HomeMy WebLinkAboutFood Service Establishment Inspection 94 (3) Establishment: S Inspection Date: L- -u Time: 11gi, C ROinsp Einsp
ddress/City0A ja ���Uan �Vf. Health Dept: GtI ✓ Class: f 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 debitable items C /0 I N/A I DNC {KEY_: C[complies] NIO[not observed] NIA[not applicable]
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4
3 DNC[does not comply] 0[other] RTE[ready-to-eat]
" 2 1' eranl wlth;infect�an res#rioted NI0 NIA 4 '
„ A Food workers have no exposed infected lesions/burns
2 B
° Personnel with infection restricted Ll
Ts �s C Communicable disease of worker reported to local health director
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B Food cans in good condition(not dented,rusty,bloated,leaking) pro�itli,itt> !tsted,clean'' -C 1410 NIA 4
A Handwash facilities in all food prep/dispensing&warewash areas
C Wholesome/nonadulteratedfoods/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 I Proper handwash procedure
0
E Handwashing at appropriate times
00-
110" R1 10 MM"
v O �5 kidcd'ity�enfc practices. C. NI0 NIA 2
A Hot holding greater than or equal to 1400F. (whole beef/porkroasts 1300 e) A O No eating ❑ No smoking while working
B Cold holding less than or equal to 450 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 24 a ltiotvoFn.rinse(hots"water cherxti ) e W03 WA' 2
0 A Approved sanitizer available/adequate concentration ofsanitizer
F
' f �lQo
ot C QI/ Nib ' g Food contact surfaces and utensils used for potentially
{ praire rr► ' �s.pltwi�i hazardous food sanitized at least every 4 hours
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A Food thermometer available and accurate C Adequate dishwashersanitizer ❑final rinse temp
D Proper sanitizing procedure
B Properfood thermometerfor product
E Sanitizing between raw animal origin&ready to-eat food
—
C Thermometers appropriately placed in cooler units
0 0
limp2S Gis n Wiping;olo#hs -two: N6A N—MMIN MIN, 1
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/preparednearready-to-eat foods 0
� �ti . ► NIA .:
C Food covered properly �` . �. �-
A Food equipment clean,utensils clean,equipment interiors clean 5
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 0
Food containers stored off the floor
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pifiovfdet NOW
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No unnecessary handling RTE and/or cooked foods with bare hands A Soap paper towels drying device available
B
Dispenser(s)working: ❑Soap ❑Paper towel
B Minimize food handling,other than ready-to-eat,with bare hands C I Handwash sinks)clean I waste receptacle at handwash sink
C Adequate utensil(s)for dispensing food/ice TE] i . 0
0 *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 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 ILyes 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):UFO 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 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 f of 2
ES a tishment: V-W eo� -r- " %-k4 r Dale of Inspection:
Address: A SKA It�iil - t Owner or Operator:
ADDITIONAL FOUR POINT ITEMS KEY: DNC [DOES NOT COMPLY]
6 Foods not re-served.
-Unwrapped foods not re-served 4 31 Sewage disposal approved. 4`'
-P0tE;r1'LiC-1IIy hazardous foods i lot re-served -Operating as required
1 Toxic chemicals. No cross connections,back siphonage,backflow 4
1 4 Proper type/installation/backflow prevention device/air gap for:
-Stored properly,labeled properly,used properly -Food equipment -Hose connections -Dish machines
-Sanitizer concentration not to exceed maximum permitted -Soda system carbonator -Beverage dispensers -Toilet tanks
-No unnecessary toxics on the premises -Chemical dispensers -Ice machines
-Pesticides/rodenticides properly dispensed Proper drain for:
29 Water source adequate,safe. 4 -Food equipment -Dish machines -Ice machines
-Well/well head 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] n
2 Sources of food: Original container,properly labeled 1 0 Garbage/rubbish storage area/rooms,enclosures-properly constructed,clean 1
Potentially hazardous food properly thawed 41 Garbage/rubbish disposed of in an approved manner,at approved frequency
Food dispensing utensils properly stored 42 Vermin Control: No insects/rodents present 2
14 Food worker:Clean outer clothes,effective hair restraints 1 43 Outeropenings protected against entrance of insects/rodents 1
4 Floors: Floor covering installed,constructed as required,good repair,clean i
16 Food-contact surfaces designed,constructed,maintained,installed, 2 45 Floors graded,drained as required
located
6 Floor,wall juncture covered
17 Nonfood-contact surfaces designed,constructed,maintained, 1 47 Mats removable,good repair,clean
installed,located _-
8 Exterior walking,driving surfaces,good repair,clean
1
18 Single service articles,storage,dispensing 2
19 No reuse of single service article 9 Walls,ceilings attached,equipment properly constructed,good 1
repair,clean.Wall&ceiling surfaces as required
20 Dishwashing facilities approved design,adequately constructed, 2
maintained installed located 50 Dustless cleaning methods used,cleaning equipment properly stored i
Equipment&Utensils: Cleanliness 1 51 Adequate lighting provided as required 1
21 Preflushed,scraped,soaked and racked 52 Room free of steam,smoke odors 1
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 1
271 Nonfood contact surfaces of utensils&equipment clean 1 55 Establishment and premisesfree of litter,no insect/rodent harborage, 1
28 Equipment/utensils,storage,handling 1 no unnecessary articles
32 Proper disposal of waste water 1 56 Complete separation from living/sleeping quarters and laundry 1
33 Plumbing location,installation,maintenance 1 57 Clean/soiled linens stored properly 1
36 Toilet rooms enclosed with self-closing door
58 No live birds,turtles,or other animals(except guide dogs) 1
1
59 Seats 75 or more:Nonsmoking area provided,sign(s)posted at
37 Propertoiletfixturesyrovided,good repair,clean 3
entrance(s),smoking area indicated by sign(s)
39 Approved garbage/rubbish containers,adequate number,covered, 1_;
rodent proof,clean ITRoutine Inspection ❑Reinspection ❑ Preoperational Inspection
Other Inspection:
IN E TOR: rl PE SO (IN CHARGE: Demerit Score: *Include demerits from page 1
�J 4 3 2 1 Total Rating
s' ture gnature
print name r� pr t name X xu�f M06 V0���' `r `� ��� DATE CORRECTIONS DUE:
phoYie number title
1( Page 2 of 2 plus A_continuation pages Focused Inspection 112002
Page of
INSPECTION REPORT STATE OF CONNECTICUT
FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH
CONTINUATION SHEET
NAME OF ESTABLISHMENT TOWN DATE OF INSPECTION
r
INSPECTION FORM# REMARKS
2
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(AY Q G S S V T Y\ w G
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INITIAL(INSPECTOR) INITIAL(PERSON IN CHARGE)
Distribution: 1st-White-Health Department 2nd-Yellow- Owner/Manager
Establishment: t, ;0 Inspection Date: L-0 Z Time: 11 RO[nsp Einsp
ddress/City-c<y Al,e. Health Dept: 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 debitable items 0 I WA DNC KEY: C[complies] NIO[not observed] NIA[not applicable]
3 DNC[does not comply] 0[other] RTE[ready-to-eat]
2
A Food workers have no exposed infected lesions/bums
2 B Personnel with infection restricted
C Communicable disease of worker reported to local health director ✓
B Food cans in good condition(not dented,rusty,bloated,leaking) A Handwash facilities in all food prep/dispensing&warewash areas
C Wholesome/nonadulteratedfoods/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 1400F. (wmoie eeevporx roasts 1300 F.) A ❑ No eating ❑No smoking while working
B 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
0 A Approved sanitizeravailable/adequate concentration ofsanitizer
B Food-contact surfaces and utensils used for potentially
hazardous food sanitized at least every 4 hours
A Foodthermometeravailable and accurate C Adequate Eirdishwashersanitizer ❑final rinse temp
D Proper sanitizin procedure
B Properfood thermometerfor product E Sanitizing between raw animal origin&ready-to-eat food
C Thermometers appropriately placed in cooler units
0 0
A Cloths and/orspongas in good repair and clean
A Produce washed
B Wiping cloths kept in sanitizer between uses
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 0
Food containers stored off the floor
No unnecessary handling RTE and/or cooked foods with bare hands A Soap/paper towels I drying device available
B Dispenser(s)working: ❑Soap El Paper towel
B Minimize food handling,other than ready-to-eat,with bare hands C Handwash sink(s)clean/waste receptacle at handwash sink
C Adequate utensil(s)fordispensingfood/ice 0
0 •DESCRIBE DEFICIENCIES ON CONTINUATION SHEETS
The following information is not debitable and does not affect your score. _M: QFO[qualified food operator],DA[designated aftemate],PHF[potentially hazardous food],FB[foodbome]
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 do you cook:
Poultry Ground Beef Roasts Other Pork What diseases related to FB illness are you required to report to the local health department?
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 )f ves 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 report is a two page form(total of 62 debitable items) Page 1 of 2