HomeMy WebLinkAboutFood Service Establishment Inspection 24 (4) EHS106-Rev.06/01+ INSPECTION REPORT STATE OF CONNECTICUT l CLROUTINE INSPECTION ❑ REINSPECTION
FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH ❑ PREOPERATIONAL ❑ OTHER
410 Capitol Avenue,MS#51 FDP,Hartford,CT 06134
NAME OF G ESTABLISHMENT ESTABLISHMENT
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STREET ADDRESS TOWN�.�� / /�Q� /� _ ��
OPERATOR
OWNER or W`^ INSPECTION
DATE and TIME S r iq he , Kj
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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. J
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 protected against entrance of 12 Original container,properly labeled 1 23 Accurate thermometers provided,dish basket,f used :O:ut:eropenings
odents
2 Sanitization rinse(hat water-chemical)
FOOD PROTECTION 25 Clean wiping cloths 1 ORS,WALLS&CEILINGS
3 Potentially hazardous food meets 4 26 Food-contact surfaces of utensils& 2 4 loors: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
equipment clean 46 Floor,wall juncture covered 1
4 Adequate facilities to maintain product temperature,thermometers provided 2 28 Equipment/utensils,storage,handling 1 47 Mats removable,good repair,clean
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 R30
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 1N50 ]Dustless
s used,SEWAGE DISPOSAL an stored
9 Handling of food minimized 2 31 Sewage disposal approved EER
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10 Food dispensing utensils properly stored 1 32 Proper disposal of waste water LIGHTING&VENTILATION
11 Toxic items properly stored,labeled,used 4 51 Adequate lighting provided as required 1
PLUMBING 52 Room free of steam,smoke odors
PERSONNEL 33 Location,installation,maintenance 1 53 Room&equipment hoods,ducts,vented as required 1
12 1 Personnel with infection restricted 14 34 1 No cross connection,back siphonage,backflow 4
CLEANLINESS OF PERSONNEL DRESSING ROOMS&LOCKERS
TOILET FACILITIES 54 Rooms adequate,clean,adequate lockers 1
F
Handwashing facilities provided, 4 35 Adequate,convenient,accessible,designed, 4 provided,facilities clean
ersonnel hands washed clean installed
Clean outer clothes,effective hair restraints 1 36 Toilet rooms enclosed with self-closing door
Good hygienic practices,smoking restricted 2 137 Proper fixtures provided,good repair,clean 1
HOUSEKEEPING
55 Establishment and premises free of litter,no 1 EQUIPMENT&UTENSILS: DESIGN, HANDWASHING FACILITIES insect/rodent harborage,no unnecessary articles
CONSTRUCTION&INSTALLATION 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
Nonfood contact surfaces designed,
1558 No live birds,turtles,or other animals 1 onstructed,maintained,installed,located GARBAGE/RUBBISH STORAGE&DISP I (except guide dogs)
Single service articles,storage,dispensing 39 Approved containers,adequate number, 1
19 No reuse of single service article covered,rodent proof,clean NONSMOKING AREAS
20 Dishwashing facilities approved design,adequately 2 40 Storage area/rooms,enclosures— 59 Seats 75 or more:Nonsmoking area provided, 3
constructed,maintained,installed,located properly constructed,clean sign(s)posted at entrance(s),smoking area
1 indicated b sin s
41 Garbage disposed of in an approved manner,
at approved frequency QUALIFIED FOOD OPERATOR
DEMERIT SCORE 6 Qualified Food Operator 3
4 0 3 2� RISK FACTOR VIOLATIONS D n d ter to 2
(' tt o e ti of tr rogram 2
charge �� t
TOTAL RATING Date Corrections Due Signal o son in
SIGNED(Insp
DESCRIBE DEFICI NCIES ON CONTINUATION SHEETS
Page )�f
INSPECTION REPORT STATE OF CONNECTICUT
FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH
CONTINUATION SHEET
NAME OF ESTABLISHMENT TOWN DATE OF INSPECTION
QiU.-LD
INSPECTION
FORM# REMARKS
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INITIAL(INSPECTOR) INITIAL(PERSON IN CHARGE) 'fit
Distribution: 1st-White-Health Department 2nd-Yellow-Owner/Manager , `�