Plant food properly cooked for hot holding. Approved ... Hot and cold water available; adequate pressure ... Required re
Retail Food Establishment Inspection Report
Score
Rating
Inspection Start Time :
End Time :
Bureau of Environmental Health Services Division of Food Protection & Rabies Prevention
SAMPLE Establishment Name
Type of Inspection
Address
Permit # -
City
1 IN 2 IN 3 IN 4 IN 5 IN 6 IN 7 IN 8 IN 9 IN 10 IN 11 IN 12 IN NA 13 IN NA 14 IN 15 IN 16 17 18 19 20 21 22
IN IN IN IN IN IN IN
NA NA NA NA NA NA NA
23 IN NA 24 IN NA 25 IN NA 26 IN 27 IN NA
County
Zip
-
Foodborne Illness Risk Factors & Interventions Supervision PIC Present, Demonstration, Certification, Performance Employee Health Management; employee knowledge; responsibilities & reporting Proper use of reporting, restriction, and exclusion Employee Good Hygienic Practices Proper eating, tasting, drinking or tobacco use No discharge from eyes, nose, or mouth Preventing Contamination by Hands Hands clean & properly washed NO No bare hand contact with RTE foods Handwashing sinks supplied & accessible Approved Source Food obtained from approved source NO Food received at proper temperature Food in good condition, safe, and unadulterated Required records available: shell stock tags, parasite NO destruction Protection from Contamination Food separated & protected Food-contact surfaces: cleaned & sanitized Proper disposition of returned, previously served, reconditioned, and unsafe food Time/Temperature Control for Safety (TCS Food) NO Proper cooking time and temperature NO Proper reheating procedures for hot holding NO Proper cooling time and temperatures NO Proper hot holding temperature NO Proper cold holding temperature NO Proper date marking and disposition NO Time as a Public Health Control: procedures & records Consumer Advisory Consumer advisory provided for raw or undercooked foods Highly Susceptible Populations Pasteurized foods used; prohibited foods not offered Chemical Food additives: approved and properly used Toxic substances properly identified stored and used Conformance with Approved Procedures Compliance with variance, specialized process, reduced oxygen packaging criteria or HACCP plan
Remarks:
OUT CDI
2
28 IN NA 29 IN 30 IN NA
2 2
31 IN
2 2
1
4 3 2
2 2 1
2 2 2
1 1 1
2 3 3
2 2
2
1
3 3 3 3 3 3 2
2 2 2 2 2 2 1
1 2
1
2 2
1 1
2
32 IN NA 33 IN NA 34 IN 35 IN 36 IN 37 IN 38 IN 39 IN 40 IN 41 IN 42 IN 43 IN 44 IN 45 IN 46 IN 47 IN 48 49 50 51 52 53
IN IN IN IN IN IN
54 IN 55 IN 56 IN
Date / / Category 1
2
3
4
Follow up o Within ______ days
Good Retail Practices Safe Food & Water Pasteurized eggs used where required Water and ice from approved source Variance obtained for specialized processing methods Food Temperature Control Proper cooling methods used; adequate equipment for temperature control NO Plant food properly cooked for hot holding NO Approved thawing methods used Thermometers provided and accurate Food Identification Food properly labeled: original container Prevention of Food Contamination Insects & rodents not present; no unauthorized animals Contamination prevented during food preparation, storage & display Personal cleanliness Wiping cloths: properly used and stored Washing fruits and vegetables Proper Use of Utensils In-use utensils: properly stored Utensils, equipment and linens: properly stored, dried and handled Single-use and single-service articles: properly stored and used Gloves used properly Utensils & Equipment Equipment, food & non-food contact surfaces approved, cleanable, properly designed, constructed & used Warewashing facilities: installed, maintained & used; test strips Non-food contact surfaces clean Physical Facilities Hot and cold water available; adequate pressure Plumbing installed; proper backflow devices Sewage and waste water properly disposed Toilet facilities: properly constructed, supplied & cleaned Garbage & refuse properly disposed; facilities maintained Physical facilities installed, maintained and clean Meets ventilation and lighting requirements; designated areas used Chapter 8 & 9 Violations Chapter 8: Compliance & Enforcement C hapter 9: Standards for Additional Operations
OUT CDI
1 2 1
0 1
1
0
1 1 1
0 0 0
1
0
2
0
2
1
2 1 1
1 0 0
1
0
1
0
1
0
1
0
2
1
1
0
1
0
2 2 2 1 1 1
1 1 1 0 0 0
1
0
1
DHEC Inspector Name _______________________________ DHEC Inspector Signature ____________________________ Phone # ___________________________ PIC Name ________________________________________ PIC Signature _______________________________ DHEC 1722AW (06/2016)
SOUTH CAROLINA DEPARTMENT OF HEALTH AND ENVIRONMENTAL CONTROL
Consecutive violations may be subject to enforcement action and penalty Information collected on this form is subject to public scrutiny or release as well as the Freedom of Information Act
Page 1 of ___
Retail Food Establishment Inspection Report I. Purpose Items with a point value circled indicate violations observed during this inspection. Based on this inspection report, items marked out of compliance must be corrected by the next routine inspection or such a period of time as may be specified in writing by the Department. Failure to comply with this notice may result in suspension of your permit, or downgrading of the establishment. If required, an inspector from the Department will return within 10 days of this inspection to conduct a followup inspection. II. Explanation and Definition In Out NA NO CDI
= = = = =
In compliance Out of compliance Not Applicable Not Observed Corrected During Inspection
Foodborne Illness Risk Factors and Interventions - Contributing factors that increase the chance of developing foodborne illness. Good Retail Practices - Preventative measures to control the addition of pathogens, chemicals, and physical objects into food. III. Score & Rating Score 88-100 78-87
