The documents provided in this Annex are intended to facilitate adoption of the Food Code and the application of its provisions as they relate to applicants' and food employees' health and to food establishment inspections.

Forms 1-A - 1-C, Guides 1-D and 1-E, and List 1-F are designed to assist those responsible for preventing foodborne disease. The Food Code specifies that the permit holder is responsible for requiring applicants and food employees to report certain symptoms, diagnoses, past illnesses, high-risk conditions, and foreign travel as they relate to diseases transmitted through food by infected workers. The food employee is personally responsible for reporting this information to the person in charge.

Forms 2-A and 2-B can be used for the Code adoption process and Forms 3-A and 3-B are provided for use in recording HACCP information and inspectional observations. Guide 3-C is a compressed outline of the Code to use as a tool in locating and citing Code provisions.

The purpose of this form is to ensure that Applicants to whom a conditional offer of employment has been made and Food Employees advise the Person in Charge of past and current conditions described so that the Person in Charge can take appropriate steps to preclude the transmission of foodborne illness.

Applicant or Employee name (print) _______________________________________________________
Address __________________________________________________________________________________
__________________________________________________________________________________________
  Telephone  Daytime:____________________________  Evening:_______________________________

TODAY:

Are you suffering from any of the following:

• 1. Symptoms

  Diarrhea?	YES/NO
  Fever?	YES/NO
  Vomiting?	YES/NO
  Jaundice?	YES/NO
  Sore throat with fever?	YES/NO

  
  

• 2. Lesions containing pus on the hand, wrist or an exposed body part?

  (such as boils and infected wounds however small)

  YES/NO

PAST:

HIGH-RISK CONDITIONS

    Name, Address, and Telephone Number of your Doctor:
    Name    _________________________________________________________________
    Address _________________________________________________________________
    _________________________________________________________________________
    Telephone  Daytime:_____________________  Evening:_______________________
 Signature of Applicant or Food Employee __________________________________ Date ________
 Signature of Permit Holder's Representative ______________________________ Date ________

The purpose of this agreement is to ensure that Food Employees notify the Person in Charge when they experience any of the conditions listed so that the Person in Charge can take appropriate steps to preclude the transmission of foodborne illness.

I AGREE TO REPORT TO THE PERSON IN CHARGE:

FUTURE SYMPTOMS and PUSTULAR LESIONS:

FUTURE MEDICAL DIAGNOSIS:

Whenever diagnosed as being ill with typhoid fever (Salmonella Typhi ), shigellosis (Shigella spp.), Shiga toxin-producing Escherichia coli infection (Escherichia coli O157:H7), or hepatitis A (hepatitis A virus)

FUTURE HIGH-RISK CONDITIONS:

• Exposure to or suspicion of causing any confirmed outbreak of typhoid fever, shigellosis, Shiga toxin-producing Escherichia coli infection, or hepatitis A
   

• 2. A household member diagnosed with typhoid fever, shigellosis, illness due to Shiga toxin-producing Escherichia coli, or hepatitis A
   

• 3. A household member attending or working in a setting experiencing a confirmed outbreak of typhoid fever, shigellosis, Shiga toxin-producing Escherichia coli infection, or hepatitis A
   

I have read (or had explained to me) and understand the requirements concerning my responsibilities under the Food Code and this agreement to comply with:

1. Reporting requirements specified above involving symptoms, diagnoses, and high-risk conditions specified;
2. Work restrictions or exclusions that are imposed upon me; and
3. Good hygienic practices.

I understand that failure to comply with the terms of this agreement could lead to action by the food establishment or the food regulatory authority that may jeopardize my employment and may involve legal action against me.

 Applicant or Food Employee Name (please print) _________________________________________
 Signature of Applicant or Food Employee __________________________________ Date ________
 Signature of Permit Holder's Representative ______________________________ Date ________

The Food Code specifies, under Part 2-2 Employee Health Subpart 2-201 Disease or Medical Condition, that Applicants to whom a conditional offer of employment has been made and Food Employees obtain medical clearance from a physician licensed to practice medicine whenever the individual:

1. Is chronically suffering from a symptom such as diarrhea; or
2. Meets one of the high-risk conditions specified under Paragraph 2-201.11(D) and is suffering from any symptom specified under Subparagraph 2-201.11(B)(1).
3. Has a current illness involving Salmonella Typhi (typhoid fever), Shigella spp. (shigellosis), Shiga toxin-producing Escherichia coli (Shiga toxin-producing Escherichia coli infection), or hepatitis A virus (hepatitis A), or
4. Reports past illness involving S. Typhi (typhoid fever), Shigella spp. (shigellosis), Shiga toxin-producing Escherichia coli, or hepatitis A virus (hepatitis A), if the establishment is a facility serving a highly susceptible population such as preschool age children, immunocompromised persons, or older adults.

REASON FOR MEDICAL REFERRAL: The reason for this referral is checked below:

PHYSICIAN'S CONCLUSION:

COMMENTS: (In accordance with Title I of the Americans with Disabilities Act (ADA) and to provide only the information necessary to assist the food establishment operator in preventing foodborne disease transmission, please confine comments to explaining your conclusion and estimating when the employee may be reinstated.)

___________________________________________________________________________________

 Signature of Physician ___________________________________________________ Date ________

Paraphrased from the FDA Food Code for Physician's Reference

From § 2-201.11(A) Organisms of Concern:

Any foodborne pathogen, with special emphasis on these 4 organisms:

From § 2-201.11(B)(1) Symptoms:

Symptoms associated with an acute gastrointestinal illness such as:

From § 2-201.11(D) High-Risk Conditions Related to a Person's Activities:

1. Suspected of causing a foodborne outbreak or being exposed to an outbreak caused by 1 of the 4 organisms above, at an event such as a family meal, church supper, or festival because the person:
   Prepared or consumed an implicated food; or
   Consumed food prepared by a person who is infected or ill with the organism that caused the outbreak or who is suspected of being a carrier;
2. Lives with, and has knowledge about, a person who is diagnosed with illness caused by 1 of the 4 organisms; or
3. Lives with, and has knowledge about, a person who works where there is an outbreak caused by 1 of the 4 organisms.

From § 2-201.12 Exclusion and Restriction:

Decisions to exclude or restrict a food employee are made considering the available evidence about the person's role in actual or potential foodborne illness transmission. Evidence includes:

• In facilities serving highly susceptible populations such as day care centers and health care facilities, a person for whom there is evidence of foodborne illness is almost always excluded from the food establishment.
• In other establishments that offer food to typically healthy consumers, a person might only be restricted from certain duties, based on the evidence of foodborne illness.
• Exclusion from any food establishment is required when the person is:
  Diagnosed with illness caused by 1 of the 4 organisms of concern; or
  Jaundiced within the last 7 days.

From § 8-501.40 Release of Employee from Exclusion or Restriction:

In addition to local law, these requirements must be met in the situations specified:

• For infection with S. Typhi, the person's stools must be negative for 3 consecutive cultures taken at least 1 month after onset, no earlier than 48 hours after antibiotics are discontinued, and at least 24 hours apart.
• For Shigella spp. or Shiga toxin-producing Escherichia coli infections, the person's stools must be negative for 2 consecutive cultures taken no earlier than 48 hours after antibiotics are discontinued and at least 24 hours apart.
• For hepatitis A virus infection, the symptoms must cease or at least 2 blood tests must show falling liver enzymes.

* High-risk conditions apply only to exclusions under this Subparagraph.

*Where "doctor" is indicated, nurse practitioner or physician assistant, if allowed by law, may provide documentation.

The following list of countries and regions shows where typhoid fever, hepatitis A, and various diarrheal diseases commonly occur or are epidemic as reported to the Centers for Disease Control and Prevention (CDC) by the World Health Organization (WHO). CDC publishes this information annually in what is referred to as the "Yellow Book," Health Information for International Travel. Statistics cited were adapted from CDC's 1996-97 edition in the section entitled "Geographical Distribution of Potential Health Hazards to Travelers." The list is not comprehensive. Reporting to WHO is voluntary and is based on mortality, not morbidity. Where the Yellow Book refers to nonspecific Adiarrheal disease,@ Shiga toxin-producing Escherichia coli has been denoted as a possible cause in the U.S., Canada, Europe, Japan and Argentina.

This list is intended to be used as an aid to increase awareness of the person in charge that travel to some points outside the U.S. may increase the risk for acquiring foodborne illness. The person in charge can use the list to educate food employees about the need to be vigilant in the protection of their health during travel and the importance of informing the person in charge if symptoms occur or if there is a diagnosis of an illness (due to one of the four pathogens listed above) during or following travel.

Northern Africa

Typhoid

Shigellosis

Shiga toxin-producing Escherichia coli

Hepatitis A

Algeria, Egypt, Libyan Arab Jamahiriya, Morocco, and Tunisia

Sub-Saharan Africa

Typhoid

Shigellosis

Shiga toxin-producing Escherichia coli

Hepatitis A

Angola, Benin, Burkina Faso, Burundi, Cameroon, Cape Verde, Central African Republic, Chad, Comoros, Congo, Côte D'Ivoire, Djiouti, Equatorial Guinea, Eritrea, Ethiopia, Gabon, Gambia, Ghana, Guinea, Guinea-Bissau, Kenya, Liberia, Madagascar, Malawi, Mali, Mauritania, Mauritius, Mozambique, Niger, Nigeria, Réunion, Rwanda, Sao Tome and Principe, Senegal, Seychelles, Sierra Leone, Somalia, Sudan, Togo, Uganda, United Republic of Tanzania, Zaire, Zambia, and Zimbabwe.

Southern Africa

Typhoid

Shigellosis

Shiga toxin-producing Escherichia coli

Hepatitis A

Botswana, Lesotho, Namibia, St. Helena, South Africa, and Swaziland.

North America

Typhoid

Shigellosis

Shiga toxin-producing Escherichia coli

Hepatitis A

Bermuda, Canada, Greenland, St. Pierre and Miquelon and the United States of America.

Mainland Middle America

Typhoid

Shigellosis

Shiga toxin-producing Escherichia coli

Hepatitis A

Belize, Costa Rica, El Salvador, Guatemala, Honduras, Mexico, Nicaragua, and Panama.

Caribbean Middle America

Typhoid

Shigellosis

Shiga toxin-producing Escherichia coli

Hepatitis A

Antigua and Barbuda, Aruba, Bahamas, Barbados, British Virgin Islands, Cayman Islands, Cuba, Dominica, Dominican Republic, Grenada, Guadeloupe, Haiti, Jamaica, Martinique, Montserrat, Netherlands Antilles, Puerto Rico, St. Christopher and Nevis, Saint Lucia, Saint Vincent, and the Grenadines, Trinidad and Tobago, Turks and Caicos Islands, and the Virgin Islands (USA).

Tropical South America

Typhoid

Shigellosis

Shiga toxin-producing Escherichia coli

Hepatitis A

Bolivia, Brazil, Colombia, Ecuador, French Guiana, Guyana, Paraguay, Peru, Suriname, and Venezuela.

Temperate South America

Typhoid

Shigellosis

Shiga toxin-producing Escherichia coli

Hepatitis A

Argentina, Chile, Falkland Islands (Malvinas), and Uruguay.

East Asia

Typhoid

Shigellosis

Shiga toxin-producing Escherichia coli

Hepatitis A

China, the Democratic People=s Republic of Korea, Hong Kong, Japan, Macao, Mongolia, and the Republic of Korea.

Eastern South Asia

Typhoid

Shigellosis

Shiga toxin-producing Escherichia coli

Hepatitis A

Brunei Darussalam, Cambodia, Indonesia, Lao People's Democratic Republic, Malaysia, Myanmar (formerly Burma), the Philippines, Singapore, Thailand, and Viet Nam.

Middle South Asia

Typhoid

Shigellosis

Shiga toxin-producing Escherichia coli

Hepatitis A

Afghanistan, Armenia, Azerbaijan, Bangladesh, Bhutan, India, Islamic Republic of Iran, Kazakhstan, Kyrgyzstan, Maldives, Nepal, Pakistan, Sri Lanka, Tajikistan, Turkmenistan, and Uzbekistan.

Western South Asia

Typhoid

Shigellosis

Shiga toxin-producing Escherichia coli

Hepatitis A

Bahrain, Cyprus, Iraq, Israel, Jordan, Kuwait, Lebanon, Oman, Qatar, Saudi Arabia, Syrian Arab Republic, Turkey, the United Arab Emirates, and Yemen.

Northern Europe

Typhoid

Shigellosis

Shiga toxin-producing Escherichia coli

Hepatitis A

Belarus, Belgium, Czech Republic, Denmark (with the Faroe Islands), Estonia, Finland, Germany, Iceland, Ireland, Latvia, Lithuania, Luxembourg, Netherlands, Norway, Poland, Republic of Moldova, Russian Federation, Slovakia, Sweden, Ukraine, and the United Kingdom (with the Channel Islands and the Isle of Man).

Southern Europe

Typhoid

Shigellosis

Shiga toxin-producing Escherichia coli

Hepatitis A

Albania, Andorra, Austria, Bosnia, and Herzegovina, Bulgaria, Croatia, France, Gibraltar, Greece, Hungary, Italy, Liechtenstein, Malta, Monaco, Portugal (with the Azores and Madeira), Romania, San Marino, Slovenia, Spain (with the Canary Islands), Switzerland, and the former Yugoslav Republic of Macedonia, and Yugoslavia.

Australia, New Zealand & Antarctic

Typhoid

Shigellosis

Shiga toxin-producing Escherichia coli

Hepatitis A

Melanesia & Micronesia (Polynesia)

Typhoid

Shigellosis

Shiga toxin-producing Escherichia coli

Hepatitis A

American Samoa, Cook Islands, Easter Island, Federated States of Micronesia, Fiji, French Polynesia, Guam, Kiribati, Marshall Islands, Nauru, New Caledonia, Niue, Palau, Papua New Guinea, Pitcairn, Samoa, Solomon Islands, Tokelau, Tonga, Trust Territory of the Pacific Islands, Tuvalu, Vanuata, Wake Island (U.S.) and the Wallis and Futuna Islands.

This "short form" may be used by governmental bodies adopting the Food Code where authorized by law. Use of the adoption by reference form may substantially reduce the cost of publishing and printing.

The description of the Food Code, below, includes Chapter 8 and the Chapter 8 annex (Annex 1). Modifications to the description may be necessary, based on what provisions are being adopted and whether they are being adopted as law or regulation.

Section 2 lists provisions that may require modifications to be consistent with existing law or that require insertion of dollar amounts.

___(statute/regulation/ordinance)_____ Number __________

ADOPTING THE 2001 EDITION OF THE "FOOD CODE" REGULATING THE RETAIL SALE, COMMERCIAL AND INSTITUTIONAL SERVICE, AND VENDING OF FOOD; DEFINING PERMIT HOLDER, PERSON IN CHARGE, EMPLOYEE, FOOD, POTENTIALLY HAZARDOUS FOOD, FOOD ESTABLISHMENT, SAFE MATERIAL, SANITIZATION, AND OTHER TERMS; AND PROVIDING STANDARDS FOR EMPLOYEE FOOD SAFETY KNOWLEDGE, HEALTH, AND PRACTICES; FOOD SOURCES, PREPARATION, HOLDING TEMPERATURES, AND PROTECTION; EQUIPMENT DESIGN, CONSTRUCTION, INSTALLATION, CLEANING, AND SANITIZATION; WATER, AND LIQUID AND SOLID WASTES; FACILITIES CONSTRUCTION AND MAINTENANCE, AND STORAGE AND USE OF POISONOUS AND TOXIC MATERIALS; REQUIRING A PERMIT TO OPERATE A FOOD ESTABLISHMENT; AND PROVIDING FOR THE RESTRICTION OR EXCLUSION OF EMPLOYEES, THE EXAMINATION AND CONDEMNATION OF FOOD, AND THE ENFORCEMENT OF THIS CODE INCLUDING THE SETTING OF PENALTIES.

The __(governing body)__ of the __(jurisdiction)__ does ordain as follows:

SECTION 1. ADOPTION OF FOOD CODE

That a certain document, three copies of which are on file in the office of the (jurisdiction's keeper of records) of the __(type of jurisdiction)__ of __(name of jurisdiction)__ being marked and designated as the Food Code, 2001 Recommendations of the United States Public Health Service/Food and Drug Administration as published by the U.S. Department of Health and Human Services, Public Health Service, Food and Drug Administration be, and is hereby adopted as, the Food Code of __(type of jurisdiction)__ of __(name of jurisdiction)__ in the State of (state name); for regulating the design, construction, management and operation of food establishments, and providing for plans submission and approval and the issuance of permits and collection of fees therefore.

SECTION 2. INSERTIONS AND CHANGES

That the following provisions are hereby revised as follows:

Paragraph 8-811.10(B) Insert (Dollar Amount)
Paragraph 8-813.10(B) Insert (Dollar Amounts)
Subparagraph 8-811.10(B)(2) Insert (Number of Year(s))

SECTION 3. INCONSISTENT CODES REPEALED

That (statute/regulation/ordinance) number (present code number) of the (jurisdiction) titled,
(complete title of the food code[s] in effect at the present time so they will be repealed by definite mention)
and all other codes or portions of codes in conflict herewith are hereby repealed in that respect only.

SECTION 4. CERTIFICATION OF ADOPTION AND PUBLISHING

That the ___(jurisdiction's keeper of records)___ shall certify the adoption of this
(statute/regulation/ordinance___ and cause the same to be published as required by law.

SECTION 5. EFFECTIVE DATE

That this Code and the rules, regulations, provisions, requirements, orders, and matters established and
adopted hereby shall take effect and be in full force and effect (time period) from and after the date of
its final passage and approval.

PASSED AND APPROVED BY (name of adopting authority) on this (day) of (month, year) .

BY: ____________________________________

Examples of how some jurisdictions have set fines, sentences, and penalties:

California law provides:

A. For Food Manufacturing Violations:

Criminal fines and sentence for violations of up to $10,000 and one year imprisonment if there is shown an intent to defraud or mislead, and

Civil penalties of up to $5,000 per day for certain violations.

B. For Retail Food Violations:

Criminal fines and sentence for violations of not less than twenty-five dollars ($25) or more than one thousand dollars ($1000) for each offense, or by imprisonment in the county jail for a term not exceeding six months, or by both such fine and imprisonment.

Maryland law provides:

Criminal fines and sentence for certain violations of up to $10,000 and one year imprisonment, and in the case of repeat code violation convictions, up to $25,000 and three years imprisonment; and

Civil penalties of up to $5,000 for each violation and for each day the violation continues.

Texas law provides:

Criminal fines and sentence for certain violations of up to $10,000 and two years imprisonment; and

Assessment of five "severity" levels of administrative or civil penalties with base amounts ranging from $1,250 through $10,000. Base amounts can be decreased or increased by as much as 50% considering factors such as past performance, good faith, direct impact on health and safety, high-risk populations involved, etc.

Federal law provides under the Criminal Fine Enforcement Act of 1984 for a fine up to $100,000 for a misdemeanor by a corporation or individual not resulting in death and, for misdemeanors resulting in death, a fine of up to $250,000 for individuals and $500,000 for corporations.

This "long form" may be used by governmental bodies adopting the Food Code section-by-section.

The description of the "Food Code," below, includes Chapter 8 and the Chapter 8 annex (Annex 1). Modifications to the description may be necessary, based on what provisions are being adopted and whether they are being adopted as law or regulation.

Section 2 lists provisions that may require modifications to be consistent with existing law or that require insertion of dollar amounts.

__(statute/regulation/ordinance)__ Number _________

ADOPTING A CODE REGULATING THE RETAIL SALE, COMMERCIAL AND INSTITUTIONAL SERVICE, AND VENDING OF FOOD; DEFINING PERMIT HOLDER, PERSON IN CHARGE, EMPLOYEE, FOOD, POTENTIALLY HAZARDOUS FOOD, FOOD ESTABLISHMENT, SAFE MATERIAL, SANITIZATION, AND OTHER TERMS; AND PROVIDING STANDARDS FOR EMPLOYEE FOOD SAFETY KNOWLEDGE, HEALTH, AND PRACTICES; FOOD SOURCES, PREPARATION, HOLDING TEMPERATURES, AND PROTECTION; EQUIPMENT DESIGN, CONSTRUCTION, INSTALLATION, CLEANING AND SANITIZATION; WATER, AND LIQUID AND SOLID WASTES; FACILITIES CONSTRUCTION AND MAINTENANCE, AND STORAGE AND USE OF POISONOUS AND TOXIC MATERIALS; REQUIRING A PERMIT TO OPERATE A FOOD ESTABLISHMENT; AND PROVIDING FOR THE RESTRICTION OR EXCLUSION OF EMPLOYEES, THE EXAMINATION AND CONDEMNATION OF FOOD, AND THE ENFORCEMENT OF THIS CODE INCLUDING THE SETTING OF PENALTIES.

The ___(governing body)___ of the ___(jurisdiction)___ does ordain as follows:

(REPRINT THE FOOD CODE, 2001 RECOMMENDATIONS OF THE UNITED STATES PUBLIC
HEALTH SERVICE/FOOD AND DRUG ADMINISTRATION, SECTION-BY-SECTION)

SECTION 2. INSERTIONS AND CHANGES

That the following provisions may need to be completed as follows:

Paragraph 8-811.10(B) Insert (Dollar Amount)
Paragraph 8-813.10(B) Insert (Dollar Amounts)
Subparagraph 8-811.10(B)(2) Insert (Number of Year(s))

SECTION 3. INCONSISTENT CODES REPEALED

That ___(statute/regulation/ordinance)___ number ___(present code number)___ of the ___(jurisdiction)___ titled, (complete title of the food code[s] in effect at the present time so they will be repealed by definite mention) and all other codes or portions of codes in conflict herewith are hereby repealed in that respect only.

SECTION 4. CERTIFICATION OF ADOPTION AND PUBLISHING

That the ___(jurisdiction's keeper of records)___ shall certify the adoption of this (statute/regulation/ordinance and cause the same to be published as required by law.

SECTION 5. EFFECTIVE DATE

That this Code and the rules, regulations, provisions, requirements, orders, and matters established and adopted hereby shall take effect and be in full force and effect ___(time period)___ from and after the date of its final passage and approval.

PASSED AND APPROVED BY __(name of adopting authority)__ on this __(day)__ of __(month, year)__.

BY:____________________________________

Examples of how some jurisdictions have set fines, sentences, and penalties:

California law provides:

A. For Food Manufacturing Violations:

Criminal fines and sentence for violations of up to $10,000 and one year imprisonment if there is shown an intent to defraud or mislead, and

Civil penalties of up to $5,000 per day for certain violations.

B. For Retail Food Violations:

Criminal fines and sentence for violations of not less than twenty-five dollars ($25) or more than one thousand dollars ($1000) for each offense, or by imprisonment in the county jail for a term not exceeding six months, or by both such fine and imprisonment.

Maryland law provides:

Criminal fines and sentence for certain violations of up to $10,000 and one year imprisonment, and in the case of repeat code violation convictions, up to $25,000 and three years imprisonment; and

Civil penalties of up to $5,000 for each violation and for each day the violation continues.

Texas law provides:

Criminal fines and sentence for certain violations of up to $10,000 and two years imprisonment; and

Assessment of five "severity" levels of administrative or civil penalties with base amounts ranging from $1,250 through $10,000. Base amounts can be decreased or increased by as much as 50% considering factors such as past performance, good faith, direct impact on health and safety, high-risk populations involved, etc.

Federal law provides under the Criminal Fine Enforcement Act of 1984 for a fine up to $100,000 for a misdemeanor by a corporation or individual not resulting in death and, for misdemeanors resulting in death, a fine of up to $250,000 for individuals and $500,000 for corporations.

The HACCP Inspection Data form is designed to accommodate the recording of observations during an inspection. The design of the form focuses on information related to the flow of potentially hazardous foods being prepared, displayed, sold, and served within the establishment. The form is intended as a worksheet for use in noting food temperatures/times at each step and other pertinent data as they compare to the established critical limits. This juxtaposition of the observations and the critical limits highlights the violative steps. The information then is transferred to the Establishment Inspection Report form.

Refer to Annex 4, Food Establishment Inspection, Sections 5 and 10, for further discussion regarding the use of the form.

DEPARTMENT OF HEALTH AND HUMAN SERVICES PUBLIC HEALTH SERVICE FOOD AND DRUG ADMINISTRATION

HACCP INSPECTION DATA

The food establishment inspection report is the official agency document regarding compliance of the establishment with agency requirements. The goal of the report is to clearly, concisely, and fairly present the compliance status of the establishment and to convey compliance information to the permit holder or person in charge at the conclusion of the inspection. The Food Establishment Inspection Report form is provided as a model for use during routine, follow-up, and investigative inspections.

Refer to Annex 4, Food Establishment Inspection, Sections 6, 11, and 12, for further discussion.

DEPARTMENT OF HEALTH AND HUMAN SERVICES PUBLIC HEALTH SERVICE FOOD AND DRUG ADMINISTRATION

FOOD ESTABLISHMENT INSPECTION REPORT

Violations cited in this report shall be corrected within the time frames specified below, but within a period not to exceed 10 calendar days for critical items (§ 8-405.11) or 90 days for noncritical items (§ 8-406.11).

 ESTABLISHMENT:                               PERMIT NUMBER:                DATE:

 ADDRESS:                                   CITY:                    STATE:     ZIP:

 PERSON IN CHARGE / TITLE:                                               TELEPHONE:

 INSPECTOR / TITLE:

 INSPECTION TYPE:     ROUTINE    FOLLOW-UP    COMPLAINT    OTHER:               TIME:

Food Establishment Inspection Report Page __ of __

FOOD ESTABLISHMENT INSPECTION REPORT

 ESTABLISHMENT:                               PERMIT NUMBER:                DATE:

Food Establishment Inspection Report Page __ of __

The major headings from each of the Code chapters have been extracted and condensed in this Guide to key word phrases to assist the person conducting inspections in locating the Code citation that corresponds to a given violation. The Guide is intended to be used during inspections as an aid in referencing Code provisions, ensuring that provisions of the Code are not overlooked during the inspection, and accurately completing the Food Establishment Inspection Report form.

Text version of summary chart 4-C

Example: The morning of October 1, a chicken was cooked, then cooled, refrigerated for 2 days at 41°F and then frozen. If the chicken is thawed October 10, the food must be consumed or discarded no later than midnight of October 14.

This table is a plan review and inspectional guide for mobile food establishments based on the mobile unit's menu and operation. Mobile units range in type from push carts to food preparation catering vehicles.

To use the table, read down the columns based on the menu and operation in use. For example, if only prepackaged potentially hazardous food is served, then requirements listed in the Potentially Hazardous Menu - Prepackaged column apply. Likewise, if only food that is not potentially hazardous is prepared on board, then requirements listed in the Not Potentially Hazardous Menu - Food Preparation column apply. Note that if a mobile food establishment has available for sale to the consumer both prepackaged potentially hazardous food and potentially hazardous food prepared on board, then the more stringent requirements of the Potentially Hazardous Menu - Food Preparation column apply.

It is important to remember that mobile units may also be subject to all Food Code provisions that apply to food establishments. Consult the local regulatory authority for specific local requirements.

The local regulatory authority's decision to require auxiliary support services such as a commissary or servicing area should be based on the menu, type of operation and availability of on-board or on-site equipment.

NOTE: The Food Code definition of "Food Establishment" does not include an establishment that offers only prepackaged foods that are not potentially hazardous.

* April 2004 Update: Editorial edits were made to the 2001 Food Code to incorporate the Errata Sheet, corrections since original posting date, and for content accuracy. Links were also added where references exist to other parts/sections of the Food Code, the Code of Federal Regulations, the United States Code, and the Supplement to the 2001 Food Code.

Return to Chart 4-C