HomeMy WebLinkAboutFood Service Establishment Inspection 17 (36) C/�_,Wft
Establishment:�zye4 S f ,a �i Inspection Date: r Time:� R [ns E[nsp
Address/City: r3 �/�dit��9 .�7� Health ept: i t Class: 1 2
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 NIO NIA JDNC I KEY: C[complies] NIO[not observed] N/A[not applicable]
'60. Quattfted Faod Operators g DNC[does not comply] 0[other] RTE[ready-to-eat)
12 Personnel with infection restricted ,:N10 NIA 34
61 Destgnateti Alternate 2 A Food workers have no exposed infected lesions 1 burns
62 Written documentation of training program 4 B personnel with infection restricted
1 Aproyetl.source,.wholesome,nonatjulterated N10 NIA 4
r C Communicable disease of worker reported to local health director
A Approved shellfish,5nfish,meat&poultry USDA approved 13. gand*slling;fac lifies provided;handswash�„clean ;G• N10 NIA 14
8 Food cans in good condition(not dented,rusty,bloated,leaking) A Handwash facilities in all food prop/dispensing& waiiih sh areas
C Wholesomelnonadulteratedfoodslsafe B Handwash facilities in or immediately adjacent to toilet rooms
D Commercial products(no home grown/canned food) C Handwash facilities access!blelconvenlent to use
E Potentially hazardousfoods received at proper temperature D Personnel hands washed,clean I Proper handwash procedure
0 E Handwashing at appropriate times
3 Potentra11 hazardous food meets;temperature;requiremeliCs ;C 10' N1A 4`;. 0
durld�,s orage,,go, ration,display service and transportafI n
x d ahygte cpr� C Nf0 :N!A 2
ni cti;ces`•:
A Hot holding greater than or equal to 140°F. ( ole ee ork roast a2 F.) A ❑ No eating ❑No smoking while`working
B Cold holding less than or equal to 45e F. B Wounds covered adequately
C Proper cooling C Proper sink used for handwashing
D Proper re-heating 0
E Proper internal cooking/consumer advisory posted 100 ;24 •Samtizatiorrrriiis (httrater+-chemical) �C 'N1.0.`N1A2
0 A Approvedsanitizerevailableladequateoonoentmtionofsanifizer
4 quate facilitiesote marntin�p fgdpet f <,x. K CI10 iNIA r:2 g Food-contact surfaces and utensils used for potentially
t 1 �temeattre, rmotnes prove r p ` ' k N hazardous food sanitized at least every 4 hours
A Food thermometer available and accurate C Adequate ❑dishwashersanitizer' ❑final rinse temp
D Proer sanitizing
B Proper food thermometer for product
procedure
E Sanitizing between raw animal origin&ready-lo-eatfood
C Thermometers appropriately placed in cooler units 0
0
�.„r 25 CrlatOn wiping}clpths 4 : I,O tN10,WA 1
7 �Fptid=protected urrngtstbYa e, preparation, ° � IC N10,lN1A 2:
_.
display,service and transportation ," r 4 • A Clolhsandlorspongesin good repairandclean
A Produce washed B Wiping cloths kept in sanitizer between uses
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B Raw meats not storedlpreparetl near ready-to-eatfoods a6 ,F Or ood-ct�rts'il`itxfacenr
C Food covered properly ;• as
A Food equipment clean,utensils clean,equipment interiors clean
D Adequate splash guards Isneeze 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
Food containers stored off lhefloor '360 ;Rikani cold waterunderpres§ure4'kQlded as.requtred it lKVA 2.
�- .. •:.:�;s:;;'^k$-'3 ,*, .� .- .. x . :. vh .. a, .. rw t:; ,,; i5 �7:.Yin t`'}
0 i38'tfattdlw si tr g a,,cetlisories provided ',C 1VI0 .141A 1
9 Hntl n' of food`minimiaedw 2
. ....,...�).'g,� q Soap!paper towels 1 drying device available
A No unnecessary handling RTE and/or cooked foods with be re hands B SoDisap paper
❑soap ❑Paper towel
B 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)for dispensing foodlice 0
Ole—
o •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]
PHFs are hot held at: F. 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
j Describe re-heating procedures: Is there a written illness policy that requires 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 saved? Y N Is there a language barrier between inspector&QFO? Y N Iflf ves 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 far time&temp? Y Nis the monitoring of cooling recorded? Y N Indicate the title of above person(circle all that apply):QFO A Mgr Cook Owner FW
•Obtain signature of the a'on who received a QFO respon ibilities information t the time of the
ris there a produce washing policy? Y N ♦Describe what is washed and inspection:here: Note: This report is a wo age form[ t of 6 ebtta le items} Page t of 2
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i41,H1LTH dEVT,� lf+zr7�. r ADDRESSICITY
Establishment::ci�' . �, i/Q` � � / Date of Inspection:
�. .
Oddress:
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
11 Toxic chemicals, No cross connections,back siphonage,backflow 4
4� Proper typelinstallationl backflow prevention device/air gap for:
-Stored properly,labeled properly,used properly -Food equipment -Hose connections -Dish machines
-Sanitizerconcentration not to 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 1 well head protected from contamination 35 Toilet facilities. Adequate,convenient,accessible, 4.
-Water quality in compliance
-Monitoring incompliance designed,properly installed
OTHER ITEMS z '
o, KEY: DNC [DOES NOT COMPLY] �
c�.
2 Sources of food: Original container,properly labeled 1 0 Garbage/rubbish storage area/rooms,end osures-propedywnstructed,clean 1:
5 Potentially hazardous food properly thawed 2 41 Garbage/rubbish disposed of in an approved manner,at approved frequency i
10 Food dispensing utensils property stored 1 42 Vermin Control: No insects/rodents present :2`
14 Food worker:Clean outer clothes,effective hair restraints 1 43 Outeropentngs protected against entrance of insectslrodents
4 Floors: Floor covering installed,constructed as required,good repair,clean 1
16 Food-contact surfaces designed,constructed,maintained,installed, ;.2 5 Floors graded,drained as required
located
6 Floor,wall juncture covered
17 Nonfood-contactsurfacesdesigned,constructed,maintained, 1 7 Mats removable,good repair,clean
installed,located
Exterior walking,driving surfaces,good repair,clean :1
18 Single service articles,storage,dispensing 2;.
19 No reuse of single service article 9 41alls,ceilings attached,equipment properly constructed,good f'2
air,clean.Wall&ceiling surfaces as required
20 Dishwashing facilities approved design,adequately constructed, 2;
maintained installed located 5 -D stless 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 1
22 Washwalerclean,proper temperature 53 Rooms&equipment hoods,ducts,vented as required
23 Accurate thermometers provided,dish basket,if used 54 Rooms adequate,clean,adequate lockers provided,facilities clean t 3
27 Nonfood-contact surfaces of utensils&equipment clean
55 Establishment and premisesfreeoflitter,notnsectlrodentharborage, 1
28 Equtpmentlutensils,storage,handling 1" no unnecessary articles
32 Proper disposal of waste water 1- 56 Complete sepa ration fro m livinglsleeping quarters and laundry 1T
57 Clean/soiled linensstored properly
33 Plumbing location,installation,maintenance 1
581 No live birds,turtles,or other animals(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
37 Proper toilet Wures provided,good repair,clean entrance(s),smoking area indicated by sign(s) 3
39 Approved garbage/rubbish containers,adequate number,covered, 1
rodent proof,clean Routine Inspection ❑Reinspection ❑ Preoperational Inspection
Other Inspection:
TOR: PERSON IN G�9RCE: Demerit Score: *Include demerits from page 1
4 3 2 1 Total Rating
re Np
n �1re
print name nt n i
DATE CORRECTIONS DUE:
one number tItILK
Page 2 of 2 plus continuation pages Focused Inspection 1/2002
Paged of
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INSPECTION REPORT STATE OF CONNECTICUT
FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH
CONTINUATION SHEET
NAME OF ESTABLISHMENT TOWN DATE OF INSPECTION
Sf-ffav?,� Gv�
INSPECTION REMARKS
FORM#
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INITIAL(INSPECTOR) INITIAL(PERSON IN CH GE}
Distribution: Ist-White-Health Department 2nd-Yellow-Owner/M )r