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HomeMy WebLinkAboutFood Service Establishment Inspection 60 (10) Establishment: ve uU LA L)Y'*_ z Inspection Date: Time: of REins ddresslCity: Health Dept: class: f 2 3 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 C NIO INA IDINCI KEY: C[complies] N10[not observed] NIA[not applicable] g a Ifta RoodrQperat0 3 DNC[does not comply] 0[other]b RATE jreadyto eat] n 1 tt�ith infer ion{refFITted, �, 2 ee A Food workers have no exposed infected lesions/burns F ° iaioof tramig p a + P, 2 B Personnel with infection restricted ✓ s9itsont 'o a t +C Nl,�i C Communicable disease of worker reported to-local health director A Approved shellfish finfish,meat&poultry USDA approved V1z a ' ' t'f drtieS rovide ;'hats wa l>OAa 4 1 B Food cans in good condition(not dented,rusty,bloated,leaking) A Handwash facilities in all food 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 access iblelconvenient to use E Potentially hazardous foods received at proper temperature D Personnel hands washed,clean I Proper handwash procedure E Handwashing at appropriate times ` otew�ba lY hdz ' t timpe� 'pt i s t /0 NIA 0 dttYih storag pr6011k o e iffie d r'af(sp rr n ,� e� ? 9 !pi Nll� ?ai s re + � ;t , ter; A Hot holding greater than or equal to 140 F. (whole beef/pork oasts 130°F.) A ❑ No eating ❑ No smoking while working B Cold holding less than or equal to 45°F. B Wounds covered adequately C Proper cooling C Proper sink used for handwashing D Proper re-heating 01 p 9 advisory posted �4+. ,axrit �ttt [t1Yi a ftae h ides E Proper internal cookie 1 consumer adviso � 0 Approved sanitizeravailableladequate concentration of sanitizer at®faaurtteoq�tat, r sett [� y B Food-contact surfaces and utensils used for potentially pi<ow: A Food thermometer available and accurate ;. hazardous f od410V anitized at least every 4 hours C Adequate shwashersanitizer ❑final rinse temp V D Proper san'izin rocedure 6 Proper food thermometer for product E Sanitizing between raw animal origin&ready-to-eat food C 1 Thermometers appropriately placed in cooler units 0 r frpi LA dzr `" A Cloths andlor sponges in good repairand clean : , ; ' B Wiping cloths kept in sanitizer between uses A Produce waa shed 0 B Raw meats not stored/prepared near ready-to-eat foods is?a C Food covered properly V � 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 ftWtrfdC' tltWaruntler pe;surpvile `a `.�gf)if� 0 8 �n w g Co e COv r - „ � A No unnecessary handling RTE and/or cooked foods with bare hands A Soap 1 paper towels I drying device available B Dispensers}working: ❑Soap ❑Paper towel B Minimize food handling,otherthan ready-to-eat,with bare hands C Handwash slink(s)clean I waste receptacle at handwash sink C Adequate utensil(s)for dispensing foodlice 1011 0 +DESCRIBE DEFICIENCIES ON CONTINUATION SHEETS The following information is not debitable 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: 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 recordedhogged 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 tf_yes indicate language spoken List products cooled: by QFOIDA: *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: I Note: This report is a two page form(total of 62 debitable items) Page 1 of 2 . N EA'ablishment: >. . , pp� . ddress: Ownert,rQper=a or _ .. . .1 W1:+m: ADDITIONAL FOUR POINT ITEMS KEY: DNC [DOES NOT COMPLY] G� 6 Foods not reserved. 4 31 Sewage disposal approved. -Unwrapped foods not re-served 4 -Potentially hazardous foods not re-served -Operating as required No cross connections,back siphonage,backflow 11 Toxic chemicals. 4 -Stored properly,labeled properly,used properly 4 Proper elinstallatiop/backf aw prevention device/air gap for; -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 -Pest icideslrodenticides properly 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 -Water quality in compliance Ldes acilities. Adequate,convenient,accessible, 4-Monitoring in complianced,properly installed OTHER ITEMS ' KEY: DNC [DOES NOT COMPLY] 2 Sources of food: Original container,properly labeled 1 40 Garbageirubbishstoragearealrooms,enclosures-propedyconstructed,clean 1' Potentially hazardous food properly thawed 2° 41 Garbage/rubbish disposed of in an approved manner,atapproved 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 Outer openings protected against entrance of insectslrodents 44 Floors: Floor covering installed,constructed as required,good repair,clean aj 16 Food-contactsurfaces designed,constructed, maintained,installed, 2; s' 5 Floors graded,drained as required located 46 Floor,wall juncture covered 17 surfaces designed,constructed,maintained, 17 Mats removable,good repair,clean �nfood-contact talled,located g Exterior walking,driving surfaces,good repair,clean 18 Single service articles,storage,dispensing 2 19 No reuse of single service article 49 repair,clean.Wall&ceiling surfaces as required Walls,ceilings attached,equipment properly constructed,good 20 Dishwashing facilities approved design,adequately constructed, Z 1 maintained installed located 50 Dustless cleaning methods used,cleaning equipment properly stored Equipment&Utensils: Cleanliness I 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 Accu rate the rm om ete rs;provided,dish basket,if used 54 Rooms ad equate,clean,adequate lockers provided,facilities clean 1 27 Nonfood-contact surfaces of utensils&equipment clean I 55 Establishment and premises free of litter,no insect/rodent harborage, 1 28 Equipmentlutensils,storage,handling 1- no unnecessary articles 32 Proper disposal of waste water 1 ; 56 Complete separation from Iivinglsleeping quarters and laundry 1 33 Plumbing location,installation,maintenance 1 57 Clean/soiled linens stored properly 1 58 No live birds,turtles,orother animals(except guide dogs) 1 36 Toilet rooms enclosed withsetf-closing door 1 59 Seats 75 or more:Nonsmoking area provided,sign(s)posted at 37 Propert6let fixtures provided,good repair,clean 3 entrance(s),smoking area indicated by sign(s) 39 Approved garbagelrubbish containers,adequate number,covered, 1 rodent proof,clean Woutine Inspection ©Reinspection ❑ Preoperational Inspection IN§PECTOR: PE RSONJUMARG& Other Inspection: Demerit Score: *Include demerits from page 1 4 3 2 1 Total Rating si ature Q signaa ure IV pri t me print name 1</ CA phone number title DATE CORRECTIONS DUE: 2� Page 2 of 2 plus continuation pages Focused rnspecdon112002 Page of ,ary INSPECTION REPORT STATE OF CONNECTICUT L� FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH CONTINUATION SHEET NAME OF ESTABLISHMENT TOWN DATE OF INSPECTION INSPECTION REMARKS FORM# vt c S /L N4/"A1A1jjC2,� I INITIAL(INSPECTOR) INITIAL(PERSON IN CHARGE) Distribution: lst-White-Health Department 2nd-Yellow-Owner/Manager