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HomeMy WebLinkAboutFood Service Establishment Inspection 20 (2) Page of INSPECTION REPORT STATE OF CONNECTICUT FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH CONTINUATION SHEET NAME OF ISTABLISHMENT TOWN DATE OF INSPECTION INSPECTION REMARKS FORM# 7 - (M, ,S/rgl Z_ Tza GZOa�6 0 Q&:& I d&14C�. :7 SgALW(J"y A D-7L- 1_zl� 4A a" &A4k a 4 rl 4y, aj 4,�ACE--f F e INITIAL(INSPECTOR) INITIAL(PERSON IN CHARG anager Distribution: 1st-White-Health Department 2nd-Yellow-Owner Establishment: Date of Inspection: Address: A2cyy Owner or Operator: ADDITIONAL FOUlt POINT ITEM KEY: DNC [DOES NOT COMPLY] 6 Foods not re-served. -Unwrapped foods not re-served ,' 31 Sewage disposal approved. ; -Potentially hazardous foods not re-served -Operating as required 11 Toxic chemicals. No cross connections,back siphonage,backflow -Stored properly,labeled properly,used properly Proper type/installation/backflow prevention device/air gap for: -Sanitizer concentration not to exceed maximum permitted -Food equipment -Hose connections -Dish machines -No unnecessary toxics on the premises -Soda system carbonator -Beverage dispensers -Toilet tanks -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 35rdesig'nfed,properly lities. Adequate,convenient,accessible, -Water quality in compliance installed -Monitoring in compliance OTHER ITEMS KEY: DNC [DOES NOT COMPLY] Sources of food:Original container,properly labeled 40 Garbage/rubbish storagearea/rooms,enclosures-properly constructed,clean 5 Potentially hazardous food properly thawed 41 Garbagelrubbish 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 Outeropenings protected against entrance of insects/rodents 4 loors: Floor covering installed,constructed as required,good repair,clean od-contact surfaces designed,constructed,maintained,installed, 5 Floors graded,drained as required ocated 6 Floor,wall juncture covered 17 onfood-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 19 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 properlystored 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 54 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 6 koilet rooms enclosed with self-closing door 58 No live birds,turtles,or other animals(except guide dogs) 59 Seats 75 or more:Nonsmoking area provided,sign(s)posted at 37 Proper toilet fixtures provided,good repair,clean entrance(s),smoking area indicated by sign(s) 39 Approved garbage/rubbish containers,adequate number,covered, rodent proof,clean Aloutine Inspection ❑Reinspection ❑ Preoperational Inspection Othe spection: IN PE T R: PERSON IN�HARGE: Demerit Score: *Include demerits from page 1 y5a� 1 4 3 2 1 Total Rating tur 611 /4Z s re �t n � v print name - phone umber title DATE CORRECTIONS DUE: J CCC Page 2 of 2 plus continuation pages IFocused Inspection ll2 Establishment: r►tia,... Inspection Date: —O Time: Roins E[nsp ddress/City: Health Dept: class: Based on an inspection this day,thMtems marked DNC ide ify the 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/A DNC KEY: C[complies] N/O[not observed] NIA[not applicable] $ DNC[does not comply] 0[other] RTE[ready-to-eat] A Food workers have no exposed infected lesions/burns �%V109 pCOgCtf� 2 B Personnel with infection restricted .� °4, C Communicable disease of worker reported to local health director - A Approved shellfish,finfish,meat&poultry USDA approveAA d B Food cans in good condition(not dented,rusty,bloated,leaking) '° A Handwash facilities in all food prep/dispensing&warewash areas C Wholesome/nonadulteratedfcods/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 1,00 D Personnel hands washed,clean/Proper handwash procedure 0 mill E Handwashing at appropriate times 0 t� z A Hot holding greater than or equal to 140 F. (whoie beoupork roasts 13o°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/ d 0 A Approved sanitizeravailable/adequate concentration of sanitizer lollB 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 L Proper sanitizinq procedure B Proper food thermometer for product 41 E Sanitizing between raw animal origin&ready-to-eat food C Thermometers appropriately placed in cooler units 0 0 Cloths and/or sponges in good repair and clean A Produce washed MIT B Wiping cloths kept in sanitizer between uses 0 B Raw meats not stored/prepared near ready-to-eat foods C Food covered properly 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 _x A Soap I 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)fordispensing food/ice 0 0 •DESCRIBE DEFICIENCIES ON CONTINUATION SHEETS The following information is not debitable and does not affect your score. KEY: QFO[qualified food operator],DA[designated alternate],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 temperatures taken? Y N *To what temperature do you cook: Poultry Ground Beef Pork What diseases re l to FB illness are you required to report to the local health department? Roasts Other Describe re-heating procedures: Is there ritten illness policy that requires the food worker to report specific illness conditions Are temperatures recorded/logged for cold holding foods/equipment? Y N a eases to the QFO? Y N ♦Do you have a paid sick leave policy? Y N Are foods cooked in advance and cooled? Y N *Are leftovers saved? Y Is there a language barrier between inspector&QFO? Y N If yes indicate language spoken List products cooled: by CFO/DA: *Can the QFO/DA read the inspection report? Y N Describe cooling methods: Indicate who answered the above questions: Name(print): Indicate the title of above person(circle all that apply):QFO DA Mgr Cook Owner FW Is cooling monitored for time&temp? Y N Is the monit ' g of cooling recorded? Y N .Obtain signature of the person who received the QFO responsibilities information at the time of the Is there a produce washing policy? Y N ♦Desc' a what is washed and inspection: where: Note: This report is a two page form(total of 62 debitable items) Page 1 of 2 i Establishment: 4b,1 tj/,oJVJ - Inspection Date: Time: RO[nsp RE]nsp Address/City: Health Dept: ��/fc� 'O'� ass: 1 _ep 4 Based on an inspection this day,the iterrI6 marked DNC identify theiviolations 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/ N/A DNC KEY: C[complies] NIO[not observed] NIA[not applicable] 3 DNC[does not comply] 0[other] RTE[ready-to-eat] q , Food workers have no exposed infected lesionsI burns F, 2 B Personnel with infection restricted C Communicable disease of worker reported to local health director A Approved shellfish,finfish,meat&poultry USDA approved , �f critt S pr8�r l d:haf ;can' .'C Nf, 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/nonadulteratedfoods/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 D Personnel hands washed,clean/Proper handwash procedure 0 E Handwashing at appropriate times 0 A Hot holding greater than or equal to 1400F. (whole beef/pork roasts 130e F.) A �❑ No eating ❑ No smoking while working B Cold holding less than or equal to 450 F. IB Wounds covered adequately C Proper cooling C Proper sink used for handwashing too D Proper re-heating 0 E Proper internal cooking/consumer advisory posted ly / F��� E M1 M N 0 V IApproved sanitizer available/adequate concentration of sanitizer B Food-contact surfaces and utensils used for potentially or hazardous food sanitized at least every 4 hours A Food thermometer available and accurate C I Adequate ❑dishwashersanitizer ❑final rinse temp D Proper sanitizin procedure B Properfood thermometerfor 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 A Produce washed B Wiping cloths kept in sanitizer between uses B Raw meats not stored/prepared near ready-to-eat foods C Food covered properly A Food equipment clean,utensils clean,equipment interiors clean D Adequate splash guards/sneeze guard B Single use gloves changed when soiled E No unauthorized personnel 01C Food contact surfaces clean F No pooling of eggs not cooked immediately 0 8 Food containers stored off the floor 0 e AL A No unnecessary handling RTE and/orcooked foods with bare hands / owel A Soap drying device available B Disp orking: ❑Soap ❑Papertowel 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 O •DESCRIBE DEFICIENCIES ON CONTINUATION SHEETS The following information is not debitable and does not affect your score. KEY: QFO[qual' operator],DA[designated aftemate],PHF[potentially hazardous food],FB[foodbome] PHFs are hot held at: IF. PHFs are cold held at: OF. Descri illness conditions when you would exclude a food worker from working: Are internal cooking temperatures taken? Y N *To what temperature do you cook: Poultry Ground Beef Pork at 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 worker to report specific illness conditions Are temperatures recorded/logged for cold holding foods/equipment? Y N and diseases to the QFO? Y N *Do you have a paid sick leave policy? Y N Are foods cooked in advance and cooled? Y N *Are leftovers saved? N Is there a language barrier between inspector&QFO? Y N If yes indicate language spoken List products cooled: by QFO/DA: *Can the QFO/DA read the inspection report? Y N Describe cooling methods: Indicate who answered the above questions: Name(print): Indicate the title of above person(circle all that apply):QFO DA Mgr Cook Owner FW Is cooling monitored for time&temp? Y N Is the monitoring: cooling recorded? Y N .Obtain signature of the person who received the QFO responsibilities information at the time of the Is there a produce washing policy? Y N ♦Describe w is washed and inspection: where: Note: This report is a two page form(total of 62 debitabte items) Page 1 of 2 _ Establishment: Date of inspection: F�'/ Address: Owner or Operator: ADDITIONAL FOUR POI FIT ITEMS ens KEY: DNC [DOES NOT COMPLY] 6 Foods not re-served. -Unwrapped foods not re-served 4 31 Sewage disposal approved. 4 -Potentially hazardous foods not re-served -Operating as required No cross connections,back siphonage,backfiow 11 Toxic chemicals. Proper type/installation/backfiow prevention device/air gap for: -Stored properly,labeled properly,used properly -Food equipment -Hose connections -Dish machines -Sanitizer concentration notto 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 -Monitoring in compliance designed,properly installed OTHER ITEMS KEY: DNC [DOES NOT COMPLY] 2 Sources of food: Original container,properly labeled 40 Garbage/rubbish storage area/rooms,enclosures-properly constructed,clean 5 :Etentially hazardous food properly thawed 41 Garbage/rubbish disposed of in an approved manner,at approved frequency 0 Ood dispensing utensils properly stored 42 Vermin Control: No insects/rodents present Food worker:Clean outer clothes,effective hair restraints ropenings protected against entrance of insects/rodents oors: Floor covering installed,constructed as required,good repair,clean 16 Food-contact surfaces designed,constructed,maintained,installed, 5 Floors graded,drained as required Gated 6 Floor,wall juncture covered q'il Xonfood-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 ails,ceilings attached,equipment properly constructed,good 20 Dishwashing facilities approved design,adequately constructed, repair,clean.Wall&ceiling surfaces as required maintained installed located Pdstiess cleaning methods used,cleaning equipment properlystored 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 themnometers provided,dish basket,if used 54 Rooms adequate,clean,adequate lockers provided,facilities clean 2 onfood-contact surfaces of utensils&equipment clean 55 Establishment and premises free of litter,no insect/rodent harborage, 8 Equipment/utensils,storoge,handling no unnecessary articles 32 Proper disposal of wastewater 56 Complete separation from living/sleeping quarters and laundry 33 Plumbing location,installation,maintenance 57 Clean/soiled linens stored properly 36 Toilet rooms enclosed with self-closing door 58 No live birds,turtles,or other animals(except guide dogs) 37 Proper toilet fixtures 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 Approved garbage/rubbish containers,adequate number,covered, rodent proof,clean outine Inspection ❑Reinspection ❑ Preoperational Inspection IN P T R: , PERSON IN CHARGE: Othe pection: Demerit Score: *Include demerits from page 1 4 3 2 1 Total Rating to atureF ri n print name A0 V-4 /-tj "Ir� J� phone nu ber tide ATE CORRECTIONS DUE: ' Page 2 of 2 plus continuation pages Fe ea Inspection 1/2002 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 r _ iA- 4/0 .` L ` r .� J 72426�i azd, A-Loteo� I INITIAL(INSPECTOR) INITIAL(PERSON IN CHARG ) Distribution: 1st-White-Health Department 2nd-Yellow-Owner anager