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HomeMy WebLinkAboutFood Service Establishment Inspection 53 (8) 1Nil {7 Establishment: Inspection Date: Time: Maw ]nsp Address/City: a Health ept: Class. 2 s Based on an inspection this day,this 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 NIO NIA JDNC I KEY: C[complies] N10[not observed] N/A[not applicable] 60 Qualified Foo430perator x 3 DNC[does not comply] 0[other] RTE[ready-to-eat] } 12. Personnel with infectionrestricted 61� 17esi noted Alternate _ z ;C,,N1fJ N1A.,4 9 62 ;'Written documentationtoftiaining program A Food workers have no exposed infected lesions 1 burns 2 B Personnel with infection restricted 1 ,Approved source,wholesome,;nonadulterated C.. IN! NIA 4. t. m unicable disease of worker reported to local health director A Approved shellfish,finfish,meat& cult USDA approved .H dvuashing.fbd litiessprovided,handswashed;clean Ic NL0' 4 /� B Food cans in good condition(not dented,rusty,bloated,leaking) Lc— 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 access!blelcanvenient to use E Potentially hazardous foods received at proper temperature D Personnel hands washed,clean l Proper handwash procedure ., r rtrt .. .. Handwashing at appropriate times P entiallyhazardous fcod meets iimp.et.aturelrequirements 1, ICE N10 NI 4 ififrin Storage,preparav: diapiay,service andwtranaportation 1 4 x 15;', odh..ygienicp�aCtices FC o p A Hot holding greater than or equal to 140oF. (whole beef/porkmasts 430oF.) ❑ Notating ❑ No smoking while working B lCold holding less than or equal to 45oF. B Wounds covered adequately C Proper cooling C Proper sink used for handwashing D Proper re-heating 0 E Proper internal cooking l consumer advisory posted 24 a ni]ttzatiort rir ste ( ..o water . Chemical) i,C;�N10 1 2': pproved sanitizeravailableladequate concentration ofsanitizer ro� tA- �7aaie, rlri�sfq fna�rirc:ut RIO §. B ood-contact surfaces and utensils used for potentially raure%ihermornetewpr©vil �s.•[b A 4e - �1 f� hazardous food sanitized at least every 4 hours R.d.::? Food thermometer available and accurate C Adequate rdishwashersanitizer ❑final rinse temp D Proper sanitizin rocedure B Proper food thermomelerforproduct E Sanitizing between raw animal origin&ready-to-eat food C Thermometers appropriately placed in cooler units 0 0can WI rn rC,btFis ' A p11 ? k prate" , p g ofi, C Q?WA 1 ayf a ree r*ditrlraan sp�o at�ron0 v # E'y A Cloths and/or sponges in good repairand clean B Wiping cloths kept in sanitizer between uses A Produce washed 0 B Raw meats not stored/prepared near ready-to-eat foods N26 ooc!-eontaot s'aacea'Clean [ ;C ,WO NIA 2 C Food covered properly A, �.*, .11,11W �W. ".v 4 .�, 4:, A Food equipment clean,utensils clean,equipment interiors clean k D Adequate splash guards/sneeze guard B Single use gloves changed when soiled E No unauthorized personnel ki C Food--contact surfaces clean Ile I F No pooling of eggs not cooked immediately 0 8 Food containers stored off thegoor ;.'•,30 F °t artcal �vraerunde�]gssure,provided;is requir 0 N!A 2 0 4-0;, :hi::'+f'. 9':,'g:>'?" -s` i -4..; t1n, of food 1m1 e ' v. r ndtivsfinghacessoriespravit3eal C'�.,0 1 f?, d_ 9.._��.._..xti Soap/papertowei ryi evice available A No unnecessary handling RTE andlorcooked foods with bare hands B Dispenser(s)wor 'ng; 11 pr aper 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 operator],DA[designated alternate],PHF[potentially 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 Pork What diseases related to FB ilines are you required to report to the local health department? Roasts Other Describe reheating procedures: Is there a written illness poll that requires the food worker to report specific illness conditions Are temperatures recordecillogged for cold holding foodslequipment? 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 le ov rs saved? Y N Is there a language baler between inspector&QFO? Y N If ves indicate language spoken List products cooled: by QFOIDA: *Can the QFOID read the inspection report? Y N Describe cooling methods. Indicate who answered the above questio a rint): Indicate the title of above person at ply• 0 DA Mgr Cook Owner FW Is cooling monitored for time&temp? Y N Is the moni ring of cooling recorded? Y N .Obtain signature of the pers oa' d e responsibilities information at the time of the Is there a produce washing policy? Y N •Describ what is washed and inspection: ,vhere: Note: This report rs a two page form(total of 62 debitable items) Page 1 of 2 S1ATI=+df=CONNECTICIII' bEPARTMEITOFP1113L[G:H1=AL`TH-41=APITt)LAVENUE-MS#5.1FDP-HA1RTF0RD,CTa6134 FbCUSED FORD-SERVICE l[NSI GTI01 REPORT LQGAL HEALTHbEPT rrli7� ..;ADDRESSlCITY . a - —-- Establishment: ` = Date of.Inspection: ddress:' f Owner or,Operator,.: ADDITIONAL FOUR DINT ITEM KEY: DNC [DOES NOT COMPLY] d 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 11 Toxic chemicals. No cross connections,back siphonage,backflow <;4 4 Proper voehristallationl backflow prevention devicelairgapfor: -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. 4 -Food equipment -Dish machines -Ice machines -Well/well head protected from contamination 35 Toilet facilities. Adequate,convenient,accessible, 4 -Water quality in compliance -Monitoring in compliance designed,properly installed OTHER ITEMS 0 KEY: DNC [DOES NOT COMPLY] 2 Sources of food:Original container,properly labeled 1 0 Garbage/rubbish storage area/roams,enclosures-properly constructed,clean , + 5 Potentially hazardous food properly thawed 2 1 Garbagelrubbish disposed of in an approved manner,at approved frequency 10 Food dispensing utensils properly stored 1 2 in Control: No insects/rodents present 14 Food worker:Clean outer clothes,effective hair restraints 1 Dateropenings protected against entrance ofinsects!rodents rl 4 Floors: Floorcovering installed,constructed as required,good repair,clea 16 Food-contact surfaces designed,constructed,maintained,installed, 2 5 Floors graded,drained as required located 6 Floor,walliunciure covered 17 Nonfood-contact surfaces designed,constructed,maintained, L` 7 Mats removable,good repair,clean installed,located 8 Exterior walking,driving surfaces,good repair,clean a 1° 18 Single service articles,storage,dispensing 2 9 Walls,ceilings attached,equipment properly constructed,good 19 No reuse of single service article i- repair,clean.Wall&ceiling surfaces as required 1' 20 Dishwashing facilities approved design,adequately constructed, 3= . maintained installed located 50 Dustless cleaning methods used,cleaning equipment properly stored 2 Equipment&Utensils: Cleanliness 51 Adequate lighting provided as required 4 21 Preflushed,scraped,soaked and racked 52 Room free of steam,smoke odors / 1. 2 Was water clean,proper temperature LaQ4X 53 Rooms&equipment hoods,ducts,vented as required 23 urate thermometers provided,dish basket,if used 4 Rooms adequate,clean,adequate lockers provided,facilities clean r 1= onfood contact surfaces of utensils&equipment clean 1` 55 Establishment and premises freeof litter,no insectlrodentharborage, L 28 EquipmenUutensils,storage,handling 1 no unnecessary articles 32 Proper disposal of waste water 56 Complete separation from living/sleeping quarters and laundry 1: 33 Plumbing location,installation,maintenance f' 57 Clean/soiled linens stored properly 1 58 No live birds,turtles,or other animals(except guide dogs) 1 36 Toilet rooms enclosed with self-closing door 1 59 Seats 75 or more:Nonsmoking area provided,signs)posted at 3 37 Proper toiletfxtures provided,good repair,clean entrance(s),smoking area indicated bysign(s) 39 Approved garbagelrubbish containers,adequate number,covered, 1 rodent proof,clean 011outine Inspection ❑Reinspection ❑ Preoperational Inspection INSPECTOR: PERSON Other Inspection: Demerit Score: *Include demerits from page 1 4 3 2 1 Total Rating ignature sign fure, i t name print name l,,a �G�� ��� �/ DATE CORRECTIO DUE: phone number title J �� Page 2 of 2 plus onktlnuation pages Focused Inspection 1120 Page of ;C_14zi�v INSPECTION REPORT STATE OF CONNECTICUT FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH CONTINUATION SHEET NAME OF ESTABLISHMENT TOWN DATE OF INSPECTION )j ' � �IJi�ll✓� � cif � INSPECTION REMARKS FORM# e S7 `� i r� a 2Z� z,22tL,,g INITIAL(INSPECTOR) INITIAL(PERSON IN CHARGE) Distribution; I st-White-Health Department 2nd-Yellow-Owner/Manager Page-of -rA INSPECTION REPORT STATE OF CONNECTICUT FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH CONTINUATION SHEET NAME OF ESTABLISHMENT TOWN DATE OF INSPECTION f INSPECTION REMARKS FORM# DQ ne'� Emplead° PASS W HEN BLUE RAR �rl ES ARrt1N3[UFNW Kp4(ANSUACOIORM{7N� !A— b e,5 It"eo 2e 93 &,2 ec� INITIAL(INSPECTOR) INITIAL(PERSON IN CHARGE) Distribution: Ist-White-Health Department 2nd-Yellow- Owner/Manager