HomeMy Public PortalAboutFood Plan Review Application fillable_202009040835129192
Larry Ramdin, MPH, REHS, CHO, CP-FS
Director of Public Health
TOWN OF WATERTOWN
Board of Health
Administration Building
149 Main Street
Watertown, MA 02472
Phone: 617-972-6446
Fax: 617-972-6499
www.watertown-ma.gov
Fees: New Establishment: $100.00 Minor Renovations, Change of Equipment, or Menu: $ 50.00 Major Renovations: $50.00
Make Checks payable to: “Town of Watertown” No cash is accepted
FOOD ESTABLISHMENT PLAN REVIEW APPLICATION
____NEW ____REMODEL ____CONVERSION
Date: __________________
Name of Establishment:
Category: Restaurant , Institution , Daycare , Retail Market , Other .
Address:
Phone if available:
Name of Owner:
Mailing Address:
Telephone: Email:
Applicant's Name:
Title (owner, manager, architect, etc.):
Mailing Address:
Telephone: Email:
I have submitted plans/applications to the following authorities on the following dates:
__________ Licensing Board __________Plumbing
__________Zoning __________ Police
__________Building __________ Fire
__________ Electric __________ Other
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Hours of Operation: Sun ______ Thurs______
Mon ______ Fri _______
Tues______ Sat _______
Wed ______
Number of Seats:
Number of Staff:
(Maximum per shift)
Total Square Feet of Facility:
Number of Floors on which
operations are conducted
Maximum Meals to be Served:
(approximate number)
Breakfast
Lunch
Dinner
Projected Date for Start of
Project:
Projected Date for Completion
of Project:
Type of Service:
(check all that apply) Sit Down Meals Mobile Vendor
Take Out Caterer
Frozen Dessert Bakery
Seasonal Food Other
Enclose the following documents:
o Proposed Menu (including seasonal, off-site and banquet menus)
o Manufacturer Specification sheets for each piece of equipment shown on the plan
o Site plan showing location of business in building; location of building on site including alleys,
streets; and location of any outside equipment (dumpsters, well, septic syst em - if applicable)
o Plan (floor and elevations shown) drawn to scale of food establishment showing location of
equipment, plumbing, electrical services and mechanical ventilation
o Equipment schedule
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CONTENTS AND FORMAT OF FLOOR PLANS AND SPECIFICATIONS
1. Provide plans that are a minimum of 11 x 14 inches in size including the layout of the floor plan
accurately drawn to a minimum scale of 1/4 inch = 1 foot. This is to allow for ease in reading plans.
a. Include: proposed menu, seating capacity, and projected daily meal volume for food service
operations.
b. Show the location and elevated drawings of all food equipment. Each piece of equipment must
be clearly labeled on the plan with its common name. Submit drawings of self-service hot and
cold holding units with sneeze guards.
c. Designate clearly on the plan equipment for adequate rapid cooling, including ice baths and
refrigeration, and for hot-holding potentially hazardous foods.
d. Label and locate separate food preparation sinks when the menu dictates to preclude
contamination and cross-contamination of raw and ready-to-eat foods.
e. Clearly designate adequate hand washing lavatories for each toilet fixture and in the immediate
area of food preparation.
f. Provide the room size, aisle space, space between and behind equipment and the placement of
the equipment on the floor plan.
g. On the plan represent auxiliary areas such as storage rooms, garbage rooms, toilets, basements
and/or cellars used for storage or food preparation. Show all features of these rooms as required
by this guidance manual.
h. Include and provide specifications for:
i. Entrances, exits, loading/unloading areas and docks;
ii. Complete finish schedules for each room including floors, walls, ceilings and coved juncture
bases;
iii. Plumbing schedule including location of floor drains, floor sinks, water supply lines,
overhead waste-water lines, hot water generating equipment with capacity and recovery rate,
backflow prevention, and wastewater line connections;
iv. Lighting schedule with protectors;
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1. At least 110 lux (10 foot candles) at a distance of 75 cm (30 inches) above the floor, in
walk-in refrigeration units and dry food storage areas and in other areas and rooms during
periods of cleaning;
2. At least 220 lux (20 foot candles):
a. At a surface where food is provided for consumer self-service such as buffets and
salad bars or where fresh produce or packaged foods are sold or offered for
consumption;
b. Inside equipment such as reach-in and under-counter refrigerators;
c. At a distance of 75 cm (30 inches) above the floor in areas used for hand washing,
ware washing, and equipment and utensil storage, and in toilet rooms; and
3. At least 540 lux (50 foot candles) at a surface where a food employee is working with
food or working with utensils or equipment such as knives, slicers, grinders, or saws
where employee safety is a factor.
i. Food Equipment schedule to include make and model numbers and listing of equipment that is
certified or classified for sanitation by an ANSI accredited certification program (when
applicable).
j. Source of water supply and method of sewage disposal. Provide the location of these facilities
and submit evidence that state and local regulations are complied with;
k. A color coded flow chart demonstrating flow patterns for:
- food (receiving, storage, preparation, service);
- food and dishes (portioning, transport, service);
- dishes (clean, soiled, cleaning, storage);
- utensil (storage, use, cleaning);
- trash and garbage (service area, holding, storage);
l. Ventilation schedule for each room;
m. A mop sink or curbed cleaning facility with facilities for hanging wet mops;
n. Garbage can washing area/facility;
o. Cabinets for storing toxic chemicals;
p. Dressing rooms, locker areas, employee rest areas, and/or coat rack as required;
2. Site plan (plot plan)
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FOOD PREPARATION REVIEW
Check categories of Time/Temperature Control for Safety Foods (TCS) to be handled, prepared and
served.
CATEGORY* (YES) (NO)
1. Thin meats, poultry, fish, eggs (hamburger; sliced meats; fillets) ( ) ( )
2. Thick meats, whole poultry (roast beef; whole turkey, chickens, hams) ( ) ( )
3. Cold processed foods (salads, sandwiches, vegetables) ( ) ( )
4. Hot processed foods (soups, stews, rice/noodles, gravy, chowders,
casseroles)
( ) ( )
5. Bakery goods (pies, custards, cream fillings & toppings) ( ) ( )
6. Other_______________________________________________________________________
* A generic HACCP plan for each category of food may be available from the
regulatory authority for reference.
PLEASE CIRCLE/ANSWER THE FOLLOWING QUESTIONS
FOOD SUPPLIES:
7. Are all food supplies from inspected and approved sources? YES / NO
8. What are the projected frequencies of deliveries for frozen foods , Refrigerated
foods , and Dry goods .
9. Provide information on the amount of space (in cubic feet) allocated for:
Dry storage , Refrigerated Storage , and
Frozen storage .
10. Describe how will dry goods be stored off the floor?
COLD STORAGE:
11. Is adequate and approved freezer and refrigeration available to store frozen foods frozen and
refrigerated foods at 41°F (5°C) and below? YES / NO
12. Will raw meats, poultry and seafood be stored in the same refrigerators and freezers with
cooked/ready-to-eat foods? YES / NO
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a. If yes, how will cross-contamination be prevented?
13. Does each refrigerator/freezer have a thermometer? YES / NO
Number of refrigeration units: Number of freezer units:
14. Is there a bulk ice machine available? YES / NO
THAWING FROZEN TIME/TEMPERATURE CONTROL FOR SAFETY FOOD:
Please indicate by checking the appropriate boxes how frozen Time/Temperature Control for Safety
Foods (TCS) in each category will be thawed. More than one method may apply. Also, indicate where
thawing will take place.
Thawing Method *THICK FROZEN FOODS *THIN FROZEN FOODS
Refrigeration
Running Water Less than
70°F(21°C)
Microwave (as part of cooking
process)
Cooked from Frozen state
Other (describe)
*Frozen foods: approximately one inch or less = thin, and more than an inch = thick.
COOKING:
16. Will food product thermometers be used to measure final cooking/reheating temperatures of TCS
foods? YES / NO
1. What type of temperature measuring device: __________________________
Minimum cooking time and temperatures of product utilizing convection and conduction heating
equipment:
beef roasts 130°F (121 min)
solid seafood pieces 145°F (15 sec)
other PHF's 145°F (15 sec)
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eggs:
Immediate service 145°F (15 sec)
pooled* 155°F (15 sec)
(*pasteurized eggs must be served to a highly susceptible
population)
pork 145°F (15 sec)
comminuted meats/fish 155°F (15 sec)
poultry 165°F (15 sec)
reheated PHF's 165°F (15 sec)
17. List types of cooking equipment.
HOT / COLD HOLDING:
18. How will hot TCS foods be maintained at 135°F or above during holding for service? Indicate
type and number of hot holding units.
19. How will cold TCS foods be maintained at 41°F or below during holding for service? Indicate
type and number of cold holding units.
COOLING:
20. Please indicate by checking the appropriate boxes how TCS foods will be cooled to 41°F (5°C)
within 6 hours (135°F to 70°F in 2 hours and 70°F to 41°F in 4 hours). Also, indicate where the
cooling will take place.
COOLING
METHOD
THICK
MEATS
THIN
MEATS
THIN
SOUPS/
GRAVY
THICK
SOUPS/
GRAVY
RICE/
NOODLES
Shallow Pans
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Ice Baths
Reduce
Volume or
Size
Rapid Chill
Other
(describe)
REHEATING:
21. 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 type and number
of units used for reheating foods.
22. How will reheating foods to 165°F for hot holding be done rapidly and within 2 hours?
PREPARATION:
23. Please list the categories of foods prepared more than 12 hours in advance of service.
24. Will disposable gloves and/or utensils and/or food grade paper be used to prevent handling of
ready-to-eat foods? YES / NO
25. Will ingredients for cold ready-to-eat foods such as tuna, mayonnaise and eggs for salads and
sandwiches be pre-chilled before being mixed and/or assembled? YES / NO
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If not, describe how will ready-to-eat foods be cooled to 41°F?
26. Will all produce be washed on-site prior to use? YES / NO
27. Is there a separate sink designated for washing produce? YES / NO
If not, describe the procedure for cleaning and sanitizing multiple use sinks
between uses.
28. Describe the procedure used for minimizing the length of time TCS foods will be kept in the
temperature danger zone (41°F - 135°F) during preparation.
29. How will cooking equipment, cutting boards, counter tops and other food contact surfaces which
cannot be submerged in sinks or put through a dishwasher be sanitized? Please describe process:
Chemical sanitizer type:
Concentration:
Test kits available: YES / NO
30. Will the facility be serving food to a highly susceptible population? YES / NO
If yes, how will the temperature of foods is maintained while being transferred
between the kitchen and service area?
FINISH SCHEDULE
34. Applicant must indicate which materials (quarry tile, stainless steel, 4" plastic coved molding,
etc.) will be used in the following areas.
Kitchen FLOOR COVING WALLS CEILING
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Bar
Food Storage
Other Storage
Toilet Rooms
Dressing Rooms
Garbage &
Refuse Storage
Mop Service
Basin Area
Ware washing
Area
Walk-in
Refrigerators
and Freezers
INSECT AND RODENT CONTROL
Applicant must check the appropriate boxes.
YES NO NA
36. Will all outside doors be self-closing and rodent proof? ( ) ( ) ( )
37. Are screen doors provided on all entrances left open to the outside? ( ) ( ) ( )
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38. Do all openable windows have a minimum #16 mesh screening? ( ) ( ) ( )
39. Is the placement of electrocution devices identified on the plan? ( ) ( ) ( )
40. Will all pipes & electrical conduit chases be sealed; ventilation systems
exhaust and intakes protected?
( ) ( ) ( )
41. Is area around building clear of unnecessary brush, litter, boxes and other
harborage? ( ) ( ) ( )
42. Will air curtains be used? If yes, where? ________________ ( ) ( ) ( )
GARBAGE AND REFUSE
Inside
43. Do all containers have lids? ( ) ( ) ( )
44. Will refuse be stored inside? ( ) ( ) ( )
45. If so, where? ___________________________________________________
46. Is there an area designated for garbage can or floor mat cleaning? ( ) ( ) ( )
Outside
47. Will a dumpster be used?
Number ________ Size ________ Frequency of pickup ___________
Contractor ___________________
( ) ( ) ( )
48. Will a compactor be used?
Number ________ Size ________ Frequency of pick up ___________
Contractor ___________________
( ) ( ) ( )
49. Will garbage cans be stored outside? ( ) ( ) ( )
50. Describe surface and location where dumpster/compactor/garbage cans are to be stored
51. Describe location of grease storage receptacle
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52. Is there an area to store recycled containers? ( ) ( ) ( )
Indicate what materials are required to be recycled;
( ) Glass ( ) Metal
( ) Paper ( ) Cardboard
( ) Plastic ( ) Other
53. Is there any area to store returnable damaged goods? ( ) ( ) ( )
PLUMBING CONNECTIONS
Applicant must check the appropriate boxes.
AIR
GAP
AIR
BREAK
*INTEGRAL
TRAP
*"P"
TRAP
VACUUM
BREAKER
CONDENSATE
PUMP
Toilet
Urinals
Dishwasher
Garbage Grinder
Ice machines
Ice storage bin
Sinks
a. Mop
b. Janitor
c. Hand wash
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d. 3 Compartment
e. 2 Compartment
f. 1 Compartment
g. Water Station
Steam tables
Dipper wells
Refrigeration
condensate/ drain
lines
Hose connection
Potato peeler
Beverage Dispenser
w/carbonator
Other
_____________
* TRAP: A fitting or device which provides a liquid seal to prevent the emission of sewer gases without
materially affecting the flow of sewage or waste water through it. An integral trap is one that is built
directly into the fixture, e.g., a toilet fixture. A “P” trap is a fixture trap that provides a liquid seal in the
shape of the letter “P”. Full “S” traps are prohibited.
54. Are floor drains provided & easily cleanable, if so, indicate location:
WATER SUPPLY
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55. Is water supply public ( ) or private ( )?
56. If private, has source been approved? YES ( ) NO ( ) PENDING ( )
2. Please attach copy of written approval and/or permit.
57. Is ice made on premises ( ) or purchased commercially ( )?
If made on premise, are specifications for the ice machine provided? YES ( ) NO ( )
Describe provision for ice scoop storage:
Provide location of ice maker or bagging operation
58. What is the capacity of the hot water generator?
59. Is the hot water generator sufficient for the needs of the establishment?
60. Is there a water treatment device? YES ( ) NO ( )
If yes, how will the device be inspected & serviced?
61. How are backflow prevention devices inspected & serviced?
SEWAGE DISPOSAL
62. Is building connected to a municipal sewer? YES ( ) NO ( )
63. If no, is private disposal system approved? YES ( ) NO ( ) PENDING ( )
Please attach copy of written approval and/or permit.
64. Are grease traps provided? YES ( ) NO ( )
If so, where?
Provide schedule for cleaning & maintenance of grease traps
DRESSING ROOMS
65. Are dressing rooms provided? YES ( ) NO ( )
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66. Describe storage facilities for employees' personal belongings (i.e., purse, coats, boots,
umbrellas, etc.)
GENERAL
67. Are insecticides/rodenticides stored separately from cleaning & sanitizing agents?
YES ( ) NO ( )
Indicate location:
68. Are all toxics for use on the premise or for retail sale (this includes personal medications), stored
away from food preparation and storage areas? YES ( ) NO ( )
69. Are all containers of toxics including sanitizing spray bottles clearly labeled? YES ( ) NO ( )
70. Will linens be laundered on site? YES ( ) NO ( )
If yes, what will be laundered and where?
If no, how will linens be cleaned?
71. Is a laundry dryer available? YES ( ) NO ( )
72. Location of clean linen storage:
73. Location of dirty linen storage:
74. Are containers constructed of safe materials to store bulk food products? YES ( ) NO ( )
Indicate type:
EXHAUST HOODS
75. Indicate all areas where exhaust hoods are installed:
LOCATION FILTERS
&/OR
EXTRACTION
DEVICES
SQUARE
FEET
FIRE
PROTECTION
AIR
CAPACITY
CFM
AIR
MAKEUP
CFM
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76. How is each listed ventilation hood system cleaned and what is the frequency?
SINKS
77. Is a mop sink present? YES ( ) NO ( )
If no, please describe facility for cleaning of mops and other equipment:
78. If the menu dictates, is a food preparation sink present? YES ( ) NO ( )
DISHWASHING FACILITIES
79. Will sinks or a dishwasher be used for ware washing?
Dishwasher ( )
Two compartment sink ( )
Three compartment sink ( )
80. Dishwasher
Type of sanitization used:
i. Hot water (temp. provided)
ii. Booster heater
iii. Chemical type
Is ventilation provided? YES ( ) NO ( )
81. Do all dish machines have templates with operating instructions? YES ( ) NO ( )
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82. Do all dish machines have temperature/pressure gauges as required that are accurately working?
YES ( ) NO ( )
83. Does the largest pot and pan fit into each compartment of the three compartment sink?
YES ( ) NO ( )
If no, what is the procedure for manual cleaning and sanitizing?
84. Are there drain boards on both ends of the compartment sink? YES ( ) NO ( )
85. What type of sanitizer is used?
□ Chlorine
□ Iodine
□ Quaternary ammonium
□ Hot Water
□ Other
86. Are test papers and/or kits available for checking sanitizer concentration? YES ( ) NO ( )
HANDWASHING / TOILET FACILITIES
87. Is there a hand washing sink in each food preparation and ware washing area? YES ( ) NO ( )
88. Do all hand washing sinks, including those in the restrooms, have a mixing valve or combination
faucet? YES ( ) NO ( )
89. Do self-closing metering faucets provide a flow of water for at least 15 seconds without the need
to reactivate the faucet? YES ( ) NO ( )
90. Is hand cleanser available at all hand washing sinks? YES ( ) NO ( )
91. Are hand drying facilities (paper towels, air blowers, etc.) available at all hand washing sinks?
YES ( ) NO ( )
92. Are covered waste receptacles available in each restroom? YES ( ) NO ( )
93. Is hot and cold running water under pressure available at each hand washing sink? YES ( ) NO
( )
94. Are all toilet room doors self-closing? YES ( ) NO ( )
95. Are all toilet rooms equipped with adequate ventilation? YES ( ) NO ( )
96. Is a hand washing sign posted in each employee restroom? YES ( ) NO ( )
SMALL EQUIPMENT REQUIREMENTS
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97. Please specify the number, location, and types of each of the following:
Slicers
Cutting boards
Can openers
Mixers
Floor mats
Other
FROZEN DESSERT OR SOFT SERVE ICE CREAM MANUFACTURER
98. Will the establishment manufacture frozen dessert or soft serve ice cream? YES / NO
If so, is frozen dessert / ice cream mix pasteurized? YES / NO
If so, will monthly bacteriological lab reports from a certified lab for the frozen dessert or
soft serve ice cream products manufactured at the facility be submitted to the Health
Department? YES / NO
PERSON IN CHARGE
99. Will food employees be trained in good food sanitation practices? YES / NO
Method of training:
Numbers of employees:
Dates of completion:
100. Is there a written policy to inform employees in a verifiable manner of their responsibility to
report all diseases that are transmissible through food? YES / NO
101. Is there a written policy to exclude or restrict food workers who are sick or have infected cuts
and lesions? YES / NO
102. Is there a written procedure for responding to and cleaning up of vomiting and diarrheal
events? YES / NO
HAZARD ANALYSIS CRITICAL CONTROL POINT (HACCP) REQUIREMENT
103. Provide a HACCP Plan and written documentation for:
Time Only as a Public Health Control
Juice packaged in the food establishment
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VARIANCE REQUIREMENT
104. Food establishment shall obtain a variance from Health Department before. Provide variance request,
HACCP plan, and supporting documentation before conducting:
Smoking food
Curing food
Using food additives such as vinegar to render a food so that it is not time/temperature control for
safety food.
Packaging food using a reduced oxygen packaging method except where the growth of and toxin
formation by Clostidium botulinum and the Listeria monocytogenes are controlled as specified
under Food Code § 3-502.12
Operating a molluscan shellfish life-support systems display tank use to store or display shellfish
that are offered for human consumption
Custom processing animals that are for personal use as food and not for sale or service in a food
establishment
Preparing food by another method that is determined by the regulatory authority to require a
variance
Sprouting seeds or beans
************
STATEMENT: I hereby certify that the above information is correct, and I fully understand that
any deviation from the above without prior permission from the Watertown Health Department
may nullify final approval.
Signature(s)
Owner(s) or responsible representative(s)
Date:
************
Approval of these plans and specifications by the Watertown Health Department does not indicate compliance
with any other code, law or regulation that may be required--federal, state, or local. It further does not constitute
endorsement or acceptance of the completed establishment (structure or equipment). A preopening inspection of
the establishment with equipment in place & operational will be necessary to determine if it complies with the
local and state laws governing food service establishments.