HomeMy WebLinkAboutFood Service Establishment Inspection 70 (8) Establishment: Inspection Date: y Time: 3 1(01nsp Einsp
Address/City: gaff Health D pt: �r 7 lciia� 54'A ass: 1 2ep
Based on an inspection this day,'Me 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 !Aj DNC KEY: C[complies] N10[not observed] NIA[not applicable]
60 Qtzattfied Foot!Operator 3 DNC[does not comply] 0[other] dy-to-eat]RTE[rea
112 /A6 Dggt A te z z . 4
niae, A Food workers have no exposed infected lesions 1 burns
62 L. Ordopu!rentatiowofi,trarning program 2 B Personnel with infection restricted
�1 Approved source,wholesom e;oonaduiteratetl `` C N10•NIA- 4
:. .:...: .....: : C Communicable disease of worker reported to local health director
A Approved shellfish,Finfish,meat&poultry USDA approved 113 a{andvuashing facilities provided; hands washed,clean C iN10 °NIA`'4
B Food cans in good condition(not dented,rusty,bloated,leaking) DC A Handwash facilities in all food prep/dispensing&warewash areas
C Wholesomelnonadulteratedfoods/safe B Handwash faci'ies in or immediately adjacent to toilet rooms
D Commercial products(no home grown/canned food) C Handwash lines accessible/convenient to use
E Potentially hazardous foods received at proper temperature D Personnel ad s ed, clean 1 Proper handwash procedure
0 E Handwashing at appropriate times
3 IPaterttial�y hazardous food meets temperature requirements C N10 IN/A a 4 0
a during storage,preparation dtsplay,Qserv)e and trans orttitlon
15 °Good'�t gieic.. Y 00 N1,4 2:
A Hot holding greater than or equal t 40 F (whale beevpork roasts 130o F.) A ❑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
E tProperinternalcookinglconsumeradvisorypos#ed 424 an(tizatron rinse (hpt`±i+va r,,.-;cli40),il aa)`
Approved sanitizeravailableladequateconcentrationofsanitizer -�
x,adequate^facihtres to m8rrf4a�npriaiu x. �.x . „ . M;(u10: x2; Food-contact surfaces and utensils used for potentially
ytnQeratutfe,4hermometersprovtded t rt s hazardous food sanitized at least every 4 hours
Food thermometer available and accurate _ C Adequate ❑dishwashersenitizer ❑finalrinsetemp
B Proper food thermometer for product � D Pro ersanitizin rocedure
E Sanitizing between raw animal or]gin&ready-to-eat food
C Thermometers appropriately placed in cooler units 0
0 `25`,0ieatl Nvil iti #Cloths, a{ n y -s ..:M k '+ L •^a a ;x
;ti 1 -t.�a k :n ._ . C {N10. N/A 1
� ed d
F gd pro e�c un tagratfo�,f. „ ., [C�-N10� N!A 2
'I,#4V Valli iar a �rgnsporl t[on� i= y A Cloths and/or sponges in good repair and clean
... ......._,�
A Produce washed B Wiping cloths kept in sanitizer between uses
0
B Raw meats notstoredlprepared near readytoeaffoods [26 pood-c+britelc5irfabes'ele�r � �'"� " c 'N10 WPi
C Food covered properly �! A Food equipmentclean,utensifs 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 re
F No pooling of eggs not cooked immediately k 0
8 Food containers stored off the floor ' ` and cold waterxtinderrpressure,piovtded as+require ! a ON,',
2
30;
,:y 3t7.s::9:'�,M. .3.'C tic;? >�•:kF �, +: e :, 7. .4 A*s.a; F ,F kw..
0 8 ndwashing acesones ovrded'..f , x ' kfiUO; , 1
g�� fHaa�ndllrt' :of,:'gd•rntmrnizad C NI IA .2 = .
Soap 1 paperlowels! drying device available
A No unnecessary handling RTE and/or cooked foods with bare hands B Dispenser(s)working: ❑Soap ZPaper 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 foodlice 0
0 I F I 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]
HFs are hot held at: F. PHFs are cold held at: T. Describe illness conditions when you would exclude a food worker from working:
Are internal cooking temperatures taken? Y N *To what temperature do ou 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 poll that requires the food worker to report specific illness conditions
Are temperatures recorded/logged for cold holding foodslequipmentT N and diseases to the OF OT N ♦Do you have a paid sick leave policy? Y N
Are foods cooked in advance and cooled? Y N *Are left o -rs saved? Y N Is there a language tier between inspector&QFO? Y N ifif yes indicate language spoken
List products cooled: by QFOlDA: *Can the QFOIDA read the inspection report? Y N
Describe cooling methods: Indicate who a swered 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 N Is the molnitoring of cooling recorded? Y N .Obtain signature of the person who received the QFO responsibilities information at the time of the
Is there a produce washing policy Y N ♦Des vibe what is washed and inspection:
where: Note: This report is a two page form(total of 62 debitable items) Page 11 of 2
S Al"BsOF CCiNN CTILUT p PARTMENTOF PUBLIC HEALTH 416CAPITQL 8NUE-MS4
59FOP-HARTFOIRD,CT 06134
s,�r FtaCUSE�40616'SERVICE i€NSP,ECTipI jfiEPOR
�LQ�G�pL HEALTH DEPT; �, (" %l rJi �/ ADDRESSIC�fTY
Establishment-° Date,of lnspdctlow,
ddrtSS Owner or Operator:
ADDITIONAL FOUR POINT ITEMS 0= KEY: DNC ^[DOES NOT COMPLY] 50
6 Foods not re-served.
4 31 Sewage disposal approved.
-Unwrapped foods not re-served 4
-Operating as required
-Potentially hazardous foods not re-served
No cross connections,back siphonage,backflow
11 Toxic chemicals. 4,
4 PfQper type/installation/backflow prevention device/air gap for:
-Stored properly,labeled properly,used properly -Food equipment -Hose connections -Dish machines
-Sanitizer concentration no##o exceed maximum permitted -Soda system carbonator -Beverage dispensers -Toilettanks
-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 designed,properly installed
-Monitoring in compliance
OTHER ITEMS KEY: DNC [DOES NOT COMPLY]
2 Sources of food: Original container,properly labeled 401 Garbage/rubbish storageareafrooms,enclosures-properly constructed,clean
5 Potentially hazardous food property thawed 2" 1 Garbageirubbish disposed of inan approved manner,atapproved frequency
10 Food dispensing utensils properlystored 1n" 42 Vermin Control: No insectslrodents present 2 _
14 Food worker:Clean outer clothes,effective hair restraints .1:;, 3 Outeropenings protected againstentrance of insects/rodents lR
4 Floors: Floor covering installed,constructed as required,good repair,clean "
16 Food-contact surfaces designed,constructed,maintained,installed, 2 45 Floors graded,drained as required
located
6 Floor,walljuncture covered
17 Nonfood-contact surfaces designed,constructed,maintained, 1> 47 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 Walls,ceilings attached,equipment properly constructed,good 1
clean.Wall&ceiling surfaces as required
0 Dishwashing facilities approved design,adequately constructed, 2 1;
maintained installed located 4 50 D sfless cleaning methods used,cleaning equipment properlystored
Equipment&Utensils: Cleanliness 1 51 Adequate lighting provided as required 1
21 Preflushed,scraped,soaked and racked 52 Room free of steam,smoke odors
22 Wash wafer clean,proper temperature 53 Rooms&equipment hoods,ducts,vented as required
curate the provided,dish basket,if used 54 Rooms adequate,clean,adequate lockers provided,facilities clean Y
27 onfood-contact surfaces of utensils&equipment clean 1>
55 Establishment and premises free of litter,no insect/rodent harborage, zl<
8 ui mentlutensils,storage,handling
p g g no unnecessary articles
32 Prop rdisposal of wastewater r 56 Complete separation from living/sleeping quarters and laundry 1
Plumbing location,installation,maintenance 1 57 Clean/soiled linens stored properly :
58 No live birds,turtles,oroiher animals(except guide dogs) I Ii
36 Toilet rooms enclosed with self-closing door
1 59 Seats 75 or more:Nonsmoking area provided,sign(s)posted a1 k
37 Proper toilet fixtures provided,good repair,clean entrance(s),smoking area indicated by sign(s) 3
39 Approved garbage/rubbish containers,adequate number,covered, 1
rodent proof,clean [,Routine Inspection OReinspection O Preoperational Inspection
INSPECTOR: PERSON IN CHARGE: Other Inspection:
Demerit Score: •Include demerits from page I
� r % - a ' 4 3 2 1 Total Rating
�sfgnature signature �t
w- �print name print name
0/16 6�._� ��
phone number PATE CORRECTIONS DUE: '
title
Page 2 of 2 plus continuation pages Focused lns,ec 1l o
Page of
INSPECTION REPORT STATE OF CONNECTICUT
FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH
CONTINUATION SHEET
NAME OF ESTABLISHMENT TOWN DATE OF INSPECTION
Y1,71e /
INSPECTION FORM# REMARKS
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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
.,al.Zo- &�� �
INSPECTION REMARKS
FORM#
OOOF
INITIAL(INSPECTOR) INITIAL(PERSON IN CHARGE) VIE j
Distribution: 1st-White-Health Department 2nd-Yellow-Owner/Manager