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HomeMy WebLinkAboutFood Service Establishment Inspection 86 (2) i Establishment: Inspection Date: ►3 OtIM Time: ( 1 ROinsp REinsp Address/City: He Dep. u jy Class: 1 z 3 C Based on an inspection this day,the items marked DNC identify 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 )CO N/A JDNC I KEY: C[complies] N/O[not observed] N/A[not applicable] � �� 3 DNC[does not comply] 0[other] RTE[ready-to-eat] 61 besigtiated Alternate 2 12 Rdrsonnet-With infectilon restrictedCA NIA 4 62 Written documentation of training program 2 A Food workers have no exposed infected lesions/burns 1 Approved source,wholesome,nonadulterated C 00b N/A 4 B Personnel with infection restricted C Communicable disease of worker reported to local health director A Approved shellfish,finfish,meat&poultry USDA approved 13 Handwashing facilities provided,hands washed,tin C N10' 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/nonadulteratedfoodslsafe B Handwash facilities in or immediately adjacent to toilet rooms Af 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 andwashing at appropriate times 95 ` 66d,h`y4166116practices hU` A Hot holding greater than or equal to 140°F. (whole beeupork roasts 130'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 V C Proper sink used for handwashing D Proper re heating VZ0 r� E Proper internal cooking I consumer advisory posted o z 0 Approved sanitizer availableladequate concentration of sanitizer g Food contact surfaces and utensils used for potentially hazardous food sanitized at least every 4 hours A Foodthermometeravailableandaccurate C Adequate ❑dishwashersanitizer ❑final rinse temp D Proper sanitizin rocedure B Proper food thermometer for product C Thermometers appropriately placed in cooler units E Sanitizing between raw animal origin&ready-to-eat food e A Cloths and/or sponges in good repair and clean B Wiping cloths kept in sanitizer between uses A Produce washed 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 C Food—contact surfaces clean F No pooling of eggs not cooked immediately 0 8 Food containers stored off the floor KIM i f t f C V_10 W A Soap/paper towels/ drying device av 'table A No unnecessary handling RTE and/or cooked foods with bare hands B Dispenser(s)working: ❑Soap per towel B Minimize food handling,other than ready-to-eat,with bare hands C Handwash sink(s)clean/waste recelRadeat 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. KEY: QFO[qualified food operator],DA[designated alternate],PHF[potentially hazardous food],FB[foodborne] .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 related to FB illness are you require o the local health department? Roasts Other Describe re-heating procedures: Is there a written illness p a requires the food worker to report specific illness conditions Are temperatures recorded/logged for cold holding foodslequi N and diseases to the . Y N *Do you have a paid sick leave policy? Y N Are foods cooked in advance and cooled? *Are leftovers saved? Y N Is there a I uage barrier between inspector&QFO? Y N If yes indicate language spoken List products cooled: by Q A: *Can the CFO/DA read the inspection report? Y N Describe coolin ods: dicate who answered the above questions: Name(print): Indicate the title of above person(circle all that apply):QFO DA 't gr Cook Owner FW Is cooling monitored for time&temp? Y N Is the monitoring of cooling recorded? Y 7 NJ .Obtain signature o h person who received the QFO responsibilities information at the time of the Is there a produce washing policy? Y N *Describe what is washed and inspection: where: Note: This report is a two page form(total of 62 debitable items) Page 1 of 2 . e Establishment: Date of Inspection: '3 v) ddress: �� L Owner or Operator: '��-•iCZ ADDITIONAL FOUR POINT ITEMS 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 11 oxic chemicals. No cross connections,back siphonage,backflow -Stored properly,labeled properly,used properly Proper type/installation/backflow prevention device/air gap for: -Food equipment -Hose connections -Dish machines -Sanitizerconcentration 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-Water quality in compliance 35 Toilet facilities. Adequate,convenient,accessible, -Monitoring in compliance designed,properly installed OTHER ITEMS KEY: DNC [DOES NOT COMPLY] 2i Sources of food: Original container,properly labeled 401 Garbage/rubbish storage area/rooms,enclosures-properly constructed,clean 5 Potentially hazardous food properly thawed 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, 5 Floors graded,drained as required located 6 Floor,wall juncture covered 17 onfood-contact surfaces designed,constructed, maintained, 7 Mats removable,good repair,clean installed,located 8 'Single service articles,storage,dispensing 8 Exterior walking,driving surfaces,good repair,clean No reuse of single service article 49,rWalls,ceilings attached,equipment properly constructed,good 20 Dishwashing facilities approved design,adequately constructed, repair,clean.Wall&ceiling surfaces as required maintained installed located 50 ustless 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 2 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 51,Establishment and premises free of litter,no insectlrodent harborage, 28 Equipment/utensils,storage,handling no unnecessary articles 32 Proper disposal of waste water 561 Complete separation from living/sleeping quarters and laundry 33 Plumbing location,installation,maintenance 57 Clean/soiled linens stored properly 58 No live birds,turtles,or other animals(except guide dogs) 6 Toilet rooms enclosed with self-closing door 59 Seats 75 or more:Nonsmoking area provided,sign(s)posted at 3 Propertoiletfixturesprovirled,good repair,clean entrance(s),smoking area indicated by sign(s) 39 Approved garbage/rubbish containers,adequate number,covered, rodent proof,clean Routine Inspection OReinspection 0 Preoperational Inspection Other Inspection: INSPECTOR: PERSON IN CHARGE: Demerit Score: *Include demerits from page 1 4 3 2 1 Total. Rating signature si ature _Ain_:_ X,. -��rgprint name print na - - V phone number title Page 2 of 2 plus continuation pages Focused Inspecti 1/2002 • • NAME OF • DATE OF '1• • MEW=MEMO- "NA th . . I mm nVomsmm.-Im _ 1 �c3F111 I-RE 1iiiiiiiiiiiiiiiiiiiijllilli pig !1110 W- W,1�4 I A b% ?A 'v ALI { • - � /r . {'�� � '� � ► �. � � _Its L INITIAL •R �r Page of INSPECTION REPORT STATE OF CONNECTICUT FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH CONTINUATION SHEET NAME OF ESTABLISHMENT TOWN DATE OF INSPECTION S I r Lt3 hi 7SPECTIW REMARKS FORM# Q2� J l c) H-xi 1`�— �c'�c- �� o,. `ter ` �►` s��-Q� INITIAL(INSPECTOR) INITIAL(PERSON IN CHARGE) y�\ Distribution: 1st-White-Health Department 2nd-Yellow-Owner/Manager t' lo�A t N�6 _ `/7f7 q f'0'�1►/.r� f/� Ako tJ'�1/�\ �' •EHS;106-Rev.06101 INSPECTION REPORT STATE OF CONNECTICUT ❑ ROUTINE INSPECTION <REINSPECTION FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH ❑ PREOPERATIONAL ❑ OTHER 410 Capitol Avenue,MS#51 FDP,Hartford,CT 06134 NAME OF ESTABLISHMENT ESTABLISHMENT CLASS STREET TOWN ADDRESS t W► C? OWNER or INSPECTION OPERATOR DATE and TIME I Based on an inspection this items marke a identify the violations in operation or facilities which must be corrected by the date specified 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 Original container,properly labeled 1 3 Accurate themrometers provided,dish basket,if used insects/rodents Sanitization rinse(hot water-chemical) 2 FOOD PROTECTION 25 Clean wiping cloths 1 F OORS,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 7Nonfood contact surfaces of utensils& 1 45 Floors,graded,drained as required 9 equipment clean 46 Floor,wall juncture covered 4 Adequate facilities to maintain product 2 28 Equipmentlutensils,storage,handling 1 47 Mats removable,good repair,clean temperature,thermometers provided 5 Potentially hazardous food properly thawed 2 48 1 Exterior walking,driving surfaces, 1 6 Unwrapped or potentially hazardous food 4 WATER SUPPLY 12. good repair,clean not reserved Water source adequate,safe 4 Lo Walls,ceilings attached,equipment properly 1 7 Food protected during storage,preparation, Hot and cold water under pressure, 2 constructed,good repair,clean. Wall&ceiling display,service&transportation provided as required surfaces as required. CFood containers stored off floor Dustless cleaning methods used, ll// SEWAGE DISPOSAL cleaning equipment properly stored 9 Handling of food minimized 2 31 Sewage disposal approved 4 Food dispensing utensils properly stored 1 32 Proper disposal of waste water 1 LIGHTING&VENTILATION 1 Toxic 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,vented as required 12 1 Personnel with infection restricted 14 34 1 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 1 757 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 8 Suitable hand cleaner and sanitary towels or 1 56 Complete separation from living/sleeping quarters 1 16 Food-contact surfaces designed,constructed, 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 No live birds,turtles,or other animals 1 constructed,maintained,installed,located GARBAGEIRLIBBISH STORAGE&DISPOSAL I(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 NONSMOKING AREAS 20 Dishwashing facilities approved design,adequately 2 40 Storage arealrooms,enclosures— 59 Seats 75 or more:Nonsmoking area provided, 3 constructed,maintained,installed,located properly constructed,clean sign(s)posted at entrance(s),smoking area 1 indicated by sign(s) 41 Garbage disposed of in an approved manner, at approved frequency QUALIFIED FOOD OPERATOR DEMERIT SCORE 60 Qualified Food Operator 3 40 3© 2 RISK FACTOR VIOLATIONS IN RED 61 Designated alternate 2 62 Written documentation of training program 2 Signature of Perso n c ge TOTAL RATING Date Corrections Due SIGNE ( spe DESCRIBE DEWiENCIES CONT6WATMN SHEETS NAME OF ESTABLISHMENT DATE OF INSPECTION I W-�M-i P"0-1 Mod% FA L ma VMS.0 1,�p�j�m' 0�'� mv INITIAL t 1 r:L ice. !. .••o ` �`� • ,� „ �, „� •�� � ) ��:��1, , � rt• ��l'!. :ram •' • , EHS-106-Rev.06/01 INSPECTION REPORT STATE OF CONNECTICUT ❑ ROUTINE INSPECTION V REINSPECTION*a FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH ❑ PREOPERATIONAL ❑ OTHER 410 Capitol Avenue,MS#51 FDP,Hartford,CT 06134 NAME OF ESTABLISHMENT ESTABLISHMENT CLASS STREET TOWN ADDRESS_ , OWNER or INSPECTION OPERATOR DATE and TIME Based on an inspecti his ay,the items below identify the violations in operation or facilities which must be corrected by the date specified 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 Original container,properly labeled 23 Accurate thermometers provided,dish basket,If used insects/rodents 24 Sanitization rinse(hot water-chemical) 2 FOOD PROTECTION 25 Clean wiping cloths 1 F OORS,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 7 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 reserved 29 Water source adequate,safe 4 49 ells,ceilings attached,equipment properly 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 Dustless cleaning methods used, 1 SEWAGE DISPOSAL cleaning equipment properly stored 9 Handling of food minimized 2 31 Sewage disposal approved 4 10 Food dispensing utensils properly stored 1 32 Proper disposal of waste water 1 LIGHTING&VENTILATION 11 Toxic 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,vented as required 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 i Nonfood-contact surfaces designed, 1 58 No live birds,turtles,or other animals 1 constructed,maintained,installed,located GARBAGEIRUBBISH STORAGE&DIS I(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 NONSMOKING AREAS 20 Dishwashing facilities approved design,adequately 2 40 Storage area/rooms,enclosures— 1 59 Seats 75 or more:Nonsmoking area provided, 3 constructed,maintained,installed,located properly constructed,clean sign(s)posted at entrance(s),smoking area 1 indicated by sign(s) 41 Garbage disposed of in an approved manner, at approved frequency QUALIFIED FOOD OPERATOR DEMERIT SCORE 60 Qualified Food Operator 3 4 YO 1 +� RISK FACTOR VIOLATIONS IN RED 61 Designated alternate 262 Written documentation of training program 2 Signature of Person in charge y TOTAL RATING Date Corrections Due cis SIGNED Ins&ctor) DESCRIBE DEFICIENCIES ON TINUATION SHEETS L •. •' 1 a NAME OF • OF • aw -�-W.V-41WIVIIWFF W7 ws Ev 111n—r-M—'iA. -"40 !-k W-—4 1 MUSAW11 1111110 L1, A.:mW IiAllIIIIIII 110—"1 �11 yr. /J� � ►,. � • � lrii � !r r__ IL BASIN ME lgpii��ijji� m p INITIAL(INSPECTOR) INITIAL(PERSON IN CHARGE '�. � �.i�� �• \ 1 �� fry+ .� j�'��ra`� ��i.l� _ "�• I ® �i ��� LJ :�.i���r� 1 mac•.�� t1• ,�I� �l