623 lines
11 KiB
Text
623 lines
11 KiB
Text
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)
|
|
|
|
|