HomeMy WebLinkAboutFood Service Establishment Inspection 10 (24) i
Establishment: Inspection Date: 7 i7 [ Time: 9l�� Roins REinsp
Address/City: 100 13t'&wed 1-�tl Health Dept- tin , 2 3(�7
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 WO N/A JDNC I KEY: C[complies] NIO[not observed] NIA[not applicable]
$ DNC[does not comply] 0[other] RTE[ready-to-eat]
QQ8s gt €ed A rli e' 2 Pit so rC�t v li t iiif of lift, C ` NIA, 4
Writer►dol;yntentation of troop tg program 7Z2 A Food workers have no exposed infected lesions I burns
B Personnel with infection restricted
1 JWrpVed s',6ume.wito[8t time,nonad(dilerated C 14 ) N/A 4 C Communicable disease of worker reported to local health director
A I Approved shellfish,finfish,meat&poultry USDA approved 13 `Hanctwa hir�g faC1W0s provided,handsxres*,clean; C 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/nonadu Iterated 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 0 D Personnel hands washed,clean I Proper handwash procedure
o E Handwashing at appropriate times
NO0
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15 darod hygi�rr c practices C N/ 'NIA 2
A Hot holding greater than or equal to 1400F. (whole beef/pork roasts 130'F.) A ❑ No eating ❑ No smoking while working
B Cold holding less than or equal to 45e F. V V B Wounds covered adequately
C Proper cooling C Proper sink used for handwashing
D Proper re-heating V 0
E Proper internal cooking I consumer advisory posted V 40
0 A Approved sanitizeravailable/adequate concentration ofsanitizer
g Food-contact surfaces and utensils used for potentially
hazardous foods 'Izetl at least every 4 hours
A Food thermometeravailableandaccurate t C Adequate ishwashersanitizer ❑final rinse temp
B Proper food thermometer for product
D Proper sanitizin rocedure
E Sanitizing between raw animal origin&ready-to-eat food
C Thermometers appropriately placed in cooler units 0
0 ff. '
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IT W IT
dtg"'fey,se triee arlid#ransporEatiori A Cloths and/or sponges in good repair and clean
B Wiping cloths kept in sanitizer between uses
A Produce washed
0
B Raw meats not stored/prepared near ready-to-eat foods
C Food covered properly A Food equipment clean,utensils clean,equipment interiors clean
D Adequate splash guards/sneeze guard B Single use gloves changed when soiled
E No unauthorized personnel C Food—contact surfaces clean
F No pooling of eggs not cooked immediately v 0
8 Food containers stored off the floor
0 :.
_ ewiM1i ,t .; WA 7T , .
A No unnecessary handling RTE and/or cooked foods with bare hands A Soap/paper towels I drying device available
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B Dispenser(s)working: ❑Soap ❑Paper towel
B Minimize food handling,other than ready-to-eat,with bare hands C Handwash sink(s)clean/waste receptacle at handwash sink 00,
C Adequate utensil(s)for dispensing food/ice LT I I0
O Ll •DESCRIBE DEFICIENCIES ON CONTINUATION SHEETS
The following information is not debitable and does not affect your score. KEY: QFO[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:
Are internal cooking temperatures taken? Y N *To what temperature d you cook:
Poultry Ground Beef P What diseases related to FB illness are you required to re a local health department?
Roasts Other
Describe re-heating procedures: Is there a written illness policy that re a food worker to report specific illness conditions
Are temperatures recorded/logged for cold holdi s/equipment? Y N and diseases to the QFO? Y ♦Do you have a paid sick leave policy? Y N
Are foods cooked in advance and ? Y N *Are leftovers saved? Y N Is there a language er between inspector&QFO? Y N If ves indicate language spoken
List products cooled: by QFO/DA: *Can the QFO/DA read the inspection report? Y N
Describe cooling hods: 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 monit red for time&temp? Y N Is the monitoring of cooling recorded? Y N .Obtain signature of the person who received the CFO 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. K)bYrYr ^' Date of Inspection: j 0
ddress: l(1) IS,�dv,.a,4A CJS4 t^� Owner or Operator:
ADDITIONAL FOUR POINT ITEMS ca
KEY: DNC [DOES NOT COMPLY] z
6 Foods not re-served. 5L
sir 31 Sewage disposal approved.
-Unwrapped foods not re-servedx 4
-Potentially hazardous foods not re-served -Operating as required
11 Toxic chemicals. No cross connections,back siphonage,backflow
4, Proper type/installation/backflow prevention device/air gap for:
-Stored properly,labeled properly,used properly -Food equipment -Hose connections -Dish machines
-San itizer concentration notto exceed maximum permitted r -Soda system carbonator -Beverage dispensers -Toilet tanks
-No unnecessary toxics on the premises -Chemical dispensers -Ice machines
-Pesticides/rodenticides properly dispensed >s' Proper drain for:
29 Water source adequate,safe. -Food equipment -Dish machines -Ice machines
-Well/wellhead protected from contamination 35 Toilet facilities. Adequate,convenient,accessible, 4
-Water quality in compliance � designed,properly installed
-Monitoring in compliance
OTHER ITEMS KEY: DNC [DOES NOT COMPLY]
2 Sourcesof food: Original container,properly labeled }' 0 Garbage/rubbish storagearea/rooms,enclosures-properly constructed,clean [ 1
5 Potentially hazardous food properly thawed r' 1 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 Outeropenings protected against entrance of insects/rodents 1
y
4 Floors: Floor covering installed,constructed as required,good repair,clean 1
16 Food-contact surfaces designed,constructed,maintained,installed, 45 Floors graded,drained as required
9 q
located6 Floor,wall juncture covered
17 Nonfood-contact surfaces designed,constructed,maintained, X 7 Mats removable,good repair,clean
installed,located
Single service articles,storage,dispensing u
8 Exterior walking,driving surfaces,good repair,clean
18 1
19 No reuse of single service article 9 Walls,ceilings attached,equipment properly constructed,good i
repair,clean.Wall&ceiling surfaces as required
20 Dishwashing facilities approved design,adequately constructed,
maintained installed located 50 Dustless cleaning methods used,cleaning equipment properly stored
Equipment&Utensils: Cleanliness qrp 51 Adequate lighting provided as required 1'
21 Prefiushed,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
2 Nonfood contact surfaces of utensils&equipment clean 55 Establishment and premises free of litter,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
58 No live birds,turtles,or other animals(except guide dogs)
36 Toilet rooms enclosed with self-closing door
59 Seats 75 or more:Nonsmoking area provided,sign(s)posted at
37 Proper toilet fixtures provided,good repair,clean
entrance(s),smoking area indicated by sign(s)
39 1 Approved garbage/rubbish containers,adequate number,covered,
rodent proof,clean gWoutine Inspection ❑Reinspection ❑ Preoperational Inspection
Other Inspection:
INSPECTOR: PERSON IN CHARGE: Demerit Score: *Include demerits from page 1
4 3 2 1 Total Rating
sign ture nature
M,l �J��vl Mtno.rr�- p p
print name print name
5-410-I K-20 a DATE CORRECTIONS DUE:
phone number � ,�j title
•G"�'� 11 Page 2 of 2 plus continuation pages Focused Inspecti�1/2002
Page of
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INSPECTION REPORT STATE OF CONNECTICUT
FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH
CONTINUATION SHEET
NAME
�O,F,ESTABLISHMENT TOWN DATE OF INSPECTION
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INSPECTION FORM# REMARKS
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INITIAL(INSPECTOR) INITIAL(PERSON IN CHARGE)
Distribution: lst-White-Health Department 2nd-Yellow-Owner/Manager