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HomeMy WebLinkAboutFood Service Establishment Inspection 96 (4) Establishment: ia.�/� R Inspection Date: 0 /6 Time: o]ns REinsp p Address/City: q v t Health D pt: �'o lN 2—�r s 9. 1 3 4 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 N/O N/A DN KEy: C[complies] N/O[not observed] NIA[not applicable] 60 QiLafBf1'rsO4f` efatr�r 3 DNC[does not comply] 0[other] RTE[ready-to-eat] 61 De gnated Alternate L.0 Z 12 '-Personnel with iinfect ran restricted C WO 4 A Food workers have no exposed infected lesions/burns 62 Written documentation of training programLA 2 B Personnel with infection restricted 1 Approved source,wholesome,ndnaduiterated C N10 NIA 4 C Communicable disease of worker reported to local health director A I Approved shellfish,finfish,meat&poultry USDA approved 1131Handwtashing fact7ities provided,hands washed,clean C Nt0 NIA 4 B Food cans in good condition(not dented,rusty,bloated,leaking) A I Handwash facilities in all food prep/dispensing&warewash areas C Wholesome/nonadulteratedfoods/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 60 D Personnel hands washed,clean/Proper handwash procedure 0 E Handwashing at appropriate times 3 PrdetiaN iiazatdos food thus tt p raper r srer�e 4 0 duiring s€orage,preparatron,display,service and.t i apor#aticar 15 Good hygiento practices C NYO N/A 2 A Hot holding greater than or equal to 140°F. (whole beef/pork roasts 1300 F.) L000 A ❑ No eating ❑ No smoking while working B Cold holding less than or equal to 450 F. B Wounds covered adequately C Proper cooling C Proper sink used for handwashing D Proper re-heating D E Proper internal cooking/consumer advisory posted ' 4 1 i�ast�("k p A Approved sanitizeravailableladequate concentration ofsanitizer 4 Adoquate facgiial"a to 0401'Iacd proditc# � g Food contact surfaces and utensils used for potentially teaxtpe ratulm, errncarneter p hazardous food sanitized at least every 4 hours ' yo idad � A Food thermometer available and accurate C Adequate ❑dishwashersanitizer ❑final rinse temp B Proper food thermometer for product D Pro ersanitizinrocedure C Thermometers appropriately placed in cooler units OF E Sanitizing between raw animal origin&ready-to-eat food 0 O Food"pr©acted". i' . y° i . T, dismay,*,service and tr pertotton 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 OEM W A Food equipment clean,utensils clean equipment interiors clean D Adequate splash guards/sneeze guard Lo B Single use gloves changed when soiled E No unauthorized personnel Food--contact surfaces clean No pooling of eggs not cooked immediately 8 IFood containers stored off the floor LO j , Pt € .� / .,< �k f 9 Handling of food mintnalzed lc NfO. MIA '2 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 I waste receptacle at handwash sink 000l C Adequate utensil(s)fordispensing food/ice L.0 01 ` p 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: 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 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? N and diseases to the QFO? Y N *Do you have a paid sick lea Icy? Y N Are foods cooked in advance and cooled? Y N e leftovers saved? Y N Is there a language barrier between inspector&QFOj If yes indicate language spoken List products cooled: by QFO/DA: the QFO/DA read the inspection report? Y N Describe cooling methods: Indicate who answered ove questions: Name(print): Indicate the title o above person(circle all that apply):QFO DA Mgr Cook Owner FW Is cooling monitored for time&temp? Y N Is the monitoring of cooling recorded? Y N .Obtain signature of the person who received the QFO responsibilities information at the time of the [where: ere a produce washing policy? Y N *Describe what is washed and inspection: Note: This report is a two page form(total of 62 debitable items) Page 1 of 2 LOCAL HEALTH DEPTI .S 2—ADDRESSam. ry 8 :. r7, Establishment: 'DJ/\ /e- Date of Inspection. ddress: ✓­— Owner or Operator: ADDITIONAL FOUR 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 No cross connections,back siphonage,backflow 11 Toxic chemicals. 4 Proper type/installation/backflow prevention device/air gap for: -Stored properly,labeled properly,used properly -Food equipment -Hose connections -Dish machines - -Sanitizer concentration not to exceed maximum permitted -Soda system carbonator -Beverage dispensers -Toilet tanks ffi -No unnecessary toxics on the premises -Chemical dispensers -Ice machines -Pesticides/rodenticides properly dispensed Proper drain for: 29 Water source adequate,safe. 4 -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 40 Garbage/rubbish storage area/rooms,enclosures-properly constructed,clean 5 Potentially hazardous food properly thawed 2 41 Garbage/rubbish disposed of in an approved manner,at approved frequency 10 Food dispensing utensils properly stored 1 42 Vermin Control: No insects/rodents present 14 Food worker:Clean outer clothes,effective hair restraints 1 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, 45 Floors graded,drained as required located 6 Floor,walljuncturecovered 17 Nonfood-contact surfaces designed,constructed,maintained, 47 Mats removable,good repair,clean installed,located 8 Exterior walking,driving surfaces,good repair,clean 18 Single service articles,storage,dispensing 2: 19 No reuse of single service article 9 Walls,ceilings attached,equipment properly constructed,good 20 Dishwashing facilities approved design,adequately constructed, 2 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 27 Nonfood-contact surfaces of utensils&equipment clean 1 55 Establishment and premises free of litter,no insect/rodent harborage, 28 Equipment/utensils,storage,handling 1 no unnecessary articles 32 Proper disposal of waste water 1 56 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) 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 O=outine Inspection ❑Reinspection ❑ Preoperational Inspection INSP T PERSON IN CHARGE. Other Inspection: Demerit Score: *Include demerits from page 1 j�& P 4 3 2 1 Total Rating si a r signature Yr1 G1 1I Vt�,�t rR name print name I ph k� DATE CORRECTIONS DUE: -phone number title Page 2 of 2 plus t continuation pages Focused Inspection 1 2002 Page of a� INSPECTION REPORT STATE OF CONNECTICUT FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH CONTINUATION SHEET NAME OF ESTABLISHMENT TOWN DATE OF SPECTION C�'�► � O� /f �-- INSPECTION fREMARKS FORM# / /} rt-A (cro -"A 41, of LUA-1 k F e ---I -r INITIAL(INSPECTOR) t 1�� INITIAL(PERSON IN CHARGE) u C, Distribution: lst-White-Health Department 2nd-Yellow- Owner/Manager