HomeMy WebLinkAboutFood Service Establishment New 301 Everg (2) � Pine 30�
REGULATORY AUTHORITY
COMPLIANCE REVIEW LIST AND
APPROVAL/DISAPPROVAL FORM
REGULATORY AUTHORITY COMPLIANCE REVIEW LIST
INSUFF.
SAT. UNSAT. N/A INFORM.
1. Food Preparation Review
Raw food prep table(s) O O ( )
Raw food prep sink(s) ( ) ( ) ( )
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Adequate refrigeration ( ( ) O ( )
Adequate cold holding
facilities ( ) ( ) ( )
Adequate hot holding
facilities ( ) ( ) ( )
Adequate hot food
preparation equip. O O ( )
Vacuum packaging ( ) ( ) ( )
(HACCP plan)
2. Utensil & Equipment
Clean Storage (v) O O ( )
Soiled Storage
Counter mounted equip.
Floor mounted equip.
Vacuum packaging equip.
Bulk food
O O
Self service
Salad Bar O O ( ( )
Hot/Cold Buffet O O ( ( )
INSUFF.
SAT. UNSAT. N/A INFORM.
3. Kitchen Equipment
Space between units or wall
closed; moveable, or
adequate space for
easy cleaning ( ( ) ( ) ( )
Work space & aisles
sufficient ( O O ( )
Storage 6" off floor ( ( ) ( ) ( )
Countertops & cutting boards
of suitable material O O ( )
Self serve food area
adequately protected { O O ( )
Approved thermometer for each
refrigerator &freezer, and for
taking food temperatures ( ( ) ( ) ( )
4. Finish Schedule
KitchenO/ ( )
Bar O O (V O
Food Storage ( O O ( )
Other Storage
Toilet Rooms
Dressing Rooms O O wK ( )
Garbage & Refuse Storage
Mop Service Area O O ( )
Warewashin O O ( )
Walk-in efrigerato freezers ( ( ) O ( )
Other ( ) ( ) ( ) ( )
5. Plumbing
Cross Connections Water lines
Cross Connections Drains
Water Supply V,',qV�_ ( ( ) O ( )
Sewage Disposal
Hand Sinks
- Dishwashing & Pot Sinks -
Grease Traps ( O O
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INSUFF
SAT. UNSAT. N/A INFORM.
Service/Janitorial Sinks ( ( ) ( ) ( )
Hot Water O O ( )
6. Physical Facilities
Dressing Rooms
Separate Toxic Storage ( ( ) ( ) ( )
Laundry Facilities
Linen Storage
Lighting ( O O ( )
Food Storage
Dry goods storage
7. Refuse & Pest Control
Garbage & Refuse Storage
Insect & Rodent
Control Measures ( ( ) { ) ( )
8. Ventilation
Exhaust Hoods O O ( ( )
Ventilation O O ( ( )
9. Restrooms
Location (+ O O ( )
Number
Soap Dispensers
Hand Drying (✓� O O ( )
Sinks ( ( ) ( ) ( )
Toilets
Urinals
Hot and Cold Water Provided
Waste Receptacles
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Comments: (explain why any item was noted "Unsatisfactory")
P _
Reviewe ignature Dat
-Z`Reviewer Title
APPROVAL: DATE:
DISAPPROVAL: DATE:
REASON FOR DISAPPROVAL:
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