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HomeMy WebLinkAboutFood Service Establishment Inspection 46 (15) � Q r� � Wto �f% /.��i•�� st Establishment: AZ5 ca nspection Date: Time j/.'/ AOInO REinsp Address/City: ,CCU Health Dept. ) lass: 11 2 3 11 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 WA JDNC I KEY: C[complies] NIO[not observed] N/A[not applicable] 60+ Q ahfetl Fopd,6peWor e 3 DNC[does not comply] O[other] RTE[ready-to-eat] 92 Personnel with infedtion rest�lcted ? 51 DesignatedA#ternate 2 C Nl0 i+UAi14: A Food workers have no exposed infected lesions!burns 62' 4 UI(ritten documentation of training program 2 B Personnel with infection restricted 1 `EApproved source,wholesome;;nonadulferated C .NIO IV1A 4 C Communicable disease of worker reported to local health director yc. .. A Approved shellfish,finfish,meat&pout# USDA approved 13 ;,Handwashing faciiit'ies,p*ided, haridswashed,clean C l NIA' 4 B Food cans in good condition(not dented,rusty,bloated,leaking) A Handwash facilities in all food prep/dispensing&warewash areas C Wholesomelnonadulteratedfoods/safe B Handwash facilities in or Imme iately adjacent to toilet rooms D Commercial products(no home grown/canned food) OC C Handwash facilities acc lconvenie t to use E Potentially hazardous foods received at proper temperature BC D Personnel hands washed,cl an!P r handwash procedure 0 E Handwashing at appropria i es r3 ]ffidpefitipatly�iaiaidousfood-meets te>fip'lure requirements= C N10- NIA: 4 0 �duritrg storage,preparation,dlsptay%s$rvrce and transportation E , ,s Good:h ien'ic ractices'., A Hot holding greater than or equal to 140°F. (whole beef/pork roasts 1300F:) k A ❑ No eating ❑No smoking while working B Cold holding less than or equal to WE B Wounds covered adequately C Proper cooling Ao, C Proper sink used for handwashing D Proper re-heating Ae 0 E Proper internal cooking/consumer advisory posted 141�Sanitiizatton;rnser(hdtwater ;chemical}+ C rN10 NIA 2 0 - A Approved sanitizeravailable/adequate concentration ofsanitizer ks 4 �Adegrtaft facifities'to maintaln oroduict �,;; ' 'C iNIO 2 g Food-contact surfaces and utensils used for potentially ter►�perattire,thermometers pipvrci�0& w }> * _ * .r r* r hazardous food sanitized at least every 4 hours A Food therm oineterava1 lab Ia and accurate C Adequate kdishwashersanitizer ❑final rinse temp D Proper sanitizing procedure B Proper food thermometer for product E Sanitizing between raw animal origin&ready-to-eat food C Thermometers appropriately placed in cooler units 0 he 0 . +, . w x:.r $ Glesin d�{iQi °" i#1i8� .:.r C (:l' ( Food pro#ectedrJrtbFstorage,prepare"tlatf� s•N 0 IVI. 2 display,.service acid t ai spo`�t gn��i,�a iQ i �iwxt� a, " A Cloths and/orspongesin good repairandclear A Produce washed B Wiping cloths kept in sanitizer between uses 0 B Raw meats not stored/prepared near ready-to-ealfoods 151 14ow4##n"tar�faoeeslen 'E N10 ;fly 2 C Food covered properly X _ "` fi: ,. A Food equipment clean,utensils clean,equipment interior-clean D Adequate splash guards/sneeze guard DC g 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 the floor / QA 2nder pressure, . 0 , r, i38 aFlandwashing aftebsories provided _�,r art�iling;of foo)[!r ildimized A Soap!papertawelsl drying device available No unnecessa andling RT and/orcee ed ods with bare hands B Dispenser(s)working: ❑Soap ❑Paper towel B Minimize food hen Ing,o er an ready to-eat,with bare hands C Handwash sink(s)clean/waste receptacle at handwash sink C Adequate utensils)ford ispensing foodlice 0 01 •DESCRIBE DEFICIENCIES ON CONTINUATION SHEETS The following information is not debitable and does not affect your score. KEY: QFO[quail food operator],DA[designated altemate],PHF[potentially hazardous food],FB[foodborne] PHFs are hot held at: IF. 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 illness policy that re 'es the food worker to report specific illness conditions Are temperatures rewrdedllogged for cold holding foodslequlpment? 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 le fto rs saved Y N Is there a language barrier be en inspector&QFO? Y N If yes 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 above person(circle all that apply):QFO DA Mgr Cook Owner FW Is cooling monitored for time&temp? Y N Is the mo oring of cooling recorded? Y N •Obtain si nature oft ' r F� p e',Q� o i e� r olasibilities information at the time of the Is there a produce washing policy? Y N ♦Describe what is washed and inspection: a �`/ where: Note: This report is a two page form (total of 62 debitable items) Page f of 2 a nrEr/ © 71 40150016 N. v , �"��'���0�►Inr�� �p�e�at0r� ADDITIONAL FOUR POINT ITEMS KEY: DNC [DOES NOT COMPLY] 6 Foods not re-served. f . 31 Sewage disposal approved. -Unwrapped foods not re-served -Operating as required 4g -Potentially hazardous foods not re-served ` 74 No cross connections,back siphonage,backflow 11 Toxic chemicals. kfl , 4° Proper ypelinstallationl bacow,prevention device/air gap for: -Stored properly,labeled properly,used properly = -Food equipment -Hose connections -Dish machines -Sanitizer concentration not to exceed maximum permitted -Na unnecessary toxics on the premises k -Soda system carbonator -Beverage dispensers -Toilet tanks 41 -Pesticideslrodenticides properly dispensed 41 -Chemical dispensers -Ice machines Proper drain for: -Food equipment -Dish machines -Ice machines 29 Water source adequate,safe. w -Well I well head protected from contamination x' 351 Toilet facilities. Adequate,convenient,accessible, -Water quality in compliance 4 -Monitoring in compliance designed,properly installed OTHER ITEMS KEY: DNC [DOES NOT COMPLY] 2 Sources of food: Original container,properly labeled 40 rbagelrubbish storage arealrooms,enclosures-proper) constructed,clean ' 5 entially hazardous food properly thawed 1 Garbage/rubbish disposed of in an approved manner,at approve r cy Fa I © d dispensing utensils properly stored 42-!fie In Control: 11 msectslr'ents presentMM) Food worker:Clean outer clothes,effective hair restraints 43 Outer openings protected against entrance of insects/rodents ' I'° oors:Floor covering installed,constructed as required,good rep r;clean`4 16 Food-oontact surfaces designed,constructed,maintained,installed, 2, 5 Floors graded,drained as required located _ �- 6 Floor,wall juncture covered 17 Nonfood-contactsurfacesdesigned,constructed, maintained, 7 Mats removable,good repair,clean installed,located 48 Exterior walking,driving surfaces,good repair,clean t i? 18 Single service articles,storage,dispensing 19 No reuse of single service article 4 alls,ceilings attached,equipment properly constructed,good 1, repair,clean.Wall&ceiling surfaces as required 20 Dishwashing facilities approved design,adequately constructed, installed located 50 Dustless cleaning methods used,cleaning equipment properly stored maintained Equipment&Utensils: Cleanliness 51 Adequate lighting provided as required #1 21 Preflushed,scraped,soaked and racked 52 Room free of steam,smoke odors 22 Wash water clean,proper temperature ! 53 Rooms&equipment hoods,ducts,vented as required w It. : 23 Accurate thermometers provided,dish basket,if used 54 Rooms adequate,clean,adequate lockers provided,facilitiesclean �1 27 Nonfood contact surfaces of utensils&equipment clean 1` 55 Establishment and premises free of litter,no insectlrodent harborage, 28 Equipmentlutensils,storage,handling no unnecessary articles j 32 Proper disposal of waste water 56 Complete separation from livinglsleeping quarters and laundry 4 57 Clean/soiled linens stored properly. 33 Plumbing location,installation,maintenance 1 58 No live birds,turtles,or other animals(exceptguide dogs) Lail 36 Toilet rooms enclosed with self-closing door , j�"' 59 Seats 75 or more:Nonsmoking area provided,sign(s)posted at A 37 Proper toilet Mures provided,good repair,clean a entrance(s),smoking area indicated by sign(s) t a 39 Approved garbagelrubbish containers,adequate number,covered, rodent proof,clean i outine Inspection E3Reinspection D Preoperational Inspection PERSON IN CHARGE: Sher Inspection: Demerit Score: *Include demerits from page 9 4 3 2 1 Total: Rating %ignature signature �,a r G/y . �f name print nam DATE CORRECTIONS DUE: phone number title Page 2 of 2 plus 72K continuation pages Feeusea Inspection 111202 Page—Z of INSPECTION REPORT STATE OF CONNECTICUT FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH CONTINUATION SHEET NAME OF ESTABLISHMENT TOWN DATE OF INSPECTION r Gvr i 0 INSPECTION REMARKS FORM# � l jr 0 � 8 INITIAL(INSPECTOR) INITIAL(PERSON IN CHARGE) , Distribution: 1st-White-Health Department 2nd-Yellow-Owner/Manager Page of INSPECTION REPORT STATE OF CONNECTICUT FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH CONTINUATION SHEET NAME OF ESTABLISHMENT TOWN DATE OF INSP CTION INSPECTION REMARKS FORM# VIC a:Z�L r i INITIAL(INSPECTOR) INITIAL(PERSON IN CHARGE) , Distribution: 1st-White-Health Department 2nd-Yellow-Owner/Manager