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HomeMy WebLinkAboutFood Service Establishment Inspection 65 (11) ? . -- 5, 3 I. o, S JD OOD SEI2VIC XSP-,C[TT(}�Nt, a. . v, GtiGcit� Establishment: , t, ! c [ section Date: 7i Time: ROins REinsp ddresslCity: ' Health ept: class: 1 z 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 NIO WA DNC KEY: C[compliesl NIO[not observed] NIA[not applicable] fi0 Quahfled Feod 0 era or ° 3 DNC[does not comply] 0[other] RTE[ready-to-eat] 61 rDestgndted Alternate 2 12 [ Pe restrict i C, NI0 WA `4 rsonriel with infection ed a Food workers have no exposed infected lesions!burns 62 Written documentation of tramtngprogram 2 Personnel with infection restricted [4` A d source,wholesome,nonadulterated :C. N?O•Nl _ C Communicable disease of worker reported to local health director A I Approved shellfish,finfish,meat&poultry USDA approved /tC 13 `.Handwashing facilities provtaled;ISands washed,clean C N10° N/A''4' B Food cans in good condition(not dented,rusty,bloated,leaking) kq Handwash facilities in all food prepldtspensing&warewash areas C Wholesomelnonadulteratedfoodslsafe B Handwash facilities in or immediately adjacent to toilet rooms D Commercialproducts(nohomegrownlcannedfood) C Handwash facilities accessiblelconvenient to use E Potentially hazardous foods received at proper temperature JLD Personnel hands washed,clean I Proper handwash procedure 0 E Handwashing at appropriate times �'owt allphazardotts;fggd ii'ee-1 Ptei�pKe afure requirementai� !C.: )VIO:'.i A; i during stwagie preparation display ssrvrr a and transportation r 0 16 `Good hyg enic�raGtices= ' 00 NlA :2 A.. Hot holding greater than or equal to140°F. (whmehaeflperk roosts 13o°F) A ❑No eating ❑•No'smoking while working B Cold holding less than or equal to450F. B Wounds covered adequately C Proper cooling A, C Proper sink used for handwashing D Proper re-heating 0 E Proper internalwokinglwnsumeradvisoryposted 24. Santttzationrrirtse(tDt�il►$tgr olieiRieal} C fbUON(A Ili ::s .. 0 A Approved sanitizeravailableladequateooncentrafronofsanitizer �L [4 + Adequate"=' "c IlttesatoAmafntain roduct �'� , '" a t p G tNlO N!A g Food-contact surfaces and utensils used for potentially r ` .: : hazardous food sanitized at least eve 4 hours temperature,thermometers"prouitlad� � � :� every A Food thermometer available and accurate C Adequate ❑dishwashersanitizer '{final rinse temp B Proper food thermometer for product L Proper sanitizin rocedure C Thermometers appropriately placed in cooler units E Sanitizing between raw animal origin&ready-to-eat food 0 i 5 ):Cleo9i tin elothsw » v }_ -A• *A 7 l odrprota t u`i ra'a re"p.ratiofr C /o N"1 2t pA. C'IN/0 NIA 1 tt 7slti serviceaftd trTrs ott t`' ' ` ' 4 r w ,L w t r r: Cloths andlorsponges in goad repair and clean .. . ..._ B Wiping cloths kept in sanitizes between uses A Produce washed 0 B Raw meats not storediprepared near ready-to-eat foods *- 1 f �?bB:, gpd contaet�auifa�es Blear . «G iIV10 ,1A, C Food covered properly r A Food equipmentclean,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 I F No pooling of eggs not cooked immediately Q 8 Food containers stored offthefloor 30 i=Hot andp5jd waferu�ider pressure,provided as.requireT �C N1A 2 6l r� 0 t3B;•Handwashing h�tie so{riea'prov ded, r C %9 W n i of�foodmintmize +� . ..� >ti a:.. G t N10 iN1A JV A Soap!paper towels 1 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,other than ready-to-eat,with bare hands C Handwash sink(s)clean!waste receptacle at handwash sink C Adequate utensil(s)for dispensing foodlice 0 0 •DESCRIBE DEFICIENCIES ON CONTINUATION SHEETS The following information is not debitable and does not affect your score. KEY: QFO[quelled food operator],DA[designated alternate],PHF[pctentally 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 wriftegAllness policy that requires the food worker to report specific illness conditions Are temperatures recordedilogged for cold holding foodslequipment? N and diseases the QFO? Y N +Do you have a paid sick leave policy? Y N Are foods cooked in advance and cooled? Y N *Are left ors saved? Y N Is there aJ nguage barrier between inspector&QFO? Y N If ves indicate language spoken List products cooled: by QF ! A: *Can the QFOIDA read the inspection report? Y N Describe cooling methods: Indicate who answered the above questions: Name(print): Indicate the title of above per n ircle all that ap DA Mgr Cook Owner FW Is cooling monitored for time&temp? Y N Is the mo storing of cooling recorded? Y N .Obtain signature the e n w o receive F re sIb 'es information at the time of the Is there a produce washing policy? Y N ♦Desc The what is washed and inspection: where: Note: This report is a two page form(total of 6l a ttable items) Page 1 of Z AT 1TE o CONNECTICUT DEPARTMENT�F PUBLIC.HEALTtf 41©'GAP#T.OL RVENUE=lfAS#$1 FDP-HAi2TFORID;CT{t)6 34 F.(SCiJSEU FUdD'SEAPICE INSPLCTIOI� REPE311T k LOB /i�HEAL`?N b P C y C fsu a6 AQDfTESSICITY: Establishment /LtA- �,3 u �� / i¢rJ6UL�E'efda J!Date of.lnspectlon; ,� r ddress.' � .� — .0 c 1 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 -Potentially hazardous foods not re-served -Operating as required No cross connections, back siphonage,backflow 11 Toxic chemicals, 4 4 Proper typelinstallation/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 -Pesticideslrodenticides 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 -Monitoring in compliance designed,properly installed OTHER ITEMS N KEY: DNC [DOES NOT COMPLY] io; T' _ esoffood: Original container,properly labeled 0 Garbagelrubbishstoragearealrooms,enclosures-properly constructed,clean i l otentially hazardous food properly thawed Garbagelrubbish disposed of in an approved manner,at approved frequency 10 Food dispensing utensils property stored Ti:_:C� 2 Vermin Control: No insectslrodents present Z i - 14 Food worker:Clean outer clothes,effective hair restraints =1 3 Outer openings protected against entrance of insects/rodents F 1 4 Floors: Floorcovering installed,constructed as required,good repair,clean 1` 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, 1471 Mats removable,good repair,clean installed,located 8 Exterior walking,driving surfaces,good repair,clean 18 Single service articles,storage,dispensing 2, d 19 No reuse of single service article 9 Walls,ceilings attached,equipment properly constructed,good 1; repair,clean.Wall&ceiling surfaces as required R 20 Dishwashing facilities approved design,adequately constructed, 2- maintained installed located 50 Dustless cleaning methods used,cleaning equipment properly stored Equipment&Utensils: Cleanliness 1 51 Adequate lighting provided as required 1 Prefiushed,scraped,soaked and racked 52 Room free of steam,smoke odors l 2 Wash water clean,proper temperature 53 Rooms&equipment hoods,ducts,vented as required -AeNSate thermometers provided,dish basket,if used 54 Rooms adequate,clean,adequate lockers provided,facilitiesclean 1' 27 food-contact surfaces of utensils&equipment clean 1 5 Establishment and premises free of litter,no insect/rodent harborage, t;l° 28 Equipmentlutensils,storage,handling no unnecessary articles 32 Proper disposal of wastewater 1 56 Complete separation from living/sleeping quarters and laundry 1 33 Plumbing location,installation,maintenance =1 57 Clean/soiled linens stored properly 1 ` 58 No live birds,turtles,or other animals(except guide dogs) 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) 39 Approved garbage/rubbish containers,adequate number,covered, 1 rodent proof,clean " outine Inspection OReinspection 0 Preoperational Inspection PECTOR: PERSON_IN CHARGE: Other Inspection: Dee erit (tore: *Include demerits from page 1 G 4 3 2 1 Total Rating P ture sign o211 41X � name f pri ame V DATE CORRECTIONS DUE: �1� phone number title � �� Page 2 of 2 plus continuation pages FocusedInspecHon 112002 Page of INSPECTION REPORT STATE OF CONNECTICUT FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH CONTINUATION SHEET NAME OF ESTABLISHMENT TOWN DATE OF SPEC ON INSPECTION REMARKS FORM# y/ �3,9 6x� J Z�0-6 ✓1.�/�—f 65�ib / , tea+, [w DItt" f/ fe ha "` PASS WHEN BLUE 9AR 1U1 1 1 0 OAANGE u Lid , «1fi0m°Fr»�c. INITIAL(INSPECTOR) FINITIAL(PERSON IN CHARGE) Distribution: 1st-White-Health Department 2nd-Yellow-Owner/Manager Page�f INSPECTION REPORT STATE OF CONNECTICUT FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH CONTINUATION SHEET NAME OF ESTABLISHMENT TOWN DATE OF INSPECTION l� . �- INSPECTION REMARKS FORM# � li GJ &-2 6100 INITIAL(INSPECTOR) INITIAL(PERSON IN CHARGE Distribution: Ist-White- ealth Department 2nd-Yell Ai---Owner/Manager * / - > / %� #k@ . %6H \ \�d# y q 9 � \tom N .�\ %.<