Food Service Plan Review Work Sheet - Cheyenne Laramie County Public Health

Plans must be submitted to this office 30 days prior to construction. This plan review will be good for 12 months from the date of review. Prior to the expiration date, a new plan review and the appropriate fee will need to be resubmitted. To review the Plan Review Fee Schedule, click here.

Establishment Name:(Required)

Establishment Address:(Required)

Street Address City State ZIP Code

Establishment Phone:(Required)

Establishment Fax:

Establishment Email:

Enter Email Confirm Email

Contact Person:(Required)

First Last

Owner Name:(Required)

First Last

Owner Address:(Required)

Street Address City State ZIP Code

Owner Phone:(Required)

The following MUST be uploaded with this questionnaire:

1. Hard copy of floor plan showing layout of equipment and mechanical layout.
2. Complete menu.
3. Standard Operating Procedures (SOP) outlining cooling and reheating procedures for any PHF/TCS foods.
4. Specification sheet of equipment (including shelving) showing NSF or equivalent approvals.
(incomplete plans will NOT be accepted)

Floor plan showing layout of equipment and mechanical layout(Required)

Max. file size: 50 MB.

Complete menu(Required)

Max. file size: 50 MB.

SOP outlining cooling and reheating procedures for any PHF/TCS foods(Required)

Max. file size: 50 MB.

Specification sheet of equipment (including shelving) showing NSF or equivalent approvals(Required)

Max. file size: 50 MB.

Will this establishment be:(Required)

Temporary

Permanent

Will this establishment be:(Required)

Mobile

Stationary

Do your managers or employees have food safety training?(Required)

Yes

Please list the type of training below.

To add new type of training click the (+)

What is the seating capacity of your facility?(Required)

Will this establishment do any catering outside the establishment?(Required)

Yes

Does your establishment have a HACCP plan?(Required)

Yes

Please upload a copy of HACCP plan and logs:

Max. file size: 50 MB.

DISHWASHING

What is the size of the largest piece of equipment (including pans, pots, etc)? Please provide LxWxD measurement:(Required)

What size is each compartment of the three-compartment sink? Please provide LxWxD measurement:(Required)

Does the three-compartment sink have integral drain boards?(Required)

Yes

Will this establishment have a dishwasher?(Required)

Yes

Will the dishwasher have an indirect drain?

Yes

Will the dishwasher be a:

High temp sanitizing machine

Chemical sanitizing machine

Will a hood be provided to vent steam out of the building?

Yes

Will any of the sinks or dishwashers have a pre-wash spray hose?(Required)

Yes

Where will they be located?

Will the spray hoses be provided with back flow prevention?

Yes

Will the mop sink be provided with back flow prevention?

Yes

Are Facilities provided for hanging wet mops?

Yes

Where?

WATER AND SEWER SUPPLY

Will water supply be from:(Required)

City

Community Water

Private Well

Will Sewage be disposed of by:(Required)

City

Septic System

How many hot water heaters will be provided?(Required)

What size (in gallons) will the water heater(s) be?(Required)

What size (in gallons) will the outside grease trap be?(Required)

Where will the outside grease trap be located?(Required)

Where will coolers and freezers drain?(Required)

How many restrooms will be provided?(Required)

Will restrooms have self-closing doors?(Required)

Yes

SHELVING AND STORAGE

How many, and what type of shelving will be used for coolers?(Required)

How many, and what type of shelving will be used for freezers?(Required)

How many and what type of shelving will be used for dry storage?(Required)

Where will chemicals be stored?(Required)

Will everything be stored at least 6” off the floor?(Required)

Yes

Will each refrigerator and freezer have thermometers?(Required)

Yes

VENTILATION AND FIRE SUPPRESSION

Is any frying going to be done in this establishment?(Required)

Yes

Are ventilation hoods/filters provided in kitchen?(Required)

Yes

How many in the cooking area?

How many in the dishwashing area?

Is fire suppression provided on hoods?

Yes

Do restrooms have vent fans venting to the outside?(Required)

Yes

OUTSIDE OPENINGS

Do all exterior doors open outward?(Required)

Yes

Are air curtains provided on any exterior doors?(Required)

Yes

Are screen doors provided on any doors?(Required)

Yes

Are screens provided on any windows that open?(Required)

Yes

LIGHTING

Is adequate lighting provided in all areas?(Required)

Yes

Are all lights shielded in food prep, storage, and serving areas (including coolers & freezers)?(Required)

Yes

Are all lights that are not shielded provided with shatterproof bulbs?(Required)

Yes

TRASH AREA

How many dumpsters with lids will be provided?(Required)

Will a grease barrel be provided?(Required)

Yes

Will a dumpster pad and enclosure be provided for trash area?(Required)

Yes

FOOD PROTECTION AND PREPARATION

Will any buffets, salad bars, or food bars be used in this establishment?(Required)

Yes

Will sneeze guards be provided?(Required)

Yes

Will hard ice cream be served?(Required)

Yes

Will dipper wells be provided?

Yes

How will hot foods be cooled?(Required)

Where will fresh produce be washed?(Required)

Where will frozen foods be thawed?(Required)

FACILITIES

(Finish schedule - Applicant must fill in materials, i.e., quarry tile, stainless steel, FRP board etc. )

Kitchen/Prep Area Floor Material(Required)

Kitchen/Prep Area Floor Finish(Required)

Kitchen/Prep Area Floor Cove(Required)

Kitchen/Prep Area Wall Material(Required)

Kitchen/Prep Area Wall Finish(Required)

Kitchen/Prep Area Ceiling Material(Required)

Kitchen/Prep Area Ceiling Finish(Required)

Kitchen/Cooking Area Floor Material(Required)

Kitchen/Cooking Area Floor Finish(Required)

Kitchen/Cooking Area Floor Cove(Required)

Kitchen/Cooking Area Wall Material(Required)

Kitchen/Cooking Area Wall Finish(Required)

Kitchen/Cooking Area Ceiling Material(Required)

Kitchen/Cooking Area Ceiling Finish(Required)

Storage Area Floor Material(Required)

Storage Area Floor Finish(Required)

Storage Area Floor Cove(Required)

Storage Area Wall Material(Required)

Storage Area Wall Finish(Required)

Storage Area Ceiling Material(Required)

Storage Area Ceiling Finish(Required)

Serving Area Floor Material(Required)

Serving Area Floor Finish(Required)

Serving Area Floor Cove(Required)

Serving Area Wall Material(Required)

Serving Area Wall Finish(Required)

Serving Area Ceiling Material(Required)

Serving Area Ceiling Finish(Required)

Dining Area Floor Material(Required)

Dining Area Floor Finish(Required)

Dining Area Floor Cove(Required)

Dining Area Wall Material(Required)

Dining Area Wall Finish(Required)

Dining Area Ceiling Material(Required)

Dining Area Ceiling Finish(Required)

Dishwashing Area Floor Material(Required)

Dishwashing Area Floor Finish(Required)

Dishwashing Area Floor Cove(Required)

Dishwashing Area Wall Material(Required)

Dishwashing Area Wall Finish(Required)

Dishwashing Area Ceiling Material(Required)

Dishwashing Area Ceiling Finish(Required)

Restroom Floor Material(Required)

Restroom Floor Finish(Required)

Restroom Floor Cove(Required)

Restroom Wall Material(Required)

Restroom Wall Finish(Required)

Restroom Ceiling Material(Required)

Restroom Ceiling Finish(Required)

Garbage & Refuse Area Floor Material(Required)

Garbage & Refuse Area Floor Finish(Required)

Garbage & Refuse Area Floor Cove(Required)

Garbage & Refuse Area Wall Material(Required)

Garbage & Refuse Area Wall Finish(Required)

Garbage & Refuse Area Ceiling Material(Required)

Garbage & Refuse Area Ceiling Finish(Required)

Other:

For areas not listed above, please specify the name of the area; the floor material, finish, and cove; the wall material and finish; and the ceiling material and finish.

PLUMBING

3-Compartment Sinks: Number of Fixtures(Required)

3-Compartment Sinks: Drain Type(Required)

Direct

Indirect

3-Compartment Sinks: Location(Required)

Prep Sinks: Number of Fixtures(Required)

Prep Sinks: Drain Type(Required)

Direct

Indirect

Prep Sinks: Location(Required)

Hand Sinks: Number of Fixtures(Required)

Hand Sinks: Drain Type(Required)

Direct

Indirect

Hand Sinks: Location(Required)

Dipper Wells: Number of Fixtures(Required)

Dipper Wells: Drain Type(Required)

Direct

Indirect

Dipper Wells: Location(Required)

Salad Bars: Number of Fixtures(Required)

Salad Bars: Drain Type(Required)

Direct

Indirect

Salad Bars: Location(Required)

Buffet Tables: Number of Fixtures(Required)

Buffet Tables: Drain Type(Required)

Direct

Indirect

Buffet Tables: Location(Required)

Mop Sinks: Number of Fixtures(Required)

Mop Sinks: Drain Type(Required)

Direct

Indirect

Mop Sinks: Location(Required)

Other:

For plumbing not listed above, please specify the name, number of fixtures, drain type (direct or indirect),and location.