HomeMy WebLinkAboutFood Service Establishment Inspection 17 (17) i
Establishment: Inspection Date: rr z i Time: kOins REinsp
Address/City: ,J S Health De t: 5 , y�t�+- � : 1 2 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/0 N/A IDNC I ICU: C[GQMP1i08j NIO[not observed] I[not applieablej
60 QtlalNed Fold Opetl'tor g DNC[does not comply] 0[other] RTE[ready-to-eat]
61 Designated Alternate 2
12 '`Persormet with infection restricted C W A 4
62 Written documentation of training program 2 A Food workers have no exposed infected lesions/burns
B Personnel with infection restricted
1 Approved source,wholesome,nonadutterated C Nqo N1A 4 C Communicable disease of worker reported to local health director
A Approved shellfish,finfish,meat&poultry USDA approved 13 f andwashing facilities provided,hands washed,clean C II 'N/A 4
B Food cans in good condition(not dented,rusty,bloated,leaking) A Handwash facilities in all food prep/dispensing&warewash areas
to
C Wholesome/nonadulteratedfoods/Safe B Handwash facilities in or immediately adjacent to toilet rooms Lo
D Commercial products(no home grown/canned food) Lo C Handwash facilities accessible/convenient to use
E Potentially hazardous foods received at proper temperature D Personnel hands washed,clean/Proper handwash procedure
0 E Handwashing at appropriate times
3 Potenff 1, hazardous f6od meats te ra an5p�� } 0
rg®,prpad wn display,serWceahafra_ an
19 Gtiotl hgienic,practices C N(0: 2'
A Hot holding greater than or equal to 140°F. (whole heef/pork roasts 1300 F.) A El No eating ❑ No smoking while working
B Cold holding less than or equal to 45°F. B Wounds covered adequately
C Proper cooling C Proper sink used for handwashing Co 7Z
D Proper re-heating L.0 0
E Proper internal cooking I consumer advisory posted * rl tee water carp l) C N10, 2
0 A Approved sanitizeravailable/adequate concentration ofsanitizer
4 A0446AII tales tD mai�to'rnrrrdrt a r m B Food contact surfaces and utensils used for potentially
teryperattr �tetrrtametera rood , � ,� hazardous food sanitized at least every 4 hours
�� a�° y
A Food thermometer available and accurate C Adequate ❑dishwashersanitizer ❑final rinse temp
Proper
B Proper food thermometer for product
D rocedure
E Sanitizing between raw animal origin&ready-to-eatfood
C Thermometers appropriately placed in cooler units
0 O
F" protected doritt�storage;�tiropara' h, A T A L Cloths and/orsponges in good repair an
display,service and transportation9 p d clean
B Wiping cloths kept in sanitizer between uses
A Produce washed
0
B Raw meats not stored/prepared near ready-to-eat foods
Ili! 111 pal
C Food covered properly A Food equipment clean,utensils clean,equipment interiors clean
D Adequate splash guards/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 I oe0
8 Food containers stored off the floor ton
0tcfssriri Opt
o'rided C.;N60 N/A` 9.
9 Handling of food minimized C N' 2 A Soap/paper towels/ drying device available
A No unnecessary handling RTE and/or cooked foods with bare hands B
Dispensers)working: ❑Soap ❑Paper towel
B Minimize food handling,other than ready-to-eat,with bare hands C_j Handwash sink(s)clean/waste receptacle at handwash sink
C Adequate utensils)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 alternate],PHF[potentially hazardous food], FB[foodborne]
PHFs are hot held at: OF. 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 illn conditions
Are temperatures recorded/logged for cold holding foods/equipment? Y and diseases to the QFO? Y N *Do you have a paid sick Is ? Y N
Are foods cooked in advance and cooled? Y N *Are lefto saved? Y N Is there a language barrier between inspector&QFO? Y indicate language spoken
List products cooled: by QFO/DA: *Can the A read the inspection report? Y N
Describe cooling methods: Indicate who answered the above ions: Name(print):
Is cooling monitored for time&temp? Y N Is the monitoring of cooling recorded? Y NIndicate the title of above son(circle all that apply):QFO DA Mgr 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 report is a two page form(total of 62 debitable items) Page 1 of 2
L Ai- 1. T Y a
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Establishment: �5nellw_lfknlo Date of Inspection: ! z
Address: 1731 1 Owner or Operator:
ADDITIONAL FO R POINT ITEMS KEY. DNC zn [ ]
U DOES NOT COMPLY
6 Foods not re-served.
-Unwrapped foods not re-served 4, 31 Sewage disposal approved. 4'
-Potentially hazardous foods not re-served -Operating as required
11 Toxic chemicals. No cross connections,back siphonage,backflow
A 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
M -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. IN -Food equipment -Dish machines -Ice machines
-Well/well head protected from contamination
� 35 Toilet facilities. Adequate,convenient,accessible,
-Water quality in compliances
-Monitoring in compliance designed,properly installed
OTHER ITEMS KEY: DNC [DOES NOT COMPLY]
2 Sources of food: Original container,properly labeled " 40 Garbage/rubbish storagearea/rooms,enclosures-properly constructed,clean
5 Potentially hazardous food properly thawed 1 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 41W 3 Outer openings protected against entrance of insects/rodents
4 Floors: Floorcovering installed,constructed as required,good repair,clean
16 Food-contact surfaces designed,constructed, maintained,installed, 45 Floors graded,drained as required
located
6 Floor,wall juncture covered
17 nfood contact surfaces designed,constructed, maintained, _; 7 Mats removable,good repair,clean
installed,located ;
Exterior walking,driving surfaces,good repair,clean
18 Single service articles,storage,dispensing
19 No reuse of single service article 92pair,
alls,ceilings attached,equipment properly constructed,good
clean.Wall&ceiling surfaces as required
20 Dishwashing facilities approved design,adequately constructed, 2
maintained installed located P _ 50 Dustless cleaning methods used,cleaning equipment properly stored
Equipment&Utensils• Cleanliness 51 Adequate lighting provided as required
21 Preflushed,scraped,soaked and racked r 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 4 Rooms adequate,clean,adequate lockers provided,facilities clean
7)Nonfood-contact surfaces of utensils&equipment clean 5 Establishment and premises free of litter,no insect/rodent harborage,
28 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
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 outine Inspection ❑Reinspection ❑ Preoperational inspection
0 her Inspection:
IN PET PERSON IN CHARGE: Demerit Score: *Include demerits from page 1
4 3 2 1 Total Rating
signature signature ,^ I
print name t nt name
5-t JCL DATE CORRECTIONS DUE:
phone number title �C`tea
"�� Page 2 of 2 plus continuation pages Focused Inspectlon 1/2002
., W PageS of 3
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INSPECTION REPORT STATE OF CONNECTICUT
FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH
CONTINUATION SHEET
NAME OF ESTABLIS NT TOWN DATE OF INSPECTION
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INSPECTIC& REMARKS
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INITIAL(INSPECTOR) INITIAL(PERSON IN CHARGE)
Distribution: 1st-White-Health Department 2nd-Yellow-Owner/Manager