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The DBPR HR 5021 103 form serves a critical role in the regulation of public food service establishments in Florida by ensuring that they meet necessary standards before increasing their seating capacity. This form requires establishments to provide key information, including their current and proposed number of seats, establishment name, and contact details to facilitate evaluation. The form is divided into two main sections that emphasize wastewater systems and fire safety. In the wastewater system section, establishments must specify their sewage disposal system, whether it be municipal, grease traps, or septic tanks. Each type requires different evaluations and is subject to approval or denial based on compliance with local regulations. The second section focuses on fire safety, examining factors such as the number of exits available and overall safety compliance. By submitting this form to the local Division of Hotels and Restaurants, food service operators can ensure they are adhering to necessary health and safety guidelines, thereby protecting both their patrons and their business interests.

Dbpr Hr 5021 103 Example

State of Florida

Department of Business and Professional Regulation

Division of Hotels and Restaurants

SEATING CHANGE EVALUATION

Completion of this form ensures that public food service establishments are evaluated for adequate sewage and fire services before expanding seating operations. Submit the completed form to the local Division of Hotels and Restaurants district office.

SECTION 1 – ESTABLISHMENT INFORMATION

Establishment Name:

License Number: Current No. Seats: Proposed No. Seats:

Address of Establishment:

Contact Person Name / Phone No.:

City:

County:

Zip:

Contact Person E-Mail Address:

SECTION 2 – WASTEWATER SYSTEM

(To Be Completed By DOH, DEP or Utility Authority)

The above named food service establishment uses the following wastewater disposal system (choose one type):

Municipal / Utility

Name of Provider:

 

 

Grease Trap Required

Location

 

 

 

 

 

Yes

No

In-ground

Undersink

 

 

 

 

Package Plant

Name of Provider:

 

 

Grease Trap Required

Location

 

 

 

 

 

Yes

No

In-ground

Undersink

 

 

 

 

Septic Tank

Permit #:

 

Tank Size:

Drainfield Size:

 

Grease Trap Size:

System

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

SYSTEM EVALUATION RESULT:

 

 

 

 

 

 

Permit Issued

Final Approval

Denied (see comments)

 

 

 

 

 

 

 

 

 

 

LIMITATIONS ON SYSTEM

 

Comments:

 

 

 

 

 

Single-Service Only

Other Conditions

 

 

 

 

 

 

 

Maximum Number of Hours of Operation

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Maximum Number of Seats Permitted

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Menu Restricted (see comments)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Name & Title

Agency

Signature

Date

Address

Phone

SECTION 3 – FIRE SAFETY

(To Be Completed By Local Authority Having Jurisdiction)

The above named food service establishment proposes to increase the seating capacity

Number of Exits

Public:

Employee:

Total:

FIRE SAFETY EVALUATION RESULT:

Approved

Denied (see comments)

Comments:

Name & Title

Agency

Signature

Date

Address

Phone

H&R Change Record Form Attached

DBPR Form HR 5021-103

www.MyFloridaLicense.com/dbpr/hr 61C-1.002, FAC

2008 October 22

Form Characteristics

Fact Name Description
Purpose This form ensures that public food service establishments in Florida are evaluated for adequate sewage and fire services before expanding seating operations.
Submission Completed forms must be submitted to the local Division of Hotels and Restaurants district office for review.
Sections Included The form consists of three main sections: Establishment Information, Wastewater System Evaluation, and Fire Safety Evaluation.
Governing Laws This form complies with Florida Administrative Code 61C-1.002, governing public food service operations.
Evaluation Results Both wastewater and fire safety sections provide results such as 'Approved', 'Denied', or comments noting conditions and limitations.

Guidelines on Utilizing Dbpr Hr 5021 103

After gathering all necessary information, you are ready to fill out the DBPR HR 5021 103 form. This form is essential for evaluating a food service establishment's capacity to manage increased seating while ensuring proper sewage and fire services are in place. Once completed, submit it to your local Division of Hotels and Restaurants office.

  1. Section 1 – Establishment Information:
    • Write the name of your establishment in the designated field.
    • Enter your establishment's license number.
    • Input the current number of seats available.
    • State the proposed number of seats you wish to add.
    • Fill in the address of the establishment, including city, county, and zip code.
    • Provide the contact person's name and phone number.
    • Include the contact person's email address.
  2. Section 2 – Wastewater System: This section requires input from the Department of Health, Department of Environmental Protection, or Utility Authority.
    • Select the type of wastewater disposal system your establishment uses (options include municipal, grease trap, septic tank, etc.).
    • If applicable, provide the name of your utility provider.
    • Indicate if a grease trap is required and specify the location.
    • For septic tanks, provide the permit number, tank size, and drainfield size.
    • Enter the grease trap size.
    • After evaluation, record the results including whether a permit was issued or denied and note any limitations on the system.
    • Include the name and title of the evaluating agency representative, along with their signature and date.
  3. Section 3 – Fire Safety: This section should be filled out by the local authority responsible for fire safety.
    • Indicate the number of exits for both public and employees.
    • State whether fire safety has been evaluated and whether it was approved or denied.
    • List any comments provided by the fire safety authority.
    • Record the name and title of the evaluating agency representative, and include their signature and date.

Make sure all sections are accurately completed before submission to ensure a smooth evaluation process. It's important for the safety and compliance of your establishment.

What You Should Know About This Form

What is the purpose of the DBPR HR 5021 103 form?

The DBPR HR 5021 103 form is designed for public food service establishments in Florida that plan to expand their seating capacity. The form ensures that these establishments are evaluated for adequate sewage and fire services before proceeding with the expansion. This step helps to maintain health and safety standards within the community.

Where should I submit the completed form?

After completing the DBPR HR 5021 103 form, it should be submitted to the local Division of Hotels and Restaurants district office. This ensures that the appropriate authorities can evaluate the facility based on current health and safety regulations.

What information is required in Section 1 of the form?

Section 1 requires details about the establishment, including the name, license number, current and proposed number of seats, address, and contact person information. This information helps local authorities identify and assess the establishment accurately.

How is the wastewater system evaluated?

The evaluation of the wastewater system is completed by the Department of Health (DOH), Department of Environmental Protection (DEP), or the Utility Authority. The form includes options to specify the type of wastewater disposal system used. Information such as permit numbers, tank sizes, and grease trap requirements must be provided to facilitate this evaluation.

What happens if the wastewater system fails the evaluation?

If the wastewater system does not meet the necessary requirements, the evaluation result will indicate "Denied" along with relevant comments. Limitations may be placed on the system, which can include restricted menu options, maximum hours of operation, and maximum seating capacity until compliance is achieved.

What is assessed in the fire safety evaluation section?

Fire safety evaluation assesses the proposed increase in seating capacity concerning fire safety regulations. It includes information about the number of exits for both the public and employees. A local authority reviews this section to ensure that the establishment can safely accommodate its patrons in case of an emergency.

What should I do if my fire safety evaluation is denied?

If the fire safety evaluation result is "Denied," the comments provided should be reviewed to understand the reasons behind this decision. The establishment will need to address the concerns listed and may require further modifications to meet fire safety requirements before reapplying.

Are there any follow-up documents required along with the form?

Yes, the form requires the submission of the H&R Change Record Form as an attachment. This additional document supports the evaluation process and helps maintain accurate records for the establishment's change in seating capacity.

Common mistakes

When filling out the DBPR HR 5021 103 form, many individuals make common mistakes that can lead to delays or denials. One prevalent error occurs when applicants fail to provide accurate and complete information about the establishment. Specifically, missing details such as the establishment name, license number, or address can create confusion for the reviewing authorities. It's crucial that every field is filled out with precision to avoid unnecessary back-and-forth communication.

Another mistake often seen is the improper completion of the wastewater system section. Applicants may not fully understand the requirements for their specific system, which can lead to the selection of an incorrect option. For example, choosing the type of wastewater disposal system without consulting with local utility providers or the Department of Health can yield inaccurate documentation. This oversight can ultimately result in significant complications as the form progresses through the evaluation process.

Inadequate information regarding the proposed seating capacity is also a frequent pitfall. Some applicants might opt not to indicate the current and proposed number of seats, or they may provide conflicting figures. This inconsistency can raise red flags and prompt more extensive reviews or outright denials. It is essential to present clear and matchable numbers that reflect the true intention behind the expansion.

Moreover, neglecting to include necessary contact information for follow-up can be detrimental. Applicants should ensure that contact person details—such as name, phone number, and email address—are accurate and up-to-date. A lack of accessible contact information can hinder the process, making it challenging for regulatory authorities to clarify any issues or gather additional data.

Finally, one cannot overlook the importance of addressing fire safety requirements adequately. Omitting or incorrectly filling in the details regarding number of exits or providing unclear comments can similarly undermine an application. Authorities must assess fire safety as part of evaluating seating changes, and any gaps in this information can lead to denials or conditions that could have been avoided. Ensuring that all sections of the form are complete and accurate is key to a smooth evaluation.

Documents used along the form

The Dbpr Hr 5021 103 form is critical for food service establishments in Florida seeking to change their seating capacity. Several other documents typically accompany this form to ensure comprehensive evaluations of health, safety, and regulatory compliance. Below is a selection of related forms that support the process.

  • DBPR HR 5020: This form is used to apply for food service licensing. It gathers essential information about the establishment's operations, ownership, and management. Completing this form is a prerequisite for obtaining or renewing a food service license.
  • Fire Safety Evaluation Form: This document is completed by the local fire authority to assess compliance with fire safety regulations. It evaluates the number of exits and overall fire safety measures in place for the establishment, ensuring the safety of patrons and staff.
  • Wastewater System Evaluation Report: Required by the Department of Health or Utility Authority, this report assesses existing sewage systems. It evaluates the capability of the current system to handle increased capacity, requiring thorough analysis of various system types and conditions.
  • Change of Ownership Form: If there is a transfer of ownership during the seating change evaluation, this form must be submitted. It updates the licensing body on changes in ownership, ensuring compliance with state regulations.
  • Menu Change Approval Form: When expanding seating, adapting the menu may also be necessary. This form seeks approval for any menu changes that accompany the increased capacity, including considerations around food preparation and service.

These forms and documents play a vital role in ensuring that food service establishments not only comply with regulatory standards but also prioritize the safety and well-being of their patrons. Proper completion and submission of these documents streamline the approval process for changes to seating capacity.

Similar forms

The DBPR HR 5021 103 form assesses the adequacy of sewage and fire services for public food service establishments planning to expand seating. It shares similarities with several other forms typically required in various regulatory contexts. The following documents are comparable in purpose or function:

  • Building Permit Application: Like the DBPR HR 5021 103 form, a building permit application ensures compliance with local regulations before construction or modification of an establishment. Both documents require documentation of existing conditions and proposed changes.
  • Health Department Inspection Report: This form evaluates public health standards and safety, similar to how the DBPR HR 5021 103 assesses sewage and fire safety. Both can affect operational permits based on compliance with relevant codes.
  • Fire Safety Inspection Report: This document addresses fire safety requirements for a facility. Similar to the DBPR HR 5021 103, it reviews the establishment for fire hazards and ensures readiness in case of emergencies.
  • Utility Connection Application: Establishing new utility connections or upgrades often requires submission of this form. Both documents ensure systems are adequate to support operational changes, verifying that services, like water and sewage, can accommodate increased capacity.
  • Septic Tank Installation Permit: When expanding a facility, this permit is required for new septic systems or modifications. It evaluates wastewater management similar to the sewage assessment in the DBPR HR 5021 103 form, ensuring health standards are met.

Dos and Don'ts

When filling out the DBPR HR 5021 103 form, it is important to follow certain guidelines to ensure accuracy and completeness. Here is a list of things you should and shouldn't do.

  • Do provide clear and accurate establishment information.
  • Do confirm that all fields are complete before submission.
  • Do check for any required signatures before submitting the form.
  • Do keep a copy of the completed form for your records.
  • Do submit the form to the correct local district office.
  • Don't use abbreviations that are not commonly understood.
  • Don't leave any field blank unless it is explicitly marked as optional.
  • Don't provide inaccurate or outdated contact information.
  • Don't forget to follow up on the status of your submission.

Misconceptions

Misconceptions surrounding the DBPR HR 5021 103 form can lead to confusion and delays for establishments looking to expand their seating capacity. Here are five common misunderstandings:

  • Misconception 1: The form is optional for food service establishments.
  • This is false. Completing the DBPR HR 5021 103 form is mandatory if an establishment plans to increase its seating. The evaluation ensures compliance with public health and safety regulations.

  • Misconception 2: Approval from one agency covers all requirements.
  • While the form contains sections for both wastewater system evaluations and fire safety assessments, it is crucial to obtain approvals from each relevant agency. One approval does not negate the need for the other.

  • Misconception 3: Only large establishments need to fill out the form.
  • This is untrue. Regardless of size, any food service operation planning a seating increase must submit the form. Small establishments are equally subject to the same health and safety regulations.

  • Misconception 4: The form guarantees automatic approval for increased seating.
  • Submitting the form is just the first step in the evaluation process. Approval will depend on the assessment results from the appropriate authorities regarding sewage and fire safety adequacy.

  • Misconception 5: The turnaround time for processing the form is immediate.
  • Many establishments mistakenly believe that the evaluation will be completed right away. However, processing times vary based on the workload of the agencies involved, and applicants should plan accordingly.

Key takeaways

When filling out the DBPR HR 5021 103 form, consider these key points:

  1. Establishment Information: Make sure to accurately provide details like the establishment name, license number, current and proposed seating numbers, and contact information.
  2. Submit Locally: After completion, send the form to your local Division of Hotels and Restaurants district office for processing.
  3. Wastewater System Details: Clearly indicate the type of wastewater disposal system being used and the corresponding utility provider.
  4. System Evaluation: Understand that the evaluation can result in 'Permit Issued', 'Final Approval', or 'Denied', so ensure all information is complete to avoid delays.
  5. Grease Trap Information: Indicate if a grease trap is required and where it's located. This is essential for food service establishments.
  6. Fire Safety Section: This section must be completed by the local authority. Pay attention to fire exit details and safety evaluations.
  7. Approval Process: Know that you will receive either an approval or a denial for the fire safety evaluation, along with comments if denied.
  8. Limitations on System: Take note of any limitations imposed on your establishment, which could affect operations and seating capacity.
  9. Document Everything: Keep copies of the submitted form and any correspondence for record-keeping purposes.
  10. Stay Informed: Regularly check for updates on any changes in local regulations that may impact your compliance with this form.

By following these points, you can efficiently complete the DBPR HR 5021 103 form and ensure your food service establishment operates smoothly during seating changes.