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HomeMy WebLinkAboutFood Service Establishment Inspection 58 (6) S+Tr1TF� O G�NNk1C CICi3I �: 4 U�S'ED aF© T _ 1� IS+ s r -aDF➢P�iR€l1VIk31Ytf OF PiJBL�IC�k HFALhH I s6..F.6: Establishment: Inspection Date: U Time: So RO[nsp REins Address/City: Health Dept: S. Lv`, class: 1 2 3 a 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 G 10 N/A JDNC I KEY: C[complies] NIO[not observed] NIA(not applicable] 60 Qualified,Food Operator- 3 DNC[does not comply] 0(other] RTE[r dy-to-eat] 61 Designated Alternate 2 12 Personnel with infection restricted C NiO' N1A 4 62 Written documentation of training program 2 A Food workers have no exposed infected lesions 1 burns B Personnel with infection restricted 1 Approved source,wholesome,nonadulterated NO N/A 4 C Communicable disease of worker reported to local health director A Approved shellfish,finfish,meat&poultry USDA approved v 13 Hand wadhing facilities provided,hands washed,clean C ,N10 N/A 4 B Food cans in good condition(not dented,rusty,bloated,leaking) A Handwash facilities in all food prepldispensing&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 accessiblelconvenient 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 3 Potentially hazardous food meets temperature requirements C, 0-NIA' 4 0 during storage,preparation,display,service and transportation - 15 :Good hygienic practices 7C N10: NIA 2 A Hot holding greater than or equal to 1400F. (whole beetrpork roasts 1300F) A ❑ No eating ❑ No smoking while working B Cold holding less than or equal to 450F. B wounds covered adequately C I Proper cooling C Proper sink used for handwashing D Proper re-heating 0 E Proper internal cooking l consumer advisory posted 24 Sanitization`rinse(hot water-chemical) C NIO NIA 2 0 A Approved sanitizeravailableladequate concentration ofsanitizer 4 Adequate facilities to maintain product C N10 NIA: 2 B Food-contact surfaces and utensils used for potentially temperature,thermometers provided hazardous food sanitized at least every 4 hours C Adequate Vshwashersanitizer Ofina[rinse temp A Food thermometer available and accurate D Proper sanitizing procedure B Proper food thermometer for product E Sanitizing between raw animal origin&ready-to-eat food C Thermometers appropriately placed in cooler units 0 0 on 25 Clean wiping cloths C N10 NIA 1 ? Food protected -storage,ring prnaratior, N10 NIA -'2 display, service and.tpa A Cloths and/or sponges in good repair and clean B Wiping cloths kept in sanitizer between uses A Produce washed 0 B Raw meats not stored/prepared near ready-to-eat foods 26 Food-contact surfaces clean N10 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 off the Floor 30, Hot and cold Vdter under pressure,provided as required' I0;NIA 2 0 38' Handwashing accessories provided C NI0 ',NIA 1 9 Handling of food minimized, N10 NIA 2> A Soap 1 paper towels 1 drying device available A No unnecessary handling RTEandlorcooked foodswith bare hands B Dispenser(s)working: []Soap ❑Paper towel B Minimize food handling,other than ready-to-eat,with bare hands LA C Handwash sink(s)clean 1 waste receptacle at handwash sink C Adequate utensil(s)for dispensing food/ice 101 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[potentially hazardous food[,FB[foodborne] PHFs are hot held at: OF. PHFs are cold held at: F. 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 foods/equipment? Y N and diseases to the QF0? 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 ILyes indicate language spoken List products cooled: by QF01DA: *Can the QF01DA 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) Paga 1 of 2 F ? �@ o a T Lp i L CMS#5�1]FDP HAPtTFORb 4 x Y x , { JD E ��AWb©EI$T yr^� Es#ablistime'nt-, S °�� � �Y1Y . ✓ Date 6f Inspection: J' ddress'A .S��d tii " {k t�� _ Owner or Operat6r: .a V ' _ v 11 ADDITIONAL FOUR POINT !TENS an KEY: DNC [DOES NOT COMPLY] tZ. 6 Foods not re-served. -Unwrapped foods not re-served 4' 31 Sewage disposal approved. 4. -Potentially hazardous foods not re-served 37 -Operating as required 11 Toxic chemicals. No cross connections,back siphonage,backflow 4 4 Proper ttrue/installation/backflow prevention device/air gap for: -Stored properly,labeled properly,used properly -Food equipment -Hose connections -Dish machines -San itizer concentration notto 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 i well head protected from contamination 35 Toilet facilities. Adequate,convenient,accessible, 4 -Water quality in compliance -Monitoring in compliance designed,properly installed OTHER ITEMS o KEY. DNC [DOES NOT COMPLY] 2 Sources of food:Original container,properly labeled 1' 40 Garbagelrubbish storage arealrooms,enclosures-propedyconstructed,dean 1. 5 Potentially hazardous food properly thawed 2 41 Garbagelrubbish disposed of in an approved manner,at approved frequency 10 Food dispensing utensils properly stored l,' 42 Vermin Control: No insects/rodents present 2 14 Food worker:Clean outer clothes,effective hair restraints 1; 43 Outeropenings protected againstentrance ofinsectslrodents 1' 4 Floors: Floor covering installed,constructed as required,good repair,clean 1 16 ood-contact surfaces designed,constructed,maintained,installed, 2 45 Floors graded,drained as required located 46 Floor,wall juncture covered 17 Nonfood-contact surfaces designed,constructed,maintained, 47 Mats removable,good repair,clean installed,located ------- --- -- 1- 48 Exterior walking,driving surfaces,good repair,clean 18 Single service articles,storage,dispensing 2 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, maintained,installed located 50 Dustless cleaning methods used,cleaning equipment properly stored Equipment&Utensils: Cleanliness 1` 51 Adequate lighting provided as required 1 21 Preflushed,scraped,soaked and racked 52 Room free of steam,smoke odors ;1 22 Wash water clean,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 premisesfree oflitter,no insect/rodent harborage, 1. 28 Equipment/utensils,storage,handling 1 no unnecessary articles 32 Proper disposal of wastewater 1 56 Complete separation from living/sleeping quartersand laundry 1• 33 Plumbing location,installation,maintenance 1 57 Clean/soiled linensstored properly 1, 58 No live birds,turtles,or other animals(except guide dogs) 36 Toilet rooms enclosed with self-closing door 1 59 Seats 75 or more:Nonsmoking area provided,sign(s)posted at `3 37 Propertoiletfixturesprpvided,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 ❑Reinspection ❑ Preoperational Inspection IN PECT R: P RW IN CHARGE: Other Inspection: Demerit Score: •Include demerits from page 1 4 3 2 1 Total Rating s nature signature prntname ` name -02�) b�- �—� DATE CORRECTIONS DUE: phone number tltt �V�C4 Page 2 of 2 plus continuation pages Focused Inspection 12002 Page,_of INSPECTION REPORT STATE OF CONNECTICUT FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH CONTINUATION SHEET NAME OF ESTABLISHMENT TOWN DATE OF INSPECTION INSPECTION REMARKS FORM# -12 VIA, r s0 T �— CJ c� INITIAL(INSPECTOR) INITIAL(PERSON IN CHARGE) Distribution: I st-White-Health Department 2nd-Yellow-Owner/Manage