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Home My WebLink AboutFood Service Establishment Inspection 67 it Establishment: ss is; Inspection Date: I ,3 Time: Ua (ROInso REinsp Address/City: L73 JEJ(,' Health Dept: S!. 4 : class: 1 2 38 Based on an inspection t ' 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 I N/O N/A DNC KEY: C [complies N/0 n ot observed] N/A font Applicablej 6i1 pOro 'Dpg i $ _ 3 DNC[does not comply] 0[other] RTE[ready-to-eat] "scf ti#OM ii irton 61 Designated Alte rdshidedrnate 2 N(t NIA 4 62 Writ#en documentation of training program 2 A Food workers have no exposed infected lesions/burns B Personnel with infection restricted 1 Approved source,wholesome,nonaduiteratetl C /0 NIA -4! C Communicable disease of worker reported to local health director A Approved shellfish,flnfish,meat&poultry USDA approved V 13 Fiandwashing faCilities provided,hands ara5#1ett,dean', C Iwo NIA 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 B Handwash facilities in or immediately adjacent to toilet rooms D Commercial products(no home grown/canned food) V1C 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 Potenji Hazard®tts.fflod 1xlets r 0 doring storm partition df§pp, k rm . r 35 ifd`tiyrgiertic6pract}ices G N/t� NIA 2 A Hot holding greater than or equal to 140eF. (whole beef/pork roasts 1300 F) A ❑ No eating ❑ No smoking while working B Cold holding less than or equal to 45e F. B Wounds covered adequately C Proper cooling C Proper sink used for handwashing D Proper re-heating 0 E Pro er internal cookin /consumer advisor atr d i, i C pi/ 2e�' p 9 ry posted �( k 0 A Approved sanitizeravailable/adequate concentration of sanitizer 4 /kquate faif#1es riniri B Food-contact surfaces and utensils used for potentially tomperatiird,tilemrlr fifer 'pro r hazardous food sanitized at least every 4 hours A Food thermometer available and accurate C Adequate ❑dishwashersanitizer ❑final rinse temp D Proper sanitizin B Proper food thermometer for product procedure E Sanitizing between raw animal origin&ready-to-eat food C Thermometers appropriately placed in cooler units 0 0 i� 6 'ph0tf3Cted dttt�1 parr , A Cloths and/orsponges in good repair and clean display,service and transportation9 P A Produce washed oe B Wiping cloths kept in sanitizer between uses B Faw meats not stored/prepared near ready-to-eat foods 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 be E No unauthorized personnel C Food contact surfaces clean F No pooling of eggs not cooked immediately 4 - 0 8 Food containers stored off the floorV 1 1s r 0 a $ �s.p 9 tfar dti rtg of fdod rrrinirnized A No unnecessary handling RTE andlorcooked foods with bare hands V1 I A Soap I paper towels I 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 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. 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 w working: Are internal cooking temperatures taken? Y N *To what temperatur you cook: Poultry Ground Beef e c What diseases related to FB illne you required to report to the local health department? Roasts Other Describe re-heating procedures: Is there a writteaAm6ss policy that requires the food worker to report specific illness conditions Are temperatures recorded/logged for cold ing foods/equipment? Y N and dise o the QFO? Y N *Do you have a paid sick leave policy? Y N Are foods cooked in advance a oled? Y N Are leftovers saved? Y N Is there a language barrier between inspector&QFO? Y N ILyes indicate language spoken List products cooled: by QFO/DA: *Can the QFO/DA read the inspection report? Y N Describe coo' methods: _ Indicate who answered the above questions: Name(print): Indicate the title of above person(circle all that apply):QFO DA Mgr &ook Owner FW Is c6ling monitored for time&temp? Y N Is the monitoring of cooling recorded? Y N .Obtain signature of the person who eived 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 age form(total of 62 debitable items) Page 1 of 2 Establishment: ratio ti C,e� Aeb-i's i Date of Inspection: Owner or Aerator: ADDITIONAL FO R 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. 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 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 compliance -Monitoring 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 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 43 Outeropenings protected against entrance of insects/rodents 4 Floors: Floorcovering installed,constructed as required,good repair,clean 16 ood-contact surfaces designed,constructed,maintained,installed, 5 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 9 Walls,ceilings attached,equipment properly constructed,good 20 Dishwashing facilities approved design,adequately constructed, repair,clean.Wall&ceiling surfaces as required maintained installed located 50 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 23 Accurate thermometers provided,dish basket,if used 54 Rooms adequate,clean,adequate lockers provided,facilities clean Nonfood-contact surfaces of utensils&equipment clean 55 Establishment and premisesfree of litter,no insect/rodentharborage, 28 Equipment/utensils,storage,handling no unnecessary articles 32 Properdisposal of waste water 561 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) 59 Seats 75 or more:Nonsmoking area provided,sign(s)posted at 37 PropertoiletfixturesArovided,good repair,clean entrance(s),smoking area indicated by sign(s) 39 Approved garbage/rubbish containers,adequate number,covered, rodent proof,clean 011outine Inspection ❑Reinspection ❑ Preoperational Inspection Other Inspection: IN PE T R: PERSON IN CHARGE: Demerit Score: *Include demerits from page 1 4 3 2 1 Total Rating si nature Anat6re � print name pri t,n4 9 9 j Yo r ' LC-) DATE CORRECTIONS phone number �rti ,d title " d� ill Page 2 of 2 plus--A _continuation pages Focused Inspection 1/2002 Page 3 of 3 INSPECTION REPORT fYIN-NE.CT-If TIT' FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH CONTINUATION SHEET NAME OF ESTABLISHMENT TOWN DATE OF INSPECTION INSPECTION FORM# REMARKS m 6 C. LG I i 1 r qMQ d n' 1 ns INITIAL(INSPECTOR) INITIAL(PERSON IN CHARGE) Distribution: Ist-White-Health Department 2nd-Yellow-Owner/Manager