HomeMy WebLinkAboutSchool Inspection 100 Arnold Way (4) t 3TA E..yOs. . Ti E
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Establishment:-M w Inspection Date: Time: Z',Sdle ROinsp REinsp
Address/City: Health Dept: Class: 1 2 3 4
Based on an inspection this day,the items marked i- C 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 NIO NIA NCI KEY: C[complies] NIO[not observed] NIA[not applicable]
60 Qualified Food OperatoY 3 DNC[does not comply] 0[other] RTE[ready-to-eat]
61 Designated Alternate 2 12 Personnel with infection'restricted C `NIO I NlA `4.
A Food workers have no exposed infected lesions/burns
62 Written documentation of training program 2
B Personnel with infection restricted
1 Approved source,wholesome;nonadulterated C NIO 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 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 N10 NIA' 4 0
during storage,preparation,display,service and transportation
15 Good'hygleric practices N10 N/A 2:
A Hot holding greater than or equal to 1400F, (whole beeflparkmasts 1300 F.) 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 0
E Proper internal cookin I consumer adviso ry posted 24 Sanitization'rinse(hot water-chemical) WO NIA 2
0 A Approved sanitizer available/adequate concentration ofsanitizer
4 Adequate facilities to maintain product C 0 NIA 2 B Food contact surfaces and utensils used for potentially
temperature,-thermometers-provided - hazardous food sa itized at least every 4 hours
A Food thermometer available and accurate C Adequate Mdishwashersanitizer ❑final rinse temp
LY Pro ersanitizin
B Proper food thermometer for product
D rocedure
E Sanitizing between raw animal origin&ready-to-eat food
C Thermometers appropriately placed in cooler units
0 0
25 ;Clean,w-rping cloths C N10 NIA 1
7 Food,protected during storage,,preparation,. C N10' NIA ``2 A Cloths and/ors on es in re'good strand clean
display,service and transportation P 9 9 P
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,surfaees clean': 10 N/A 2
C Food covered properly A Food equipment clean,utensils clean,equipment interiors clean
D Adequate splash guards 1 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 water underpressure,provided as required 0' N/A 2'
0 381 Handwashing accessories provided G WO NIA' , 1 .
9 Handling of food minimized C' ll WA 2 p Soap l paper towels l drying device available
A I 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 utensils)for dispensing food/ice 0
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 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 U-M 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
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ADDITIONAL FOUR POINT I EMS KEY: DNC [DOES NOT COMPLY]
6 Foods not re-served. Q
-Unwrapped foods not re-served 4 31 Sewage disposal approved. 4
-Potentially hazardous foods not re-served -Operating as required
11 Toxic chemicals. 74 No cross connections,back siphonage,backflow 4
4 Pro per type/installation/backflow prevention device/air gap for:
-Stored properly,labeled properly,used properly -Food equipment -Hose connections -Dish machines
-Sanitizer concentration notto exceed maximum permitted -Soda system carbonator -Beverage dispensers -Toilettanks
-No unnecessary toxics on the premises -Chemical dispensers -Ice machines
-Pesticides/rodenticides properly dispensed 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
-Monitoring in compliance designed,properly installed
OTHER ITEMS
KEY. DNC [DOES NOT COMPLY] .c
2 Sources of food:Original container,properly labeled 1 40 Garbage/rubbish storage arealrooms,enclosures-properly constructed,clean ( ,
5 Potentially hazardous food properly thawed 2' 41 Garbage/rubbish 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 1 43 Outeropenings protected against entrance of insectstrodents 1'
44 Floors: Floor covering installed,constructed as required,good repair,clean 1
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
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, 2: 1
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 j<
22 Wash waterclean,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 premisesfreeof litter,noinsecUrodentharborage, 1-
28 Equipmentlutensils,storage,handling I'.° no unnecessary articles
32 Proper disposal of waste water y 56 Complete separation from livinglsleeping quarters and laundry 1:
33 Plumbing location,installation,maintenance Ll 57 Cleanlsoiled linens stored properly
581 No live birds,turtles,or othe r a n im als(exceptguide dogs) 1
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 en once{s},smoking area indicated by sign(s)
.39 Approved garbage/rubbish containers,adequate number,covered, 1
rodent proof,clean EfRoutine Inspection 13Relnspection ❑ Preoperational Inspection
IN PE 0 PERSON IN CHARGE: Other Inspection:
Demerit Score: *Include demerits from page I
ktA et 4 3 2 i 1 Total Rating
si eture signaturephF?t ,}alm � ��{� print n e
ba[�K`\) title DATE CORRECTIONS DUE:
phone number �7 (fir
lJ �i J c? -�-t/ Page 2 of 2 plus- J continuation pages Focused Inspection 112002
Page of
INSPECTION REPORT STATE OF CONNECTICUT
FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH
CONTINUATION SHEET
NAME OF ESTABLISHMENT TOWN DATE OF INSPECTION
S t 1 � -
IN PECTION REMARKS
FORM#
0AJ-4-V6 11Y
INITIAL(INSPECTOR) INITIAL(PERSON IN CHARGE)
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Distribution: 1 st-White-Health Department 2nd-Yellow-Owner/Manager