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2. Facility Name*
4. Facility Address*
6. Owner*
8. Facility Email *
10. Check all that apply in the following sections
12. Risk Category 1

    1. Serving only beverages with or without prepackaged snack food (non TCS food)
    2. Serving commercially prepackaged foods that are reheated immediately before serving
    3. Heating only commercially processed, TCS foods for hot holding with no cooling or reheating
14. Risk Category 2

    1. Prepare foods for service from raw ingredients
    2. Provide a limited number of menu items that are cooked/cooled/reheated for service
    3. Schools not serving a highly susceptible population
16. Risk Category 3

    1. Complex preparation involving cooking, cooling, and reheating for hot holding that involves many TCS foods
    2. Cooling TCS foods
    3. Reheating TCS foods that were previously cooked and cooled
18. Risk Category 4

    Conduct one of the following which require a HACCP.  Please check all that apply:

    1. Smoking food as a means of preservation
    2. Curing food
    3. Using food additives for preservation
    4. Reduced oxygen packaging for extended shelf life
    5. Operating a molluscan shellfish display tank
    6. Custom processing animals for personal use as food
    7. Sprouting seeds or beans
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