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HomeMy WebLinkAboutFood Service Establishment Inspection 89 i Page of INSPECTION REPORT STATE OF CONNECTICUT FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH CONTINUATION SHEET NAME OF ESTABLISHMENT TOWN DATE OF INSPECTION INSPECTION FORM# REMARKS P02..le— Sxnti�b c1oz`AZ Z.v° S 1 DS �i< e- c- •y Lc-A.+j INITIAL(INSPECTOR) C./t INITIAL(PERSON IN CHARGE Distribution: 1 st-White-Health Department 2nd-Yellow-Owner/Manager �EHS-106-Rev.11/05 INSPECTION REPORT STATE OF CONNECTICUT ROUTINE INSPECTION ❑ REINSPECTION FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH ❑ REOPERATIONAL ❑ OTHER 410 Capitol Avenue,MS#11FDP,Hartford,CT 06134 NAME OF ESTABLISHMENT ESTABLISHMENT C) CLASS STREET TO � WN ADDRESS Es_vZ(��„{u1�j J , W, ,� NA- OWNER or INSPECTION OPERATOR DATE and TIME 1 Based on an inspection this day,the items marked below identify the violations in operation or facilities which must be corrected by the date pecified below, SOURCES OF FOOD EQUIPMENT&UTENSILS:CLEANLINESS VERMIN CONTROL 1 Approved source,wholesome, 4 21 Preflushed,scraped,soaked and racked 42 Presence of insects/rodents 2 nonadulterated 22 Wash water clean,proper temperature 1 43 Outer openings protected against entrance of 1 2 Origin l container,properly labeled 1 23 Accurate thermometers provided,dish basket,if used insects/rodents 24 Sanitization rinse(hot water-chemical) 2 FOOD PROTECTION 25 Clean wiping cloths 1 FLOORS,WALLS&CEILINGS 3 Potentially hazardous food meets 4 26 Food-contact surfaces of utensils& 2 44 Floors:floor covering installed, temperature requirements during storage, equipment clean constructed as required,good repair,clean preparation,display,service,and transportation 27 Nonfood-contact surfaces of utensils& 1 45 Floors,graded,drained as required 1 equipment clean 46 Floor,wall juncture covered 4 Adequate facilities to maintain product 2 28 Equipment/utensils,storage,handling 1 47 Mats removable,good repair,clean temperature,thermometers provided 5 Potentially hazardous food properly thawed 2 48 Exterior walking,driving surfaces, 1 6 Unwrapped or potentially hazardous food 4 WATER SUPPLY good repair,clean not re-served 29 Water source adequate,safe 4 49 Walls,ceilings attached,equipment properly 1 7 Food protected during storage,preparation, 30 Hot and cold water under pressure, 2 constructed,good repair,clean. Wall&ceiling display,service&transportation 2 provided as required surfaces as required. 8 Food containers stored off floor 50 1 Dustless cleaning methods used, 1 SEWAGE DISPOSAL cleaning equipment properly stored IToxi9 Handling of food minimized 2 31 Sewage disposal approved 4 10 Food dispensing utensils properly stored 1 32 Proper disposal of wastewater 1 LIGHTING&VENTILATION 11 c items properly stored,labeled,used 4 51 Adequate lighting provided as required 1 PLUMBING 52 Room free of steam,smoke odors 1 PERSONNEL 33 Location,installation,maintenance 1 53 Room&equipment hoods,ducts,ventetlasrequired 12 1 Personnel with infection restricted 14 34 No cross connection,back siphonage,backflow 4 DRESSING ROOMS& LOCKERS CLEANLINESS OF PERSONNEL TOILET FACILITIES 54 Rooms adequate,clean,adequate lockers 1 13 Handwashing facilities provided, 4 35 Adequate,convenient,accessible,designed, 4 provided,facilities clean personnel hands washed,clean installed 14 Clean outer clothes,effective hair restraints 1 36 Toilet rooms enclosed with self-closing door 1 15 Good hygienic practices,smoking restricted 2 37 Proper fixtures provided,good repair,clean HOUSEKEEPING 55 Establishment and premises free of litter,no 1 EQUIPMENT&UTENSILS: DESIGN, HANDWASHING FACILITIES insect/rodent harborage,no unnecessary articles CONSTRUCTION&INSTALLATION 38 Suitable hand cleaner and sanitary towels or 1 56 Complete separation from living/sleeping quarters 1 16 Food-contact surfaces designed,constructed, 2 approved hand drying devices provided, and laundry maintained,installed,located tissue waste receptacles provided 57 Clean/soiled linens stored properly 1 17 Nonfood-contact surfaces designed, 1 58 1 No live birds,turtles,or other animals 1 constructed,maintained,installed,located GARBAGE/RUBBISH STORAGE&DISPOSAL (except guide dogs) 18 Single service articles,storage,dispensing 2 39 Approved containers,adequate number, 1 19 No reuse of single service article covered,rodent proof,clean SMOKING PROHIBITED 20 Dishwashing facilities approved design,adequately 2 40 Storage area/rooms,enclosures— 59 Smoking prohibited,signs posted at each 3 constructed,maintained,installed,located properly constructed,clean entrance 1 41 Garbage disposed of in an approved manner, at approved frequency QUALIFIED FOOD OPERATOR DEMERIT SCORE r60 Qualified Food Operator 3 4` 3-- 2 1 RISK FACTOR VIOLATIONS IN RED Designated alternate 2 ._— r Written documentation of training program 2 Signature of Per on i arge TOTAL RATING Date Corrections Due CV SIGNED sp tor) DESCRIBE DEFICIENCIES ON CONTINUATION SHE DISTRIBUTION:1"-White—Health Department 2°d—Yellow—Owner/Operator i Establishment: 2 Inspection Date: —D Time: R01nsp REinsp Address/City: f lJ Health Dept: J-J6 dL__ Ckqo 2 3 4 Based on an inspection this day,the items marked DNC identify a violations in operation or facilities which must be corrected by the date specified on page 2. RISK FACTOR ITEMS:Listing is not inclusive of all possible debitable items C N/O WA DNC KEY_: C[complies] N/O[not observed] NIA[not applicable] 3 DNC[does not comply] 0[other] RTE[ready-to-eat] 16M, 2 f .. A` - G2, Written decal ttta�gn:ofiratztri g Pragrat t 2 A Food workers have no exposed infected lesions I burns B Personnel with infection restricted 'App* 0 �wbeW me,mo tadittersted C �0 N/A C Communicable disease of worker reported to local health director A Approved shellfish,finfish,meat&poultry USDA approved 13 tfanc as pro'akW,Wds'vvY t�d,dees C N N/A 4 B Food cans in good condition(not dented,rusty,bloated,leaking) A Handwash facilities in all food prep/dispensing&warewash areas C Wholesome/nonadulterated foods/Safe B Handwash facilities in or immediately adjacent to toilet rooms D Commercial products(no home grown/canned food) C Handwash facilities accessible/convenient to use E Potentially hazardous foods received at proper temperature 0 D Personnel hands washed,clean/Proper handwash procedure E Handwashing at appropriate times 0 77tfA 2`<, A Hot holding greater than or equal to 1400F. (whole beef/pork roasts 1300 F.) A ❑ No eating ❑ No smoking while working B Cold holding less than or equal to 450 F. B Wounds covered adequately C Proper cooling C Proper sink used for handwashing D Proper re-heating 0 E Proper internal cooking/consumer advisory posted 0 A Approved sanitizeravailable/adequate concentration of sanitizer B Food-contact surfaces and utensils used for potentially hazardous food sanitized at least every 4 hours A Food thermometer available and accurate C Adequate ❑dishwashersanitizer ❑final rinse temp D Proper sanitizin procedure B Proper food thermometer for product E Sanitizing between raw animal origin&ready-to-eat food C Thermometers appropriately placed in cooler units O 0 A Cloths and/or sponges in good repair and clean INEEMANNIM B Wiping cloths kept in sanitizer between uses A Produce washed B Raw meats not stored/prepared near ready-to-eat foods 0 C Food covered properly A Food equipment clean,utensils clean,equipment interiors clean D Adequate splash guards/sneeze guard g Single use gloves changed when soiled E No unauthorized personnel C Food--contact surfaces clean F No pooling of eggs not cooked immediately 0 8 Food containers stored off the floor 0 A Soap/paper towels/ drying device available A No unnecessary handling RTE and/or cooked foods with bare hands B Dispenser(s)working: ❑Soap ❑Paper towel B Minimize food handling,other than ready-to-eat,with bare hands C Handwash sink(s)clean/waste receptacle at handwash sink C Adequate utensil(s)for dispensing food/ice 0 0 •DESCRIBE DEFICIENCIES ON CONTINUATION SHEETS The following information is not debitable and does not affect your score. _M: QFO[qualified food operator],DA[designated aftemate],PHF[potentially hazardous food],FB[foodbome] PHFs are hot held at: OF. PHFs are cold held at: OF. Describe illness conditions when you would exclude a food worker from working: Are internal cooking temperatu lea taken? Y N *To what temperature do you cook: Poultry GrounU Pork What diseases related to FB illness are you required to report to the local health department? Roasts Other Describe re-heating procedures: Is there a written illness policy that requires the food nditions Are temperatures recorded/logged for cold holding foods/equipment. and diseases to the *Do you have a paid sick leave policy? Y N Are foods cooked in advance and cooled? Y N *Are leftovers saved? Is7here a language barrier between inspector&QFO? Y N Iflf ves indicate language spoken List products cooled: by *Can the QFO/DA read the inspection report? Y N Describe cooling methods: Indicate who answered the �received rint): Indicate the title of above pers :QFO DA Mgr Cook Owner FW Is cooling monitor or time&temp? Y N Is the monitoring of cooling recorded? Y N .Obtain signature of the perso nsibilities information at the time of the Is there a produce washing policy? Y N *Describe what is washed and inspection: where: INote: This report is a two page form(total of 62 debitable items) Page 1 of 2 Page_of_ s'YG INSPECTION REPORT STATE OF CONNECTICUT FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH CONTINUATION SHEET NAME OF ESTABLISHMENT, TOWN DATE OF INSPECTION impaction Form M Ranarks: A. YA-e r vv�7� f ��TN�TIAINSPECTOR) INITIAL(PERSON IN CHARGE) Distribu lon: Ist-White-Health Department 2nd-Yellow-Owner/Manager c:\cen\msform2.crt - 7Earbshmettt: 7 Date of Inspec#ion: s: Owner or Operator: ADDITIONAL FOUR POINT ITEMS KEY: DNC [DOES NOT COMPLY] 6 Foods not re-served. -Unwrapped foods not re-served 4 31 Sewage disposal approved. -Potentially hazardous foods not re-served -Operating as required No cross connections,back siphonage,backflow 11 Toxic chemicals. Proper type/installation/backflow prevention device/air gap for: -Stored properly,labeled properly,used properly -Food equipment -Hose connections -Dish machines -Sanitizer concentration not to exceed maximum permitted -Soda system carbonator -Beverage dispensers -Toilet tanks -No unnecessary toxics on the premises -Chemical dispensers -Ice machines -Pesticides/rodenticides properly dispensed Proper drain for: 29 Water source adequate,safe. -Food equipment -Dish machines -Ice machines -Well/well head protected from contamination 35 Toilet facilities. Adequate,convenient,accessible, -Water quality in compliance designed,properly installed -Monitoring in compliance OTHER ITEMS KEY: DNC [DOES NOT COMPLY] 2 Sources of food: Original container,properly labeled 0 Garbage/rubbish storagearea/rooms,enclosures-properly constructed,clean 5 Potentially hazardous food properly thawed 41 Garbage/rubbish disposed of in an approved manner,at approved frequency 10 Food dispensing utensils properly stored 42 Vermin Control: No insects/rodents present 14 Food worker:Clean outer clothes,effective hair restraints 43 Outer openings protected against entrance of insects/rodents 4 Floors: Floor covering installed,constructed as required,good repair,clean 16 Food-contact surfaces designed,constructed,maintained,installed, 45 Floors graded,drained as required located 6 Floor,wall juncture covered 17 Nonfood-contact surfaces designed,constructed,maintained, 7 Mats removable,good repair,clean installed,located 8 Exterior walking,driving surfaces,good repair,clean 18 Single service articles,storage,dispensing 19 No reuse of single service article 9 Walls,ceilings attached,equipment properly constructed,good 20 Dishwashing facilities approved design,adequately constructed, repair,clean.Wall&ceiling surfaces as required maintained installed located 50 Dustless cleaning methods used,cleaning equipment properly stored Equipment&Utensils: Cleanliness 51 Adequate lighting provided as required 21 Preflushed,scraped,soaked and racked 52 Room free of steam,smoke odors 22 Wash water clean,proper temperature 53 Rooms&equipment hoods,ducts,vented as required 23 Accurate thermometers provided,dish basket,if used 541 Rooms adequate,clean,adequate lockers provided,facilities clean 27 Nonfood-contact surfaces of utensils&equipment clean 55 Establishment and premises free of litter,no insect/rodent harborage, 28 Equipment/utensils,storage,handling no unnecessary articles 32 Proper disposal of waste water 56 Complete separation from living/sleeping quarters and laundry 33 Plumbing location,installation,maintenance 57 Clean/soiled linens stored properly 36 Toilet roams enclosed with self-closing door 58 No live birds,turtles,or other animals(except guide dogs) 37 Proper toilet Mures provided,good repair,clean 59 Seats 75 or more:Nonsmoking area provided,sign(s)posted at entrance(s),smoking area indicated by sign(s) 39 1 Approved garbage/rubbish containers,adequate number,covered, rodent proof,clean ❑Routine Inspection ❑Reinspection ❑ Preoperational Inspection Other inspection: IN P R: ' PERSON IN CHARGE: Demerit Score: *Include demerits from page 1 ' 4 3 2 1 Total Rating signature signature print name ,/'/ print name _�f 0—6 7"7�� Co ti mf U C-Tta-) S J� �►s DATE CORRECTIONS DUE: phone number title Page 2 of 2 plus continuation pages Focused Inspection 1/2002