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Kansas Department of Agriculture Division of Food Safety and Lodging 109 S.W. 9th St. Topeka, KS 66612 (Office) 785-296-5600 (Fax) 785-296-6522 KANSAS FOOD ESTABLISHMENT INSPECTION REPORT Insp Date: 1/7/2014 Business ID: 99368FE Inspection: 58002645 Business: EL DOS DE OROS MEXICAN RESTAURANT Store ID: Phone: 7854836220 1002 E 41ST ST Inspector: KDA58 HAYS, KS 67601 Reason: 01 Routine Time In / Time Out Date In Out Insp Travel Total Mileage Notes; 01/07/14 10:05 AM 11:50 AM 1:45 0:12 1:57 0 Total: 1:45 0:12 1:57 0 FOOD ESTABLISHMENT PROFILE No Lic. Insp. Print Insp. Notification 3 Priority(P) Violations 1 Priority foundation(Pf) Violations þ Address Verified ¨ Certified Manager on Staff 2,400 Actual Sq. Ft. ¨ Certified Manager Present INSPECTION INFORMATION Risk factors are improper practices or procedures identified as the most prevalent contributing factors of food-borne illness or injury. Public health interventions are control measures to prevent food-borne illness or injury. Good Retail Practices are preventative measures to control the addition of pathogens, chemicals and physical objects into foods. Violations cited in this report must be corrected within the time frames entered below, or as stated in sections 8-405.11 of the food code. P=Priority Violation, Pf=Priority foundation violation, HACCP=Hazard Analysis-Critical Control Point, BHC=Bare Hand Contact, RTE=Ready to Eat, HSP=Highly Susceptible Population, K.S.A.=Kansas Statutes Annotated, All temperatures are measured in degrees Fahrenheit (°F). IF YOU HAVE ANY QUESTIONS PLEASE VISIT www.agriculture.ks.gov, EMAIL [email protected], OR CALL (785) 296-5600. COMPLIANCE KEY: Y=in compliance; N=not in compliance; O=not observed; A=not applicable; C=corrected on-site during inspection; R=repeat violation. FOODBORNE ILLNESS RISK FACTORS AND PUBLIC HEALTH INTERVENTIONS Demonstration of Knowledge R C A O N Y 1. Certification by accredited program, compliance with Code, or correct responses. ¨ ¨ ¨ þ ¨ ¨ Employee Health R C A O N Y 2. Management awareness; policy present. ¨ ¨ ¨ ¨ ¨ þ 3. Proper use of reporting, restriction and exclusion. ¨ ¨ ¨ ¨ ¨ þ Page 1 of 6

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Kansas Department of AgricultureDivision of Food Safety and Lodging

109 S.W. 9th St. Topeka, KS 66612(Office) 785-296-5600 (Fax) 785-296-6522

KANSAS FOOD ESTABLISHMENT INSPECTION REPORT

Insp Date: 1/7/2014 Business ID: 99368FE Inspection: 58002645Business: EL DOS DE OROS MEXICAN RESTAURANT Store ID:

Phone: 78548362201002 E 41ST ST Inspector: KDA58 HAYS, KS 67601 Reason: 01 Routine

Time In / Time OutDate In Out Insp Travel Total Mileage Notes;

01/07/14 10:05 AM 11:50 AM 1:45 0:12 1:57 0Total: 1:45 0:12 1:57 0

FOOD ESTABLISHMENT PROFILE

No Lic. Insp. Print Insp. Notification

3Priority(P) Violations 1Priority foundation(Pf) Violations

þAddress Verified¨Certified Manager on Staff 2,400Actual Sq. Ft.

¨Certified Manager Present

INSPECTION INFORMATION

Risk factors are improper practices or procedures identified as the most prevalent contributing factors of food-borne illness or injury. Public health interventions are control measures to prevent food-borne illness or injury.Good Retail Practices are preventative measures to control the addition of pathogens, chemicals and physical objects into foods.Violations cited in this report must be corrected within the time frames entered below, or as stated in sections 8-405.11 of the food code.

P=Priority Violation, Pf=Priority foundation violation, HACCP=Hazard Analysis-Critical Control Point, BHC=Bare Hand Contact, RTE=Ready to Eat, HSP=Highly Susceptible Population, K.S.A.=Kansas Statutes Annotated, All temperatures are measured in degrees Fahrenheit (°F).

IF YOU HAVE ANY QUESTIONS PLEASE VISIT www.agriculture.ks.gov, EMAIL [email protected], OR CALL (785) 296-5600.

COMPLIANCE KEY: Y=in compliance; N=not in compliance; O=not observed; A=not applicable; C=corrected on-site during inspection; R=repeat violation.

FOODBORNE ILLNESS RISK FACTORS AND PUBLIC HEALTH INTERVENTIONS

Demonstration of Knowledge RCAONY

1. Certification by accredited program, compliance with Code, or correct responses. ¨¨¨þ¨¨

Employee Health RCAONY

2. Management awareness; policy present. ¨¨¨¨¨þ

3. Proper use of reporting, restriction and exclusion. ¨¨¨¨¨þ

Page 1 of 6

KANSAS FOOD ESTABLISHMENT INSPECTION REPORT

Good Hygienic Practices RCAONY

4. Proper eating, tasting, drinking, or tobacco use ¨¨¨¨¨þ

5. No discharge from eyes, nose and mouth. ¨¨¨¨¨þ

Preventing Contamination by Hands RCAONY

6. Hands clean and properly washed. ¨¨¨¨¨þ

7. No bare hand contact with RTE foods or approved alternate method properly followed. ¨¨¨¨¨þ

8. Adequate handwashing facilities supplied and accessible. ¨¨¨¨¨þ

Approved Source RCAONY

9. Food obtained from approved source. ¨¨¨¨¨þ

10. Food received at proper temperature. ¨¨¨þ¨¨

11. Food in good condition, safe and unadulterated. ¨¨¨¨¨þ

12. Required records available: shellstock tags, parasite destruction. ¨¨þ¨¨¨

Protection from Contamination RCAONY

13. Food separated and protected. ¨¨¨¨¨þ

14. Food-contact surfaces: cleaned and sanitized. ¨þ¨¨þ¨

This item has Notes. See Footnote 1 at end of questionnaire.

Fail Notes 4-601.11(A) Pf - Food Contact Clean to Sight and Touch - EQUIPMENT FOOD-CONTACT SURFACES and UTENSILS shall be clean to sight and touch.[Observed gallon can opener with dried on food residue. COS by immediately cleaning ]

4-702.11 P - Sanitizing Before Use, After Cleaning - UTENSILS and FOOD-CONTACT SURFACES of EQUIPMENT shall be SANITIZED before use after cleaning.[Recently washed dishes while on site observed to have no detect for chlorine sanitizer at the auto wash machine. Observed that the supply bucket was so near empty that solution could not be drawn up through the supply tube. There was on ejection of fluid from the end of the supply tube into the machine. COS employee transfered supply tube to a new full bucket of sanitizer. A proper 100 parts per million test resulted.]

15. Proper disposition of returned, previously served, reconditioned and unsafe food. ¨¨¨þ¨¨

Potentially Hazardous Food Time/Temperature RCAONY

16. Proper cooking time and temperatures. ¨¨¨þ¨¨

17. Proper reheating procedures for hot holding. ¨¨¨¨¨þ

This item has Notes. See Footnote 2 at end of questionnaire.

18. Proper cooling time and temperatures. ¨¨¨þ¨¨

19. Proper hot holding temperatures. ¨¨¨¨¨þ

This item has Notes. See Footnote 3 at end of questionnaire.

20. Proper cold holding temperatures. ¨¨¨¨¨þ

This item has Notes. See Footnote 4 at end of questionnaire.

21. Proper date marking and disposition. ¨¨¨¨¨þ

22. Time as a public health control: procedures and record. ¨¨þ¨¨¨

Consumer Advisory RCAONY

Page 2 of 6

KANSAS FOOD ESTABLISHMENT INSPECTION REPORT

Consumer Advisory RCAONY

23. Consumer advisory provided for raw or undercooked foods. ¨¨þ¨¨¨

Highly Susceptible Populations RCAONY

24. Pasteurized foods used; prohibited foods not offered. ¨¨¨¨¨þ

Chemical RCAONY

25. Food additives: approved and properly used. ¨¨¨þ¨¨

26. Toxic substances properly identified, stored and used. ¨þ¨¨þ¨

Fail Notes 7-201.11(B) P - Chemical Storage (Not Above Food, etc.) POISONOUS OR TOXIC MATERIALS shall be stored so they cannot contaminate FOOD, EQUIPMENT, UTENSILS, LINENS, and SINGLE-SERVICE and SINGLE-USE ARTICLES by locating the POISONOUS OR TOXIC MATERIALS in an area that is not above FOOD, EQUIPMENT, UTENSILS, LINENS, and SINGLE-SERVICE or SINGLE-USE ARTICLES.[observed one squeeze bottle of J&J baby lotion laying on its side on wire shelf in kitchen above full bag of whole unpeeled onions. COS moved lotion to other location]

Conformance with Approved Procedures RCAONY

27. Compliance with variance, specialized process and HACCP plan. ¨¨þ¨¨¨

GOOD RETAIL PRACTICES

Safe Food and Water RCAONY

28. Pasteurized eggs used where required. ¨¨þ¨¨¨

29. Water and ice from approved source. ¨¨¨¨¨þ

30. Variance obtained for specialized processing methods. ¨¨þ¨¨¨

Food Temperature Control RCAONY

31. Proper cooling methods used; adequate equipment for temperature control. ¨¨¨þ¨¨

32. Plant food properly cooked for hot holding. ¨¨¨þ¨¨

33. Approved thawing methods used. ¨¨¨¨¨þ

34. Thermometers provided and accurate. ¨¨¨¨¨þ

Food Identification RCAONY

35. Food properly labeled; original container. ¨¨¨¨¨þ

Prevention of Food Contamination RCAONY

36. Insects, rodents and animals not present. ¨¨¨¨¨þ

37. Contamination prevented during food preparation, storage and display. ¨¨¨¨¨þ

38. Personal cleanliness. ¨¨¨¨¨þ

39. Wiping cloths: properly used and stored. ¨¨¨¨¨þ

40. Washing fruits and vegetables. ¨¨¨þ¨¨

Proper Use of Utensils RCAONY

41. In-use utensils: properly stored. ¨¨¨¨¨þ

42. Utensils, equipment and linens: properly stored, dried and handled. ¨þ¨¨þ¨

Page 3 of 6

KANSAS FOOD ESTABLISHMENT INSPECTION REPORT

Proper Use of Utensils RCAONY

Fail Notes 4-903.12(A) Cleaned and SANITIZED EQUIPMENT, UTENSILS, laundered LINENS, and SINGLE-SERVICE and SINGLE-USE ARTICLES may not be stored: In locker rooms (except for laundered LINENS and SINGLE-SERVICE and SINGLE-USE ARTICLES that are PACKAGED or in a facility such as a cabinet); In toilet rooms; In garbage rooms; In mechanical rooms; Under sewer lines that are not shielded to intercept potential drips; Under leaking water lines including leaking automatic fire sprinkler heads or under lines on which water has condensed; Under open stairwells; or, Under other sources of contamination.[bottles used for table service that hold salsa stored as clean, in bucket under the kitchen hand wash sink. COS moved to other location.]

43. Single-use and single-service articles: properly used. ¨¨¨¨¨þ

44. Gloves used properly. ¨¨¨¨¨þ

Utensils, Equipment and Vending RCAONY

45a. Food and non-food contact surfaces cleanable, properly designed, constructed and used-P and Pf items

¨¨¨¨¨þ

45b. Food and non-food contact surfaces cleanable, properly designed, constructed and used-Core items

¨¨¨¨¨þ

46. Warewashing facilities: installed, maintained, and used; test strips. ¨¨¨¨¨þ

47. Non-food contact surfaces clean. ¨¨¨¨¨þ

Physical Facilities RCAONY

48. Hot and cold water available; adequate pressure. ¨¨¨¨¨þ

This item has Notes. See Footnote 5 at end of questionnaire.

49. Plumbing installed; proper backflow devices. ¨þ¨¨þ¨

Fail Notes 5-203.14 P - A PLUMBING SYSTEM shall be installed to preclude backflow of a solid, liquid, or gas contaminant into the water supply system at each point of use at the FOOD ESTABLISHMENT, including on a hose bibb if a hose is attached or on a hose bibb if a hose is not attached and backflow prevention is required by LAW, by: Providing an air gap as specified under § 5-202.13; or, Installing an APPROVED backflow prevention device as specified under § 5-202.14.[spray hose at the 3 compartment sink is hanging 3 1/2 inches below the flood rim of the sink. COS correcting by hanging on supply pipe provide hook for that purpose.]

50. Sewage and waste water properly disposed. ¨¨¨¨¨þ

51. Toilet facilities: properly constructed, supplied and cleaned. ¨¨¨¨¨þ

52. Garbage and refuse properly disposed; facilities maintained. ¨¨¨¨¨þ

53. Physical facilities installed, maintained and clean. ¨¨¨¨¨þ

54. Adequate ventilation and lighting; designated areas used. ¨¨¨¨¨þ

Administrative/Other RCAONY

55. Other violations ¨¨¨¨¨þ

EDUCATIONAL MATERIALS

The following educational materials were provided þ

Material Distributed Education Title #36 Manual Cleaning Sanitizing

Page 4 of 6

KANSAS FOOD ESTABLISHMENT INSPECTION REPORT

Footnote 1

Notes: After attempts to draw the fluid up by running the machine 4 times resulting in no dispenser so education was done for two staff on how and where to prime the machine to remove the air bubbles.

Footnote 2

Notes: previously cooked refried beans were observed reheat and in hot hold steam table were 189

Footnote 3

Notes: on make table steam table in kitchen: Fried rice, Refreid beans, taco meat chicken fajita and little cubed beefs in suace was the coolest at 168

Footnote 4

Notes: Make table (West) choped lettuce and cut tomatoes were the warmest at 41Make table (east) next to grill : raw shrimp and beef was the warmest at 41left WIC: cooked beef 2 inch x 2 inch cubes and previously cooked refried beans both at 38right WIC (when facing east) : prepped diced tomatoes/onions mix at 38

Footnote 5

Notes: hot water at hand sink 119 ok

Page 5 of 6

NOTICE OF NON COMPLIANCE WITH KANSAS LAW

Insp Date: 1/7/2014 Business ID: 99368FE Inspection: 58002645Business: EL DOS DE OROS MEXICAN RESTAURANT Store ID:

Phone: 78548362201002 E 41ST ST Inspector: KDA58 HAYS, KS 67601 Reason: 01 Routine

Time In / Time OutDate In Out Insp Travel Total Mileage Notes;

01/07/14 10:05 AM 11:50 AM 1:45 0:12 1:57 0Total: 1:45 0:12 1:57 0

NOTICE OF NON COMPLIANCE WITH KANSAS LAW

The Kansas Food, Drug and Cosmetic Act, effective July 1, 2012 includes K.S.A. 65-619 et seq. and regulations promulgated pursuant thereto and grants the Kansas Department of Agriculture the authority to regulate food establishments and food processing plants. The Kansas Food, Drug and Cosmetic Act requires that all violations shall be corrected no later than 10 days after this inspection unless otherwise directed on this form. Failure to comply with the food safety law and its regulations may result in embargo of non-compliant products; immediate closure of your establishment; civil penalties of up to $1,000.00 per violation; denial of license renewal, modification, suspension and/or revocation of any license or authority issued pursuant to the food safety law; and/or any other penalty authorized by law. Pursuant to K.S.A. 65-619 et seq, licensees issued authority under the Kansas Food, Drug and Cosmetic Act may apply to the secretary for an extension of the time prescribed above.

PLEASE CALL (785) 296-5600 IF YOU HAVE ANY QUESTIONS.

01/17/14Follow up Scheduled

58002645Inspection Report Number 01/07/14Inspection Report Date

EL DOS DE OROS MEXICAN RESTAURANTEstablishment Name

1002 E 41ST STPhysical Address HAYSCity

67601Zip

Additional Notesand Instructions

Page 6 of 6

Kansas Department of AgricultureDivision of Food Safety and Lodging

109 S.W. 9th St. Topeka, KS 66612(Office) 785-296-5600 (Fax) 785-296-6522

KANSAS FOOD PROCESSING PLANT INSPECTION REPORT

Violations cited in this report must be corrected immediately unless otherwise noted.

PLEASE CALL (785) 296-5600 OR VISIT www.ksda.gov/food_safety/ IF YOU HAVE ANY QUESTIONS.

COMPLIANCE KEY: Y=in compliance; N=not in compliance; O=not observed; A=not applicable; C=corrected on-site during inspection; R=repeat violation.

Insp Date: 1/14/2014 Business ID: 56414FP Inspection: 58002651Business: H E HUTCHISON & SONS INC Store ID:

Phone: 7856253656801 E 11TH PO BOX 804 Inspector: KDA58 HAYS, KS 67601 Reason: 06 FDA Contract

Results: No Follow-up

Time In / Time OutDate In Out Insp Travel Total Mileage Notes;

01/14/14 09:15 AM 11:00 AM 1:45 0:12 1:57 0Total: 1:45 0:12 1:57 0

PROCESSING PLANT PROFILE

2No. of Violations No Lic. Insp. Fax Insp. Notification

785-625-3671Notification Sent To

þAddress Verified

BUILDING AND GROUNDS RCAONY

1. Are premises free of harborage which may attract rodents, insects and other pests? ¨¨¨¨¨þ

2. Is adequate drainage provided to avoid contamination of facilities and products? ¨¨¨¨¨þ

3. Is sufficient space provided for the placement of equipment, storage of materials and for production operations?

¨¨¨¨¨þ

4. Are floors, walls and ceilings constructed of easily cleanable materials and kept clean and in good repair?

¨þ¨¨þ¨

Fail Notes 21 CFR 110.20(b)(4) Floors, walls, and ceilings easily cleanable[in the lower left corner of the east side over-head loading door was a collection of webbing with one live active movement of a spider. COS wswept away webbing and immobilized the spider.]

5. Are food and food contact surfaces protected from contamination in working areas? ¨þ¨¨þ¨

Fail Notes 21 CFR 110.20(b)(2) Food protected from contamination, separated from operation likely to cause contamination.[Observed one open case containing an assortment of smokeless tobacco containers and one open out of the case stack of same stored directly on the concrete floor in the warehouse loading and storage area during a time of non-active loading of products onto delivery vehicles. COS by elevating off the floor. ]

Page 1 of 4

KANSAS FOOD PROCESSING PLANT INSPECTION REPORT

BUILDING AND GROUNDS RCAONY

6. Are food processing areas effectively separated from other operations which may cause contamination of food being processed?

¨¨¨¨¨þ

7. Are food products and processing areas protected against contamination from breakage of light bulbs and other glass fixtures? Is interor lighting sufficient?

¨¨þ¨¨¨

8. Is air quality and ventilation adequate to prevent contamination by dust and/or other airborne substances?

¨¨¨¨¨þ

9. Are doors, windows and other openings protected to eliminate entry by insects, rodents and other pests?

¨¨¨¨¨þ

EQUIPMENT AND UTENSILS RCAONY

10. Are all utensils and equipment constructed of materials suitable for their intended use and easily cleanable? Is the equipment designed and used in a manner that precludes contamination with lubricants, metal fragments, or other sources? Is the equipment installed and maintained so as to facilitate the cleaning of equipment and adjacent areas?

¨¨þ¨¨¨

11. Is non-food contact equipment in manufacturing or food-handling areas easily cleanable? ¨¨þ¨¨¨

12. Are refrigerator/freezer units equipped with suitable thermometers? ¨¨¨¨¨þ

SANITARY FACILITIES AND CONTROLS RCAONY

13. Is the water supply from an approved source and adequate in quantity for its intended uses? ¨¨¨¨¨þ

14. Are the water temperatures and pressures maintained at suitable levels for its intended use? ¨¨¨¨¨þ

15. Is sewage disposed of through a public sewer system and/or an on site sewage disposal system that is operated and maintained according to applicable requirements?

¨¨¨¨¨þ

16. Is the plumbing adequately designed, installed and maintained in a manner to prevent contamination including backflow, back siphonage and cross connection?

¨¨¨¨¨þ

17. Are adequate toilet rooms provided, equipped and maintained clean and in good repair? ¨¨¨¨¨þ

18. Are adequate handwashing facilities provided and supplied with hot and cold water, soap and sanitary towels?

¨¨¨¨¨þ

19. Is all refuse properly stored and protected where necessary from insects, rodents and other pests and disposed of in an adequate manner?

¨¨¨¨¨þ

SANITARY OPERATIONS RCAONY

20. Is the facility kept clean and in good physical repair? ¨¨¨¨¨þ

21. Are detergents, sanitizers, hazardous materials and other supplies used in a safe and effective manner, kept in original containers, and stored separate from raw materials?

¨¨¨¨¨þ

22. Are all areas maintained free of insects, rodents, birds and other pests? ¨¨¨¨¨þ

23. Are all utensils and equipment cleaned and sanitized, and at frequent enough intervals to avoid contamination of food products?

¨¨¨¨¨þ

24. Are single use items stored, handled, dispensed, used and disposed of in a manner that prevents contamination?

¨¨¨¨¨þ

25. Are clean utensils and portable equipment stored so as to protect them from splash, dust and other contamination?

¨¨¨¨¨þ

PROCESSES AND CONTROLS RCAONY

26. Is responsibility for overall plant sanitation specifically assigned to an individual and are chemical microbiological or extraneous material testing procedures used where necessary to identify sanitation failures or food contamination? Is the facility licensed?

¨¨¨¨¨þ

27. Are raw materials and ingredients adequately inspected and stored to assure that only clean, wholesome materials are used? ¨¨þ¨¨¨

Page 2 of 4

KANSAS FOOD PROCESSING PLANT INSPECTION REPORT

PROCESSES AND CONTROLS RCAONY

28. Is food processing conducted in a manner to prevent contamination and minimize harmful microbiological growth?

¨¨þ¨¨¨

29. Are packaging processes and materials adequate to prevent contamination? ¨¨þ¨¨¨

30. Are only approved food and/or color additives used? ¨¨þ¨¨¨

31. Are products coded to enable positive lot identification, and are records maintained in excess of expected shelf-life?

¨¨þ¨¨¨

32. Are weighing and measuring practices adequate to ensure the declared quantity of contents? ¨¨þ¨¨¨

33. Are labels of products covered during inspection in compliance (submit violative labels as exhibits)?

¨¨þ¨¨¨

34. Are finished products stored and shipped under conditions which will avoid contamination and deterioration?

¨¨¨¨¨þ

35. Does firm have a HACCP Plan? ¨¨þ¨¨¨

PERSONNEL RCAONY

36. Are personnel with sores, infections, etc., restricted from handling food products? ¨¨¨¨¨þ

37. Do employees wear clean outer garments, use adequate hair restraints and remove excess jewelry when handling food?

¨¨¨¨¨þ

38. Do employees thoroughly wash hands as necessary? ¨¨¨þ¨¨

39. Do employees refrain from eating, drinking and smoking and observe good food handling techniques in processing areas?

¨¨¨¨¨þ

TRANSPORTATION PRACTICES RCAONY

40. Are food delivery vehicles clean and in good repair? ¨¨¨¨¨þ

41. Are food stuffs loaded in the same vehicle with toxic chemicals or other potential contaminants?

¨¨þ¨¨¨

42. Are vehicles delivering refrigerated and/or frozen foods equipped to maintain temperatures specified?

¨¨¨þ¨¨

This item has Notes. See Footnote 1 at end of questionnaire.

EDUCATIONAL MATERIALS

þThe following educational materials were provided

This item has Notes. See Footnote 2 at end of questionnaire.

Materials Distributed Education Title # 21 FDA Registration Handout

FDA Handout F.I.R.S.T. Handout

FDA Handout Reportable Food Registry

Page 3 of 4

KANSAS FOOD PROCESSING PLANT INSPECTION REPORT

Footnote 1

Notes: Not observable as vehicles that might be transporting frozen commerical deli sandwiches were on the road for deliveries and amount to a small segment of the overall products handled.

Footnote 2

Notes: plus the Information Sheet - Assessment of Reinspection and Recall Fees by the FDA

Page 4 of 4

Kansas Department of AgricultureDivision of Food Safety and Lodging

109 S.W. 9th St. Topeka, KS 66612(Office) 785-296-5600 (Fax) 785-296-6522

KANSAS FOOD ESTABLISHMENT INSPECTION REPORT

Insp Date: 1/2/2014 Business ID: 107337FE Inspection: 55001724Business: JIMMY JOHN'S Store ID:

Phone: 78562122271104 E 27TH Inspector: KDA55 HAYS, KS 67601 Reason: 20 Shadow

Time In / Time OutDate In Out Insp Travel Total Mileage Notes;

01/02/14 01:45 PM 03:45 PM 2:00 1:15 3:15 0Total: 2:00 1:15 3:15 0

FOOD ESTABLISHMENT PROFILE

Lic. Insp. Fax Insp. Notification Sent Notification To

3Priority(P) Violations 4Priority foundation(Pf) Violations

þAddress Verified¨Certified Manager on Staff Actual Sq. Ft.

¨Certified Manager Present

INSPECTION INFORMATION

Risk factors are improper practices or procedures identified as the most prevalent contributing factors of food-borne illness or injury. Public health interventions are control measures to prevent food-borne illness or injury.Good Retail Practices are preventative measures to control the addition of pathogens, chemicals and physical objects into foods.Violations cited in this report must be corrected within the time frames entered below, or as stated in sections 8-405.11 of the food code.

P=Priority Violation, Pf=Priority foundation violation, HACCP=Hazard Analysis-Critical Control Point, BHC=Bare Hand Contact, RTE=Ready to Eat, HSP=Highly Susceptible Population, K.S.A.=Kansas Statutes Annotated, All temperatures are measured in degrees Fahrenheit (°F).

IF YOU HAVE ANY QUESTIONS PLEASE VISIT www.agriculture.ks.gov, EMAIL [email protected], OR CALL (785) 296-5600.

COMPLIANCE KEY: Y=in compliance; N=not in compliance; O=not observed; A=not applicable; C=corrected on-site during inspection; R=repeat violation.

FOODBORNE ILLNESS RISK FACTORS AND PUBLIC HEALTH INTERVENTIONS

Demonstration of Knowledge RCAONY

1. Certification by accredited program, compliance with Code, or correct responses. ¨¨¨þ¨¨

Employee Health RCAONY

2. Management awareness; policy present. ¨¨¨¨¨þ

3. Proper use of reporting, restriction and exclusion. ¨þ¨¨þ¨

Page 1 of 8

KANSAS FOOD ESTABLISHMENT INSPECTION REPORT

Employee Health RCAONY

Fail Notes 2-201.12(H) P - Restricting Employees (Uncovered lesion with pus) The PERSON IN CHARGE shall RESTRICT a FOOD EMPLOYEE infected with a skin lesion containing pus, such as a boil or infected wound, that is open or draining and not properly covered.[Employee had a red swollen cut on thumb and scooped ice for drink ungloved. Bandaged and gloved.]

Good Hygienic Practices RCAONY

4. Proper eating, tasting, drinking, or tobacco use ¨þ¨¨þ¨

Fail Notes 2-401.11 EMPLOYEES shall eat, drink, or use any form of tobacco only in designated areas where the contamination of exposed FOOD; clean EQUIPMENT, UTENSILS, and LINENS; unwrapped SINGLE-SERVICE and SINGLE-USE ARTICLES; or other items needing protection cannot result.[Open styrofoam cups were used for employee drinks. Removed.]

5. No discharge from eyes, nose and mouth. ¨¨¨¨¨þ

Preventing Contamination by Hands RCAONY

6. Hands clean and properly washed. ¨¨¨¨¨þ

7. No bare hand contact with RTE foods or approved alternate method properly followed. ¨¨¨¨¨þ

8. Adequate handwashing facilities supplied and accessible. ¨þ¨¨þ¨

Fail Notes 5-205.11(A) Pf - A HANDWASHING SINK shall be maintained so that it is accessible at all times for EMPLOYEE use.[When inspector entered establishment the kitchen handsink was being used to hold pans for dishwashing and the back handsink was used to hold towels. Removed.]

6-301.14 A sign or poster that notifies FOOD EMPLOYEES to wash their hands shall be provided at all HANDWASHING SINKS used by FOOD EMPLOYEES and shall be clearly visible to FOOD EMPLOYEES.[Handwashing instructions were not posted at handsinks. Provided.]

Approved Source RCAONY

9. Food obtained from approved source. ¨¨¨¨¨þ

10. Food received at proper temperature. ¨¨¨þ¨¨

11. Food in good condition, safe and unadulterated. ¨¨¨¨¨þ

12. Required records available: shellstock tags, parasite destruction. ¨¨þ¨¨¨

Protection from Contamination RCAONY

13. Food separated and protected. ¨¨¨¨¨þ

14. Food-contact surfaces: cleaned and sanitized. ¨¨¨¨¨þ

This item has Notes. See Footnote 1 at end of questionnaire.

15. Proper disposition of returned, previously served, reconditioned and unsafe food. ¨¨¨þ¨¨

Potentially Hazardous Food Time/Temperature RCAONY

16. Proper cooking time and temperatures. ¨¨þ¨¨¨

17. Proper reheating procedures for hot holding. ¨¨þ¨¨¨

18. Proper cooling time and temperatures. ¨¨¨¨þ¨

Page 2 of 8

KANSAS FOOD ESTABLISHMENT INSPECTION REPORT

Potentially Hazardous Food Time/Temperature RCAONY

Fail Notes 3-501.14(B) P - Cooling PHF/TCS (ambient temp ingredients) POTENTIALLY HAZARDOUS FOOD (TIME/TEMPERATURE CONTROL FOR SAFETY FOOD) shall be cooled within 4 hours to 5°C (41°F) or less if prepared from ingredients at ambient temperature, such as reconstituted FOODS and canned tuna.[Prep table pans of shredded lettuce were found in the prep table at 48. The owner state that the lettuce had been prepared 5 or more hours earlier. Discarded.]

19. Proper hot holding temperatures. ¨¨þ¨¨¨

20. Proper cold holding temperatures. ¨¨¨¨¨þ

This item has Notes. See Footnote 2 at end of questionnaire.

21. Proper date marking and disposition. ¨¨¨¨¨þ

22. Time as a public health control: procedures and record. ¨¨þ¨¨¨

Consumer Advisory RCAONY

23. Consumer advisory provided for raw or undercooked foods. ¨¨þ¨¨¨

Highly Susceptible Populations RCAONY

24. Pasteurized foods used; prohibited foods not offered. ¨¨þ¨¨¨

Chemical RCAONY

25. Food additives: approved and properly used. ¨¨¨þ¨¨

26. Toxic substances properly identified, stored and used. ¨þ¨¨þ¨

Fail Notes 7-204.11 P - Chemical SANITIZERS and other chemical antimicrobials applied to FOOD-CONTACT SURFACEs shall meet the requirements specified in 40 CFR 180.940 Tolerance exemptions for active and inert ingredients for use in antimicrobial formulations (food-contact surface sanitizing solutions).[The spray bottle of chlorine sanitizer used for the sanitizing of the slicer had a concentration of over 200ppm. Diluted.]

Conformance with Approved Procedures RCAONY

27. Compliance with variance, specialized process and HACCP plan. ¨¨þ¨¨¨

GOOD RETAIL PRACTICES

Safe Food and Water RCAONY

28. Pasteurized eggs used where required. ¨¨þ¨¨¨

29. Water and ice from approved source. ¨¨¨¨¨þ

30. Variance obtained for specialized processing methods. ¨¨þ¨¨¨

Food Temperature Control RCAONY

31. Proper cooling methods used; adequate equipment for temperature control. ¨þ¨¨þ¨

Fail Notes 3-501.15(A) Pf - TCS Cooling (Methods) - Cooling shall be accomplished in accordance with the required time and temperature criteria by using one or more of the following methods based on the type of FOOD being cooled: placing the FOOD in shallow pans; separating the FOOD into smaller or thinner portions; using rapid cooling EQUIPMENT; stirring the FOOD in a container placed in an ice water bath; using containers that facilitate heat transfer; adding ice as an ingredient; or, other effective methods.[The shredded lettuce was found in large quantities and tightly covered containers. Discarded.]

32. Plant food properly cooked for hot holding. ¨¨þ¨¨¨

Page 3 of 8

KANSAS FOOD ESTABLISHMENT INSPECTION REPORT

Food Temperature Control RCAONY

33. Approved thawing methods used. ¨¨¨þ¨¨

34. Thermometers provided and accurate. ¨¨¨¨þ¨

Fail Notes 4-302.12(A) Pf - Food Temperature Measuring Devices (Provided & Accessible) FOOD TEMPERATURE MEASURING DEVICES shall be provided and readily accessible for use in ensuring attainment and maintenance of required FOOD temperatures.[A probe type thermometer for measuring internal temperatures is not provided.]

Food Identification RCAONY

35. Food properly labeled; original container. ¨¨¨¨¨þ

Prevention of Food Contamination RCAONY

36. Insects, rodents and animals not present. ¨¨¨¨¨þ

37. Contamination prevented during food preparation, storage and display. ¨¨¨¨¨þ

38. Personal cleanliness. ¨¨¨¨¨þ

39. Wiping cloths: properly used and stored. ¨¨¨¨¨þ

40. Washing fruits and vegetables. ¨¨¨¨¨þ

Proper Use of Utensils RCAONY

41. In-use utensils: properly stored. ¨þ¨¨þ¨

Fail Notes 3-304.12(B) In-use utensil storage (Non-PHF/TCS-handles above food) During pauses in FOOD preparation or dispensing, FOOD preparation and dispensing UTENSILS shall be stored in FOOD that is not POTENTIALLY HAZARDOUS (TIME/TEMPERATURE CONTROL FOR SAFETY FOOD) with their handles above the top of the FOOD within containers or EQUIPMENT that can be closed, such as bins of sugar, flour, or cinnamon.[Ice scoop for the drive thru ice bin had its handle in contact with the ice. Moved.]

42. Utensils, equipment and linens: properly stored, dried and handled. ¨¨¨¨þ¨

Fail Notes 4-901.11(A) Equipment/utensils (Air drying) After cleaning and SANITIZING, EQUIPMENT and UTENSILS shall be air-dried or used after adequate draining as specified in the first paragraph of 40 CFR 180.940 Tolerance exemptions for active and inert ingredients for use in antimicrobial formulations (food-contact surface SANITIZING solutions), before contact with FOOD.[Prep psns were observed stacked wet before air drying.]

43. Single-use and single-service articles: properly used. ¨¨¨¨þ¨

Fail Notes 4-903.11(C) SINGLE-SERVICE and SINGLE-USE ARTICLES shall be stored as specified under ¶ 4-903.11(A) and shall be kept in the original protective PACKAGE or stored by using other means that afford protection from contamination until used.[Napkins, paper towels and toilet paper were found stored on wire rack below dripping pans.In the shed at the back of the parking lot boxes single use cups and napkins were stored on the floor.]

44. Gloves used properly. ¨¨¨¨¨þ

Utensils, Equipment and Vending RCAONY

45a. Food and non-food contact surfaces cleanable, properly designed, constructed and used-P and Pf items

¨¨¨¨¨þ

45b. Food and non-food contact surfaces cleanable, properly designed, constructed and used-Core items

¨¨¨¨¨þ

Page 4 of 8

KANSAS FOOD ESTABLISHMENT INSPECTION REPORT

Utensils, Equipment and Vending RCAONY

46. Warewashing facilities: installed, maintained, and used; test strips. ¨þ¨¨þ¨

Fail Notes 4-302.14 Pf - A test kit or other device that accurately measures the concentration in mg/L of SANITIZING solutions shall be provided.[No test strips for chlorine sanitizer were provided. Spray bottle chlorine sanitizer tested over 200ppm.]

47. Non-food contact surfaces clean. ¨¨¨¨¨þ

Physical Facilities RCAONY

48. Hot and cold water available; adequate pressure. ¨¨¨¨¨þ

49. Plumbing installed; proper backflow devices. ¨¨¨¨¨þ

This item has Notes. See Footnote 3 at end of questionnaire.

50. Sewage and waste water properly disposed. ¨¨¨¨¨¨

51. Toilet facilities: properly constructed, supplied and cleaned. ¨¨¨¨þ¨

Fail Notes 5-501.17 A toilet room used by females shall be provided with a covered receptacle for sanitary napkins.[Womens restroom does not have a covered waste receptacle.]

52. Garbage and refuse properly disposed; facilities maintained. ¨¨¨¨¨þ

53. Physical facilities installed, maintained and clean. ¨¨¨¨¨þ

54. Adequate ventilation and lighting; designated areas used. ¨¨¨¨¨þ

Administrative/Other RCAONY

55. Other violations ¨¨¨¨¨þ

EDUCATIONAL MATERIALS

The following educational materials were provided þ

Material Distributed Education Title #06 Cooling

Education Title #11 Employee Handwashing

Education Title #31 Product Cooling Temperature Log

Page 5 of 8

KANSAS FOOD ESTABLISHMENT INSPECTION REPORT

Footnote 1

Notes: Sanitizer3 Compartment Sink - Observed pans sanitized in 100ppm Chlorine solution.

Footnote 2

Notes: Cold HoldNoon Prep Table - Turkey 34Main Prep Table - Roast Beef 41, Sliced Tomatoes 41Walk In Cooler - Turkey 39.7, Head Lettuce 38.6

Footnote 3

Notes: Hot WaterHandsink - 106

Page 6 of 8

NOTICE OF NON COMPLIANCE WITH KANSAS LAW

Insp Date: 1/2/2014 Business ID: 107337FE Inspection: 55001724Business: JIMMY JOHN'S Store ID:

Phone: 78562122271104 E 27TH Inspector: KDA55 HAYS, KS 67601 Reason: 20 Shadow

Time In / Time OutDate In Out Insp Travel Total Mileage Notes;

01/02/14 01:45 PM 03:45 PM 2:00 1:15 3:15 0Total: 2:00 1:15 3:15 0

NOTICE OF NON COMPLIANCE WITH KANSAS LAW

The Kansas Food, Drug and Cosmetic Act, effective July 1, 2012 includes K.S.A. 65-619 et seq. and regulations promulgated pursuant thereto and grants the Kansas Department of Agriculture the authority to regulate food establishments and food processing plants. The Kansas Food, Drug and Cosmetic Act requires that all violations shall be corrected no later than 10 days after this inspection unless otherwise directed on this form. Failure to comply with the food safety law and its regulations may result in embargo of non-compliant products; immediate closure of your establishment; civil penalties of up to $1,000.00 per violation; denial of license renewal, modification, suspension and/or revocation of any license or authority issued pursuant to the food safety law; and/or any other penalty authorized by law. Pursuant to K.S.A. 65-619 et seq, licensees issued authority under the Kansas Food, Drug and Cosmetic Act may apply to the secretary for an extension of the time prescribed above.

PLEASE CALL (785) 296-5600 IF YOU HAVE ANY QUESTIONS.

01/13/14Follow up Scheduled

55001724Inspection Report Number 01/02/14Inspection Report Date

JIMMY JOHN'SEstablishment Name

1104 E 27THPhysical Address HAYSCity

67601Zip

Additional Notesand Instructions

Page 7 of 8

VOLUNTARY DESTRUCTION REPORT

Insp Date: 1/2/2014 Business ID: 107337FE Inspection: 55001724Business: JIMMY JOHN'S Store ID:

Phone: 78562122271104 E 27TH Inspector: KDA55 HAYS, KS 67601 Reason: 20 Shadow

Time In / Time OutDate In Out Insp Travel Total Mileage Notes;

01/02/14 01:45 PM 03:45 PM 2:00 1:15 3:15 0Total: 2:00 1:15 3:15 0

ACTIONS

1 Number of products Voluntarily Destroyed

VOLUNTARY DESTRUCTION REPORT

I have this day voluntarily destroyed, or caused to be destroyed, the merchandise described below. Said merchandise found in my possession was unfit for human consumption, misbranded, or otherwise unlawful. Destruction and final disposition of said merchandise has been done in a manner approved by the above named Inspector, representative of the Kansas Department of Agriculture.

I hereby release the Kansas Department of Agriculture, and its members, agents, and representatives from any and all liability.

Shredded Lettuce1. Product lbs Units 10Value $4Qty

Description

Adulterated Reason Product Destroyed Trash Can Method Product Destroyed

Firm Disposal Location N/AEmbargo Hold Tag #

Page 8 of 8

Kansas Department of AgricultureDivision of Food Safety and Lodging

109 S.W. 9th St. Topeka, KS 66612(Office) 785-296-5600 (Fax) 785-296-6522

KANSAS FOOD ESTABLISHMENT INSPECTION REPORT

Insp Date: 1/2/2014 Business ID: 109771FE Inspection: 25004116Business: MALL 8 HAYS Store ID:

Phone: 78562864062918 VINE Inspector: KDA25 HAYS, KS 67601 Reason: 01 Routine

Time In / Time OutDate In Out Insp Travel Total Mileage Notes;

01/02/14 03:00 PM 05:30 PM 2:30 0:10 2:40 0Total: 2:30 0:10 2:40 0

FOOD ESTABLISHMENT PROFILE

No Lic. Insp. Email Insp. Notification Sent Notification To

0Priority(P) Violations 0Priority foundation(Pf) Violations

þAddress Verified¨Certified Manager on Staff 300Actual Sq. Ft.

¨Certified Manager Present

INSPECTION INFORMATION

Risk factors are improper practices or procedures identified as the most prevalent contributing factors of food-borne illness or injury. Public health interventions are control measures to prevent food-borne illness or injury.Good Retail Practices are preventative measures to control the addition of pathogens, chemicals and physical objects into foods.Violations cited in this report must be corrected within the time frames entered below, or as stated in sections 8-405.11 of the food code.

P=Priority Violation, Pf=Priority foundation violation, HACCP=Hazard Analysis-Critical Control Point, BHC=Bare Hand Contact, RTE=Ready to Eat, HSP=Highly Susceptible Population, K.S.A.=Kansas Statutes Annotated, All temperatures are measured in degrees Fahrenheit (°F).

IF YOU HAVE ANY QUESTIONS PLEASE VISIT www.agriculture.ks.gov, EMAIL [email protected], OR CALL (785) 296-5600.

COMPLIANCE KEY: Y=in compliance; N=not in compliance; O=not observed; A=not applicable; C=corrected on-site during inspection; R=repeat violation.

FOODBORNE ILLNESS RISK FACTORS AND PUBLIC HEALTH INTERVENTIONS

Demonstration of Knowledge RCAONY

1. Certification by accredited program, compliance with Code, or correct responses. ¨¨¨þ¨¨

Employee Health RCAONY

2. Management awareness; policy present. ¨¨¨¨¨þ

3. Proper use of reporting, restriction and exclusion. ¨¨¨þ¨¨

Page 1 of 7

KANSAS FOOD ESTABLISHMENT INSPECTION REPORT

Good Hygienic Practices RCAONY

4. Proper eating, tasting, drinking, or tobacco use ¨¨¨¨¨þ

5. No discharge from eyes, nose and mouth. ¨¨¨¨¨þ

Preventing Contamination by Hands RCAONY

6. Hands clean and properly washed. ¨¨¨¨¨þ

7. No bare hand contact with RTE foods or approved alternate method properly followed. ¨¨¨¨¨þ

8. Adequate handwashing facilities supplied and accessible. ¨¨¨¨¨þ

Approved Source RCAONY

9. Food obtained from approved source. ¨¨¨¨¨þ

10. Food received at proper temperature. ¨¨¨þ¨¨

11. Food in good condition, safe and unadulterated. ¨¨¨¨¨þ

12. Required records available: shellstock tags, parasite destruction. ¨¨þ¨¨¨

Protection from Contamination RCAONY

13. Food separated and protected. ¨¨¨¨¨þ

14. Food-contact surfaces: cleaned and sanitized. ¨¨¨¨¨þ

15. Proper disposition of returned, previously served, reconditioned and unsafe food. ¨¨¨þ¨¨

Potentially Hazardous Food Time/Temperature RCAONY

16. Proper cooking time and temperatures. ¨¨þ¨¨¨

17. Proper reheating procedures for hot holding. ¨¨þ¨¨¨

18. Proper cooling time and temperatures. ¨¨þ¨¨¨

19. Proper hot holding temperatures. ¨¨þ¨¨¨

20. Proper cold holding temperatures. ¨¨þ¨¨¨

21. Proper date marking and disposition. ¨¨þ¨¨¨

22. Time as a public health control: procedures and record. ¨¨þ¨¨¨

Consumer Advisory RCAONY

23. Consumer advisory provided for raw or undercooked foods. ¨¨þ¨¨¨

Highly Susceptible Populations RCAONY

24. Pasteurized foods used; prohibited foods not offered. ¨¨þ¨¨¨

Chemical RCAONY

25. Food additives: approved and properly used. ¨¨¨¨¨þ

26. Toxic substances properly identified, stored and used. ¨¨¨¨¨þ

Conformance with Approved Procedures RCAONY

27. Compliance with variance, specialized process and HACCP plan. ¨¨þ¨¨¨

GOOD RETAIL PRACTICES

Safe Food and Water RCAONY

28. Pasteurized eggs used where required. ¨¨þ¨¨¨

29. Water and ice from approved source. ¨¨¨¨¨þ

Page 2 of 7

KANSAS FOOD ESTABLISHMENT INSPECTION REPORT

Safe Food and Water RCAONY

30. Variance obtained for specialized processing methods. ¨¨þ¨¨¨

Food Temperature Control RCAONY

31. Proper cooling methods used; adequate equipment for temperature control. ¨¨þ¨¨¨

32. Plant food properly cooked for hot holding. ¨¨þ¨¨¨

33. Approved thawing methods used. ¨¨þ¨¨¨

34. Thermometers provided and accurate. ¨¨þ¨¨¨

Food Identification RCAONY

35. Food properly labeled; original container. ¨¨¨¨¨þ

Prevention of Food Contamination RCAONY

36. Insects, rodents and animals not present. ¨¨¨¨¨þ

37. Contamination prevented during food preparation, storage and display. ¨¨¨¨¨þ

38. Personal cleanliness. ¨¨¨¨¨þ

39. Wiping cloths: properly used and stored. ¨¨¨þ¨¨

40. Washing fruits and vegetables. ¨¨þ¨¨¨

Proper Use of Utensils RCAONY

41. In-use utensils: properly stored. ¨¨¨¨¨þ

42. Utensils, equipment and linens: properly stored, dried and handled. ¨¨¨¨¨þ

43. Single-use and single-service articles: properly used. ¨¨¨¨¨þ

44. Gloves used properly. ¨¨¨¨¨þ

Utensils, Equipment and Vending RCAONY

45a. Food and non-food contact surfaces cleanable, properly designed, constructed and used-P and Pf items

¨¨¨¨¨þ

45b. Food and non-food contact surfaces cleanable, properly designed, constructed and used-Core items

¨¨¨¨¨þ

46. Warewashing facilities: installed, maintained, and used; test strips. ¨¨¨¨¨þ

47. Non-food contact surfaces clean. ¨¨¨¨¨þ

Physical Facilities RCAONY

48. Hot and cold water available; adequate pressure. ¨¨¨¨¨þ

49. Plumbing installed; proper backflow devices. ¨¨¨¨¨þ

50. Sewage and waste water properly disposed. ¨¨¨¨¨þ

51. Toilet facilities: properly constructed, supplied and cleaned. ¨¨¨¨¨þ

52. Garbage and refuse properly disposed; facilities maintained. ¨¨¨¨¨þ

53. Physical facilities installed, maintained and clean. ¨¨¨¨þ¨

Fail Notes 6-501.12(A) PHYSICAL FACILITIES shall be cleaned as often as necessary to keep them clean.[One floor drain of four has accumulation of popcorn and kernals plugging the drain. The walls behind the popcorn machine and icee machine has accumulation of loose lint. Under the cabinet under the icee machine is 10 old rodent droppings. (There is no indication they are fresh)]

Page 3 of 7

KANSAS FOOD ESTABLISHMENT INSPECTION REPORT

Physical Facilities RCAONY

54. Adequate ventilation and lighting; designated areas used. ¨¨¨¨¨þ

Administrative/Other RCAONY

55. Other violations ¨¨¨¨þ¨

Fail Notes K.S.A. 65-689(a) It shall be unlawful for any person to engage in the business of conducting a food establishment or food processing plant unless such person shall have in effect a valid license therefor issued by the secretary.[Operating without a current license under new ownership.]

EDUCATIONAL MATERIALS

The following educational materials were provided þ

This item has Notes. See Footnote 1 at end of questionnaire.

Page 4 of 7

KANSAS FOOD ESTABLISHMENT INSPECTION REPORT

Footnote 1

Notes: email application and CC application

Page 5 of 7

VOLUNTARY CLOSURE STATEMENT

Insp Date: 1/2/2014 Business ID: 109771FE Inspection: 25004116Business: MALL 8 HAYS Store ID:

Phone: 78562864062918 VINE Inspector: KDA25 HAYS, KS 67601 Reason: 01 Routine

Time In / Time OutDate In Out Insp Travel Total Mileage Notes;

01/02/14 03:00 PM 05:30 PM 2:30 0:10 2:40 0Total: 2:30 0:10 2:40 0

VOLUNTARY CLOSURE STATEMENT

BECAUSE OF DEFICIENCIES NOTED ON THE ATTACHED KANSAS DEPARTMENT OF AGRICULTURE INSPECTION REPORT, I VOLUNTARILY AGREE TO CLOSE THIS ESTABLISHMENT AND CEASE OPERATION UNTIL NEEDED CORRECTIONS HAVE BEEN COMPLETED. I AGREE NOT TO REOPEN THIS ESTABLISHMENT PRIOR TO RE-INSPECTION BY THE FOOD, DRUG, AND LODGING SURVEYOR.

2918 Vine

01/02/14Reinspection is currently scheduled for

25004116Inspection Report Number 01/02/14Inspection Report Date

Mall 8Establishment Name

Physical Address HaysCity

67601Zip

facility is operating under former owner license, voluntarily close. Mr. Daniels Corporate representative faxed in application and CC payment form so able to reopen.

Additional Notes

Page 6 of 7

NOTICE OF NON COMPLIANCE WITH KANSAS LAW

Insp Date: 1/2/2014 Business ID: 109771FE Inspection: 25004116Business: MALL 8 HAYS Store ID:

Phone: 78562864062918 VINE Inspector: KDA25 HAYS, KS 67601 Reason: 01 Routine

Time In / Time OutDate In Out Insp Travel Total Mileage Notes;

01/02/14 03:00 PM 05:30 PM 2:30 0:10 2:40 0Total: 2:30 0:10 2:40 0

NOTICE OF NON COMPLIANCE WITH KANSAS LAW

The Kansas Food, Drug and Cosmetic Act, effective July 1, 2012 includes K.S.A. 65-619 et seq. and regulations promulgated pursuant thereto and grants the Kansas Department of Agriculture the authority to regulate food establishments and food processing plants. The Kansas Food, Drug and Cosmetic Act requires that all violations shall be corrected no later than 10 days after this inspection unless otherwise directed on this form. Failure to comply with the food safety law and its regulations may result in embargo of non-compliant products; immediate closure of your establishment; civil penalties of up to $1,000.00 per violation; denial of license renewal, modification, suspension and/or revocation of any license or authority issued pursuant to the food safety law; and/or any other penalty authorized by law. Pursuant to K.S.A. 65-619 et seq, licensees issued authority under the Kansas Food, Drug and Cosmetic Act may apply to the secretary for an extension of the time prescribed above.

PLEASE CALL (785) 296-5600 IF YOU HAVE ANY QUESTIONS.

2918 Vine

01/02/14Follow up Scheduled

25004116Inspection Report Number 01/02/14Inspection Report Date

Mall 8Establishment Name

Physical Address HaysCity

67601Zip

operating without license, Faxed application and CC payment form to able to reopen.Additional Notesand Instructions

Page 7 of 7

Kansas Department of AgricultureDivision of Food Safety and Lodging

109 S.W. 9th St. Topeka, KS 66612(Office) 785-296-5600 (Fax) 785-296-6522

KANSAS FOOD ESTABLISHMENT INSPECTION REPORT

Insp Date: 1/9/2014 Business ID: 116318FE Inspection: 55001729Business: MJ'S BARBEQUE Store ID:

501-B S. Vine St. Phone: 7854212086501 S VINE ST Inspector: KDA55 HAYS, KS 67601 Reason: 02 Follow-up

Results: No Follow-up

Time In / Time OutDate In Out Insp Travel Total Mileage Notes;

01/09/14 02:20 PM 03:00 PM 0:40 0:05 0:45 0Total: 0:40 0:05 0:45 0

FOOD ESTABLISHMENT PROFILE

501 S VINE STPhysical Address HAYSCity

501-B S. Vine St. 67601Zip

Owner FELicense Type

RAC# 06 High RiskRisk Category Under 5,000 sq feetSize RangeþRAC/Size Confirmed

Lic. Insp. Email Insp. Notification Sent Notification To

0Priority(P) Violations 1Priority foundation(Pf) Violations

¨Address Verified¨Certified Manager on Staff Actual Sq. Ft.

¨Certified Manager Present

INSPECTION INFORMATION

Risk factors are improper practices or procedures identified as the most prevalent contributing factors of food-borne illness or injury. Public health interventions are control measures to prevent food-borne illness or injury.Good Retail Practices are preventative measures to control the addition of pathogens, chemicals and physical objects into foods.Violations cited in this report must be corrected within the time frames entered below, or as stated in sections 8-405.11 of the food code.

P=Priority Violation, Pf=Priority foundation violation, HACCP=Hazard Analysis-Critical Control Point, BHC=Bare Hand Contact, RTE=Ready to Eat, HSP=Highly Susceptible Population, K.S.A.=Kansas Statutes Annotated, All temperatures are measured in degrees Fahrenheit (°F).

IF YOU HAVE ANY QUESTIONS PLEASE VISIT www.agriculture.ks.gov, EMAIL [email protected], OR CALL (785) 296-5600.

COMPLIANCE KEY: Y=in compliance; N=not in compliance; O=not observed; A=not applicable; C=corrected on-site during inspection; R=repeat violation.

FOODBORNE ILLNESS RISK FACTORS AND PUBLIC HEALTH INTERVENTIONS

Page 1 of 4

KANSAS FOOD ESTABLISHMENT INSPECTION REPORT

Demonstration of Knowledge RCAONY

1. Certification by accredited program, compliance with Code, or correct responses. ¨¨¨¨¨¨

Employee Health RCAONY

2. Management awareness; policy present. ¨¨¨¨¨¨

3. Proper use of reporting, restriction and exclusion. ¨¨¨¨¨¨

Good Hygienic Practices RCAONY

4. Proper eating, tasting, drinking, or tobacco use ¨¨¨¨¨¨

5. No discharge from eyes, nose and mouth. ¨¨¨¨¨¨

Preventing Contamination by Hands RCAONY

6. Hands clean and properly washed. ¨¨¨¨¨¨

7. No bare hand contact with RTE foods or approved alternate method properly followed. ¨¨¨¨¨¨

8. Adequate handwashing facilities supplied and accessible. ¨¨¨¨¨¨

Approved Source RCAONY

9. Food obtained from approved source. ¨¨¨¨¨¨

10. Food received at proper temperature. ¨¨¨¨¨¨

11. Food in good condition, safe and unadulterated. ¨¨¨¨¨¨

12. Required records available: shellstock tags, parasite destruction. ¨¨¨¨¨¨

Protection from Contamination RCAONY

13. Food separated and protected. ¨¨¨¨¨¨

14. Food-contact surfaces: cleaned and sanitized. ¨¨¨¨¨¨

15. Proper disposition of returned, previously served, reconditioned and unsafe food. ¨¨¨¨¨¨

Potentially Hazardous Food Time/Temperature RCAONY

16. Proper cooking time and temperatures. ¨¨¨¨¨¨

17. Proper reheating procedures for hot holding. ¨¨¨¨¨¨

18. Proper cooling time and temperatures. ¨¨¨¨¨¨

19. Proper hot holding temperatures. ¨¨¨¨¨¨

20. Proper cold holding temperatures. ¨¨¨¨¨¨

21. Proper date marking and disposition. ¨¨¨¨¨¨

22. Time as a public health control: procedures and record. ¨¨¨¨¨¨

Consumer Advisory RCAONY

23. Consumer advisory provided for raw or undercooked foods. ¨¨¨¨¨¨

Highly Susceptible Populations RCAONY

24. Pasteurized foods used; prohibited foods not offered. ¨¨¨¨¨¨

Chemical RCAONY

25. Food additives: approved and properly used. ¨¨¨¨¨¨

26. Toxic substances properly identified, stored and used. ¨¨¨¨¨¨

Conformance with Approved Procedures RCAONY

Page 2 of 4

KANSAS FOOD ESTABLISHMENT INSPECTION REPORT

Conformance with Approved Procedures RCAONY

27. Compliance with variance, specialized process and HACCP plan. ¨¨¨¨¨¨

GOOD RETAIL PRACTICES

Safe Food and Water RCAONY

28. Pasteurized eggs used where required. ¨¨¨¨¨¨

29. Water and ice from approved source. ¨¨¨¨¨¨

30. Variance obtained for specialized processing methods. ¨¨¨¨¨¨

Food Temperature Control RCAONY

31. Proper cooling methods used; adequate equipment for temperature control. ¨¨¨¨¨¨

32. Plant food properly cooked for hot holding. ¨¨¨¨¨¨

33. Approved thawing methods used. ¨¨¨¨¨¨

34. Thermometers provided and accurate. ¨¨¨¨¨þ

Food Identification RCAONY

35. Food properly labeled; original container. ¨¨¨¨¨¨

Prevention of Food Contamination RCAONY

36. Insects, rodents and animals not present. ¨¨¨¨¨¨

37. Contamination prevented during food preparation, storage and display. ¨¨¨¨¨¨

38. Personal cleanliness. ¨¨¨¨¨¨

39. Wiping cloths: properly used and stored. ¨¨¨¨¨¨

40. Washing fruits and vegetables. ¨¨¨¨¨¨

Proper Use of Utensils RCAONY

41. In-use utensils: properly stored. ¨¨¨¨¨¨

42. Utensils, equipment and linens: properly stored, dried and handled. ¨¨¨¨¨¨

43. Single-use and single-service articles: properly used. ¨¨¨¨¨¨

44. Gloves used properly. ¨¨¨¨¨¨

Utensils, Equipment and Vending RCAONY

45a. Food and non-food contact surfaces cleanable, properly designed, constructed and used-P and Pf items

¨¨¨¨¨¨

45b. Food and non-food contact surfaces cleanable, properly designed, constructed and used-Core items

¨¨¨¨¨¨

46. Warewashing facilities: installed, maintained, and used; test strips. ¨¨¨¨þ¨

Fail Notes 4-302.14 Pf - A test kit or other device that accurately measures the concentration in mg/L of SANITIZING solutions shall be provided.[Has a "pool" chlorine test kit and quat test strips but not "50-200" Chlorine test strips. Owner correctly made a 100ppm chlorine solution.]

47. Non-food contact surfaces clean. ¨¨¨þ¨¨

Physical Facilities RCAONY

48. Hot and cold water available; adequate pressure. ¨¨¨¨¨¨

49. Plumbing installed; proper backflow devices. ¨¨¨¨¨þ

50. Sewage and waste water properly disposed. ¨¨¨¨¨¨

Page 3 of 4

KANSAS FOOD ESTABLISHMENT INSPECTION REPORT

Physical Facilities RCAONY

51. Toilet facilities: properly constructed, supplied and cleaned. ¨¨¨¨¨¨

52. Garbage and refuse properly disposed; facilities maintained. ¨¨¨¨¨¨

53. Physical facilities installed, maintained and clean. ¨¨¨¨¨¨

54. Adequate ventilation and lighting; designated areas used. ¨¨¨¨¨¨

Administrative/Other RCAONY

55. Other violations ¨¨¨¨¨¨

EDUCATIONAL MATERIALS

The following educational materials were provided ¨

Page 4 of 4

Kansas Department of AgricultureDivision of Food Safety and Lodging

109 S.W. 9th St. Topeka, KS 66612(Office) 785-296-5600 (Fax) 785-296-6522

KANSAS FOOD ESTABLISHMENT INSPECTION REPORT

Insp Date: 1/11/2014 Business ID: 98567FE Inspection: 58002648Business: QUALITY INN Store ID:

Phone: 78562880082810 VINE Inspector: KDA58 HAYS, KS 67601 Reason: 02 Follow-up

Results: No Follow-up

Time In / Time OutDate In Out Insp Travel Total Mileage Notes;

01/11/14 08:15 AM 08:55 AM 0:40 0:12 0:52 0Total: 0:40 0:12 0:52 0

FOOD ESTABLISHMENT PROFILE

No Lic. Insp. Fax Insp. Notification Sent Notification To

0Priority(P) Violations 0Priority foundation(Pf) Violations

þAddress Verified¨Certified Manager on Staff 300Actual Sq. Ft.

¨Certified Manager Present

INSPECTION INFORMATION

Risk factors are improper practices or procedures identified as the most prevalent contributing factors of food-borne illness or injury. Public health interventions are control measures to prevent food-borne illness or injury.Good Retail Practices are preventative measures to control the addition of pathogens, chemicals and physical objects into foods.Violations cited in this report must be corrected within the time frames entered below, or as stated in sections 8-405.11 of the food code.

P=Priority Violation, Pf=Priority foundation violation, HACCP=Hazard Analysis-Critical Control Point, BHC=Bare Hand Contact, RTE=Ready to Eat, HSP=Highly Susceptible Population, K.S.A.=Kansas Statutes Annotated, All temperatures are measured in degrees Fahrenheit (°F).

IF YOU HAVE ANY QUESTIONS PLEASE VISIT www.agriculture.ks.gov, EMAIL [email protected], OR CALL (785) 296-5600.

COMPLIANCE KEY: Y=in compliance; N=not in compliance; O=not observed; A=not applicable; C=corrected on-site during inspection; R=repeat violation.

FOODBORNE ILLNESS RISK FACTORS AND PUBLIC HEALTH INTERVENTIONS

Demonstration of Knowledge RCAONY

1. Certification by accredited program, compliance with Code, or correct responses. ¨¨¨¨¨¨

Employee Health RCAONY

2. Management awareness; policy present. ¨¨¨¨¨¨

3. Proper use of reporting, restriction and exclusion. ¨¨¨¨¨¨

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KANSAS FOOD ESTABLISHMENT INSPECTION REPORT

Good Hygienic Practices RCAONY

4. Proper eating, tasting, drinking, or tobacco use ¨¨¨¨¨¨

5. No discharge from eyes, nose and mouth. ¨¨¨¨¨¨

Preventing Contamination by Hands RCAONY

6. Hands clean and properly washed. ¨¨¨¨¨¨

7. No bare hand contact with RTE foods or approved alternate method properly followed. ¨¨¨¨¨¨

8. Adequate handwashing facilities supplied and accessible. ¨¨¨¨¨þ

This item has Notes. See Footnote 1 at end of questionnaire.

Approved Source RCAONY

9. Food obtained from approved source. ¨¨¨¨¨¨

10. Food received at proper temperature. ¨¨¨¨¨¨

11. Food in good condition, safe and unadulterated. ¨¨¨¨¨¨

12. Required records available: shellstock tags, parasite destruction. ¨¨¨¨¨¨

Protection from Contamination RCAONY

13. Food separated and protected. ¨¨¨¨¨¨

14. Food-contact surfaces: cleaned and sanitized. ¨¨¨¨¨¨

15. Proper disposition of returned, previously served, reconditioned and unsafe food. ¨¨¨¨¨¨

Potentially Hazardous Food Time/Temperature RCAONY

16. Proper cooking time and temperatures. ¨¨¨¨¨¨

17. Proper reheating procedures for hot holding. ¨¨¨¨¨¨

18. Proper cooling time and temperatures. ¨¨¨¨¨¨

19. Proper hot holding temperatures. ¨¨¨¨¨¨

20. Proper cold holding temperatures. ¨¨¨¨¨þ

This item has Notes. See Footnote 2 at end of questionnaire.

21. Proper date marking and disposition. ¨¨¨¨¨¨

22. Time as a public health control: procedures and record. ¨¨¨¨¨¨

Consumer Advisory RCAONY

23. Consumer advisory provided for raw or undercooked foods. ¨¨¨¨¨¨

Highly Susceptible Populations RCAONY

24. Pasteurized foods used; prohibited foods not offered. ¨¨¨¨¨¨

Chemical RCAONY

25. Food additives: approved and properly used. ¨¨¨¨¨¨

26. Toxic substances properly identified, stored and used. ¨¨¨¨¨¨

Conformance with Approved Procedures RCAONY

27. Compliance with variance, specialized process and HACCP plan. ¨¨¨¨¨¨

GOOD RETAIL PRACTICES

Safe Food and Water RCAONY

28. Pasteurized eggs used where required. ¨¨¨¨¨¨

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Safe Food and Water RCAONY

29. Water and ice from approved source. ¨¨¨¨¨¨

30. Variance obtained for specialized processing methods. ¨¨¨¨¨¨

Food Temperature Control RCAONY

31. Proper cooling methods used; adequate equipment for temperature control. ¨¨¨¨¨¨

32. Plant food properly cooked for hot holding. ¨¨¨¨¨¨

33. Approved thawing methods used. ¨¨¨¨¨¨

34. Thermometers provided and accurate. ¨¨¨¨¨þ

This item has Notes. See Footnote 3 at end of questionnaire.

Food Identification RCAONY

35. Food properly labeled; original container. ¨¨¨¨¨¨

Prevention of Food Contamination RCAONY

36. Insects, rodents and animals not present. ¨¨¨¨¨¨

37. Contamination prevented during food preparation, storage and display. ¨¨¨¨¨¨

38. Personal cleanliness. ¨¨¨¨¨¨

39. Wiping cloths: properly used and stored. ¨¨¨¨¨¨

40. Washing fruits and vegetables. ¨¨¨¨¨¨

Proper Use of Utensils RCAONY

41. In-use utensils: properly stored. ¨¨¨¨¨¨

42. Utensils, equipment and linens: properly stored, dried and handled. ¨¨¨¨¨¨

43. Single-use and single-service articles: properly used. ¨¨¨¨¨¨

44. Gloves used properly. ¨¨¨¨¨¨

Utensils, Equipment and Vending RCAONY

45a. Food and non-food contact surfaces cleanable, properly designed, constructed and used-P and Pf items

¨¨¨¨¨¨

45b. Food and non-food contact surfaces cleanable, properly designed, constructed and used-Core items

¨¨¨¨¨¨

46. Warewashing facilities: installed, maintained, and used; test strips. ¨¨¨¨¨þ

This item has Notes. See Footnote 4 at end of questionnaire.

47. Non-food contact surfaces clean. ¨¨¨¨¨¨

Physical Facilities RCAONY

48. Hot and cold water available; adequate pressure. ¨¨¨¨¨¨

49. Plumbing installed; proper backflow devices. ¨¨¨¨¨þ

This item has Notes. See Footnote 5 at end of questionnaire.

50. Sewage and waste water properly disposed. ¨¨¨¨¨¨

51. Toilet facilities: properly constructed, supplied and cleaned. ¨¨¨¨¨¨

52. Garbage and refuse properly disposed; facilities maintained. ¨¨¨¨¨¨

53. Physical facilities installed, maintained and clean. ¨¨¨¨¨¨

54. Adequate ventilation and lighting; designated areas used. ¨¨¨¨¨¨

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Administrative/Other RCAONY

55. Other violations ¨¨¨¨¨¨

EDUCATIONAL MATERIALS

The following educational materials were provided ¨

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Footnote 1

Notes: In Compliance with hand towels provided at hand sink

Footnote 2

Notes: In compliance with proper cold holding of eggs. Logs kept to indicate that boiled eggs not consumed by 9:00 am are discarded

Footnote 3

Notes: In Compliance with ambient air temperature devices are in all coolers.

In Compliance with food temeprature device to monitor hot hold/cooking temperatures (new digital one)

Footnote 4

Notes: In compliance with quat test strips, new replacements on hand

Footnote 5

Notes: In compliance with mop/service sink In compliance with fix done for leak that was under the 3 compartment sink. (new joint fitting)

Page 5 of 5

Kansas Department of AgricultureDivision of Food Safety and Lodging

109 S.W. 9th St. Topeka, KS 66612(Office) 785-296-5600 (Fax) 785-296-6522

KANSAS FOOD PROCESSING PLANT INSPECTION REPORT

Violations cited in this report must be corrected immediately unless otherwise noted.

PLEASE CALL (785) 296-5600 OR VISIT www.ksda.gov/food_safety/ IF YOU HAVE ANY QUESTIONS.

COMPLIANCE KEY: Y=in compliance; N=not in compliance; O=not observed; A=not applicable; C=corrected on-site during inspection; R=repeat violation.

Insp Date: 1/14/2014 Business ID: 73801FP Inspection: 58002652Business: COCA-COLA REFRESHMENTS USA INC Store ID:

Phone: 78573594981310 N CATHEDRAL Inspector: KDA58 VICTORIA, KS 67671 Reason: 06 FDA Contract

Results: No Follow-up

Time In / Time OutDate In Out Insp Travel Total Mileage Notes;

01/14/14 01:21 PM 02:24 PM 1:03 0:15 1:18 0 from HaysTotal: 1:03 0:15 1:18 0

PROCESSING PLANT PROFILE

No. of Violations No Lic. Insp. Email Insp. Notification

[email protected] Sent To

þAddress Verified

BUILDING AND GROUNDS RCAONY

1. Are premises free of harborage which may attract rodents, insects and other pests? ¨¨¨¨¨þ

2. Is adequate drainage provided to avoid contamination of facilities and products? ¨¨¨¨¨þ

3. Is sufficient space provided for the placement of equipment, storage of materials and for production operations?

¨¨¨¨¨þ

4. Are floors, walls and ceilings constructed of easily cleanable materials and kept clean and in good repair?

¨¨¨¨¨þ

5. Are food and food contact surfaces protected from contamination in working areas? ¨¨¨¨¨þ

6. Are food processing areas effectively separated from other operations which may cause contamination of food being processed?

¨¨þ¨¨¨

7. Are food products and processing areas protected against contamination from breakage of light bulbs and other glass fixtures? Is interor lighting sufficient?

¨¨¨¨¨þ

8. Is air quality and ventilation adequate to prevent contamination by dust and/or other airborne substances?

¨¨¨¨¨þ

9. Are doors, windows and other openings protected to eliminate entry by insects, rodents and other pests?

¨¨¨¨¨þ

EQUIPMENT AND UTENSILS RCAONY

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EQUIPMENT AND UTENSILS RCAONY

10. Are all utensils and equipment constructed of materials suitable for their intended use and easily cleanable? Is the equipment designed and used in a manner that precludes contamination with lubricants, metal fragments, or other sources? Is the equipment installed and maintained so as to facilitate the cleaning of equipment and adjacent areas?

¨¨¨¨¨þ

11. Is non-food contact equipment in manufacturing or food-handling areas easily cleanable? ¨¨¨¨¨þ

12. Are refrigerator/freezer units equipped with suitable thermometers? ¨¨þ¨¨¨

SANITARY FACILITIES AND CONTROLS RCAONY

13. Is the water supply from an approved source and adequate in quantity for its intended uses? ¨¨¨¨¨þ

14. Are the water temperatures and pressures maintained at suitable levels for its intended use? ¨¨¨¨¨þ

15. Is sewage disposed of through a public sewer system and/or an on site sewage disposal system that is operated and maintained according to applicable requirements?

¨¨¨¨¨þ

16. Is the plumbing adequately designed, installed and maintained in a manner to prevent contamination including backflow, back siphonage and cross connection?

¨¨¨¨¨þ

17. Are adequate toilet rooms provided, equipped and maintained clean and in good repair? ¨¨¨¨¨þ

18. Are adequate handwashing facilities provided and supplied with hot and cold water, soap and sanitary towels?

¨¨¨¨¨þ

19. Is all refuse properly stored and protected where necessary from insects, rodents and other pests and disposed of in an adequate manner?

¨¨¨¨¨þ

SANITARY OPERATIONS RCAONY

20. Is the facility kept clean and in good physical repair? ¨¨¨¨¨þ

21. Are detergents, sanitizers, hazardous materials and other supplies used in a safe and effective manner, kept in original containers, and stored separate from raw materials?

¨¨¨¨¨þ

22. Are all areas maintained free of insects, rodents, birds and other pests? ¨¨¨¨¨þ

23. Are all utensils and equipment cleaned and sanitized, and at frequent enough intervals to avoid contamination of food products?

¨¨þ¨¨¨

24. Are single use items stored, handled, dispensed, used and disposed of in a manner that prevents contamination?

¨¨¨¨¨þ

25. Are clean utensils and portable equipment stored so as to protect them from splash, dust and other contamination?

¨¨¨¨¨þ

PROCESSES AND CONTROLS RCAONY

26. Is responsibility for overall plant sanitation specifically assigned to an individual and are chemical microbiological or extraneous material testing procedures used where necessary to identify sanitation failures or food contamination? Is the facility licensed?

¨¨¨¨¨þ

27. Are raw materials and ingredients adequately inspected and stored to assure that only clean, wholesome materials are used? ¨¨¨¨¨þ

28. Is food processing conducted in a manner to prevent contamination and minimize harmful microbiological growth?

¨¨þ¨¨¨

29. Are packaging processes and materials adequate to prevent contamination? ¨¨þ¨¨¨

30. Are only approved food and/or color additives used? ¨¨þ¨¨¨

31. Are products coded to enable positive lot identification, and are records maintained in excess of expected shelf-life?

¨¨þ¨¨¨

32. Are weighing and measuring practices adequate to ensure the declared quantity of contents? ¨¨¨þ¨¨

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PROCESSES AND CONTROLS RCAONY

33. Are labels of products covered during inspection in compliance (submit violative labels as exhibits)?

¨¨¨þ¨¨

34. Are finished products stored and shipped under conditions which will avoid contamination and deterioration?

¨¨¨¨¨þ

35. Does firm have a HACCP Plan? ¨¨þ¨¨¨

PERSONNEL RCAONY

36. Are personnel with sores, infections, etc., restricted from handling food products? ¨¨¨¨¨þ

37. Do employees wear clean outer garments, use adequate hair restraints and remove excess jewelry when handling food?

¨¨¨¨¨þ

38. Do employees thoroughly wash hands as necessary? ¨¨¨þ¨¨

39. Do employees refrain from eating, drinking and smoking and observe good food handling techniques in processing areas?

¨¨¨þ¨¨

TRANSPORTATION PRACTICES RCAONY

40. Are food delivery vehicles clean and in good repair? ¨¨¨¨¨þ

41. Are food stuffs loaded in the same vehicle with toxic chemicals or other potential contaminants?

¨¨þ¨¨¨

42. Are vehicles delivering refrigerated and/or frozen foods equipped to maintain temperatures specified?

¨¨þ¨¨¨

EDUCATIONAL MATERIALS

þThe following educational materials were provided

This item has Notes. See Footnote 1 at end of questionnaire.

Materials Distributed Education Title # 21 FDA Registration Handout

FDA Handout F.I.R.S.T. Handout

FDA Handout Reportable Food Registry

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Footnote 1

Notes: plus Information Sheet- Assessment of Reinspection and Recall Fees by the FDA

Page 4 of 4