Certified Food Manager Variance - Arlingtonva
Environmental Health Program 2110 Washington Blvd., Suite 350 Arlington, VA 22204 Phone: 703–228–7400 Fax: 703–228–7401 [email protected]
Certified Food Manager Variance Instructions Please complete this application to request a variance for the Certified Food Manager (CFM) requirement (Chapter 9.2-12, Arlington County Code). You may submit your application via mail, email, or fax. Establishment Information Food Establishment Name: Street:
City:
State: ____ Zip:
Owner Information Owner Name: Phone:
Email: Variance Information
Please acknowledge that you agree to comply with the conditions listed below by marking the adjacent box. During your application review, you may be asked to provide details on how you will ensure compliance. Sell only pre-packaged Time/Temperature Control for Safety (TCS) foods
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Notify the Environmental Health Program of any changes in products sold
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Ensure that there is a person in charge who demonstrates knowledge in the areas specified in §2-102.11, 2013 FDA Food Code
☐
Ensure all duties specified in 2-103.11, 2013 FDA Food Code, related to the operation are carried out
☐
Take and record temperatures every 4 hours on all refrigerators/freezers and keep logs during the licensing period that are available to the Environmental Health Program on request
☐
Immediately address temperatures that vary from the acceptable range and note corrective actions on the log
☐
Post the variance in a conspicuous place for the public to view
☐
The variance is non-transferable. The Environmental Health Program may revoke a variance if the Establishment’s license is revoked, or if there has been a violation of the conditions of the variance (§8-304.11B)
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Page 1 of 2 Revised April 2018
Certification I represent by my signature below that I am the owner of the Establishment and that I will comply with the conditions of the variance.
Owner Signature
Date
OFFICE USE ONLY Date of Receipt: EHS Review: Variance Accepted:
Date: Yes
No
Supervisor Review:
Date:
Bureau Chief Review:
Date:
Variance Decision:
Approved
Denied
Final Variance Issued:
Page 2 of 2 Revised May 2018
Certified Food Manager Variance Instructions Please complete this application to request a variance for the Certified Food Manager (CFM) requirement (Chapter 9.2-12, Arlington County Code). You may submit your application via mail, email, or fax. Establishment Information Food Establishment Name: Street:
City:
State: ____ Zip:
Owner Information Owner Name: Phone:
Email: Variance Information
Please acknowledge that you agree to comply with the conditions listed below by marking the adjacent box. During your application review, you may be asked to provide details on how you will ensure compliance. Sell only pre-packaged Time/Temperature Control for Safety (TCS) foods
☐
Notify the Environmental Health Program of any changes in products sold
☐
Ensure that there is a person in charge who demonstrates knowledge in the areas specified in §2-102.11, 2013 FDA Food Code
☐
Ensure all duties specified in 2-103.11, 2013 FDA Food Code, related to the operation are carried out
☐
Take and record temperatures every 4 hours on all refrigerators/freezers and keep logs during the licensing period that are available to the Environmental Health Program on request
☐
Immediately address temperatures that vary from the acceptable range and note corrective actions on the log
☐
Post the variance in a conspicuous place for the public to view
☐
The variance is non-transferable. The Environmental Health Program may revoke a variance if the Establishment’s license is revoked, or if there has been a violation of the conditions of the variance (§8-304.11B)
☐
Page 1 of 2 Revised April 2018
Certification I represent by my signature below that I am the owner of the Establishment and that I will comply with the conditions of the variance.
Owner Signature
Date
OFFICE USE ONLY Date of Receipt: EHS Review: Variance Accepted:
Date: Yes
No
Supervisor Review:
Date:
Bureau Chief Review:
Date:
Variance Decision:
Approved
Denied
Final Variance Issued:
Page 2 of 2 Revised May 2018
