HomeMy WebLinkAboutFood Service Establishment Inspection 19 (13) yet - t7, fDj' �S ,dr. wi r D+n:'E
Establishment: 6u Inspection Date: Time: ` ' Roins insp
Address/City: .—Ohw i_ Health Dept: �ar�7-t LcJ/y7jSC _Class: 1 2 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 not inclusive of all possible debitable items C NL NIA DNC KEY: C[complies] NIO[not observed] NIA[not applicable]
.60 Qualf(ed:Foact'dperdtor 3 DNC[does not comply] 0[other] RTE[ready-to-eat]
"personnel with n Infectio restricted
61 ; tern Doti noted Al ate 2 C ;NI¢
A Food workers have no exposed infected lesions I burns
62` `Wrdten documentation of tralining program 2
"` B Personnel with infection restricted
1 Approved source;wholesome,nonadUl,oratetl !C. ;N10 N!A °4 C Communicable disease of worker reported to local health director
A Approved shellfish,finfish,meat&poultry USDA approved 13 ,,Haridwashing;fagllrtres'provided handsw`h-ed,clear?!: C .NIO NIA 4
B Food cans in goad condition(not dented,rusty,bloated,leaking) ,� A Handwash f Byes in all food prepldispe ing&�arewash areas
C Wholesome/nonadulteratedfoods/safePe Ia Handw h IgOlties in or imme a ut_!e-toilet rooms
D Commercial products(no home grown/canned food) C Hand cili'es i to use
E Potentlally hazardous foods received at proper temperature p Per noel hand h I n roper handwash procedure
Handbalsffingat appropriate times
3 t .Qtenfiaiiy'rtiazardous*foal itieefstemperature,repuiremerits C NlO A 0
dLrsng storage,preparation,displays serwce aKd transportation
15
: ., . l ;Goad hygienic=pract[d. s
C NfO ''WA ;2
A Hot holding greater than or equal to 140°F. (wholebeeflp°rk roasts too°F.) ki A ❑ No eating ❑ No smokin while working
B Cold holding lessthan orequal045°F. B Wounds covered adequately
C Proper cooling C Proper sink used for handwashing
D Proper re-heating
E Proper cooking/ 24 '5anit zatio 'rinse half water-cheimir 'k: G N/O` 'NIA
�..:.:x
P 9 advisory Posted ,... ,• ,.. � �.
A Approved senitizeravailableladequate concentration ofsanitizer
degaatia.`f cfittres3 mainthilit }uct ,; C. ;Nip iN /B Food-contact surfaces and utensils used for potentially
+ri, *�.y
temperature;therri�toSrgeter's provided i* l ". hazardous food sanitized at least every 4 hours
A Food thermometer available and accurate C Adequate ❑dishwashersanilizer ❑final rinse temp
B Properfood thermometerfor product
L Proper sanitizin rocedure
E Sanitizing between raw animal origin&ready-to-eat food
C Thermometers appropriately placedin cooler units
C `.,:,l a, r ' !part wrp ° # 4z` G3 1VLO;,NIA 1
9g 0CC r ,Y�7ry/� y
9 }}j, M W �i ig:6!3{7M .4 ! 1 �J...0 t:FLQJ'T'[. trS
N t,Foad Mpro a- c dNring itG"ragnQr�;�a m,lonl� '" C k NIAr G2
diIy,serwFlae and*rgnspQlrtatron fM A Cloths and/or sponges ingood repair and clean
!.
B Wiping cloths kept in sanilizer between uses
A Produce washed
0
B Raw meats not stored/prepared near ready-to-eat foods t �1-contaef surfs $ .I.
� $ C [W0 NIA '
C Food covered properly A Food equipment clean,utensilsclean, uipmentinteriorscl
D Adequate splash guards!sneeze guard B Single use gloves changed when soile
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 erru°nder t
�30 `Hot�aftti of wa presstire, vid proed as'req'Irea,fC I .NlA. 42
C
38 Handwashlrg,aidcessoftessprovided C r'Nl0' A
i9§'t'H itdtln rofifa�Cd: tr0611 edk� ` }":,
.a..�. �: f•�: ., ;.'. `CtN10 JWA -2 A Soap 1 paper towels 1 drying device available ,
A No unnecessary handling RTE and/or cooked foods with bare hands B Dispenser(s)working: ❑Soap ❑Paper towel
B Minimize food handling,other than ready-to-eat,with bare hands X C Handwash sinks)clean/waste receptacle at handwash sink
C Adequate utensil(s)for dispensing food/ice D
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],FHF[potentially hazardous food],FB ffoodborne]
PHFs are hot held at: IF. PHFs are cold held at: F. Describe illness conditions when you would exclude a food worker from working:
Are internal cocking temperatures taken? Y N *To what temperature do you cook:
Poultry Ground Beef Pork What diseases related to FIB illness are you re qui d to report to the local health department?
Roasts Other
Describe re-heating procedures: Is there a written illness policy that requirayffie food worker to report specific illness conditions
Are temperatures recordedilogged for cold holding foodsleq ' ment? Y N and diseases to the QFO? Y N Do you have a paid sick leave policy? Y N
Are foods cooked in advance and cooled? Y N ♦ re leftovers saved? Y N Is there a language barrier between i pector&QFO? Y N ff.yes indicate language spoken
List products coaled: 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 above person(circle all that apply):CFO DA Mgr Cook Owner FW
Is cooling monitored for time&temp? Y N Is monitoring of cooling recorded? Y N .Obtain signature e eto received the QFO responsibilities information at the time of the
Is there a ce produ washing policy? Y N Describe what Is washed and inspection:
where: Note: This report is o a 'g form(total of 62 debitable items) Page 1 of 2
S1�A7fEOF CONNECTIC�i" IaEPARTMEAIT OF PUBI.tC Hf~14LTH 49,0 pPIT,t LAUENtJE M� 51FDP H,4RTFORD,CT 0 4
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t�OYALHEALTN,DEPir�tf Livvh ADDRES5fCITY
Establtshment : Z?� 7Zo t:! e Aeu uDS Date of4rispedtion:
Add ess C .T6tfx► tOwner or Operator. Li
ADDITIONAL POUR POINT ITEMS
KEY: DNC [DOES NOT COMPLY]
o
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- Pro per ypelinstallationt backflow prevention device/air gap for: a
-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 Proper drain for;
29 Water source adequate,safe. -Food equipment -Dish machines -Ice machines
a
-Well l 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 of food:Original container,properly labeled 40 Garbage/rubbish storage arealrooms,enclosures-properly constructed,dean
5 Potentially hazardous food properly thawed 41 Garbage/rubbish disposed of in an approved manner,at approved frequency
10 Food dispensing utensils properly stored ,Yl 42 Vermin Control: No insects/rodents present
14 Food worker:Clean outer clothes,effective hair restraints 43 Outeropenings protected againstentranceofinsectslrodents ;
4 Floors: Floor covering installed,constructed as required,good repair,clean 1
16 Food-contact surfaces designed,constructed,maintained,installed, 2 45 Floors graded,drained as required
located
6 Floor,waIIjunclure cove red
17 Nonfood-contact surfaces designed,constructed,maintained, 11
installed,located r "
7 Mats removable,good repair,clean r-
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
repair,clean.Wall&ceiling surfaces as required
20 Dishwashing facilities approved design,adequately constructed, 2 61
maintained installed located 50 Dustless cleaning methods used,cleaning equipment properly stored
Equipment&Utensils: Cleanliness 51 Adequate lighting provided as required l
1 Preflushed,scraped,soaked and racked �''
P 52 Room free of steam,smoke odors Y
22 Washwaterclean,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
27 Nonfood-contact surfaces of utensils&equipment clean `1
55 Establishment and premises free of litter,no insect/rodent harborage, 1
28 Equipment/utensils,storage,handling 1 no unnecessary articles r
32 Proper disposal of waste water 56 Complete separation from living/sleeping quarters and laundry °
1
33 Plumbing location,installation,maintenance r 1*
57 Clean/soiled linens stored properly
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,slgn(s)posted at
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 ❑Reinspection ❑ Preoperational Inspection
R: PERSON N C±LAKE: Other Inspection:
Demerit Score: +Include demerits from page 1
4 3 2 1 Total Rating
n fire Big - I
i7
print name��� print name
phone number title DATE CORRECTIONS DUE:
Page 2 of 2 plus continuation pages F—sed 1n pe ti /2002
Page of
INSPECTION REPORT STATE OF CONNECTICUT
FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH
CONTINUATION SHEET
NAME OF ESTABLISHMENT TOWN DATE OF INSPECTION
S C),., �s
INSPECTION REMARKS
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INITIAL(INSPECTOR) INITIAL(PERSON IN CHARGE
i` 3°sribrution: 1st- -Health Department 2nd-Yellow- Owner/Ma ger
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INSPECTION REPORT STATE OF CONNECTICUT
FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH
CONTINUATION SHEET
NAME OF ESTABLISHMENT TOWN DATE OF INSPECTI N
INSPECTION REMARKS
FORM#
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INITIAL(INSPECTOR) INITIAL(PERSON IN CH
Distribution: 1st-White-Health Department 2nd-Yellow- Owne/Manager