HomeMy WebLinkAboutFood Service Establishment Inspection 46 (11) a.,
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Establishment: Inspection Date: `1 Vks � Time: ROinsp 14irl
Address/City: vt f GHQ Health Dept: - (nit v/ Class; 1 2 4
Based on an inspection this day,the items marked DNC identify 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 NIA JDNC KEY: C[complies] NIO[not observed] NIA[not applicable)
60 Qualified Food Operator 3 DNC[does not comply] 0[other] RTE[ready-to-eat]
` 12 Personnel With'Infection restricted C 10 N/A 4
61' Designated Alternate " 2
A Food workers have no exposed infected lesions 1 burns
62 Wriften documentation of training program 2 B Personnel with infection restricted
1 Approved source,wholesome;noredulterated C 10 NIA 4 C Communicable disease of worker reported to local health director
A Approved shellfish,finfish meat&poultry USDA approved 13 Hand
washing facilities provided, hands washed;clean C NI0 NIA_ 4
B Food cans in good condition(not dented,rusty,bloated,leaking) A Handwash facilities in all food prep/dispensing&warewash areas
C Wholesome/nonadulteratedfoods/safe 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 I Proper handwash procedure
0 E Handwashing at appropriate times
3 Potentially hazardous food meets temperature-requ[rements C 0 NIA 4 0
during storage,preparation,display,service anddransportation
15' Good hygienic practices C NIO NIA 2
A Hot holding greater than or equal to 140°F. (whole beerrporkroasts 1300F.) A ❑No eating Cl No smoking while working
B Cold holding less than or equal to 45°F. loll ol, B Wounds covered adequately
C Proper cooling C Proper sink used for handwashing
D Proper re-heating 0
E Proper internal cooking I consumer advisory posted 24`Sanitization rinse (hot water-chemical) C" N10 NIA 2
0 A Approved sanifizeravailableladequateconcentrationofsanitizer
4 Adequate facilities,to'maintain product C 0 NIA; 2'11 g Food-contact surfaces and utensils used for potentially
temperature,thermometers•provides& hazardous food i]zed at least every 4 hours
A Food thermometer available and accurate C Adequate dishwashersanitizer ❑final rinse temp
B Proper food thermometer for product D I Proper sanitizing procedure
E Sanitizing between raw animal origin&ready-to-eat food
C Thermometers appropriately placed in cooler units 0
0 25, Clean wiping`,cloths r10 NIA 1
7 Food protected during storage,preparation,, N/0 NIA 2
display,service and transportation5 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 storediprepared near ready-to-eat foods 26 Food-c6r tactsuili6 s clean ! C 10 NIA 2,
G 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 30' 'Hot and cold waterunder pressure,provided as required INIO NIA 2
0 38 Handwashing.accessorles provided FC INI& NIA 1
9 Handling of food minimized C: NIO .NIA -2, A Soap l paper towels l 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 1 waste receptacle at handwash sink
C Adequate utensil(s)for dispensing food/ice 0I I I H
0 •DESCRIBE DEFICIENCIES ON CONTINUATION SHEETS
The following information is not debitable and does not affect your score. JSEY: QFO[qualified food operator],DA[designated alternate],PHF[potentially 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 written illness policy that requires the food worker to report specific illness conditions
Are temperatures recordedilogged 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 K_=indicate language spoken
List products cooled: by QF01DA *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):QF0 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 1 of 2
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Dade of Inspestion�
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dress:, . .. : Owner or 40pet�ator t (. r tt
ADDITIONAL FOUR POINT ITEMS KEY: DNC [DOES NOT COMPLY]
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6 Foods not re-served.
-Unwrapped foods not re-served 4 31 Sewage disposal approved.
-Operating as required
-Potentially hazardous foods not re-served
34 No cross connections,back siphonage,backflow
11 Toxic chemicals. 4
4 Proper tvpelinstaIlation/backf low prevention device/air gap for:
-Stored properly,labeled properly,used properly
-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 property dispensed -Chemical dispensers -Ice machines
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 designed,properly installed
-Monitoring in compliance
OTHER ITEMS
KEY: DNC [DOES NOT COMPLY]
2 Sources of food: Original container,properly labeled
g 40 Garbage/rubbish storagearea/rooms,enclosures-properly constructed,clean �1
5 Potentially hazardousfood properly thawed2 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 1 43Outeropenings protected against entrance ofinsectslrodenis
44 Floors: Floorcovering installed,constructed as required,good repair,clean
16 Food-contact surfaces designed,constructed,maintained,installed, 2 45 Floors graded,drained as required
located
6 Floor,wall juncture covered
17 Nonfood-contactsurfaces designed,constructed, maintained, 1 47 Mats removable,good repair,clean
installed,located 1
18 Single service articles,storage,dispensing 2
48 Exterior walking,driving surfaces,good repair,clean
19 No reuse of single service article 49 Walls,ceilings attached,equipment properly constructed,good 1
+ repair,clean.Wall&ceiling surfaces as required
•�Y4
20 Dishwashing facilities approved design,adequately constructed, 2r 1
installed located
50 Dustless cleaning methods used,cleaning equipment properly stored
maintained
Equipment&Utensils Cleanliness 1" 51 Adequate lighting provided as required 1
21 Preflushed,scraped,soaked and racked 52 Room free of steam,smoke odors V
22 Wash waterclean,proper temperature `
53 Rooms&equipment hoods,ducts,vented as required t�,�•,
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 insect/rodent harborage,
28 Equipment/utensils,storage,handling 1 no unnecessary articles
32 Properdisposal of waste water ; i 56 Complete separation from livinglsleeping quarters and laundry
33 Plumbing location,installation,maintenance 1 57 Clean/soiled linens stored properly
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 3
37 Proper toiletfixtures provided,good repair,clean enlrance(s),smoking area indicated by sign(s)
39 Approved garbage/rubbish containers,adequate number,covered, 4
rodent proof,clean ❑Routine Inspection ❑Reinspection ❑ Preoperational Inspection
Otherinspection:
IN�PET PERSON IN CHARGE: Demerit Score; *Include demerits from page 1
(� 4 3 2 1 Total Rating
si nature signature
p 1 name print name
DATE CORRECTIONS DUE:
phone number {'' title
J '' Page 2 of 2 plus continuation pages Focusedrospe&Io 12002
Page of
INSPECTION REPORT STATE OF CONNECTICUT
FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH
CONTINUATION SHEET
NAME OF ESTABLISHMENT TOWN DATE OF INSPECTION
i `s ,Z�� S
INSPECTION REMARKS
FORM#
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INITIAL(INSPECTOR) INITIAL(PERSON IN CHARGE)
Distribution: 1st-White-Health Department 2nd-Yellow- Owner/Manager