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HomeMy WebLinkAboutFood Service Establishment Inspection 19 (10) � I Establishment: S Inspection Date: ,� Time: tns REinsp Address/City: (� Health Dept:'4-,� / J,.A— Class; 1 2 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 possible debatable items C N/0 N/A DNC �; C[complies] N/O[not observed] N/A[not applicable] a�€tPd Ptibd Q, r -" DNC does not comply] 0[other] RTE read-to-eat p [ p vl [ y ] 4' � r rntif ii�fetia refcted designated Atetnate C tit? NFA 4 62 Written documentation of training program 2 A Food workers have no exposed infected lesions I burns 1 Approved source,wholesome,nonadufterated C Nib N/A 4 B Personnel with infection restricted C Communicable disease of worker reported to localq__ A Approved shellfish,finfish,meat-&poultryUSDA approved 93 - B Food cans in good condition(not dented,rusty,bloated,leaking) mar ►ashing� a an t NIA 4 C Wholesome/nOnadulterated foods/safe A Handwash facilities in all food prep/dispensing&w D Commercial products(no home grown/canned food) B Handwash facilities in or immediately adjacentE Potentially hazardous foods received at proper temperature C Handwash facilities accessible/convenient to 0 D Personnel hands washed,clean/Proper handwash procedure E Handwashing at appropriate times 3 Rotentiatly hazardous food meets t In par regrseetnf its NIfl1, 0 during storage,prepareEfem,disp(�r,sertri�find tiartspmr�dtifis ? 1a 'Good t gtenic practices G WO NIA 2 A Hot holding greater than or equal to 1400F. (whole beef/pork roams 130e F.) A ❑ No eating ❑ No smoking while working B Cold holding less than or equal to 450F. 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 , 0 A Approved sanitizeravailable/adequate concentration ofsanitizer Adequate facnitiies fe marfl fs#n►n 0"d t B Food-contact surfaces and utensils used for potentially temperature;therrnoaa 'ptQvitled hazardous food sanitized at least every 4 hours A Food thermometer available and accurate C Adequate ❑dishwashersanitizer Ofinal rinse temp B Proper food thermometer for product D Pro ersanitizin rocedure C Thermometers appropriately placed in cooler units E Sanitizing between raw animal origin&ready-to-eat food t c f0 7 t=oad pr©tec�ed during sf' ';prepata tri, 0'' hf/Q `iVIA 1' dfsptay,service and transportation OA Cloths and/or sponges in good repair and clean A Produce washed B Wiping cloths kept in sanitizer between uses B Raw meats not stored/prepared near ready-to-eat foods C Food covered properly OF OEM A Food equipment clean,utensils clean,equipment interiors clean D Adequate splash guards/sneeze guard E No unauthorized personnel B Single use gloves changed when soiled F No pooling of eggs not cooked immediately Food--contact surfaces clean 0 8 Food containers stored off the floor , 0 9 Handling of food a InhAfzed; C'4410 � e A No unnecessary handling RTE and/or cooked foods with bare hands a drying device available Dispenser(s)working: 196oap ❑Paper towel B Minimize food handling,other than ready-to-eat,with bare hands C Adequate utensil(s)for dispensing food/ice Handwash sink(s)clean/waste receptacle at handwash sink 0 0 —_±±:N •DESCRIBE DEFICIENCIES ON CONTINUATION SHEETS The following information is not debitable and does not affect�yourscore.mmh=BEY: QFO[qualified food operator],DA[designated altemate],PHF[potentially hazardous food],FB[foodborne] PHFs are hot held at: F. 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 A-yea 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 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 #k Establishment: Date of Inspection: avZ Address: l✓J 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. 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 -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 q -Monitoring in compliance designed,properly installed 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 42 Vermin Control: No insects/rodents present 14 Food worker:Clean outer clothes,effective hair restraints 3 Outer openings protected against entrance of insects/rodents 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 17 Nonfood-contact surfaces designed,constructed,maintained, Floor,wall juncture covered installed,located 7 Mats removable,good repair,clean 18 Single service articles,storage,dispensing 8 Exterior walking,driving surfaces,good repair,clean .tea 19 No reuse of single service article 49 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 properlystored 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,no insect/rodent harborage, 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 ❑Routine Inspection ❑Reinspection ❑ Preoperational Inspection INSPECTOR: PERSON IN CHARGE: Other Inspection: Demerit Score: *Include demerits from page 1 4 3 2 1 1 Total Rating s' ature / / / signature Lax print name print name Ic p :3 _O io` �`� DATE CORRECTIONS DUE: phone number title Page 2 of 2 plus continuation pages Focused Inspection 1/2002 INSPECTION REPORT STATE OF CONNECTICUT �� FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH CONTINUATION SHEET NAME OF ESTABLISHMENT TO DATE OF INSPECTION 7sPECTION FORM REMARKS AK M U �1h vfre..... kf) rul, c-,ok � 1 --15kAA 3�_ Ste` u. fr Aot A ° S ''l�i'1'1 g /off co V? , E�,LJ N �- &I cz� INITIAL(INSPECTOR) INITIAL(PERSON IN CHARGE) istribution: 1st-White-Health Department 2nd-Yellow-Owner/Manager