HomeMy WebLinkAboutFood Service Establishment Inspection 58 (7) E Qlf rJT r/i O��TSll FbC)D fir INSPE TION IZbR • D AI�TMNTb '' IJBLIC]% AI1F r ;';
Establishment: C,i,WTlnspection Date: i` Time: ROinsp E
ddress/City: Health Dept: y/.mob Srts. _class: 1 z 32
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 INIO NIA DNCI KEY: C[complies] N10[not observed] NIA[not applicable]
'64 QUalrfred Food Operator ;.: g DNC[does not comply] 0[other] RTE[ready-to-eatl
fit Designated Alternate 2
'f2' Personnel with l0ection restricted C;;N10. N/A 4
62 Written dociimentafion o.training program',KJ 2 A Food workers have no exposed infected lesions 1 burns
B Personnel with infection restricted
1 FApproved source;whoiesome,nonadutterated C N1! NA '4
C Communicable disease of worker reported to local Pealth director �[
A Approved shellfish finfish meat&poultry USDA approved 13 Handwashingfactiitiesprovide ,hand aS ed;clean ;G ;N/Q "NIA 4
B Food cans in good condition(not dented,rusty,bloated,leaking) J( A Handwash facrl es in all food pre a sin & arewash eas
C Wholesomelnonadu[teratedfoods/safe 6 Handwash f ties in or i ant to at ms
D Commercial products(no home grown/canned food) C Handwa acilit ac., si nient
E Potentially hazardous foods received at proper temperature D Perso net hams ashed,clean 1 ProWfWdyasf procedure
0 E Handw irtfat appropriate time
3 ,Potentially hazardous food meats tet 06NIlure ref ri"r,,ements . C �110 N!A 4; 0
t during storage,preparation;display;sp"q eland trpnsportaftorr - [ r,'
18 Good hygienic ,rectices" ;
A Hot holding greater than or equal to 14eF. (whore beef/pork roasts 1300F.) A ❑ No eating ❑No smoking while working
B lColdholding less than or equal to 45 F. B Wounds covered adequately
C Proper Cooling C Proper sink used for handwashing
D Proper re-heating
2A . nrtizatron rinse hot'water,.-chemical; C :w10
E Proper internal cooking I consumer advisory posted
Q Approved sanifizeravailableladequate concentration of sanitizer
14.. *Adequatb.fagririties$o maintain product 4+t h C ;IV10 N/A; -;2 B Food-contact surfaces and utensils used for potentially
' hazardous food sanitized at least every 4 hours
,a
t;,i temperature thermbrrteters prow x , r,
A Food thermometer available and accurate C Adequate ❑dishwashersanitizer ❑final rinse temp
B Proper food thermometer for product
D Proper sanitizin rocedure
Ce rmometers appropriately placed in coolerunits E Sanitizing between raw animal origin&ready-to-eat food
0
i Clean wiping cloths v- f y c C iNlO' N1A 1
} [• od pr�ta�CY�.�<ii�irrng�s�orage,.rpreparatfan;+ t C 'NIQ
d0.st�laty,service and tran 9,, 1 �s"° E �r A Cloths and/or sponges in good repairand clean
x a Y,+c '.e ..a., s.r•P: I kS;:.
B Wiping cloths kept in sanitizer between uses
A Produce washed 0
B Raw meats not stored/prepared near'ready-to-eatfoods 2G Foci iAtzlct, if eel clean a ; ` C' Nl N1A 2
++ul C
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 Ilk-
7 Food--contact surfaces clean
F No pooling of eggs not cooked immediately 0
Food containers stored off the Floor '= " I
30 C:Floc fin ,cald vuater•underpressure,provrded as required16 Haedwatlltfng acc0eorces"p aurded ": C NIA'NIO iNlA �2"
' A Soap!paper towels 1 drying device available
A No unnecessary handling RTE andlorcooked foods with bare hands B Dispenser(s)working: ❑Soap ❑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 utensils)fordispensing 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 operator],DA[designated alternate],PHF[poten&ally 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 Park What diseases related to FB illness re you required to report to the local health department?
Roasts Other
Describe re-heating procedures: Is there a written illness policy at requires the food worker to report specific illness conditions
Are temperatures recorded/lagged for cold holding foods/equipment? Y N and diseases to the QFO? N *Do you have a paid sick leave policy? Y N
Are foods cooked in advance and cooled? Y N Are leftovers aved? Y N Is there a language barj r between inspector&QFO?sY N J 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):
Indicate the title ab a person(circle all tat apply):CFO DA Mgr Cook Owner FW
Is cooling monitored for time temp? Y N Is the monitori of cooling recorded? Y N .Obtain signaturAL "23 received the CFO r ibilities information at the time of the
r1sth—erre a produce washing policy? Y N ♦Describe wt is washed and inspection:
re: I Note: This report is a two page form(total of 62 debitable items) Page 1 of 2
TIOU �AEPA,,,, FNT OF PUBL[C HEALTH 410 CAPITOLAVE IJ -1MS#51 EDP-HART>=ORD,CT 06134
r ►1?I? ESSICITIf:
Esta6ii`shrrtent " , .iTr - Date of Inspection:
e `GrJi�DSh�G i
ddress}* ` ' �"aNxJ f wner orMOperior, .
ADDITIONAL FOUR POINT ITEMS KEY: DNC [DOES NOT COMPLY] o
6 Foods not reserved.
-Unwrapped foods not re-served -4' 31 Sewage disposal approved. 4
-Potentially hazardous foods not re-served -Operating as required
No cross connections,back siphonage,backflow
11 Toxic chemicals.
4 Proper type/installation/backflow prevention device/air gap 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
-Pesticides/rodenticides properly dispensed Prover drain for:
29 Water source adequate,safe, 4 -Food equipment -Dish machines -Ice machines
-Well l well head protected from contamination 35 Toilet facilities. Adequate,convenient,accessible, °4
-Water quality in compliance
-Monitoring in compliance designed,properly installed
OTHER ITEMS z
KEY: DNC [DOES NOT COMPLY]
2 Sources of food:Original container,properly labeled 1 0 Garbage/rubbish storagearealrooms,enclosures-properlyconstrudetl,dean 1
5 Potentially hazardous food properly thawed 2 41 Garbage/rubbish disposed of in an approved manner,at approved frequency
10 Food dispensing utensils property stored ;1; 2 Vermin Control: No insects/rodents present 2'
14 Food worker:Clean outer clothes,effective hair restraints t,- Outeropenings protected against entrance ofinsects!rodents ;
4 ors: Floorcovering installed,constructed as re fired,god repair,den M
16 Food-contact surfaces designed,constructed,maintained,installed, 5 Floors graded,drained as required -------------------
located
6 Floor,wall juncture 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 Singleservicearticles,storage,dispensing 2 -
19 No reuse of single service article 9 i ings al{ac�lsd,equipment properly constructed,good =1}p
repaiP, lean-Wa71&ceiling surfaces as required
20 Dishwashing facilities approved design,adequately constructed, 2'
maintained installed located 50 Dustless cleaning methods used,cleaning equipment properly stored
Equipment&Utensils Cleanliness 51 Adequate lighting provided as required
21 Preflushed,scraped,soaked and racked 52 Room free of steam,smoke odors
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-
7 Nonfood-contact surfaces of utensils&equipment clean 1 .,
55 Establishment and premises freeoflifter,noinsectlrodentharborage,
8 Equipmentlutensils,storage,handling 1 no unnecessary articles
32 Properdisposal ofwaste water 1 56 Complete separation from living/sleeping quarters and laundry 1
33 Plumbing location,installation,maintenance 1; 57 Clean/soiled linens stored properly
58 No live birds,turtles,or other animals(except guide dogs) 1
36 Toiletroomsenclosedwithself-closing door 1
59 Seats 75 or more:Nonsmoking area provided,sign(s)posted at 3'
37 Proper toilet fixtures provided,good repair,clean entrance(s),smoking area indicated by sign(s)
39 Approved garbage/rubbish containers,adequate number,covered, 1
rodent proof,clean Routine Inspection I1111einspection 0 Preoperational Inspection
TOR: PERSON IN Ham: Other Inspection:
Demerit Score: *Include demerits from page 1
4 3 2 1 Total Rating
stgnature signature
print name. � e print name
`� -� u.? j
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phone number� title DATE CORRECTIONS DUE: ;
�_ Page 2 of 2 plus continuation pages Focused Ins a don 112002
Page of
+ems ej
INSPECTION REPORT STATE OF CONNECTICUT °
FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH
CONTINUATION SHEET
NAME OF ESTABLISHMENT TOWN DATE OF INSPECTION
0 �/G//tJ1, 1> /
INSPECTION REMARKS
FORM#
36
IWOL�0,e.-AA c, 41,
e �-
INITIAL(INSPECTOR) INITIAL(PERSON IN CHARGE)
Distribution: 1 st-White-Health Department 2nd-Yellow- Owner/Manager
Page°,;v4of
INSPECTION REPORT STATE OF CONNECTICUT
FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH
CONTINUATION SHEET
NAME OF ESTABLISHMENT TOWN DATE OF INSPECTTIION
:5v-CU)
INSPECTION REMARKS
FORM#
INITIAL(INSPECTOR) INITIAL(PERSON IN CHARGE) /
Distribution: 1 st-White-Health Department 2nd-Yellow- Owner/Manager