1 Type of establishment |
---|
1) Hotel
| 4) Tej bet
|
2) Restaurant | 5) Other: |
3) Tea house | _________________________________ |
2 Licence |
---|
1) Yes | 2) No |
3 Water supply |
---|
3.1 Source | 1) Piped private |
| 2) Piped shared |
| 3) Piped public stand post |
| 4) Private well, protected |
| 5) Private well, unprotected |
| 6) Unprotected source (describe): |
| _________________________________ |
3.2 Handwashing facilities | 1) Washbasin |
| 2) Water trough |
| 3) Manual |
| 4) Other, describe: |
| _________________________________ |
4 Excreta disposal (for public use only) |
---|
4.1 Is there a latrine? | 1) Yes |
| 2) No |
4.2 Type | 1) Water carriage/flush toilet
|
| 2) Dry latrine |
4.3 Number of squatting holes for the above types | _______ |
4.4 Does the dry pit latrine have a vent pipe? | 1) Yes |
| 2) No |
4.5 Is there a septic tank? | 1) Yes |
| 2) No |
4.6 Maintenance condition of latrine at the time of visit | 1) Needs minor repair
|
| 2) Needs major repair |
| 3) No need of repair |
4.7 Cleanliness of latrine at the time of visit | 1) Clean and next person can use it |
| 2) Unclean and next person cannot use it |
5 Liquid waste management |
---|
5.1 Where is the wastewater from the hand and dishwashing facilities disposed of? | 1) Septic tank
|
| 2) Seepage |
| 3) Storm pipe |
| 4) Open ditch |
| 5) Latrine |
5.2 Are there any insects breeding around the liquid waste facilities? | 1) Yes
|
| 2) No |
| If yes, what vector: |
| _________________________________ |
5.3 Is there any overflowing liquid waste at the time of inspection? | 1) Yes |
| 2) No |
6 Solid waste management |
---|
6.1 Is there a refuse container for public use? | 1) Yes |
| 2) No |
6.2 Is there a garbage container for kitchen use? | 1) Yes |
| 2) No |
6.3 How is the refuse and garbage finally disposed of? | 1) Burning |
| 2) Refuse pit burial |
| 3) Open field dumping |
| 4) Municipal service |
| 5) Other, specify: |
| _________________________________ |
7 Equipment washing facilities |
---|
7.1 Dishwashing | |
7.1.1 How many containers are used? | 1) One |
| 2) Two |
| 3) Three |
7.1.2 The above container is: | 1) Fixed type with a water tap |
| 2) Bowls/buckets |
7.1.3 Hot water used for Dishwashing | 1) Yes |
| 2) No |
7.1.4 Detergent used for Dishwashing | 1) Yes |
| 2) No |
7.2 Drinking glass washing facilities | |
7.2.1 How many containers are used? | 1) One |
| 2) Two |
| 3) Three |
7.2.2 The above compartment is: | 1) Fixed type with a water tap |
| 2) Bowls/buckets |
7.2.3 Hot water used for glass washing | 1) Yes |
| 2) No |
7.2.4 Detergent used for glass washing | 1) Yes |
| 2) No |
8 Food handlers’ personal hygiene |
---|
Check the following in at least one food handler working in kitchen and dining area: |
8.1 Fingernails cut short | 1) Yes |
| 2) No |
8.2 Hair covered during work | 1) Yes |
| 2) No |
8.3 Finger ornaments worn during work | 1) Yes |
| 2) No |
8.4 Any infection present at a time of visit | 1) Skin (open wound) |
| 2) Respiratory infection |
| 3) Diarrhoeal infection |
| 4) Discharge from the eye |
| 5) Discharge from the nose |
| 6) Discharge from the ear |
| 7) Other, specify: |
| _________________________________ |
8.5 Outer garment (apron/gown) worn? | 1) Yes |
| 2) No |
8.6 Colour of working outer garment | 1) White
|
| 2) Blue |
| 3) Red |
| 4) Grey |
| 5) Other, specify: |
| _________________________________ |
8.7 Is the outer garment visibly dirty? | 1) Yes |
| 2) No |
9 Food servicing hygiene practice |
---|
9.1 When is the food served? | 1) Any time of day
|
| 2) At specified times (e.g. for breakfast, lunch and dinner) |
9.2 How are perishable food items stored? | 1) Prepared foods kept in fridges and then served
|
| 2) Hot foods served immediately |
| 3) Food leftovers reheated and served |
| 4) Other, specify: |
| _________________________________ |
10 Building conditions |
---|
10.1. Kitchen | |
10.1.1 Visible smoke (check the wall and ceiling/roof for smoke particles) | 1) Yes |
| 2) No |
10.1.2 Is there overcrowding? | 1) Yes |
| 2) No |
10.1.3 Handling of foods like injera at the time of visit | 1) Cover |
| 2) No cover |
10.1.4 Presence of vectors | 1) Yes
|
| 2) No |
| If yes, specify: |
| _________________________________ |
10.2 Dining room | |
10.2.1 Walls in good condition | 1) Yes |
| 2) No |
10.2.2 Ceiling in good condition | 1) Yes |
| 2) No |
10.2.3 Adequate lighting | 1) Yes |
| 2) No |
10.2.4 Adequate ventilation | 1) Yes |
| 2) No |
10.2.5 Tables and chairs in good condition | 1) Yes |
| 2) No |
11 Butchery |
---|
11.1 Source of meat (check the presence of municipal stamp) | 1) From Municipality abattoir
|
| 2) Private sources |
11.2 Quality of meat on visual inspection (do not touch, but check colour and odour) | 1) Fresh and good
|
| 2) Odourous, with discharges |
| 3) Other, specify: |
| _________________________________ |
11.3 Knives kept in drawer when not used | 1) Yes |
| 2) No |
11.4 Handwashing facilities present in the vicinity | 1) Yes |
| 2) No |
11.5 Knife washing facilities in the vicinity | 1) Yes |
| 2) No |
11.6 Latrine presence in the vicinity | 1) Yes |
| 2) No |
11.7 Chopping block cleanliness | 1) Clean
|
| 2) Unclean |
11.8 Chopping surface cleanliness | 1) Clean
|
| 2) Unclean |
11.9 Offal kept separately from the meat | 1) Yes |
| 2) No |
11.10 Vector presence on visual inspection | 1) Yes
|
| 2) No |
| If, yes specify: |
| _________________________________ |
1.11 Walls in good condition | 1) Yes |
| 2) No |
11.12 Ceiling in good condition | 1) Yes |
| 2) No |
11.13 Adequate lighting | 1) Yes |
| 2) No |
11.14 Adequate ventilation | 1) Yes |
| 2) No |
11.15 Dustbin availability | 1) Yes |
| 2) No |
11.16 Meat wrapped when sold | 1) Yes |
| 2) No |