FOOD SERVICE FACILITY PERMIT APPLICATION

Facility Name: ______________________________________________________________

Former Facility Name: ________________________________________________________

Facility (911) Address: ________________________________________________________

Facility Phone: _____________________________________________________________

Facility Property Tax ID (located on tax bill): ______________________________________

Applicant Name: ____________________________________________________________

Mailing Address: ____________________________________________________________

Daytime Phone: ____________________________________________________________

Email: ____________________________________________________________________

Fax: _____________________________________________________________________

Days and Hours of Operation: ________________________________________________

Number of seats: _____________________

q A Workers’ Compensation Insurance Certificate listing the insurance company name and the binder number is attached.  Caroline County Health Department is listed as a certificate holder.

OR

qCertificate of Compliance is attached.

Applicant Statement: Application is hereby made for a permit to operate a Food Service Facility, in accordance with COMAR 10.15.03.  I hereby certify that the information in this application is correct.

Applicant Signature: __________________________________________ Date: ______________

-Health Department Use Only-

Date Received:                        Receipt#:                                                Amount:                   Reviewed By:                   Priority:

Training & Policies

Personal Health & Sanitation (COMAR 10.15.03.14)

1. Submit your policies on food worker illness, employee hygiene, & sanitation: including dress code and hand washing.

·        At a minimum you must include your plan to exclude or restrict food workers who are sick or have infected cuts and lesions. 

·        Education for your employees on personal hygiene.

·        How you plan to correct any deficiencies found within your operation.

·        Frequency of training.

Thermometers (COMAR 10.15.03.09)

1. List the types of food probe thermometers (0-220°F) that food handlers will be using and where the thermometers will be kept.

2. How do you calibrate your food probe thermometers and how often? Who is responsible for calibrating thermometers?

3. Specify how you will clean and sanitize your probe thermometer.

Sanitization (COMAR 10.15.03.16)

1. What type of chemical sanitizer do you use: qchlorine    qquaternary ammonium    qiodine?

2. At what concentration do you use this sanitizer? __________________

3. What type of test kit do you have? __________________

4. When do you use your test kit? __________________

5. What is the proper manual dish wash procedure for a 3 compartment sink?

6. Describe how cutting boards, counter tops, equipment and other food contact surfaces that are too big to be submerged into sinks and too big for the dishwasher are cleaned and sanitized?

Food Preparation (COMAR 10.15.03.09)

1. Identify where raw and ready-to-eat food (including washing produce) will be prepared.

2. Will any animal food products be served raw or undercooked (e.g. hamburgers, steaks, sushi, steak tartar, and oyster shooters)? qYes qNo

·        If yes, list food from animals that you will serve raw or partially cooked.

·        2b. If yes, a consumer advisory will be required for those food items listed above.

·        2c. If serving raw fish (sushi, lox, ceviche), will parasite destruction be done on-site or by the supplier?

qOn-site. Provide your procedure on parasite destruction (A freezer used for parasite destruction must maintain – 4°F for 7 days.)

qSupplier. Provide the name of your supplier and documentation to show parasite destruction.

3. Will any foods be processed within the facility (smoking meats, sous vide, canning, specialty processing, etc.)? qYes qNo

·        If yes, describe food processing within your facility:

4. What is done with leftover food?

5. Will salads such as tuna, egg, chicken, macaroni, pasta and potato be prepared from scratch in your facility? qYes qNo

·        If yes, will the ingredients be: qpre-chilled before being mixed or assembled or qcooled from 70ºF to 41ºF within 4 hours?

6. Describe how you will minimize the handling of ready-to-eat food. For example will you use disposable gloves to prepare ready-to-eat.

7. Will food be transported to another location as with a catering operation or satellite kitchen?

    qYes q No

·        List all of the proposed equipment to be utilized for transport, holding and serving.

·        All catering must be addressed in the proposed HACCP plan.

·        Describe the proposed catering operation.  The proposal must address transport and on site procedures for hand washing, on site food preparation (if applicable), food storage, serving foods, and how utensils & equipment will be cleaned and sanitized on site, etc.

Holding Food Temperatures Cold & Hot

1. Refrigerated food must be maintained at 41°F or colder. How did you determine the amount of cold storage/holding that you will need for your operation?

2. How will you ensure that each refrigerator has a working thermometer and that the temperature is maintained at 41°F or colder?

3. If you will be using ice for keeping food cold such as in a salad bar, how should the food be stored in the ice? Please describe:

4. Describe your procedure product rotation of potentially hazardous food items (e.g. time & date stamp)?

5. How will you store raw animal food to prevent contamination of ready-to eat food?

Note: When storing raw animal products above one another, their storage must be based on the final required cooking temperature of each animal product. The animal product with the lowest cooking temperature must be stored above other raw animal products that require a higher cooking temperature (e.g., raw fish above raw ground beef).

6. How and where will frozen food be thawed?

7. What type of equipment will you use for holding food hot?

8. How will you ensure that food is at the required temperature throughout the day?

9. Describe how food temperatures (hot and cold) will be maintained while in transport and at the catered site or satellite kitchen(s)?

Note: You must adhere to maximum and minimum temperature requirements.

Cooling (COMAR 10.15.03.11)

1. Identify the equipment that will be used for rapid cooling, including ice baths and refrigeration.

2. In the appropriate box, list menu items of food items that will be cooled.

* Adequate and appropriate refrigeration is required

** Food-preparation sink and ice machine are required

3. How will food handlers know that the food has cooled from 135°F to 70 °F within two hours and then from 70°F to 41°F within 4 hours?

Cooking & Reheating (COMAR 10.15.03.10 & .11)

1. Describe how the food worker will know when products have achieved the minimum internal cooking or reheating temperature:

Note: Required cooking temperatures are listed in the COMAR regulations governing “Food Service Facilities”

2. For reheating, how will the cook know that all parts of the food being reheated have reached at least 165°F for 15 seconds within 2 hours?

3. Identify all equipment that will be used for rapid reheating:

qMicrowave

qConventional Oven

qConvection Oven

qGriddle

qStove top

qOther: _________________________________

Self Service

1. Will you provide self-service food to your customers (salad bar, buffet line, hot dog grill, etc.)?

q Yes           

q No

2. How will you protect food in self-service areas from customer contamination?