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HomeMy WebLinkAboutFood Service Establishment Inspection 25 (3) �;1 1 (� ��� Sly•'� LJ � vc. j Establishment: IA.)/&1-1904_S Inspection Date: Time: oins Einsp ddress/City: V Health ept: � ;•�fi� ;�..fnSv� class: 1 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 NJO N/A IDNC I KEY: C[complies] NIO'[not observed] NIA[not applicable] QitallfledfFood,Opera u DNC[does not comply] 0[other] RTE(ready-to-eat] tor , c 3 �� ' ` �2 "Perdue!Vvittt mfectionrsrErl�ted�' C .. LL . 61� ae$tgr�ated Alternate 2 _:: A A Food workers have no exposed infected lesions l burns 62 1Ntittgn documentatioh of train' Q r 2 B Personnel with infection restricted 1 WApproYod.source,wholesome,ribnadttltoatetl N 0 NJ ` C Communicable disease of worker reported to local health director A Approved shellfish finfish,meat&poultry USDA approved 13 'Haridwasbin facrlrtfes provtded;r,hands"washed,Iefeah NCO NIA 4" B Food cans in good condition(not dented,rusty,bloated,leaking) s A Handwash facilities in all food prep/dispensing&warewash areas AlitC Wholesomelnonadulteratedfoods/safe j B Handwash facilities in or immediately adjacent to toilet rooms D Commercial products(no home grown/canned food) 1C C Handwash facilities accessiblelconvenient to use A E Potentially hazardous foods received at proper temperature D Personnel hands washed,clean J Proper handwash procedure E Handwashing at appropriate times 3 :Ootedtiall�phaizefd!6 i food rneefs{ernk rAiria reg61rements E N10 "NlA� 4< 0 during sto�pge,,,preparation,display,service and transportation (� c r tl 4 m x r spy :g x 1,5 GO6Ci. YIeiICraC�tG@3 s ° N �• aIVt NIX&2 A Hot holding reater than or equal to 144 F. (whole basupork roasts 130oF) A © No eating 13 No smoking while working B Cold holding less than or equal to45'F. J1111B Wounds covered adequately C Proper cooling C Proper sink used for handwashing Ae D Proper re-heating JC 0 E Proper consumer 4 'S'anit'' ton' see{hod Water",chain at p C'`N1 if1A 2 P 9 advisory posted ~ Q 0 A "Approved sanitizeravailable/adequateooncentratienofsanitizer � -, w �,>. � � � 4� `,i�dequate acillttes to matnta n,,�rp�d�ct , :E,,-I T,2 g Food-contact surfaces and utensils used for potentially ;t t`� t, #ii�ert�iometeirstl providdd,`� *'`_e 4 T x hazardous food sanitized at least every 4 hours ��..•r A Food thermometer available and accurate C Adequate ❑dishwashersanitizer ❑final rinse temp D Proper sanitizing procedure AL B Proper food thermometerfor product d( E Sanitizing between raw animal origin&ready-to-eat food C Thermometers appropriately placed in cooler units 0 AC O� kId' 25 Clear w li fit clOthsr C,k"•r ar' a"_•m e: a", ., K'u£ w•a .. ks 'w- s4,ar.v..,1 w .: k % t 6 t Fao�protected,durin�g s crag ;p e�p ra or =NId N "I k � � dig l3la r sejvlcelantlIransportatior A Clothsandlorspongesingoodrepairandclean B Wiping cloths kept in sanitizer between uses A Produce washed 0 B Raw meats not stored/prepared near ready-to-eat foods 4gkNo4d,,4i6tac urfacev"ilean C Food covered properly �� .��.,��:�� .,�.b„�� .�-_ �,• ���_a� <_ �.� : -. 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 F No pooling of eggs not cooked immediately 0 8 Food containers stored off the floor o- &Ho.an�'i� ., 3 r, o��°wafernier:pressure,provtdedras?rAgUireii' �7 " 0 38 "HandWashing accesaorjes P'- " CIG, X�"NIG %A �r1 ��, '.Handltng,.of food_mtntn)izetl • . _ .s. , C ;,N/0;N/A :"2; A Soap/paper towels I 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 sinks)clean/waste receptacle at handwash sink C Adequate utensil(s)for dispensing food/ice sc 0 0 1 •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],F8[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 FB illness are you required to r port to the local health department? Roasts Other Describe re-heating procedures: I Is there a written illness policy that requires the foo orker to report specific illness conditions Are temperatures recorded/logged for cold holding foods/equipment? Y N and diseases to the QFO? Y N *Do yo ave a paid sick leave policy? Y N Are foods cooked in advance and cooled? Y N +Are leftover saved? Y N Is there a language barrier between inspecto QFO? Y N If)Les indicate language spoken List products cooled: by QFOIDA: an the QFOlDA read the inspection report? Y N Describe cooling methods: Indicate who answered tVabovetions: Name(print): ndicate the title of aboveall that apply):QFO DA Mgr Cook Owner FW Is cooling monitored for time&temp?.Y N Is the monitoring f cooling recorded? Y N .Obtain signature of the ived the QFO responsibilities information at the time of the Is there a produce washing policy? Y N *Describe what is washed and inspection: where: Note: This rep t e form(total of 62 debitable items) Page 1 of 2 V,s, A.' W, �'- V 1 4 :A .,SS,- -- gas-a>; ' •. M _�: r �y r ,nct�ldn ® , �" k °OWnor or,, ADDITIONAL FOUR POINT ITEMS KEY: DNC [DOES NOT COMPLY] 6 Foods not re-served. -Unwrapped foods not re-served ;4 31 Sewage disposal approved. -Potentially hazardous foods not re-served -Operating as required No cross connections,back siphonage,backflow 11 Toxic chemicals. 4 4' P-m er elinstallation/backflow prevention device/air gap for: -Stored properly,labeled properly,used properly -Food equipment -Hose connections -Dish machines -a -Sanitizer concentration not to exceed maximum permitted -Soda system carbonator -Beverage dispensers -Toilet tanks -No unnecessary toxics on the premises -Chemical dispensers -Ice machines -Pesticides/rodenticides properly dispensed 4g Proper drain for. 29 Water source adequate,safe. -Food equipment -Dish machines -Ice machines -Well/well head protected from contamination i -Wafer quality in compliance 35 Toilet facilities. Adequate,convenient,accessible, designed,properly installed -Monitoring in compliance OTHER ITEMS KEY: DNC [DOES NOT COMPLY] 2 Sources of food:Original container,properly labeled 40 Garbage/rubbish storage arealrooms,enclosures-properly constructed,clean 5 Potentially hazardous food properlythawed 41 Garbagelrubbish disposed of in an approved manner,at approved frequency 10 Food dispensing utensils properly stored le+ 42 rmin Control: No insects/rodents present 14 Food worker:Clean outer clothes,effective hair restraints (k�' 4 pteropenings protected against entrance of insects/rodents Oki 4.FI rs: Floor covering installed,constructed as require , od repair, lean 16 Food-contact surfaces designed,constructed,maintained,installed, V 5 Floors graded,drained as required located Floor,wall juncture covered 17 Nonfood-contact surfaces designed,constructed,maintained, � 7 its removable,good repair,clean installed,located Exterior walking,driving surfaces,good repair,clean 18 Single service articles,storage,dispensing ' 49 Walls,ceilings attached,equipment properly constructed,good 19 No reuse of single service article r repair,clean.Wall&ceiling surfaces as required 20 Dishwashing facilities approved design,adequately constructed, t2.' Ala maintained installed located ;Fe50 Dustless cleaning methods used,cleaning equipment properly stored Equipment&Utensils: Cleanliness 51 Adequate lighting provided as required 21 Preflushed,scraped,soaked and racked S2 Room free of steam,smoke odors 22 Wash water clean,proper temperature 53 Rooms&equipment hoods,ducts,vented as required i 23 Accurate thermometers provided,dish basket,if used 54 Rooms adequate,clean,adequate lockers provided,facilities clean 1 27 nfood-contact surfaces of utensils&equipment clean t l IL- 55 Establishment and premises free of litter,no inseegrodent harborage, S Equipmentlutensils,storage,handling 1 ; no unnecessary articles 2 JP per disposal of waste water- 1 56 Complete separation from livingisleeping quarters and laundry 33 71 i umbing location,installation,maintenance 57 Clean/soiled linens stored properly 'r 58 No live birds,turtles,orotheranimals(except guide dogs) 36 Toilet rooms enclosed with self-closingdoor 59 Seats 75 or more:Nonsmoking area provided,sign(s)posted at 37 Proper toiletfixtures provided,good repair,clean �. � entrance(s),smoking area indicated bysign(s) 39 Approved garbagelrubbish containers,adequate number,covered, 1 rodent proof,clean ?t outine Inspection ❑Reinspection ❑ Preoperational Inspection IN P T ER Other Inspection: Demerit Score: *Include demerits from page 1 c.z 4 3 2 1 Total Rating signature signaiddV 414 4/ print name Ifridt name L J — %nrr6L.1 f'1'iC'YI q,'l' DATE CORRECTIONS DUE: phone number title 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 6o e—L— a / INSPECTION REMARKS FORM# �� C s f 1 iL 7� Le C 1 � ILL �c� A/, 7� (,6 INITIAL(INSPdTOR) UQ� I INITIAL{PERSON IN CHARGE) 9 Dist- u tion: st-White-Health Depart�t �Yellow- Wner/Marra'g rr