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HomeMy WebLinkAboutFood Service Establishment Inspection 29 (2) i AAAP Establishment: ivy -Q Inspection Date: 144 3 L Time:�— ROins REins Address/City: Health Dept: ,Jc.uJ+ n;� class: 1 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 b6HDLN6HDNC ; C[complies] NIO n 60' `Qua sd Fe btl 0 z parat�r 3 DNC[does not comply] 0[other] RTE[ready-to-eat) 32 Ptirstonfiba with infedioln'res�cted 61 i]esignated t4lternate ' 2 4 62 Written documentation of training program A Food workers have no exposed infected lesions/burns 2 B Personnel with infection restricted 1 Approved source,wholesome,nonadulterated N/0 NIA 4C Communicable disease of worker reported to local health director A Approved shellfish,finfish,meat&poultry USDA approved 13 'Handwtashing facilit"tes provided,'hands washed,dealt C N10,4K q' 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 D Personnel hands washed,clean/Proper handwash procedure 0 E Handwashing at appropriate times e awdous food,meets f, - , iJ o dtij trage,ptpara#ort,diflajr serarl d ilf �;� �� � ` `Good tryglenrc practtces� A Hot holding greater than or equal to 140°F. (whole beef/pork roasts 1300 F.) A ❑ No eating ❑ No smoking while working B Cold holding less than or equal to 45°F. B Wounds covered adequately C Proper cooling LI_ C Proper sink used for handwashing D Proper re-heating 0 E Proper internal cooking/consumer advisory posted $ �' ► � r�r» F 0 A Approved sanitizeravailableladequate concentration ofsanitizer 4 Rde€#rra#e fiacflt#ies to maintain du [ X�� B Food-contact surfaces and utensils used for potentially #etopera#Ftr .#�erna©teeters psded hazardous food sanitized at least every 4 hours A Food thermometer available and accurate C Adequate ❑dishwashersanitizer ❑final rinse temp B Proper food thermometer for product D Pro ersanitizin rocedure C Thermometers appropriately placed in cooler units 01 E Sanitizing between raw animal origin&ready-to-eat food O 0 If Mot,V 7 c t7i� tttl ecfLtl ii �, K display,sorWice and transportation �� 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 C Food covered properly A Food equipment clean,utensils clean,equipment interiors clean D Adequate splash guards I sneeze guard B Single use gloves changed when soiled E No unauthorized personnel LO C Food--contact surfaces clean F No pooling of eggs not cooked immediately 0 8 Food containers stored off the floor 9 `HatadNrng of food mi irtiizdtl 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 Handwash sink(s)clean/waste receptacle at handwash sink 0 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 alternate],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 eases related to FB illness are you required to report to the local h Ith department? Roasts Other Describe re-heating procedures: Is there a written illness policy that requires the food wor report specific illness conditions Are temperatures recordedllogged for cold holding foods/equipment? Y and diseases to the QFO? Y N *Do yo e a paid sick leave policy? Y N Are foods cooked in advance and cooled? Y N Are overs saved? Y N Is there a language barrier between' ctor&QFO? Y N ff-M indicate language spoken List products cooled: by QFO/DA: ♦Can the QFO/DA read the inspection report? Y N Describe cooling methods: 4111 jIndicate who Bred the above questions: Name(print): Is cooling monitored for time&temp? Y N Is the monitoring of cooling recorded? Y N Indicate title of above person(circle all that apply):QFO DA Mgr Cook Owner FIN • in 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 � Establishment: stJ s.� tS� Date of Inspection: Z 3 Z Address: Owner orOperator: 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 No cross connections,back siphonage,backflow 11 Toxic chemicals. Proper type/installation/backflow prevention device/air gap for: -Stored properly,labeled properly,used properly -Food equipment -Hose connections -Dish machines -San itizer 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/well head protected from contamination 35 Toilet facilities. Adequate,convenient,accessible, -Water quality in complianceVi -Monitoring in compliance designed,properly installed f OTHER ITEMS KEY: DNC [DOES NOT COMPLY) 2 Sources of food:Original container,properly labeled 0 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 2 Vermin Control: No insects/rodents present 14 Food worker:Clean outer clothes,effective hair restraints 3 Outer openings protected against entrance ofinsects/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 Nonfood-contact surfaces designed,constructed, maintained, 7 Mats removable,good repair,clean installed,located ° 44 8 Exterior walking,driving surfaces,good repair,clean 18 Single service articles,storage,dispensing 19 No reuse of single service article 9 Walls,ceilings attached,equipment properly constructed,good 20 Dishwashing facilities approved design,adequately constructed, u repair,clean.Wall&ceiling surfaces as required maintained installed located 501 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 free of litter,no insect/rodent harborage, 28 Equipmentlutensils,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 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 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 garbagelrubbish containers,adequate number,covered, rodent proof,clean 1311outine Inspection %gReinspection 0 Preoperational Inspection IN PET PERSON IN CHARGE: Other Inspection: Demerit Score: *Include demerits from page 1 C{ ��X41-1 4 3 2 1 Total Rating si nature signature paint name print name o v DATE CORRECTIONS DUE: S phone number title Page 2 of 2 plus_�continuation pages Focused Inspection 1/2002 Page j of INSPF.C''TTnN RFPnRT STATE nF CONNECTIcgT• FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH CONTINUATION SHEET NAME OF ESTABLISHMENT TOWN `' f� r ' DATE OF INSPE TION JA, SJlJ tJll�je 'a v Fv/ Wr J�2— 2... ,Z 3 INSPECTION FORM# REMARKS (k) � ,p q3 6F ( ceS i' s — JZ `F S - - 2,` - r - 1 OF ( 24 CUV�q�j Ift- �1 dl INITIAL(INSPECTOR) INITIAL(PERSON IN CHARGE) Distribution: 1st-White-Health Department 2nd-Yellow-Owner/Manager