The URL can be used to link to this page

Home My WebLink AboutFood Service Establishment Inspection 17 (9) Establishment: Inspection Date: ;Q3 Ii 3 Time: D.30 oins REinsp Address/City: 1-7 Is Health ept: S. W"-.otsor— class: t 2 3QS Based on an inspection this da , 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 00 ae$4ter DN 3 C[does not comply] 0[other] RTE[ready-to-eat] 61 Designated Alternate 2 NA 4 1 e so l with itifectlibn restricted 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,rx0rradtlhetated0 NIAC Communicable disease of worker reported to local health director A Approved shellfish,finfish,meat&poultry USDA approved 11 Hanch0shing facfts provided,hands tsri,ciean' 0 WA 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 V 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 'Peteo kky halzardousI60 "Ild t p t rs t l i,. � 0 during s#orage,preparation,d4aplay,serrte 011 # pttat . a� 1 C=odd i iertic'practicss C NIA 2' A Hot holding greater than or equal to 140oF. (whole beef/pork roasts 1300 F.) V A ❑ No eating ❑ No smoking while working B Cold holding less than or equal to450F. V 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 0 A Approved sanitizeravailable/adequate concentration ofsanitizer 4 Adequate faatties to rnatntafn product " q` B Food contact surfaces and utensils used fo otentially temperature,thtermorneters provided• hazardous food sanitized at least every 4 Ars A Food thermometer available and accurate C Adequate ❑dishwashersanitizer 9final rinse temp D Proper sanitizin procedure B Proper food thermometer for product E Sanitizing between raw animal origin&ready-to-eat food C Thermometers appropriately placed in cooler units 0 0 77, T rotected 'story# - ;�• R p 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 A Food equipment clean,utensils clean,equipment interiors clean D I 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 8 Food containers stored off the floor mrtes°pbbttied . g Handl g of food mirr➢arized' � � b �A 2 A INo unnecessary handling RTE and/or cooked foods with bare hands A Soap I paper towels I drying de 'ce available B Dispenser(s)working: cap ❑Paper towel B Minimize food handling,other than ready-to-eat,with bare hands C Handwash sink(s)clean7 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. Imo(: QFO[qualified food operator],DA[designated alternate],PHF[potentially hazardous food], FB[foodborne] PHFs are hot held at: OF. PHFs are cold held OF. Describe illness conditions when you would exclude a food worker from working: Are internal cooking temperatures taken? Y N *To aYtemperature do you cook: Poultry Ground Beef Pork What diseases related to FB illness are o report to the local health department? Roasts Other Describe re-heating procedures: Is there a written 04egT policy that requires the food worker to report specific illness conditions Are temperatures recorded/log or cold holding foods/equipment? Y N and dise o the QFO? Y N *Do you have a paid sick leave policy? Y N Are foods cooked in a nce and cooled? Y N +Are leftovers saved? Y N Is there a language barrier between inspector&QFO? Y N Ayes indicate language spoken List products coo : by QFO/DA: *Can the QFO/DA read the inspection report? Y N Descri oling methods: Indicate who answered the above questions: Name(print): .4 1 Indicate the title of above perso a all that apply): A Mgr Cook Owner FW Is cooling monitored for time&temp? Y N Is the monitoring of cooling recorded? Y N .Obtain signature of the o received sponsibilities 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 i Establishment: Date of Inspection: 1 3 Address: / 7fS 25/ ,. d C 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 74 -Operating as required 11 Toxic chemicals. No cross connections,back siphonage,backflow Proper type/installation/backflow prevention device/air gap fo -Stored properly,labeled properly,used properly r: -Food equipment -Hose connections -Dish machines -Sanitizer concentration not to exceed maximum permitted the premises -Soda system carbonator -Beverage dispensers -Toilettanks -No unnecessary radon of -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-Water quality in compliance tdeslgoiletfaclities. Adequate,convenient,accessible, -Monitoring in compliance ned,properly installed OTHER ITEMS KEY: DNC [DOES NOT COMPLY] 2 Sources of food:Original container,properly labeled 0 Garbage/rubbish storagearea/rooms,enclosures-properly constructed,clean 5 Potentially hazardous food properly thawed 1 Garbage/rubbish disposed of in an approved manner,at approved frequency 10 Food dispensing utensils properly stored 2 Vermin Control: No insects/rodents present 14 Food worker:Clean outer clothes,effective hair restraints 3 Outeropenings protected againstentrance of insects/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 Nonfood-contact surfaces designed,constructed,maintained, 47 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 repair,clean.Wall&ceiling surfaces as required 20 Dishwashing facilities approved design,adequately constructed, maintained installed located 5 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 premises free of 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 5 Clean/soiled linens stored properly 58 No live birds,turtles,or other animals(except guide dogs) 36 Toilet rooms enclosed with self-closing door 59 Seats 75 or more:Nonsmoking area provided,sign(s)posted at 37 Proper toilet fixtures provided,good repair,clean entrance(s),smoking area indicated by sign(s) 39 Approved garbage/rubbish containers,adequate number,covered, rodent proof,clean tine Inspection ❑Reinspection ❑ Preoperational Inspection INSPECTOR: PER N HAR • Other Inspection: Demerit Score: *Include demerits from page 1 4 3 2 1 Total Rating signet sign e print name prin me �+ y/�Z y ^6 -asp ��2`S�` DAT Z� L E CORRECTIONS DUE: VV eKk- i phone number title Page 2 of 2 plus continuation pages Focused Iuspectlau 1/2002 1t r Page�of FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH CONTINUATION SHEET NAME OF ESTABLISHMENT TOWN DATE OF INSPECTION -23 UJ INSPECTION REMARKS FORM# s akS�'1 tr1�i � b ` , , i h� ova-or, cave° .�a,LT� a •-.-- a3 � sue, vu O b SO vS _ G LLLLJJ�JJ✓✓// t INITIAL(INSPECTOR) J�/1'( INITIAL(PERSON IN CHARGE) Distribution: 1st-White-Health Department 2nd-Yellow-Owner/Manager