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HomeMy WebLinkAboutFood Service Establishment Inspection 58 (4) AA44 Establishment: `, �� 1-G,- 7�, Inspection Date: z Time- Roins REinsp ddress/City: S K y Health ept: class: 1 2 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 I N/0 JOA JDNC I tom: C [complies N/0 n ot observed] N/A Inn-t npplirahlej $ DNC[does not comply] 0[other] RTE[ready-to-eat] 61 i)estiated Attarr►ate 2 th on C N/0 A 4' 62 VYd ten documentation of training pregram 2 A Food workers have no exposed infected lesions I burns B Personnel with infection restricted Approved source,wholesome,taon8drtlt8fdted C N! [A 4 I C Communicable disease of worker reported to local health director A Approved shellfish,finfish,meat&poultryUSDA approved 13 Ftandweshing facilities provided,hands washed,Clean C A 4 B Food cans in good condition(not dented,rusty,bloated,leaking) A Handwash facilities in all food prep/dispensing&warewash areas C Wholesome/nonadulterated 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 0 p Personnel hands washed,clean/Proper handwash procedure 00,Handwa 14 shing at appropriate times Ads ing�toi ,poeparatton , ` s Gcsot'hygrtic l5racioes C N/0 NtA 2 A Hot holding greater than or equal to 1400F. (Whole beef/pork roasts 1300 F.) Lo 0000r 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, 0 E Proper internal cooking/consumer advisory posted 0 A Approved sanitizer available/adequate concentration of sanitizer �� d �� 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 Properfood thermometer for product �L Proper sanitizin rocedure E Sanitizing between raw animal origin&ready-to-eat food C Thermometers appropriately placed in cooler units 0 0 f ; dlsipfilay,service and transportation 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 0 C Food covered properly Food equipment clean,utensils clean,equipment interiors clean aim D Adequate splash guards/sneeze guard B Single use gloves changed when soiled E No unauthorized personnel %.00'-AC Food--contact surfaces clean F No pooling of eggs not cooked immediately ood containers stored off the floor G8-2 ' elin8©f fciotl men tiie€f n 00, 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 I Handwash sink(s)clean/waste receptacle at handwash sink 0 O •DESCRIBE DEFICIENCIES ON CONTINUATION SHEETS The following information is not debitable and does not affect your score. IM: QFO_[qualified foo l-operati:4- tdesignated attemate]rP-HF-[potentially-hazardous feod];-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 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: 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 Ieftovers ? Y N Is there a language barrier between inspector&QFO? If yes indicate language spoken List products cooled: by QFO/DA: ♦ e QFO/DA read the inspection report? Y N Describe cooling methods: Indicate who answere ove questions: Name(print): Is cooling monitored for time&temp? Y N Is the monitoring of cooling recorded? Y N Indicate th of above person(circle all that apply):QFO DA Mgr Cook Owner FW • signature of the person who received the CFO responsibilities information at the time of the Is there a produce washing policy? 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 Establishment: tiif/i Date of Inspection: 2 ddress: C41 A Ft weer or operator: ADDITIONAL FOUR POINT ITEMS z = ra, KEY: DNC [DOES NOT COMPLY] 6 Foods not re-served. 4 31 Sewage disposal approved. -Unwrapped foods not re-served -Operating as required -Potentially hazardous foods not re-served 4 11 Toxic chemicals. 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 machinesProper 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, -Monitoring in compliance -Water quality 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 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 1 t 3 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, a 45 Floors graded,drained as required located 6 Floor,walljuncture covered 17 Nonfood-contact surfaces designed,constructed,maintained, 7 Mats removable,good repair,clean installed,located 18 Single service articles,storage,dispensing M, 48 Exterior walking,driving surfaces,good repair,clean 19 No reuse of single service article 9 Walls,ceilings attached,equipment properly constructed,good repair,clean.Wall&ceiling surfaces as required 0 Dishwashing facilities approved design,adequately constructed, maintained installed located 50 Dustless cleaning methods used,cleaning equipment properly stored EEquipment&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 231 Accurate thermometers provided,dish basket,if used 54 Rooms adequate,clean,adequate lockers provided,facilities clean 27 Nonfood-contact surfaces of utensils&equipment clean 55 Establishment and premises flee of litter,no insect/rodent harborage, 28 Equipment/utensils,storage,handling no unnecessary articles 32 Proper disposal of waste water 56 Complete separation from living/sleeping quarters and laundry 33 Plumbing location,installation,maintenance Clean/soiled linens stored properly 36 Toilet rooms enclosed with self-closing door 58 No live birds,turtles,or other animals(except guide dogs) 3'7 Proper toilet fixtures provided,good repair,clean 59 -Seats-7Zor-more,Nonsmoking area-provided,sign(s)-postedat -- entrance(s),smoking area indicated by sign(s) 39 Approved garbage/rubbish containers,adequate number,covered, rodent proof,clean outine Inspection OReinspection 0 Preoperational Inspection Other Inspection: IN N IN CHARGE: Demerit Score: *Include demerits from page 1 # �fi'.(91,- A, &&,-,J , ( 4 3 2 1 Total Rating s' na - n signature L print name / print name �. vo , / hYyeo� (� phone number titl a DATE CORRECTIONS DUE: rc"we v _ Page 2 of 2 plus_'L__continuation pages Focused Inspection 1/2002 Page `� Of 3 INSPECTION REPORT STATE OF e0NNECTIeUT FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH CONTINUATION SHEET NAME OF ESTABLISHMENT TOWN DATE OF INSPE ON G ' / Z /7 CTL INSPECTION FORM# REMARKS ti A0 --p. 's—cp u yo OF ko� L&6&A- Ks -:> ---> I A Ou4s4 -f—,eux 4s, Ll 6JL ,c4y, j DeffL PM-efl INITIAL(INSPECTOR) INITIAL(PERSON IN CHARGE) Distribution: 1st-White-Health Department 2nd-Yellow-Owner/Manager