Nassau Comptroller George Maragos Thursday called on the county health department to follow New York City and post letter grades in the windows of all county restaurants to allow the public to determine their cleanliness and performance in recent inspections.

The department's Office of Food Protection assigns a letter grade from A-E based on a restaurant's performance during an inspection. Inspectors consider issues such as food servers who do not wash their hands, meat that is not properly refrigerated and the presence of rodents on site.

Maragos, who released an audit of the health department Thursday, said in an interview that posting letter grades would create greater transparency and could prompt restaurants to "operate with higher standards. Hopefully they would clean up their act."

In response, the health department said a grading system would not provide "useful information to the public and protection of health" because violations and sanitary conditions "can change on a daily basis."

The department said it preferred to create a database where the public could easily access inspection histories.

The inspection reports currently are available by request at restaurants and on the state Department of Health website, said spokeswoman MaryEllen Laurain.

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New York City began requiring restaurants to post letter grades in 2010. Suffolk does not mandate letter grades in restaurants but posts inspection reports and violations data on a county website.

Nassau monitors about 6,500 food service establishments.

High-risk establishments, defined as full-scale restaurants where food is handled, cooled, processed and cooked on site, must be inspected twice a year; medium-risk establishments including fast-food restaurants once a year and low-risk businesses such as coffee shops and bars once every two years.

The audit found that in 2012-13, 74 percent of high-risk restaurants failed to receive a recommended second inspection. The failure to conduct follow-up inspections, including restaurants with repeated problems, could put the public's health at risk, Maragos said.

"People should be mildly concerned," said Maragos, adding that there has been no increase in food-borne illnesses. "Multiple small weaknesses in the system could add up to something substantial."

Laurain said the office would evaluate the audit recommendations. "We will continue to protect the public's health and be the lead agency of public health policy in Nassau County," she said.

Maragos also said the health department has only 18 full-time food safety inspectors despite federal staffing standards stipulating that Nassau would have needed 28 full-time inspectors to conduct the more than 8,800 food safety inspections that should have been performed in 2013.

Laurain said the department has four supervisors who can conduct inspections if needed.

Maragos said the department also does not have a comprehensive system for tracking the payment of fines.

He said that unlike in Suffolk and Westchester counties, the department lacks an expedited process for businesses to settle minor violations.