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S Retail Food Establishment Inspection Report
State Form 22116 (R7 /12-04) SDH Form 51-0001
Based on an inspection this day, the item(s) noted below identify violations of 410 IAC 7-24, Indiana Retail Food Establishment Sanitation Requirements.The time limit for correction of each violation is specified in the narrative portion of this report.
Establishment Name
Establishment Address (number and street, city, state, zip code)
Telephone Number ( ) Establishment
( ) Owner
Date of Inspection (mm/dd/yr)
ID #
Owner Follow-up Release Date
Owner’s Address
Person in Charge
Summary of Violations:
C_____ NC_____ R_____
Responsible Person’s E-mail
Certified Food Handler
Purpose:
1. Routine
2. Follow-up
3. Complaint
4. Pre-Operational
5. Temporary
6. HACCP
7. Other (list) _________________
Menu Type (See additional page)
1____2____3____4____5___
• CRITICAL ITEMS ARE IDENTIFIED IN THE CHECKLIST AND NARRATIVE COLUMNS MARKED “C”
• VIOLATION(S) REPEATED FROM PREVIOUS INSPECTIONS ARE DENOTED IN THE “SUMMARY OF VIOLATIONS” AND IN THE NARRATIVE BELOW AS “R”
Section# C/NC R Narrative To Be Corrected By
Received by (name and title printed): Inspected by (name and title printed):
Received by (signature): Inspected by (signature):
cc: cc: cc:
Dubois County Health Department
Telephone 812-481-7055Fax 812-481-7069
HAMPTON INN 812-481-1888
355 3RD AVENUE, JASPER, IN, 47546 812-630-135505/30/2018
86
MGA FAMILY GROUP INC. ✔ 06/09/2018
355 3RD AVENUE, JASPER, IN, 47546
MGA FAMILY GROUP INC.0 0 0
Jane Hochgesang exp. 4/16/2023
No violations at this time
Lana Griffith Christina Pierini
S Retail Food Establishment Inspection Report
State Form 22116 (R7 /12-04) SDH Form 51-0001
Based on an inspection this day, the item(s) noted below identify violations of 410 IAC 7-24, Indiana Retail Food Establishment Sanitation Requirements.The time limit for correction of each violation is specified in the narrative portion of this report.
Establishment Name
Establishment Address (number and street, city, state, zip code)
Telephone Number ( ) Establishment
( ) Owner
Date of Inspection (mm/dd/yr)
ID #
Owner Follow-up Release Date
Owner’s Address
Person in Charge
Summary of Violations:
C_____ NC_____ R_____
Responsible Person’s E-mail
Certified Food Handler
Purpose:
1. Routine
2. Follow-up
3. Complaint
4. Pre-Operational
5. Temporary
6. HACCP
7. Other (list) _________________
Menu Type (See additional page)
1____2____3____4____5___
• CRITICAL ITEMS ARE IDENTIFIED IN THE CHECKLIST AND NARRATIVE COLUMNS MARKED “C”
• VIOLATION(S) REPEATED FROM PREVIOUS INSPECTIONS ARE DENOTED IN THE “SUMMARY OF VIOLATIONS” AND IN THE NARRATIVE BELOW AS “R”
Section# C/NC R Narrative To Be Corrected By
Received by (name and title printed): Inspected by (name and title printed):
Received by (signature): Inspected by (signature):
cc: cc: cc:
Dubois County Health Department
Telephone 812-481-7055Fax 812-481-7069
DAYS INN OF JASPER 812-482-6000
272 BRUCKE STRASSE, JASPER, IN, 47546 812-661-783605/30/2018
53
KALA INC. ✔ 06/09/2018
272 BRUCKE STRASSE, JASPER, IN, 47546
MARY KLEM0 0 0
Molly Mehringer 1/11/2022
No violations at this time
Mary Klem Christina Pierini
S Retail Food Establishment Inspection Report
State Form 22116 (R7 /12-04) SDH Form 51-0001
Based on an inspection this day, the item(s) noted below identify violations of 410 IAC 7-24, Indiana Retail Food Establishment Sanitation Requirements.The time limit for correction of each violation is specified in the narrative portion of this report.
Establishment Name
Establishment Address (number and street, city, state, zip code)
Telephone Number ( ) Establishment
( ) Owner
Date of Inspection (mm/dd/yr)
ID #
Owner Follow-up Release Date
Owner’s Address
Person in Charge
Summary of Violations:
C_____ NC_____ R_____
Responsible Person’s E-mail
Certified Food Handler
Purpose:
1. Routine
2. Follow-up
3. Complaint
4. Pre-Operational
5. Temporary
6. HACCP
7. Other (list) _________________
Menu Type (See additional page)
1____2____3____4____5___
• CRITICAL ITEMS ARE IDENTIFIED IN THE CHECKLIST AND NARRATIVE COLUMNS MARKED “C”
• VIOLATION(S) REPEATED FROM PREVIOUS INSPECTIONS ARE DENOTED IN THE “SUMMARY OF VIOLATIONS” AND IN THE NARRATIVE BELOW AS “R”
Section# C/NC R Narrative To Be Corrected By
Received by (name and title printed): Inspected by (name and title printed):
Received by (signature): Inspected by (signature):
cc: cc: cc:
Dubois County Health Department
Telephone 812-481-7055Fax 812-481-7069
SUPER 8 812-630-9936
75 INDIANA STREET, JASPER, IN, 47546 812-481-200805/30/2018
190
DAXESH PATEL ✔ 06/09/2018
75 INDIANA STREET, JASPER, IN, 47546
Pritesh Patel0 0 0
Daxeshkumar Patel exp. 10/25/2022
No violations at this time
Marlissa Bledsole Christina Pierini
S Retail Food Establishment Inspection Report
State Form 22116 (R7 /12-04) SDH Form 51-0001
Based on an inspection this day, the item(s) noted below identify violations of 410 IAC 7-24, Indiana Retail Food Establishment Sanitation Requirements.The time limit for correction of each violation is specified in the narrative portion of this report.
Establishment Name
Establishment Address (number and street, city, state, zip code)
Telephone Number ( ) Establishment
( ) Owner
Date of Inspection (mm/dd/yr)
ID #
Owner Follow-up Release Date
Owner’s Address
Person in Charge
Summary of Violations:
C_____ NC_____ R_____
Responsible Person’s E-mail
Certified Food Handler
Purpose:
1. Routine
2. Follow-up
3. Complaint
4. Pre-Operational
5. Temporary
6. HACCP
7. Other (list) _________________
Menu Type (See additional page)
1____2____3____4____5___
• CRITICAL ITEMS ARE IDENTIFIED IN THE CHECKLIST AND NARRATIVE COLUMNS MARKED “C”
• VIOLATION(S) REPEATED FROM PREVIOUS INSPECTIONS ARE DENOTED IN THE “SUMMARY OF VIOLATIONS” AND IN THE NARRATIVE BELOW AS “R”
Section# C/NC R Narrative To Be Corrected By
Received by (name and title printed): Inspected by (name and title printed):
Received by (signature): Inspected by (signature):
cc: cc: cc:
Dubois County Health Department
Telephone 812-481-7055Fax 812-481-7069
HOLIDAY FOODS #5 812-482-4464
847 3RD. AVENUE, JASPER, IN, 47546 812-937-442805/30/2018
95
JOSHUA WINKLER ✔ 06/09/2018
P.O. Box 139, SANTA CLAUS, IN, 47579
Mark Reeder2 1 0
Mark Reeder exp. 1/12/2021
144 C Several dented cans found throughout the store177 C potentially hazardous food should to be stored 6" of the ground295 NC Mesh vents in the case cooler showing signs of debris
meat dept ceiling tiles and fans producing condensation and mold
Mark Reeder Christina Pierini
S Retail Food Establishment Inspection Report
State Form 22116 (R7 /12-04) SDH Form 51-0001
Based on an inspection this day, the item(s) noted below identify violations of 410 IAC 7-24, Indiana Retail Food Establishment Sanitation Requirements.The time limit for correction of each violation is specified in the narrative portion of this report.
Establishment Name
Establishment Address (number and street, city, state, zip code)
Telephone Number ( ) Establishment
( ) Owner
Date of Inspection (mm/dd/yr)
ID #
Owner Follow-up Release Date
Owner’s Address
Person in Charge
Summary of Violations:
C_____ NC_____ R_____
Responsible Person’s E-mail
Certified Food Handler
Purpose:
1. Routine
2. Follow-up
3. Complaint
4. Pre-Operational
5. Temporary
6. HACCP
7. Other (list) _________________
Menu Type (See additional page)
1____2____3____4____5___
• CRITICAL ITEMS ARE IDENTIFIED IN THE CHECKLIST AND NARRATIVE COLUMNS MARKED “C”
• VIOLATION(S) REPEATED FROM PREVIOUS INSPECTIONS ARE DENOTED IN THE “SUMMARY OF VIOLATIONS” AND IN THE NARRATIVE BELOW AS “R”
Section# C/NC R Narrative To Be Corrected By
Received by (name and title printed): Inspected by (name and title printed):
Received by (signature): Inspected by (signature):
cc: cc: cc:
Dubois County Health Department
Telephone 812-481-7055Fax 812-481-7069
K-MART #3823 812-482-2200
723 THIRD AVENUE, JASPER, IN, 47546 847-286-250005/30/2018
122
SEARS HOLDING CORPORATION ✔ 06/09/2018
3333 BEVERLY ROAD, HOFFMAN ESTATES, IL, 60179
Mike Mcclung0 1 0
NONE GIVEN
296 NC Milk fridge is showing signs of mold build up Corrected
Mike Mcclung Christina Pierini
S Retail Food Establishment Inspection Report
State Form 22116 (R7 /12-04) SDH Form 51-0001
Based on an inspection this day, the item(s) noted below identify violations of 410 IAC 7-24, Indiana Retail Food Establishment Sanitation Requirements.The time limit for correction of each violation is specified in the narrative portion of this report.
Establishment Name
Establishment Address (number and street, city, state, zip code)
Telephone Number ( ) Establishment
( ) Owner
Date of Inspection (mm/dd/yr)
ID #
Owner Follow-up Release Date
Owner’s Address
Person in Charge
Summary of Violations:
C_____ NC_____ R_____
Responsible Person’s E-mail
Certified Food Handler
Purpose:
1. Routine
2. Follow-up
3. Complaint
4. Pre-Operational
5. Temporary
6. HACCP
7. Other (list) _________________
Menu Type (See additional page)
1____2____3____4____5___
• CRITICAL ITEMS ARE IDENTIFIED IN THE CHECKLIST AND NARRATIVE COLUMNS MARKED “C”
• VIOLATION(S) REPEATED FROM PREVIOUS INSPECTIONS ARE DENOTED IN THE “SUMMARY OF VIOLATIONS” AND IN THE NARRATIVE BELOW AS “R”
Section# C/NC R Narrative To Be Corrected By
Received by (name and title printed): Inspected by (name and title printed):
Received by (signature): Inspected by (signature):
cc: cc: cc:
Dubois County Health Department
Telephone 812-481-7055Fax 812-481-7069
WALMART #870 812-634-1233
4040 N NEWTON STREET, JASPER, IN, 47546 479-258-224305/30/2018
207
WAL-MART STORES EAST, LP ✔ 06/09/2018
702 SW 8TH STREET, DEPT 8916, BENTONVILLE, AR, 72716-0500
WAL-MART STORES EAST, LP1 1 0
187 C Observed cold holding unit of packaged food at approximately 51 degrees 06/06/2018256 NC Cooling units in deli were not all equipped with a temperature measuring device 06/29/2018
caleb johnson Kylie Shephard
S Retail Food Establishment Inspection Report
State Form 22116 (R7 /12-04) SDH Form 51-0001
Based on an inspection this day, the item(s) noted below identify violations of 410 IAC 7-24, Indiana Retail Food Establishment Sanitation Requirements.The time limit for correction of each violation is specified in the narrative portion of this report.
Establishment Name
Establishment Address (number and street, city, state, zip code)
Telephone Number ( ) Establishment
( ) Owner
Date of Inspection (mm/dd/yr)
ID #
Owner Follow-up Release Date
Owner’s Address
Person in Charge
Summary of Violations:
C_____ NC_____ R_____
Responsible Person’s E-mail
Certified Food Handler
Purpose:
1. Routine
2. Follow-up
3. Complaint
4. Pre-Operational
5. Temporary
6. HACCP
7. Other (list) _________________
Menu Type (See additional page)
1____2____3____4____5___
• CRITICAL ITEMS ARE IDENTIFIED IN THE CHECKLIST AND NARRATIVE COLUMNS MARKED “C”
• VIOLATION(S) REPEATED FROM PREVIOUS INSPECTIONS ARE DENOTED IN THE “SUMMARY OF VIOLATIONS” AND IN THE NARRATIVE BELOW AS “R”
Section# C/NC R Narrative To Be Corrected By
Received by (name and title printed): Inspected by (name and title printed):
Received by (signature): Inspected by (signature):
cc: cc: cc:
Dubois County Health Department
Telephone 812-481-7055Fax 812-481-7069
SUBWAY #37170 -Lakshmi Inc. (@ Wal-Mart) 812-634-9898
4040 N NEWTON STREET, JASPER, IN, 47546 812-661-965805/30/2018
186
RINA AND PRAVEZ SHARMA ✔ 06/09/2018
3289 ST. CHARLES STREET, JASPER, IN, 47546
RINA AND PRAVEZ SHARMA0 3 0
Rina Sharma exp. NONE GIVEN
308 NC Ventilation in walk in cooler unit shows a lot of buildup dust and debris 05/31/2018214 NC Cutting boards deeply scored on food prep line 06/13/2018295 NC Non-food contact surfaces contain accumulation of food debris, specifically near front sandwich making line 05/31/2018
sharon jones Kylie Shephard
S Retail Food Establishment Inspection Report
State Form 22116 (R7 /12-04) SDH Form 51-0001
Based on an inspection this day, the item(s) noted below identify violations of 410 IAC 7-24, Indiana Retail Food Establishment Sanitation Requirements.The time limit for correction of each violation is specified in the narrative portion of this report.
Establishment Name
Establishment Address (number and street, city, state, zip code)
Telephone Number ( ) Establishment
( ) Owner
Date of Inspection (mm/dd/yr)
ID #
Owner Follow-up Release Date
Owner’s Address
Person in Charge
Summary of Violations:
C_____ NC_____ R_____
Responsible Person’s E-mail
Certified Food Handler
Purpose:
1. Routine
2. Follow-up
3. Complaint
4. Pre-Operational
5. Temporary
6. HACCP
7. Other (list) _________________
Menu Type (See additional page)
1____2____3____4____5___
• CRITICAL ITEMS ARE IDENTIFIED IN THE CHECKLIST AND NARRATIVE COLUMNS MARKED “C”
• VIOLATION(S) REPEATED FROM PREVIOUS INSPECTIONS ARE DENOTED IN THE “SUMMARY OF VIOLATIONS” AND IN THE NARRATIVE BELOW AS “R”
Section# C/NC R Narrative To Be Corrected By
Received by (name and title printed): Inspected by (name and title printed):
Received by (signature): Inspected by (signature):
cc: cc: cc:
Dubois County Health Department
Telephone 812-481-7055Fax 812-481-7069
BRICK OVEN PIZZA / CHESTER CHICKEN 812-481-2766
1281 3RD AVENUE, JASPER, IN, 47546 812-309-209705/31/2018
18
ROBERT KNIGHT ✔ 06/10/2018
13465 N SR 62, GENTRYVILLE, IN, 47537
ROBERT KNIGHT2 3 0
Kristina N. Beckner exp. 4/26/2018
296 C 4 door pizza prep table is showing signs of heavy food buildup 06/29/2018as well as signs of mold, the restaurant has heavy
grease, dust and dirt buildup throughout, specifically hoods,corners
of floors, vents and light fixtures295 C potato slicer has buildup of food debris, can openers blade is worn 05/31/2018
away and is recommended being replaced so metal shavingsdont contaminate their food
174 NC majority of food is not being labeled with the products name or the date 06/29/2018199 NC observed tenderloin being thawed in warm water 05/31/2018269 NC 3 compartment sink not being used properly with a soap, rinse, sanitze 06/29/2018
Robert Knight Christina Pierini
S Retail Food Establishment Inspection Report
State Form 22116 (R7 /12-04) SDH Form 51-0001
Based on an inspection this day, the item(s) noted below identify violations of 410 IAC 7-24, Indiana Retail Food Establishment Sanitation Requirements.The time limit for correction of each violation is specified in the narrative portion of this report.
Establishment Name
Establishment Address (number and street, city, state, zip code)
Telephone Number ( ) Establishment
( ) Owner
Date of Inspection (mm/dd/yr)
ID #
Owner Follow-up Release Date
Owner’s Address
Person in Charge
Summary of Violations:
C_____ NC_____ R_____
Responsible Person’s E-mail
Certified Food Handler
Purpose:
1. Routine
2. Follow-up
3. Complaint
4. Pre-Operational
5. Temporary
6. HACCP
7. Other (list) _________________
Menu Type (See additional page)
1____2____3____4____5___
• CRITICAL ITEMS ARE IDENTIFIED IN THE CHECKLIST AND NARRATIVE COLUMNS MARKED “C”
• VIOLATION(S) REPEATED FROM PREVIOUS INSPECTIONS ARE DENOTED IN THE “SUMMARY OF VIOLATIONS” AND IN THE NARRATIVE BELOW AS “R”
Section# C/NC R Narrative To Be Corrected By
Received by (name and title printed): Inspected by (name and title printed):
Received by (signature): Inspected by (signature):
cc: cc: cc:
Dubois County Health Department
Telephone 812-481-7055Fax 812-481-7069
SUNSET CITGO 812-634-6530
1281 THIRD AVENUE, JASPER, IN, 47546 812-683-452905/31/2018
189
JAYME RASCHE ✔ 06/10/2018
610 S Foxtrot Ct., HUNTINGBURG, IN, 47542
Nicole McMickle0 2 0
Nicole McMickle 5/1/2023
177 NC Frazel drink mix not being stored 6" of the floor, manager moved the product Corrected422 NC Employees personal food items being stored with product being used for the store Corrected
Nicole McMickle Christina Pierini
S Retail Food Establishment Inspection Report
State Form 22116 (R7 /12-04) SDH Form 51-0001
Based on an inspection this day, the item(s) noted below identify violations of 410 IAC 7-24, Indiana Retail Food Establishment Sanitation Requirements.The time limit for correction of each violation is specified in the narrative portion of this report.
Establishment Name
Establishment Address (number and street, city, state, zip code)
Telephone Number ( ) Establishment
( ) Owner
Date of Inspection (mm/dd/yr)
ID #
Owner Follow-up Release Date
Owner’s Address
Person in Charge
Summary of Violations:
C_____ NC_____ R_____
Responsible Person’s E-mail
Certified Food Handler
Purpose:
1. Routine
2. Follow-up
3. Complaint
4. Pre-Operational
5. Temporary
6. HACCP
7. Other (list) _________________
Menu Type (See additional page)
1____2____3____4____5___
• CRITICAL ITEMS ARE IDENTIFIED IN THE CHECKLIST AND NARRATIVE COLUMNS MARKED “C”
• VIOLATION(S) REPEATED FROM PREVIOUS INSPECTIONS ARE DENOTED IN THE “SUMMARY OF VIOLATIONS” AND IN THE NARRATIVE BELOW AS “R”
Section# C/NC R Narrative To Be Corrected By
Received by (name and title printed): Inspected by (name and title printed):
Received by (signature): Inspected by (signature):
cc: cc: cc:
Dubois County Health Department
Telephone 812-481-7055Fax 812-481-7069
BUFFALO WINGS AND RINGS 812-482-9464
1910 HOSPITALITY DRIVE, JASPER, IN, 47546 812-630-416905/31/2018
21
MIKE WEYER ✔ 06/10/2018
P.O. BOX 667, JASPER, IN, 47547✔Ann Bennett
0 3 0
Ann Bennett exp. 11/12/2018
295 NC General cleaning in kitchen area, vents, bag in the box station and 06/30/2018ice machines
342 NC 2 hand washing stations are not providing water at a minimum temp. 06/30/2018of 100 strongly recommend having staff use the other hand washing
stations in the kitchen204 NC Raw chicken and raw hamburger patties being stored side by side 06/08/2018
on production line
Ann Bennett Christina Pierini
S Retail Food Establishment Inspection Report
State Form 22116 (R7 /12-04) SDH Form 51-0001
Based on an inspection this day, the item(s) noted below identify violations of 410 IAC 7-24, Indiana Retail Food Establishment Sanitation Requirements.The time limit for correction of each violation is specified in the narrative portion of this report.
Establishment Name
Establishment Address (number and street, city, state, zip code)
Telephone Number ( ) Establishment
( ) Owner
Date of Inspection (mm/dd/yr)
ID #
Owner Follow-up Release Date
Owner’s Address
Person in Charge
Summary of Violations:
C_____ NC_____ R_____
Responsible Person’s E-mail
Certified Food Handler
Purpose:
1. Routine
2. Follow-up
3. Complaint
4. Pre-Operational
5. Temporary
6. HACCP
7. Other (list) _________________
Menu Type (See additional page)
1____2____3____4____5___
• CRITICAL ITEMS ARE IDENTIFIED IN THE CHECKLIST AND NARRATIVE COLUMNS MARKED “C”
• VIOLATION(S) REPEATED FROM PREVIOUS INSPECTIONS ARE DENOTED IN THE “SUMMARY OF VIOLATIONS” AND IN THE NARRATIVE BELOW AS “R”
Section# C/NC R Narrative To Be Corrected By
Received by (name and title printed): Inspected by (name and title printed):
Received by (signature): Inspected by (signature):
cc: cc: cc:
Dubois County Health Department
Telephone 812-481-7055Fax 812-481-7069
DOMINO'S PIZZA 812-634-9897
410 US-231, JASPER, IN, 47546 502-773-297205/31/2018
61
SCOTT AND BRENDA WILSON ✔ 06/10/2018
1044 WHITEOAK CT., LANESVILLE, IN, 47136
ANTHONY NEUKAM0 0 0
ANTHONY NEUKAM EXP 6/13/22
No violations at this time
Darren Scraper Christina Pierini
S Retail Food Establishment Inspection Report
State Form 22116 (R7 /12-04) SDH Form 51-0001
Based on an inspection this day, the item(s) noted below identify violations of 410 IAC 7-24, Indiana Retail Food Establishment Sanitation Requirements.The time limit for correction of each violation is specified in the narrative portion of this report.
Establishment Name
Establishment Address (number and street, city, state, zip code)
Telephone Number ( ) Establishment
( ) Owner
Date of Inspection (mm/dd/yr)
ID #
Owner Follow-up Release Date
Owner’s Address
Person in Charge
Summary of Violations:
C_____ NC_____ R_____
Responsible Person’s E-mail
Certified Food Handler
Purpose:
1. Routine
2. Follow-up
3. Complaint
4. Pre-Operational
5. Temporary
6. HACCP
7. Other (list) _________________
Menu Type (See additional page)
1____2____3____4____5___
• CRITICAL ITEMS ARE IDENTIFIED IN THE CHECKLIST AND NARRATIVE COLUMNS MARKED “C”
• VIOLATION(S) REPEATED FROM PREVIOUS INSPECTIONS ARE DENOTED IN THE “SUMMARY OF VIOLATIONS” AND IN THE NARRATIVE BELOW AS “R”
Section# C/NC R Narrative To Be Corrected By
Received by (name and title printed): Inspected by (name and title printed):
Received by (signature): Inspected by (signature):
cc: cc: cc:
Dubois County Health Department
Telephone 812-481-7055Fax 812-481-7069
RUXER MUNI GOLF COURSE 812-482-5959
400 S CLAY ST, JASPER, IN, 47546 812-482-595905/31/2018
245
CITY OF JASPER ✔ 06/10/2018
1301 ST. CHARLES ST, JASPER, IN, 47546
JOHN BERTGES0 0 0
No violations at time of inspection
rex may Kylie Shephard
S Retail Food Establishment Inspection Report
State Form 22116 (R7 /12-04) SDH Form 51-0001
Based on an inspection this day, the item(s) noted below identify violations of 410 IAC 7-24, Indiana Retail Food Establishment Sanitation Requirements.The time limit for correction of each violation is specified in the narrative portion of this report.
Establishment Name
Establishment Address (number and street, city, state, zip code)
Telephone Number ( ) Establishment
( ) Owner
Date of Inspection (mm/dd/yr)
ID #
Owner Follow-up Release Date
Owner’s Address
Person in Charge
Summary of Violations:
C_____ NC_____ R_____
Responsible Person’s E-mail
Certified Food Handler
Purpose:
1. Routine
2. Follow-up
3. Complaint
4. Pre-Operational
5. Temporary
6. HACCP
7. Other (list) _________________
Menu Type (See additional page)
1____2____3____4____5___
• CRITICAL ITEMS ARE IDENTIFIED IN THE CHECKLIST AND NARRATIVE COLUMNS MARKED “C”
• VIOLATION(S) REPEATED FROM PREVIOUS INSPECTIONS ARE DENOTED IN THE “SUMMARY OF VIOLATIONS” AND IN THE NARRATIVE BELOW AS “R”
Section# C/NC R Narrative To Be Corrected By
Received by (name and title printed): Inspected by (name and title printed):
Received by (signature): Inspected by (signature):
cc: cc: cc:
Dubois County Health Department
Telephone 812-481-7055Fax 812-481-7069
GROUNDED 812-482-4060
323 S. US HWY 231, JASPER, IN, 47546 812-631-013105/31/2018
84
STEPHEN AND CHRISTY GORDON ✔ 06/10/2018
570 S 900 W, VELPEN, IN, 47590
STEPHEN AND CHRISTY GORDON0 0 0
CHRISTY GORDON EXP 6/13/2022
No violations at time of inspection.
Krista Dittelberger Kylie Shephard
S Retail Food Establishment Inspection Report
State Form 22116 (R7 /12-04) SDH Form 51-0001
Based on an inspection this day, the item(s) noted below identify violations of 410 IAC 7-24, Indiana Retail Food Establishment Sanitation Requirements.The time limit for correction of each violation is specified in the narrative portion of this report.
Establishment Name
Establishment Address (number and street, city, state, zip code)
Telephone Number ( ) Establishment
( ) Owner
Date of Inspection (mm/dd/yr)
ID #
Owner Follow-up Release Date
Owner’s Address
Person in Charge
Summary of Violations:
C_____ NC_____ R_____
Responsible Person’s E-mail
Certified Food Handler
Purpose:
1. Routine
2. Follow-up
3. Complaint
4. Pre-Operational
5. Temporary
6. HACCP
7. Other (list) _________________
Menu Type (See additional page)
1____2____3____4____5___
• CRITICAL ITEMS ARE IDENTIFIED IN THE CHECKLIST AND NARRATIVE COLUMNS MARKED “C”
• VIOLATION(S) REPEATED FROM PREVIOUS INSPECTIONS ARE DENOTED IN THE “SUMMARY OF VIOLATIONS” AND IN THE NARRATIVE BELOW AS “R”
Section# C/NC R Narrative To Be Corrected By
Received by (name and title printed): Inspected by (name and title printed):
Received by (signature): Inspected by (signature):
cc: cc: cc:
Dubois County Health Department
Telephone 812-481-7055Fax 812-481-7069
V.F.W. POST #673 812-482-5010
1907 NEWTON STREET, JASPER, IN, 47546 812-482-501006/01/2018
204
MEMBERS OF CLUB ✔ 06/11/2018
1907 NEWTON STREET, JASPER, IN, 47546
NANCY DREW0 0 0
NANCY DREW 11/12/18
No violations observed at time of inspection
Nancy Drew Kylie Shephard
S Retail Food Establishment Inspection Report
State Form 22116 (R7 /12-04) SDH Form 51-0001
Based on an inspection this day, the item(s) noted below identify violations of 410 IAC 7-24, Indiana Retail Food Establishment Sanitation Requirements.The time limit for correction of each violation is specified in the narrative portion of this report.
Establishment Name
Establishment Address (number and street, city, state, zip code)
Telephone Number ( ) Establishment
( ) Owner
Date of Inspection (mm/dd/yr)
ID #
Owner Follow-up Release Date
Owner’s Address
Person in Charge
Summary of Violations:
C_____ NC_____ R_____
Responsible Person’s E-mail
Certified Food Handler
Purpose:
1. Routine
2. Follow-up
3. Complaint
4. Pre-Operational
5. Temporary
6. HACCP
7. Other (list) _________________
Menu Type (See additional page)
1____2____3____4____5___
• CRITICAL ITEMS ARE IDENTIFIED IN THE CHECKLIST AND NARRATIVE COLUMNS MARKED “C”
• VIOLATION(S) REPEATED FROM PREVIOUS INSPECTIONS ARE DENOTED IN THE “SUMMARY OF VIOLATIONS” AND IN THE NARRATIVE BELOW AS “R”
Section# C/NC R Narrative To Be Corrected By
Received by (name and title printed): Inspected by (name and title printed):
Received by (signature): Inspected by (signature):
cc: cc: cc:
Dubois County Health Department
Telephone 812-481-7055Fax 812-481-7069
WENDY'S #384 812-482-3111
3565 NEWTON STREET, JASPER, IN, 47546 812-482-321206/01/2018
210
SERVUS, INC. ✔ 06/11/2018
4201 MANNHEIM RD., STE. A, JASPER, IN, 47546
Ken Burzynski1 5 1
Brandon Jump exp. 12/10/2020 John Swick 2019
191 C Some items in walk in cooler observed to not be dated (cut tomatoes, lettuce) 06/01/2018298 NC R Food accumulation on roof of microwave 06/01/2018355 NC Service sink contained food items and debris 06/01/2018433 NC Mop observed not being hung to dry 06/01/2018239 NC Single service items stored on floor in dry storage (cup lids, salad lids) 06/01/2018431 NC Excessive food and debris buildup found throughout establishment, on front line, and dry storage 06/01/2018
John Swick Kylie Shephard
S Retail Food Establishment Inspection Report
State Form 22116 (R7 /12-04) SDH Form 51-0001
Based on an inspection this day, the item(s) noted below identify violations of 410 IAC 7-24, Indiana Retail Food Establishment Sanitation Requirements.The time limit for correction of each violation is specified in the narrative portion of this report.
Establishment Name
Establishment Address (number and street, city, state, zip code)
Telephone Number ( ) Establishment
( ) Owner
Date of Inspection (mm/dd/yr)
ID #
Owner Follow-up Release Date
Owner’s Address
Person in Charge
Summary of Violations:
C_____ NC_____ R_____
Responsible Person’s E-mail
Certified Food Handler
Purpose:
1. Routine
2. Follow-up
3. Complaint
4. Pre-Operational
5. Temporary
6. HACCP
7. Other (list) _________________
Menu Type (See additional page)
1____2____3____4____5___
• CRITICAL ITEMS ARE IDENTIFIED IN THE CHECKLIST AND NARRATIVE COLUMNS MARKED “C”
• VIOLATION(S) REPEATED FROM PREVIOUS INSPECTIONS ARE DENOTED IN THE “SUMMARY OF VIOLATIONS” AND IN THE NARRATIVE BELOW AS “R”
Section# C/NC R Narrative To Be Corrected By
Received by (name and title printed): Inspected by (name and title printed):
Received by (signature): Inspected by (signature):
cc: cc: cc:
Dubois County Health Department
Telephone 812-481-7055Fax 812-481-7069
THE CORNER BAR & GRILL (GARRS LLC) 812-678-2491
4492 N 4th STREET, DUBOIS, IN, 47527 812-630-165406/04/2018
80
TINA RECKELHOFF ✔ 06/14/2018
5575 E MAIN ST., DUBOIS, IN, 47527
TINA RECKELHOFF0 0 0
SHARON RECKELHOFF EXP. 5/6/18
No violations at time of inspection
Tina Reckelhoff Kylie Shephard
S Retail Food Establishment Inspection Report
State Form 22116 (R7 /12-04) SDH Form 51-0001
Based on an inspection this day, the item(s) noted below identify violations of 410 IAC 7-24, Indiana Retail Food Establishment Sanitation Requirements.The time limit for correction of each violation is specified in the narrative portion of this report.
Establishment Name
Establishment Address (number and street, city, state, zip code)
Telephone Number ( ) Establishment
( ) Owner
Date of Inspection (mm/dd/yr)
ID #
Owner Follow-up Release Date
Owner’s Address
Person in Charge
Summary of Violations:
C_____ NC_____ R_____
Responsible Person’s E-mail
Certified Food Handler
Purpose:
1. Routine
2. Follow-up
3. Complaint
4. Pre-Operational
5. Temporary
6. HACCP
7. Other (list) _________________
Menu Type (See additional page)
1____2____3____4____5___
• CRITICAL ITEMS ARE IDENTIFIED IN THE CHECKLIST AND NARRATIVE COLUMNS MARKED “C”
• VIOLATION(S) REPEATED FROM PREVIOUS INSPECTIONS ARE DENOTED IN THE “SUMMARY OF VIOLATIONS” AND IN THE NARRATIVE BELOW AS “R”
Section# C/NC R Narrative To Be Corrected By
Received by (name and title printed): Inspected by (name and title printed):
Received by (signature): Inspected by (signature):
cc: cc: cc:
Dubois County Health Department
Telephone 812-481-7055Fax 812-481-7069
BUFFALO TRACE GOLF COURSE 812-482-4600
1728 JACKSON ST, JASPER, IN, 47546 812-482-595906/04/2018
217
CITY OF JASPER ✔ 06/14/2018
1301 ST. CHARLES ST, JASPER, IN, 47546
JOHN BERTGES0 0 0
No violations at this time
Kurt Uebelhor Christina Pierini
S Retail Food Establishment Inspection Report
State Form 22116 (R7 /12-04) SDH Form 51-0001
Based on an inspection this day, the item(s) noted below identify violations of 410 IAC 7-24, Indiana Retail Food Establishment Sanitation Requirements.The time limit for correction of each violation is specified in the narrative portion of this report.
Establishment Name
Establishment Address (number and street, city, state, zip code)
Telephone Number ( ) Establishment
( ) Owner
Date of Inspection (mm/dd/yr)
ID #
Owner Follow-up Release Date
Owner’s Address
Person in Charge
Summary of Violations:
C_____ NC_____ R_____
Responsible Person’s E-mail
Certified Food Handler
Purpose:
1. Routine
2. Follow-up
3. Complaint
4. Pre-Operational
5. Temporary
6. HACCP
7. Other (list) _________________
Menu Type (See additional page)
1____2____3____4____5___
• CRITICAL ITEMS ARE IDENTIFIED IN THE CHECKLIST AND NARRATIVE COLUMNS MARKED “C”
• VIOLATION(S) REPEATED FROM PREVIOUS INSPECTIONS ARE DENOTED IN THE “SUMMARY OF VIOLATIONS” AND IN THE NARRATIVE BELOW AS “R”
Section# C/NC R Narrative To Be Corrected By
Received by (name and title printed): Inspected by (name and title printed):
Received by (signature): Inspected by (signature):
cc: cc: cc:
Dubois County Health Department
Telephone 812-481-7055Fax 812-481-7069
BUTCHIE'S WESTERN SALOON & FAMILY RESTAURANT 812-678-2591
5353 E MAIN STREET, DUBOIS, IN, 47527 812-678-316106/04/2018
24
DENNIS R. TERWISKE ✔ 06/14/2018
5455 MAIN STREET, DUBOIS, IN, 47527
DENNIS R. TERWISKE0 0 0
DIANA TERWISKE EXP 3/13/22
No violations at time of inspection
Dennis Terwiske Kylie Shephard
S Retail Food Establishment Inspection Report
State Form 22116 (R7 /12-04) SDH Form 51-0001
Based on an inspection this day, the item(s) noted below identify violations of 410 IAC 7-24, Indiana Retail Food Establishment Sanitation Requirements.The time limit for correction of each violation is specified in the narrative portion of this report.
Establishment Name
Establishment Address (number and street, city, state, zip code)
Telephone Number ( ) Establishment
( ) Owner
Date of Inspection (mm/dd/yr)
ID #
Owner Follow-up Release Date
Owner’s Address
Person in Charge
Summary of Violations:
C_____ NC_____ R_____
Responsible Person’s E-mail
Certified Food Handler
Purpose:
1. Routine
2. Follow-up
3. Complaint
4. Pre-Operational
5. Temporary
6. HACCP
7. Other (list) _________________
Menu Type (See additional page)
1____2____3____4____5___
• CRITICAL ITEMS ARE IDENTIFIED IN THE CHECKLIST AND NARRATIVE COLUMNS MARKED “C”
• VIOLATION(S) REPEATED FROM PREVIOUS INSPECTIONS ARE DENOTED IN THE “SUMMARY OF VIOLATIONS” AND IN THE NARRATIVE BELOW AS “R”
Section# C/NC R Narrative To Be Corrected By
Received by (name and title printed): Inspected by (name and title printed):
Received by (signature): Inspected by (signature):
cc: cc: cc:
Dubois County Health Department
Telephone 812-481-7055Fax 812-481-7069
NICHOLSON VALLEY GROCERY 812-678-3333
10191 EAST STATE RD. 56, DUBOIS, IN, 47527 812-678-333306/04/2018
149
GILBERT A AND TRUDY SCHNEIDER ✔ 06/14/2018
10163 EAST STATE RD. 56, DUBOIS, IN, 47527
GILBERT A AND TRUDY SCHNEIDER0 0 0
Trudy E. Schneider exp. 1/22/2019
No violations at time of inspection
Gilbert Schneider Kylie Shephard
S Retail Food Establishment Inspection Report
State Form 22116 (R7 /12-04) SDH Form 51-0001
Based on an inspection this day, the item(s) noted below identify violations of 410 IAC 7-24, Indiana Retail Food Establishment Sanitation Requirements.The time limit for correction of each violation is specified in the narrative portion of this report.
Establishment Name
Establishment Address (number and street, city, state, zip code)
Telephone Number ( ) Establishment
( ) Owner
Date of Inspection (mm/dd/yr)
ID #
Owner Follow-up Release Date
Owner’s Address
Person in Charge
Summary of Violations:
C_____ NC_____ R_____
Responsible Person’s E-mail
Certified Food Handler
Purpose:
1. Routine
2. Follow-up
3. Complaint
4. Pre-Operational
5. Temporary
6. HACCP
7. Other (list) _________________
Menu Type (See additional page)
1____2____3____4____5___
• CRITICAL ITEMS ARE IDENTIFIED IN THE CHECKLIST AND NARRATIVE COLUMNS MARKED “C”
• VIOLATION(S) REPEATED FROM PREVIOUS INSPECTIONS ARE DENOTED IN THE “SUMMARY OF VIOLATIONS” AND IN THE NARRATIVE BELOW AS “R”
Section# C/NC R Narrative To Be Corrected By
Received by (name and title printed): Inspected by (name and title printed):
Received by (signature): Inspected by (signature):
cc: cc: cc:
Dubois County Health Department
Telephone 812-481-7055Fax 812-481-7069
DEB'S TRUCK STOP 812-389-2290
502 W HWY 64, BIRDSEYE, IN, 47513 812-639-752606/04/2018
54
DEBORAH D ERNST 06/14/2018✔
25150 CHANDLER RD, BRISTOW, IN, 47515
DEBORAH D ERNST5 0 5
DEBORAH ERNST EXP. 7/9/2019
295 C R significant grease and food build up 177 C R observed single use items on the floor188 C R food items stored in refrigeration units do not have covers218 C R sandwich prep table not functioning and hold product at 63 degress
296 C R refrigeration handles, drawers handle, inside re-fridge also needs to be cleaned
At this time I will be notifying the Administrative Director at the Dubios
County Health Dept and will be recommending a hearing to discuss
ways to ensure Debs Truck stop is operating at food safety and sanitary
standards
Deborah Ernst Christina Pierini
S Retail Food Establishment Inspection Report
State Form 22116 (R7 /12-04) SDH Form 51-0001
Based on an inspection this day, the item(s) noted below identify violations of 410 IAC 7-24, Indiana Retail Food Establishment Sanitation Requirements.The time limit for correction of each violation is specified in the narrative portion of this report.
Establishment Name
Establishment Address (number and street, city, state, zip code)
Telephone Number ( ) Establishment
( ) Owner
Date of Inspection (mm/dd/yr)
ID #
Owner Follow-up Release Date
Owner’s Address
Person in Charge
Summary of Violations:
C_____ NC_____ R_____
Responsible Person’s E-mail
Certified Food Handler
Purpose:
1. Routine
2. Follow-up
3. Complaint
4. Pre-Operational
5. Temporary
6. HACCP
7. Other (list) _________________
Menu Type (See additional page)
1____2____3____4____5___
• CRITICAL ITEMS ARE IDENTIFIED IN THE CHECKLIST AND NARRATIVE COLUMNS MARKED “C”
• VIOLATION(S) REPEATED FROM PREVIOUS INSPECTIONS ARE DENOTED IN THE “SUMMARY OF VIOLATIONS” AND IN THE NARRATIVE BELOW AS “R”
Section# C/NC R Narrative To Be Corrected By
Received by (name and title printed): Inspected by (name and title printed):
Received by (signature): Inspected by (signature):
cc: cc: cc:
Dubois County Health Department
Telephone 812-481-7055Fax 812-481-7069
HEICHELBECH'S RESTAURANT AND BAR 812-482-4050
222 E 12TH STREET, JASPER, IN, 47546 812-631-161206/04/2018
92
RONALD AND MAXINE KUNZ ✔ 06/14/2018
840 SUSANNA AVENUE, JASPER, IN, 47546
RONALD AND MAXINE KUNZ0 1 0
Stephen Kunz exp. 2/4/2018
146 NC Frozen meat is outside of original package, please keep info. on where
the product comes from
Kitchen is very clean and being well maintainedCertified food handler is expired please take care of that with in 30 days
Maxine Kunz Christina Pierini
S Retail Food Establishment Inspection Report
State Form 22116 (R7 /12-04) SDH Form 51-0001
Based on an inspection this day, the item(s) noted below identify violations of 410 IAC 7-24, Indiana Retail Food Establishment Sanitation Requirements.The time limit for correction of each violation is specified in the narrative portion of this report.
Establishment Name
Establishment Address (number and street, city, state, zip code)
Telephone Number ( ) Establishment
( ) Owner
Date of Inspection (mm/dd/yr)
ID #
Owner Follow-up Release Date
Owner’s Address
Person in Charge
Summary of Violations:
C_____ NC_____ R_____
Responsible Person’s E-mail
Certified Food Handler
Purpose:
1. Routine
2. Follow-up
3. Complaint
4. Pre-Operational
5. Temporary
6. HACCP
7. Other (list) _________________
Menu Type (See additional page)
1____2____3____4____5___
• CRITICAL ITEMS ARE IDENTIFIED IN THE CHECKLIST AND NARRATIVE COLUMNS MARKED “C”
• VIOLATION(S) REPEATED FROM PREVIOUS INSPECTIONS ARE DENOTED IN THE “SUMMARY OF VIOLATIONS” AND IN THE NARRATIVE BELOW AS “R”
Section# C/NC R Narrative To Be Corrected By
Received by (name and title printed): Inspected by (name and title printed):
Received by (signature): Inspected by (signature):
cc: cc: cc:
Dubois County Health Department
Telephone 812-481-7055Fax 812-481-7069
J. R. 'S BAR (TAYLOR MICHAELS INC) 812-482-9694
23 S. CLAY STREET, JASPER, IN, 47546 812-639-348806/04/2018
110
MICHAEL BECK ✔ 06/14/2018
1515 JACKSON ST. , JASPER, IN, 47546
MICHAEL BECK1 3 0
Micheal Beck 2/15/2023
295 C observed significant amounts grease, dirt and debris build up around 07/03/2018the kitchen area and the fryer and grill area as well as the fans in the
walk in cooler and standing fan in kitchen146 NC Not all product is being labeled with its name and date of prep 06/12/2018130 NC No dedicated hand washing sink in either the bar or kitchen 07/31/2018177 NC observed some product not being stored 6' off the floor 06/12/2018
Barb Kunkler Christina Pierini
S Retail Food Establishment Inspection Report
State Form 22116 (R7 /12-04) SDH Form 51-0001
Based on an inspection this day, the item(s) noted below identify violations of 410 IAC 7-24, Indiana Retail Food Establishment Sanitation Requirements.The time limit for correction of each violation is specified in the narrative portion of this report.
Establishment Name
Establishment Address (number and street, city, state, zip code)
Telephone Number ( ) Establishment
( ) Owner
Date of Inspection (mm/dd/yr)
ID #
Owner Follow-up Release Date
Owner’s Address
Person in Charge
Summary of Violations:
C_____ NC_____ R_____
Responsible Person’s E-mail
Certified Food Handler
Purpose:
1. Routine
2. Follow-up
3. Complaint
4. Pre-Operational
5. Temporary
6. HACCP
7. Other (list) _________________
Menu Type (See additional page)
1____2____3____4____5___
• CRITICAL ITEMS ARE IDENTIFIED IN THE CHECKLIST AND NARRATIVE COLUMNS MARKED “C”
• VIOLATION(S) REPEATED FROM PREVIOUS INSPECTIONS ARE DENOTED IN THE “SUMMARY OF VIOLATIONS” AND IN THE NARRATIVE BELOW AS “R”
Section# C/NC R Narrative To Be Corrected By
Received by (name and title printed): Inspected by (name and title printed):
Received by (signature): Inspected by (signature):
cc: cc: cc:
Dubois County Health Department
Telephone 812-481-7055Fax 812-481-7069
HOT HOT LOVER 812-973-9000
8985 S 450 E, FERDINAND, IN, 47532 812-973-900006/04/2018
102
ZACH ABELL ✔ 06/14/2018
8985 S 450 E, FERDINAND, IN, 47532
ZACH ABELL0 0 0
Exempt
No violations at time of inspection
Zach Abell Kylie Shephard
S Retail Food Establishment Inspection Report
State Form 22116 (R7 /12-04) SDH Form 51-0001
Based on an inspection this day, the item(s) noted below identify violations of 410 IAC 7-24, Indiana Retail Food Establishment Sanitation Requirements.The time limit for correction of each violation is specified in the narrative portion of this report.
Establishment Name
Establishment Address (number and street, city, state, zip code)
Telephone Number ( ) Establishment
( ) Owner
Date of Inspection (mm/dd/yr)
ID #
Owner Follow-up Release Date
Owner’s Address
Person in Charge
Summary of Violations:
C_____ NC_____ R_____
Responsible Person’s E-mail
Certified Food Handler
Purpose:
1. Routine
2. Follow-up
3. Complaint
4. Pre-Operational
5. Temporary
6. HACCP
7. Other (list) _________________
Menu Type (See additional page)
1____2____3____4____5___
• CRITICAL ITEMS ARE IDENTIFIED IN THE CHECKLIST AND NARRATIVE COLUMNS MARKED “C”
• VIOLATION(S) REPEATED FROM PREVIOUS INSPECTIONS ARE DENOTED IN THE “SUMMARY OF VIOLATIONS” AND IN THE NARRATIVE BELOW AS “R”
Section# C/NC R Narrative To Be Corrected By
Received by (name and title printed): Inspected by (name and title printed):
Received by (signature): Inspected by (signature):
cc: cc: cc:
Dubois County Health Department
Telephone 812-481-7055Fax 812-481-7069
ST BENEDICT'S BREW WORKS 812-998-2337
860 E 10TH STREET, FERDINAND, IN, 47532 812-719-230106/04/2018
182
VINCE LUECKE ✔ 06/14/2018
13758 E CR 1225 N, EVANSTON, IN, 47531
VINCE LUECKE0 0 0
VINCENT LUECKE exp 12/9/2020
No violations observed at time of inspection
Daniel W Harlan Kylie Shephard
S Retail Food Establishment Inspection Report
State Form 22116 (R7 /12-04) SDH Form 51-0001
Based on an inspection this day, the item(s) noted below identify violations of 410 IAC 7-24, Indiana Retail Food Establishment Sanitation Requirements.The time limit for correction of each violation is specified in the narrative portion of this report.
Establishment Name
Establishment Address (number and street, city, state, zip code)
Telephone Number ( ) Establishment
( ) Owner
Date of Inspection (mm/dd/yr)
ID #
Owner Follow-up Release Date
Owner’s Address
Person in Charge
Summary of Violations:
C_____ NC_____ R_____
Responsible Person’s E-mail
Certified Food Handler
Purpose:
1. Routine
2. Follow-up
3. Complaint
4. Pre-Operational
5. Temporary
6. HACCP
7. Other (list) _________________
Menu Type (See additional page)
1____2____3____4____5___
• CRITICAL ITEMS ARE IDENTIFIED IN THE CHECKLIST AND NARRATIVE COLUMNS MARKED “C”
• VIOLATION(S) REPEATED FROM PREVIOUS INSPECTIONS ARE DENOTED IN THE “SUMMARY OF VIOLATIONS” AND IN THE NARRATIVE BELOW AS “R”
Section# C/NC R Narrative To Be Corrected By
Received by (name and title printed): Inspected by (name and title printed):
Received by (signature): Inspected by (signature):
cc: cc: cc:
Dubois County Health Department
Telephone 812-481-7055Fax 812-481-7069
OASIS BAR AND GRILL 812-367-1250
935 MAIN STREET, FERDINAND, IN, 47532 812-661-263606/04/2018
151
CHERYL HOOPER ✔ 06/14/2018
1025 MISSOURI STREET, FERDINAND, IN, 47532
CHERYL HOOPER0 7 2
JOHNNY MARMELO EXP 8/8/21
295 NC R Grease accumulation on walls near cooking line, specifically wall next to fryers 07/04/2018214 NC R Cutting boards extremely scored and discolored 07/04/2018399 NC Floor near walk in cooler has pieces missing 12/04/2018256 NC Observed no temperature measuring devices in small fridge near kitchen entrance and large walk in cooler 06/11/2018146 NC Observed multiple food items in small fridge and large cooler without labels 06/12/2018239 NC Food-contact items not being stored at least 6 inches off the floor 06/05/2018351 NC No covered receptacle in female restroom 06/08/2018
Natalie Jones Kylie Shephard
S Retail Food Establishment Inspection Report
State Form 22116 (R7 /12-04) SDH Form 51-0001
Based on an inspection this day, the item(s) noted below identify violations of 410 IAC 7-24, Indiana Retail Food Establishment Sanitation Requirements.The time limit for correction of each violation is specified in the narrative portion of this report.
Establishment Name
Establishment Address (number and street, city, state, zip code)
Telephone Number ( ) Establishment
( ) Owner
Date of Inspection (mm/dd/yr)
ID #
Owner Follow-up Release Date
Owner’s Address
Person in Charge
Summary of Violations:
C_____ NC_____ R_____
Responsible Person’s E-mail
Certified Food Handler
Purpose:
1. Routine
2. Follow-up
3. Complaint
4. Pre-Operational
5. Temporary
6. HACCP
7. Other (list) _________________
Menu Type (See additional page)
1____2____3____4____5___
• CRITICAL ITEMS ARE IDENTIFIED IN THE CHECKLIST AND NARRATIVE COLUMNS MARKED “C”
• VIOLATION(S) REPEATED FROM PREVIOUS INSPECTIONS ARE DENOTED IN THE “SUMMARY OF VIOLATIONS” AND IN THE NARRATIVE BELOW AS “R”
Section# C/NC R Narrative To Be Corrected By
Received by (name and title printed): Inspected by (name and title printed):
Received by (signature): Inspected by (signature):
cc: cc: cc:
Dubois County Health Department
Telephone 812-481-7055Fax 812-481-7069
SCHNITZELBANK CATERING 812-634-2584
409 3RD AVENUE, JASPER, IN, 47546 812-482-264006/05/2018
173
ALAN HANSELMAN/GAIL HETTINGER ✔ 06/15/2018
443 N. Whoderville Rd, JASPER, IN, 47546
Royce Hurst / Lori Braun0 2 1
Kenneth McSpadden exp. 5/12/2021
146 NC Food in black containers with clear lids were not labeled or dated 06/06/2018
239 NC R Single service items being stored on floor in large storage area 01/12/2019
Kenneth B. McSpadden Kylie Shephard
S Retail Food Establishment Inspection Report
State Form 22116 (R7 /12-04) SDH Form 51-0001
Based on an inspection this day, the item(s) noted below identify violations of 410 IAC 7-24, Indiana Retail Food Establishment Sanitation Requirements.The time limit for correction of each violation is specified in the narrative portion of this report.
Establishment Name
Establishment Address (number and street, city, state, zip code)
Telephone Number ( ) Establishment
( ) Owner
Date of Inspection (mm/dd/yr)
ID #
Owner Follow-up Release Date
Owner’s Address
Person in Charge
Summary of Violations:
C_____ NC_____ R_____
Responsible Person’s E-mail
Certified Food Handler
Purpose:
1. Routine
2. Follow-up
3. Complaint
4. Pre-Operational
5. Temporary
6. HACCP
7. Other (list) _________________
Menu Type (See additional page)
1____2____3____4____5___
• CRITICAL ITEMS ARE IDENTIFIED IN THE CHECKLIST AND NARRATIVE COLUMNS MARKED “C”
• VIOLATION(S) REPEATED FROM PREVIOUS INSPECTIONS ARE DENOTED IN THE “SUMMARY OF VIOLATIONS” AND IN THE NARRATIVE BELOW AS “R”
Section# C/NC R Narrative To Be Corrected By
Received by (name and title printed): Inspected by (name and title printed):
Received by (signature): Inspected by (signature):
cc: cc: cc:
Dubois County Health Department
Telephone 812-481-7055Fax 812-481-7069
MILL HOUSE OF JASPER, INC. 812-482-4345
1340 MILL STREET, JASPER, IN, 47546 812-309-600306/05/2018
144
WILLIAM AND KIMBERLY AULL ✔ 06/15/2018
2150 W. SHILOH LANE, JASPER, IN, 47546
WILLIAM AND KIMBERLY AULL0 3 0
Shana Silvis exp. 1/22/2019
295 NC Grease accumulation on walls, white rack near kitchen entrance has food debris accumulation 12/05/2018298 NC Microwave showed accumulation of food 06/05/2018214 NC Surfaces of cutting boards were deeply scored 12/05/2018
Kimberly Aull Kylie Shephard
S Retail Food Establishment Inspection Report
State Form 22116 (R7 /12-04) SDH Form 51-0001
Based on an inspection this day, the item(s) noted below identify violations of 410 IAC 7-24, Indiana Retail Food Establishment Sanitation Requirements.The time limit for correction of each violation is specified in the narrative portion of this report.
Establishment Name
Establishment Address (number and street, city, state, zip code)
Telephone Number ( ) Establishment
( ) Owner
Date of Inspection (mm/dd/yr)
ID #
Owner Follow-up Release Date
Owner’s Address
Person in Charge
Summary of Violations:
C_____ NC_____ R_____
Responsible Person’s E-mail
Certified Food Handler
Purpose:
1. Routine
2. Follow-up
3. Complaint
4. Pre-Operational
5. Temporary
6. HACCP
7. Other (list) _________________
Menu Type (See additional page)
1____2____3____4____5___
• CRITICAL ITEMS ARE IDENTIFIED IN THE CHECKLIST AND NARRATIVE COLUMNS MARKED “C”
• VIOLATION(S) REPEATED FROM PREVIOUS INSPECTIONS ARE DENOTED IN THE “SUMMARY OF VIOLATIONS” AND IN THE NARRATIVE BELOW AS “R”
Section# C/NC R Narrative To Be Corrected By
Received by (name and title printed): Inspected by (name and title printed):
Received by (signature): Inspected by (signature):
cc: cc: cc:
Dubois County Health Department
Telephone 812-481-7055Fax 812-481-7069
SNAPS 812-848-7627
1115 MAIN STREET, JASPER, IN, 47546 812-848-762706/05/2018
177
KIM MITCHELL (WTFDS LLC) ✔ 06/15/2018
4981 W ST RD 56, JASPER, IN, 47546
KIM MITCHELL (WTFDS LLC)0 1 0
KIM MITCHELL EXP 9/12/22
433 NC observed mops not hanging to air dry 06/12/2018
noticed a very consistent system of date marking throughout the facility
Kim Mitchell Christina Pierini
S Retail Food Establishment Inspection Report
State Form 22116 (R7 /12-04) SDH Form 51-0001
Based on an inspection this day, the item(s) noted below identify violations of 410 IAC 7-24, Indiana Retail Food Establishment Sanitation Requirements.The time limit for correction of each violation is specified in the narrative portion of this report.
Establishment Name
Establishment Address (number and street, city, state, zip code)
Telephone Number ( ) Establishment
( ) Owner
Date of Inspection (mm/dd/yr)
ID #
Owner Follow-up Release Date
Owner’s Address
Person in Charge
Summary of Violations:
C_____ NC_____ R_____
Responsible Person’s E-mail
Certified Food Handler
Purpose:
1. Routine
2. Follow-up
3. Complaint
4. Pre-Operational
5. Temporary
6. HACCP
7. Other (list) _________________
Menu Type (See additional page)
1____2____3____4____5___
• CRITICAL ITEMS ARE IDENTIFIED IN THE CHECKLIST AND NARRATIVE COLUMNS MARKED “C”
• VIOLATION(S) REPEATED FROM PREVIOUS INSPECTIONS ARE DENOTED IN THE “SUMMARY OF VIOLATIONS” AND IN THE NARRATIVE BELOW AS “R”
Section# C/NC R Narrative To Be Corrected By
Received by (name and title printed): Inspected by (name and title printed):
Received by (signature): Inspected by (signature):
cc: cc: cc:
Dubois County Health Department
Telephone 812-481-7055Fax 812-481-7069
SANDER PROCESSING 812-481-0044
6614 E STATE ROAD 164, CELESTINE, IN, 47521 812-481-004406/05/2018
170
CHRIS SANDER ✔ 06/15/2018
1121 N BEAVER LAKE RD, JASPER, IN, 47546
CHRIS SANDER0 0 0
Amy Berg exp. 5/10/2021
No violations observed at time of inspection
Amy Berg Kylie Shephard
S Retail Food Establishment Inspection Report
State Form 22116 (R7 /12-04) SDH Form 51-0001
Based on an inspection this day, the item(s) noted below identify violations of 410 IAC 7-24, Indiana Retail Food Establishment Sanitation Requirements.The time limit for correction of each violation is specified in the narrative portion of this report.
Establishment Name
Establishment Address (number and street, city, state, zip code)
Telephone Number ( ) Establishment
( ) Owner
Date of Inspection (mm/dd/yr)
ID #
Owner Follow-up Release Date
Owner’s Address
Person in Charge
Summary of Violations:
C_____ NC_____ R_____
Responsible Person’s E-mail
Certified Food Handler
Purpose:
1. Routine
2. Follow-up
3. Complaint
4. Pre-Operational
5. Temporary
6. HACCP
7. Other (list) _________________
Menu Type (See additional page)
1____2____3____4____5___
• CRITICAL ITEMS ARE IDENTIFIED IN THE CHECKLIST AND NARRATIVE COLUMNS MARKED “C”
• VIOLATION(S) REPEATED FROM PREVIOUS INSPECTIONS ARE DENOTED IN THE “SUMMARY OF VIOLATIONS” AND IN THE NARRATIVE BELOW AS “R”
Section# C/NC R Narrative To Be Corrected By
Received by (name and title printed): Inspected by (name and title printed):
Received by (signature): Inspected by (signature):
cc: cc: cc:
Dubois County Health Department
Telephone 812-481-7055Fax 812-481-7069
HAPPY HOUR SPORTS BAR AND GRILL 812-481-2400
6679 E ST. RD. 164, CELESTINE, IN, 47521 812-639-875306/05/2018
87
JEREMY BETZ ✔ 06/15/2018
766 N BEAVER LAKE RD., JASPER, IN, 47546
JEREMY BETZ2 2 0
Jeremy Betz exp. 8/30/2021
173 C Raw chicken being stored above ready to eat food items Corrected187 C Salad toppings (cheese, tomatoes, etc) measured at approx 50-55 degrees. Corrected
Were instructed to use time as a temperature control146 NC Items in walk in cooler not properly labeled with common name and date 06/12/2018177 NC Food items in walk in cooler observed to be uncovered Corrected
Melissa Gogel Kylie Shephard
S Retail Food Establishment Inspection Report
State Form 22116 (R7 /12-04) SDH Form 51-0001
Based on an inspection this day, the item(s) noted below identify violations of 410 IAC 7-24, Indiana Retail Food Establishment Sanitation Requirements.The time limit for correction of each violation is specified in the narrative portion of this report.
Establishment Name
Establishment Address (number and street, city, state, zip code)
Telephone Number ( ) Establishment
( ) Owner
Date of Inspection (mm/dd/yr)
ID #
Owner Follow-up Release Date
Owner’s Address
Person in Charge
Summary of Violations:
C_____ NC_____ R_____
Responsible Person’s E-mail
Certified Food Handler
Purpose:
1. Routine
2. Follow-up
3. Complaint
4. Pre-Operational
5. Temporary
6. HACCP
7. Other (list) _________________
Menu Type (See additional page)
1____2____3____4____5___
• CRITICAL ITEMS ARE IDENTIFIED IN THE CHECKLIST AND NARRATIVE COLUMNS MARKED “C”
• VIOLATION(S) REPEATED FROM PREVIOUS INSPECTIONS ARE DENOTED IN THE “SUMMARY OF VIOLATIONS” AND IN THE NARRATIVE BELOW AS “R”
Section# C/NC R Narrative To Be Corrected By
Received by (name and title printed): Inspected by (name and title printed):
Received by (signature): Inspected by (signature):
cc: cc: cc:
Dubois County Health Department
Telephone 812-481-7055Fax 812-481-7069
CATERING BY MEYER 812-387-1690
6655 S. OLD STATE RD 162, HUNTINGBURG, IN, 47542 812-367-169006/06/2018
20
BRAD BROWN & JARED FELTNER ✔ 06/16/2018
6655 S OLD RD 162, HUNTINGBURG, IN, 47542
BRAD BROWN & JARED FELTNER0 0 0
Brad Brown exp. 7/18/2022
No violations at this time
Brad Brown Christina Pierini
S Retail Food Establishment Inspection Report
State Form 22116 (R7 /12-04) SDH Form 51-0001
Based on an inspection this day, the item(s) noted below identify violations of 410 IAC 7-24, Indiana Retail Food Establishment Sanitation Requirements.The time limit for correction of each violation is specified in the narrative portion of this report.
Establishment Name
Establishment Address (number and street, city, state, zip code)
Telephone Number ( ) Establishment
( ) Owner
Date of Inspection (mm/dd/yr)
ID #
Owner Follow-up Release Date
Owner’s Address
Person in Charge
Summary of Violations:
C_____ NC_____ R_____
Responsible Person’s E-mail
Certified Food Handler
Purpose:
1. Routine
2. Follow-up
3. Complaint
4. Pre-Operational
5. Temporary
6. HACCP
7. Other (list) _________________
Menu Type (See additional page)
1____2____3____4____5___
• CRITICAL ITEMS ARE IDENTIFIED IN THE CHECKLIST AND NARRATIVE COLUMNS MARKED “C”
• VIOLATION(S) REPEATED FROM PREVIOUS INSPECTIONS ARE DENOTED IN THE “SUMMARY OF VIOLATIONS” AND IN THE NARRATIVE BELOW AS “R”
Section# C/NC R Narrative To Be Corrected By
Received by (name and title printed): Inspected by (name and title printed):
Received by (signature): Inspected by (signature):
cc: cc: cc:
Dubois County Health Department
Telephone 812-481-7055Fax 812-481-7069
HASENOUR'S ALL NATURAL PORK AND BEEF 812-683-4780
8564 S 200 W, HUNTINGBURG, IN, 47542 812-683-478006/06/2018
90
CHRIS & ANGIE HASENOUR ✔ 06/16/2018
8564 S 200 W, HUNTINGBURG, IN, 47542
CHRIS & ANGIE HASENOUR0 0 0
Exempt
No violations at this time
Angie Hasenour Christina Pierini
S Retail Food Establishment Inspection Report
State Form 22116 (R7 /12-04) SDH Form 51-0001
Based on an inspection this day, the item(s) noted below identify violations of 410 IAC 7-24, Indiana Retail Food Establishment Sanitation Requirements.The time limit for correction of each violation is specified in the narrative portion of this report.
Establishment Name
Establishment Address (number and street, city, state, zip code)
Telephone Number ( ) Establishment
( ) Owner
Date of Inspection (mm/dd/yr)
ID #
Owner Follow-up Release Date
Owner’s Address
Person in Charge
Summary of Violations:
C_____ NC_____ R_____
Responsible Person’s E-mail
Certified Food Handler
Purpose:
1. Routine
2. Follow-up
3. Complaint
4. Pre-Operational
5. Temporary
6. HACCP
7. Other (list) _________________
Menu Type (See additional page)
1____2____3____4____5___
• CRITICAL ITEMS ARE IDENTIFIED IN THE CHECKLIST AND NARRATIVE COLUMNS MARKED “C”
• VIOLATION(S) REPEATED FROM PREVIOUS INSPECTIONS ARE DENOTED IN THE “SUMMARY OF VIOLATIONS” AND IN THE NARRATIVE BELOW AS “R”
Section# C/NC R Narrative To Be Corrected By
Received by (name and title printed): Inspected by (name and title printed):
Received by (signature): Inspected by (signature):
cc: cc: cc:
Dubois County Health Department
Telephone 812-481-7055Fax 812-481-7069
EL RINCONCITO LLC 812-684-8021
600 E 6TH STREET, HUNTINGBURG, IN, 47542 812-309-985206/06/2018
67
TATIANA ZELAYA ✔ 06/16/2018
615 BRETZ ST, HUNTINGBURG, IN, 47542
TATIANA ZELAYA0 0 0
EXEMPT
No violations at this time
Tatiana Zelaya Christina Pierini
S Retail Food Establishment Inspection Report
State Form 22116 (R7 /12-04) SDH Form 51-0001
Based on an inspection this day, the item(s) noted below identify violations of 410 IAC 7-24, Indiana Retail Food Establishment Sanitation Requirements.The time limit for correction of each violation is specified in the narrative portion of this report.
Establishment Name
Establishment Address (number and street, city, state, zip code)
Telephone Number ( ) Establishment
( ) Owner
Date of Inspection (mm/dd/yr)
ID #
Owner Follow-up Release Date
Owner’s Address
Person in Charge
Summary of Violations:
C_____ NC_____ R_____
Responsible Person’s E-mail
Certified Food Handler
Purpose:
1. Routine
2. Follow-up
3. Complaint
4. Pre-Operational
5. Temporary
6. HACCP
7. Other (list) _________________
Menu Type (See additional page)
1____2____3____4____5___
• CRITICAL ITEMS ARE IDENTIFIED IN THE CHECKLIST AND NARRATIVE COLUMNS MARKED “C”
• VIOLATION(S) REPEATED FROM PREVIOUS INSPECTIONS ARE DENOTED IN THE “SUMMARY OF VIOLATIONS” AND IN THE NARRATIVE BELOW AS “R”
Section# C/NC R Narrative To Be Corrected By
Received by (name and title printed): Inspected by (name and title printed):
Received by (signature): Inspected by (signature):
cc: cc: cc:
Dubois County Health Department
Telephone 812-481-7055Fax 812-481-7069
WOOPENHEIMER'S BAR AND GRILL 812-695-3211
451 W. HAYSVILLE RD., JASPER, IN, 47546 812-295-830606/06/2018
214
BRANDON AND LUCINDA GRIMES ✔ 06/16/2018
18867 ST. JOSEPH RD., LOOGOOTEE, IN, 47553
BRANDON AND LUCINDA GRIMES0 4 0
LUCINDA GRIMES EXP 7/26/21
355 NC No service sink in establishment and mop water being disposed of in an unapproved way 12/05/2018297 NC Mold buildup on downstairs ice bin 06/07/2018146 NC Food items missing labels with common name/date 06/07/2018295 NC Food contact and non-contact surfaces showing large amounts of food and grease debris 08/05/2018
Lucinda Grimes Kylie Shephard
S Retail Food Establishment Inspection Report
State Form 22116 (R7 /12-04) SDH Form 51-0001
Based on an inspection this day, the item(s) noted below identify violations of 410 IAC 7-24, Indiana Retail Food Establishment Sanitation Requirements.The time limit for correction of each violation is specified in the narrative portion of this report.
Establishment Name
Establishment Address (number and street, city, state, zip code)
Telephone Number ( ) Establishment
( ) Owner
Date of Inspection (mm/dd/yr)
ID #
Owner Follow-up Release Date
Owner’s Address
Person in Charge
Summary of Violations:
C_____ NC_____ R_____
Responsible Person’s E-mail
Certified Food Handler
Purpose:
1. Routine
2. Follow-up
3. Complaint
4. Pre-Operational
5. Temporary
6. HACCP
7. Other (list) _________________
Menu Type (See additional page)
1____2____3____4____5___
• CRITICAL ITEMS ARE IDENTIFIED IN THE CHECKLIST AND NARRATIVE COLUMNS MARKED “C”
• VIOLATION(S) REPEATED FROM PREVIOUS INSPECTIONS ARE DENOTED IN THE “SUMMARY OF VIOLATIONS” AND IN THE NARRATIVE BELOW AS “R”
Section# C/NC R Narrative To Be Corrected By
Received by (name and title printed): Inspected by (name and title printed):
Received by (signature): Inspected by (signature):
cc: cc: cc:
Dubois County Health Department
Telephone 812-481-7055Fax 812-481-7069
TACO BELL #3001034 (Jasper) 812-634-9536
3592 NEWTON STREET, JASPER, IN, 47546 503-722-282506/06/2018
194
BELL INDIANA, LLC ✔ 06/16/2018
PO BOX 507, WEST LINN, OR, 97068
BELL INDIANA, LLC1 1 1
Carrie Broadway exp. 7/21/2022
295 C R Accumulation of food debris and grease throughout the establishment on food and non food contact surfaces 12/05/2018355 NC Food buildup in service sink Corrected
Carrie Broadway Kylie Shephard
S Retail Food Establishment Inspection Report
State Form 22116 (R7 /12-04) SDH Form 51-0001
Based on an inspection this day, the item(s) noted below identify violations of 410 IAC 7-24, Indiana Retail Food Establishment Sanitation Requirements.The time limit for correction of each violation is specified in the narrative portion of this report.
Establishment Name
Establishment Address (number and street, city, state, zip code)
Telephone Number ( ) Establishment
( ) Owner
Date of Inspection (mm/dd/yr)
ID #
Owner Follow-up Release Date
Owner’s Address
Person in Charge
Summary of Violations:
C_____ NC_____ R_____
Responsible Person’s E-mail
Certified Food Handler
Purpose:
1. Routine
2. Follow-up
3. Complaint
4. Pre-Operational
5. Temporary
6. HACCP
7. Other (list) _________________
Menu Type (See additional page)
1____2____3____4____5___
• CRITICAL ITEMS ARE IDENTIFIED IN THE CHECKLIST AND NARRATIVE COLUMNS MARKED “C”
• VIOLATION(S) REPEATED FROM PREVIOUS INSPECTIONS ARE DENOTED IN THE “SUMMARY OF VIOLATIONS” AND IN THE NARRATIVE BELOW AS “R”
Section# C/NC R Narrative To Be Corrected By
Received by (name and title printed): Inspected by (name and title printed):
Received by (signature): Inspected by (signature):
cc: cc: cc:
Dubois County Health Department
Telephone 812-481-7055Fax 812-481-7069
KRODEL VENDING 812-482-3995
1250 WERNSING ROAD, JASPER, IN, 47546 812-630-181206/06/2018
124
DAN SMITH ✔ 06/16/2018
8823 S CO RD 775 E, STENDAL, IN, 47585
JANET SMITH0 1 0
LISA RASCHE 7/26/21
146 NC Observed items not labeled with common name/date 06/07/2018
Janet Smith Kylie Shephard
S Retail Food Establishment Inspection Report
State Form 22116 (R7 /12-04) SDH Form 51-0001
Based on an inspection this day, the item(s) noted below identify violations of 410 IAC 7-24, Indiana Retail Food Establishment Sanitation Requirements.The time limit for correction of each violation is specified in the narrative portion of this report.
Establishment Name
Establishment Address (number and street, city, state, zip code)
Telephone Number ( ) Establishment
( ) Owner
Date of Inspection (mm/dd/yr)
ID #
Owner Follow-up Release Date
Owner’s Address
Person in Charge
Summary of Violations:
C_____ NC_____ R_____
Responsible Person’s E-mail
Certified Food Handler
Purpose:
1. Routine
2. Follow-up
3. Complaint
4. Pre-Operational
5. Temporary
6. HACCP
7. Other (list) _________________
Menu Type (See additional page)
1____2____3____4____5___
• CRITICAL ITEMS ARE IDENTIFIED IN THE CHECKLIST AND NARRATIVE COLUMNS MARKED “C”
• VIOLATION(S) REPEATED FROM PREVIOUS INSPECTIONS ARE DENOTED IN THE “SUMMARY OF VIOLATIONS” AND IN THE NARRATIVE BELOW AS “R”
Section# C/NC R Narrative To Be Corrected By
Received by (name and title printed): Inspected by (name and title printed):
Received by (signature): Inspected by (signature):
cc: cc: cc:
Dubois County Health Department
Telephone 812-481-7055Fax 812-481-7069
DUTCH MART- BLESCH SALES AND SERVICES INC. 812-536-3421
402 E. MAIN ST., HOLLAND, IN, 47541 812-536-342106/06/2018
14
DON BLESCH ✔ 06/16/2018
P.O. BOX 141, HOLLAND, IN, 47541
BECKY BLESCH0 0 0
No violations at this time
Becky Blesch Christina Pierini
S Retail Food Establishment Inspection Report
State Form 22116 (R7 /12-04) SDH Form 51-0001
Based on an inspection this day, the item(s) noted below identify violations of 410 IAC 7-24, Indiana Retail Food Establishment Sanitation Requirements.The time limit for correction of each violation is specified in the narrative portion of this report.
Establishment Name
Establishment Address (number and street, city, state, zip code)
Telephone Number ( ) Establishment
( ) Owner
Date of Inspection (mm/dd/yr)
ID #
Owner Follow-up Release Date
Owner’s Address
Person in Charge
Summary of Violations:
C_____ NC_____ R_____
Responsible Person’s E-mail
Certified Food Handler
Purpose:
1. Routine
2. Follow-up
3. Complaint
4. Pre-Operational
5. Temporary
6. HACCP
7. Other (list) _________________
Menu Type (See additional page)
1____2____3____4____5___
• CRITICAL ITEMS ARE IDENTIFIED IN THE CHECKLIST AND NARRATIVE COLUMNS MARKED “C”
• VIOLATION(S) REPEATED FROM PREVIOUS INSPECTIONS ARE DENOTED IN THE “SUMMARY OF VIOLATIONS” AND IN THE NARRATIVE BELOW AS “R”
Section# C/NC R Narrative To Be Corrected By
Received by (name and title printed): Inspected by (name and title printed):
Received by (signature): Inspected by (signature):
cc: cc: cc:
Dubois County Health Department
Telephone 812-481-7055Fax 812-481-7069
MONTE'S PIZZA 812-481-9966
4951 ST. RD. 56, JASPER, IN, 47546 812-709-226206/06/2018
146
NICK STRANGE ✔ 06/16/2018
13682 E 650 S, LOOGOOTEE, IN, 47553
NICK STRANGE0 1 0
Chelsey Strange exp.12/8/2021
298 NC Food debris accumulation in microwave
Nick Strange Kylie Shephard
S Retail Food Establishment Inspection Report
State Form 22116 (R7 /12-04) SDH Form 51-0001
Based on an inspection this day, the item(s) noted below identify violations of 410 IAC 7-24, Indiana Retail Food Establishment Sanitation Requirements.The time limit for correction of each violation is specified in the narrative portion of this report.
Establishment Name
Establishment Address (number and street, city, state, zip code)
Telephone Number ( ) Establishment
( ) Owner
Date of Inspection (mm/dd/yr)
ID #
Owner Follow-up Release Date
Owner’s Address
Person in Charge
Summary of Violations:
C_____ NC_____ R_____
Responsible Person’s E-mail
Certified Food Handler
Purpose:
1. Routine
2. Follow-up
3. Complaint
4. Pre-Operational
5. Temporary
6. HACCP
7. Other (list) _________________
Menu Type (See additional page)
1____2____3____4____5___
• CRITICAL ITEMS ARE IDENTIFIED IN THE CHECKLIST AND NARRATIVE COLUMNS MARKED “C”
• VIOLATION(S) REPEATED FROM PREVIOUS INSPECTIONS ARE DENOTED IN THE “SUMMARY OF VIOLATIONS” AND IN THE NARRATIVE BELOW AS “R”
Section# C/NC R Narrative To Be Corrected By
Received by (name and title printed): Inspected by (name and title printed):
Received by (signature): Inspected by (signature):
cc: cc: cc:
Dubois County Health Department
Telephone 812-481-7055Fax 812-481-7069
MERKLEY AND SONS, INC. 812-482-7020
3994 W 180 N, JASPER, IN, 47546 812-482-565906/06/2018
140
JAMES AND DAVID MERKLEY ✔ 06/16/2018
214 E. 8th St., JASPER, IN, 47546
JAMES AND DAVID MERKLEY1 0 0
Brad Merkley exp. 10/17/2021
345 C Hand washing sink observed being used for purposes other than hand washing 06/06/2018
Neil Greenwell Kylie Shephard
S Retail Food Establishment Inspection Report
State Form 22116 (R7 /12-04) SDH Form 51-0001
Based on an inspection this day, the item(s) noted below identify violations of 410 IAC 7-24, Indiana Retail Food Establishment Sanitation Requirements.The time limit for correction of each violation is specified in the narrative portion of this report.
Establishment Name
Establishment Address (number and street, city, state, zip code)
Telephone Number ( ) Establishment
( ) Owner
Date of Inspection (mm/dd/yr)
ID #
Owner Follow-up Release Date
Owner’s Address
Person in Charge
Summary of Violations:
C_____ NC_____ R_____
Responsible Person’s E-mail
Certified Food Handler
Purpose:
1. Routine
2. Follow-up
3. Complaint
4. Pre-Operational
5. Temporary
6. HACCP
7. Other (list) _________________
Menu Type (See additional page)
1____2____3____4____5___
• CRITICAL ITEMS ARE IDENTIFIED IN THE CHECKLIST AND NARRATIVE COLUMNS MARKED “C”
• VIOLATION(S) REPEATED FROM PREVIOUS INSPECTIONS ARE DENOTED IN THE “SUMMARY OF VIOLATIONS” AND IN THE NARRATIVE BELOW AS “R”
Section# C/NC R Narrative To Be Corrected By
Received by (name and title printed): Inspected by (name and title printed):
Received by (signature): Inspected by (signature):
cc: cc: cc:
Dubois County Health Department
Telephone 812-481-7055Fax 812-481-7069
JASPER SHONEY'S 812-481-1466
25 INDIANA STREET, JASPER, IN, 47546 270-885-111506/07/2018
116
DONALD HENDERSON ✔ 06/17/2018
2919 FORT CAMPBELL BLVD., HOPKINSVILLE, KY, 42240
Terry A Fogle4 3 1
Terry A Fogle exp. 1/19/2022
173 C Raw sausage patties being stored above ready to eat items in fridge on cooking line Corrected345 C Hand wash sink being used for multiple procedures other than hand washing 06/08/2018295 C Mold, food, grease, dirt debris buildup throughout entire establishment 09/07/2018187 C Salad bar items not being held at proper temps. (Cheese at approx 55, dressing at approx 50) 06/08/2018297 NC Mold buildup on ice machine 06/08/2018402 NC Significantly damaged floor tiles leading to the harboring of grease and water 09/07/2018413 NC R Large gap in back exit door 09/07/2018
angie brooks Kylie Shephard
S Retail Food Establishment Inspection Report
State Form 22116 (R7 /12-04) SDH Form 51-0001
Based on an inspection this day, the item(s) noted below identify violations of 410 IAC 7-24, Indiana Retail Food Establishment Sanitation Requirements.The time limit for correction of each violation is specified in the narrative portion of this report.
Establishment Name
Establishment Address (number and street, city, state, zip code)
Telephone Number ( ) Establishment
( ) Owner
Date of Inspection (mm/dd/yr)
ID #
Owner Follow-up Release Date
Owner’s Address
Person in Charge
Summary of Violations:
C_____ NC_____ R_____
Responsible Person’s E-mail
Certified Food Handler
Purpose:
1. Routine
2. Follow-up
3. Complaint
4. Pre-Operational
5. Temporary
6. HACCP
7. Other (list) _________________
Menu Type (See additional page)
1____2____3____4____5___
• CRITICAL ITEMS ARE IDENTIFIED IN THE CHECKLIST AND NARRATIVE COLUMNS MARKED “C”
• VIOLATION(S) REPEATED FROM PREVIOUS INSPECTIONS ARE DENOTED IN THE “SUMMARY OF VIOLATIONS” AND IN THE NARRATIVE BELOW AS “R”
Section# C/NC R Narrative To Be Corrected By
Received by (name and title printed): Inspected by (name and title printed):
Received by (signature): Inspected by (signature):
cc: cc: cc:
Dubois County Health Department
Telephone 812-481-7055Fax 812-481-7069
RON'S PLACE 812-683-9412
504 N VAN BUREN STREET, HUNTINGBURG, IN, 47542 812-639-354806/07/2018
167
BOB BUECHLEIN ✔ 06/17/2018
345 S TINSEL CIRCLE E, SANTA CLAUS, IN, 47579
BOB BUECHLEIN0 2 0
Bob Buechlein exp. 5/21/2018
218 NC Noticed rust build up on the inside of ice machine 07/31/2018418 NC Floor in the kitchen appears to be need of repair 08/01/2018
Ashton Buechlein Christina Pierini
S Retail Food Establishment Inspection Report
State Form 22116 (R7 /12-04) SDH Form 51-0001
Based on an inspection this day, the item(s) noted below identify violations of 410 IAC 7-24, Indiana Retail Food Establishment Sanitation Requirements.The time limit for correction of each violation is specified in the narrative portion of this report.
Establishment Name
Establishment Address (number and street, city, state, zip code)
Telephone Number ( ) Establishment
( ) Owner
Date of Inspection (mm/dd/yr)
ID #
Owner Follow-up Release Date
Owner’s Address
Person in Charge
Summary of Violations:
C_____ NC_____ R_____
Responsible Person’s E-mail
Certified Food Handler
Purpose:
1. Routine
2. Follow-up
3. Complaint
4. Pre-Operational
5. Temporary
6. HACCP
7. Other (list) _________________
Menu Type (See additional page)
1____2____3____4____5___
• CRITICAL ITEMS ARE IDENTIFIED IN THE CHECKLIST AND NARRATIVE COLUMNS MARKED “C”
• VIOLATION(S) REPEATED FROM PREVIOUS INSPECTIONS ARE DENOTED IN THE “SUMMARY OF VIOLATIONS” AND IN THE NARRATIVE BELOW AS “R”
Section# C/NC R Narrative To Be Corrected By
Received by (name and title printed): Inspected by (name and title printed):
Received by (signature): Inspected by (signature):
cc: cc: cc:
Dubois County Health Department
Telephone 812-481-7055Fax 812-481-7069
PIZZA HUT #316854 (HUNTINGBURG) 812-683-0130
701 N. MAIN STREET, HUNTINGBURG, IN, 47542 502-874-611106/08/2018
160
PIZZA HUT OF AMERICA, LLC. ✔ 06/18/2018
P.O. BOX 34080, LOUSIVILLE, KY,
MARINA J FORTES0 0 0
Marina Fortes exp 5/19/2021
No violations at this time
Marina Fortes Christina Pierini
S Retail Food Establishment Inspection Report
State Form 22116 (R7 /12-04) SDH Form 51-0001
Based on an inspection this day, the item(s) noted below identify violations of 410 IAC 7-24, Indiana Retail Food Establishment Sanitation Requirements.The time limit for correction of each violation is specified in the narrative portion of this report.
Establishment Name
Establishment Address (number and street, city, state, zip code)
Telephone Number ( ) Establishment
( ) Owner
Date of Inspection (mm/dd/yr)
ID #
Owner Follow-up Release Date
Owner’s Address
Person in Charge
Summary of Violations:
C_____ NC_____ R_____
Responsible Person’s E-mail
Certified Food Handler
Purpose:
1. Routine
2. Follow-up
3. Complaint
4. Pre-Operational
5. Temporary
6. HACCP
7. Other (list) _________________
Menu Type (See additional page)
1____2____3____4____5___
• CRITICAL ITEMS ARE IDENTIFIED IN THE CHECKLIST AND NARRATIVE COLUMNS MARKED “C”
• VIOLATION(S) REPEATED FROM PREVIOUS INSPECTIONS ARE DENOTED IN THE “SUMMARY OF VIOLATIONS” AND IN THE NARRATIVE BELOW AS “R”
Section# C/NC R Narrative To Be Corrected By
Received by (name and title printed): Inspected by (name and title printed):
Received by (signature): Inspected by (signature):
cc: cc: cc:
Dubois County Health Department
Telephone 812-481-7055Fax 812-481-7069
THE OVERTIME 812-683-2494
422 4TH STREET, HUNTINGBURG, IN, 47542 812-630-423106/08/2018
157
MELL BICKNELL ✔ 06/18/2018
6105 S 500 W, HUNTINGBURG, IN, 47542
MELL BICKNELL3 2 0
APRIL ROBB EXP. 2/11/19
296 C Observed heavy ice build up on several freezer units as well as heavy 07/01/2018dirt and debris in all of the fridge and freezer units in the facilityAlso grease and food debris build up observed in the kitchen
344 C Observed hand washing sink being used to thaw raw meat Corrected218 C Temp on sandwich prep table only registering at 50 degress 06/08/2018
owner will call a tech out to look at it 06/08/2018146 NC Noticed not all of the product is being dated and labeled 06/08/2018410 NC One of the light shields is missing above grilling area 07/01/2018
Mel Bicknell Christina Pierini