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HomeMy WebLinkAboutFood Service Establishment Inspection 10 (11) Establishment: Wh-c� Inspection Date: a3 Time: 10,2�- ninsp RE[nsp Address/City: lNao Sk-re� He class: 1 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 ITEMS: Listing is not inclusive of all gossible debitable items { � _ �y j go , e 3 DNC[does not comply] 0[other] RTE[ready-to-eat] ei` virlt `tdn�re rii NIO NIA 4 61 Desigaatetl Attsnate� � � � 2 62 Written documentation of training program 2 A Food workers have no exposed infected lesions/burns B Personnel with infection restricted 7 Approved source,wholesome,nonadutterated C WA 4 C Communicable disease of worker reported to local health director A Approved shellfish,flnfish,meat&poultry USDA approved 13 Hartdwashing f�el�ties provided,ttandswshed,clan' C} NIA q B Food cans in good condition(not dented,rusty,bloated,leaking) A Handwash facilities in all food prep/dispensing&warewash areas vy 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 D Personnel hands washed,clean/Proper handwash procedure 0 E Handwashing at appropriate times 3 °P©tehtto ty h dofrs f aqd dur rage,ppa�tioa, sp5h s fcg pt esKtj ; t5 Gcso hy��c practicers C WAI 2 A Hot holding greater than or equal to 1400F. (whole beef/pork roasts 1300 F.) V 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 Ve- SO E Proper internal cooking I consumer advisory posted 2 i on rip a�hr t water-e rai al 0 A Approved sanitizeravailable/adequate concentration of sanitizer 4 Adegiat "fa4crllY to r tb s Y , r B Food-contact surfaces and utensils used for potentially pel re,tier cs►ne#er rbV E i3Clg � �� 4� � hazardous food sanitized at least eve 4 urs .: A Food thermometeravailableandaccurate w C Adequate ❑dishwashersanitizer final rinse temp D Proper sanitizin B Proper food thermometer for product procedure E Sanitizing between raw animal origin&ready-to-eat food C Thermometers appropriately placed in cooler units 0 777 z3id ptid cFWT fg'° � display,service and transportation " A Cloths and/or sponges in good repair and clean A Produce washed B Wiping cloths kept in sanitizer between uses 0 B Raw meats not stored/prepared near ready-to-eat foods C Food covered properly V,Of A Food equipment clean,utensils clean,equipment interiors clean Mai D Adequate splash guards I 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 $' anttftrtg of foot/r�airrtrizel - A ' � , �E I / A No unnecessary handling RTE and/or cooked foods with bare hands A Soap 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 Ll�Of C Adequate utensil(s)fordispensing food/ice 0 0 1 •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: IF. PHFs are cold held at: OF. Describe illness conditions when you would exclude a food worker fr orking: Are internal cooking temperatures taken? Y N *To what temp tTE a do you cook: Poultry Ground Beef Pork What diseases related to FB illness required to report to the local health department? Roasts Other Describe re-heating procedures: Is there a i wri ess policy that requires the food worker to report specific illness conditions d fo Are temperatures recorded/logge holding foods/equipment? Y N and dseases o he QFO? Y N *Do you have a paid sick leave policy? Y N Are foods cooked in 50yarEe and cooled? Y N *Are leftovers saved? Y N Is there a language barrier between inspector&CFO? Y N If yes indicate language spoken List products by QFO/DA: *Can the QFO/DA read the inspection report? Y N C Describe-cooling methods: Indicate who answered the above questions: Name(print): OW Indicate the title of above person(circle all that apply):CFO DA Mgr Cook Owner FW Is cooling monitored for time&temp? Y N Is the monitoring of cooling recorded? Y N .Obtain signature of th erson who received the QF responsibilities information at the time of the [where: here a produce washing policy? N ♦Describe what is washed and inspection: Note: This report is a two page form(total of 62 debitable items) Page 1 of 2 Establishment: U' Date of Inspection: Address: Q 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 34 No cross connections,back siphonage,backflow 11 xic chemicals. Proper type/installation/backflow prevention device/air gap for: -Stored properly,labeled properly,used properly -Food equipment -Hose connections -Dish machines -San itizerconc ion no o exceed maximum permitted -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 designed,properly installed -Monitoring in compliance OTHER ITEMS KEY: DNC [DOES NOT COMPLY] 2 Sources of food:Original container,properly labeled 401 Garbage/rubbish storage area/rooms,enclosures-properly constructed,dean 5 Potentially hazardous food properly thawed 41 Garbage/rubbish disposed of in an approved manner,at approved frequency 10 ood dispensing utensils properly stored 42 Vermin Control: No insects/rodents present 4 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, 45 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 Walls,ceilings attached,equipment properly constructed,good 20 Dishwashing facilities approved design,adequately constructed, 010 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 onfood-contact surfaces of utensils&equipment clean 55 Establishment and premises tee of litter,no insect/rodent harborage, 28 Equipment/utensils,storage,handling no unnecessary articles 32 Proper disposal of waste water 56 Complete sepa ration from living/sleeping quarters and laundry 33 Plumbing location,installation,maintenance 571 Clean/soiled linens stored properly 36 Toilet rooms enclosed with self-closing door 581 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 Routine Inspection ❑Reinspection ❑ Preoperational Inspection Other Inspection: INSPECTOR: PERAQN IN AR GE: Demerit Score: *Include demerits from page 1 2 4 3 2 1 Total Rating sig ature sig ure c� m �5?041J print name V pnn ame y o 90-6oy-�) ' ��� DATE CORRECTIONS phone number title Pagep2�of 2 pllus�`�_continuation pages Focusled�InsApec'Nou 1/2002 Page3_of FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH CONTINUATION SHEET NAME OF ESTABLISHMENT TOWN TOWN ^ q // DATE OF INSPECTION e + INSPECTION REMARKS FORM# yy Earl r�a' 1 ►o \ W Sx— �• ti i n a-� - 5 �:ZR 0 C)lkU LJU,2.r t ct , 1 ✓.\ i9 \ r. w•cle.rn,. 5 - — 4A r r Wl ti INITIAL(INSPECTOR) INITIAL(PERSON IN CHARGE) Distribution: 1st-White-Health Department 2nd-Yellow-Owner/Manager