HomeMy WebLinkAboutHealth Department Files_81077_pg0003 Establishment: Date of Inspection: "
Address: Owner or Operator:
ADDITIONAL FOUR POINT ITEMS KEY: DNC [DOES NOT COMPLY]
6 Foods not re-served.
-Unwrapped foods not re-served 4 31 Sewage disposal approved.
-Potentially hazardous foods not re-served -Operating as required
34 No cross connections,back siphonage,backflow
-11 Toxic chemicals.red properly,labeled properly,used properly Proper type/installation/backflow prevention device/air gap for:
-Stored-Sanitizer concentration not to exceed maximum permitted -Food equipment -Hose connections -Dish machines
-No unnecessary toxics on the premises -Soda system carbonator -Beverage dispensers -Toilet tanks-Pesticides/rodenticides properly dispensed -Chemical dispensers -Ice machinesProper drain for:
29 Water source adequate,safe. -Food equipment -Dish machines -Ice machines
-Well/well head protected from contamination 35 Toiletfacilitles. Adequate,convenient,accessible,
-Water quality in compliance designed,properly installed
-Monitoring in compliance
OTHER ITEMS KEY: DNC [DOES NOT COMPLY]
2 Sources of food: Original container,properly labeled 40 Garbage/rubbish storagearea/rooms,enclosures-properly constructed,clean
5 Potentially hazardous food properly thawed 41 Garbage/rubbish disposed of in an approved manner,at approved frequency
10 Food dispensing utensils properly stored 2 rmin Control: No insects/rodents present
14 Food worker:Clean outer clothes,effective hair restraints ter openings protected against entrance of insects/rodents
4 ors: Floorcovering installed,constructed as required,good repair,clean
locateeontactsurfaces 16 Food- designed,constructed,maintained,installed, 5 Floors graded,drained as required
d
6 Floor,walljuncture covered
17 Nonfood-contact surfaces designed,constructed, maintained, 7 Mats removable,good repair,clean
installed,located
8 Exterior walking,driving surfaces,good repair,clean
18 Single service articles,storage,dispensing
19 No reuse of single service article 9 alls,ceilings attached,equipment properly constructed,good
20 Dishwashing facilities approved design,adequately constructed, repair,clean.Wall&ceiling surfaces as required
maintained installed located 50 Dustless cleaning methods used,cleaning equipment properly stored
Equipment&Utensils: Cleanliness 51 Adequate lighting provided as required
21 Preflushed,scraped,soaked and racked 52 Room free of steam,smoke odors
22 Wash water clean,proper temperature 53 Rooms&equipment hoods,ducts,vented as required
23 Accurate thermometers provided,dish basket,if used 54 Rooms adequate,clean,adequate lockers provided,facilities clean
7 onfood-contact surfaces of utensils&equipment clean
55 Establishment and premises free of litter,no insect/rodent harborage,
Equipment/utensils,storage,handling no unnecessary articles
32 roper disposal of waste water 56 Complete separation from living/sleeping quarters and laundry
33 Rfumbing location,installation,maintenance 57 Clean/soiled linens stored properly
58 No live birds,turtles,or other animals(except guide dogs)
36 Toilet rooms enclosed with self-closing door
59 Seats 75 or more:Nonsmoking area provided,sign(s)posted at
[39
7 Proper toilet fixtures provided,good repair,clean entrance(s),smoking area indicated by sign(s)
Approved garbage/rubbish containers,adequate number,covered,
rodent proof,clean ARoutine Inspection ❑Reinspection ❑ Preoperational Inspection
0 nspection:
INSPI CTOR- P N N CHAR WE: Demerit Score: *Include demerits from page 1
4 3 2 1 Totatl Rati g
ig tur `
p n Ztf
ame v /�
i t nam ZVV���CCC///
one nu ber�;V) �mtitle
DATE CORRECTIONS UE: s
^j�l�(t,, Page 2 of 2 plus continuation pages Focul Inspection 1/2002