FOOD ESTABLISHMENT PLAN REVIEW APPLICATION Ogle County Health Department 907 West Pines Road Oregon, Illinois 61061 815-732-7330 1
OGLE COUNTY HEALTH DEPARTMENT FOOD ESTABLISHMENT PLAN REVIEW APPLICATION TYPE: NEW REMODEL CHANGE OF OWNERSHIP Name of Establishment: Category (Circle one): School Retail Recreational Restaurant Other Address: Phone: Email Name of Owner: Mailing Address: Owner Phone: Applicant=s Name: Mailing Address: Applicant Phone: Applicant Position (ie. owner, architect, manager): I have submitted plans/applications to the following authorities, as applicable, on the following dates: / / Zoning / / City or Municipality / / Police / / Fire / / Plumbing / / Other / / Electric Hours of Operation: Sun. Tues. Thurs. Sat. Mon. Wed. Fri. Projected start date for project: Projected completion date for project: Type of service: Sit Down Meals Take Out Caterer 2
Mobile Vendor Please enclose the following documents: Proposed menu (including seasonal, off-site and banquet menus) Manufacturer specification sheets for each piece of equipment Site plan showing location of business in building, location of building on site, including streets, and location of outside equipment (dumpsters, well, etc.) Plan drawn to scale of food establishment showing location of equipment, plumbing, electrical services, and mechanical ventilation CONTENT AND FORMAT OF PLANS AND SPECIFICATIONS 1. Show accurate layout of floor plan 2. Include: proposed menu, seating capacity and projected daily meal volume 3. Show location of all food equipment, clearly labeled 4. Indicate equipment for rapid cooling and hot-holding 5. Note food preparation sinks when menu dictates to prevent contamination and crosscontamination of raw and ready-to-eat foods 6. Clearly designate handwashing lavatories for each toilet fixture and in area of food preparation 7. Show room size, aisle space, space between and behind equipment, and placement on floor 8. Show extra rooms; such as, storage rooms, garbage rooms, toilets, and basements 9. Show entrances, exits, loading and unloading areas 10. Specifications of equipment 11. Source of water supply and method of sewage disposal 12. Show flow patterns of: - food (receiving, storage, preparation, service) - food & dishes (portioning, transport, service) - dishes (clean, soiled, storage) - trash (service area, storage) 13. Show mop sink and facilities for cleaning supplies 14. Location of storage for toxic chemicals 15. Location of dressing rooms, locker areas, employee break areas, coat racks 3
FOOD PREPARATION REVIEW Check categories of Potentially Hazardous Food=s (PHF=s) to be handled, prepared and served. CATEGORY YES NO 1. Thin meats, poultry, fish, eggs (Hamburger, sliced meats, fillets) 2. Thick meats, whole poultry (Roast beef, whole turkey, chickens, hams) 3. Cold, processed foods (Salads, sandwiches, vegetables) 4. Hot, processed foods (Soups, stews, rice/noodles, gravy, casseroles) 5. Bakery Goods (Pies, custards, cream fillings, toppings) 6. Other A generic HACCP plan for each category of food may be available from the regulatory authority for reference. PLEASE CIRCLE/ANSWER THE FOLLOWING QUESTIONS FOOD SUPPLIES Are all food supplies from inspected and approved sources? COLD STORAGE 1. Is adequate and approved freezer and refrigeration available to store frozen foods frozen, and refrigerated foods at 41 F (5 C) and below? 2. Will raw meats, poultry and seafood be stored in the same refrigerators and freezers with ready-to-eat foods? If yes, how will cross-contamination be prevented? 4
3. Does each refrigerator/freezer have a thermometer? 4. Is there a bulk ice machine available? THAWING FROZEN POTENTIALLY HAZARDOUS FOOD Please indicate by checking the appropriate boxes how frozen PHF=s in each category will be thawed. More than one method may apply. METHOD THICK, FROZEN FOOD ( 1") THIN, FROZEN FOOD ( 1") Refrigeration Running water less than 70 Microwave (as part of cooking process) Cooked from frozen state COOKING 1. Will food product thermometers be used to measure final cooking/reheating temperatures of PHF=s? What type of device will be used? 2. List types of cooking equipment: HOT/COLD HOLDING 1. How will hot PHF=s be maintained at 135 degrees F (60 degrees C) or above during holding for service? 2. How will cold PHF=s be maintained at 41 degrees F (5 degrees C) or below during holding for service? COOLING Please indicate by checking the appropriate boxes how PHF=s will be cooled to 41 F (5 C) within 6 hours. (135 to 70 in 2 hours, 70 to 41 in 4 hours Cooling Method THICK MEATS THIN MEATS/GRAVY Shallow Pans THIN SOUPS/GRAVY THICK SOUPS RICE/NOODLES 5
Ice Baths Reduce Volume Rapid Chilling REHEATING 1. How will PHF=s that are cooked, cooled and reheated for hot holding be reheated so that all parts of the food reach a temperature of at least 165 degrees for 15 seconds. 2. How will reheating food to 165 degrees for hot holding be done rapidly and within 2 hours? PREPARATION 1. Please list categories of foods prepared more than 12 hours in advance of service. 2. Will food employees be trained in good food sanitation practices? Method of training: Name of employees and dates of completion: 3. Will disposable gloves and/or utensils and/or food grade paper be used to prevent handling of ready-to-eat foods? 4. Is there a policy to excluded or restrict food workers who are sick or have infected cuts or lesions? Please describe 5. How will cooking equipment, cutting boards, counter tops and other food surfaces which cannot be submerged in sinks or put through a dishwasher be sanitized? Chemical type Concentration Test Kit 6. Will ingredients for cold ready-to-eat foods, such as, tuna, mayonnaise and eggs for sandwiches 6
be pre-chilled before being mixed and/or assembled? If not, how will ready-to-eat foods be cooled to 41 degrees? 7. Will all produce be washed on site prior to use? Where will it be washed? 8. Describe the procedure used for minimizing the length of time PHF=s will be kept in the temperature danger zone (41 F to 135 F) during preparation. 9. Provide a HACCP (Hazard Analysis Critical Control Points) plan for specialized processing methods such as vacuum packaged food items prepared onsite or otherwise required by regulatory authority. 10. Will the facility be serving food to a highly susceptible population? If yes, how will the temperature of foods be maintained while being transferred between the kitchen and service area? INSECT & RODENT CONTROL Please circle appropriate answer. 1. Will all outside doors be self-closing and rodent proof? 2. Are screen doors provided on all outside entrances left open to outside? 3. Do all openable windows have screens? 4. Do you have electrocution devices? 5. Will all pipes & electrical conduit chases be sealed: ventilation systems exhaust and intakes protected? 6. Is area around building clear of unnecessary brush, litter, boxes and other harborage? 7. Will air curtains be used? If yes, where GARBAGE & REFUSE 8. Do all containers have lids? 9. Will refuse be stored inside? 10. Is there an area designated for garbage can or floor mat cleaning? 11. Will a dumpster be used? 12. Will a compactor be used? 13. Will garbage cans be stored outside? 14. Describe surface and location where dumpsters/compactors are to be stored. 7
15. Describe location of grease storage receptacle. 16. Describe location for storing recycled containers. 17. Is there any area to store returnable damaged goods? WATER SUPPLY 18. Is water supply public ( ) or private ( )? 19. If private, has the source been approved? Pending 20. Is ice made on premises ( ) or purchased commercially ( )? If made on premises, are specifications for ice machine provided? SEWAGE DISPOSAL 21. Is building connected to a municipal sewer? 22. If no, is private system approved? 23. Are grease traps provided? If so,where? DRESSING ROOMS 24. Are dressing rooms provided? 25. Describe storage facilities for employee=s personal belongings. GENERAL 26. Are insecticides/rodenticides stored separately from cleaning & sanitizing agents? 27. Are all toxics for use on the premise or for retail sale stored away from food preparation and storage area? 28. Are all containers of toxics including sanitizing spray bottles clearly labeled? 29. Is lighting sufficient for safe food preparation and serving? 30. Will linens be laundered onsite? If yes,what and where? If no, how will linens be laundered? 31. Is a laundry dryer available? 32. Location of clean linens 33. Location of dirty linens 34. Are containers constructed of safe materials to store bulk food products? 35. Indicate where exhaust hoods will be installed 8
SINKS/DISHWASHING FACILITIES 36. Is a mop sink available? 37. If menu dictates, is a food preparation sink present? 38. Will sinks or dishwasher be used for warewashing? 39. Type of sanitation used with dishwasher: Hot water Booster heater Chemicals Is ventilation provided? 40. Do dish washing machines have templates with operating instructions? 41. Are temperature/pressure gauges on dish washing machines working? 42. Is hot water generator sufficient for needs of establishment? 43. Does the largest pot/pan fit into each sink compartment? If no, what is cleaning procedure 44. Are there drain boards on both ends of the sink? 45. What type of sanitizer is used? Chlorine Iodine Quaternary ammonium Hot water Other 46. Are test papers or kits available for checking sanitizer concentration? 47. How is the ventilation hood system cleaned? HANDWASHING/TOILET FACILITIES 48. Is there a handwashing sink, convenient for staff to use, for food preparation and warewashing areas? 49. Do all handwashing sinks, including those in the restrooms, have a mixing valve or combination faucet? Yes /No 50. Do self-closing metering faucets provide a flow of water for at least 15 seconds without the need to reactivate the faucet? 51. Is hand cleanser available at all handwashing sinks? 52. Are hand drying facilities available at all hand washing sinks? 53. Are covered waste receptacles available in each restroom? 54. Is hot and cold running water under pressure available at each handwashing sink? 9
55. Are all toilet room doors self-closing? 56. Are all toilet rooms equipped with adequate ventilation? 57. If required, is a handwashing sign posted in each restroom? DRY GOODS STORAGE 58. Is the projected frequency of deliveries specified? 59. Is appropriate dry goods storage space provided for based upon menu, meals, and frequency of deliveries? 60. How will dry goods be stored off the floor? WATER SUPPLY 61. Is there a water treatment device? Yes/No If so, how will it be inspected and treated? 62. How are backflow prevention devices inspected and serviced? ****************************************************************************** STATEMENT I hereby certify that the above information is correct, and I fully understand that any deviation from the above without prior permission from the Ogle County Health Department may nullify final approval. SIGNATURE(S) Owner(s) or responsible representative DATE Approval of these plans and specifications by the Ogle County Health Department does not indicate compliance with any other code, law or regulation that may be required-federal, state or local. It further does not constitute endorsement or acceptance of the completed establishment. A preopening inspection of the establishment with equipment in place & operational will be necessary to determine if it complies with local and state laws governing food service establishments. Updated: 12/12/2012 U:\LML\FORMS\foodapp.doc 10