HomeMy WebLinkAboutFood Service Establishment Inspection 85 (19) lGf,�i r a u vim '
Establishment: � �,� F40t /) ection Date: Time• �al/
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Address/City: Health Dept: ei ZZSC /cam
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 passible debitable items C NIO NIA DNC KEY: C[complies] N10[not observed] NIA[not applicable]
60 =Qualified Foie Operator 3 comply] 0[other} RYE[ready-to-eat]DNC[does not
t r` 12 :Perso ItK Infection restricted;
61 Oeslgnafed Alternate• 2
• ; •l r A Food workers have no exposed infected lesions 1 burns
C ,NlO: N!A '4
�62 t Written doeumenfation of tralntngprog�ram 2
B Personnel with infection restricted
1 Approved Source,wholesome,rlonadulterated C',N10 N/A 4 C Communicable disease of worker reported to local health director
A Approved shellfish,finfsh,meat&poultry USDA approved
13 'HandvtrashingAfacUttfesprovided,handswashed;clean- C .IWO: NIA :4
B Food cans in good condition(not dented,rusty,bloated,leaking)
A Handwash facilities in all food prepldisp ing&wa ash areas
C Wholesome/nonadulteratedfoods/safe .< B Handwas Ac ities in or imme ' adjac o toilet rooms
D Commercial products(no home grown/canned food) C Handwy chits Xi i us
E Potentially hazardous foods received at proper temperature p Persa net hold can roper h €ocedure
0
E Handwashing at appropriat i
,3 Potenfielfy`Ija4ardous fao i rneets,temperature�regirtr�em nts iC`1d10 N1A 4" p
dtffI' sfforage preparatrcn display,Servrcerafid,trar{sportation
r 5 apra ;Cr` O .IWA 2
i. Gcod nl ctices
A Hot holding greater than or equal to 140 F. (whole beellpork roasts 1309 F.) k A ❑No eating ❑ No smoking while working
B Cold holding less than or equal to 45'F. B Wounds covered adequately
C j Proper cooling bL p. C Proper sink used for handwashing
D I Proper re-heating 0
;. hE Proper internal cookin l consumer adviso advisory d; a 'tztninsk , wat49.? E .. . .CNIQ°' ..,.;. 2
0 A A -roved sanitizeravailableladequateconcentrationofsanitizer
K� ►dequate„ amlit eE to MI In prgdudt#ok z �fi LwO ;4V11 B Food-contact surfaces and utensils used for potentially
te[iper tore,thermometerseprovlded� I a Y a hazardous food sanitized at least every 4 hours
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A k ue it,d hs.'} r:^
A Food thermometer available and accurate C Adequate ❑dishwashersanilizer ❑final rinse temp
L Proper sanitizin rocedure
B Properfood thermometerfor product
E Sanitizing between raw animal origin&ready-to-eatfood
C Thermometers appropriately placed in cooler units
O
L—tx I" r 5 Gleah;N►".#nqt $.*S, se
POOr :pPrationvarN!0 l�dllera4 W" 3 sk ' "I A Clothsandlorspongesingoodrepairandclean
[• ."-� '. .:�.,,s�`�a..:a s. n >:u. l}.:;g "$. $:tr.:4 "fMI ' +
B Wiping cloths kept in sanitizer between uses
A Produce washed
Raw meats not stored/prepared near ready-to-eat foods
Fo -contacsur#acessclean r '°'�C'[%0) 2
Food covered properlyt .a
6d equipment clean,utensils clean,equipment interiors clean
Adequate splash guards/sneeze guard Single use gloves changed when soiled 4�
E No unauthorized personnel C Food--contact surfaces clean
No pooling of eggs not cooked immediately 0
8 food containers stored off the floor et? [,Hot anc fold water u cl r pressure,provided as-requtr Or N/A ;2
ti..'S
l .,i.Juri dwa s�irng aceessonestprovIded µ t iNh7
x t Znc l lin $ofropd,rriiinimized= ", x , : r:nCK kN10 INl 2 A Soap!paper towels 1 drying device available
No unnecessary handling RTE and/or cooked foods with bare he B Dispenser(s)working: ❑Soap ❑Paper towel
B Minimize food handling,other than ready-to-eat,with bare hands C 1 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 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: 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-healing procedures: Is there a written illnessplicy'that requires the food worker to report specific illness conditions
Are temperatures recordedliogged for cold holding foodslequipmerd? N and diseases to the Q ? Y N *Do you have a paid sick leave policy? Y N
Are foods cooked in advance and coaled? Y N *Are le fto ors saved. Y N Is there a langua barrier between inspector&QFO? Y N Ives indicate language spoken
List products cooled: by QFO/DA: *Can the QFOIDA read the inspection report? Y N
Describe cooling methods: Indicate ul140 answered the above questions:Name[print]:
Indicate the title of abov person(circle ail that bappl, QFO DA Mgr Cook Owner FW
Is cooling monitored for time&temp? Y N Is them itoring of cooling recorded? Y N .Obtain signatur n who receive thesponsibilities information at the lime of the
77 Is there a produce washing policy? Y N ♦Describe what is washed and
Is
where: Note: This report is a Iwo page form(total of 62 debitable items) Page 1 of 2
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FOCUS D FOaEi $E$S'iGEz�?S PECTiO T +PO tT
ADDRESS'1CITy;' m
Estabhshlment. 07 Sv jade.of;Inspection: �d
ddr"essE �xJ / G1 al Owner or Operator. '
ADDITIONAL FOUR POINT ITEMS KEY: Dill [DOES NOT COMPLY'
tom§
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
1 Toxic chemicals.
74 No cross connections,back siphonage,backflow
1 4"
4 Proper typeliostallation/backflow prevention device/air gap
-Stored properly,labeled properly,used properly -Food equipment -Hose connections -Dish machines
-Sanitizes concentration not to exceed maximum permitted -Soda system carbonator -Beverage dispensers -Toilet tanks
-No unnecessarytoxics on the premises -Chemical dispensers -Ice machines
-Pesticideslmdenticides properly dispensed Prover drain for:
29 Water source adequate,safe, -Food equipment -Dish machines -Ice machines
4
-Well I well head protected from contamination 35 Toilet facilities. Adequate,convenient,accessible,
-Water quality in compliance designed,properly installed
-Monitoring in compliance
OTHER ITEMS KEY: DNC [DOES NOT COMPLY "
2 Sourcesoffood: Original container,properly labeled 40 Garbagelrubbishstoragearealrooms,enclosures-properly constructed,dean
5 Potentially hazardous food properlyihawed ;2'; 41 Garbageirubbish disposed of in an approved manner,atapproved frequency
10 Food dispensing utensils properly stored 42 Vermin Control: No insects/rodents present 2' _
14 Food worker:Clean outer clothes,effective hair restraints 43 Outer openings protected ag a I nst entrance of insectslrodenis
I
4 oors: Floor covering installed,constructed as required,good r r,cl�ari`
6 F od-contact surfaces designed,constructed,maintained,installed, 2 Floors graded,drained as required
located
6 Floor,wall juncture covered
17 Nonfood-contact surfaces designed,constructed, maintained, 1` 197
Mats removable,good repair,clean
installed,located
xteriorwalking,driving surfaces,good repair,clean
18 Single service articles,storage,dispensing 2
19 No reuse of single service article )halls,ceilings attached,equipment properly constructed,good
�tpair,clean.Wall&ceiling surfaces as required n
20 Dishwashing facilities approved design,adequately constructed, 2
maintained installed located ustless cleaning methods used,cleaning equipment properly stored
i 51 equatetighting provided as required
1 Preflushed,scraped,soaked and racked Room free of steam,smoke odors
22 Wash water clean,proper temperature 53 Rooms&equipment hoods,ducts,vented as required i
23 Accurate thermometers provided,dish basket,if used y
54 Rooms adequate,clean,adequate lockers provided,facilities clean `;.
onfood contact surfaces of utensils&equipment clean _ 5� E tablishmentand premises free of litter,no insect/rodent harborage,
S Equipmentlutensils,storage,handling 1 / no unnecessary articles r
per disposal of wastewater 56 Complete separation from living/sleeping quarters and laundry 1
33 Plumbing location,installation,maintenance 1 57 Clean/soiled linens stored properly 1
r<-
58 No live birds,turtles,or other animals(except guide dogs) 14
36 Toiletrooms enclosed with self-closing door 1
59 Seats 75 or more:Nonsmoking area provided,sign(s)posted at
37 Proper toilet 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 Routine Inspection ❑Reinspection ❑ Preoperational Inspection
gher Inspection:
PERSON IN CHARGE:
Demerit Score: •Include demerits from page 1
4 3 2 1 Total Rating
sE nature L sl na,
rint name print name
go � �/� 5 rC W�
p one number title DATE CORRECTIONS DUE: h r UCCCIII
Page 2 of 2 plus continuation pages Focused 1n �noo 112002
Pag5/--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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Distribution: I.st-White-Health Department 2nd-YeIlow-Owner/Manager
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INSPECTION REPORT STATE OF CONNECTICUT
FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH
CONTINUATION SHEET
NAME OF ESTABLISHMENT TOWN S DATE OF INSP CTION
INSPECTION REMARKS
FORM#
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INITIAL(INSPECTOR) INITIAL(PERSON IN CHARGE)
Distribution: 1st-White-Health Department 2nd-Yellow-Owner/Manager
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INSPECTION REPORT - STATE OF CONNECTICUT
FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH
CONTINUATION SHEET
NAM F ESTABLISHMENT TOWN DATE OF INS ECTION
4el�.F/?.>SC� J � C
INSPECTION REMARKS
FORM#
INITIAL(INSPECTOR) INITIAL(PERSON IN CHARGE)
Distribution: 1st-White-Health Department 2nd-Yellow-Owner/Manager