HomeMy WebLinkAboutFood Service Establishment Inspection 10 (19) i
Establishment: kikiiInspection Date: RZ VYyl Time: :!, ftimf REinsp
ddress/City: � Health Dept: _3,Gut1ne1_), Ic ass; 1 2
Based on an inspection this day,the items...-ke H D C 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 debltable items C N/O N/A DNC ice: C[complies] N/0[not observed] NIA[not applicable]
g � ) _ l 3 DNC[does not comply] 0[other] RTE[ready-to-eat]
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12 ``Pais" ieri ti"idfecton resfiicteri C "N/Q NIA 4
161" Designated AlteFnate 2
62 Written documentation of training program 2 A Food workers have no exposed infected lesions/burns
B Personnel with infection restricted
1 Approved source,wholesome,nonadulterated C NIA NIA 4 C Communicable disease of worker reported to local health director
A Approved shellfish,finfish,meat&poultry USDA approved 13 Handt ping facilities provided,handswashett,clean C NIO; 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/nonadulteratedfoods/safe B Handwash facilities in or immediately adjacent to toilet rooms
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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
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1 d61ot1 liy+gli"k praiittces C WO` NIA 2
A Hot holding greater than or equal to 140°F. (whole beef/pork roasts 1300 F.) A ❑ No eating ❑ No smoking while working
B lCold 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 " ardor re.( #i+irat6r ceai) Pi(0 Nt
0 Approved sanitizeravailable/adequate concentration ofsanitizer
4 Adel tildes ' p € Gt ;� { B Food contact surfaces and utensils used for potentially
A 2 hazardous food sanitized at least every 4 hours
A Food thermometer available and accurate C Adeq Is w er 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
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C ? ttUA A Cloths and/or
display,serves and transportation � sponges in good repair and clean
B Wiping cloths kept in sanitizer between uses 1,001
A Produce washed
0
B Raw meats not stored/prepared near ready-to-eat foods
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 0
8 Food containers stored off the floor
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A No unnecessary handling RTE and/or cooked foods with bare hands A Soap/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 sinks)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 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 recordedllogged 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 vas 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):CFO 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
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
Establishment: HV &LkADate of Inspection:
Address: Owner or Operat€�r: � �Ve 2
ADDITIONAL FOUR POINT ITEMS KEY: DNC [DOES NOT COMPLY]
6 1 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:
-Sanitizerconcentration 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-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
5 Potentially hazardous food properly thawed 41 Garbage/rubbish disposed of in an approved manner,at approved frequency
10 Food dispensing utensils properly stored 42 Vermin Control: No insects/rodents present
14 Food worker:Clean outer clothes,effective hair restraints 4ZLouteropenings protected against entrance ofinsects/rodents
4 ors: Floor covering installed,constructed as required,good repair,clean
16 F od-contact surfaces designed,constructed,maintained,installed 45 Floors graded,drained as required
located
6 Floor,wall juncture covered
7 onfood-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 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
7Nonfood-contact surfaces of utensils&equipment clean
55 Establishment and premises free of litter,no insect/rodent harborage,
Equipment/utensils,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
58 No live birds,turtles,or other animals(except guide dogs)
36 Toilet rooms enclosed with self-closing door
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 ORoutine Inspection ❑Reinspection 0 Preoperational Inspection
Other Inspection:
INSPECTOR: PERSON IN CHARGE: Demerit Score: *include demerits from page 1
4 3 2 1 Total Rating
4:;�
signature
r� cIs W. P1 - D
print na e I print name 6
G— �Sr `- �� DATE CORRECTIONS DUE:
phone number title
Page 2 of 2 plus continuation pages Focused Inspection 1/2002
Page of
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INSPECTION REPORT STATE OF CONNECTICUT
FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH
CONTINUATION SHEET
NAME OF ESTABLISHMrrENrrT TOWN ! �^ DATE OF SPE TION
INSPECTION FORM# REMARKS
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INITIAL(INSPECTO INITIAL(PERSON IN CHARGE)
Di$tribution: lst-White-Health Department 2nd-Yellow-Owner/Manager