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HomeMy WebLinkAboutFood Service Establishment Inspection 60 (8) d Establishment: h Inspection Date: 3 me: (v Oins REinsp Address/City: 60 l Health ept: A3(—& wl Class: 1 26 4 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 possibn 0 N/A DNC �; C[complies] N/O[not observed] NIA[not applicable] 60CNff&t� OQd'} Fax 3 DNC[does not comply] 0[other] RTE[ready-to-eat] I2 Pshill6hni Vith fnfect bn'rest'rh6tetlDdilrector fit? NIA' 4 61 Designated Alternate 2 A Food workers have no exposed infected lesions/ 62 Written documentation of training program2 B Personnel with infection restricted 1 Approved source,wholesome,nonaduiterated N/0 N/A 4 C Communicable disease of worker reported to local hA A roved shellfish,finfish,meat& oult USDA a roved 13 Han�rashingfacilities provided,handsw 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/nonadulteratedfoodslsafe 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 Potdntiaiiyy hazardous food moor tern p'erature refill* o Q NtA' 4° 0 during stara e,prepay ,d©n,di�hry,se ise and ha006 t on; 11510,6cdl renlC attic as t+ Pr C WO. NIA 2Il A Hot holding greater than or equal to 1400F. (whole beef/pork roasts 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 E Proper internal cooking/consumer advisory posted 'A ' Ali, r!;r s water`chi WA 2 0 A Approved sanitizeravailable/adequate concentration ofsanitizer 4 Adequate facfiPith6s to msintam pr~o uct' 0 q °` B Food-contact surfaces and utensils used for potentially teraperaturc,thermometers provided hazardous food sanitized at least every 4 hours A Food thermometer available and accurate Y1C Adequate ❑dishwashersanitizer ❑final rinse temp L Proper san tizin procedure B Proper food thermometer for product E Sanitizing between raw animal origin&ready-to-eat food C Thermometers appropriately placed in cooler units 0 0 2 C t 1A 1 7 Food protected iftrirg storage;pieprat " ,° on es A Cloths and/ors in ood re air d per,service and transportation p g g p 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 C Food covered properly A Food equipment clean utensils clean,equipment interiors clean D Adequate splash guards I sneeze guard g Single use gloves changed when soiled 01 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 , . 0 � e 9 Handling of foodmimmlZed sa A No unnecessary handling RTE and/or cooked foods with bare hands A Soap I 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 sink(s)clean/waste receptacle at handwash sink C Adequate utensil(s)for dispensing food/ice DO0 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 ves 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 QFO responsibilities information at the time of the Is there a produce washing y. inspection: p g policy? Y N *Describe what is washed and where: Note: This report is a two page form(total of 62 debitable items) Page 1 of 2 b k x Establishmenrt Date of Inspection ` f Address: C _ _� I 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.-Operating -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- -Pesticideslrodenticides properly dispensed Chemical dispensers -Ice machines Proper drain for: 29 Water source adequate,safe. -Food equipment -Dish machines -Ice machines .Well lwell 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 M Aarbage/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 Vermin Control: No insects/rodents present 14 Food worker:Clean outer clothes,effective hair restraints 43 Outeropenings protected againstentrance 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 481 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 501 Dustless cleaning methods used,cleaning equipment properlystored ;equipment&Utensils• Cleanliness 511 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 541 Rooms adequate,clean,adequate lockers provided,facilities clean 271 Nonfood-contact surfaces of utensils&equipment clean 55 Establishment and premises free of litter,no insect/rodent harborage, 8 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 Propertoiletfixturespmvided,good repair,clean entrance(s),smoking area indicated by sign(s) 39 Approved garbage/rubbish containers,adequate number,covered, rodent proof,clean R utine Inspection OReinspection 0 Preoperational Inspection Other Inspection: INSPECTOR�j,, PERSON IN CHARGE: Demerit Score: *Include demerits from page 1 4 3 2 1 Total Rating si ture V`��� 'skjnafure r p �t' game ' print name G n _ ` ' 3 o`F" _�y�'a��� �h� s4lYLPrIl�,A- 1��L�m DATE CORRECTIONS D%U'E: phone number title Page 2 of 2 plus If continuation pages Focused Inspection 1 2002 Page J of'? INSPECTION REPORT STATE OF CONNECTICUT FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH CONTINUATION SHEET NAME OF ESTABLISHMENT TOWN DATE OF INSPECTIO &_� s �► � � INSPECTION REMARKS FORM# / IC-LIU,"' Z� 1_77� _Zf_3 INITIAL(INSPECTOR) INITIAL(PERSON IN CHARGE) Distribution: 1st-White-Health Department 2nd-Yellow-Owner/Manager