TexasDepartment of StateHealth Services
Retail Food EstablishmentInspectionReport
San
Code
Time In
Dat€
Purpose oflnspection:
l-Compliance
Establishment:
IN
Establishment Number
2-Routine
3-Field Investigation
Permit Number
4-Visit
Risk Category
5-Other
Owner:
PhysicalAddress:
OUT
5 Pts
Time Out
Page1 of2
NA
NO
zip:
cos FoodTemperature/TimeRequirements
Phone: (
ViolationsRequireImmediateCorreativeAction
)
Remarks
1. Proper Cooling for Cooked/PreparedFood
2 . C o l d H o l d ( 4 1d e g r e e F
) ahrenhe4
i t 5 d e j t r e eFs a h r e n h e i r t
3. Hot Hold (135 degreesFahrenheit)
4. ProperCookingTemperatures
(165degrees
5. RapidReheating
Fahrenheit
in 2 Hrs)
.[tem,{Location/Temperature
OUT
4 Pts
OUT
3 Pts
IN
IN
NA
NA
NO
NO
COS
COS
PersonneVHandling/Source
Requirements
ViolationsRequireImmediateCorrectiveAction
Remarks
6. Personnelwith Infections Restricted/Excluded
7. Proper/Adequate
Handwashing
8. Good Hygienic Practices(Eating/Drinking/Smoking/Other)
9. ApprovedSource/Labeling
10. SoundCondition
l l . P r o p e rH a n dl i n go f R e a d -r T o - F a tF o o d s
12. Cross-contaminationof Raw/CookedFoods/Other
13. Approved Systems(HACCP Plans/Timeas Public Health Control)
14. Water Supply Approved Sources/SufhcientCapacity/Hot and Cold Under Pressure
Facility and Equipment Requirements
Violations Require lmmediate Corection, Not To Exceed l0 Days
Remarks
1 5 . F q u i p m e nA
t d e q u a tteo M a i n t a i nP r o d u cTt e m p e r a l r r r e
I 6. HandwashFacilities Adequateand Accessible
l - . H a n d w a sF
h a c i l j t i eus i t h S o a pa n d f o w e l s
18. No Evidenceof Insect Contamination
19. No Evidenceof Rodents/OtherAnimals
20. Toxic Items Prooerlv Labeled/Stored,tlsed
21. Manual/MechanicalWarewashingand Sanitizing at ( )ppdtemperature
22. ManagerDemonstrationof Knowledge/Cetified Food Manager
23. ApprovedSewage/Wastewater
DisposalSystem,ProperDisposal
24. ThemometersProvided/Accurate/Properly
Calibrated(+2 degrees
Fahrenheit)
Subrotal
25. Food Contact SurfacesofEquipment and Utensils Cleaned/Sanitized/Good
Renair
2 6 . P o s t i n go f C o n s u m e rA d v i s o r i e(:H e i m l i c hD i s c l o s u rR
e e m i n d eB
r u f f e lP l a t e '
27. Food EstablishmentPermit
Other Violations - Require Corrective Action, Not to Exceed90 Days or the Next Inspection.Whichever ComesFirst
5Dt
4pt
3pt
Total
Fru
Yes/ No
lnspectedby:
Print:
Receivedby:
Print:
FormEH-06(12108)
Title: