How Restaurant Health Inspections Work

Starting with the passage of the U.S. Constitution, the public health and welfare of Americans has largely been the responsibility of individual states. In the late 1790s, this regulatory and enforcement power was put to test with an outbreak of yellow fever, forcing authorities to quarantine the entire population of New York City, cutting off all contact with the nation's capital in Philadelphia [source: Richards].

It wasn't until the turn of the 20th century that the federal government took an interest in food safety. The catalyst was the 1905 publication of "The Jungle" by journalist Upton Sinclair, a scathing expose of the unsanitary and inhumane conditions at American slaughterhouses. Since meat from these packing plants was shipped across state lines, it fell under federal regulations. In 1906, Congress passed both the Federal Meat Inspection Act and the Pure Food and Drug Act, which were responsible for creating the Food and Drug Administration (FDA) [source: USDA].

In 1934, the FDA and the U.S. Public Health Service created the first "Restaurant Sanitation Program," a voluntary set of food safety regulations for restaurants that could be adopted by individual states [source: Fuchs]. The early inspection system included grade-based restaurant ratings — A, B and C — and focused on many of the same food safety concerns we see today. Handwashing and hygiene of workers were paramount, as was refrigeration of perishable foods and general cleanliness of kitchen and bathrooms. The original guidelines also included a prohibition against using cyanide-based polish to clean silverware. Smart.

That original Restaurant Sanitation Program expanded over the decades, eventually becoming known simply as the federal Food Code [source: USPHS and FDA]. Starting in 1993, the Food Code was updated and republished every two years until 2001, when the schedule was moved to every four years. The Food Code is continuously updated to reflect the latest scientific understanding of the causes of foodborne illnesses and the best industry practices for keeping restaurant-goers safe.

Today's Food Code, like the original 1934 document, is a voluntary set of regulations, not federal law. It's still up to individual states to write their own food safety rules, although most states align their regulations closely with the recommendations of the FDA.

To make things more complicated, restaurant inspections are often conducted by city or county officials, not state regulators. In those cases, it's the local health authorities who write and enforce their own food safety regulations. In Denver, for example, the city is actually older than the state, and it governs itself under the law of "home rule." Food safety regulations are written into Denver's municipal code, but they are updated every few years to closely follow state laws and federal guidelines [source: Peterson].

State and local health departments usually conduct three different kinds of restaurant food safety inspections. The most common is known as a routine inspection and is conducted as often as every six months or as infrequently as every 18 months, depending on the type of food served and the restaurant's inspection history. The two other types of inspections are follow-up inspections to resolve outstanding violations and inspections triggered by a consumer complaint.

In most state and local health departments, routine inspections are scheduled based on a risk-based system that weighs the likelihood of a restaurant being the source of a foodborne illness. Higher-risk establishments are inspected more frequently than low-risk restaurants and are based on standardized risk factors established by the FDA.

The first risk factor has to do with the type of food served at the restaurant and how it's prepared. A corner deli that assembles cold-cut sandwiches, but doesn't actually cook anything, is considered a lower risk than a burger joint that handles and cooks raw ground beef. Likewise, a sushi bar is considered an even higher risk if it actually serves customers raw or undercooked seafood.

The second risk factor is a restaurant's inspection and compliance history. If a soup-and-salad joint has a recent record of violations, it's going to be inspected more frequently than the sandwich place around the corner that routinely aces its inspections. Restaurants with the very highest risk are those that have been the source of a known foodborne illness outbreak [source: Florida DPBR].

Restaurants are assigned an initial risk level when they're licensed, but that can change over the course of routine inspections. In Denver, the highest-risk restaurants will get inspected every six months, medium-risk places every 12 months and low-risk establishments every 18 months [source: Peterson]. In Florida, if a restaurant is the cause of an outbreak, it will be inspected every three months for the next year [source: Florida DPBR]. Inspection schedules are computer-generated for maximum efficiency and fairness.

In some cases, an inspector will cite a violation that requires a follow-up visit. Follow-up inspections are usually conducted within a week of the violation, especially if it poses a serious risk of foodborne illness.

Inspections also happen because of consumer complaints. All health departments have consumer hotlines and online forms for reporting unhygienic conditions, unsafe food handling or possible food poisoning from restaurants. Even though it's not always easy to identify the source of a foodborne illness, health departments follow up on every consumer complaint and look for unsafe cooking or cooling practices, or expired ingredients, that could have made customers sick.

Since restaurant health inspections are unannounced, the first thing the health inspector does is to introduce herself, show an official ID and ask to speak with the manager, owner or person in charge. The manager stays with the inspector throughout the inspection to answer questions and receive immediate feedback and suggestions.

The first stop is what health inspectors call the "dynamic" areas of the restaurant, where food is actively being handled and prepared. By visiting those areas first, the inspector hopes to get the most accurate snapshot of how well the kitchen is complying with food safety regulations [source: Peterson]. The inspector will start with 100 points and then deduct points for various infractions.

In the kitchen, one of the first things that inspectors look for is proper employee hygiene. Kitchen workers need to be following the rules regarding hand washing (rinse, apply soap, scrub for 15 to 20 seconds, dry off with a one-use towel), glove use and hair protection, and no employees should be working while they are ill or have open cuts or wounds (yuck).

Food and storage temperature are also a top priority. The inspector whips out her digital thermometer to test whether raw meats and fish are being cooked to the right temperature: 160 F (71 C) for ground beef, 145 F (62 C for fish) [source: FoodSafety.gov]. She also checks the temperature in all cold food storage areas to be sure they are 40 F (4 C) or below for refrigerators and zero F (minus 18 C) or below for freezers [source: FoodSafety.gov]. Then the inspector quizzes the manager and cooks about their thawing and reheating practices. For example, frozen meat should never be left out to thaw on a counter and leftover soups and broths must be brought to a boil during reheating.

Cross-contamination is another big no-no. Inspectors will observe food preparation practices to make sure that anything that comes in contact with raw meat (knives, cutting boards, hands) is separated from ready-to-eat foods and properly washed and sanitized. The inspector will make sure that all processed and pre-made ingredients used by the kitchen come from approved sources, namely licensed commercial kitchens, and are stored properly.

From there, it's time to inspect the static areas of the restaurant, things that don't change much from day to day. That includes the dishwashing equipment and dish storage areas, handwashing sinks in the kitchen, and the employee and customer bathrooms. Inspectors also check on how toxic cleaning products are stored and labeled and whether the HVAC systems and smoke detectors are functioning properly, as well as the general cleanliness of dining tables, floors, walls and ceilings. Finally, they take a trip out back to inspect the dumpster and garbage areas.

A routine inspection of a casual sit-down restaurant usually takes between one-and-a-half and two hours, while a large hotel kitchen might take as long as four hours [source: Peterson]. If an inspector notices small issues during the walk-through — like a dented can or ketchup bottle — she'll likely have the manager fix it on the spot and not include it as a violation in the report. But anything more serious is going to show up on that report.

An inspector will deduct one point each for most static violations (like dining room furniture not being in good condition or the garbage can being uncovered); two points each for minor infractions (improper storage of toxic cleaning products, employees keeping cell phones in the kitchen, one live roach); and four or five points each for major violations like improper storage temperatures for food or improperly cleaned food contact surfaces [source: FitzGerald].

Restaurant inspection reports are public record, but the forms filled out by inspectors are meant to show if a restaurant is in compliance with specific state and local regulations, not to communicate straightforward information to consumers. That's why it's important to understand the different types of violations and which ones are serious enough to shut a restaurant down.

Most health departments divide inspection violations into two or three categories based on the likelihood that the violation will lead to a foodborne illness. The FDA has identified five risk factors that increase the odds of a restaurant making its customers sick: improper holding temperatures, inadequate cooking, contaminated equipment, unsafe sources and poor personal hygiene. Violations that involve one or more of those five risk factors are generally considered serious and must be fixed immediately.

In Florida, for example, there are three types of violations: High Priority, Intermediate and Basic. When you look up an inspection report on the Florida Department of Business & Professional Regulation website, violations are labeled with their corresponding risk level. Basic violations might include anything from grease accumulated on an exhaust hood to jugs of cooking oil being stored on the floor. Examples of high-priority violations could be raw chicken stored on a refrigerator shelf above an uncovered bin of lettuce, or leftover prepared food being stored at temperatures above 40 degrees Fahrenheit.

In the city of Denver, they issue Type 1 and Type 2 violations, also known as critical and noncritical violations. (You can look up a restaurant's inspection history at the city's Food Safety Inspection website.) Noncritical Type 2 violations usually involve a warning from the inspector with the promise that it will be fixed by the next routine visit. Type 1 violations are a different story.

"With critical violations, we want to fix them right there on site," says Alison Peterson, a food safety supervisor in the Denver Department of Environmental Health. That might mean adjusting cooking times so that chicken breasts are fully cooked, or turning down the temperature in a cold storage unit.

If the critical violation requires some kind of maintenance, like fixing a malfunctioning freezer or installing a dedicated handwashing sink in the kitchen, the inspector will return for a follow-up inspection within a couple of days. If a restaurant fails to fix a critical violation, it can be fined.

There are a handful of super-serious health code violations that could provoke a health inspector to temporarily shut down a restaurant until the problem is fixed. Examples include a lack of hot water on the premises, a pest infestation (cockroaches or — shudder — rats) or a major foodborne illness outbreak [source: Peterson].

So what about that fried chicken restaurant with the B rating in the window? Does it mean that you're more likely to get sick from eating a dark meat bucket at this place than if you ate a platter of fried shrimp at the A-rated seafood restaurant down the street? In other words, how much should we really care about restaurant inspection scores?

First, it's important to understand what those letter grades or number scores mean. In general, restaurants are docked a certain amount of points for each violation. And you can find those numbers on the actual inspection report, which most jurisdictions make public. A perfect score is 100. For states and counties that use the letter-grade system, a 90-to-100 point score is an A, 80 to 89 is a B and so forth. Some cities and states require the restaurant to prominently display its most recent grade.

More important than the final score or grade are the specific violations that earned that score. If you really want to know if that chicken joint is safe, you need to look up the inspection report and see if the restaurant committed critical errors that can spread foodborne illnesses, like undercooking food or cross-contamination. Does that mean you'll definitely get sick if you eat there? No, but you can be a more informed consumer.

Second, it's important to understand that restaurant inspections are merely a snapshot of the daily operations of a restaurant. Once or twice a year, inspectors spend a couple of hours inside a business that operates six days a week, 12 hours a day. Since health inspectors are government employees, most of them work daytime hours only, which means they visit most restaurants during lunch shifts, not the dinner rush [source: Hassiotis]. The inspection report may be an accurate representation of what the inspector saw, but it doesn't tell the whole story.

Now there are two ways to think about that snapshot inspection score: as an optimist or as a pessimist. An optimist sees a B rating and thinks, "Well, they caught the kitchen on a bad day and if the violations were really serious, the health department would have shut them down." A pessimist sees that B rating and thinks, "And that's only what the inspector found. Imagine the violations that could happen every other day!"

Ultimately, it's up to the consumer to decide. Inspections are important public services designed to keep restaurant-goers healthy and informed. A low inspection score does not mean that you will get sick, nor does a high score mean that you are guaranteed to be safe. But just be thankful that somebody out there has your back.