+ FACILITY or AIRCRARTE OPERATIONAL UNIT Qrsscd ale Poof Cin ITEMS EVALUATED a wow! com. PLIANCE | DATE CcOR- 5S. HEALTH CERTIFICATES B. PERSONAL HYGIENE C. TRAINING CERTIFICATES D. 2. EXAMINATION BY SUPERVISORS FACILITIES ANDO EQUIPMENT A. DESIGN AND CONSTRUCTION 8. VENTILATION c. FLOORS D. INSECT AND RODENT CONTROL E. PREPARATION SURFACES 6. COM. PLIANCE! SANDWICHES GREEN VEGETABLES FROZEN FOOO LEFT-OVER FOODS DISHES AND UTENSILS HANDLING PROCEDURES WASHING AND SANITIZING PRE-WASH a. WASH (Temperature) HAND WASHING FACILITIES c. RINSE (Temperature) MOP AND BROOM RACK D. SANITIZING (Temperature or t. OUTSIDE AREA J. LATRINE(S) Chemical} —. LARGE FQUIPMENT /Pors, Pans, etc. } FROM APPROVED SOURCES FOOD 8 WATER/ICE F. AIRCRAFT WATER AND COFFEE z a CONTAINERS STORAGE TECHNIQUE A. REFRIGERATORS 8. FREEZERS ‘. COR. RECTED SERVING LINE (Temperature) H. A. (65 o¢ DATE POTENTIALLY HAZARDOUS FOODS G. r}a}aimioin 4. fe#2 7 NON- TIME PREPARATION TECHNIQUE A. F. UTENSIL STORAGE 3. DATE EVALUATED ITEMS EVALUATED RECTED FOOD HANDLERS 4. Hae YadPoe NO, rlajaimio {ols |> 1. AOSadr FOOD FACILITY SANITATION CHECK LIST 7. OTHER FOOO CONTACT SURFACES VENDING MACHINES FACILITY CLEANLINESS VEGETABLES A. GARBAGE STANDS/DUMPSTERS BREAD AND BAKERY PROOUCTS B. GREASE (INTERCEPTORS MILK DISPENSERS Cc. AIRCRAFT REFUSE HANDLING DRY STORAGE NON-FOOD 8. OTHER CLEAN EQUIPMENT WENDING MACHINES lettae 2 Venti Vata, a REMARKS ANO RECOMMENDATIONS /Use reverse, if necessary) AY aa Qlek ck one fale | satiseactory Aad, WMepeures Ste al.o tat... Si FOOD FACILITY REPRESENTATIVE “ F oR mM 977 MAW 75 ho7-~—— PREV(Ods EDITIONS ARE OBSOLETE. 11 hee fete fia LeMLL WA. a SLAe Praliatine Dae f-ftes LL, UNSATISFACTORY SIGNATURE OF EVALUATOR Lobet f ted 2S¢4 UAE iP