Michigan Department of Agriculture and Rural Development

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Pages 6 10 ask structural and equipment questions that the. operator may wish to have the contractor or architect complete. Refer to the food establishment plan review manual for technical. assistance The manual is available from your reviewing agency or by. visiting www michigan gov mdard Search Plan Review. Information contained in the plans may be referenced and does not have. to be repeated in the worksheet e g see plan sheet 3a 6. Food Manager Knowledge, Under the Food Law of 2000 as amended retail food establishments are required to have a. person in charge PIC during all hours of operation and employee at least managerial. employee under a program accredited by American National Standards Institute. 1 Check all that apply, A designated person in charge that can demonstrate knowledge of foodborne disease. prevention application of food safety HACCP principles and the requirements of the Food. Code will be available during all hours of operation REQUIRED. Certified Managerial Employees under ANSI A written food safety HACCP plan will. Requirements is provided REQUIRED be provided Only required under. certain circumstances,Animal based foods such as meat. Standard operating procedures SOP poultry fish shellfish or eggs served. including a policy that excludes or restricts raw or undercooked or not otherwise. food workers who are ill or have infected cuts processed to eliminate pathogens. or lesions, Please submit copies of these documents or an inventory if there are numerous large documents. and training videos, If you checked this item then the customer must be informed by means of a consumer advisory.
upon ordering that a particular menu item contains raw or undercooked foods of animal origin. The consumer advisory must be made whether the food is normally prepared undercooked or is. prepared undercooked only at the customer s order Submit a copy of the menu for review For. further clarification please contact your reviewing health agency or read the consumer advisory. guidance document at http www michigan gov mdard Search Updated Food Law Food Code. Food Preparation Review,See manual parts 1 and 3, 2 How will potentially hazardous food time temperature control for safety food be. thawed Check all that apply, Thawing Method Foods less than 1 thick Foods more than 1 thick. Refrigeration,Running water less than 70 F,Microwave as part of cooking process. Cook from frozen, 3 Cooking and reheating potentially hazardous food time temperature control for safety. food List all cooking and reheating equipment and check all applicable boxes. Equipment Name Cooking Reheating New Used NSF Approved or. Equivalent, 4 Hot and cold holding of potentially hazardous food time temperature control for safety.
food List all hot and cold holding equipment and check all applicable boxes. Equipment Name Hot Cold New Used NSF Approved,Holding Holding Or Equivalent. 5 Will ice be used as a refrigerant for potentially hazardous foods time temperature. control for safety food Yes No, If yes describe which foods will be held on ice for how long where this will occur and the source. of the ice, 6 Will time be used for bacterial growth control instead of hot or. cold holding Yes No, If yes submit a list of the foods involved and the standard operating procedures. that will be used to monitor the use of time as a control. 7 Cooling Potentially Hazardous Food List foods that will be cooled using each of the. following methods Foods must be cooled from 135oF to 70 F in 2 hours or less and with a total. of 6 hours from 135oF to 41 F or less,A Shallow pans in refrigerator.
B Ice baths,C Volume reduction e g quartering a large roast. D Rapid chill devices e g blast freezers,E Ice paddles. 8 Food Preparation, A List foods that will be prepared a day or more in advance of service or sale. B How will employees avoid bare hand contact with ready to eat foods Check all that apply. Disposable gloves Suitable utensils,Deli tissue Other. C Will produce be cleaned on site Yes No, D If C is yes describe which sink s will be used for food preparation.
9 Date Marking, When potentially hazardous food time temperature control for safety food is ready to eat and. will be kept under refrigeration for more than 24 hours after preparation opening a date marking. system must be utilized Note The day of preparation counts as Day 1. A Will the establishment have food items that must be date marked Yes No. If yes describe the date marking system that will be used and. provide written standard operating procedures,10 Catering Off Site Satellite. Complete if establishment will cater foods to another location or performing any cooking or. preparations off site at other locations,A List menu items. B Maximum number of meals per day taken to or prepared at off site location. C How will hot food be held at proper temperature during transportation and at the remote serving. D How will cold food be held at proper temperature during transportation and at the remote serving. E What types of vehicles will be used to transport food. F What types of sneeze guards or food protection devices will be used See manual part 4. Dishwashing,See manual part 8, 11 Dishwashing methods check all that apply Dishmachine Sink. Dishwashing Sinks Length inches Width inches Depth inches. A Sink 1 Size of compartments,B Sink 2 Size of compartments.
C Sink 3 Size of compartments, D What is the largest item that will have to be washed in a sink and its size. E List the location of all garbage disposals, 12 Will employee dressing rooms be provided Yes No. See manual part 16, 13 If no describe how personal belongings will be stored. 14 Check which of the following will be used Washer Dryer. 15 Describe what will be laundered on site, 16 What type of mop sink will be provided e g curbed floor drain mop sink on legs etc. See manual part 8,Room Finish Schedules,Fill in materials to be used See manual part 10.
Area Floor Coving Wall Ceiling,17 Preparation,18 Cooking. 19 Dishwashing,20 Food Storage,23 Employee Restrooms. 24 Dressing Room,25 Walk In Refrigerator,26 Walk In Freezer. 27 Garbage Room,28 Janitor Closet, List the material that will be used to provide a smooth rounded and cleanable surface where the. floor and wall joins Note Please explain abbreviations. Water Supply,See manual part 5, 31 Will the water supply be Municipal Existing on site New on site.
32 If an on site water supply is being used is the local. health department in the process of approving Yes No. Sewage Disposal,See manual part 5, 33 Will the sewage disposal be Municipal Existing on site New on site. 34 If an on site sewage system is being used is the. local health department or Michigan Department of Yes No. Environmental Quality in the process of approving, It is recommended that you contact your local health department to begin the approval process. Insect and Rodent Control,See manual part 13,35 Will outside doors be self closing Yes No. 36 Will the facility have a drive thru or walk up window Yes No. 37 If 36 is yes describe how insects will be kept out e g self closer air curtains etc. 38 Are other openable windows screened NA Yes No, 39 Will openings around pipes electrical conduits chases and other. wall perforations be sealed Yes No, 40 Will garage style or loading bay doors be present Yes No.
41 If 40 is yes how will garage style or loading doors be protected against vermin entry. Solid Waste Storage,See manual part 17,42 Outside Storage. A What type of storage will be used Compactor Dumpster Cans. B What type of surface will be under the container. C What is the minimum pick up frequency, Remember to show details on site plan including unit location and slope of surface under the unit. 43 Inside Storage, A Describe how garbage boxes etc will be stored inside. B Describe any inside storage or cleaning area e g garbage can cleaning area. C Will any compactors or dumpsters be located inside If yes show on plans Yes No. D Describe any area where damaged merchandise returned for credit to vendor will be stored. E Describe how waste grease will be handled and stored. F Describe how and where recyclables will be stored. G Check the types of materials that will be recycled. Glass Metal Paper Cardboard Plastic,Plumbing Cross Connections. See manual part 12, The following technical information is needed on the proposed plumbing This section is best.
completed by a qualified plumber architect or engineer Be sure to include all devices equipment. and fixtures that have cross connection protection Remember to complete both the water supply. and waste side e g a dishwasher may have an AVB on the water supply and an air gapped drain. Fixture Sewage Disposal Water Supply,Air Gap Air Break Direct AVB PVB RPZ VDC HB Air. Connect Gap,44 Dishwasher,45 Glasswasher,46 Garbage grinder. 47 Ice machines,48 Ice storage bin,49 Mop sink faucet. 50 3 compartment sink,51 2 compartment sink,52 1 compartment sink. 53 Steam tables,54 Dipper wells,55 Hose connections.
56 Refrigeration,condensate drain lines,57 Beverage dispenser. with carbonator,58 Water softener,59 Potato peeler. 60 Walk in floor drain,61 Chinese range,62 Detergent feeder on. 63 Outside sprinkler or,irrigation system,64 Power washer. 65 Retractable hose reel,69 Bain marie,70 Espresso machine.
71 Combi style oven,73 Rethermalizer,74 Steamer,75 Overhead spray rinse. 76 Hot water dispenser, AVB atmospheric vacuum breaker HB hose bib vacuum breaker. PVB pressure vacuum breaker VDC vented double check valve. RPZ reduced pressure principle backflow preventer,Formula Information. Several calculations are required to determine if there will be adequate hot water ventilation dry. storage space and refrigerated storage space The information requested on the following two pages. provides the necessary data for performing calculations See the plan review manual for formulas. and directions,79 Hot Water see manual part 9, List each type of plumbing fixture that uses hot water fixtures. Bathroom Sinks,1 Compartment Sink,2 Compartment Sink.
3 Compartment Sink,Vegetable Sink,Overhead Spray Rinse. Bar Sink 3 compartment 4 compartment,Hot Water Filling Faucet. Bain marie,Coffee Urn,Kettle Stand,Garbage Can Washer. 9 12 lb Clothes Washer,16 lb Clothes Washer,Employee Shower. Dishmachine hot water chemical,Dishmachine Make model.
80 Water Heater 1 Manufacturer Model number,A Hot water heater proposed size Electric KW. Gas BTU s Thermal Efficiency,B Hot water heater storage capacity gallons. C Hot water heater recovery rate gallons per hour 100 rise. Attach information for any additional water heaters Specify what area each water heater. services and whether or not units will be installed in parallel. 81 Do hot water heater s serve any non food equipment areas. If yes describe,82 Dishmachine Booster Heater KW BTU Make Model. 83 Refrigerated and Dry Food Storage see manual parts 3 7. It is essential that a reliable estimate be made of the number of customers that are served or buy food. between deliveries in order to calculate dry and refrigerated storage capacities. A meals or people served per day, B days between deliveries Dry Food Refrigerated Items. C meals between deliveries AxB Dry Food Refrigerated Items. Please describe any assumptions made in determining the meal quantity estimate. 84 Refrigerated Storage see manual part 3, Walk in Item Interior Usable Interior Length ft Interior Width ft.
Upright Item Interior Depth in Interior Width in Interior Height in. Working preparation and line refrigerators should not be included Only storage units. 85 Dry Storage see manual part 7,Storage Rooms, Usable room height ft Interior Length ft Interior Width ft. Please note the location of any auxiliary storage i e outside storage. To determine usable height determine height from floor to ceiling then subtract height of food off. floor usually 6 and height of food from ceiling usually 12 18. Or if there is no dry storage room proposed,For full height shelves. Total Shelving Length ft Shelving Width ft,Suggestion Sheet. Food Establishment Plan Review Worksheet, Suggestions for changes to this plan review worksheet are welcomed from all users. e g food service operators architects engineers and regulators etc Revisions to. documents are made periodically as needed Thank you for taking the time to. submit your ideas,Name Phone Fax,City State Zip,Plan Review Specialist.
Food Service Sanitation Section,Food Dairy Division. Michigan Department of Agriculture,PO Box 30017,Lansing MI 48909. Fax 517 373 3333,E mail greens2 michigan gov, For suggested changes please list section specific location in document You may. list your suggestions below or attach separate sheets Please be specific and clear. Food Dairy Division,Michigan Department of Agriculture. and Rural Development,PO Box 30017,Lansing MI 48909.
Michigan Department of Agriculture and Rural Development Fixed Food Establishment Plan Review Worksheet Establishment Name Address

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