FOOD OPERATION INSPECTION REPORT

(Instructions for completing this form are provided in TB MED 530/NAVMED P-5010-1/AFMAN-48-147 IP, Appendix E)
1. FACILITY NAME 2. FACILITY ADDRESS 3. INSTALLATION 4. DATE(YYYYMMDD)
, , 1

□ □ □
I
5. INSPECTION Other (Specify)
TYPE (Xone)
D Routine Follow-up complaint DPreoperational
a. NAME AND RANK b. PHONE c. E-MAIL
6. INSPECTOR

d. UNIT/ORGANIZATION 7. START TIME 18. END TIME

lo
Various
timeframes
9. PERSONIN
CHARGE(PIC)
I
a. FULL NAME

10. NUMBER a.# of Critical: 11. INSPECTION Fully Compliant□

b. PHONE

□
substantially Compliant
I
C. OFFICIAL E-MAIL

□
Partially Compliant Follow-up date
ANDTYPE OF RATING
VIOLATIONS b.# of Non-critical: (Xone) D
Non-Compliant (Provide date scheduled for follow-up)
12. COMPLIANCE STATUS (The asterisk • indicates the Item grouping or provision are scored as CRITICAL, unless "Only a Non-Critical violation cited" is
marked.) Refer to the INSTRUCTIONS on page 5 of this form for guidance when marking items in the checklist and completing the associated REMARKS (block
18).
Item Supervision and Training cos R Item Temperature Control cos R
1· □ PIC: present; demonstrates knowledge; approved
to operate □ Only a Non-Critical violation cited □ □ 26
27* □
NIAi NIQ
NIA[] Nie(]
I Thawing frozen TCS foods
cooking & reheating time and
temoeratures □ □
2 PIC duties; employee training □ 2-201.11(A)*

3
Heal th and Hygiene
Hand wash sink: available; supplied; accessible
28
29*
□ □ NIA
N/A
Nie(]
N/Q
i-ru1ts1Vegetao1es neated tor not
holdina
Cooling time & temperature
□ □
I
4 □ Ni e(]
Handwashing D 2-301.11* □ 2-301.12*
□ 2-301.14* □ □ 30
31*
N/A
NIA
Cooling methods; adequate equipment
NI� I Hot holding temperature
5• □ Ill employee: report; restrict; exclude
□ Only a Non-Critical violation cited □ □ 32*
33*
NIA
N/A
Cold holding and storage
Consumer advisory: raw/undercooked food
6* □ NIAD Nie(] b
are hand/arm contact with food
Only a Non-Critical violation cited □ □ 34 □ □ NIA
Time as public health control; HACCP;
variance procedures □ 3-501.19*0 3-502.11* □ □
Personal hygiene: clothing; hair; jewelry
D 3.502.12• oa-103.12•
7
8 □ Nie(]
Eating, dfinking, tobacco use; proper tasting
procedures D 3-301.12* □ □ 35 NIA
Utensils and Equipment
Thermometers provided and accurate
Food Source, Identification, Condition
36 NIA In-use utensil storage
9• □ Approved sources; food specifications
D Only a Non-Critical violation cited □ □ Food equipment: installation, condition, use

10 □ Food condition; unadulterated; receipt temperature

D 3.101.11• o 3-202.11• 3-202.15•
o □ □ 37 □ 0 4-101.11*0 4-101.14*0 4-101.15*0 4-201.12*
D 4-202.11•0 4-204.13*0 4-204.111•
□ □
11• □ NIA□
equired records: shellstock tags;
NIO1q;arasite destruction □ □ 38 □ NIAD
Utensils, equipment, linens: drying, storage,
handlina □ □
12 □ Nie(]
Only a Non-Critical Violation Cited
Food labels; original container; major fooa
□ □
39 □ Single-use/service items: storage; usl!J 4-102.11•
D 4-502.12• □ □
13* □ NIA□
alleroen
Nie[]
Leftovers
□ □
40
41
□ NIAO
Warewashing: equipment; procedures;
cleaners & sanitizers; test kits
Nonfood-contact surfaces; cooking/baking surfaces
□ □
□ Only a Non-Critical violation citec
. Iemperature Control ror �afety l ' L;�J Physical Facilities
14* □ NIA□ Nie(]I I food: date marking, retention,
disoosition
□ □ 42 Hot and cold water: available; capacity; pressure
Potable water; plumbing system; cross
Contamination Protection and Prevention
15 □ NIAD Nie[] b
ood separated & protected in storage
3-302.11* □ □ 43 □ NIA[]
connections □ 5-101* □ 5-102* □ 5-201*
::J 5-202* □ 5-203* □ 5-205* □ 5-301* □ □
tJ 5-302* □ 5-303* □ 5-304*
16 NIAi I Fresh fruits and vegetables properly washed
17* □ □ Clean/sanitized food-contact surfaces
□ Only a Non-Critical violation cited □ □ 44 □ Sewage/wastewater system; disposal; grease traps
D 5-402.11• o 5-402.13• o5-403.11• □ □
□
N/A

18* □ Food: returned, previously served, recona1tioned;

hiohlv suscectible oooulation orohibitions □ □ 45
46
l;;arbage/refuse: d1sposa1; racilities; coverea
recectacles
Restrooms: proper install; supplied; clean
□ □
19 □ Contamination prevented during food prep, service &
display □ 3-302.13* □ 3-304.11* □ 3-306.13* □ □ 47 □ Physical facilities: proper install; repair; clean
:J 6-202.111* □ □
20* NIAi I Food additives: approved; proper use
48 Lighting: adequate; proper fixtures
21 □ Ice used as coolant; food contact with water/ice
::J 3-303.11* □ □ 49
50
N/A
N/A
Ventilation & hoods: adequate, maintained
Ice machines properly maintained, operated
22 NIAi I N/Cl 11 Gloves used properly
23
24
NIAi I Wiping cloths: use; storage
Insects, rodents, animals
51 □ Other findings: 1.,neck this box and enter prov1s1on
number with findinas in block 17 REMARKS. □ □
Toxic substances: authorized; properly identified,
25* □ stored & used
D Onlv" Non-Critical violation cited
□ □
DD FORM 2973, MAR 2019
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