Form ETA 6-36 ETA 6-36 Environmental Health Inspections

Job Corps Environmental Health Program: Inspection of Food Service Facilities

Purpose of this form: The form provides Job Corps with a quarterly record of the performance and health evaluation of Job Corps centers’ food services facilities.

Center Name:	Enter information here	Center Director:	Enter information here
Center Address:	Enter information here	Year/Quarter (for example, 2008/1 QTR):	Enter information here

Item	WT.	Comments
Food
* 1. Sources, sound condition, no spoilage, milk pasteurized, meats are USDA approved	5	Enter information here
2. Original container or approved dispenser, properly labeled	1	Enter information here
Food Protection
* 3. Potentially hazardous food meets temperature requirements during storage, preparation, display, service, transport	5	Enter information here
* 4. Proper facilities to maintain product temperature	4	Enter information here
5. Thermometers provided and conspicuous	1	Enter information here
6. Potentially hazardous food properly thawed	2	Enter information here
7. Unwrapped and potentially hazardous food not reserved	3	Enter information here
8. Food properly protected during storage, preparation, display, service, transportation	2	Enter information here
9. Handling of food and ice minimized	2	Enter information here
10. In use, food and ice dispensing utensils properly stored	1	Enter information here
11. Fruits and vegetables washed	1	Enter information here
Personnel
*12. Personnel with infections restricted	5	Enter information here
13. Persons with hepatitis excluded for 45 days after symptoms	2	Enter information here
14. Personnel have local food handlers certificates if required	1	Enter information here
*15. Hands washed and clean, good hygienic practices	4	Enter information here
16. Clothes clean, hair restrained	1	Enter information here
Food Equipment and Utensils
17. Food contact surfaces: adequately designed, constructed, maintained, installed, located	2	Enter information here
18. Non-food contact surfaces: adequately designed, constructed, maintained, installed, located	1	Enter information here
19. Dishwashing facilities properly designed, constructed, maintained, installed, operated	2	Enter information here
20. Accurate thermometers or chemical test kits provided; gauge cocks provided	2	Enter information here
21. Dishes and utensils pre-flushed, scraped, soaked	1	Enter information here
22. Wash, rinse water: clean, proper temperature	2	Enter information here
*23. Sanitizing rinse: clean, appropriate temperature, concentration, exposure time. Equipment, utensils sanitized	5	Enter information here
24. Wiping cloths: clean, stored, restricted in use	1	Enter information here
25. Food contact surfaces of equipment, utensils clean, free of abrasives, detergent	4	Enter information here
26. Non-food contact surfaces of equipment, utensils clean	1	Enter information here
27. Satisfactory storage, handling of clean utensils, equipment	1	Enter information here
28. Single-service articles: non-toxic, properly stored, dispensed, handled, in use when dishwashing facilities are not operating	1	Enter information here
29. No reuse of single service articles	1	Enter information here
Water
*30. Water source safe, hot and cold under pressure	6	Enter information here
Plumbing
31. Properly installed, maintained, non-potable piping identified	1	Enter information here
*32. No back siphonage, cross-connection, backflow	4	Enter information here
Toilet and Handwashing Facilities
*33. Adequate number, convenient, accessible, properly designed, installed	3	Enter information here
*34. Toilet rooms enclosed, self-closing doors, fixtures in good repair, clean. Hand cleanser, hand drying device, soap, toilet tissues, waste receptacles provided. Adequate ventilation	3	Enter information here
Garbage and Refuse Disposal
35. Containers covered, adequate number, insect/rodent proof, clean, removal frequent	2	Enter information here
36. Outside storage area enclosures properly constructed, clean, controlled incineration	1	Enter information here
Insect, Rodent, Animal Control
*37. No insects, rodents. Outer openings protected. No birds, turtles, other animals	4	Enter information here
Floors, Walls, Ceilings
38. Floors: properly constructed, drained, clean, good repair, covering installation, dustless cleaning	1	Enter information here
39. Walls, ceilings, attached equipment: properly constructed, good repair, clean surfaces, dustless cleaning methods	1	Enter information here
Lighting
40. Lighting provided as required, fixtures shielded	1	Enter information here
Ventilation
41. Rooms and equipment vented as required; no odors, steam	1	Enter information here
Other
42. Dressing rooms clean, lockers provided, facilities conveniently located and used	1	Enter information here
*43. Necessary toxic items properly stored, labeled, used	5	Enter information here
44. Premises maintained, free of litter, unnecessary articles. Cleaning/maintenance equipment properly stored. No unauthorized persons	1	Enter information here
45. Complete separation from living/sleeping quarters, laundry	1	Enter information here
46. Clean, soiled linen properly stored	1	Enter information here

Total Score⁺: / 100

The items circled above are violations found on this date and must be corrected by next inspection or earlier.

*Critical items requiring immediate corrective action by Center Director

+A score less than 100 requires follow-up correspondence from the Center Director to the National Office of Job Corps and

Regional Office with this inspection report detailing necessary corrective action and proposed schedule for completion.

Inspection Date:	Enter information here	Inspected By:	Enter information here
Agency or Company:	Enter information here

I, the Center Director, or designee, have received a copy of this report and understand its contents.
Title
SIGNATURE:		DATE: Click or tap to enter a date.

FORWARD SCANNED FORM AND CORRECTIVE

ACTION WITHIN 7 DAYS OF INSPECTION TO:

U.S. Department of Labor/Office of Job Corps OJC 6-36

E-mail: [email protected] June 2008

INSPECTION OF FOOD SERVICE FACILITIES

1. Purpose. The purpose of this form is to provide Job Corps with a quarterly record of the performance and health evaluation of Job Corps centers’ food services facilities.

2. Originator. This form is completed by an appropriate representative of an authorized public health agency or another qualified environmental health specialist, other than center-related personnel, selected by the Center Director.

3. Frequency. Quarterly by December 31, March 31, June 30, and September 30, and any additional time that conditions may warrant.

4. Distribution. This form may or may not be a multi-copy form. The original copy is retained by the center for action purposes. The original should be scanned and forwarded via e-mail to (1) the National Office of Job Corps, (2) the Regional Office of Job Corps, (3) agency or contractor operator office, and (4) the contracted inspector, if requested.

5. General Instructions. This form consists of three pages—a two-page inspection form and one page of instructions. Each item of the inspection form should be completed by the authorized person performing the inspection.

6. Detailed Instructions.

1. If the center offers a culinary arts program, there may be a need to use separate forms for the food services facility and the culinary arts facility.

2. Indicate deficiencies by marking the WT. column (circle, “x” out, etc., the numerical weight) and providing an explanation in the comments column.

3. The full weighted value of an item found to be deficient will be subtracted from the total score. An explanation of exactly what was wrong should be provided by the inspector. If comments do not fit in the space provided, additional sheets may be attached to the form.

1. Disposition. Each recipient of this form is to maintain it on file for a period of 3 years, and then destroy.

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