HomeMy WebLinkAboutFood Service Establishment Inspection 28 (9) Establishment: / 2 inspection Date: Time: I oinsp Elnsp
Address/City: Heaith Dept: vT Guiofi Class 1 z
Based on an inspection this day,the items marked DNC identify the violations in operation orfacilities 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 I NIA JDNC I KEY: C[complies] N10[not observed] NIA[not applicable]
r60 Qualified Food Operator g DNC[does not comply] 0(other) RTE[ready-to-eat]
tZr Personiief n 4 , 77C wo NA signatedAlternate
ritten doo4mentation of training program .. A Food workers have no exposed infected lesions 1 burns
Personnel with infection restrictedhol Cw .
, o municable disease of worker reported to local health director
A "Approved shellfish,finfish meat&poultry USDA approved 3 ri stltn facihtles rCvtded handsWashe .clean C N/13 IA
B Food cans in good condition(not dented,rusty,bloated,leaking) g .._..,I h�
Handwash facilities in all food prepldlspensing&warewash areas
C Wholesomelnonadulteratedfoods/safe B Handwash facilities in or immediately adjacent to toilet rooms
D Commercial products(no home grown/canned food) C Handwash facilities access!b lelconveni ant to use
E Potentially hazardousfoods received at proper temperature D Personnel hands washed,clean/Proper handwash procedure
E ashing at appropriate times
3 Potential hazardbUsdrleet temperature regElrhrei]t"s ' "NJO N1A 4'
durin s ora9e'prepara lop,xd[splay sarvrce and tfa tt spbrtatton
a 3 ^� �.iti:kt,sr[rG}J 1 i92;
A Hot holding greater than or equal to 140°F. (whole beef/pork masts 1300F.) 7 ❑ No eating ❑No smoking white working
B Cold holding less than or equal to460F. B wounds covered adequately
C Proper cooling C Proper sink used for h washing
D Proper re-heating 0 uo
E Proper internal cooking l consumer advisory posted 424 • artttiAtla 'al (hd,V ater ehetriit fi ,• r Cx f O;e A 2
0 A Approved sanitizerevailableladequateconcentrationofsenitizer
q Y Aae q(stexfaoBitlesto�rrianfarrfirout C rN10a NIA °�2= B Food-contact surfaces and utensils used for potentially
temtperdtii „thermometers pnovidelti hazardous food sanitized at least every 4 hours
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A Food thermometer available and accurate C Adequate 0dishwashersanitizer mal rinse temp
B Properfoodthermometerforproduct
D Proper sanitizing procedure
E Sanitizing between raw animal origin&ready-to-eat food
C Thermometers appropriately placed in cooler units
01:.. t 5e�anp)tjgAci4,ths° � G N/0 �€ €
Ftio'dRoeated duPm�Pog stor�ge;.preparation " C N(0 N! 2 .. ..�,. _.
dlspla , s "('cep d`transportation I lothsandlor sponges in good re'pairandclean
B Wiping cloths kept in sanitizer between uses
A Produce washed
B Raw meats not stored/prepared near ready-to-eat foods s F od agaits•tia c AV
anhpi
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
No pooling of eggs not cooked immediately 0
8 Food containers stored off the Floor „ t and cold water ut tlddr,p eessure,`.proviclsed° s require Y sC MCI'
0 A
8 andWasf log accessorries provided
ftg�o=food,minlmixec( ;w :: ± - y, „C�INTO NIA �2f Soap 1 paper towels 1 drying device available
A No.unnecessary handling RTE andlorcookedfoods with bare hands B
Dispenser(s)working: ❑Soap Paper tow
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
0 *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..cook:
Poultry Ground Beef Pork What diseases related to FB illness are you quired to report to the local health department?
Roasts Other
Describe re-heating procedures: Is theta a written illness policy that uires the food worker to report specific illness conditions
Are temperatures recorded/logged for cold holding foodslequip t? Y • N and diseases to the QFO? Y *Do you have's paid sick leave policy? Y N
Are foods cooked in advance and cooled? Y N eftovers saved? Y. N Is there a language barrier tween 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 ans red the above questions, ame(print
Is cooling monitored far time&temp? Y N Is the monitoring of cooling recorded? Y N Indicate the tit/ of abo perso ch,I I a ply]: 0 Mgr Cods Owner FW
*Obtain signature of) p o ace the OF espon ' dies information at the time of the
Is there a produce washing policy? Y N Describe what is washed and inspection:
where: Note: This rep is two pa form(total of 62 debitable items) Page 1 of 2
t mji, t ba a of lnspaction-
ADDITIONAL FOUR POINT ITEMS KEY: DNC [DOES NOT COMPLY]
6 Foods not re-served. ,a
-Unwrapped foods not re-served 4`N 31 Sewage disposal approved. 4
-Potentially hazardous foods not re-served -Operating as required
11 Toxic chemicals.
34 No cross connections,back siphonage,backflow
� � 4�
Proper typelinstallationl b
-Stored properly,labeled properly,used properly 4 ackflow prevention device/air gap for:
-Sanitizer concentration not to exceed maximum permitted -Food equipment -Hose connections -Dish machines
-Na unnecessary toxics on the premises � -Soda system carbonator -Beverage dispensers -Toilet tanks 0
-Pesticideslrodenticides properly dispensed -Chemical dispensers -Ice machines
Rmper drain for:
29 Water source adequate,safe. 1 -Food equipment -Dish machines -Ice machines
-Well/well head protected from contamination-Water quality in compliance 35 Toilet facilities. Adequate,convenient,accessible, 4"
�~-Monitoring in compliance designed,properly installed
�s
OTHER ITEMS KEY: DNC [DOES NOT COMPLY]
2 Sources of food: Original container,properlylabeled 1 40 Garbage/rubbish storagearea/rooms,enclosures-properly constructed,dean
5 otentially hazardous food properly thawed 41 agelrubbish disposed of in an approved manner,at approved frequency 4
0 ood dispensing utensils properly stored 2 V in Control:No insects/rodents present
14 Food worker.Clean outer clothes,effective hair restraints Outeropenings protected against entrance of insects/rodents 1
4 oors: Floor covering installed,constructed as required od c can
6 od-contact surfaces designed,constructed,maintained,installed, 5 Floors graded,drained as required a
located g
6 Floor,wall juncture covered `
onfood-contaclsurfaces designed,constructed,maintained, s 7 Mats removable,good repair,clean �' 4
installed,located 6 0
2
4 Exterior walking,driving surfaces,good repair,clean 4
18 Single service articles,storage,dispensing
19 No reuse of single service article 49Malls,ceilings attached,equipment properly constructed,good e
= ' repair,clean.Wall&ceiling surfaces as required
20 Dishwashing facilities approved design,adequately constructed, ?,
maintained,installed located M 50 Dustless cleaning methods used,cleaning equipment properly stored
Equipment&Utensils: Cleanliness 51 Adequate lighting provided as required
21 Preflushed,scraped,soaked and racked 52 Room free of steam,smoke odors 1•
22 Wash water clean,proper temperature _� t
53 Rooms&equipment hoods,ducts,vented as required
3 Accurate thermometers provided,dish baskel,if used
� 54 Rooms adequate,clean,adequate lockers provided,facilities clean F 1
7 Nonfood-contact surfaces of utensils&equipment clean �1, �. -�
55 Establishment and premises tee of liter,noinsectlrodentharborage,
28 Equipmenflutensils,storage,handling P
no unnecessary articles ;
2` per disposal of waste water 6 Complete separation from living/sleeping quarters and laundry
33 Plumbing location,installation,maintenance N 57 Clean/soiled linens stored properly
58 No live birds,turtles,or other animals(except guide dogs)
36 Toilet rooms enclosed with self-closing door
37 P roper to!letfixtures provided,gcod repair,clean
59 Seats 75 or more:Nonsmn g area pir e ,sign(s)posted at
3
entrance(s),smo ' a dicated b i rf(a)
39 Approved garbagelrubbish containers,adequate number,covered, "
rodent proof,clean i. n Rein coon Preoperational Inspection
1= P P
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IiVSPECTOR: PERSON IN CHARGE; D Sore: •include demerits from page 1
c.G _ 4 3 2 1 Total Rating
gnature signature to
pri name print name
phone number title
DATE CORRECTIONS DUE:
Page 2 of 2 plus continuation pages Focused Inspecdon Il2002
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INSPECTION REPORT STATE OF CONNECTICUT
FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH
CONTINUATION SHEET
NAME OF ESTABLISHMENT TOWN DATE OF IN PEC ION
INSPECTION FORM# REMARKS
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INITIAL(INSPECTOR) INITIAL(PERSON IN CHARGE)
Distrib dst-White-Health Department 2nd-Yellow- Owner/Manager
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INSPECTION REPORT STATE OF CONNECTICUT
FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH
CONTINUATION SHEET
NAM�9_F ESTABLISHMENT TOWN ) DATE OF INSPECTIO
116
INSPECTION FORM REMARKS
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INITIAL(INSPECTOR) INITIAL(PERSON IN CHARGE)
Distribution: I st-White-Health Department 2nd-Yellow- Owner/Manager