Da Form 5161 1 R PDF Details

The DA 5161 1 R form, known as the Food Establishment Sanitation Inspection - Remarks Form, plays a vital role in maintaining public health and safety standards within food service establishments associated with the Department of the Army. By setting a standardized method for documenting sanitation inspections, this form ensures that all necessary temperature and warewashing data are accurately recorded and reviewed. It requires the inspector to input detailed information on refrigerator, freezer, hot holding, and food temperatures, alongside warewashing equipment's performance, including temperatures and sanitizer concentrations. This form, mandated by TB MED 530 and supported by the Office of The Surgeon General (OTSG), is attached to and becomes a permanent part of the DA Form 5161-R, making the documentation process thorough and integrated. With sections dedicated to explicit data entry such as manual and mechanical warewashing data, and a segment for additional remarks, the form is designed to provide a comprehensive view of a facility’s adherence to sanitation protocols, thereby ensuring the health and safety of personnel and patrons alike.

QuestionAnswer
Form NameDa Form 5161 1 R
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other namesA5161_1_R tb med 530 army form

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FOOD ESTABLISHMENT SANITATION INSPECTION - REMARKS FORM

For use of this form, see TB MED 530; the proponent agency is OTSG.

Form will be attached to and becomes a permanent part of DA Form 5161-R.

1.

ESTABLISHMENT

 

 

2. DATE (YYYYMMDD)

3. INSPECTOR

 

 

 

 

 

 

 

 

 

 

 

 

4.

TEMPERATURE DATA

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

a. Refrigerator Temperatures

b. Freezer Temperatures

c. Hot Holding Temperatures

d. Food Temperatures

 

 

 

 

 

 

 

 

 

 

 

 

UNIT

°F

UNIT

°F

UNIT

 

°F

UNIT

°F

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

5.WAREWASHING DATA

a.Manual

(1)Sanitizing Temperature (°F)

(2)Chemical Sanitizer Type

(3)Chemical Sanitizer Concentration (ppm)

b.Mechanical

(1)Wash Temperature (°F)

(2)Rinse Temperature (°F)

(3)Final Rinse Temperature (°F)

(4)Chemical Sanitizers (Type and Concentration) (ppm)

(5)Final Rinse Time (Seconds)

6.REMARKS

DA FORM 5161-1-R, OCT 2001

DA FORM 5161-1, AUG 91, IS OBSOLETE.

APD PE v1.00