HomeMy WebLinkAboutDA 100 Hemlock Ave Alternate Person in Charge Demonstrated Knowledge Statement, Continued
(B) Demonstrable Elements of Competency
(i) Assess the potential for foodborne illness in a food service establishment—perform
operational food safety assessment; recognize and develop standards, policies and
procedures, select and train employees; implement self audit/inspection program; revise
policy and procedure(feedback loop); implement crisis management program.
(ii) Assess and manage the process flow-identify approved source; implement and maintain a
receiving program; implement and maintain storage procedures; implement and maintain
preparation procedures; implement and maintain holding/service/display procedures;
implement and maintain cooling and post preparation storage procedures; implement and
maintain re-service procedures; implement and maintain transportation procedures.
I JV 1/J attest that ��It
(Print Name of Owner or Ope tor) (Print Name of Alternate Person in Charge)
is employed as the alternate person in charge and has demonstrated to me the elements of knowledge
and demonstrable elements of competency as described in A and B, as listed above.
Signature `yam 2
and Title 7� �� _Date 1 U`
(Signed by Owner/Op6rator of the Establishment)
Signature
and Title Date
(Si *n y ter P rson in Charge)
Name of
Establishment
Address of
Establishment
�A
4
City RECEIVED State zip
NOV 10 2016
Connecticut Department of Public Health o �tl 9ram,Revised 2006 Page 2