PWS Attachment 5 - AF IMT 977 - Food Facility Evaluation.pdf

REINSPECTION DATE FOOD FACILITY EVALUATION

FOOD FACILITY NAME BLDG NO. DATE EVALUATED TIME NLT:

(If required))

DISCREPANCY CATEGORIES

DATE

CORRECTED

DATE

CORRECTED

ITEMS EVALUATED ITEMS EVALUATED

(Check applicable items) (Check applicable items)

MANAGEMENT AND PERSONNEL WATER, PLUMBING, AND WASTE

2-1. SUPERVISION 5-1. WATER

2-2. EMPLOYEE HEALTH 5-2. PLUMBING SYSTEM

2-3. PERSONAL CLEANLINESS 5-3. MOBILE WATER TANK AND MOBILE FOOD

ESTABLISHMENT WATER TANK 2-4. HYGIENIC PRACTICES

FOOD 5-4. SEWAGE, OTHER LIQUID WASTE, AND

RAINWATER 3-1. CHARACTERISTICS

5-5. REFUSE, RECYCLABLES, AND 3-2. SOURCES, SPECIFICATIONS, AND

RETURNABLES ORIGINAL CONTAINERS

PHYSICAL FACILITIES 3-3. PROTECTION FROM CONTAMINATION

AFTER RECEIVING 6-1. MATERIALS FOR CONSTRUCTION AND

REPAIR 3-4. DESTRUCTION OF ORGANISMS OF PUBLIC

HEALTH CONCERN 6-2. DESIGN AND CONSTRUCTION

6-3. NUMBERS AND CAPACITIES 3-5. LIMITATION OF GROWTH OF ORGANISMS

OF PUBLIC HEALTH CONCERN 6-4. LOCATION AND PLACEMENT

6-5. OPERATION AND MAINTENANCE 3-6. FOOD IDENTITY, PRESENTATION, AND

ON-PREMISES LABELING POISONOUS OR TOXIC MATERIALS

3-7. CONTAMINATED FOOD 7-1. LABELING AND IDENTIFICATION

EQUIPMENT, UTENSILS, AND LINENS 7-2. OPERATIONAL SUPPLIES AND

APPLICATION 4-1. MATERIALS FOR CONSTRUCTION AND REPAIR

4-2. DESIGN AND CONSTRUCTION 7-3. STOCK AND RETAIL SALE

4-3. NUMBERS AND CAPACITIES OTHER

4-4. LOCATION AND INSTALLATION

8-401. SELF EVALUATIONS

4-5. MAINTENANCE AND OPERATION

4-6. CLEANING OF EQUIPMENT AND UTENSILS

4-7. SANITIZATION OF EQUIPMENT AND UTENSILS

4-8. LAUNDERING

4-9. PROTECTION OF CLEAN ITEMS

REMARKS AND RECOMMENDATIONS

ROUTINE SIGNATURE OF FACILITY REPRESENTATIVE EXCELLENT SIGNATURE OF EVALUATOR

FOLLOW-UP SATISFACTORY

WALK-THRU MARGINAL

OTHER UNSATISFACTORY

PREVIOUS EDITION IS OBSOLETE. AF IMT 977, 19940501, V2

REMARKS AND RECOMMENDATIONS (Continued)

AF IMT 977, 19940501, V2 (REVERSE)