HomeMy WebLinkAboutFood Service Establishment Inspection 17 (21) Establishment: Inspection Date: Time: fi, �,n, REinsp
ddress/City: l� i� Health ept: (.s class: � z
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 debatable items C N/0 N/A DNC KEY: C[complies] N/O[not observed] N/A[not applicable]
Qualified Food Operator DNC[does not comply] 0[other] RTE[ready-to-eat]
61 Designated Alternate 12 Personnel with infection restricted(10111110 C N/t7 N/A 4<
62 Written documentation of training program 2 A Food workers have no exposed infected lesions/burns i Approved source,wholesome,nonadttitera#etl C NJO N/A 4 B Personnel with infection restricted
C Communicable disease of worker reported to local health director
B o roved shellfish,condition
meat&dented,
USDA approved 13 Hand washing facilities provided,hands washed,clean C N/0 N/A 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
D Commercial products(no home grown/canned food) B Handwash facilities in or immediately adjacent to toilet rooms
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
Potentially hazardous food meets temperature requirements C NO N/ 0
during storage,preparation,display,service and transportation!
Good hygienic practices C NI0 N/A
A Hot holding greater than or equal to 140°F. (Whole beef/pork roasts 1300 F) A e ❑ No smoking while working
PCold holding less than or equal to 45°F. 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 24 Sanitization rinse(hot water chemical) C N10'' N/A 2
0 A Approvedsanitizeravailable/adequate concentration ofsanitizer
4 Adequate facilities to maintain product C N/0 WA 2 B Food-contact surfacesde edoentially
temperature,thermometers provided hazardous food sanitized at least every 4 hours
A Food thermometer available and accurate C Adequate ❑tlishwashersanitizer final rinse
B Properfood 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
7 Food protected during storage,preparation, C WO N/A 2' 25 Clean wiping cloths C N/0 N/A 1
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 26 Food-contact surfaces clean C WO WA_ 2
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
F No pooling of eggs not cooked immediately C Food-contact surfaces clean
0
8 Food containers stored off the floor 36 Hot and cold water under pressure,provided as required 0 WA 2
38" Harrdwashing accessories provided C N/0 N/A 1
Handling of food minimized; C N/0' N/A
A No unnecessary handling RTE and/orcooked 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 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 alternate],PHF[potentially hazardous food], FB[foodborne]
PHFs are hot held at: IF. 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 Roasts Other What diseases related to FB illness are you required to report to the local health department?
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 CFO? 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 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):
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):CFO DA Mgr Cook Owner FW
•Obtain signature of the person who received the CFO 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
! Dete�fi lnspecfion.
cuss } Owner ,or Qperatflr:
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
4 Proper type/installation/backflow prevention device/air gap for: 4-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. 4; -Food equipment -Dish machines -Ice machines
-Well/well head protected from contamination-Water quality in compliance 35 Toilet facilities. Adequate,convenient,accessible, 4
-Monitoring in compliance designed,properly installed
OTHER ITEMS KEY: DNC [DOES NOT COMPLY]
2 Sources of food: Original container,properly labeled 1 0 Garbage/rubbish storage area/rooms,enclosures-properly constructed,clean
,1
5 Potentially hazardous food properly thawed 2 41 Garbage/rubbish disposed of in an approved manner,at approved frequency
10 Food dispensing utensils properly stored 1 42 Vermin Control: No insects/rodents present 2
14 Food worker:Clean outer clothes,effective hair restraints 43 Outer openings protected againstentrance of insects/rodents 1
4 Floors: Floor covering installed,constructed as required,good repair,clean 1
16 Food-contact surfaces designed,constructed, maintained,installed, 2 45 Floors graded,drained as required
located
6 Floor,wall juncture covered
17 Nonfood-contact surfaces designed,constructed,maintained, 1
7 Mats removable,good repair,clean
installed,located
18 Single service articles,storage,dispensing 2 8 Exterior walking,driving surfaces,good repair,clean 1
19 No reuse of single service article 49 Walls,ceilings attached,equipment properly constructed,good 1
20 Dishwashing facilities approved design,adequately constructed, 2 repair,clean.Wall&ceiling surfaces as required
maintained,installed located 50 Dustless cleaning methods used,cleaning equipment properly stored 1
EEquipment&Utensils: Cleanliness 2 51 Adequate lighting provided as required 1
21 Preflushed,scraped,soaked and racked 52 Room free of steam,smoke odors 1
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 1
onfood-contact surfaces of utensils&equipment clean
55 Establishment and premises free of litter,no insect/rodent harborage, i
28 Equipment/utensils,storage,handling 1 no unnecessary articles
32 Proper disposal of waste water 1 56 Complete separation from living/sleeping quarters and laundry 1
33 Plumbing location,installation,maintenance 1 57 Clean/soiled linens stored properly 1
36 Toilet rooms enclosed with self-closing door t
58 No live birds,turtles,or other animals(except guide dogs) = 1
37 Propertoilet fixtures provided,good repair,clean
59 Seats 75 or more:Nonsmoking area provided,sign(s)posted at 3
entrance(s),smoking area indicated by sign(s)
39 Approved garbage/rubbish containers,adequate number,covered, 1,
rodent proof,cleanffRoutine Inspection ❑Reinspection ❑ Preoperational Inspection
INSPECTOR: PERSON IN CHARGE: Other Inspection:
Demerit Score: *Include demerits from page 1
4 3 2 1 Total Rating
si ature � ign
print name 'n ame
y ^� v 3Z Co
phone number {� t DATE CORREC DUE:
Page 2 of 2 plus continuation pages Focused Inspection 1Q002
Page
of
INSPECTION REPORT STATE OF CONNECTICUT
FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH
CONTINUATION SHEET
NAME OF ESTABLISHMENT TOWN DATE OF IN PECTI
OIX
INSPECTION
FORM# REMARKS
CS6(
*311
U`� C 6
INITIAL(INSPECTOR) INITIAL(PERSON IN CHARGE
Distribution: 1st-White-Health Department 2nd-Yellow-Owner/ anager
EHS-106-Rev.06101 INSPECTION REPORT STATE OF CONNECTICUT
FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH El ROUTINE INSPECTION -4*-
TINSPECTION
L 410 Capitol Avenue,MS#51 FDP,Hartford,CT 06134 ❑ PREOPERATIONAL ❑ OTHER
NAME OF
ESTABLISHMENT ESTABLISHMENT le
STREET CLASS
ADDRESS TOWN � ff
OWNER or `"�/ ✓�
OPERATOR INSPECTION
DATE and TIME w
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 VERMIN CONTROL
1 Approved source,wholesome, 4 J24Sanitization
Preflushed,scraped,soaked and racked
nonadulterated 42 Presence of insects/rodents 2
Wash water clean,proper temperature 1 43 Outer openings protected against entrance of 1
2 Original container,properly labeled 1 Accurate thermometers provided,dish basket,if used insects/rodents
rinse(hot water-chemical) 2FOOD PROTECTION Clean wiping cloths 1
FLOORS,WALLS&CEILINGS
3 Potentially hazardous food meets 4 26 Food-contact surfaces of utensils& 2
temperature requirements duringstorage, 44 Floors:floor covering installed,
9 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
equipment clean 46 Floor,wall juncture covered 1
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
6 Unwrapped or potentially hazardous food 48 Exterior walking,driving surfaces, 1
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 2
50 Dustless cleaning methods used, T
SEWAGE DISPOSAL cleaning equipment properly stored
9 Handling of food minimized 2 31 Sewage disposal approved 4
10 Food dispensing utensils properly stored 1 32 Proper disposal of waste water 1
11 Toxic items properly stored,labeled,used LIGHTING&VENTILATION
4 51 Adequate lighting provided as required 1
PLUMBING 52 Room free of steam,smoke odors
PERSONNEL 33 Location,installation,maintenance 1 53 Room&equipment hods,ducts,vented as required 1 12 Personnel with infection restricted 4 34 No cross connection,back siphonage,backflow 4
CLEANLINESS OF PERSONNEL TOILET FACILITIES DRESSING ROOMS&LOCKERS54 Rooms adequate,clean,adequate lockers 1
[14
Handwashing facilities provided, 4 35 Adequate,convenient,accessible,designed, 4 provided,facilities clean
personnel hands washed clean installed
Clean outer clothes,effective hair restraints 1 36 Toilet rooms enclosed with self-closing door
Good hygienic practices,smoking restricted 2 37 Proper fixtures provided,good repair,clean 1
HOUSEKEEPING
tter,no
EQUIPMENT&UTENSILS: DESIGN, HANDWASHING FACILITIES T57ean
ent Establishmentharborrage,,Establishment and Inounneceses free ofssaryarticles 1
CONSTRUCTION&INSTALLATION 38 Suitable hand cleaner and sanitary towels or 1 separation from living/sleeping quarters 1
16 Food-contact surfaces designed,constructed, 2 approved hand drying devices provided, ry
maintained,installed,located tissue waste receptacles provided
17 Nonfood-contact surfaces designed, 1 Cled linens stored properly 1
constructed,maintained,installed,located 58 No live birds,turtles,or other animals 1
GARBAGEIRUBBISHI 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
20 Dishwashing facilities approved design,adequately 2 40 Storage area/rooms,enclosures— NONSMOKING AREAS
constructed,maintained,installed,located 59 Seats 77ormore:Nonsmoking area provided, 3
properly constructed,clean sign(s)pat entrance(s),smoking area
1 indicate
41 Garbage disposed of in an approved manner,
at approved frequency QUALIFIED FOOD OPERATOR
DEMERIT SCORE 2 60 Qualified Food Operator 3
4 RISK FACTOR VIOLATIONS IN RED
61 Designated alternate 2
(� 62 Written documentation of training program 2
TOTAL RATING Date Corrections Due Signature of Person i harge
`, SIGNED(Insp
DESCRIBE DE CIENCIES ON CONTINUATI N SHEETS
I av
Page of
INSPECTION REPORT STATE OF CONNECTICUT
FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH
CONTINUATION SHEET
NAME OF ESTABLISHMENT TOWN DATE OF INSPECTION
,fR4,S S-��k
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v v
INSPECTION
FORM# REMARKS
W� x�G
1
INITIAL(INSPECTOR) INITIAL(PERSON IN CHARGE)
Distribution: 1 st-White-Health Department 2nd-Yellow-Owner/Manager