Att 3 - Example of Data Collection Instrument

Attachment 3- Example of EHS-Net Data Collection Instrument- Interview

EHS-Net Cooling Practices Study

Part I: Manager Interview

1. Does this establishment cool heat-processed potentially hazardous foods?

 Yes

 No (End evaluation)

 Unsure

 Refused

2. Which one of the options below best describes the menu for this establishment?

 American (non-ethnic)

 Chinese

 French

 Italian

 Japanese

 Mexican

 Thai

 Other (Please describe): ____________________________________

3. Is this an independent establishment or a chain establishment?

 Independent

 Chain

 Unsure

 Refused

4. Approximately how many meals are served here daily? _______  Unsure

 Refused

5. Approximately how long have you been a kitchen manager here? _______ Unsure

 Refused

6. Including yourself, how many kitchen managers do you have?_______  Unsure

 Refused

Public reporting burden for this collection of information is estimated to average 30 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to: CDC/ATSDR Information Collection Review Office, MS D-74; 1600 Clifton Road NE, Atlanta, Ga. 30333; ATTN: PRA (0920-0792)

7. How many managers speak the following languages as their primary language?

 English __________

 Spanish__________

 Chinese__________

 Other (describe) ____________________________________

 Unsure

 Refused

8. Have any kitchen managers received food safety training? This training can be a course or a class, or it can be training that occurs on the job.

 Yes

 No (Skip to # 10)

 Unsure (Skip to # 10)

 Refused (Skip to # 10)

9. Did the food safety training include information on how to properly cool potentially hazardous foods?

 Yes

 No

 Unsure

 Refused

10. Does this establishment require kitchen manager food safety certification?

 Yes

 No

 Unsure

 Refused

11. Are any kitchen managers food safety certified?

 Yes

 No

 Unsure

 Refused

12. How many food workers do you have total? _______  Unsure

 Refused

13. Do any food workers receive food safety training? This training can be a course or a class, or it can be training that occurs on the job.

 Yes

 No (Skip to #16)

 Unsure (Skip to #16)

 Refused (Skip to #16)

14. How many food workers have had food safety training? _______  Unsure

 Refused

15. Did the food safety training include information on how to properly cool potentially hazardous foods?

 Yes

 No

 Unsure

 Refused

16. How many food workers speak the following languages as their primary language?

 English __________

 Spanish__________

 Chinese__________

 Other (describe) ____________________________________

 Unsure

 Refused

17. What is the language spoken most often in the kitchen?

 English

 Spanish

 Chinese

 Other (describe) ____________________________________

 Unsure

 Refused

18. Does this establishment use an instrument to check food temperatures?

 Yes

 No (Skip to # 23)

 Unsure (Skip to # 23)

 Refused (Skip to # 23)

19. What type of instrument is used to check food temperatures? (Check all that apply)

 Digital/thermocouple probe thermometer

 Bi-metallic probe thermometer

 Computerized Data logger

 Infrared/laser thermometer

 Other (describe) ____________________________________

 Unsure

 Refused

20. Is anyone trained to check the accuracy of these instruments?

 Yes

 No

 Unsure

 Refused

21. Who is trained to check the accuracy of these instruments? (Check all that apply)

 Food worker

 Manager

 Other (describe) ____________________________________

 Unsure

 Refused

22. How often are these instruments checked for accuracy?

 Never

 At least once a day

 At least once a week

 At least once a month

 Other (Please describe) ________________________________________

 Unsure

 Refused

23. In your state or county, what is the required cooling time and temperature?

 Two-stage (135^oF to 70^o F in ≤ 2 hours; then 70^oF to ≤41^o F in 4 additional hours or less)

 Two-stage (140^oF to 70^o F in ≤ 2 hours; then 70^oF to ≤41^o F in 4 additional hours or less)

 Single-stage (135^o F to 41^o F in 4 hours or less)

 Single-stage (140^o F to 41^o F in 4 hours or less)

 Single-stage (140^o F to 45^o F in 4 hours or less)

 Other_________________________________________________

 Unsure

 Refused

24. What types of food are cooled? (Check all that apply)

 Meat – large cuts  Pasta or noodles

 Meat – pieces/grinds  Casseroles (such as egg bakes or lasagna)

 Poultry – whole  Rice

 Poultry – pieces/grinds  Cooked vegetables

 Seafood  Beans (whole)

 Soups  Beans (refried)

 Stews  Other________________________

 Gravies  Unsure

 Sauces  Refused

 Pudding or custard

25. Who is responsible for cooling foods? (Check all that apply)

 Food worker

 Manager

 Other (describe) ____________________________________

 Unsure

 Refused

26. Do you have formal procedures or processes for cooling potentially hazardous foods?

 Yes

 No (Skip to #30)

 Unsure (Skip to #30)

 Refused (Skip to #30)

27. Are the procedures or processes written?

 Yes

 No

 Unsure

 Refused

28. Have employees been trained on the procedures or processes?

 Yes

 No

 Unsure

 Refused

29. Are the cooling procedures tested and verified? Testing and verification are the processes of measuring temperatures throughout the cooling cycle to ensure the cooling method works.

 Yes

 No

 Unsure

 Refused

30. What types of methods are used to cool foods? (Check all that apply)

 (A) Shallow container in walk-in cooler (≤ 3” container and/or product depth)

 (B) Deep container in walk-in cooler (>3” container and/or product depth)

 (C) Shallow container in reach-in cooler (≤ 3” container and/or product depth)

 (D) Deep container in reach-in cooler (>3” container and/or product depth)

 (E) Ice bath

 (F) Ice wand

 (G) Blast chiller

 (H) Freezer

 (I) Ice or frozen food added as an ingredient

 (J) Water and/or ice used as a cooling medium

 (K) Leaving food at room/ambient temperature

 (L) Other (describe) ____________________________________

 Combination method(s) 1: _______________ (e.g: K, E, A)

2: _______________

3: _______________

4: _______________

 Unsure

 Refused

31. Are times or temperatures monitored during cooling processes? In other words, do you take repeated temperatures of the food or watch the time during cooling?

 Yes

 No (Skip to # 36)

 Unsure (Skip to # 36)

 Refused (Skip to # 36)

32. How often are cooling processes monitored? (Read answers aloud)

 Always  Rarely

 Often  Unsure

 Sometimes  Refused

33. How are cooling processes monitored? (Check all that apply)

 Probe thermometer  Time only

 Data logging thermometer  Other___________________________________

 Sight only  Unsure

 Touch only  Refused

34. Are cooling time and temperature measurements recorded?

 Yes

 No

 Unsure

 Refused

35. What corrective actions are taken if improper cooling processes are identified?

 Food is reheated then cooled again

 Food is discarded

 No action is taken

 Other (describe) ____________________________________

 Unsure

 Refused

36. Are you familiar with HACCP?

 Yes

 No

 Unsure

 Refused

Part II: Environmentalist section: Answered by data collector.

1. Establishment Type:

 Prep Serve

 Cook Serve

 Complex

2. Is this establishment

a. …a sit down establishment?

Yes No Unsure

b. …a buffet establishment?

Yes No Unsure

c. …a quick-service or fast-food establishment?

Yes No Unsure

d. …a caterer?

Yes No Unsure

e. …a banquet hall?

Yes No Unsure

f. …an institutional foodservice?

Yes No Unsure

3. What is the requirement for cooling cooked potentially hazardous foods in this county?

 Two-stage (135^oF to 70^o F in ≤ 2 hours; then 70^oF to ≤ 41^o F in 4 additional hours or less)

 Two-stage (140^oF to 70^o F in ≤ 2 hours; then 70^oF to ≤ 41^o F in 4 additional hours or less)

 Single-stage (135^o F to 41^o F in 4 hours or less)

 Single-stage (140^o F to 41^o F in 4 hours or less)

 Single-stage (140^o F to 45^o F in 4 hours or less)

 Other_________________________________________________

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