Revised 02.21.17
Y:FORMS-INFORMATION/Retail Food/Applications/Plan Review vs. Facility Evaluation Questionnaire
ENVIRONMENTAL HEALTH DIVISION
2120 Diamond Blvd., Suite 200
Concord, CA 94520
Phone: (925) 692-2500
Fax: (925) 692-2502
www.cchealth.org/eh
PLAN REVIEW vs. FOOD FACILITY CODE EVALUATION Questionnaire
The purpose of this questionnaire is to determine if the proposed ownership change will require the applicant to
go through the PLAN REVIEW process or if it needs to go through a FOOD FACILITY CODE EVALUATION process. The
project must go through the PLAN REVIEW process if any of the boxes below are checked yes.
Yes No
The facility has NEVER obtained an Environmental
Health Permit to Operate for its previous or current
business use.
Yes No
To your knowledge, the previous use of the food
facility was limited to prepackaged non-potentially
hazardous food and beverages (e.g. chips, jerky,
bottled/canned sodas, etc.) AND now you intend to
cook food (from raw state of meat or vegetables).
Yes No
Facility has a current permit to operate as a market
or a prepackaged food facility with no food
handling and is proposing to add a deli or other
services that would require the preparation of
food.
Yes No
If facility currently holds an incidental retail food
market permit, will the pre-packaged non-
potentially hazardous food storage/display area be
increased greater than 300 sq. ft.?
Yes No
Adding Equipment to the Food Facility?
(Check all that apply)
Exhaust hood
Cooking equipment
Walk-in refrigeration unit
Sink
Water heater
Ice machine
Dish or glass washer
Equipment requiring modification to electrical or
plumbing
Dishwasher
Yes No
Changing Equipment in the Food Facility?
(Check all that apply)
Exhaust hood
Walk-in refrigeration unit
Dishwasher
Water heater
Equipment requiring modification to
electrical or plumbing
Yes No
Will food equipment be added that will require
modifications to the following:
(Check all that apply)
Floors
Walls
Ceiling
Electrical Connections
Plumbing Connections
Yes No
Will any of the following areas be added to the
facility?
(Check all that apply)
Food preparation area
Cook line
Storage area
Warewashing station
Waitress station
Employee locker room
Restroom
Trash enclosure
Bar
NOTE: This checklist is not intended to capture all situations that
will require a project to go through the plan review process. During
the course of a facility evaluation, the inspector may find that due to
facility alterations or menu changes, the facility will be required to
complete the plan review process.
Signature:____________________________________________________________ Date:______________________
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