HomeMy WebLinkAboutFood Service Establishment Inspection 10 (37) r
sTA�7ClE.' K° Qt $9D FOOD SEftv'<CE INSPECTIOPt • IiEA2T1V11T� 5P`kIJIh,. it ;Q
Establishment: GWt�-p v e z_ Inspection Date: / Time: oins Einsp
Address/City: r VLV2— _i-`Z: 7W tzi Health Dept: i lass: 1 z
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 JDNC I KEY: C[complies] N10[not observed] NIA[not applicable]
,60 'Qtatified F,oed Qperatgr" 3 DNC[does not comply) 0[other] RTE[ready-to-eat]
61 Designated Al z
12 'Rersonnel with infection restricted
ternate :C.,N10; N!A '.4 .
62 i Written documentation of training"program 2 A Food workers have no exposed infected lesions 1 burns
B Personnel with infection restricted
1 Approved source,wholesome,isonadulte�ated C 1410 N/A' 4
C Communicable disease of worker reported to local health director
A I Approved shellfish,finfsh,meat& Quit USDA aRproved 13 :Handwash[ng'facHit[es provided -handswashed,-clean C .N10 'WA 4
B Food cans in good condition(not dented,rusty,bloated,leaking) A Handwash facilities in all food prepldispensing&warewash areas
C Wholesomelnonadulterated foodslsafe B Handwash fa 'it es in or imirnedijtely adjacent to toilet rooms
D Commercial products(no home grown/canned food) A C Handwash acilities a ces ibl con; ient to use
E Potentially hazardous foods received at proper temperature D Personn ha ds w'h l a an sh procedure
E Handwas at appropriat ti es _
3 IPbfentially hazardous food meets emperatltre rrqurrements; `,C`N!0 N/ 4 C
during storage,preparafron,display,stlnride antl Eran'sportatton. ;n
15. Yg:Good h tentc ractices C NIO NIA 2
p
S:
A Hot holding greater than or equal to 14eF. (whole beepporkroasts U00F.) A ❑ No eating ❑No smoking while working
B Cold holding less than or equal to 45e F. B Wounds covered adequately
C Proper cooling LkC Proper sink used for handwashing
D Proper re-heating 0
E Proper internal cooking I consumer advisory posted 2L Samtization=rinse;(hoty ter',c riiii cal} ":E.0 N/0 ,NIA 2
w
A Approved sanitizeravallableladequate ooncentration ofsenitizer
ale°fc:lisY,fb"mi. tdnproduct b x°k l �: t ' . Food-contact surfaces and utensils used for potentially
k x. w'� r i 2.. hazardous food sanitized at least eve 4 hour
. [.., re,thermometEtrs ]3foxtdedv r g * r t ' �` every
A Food thermometer available and accurate x C Adequate ❑dishwashersanitizer ❑final rinse temp
D Proper sanitizing procedure
B Properfoad ihermometerfor product
E Sanitizing between raw animal origin&ready-to-eat food
C Thermometers appropriately placed in cooler units
o c:. wo pnu.
k25eari tMip[t�g,clo(hs
7a Fcooj46rtec#ed`dtaring storage,preparatton,r x �C° N!0 NIA 12 A Cloths and/or sponges in good repair and clean
aIU-
; r s t
i a ,}S@rvice and transor Ota�'O
C
A Produce washed B Wiping cloths kept in samtizer between uses
0
B Rawmeatsnotstored/preparednearready-to-eatfoods r
126 W bo aontactfsurfddemdletfrn"
C Food covered properly a ro- 4RA a � - ,+ rr=a,M• .M :wG
A Food equipmentclean,utensils clean,equipment interiors clean
D Adequate splash guards sneeze guard kB Single use gloves changed when soiled
E No unauthorized personnel C Food--contact surfaces clean
F No pooling of eggs not cooked immediately Ne 0
8 Food containers stored offlhefioor
I
;.H,ri and;cold waterrunder pressure;,prtnridsd'a$ratgall . N!A '2.I
. "Hattdi�rds..'[rt aci(stnes:;povde h
K k Handim of}food minimia®d; r +:-$ + ^ C i_!0 N/A 2 " ` tN � ,"` po Soap 1 paper towels! drying device available
A No unnecessary handling RTE and/or cooked foods with bare hands Dispenser(s)working: ❑Soap ElPaper towel
B Minimize food handling,other than ready-to-eat,with bare hands Handwash sink(s)clean!waste receptacle at handwash sink
C Adequateulensil(s)for dispensingfoodlice
0 1 1 1 •DESCRIBE DEFICIENCIES ON CONTINUATION SHEETS
The following information is not debitable and does not affect your score. KEY: QFO[qual'died food operator],DA[designated alternate],PHF[potentially hazardous food],FB[foodborne]
PHFs are hot held at: IF. PHFs are cold held at: F. Describe illness conditions when you Id exclude a food worker from working:
Are internal cooking temperatures taken? Y N ♦To what temperature do you cook:
Poultry Ground Beef Po IF What diseases related to FB ihn are you required to report to the local health department?
Roasts Other
Describe re-heating procedures: Is there a written illness po i y that requires the food worker to report specific illness conditions
Are temperatures recorded/logged for cold holding foodslequipm t? Y N and diseases to the QF Y N *Do you have a paid sick leave policy? Y N
Are foods cooked in advance and cooled? Y N ♦Ar eftovers saved? Y N Is there a language bdreler between inspector&QFO? Y N If)Les indicate language spoken
List products cooled: by QFOIDA: *Can the QFOIDA read the inspection report? Y N
Describe cooling methods: Indicate who answered r above questions:Name(print[:
Indicate the title of a5(Velr- �all the ly):QFO DA Mgr Cook Owner FW
Is cooling monitored for time&temp? Y N Is a monitoring of cooling recorded? Y N .Obtain sh to f FO responsibilities information at the time of the
r o
Is there a produce washing poiicy? Y N ♦Describe what is washed and inspection:
where: Note: This i a two page rm(total of 62 debitable items) Page 1 of 2
3T1►TI OF CdNTCUT AT O A-TH AdL AVU M #5 FD -HARTFORD,C ; ' L 0 - IT CT Ot 134'
d U+ TS 0 S,lt'VICE 149,PECT10N REP.6RT
� 0 .'hHELTi DEp T: ADDRf_5SICITY
Establishment: L, Date:.of,irispection:
ddress„ Owner.or Operator: €7
ADDITIONAL POUR POINT ITEMSo KEY: DNC [D`OES NOT COMPLY] z
6 Foods not re-served.
Unwrapped foods not re served A-_
31 Sewage disposal approved. ;
-Potentially hazardous foods not re-served -Operating as required
11 Toxic chemicals. 34 No cross connections,back siphonage,backflow 4
4: Proper typelinstallation/backflow prevention device/air gap far:
-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
-Pesticides/rodenticides properly dispensed groper drain for:
29 Water source adequate,safe, -Food equipment -Dish machines -Ice machines
-Well 1 well head protected from contamination 35 Toilet facilities, Adequate,convenient,accessible, 4
-Water quality in compliance design
-Monitoring in compliance ed,properly installed
OTHER ITEMS a KEY: DNC [DOES NOT COMPLY]
2 5ourcesoffootl: Original container,properly labeled 1 0 Garbage/rubbish storagearealrooms,enclosures-property constructed,dean
5 Potentially hazardous food properly thawed 2 41 Garbagelrubbish disposed of in an approved manner,at approved frequency
10 Food dispensing utensils properly stored 1 2 Vermin Control: No insectslrodents present 2
14 Food worker:Clean outer clothes,effective hair restraints 43 Outer openings protected against entrance of insects/rodents 1
4 Floors: Floorcovering installed,constructed as required,good repair,clean
16 Food-contact surfaces designed,constructed,maintained,installed, 2 5 Floors graded,drained as required
located
6 Floor,wall juncture covered
17 Nonfood-contact surfaces designed,constructed, maintained, 1 7 Mats removable,good repair,clean
installed,located
2
8 Exterior walking,driving surfaces,good repair,clean
18 Single service articles,storage,dispensing lY:
19 No reuse of single service article 9 Walls,ceilings attached,equipment properly constructed,good 1
repair,clean.Wall&ceiling surfaces as required
0 Dishwashing facilities approved design,adequately constructed, 2
maintained installed located 50 Dustless cleaning methods used,cleaning equipment property stored 1
Equit2mt&Utensils Cleanliness i 51 Adequate lighting provided as required
21 Preflushed,scraped,soaked and racked 52 Room free of steam,smoke odors rl
22 Washwaterclean,proper temperature 53 Rooms&equipment hoods,ducts,vented as required
urate thermometers provided,dish basket,if used 54 Rooms adequate,clean,adequate lockers provided,facilities clean 1
27 bnfood-contact surfaces of utensils&equipment clean 1 ,
55 Establishment and premises free of litter,no insectlrodent harborage, �1
28 Equipment/utensils,storage,handling 1"
no unnecessary articles td,
32 Pro perdisposaI of waste water 1 56 Complete separation fro m living/sleeping quarters and laundry
33 Plumbing location,installation,maintenance 1' 57 Cleanlsoiled linens stored properly 1a
36 Toilet rooms enclosed with self-closing door
58 No live birds,turtles,or other animals(except guide dogs)
'.
I
59 Seats 75 or more:Nonsmoking area provided,sign(s)posted at
37 Propertoiletfixturesprovlded,good repair,clean 3
entrance(s),smoking area indicated by sign(s)
39 Approved garbagelrubbish containers,adequate number,covered, 0.1.
rodent proof,clean >,"t. ❑Routine Inspection ❑Reinspection ❑ Preoperational Inspection
Other Inspection:
IN TOR: PERSON IN CHARGE:
Demerit Score: *Include demerits from page 1
G 4 3 2 1 Total Rating
Z.signature si u s�
print name prinpt
phone number thl. `�� DATE CORRECTIONS DUE: 1/ /
Page 2 of 2 plus continuation pages Focused Inspection ll20D2
OF 1 • • ON
mh LAr m 1��
t f�
I W
i M- NEWA�
mjw,og IN
-n.Fo�tirpl MACE M Ml AM=
ramm
,
aMCI W�0111111;i
�
4
�ml� gi
a
l R
J1
INITIAL(INSPECTOR) INITIAL(PERSON IN CHARG
PaE�:�—O?Z
�,am
INSPECTION REPORT STATE OF CONNECTICUT
FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC IiEALT CONTINUATION SHEET
NAME OF ESTABLISHMENT TOWN DATE OF SPE TION
INSFORMION REMARKS
pate
FecFa
fmpicoo ENgLUE E
Y' Vim'' ' � PI •� /�� e�ppNAN���i
�e
d .mod
r
aZ A
`/Lr
rem— 6
INITIAL(INSPECTOR) INITIAL(PERSON IN CHARGE)
Distribution: 1st-White-Health Department 2nd-Yellow- Owner/M nagerR
Page of/
a�v
INSPECTION REPORT STATE OF CONNECTICUT
FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH
CONTINUATION SHEET
NAM F ESTABLISHMENT TOWN DATE OF WSPEOTION
INSPECTION REMARKS ?/�/45/
FORM#
_ �-- � Cam✓
ems"
INITIAL(INSPECTOR) INITIAL(PERSON IN CHARGE)
Distribution: 1 st-White-Health Department 2nd-Yellow-Owner/Mans r