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HomeMy WebLinkAboutFood Service Establishment Inspection 46 (17) Establishment: / Inspection Dater Time: Ro[ Ems Address/City: {j(� '�QCG� � ! ,¢ _Health apt: c��t."i �✓ Sriclass: 1 2 3t 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 NIA NCI KEY: C[complies] NIO[not observed] NIA[not applicable] G4� Qttahhed Food Ope 3 DNC[does not comply) 0[other] RTE[ready-to-eat] 72: ;;Personnel withihfedtiob"terit'r(ct6ds �� Cr NIO'' N1A q D0.85�gnd8d AI ernate „ c 2 _ <e. .z. a : , '. ._ A Food workers have no exposed infected lesions T burns B Written docurnentatidn,of training Orooari , ' ,"# B Personnel with infection restricted ApprAved source,wholesome,'onadulfra'}ed a C N70 NTA C Communicable disease of worker reported to local health director A Approved shellfish finfish,meat&poultry USDA approved 13• Handwa' in faG Utie, ovtdei! a washed clean Ct N! "NlA !4r" B Food cans in good condition(not dented,rusty,bloated,leaking) A Handwash 'lie s in all foodppr y #.,y,f s SQ 4 C Wholesomelnonadulterated foods/safe 1 ensin &ware! areas B Hari dw acilities in or i di nt to jtoiKet rooms D Commercial products(no home grown/canned food) C Hand fa Ii i c V I Ic nl se E Potentially hazardous foods received at proper temperature D Pars nel h le wash procedure E Handwashing at appropriate times 3 PoteiYbaliy hazardous food meets tem�erattire"re u) r tenfs C IIO NIA 4 o dur)�g aorage;preparation„displpy,servrcq-�nd�tfartspottaho „n a 1!'s Good hygienrtprctien A Hot holding greater than or equal to 140 F. (whole beafrpark roasts 1300F.) JA< A ❑ No eating ❑ No smoking while working B Cold holding less than or equal to 45 F. B Wounds covered adequately C Proper cooling C Proper sink used for handwashing Je­ D Proper re-heating yC v n E Proper internal cooking/consumer advisory posted 4 Sanitization rir a(F of nia �r chemical) ,� C 401 p Approved sanitizeravaiiableladequate concentration of sanitizer t44 Adequate-facilities to maintain<productt �w+� � mac+NTO INN I B Food-contact surfaces and utensils used for potentially ate rr erature,xthermometers provirYetl � ,� �.x -u-� � � �4 h hazardous food sanitized at least every 4 hours dC A Food thermometer available and accurate C Adequate ❑dishwashersanitizer ❑final rinse temp D Proper sanitizin rocedure B Properfood thermometer for product lk E Sanitizing between raw animal origin&ready-to-eat food C Thermometers appropriately placed in cooler units O h 25 Clean wiping idth �, I -a � � �, �_> rc 3 . bob proteEted:during storage,preparation, rC Nl©` f � dis l y,ser tce and transporfattoe� ,v4�ill�ki�1 jo, A P, A Cloths and/or sponges in good repair and clean B Wiping cloths kept in sanitizer between uses A .Produce washed p� 0 B Raw meats not storedlprepared near ready-to-eat foods g26� o{rc cost sut:faees-t lean `"'IV, NO ° 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 F No pooling of eggs not cooked immediately 0 8 Food containers stored off the floor 0�' oil u aiId`yraei ind�sr pressure,�provided,aseqveii C "N( ' 1h 0 , 38 andwashing acce§4orfes,'Oedvided �E r flC Nl 9 ' Handling offo -minimized GNIO.N! A paper - : / A No unnecessary handling RTEand/or cooked foods with bare hands Boa Ttowels! drying device B.: Dispenser(s)working: ❑Soap ❑Paper towel B Minimize food handling,other than ready-to-eat,with bare hands y[ C Handwash sink(s)clean 1 waste receptacle at handwash sink C Adequate utensil(s)for dispensing foodlice 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 foods,FS[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 F illness are you required to report to the local health department?' Roasts Other Describe re-heating procedures: Is there a written illnes policy that requires the food worker to report specific illness conditions Are temperatures recordedliogged for cold holding foodslequipmenYY N and diseases to the 0? 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 languag barrier between 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 above person(circle all that apply):QFO DA Mgr Cook Owner FW Is cooling monitored for time&temp? Y N Is them itoring of cooling recorded? Y N .Obtain signature of a pars h r _-bltties In motion at thi time of the Is there a produce washing policy? Y N *De s ibe what is washed and inspection: -— where: Note: This report Is a two page form(total of 62 debitable items) Page 1 of 2 lam':�"n aT "n , 6 va a QIIYfeC ip�raOr t ADDITIONAL FOUR POINT ITEMS KEY: DNC [DOES NOT COMPLY) V41_�?i�J P 6 Foods not re-served. t . -Unwrapped foods not re-served 4 31 Sewage disposal approved. 41 -Potentially hazardous foods not re-served ; -Operating as required ,R No cross connections,back siphonage,backfiow 11 Toxic chemicals. �4" Propert ein II prevention device/ -Stored properly,labeled properly,used properly 'pTlt -Food equipment -Hose connections -Dish machines ' -Sanitizer concentration not to exceed maximum permitted k -Soda system carbonator -Beverage dispensers -Toilet tanks -No unnecessary toxics on the premises -Chemical dispensers -Ice machines -Pesticides/rodenticides properly dispensed Proper drain for: a 29 Water source adequate,safe. -Food equipment -Dish machines -Ice machines -Well!well head protected from contamination �_R 35 Toilet facilities. Adequate,convenient,accessible, 4, -Water quality in compliance 1•-_ -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 arealrooms,enclosures-properly constructed,clean 5 Potentially hazardous food properly thawed i 1 41 Garbagelrubbish disposed of in an approved manner,at approved frequency 10 Food dispensing utensils properly stored 2 Vermin Control: No insectsirodents present '$ 14 Food worker:Clean outer clothes,effective hair restraints L1? 43 Outeropeningsprotectedagainstentranceofinsects!rodents 4 FI ry Floor covering installed,constructed as re ui ,goad pair,Cie �1 16 Food-contactsurfaces designed,constructed,maintained,installed, Floors graded,drained as required , X catetl 6 Floor,wail juncture covered nfood-oontactsurfacesdesigned,constructed,maintained, ' installed,located o 7 Mats removable,good repair,clean 48 Exterior walking,driving surfaces,good repair,clean 18 Single service articles,storage,dispensing1 19 No reuse of single service article " 9 all ,ceilings attached,equipment properly constructed,good air,clean.Wall&ceiling surfaces as required 20 Dishwashing facilities approved design,adequately constructed, k i maintained installed located ( 5 stlesscleaningmethodsused,cleaningequipmentproperlystored Equipment&Utensils�_Cleanlinass 51 Adequate lighting provided as required 21 Preflushed,scraped,soaked and racked 52 Room free of steam,smoke odors t ` 22 Wash water clean,proper temperature F 53 Rooms&equipment hoods,ducts,vented as required P 23 Accurate thermometers provided,dish basket,if used 54 Rooms adequate,dean,adequate lockers provided,facilities clean 27 Nonfood-contact surfaces of utensils&equipment clean 1 55 Establishment and premisesfreeof litter,no insect/rodent harborage, 28 Equipmentlutensils,storage,handling no unnecessary articles 32 Ofoper disposal of waste water ,} 56 Complete separation from livingisleeping quarters and laundryLit 33 Plumbing location,installation,maintenance 57 Clean/soiled linens stored properly 36 Toilet rooms enclosed with self-closing door [59 8 No live birds,turtles,orotheranimals(except guide dogs) Seats 75 ormore:Nonsmoking area provided,sign(s)posted at 37 Proper toilet fixtures provided,good repair,clean a entrance(s),smoking area indicated by sign(s) ,Y 39 Approved garbage/rubbish containers,adequate number,covered, rodent proof,clean Pr utine inspection ❑Reinspection ❑ Preoperational Inspection INSPECt Other Inspection: T R: PERSON IN CHARGE: Demerit Score: *Include demerits from page 1 t� g 4 3 2 1 Total Rating nature signature print name print name M DATE CORRECTIONS DUE: t^, t�(� phone number � •� title Page 2 of 2 plus continuation pages Focused Inspection U2002 ')0��op Page4 ofc�_ INSPECTION REPORT STATE OF CONNECTICUT FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH CONTINUATION SHEET NAME OF ESTABLISHMENT TOWN DATE OF INSP CTION ' INSPECTION FORM# REMARKS � A444 1-/0 -3 _/ o� E �' � a� L°°�- � G 67 0 5,620 INITIAL(INSPECTOR) INITIAL(PERSON IN C _.Z.11 Distribtfion: 1st-White-Health Department 2nd-Yellow- Owner/Manager Page of �a�tx, INSPECTION REPORT STATE OF CONNECTICUT FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH CONTINUATION SHEET NAME OF ESTABLISHMENT TOWN DATE OF INSP CTION 4;�,L / INSPECTION FORM# REMARKS r,. INITIAL(INSPECTOR) INITIAL(PERSON IN CHI E) Distribution: I st-White-Health Department 2nd-Yellow- Owner