HomeMy WebLinkAboutFood Service Establishment Inspection 10 (32) Establishment: i6 /fig- Inspection Date: 5 jj 6 47w Time: 3 oinsp Einsu
Address/City: j04.1-2 A,q-y f,, S7— Health Dept: w Class: f 2 311
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 I DNC KEY: C[complies[ NIO[not observed] NIA[not applicable]
'60t�llfed Food Operator DNC[does not comply] 0[other] RTE[ready-to-eat]
r y: 3 I "Personnel with !nfectloa restricted AID
'
61 1Designated°Altern ate; 2 C O,NIA r4 -
A Food workers have no exposed infected lesions I burns
62 i Written documentallcn of training program 2 B
Personnel with infection restricted ,
1 Apprgvedotlrce,wf3clesome;nonadul(erated C N10 NIA '4 C Communicable disease of worker reported to local health director
A Approved shellfish,finfish,meat&poultry USDA approvedX 13;"Ffandwashtng facrhtre `,ovided...hands washed,clean ',C ,N10 NIA i4.
B Food cans in goad condition(not dented,rusty,bloated,leaking) A Handwash facilities in all food prep/dispensing& are wash areas
C Wholesomelnonadulterated foodsisafe
D Commercial products(no home grown/canned food) B Handwash f W , in or immedia j e t to toilet rooms
C Handwas flities accessible/ n e
E Potentially hazardous foods received at proper temperature D Personne s e , oper ha awash procedure
0 E andwa ng a a 4riate times
3 ,dot"entially hazardous foatd ib its temperature requirements C V1b NIA: 4 O
during**storage,preparation,display,service and ttansfiortat]ori
! ' 95 Go �fi'y enic practice l C.: Nl0 2
..o:t x
A Hot holding greater than or equal to 140°F. (,hole beef/pork roasts 1300 F.) ❑ No eating ❑ No smoking while working
B Cold holding less than or equal to 450F. B Wounds covered adequately
C Proper cooling C Proper sink used for handwashing
D Proper re-heating 0
E Proper internalcookinglconsumeradvisoryposted 24 .ySanitization rinser(Irdt'tjiraYer-;';ciie.nnica 1. C pNiQ A, "2
0 A Approved samtizeravalfableladequate concentration ofsanitizer
4A� rties to+maintainroduct 4, C Nl0 NIA ;` B Food-contact surfaces and utensils used for potentially
hazardous food sanitized at least eve 4 hours
r t.emper`ature,t errltometerst provided i n ! every
A Food thermometer available and accurate C Adequate ❑dishwashersanitizer 9final rinse temp
B Properfood thermometer for product D Propersantizing procedure
C Thermometers appropriately placed in ceolerunits
E Sanitizing between raw animal origin&ready-to-eat food 0 0
125Clean�"i�i `sclaths
,� � .. � 'axPD�i. r � < f. CiN10' NIAi�...
7 Food protected during sfbt?a�j ,p'Fepraoni % ICE N/O ,N/A 1`2-display, service and transportation A Cloths andlor-sponges in good repair and clean
" B Wiping cloths kept in sanitizer between uses
A Produce washed
0
B Raw meats not stored/prepared near ready-to-eat foods 12 t=�49�contadtssurfacescleia
C Food covered properly t. . i *. .< .:,�.� x r
A Food equipmentelean,utensils clean,equipment interiors clean
D Adequate splash guards l 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 03b I Hot and cold water under pressure,Prfwide t As�Ireq'U C iN10 NIA 2`
j M, rs a
r$ Handwashing accessories provided' 0 iT;
A.
aindlin of F d minimizstln w.a- .r �.`,v . •,.
4 ego s. .;,w,;, , ,,.xC NI0 ??, Soap/paper towels I drying device available
No unnecessary handling RTE and/or cooked foods with bare hands B Dispenser(s)working: ❑Soap ❑Papertowel
B Minimize food handling,other than ready-to-eat,with bare hands C I Handwash sink(s)clean/waste receptacle at handwash sink
C Adequate utensil(s)for dispensing foodlice 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]
Pli 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 re you required to report to the local health department?
Roasts Other
Describe re-heating procedures: Is there a written illness policy at requires the food worker to report specific illness conditions
Are temperatures recorded/logged for cold holding foodslequi ent? Y N and diseases to the QF0? Y N *Do you have a paid sick leave policy? Y N
Are foods cooked in advance and cooled? Y N ♦Ar leftovers saved? Y N Is there a language barite etween inspector&QFO? Y N If ves indicate language spoken
List products cooled: by QFOlDA: *Can the QFOIDA read the inspection report? Y N
i
I Describe cooling methods: Indicate who answ/�ed the above questions: Name(print):
Is cooling monitored for time&temp? Y N Is th monitoring of cooling recorded? Y N Indicate the title of above person(circle all that apply):QFO DA Mgr Cook Owner FIN
Obtain signature of th rs o received the QFO responsibilities information at the time of the
Is there a produce washing policy? Y N ♦ scribe what is washed and inspection:
where: Note: This repo is a two page form(total of 62 debitable items) Page 1 of 2
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AIDDESSICITY.
Establishment: -7�:�C�, 'r 1- A2�i�c y ate,of Inspection:
Ownerror Operator:, y'30w�, >-r
ADDITIONAL FOUR POINT ITEMS
KEY: DNC [DOES NOT COMPLY] �
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
No cross connections,back siphonage,backflow
11 Toxic chemicals. t Propertype/installation!backflow prevention device!air gap for: 4
-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
=,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 Sources of food: Original container,properly labeled 1A 0 Garbagelrubbishstoragearea/rooms,enclosures-properlyconstructed,dean
5 Potentially hazardous food properly thawed 2 41 Garbage/rubbish disposed of in an approved manner,at approved frequency
10 Food dispensing utensils properly stored 1 2 V r in Control: No insects/rodents present ;2
14 Food worker,Clean outer clothes,effective hair restraints 43 Outer openings protected against entrance of insectslrodents
4 Faools, Floor covering installed,constructed as required,good rep it clean- 1
16 Food-contact surfaces designed,constructed, maintained,installed,
5
Floors graded,drained as required
located
6 Floor,wall juncture covered
17 Nonfood-wntactsurfaces designed,constructed,maintained, 1 7 Mats 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 9 Walls,ceilings attached,equipment properly constructed,good 1`
repair,clean.Wall&ceiling surfaces as required
0 Dishwashing facilities approved design,adequately constructed, 2
maintained installed located 50 Dustless cleaning methods used,cleaning equipment properly stored 1"
1 51 Adequate lighting provided as required1"
21 Preflushed,scraped,soaked and racked
p 52 Room free of steam,smoke odors ,1:
22 Wash water clean,proper temperature 53 Rooms&equipment hoods,ducts,vented as required
curate thermometers provided,dish basket,if used 4 Rooms adequate,clean,adequate lockers provided,facilities clean 1
27 n# od-contact surfaces of utensils&equipment clean
5 Establishment and premisesfreeof litter,no insect/rodent harborage, 1
28 Equip ment/ulensils,storage,handling no unnecessary articles
32 Proper disposal of wastewater 1 561 Complete separation from livingisleeping quarters and laundry
33 Plumbing location,installation,maintenance 1 57 Clean/soiled linens stored properly
58 No live birds,turtles,orother animals(except guide dogs) 1
36 Toilet rooms enclosed with self-closing door 1 r
59 Seats 75 or more:Nonsmoking area provided,signs)posted at
37 Proper toilet fixtures provided,good repair,clean entrances,smoking area indicated b sign(s)
f1 9 Y 9 ( ) rn;=
39 Approved garbage/rubbish containers,adequate number,covered, 1 `-
rodent proof,clean outine Inspect•q ❑Reinspection Preoperational Inspection
t ther Inspection:
TOR: PERSON IN CHARGE: Demerit Score: •Include demerits from page 1
4 3 2 1 Total Rating
i nature sii lure
print name print name
R&2 CORRECTIONS DUE:
phone number title
��,jI Page 2 of 2 plus continuation pages Focused 3nyeeson 112002
Page_jof
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INSPECTION REPORT STATE OF CONNECTICUT
FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH
CONTINUATION SHEET
NAME OF ESTABLISHMENT TOWN DATE OF)SPECTIO
!mac fib} yr 077f Z,,,/
INSPECTION REMARKS
FORM#
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L `
INITIAL,(INSPECTOR) INITIAL(PERSON IN CHARGE)
Distribution: Ist-White-Health Department 2nd-Yellow- Owner/Manager