HomeMy WebLinkAboutFood Service Establishment Inspection 60 (5) Establishme„t: 'cs Inspection Date: 1 A 3 Time:__L9,&P1AQR01nsp>Einsp
Address/City: XJ6A Health ept: I S, 1 js,^A5" Class: 1 2 3(d�
Based on an inspection this day,the items marked DNC identify the violations in operation orfacilities 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/O N/A I DNC
(y DNC[does not comply] 0[other] RTE[ready-to-eat]
3
12p':: `sd 61 with inffecctildn reetric�d
61 Designated Alternate 2 C 1,WONIA 14
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,nanaduiterated Q f0 /A C Communicable disease of worker reported to local health director
A Approved shellfish,finfish,meat&poultry USDA approved 43 Sidi �g fades provided,handswastlelt C NSA, 4
B Food cans in good condition(not dented,rusty,bloated,leaking) A Handwash facilities in all food prep/dispensing&warewash areas
C Wholesome/nonaduIterated 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 V D Personnel hands washed,clean/Proper handwash procedure
0
E Handwashing at appropriate times
3i?iitert hatrl ;ftpt ttp rd i` 0
dui4i IpEfide dir s7
ltgiric prac3cds w, N/A 2
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 450 F. B Wounds covered adequately
C Proper cooling C Proper sink used for handwashing
D Proper re-heating 0
E Proper internal cooking I consumer advisory posted � ! ( t►t Gut�r- eyn
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0 A Approved sanitizer available/adequate concentration of sanitizer
4 Adequate elide$#o re aintdin j"deat a _ :' B Food-contact surfac_es and utensils used for potentially
terrlperature,thorrnometen; provided hazardous foods ized at least every 4 hours
A Food thermometer available and accurate C Adequate WElishwashersanitizer ❑final rinse temp
D Proper sanitizing procedure VI
B Proper food thermometer for product
E Sanitizing between raw animal origin&ready-to-eat food
C Thermometers appropriately placed in cooler units
0 0
i=ood prd c d i#irriog`S io,, ,` { 2 s s
display,service and transportation A Cloths and/or sponges in good repair and clean
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A Produce washed
B Wiping cloths kept in sanitizer between uses
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/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 7Z 0
8 Food containers stored off the floor
0
9 Handling of food mirrirntzed 0 .>2- �etre > irldpr '3} ;
A No unnecessary handling RTE and/or cooked foods with bare hands V A Soap/paper towels/ drying devic vailable
B Dispenser(s)working: oap ❑Paper towel
B Minimize food handling,other than ready-to-eat,with bare hands C Handwash sink(s)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. �Y: QFO[qualified food operator],DA[designated alternate],PHF[potentially hazardous food], FB foo
PHFs are hot held at: OF. PHFs are cold held at: OF. Describe illness conditions when you would exclude a food work orking:
Are internal cooking temperatures taken? Y N *To what temperature do you cook:
Poultry Ground Beef t-y� What diseases related to FB illness are your o report to the local health department?
Roasts Other
Describe re-heating procedures: Is there a written illness po' at requires the food worker to report specific illness conditions
Are temperatures recorded/loge cold holding foods/equipment? Y N and diseases to the Y N ♦Do you have a paid sick leave policy? Y N
Are foods cookelpervance and cooled? Y N *Are leftovers saved? Y N Is there a language barrier between inspector&QFO? Y N tfM indicate language spoken
List prod ooled: by QFO/DA: *Can the QFO/DA read the inspecton port? Y N
Describe cooling methods: Indicate who answered the 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 th erso who a e' d the QFO responsibilities information at the time of the
Is there a produce washing policy? Y N *Describe what is washed and inspection: p
where: Note: This report is a two page form(total of 62 debitable items) Page 1 of 2
Establishment: Date of Inspection:
wner or Operator:
ADDITIONAL FOUR POINT ITEMS KEY: DNC [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. 34 No cross connections,back siphonage,backflow
-Stored properly,labeled properly,used properly limper type/installation/backflow prevention device/air gapffor:
-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 machines
Proper drain for:
29 Water source adequate,safe. -Food equipment -Dish machines -Ice machines
-Well/well head protected from contamination 35rdesnfed
lities. Adequate,convenient,accessible,
-Water quality in compliance properly installed
-Monitoring in compliance
OTHER ITEMS KEY: DNC [DOES NOT COMPLY]
2 Sources of food: Original container,properly labeled 40 Garbage/rubbish storage area/rooms,enclosures-pro perly constructed,clean
5 Potentially hazardous food properly thawed 41 Garbage/rubbish disposed of in an approved manner,at approved frequency
1703 Food dispensing utensils properly stored 42 Vermin Control: No insects/rodents present
14 Food worker:Clean outer clothes,effective hair restraints 43 Outer openings protected against entrance of insects/rodents
4 hoors: 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
18 Single service articles,storage,dispensing
8 Exterior walking,driving surfaces,good repair,clean
19 No reuse of single service article 41 alls,ceilings attached,equipment properly constructed,good
20 Dishwashing facilities approved design,adequately constructed, repair,clean.Wall&ceiling surfaces as required
maintained installed located 501 Dustless cleaning methods used,cleaning equipment properly stored
Equipment&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
3 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 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 5 lean/soiled linens stored properly
36 Toilet rooms enclosed with self-closing door 58 No live birds,turtles,or other animals(except guide dogs)
59 Seats 75 or more:Nonsmoking area provided,sign(s)posted at
37 Propertoilet fixtures provided,good repair,clean entrance(s),smoking area indicated by sign(s)
39 Approved garbage/rubbish containers,adequate number,covered,
rodent proof,clean ❑Routine Inspection ❑Reinspection ❑ Preoperational Inspection
Other Inspection:
INSPECTOR: E N INCHAR E: Demerit Score: *Include demerits from page 1
4 3 2 1 Total Rating
signature si re
print name print n m
phone number title ()
-h -as �i �' DATE CORRECTIONS DUE: ti ;
� �'�� Page 2 of 2 plus continuation pages Focused Inspection 7.
Page 3 of
TNSPECTTON REPORT STATE OF CONNECTIeUT
FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH
CONTINUATION SHEET
NAME OF ESTABLISHMENT TOWN DATE OF INSPECTION
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INSPECTION REMARKS
FORM#
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INITIAL(INSPECTOR) r INITIAL(PERSON IN CHARGE)
Distribution: 1st-White-Health Department 2nd-Yellow-Owner/Manager