HomeMy WebLinkAboutFood Service Establishment Inspection 46 r
Establishment: - ' 1 �1 Inspection Date: Tim-
Address/City: ,/SIr� L • u� /�-�7 Health Dept: i,t �'2�Ciass: 1 2 3�
Based on an inspection this day,the items marked DIVC 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 N/O NIA DNC KEY: C[complies] NIO[not observed] NIA[not applicable]
60i r�Qualif]ed Food=Oparator a ., s r 3 DNC[does not comply] 0[other] RTE[ready to-eat]
` a "" 12 t Persgnnel with rnfection cestcicted :;
6� ; DeslgnaietlIlternat s y C'�;NlO iN1A 4
m A Food workers have no exposed infected lesions 1 burns
82 ,Written dtcrhdpYation�of trammg program 2
B Personnel with infection restricted
t1, Ap�lroved source,whdlesame,noftadulter"ated C' N10 N1A 4` C Communicable disease of worker reported to local health director
A Approved shellfish,5nfish,meat&poultry USDA approved t13 HiiindwAshih fat�d�ties provided,-hands.washed,clean s C iNICJ' NIX 4
B Food cans in good condition(not dented,rusty,bloated,leaking) A Handwash faciTtles in all food prepldispensing&warewash areas 1/1
C Wholesomelnonadulteratedfoods/safe B Handwash facilities in or immedi Ay adjacent to toilet rooms
D Commercial products(no home grown/canned food) it! C Handwash facilities accessi onvenient to use
E Potentially hazardous foods received at proper temperature D Personnel hands washed,cle ro r ha wash procedure
0 r# ,,> r E Handwashing at appropriate times
3 �otentrally haz6o*sjoad urge#�*149a�gre�,r�qul�e�nenfs C �lfbs JV/A �4 O
during storageM040arat!on�,�fisplay;s(rvfga and tfariiilat"', X if,,9 ,.
r a« A' d hygienic;prattjces� �� �� a� � � ; `C. ;(�a>
0 x r.R"s.kit:.C: Y4 .,•:.:. ..
A Hat holding greater than or equal to 140 F. (whole beef/porkmasls330°F.) A ❑ No eating ❑ No smoking while working
B lCold holding less than orequalto45 F. B Wounds covered adequately
C I Proper cooling C Proper sink used for handwashing
D Proper re-heating
E Proper internal cooking i consumer advisory posted
4` rfiltiriElori.rirSse(hot:water�'cheirneal) CNIQ 1
0 Approved sanitizer availableladequate concentration of sanitizer
a Adequate4aciIAI64j 0 triaint941"Illduct� � �[N71�I[�(A; 1 B Food-contact surfaces and utensils used for potentially
t a o�1' ters �i "* f ! hazardous food sanitized at least every 4 hours
A Food thermometeravailableantlaccurate C Adequate Xis hwashersanitizer ❑final rinse temp
D Proper sanitizin rocedure
B Properfoodlhermometerforproduct
E Sanitizing between raw animal origin&ready-to-eat food
C Thermometers appropriately placed in cooler units 0
0 ; 5 'Clean wiping cloths C NO N/A ,1
r la} ger yr a an i transp�artatal@n� a A Cloths and/or sponges in good repair and clean
' � 'w B Wiping cloths kept in sanitizer between uses
A Produce washed
B Raw meats not stored/prepared near read y-to-eat foods11 od-contactsurFac l C *O
C Food covered properly Food equipment clean,utensils clean,equipment interiors clean IT
D Adequate splash guards 1 sneeze guard B Single use gloves changed when soiled
E No unauthorized personnel C Food--contact surfaces clean
F pooling of eggs not cooked immediately 0
8 �F od containers stored off the floor 3D n router antler pressure,proJided as`require iN1A
d cessgrle& iovided KE ,C N10 ,
I ; Handlrglg�af foodsmrnrmrzed C NIO NIA '2 p� '
A No unnecessary handling RTE and/or cooked foods with bare hands Soap I paper towels I drying device available
B Dispenser(s)working: ❑Soap ❑Paper towel AL
B Minimize food handling,other than ready-to-eat,with bare hands C Handwash sinks)clean/waste receptacle at handwash sink
C Adequate utensil(s)for dispensing foodhce p
i _il
O •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: 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 i1I ass are you required to report to the local health department?
Roasts Other
Describe re-heating procedures: Is there a written illness p !cy that requires the food worker to report specific illness conditions
Are temperatures recordedliogged for cold holding foodslequip nt? Y N and diseases to the OF . Y N *Do you have a paid sick leave policy? Y N
Are foods cooked in advance and cooled Y N *Are Rovers saved? Y N Is there a language rrier between inspector&QFO? Y N If yes indicate language spoken
List products cooled' by OFOlDA: ♦Can the QFO/DA read the inspection report? Y N
Describe cooling methods: Indicate who answered the above questions: Name(print):
Indicate the title of above person clrctf all that apply):QFO DA Mgr Cook Owner FW
Is cooling monitored for time&temp? Y N Is the onitoring of cooling recorded? Y N .Obtain signature of the person o r ived the QFO responsibilities information at the time of the
Is there a produce washing policy? Y N ♦De tribe what is washed and inspection:
where: Note: This r port is a two Ae form(total of 62 deb!table items) Page 1 of 2
GON, ICIIT DEPAR MENT OF PIIBLIC�HEALTH 410 CAPITQL AVE1NU MS#51 FOP HARTFORD;CT 06134°
Fi�CUSED Fp011 SEIivilrc INSPgCT 1� RPI'aIL a
L�OAL HEALTH t]EPT:' V� / J�sr) y ADDRESSICITY:
Establishment: � ti�.� ?N ! of-� L� Date of1nspectton: / i
dd'ressix"�11r Owner or Operator � JtJf +
ADDITIONAL FOUR POINT ITEMS
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,backffow !
4 Proper typelinstallation/backflow rreeyentjon device/air gap for:
-Stored properly,labeled properly,used properly -Food equipment -Hose connections -Dish machines
-Sanitizer concentration notto exceed maximum permitted -Soda system carbonator -Beverage dispensers -Toilet tanks
-No unnecessary toxics on the premises -Chemical dispensers -Ice machines
-Pesticides/rodenticides properly dispensed Proper drain 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�j
-Water quality in compliance
-Monitoring in compliance designed,properly installed
OTHER ITEMS KEY: DNC [DOES NOT COMPLY]
t-
ourcesoffood: Originalcontainer,properlylabeled P 0 Garbage/rubbish storagearea/rooms,enclosures-properly constructed,clean 1
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 2 Vermin Control: No insects/rodents present 2
14 Food worker:Clean outer clothes,effective hair restraints 1 3 ropenings protected against entrance ofinsects/rodents 1°
4 oors: Floor covering installed,constructed as required,good repair,clean
16 Food-contact surfaces designed,constructed,maintained,installed, 5 Floors graded,drained as required
Gated
6 Floor,walljuncture covered
17 nfood-contact surfaces designed,constructed,maintained, 7 Mats removable,good repair,clean
installed,located
$ Exterior walking,driving surfaces,good repair,clean1'
18 Single service articles,storage,dispensing
19 No reuse of single service article 9 Walls,ceilings attached,equipment properly constructed,good 1
repair,clean.Wall&ceiling surfaces as required
20 Dishwashing facilities approved design,adequately constructed, 2 €1
maintained installed located 50 Dustless cleaning methods used,cleaning equipment properly stored
x1 ;
51 Adequate lighting provided as required 1s
21 Preflushed,scraped,soaked and racked 52 Room free of steam,smoke odors 1
2 Wash waterclean,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 3
55 Establishment and premisesfreeof lifter,noinsect/rodentharborage, 1
28 Equipmentlutensils,storage,handling 1:' no unnecessary articles
32 Properdisposalofwastewater 1 56 Complete separation from living/sleepingquartersandlaundry 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)posted at
37 Proper toilet fixtures provided,good repair,clean entrance(s),smoking area indicated by sign(s) 3
39 Approved garbagelrubbish containers,adequate number,covered, l
rodent proof,clean QRoutine Inspection ❑Reinspection ❑ Preoperational Inspection
IN PERSON IN CHARGE: Other Inspection:
Demerit Score: *Include demerits from page 1
4 3 2 1 Total Rating
sl nature signature
RA,pli name print name
phone number title DATE CORRECTIONS DUE:
� � Page 2 of 2 plus continuation pages Focused Inspection 112002
Page / of
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INSPECTION REPORT STATE OF CONNECTICUT
FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH
CONTINUATION SHEET
NAME OF ESTABLISHMENT TOWN DATE OF INSPECTION
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INSPECTION REMARKS
FORM#
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INITIAL(INSPECTOR) W AL(PE ON IN CHARGE)
Distribution: I st-White-Health Department 2nd-Yellow- Owner/Manager
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INSPECTION REPORT STATE OF CONNECTICUT
FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH
CONTINUATION SHEET
NAME OF ESTABLISHMENT TOWN DATE OF I72--e
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INSPECTION REMARKS
FORM#
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INITIAL(INSPECTOR) INITIAL(PERSON IN CHARGE)
Distribution: Ist-White-Health Department 2nd-Yellow-Owner/Manager