HomeMy WebLinkAboutFood Service Establishment Inspection 83 (5) i
Establishment: (1iu.—C /be —Inspection Date: Time: 0[ RE[nsp
ddress/City: Health Dept: r / Class: 1 z 4
Based on an inspection this day,the items marked DNC identify the violations in operation orfacilities 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/0 N/A IDNC I KEY: C[complies] N/0[not observed] NIA[not applicable]
69 Ftmd## errs g DNC[does not comply] 0[other] RTE[ready-to-eat]
2 Persv#met"rn itti irifteMon re ruled
61 Designated Alternate 2 C N/0 NIA 14
62 Written documentation of tralning program 170 2 A Food workers have no exposed infected lesions/burns
1 Approved source,wholesome,nonadulterated C N/0 N/A 4 B Personnel with infection restricted
C Communicable disease of worker reported to local health director
A Approved shellfish, meat& o USDA a roved 13 Handwashingfacilitiesprovided,Imndswashad,clean C N/0' N/A 4
B Food cans in good condition(not dentedd,,rusty,bloated,leaking)
C Wholesome/nonadulteratedfoods/safe A Handwash facilities in all food prep/dispensing&warewash areas
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
0 hands washed,clean/Proper handwash procedure
Handwa shing at appropriate times
3 potential Y haza`fdaas.1166 st er �
dufng storage preparatictt, fay, tte s 0
citi' # ►1 c'p c#ioes� C Wo NZA 2
A Hot holding greater than or equal to 1400F. (Whole beer/pork roans 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 Proper sink used for handwashing
D Proper re-heating 0
twk� P
E Proper internal cooking/consumer advisory posted
0 A Approved sanitizeravailable/adequate concentration of sanitizer
4 Adequate facile ties.ts,rnatntolif rod,
� � g Food contact surfaces and utensils used for potentially
ten,p0atlura,therrxrometcrs pPtswdei W hazardous food sanitized at least every 4 hours
x ,- ..-A .
A Food thermometer available and accurate C Adequate ❑dishwashersaniti Ina ' se 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
Food pro#ected t trFrtg or�g ;'`" epara 15 211 14o` tp c:Nd0 "WA 9
displaty,service and transportation A Cloths and/or sponges in good repair and clean Ll
A Produce washed B Wiping cloths kept in sanitizer between uses
0
B Raw meats not stored/prepared near ready-to-eat foods
MEC Food covered properly A Roodquipment clean,utensils clean,!quipm=enCintenors clean
D Adequate splash guards I 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
ttig 6�cd#3dr pkot Nita
9 Handling of food minimized C;
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
20C 0 Handwash sink(s)clean/waste receptacle at handwash sink
C Adequate utensil(s)fordispensingfood/ice •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: F. 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 ff—m 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
[where:
e 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
Establishment: Date of Inspection: x 1
Address: U titer ,off tu/ 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 fir:
San itizer 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 Toil In
-Monitoring in compliance designed,properly' stalled
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 42 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 49 Walls,ceilings attached,equipment properly constructed,good
0 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
27 Nonfood-contact surfaces of utensils&equipment clean
55 Establishment and premises free of litter,no insect/rodent harborage,
28 Equipment/utensils,storage,handling no unnecessary articles
32 Proper disposal of waste water 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
59 Seats 75 or more:Nonsmoking area provided,sign(s)posted at
37 Propertoiletfixturesprovided,good repair,clean entrance(s),smoking area indicated by sign(s)
39 Approved garbage/rubbish containers,adequate number,covered, _
rodent proof,clean e I ectio ❑Reinspection ❑ Preoperational Inspection
INSPECTOR: PERSON IN CHARGE: Other Inspection:
Demerit Score: *Include demerits from page 1
X;210�"Oe�' A 4 3 2 1 Total Rating
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DATE CORRECTIONS DUE:
phone number �//p/' title
`�jjk 16 G Page 2 of 2 plus continuation pages Focused Inspection 112002
Page-� of 3
INSPECTION REPORT STATE OF CONNECTICUT
FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH
CONTINUATION SHEET
NAME OF ESTABLISHMENT TOWN DATE OF INSPECTION
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INSPECTION FORM# REMARKS
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INITIAL(INSPECTOR) INITIAL(PERSON IN CHARGE)
L-IDistribution: 1st-White-Health Department 2nd-Yellow-Owner/Manager