) Pre-cked ptentially hazardus fds Cut leafy greens, cut tmats, raw garlic in il mixtures Unpastuerized shell eggs Smked, cured, r special prcess fds* Other *Submit a HACCP plan fr special prcess fds. Special Prcesses Requiring a HACCP Plan: Yes HACCP PLAN REQUIREMENTS HACCP: A written dcument that delineates the frmal prcedures fr fllwing the HAZARD Analysis and CRITICAL CONTROL POINT principles develped by The Natinal Advisry Cmmittee n Micrbilgical Criteria fr Fds. N Reduced Oxygen Packaging (ROP) The term ROP can be used t describe any packaging prcedure that results in a reduced xygen level in a sealed package. The term is ften used because it is an inclusive term and can include packaging ptins such as: Ck-chill, Cntrlled Atmsphere Packaging (CAP), Mdified Atmsphere Packaging (MAP), Sus Vide, Vacuum Packaging Other Fd Manufacturing/Prcessing Operatins Smking and Curing (fr preservatin nt fr flavring) Fermentatin and Dehydratin Raw juicing fr Retail sale If yu are unsure if yu have a special prcess that wuld require a HACCP Plan r have questins, please cntact an inspectr at the health department fr mre infrmatin. Are all fd supplies frm an apprved surce? Yes N What are the prjected frequencies f deliveries fr: Frzen fds Refrigerated fds Dry gds Hw will fd and single use items be stred ff the flr: FOOD SUPPLIES COLD STORAGE Will raw meats, pultry, and seafd be stred in the same refrigeratrs and freezers with cked/ready-t-eat fd? Yes N If yes, hw will crss-cntaminatin be prevented? Des each refrigeratr/freezer have a thermmeter? Yes N Page 2

3 THAWING FROZEN POTENTIALLY HAZARDOUS FOOD Please indicate by checking the apprpriate bxes hw frzen Ptentially Hazardus Fd (PHF s) in each categry will be thawed. Mre than ne methd may apply. Thawing Methd Refrigeratin Thick Frzen Fds (mre than an inch) Thin Frzen Fds (apprx. ne inch r less) Running water less than 70 F (21 C Micrwave (as part f cking prcess) Cked frm frzen state Other (describe) COOKING What type f temperature measuring devices will be available: List types f cking equipment: HOT/COLD HOLDING Hw will ht PHF s be maintained at 135 F (60 C) r abve and cld PHF s be maintained at 41 F (5 C) r belw during hlding service? Indicate type and number f ht hlding units: COOLING Please indicate by checking the apprpriate bxes hw PHF s will be cled t 41 F (5 C) within 6 hurs (135 F t 70 F in 2 hurs and 135 F t 41 F in 6 hurs). Cling Methd Thick Meats Thin Meats Thin Sups/Gravy Thick Sups/Gravy Rice/Ndles Shallw pans Ice Bath Reduce vlume/size Rapid chill Other (describe) Page 3

4 REHEATING Hw will PHF s that are cked, cled, and reheated fr ht hlding be reheated s that all parts f the fd reach a temperature f at least 165 F fr 15 secnds within 2 hurs. Indicate type and number f units used fr reheating fds: PREPARATION Please indicate all emplyees that have dcumented fd safety training: Ttal number f emplyees: Number f certified fd managers: Number f certified fd handlers Will dispsable glves be available fr handling f ready-t-eat fds? Yes N Is there a written plicy t exclude r restrict fd wrkers wh are sick r have infected cuts and lesins? Yes N Hw will cking equipment, cutting bards, cunter tps, and ther fd cntact surfaces which cannt be submerged in sinks r put thrugh a dishwasher be sanitized? A test kit fr the sanitizer must be readily available at all times. Chemical Type: Chlrine Idine Quaternary Ammnium Ht Water Other: Will ingredients fr cld ready-t-eat fds such as tuna, maynnaise, and eggs fr salads and sandwiches be pre-chilled befre being mixed and/r assembled? Yes N If nt, hw will ready-t-eat fds be cled t 41 F? Will all prduce be washed n-site prir t use? Yes N Is there a planned lcatin used fr washing prduce? Yes N Please describe prduce washing area: Describe the prcedure fr minimizing the length f time PHF s will be kept in the temperature danger zne (41 F-135 F) during preparatin: Will the facility be serving fd t a *highly susceptible ppulatin? Yes N If yes, hw will the temperature f fds be maintained while being transferred between the kitchen and service area? * Highly Susceptible Ppulatin: Persns wh are mre likely than ther peple in the general ppulatin t experience fdbrne disease because they are: (1) Immuncmprmised; preschl age children, r lder adults; and (2) Obtaining FOOD at a facility that prvides services such as custdial care, health care, r assisted living, such as a child r adult day care center, kidney dialysis center, hspital r nursing hme, r nutritinal r scializatin services such as a senir center. Page 4

5 FINISH SCHEDULE Applicant must indicate which materials (quarry tile, stainless steel, 4 plastic cved mlding, etc.) will be used in the fllwing areas: AREA FLOOR COVING WALLS CEILING Kitchen Bar Fd Strage Other Strage Tilet Rms Garbage & Refuse Strage Mp Service Basin Area Ware Washing Area Walk-in Refrigeratrs & Freezers INSECT AND RODENT CONTROL Will all utside drs be self-clsing and rdent prf? Yes N NA Are screen drs prvided n all entrances left pen t the utside? Yes N NA D all perable windws have a minimum #16 mesh screening? Yes N NA Is the placement f electrcutin devices identified n the plan? Yes N NA Will all pipes and electrical cnduit chases be sealed and ventilatin systems, exhaust, and intakes prtected? Yes N NA Is area arund the building clear f unnecessary brush, litter, bxes, and ther harbrage? Yes N NA Will air curtains be used? Yes N NA Will facility have mnthly prfessinal pest cntrl? Yes N GARBAGE AND REFUSE Inside D all cntainers have lids? Yes N Will refuse be stred inside? Yes N If s, where? Is there an area designated fr garbage can r flr mat cleaning? Yes N NA Outside Will a dumpster be used? Yes N NA Number: Size: Stred n Nn-prus Surface? Yes N Frequency f Pickup: Cntractr: Will a grease bin be used? Yes N NA Frequency f Pickup: Cntractr: Page 5

6 PLUMBING CONNECTIONS Are flr drains prvided and easily cleanable? Yes N NA If s, indicate lcatin: Please mark all that apply n table belw Plumbing Fixture Air Gap Air Break Integral Trap* P Trap* Vacuum Breaker Cndensate Pump Dishwasher Garbage Grinder Ice Machines Ice Strage Bin Sinks 3 Cmpartment 2 Cmpartment 1 Cmpartment Steam Tables Dipper Wells Refrigeratin Cndensate/ Drain Lines Beverage Dispenser w/carbnatr *Trap: a fitting r device which prvides a liquid seal t prevent the emissin f sewer gases withut materially affecting the flw f sewage r waste water thrugh it. An integral trap is ne that is built directly int the fixture, e.g., a tilet fixture. A P trap is a fixture trap that prvides a liquid seal in the shape f the letter P. Full S traps are prhibited. Page 6

7 WATER SUPPLY Is water supply public r private? Public Private If private, has surce been apprved? Yes N Pending What is the capacity f the water heater? Will water heater meet peak water demand? Yes N Is ice made n premises r purchased cmmercially? Made n Premises Purchased Cmmercially Describe prvisin fr ice scp strage: SEWAGE DISPOSAL Is building cnnected t a municipal sewer? Yes N If n, is private dispsal system apprved? Yes N Pending Are grease traps prvided? Yes N If s, where? Prvide schedule fr cleaning and maintenance: GENERAL Describe strage facilities fr emplyees persnal belngings (i.e., purse, cats, bts, etc.): Are all chemicals fr use n the premise r fr retail sale, stred away frm fd preparatin and strage areas? Yes N Will linens be laundered n site? Yes N If yes, what will be laundered and where? If n, hw will linens be cleaned? Lcatin f clean linen strage: Lcatin f dirty linen strage: Are bulk fd cntainers cnstructed f fd grade materials? Yes N Indicate type: Indicate all areas where exhaust hds are installed EXHAUST HOODS Lcatin Hd Type Fire Prtectin Air Capacity CFM Air Makeup CFM Cleaning Frequency Page 7

8 Is a mp sink present? Yes N SINKS If n, please describe facility fr cleaning mps and ther equipment: If the menu dictates, is a fd preparatin sink present? Yes N Will sinks r a dishwasher be used fr ware washing? Dishwasher Three cmpartment sink Tw cmpartment sink* *Health Department must apprve befre Installatin r use. DISHWASHING FACILITIES Type f sanitizatin used: Ht Water (prvide temp): Chemical Type: Chlrine Idine Quaternary Ammnium Other Is ventilatin prvided? Yes N D all dish machines have templates with perating instructins? Yes N D all dish machines have temperature/pressure gauges as required that are accurately wrking? Yes N Are there drain bards n bth ends f the pt sink? Yes N Are test papers and/r kits available fr checking sanitizer cncentratin? Yes N HANDWASHING/TOILET FACILITIES Is there a handwashing sink in each fd preparatin and warewashing area? Yes N D all handwashing sinks have a minimum water temperature f 100F? Yes N D self-clsing metering faucets prvide a flw f water fr at least 15 secnds withut the need t reactivate the faucet? Yes N Is hand cleanser available at all handwashing sinks? Yes N Are hand drying facilities (paper twels, air blwers, etc.) available at all handwashing sinks? Yes N Are cvered waste receptacles available in each restrm? Yes N Are all tilet rms drs self-clsing? Yes N Are all tilet rms equipped with adequate ventilatin? Yes N Is a handwashing sign psted in each emplyee restrm and at all handwashing sinks? Yes N I hereby certify that the abve infrmatin is crrect, and I fully understand that any deviatin frm the abve withut prir permissin frm this Health Regulatry Office may nullify final apprval. Signature(s): Date: Date: Owner(s) r Respnsible Representative(s) Apprval f these plans and specificatins by this Regulatry Authrity des nt indicate cmpliance with any ther cde, law, r regulatin that may be required-federal, state, r lcal. It further des nt cnstitute endrsement r acceptance f the cmpleted establishment (structure r equipment). A pre-pening inspectin f the establishment with equipment in place and peratinal will be necessary t determine if it cmplies with the lcal and state laws gverning fd service establishments. Apprved: Date: Inspectr Signature Updated 04/2018 Page 8