HomeMy WebLinkAboutHealth Department Files_81077_pg0043 Establishment: Inspection Date:R Time:� ins insp
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Address/City: Or- �i Health Dept:_5', 1�7liaza So,� Class: 1 2 4
Based on an inspection this day,the items marked DNC identify the violations in operation or facilities which must be corrected by the date specified on page 2.
JAppraved
FACTOR ITEMS: Listing is not inclusive of all possible debitable items C NIO N/A DNC KEY: C[complies] N/0[not observed] NIA[not applicable]
MEN 3 DNC[does not comply] 0[other] RTE[ready-to-eat]
A fttat tEcf �C WOWA4fri len documentation of training program A Food workers have no exposed infected lesions/burns
B Personnel with infection restricted source,wholesome,nonadugerated C N10 /A 4 C Communicable disease of worker reported to local health director
A Approved shellfish,finfish,meat&poultry USDA approved 13 .
B Food cans in good condition(not dented,rusty,bloated,leaking) fl fec i ►4 idtu,har# hee#,C an, _C NIA 4
C Wholesome/nonadulterated foods/safe A Handwash facilities in all food prep/dispensing&warewash areas
B Handwash facilities in or immediately adjacent to toilet rooms
D Commercial products(no home grown/canned food) C Handwash facilities accessible/convenient 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
A Hot holding greater than or equal to 1400F. (whole beef/porkroasrs 1300 F.) A o eating ErSo smoking while working
B Cold holding less than or equal to 45°F. B Wounds covered adequately
C Proper cooling 1 6001 1 C Proper sink used for handwashing
D Proper re-heating 0
E Proper internal cooking/consumer advisory posted _a"
A oApprovedsanitizeravailable/adequateconcentrationofsanitizer
B Food-contact surfaces and utensils used for potentially
hazardous food sanitized at least every 4 hoursAll
A Food thermometer available and accurate C Adequate ❑dishwashersanitizer ❑final rinse temp
B Proper food thermometer for product D Proper sanitizin rocedure
C Thermometers appropriately placed in cooler units
E Sanitizing between raw animal origin&ready-to-eat food
0 0
tgoo#f _ A Cloths and/or sponges in good�repairand clean
B Wiping cloths kept in sanitizer between uses
A Produce washed
B Raw meats not stored/prepared near ready-to-eat foods 0
C Food covered properly A Food equipment clean,utensils clean,equipment interiors clean
-
D Adequate splash guards/sneeze guard B Single use gloves changed when soiled
E No unauthorized personnel C Food—contact surfaces clean
F No pooling of eggs not cooked immediately PAW I0
8 Food containers stored off the floor
0
`a A Soap/ /
A� No unnecessary handling RTE and/or cooked foods with bare hands paper towels drying device available
B
Dispenser(s)working: ❑Soap ❑Paper towel
B Minimize food handling,other than ready-to-eat,with bare hands V C Handwash sink(s)clean it wnstp acle at handwash sin
000
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 aftemate],PHF[potentially hazardous food],FB[foodbo I
of held at: °F. PHFs are cold held at: °F. Describe illness conditions when you would exclude a food worker from
Are internal coo c ratures taken? Y N *To what temperature do you cook:
Poultry eef Pork What diseases related to FB illness are your report to the local health department?
Roasts Other
Describe re-heating procedures: Is there a written it icy that requires the food worker to report specific illness conditions
Are temperatures recorded/logged for cold holding foods/equipment? and di he 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? aguage barrier between inspector&CFO? Y N If yes 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: int):
Is cooling monitored �&temp? Is the monitoring of cooling recorded? Y N Indicate the title of above person(circle all that apply):QFO Cook Owner FW
*Obtain signature of the person who received the QFO responsibilities informa a of the
Is ther$AoVr0dUCe washing policy? Y N *Describe what is washed and inspection:
e' Note: This report is a two page form(total of 62 debitable items) Page 1 of 2