HomeMy WebLinkAboutFood Service Establishment Inspection 98 (11) F S�t1 E,fS .wCAO.N �C r; �Let pil)
Establishment: �l n �� �3f�. Inspection Date: Time: pinsddress/City:FS �f Lt_1A,)1,2M,y He;i Dept: c.ITi� w�,e„�Sc✓2� 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 NIO NIA DNC KEY: C(complies) NIO[not observed] NIA[not applicable]
t Qualified Food40perator '* 4.
3 DNC[does not comply] 0[other] RTE[ready-to-eat]
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g:� �' ;..: 1Zv .iPersonnelawithainfectiobtrestncted, ,. ,,.
61*ksl naled;,4lternate,-. , ;z r r �. 2 a. a r C NIO NIA tlf
t32 s,n documentation ofitrainingiprograrn k r -� �.., A Food workers have no exposed infected lesions I burns
B Personnel with infection restricted
Approved source,wholesome;rianadultefatedk _ G N10 N!
,.-.i .u.:i C Communicable disease of worker reported to local health director
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A Approved shellfish,finfish;meat&poultry USDA approved 73 iHantlui aghl' .4W..1IrtreS�}ripvided,handswasl�ed;dean C NlO NIA x4
B Food cans in good condition(not dented,rusty,bloated,leaking) "
A Handwash facilities in all food prepldisp'Snsing&warewash areas
C Wholesomelnonadulteratedfoodslsafe B Handwash facilities in or irrutirediately adjacent to toilet rooms
D Commercial products(no home grownicanned food) ,r C Handwash facilities acc lelconvenient to use
E Potentially hazardous foods received at proper temperature D Personnel hands washe , can I Proper handwash procedure
D E Handwashing at appropdat imes ,
3 Pott nttdlly 11ZardouS food meets temperature requirements 1+Or NIA 4 0
du�ing stforage,prepa!stlonj displays service and transportation a;.;
_.x .. ,t5' Goodhygllenrc�,ibracticesF "t fi M'" ,i' C NIOrN/A 2
A Hot holding greater than or equal 10 1400F. (whole beeflpork roasts 1300 F.) A ❑No eating ❑ No smoking while working
B Cold holding less than or equal to45°F. 8 Wounds covered adequately
C Proper cooling C Proper sink used for handwashing Lort
D Proper re-heating p( 0
E Proper internal cooking I consumer advisory posted 24*Sarfitill'06n rr 'sq (hot uir�ter�fi them iFal C NIO NIA 2
3. .m. . .-
0 A Approved sanitizeravallableladequate concentration of sanitizer
Adequate facilities U itiain in,pr d ct * e (}�i]�( ;Z B Food contact surfaces and utensils used for potentially
m '. MIr perature,thermometers provided hazardous food sanitized at least every 4 hours
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A Food thermometeravallable and accurate /�V
L Pro ersanitizin rocedure
B Properfoed thermometer for product E Sanitizing between rawanimal origin&ready-to-eat food
C Thermometers appropriately placed in coolerunits 0
0 5 [Clean vviprt g ctoths
+F + � C NIO 'NIA4 I
rood protected d ring stt rrr �dS e i it%4.� , � ,1(QI l! .; A Cloths and/or sponges in pod repairand clean
i§ lay,s.eruice and°transpoertation� ,# rt. s.F 9
B Wiping cloths kept in sanitizer between uses
A Produce washed 0
B Rawmeatsnotstoredlprepared near ready-to-eat foods 6 d As m a
C Food covered properly A Food equipment clean,utensils clean,equipment interiors clean k
D Adequate splash guards!sneeze guard k B Single use gloves changed when soiled k
E No unauthorized personnel C Food--contact surfaces clean
,F,jo 14o pooling of eggs not cooked immediately 0
pod containers stored off the Floor '3D; F4o tin'd cgld;iatereunder pres,Sure,provided asgre uired C NO NIA 2
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-361 Hand Siaahingaccesstirles��p0iridad,y a '-
:.. : � �. : � _ r 7 G 0 NIA 1
;9a t"angling of food o'00!lrnize:l - ,. ,4& C VIQ Yt(A� 2 A Soap!paper towels! 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 sink(s)clean/waste receptacle at handwash sink
C Adequate utensil(s)for dispensing foodlice 0
Q •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: 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. k:
,c o
Poultry Ground Beef Pork What diseases related to FB Nnes are you required to report to the local health department?
Roasts Other
Describe re-heating procedures: Is there a written illness polic at requires the food worker to report specific illness conditions
Are temperatures recorded/logged for cold holding foodslequipment? Y N and diseases to the QFO? N *Do you have a paid sick leave policy? Y N
Are foods cooked in advance and cooled? Y N *Are leftovers sav ? Y N Is there a language bard between inspector&QFO? Y N If es indicate language spoken
List products cooled: by QF01DA: *Can the QFOIDA re the inspection report? Y .N
Describe cooling methods: Indicate who answeredj;rson
a above questions:Name(print):
Indicate the title of ab erson( irc a II th t a ly): DA Mgr Cook Owner FW
Is cooling monitored for time&temp? Y N Is the monitoring of poling recorded? YdN •Obtain signature of w r c` e 0 r p ibilities information at the time of the
Is there a produce washing policy? Y N Describe what i washed an inspection:
where: Note; This report is a two page form(total of 62 debit le it ms) Page 1 of 2
a " te o fnspctiR
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411 .
44
ADDITIONAL FOUR POINT ITEMS KEY: DNC [DOES NOT COMPLY] Z
6 Foods not re-served. .,
-Unwrapped foods not re-served4, 31 Sewage disposal approved.
4,
-Potentially hazardous foods not re-served 4 -Operating as required
No cross connections,back siphonage,backftow
11 Toxic chemicals.
4 Proper tvoelinstallation/backflow prevention device/air gap for:
-Stored properly,labeled properly,used properly -Food equipment -Hose connections -Dish machines
-Sanitizer concentration notto exceed maximum permitted !
-No unnecessa toxics on the remises j -Soda system carbonator -Beverage dispensers -Toilet tanks
Pesticideslrodenticides properly dispensed a to> -Chemical dispensers -Ice machines f
Proper drain for:
-Food equipment -Dish machines -Ice machines Z'
29 Water source adequate,safe. 4
-Well/well head protected from contamination 35 Toilet facilities. Adequate,convenient,accessible,
-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 40 Garbagelrubbishstoragearealrooms,enclosures-properly constructed,dean
5 Potentially hazardous food properly thawed k2y w 41 Garbage/rubbish disposed of in an approved manner,at approved frequency
10 Food dispensing utensils properly stored 42 Vermin Control: No insectslrodents present Z
14 Food worker:Clean outer clothes,effective hair restraints �14 43 Outeropeningsprotectedagainstentranceonsectsrodents f l
?.f fi ! ,,
4 Floors:floor covering installed,constructed as required,good repair,clean1
16 Food-contact surfaces designed,constructed, maintained,installed, 45 Floors graded,drained as required I
located
6 Floor,wall juncture covered "
17 Nonfood-contact surfaces designed,constructed,maintained, I
installed,located i
.'.
'�� 7 Mats removable,good repair,clean x1,,
48 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 ; _ s
repair,clean.Wall&ceiling surfaces as required
20 Dishwashing facilities approved design,adequately constructed, (�
maintained installed located , 50 Dustless cleaning methods used,cleaning equipment properly stored 1
Equipment&Utensils: Cleanliness t. 51 Adequate fighting provided as required
21 Preflushed,scraped,soaked and racked 52 Room free of steam,smoke odors
22 Wash waterclean,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 hl
27 Nonfood-contact surfaces of utensils&equipment clean a A
55 Establishment and premises free of litter,no insecUrodent harborage, ale
28 Equipmentlutensils,storage,handling I no unnecessary articles
32 Proper disposal of waste water fa 56 Complete sepa ration fro mlivinglsleepingquartersandlaundry a
s�
57 Cleantsoiled linens stored properly
33 Plumbing location,installation,maintenance
581 No live birds,turtles,orotheranimals(exceptguide dogs) `
36 Toilet rooms enclosed with self-closing door
591 Seats 75 or more:Nonsmoking area provided,sign(s)posted at 3
37 Propertoilet fixtures provided,goad repair,clean entrance(s),smoking area indicated by sign(s)
39 Approved garbage/rubbish containers,adequate number,covered, i
rodent proof,clean ( outine Inspection ❑Reinspection ❑ Preoperational Inspection
INSPECTOR: P N HAR E: her Inspection:
Demerit Score: •Include demerits from page 1
I - t/ // 4 3 2 1 Total Rating
ignature sigTe.
rint name print n m
'phone number title DATE CORRECTIONS DUE:
Page 2 of 2 plus continuation pages Peeusea Inspection 112002
I a�v Page of
INSPECTION REPORT STATE OF CONNECTICUT
FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH
CONTINUATION SHEET
NAME OF ESTABLISHMENT TOWN DATE F INSPECTION
T � cif GcJr'�.�5
INSPECTION FORM# REMARKS
p .ram j r'y e
6
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k.1A 44
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INITIAL(INSPECTOR) INITIAL(PERSON IN CHARGE)
Distribution: I st-White-Health Department 2nd-Yellow- Owner/Man er
Pageof
INSPECTION REPORT STATE OF CONNECTICUT
FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH
CONTINUATION SHEET
NAME OF ESTABLISHMENT TOWN DATE OF SPEC ION
r 60
INSPECTION REMARKS
FORM##
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INITIAL(INSPECTOR) INITIAL(PERSON IN CHARGE)
Distribution: I st-White-Health Department 2nd-Yellow- Owner/Manag