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HomeMy WebLinkAboutFood Service Establishment Inspection 64 (5) i STWTE 00 COI+1 fLt+C1"ICIII 1 lik L t E It�I�S © PORZ -� DEPARPNI I�I F a86 W LT^H Establishment: tw�e S 1� ,J Inspection Date: (� Time: Lk ROinsp REins Address/City: ke s✓t 5- S .,\\\ u r,c\ -C , Health Dept: S- : n A u/ : 1 2 4 Based on an inspection this day,the items marked DNC identify the ' lotions in operation orfacilities which must be corrected by the date specified on page 2. RISK FACTOR ITEMS:Listing is not inclusive of all possible debitable items C tO NIA JDNC ; C[complies] N10[not observed] NIA[not applicable] 60 Qtlalifted'Food Operator ✓ g DNC[does not comply] 0[other] RTE[ready-to-eat] 61 Designated Alternate' 2 121 Personnel,with infection restricted N10 NIA 4 82 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 C V10 NIA 4 C Communicable disease of worker reported to local health director A I Approved shellfish,finfish,meat&poult USDA app roved 51F 13 Handwashing facilities provided,hands washed,clean N10 NIA 14 B Food cans in good condition(not dented,rusty,bloated,leaking) A Handwash facilities in all fend prepldispensing&warewash areas C Wholesomelnonadulteratedfoods/safe 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 hazardousfoods received at proper temperature D Personnel hands washed,clean I Proper handwash procedure 0 E Handwashing at appropriate times 3 Potentially hazardous food meats temperature requlrerrtents, C` N10 N/A 4 0 during storage,preparation,display,service and transportation ' 15 'Good hygienic practices N10 NIA `2 A Hot holding greater than or equal to 140°F. (whole beef/pork masts 1300 F.) ✓ A ❑ No eating ❑No smoking while working B Cold holding less than or equal 10 45"F. B wounds covered adequately C Proper cooling C Proper sink used for handwashing D Proper re-heating 0 E Proper internal cooking/consumer advisory posted 24 Sanitization rinse(hot.water-chemical) C N/O NIA 2 A Approvedsanitizer available/adequate concentration ofsanitizer t4 , Adequate facilities to maintain.product C N10 NIA B Food-contact surfaces and utensils used for potentially temperature,thermometers provided' : , hazardous food sanitized at least every 4 h s A Food thermometeravailableandaccurate C Adequate ❑dishwashersanitizer Inal rinse temp 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 25 'Clean wiping"cloths WO N/A 1 7 Food protected during storage,preparation, C N10 N/A, 2': A Clothsandlorsponges in good alrandclean display,service'and transportationP 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 /0; WA 2- C Food covered properly LiA Food equipment clean,utensils clean,equipment interiors clean D Adequate splash guards!sneeze guard IB Single use gloves changed when soiled E No unauthorized personnel C Food--contact surfaces clean F No pooling of eggs not cooked immediately 0 S Food containers stored off the floor 30 Rot-and told water,under pressure;provided as required C N/0 N/A'2 0 36 1,Handvuashing accessories provided C, WO NIA 9 Handling of food minimized , C -N10 N/A 2 A Soap l paper towels! drying device available A No unnecessary handling RTE and/or cooked foods with bare hands BDispenserpaper 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 01 C Adequate utensil(s)fordispensing food/ice p 1 tf 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: °F. 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 FS 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 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 tLyas 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 coaling 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 in Note: This report is a two page form(total of 62 dabitable items) Page 1 of 2 a �e cNi%�-�- �.{ Dat of Inspection. Owner.or Opeirator: a' . r ADDITIONAL FOUR POINT ITEMS r., say 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 11 Toxic chemicals. 34 No cross connections,back siphonage,backflow 4" 4 ProWrtypelinsta lationl backflow prevention device/air pan for; -Stored properly,labeled properly,used properly -Food equipment -Hose connections -Dish machines -Sanitizer concentration not to exceed maximum permitted -Soda system carbonator -Beverage dispensers -Toilet tanks -Na unnecessary toxics on the premises -Chemical dispensers -Ice machines -Pesticides/rodenticides properly dispensed Proper drain for: 29 Water source adequate,safe. " -Food equipment -Dish machines -Ice machines -Well/well head protected from contamination-Water quality in compliance 35 Toilet facilities. Adequate,convenient,accessible, 4 -Monitoring in compliance designed,properly installed OTHER ITEMS KEY: DNC [DOES NOT COMPLY] rn�_ Sources of food: Original container,properly labeled 40 Garbage/rubbish storage area/rooms,enclosures-properly constructed,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 '1 42 Vermin Control:No insects/rodents present 2 14 Food worker:Clean outer clothes,effective hair restraints 43 Outeropenings protected againstentranceof insectslrodents 1 4 Floors:Floor covering installed,constructed as required,good repair,clean 2 16 Food-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, 1 47 Mats removable,good repair,clean installed,located 1 1$ Single service articles,storage,dispensing `2 481 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 20 Dishwashing facilities approved design,adequately constructed, 2 1 maintained installed located 50 Dustless cleaning methods used,cleaning equipment properly stored EEquipment&Utensils: Cleanliness 51 Adequate lighting provided as required 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 premises free of litter,noinsectlrodentharborage, 1' 28 Equipmentlutensils,storage,handling 1 no unnecessary articles } 32 Properdisposal of wastewater 1, 56 Complete separation from livinglsleeping quartersand laundry 33 Plumbing location,installation,maintenance L` 57 Cleanlsoiled linens stored properly 58 No live birds,turtles,orotheranimals(except guide dogs) 36 Toilet roomsenclosed with self-closing door 59 Seats 75 or more:Nonsmoking area provided,sign(s)posted at 3 37 Propertoifetfixtures provided,good repair,clean entrance(s),smoking area indicated by sign(s) 39 Approved garbage/rubbish containers,adequate number,covered, '1 rodent proof,clean 2koutine Inspection 1711einspection E3 Preoperational Inspection IN PECTOR: PERSON IN CHARGE: I Other Inspection: Demerit Score: *Include demerits from page 1 4 3 2 1 Total Rating stg tune � sig ire ,5� S7 print name 906) L,Ll L u �` -Cqk`b�� DATE CORRECTIONS DUE: phone number title x� Page 2 of 2 plus continuation pages Focused Inspection I12002 Page of,,- INSPECTION REPORT STATE OF CONNECTICUT FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH CONTINUATION SHEET NAME OF ESTABLISHMENT TOWN DATE OF INSPECTION %orri\ e s V,b c� �10 LAi: INSPECTION REMARKS FORM# �rn�u � '(V`� w v.� �� f✓t CSL� o Q A-�Q �JALJtA)C4 -�- �� A 2 2 i Ab Q (i . MNA INITIAL(INSPECTOR) INITIAL(PERSON IN CHARGE) 6 Distribution: 1st-White-Health Department 2nd-Yellow-Owner/Manager