HomeMy WebLinkAboutFood Service Establishment Inspection 17 (29) a Ulm
Establishment: inspection Date: r Time: ;/p insp Einsp
Address/City: e7/ Heal h Dept: 2 4
Based on an inspection this day,the items marked DNC ideli 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 NIO NIA DNC KEY: C[complies] NIO[not observed] NIA[not applicablel
60 10'..IMed Foot!Operator 9 DNC[does not comply] 0[other] RTE(ready to-eat]
7 Personnel with:infection re'sfrtcted C ,fJl(? NIA A
61 ,Degndted Alternate 2
q Food workers have no exposed infected lesions 1 burns
riften docurnentatlon of tralnirt program
B Personnel with infection restricted
r1 pprQ source,wholesome,nona�d0IN4 ted is N/0 N/
_ i municable disease of worker reported to local health director
A Approved shellfish,finfish,meat&poultry USDA approved H dwashmg facihtres provided;�tandswashed,clean C NlO 4
B Food cans in good condition(not dented,rusty,bloated,leaking) Handwash facilities in all food prep/dispensing&warewash areas -�
C Wholesomelnonaduiterated foods/safe
B Handwash facilities in or immediately adjacent to toilet rooms
D Commercial products(no home grownkanned food) C Handwash facilities access!blelconvenient to use
E Potentially hazardous foods received at proper temperature D Personnel hands washed,clean I Proper handwash procedure
E Handwashing at appropriate times
o e`ntrally hazardogs gdineets temperature tegl irements C N10
dunngsstorage,prepar;ltionr displays seNide and transportation. r i
! } x ¢ _ ;. s t I i.15 t'ood*hygienlcprac�tices C NID` w 2 A Hot holding greater than or equal to 1400F. (whose beeflpork roasts 13DOF.) A o No eating ❑ No smoking while working
B Cold holding less than or equal to45oF. B Wounds covered adequately
C Proper cooling C Proper sink used for handwashin
D Proper re-heating 0
E Proper internal cooking lconsumer advisory posted 14t n ri r4i awaer sN10 2'
l Approved sanitizeravailableladequate concentration ofsanitizer
f4 ;,.rAdequate f,Aa [�it to mantatnrbMs`cty •„ G l[�]I04 r ,gZ Food-contact surfaces and utensils used for potentially
F teme`mire;theranb}�r ro►rided s '' ` $"4 hazardous food sanitized at least every 4 hours
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A Food thermometer available and accurate C Adequate ❑dishwashersanitizer ❑final rinse temp
B Properfood thermometer forproduct
D Proper sanitizing procedure
• '7 ermo meters appropriately placed in coolerunits E Sanitizing between rawanimal origin&ready-to-eat food
F otl protec ra�11, -'pr.n.g. dya,Otahke lN 3}
4,ted during stiA " T1 ° 1y
v 14>W Cloths andlorsponges in good repair and clean
drsla rservice and trnepot
B Wiping cloths kept in sanitizer between uses
A Produce washed
B Raw meats not storedlprepared near ready-to-eat foods Orood
C Food covered properly equipment clean,utensils clean,equipment interiors clean
D Adequate splash guards l sneeze guard g ingle use gloves changed when soiled
E No unauthorized personnel C Food contactsurfacesctean
0 ooNng of eggs not cooked immediately 0
od containers stored offthe floor r `?Hot an 10ji,w 4ater underprepski e;prguJdec es:required' r 0 NJ�fi 3
O .. t"• Te 53 iy Ii5 T..:
dwashind"abce�sories providttd� ' 'f 'c 'N!0 A'
;� rca x. _
[C� Nl0 N!A ( q�Soap 1 paper towels l drying device available
A No unnecessary handling RTE and/or cooked foods with bare hands B Dispenser(s)working: ❑Soap ❑Paper towel
B Minimize food handling,otherihan ready-to-eat,with bare hands C Handwash sink(s)clean Iwaste receptacle at handwash sink
C Adequate utensil(s)for dispensing foodlice 0
0 1 ESCRIBE 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: IF, Pli 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 food slequipmem? Y N and diseases to the QFO? Y N *Do you have a paid sick leave policy? Y N
Are foods cocked in advance and cooled? Y N *Are leftovers aved? Y N Is there a guage barrier between inspector&QFO? Y N If yes indicate language spoken
List products cooled: by QF A: *Can the QFOIDA read the inspection report? Y N
Describe cooling methods: I icate who answered the a ve estions: ame(print):
Is cooling monitored for time&temp? Y N Is the monilori of cooling recorded? Y N •ndicate the title of oho e p on ircle all th apply):QFO DA Mgr Cook Owner FW T
Obtain signature f t "on
w o received a QFO at i=ime ]theIs there a produce washing policy? Y N ♦Describe w at is washed and pection:where: Note: This repo f I of 62 de
two page bits I Page 1 o
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ST�r T (XF CONNECTICtaT,r O� AR'_MENT OE PUSLIC HEgLTF� 410 QAPITQIrAYENUE--MS#51FDP HARTFORD,CT 06134.
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Establishment. ' �` : Date of.,Inspection.
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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
No cross connections,back siphonage,backflow
11 Toxic chemicals. 4
4 Proper typelinstallationl 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 unnecessarytoxics on the premises -Chemical dispensers -Ice machines
-Pesticideslrodenticides properly dispensed Proper drain for:
29 Water source adequate,safe. -Food equipment -Dish machines -Ice machines
4
-Well/well head protected from contamination 35 Toilet facilities. Adequate,convenient,accessible, 4
-Water quality in compliance
-Monitoring in compliance designed,properly installed
OTHER ITEMS z Z
o KEY: DNC [DOES NOT COMPLY];
2 Sources of food: Original container,property labeled 1 0 Garbagelrubbish storage area/rooms,enclosures-properlyoonstructed,dean
5 Potentially hazardous food properly thawed 2 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 t 43 Outeropenings protected against entrance of insects/rodents 1<
4 oors: Floor covering installed,constructed as required,good rep �r,clean"
1food-contact surfaces designed,constructed, maintained,installed, 5 Floors graded,drained as required
� Ioted
6 Floor,wall juncture covered
17 No ood-contact surfaces designed,constructed,maintained, 47 Mats removable,good repair,clean
installed,located
2'.
S Exterior walking,driving surfaces,good repair,clean
18 'Single service articles,storage,dispensing Ip
19 No reuse of single service article 9 Walls,ceilings attached,equipment properly constructed,good ;1`u
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 propedy stored
Eauioment&Utensils• Cleanliness ri 51 1 Adequate lighting provided as required .;
=.
21 Preflushed,scraped,soaked and racked 52 Room free of steam,smoke odors d"
22 Wash water clean,proper temperature a
53 Rooms&equipment hoods,ducts,vented as required t <;
3-3 urate thermometers provided,dish basket,if used Rooms adequate,clean,adequate lockers provided,facilities clean '1
2 •nfood-contact surfaces of utensils&equipment clean
5 Establishment and premises tee of liter,no insect/rodent harborage, 1
8 qumentlutensiis,storage,handlingLL no unnecessary articles
2 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
b 59 No live birds,turtles,or other animals(except guide dogs) 1;
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) 3„
39 Approved garbage/rubbish containers,adequate number,covered, 1;
rodent proof,clean aRoutine Inspection ❑Reinspection O Preoperational Inspection
CTOR: PERSON IN CHARGE: ther Inspection:
Demerit Score: *Include demerits from page 1
4 3 2 1 Total Rating
signature signature
L � 1pa m �-nt name / print nae iQ _
6`{� / ------- DATE CORRECTIONS v z�r� -
phone number title .�
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INSPECTION REPORT STATE OF CONNECTICUT
FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH
CONTINUATION SHEET
NAM/E�OF ESTABLISHMENT TOWN DATE OF INSPECTION
INSPECTION REMARKS
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Page of
INSPECTION REPORT STATE OF CONNECTICUT
FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH
CONTINUATION SHEET
NAME OF ESTABLISHMENT TOWN DATE OFF INSPE TION
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INSPECTION! REMARKS
FORM#
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INITIAL(INSPECTOR) INITIAL(PERSON IN CHARGE)
Distribution: 1st-White- ealth Department 2nd-Yellow-Owner/Manager
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