Loading...
HomeMy WebLinkAboutFood Service Establishment Inspection 86 (5) Establishment: Inspection Date: •7 Time: W ROins REinsp Address/City: Health D pt: L,.a class: 2 s Based on an inspection this day,the[terns marked DNC identify the violations in operation orfacilities which must be corrected by the date specified on page 2. RISK FACTOR ITEMS Listing is not inclusive of all possible debatable items C /0 N/A DNC may; C[complies] N/O[not observed] NIA[not applicable] g DNC[does not comply] 0[other] RTE[ready-to-eat] 2 _ NIA 4 62 Written documentation of training program 2 A Food workers have no exposed infected lesions/burns 1 Approved source,wholesome,nonadnitetated B Personnel with infection restricted /© /A C Communicable disease of worker reported to local health director A Approved shellfish,finfish,meat It USDA a roved B Food cans in good conditi not dente usty,bloated,leaking) 13 Handwashtng facilities provided,hands washed,clean C p ]qlq 4 C Wholesome/nonadulterate s safe A 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 tr ar es'faod meG S lain to, Fe `F E Handwashing at appropriate times 3 Potentially drUdng,steragq preAa�tl�; o�d iygi tom'pracil s C 2' A Hot holding greater than or equal to 1400F. (Whole l roasts taco e> A ❑ No eating ❑ No smoking while working B Cold holding less than or equal to 45o F. B Wounds covered adequately C Proper cooling or C Proper sink used for handwashing D Proper re-heating 0 6 E Proper internal cooking/consumer advisoryposted P �x a{1 �Irariai� ti A Approvedsanitizer available/adequate concentration ofsanitizer d. iota fsellittes to maiotaln oi � . g g Food-contact surfaces and utensils used for potentially ierairegaelc8ttar$:prove hazardous food sanitized at least every 4 hours A Food thermometer available and accurate C Adequate Ill,dishwashersanitizer ❑final rinse temp B Properfood thermometerfor product D Proper sanitizin rocedure C Thermometers appropriately placed in cooler units Sanitizing between raw animal origin&ready-to-eat food ✓ 0 0 ai. t �w 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 C Food covered properly ffi A Food equipment clean,utensils clean,equipment interiors clean D Adequate splash guards/sneeze guard E No unauthorized personnel B Single use gloves changed when soiled F No pooling of eggs not cooked immediately 0 Food--contact surfaces clean 8 Food containers stored off the floor ., 8' tlatidlltrg afi€tiodirtalzedr. -` /O NtA 2 No unnecessary handling RTE and/or cooked foods with bare hands A Soap/paper towels/ drying device available 7 7- B Minimize food handling,other than ready-to-eat,with bare hands B Dispenser(s)working: ❑Soap ❑Paper towel C C Adequate utensils)for dispensing food/ice Handwash sink(s)clean/waste receptacle at handwash sink 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: °F. 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 required to re a oc health department? Roasts Other Describe raheating procedures: Is there a written illness policy that re a food worker to report specific illness conditions Are temperatures recorded/logged for col ing foods/equipment? Y N and diseases to the QFO? Y *Do you have a paid sick leave policy? Y N Are foods cooked in advance cooled? Y N Are leftovers saved? Y N Is there a language ba ' etween inspector&QFO? Y N indicate language spoken List products cooled: by QFO/DA: *Can the QFO/DA read the inspection report? Y N Describe cool i ethods: 000, Indicatilif who answered the above questions: Name(print Is cooling monitored for time&temp? Y N Is the monitoring of cooling recorded? Y N Indicate the title of above person(circle all that apply):QFO DA 1116 Cook Owner FW •Obtain signature of t 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 rep rt is a two page form(total of 62 debitable items) Page 1 of 2 Establishment: Date of Inspection: Cl Z Address: Owner or.:.Operator: � 6� 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 11 Toxic chemicals. 34 No cross connections,back siphonage,backflow -Stored propel,labeled properly,used properly Pro-per 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 -Pesticides/rodenticides properly dispensed -Chemical dispensers -Ice machines 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 0 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 2 Vermin Control: No insects/rodents present 4 Food worker:Clean outer clothes,effective hair restraints jA Outer openings protected against entrance of insects/rodents 4 oors: Floor covering installed,constructed as required,good repair,clean 1 Food-contact surfaces designed,constructed,maintained,installed, Floors graded,drained as required located 0.4 6 Floor,wall juncture covered 17 Nonfood-contact surfaces designed,constructed,maintained, installed,located 7 Mats removable,good repair,clean 1 Single service articles,storage,dispensing 8 Exterior walking,driving surfaces,good repair,clean 19 No reuse of single service article 49 1 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; CI anlin ss 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 2 Accurate thermometers provided,dish basket,if used 54 Rooms adequate,clean,adequate lockers provided,facilities clean 7 onfood-contact surfaces of utensils&equipment clean 55 Establishment and premises free of litter,no insect/rodent harborage, 8 Equipment/utensils,storage,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 6 Toilet rooms enclosed with self-closing door 58 No live birds,turtles,or other animals(except guide dogs) 3 Proper toilet fixtures provided,good repair,clean 59 Seats 75 or more:Nonsmoking area provided,sign(s)posted at 3� entran (s),smoking area indicated by sign(s) 39 Approved garbage/rubbish containers,adequate number,covered, rodent proof,clean outine Inspection ❑Reinspection ❑ Preoperational Inspection INSPECTOR: PERSON Other Inspection: Demerit Score: *Include demerits from page 1 i 4 3 2 1 Total Rating sign ure sign S a 2k 10 print name print nam 3S (S ,-4_ - � Q n r.� phone number title DATE CORRECTIONS DUE: _11Page 2 of 2 plus _continuation pages Focus- Iu peal-- NAME OFTOWNDATE OF • out REMARKS i_ ¢i y ► L .� _ its -ONON ZVII UP ►� 1 ► .,r ,�M. M., 1�A � • \�1� Sim • >•A �.. fit', �.��� 1 f.�_�[� .._ ��• � _ :� � . ,_ . I. t t1 �. r!�l`r� • rSWITY1 �* • INITIAL •, (PERSONINITIAL I Qv Page of INSPECTION REPORT STATE OF CONNECTICUT FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH CONTINUATION SHEET NAME OF ESTABLISHMENT TOWN DATE OF INSPECTION W\ S Z INSPECTION, # REMARKS on -t o O1p1cm P l n` `'mal/ L \Ij r1 i, v t�0.o4z 1 2mA4 3d dw �• o i \ L a � `C\ S - �CN 5 < C , cow W 20 NO } \ S INITIAL(INSPECTOR) ��^ INITIAL(PERSON IN CHARGE) Distribution: 1st-White-Health Department 2nd-Yellow-Owner/Manager