6 - Environmental Observation

Form Approved

OMB No. 0920-0792

Exp. Date 2/28/2015

Attachment 6: Restaurant Environment Observation

This section is to be completed by the data collector through observations of the restaurant.

1. Does the menu mention anything about allergens?

 Yes (Go to #1a)  No  Unsure  Unable to observe

1a. What does it say? _________________________________________________________________

______________________________________________________________________________

2. Is there any documentation in the front of the house/dining area about allergens?

 Yes (Go to #2a)  No  Unsure  Unable to observe

2a. Where is this documentation? (Check all that apply)

 Sign

2a1. What does it say? ___________________________________________________________

______________________________________________________________________________

 Table topper

2a2. What does it say? ___________________________________________________________

______________________________________________________________________________

 Salad bar/buffet

2a3. What does it say? ___________________________________________________________

______________________________________________________________________________

 Other Describe: ____________________________________________________________

2a4. What does it say? ___________________________________________________________

______________________________________________________________________________

2b. In what language(s) is the documentation? (Check all that apply)

 English  Korean  Other Describe: ___________________________

 Spanish  Tagalog  Do not know

 Chinese  Vietnamese

3. Is there any documentation about allergens in the kitchen area?

 Yes (Go to #3a)  No  Unsure  Unable to observe

3a. Where is this documentation? (Check all that apply)

 Reach-in cooler

3a1. What does it say? ___________________________________________________________

_____________________________________________________________________________

 Walk-in cooler

3a2. What does it say? ___________________________________________________________

_____________________________________________________________________________

 Prep line

3a3. What does it say? ___________________________________________________________

______________________________________________________________________________

 Cook line

3a4. What does it say? ___________________________________________________________

______________________________________________________________________________

 Wait station

3a5. What does it say? ___________________________________________________________

______________________________________________________________________________

 Store room/Storage

3a6. What does it say? ___________________________________________________________

______________________________________________________________________________

 Break room

3a7. What does it say? ___________________________________________________________

______________________________________________________________________________

 Other Describe: ___________________________________________________________

3a8. What does it say? ___________________________________________________________

______________________________________________________________________________

3b. In what language(s) is the documentation? (Check all that apply)

 English  Korean  Other Describe: ___________________________

 Spanish  Tagalog  Do not know

 Chinese  Vietnamese

4. Did you observe any food item lists or recipes listing ingredients?

 Yes  No  Unsure

5. Did you observe a designated set of utensils and equipment for preparing allergen-free food items?

 Yes  No  Unsure

6. Did you observe a designated area in the kitchen for preparing allergen-free food items?

 Yes  No  Unsure

7. Did you observe a designated fryer for cooking allergen-free food items?

 Yes  No  Unsure  No fryer

8. Did you observe a designated pick-up area for food for customers with food allergies?

 Yes  No  Unsure  No fryer

9. Which of the following best describes this restaurant?

• Full service casual dining  Quick service  Unsure

• Full service fine dining  Fast casual service (e.g., Moe’s)

10. What is the establishment type?

• Prep Serve m Cook Serve m Complex

11. Please check all of the following that describe this restaurant.

• sit-down restaurant  buffet  quick service/fast food

• banquet hall  ethnic  caterer

12. What is the price of the highest priced food item on the menu? _______

13. What is the price of the lowest priced food item on the menu? _______

14. How many critical violations did this restaurant receive on its last routine inspection? _____

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