Food Facility Risk Assessment Survey Page 2
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1
2POINT
VALUE
AWARDED
RISK FACTORS
YES
NO
POINTS
(For yes
response)
9. POPULATION SERVED (Specific populations are more likely to develop foodborne illness based on age and environment. Likelihood of foodborne
illness also increases with number of meals or patrons serve.)
(1) > 900
10
a. Number of customers
(2) 300 - 899
8
served per day (Only mark
(3) < 300
5
one item “yes” from this list)
(4) N/A - retail store
0
(1) Highly susceptible population: Initial entry service members;
infants or children (less than 5 years of age), elderly or infirmed
who are fed at/or from day care, elementary schools, after school
12
b. Typical patronage (This
programs, retirement homes, convalescent centers, or hospitals.
category considers both
Military personnel and US civilians, including contractors, during
the population type and
deployments or extended (> 2 weeks) field training.
location; only mark one
(2) Shipboard. Check this box for all subsistence operations
item "yes" from this list)
conducted aboard a nautical vessel regardless if in port or
18
deployed/at sea. [If selected, check No for item 9b(1)]
(3) All others (general population)
0
0
Max Possible Points this section
28
10. FOOD OPERATIONS (Operations or food preparation activities carried out in the food establishment or retail food facility)
a. Temperature-controlled processes (e.g. cooking and holding PHFs hot or cold)
6
b. Rapid cooling PHFs (after cooking or retaining leftovers)
4
c. Re-heating leftovers
4
d. Time as a Public Health Control
4
e. Operating under a variance from requirement of the Code.
2
f. Manual preparation of ready-to-eat foods (e.g. sandwiches, salads, slicing deli meats and
4
cheeses).
g. Remote, satellite, or field feeding, including transportation of PHFs.
1
h. Cook-chill or sous-vide operations
2
Max Possible Points this section
27
11. FACILITIES AND EQUIPMENT (Evaluation based on adequate numbers on hand and equipment operating properly)
a. Inadequate handwashing facilities. (Field expedient handwashing facilities are acceptable in
3
field and temporary food operations.)
b. Inadequate refrigeration and/or cooling equipment.
5
c. Inadequate cooking and/or hot holding equipment.
3
d. Inadequate dishwashing and/or pot and pan washing and storage equipment.
2
Max Possible Points this section
13
12. INSPECTION AND EMPLOYEE HISTORY (Results of previous inspections/audits provide insight as to where public health and veterinary
resources and training should be directed. The following are indicators of poor managerial controls)
a. Two or more unsatisfactory or non-compliant inspections within the previous 12 inspections.
2
b. Person-in-charge not present or failed to meet requirements for demonstration of knowledge.
4
Max Possible Points this section
6
Maximum Points Possible for Food Service
118
13. TOTAL SCORE (Sum of items 8 -12; use this score to determine
the Risk Category in item 7)
Maximum Points Possible for Retail Stores
121
14. REMARKS
b. PHONE
c. DATE (YYYYMMDD)
a. NAME, RANK, AND DUTY POSITION
15. ASSESSOR
d. OFFICIAL E-MAIL
e. ORGANIZATION
16. SUPERVISOR (Completed by Public Health Supervisor after reviewing this form)
a. NAME AND TITLE
b. ORGANIZATION
c. DATE (YYYYMMDD)
d. OFFICIAL E-MAIL
e. PHONE
f. SIGNATURE
DD FORM 2972 (BACK), NOV 2013
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