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HomeMy WebLinkAboutFood Service Establishment Inspection 17 _ - 1x "..�j 2 _e Establishment: Inspection Date. Time: R Ins ins Address/City: Health Dept: (Dgclass: 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 N10 NIA JDNC I KEY: C[complies] N10[not observed] NIA[not applicable] 80 ualif[ed>Food 0 erator 3 DNC[does not comply] 0[other] RTE[ready-to-eaq :P 12 :Perso n411L ith infection restricted ;61 Pisigrtdted Alternate' ,G a C N10::NIA 4' w A Food workers have no exposed infected lesions/burns tits Witten d40umentatlon of trjmmg program 2 B Personnel with infection restricted 1 rApprove�'saurce,wholesome,.rionatluEterated C' N10 N/A [4. C Communicable disease of worker reported to focal health director A Approved shellfish,finfish,meat&poultryUSDA approved 13 Haridvrashing;faCifit[es provided,-hands.washetl;clean C NlO<P'":: B Food cans in good condition(notdented,rusty,bloated,leaking) A Handwash facilities in all food prep/dispensing& ,wash sh areas C Wholesomelnonadulterafedfoodslsafe X B Handwash facilities in or immediately adjacent to toilet rooms D Commercial products(no home grown/canned food) it. C Handwash facilities accessiblelconvenient to use E Potentiallyhazardousfoods received at proper temperature De D Personnel hands washed,clean l Proper handwash procedure 0 E Handwashing at appropriate times , omtmpeatuamt3 !Potenft$Ily;hazardous f ` e I4A 0 during storage,prepara.9 display,servl and transportation' a 15 >Good hyleriio practices Cz N10".NIA 2 A Hot holding greater than or equal to 140oF. (whole beef/pork roasts 130°F.) A CI No eating ❑ No smoking whileworking B Cold holding less than or equal to4eF. B Wounds covered adequately C Propercooling C Proper sink used for handwashing D Proper re-heating Ale— E Proper internal cooking I consumer advisory posted t24=*tiiittzatt ii4l' {h 3f"wate�k:- heal coil .`:..,, ,,C kNQ �,N1A 2`;` Approved sanitizeravailableladequate concentration ofsanitizer A' equatef�ac]I�bg ->)oxmaletan�pr ;dct; 5 ,G" 'NIO� 2 Food-contact surfaces and utensils used for potentially p±3raur ,therrnorieters:ptnvided 3. v '} (. hazardous food sanitized at least every 4 hours ..r..•'r -F:'t w h-.*, b_ ... . •. A Food thermometer available and accurate C Adequate ❑dishwashersanitizer ❑final rinse temp X B Proper food thermomelerforproduct D Proper sanitizing procedure E Sanitizing between raw animal origin&ready-to-eat food C Thermometers appropriately placed in cooler units 0 D 4 .� A N1 '7 Food rot 25 1AClan�vti�in ycl# hs y t w C 101/ ;7e A Cloths re and/orsponges in ood repair and clean [ cod, 1 ndtrnsogtal x ` 9 P A Produce washed B Wiping cloths kept in sanitizer between uses B Raw meats not stored/prepared near ready-to-eat foods �=�A l ,,,, Ii/0 sai 'tJI C Food covered properly A Food equipment clean,utensils clean 1pmentmteriorsclea� D Adequate splash guards 1 sneeze guard B Single use gloves changed when s ' E No unauthorized personnel C Food--contact surfaces clean F No pooling of eggs not cooked immediately 0 8 Food containers stored off the floor m 30 liHot and.cotd;weiriiQr pisurei:prov[ded as=requlr i rN/a 2 D a es er s f• ;9r -� Fndlirrygof�fgio�{];mirsimized,� . w h ,38 Naidwa cc�s kie provide Y IVICf11�117r 4'� S t w , PM N/© N!A H� A Soap!papertowels! drying device available A No unnecessary handling RTE and/or Cooked foods with bare he tHandeWeshsink(s) opapertoweing: ❑Soap ❑Papertowel B Minimize food handling,otherthan ready-to-eat,with bare hands � clean/waste receptacle a#handwash sink C Adequate utensil(s)for dispensing foodlice 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: F. 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 o you cook. Poultry Ground Beef Pork What diseases related to F 'Irness are you required to report to the local health department? Roasts Other Describe re-heating procedures: Is there a written Nnes policy that requires the food worker to report specific illness conditions Are temperatures recorded/logged for cold holding foods/equipment? N and diseases to the 0? Y N *Do you have a paid sick leave policy? Y N Are foods cooked in advance and cooled? Y N Are left o rs saved? Y N Is there a longue barrier between inspector&MO? Y N Iflf ves indicate language spoken List products cooled: by QFOIDA: *Can the QFOIDA read the inspection report? Y N Describe cooling methods: Indicate wh answered the above questions:Name(print): Indicate he title of above person(circle all that apply):CFO DA Mgr Gook Owner FW Is cooing monitored for time&temp? Y N Is the mon ring of cooling retarded? Y N •Obtai _* nature o the pe w recet0€d the CFO responsibilities information at the time of the Is there a produce washing policy? Y N ♦Descri a what is washed and inspection: where: Note: This report is a two page form(total of 62 debilable items) Page 1 of 2 1..an ., SAE,+E�FCONN �TIUT,_ g EPA p2TMl1 bFp IOLfO.H�NLTH 410GAF�ITL�IVN=NUS IUh;#51FDP-)IARTFORD,CT. fl6134 FOOD SERVI,CE W',CTTOL�T REPORT ~ ADDRESS/CITY; Establishment. date,of Inspection 47, ddr"ess: _ Owner or..,,operator: ADDITIONAL FOUR POINT ITEMS y .mot 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 11 Toxic chemicals. No cross connections,back siphonage,backflow 4 4 Propertypelinstallationl backf Qw prevention device/air gap for: -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 -Pesticideslrodenticides properly dispensed Proper drain for; 29 Water source adequate,safe. -Food equipment -Dish machines -Ice machines 4 -Well I well head protected from contamination 35 Toilet facilities. Adequate,convenient,accessible, 4`.. -Water quality in compliance -Monitoring in compliance designed,properly installed OTHER ITEMS Q KEY: DNC [DOES NOT COMPLY] r 2 Sources of food:Original container,properly labeled 1 40 Garbagelrubbishstoragearealrooms,enclosures-properly constructed,clean r1; 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 insectsirodents present 2' 14 Food worker:Clean outer clothes,effective hair restraints ;4 3 Outeropenings protected againstentrance of insects/rodents 9 4 ors: Floor covering installed,constructed as r wired,gpotf repair,clean 16 Food-contact surfaces designed,constructed,maintained,installed, 2'°i Floors graded,drained as required located 6 Floor,wall juncturecovered 17 Nonfood-contact surfaces designed,constructed, maintained, 1; 7 Mats removable,good repair,clean installed,located R1 Single service articles,storage,dispensing 2 8 Exteriorwalking,driving surfaces,good repair,clean 18 19 No reuse of single service article 9 Walls,ceilings attached,equipment properly constructed,good 1 IV I repair,clean.Wall&ceiling surfaces as required 20 Dishwashing facilities approved design,adequately constructed, 2 maintained installed located 50 Dustless cleaning methods used,cleaning equipment properly stored s 1 w Equipment&Utensils: Cleanliness 1 51 Adequate lighting provided as required wl' 21 Preflushed,scraped,soaked and racked 52 Room free of steam,smoke odors t-1. 1 , 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 alq 27 Nonfood-contact surfaces of utensils&equipment clean l" 55 Establishment and premises free of litter,no insectirodent harborage, 4 28 Equipmentlutensils,storage,handling 1 no unnecessary articles 32 Proper disposal ofwastewater 1 56 Complete separation from living/sleeping quarters and laundry j{3 33 Plumbing location,installation,maintenance 1 57 Cleanlsolled 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 3; 37 Proper toilet fixtures provided,good repair,clean entrance(s),smoking area indicated by sign(s) 39 Approved garbagelrubbish containers,adequate number,covered, ; rodent proof,clean Agoutine Inspection ❑Reinspection ❑ Preoperational Inspection I CTOR: PERSON_ILLCklA13GE: Other Inspection: =/J Demerit 5core: *Include demerits from page 1 (­7 pi 7r, 4 3 2 1 Total Rating signature TigInature ee int name print nam ✓ / Sk '� h DATE CO RRECTI®NS DUE: �, phone number PL the ycl� Ill Page 2 of 2 plus continuation pages Foc dIuapectlon 12002 4 DATE r 11M�Ws- s �llll 014. 'All /1 IN `! :_ i.. — Y '011111 MONO;! trill Y/ voo �!Iwo ,. ,INITIAL i r. ,M�, 6 I •