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HomeMy WebLinkAboutFood Service Establishment Inspection 10 r .I Establishment: Inspection Date: Time:�,�ltsPREinsp Address/City: Healtli Dept S. V��Y�,RS1� Class: 1 2 3 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. RISK FACTOR ITEMS: Listing is not inclusive of all possible debitable items C N/ /A NCI KEY: C[complies] N/0[not observed] NIA[not applicable] 3 DNC[does not comply] 0[other] RTE[ready-to-eat] s a 2 A -F iii G NIA d`r 62 4t(► tef1 doCSUJtI@n On of tra(fig progtrapt 2 A Food workers have no exposed infected lesions/burns B Personnel with infection restricted 1 A 004Vild sourciid Oolialsome,nonadubrat®d C 0 NIA 4 C Communicable disease of worker reported to local health director A Approved shellfish,finfish,meat&poultry USDA approved 1 a H.nd hir►g.facffi4�,5 no i handathrasthed; C . NIA 4 B Food cans in good condition(not dented,rusty,bloated,leaking) A Handwash facilities in all food prep/dispensing&warewash areas C Wholesome/nonadulteratedfoods/safe 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 7 D Personnel hands washed,clean/Proper handwash procedure O E Handwashing at appropriate times 0 A Hot holding greater than or equal to 1400F. (whole beef/pork roasts 1300F) A ❑ No eating ❑ No smoking while working B Cold holding less than or equal to 450 F. B Wounds covered adequately C Proper cooling C Proper sink used for handwashing D Proper re-heating 0 E Proper intemal cooking/consumer advisory posted 0 A Approved sanitizeravailable/adequate concentration ofsanitizer 10111 B Food-contact surfaces and utensils used for potentially or hazardous food sanitized at least every 4 hours A Food thermometer available and accurate C Adequate ❑dishwashersanitizer nal rinse temp D Propersanitizin rocedure B Properfood thermometer for product E Sanitizing between raw animal origin&ready-to-eat food C Thermometers appropriately placed in cooler units 0 HolF , 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 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 0 8 Food containers stored off the floor 0 A No unnecessary handling RTE and/or cooked foods with bare hands V A Soap I paper towels/ drying device available B Dispenser(s)working: ❑Soap ❑Paper towel B Minimize food handling,other than ready-to-eat,with bare hands C Handwash sink(s)clean/waste receptacle at handwash sink C Adequate utensil(s)for dispensing food/iceLe :fl0 O •DESCRIBE DEFICIENCIES ON CONTINUATION SHEETS The following information is not debitable and does not affect your score. KEY: CFO[qualified food operator],DA[designated alternate],PHF[potentially hazardous food],FB[foodborne] 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 temper redo you cook: Poultry Ground Beef Pork What diseases related to FB illness are you required to report to the local health Roasts Other Describe re-heating procedures: Is there a written illness policy that requires the f er to report specific illness conditions Are temperatures recorded/logged for co olding foods/equipment? Y N and diseases to the QFO? Y N you have a paid sick leave policy? Y N Are foods cooked in advance cooled? Y N *Are leftovers saved? Y N Is there a language barri een inspector&QFO? 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 thods: 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 T�W`nitored for time&temp? Y IN Is the monitoring of cooling recorded? Y N Obtain signature of th�.pers�on who re&gjy�d the responsibilities information at the time of the Is there a produce washing policy? Y N *Describe what is washed and inspection: �Gj where: Note: This report is a two page form(total of 62 debitable items) Page 1 of 2 w ME ME 7Estabisishment: Date of inspection: 0 � 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. 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 -Sanitizer concentration not to exceed maximum permitted -Food equipment -Hose connections -Dish machines -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 storage area/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 ermin Control: No insects/rodents present 14 Food worker:Clean outer clothes,effective hair restraints Outer openings protected against entrance of insects/rodents 4 oors: Floor covering installed,constructed as required,good repair,clean 16 Food-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 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 repair,clean.Wall&ceiling surfaces as required 20 Dishwashing facilities approved design,adequately constructed, maintained installed located 50 Dustless cleaning methods used,cleaning equipment properly stored Equipment&Utensils: Cleanliness 51 Adequate lighting provided as required 1 Prefiushed,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)Nonfood-contact surfaces of utensils&equipment clean 55 Establishment and premises free of litter,no insect/rodent harborage, 28 Equipment/utensils,storage,handling no unnecessary articles 32 Proper disposal of wastewater 56 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 Propertoiletfixturesprpvided,good repair,clean entrance(s),smoking area indicated by sign(s) 39 Approved garbage/rubbish containers,adequate number,covered, rodent proof,clean outine Inspection 1311einspection 17 Preoperational Inspection Other Inspection: IN PE T R: PERSON IN CHARGE: Demerit Score: *Include demerits from page 1, 4 3 2 1 Total I Rating signature ign re Q print a prm me © o C ,\ <ALQ —6Hf`1 DATE CORRECTIONS DUE: i phone number p iroak44 a Page 2 of 2 plus_�__continuation pages Focused Inspection 1/2002 • • DATE OF • E W-3MME12" Mm w,ra a •' i� eL _f� � L � , r �� ��M- 1a. �! , Ev.,ir . • ` ,y. �._ ti ,..• �./a.Y • s ro-Mq I IIIII MINI "dillip,�Jff ME a V d � i t lig I dip ilk 1111� ` b WIN , Wl- •. 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