HomeMy WebLinkAboutFood Service Establishment Inspection 96 (6) Establishment: tr ,sV Inspection Date: it 112--112— Time: Roinsp REinsp
Address/City: ' V"M V--e— Health ept: , t 2 3
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!Tift Listing is inell-sive of.all possible debitable KEY: C[complies] N/O[not observed] N/A[not applicable]
` ISd Ot1g �t t * DNC[does not comply] 0[other] RTE[ready-to-eat]
3
92`'f�er4ti ei`11tf n infee restricted 61 �►e igr�ated Alternate� 2 td CI NgINZA 4`
62 Written documentation of training program A Food workers have no exposed infected lesions/burns
2 B Personnel with infection restricted
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1 Approved source,wholesome,noaadatterated C N/0 4 C Communicable disease of worker reported to local health director �
A Approved shellfish,finfish,meat&poultry USDA approved �S, ancfvrashing proviclecl, n c C
B Food cans in good condition(not dented,rusty,bloated,leaking)
C Wholesome/nonadulteratedfoods/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
ti E Handw aching at appropriate times
3' 0 enf ` hag s food tzteg s t ripe $ e f r s
.during sore,preperption dray eP a � �� �� 0
1g Good' ygierlc'pactfcs C PfWA 2'
A Hot holding greater than or equal to 1400F. (whole beef/pork roasts 130e F.) ❑ No eating ❑ No smoking while working
B Cold holding less than or equal to 450 F. L,000 B Wounds covered adequately 70
C Proper cooling C Proper sink used for handwashing
D Proper re-heating C
01
E Proper internal cooking/consumer advisory postede rf _ ( 1vv�tefr c #rr �i
0 Approved sanitfzer available/adequate concentration of sanitizes too
Aiet�t$'fiacregh� #t e g Food contact surfaces and utensils used for potentially 00,
ttpeTai ;y t�t�o7r#eter 1p�e �f hazardous food sanitized at least every 4 hours
A Food thermometer available and accurate C Adequate ❑dishwashersanitizer ❑final rinse temp
B Proper food thermometerfor product D Proper sanitizin rocedure
C Thermometers appropriately placed in cooler units
E Sanitizing between raw animal origin&ready-to-eat food
0 0
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"Foitpiatececl`dttrtrc, rtia,. m. -
display,service and transportation Cloths and/or sponges in good repair and clean
A Produce washed
Wiping cloths kept in sanitizer between uses
0
B Raw meats not stored/prepared near ready-to-eat foods
C Food covered properly Food equipment clean,utensils clean,equipment interiors clean
D Adequate splash guards/sneeze guard B Single use gloves changed when soiled Le
E No unauthorized personnel C Food--contact surfaces clean LIK
F No pooling of eggs not cooked immediately 0
8 Food containers stored off the floor
11 0 f�
Halag of food rrti�*e€I �, wF ... � Y ( s,
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MCI VX
A No unnecessary handling RTE and/or cooked foods with bare hands A Soap I paper towels/drying device available
B Minimize food handling,other than ready-to-eat,with bare hands B Dispenser(s)working: ❑Soap ❑Paper towel
C Handwash sink(s)clean/waste receptacle at handwash sink
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. JKEY: QFO[qualified food operator],DA[designated altemate],PHF[potentially hazardous food],FB[foodborne]
PHFs are hot held at: IF. PHFs are cold held at: OF. Describe illness conditions when you would exclude 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 squired to report to the local health department?
Roasts Other
Describe re-heating procedures: Is there a written illness poli at requires the food worker to report specific illness conditions
Are temperatures recorded/logged for cold holding foods/equipment? and diseases to the QF . Y N ♦Do you have a paid sick leave policy? Y N
Are foods cooked in advance and cooled? Y N ♦ eftovers saved? Y N Is there a Ian a barrier between inspector&CFO? Y N ff M indicate language spoken
List products cooled: by QFO *Can the QFO/DA read the inspection report? Y N
Describe cooling methods: Indicate who answered the above questions: Name(print):
Is cooling monitored for time&temp? Y N Is the monitoring of cooling recorded? Y N Indicate the title of above person(circle all that apply):QFO DA Mgr Cook Owner FW
•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 page form(total of 62 debitable items) Page 1 of 2
toi:i' ttl - ADORESSICITY rt.
Establishment: `p SS .-e S Date of Inspection: I Z Z
Address: (if VA4 Owner or Operator:
ADDITIONAL FOUR POINT ITEMS z_
o; KEY: DNC [DOES NOT COMPLY]
6 Foods not re-served.
-Unwrapped foods not re-served 4 31 Sewage disposal approved.
-Potentially hazardous foods not re-served
-Operating as required
11 oxic chemicals. o cross connections,back siphonage,backflow
I typelinstallation/backflow revention devicW- i
a for'
-Stored properly,labeled properly,used properly � � -Food equipment -Hose connections mac mes
-Sanitizer concentration not to exceed maximum permitted d -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. 4
-Food equipment -Dish machines -Ice machines
-Well/well head protected from contamination
-Water quality in compliance 35 Toilet facilities. Adequate,convenient,accessible,
-Monitoring incompliance �
designed,properly installed
OTHER ITEMS KEY: DNC [DOES NOT COMPLY]
2 ources of food: Original container,properly labeled 40 Garbage/rubbish storage area/rooms,enclosures-properly constructed,clean
5 Potentially hazardous food properly thawed 2`,'; 1 Garbage/rubbish 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 Outeropenings protected against entrance ofinsects/rodents
4 Floors: Floor covering installed,constructed as required,good repair,clean
16 Food-contact surfaces designed,constructed,maintained,installed, 45 Floors graded,drained as required
located
6 Floor,wall juncture covered
17 onfood-contact surfaces designed,constructed,maintained,
installed,located 7 Mats removable,good repair,clean
{ 481 Exterior walking,driving surfaces,good repair,clean
18 Single service articles,storage,dispensing
19 No reuse of single service article 49 Walls,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&Utensilsi leanliness �e 51 Adequate lighting provided as required
21 Preflushed,scraped,soaked and racked
P 52 Room free of steam,smoke odors
22 Wash water clean,proper temperature S3 Rooms&equipment hoods,ducts,vented as required
23 Accurate thermometers provided,dish basket,if used 4 ooms adequate,clean,adequate lockers provided,facilities clean
6�20
onfood-contact surfaces of utensils&equipment clean Establishment and premises free of litter,no insect/rodent harborage,
0
quipmentlutensils,storage,handling no unnecessary articles
31 Proper disposal of wastewater 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 Propertoiletfixtures provided,good repair,clean entrance(s),smoking area indicated by sign(s)
39 Approved garbage/rubbish containers,adequate number,covered,
rodent proof,clean Woutine Inspection ❑Reinspection ❑ Preoperational Inspection
INSOther Inspection:
P PER HARGE:I J Demerit Score: *Include demerits from page 1
I'S(5 40 6� 4 3 2 1 Total Rating
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L 'I( x L1 - DATE CORRECTIONS DYUE: Z
phone number title
Page 2 of 2 plus continua on pages Focused Inspection 1/2002
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FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH
CONTINUATION SHEET
NAME OF ESTABLISHMENT TOWN DATE OF INSPECTION
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INSPECTION REMARKS
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Distribution: Ist-White-Health Department 2nd-Yellow-Owner/Manager
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FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH
CONTINUATION SHEET
NAME OF ESTABLISHMENT TOWN DATE OF SPE TION
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INITIAL(INSPECTOR) INITIAL(PERSON IN CHARGE)
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