HomeMy WebLinkAboutFood Service Establishment Inspection 57 (15) I[.W " , sTA�'�'t7�i la. �� � .`'k`,(�` S�D F`QOA �� E• I1�I;SP�CTIOIV�Iz }' ,"� A 1 ��` t!"rI'�1��,Ci � _
Establishment: iZs � �:,¢�� ,7�-Inspection Date: „�6 Time:/Cn5 oinsp Einsp
Address/City: ,' /j ,d t Chi' Z3L Health Dept: Z4 1J'7''Y% k- 26e�5~;- 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 NO,N1A DNC I KEY: C[complies] NIO[not observed] NIA[not applicable]
60 1 Qualified Food Operator 3
72 ; Personnel with.irafectioDNC[does not [n.r,estrrcterd
61 rDestgpatedAlternate 2 Food workers o s infected urns A F kers have exposed info d lesions I b
C [N1C) NIA, 4:
162 Wrl#ten documentation of fratn[ng program 2 B Personnel with infection restricted
1 °Approved.source,wholesome; di I' C :NlO NIA '4
i C Communicable disease of worker reported to local health director
A Approved shellfish,finfish,meat&poultry USDA approved V 413 HaridwasFiing;faciilit:ies provided,:handswashed,clean. C ;N10 NIA '4
B Food cans in good condition(not dented,rusty,bloated,leaking) A Handwash facilities in all food prep/dispensing&warewash areas
C Wholesome/nonadulteratedfoods/safe B Handwash facilities in or immediately adjacent to toilet rooms
D Commercial products(no home grownicanned food) C Handwash facilities accessible/convenient to use
E Potentially hazardous foods received at proper temperature D Personnel hands washed,clean I Proper handwash procedure .44
E Handwashing at appropriate times
a3 iPoterdially'fiaZA.dq'us'.. 6 m'ee3s"#emoeratur regili mer}ts C f+IIO NIA 1,4,; 0
r durlrlg,sto�age preparation displays service at transportation
r „ .. . : 115 :Good hYg,leni ,;pract[ces C NlO;`IWA 2
A Hot holding greater than or equal to 140eF. (whole beef/porkroasie 1300 F.) A ❑ No eating ❑ No smoking while working
B Cold holding lessihanorequaltoOF. B Wounds covered adequately
C Proper cooling C Proper sink used for handwashing
D Proper re-heating 0
Sa itizattort rinse.h; t wa
E roper internal cooking/consumer advisory posted t i ( Q. ,,er 3 cf)em cal} C EN10 !A 2
t �,
A rovedsanitizeravailableladequateconcentrationofsanitizer
i egtiate facihtlar ammarnta to'd6Ct * j*'= (�yr*j, Nj B Food-contact surfaces and utensils used for potentially
' '' ' ' a* * 4.A." " v . k: hazardous food sanitized at least every 4 hours
Y t �grat thermometers>pr9vId6d r x• t
r __...,�:.. eY..d.n L. d c--..y •n g..
A Food thermometer available and accurate C Adequate Ekishwashersanitizer ❑final rinse temp
L Proper sa itizinn procedure
B Proper food thermometer for product
E Sanitizing between raw animal origin&ready-to-eai food
C Thermometers appropriately placed in cooler units 0
0 45' :Clean wl to cloths
I Fbcproteeed*cu#„n tore;yptratior; w C N1O VNjA 2. A J
dislh , Fsr arlol#ions arE16 Cloths andlorsponges in good repairand clean
l k a ISat1 2. t , ;s k
" `na• "t 'ti •E.r�a s '..e ` t '` ` r B Wiping cloths kept in sanitizer between uses
A Produce washed Ar I 1 0
B Raw meats not stored/prepared near ready-to-eat foods !A 2:12tif'Fo�oc o.r t�G u�SceS Clsan .:t r � 03 r..
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 A�
E No unauthorized personnel AlC Food contact surfaces clean
F No pooling of eggs not cooked immediately lk 1 C
8 Food containers stored off the floor 3l1'yHot alto,l�ic�+it 11,ifn�er;pres�i�ft.prbvide8 a$regtiiretf'r i N!A M2,
y.k.
i 3B ;Handwashing alscessories provided r. N0. WA idi
a r x b:^S,At:ac c; n: , s.. :r. Y 'r.. .t r ,;:.:3•�: ,. ...:.
,4 Ha}teltrtg of food rninrmlzel , ` x t F C F NO VA ,.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 Cl 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 0
0 1 •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]
PHF.are hot held at: OF. PHFs are cold held at: F. 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 that r uires the food worker to report specific illness conditions
Are temperatures recorded/logged for cold holding foods/equipment? 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 *Are leftovers sav d? Y N Is there a language barrier be an inspector&QF0? Y N If yes indicate language spoken
List products cooled: by QFOIDA: I +Can the QFOIDA read the inspection report? Y N
Describe cooling methods: Indicate who ar�w ra�ie/� a above questions: Name(print):
Indicate the title of� dve perso circle all that apply):QFO DA Mgr Cook Owner FW
Is cooling monitored for time&temp? Y N Is the monitoring f cooling recorded? Y N .Obtain signature of th rs recetved the QFO responsibilities information at the time of the
Is there a produce washing policy? Y N *Describe wh is washed and inspection:
where: 1 1 Note: This report is a t o age form(total of 62 debilable items) Page 1 of 2
S1f►'I EOF CONNF`TICl1aT 13 PAI�TM �1T�.C}F-RUBLtC�1iEAlLTH 41Q.CAPIt, VE'NU'E' ,MS#S IFI]P HART ORf],CT 061 4
FOCi1SED FQQiD SERVICE INS+ECTI01 REPORTx.
L �Q ADDRESSICITY:
Establishment #s�f/fi19: . T�#Ll .f��acu7`- Date of Inspection:
VbO*nt+r or Operator r T
ADDITIONAL FOUR POINT ITEMS KEY: DNC [DOES NOT COMPLY]
01
6 Foods not re-served.
-Unwrapped foods not re-served 4 31 Sewage disposal approved. 4
-Potentially hazardous foods not re-served -Operating as required
11 Toxic chemicals. No cross connections,back siphonage,backflow :4:
4'„ Proper type/installation)backflow prevention device/air yap for:
-Stared 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
-Pesticitleslrotlenticides properly dispensed Proper drain for:
29 Water source adequate,safe, 4 -Food equipment -Dish machines -Ice machines
-Well Iwell head protected from contamination 35 Toilet facilities. Adequate,convenient,accessible, 4
-Water quality in compliance
-Monitoring incompliance designed,properly installed
I
OTHER ITEMS z
c KEY: DNC [DOES NOT COMPLY]
2 Sources of food:Original container,property labeled 1 0 Garbagelrubbish storage area/rooms,enclosures-properlyoonstructed,clean `
5 Potentially hazardous food properly thawed 2 1 Garbage/rubbish disposed of in an approved manner,atapproved frequency
10 Food dispensing utensils properly stored 1 2 Vermin Control: No insects/rodents present 2
14 Food worker:Clean outer clothes,effective hair restraints 1 3 Outeropenings protected against entrance ofinsects/rodents 1;
too : Floor covering installed,constructed as require good repair,clean
16 Food-contact surfaces designed,constructed,maintained,installed, 2.F45 Floors graded,drained as required . .,
sated
6 Floor,wall juncture covered
11 lY &food-contact surfaces designed,constructed, maintained, 47 Mats removable,good repair,clean
installed,located
8 Exterior walking,dnvingsurfaces,good repair,clean
18 Single service articles,storage,dispensing
19 No reuse of single service article Wal s i' attached,equipment pro Orly constructed,good !'
repai ean. iling-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 1 ` 51 Adequate lighting provided as required 1
21 Preflushed,scraped,soaked and racked 52 Room free of steam,smoke odors j
22 Wash water clean,proper temperature 53 Rooms&equipment hoods,ducts,vented as required
urate thermometers provided,dish basket,if used 54 Rooms adequate,clean,adequate lockers provided,facilities clean I'
27 No food-contact surfaces of utensils&equipment clean
55 Establishment and premises free of litter,noinsecflrodentharborage, 1
28 Equipmenllutensils,storage,handling no unnecessary articles
32 Properdisposal of waste water 1 56 Complete separationtom livingisleeping quarters and laundry 1
33 Plumbing location,installation,maintenance 1 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 Seals 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 jigoutine Inspection ❑Reinspection ❑ Preoperational Inspection
Other Inspection:
IN OR: PERSON IN CHARGE: Demerit Score: *Include demerits from page 1
4 3 2 1 Total Rating
signature signature
DL,4& Y3 0, ?
rint name print name
DATE CORRECTIONS DUE: 8 i G
phone numbers title
_ D �� �J e Page 2 of 2 plus continuation pages Focused Inspection 112002
Page of
INSPECTION REPORT STATE OF CONNECTICUT
FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH
CONTINUATION SHEET
NAME OF ESTABLISHMENT TOWN DATE OF INSPECTION
L.4SG414,4
INSPECTION REMARKS
FORM# `
C
r-
INITIAL(INSPECTOR) INITIAL(PERSON IN CHARGE)
Distribution: I st-White-Health Department 2nd-Yellow�-Owner/Manager
J 5, tiy111- c j/L—