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HomeMy WebLinkAboutFood Service Establishment Inspection 50 (2) `A f,l Establishment: ✓} Inspection Date: Time: -- oinsp REinsp ddress/City: O 6 Health Dept: S� w�w.J1 class: 2 s Based on an inspection this day the items marked DNC i entify 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/0 N/A DNC �; C[complies] N/O[not observed] NIA[not applicable] �# pf �� 3 DNC[does not comply] 0[other] RTE[ready-to-eat] fig Degiaafieillterrnate� 2 his rs v�r 'h rir restracctW` C NEA 4 62 tit€ tten documentation of training program 2 A Food workers have no exposed infected lesions/burns B Personnel with infection restricted 1 �source,wholesome,pona€iteTated C /A 4 C Communicable disease of worker reported to local health director B o roved shellfish,condition meat&dented, USDA approved tld--ashl rg facilities providedt laandswas�ed,clean C hIt N/A 4 B Food cans in good condition(not dented,rusty,bloated,leaking) C Wholesome/nonadulterated foods/Safe Handwash facilities in all food prep/dispensing&warewash areas D Commercial products(no home grown/canned food) B Handwash facilities in or immediately adjacent to toilet rooms E Potentially hazardous foods received at proper temperature C Handwash facilities accessible/convenient to use 0 D Personnel hands washed,clean/Proper handwash procedure 10.1 E Handwashing at appropriate times #�otentia113r�sza� o is ttp n Outing sforege,pparaticn, lay seI rod ' 0 6 boot I yg4 practices C N10 N/A 2 A Hot holding greater than or equal to 1400F. (whojebeefloork roasts 13o°e) ❑ No eating ❑ No smoking while working B Cold holding less than or equal to 450F. 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 Approved sanitizeravailable/adequate concentration of sanitizer 4 Adequate fsstilltres toift �� B Food contact surfaces and utensils used for potentially It -Pt + eH � hazardous food sanitized at least every 4 hoursLoo 7. ' . ®�. �..-, -101 ,k, � A Food thermometer available and accurate to 0,il' Adequate hwashersanitizer ❑final rinse temp B Proper food thermometer for product LOOPro er sanitizing rocedure C Thermometers appropriately placed in cooler units E Sanitizing between raw animal origin&ready-to-eat food 0 '" odptotc $• 4" NSA 1 display,service and transportation 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 0 a Flean C Food covered properlyA Food equipment clean,utensils clean,equipment interiors 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 a �, 0 Fd AlAsiRo"T@o 'r � n 0 ,. .,,. N ,, n . i A No unnecessary handling RTE and/or cooked foods with bare hands A Soap I paper towels I drying device available 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 I Adequate utensil(s)for dispensing food/ice 0 101 - ff •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: IF. 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 Roasts Other What diseases related to FB illness are you required to report to the local health department? Describe re-heating procedures: Is there a written illness policy that requires the food worker to report ecific 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 ve policy? Y N Are foods cooked in advance and cooled? Y N ♦ ers saved? Y N Is there a language barrier between inspector& N Iflf ves indicate language spoken List products cooled: by QFO/DA: an the QFO/DA read the inspection report? Y N Describe cooling methods: Indicate who answ a above questions: Name(print): Is cooling monitored for time&temp? Y N Is the monitoring of cooling recorded? y N Indicat a of above person(circle all that apply):QFO DA Mgr Cook Owner FW • ain signature of the 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 LOCAL HEALTH 76 - : tZ ADDRES,' T . Establishment: t �N t Date of Inspection: O ddress: Owner or Operator: ADDITIONAL FO R POINT ITEMS c; 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 11 Toxic chemicals. No cross connections,back siphonage,backflow Pro -Stored properly,labeled properly,used properly ear type/installation/backflow prevention devi .aircd r for: -Food equipment -Hose connections - is mac ines -Sanitizer concentration not to exceed maximum permitted p -Soda system carbonator -Beverage dispensers -Toilet tanks -No unnecessary toxics on the premises -Pesticides/rodenticides properly dispensed -Chemical dispensers -Ice machines Proper drain for: 29 Water source adequate,safe. ; -Food equipment - ish 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] Sources of food: Original container,properly labeled 40 Garbage/rubbish storage area/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, 5 Floors graded,drained as required located 6 Floor,wall juncture covered 17 1 Nonfood-contact surfaces designed,constructed,maintained, ER 7 Mats removable,good repair,clean installed,located 18 Single service articles,storage,dispensing 8 Exterior walking,driving surfaces,good repair,clean � •, 19 No reuse of single service article 9 Walls,ceilings attached,equipment properly constructed,good repair,clean.Wall&ceiling surfaces as required 20 Dishwashing facilities approved design,adequately constructed, a 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 54 ooms adequate,clean,adequate lockers provided,facilities clean Nonfood-contact surfaces of utensils&equipment clean [56 Establishment and premises free of litter,no insect/rodent harborage, quipment/utensils,storage,handling no unnecessary articles 32 Proper disposal of wastewater Complete separation from living/sleeping quarters and laundry 33 Plumbing location,installation,maintenance Clean/soiled linens stored properly 581 No live birds,turtles,or other animals(except guide dogs) 36 Toilet rooms enclosed with self-closing door 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 rpoutine Inspection ❑Reinspection E3 Preoperational Inspection Other Inspection: INSPECT PERSON IN CHARGE: Demerit Score: *Include demerits from page 1 AL4 4 3 2 1 Total Rating s' nature ' nature print name print name /2,phone number title DATE CORRECTIONS DUE: r2Pchf'fe-r— Page 2 of 2 plus continuation ; es Focused Inspection1/2002 Page 3 of INSPECTION REPORT STATE OF CONNECTICUT FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH CONTINUATION SHEET NAME OF ESTABLISHMENT TOWN DATE OF INS ECTION ��-t) � 5� � �� � �— ION FORM REMARKS C � 4-v ¢- f dc fcp Ue C YLI c� Z Z n s 3� s m °F= C �0 -- 162,-F `T 7 v 6 3 e"D17 &ref vuip, e4o r�-r � J vvt ( TJ_o t eQ 3 SIA- S-f 6r F k I PL&�L v S 4 1 ©U f5 ( 7. 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