HomeMy WebLinkAboutFood Service Establishment Inspection 19 (11) 1
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Establishment: w inspection Date: (. Time: oinsp RE[nsp
Address/City: �� -}6b" 1(. �c 1, \,j� . Health Dept: ,y r .. �: 1 2 3(
Based on an inspection this day,the items marked DNC identify t 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 0 1 NIA JDNC I KEY: C[complies] N1O[not observed] NIA[not applicable]
V xW..* DNC[does not comply] 0[other] RTE[ready-to-eat]
- - 12<s Personnel=frith Infection re trio# d`" Y 10,01 141A,A',
t ��ilgnat@d Alt@Frtdt@'Tr �,4 r-. .-0'4� 2 vt
. F - A Food workers have no exposed infected lesions!burns
r.Writtert=dactamentation of trainingsprdgram t. � 2 B personnel with infection restricted
i pprovedrsource,-whclesome,nonedultetated w� � N10 N1Ai 4
C Communicable disease of worker reported to local health director
A I Approved shellfish,finfish,meat&poultry USDA approved ,11�Wandwasgin ffie$Irt�es ptovrdg ,'h ndswashed,plain., .0 /01 NIA"(4'
B Food cans in good condition(not dented,rusty,bloated,leaking) A e 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 grown/canned food} C Handwash facilities accessible/convenient to use
E Potentially hazardous foods received at proper temperature D Personnel hands washed,clean 1 Proper handwash procedure
0
E Handwashing at appropriate times
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d rr f� s Rr&P6r�at-r4,�i344 88�'`,& a r s p
$ R an v. 4.�is# As 'fix,t t v 'g 18j O�OCtBi1�IgIP,t11C practices R € n C
A Hot holding greater than or equal to 1400F. (wholeheaupork roasts 1300F) o, ❑No eating 0 No smoking while working
B Cold holding less than or equal to460F. B Wounds covered adequately
C Proper cooling C Proper sink used for handwashing
D Proper re-heating 0 5
E Proper internal cooking!consumer advisory posted �2 3an"i it`at'io'r!rlj�s 1,(hint water ache nllcal) +, C, :Q N1Au 2_.
0 A Approved sanitizeravailableladequate concentration ofsanitizer
' ? A e y t aF,Trt IS(tp,mai it it r � j](NjA g Food contact surfaces and utensils used for potentially
tetrpsratufe;tFehnfit§terse�tro�id 3 r I hazardous food sanitized at least every 4 hours
#YIi,X 4:h�# '.4 V__ *A_ i i q
A Food thermometer available and accurate C Adequate shwashersanitizer ❑final rinse temp
B Properfood thermometer for product L, L Proper sanitizing procedure
C Thermometers appropriately placed in cooler units
E Sanitizing between raw animal origin&ready-to-eat food
0
0
noel rdt , a , ` � 25 40leanfwipigrcloths "
, W
ectetldJr M C
.
re in on es A Cloths and/or s good repair and clean
ice6an�lstran5perta sponges 9 P
_f B Wiping cloths kept in samtizer between uses
A Produce washed
0
B Raw meats not stored/prepared near ready-to-eat foods � 6[ Fiodsctac § fasclan [. !®W/A 4
C Food covered properly .
A Food equipment clean,utensils clean,equipment in#eriors clean
D Adequate splash guards/sneeze guard B Single use gloves changed when soiled
E No unauthorized personnel 6. C Food--contact surfaces clean
F No pooling of eggs not cooked immediately 0
Food containers stored off the floor 401 *Wndt�co d water under piessure'-', ided l d,PN/qj N/A, 9 l
0 .s g3A F ai du a h[ gas c s&soriea'grovrded NIOt N/A( �
. -N 4 .
9 co minimtzec ° _ `I�.1.(� WY "-2 A 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 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 debatable and does not affect your score. M: QFO[qualifed food operator],DA[designated alternate],PHF[potentially hazardous food[,FB[foodborne]
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 recorded/logged 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 lf-M indicate language spoken
List products cooled: by QFOIDA: *Can the QFO/DA 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 ltems) Page 1 of 2
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IEsftiti(� h ent: Y1 °Date oflisp �tib`i� � 11° ( ,
Owner or 0 orator
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ADDITIONAL FOUR POINT ITEMS KEY: DNC [DOES NOT COMPLY]
6 Foods not re-served.
4'. 31 Sewage disposal approved.
-Unwrapped foods not re-served
-Potentially hazardous foods not re-served g -Operating as required .;;
11 Toxic chemicals. No cross connections,back siphonage,backflow 4
4 Pro per typelinsiallationl backflow prevention device/air ga for:
-Stored properly,labeled properly,used properly -Food equipment -Hose connections -Dish machines
-Sani nn 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 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,
-Water quality in compliance
-Monitoring in compliance designed,properly installed
OTHER ITEMS oti KEY: DNC [DOES NOT COMPLY]
2 Sources of food: Original container,properly labeled 1 40 Garbage/rubbish storage arealrooms,enclosures-properly constructed,clean "
I
5 Potentially hazardous food properly thawed 2 41 Garbagelrubbish disposed of in an approved manner,at approved frequency
10 Food dispensing utensils properly stored 1 42 Vermin Control: No insectslrodents present fi
14 Food worker:Clean outer clothes,effective hair restraints 1 43 Outer openings protected against entrance of insectslrodents
4 Floors: Floorcovering installed,constructed as required,good repair,clean 1
cod-contact surfaces designed,constructed,maintained,installed, 5 Floors graded,drained as required
ocated D46 Floor,wall juncture covered
17 onfood-contact surfaces designed,constructed, maintained,
7 Mats removable,good repair,clean
installed,located
1$ Single service articles,storage,dispensing 2
48 Fxteriorwalking,driving surfaces,good repair,clean 3
9 Walls,ceilings attached,equipment properly constructed,good
19 No reuse of single service article ,
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
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 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 1
27 Nonfood-contact surfaces of utensils&equipment clean 1
55 Establishment and premisesfreeof litter,noinsectlrodentharborage, 1
28 Equipmentlutensils,storage,handling 1- no unnecessary articles
32 Proper disposal of waste water 1' 56 Complete separation from living/sleeping quarters and laundry 1'
33 Plumbing location,installation,maintenance 1' 57 Cleanlsoiled linens stored properly 1
58 No live birds,turtles,or other 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 3
37 Propertoilet fixtures provided,good repair,clean eritrance(s),smoking area indicated by sign(s)
39 Approved garbagelrubbish containers,adequate number,covered, 1
rodent proof,clean Routine Inspection ❑Reinspection ❑ Preoperational Inspection
Other Inspection:
IN PECTOR: PERSON IN CHARGE: Demerit Score: *Include demerits from page 1
4 3 2 1 Total Rating
si ature slgnatur
I
pr n me print name
Cone num er � _ �S tit �r DATE CORRECTIONS DUE:
[� Page 2 of 2 plus continuation pages Focused Inspection112002
Page,3 Of
INSPECTION REPORT STATE OF CONNECTICUT
FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH
CONTINUATION SHEET
NAME OF ESTABLISHMENT TOWN DATE OFF INSiP[ECTION
,u R 1(1 L
INSPECTION REMARKS
FORM#
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INITIAL(INSPECTOR) INITIAL(PERSON IN CHARGE)
Distribution: I st-White-Health Department 2nd-Yellow-Owner/Manager