HomeMy WebLinkAboutFood Service Establishment Inspection 10 (24) Establishment: fZ z3 l Inspection Date: 2 Time: I ( 0[nsp R [nsp
Address/City: . Health Dept: vlc� , %. Class: 1 2
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 N!0 N!A DNC KEY: C[complies] N10[not observed] NIA[not applicable]
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DNC[does not comply] 0[other] RTE[ready-to-eat)
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� ., � Lq A Food workers have no exposed infected lesions!burns
tri �1Ctifentation aftratni ,p¢o r�• 2 g personnel with infection restricted
{Ajryetiufe,iytrhale�o[riQ,;nraue3e �;1 !!0 C Communicable disease of worker reported to local health director
A I Approved shellfish,flnfish,meat&poultry USDA a roved 14i: �lan t facillties rbvtded-'handslushedafedn
B Food cans in good condition(not dented,rusty,bloated,leaking) , , g ` ``
A Handwash facilities in all food prep/dispensing&warewash areas
C Wholesomelnonadulteratedfoodslsafe B Handwash facilities in or immediately adjacent to toilet rooms
D Commercial products(no home grownlcannedfood) C Handwash facilities accessiblelconvenient 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
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iPatenftal yhazardousfoodrmeets tempertura req�trgrttt Its 1 Nld v.4 p
&tPrtii�3storage,preparation;dlspley;aeriifai2 and�Yrah>; ortadon ,
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A Hot holding greater than or equal to 140 F. (whole beellpork roasts 130,F) A ❑No eating ❑No smoking while working
B Cold holding less than orequal to 450 F. Li B Wounds covered adequately
C Proper cooling C Proper sink used for handwashing
D Proper re-heating 0
E Proper internal cooking lconsumer advisory posted 24•1S0'0111 iOrt$ri'nse(hot 4gfet Nkj NIA'ki
0 A Approved sanitizeravailabieladequate concentration ofsanitizer
fa *1 40008te•'fact Ilttes'to matnwIn. ibdu+dt p (� 2 B Food-contact surfaces and utensils used for potentially
` {j to ' hazardous foods 'tized at least every 4 hours
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'`dam'lI �:w� C Adequate tshwashersanitizer ❑final rinse temp
A Food thermometer available and accurate
L Pro ersanitizin procedure
B Proper food thermometer for product E Sanitizing between raw anima[origin&ready-to-eat food
C Thermometers appropriately placed in cooler units 0
0 25Ii fi i tGlean;Hriping cfothsu . s ; N10 N!A],1
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NO �servict:�':a�id t�•�r �t ;; A Cloths and/or sponges in good repair and clean
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A Produce washed B Wiping cloths kept in sanitizer between uses
0
B Raw meats not stored/prepared near ready-to-eat foods t : 0 t�ta t ti a at
A 44,#' 4 i ��'� �
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
8 Food containers stored off the floor ' p *"" ,' r ' " '
3D } o and=¢ �va#erfuna)er�pressure,xproutdedtas4requtre N10 fNIA'f 12
'('•?�ri'.° "' '.4 - - {�� tSs cot s xt=. k�t:-.w.. •�t!r •,
0 38' Fiaic�asht�ng ad�t essorts, ovided; Y , "j N10!I NlA` 1,
) Hrtdl�nggoffoodrrltnrmtred kClO;,MlA2
A� No unnecessary handling RTE andlorcooked 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 Handwash sink(s)clean/waste receptacle at handwash sink
C Adequate utensil(s)for dispensing food/ice 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 fpotentially 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 wok:
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 H-3m indicate language spoken
List products cooled: by QF01DA: *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 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 9 of 2
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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. 4
-Potentially hazardous foods not re-served -Operating as required
3-4 No cross connections,back siphonage,backflow
11 Toxic chemicals. 4''4
-Stored properly,labeled properly,used properly Proper typelinstallationl backflow prevention device/air gap for:
-Sanitizer concentration not to exceed maximum permitted -Food equipment -Hose connections -Dish machines
-No unnecessary toxics on the premises -Soda system carbonator -Beverage dispensers -Toilet tanks
-Pesticideslrodenticides properly dispensed -Chemical dispensers -Ice machines
Proper drain far:
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] 77
2 Sources of food: Original container,properly labeled 1 {"
g p p y 40 Garbage/rubbish storagearealrooms,enclosures-properiywnstructed,clean
5 Potentially hazardous food properly thawed ..'. 41 Garbageirubbish disposed of in an approved manner,at approved frequency
10 Food dispensing utensils properly stored sly+ 42 Vermin Control: No insects/rodents present 2
14 Food worker:Clean outer clothes,effective hair restraints 1" 43 0uteropeningsprotectedagainst entrance ofIn sects/rod ants 1,'
4 Floors: Floorcovering installed,constructed as required,good repair,clean i
16 Food-contact surfaces desi designed, maintained,installed, {`
g �2.p 45 Floors graded,drained as required
located r 46 Floor,walljuncturecovered €
17 Nonfood-contactsurfacesdesigned,constructed, maintained, 1
nstalled,located s w 7 Mats removable,good repair,clean
u
8 Exterior walking,driving surfaces,goad repair,clean
18 Single service articles,storage,dispensing 2'A :.
19 No reuse of single service article
` 49 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 1
Equipment&Utensils: Cleanliness 51 Adequate lighting provided as required 1
21 Preflushed,scraped,soaked and racked 52 Room free of steam,smoke odors 1
22 Wash waterclean,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,
28 Equipment/utensils,storage,handling 1 no unnecessary articles
32 Proper disposal of waste water 1 56 Complete separation from livingisleeping quarters and laundry .
33 Plumbing location,installation,maintenance 1 57 Clean/soiled linens stored properly 1
58 No live birds,turtles,orother animals(except guide dogs) 1.
36 Toilet rooms 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 entrance(s),smoking area indicated by sign(s)
3"
39 Approved garbage/rubbish containers,adequate number,covered, 1
rodent proof,clean Egoutine Inspection ❑Reinspection ❑ Preoperational Inspection
IN ECT R: PERSON IN CHARGE: Other Inspection:
Demerit Score: *Include demerits from page 1
7 4 3 2 1 Total Rating
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phone num Sber title C'j DATE CORRECTIONS DUE:
t< Z Page 2 of 2 plus continuation pages Focused Inspection2l2002
Page Of
INSPECTION REPORT STATE OF CONNECTICUT
FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH
CONTINUATION SHEET
NAME OF ESTABLISHMENT TOWN DATE OF INSPECTION
w S , W '�V\�QU 2 Z�
INSPECTION REMARKS
FORM#
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INITIAL(INSPECTOR) INITIAL(PERSON IN CHARGE
Distribution: Ist-White-Health Department 2nd-Yellow-Owner/Manager