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HomeMy WebLinkAboutFood Service Establishment Inspection 49 Establishment: Inspection Date: ► Time:► � oinsp REinsp Address/City: Healt Dep: '� Ll/,n c2r Class: 1 2 Q4 Based on an inspection this day,N items marked DNC identify,the violations in operation or facilities which must be corrected by thp1date specified on page 2. RISK FACTOR ITEMS: Listing is not inclusive of all possible debitable items C_ /0 1 N/A I DNC I KEY- C lcomplopgi NIO[Lint observedj -,,'NIA[hot appliGable! �; 3 DNC[does not comply] 0[other] RTE[ready-to-eat] .� t4 °PasQi viitiap ect restricted 61 Designated Alternate ' 2 C NIA 4 6-2 Written documentation of traini r© am A Food workers have no exposed infected lesions I burns �9 p $r 2 B Personnel with infection restricted 1 Approved source,wholesome,nonadulterated' C A10 IA 4 C Communicable disease of worker reported to local health director A I Approved shellfish,finfish,meat&poultry USDA approved 13 Handwashing facilities prodded,hands washed,clean C 40 NIA 4 B Food cans in good condition(not dented,rusty,bloated,leaking) VA 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) C Handwash facilities accessible/convenient to use E Potentially hazardous foods received at proper temperature D. Personnel hands washed,clean/Proper handwash procedure 0 �nr E Handwashing at appropriate times ��� Vf 3 Pate he' --do us food maolls pet iir r trsrs � Q ping �ragi,`prepara#fot�,tp!aY,sew asd'tlaaspc�ta{[ei �5 G+©od hygiertic'iiracces C 00N/A 2 or A Hot holding greater than or equal to 1400F. (whole beeflpork roasts 130'F.) A ❑ No eating ❑ No smoking while working B Cold holding less than or equal to 450F. B Wounds covered adequately C Proper cooling C Proper sink used for handwashing D Proper re-heating 0 E Proper internal cooking/consumer advisory posted 24 #€iz ti n rime(hGr .tnrafer=ch i ; '; C O NAk .. 0 A Approved sanitizeravailable/adequate concentration ofsanitizer 4 Ad `fac►ilties`to rtxtat product B Food-contact surfaces and utensils used for potentially tert5peratitre,ttTerltldrrtsrs`�prltde " hazardous food sanitized at least every 4 hours tea. o� ._= n `_ A Food thermometer available and accurate C Adequate ❑dishwashersanitizerAin-al rinse temp D Proper sanitizin procedure B Proper food thermometerfor product E Sanitizing between raw animal origin&ready-to-eat food C Thermometers appropriately placed in cooler units 0 pittv 7 R6od protected doling stag ,`i ' jo display,servr A ce add transportation 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/sneeze guard Z I VIB Single use gloves changed when soiled E No unauthorized personnel C Food—contact surfaces clean F No pooling of eggs not cooked immediately 0 8 Food containers stored off the floor 9 Handling&food tntnirnized A No unnecessary handling RTE and/or cooked foods with bare hands A Soap/paper towels/'drying device available B Dispenser(s)working: []Soap ❑Papertowel 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 worker from working: Are internal cooking temperatures taken? Y N *To what tem do you cook: Poultry Ground Beef Pork What diseases related to FB illness are you required t e local health department? Roasts Other Describe re-heating procedures: Is there a written illness polic squires the food worker to report specific illness conditions Are temperatures recorded/logged for holding foods/equipment? Y N and diseases to th Y N *Do you have a paid sick leave policy? Y N Are foods cooked in advanpKnd cooled? Y N *Are leftovers saved? Y N Is a language barrier between inspector&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 oling methods: Indicate who answered the above questions: Name(print): � QCAA K0! {A,-n Indicate the title of above person(circle all that apply):CFO DA Mgr Cook Owner FW Is cooling monitored for time&temp? Y N Is the monitoring of cooling recorded? Y N .Obtain signature of he person who recQiyed tres onsibilities 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 .i Establishment: Date of Inspection: / t Ro o;-_ak Owner or Op or: ADDITIONAL FOUR POINT ITEMS o' KEY: DNC [DOES NOT COMPLY] 6 Foods not re-served. 4 31 Sewage disposal approved. -Unwrapped foods not re-served -Operating as required 4 -Potentially hazardous foods not re-served No cross connections,back siphonage,backflow 11 Toxic chemicals.-Stored properly,labeled properly,used properly Proper type/installation/backflow prevention device/air as for: � "-Sanitizer concentration not to exceed maximum permitted -Food equipment -Hose connections -Dish machines-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 -Well/well head protected from contamination 35 Toilet facilities. Adequate,convenient,accessible, -Water quality in compliance designed,properly installed -Monitoring in compliance OTHER ITEMS KEY: DNC [DOES NOT COMPLY] 2 Sources of food:Original container,properly labeled 401 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 Outer openings 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 Nonfood-contact surfaces designed,constructed,maintained, 7 Mats removable,good repair,clean installed,located 8 Exterior walking,driving surfaces,good repair,clean 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, 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 27 Nonfood-contact surfaces of utensils&equipment clean 55 Establishment and premises free of litter,no insect/rodent harborage, 28 Equipment/utensils,stnrage,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 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 Propertoiletfixturesprnvided,good repair,clean entrap s),smoking area indicated by sign(s) 39 Approved garbage/rubbish containers,adequate number,covered, rodent proof,clean outine Inspection ❑Reinspection ❑ Preoperational Inspection Other Inspection: I PE T R: PERSON IN CHARGE: Demerit Score: *Include demerits from page 1 4 3 2 1 Total Rating si na ure ignature � � � :Z0 print name print name 00 �O i DATE CORRECTIONS DUE: phone number title Page 2 of 2 plus continuation pages Focused Iuspeehun inooz Page 3 of',3 INSPEeTION REPORT STATE OF eONNEeTICUT FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH CONTINUATION SHEET NAME OF ESTABLISHMENT TOWN DATE OF INSPECTION fly. S, uji j ";"3 !3 INSPECTION REMARKS FORM# �C ►�, low o 04&�, I (0 IS �<6 iv, sari CNOck �, �" o- rah n �+ZXw 1972 Ili v INITIAL(INSPECTOR) INITIAL(PERSON IN CHARGE) Distribution: 1st-White-Health Department 2nd-Yellow-Owner/Manager