Food Establishment Inspection Report |
||||||||||||||||||||||||||
Page 1 of ????????? | ||||||||||||||||||||||||||
|
|
FOODBORNE ILLNESS RISK FACTORS AND PUBLIC HEALTH INTERVENTIONS |
Circle designated compliance status (IN, OUT, N/O, N/A) for each numbered item IN=in compliance OUT=not in compliance N/O=not observed N/A=not applicable Mark "X" in appropriate box for COS and/or R COS=corrected on-site during inspection R=repeat violation |
Risk factors are important practices or procedures identified as the most prevalent contributing factors of foodborne illness or injury. Public health interventions are control measures to prevent foodborne illness or injury. |
|
|
GOOD RETAIL PRACTICES |
Good Retail Practices are preventative measures to control the addition of pathogens, chemicals, and physical objects into foods. Mark "X" in box if numbered item is not in compliance Mark "X" in appropriate box for COS and/or R COS=corrected on site during inspectionR=repeat violation |
|
|
IOCI 17-356
![]() |
Food Establishment Inspection Report |
|
Page 2 of ?????? | |
Establishments: GRACE UNITED METHODIST CHURCH | Establishment #: 717 |
Water Supply: Public Private Waste Water System: Public Private | ||
Temperature Documentation: NO | License Posted: NO | Complaint Number: |
Sanitation Information | ||
Name: ROY JOHNSON | ||
Name: KYLE NELSON |
SANITIZER OBSERVATIONS |
|||||
Location | Location Desc. | Method Used | Chemical Sanitizer Used | PPM | Water Temp |
3-Compartment Sink | in kitchen | Chemical Sanitizer | Chlorine | 50.00 | 0.00 |
Dish Machine | Hot Water | 0.00 | 180.00 |
TEMPERATURE OBSERVATIONS |
Item/Location |
Temp |
Item/Location |
Temp |
Item/Location |
Temp |
butter/True refrigerator | 33.00°F | creamer/True refrigerator | 41.00°F | juice/True refrigerator | 38.00°F |
air temp/True freezer | 3.00°F |
OBSERVATIONS AND CORRECTIVE ACTIONS |
Item Number |
Violations cited in this report must be corrected within the time frames below. |
Inspection Comments |
No violations noted at time of inspection! See attached inspection report for the original signature from Roy. |
HACCP Topic: sanitizer discussion |
Person In Charge (Signature)Roy Johnson |
Date:06/11/2024 |
InspectorKate Brown |
Follow-up: Yes No Follow-up Date: |