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HomeMy WebLinkAboutFood Service Establishment Inspection 10 (23) Establishment: o` Inspection Date: Time: 0 o` ROinsp RE[nsp Address/City: A p U M o,;n S k, Health Dept: Class: 1 2 NO 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 C 0 N/A DNC KEY: C[complies] NIO[not observed] NIA[not applicable] 3 DNC[does not comply] 0[other] RTE[ready-to-eat] FrIM0 Or .I . � nn� [ ] A Food workers have no exposed infected lesions/burns If Jp '� 2 B Personnel with infection restricted i>Cr;'4YI1o1 $dtltB'rfbiitii(t11#el8ted N6© M#A 4° C Communicable disease of worker reported to local health director A I Approved shellfish,finfish,meat&poultry USDA a roved 13 Handwashing facnities provii hates washed,clean 0 W4 4 B Food cans in good condition(not dented,rusty,bloated,leaking) A Handwash facilities in all food prep/dispensing&warewash areas C Wholesome/nonadulterated foods/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 0 A Hot holding greater than or equal to 140oF. (whole beef/pork roasts fsoo F.) t/ A ❑ No eating ❑ No smoking while working B Cold holding less than or equal to 45oF. v 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 WN "IN ; 0 A Approved sanitizeravailable/adequate concentration ofsanitizer B Food-contact surfaces and utensils used for potentially hazardous food sanitized at least every 4 111 A Food thermometer available and accurate C Adequate ❑dishwashersanitizer Winal rinse temp LX B Proper food thermometer for product D Proper sanitizinq procedure C Thermometers appropriately placed in cooler units co E Sanitizing between raw animal origin&ready-to-eat food 0 0 vws , .:3 A 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 Food equipment clean,utensils clean,equipment interiors clean D Adequate splash guards I 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 0 8 Food containers stored off the floor 0 I I A No unnecessary handling RTE and/or cooked foods A Soap paper towels drying device available with bare hands B Dispenser(s)working: ❑Soap ❑Papertowel B Minimize food handling,other than ready-to-eat,with bare hands VC Handwash sink(s)clean/waste receptacle at handwash sink C Adequate utensil(s)for dispensing food/ice 0 017 1 •DESCRIBE DEFICIENCIES ON CONTINUATION SHEETS The following information is not debitable and does not affect your score. KEY: QFO[qualified food operator],DA[designated aftemate],PHF[potentially hazardous food],FB[foodborne] I 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 recordedllogged for cold holding foods/equipment? Y N and diseases to the I 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 byes indicate language spoken List products cooled: by QFOIDA: *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 I 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 I of 2 i W Establishment: �G�11�� € � `M A <Q�ti� Date of Inspection. 7101 Address: t1 ti� QA(� �--�- f �—�t Owner or Operator: �(�Yn ADDITIONAL FOUR POINT ITEMS o` KEY: DNC [DOES NOT COMPLY] �� 6 Foods not reserved. -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 ype/installation/backflow prevention device/air gapfoor: -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-Water quality in compliance 35 Toilet facilities. Adequate,convenient,accessible, -Monitoring in compliance designed,properly installed OTHER ITEMS KEY: DNC [DOES NOT COMPLY] 2 Sources of food:Original container,properly labeled 40 Garbage/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 42 Vermin Control:No insects/rodents present 14 Food worker:Clean outer clothes,effective hair restraints 43.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 N food-contact surfaces designed,constructed,maintained, 7 Mats removable,good repair,clean stalled,located 18 Single service articles,storage,dispensing 8 Exterior walking,driving surfaces,good repair,clean 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 2 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 7 Nonfood-contact surfaces of utensils&equipment clean 55 Establishment and premises free of litter,no insect/rodent harborage, 28 Equipment/utensils,stnrage,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 58 No live birds,turtles,or other animals(except guide dogs) 36 Toilet rooms enclosed with self-closing door 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 EgRoutine Inspection ❑Reinspection 13 Preoperational Inspection INSPECTOR: PERSON IN CHARGE: Other Inspection: Demerit Score: *Include demerits from page 1 4 3 2 1 Total Rating sig ture st ture ` nt name D P print name one ou b��� _Z�t title 1�w � � DATE CORRECTIONS DUE: X Page 2 of 2 plus continuation pages Focused Inspection 1/2002 • Page 3 of INSPECTION REPORT STATE OF CONNECTICUT FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH CONTINUATION SHEET NAME OF ESTABLISHMENT TOWN DATE OF INSPECTION N 6� s �.A L L) lLk INSPECTION REMARKS FORM# U lu or, rv\- CK— V 1, l~ V., 0 s +� s re v✓ INITIAL(INSPECTOR) INITIAL(PERSON IN CHARGE) Distribution: 1st-White-Health Department 2nd-Yellow-Owner/Manager