HomeMy WebLinkAboutFood Service Establishment Inspection 29 (7) soul
Establishment: Inspection Date: 1 q /6 Time: J 4^ Rl insp
ddresslCity: Health Dept: S class: f
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 N10 NIA IONCI KEY: C[complies] NIO[not observed] NIA[not applicable]
fib �j peratQr 3
DNC[does not comply] 0[other] RTE[ready to-eat]
1� Personnel with infection restricted
tit EDlnated hltemate u
2 C 'N10'.NIA 4
Food workers have no exposed infected lesions 1 burns
fit FORMOli►neRt3t10�pftrainlrig pPO�rdh! 2 B Personnel with infection
restricted
mno ete Cpp Communicable disease of worker reported to local health director
A Approved shellfish,finfish meat&poultry USDA; roved A3, Ft0c�t+lif�e trig faciUttesmprov�ded,h +ivasiie",'Cle, E Cs NtO NIA '4
B Food cans in good condition(not denied,rusty,bloated,leaking) A Handwash facilities in all food prep/disl&warewash areas
C Wholesome/non adulterated foods/safe B Handwash facilities in or i media ey d] cent to toilet rooms
D Commercial products(no home grownlcanned food) 4 C Handwash faci' es ac ' !c nient to use
E Potentially hazardous foods received at proper temperature D Personnel h wa a handwash procedure
E Han dwashin propriate times
3 �E'ot ittta l h AlaU Q�!'nleefs 0,00era1 �t'Qq lreme P q Nl� 4 0
} during�s araga preparation'disp,iay,4rvfti♦end transporiatiop; }
r 7 rs�4dtY9�e ci vas C.; l70 NIA 2
A Hot holding greater than or equal to 140 F. (whoia beettpork roasts fso°e) sG A ❑ No eating Q No smoking while working
B Cold holding less than or equal to450F. B Wounds covered adequately
C Proper cooling C Proper sink used for handwashing
D Proper re-healing
JIL
E Proper internal cooking 1 consumer advisory posted
r2 .' itiCatian'ritee h't`water; ° r ]N10; NIA °?
0 Approved sanitizeravailableladequate centrationofs nifize
rr1 � r yaYiiir } uir B Food contact surfaces and utensils used for poten ra y
� � ertnbrneteta pro�r�et �, i F hazardous food sanitized at least every 4 hours
A Food thermometer available and accurate C Adequate ❑dishwashersanitizer ❑final rinse temp
D Proper sanitizin rocedure
B Proper food thermometer for product E Sanitizing between raw animal origin&ready-to-eat food
C Thermometers appropriately placed in cooler units
0 oll
_ ? ;1
Cloihs and/or sponges in good repair and clean
B Wiping cloths kept in sanitizer b etwee n uses
A Produce washed 0
B Raw meats not stored/prepared near ready-to-eatfoods `, � rciSntCt strfa es dleanrt - g a C iWo NIA 2
C Food covered properly A Food equipment clean,utensils clean,equipment interiors clean
D Adequate splash guards I 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
8 Food containers stored offthe floor ate "antler pr s�trre,prbartderi aS;fequfred, 0 �N1A ,2')
Ey I ,. art va k oc k' .6
0 f g�ccessori�s provided .i C � 0 ;;NIA 1
' a dw� In �. - .. rNI
z A Soap I paper towels hdrying device available
A No unnecessary handling RTEandlorcooked foods with bare hands B Dispenser(s)working: ❑Soap ❑Paper towel
B Minimize food handling,other than ready-to-eat,with bare hands C Handwash slnk(s)clean/waste receptacle at handwash sink
C Adequate utensil(s)for dispensing food/ice o
O 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 aTemate],PHF[potentially hazardous food],FIB[feodborne]
PHFs are hot held at: IF. Pl are cold held at: OF. Describe illness conditions when you would exclude a food w from working:
Are internal cooking temperatures taken? Y N ♦To what temperature do you cook:
Poultry Ground Beef Pork 1hat diseases related to FB illness are you requ' o report to the local health department?
Roasts Other
Describe re-heating procedures: Is there a written illness policy tha Tres the food worker to report specific illness conditions
Are temperatures recordedilogged for cold holding foodslequipment? Y and diseases to the QFO *Do you have a paid sick leave policy? Y N
Are foods waked in advance and cooled Y ♦ re left saved? Y N Is there a language barrier between inspector&QFO? Y N l indicate language spoken
List products cooled: by QFOIDA: ♦Can the QFOIDA read the inspection report? Y N
Describe cooling methods: Indicate who answered the above questions: Name(print):
Indicate the title a person(circle all that apply):QFO DA Mgr Cook Owner FW
Is cooling monitored for Time&temp? Y N the monitoring of cooling recorded? Y N ,obtain at re of he person who received the QFO responsibilities information at the time of the
s there a produce washing policy? Y N ♦Describe what is washed and in
ction: �
where: Note: fhihereport is a two page form(total of 62 debitable items) Page 1 of 2
_ `}T bf}{O N , :�1 - 1.� �EP RAT T F�F�: �101� '�T F� -� �`, ��C�I [ # F=P� 11�► '� F�[� C706�134
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Establishment: 24
L MWpf Inspection:
ddress ° '/ Owner„or:Operattar;:. 1N.4-i " t �.•
ADDITIONAL SOUR POINT ITEMS KEY: DNC [DOES NOT COMPLY]
6 Foods not re-served. `
4-Unwrapped foods not re-served 31 Sewage disposal approved. 4.
-Potentially hazardous foods not re-served K. -Operating as required
11 Toxic chemicals. No cross connections,back siphonage,backflow 4,
4 Proper tyypelinstallation/backflow rreeyenliQn device/airaaofor:
-Stored properly,labeled properly,used properly -Food equipment -Hose connections -Dish machines
-Sanitizer concentration notto exceed maximum permitted -Soda system carbonator -Beverage dispensers -Toilet tanks
-No unnecessary toxics on the premises -Chemical tlispensers -Ice machines
-Pesticideslrodenticides properly dispensed Proper drain for:
-Food equipment -Dish machines -Ice machines
29 Water source adequate,safe. 4
-Well/well head protected from contamination jd�esigoiletacilities. Adequate,convenient,accessible, 4
-Water quality in compliance
-Monitoring in compliancened,properly installed
OTHER ITEMS z;? KEY: DNC [DOES NOT COMPLY]
2 Scurcesoffood: Original container,properly labeled 1 0 Garbagetrubbishstoragearealrooms,enclosures-properly constructed,clean 1
5 Potentially hazardous food properlythawed 2,' 41 Garbagelrubbish disposed of in an approved manner,atapproved frequency
10 Food dispensing utensils prop erly stored 42 vermin Control: No insectstrodents present 2
14 Food worker,Clean outer clothes,effective hair restraints 43 Outer openings protected against entrance ofinsectslrodents 1;
4 Floors: Floor covering installed,constructed as required,good repair,clean 1:
6 od-contact surfaces designed,constructed,maintained,installed,
g ,Z; � 5 Floors graded,drained as required
located
6 Floor,wall juncture covered
17 Nonfood-contact surfaces designed,constructed,maintained, 1: ] Mats removable,good repair,clean
installed,located 1
8 Exterior walking,driving surfaces,good repair,clean
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
installed located
50 Dustless cleaning methods used,cleaning equipment properly stored
maintained 1
Equipment&Utensils: Cleanliness 1 ' 51 Adequate lighting provided as required1v;
21 Preflushed,scraped,soaked and racked 52 Room free of steam,smoke odors
1e
22 Washwaterclean,proper temperature 53 Rooms&equipment hoods,ducts,vented as required
231 Accurate thermometers provided,dish basket,!fused 54 Rooms adequate,clean,adequateiockersprovided,facilitiesclean
7 Nonfood-contact surfaces of utensils&equipment clean 1
55 Establishment and premises tee oflitter,noinsectlrodentharborage, 1
$ Equipmentlutensils,storage,handling 1 no unnecessary articles r,,t
32 Proper disposal ofwaste water 1 56 Complete separation from living/sleeping quarters and laundry
iFa
33 Plumbing location,installation,maintenance 1 57 Clean/soiled linens stored properly
58 No live birds,turtles,or other animals(except guide dogs) 1
36 Toilet rooms enclosed with self-closing door 1` n
59 Seats 75or more:Nonsmoking area provided,signs)posted at '3
37 Proper toilet fixtures provided,good repair,clean entrance(s),smoking area indicated by sign(s)
39 JApproved garbagelrubbish containers,adequate number,covered, 1'
rodent proof,clean ❑Routine Inspecti n Reinspecti Preoperational Inspection
INSPECTOR: PERSON INCHARGE: Other Inspection:
ZL/ �: *Include demerits from page 1"?_ /_ , C,C-C _. 4 3 2 1 Total Rating
re signature f
p' name print name
}
phone number
title DATE CORRECTIONS DUE: L
Page 2 of 2 plus continuation pages Focused Inspec on 112002
I a�vPage off
INSPECTION REPORT STATE OF CONNECTICUT
FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH
CONTINUATION SHEET
NAME OF ESTABLISHMENT TOWN DATE O INSPECTION
5 v-cr
INSPECTION REMARKS
FORM#
OF
1, 141, "'d
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INITIAL(INSPECTOR) INITIAL(PERSON IN CHARGE)
Distribution: 1st-White-Health Department 2nd-Yellow-Owner/Manager
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NAME OF • DATE OF P CTION
Will
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(INSPECTOR) It (PERSON
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