HomeMy WebLinkAboutFood Service Establishment Inspection 57 (16) OD"SERV)(C EU-10 T,REPO • b�. A F .
Establishment: 1�l�- ��zz Inspection Dat Time: Oinsp Eins
Address/City: 5, -s �3-6i4,y 7t-t re_4,o: 6L-e��7� _Health Dept: ,���Tl� r,.c,��,���.,.� class: 1 z 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.
CTOR ITEMS: Listing is not inclusive of all possible debitable items C N10 N/A DNC KEY: C[complies] NIO[not observed] NIA[not appNcable]
6 Quallfietl Food Operator 3 DNC[does not comply] 0[other] RTE[ready-to-eat]
esignatedAlfemate ' P.er;mnne!with Infection restricted C ►�jp NIA: 4
lip q Food workers have no exposed infected lesions!burns
ylNritten doeumentatt rogram11 2 B Personnel with infection restricted
Approved source,wh0Lesome.-riori ulterated C';N10 NIA ;A.. C Communicable disease of worker reported to local health director
A I Approved shellfish,finfrsh,meal&poultry USDA approved 13 ',Flandwashrn factllbes rovtded,handswasheit,'clean C ;NIO •N/A" 4
B Food cans in good condition(not dented,rusty,bloated,leaking) K 9` F
A Handwash facilities in all food prepldispensing&warewash areas
C Wholesomelnonadultera#ed foods/safe K B Handwash facilities in or immediately adjacent to toilet rooms
D Commercial products(no home grown/canned food) C Handwash facilities access iNelconvenlent to use
E Potentially hazardous foods received at proper temperature D Personnel hands washed,clean I Proper handwash procedure
E Handwashing at appropriate times
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3 Pa4entlally hazardous food meets"Keinpettdre'te•uiretnexts C l0�NIA•;4
during storage4 prep�ra#idn�dlspla!tentice and,transportation
,x ..
l95; ..0idd:hyglenic prarctices
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A Hot holding greater than or equal to 1400F. (whole beetrpork roasts 13&F.) y� A I M 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
241106tatlonrrE Proper internal cooking lconsumer advisory posted ' ' ;pC.i EN1Q; Nlq.2
0 A Approved sanitizeravailableladequateconoentrationofsenitizer
4 Atlgc( A e;1gc(i ties;to meilntalnQpcoduct* .n„ * " `I NjA;;:2: B Food-contact surfaces and utensils used for potentially
" ` hazardous food sanitized at least eve 4 hours
41 f
temperatutre;tlid o�rrte rdtivled,� =r w ; w * every
._ y ... § P .x a �... r;� s
A Foodthermometer available and accurate C Adequate Odishwashersanitizer ❑final rinse temp
L Proper sanitizing procedure
B Proper food thermometer for product
E Sanitizing between rawanimal origin&ready-to-eat food
C Thermometers appropriately placed in cooler units
F . Y 5 ,Clean wtpmg�clothsY C ,NIOR N/A a1'
Cr 001701rotecliring storage,prepar�tin 2A Cloths and/or sponges in good repairand clean
day service and�t ansportati„a * 1�. ,£
B Wiping cloths kept in sanitizer between uses
A Produce washed
0
B Raw meats not stored/prepared near ready-to-eat foods 1
Y- 28 i Foodll aon aCfi urf 4��es [g r1� ; o- ,r+ ••c rF r ,C N10 �,A 171
C Food covered properly ..n .. x. .W_A,
A Food equipment clean,utensils clean,equipment interiors clean
D Adequate splash guards/sneeze guard
B Single use gloves changed when soiled
E No unauthorized personnel k,
AC Food--contact surfaces clean
F No pooling of eggs not cooked immediately 0
8 Food containers stored off the floor A30 i Motvandcald wafer ender pros§dire,proirided:�s„requIr (` !NI,O
::XY."t."t iA 4. 3'e�"re f: t, N• f' ["v :!'IA n ik.4
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9 t e ] ^ Hw .., .c..ra ded r
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_;+ Nl /AiAoig of t !N/.0"` A�•t ,!x;,A Soap paper towels l drying device available
A No unnecessary handling RTE and/or cooked foods with bare hands B
Dispenser(s)working: OSoap ❑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 foodlice 0
0 •DESCRIBE DEFICIENCIES ON CONTINUATION SHEETS
The following information is not debitable and does not affect your score. KEY: QFD[qualified food operator],DA[designated aitemate],PHF[potentially hazardous food],FB[foodbcrne]
PHFs are hot held at: F. 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 flingss policy that requires the food worker to report speciftc illness conditions
Are temperatures recorded/logged for cold holding foods quipment? Y N and diseases to the FO? Y N ♦Do you have a paid sick leave policy? Y N
Are foods cooked in advance and coaled? Y N Are leftovers saved? Y N Is there a Iangua6 barrier between inspector&QFO? Y N If vas indicate language spoken
List products cooled: by QFOIDA: *Can the QF01DA read the inspection report? Y N
Describe cooling methods: Indicate wh answered the above questions:Name(print):
Indicate the title of a g cle all that apply};QFO DA Mgr Cook Owner FW
Is cooling monitored for time&tamp? Y Is the monitoring of cooling recorded? Y N .Obtain signature of 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 rep is a two page form (total of 62 debitable items) Page 1 of 2
$TA Q GaNN C�lCUTv DEPART'MEN'-t FIR SIC.�H,EA 11 LTH-410CAPITOLAVENUE MS#51FDP-HA�2TI=0RD,CT0C134I
° _OCUSEbOOB.�SERVICE INSPECTION RPORF
LLALHEAL'TH`QEPt_ C _ _ ADDRESS(CITy: .
Establlshmettt //L�1. Date of Inspection:
ddlress =�` .T.n " ClL �3Lt ^_ Owner or Operator Vc�SS /
ADDITIONAL FOUR POINT ITEMS
ta: KEY: DNC [DOES NOT COMPLY]
6 Foods not re-served. s
4 31 Sewage disposal approved.
-Unwrapped foods not re served 4
-Potentially hazardous foods not re-served -Operating as required
No cross connections,back siphonage,backflow
11 Toxic chemicals. 4
4 Proper pelinstallationlbackflow prevention device/airgaofor;
-Stored properly,labeled properly,used properly -Food equipment -Hose connections -Dish machines
-Sanitizes concentration notto exceed maximum permitted -Soda system carbonator -Beverage dispensers -Toilet tanks
-No unnecessary toxics on the premises -Chemical dispensers -Ice machines
-Pesticideslrodenticides properly dispensed Proper drain for:
29 Water source adequate,safe. 4 -Food equipment -Dish machines -Ice machines
-Well/well head protected from contamination 35 Toilet facilities. Adequate,convenient,accessible, 4
-Water quality in compliance
-Monitoring in compliance designed,properly installed
OTHER ITEMS o; KEY: DNC DOES NOT COMPLY
2 Sources of food:Original container,properiylabeled I` 0 Garbage/ubbishstorage area/rooms,enclosures-property constructed,clean 1
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` 42 Vermin Control: No insects/rodents present 2,
14 Food worker:Clean outer clothes,effective hair restraints 1> 3 Outer openings protected aga inst entrance of insectslrodents
4 Floors:Floorcovering installed,constructed as required,good repair,clean 4
16 Food-contactsurfaces 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
installed,located I
18 Single service articles,storage,dispensing 2
481 Exterior walking,driving surfaces,good repair,clean
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 `.
Equipment&Utensils: Cleanliness 1 51 Adequate lighting provided as required 4
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21 Preflushed,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
231 Accurate thermometers provided,dish basket,if used 154 Rooms adequate,clean,adequate lockers provided,facilities clean 1
7 Nonfood-contact surfaces of utensils&equipment clean 1
55 Establishment and premises freeof litter,no insect/rodent harborage, '1
28 Equipmentlutensils,storage,handling 1 no unnecessary articles
32 Proper disposal of wastewater I 56 Complete separation from livinglsleeping quarters and laundry 1
33 Plumbing location,installation,maintenance 1 57 Clean/soiled linens stored properly I
58 No live birds,turtles,orotheranimals(except guide dogs) 1
36 Toilet rooms enclosed with self-closing door 1
59 Seats 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 garbagelrubbish containers,adequate number,covered, 1
rodent proof,clean outine Inspection ❑Reinspection ❑ Preoperational Inspection
C
INSPECTO PERSON IN qHARGE- er Inspection:
Demerit Score: *Include demerits from page 1
4 3 2 1 Total Rating
ignature _ s' ur
pri >n me prin a
DATE CORRECT ONS DUE: i t
one number L tlt
:]C)ZY Page 2 of 2 plus continuation pages "9 ea r�pe r;zouz
Page I of
INSPECTION REPORT STATE OF CONNECTICUT
FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH
CONTINUATION SHEET
NAME OF ESTABLISHMENT TOWN DATE OF INSPE TION
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loe d
INSPECTION REMARKS
FORM#
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INITIAL(INSPECTOR) INIT GE)
Distribution: 1st-White-Health Department 2nd-Yellow- Owner/Manager
Page j of l
INSPECTION REPORT STATE OF CONNECTICUT
FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH
CONTINUATION SHEET
NAME OF ESTABLISHMENT TOWN DATE OF INSPECTION
INSPECTION REMARKS
FORM#
Ali
0 J/
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1
INITIAL(INSPECTOR) INITIAL CHARGE)
Distribution: 1st-White-Health Depa 2nd-Yellow-,Owner/Manager