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HomeMy WebLinkAboutFood Service Establishment Inspection 40 (11) Establishment:l.3ave- 6,0_111__4 Inspection Date: Time: ,4.' ' Roi sp Einsp Address/City: 6 Healt ept: ass: 1 2 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. RISK FACTOR ITEMS:Listing is not inclusive of all possible debitable items C NIO NIA JDNC KEY: C[complies] NIO[not observed] N/A[not applicable] ' 1r�QUIIfedrFOoOprtor z � 3 DNC[does not comply) 0[other] RTE[ready-to-eat] 12 *Personnel With infeotio "erR �r to ." �� x C 61 Dslgn�afetl j4iternate s e 2 '" ' N�0]? NIA 44` 2 Wtitten,documentahon of training program r= x 2 A Food workers have no exposed infected lesions 1 burns B Personnel with infection restricted ✓ ,Appra'vgd.saurce,wholesome,-nonadutterated t `° t C /0 NJAg 4`,, „ . r ;, C Communicable disease of worker reported to local health director A Approved shellfish,finfish,meat&poulty USDA approved r13 'tHandti�shtng,fs��litles pr'ovlaed,khands5washed,cleans C NIOt N�A� 4u; B Food cans in good condition(not dented,rusty,bloated,leaking) A Handwash facilities in all food prepldispensing&warewash areas C Wholesomelnonadulterated foods/safe B Handwash facilities in or immediately adjacent to toilet rooms D Commercial products(no home grown/canned food) C Handwash facilities accessible/convenient to use E I Potentially hazardous foods received at proper temperature D Personnel hands washed,clean I Proper handwash procedure C E Handwashing at appropriate times 3 Po#entiaiiy iraiartlous(food;meefs tempeetature equirements Gz NIO N/A' 4 0 dup ig attorage,preparation,display,,sarvice a64'itrinsportation w 1`5 Good h e it:'' racti es W: � + � a k . 2*.; CNIQ� x'NA �. A Hot holding greater than or equal to 140°F. (whole beel pork roasts 130F.) A ❑No eating ❑ No smoking while working B Cold holding less than orequal to 45o F. B Wounds covered adequately C Proper cooling C Proper sink used for handwashing D Proper re-heating 0 E Proper internal cooking I consumer advisory posted b 24 �C* Nl@ NIA *2� 0 A Approvedsanitizeravailableladequateconcentration�ofsanit]zer�� .A equate facilities"toe,maintairr°product � `n ��.; 0 Food-contact surfaces and utensils used for potentially e�raure,1hermometers`provide - Q = hazardous food sanitized at least every 4 hours s_s;.-:ak .t_ i._.�,. s;:air rn .5.i-'Q-$ :.'qi i:d$U, .. A Footlthermometeravailabieandaccurate C Adequate ❑dishwashersanitizer t❑�rinse temp Proper B Properfood thermometerfor product D rocedure C Thermometers appropriately placed in cooler units E Sanitizing between raw animal origin&ready-to-eat food 0 � '251 Clean WI RnyIclo hii x Fo4Mpr'otected during storage,prelp at nn r =dilas, ri ce*and transportation _ .+.� a .� A Cloths and/or sponges in good repair and clean . _ m B Wi 'A cloths kept in sanitizer between uses A Produce washed B Raw meats not stored/prepared near ready-to-eat foods go- C Food covered properly Food equipment clean,utensils clean,equipment inferiors clean JV D Adequate splash guards(sneeze 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 ! 8 Food containers stored off the flo 13 Opt s100.0�d wat�"r;�nder lessu�e,� ovfded as re uire' - tJ NI4 s R� _ 1P p q 0 8 x anduvashhing�accessoriesfr�bVtd d; S Q� Il 9 1H`ndiing;of food,minim[zed �- CJ . 0"VIA_2, �� Soap I paper towels 1 drying device available �._�. _ A No unnecessary handling RTEand/orcooked foods with bare hands B Dispensers)working: ❑Soap ❑Paper towel B Minimize food handling,other than ready-to-eat,with bare hands C H n w sink(s)cleagJRraste receptacle at handwash sink .0 Adequate utensil(s)fordispensing food/ice 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],FB[foodborne] 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 B illness are you required to report to the local health department? Roasts Other Describe re-heating procedures: Is there a written ill ss policy that requires the food worker to report specific illness conditions Are temperatures recorded/logged for cold holding foods/equipme)l Y N and diseases to th QF0? Y N ♦ y u have a paid sick leave policy? Y N Are foods cooked in advance and cooled? Y N *Are le vers saved? Y N Is there a langu ge barrier between inspe or& FO? Y N if ves indicate language spoken List products cooled: by QF01DA: Ca the QFOIDA read the inspection report? Y N Describe cooling methods: Indicate who danswered the abov quest Name(print): Air Indicate the title of above person(cir;l t at a ly):QFO DA Mgr Cook Owner FW Is cooling monitored for time&temp? Y N Is the moni ring of cooling recorded? Y N .Obtain signatu e dre ed the responsibilities information at the time of the r1s there a produce washing policy? Y N ♦Describ what is washed and inspection: here: Note: This report is a two pag debitable items) Page 1 of 2 / a Date of-Inspectlon:+- ,��T ,k 06 V,�A -nits- ADDITIONAL FOUR POINT ITEMS KEY: DNC [DOES NOT COMPLY] 6 Foods not re-served. ' 4', 31 Sewage disposal approved. -Unwrapped foods not re-served ti.4 } -Operating as required -Potentially hazardous foods not re-served I 34 No cross connections,back siphonage,backflow p I 1 Toxic chemicals. 4 Proper type/installation/backflow prevention device/air gap for: -Stored properly,labeled properly,used properly -Food equipment -Hose connections -Dish machines Z -Sanitizer concentration notto exceed maximum permitted I;.,:; -Soda system carbonator -Beverage dispensers -Toilet tanks -No unnecessary toxics on the premises -Chemical dispensers -Ice machines -Pesticideslrodenticides properly dispensed " "b Proper drain foAl r: g , 29 Water source adequate,safe. 4 -Food equipment -Dish machines -Ice machines -Well/well head protected from contamination 35 Toilet facilities. Adequate,convenient,accessible, : -Water quality in compliance designed,properly installed -Monitoring in compliance , r, OTHER ITEMS KEY: DNC [DOES NOT COMPLY] 2 Sources of food: Original container,properly labeled 40 Garbage/rubbish storage arealrooms,enclosures-properlyconstrucfed,clean i 5 Potentially hazardous food properly thawed 41 Garbage/rubbish disposed of in an approved manner,at approved frequency 10 Food dispensing utensils properly stored a 2 Vermin Control: No insects/rodents present 2 14 Food worker:Clean outer clothes,effective hair restraints 43 Outeropenings protected against entrance of insectslrodents1 E. 4 Floors:Floor covering installed,constructed as required,good repair,clean :. 16 F od-contact surfaces designed,constructed,maintained,installed, ', 5 Floors graded,drained as required �Nited 6 Floor,wall juncture covered 7 o food-contactsurfaces designed,constructed, maintained, �1 7 Mats removable,good repair,clean nstalled,located VAR _7774 erior walking,driving surfaces,good repair,clean V 18 Single service articles,storage,dispensing _- 19 No reuse of single service article -4 4 W II attached,equipment properly constructed,good ' re ir,clean. II&ceiling surfaces as required VA 20 Dishwashing facilities approved design,adequately constructed, 2 1" maintained installed located ; 50 Dustless cleaning methods used,cleaning equipment properly stored i 51 Adequate lighting provided as required 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 uratethermometers provided,dish basket,if used 54 Rooms adequate,clean,adequate lockers provided,facilities clean 27 food-contact surfaces of utensils&equipment clean 55 Establishmentandpremises free ofIitter,noinsecllrodentharborage, 29 Equipment/utensils,storage,handling 1` no unnecessary articles 32 Proper disposal of waste water s 56 Complete separation from living/sleeping quarters and laundry f + 1 33 Plumbing location,installation,maintenance 57 Clean/soiled linens stored properly� w _ 58 No live birds,turtles,or other animals(except guide dogs) 36 Toilet rooms enclosed with self-closing door ; 59 Seats 75 or more:Nonsmoking area provided,sign(s)posted at 37 Proper toilet fixtures provided,good repair,clean entrances),smoking area indicated by sign(s) 39 Approved garbage/rubbish containers,adequate num er,co ered, [[ ' rodent proof,clean � outine Inspection DReinspection © Preoperational Inspection T R; ER I RG 0 her Inspection: Demerit Score: *Include demerits from page 1 4 3 2 1 Total Rating i nature sign re �11_jli!4 lo, Ee ri me r t naZ�j Ofi one number title DATE CORRECTIONS DUE: � 4 Page 2 of 2 plus continuation pages Focused InsPectlon II2002 --- Page ok�)_ INSPECTION REPORT STATE OF CONNECTICUT FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH CONTINUATION SHEET NAME OF ESTABLISHMENT TOWN DATE OF SP�EtCTIO ,-1 Z 4— INSPECTION FORM# REMARKS Ad .r l G INITIAL(INSPECTOR) INITIAL(PERSON IN CHARGE) Distribution: 1st-White-Health Department 2nd-Yellow-Owner/Manager Pagea .,,, INSPECTION REPORT STATE OF CONNECTICUT FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH CONTINUATION SHEET NAME OF ESTABLISHMENT TOWN DATE OF 1NSP CTION INSPECTION REMARKS FORM# L-0 W 19 INITIAL(INSPECTOR) INITIAL(PERSON IN CHARGE) Distribution: 1st-White-Health Department 2nd-Yellow-Owner/Manager