HomeMy WebLinkAboutFood Service Establishment Inspection 95 (13) igC
Establishment: Inspection Date: Time: 3(Q ROins REinsp
Address/City: Healt Dept: 5 , L'i class: 2 3C4j
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 N/A DNC KEY: C[complies] N/O(not observed) NIA[not applicable]
0 ua rg[)aFo1i�Qperatprk' 3 DNC[does not comply] 0[other] RTE[ready-to-eat]
12Rersortnel+jajfh,ii�fecion resttrtated , g 'y "1 NOrNIA4t.
i nated Altemafe A Food workers have no exposed infected lesions burns
tM1riten documentafion�of traming�prog�am i 2
y B Personnel with infection restricted +.
f p7o�,ed source,whdlesbme;no adulf�rafetl N103 lA; 4 C Communicable disease of worker reported to local health director
c/
A Approved shellfish,finfish,meat&poultry USDA approved ;14�Handviiashipg,0 lllttes prpvided elands uvashed;clear "C N10 N/A 14
B Food cares in good condition(not dented,rusty,bloated,leaking) A " Handwash facilities in all foodprep/dispensing&warewash areas c.
C Wholesomelnonadulleraled foods/safe B Handwash facilities in or immediately adjacent to toilet rooms cr
D Commercial products(no home grownlcannedfood) 71
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
Jldlly,hazardoiKfood)nets�t, t�t' e�requirements 1 Nl0 N/A'�4 p
4�Ing storage preparation dlspJay, a 'c id 1Vif1 ottati8hv i
°;. ii ';&�l �.., JeY Gogp l rgi" n�;prYaCfic s 6 t._ C ;N/Qi N A�o. a. n > ,,
A Hot holding greater than or equal to 140 F. (whoie beeflpork roasts 1300r:.) A ❑ No eating ❑ No smoking while working
B Cold holding less than or equal to 450F. L B Wounds covered adequately
C I Proper cooling C Proper sink used for handwashing too
D Proper re-heating 0
E Proper internal cooking/consumer advisory posted tariitization rinse(hot�water-ehemisal)6 Cj Nlt.: •N ;, 2`
0 A Approved sanitizeravailableladequateconoentraf!on ofsanitizer~
'¢eg46(0'�4T]Irti®s to rrialn'�d tt p dti - g Food contact surfaces and utensils used for potentially
hazardous food sanitized at least every 4 hours
i"ailuW.therrrtbm`efeM'0fd`1d' , :
A Food thermometer available and accurate C Adequate Itrdishwashersanitizer 0final rinse temp
D Proper san tizin rocedure
B Proper food thermometerfor product E Sanitizing between raw animal origin&ready-to-eat food
C Thermometers appropriately placed in cooler units
0
rfotee�ted dairiiigPstoTag�, re $F i C NI® N/Q 3r,
- A Cloths and/or sponges in good repairand clean
sptaYser,Ntqe andxra�nspr� ! ; 1 B Wiping cloths kept in sanitizer between uses
A Produce washed 0
B Raw meats notstored/prepared near ready-to-eat foods 2S <_, pMtacpfa dean a�« Nil CIA 24 `
C Food covered properly Aw
A Food equipment clean,utensils clean,equipment interiors clean
D Adequate splash guards I sneeze guard B Single use gloves changed when soiled
E No unauthorized personnel V C Food--contact surfaces clean
F No pooling of eggs not cooked immediately 0
8 Food containers stored off the floor !3 Hott t c ld ater n e p esscird;[iroi ided'as ret uifed C !0?NIA 3
C Han washmgra¢aessories provided�: �
C N(t " NIA 9a
..� .
i'lIar;diigg of foodd minfmiet, _,, ]$r"t !} 7 Soap 1 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 4., C Handwash sink(s)clean 1 waste receptacle at handwash sink
C Adequate utensil(s)for dispensing food/ice p
it
0 *DESCRIBE DEFICIENCIES ON CONTINUATION SHEETS
The following information is not debatable and does not affect your score. KEY: QFO[qualified food operator],DA[designated alternate],PHF[potentially hazardous food],FB Ifoodborne]
PHFs are hot held at: IF. 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 written illness policy that requires the food worker to report specific illness conditions
Are temperatures recordedllogged for cold holding foodslequipment? 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 ff-M 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 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
[where:
here a produce washing policy? Y N ♦Describe what is washed and inspection:
Note: This report is a two page form(total of 62 debltable items) Page 1 of 2
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ADDITIONAL FOUR POINT ITEMS
§ KEY: DNC [DOES NOT COMPLY]
6 Foods not re-served.
41 31 Sewage disposal approved.
.Unwrapped foods not re served Mll 4
-Potentially hazardous foods not re-served -Operating as required
I I Toxic chemicals. No cross connections,back siphonage,backflow 4
-Stored properly,labeled properly,used properly Proper typelinstallation/backflow prevention device/air gap for:
-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
-Pesticides/rodenticides properly dispensed
Proper drain for:
I
29 Water source adequate,safe. 4 -Food equipment -Dish machines -Ice machines
-Well/well head protected from contamination
-Water quality in compliance 35 Toilet facilities. Adequate,convenient,accessible, 4,
designed,properly installed
-Monitoring in compliance
OTHER ITEMS
KEY: DNC [DOES NOT COMPLY]
Sources of food: Original container,properly labeled
A 40 Garbage/rubbish storage area/rooms,enclosures-properly constructed,clean
Potentially hazardDUSfood properly thawed 1,1 41 Garbagelrubbish 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 J a43 Outeropenings protected againstentrance of insectsirodents
44 Floors: Floor covering installed,constructed as required,good repair,clean
7"
Food-contact surfaces designed,constructed, maintained,installed, 2 5 Floors graded,drained as required
located46 Floor,wall juncture covered
)onfbod-contact surfaces designed, constructed,maintained, 4 Mats removable,good repair,clean
installed,located !�p 7 48 Exterior walking,driving surfaces,good repair,clean
.18 Single service articles,storage,dispensing 2
491 Walls,ceilings attached,equipment properly constructed,good
191 No reuse of single service article repair,clean-Wall&c8iling surfaces as required
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
21 Preflushed,scraped,soaked and racked 52 Room free of steam,smoke odors
22 Wash water clean,proper temperature 53 Rooms&equipment hoods,ducts,vented as required
,PA
231 Accurate thermometers provided,dish basket,if used
541 Rooms adequate,clean,adequate lockers provided,facilities clean is
27 Nonfood-contact surfaces of utensils&equipment clean 1 55 Establishment and premisesfree of liter,no insectfrodent harborage,
28 Equip me nVuie n sils,storage,handling 1 no unnecessary articles
32 Proper disposal of waste water 1 56 Complete separation from living/sleeping quarters and laundry
33 Plumbing location,installation,maintenance 157 Cleanisoiled linens stored properly
581 No live birds,turtles,or other animals(except guide dogs)
36 Toilet rooms enclosed with self-closing door 159 Seats 75 or more:Nonsmoking area provided,sign(s)posted at
3
37 Pfopertoilet 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 h I I Oftoutine Inspection E3Reinspection 13 Preoperational Inspection
T R: TRSO!N IN CHARGE: Other Inspection:
Demerit Score: *Include demerits from page 1
4 3 2 1 Total Rating
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phone number title
Z--�t Page 2 of 2 plus continuation pages Focused Inspection 112002
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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 OF INSPECTION
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INsrECTION 61 REMARKS
FORM# _-44
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INITIAL(INSPECTOR) INITIAL(PERSON IN C
Distribution: 1st-White-Health Department 2nd-Yel w-Ow an r
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