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HomeMy WebLinkAboutFood Service Establishment Inspection 58 (3) i Establishment: Inspection Date: Time: oinsp REinsp ddress/City: �� lk-a , Health ept: �-: �ii^xt'd Class: 1 2 310 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 LWO I N/A JDNC I KEY: C[complies] N/O[not observed] NIA[not applicable] 3 DNC[does not comply] 0[other] RTE[ready-to-eat] 6 Dede e`d" - 2 t ` P�`irt1`wfst�"°iilecion resrlfd"`"` `CT NiA 4` 62 Wriften doculmentatlon of tralnibg NO In 2 A Food workers have no exposed infected lesions I burns graB Personnel with infection restricted 1 Approved 9FIi fCef tsl olesome,nonaduf crated C N/A 4" C Communicable disease of worker reported to local health director A Approved shellfish,finfish,meat&poultry USDA approved ?� FlaFtd�ng fecitiffes prodded,hands NrasFed,tin -C N/A 4JJW B Food Cans in good condition(not dented,rusty,bloated,leaking) VA Handwash facilities in all food prep/dispensing&warewash areas C Wholesomelnonadulterated foods/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 d apPropna times andwashing at to W , _; d •°4 5` docT hygi>rnic r€ctices C N/0' NIA 2 A Hot holding greater than or equal to 1400F. (whole beef/pork roasts fsoo F) A ❑ No eating ❑ No smoking while working B Cold holding less than or equal to 45'F. VB Wounds covered adequately C Proper cooling C Proper sink used for handwashing D Proper re-heating 0 E Proper internal cooking I consumer advisory posted I t hbylrr� ' 0 Approved sanitizer available/adequate concentration of sanitizer B Food-contact surfaces and utensils used for potentially � rrowtded hazardous food sanitized at least every 4 hours A Food thermometer available and accurate C Adequate ❑dishwashersanitizer ❑final rinse temp B Properfood thermometer for product D Proper sanitizin rocedure C Thermometers appropriately placed in cooler units E Sanitizing between raw animal origin&ready-to-eat food 0 0 911 dis�slay,8 IYFCQ arkd transportation s 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 VB 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 , A No unnecessary handling RTE and/or cooked foods with bare hands ,, A Soap/paper towels/ drying device available B Dispenser(s)working: ❑Soap ❑Paper towel B Minimize food handling,other than ready-to-eat,with bare hands C Handwash sinks)clean/waste receptacle at handwash sink C Adequate utensil(s)for dispensing food/ice 0 0 1 it •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 g: 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 t to the local health department? Roasts Other Describe re-heating procedures: Is there a written illness policy that re ' the food worker to report specific illness conditions Are temperatures recorded/logged for cold holdingequipment? Y N and diseases to the QFO? Y *Do you have a paid sick leave policy? Y N Are foods cooked in advance and Y N *Are leftovers saved? Y N Is there a langua ier between inspector&QFO? Y N If yes indicate language spoken List products cooled: by ♦Can the QFO/DA read the inspection report? Y N Describe co methods: Indicate who answered the above questions: Name(print): ��'(`I�A Is cooli monitored for time&temp? Y N Is the monitoring of cooling recorded? Y N Indicate the title of a o3e person(circle all that apply):QFO DA Mgr Cook Owner FW Obtain signature of p s who received the QF espensibilities 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 0 2 Abdable items) Page 1 of 2 7 Establishment: �� �� - �rt`r> i/' Date of Inspection. 2_ ddress: S , lv Owner or Operator: 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 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 -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 ,desi ned properly installed -Monitoring in compliance g p p y 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 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 6 Food-contact surfaces designed,constructed,maintained,installed, Floors: Floor covering installed,constructed as required,good repair,clean located 1 5 Floors graded,drained as required 6 Floor,walljuncturecovered 17 Nonfood-contact surfaces designed,constructed,maintained, 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 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 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 7 Nonfood-contact surfaces of utensils&equipment clean 55 Establishment and premises free of litter,no insect/rodent harborage, 28 Equipment/utensils,storoge,handling no unnecessary articles 3 21 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 36 Toilet 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 lZRoutine Inspection ❑Reinspection ❑ Preoperational Inspection INSPECTOR: PERSON IN CHARGE: Other Inspection: Demerit Score: *Include demerits from page 1 4 3 2 1 Total Rating si a re s-itliature V GAT, print name print name phone number title TDATE CORRECTIONS DUE: 1 Page 2 of 2 plus__L_continuation pages Focused Inspection 11202 Page of 3 INSPECTION REPORT STATE OF CONNECTICUT FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH CONTINUATION SHEET NAME OF ESTABLISHMENT TOWN DATE OF INSPECTION S. tc&,N+ INSPECTION FORM# REMARKS © O 2 per of pMj ` wW { V a9 INITIAL(INSPECTOR) Q �1 INITIAL(PERSON IN CHARGE) Distribution: 1st-White-Health Department 2nd-Yellow-Owner/Manager