Ensuring the safety and hygiene of food served in retail food establishments is a paramount concern for public health authorities. The E3 form, a comprehensive Retail Food Establishment Inspection Report, plays a crucial role in this endeavor. This detailed document is structured into two pages, meticulously designed to cover various aspects of an establishment's operation, ranging from food handling and temperature controls to the conditions of facilities and equipment. Inspectors use the form during visits to assess compliance with health standards, categorizing violations that require immediate attention and those that allow for a brief window to rectify. The report includes sections for recording temperatures of stored food, verifying that personnel follow hygiene practices, ensuring the adequacy and accessibility of handwash facilities, and evaluating the maintenance and cleanliness of food contact surfaces. Each violation noted on the inspection form demands a specific corrective action, with the severity of the infraction determining the urgency of the response. Moreover, the form goes beyond just flagging current issues, offering a structured approach for establishments to take corrective actions, thereby contributing to the overall mission of protecting public health. The emphasis on temperature control, proper sourcing, and prevention of cross-contamination underscores the rigorous standards set forth to minimize risks to consumers. This form, updated periodically to reflect best practices and regulatory changes, stands as a testament to the ongoing commitment to food safety, ensuring that eating out remains a pleasant and safe experience for everyone.
| Question | Answer |
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| Form Name | Form E 3 |
| Form Length | 2 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 30 sec |
| Other names | Reheating, establishment report example, PHF, Pts |
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Retail Food Establishment Inspection Report |
Page 1 of 2 |
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Date |
Time In |
Time Out |
Establishment Number |
Permit Number |
Risk Category |
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Code |
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Purpose of Inspection: |
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Establishment: |
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Owner: |
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Physical Address: |
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Zip: |
Phone: ( |
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OUT |
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NA |
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NO |
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COS |
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Food Temperature/Time Requirements |
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5 Pts |
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Violations Require Immediate Corrective Action |
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Remarks |
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1. Proper Cooling for Cooked/Prepared Food |
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2. Cold Hold (41 degrees Fahrenheit /45 degrees Fahrenheit) |
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3. Hot Hold (135 degrees Fahrenheit) |
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4. Proper Cooking Temperatures |
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5. Rapid Reheating (165 degrees Fahrenheit in 2 Hrs) |
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Item/Location/Temperature |
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OUT |
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NA |
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NO |
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COS |
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Personnel/Handling/Source Requirements |
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4 Pts |
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Violations Require Immediate Corrective Action |
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Remarks |
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6. |
Personnel with Infections Restricted/Excluded |
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7. |
Proper/Adequate Handwashing |
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Good Hygienic Practices (Eating/Drinking/Smoking/Other) |
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Approved Source/Labeling |
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10. |
Sound Condition |
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11. |
Proper Handling of |
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13. |
Approved Systems (HACCP Plans/Time as Public Health Control) |
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14. |
Water Supply – Approved Sources/Sufficient Capacity/Hot and Cold Under Pressure |
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OUT |
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NA |
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NO |
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COS |
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Facility and Equipment Requirements |
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3 Pts |
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Violations Require Immediate Correction, Not To Exceed 10 Days |
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Remarks |
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15. |
Equipment Adequate to Maintain Product Temperature |
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16. |
Handwash Facilities Adequate and Accessible |
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17. |
Handwash Facilities with Soap and Towels |
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18. |
No Evidence of Insect Contamination |
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19. |
No Evidence of Rodents/Other Animals |
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20. |
Toxic Items Properly Labeled/Stored/Used |
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21. |
Manual/Mechanical Warewashing and Sanitizing at ( )ppm/temperature |
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22. |
Manager Demonstration of Knowledge/Certified Food Manager |
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23. |
Approved Sewage/Wastewater Disposal System, Proper Disposal |
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24. |
Thermometers Provided/Accurate/Properly Calibrated (±2 degrees Fahrenheit) |
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25. |
Food Contact Surfaces of Equipment and Utensils Cleaned/Sanitized/Good Repair |
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26. |
Posting of Consumer Advisories (Heimlich/Disclosure/Reminder/Buffet Plate) |
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27. |
Food Establishment Permit |
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Subtotal |
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Other Violations – Require Corrective Action, Not to Exceed 90 Days or the Next Inspection, Whichever Comes First |
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5pt |
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4pt |
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3pt |
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Total |
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Inspected by: |
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Print: |
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F/U |
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Received by: |
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Print: |
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Title: |
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Yes/ No |
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Form
Corrective Actions to Ensure Safe Food |
Page 2 of 2 |
Item No.
1Cooling
•PHF/TCS* food cooled from 135° F to 70° F more than 2 hours OR 135° F to 41° F (45° F) more than 6 hours; OR prepared food cooled to 41° F (45° F) more than 4 hours:
Action: Voluntary destruction, rapid reheating of cooked foods if less than 4 hours
2Cold Hold
•PHF/TCS food held above 41° F (45° F) more than 4 hours:
Action: Voluntary destruction
•PHF/TCS food held above 41° F (45° F) less than 4 hours:
Action: Rapid cool (e.g. ice bath)
3Hot Hold
•PHF/TCS food held below 135° F more than 4 hours:
Action: Voluntary destruction
•PHF/TCS food held below 135° F less than 4 hours:
Action: |
Rapid reheat to 165° F or more |
4Cooking
•PHF/TCS food undercooked:
Action:
5Rapid Reheating
•Cold PHF/TCS food improperly reheated:
Action: Reheat rapidly to 165° F
7Handwashing
•Food employees observed not washing hands:
Action: Instruct employees to wash hands as specified in the Rules.
9, 10 Approved Source/Sound Condition
•Foods from unapproved sources/unsound condition:
Action: Voluntary destruction
11Proper Handling of
•Employee did not properly wash and sanitize hands before touching
Action: Voluntary destruction
12
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Action: Voluntary destruction of
14Water Supply
•Facility does not have water for washing hands, preparing food, or cleaning equipment/utensils:
Action: Voluntary suspension of food preparation
*Potentially Hazardous Food (PHF) / Time/Temperature Control for Safety (TCS)