Loading...
HomeMy WebLinkAboutFood Service Establishment Inspection 80 13 Establishment: i i2 A Inspection Date: 117113 Time: Roinsp REinsp Address/City: Health Dep : Ica W 0��" class: 1 2 , Based on an inspection this day,the it s marked DNC identi 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/A DNC DNC[does not comply] 0[other] RTE[ready-to-eat] r . . y cted. C N1 4' 61 Designated Alternate A Food workers have no exposed infected lesions/burns Written documentation of training program 2 B Personnel with infection restricted 1 Approved source,wholesome,nonadult®rated C 4' C Communicable disease of worker reported to local health director A Approved shellfish,finfish,meat&poultryUSDA approved 13 andwashing facili#ies provided, C A 4' B Food cans in good condition(not dented,rusty,bloated,leaking) Handwash facilities in all food prep/dispensing&warewash areas C Wholesome/nonadulteratetlfoodslsafe 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 too 3 Pvtet< yy tr us:f� #s 0 dining st©rage,preperaa©fi,ai�pyeiee at1 © _ ` cr4sd hygi®rtic;practices C fill Nf 2 A Hot holding greater than or equal to 1400F. (whole beef/pork roasts 130'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 handwash' g D Proper re-heating 0 E Proper internal cooking I consumer advisory posted011 {bi vlrater Cti® l� ) 'WO NZA 0 T Approved sanitizer available/adequate concentration of sanitizer 4 Ad ate facffitme to rf' t- pi odu t B Food-contact surfaces and utensils used for potentially temperature,tc p � hazardous food sanitized at least every 4 hours A Food thermometer available and accurate C I Adequate Xdishwashersanitizer ❑final rinse temp L Proper sanitizing procedure B Proper food thermometer for product LOO E Sanitizing between raw animal origin&ready-to-eatfood C Thermometers appropriately placed in cooler units 0 O 7 Faod protected rlvrirsg§on` .00 display,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 00 0 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 8 Food containers stored off the floor r 0 ` # Al. p fidad'- '.'-IYQ-', A ,j i 9 Handiin of food rnirr rffized A No unnecessary handling RTE and/orcooked foods with bare hands A Soap I paper towels I drying device availableLoo B Dispenser(s)working: []Soap ❑Papertowel B Minimize food handling,other than ready-to-eat,with bare hands C Handwash sink(s)clean I waste receptacle at handwash sink C Adequate utensil(s)for dispensing food/ice P 0 0 1 •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 tempest 6you cook: Poultry Ground Beef Pork What diseases related to FB illness are you required to report to the loca[,beat ff'department? Roasts Other Describe re-heating procedures: Is there a written illness policy that requires the foog_wa Tr to report specific illness conditions Are temperatures recorded/logged for cold hol ' ids/equipment? Y N and diseases to the QFO? Y N ♦Do,yddTave a paid sick leave policy? Y N Are foods cooked in advance and cc . Y N *Are leftovers saved? Y N Is there a language barrier betwe�a, spie' r&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 me Indicate who veered the above questions:Name(print): Indicate`fie title of above person(circle all that apply):QFO DA Mgr Cook Owner FW Is cooling apCored 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 r p 4 101 Establishment: 1 t , 4�Date of inspection:` a ` Uw ner or Operator: ADDITIONAL FOUR POINT ITEMS z a 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-Operating as required 11 Toxic chemicals. 34 RIM No cross connections,back siphonage,backflow -Stored properly,labeled properly,used properly Proper type/installation/backflow prevention device/air gap for: -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 -Pesticides/rodenticides properly dispensed -Chemical dispensers -Ice machines Proper drain for: 29 Water source adequate,safe. -Food equipment -Dish machines -Ice machines -Well/wellhead protected from contamination 35-Water quality in compliance Toilet facilities. Adequate,convenient,accessible, -Monitoring in compliance designed,properly installed OTHER ITEMS KEY: DNC [DOES NOT COMPLY] 2 Sources of food:Original container,properly labeled 0 Garbage/rubbish storage arealrooms,enclosures-properly constructed,dean 5 Potentially hazardous food properly thawed 41 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 3 Outer openings protected against entrance of insects/rodents 4 loors: Floor covering installed,constructed as required,good repair,clean 16 Food-contact surfaces designed,constructed,maintained,installed, 5 Floors graded,drained as required located 7 N nfood-contact surfaces designed,constructed,maintained, 6 Floor,wall juncture covered installed,located 7 Mats removable,good repair,clean 8 Exterior walking,driviog surfaces,good repair,clean 18 Single service articles,storage,dispensing 19 No reuse of single service article 49 ceilings attached,equipment properly constructed,good �alls, pair,clean.Wall&ceiling surfaces as required 0 ishwashing facilities approved design,adequately constructed, aintained installed located 50 Dustless cleaning methods used,cleaning equipment properly stored Equipment&Utensils: I anlin ss 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 27 Nonfood-contact surfaces of utensils&equipment clean 54 Rooms adequate,clean,adequate lockers provided,facilities clean uipment/utensils,storoge,handling 55 Establishment and premises free of litter,no insect/rodent harborage, no unnecessary articles 32 Yroperdisposal of waste water 56 Complete separation from living/sleeping quarters and laundry 33 Plumbing location,installation,maintenance 57 Clean/soiled linens stored properly 36 Toilet rooms enclosed with self-closing door 58 No live birds,turtles,or other animals(except guide dogs) 37 Proper toilet fixtures provided,good repair,clean 59 Seats 75 or more:Nonsmoking area provided,sign(s)posted at entrance(s),smoking area indicated by sign(s) 39 Approved garbage/rubbish containers,adequate number,covered, rodent proof,clean Routine Inspection ❑Reinspection ❑ Preoperational Inspection YPE PERSON IN CHARGE: IIher Inspection: Demerit Score: *Include demerits from page 1 4 3 2 1 Total Rating sig ture so t re print name riot name '/�//Xo 7/1 73' phone number title DATE CORRECTIONS DUE: ^ Page 2 of 2 plus continuation pages Focused Inspection I/2002 r Page of a�v FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH CONTINUATION SHEET NAME OF ESTABLISHMENT TOWN DATE OF INSPECTION (�D 'X Vjt Vj�p _rAA INSPECTION REMARKS FORM# it es- `F- &4 e s bn q L� L t A,0 504 A-ha 6�7 S r (Ly, ,If .3 0 CC , Ae s 1--136-14 /3 It (/( fA-R- .v 0 A-4 <I,led Nosx iAAv•M (0 � �� -- V/ 97 i5� Aaiw 510 INITIAL(INSPECTOR) XAP INITIAL(PERSON IN CHARGE) Distribution: I st-White-Health Department 2nd-Yellow-Owner/Manager Page � of INSPECTION REPORT STATE OF CONNECTICUT FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH CONTINUATION SHEET NAME OF ESTABLISHMENT TOWN DATE OF INS ECTION Wlwa02 j13 INSPECTION FORM# REMARKS -2 S rd Juc-f uvx ,i v, 6 0 Q� ✓� le 1:�fjj�?V-OAA- 0A r7/t 0 1Z_ 7. Ar e. r J-v C/'sS�C —7 Pik i UA/(011L0J_ 3 2- our �W i;` r '' `�_ Sup C �a �� {� S ,• � 1_ S02- Ar — r S r I/?S/g .� S I u :Pcc — S h, e TOY _74))4CdaP- 17 e6 s ;�I-A Ito rA/0 l.� 1 a/ (azp(DIC Reckg r. er A � Pc-.lr clvq cs" / -- -1 INITIAL(INSPECTOR) INITIAL(PERSON IN CHARGE) Distribution: 1st-White-Health Department 2nd-Yellow-Owner/Manager