HomeMy WebLinkAboutFood Service Establishment Inspection 65 (9) EHS-106-Rev.06/0L INSPECTION REPORT STATE OF CONNECTICUT ❑ ROUTINE INSPECTION <1WEINSPECTION
FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH ❑ PREOPERATIONAL ❑ OTHER
410 Capitol Avenue,MS#51 FDP,Hartford,CT 06134
NAME OF ESTABLISHMENT
ESTABLISHMENT J CLASS
STREET
ADDRESS Uzi
f _t� Ste_ TOWN `
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OWNER or
OPERATOR INSPECTION
saz C DATE and TIME h
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 21 Preflushed,scraped,soaked and racked 42 Presence of insects/rodents 2
nonadulterated 22 Wash water clean,proper temperature 1 43 Outer openings protected against entrance of 1
2 Original container,properly labeled 1 23 Accurate thermometers provided,dish basket,if used insects/rodents
24 Mitizabon rinse(hot water-chemical)
FOOD PROTECTION 25 Clean wiping cloths 1 FLOORS,WALLS&CEILINGS
3 Potentially hazardous food meets 4 26 Food-contact surfaces of utensils& 2 44 Floors:floor covering installed,
temperature requirements during storage, 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 1
equipment clean 46 Floor,wall juncture covered
4 Adequate facilities to maintain product 2 28 1 Equipmentlutensils,storage,handling 1 47 Mats removable,good repair,clean
tem erature thermometers provided
5 Potentially hazardous food properly thawed 2 48 Exterior walking,driving surfaces, 1
6 Unwrapped or potentially hazardous food 4 WATER SUPPLY good repair,clean
not reserved — FT
Water source adequate,safe 4 49 Walls,ceilings attached,equipment properly 1
7 Food protected during storage,preparation, Hot and cold water under pressure, 2 constructed,good repair,clean. Wall&ceiling
display,service&transportation 2 provided as required surfaces as required.
8 Food containers stored off floor 50 Dustless cleaning methods used, 1
SEWAGE DISPOSAL cleaning equipment properly stored
Handling of food minimized 2 31 Sewage disposal approved 4
10 Food dispensing utensils properly stored 1 32 1 Proper disposal of waste water 1 LIGHTING&VENTILATION
11 1 Toxic items properly stored,labeled,used 14 51 Adequate lighting provided as required 1
PLUMBING 52 Room free of steam,smoke odors 1
PERSONNEL 33 Location,installation,maintenance 1 53 Room&equipment hoods,ducts,vented as required
12 1 Personnel with infection restricted 14 34 No cross connection,back siphonage,backflow 4
DRESSING ROOMS&LOCKERS
CLEANLINESS OF PERSONNEL TOILET FACILITIES 54 Rooms adequate,clean,adequate lockers 1
13 Handwashing facilities provided, 4 35 Adequate,convenient,accessible,designed, 4 provided,facilities clean
ersonnel hands washed clean installed
14 Clean outer clothes,effective hair restraints 1 36 Toilet rooms enclosed with self-closing door 1
15 Good hygienic practices,smoking restricted 2 37 Proper fixtures provided,good repair,clean HOUSEKEEPING
55 Establishment and premises free of litter,no 1
EQUIPMENT&UTENSILS: DESIGN, HANDWASHING FACILITIES insect/rodent harborage,no unnecessary articles
CONSTRUCTION&INSTALLATION 38 Suitable hand cleaner and sanitary towels or 1 56 Complete separation from living/sleeping quarters 1
16 Food-contact surfaces designed,constructed, 2 approved hand drying devices provided, and laundry
maintained,installed,located tissue waste receptacles provided
57 Clean/soiled linens stored properly 1
17 Nonfood-contact surfaces designed, 1 58 1 No live birds,turtles,or other animals 1
constructed,maintained,installed,located GARBAGE/RUBBISH STORAGE&DISPOSAL I (except guide dogs)
18 Single service articles,storage,dispensing 2 39 1 Approved containers,adequate number, 1
19 No reuse of single service article covered,rodent proof,clean NONSMOKING AREAS
20 Dishwashing facilities approved design,adequately j
40 Storage arealmoms,enclosures— 59 1 Seats 75 or more:Nonsmoking area provided, 3
constructed,maintained,installed,located properly constructed,clean sigh(s)posted at entrance(s),smoking area
1 I indicated by sign(s)
41 Garbage disposed of in an approved manner,
at approved frequency QUALIFIED FOOD OPERATOR
DEMERIT SCORE 60 Qualified Food Operator 3
4 3® 2 1® LRISK FAC' R VIOLATIO IN 1 Designated alternate 2
62 Written documentation of training program 2
TOTAL RATING Date Corrections Due Signatu o e o i har
p6� IGNE p tor) 901
5E__S_CRIBLT11fFICIENCIES ON CONTINUATION SHEETS
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Page
INSPECTION REPORT STATE OF CONNECTICUT
FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH
CONTINUATION SHEET
NAME OF ESTABLISHMENT TOWN DATE OF INSPECTION
INSPECTION ✓_V
FORM# REMARKS /
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INITIAL(INSPECTOR) INITIAL(PERSON IN CHARGE)
Distribution: lst-White-Health Department 2nd-Yellow-Owner/Manager
Establishment: 61 Inspection Date: j cL Timer f R ' s REinsp
Address/City: �f— —1—'A A �j Health Dept: S'� GJt,�p�J✓1�.� Class; f z 3
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 NIO N/A DNC KEY: C[complies] NIO[not observed] NIA[not applicable]
DNC does not comply]
Gluitf[r#d)`od Ottelr ",- 3 [ p Yl 0[other] RTE[ready-to-eat]
61 Designated Alternate z
1 'Persortnei t�itdt'irsfectian restricted G NGQ IfiA 14
Written documentation of training pmgn
A Food workers have no exposed infected lesions/burns
B Personnel with infection restricted
'! Approved source,wholesome,nonatlulterated C Nf0 N/A 4' C Communicable disease of worker reported to local health director
B o roved shellfish,condsh,ition
meat a ed, USDA approved 13 Handwashing facilities prodded,.hands washed,clean' C N/0 NfA 4
B Food cans in good condition(not dented,rusty,bloated,leaking) A Handwash facilities in all food prep/dispensing&warewash areas
C Wholesomelnonadulterated 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
3 teta hazardous#bed meets tereper�urI.160 €ut C' N/p 0
deeing arage,preparatirrrt,dl9pfay,servic6 an tra pert i `
1� Gos�i'l�enic practices C NIO' NIA 2
A Hot holding greater than or equal to 140°F. (whole beef/pork Aso°F.l A ❑ No eating ❑ No smoking while working
B Cold 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
E Proper internal cooking/consumer advisory posted ;„. nrtlter1)a
0 Approved sanitizeravailable/adequate concentration ofsanitizer
4 [''A dcflftids tc inaietbin product C 1�0� � � B Food-contact surfaces and utensils used for potentially
temperatuire,thermometers provided hazardous food sanitized at least every 4 hours
A Food thermometer available and accurate C Adequate inal rinse temp
B Proper food thermometer for product
Propersanitizinpprocedure
E Sanitizing between raw animal origin&ready-to-eat food
C Thermometers appropriately placed in cooler units
7 Faori`pfotecteci durifig skorae;preparation, ib 2:..
. teeiii' �°ctha': t0i l4A
display,service and trainksperta?tion Cloths and/or sponges in good repair and clean
B Wiping cloths kept in sanitizer between uses
A Produce washed
B Raw meats not stored/prepared near ready-to-eat foods 0 f
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 O
8 Food containers stored off the floor
l + Ifrtde G 0
Handling of food ntinitnized G I NO I NfA`' 9 No unnecessary handling RTE and/or cooked foods with bare hands Soap a er s/ 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 1 •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 Iflf=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
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Establishment: c Date of Inspection — — -
ddress: _ 4n Owner or Operator. ' 0-
ADDITIONAL FOUR POINT ITEMS ! KEY: DNC [DOES NOT COMPLY] o
6 Foods not re-served.
-Unwrapped foods not re-served 4 31 Sewage disposal approved. 4
-Potentially hazardous foods not re-served 4 -Operating as required
No cross connections,back siphonage,backflow
11 Toxic chemicals. cl
Proper type/installation/backflow prevention device/air gap for:
-Stored properly,labeled properly,used properly
-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. 7 -Food equipment -Dish machines -Ice machines
-Well/well head protected from contamination
h, 35 Toilet facilities. Adequate,convenient,accessible,
-Water quality in compliance 4
-Monitoring in compliance designed,properly installed
OTHER ITEMS KEY: DNC [DOES NOT COMPLY]
2 Sources of food:Original container,properly labeled , 40 rbage/rubbish storage area/rooms,enclosures-properly constructed,clean
5 Potentially hazardous food properly thawed 4T Garbage/rubbish disposed of in an approved manner,at approved frequency
10 Food dispensing utensils properly stored 2 Vermin Control: No insects/rodents present d
14 Food worker:Clean outer clothes,effective hair restraints 43 Outer openings protected against entrance of insects/rodentsff e)L"
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4 FI rs: Floor covering installed,constructed as required,good repair,clean
16 Food-contact surfaces designed,constructed,maintained,installed, Floors graded,drained as required
located
6 Floor,wall juncture covered
17 Nonfood-contact surfaces designed,constructed,maintained, *q' 7 Mats removable,good repair,clean
installed,located
8 Exterior walking,driving surfaces,good repair,clean 4
18 Single service articles,storage,dispensing
19 No reuse of single service article 9 Walls,ceilings attached,equipment properly constructed,good 1
repair,clean.Wall&ceiling surfaces as required
20 Dishwashing facilities approved design,adequately constructed,
maintained installed located 50 Dustless cleaning methods used,cleaning equipment properly stored
Equipment&Utensils: Cleanliness 51 Adequate lighting provided as required 1`
21 Preflushed,scraped,soaked and racked 52 Room free of steam,smoke odors ="
.y
22 Wash water clean,proper temperature 53 Rooms&equipment hoods,ducts,vented as required }
231 Accurate thermometers provided,dish basket,if used 54 Rooms adequate,clean,adequate lockers provided,facilities clean
7 onfood 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 Proper toilet fixtures provided,good repair,clean entrance(s),smoking area indicated by sign(s)
39 Approved garbage/rubbish containers,adequate number,covered,
rodent proof,clean ❑Routine Insp ion Rein ec n ❑ Preoperational Inspection
Other Inspection:INSPECTOR: PERSO R Demerit Score: *Inc de demerits from page 1
`�� 4 3j 2 1 Total Rating
S19pature
= �//l�v t/ 1
print name f�
�� � ®'�(/"rt'r�yL DATE CORRECTIONS DUE:
title
Page 2 of 2 plus continuation pages Focused Inspection 1/2002
Page_of
INSPECTION REPORT STATE OF CONNECTICUT
FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH
CONTINUATION SHEET
NAME OF ESTABLISHMENT TOWN DATE OF INSPECTION
INSPECTION FORM# REMARKS
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INITIAL(INSPECTOR) INITIAL(PERSON IN CHARGE)
Distribution: 1st-White-Health Department 2nd-Yellow-Owner/Manager
Page of
INSPECTION REPORT STATE OF CONNECTICUT
FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH
CONTINUATION SHEET
N E OF ESTABLISHMENT TOWN DATE OF INS ECT ON
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INSPECTION FORM# REMARKS
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INITIAL(INSPECTOR) INITIAL(PERSON IN CHARGE)
Distribution: 1st-White-Health Department 2nd-Yellow-Owner/Manager