HomeMy WebLinkAboutFood Service Establishment Inspection 85 (27) f t
Establishment: 4ular A!-- iz Inspection Date: , Time: !� tnsp REinss
Address/City: PSG j7 t4/ Z_1 re- ,.,-T,-z,,�r 5 cr Ciass: 1 z 3 4
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 NIA DNC KEY: C[complies] NIO[not observed] NIA[not applicable]
a �s w$ 3 DNC[does not comply] 0[other] RTE[ready-to-eat]
6fl qualifted o d Operator �u r Ile-�� #. +r'*V F'i � n" �
2 124i?ersonnet wrtfin[e3to.p reslct�t #„k Nf0•,`NlAvfi
6 ginated'Alfernae Food workers have no exposed infected lesions/burns
2 Written documentation,of tramf program + ° ~
r� R - B Personnel with infection restricted
9 d Approve source,wholesome;nonadulter tad 6 N/O N%I� .4 C Communicable disease of worker reported to local health director
A I Approved shellfish,finfish,meat&poultry USDA approved Y. I ,13 'Ha�dvrshm�faclittes piovtded,liandswasfled,c(eaj; C,
B Food cans in good condition(not dented,rusty,bloated,leaking) A Handwash facilities in all food prep/dispensing&warewash areas
C Wholesomelnonadu Iterated foods/safe B Handwash facilities in or immediately 4djacent to toilet rooms ,C
D Commercial products(no home grown/canned food) C Handwash facilities accessiblelcorwient to use
E Potentially hazardousfoods received at proper temperature D Personnel hands washed,clean 1 Pr &-handwash procedure
E Handwashmg at appropriate times
* Potentraily hazartlops"food meets temperature requi�emns `C NIO4 NIA 4`�
during storage,preparation,display,aewldb1arttd!transportation ', yg -p ,,CF N1 Ni
-_ a� oM . 1�:� ,.;. 15 ,', oOdh lenlcx tactic@5 �i-re. s k s.x:
A Hot holding greater than or equal to 1400F. (whole beef/pork toasts 1300 F.) ❑ No eating ❑ No smoking while working
B Cold holding less than or equal to 45oF. B Wounds covered adequately
C Proper cooling C I Proper sink used for handwashing 640
D Proper re-heating 0
E Proper internal cooking lconsumer advisory posted 2 `Sanitizationt<rirhseN(hot uatef c�-Inn! ) C "NfO iNit ¢
0 A App roved sanitize r eve ilableladequate concentration of sanitizer
T W'�:a Ade byte�facrlittes Cot maintain profi t :,q C JNlp� Nlq� �� g Food-contact surfaces and utensils used for potentially
4 . �'� " ` ' - �� j` hazardous food sanitized at feast eve 4 hours
eTatur�;thermometers.prOV10 ati_ , ,~ , every
A Foad thermometer availableand s" �accurate C Adequate ❑tlishwashersanitizer ❑final rinse temp
D Proper sanitizin rocedure
B Properfood thermometerfor product xE Sanitizing between raw animal origin&ready-to-eat food
C Thermometers appropriately placed in cooler units A 0
CEeari:wping�ctgths"'?,' V� I� 1 � W �
G.
rit r�F.o gl p o>t cted dtfrrng storage,;ppep . I'-4, � i It( Nl0-N Cloths and/or sponges in good repairend clean
` dl�s°Esljay s lrvslce and transpbrtatl'on a,: .�. 9
B Wiping cloths kept in sanitizer between uses
A Produce washed It0
B Raw meats not stored/prepared near ready-to-eat foods ;2g A-66 ! ac §riiface cleaner
C Food covered properly A� Food equipment clean,utensils clean,equipment interiors clean
D Adequate splash guards/sneeze guard A B Single use gloves changed when soiled
E No unauthorized personnel AC Food--contact surfaces clean PC
F No pooling of eggs not cooked immediately k 0
8 Food containers stored off the floor " � "`� `�
�3b H�btand cold water under pressure,provided,asfrequire ' ;Ni_Al2
V
�Hand°washmg accessories provided ,�, � � ;� ,� ® NIA
�2L^t, n0%6ffoo&imlhIrn1 zed C, Soap!paper towels l drying device available
No unnecessary handling RTE and/or cooked foods with bare hands B
Dispensers}working; ❑Soap ❑Papertowel
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)fordispensing food/ice p
0 etD g •DESCRIBE DEFICIENCIES ON CONTINUATION SHEETS
The following information is not debitable and does not affect your score. KEY: QFO[qualified food operator],DA[designated altemate],PHF[potentially hazardous food], FB(foodborne]
PHFs are hot held at: IF. 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 ou required to report to the local health department?
Roasts Other
Describe re-heating procedures: Is there a written illness policy th requires the food worker to report specific illness conditions
Are temperatures recordedllogged for cold holding f dslequipment? Y N and diseases to the QFO? Y ♦Do you have a paid sick leave policy? Y N
Are foods cooked in advance and cooled? Y +Are leftovers saved? Y N. Is there a language barrier etween inspector&QFO? Y N Iflf ves indicate language spoken
List products cooled: by QFOIDA: // *Can the QFOIDA read the inspection report? Y N
Describe cooling methods: Indicate who ansyvered 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 the monitoring of cooling recorded? Y N .Obtain signature of jlie person wh9 receiv the QFO r sponsibililies information at the time of the
[where;
ere a produce washing polio Y N *Describe what is washed and inspection:
Note: This report is a two page form(total of 62 debitable items) Page 1 of 2
. -.. fat �11In a tio�n.
TAi xe 44, .E
OW, r Opp t r m
ADDITIONAL FOUR POINT ITEMS KEY: DNC [DOES NOT COMPLY] `
6 Foods not re-served. 711 1 f
-Unwrapped foods not re-served
31 Sewage disposal approved.
-Potentially hazardous foods not re-served -Operating as required -
74 No cross connections,back siphonage,backflow
11 Toxic chemicals. i 4 Proper type/installation/backflow prevention device/air gap for:
-Stored properly,labeled properly,used properly -Food equipment -Hose connections -Dish machines
-5anitizer 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 Proper drain for:
f �
-Food equipment -Dish machines -Ice machines
29 Water source adequate,safe. 4
-Welllwell head protected from contamination r. 351 Toilet facilities. Adequate,convenient,accessible, �4
11
-Water quality in compliance I V
-Monitoring in compliance designed,properly installed
OTHER ITEMS KEY: DNC [DOES NOT COMPLY]
2 Sources of food: Original container,properly labeled �1 40 Garbage/rubbish storage arealrooms,enclosures-properly constructed,clean
5 Potentially hazardous food properly thawed p 41 Garbagelrubbish disposed of in an approved manner,at approved frequency '
od dispensing utensils properly stored 421 vermin Control: No insects/rodents present .
4>d worker:Clean outer clothes,effective hair restraints T1 ! 43 1 Outeropenings protected againstentrance of insects/rodents 1
loors:Floor covering installed,constructed as required,good re i,clean
16 od-contact surfaces designed,constructed,maintained,installed, f5 Floors graded,drained as required E
located t
6 Floor,walliuncture covered
17 Nonfood-contact surfaces designed,constructed,maintained, -1 r
IV 7 Mats removable,good repair,clean
tolled,located '4� 1
481 Exterior. walking,driving surfaces,good repair,clean r
18 gle service articles,storage,dispensing _
9 No reuse of single service article
49 Walls,ceilings attached,equipment properly constructed,good 1
repair,clean.Wall&ceiling surfaces as required
20 Dishwashing facilities approved design,adequately constructed, 02
installed located
50 Dustless cleaning methods used,cleaning equipment properly stored
maintained1
Equipment&Utensils: Cleanliness. 51 Adequate lighting provided as required 1
21 Preflushed,scraped,soaked and racked 52 Room free of steam,smoke odors
22 Washwater clean,proper temperature
53 Rooms&equipment hoods,ducts,vented as required
2 .,Accurate thermometers provided,dish basket,if used 4
Rooms adequate,clean,adequate lockers provided,facilities clean ,
27 food contacf surfaces of utensils&equipment clean 5 Establishment and premises free of litter,no insectlrodent harborage,
Equipmentlutensils,storage,handling no unnecessary articles
32 Proper disposal of waste water 561 Complete separation from living/sleeping quarters and laundry
57 Clean/soiled linens stored properly
33 Plumbing location,installation',maintenancePAM
r
58 No live birds,turtles,or other animals(exceptguide dogs)
36 Toilet rooms enclosed with self-closing door r
t�� 59 Seats 75 or more:Nonsmoking area provided,sign(s)posted at
37 Proper toilet fixtures provided,good repair,clean t
entrance(s),smoking area indicated by sign(s)
39 Approved garbage/rubbish containers,adequate number,covered, ,
rodent proof,clean outine Inspection OReinspection O Preoperational Inspection
PERSON IN CHARGE: Other Inspection:
Score: *Include demerits from page 1
rv� 4 3 2 1 Total Rating
signature si ture
pri t name print name
none number title DATE CORRECTIO S `DUE: Gam.
Page 2 of 2 plus continuation pages Focused Inspection V2002
4 Page of
INSPECTION REPORT STATE OF CONNECTICUT
FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH
CONTINUATION SHEET
NAME OF ESTABLISHMENT TOWN DATE OF INSPECTION
),,
v'F
INSPECTION REMARKS
FORM -01
#
117.
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INITIAL(INSPECTOR) INITIAL(PERSON IN CHARGE)
Distribution: Ist-White-Health Department 2nd-Yellow-Owner/Manager
Pag of
INSPECTION REPORT STATE OF CONNECTICUT
FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH
CONTINUATION SHEET
NAME OF ESTABLISHMENT TOWN DATE O INSPECTION
�s C„J LJ
INSPECTION REMARKS
FORM#
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INITIAL(IN SPE R) 1
INITIAL(PERSON IN CHARGE)
Distribution: 1st-White-Health Department 2nd-Yellow-Owner/Manager