HomeMy WebLinkAboutFood Service Establishment 432 Buckland STATE ova o�ir[T�CT>Cu� r: G[JSED FOO 5 INSPEGTIQN. >'(l' t • p ARrI� rt 0 i�xc'H "`
Establishment. v Inspection Date: Time: ' 0 RO!rhlsp 5tinsp
Address/City: 610'f'Lr Heald Dept: ass: 1 2 3
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 WA JDNCJ KEY: C[complies] NIO[not observed] NIA[not applicable]
60 `;puallfled Food Operator 3 DNC[does not comply] 0[other] RTE[ready-to-eat]
:12 Personnel with infection restricted C 'NlO A 4
61 Designated Alternate " 2
A Food workers have no exposed infected lesions/burns
62 l Written documentation o tratn.'ing program 12
B Personnel with infection restricted
1 rApprovedgo :r:e0 wh1l i- 1 nonadulterated .. .. C NIO NIA 4 C Communicable disease of worker reported to local health director
A I Approved shellfish,finfish,meal&poultry USDA approved 131.Handwathlhg Ncilitiesl)rovided.,hohd&washed,clean ic ;N10 ]N1A `4
B Food cans in good condition(not dented,rusty,bloated,leaking) A I Handwash facilities in all food prep/dispensing&warewash areas
C Whalesomelnonadulteratedfoodslsafe B Handwash facilities in or im ediately adjacent to toilet rooms
D Commercial products(no home grown/canned food) L I C Handwash t hies c le onvenient to use
E Potentially hazardous foods received at proper temperature D Personnel h n le _ashe er handwash procedure
D E Handwashing at rop ate im
1, P ttll zrdousfoodmette ements `CNO Oenay aa
during sitoorage,preparation,display,service sa ransporkation;
75 Good hygieri[c practices C N/0 NIA 2
A Hot holding greater than or equal to 140 F. (whole teeftpork roasts 1309F) A ❑ No eating ❑No smoking while working
B Cold holding less than or equal to 45°F. Y-1 I B Wounds covered adequately k
C Proper cooling Y, C Proper sink used for handwashing
D Proper re-heating 0
E Proper internal cooking/consumer advisory posted :2d 'SanitizatfonFrinse(hut'water chemi at) ;C ;N/0�N/A 2
0 A Approved sanitizer available/adequate concentration ofsanitizer
"Adequate:facitities�tokmarntarn produictw ^ C;:NI,O NIA 2 B Food-contact surfaces and utensils used for potentially
t ",temperature.thermorrieters provided W - } hazardous food sanitized at least every A hours
A Foodthermomefer available and accurate C Adequate ❑dishwashersanitizer junal rinse temp
B Proper food thermometer for product D Proper sanitizing procedure
E Sanitizing between raw animal origin&ready-to-eat food
C Thermometers appropriately placed in cooler units 0
0
ti 25: Cleanrtwiping cloths r ,.: C. €NO:hVk
7 F�Obc `pr„ote�ctejd during storage,preparation, C{ NIO N!A i1
]display,service ahoy fansiiortto*n A Clothsandlorsponges in good repairandclean
A Produce washed B Wiping cloths kept in sanitizer between uses
0
B Raw meats not stored/prepared near ready-to-eat foods i26.6Food:contaat>surfacesclean*y= t G lWOIlA 2`
C Food covered properly i:: 6 6�.��;�� r�<���.'� :��: ��.� �:�' �a,�;�,�� �:,;�
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
F No pooling of eggs not cooked immediately D
8 Food containers stored off lhefioor °' 4
0, N9tiandegfisr�iri�tet,pesaur®;,prorisii as•regiilre WA ;;Z:
0 �B Handwashin accessories rovided
9 Handling of food,minimazet ;, ;,,• a :,:v. 113
N/A";Z' A Soap!papertowels 1 drying device available
A No unnecessary handling RTE and/or cooked foodswith bare hands B Dispenser(s)working: ❑Soap ❑Paperiowel -19
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 food/ice p
0 •DESCRIBE DEFICIENCIES ON CONTINUATION SHEETS
The following information is not debatable 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: 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: 4 Is there a written illness Ay that requires the food worker to report specific illness conditions
Are temperatures recordedilogged for cold h_96g foods/equipment? Y N and diseases to the Q ? 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 languao barrier between inspector&QFO? Y N If yes indicate language spoken
List products cooled: by QF01DA: *Can the QFOIDA read the inspection report? Y N
Describe cooling methods: indicate who answered the above questions:Name(print):
Indicate the title of above rs n(circle all that apply):QFO DA Mgr Cook Owner FW
Is cooling monitored for time emp? Y N Is the monitoring of cooling recorded? Y N .Obtain signatur of t e r respo f ies informatlon at the time of the
Is there a produce was hin policy? Y N *Describe what is washed and inspection:
where: Note: This epo a two page form(total of 62 debitable items) Page t of 2
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LpCAL HEALTH DEFT:', ADD tMICITY
6
Establishment.— te of Inspe6tion:
ddress' `` Owner or Operator:
ADDITIONAL FOUR POINT ITEMS ff KEY: DNC [DOES NOT COMPLY]
6 Foods not re-served.
-Unwrapped foods not re-served 4 31 Sewage disposal approved. 4
-Potentially hazardous foods not re-served -Operating as required
77 No cross connections,back siphonage,backflow
11 Toxic chemicals. 4 Pro per typelinstallation/backflow prevention device/air gap for: 4
-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
-No unnecessary toxics on the premises -Chemical dispensers -Ice machines
-Pesticideslrodenticides properly dispensed Proper drain for:
29 Water source adequate,safe. 4 -Food equipment -Dish machines -Ice machines
-Well/well head protected from contamination Ldes
acilities. Adequate,convenient,accessible, 4
-Water quality in compliance-Monitoring in compliance d,properly installed
OTHER ITEMS KEY: DNC [DOES NOT COMPLY]
2 Sources of food: Original container,properly labeled 40 Garbage/rubbish storagearea/rooms,enclosures-properly constructed,clean 1
5 Potentially hazardous food properly thawed 2 agelrubbish disposed of in an approved manner,at approved frequency
10 Food dispensing utensils properly stored 42 in Control: No insectslrodents present
14 Food worker:Clean outer clothes,effective hair restraints 1: 3 Outer openings protected against entrance of insects/rodents 1
4 Floors: Floor covering installed,constructed as required,good repair,clean ;1
16 Food-contact surfaces designed,constructed,maintained,installed, 2- 5 Floors graded,drained as required
located
6 Floor,wall juncture covered
17 Nonfood-contactsurfaces designed,constructed, maintained, ] Mats removable,good repair,clean
installed,located
481 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
.71 repair,clean.Wall&ceiling surfaces as required
20 Dishwashing facilities approved design,adequatelywnslructed, 2
maintained installed located 50 Dustless cleaning methods used,cleaning equipment properly stored i
Equipment.4 Utensils: Cleanliness -I 51 Adequate lighting provided as required 1"
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 Roomsadequate,clean,adequate lockers provided,facilities clean 1
271 Nonfood-contact surfaces of utensils&equipment clean 1 a`
55 Establishment and premises free of litter,no insecflrodentharborage, 1
28 Equipmentlutensils,storage,handling no unnecessary articles
32 Proper disposal of wastewater 1 56 Complete separation from living/sleeping quarters and laundry 1
33 Plumbing location,installation,maintenance 1
57 Clean/soiled linens stored properly 1'
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,signs)pasted at
37 Proper toilet fixtures provided,good repair,clean entrance(s),smoking area indicated by sign(s) 3.
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39 Approved garbage/rubbish containers,adequate number,covered, 1 Al
rodent proof,clean utine Inspection 13Reinspection 0 Preoperational Inspection
R: ;PERSON IN CHARGE: Other Inspection;
Demerit Score: *Include demerits from page 1
4 3 2 1 Total Rating
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print name print name l
�� ��// ► � DATE CORRECTIONS DUE: r —
phone number title
Page 2 of 2 plus continuation pages Focused Inspection vzo
I
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INSPECTION REPORT STATE OF CONNECTICUT
FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH
CONTINUATION SHEET
NAME OF ESTABLISHMENT TOWN DATE Zf
SPE TION
INSPECTION REENrARKS
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INSPECTION REPORT STATE OF CONNECTICUT
FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH
CONTINUATION SHEET
NAME OF ESTABLISHMENT TOWN DA E OFSPECTION
INSPECTION REMARKS
FORM#
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INITIAL(INSPECTOR) INITIAL(PERSON IN CHARGE)
Distribution: I st-White-Health Department 2nd-Yellow-Owner/Manager