Standard Inspection Report

Authority Chapters 3717 and 3715 Ohio Revised Code
Name of facility
Check one
  FSO    RFE		 License number
    		 Date
--
Address:  
                 		Category/Descriptive
License holder
 Inspection Time (min)
    		 Travel Time (min)
    		 Other
Type of visit (check)
  Standard       Follow Up       Foodborne       30 Day
  Complaint      Prelicensing    Consultation     Other specify		 Follow-up date
(if required)
--		 Sample date/result
(if required)
--
Chapter 3717-1 OAC Violation Checked
Management and Personnel Poisoness and Toxic Materials
  2.1  Employee health
  2.2  Personal cleanliness
  2.3  Hygienic practices
  2.4  Supervision
Food
  3.0  Safe, unadulterated and honestly
 presented
  3.1  Sources, specification and
 original containers
  3.2  Protection from contamination after
 receiving
  3.3  Destruction of organisms
  3.4  Limitation of growth of organisms
  3.5  Identity,presentation on
 premise labeling
  3.6  Discarding or reconditioning
 unsafe, adulterated
  3.7  Special requirements for
 highly susceptible populations
Equipment, Utensils,Linens
  4.0  Materials for construction and repair
  4.1  Design and construction
  4.2  Numbers and capacities
  4.3  Location and installation
  4.4  Maintenance and operation
  4.5  Cleaning of equipment and utensils
  4.6  Sanitizing of equipment and utensils
  4.7  Laundering
  4.8  Protection of clean items
Water,Plumbing, and Waste
  5.0  Water
  5.1  Plumbing system
  5.2 Mobile water tank and mobile
FSO/RFE water tanks
  5.3 Sewage, other liquid
waste and rainwater
  5.4 Refuse, recyclables, and
returnables
Physical Facilities
  6.0 Materials for construction and repair
  6.1 Design, construction and installation
  6.2 Numbers and capacities
  6.3 Location and placement
  6.4 Maintenance and operation
 
 
  7.0 Labeling and identification
  7.1 Operational supplies and
applications
  7.2 Stock and retail sale separation
Special Requirements
  8.0 Fresh jucie production
  8.1 Heat treatment dispensing
freezers
  8.2 Custom processing
  8.3 Bulk water machine criteria
  8.4 Acidified white rice
preparation criteria
  9.0 Facility layout and equipment
specificatins
  20 Existing facilities and equipment
901:3-4 OAC RFE Only
  12 Articles - Cease use
  13 Records
  14 Food sample collected
  15 Embargo of food/Voluntary
destruction
3701-21 OAC FSO Only
  27 Embargo of food
  
  
Inspected by
 R.S./SIT #
 Licensor
Canton City Health Department
Received by
 Title
 Phone
 

Continuation Report

Authority: Chapters 3717 and 3715 Ohio Revised Code
Facility Name
Type of inspection
Violation(s)/Comment(s)