HomeMy WebLinkAboutFood Service Establishment Inspection 65 (7) i
Establishment: Le, 3 Inspection Date: Tim : ROin p RE[nsp
Address/City:t'�S l ,('J'h'1'11' Health Not: '�, ,��yUl-)I class: 1 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 I N/0 I N/A DNC I tom: C[complies] N/O[not observed] NIA[not applicable]
60 Quatifled Food Operator 3 DNC[does not comply] 0[other] RTE[ready-to-eat]
61 Designated Alternate 2 12 Personnel with infection restricted C WO N/A 4
62 Written documentation of training program 2 A Food workers have no exposed infected lesions/burns 1 Approved source,wholesome,nonaduttera#ed C N/0 NIA 4 B Personnel with infection restrictedC Communicable disease of worker reported to local health director
A Approved shellfish,finfish,meat&poultry USDA approved 13 Handwashing facilities provided,hands washed,clean' C
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 I
N/0 N/A 4
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
0 D Personnel hands washed,clean/Proper handwash procedure
E Handwashing at appropriate times
3 Potentially hazardous food meets temperature requirements C WO N/A 4 0
during storage,preparation,display,service and transportation'
15 Good hygienic practices C N/0' N/A 2
A Hot holding greater than or equal to 140°F. (whole beef/pork roasts 1300 F.) A El NO eating ❑ No smoking while working
B Cold holding less than or equal to 450 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 4 unitization rinse(hot water-chemical) C JWONIAg
0 Approved sanitizer available/adequate concentration of sanitizer
4 Adequate facilities to maintain product C N10 N/A 2 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 Adequate �dishwashersanitizer ❑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
7 Food protected during storage, 25 Glean wiping cloths C WO N/A
p g 9 ,preparation, C,N� N/A
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 ood-contact surfaces clean
C Food covered properly C N/A
D Adequate splash guards/sneeze guard A Food equipment clean,utensils clean,equipment interiors clean
E No unauthorized personnel B ; Single use gloves changed when-soiled
F No pooling of eggs not cooked immediately C Food--contact surfaces clean
0
Food containers stored off the floor 30 Hot and cold water under pressure,provided as required N/0'N/A 2
0 35 Handwasbing accessories provided C N/0 WA 1 9 Handling of food minimized' C N/0 WA 2
A No unnecessary handling RTE and/or cooked foods with bare hands A Soap/paper towels/ drying device available
B Minimize food handling,other than ready-to-eat,with bare hands B Dispenser(s)working: ❑Soap ❑Paper towel
C Adequate utensil(s)for dispensing food/ice
C Handwash sink(s)clean/waste receptacle at handwash sink
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[foodbornej
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 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 oAre leftovers saved? Y N Is there a language barrier between inspector&QFO? Y N If 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:
Note: This report is a two page form(total of 62 debitable items) Page t of 2
�s#alhtt° �S Date flf Itspction'
ttdrss t' Ovurer or Operate
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
34 No cross connections back si hona a backflow
11 Toxic chemicals. � p g � 4
-Stored properly,labeled properly,used properly 4 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, 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 40 Garbage/rubbish storagearea/rooms,enclosures-properly constructed,clean l
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 1 43 Outer openings protected against entrance of insects/rodents _1
4 loors: Floor covering installed,constructed as required,good repair,clean
1 Food-contact surfaces designed,constructed,maintained,installed, 45 Floors graded,drained as required
located
6 Floor,walljuncture covered
7 Nonfood contact surfaces designed,constructed,maintained, 1 7 Mats removable,good repair,clean
installed,located
18 Single service articles,storage,dispensing 2
481 Exterior walking,driving surfaces,good repair,clean 1
19 No reuse of single service article 9 Walls,ceilings attached,equipment properly constructed,good 1
repair,clean.Wall&ceiling surfaces as required
ishwashing facilities approved design,adequately constructed,
maintained installed located 501 Dustless cleaning methods used,cleaning equipment properly stored 1
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 1
Nonfood-contact surfaces of utensils&equipment clean
55 Establishment and premises free of litter,no insect/rodent harborage, 1
28 Equipment/utensils,storage,handling 1 no unnecessary articles
32 Proper disposal of waste water 56 Complete separation from living/sleeping quarters and laundry 1
33 Plumbing location,installation,maintenance 1 57 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 toiletfixtures provided,good repair,clean entrance(s),smoking area indicated by sign(s)
39 Approved garbage/rubbish containers,adequate number,covered,
rodent proof,clean ❑Routine Inspection ❑Reinspection ❑ Preoperational Inspection
INSPECTOR: PERSPN IN CHARGE Other Inspection:
02A
r Demerit Score: •Include demerits from page 1
4 3 2 1 Total Rating
si ture signatgqre
l) S Ltli ('y�
print name print name
DATE CORRECTIONS DUE: y
phone number (� title
1k d1. 1 Page 2 of 2 plus continuation pages Focused Inspection 1/2002
Page J of
INSPECTION REPORT STATE OF CONNECTICUT
FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH
CONTINUATION SHEET
NAME OF ESTABLISHMENT TOWN DATE OF INSPECTION
/ -.,P-14 ., &3Lk
INSPECTION FORM REMARKS
#
±L
C
cr
hIL
/(-'p P41�2d 47/L-714,J /In Cll�
VAT
f
Y1'l
f� �rn-P ; S��--� cam' /',' -r�-�E,•- �
�f 'e- L, '
W
INITIAL(INSPECTOR) —7INITIAL(PERSON IN CHARGE)
Distribution: 1 st-White-Health Department 2nd-Yellow-Owner/Manager