HomeMy WebLinkAboutFood Service Establishment Inspection 10 (28) not— eo
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Establishment: &rb spection Date: i Time: ;o Einsp
Address/City: Jjd d4OIL-nl� Health Dept: lass:
Based on an inspection this day,the items marked DNG identify the violations in operation or facilities which must be corrected by the date specified on page 17
.
RISK FACTOR ITEMS:Listing is not inclusive of all possible debitable items C NIO NIA JDNC I KEY: C[complies] NIO(not observed] WA[not applicable]
60'i';Quallfred Footl;Q[ierator ". :. - 3 DNC[does not comply] 0[other] RTE[ready-to-eat]
" 12 Perso.nnef<vdith Infection restricted " NlA 14
61 Deslgnatt d Alternate 2
c N1Q;
A Food workers have no exposed infected lesions 1 burns
6� ,Written documentation ofAraimng program 2
ion restricted
1 rApp`roved Source,wholesome,rtonadultelated C 1 NIA-l4 Personnel with infection B t t
C Communicable disease of worker reported to local health director
A I Approved shellfish,finfish,meat&poultry USDA approved
:13 'Handvvashing facilitiesprovided, hands washed,clean 'C N/Q,'WA 14
B Food cans in good condition(not dented,rusty,bloated,leaking) A Handwash facilities in all food prepldispensing&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!blelconveniant to use
E Potentially hazardous foods received at proper temperature D Personnel hands washed,clean I Proper handwash procedure
E Handwashing at appropriate times
t3 �Pgferitiaily fiazardous`food nieetis temperature requirements C N10 NIA f 4` 0
! ttdr V.g,storage preparptioni draplayysservice and transportatlnn' I.
t;: • !15 Good hygie''r1 ic•.practices
r - ,C iN10 N!A 2:
A Hot holding greater than or equal to 140 F. (whole WOOD* 1300 F.) A ❑ No eating 0 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 Properinlernalcookinglconsumeradvisoryposted �24 :Sranitizaf�ori,[in .e;{ho vuater;-EhethibdIX, • ' iC +I+N ` NjA 24
0 A Approved sanitizeravailableladequateooncentration of sanitizer k
4 Adequatekfacrlrties 40 maintam"prodc r C n NO IWA:•12
B Food-contact surfaces and utensils used for potentially
temp�raure,thormometerss novided '' ` ` ! hazardous food sanitized at least eve 4 hours K
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A Foodthermometeravailableandaccurate C Adequate ❑dishwashersanitizer ❑final rinse temp
D Proper sanitizin rocedure
B Proper food thermometer for product E Sanitizing between raw animal origin&ready-to-eat food
C Thermometers a pro riately placed in cooler units
0
0 1 25 q Glean Yll1 in Cldth$ ' f t
7 rotectea�aunn +store a re a atibit P 9 .,,, �. 9 C wfl 'NlA ,7
F, Qo4 9 k t N10 Nl�1 Z•
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n 4 s t x i A Cloths and/or sponges in good repair and clean x
r
A Produce washed B Wiping cloths kept in sanitizer between uses
0
B Raw meats not stored/prepared nearready-to-eat foods G26°'Eood'h6'tac s "rf`e �plean - s r' tCx NrA�:2
C Food covered properly t' • ::. °.. _• +�;_. . a ,F +..
A Food equipment clean,utensils clean,equipment interiors clean
D Adequate splash guards 1 sneeze guard fC 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
I' S Fo co tainers stored off thefio�� f.. ;,Hot and cold wader uhdsr',(�s§die'rovided as're ulre 0 lN/A' 2
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4 1. #W.a' WLf :g: 'AIR I�r y t `I4 f .i !
I j. i d ... .. ' . . . . ,.
i� a cfl n'` 'of flood m+mmized � � + �< �� ` �'' C �I10 I Z � ; Han washing accessor es�prav , :, � NIO 'NIA I°y
A Soap 1 paper towels 1 drying device available
No unnecessary handling RTE and/or cooked foods with bare hands B
Dispenser(s)working: ❑Soap ❑Papertowel �
1 B Minimize food handling,other than ready-to-eat,with bare hands C Handwash sink(s)clean!waste receptacle at handwash sink
C Adequate utensil(s)for dispensing foodlice 0
0 4:R •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: 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 ork 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 r uires the food worker to report specific illness conditions
Are temperatures recordedilogged for cold holding foodslequipm t? Y N and diseases to the QFO? Y N *Do you have a paid sick leave policy? Y N
Are foods cocked in advance and cooled? Y N *Are ftovers saved? Y N Is there a language barrier b een 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 answer d the above questions: Name(print):
Indicate the title of above person(circle all that apply):CFO DA Mgr Cook Owner FW
Is cooling monitored for time&temp? Y N Is th monitoring of cooling recorded? Y N .Obtain signature oft a pers ho received the FO responsi information at the lime of the
Is there a produce washing policy? Y N ♦ escribe what is washed and
inspection:
where: Note; This report is a two page form(total of 62 debi le items) Page 1 of 2
STXITE OF'GONN CTJCUT I IwP%�RYMENT OF PUBLIC HEAL T I ,41 Q CAPIT A AVENIUE 'MS#51 FDP
ROCUSE FOOD SERVICE TSECiQ1 RBpRT ,
L� iOt,H1=ACTH QEPT�I T". lyeJ7. 5+P L 'ADDRESS + .
Establishmentlste7 v Date of Inspection. Zc�
ddress D .4rit�=D[� zt �/.. Ownerar0 erato`r.:; y� `�'
ADDITIONAL FOUR POINT ITEMS KEY: DNC [DOES NOT COMPLY]
6 Foods not re-served. J
-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 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 -Toilet tanks
-No unnecessary toxics on the premises -Chemical dispensers -Ice machines
-Pesticides/rodenticides properly dispensed Proper drain far-
-Food equipment -Dish machines -Ice machines
29 Water source adequate,safe. 4
-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 0 Garbage/rubbish storage area/rooms,enclosures-properly constructed,dean
1.
j 5 Potentially hazardous food properlyihawed 41 Garbage/rubbish disposed of in an approved manner,at approved frequency
10 Food dispensing utensils prop edy stored .1=; 42 Vermin Control: No insects/rodents present ;2
14 Foodworker:Cleanouter clothes,effective hairrestraints 1 3 Outer openings protected against entrance of insects/rodents `I
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, 1 7 Mats removable,good repair,clean
installed,located : '�
k2'
8 Exterior walking,driving surfaces,good repair,clean
18 Single service articles,storage,dispensing I
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, 1
maintained installed located 50 Dustless cleaning methods used,cleaning equipment properly stored
Equipment&Utensils Cleanliness 51 Adequate lighting providedas required 1,
1 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 1
271 Nonfood-contact surfaces of utensils&equipment clean i' 55 Establishment and premises free of litter,no Insect/rodent harborage, T
28 Equipmentlutensils,storage,handling 1== no unnecessary articles
32 Proper disposal of wastewater 56 Complete separation from living/sleeping quarters and laundry
33 Plumbing location,installation,maintenance 57 Clean/soiled linens stored properly j
58 No live birds,turtles,orotheranimals(except guide dogs) 1
36 Toilet rooms enclosed with self-closing door �
59 Seats 75 or more:Nonsmoking area provided,sign(s)posted at 3
37 Properioiletfxturesprovtded,good repair,clean entrance(s),smoking area indicated by sign(s)
39 Approved garbagelrubbish containers,adequate number,covered, 1
rodent proof,clean Imoutine Inspection ❑Reinspection ❑ Preoperational Inspection
I T < PERSON IN CHARGE- Other Inspection:
Demerit Score: *Include demerits from page I
4 3 2 1 Total Rating
- signature signature /
Vic
print name > print name
/;��"�;l
DATE CORRECTIONS DUE: d!
phone number tllle —
Page 2 of 2 plus continuation pages Focused Inspectlan 112002
Page , of
� ,.,_� r ACT
INSPECTION REPORT STATE OF CONNECTICUT
FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH (1
CONTINUATION SHEET
NAME OF ESTABLISHMENT TOWN DATE OF INSPECTION
/
INSPECTION REMARK
FORM#
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INITIAL(INSPECTOR) INITIAL(PERSON IN CHARGE)
Distribution: 1st-White-Health Department 2nd-Yellow-Owner/Manager