HomeMy WebLinkAboutFood Service Establishment Inspection 51 (7) Establishment: inspection Date: Time: 6 .Rot Einsp
ddre.ss/City: 516 Health Dept: class: 1 2
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 N/A JDNC I KEY: C fcomplfes) NIO[not observed] NIA[not applicable]
606 Qualt1led For1dP0`era}}or a v 3 DNC[does not comply] 0[other] RTE[ready-to-eat]
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w n at X , l2i; Personnel w[tF rinfegt[on restrlctied r 1-� i0 N VA111g
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A Food workers have no exposed infected lesions 1 burns
4i2 1Atritto documentation of traimhg pYrogre i k, ` a s y
m a s , ,, B Personnel with infection restricted
I 'A Who wholesome,nohddtilt f te� X , C,N/O N1A u4 C Communicable disease of worker reported to local health director
A Approved shellfish,Fnfish;meat&poultry USDA approved
B Food cans in good condition(not dented,rusty,bloated,leaking) fa3i Handwashmg facditi5 pr�fvtce , hgnifswashed,clean: ?C; W0 NIA 4
A Handwash facilities in all food prop/dispensing&warewash areas b
C Wholesomelnonadulleratedfoods!safe B Handwash facilities in or immediately adjacent to toilet rooms
D Commercial products(no home grownicannedfood) C Handwash facilities accessiblelconvenientto use
E Potentially hazardousfoods received alpropertemperature D Personnel hands washed,clean 1 Proper handwash procedure
tt nha`i �ha�arr)ousfood meets fempeicaturl;regulhettiOntsk Nl0' N 0 Ha ndwashing at appropriate times
duting s.0rof preparation display servic a and t arts B tfoh'''
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A Hot holding greater than or equal to 140"R (whole beef/pork masts 130oF.) k0 A ❑No eating ❑ No smoking while working
IV old holding less than or equal to 45e F. B wounds covered adequately
10 Proper cooling C Proper sink used for handwashing
D Proper re-heating 0
E Properinternal cooking/consumer advisory posted ;2A Santtization rinsd ho v( te'';c eirrijcal)T C [V1 11A r2
A Approved sanitizeravaiiableladequateooncentrationofsaniOzer
deq*ats factliP.0$,to malnn07,R.30. C,l , ,h,. ,;, 'I fir Food-contact surfaces and utensils used for potentially
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uret thermometers+provi ei a'` " "� `r " av- a u 4 *' hazardous food sanitized at least every 4 hours
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A Food thermometer available and accurate C Adequate dishwashersanitizer ❑final rinse temp
D Proper san tizing procedure
B . Proper food thermometer for product
E Sanitizing between raw animal origin&ready-to-eat food
C Thermometers appropriately placed in cooler units 0
0
rr � w: 7S lea�lp,viriping cloths u ..uP :
<;Fgodaproffiklec ed d[[ir[�t stior >� Pl�e�ara�lard, C� 110 ll ?� ,.. y :� Oast >: r .a� C W0 NA: 1
Or °d,�spl� ,-s.e lce.andtrans b6tatilb, "'� "'r��'�""r �� W� �t A Clothsandlorspongesin good repair and clean
"'t y... .. ro y ,fr:P{/t4 -E4 r?k 4 F f$�s t i?e f 7k. sa h.#¢
.� .. - _ _ .. ..�_.., ... ... B Wiping cloths kept in sanitizer between uses
A Produce washed b( 0
B Raw meats notstoredlprepared near ready-to-eat foods v26s
�._ .~* a ram_._
C Food covered properly I.
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--contactsudaces clean
F No pooling of eggs not cooked immediately 0
8 Food containers stored off the floor °30 Hot andictild.waterPundeh'pro sU?;' "'{�, pFof p._ as.required C NI0 'WA 2
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.4: �r�$hin ,a�Ceasores pro���. ���, ,V +P ,� ,�..,��� C NIO ;NIA 9
H ndCin of food mtntmized N!b;NIA .;
�' A Soap 1 paper towels!drying device available
A No unnecessary handling RTEandlorcooked foadswith bare hands B Dispenser(s)working: OSoap ❑Papertowel
B Minimize food handling;other than ready-to-eat,with bare handsk C Handwash sink(s)clean lwaste receptacle at handwash sink
C Adequate utensil(s)for dispensing foodlice X0
0 •DESCRIBE DEFICIENCIES ON CONTINUATION SHEETS
The following information 1s 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: DF Describe illness conditions when you would exclude a food morker from working:
Are internal cooking temperatures taken? Y N *To what temperature do you.cook:
Poultry Ground Beef Pork What diseases related to F3 illn are you required to report to the local health department?
Roasts Other
Describe re-heating procedures: is there a written illness poi y that requires the food worker to report specific illness conditions
Are rtemperatures recordedtfogged for cold,holding foodslequipmen. Y N and diseases to the OF O Y N *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 b rier between inspector&QFO? Y N Iflf yes indicate language spoken
List products cooled: by QF01DA: *Can the QFOIDA read the inspection report? Y N
Describe cooling met1.hods:. Indicate who answered the abovequestion • ame rint):
Indicate the title of a � a rson(circl all that, 6/11 QFO DA Mgr Cook Owner FW
Is coaling olonitored for time&temp? Y N Is the moot ring of cooling recorded? Y N *
Obtain signatur �he'p sbq, ,receivetl tt`ie_,QF sponsibilities information at the time of the
Is there a produce washing policy? Y N *Describe what is washed and spection: f
where: This r ort'.t two page form�Jto)V&Hff 62 debitablle items) Page f of 2
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ADDITIONAL FOUR POINT ITEMS KEY: DNC [DOES NOT COMPLY]
6 Foods not re-served.
-Unwrapped foods not re-served '' 31 Sewage disposal approved.
-Potentially hazardous foods not re-served
F -Operating as required
74
No cross connections,back siphonage,backflow
11 Toxic chemicals. 4', Proper typelinstallation/backflow prevention devicel air gap for: -4
-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 -Chemical dispensers -Ice machines
-Pesticideslrodenticides properly dispensed s Prover drain for:
-Food equipment -Dish machines -Ice machines
29 Water source adequate,safe. �4`-
-Well 1 well head protected from contamination
}_ 35 Toilet facilities. Adequate,convenient,accessible,
-Water quality in compliance _; Am
-Monitoring in compliance designed,properly installed
OTHER ITEMS KEY: DNC [DOES NOT COMPLY]
2 Sources of food:Original container,properly labeled
9 P P y ,�, 40 Garbagelrubbishstoroge arealrooms,enclosures-properly constructed,clean
5 Potentially hazardous food properly thawed ?' 41 Garbage/rubbish disposed of in an approved manner,at approved frequency
10 Food dispensing utensils properly stored 1 2 Vermin Control: No insectsirodents present F2
14 Food worker:Clean outer clothes,effective hair restraints 43 Outeropenings protected against entrance of insects/rodents Y
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 �,f
located
6 Floor,wall juncture covered l
17 Nonfood-contactsurfaces designed,constructed,maintained, + 7 Mats removable,good repair,clean
installed,located
18 Single service articles,storage,dispensing N2
8 Exterior walking,driving surfaces,good repair,clean1
49 Walls,ceilings attached,equipment properly constructed,good
19 No reuse of single service article
repair,clean.Wall&ceiling surfaces as required
20 Dishwashing facilities approved design,adequately constructed, 02 `
maintained installed located 50 Dustless cleaning methods used,cleaning equipment properly stored r .
Fquioment&Utensils: Cleanliness 51 Adequate lighting provided as required
21 Preflushed,scraped,soaked and racked 52 Room free of steam,smoke odors1
22 Wash water clean,proper temperature �41
53 Rooms&equipment hoods,ducts,vented as required
urate thermometers provided,dish basket,if used 54 Rooms adequate,clean,adequate lockers provided,facilities clean
27 food contact surfaces of utensils&equipment clean r�' 55 Establishment and premisesfree of litter,no insectlrodent harborage,
28 Equipmentlutensils,storage,handling V no unnecessary articles
56 Complete separation from living/sleepinguarters and laundry
32 Proper disposal of wastewater € P p q 1
33 Plumbing location,installation,maintenance x. 57 Clean/soiled linens stored properly
" 58 No live birds,turtles,or other animals(except guide dogs) s
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
entrance(s),smoking area indicated by sign(s) t
f
39 Approved garbage/rubbish containers,adequate number,covered, 1
rodent proof,clean )@Routine Inspection ❑Reinspection ❑ Preoperational Inspection
Other Inspection:
INSPECTOR: PE E;,_
Demerit Score: •Include demerits from page 1
4 3 2 1 Total Rating
nature n ure
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p mt name !� int n me
�' �"/' 7 �a 4 r'� DATE tORRECTIONS DUE:
I-Plione number title
16 Page 2 of 2 plus continua on pa s Focue dI---ectia-
c Page Of 9
INSPECTION REPORT STATE OF CONNECTICUT
FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH
CONTINUATION SHEET
NAME OF ESTABLISHMENT TOWN DATE OF SPECTION
INSPECTION REMARKS
FORM#
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INITIAL INSPECTOR) INITIAL INITIAL(PERSON IN CHARGE)
Distribution: I st-White-Health Department 2nd-Yellow-Owner/Manager
Pag of V
INSPECTION REPORT STATE OF CONNECTICUT
FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH
CONTINUATION SHEET
NAME O _ESTABLISHMENT TOWN DATE OF SPECT ON
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INSPEC ION REMARKS
FORM#
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INITIAL(INSPECTOR) INITIAL(PERSON IN CHARGE)
Distribution: 1st-White-Health Department 2nd-Yellow- Owner/Manager