HomeMy WebLinkAboutFood Service Establishment Inspection 5 (3) VIMx 1,
Establishment: xc X A: Inspection Date: '' Time: // . a insp insp
Address/City: ziq—• ALI Health Dept: Class: 1 I
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 NIA IDNC I KEY: C[complies] NIO[not observed] NIA[not applicable]
60 Qualified 1=o'od Operator 3 DNC[does not comply] 0[other] RTE[ready-m-eat]
12.: Personnel with infection restricted C ;N10 NIA 4
61 Destgnatetl:Alternate=.' 2 q Food workers have no exposed infected lesions!burns
&2 Written�odumentation of training programk y
B Personnel with infection restricted
;1 Approved source,wholesome,nonadulterated `C [N/0"NIA IA C Communicable disease of worker reported to local health director
A Approved shellfish,finfish,meat&poultry USDA approved 13: Wandwashing;fac(lities provided,hands washed,clean C :NCO 'NIA 4
B Food cans in good condition(notdented,rusty,bloated,leaking) A Handwash facilities in all food prepldispensing&warewash areas
C Wholesomelnonadulterated foods/safe
B Handwash facilities in or immediately adjacent to toilet rooms
D Commercial products(no home grown/canned food) C Handwash facilities accessiblelconven!ant to use
E Potentially hazardous foods received at proper temperature D Personnel hands washed,clean I Proper handwash procedure
0 E Handwashing at appropriate times
,. ,.. .- t. .a.. x x•.. r b: ... ..
,potent191Iy1ha#r,_u .food m5,ee4s temperature requ[rements xC NIO NIA .4 0
durlrt�storage,preparatrom,display servrc0and transportation, ;
;. !0 'Nl
r f5 ;Good hygienic practic`es a: iC<<N. A 2..:... .:..: t .,
A Hot holding greater than or equal to 1400F. (whole beerrporkmasts 13&F.) A ❑ No eating ❑ No smoking while working
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 internal cooking I consumer advisory posted 24:5anitization firise (hot w teit=c�erfi c'al) `C ;IN PNIA 12
0 A Appmvedsanitizeravailableladequateconceritrafionafsanitizer k
6q t IlitgquaEe.facltrties+to�marntarn roduct. :* . C, ;hyp INIIA ,2 B Food-contact surfaces and utensils used for potentially
f �temperaturB„thermometers provided x v:. ,y; ,., :;; ;, hazardous food sanitized at]east every 4 hours
A Food thermometer available and accurate C Adequate ❑dishwashersanitizer ❑final rinse temp
B Properfood thermometer for product D Proper sanitizin rocedure
E Sanitizing between raw animal origin&ready-to-eat food
C Thermometers appropriately placed in coolerunits 0
AL
0 '25 ;`Clean wiping cloths 4= N Q [►�j0 NIA 1•.
4A u Fobti` r i�tect dU ng storage, p. u• rt . ,
ire aharo „1 n .
s` ' " r a k K. .6 a::3: x +.• �.. A Cloths and/ors on es in good re airand clean
i hrspit ay,'xra1� tsportatrorl� ; : : �r ,� P g 9 P "
.T : .p......... ...'_.....:,....,....,,. .s..e..&.W. U;v. A.:.;*•y• . � �.' °.....,; .]:...' B Wiping cloths kept in sanitizer between uses
A Produce washed
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B Raw meats not storedlprepared near ready-to-eat foods ,2& rFpod�c n�ta t r e ",ct ti ;.n ;A h e xC LW
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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--contact surfaces clean
F No pooling of eggs not cooked immediately 0
8 Food containers stored off the floor 0 ndscald�water under pressure;provided as requii
,. ;
0 $E;;Ha tlwa's.'hln`"accessories provided;'; -All
lc iW �N!
9 H]andiin o food:rrtinimized C 'NL,0.'N/A"
.B<.fr ,. . k . oa 4$ap tow s•!' rying device available
A No unnecessary handling RTE and/or cooked foods with bare hands B Dis enser s working: ❑Soo per towe
B Minimize food handling,other than ready-to eat,with bare hands Handwash sink(s)c e isle receptacle at handwash sink
C Adequate utensil(s)for dispensing food/lee
1-04
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[potentally hazardous food],FB[foodbornel
PHF9 are hot held at: F. 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 y cook:
Poultry Ground Beef Pork What diseases related to Fa less are you required to report to the local health department?
Roasts Other
Describe re-heating procedures: Is there a written illness p icy that requires the food worker to report specific illness conditions
Are temperatures recordedllogged for cold holding foedslequipment? 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 leftover saved Y N Is there a language b mar between inspector&QFO? Y N If yes indicate language spoken
List products cooled: by QFOIDA: *Can the QFOIDA read the inspection report? Y N
Describe cooling methods: Indicate who answered the abov uestions:Name(print):
Indicate the title of above rso i Igala�QFly):CFO DA Mgr Cook Owner FW
Is cooling monitored for time&temp? Y N Is the mon' ring of coaling recorded? Y N .Obtain signalur of the rson w r e O responsibilities information at the time of the
Is there a produce washing policy? Y N ♦Desc' a what is washed and inspection: -
where: Note: This report is a two pw form(total of 62 debitable items) Page 1 of 2
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SfiATE OFCONNECTICG7 DEPARTMENT OF Pl1BLIG.H�11-TF 4'I{1 APf L.AVENUL MS#51FDP-HARTF'ORD,CT 061:3
�QCTIS B FOOD�ikVf-E [NSP C°I`Ii�N REPORT
"ADDRES.51C61'Ty
Establishment. : "" Date of irtspection: 21
ddress %� rGt� " �11� Owner or Operatgr `�i�,i2IJ1/'
ADDITIONAL FOUR POINT ITEMS z
KEY: DNC [DOES NOT COMPLY] 1
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
34 No cross connections,back siphonage,backflow
11 Toxicchemicals. .4
4' Proper type/installation/backflow prevention device/airgaofor:
-Stored properly,labeled properly,used properly -Food equipment -Hose connections -Dish machines
-San itizer concentration notto 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. ;42 -Food equipment -Dish machines -Ice machines
-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 a` KEY: DNC [DOES NOT COMPLY]
2 Sources of food:Original container,properly labeled 40 Garbage/rubbish storage area/rooms,enclosures-properly constructed,clean 1
5 Potentially hazardous food properlyihawed 41 Garbagelrubbish disposed of in an approved manner,at approved frequency i
10 Food dispensing utensils properly stored 42 Vermin Control: No insecislrodents present 2
14 Food worker:Clean outer clothes,effective hair restraints 43 Outer openings protected against entrance ofinsects!rodents
4 Floors: Floor covering installed,constructed as required,good repair,clean l
16 Food-contact surfaces designed,constructed, maintained,installed, 45 Floors graded,drained as required
located
6 Floor,wall juncture covered
17 Nonfood-contact surfaces designed,constructed,maintained, ;.1; 7 ats 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 ails,ceilings attached,equipment properly constructed,good 1
repair,clean.Wall&ceiling surfaces as required r
20 Dishwashing facilities approved design,adequately constructed,
maintained installed located 50 Dustless cleaning methods used,cleaning equipment properly stored
Equipment&Utensils: Cleanliness 51 Adequate lighting provided as required 1
21 Preflushed,scraped,soaked and racked 52 Room free of steam,smoke odors
22 Washwaierclean,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-contact surfaces of utensils&equipment clean 1
55 Establishment and premises free of litter,noinsect/rodent harborage, '1
28 Equipmentlutensils,storage,handling no unnecessary articles
32 Properdisposalofwastewater .1� 561 Complete separationfromlivinglsleeping quarters and laundry 1
33 Plumbing location,installation,maintenance 1 µ 57 Clean/soiled linens stored properly 1
,E 58 No live birds,turtles,or other animals(except guide dogs) 1
36 Toilet rooms enclosed with self-closing door
59 Seals 75 or more:Nonsmoking area provided,sign(s)posted at
37 Proper toilet fixtures provided,good repair,clean 3
enirance(s),smoking area indicated by sign(s)
39 Approved garbageirubbish containers,adequate number,covered, _1
rodent proof,clean ine Inspection ❑Reinspection ❑ Preoperational inspection
L—IOther Inspection:
TOR: PERSON A E: Demerit Score: *Include demerits from page 1
4 3 2 1 Total Rating
signature slgnat l
r ' yl Fall
pri name print name •�
U C � DATE CORRECTIONS DUE: c
phone number title
c__0'C- Page 2 of 2 plus continuation pages Foc—dPnspectiun t ooz
Page of
INSPECTION REPORT STATE OF CONNECTICUT
FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH
CONTINUATION SHEET
NAME OF ESTABLISHMENT TOWN DATE OF INSPECTION
G.44
-v S U 7r GcJ oti�s
INSPECTION FORM# REMARKS
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INITIAL(INSPECTOR) INITIAL(PERSON IN CHARGE)
Distribution: 1 st-White-Health Department 2nd-Yellow-Owner/Manager