HomeMy WebLinkAboutFood Service Establishment Inspection 60 (11) IMP
ho MS.
Establishment: Inspection Date: Time: in RE[nsp
Address/City: p ,Q/ �,� t! L a¢y Heai h Dept: 2� z_t��ie,� Class: 1 2
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 N/0 NIA DNC KEY: C[complies] N/0[not observed] NIA[not applicable]
fiQ f ualtfied:Food Operator,, 3 DNC[does not comply] 0[other] RTE(ready-to-eat]
61 stgnated Atterrtate
12 Persohnel with infection restricted ;C .NlO '.IAA 4
A Food workers have no exposed infected lesions/burns
rttten documentation of train[no program 2 B personnel with infection restricted
}APproved source,wholesome;'fionadullerated lC N10 NIA C Communicable disease of worker reported to local health director
A Approved shellfish finfish,meat&poultry USDA approved 13 Handwashingfacflities provided,hands washed,clean C N/0 NIA 4
B Food cans in good condition(not dented,rusty,bloated,leaking) A Handwash facilities in all food prep/dispensing&warewash areas
C Wholesome/nonadulteratedfoods/safe B Handwash facilities in or immediately adjacent to toilet rooms
D Commercial products(no home grown/canned food) C Handwash facilities access iblelconvenlent to use
E Potentially hazardous foods received at proper temperature D Personnel hands washed,clean/Proper handwash procedure
0
3 E Handwashing at appropriate times
p olentially hazardous foori meets tempetature`�egtiirements C N10 WA 4 o
.durmg storage,pfeparatlon=display,service and transportatiort
]15Good`hYgienc practices G NIO"NIA °2`
s - ° ,
A Hot holding greater than or equal to 140eF. (whole beeBperkroasts 1300F.) A ❑ No eating ❑No smoking while working Al
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 Pro erinternalcookinglconsumeradvisoryposted 2>a Santtization ` NiO NIA �2
pproved sanitizer availableladequate concentration of sanitizer V.
4 �A ec r atg facilities toArrr�loatin�product y n:b C 'Nl0 /A ,",2 B cod-contact surfaces and utensils used for potentially
b t perattlre'therr>fonnetein;pMyided _ a azardous food sanitized at least every 4 hours
t � . 'r m ,;
W_ Food thermometer available and accurate C Adequate ❑dishwashersanitizer ❑final rinse temp
B Proper food thermometer for product
D Pro er sanitizing procedure
C Thermometers appropriately placed incooler units
E Sanitizing between raw animal origin&ready-to-eat food
0
0 aFoopda gyr site r�Yteictle rtdtr-an"sort a a ,2attrinostora C �NIO N/A �� 2atd � ,
IA 2 5 ,CCloIt sh as,and/or
wd�/oi prsin sponges celostinh so od�repair
air and;clean
ea�nr °
A Produce washed & B Wiping cloths kept in sanitizer between uses
0
B Raw meats nofstored/prepared near ready-to-eat foods )26 P, e r Ol[NIA i2
C Food covered property t. € 4
A Food equipment clean,utensils clean,equipment interiors clean
D Adequate splash guards/sneeze guard B Single use gloves changed when soiled
E No unauthorized personnel C Food--oontact surfaces clean
F No pooling of eggs not cooked immediately 0
8 Food containers stored off the floor 30 '.I of and,_old Water undeC pressure;q oirided as requir 0 NItC 1,�
C � � i i
38 `Ha idwa King accessories provided woo 1 N/A 1
9p' Handling of foodtim IMI;Ied ��. µ C N10 iNhq ,;? �A� Soap 1 paper towels! drying device available 1 �
A No unnecessary handling RTE and/or cooked foods with bare hands k B
Dispenser(s)working: ❑Soap ❑Paper towel
B Minimize food handling,other than ready-to-eat,with bare hands C Handwash sink(s)clean/waste receptacle at handwash sink
C Adequate utensi[(s)for dispensing foodlice 0
O 1 1 j •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[potentally hazardous food],FS[foodborne]
PHFs are hot held at: IF. 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 As the food worker to report specific illness conditions
Are temperatures recorded/logged for cold holding foodsle ipment? Y N and diseases to the QFO? Y N req ♦Do you have a paid sick leave policy? Y N
Are foods cooked in advance and cooled? Y N ♦ re leftovers saved? Y N Is there a language barrier betweh inspector&QFO? Y N Iflf yes indicate language spoken
List products cooled: by QFO/DA: *Can the OFO/DA read the inspection report? Y N
Describe cooling methods: _ / Indicate who answereZla;bov-el estion�ame-(prinf6-
Indicate the title of abon(circle ail tha apply): rCook Owner FW
Is cooling monitored for time&temp? Y N Istfie monitoring of cooling recorded? Y N .Obtain signature of lhho ceived a QF espo bit ieff s 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 tw ge form(total of 62 debitable items) a f 2 .,
r
STATE bF'40NI EGTfCU�T p P�41 t1'NlEIVT QF pllHLlC;HEALTH 499 CAPITQI<A1lENUE `MS#51 FDP-FIARTFORI);CT 06134'
"` s FOCUSED FOOD;SERVTL7 1NSPECTTO RE3P0 2{T r
LSO AL1fE:ALTH`Dep7° t '`l, r;� f i . 'DDR S41;
Esfiabl:shment �✓GL�:.L��/ 1 D"ate of;Inspection, �
MOMS
/l�L�✓ L-C_ f,� __ Owner dr..OpeGator.
ADDITIONAL FOUR POINT ITEMS c KEY: DNC [DOES NOT COMPLY]
6 Foods not re-served.
-Unwrapped foods not re-served 4 31 Sewage disposal approved. 4
-Potentially hazardous foods not re-served -Operating as required
34 No cross connections,back siphonage,backflow
11 Toxic chemicals. 4 4;
-Stored properly,labeled properly,used properly Proper type/installation/backflow prevention device!air gafoi:
-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
-Pesticideslrodenticides properly dispensed -Chemical dispensers -Ice machines
Proper drain for:
29 Water source adequate,safe. -Food equipment -Dish machines -Ice machines
4
-Well/well head protected from contamination-Water quality in compliance 35 Toilet facilities. Adequate,convenient,accessible, 4
-Monitoring in compliance designed,properly installed
OTHER ITEMS c; KEY: DNC [DOES NOT COMPLY]
2 Sources of food:Original container,properly labeled X 0 Garbagelrubbishstoragearealrooms,enclosures-properly constructed,dean G
4
5 Potentially hazardous food properlythawed 41 Garbage/rubbish disposed of in an approved manner,at approved frequency
10 Food dispensing utensils properly stored ;1" 42 Vermin Control: No insectslrodenis present 2
14 Food worker:Clean outer clothes,effective hair restraints 43 Outer openings protected against entrance of insects/rodents
4 Floors: Floor covering installed,constructed as required,good repair,clean 1
6 F d-contact surfaces designed,constructed,maintained,installed, 2: 5 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
8 Exterior walking,driving surfaces,good repair,clean
18 Single service articles,storage,dispensing 2
19 No reuse of single service article 9 Walls,ceilings attached,equipment properly constructed,good l
ir, lean.Wall&ceiling surfaces as required
20 Dishwashing facilities approved design,adequately constructed, :
maintained installed located 50 Dust ss cleaning methods used,cleaning equipment propedy stored
Equipment&Utensils: Cleanliness :i 51' Adequate lighting provided as required
21 Preflushed,scraped,soaked and racked 52 Room free of steam,smoke odors `)
22 Wash water clean,proper temperature ;.i
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
Sw f:
27 Nonfood-contact surfaces of utensils&equipment clean 1
55 Establishment and premises free of litter,no insect/rodent harborage, A
28 Equipment/utensils,storage,handling Y1* no unnecessary articles
32 Proper disposal of waste water 1 56 Complete separation from livinglsleeping quarters and laundry I1,'
33 Plumbing location,installation,maintenance
57 Clean/soiled linens stored properly
58 No live birds,turtles,or other animals(except guide dogs) 1
36 Toilet rooms 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 3entrance(s),smoking area indicated by sign(s)
39 Approved garbageirubbish containers,adequate number,covered, 1 Y'
rodent proof,clean outine Inspection ❑Reinspection ❑ Preoperational Inspection —
NSP CTOR: PE ther Inspection:
_ Demerit Score: *Include demerits from page 1
'ter
4 3 2 1 Total Rating
signature slgna —�
print name
DATE CORRECTIONS
phone num ear title
Page 2 of 2 plus continuation pages Focused n pecdon 1/2002
Page of
INSPECTION REPORT STATE OF CONNECTICUT
FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH
CONTINUATION SHEET
NAME OF ESTABLISHMENT TOWN DATE OF SPECTION
INSPECTION REMARKS
FORM#
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101144 �-
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INITIAL(INSPECTOR) INITIAL(PERSON IN CHARGE)
Distribution: Ist-White-H-e-altk Department 2nd-Yellow-Owner/Manager