Free INDIANA STATE DEPARTMENT OF HEALTH - Indiana

PLAN REVIEW QUESTIONNAIRE
State Form 50004 (R2/11-01)

Indiana State Department of Health Food Protection Program

This questionnaire is not designed as a complete list of requirements but should be used as a guideline only. PROJECT NAME ADDRESS OWNER/CORPORATION ARCHITECT/ENGINEER PROJECT # DATE REVIEWED REVIEWER TELEPHONE # TELEPHONE #

Contents and Specifications for Facility and Operating Plans
(Check what has been submitted)
Intended Menu Anticipated Volume of Food Proposed layout, mechanical schematics, construction materials, and finish schedule Proposed equipment types, manufacturers, model numbers, locations, dimensions, performance capacities, and installation specifications Evidence that standard procedures (SSOP's) to ensure compliance with 410 IAC 7-20 are developed or are being developed.

Included
YES NO

YES = Plans do comply;
1.

NO = Plans do not comply;

N/A = Not applicable
YES NO N/A

SANITATION STANDARD OPERATING PROCEDURES (SSOP'S)
Foodborne illness prevention training has been provided by the retail food establishment to at least one (1) employee who has a primary oversight responsibility for food safety at the establishment. Section 95. SSOP's have been established requiring the food employees and applicants to report to the person-in-charge information about their health and activities as they relate to diseases that are transmissible through food. Section 97. SSOP's have been established regarding the exclusion and/or restriction of employees diagnosed with an infectious agent specified in section 97(1) of 410 IAC 7-20. Section 98. SSOP's have been established regarding proper handwashing procedures and the use of hand sanitizers. Sections 106 and 109. SSOP's have been established regarding the use of good hygienic practices. Sections 113-116. The retention of molluscan shellfish records as required. Sections 131-135. SSOP's have been established to prevent contamination of food from hands when utensils can be used. Section 136. SSOP's (recipes) have been established for the cooking of raw animal foods, such as eggs, fish, meat, poultry, and foods containing these raw animal foods to temperatures. Section 161. Fish, other than molluscan shellfish, intended for service or sale in a ready-to-eat form, raw, raw-marinated, partially cooked, or marinated-partially cooked have been adequately frozen and records have been established by the person-in-charge. Sections 164 and 165. SSOP's have been established for the cooling methods to be used on the various food items that are to be cooled within the time frames. Section 172. SSOP's have been established for the implementation of a date-marking system for ready-toeat potentially hazardous foods prepared and held refrigerated more than twenty-four (24) hours in the establishment. Section 174.

2.

3. 4. 5. 6. 7. 8.

9.

10. 11.

*RECOMMENDATION

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This questionnaire is not designed as a complete list of requirements but should be used as a guideline only.

YES = Plans do comply;
12.

NO = Plans do not comply;

N/A = Not applicable
YES NO N/A

SANITATION STANDARD OPERATING PROCEDURES (SSOP'S)
Written procedures, including records, have been established for time, rather than time in conjunction with temperature, to be used as the public health control for the working supply of potentially hazardous food before cooking, or for ready-to-eat potentially hazardous food that is displayed or held for service for immediate consumption. Section 175. Hazard Analysis Critical Control Point (HACCP) plan has been established and approved for retail food establishments that use reduced oxygen packaging. Section 177. Brochure, deli case or menu advisories, label statements, table tents, placards or other effective means have been established to inform the consumer of the significant risk associated with certain foods in raw or undercooked form. Section 181. SSOP's are established for the cleaning frequency and maintenance of physical facilities and equipment. Sections 244, 247, 264-267, 272, 317, and 396. SSOP's established to minimize the presence of insects, rodents, and other pests on the premises. Section 402. SSOP's have been established for the handling of an imminent health hazard, such as a fire; a flood; an extended interruption of electrical or water service; sewage backup; misuse of poisonous or toxic materials; onset of apparent foodborne illness outbreak; gross unsanitary occurrence or condition, or any other circumstance that may endanger public health. The SSOP's include notifying the regulatory authority of the imminent health hazard and if the operations were discontinued as specified under Section 429, getting approval from the regulatory authority, before resuming operations. Section 429.

13. 14.

15. 16. 17.

Notes:

YES = Plans do comply;
1. 2. 3.

NO = Plans do not comply;
FOOD

N/A = Not applicable
YES NO N/A

Food is obtained from sources that comply with the law. Sections 118-135. Food processing in a retail food establishment meets all applicable state or federal requirements for food processing. Section 119. Provisions have been made for the use of pasteurized products where required. Section 183.

Notes:

*RECOMMENDATION

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This questionnaire is not designed as a complete list of requirements but should be used as a guideline only.

YES = Plans do comply;
1. 2. 3. 4. 5. 6. 7. 8. 9. 10.

NO = Plans do not comply;
EQUIPMENT

N/A = Not applicable
YES NO N/A

Use of properly designed display cases and food shields where required. Section 156. Use of only those pieces of food-service equipment which meet materials for construction and repair. Sections 184-195. Use of only those pieces of food-service equipment which meet materials for design and construction. Sections 196-231. Ventilation for food-service equipment is designed, installed, and adequate. Sections 205, 209, 235, 373, and 390. Adequate mechanical utensil-washing facilities. Sections 221-223 and 225. Properly located 1/4-inch iron pipe size (ips) valve and pressure gauge for mechanical utensil-washing machines where required. Section 226. Reuse of only those pieces of existing food-service equipment which meet the requirements of Section 426. Equipment for cooling and cold holding and/or heating and hot holding food sufficient in number and capacity to provide food temperatures. Sections 232 and 117-183. A three (3) compartment sink provided for the manual washing, rinsing, and sanitizing of utensils and equipment. Section 233. Do you plan to use alternative manual warewashing equipment? Has approval from the regulatory authority been obtained for the use of the alternative manual warewashing method? Section 233. Adequate drainboards, utensil rack, or tables provided to accommodate the threecompartment sinks and/or mechanical warewashing machine. Sections 227 and 234. Sink or mechanical clothes washer and dryer provided, when required. Sections 236 and 280. Facilities used for the storage of food or a cabinet that is used to store cleaned and sanitized equipment, utensils, laundered linens, and single-service and single-use articles are located properly. Section 241. Proper installation of floor and/or countertop mounted food-service equipment. Sections 242 and 243.

11. 12. 13.

14.

Notes:

*RECOMMENDATION

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This questionnaire is not designed as a complete list of requirements but should be used as a guideline only.

YES = Plans do comply;
1.

NO = Plans do not comply;

N/A = Not applicable
YES NO N/A

WATER, PLUMBING, AND WASTE
PUBLIC WATER SUPPLY ______ PRIVATE WATER SUPPLY ______

2. 3 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14.

Water supply from a source constructed and operated according to law. Sections 291, 299, and 300. Has approval been obtained from the Indiana Department of Environmental Management (IDEM) regarding the public water supply? Section 291. Hot and/or cold water provided at all fixtures and equipment that use water. Sections 297, 298, and 303. Plumbing system and hoses conveying water constructed and/or repaired with approved material. Section 301. Plumbing system designed, constructed, and installed according to law. Section 302. Properly designed mixing valve and/or combination faucets on handwashing lavatories. Section 303. Handwashing lavatory, sufficient number and capacities provided. Section 307. Sufficient number and conveniently located toilet facilities for food employees. Section 308. Adequate and properly located service sink or curbed cleaning facility. Section 309. Water filter, screen, and other water conditioning devices installed to facilitate disassembly for periodic servicing and cleaning. Section 313. Is the mobile water tank designed and constructed according to code? Sections 319-332. Is the capacity and drainage design of the sewage holding tank of the mobile retail food establishment according to code? Section 333. Floor drain, graded to drain, is provided if a water flush method of cleaning is used. Section 366.
PUBLIC SEWAGE SYSTEM ______ PRIVATE SEWAGE SYSTEM ______

15.

16.

Sewage and wastewater disposal adequate and operated according to law. Sections 302, 337, 340, and 341. Has approval for the commercial on-site sewage disposal system been obtained from Sanitary Engineering, Indiana State Department of Health; or IDEM? Sections 302, 337, 340, and 341. Is the warewashing machine directly connected to the sewage system? Is the machine located within five (5) feet of a trapped floor drain and the machine outlet connected to the inlet side of a properly vented floor drain trap? Section 335.

Notes:

*RECOMMENDATION

Page 4

This questionnaire is not designed as a complete list of requirements but should be used as a guideline only.

YES = Plans do comply;
1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15.

NO = Plans do not comply;

N/A = Not applicable
YES NO NA

PHYSICAL FACILITIES
Materials for indoor floor, wall, and ceiling surfaces are according to code. Section 362. Materials for outdoor area surfaces are according to code. Section 363. Floors, floor coverings, walls, wall coverings, and ceilings are designed, constructed, and installed according to code. Sections 364, 367, and 369. Installation of exposed pipes, lines, and conduits do not obstruct or prevent cleaning of floors, walls, and ceilings. Section 365. Coved or sealed floor/wall junctures where required. Section 366. Shielded, coated, or shatter-resistant lighting in areas of exposed food; clean equipment, utensils, and linens; unwrapped and single-use articles. Section 372. At least 70 foot-candles of lighting in food preparation and equipment or utensil washing work levels. Section 389. At least 20 foot-candles of lighting in utensil and equipment storage areas, lavatory and toilet areas, walk-in refrigeration units, and dry food storage areas. Section 389. Retail food establishment provided with an enclosed toilet room with tight-fitting and selfclosing door where required. Section 375. Proper design and installation of insect control devices. Section 374. Outer openings protected against the entrance of insects and rodents by closed, tight-fitting windows and solid, self-closing, and tight-fitting doors. Section 376. Sixteen (16) mesh to one (1) inch screen; properly designed and installed air curtain or other effective means on windows or doors where required. Section 376 (d). Overhead protection provided for vending machines located outdoors. Section 378. Overhead protection provided on outdoor servicing areas as required. Section 379. Outdoor refuse area constructed in accordance with law and curbed and graded to drain. Section 381. Handwashing sinks are provided with hand cleanser as required. Section 384. Handwashing sinks are provided with hand-drying provisions as required. Section 385. Waste receptacle provided at each handwashing sink as required. Section 348.

16.
17. 18.

Notes:

*RECOMMENDATION

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This questionnaire is not designed as a complete list of requirements but should be used as a guideline only.

YES = Plans do comply;
1. 2. 3.

NO = Plans do not comply;

N/A = Not applicable
YES NO NA

REFUSE, RECYCLABLES, AND RETURNABLES
Is the outside storage surface for refuse, recyclables, and returnables constructed of nonabsorbent materials? Section 343. Is the outside enclosure for refuse, recyclables, and returnables constructed of durable and cleanable materials? Section 344. Are the receptacles and waste-handling units for refuse, recyclables, and returnables constructed of durable, cleanable, insect-resistant, rodent-resistant, leakproof, and nonabsorbent materials? Section 345. Are the outside receptacle and waste-handling units for refuse, recyclables, and returnables designed and constructed with tight-fitting lids, doors, or covers? Section 347. Is the inside and/or outside storage area and/or enclosure area sufficiently sized to hold the refuse, recyclables, and returnables that accumulate? Section 348. Suitable cleaning implements and supplies provided for the effective cleaning of receptacles and waste-handling units when required. Section 350. Is the location of the storage area for redeeming machines, receptacles, and waste-handling units properly located? Section 351.

4. 5. 6. 7.

Notes:

YES = Plans do comply;
1. 2.

NO = Plans do not comply;

N/A = Not applicable
YES NO NA

POISONOUS OR TOXIC MATERIALS
Poisonous or toxic materials and personal care items bear a legible manufacturer's label. Section 407. Storage of poisonous or toxic materials is such that food, equipment, utensils, linens, and single-service and single-use articles are not contaminated and are used according to law. Sections 409 and 411. Chemical sanitizers and other chemical antimicrobials applied to food-contact surfaces meet the requirements specified in 21 CFR 178.1010. Section 413. Chemicals used to wash or peel raw, whole fruits and vegetables meet the requirements specified in 21 CFR 173.315. Section 414. Chemicals used as boiler water additives meet the requirements specified in 21 CFR 173.310. Section 415. Drying agents used in conjunction with sanitization meets the requirements listed in Section 416. Lubricants used on food-contact surfaces, on bearings and gears located on or within foodcontact surfaces, or on bearings or gears that are located so that lubricants may leak, drip, or be forced onto food or onto food-contact surfaces meet the requirements specified in 21 CFR 178.3570. Section 417. Restricted-use pesticides used in the establishment meet the requirements specified in 40 CFR 152, Subpart I. Section 418

3. 4. 5. 6. 7.

8.

*RECOMMENDATION

Page 6

This questionnaire is not designed as a complete list of requirements but should be used as a guideline only.

YES = Plans do comply;
9.

NO = Plans do not comply;

N/A = Not applicable
YES NO NA

POISONOUS OR TOXIC MATERIALS
Storage of medicines is such that the food, equipment, utensils, linens, and single-service and single-use articles are not contaminated; and if refrigeration is required, the storage is according to Sections 421 and 422. First aid supplies are properly stored. Section 423

10. Notes

YES = Plans do comply;
1. 2. 3. 4. 5.

NO = Plans do not comply;

N/A = Not applicable
YES NO NA

MISCELLANEOUS
No part of the retail food establishment opens directly into any part of the living or sleeping quarters. Section 382. Adequate facilities for the storage of employees' personal clothing and belongings. Sections 391 and 393. Designated area for employees to eat, drink, and use tobacco provided. Sections 113 and 393. Adequate facilities provided for the storage of maintenance and cleaning tools. Section 404. Has the retail food establishment registered with the regulatory authority as required? Section 427.

Notes:

*RECOMMENDATION

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