Restaurant Environment Observation Form 2023 EHS-Net Food Safety Culture Study Contents Restaurant Environment Observation Form 2023 EHS-Net Food Safety Culture Study..............ssscccsssssseeeees 1 NOLO is se ciccn ceceeccsccsccucctsnstesscsecacecsccteucstedcvebeuscustesccevonecdsccescnccececsetestedcnscusecsecsscnescoscuutsssustenssesccuscdscsceneeccdsses 2 Regulatory Requirements for This Establishment ...........cccccssssccccsssscecccsssececcesssceccecssscesccessscecceasseeceoeesseeeoes 2 Restaurant ODSCIVvationsS siisasccscteincivenecnesbansussnsunssulinwooauezscusupeudabidsennuncackasibeautsvanscncsbatinsencusssinucteanessiwocniiies 3 Page 1 of 9 — Restaurant Environment Observation Form (2023 EHS-Net Study) Form Approved OMB Number: 0920-0792 Expiration Date: 9/30/2018 CDC estimates the average public reporting burden for this collection of information 30 minutes per response, including the time for reviewing instructions, searching existing data/information sources, gathering and maintaining the data/information needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate to: CDC/ATSDR Information Collection Review Office, MS D-74, 1600 Clifton Road, NE, Atlanta, GA 30333 ATTN: PRA (0920-0792). Notes This form is to be completed by Environmental Health Specialists or Data Collectors. Establishment Code: Date of Observation: Regulatory Requirements for This Establishment Note: This section can be filled out prior to or following the onsite visit. It is intended to identify if the restaurant is in compliance with its regulatory requirements. 1. Does this jurisdiction have a CFP-ANSI recognized manager certification requirement? OQ No 1 One per restaurant O1 All hours of operation 1] Other (please describe): 2. Does this jurisdiction allow bare-hand contact with ready-to-eat foods? O Yes O No 3. Does this jurisdiction have a consumer advisory requirement? If so, does it have specific language? O Yes—No specific language O Yes — Specific language O No OQ Other (please describe): 4. Does this jurisdiction allow foods to be served raw or undercooked? O Yes O No 5. What is the maximum cold-holding temperature for TCS/PHF products? O 45°F O 41°F O Other (please describe): Page 2 of 9— Restaurant Environment Observation Form (2023 EHS-Net Study) 6. 7. 8. Does the jurisdiction require date-marking of ready-to-eat TCS/PHF products (that would be subject to date- marking under the FDA Food Code)? O Yes—7 days O Yes —4 days O Yes —7 or 4 days depending on temperature O No What is the cooling requirement for a food that has been cooked and then cooled? OQ 135°F / 140°F to 70°F within 2 hours and then to 41°F / 45°F within an additional 4 hours (6 hours total) O 135°F / 140°F to 41°F / 45°F within 4 hours OQ Other (please describe): What is the minimum hot-holding temperature for TCS/PHF products? O 135°F O 140°F OQ Other (please describe): Restaurant Observations Note: This section should be filled out onsite. 9. 10. 11. 12. How many critical violations / priority items / priority foundation items were noted during the last routine inspection? Enter number: Establishment Type? O Prep-serve OQ Cook-serve O Complex Does the establishment serve raw or undercooked animal products (for example, oysters or runny eggs) in any menu item? O Yes O No O Unsure Is a consumer advisory regarding the risk of consuming raw or undercooked animal products provided (for example, on the menu, on a sign)? O Yes O No O Not applicable a. If the answer to question 12 is “Yes”: Where is the consumer advisory posted? [Check all that apply.] MO Onthe menu as a footnote 1 Onthe menu, in the menu item description O Onasign 1] Other (please describe): b. If the answer to question 12 is “Yes”: Are the menu items that contain raw or undercooked animal products disclosed (for example, in the product description or with a symbol)? O Yes OQ No O Not applicable Page 3 of 9-— Restaurant Environment Observation Form (2023 EHS-Net Study) 13. Which one of the options below best describes the menu for this establishment? American (Non-ethnic) Chinese Thai Japanese Mexican / Latin American Italian French Other (please describe): OCOO00000 14. Does the establishment date-mark any of the ready to eat PHF/TCS foods? O Yes O No O Not applicable If answered “No” or “Not applicable” to question 14, go to question 15. a. Do they use a system to mark when it was prepared or when it should be discarded (either an actual date, day-dot, or other system)? [Check all that apply.] 1] Date it was prepared/opened O Date to discard 1 Other (please describe): O Not applicable b. If they do date-mark ready to eat foods, how many days is it marked for including the date of preparation? OQ Number of days: O Not applicable 15. What is the cold holding temperature in the main refrigerators where foods are held? O Less than or equal to 41°F O Greater than 41°F and less than or equal to 45°F O Greater than 45°F 16. Are temperature logs present? [Check all that apply.] Cold holding Hot holding Cooking logs Cooling logs Other (please describe): Not applicable OOOoOo0d 17. Are shift or other check-sheets present (e.g., covering temperatures and conditions in the kitchen)? O Yes — Shift O Yes — Daily O Yes — Other (please describe): OQ No If answered “No” to question 17, go to question 19. 18. Are shift or other check-sheets filled out? O Yes O Partially O No O Not applicable Page 4 of 9 — Restaurant Environment Observation Form (2023 EHS-Net Study) 19. Are cleaning schedules posted? O Yes O No 20. Is documentation that the cleaning was conducted present? O Yes O No O Not applicable 21. > re food-safety related job aids posted? [Check all that apply.] MO Handwash reminder 1 Food safety policies O Food-safety related posters/signs 1 None seen 1] Other (please describe): 22. What is the activity level in the restaurant at the time of the site visit? O Light OQ Moderate O Heavy 23. Do any of the following have bare-hand contact with ready-to-eat foods that are not subject to cooking afterwards? a. Employees working on cook line: O Yes O No O Not observed O Not applicable b. Employees doing food prep: O Yes OQ No O Not observed O Not applicable c. Servers: O Yes O No O Not observed O Not applicable d. Other (please describe): O Yes OQ No O Not observed O Not applicable 24. Are handwash sinks properly stocked and available? Mark the area of the kitchen where the sink is located. Insert an identifying name if there is more than one sink in an area. Mark “Yes” if it is in compliance, “No” if it is not in compliance, “Not Applicable” if it is not applicable (provide comments in Question 26 to explain), and “Not Observed” if it is not observed. For the evidence of sink use, observe if there is water in the sink from handwashing, discarded paper towels or gloves in the trash next to the sink, immediate hot water when the sink is turned on, etc. Page 5 of 9— Restaurant Environment Observation Form (2023 EHS-Net Study) O Cook line: a. Is the sink accessible? O Yes OQ No O Not observed O Not applicable b. Is the sink quipped with soap? O Yes O No O Not observed O Not applicable c. Is the sink equipped with a hand drying device? O Yes O No O Not observed O Not applicable d. Does the sink have hot water in less than 30 seconds? O Yes O No O Not observed O Not applicable e. Is there evidence that the sink is being used for handwashing? O Yes O No O Not observed O Not applicable C] Prep area: a. Is the sink accessible? O Yes OQ No O Not observed O Not applicable b. Is the sink quipped with soap? O Yes O No O Not observed O Not applicable c. Is the sink equipped with a hand drying device? O Yes O No O Not observed O Not applicable d. Does the sink have hot water in less than 30 seconds? O Yes OQ No O Not observed O Not applicable Page 6 of 9— Restaurant Environment Observation Form (2023 EHS-Net Study) e. Is there evidence that the sink is being used for handwashing? O Yes O No O Not observed O Not applicable O Server area: a. Is the sink accessible? O Yes O No O Not observed O Not applicable b. Is the sink quipped with soap? O Yes O No O Not observed O Not applicable c. Is the sink equipped with a hand drying device? O Yes O No O Not observed O Not applicable d. Does the sink have hot water in less than 30 seconds? O Yes O No O Not observed O Not applicable e. Is there evidence that the sink is being used for handwashing? O Yes O No O Not observed O Not applicable 1] Warewash area: a. Is the sink accessible? O Yes O No O Not observed O Not applicable b. Is the sink quipped with soap? O Yes O No O Not observed O Not applicable c. Is the sink equipped with a hand drying device? O Yes O No O Not observed O Not applicable Page 7 of 9— Restaurant Environment Observation Form (2023 EHS-Net Study) d. Does the sink have hot water in less than 30 seconds? O Yes O No O Not observed O Not applicable e. Is there evidence that the sink is being used for handwashing? O Yes O No O Not observed O Not applicable 1 Restroom: a. Is the sink accessible? O Yes O No O Not observed O Not applicable b. Is the sink quipped with soap? O Yes O No O Not observed O Not applicable c. Is the sink equipped with a hand drying device? O Yes O No O Not observed O Not applicable d. Does the sink have hot water in less than 30 seconds? O Yes O No O Not observed O Not applicable e. Is there evidence that the sink is being used for handwashing? O Yes O No O Not observed O Not applicable 1 Other (please describe): a. Is the sink accessible? O Yes O No O Not observed O Not applicable b. Is the sink quipped with soap? O Yes O No O Not observed O Not applicable Page 8 of 9— Restaurant Environment Observation Form (2023 EHS-Net Study) c. Is the sink equipped with a hand drying device? O Yes O No O Not observed O Not applicable d. Does the sink have hot water in less than 30 seconds? O Yes O No O Not observed O Not applicable e. Is there evidence that the sink is being used for handwashing? O Yes O No O Not observed O Not applicable 25. Are employees properly washing their hands (as per Food Code 2-301.12)? a. Employees working on cook line: O Yes O No O Not observed O Not applicable b. Employees doing food prep: O Yes O No O Not observed O Not applicable c. Servers: O Yes O No O Not observed O Not applicable d. Employees doing warewashing: O Yes OQ No O Not observed O Not applicable e. Other (please describe): O Yes O No O Not observed O Not applicable 26. Other comments/explanation on the above questions: Question number and explanation/comment: Page 9 of 9— Restaurant Environment Observation Form (2023 EHS-Net Study)