Date: Time: Report: 11/21/17 13:30:00 1006171170 Minnesota Department of Health Environmental Health, FPLS P.O. Box 64975 St. Paul, MN 55164-0975 651-201-4500 Page 1 Location: 4894 Miller Trunk Highway Hermantown, MN55811 St. Louis County, 69 Establishment Info: ID #: 0021616 Risk: Medium Announced Inspection: No License Categories: FBLB, HOSP, FBC2, FAFB Operator: Daves Pizza Phone #: 2187278555 Expires on: 12/31/17 ID #: 27012 The violations listed in this report include any previously issued orders and deficiencies identified during this inspection. Compliance dates are shown for each item. The following orders previously issued on 05/18/16 have NOT been corrected. 3-300C Protection from Contamination: equipment/utensils, consumers 3-305.14 MN Rule 4626.0315 Protect unpackaged food from environmental sources of contamination during preparation. ICE BIN IN BAR IS DIRECTLY NET TO THE HAND WASHING SINK WITHOUT A FORM OF SEPARATION. PUT A SPLASH GUARD IN TO SEPARATE THE TWO AND PREVENT SPLASH FROM HAND WASHING CONTAMINATING THE ICE. Issued on: 05/18/16 Comply By: 08/18/16 The following orders were issued during this inspection. 3-300B Protection from Contamination: cross-contamination, eggs 3-302.12 MN Rule 4626.0240 Properly label all working containers holding food or food ingredients with the common name of the food. A BULK FLOUR CONTAINER WAS NOT LABELED. STAFF LABELED IMMEDIATELY. Corrected on Site 3-300C Protection from Contamination: equipment/utensils, consumers 3-304.12A MN Rule 4626.0275 Store food preparation or dispensing utensils in the food with the handles above the top of the food within the container, in running water of sufficient velocity to flush particulates to the drain, or on a clean portion of the food preparation table if the utensil is cleaned and sanitized at least every four hours or in another approved, protected location. THERE WAS A PLASTIC CUP BEING USED AS A SCOOP IN THE BROWN SUGAR CONTAINER FOR DESSERT PIZZAS, PROVIDE A SCOOP WITH A HANDLE AND SCOOP CAN BE KEPT IN
Page 2 THE CONTAINER AS LONG AS THE HANDLE IS STORED ABOVE THE TOP OF THE FOOD. Comply By: 11/21/17 4-600 Cleaning Equipment and Utensils 4-601.11C MN Rule 4626.0840 Clean non-food contact surfaces of equipment and maintain free of accumulations of dust, dirt, food residue, and other debris. ESTABLISHMENT DID PLACE FRP PANELING BEHIND THE DISHWASHING AREA IN THE KITCHEN, BUT A BLACK MOLD LIKE DEBRIS IS STILL ACCUMULATING BEHIND THE SINK. DISCUSSED CLEANING WITH BLEACH AT A FREQUENCY TO LIMIT GROWTH. Comply By: 11/21/17 Surface and Equipment Sanitizers Chlorine: = 100 PPM at Degrees Fahrenheit Location: DISHWASHER IN BAR Chlorine: = 100 PPM at Degrees Fahrenheit Location: DISHWASHER IN KITCHEN Chlorine: = 200 PPM at Degrees Fahrenheit Location: SANITIZER BUCKET IN KITCHEN Food and Equipment Temperatures Process/Item: Salad Bar Temperature: 39 F Degrees Fahrenheit - Location: LETTUCE Process/Item: Salad Bar Temperature: 39 F Degrees Fahrenheit - Location: DICED TOMATOES Process/Item: Salad Bar Temperature: 39 F Degrees Fahrenheit - Location: CHOPPED EGGS Process/Item: Hot Holding Temperature: 150 F Degrees Fahrenheit - Location: CHICKEN NOODLE SOUP Process/Item: Hot Holding Temperature: 178 F Degrees Fahrenheit - Location: TACO MEAT Process/Item: Hot Holding Temperature: 141 Degrees Fahrenheit - Location: HAWAIIAN PIZZA
Page 3 Process/Item: Upright Freezer Temperature: Degrees Fahrenheit - Location: ALL FOODS FROZEN- TO-GO PIZZA FREEZER UP FRONT Process/Item: Walk-In Freezer Temperature: Degrees Fahrenheit - Location: ALL FOODS FROZEN Process/Item: Walk-In Cooler Temperature: 38 F Degrees Fahrenheit - Location: PRECOOKED CHICKEN WINGS Temperature: 40 F Degrees Fahrenheit - Location: DICED TOMATOES- TOP Temperature: 38 F Degrees Fahrenheit - Location: SAUSAGE- TOP Temperature: 39 F Degrees Fahrenheit - Location: MARINARA- TOP Temperature: 38 F Degrees Fahrenheit - Location: SAUSAGE- BOTTOM Temperature: 32 F Degrees Fahrenheit - Location: DICED TOMATOES- TOP Temperature: 33 F Degrees Fahrenheit - Location: CHEDDAR CHEESE- TOP Temperature: 34 F Degrees Fahrenheit - Location: SALSA- BOTTOM Process/Item: Cooling Temperature: 55 F Degrees Fahrenheit - Location: CHICKEN WINGS IN WALK-IN COOLER @~ 3 HOURS COMMENTS: Total Critical Orders This Report: Total Non-Critical Orders This Report: INSPECTION ACCOMPANIED BY MANAGER COREY KOLQUIST. 0 4
Page 4 BARTENDERS CUT THEIR OWN GARNISHES, BUT NO GLOVES WERE SEEN IN THE BAR. DISCUSSED WITH MANAGER PROVIDING GLOVES FOR STAFF WHEN HANDLING ANY READY TO EAT FOODS. BAR GARNISHES ARE WASHED PRIOR TO BEING CUT. BUFFET RUNS FROM 11-2, ANYTHING THAT IS LEFT AT THE END OF SERVICE IS THROWN OUT. STAFF DO MAKE THEIR OWN MARINARA SAUCE AND WILL PRECOOK CHICKEN WINGS. DISCUSSED PROPER COOLING REQUIREMENTS AND METHODS WHEN DOING THIS. STAFF PLACE THE CHICKEN WINGS IN A FAIRLY SHALLOW PLASTIC CONTAINER AND PLACE IN THE FREEZER FOR A COUPLE OF HOURS, THEN PLACE IN THE WALK-IN COOLER. COOLING LOGS WERE LEFT WITH STAFF TO HELP ENSURE PROPER TIME AND TEMPERATURE REQUIREMENTS ARE BEING MET WHEN COOLING, FOR A REMINDER FOODS NEED TO BE COOLED FROM 140 F-70 F IN 2 HOURS THEN FROM 70 F- 41 F OR LOWER IN 4 ADDITIONAL HOURS, FOR A TOTAL OF 6 HOURS. ALSO, WHEN DEEP FRYING THE PRECOOKED CHICKEN WINGS, THEY NEED TO REACH AN INTERNAL TEMPERATURE OF 165 F. STAFF HAVE DONE A GREAT JOB IMPROVING DATE MARKING THROUGHOUT THE ESTABLISHMENT. DISCUSSED THE IMPORTANCE OF FREQUENT HAND WASHING AND LIMITING BARE HAND CONTACT WITH ALL READY TO EAT FOODS. ALSO, SWITCH GLOVES FREQUENTLY WHENEVER THEY BECOME SOILED OR WHEN CHANGING TASKS. DISCUSSED THE EMPLOYEE ILLNESS POLICY AND THE ECLUSION OF EMPLOYEES SICK WITH SYMPTOMS OF VOMITING AND/OR DIARRHEA UNTIL 24 HOURS AFTER THEIR LAST SYMPTOM. ALSO, CONTACT THE DEPARTMENT OF HEALTH IF ANY EMPLOYEES ARE DIAGNOSED WITH SALMONELLA, SHIGELLA, HEPATITIS A., OR E. COLI O157:H7 OR IF THERE ARE ANY CUSTOMER ILLNESS COMPLAINTS. REPORT EMAILED TO: CKOLQUIST@SKYLINELANES.COM NOTE: All new food equipment must meet the applicable standards of NSF International. Plans and specifications must be submitted for review and approval prior to new construction, remodeling or alterations. I acknowledge receipt of the Minnesota Department of Health inspection report number 1006171170 of 11/21/17. Certified Food Manager: Certification Number: Roxie L. Karppinen FM86021 Expires: 09/29/19 Inspection report reviewed with person in charge and emailed. Signed: Corey Kolquist Manager Signed: Callie Bursch Public Health Sanitarian Duluth District Office 218-302-6173
Page 5 callie.bursch@state.mn.us
Report #: 1006171170 Minnesota Department of Health Environmental Health, FPLS P.O. Box 64975 St. Paul, MN 55164-0975 Food Establishment No. of RF/PHI Categories Out No. of Repeat RF/PHI Categories Out Legal Authority MN Rules Chapter 4626 Address City/State Zip Code Telephone 4894 Miller Trunk Highway Hermantown, MN 55811 2187278555 License/Permit # Permit Holder Purpose of Inspection Est Type 0021616 Daves Pizza FOODBORNE ILLNESS RISK FACTORS AND PUBLIC HEALTH INTERVENTIONS Circle designated compliance status (IN, OUT, N/O, N/A) for each numbered item Date Time In Mark "" in appropriate box for COS and/or R Time Out Risk Category M IN= in compliance OUT= not in compliance N/O= not observed N/A= not applicable COS= corrected on-site during inspection R= repeat violation Compliance Status COS R 1A N/A Demonstration of Knowledge Certified food manager, duties 1B PIC knowledgeable; duties & oversight Employee Health 2 Management awareness; policy present 3 4 5 6 7 8 9 10 11 12 13 14 15 Proper use of reporting, restriction & exclusion Good Hygenic Practices N/O Proper eating, tasting, drinking, or tobacco use N/O No discharge from eyes, nose, and mouth Preventing Contamination by Hands N/O Hands clean & properly washed N/A N/O Hand contact with RTE foods restricted Adequate handwashing facilities supplied & accessible Approved Source Food obtained from approved source N/A N/O Food received at proper temperature N/A N/O N/A N/A Food in good condition, safe, & unadulterated Required records available; shellstock tags, parasite destruction Protection from Contamination Food separated/protected from cross contamination Food contact surfaces: cleaned & sanitized Proper disposition of returned, previously served, reconditioned, & unsafe food Compliance Status Potentially Hazardous Food Time/Temperature 16 N/A N/O Proper cooking time & temperature 17 N/A N/O Proper reheating procedures for hot holding 18 N/A N/O Proper cooling time & temperature 19 N/A N/O Proper hot holding temperatures 20 21 22 N/A Consumer Advisory 23 N/A in MN Consumer advisory for raw or undercooked foods 24 25 26 GOOD RETAIL PRACTICES Proper cold holding temperatures N/A N/O Proper date marking & disposition N/A N/O Time as a public health control: procedures & record N/A in MN N/A Highly Susceptible Populations Pasteurized foods used; prohibited foods not offered Chemical Food additives: approved & properly used Toxic substances properly identified, stored, & used Conformance with Approved Procedures 27 N/A Compliance with HACCP plan and variance 0 0 11/21/17 13:30:00 Risk factors (RF) are improper practices or proceedures identified as the most prevalent contributing factors of foodborne illness or injury. Public Health Interventions (PHI) are control measures to prevent foodborne illness or injury. Good Retail Practices are preventative measures to control the addition of pathogens, chemicals, and physical objects into foods. Mark "" in box if numbered item is not in compliance Mark "" in appropriate box for COS and/or R COS=corrected on-site during inspection R= repeat violation Safe Food and Water 28 Pasteurized eggs used where required 29 30 31 32 33 Water & ice from approved source Variance obtained for specialized processing methods, documentation on file Food Temperature Control Proper cooling methods used; adequate equipment for temperature control Plant food properly cooked for hot holding Approved thawing methods used 34 Thermometers provided and accurate Food Protection 35 Food properly labled; original container 36 Insects, rodents, & animals not present; no unauthorized persons 37 38 39 40 N/A N/A Food Recalls: Contamination prevented during food prep, storage & display Personal cleanliness Wiping cloths: properly used & stored Washing fruits & vegetables COS R 41 In-use utensils: properly stored 42 43 45 46 47 49 50 51 52 Proper Use of Utensils Utensils, equipment & linens: properly stored, dried, & handled Single-use & single service articles: properly stored & used 44 Gloves used properly 48 53 54 55 56 Utensil Equipment and Vending Food & non-food contact surfaces cleanable, properly designed, constructed, & used Warewashing facilities: installed, maintained, & used; test strips Non-food contact surfaces clean Physical Facilities Hot & cold water available; adequate pressure Plumbing installed; proper backflow devices Sewage & waste water properly disposed Toilet facilities: properly constructed, supplied, & cleaned Garbage & refuse properly disposed; facilities maintained Physical facilities installed, maintained, & clean Adequate ventilation & lighting; designated areas used Compliance with MCIAA & Choking Poster Compliance with licensing & plan review COS COS R R Person in Charge (Signature) Date: 11/22/17 Inspector (Signature) Follow-up Needed: YES NO (Circle one) Follow-up Date: / /