HomeMy WebLinkAboutFood Service Establishment Inspection 86 (10) 1411 Absp V19A � c G
x
F < { y y
Establishment: d' NG Ins ection Date: r .(o • e)1 . Time:� R01nsp ins
Address/City: U Health Dept:_ i�,��; Class: 1 2
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 I NIA IDNC I KEY: C[complies] N!0[not observed) NIA[not applicable]
Ac�fluairfred FoofdOperator g DNC[does not comply] 0[other] RTE[ready-to-eat]
;.
2 112 Persort;nel wltl infection res#Acted. C NLO';N1A �4
$1 Dergnated Alternate a
62 Written.documentation of training prograM A Food workers have no exposed infected lesions!bums
B Personnel with infection restricted
1 IApproVed source,wholesome,*nonadulterated C ;N10 NIA hrC Communicable disease of worker reported to local health director
A Approved shellfish,finfish meat&poultry USDA approved 73 iiandvvashing facilities ptovrded;hands washed;clean C N10 NIX, 4
B Food cans in good condition(not dented,rusty,bloated,leaking) '
A Handwash facilities in all food prepidispensing&warawash areas
C Wholesomelnonadulteratedfoodslsafe B Handwash facilities in or immediately adjacent to toilet rooms
D Commercial products(no home grown/canned food) C Handwash facilities access iblelconven!ant to use
E Potentially hazardous foods received at proper temperature 0 D Personnel hands washed,clean I Proper handwash procedure
E Handwashing at appropriate times
3 Patentrally hazardous food meets temperature requirements :C N10 N1A `4 0
durrri$stofpge,preparation,display„ssrvrce and trarisgortation; ;
z , 15 Good,Fygienic;prractices Jg10 Ni 2`
A Hot holding greater than or equal to 140°F. (wholebeeoporkroasis 1300 F.) A ❑No eating ❑ No smoking while working Ile, '
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 Iconsumeradviso posted 24 Salr+jti stron,nnse°,(fiQtswater�-ciemical) C NIO E<'NJA 2
p 9 advisory p - f. : y a•
0 A Approved senitizeravaflableladequate concentration ofsanitizer
r4k Ikdeq�ua)e'facilit es:o matnteirnprradutt :; r; :µ A(�]l0 [NIA, 2° B Food-contact surfaces and utensils used for potentially
a.° . ...
i x temperatC re,,thermomete .p3 dyl l sd µ Y x „, k, r hazardous food sanitized at feast every 4 hours
k C Adequate Odishwashersanitizer ❑final rinse temp
A Food thermometer available and accurate
B Properfood thermometerfor product L Proper sanitizin rocedure
4. E Sanitizing between raw animal origin&ready-to-eat food
C Thermometers appropriately placed in cooler units 0
0
µ N25hl4latt�vgipingclgths f:r �, > * ;-", C IN10? NlA"r1;
! food protec'ed dttiitti ,storage,p�eparatipn,
84 gy,se c fi`l transportatiorf A Cloths and/or sponges in good repair and clean
B Wiping cloths kept in sanitizer between uses
A Produce washed
0
B Raw meats not stored/prepared near ready-to-eat foods
`26� pod-coyr#act surfaees.blean
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 dean
F No pooling of eggs not cooked immediately 0
8 Food containers stored offthefloor 30�,'Hot and coflwafer undet4iessurw proyldw as rec)urre fC Nip ;NJA �2
0 � d Hff ,, a.... r 3 n�d'wk°
a1ng acesoeHa p1.d
i od .
C
a , l p M9 d� rr . W )1
A No unnecessary handling RTE andlorcooked foods with bare hands A Soap!paper Towels 1 drying device available
B
Dispenser(s)working: ❑Soap ❑Paper towel
B Minimize food handling,other than ready-to-eat,with bare hands
C Handwash sink(s)clean Iwaste receptacle at handwash sink
C Adequate utensil(s)fordispensing food/ice 0
01 IT I *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: 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 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: r I Is there a written ill Ill policy that requires the food worker to report specific illness conditions
Are temperatures recorded/logged for cold holding foodslequipment? N and diseases to th QFO? Y N ♦Do you have a paid sick leave policy? Y N
Are foods cooked in advance and cooled? Y N ♦Are leftove saved? Y N Is there a ang ge barrier between inspector&QFO? Y N If ves indicate language spoken
List products cooled: by QFO/DA: *Can the QFOIDA read the inspection report? Y N
Describe cooling methods: Indicate o answered the above questions: Name(print):
Indicat 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 monitor! of cooling recorded? Y N •Obt n signature of the erson who received QFO responsibilities' mation at the time of the
Is there a produce washing policy? Y N ♦Describe what is washed and inspection:
where: Note: This report i a tw page for of debits a ite Page 1 of 2
STATE"OF.CON ,. AVENU VS#51DPA ,CT iG134NEdTW TR PAYMEIVTOFPUBLC N'EXTH-410CAPITOL E F
Vnc�rSEWF66D si�rzvrcr sr»e opt R» �r
LbCAL NEALTW bEPi /�TF L. /�tJ�j: ,�C�: ADDRESS/CITY
Establishment: Date of Inspection:, 2 i v 16
Address;, r lfl9 'UGL/✓. i�J . -r�'�?� Owner or;.Operator: AlAd
ADDITIONAL FOUR POINT ITEMS Z t'
Q KEY: DNC [DOES NOT COMPLY] '.
�x
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
37 No cross connections,back siphonage,backflow
11 Toxic chemicals. 4;`
4 Proper type/installation/backflow prevention devicel air gap for:
-Stored properly,labeled properly,used properly -Food equipment -Hose connections -Dish machines
5anitizer 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
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] C
2 Sources of food: Original container,properly labeled 1 0 Garbagelrubbishstoragearealrooms,enclosures-properly constructed,clean
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 42 Vermin Control: No insectslredents present °2
14 Food worker:Clean outer clothes,effective hair restraints 1r 3 Outeropenings protected againstenlrance of insects/rodents 3
floors: Floor covering installed,constructed as requir d,good repa clean
16 Food-contact surfaces designed,constructed,maintained,installed, ;2; 5 '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
8 Exterior walking,driving surfaces,good repair,clean 1
18 Single service articles,storage,dispensing 2;
19 No reuse of single service article 9 j311s,ceilings attached,equipment properly constructed,good
repair,clean.Wall&ceiling surfaces as required
20 Dishwashing facilities approved design,adequately constructed, iY+
maintained installed located 50 Dustless cleaning methodsused,cleaning equipment properlystored
Equipment&Utensils: Cleanliness 51 Adequate lighting provided as required
21 Preftushed,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
23 Accurate thermometers provided,dish basket,if used 54 Rooms adequate,clean,adequate lockers provided,facilities clean 1.
27 Nonfood-contacl surfaces of utensils&equipment clean 1.`.
55 Establishment and premises free of lifter,no insect/rodent harborage, rl;
28 Eouipm7ttutensils,storage,handling T> no unnecessary articles _
P.r a disposal of wastewater ' 56 Complete separation from Iiving/sleeping quarters and laundry }1;
tµ .j
3,
Plumbing location,installation,mainteh'nce 57 Clean/soiled linens stored properly
58 No live birds,turtles,or other animals(except guide dogs) 1
36 Toilet rooms enclosed with self-closing door i'r'
59 Seats 75 or more:Nonsmoking area provided,sign(s)posted at 3
37 Proper toilet fixtures provided,good repair,clean = . enirance(s),smoking area indicated by sign(s)
39 Approved garbage/rubbish containers,adequate number,covered, '1
rodent proof,clean Moutine Inspection ❑Reinspection ❑ Preoperational Inspection
To Other Inspection:
PERSON IN CJ1AR_GE:
Demerit Score: *Include demerits from page 1
4 3 2 1 Total Rating
signature sig ture 7
r -
printname print name
pp
�n a 7-` a DATE CORRECTIONS
phone number title
Page 2 of 2 plus continuation pages Focused Inspecdo v.02
�I
� y
i i • ' i � t . t � � � .
NAME OF WIVE!
005,
s •
-
-p"l 4
,u 1=�.._
1111111r,11111,w'' Wplaw.--d" 2 UP 9c,W-
lm- � 11WIlli ME
W=M=
� .
9'�Ow MOP WINME jig
WA
WWII E!!l to I
-ApR
I VAN IPA
INITIAL
(INSPECTOR) J / (PERSON IN CHARGE)