Complete in duplicate and forward the original to the ...

1、 PERMIT APPLICATION FOR FOOD SERVICE ESTABLISHMENTS, EXTENDED FOOD SERVICE OPERATIONS, AND MOBILE FOOD SERVICE BASE OF OPERATIONS NOTICE THIS PERMIT APPLICATION PACKET IS COMPOSED OF THREE PARTS: ADMINISTRATIVE INFORMATION; OPERATIONAL INFORMATION; AND PLAN REVIEW INFORMATION. ADMINISTRATIVE INFORMA

2、TION: THIS INFORMATION WILL BE USED TO ESTABLISH COMMUNICATION BETWEEN THE LOCAL HEALTH AUTHORITY AND THE PERMIT APPLICANT/PERMIT HOLDER. IT WILL ALSO BE USED TO ADMINISTER THE PERMITTING AND ESTABLISHMENT INSPECTION PROCESSES. OPERATIONAL INFORMATION: THIS INFORMATION WILL BE USED TO ENABLE THE LOC

3、AL HEALTH AUTHORITY TO BECOME FAMILIAR WITH THE QUESTIONS OF WHAT TYPES, WHEN, HOW MUCH, AND WHERE FOOD WILL BE PREPARED AND SERVED BY THE PROPOSED FOOD SERVICE ESTABLISHMENT. PLAN REVIEW INFORMATION: IN ACCORDANCE WITH DPH RULE 511-6-1-.02(4)(A), THIS INFORMATION WILL BE UTILIZED BY THE LOCAL HEALT

4、H AUTHORITY IN ITS REVIEW AND APPROVAL PROCESS OF SUBMITTED PLANS AND SPECIFICATIONS FOR PROPOSED NEW CONSTRUCTION, OR REMODELING AND CONVERSION OF EXISTING BUILDINGS FOR PROPOSED FOOD SERVICE ESTABLISHMENTS. ADDITIONALLY, THIS INFORMATION WILL BE UTILIZED BY THE LOCAL HEALTH AUTHORITY TO ACCESS THE

5、 LEVEL OF COMPLIANCE STATUS OF EXISTING FOOD SERVICE ESTABLISHMENTS DURING THE OCCURRENCE OF A CHANGE IN PERMIT HOLDER. AS PER DPH CHAPTER 511-5-14-.02(1)(C), IN ORDER TO QUALIFY FOR A PERMIT TO OPERATE A FOOD SERVICE ESTABLISHMENT, THE PERMIT APPLICANT MUST DEMONSTRATE SATISFACTORY COMPLIANCE WITH

6、DPH CHAPTER 511-5-14. TO RECEIVE A PERMIT FROM THE HEALTH AUTHORITY, THE APPLICANT MUST BE AN OWNER OF THE PROPOSED FOOD SERVICE ESTABLISHMENT OR AN OFFICER OF THE LEGAL OWNERSHIP, AGREE TO ALLOW THE HEALTH AUTHORITY ACCESS TO THE FOOD SERVICE ESTABLISHMENT, PROVIDE ALL REQUIRED INFORMATION REQUESTE

7、D BY THE HEALTH AUTHORITY, AND PAY ALL APPLICABLE FEES; AT THE HEALTH AUTHORITYS INITIAL INSPECTION OF THE COMPLETED FOOD SERVICE ESTABLISHMENT AND PRIOR TO THE ISSUANCE OF A PERMIT BY DEMONSTRATING SATISFACTORILY COMPLIANCE WITH THE PROVISION OF DPH CHAPTER 511-6-1; AND PROVIDING WRITTEN DOCUMENTAT

8、ION INDICATING SATISFACTORY COMPLIANCE WITH ALL OTHER PROVISIONS OF LAWS THAT APPLY TO THE FOOD ESTABLISHMENTS LOCATION, CONSTRUCTION AND MAINTENANCE, AND THE SAFETY OF PERSONS THEREIN. APPROVAL OF ALL OTHER AGENCIES. INSTRUCTIONS: COMPLETE THE FOLLOWING APPLICATION DOCUMENT IN DUPLICATE AND FORWARD

9、 THE ORIGINAL COMPLETED DOCUMENT TO ENVIRONMENTAL HEALTH, IN WHICH THE FOOD SERVICE ESTABLISHMENT IS TO BE LOCATED AND OPERATED. KEEP A COPY OF ALL APPLICATION DOCUMENTS FOR YOUR RECORDS. GLYNN COUNTY FOOD SERVICE PERMIT APPLICATION Step 1 Beginning the Process Pick up an Environmental Health applic

10、ation and design a plan for your food facility by following the “ Plan Review/Construction Guide”. Online construction guide at http:/health.state.ga.us/programs/envservices/FSPlanReviewManual.asp Contact other agencies including your local Building inspection, Joint Water and Sewer, and the Fire In

11、spector for information concerning their requirements. Step 2 Submittal of Application, Plan and FeesTurn in your completed application, and a copy of your plan and a full menu/consumer advisory and plan review fee to the Environmental Health for review. Allow 10 days for Environmental Health to rev

12、iew all applications and plans. Step 3 Plan Review ProcessYour Plan will be reviewed by the EHS. The proposed facility plan is checked according to the requirements of the” Georgia Foodservice Rules and Regulations 511-6-1. New businesses and change of ownership on all facilities will be required to

13、 meet the current laws. Inadequate plans may result in a delay of approval. In this case, a letter may be mailed to you outlining the deficiencies and/or requesting additional information. If any changes on the plans are desired by the facility, revised plans must be submitted to Environmental Healt

14、h for review and approval before construction begins.Step 4 Construction and Pre-opening InspectionsTwo or more inspections may be necessary. One construction inspection to ensure that installation is completed to specifications. Second inspection after construction and before opening for business,

15、is required. The Permit Application fee is due at the time of your final inspection before we issue your Foodservice Permit. All construction should be finished, all other agencies should have given approval, all equipment should be installed and functional and your pre opening checklist should be c

16、omplete,. Step 5 Routine Facility Inspections After you are open for business, your EHS will be making periodic unannounced inspections of your facility. An operating food service facility is required to maintain a clean organized environment in good repair. Employees are required to practice safe a

17、nd sanitary methods of handling food at all times. As a “Food Service Operator” you are required to know the “Georgia Foodservice Rules and Regulations”. Glynn County Environmental Health. 1725 Reynolds Street #105. Brunswick, GA 31520Phone: 912.279.2940 Fax: 912.267.4879ADMINISTRATIVE INFORMATION F

18、OR HEATLH AUTHORITY USE ONLY: Amt. DueDate PaidDate ApprovedCommentsPlan Review FeeYearly Inspection FeeBusiness PlanCompleted ApplicationMenuFloor PlanEquipment ListSite PlanResidency FormSign Off SheetVomitus/Diarrheal Cleanup PlanEmployee Health PolicyVariance/HACCP Plan/Procedures Food Service R

19、isk CategorizationRisk Type IDo not cook any food may reheat commercially precooked ingredientsRisk Type IICook and/or hold and reheat foods that are prepared on siteRisk Type IIIRequires a HACCP Plan Name of Establishment: (Legal business name to appear on permit)Street Address:City: State: ZIP:Pho

20、ne: Email Address: Date of Project BeginingDate of Project Completion New RestaurantNew Extended Food ServiceNew Mobile UnitInstitution (school, hospital, nursing home etc)New Mobile BaseIncubator B (Cubicle/build out units)New Catering OperationWholesalerChange of OwnershipRenovation of Existing Es

21、tablishmentName of Business Owner: (the business owners name or corporation name as it appears on the business license)Street Address:City: State: ZIP:Phone: Email Address: Billing Address:City: State: Zip: Individual Corporation Partnership LLC AssociationIf Corporation, Partnership, LLC, Associati

22、on, or Other Legal Entity, please provide a listing of all persons comprising the legal ownership to include the name(s), title(s), address and phone numbers, including owners and officers. Please attach additional page, if necessary.Name of regional/district manager:(Person who functions as the imm

23、ediate supervisor of the food service managers Street Address:City: State: ZIP:Phone: Email Address: OPERATIONAL INFORMAITONHours of OperationSundayMondayTuesdayWednesdayThursdayFridaySaturdayTotal square feet of facilityNumber of kitchensNumber of BarsTotal number of seatsSeats outsideSeats InsideN

24、umber of meals per dayBreakfastLunch DinnerNumber of Staff (max per shift)Type of service (check all that apply)Sit Down MealsDrive thruTake outOnlineMobile UnitDeliveryCateringOtherPets in outside dining areaCATEGORY (Answer the following based on your operation) (check all that apply): YESNOThin m

25、eats, poultry, fish, eggs (hamburger, sliced meats, fillets)Seafood and shellfishThick meats, whole poultry (roast beef, whole turkey, chickens, hams)Cold processed foods (salads, sandwiches, vegetables)Hot processes foods (soups, stews, rice/noodles, gravy, chowders, casseroles)Bakery goods (pies,

26、custards, cream fillings and toppings)Fresh Fruit/ProduceSpecialty foods (i.e. acidification, curing, drying, reduced oxygen packaging etcEstablishment does not cook any raw animal foods; only reheats commercially precooked ingredientsEstablishment cooks raw animal foods and reheats cooked foods tha

27、t are prepared onsiteEstablishment serves raw or undercooked animal foods in a ready to eat form (i.e. rare steaks/burgers, sashimi, raw oysters etc) OtherIf Applicable, identify all counties and/or locations in Glynn County in which Mobile Unit(s) will operate: _ _Imminent Health HazardIf an immine

28、nt Health Hazard exists because of an emergency such as fire, flood, interruption of electrical or water service for two (2) or more hours, sewage malfunction, misuse of poisonous or toxic materials, onset of an apparent foodborne illness outbreak, gross unsanitary occurrence or condition or other c

29、ircumstances that may endanger public health, then operations shall be immediately discontinued and the Health Authority notified._Signature of Authorized Agent DateSubmit a detailed description of your business plan (which includes a business and concept description, operations plan, identify your

30、market/consumers and services provided, etc. You may obtain a copy of the Rules and Regulations for Food Service by visiting our website at /food-rules-and-regulations FOOD PREPARATION REVIEWSUPERVISIONCFSM:1. Total Number Managers (have supervisory/management responsibility) wh

31、ich are certified in Food Safety? _ 2. Name of CFSM _3. Indicate how and when employees will be trained on employee health policy, food safety, and allergens? Method of training and tracking training? _ GOOD HYGIENIC PRACTICES, PREVENTING CONTAMINATION BY HANDSEMPLOYEE HEALTH:4. Is there a written p

32、olicy to exclude or restrict employees who are ill or have open lesions or cuts? YES q NO q Attach written policy ( must include reportable illnesses and symptoms for exclusion/restriction ):5. Is there a written response procedure for cleaning vomiting or diarrheal events? YES q NO q Attach written

33、 policy:HANDWASHING:6. Is there a hand washing sink in each food preparation and ware washing area? YES q NO q 7. Are there reminder signs at each hand sink explaining the hand wash process? YES q NO q 8. List all 5 hand washing steps:.5. 9. Do all hand washing sinks, including those in the r

34、estrooms, have a mixing valve or combination faucet? YES q NO q 10. Do self-closing metering faucets provide a flow of water for at least 15 seconds without the need to reactivate the faucet? YES q NO q NA11. Is hand soap available at all hand washing sinks? YES q NO q 12. Are hand drying facilities

35、 (paper towels, blowers) available at all hand wash sinks? YES q NO q 13. Are waste receptacles available at each hand sink and covered waste receptacles available in each restroom? YES q NO q 14. Is hot and cold running water under pressure available at each hand sink? YES q NO q NO BARE HAND CONTA

36、CT:15. Which barrier(s) (such as disposable, single use gloves, utensils, food grade paper etc.) do you plan to utilize to prevent handling of ready to eat foods with bare hands? _APPROVED SOURCES16. Are all food supplies from inspected, permitted approved facilities? YES q NO q 17. List suppliers:

37、_18. What are the projected frequencies of deliveries for:Type of FoodDay of the WeekAM / PMFrozen FoodRefrigerated FoodDry Goods19. Provide information on the amount of space ( cubic feet ) allocated forFrozen Storage Cubic FeetRefrigerated Storage Cubic FeetDry Storage Cubic FeetREQUIRED RECORDS,

38、SHELLSTOCK TAGS, PARASITE DESTRUCTION: (Answer Not Applicable if there is no shellstock or raw fish served in this facility)20. What is the record keeping procedure for maintaining shellstock tags? _21. If serving raw fish (sushi, lox, cerviche), will parasite destruction be done on-site or by suppl

39、ier?A. On-site: Provide your procedure on parasite destructionB. Supplier: Provide the name of your supplier and documentation to show parasite destruction. (Each invoice received from the supplier shall state the specific fish by species that have been frozen to meet parasite destruction requiremen

40、ts)PROTECTION FROM CONTAMINATIONFOOD SEPARATED AND PROTECTED: 22. Will raw meats, poultry and seafood be stored in the same refrigerators and freezers with cooked and ready to eat foods? YES q NO q If yes, how will cross-contamination be prevented? (How is food stored from top to bottom in refrigera

41、tion units?) PROPER DISPOSITION OF RETURNED, PREVIOUSLY SERVED FOOD:23. What is the procedure for food that has been returned, previously served? (ie is it discarded, reserved etc)SELF SERVICE AREA(S):24. Will you provide self service food to your customers? YES q NO q 25. Will you have a buffet or

42、salad bar? YES q NO q 26. Is it mechanically refrigerated/ or heated? YES q NO q 27. If no, how is temperature of TCS food maintained?28. How is food in self serve area protected (sneeze guard etc.)? N/A q 29. What will happen to any food leftover from buffet (will it be cooled and reused)? N/A q FO

43、OD CONTACT SURFACES CLEANED AND SANITIZED:DISHWASHING FACILITIES: 30. Will sinks or a dishwasher be used for warewashing? Check all that apply. 3 Compartment sink Chemical Type: Quat, Chlorine, Iodine Concentration: _ Test kit YES q NO q Dish Machine Dishwasher type of sanitizer used:High Temp:_ Boo

44、ster Heater _ Chemical Type: Quat, Chlorine, Iodine Test kit YES q NO q 31. Is ventilation provided for dish machine as required? YES q NO q 32. Do all dish machines have templates with operating instructions? YES q NO q 33. Do all dish machines have temperature/pressure gauges as required that are

45、accurately working? YES q NO q 34. Does the largest pot and pan fit into each compartment of the pot sink? YES q NO q 35. Are there drain boards on both ends of the pot sink? YES q NO q 36. How will large equipment, such as cutting boards, countertops, that CANNOT be submerged in sinks or put throug

46、h a dishwater be sanitized?Chemical Type: Quat, Chlorine, Iodine Concentration: _ Test kit YES q NO q PROPER COOKING TIME AND TEMPERATURE:37. Will food product thermometers be used to measure final cooking/reheating temperatures of TCS* foods? Yes No38. What type of temperature measuring device will

47、 be used? _39. List types of cooking equipment _Minimum cooking time and temperaturesBeef roasts (using convection and conduction heating equipment)130 F (121 minutes)Seafood145 F (15 Seconds)Eggs for immediate service145 F (15 Seconds)Eggs for hot holding or pooled eggs155 F (15 Seconds)Pork 145 F

48、(15 Seconds)Comminuted/Ground Meats/Fish155 F (15 Seconds)Poultry (chicken/Turkey)165 F (15 Seconds)Reheated for hot holding of cooked and cooled TCS foods 165 F (15 Seconds)Reheated commercially precooked TCS foods135 F (15 Seconds)*TCS Temperature controlled for safetyREHEATING:40. How will TCS foods that are cooked, cooled, and reheated for hot holding be reheated so that all parts of the food reach a temperature of at least 165 F for 15 seconds? Indicate the type and number of units for reheating foods._CONSUMER ADVISORY: 41. Will meat, poultry, eggs