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HomeMy WebLinkAboutFood Service Establishment Inspection 17 (11) Establishment: c Inspection Date: - 1-14 Time: ROinsp Einsp Address/City: 3 r Ell YL� Health ep , class: 1 2 4 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 /A IDNC ( -F -4 4®ldtbta `, $ DNC[does not comply] 0[other] RTE[ready-to-eat] t2 4ftb net With infection restrioted C A 4 61 Qesignated Alternate2 q Food workers have no exposed infected lesions I burns 100, 62 Written d©CtJrrtett#atitt of training program2 B Personnel with infection restricted 1 Approved source,wholesome,nonadultended C 11/0 N/A 4 C Communicable disease of worker reported to local health director A Approved shellfish,finfish,meat&poultry USDA approved 13 Handwashingfacilities provided,hands washedclean C N1 4 B Food cans in good condition(not dented,rusty,bloated,leaking) LA Handwash facilities in all food prep/dispensing&warewash areas C Wholesomelnonadulteratedfoodslsafe 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 3 Potentietlyy hasardous faod,eteets temperature tegt tents C N 4. O during sEorags,preparation,dtspi�y,"servic2.and trah portatf i 15 flood hygienic practices C NO AA 2 A Hot holding greater than or equal to 1400F. (whole beef/pork roasts tsoo 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 2eL I&A, ot1 x c r E Proper internal cooking/consumer advisory posted � lh grater,'cue �C N(0F 2' 0 A Approvedsanitizer available/adequate concentration ofsanitizer 4 Adequate feclifYes to fnatrttaio pr6duct B Food-contact surfaces and utensils used for potentially temperature,thermometers provided 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 Proper sanitizin rocedure E Sanitizing between raw animal origin&ready-to-eat food C Thermometers appropriately placed in cooler units 0 Q 7 F000 proteocidring` tot`age;pie}ia � ,k.. Jay,service and transportation A Cloths and/or sponges in good repair and clean A Produce washed B Wiping cloths kept in sanitizer between uses 10 B Raw meats not stored/prepared near ready-to-eat foods ZN C Food covered properly A Food equipment clean,utensils clean equipment interiors clean D Adequate splash guards/sneeze guard g Single use gloves changed when soiled E No unauthorized personnel C Food--contact surfaces clean F No pooling of eggs not cooked immediately 0 Food containers stored off the floor • ; tggf r 0 . ttce1b@$, t�teid, C 9 Hatodting of{Dori riiidd 2" 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 C Adequate utensils)for dispensing food/ice 110- 0 O •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 temperature do you cook: Poultry Ground Beef Pork What diseases related to FB illness are you required to report to the local health department? Roasts Other Describe re-heating procedures: Is there a written illness policy that re 'es the food worker to report ness conditions Are temperatures recorded/logged for cold holding foods/equipment? Y N and diseases to the QF *Do you have a pa' ' eave policy? Y N Are foods cooked in advance and cooled? Y N *Are leftovers saved? Y N . Is then guage barrier between inspector& . Y N 11-M indicate language spoken List products cooled: y QFO/DA: ♦ an the QFO/DA read the inspection report? 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 the person who received the QFO responsibilities information at the time of the s there a produce washing policy? Y N *Describe what is washed and rIwhere: inspection: Note: This report is a two page form(total of 62 debitable items) Page 1 of 2 } IM Establishment: �r Date of Inspection: Owner 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. -Potentiallyhazardous foods not re-served -Operating as required No cross connections,back siphonage,backflow 11 Toxic chemicals. a Proper typetinstallation/backflow prevention device/air gap for: -Stored properly,labeled properly,used properly -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 -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 -Monitoring incompliance designed,properly installed 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 3 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, 5 Floors graded,drained as required located 6 Floor,wall juncture covered 17 Nonfood-contact surfaces designed,constructed,maintained, 7 Mats removable,good re clean installed,located g repair, 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 j 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, 8 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 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 Propertoiletfixturesprovlded,good repair,clean entrance(s),smoking area indicated by sign(s) 39 Approved garbage/rubbish containers,adequate number,covered, rodent proof,clean ❑Routine Inspection IF430weinspection ❑ Preoperational Inspection Other Inspection: E R N IN R Demerit Score: *Include demerits from page 1 A, Q 4 3 2 1 Total Rating s' n ture signature 4�c _"S I A tv Z_/ print name print name t1Y u f� t phone number title DATE CORRECTIONS DUE: Page 2 of 2 plus continuation pages Focused Inspection 1/2002 y Page of ENSP-EeTIONREPORT STATE OF TONNE.CTICUT FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH CONTINUATION SHEET NAME OF EST LISHMENT TOWNj( DATE OF INSP CTION 4PEON REMARKS FORM# 4A ci iko s r-� O � f crr t Cr LAJ&'/t� Sv fz 03 �✓,o L4ca/ Pi INITIAL(INSPECTOR) INITIAL(PERSON IN CHARGE) Distribution: 1st-White-Health Department 2nd-Yellow-Owner/Manager