HomeMy WebLinkAboutFood Service Establishment Inspection 97 (6) Establishment: Ifs Inspection Date:_�J!j a-1 dull Time: Ot Dins REinsp
ddress/City: +I�� � Health Dept: _�y„- lit wtd.�,V Class: 1 2 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 debltable items C N/O N/A DNC (BEY: C[complies] NIO[not observed] NIA[not applicable]
Q ali f-odt p'a 16 g DNC[does not comply] 0[other] RTE[ready-to-eat]
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[IesigrratedAiternate� ; ' C� Nt(� NIA 4
Written documentation of training program. A Food workers have no exposed infected lesions/burns
B Personnel with infection restricted
1 Approved source,wholesome,ttonddt♦ItatBtatl C N/D /A 4 C Communicable disease of worker reported to local health director
A Approved shellfish,finfish,meat&poultry USDA approved 13 HandWatahing taolilties prowlded,h andswasb �ctea C 4
B Food cans in good condition(not dented,rusty,bloated,leaking) A Handwash facilities in all food prep/dispensing&warewash areas
C Wholesome/nonadulterated 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
0
E Handwashing at appropriate times
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dur8ag storage, iiaralEten,display,seiiricp#p f
too gidr'tc 1prac#f e C N/0''. N/A.
A Hot holding greater than or equal to 1400F. (whole beef/pork roasts 130'F.) A ❑ No eating ❑ No smoking while working
Cold holding less than or equal to 45°F. B Wounds covered adequately
C Proper cooling jyj I C Proper sink used for handwashing
D Proper re-heating 0
E Proper internal cookin onsumer advisory po �]ti�►l 1 ►s�r �t il�ateP-chaalj �, ,gip.N/A
0 i°ke VG f Approved sanitizer available/adequate concentration of sanitizer
Attet;uate fac+tities to rnalntsm pradpct 3 B Food-contact surfaces and utensils used for potentially
temperature,thermomet pKo dad p, hazardous food sanitized at least every 4 hours
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A Food thermometer available and accurate C Adequate ishwa ersa—Mirvir ❑final rinse temp
Proper food thermometer for product D Proper sanitizin rocedure
Thermometers appropriately placed in cooler units
E Sanitizing between raw animal origin&ready-to-eat food
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' Fond prt&,;tee!during s ;prep�rafion; A
display,service artd transportation Cloths and/or sponges in good repair and clean
Produce washed
B Wiping cloths kept in sanitizer between uses
B Raw meats not stored/prepared near ready-to-eat foods 0 s
C Food covered properlyff Modeqment cleanWensi pment interiors clean
D Adequate splash guards/sneeze guard g 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 {
Ha�diing of food minimized NlA '
No unnecessary handling RTE and/orcooked foods with bare hands A Soap/paper towels I drying device available
B Dispenser(s)working: ❑Soap ❑Papertowel
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: 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 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):
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 1 of 2
ME F,
Establishment: Date of Inspection:
a
Address: 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 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,
-Water quality in compliance designed,properly installed
-Monitoring in compliance
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 Outer openings protected against entrance of insects/rodents
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 141 Exterior walking,driving surfaces,good repair,clean '.
19 No reuse of single service article Walls,ceilings attached,equipment properly constructed,good
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
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
36 Toilet rooms enclosed with self-closing door 58 No live birds,turtles,or other animals(except guide dogs)
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 ❑Routine Inspection einspecti ❑ Preopper tional Inspection
Other Inspection: Ltl�-cLl�
INSPECTOR: ER �HARG�E: � Demerit Score: •Include demerits from page 1
/G�� '�"'• 4 3 2 1 Total Rating
ture � signature � �I ��
print name print name V
phone numbers® title
— / DATE CORRECTIONS DUE:
V tm� —' ci�F Page 2 of 2 plus continuation pages Focused Insp=M.W
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INSPECTION REPORT STATE OF CONNECTICUT
FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH
CONTINUATION SHEET
NAME OF ESTABLISHMENT TOWN DATE OF IPSPECTION
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INSPECTION FORM# REMARKS
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INSPECTION REPORT STATE OF CONNECTICUT
FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH
CONTINUATION SHEET
NAME OF ESTABLISHMENT TO DATE OF IN PEC ION
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INSPECTION REMARKS
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INITIAL(INSPECTOR) INITIAL(P SO Im
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