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Forms and Publications

Food Safety | Recreation | Body Art

Forms

F-47013 State of Wisconsin Permit Application (Word, fillable form)

DPH FSRL Fee Schedule (PDF, 18 KB)

F-47346 Application for Certified Food Manager (PDF, 48 KB)

F-47460 Application for Recertification of Food Manager (PDF, 48 KB)

F-47014 State of Wisconsin Permit Application for Food Vending Machine Operator, Food Vending Machine and Food Vending Commissary/Supply Storage (Word, 71 KB)

F-47018 State of Wisconsin Permit Application to Operate a Mobile Restaurant/Mobile Service Base (Word, 68 KB)

F-47453 Application for Tattooist / Body Piercer (PDF, 53 KB)

Reinspection Criteria

Reinspection Criteria for Water Recreation Establishments (PDF, 26 KB)

Reinspection Criteria for Tattoo and Body Piercing Establishments (PDF, 24 KB)

Reinspection Criteria for Recreational and Educational Camps (PDF, 28 KB)

Reinspection Criteria for Campground Establishments (PDF, 24 KB)

Reinspection Criteria for Hotel, Motel, Tourist Rooming Houses and Bed & Breakfast Establishments (PDF, 27 KB)

Reinspection Criteria for Restaurant, Vending Machine Commissaries and Storage Establishments (PDF, 33 KB)

Food Safety (Restaurants, Vending, Catering)

Signs

Publication Translation
Hair Restraints (PDF, 35 KB) Not Available
No Smoking (PDF, 40 KB) Not Available
Wash Hands (PDF, 26 KB) Not Available
When to Wash Hands (PDF, 39 KB) Spanish  (PDF, 12 KB)

Handouts

Publication Translation
Plan Review Checklist and Guide (PDF, 107 KB) Not Available
Transportation Fact Sheet (PDF, 94 KB) Not Available
Guideline for Food Safety During Power Outages (PDF, 99 KB) Not Available
Temporary Restaurant Guidelines (PDF, 324 KB) Not Available
Wisconsin Fairground Recommendations (PDF, 81 KB) Not Available
Mayonnaise (Mayo) is not Potentially Hazardous (PDF, 444 KB) Not Available
Food Display Guidelines (PDF, 173 KB) Not Available
Food Temperature Logs
  Log 1 (PDF, 36 KB)
  Log 2 (PDF, 60 KB)
  Log 3 (PDF, 73 KB)
Not Available
Bare Hand Contact with Ready-To-Eats Foods Plan Template (PDF, 205 KB) Not Available
Bare Hand Contact with Ready-To-Eats Foods Enforcement Guidelines (PDF, 148 KB) Not Available

Fact Sheets

Publication Translation
Fact Sheet 1Handwashing (PDF, 15 KB)
Fact Sheet 2 Standard Operating Procedure for Handwashing (PDF, 17 KB) Not Available
Fact Sheet 3 - Bare Hand Contact with Ready-To-Eat Foods (PDF, 30 KB)
Fact Sheet 4 Significant Changes in the Wisconsin Food Code (PDF, 222 KB) Not Available
Fact Sheet 5 Using Disposable Gloves (PDF, 103 KB)
Fact Sheet 6 Employee Hygiene (PDF, 25 KB)
Fact Sheet 7 Thermometer Calibration (PDF, 37 KB)
Fact Sheet 8 Recommended Cooling Procedures (PDF, 37 KB)
Fact Sheet 9 Consumer Advisory (PDF, 30 KB) Not Available
Fact Sheet 10 Checking Food Product Temperatures (PDF, 14 KB) Not Available
Fact Sheet 11 Cooking and Holding of Potentially Hazardous Foods (PDF, 53 KB)
Fact Sheet 12 Temperature Guide (PDF, 29 KB) Not Available
Fact Sheet 13 Hand Sanitizers (PDF, 17 KB)
Fact Sheet 14 Demonstration of Knowledge (PDF, 19 KB) Not Available
Fact Sheet 15 Time as a Public Health Control (PDF, 31 KB) Not Available
Fact Sheet 16Datemarking (PDF, 33 KB)
Fact Sheet 17 Thawing Food Safely (PDF, 95 KB) Not Available
Fact Sheet 18 Foodborne Illness (PDF, 73 KB) Not Available
Fact Sheet 19 – Employee Health
  Employee Health (19a) – General (PDF, 73 KB)
  Employee Health (19b) – Highly Susceptible Population (PDF, 73 KB)
  Employee Health (19c) – Employee Health Definitions (PDF, 55 KB)
  Employee Health Supplement – Food Employee Reporting Agreement (PDF, 78 KB)
Not Available
Fact Sheet 20 Organizing Your Walk-In Cooler (PDF, 94 KB) Not Available
Fact Sheet 21 When is a Variance or HACCP (Hazard Analysis Critical Control Point) Plan Required (PDF, 78 KB) Not Available
Fact Sheet 22 Washing and Sanitizing Food Contact Surfaces (PDF, 75 KB) Not Available
Fact Sheet 23 Temporary Food Events (PDF, 261 KB) Not Available
Fact Sheet 24 Outdoor Cooking (PDF, 70 KB) Not Available

Hazard Analysis and Critical Control Point (HACCP) Materials

Publication Translation
Action Plan Worksheet (PDF, 41 KB) Not Available
Flow Chart (PDF, 27 KB) Not Available
Food Product or Equipment Temperature Log (PDF, 24 KB) Not Available
HACCP Worksheet (PDF, 63 KB) Not Available
Temperature Log (PDF, 35 KB) Not Available
HACCP Principles (PDF, 202 KB) Not Available
What is HACCP (PDF, 202 KB) Not Available
HACCP Principles and Application Guidelines (PDF, 242 KB) Not Available

Foodborne Illness Information

Publication Translation
Water and Foodborne Illness Chart (PDF, 31 KB) Not Available
FDA Bad Bug Book (Word, 23 KB) Not Available

Signs

Notice to disabled guests (PDF, 3 KB)
Room Rate Cards (PDF, 5 KB)

Recreation (Swimming Pools, Waterparks, Water Attractions)

For copies of the following material contact our office at 608-266-2835.

Water Safety Rule Poster (PDF, 709 KB)

 Picture of Water Safety Poster.  To download a pdf version of the poster, click on the image.

Pool Related Websites See websites below.
Fecal Response  (exit DHS) http://www.cdc.gov/healthywater/swimming/
Fecal Accident Response (exit DHS) http://www.cdc.gov/healthyswimming/fecalacc.htm
Tips for Water Safety Water Safety Video

Body Art

Body Art Autoclave Information See website below.
FDA registered and listed autoclaves (exit DHS) http://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfpmn/pmn.cfm

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Last Revised: December 15, 2011