YE
SN
O
SM
OK
E-F
RE
E A
IR A
CT
15R
“No
Smok
ing
or U
sing
Elec
tron
ic C
igar
ette
s” si
gn n
ot c
onsp
icuo
usly
pos
ted.
Hea
lth w
arni
ng n
ot p
rese
nt o
n “S
mok
ing
Perm
itted
” sig
n.
15S
“Sm
okin
g or
Usin
g El
ectr
onic
Cig
aret
tes P
erm
itted
” sig
n no
t con
spic
uous
ly p
oste
d. H
ealth
war
ning
not
pre
sent
on
“Sm
okin
g Pe
rmitt
ed”
sign.
15T
“Sm
okin
g is
Proh
ibite
d in
All
Area
s of t
his H
otel
(Mot
el),
Exce
pt in
Gue
st R
oom
s Des
igna
ted
as S
mok
ing
Roo
ms.
Plea
se E
xtin
guish
You
r Cig
aret
te, C
igar
or P
ipe,
or E
lect
roni
c C
igar
ette
” sig
n no
t con
spic
uous
ly p
oste
d. H
ealth
war
ning
not
pre
sent
on
“Sm
okin
g Pe
rmitt
ed”
sign.
15U
Size
of t
he le
tterin
g of
the
“Sm
okin
g Pe
rmitt
ed A
nd E
lect
roni
c C
igar
ette
Use
Per
mitt
ed”
sign
exce
eds t
hat o
f the
“N
o Sm
okin
g/N
o El
ectr
onic
Cig
aret
te U
se”
sign.
15V
“No
Smok
ing/
No
Elec
tron
ic C
igar
ette
Usa
ge”
mes
sage
not
show
n on
mot
ion
pict
ure
scre
en.
15W
Asht
rays
in sm
oke-
free
area
(s).
15X
Ope
rato
r fai
led to
mak
e go
od fa
ith e
ffort
to in
form
smok
ers o
f the
Sm
oke-
Free
Air
Act p
rohi
bitio
n of
smok
ing
or u
sing
elect
roni
c ci
gare
ttes.
Smok
ing
perm
itted
in a
n ar
ea w
here
it
is pr
ohib
ited.
15Y
Smok
ing
use
perm
itted
and
/or a
llow
ed in
smok
ing
proh
ibite
d ar
eas u
nder
the
cont
rol o
f the
ope
rato
r.
15Z
Smok
ing
and
elec
tron
ic c
igar
ette
use
wor
kpla
ce p
olic
y in
adeq
uate
, not
pos
ted
or n
ot p
rovi
ded
to e
mpl
oyee
s.
15A
AU
se o
f tob
acco
pro
duct
on
scho
ol p
rem
ises (
at o
r bel
ow th
e 12
th-g
rade
leve
l) ob
serv
ed.
15A
BFa
ilure
to re
gist
er re
tail
toba
cco
or e
lect
roni
c ci
gare
tte st
ore.
SA
LE
OF
HE
RB
AL
CIG
AR
ET
TE
S,
TO
BA
CC
O H
EA
LT
H W
AR
NIN
G A
ND
SM
OK
ING
CE
SS
AT
ION
15A
CSa
le o
f her
bal c
igar
ette
s to
min
ors o
bser
ved.
RE
ST
RIC
TIO
N O
N T
HE
SA
LE
OF
CE
RT
AIN
FL
AV
OR
ED
TO
BA
CC
O
15A
DA
flavo
red
toba
cco
prod
uct s
old
or o
ffere
d fo
r sal
e in
an
esta
blish
men
t oth
er th
an a
toba
cco
bar.
15A
EO
rigin
al la
bel f
or to
bacc
o or
non
-toba
cco
prod
ucts
for s
mok
ing
sold
or o
ffere
d fo
r sal
e no
t mai
ntai
ned
on si
te.
AR
TIF
ICIA
L T
RA
NS
FA
T
16A
A fo
od c
onta
inin
g ar
tifici
al tr
ans f
at, w
ith 0
.5 g
ram
s or m
ore
of tr
ans f
at p
er se
rvin
g, is
bei
ng st
ored
, dist
ribut
ed, h
eld
for s
ervi
ce, u
sed
in p
repa
ratio
n of
a m
enu
item
or s
erve
d.
16B
The
orig
inal
nut
ritio
nal f
act l
abel
s and
/or i
ngre
dien
t lab
el fo
r a c
ooki
ng o
il, sh
orte
ning
or m
arga
rine
or fo
od it
em so
ld in
bul
k or
acc
epta
ble
man
ufac
ture
r’s d
ocum
enta
tion
not m
aint
aine
d on
site
. C
AL
OR
IE M
EN
U L
AB
EL
ING
16C
Cal
oric
con
tent
not
pos
ted
on m
enus
, men
u bo
ards
or f
ood
tags
, in
a fo
od se
rvic
e es
tabl
ishm
ent t
hat i
s 1 o
f 15
or m
ore
outle
ts o
pera
ting
the
sam
e ty
pe o
f bus
ines
s nat
iona
lly u
nder
com
mon
ow
ners
hip
or c
ontr
ol, o
r as a
fran
chise
or d
oing
bus
ines
s und
er th
e sa
me
nam
e, fo
r eac
h m
enu
item
that
is se
rved
in p
ortio
ns, t
he si
ze a
nd c
onte
nt o
f whi
ch a
re st
anda
rdize
d.
16E
Cal
oric
con
tent
rang
e (m
inim
um to
max
imum
) not
pos
ted
on m
enus
and
or m
enu
boar
ds fo
r eac
h fla
vor,
varie
ty a
nd si
ze o
f eac
h m
enu
item
that
is o
ffere
d fo
r sal
e in
diff
eren
t flav
ors,
varie
ties a
nd si
zes.
16F
Spec
ific
calo
ric c
onte
nt o
r ran
ge th
ereo
f not
pos
ted
on m
enus
, men
u bo
ards
or f
ood
tags
for e
ach
men
u ite
m o
ffere
d as
a c
ombi
natio
n m
eal w
ith m
ultip
le o
ptio
ns th
at a
re li
sted
as
singl
e ite
ms.
SO
DIU
M M
EN
U L
AB
EL
ING
16J
Sodi
um w
arni
ng ic
on n
ot p
oste
d on
men
us, m
enu
boar
ds o
r foo
d ta
gs fo
r foo
d ite
ms t
hat c
onta
in 2
,300
mg
or m
ore
of so
dium
in a
food
serv
ice
esta
blish
men
t tha
t is 1
of 1
5 or
mor
e ou
tlets
oper
atin
g th
e sa
me
type
of b
usin
ess n
atio
nally
und
er c
omm
on o
wne
rshi
p or
con
trol
, or a
s a fr
anch
ise o
r doi
ng b
usin
ess u
nder
the
sam
e na
me,
for e
ach
men
u ite
m th
at is
serv
ed in
por
tions
, th
e siz
e an
d co
nten
t of w
hich
are
stan
dard
ized.
16K
Sodi
um w
arni
ng ic
on p
oste
d on
men
us, m
enu
boar
ds o
r foo
d ta
gs fo
r foo
d ite
ms t
hat c
onta
in 2
,300
mg
or m
ore
of so
dium
is n
ot a
bla
ck a
nd w
hite
equ
ilate
ral t
riang
le; a
nd/o
r the
equ
ilate
ral
tria
ngle
is n
ot a
s wid
e as
it is
tall,
and
/or i
s not
equ
al in
hei
ght t
o th
e la
rges
t let
ter i
n th
e fo
od it
em’s
nam
e, a
s disp
laye
d on
the
men
u, m
enu
boar
d or
tag.
16L
Sodi
um w
arni
ng st
atem
ent n
ot p
oste
d co
nspi
cuou
sly a
t the
poi
nt o
f pur
chas
e. “
War
ning
: [ic
on im
age]
indi
cate
s tha
t the
sodi
um (s
alt)
cont
ent o
f thi
s ite
m is
hig
her t
han
the
tota
l dai
ly
reco
mm
ende
d lim
it (2
,300
mg)
. Hig
h so
dium
inta
ke c
an in
crea
se b
lood
pre
ssur
e an
d ris
k of
hea
rt d
iseas
e an
d st
roke
.”A
DM
INIS
TR
AT
ION
AN
D D
OC
UM
EN
TA
TIO
N
18A
Cur
rent
val
id p
erm
it, re
gist
ratio
n or
oth
er a
utho
rizat
ion
to o
pera
te e
stab
lishm
ent n
ot a
vaila
ble.
18B
Doc
umen
t iss
ued
by th
e Bo
ard
of H
ealth
, Com
miss
ione
r or D
epar
tmen
t unl
awfu
lly re
prod
uced
or a
ltere
d.
18C
Not
ice
of th
e D
epar
tmen
t or B
oard
of H
ealth
mut
ilate
d, o
bstr
ucte
d or
rem
oved
.
18D
Failu
re to
com
ply
with
an
Ord
er o
f the
Boa
rd o
f Hea
lth, C
omm
issio
ner o
r Dep
artm
ent.
18E
Failu
re to
repo
rt o
ccur
renc
es o
f sus
pect
ed fo
od-b
orne
illn
ess t
o th
e D
epar
tmen
t.
18F
Perm
it no
t con
spic
uous
ly d
ispla
yed.
18G
Food
Pro
tect
ion
Cer
tifica
te n
ot a
vaila
ble
for D
epar
tmen
t ins
pect
ion.
18H
Failu
re o
f eve
nt sp
onso
r to
excl
ude
vend
or w
ithou
t a c
urre
nt v
alid
per
mit
or re
gist
ratio
n. O
pera
tor o
f sha
red
kitc
hen
allo
wed
unp
erm
itted
cat
erer
or o
ther
use
r; or
faile
d to
pro
vide
cop
y of
ag
reem
ent b
etw
een
oper
ator
and
use
r.
18I
Failu
re to
pro
duce
pes
t man
agem
ent c
ontr
act;
failu
re to
kee
p re
cord
s sho
win
g ex
isten
ce o
f con
trac
t at e
stab
lishm
ent.
18J
Una
ppro
ved
outd
oor,
stre
et o
r sid
ewal
k co
okin
g.
SIG
NA
GE
20A
Food
alle
rgy
info
rmat
ion
post
er n
ot c
onsp
icuo
usly
pos
ted
whe
re fo
od is
bei
ng p
repa
red
or p
roce
ssed
by
food
wor
kers
.
20B
Food
alle
rgy
info
rmat
ion
post
er n
ot p
oste
d in
lang
uage
und
erst
ood
by a
ll fo
od w
orke
rs.
20C
Food
alle
rgy
post
er d
oes n
ot c
onta
in te
xt p
rovi
ded
or a
ppro
ved
by D
epar
tmen
t.
20D
“Cho
king
firs
t aid
” po
ster
not
pos
ted.
“Alc
ohol
and
pre
gnan
cy”
war
ning
sign
not
pos
ted.
“R
esus
cita
tion
equi
pmen
t: ex
hale
d ai
r res
usci
tatio
n m
asks
(adu
lt &
ped
iatr
ic),
late
x gl
oves
” sig
n no
t po
sted
.20E
Lette
r gra
de o
r “G
rade
Pen
ding
” ca
rd n
ot c
onsp
icuo
usly
pos
ted
and
visib
le to
pas
sers
by.
20F
Cur
rent
lette
r gra
de o
r “G
rade
Pen
ding
” ca
rd n
ot p
oste
d.
20G
Food
Pro
tect
ion
Cer
tifica
te n
ot a
vaila
ble
for i
nspe
ctio
n.
NU
ISA
NC
E A
ND
MIS
CE
LL
AN
EO
US
22A
Nui
sanc
e cr
eate
d or
allo
wed
to e
xist
. Fac
ility
not
free
from
uns
afe,
haz
ardo
us, o
ffens
ive
or a
nnoy
ing
cond
ition
s.
22C
Bulb
not
shie
lded
or s
hatte
rpro
of, a
nd/o
r end
caps
or o
ther
dev
ices
not
pro
vide
d in
are
as w
here
ther
e is
extre
me
heat
, tem
pera
ture
cha
nges
, or w
here
acc
iden
tal c
onta
ct m
ay o
ccur
.
22D
Plas
tic c
onta
iner
s with
mic
row
ave
safe
mar
king
s not
use
d fo
r hea
ting
food
.
22E
ROP
proc
essin
g eq
uipm
ent n
ot a
ppro
ved
by th
e D
epar
tmen
t.
22F
Misb
rand
ed, m
islab
eled
pac
kage
d fo
od p
rodu
cts.
Bure
au o
f Foo
d Sa
fety
and
Com
mun
ity S
anita
tion
SE
LF-I
NSP
EC
TIO
N W
OR
KSH
EE
T F
OR
FO
OD
SE
RVIC
E E
STA
BLIS
HM
EN
TS c
ont.
*Pu
blic
Hea
lth H
azar
ds (P
HH
) mus
t be
corr
ecte
d im
med
iate
ly+
Pre-
perm
it Se
rious
(PPS
) Vio
latio
ns th
at m
ust b
e co
rrec
ted
befo
re p
erm
it is
issue
d
Bure
au o
f Foo
d Sa
fety
and
Com
mun
ity S
anita
tion
Con
tact
Info
rmat
ion
Phon
e: 2
12-6
76-1
600
Fax:
212
-676
-166
6 W
eb: n
yc.g
ov/h
ealth
Mic
hael R
. B
loom
berg
Mayo
r
Thom
as
Farl
ey,
M.D
., M
.P.H
.C
om
mis
sioner
Michael R. BloombergMayor
Thomas Farley, M.D., M.P.H.Commissioner
CO
ND
ITIO
N
OB
SE
RV
ED
Self-Inspection Worksheetfor Food Service Establishments
June 2016
Bureau of Food Safety and Community SanitationSELF-INSPECTION WORKSHEET FOR FOOD SERVICE ESTABLISHMENTS
PART ONE – SCORED VIOLATIONS
CRITICAL VIOLATIONSCONDITIONS
SCOREI II III IV V
FOOD TEMPERATURE2A* Food not cooked to required minimum temperature:
• Poultry, meat stuffing, stuffed meats > 165°F for 15 seconds • Ground meat and food containing ground meat > 158°F for 15 seconds • Pork, any food containing pork > 155°F for 15 seconds • Rare roast beef, rare beefsteak except per individual customer request > required temperature and time • All other foods except shell eggs per individual customer request > 145°F for 15 seconds
– – – 10 28
2B* Hot food item not held at or above 140°F. 7 8 9 10 282C Hot food item that has been cooked and refrigerated is being held for service without first being reheated to 165°F or above within 2 hours. 5 6 7 8 –2D Precooked potentially hazardous food from commercial food processing establishment that is supposed to be heated, but is not heated to 140°F within 2 hours. 5 6 7 8 –2E Whole frozen poultry or poultry breasts, other than a single portion, is being cooked frozen or partially thawed. 5 6 – – –2F Meat, fish or molluscan shellfish served raw or undercooked without prior notification to customer. – – – 8 –2G* Cold food item held above 41°F (smoked fish and reduced oxygen packaged foods above 38°F) except during necessary preparation. 7 8 9 10 282H* Food not cooled by an approved method whereby the internal product temperature is reduced from 140º F to 70º F or less within 2 hours,
and from 70°F to 41°F or less within 4 additional hours. 7 8 9 10 28
2I Food prepared from ingredients at ambient temperature not cooled to 41°F or below within 4 hours. 5 6 7 8 –2J* Reduced oxygen packaged (ROP) foods not cooled by an approved method whereby the internal food temperature is reduced to 38°F within two hours of
cooking and if necessary further cooled to a temperature of 34°F within six hours of reaching 38°F. 7 8 9 10 28
FOOD SOURCE3A* Food from unapproved or unknown source or home canned. Reduced oxygen packaged (ROP) fish not frozen before processing; or ROP foods prepared on
premises transported to another site. – – – 10 28
3B* Shellfish not from approved source, improperly tagged/labeled; tags not retained for 90 days. – – – 10 283C* Eggs found dirty/cracked; liquid, frozen or powdered eggs not pasteurized. 7 8 9 10 283D* Canned food product observed swollen, leaking or rusted, and not segregated from other consumable food items. 7 8 9 10 283E* Potable water supply inadequate. Water or ice not potable or from unapproved source. Cross connection in potable water supply system observed. – – – 10 283F* Unpasteurized milk or milk product present. – – – 10 283G Raw food not properly washed prior to serving. 5 6 7 8 –
FOOD PROTECTION4A Food Protection Certificate not held by supervisor of food operations. – – – – 104B* Food worker prepares food or handles utensil when ill with a disease transmissible by food, or has exposed infected cut or burn on hand. – – – 10 284C* Food worker does not use proper utensil to eliminate bare hand contact with food that will not receive adequate additional heat treatment. 7 8 9 10 284D* Food worker does not wash hands thoroughly after using the toilet, coughing, sneezing, smoking, eating, preparing raw foods or otherwise contaminating hands. – – – 10 284E* Toxic chemical improperly labeled, stored or used such that food contamination may occur. 7 8 9 10 284F* Food, food preparation area, food storage area, area used by employees or patrons contaminated by sewage or liquid waste. – – – 10 284G* Unprotected potentially hazardous food re-served. – – – 10 284H* Raw, cooked or prepared food is adulterated, contaminated, cross-contaminated or not discarded in accordance with HACCP plan. 7 8 9 10 284I Unprotected food re-served. 5 6 7 8 –4J Appropriately scaled metal stem-type thermometer or thermocouple not provided or used to evaluate temperatures of potentially hazardous foods
during cooking, cooling, reheating and holding. – – – 8 –
4K Evidence of rats or live rats present in facility’s food and/or non-food areas. 5 6 7 8 284L Evidence of mice or live mice present in facility’s food and/or non-food areas. 5 6 7 8 284M Live roaches present in facility’s food and/or non-food areas. 5 6 7 8 284N Filth flies or food/refuse/sewage-associated (FRSA) flies present in facility’s food and/or non-food areas. Filth flies include house flies,
little house flies, blow flies, bottle flies and flesh flies. Food/refuse/sewage-associated flies include fruit flies, drain flies and Phorid flies. 5 6 7 8 28
4O Live animals other than fish in tank or service animal present in facility’s food and/or nonfood areas. 5 6 7 8 –
FACILITY DESIGN5A* Sewage disposal system improper or unapproved. – – – 10 285B* Harmful, noxious gas or vapor detected. CO > 13 ppm. – – – 10 285C+ Food contact surface improperly constructed or located. Unacceptable material used. 7 8 9 10 285D+ Hand-washing facility not provided in or near food preparation area and toilet room. Hot and cold running water at adequate pressure to
enable cleanliness of employees not provided at facility. Soap and an acceptable hand-drying device not provided. – – – 10 28
5E+ Toilet facility not provided for employees or for patrons when required. – – – 10 285F+ Insufficient or no refrigerated or hot holding equipment to keep potentially hazardous foods at required temperatures. – – – 10 285G+ Properly enclosed service/maintenance area not provided. (Mobile Food Commissary) – – – 10 285H+ No facilities available to wash, rinse and sanitize utensils and/or equipment. – – – 10 285I+ Refrigeration used to implement HACCP plan not equipped with an electronic system that continuously monitors time and temperature. – – – 10 28
PERSONAL HYGIENE & OTHER FOOD PROTECTION6A Personal cleanliness inadequate. Outer garment soiled with possible contaminant. Effective hair restraint not worn in an area where food is prepared. 5 6 7 8 –6B Tobacco use, eating or drinking from open container in food preparation, food storage or dishwashing area observed. 5 6 7 8 –6C Food not protected from potential source of contamination during storage, preparation, transportation, display or service. 5 6 7 8 –6D Food contact surface not properly washed, rinsed or sanitized after each use and following any activity when contamination may have occurred. 5 6 7 8 –6E Sanitized equipment or utensil, including in-use food-dispensing utensil, improperly used or stored. 5 6 7 8 –6F Wiping cloths soiled or not stored in sanitizing solution. 5 6 7 –6G* HACCP plan not approved or approved HACCP plan not maintained on premises. – – – 10 286H Records and logs not maintained to demonstrate that HACCP plan has been properly implemented. – – – – 286I Food not labeled in accordance with HACCP plan. – – – 10 28
OTHER CRITICALS7A Duties of an officer of the Department interfered with or obstructed. – – – – 28
CRITICAL VIOLATIONS TOTAL
GENERAL VIOLATIONSCONDITIONS
SCOREI II III IV V
VERMIN / GARBAGE8A Facility not vermin proof. Harborage or conditions conducive to attracting vermin to the premises and/or allowing vermin to exist. – – 4 5 –8B Covered garbage receptacle not provided or inadequate, except that garbage receptacle may be uncovered during active use.
Garbage storage area not properly constructed or maintained; grinder or compactor dirty. 2 3 4 5 –
8C Pesticide use not in accordance with label or applicable laws. Prohibited chemical used/stored. Open bait station used. 2 3 4 5 28
FOOD SOURCE9A Canned food product observed dented and not segregated from other consumable food items. 2 3 4 5 –9B Thawing procedures improper. 2 3 4 5 –9C Food contact surface not properly maintained. 2 3 4 5 –
FACILITY MAINTENANCE10A Toilet facility not maintained and provided with toilet paper, waste receptacle and self-closing door. 2 3 4 5 –10B Plumbing not properly installed or maintained; anti-siphonage or backflow prevention device not provided where required; equipment
or floor not properly drained; sewage disposal system in disrepair or not functioning properly. 2 3 4 5 28
10C Lighting inadequate; permanent lighting not provided in food preparation areas, ware washing areas, and storage rooms. 2 3 4 5 –10D Mechanical or natural ventilation system not provided, improperly installed, in disrepair and/or fails to prevent excessive build-up of grease, heat, steam
condensation vapors, odors, smoke and fumes. 2 3 4 5 –
10E Accurate thermometer not provided in refrigerated or hot holding equipment. 2 3 4 5 –10F Non-food contact surface improperly constructed. Unacceptable material used. Non-food contact surface or equipment improperly maintained
and/or not properly sealed, raised, spaced or movable to allow accessibility for cleaning on all sides, above and underneath the unit. 2 3 4 5 –
10G Food service operation occurring in room used as living or sleeping quarters. 2 3 4 5 –10H Proper sanitization not provided for utensil ware washing operation. 2 3 4 5 –10I Single service item reused, improperly stored, dispensed; not used when required. 2 3 4 5 –10J “Wash hands” sign not posted at hand-wash facility. 2
OTHER GENERALS99B Other general. 2 3 4 5 28
GENERAL VIOLATIONS TOTAL:
CRITICAL AND GENERAL COMBINED TOTAL:
PART TWO – UNSCORED VIOLATIONS
CONDITION OBSERVEDYES NO
DISTRIBUTION OF TOBACCO PRODUCTS THROUGH VENDING MACHINES
15A Tobacco vending machine present where prohibited.
15B Tobacco vending machine placed less than 25 feet from entrance to premises.
15C Tobacco vending machine not visible to the operator, employee or agent.
15D Durable sign with license number, expiration date, address and phone number not posted.
TOBACCO PRODUCT REGULATION ACT
15E Out-of-package sale of tobacco products observed.
15F Employee under the age of 18 selling tobacco product without direct supervision of an adult retail dealer or dealer.
15G Sale of cigarettes, tobacco products, liquid nicotine or electronic cigarettes to persons under age 21 observed.
15H Sign prohibiting sale of tobacco products/electronic cigarettes to persons under age 21 not conspicuously posted.
15HH Sign prohibiting sale of non-tobacco shisha, pipes, or rolling papers to persons under age 18 not conspicuously posted.
15I Cigars that cost more than $3 each not sold in packages of four or more.
15J Little cigars sold individually or in packages that contain less than twenty little cigars.
15K “Sale of Cigarettes” tax stamp sign not posted.
15L Sale of cigarettes without tax stamp.
15M Sale of non-tobacco shisha, pipes or rolling papers to individuals under 18 years of age observed.
REGULATING TOBACCO SALES
15N Sale of cigarettes and little cigars at less than the floor price.
15O Sale of cigars and cigarettes at less than the listed price.
15P Sale of tobacco products at less than the listed price.
15Q Distributing tobacco at less than basic cost to the public or at a public event.
* Public Health Hazards (PHH) must be corrected immediately + Pre-permit Serious (PPS) Violations that must be corrected before permit is issued
Michael R. BloombergMayor
Thomas Farley, M.D., M.P.H.Commissioner
YES NO
SMOKE-FREE AIR ACT
15R “No Smoking or Using Electronic Cigarettes” sign not conspicuously posted. Health warning not present on “Smoking Permitted” sign.
15S “Smoking or Using Electronic Cigarettes Permitted” sign not conspicuously posted. Health warning not present on “Smoking Permitted” sign.
15T“Smoking is Prohibited in All Areas of this Hotel (Motel), Except in Guest Rooms Designated as Smoking Rooms. Please Extinguish Your Cigarette, Cigar or Pipe, or Electronic Cigarette” sign not conspicuously posted. Health warning not present on “Smoking Permitted” sign.
15U Size of the lettering of the “Smoking Permitted And Electronic Cigarette Use Permitted” sign exceeds that of the “No Smoking/No Electronic Cigarette Use” sign.
15V “No Smoking/No Electronic Cigarette Usage” message not shown on motion picture screen.
15W Ashtrays in smoke-free area(s).
15XOperator failed to make good faith effort to inform smokers of the Smoke-Free Air Act prohibition of smoking or using electronic cigarettes. Smoking permitted in an area where it is prohibited.
15Y Smoking use permitted and/or allowed in smoking prohibited areas under the control of the operator.
15Z Smoking and electronic cigarette use workplace policy inadequate, not posted or not provided to employees.
15AA Use of tobacco product on school premises (at or below the 12th-grade level) observed.
15AB Failure to register retail tobacco or electronic cigarette store.
SALE OF HERBAL CIGARETTES, TOBACCO HEALTH WARNING AND SMOKING CESSATION
15AC Sale of herbal cigarettes to minors observed.
RESTRICTION ON THE SALE OF CERTAIN FLAVORED TOBACCO
15AD A flavored tobacco product sold or offered for sale in an establishment other than a tobacco bar.
15AE Original label for tobacco or non-tobacco products for smoking sold or offered for sale not maintained on site.
ARTIFICIAL TRANS FAT
16A A food containing artificial trans fat, with 0.5 grams or more of trans fat per serving, is being stored, distributed, held for service, used in preparation of a menu item or served.
16BThe original nutritional fact labels and/or ingredient label for a cooking oil, shortening or margarine or food item sold in bulk or acceptable manufacturer’s documentation not maintained on site.
CALORIE MENU LABELING
16CCaloric content not posted on menus, menu boards or food tags, in a food service establishment that is 1 of 15 or more outlets operating the same type of business nationally under common ownership or control, or as a franchise or doing business under the same name, for each menu item that is served in portions, the size and content of which are standardized.
16ECaloric content range (minimum to maximum) not posted on menus and or menu boards for each flavor, variety and size of each menu item that is offered for sale in different flavors, varieties and sizes.
16FSpecific caloric content or range thereof not posted on menus, menu boards or food tags for each menu item offered as a combination meal with multiple options that are listed as single items.
SODIUM MENU LABELING
16J
Sodium warning icon not posted on menus, menu boards or food tags for food items that contain 2,300 mg or more of sodium in a food service establishment that is 1 of 15 or more outlets operating the same type of business nationally under common ownership or control, or as a franchise or doing business under the same name, for each menu item that is served in portions, the size and content of which are standardized.
16KSodium warning icon posted on menus, menu boards or food tags for food items that contain 2,300 mg or more of sodium is not a black and white equilateral triangle; and/or the equilateral triangle is not as wide as it is tall, and/or is not equal in height to the largest letter in the food item’s name, as displayed on the menu, menu board or tag.
16LSodium warning statement not posted conspicuously at the point of purchase. “Warning: [icon image] indicates that the sodium (salt) content of this item is higher than the total daily recommended limit (2,300 mg). High sodium intake can increase blood pressure and risk of heart disease and stroke.”
ADMINISTRATION AND DOCUMENTATION
18A Current valid permit, registration or other authorization to operate establishment not available.
18B Document issued by the Board of Health, Commissioner or Department unlawfully reproduced or altered.
18C Notice of the Department or Board of Health mutilated, obstructed or removed.
18D Failure to comply with an Order of the Board of Health, Commissioner or Department.
18E Failure to report occurrences of suspected food-borne illness to the Department.
18F Permit not conspicuously displayed.
18G Food Protection Certificate not available for Department inspection.
18HFailure of event sponsor to exclude vendor without a current valid permit or registration. Operator of shared kitchen allowed unpermitted caterer or other user; or failed to provide copy of agreement between operator and user.
18I Failure to produce pest management contract; failure to keep records showing existence of contract at establishment.
18J Unapproved outdoor, street or sidewalk cooking.
SIGNAGE
20A Food allergy information poster not conspicuously posted where food is being prepared or processed by food workers.
20B Food allergy information poster not posted in language understood by all food workers.
20C Food allergy poster does not contain text provided or approved by Department.
20D“Choking first aid” poster not posted. “Alcohol and pregnancy” warning sign not posted. “Resuscitation equipment: exhaled air resuscitation masks (adult & pediatric), latex gloves” sign not posted.
20E Letter grade or “Grade Pending” card not conspicuously posted and visible to passersby.
20F Current letter grade or “Grade Pending” card not posted.
20G Food Protection Certificate not available for inspection.
NUISANCE AND MISCELLANEOUS
22A Nuisance created or allowed to exist. Facility not free from unsafe, hazardous, offensive or annoying conditions.
22C Bulb not shielded or shatterproof, and/or endcaps or other devices not provided in areas where there is extreme heat, temperature changes, or where accidental contact may occur.
22D Plastic containers with microwave safe markings not used for heating food.
22E ROP processing equipment not approved by the Department.
22F Misbranded, mislabeled packaged food products.
Bureau of Food Safety and Community SanitationSELF-INSPECTION WORKSHEET FOR FOOD SERVICE ESTABLISHMENTS cont.
* Public Health Hazards (PHH) must be corrected immediately + Pre-permit Serious (PPS) Violations that must be corrected before permit is issued
Bureau of Food Safety and Community Sanitation Contact InformationPhone: 212-676-1600 Fax: 212-676-1666 Web: nyc.gov/health
Michael R. BloombergMayor
Thomas Farley, M.D., M.P.H.Commissioner
Mic
hael R
. Blo
om
berg
Mayo
r
Thom
as F
arle
y, M.D
., M.P
.H.
Com
missio
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CONDITION OBSERVED
Self-Inspection
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June 2
016