Attachment 7 - CG Form CG-5145 - Food Services Establishment Inspection Report Form.pdf
PDF 1 MB Posted
- Solicitation number
- 70Z08426RDL950004
About this file
This is a U.S. Coast Guard Food Service Establishment Inspection Report Form (CG-5145, 04/20) used to document sanitary conditions and compliance with food safety regulations at Coast Guard food service facilities.
The form serves as a comprehensive inspection checklist covering 46 items organized into nine categories: Approved Source, Food Protection, Time/Temperature Control for Safety, Personnel, Food Equipment and Utensils, Water, Sewage, Plumbing, Toilet and Handwashing Facilities, Garbage and Refuse Disposal, Insect/Rodent and Animal Control, Floors/Walls/Ceilings, Lighting and Ventilation, and Other Operations. Inspectors mark violations with an "X" and indicate whether corrections were made on-site (COS) or if violations are repeat occurrences (R). Critical items requiring immediate attention are identified with asterisks and include food source approval, date marking, food protection during storage, proper cooking temperatures, hot/cold holding temperatures, personnel hygiene, thermometer accuracy, sanitizing procedures, water safety, sewage disposal, backflow prevention, handwashing facilities, pest control, and proper storage of toxic items. The form captures basic facility information including district, unit name and address, seating capacity, water supply type, sewage disposal method, inspection type, and inspection purpose (routine, follow-up, complaint investigation, or other). The form also records whether food service personnel are certified and have received required physicals, along with inspection date and inspector identification.
View the file
Other files
Show all 26
On GovTribe
Work with this file
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
Text version
PREVIOUS EDITIONS ARE OBSOLETE
CG-5145 (04/20)
DEPARTMENT OF HOMELAND SECURITY
U.S. COAST GUARD
FOOD SERVICE ESTABLISHMENT INSPECTION REPORT FORM
* CRITICAL ITEMS REQUIRING IMMEDIATE ATTENTION
DISTRICT UNIT NAME AND ADDRESS DATE
SEATING CAPACITY
INSTRUCTIONS: Mark X in the items below that have been identified as inadequate or in violation of the recommendations of the Food Safety and Sanitation TTP. Consult the TTP for guidance on correction of violations. Mark Corrected on Site (COS) or Repeat Violation (R) accordingly.
WATER SUPPLY (check one)
PRIVATEPUBLIC
SEWAGE DISPOSAL (check one) TYPE OF INSPECTION (check one)
PRIVATEPUBLIC CLUBGALLEY OTHER
PURPOSE OF INSPECTION (check one)
FOLLOW-UPROUTINE COMPLAINT INVESTIGATION OTHER
FOOD SERVICE PERSONNEL CERTIFIED (check one): NOYES FOOD SERVICE PERSONNEL PHYSICALS (check one): NOYES
ITEM X COS R DESCRIPTION
APPROVED SOURCE
*1 Food obtained from approved source.
2 Food received at proper temperature.
3 Food in good condition, safe and unadulterated.
4 Required source records available for selected foods (e.g., shellstock tags).
FOOD PROTECTION
*5 Proper date marking and handling for leftovers.
*6 Food protection during storage, preparation, display, service and transportation.
7 Handling of food and ice is minimized.
8 Food and ice dispensing utensils properly stored.
9 Consumer advisory provided for raw/undercooked food.
TIME/TEMPERATURE CONTROL FOR SAFETY
*10 Proper cooking time and temperatures.
11 Proper reheating procedures for hot holding.
12 Proper cooling time and temperature.
*13 Proper hot/cold holding temperatures.
14 Approved thawing methods used.
PERSONNEL
*15 Personnel with infections restricted.
*16 Hands washed and clean, good hygienic practices.
17 Clean clothes and hair restraints.
FOOD EQUIPMENT AND UTENSILS
18 Food and ice contact surfaces: properly designed, constructed, maintained, installed and located.
19 Dishwashing facilities: properly designed, constructed, maintained, installed, located and operated.
*20 Thermometers provided and accurate.
21 Single-service articles: proper storage and dispensing.
22 No re-use of single-service articles.
23 Pre-flushed, scraped, soaked.
24 Wash rinse water: clean, proper temperature.
*25 Sanitizing rinse: clean, temperature, concentration.
26 Wiping cloths, clean, use restricted.
27 Food-contact surfaces of equipment/utensils clean, free of abrasives and detergents.
28 Storage, handling of clean equipment/utensils.
DATE OF INSPECTION RECEIVED BY INSPECTED BY
ITEM X COS R DESCRIPTION
WATER
*29 Water source safe: Hot and cold under pressure.
SEWAGE
*30 Sewage and waste water properly disposed.
PLUMBING
31 Installed, maintained.
*32 Cross connection, backflow prevented.
TOILET AND HANDWASHING FACILITIES
*33 Handwashing and toilet facilities properly constructed, supplied, and cleaned.
GARBAGE AND REFUSE DISPOSAL
34 Containers or receptacles, covered: adequate number, insect/rodent proof, emptied and cleaned frequently.
35 Garbage and refuse properly disposed; facilities maintained.
INSECT, RODENT AND ANIMAL CONTROL
*36 Presence of insect/rodent - outer openings protected, no dogs, cats or other animals.
37 Integrated Pest Management Program up-to-date.
FLOORS, WALLS AND CEILINGS
38 Floors: constructed, drained, clean and in good-repair, covering installation, dustless cleaning methods.
Walls, ceilings, and attached equipment: properly constructed, good repair, clean surfaces, dustless cleaning methods.
LIGHTING AND VENTILATION
40 Adequate ventilation and lighting in food service, storage and sanitary areas.
41 Range exhaust hood: free of grease build-up and manufacturer specifications kept on file.
42 Ventilation hoods provided and maintained, lighting fixtures shielded or shatter resistant.
OTHER OPERATIONS
*43 Toxic items properly stored, labeled and used.
Premises: maintained free of litter/unnecessary articles, cleaning/maintenance equipment properly stored, authorized personnel only.
45 Complete separation from living/sleeping quarters and laundry.
46 Clean and soiled linens properly stored.
DEPARTMENT OF HOMELAND SECURITY
U.S. COAST GUARD
FOOD SERVICE ESTABLISHMENT INSPECTION REPORT FORM
Page of
PREVIOUS EDITIONS ARE OBSOLETE
CG-5145 (04/20)
* CRITICAL ITEMS REQUIRING IMMEDIATE ATTENTION
INSTRUCTIONS: Mark X in the items below that have been identified as inadequate or in violation of the recommendations of the Food Safety and Sanitation TTP. Consult the TTP for guidance on correction of violations. Mark Corrected on Site (COS) or Repeat Violation (R) accordingly.
WATER SUPPLY (check one) SEWAGE DISPOSAL (check one) TYPE OF INSPECTION (check one) PURPOSE OF INSPECTION (check one) FOOD SERVICE PERSONNEL CERTIFIED (check one):
FOOD SERVICE PERSONNEL PHYSICALS (check one):
ITEM
X
COS
R
DESCRIPTION
APPROVED SOURCE
*1 Food obtained from approval source.
Food obtained from approved source.
Food obtained from approval source.
Food received at proper temperature.
Food received at proper temperature.
Food received at proper temperature.
Food in good condition, safe and unadulterated.
Food in good condition, safe and unadulterated.
Food in good condition, safe and unadulterated.
Required source records available for selected foods (e.g., shellstock tags) Required source records available for selected foods (e.g., shellstock tags).
Required source records available for selected foods (e.g., shellstock tags)
FOOD PROTECTION
*5 Proper date marking and handling for leftovers.
Proper date marking and handling for leftovers.
Proper date marking and handling for leftovers.
*6 Food protection during storage, preparation, display, service and transportation.
Food protection during storage, preparation, display, service and transportation.
Food protection during storage, preparation, display, service and transportation.
Handling of food and ice is minimized.
Handling of food and ice is minimized.
Handling of food and ice is minimized.
Food and ice dispensing utensils properly stored Food and ice dispensing utensils properly stored.
Food and ice dispensing utensils properly stored Consumer advisory provided for raw/undercooked food.
Consumer advisory provided for raw/undercooked food.
Consumer advisory provided for raw/undercooked food.
TIME/TEMPERATURE CONTROL FOR SAFETY
*10 Proper cooking time and temperatures.
Proper cooking time and temperatures.
Proper cooking time and temperatures.
Proper reheating procedures for hot holding.
Proper reheating procedures for hot holding.
Proper reheating procedures for hot holding.
Proper cooling time and temperature.
Proper cooling time and temperature.
Proper cooling time and temperature.
*13 Proper hot/cold holding temperatures.
Proper hot/cold holding temperatures.
Proper hot/cold holding temperatures.
Approved thawing methods used.
Approved thawing methods used.
Approved thawing methods used.
PERSONNEL
*15 Personnel with infections restricted.
Personnel with infections restricted.
Personnel with infections restricted.
*16 Hands washed and clean, good hygienic practices.
Hands washed and clean, good hygienic practices.
Hands washed and clean, good hygienic practices.
Clean clothes and hair restraints.
Clean clothes and hair restraints.
Clean clothes and hair restraints.
FOOD EQUIPMENT AND UTENSILS
Food and ice contact surfaces: properly designed, constructed, maintained, installed and located.
Food and ice contact surfaces: properly designed, constructed, maintained, installed and located.
Food and ice contact surfaces: properly designed, constructed, maintained, installed and located.
Dishwashing facilities: properly designed, constructed, maintained, installed, located and operated.
Dishwashing facilities: properly designed, constructed, maintained, installed, located and operated.
Dishwashing facilities: properly designed, constructed, maintained, installed, located and operated.
*20 Thermometers provided and accurate.
Thermometers provided and accurate.
Thermometers provided and accurate.
Single-service articles: proper storage and dispensing.
Single-service articles: proper storage and dispensing.
Single-service articles: proper storage and dispensing.
No re-use of single-service articles.
No re-use of single-service articles.
No re-use of single-service articles.
Pre-flushed, scraped, soaked.
Pre-flushed, scraped, soaked.
Pre-flushed, scraped, soaked.
Wash rinse water: clean, proper temperature.
Wash rinse water: clean, proper temperature.
Wash rinse water: clean, proper temperature.
*25 Sanitizing rinse: clean, temperature, concentration.
Sanitizing rinse: clean, temperature, concentration.
Sanitizing rinse: clean, temperature, concentration.
Wiping cloths, clean, use restricted.
Wiping cloths, clean, use restricted.
Wiping cloths, clean, use restricted.
Food-contact surfaces of equipment/utensils clean, free of abrasives and detergents.
Food-contact surfaces of equipment/utensils clean, free of abrasives and detergents.
Food-contact surfaces of equipment/utensils clean, free of abrasives and detergents.
Storage, handling of clean equipment/utensils.
Storage, handling of clean equipment/utensils.
Storage, handling of clean equipment/utensils.
ITEM
X
COS
R
DESCRIPTION
WATER
*29 Water source safe: Hot and cold under pressure.
Water source safe: Hot and cold under pressure.
Water source safe: Hot and cold under pressure.
SEWAGE
*30 Sewage and waste water properly disposed.
Sewage and waste water properly disposed.
Sewage and waste water properly disposed.
PLUMBING
Installed, maintained.
Installed, maintained.
Installed, maintained.
*32 Cross connection, backflow prevented.
Cross connection, backflow prevented.
Cross connection, backflow prevented.
TOILET AND HANDWASHING FACILITIES
*33 Handwashing and toilet facilities properly constructed, supplied, and cleaned.
Handwashing and toilet facilities properly constructed, supplied, and cleaned.
Handwashing and toilet facilities properly constructed, supplied, and cleaned.
GARBAGE AND REFUSE DISPOSAL
Containers or receptacles, covered: adequate number, insect/rodent proof, emptied and cleaned frequently.
Containers or receptacles, covered: adequate number, insect/rodent proof, emptied and cleaned frequently.
Containers or receptacles, covered: adequate number, insect/rodent proof, emptied and cleaned frequently.
Garbage and refuse properly disposed; facilities maintained.
Garbage and refuse properly disposed; facilities maintained.
Garbage and refuse properly disposed; facilities maintained.
INSECT, RODENT AND ANIMAL CONTROL
*36 Presence of insect/rodent - outer openings protected, no dogs, cats or other animals.
Presence of insect/rodent - outer openings protected, no dogs, cats or other animals.
Presence of insect/rodent - outer openings protected, no dogs, cats or other animals.
Integrated Pest Management Program up-to-date.
Integrated Pest Management Program up-to-date.
Integrated Pest Management Program up-to-date.
FLOORS, WALLS AND CEILINGS
Floors: constructed, drained, clean and in good-repair, covering installation, dustless cleaning methods.
Floors: constructed, drained, clean and in good-repair, covering installation, dustless cleaning methods.
Floors: constructed, drained, clean and in good-repair, covering installation, dustless cleaning methods.
Walls, ceilings, and attached equipment: properly constructed, good repair, clean surfaces, dustless cleaning methods.
Walls, ceilings, and attached equipment: properly constructed, good repair, clean surfaces, dustless cleaning methods.
Walls, ceilings, and attached equipment: properly constructed, good repair, clean surfaces, dustless cleaning methods.
LIGHTING AND VENTILATION
Adequate ventilation and lighting in food service, storage and sanitary areas.
Adequate ventilation and lighting in food service, storage and sanitary areas.
Adequate ventilation and lighting in food service, storage and sanitary areas.
Range exhaust hood: free of grease build-up and manufacturer specifications kept on file.
Range exhaust hood: free of grease build-up and manufacturer specifications kept on file.
Range exhaust hood: free of grease build-up and manufacturer specifications kept on file.
Ventilation hoods provided and maintained, lighting fixtures shielded or shatter resistant.
Ventilation hoods provided and maintained, lighting fixtures shielded or shatter resistant.
Ventilation hoods provided and maintained, lighting fixtures shielded or shatter resistant.
OTHER OPERATIONS
*43 Toxic items properly stored, labeled and used.
Toxic items properly stored, labeled and used.
Toxic items properly stored, labeled and used.
Premises: maintained free of litter/unnecessary articles, cleaning/maintenance equipment properly stored, authorized personnel only.
Premises: maintained free of litter/unnecessary articles, cleaning/maintenance equipment properly stored, authorized personnel only.
Premises: maintained free of litter/unnecessary articles, cleaning/maintenance equipment properly stored, authorized personnel only.
Complete separation from living/sleeping quarters and laundry.
Complete separation from living/sleeping quarters and laundry.
Complete separation from living/sleeping quarters and laundry.
Clean and soiled linens properly stored.
Clean and soiled linens properly stored.
Clean and soiled linens properly stored.
8.2.1.4029.1.523496.503679 Food Service Establishment Inspection Report Form.
CG-5145
| Reset.: |
| CurrentPage: |
| PageCount: |
| INSPECTED BY.: |
| DATE OF INSPECTION. Enter as 2 digit month, 2 digit day, 4 digit year.: |
| 46. Clean and soiled linens properly stored. Repeat Violation (R).: |
| 32. Cross connection, backflow prevented. CRITICAL ITEM REQUIRING IMMEDIATE ATTENTION. Inadequate or in violation of the recommendations of the Food Safety and Sanitation TTP. : |
| 32. Cross connection, backflow prevented. CRITICAL ITEM REQUIRING IMMEDIATE ATTENTION. Corrected on Site (C O S).: |
| 32. Cross connection, backflow prevented. CRITICAL ITEM REQUIRING IMMEDIATE ATTENTION. Repeat Violation (R).: |
File details come from the government source that posted it. Updated .