HomeMy WebLinkAboutFood Service Establishment Inspection 97 L
Establishment: Inspection Date:x [ Time: jnsp REinsp
Address/City: q'\�o S(A`�(V gr,,OV 2 . Health Dept: S. W , n&4 t:-)/ . Class: 1 2 4
Based on an inspection this day,the items marked DNC identify t iolations 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 YO NIA IONIC 1 11 KEY: C[complies] N10[not observed] NIA[not applicable]
=eb", ouailffetlr"ad Operator ; 3 DNC[does not comply] 0[other] RTE[ready-to-eat]
[ ' Designated Alternate p w' 2 ]z Pgrs. nne]vyi.j h I'Ofection restrrated C N/0' NIA 4''
62 Written documentation of training program rt 2
A Food workers have no exposed infected lesions I bums
B Personnel with infection restricted
Approved sogTc wholesome,honadulterated C L lO'NIA; "4 C Communicable disease of worker reported to local health director
A I Approved shellfish,finfish,meat&poultry USDA approved ;Handwashing#aahfiesprovided,hands'washed,clean
B Food cans in good condition(not dented,rusty,bloated,leaking) _ '
A Handwash facilities in all food prepldispensing&warewash areas
C Wholesomelnonadulleratedfoods/safe B Handwash facilities in or immediately adjacent to toilet rooms
D ,Commercial products{no home grown/canned food} C Handwash facilities accessiblelconvenient to use
E Potentially hazardous foods received at proper temperature V D Personnel hands washed,clean I Proper handwash procedure
o E Handwashing at appropriate times
Pbtfltallyaa�daus food meets temperauiaireguuements ° C�N10 NIA 0
dunng storage,preparation,display,setvlcevand4trdnsporla6ort F 9 �) "'"; g
CQd,Nygfelllt:rf]raGtliceS: NltJ� J/A`
A Hot holding greater than or equal to 140°F. (whole beeflpork roasts 1300F.) A C3 No eating 0 No smoking while working
B Cold holding less than or equal to45 F. B wounds covered adequately
C Proper cooling C Proper sink used for handwashing
D Proper re-heating 0
E Proper internal cooking lconsumer advisory posted 24i:,S°anI Izatfon rinse fhntwater chemicals 3 a!Q NIP'
0 A Approved sanitizeravailableladequateconcentrattonof.sanitizer
sr I�dequate feoilltlir fC+ t lai t i olfLc�t� iV10 WAl 2a B Food-cont ct surfaces and utensils used for potentially
a I hazardous food anitized at least every 4 hours
tee�nRe dfuTeettltarmomwet pre Ided a *� '� ° ° a
A Food thermometer availableandaccurate C Adequate dishwashersanitizer 0final rinse temp
B Proper food thermometer for product D Proper sa itizing procedure
E Sanitizing between raw animal origin&ready-to-eat food
C • Thermometers appropriately placed in cooler units
0
G�lean,wiping;,cjfrtiS�
txfabopro�tacted.dFrr � � r ! �!k'�f. C N10 �N� i2:i k r . . F -,..z '-,l r #:.t .•to
s sg « an�IrtanspprtFori� - r x+;-'xt A Cloths and/or sponges in good repair and clean
t = rc.A 'LAV JV ;.. .rk
B Wiping cloths kept in sanitizer between uses
A Produce washed
B Raw meats not stored/prepared near readytoeatfoods 6t'food-aantactsutrfaaesti,e n ¢ * '' +
C Food covered properly J ot: ) ai✓; t
Food equipment clean,utensils clean,equipment interiors clean
D Adequate splash guards/sneeze guard B Single use gloves changed when soiled V
E No unauthorized personnel C Food--contact surfaces clean
F No pooling of eggs not cooked immediately 0
Food containers stored off the floor 01 ; i, w " " i f"
,30 110 and mold wateri: der;pressure,aprawded as re-qui # C N10i YA-01
0 1.5yi. Wandwshmg agcessorles pravlded' N1Q N1A� 4
<. :.
t l[riggffoad mrn(rireti 3'�,� a j; E;N�(Qa !i= A Soap l paper towels/ drying device available
A No unnecessary handling RTE and/or cooked.foods with bare hands B
Dispenser(s)working: ❑Soap QPaper towel
B Minimize food handling,otherthan ready-to-eat,with bare hands C Handwash sink(s)clean/waste receptacle at handwash sink lol
C Adequate utensil(s)for dispensing foodlice 0
0 *DESCRIBE DEFICIENCIES ON CONTINUATION SHEETS
The following information is not debitabie and does not affect your score. _M: QFO[qualified food operator],DA[designated alternate],PHF[potentially hazardous food],FB[feodborne]
PHFs are hot held at: F PHFs are cold held at: °F. 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 required to report to the local health department?
Roasts Other
Describe re heating procedures: Is there a written illness policy that requires the food worker to report specific illness conditions
Are temperatures recorded/logged for cold holding foodslequipment? Y N and diseases to the QFO? Y N *Do you have a paid sick leave policy? Y N
Are foods cooked in advance and cooled? Y N *Are leftovers saved? Y N Is there a language barrier between inspector&QFO? Y N tf-s indicate language spoken
List products cooled- by QFO/DA: *Can the QFOIDA read the inspection report? Y N
Describe cooling methods: Indicate who answered the above questions: Name(print):
Lw
cooling monitored for time&temp7 Y N Is the monitoring of cooling recorded? Y N Indicate the title of above person(circle all that apply):QFO DA Mgr Cook Owner FW
Obtain signature of the person who received the CFO responsibilities information at the time of the
there a produce washing policy? Y N Describe what is washed and inspection:
here: I Note: This report is a two page form(total of 62 debitabie items) Page 1 of 2
m- IE� 6N
Establishment: -� CA)0t 1�. Date of,Inspection Zt
ddress: S L4 U A46 "pr Operator:
ADDITIONAL FOUR POINT ITEMS ;o KEY: DNC [DOES NOT COMPLY]
6 Foods not re-served.
4 31 Sewage disposal approved.
-Unwrapped foods not reserved 4
-Potentially hazardous foods not re-served -Operating as required
No cross connections,back siphonage,backfiow
11 Toxic chemicals. 4
4 Proper typetinstallation/backflow prevention device/air gap far:
-Stored properly,labeled properly,used properly -Food equipment -Hose connections -Dish machines
-Sanitizes concentration not to exceed maximum permitted -Soda system carbonator -Beverage dispensers -Toilet tanks
-Na unnecessary toxics on the premises
Pesticides/rodenticides properly dispensed -Chemical dispensers -Ice machines
Proper drain for:
29 Water source adequate,safe. 4 -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
OTHER ITEMS KEY: DNC [DOES NOT COMPLY]
2 Sources offood: Original container,properly labeled 1 40 Garbage/rubbish storagearealrooms,enclosures-properly constructed,clean
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 42 Vermin Control: No insects/rodents present 2'
14 Food worker:Clean outer clothes,effective hair restraints .1, 43 Outeropenings protected against entrance ofinsectslrodents 1'
y" 44 Floors: Floor covering installed,constructed as required,good repair,clean 1;
16 Food-contact surfaces designed,constructed, maintained,installed, �2
r, , 45 Floors graded,drained as required
located 46 Floor,wall juncture covered
17 onfood-contact surfaces designed,constructed, maintained, 47 Mats removable,good repair,clean
''P
installed,located
481 Exterior walking,driving surfaces,good repair,clean
18 Single service articles,storage,dispensing 2 1
19 No reuse of single service article 9 Walls,ceilings attached,equipment properly constructed,good '
repair,clean.Wall&ceiling surfaces as required W
20 Dishwashing facilities approved design,adequately constructed, 2
maintained installed located 50 Dustless cleaning methods used,cleaning equipment properly stored ;
Equipment&Utensils: Cleanliness 1 51 Adequate lighting provided as required ;
21 Preflushed,scraped,soaked and racked 52 Room free of steam,smoke odors '
2 Wash waterclean,proper temperature 53 Rooms&equipment hoods,ducts,vented as required
23 Accurate thermometers provided,dish basket,ifused 54 Roomsadequate,clean,adequate lockers provided,facilitiesclean -1
27 Nonfood-contact surfaces of utensils&equipment clean 1 55 Establishment and premises free of litter,no insectlrodentharborage,
x.
8 Equipmentlutensils,storage,handling f no unnecessary articles
32 Proper disposal of waste water 1 56 Complete separation from living/sleeping quarters and laundry
33 Plumbing location,installation,maintenance 1
57 Cleanlsoiled linens stored properly
58 No live birds,turtles,or other animals(except guide dogs)
36 iletroomsenclosedwithself-closing door y';
59 Seats 75 or more:Nonsmoking area provided,sign(s)posted at p
37 Proper toilet fixtures provided,good repair,clean r
i 1 entrance(s),smoking area indicated by sign(s)
39 Approved garbage/rubbish containers,adequate number,covered, 1
rodent proof,clean : '. routine Inspection ❑Reinspection ❑ Preoperational Inspection
Other Inspection:
I T R: PERSON IN CHARGE: Demerit Score: *Include demerits from page 1
4 3 2 1 Total Rating
Sig lure ate
print name pit name ` 3
DATE CORRECTIONS
phone number title `
C CAL/`-' ^p r Page 2 of 2 plus continuation pages Focused Inspection 1/2002
Page 3 Of
Iq Todd
INSPECTION REPORT STATE OF CONNECTICUT
FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH
CONTINUATION SHEET
NAME OF ESTABLISHMENT TOWN DATE OF INSPECTION
INSPECTION REMARKS
FORM#
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INITIAL(INSPECTOR) INITIAL(PERSON CHAR E)
Distribution: 1st-White-Health Department 2nd-Yellow-Owner/Manager