HomeMy WebLinkAboutFood Service Establishment Inspection 86 (9) -.rtr
' F( OD fix; �OR
' fl� t
Establishment: Inspection Date: i �— 1'6 Time: , ' b 0[n �RElr
Address/City: Health Dept: class: 1 z
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 N10 NIA DNC KEY: C[compliesi NIO[not observed] NIA[not applicable]
60 QualifledFoo 0 erator g DNC[does not comply] 0(other] RTE[ready-to-eat]
p
12 :;Personnel with tnfectton restricted
eaignated Alternate z _ C, Nita;
" q Food workers have no exposed infected lesions!burns
2MFr It 4n documentation of training grograirrt z,
B Personnel with infection restricted
,Approved source,whoiesbme,nonadutterbit C iN10 N/A 4 C Communicable disease of worker reported to local health director
s.. .
A Approved shellfish,finfish,meat&poultry USDA approved
Handwashln 'facilities pr.,ovided, hands washed clean C :NTO 'NlA 4
B Food cans in good condition(not dented,rusty,bloated,leaking) k I A Handwash facilities in all food prepldis a s' ewash areas
C Wholesomelnonadulterated foods/safe a Handw fe li'es i mme d' c tet ooms
D Commercial products(no home grown/canned food) C Hand IT fac I 'Ks. es n nt to use
E Potentially hazardous foods received at proper temperature D Per annel an washed,clean I Pr andwash procedure
0 E Handwashing at apprc r' t es
;3 .1 otir'nfially hazai.dd.b food meets temperature requiremenfso•; C'f N1A.,4 0
dunr+g storage,prejiarat+on display,service and transportitidn r
od'h
M101:
Ygle c Pro G. :NIA e 2
1 ni dices
A Hot holding greater than or equal to 140 F. (whole beefrporkroaets 1300F.) A ❑ No eating ❑ No smoking while working
B Cold holding less than or equal to450F. k1 B Wounds covered adequately
C Proper cooling I C Proper sink used for handwashing
D Proper re-heating
E Proper internal cooking lconsumer advisory posted r R, a tizatiori rinse{hat waxar t
:,•...: .
A pprovedsanifizeravaifableladequate concentration ofsanitizer
rAt�c�uae",fcilltles:to=mainEat�h product " ' G NlQ°' g Food-contact surfaces and utensils used for potentially
y i temperature therlr me am,provided 1 a 41 hazardous food sanitized at feast every 4 hours
A Food thermometer available and accurate C Adequate Pdishwashersanitizer ❑Final rinse tamp
D Proper sanitizin
B Properfoodihermomeierforproduct rocedure
10 E Sanitizing between raw animal origin&ready-to-eat food
C Thermometers appropriately placed in cooler units 0
,w 4 u. ,. , 25,+;Clealrwipgaclditts*� & 'y; x 3 t C IN10 Nlq i1
t7 ;+ood prot dte d'uriggisto age,pre ar t nn x N 0 ! 12;
display,service d°etranp�o�rain s . . : �:_v= >r: �' I s' A Cloths and/or sponges in good repair and cleanAt
I �a r, B Wiping cloths kept in sanitizer between uses
A Produce washed _ k
B Rawmeatsnotstoredlpreparednearready-to-eatfoods s26f=F,'d#codtac4�su�f�irescean �r l$C NIO �A t2'
C Food covered properly , ". . :. . ; .' • . f; f
Food equipment clean,utensils clean,a uipmer(interfors dean
D Adequate splash guards!sneeze guard B Single use gloves changed when soiled
E No unauthorized personnel C Food--contact surfaces clean
F 40 pooling of eggs not cooked immediately 0
8 ood containers stored off the floor 302;116* and cold wafer until rpreeauref prodded as reg d ,C 0 IrOw 0
0
'si I 09
taecassones provided C 1
-9 ('HrtJiingkafifoed;m'nlm)zgd, € C N1,QN11# i Soap! pertowelsl dryingdeviceavailable i
A No unnecessary handling RTE and/or cooked foods with bare hands
1spenser(s)working: Soap p ruowel
B Minimize food handling,otherthan ready-to-eat,with bare hands C Handwash sink(s)cl an I wasterrec6ptacle at handwas sink
C Adequate utensil(s)fordispensing food/ice p
0 •DESCRIBE DEFICIENCIES ON CONTINUATION SHEETS
The following information is not debitable and does not affect your score. KEY: CFO[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 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 writte llness policy that requires the food worker to report specific illness conditions
Are temperatures recorded/logged for cold holding foods/equip ant? Y N and diseases t he QFO? Y N ♦Do you have a paid sick leave policy? Y N
Are foods cooked in advance and cooled? Y N *Are ftovers saved? Y N Is there a la uage barrier between inspector&QFO? Y N If yes indicate language spoken
List products coaled: by QFo1D.: *Can the QFOIDA read the inspection report? Y N
Describe coaling methods: Indicaliq who answered the above questions:Name(print):
Indica(e the title of a e person(circle all that apply):QFO DA Mgr Cook Owner FW
Is cooling monitored for time&temp? Y N Is the onitodng of cooling recorded? Y N .Obtain sig at re o er on who eived the QFO rep s ilities information at the time of the
Is there a produce washing policy? Y N ♦D cribe what is washed and inspection
where: Note: This report is;-two p e farm(total 0 2 debitable.item Page 1 of 2
,. ;q s ...
,
PAL(;OF G,ONN CTIO�J ''DEPAFCTM N7 E PU��IG,HEALTH 490 GAPITO AY N tUl a � HA FARD,G D67ti�k�
` (SC�l5ED FQ�➢:SERVICE &SVtCTIbN REPf1RT
LOGAl-HEAL'[H DEFTr, SSICITY 3
Establishment �c f° uS Date of Inspection:Address- r�L:4I;!% ;;r!; , lU Qwner,or Operator .v i;
ADDITIONAL FOUR POINT ITEMS KEY: DNC [DOES NOT COMPLY]
6 Foods not re-served.
-Unwrapped foods not re-served 4 F'tewalge.disposal approved.
-Potentially hazardous foods not re-served erating as required
o cc oss connections,back siphonage,backflow
11 Toxic chemicals. 4 Pro ear tvoelihstallationl backflow prevention device/air gap igj:
-Stored
prooperly,labeled properly,used properly -Food equipment -Hose connections -Dish machines
-Sanitizer concentration not to exceed maximum permitted -Soda system carbonator - a e dispensers -Toilet tanks
-No unnecessary toxics on the premises -Chemical dispensers -ce machines
Pesticideslrotlenticidesproperly dispensed Proper drain°for:
29 Water source adequate,safe. -Food equipment -Dish machines -Ice machines
4
-Well/well head protected from contamination 35 Toilet facilities. Adequate,convenient,accessible, 4;
-Water quality in compliance designed,properly installed
-Monitoring in compliance
OTHER ITEMS o KEY: DNC [DOES NOT COMPLY]
n�
2 Sources of food: Original container,properly labeled 1 40 Garbage/rubbish storagearea/rooms,enclosures-property constructed,dean
5 Potentially hazardous food properly thawed 2 41 Garbageirubbish disposed of In an approved manner,at approved frequency
10 Food dispensing utensils property stored 1 42 Vermin Control: No insectslrodents present 2
14 Food worker:Clean outer clothes,effective hair restraints 1 3 Outer openings protected againstentrance of insects/rodents 1
44 oars: Floor covering installed,constructed as requir d,good repair, lean 1
16 F od-contact surfaces designed,const cte ; maintained 'nstalled, z, �A.
located U, Floors graded,drained as required
r' 6 Floor,walliuncture covered
17 Nonfood-contact surfaces designed,constructed, maintained, 7 Mats removable,good repair,clean
_,.installed,located
8 mgle service articles,storage,dispen / 2
8 Exterior walking,driving surfaces,good repair,clean T:
19 No reuse of single service article Lc� 9 W�11 ,ceilings attached,equipment properly constructed,good
repair,clean.Wall&ceiling surfaces as required
20 Dishwashing facilities approved design,adequately constructed, 2 ' 1
maintained installed located 50 Dustless cleaning methods used,cleaning equipment properly stored
Equipment&Utensils Cleanliness 1 ` 51 Adequate lighting provided as required 1
21 Preflushed,scraped,soaked and racked 52 Room free of steam,smoke odors 1
22 Wash waterclean,proper temperature 53 Rooms&equipment hoods,ducts,vented as required
23 Accurate thermometers provided,dish basket,if used j 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, 1.
28 Equipment/utensils,storage,handling Y: no unnecessary articles
3 per disposal ofwaste water 1 56 Complete separation from living/sleeping quarters and laundry E 1;
33 Plumbing location installation,maintenance j57 Clean/soiled linens stored properly 1;
58 No live birds,turtles,orotheranimals(exceptguide dogs) 1
36 oil trooms enclosed with self-closing door
59 Seats 75or more:Nonsmoking area provided,sign(s)posted at I
37 1`4f�er toilet fixtures provided,good repair,clean 3>
entrance(s),smoking area indicated by sign(s)
39 Approved garbagelrubbish containers,adequate number,covered, 1"
rodent proof,clean Routine Inspection ❑Reinspection ❑ Preoperational Inspection
IN OR: PERSON IN C-IdAR GE: Cher Inspection:
Demerit Score: *Include demerits from page 1
�✓ "' 4 3 2 1 Total Rating
signs ure f:- signature
inert name print name
rT
phone number title DATE CORRECTIONS DUE: Z—r� J
�- Page 2 of 2 plus continuation pages Focused Inspection 112002
I av Page/— Of
INSPECTION REPORT STATE OF CONNECTICUT
FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH
CONTINUATION SHEET
NAME OF ESTABLISHMENT ( TOWN DA4T,EjOF SPEECCT"I N
INSPECTION REMARKS,
FORM#
2
s
0-4 2L ::L / � w _
a. i4
}
live
INITIAL(INSPECTOR) INITIAL(PERSON IN CHARGE)
Distribution: 1st-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 IN PECTI
INSPECTION REMARKS
FORM#
-75
t%
r
olol Id
r
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
40
S-
INSPECTION REMARKS
FORM#
r_
r-e ,
L11Z /
,� �2- G �ti A o -
INITIAL(INSPECTOR) AV INITI L(PERSON IN CHARGE)
�7-- Distribution:
,'It
_-White-Health Department 2nd-Yellow-Owner/Manager
v"�