Mobile Food Facility Official Inspection Form Sample - Alameda County
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4MOBILE FOOD FACILITY
OFFICIAL INSPECTION REPORT
County of Alameda
Date: _______________
Page 1 of __________
Department of Environmental Health
Time In: _____________ Time Out: _____________
(510) 567-6700 Fax: 510-337-9134
1131 Harbor Bay Parkway
REHS Specialist (Initial): ______________________
Alameda, CA 94502-6577
Business Name:
Site Address of Inspection:
DMV Plate #
Record ID #
Inspection Type:
Structural
Consult
FA PR SR
Annual Permit Issued: Y N Current Decal # (
)__________
Operational
Complaint
Follow-up
Interim Permit Exp Date:______________________
Other:
PE
Note: Permit and Placard must be displayed in clear view when in Alameda County
See reverse side for the code sections and general requirements that correspond to each violation listed below
____________
Major violations pose threats to public health and must be corrected immediately. Non-compliance may warrant closure of the facility
____________
____________
OUT = Out of Compliance
COS = Corrected on-site
PTS = Points
PTS Lost = Points lost
MAJOR VIOLATIONS
PTS
APPROVED RETAIL PRACTICES
OUT
PTS
Lost
PTS
DEMONSTRATION OF KNOWLEDGE
OUT
COS
PTS
PERSONAL CLEANLINESS
Lost
23. Personal cleanliness and hair restraints
1
1. Demonstration of knowledge; food safety
□
□
2
GENERAL FOOD SAFETY REQUIREMENTS
certification; food handler cards current
24. Approved thawing methods used, frozen food
1
Food Safety Cert Name:
Exp. Date:
25. Safe food preparation
1
EMPLOYEE HEALTH & HYGIENIC PRACTICES
26. Consumer self-service
1
*
□
□
4
2. Communicable disease procedures
27. Food properly labeled & honestly presented
1
3. No discharge from eyes, nose, and mouth
□
□
2
28.Toxic substances/non-food items properly identified, stored, used
1
4. Proper eating, tasting, drinking or tobacco use
□
□
2
PREVENTING CONTAMINATION BY HANDS
EQUIPMENT/ UTENSILS/ LINENS
5. Hands clean and properly washed; gloves used
29. Warewashing facilities: installed, maintained, used; test strips
1
□
□
4
*
properly; RTE food handling
30. Thermometers provided and accurate
1
6. Adequate hand washing facilities supplied &
31. Compliance with water heater requirements
1
□
□
2
accessible
32. Equipment, utensil storage, seals and latches in good repair
1
TIME AND TEMPERATURE RELATIONSHIPS
33. Wiping cloths: properly used and stored
1
*
7. Proper hot and cold holding temperatures
□
□
4/2
SIGNAGE & SUPERVISION REQUIREMENTS
8. PHF above 135°F destroyed at end of day. No
34. Food safety signs posted; last inspection report available
1
□
□
4
*
cooling on MFF
35. Permanent and proper signage on outside of Facility
1
*
□
□
4
9. Proper cooking time & temperatures
36. Person in Charge
1
*
□
□
4
10. Proper reheating procedures for hot holding
PHYSICAL FACILITIES
PROTECTION FROM CONTAMINATION
37. Approved & adequate ventilation and lighting; covers, shields
1
*
□
□
4/2
11. Food in good condition, safe and unadulterated
38. Pass-thru windows & ceiling vent screens
1
*
39. Hand washing sinks, Warewashing sinks
1
□
□
4/2
12. Food contact surfaces: clean and sanitized
40. Potable water and waste water tanks installed, gate valves
FOOD FROM APPROVED SOURCES
1
adequate, proper use
*
13. Food obtained from approved source
□
□
4
41. Equipment Construction Requirements/Utensils ANSI approved
1
14. Compliance with shell stock tags, condition,
□
□
2
42. Proper, unobstructed height and width of occupied areas
1
display
43. Location and operation of compressors
1
15. Compliance with Gulf Oyster Regulations
□
□
2
44. Required Fire Suppression System provided
1
CONFORMANCE WITH APPROVED PROCEDURES
GENERAL MFF REQUIREMENTS
16. Compliance with variance, specialized process,
□
□
4/2
45. Compliance with commissary/com kitchen req’s; Agmnt on file
1
& HACCP Plan
46. Cleaning and servicing; SOP’s on file for unenclosed MFFs
1
CONSUMER ADVISORY
17. Consumer advisory provided for raw or
47. Restroom facilities within 200 ft (if stopped for > 1hr)
1
□
□
2
undercooked foods and foods with ½ % alcohol
1
48. Exterior and surrounding area sanitary
WATER/ HOT WATER
49. Compliance with safety requirements
*
18. Hot and cold water available
First Aid Kit
Fire Extinguisher (10BC min)
1
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4/2
Adequate pressure Y N
2
exit
Latches: fryer lid steam table
nd
LIQUID WASTE DISPOSAL
COMPLIANCE & ENFORCEMENT
19. Wastewater properly disposed
□
□
2
50. Compliance with plan review requirements
1
VERMIN
51. Certification from State Housing & Community Development
*
2
□
□
4/2
20. No rodents, insects, birds, or animals
(HCD) Ph: 916-255-2501
MAJOR MFF REQUIREMENTS
*
21. Approved and adequate Power Source
; Plug-in
52. Facility operating with valid Health Permit*/Placard posted
4/2
□
□
4/2
Agreement on file
53. Food Impoundment or VCD
*
□
□
4/2
22. Mechanical refrigeration provided
54. Permit Suspension/Require Closure
Other:
□
□
Inspection Total Score: ______________/______________
*
Denotes the violations that if left uncorrected will result in a point total of 26 points per violation AND immediate closure
RED – Fail
Placard
GREEN – Pass
YELLOW – Conditional Pass; Follow-up Inspection Required by: ___/___/_________
CLOSED until released by this
Note:
Agency
A Re-inspection Fee will be charged at the second & subsequent follow-up inspection at $________ per inspection.
Received by (Signature)
Phone #:
Date:
O:\OPERATIONS TECHNICAL\FOOD PROGRAM\UNIT 5\VEHICLES\Grading System - Mobile Food Dept\Placarding\Inspection Report Drafts - Alameda County\Website Version SAMPLE.docx
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