HomeMy WebLinkAboutFood Service Establishment Inspection 96 (10) -7 1
Establishment: , / r U Inspection Date: Time: p. dins REins
ddresslCity:_p S- UL.�I/1„4 �� Health Dept: Lei 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 N!0 NIA JDNC I KEY: C[complies] N10[not observed] NIA[not applicable]
60r tauallfled Food Opetator 3 DNC[does not comply] 0[other] RTE[ready-to-eat]
"gna ;. 12 Personnel with infection restr[cfed`; C �N10 1NIA
61 Desited ternate 2 Al :
A Food workers have no exposed infected lesions 1 burns
62 Writton,d
ocurnerritation of training program ' 2
B Personnel with infection restricted
1 1pproved Source,wholesome;nonadul#ei'atetl C.fd10-NIA 4 C Communicable disease of worker reported to local health director
A Approved shellfish,finfish,meat&poultry USDA approved A 6dwashingifacilities proyided,,:handswashed;clean CFNIA '4
B Food cans in good condition(not dented,rusty,bloated,leaking) A Handwash faal yes in all food prep/dispensing&warewash areas
C Wholesomelnonadulteratedfoods/safe B Handwash cilities in or lately adjacent to toilet rooms
D Commercial products(no home grown/canned food) C Handw nvenient to use
E Potentially hazardous foods received at proper temperature p PersofnedEdf Wshed,clean andwash procedure
E Handwashing at app --
;3. 1Potelttla1l[yy'liazardops:tfood meets#empe�ature requirements - `C' N/0 N1A :4 0
dbrina 4,1 .4ge.,preparation,display,serviceland transpottatl'on
is Good':hygienicpractices N. C :N10 NIA, 2
A Hot holding greater than or equal to 140°F.,(whole beefrpwkroasrs 1300 F.) A m No eating ❑No smoking while working
B Cold holding less than or equal to45°F. B Wounds covered adequately k
C Proper cooling C Proper sink used for handwashing
D Proper re-heating 0
E Proper internal cooking consumer advisory posted 24 Sasn[ttiatlonihiet(hot water-cheniiica<<); MNfO
0 A Approved sanitizeravailable/adequateconcentrationofsanitizer
[ r .. C �N(0 iN1A :2. g Food-contact surfaces and utensils used for potentially
i e 5 a .r
r f=leperaure,thermometersr providrd. 1 " ' ' I
i 1 :.::� hazardous food sanitized at least every 4 hours
_.. .I. .x....,�'.�,x. a. .,ay ,r ik•K.a�tr"4.x 2,.. � ve.c h �r`'�, �.r:.
A Food thermometer available and accurate C Adequate ❑dishwashersanitizer ❑final rinse temp
B Proper food thermometerfor product � D Proper sanitizin rocedure '
E Sanitizing between raw animal origin&ready-to-eat food
C Thermometers appropriately placed in cooler units
0
5.Clean wrp yng clokts zC Nl `tNIA: 1 -
r E
ev. ed duri�n{g stb�a a :r a�-atlon, � =C kN%0 rN! 2
displh►,sQ�vr n A Cloths and/or sponges in good repair and clean
?r � ��#.�<dAtrarlspAfttat11011�:� �..�,.
A Produce washed B Wiping cloths kept in sanitizer between uses
a
6 Raw meats notstoredlpreparetl near ready-to-eat foods dC Vie. Foe cod ct'sur#�ces alearr� ,' iN!® tW7 2
C Food cover o erl _ .E 6�.
A Food equipment clean,utensils clean,equipment interiors clean ,
D A qu a splash guar sneeze guard B Single use gloves changed when soiled
E Nd`tma&a6ze4eFsTnnel C Food contactsurfacesclean
F No pooling of eggs not cooked immediately 0
8 Food containers stored off the floor y3D Hol and coltl watbr trtr p"re'ssure,:provtded as requne 0`'(VJA :2'�
as
0 sB.'W t! ashmg accessories provided _: ; ` C N!0
59t+ i I`n ri ofnfood minrltrrzed x:, C,(N/0'N!A Z W , .. . ...r.. .
A Soap!paper towels! drying device available
A No unnecessary handling RTE andlorcooked foods with bare hands B Dispensers)working: OSoap ❑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
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],FIB[foodborne]
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 who terringralure do you cook:
Poultry Ground Beef. Pork What diseases related to FB llinal you required to report to the local health department?
Roasts Other
Describe re-heating procedures: Is there a written illness policy Y
requires the food worker to report specific illness conditions
Are temperatures recorded/logged for cold holding foods/equi ant? Y N and diseases to the QFO? Y ♦Do you have a paid sick leave policy? Y N
Are foods cooked in advance and cooled? Y N ♦Ar leftovers saved Y N !s there a language barrier b� een inspector 8 QFO? Y N f es 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 coding monitored for time&temp? Y N Is the m nitodng of cooling recorded? Y N Indicate the title of above person(circle all that apply):QFO DA Mgr Cook Owner FW
Obtain signatu a of there n who 1ved the esponslbilitles 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 two page form(total of 62 debilable items) Page 1 of 2
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Establishment:= LL' -�5 Dafe of- nspectiom
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ddress QCo y !'I/sfry "„�4=�/ Owner or Opera#or: .1i4�1' f
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
74 11 Toxic chemicals. No cross connections,back siphonage,backflow .4
4 Primer type/installation/backflow prevention device)aE.Q forfor:
-Stored properly,labeled properly,used properly -Food equipment -Hose connections -Dish machines
-San itizer concentration notto 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. 4 -Food equipment -Dish machines -Ice machines
-Well lwell head protected from contamination 35 Toilet facilities. Adequate,convenient,accessible, .
-Water quality in compliance designed,properly installed
-Monitoring in compliance
OTHER ITEMS KEY: DNC [DOES NOT COMPLY]
2 Sourcesoffood: Original container,properly labeled 40 Garbagehubbish storage area/rooms,enclosures-properlyconstructed,clean
ltl
5 Potentially hazardous food properly thawed 41 Garbagelrubbish disposed of in an approved manner,at approved frequency
10 Food dispensing utensils properly stored 42 Vermin Control: No insectslrodents present r 2
14 Food worker:Clean outer clothes,effective hair restraints _1 ; 3 Outer openings protected against entrance of insects/rodents 1;
loors: Floorcovering installed,constructed as required od repai cle4
16 F d-contactsurfacesdesigned,constructed, maintained,installed,
5 Floors graded,drained as
required
located
__)floor,wall juncture covered
17 Nonfood-contact surfaces designed,constructed,maintained, I. Hats remcva 1 ,gooe" d repair,dean
installed,located
18 Single service articles,storage,dispensing �2
8 Exterior walking, i ig surfaces,good repair,clean
19 No reuse of single service article 9 Walls,ceilings attached,equipment properly constructed,good lx
repair,clean.Wall&ceiling surfaces as required
20 Dishwashing facilities approved design,adeq u ately co nstru cted,
maintained installed located 50 Dustless cleaning methods used,cleaning equipment property stored
Equipment&Utensils• Cleanliness 51 Adequate lighting provided as required 1
1"
1 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
23 Accurate thermometers provided,dish basket,if used 54 Rooms adequate,clean,adequate lockers provided,facilities clean 1
27 Nonfood-contact surfaces of utensils&equipment clean :
55 Establishment and premisesfreeof litter,noinsecthodentharborage, 1-
28 Equipmentlutensils,storage,handling .L no unnecessary articles
32 Proper disposal of waste water 1 56 Complete separation from livingisleeping 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) 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 fixtures 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 outine Inspection ❑Reinspection ❑ Preoperational Inspection
R., PERSON I CHARGE: Other Inspection;
Qemerit_Scm: *Include demerits from page 1
4 3 2 1 Total Rating
nature - sign ur
l rL g � C
Print name print name
DATE CORRECTIONS DUE:
phone number �jt
' ( ( Page 2 of 2 plus continuation pages Focused hq,dion f.,
Page 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
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INSSPECTION PEMARKS
FORM#
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INITIAL(INSPECTOR) INITIAL(PERSON IN CHARGE)
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Distribution: I st-White-Health Department 2nd-Yellow- Owner/Manager