HomeMy WebLinkAboutFood Service Establishment Inspection 90 (4) a
Establishment: ' spection Date; --/ Time:/o:. R lnsp Einsp
Address/City: Health Dept: :�vL, ju�yv?SS�y�� class: f
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 WA JDNC I KEY: C[complies] NIO[not observed] NIA[not applicable]
60 }'Qual[fled Food Operator_. 3 DNC[does not comply] 0[other] RTE[ready-to-eat]
1 rP�rsQQnel wfthirfeationresfrrc�ed ::: C; NICE 1NlA:, 4
,61 'Designated Attertfate
62 t Written documentation of training program 2 A Food workers have no exposed infected lesions 1 burns
B Personnel with infection restricted
t �ppproved source,whotesome nonadulterated C NIO Nl I
r: C Communicable disease of worker reported to local health director
A Approved shellfish,flnfish meat&poultry USDA approved Handwa hlng foci 1t1t#s rovtc�ed=handswasFted,eteaa ,;C;EN10 N!A 4'r�.,:
B Food cans in good condition(not dented,rusty,bloated,leaking) �. ..
A Handwash facilities in all food prepldispensin &ware sh areas
C Whol esom eln onad u iterated foods/safe B Hand sh f ilities in or immedi tbl d" ce !toilet rooms
D Commercial products(no home grownlcanned food) C Hand sh facll'ties a s ible
E Potentially hazardous foods received at proper temperature D Pets nnei han s an Wiper-har dwash procedure
0 —1E Handwashing at approprial Imes
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A Hot holding greater than or equal to 144 F. (wholebeef/porkroasts 13Do F.) A 0 No eating ❑ No smoking while working
B Cold holding less than or equal to 450 F. B Wounds covered adequately
C Proper cooling C Proper sink used for handwashing
D Proper re-heating 0
E Proper internal cooking I consumer advisory posted 2, r�tfbz�a�ton rlt sa( water hesmrCal 174 C tlVlt �A 2
0 Approved sanitizer available/adequate concentration of sanitizer All
4 +equ e, i 1P o arhta n prodUoi •gyp Ihy2 B Food-contact surfaces and utensils used for potentially
r perptitr ,f�t:rtrl9ritetgr3`praWdet hazardous food sanitized at least every 4 hours
C Adequate ❑dishwashersanitizer ❑final rinse temp
ood thermometer available and accurate
D Proper sanitizing procedure
13 Proper food thermometer for product
E Sanitizing between raw animal origin&read y-to-e at food ¢�
C Thermometers appropriately placed incoolerunits 0
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A Cloths and/or sponges In good repair and clean
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B Wiping cloths kept in sanitizer between uses
A Produce washed IQ
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B Raw meats notstored/prepared near ready-to-eat foods
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C Food covered properly "
A Food equipmentclean,utensils clean,equipment interiors clean k,
D Adequate splash guards/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 (3!1 ;Hot and cold water Under pressure,provided as required 0`;N/A 2 �
0 3B tHandwashing`accessories provided. ,NIO NIA 1
A No unnecessary handling RTE and/or cooked foods with bare hands A Soap/paper towels 1 drying device available
B Dispenser(s)working: ❑Soap ❑Paper towel
B Minimize food handling,other than ready-to-eat,with bare hands k^ C Handwash sink(s)clean/waste receptacle at handwash sink
C Adequate utensil(s)for dispensing foodlice 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[foedborre]
PHFs are hot held at: IF. PHFs are cold held at: F. Describe illness conditi ns 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 rel d to FB illness are you required to report to the local health department?
Roasts Other
Describe re-heating procedures: Is there a wrist n illness policy that requires the food worker to report specific illness conditions
Are temperatures recordedllogged for cold holding foods/e ipment? 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 inspector&QFO? Y N Iflf vas 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 of abov erson(circle all that apply):QFO DA Mgr Cook Owner FW
Is cooling monitored for time&temp? Y N Is 1 e monitoring of cooling recorded? Y N .Obtain signature t e rs inwho received the QFO responsibilities information at the time of the
Is there a produce washing policy? Y N *,Describe what is washed and inspection.
where: / Note: This report is a o page form(total of 62 debitable items) Page 1 of 2
r O>�GQNN C IGIJTy I EPARTf NT OF P[UB I fiEALTF 410 CAPiTQL Ail UE mt3l;51 FDP HARTFORDr��f 3t4i
ADDRESS/CITY.. , , ,
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Establishment STD. '. •. pate of Inspection:; .� f
tddress 9aUL%.( .rr % ?� owner or Operator..
ADDITIONAL FOUR POINT ITEMS
KEY: DNC [DOES NOT COMPLY] c
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. 4`
4 Pro er ypelinstaLlatianl backfl w prevention device!air gap for:
-Stored properly,labeled properly,used properly -Food equipment -Hose connections -Dish machines
-Sanitizerconcentration no#to exceed maximum permitted -Soda system carbonator -Beverage dispensers -Toilettanks
-No unnecessary toxics on the premises -Chemical dispensers -Ice machines
-Pesticideslrodenticides properly dispensed Proper drain for:
-Food equipment -Dish machines -Ice machines
29 Water source adequate,safe. 4
-Well/wel!head protected from contamination 35Ldesnedi
ties. Adequate,convenient,accessible,-Waterquality in compliance-Monitoring in compliance roperly installed
OTHER ITEMS
KEY: DNC [DOES NOT COMPLY]
2 Sourcesoffood: Original container,properly labeled 0 Garbagelrubbishstoragearearooms,enclosures-property constructed,clean '
5 Potentially hazardous food properlythawed T 41 Garbagelrubbish disposed of in an approved manner,at approved frequency I;
10 Food dispensing utensils properly stored 1, 42 Vermin Control: No insectslrodents present =2:
14 Food worker:Clean outer clothes,effective hair restraints 43 Outeropenings protected againstentrance of insectsfrodents 1
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,wall juncture covered
17 Nonfood-contact surfaces designed,constructed,maintained, 1 47 Mats removable,good repair,clean
M stalled,located
service articles,storage,dispensing
8 Exterior walking,driving surfaces,good repair,clean
18 Singl 1.
19 No reuse of single service article 9 Walls,ceilings attached,equipment properly constructed,goad l:
repair,clean.Wall&ceiling surfaces as required
20 Dishwashing facilities approved design,adequately constructed, 2= a
maintained installed located 50 Dustless cleaning methods used,cleaning equipment properly stored
Equipment&Utensils• Cleanliness 1 51 Adequate lighting provided as required
21 Prefiushed,scraped,soaked and racked 52 Room free of steam,smoke odors ;1
22 Wash water clean,proper temperature 53 Rooms&equipment hoods,ducts,vented as required
23 a to thermometers provided,dish basket,if used 54 Rooms adequate,clean,adequate lockers provided,facilities clean 1
7 f od-contact surfaces of utensils&equipment clean I 55 Establishment and premises free of Her,no insectlrodent harborage, 1
28 Equipment/utensils,storage,handling 1 no unnecessary articles
32 Proper disposal of waste water 1 56 Complete separation from living/sleeping 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)
filet rooms enclosed with self-closing door 1
" 59 Seats 75or more:Nonsmoking area provided,sign(s)posted at 3,
37 Pr pe toiletfixture rov" ed,g�p,od repair,clean
'D �. entrance(s),smoking area indicated by sign(s)
39 Approved garbage/rubbish containers,adequate number,covered,
rodent proof,clean ,Pgoutine Inspection E3Reinspection E3 Preoperational Inspection
I PER N I CHARGE: Other Inspection;
5 Demerit Score: *Include demerits from page 1
- 4 3 2 1 Total Rating
signature signature
print name 'G print name
'phone hone number 'tilts a DATE CORRECTIONS DUE:11[ ✓ fit- L
(a�. Page 2 of 2 plus continuation pages Focused Inspedia 1/2002
Page of
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INSPECTION REPORT STATE OF CONNECTICUT
FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH
CONTINUATION SHEETt�
NAME OF ESTABLISHMENT TOWN DATE OF INSPECTION
INSPECTION REMARKS
FORM#
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INITIAL(INSPECTOR) INITIAL(PERSON IN CHARGE) I V
Distribution: lst-White-Health Department 2nd-Yellow-Owner/Manager