HomeMy WebLinkAboutFood Service Establishment Inspection 46 (14) Si iYIE' Gt7N ECTi�L1 : IFQ USED FOOD SERVICE N$PFCT1QPf Ii PORT" a ,Ia PAItTM tVT (y; ( L Al
Establishment: i o 4*,g, 1z_z,4 inspection Date: Time: FtOinsp REinsp
ddresslCity: ��" 6 1 ;:�> Health Dept: .,, ,,� 1-6 b
���'Adwe/A_ Class: 1 z
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 possible debitable items ANIO NIA DNC KEY: C[complies] N10[not observed] NIA[not applicable]
60 Qualified Food Operator 3 DNC[does not comply] 0[other] RTE(ready-to-eat]
Designated Alternate311
A
11 ° ,ers.onnel:with inf
ection restricted C N/0 "NIA;; 4'
Food workers have no exposed infected lesions I burns.
Rf
ritten documentation oftrainiing program 2 B Personnel with infection restricted
L111 pproved source,wholesome monadulterated C NIO N/A ' rC Communicable disease of worker reported to local health director
A Approved shellfish,finfish,meat&poultryUSDA approved 13 'Handwashrng HIM as provided,handswashed,clean C ;N/0 NIA '4
B Food cans in good condition(not dented,rusty,bloated,leaking) A Handwash facilities in all food pre di ensing&werewash areas
C Wholesomelnonedulteratedfoodsisafe B Handwash fe lt s in or imm i ly adj nt to toilet rooms
D Commercial products(no home grown/canned food) C Handwash oil'' t to use
E Potentially hazardous foods received at proper temperature D Personnel an d,cle ro rocedure
o E Handwashing at appro '
3 ,Potentially hazarddug., od meets temperature.requlreme ts; C �l10 NIA 4`
dkj g s orage,preparation,drspfa�f,�ervti a and;transporta#toil.: ; i O
15 ;Good shYglenic practicesC, NIQ ,fJIA' 2.
A Hot holding greater than or equal to 1400F. (whole beeflpark roasts 13CPF.) A ❑ No eating ❑No smoking while working At I
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 PL
E Proper internal cooking lconsumer advisory posted 24 ':Sanitizatron rir se(hot water-'chemical)=."_ ; tc NlO N1A'2
0 A Approved sanitizeravailableladequate concentration ofsanitizer
�4 g yAdepya(e,;factlftie5:tor marntam`prodc k z G �!!0` (/A;;'2a B Food contact surfaces and utensils used for potentialty
ii temperatur'e'thgmete�rs<provided r' "' hazardous f d sanitized at least eve 4 hours
......m :+ +z t r.'e I,+.. ..,(.: e I a every
A Food thermometer available and accurate C Adequate ^lshwashersanitizer ❑f!nal rinse temp
B Proper food thermometerfor product D Pro ersanitizin rocedure
C Thermometers appropriately placed in cooler units E Sanitizing between raw animal origin&ready-to-eat food
0
S.,Clearrwipingclgths kC.' tiNJA r1
7dd}rote #1 f.d�rir�gs#o�age;prepaffiaon, NJO !NI 2
t d4WaayjsQm►ace nd ashs ri #o .° i'' A Cloths and/or sponges in good repair and clean
B Wiping cloths kept in sanitizer between uses X.
A Produce washed o
B Rawmeals not storedlprepared near ready-to-eat foods 126 PR d cbhtac# °c, $n�
C - Food covered properly A Food equipment clean,utensils clean,equ1pmant1ntedors 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 V1 0
8 Food containers stored off the Ii30� Hot and cold wader under>>pressure,provrdid as require I 0 �38 "Handwas ing cce &cites provided iC S..01 N1A<.,�
9� Hand goof food minimized' �. :` , C CNIrn;NIA
" A Soap I paper towels drying device available
A No unnecessary handling RTE andlorcookedfoods with bare hands 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
C Adequate utensil(s)for dispensing foodilea 0 at
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 alternate],PHF Dotert'ally hazardous food],FB[foodborne]
PHFs are hot held at: OF. 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 you cook:
Poultry Ground Beef Pork What diseases related to FB illness a you required to report to the Iotal health department?
Roasts Other
Describe re-heating procedures: 00 Is there a written illness policy th requires the food worker to report specific illness conditions
Are temperatures recorded/logged for cold holding foods/equipment? Y and diseases to the QFO? Y *Do you have a paid sick leave policy? Y N
00000000
Are foods cooked in advance and cooled? Y N *Are leftovers sav d? Y N Is there a language barrier b eon inspector&OF07 Y N If yes indicate language spoken
List products cooled: by QFOIDA: *Can the QFO/DA read the inspection report? Y N
Describe cooling methods: Indicate who answers the above questions:Name(print):
N Indicate the title of above person(title all that apply):QFO DA Mgr Cook Owner FW
Is cooling monitored for time&temp? Y N Is the monitoring of ooling recorded? Y
-obtain signature of the ho rec FO responsibilities information at the time of the
r1sther.e a produce washing policy? Y N ♦Describe what washed and inspectio .re Note: This report is a two page form(total of 62 debitable items) Page t of 2
ySTRITE OF GGNNI:OI"ICUT AEPAR7 MENT aP PUELIC HEALT�I 410ARITOL AilENU M551 FDP .H,4RTRt3lp,CT:0�134'
g v� (�C�fS CIi FO()11 SERVICE INS PECTIC kUY1C
LpAE,1�E"A - DEP� � ADDRESI�i :
Etablishrnent " " 1'/a�u'`S'' fi- �L iz Date of Inspection:
ddress.. Owner or Operator. � J f! /
_ _ .
ADDITIONAL FOUR POINT ITEMS Q3 KEY: DNC [DOES NOT COMPLY] 1.5
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
11 Toxic chemicals. No cross connections,back siphonage,backflow 4.
4 Proper typetinstallation/backflow prevention devicel air gap for:
-Stored properly,labeled properly,used properly -Food equipment -Hose connections -Dish machines
-Sanitizer concentration notto 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. 4 -Food equipment -Dish machines -Ice machines
-Well(well head protected from contamination 35 Toilet facilities. Adequate,convenient,accessible, 4
-Water quality in compliance
-Monitoring in compliance designed,properly installed
OTHER ITEMS z KEY: DNC [DOES NOT COMPLY]
Sources of food: Original container,properly labeled 40 Garbagelrubbishstoragearea/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 1;': 42 Vermin Control: No inseclslrodents present .2
14 Food worker:Clean outer clothes,effective hair restraints 1,' 3 Outeropenings protected againstentranceof insects/rodents 1
r :.
F rs: Floor covering installed,constructed as required,good repair,cle ::1'
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, 1: 7 Mats removable,good repair,clean
installed,located 1
18 Single service articles,storage,dispensing 2 µ;
8 Exterior walking,driving surfaces,good repair,clean
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, 2 1
maintained installed located 50 Dustless cleaning methods used,cleaning equipment properly stored
Equipment&Utensils: Cleanliness `' 51 Adequate lighting provided as required :1'
21 Preflushed,scraped,soaked and racked 52 Room free of steam,smoke odors r 1,
2 Washwaterclean,proper temperature
53 Rooms&equipment hoods,ducts,vented as required
23 ate thermometers provided,dish basket,if used 54 Rooms adequate,clean,adequate lockers provided,facilities clean
2 food-contact surfaces of utensils&equipment clean
55 Establishment and premisesfreeof litter,no insect/rodent harborage, "1
Equipmentlutensils,storage,handling no unnecessary articles
32 Proper disposal of wastewater 1 56 Complete separation from living/sleeping quarters and laundry 1
33 Plumbing location,installation,maintenance n 57 Clean/sailed linens stored properly r 1...
58 No live birds,turtles,orother animals(except guide dogs) 1''
36 Toilet rooms enclosed with self-closing door
�+4 59 Seals 75 or more:Nonsmoking area provided,sign(s)posted at 3
37 Proper toilet fixtures provided,good repair,clean entrance(s),smoking area indicated bysign(s)
39 Approved garbagelrubbish containers,adequate number,covered, 1
rodent proof,clean Poutine Inspection ❑Reinspection ❑ Preoperational Inspection
Other Inspection:
INSPECTOR: PERSON tN CJiABGE:
Demerit Score: *Include demerits from page 1
6 - 4 3 2 1 Total I Rating
ell signature signature _� r ,
� kah nrrell(
print nam print name (�
phone number title DATE CORRECTIONS DU :
Page 2 of 2 plus continuation pages Focused tospectf a,
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