HomeMy WebLinkAboutQuality Suites 200048 04 06 15.jh.pdfName Change
Verification of Closure
Status Change
Inspection
Re-inspection
VisitCommunityOn-Site System
Water Community
Transient Non-Community
Non-Transient Non-Community
Non-Public Water Supply
LOBBY, HALLS AND STAIRS (.1808)
1. Ventilation clean and in good repair .........................................................................
2. Lighting meets requirements .....................................................................................
3. Floors, walls and ceilings clean and in good repair ..................................................
4. Furniture and accessories clean and in good repair ..................................................
LAVATORIES, TOILETS, AND BATHS (.1809)
5. Sewage and other liquid waste disposed of by approved methods ........................
6. Properly operating sewage systems ........................................................................
7. Fixtures clean and in good repair, provided in each room if required ......................
8. Lavatory and vanity sanitized, testing method available and used .........................
9. Towels provided clean and in good repair, soap .....................................................
10. Floors, walls and ceilings cleanable, clean and in good repair .................................
WATER SUPPLY (.1809, .1810)
11. Meets requirements in 15A NCAC 18A .1700 or 15A NCAC 18C ..........................
12. Cross-connections prohibited ......................................................................................
13. Hot and cold running water provided; (116°-128° F) in guestrooms ..........................
DRINKING WATER FACILITIES (.1811)
14. Water cooler, fountain or dispenser approved .............................................................
15. Multi-use utensils washed, rinsed, sanitized, properly stored and handled; approved
facilities if required ...................................................................................................
16. Ice buckets with liners, ice bucket lids washed, rinsed and sanitized in an approved
manner .......................................................................................................................
17. Ice machines clean and in good repair; ice machines meet requirements .................
18. Ice stored and handled to prevent contamination, scoops provided .......................
19. Single service articles properly stored and handled .................................................
BEDROOMS (.1812)
20. Ventilation clean and in good repair .........................................................................
21. Outside openings screened unless air conditioned ..................................................
22. Lighting meets requirements .....................................................................................
23. Window coverings clean and in good repair .............................................................
24. Two clean sheets on each bed, folded under mattress and over cover 6 inches ......
25. Sheets, pillow cases, blankets and bed spreads clean and in good repair ...............
26. Floors, walls, and ceilings clean and in good repair .................................................
27. Furniture, fixtures and accessories clean and in good repair ...................................
28. No roaches, flies or other pests ...............................................................................
29. Coffee and tea makers kept clean .............................................................................
STORAGE (.1813)
30. Storage provided for supplies, linen and equipment; kept clean ............................
31. Linen properly handled and stored ..........................................................................
32. Supplies on carts properly stored, carts clean and stored properly .......................
TRASH; DISPOSAL OF GARBAGE AND PREMISES (.1814)
33. Garbage containers covered, kept clean, facilities for cleaning................................
34. Rubbish, litter and other items not permitted to accumulate on the premises .......
35. No undrained areas, no fly or mosquito breeding places or rodent harborages ......
36. Premises kept neat and clean ...................................................................................
N.C. Department of Environment and Natural Resources
Division of Environmental Health
Inspection of
Lodging Establishment
Health Department
Current Facility ID
Old Facility ID
Score:
Date of Insp/Chg:
Status Code:
Wastewater System:
Water sample taken today?
NC
Name of Establishment:Owner/Operator:
Mailing Addr:
State:City:Zip
Location Address:
City:
Inspection by: ________________________________________________EHS I.D. #
Rept Received by: _____________________________________________ Owner/Operator
Purpose: General Statute 130A-248 requires the Commission for Health Services to adopt rules governing the sanitation of establishments where lodging is provided for pay. 15A NCAC 18A .1805 specifies the
contents of an inspection form to record the results of inspections made of such establishments. This form is developed to be used in making inspections of hotels, motels, tourist homes and similar establishments. Preparation: Local environmental health specialists shall complete the form every time they conduct an inspection. Prepare an original and two copies for: 1. Original to be left with the responsible person. 2.
Copy for the local health department. 3. Copy for the Environmental Health Services Section, Division of Environmental Health. Disposition: This form may be destroyed in accordance with Standard-8.B.6., Inspection Records, of the Records Disposition Schedule published by the N.C. Division of Archives and History. Additional forms may be ordered from: Division of Environmental Health, 1632 Mail Service
Center, Raleigh, NC 27699-1632, (Courier 52-01-00)
EHS 3977 (Revised 7/05)
Environmental Health Services Section (Review 7/08)
Deduction
Full/half
Comment Sheet Attached
COMMENTS
TOTAL DEDUCTIONS _________
1
2
3
4
12
1
2
V
3 1.5
1 .51.51.51.5
2 131.531.5212121
6 3
3 1.5
4 2
4 2
4 231.531.531.5
1 .51.51.52131.5
4 242
4 24231.5
3 1.531.531.5
4 24231.521
** SEE COMMENT SHEET ATTACHED **
Yes No
St Zip:
Yes No
//
18
2018200048
98.5
0 4 0 6 2 0 1 5
A
SHIV SAI HOTELS OF QS INCQUALITY SUITES
1125 13TH AV DR SE
HICKORY 28602
1125 13TH AV DR SE
HICKORY
1.5
1654 - Huffman, Jason
100
Total Time:
N.C. Department of Environment and Natural Resources
Division of Environmental Health
COMMENT ADDENDUM
Time In:
Time Out:
City:
Street:
ID:
Name:am
pm
am
pm
:
:
QUALITY SUITES
2018200048
1125 13TH AV DR SE
HICKORY
0 9 2 1
0 9 2 2
1 minute
13 provide 116-128deg f hot water in guest rooms. temp noted at 136 deg f in soome rooms.
N.C. Department of Environment and Natural Resourses
Division of Environmental Health
COMMENT ADDENDUM City:
Street:
ID:
Name:QUALITY SUITES
2018200048
1125 13TH AV DR SE
HICKORY
N.C. Department of Environment and Natural Resourses
Division of Environmental Health
COMMENT ADDENDUM City:
Street:
ID:
Name:
General Comments:
QUALITY SUITES
2018200048
1125 13TH AV DR SE
HICKORY
sanitizing aolution provided on cart slightly strong. use teat strips to mix accordingly