HomeMy WebLinkAboutFood Service Establishment Inspection 17 (28) -7 7,
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Establishment: Inspection Date: z.� Time: R Ins ins
Address/City: Health Dept: Class: 1 2 3
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 DNC I KEY: C[complies] N/O[not observed] NIA[not applicable]
MI Qualified`Food Operator 3 DNC[does not comply] 0[other] RTE[ready-to-eat]
S7 lesignated,Atternae ,� 2
12 :Personnehwith infection resfriated s C ;Nlt3 NIA 4'.
A Food workers have no exposed infected lesions f burns
62 j ,Wrltten documentation of training program 2 B Personnel with infection restricted
1 ApproVe�l Source,wholesome;Donadufterated' :C° N10 N/A -4' C Communicable disease of worker reported to local health director
A Approved shellfish,finfish,meat& Quit USDA approved 13 Handwashing facillit[es provided, hands washed;clean C N/d N/A 4'
6 Food cans in good condition(not dented,rusty,bloated,leaking) A Handwash facilities in all food prepldispensing&warewash areas
C WholesomelnOnadulteratedfoodSlsafe B Handwash facilities in or immediately adjacent to toilet rooms
D Commercial products(no home grown/canned food) Y— 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
3 3Rotenttsl[y hazardous foo4l meets temperature equire'mehts C,Nl0 N/A]�4'
+ a i d�nng•starage,preparatipn,display,servlge and transportatioi' 0
t.. 15 ,Good hygiertie pealctices
A Hot holding greater than or equal to 1400F. (whole beeflpork roasts 1300F.l A ❑ No eating ❑ No smoking whileworking
B Cold holding less than or equal to450F. B Wounds covered adequately X
C Proper cooling C Proper sink used for handwashing
D Proper re-heating 0
E Praperinternal cooking l consumer advisory posted [24"„Sariitizatton�rise�h$fvpater��,-=chemidalj' :.; ",C �NIOrNJA 2
Approved sanitizer available/adequate concentration of sanitizer
o , ' equate iac]I�tfs.fo�maintarn�prdet, , '; C, 'N/0 t7 Food-contact surfaces and utensils used for potentially
p+3raure,thermorteters.provided� hazardous food sanitized at least every 4 hours
x4,, .u lydl A Food thermometer available and accurate C Adequate ❑dishwasher sanitizer ❑final rinse temp
B Proper food thermometer for product
D Proper sanitizing procedure
E Sanitizing between raw animal origin&ready to eatfood
C Thermometers appropriately placed in cooler units 0
0 125 Clean°vs p�jng;clQ hs v
� ro scted#dtfirioj storaee� e� r4.tion,� C` �110 ,' l/A `9Y.
t d, �,, Ac- ,„ 9 � w y�E`N� Nl 2 A Cloths and/orsponges in
( r �$ I ? ,a" tns °a ! 9 good repair and clean
A Produce washed n B Wiping cloths kept in sanitizer between uses
0
B Raw meats not stored/prepared near ready-to-eat foods i
6? oaYnacsu aceslear C fN/0#
C Food covered properly
A Food equipment clean,utensils clean ipment interiors cleat
D Adequate splash guards 1 sneeze guard g Single use gloves changed when s '
E No unauthorized personnel C Food--oontactsurfaces clean
F No pooling of eggs not cooked immediately 0
8 Food containers stored off the floor a p
30 t Motand coldwatr iu 8er �essure,provided as require [Nr .;NIA{12.
0 n [
(9b-0;Htdlin �offood:fnin�mized �, 38}Hoftdwalirig,accessonesYprbvttled NIO ',(U!� 1
9'' . , M . �.Y .� ,C VE) �. r
A 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,otherihan ready-to-eat,with bare hands & C Handwash sink(s)clean/waste receptacle at handwash sink
C Adequate utensils)for dispensing food/ice 0
0 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 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 o 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 illnes policy that requires the food worker to report specific illness conditions
Are temperatures recorded/logged for cold holding foods/equipment? N and diseases to the O? Y N *Do you have a paid sick leave policy? Y N
Are foods cooked in advance and cooled? Y N *Are lefto rs saved? Y N Is there a langua barrier between inspector&QFO? Y N Iflf ves indicate language spoken
List products cooled: by QFOIDA: *Can the CFO/DA read the inspection report? Y N
Describe cooling methods: Indicate wh answered the above questions:Name(print):
Indicate he title of above person(circle all that apply):CFO DA Mgr Cook Owner FW
Is cooling monitored for time&temp? Y N Is the mon'oring of cooling recorded? Y N •Obtai�' nature o the pe w receNEd the QFO responsibilities irtformatien at the time of the
Is there a produce washing policy? Y N ♦Descri a what is washed and in
where: Note; This report is a two page form(total of 62 debitable items) Page 1 of 2
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S7'�4E,+E OF CONNEC7IUT DEPARTMENT bF PLIt3LIC.HEAL7H-41 fl GAP17QiL AVENUE-MS#51 FDP-I IARTFORD,CT. fl8134
t Ff?C C7SE t�Ob SlEkv ,..INS EtvTiOREPORT
LTH DEADDRESSICITY.
Esiabltsfiment_ date,of Inspection: 2
digress, ,; 4 Owner or..',Operator:
ADDITIONAL FOUR POINT ITEMS ' y
KEY: DNC [DOES NOT COMPLY]
6 Foods not re-served.
-Unwrapped foods not re-served 4 31 Sewage disposal approved. 4
-Potentially hazardous foods not re-served -Operating as required
11 Toxic chemicals. No cross connections,back siphonage,backflow 4
4 Propertvnelinstallationl backf Qw 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
-Pesticideslrodenticides properly dispensed Proper drain for;
29 Water source adequate,safe. -Food equipment -Dish machines -Ice machines
-Well I well head protected from contamination 35 Toilet facilities, Adequate,convenient,accessible, 4`..
-Water quality in compliance
-Monitoring in compliance designed,properly installed
OTHER ITEMS Q', KEY: DNC [DOES NOT COMPLY]
r
2 Sources of food:Original container,properly labeled 1 0 Garbageirubbish storage arealrooms,endosures-propedy constructed,clean
rl;
5 Potentially hazardous food properly thawed 2 41 Garbagelrubbish disposed of in an approved manner,at approved frequency
10 Food dispensing utensils properly stored 1 42 Vermin Control: No insectsirodents present 2'
14 Food worker:Clean outer clothes,effective hair restraints ;4 3 Outer openings protected against entrance of insects/rodents Y
4 ors: Floor covering installed,constructed as r wired,gootf repair,clean
16 Food-contact surfaces designed,constructed,maintained,installed, 2' Floors graded,drained as required
located
6 Floor,wall juncture covered
17 Nonfood-contact surfaces designed,constructed, maintained, 1; 7 Mats removable,good repair,clean
installed,located Rl
8 Exteriorwalking,driving surfaces,good repair,clean
18 Single service articles,storage,dispensing 2
{ 9 Walls,ceilings attached,equipment properly constructed,good Al
19 No reuse of single service article E £�
repair,clean.Wall&ceiling surfaces as required
20 Dishwashing facilities approved design,adequately constructed, 2
maintained installed located 50 Dustless cleaning methodsused,cleaning equipment properly stored &1w
Equipment&Utensils: Cleanliness 1 51 Adequate lighting provided as required wl'
21 Preflushed,scraped,soaked and racked 52 Room free of steam,smoke odors 1-1.
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
27 Nonfood-contact surfaces of utensils&equipment clean 1= 55 Establishment and premises free of litter,no insectirodent harborage, q
28 Equipmentlutensils,storage,handling 1
no unnecessary articles
32 Proper disposal of wastewater 1 56 Complete separation from living/sleeping quarters and laundry j{3
57 Clean/soiled linens stored f
33 Plumbing location,installation,maintenance 1 properly
f'1'
58 No live birds,turtles,or other animals(except guide dogs) 1
36 To 1 let room s enclosed with self-closing door ;
1 59 Seats 75 or more:Nonsmoking area provided,sign(s)posted at
37 Proper toilet fixtures provided,good repair,clean ,,.3'
entrance(s),smoking area indicated by sign(s)
39 Approved garbagelrubbish containers,adequate number,covered, ;
rodent proof,clean Agoutine Inspection ❑Reinspection ❑ Preoperational Inspection
I CTOR: PERSON IrLCk1�13GE: Other Inspection:
Demerit 5c91e: *Include demerits from page 1
c 4 3 2 1 Total Rating
signature IfIgInature
ee
N
name r_y?
nt nam��G� lS� '� h DATE CORRECTIONS DUE:
phone number
�,yCl� Page 2 of 2 plus continuation pages F—sedInapectlon 12002
4
DATE FIN PECTION
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