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HomeMy WebLinkAboutFood Service Establishment Inspection 59 (5) Ilan Establishment: P&A Inspection Date: Time: b ,'Q R01nsp Ill Address/City: Healt ept: t� lass: f 2 Based on an inspel 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 JIDNC I KEY: C[complies] NIO[not observed] NIA[not applicable] 60 s QSalihhtl foo Operator g DNC[does not comply] 0[other] RTE[ready-to-eat] 2 12 Personnel with infe'ctionresEricted ' 61 Destgnated'Altemate' C NNIA!0 ' 4 A Food workers have no exposed infected lesions burns r 62 Written docttmentatlon of trailning prAgrtim 2 B Personnel with infection restricted 11 Approved source,wholesome;nonadufte ated C- NI0 NIA `4 C Communicable disease of worker reported to local health director A Approved shellfish,frnffsh meat&poultry USDA approved :13 'Flandwashl1ng,,4 chill pirovided, ha li nds washed;clean C NIO NIA'4B Food cans in good condition(not dented,rusty,bloated,leaking) A Handwash facilities in all food prepldisp nsing&warewash areas C Wholesomelnonadulteraiedfoodslsafe B Handwas ecilities in or immedi t adja t to toilet rooms " D Commercial products(no home grown/canned food) C Handwa h fac i accesslblel ve t use E Potentially hazardous foods received at proper temperature D Person el h d a d, / rop r acedure E Handw shi ap ropriate time 3 ;,Potentally hazardous food meets temperature retutrt>iezlts C WNIA t4': dryng-storage,prrtparation,dlsplay,s€niicle tend transportation - giertic plractices ' d G 'h Nho A Hat holding greater than or equal to 140°F. (wwe kd/pork masts 1300F.) ❑No eating ❑No smoking while working B Cold holding lessthanorequalto45°F. B Wounds covered adequately C Proper cooling C Proper sink used for handwashing D Proper re-heating E Proper internal cooking/consumer advisory posted ; S mt xatton"rlttset(hat water chetn cal)r `C. Ni.0 2 - ( A proved sanitizeravailableladequate concentration ofsanitizer i4? aAdscute farrf(it(es�ta{maintain,pdu rcot { ' Yp [�A 2y g Food contact surfaces and utensils used for potentially S,.1.< t t ¢ temperature,therrttiiSter pt�ou ;.,.,.:n: r ;• E hazardous food sanitized at least every 4 hours A Food thermometer available and accurate C Adequate�dishwashersanitizer ❑final rinse iemp B Proper food thermometerfor product -L PM sanitizing procedure E Sanitizing between raw animal origin&ready-to-eat food C Thermometers appropriately placed in cooler units 0 O me.m„y a x a x vt m 1, 1 25 s Cteanawrping+ClothS ' w' 771 Food protected dorm store e,ep sparatill I ,. p g g c Nro ]NA z - display,service and Iran pro tib °* ' "' A Cloths and/or sponges in good repair and clean A Produce washed B Wiping cloths kept in sanitizer between uses 0 B Raw meats not stored/prepared near ready-to-eat foods ,od +snt�act s�t`ilill 9"�c�aFill C Food covered properly Food equipmentclean,utensils clean,equipment interiors clean D Adequate splash guards 1 sneeze guard B Single use gloves changed when soiled E No unauthorized personnel r7, 00d--contact surfaces clean F No pooling of eggs not cooked immediately -0 8 Food containers stored off the floor $0'Hof slid cold water under pressure,Qrovrded as required 8"ll ;H Ini 4 hang accessarriil rovtded. : IC-NlO WA I andlingoivf "mirnmized" :NIO 1. ` 'e 2 A Soap!paper towels 1 drying device available A No unnecessary handling RTE and/or cooked foods with bare hands B Dispenser(s)working: ❑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 utensils)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],FB[foodborne] PHFs are hot held at: IF. Pl 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 the quires the food worker to report specific illness conditions Are temperatures recordedllogged for cold holding foods/equipment? 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 *Are left ers saved? Y N Is there a language Barrie etween inspector&QFO? Y N If ves indicate language spoken List products cooled: by QFOIDA: *Can the QFOIDA read the inspection report? Y N O Describe cooling methods: Indicate who ans md-th bove questions: ame(print]: Indicate the titl of abov Ro ircle all that apply):QF Mgr Cook Owner FW Is cooling monitored for time&temp? Y N Is the nitoring of cooling recorded? Y N .Obtain signat e t tfi-e pers rt i 0 respo s' Iltiss:formation 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 0iii4 ttable items) Page 1 of 2 1 .3 ,utebOInCtil.g,u perator� . � • ADDITIONAL FOUR POINT ITEMS KEY: DNC [DOES NOT COMPLY] 6 Foods not re-served. - �4€ 31 Sewage disposal approved. -Unwrapped foods not re-served , -Operating as required4. -Potentially hazardous foods not re-served 74 No cross connections,back siphonage,backflow 11 Toxic chemicals. ,e -Stored properly,labeled properly,used properly 4 Proper type/installation/__backftoAprewntion Je cel air gap for; -Senitizer concentration notto exceed maximum permitted -Food equipment -Hose connections -Dish machines -No unnecessary toxics on the premises -Soda system carbonator -Beverage dispensers -Toilet tanks 14 -Pesticideslrodenticides properly dispensed -Chemical dispensers -Ice machines_ Proper drain for; gt -Food equipment -Dish machines -Ice machines 29 Water source adequate,safe. -Well 1 well head protected from contamination 35 Toilet facilities. Adequate,convenient,accessible, `�4 -Water quality in compliance -Monitoring in compliance designed,properly installed - OTHER ITEMS KEY; DNC [DOES NOT COMPLY] 2 Sources of food:Original container,properly labeled 40 Garbage/rubbish storage area/rooms,enclosures-properly constructed,clean j 5 Potentially hazardous food properly thawed 4 41 Garbagelrubbish disposed of in an approved manner,at approved frequency 10 Food dispensing utensils properly stored 42 Vermin Control: No insectslrodents present t 14 Food worker:Clean outer clothes,effective hair restraints i 43 Outeropenings protected against entrance of insects/rodents &1 i 44 Floors: Floor covering installed,constructed as required,good repair,clean 16 Food-contact surfaces designed,constructed,maintained,installed, '° � - 5 Floors graded,drained as required � cated r ' 6 Floor,wall juncture covered 17 onfood-contact surfaces designed,constructed,maintained, ) 7 Mats removable,good repair,clean installed,located 48 Exterior walking,driving surfaces,good repair,clean 18 Single service articles,storage,dispensing 2�: JAU 19 No reuse of single service article 49 Walls,ceilings attached,equipment properly constructed,good repair,clean.Wall&ceiling surfaces as required 20 Dishwashing facilities approved design,adequately constructed, maintained,installed located 50 Dustless cleaning methods used,cleaning equipment properly stored i "" Equipment&Utensils: Cleanliness1', 51 Adequate lighting provided as required 21 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 K 21 curate thermometers provided,dish basket,if used 5 54 Rooms adequate,clean,adequate lockers provided,facilitiesclean112-71 ;g Nonfood-contact surfaces of utensils&equipment clean F", 55 Establishment and premises free of litter,noinsecflrodentharborage, 28 Equipmentlutensils,storage,handling i� no unnecessary articles 9Po er disposal of waste water 6 Complete separation from living/sleeping quarters and laundry t 33 Plumbing location,installation,maintenance ; 57 Clean/soiled linens stored properly 58 Nolivebirds,turtles,or other animals(except guide dogs) 36 Toilet rooms enclosed with self-closing door O 59 Seats 75 or more:Nonsmoking area provided,sign(s)posted at 3 37 Proper toilet fixtures provided,good repair,clean entrance(s),smoking area indicated by sign(s) W .� 39 Approved garbageirubbish containers,adequate number,covered, l4 rodent proof,clean j Routine Inspection ❑Reinspection ❑ Preoperational Inspection Other Inspection: ININ Pam: E: Demerit Score: *include demerits from page 1 C 4 3 2 1 Total Rating signature signature._ print name print name �In/)—�a� -• S%�� DATE CORRECTIONS fDUEE: phone number title r Page 2 of 2 plus continuation pages Focused Inspection 1/2002 UL Page of INSPECTION REPORT STATE OF CONNECTICUT FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH CONTINUATION SHEET NAME OF ESTABLISHMENT TOWN DATE OF INSPECTION L� 3 (1 !3 INSPECTION REMARKS FORM# ©a/Ic e 12 s a j INITIAL(INSPECTOR) IN IAL(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 TO DATE OF IN ECTI "P"�J7 v �3 INSPECTION REMARKS FORM# je- I , � N v4�V� •� W INITIAL(INSPECTOR) INITIAL(PERSON IN CHARGE) Distribution: 1st-White-Health Department 2nd-Yellow-Owner/Manager