Number of seats:
Total square feet of the facility:
Number of floors on which operations are conducted:
(include basement, etc.)
Maximum meals to be served:
Breakfast
Lunch
Dinner
(approximate number)
Type of service: (check all that apply)
Sit down meals:
Mobile vendor:
Take out:
Caterer:
Other:
Who (job title) will be your certified food handler? (Title IC 16-42-5.2) (Title 410 IAC 7-26 sect.135)
Title:
Name:
Certificate #:
How will employees be trained in food safety? (sect. 136):
The following procedures/questions should be considered before any further planning/construction
begins or continues to ensure that special consideration is given to these standard sanitary operating
procedures (SSOP's).
This section should be completed by the operator.
Please indicate (by either checking or completing the answers) whether or not a section applies to your operation.
MENU REQUIREMENTS
Will raw animal food(s) be offered to the public in an undercooked or raw form (rare hamburgers, eggs over easy, made from scratch dressings, sushi, etc.)?
Yes
No
*If yes, please provide a copy of the menu with the consumer advisory statement (sect. 223)
The person-in-charge shall notify consumers by written notification of the presence of major food allergens:
Milk, Eggs, Fish (such as bass, flounder or cod), Crustacean shellfish (such as crab, lobster or shrimp), Tree
nuts (such as almonds, pecans or walnuts), Wheat, Peanuts, Soybeans, Sesame or a food ingredient containing
protein derived from these listed food ingredients as an ingredient in unpackaged food items served or sold to
the consumer. (sect. 222b)