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HomeMy WebLinkAboutFood Service Establishment Inspection 43 (6) 101 INN 10 NO NOR Establishment: e' mr d ve4,iyjnspection Date: I Time: 0[nsp REIN Address/City: y�z� ,�taZ1c-r- r� Z, .—e `440—, Health ept: r' '/ v�A �'SSt� ss: 2 Based on an inspection this day,the items marked DNC identify the violaf]ons 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 Nl0 N/A DNC I KEY: C[complies] N10[not observed] NIA[not applicable) 4M!QualifiedoodfOperator 3 DNC[does not comply] 0[other] RTE[ready-to-eat] 72 ; Personnel with infection"restricted. :, 6i Designated Alternate ' 2 C. rNiD A Food workers have no exposed infected lesions I burns f NIA '4 B2 'Written documentation of traln'ng�rogfam y B Personnel with infection restricted it 'Approved source,wholesomE,nonadulterated C N10 NIA. 4.: C Communicable disease of worker reported to local health director A Approved shellfish,finfish,meat&poultry USDA approved 13 '.Handwaohin facilities provided;'handswashed;clean ;C'-N10 NIA,i4 B Food cans in good condition(not dented,rusty,bloated,leaking) 9 A Handwash fa iti s in all food pre dis ensing&warewash areas C Wholesome/nonadulterated foods/safe B Handwa4 f ities i or im i t y d] t oilet rooms D Commercial products(no home grown/canned food) C Hand sh faoil!' s i I e t to use E Potentially hazardous foods received at proper temperature D Perso ei ha a an!Proper Kandwash procedure 0 E Handwas irig at appropriate times 3 PoCenttallyy hazatdous:#ood=m@ets�temperatUrq're'guirelnertts C Nib NIA >4 0 dytmg,storaga,p i` 'f ititln,diepfaktohlp, qer$t lro'.f ansportatron r 15odhygienic.practices; C N/0 �N! A Hot holding greater than or equal to 140°F. (whole beef/pork roasis 130 F.) A ❑No eating ❑ No smoking while working B Cold holding less than or equal to45°F. 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 ;S;ar7,[t[zabonrrinse{hotG�►aker=..,c kMI G.,NLO NIA 2 0 1 A Appmvedsanitizer avail ableladequate concentration of sanitize r 4 [ Adequate fpci[itiea to maintain produi�cta s 4 Y C rh!!0 'NIA i 2 B Food-contact surfaces and utensils used for potentially ] y i tg p�rature ihermgrr5e ens proved ed % I w s ° hazardous food sanitized at least every 4 hours t_ .......:... F+.:.:..d�;+e�` •._ _.....s....... .._.. ........,� v. i i r t �, A Food thermometer available and accurate C Adequate ❑dishwashersanitizer final rinse Temp B Proper food thermometer for product D Proper sanitizin rocedure C Thermometers appropriately placed in cooler units E Sanitizing between raw animal origin&ready-to-eat food Pill;. :�• ¢ �_ 124, .Crle„ail rtpingac10 hs , . u i., 4 INI03 blIA3 7,; od protected during stg.r},agepreparation�}p ,Ile: I tsplay,service and trap'pb t ti; .a A Cloths and/or sponges in good repair and clean '' B Wiping cloths kept in sanitizer between uses 'Q Produce washed o B Raw meals not stored/prepared near ready-to-eat foodssF Fcati dontactfsu rfac ° ISs n '° "' i NIA 2 C Food covered properly A Food equipmentclean,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 o pooling of eggs not cooked immediately 0 old containers stored off the floor 3�;Hot and coldawafer'underrPressure,provicfd as`tegluEr� I 1I/� l2 0/ 138, Handwashing accesrsoriesrpiovtded: x W. i N10 N1A 1 . 9 .E: lntflrnofi>tO1t��RlfrEitlliZfs a a. 5: ._ . ..: +r, i �. C 'N10 NIA 2 A Soap I paper towels/drying device available A No unnecessary handling RTEand/or cooked foods with bare hands B Dispensers)working: ❑Soap El Paper towel B Minimize food handling,other than ready-to-eat,with bare hands C Handwash sinks)clean/waste receptacle at handwash sink C Adequate utensil(s)for dispensing food/ice p 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: OR 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 illness are you required to report to the local health department? Roasts Other Describe re-heating procedures: Is there a written illness policy th requires the food worker to report specific illness conditions Are temperatures recorded/logged for cold holding foodslequipm t? Y N and diseases to the QFO? Y *Do you have a paid sick leave policy? Y N Are foods cooked in advance and cooled? Y N eftovers saved? Y N Is there a language barrier tween inspector&QFO? Y N If yes indicate language spoken List products cooled: by QFOIDA: *Can the QFO/DA read the inspection report? Y N Describe cooling methods: Z Indicate who answer d the above questions: Name(print): the monitoring of wolfing recorded? Y N .ndicate the title of above per J�(circle all that apply):QFO DA Mgr Cook Owner FW Is cooling monitored for time&temp? Y N Obtain signatu f the eirf who received th 0 res ons_ibililies information at the time of the Is there a produce washing policy? Y N ♦Describe what is washed and inspection: where: Note: This r9pdPda two page form(total of 62 debitable items) Page 1 of 2 � oPc`on�nr cTlcu�r � pr TM r To�pu��.i �` a�EAs_T a 1acAPiT©LAVENUF MS#SlP P IHA r�o k PiOC1i5EDOD jSERVI+ E INSPECTION REPORT . t�A Y�1rDEP .5v A©DRESSICIM. Establishmierit: �'� r 4;1=7-101ate of,Inspection. Owner or.Operafo�: L�:c ADDITIONAL FOUR POINT ITEMS KEY: DNC [DOES NOT COMPLY] . ,cad 6 Foods not re-served. 4 31 Sewage disposal approved. -Unwrapped foods not re-served -Operating as required 4 -Potentially hazardous foods not re-served 34 No cross connections,back siphonage,backflow 11 Toxic chemicals. 4' 4 Proper typelinstallation/backflow prevention device/air gap for: -Stored properly,labeled properly,used properly -Food equipment -Hose connections -Dish machines -San itizerconcentration notto exceed maximum permitted -Soda system carbonator -Beverage dispensers -Toilet tanks -No unnecessary toxics on the premises -Chemical dispensers -Ice machines -PesticidesJrodenticides 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 Sourcesoffood: Original container,properly labeled 0 Garbage/rubbish storage arealrooms,enclosures properly constructed,clean 5 Potentially hazardous food properly thawed 2 1 Garbagelrubbish disposed of in an approved manner,at approved frequency h ;' 10 Food dispensing utensils properly stored 7', 2 vermin Control: No insectsirodents present 2•) 14 Food worker:Clean outer clothes,effective hair restraints 1= 3 Outeropenings protected againslentranceofinsects/rodents 4 Floors: Floorcovering installed,constructed as required,good repair,clean 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, 47 Mats removable,good repair,clean lied,located 1$ . 8 Exterior walking,driving surfaces,good repair,clean Si gle service articles,storage,dispensing 9 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 I maintained installed located 50 Dustless cleaning methods used,cleaning equipment properly stored Equipment&Utensils• Cleanliness 1 51 Adequate lighting provided as required 1 21 Preflushed,scraped,soaked and racked 52 Room free of steam,smoke odors "1 22 Wash waterclean,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 55 Establishment and premises free of litter,no insect/rodent harborage, 28 Equipment/utensils,storage,handling no unnecessary articles 32 Proper disposal of waste water 56 Complete separation from living/sleeping quarters and laundry a� 33 Plumbing location,installation,maintenance 1 57 Clean/soiled linens stored properly 1 581 No live birds,turtles,or other animals(except guide dogs) 1 36 Toilet rooms enclosed with self closing door I 59 Seats 75 or more:Nonsmoking area provided,sign(s)posted at 77 37 Proper toilet fixtures provided,good repair,clean en#rance(s),smoking area indicated by sign(s) 3" 39 Approved garbage/rubbish containers,adequate number,covered, 1` rodent proof,clean outine Inspection ❑Reinspection ❑ Preoperational Inspection CT R: PERSON IN MRGE: 0 er Inspection: Demerit Score: *Include demerits from page 1 i 4 3 2 1 Total Rating signature ,�jgr� re Z print name print name �- 7 DATE CORRECTIONS DUE: Z p onon—der title = ) Page 2 of 2 plus continuation pages Focused Inspectlo ,zouz Page of �,a�v Emp: EAR'IVR INSPECTION REPORT STATE OF CONNECTICUT BAR FU NS ORANGE FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH ���"" " ua�E, ,wiuxaw►Eao�xwHw CONTINUATION SHEET «160°F»>-c. NAME OF ESTABLISHMENT TOWN DATE OF INSPECTION �/4®&� l ' INSPECTION FORM# REMARKS e Pia 4 � r v J _ w- i � l INITIAL(INSPECTOR) INITIAL(PERSON IN CHARGE) istribution: Ist-White-Health Department 2nd-Yellow-Owner/Manager