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HomeMy WebLinkAboutFood Service Establishment Inspection 65 (10) f Establishment: Inspection Date: im J insp REinsp Address/City: (,, X Health Dept: �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 CA/0 N/A DNC KEY_: C[complies] N/0[not observed] N/A[not applicable] $tl_ (Welif[ed Food Operator 3 DNC[does not comply] 0[other] RTE[ready-to-eat] 42 111 "VIth tnfect isn rest�cted 61 Designated Alternate 2 G N O 1 IA 4 62 Written documentation of training program 2 A Food workers have no exposed infected lesions/burns B Personnel with infection restricted 1 Approved source,wholesome,nonadulterated C 14/0 N/A 4 C Communicable disease of worker reported to local health director B o roved shellfish,condition meat&dented, USDA approved 13-Handwashing fac6Yies provided,hands washed,clean C N10 N/A 4 B Food cans in good condition(not dented,rusty,bloated,leaking) A Handwash facilities in all food prep/dispensing&warewash areas C Wholesome/nonatlulteratedfoods/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 3 Potentiall hazardous#dad trteets to,"pifatu're q tement y ` 0 during s stage,preparatten,displAy,seNice and�p#ts�rN��, ,z, � � _ 15ocid�rygit►ic''practices C N/0 NIA 2 A Hot holding greater than or equal to 140GF. (wnoie beef/pork roasts isoo F.) A ❑ No eating ❑ No smoking while working B Cold holding less than or equal to 45o F. B Wounds covered adequately C Proper cooling C Proper sink used for handwashing D Proper re-heating ol 0 E Proper internal cooking/consumer advisory posted tit ( kiia p}/p N , _Sr 7�� .. �.. . � w, . 0 A Approved sanitizeravailable/adequateconcentrationofsanitizer 4 Ada4uate fAc1f1#io to rnaint pr�oducf B Food-contact surfaces and utensils used for potentially temperature,therttle hazardous food sanitized at least every 4 hours A Food thermometer available and accurate C Adequate ❑dishwashersanitizer gfinal rinse 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 r th s } i s ¢ T Fosd"pr©tested during stArage,jir` araitm, u°* 2i i+g0' `71" 2splayr,service acid 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 C Food covered properly ol A Food equipment clean,utensils clean,equipment 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 I X, 10 8 Food containers stored off the floor 9 Handling of food rnirrim,hied 40 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 sinks)clean I waste receptacle at handwash sink C Adequate utensil(s)for dispensing food/ice 0 0 :::p •DESCRIBE DEFICIENCIES ON CONTINUATION SHEETS The following information is not debitable and does not affect your score. KEY: OFO[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: t 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 yes 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 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: Address: IJ Owner or Operator: ADDITIONAL FOUR POINT ITEMS a�= 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/bac0ow 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 machinesProper 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 2 Vermin Control: No insects/rodents present 14 Food worker:Clean outer clothes,effective hair restraints 3 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, 5 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 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 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 lifter,noinsect/rodentharborage, 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 ORoutine inspection ❑Reinspection ❑ Preoperational Inspection Other Inspection: INSPECTOR: PERSON IN CHARGE: Demerit Score: *Include demerits from page 1 4 3 2 1 Total Rating si ature si a re punt name pri Aname ` R mom~ DATE CORRECTIONS DUE: 111 phone numb title Page 2 of 2 plus_33—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 PECTI rN�� INSPECTION FORM# REMARKS Cj4 Let -p a aL INITIAL(INSPECTOR) INITIAL(PERSON IN CHARGE) Distribution: 1st-White-Health Department 2nd-Yellow-Owner/Manager