HomeMy WebLinkAboutHealth Department Files_81077_pg0018 Establishment: Date of Inspection: ;77-R-.;7-3
Address: Owner or Operator:
ADDITIONAL FOUR P INT ITEMS KEY: DNC [DOES NOT COMPLY]
6 Foods not re-served. 4 31 Sewage disposal approved.
-Unwrapped foods not re-served 4
-Potentially hazardous foods not re-served -Operating as required
No cross connections,back siphonage,backflow
11 Toxic chemicals. Proper type/installation/backflow prevention device/air gap for:
-Stored properly,labeled properly,used properly -Food equipment -Hose connections -Dish machines
-Sanitizer concentration not to exceed maximum permitted -Soda system carbonator -Beverage dispensers -Toilet tanks
-No unnecessary toxics on the premises -Chemical dispensers -Ice machines
-Pesticides/rodenticides properly dispensed Proper drain for:
29 Water source adequate,safe. -Food equipment -Dish machines -Ice machines
-Well/well head protected from contamination 35 Toilet facilities. Adequate,convenient,accessible,
-Water quality in compliance-Monitoring in compliance designed,properly installed
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
0 Xod dispensing utensils properly stored 42 vermin Control: No insects/rodents present
4 Food worker:Clean outer clothes,effective hair restraints 43 Outer openings protected against entrance of insects/rodents
4 loors: Floor covering installed,constructed as required,good repair,clean
16 ood-contact surfaces designed,constructed,maintained,installed, 5 Floors graded,drained as required
located
6 Floor,wall juncture covered
17 Nonfood-contact surfaces designed,constructed,maintained, 7 Mats removable,good repair,clean
installed,located
18 Aingleservice articles,storage,dispensing
8 Exterior walking,driving surfaces,good repair,clean
9 No reuse of single service article 9 Walls,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 properlystored
EEquipment&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 Noms&equipment hoods,ducts,vented as required
23 Accurate thermometers provided,dish basket,if used oo 4 oms adequate,clean,adequate lockers provided,facilities clean
7 Nonfood-contact utensils&equipmentclean ablishment and premises free oflitter,no insect/rodent harborage,
Equipment/utensils,stnrage,handling no unnecessary articles
32 Proper disposal of waste water 561 Complete separation from living/sleeping quarters and laundry
33 Plumbing location,installation,maintenance 57 Clean/soiled linens stored properly
36 Toilet rooms enclosed with self-closing door 58 No live birds,turtles,or other animals(except guide dogs)
59 Seats 75 or more:Nonsmoking area provided,sign(s)posted at
37 Propertoiletfixturesprovided,good repair,clean entrance(s),smoking area indicated by sign(s)
39 Approved garbage/rubbish containers,adequate number,covered,
rodent p of,clean rRRoutine Inspection ❑Reinspection ❑ Preoperational Inspection
Ot Inspection:
R• P N I H RGE: Demerit Score: *Include demerits from page 1
4 3 2 1 Total Rating
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Sfi` _ �I �tV Page 2 of 2 plus continuation pages Focused Inspection 1/2002