HomeMy WebLinkAboutFood Service Establishment Inspection 40 (12) /r
Establishment: re_rAt>,j inspection Date: Z16 Time://- Roinsp" E[nsp
Address/City: v Health ept: class: zia
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] NIA[not applicable]
rt _ r, DNC[does not comply] 0[other] RTE[ready-to-eat]
BOg Qplift�e�Fpod,Opefato_r g 3
Personnel vuitinfect�ion�restrieted
Ot a Designated Alternate r b _ a C ° 9°tq/A
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• 4 a i h A Food workers have no exposed infected lesions 1 burns
62 (Written documentation of trainingjpto�fam , � 2
B Personnel with infection restricted
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Approved source,wholesorge,'notlfabultdidwd d ,'` ' 1 C�N10 N/A ,�4 C Communicable disease of worker reported to local health director
A Approved shellfish,frnfish,meat&poultry USDA approved M3, yandvyashing facitides provided,fiends washedrelean..;�C; V/A '
B Food cans in good condition(not dented,rusty,bloated,leaking) A Handwash facilities in all food prep/dispensing&warewash areas
C Wholesome/nonadulterated foods/safe
B Handwash facilities in or immediately adjacent to toilet rooms
D Commercial products(no home grown/canned food)
C Handwash facilities accessibfelconvenient to use
E Potentially hazardous foods received at proper temperature D Personnel hands washed,clean I Proper handwash procedure
0 E Handwashing at appropriate times
,P,otentially`J azardous food meets temperaturearequfremeri s C NI/Oa f�UA 14 p
during 5storage,preparation display,seivfce'abd�transportation
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15 Goodl hygienic practices .0 YVO !{ 2
g 9 q ( A ❑ No eat
A Hot holdin reater than or a dal to 140°F. whole roasts 130°F.i ing ❑No smoking while working
B Cold holding less than or equal to 45°F. IL B Wounds covered adequately
C Proper cooling C Proper sink used for handwashing
D Proper re-healing C
E Proper Iconsumeradviso posted 43. itizntton rinse`{hpt�water ichemtcat)�e eC °NO �N j;i
p 9 advisory p pr; A, 4x
0 Approved sanitizer available/adequate concentration of sanitizer
Ade date facrht'e$to,ma!ntaihpiyo�ii� ,� ;C ll,0 �11A f;2 g Food-contact surfaces and utensils used for potentially
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#te nperaturejthermo rniaters pk*vlk16d1'v'4,� i x hazardous food sanitized at least every 4 hours
A Foadthermometeravailableandaccurate C Adequate ❑dishwashersanitizer ❑final rinse temp
D Proper sanitizing procedure
B Properfood thermometer for product k
E Sanitizing between raw animal origin&ready-to-eat food
C Thermometers approprlately placed in cooler units
p 0
25 DCJeata ilpa�9 clgtfis <.tr R nC 41.0' N/V Rr;
i 1v s+&m4.w �•„Y.B- x ,S::S. u,9 .S,4c :>.;e..s. ;6i J .°.tt.
�Yoteced ifurtngtorage,p�iir, ,C 8/`N� -W , A Cloths and/orsponges in ood repair and clean
t t is.'playy�service=and trarisportatibonm g P
kal,i' -TIV rV''� � ° `q O * � Y, �X,# ,'° B Wiping cloths kept in sanitizer between uses
A Produce washed 0
B Raw meats not stored/prepared near ready-to-eat foods 1F'oodab6ntact1surfa6es�61
C Food covered properly A Food equipment clean,utensils clean,equipment interiors clean
D Adequate splash guards/sneeze guard , B Single use gloves changed when soiled
E No unauthorized personnel C Food--contact surfaces clean Ae
F No pooling of eggs not cooked immediately 0
8 Food containers stored off the floor 30 4Hot and cold water under pfessure;provided as&ire` d x NSA 2w
C 3r8;
9x ,Wandling of food i i . . . _ Has es prove d A NQNfA1ide
MIze( �Ca WQ NA 2
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A No unnecessary handling RTE and/or cooked foods with bare hands A Soap paper towels 1 drying device available
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 utensil(s)for dispensing food/ice 0 ta
0. •DESCRIBE DEFICIENCIES ON CONTINUATION SHEETS
The fallowing information is not debitable and does not affect your score. KEY: QFO[qualified food operator],DA[designated alternate],PHF[potentally 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 requi a food worker to report specific illness conditions
Are temperatures recorded/logged for cold holding foods/equipment, 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 ers saved? Y N Is there a language band iweon inspector&QFO? Y N If yes 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):
Indicate the title of bo person(circle all that apply):QFO DA Mgr Cook Owner FW
Is cooling monitored for time&temp? Y Is the monitoring of cooling recorded? Y N .Obtain signatu 'o t h received ltol,4 the QFO resp si il!ties information at the time of the
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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 debitable' Page t of 2
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Operator: - -
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ADDITIONAL FOUR POINT ITEMSHtn KEY: DNC [DOES NOT COMPLY] .
6 Foods not re-served.
-Unwrapped foods not re served 4; 31 Sewage disposal approved.
-Operating as required
-Potentially hazardous foods not re-served
No cross connections,back siphonage,backflow
11 Toxic chemicals. 14
4 Prppertypelinstallation/backflow prevention device/air gap for: ..
-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 F
-No unnecessary toxics on the premises -Chemical dispensers -ice machines
-Pesticideslrodenticides properly dispensed g Proper drain fQr:
29 Water source adequate,safe. >� -Food equipment -Dish machines -Ice machines
4
-Well/well head protected from contamination 35 Toiletfacilities. Adequate,convenient,accessible,
-Water quality in compliance .
-Monitoring incompliance designed,properly installed
OTHER ITEMS KEY: DNC [DOES NOT COMPLY]
2 Sources offaod:Original container,properly labeled r 40 Garbagelrubbish storage area/rooms,enclosures-propedyoonstructed,clean
5 Potentially hazardous food properly thawed P�2; 41 Garbage/rubbish disposed ofin an approved manner,at approved frequency t
10 Food dispensing utensils properly stored 1 42 Vermin Control: No insects/rodents present �2
14 Food worker:Clean outer clothes,effective hair restraints 43 Outeropenings protected against entrance ofinsectslradents ]
a 4 Floors: Floor covering installed,constructed as required,good repair,clean
16 Food-contact surfaces designed,constructed,maintained,installed, 5 Floors graded,drained as required a
located *
14
6 Floor,wall juncture covered ,
17 Nonfood-contact surfaces designed,constructed,maintained, 1 '
installed,located x
7 Mats removable,good repair,clean r< ,
8 Exterior walking,driving surfaces,good repair,clean ;
18 Single service articles,storage,dispensing
19 No reuse of single service article
49 Walls,ceilings attached,equipment properly constructed,good r
'�� s 1
repair,clean.Wall&ceiling surfaces as required N
20 Dishwashing facilities approved design,adequately constructed,
maintained,installed located 8'r 50 Dustless cleaning methods used,cleaning equipment properly stored
Equipment&Utensils: Cleanliness 51 Adequate lighting provided as required
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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
23 Accurate thermometers provided,dish basket,if used 54 Rooms adequate,clean,adequate lockers provided,facilities clean
27 Nonfood-contact surfaces of utensils&equipment clean 55 Establishment and premises free of litter,no insectlrodentharborage, �1'
28 Equipmentfutensils,storage,handling 1Z no unnecessary articles
32 Proper disposal ofwaste water 56 Complete separation from living/sleeping quarters and laundry 1
33 Plumbing location,installation,maintenance [#1
57 Clean/soiled linens stored properly
58 No live birds,turtles,or other animals(except guide dogs) a
36 Toilet rooms enclosed with self-closing door i 1
4. 59 Seats 75 or more:Nonsmoking area provided,sign(s)posted at .
37 Proper toilet fixtures provided,good repair,clean r
entrance(s),smoking area indicated by sign(s)
39 Approved garbage/rubbish containers,adequate number,covered,
i` outine Inspection OReinspection 0 Preoperational Inspection
rodent proof,clean r
PERSON IN CHARGE: 0 her Inspection:
_ Demerit Score: *Include demerits from page 1
4 3 2 1 Total IRating
ignatuie st nature
�-
r nr name print name
phone number
titre E CORRECTIONS DUE:
Page 2 of 2 plus continuation pages FocusedInspecUon 1h002
Page f of
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INSPECTION REPORT STATE OF CONNECTICUT
FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH
CONTINUATION SHEET
NAME OF ESTABLISHMENT TOWN DATE
0 QSPEC ION
INSPECTION REMARKS
FORM#
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INITIAL(INSPECTOR) INITIAL(PERSON IN CHARGE)
Distribution: 1 st-White-Health Department 2nd-Yellow- Owner/Manager