HomeMy WebLinkAboutFood Service Establishment Inspection 98 1 ,fr
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Establishment: & ,tr /P-/i6�,A Inspection Date: Time: S` ROinsp Einsp
Address/City: < lltj e Health Dept: , class: 1 2 s
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 N1O NIA DNC I KEY: C[complies] WO[not observed] NIA[not applicable]
'60 .,Quallhl}d=Food Operator _ 3 DNC[does not comply] 0[other] RTE[ready-to-eat]
` 12 . Personnel with infection rtl tricted
ignatedAlternate 2
Food workers have no exposed infected lesions 1 burns
62 ritten documentation of training program
Approved s ,ource wholesome,no nadulteiated C NIO N Personnel with infection restricted
C Communicable disease of worker reported to local health director
A Approved shellfish,finfish,meat&poultry USDA approved 13'' t�iaridwashtng«faeilluds provided,.hantlswashetl;clean
B Food cans in good condition(not dented,rusty,bloated,leaking) A Handwash facilities in all food prep/dispensing&warewash areas
C Wholesomelnonadulteratedfoods/safe B Handwash facilities' or immediately adjacent to toilet rooms
D Commercial products(no home grownlcanned food) C Handwash facWftcessiblelcorivenient to use
E Potentially hazardous foods received at proper temperature D Personnel hart as , can I Proper handwash procedure
0 E HandwashjDg appropriate limes
3 Potehtialiy ha ardddf fgb itreets fempeia1u`re"requirements EC''NIO'NIA 4
during storage;.prep'ara#(on,displays sereiceiand transportation E ;= z
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i15 �Good ygieiii �iractices C.[gjtj:xN!
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A Hot holding greater than orequal to 140 F. (whole beef1porkroasls130'F) a eating ❑ No smoking while working
B Cold holding less than orequal to 45 F. B Wounds covered adequately y�
C Proper cooling C Proper sink used for handwashing
D Proper re-heating 0
E Proper internal cooking l consumer advisory posted i2f{ anitizabor> 1ttse;tFotwa . ,:, v rNl0' 2
0 Approved sanitizeravailablelade ateooncentraffonofsanitizer
ate,f�crlit}e =to�mainEaK'pCoduct ,4 h - 19>� ' Nfq.,2 Food-contact surfaces and ut s used for ee##isi
r i �.� iC sib B Y
t mpsraf, thermometers prbvi�li a ,x n •r r t u hazardous food sanitized at least every ours
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A Food thermometer available and accurate C Adequate ❑dishwashersan[lizer ❑final rinse temp
B Proper food thermometer for product L Proper sanitizin rocedure
C Thermometers appropriately placed in cooler units
E Sanitizing between raw animal origin&ready-to-eat food
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a* F d, rote cted dtfrthtrieyrr #llor*y fu IG ( 2;
e di ay,service and ttrain 01.ation* � r Cloths and/or sponges in good repair and clean
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Produce washed [ B Wiping cloths kept in sanitizer between uses •
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B Raw meats not stored/prepared near ready-to-eat foods i213 F o o itatxt sus aces dlearr• N Nl 1�
C Food covered properly ....:, .a"M�.,;�.= .: tik*cw ax•• .:..,, •a:..
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A Food equipment clean,utensils clean,equipment interiors clean
D Adequate splash guards/sneeze guard g Single use gloves changed when soiled
E No unauthorized personnel 44 C Food--contact surfaces clean
F No pooling of eggs not cooked immediately 0
8 Food.eontainersstoied off the floor 3 [Hot and cold"titer u td r[treasure;grgyided as,requtre-j ! :N(A .2-
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t3 w:Handwas i[ng accessoriesiprovrded, ' j"Wi fNIA 1.1
N. ,{�n14011141 o f rnlmm]zed ; 4N10 r 1A ;','2" n
A No unnecessary handling RTE and/or cooked foods with bare hands A Soap!paper towels 1 drying device available
B Dispenser(s)working: ❑Soap ❑Paper towel
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 rr— tt—
0 •DESCRIBE DEFICIENCIES ON CONTINUATION SHEETS
The following information is not debitable 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: OF. 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 ill ess are you required to report to the local health department?
Roasts Other
Describe reheating procedures: I Is there a written illness p icy that requires the food worker to report specific illness conditions
1 Are temperatures recorded/logged for cold holding foods/equipment? N and diseases to the QF Y N *Do you have a paid sick lea>8 policy? Y N
Are foods cooked in advance and cooled? Y N Are lekove saved? Y N Is there a language arrier between inspector&QFO? Y N If es ndicate language spoken
List products cooled: by QFOlDA: *Can the QFO/DA read file inspection report? Y N
Describe cooling methods: Indicate who nswer d the ab a questions:Name(print):
Is cooling monitored for time&tamp? Y N Is the monit ng of cooling recorded? Y N ndicate th title of a e perso (c cl all tqpe =resw
0 DA Mgr Cook Owner FW
Obtain sgnalure person ho re sibilities information at the time of the
Is there a produce washing policy? Y N ♦Describ what is washed andinspection:
where: Note: This report' a two pa a form(total of 62 debt ab items) Page 1 of 2
S t1 OF CONNECTICU DEI?AR TMENT QF-I?l1BLlC IiEALTH 4'I.O;CAPITOL AVEiVIJE. MS#5 I FDP:-HARTFORD,CT Qti134
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ADORICITY:. 4 P
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Owner or,0 erator: A.ti
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ADDITIONAL FOUR POINT ITEMS
KEY: DNC [DOES NOT COMPLY]
6 Foods not reserved. ;4 31 Sewage disposal approved.
-Unwrapped foods not re-served 4
-Potentially hazardous foods not re-served -Operating as required
11 Toxic chemicals. No cross connections,back siphonage,backflow 4
4. Em e�rtype/installation/backflowpreventiondeyicelairga for:
-Stored properly,labeled properly,used properly -Food equipment -Hose connections -Dish machines
-Sanitizerconcentration notto exceed maximum permitted -Soda system carbonator -Beverage dispensers -Toilettanks
-No unnecessary toxics on the premises -Chemical dispensers -Ice machines
-Pestfcideslrodenticides properly dispensed Proper drab for:
29 Water source adequate,safe. -Food equipment -Dish machines -Ice machines
4
-Well/well head protected from contamination 35 Toilet facilities. Adequate,convenient,accessible, 4':
-Water quality in compliance designed,properly installed
-Monitoring in compliance
OTHER ITEMS o, KEY: DNC [DOES NOT COMPLY]
2 Sources of food: Original container,properly labeled 40 Garbage/rubbish storage area/rooms,enclosures-properly constructed,clean
5 Potentially hazardousfood 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 insectslrodents present 2:.
14 Food worker:Clean outer clothes,effective hair restraints 1 43 Outer openings protected against entrance of insects/rodents 1;
4 Floors: Floor covering installed,constructed as required,good repair,clean
16 Food-contact surfaces designed,constructed, maintained,installed, 45 Floors graded,drained as required
o ted
Floor,wall juncture covered
1- food-contact surfaces designed,constructed,maintained, 1E,
z: <. Mats removable,good repair,clean
installed,located
2
8 Exterior walking,driving surfaces,good repair,clean
18 Single service articles,storage,dispensing .1.
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 properly stored w fir.
Equipment&Utensils; Cleanliness 1 51 Adequate lighting provided as required 1
21 Preflushed,scraped,soaked and racked 52 Room free of steam,smoke odors ;1
22 Wash water clean,proper temperature 53 Rooms&equipmenthoods,ducts,vented as required
urate thermometers provided,dish basket,if used 54 Rooms adequate,clean,adequate lockers provided,facilities clean
nfoo ontact surfaces of utensils&equipment clean
55 Establishment and premises freeof litter,no insect/rodent harborage, 1
28 -Equipme utensils,storage,handling 1 no unnecessary articles
6operdisposal 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,sign{s)posted at
37 Proper toilet fixtures provided,good repair,clean 3
entrance{s},smoking area indicated by sign(s)
39 JApproved garbagelrubbish containers,adequate number,covered, 1
rodent proof,clean Routine Inspection ❑Reinspection ❑ Preoperational Inspection
7TOR: RGE:
Other Inspection:
Demerit_Score: *Include demerits from page 1
4 3 2 1 Total Rating
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print name print name _ 6;A1
� c7 DATE CORRECTIONS DUE: ( �r
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Page-2of
INSPECTION REPORT STATE OF CONNECTICUT
FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH
CONTINUATION SHEET
NAME OF ESTABLISHMENT TOWN DATE OF INSPECTION
INSPECTION FORM# REMARKS
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INITIAL(INSPECTOR) INITIAL(PERSON IN CHARGE)
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NAME OF ESTABLISHMENT
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Page-5of
INSPECTION REPORT STATE OF CONNECTICUT
FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH
CONTINUATION SHEET
NAME OF ESTABLISHMENT,, TOWN DATE OF INSPE TION
INSPECTION FORM# REMARKS
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INITIAL(INSPECTOR) INITIAL(PERSON IN CHARGE) i
Distribution: 1st-White-Health Department 2nd-Yellow-Owner/Manager