HomeMy WebLinkAboutFood Service Establishment Inspection 85 (12) i
Establishment: Inspection Date: Time: Roins REinsp
I Hea ept:ddresslCity: class: 2 ;
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/O NIA DNC KEY: C[complies] N/0[not observed] NIA[not applicable]
3 DNC[does not comply] 0[other] RTE[ready-to-eat]
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A Food workers have no exposed infected lesions I burns
B Personnel with infection restricted
C Communicable disease of worker reported to local health director
A Approved shellfish,finfish,meat&poultry USDA approved I "'I' i - r_vim
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) C Handwash facilities accessible/convenient to use
E Potentially hazardous foods received at proper temperature D Personnel hands washed,clean I Proper handwash procedure
E Handwashing at appropriate times
0
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Hot holding greater than or equal to 140oF. (whole beef/pork roasts taoo r.) A No ea n ❑ No smoking while working
B Cold holding less than or equal to 450 F. B nds covered adequately
Proper cooling C Proper sink used for handwashing
D Proper re-heating 0
E Proper internal cooking I consumer advisory posted
A Approved sanitizer available/adequate concentration ofsanitizer
B Food-contact surfaces and utensils used for potentially
hazardous food sanitized at least every 4 hours
A Food thermometer available and accurate C Adequate ❑dishwashersanitizer Mal rinse temp
B Proper food thermometer for product D Proper sanitizing procedure
E Sanitizing between raw animal origin&ready-to-eat food
0
C T Produce washed Thermometers appropriately placed in cooler units
0
A Cloths and/or sponges in good repair and clean
B Wiping cloths kept in sanitizer between uses
A
o
0
B Raw meats not stored/prepared near ready-to-eat foods
C Food covered properly OPENS
A Food equipment clean,utensils clean,equipment interirs 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
8 Food containers stored off the floor
No unnecessary handling RTE and/or cooked foods with bare hands A Soap/paper towels I 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 afiematej,PHF[potentially hazardous food],FB[foodbome]
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&CFO? Y N If Yes 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):
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
[where:
ere a produce washing policy? Y N *Describe what is washed and inspection:
Note: This report is a two page form(total of 62 debitable items) Page 1 of 2
Establishment: Date of Inspection: ' O "')'V
Address: '.r IJL/ Owner or Operator:
ADDITIONAL FOUR POINT ITEMS KEY: DNC [DOES NOT COMPLY] z`
6 Foods not re-served.
-Unwrapped foods not re-served 4 31 Sewage disposal approved. 4
-Operating as required
-Potentially hazardous foods not re-served 37 y
11 Toxic chemicals. No cross connections,back siphonage,backflow
-Stored properly,labeled properly,used properly Proper type/installation/backflow_prevention device/air g�for:
-Food equipment -Hose connections -Dish machines
-Sanitizer concentration notto 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 in compliance designed,properly installed
OTHER ITEMS KEY: DNC [DOES NOT COMPLY]
2 Sources of food:Original container,properly labeled 0 Garbage/rubbish storagearea/rooms,enclosures-properly constructed,clean
5 Potentially hazardous food properly thawed 1 Garbage/rubbish disposed of in an approved manner,at approved frequency
10 Food dispensing utensils properly stored 2 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, 45 Floors graded,drained as required
located
6 Floor,wall juncture covered
1 Nonfood-contact surfaces designed,constructed, maintained, 47 Mats removable,good repair,clean
installed,located
8 Exterior walking,driving surfaces,good repair,clean
13 Single service articles,storage,dispensing
19 No reuse of single service article 9 alls,ceilings attached,equipment properly constructed,good
repair,clean.Wall&ceiling surfaces as required
0' Dishwashing facilities approved design,adequately constructed,
maintained installed located 5(f 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
271 Nonfood-contact surfaces of utensils&equipment clean
55 Establishment and premises free of litter,no insect/rodent harborage,
28 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
58 No live birds,turtles,or other animals(except guide dogs)
36 Toilet rooms enclosed with self-closing door
59 Seats 75 or more:Nonsmoking area provided,sign(s)posted at
37 Proper toilet fixtures provided,good repair,clean entrance(s),smoking area indicated by sign(s)
39 Approved garbage/rubbish containers,adequate number,c
rodent proof,clean J R'butine Inspection ❑Reinspection ❑ Preoperational Inspection
I PE E: Other Inspection:
Demerit Score: *Include demerits from page 1
4 3 2 1 Total Rating
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pri t name print name 114—
�'/ ��l/ DATE CORRECTIONS DUE:
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..P bW�� RV4 Page 2 of 2 plus continuation pages Focused Inspection 1/2002
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INSPECTION REPORT STATE OF CONNECTICUT
FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH
CONTINUATION SHEET
NAME OF ESTABLISHMENT TOWN DATE OF INSP CTION
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INSPECTION REMARKS
FORM
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INITIAL(INSPECTOR) INITIAL(PERSON IN CHARGE)
Distribution: Ist-White-Health Department 2nd-Yellow-Owner/Manager
Page_j of
INSPECTION REPORT STATE OF CONNECTICUT
FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH
CONTINUATION SHEET
NAME OF ESTABLISHMENT TOWN DATE OF INSPE TION
INSPECTION FORM# REMARKS
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INITIAL(INSPECTOR) INITIAL(PERSON IN CHARGE)
Distribution: 1st-White-Health Department 2nd-Yellow-Owner/Manager
EHS-106-Rev.06101 INSPECTION REPORT STATE OF CONNECTICUT 13 ROUTINE INSPECTION N
FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH 13 PREOPERATIONAL O OTHER
410 Capitol Avenue,MS#51 FDP,Hartford,CT 06134
NAME OF ESTABLISHMENT
ESTABLISHMENT �� I C A l W1 CLASS
STREET =w TOWN t �ADDRESS SLJ 11,)ti,, A,, r W"kcAl /
OWNER or (I INSPECTION
OPERATOR �V) DATE and TIME ( 67 3
Based on an inspection this day,the 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 I VERMIN CONTROL
1 .Approved source,wholesome, 4 21 Preflushed,scraped,soaked and racked 42 Presence of insects/rodents 2
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 25 Clean wiping cloths 1 FLOORS,WALLS&CEILINGS
3 Potentially hazardous food meets 4 26 Food-contact surfaces of utensils& 2 44 Floors:floor covering installed,
temperature requirements during storage, equipment clean constructed as required,good repair,clean
preparation,display,service,and
transportation -27 Nonfood-contact surfaces of utensils& 1 45 Floors,graded,drained as required 1
equipment clean 46 Floor,wall juncture covered
4 Adequate facilities to maintain product 2 28 1 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 49 Walls,ceilings attached,equipment properly 1
7 Food protected during storage,preparation, 30 Hot and cold water under pressure, 2 constructed,good repair,clean. Wall&ceiling
display,service&transportation provided as required surfaces as required.
8 Food containers stored off floor 50 Dustless cleaning methods used, 1
SEWAGE DISPOSAL cleaning equipment properly stored
andling of food minimized 31 Sewage disposal approved 4
Food dispensing utensils properly stored 32 Proper disposal of wastewater 1 LIGHTING&VENTILATION
F11Toxic items properly stored,labeled,used 4 51 Adequate lighting provided as required 1
PLUMBING 52 Room free of steam,smoke odors 1
PERSONNEL 33 Location,installation,maintenance 1 53 Room&equipment hoods,ducts,vented as required
12 Personnel with infection restricted 4 FM No cross connection,bads siphonage,badcflow 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 1 Establishment and premises free of litter,no 1
EQUIPMENT&UTENSILS: DESIGN, HANDWASHING FACILITIES insect/rodent harborage,no unnecessary articles
CONSTRUCTION&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 GARBAGE/RUBBISH 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 Seats 75 or more:Nonsmoking area provided, 3
constructed,maintained,installed,located properly constructed,clean sign(s)posted at entrance(s),smoking area
L1 indicated by sign(s)
41 Garbage disposed of in an approved manner,
at approved frequency 1 D FOOD OPERATOR
DEMERIT SCORE 60 ifled Food Operator 3
4 3,p 2 1� RISK FACTOR VIOLATIONS IN D esignated alternate 2
tJ 2 Written documentation of training program 2
Signature of Person in charge
TOTAL RATING Date Corrections Due
SIGN p(Inspe afp
DESCRIBE DE CIENCIES ON CONTINUATION SHEETS
Page o
INSPECTION REPORT STATE OF CONNECTICUT
FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH
CONTINUATION SHEET
NAME OF ESTABLISHMENT TOWN DATE O INSPECTION
INSPECTION FORM# REMARKS
Y1 �
717
INITIAL(INSPECTOR) INITIAL(PERSON R E)
Distribution: 1st-White-Health Department 2nd-Ye ow-Owner/Manager