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FOOD OPERATION INSPECTION REPORT

(Read instructions in the Tri-S ervice Food Code, Appendix E , before completing this form)

1. FACILITY NAME

2. FACILITY ADDRESS

3. INSTALLATION

4. DATE (Y Y Y Y MMDD)

5. INSPECTION

Routine

Follow-up

Complaint

Preoperational

Other (S pecify)

TYPE (X one)

6. INSPECTOR

NAME

AND RANK

b. PHONE

c. E-MAIL

d. UNIT/ORGANIZATION

7. START TIME

8. END TIME

Various

timeframes

9. PERSON IN

a. FULL NAME

b. PHONE

c. OFFICIAL E-MAIL

CHARGE (PIC)

10.NUMBER AND TYPE OF VIOLATIONS

a.Critical

b.Non- critical

11.INSPECTION RATING

(X one)

Fully Compliant	Substantially Compliant		Partially Compliant

Non-Compliant (Provide date		Follow-up date
scheduled for follow-up)

12.COMPLIANCE STATUS (Numbered items and specified provisions noted with an asterisk * indicates a CRITICAL deficiency)

Mark “X” in the box to indicate the provision was NOT in compliance; circle N/O for items not observed or N/A for not applicable. Where multiple provisions are included in the item description, only mark the CRITICAL provision if non-compliant. An unmarked item indicates all provisions within the grouping are fully compliant. For items that are OUT of compliance, Mark “X” in the appropriate box for COS (corrected on-site during the inspection) and R (repeat violation from previous inspection.)

Item

Supervision and Training

COS

Item

Temperature Control

COS

Person in charge (PIC) is present; demonstrates

N/A

N/O

Approved thawing & slacking methods for

knowledge [

2-101.11*;

2-102.11*]

frozen PHFs

27*

Proper cooking & reheating time and

PIC & employees: duties; training [

2-201.11(A)*]

N/A

N/O

temperature

Health and Hygiene

Fruits & vegetables properly cooked for hot

N/A

N/O

Hand wash facilities: supplied, accessible, used

holding

N/O

Hands clean; properly washed

29*

Proper cooling time and temperature

N/A

N/O

[ 2-301.11*;

2-301.12*;

2-301.14*]

Proper cooling methods; adequate

Ill employee reporting, restriction, exclusion

N/A

equipment

[ 2-201.11*;

2-201.12*;

2-201.13*]

31*

Proper hot holding temperature

N/A

N/O

Bare hand/arm contact with food

32*

Proper cold holding temperature

N/A

N/O

[

3-301.11*]

Consumer Advisory for raw/undercooked

Personal cleanliness: clothing; hair restraint; jewelry

33*

N/A

foods

N/O

Eating, drinking, tobacco use in food

N/A

Time as public health control; variance

prep & service areas; proper tasting

procedures [

3-501.19*;

3-502.11*;

procedures [

3-301.12*]

8-103.12*]

Food Source, Identification, Condition

Utensils and Equipment

Food & water from approved sources

N/A

Thermometers provided and accurate

10*

Food in good condition, safe, & unadulterated;

In-use utensils properly stored between use

N/A

receipt temperature

N/A

N/O

Required records available: shellstock

Food/non-

food contact surfaces: cleanable; installed;

tags [ 3-202.18*;

3-203.12*]; parasite

used [

4-101* various;

4-102.11*;

4-201.12*;

destruction

[

3-402.11*]

4-202.11*; 4-204.13*;

4-204.111*;

4-603.17*]

N/O

Food properly labeled; original

N/A

Utensils, equipment & linens properly dried,

container; major food allergen

stored, handled

13*

N/A

N/O

Leftover PHFs properly labeled, stored,

Single-use/single-service items: properly stored & used

handled

[ 4-502.12*]

14*

N/A

N/O

Proper date marking and disposition

N/A

Warewashing equipment: use; maintained;

test kits

Contamination Protection and Prevention

Nonfood contact surfaces clean

N/A

N/O

Food separated and protected

Physical Facilities

[ 3-302.11*; 3-304.11*; 3-306.13*]

N/A

Fresh fruits and vegetables properly

Hot and cold water available; adequate capacity and

washed [

7-204.12*]

pressure

17*

N/A

Food contact surfaces cleaned &

Plumbing cross connections; backflow

sanitized

devices [

specify critical:]

18*

Proper disposition of returned, previously served,

Sewage &

waste water properly disposed; grease traps

reconditioned, & unsafe food

[

5-402.11*;

5-402.13*;

5-403.11*]

Contamination prevented during food prep, storage

Garbage/refuse proper disposal; facilities maintained;

& display [

3-304.11*;

3-306.13*]

covered receptacles

20*

N/A

Food additives approved & proper use

Restrooms properly installed, supplied, maintained

Protection

from ice used as coolant [

3-303.11*];

Physical facilities: installed, maintained, cleaned

food contact with water/ice

[

6-202.111*]

N/A

N/O

Gloves used properly

Lighting: adequate; proper fixtures

N/A

Wiping cloths: properly used and stored

N/A

Ventilation & hoods: adequate, maintained

Insects, rodents, animals: not present

N/A

Ice machines properly maintained

and

operated

Toxic substances properly identified, stored & used

[

7-201.11*;

7-202.12*;

7-203* thru 7-207*;

Other findings: X this box and enter provision number with

7-301.11*]

findings in block 17, RE MARKS .

FORM 2973, NOV 2013

REPLACES DA FORMS 5161-R, 5162-R, NAVMED 6240/1, AND AF FORM 977,

Page 1 of _____ Pages

WHICH ARE OBSOLETE.

FOOD OPERATION INSPECTION REPORT

13. FACILITY NAME

14. DATE

15. INSPECTION

Routine

Follow-up

Complaint

TYPE

Preoperational

Other:

16. TEMPERATURE OBSERVATIONS (Mark the temperature scale used)

Food Item & Location

Temp

Food Item & Location

Temp

Food Item & Location

Temp

oF / oC

17. REMARKS (Observations and Corrective Actions)

Summary of findings, corresponding provision number, and recommended corrective actions. (Corrective action is required within the time frames
	specified below, or as stated in sections 8-405.11 and 8-406.11 of the Tri-S ervice Food Code)
IHH	Mark this box if an imminent health hazard (IHH) was found; describe the situation and remediation in this section.

Item

Number

	Inspection Rating Criteria:
	Inspection Rating Criteria:		Partially Compliant = no IHH and 3 or more Critical findings COS, and/or 6 or
	Fully Compliant = no deficiencies
	Fully Compliant = no deficiencies		more Non-Critical findings.
	Substantially Compliant = no IHH and 2 or less Critical findings		more Non-Critical findings.
			Non-Compliant = IHH present, or one or more Critical findings not COS.
	corrected on site (COS), and/or 5 or less Non-Critical findings

18.SIGNATURE Signature on this form represents acknowledgement that the person in charge has been briefed on the deficiencies noted, corrective actions and time frame for completion, the final inspection rating, and date scheduled for follow-up inspection (non-compliant ratings only).

a. INSPECTOR SIGNATURE	b. DATE SIGNED

c. PERSON IN CHARGE SIGNATURE	d. DATE SIGNED

DD FORM 2973 (BACK), NOV 2013	Page 2 of _____ Pages

FOOD OPERATION INSPECTION REPORT (Continued)

FACILITY NAME

DATE

INSPECTION TYPE

Routine	-up	Complaint
Routine	Follow	Complaint
Preoperational	Other:
Preoperational

TEMPERATURE OBSERVATIONS (Mark the temperature scale used)

Food Item & Location

Temp

oF / oC

Food Item & Location

Temp

oF / oC

Food Item & Location

Temp

oF / oC

REMARKS (Observations and Corrective Actions)

Item

Number

Summary of findings, corresponding provision number, and recommended corrective actions. (Corrective action is required within the time frames specified below, or as stated in sections 8-405.11 and 8-406.11 of the Tri-Service Food Code)

INSPECTOR’S		Fully Compliant	Partially Compliant
INITIALS	FINAL INSPECTION	Fully Compliant	Partially Compliant
INITIALS	FINAL INSPECTION
	RATING
PIC’S INITIALS	RATING	Substantially Compliant	Non-Compliant
PIC’S INITIALS		Substantially Compliant	Non-Compliant

DD FORM 2973 (CONTINUATION PAGE), NOV 2013			Page 3 of _____ Pages

INSTRUCTIONS FOR MARKING THE FOOD OPERATION INSPECTION REPORT

1.	FACILITY NAME. As stated.	13.	FACILITY NAME. As stated. (Should match first page)
2.	FACILITY ADDRESS. Provide the street number, city, state, and zip	14.	DATE. As stated. (Should match first page)
	code.	15.	INSPECTION TYPE. Place an “X” in the box to indicate the type
3.	INSTALLATION. Provide the name of the military installation, camp,	15.
3.			of inspection being conducted. Select only one. If “Other” is
	training area, or vessel where the food operation is located.		marked, specify the inspection type (e.g., Self Evaluation, Walk-
4.	DATE. As stated.		through). (Should match first page)
4.	DATE. As stated.	16.	TEMPERATURE OBSERVATIONS. For food, identify the food
5.		16.	TEMPERATURE OBSERVATIONS. For food, identify the food
5.	INSPECTION TYPE. Place an “X” in the box to indicate the type of		item and location of the food in the facility when the internal
	inspection being conducted. Select only one. If “Other” is marked,		product temperature was taken (e.g., meatloaf/serving line). For
	specify the inspection type (e.g., Self Evaluation, Walk-through)		equipment, identify the equipment type and location in the
6.			facility where the ambient air temperature was taken (e.g., walk-
6.	INSPECTOR. Provide the full name (and military rank), phone number		in refer #2, outside). Provide the temperature measurement as
	with area code, official e-mail, and assigned unit of the person		indicated on your thermometer. Mark the temperature scale
	conducting the inspection.		used (oF or oC). If more space is needed to document
7.			measurements, use the REMARKS section or continuation
7.	START TIME. Time the inspection began; use 24-hour clock notation.		page.
8.	END TIME. Time the inspection officially ended; use 24-hour clock	17.	REMARKS. Briefly describe specific observations for
	notation. Place an “X” in the box to indicate the inspection occurred at		deficiencies.
	multiple time intervals throughout the day.		- IHH – Place an “X” in the box if an imminent health hazard was
9.			found and describe the situation in the space provided.
9.	PERSON IN CHARGE (PIC). Provide the full name (and military rank),		- Item Number – Indicate the item number from the list of
	phone number with area code, and official e-mail of the PIC who		provision groupings in block 12, COMPLIANCE STATUS, on
	accompanied the inspector.		page 1 where a deficiency was found, describe the findings, and
10.	NUMBER AND TYPE OF DEFICIENCY. Provide the total number of		provide remediation guidance.
10.	NUMBER AND TYPE OF DEFICIENCY. Provide the total number of	18.
	“Critical” deficiencies and “Non-critical” deficiencies found during the	18.	SIGNATURE. The inspector and PIC sign and date the form
	inspection. Do not mark the box if no deficiencies were noted.		after reviewing inspection findings, the facility inspection rating,
11.	INSPECTION RATING. Using the “Inspection Rating Criteria” provided		remediation actions, and the scheduled follow-up date (for non-
11.			compliant inspection ratings only.)
	on page 2 of the form, place an “X” in the box to indicate the overall		Page Number. Indicate the page number and total number of
	level of compliance for the facility. When a “non-compliant” rating is		Page Number. Indicate the page number and total number of
	assessed, provide the date in which a follow-up inspection will be		pages starting on page 1 and on subsequent pages containing
	conducted.		inspection data.

Provision Quick Reference Guide

12.COMPLIANCE STATUS. Refer to the listed provisions for a detailed discussion regarding assessment criteria in each item grouping. Appendix E, Section II of the Tri-Service Food Code provides a summary guide for debiting each item grouping. (Item numbers containing an asterisk * indicates all provisions within the grouping are CRITICAL. Non-critical items within a grouping are scored as critical if the Item Number was marked as non- compliant. Provision numbers that are bolded are CRITICAL requirements.)

1s26 3-501.12; 3-501.132-101.11*; 2-102.11(A); 2-102.11(B)*; 2-102.11(C)

2	2-103.11; 2-201.11(A)*; 2-501.11; 2-502.11; 2-503.11; 2-503.12;	27*	3-401.11; 3-401.12; 3-403.11*
2	2-503.13; 2-505.11	28	3-401.13
3	5-202.12; 5-203.11; 5-205.11; 6-301.11 thru 6-301.14	29*	3- 501.14*
4	2-301.11; 2-301.12; 2-301.14*; 2-301.15; 2-301.16	30	3-501.15; 4- 301.11
5	2-201.11; 2-201.12; 2-201.13*; 2-401.12	31*	3-501.16*
6	3-301.11*; 3-301.11(C) s	32*	3-501.11; 3-501.16
7	2-302.11; 2-303.11; 2-304.11; 2-402.11	33*	3-603.11*
8	2-401.11; 3-301.12*	34	3-501.19; 3-502.11; 8-103.12*; 8-201.13
9*	3-201.11* thru 3-201.18; 3-202.13; 3-202.14; 3-202.110; 5-101.13*	35	4-203.11; 4-203.12; 4-302.12; 4-502.11
10*	3-101.11; 3-202.11; 3-202.15*	36	3-304.12
11	3-202.18; 3-203.12; 3-402.11*; 3-402.12		3-304; 4-101.11* thru 4-101.15; 4-102.11; 4-201.11; 4-
12	3-203; 3-302.12; 3-602.11	37	201.12; 4-202.11; 4-202 various; 4-204.13; 4-204.111; 4-
13*	3-501.110*		204; 4-302.11; Parts 4-4 & 4-5; 4-603.17*; 4-902

14*	3-501.17; 3-501.18	38	Various in subparts: 4-801; 4-802; 4-803; 4-901; 4-903; 4-904

15	3-302.11; 3-304.11; 3-304.15; 3-306.13*	39	4-502.12*; 4-502.13; 4-903.11; 4-903.12; 4-904.11

16	3-302.15; 7-204.12*	40	4-204; 4-204; 4-301.12; 4-301.13; 4-302.14; 4-501; 4-603

17*	4-501.111; 4-501.112; 4-501.113; 4-501.114; 4-501.115; 4-601.11(A);	41	4-601.11; 4-602.13
17*	4-602.12; 4-702.11; 4-703.11	42	5-103.11; 5-103.12; 5-104.11
18*	3-306.14; 3-701.11	43	Various in subparts: 5-202; 5-203; 5-205; 5-301; 5-302;
19	3-304.11*; 3-305.11; 3-305.12; 3-305.14; 3-306.11; 3-306.12;	43	5-304; [some critical provisions apply]
19	3-306.13*; 3-307.11; 6-404.11	44	5-401.11; 5-402.11; 5-402.12; 5-402.13; 5-403.11*
	3-306.13*; 3-307.11; 6-404.11	44	5-401.11; 5-402.11; 5-402.12; 5-402.13; 5-403.11*
20*	3-202.12; 3-302.14	45	5-501.11 thru 5-501.16; 5-501.18; 5-501.19; 5-501.110 thru 5-

			501.116; 5-503; 6-202.110
			501.116; 5-503; 6-202.110
21	3-303.11*; 3-303.12	46	5-203.12; 5-501.17; Parts 6-1, 6-2, 6-3, 6-4 & 6-5
22	3-304.15	47	4-301.15; 4-401.11; 4-803.13; Parts 6-1, 6-2 & 6-5; 6-202.111*
23	3-304.14; 4-101.16; 4-901.12	48	6-202.11; 6-303.11
24	2-403.11; 6-202.13; 6-202.15; 6-202.16; 6-501.111	49	4-202.18; 4-301.14; 6-202.12; 6-304.11; 6-304.12; 6-501.14
25	Chapter 7; 7-201.11; 7-202.12; 7-203* thru 7-207; 7-301.11	50	4-401.12; 4-503.11; 4-503.12
DD	FORM 2973 (INSTRUCTIONS), NOV 2013		Page 4 of _____ Pages

Question	Answer
Form Name	Dd Form 2973
Form Length	4 pages
Fillable?	No
Fillable fields	0
Avg. time to fill out	1 min
Other names	dd form 2973, dd form 2973 food operation inspection report, dd 2973, dd2973

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