Dd Form 2973, Food Operation Inspection Report, November 2013 Page 4
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4INSTRUCTIONS FOR MARKING THE FOOD OPERATION INSPECTION REPORT
1.
FACILITY NAME. As stated.
13.
FACILITY NAME. As stated. (Should match first page)
2.
FACILITY ADDRESS. Provide the street number, city, state, and zip
14.
DATE. As stated. (Should match first page)
code.
15.
INSPECTION TYPE. Place an “X” in the box to indicate the type
3.
INSTALLATION. Provide the name of the military installation, camp,
of inspection being conducted. Select only one. If “Other” is
training area, or vessel where the food operation is located.
marked, specify the inspection type (e.g., Self Evaluation, Walk-
through). (Should match first page)
4.
DATE. As stated.
16.
TEMPERATURE OBSERVATIONS. For food, identify the food
5.
INSPECTION TYPE. Place an “X” in the box to indicate the type of
item and location of the food in the facility when the internal
inspection being conducted. Select only one. If “Other” is marked,
product temperature was taken (e.g., meatloaf/serving line). For
specify the inspection type (e.g., Self Evaluation, Walk-through)
equipment, identify the equipment type and location in the
facility where the ambient air temperature was taken (e.g., walk-
6.
INSPECTOR. Provide the full name (and military rank), phone number
in refer #2, outside). Provide the temperature measurement as
with area code, official e-mail, and assigned unit of the person
indicated on your thermometer. Mark the temperature scale
o
o
conducting the inspection.
used (
F or
C). If more space is needed to document
measurements, use the REMARKS section or continuation
7.
START TIME. Time the inspection began; use 24-hour clock notation.
page.
8.
END TIME. Time the inspection officially ended; use 24-hour clock
17.
REMARKS. Briefly describe specific observations for
notation. Place an “X” in the box to indicate the inspection occurred at
deficiencies.
multiple time intervals throughout the day.
- IHH – Place an “X” in the box if an imminent health hazard was
found and describe the situation in the space provided.
9.
PERSON IN CHARGE (PIC). Provide the full name (and military rank),
- Item Number – Indicate the item number from the list of
phone number with area code, and official e-mail of the PIC who
provision groupings in block 12, COMPLIANCE STATUS, on
accompanied the inspector.
page 1 where a deficiency was found, describe the findings, and
provide remediation guidance.
10.
NUMBER AND TYPE OF DEFICIENCY. Provide the total number of
“Critical” deficiencies and “Non-critical” deficiencies found during the
18.
SIGNATURE. The inspector and PIC sign and date the form
inspection. Do not mark the box if no deficiencies were noted.
after reviewing inspection findings, the facility inspection rating,
remediation actions, and the scheduled follow-up date (for non-
11.
INSPECTION RATING. Using the “Inspection Rating Criteria” provided
compliant inspection ratings only.)
on page 2 of the form, place an “X” in the box to indicate the overall
level of compliance for the facility. When a “non-compliant” rating is
Page Number. Indicate the page number and total number of
assessed, provide the date in which a follow-up inspection will be
pages starting on page 1 and on subsequent pages containing
conducted.
inspection data.
Provision Quick Reference Guide
12. COMPLIANCE STATUS. Refer to the listed provisions for a detailed discussion regarding assessment criteria in each item grouping. Appendix E,
Section II of the Tri-Service Food Code provides a summary guide for debiting each item grouping. (Item numbers containing an asterisk * indicates all
provisions within the grouping are CRITICAL. Non-critical items within a grouping are scored as critical if the Item Number was marked as non-
compliant. Provision numbers that are bolded are CRITICAL requirements.)
s
1
2-101.11*; 2-102.11(A); 2-102.11(B)*; 2-102.11(C)
26
3-501.12; 3-501.13
2-103.11; 2-201.11(A)*; 2-501.11; 2-502.11; 2-503.11; 2-503.12;
27*
3-401.11*; 3-401.12*; 3-403.11*
2
2-503.13; 2-505.11
28
3-401.13
3
29*
3- 501.14*
5-202.12; 5-203.11; 5-205.11; 6-301.11 thru 6-301.14
4
2-301.11*; 2-301.12*; 2-301.14*; 2-301.15; 2-301.16
30
3-501.15; 4- 301.11
5
2-201.11*; 2-201.12*; 2-201.13*; 2-401.12
31*
3-501.16*
s
6
3-301.11*; 3-301.11(C)
32*
3-501.11*; 3-501.16*
7
33*
3-603.11*
2-302.11; 2-303.11; 2-304.11; 2-402.11
8
2-401.11; 3-301.12*
34
3-501.19*; 3-502.11*; 8-103.12*; 8-201.13
9*
9*
3-201.11* thru 3-201.18*; 3-202.13*; 3-202.14*; 3-202.110*; 5-101.13*
35
4-203.11; 4-203.12; 4-302.12; 4-502.11
10*
10*
3-101.11*; 3-202.11*; 3-202.15*
36
3-304.12
11
11
3-202.18*; 3-203.12*; 3-402.11*; 3-402.12
3-304; 4-101.11* thru 4-101.15*; 4-102.11*; 4-201.11; 4-
12
3-203; 3-302.12; 3-602.11
37
201.12*; 4-202.11*; 4-202 various; 4-204.13*; 4-204.111*; 4-
204; 4-302.11; Parts 4-4 & 4-5; 4-603.17*; 4-902
13*
3-501.110*
14*
3-501.17*; 3-501.18*
38
Various in subparts: 4-801; 4-802; 4-803; 4-901; 4-903; 4-904
15
3-302.11*; 3-304.11*; 3-304.15; 3-306.13*
39
4-502.12*; 4-502.13; 4-903.11; 4-903.12; 4-904.11
16
3-302.15; 7-204.12*
40
4-204; 4-204; 4-301.12; 4-301.13; 4-302.14; 4-501; 4-603
41
4-501.111; 4-501.112; 4-501.113; 4-501.114*; 4-501.115; 4-601.11(A)*;
4-601.11; 4-602.13
17*
4-602.12; 4-702.11*; 4-703.11*
42
5-103.11; 5-103.12; 5-104.11
18*
3-306.14*; 3-701.11*
Various in subparts: 5-202; 5-203; 5-205; 5-301; 5-302;
43
5-304; [some critical provisions apply]
3-304.11*; 3-305.11; 3-305.12; 3-305.14; 3-306.11; 3-306.12;
19
3-306.13*; 3-307.11; 6-404.11
44
5-401.11; 5-402.11*; 5-402.12; 5-402.13*; 5-403.11*
5-501.11 thru 5-501.16; 5-501.18; 5-501.19; 5-501.110 thru 5-
20*
3-202.12*; 3-302.14*
45
501.116; 5-503; 6-202.110
21
3-303.11*; 3-303.12
46
5-203.12; 5-501.17; Parts 6-1, 6-2, 6-3, 6-4 & 6-5
22
47
4-301.15; 4-401.11; 4-803.13; Parts 6-1, 6-2 & 6-5; 6-202.111*
3-304.15
23
48
3-304.14; 4-101.16; 4-901.12
6-202.11; 6-303.11
24
2-403.11; 6-202.13; 6-202.15; 6-202.16; 6-501.111
49
4-202.18; 4-301.14; 6-202.12; 6-304.11; 6-304.12; 6-501.14
25
Chapter 7; 7-201.11*; 7-202.12*; 7-203* thru 7-207*; 7-301.11*
50
4-401.12; 4-503.11; 4-503.12
DD FORM 2973 (INSTRUCTIONS), NOV 2013
Page 4 of _____ Pages
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