HomeMy WebLinkAboutFood Service Establishment Inspection 85 (18) �' + >�� SrI'AT�'"Olkw`C�OIYNECT3I�r,U�T ��� '4� ���I����i�S'F�IA�ICtiiEIPF$ HC�7[�I� P�R4�# ��'maDEPA&TMISNT .OTta PUBI3IQi HEALT� Y�.
Establishment:!HQ_ il.ed(fAi A^ Inspection Date: Time: _ R Ins _ REinsp
Address/City: S�,,\I,iUgn A-ig - Health Dept:�� 6 W',AL Class: 1 2 3(D
Based on an inspection this day,the items marked DNC identify violations 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 0 NIA IDNC I M: C[complies] NIO[not observed] N/A[not applicable]
$0 Qualified Food Operator 3 DNC[does not comply] 0[other] RTE[ready-to-eat]
2 12 Personnel with infection restricted N10' N/A 4
61 Designated Alternate A Food workers have no exposed infected lesions 1 burns
62 Written documentation of training program 271-
B Personnel with infection restricted
1 Approved source,wholesome,'nonadulterated C A10 NIA 4 C Communicable disease of worker reported to local health director
A Approved shellfish,finfish,meat&-poultry USDA approved 13 Handwashing facilities provided,hands washed,clean C 10 NIA 4
B Food cans in good condition(not dented,rusty,bloated,leaking) A Handwash facilities in all food prepldispensing&warewash areas
C Wholesome/nonadulteratedfoodslsafe B Handwash facilities in or immediately adjacent to toilet rooms
D Commercial products(no home grownlcannedfood) 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
Potentially hazardous-food meets temperature requirements , C' NO, NIA' 4 0
during storage,preparation,display,service and transportation
15 'Good:hyglehic'practices C' 0' NIA 2
A Hot holding greater than or equal to 140°F. (whole beef/pork roasts 1360F) A ❑No eating ❑ No smoking while working
B Cold holding less than or equal to450F. B Wounds covered adequately
C Proper cooling C Proper sink used for handwashing
D Proper re-heating V 0
E Proper internal cooking l consumer advisory posted 24 Sanitization`rinse(hot water-chemical) NIO NIA 2
Ae 0 A Approved sanitizeravailableladequateconoentrationofsanitizer
4 Adequate facilities to maintain product C !N10,,, NIA, 2 B Food-contact surfaces and utensils used for potentially
temperature,thermometers provided` hazardous foods 'ized at least every 4 hours
A Food thermometer available and accurate C Adequate Wishwashersanitizer ❑final rinse temp
D 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 C 0 NIA 1,
7 Food protected during:storage,';preparation,. C, N10 _N/A 2
display,service;`and transportationA Cloths and/or sponges in good repairand clean
B Wiping cloths kept in sanitizer between uses
A Produce washed
B Raw meats not storediprepared near ready-to-eat foods 26 ood-contact surfaces clean, C .N10 FNI 2
C Food covered properly A Food equipment clean,utensils A
clean,equipment interiors clean
D Adequate splash guards I sneeze guard B Single use gloves changed when soiled
E No unauthorized personnel Cfood--contact surfaces clean
F No pooling of eggs not cooked immediately
8 ood containers stored offthefloor 30 -,Hot and cold water under,pressure,provided as.require N10 NIA 2
38 Handw'ashing accessories provided' N N/A 1
9 Handling of food minimized VO NlA= 2 A Soap I 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 oe C Handwash sink(s)clean 1 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[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 wok:
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 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 A_=indicate language spoken
List products cooled: by QFO/DA: *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
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
111%trin V: _ .` p -Jdrot:In"section t
A �ress Qwner or�`Operator� �V�V\V/A_n.�cr �Xr�✓ �'r "�
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ADDITIONAL. FOUR POINT ITEMS KEY: DNC [DOES NOT COMPLY] c
6 Foods not re-served.
-Unwrapped foods not re-served 4.; 31 Sewage disposal approved. 4,
-Operating as required
-Potentially hazardous foods not re-served
No cross connections,back siphonage,backfiow
11 Toxic chemicals. 4 PCopPryrzelinstallationl backfiow prevention device)airs for: 4
-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
.No 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
4
-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 a '
KEY: DNC [DOES NOT COMPLY]
2 Sources of food: Original container,properly labeled 1. 40 Garbage/rubbish storage arealrooms,enclosures-properly constructed,clean 1.
5 Potentially hazardous food properly thawed Z 41 Garbage/rubbish disposed of in an approved manner,at approved frequency
10 Aod dispensing utensils properly stored 1'; 42 Vermin Control:No insectslrodents present 2
14 Food worker:Clean outer clothes,effective hair restraints 1 43 Outer openings protected against entrance of insectslrodents t,
4 Floors:Floor covering installed,constructed as required,good repair,clean 1;
16 Food-contact surfaces designed,constructed,maintained,installed, 45 Floors graded,drained as required
located
6 Floor,wall juncture covered
17 onfood-contact surfaces designed,constructed,maintained, l:
7 Mats removable,good repair,clean
installed,located i
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
20 Dishwashing facilities approved design,adequately constructed, 2' 1.
maintained installed located 50 Dustless cleaning methods used,cleaning equipment properly stored
Equipment&Utensils: Cleanliness 51 Adequate lighting provided as required 1
1,
21 Preflushed,scraped,soaked and racked 52 Room free of steam,smoke odors 1
22 Wash waterclean,proper temperature 53 Rooms&equipment hoods,ducts,vented as required
23 Accu rate thermometers provided,dish basket,if used 54 Rooms adequate,clean,adequate lockers provided,facilities clean 1
2 Nonfood-contact surfaces of utensils&equipment clean 1
55 Establishment and premises free of litter,noinsectlrodentharborage, 1"
quipmenUutensils,storage,handling r no unnecessary articles
32 Proper disposal ofwastewater 17 56 Complete separation from living/sleeping quarters and laundry i:;
33 Plumbing location,installation,maintenance 1=; 571 Clean/soiled linens stored properly t o
58 No live birds,turtles,or otheranimals(except guidedogs)
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 entrance(s);smoking area indicated by sign(s)
.39 Approved garbage/rubbish containers,adequate numb:�/6
;1
rodent proof,clean outine Inspection ❑Reinspection 0 Preoperational Inspection
Other Inspection:
INSPECTOR: PERSON! E: Demerit Score: •Include demerits from page 1
4 3 2 1 Total Rating
s ure WStu
print 4l nae, ��j(,r print name
( nTJ=)`c' '—f DATE ORRECTIC DUE:
phone number title
�'t/VV Page 2 of 2 plus__A__continuation pages Focused Inspection 70w
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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INSPECTION REMARKS
FORM#
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INITIAL(INSPECTOR) INITIAL(PERSON IN CHARGE)
Distribution: 1st-White-Health Department 2nd-Yellow-Owner/Manager