HomeMy WebLinkAboutFood Service Establishment Inspection 40 (9) Establishment: e,>iL Inspection Date: Piz 6- Time: ,0,' qj Q RCI ns REinsp
Address/City: ealth Dept: Az)i)� � j ;,,,,eA, 2� r . Class: 1 4
Based on an inspection this day,the items marked DNC identifythe 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 NIA DNC KEY: C[complies] N10[not observed] NIA[not applicable]
6Q. =QUallfled Food`:Operator- - 3 DNC[does not comply] 0[other] RTE[ready-to eat]
_.s. s 2V.Personnel with infection restricted" C Nlq NIA„ 4
6V Designated Alternate:; 2
q Food workers have no exposed Infected lesions I burns
62 ,Written documentation of training program " 2
B Personnel with infection restricted
1 'Appr'.o�ed source,wholesome`,notiadulterated , C. N/0 NIA '4 C Communicable disease of worker reported to local health director K
A Approved shellfish frnfish meat&poultry USDA approved 13 Handwashlhaftellitles provided;handsvrashed,clean 'C ,N10 N1A '4
B Food cans in good condition(not dented,rusty,bloated,leaking) A Handwash facilities in all food prepldispensing&warewash areas
C Wholesomelnonadulterated foods/safe }C 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 I Proper handwash procedure
0 E Handwashing at appropriate times
:3 1lp4entI ifly'ihazardous food meets teftipeeature reguiretnenfs C ;N10 4 O
k dflring storage,pre "Ll on, splay di ;service and trartsgortatton t
N5 lGood^,'hygfen[c practices- C.Ill NIA; 2`
A Hot holding greater than or equal to 10. (whole beefrporkroests 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 0
E Proper internal cooking Iconsumeradvisoryposted i24.3anitiaatron rinse(hot water=chemical) C KNIO NIA 2
..._
0 A Approved saniti zer availableladequate concentration of sanitizer
'41 Ai�egefate facftfties;tomalntain product t . a ::t. t c, N1Q NIA i 2 g Food contact surfaces and utensils used for potentially
t i 'tern ernture thermome{�rs rovidr3ri hazardous food sanitized at least every 4 hours
.1 r.:.x .: o-11l ..p h.d ti . .# z v t µ t''+
A Food thermometer available and accurate C Adequate ❑dishwashersanilizer ❑final rinse temp
L Proper sanitizin rocedure
B Proper food thermometer for product E Sanitizing between raw animal origin&ready-to-ealfood C Thermometers appropriately placed in 000lerunits 0
0 x k A w r , .•....,. 25 ean viriRl.o clof hs r C INIt}s rNlA 9,.
;? ' id{p) tfsf.Ttel furflag storage,preparation,v C IVIO
x I x i z" A Cloths andlor sponges in good repair and clean
dpllays@rV[ce artd))tralSporktat°E �c
B Wiping cloths kept in sanitizer between uses
A Produce washed
0
B Raw meats not stored/prepared near ready-lo-eat foods 46+:Food contact4_966ees iclean= x.4 4Y A tw.x G lil WA 2
C Food covered properly
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--contactsurfaces clean
F No pooling of eggs not cooked immediately Q
8 Food containers stored off the floor r ei.. ' "
p30 Hot and cold water:undek Assure,ptgvhded ate require
r..;:e .c:. 4;,.i}6!w
0 k38 wH�tldr8f;hung fice$sorifs provided
9k° Andling A fold mintm.ized x NIO N!A .2.. A Soap/papar towels 1 drying device available
A No unnecessary handling RTE and/or cooked foods with bare hands jC 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 utensil(s)for dispensing foodlIce 0
0 •DESCRIBE DEFICIENCIES ON CONTINUATION SHEETS
The following information is not debitable and does not affect your score. KEY QFO[quafi6ed food operator],DA[designated alternate],PHF Dotentally hazardous food],FB Ifoodborne]
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: i Is there a written tllne policy that requires the food worker to report specific illness conditions
Are temperatures recorded/logged for cold holding foodslequip ent? Y N and diseases to the FO? Y N *Do you have a paid sick leave policy? Y N
Are foods cooked in advance and cooled? Y N +Are eftovers saved? Y N Is there a langua barrier between inspector&QFO? Y N Iflf ves indicate language spoken
List products cooled: by QFOIDA: *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 onitoring of cooling recorded? Y N .Obtain signature cAthe person who received the QF_0 responsibilities information at the time of the
Is there a produce washing policy? Y N ♦D scribe what is washed and inspection: (, rXL4
where' Nate: This report is a two page form(total of 52 debitable items) Page 1 of 2
U CQNNEi TL UT� DEPARTMEMTOF PUBLIC HEAT-TH 410 CA ?I C LA UE MS#51FDP-HARTF'ORD,CT 00134
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4
Lo II. IEALTH DEPr? , ADDRESSXITY,
Establishment: �`aGe.�.tt�, /7'�'h� / ° Date of Inspection:
a
ddrass, ° a s : Owner or Operator:
ADDITIONAL FOUR POINT ITEMS
la, 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
No cross connections,back siphonage,backflow
11 Toxic chemicals. 4.
4 Proper ype/installation/backflow prevention device/air gap 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
-Pesticides/rodenticides properly dispensed Proper drain for:
29 Water source adequate,safe, -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]
2 Sources of food: Original container,properly labeled 1- 0 Garbageirubbish storage arealrooms,enclosures-properly constructed,dean „1
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 lM 42 Vermin Control: No insects/rodents present 2
14 Food worker:Clean outer clothes,effective hairrestraints .1. 3 Outer openings protected against entrance of insects!rodents ;-
4 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
6 Floor,wall juncture covered
17 Nonfood-contactsurfaces designed,constructed, maintained, 1 47 Mats removable,good repair,clean
installed,located 1
18 Single service articles,storage,dispensing 2
48 Exterior walking,driving surfaces,good repair,clean
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 approveddesign,adequately constructed, 2 r
maintained installed located 50 Dustless cleaning methods used,cleaning equipment properly stored 1t
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 Wash water clean,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 le`
27 Nonfood-contact surfaces of utensils&equipment clean 1
55 Establishment and premises free of litter,no insect/rodentharborage, 1
28 Equipment/utensils,storage,handling 1, no unnecessary articles
32 Proper disposal of waste water 1; 56 Complete separation from livinglsleeping quarters and laundry 1
33 Plumbing location,installation,maintenance 1 57 Clean/soiled linens stored properly 1
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 Propertoitetfixtures provided,good repair,clean entrance(s),smoking area indicated by sign(s) 3
39 Approved garbage/rubbish containers,adequate number,covered, 1
rodent proof,clean ❑Routine Inspection ❑Reinspection ❑ Preoperational Inspection —
INSPECTOR: PERSON IN CHARGE: Other Inspection:
� Demerit Score: •Include demerits from page 1
Vgnature
cep s7`l;,a,, , 4 3 2 1 Total Rating
signature r
pri t name print name
r� `57f As:,,c'aL4, DATE CORRECTIONS DUE: AL
phone number title
-' , Page 2 of 2 plus continuation pages Focused inspection 112002
Page / Of l
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INSPECTION REPORT STATE OF CONNECTICUT
FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH
CONTINUATION SHEET
NAME OF ESTABLISHMENT TOWN DATE OF INSPECTION
Z/,O A
rNSPECTION REMARKS
FORM#
�Lc
INITIAL(INSPECTOR) INITIAL(PERSON IN CHARGE) M t j
Distribution: 1st-White-Health Department 2nd-Yellow- Owner/Manager