Reset Form PLAN REVIEW QUESTIONNAIRE State Form 50004 (R3/605) Indiana State Department of Health Food Protection Program Instructions: 1 - fwhealth 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering the name and location of your facility, along with the contact name and phone number in the designated fields.
3. Provide details about your plans/applications submitted to various authorities, including zoning, plumbing, septic, planning, electric, fire, and building.
4. Fill in the number of seats, total square footage of the facility, and the number of floors where operations will be conducted.
5. Indicate the maximum meals to be served for breakfast, lunch, and dinner. Check all applicable types of service such as sit-down meals or takeout.
6. Complete sections regarding food handling procedures and employee training in food safety by providing detailed responses to each question.
7. Review all sections carefully before submitting your completed form back to the Indiana State Department of Health.

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