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HomeMy WebLinkAboutFood Service Establishment Inspection 19 (8) � y Establishment: cl' A Inspection Date: Time: oins R Address/City: �,,,� Head ept: LV Ad(. Z '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 N/A JDNC I KEY: C[complies] N/O[not observed] NIA[not applicable] 60 Qualified Food Operator 3 DNC[does not comply] 0[other] RTE[ready-to-eat] 12 Personnel with infection restricted C NO NIA 4 61 Designated Alternate 2 A Food workers have no exposed infected lesions/burns 62 Written documentation of training program 2 B Personnel with infection restricted 1 Approved source,wholesome,nonadulterated C N10 N/A 4'" C Communicable disease of worker reported to local health director A I Approved shellfish,finfish,meat&poultry USDA approved 13 Handwashing facilities provided,hands washed,clean C WO NIA 4 B Food cans in good condition(not dented,rusty,bloated,leaking) A Handwash facilities in all food prep/dispensing&warewash areas C Wholesome/nonaduIterated foods/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/Proper handwash procedure E Handwashing at appropriate times Potentially hazardous food meets temperature requirements C N10 NIA 4' o during storage,preparation,display,service and transportation 15 Good hyglenic,practices C WO NIA 2 A Hot holding greater than or equal to 1400F. (whole beef/pork roasts 1300 F.) A ❑ No eating ❑ No smoking while working B Cold holding less than or equal to 450 F. B Wounds covered adequately C Proper cooling C I Proper sink used for handwashing D Proper re-heating 0 E Proper internal cooking/consumer advisory posted 24 Saniitizetion rinse(hot water-chemical) C WO NIA 2 0 1 A Approved sanitizeravailable/adequate concentration ofsanitizer 4 Adequate facilities to maintain product C NO N/A 2 B Food-contact surfaces and utensils used for potentially temperature,thermometers provided hazardous food sanitized at least every 4 hour A Food thermometer available and accurate I oe C Adequate ❑dishwashersanitizer Xnal rinse temp D Proper sanitizin rocedure B Proper food thermometer for product E Sanitizing between raw animal origin&ready-to-eat food C Thermometers appropriately placed in cooler units 0 25 Clean wiping cloths C NIO NIA 1 7 Food protected during storage,preparation, C N10 N/A display,service and transportation A Cloths and/or sponges in good repair and clean B Wiping cloths kept in sanitizer between uses A Produce washed 0 B Raw meats not stored/prepared near ready-to-eat foods 26 Food-contact surfaces clean C NIO NIA 2 C Food covered properly 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 8 Food containers stored off the floor Hot and cold water under pressure,provided as required C NO NIA 0 38 Handwashing accessories provided C NIO NIA 1 9 Handling of food minimized C A 2 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 ❑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 1 i -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 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 Essriient =. ! Date ©f inspe #f®nP dress{ -ft-nor or Qperator: 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 cross connections,back siphonage,backflow 4 11 Toxic chemicals. 4 15yroner type/installation/backflow prevention device/air gap for: -Stored properly,labeled properly,used properly -Food equipment -Hose connections -Dish machines -Sanitizer concentration not to 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. 4 -Food equipment -Dish machines -Ice machines -Well/well head protected from contamination 35 Toilet facilities. Adequate,convenient,accessible, 4 -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 1 Garbage/rubbish storage area/rooms,enclosures-properly constructed,clean 5 Potentially hazardous food properly thawed 2 ' Garbage/rubbish disposed of in an approved manner,at approved frequency 10 Food dispensing utensils properly stored 1 2 Vermin Control: No insects/rodents present 2 f 14 Food worker:Clean outer clothes,effective hair restraints i 3 uteropenings 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, 2 45 Floors graded,drained as required located 6 Floor,wall juncture covered 17 Nonfood-contact surfaces designed,constructed, maintained, 1 47 Mats removable,good repair,clean installed,located 1 18 Single service articles,storage,dispensing 2 Exterior walking,driving surfaces,good repair,clean 19 No reuse of single service article 9Malls,ceilings attached,equipment properly constructed,good 20 Dishwashing facilities approved design,adequately constructed, 2 repair,clean.Wall&ceiling surfaces as required , maintained installed located 5 Dustless cleaning methods used,cleaning equipment properly stored Equipment&Utensils: Cleanliness 1 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 i 7 Nonfood-contact surfaces of utensils&equipment clean 55 Establishment and premises free of litter,noinsect/rodentharborage, i Equipment/utensils,storage,handling 1 no unnecessary articles 32 Proper disposal of wastewater 1 56 Complete separation from living/sleeping quarters and laundry 1 33 Plumbing location,installation,maintenance 1 571 Clean/soiled linens stored properly 1 58 No live birds,turtles,or other animals(except guide dogs) 1 36 Toilet rooms enclosed with self-closing door 1 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) 3 Approved garbage/rubbish containers,adequate number,covered, rodent proof,clean6 ❑Routine Inspecti JiReins a on ❑ Preopera7 tional Inspection Other Inspection: INSPECTO I PERSON IN H E: Demerit Score: •Include demerits from page 1 4 3 2 1 Total Rating si ature ur ki e e PV, p int name , print name DATE CORRECTIONS DU phone number � i� title Page 2 of 2 plus continuation pages Focused Inspection 112002 I av PageRof INSPECTION REPORT STATE OF CONNECTICUT FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH CONTINUATION SHEET NAME OFIESTABLISHMENT TO DATE OF INSPECTI N Ott, INSPECTION REMARKS FORM# lq nfor-4c-, ��A/ clp�j�lr_/v 51� _4Ad)l c� -- bl_ � 1-7 knc� 7,rY 4�57hd Vi —A cy- INITIAL(INSPECTOR) INITIAL(PERSON IN CHARGE) Distribution: 1st-White-Health Department 2nd-Yellow-Owner/Manager r.f /Jrc , �L�_ , �JL, //y,If/,M -- � S►