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HomeMy WebLinkAboutFood Service Establishment Inspection 53 Establishment: Q I N t S Inspection Date: y—Is—/ Time ddress/City: Oinsp REins Health Dept- 5o l y� a- class: 2 3 a Based on an inspection this 78y,the items m�arkedDNCentify 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 debatable items C I N/0 AYAJ DNC KEY: C[complies] N/O[not observed] N/A[not applicable] F6od 0eCa �ok'E � DNC[does not comply] 0[other] RTE[ready-to-eat] 61 13ess1 dtedAltainafe� � � 2 i2 'Peifs�f �� few`tenre�trictetl' C QA 62 t#Idrltten documentation of training program 2 A Food workers have no exposed infected lesions/burns LOO1 Approved source,wholesome,nonadttiterated /A `4 B Personnel with infection restricted 01 C Communicable disease of worker reported to local health director A Approved shellfish,finfish,meat&poultry USDA approved B Food cans in good condition(not dented,rusty,bloated,leaking) 13 Handt+trsl�in9 facilities provided,hand yy [ +cleaq NJ NIA 4 C Wholesome/nonadulterated foods/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 enbally,hazardous food m e#s tempera ure r �re� $ ` E appropriate Handwashing at propriate times during-storage,i3repatautn, �play�sett' atiltapQon Fa° G�s1' + ec praties C Nita NIA A Hot holding greater than or equal to 140°F. (Whole beef/pork roasts tso°F.l B Cold holding less than or equal to45°F. A No eating ❑ No smoking while working B Wounds covered adequately C Proper Cooling C Proper sink used for handwashing D Proper re-heating 101 E Proper internal cooking/consumer advisory posted }� �t�a �I►stt tr Ch777777VHPI0 rn Approved sanitizer available/adequate concentration of sanitizer 4 crate cllitret,to inij [ pry t 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 B Proper food thermometer for product D Pro ersanitizin rocedure C Thermometers appropriately placed in cooler units E Sanitizing between raw animal origin&ready-to-eat food 0 0 LOO , . `� c °�i w r.,� . Nam'' display,service a-nd transportation A Cloths and/ 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 O C Food covered properly A Food equipment clean,utensils clean,equipment interiors clean D Adequate splash guards/sneeze guard E No unauthorized personnel 71Z B Single use gloves changed when soiled F No pooling of eggs not cooked immediately C Food--contact surtaces clean 8 Food containers stored off the floor 0 0dim- 9 Ftar atting af'foosd trt i i ed s OO ed. A No unnecessary handling RTE and/or cooked foods with bare hands A Soap I paper towels/ drying device available B Minimize food handling,other than ready-to-eat,with bare hands B Dispenser(s)working: ❑Soap ❑Paper towel C C Adequate utensil(s)for dispensing food/ice Handwash sink(s)clean/waste receptacle at handwash sink0 PO 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 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 le cy? Y N ` Are foods cooked in advance and cooled? Y N *Are le saved? Y N Is there a language barrier between inspector&QFO? i List products cooled: indicate language spoken by QFO/DA: ♦ e QFO/DA read the inspection report? Y N Describe cooling methods: Indicate who answered the a 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 Mgr Cook Owner FW *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 what is washed and inspection: where: Note: This report is a two page form(total of 62 debitable items) Page 1 of 2 L y Establishment: �/ .� Date of Inspection ddress: Owner or Operator: ADDITIONAL VOUR POINT bTEMS z 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 -Stored properly,labeled properly,used properly V Proper type/installation/backflow prevention device/air gap for: -Sanitizer concentration notto exceed maximum permitted -Food equipment -Hose connections -Dish machines -No unnecessary toxics on the premises k -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 ources offood:Original container,properly labeled 0 Garbage/rubbish storage area/rooms,enclosures-properly constructed,clean Potentially hazardous food properly thawed 1 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 Outeropenings protected against entrance of insects/rodents E 44 Floors: Floor covering installed,constructed as required,good repair,clean 16 Food-contact surfaces designed,constructed, maintained,installed, 1, 45 Floors graded,drained as required located 6 Floor,wall juncture covered 1 Nonfood-contact surfaces designed,constructed,maintained, installed,located 7 Mats removable,good repair,clean 7- 1 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 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 K 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 Rooms adequate,clean,adequate lockers provided,facilities clean Nonfood-contact surfaces of utensils&equipment clean 55 Establishment and premises free of litter,no insect/rodent harborage, quipment/utensils,storoge,handling no unnecessary articles 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 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, r rodent proof,clean outine Inspection ❑Reinspection 0 Preoperational Inspection INSPECT PERSON IN CHARGE: Other Inspection: Demerit Score: *Include demerits from page 1 4 3 2 1 1 Total Rating sicJfiaiure signature ver print name print name 7 3 phone number titre DATE CORRECTIONS DUE: t — U� 2 Page 2 of 2 plus continuation pages Fo¢u 3 ha.vzooz Page C3 of Y- INSPECTION REPORT STATE OF CONNECTICUT FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH CONTINUATION SHEET NAME OF ESTABLISHMENT TOWN JS DATE OF INSPECTION fee - .S -�'c� �iV r o`C- - Is - Z- INSPECTION FORM# REMARKS AC 6t W V✓t ��u-c-Gu-c PAre Coo 4C -1-� 2-- �Fy �&J 04 /)A. -Q t� OL&�Q ) Z-6Cj 9tA e, OAJ < & c f — �u U,( Ce- s /M(sk Dom- SQ C tc ov- JSRb�4 .,—Rr<�44 i Art o.,, AoreA OVQf N \ 1 �eALA< — S o�g (-/t v) LAO mkdx--, F� x a t F _ a r dkJ Jy 2 K e CL f 2t-e 1 3-- 2 S 2 S INITIAL(INSPECTOR) INITIAL(PERSON IN CHARGE) Distribution: 1st-White-Health Department 2nd-Yellow-Owner/Manager ` Page of —Y— INSPECTION REPORT STATE OF CONNECTICUT FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH CONTINUATION SHEET NAME OF ESTABLISHMENT TOWN DATE OF INSPECTION 0A, INSPECTION REMARKS FORM# V C Z • 17 a& P" - C.t cSvl O V - 3F - z ( ( " ©0 Q � C "#fv- i t Nz INITIAL(INSPECTOR) AAO INITIAL(PERSON IN CHARGE) Distribution: Ist-White-Health Department 2nd-Yellow-Owner/Manager