DA Form 7849 "FCC Home: Environmental Health Sanitation Inspection"

What Is DA Form 7849?

This is a military form that was released by the U.S. Department of the Army (DA). The form, often mistakenly referred to as the DD Form 7849, is a military form used by and within the U.S. Army. As of today, no separate instructions for the form are provided by the DA.

Form Details:

  • A 3-page document available for download in PDF;
  • The latest version available from the Army Publishing Directorate;
  • Additional instructions and information can be found on page 1 of the document;
  • Editable, free, and easy to use;

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Download DA Form 7849 "FCC Home: Environmental Health Sanitation Inspection"

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DATE (YYYYMMDD):
FCC HOME: ENVIRONMENTAL HEALTH SANITATION INSPECTION
For use of this form, see TB MED 531; the proponent agency is OTSG.
The checklist items presented in sections 1 – 7 of this form serve as an inspection guide to ensure essential requirements for achieving and maintaining food
safety and general sanitary control in child care homes are evaluated. Inspection personnel must refer to TB MED 530, Tri-Service Food Code, and TB MED
531, chapter 8, Child, Youth, and School Facilities, for a complete understanding and identification of required food safety controls, general sanitation controls,
and hygienic practices that promote a safe and healthy environment for children.
HOME LOCATION
STREET ADDRESS:
INSTALLATION (or TOWN/CITY)
STATE
FCC HOME PROVIDER
FULL NAME:
EMAIL ADDRESS (optional):
PHONE:
INSPECTOR
Environmental Health
Public Health Nurse
Program Staff
Other
FULL NAME (Include Rank):
OFFICIAL EMAIL ADDRESS:
ORGANIZATION:
OFFICE PHONE:
INSPECTION TYPE (Select One)
Initial Certification
Recertification
Periodic
Follow-up (attach to original inspection)
Comprehensive Health and Sanitation
Multi-Disciplinary Team Inspection
Other (specify):
INSPECTION RATING
Follow-up Required:
Critical:
Number of Critical not Corrected:
Number of
Violations
No
Yes
Non-Critical:
Number of Non-Critical not Corrected:
Satisfactory
Marginal
Unsatisfactory (follow-up required)
0-1 Critical—corrected on site;
2-3 Critical—corrected on site;
1 or more uncorrected Critical; or
0-3 Non-critical (corrected or uncorrected); or
4-6 Non-critical (corrected or uncorrected); or
4 or more total Critical; or
Any combination above
Any combination above
7 or more Non-critical (regardless if corrected)
1. FOOD SAFETY (IAW TB MED 530 & TB MED 531, paragraph 8-16.)
CODE
A.3.c.16
a. FCC provider has completed initial and annual refresher food safety training on foodborne illness risk
C
NC
R
factors and food allergens.
A.3.e.9
b. Food is from approved sources. Home-canned/jar food is not served. (Fresh fruits and vegetables from
C
NC*
COS
R
B.7.a.10
provider’s home garden are allowed.)
c. Fruit juices are purchased pasteurized or are fresh-squeezed at home on the day of service. (Fresh-
C
NC*
COS
R
squeezed juice is not retained beyond the date it was prepared; container is labeled with date prepared.)
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NC*
COS
R
e. Packaged foods are not used after the expiration or use-by date.
C
NC
COS
R
B.7.a.12
B.7.a.15
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NC*
COS
R
B.7.a.13
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NC*
COS
R
B.7.a.15
F
C
F
C
F
C
F
C
C
NC*
COS
R
B.7.a.13
F
C
F
C
C
NC
COS
R
B.7.a.13
F
C
F
C
B.7.a.7
C
NC
COS
R
B.7.a.9
APD AEM v1.00ES
Page 1 of 3
DA FORM 7849, MAY 2019
DATE (YYYYMMDD):
FCC HOME: ENVIRONMENTAL HEALTH SANITATION INSPECTION
For use of this form, see TB MED 531; the proponent agency is OTSG.
The checklist items presented in sections 1 – 7 of this form serve as an inspection guide to ensure essential requirements for achieving and maintaining food
safety and general sanitary control in child care homes are evaluated. Inspection personnel must refer to TB MED 530, Tri-Service Food Code, and TB MED
531, chapter 8, Child, Youth, and School Facilities, for a complete understanding and identification of required food safety controls, general sanitation controls,
and hygienic practices that promote a safe and healthy environment for children.
HOME LOCATION
STREET ADDRESS:
INSTALLATION (or TOWN/CITY)
STATE
FCC HOME PROVIDER
FULL NAME:
EMAIL ADDRESS (optional):
PHONE:
INSPECTOR
Environmental Health
Public Health Nurse
Program Staff
Other
FULL NAME (Include Rank):
OFFICIAL EMAIL ADDRESS:
ORGANIZATION:
OFFICE PHONE:
INSPECTION TYPE (Select One)
Initial Certification
Recertification
Periodic
Follow-up (attach to original inspection)
Comprehensive Health and Sanitation
Multi-Disciplinary Team Inspection
Other (specify):
INSPECTION RATING
Follow-up Required:
Critical:
Number of Critical not Corrected:
Number of
Violations
No
Yes
Non-Critical:
Number of Non-Critical not Corrected:
Satisfactory
Marginal
Unsatisfactory (follow-up required)
0-1 Critical—corrected on site;
2-3 Critical—corrected on site;
1 or more uncorrected Critical; or
0-3 Non-critical (corrected or uncorrected); or
4-6 Non-critical (corrected or uncorrected); or
4 or more total Critical; or
Any combination above
Any combination above
7 or more Non-critical (regardless if corrected)
1. FOOD SAFETY (IAW TB MED 530 & TB MED 531, paragraph 8-16.)
CODE
A.3.c.16
a. FCC provider has completed initial and annual refresher food safety training on foodborne illness risk
C
NC
R
factors and food allergens.
A.3.e.9
b. Food is from approved sources. Home-canned/jar food is not served. (Fresh fruits and vegetables from
C
NC*
COS
R
B.7.a.10
provider’s home garden are allowed.)
c. Fruit juices are purchased pasteurized or are fresh-squeezed at home on the day of service. (Fresh-
C
NC*
COS
R
squeezed juice is not retained beyond the date it was prepared; container is labeled with date prepared.)
C
NC*
COS
R
e. Packaged foods are not used after the expiration or use-by date.
C
NC
COS
R
B.7.a.12
B.7.a.15
C
NC*
COS
R
B.7.a.13
C
NC*
COS
R
B.7.a.15
F
C
F
C
F
C
F
C
C
NC*
COS
R
B.7.a.13
F
C
F
C
C
NC
COS
R
B.7.a.13
F
C
F
C
B.7.a.7
C
NC
COS
R
B.7.a.9
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Page 1 of 3
DA FORM 7849, MAY 2019
FCC HOME: ENVIRONMENTAL HEALTH SANITATION INSPECTION (continued)
STREET ADDRESS:
INSTALLATION (TOWN/CITY)
1. FOOD SAFETY (continued)
CODE
k. Non-food contact surfaces (e.g., stove top, vent hood, dry storage shelves, dish/utensil cabinets and
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R
B.7.a.7
drawers, exterior of appliances) are free from accumulated food residues and other debris.
B.7.a.18
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COS
R
B.7.a.19
F
C
Bleach sanitizer ppm:
Sink hot water sanitizing
Yes
No
N/A
Yes
No
Dishwasher available/used
Dishwasher has hot water/heated drying
m. No plumbing cross-connections observed.
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NC*
COS
R
B.6.a.19
B.3.e.4
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COS
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B.7.e.1
2. GENERAL SANITATION (IAW TB MED 531, paragraph 8-17.)
CODE
a. Child care areas (indoors) are kept clean and organized (free from unnecessary clutter).
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NC
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R
B.7.i.1
B.7.b.14
b. Training toilets and diaper changing station/pads are cleaned and disinfected after each use. Toilet rooms
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NC*
COS
R
B.7.e.10
and hand wash sinks used by children are cleaned and disinfected daily.
B.7.f.2
c. Disinfectant is EPA-registered and used according to the label for surface application, contact time and
B.7.e.1
rinse. Chlorine solution (if used from bulk) is prepared fresh daily; proper concentration; labeled with date
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NC*
COS
R
B.7.e.6
and concentration (verify the concentration using a test strip).
Chlorine bleach solution is prepared from bulk:
No
Yes, prepared solution:
ppm
Other disinfecting products used:
No
Yes (Type):
Product is appropriate:
N/A
Yes
No
B.7.b.9
d. High-touch surfaces (e.g., door handles, computer keyboard) in child care areas are cleaned and
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R
B.7.e.11
disinfected daily. (Alcohol-based cleaning and disinfecting wipes are authorized.)
B.7.e.12
B.7.f.4
e. Diapering not conducted in kitchen or on tables used for meals/snacks.
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f. Waste receptacles for food and diapers have plastic liner; are covered when not in use; are emptied,
B.7.b.7
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cleaned and disinfected daily (or more frequently to prevent odors).
g. Floor mats used for infant crawling/tummy time are cleaned and disinfected before use by different
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NC*
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R
children and at least daily when used; fitness/activity mats are cleaned & disinfected daily when used.
h. No evidence of pests (insects/rodents); proper pest control methods/devices (if used).
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NC
COS
R
B.7.i.4
3. TOY SANITATION (IAW TB MED 531, paragraph 8-17.)
CODE
B.7.e.4
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NC*
COS
R
B.7.e.17
b. Proper sanitizing practices for hard toys: Immersion in bleach solution at 100 ppm (rinsed if 200 ppm or
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NC*
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B.7.e.6
above); 1 minute contact time; air dried. Dishwasher (if used) see item 1l. (Verify the bleach concentration
with test strip.)
No solution available at time of inspection to test.
Bleach ppm:
B.7.e.17
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NC*
COS
R
d. Water play tables are drained after use. Tables are cleaned and sanitized at least daily (when used) and
N/A
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NC*
COS
R
B.7.e.13
toys are cleaned and sanitized before reuse for other activities.
e. Wooden toys are properly sealed, free from damage. Cardboard/fiberboard toys are discarded if evidence
N/A
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COS
R
of contamination/moisture absorption.
4. SLEEP ITEMS (IAW TB MED 531, paragraph 8-17.)
CODE
a. Only 1 child occupies a bed, crib, or sleeping pad/cot at the same time. (Verify available number of
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R
B.7.e.1
accommodations.)
b. Fabric-type mattress for crib or bed is covered with a waterproof mattress cover. Plastic cover is not
N/A
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R
B.7.e.2
cracked or torn (or taped).
c. Surfaces of plastic mattress pad, plastic mattress cover, and sleep mats are cleaned and disinfected
between uses by different children, whenever soiled, at the end of each day when used, and at least
B.7.e.2
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weekly. (See item 2g. for floor & fitness mats.) Proper cleaning/disinfecting procedures applied. Cribs
are cleaned after a fire evacuation or drill.
d. Clean individual bedding provided for each child. Bedding properly stored; protected from contamination
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R
B.7.e.2
when cots or sleep pads are stored.
e. In-use bedding/linens are laundered at least weekly and before use by a different child. Linens are
removed for laundering each day when soiled with urine, feces, nasal discharges, or vomit. (Soiled fabric
N/A
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COS
R
B.7.e.2
mattresses are removed from use until properly cleaned.) Bedding retained in the FCC home during the
week is labeled with the child’s name and not stored in contact with other children’s bedding.
f. Soiled linens stored separate from clean linens in covered bins that are not accessible to children.
N/A
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NC
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R
B.7.e.16
g. Plastic mattress covers and sleep pads are not cracked/torn (or taped to “repair” a tear).
C
NC*
COS
R
DA FORM 7849, MAY 2019
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Page 2 of 3
FCC HOME: ENVIRONMENTAL HEALTH SANITATION INSPECTION (continued)
STREET ADDRESS:
INSTALLATION (TOWN/CITY)
5. HYGIENIC PRACTICES (IAW TB MED 531, paragraph 8-17.)
CODE
a. Hand wash sinks supplied with liquid soap, single-use paper or cloth hand towels, and a waste
B.7.c.1
receptacle (for paper towels). (If used, cloth towels are used by one person for a single hand wash, then
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NC
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R
B.7.c.2
laundered.) Hand wash poster provided near sink.
b. Handwashing: Provider and children wash hands after diaper change and toilet use; before and after
water play; after outdoor play, handling pets, custodial tasks, and other activities where hands may
B.7.c.3
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become soiled. Hand sanitizing gel is not used as a substitute for proper handwashing.
c. Illness: Children with fever/illness are appropriately separated from other children and parent is
immediately notified. Provider does not care for sick children except while waiting for parent to arrive.
B.7.j.2
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(Verify accommodations used if a child becomes sick.)
6. PETS AND PLANTS (IAW TB MED 531, paragraph 8-18.)
CODE
a. Pets do not pose a health or safety threat to children (current immunizations; no prohibited pets; pets
N/A
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COS
R
B.7.h.5
cleared by a veterinarian; internal & external parasite control; child pet allergies identified).
b. Pet cages, pens, holding areas, litter boxes, and food and water bowls kept clean; no objectionable
B.7.h.3
N/A
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R
odors. Pet food and supplies are inaccessible to children.
B.7.h.4
B.7.h.7
c. Plants: Indoor plants are non-toxic & labeled with common name. Landscaping plants in child play areas
B.7.h.8
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are free from poisonous berries and leaves, thorns, sharp branches, and razor-edged leaves.
B.7.h.9
7. OUDOOR PLAY AREAS (IAW TB MED 531, paragraph 8-19.)
CODE
a. Grass and landscaping maintained to prevent overgrowth, pest harborage, or concealment of harmful
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animals. Vegetation outside the perimeter fence does not encroach into the play area.
b. Outdoor play area is free from harmful insects (e.g. bee/wasp nest, fleas/ticks, & biting ants) and stray
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R
animals. Utility/storage shed/room is locked. Free from physical or chemical hazards.
c. There is no inflatable or plastic child wading pool. In- or above-ground pool and hot tub, if present, are
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NC*
COS
R
inaccessible to children (secured with locked fence/gate or sealed cover).
d. Water play: Barrier controls present for pools & hot tubs. Wading pools are not used. Sprinklers placed
N/A
C
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R
to prevent excessive water pooling and grass erosion; splash/slide pads are cleaned and disinfected
daily when used. (Mark item 3d. for water play tables.)
e. Children provided with access to drinking water during outdoor play; children prohibited from drinking
B.5.a.4
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R
water from water play tables, hoses, or sprinklers.
f. Area drainage: No prolonged pooling of water (to allow mosquito breeding); play features; play features
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R
designed to prevent pooling of water for extended periods.
g. Play area and soft landing areas (e.g., mulch) around climbing equipment and swings is free from
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R
animals and animal feces. Sandbox and sand tables are covered when not in use.
B.7.e.15
h. Play area is free from litter and food debris that may attract pests and animals.
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R
B.7.i.1
i. Play equipment is free from physical hazards/damage (e.g., protruding nails, splintering, excess rust,
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broken/missing components).
8. OTHER VIOLATIONS (Conditions specified in TB MEDs 530 or 531 that are not addressed under items 1—7 in the checklist.)
a.
Critical
Non-critical
COS
b.
Critical
Non-critical
COS
c.
Critical
Non-critical
COS
COMMENTS (optional):
SIGNATURES (Review the findings and corrective actions for this inspection with the FCC provider and leave a copy of the report with the provider.)
INSPECTOR SIGNATURE
DATE (YYYYMMDD)
PROVIDER SIGNATURE
DATE (YYYYMMDD)
This Section reserved for use by FCC Program staff to track corrective actions not completed during the inspection.
Number of violations that were not corrected at the time of inspection:
Critical
Non-Critical
Verified by
Item
Date
Action Taken / Comment
Number
Corrected
(initials)
DA FORM 7849, MAY 2019
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