Page 1 of 5 Establishment Information Name of Establishment: Business/Ownership Information Individual(s) or Corporate Name: Contact Information Name of Primary Contact: Childcare Plan Review Application PLAN REVIEW REQUIREMENTS Child Care Facility Plan Review Application must be filled out completely with fixture calculation sheet. Please indicate why a question does not apply. If food is provided by the facility please provide a menu and equipment specification sheets for all food handling equipment. Provide 2 sets of plans identifying all food handling equipment and plumbing fixtures (drawn floor plans to scale). Include a site map if facility has off-premise storage. All plans and required paperwork are required to be submitted and logged in at the Denver Building Department located at 201 W. Colfax Ave. Dept. 205. The application review cannot start until all of the above materials are provided.
Page 2 of 5 NEW REMODEL OTHER Type of Child Care Facility Child Care Facility Pre School Before/After School Care Camp Hours of Operation: Mon Tues Wed Thurs Fri Sat Sun Maximum Capacity: Children s Age Range: Number of classrooms: Number of Children per classroom: Number of Staff per classroom: (staff to child ratio) Are meals or snacks prepared on-site? ( ) YES ( ) NO Finish Schedule: Applicant must indicate which materials will be used in the following areas. FLOOR WALLS CEILING COVING Kitchen/Food Storage Bathrooms Rooms Utility Rooms Diaper Changing Areas Class Rooms Plumbing Fixtures A. Do plumbing fixtures and related connections meet the Colorado State Plumbing Code? ( ) YES ( ) NO B. Is there an indirectly drained 3 compartment sink? ( ) YES ( ) NO C. Is there an indirectly drained preparation sink? ( ) YES ( ) NO D. Is there an indirectly drained dish machine? ( ) YES ( ) NO E. Is there a mop/utility sink in the facility? ( ) YES ( ) NO Location: F. Are drinking fountains provided? ( ) YES ( ) NO If yes, list locations in facility/class room: Hot Water A. The Following are minimum temperatures for specific activities/area: Handwashing/Bathrooms: 90F to 120F
Page 3 of 5 Kitchen/Laundry/mop sink: minimum of 140F B. Is the hot water heating system sufficient for the needs of the establishment? ( )YES ( ) NO (If hot water lines exceed 50 in length, a recirculating pump is recommended.) Please provide the hot water heating system information below and complete the attached fixture calculation sheet for hot water heater sizing. Standard Tank Type Heater Make Model # KW/BTU Rating Instantaneous/Tankless Systems (Gallons Per Minute, GPM, please circle which required degree rise will be used in the flow rate column) Flow Rate (GPM) @ Storage Tank Capacity Make Model # BTU Rating 80 F or 100 F (Gallons), if applicable rise Note: For instantaneous/tankless systems when a dish machine is used, a properly sized storage tank (minimum 20 gallons), recirculation line, and an aqua stat (water thermostat) must be installed. For facilities with high temperature dishwashing machines, use 100F rise. For all other facilities, use 80F rise. If flow rate in GPM is not provided, contact the manufacturer to obtain the information. Toilet Facility A. How many toilets will be provided for each class room? # B. Describe locations other toilet facilities accessible to children: _ C. Are all toilet rooms equipped with adequate ventilation? ( ) YES ( ) NO Hand Washing A. How many hand sinks will be provided in each class room that is accessible to children?
Page 4 of 5 B. Will all bathrooms be provided with accessible hand sinks? ( ) YES ( ) NO If No, describe locations and distance of the closest hand sink to the bathroom: C. Is there a hand sink in each infant/toddler classroom adjacent to the diaper-changing table? ( ) YES ( ) NO Note: Hand sinks are required in all classrooms, food handling, and dish washing areas. Using the designated hand sinks for any other purpose other than hand washing is prohibited (i.e. using hand sink for bottle preparation, dishwashing, dumping, etc.) Laundry A. Will the facility use a washing machine? ( ) YES ( ) NO B. If yes, please provide specification sheets for machine(s). C. If yes, a dryer will also have to be installed. D. Is the dryer vented to the outside? ( ) YES ( ) NO E. Is your laundry operation physically separated from the classrooms and food preparation areas by a door or partition? ( ) YES ( ) NO F. How and where will clean linen be stored? ( ) YES ( ) NO Food Service A. Will food be prepared onsite for children? ( ) YES ( ) NO B. If food is NOT prepared onsite, and is catered in by an approved vendor or provided by parents, please provide a detailed letter explaining how food will be served and handled. Note: Please provide caterer or vendor agreement if food is provided by an outside source. C. Will domestic kitchen equipment be used? ( ) YES ( ) NO a. If Yes, list all pieces of kitchen equipment both domestic and commercial: D. Will vacuum packaging/reduced oxygen packaging or specialized processes as defined in Section 3-606 and 3-607 of the Regulation be conducted? ( ) YES ( ) NO E. Will potentially hazardous foods be rapidly cooled to 41ºF (5ºC) or below? ( ) YES ( ) NO F. What method will be used to rapidly cool potentially hazardous foods? G. List the foods that will require rapid cooling. Include foods that are made from scratch such as soups, sauces, potato salad, pastas, chili, noodles, roasts, casseroles, sausages, yogurts, etc.:
Page 5 of 5 H. Will potentially hazardous foods be reheated and then held hot before being served? ( ) YES ( ) NO a. If yes, please explain how they will be rapidly reheated to above 165ºF (74ºC) within 2 hours. (Reference 3-504 Reheating, in the Denver Retail Food Establishment Rules and Regulations.) I. Indicate how frozen foods will be thawed. (Reference 3-601 Thawing, in the Denver Retail Food Establishment Rules and Regulations.) J. Will raw meats, poultry, or seafood be stored/displayed in the same refrigerator(s) and freezer(s) with cooked, ready-to-eat foods? ( ) YES ( ) NO K. Will food be transported or delivered to another location? ( ) YES ( ) NO L. Will produce be washed? ( ) YES ( ) NO M. If not, will produce be received commercially pre-washed? ( ) YES ( ) NO If yes, please provide additional documentation verifying the source of the produce (ex. Invoice stating produce is pre-washed, written statement from distributor, etc.) N. Are food prep counters isolated from diaper changing areas? ( ) YES ( ) NO Infant and Toddler Nurseries Diaper Changing: A. Is there an adult sized hand sink adjacent to all changing tables? ( ) YES ( ) NO B. Are changing tables within reach of the storage area for child s supplies? ( ) YES ( ) NO