HomeMy WebLinkAboutBlackburn Elementary School 110004 01 30 13.ls.pdfFood Establishment Inspection Report
ELEMENTARY SCHOOL
Establishment ID: 2018110004
Score: 98.5
Date: 0 1/ 3 0/ a 0 1 3 Status Code: A
Time In: 3 @ pm Time Out: r 5 q pm
Total Time: 2 minultes
Category #: IV
Establishment Type:
Instructions:
1. Fill in the information below for the
Food Establishment:
Location Address: 4377 W NC 10 HWY
City: NEWTON
State: NC Zip: 28658
County: 1 Catawba
Permittee: CATAW A COUNTY SCHOOL
Telephone:
Inspection
ORe-Inspection
Wastewater System:
QMu n icipal/Community
On -Site System
Water Supply:
QMu n icipallCom mu nity
QOn-Site System
2. Clicklfill the appropriate circle
For "IN, OUT, NIA, NIO".
IN= In Compliance, OUT= Not in compliance
N1O=Not Observed, NIA= Not Applicable
3. Clicklcheck the appropriate
Boxes for CDI andlor R, VR.
CD1= Corrected During Inspection
R= Repeat Violation
VR= Verification Required
4. Continue to page 2 for
"Good Retail Practices".
North Carolina Department of Health & Human Services • Division of Public Health
Environmental Health Section • Food Protection Program
Page f of Food Establishment Inspection Report, 7f2gf 2
Foodborne Illness Risk Factors and Public Health Interventions
Risk factors: Contributing factors that increase the chance of developing foodborne illness.
Public Health Interventions: Control measures to prevent foodborne illness or injury.
Compliance Status I our oI I R I uR
0 0 IPIC Present; Demonstration -Certification by accredited 0 Q
IN OUT NIA program and perform duties 2 0 0 0 0
2
@
0
Management, employees knowledge, responsibilities
000
0
0
0
N
OUT
& reporting
3 1.5 0
3
@
0T
Proper use of reporting, restriction & exclusion
0 �
0
0
0
1�
food
Hygip, c
4
@
0T
Proper eating tasting drinking, or tobacco use
0 0 0
0
0
0
0T
No discharge from eyes, nose, and mouth
0 0 0IN
o
0
0
5
*
0
Hands clean & properly washed
00 0
IN
OUT
4 2 0
0 0
No bare hand contact with RTE foods orpre-approved
00 0
N OUT N10
alternate procedure properly allowed
3 1.5 0
0 0
0
8
0
IN
(1
OUT
Handwashing sinks supplied & accessible
0@ 0
2 1 0
0 0
0
9
0
0T
Food obtained from approved source
0 0 0
0
0
0
2 1 0
0
0 0 �
Food received at proper temperature
0
0
0
0
N OUT
N10
2 1 0
11
@
0T
Food in good condition, safe & unadulterated
0 0 0
0
0
0
12
0 0
0 0
Required records available: shellstock tags, parasite
0 0 0
0
0
0
N OUT
NIA N10
destruction
2 1 0
13 0 0 0 Food separated & protected 00 0
IN OUT NIA N10 3 1.5 0 0 0 0
14 0 Food -contact surfaces: cleaned &sanitized 00 0
IN OUT 3 1.5 0 0 0 0
�� 0 Proper disposition of returned, previously served, 00 0 0 0 0
N OUT reconditioned, &unsafe food 2 1 0
15
('� 0 0 0
Proper cooking time & temperatures 03
0 0
0
IN OUTN/A N10
1.5 00
17
0 0 0
Proper reheating procedures for hot holding 0
0 0
0
IN OUTN/A N10
3 1.5 00
18
0 0 0(5�
Proper cooling time &temperatures 0 0 0
0 0
0
IN OUTN/A N10
3 1.5 0
19
0 0 0
IN OUTN/A N10
Proper hot holding temperatures 00
0 0
0
3 1.5 00
20
� 0 0 0
Proper cold holding temperatures
0 010
IN OUTN/A N10
1 3 1.5 0
21
0T 0 0
Proper date marking & disposition 0
0 0IN
02
0
1.50
22
@ 0 0 0
Time as a public health control: procedures & records 00 0
0 0
0
IN OUTN/A N10
2 1 0
0 0 Consumer advisory provided for raw or undercooked 0 0 0
23 IN OUT NIA foods 105 0 0 0 0
24 � 00 0 Pasteurized foods used; prohibited foods not offered 0 1O O 0 0 0
25 a 00 0 Food additives: approved & properly used 0 0 0 0 0 0
25 IN 00 0 Toxic substances properly identified stored, & used 0 0 0 0 0 0
27 0 0 Q Compliance with variance, specialized process, 000
IN OUT NIA reduced oxygen packing criteria or HACCP plan 2 1 0 0 0 0
Food Establishment Inspection Report, continued
Establishment Name: BLACKBURN ELEMENTARY SCHOOL
Establishment ID: 2018110004
Instructions, continued:
5. Click the appropriate circle to fill-in
for "IN, OUT, NIA, NI❑".
IN= In Compliance, OUT= Not in compliance
N10=Not Observed, NIA= Not Applicable
6. Click or check the appropriate
boxes for CDI andlor R, VR
CD1= Corrected during Inspection
R= Repeat Violation
VR= Verification Required
Calculate the "Total Deductions"
and record.
7. Sign and complete "Signature Block".
8. Fill in "No. Of Risk Factor
Intervention Violations" and "No. of
Repeat Risk Factor Intervention
Violations".
9. Continue to page 3 for "Comment
Addendum to Food Establishment
Inspection Report".
Signfiture Block:
/AL01 Ct $
Person in Charge [Print
Bibirson in Charge [ ig ture]
Regulator Authority [Print]
gu + igna ure)
Contact Number: () -
Verification Required Date: 1 1
IREHS ID_: 18 - Sears, Luke
No. of Risk Factor/ No. of Repeat Risk
I ntervention Factor/1 ntervention
Violations: - Violations:
Good Retail Practices
Preventative measures to control the addition of pathogens,
chemicals, and physical objects into foods.
Compliance Status
IOUT
DI
R
VR
oafs
FQ,,.od and
W,,ater .25.53,,.25i55, 205.8
28
� 00
Pasteurized eggs used where required
0 0 0
Q
Q
Q
29
00
Water and ice from approved source
0 0 0
Q
Q
Q
30
0 IN 00 NIA
Variance obtained for specialized processing methods
0 0 0
0
0
0
Food
Temperature
Control ..
3�
0
Proper cooling methods used; adequate equipmentfor
00 0
OUT
temperature control
1 0.5 0
32
0
Plant food properly cooked for hot holding
0 0 0
0
0
0
IN OU0 N100
33
0 0 0 JD
Approved thawing methods used
00 0
0
0
0
IN OUT NIA N 0
1 0.5 0
34
it
OUT
IThermometers provided & accurate
1 1 0.5 0
01010
Fin
d Identification,
_ _2653 ..
35
0
Food properly labeled: original container
0 0 0
0
670
11 OUT
2 1 0
Pretve
tion of Food
Contamination: .2�52, .2453, 2054, :2 ,55,
.2i 57
35
Insects & rodents not present; no unauthorized animals
0 0 0
0
00
00
37
0
Contamination prevented during food preparation,
0 0 0
0
0
0
OUT
storage &display
2 1 0
38
OU0
Personal cleanliness
0 0 0
0
0
0
39
ODUT
Wiping cloths: properly used & stored
0 0 0
0
0
0
40
_0OUTWashing
fruits & vegetables
0 0 0
0
0
0
Proper
Use of Utensils....
. 2,,53,,.25i54.... ...........
41
OUT
In -use utensils properly stored
0 0 0
0
0
0
42
Utensils, equipment & linens: properly stored, dried
00 0
0
0
0
OUT
& handled
1 0.5 0
43
0
Single -use & single -service articles: properly
00 0
0
OUT
stored & used
1 0.5 0
44
it OU0
Gloves used properly
00 0
0
0
0
Utensils
and Equipment
,,,i�25.53,,.25i54,,;2563 ,
45
0
Equipment, food & non-food contact surfaces approved
00 0
0
0
0
IN OUT
cleanable, properly designed, constructed, & used
2 1 0
45
0
Warewashing facilities: installed, maintained, & used;
00 0
0
0
0
10 OUT
test strips
1 0.5 0
47
1 OUT
Non - food contact surfaces clean
000
1 0.5 0
Phsi
pal Facilitts
. 2554, :555 ,2559
48
IN OO
Hot & cold water available; adequate pressure
0 0 0
0
0
0
49
IN OUT
Plumbing installed, proper backflow devices
0 0 0
0
00
50
I NN OUTSewage
& waste water properly disposed
2 1 0
0
0
0
5�
0
Toilet facilities: properly constructed, supplied
00 0
0
0
0
N OUT
& cleaned
1 0.5 0
52
.' 0
Garbage & refuse properly disposed;
00 0
0
0
0
N OUT
facilities maintained
1 0.5 0
53
IDN OUT
Physical facilities installed, maintained & clean
00'
0
0
0
54
0
1
Meets ventilation & lighting requirements;
00 0
0
0
0
OUT
designated areas used
1 0.5 0
Total Deductions:
15
North Carolina Department of Health & Human Services • Division of Public Health
Environmental Health Section • Food Protection Program
Food Establishment Inspection Report, 7f2012 Page 2 of
Comment Addendum to Food Establishment Inspection Report
Establishment Name: BLACKBURN ELEMENTARY SCHOOL
Establishment ID: 2018110004
Date: 01130/2013
Location Address: 4377 W INC 10 HWY
City: NEWTON State: INC
County: 18 Catawba Zip: 28658
Wastewater System: 0 Municipal/Comm unity @ On -Site System
Water Supply: @ Municipal/Community 0 On -Site System
Permittee: CATAWBA COUNTY SCHOOLS
Telephone:
Temperature Observations
Item Location Temp Item Location Temp Item Location Temp
BB Q HOT LINE 143
HOT IDOGS HOT LINE 138
MILK WALK IN 42
Observations and Corrective Actions
Violations cited in this report must be corrected within the time frames below, or as stated in sections 8-405.11 of the food code.
6-301.12 Hand Drying Provision
IN 10101=01121 wo m
North Carolina Department of Health& Human Services 0 Division of Public Health 0 Environmental Health Section * Food Protection Program
Page 3 of Food Establishment inspection Report, 7f2012 N.C.Department of Health and Human Services is an equal opportunity employer and provider.