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HomeMy WebLinkAboutFood Service Establishment Inspection 10 (6) Establishment: w Inspection Date: �l IT-Time:( RO[nsp Einsp � Address/City: v r W Health Dept: S . ice, nd.4 v1 Class: z 3 Based on an inspection this day,the items marked DNC Identify the violations in operation orfacilities which must be corrected by the date specified on page 2. CTOR ITEMS: Listing is not inclusive of all possible d itable items C N/O W NC C[complies] NIO[not observed] NIA[not applicable] 3 DNC[does not comply] 0[other] RTE[ready-to-eat] 1AA2pproved A Food workers have no exposed lesions l burns g f[±Etn, nt[tu far zB Personnel with infection restricted + e Whd t?t 'n tta€Ttrt rrt i G l l N/A 4 C Communicable disease of worker reported to local health director shellfish,finfish,meat&poultry USDA approved B Food cans in good condition(not dented,rusty,bloated,leaking) 13, "art ng fac�[t��es A Handwash facilities in all food prep/dispensing&warewash areas C Wholesome/nonadulteratedfoodslsafe 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 -M_W�M-W—MMO �: 0: NtA A Hot holding greater than or equal to 1400F. (wnoie beefiiporkroasils fsoo F) V A ❑ No eating ❑ No smoking while working B Cold holding less than or equal to 450 F. B Wounds covered adequately Li C Proper cooling C Proper sink used for handwashing D Proper re-heating 0 E Proper internal cooking 1 consumer advisory posted 0 A Approved sanitizer available/adequate concentration ofsanitizer B Food-contact surfaces and utensils used for potentially hazardous foods itized at least every 4 hours ;B , Food thermometer available and accurate C Adequate ishwashersanitizer ❑final rinse temp Proper food thermometer for product D Proper sanitizin procedure E Sanitizing between raw animal origin&ready-to-eat food Thermometers appropriately placed in cooler units 0 { A f Cloths and/or sponges in good repair and clean s - Produce washed B Wiping cloths kept in sanitizer between uses 0 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 I 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 / / A No unnecessary handling RTE and/or cooked foods with bare hands Soap paper towels drying device available� � B Dispenser(s)working: ❑Soa B Minimize food handling,other than ready-to-eat,with bare hands C Handwash sink(s)cliwaste receptacle at han C Adequate utensil(s)for dispensing food/ice to0 O 1 •DESCRIBE DEFICIENCIES ON CONTINUATION SHEETS The following information is not debitable and does not affect your score. _M: QFO[qualified food operator],DA[designated altematel,PHF[potentially hazardous food],FB[foodborne] PHFs are hot held at: OF. 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 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 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): 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 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 rep rt is a two page form(total of 62 debitable items) Page 1 of 2 7Establ,iishrnent: �� vu• 1 i t2 s Date of Inspection:s: 6 W Owner or Operator: fiY)d-e\ hC,t/et.' 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. 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 designed,p -Monitoring in compliance roperly installed OTHER ITEMS KEY: DNC [DOES NOT COMPLY] 2 Tources of food: Original container,properly labeled 40 Garbage/rubbish storage area/rooms,enclosures-properly constructed,clean 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 6, surfaces designed,constructed,maintained,installed, 5 Floors graded,drained as required �od-contact cated 6 Floor,wall juncture covered 7 N nfood-contact surfaces designed,constructed,maintained, 7 Mats removable;good repair,clean nstalled,located 18 Single service articles,storage,dispensing 481 Exterior walking,driving surfaces,good repair,clean 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 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 Nonfood-contact surfaces of utensils&equipment clean 55 Establishment and premises free of litter,noinsect/rodentharborage, 8 quipment/utensils,storage,handling no unnecessary articles 32 Proper disposal of wastewater 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) 59 Seats 75 or more:Nonsmoking area provided,sign(s)posted at 37 Propertoiletfixturesprnvided,good repair,clean entrance(s),smoking area indicated by sign(s) 39 Approved garbage/rubbish containers,adequate number,covered, rodent proof,clean EfRoutine Inspection ❑Reinspection ❑ Preoperational Inspection Other Inspection: INSPECTOR: P N N HA Demerit Score: *Include demerits from page 1 Z, A, 01 4 3 2 1 Total Rating si ature si , 5 z in name\ print name C�1 6 1���� 2�� SUWf Q-tM( phone number DATE CORRECTIONS DUE: 1 title Y, Page 2 of 2 plus continuation pages Focused Inspection 1/2002` Page of 2 INSPECTION REPORT STATE OF CONNECTICUT FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH CONTINUATION SHEET NAME OF ESTABLISHMENT TOWN DATE OF INSPECTION u L W`A o I Z_w INSPECTION REMARKS FORM# / S ( J I& L-J(JQ,0U0A__ CLA iLv bo&'�_. 62� rodc, e�� Q c bppjF ` (_4v, La 0 ©\L _ CIAU d s"4 v- LAj �-; Jj INITIAL(INSPECTOR) INITIAL(PERSON IN CHARGE) Distribution: 1st-White-Health Department 2nd-Yellow-Owner/Manager