Identity of Plans:
Name of Establishment
Street & Town
Estimate of occupancy (to include patrons and employees)
FLOORS: (list type(s) of material)
Are the floor materials smooth, non-absorbent, made of a washable material?
Are the floors and wall juncture coved?
Are the floors graded to drain where necessary?
WALLS AND CEILINGS: (list type(s) of materials)
Are the materials smooth, non-absorbent, made of a washable material?
Are the walls light in color?
Are the walls washable to level of splash?
Are there any exposed pipes in the food preparation or storage areas?
Are toilet facilities conveniently located?
Are doors self-closing and without louvers?
Ventilation is provided (window or mechanical exhaust)?
Hand washing facilities provided and supplied as required?
Have necessary approvals from the Town Building Official been granted?
HAND WASHING FACILITIES:
Are there adequate and accessible hand washing facilities provided in all food preparation areas, food service areas and dishwashing areas?
Are all hand washing sinks supplied with soap, paper towels and waste receptacles?
SEWAGE AND LIQUID WASTE DISPOSAL:
Public sewer system
Approval granted from TAHD Sanitarian
Grease trap – size in gallons
Have necessary approvals from Water Pollution Control Authority been granted?
Are dishwashing machines, garbage disposals, steam tables, or any other piece of equipment connected to the potable water supply in such a manner as to prevent backflow or back siphonage?
Are there exposed overhead sewer lines in food preparation or storage areas?
Are proper backflow preventers installed on all spigots with a hose connection and the carbonator (if applicable)?
Public Water Supply
Date of most current water analysis
Have necessary approvals from the Department of Public Helath - Water Supplies Section (860) 509-7333 been granted, if establishment water supply is obtained from a private well system?
Is adequate lighting provided in all areas of the establishment?
Are light fixtures proper covered with safety shields and caps or are shatter proof bulbs installed in all food preparation areas, storage areas, display areas and dishwashing areas?
Are safety shields and caps installed or shatter proof bulbs installed in all cooling units, hot-holding units and display cases?
Are hoods provided above all grease-producing cooking units?
Are ventilation systems and exhaust fans installed properly, and therefore do not create a nuisance or health problem at the point of discharge?
Have necessary approvals from the Fire Marshal been granted?
INSECT AND RODENT CONTROL:
Are all outer openings protected against entry of insects and rodents by use of doors, screens, fans, etc.
Are all outer doors self-closing?
Are all openings in floors, walls, and ceilings for pipes, cables, wires, etc. properly chalked or protected?
BULK STORAGE AREA:
Are racks and shelves used for food storage raised to level of 6 inches or above floor? (raised to level of 12 inches or above floor - if storage unit exceeds 24 inches in width)
Are there exposed sewer, water or waste lines over the food storage areas?
Have toxic/poisonous materials been properly stored and labeled in a designated area or separate cabinet?
Has a list of all equipment with manufacturer names and model #s been attached to plan and application?
Is equipment sealed to floor and walls where necessary, mounted on a platform, and moveable to enable cleaning?
Are sneeze guards or other protective devices provided where applicable?
Have the required sinks been installed for food preparation, pot washing, hand washing, utility/ mop sink?
Provide Name and Model Number of Dishwasher
Provide Name and Model Number of Booster Heater
Provide cubic feet of refrigerated storage
Provide cubic feet of frozen food storage
In addition to the proposed plan and application, have you attached a list of foods and beverages to be served?
Has a floor plan, stating size of establishment and location of all equipment, been included with the application?
Has a copy of an approved Qualified Food Operator certificate and the statement assigning the Designated Alternate been provided for the TAHD’s records?
Have you developed an Establishment Food Safety Training Program for all employed food handlers?
Please sign and date below:
Click here to sign
Source: MaintainX (Community Member)