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HomeMy WebLinkAboutFood Service Establishment Inspection 60 (7) Establishment: Inspection Date: 7 Time: It in REinsp Address/City: Health Dept: �j 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 WO I N/A JDNC I KEY: C[complies] N/0[not observed] NIA[not applicable] 6®, Q9al ed�90d Q"Ono r " 3 DNC[does not comply] 0[other] RTE[ready-to-eat] 12 ,I ersir'trrsel with infect-lon restricted 61 Designated Alternate _ 2 C N/0 N/A 4 62 Written documentation of training program 2 A Food workers have no exposed infected lesions/burns B Personnel with infection restricted i Approved source,wholesome,r)onadulterated C 4t0 IA 4 C Communicable disease of worker reported to local health director B o Approved shellfish,ellfidcon condition son(not a poultry USDAa roved 13 Handwashingfaailidesprovided,hands washed,clean C N10 N/A 4'' B Food cans in good condition(not dented,rusty,bloated,leaking) A Handwash facilities in all food prep/dispensing&warewash areas C Wholesome/nonadulterated foods/safe B Handwash facilities in or immediately adjacent to toilet room 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 E Handwashing at appropriate times 3 Potentiall ardoas fr©daneats,tompokatyre requie�pta [ p '} 0 dwring sforage,preparat10 ,dfspfay,s®rnice and t nsportattaI[ 15 Good tryg�enlii practices C N/0 WA 2' A Hot holding greater than or equal to 1400F. (whole beef/pork roasts lsoo 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 I consumer advisory posted 0 A Approved sanitizeravailable/adequate concentration of sanitizer d, Adtaqu ' icrt'leeuto rttin u+pt - B Food-contact surfaces and utensils used for potentially temperature,trrrtorneters,�prbvtde# ,�( � � 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 L Pro ersa itizinq procedure E Sanitizing between raw animal origin&ready-to-eat food C Thermometers appropriately placed in cooler units 0 0 7" odd protect d'd rf g st ra e;p epara on; C i 0`MA, 1 misplay,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 A Food equipment clean,utensils clean,equipment interiors clean D Adequate splash guards/sneeze guard 14 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 - 0 9 Handling of food rein#Enized .� A No unnecessary handling RTE and/or cooked foods with bare hands A Soap I 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 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 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 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 Iflf ves 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 Indicate the title of above person(circle all that apply):QFO 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: Not.: This report is a two page form(total of 62 debitable it Page 1 of 2 Establish ent: . Date of Inspection: 0 �m ddress: 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 machines 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 desi ned, ro erl installed -Monitoring in compliance g p p y 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 2 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 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 50 Dustless cleaning methods used,cleaning equipment properlystored 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, uipmentlutensils,storage,handling no unnecessary articles 32 Proper disposal of wastewater 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 581 No live birds,turtles,or other animals(except guide dogs) 37 Proper toilet fixtures provided,good repair,clean 59 Seats 75 or more:Nonsmoking area provided,sign(s)posted at entrance(s),smoking area indicated by sign(s) 39 Approved garbage/rubbish containers,adequate number,covered, rodent proof,clean ❑Routine Inspection ❑Reinspection ❑ Preoperational Inspection Other Inspection: INSPECTOR: P H E: Demerit Score: *Include demerits from page 1 A7C�a� 4 3 2 1 Total Rating VC&X ure � s VI ® I C of print name nt name phonet, 14 ,0acle J , number title DATE CORRECTIONS DUE: -ate Page 2 of 2 plus continuation pages Focused Inspection 1/2002 M Page c INSPECTION REPORT STATE OF CONNECTICUT FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH CONTINUATION SHEET NAME OF ESTABLISHMENT DATE OF INSPECTION 7L,�, INSPECTION FORM# REMARKS 4 � \ Z INITIAL(INSPECTOR) INITIAL(PERSON IN CHARGE kj5xq Distribution: 1st-White-Health Department 2nd-Yellow-Owner/Manager