Fillable FOOD ESTABLISHMENT PLAN REVIEW APPLICATION (City of Coppell)

Fill Online, Printable, Fillable, Blank FOOD ESTABLISHMENT PLAN REVIEW APPLICATION (City of Coppell) Form

Use Fill to complete blank online CITY OF COPPELL (TX) pdf forms for free. Once completed you can sign your fillable form or send for signing. All forms are printable and downloadable.

FOOD ESTABLISHMENT PLAN REVIEW APPLICATION (City of Coppell)

On average this form takes 65 minutes to complete

The FOOD ESTABLISHMENT PLAN REVIEW APPLICATION (City of Coppell) form is 17 pages long and contains:

0 signatures
159 check-boxes
187 other fields

Country of origin: US
File type: PDF

U.S.A. forms for City of Coppell

BROWSE CITY OF COPPELL (TX) FORMS

Related forms

Environmental Health Department FARMERS MARKET PERMIT APPLICATION (City of Coppell)
Environmental Health Department FOOD ESTABLISHMENT PERMIT APPLICATION (City of Coppell)
Environmental Health Department PUBLIC SWIMMING POOL/SPA PERMIT APPLICATION (City of Coppell)
CITY OF COPPELL ENVIRONMENTAL HEALTH DEPARTMENT TEMPORARY FOOD (City of Coppell)
City of Coppell Environmental Health Department WASTE HAULERS (City of Coppell)
City of Coppell P.O. BOX 9478 Coppell TX (City of Coppell)
CORE Independent Contractor Packet.1018 (City of Coppell)
City of Coppell Parks & Recreation Facility Rental (City of Coppell)
COPPELL SENIOR/COMMUNITY CENTER AT G (City of Coppell)
SIGN PERMIT APPLICATION (City of Coppell)
SpecialInterestsFundingApplication AtaGlanceSummary Amount Granted Requested (City of Coppell)
City of Coppell Required Short Term Rental Informational (City of Coppell)

Fill has a huge library of thousands of forms all set up to be filled in easily and signed.

Fill in your chosen form

Sign the form using our drawing tool

Send to someone else to fill in and sign.

find another form

Redo

Arial Font

Arial
Calibri
Roboto
Open Sans

AFont color

AB
A.B
A..B
A...B
A....B

Remove Field

ADD FIELDS

FOOD ESTABLISHMENT PLAN REVIEW APPLICATION

______ NEW _____ REMODEL _____CONVERSION

Date of Application: ____________________________________________________________________

Name of Establishment: _________________________________________________________________

Category: Restaurant_____ Daycare_____ Convenience/Retail Store_____ Other_____

Address: _____________________________________________________________________________

Phone Numbers of Establishment: ________________________________________________________

Owner’s Name: _______________________________________________________________________

Mailing Address: ______________________________________________________________________

Email Address: ________________________________________________________________________

Phone Number: _______________________________________________________________________

Applicant’s Name: _____________________________________________________________________

Title (owner, manager, contractor, architect, etc.): ____________________________________________

Mailing Address: ______________________________________________________________________

Email Address: ________________________________________________________________________

Phone Number: _______________________________________________________________________

Hours of Operation: (Include the hours personnel arrive and leave the establishment)

Mon __________ Tues __________ Wed __________ Thurs __________

Fri ___________ Sat ___________ Sun ___________

Number of Seats in Establishment: _____________________

Number of Staff: _______________ Total Square Feet of Facility: _______________

(Maximum per shift)

Maximum Meals to be Served: Breakfast _____________

(approximate number) Lunch _______________

Dinner _______________

Projected Date for Start of Project: ________________________________________

Projected Date for Completion of Project: ___________________________________

Type of Service: Sit Down Meals __________

(check all that apply) Take Out __________

Caterer __________

Other __________

Please enclose the following documents:

• Proposed Menu

• Grease Trap Specifications

• Equipment Schedule

• Manufacturer Specification sheets for each piece of equipment shown on the plans

• Proposed Layout (elevated drawings of all food equipment).

• Complete finish schedules for each room including floors, walls, ceilings and coved juncture bases.

• Plumbing Schedule

• Mechanical Plans

• Lighting Schedule

FOOD PREPARATION REVIEW

Check categories of Potentially Hazardous Goods (PHF’s) 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, custard, cream fillings and toppings)

6. Other _________________________________________________________________________

______________________________________________________________________________

PLEASE CIRCLE/ANSWER THE FOLLOWING QUESTIONS

FOOD SUPPLIES:

1. What are the projected frequencies of deliveries for frozen foods _____________________________,

Refrigerated foods___________________________________, and Dry goods_____________________.

2. Provide information on the amount of space (in cubic feet) allocated for:

Dry storage ______________________________,

Refrigerated storage _______________________, and

Frozen storage ____________________________.

3. How will dry goods be stored off the floor?

_____________________________________________________________________________________

COLD STORAGE:

1. Is adequate and approved freezer and refrigeration available to store frozen foods frozen, and

refrigerated foods at 41 degrees F and below? YES / NO

Provide the method used to calculate cold storage requirements.

2. Will raw meats, poultry and seafood be stored in the same refrigerators and freezers with cooked/ready-

to-eat foods? YES / NO

If yes, how will cross contamination be prevented?

_____________________________________________________________________________________

3. Is there a bulk ice machine available? YES / NO

THAWING FROZEN POTENTIALLY HAZARDOUS FOOD:

Indicate by checking the appropriate boxes how frozen potentially hazardous foods (PHF’s) 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

degrees F

Microwave (as part of the

cooking process)

Cooked from frozen state

Other (describe)

*Frozen foods: approximately one inch or less = thin, and more than an inch = thick.

COOKING

List types of cooking equipment.

_____________________________________________________________________________________

HOT/COLD HOLDING:

1. How will hot PHF’s be maintained at 140 degrees or above during holding for service?

Indicate type and number of hot holding units.

_____________________________________________________________________________________

____________________________________________________________________________________

2. How will cold PHF’s be maintained at 41 degrees F or below during holding for service?

Indicate type and number of cold holding units.

_____________________________________________________________________________________

COOLING:

Please indicate by checking the appropriate boxes how PHF will be cooled to 41 degrees F within 6 hours

(140 to 70 in 2 hours and 70 to 41 in 4 hours). Also, indicate where the cooling where the cooling will

take place.

COOLING

METHOD

THICK

MEATS

THIN

MEATS

THIN

SOUPS/

GRAVY

THICK/SOU

PS/GRAVY

RICE/BEANS

/NOODLES

Shallow Pans

Ice Baths

Reduce

Volume or

Size

Rapid Chill

Other

(describe)

REHEATING

1. How will PHFs 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 degrees F for 15 seconds.? Indicate type and numbers if units

used for reheating foods.

_____________________________________________________________________________________

2. How will reheating food to 165 degrees F for hot holding be done rapidly and within 2 hours?

_____________________________________________________________________________________

___________________________________________________________________________________

PREPARATION

1. Please list types of foods prepared more than 12 hours in advance of service.

_____________________________________________________________________________________

2. Will food employees be trained in good food sanitation practices? YES / NO

Method of training:

_____________________________________________________________________________________

Numbers(s) of employees: _______________________________________________________________

3. Will disposable gloves and/or utensils and/or food grade paper be used to prevent handling of ready-to-

eat foods? YES / NO

4. Is there a written policy to exclude or restrict workers who are sick or have infected cuts and lesions?

YES / NO

Please describe:

_____________________________________________________________________________________

5. How will cooking equipment, cutting boards, countertops and other food contact surfaces which cannot

be submerged in sinks or put through a dishwasher be sanitized?

Chemical Type: __________________________

Concentration: __________________________

Test Kit: YES / NO

6. 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

If not, how will ready-to-eat foods be cooled to 41 degrees F?

_____________________________________________________________________________________

7. Will all produce be washed on-site prior to use? YES / NO

Is there a planned location used for washing produce? YES/ NO

Describe_____________________________________________________________________________

_____________________________________________________________________________________

If not, describe the procedure for cleaning and sanitizing multiple use sinks between uses.

_____________________________________________________________________________________

8. Describe the procedure used for minimizing the length of time PHFs will be kept in the temperature

danger zone (41-140 degrees F) during preparation.

_____________________________________________________________________________________

9. Will the facility be serving food to a highly susceptible population? YES / NO

FINISH SCHEDULE

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

Bar

Food Storage

Other Storage

Toilet Rooms

Dressing Rooms

Garbage &

Refuse Storage

Mop Sink area

Warewashing

Area

Walk-in Freezer

Walk-in Cooler

INSECT AND RODENT CONTROL

Please check appropriate boxes.

YES NO NA

1. Will all outside doors be self-closing

and rodent proof? ( ) ( ) ( )

2. Do all operable windows have a minimum

#16 mesh screening? ( ) ( ) ( )

3. Is the placement of electrocution devices

identified on the plan? ( ) ( ) ( )

4. Will all pipes & electrical conduit chases be

sealed; ventilation systems exhaust and intakes

protected? ( ) ( ) ( )

5. Is the are around the building clear of

unnecessary brush and other harborage? ( ) ( ) ( )

6. Will air curtains be used?

If yes, where? _______________________________ ( ) ( ) ( )

GARBAGE AND REFUSE

Inside

YES NO NA

1. Is there an area designated for garbage can

or floor mat cleaning? ( ) ( ) ( )

Outside

2. Will a dumpster be used? ( ) ( ) ( )

Number _________ Size ________

Frequency of pickup _______________

3. Will a compactor be used? ( ) ( ) ( )

Number _________ Size ________

Frequency of pickup _______________

4. Will garbage cans be stored outside? ( ) ( ) ( )

5. Describe surface and location where dumpster/compactor/garbage cans are to be stored:

_____________________________________________________________________________________

6. Describe location of grease storage receptacle:

_____________________________________________________________________________________

7. Is there an area to store recycled containers ( ) ( ) ( )

Describe _____________________________________________________________________________

_____________________________________________________________________________________

8. Is there an area to store returnable damaged goods? ( ) ( ) ( )

PLUMBING CONNECTIONS

AIR GAP

*INTEGRAL

TRAP

* “P” TRAP

VACUUM

BREAKER

BACKFLOW

PREVENTOR

Toilet

Urinals

Dishwasher

Ice Machines

Sinks:

a. Mop

b. Handwash

c. 3-comp

d. 2-comp

e. 1-comp

Steam tables

Dipper wells

Condensate/

Drain lines

Hose

connection

Spray hose/

3-comp sink

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 a letter “P”. Full “S” traps are prohibited.

Are floor drains provided and easily cleanable, if so, indicate location:

_____________________________________________________________________________________

WATER SUPPLY

1. Is ice made on the premises ( ) or purchased commercially ( ) ?

If made on premise, are specifications for the ice machine provided? YES ( ) NO ( )

2. Is ice bagged for retail sale on the premises? YES ( ) NO ( )

Do you have the required manufacturing permit from the Texas Department of State Health Services?

YES ( ) NO ( )

Describe provision for ice scoop storage:

_____________________________________________________________________________________

Provide location of icemaker or bagging operation:

_____________________________________________________________________________________

3. What is the capacity of the hot water heater?

_____________________________________________________________________________________

4. Is the hot water heater sufficient for the needs of the establishment? Provide the calculations used for

determining the size of the hot water heater.

_____________________________________________________________________________________

5. Is there a water treatment device? YES ( ) NO ( )

If yes, how will the device be inspected and serviced?

_____________________________________________________________________________________

6. How are backflow prevention devices inspected and serviced?

_____________________________________________________________________________________

SEWAGE DISPOSAL

1. Is a grease trap provided? YES ( ) NO ( )

If yes, where

_____________________________________________________________________________________

Grease trap size: ________________________________________________________________

Provide schedule for cleaning and maintenance ________________________________________

DRESSING ROOMS

1. Are dressing rooms provided? YES ( ) NO ( )

If no, describe storage facilities for employees’ personal belongings (i.e., purse, coats, etc.)

_____________________________________________________________________________________

GENERAL

1. Are insecticides stored separately from cleaning and sanitizing agents? YES ( ) NO ( )

Indicate location: ______________________________________________________________________

2. Are all toxics for use on the premises or for retail sale (this includes personal medications), stored away

from food preparation and storage areas? YES ( ) NO ( )

3. Will linens be laundered on site? YES ( ) NO ( )

If yes, what will be laundered and where?

_____________________________________________________________________________________

If no, how will linens be cleaned?

_____________________________________________________________________________________

4. Is a laundry dryer available? YES ( ) NO ( )

5. Location of dirty linen storage:

_____________________________________________________________________________________

6. Location of dirty linen storage:

_____________________________________________________________________________________

SINKS

1. Is a mop sink present? YES ( ) NO ( )

If no, please describe facility for cleaning of mops and other equipment.

_____________________________________________________________________________________

2. If the menu dictates, is a food preparation sink present? YES ( ) NO ( )

DISHWASHING FACIILTIES

1.Will sinks or a dishwasher be used for dishwashing?

Dishwasher ( )

Three compartment sink ( )

2. Dishwasher

Type of sanitization used:

Hot water (temperature provided) ___________________________________

Booster heater __________________________________________________

Chemical type __________________________________________________

Is ventilation provided? YES ( ) NO ( )

3. Do all dish machines have templates with operating instructions? YES ( ) NO ( )

4. Do all dish machines have temperature/pressure gauges that are accurately working? YES ( ) NO ( )

5. Does the largest pot and pan fit into each compartment of the 3-comp sink? YES ( ) NO ( )

If no, what is the procedure for manual cleaning and sanitizing?

_____________________________________________________________________________________

6. Are there drain boards on both ends of the 3-comp sink? YES ( ) NO ( )

7. What type of sanitizer is used?

Chlorine ( )

Quaternary ammonium ( )

Iodine ( )

Hot Water ( )

HANDWASHING/TOILET FACILITIES

1. Is there a handwashing sink in each food preparation and warewashing area? YES ( ) NO ( )

2. Do all handwashing sinks have a mixing valve or combination faucet? YES ( ) NO ( )

3. Do self-metering faucets provide a flow of water for at least 15 seconds without the need to reactivate

the faucet? YES ( ) NO ( )

4. Are all toilet room doors self-closing? YES ( ) NO ( )

5. Are all toilet rooms equipped with adequate ventilation? YES ( ) NO ( )

Sign the document

DRAW TYPE UPLOAD

Choose file

Sending Options

Clear

Adding Fields

Fields are being added to your document to make it really easy to fill, send and sign this PDF. Once finished you can manually add any additional fields and signatures to the document by dragging them from the toolbar.

For larger documents this process may take up to one minute to complete

Finish

Download
Save PDF to desktop

Email
Email completed PDF

Send for Signing
Email for others to sign

Print
Print document

Send for signing

Email for others to sign

Choose a Field
Click on a field and
select the person that should complete it

Want to add a signature?
You can add a signature field
and assign it to someone else
to sign

Send for signing

Email for others to sign

Choose a Field
Click on a field and
select the person that should complete it

Send for signing

Email for others to sign

Someone else

NAME

Email completed PDF

Template

Convert to a reusable Template

Complete document

FOOD ESTABLISHMENT PLAN REVIEW APPLICATION (City of Coppell)

This document is locked as it has been sent for signing.

You have successfully completed this document.

Other parties need to complete fields in the document. You will recieve an email notification when the document has been completed by all parties.

This document has been signed by all parties.

Completed 2 August 2020

Message

View Audit Log
Print With Audit Log
Duplicate Document

You're on your way to completing your first doc!

already registered?

First 20 documents completely FREE!

No credit card required

Digitally sign with 1 click

Request signatures from others

Secure storage for sensitive data

Upload your own forms

Simple PDF editing

Huge library of 1000's of forms