Please note: This application must be fully completed, with all questions answered and submitted with the plans, proposed men

FOOD ESTABLISHMENT PLAN REVIEW APPLICATION

Please note: This application must be fully completed, with all questions answered and submitted with the plans, proposed menu, complete equipment schedule, and schedule requested herein along with any necessary plan review fee paid before the review will be initiated.

Type of Application: ___NEW ___REMODEL ___CONVERSION

Name of Facility: ___________________________________________________________________________

Type of Facility:

Food Service Operation (Restaurant)_______ Food Establishment (Grocery)_________

Commercial ( ) Non-Commercial ( ) Catering ( ) Seasonal ( )

Name of License Holder: _______________________________________________________

Address of Facility: ___________________________________________________________________________

(Street Address) (City) (OH) (Zip code)

Phone of Facility:_________________________________Fax:________________________

Name of Owner or Parent Company: ___________________________________________________________________________

Mailing Address: ___________________________________________________________________________

Telephone: ___________________ Fax: ___________________ Email:__________________

Applicant's Name: ___________________________________________________________________________

Title (owner, manager, architect, etc.): ___________________________________________________________________________

Mailing Address: ___________________________________________________________________________

Telephone: _________________ Fax: ___________________ Email: ___________________

I have submitted plans/application to the following authorities on the following dates:

__________ Building ___________ Plumbing

__________ Electric ___________ Fire

__________ Police ___________ Conservation

__________ Zoning ___________ Planning

__________ Other

Hours of Operation: Mon _______ Tues ______ Wed ______ Thurs _______

Fri______ Sat ______ Sun ______

Number of Seats: _______

Number of Staff (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 _____ Take Out ______ Caterer ______ Mobile Vendor ______ Other _____

Please enclose the following documents:

______ Proposed Menu (including seasonal, off-site and banquet menus)

______ Manufacturer Specification sheets for each piece of equipment shown on the plan

______ 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 system-if applicable).

______ Plan drawn to scale of food establishment showing location of equipment, plumbing, electrical services and mechanical ventilation.

______ Equipment schedule

CONTENTS AND FORMAT OF 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.

2. Include: proposed menu, seating capacity, and projected daily meal volume for food service operations.

3. Show the location and when requested, 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.

4. Designate clearly on the plan equipment for adequate rapid cooling, including ice baths and refrigeration, and for hot-holding potentially hazardous foods.

5. Label and locate separate food preparation sinks when the menu dictates to preclude contamination and cross-contamination of raw and ready-to-eat foods.

6. Clearly designate adequate hand washing lavatories for each toilet fixture and in the immediate area of food preparation.

7. Provide the room size, aisle space, space between and behind equipment and the placement of the equipment of the floor plan.

8. On the plan represent auxiliary areas such as storage rooms, garbage rooms, toilets, basement and/or cellars used for storage or food preparation. Show all features of these rooms as required by this guidance manual.

9. Include and provide specifications for:

a. Entrances, exits, loading/unloading areas and docks;

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

c. Plumbing schedules including location of floor drains, floor sinks, water supply lines, overhead waste-water lines, hot water generation equipment with capacity and recovery rate, backflow prevention, and wastewater line connections;

d. Lighting schedule with protectors:

(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, warewashing, 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.

e. 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.

f. 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:

g. Ventilation schedule for each room;

h. A mop sink or curbed cleaning facility with facilities for hanging wet mops;

i. Garbage can washing area/facility;

j. Cabinets for storing toxic chemicals;

k. Dressing rooms, locker areas, employee rest areas, and/or coat rack;

l. Site plan (plot plan)

FOOD PREPARATION REVIEW

Check categories of Potentially Hazardous Foods (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, custards, cream fillings & 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 41F(5C) 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:

Please 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 70F
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:

List types of cooking equipment.

HOT/COLD HOLDING:

1. How will hot PHF’s be maintained at 135F or above during holding for service? Indicate type and number of hot holding units.

2. How will cold PHF’s be maintained at 41F or below during holding for service? Indicate type and number of cold holding units.

COOLING:

Please indicate by checking the appropriate boxes how PHF’s will be cooled to 41F within 6 hours (135F to 70F in 2 hours and 70F to 41F 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
Ice Baths
Reduce Volume or Size
Rapid Chill

Thawing Method