‘TENNESSEE DEPARTMENT OF HEALTH FOOD SERVICE ESTABLISHMENT INSPECTION REPORT SCORE =" 3 rovers te (Sl on a ps oe PT He neon UM ZO Grew respuonoate OT (OAILF cxssssrmers LFFLOS o Puposeerivpeetin @'oune OF owup — excasgey — eee nee ee na eaten eres LEO me TERED aT =F Sia aS eee ‘Sona Fr bry (08 Foose t|alo [9 [| # | eo} 0 Cig ae a opr ojo), fara H-o 0 6 | isratanty peecrersrnrrains ——{0 [0 ue stow { vel Conon Naas Bs one a Ts s}60 trans wooa come! SeaTe — 9) 0 @ | oparainine ners o[o et rt Po sang ing ttn ee 88 S}ete| Pe posse st rene berets 818) © cc herd cman —t Eretete 8 twee researc omer Of] «| Hel ele O° *Ip|0|0[0 femermegeegnreesem= [oo] *| [ome nt comer ry | LI ef el aT 0] 0] 2 | eee reneerennrmeesee To Tol « | 318 LO acaiaret en Spare ors —— Su | Ng ass Paper Mn ti 0/0] @) Passes txts wes sontncrnteotcteve | 0] 0] fo [o| d]o furs mae a dos pase whe ‘oe I ms | sisson em Contant ©) Food adtiives: approved and oroperiy used 0/0) lale(o|o| ptepeteanecntal losunees Pas) ome tetas —[ 66] ais ete rma = Sea so, peomniemecmramre= te {o[s|[sfelo/@| Seen ool + oor [3 Srie eerforsmrer cr righ (rescue aad [of seen i een ec ea Le 1 sensing cites, ned raraned vedienon ‘| a | 0 fjente eres unt eae sumreviowmeweun To [a] [ao rer ea peers area otal] Pal erwcoawen waar sean —— ={8] =FS1SEH (a © utesnsie! pope Stor acer = a8 OTOL] [Set oeerne an wave wa wens Sop ola [4 [-9- fam acer poy cried tied tener ——— 00 + 36 | 0 [rspepoy ves oma crane ut mendes | 0[0] + | | s#| 0 [oareerene pepe ops ses manana oo + ur Prereaon of Food Gana “6 earn te are aoe — ola @ [rset onda ma pep © [of) [| © [aca enim ny Soar ass eed 0/0 7) @ fens even ung oe ern Sb ee [or ‘amir ne 60 rama ¢ —— rosy] 0 ig psy res * hereon pe {3 32 |watta fo oe veer o Conpinos iaan ee Pre Uso sas ——— r ocbeioe PeeeiaT AS Ee suelo Termeni Poon or atest od tan pepS SO al a es ° (¢ Sng rgissenen wise aut ae od Inebeeza oa we ay core o TS loc meas ¢ A * ntl ney wet anon ton atl sn gata ondnrin aT Fron Sy fear POE ea ove Piao cal | FETA wos ors can.DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH RISK BASED FOOD INSPECTION REMARKS ESTABLISHMENT OR NAME #52] aooress 204 fits ack El gE Ci TN ror 0) co# iu [55 oe sw 870 mos (ex! fos Pe Corrective Actions Completed at the time of inspection COOKING TEMPS COLD HOLDING TEMPS HOT HOLDING TEMPS COOLING TEMPS ITeM/TEMP ewe IreM/Teme rem Teme 7 thoi TA lA z N b °F RP a5 7 W # A 5 SF F WT 7 ‘| [Hom wii oo a4 4 Tenp Observations: aT UE p Tinnslen) 5 AQ g Gull alin Send HLlet, PERSONAL HYGIENE (HP, BHCEDUCATION RAN Tippee 2) employee health policy: /4) hey si Lincthve wade Siqued cop, Desenber OT Frou EDA fe hbA plyeps' Fle Chaska ts awe of avlnboes Me Ott: Helusica th 1 eM, Les. ZBarehand contact with RTE [bo nat markat this time, EDUCATE) Education provided) N ‘etion taken ZL ee asad Ls $e ued BHO wif VTE ler 3] Handwashing/ygiene observations: f Bh hands perm adligaate Belo Ly. Dsus: 1 Lae J = ‘ROSS CONTAMINATION & WAREWASHING: “Sanitization Concentration: Temp oe ppm NID Dsesed He faieype Mutiael On Foon source: [Pino Lon eBay Ta Tip 1 on Ve it OTHER OBSERVATION: cocker LZ j Walls oneach Fey Mica Lest 5} epi S 2) No c Environmental Health Specialist i Signature . Establishment Representative be OF, one/eha ) ‘Signature : PH 4189 (Rev, 03/14) RDA 629DEPARTMENT OF HEALTH. DIVISION OF GENERAL ENVIRONMENTAL HEALTH SUPPLEMENTAL REMARKS AND RABIES PROGRAM. ESTABLISHMENT OR NAME 0! Domino's F472 aporess 294 Annes Crock wd bay TV. vate Goa HF ror 0/ cow _ QO este 1905 starre GIO vros_fgvd! REFERRED TO program cove “05 Male: Fags niet Styles best Confea | Tc. a3 A5Z-93FT siedAhe lacility on At fs 05h fis onl Wel o5fe2 jig sin walle ye 4 \ dehy : # ve. eli, y zF a DES 0 we f. IL $ Mea peo les up eat conti zal ae “ tee © earadis! fag" moh “un de pod deppings cn in fie iM fe ietataeegcet te Sih Food Temperature Readings: Sanitization Rigse Concentration/Temperature: moe _/ Ar 50a avisits | ENV IRONME OPERATOR PH-2869 Buz Food Safet EY: Availble At No Charge. RDA 629 2/06 Call 13 a (3 For Schedule.Sot 4 DEPARTMENT OF HEALTH DIVISION OF GENERAL ENVIRONMENTAL HEALTH SUPPLEMENTAL REMARKS AND RABIES PROGRAM estastisiment or name [oming’s 5471 vooess 2694 Aviles Creek Rd Cay W DATE asfeallg op 301 con GO este (Sais sey &7O_vroc [vee REFERRED TO prosram cove “05 Food Temperature Readings: Sanitization Rinse Concentration/Temperature: ENVIRONMENTALT d 5 nme _/ Ar 50min operator f2. #visits | Vv PH-2869 Food Saf PH ty Training Availble At No Charge. RDA 629 2/06 Call 4ad. D157 74/Z For Schedule.of DEPARTMENT OF HEALTH DIVISION OF GENERAL ENVIRONMENTAL HEALTH SUPPLEMENTAL REMARKS AND RABIES PROGRAM. esrastisimenr or naw (pig's 5471 ames L69Y Lures Crk bo Eroy TV. pare 25a) ror JOl cow WO st (5405 saree G70 __ vros_[Zpal REFERRED TO PROGRAM CODE (17S Me. ecu teil 0515 c any 5; Qi hoss\di lo tite im da Mop. it activity. Minugepuwat filed Thal Ll exeo Toles in walls Nive bel Seale | eed. : A 4 Mike: Makoqement alates The foclify wll remain ekseq HT facility is thcwaugh ly clagead. Food Temperature Readings: Sanitization Rinse Concentration/Temperature: ENVIRONMENTALTS J ame _[ Ar SO pin OPERATOR # VISITS BH 2669 Food Safety Training Availble At No Charge. RDA 629 Reve 5/06 Catt 425-975" 714 For Schedule.TENNESSEE DEPARTMENT OF HEALTH FOOD SERVICE ESTABLISHMENT INSPECTION REPORT SCORE jyecttamitmen © Perret ONste © tensray OSes ow mi O_ Garo [BHO ) ronson OUGS HE catmanes [5505 enemcent pup tmgacn @fatre —OFeiowp Carpet OPiray——O Contr fotowipRanied _@ Yer O No B congianas sie care Ler 7 7 =| ‘aig nd akong of Tone | Farsan ih charge prevent damoraiates Woweaye, ae ———————— o00 ee ° oro w po pancetta ogy sea 1 — BL © |B [me arwlgcer ra i = ‘Conn adn, ts Making, so Tine 68 ° [Proper use of rasiction nd exclusion ° ee ee ‘# Public Health Controt | 6 rte 3 sta sin OT a] e{ 0) "(0 pomrasing nama ttm weenie ———| ToT, | flo ow 0 franramsm unxer ° }e[9) 8 fount tm ap rove str 8{8|*| fie) 88 © Parcssnamy omnes S13] Leer mao | — {8 | ©. oper sarmanty a sao fete] TO Tee a oe ee ee Sty ©} | © | 0 [Time as 8 pubic haaim corte: procedures ancraccrds | © | O rele eLetter 0 [0 Fa tat cr TES emia peal eagerenanaw—bo10l| Jalal o| 8 fxemmmenvmmdermerowasT Too] 4 a efo dies on reson Fe [oy | | orm no — i sana pions — = HE ee ee remes ——+8 +0) «| flo] © | ¢ | Paettstote ius rneaastnsresctees | 0 [0] + fz] 0 | 0 | a | 0 [Resutes esos avai Sor ox sr ‘ofo 1 four] ma |v) 7 jor | aca Ra eo js} © | nasi meme yoy, 30 foxsianense ne are Foyora] tile[ ot rmcsnstes pussy oxmot toes ao —[ OO oR ve fol e| [im fa of 0 | farcenntctnenmn mmsnarae 9 |ols| xlo 5 a = 2 EEE vrarae nee oa Ue a Rae a “fo SS [oo wcvoraodemmnt toms ane a apa —t 5 To + 3 [Sram ond lor ° riryas) 1 PS gna se nnn ores 2, oop 19 Foto oar as rD 2 [ols 8 lest haw ae o S{3[4 0 [rnsay poe aos 2 [Sova aac Bap apt ne fo so ee Sort (© feeders ra tie: me abe © [ovtaprtes ey prs ler rind ool or von of Food eoramaton 2 prs ator ae aes arn i 7) @ ras sos een [ecu verison od gg reed wena olor Fa one rind ir apn ta 8 Sy on ‘Admit os "a {0 port cmais 0 erp aE 39] S50 [rag con oops © hiner os 218) 218 onptanas Se Repel ar oeacios PobowoT AT [ae | |eaxpiororor erste Poncorr 3 ois cama tee = {88|° 33] aan as bn ae Spt a + patton od tyne art en cw: gout odeaie — inn eal ras fd safe ang diss we veld sah mon ate cuy Psi dete al Pentecat O20) Pz ‘oonran oa cseDEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH RISK BASED FOOD INSPECTION REMARKS. 6 547 ESTABLISHMENT OR NAME aporess 2694 Aries ay WW 27s" row 301 cor FO Est# [55605 stare FZ) prog GOS Document all Corrective Actions Completed atthe time of Inspection COOKING TEMPS ‘COLD HOLDING TEMPS HOT HOLDING TEMPS COOLING TEMPS (TEM/TEMP ITEM/TEMP (TEM/TEMP ITEM/TEMP- 220. I L “ Ly “*] fella ATA i MH * Sei 4 “A 3 7 5 4 . 5 Z . Temp Observations: i Pe ae deopukaged., is fe si fee EAS ree 5, All Wing, ae ‘pieticked FCeME A HOZEN, Ss Brother empty Hey is a bal nphae z Dh=ke B PERSONAL HYGIENE: (EHP, 1) Employee health policy: Describes (7 Baton ake seg Tees tulensils Biya puden les cad Der he Band Ng pact '3) Handwashing/hygiene observations: We Enok zal eS ‘GROSS CONTAMINATION & WAREWASHING: “Sanitization Concentration: Temp “ppm oe Mat SF Up 5 7 Lead nialat dagh alc aa pkg Environmental Health Specialist Establishment Representative Signature Stiles 1% He aes exte-minalor Jour’ Trim Hurl PH 4189 (Rev. 03/14)TENNESSEE DEPARTMENT OF HEALTH FOOD SERVICE ESTABLISHMENT INSPECTION REPORT SORES cstastmertxane __DOMINO'S 5471 syoectEsainunan ‘BPomunert OvedIe nooress. 2694 Boones Creek Rd. 0 Temporary —OSeescnsl ow Gea toon LADO. mn(Gi>eece LA: 55D tnspacten vate — 4 10041 11.7 eossterment s 605155605 enbargos Puowootepecion Rowe OFstomap = OCorgnt—=—OFiaiminty «Comune Riencoomy Fatowsp Reqtss _O Yor @ No SEER Sag eros OMIT 15 To f= oan ‘coos Hyglente Practicos — 08) ola) jaa eou2 olvosiad eleza 2/008 oldodid ojddo i ‘Oss ons pny wee ~ 0 [0 Faeroe ements inc TATE Sins ree susie an ERs Sonesta W Foarresaesaroooererooatre ° © © o- o Hs 19] 0 ferent str sonco Fane No Pisaion ot Canario Ot potmeus antes ——— Toy © ° owas Ls a Z 1 See 9 | 0 Lesaneton amt arers sole Pave 9 Le] 5 tues ee sas eg © «| © |racreng testes raha ranarec vee woemss [0 [0] + Sat Food Tomer Coe —— vs = Peprotonetos ier eesecsonanremoraie | 9 |g] y| [7] 0 etcmmara ojo) EEE oo/T| faa pera warait ent [ore or form nora S1O/4| (| 8: puntrs nat noe satorsme= 61 9|- ST RO 8/01 | || © lsmoom vane wr pow as Sol od sao =i | 6- er pe sonbet Spa aor Sots 35 [0 fowivoyiy St cimlcmrermaacarecraminse [0 [O]+| [52 © fotemrue roxy crests nantes 0} + Parse oF nena | a) | 0 pa ter re md ae ool a (© sei, rts an ann et rset 0 [Of | 5+) © |acesute vente anaighns dened was ued oo} + 37 | © [Contamination prevented during food preparation, storage & display | O | OY 1 our | ‘Adetostrative toms ato iar 99 | +1 [50 femme - [olor s | 318) oe ¢ So on e+e) {3-0 |oeeny ru vepubon oer feahiey we Fropr Us oT US [0 esses mene 19] aaa area ETO ojo; | 2-8 (ests ceuemnn ne psa etree —| 8 fo nae 3/8) 6 [Ss }8 fieossance-svee ses nore Sn UGA eS NEPA NY aS o Sie 18 res fod safely Waring cages ae avalable each month af coury Peat depart = Pease cal ( 473 1 Q75-7913. to grap era cess.+ =Temp Violation DEPARTMENT OF HEALTH cOS= Corrected on Ste DIVISION OF ENVIRONMENTAL HEALTH PIC = Person in Charge RISK BASED FOOD INSPECTION REMARKS ESTABLISHMENT OR NAME Lilet [ADDRESS 2694 Boones Creek Rd Fow 301 cow 90 EST# 605155605 stare Jif 28d S70 pros 605 Document all Corrective Actions Completed at the time of Inspection COOKING TEMPS ‘COLD HOLDING TEMPS HOT HOLDING TEMPS COOLING TEMPS (TEM/TEMP: iTeEM/TEMP. TEM/TEMP- ‘TEM/TEMP_ ON Tt c 4 iD = fee Bar| at tlt | Ere A | Sz" ci ¥ = ies en Sausage |3 7 i | ‘Temp Observations: Thermometer Margin gf error = 2° F RRA OR, HA CDU ONT OTTO 1) Employee health policy: Noli Lh pluie Fi bfacapy ok FDA Fem 1B Describe: 5 Lug ult food YES Le OY hVeeS FP: cor 2] Barehand contact with RTE (D0 not mark a this time, EDUCATE) Education provided” 7 _N ‘ction taken: Ves 2 ileasils 3) “—, observations: _ Discussed proper hand washing procedures with PIC X'S lo ‘CROSS CONTAMINATION & WAREWASHING: 7 Sanitization Concentration: Temp st Stripe Vor FOOD SOURCE: =, “733. ‘OTHER OBSERVATIONS: > Backdwr 15 ret Fight ting at Te Wbiom. Environmental Health Specialist Time: _ F271, Establishment Representative Date alll ROA 629, PH 4189 (Rev. 03/14)‘TENNESSEE DEPARTMENT OF HEALTH FOOD SERVICE ESTABLISHMENT INSPECTION REPORT ‘SCORE cimuennauiere _DOMINO'S 5471 pecteowonen ‘Perens OMe ~ —_ 2694 Boones Creek Rd. ‘0 Temporary © Seasonal om Cay owen LB AO) GD roe 4 JO gD rapactn Oat TID 1 Hp cswermens — 605155605 Emooons Puce ctiepeen Gease —OFalonyp——OGampuke ~~ Pinay, Ganansoe fcaenoy ° os os mo ‘perdi 1a 0 = = ol | beater reac ata ———T OTT» se = “| heeree ghesiematctm — (218 ee ove ges toro, | "ly lox|us/o|mwoeianm ecm isle] ecroereeee g sl peewee OFT een aE — eg ge obese caer | see Epp : HE er pe et eaeres (et Seana Oe eestor Sfp See rccosemem OP | Re co a DIE] as}o] 0 [a | femameraony ponte tronendwneowieates| 0 JO] # : =| (shir cera B.| foots olga ois S18 fo) PME otr| ble tela Sc a eee eee zh flor : eh Jisenaeirg ols aie marinade ores ool + pa ° sess ale Ta Ror cnaroao [te $6" pans ss war waar sr we : [-O- Ponora rau sore Son aves xo (8- Senoe on wai wale pty Sse a» lo ° jeu Finer rs o 38 | 0 onc rodents an ant eset ° 7 | 0 (atari ng hooper, rie & apy oa “8-0 era aera ~ io io = Compan SE few [== Iam rr ‘or nchers Protcow AT | 0 fos vam pen te more wi Tne Pee Oo ‘26 Unt avg wd rare mR eda ‘S| OOo — S19] ¢ 2. |g Sorcerer neers [esses rs Sis stn tnt nema rd ein mest PN = a Cal y ARTES SERRE HS TO STS Say Ta on l Boose cal 42S 7S TOLD toanwlerncaes xeDEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH PIC = Person in Charge RISK BASED FOOD INSPECTION REMARKS ESTABLISHMENT OR NAME DOMINO'S 5471 ADDRESS __2ae names, For 301 co#___39 EST#__ 605155605. start Vast S/ PROG __ens Document all Corrective Actions Completed at the time of Inspection COOKING TEMPS COLD HOLDING TEMPS HOT HOLDING TEMPS COOLING TEMPS ITeM/TeMP ITEM/TEMP ITEM/TEMP eee Ghana di2za [4b | i 37 ‘| na “FI ee 57; Wit ci We 2 FF *F a 77 Gi * ‘Temp observations: aa PERSONAL HYGIENE: (EHP, oN Db JNDWASHING OBSERVATIONS) / 1) Employee iliness policy: folie NM Diener iy em "1 Describe: piseusced ne to preventSiole ehployees working with food @ Ne (estrlehicn eMacad 2) Barehand contact with RTE (Do not mark at this time, EDUCATE) _ Education providedy“V 2 N ‘Action taken: piscussed NO-BAREHAND CONTACT POLICY WITH PIC. WIN Fadi UPS LAS 3) Handwashing/hygiene observations: Piscussed prover hand washina proos wath PIC (VY N f fi | [ Oper plz ae Paes J L ‘ROSS CONTAMINATION & WAREWASHING: __ “Sanitization Concentration: Temp *F_ppm 2210 ; Guay’ c- ; Dish washer hole sink} rest Strips (¥.drN) \ — pam AZZ) (aust ck Senrbucker, test Strips (fat N) Yi68 FOOD SOURCE: —~FikGe “GkS ~SYSEO REINHART Lt OTHER OBSERVATIONS: 1 1 O7 Sveal DAVES eaetS Ide of 24M phan Ace a ey 4 Environmental Health Specialist TED Time: AD Ge Sinai Establishment Representative fl le Nia st Date: l 5 t PH 4189 RDA 629‘TENNESSEE DEPARTMENT OF HEALTH FOOD SERVICE ESTABLISHMENT INSPECTION REPORT ‘SCORE ‘pat esate Bo: 2A 6 patent ° borne cee COO ors LoS larageaetar bor oper] elo Provr oe fst ndencnin 0 jo|*|| |™ ee ae lds 2 e100] a Bicists 8 AE ojo ee ey fag ior SS : fee ets = Icio oe a apo Lilt oo hewsnenersecy tame ners ——Teyo| * ages teen nig eae ae (soganguonearomtc ura eran evans. | g Tg elo 0 Peps sora shots somunsoaremen rereeatve 9 Jo] « fools [tid apace aru olole| f= ofols [8 foposes tenrgmnooroes foots fe tor 1 [nemesis vied near ool t| [slo ofot 3 ian = sche ore} 0 sotaceety ares aigmatconiacogsvarecntemaiwce | [01 | | | 0 of + 5 aaa Ros Canina | 0 pres ats Fates naires aosemsn To fo} | (@ [rss reso danas nt per @ [Of [54 | 0 porte vesaton enor ensrec wear unas oft fy 0 [eananinatin pearing ind papain, sre haoay | 0 [Of | | [aut] ‘Altai 1 [Pesart cease OO) 1] [55 | 0 |corenowetpome “foyer, gig a aoa war OT] [se 1 O-tseecoiepec sams — 878 ‘hy at pane foie Comics Sain es vo] We 1G ins us wey nr 90" congo win TWh Se sie A 1 [ser on er: apy are wi an 1 [ones rosie ore rs —eio| « o 1-8 ebecs prac pa 8181 Fie ed yin | Ponte cat 2S 1S ‘ar gate co anh ane coury Peal sereren=nt 73 woargaiptre oats ree, engl Me Apis feDEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH RISK BASED FOOD INSPECTION REMARKS ESTABLISHMENT OR NAME ADDRESS 4 2 row 30) con 40 est# " SGde stare 70 Actions Completed at the time of inspection COOKING TEMPS COLD HOLDING TEMPS HOT HOLDING TEMPS COOLING TEMPS ITEM/TEMP- ITEM/TEMP_ ITEM/TEMP. yg /TEMP Papuan; #:22aVeT = 4 7 FZ || WIA LA Was Baga | Appa Ay =F (ine, 25k | Alsace aM S "Temp observations: PERSONAL HYGIENE: (EHP, BHC-EDU jon a BSERVAT] yee . ds 1) Employee iliness policy: N_/Y iy Le A ALice Dscusse] (eg iveauy). Describe: L lee bn ehah y cy FM AAAI 2] Barehand contact with RTE (Do not mark at this time, EDUCATE) _ Education providedy Y_N ‘Action taken: Disussid (eyuiemed(2, Facility uses whi ils. j 3) Handwashing/hygiene observations: Y LUV LAL LL Zt Vad: CROSS CONTAMINATION & WAREWASHING: Sanitization Concentration; Temp === “F_ppm 40 QUAT aviizeriised, al Sirs pada Wa ule. Foop source: (Jp) LUC eaopi Qe ATT LBS. OTHER OBSERVATIONS: Sle Back doo WMS Gedo Sabb A Environmental Health Specialist Time:_ 50/00 Establishment Representative _ vate /<2/, Ls Signature PH 4189 Food sey Tralningavalohe at no charge. ROA 629 7 for schedule. CallDomino's * 547/ HOT booms 0 ok hel Johnscr City FUls est 19505 @ Tennessee Environmental Health Food Code Soft Rollout: July 1- December 31, 2015 Survey of New Food Code Requirements Page 1 of 2 1) Supers ion ://tn.gov/assets/entities/health/attachments/Demonstration of Knowledge.pdf 1. Is there a Person in Charge (PIC) present? yes Discussed pegs /remg: sats 2. Can the Person in Charge (PIC) demonstrate food safety knowledge by any one of tHfé following? “2S = Certified Food Safety Manager © ANSI approved programs: 4 https://www.ansica.org/wwwversion2/outside/ALLdirectoryListing.asp?menulD=8&prgiD=8&s tatus=4 = Answer basic food safety questions applicable to the operation XS = Have an inspection with no Priority Item/ Priority Foundatio! 7) No Bare Hand Contact with Ready to Eat (RTE) Foods pol Ve yf " vp Ma Lot http://tn.gov/assets/entities/health/attachments/Bare_ Hand Contact.pdf DL t Are ready to eat (RTE) foods handled with bare hands? VO 1 piel 1b. © Handle all RTE foods with utensils, gloves, or other barriers Yes se tens | - «Apply for a variance from No Bare Hand Contact yY htto://in.gov/assets/entities/health/attachments/Apolicatioh_ for Bare Hand Contact Procedure.pdf 21) Date Marking http://tn.gov/assets/entities/health/attachments/Date Marking.pdt Are ready to eat (RTE), Time eon Control for Safety (TCS) 4 am or. je and then held for more than 24 hours? B.ey i plier ‘Those foods must be date marked to indicate the date on which the food must be served or discarded (maximum hold time is 7 days) XS. 23) Consumer Advisory Mp hi tachments/Consumer 7 ‘Are meats, fish, or eggs offered raw or undercooked Examples include over-easy eggs, sushi, medium rare hamburgers, and etc. ‘AConsumer Advisory that in customers of the increast undercooked animal f 5 Disclosure and Reminder is required to inform your ‘sk of foodborne illness associated with consuming raw or PH-4285 RDA-629,Domino's * 547] eh 19505 Page 2 of 2 TeneseeEnenmertal Heat Food Coe soft allot ly December 33,205 Survey of New Food Code Requirements whe 24) Highly Susceptible Populations http://tn.gov/assets/entities/health/attachments/High! Does this food establishment serve a Highly Susceptible Populaj foodborne disease because they are: frildren, or older adults; AND ides services such as custodial care, health care, or assisted living, center, kidney dialysis center, hospital or nursing home, or nutritional as a senior center. 1. Immunocompromised; preschool aj 2, Obtaining food at a facility that such as a child or adult day or socialization services s, IF YES: ‘© Must serve ONLY pasteurized juice or juice prepared onsite under a HACCP plan © Must use pasteurized eggs or egg products must be substituted for raw eggs in the preparation of fariance from bare hand contact is not avgitéble to establishments serving a HSP Time as a public health control may noe used for raw eggs in establishments serving a HSP 27) Conformance with Approved Procedures Does this establishment conduct any of the folowing “Special Processing Methods”? N ri Smoking food for preservatieA Curing food Acidifying foods for prpServation, to render the food Non-TCS 6. Custom processing animals for personal use as food and not for sale in a food establishment Yous ce beans g/2 Uf, SS fel Person in Charge “Hy wironmental Health Specialist PH-4285 RDA-629,