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Home My WebLink AboutFood Service Establishment Inspection 26 (4) i Establishment: f Inspection Date: Time: insp REins Address/City: ►� Health pt. 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. comp les not observed] NIA[not applicable] 60- . edbd 9e * DNC[does not comply] 0[other] RTE[ready-to-eat] 42 Pdr nM With infection restricted' 61 Designated Alternate 2 CIWUA 4 62 Written documentation of training program 2 A Food workers have no exposed infected lesions/burns B Personnel with infection restricted 1 Approved source,wholesome,nanadcit@cad C WO IA 4 C Communicable disease of worker reported to local health director A Approved shellfish,finfish,meat&poultry USDA approved 13 "andWashing b0ities provided,handswasi�d,clean C 4 B Food cans in good condition(not dented,rusty,bloated,leaking) C Wholesome/nonadulteratetl 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) L. C Handwash facilities accessible/convenient to use E Potentially hazardous foods received at proper temperature LO 01 1 1 0 D Personnel hands washed,clean I Proper handwash procedure E Handwashing at appropriate times 3 otaElyarda n di pis ttper4 r #i �� C o damn store p ay s�rv�c grad t�rrspt $t k 45 ` ooti kygientc CO'S C N/0 N/A 2 A Hot holding greater than or equal to 140eF. (whole beef/pork roasts 1300 F.) A ❑ No eating ❑ No smoking while working B Cold holding less than or equal to 45eF. B Wounds covered adequately C Proper cooling L0000 C Proper sink used for handwashing D Proper re-heating E Proper internal cooking/consumer advisory posted° ..�.: ihti 0 A Approved sanitizeravailable/adequate concentration ofsanitizer 4 Adequate facitl ;to[,, _01,40 01,04 c B Food contact surfaces and utensils used for potentially ten peirature,the . - a hazardous food sanitized at least eve ry4 hours 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 LA E Sanitizing between raw animal origin&ready-to-eat food 0 0 ,as 1+ttA r bOd'prfflE.tf3€ IIJ1� display,service and transportation A 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 4 11 D Adequate splash guards/sneeze guard E No unauthorized personnel g Single use gloves changed when soiled C Food--contact F No pooling of eggs not cooked immediately 0 8 Food containers stored off the floor 0 4 §s �e� Yi1ioir0 2 a 3` 9 Handling of food rn ninill4d A No unnecessary handling RTE and/or cooked foods with bare hands A Soap/paper towels I drying device available B Dispenser(s) B Minimize food handling,other than ready-to-eat,with bare hands working: ❑Soap ❑Papertowel C C Adequate utensil(s)for dispensing food/ice 0 Handwash sinks)clean/waste receptacle at handwash sink kF4T O •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[foodborne] PHFs are hot held at: F. 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 yo Poultry Ground Beef Pork What diseases related to FB illness are you required to report to the local health de nt? Roasts Other Describe re-heating procedures: Is there a written illness policy that requires the food worker to re ecific illness conditions Are temperatures recorded/logged for cold holding food Ipment? Y N and diseases to the QFO? Y N *Do you have sick leave policy? Y N Are foods cooked in advance and cooled? Y *Are leftovers saved? Y N Is there a language barrier between inspector 0? Y N IfI 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 ans a 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? 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 LtCAL FA1 Ili DEWT t„ .,., iD12ESSfCITY x r Establishment: r n� Date of Inspection:— If Aq 12, ddress: 1 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. -Potentially hazardous foods not re-served w -Operating as required 11 Toxic chemicals. No cross connections,back siphonage,backflow N Proper type/installation/backflow prevention device/air gap for: -Stored properly,labeled properly,used properly -Food equipment -Hose connections -Dish machines -Sanitizer concentration not to exceed maximum permitted -C -Soda system carbonator -Beverage dispensers -Toilet tanks -No unnecessary toxics on the premises , -Chemical dispensers -Ice machines -Pesticides/rodenticides properly dispensed p 5yn 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] 2J Sources of food: Original container,properly labeled 40 Garbage/rubbish storagearea/rooms,enclosures-properly constructed,clean 5 Potentially hazardous food properly thawed 2.f 1 Garbage/rubbish disposed of in an approved manner,at approved frequency 10 Food dispensing utensils properly stored i?' 2 Vermin Control: No insects/rodents present 14 Food worker:Clean outer clothes,effective hair restraints 43 Outer openings protected against entrance of insects/rodents 4 loors: Floor covering installed,constructed as required,good repair,clean 16 Food-contact surfaces designed,constructed,maintained,installed, z 5 Floors graded,drained as required located 6 Floor,wall juncture covered 17 Nonfood-contact surfaces designed,constructed,maintained, "a 7 Mats removable,good repair,clean installed,located ;q 18 Single service articles,storage,dispensing 8 Exterior walking,driving surfaces,good repair,clean r� 19 No reuse of single service article lls,ceilings attached,equipment properly constructed,good epair,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 21 Preflushed,scraped,soaked and racked 52 Room free of steam,smoke odors 2 Wash water clean,proper temperature 23 Accurate thermometers provided 53 Rooms&equipment hoods,ducts,vented as required,dish basket,if used 54 oms adequate,clean,adequate lockers provided,facilities clean 6 - onfood-contact surfaces of utensils&equipment clean 55 Establishment and premises free of lifter,no insect/rodent harborage, 8 quipmentlutensils,stnrage,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 Propertoiletfixturesyrovided,good repair,clean entrance(s),smoking area indicated by sign(s) 39 Approved garbage/rubbish containers,adequate number,covered, rodent proof,clean 1VIRoutine Inspection ❑Reinspection ❑ Preoperational Inspection Other Inspection: m INS T P O N GE: Demerit Score: *Include demerits from page 1 signature 4 3 2 1 Total Rating kIr a40A_ si n ture �j print name print name ( !14--aS // X L q DATE CORRECTIONS DUE: phone number title t �u/N Page 2 of 2 plus�_continuation pages Focused Inspection 112002 ' Page Of --� FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH CONTINUATION SHEET NAME OF 5STABLISHMENT TOWN DATE DSPECTION 14-T-esiv J INSPECTION FORM# REMARKS 4 4- LiA t n r Lg� L�2 JCa rAAL� "-V --r ukl o 7 �1, sei. c �' C v oYj Rt / C 4P 20 1-4 —So / qi - re,",ff�a :h L V(,kf S r, ACV LwsJ S k INITIAL(INSPECTOR) INITIAL(PERSON IN CHARGE) Distribution: Ist-White-Health Department 2nd-Yellow-Owner/Manager