HomeMy WebLinkAboutFood Service Establishment Inspection 53 (6) Ah
Establishment: S 1 _ ° Inspection Date: Time: ; Oinsp Eins `
ddresslCity: '' l'� E - Health Dept: }�1AJ, 5 � ass: 1 2 3 4
Based on an inspection this day,the items marked DNC identi 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 NIO WA JDNC I KEY: C[complies] N10[not observed] NIA[not applicable]
6 a lffied,176600erator 3 DNC[does not comply] 0[other] RTE[ready-to-eat)
2 Personn®I with infection.restricted N10 MA
6 signatedAlternate :C ;. 4'
` ritten=docum
- n rf `entation off training program Food workers have no exposed infected lesions 1 burns
2�= - � � "
B Personnel with infection restricted
1' Approved aource,,wholesome,nonadulterated C '',NIO N 2 C Communicable disease of worker reported to local health director
A Approved shellfish,finfish,meat&poultry USDA approved 131<Handwrashing,faciiitles provided,hands washed,clean °C UO N/A ;4
B Food cans in good condition(not dented,rusty,bloated,leaking)
C WhDlesomelnonadul#eratedfoodslsafe
K A I Handwash facilities in all food prep/dispensing&warewash areas kr
B Handwash facilities in or immediately adjacent to toilet rooms
D Commercial products(no home grown/canned food) C Handwash facilities accessible/convenient to use
E Potentially hazardousfoods received at proper temperature D Personnel hands washed,clean I Proper ha, wash procedure
0 E Handwashing at appropriate times
3 Piitehhally hazardous food meets temperature tequiremen s C N10 NIA'j 4 0
durmgstorage,preparation,display,senflce and transportation
15 Good>hygleriic,,practices, C N/0 NIA 2
A Hot holding greater than or equal to 14ft (whole beefrpork roasts 1300F.) )< A ❑No eating ❑ No smoking while working
B Cold holding less than or equal to 450 F. B Wounds covered adequately
C Proper cooling C Proper sink used for handwashing
D Proper re-heating 0
E Proper internal cooking 1 consumer advisory posted
4;' ariitization=rinse- hot water cheniicmal
Approved sanitizeravailableladequate concentration ofsanitizer
-,adequate-46cilittise tb maintaln�pr.aduct« 4. r C Nlp 2 Food-contact surfaces and utensils used for potentially
tetnp06 r, the ometers provl�le"i hazardous food sanitized at least every 4 hours
A Food thermometer available and accurate C Adequate ❑dishwashersanitizer ❑final rinse temp
L Proper sanitizing procedure
B Proper food thermometer for product
• E Sanitizing between raw animal origin&ready-to-eat food �
C Thermometers appropriately placed in cooler units 0
0 126 ',CIO't;ww ping cloths, $ k
ass r C [N1Q N/A €I
i Fo�oc pro ectedidurh source,pr$0arat[on,z �t iC} N10 ,N(�r 2
f .tlrsls'y,gsrvicea Dd 1.trarasportfi ohm A Cloths and/or sponges in good repair and clean
B Wiping cloths kept in sanitizer between uses
A Produce washed
0
B Rawmeats not stored/prepared near ready-to-eat foods - x
s: Food can}act su'rfaceg clean, �0't JIQ N 2 a
C Food covered properly k
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--contact surfaces clean
F No pooling of eggs not cooked immediately 0
8 IFood containers stored off the floor 30 ,Hot and co dew er and"r pte5scre,,provtded as require rN10 VA 12
0 ;38 i�Handwashing accessories provided; C N10 N/q.rf
9 [lndlingf food.minrmtzed z a tC<<N10 INJA _2 A. Soap 1 paper towels 1 drying device available
A No unnecessary handling RTE and/or cooked foods with bare hands B
B Dispenser(s)working: ❑Soap ❑Paper towel
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)fordispensing foodlice 0
O 1 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 alternate],PHF[potentially hazardous food],FB[foodborne]
PHFs are hot held at: OF PHFs 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 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 written illness policy th requires the food worker to report specific illness conditions
Are temperatures recordedllogged for cold holding f dslequipment? Y N and diseases to the QFO? Y *Do you have a paid sick leave policy? Y N
Are foods cooked in advance and cooled? Y IT *Are leftovers saved? Y N Is there a language barn%N etween inspector&QFO? Y N If 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 above questions; Name(print[:
Is cooling monitored for time&temp? Y r N Is the monitoring of cooling recorded? Y N Indicate the title of above per (circle all that ply]:QFO DA Mgr Cook Owner FW
Obtain signature of a pep n ho received th�FO responsibilities i ormation at the time of the
Is there a produce washing policy? Y N *Describe what is washed and inspection:
where: Note: This report is a two page form(total of 62 'able items) Page 1 of 2
5TAT QF CO IN NECTI�UT QEPAR NIE OF'p[1BLlC=HEALl�IW-41 D CAPITOI pUENUE-,MS#51FDP-HARTFORD,CT D6134'
r - FOCUSED FDOD,SEI� CE INF�C fiIfll REP,4iT
LOCAL HEALTH 17EPT:E - ADDRESSICITy
Establishment: . ` : . / Date af=Inspection:
ddre'ss: Owner.or: Or:
ADDITIONAL FOUR POINT ITEMS KEY; DNC [DOES NOT CjO11�PLY]
6 Foods not re-served.
4 31 Sewage disposal approved.
-Unwrapped foods not re-served 4
-Potentially hazardous foods not re-served -Operating as required
No cross connections,back siphonage,backflow
4
11 Toxic chemicals. Proper typelinstallationl backflow prevention deyiCel air gar 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
-Pesticideslrodenticides 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 incompliance designed,properly installed
OTHER ITEMS
KEY: DNC [DOES NOT COMPLY]
2 Sources of food: Original container,properly labeled 40 Garbage/rubbish storage arealrooms,enclosures-properlyconstructed,dean
5 Potentially hazardous food properly thawed 1 Garbage/rubbish disposed of in an approved manner,at approved frequency
ood dispensing utensils properly stored 1 2 Vermin Control: No insects/rodents present 2
14 Food worker:Clean outer clothes,effective hair restraints ',J 3 Outer openings protected against entrance of insects/rodents 1`
fors: Floor covering installed,constructed as required,good repair,clean
16 Food-contact surfaces designed,constructed, maintained,installed, Z 5 Floors graded,drained as required
located
6 Floor,wall juncture covered
17 Nonfood-oontact surfaces designed,constructed, maintained, 1' ] Mats removable,good repair,clean
installed,located 1
8 Exteriorwa€king,driving surfaces,good repair,clean
18 Single service articles,storage,dispensing 2s
19 No reuse of single service article 9 ells?ce attached,equipment properly constructed,good
rep r,clean. II&ceiling surfaces as required
20 Dishwashing facilities approved design,adequately constructed, 2
maintained installed located 50 Dustless cleaning methods used,cleaning equipment properly stored
..< 1
Equipment&Utensils: Cleanliness Y= 51 Adequate lighting provided as required
21 Preflushed,scraped,soaked and racked 52 Room free of steam,smoke odors t 1
22 Washwaterclean,proper temperature
53 Rooms&equipment hoods,ducts,vented as required
I .ka
23 Accurate thermometers provided,dish basket,if used r
54 Rooms adequate,clean,adequate lockers provided,facilities clean L
7 onfood-contacisurfacesof utensils&equipment ciean 55 Estab I is h me nt a n d pre m i ses free of litter,no insect/rode nt harborage, 1'
8 Equipment/utensils,storage,handling 1 no unnecessary articles
32 Proper disposal of wastewater 1 561 Complete separation from living/sleeping quarters and laundry
3 PI robing location,installation,maintenance 1 : 57 Clean/soiled linens stored properly t
58 No live birds,turtles,orotheranimals(except guide dogs) �.
36 Toilet rooms enclosed with self-closing door
59 Seats 75 or more:Nonsmoking area provided,sign(s)posted at �
37 Proper toiletfixtures provided,good repair,clean "3
entrance(s),smoking area indicated by sign(s)
39 Approved garbage/rubbish containers,adequate number,covered, 1'
rodent proof,clean ARoutine Inspection ❑Reinspection 0 Preoperational Inspection
!'74-ty
: PERSON IN CHARGE; Other Inspection:
Demerit Score: +Include demerits from page 1
��(�_ 4 3 2 1 1 Total Rating
signature sig at re f r
Z� y Vie) /
print name printme
` /n-2 Is y + - 5 v-r(- DATE CORRECTIONS DUE:
hone number title
Page 2 of 2 plus continuation pages Focused lnspe un1/2002
Page of
INSPECTION REPORT STATE OF CONNECTICUT
FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH
CONTINUATION SHEET
NAME OF ESTABLLIIS�HM�E�NT✓ TOWN �j T DATE OF INSPECTI N /
fvi lTl/JGt� a ' •SIT /l+�U /
INSPECTION REMARKS
FORM#
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INITIAL(INSPECTOR) INITIAL(PERSON IN CHARGE) ftL) I
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 TO ? DATE OF INSPECTION
7 —
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INSPECTION REMARKS
FORM#
44
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INITIAL(INSPECTOR) INITIAL(PERSON IN CHARGE)
Distribution: I st-White-Health Department 2nd-Yellow- Owner/Manager