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Food Establishment Plan Review Application

Food Establishment Plan Review Application

Type of Construction:(Required)
Address:(Required)

Address:(Required)

Address:(Required)

❖ Please Return completed application with a scaled drawing of kitchen/equipment/storage areas ❖ Have cash, money order, or check made payable to Swain County Health Department when application is submitted. (0-50 seats = $200; 50+ seats = $250)

I certify that the information in this application is correct, and I understand that any deviation without prior approval from this Health Regulatory Office may nullify plan approval.

(Owner or Responsible Representative)
Breakfast: ________ Lunch: _________ Dinner: ___________ Number of seats: ____________ Facility total square feet: _________________ Projected start date of construction: ____________________________ Projected completion date: __________________________________
TYPE OF FOOD SERVICE: CHECK ALL THAT APPLY(Required)
Indicate any specialized processes that will take place:
Indicate any of the following highly susceptible populations that will be catered to or served:(Required)

COLD STORAGE

Method used to determine cold storage requirements:
ft^3
ft^3
ft^3
ft^3
Food that will be held hot:
Food that will be held cold:

COOLING

Indicate by checking the appropriate boxes how cooked food will be cooled to 410F (50C) within 6 hours. If “Other” is checked indicate type of food:
Meat Seafood Poultry Other
Meat Seafood Poultry Other
Meat Seafood Poultry Other

THAWING

Indicate by checking the appropriate boxes how food in each category will be thawed. If “Other” is checked indicate type of food:
Meat Seafood Poultry Other
Meat Seafood Poultry Other
Meat Seafood Poultry Other
Meat Seafood Poultry Other

FOOD HANDLING PROCEDURES

Explain the following with as much detail as possible. Provide descriptions of the specific areas of the kitchen and corresponding items on the plan where food will be handled. Explain the handling procedures for the following categories of food. Describe the process from receiving to service including: ∙ How the food will arrive (frozen, fresh, packaged, etc.) ∙ Where the food will be stored ∙ Where (specific pieces of equipment with their corresponding equipment schedule numbers) and how the food will be handled (washed, cut, marinated, breaded, cooked, etc.) ∙ When (time of day and frequency/day) food will be handled
Provide information on the frequency of deliveries and the expected gross volume that is to be delivered each time: ____ Square feet of dry storage shelf space:___ft² Where will dry goods be stored? ____

FINISH SCHEDULE

Indicate floor, wall and ceiling finishes (e.g., quarry tile, stainless steel, vinyl coated acoustic tile)
Floor Base Walls Ceiling
Floor Base Walls Ceiling
Floor Base Walls Ceiling
Floor Base Walls Ceiling
Floor Base Walls Ceiling
Floor Base Walls Ceiling
Floor Base Walls Ceiling
Floor Base Walls Ceiling
Floor Base Walls Ceiling
Floor Base Walls Ceiling

WATER SUPPLY - SEWAGE

Is water supply: Municipal Well(Required)
Will ice:(Required)
Tank type: a. Manufacturer and model: _________ b. Storage capacity: __________ gallons ▪ Electric water heater: kilowatts (kW) _______ ▪ Gas water heater: BTU’s ________ c. Water heater recovery rate (gallons per hour at 80ºF temperature rise): _______ GPH
a. Manufacturer and model: _________ b. Quantity of tankless water heaters: ____
INDIRECT WASTE - Check the appropriate box indicating equipment drains:(Required)
INDIRECT WASTE Floor sink, Hub Drain, Floor Drain
DIRECT WASTE - Check the appropriate box indicating equipment drains:(Required)
DIRECT WASTE

WAREWASHING EQUIPMENT

What type of sanitizer will be used?(Required)

Mechanical Warewashing
Will a warewashing machine be used?(Required)

General
ft^2

HANDWASHING

EMPLOYEE ACCOMMODATIONS

REFUSE AND RECYCLABLES

Will refuse be stored inside?(Required)
Provision for refuse disposal:(Required)
Provision for cleaning dumpster/compactor:(Required)

SERVICE SINK

Is a separate mop storage area provided?(Required)

INSECT AND RODENT CONTROL

How is protection provided on all outside doors?(Required)
How is protection provided on windows?(Required)

LINEN

POISONOUS OR TOXIC MATERIALS

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