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HomeMy WebLinkAboutFood Service Establishment Inspection 17 (34) II �S��i � )) �YOU'� ;tFQCUSEDr F04 O0D11 ® t Establishment: Inspection Date: Time: R tnsp Einsp Address/City: IS— ill/�,,u6 7—,O"cl �00!4b Nealt Dept: Class: 1 z 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 N1O NIA DNC I KEY: C[complies] NIO[not observed] NIA[not applicable] $0 4tlalified Food D Operator 3 NC[does not comply] 0[other] RTE[ready-to-eat] Ago S1 Designated Alternate:: 11 2 �12. PursgnneI with infection restricted. C=;WIN!A `4. 62 i Wr[tten docum y A Food workers have no exposed infected lesions/burns entation of training program B Personnel with infection restricted 1 Approved source,wholesome,nonadulterated C; NIO NIA 1.4 mmunicable disease of worker reported to local health director A Approved shellfish,finfish,meal&poultry USDA approved aridwrashing facilities provided, handswashio dean:: C :NIO: 4 B Food cans in good condition{not dented,rusty,bloated,leaking) A Handwash facilities in all food prep/dispensing&warewash areas C Wholesomelnonadulteratedfoodslsafe B Handwash facilities in or immediately adjacent to toilet rooms D Commercial products(no home grown/canned food) C Handwash facilities accessiblelconvenie E Potentially hazardous foods received at proper temperature s/ D Personnel hands washed,cis Proper handwash proce „ , an washing at appropriate ;P tentialiy dune 9shazardous"f�qo'�meets temperature requirements t re bon dhi la sevihds n C>y WO Nl ,4 p p oo'd hygienic practices (J10"'C A Hot holding greater than or equal to 140 F. (whole beefrporkroasls 1300F.) ❑ No eating ❑No smoking while working B Cold holding less than or equal to 45o F. B Wounds covered adequately C Proper cooling C Proper sink used for handwashing D Proper re-heating °;E Properinternal cooking/consumer advisory posted 24ionxtrinsw C 'N10r•otw = 0 A rovedsanitizer x. leladequateconcentrationofsanitizer )4 Adequate faciutfes toYmaint$ir fro luct C ,wo !NIA g Food-c nta u aces and utensils used for potentially `,i � .. r hazardous food sanitized at least every 4 hours k teirnperature;thegmomekopters provided ; = a s ik A Food thermometer available and accurate C Adequate Ddishwashersanitizer ❑final rinse temp JX D Proper sanitizin procedure B Properfood thermometerfor product E Sanitizing between raw animal origin&ready-to-eat food C Thermometers appropriately placed in cooler units 0 t 2s X can wiping#cloths x H x <' tCtINIO: t7 FFgod prdtecedxduring strvag�, p *;anon, p ;C 'Nr0 N)A 12 r y a dis l yyfservict a r k " `� I x Cloths and/or sponges in good repair and clean a� .....�.. ,fz .._� anspo?rtaon r,� r w x f , A Produce washed B Wiping cloths kept in sanitizer between uses B Raw meats not stored/prepared near ready-to-eat foods 6 tOtl cantact+su ifaces*cle'an C Food covered properly ip Food equipment clean,utensilsc n,e mentinteriorscl9: D Adequate splash guards l sneeze guard B Single use gloves changed who 'le 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 30a"Hot and cold water under,,pressure provi�e)1;a4 required i NIA"2 13#9 `,liandwashingaccessoriesp,iroir[t(eit t r 4 iC " VA �7 tin ohfbo�d rri rI11Y11Z@Ci w x, !•t � I`� ' 9' "� `"' ' '"' ` T �� A Soap l paper towels I drying device available A unnecessary handling RTE and/or cooked foods with bare hands11", B Dispenser(s)working: ❑Soap ❑Paper towel Minimize food handling,other than ready-to-eat,with bare hands C Handwash sink(s)clean/waste receptacle at handwash sink C Adequate utensil(s)fordispensing foodlice 70 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[foodbornel PHFs are hot held at: OF, 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 re you required to report to the local health department? Roasts Other Describe re-heating procedures: Is there a written illness poll at requires the food worker to report specific illness conditions Are temperatures recorded/logged for cold holding foodslequipmenl? Y N and diseases to the QFO? N *Do you have a paid sick leave policy? Y N Are foods cooked in advance and cooled? Y N *Are leftovers sav ? Y N Is there a language bar rJ r between inspector&QFO? Y If yes indicate language spoken List products cooled: by QFOIDA: *Can the QFOIDA read the inspection report? Y N Describe cooling methods: Indicate who answered the above questions:Name(print): Is cooling monitored for time&temp? Y N Is the monitoring of foling recorded? Y N .ndicate the title of above person(circle all that apply):CFO DA Mgr Cook Owner FW Obtain signatLya of thip person who receive t e QFO responsibilities information at the time of the Is there a produce washing policy? Y N *Describe what is ashed and inspection: where: Note: This report is a two page form(total of 62 debitabl i(ems) Page I of 2 CdNN�GT IGh1T I�RPAR I� NT OF Pl~lBLIC MEA TH �10 CA PI (tEL AVENUE MS#51 FDP-HARTFORD,CT 06134 FipCJIISEi�FO,OD skli'' i jIC , P�2F� wM G t t.rH WEPT, + C: ,/A.X0 SS ctT Establishment". Date vf InsOction: ddri: EW ,Owner or Qperafor lJ f ADDITIONAL POUR POINT ITEMS act KEY: DNC [DOES NOT COMPLY] 6 Foods not re served. `4 31 Sewage disposal approved. nwrapped foods not re-served 4. tentialiy hazardous foods not re-served -Operating as required -P I 1 T is chemic No cross connections,back siphonage,backflow 4; 4 Proper type/installation acklowpreveniian device/air gap for; -Stored prop labeled properly,used properly -Food equipment -Hose connections -Dish machines -Sanitizer 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 pamper 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 qualify in compliance designed,properly installed -Monitoring in compliance OTHER ITEMS KEY: DNC [DOES NOT COMPLY] (�2 ouroes offood: Original container,properly labeled 1 0 Garbage/rubbish storage area/rooms,enclosures-properlyconslructed,clean 1 5 Potentially hazardous food properly thawed 111 1 Garbage/rubbish disposed of in an approved manner,at approved 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 iater openings protected againstentranceofinsects/rodents 1 ours: Floor covering installed,constructed as requirq ,g r6d j 16 Food-contact surfaces designed,constructed,maintained,installed, 'Al", Floors graded,drained as required located 6 Floor,walliuncture covered 17 Nonfood-contactsurfacesdesigned,constructed, maintained, 1, 7 Mats removable,good repair,clean installed,located Singleservicearticles,storage,dispensing 2 8 Exterior walking,driving surfaces,good repair,clean 18 rl 19 No reuse of single service article 9 Walls,ceilings attached,equipment properly constructed,good 1 air,clean.Wall&ceiling surfaces as required 0 Dshwashingfacilities approved design,adequately constructed, 2:.. maintained installed located 50 b tless cleaning methods used,cleaning equipment properly stored t Equipment&Utensils: Cleanliness 1% Adequate lighting provided as required r' 21 Preflushed,scraped,soaked and racked 52 Room free of steam,smoke odors 22 Washwaterclean,proper temperature 53 Rooms&equipment hoods,ducts,vented as required 23Accurate thermometers provided,dish basket,if used Rooms adequate,clean,adequate lockers provided,facilities clean 1 food-contact surfaces of utensils&equipment clean `." 5 Establishment and premisesfreeof lifter,no insect/rodent harborage,28- 1 q pmenf/utensils,stcrage,handling no unnecessary articles 32 Proper disposal of waste water 1 56 Complete separation from livinglsleeping quarters and laundry 33 Plumbing location,installation,maintenance Jr, 57 Clean/soiled linens stored properly 1 58 No live birds,turtles,or other animals(except guide dogs) 36 Toilet rooms enclosed with self-closing door 59 Seats 75or more:Nonsmoking area provided,sign(s)posted at t3 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 Woutine Inspection ©Reinspection ® Preoperational Inspection Other Inspection: IN5PE TOR: PERSON IN CHARGE: Demerit Score: *Include demerits from page 1 ` 4 3 2 1 Total Rating nature slgnature print name print name d ?� �� �4<r�l� � DATE CORRECTIONS DUE: phone number �L title �1�7 't)W Page 2 of 2 plus continuation pages Page / of INSPECTION REPORT STATE OF CONNECTICUT FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH CONTINUATION SHEET NAME OF ESTABLISHMENT TOWN DATE OF INSPE TION INSPECTION REMARKS FORM# e V,, �L d c r -12 4"Z 01 all INITIAL(INSPECTOR) INITIAL(PERSON IN CHARGE) Distribution: 1 st-White-Health partment 2nd-Yellow- Owner/Manager ` ) Pagef INSPECTION REPORT STATE OF CONNECTICUT FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH CONTINUATION SHEET NAME�O✓F ESTABLISHMENT TOWN DATE OF INSPECT ON Itt�A9 S--� INSPECTION FORM# REMARKS r A20Z2� 1-7 �, . r' I i 31 G del INITIAL(INSPECTOR) INITIAL(PERSON IN CHARGE) g Distribution: 1st-White-Health Department 2nd-Yellow- Owner/Manager