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Home My WebLink AboutFood Service Establishment Inspection 17 (4) i Establishment: Inspection Date: 3 _t( Time:k)xy*^ Ro[nsp REinsp Address/City: ` Health pt: 5, �� 41�c�� Class: 1 2 3 C4 Based on an inspection this da , he ems marked DNC identify the vio i 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 NI DNC KEY: C[complies] N/O[not observed] m NIA[not applicable] 3 DNC[does not comply] 0[other] RTE[ready-to-eat] * � = 2 NIA, 762 tfEE�n.d�smentat]on_nftraiftingprggratn 2 A Food workers have no exposed infected lesions/burns W` 1 '4 rmved source,�whiialiii BTe,nonadulterated C N NIA 4 B Personnel with infection restricted C Communicable disease of worker reported to local health director A Approved shellfish,finfish,meat&poultry USDA approved 13 Handwhfino WIN" � wt�s#, Or 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/nonadulteratedfoodslsafe 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 I Proper handwash procedure 0 E Handwashing at appropriate times 0 A Hot holding greater than or equal to 1400F. (whole beef1pork 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 internal cooking/consumer advisory posted I —SEEM A Approved sanitizeravailable/adequate concentration of sanitizer B Food-contact surfaces and utensils used for potentially hazardous foods 'ized at least every 4 hours A Food thermometer available and accurate C I Adequate Xdishwashersanitizer ❑final rinse temp B D Pro ers itizin procedure Properfoodthermometerforproduct E Sanitizing between raw animal origin&ready-to-eat food C Thermometers appropriately placed in cooler units 0 0 vim.-r 19 A Cloths and/or sponges in good repair and clean B Wiping cloths kept in sanitizer between uses A Produce washed 0 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 �. / I A No unnecessary handling RTE and/or cooked foods with bare hands A Soap paper towels drying device available 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 C Adequateutensil(s)fordispensingfood/ice 0 V, 7 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 aitemate],PHF[potentially hazardous food],FB[foodbome] PHFs are hot held at: OF. PHFs are cold held at: o Describe illness conditions when you would exclude a food worker from working: Are internal cooking temperatures taken? Y N *To what temperat ou cook: Poultry Ground Beef Pork What diseases related to FB illness are you re report to the local health department? Roasts Other Describe re-heating procedures: Is there a written illness poll requires the food worker to report specific illness conditions Are temperatures recordedllogged for olding foods/equipment? Y N and diseases to the Y N *Do you have a paid sick leave policy? Y N Are foods cooked in adv2xAi cooled? Y N *Are leftovers saved? Y N Is there guage barrier between inspector&CFO? Y N If yes indicate language spoken List products Goole b FO/DA: *Can the QFO/DA read the inspection report? Y N De cooling methods: Indicate who answered the above questions: Name(prin c Indicate the title of above person(circle all that ly):QFO DA Mgr Cook Owner FW Is cooling monitored for time&temp? Y N Is the monitoring of cooling recorded? Y N .Obtain sign the p rson who received a=D responsibilities info ation at lhe firrie of the Is there a produce washing policy? Y N *Describe what is washed and inspection: where: Note: This report is a two page form(total of 62 debitable items) Page 1 of 2 Establishment: Date of Inspection: 777 ress:dd ?-rIa � Owner o Operator ADDITIONAL FOI.WPOINT ITEMS KEY: DNC [DOES NOT COMPLY] 6 Foods not re-served. -Unwrapped foods not re-served 4 31 Sewage disposal approved. -Operating as required -Potentially hazardous foods not re served 11 Toxic chemicals. No cross connections,back siphonage,backflow -Stored properly,labeled properly,used properly Proper type/installation/backflow prevention device/air gap for: -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 machines 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 designed,properly installed -Monitoring in compliance OTHER ITEMS KEY: DNC [DOES NOT COMPLY] 2 Sources of food: Original container,properly labeled 40 Garbagelrubbish storage area/rooms,enclosures-properly constructed,clean 5 Potentially hazardous food properly thawed 41 Garbagelrubbish disposed of in an approved manner,at approved frequency 10 Food dispensing utensils properly stored 42 Vermin Control:No insects/rodents present 14 Food worker:Clean outer clothes,effective hair restraints 43 Outer openings protected against entrance of insects/rodents Floors: 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 18 Single service articles,storage,dispensing 8 Exterior walking,driving surfaces,good repair,clean 19 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 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 27 Nonfood-contact surfaces of utensils&equipment clean 55 Establishment and premisesfreeof litter,no insect/rodent harborage, 28 Equipment/utensils,storage,handling no unnecessary articles 32 Proper disposal of waste water 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) 37 Proper toilet fixtures provided,good repair,clean 59 Seats 75 or more:Nonsmoking area provided,sign(s)posted at entrance(s),smoking area indicated by sign(s) 39 Approved garbage/rubbish containers,adequate number,covered, rodent proof,clean tkutine Inspection ❑Reinspection ❑ Preoperational Inspection Other Inspection: IN PE TOR: PERSON IN E:NW Demerit Score: *Include demerits from page 1 4 3 2' 1 Total Rating sig� U si nature U 3 I i QC� print name print name C) ZuZ'Zo 3p DATE CORRECTIONS phone number title Page 2 of 2 plus__� continuation pages Focused Inspectlon WON NAME OF • OF • i T " . i r milli 1111151:12 Mo �- 91d1 11•i N 0110 Y� � � c 'tea.,a �_ ..L1� � alp '_ • � � _ I 5 r `_J-_ l� � �• _ , .ems ru mik WL� �1 ' w .. • • no-nct W M_ �l W_ Oil! go wo., 1, - ,.. -- 1