HomeMy WebLinkAboutFood Service Establishment Inspection 60 (6) i
Establishment: Jp U Ins ection Date: (,%13 Time: ►/ REinsp
Address/City: r Ll4 ✓ Health Dept: ,ter) Class; 1 2
Based on an inspection this day,the[terns 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 debatable items C I N/O I N/A DNC I KEY: C[complies] N/O[not observed] N/A[not applicable]
' stied FopdQr ' * * n�$ k� 3 DNC[does not comply] 0[other] RTE[ready-to-eat]
a s. 1 _Fersoitlo�l r iftfeef orr-re�#a��eater_
6'1 D s atedi4tternate "— 2 C Q WA 4
62 Written documentation of tralnin ra am A Food workers have no exposed infected lesions/burns
9 p 2 B Personnel with infection restricted
1 Approved source,wholesome,nonadulterated C N/d NIA 4
C Communicable disease of worker reported to local health director
B o roved shellfish,condition
meat&poultry USDA approved 13 Han+ skiing f eil�ies provided,hands a d,ctearr C -0 NIA, 4 B Food cans in good condition(not dented,rusty,bloated,leaking)
C Wholesome/nonadulterated foods/safe
A Handwash facilities in all food prep/dispensing&warewash areas
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 —71
E Potentially hazardous foods received at proper temperature D Personnel hands washed,clean/Proper handwash procedure
0
E Handwashing at appropriate times
3 Potentially hazartloas foiad'meefs ternpeaa {e rear 4 0
tturing sterrage, f►alo iony'dioplay serrrice
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A Hot holding greater than or equal to 1400F. (whole beef/pork roasts 130e F.) A ❑ No eating ❑ No smoking while working
B Cold holding less than or equal to 450 F. All 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 n � '
0 .0 ( A Approved sanitizeravailable/adequateconcentrationofsanitizer
X,
4 Adequate facilities to rnatiA prcdt' G ,� a 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 Adequ di washersa er ❑final rinse temp
B Proper food thermometer for product D Proper sanitizin rocedure
C Thermometers appropriately placed in cooler units E Sanitizing between raw animal origin&ready-to-eat food
0 0
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display,service and transportation A Cloths and/or sponges in good repair and clean
A Produce washed B Wiping cloths kept in sanitizer between uses
B Raw meats not stored/prepared near ready-to-eat foods 0
C Food covered properly 11 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 O
8 Food containers stored off the floorF a��
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9 Haridting of food minimized V011
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A No unnecessary handling RTE and/or cooked foods with bare hands A Soap I 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 I waste receptacle at handwash sink
C Adequate utensil(s)for dispensing food/ice 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 aftemate],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 requires the food worker to report specific illness conditions
Are temperatures recorded/logged for cold holding foods/equipment? Y N and diseases to the QFO? Y N *Do you have a paid sick leave policy? Y N
Are foods cooked in advance and cooled? Y N *Are leftovers saved? Y N Is there a language barrier between inspector&QFO? Y N If yet indicate language spoken
List products cooled: by QFO/DA: *Can the QFO/DA read the inspection report? Y N
Describe cooling methods: Indicate who answered the above questions: Name(print):
Is cooling monitored for time&temp? Y N Is the monitoring of cooling recorded? Y N .ndicate the title of above person(circle all that apply):CFO DA Mgr Cook Owner FW
Obtain signature of the person who received 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 page form(total of 62 debitable items) Page 1 of 2
OEM25
Establishment: !' Date of Inspection:
ddress: J 1- ) 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. 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
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 machinesProper 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 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 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
18 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
ash water clean,proper temperature 53 Rooms&equipment hoods,ducts,vented as required
2 ccurate thermometers provided,dish basket,if used 541 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 Equipmentlutensils,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 Propertoiletfixturesprovirled,good repair,clean entrance(s),smoking area indicated by sign(s)
39 Approved garbagelrubbish containers,adequate number,covered,
rodent proof,clean outine Inspection ❑Reinspection ❑ Preoperational Inspection
Other Inspection:
INSPECTOR: �PEIRSON IN CHARGE: Demerit Score: *Include demerits from page 1
U� 4 3 2 1 Total Rating
si ture signature _
hams t S
print name print name
phone number title CORRECTIONS DUE:
Page 2 of 2 plus continuation pages Focused Inspection 1/2002
Page-3 of
INSPECTION REPORT STATE OF CONNECTICUT
FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH
CONTINUATION SHEET
NAME OF ESTABLISHMENT TOWN DATE OF NSPE TION
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INITIAL(INSPECTOR) INITIAL(PERSON IN CHAR
Distribution: 1 s - ite-Health Department 2nd-Yellow-Owner/Manager