Food Establishment Plan Review Application

When applying for a license to operate a food establishment in Springfield Township you must first complete a PLAN REVIEW APPLICATION. This application is of primary importance in the licensing procedure.

Once your plans have been reviewed and approved you may continue with the process by completing the FOOD ESTABLISHMENT APPLICATION and by paying the appropriate fee. All of these documents must be submitted before the license to operate is issued.

If you would prefer to complete a paper form, click here 

Address

Please enter the mailing address:

Owner Information

Applicant Information

Plan/Application Submittal

Please specify which authorities plans/applications have been submitted to and a date for each:
  Authority NameSpecify OtherDate  
Export Clear Add new row
1

Establishment Information

Type of Service (Check all that apply):
Hours of Operation
Sunday
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Establishment Specs
Maximum Meals to be Served (approx.)

A. Contents and Format of Plans and Specifications

Supporting Documents

Upload
Upload
Upload
Upload
Upload
Section 52-4.C(1). Prior to construction of any new food establishment or starting alterations to an existing food establishment , the owner must first submit a Plan Review Application to the Health Officer, along with a two-hundred dollar ($200.00) review fee. The Plan Review Application and fee are intended to ensure compliance with all local and state health codes, prior to construction.

If you need further information, please contact:  Lori Devlin - Health Officer

B. Food Preparation Review

Are the following categories Potentially Hazardous Foods (PHF's) to be handled, prepared and served:
List all other Potentially Hazardous Foods (PHF's) in the grid below
  Other  
Export Clear Add new row
1

C. Food Supplies

2.  List the projected frequencies of deliveries for the following categories:

3.  Provide information on the amount of space (in cubic feet) allocated for the following categories:

D. Cold Storage

Thawing Frozen Potentially Hazardous Thick Foods

Refrigeration
Running Water Less than 70 degrees F
Microwave (as part of cooking process)
Cooked from Frozen State
Other

Thawing Frozen Potentially Hazardous Thin Foods

Refrigeration
Running Water Less than 70 degrees F
Microwave (as part of cooking process)
Cooked from Frozen State 
Other

E. Cooking

Minimum cooking time and temperatures of product utilizing convection a condition heating equipment:

Food Item

Temperature

Cooking Time

Beef Roast

130 degrees

121 minutes

Solid Seafood Pieces

145 degrees

15 seconds

Other PHFs

145 degrees

15 seconds

Eggs:  Immediate Service

145 degrees

15 seconds

Eggs:  Pooled

(pasteurized eggs must be served to  a highly susceptible population)

155 degrees

15 seconds

Pork

145 degrees

15 seconds

Comminuted Meats/Fish

155 degrees

15 degrees

Poultry

165 degrees

15 seconds

Reheated PDFs

165 degrees

15 seconds

List the types of cooking equipment that will be utilized in the grid below:
  Cooking Equipment  
Export Clear Add new row
1

F. Hot/Cold Holding

How will hot PHF's be maintained at 140 degrees F (60 degrees C) or above during holding for service? Indicate type and number of hot holding units:

How will cold PHF's be maintained at 41 degrees F (5 degrees C) or below during holding for service? Indicate type and number of cold holding units: 

G. Cooling

Indicate how PHF's will be cooled to 41 degrees F (5 degrees C) within six hours (140 degrees F in 2 hours and 70 degrees F to 41 degrees in four hours). Also, indicate where the cooling is going to take place.
N/A

Thick Meats

Thin Meats

Thick Soups/Gravy

Thin Soups/Gravy

Rice/Noodles

H. Reheating

How will PHF's that are cooked, cooled and reheated for hot holding be reheated so that all parts of the food reach a temperature of at least 165 degrees F for 15 seconds. Indicate type and number of units used for re-heating foods.

I. Preparation

List all categories of food prepared more than twelve hours in advance of service:
  Food Category  
Export Clear Add new row
1
List Food Sanitation process details below:
  Method of TrainingDate of CompletionNumber(s) of Employees  
Export Clear Add new row
1
How will cooking equipment, cutting boards, counter tops and other food contact surfaces which cannot be submerged in sinks or put through a dishwasher be sanitized?
Upload

J. Finish Schedule

Indicate which materials (quarry tile, stainless steel, 4" plastic coved molding etc.) will be used in the following areas:

Kitchen

Bar

Food Storage

Other Storage

Toilet Rooms

Dressing Rooms

Garbage & Refuse Storage

Mop Service & Basin Area

Warewashing Area

Walk-In Refrigerators & Freezers

K. Insect and Rodent Control

Garbage and Refuse 

L. Inside

M. Outside

N. Plumbing Connections

Check box where Plumbing Connections are located and explain if needed.

A TRAP is a fitting or device which provides a liquid seal to prevent the emission of sewer gases without materially affecting the flow of sewage or waste water through it.

Toilet

Urinals

Dishwasher

Garbage Grinder

Ice Machines

Ice Storage Bin

Sinks

Steam Tables

Dipper Wells

Refrigeration Condensate/Drain Lines

Hose Connection

Potato Peeler

Beverage  Dispenser with Carbonator

Other

Click 'Add' to add multiple

O. Water Supply

Upload

P. Sewage Disposal

Upload

Q. Dressing Rooms

R. General

Indicate areas where exhaust hoods are installed:
  LocationFilters/Extraction DevicesSq. FeetFire ProtectionAir MakeupAir Capacity  
Export Clear Add new row
1

S. Sinks

T. Dishwashing Facilities

Check all methods that will be used for ware washing: 
What type of dishwasher sanitation is used?
What type of sanitizer is used?

U. Handwashing/Toilet Facilities

Handwashing Facilities

Toilet Facilities

V. Small Equipment Requirements

Specify the Number, Location and Type for each of the following:

Slicers

Cutting Boards

Can Opener

Mixers

Floor Mats

Other

Click 'Add' button to add more than one piece of equipment.

Plan Review Authorization

I hereby certify that the information I have provided is correct, and I fully understand that any deviation from the above without prior permission from this Health and Regulatory Office may nullify final approval.
NOTE:  Approval of these plans and specifications by this Regulatory Authority does not indicate compliance with any other code, law or regulation that may be required - federal, state or local. It further does not constitute endorsement or acceptance of the completed establishment with equipment (structure or equipment). A pre-opening inspection of the establishment with equipment in place and operational will be necessary to determine it complies with the local and state laws governing food service establishments.
Payment of fees for this application will be requested via email once your submission has been reviewed.  Please verify that emails from donotreply@springfielddel.co are not sent to your spam/junk mail folder.  The email will contain a link to this form allowing you to make a secure payment by credit card.
Payment of fees for this application will be requested via email once your submission has been reviewed.  Please verify that emails from donotreply@springfielddel.co are not sent to your spam/junk mail folder.  The email will contain a link to this form allowing you to make a secure payment by credit card.  The amount shown below is an estimated amount and may be adjusted once your submission is reviewed.