ETA 6-36 Environmental Health Inspection

OJC 6-36

OMB Control Number: 1205-0219
Expires: xx/xx/xxxx

JOB CORPS ENVIRONMENTAL HEALTH PROGRAM

INSPECTION OF FOOD SERVICE FACILITIES
_______________________________________________________
Center Name

________________________________________________________________
Center Director

_________________________________________

________________________________________________

Center Address

Year/Quarter (for example, 2008/1 QTR)

ITEM

WT.

COMMENTS
FOOD

* 1. Sources, sound condition, no spoilage, milk
pasteurized, meats are USDA approved

5

2. Original container or approved dispenser, properly
labeled

1
FOOD PROTECTION

* 3. Potentially hazardous food meets temperature
requirements during storage, preparation, display, service,
transport

5

* 4. Proper facilities to maintain product temperature

4

5. Thermometers provided and conspicuous
6. Potentially hazardous food properly thawed

1
2

7. Unwrapped and potentially hazardous food not
reserved

3

8. Food properly protected during storage, preparation,
display, service, transportation

2

9. Handling of food and ice minimized
10. In use, food and ice dispensing utensils properly stored
11. Fruits and vegetables washed

2
1
1
PERSONNEL

*12. Personnel with infections restricted

5

13. Persons with hepatitis excluded for 45 days after
symptoms

2

14. Personnel have local food handlers certificates if
required

1

*15. Hands washed and clean, good hygienic practices
16. Clothes clean, hair restrained

4
1
FOOD EQUIPMENT AND UTENSILS

17. Food contact surfaces: adequately designed,
constructed, maintained, installed, located

2

18. Non-food contact surfaces: adequately designed,
constructed, maintained, installed, located

1

19. Dishwashing facilities properly designed, constructed,
maintained, installed, operated

2

20. Accurate thermometers or chemical test kits provided,
gauge cocks provided

2

21. Dishes and utensils pre-flushed, scraped, soaked
22. Wash, rinse water: clean, proper temperature
*23. Sanitizing rinse: clean, appropriate temperature,
concentration, exposure time. Equipment, utensils sanitized
24. Wiping cloths: clean, stored, restricted in use

1
2
5
1

25. Food contact surfaces of equipment, utensils clean,
free of abrasives, detergent

4

26. Non-food contact surfaces of equipment, utensils clean

1

27. Satisfactory storage, handling of clean utensils,
equipment

1

28. Single-service articles: non-toxic, properly stored,
dispensed, handled, in use when dishwashing facilities are
not operating
29. No reuse of single service articles

1

1

ITEM

WT.

COMMENTS
WATER

*30. Water source safe, hot and cold under pressure

5

31. Properly installed, maintained, non-potable piping
identified

1

PLUMBING

*32. No back siphonage, cross-connection, backflow

4
TOILET AND HANDWASHING FACILITIES

*33. Adequate number, convenient, accessible, properly
designed, installed
*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

3

GARBAGE AND REFUSE DISPOSAL
35. Containers covered, adequate number, insect/rodent
proof, clean, removal frequent
36. Outside storage area enclosures properly constructed,
clean, controlled incineration

2
1
INSECT, RODENT, ANIMAL CONTROL

*37. No insects, rodents. Outer openings protected. No
birds, turtles, other animals

4
FLOORS, WALLS, CEILINGS

38. Floors: properly constructed, drained, clean, good
repair, covering installation, dustless cleaning
39. Walls, ceilings, attached equipment: properly
constructed, good repair, clean surfaces, dustless cleaning
methods

1
1
LIGHTING

40. Lighting provided as required, fixtures shielded

1
VENTILATION

41. Rooms and equipment vented as required; no odors,
steam

1
OTHER

42. Dressing rooms clean, lockers provided, facilities
conveniently located and used
*43. Necessary toxic items properly stored, labeled, used
44. Premises maintained, free of litter, unnecessary
articles. Cleaning/maintenance equipment properly stored.
No unauthorized persons
45. Complete separation from living/sleeping quarters,
laundry
46. Clean, soiled linen properly stored

Total Score+:

1
5

1

1
1

/ 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: __________________________________

Inspected By: ____________________________________

Agency or Company: ______________________________
I, the Center Director or designee, have received a copy of this report and understand its contents.

__________________________________________________________________________________
SIGNED

TITLE

FORWARD SCANNED FORM AND CORRECTIVE
ACTION WITHIN 7 DAYS OF INSPECTION TO:
U.S. Department of Labor/Office of Job Corps
E-mail: safety@jobcorps.org

OJC 6-36
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.
a.
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.
b.
Indicate deficiencies by marking the WT. column (circle, “x” out, etc., the
numerical weight) and providing an explanation in the comments column.
c.
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.

7.

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

Public Burden Statement: Persons are not required to respond to this collection of information unless it displays a
currently valid OMB control number and expiration date. Public reporting burden for this collection of information, which is
required to obtain or retain benefits (29 USC 2881), is estimated to average 75 minutes per response, including time for
reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and
reviewing the collection of information. This information collection is for program management and Congressional
reporting purposes. Send comments regarding this burden estimate or any aspect of this collection of information,
including suggestions for reducing the burden, to the U.S. Department of Labor, Office of Job Corps, Room N-4507,
Washington, D.C. 20210 (Paperwork Reduction Project 1205-0219).
OJC 6-36