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HomeMy WebLinkAboutFood Service Establishment Inspection 95 (8) Establishment: 1 /t S Inspection Date: ill2._ Time, ROinsp REi ddress/City: v Health pt: fiL�i s0 Class: 1 2 s 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 FAI q not inclusive of all possible debitable IQ I'll 1 1. . . - iesj NIO[not observe not applicable] �d @ra ►r t R , t 3 DNC[does not comply] 0[other] RTE[ready-to-eat] 61 ©esignatetlAltemate' 2 12 l�ersoime , rnfectirsn restricted �° 4' 62 Written documentation of training program 2 A Food workers have no exposed infected lesions I burns 1 Approved source,wholesome,nonadalterated C N/0 B Personnel with infection restricted C Communicable disease of worker reported to local health director A Approved shellfish,finfish,meat&poultry USDA approved ILIKJ 13, Ffandwashing facilities provided,bands washed,clean C N10 WA 4 B Food cans in good condition(not dented,rusty,bloated,leaking) A 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 0 D Personnel hands washed,clean/Proper handwash procedure E Handwashing at appropriate times Peter>ti lly hazardous food tests t rl400 0 deitng`storage"prepa+ttion., fit (,tfap r'...�, 15" 'i �rtic`''practices C N10 NIA 2! A Hot holding greater than or equal to 1400F. (whole beef/Pork roasts 1300 F.) 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 0 E Proper /consumer ' P 9 advisory Posted 0 A Approved sanitizeravailable/adequate concentration of sanitizer 4 "1txtcrk► s t ii r 4 , r g Food-contact surfaces and utensils used for potentially f'am ratullr0,thBr rC to rS` r1 # ®nw iVi hazardous food sanitized at least every 4 hours A Food thermometer available and accurate C Adequate ❑dishwashersanitizer ❑final rinse temp L Proper sanitifin B Proper food thermometer for product procedure C Thermometers appropriately placed in cooler units E Sanitizing between raw animal origin&ready-to-eat food 0 0 display,service ariidl trarrsp(;r#a a A Cloths and/or sponges in good repair and clean B Wiping cloths kept in sanitizer between uses A Produce washed B Raw meats not stored/prepared near ready-to-eat foods C Food covered properly anmiiii!il;lll MOVE NEW, A Food equipment clean,utensils clean,equipment interiors clean 60 D Adequate splash guards I sneeze guard B 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 11 trtdlimg of cad rrri�rrriie" Y- „ i . . r. L .�.r .�. .. �.; . ' 3 1, ,` ` " A Soap I paper towels/ drying device available A No unnecessary handling RTE and/or cooked foods with bare hands B 1 0'oll 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 Adequate utensil(s)for dispensing food/ice 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 altemate],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? Y N and diseases to the QFO? Y N *Do you have a paid sick leave policy? Y N Are foods cooked in advance and cooled? Y N *Are leftovers saved? Y N Is there a language barrier between inspector&QFO? Y N if ves indicate language spoken List products cooled: by QFO/DA: *Can the QFO/DA read the inspection report? Y N Describe cooling methods: Indicate 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 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 r RMLOCAL HEALTH DEPT:' W ADdRESSlC1TY Establishment: ( Date of Inspection:If 4 C 2_ caner or Operator: ADDITIONAL FOUR POINT ITEMS o 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,backflowUZI 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 -No unnecessary toxics on the premises -Chemical dispensers -Ice machines -Pesticides/rodenticides properly dispensed Proper drain for: 29 Water source adequate,safe. -Food equipment -Dish machines -Ice machines 4 -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 storagearea/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 _ 2 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, 2 45 Floors graded,drained as required located 6 Floor,wall juncture covered 17 Nonfood-contact surfaces designed,constructed,maintained, 1 7 Mats removable,good repair,clean installed,located cleanair good re 8 Exterior walking,driving surfaces, p , 18 Single service articles,storage,dispensing 2 � 19 No reuse of single service article 9 Ils,ceilings attached,equipment properly constructed,good epair,clean.Wall&ceiling surfaces as required 20 Dishwashing facilities approved design,adequately constructed, 2 maintained installed located 50 Dustless cleaning methods used,cleaning equipment properly stored Equipment&Utensils: Cleanliness 1 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 ccurate thermometers provided,dish basket,if used 4 s adequate,clean,adequate lockers provided,facilities clean 7 nfood-contact surfaces of utensils&equipment clean 1 " 55 Establishment and premises free of litter,no insect/rodent harborage, 28 Equipment/utensils,storage,handling i. no unnecessary articles 32 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 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, 1 rodent proof,clean utine Inspection ❑Reinspection ❑ Preoperational Inspection therInspection: IN PET PERSON IN CHARGE: Demerit Score: *Include demerits from page 1 4 3 2 1 Total Rating si ature signature print name ®n nt name p `V (( NS DUE: ftffone number title DATE CORRECTIO ti Page 2 of 2 plus__L_continuation pages Focused Inspection 1/2002 Page �z of . INSPECTION REPORT STATE OF eONNECT!eUT FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH CONTINUATION SHEET NAME OF ESTABLISHMENT TOWN DATE OF INS P CTION INSPECTION FORM# REMARKS 9 v �vkt oz 1., ---2 C 5- Pod 16s Vv Ct 862Avxv 22 L s-AAS t INITIAL(INSPECTOR) INITIAL(PERSON IN CHARGE) Distribution: 1 st-White-Health Department 2nd-Yellow-Owner/Manager