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In the realm of establishing or maintaining a retail food establishment, navigating the administrative requirements is a critical first step towards compliance and operational success. The South Carolina Department of Health and Environmental Control (DHEC) provides a structured path to this end through the DHEC1769 form, an essential document that serves as an application for a Retail Food Establishment Permit. This comprehensive form requires detailed information about the establishment, including its name, address, and contact details, alongside specifics about ownership and management. Notably, the form delves into operational aspects such as the type of establishment, food preparation practices, and the types of cooking equipment used, both indoor and outdoor. Furthermore, it addresses crucial health and safety considerations such as the source of water supply, sewage disposal methods, and waste disposal arrangements. Applicants are also prompted to provide information about their food safety training and the establishment’s operational schedule. Emphasizing regulatory compliance, the application process involves disclosing the facility’s adherence to critical food safety practices and the potential need for Hazard Analysis Critical Control Point (HACCP) plans or Standard Operating Procedures (SOPs) for special food preparation processes. Filling out the DHEC1769 is more than a mere bureaucratic exercise; it is a testament to the establishment’s commitment to food safety, public health, and regulatory adherence in South Carolina.

Document Example

APPLICATION FOR RETAIL FOOD ESTABLISHMENT PERMIT

Establishment name:

Establishment address:

County:

Establishment phone number:

Establishment fax number:

Permit holder/owner(s):

Permit holder phone number for 24 hour emergency contact:

(Emergencies constitute, but not limited to, imminent health hazards, boil water notiications, appointments)

Business phone number if different from above:

Permit holder business fax number if different from above:

Billing address if different from above:

E-mail address of permit holder:

Would you like to receive your inspections e-mailed in PDF format in addition to a printed copy? o Yes o No

Type of ownership (check one): o Individual

o Partnership     o Limited Liability Company (LLC)

o Corporation

o Non-Proit Organization *documentation may be required for fee exemption

Manager(s) or Person(s) directly responsible for Daily Operations:

Give title, name, address and 24 hour emergency contact number if different from owner

Has the person named above taken a food safety course? If so provide the following information. Course taken:

Date of certiication:

Institution:

Number and capacity of refrigeration units (cubic feet if known):

Source of Water Supply: o Municipal (city) water

Provider name: _____________________________________

oWell (approved by DHEC-Environmental Quality Control) provide copy of approval

Facility total square feet:Number of seats:

Sewage Disposal: o Municipal (city) sewer *Grease traps must be installed approved, and maintained as per the provider. ________Initial here that you have consulted with the sewer authority on your grease trap.

Provider name: ______________________________________________

o Septic Tank system with grease trap (approved by DHEC) provide copy of approval

Waste Disposal (check all that apply): o Public dumpster o Private dumpster o Grease container

oOther (describe): ______________________________________________________________________________

List days and hours of operation:

DHEC1769 (01/2010)

SOUTH CAROLINA DEPARTMENT OF HEALTH AND ENVIRONMENTAL CONTROL Page 1 of 3

OPERATIONS INFORMATION

Type of Retail Food Establishment (check all that apply):

 

 

 

Restaurant: o Single-service (disposable) dishes and utensils or

o Multi-use (reusable) dishes and utensils

Institution: o School

o Jail Cafeteria (check one)

o State operated

o Private contractor

Grocery Store (only check those preparation areas to be covered by this permit):

 

o Meat Market

o Seafood Market

o Bakery

o Deli

o Produce

Convenience Store or other facility that engages in Limited food preparation: check applicable menu items:

oOffers menu of fully cooked items with little preparation. i.e. - Hotdogs (describe):

oOffers foods that do not require cooking with little preparation i.e. - ice cream (describe):

oCatering - Supplemental Catering Application must be completed

oBase station/ Commissary for Mobile Unit - Supplemental Mobile Unit Application must be completed

oIndoor Bar o Outdoor bar o Modiied Bar (open air)

Food Preparation

oPotentially hazardous foods are cooked, cooled and reheated

oPotentially hazardous foods are cooked and served immediately

oPotentially hazardous fully cooked foods are prepared and served (hot or cold)

oNon-potentially hazardous food – exceeds minimal preparation

Special Processes

The following types of food preparation may require Hazard Analysis Critical Control Point (HACCP) plan(s), Standard Operating Procedure(s) (SOP) or Consumer Advisories.

o Offers raw or undercooked food (describe) ____________________________________________________

(I.e., Shell ish, in ish, poultry, pork, beef, bison, ratites)

  o Reduced Oxygen Packaging o Sous Vide o Cook/Chill

o Churrascaria Style

Outdoor Cooking Section

Continue this section if engaging in outdoor cooking.

I understand that any outdoor cooking activity must comply with all the provisions of Regulation 61-25 Chapter IX

OWNER/MANAGER Initial here_______________

Type of Indoor Cooking Equipment: o Stove(s) ____# o Smoker(s) ____# o Fryer(s) ____#

oOther: (describe)________________________________________________________________

Type of Outdoor Cooking Unit: o Covered Grill o Smoker o Other:(describe) ___________________________

Frequency of Outdoor Cooking: o *Daily o *Weekly o *Monthly o Annual o *Outdoor handsink installed

List all foods cooked outside:

DHEC1769 (01/2010)

Page 2 of 3

Barbeque Pit Room Cooking Section

Continue this section if you have a Barbeque Pit Room

I understand that any Barbeque Pit Room cooking activity must comply with all the provisions of Regulation 61-25 Chapter VIII.

OWNER/MANAGER Initial here______________________

Pit room location:

oSeparate attached/detached structure

oInside restaurant facility

Attach a menu of all meals served, or if menu varies, a sample of a typical menu

I, the undersigned, attest to the accuracy of the information provided in this application and I afirm that the retail food establishment will comply with S.C. DHEC Regulation 61-25. If granted a retail food permit, I understand that changes in food preparation types (Example: going from deli sandwiches to cooking or preparing meals) additions of equipment, and/ or structural changes shall be approved by the Health Department prior to implementation and may require that I submit a new application.

Furthermore, should the facility fail to adhere to the requirements of Regulation 61-25, the permit to operate may be subject to enforcement action, which may include civil penalties pursuant to Section 44-1-150(B) of the South Carolina Code of Laws and/or permit suspension/revocation pursuant to Chapter XIV Regulation 61-25 – Retail Food Establishments.

Signature of Applicant ____________________________________________________

Signature of Individual or Corporate Name ____________________________________

Date _______________________________

DHEC1769 (01//2010)

Page 3 of 3

Form Properties

Fact Detail
Form Name and Number DHEC1769
Purpose Application for Retail Food Establishment Permit
Governing Law South Carolina DHEC Regulation 61-25, Retail Food Establishments
Key Contents Establishment details, ownership type, manager's food safety certification, water and sewage disposal, type of retail food establishment, special processes requiring additional procedures, and compliance agreement.
Special Instructions Applicants must indicate if they have special food preparation processes, outdoor cooking facilities, or a Barbeque Pit Room, and such activities must comply with specific provisions of Regulation 61-25.

Guide to Writing Dhec1769

Filling out the DHEC1769 form is a crucial step for those looking to operate a retail food establishment in South Carolina. This document is necessary to ensure compliance with health and safety regulations, aiming to provide a safe dining or shopping experience for customers. Here are the detailed steps to accurately complete the application.

  1. Start by entering the name of the establishment at the top of the form.
  2. Fill in the establishment address, including the county.
  3. Provide the establishment's phone and fax numbers.
  4. Under "Permit holder/owner(s)", list the name(s) of the establishment's owner(s) and a 24-hour emergency contact number. This is crucial for any urgent matters that may arise.
  5. If there is a different business phone number or fax number, enter these details as well.
  6. Include a billing address if it differs from the establishment address.
  7. Provide an email address for the permit holder. Decide if you would like to receive inspection reports via email in addition to a printed copy and check the appropriate box.
  8. Check the type of ownership that applies to the establishment (e.g., Individual, Partnership, etc.).
  9. For the person(s) directly responsible for daily operations, list their title, name, address, and 24-hour emergency contact number if different from the owner. Specify if they have taken a food safety course and provide the completion details.
  10. Detail the number and capacity of refrigeration units the establishment uses.
  11. Select the source of water supply and provide the provider name if it's municipal water or an approved well.
  12. Indicate the facility's total square footage and number of seats.
  13. Specify the type of sewage disposal system and grease trap installment confirmation by initialing the indicated line.
  14. For waste disposal, check all the methods employed by the establishment and describe any other methods used.
  15. List the days and hours of operation.
  16. Check all types of retail food establishment operations that apply, including the specific type of establishment (e.g., Restaurant, Grocery Store, etc.) and detail the menu items or services offered.
  17. Identify any special processes used in food preparation that might require additional compliance measures, such as HACCP plans.
  18. If engaging in outdoor cooking, continue to complete the relevant section, including the type and frequency of outdoor cooking, and initial to acknowledge the compliance with regulations.
  19. For establishments with a barbeque pit room, fill in the appropriate section regarding its location and include a menu of meals served.
  20. At the bottom of the form, the applicant must sign and date the application, attesting to the accuracy of the information provided and the commitment to comply with SC DHEC Regulation 61-25.

Each step facilitates a thorough evaluation by the South Carolina Department of Health and Environmental Control (DHEC), aiming to uphold the standards set for retail food establishments. By providing clear and accurate information, applicants can ensure a smoother review process, ultimately leading to the issuance of the retail food establishment permit.

Understanding Dhec1769

What is the DHEC1769 form used for?

The DHEC1769 form is an application for obtaining a Retail Food Establishment Permit in South Carolina. It is used by businesses that intend to operate establishments like restaurants, grocery stores, and cafeterias, requiring them to be registered and comply with health and safety regulations.

Who needs to fill out the DHEC1769 form?

Any individual or entity planning to open a retail food establishment in South Carolina, including but not limited to restaurants, grocery stores, school cafeterias, and convenience stores, must complete the DHEC1769 form as part of the process to obtain the necessary permits to operate legally.

What information is required on the DHEC1769 form?

The form requires detailed information about the establishment, including its name, address, owner or permit holder's contact details, type of ownership, management information, water supply, sewage and waste disposal, food preparation and cooking equipment, and the type of food establishment it is. Information about the manager's food safety certification and emergency contact numbers are also required.

Is a food safety course necessary for the person managing daily operations?

Yes, the form asks if the person responsible for daily operations has taken a food safety course. If so, details of the course, date of certification, and certifying institution must be provided, highlighting the importance of food safety in the establishment's operations.

Can I submit the DHEC1769 form electronically?

The form itself does not specify the methods of submission. However, as best practice, one should contact the South Carolina Department of Health and Environmental Control (DHEC) directly or visit their website to confirm the current submission requirements, which may include electronic options.

What happens if changes occur in the food preparation types after the permit is granted?

If there are any changes in food preparation types, additions of equipment, or structural changes to the facility, the permit holder must obtain approval from the Health Department before implementing these changes. This may require submitting a new application to ensure ongoing compliance with health regulations.

Is it possible to have the inspections reports emailed?

Yes, the form includes an option for the permit holder to receive inspection reports by email in PDF format, in addition to a printed copy, facilitating easier access to and storage of these important documents.

What are the consequences of failing to adhere to the regulations?

Failure to comply with Regulation 61-25 can result in enforcement action against the facility. This may include civil penalties as outlined in Section 44-1-150(B) of the South Carolina Code of Laws, and/or suspension or revocation of the permit to operate, emphasizing the importance of compliance.

How can one verify the approval of the water source and sewage disposal systems?

For establishments using well water, a copy of the approval from DHEC-Environmental Quality Control must be provided. Similarly, for those with a septic tank system, evidence of DHEC approval is required. These steps ensure that water supply and sewage disposal systems meet health and environmental standards.

Common mistakes

When completing the DHEC1769 form, which is crucial for obtaining a retail food establishment permit, individuals often make several mistakes that can delay or complicate the application process. Understanding these common errors can help applicants ensure their forms are completed accurately, facilitating a smoother approval process.

  1. Not specifying the type of ownership - This section helps classify the establishment for regulatory purposes. Forgetting to check the appropriate box (Individual, Partnership, LLC, Corporation, or Non-Profit Organization) can lead to unnecessary delays.
  2. Incomplete manager information - Failing to provide detailed information about the manager or the person directly responsible for daily operations can hinder the application's progress. It is crucial to give the title, name, address, and a 24-hour emergency contact number if different from the owner’s.
  3. Overlooking food safety certification details - If the manager or person responsible has taken a food safety course, omitting details like the course name, date of certification, and the certifying institution can raise concerns about the establishment's compliance with health and safety standards.
  4. Vague description of the water supply and sewage disposal systems - Applicants must specify their source of water (Municipal or Well) and sewage disposal (Municipal sewer or Septic Tank system) clearly, including providing approval documents where necessary. Lack of clarity in this area can result in application rejection.
  5. Incorrect or incomplete waste disposal information - It is crucial to check all that apply (Public dumpster, Private dumpster, Grease container, Other) and describe any other forms of waste disposal. Failing to do so can lead to misunderstandings regarding the establishment’s waste management practices.
  6. Omitting details about refrigeration units - Not providing the number and capacity (in cubic feet, if known) of refrigeration units overlooks a critical aspect of food safety, as adequate refrigeration is essential for preventing foodborne illnesses.
  7. Skipping the operational days and hours - Leaving this section blank can cause delays, as this information is important for scheduling inspections and understanding the establishment's operational scope.
  8. Not including a complete menu or a sample of a typical menu - This is important for assessing the types of food prepared and the potential health risks associated. Excluding menus can result in incomplete assessments of the establishment’s food safety practices.
  9. Neglecting to detail the indoor and outdoor cooking equipment - Listing the types of cooking equipment used, both indoor and outdoor, is essential for understanding the establishment’s cooking processes and ensuring they meet safety standards.
  10. Failing to sign and date the form - The most critical error is not signing or dating the form, as this is a declaration of the accuracy of the information provided and an affirmation of compliance with relevant regulations. Unsigned applications are considered incomplete and cannot be processed.

To avoid these common mistakes, applicants should review each section of the DHEC1769 form carefully, ensuring all information is complete, accurate, and clearly presented. This diligence not only aids in obtaining the necessary permit but also in establishing a foundation for safe and compliant operation.

Documents used along the form

Filling out the DHEC1769 form is just the beginning for entrepreneurs diving into the food service industry. This application for a Retail Food Establishment Permit is a crucial step, yet it's only one part of a larger puzzle. To successfully navigate the regulatory requirements, there are several other forms and documents that often accompany the DHEC1769 form, each serving a unique but interconnected purpose.

  • Business License Application: Before you can open your doors, your establishment needs to be legally recognized. This form is typically submitted to your city or county business licensing office, formalizing your operation as a legitimate business entity within your local jurisdiction.
  • Employee Health Policy Acknowledgment: This document is vital for maintaining public health standards. It outlines the protocols employees must follow should they become ill, ensuring the safety of both staff and patrons by mitigating the risk of foodborne illnesses.
  • Grease Trap Installation Permit: If your establishment will be discharging fats, oils, and grease into the sewer system, this permit is a must-have. Many local sewer authorities require specific grease trap models or sizes to minimize sewer blockages and ensure efficient wastewater treatment.
  • Food Safety Training Certification: Demonstrating that you or your staff have completed a recognized food safety course is often required. This certification is evidence that you understand the fundamentals of foodborne illness prevention, proper food handling, and safe food preparation techniques.
  • Menu: While not a legal document, including a copy of your menu with your application can provide regulators a better understanding of your operations. It helps in assessing the types of food you'll serve, the equipment you'll need, and whether your food preparation practices meet health standards.
  • Fire Safety Inspection Certificate: Safety first! This certificate proves that your establishment has been inspected and complies with local fire safety regulations. It's essential for protecting your patrons, employees, and business investments from the dangers posed by fire.

Accompanying the DHEC1769 form with these documents can streamline the permitting process, ensuring you’re covering all bases for a successful launch. Remember, the goal is not just to open your doors, but to maintain high standards of safety, quality, and compliance long after your grand opening. Navigating these requirements can seem daunting, but with the right preparation and resources, you're laying the groundwork for a thriving food establishment.

Similar forms

The Application for Business License is a document that, in many respects, closely mirrors the DHEC1769 form. Both applications seek essential information about a business, such as its name, address, owner or key contact person, and operational details. However, while the DHEC1769 form specifically targets retail food establishments needing a permit to operate in compliance with health regulations, the Application for Business License applies to a broader range of businesses seeking legal authorization to operate within a municipality or jurisdiction. Both serve as initial steps for businesses to gain the necessary credentials to legally operate, yet they cater to different regulatory needs.

The Health Department Food Service Permit Application shares a significant purpose with the DHEC1769 form, focusing on public health and safety in food-related businesses. It gathers detailed information on the establishment, including ownership, operational aspects, and specifically, food safety practices. Similar to the DHEC1769, it mandates information on water supply, waste disposal, and emergency contacts, ensuring establishments comply with health standards. Though their formats may vary, both documents are integral for monitoring and promoting food safety, targeting different which aspects under the umbrella of health department regulations.

The Alcohol Beverage License Application is another document similar to the DHEC1769 form, but with a focus on the authorization for selling or serving alcoholic beverages. Both applications require detailed information about the establishment, including ownership and operational details. The Alcohol Beverage License Application, however, is specifically concerned with ensuring that businesses meet regulatory requirements related to the sale and consumption of alcohol, including zoning laws and age restrictions. While serving different end purposes, both documents are crucial for ensuring that businesses operate legally and responsibly within their respective areas.

A Fire Safety Inspection Form bears resemblance to the DHEC1769 form in its goal to safeguard public well-being, albeit through a focus on fire safety. This form typically requires information on the establishment's layout, emergency exits, fire extinguishers, and compliance with fire codes. Like the DHEC1769, it is part of a regulatory framework intended to protect the public, though it concentrates on preventing fire hazards rather than on sanitary conditions. Each form plays a pivotal role in business operation regulation, ensuring establishments are safe for employees and patrons alike.

The Environmental Health Inspection Form, akin to the DHEC1769 form, is involved in the evaluation and regulation of establishments to protect public health. It scrutinizes aspects like waste disposal, chemical storage, and overall environmental impact, ensuring establishments adhere to environmental health standards. While the DHEC1769 is particularly concerned with food safety and sanitation practices, the Environmental Health Inspection Form has a broader scope concerning environmental protection. Both documents are critical for maintaining health and safety standards, each from its unique regulatory perspective.

The Building Permit Application, while primarily focused on construction and structural integrity, shares common ground with the DHEC1769 form through its regulatory function. This application is necessary for any additions or modifications to a building's structure, ensuring compliance with local building codes and regulations. Similar to how the DHEC1769 form might require updates or modifications for changing food preparation methods or equipment, the Building Permit Application ensures that physical alterations to premises meet safety standards. Both forms, thus, contribute to maintaining safe environments, though they focus on different aspects of business and property management.

Dos and Don'ts

When completing the Dhec1769 form, an essential document for obtaining a retail food establishment permit, attention to detail and accuracy is imperative. The following lists provide guidance on what you should and shouldn't do to ensure your application process is smooth and successful.

Do:

  1. Ensure all information is accurate and up-to-date, reflecting the current status of your establishment.
  2. Check the appropriate boxes that accurately describe your establishment's features and operations.
  3. Include a copy of the approval for your water source and sewage disposal system if not connected to municipal services.
  4. If applicable, attach a detailed menu of meals served or a sample menu if the offerings vary.
  5. Sign and date the form to attest to the truthfulness and accuracy of the information provided.

Don't:

  • Leave any required fields blank. If a section does not apply, indicate with N/A to show it was not overlooked.
  • Forget to initial the sections that require acknowledgment of understanding regarding outdoor cooking and Barbeque Pit Room cooking activities.
  • Overlook the need to submit additional applications for special food preparation processes that may require a Hazard Analysis Critical Control Point (HACCP) plan.
  • Fail to provide contact information for 24-hour emergencies. This is crucial for immediate response to health hazards or other urgent matters.
  • Assume you need to provide only minimal information. Detailed responses help the health department understand your operation better and can expedite the review process.

Adhering to these guidelines will not only streamline the process of filling out the Dhec1769 form but also help prevent delays or issues in obtaining your retail food establishment permit.

Misconceptions

When it comes to applying for a retail food establishment permit in South Carolina, specifically through the DHEC1769 form, there are several misconceptions that can complicate the process. Clarifying these misconceptions ensures that applicants are better prepared and can navigate the application process more smoothly.

  • Only Restaurants Need to Fill It Out: A common misconception is that the DHEC1769 form is solely for restaurants. However, the form applies to a range of retail food establishments, including grocery stores, school cafeterias, convenience stores, and mobile food units. Understanding the scope of what constitutes a retail food establishment is crucial for compliance.

  • Neglectable Details: Another misunderstanding is regarding the significance of providing detailed information, such as the type of water supply or sewage disposal methods. Every detail on the form is designed to ensure public health and safety, thereby necessitating accurate and comprehensive information.

  • One-Time Requirement: Some applicants believe that once they've submitted the form, no further action is required unless their establishment's details change. However, retail food permits require renewal, and establishments must stay compliant with updated health regulations, which may necessitate additional documentation or modifications to operations.

  • No Need for Food Safety Course Information: The form asks if the person directly responsible for daily operations has taken a food safety course, including the course details. This requirement is often underestimated but is crucial for ensuring the establishment's management is equipped with essential knowledge on food safety practices.

  • Assumption that Submission Equals Approval: Submitting the DHEC1769 form does not automatically grant a permit. Applications are subject to review, and the establishment may be inspected to ensure it meets all health and safety regulations. The approval process is thorough, ensuring every establishment that receives a permit complies with South Carolina's health standards.

Correcting these misconceptions fosters a streamlined application process, ensuring retail food establishments understand their responsibilities and the importance of the information they provide. This clarity not only aids in regulatory compliance but also enhances the safety and well-being of the consumers they serve.

Key takeaways

When filling out the DHEC1769 form for a Retail Food Establishment Permit in South Carolina, there are several key takeaways applicants should be aware of to ensure a smooth and compliant application process:

  • Accurate and comprehensive information is crucial. The form requires details about the establishment, including the name, address, contact information, and the type and capacity of the establishment's refrigeration units. It's important to fill in each field carefully to avoid delays or issues with the application.
  • Understanding the type of water supply and sewage disposal method your establishment will use is important. Applicants must indicate whether the establishment will use municipal or well water, and whether sewage disposal will be via municipal sewer or a septic tank system. If using a well or septic system, approval documentation from DHEC-Environmental Quality Control is necessary.
  • The form inquires about waste disposal arrangements, asking applicants to specify whether they will use a public dumpster, a private dumpster, a grease container, or other methods. Accurate descriptions help ensure that waste management practices comply with health and environmental regulations.
  • Applicants must provide details about the food preparation and types of food establishment operations, including whether potentially hazardous foods will be cooked, cooled, and reheated, or if the establishment will engage in special processes like offering raw or undercooked food. This section helps DHEC understand the risk level and necessary precautions for the establishment.
  • Finally, the form requires the applicant's acknowledgment and understanding that changes in food preparation types, additions of equipment, or structural changes must be approved by the Health Department prior to implementation. This is to ensure ongoing compliance with health regulations and to prevent potential health hazards.

By focusing on these key areas, applicants can readily navigate the application process for a Retail Food Establishment Permit in South Carolina, ensuring that all regulatory requirements are met which, in turn, facilitates a safer environment for both the establishment's employees and its customers.

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