Environmental Health Services
The purpose of the food service program is to protect public health through a uniform process that seeks to reduce the occurrence of risk factors known to cause foodborne illness. There are five major components within the program: plan review, inspections, enforcement, complaint handling, and foodborne illness investigation. Each component in its own way is critical to make the program effective. In addition, a common thread that runs through all of these activities is education of the client and public.

Plan Review

The first component of the food service program, plan review, is meant to identify construction or equipment problems before they are built into the establishment. A staff member who is trained in the requirements of plan review will review the documents submitted by the food service operator. These documents will include blueprints, menu, standard operating procedures, equipment specifications, water supply and sewage disposal information. The plan review specialist must be able to understand these documents and properly interpret the requirements of the food code. Any problems identified in the plans must be communicated to the owner or builder so that correction can be made before construction starts. A very thorough review is necessary so that risk factors that contribute to foodborne illness are not built into the new facility.

Food Facility Inspections

The second component of the food service program, the food facility inspection, is the most recognizable function of the program. The food service program sanitarian must be able to master a wide range of personal and technical skills that are necessary to conduct competent inspections. The sanitarian should have knowledge of epidemiology, food protection, principles of foodborne disease prevention, sampling procedures, sampling and testing techniques, report writing, risk assessment and communication, and management techniques. All of these skills are necessary to effectively evaluate the establishment and communicate the evaluation to the operator.

When conducting a food service inspection, the sanitarian must detect food safety hazards, identify the cause (be it lack of knowledge, problems in the work environment, or a motivational issue) and then see to it that the owner of the establishment complies with his/her responsibility to assure the safety of the food provided. To be most effective, the sanitarian must educate and motivate so that the voluntary compliance continues after the sanitarian leaves. This process begins with the entry into the establishment and the introduction to the management that includes the purpose of the visit. Ideally the introductions will put the management and staff at ease so there can be effective two way communication.

The sanitarian will then begin a systematic approach to inspect the entire operation including elements not operating during the inspection. A guide that is used to "observe" practices that take place at other times is the facility's menu. Certain foods on the menu such as roasts, soups, and even vegetables may require extensive preparation if prepared on site. Reviewing these food processes with the operator, and later with the staff, can uncover problems with preparation, cooling, storage, and reheating among others. This focus on food processes is called a risk based inspection, which is superior in uncovering problems that directly contribute to foodborne illness. Once the sanitarian has a good understanding of the operation they will continue to observe the processes taking place. Special attention is given to food temperatures, cross contamination possibilities and employee practices. Equipment and storage is checked to make sure it is sufficient for the operation and is in good condition. Throughout the inspection it is important that the sanitarian continue to ask questions to understand how an observed process works or to verify that the staff follows the same procedures explained earlier by management.

At the conclusion of the inspection the sanitarian must document the findings on an inspection report that is clear and concise. The report must stand alone and communicate what is a violation, where it occurred, why it is a violation, methods of correction, and a time frame for correction. Each item is reviewed with the operator so they have an understanding of the food code requirements and what is expected for compliance. If there are priority or priority foundation violations that cannot be corrected during the inspection a follow up inspection is scheduled with the operator. The discussion at the end of the inspection also allows the operator time to ask other questions they may have. Done effectively, the facility inspection along with a motivated operator results in a reduced potential for foodborne illness.

If the facility fails to make the necessary corrections found during the routine inspection or there is an important food safety procedure that is not being controlled as evidenced by repeated violations, the operator will be subject to enforcement. This step is taken when it is apparent the operator or management is not taking necessary steps to reduce potential causes of foodborne illness. This is a last resort as it concludes with the revocation of the operator's food service license. Included in the enforcement process are multiple opportunities for the operator to comply with food safety requirements.

The public also aids in compliance with food safety through the complaint process. When complaints are received they are evaluated based on whether an illness is alleged or other significant food safety issue is suspected. In most cases a complaint will result in a surprise inspection of the establishment. The inspection is directed to determine if evidence exists that either validates the complaint or shows otherwise. A valid complaint, which is a food code violation, is discussed with the operator and corrections are made. Each establishment has a sanitarian present for a few hours each year, therefore information from customers who experience what they feel are food safety problems can be a valuable resource.

1Michigan Department of Agriculture. "Training Program for the Professional Food Service Sanitarian, Module 1: Role of the Sanitarian" [Online] 29 January 2007.
The final link in the food service program is the foodborne illness investigation. When a foodborne illness happens a failure of the food safety system has occurred. It is the sanitarians job to evaluate the potential source of the illness. The facility staff and management are interviewed to determine if there are additional illnesses that may have occurred before the suspected outbreak. Food processes are also reviewed to determine if there may have been a source, cooking, cooling, or reheating problem. The goal of the sanitarian in the food establishment is to identify the potential cause of the illness and to put procedures in place to prevent further occurrence. Foods that may be left over from an alleged outbreak are collected using sterile methods for later laboratory analysis.

At this point the investigation becomes a team effort involving public health nursing, health education, an epidemiologist, medical director, and health officer. All participants review the available evidence to help form a hypothesis and guide the laboratory in sample analysis. Early preventative steps can be communicated to the establishment and those ill to prevent further spread of the illness. Early and effective intervention can result in the prevention of further illness.

Prevention of illness is why we are here. The sanitarian working in the Food Service Program is an important link in the prevention of disease within our community. Sanitarians conducting thorough plan reviews and inspections, taking enforcement actions when necessary, earnestly responding to complaints, and participating in foodborne illness investigations, all the while educating along the way makes an effective Food Service Program.