Score
Rating
Retail Food Establishment Inspection Report
Bureau of Environmental Health Services
Division of Food Protection & Rabies Prevention
Inspection
Establishment Name
Date
Start Time
End Time
Type of Inspection
Address
/
/
:
:
Category
Follow up
Permit #
City
County
Zip
1
2
3
4
o Within ______ days
-
-
Good Retail Practices
Foodborne Illness Risk Factors & Interventions
Supervision
Safe Food & Water
OUT CDI
OUT CDI
2
Pasteurized eggs used where required
1
IN
28
PIC Present, Demonstration, Certification, Performance
IN
NA
1
0
Employee Health
Water and ice from approved source
29
IN
2
1
Variance obtained for specialized processing methods
Management; employee knowledge; responsibilities &
30
IN
NA
1
2
2
IN
Food Temperature Control
reporting
3
2
Proper cooling methods used; adequate equipment
Proper use of reporting, restriction, and exclusion
IN
31
IN
1
0
for temperature control
Employee Good Hygienic Practices
Proper eating, tasting, drinking or tobacco use
2
32
IN
NA
NO
Plant food properly cooked for hot holding
1
0
4
1
IN
No discharge from eyes, nose, or mouth
2
Approved thawing methods used
5
33
IN
IN
NA
NO
1
0
Preventing Contamination by Hands
Thermometers provided and accurate
34
IN
1
0
Food Identification
6
4
Hands clean & properly washed
2
IN
7
3
Food properly labeled: original container
NO
No bare hand contact with RTE foods
2
35
IN
1
0
IN
Prevention of Food Contamination
2
8
Handwashing sinks supplied & accessible
1
IN
Approved Source
Insects & rodents not present; no unauthorized animals
36
IN
2
0
2
Contamination prevented during food preparation,
9
IN
Food obtained from approved source
1
37
IN
2
1
storage & display
10
2
NO
Food received at proper temperature
1
IN
Personal cleanliness
11
2
Food in good condition, safe, and unadulterated
1
38
IN
2
1
IN
Wiping cloths: properly used and stored
Required records available: shell stock tags, parasite
39
IN
1
0
12
2
NO
IN
NA
Washing fruits and vegetables
destruction
40
0
IN
1
Proper Use of Utensils
Protection from Contamination
In-use utensils: properly stored
41
IN
NA
Food separated & protected
3
2
IN
1
0
13
Utensils, equipment and linens: properly stored, dried
Food-contact surfaces: cleaned & sanitized
3
2
14
IN
42
IN
1
0
and handled
Proper disposition of returned, previously served,
2
1
15
IN
Single-use and single-service articles: properly stored
reconditioned, and unsafe food
43
IN
1
0
Time/Temperature Control for Safety (TCS Food)
and used
Gloves used properly
Proper cooking time and temperature
2
44
16
IN
NA
NO
3
IN
1
0
Utensils & Equipment
17
IN
NA
NO
Proper reheating procedures for hot holding
3
2
Equipment, food & non-food contact surfaces approved,
NA
NO
Proper cooling time and temperatures
3
2
18
IN
45
IN
2
1
cleanable, properly designed, constructed & used
NA
NO
Proper hot holding temperature
3
2
19
IN
Warewashing facilities: installed, maintained & used; test
NO
Proper cold holding temperature
3
2
20
IN
NA
46
IN
1
0
strips
NO
Proper date marking and disposition
2
21
IN
NA
3
Non-food contact surfaces clean
NO
Time as a Public Health Control: procedures & records
1
47
22
IN
NA
2
IN
1
0
Consumer Advisory
Physical Facilities
Hot and cold water available; adequate pressure
Consumer advisory provided for raw or undercooked
48
IN
2
1
NA
1
23
IN
Plumbing installed; proper backflow devices
foods
49
IN
2
1
Sewage and waste water properly disposed
Highly Susceptible Populations
50
IN
2
1
Toilet facilities: properly constructed, supplied & cleaned
Pasteurized foods used; prohibited foods not offered
1
51
IN
1
0
24
IN
NA
2
Chemical
Garbage & refuse properly disposed; facilities maintained
52
IN
1
0
Physical facilities installed, maintained and clean
1
53
25
IN
NA
Food additives: approved and properly used
2
IN
1
0
Meets ventilation and lighting requirements; designated
Toxic substances properly identified stored and used
2
1
26
IN
54
IN
1
0
Conformance with Approved Procedures
areas used
Compliance with variance, specialized process, reduced
Chapter 8 & 9 Violations
NA
2
27
IN
55
Chapter 8: Compliance & Enforcement
oxygen packaging criteria or HACCP plan
IN
IN
56
Chapter 9: Standards for Additional Operations
1
Remarks:
DHEC Inspector Name _______________________________ DHEC Inspector Signature ____________________________ Phone # ___________________________
PIC Name ________________________________________ PIC Signature _______________________________
SOUTH CAROLINA DEPARTMENT OF HEALTH AND ENVIRONMENTAL CONTROL
DHEC 1722A (06/2016)
Consecutive violations may be subject to enforcement action and penalty
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Information collected on this form is subject to public scrutiny or release as well as the Freedom of Information Act