Dd Form 2973, Food Operation Inspection Report, November 2013
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4FOOD OPERATION INSPECTION REPORT
(Read instructions in the Tri -Service Food Code, Appendix E, before completing this form)
1. FACILITY NAME
2. FACILITY ADDRESS
3. INSTALLATION
4. DATE (YYYYMMDD)
5. INSPECTION
Other (Specify)
Routine
Follow-up
Complaint
Preoperational
TYPE (X one)
a. NAME AND RANK
b. PHONE
c. E-MAIL
6. INSPECTOR
d. UNIT/ORGANIZATION
7. START TIME
8. END TIME
Various
timeframes
a. FULL NAME
b. PHONE
c. OFFICIAL E-MAIL
9. PERSON IN
CHARGE (PIC)
a. Critical
Fully Compliant
Substantially Compliant
Partially Compliant
10. NUMBER AND
11. INSPECTION
TYPE OF
RATING
b. Non-
Non-Compliant (Provide date
Follow-up date
VIOLATIONS
(X one)
critical
scheduled for follow-up)
12. COMPLIANCE STATUS (Numbered items and specified provisions noted with an asterisk * indicates a CRITICAL deficiency)
Mark “X” in the box to indicate the provision was NOT in compliance; circle N/O for items not observed or N/A for not applicable. Where multiple provisions are included in the
item description, only mark the CRITICAL provision if non-compliant. An unmarked item indicates all provisions within the grouping are fully compliant. For items that are
OUT of compliance, Mark “X” in the appropriate box for COS (corrected on-site during the inspection) and R (repeat violation from previous inspection.)
Item
Supervision and Training
COS
R
Item
Temperature Control
COS
R
Approved thawing & slacking methods for
N/A N/O
Person in charge (PIC) is present; demonstrates
1
26
frozen PHFs
knowledge [
2-101.11*;
2-102.11*]
Proper cooking & reheating time and
27*
N/A N/O
PIC & employees: duties; training [
2-201.11(A)*]
2
temperature
Health and Hygiene
Fruits & vegetables properly cooked for hot
N/A N/O
28
3
Hand wash facilities: supplied, accessible, used
holding
Hands clean; properly washed
Proper cooling time and temperature
29*
4
N/O
N/A N/O
[
2-301.11*;
2-301.12*;
2-301.14*]
Proper cooling methods; adequate
30
N/A
Ill employee reporting, restriction, exclusion
equipment
5
[
2-201.11*;
2-201.12*;
2-201.13*]
Proper hot holding temperature
31 *
N/A N/O
Bare hand/arm contact with food
N/A
N/O
Proper cold holding temperature
32*
N/A
6
N/A
N/O
[
3-301.11*]
Consumer Advisory for raw/undercooked
33*
N/A
Personal cleanliness: clothing; hair restraint; jewelry
7
foods
Eating, drinking, tobacco use in food
Time as public health control; variance
8
N/O
34
N/A
3-501.19*;
3-502.11*;
prep & service areas; proper tasting
procedures [
procedures [
3-301.12*]
8-103.12*]
Food Source, Identification, Condition
Utensils and Equipment
Food & water from approved sources
N/A
Thermometers provided and accurate
9*
35
Food in good condition, safe, & unadulterated;
10*
36
In-use utensils properly stored between use
N/A
receipt temperature
Required records available: shellstock
Food/non-food contact surfaces: cleanable; installed;
N/A
N/O
11
tags [
3-202.18*;
3-203.12*]; parasite
37
used [
4-101* various;
4-102.11*;
4-201.12*;
destruction [
3-402.11*]
4-202.11*;
4-204.13*;
4-204.111*;
4-603.17*]
Food properly labeled; original
Utensils, equipment & linens properly dried,
12
N/O
38
N/A
container; major food allergen
stored, handled
Single-use/single-service items: properly stored & used
Leftover PHFs properly labeled, stored,
N/A
N/O
13*
39
[
4-502.12*]
handled
N/A
N/O
Warewashing equipment: use; maintained;
Proper date marking and disposition
14*
40
N/A
test kits
Contamination Protection and Prevention
Nonfood contact surfaces clean
41
Food separated and protected
N/A
N/O
15
Physical Facilities
[
3-302.11*;
3-304.11*;
3-306.13*]
Fresh fruits and vegetables properly
Hot and cold water available; adequate capacity and
16
N/A
42
washed [
7-204.12*]
pressure
Food contact surfaces cleaned &
Plumbing cross connections; backflow
17*
N/A
43
N/A
devices [
specify critical:]
sanitized
Sewage & waste water properly disposed; grease traps
Proper disposition of returned, previously served,
18*
44
[
5-402.11*;
5-402.13*;
5-403.11*]
reconditioned, & unsafe food
Contamination prevented during food prep, storage
Garbage/refuse proper disposal; facilities maintained;
19
45
& display [
3-304.11*;
3-306.13*]
covered receptacles
Food additives approved & proper use
Restrooms properly installed, supplied, maintained
20*
N/A
46
Physical facilities: installed, maintained, cleaned
Protection from ice used as coolant [
3-303.11*];
21
47
[
6-202.111*]
food contact with water/ice
N/A
N/O
Gloves used properly
Lighting: adequate; proper fixtures
22
48
Wiping cloths: properly used and stored
Ventilation & hoods: adequate, maintained
23
N/A
49
N/A
Ice machines properly maintained and
Insects, rodents, animals: not present
24
50
N/A
operated
Toxic substances properly identified, stored & used
Other findings: X this box and enter provision number with
[
7-201.11*;
7-202.12*;
7-203*
7-207*;
thru
25
51
7-301.11*]
findings in block 17, REMARKS.
DD FORM 2973, NOV 2013
Page 1 of _____ Pages
REPLACES DA FORMS 5161-R, 5162-R, NAVMED 6240/1, AND AF FORM 977,
WHICH ARE OBSOLETE.
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