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HomeMy WebLinkAboutFood Service Establishment 500 Evergreen (2) �� 4 4. .. II ICU ���- �, �Pt(�QD'ar85E';R�ICE��1[�,5 'r�+C�T>I�l►1�REPQRt['�$��D� R, � TRO'Insp Establishment: `` InspectionDate: I Time: REins ddress/City: Health Dept: S_ ��� a,aV Class: 1 2 3 4 Based on an inspection this day,the Items marked DNC identify 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 IO NIA JONC I KEY: C[complies] N10[not observed] NIA[not applicable] 60 Qualified Food`Operator, 3 DNC[does not comply] 0[other] RTE[ready-to-eat] 61 . Designated Alternate 2 12 Personnel with infection restricted C ]N O NIA';'4 A Food workers have no exposed infected lesions!burns 62 Written documentation of training.program 2 1 -Approved source,wholesome;nonadulterated C !0 NIA 4 B Personnel with infection restricted c/ C Communicable disease of worker reported to local health director A I Approved shellfish,finfish,meat&poultry USDA approved 13 Handwashing facilities provided,hands washed;clean NI0 .NfA` d B Food cans in good condition(not dented,rusty,bloated,leaking) A Handwash facilities in all food prepfdispensing&warewash areas C Wholesome/nonadulteratedfoodslsafe B Handwash facilities in or immediately adjacent to toilet rooms D Commercial products(no home grown/canned food) C Handwash facilities accessible/convenient to use E Potentially hazardousfoods received at proper temperature D Personnel hands washed,clean 1 Proper handwash procedure 0 E Handwashing at appropriate times 3`,_;Potentially hazardous'food-meets'.temperature requirements - C NiO. NIA 4 0 during storage,preparation,display,service and transportation '15 'Good hygienic practices C NIO NIA 2` A Hot holding greater than or equal to 14ft (whole beef/pork masts l3o°F) f A ❑ No eating ❑ No smoking while working B Cold holding less than or equal to460F. B wounds covered adequately C Proper cooling C Proper sink used for handwashing D Proper re-heating 0 ' " ' NIA I-E Proper internal cookingconsumer advisory posted 24`Sanitizationrinse hot water-them]cal) C IO 0 A Approved sanitizeravailableladequateconcentrationofsanitizer 4 Adegulate facilities to maintain pr_obluct. N10 N/A 2 g Food-contact surfaces and utensils used for potentially temperate e;th$rmometers provided hazardous food sanitized at least every 4 hours A Food thermometer available and accurate C Adequate illndislwashersanitizer Ofinal rinse temp B Proper food thermometer for product L Proper sanitizin rocedure E Sanitizing between raw animal origin&ready-to-eat food C Thermometersappropriafelyplaced in cooler units 0 25<Cleawwtping cloths NIQ 'NIA a1 7 Food prptected du ring storage;,preparation, C N10 ;NIA 2 A Cloths and/or sponges in ood repair and clean d}splay,service,adfransportation ;} 9 P ` ',:; A Produce washed B Wiping cloths kept in sanitizer between uses B Raw meats not stored/prepared near ready-to-eat foods iNlQ jNl 2 °;Food-food -clean C C Food covered properly A Food equipment clean utensils clean,equipment interiors clean D Adequate splash guards 1 sneeze guard B Single use gloves changed when soiled E No unauthorized personnel C Food--contactsudaces clean F No pooling of eggs not cooked immediately 0 8 Food containers stored off the floor 30 Hot and cold weter'under:pressure,provided as require NIO NIA _2 0 38 Handwashing accessories provided C :N10 WA .1 9 -,Handling of.food minimized '-' C NlO'"NIA 2A Soap l paper towels l drying device available A No unnecessary handling RTE and/or cooked foods with bare hands B Dispensers}working: ❑Soap ❑Paper towel B Minimize food handling,other than ready-to-eat,with bare hands C I Handwash sink(s)clean I waste receptacle at handwash sink C Adequate utensil(s)for dispensing food/ice �' 0 0 •DESCRIBE DEFICIENCIES ON CONTINUATION SHEETS The following information is not debitable and does not affect your score. KEY: QFO[qualified food operakor],DA[designated alternate],PHF[potentially hazardous food],FB[foodhornel Pi 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 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 foods/equipment? 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 If yes indicate language spoken List products cooled: by QFO/DA: *Can the QFO/DA read the inspection report? Y N Describe cooling methods: Indicate who answered the above questions: Name(print): I Indicate the title of above person(circle all that apply):QFO DA Mgr Cook Owner FW s cooling monitored for time&temp? Y N Is the monitoring of cooling recopied? Y N Obtain signature of the person who received the QFO responsibilities information at the time of the Is there a produce washing policy? Y N *Describe what is washed and inspection: where: Note: This report is a two page form(total of 62 debitable items) Page 1 of 2 & ,h SATE OF CONNECT ICUT C3EPAI�TNEEN ( 1171 PtJII.EC..HAE-"t'M 41 ii CA17C)1.,�\tENU M557 FDP IiATF(�RQ,CT,i1S134 n, rQOL1S1) ©�D SERSC I1�tSTip PQYX LO! AL HEALTH DEPT 5�1,. i'i ��L ✓ A[)DR r G TY> '':1' '„� ' Establishment:°< { `l Date of Inspection t �Z`1I caress Owner or Qprator r ADDITIONAL FOUR POINT ITEMS o. KEY. DNC [DOES NOT COMPLY] 6 Foods not reserved. III 4 31 Sewage disposal approved. -Unwrapped foods not re-served -Potentially hazardous foods not re-served -Operating as required No cross connections,back siphonage,backflow 11 Toxic chemicals. 4 4= Proper type/installation/backflow prevention devicej air gap for: Y -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 -Pesticideslrodentleides properly dispensed Proper drain for: 29 Water source adequate,safe. 4 -Food equipment -Dish machines -Ice machines -Well/well head protected from contamination 35 Toilet facilities. Adequate,convenient,accessible, <.4 -Water quality in compliance-Monitoring in compliance designed,properly installed OTHER ITEMS KEY: DNC [DOES NOT COMPLY] z: &urces of food: Original container,properly labeled i' 40 Garbage/rubbish storage arealrooms,enclosures-properly constructed,clean 5 Potentially hazardous food properly thawed 41 Garbagelrubbish disposed of in an approved manner,atapproved frequency 10 Food dispensing utensils properly stored ;'1 42 Vermin Control: No insects/rodents present i 2 14 Food worker,Clean outer clothes,effective hair restraints 43 Outeropenings protected against entrance of insectslrodents 1 4 Floors: Floor covering installed,constructed as required,good repair,clean 1 16 Food-contact surfaces designed,constructed,maintained,installed, 45 Floors graded,drained as required located 6 Floor,wall juncture covered 17 Nonfood-contact surfaces designed,constructed,maintained, 47 Mats removable,good repair,clean installed,located 48 Exterior walking,driving surfaces,good repair,clean 18 Single service articles,storage,dispensing 2 � 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, 2E maintained installed located 5 50 Dustless cleaning methods used,cleaning equipment properly stored i Egui=ent&Utensils Cleanliness a 51 Adequate lighting provided as required "" 21 Preflushed,scraped,soaked and racked 52 Room free of steam,smoke odors ' 22 Wash water clean,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 1 27 Nonfood-contact surfaces of utensils&equipment clean I 55 Establishmeniandpremisesfreeof liter,noinsectlrodentharborage, 1 28 Equipmentlutensils,storage,handling 1 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 Clean/soiled linens stored properly 58 No live birds,turtles,or other animals(except guide dogs) 1` 36 Toilet rooms enclosed with self-closing door 1' 59 Seats 75 or more:Nonsmoking area provided,sign(s)posted at 37 Proper toilet Mures provided,good repair,clean entrance(s),smoking area indicated by sign(s) 3 39 Approved garbageirubbish containers,adequate number,covered, 1 rodent proof,clean 04outine Inspection ❑Reinspection E7 Preoperational Inspection Other Inspection: tN PECTOR: PERSON IN CHARGE: Demerit Score; *Include demerits from page 1 4 3 2 1 Total Rating si ature �/ _"re liirlrit name, nt name phone number title DATE CORRECTIONS //�� L �� -C 'f "J r�>I��C �� Page 2 of 2 plus continuation pages Focused Inspection 1/2002 I av Page of INSPECTION REPORT STATE OF CONNECTICUT FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH CONTINUATION SHEET NAME OF ESTABLISHMENT TOWN DATE OF INSPECTION ky�L (IV, 76m By I z�m� INSPECTION REMARKS FORM# VI G IL INITIAL(INSPECTOR) INITIAL(PERSON IN CHARGE) Distribution: 1st-White-Health Department 2nd-Yellow- Owner/Ma<;�F���