Child Care Center Plan Review Application

10 JOHNSTON COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 309 East Market Street , Smithfield , NC 27577 Phone 919 - 989 - 5180 Fax 919 - 989 - 5190 Email envhealth @ johnstonncgov Child Care Center Plan Review Application Application and Plan Submittal This completed Application , a drawing of the floor plan of the proposed facility see attached example and a proposed menu must be submitted to the Johnston County Environmental Health Office This packet can be submitted in person or mail to the address above , or to the email address listed above If the application is incomplete then you will be contacted with a list of deficiencies There is not a fee for this plan review General Information Name of Center ______________________________________________________________________ Center's Address _____________________________________________________________________ Name of Applicant ____________________________________________________________________ Applicant Phone # __________________________________ Email ______________________________ Name of Owner ______________________________________________________________________ Owner's Mailing Address _______________________________________________________________ Owner's Phone Number _______________________ Email ___________________________________ Who is the Contact Person for this Project _________________________________________________ Mailing Address ______________________________________________________________________ Phone # ___________________________________ Email ___________________________________ Signature of Applicant _ _________________________________________ Date __________________ Operational Information What are the days and hours that the center plans to be in operation ___________________________ ___________________________________________________________________________________ Number of children that the center will be licensed for approximately ___________________________ What are the ages of the children you plan to care for in the center _____________________________ ___________________________________________________________________________________ Will the center have a licensed afterschool program Yes No Will the center offer overnight care or two shifts Yes No If yes , explain _______________________________________________________________________ Is the proposed center an existing facility building Yes No If yes , what is the date when the facility building was constructed ______________________________ If the facility is new , what is the proposed construction start date _______________________________ What is the projected date for the opening of the center ______________________________________ What is the approximate square footage of the facility _______________________________________PageFood Preparation 1 Will meals be prepared at the facility or catered in ______________________________________________ If meals are catered into the center , what is the name and address of the catering facility ______________ _________________ ____________________________________________________________________ 2 Will the kitchen equipment be shared with any other group in the same facility Yes No If yes , what group will be sharing the equipment ________________________________________________ 3 List the equipment to be used in the kitchen and indicate whether it is commercial NSF listed or domestic ______________________________________ ___________________ _________________ _ _____________________________________ ___________________ _________________ __________________ ____________________ ___________________ _________________ __________________ ____________________ ___________________ _________________ __________________ ____________________ ___________________ _________________ 4 Will any foods be fried on - site Yes No If yes , is a commercial hood system planning to be installed Yes No 5 Check foods that will be prepared in your child care center kitchen _______ raw vegetables _______ raw chicken _ ______ raw hamburger _______ raw fish seafood _______ salads _______ precooked meats _______ pre - prepared meats _______ egg - based products pre - portioned , ready - to - cook Where will the above items be washed and or prepped ___________________________________________ __________________ ____________________________________________________________________ __________________ ____________________________________________________________________ __________________ ____________________________________________________________________ Refrigeration Freezers 1 Adequate refrigeration and freezer space provided _____________________________________________ Conspicuous and accurate thermometer in each freezer and refrigerator Yes No 2 Is a separate hand - washing lavatory provided Yes No Only food service personnel shall use this lavatory 8 Will there be a separate metal stem thermometer to check food temperatures and water temperatures Yes NoPageDishwashing Facilities 1 Will the center serve food beverage on multi - service articles single - use articles When multi - use articles are used , the center must have one of the following __________ Dishwasher and a 2 - Compartment sink __________ 3 - Compartment sink The dishwashing equipment must be of sufficient size based on the volume and size of the utensils cookware service items that will be used What are the dimensions of the sink vats that will be used for dishwashing __________ 2 - Compartment sink __________ x ___________ x __________ sq inches __________ 3 - Compartment sink __________ x ___________ x __________ sq inches There must be a total of at least 8 square feet of countertop space or drain board space on the sides of the sinks and or dish machine 2 Will the center have a dishwasher Yes No If so , list the make and model provide a spec sheet if available _____________________________________________ _________________________________________________________________ _______________________ 3 How will all food containers , utensils and service items be sanitizer in the dishwashing process ___________ ________________________________________________________________________________________ Infant Feeding Areas Classroom Food Service 1 Where will bottles be stored or prepared _____________________________________________________ If in the classroom , is there a separate hand - washing lavatory and designated food preparation counter Yes No How do you plan on heating the bottles ______________________________________________________ Where is the heating equipment located _____________________________________________________ 2 Will older children be dining in the classroom or in another location _________________________________ How will food be transported to the dining location ______________________________________________ __________________ ____________________________________________________________________ Note If bottles or " sippie cups " are stored in the classroom , a hand sink in addition to the hand - washing sink for diaper - changes is required Diaper Changing Stations 1 How many designated diaper changing areas will be in the center ________ indicate all changing stations on the plan 2 Is a hand - washing sink accessible to each diaper changing station Yes No Explain _______________________________________________________________________________ 3 How do you plan on cleaning disinfecting the changing station between uses ________________________ __________________ ____________________________________________________________________PageSolid Wastes 1 Is there a can cleaning facility or mop sink Yes No 2 Will a dumpster be used Yes No Who is the Contractor ___________________________________________________________________ 3 Is there a grease trap Yes No If yes , where is it located _________________________________________________________________ Water and Wastewater 1 Water Source Community Private well 2 Sewage service Municipal sewer On - site septic system If the center is on a private well and serves 25 or more people , documentation shall be provided from the Public Water Supply Section that the well is approved Water Heater s Water heating equipment shall be provided to meet the maximum hot water requirements of the child care center The capacity and recovery ratings are based on the number and size of sinks , capacity of dishwashing machines and laundry machines • Hot water at the kitchen sink used for cleaning and sanitizing , and laundry machines , shall have a minimum temperature of 120 ° F • Water in all areas that are accessible to children shall be tempered between 80 ° F and 110 ° F • Can - Wash or Mop sinks shall provide a minimum water temperature of 80 ° F How will these requirements be met ______________________________________________ _________________________________________________________________ ___________ ____________________________________________________________________________ ____________________________________________________________________________ List specifications of water heater s to be used This should include capacity , set temperature , and recovery rate Quantity ______ Capacity ______ gallons Recovery ______ gallons hour Temperature _______ Quantity ______ Capacity ______ gallons Recovery ______ gallons hour Temperature _______ Quantity ______ Capacity ______ gallons Recovery ______ gallons hour Temperature _______ Note Recovery must be in gallons per hour at 100 ° F rise A specification sheet from the manufacturer detailing this information will also be acceptable PagePage pageNumber5Floors , Walls , and Ceilings Indicate the materials used in each area eg , Acoustical tile , linoleum , etc Floors Walls Ceilings Kitchen _____________________ ___ __________________ _ ____________________ Food Storage _____________________ ___ __________________ _ ____________________ Toilet Rooms _____________________ ___ __________________ _ ____________________ Laundry Room _____________________ _ ____________________ _ ____________________ Utility Room _____________________ ___ __________________ _ ____________________ Classrooms _____________________ ____ _________________ __ ___________________ Ceilings in rooms in which food is prepared shall be non - absorbent Storage 1 Where will hazardous substances such as chemicals , cleaners be stored Must be stored under lock and key ________________________________________________________________________________________ 2 Where will medications be stored _________________________________________________________ 3 Where will the children's personal items bags , coats , etc be stored ______________________________ 4 Will there be cubbies or coat hooks provided Yes No 5 Where will mats or cots be stored _________________________________________________________ Lighting 1 Do all fixtures have shatterproof or shielded bulbs Yes No 2 Will there be a minimum of 50 - foot candles of light at all work surfaces including food prep area , utensils washing areas , diaper changing stations , children's work table , etc Yes No 3 Will there be a minimum of 10 - foot candles provided in all other areas Yes No Miscellaneous 1 Will linens be washed at the center or sent home _______________________________________________ 2 Where will the designated sick area be located ________________________________________________ __________________________________________________ ______________________________________ 3 How and where will toys be washed and sanitized ______________________________________________ _________________________________________________________ _______________________________ 4 Will animals be allowed on the grounds of the facility Yes No If yes , explain locations and restraints ___________________________________________ Additional Information _ ________________________________________________ _ ____________________________________________________________________ _ ____________________________________________________________________PagePage pageNumber6Example of the Drawing of the Floor Plan for a Child Care Center Label each classroom with the age group that intends to use it , all hand wash lavatories sinks , diaper changing stations , food prep areas in the classroom , kitchen and all food equipment , restrooms , can wash or mop sink and laundry room if applicable Office Playground 1 - year - old Trash Hand sink Classroom Restroom Cans Diaper Changing w Hand sink 2 - year - old class Diaper Changing Storage Station w hand sink Food Prep W D Hand sink Laundry Room Can Wash & Area Infant Room Hand sink Storage 3 - Comp Sink Cooler Prep Stove Table Freezer KitchenPage