Manager Name Certificate Number Certificate Type Issue Date Exp. Date Verified BRANDY MITCHELL ServSafe 08/24/ /24/2017 Yes

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1 P.O. Box 30017, Lansing, Michigan Phone: Fax: Establishment Information Name: DAIRY OAK PARTY STORE ID: Address: 1129 STATELINE RD Type: RETAIL FOOD ESTABLISHMENT City, State, Zip: NILES MI License Number: FRF Phone: (269) Owner Name: Fax: County: BERRIEN - EVALUATION INFORMATION: Critical Food Violations Cited: N Evaluation Date: 09/21/2012 Seizure(s): 0 Repeat Violations Cited: N Follow-up Date: Variance: No All Critical Food Violation(s) Corrected: Risk Category: Z License Limitations: No Critical Food Violation(s) Not Corrected: Evaluation Type: Follow-up Water: O Evaluation ID: Sewage: M CERTIFIED MANAGER INFORMATION: Manager Name Certificate Number Certificate Type Issue Date Exp. Date Verified BRANDY MITCHELL ServSafe 08/24/ /24/2017 Yes Based on this evaluation, the following items marked are violations of the Michigan Food Law of 2000, P.A. 92 of 2000, as amended; the Grade A Milk Law of 2001, P.A. 266 of 2001; or the Manufacturing Milk Law of 2001, P.A. 267 of Violations cited in this report shall be corrected within the time frames specified. Food establishments can not exceed ten calendar days for critical items or 90 days for noncritical items. Failure to comply with this notice may result in action against your food or dairy establishment license. Please contact us if you have questions. UN Correct By Date Page 1 of 6

2 UN Correct By Date Food Code Non Critical 06/25/ /23/2012 Observation: Various items stored in basement creates potential harborage for pests. Code Requirements: The presence of insects, rodents, and other pests shall be controlled to minimize their presence on the premises by: Eliminating harborage conditions. Method of Correction: Eliminate harborage conditions. Food Code Non Critical 06/25/ /23/2012 Observation: Walk-in cooler floor noted with food soil/debris. Code Requirements: Physical facilities shall be cleaned as often as necessary to keep them clean. Method of Correction: Maintain physical facilities clean. Food Code Critical 06/25/2012 Observation: Person in charge at time of inspection has failed to demonstrate person in charge knowledge. Page 2 of 6

3 Code Requirements: Based on the risks inherent to the food operation, during inspections and upon request the person in charge shall demonstrate to the regulatory authority knowledge of foodborne disease prevention, application of the Hazard Analysis and critical control point principles, and the requirements of this Code. The person in charge shall demonstrate this knowledge by: (A) Complying with this Code by having no violations of critical items during the current inspection; (B) Being a certified food protection manager who has shown proficiency of required information through passing a test that is part of an accredited program; or (C) Responding correctly to the inspector's questions as they relate to the specific food operation. The areas of knowledge include: (1) Describing the relationship between the prevention of foodborne disease and the personal hygiene of a food employee; (2) Explaining the responsibility of the person in charge for preventing the transmission of foodborne disease by a food employee who has a disease or medical condition that may cause foodborne disease; (3) Describing the symptoms associated with the diseases that are transmissible through food; (4) Explaining the significance of the relationship between maintaining the time and temperature of potentially hazardous food (time/temperature control for safety food) and the prevention of foodborne illness; (5) Explaining the hazards involved in the consumption of raw or undercooked meat, poultry, eggs, and fish; (6) Stating the required food temperatures and times for safe cooking of potentially hazardous food (time/temperature control for safety food) including meat, poultry, eggs, and fish; (7) Stating the required temperatures and times for the safe refrigerated storage, hot holding, cooling, and reheating of potentially hazardous food (time/temperature control for safety food); (8) Describing the relationship between the prevention of foodborne illness and the management and control of the following: (a) Cross contamination, (b) Hand contact with ready-to-eat foods, (c) Handwashing, and (d) Maintaining the food establishment in a clean condition and in good repair; (9) Describing foods identified as major food allergens and the symptoms that a major food allergen could cause in a sensitive individual who has an allergic reaction. (10) Explaining the relationship between food safety and providing equipment that is: (a) Sufficient in number and capacity, and (b) Properly designed, constructed, located, installed, operated, maintained, and cleaned; (11) Explaining correct procedures for cleaning and sanitizing utensils and food-contact surfaces of equipment;(12) Identifying the source of water used and measures taken to ensure that it remains protected from contamination such as Page 3 of 6

4 providing protection from backflow and precluding the creation of cross connections; (13) Identifying poisonous or toxic materials in the food establishment and the procedures necessary to ensure that they are safely stored, dispensed, used, and disposed of according to law; (14) Identifying critical control points in the operation from purchasing through sale or service that when not controlled may contribute to the transmission of foodborne illness and explaining steps taken to ensure that the points are controlled in accordance with the requirements of this Code; Method of Correction: Demonstrate person in charge knowledge as outlined in the law. Correction Detail: Person in charge has demonstrate knowledge and is a certified manager. Food Code Critical 06/25/2012 Observation: Open chubs of lunchmeat, sliced lunchmeat, and sliced cheese found lacking appropriate date marking. Code Requirements: Refrigerated, ready-to-eat, potentially hazardous food (time/temperature control for safety food) prepared and held in a food establishment for more than 24 hours shall be clearly marked to indicate the date or day by which the food shall be consumed on the premises, sold, or discarded, based on the temperature and time combinations specified below. The day of preparation shall be counted as Day 1. (1) 5 C (41 F) or less for a maximum of 7 days Method of Correction: Maitain datemarking for refrigerated, ready-to-eat potentially hazardous food. Correction Detail: Lunchmeat not sold since license limitation. Certified manager demonstrated knowledge of datemarking requirements. Food Code Critical 06/25/2012 Observation: Slicer found stored with dried food soil residues. Code Requirements: Equipment food-contact surfaces and utensils shall be clean to sight and touch. Method of Correction: Maintain equipment food-contact surfaces clean to sight and touch. Correction Detail: Slicer noted clean at time of inspection. Food Code Critical 06/25/2012 Observation: According to manager, slicer is not sanitized before use after cleaning. Firm lacks a supply of sanitizer at time of evaluation. Code Requirements: A test kit or other device that accurately measures the concentration in mg/l of sanitizing solutions shall be provided. Method of Correction: Utensils and food-contact surfaces of equipment shall be sanitized before use after cleaning. Correction Detail: Slicer cleaning procedures posted. Warewashing supplies have been aquired. Food Code Critical 06/25/2012 Observation: Several live flies found in store at time of inspection. Page 4 of 6

5 Code Requirements: The presence of insects, rodents, and other pests shall be controlled to minimize their presence on the premises by: (A) Routinely inspecting incoming shipments of food and supplies;n (B) Routinely inspecting the premises for evidence of pests;n (C) Using methods, if pests are found, such as trapping devices or other means of pest control as specified under , , and Method of Correction: Maintain effective pest control. Correction Detail: No flies noted at inspection. Firm appears to have adequate pest control. Food Code Non Critical 06/25/2012 Observation: Firm lacks a three- compartment sink for manual warewashing. Code Requirements: A sink with at least 3 compartments shall be provided for manually washing, rinsing, and sanitizing equipment and utensils. Method of Correction: Install a sink with at least 3 compartments for manual warewashing. Sink must be installed according to law. Correction Detail: Three compartment sink has been installed for wareashing. Food Code Non Critical 06/25/2012 Observation: Firm lacks test papers for sanitizer. Code Requirements: A test kit or other device that accurately measures the concentration in mg/l of sanitizing solutions shall be provided. Method of Correction: Attain sanitizer test kit. Correction Detail: Firm now has test papers. Food Code Non Critical 06/25/2012 Observation: A gap noted under delivery door creates potential for pest entry as it is not tight-fitting. Code Requirements: Except as specified in (B), (C), and (E) and under (D) of this section, outer openings of a food establishment shall be protected against the entry of insects and rodents by: (1) Filling or closing holes and other gaps along floors, walls, and ceilings; (2) Closed, tight-fitting windows; and (3) Solid, self-closing, tight-fitting doors. Method of Correction: Make door tight-fitting. Correction Detail: Delivery door has been repaired. Food Code Non Critical 06/25/2012 Observation: Handwashing sink near ice cream vending found lacking a supply of paper towel. Page 5 of 6

6 Code Requirements: Each handwashing sink or group of adjacent handwashing sinks shall be provided with: (A) Individual, disposable towels; (B) A continuous towel system that supplies the user with a clean towel; or (C) A heated-air hand drying device. Method of Correction: Provide hand-drying device. Correction Detail: Handwashing sink found properly supplied. Food Code Non Critical 06/25/2012 Observation: Flooring in ice cream vending area noted with damage. Code Requirements: Physical facilities shall be maintained in good repair. Method of Correction: Maintain physical facilities in good repair. Correction Detail: Flooring has been replaced. Food Law Non Critical 06/25/2012 Observation: Firm lacks a certfied food manager. Code Requirements: Beginning June 30, 2009, the following food establishments shall employ a minimum of 1 managerial employee who is currently certified under a personnel certification program accredited by the American national standards institute, utilizing the conference for food protection standards: (a) A food service establishment that is not any of the following: (i) A mobile food establishment. (ii) Operating under a temporary food service establishment license. (iii) A special transitory food unit. (iv) A vending machine location. (b) An extended retail food establishment. (c) The operation of a food service establishment within a retail grocery. Method of Correction: Employ a certified food manager according to law. Correction Detail: Firm now has a certified food manager. COMMENTS: his firm is hereby rescinded due to improvements to the facility and certified food manager training received by the manager. Firm may resume the production of popcorn, beverage machines, ice cream, and lunchmeat and cheese slicing. Addition of other food items may require prior approval. Please contact inspector prior to adding additional food activities. Page 6 of 6