HomeMy WebLinkAboutHealth Department Files_81077_pg0029 i
Establishment: Inspection Date: —� Time: RO[nsp Eins
ddress/City: Health Dept: , !.�/ Class: 1 2 3 a
Based on an inspection this day,t items marked DNC id ntify the violations in operation or facilities which must be corrected by the date specified on page 2.
RISK FACTOR ITEMS:Listing is not inclusive of all possible debitable items C N/ N/A DNC I KEY: C[complies] N/O[not observed] NIA[not applicable]
two OOF 3 DNC[does not comply] 0[other] RTE[ready-to-eat]
1 ? si ergte `` 2 ors I 'ri drrre�'acted C, tU/0` _ 4
A Food workers have no exposed infected lesions/burns
62 t ,doeathmtatt+pn 0f ca z
B Personnel with infection restricted
11p�roved$� Ce'w�OeS0t#t}�,efaitte> fed N�0 N/A C Communicable disease of worker reported to local health director
A Approved shellfish,finfish,meat&poultry USDA approved 13 Handyl4:ping facfl11ilies Provil bandswas�esl,t t7 NIA 4
B Food cans in good condition(not dented,rusty,bloated,leaking) A Handwash facilities in all food prep/dispensing&waashwrewash areas
C Wholesome/nonadulteratedfoodslsafe B Handwash facilities in or immediately adjacent to toilet rooms
D Commercial products(no home grown/canned food) C Handwash facilities access ib le/co nvenient to use
E Potentially hazardous foods received at proper temperature D Personnel hands washed,clean/Proper handwash procedure
0 E Handwashing at appropriate times
0
t `MOW A 2
A Hot holding greater than or equal to 1400F. (Whole beef/pork roasts 1300 F.) A ❑ No eating ❑ No smoking while working
B Cold holding less than or equal to 450F. B Wounds covered adequately
C Proper cooling C Proper sink used for handwashing
D Proper re-heating 0
E Proper internal cooking/consumer advisory posted
ass 0.4
0 A Approved sanitizeravailable/adequateconcentrationofsanitizer
B Food-contact surfaces and utensils used for potentially
11 EMM- hazardous food sanitized at least every 4 hours
A Food thermometer available and accurate C Adequate ❑dishwashersanitizer ❑final rinse temp
B Proper food thermometer for product
D Proper sanitizin rocedure
E Sanitizing between raw animal origin&ready-to-eat food
C Thermometers appropriately placed in cooler units O
0
r
" t A Cloths and/or sponges in good repair and clean
B Wiping cloths kept in sanitizer between uses
A Produce washed
B Raw meats not stored/prepared near ready-to-eat foods
C Food covered properly aw
Food equipment clean,utensils clean,equipment interiors clean
D Adequate splash guards/sneeze guard g Single use gloves changed when soiled
E No unauthorized personnel C Food--contact surfaces clean
F No pooling of eggs not cooked immediately 0
8 Food containers stored off the floor
E.
�R` _ Soap I paper towels/ drying device available � �
f :
No unnecessary har Adling RTE and/or cooked foods with bare hands B
Dispensers)working: ❑Soap ❑Paper towel
B Minimize food handling,other than ready-to-eat,with bare hands C Handwash sink(s)clean I waste receptacle at handwash sink q
C Adequate utensil(s)for dispensing food/ice 0
0 •DESCRIBE DEFICIENCIES ON CONTINUATION SHEETS
The following information is not debitable and does not affect your score. KEY: QFO[qualified food operator],DA[designated alternate],PHF[potentially hazardous food],FB[foodbome]
PHFs are hot held at: OF. PHFs are cold held at: OF. Describe illness conditions when you would exclude a food worker from working:
Are internal cooking temperatures taken? Y N *To what temperature do you cook:
Poultry Ground Beef Pork What diseases related to FB illness are you required to report to the local health department?
Roasts Other
Describe re-heating procedures: Is there a written illness policy that requires the food worker to report specific illness conditions
Are temperatures recorded/logged for cold holding foods/equipment? Y N and diseases to the QFO? Y N *Do you have a paid sick leave policy? Y N
Are foods cooked in advance and cooled? Y N *Are leftovers saved? Y N Is there a language barrier between inspector&QFO? Y N Iflf ves indicate language spoken
List products cooled: by QFO/DA: *Can the QFO/DA read the inspection report? Y N
Describe cooling methods: Indicate who answered the above questions: Name(print):
Indicate the title of above person(circle all that apply):QFO DA Mgr Cook Owner FW
Is cooling monitored for time&temp? Y N Is the monitoring of cooling recorded? Y N .Obtain signature of the person who received the QFO responsibilities information at the time of the
[Is there a produce washing policy? Y N *Describe what is washed and inspection:
where: Note: This report is a two age form(total of 62 debitable items) Page 1 of 2
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