HomeMy WebLinkAboutFood Service Establishment Inspection 59 (4) ft
Establishment: 6rA Inspection Date: � Time: 1 ' insp Einsp
Address/City: / Health Dept .� .S Class: 1 2 (LO
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 I N10 NIA IDNC I KEY: C[complies] NIO[not observed] NIA[not applicable]
60 Quahfled Food Operator, 3 DNC[does not comply] 0[other] RTE[ready-to-eat]
12 Personnel with,infection restricted- C ,WO WA 4.
61 gesidnated�Alternate , 2 ,' -
62 Written-dotiurnentatian of training•program 2 A Food workers have no exposed infected lesions!burns
B Personnel with infection restricted k
1 rApproved source,:wholesome,nonadutterated C ;N/0 NIA '4 C Communicable disease of worker reported to local health director
Ilk-
A I Approved shellfish,finfish,meat&poultry USDA approved k 13 Handwashrng facilities provided,hands washed,clean ;C Wa .WA'j 4
B Food cans in good condition(not dented,rusty,bloated,leaking) 14A Handwash facilities in all food prep/dispensing&warewash areas
C Wholesomelnonadulterafedfoods!safe B Handwash facilities in or immediately adjacent to toilet rooms
D Commercial products(no home grownlcanned food) A C Handwash facilities accessible/convenient 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 ,Potentially'!azar',qu,, od meets temps atu�e}requirements C N10 NIA 4'
i "durigg,stordgp,-preparation,display service4nd transportation,
;15 G`•od Py.9jeniq practices G. NIO'. A- 2
A Hot holding greater than or equal to 1400F. (wholebeefrpork roasts 1300 F.) ❑ No eating ❑ No smoking while working
B Cold holding less than or equal to 45°F, B Wounds covered adequately k
C Proper cooling C Proper sink used for andwashmg
D Proper re-heating 0
E Proper internal cooking lconsumer advisory posted �24! Santtizatton '(hQt�vatertehemical CIN10 WA _fie.
0 A Approved sanitizer availableladequate concentration of sanitizer
4 : Adegiratefiacrutres o rnaintal ' irgd gt C=�N10 INlA �'2 B Food-contact surfaces and utensils used for potentially
rOW l o r ` �;•p ` " k > 1 hazardous food sanitized at least every 4 hours
`��p� ,thermometers-� rovided � � "`
94-
A Food thermometer available and accurate H C I Adequate ❑dishwashersanitizer ❑final rinse temp
L Pro ersanitizin rocedure
B Proper food thermometer for product E Sanitizing between raw animal origin&ready-to-eat food �(
C Thermometers appropriately placed in cooler units
0 0
4 , Clean wiping}cloths „u i Cr U& NIA, 1
7 Roodgprotectedlid6r'ing itora nCm N10 NIAa 2Yt
dis hy,se W0,00d:tronspa rr rtat[o °= ,; r ' A Cloths andlorsponges in good repairand clean
` n 1,"A' `&' '� °� § �' B Wiping cloths kept in sanitizer between uses
A Produce washed
0
B Raw meats not stored/prepared near ready-to-eat foods 12&fod&cokt3 "a c�ffia lean,� � �
C Food covered properly �k,.�-f-4. � C] 0 N!A•2
A Food equipment clean,utensils clean,equipment interiors clean
D Adequate splash guards I sneeze guard 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
8 Food containers stored off the floor 30 .Hot and{cold wafewtSnder pressure,prc vrded as requirey !0;N1A 2 I
0 36`' Handvtashtng aceessones provided W CJIO rWA t1`:
'9" r .and[in of foodirnnimized.< ° ;
t,.,-0 - g_. �r -; . P,,` °C, N10:WA� 2•A No unnecessary handling RTE and/or cooked foods with bare hands A Soap 1 paper towels! drying device available
B
Dispenser(s)working: ❑Soap ❑Papertowel
B Minimize food handling,other than ready-to-eat,with bare hands C Handwash sinks)clean/waste receptacle at handwash sink
C Adequate utensil(s)for dispensing food/ice 109, 0
0 1 1 •DESCRIBE DEFICIENCIES ON CONTINUATION SHEETS
The following information is not debitable and does not affect your score. KEY: CFO[quali1ed food operator],DA[designated alternate],PHF[poter ly 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 d you cook:
Poultry Ground Beef Pork What diseases related to FB Illness are ye squired to report to the local health department?
Roasts Other
Describe re-heating procedures: Is there a written illness policy tha7 +Do
ires the food worker to report specific illness conditions
Are temperatures recorded/logged for cold holding foods/equipment? N and diseases to the C Y N you have a paid sick leave policy? Y N
Are foods cooked in advance and coaled? Y N Are le ov s saved? Y N Is there a language barrier betw n 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 bove 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 monllor'h of cooling recorded? Y N .Obtain signatur of the pe on who received the QF sponsibilities information at the time of the
Is there a produce washing policy? Y N ♦Describe what is washed and tnspection:
where: Note; This rep rt is a two page form(total of 62 debitable items) Page 1 of 2
S ITE OF CQNNECTICUT DEPARTMENT CJI=PUBt.1C''IiEAI,TH 410 CAPITAL AVENUE MS#5 i t=DP-HART ORD,C f` 813d'
Y t�ncost�oon s> xut TIQi tortr
�GQ�C�At:HEALTH DEPT. , , (,,�f� . �ADDRESSlCiTY
Establishment: Iig4le�- 7.—. . L-L��S� L.��i�?. .Date of. Inspection: l �b
dtlress / ///� To�y ' ��¢7� Owner or Operator:
.. . ,
07
ADDITIONAL FOUR POINT ITEMS KEY: DNC [DOES NOT COMPLY] o
6 Foods not re-served.
-Unwrapped foods not re-served 4 31 Sewage disposal approved.
-Potentially hazardous foods not re-served -Operating as required
34 No cross connections,back siphonage,backflow
I 1 Toxic chemicals, 4
4 Propertypelinstallationt 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. 4 -Food equipment -Dish machines -Ice machines
-Well/well head protected from contamination Ldesignfedi
clities. Adequate,convenient,accessible, 4'-Water quality in compliance
-Monitoring in compliance ,properly installed
OTHER ITEMS ! KEY: DNC [DOES NOT COMPLY]
2 Sources of food: Original container,properly labeled 1`, 40 Garbage/rubbish storage area/rooms,enclosures-properly constructed,clean
5 Potentially hazardous food properly thawed 41 Garbagelrubbish disposed of in an approved manner,at approved 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 Outeropenings protected against entrance of insects/rodents
4 Floors: Floor covering installed,constructed as required,good repair,clean =I
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, 47 Mats removable,good repair,clean
installed,located
18 Single service articles,storage,dispensing
8 Exterior walking,driving surfaces,good repair,clean 1
2<
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, 2 1s
maintained installed located 50 Dustless cleaning methods used,cleaning equipment properly stored
Equipment&Utensils: Cleanliness 1 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
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
27 Nonfood-contact surfaces of utensils&equipment clean 1
55 Establishment and premisesfreeof litter,no insect/rodent harborage, l;
28 Equipmentlutensils,storage,handling 1 no unnecessary articles
32 Proper disposal ofwastewater 1 56 Complete separation from living/sleeping quartersand laundry mid
33 Plumbing location,installation,maintenance 1 57 Clean/soiled linens stored properly ;
591 No live birds,turtles,orotheranimals(except guide dogs)
36 Toilet rooms enclosed with self-closing door
I 59 Seats75 or more:Nonsmoking area provided,signs)posted at i 3
37 Proper toilet f xtures provided,good repair,clean entrance(s),smoking area indicated by sign(s) -
39 Approved garbage/rubbish containers,adequate number,covered, 1` -
rodent proof,clean PRoutine Inspection ❑Reinspection ❑ Preoperational Inspection
INSPE TOR: PERSON IN CHARGE: er Inspection:
Demerit 5cr : *Include demerits from page 1
4 3 2 1 Total Rating
ignature si nature �.
v IS'c-, 6 A -
'print name print name
6 eae Q DATE CORRECTIONS DUE: �—
phone number
r
Page 2 of 2 plus continuation pages Focused inspection 112002
Page of
INSPECTION REPORT STATE OF CONNECTICUT
FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH
CONTINUATION SHEET
NAME OF ESTABLISHMENT TOWN DATE OF INS ECTION
INSPECTION REMARKS
FORM#
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INITIAL(INSPECTOR) INITIAL(PERSON IN CHARGE)
Distribution: 1st-White-Health Department 2nd-Yellow-Owner/Manager