HomeMy WebLinkAboutFood Service Establishment Inspection 10 (30) dl'� is / cryo / n /,rill! IL
s
( z .
S r
Establishment: Inspection Date: i Time /�_' E[nsp
Address/City: le o odlA- ST Health Dept: U�f10 AI b � class: t z 3
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 rot inclusive of all possible debitable items C N10 I NIA JDNC I KEY: C(complies] N10[not observed] NIA[not applicable]
:fi0x Qtiah#led Food Operator x 3 DNC[does not comply] 0[other] RTE[ready-to-eat]
" 12 ; Personnel with'infection restricted, WO
4>:
61 Qestgnated Alternate 2
A 'Food workers have no exposed infected lesions/burns
62 E Written do umentahon of tratmng program4 2
B Personnel with infection restricted
t ,`Apyrovgd source wholesome,nonadulterated C ;N/0,NIA' 4>;
I ' :. :. . Co municable disease of worker reported to local health director
A Approved shellfish,finfish,meat&poult USDA approved 3 ' andwashtng:facthttts provided, handswastied,clean ,C Nt0 4
B Food cans in good condition(not dented,rusty,bloated,leaking) Handwash facilities in all food prep/dispensing&warewash areas
C Wholesomelnonadulterated foods/safe B Handwash facilities in or immediately adjacent to toilet rooms 44
D Commercial products(no home grownlcanned food) C Handwash facilities access iblelconvenlent to use p(
E Potentially hazardous foods received at proper temperature AY D Personnel hands washed, clean 1 Proper handwash procedure
0
E H dwashing at appropriate times
3 Potentraily hazarddkt ;food m ats temp*erttOre°t'et�ttftOtn6a s, C N[0 NIA: 4
during storage,pYeparatron„di shay,service and transportation.
, .:..
7 od hygienic practices
A Hot holding greater than or equal to 1400
F. (whole beef1parkroasts1300F) ❑No eating ❑ No smoking while working
B Cold holding less than or equal to45aF. 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..�.Sranitizationsrrise iy(hofiwafer a emlcakyy C ywo N!A '2
i ...t.•.. .k, ra
0 A Approved sanitizeravailablelal late concentration ofsanitizer
.4 ;Adcjuag`# cilttlesatormainlalnAprbduct n vk IC"N10 NIA 2' g Food-contact surfaces and utensils used for potentially
"¢ h ` wool;o� � �� s k hazardous food sanitized at least eve 4 hours �
(i., temperatutre,�th�rtnpfrteters;provtdec�� i $ � , every
r �t:i _.... .. . ,. .:
A Food thermometer available and accurate C Adequate ❑dishwashersanitizer �#fnal rinse temp Je
D Proper sanitizing procedure
B Properfood thermometerfor product
E Sanitizing between raw animal origin&ready-to-eat food
C Thermometers appropriately placedincoolerunils
0 ,r a w - . , 25wiptitgrclo(hs n z r r 7 C [NIOs,NIA 1=
t?4 P+ty'ogdkpt to t ;tiunng s1Prage,ypraPU ion; ":�t:, C N10 W ,
dstptgy,�sem+ree aid ta1npdrfaatrOr ' " A Cloths and/or sponges in good repair and clean
:..,t8M..1ffi: .,i4 .,.lriiti}6 t *,`. `._ ;.a.it +i g....._.. dF 4i:ty �•'.%-•Si',T^ l h as �?:, fi? I ..
B Wiping cloths kept in sanitizer between uses
A Produce washed 0
B Raw meats not stored/prepared near ready-to-eat foods g.. Qd�cantactssur at:es�clean �*-t a ,1 C ISO f i
C Food covered properly :r� . , 1 ;. 1 L i .:
food equipment clean,utensils clean,equipment inter[orsclean
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 thefloor ¢ "' *' ''�%4 x r
3D, ;Hof�apdTcofcwater under prssure,provided as required ;NIA F2;iII
.
0 . :. ,, ;38; HantlwasNtg atcesories'provtded;
I a andliiag of foorrtrZ ir�tiYeatlr,�,,:f:.a t k:. ..:, r !W4 r t 2• A Soap./paper towels drying device available
A No unnecessary handling RTE andlor000ked foods with bare hands B
Dispenser{s}working: OSoap ❑Paper towel �
B Minimize food handling,other than ready-to-eat,with bare hands C Handwash sink(s)clean!waste receptacle at handwash sink
C Adequate utensil(s)for dispensing food/ice 0
0 -DESCRIBE DEFICIENCIES ON CONTINUATION SHEETS
The following information is not debitable and does not affect your score. KEY: QFO[qualified food operatorl,DA[designated altemate],PHF[potentially hazardous food],FB[foodborne]
PHFs are hot held at: IF PHFs are cold held at: IF. 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 that requires the food worker to report specific illness conditions
Are temperatures recordedllogged for cold holding foods/equip-7-Ant? Y N and diseases to the QF ? Y N +Do you have a paid sick leave policy? Y N
Are foods cooked in advance and cooled? Y N *Are eftovers saved? Y N Is there a languag arrter between inspector&QFO? Y N if yes indicate language spoken
List products cooled: by QFO/DA: - *Can the QFOIDA read the inspection report? Y N
i
Describe coding methods: Indicate who answered the above 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 Nis the onitodng of coaling recorded? Y N .Obtain sigri of the rsgh q recelved the QFO responsibilities information at the time of the
Is there a produce washing policy? Y N *Do cribe what is washed and inspection: .
where: Note: This report is a two page form(total of 62 debitable items) Page 1 of 2
€� ,�, , �^rs ;r, -�'�"ys St '.' �ef�`�ct.t, -enr'.:��:ta �z - y.,-t �ix3 ""`, '�,aa*;rq,'� i .3#. t '• iyr '7 '"fi"�'a,
ATT4 TEt?F GONN # T1ClJ DEPARTNrENTOF PUBhLIC.HppEALyyTH 410 CARTQ�rILAVgE_NUE CMS#9IFDP
FQD F�6�..SA:i.alVAC INS,
+c4T1�1\ i+:��
r
rtMi.
AiDRESS1fITY �,lishment. pry- !6  . Date of Inspection;
ADDITIONAL FOUR POINT ITEMS KEY: DNC [DOES NOT COMPLY]
6 Foods not re-served.
4< 31 Sewage disposal approved.
-Unwrapped foods not re-served 44
-Potentially hazardous foods not re-served -Operating as required
No cross connections,back siphonage,backflow
I 1 Toxic chemicals.
4 Proper typelinstallation/backflow payenfion device/atgap for:
-Stored properly,labeled properly,used properly -Food equipment -Hose connections -Dish machines
-5anitizerconceniration notto exceed maximum permitted -Soda system carbonator -Beverage dispensers -Toilet tanks
-No unnecessary toxics on the premises -Chemical dispensers -Ice machines
-Pest!cideslrodent+tides properly dispensed Prover 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 z KEY: DNC [DOES NOT COMPLY]
2 Sources offood: Original container,properly labeled 1 0 Garbageirubbishstoragearea/rooms,enclosures-properly constructed,clean
1"
5 Potentially hazardous food property thawed 2 41 Garbagelrubbish disposed of in an approved manner,at approved frequency
10 Food dispensing utensils properly stored ;.1r 42 Vermin Control: No insects/rodents present 2
14 Food worker:Clean outer clothes,effective hair restraints 1 3 Outer openings protected against entrance ofinsects/rodents
4 Dots: Floor covering installed,constructed as required,good repair,clean
16 Food-contact surfaces designed,constructed, maintained,installed, 2 5 Floors graded,drained as required
located
6 Floor,wall juncture covered
No food-contact surfaces designed,constructed, maintained, 1 '7 Mats removable,good repair,clean
_ --itSstalled,located 1'
2
8 Exterior walking,driving surfaces,good repair,clean
18 Single service articles,storage,dispensing
19 o reuse ofsingle service article 9 Walls,ceilings attached,equipment properly constructed,good 1
repair,clean.Wall&ceiling surfaces as required i
0 ishwashing facilities approved design,adequately constructed, 2: F
maintained installed 50
located usilesscleaning methods used,cleaning equipment properly stored a i
Equipment&Utensils: Cleanliness (51 Md"equatelighting provided as required
21 Preflushed,scraped,soaked and racked 52 Room free of steam,smoke odors 1
22 Wash water clean,proper temperature 53 Rooms&equipmenthoods,ducts,vented as required
23 Aqcurate thermometers provided,dish basket,if used 54 Rooms adequate,clean,adequate lockers provided,facilities clean 2
7 onfood-contact surfaces of utensils&equipment clean
5, Establishment and premises free of litter,no insectlrodentharborage, L
28 Equipmentlutensils;storage,handling no unnecessary articles
32 Proper disposal ofwaste water 56 Complete separation from livinglsleeping quarters and laundry 1
33 Plumbing location,installation,maintenance 1 s 57 Clean/soiled linens stored properly 1
58 No live birds,turtles,oroiheranimals(except guide dogs) 1
36 Toilet rooms enclosed with self-closing door k
59 Seals 75 or more:Nonsmoking area provided,sign(s)posted at 3
37 Proper toilet Wuresprovided,good repair,clean enirance(s),smoking area indicated by sign(s)
39 Approved garbage/rubbish containers,adequate number,covered, :1'
rodent proof,clean Routine Inspection ❑Reinspection ❑ Preoperational Inspection
7,1T R: PERSON IN HARGE: her Inspection:
✓�-' Demerit Score: *Include demerits from page 9
4 3 2 1 Total Rating
sig a ure signature _
tint name print name
DATE CORRECTIONS DUE: /,¢ C
hone number title ,�v�. � z •,
U Page 2 of 2 plus continuation pages Focusedlnspecfion 1/2002
Page 4,-
Date.
F.,M
INSPECTION REPORT STATE OF CONNECTICUT E"'°
EmpRado
PASS WHEN BLUE
BAR TURNS ORANGE
FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH
CONTINUATION SHEET 160°Fi7iec
NAME OF ESTABLISHMENT TOWN DATE OF INSPECTION
Z16&211"Al (IV
INSPECTION FORM# REMARKS
or
r 36
zk
s
e
INITIAL(INSPECTOR) j INITIAL(PERSON IN C CTE)
Distribution: 1st-White-Health Department 2nd-Yellow- Owner/Manager
1
Pageof
INSPECTION REPORT STATE OF CONNECTICUT
FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH
CONTINUATION SHEET
NAME OF ESTABLISHMENT TOWN DATE OF INSPECTION
Apoflael
INSPECTION REMARKS
FORM#
C�
�-
INITIAL(INSPECTOR) INITIAL(PERSON IN CHARGE) �( ,
Distribution: Ist-White-Health Department 2nd-Yellow-Owner/Manager