HomeMy WebLinkAboutFood Service Establishment Inspection 15 (6) EHS-106-Rev.06/01 INSPECTION REPORT STATE OF CONNECTICUT b UTINE INSPECTION ❑ REINSPECTION
MOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH PREOPERATIONAL ❑ OTHER
410 Capitol Avenue,MS#51 FDP,Hartford,CT 06134
NAME OF ESTABLISHMENT
ESTABLISHMENT Pt GBS �K CLASS
STREET TOWN
ADDRESS 1 S � � sM
OWNER or n � ` INSPECTION
OPERATOR �� ,r-�Y,,,p DATE and TIME 13
Based on an inspection this day, items marked below identify the violations in operation or facilities which must be corrected by the date specified below.
SOURCES OF FOOD EQUIPMENT&UTENSILS:CLEANLINESS VERMIN CONTROL
1 Approved source,wholesome, 4 21 Preflushed,scraped,soaked and racked 42 Presence of insects/rodents
nonadulterated 22 Wash water clean,proper temperature 1 43 Outer openings protected against entrance of 1
2 Original container,properly labeled 1 23 Accurate thermometers provided,dish basket,if used insects/rodents
24 Sanitization rinse(hot water-chemical) 2
FOOD PROTECTION P Clean wiping cloths 1 FLOORS,WALLS&CEILINGS
3 Potentially hazardous food meets 4 26 Food-contact surfaces of utensils& U, 44 Floors:floor covering installed,
temperature requirements during storage, equipment clean constructed as required,good repair,clean
preparation,display,service,and 27 Nonfood-contact surfaces of utensils& 1 45 Floors,graded,drained as required
transportation equipment clean g1
46 Floor,wall juncture covered
4 Adequate facilities to maintain product 2 28 Equipment/utensils,storage,handling 1 47 Mats removable,good repair,clean
temperature,thermometers provided
5 Potentially hazardous food properly thawed 2 48 Exterior walking,driving surfaces, 1
6 Unwrapped or potentially hazardous food 4 WATER SUPPLY good repair,clean
not reserved 29 Water source adequate,safe 4 4 Walls,ceilings attached,equipment properly
7 Food protected during storage,preparation, 30 Hot and cold water under pressure, 2 constructed,good repair,clean. Wall&ceiling
display,service&transportation 2 provided as required surfaces as required.
8 Food containers stored off floor 50 Dustless cleaning methods used, 1
SEWAGE DISPOSAL I cleaning equipment properly stored
9 Handling of food minimized 2 31 Sewage disposal approved 4
10 Food dispensing utensils properly stored 1 32 1 Proper disposal of wastewater 1 aGHTING&VENTILATION
11 Toxic items properly stored,labeled,used 14 51 Adequate lighting q g g provided as required
PLUMBING 52 Room free of steam,smoke odors 1
PERSONNEL 33 Location,installation,maintenance 1 53 Room&equipment hoods,ducts,vented as required
12 1 Personnel with infection restricted 14 34 No cross connection,back siphonage,backflow 4
DRESSING ROOMS&LOCKERS
CLEANLINESS OF PERSONNEL TOILET FACILITIES 54 Rooms adequate,clean,adequate lockers 1
13 Handwashing facilities provided, 4 35 Adequate,convenient,accessible,designed, 4 provided,facilities clean
personnel hands washed clean installed
14 Clean outer clothes,effective hair restraints 1 36 Toilet rooms enclosed with self-closing door 1
15 Good hygienic practices,smoking restricted 2 37 Proper fixtures provided,good repair,clean HOUSEKEEPING
55 Establishment and premises free of litter,no 1
EQUIPMENT&UTENSILS: DESIGN, HANDWASHING FACILITIES insect/rodent harborage,no unnecessary articles
NSTRUCTION &INSTALLATION 38 Suitable hand cleaner and sanitary towels or 1 56 Complete separation from living/sleeping quarters 1
16 Food-contact surfaces designed,constructed, 2 approved hand drying devices provided, and laundry
maintained,installed,located tissue waste receptacles provided
57 Clean/soiled linens stored properly 1
17 Nonfood-contact surfaces designed, 1 58 No live birds,turtles,or other animals 1
constructed,maintained,installed,located GARBAGEIRUBBISH STORAGE&DISPOSAL (except guide dogs)
18 Single service articles,storage,dispensing 2 39 Approved containers,adequate number, 1
19 No reuse of single service article covered,rodent proof,clean NONSMOKING AREAS
20 Dishwashing facilities approved design,adequately 2 40 Storage area/rooms,enclosures- 59 1 Seats 75 or more:Nonsmoking area provided, 3
constructed,maintained,installed,located properly constructed,clean sign(s)posted at entrance(s),smoking area
1 indicated by sign(s)
41 Garbage disposed of in an approved manner,
at approved frequency- QUALIFIED FOOD OPERATOR
DEMERIT SCORE F62
Qualified Food Operator34 (� 3 2 t 1 RISK FACTOR VIOLATIONS IN RED Designated alternate 2 Written documentation of training program 2
TOTAL RATING Date Corrections Due Signature of Person in charge
c�q �nor. -hj SIGNED(Inspect )
D SCRIBE DEFICIENCIES ON NTINUA ON SHEETS
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INSPECTION REPORT STATE OF CONNECTICUT
FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH
CONTINUATION SHEET
NAME IO�F ESTABLISHMENT TOWN DATE OF INSPECTION
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INSPECTION FORM# REMARKS
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INITIAL(INSPECTOR) <�, INITIAL(PERSON IN CHARGE)
Distribution: 1 st-White-Health Department 2nd-Yellow-Owner/Manager