HomeMy WebLinkAboutFood Service Establishment Inspection 28 (6) . ? SiPAE'Ye} t P , 4PSERVeIh3iTNPC`I
Establishment: /7✓ Inspection Date: Time: _VZV O[n p Eins
Address/City: Health Dept: tt'/� Class: 1 2 3 4
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/O NIA DNC KEY: C[complies] NIO[not observed] NIA]not applicable]
60 Qualified Food Operator. 3 DNC[does not comply] 0[other] RTE[ready-to-eat]
61 esignated'Alternate �/ 2 12 Personnel with infection restricted C ^N1O NIA 4
Food workers have no exposed infected lesions 1 burns
62 ,ritten.documentation of training program h.2
ersonnel with infection restricted k
Approved source,wholesome,"nonadulterated ,C N1O NIA i 4 o municable disease of worker reported to local health director
A Approved shellfish,finfish,meat&poultry USDA approved 13 ndwashing facilities provided,hands washed,clean :C N/0 4
B Food cans in good condition(not dented,rusty,bloated,leaking) Handwash faces in all food prepldispensing&warewash areas
C Wholesomelnonadulteratedfoods/safe 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 hazardousfoods received at proper temperature he I D Personnel hands washed,clean/Proper handwash procedure
0 E Handwashing at appropriate times
3 Ootentially',hezardous food Mee tsteinperature.requirements ;C� N10 NIA 4 0
aunn#storage,preparation,display,servide,and transportation
15, Good hygienic practices ,.C,N10_ NIA 2"
A Hot holding greater than or equal to 140°F. (whole beefloork masts 1300 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 I consumer advisory posted �24 Sanitization rinse(hot''nrater-'chemicail)- i C N1O?NJ
0 A Approved sanitizeravailable/adequateconcentrationofsanitizer /
4 Adequate faclIities:to,-.maIntaIn product. s> "C" NIO, N/A ,2' g Food-contact surfaces and utensils used for potentially C.
`i, t k hazardous food sanitized at least every 4 hours
temperatu&ie,th ermom eters;proufd et!
A Food thermometer available and accurate C Adequate ❑dishwashersanitizer ❑final rinse temp
B Properfood thermometerfor product D Pro ersanitizin rocedure
C Thermometers appropriately placed in cooler units E Sanitizing between raw animal origin&ready-to-eat food
0 K n 5 an iWipl�g&iQtlts lNlO; 1'
A v
E d protected drrjtprage,preparattiop,� fC Nla fN! f ;
s I p y,,servtce and transportat onb u A Cloths and/or sponges in good repair and clean
-� -A 1 Produce washed B Wiping cloths kept in sanitizer between uses
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B Raw meats not stored/prepared near ready-to-eat foods, -
26 kt=o d-contacfasurfacestclean `*: ri :$ ,K ` C tN/d ;2
C Food covered properly
9 ood equipmentclean,utensils clean,equipment interiors clean
D Adequate splash guards/sneeze guard B Single use gloves changed when soiled
E No unauthorized personnel C Food--contact surfacesclean
F No pooling of eggs not cooked immediately 0
8 Food containers stored off the floor a 0 t n cold water,under pressure;prpwded asxrequired i� {N10
Nl,
r Z u I r t
0 Y 4s; andwashing acceisories.provided C !N10 W
9y ;'Handling of food minimized �� � C,'HP,NIA r
A No unnecessary handling RTE and/or cooked foods with bare hands A Soap/papertowels I drying device available
B Dispenser(s)working: ❑Soap ❑Papertowel
B Minimize food handling,other than ready-to-eat,with bare hands C Handwash sink(s)clean I waste receptacle at handwash sink
C Adequate utensil(s)for dispensing food/ice 0
0 1 •DESCRIBE DEFICIENCIES ON CONTINUATION SHEETS
The following information is not debitable and does not affect your score. KEY: QFO[qualified food operator],DA(designated altemate],PHF[potentially hazardous food],FB[foodborne]
PH F,are hot held at: IF, Pli 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 d you cock:
Poultry Ground Beef ork What diseases related to FB illness are you required to repon ca health department?
Roasts Other
Describe re-heating procedures: Is there a written illness policy that requires t od worker to report specific illness conditions
Are temperatures recorded/logged for cold holding f slequipment? Y N and diseases to the QFO? Y N o you have a paid sick leave policy? Y N
Are foods cooked In advance and 000fed? Y *Are leftovers saved? Y N Is there a language barrier betty inspector&QF07 Y N Iflf-yes indicate language spoken
List products cooled: by QFOIDA: *Can the QFOIDA rea the' spectionareport? Y N
Describe cooling methods: Indicate who answ d the above questions:Name(print
Indicate the title above person(circle all that apply):Q 0 DA 11gr Cook Owner FW
Is cooling monitored for time&temp? Y N Is the monitoring of cooling recorded? Y N .Obtain signature of the person who received the QFO responsibilities information at the time of the
s there a produce washing policy? Y N *Describe what is washed and tIwhere:
inspection:
Note: This report is a two page form(total of 62 debitable items) Page 1 of 2
NECTlOUT�DEPARTMENTQ u4.5r9 `"� ., '9n."�'_- ",.m •-;g: e 7 rt
jSt'ATE`OF"G0IVFPUBL1C HEALTH- 41IQ'CAPITOLAVENUE=MS#51FOP-HARTFORQ G' 6
FOCFISEDFOOD-s9R,,wCE INSPEC IOI RE -0R'T =
LOCAL HEALTH KEPT ADDRESS 11
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4
Esta.6111shme t ! Date of Inspection:
ddress Owner or"Operator: .
ADDITIONAL FOUR POINT ITEMS m KEY: DNC (DOES NOT COMPLY] V
6 Foods not re-served.
-Unwrapped foods not re-served 4 31 Sewage disposal approved. 4
oten'tj Ily hazardous foods not re-served -Operating as required
No cross connections,back siphonage,backflow
1 To iechemicals. 4
4 Proffer t elinst II 'qnl backflow prevention device/air gam:
T-Sanitizer
oronerly labeled properl ,used properl __ -Food equipment -Hose connections -Dish machines
concentration not to exceed maximum permitted -Soda system carbonator -Beverage dispensers -Toilettanks
nnecessary toxics on the premises
�C -Chemical dispensers -Ice machines
-Pesticides/rodenticides properly dispensed �p
Proper drain for:
� -Food equipment -Dish machines -Ice machines
29 Water source adequate,safe. 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 o_ KEY: DNC [DOES NOT COMPLY]
2 Sources of food:Original container,properly labeled 40 Garbage/rubbish storage area/rooms,enclosures-property constructed,clean 1
5 Yotenlially hazardous food properly thawed 2 gelrubbish disposed of in an approved manner,atapproved frequency
0 1400d dispensing utensils properly stored 42 yermin Control: No insects/rodents present 2
4 Food worker:Clean outer clothes,effective hair restraints ;1' 3 0 eropenings protected against entrance of insectslrcdenis ly
4 oors: Floor covering installed,constructed as req fid,good re air,c ea r ;
16 Food-contact surfaces designed,constructed,maintained,installed, 2 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
18 Single service articles,storage,dispensing 2
8 Exterior walking,driving surfaces,good repair,clean 3
19 No reuse of single service article V17ails,ceilings attached,equipment properly constructed,good r
repair,clean.Wall&ceiling surfaces as required
20 Dishwashing facilities approved design,adequately constructed, Z
maintained installed located 50 Dustless cleaning methods used,cleaning equipment properly stored
Equipment&Utensils Cleanliness 1' 1 Adequate lighting provided as required 1
21 Preflushed,scraped,soaked and racked 52 Room free of steam,smoke odors 1
22 Wash water clean,proper temperature 53 Rooms&equipment hoods,ducts,vented as required
curate thermometers provided,dish basket,if used'T�c� S 54 Rooms adequate,clean,adequate lockers provided,facilities clean 1
nfood-contact surfaces of utensils&equipment clean
55 Establishment and premises free of litter,no insect/rodent harborage, 1
q ipment/utensils,storage,handling 1 no unnecessary articles
_ Pr per disposal of waste water % 56 Complete separation from livinglsleeping quarters and laundry 'W
3 P bing locat' n,installati ,maintenance 7 E an/soiled linens stored properly 1
- 58 No live birds,turtles,oroiheranimals(except guide dogs) 1
36 Toiletrooms enclosed with self-closing door
59 Seats 75 or more:Nonsmoking area provided,sign(s)posted a1 k3
37 Propertoilel fixtures provided,good repair,clean f entrance(s),smoking area indicated by sign(s)
39 JApproved garbage/rubbish containers,adequate number,covered, 1
rodent proof,clean PRoutine Inspection ❑Reinspection ❑ Preoperational Inspection
R: PERSON IN CHARGE: her Inspection:
Demerit Score: +Include demerits from page 1
4 3 2 1 Total Rating
1lignature � Sig
priat name p name �� .� ,�� / 1/ ✓ c
phone number title DATE CORRECTIONS DUE: t�f� .3 f /(� 0
Page 2 of 2 plus continuation pages Focused Inspection 112002
Page of
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INSPECTION REPORT STATE OF CONNECTICUT
FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH
CONTINUATION SHEET
NAME OF ESTABLISHMENT TOWN DATE OF INSPECT N
INSPECTION FORM# REMARKS
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INITIAL(INSPECTOR) INITIAL(PERSON IN CHARGE)
Distribution: 1 st-White-Health Department 2nd-Yellow-Owner/Manager
Page, 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
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INITIAL(INSPECTOR) INITIAL(PERSON IN CHARGE) a2
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