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HomeMy WebLinkAboutFood Service Establishment Inspection 84 (7) Establishment: ,� Inspection Date: Time: 1a( Romsp REinsp Address/City: ,(��� e7771e/L_, 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 debitable items C I N/0 I N/A JDNCI KEY; C[complies] NIO[not observed] NIA[not applicable] ppdjgj (py` _; 3 DNC[does not comply] 0[other] RTE[ready-to-eat] 61 Designated Alternate ? z 12 personnel with infection'restricted ' C N/Q NIA 4 62 Written docrrmentatiod of training program 2 A Food workers have no exposed infected lesions/burns0<1 B Personnel with infection restricted 1 Approved source,wholesome,nonadttltersted C NIO /A 4 C Communicable disease of worker reported to local health director A Approved shellfish,finfish,meat&poultry USDA approved 13 Handwashing facilities provided,Wands washer),clean C NO 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 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 I Proper handwash procedure E Handwashing at appropriate times 3 Fotentfail hazardous food m®fats temperature to quhni6n C 4= 0 do n9 6 orap,prepa�tion,dieplsy�senc€ce and tansportsdi©n 06ird epic t►Y9i practices C WO NIA 2 A Hot holding greater than or equal to 1400F. (whole beeflpork roasts 1300 F.) No eating ❑ No smoking while working B Cold holding less than or equal to 450 F. Wounds covered adequately C Proper cooling C Proper sink used for handwashing D Proper re-heating 0 E Proper internal cooking I consumer advisory (ilof water-chetnicpi)' C N10 NIA, 2 P 9 ry posted '- 2,4. n. z�tion riso 0 A Approvedsanitizeravailable/adequateconcentrationofsanitizer 4 k8eg4►ete faaifities to rrreintnmdict B Food contact surfaces and utensils used for potentially -tam,peraturg,therao'saet�rs stied �' 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 L Proper sanitizin rocedure C Thermometers appropriately placed in cooler units E Sanitizing between raw animal origin&ready-to-eat food 0 7 ® d rrect�di rt(rr stFa a is"a�a#inn 1' sg ciotts° N/b NtA P � g �p aC, .�. 2 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 0 B Raw meats not stored/prepared near ready-to-eat foods p C Food covered properly A Food equipment clean,utensils clean equipment interiors clean D Adequate splash guards/sneeze guard X 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 Food containers stored off the floor �� dot 'W Z 0 3t ,,; 9 acess�s it# r f: 1 9 Handling of food r inimiaetl ' C, `# 0 AAA 2` A No unnecessary handling RTE and/or cooked foods with bare hands A Soap I paper towels/ 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 O •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 Roasts Other What diseases related to FB illness are you required to report to the local health department? 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 1f-ps 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):QFO 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 CFO responsibilities information at the time of the ll 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: Date of Inspection: 1N Address: Owner or;Operator: v ADDITIONAL FOUR POINT ITEMS KEY: DNC [DOES NOT COMPLY] ; 6 Foods not re-served. -Unwrapped foods not re-served 4 31 Sewage disposal approved. -Potentially hazardous foods not re-served -Operating as required 11 Toxic chemicals. 74 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 0 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 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 f 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 501 Dustless cleaning methods used,cleaning equipment properly stored Equipment&Utensils; Cleanliness 5 11 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 flee of litter,no insect/rodent harborage, 28 Equipmentlutensils,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) 59 Seats 75 or more:Nonsmoking area provided,sign(s)posted at 37 Propertoiletfixturesprpvided,good repair,clean entrance(s),smoking area indicated by sign(s) 39 Approved garbage/rubbish containers,adequate number,covered, rodent proof,clean ❑Reinspection ❑ Preoperational Inspection Other Inspection: INSPECTOR: PERSON IN CHARGE: Demerit Score: *Include demerits from page 1 4 3 2 1 1 Total Rating t e signature C f w print namey�C� print name Z )�/ \Ty/ phone number title DAT CORRECTIONS DUE: PAC f" __III Page 2 of 2 plus continuation pages Focused Inspection 1/2002 Page a ok3_ INSPECTION REPORT STATE OF CONNECTICUT FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH CONTINUATION SHEET NAME OF ESTABLYNT TOWN DATE OF INSP2ECTION nr� INSPE REMARKS FORMM# o r4i IA41 v 5f+ � Ltd WV►�+✓� p�u W,�� r C (-L2i w, I i �- kwikce <0 L,,l UAe� e-mv)i 'L JLV-ze __gI4� 4, kin( iofoklc_(_� l - INITIAL(INSPECTOR) INITIAL(PERSON IN CHARGE) istribution: 1st-White-Health Department 2nd-Yellow-Owner/Manager