HomeMy WebLinkAboutFood Service Establishment Inspection 65 (14) Establishment: {zjs;F-,u 1�1 / ^S '� Gtw6'7 Inspection Date: Time: 4 / Roins Eins
Address/City: S7 Healt ept; , evsa.�7�So� class: 1 z 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 N10 NIA JDNC I KEY: C[complies] N/O[not observed] N/A[not applicable]
s ti 'W'k*4& DNC[does not comply] 0[other] RTE[ready-to-eat]
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Qtrlifled't:ood Operator 5 3 t '0;,NlA4
- 12 Per�sonn I t n e t astr f § u,
esnateAenate r 43
z A ffi Food workers have no exposed infected lesions 1 burns
62 sWrltten,d ,0 ntetEQn of trattiirt��t"�o f811t� ry 2 g personnel with infection restricted
1 =Apprgve�source,wholesome iSn ti a atetl rr 4 N70�N1 f,r4` C Communicable disease of worker reported to local health director
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A g Approved shellfish,iinfish,meat&poultryUSDA approved t13�_Mantlwashtn faQi toes pKotu)tedr€an�s.wa5hetl afea C i y Nl1
B Food cans in good condition(not dented,rusty,bloated,leaking) " " 9 h ` '� �';
A Handwash facilities'n all food prepldis nsing&werewash areas
C Wholesomelnonadu Iterated foodsisafe k B Handwash faell' es in or immed' y adjacent to toilet rooms
D Commercial products(no home grownkanned food) C Handwash f ilitie ces ib nvenie to use
E Potentially hazardous foods received at proper temperature D Personnel h nds a can was procedure
0 E Handwashing at appropri
of$nt ably I t t rtla0s#dodjmeets temperA re T n66t's C� N!0 sNIAi X,
+ a during storage,preparation,d sp ay,vsent+cerandatran§part�figri t ,� 0
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A Hot holding greater than or equal to 14 17. (whole beef/park roasts 130°F.) A ❑No eating ❑No smoking while working
B Cold holding less than or equal to45°F. B Wounds covered adequately
C Proper cooling I C Proper sink used for handwashing
D Proper re-heating 0
E Proper internal cooking l consumer advisory posted 24 a!nr Azq ibr4rtr�jee( i� =vohemlpalj *G
.: era
0 pprovedsanitizeravailabl deq econcentratienofAnitizer -
�10,r AAi/equate,facilities�to�maintatnai ��d t .� Nj( , �;;' g Food contact surfaces and u ensr s use or potentially
�fer� pYovti� c hazardous food sanitized at least every 4 hours
Pry, erm4m .. _ . .� *.4 ,r ;
A Food thermometer available and accurate C Adequate ❑dishwashersanitizer ❑final rinse temp
B Properfood thermometerfor product D Pro ersanitizinrocedure
IL E Sanitizing between raw animal origin&ready-to-eat food
C Thermometers appropriately placed in cooler units 0
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a aod4prgtected during stoea is tan , s In on es A Cloths and/or s cod repair and clean
7 s t sponges 9 P
*, R r e vtc�e a rfdfitran I ..#` .-iron e t
, 1 -.. 4 .z_ -- :� B Wiping cloths kept in sanitizer between uses
A Produce washed
0
8 Raw meals not stored/prepared near ready-to-eat foods 2 t cad-contacattsur
C Food covered properly A Food equipmentclean,utensils clean,equipment interiors clean
D Adequate splash guards!sneeze guard B Single use gloves changed when soiled
E No unauthorized personnel X C Food--contact surfaces clean
F Apooling of eggs not cooked immediately 0
F d containers stored off the floor '
k. �iUi�F�o'�aftc�cotwa,g�ttn �r[�rssit ,pr�vrd�tl a�requtradt r
0 3 �a s i ssdrieS pr ni e(1_ !A
9 £Handling of�food m[nimiz ,�" � A -ATP, v" "
� A Soap l paper towels l drying device available
A No unnecessary.handling RTE andlorcooked foods with bare hands B Dispenser(s)working: ❑Soap OPaper 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],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 ork What diseases related to FB iII s are you required to report to the local health department?
Roasts Other
Describe re-heating procedures: Is there a written illness go icy that requires the food worker to report specific illness conditions
Are temperatures recordedllogged for cold holding foodslequi ant? Y N and diseases to the QF ? Y N *Do you have a paid sick leave policy? Y N
Are foods cooked in advance and cooled? Y N ♦ leftovers saved? Y N Is there a langua barrier between inspector&QFO? Y N ivies indicate language spoken
List products cooled: by QF01DA: *Can the QF01DA read the inspection report? Y N
Describe cooling methods: Indicate w o answered the above questions:Name(print):
Indicate the title of above person(circle all that ):QFO DA Mgr Cook Owner FW
Is cooling monitored for time&temp? Y Ifthe monitoring of cooling recorded? Y N .Obtain signature of th he QFO responsibilities information at the time of the
Is there a produce washing policy? Y *Describe what is washed and inspection:
where: Note: This report is a wo page form(total of 62 debitable items) Page 1 of 2
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{ A '4 4-4l. E'K 4 V% Date of in t nr �f ,
'46 �; z, 4 W ner�or. erdtOr
ADDITIONAL FOUR .POINT ITEMS KEY: DNC [DOES NOT COMPLY]
6 Foods not re-served. 4 31 Sewage disposal approved.
-Unwrapped foods not re-served ,a
-Potentially hazardous foods not re-served .4t -Operating as required
R74 No cross connections, back siphonage,backflow
11 Toxic chemicals. 4' Proper type/installation/backfiow prevention device/air gap
-Stored properly,labeled properly,used properly -Food equipment -Hose connections -Dish machines
-Sanitizer concentration not to exceed maximum permitted *' -Soda system carbonator -Beverage dispensers -Toilet tanks
-No unnecessary toxics on the premises
-Pesticides/rodenticides properly dispensed -Chemical dispensers -Ice machines
.b
Proper drain for:
29 Water source adequate,safe. 4 -Food equipment -Dish machines -Ice machines
-Well/well head protected from contamination u
35 Toiletfacilities. Adequate,convenient,accessible, ..4r
-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 8 40 Garbagetrubbish storage arealrooms,enclosures-properly constructed,clean 1t.
5 Potential/ hazardous food properly thawed t 41 Garbage/rubbish a/rubbish disposed of in an approved manner,at approved frequency
Y P P Y �z� 9 p PP PP q Y
10 Food dispensing utensils properly stored 42 Vermin Control: No insects/rodents present
14 Food worker:Clean outer clothes,effective hair restraints 43 Outeropenings protected againstentranceofinsects/rodents i
4 Floors: Floorcovering installed,constructed as required,good repair,clean
16 Food-contact surfaces designed,constructed,maintained,installed, > 4 `
� 5 Floors graded,drained as required
located 14
6 Floor,wall juncture covered
17 Nonfood-contact surfaces designed,constructed,maintained,
7 Mats removable,good repair,clean
installed,located 1
48 Exterior walking,driving surfaces,good repair,clean
18 Single service articles,storage,dispensing
9 Walls,ceilings attached,equipment ro erE constructed,good
19 No reuse of single service article y gproperly Y g s
repair,clean.Wall&ceiling surfaces as required �
20 Dishwashing facilities approved design,adequately constructed, (2P
maintained installed located B 50 Dustless cleaning methods used,cleaning equipment properly stored 1,
Eauioment&Utensils: Cleanliness 51 Adequate lighting provided as required
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 `
2 -Accurate thermometers provided,dish basket,if used 641 �4 Rooms adequate,clean,adequate lockers provided,facilities clean i=1
27 food-contact surfaces of utensils&equipment clean
55 Establishment and premises free of litter,noinsectlrodentharborage,
27 Equipmentlutensils,storage,handling nl no unnecessary articles .:
.� ry
32 Proper disposal of wastewater 56 Complete separation from living/sleeping quarters and laundry
33 Plumbing location,installation,maintenance 1s 57 Cleanlsoiled linens stored properly
58 No live birds,turtles,orother animals(except guide dogs)
36 Toilet rooms enclosed with self-closing door i iw'
59 Seats 75 or more:Nonsmoking area provided,sign(s)posted at
37 Proper toiletfixtures provided,good repair,clean
entrance(s),smoking area indicated by sign(s) ;
39 Approved garbage/rubbish containers,adequate number,covered,
rodent proof,clean J21koutine Inspection OReinspection O Preoperational Inspection
R N IN CHARGE: Other Inspection:
Demerit Score: *Include demerits from page 1
(� 4 3 2 1 Total Rating
nature Lf� si lure r
ci t name _ print name
DATE CORRECTIONS DUE: r 4'�41
phone number title C
Page 2 of 2 plus continuation pages Focused Inspection 112002
Page of
INSPECTION REPORT STATE OF CONNECTICUT
FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH
CONTINUATION SHEET
NAME OF ESTABLISHMENT TOWN DATE OF INSPECTION
L ' S l -
INSPECTION REMARKS
FORM#
4 `
ey
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Y'
9
I - e-_irA_
INITIAL(INSPECTOR) INITIAL(PERSON IN CHARGE)
Distribution: 1st-White- ealth Department 2nd-Yellow-Owner/Manager