HomeMy WebLinkAboutFood Service Establishment Inspection 17 (2) -
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Establishment: Inspection Date: r Time: /p insp Einsp
Address/City: Heal h Dept: 2 C4
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 NIA DNC KEY: C[complies] NIO[not observed] NIA[not applicable)
60 I Qualrfred FbOti�Operator 9 DNC[does not comply] 0[other] RTE[ready-to-eat]
`Personnel with:infection re'sfrtcted K
6f r Qegndted Alternate x; 2 G rNlt)[NIA 4
A Food workers have no exposed infected lesions l burns
Fiften documentation of tralnitt program
B Personnel with infection restricted
E1 E pprpved Nl
source,wholesome,rich ulterated tC 4
_ municable disease of worker reported to local health director
A Approved shellfish,finfish,meat&poultry USDA approved H dwashtng facihties provided;handswashed,clean C NlO.i 4
B Food cans in good condition(not dented,rusty,bloated,leaking) Handwash facilities in all food prep/dispensing&warewash areas
C Wholesomelnonaduiterated foods/safe
B Handwash facilities in or immediately adjacent to toilet rooms
D Commercial products(no home grownicanned food) C Handwash facilities access!blelconvenient to use
E Potentially hazardous foods received at proper temperature D Personnel hands washed,clean I Proper handwash procedure
o>Eentiall hatardoti foodineets tem r E Handwashing at appropriatetimes
y perature reireatieri
i durmg=sto�ragg,prepar;tron,drsplaq
861161
sN[ o as nd tt.r ap poddtion. oodhy � NIQ
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A Hot holding greater than or equal to 1400F. (whole beevpork roasts 13DOF.) A o No eating ❑ No smoking while working
B Cold holding less than or equal to45oF. B wounds covered adequately
C Proper cooling C Proper sink used far handwashin
D Proper re-heating Al0
E Proper internal cookinglconsumeradvisoryposted 14t., nft�,ition ri se awaer ,chemical `C s]�/p 1 2'
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l Approved sanifizeravailableladequate concentration ofsanitizer
l4 ;;.rAdequate fa�' ii to maintarh�pfot� ct ..`,. W •� C i[�ps r gay Food-contact surfaces and utensils used for potentially
f femperarre;dtermometers provided s '" `y "{{ hazardous food sanitized at least every4 hours
A Food thermometer available and accurate C Adequate ❑dishwashersanitizer ❑final rinse temp
L Proper sanitizing procedure
B Properfood thermometer for product
E Sanitizing between rawanimal origin&ready-to-eat food
Cly'7 ermo meters appropriately placed in coolerunits
ean�w]ping Clbthbt '� `.a:a3 •, c rr r + t rt p,
totl protected dining storage,prep aatiir :• iC JN10' N 3'.
dis laf service and trans ortat [ a*0 �. s Clothsandlorspongesingoodrepairandclean
p a+� �* ^ ,
B Wiping cloths kept in sanitizer between uses
A Produce washed Jel
B Raw meats not storediprepared near ready-to-eat foods 6t Fo -contact rs`fi
C Food covered properly ood equipment clean,utensils clean,equipment interiors clean
D Adequate splash guards l sneeze guard
B Ingle use gloves changed when soiled
E No unauthorized personnel C Food--contact surfacesclean
0 ooNng of eggs not cooked immediately Q
od containers stored off the floor >, s
1664 go( wateraunde>spre su at"p�gvldel as:requlred r Q NJIfi 3
Q .+a..,ti::tMS�'r :b�fit.F+xF va+xAb :. a r Y:.A €F
dwash..in""a�ceasoie's provided ''' �; x fC
tl%;I yFlandim>g?of o rniin m�zed; [Gt N10 N!A I A�Soap l paper towels l drying device available
A No unnecessary handling RTE and/or cooked foods withpap
bare hands B Dispenserertowking: ❑Soap ❑Papertowel
B Minimize food handling,otherthan ready-to-eat,with bare hands C Handwash sinks)clean!waste receptacle at handwash sink Ise
C Adequate utensil(s)for dispensing foodlice Q
0 1 •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 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 polley.that requires the food worker to report specific illness conditions
Are temperatures recordedflogged for cold holding food slequipmem? Y N and diseases to the QFO? Y N *Do you have a paid sick leave policy? Y N
Are foods cocked in advance and cooled? Y N *Are leftovers aved? Y N Is there a jarrguage barrier between inspector&QFO? Y N If yes indicate language spoken
List products cooled: by FPfk *Can the QFOIDA read the inspection report? Y N
Describe cooling methods: I icate who answered the a ve estions: ame(print):
Is cooling monitored for time&tamp? Y N Is the monilori of cooling recorded? Y N .ndicate the title of oho e p on ircle all th apply):QFO DA Mgr Cook Owner FW
Obtain signature f t rson w o received a CFO a e ime of the
Is there a produce washing policy? Y N *Describe w at is washed and inspection:
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where: Note: This repo two page f I of 62 debits I Page 1 of 2
ST T OF CONNECTICU I r DEPgRTMENT OF PIISLi HEALTH 410 C`APITQ�AVENUIE-MS#51FDP-HARTFORD,CT 06134'
UD SR[�IC INS7CTI011T REPORT
ALFH I EPT �1QDliESS>rCITY:
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Establishment: ' " : r Dane of.,Inspection:
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dotes .. a..< Qwner..ar Operator:.
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ADDITIONAL FOUR POINT ITEMS KEY: DNC [DOES NOT COMPLY]
6 Foods not re-served. 'M!
-Unwrapped foods not re-served 31 Sewage disposal approved.
-Potentially hazardous foods not re-served -Operating as required
1 Toxic chemicals.
No cross connections,back siphonage,backflow
1 4
4 Proper typelinstallationl backflow prevention device/air gap for:
-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 unnecessarytoxics on the premises -Chemical dispensers -Ice machines
-Pesticideslrodenticides properly dispensed Proper drain lid
29 Water source adequate,safe. -Food equipment -Dish machines -Ice machines
4
-Well/well head protected from contamination ]Ldesn
ties. Adequate,convenient,accessible, 4
-Water quality in compliance-Monitoring in compliance roperly installed
OTHER ITEMS z Z
0 KEY: DNC [DOES NOT COMPLY];
2 Sources of food: Original container,properly labeled 0 Garbagelrubbishstoragearea/rooms,enclosures-properlyoonstructed,dean
5 Potentially hazardous food properly thawed Z 1 Garbage/rubbish disposed of in an approved manner,at approved frequency
10 Food dispensing utensils properly stored 1" 2 Vermin Control: No insects/rodents present `Z,
14 Food worker:Clean outer clothes,effective hair restraints i` 3 Outeropenings protected against entrance of insects/rodents 1<
4 oors: Floor covering installed,constructed as required,good rep ir,clean"
1 ood-contacl surfaces designed,constructed, maintained,installed, 5 Floors graded,drained as required
ted
6 Floor,wall juncture covered
17 No ood-contact surfaces designed,constructed,maintained, 7 Mats removable,good repair,clean
installed,located
S Exterior walking,driving surfaces,good repair,clean It'
18 'Single service articles,storage,dispensing 2:
19 No reuse of single service article 491 Walls,ceilings attached,equipment properly constructed,good ;1`u
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 propedy stored
Equipment&Utensils' Cleanliness ` .
1, 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 t „
required t _;
24 urate thermometers provided,dish basket,if used Rooms adequate,clean,adequate lockers provided,facilities clean '1
2 nfood-contact surfaces of utensils&equipment clean
5 Establishment and premises tee of liter,no insect/rodent harborage, ;1
8 qumentlutensiis,storage,handling Ir P no unnecessary articles
2 Proper disposal of waste water 1: 56 Complete separation from living/sleeping quarters and laundry 1
33 Plumbing location,installation,maintenance 1 57 Clean/soiled linens stored properly 1
59 No live birds,turtles,crother 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 entrance(s),smoking area indicated by sign(s) 3
39 Approved garbage/rubbish containers,adequate number,covered, 1;
rodent proof,clean t. aRoutine Inspection ❑Reinspection O Preoperational Inspection
CTOR: PERSON IN CHARGE: ther Inspection:
Demerit Score: *Include demerits from page 1
4 3 2 1 Total Rating
signature signature
�- 1pant name / print name iQ _
617 �// ----�--- DATE CORRECTIONS /DUE: v phone �-
number title .�
e.Q Page 2 of 2 plus continuation pages Focusedlnspection 11200
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NAME OF DATE OF •
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INSPECTION REPORT STATE OF CONNECTICUT
FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH
CONTINUATION SHEET
NAM/E�OF ESTABLISHMENT TOWN DATE OF INSPECTION
INSPECTION REMARKS
FORM#
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INITIAL{INSPECTOR) INITIAL(PERSON IN CHARGE)
Distribution: I st-White-Health Department 2nd-Yellow- Owner/Manager
Page of
INSPECTION REPORT STATE OF CONNECTICUT
FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH
CONTINUATION SHEET
NAME OF ESTABLISHMENT TOWN DATE OFF INSPE TION
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INSPECTION REMARKS
FORM#
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INITIAL(INSPECTOR) INITIAL(PERSON IN CHARGE)
Distribution: 1st-White- ealth Department 2nd-Yellow-Owner/Manager
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