HomeMy WebLinkAboutFood Service Establishment Inspection 80 (6) U.
Establishment: Inspection Date: Time insp R insp
ddresslCity:egjoL ZIC MW Health Dept: wiN S class; z 3 4
Based on an inspection this day,the items marked DNC identify the violations[n operatlon 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 NIA DNC KEY: C[complies] NIO[not observed] I[not applicable]
t80 Qualified Fao"d Operat+,rA �� ,' M 3 DNC[does not oorr�ly] 0[other] RTE[ready-to eat]
61 }Designated Alternattt 2
12.:.Personnel'inrith infection restricted
$2 Wtitten documentatlgn of training program 2 A Food workers have no exposed infected lesions!burnsjk
B Personnel with infection restricted
1 k rApproved source;wholesgme,nonadul#e ated C Ni N/A 4` C Communicable disease of worker reported to local health director
A ADproved shellfish,finfish meat&poultry USDA approved k93; Handwiilshin' .'fi lities provides!,,.hands washed;clean ?C NIQ; NIA: )4.
B Food cans in good condition(not dented,rusty,bloated,leaking) A Handwash facilities in all food prep/dispensing&w wash areas
C Wholesome/nonadulteratedfoodslsafe B Handw facilities in or lmmedWejY1di 0 toilet rooms-
&'---D Commercial products(no home grown/canned food) C He. fa llities a essi e n r rent
E Potentially hazardous foods received at proper temperature D e pro
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A Hot holding greater than or equal to 140°F. (wholebeefrporkroasts 1309 F.) A ❑ No eating ❑ No smoking while working
B Cold holding less than or equal to45 F. k B Wounds covered adequately
C Proper cooling C Proper sink used for handwashing
D Proper re-heating 0
E Proper[nternal cooking/consumeradvisoryposted Q4 Sarntization rinse(hc t wa£dr chemical) ;;'C NL0 4NlA 'Z:.
A Approved sanitizeravailableladequateconcentmlionofsanitizer
` eg>role el�toI"x acilitir(aa 61i pro u ;�„ a a� } 0 1[,yA ,:.r Food-contact surfaces and utensils used for potentially
temperature,thermometers provided W �� ��� � � �Y+e.� 2 '; i�. hazardous food sanitized at least every 4 hours X
A Food thermometer available and accurate C Adequate dishwashersanitizer Elfinal rinse temp
D Pro ersanitizin rocedure
B Properfood thermometer for product E Sanitizing between raw animal origin&ready-to-eat food
C Thermometers appropriately placed in cooler units
0 0
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e4. nd ptq <ti r�gsd�9e;,prepar ' rl, NIVlO I4lq( fi •� _ 'NIA 1
d1pY1X+�erGi agd transportaa A Cloths and/or sponges in good repair and clean
B Wiping cloths kept in sanitizer between uses
A Produce washed
B Rawmeals notstoredlprepared near ready to eatfoods A6i i oo c r t t surtface$ Ig n ":•. * C��W lA
C Food covered properly
A d equipment clean,utensils clean,equipment interiors clean
D Adequate splash guards(sneeze guard � g 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 F dontainerssforedoffihefioor e t r w µ }
0 eFlgt anda Id weer.y.t. a ppre sstirehpro�vid�yd'as%egwre !0>iNlA 2
Hal(fdwa,'shingaccessotie��ro►rlded':� ,`Utz. IfiVQ, k1�lA.F�1;
'nft ngroff�io ;ttitrnmized '
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A Soap 1 paperlowels/ drying device available
No unnecessary handling RTE and/or cooked foods with bare hands B Dispenser(s)working: ❑Soap ❑Papertowel
B Minimize food handling,other than ready-to-eat,with bare hands C Handwash ink(s)clean!waste receptacle at handwash sink
C Adequate utensils)for dispensing foodlice 0
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[poten@ally 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 temperatur do you cook:
Poultry Ground Beef �k` What diseases related to FB ill7 are you required to report to the local health department? -
Roasts Other
Describe re-heating procedures: Is there a written illness po' that requires the food worker to report specific illness conditions
Are temperatures recorded/logged for cold holding foodslequip. nt? 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 *A leftovers saved? Y N Is there a language rrier between inspector&QFO? Y N If yes indicate language spoken
List products cooled: by QFOIDA: *Can the QFOIDA read the inspection report? Y N
Describe cooling methods: Indicate who swered the above questions: Name(print):
Is coaling monitored for time&temp? Y N Is t e monitoring of cooling recorded? Y N Indicate the ifle of abov e n{circle all that apply):QFO DA Mgr Cook Owner FW
Obtain si ature of tit perso who receive a QFO responsibilities information at the time of the
rwhe7re:
produce washing policy? Y N *Describe what Is washed and inspec� n:
Note: This report is Y!!fAgAcrm NtaFA debitable items) Page f of 2
'S E��GONNEG'TICLIT DEpA,RTMENTOF=I? 1f3L1C HI=aL7, APITOCAVENUP. {A,S IF �WA'R�FOR O�T>Q6fl34`
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BQOUS1�FOOD.SERVYSIzECT1O1' ' x
L HEALTH blrpT (J .1 a ��.ADDRESSICITY _M
East`blisfiment -�.4,(i�=,tv1¢ , (f Date of Inspection:
3.
dd`ress Owner or rOperator:
ADDITIONAL POUR POINT ITEMS `V- 3
o: KEY: DNC [DOES NOT COMPLY]
6 Foods not re-served. 4 31 Sewage disposal approved.
-Unwrapped foods not re-served 4
-Potentially hazardous foods not re-served -Operating as required
74 No cross connections,back siphonage,backflow
11 Toxic chemicals.
4 Pro per typelinstallationl backflow prevention device/airga 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
-No unnecessary toxics on the premises -Chemical dispensers -Ice machines
-Pesticideslrodenticides properly dispensed Proper drain for:
29 Water source adequate,safe. -Food equipment -dish machines -Ice machines
4
-Well Iwell head protected from contamination 35 Toiletfacilities. 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 0 Garbagelrubbish storage area/rooms,enclosures-propedyconstructed,clean
lv
5 lentially hazardous food properly thawed 2 41 Garbagelrubbish disposed of in an approved manner,at approved frequency
1 #cocl dispensing utensils properly stored 42 vermin Control: No insectsfrodents present 2
14 Food worker:Clean outer clothes,effective hair restraints 43 Outer openings protected against entrance of insects/rodents l
4 Floors: Floor covering installed,constructed as required,good repair,clean
16 Food-contact surfaces designed,constructed,maintained,installed, 45 Floors graded,drained as required
located
6 Floor,wall juncture covered
17 Nonfood-contact surfaces designed,constructed,maintained, 47 Mats removable,good repair,clean
installed,located
2
S Exteriorwalking,driving surfaces,good repair,clean
IS Single service articles,storage,dispensing 1`
19 No reuse of single service article 9 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
22 Washwaterclean,proper temperature 53 Rooms&equipment hoods,ducts,vented as required
2 ccurate thermometers provided,dish basket,if used 54 Rooms adequate,clean,adequate lockers provided,facilities clean
7 onfood-contact surfaces of utensils&equipment clean
55 Establishment and premises free of litter,no insect/rodent harborage, 1;
EquipmenUutensils,storage,handling 1 no unnecessary articles
32 P roper disposalof waste water 1 56 Com plete s epa ratio n from I ivi n g/sl ee pi n g q ua rlers a n d la u n dry j
33 Plumbing location,installation,maintenance 57 Clean/soiled linens stored properly '1
58 No live birds,turtles,orother animals(except guide dogs) 1
36 Toilet rooms enclosed with self-closing door l
59 Seats 75 ormore:Nonsmoking area provided,sign(s)posted at
37 Propertoilettixtures provided,good repair,clean 3
entrance(s),smoking area indicated by sign(s)
39 1 Approved garbagelrubbish containers,adequate number,covered, 1 1
rodent proof,clean Pgoutine Inspection OReinspection 0 Preoperational Inspection —
Other Inspection:
INSPECTOR: PERSON IN CHAR � Demerit Score: *include demerits from page 1
�J 4 3 2 1 Total Ratin
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signature signature
print name print name I Z�
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-—_ 0 1 AP/I� DATE CORRECTIONS DUE: �
phone number title
Page 2 of 2 plus continuation pages Focused mspe bon u2002
Page4 of
INSPECTION REPORT STATE OF CONNECTICUT
FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH
CONTINUATION SHEET
NAME OF ESTABLISHMENT TOWN DATE OF INSPECTION
-
INSPECTION MARKS
FORM# JJ��
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Distribution: 1st-White-Health Department 2nd-Yellow-Owner/Ma ager
Pageof�3--
INSPECTION REPORT STATE OF CONNECTICUT
FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH
CONTINUATION SHEET
NAME OF EST LISHMENT DATE OF INSPECTION TO
1 6,o 3 'L
INSPECTION REMARKS
FORM#
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IMTIAL(INSPECTOR) INITIAL(PERSON IN CHARGE)
Distribution: I st-White-Health Department 2nd-Yellow- Owner/Manager
Page_of
INSPECTION REPORT STATE OF CONNECTICUT
FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH
CONTINUATION SHEET
NAM F ESTABLISHMENT TOWN j� DATE OF IN ECTI N
INSPECTION REMARKS
FORM#
491
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INITIAL(INSPECTOR) INITIAL(PERSON IN CHARGE) y
Distribution: Ist-White-Health Department 2nd-Yellow-Owner/Manager