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HomeMy WebLinkAboutFood Service Establishment Inspection 75 (4) i Establishment: b4iV WV} r PI1V1 IDo Inspection Date: la t ddress/City: Time: Lspecifiedon insp Z2. Health Dept: t class: Based on an inspection this day,the items marked DNC identify the violations in operation or facilities which must be corrected by the dat page RISK FACTOR ITEMS Listing is not inclusive of all possible debatable items C N/0 N/A DNC t(FY; C[complies] N/O not observed�� Qi14f38d: Abd 0jetr e ] N/A[not applicable] 3 DNC[does not comply] 0[other] RTE[ready-to-eat] 61 DesignOt®d Aitilit e' 12• ° +etr i''.el,inii l t`frif 5"f�iri r`es r edici 2 C WO WA 4 62 Written documentation of training program 2 A Food workers have no exposed infected lesions/burns 1 Approved source,wholesome,nonaduiterated N/A 4 B Personnel with infection restricted A roved shellfish,finfish,meat& cult USDA approved C Communicable disease of worker reported to local health director A B Food cans in good condition(not dented,rusty,bloated,leaking) 13 Handwashing facilities provided,hands wanted,etean C WO WA 4 C Wholesome/nonadulterated foods/safe A Handwash facilities in all food prep/dispensing&ware ash areas D Commercial products(no home grown/canned food) B Handwash facilities in or immediately adjacent to toilet rooms E Potentially hazardous foods received at proper temperature C Handwash facilities accessible/convenient to use D Personnel hands washed,clean/Proper handwash procedure pgdy#t8ar(toi ffpd meets g E Handwashing at appropriate times dn�ing s orage,prrauoq dlrptatr,s�e�wita�end trat>sp �°` cad Fe;rgta C pro s C- t 0'� NA 2 A Hot holding greater than or equal to 140°F. (win°re neerino °asrs Sao°FI B A ❑ No eating ❑ No smoking while working Cold holding less than or equal to 45°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 2 " 4 ,adequate fees m 10 # A Approvedsanitizeravailable/adequateconcentrationofsanitize IVA r d x a loll B Food-contact surfaces and utensils used for potentially rrrre� roraters: royudd hazardous food sanitized at least every 4 hours Food thermometer available and accurate C Adequate ❑dishwashersanitizer ❑final rinse temp B Proper food the rmometer for product D Pro ersanitizin rocedure Thermometers appropriately placed in cooler units E Sanitizing between raw animal origin&ready-to-eat food 0 ► ► ed . a ._, *�3t7f1t1 ( olfi C N/0 y° ffAA display,service and transportation A Cloths and/or sponges in good repair and clean A Produce washed Wiping cloths kept in sanitizer between uses B Raw meats not stored/prepared near ready-to-eat foods 0 C Food covered properly " D Adequate splash guards/sneeze guard A Food equipment clean,utensils clean,equipment interiors clean E No unauthorized personnel B Single use gloves changed when soiled F No pooling of eggs not cooked immediately C Food--contact surfaces clean 8 Food containers stored off the floor O Mantling of f©otl rnittimirad C WO NA a t3 e N C N/0 NIA 1 No unnecessary handling RTE and/or cooked foods with bare hands A Soap/paper towels/ drying device available B Minimize food handling,other than ready-to-eat,with bare hands B Dispenser(s)working: ❑Soap ❑Paper towel Adequate utensil(s)for dispensing food/ice C Handwash sink(s)clean/waste receptacle at handwash sink 0 0 •DESCRIBE DEFICIENCIES ON CONTINUATION SHEETS The following information is not debitable and does not affect your score. KEY: QFO[qualfied food operator],DA[designated alternate],PHF[potentially hazardous food], FB[foodborne] PHFs are hot held at: IF. PHFs are cold held at: °F. 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: Are temperatures recorded/logged for cold holding foods/equipment? Y N Is there a written illness policy that requires the food worker to report specific illness conditions 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 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 where: ce washing polic? Y N Is there a produy *Describe what is washed and inspection: Note: This report is a two page form(total of 62 debitable items) Page 1 of 2 Establishment: -L y. dress: Date of Inspection. D I Owner or Operator: ADDITIONAL FOUR POINT ITEMS ' 6 Foods not re-served. ©, KEY: DNC [DOES NOT COMPLY] -Unwrapped foods not re-served 4 31 Sewage disposal approved. -Potentially hazardous foods not re-served -Operating as required 11 Toxic chemicals. No cross connections,back siphonage,backflow -Stored properly,labeled properly,used properly Pro—pertypelinstallation/backflow prevention device/air gapfor or; 4 -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 29 Water sou Proper drain for: rce adequate,safe. -Food equipment -Dish machines -Ice machines { -Well/well head protected from contamination -Water quality in compliance 35 Toilet facilities. Adequate,convenient,accessible, -Monitoring in compliance designed,properly installed OTHER ITEMS 2 Sources of food:Original container,properly labeled KEY: DNC [DOES NOT COMPLY] 0 Garbage/rubbish storage area/rooms,enclosures-properly constructed,clean 5 Potentially hazardous food properly thawed 1 Garbage/rubbish disposed of in an approved manner,at approved frequency Food dispensing utensils properly stored Vermin Control:No insects/rodents present 14 Food worker:Clean outer clothes,effective hair restraints 3 Outer openings protected against entrance ofinsects/rodents good air,clean ,uired t constr 4 Floors: Floor covering installed,constructed as re re 16 Food-contact surfaces designed,constructed,maintained,installed, q 9 p located 5 Floors graded,drained as required 17 Nonfood-contact surfaces designed,constructed,maintained, 6 Floor,wall juncture covered installed,located 7 Mats removable,good repair,clean Single service articles,storage,dispensing 8 Exterior walking,driving surfaces,good repair,clean lx 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 � 50 Dustless cleaning methods used,cleaning equipment properly stored Equioment&Utensils: Cleanliness 51 Adequate lighting provided as required 21 Preflushed,scraped,soaked and racked 22 Wash water clean,proper temperature 52 Room free of steam,smoke odors 23 Accurate thermometers provided,dish basket,if used 53 Rooms&equipment hoods,ducts,vented as required 54 Rooms adequate,clean,adequate lockers provided,facilities clean 2 Nonfood-contact surfaces of utensils&equipment clean 8 Equipment/utensils,storage,handling 55 Establishment and premises free of litter,no insect/rodent harborage, 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 4 einspection ❑ Preoperational Inspection INSPECTOR: PERSON N CHARGE: Other Inspection: �; � pp Demerit Sc re: *Include demerits from page 1 si at ignatur - r' 4 3 2 1 Total Rating print name l /� pn a number title LAJ DATE CORRECTIONS DUE: N 2�j Page 2 of 2 plus continuation es a P g Focused Iuspectlou 1Y2002 Pag2 of L Qm INSPECTION REPORT STATE OF CONNECTICUT FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH CONTINUATION SHEET NAME OF ESTABLISHMENT TOWN DATE OF SPECTION INSPECTION FORM# REMARKS c� oll Jim � S 3 � C LJ ll� � v 0 � � 1 �f - v c INITIAL(INSPECTOR) INITIAL(PERSON IN CHARGE) Distribution: 1st-White-Health Department 2nd-Yellow-Owner/Manager