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HomeMy WebLinkAboutFood Service Establishment Inspection 60 (5) iIN Establishment: ` PAS lhispection Date: Time: ROinsp RE]nsp Address/City: 14,n Rk4 Health D pt: I fo (,V UO2 : 1 2 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. K FACTOR ITEMS:Listino is not inclusive of all possible Hlif" lOtf Qpefr DNC[does not comply] 0[other] RTE[ready-to-eat] 1 Persm,` toe'Wi 'infection restricted 61 Designated Alternate 2 C iV1' A "4 63 Written docttntentation of training program 2 A Food workers have no exposed infected lesions/burns B Personnel with infection restricted 01 1 Approved source,wholesome,nonadulterated C N/0 A 4 C Communicable disease of worker reported to local health director A 1 Approved shellfish,finfish,meat&poultry USDA approved 13 Handwashing facilities provided,hands Washed,clean C Nf 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 Ll B Handwash facilities in or immediately adjacent to toilet rooms D Commercial products(no home grown/canned food) L 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 i'o$pntia[!y,hazardous f<a©d eieets tepure rdit�# its 0 during s e ,preparation,cftptJey serrti end af5per#a 3ba , ces N10 `NIA 2'i A Hot holding greater than or equal to 1400F. (whole beef/pork roasts 1300 F.) A ❑ No eating ❑ No smoking while working oe B Cold holding less than or equal to 450 F. B Wounds covered adequately C Proper cooling C Proper sink used for handwashing Loo D Proper re-heating Loo 0 E Proper internal cooking/consumer advisory posted dater = 31 f ? ;,' , .m 0 A Approved sanitizeravailable/adequateconcentrationofsanitizer 4 Adequate facHi#ieste main yarQdetzt B Food-contact surfaces and utensils used for potentially temperature,thermometers'proviided � � hazardous food sanitized at least every 4 hours A Food thermometeravailableandaccurate C Adequate ❑dishwashersanitizer ❑final rinse temp L Proper sanitizin rocedure B Properfood thermometerfor product E Sanitizing between raw animal origin&ready-to-eat food C Thermometers appropriately placed in cooler units O Df�p�ec�e s :� , ;3 display,service and tra isporta?titan A Cloths and/or sponges in good repair and clean A Produce washed B Wiping cloths kept in sanitizer between uses 0 B Raw meats not stored/prepared near ready-to-eat foods 000, C Food covered properly N NONE 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 oll, C Food--contact surfaces clean F No pooling of eggs not cooked immediately PFood containers stored off the floorj � ,100 9 Handling of food milnirrafzpdZ I A No unnecessary handling RTE and/or cooked foods with bare hands A Soap/paper towels I drying device available B Dispenser(s)working: ❑Soap ❑Paper towel B Loo 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 •DESCRIBE DEFICIENCIES ON CONTINUATION SHEETS ---The-following information is--not-debitable-and-does-not--affect-your-score: -- ---KEFY:- QFOlqualified 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 con di' en 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 sus related to FB illness are you required to report to the local health partment? Roasts Other -i Describe re-heating procedures: Is there a written illness policy that requires the food worker ort specific illness conditions Are temperatures recordedllogged for cold holding foods/equipment? Y N and diseases to the QFO? Y N *Do you h paid sick leave policy? Y N Are foods cooked in advance and cooled? Y N *Are leftovers sa Y N Is there a language barrier between inspe QFO? Y N If-yes indicate language spoken List products cooled: by QFO/DA: *Can the QFO/DA read the inspection report? Y N Describe cooling methods: 41 Indicate who answere above questions: Name(print): Indicate the title of 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 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 .z ;s LOCAL HEALTH DEPT: `J � ADDRESStGITY: . . `-° ; t , Establishment: C' Date of Inspection: 1 L -7 ) Z 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 11 Toxic chemicals. 34 No cross connections,back siphonage,backflow x 4; Proper type/installation/backflow prevention device/air gap for: �R -Stored properly,labeled properly,used properly -Food equipment -Hose connections -Dish machines P -San itizer concentration notto 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 rdesig tfacilities. Adequate,convenient,accessible, -Monitoring in compliance-Water quality in compliance ned,properly installed OTHER ITEMS KEY: DNC [DOES NOT COMPLY] 2 Sources of food:Original container,properly labeled 1 0 Garbage/rubbish storage area/rooms,enclosures-properly constructed,clean ref Potentially hazardous food properly thawed 2 1 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 Outeropenings 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,wall juncture covered 17 onfood contactsurfacesdesigned,constructed,maintained, 1, 7 Mats removable,good repair,clean installed,located 18 Single service articles,storage,dispensing 2 " 8 Exterior walking,driving surfaces,good repair,clean 19 No reuse of single service article alls,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 23 Accurate thermometers provided,dish basket,if used 54 Rooms adequate,clean,adequate lockers provided,facilities clean Nonfood-contact surfaces of utensils&equipment clean 1 55 Establishment and premises free of litter,no insect/rodent harborage, E uipment/utensils,storage,handling 1',` no unnecessary articles 32 Proper disposal of wastewater T 56 Complete separation from living/sleeping quarters and laundry Plumbing location,installation,maintenance 1-, sore properly 58 No live birds,turtles,orotheranimals(exceptguide dogs) 36 Toilet rooms enclosed with self-closing door 1. _59 Seats 75_or more:_Nonsmoking-area provided,sign(s)posted at — - - 37 Propertoiletfixtures provided,good repair;clean 4, entrance(s),smoking area indicated by sign(s) 39 Approved garbage/rubbish containers,adequate number,covered, 19 1. rodent proof,clean Moutine Inspection OReinspection 0 Preoperational Inspection Other Inspection: INSPECT PERSON IN BARGE: Demerit Score: *Include demerits from page 1 4 3 2 1 Total Rating si ature signature o j print name nn(am`e print name ® 3 7 7 1( Z � DATE CORRECTIONS DUE: phone number title Page 2 of 2 plus continuation pages Focused Inspection 1/2002 �1 (70 S Page of INSPECTION REPORT STATE OF CONNECTICTJT FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH CONTINUATION SHEET NAME OF ESTABLISHMENT TOWN DATE OF INSPECTION 2,S Sa �rh � a 2 INSPECTICIN FORM# REMARKS o 6 I^ t L44 /�Q • t Ly/ BL oZ . r (� U -- �� 0 - �r ( P Irks-�r.� �o aFc) cer4t 7r-,<, 1e ck' �f'l( AX14 S&jr,,jj INITIAL(INSPECTOR) AAv INITIAL(PERSON IN CHARGE) Distribution: 1 st-White-Health Department 2nd-Yellow-Owner/Manager