HomeMy WebLinkAboutFood Service Establishment Inspection 29 _es
Establishment: Inspection Date: 1 q /6 Time: Ro[ns insp
ddresslCity: /' Health Dept: S class t
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 DNC KEY: C[complies] NIO[not observed] NIA[not applicable]
fib m pera}Qr 3 DNC[does not comply] 0[other] RTE[ready to-eat]
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12 Personnel with infection restricted C [N10".WA 4
tit lDesl6fik Altemate u 2
N' Food workers have no exposed infected lesions 1 bums
ften tlocumentatror►aftrainirtg pro�ratn 2
B Personnel with infection restrictedLe
t �ppr'oyed source°Y hlesa N0 Io V .
_ C Communicable disease of worker reported to local health director
isA ed,cA Approved shellfiish,fnfsh meat& Dull USDA a roved 93 d lean `C 0 N/A 4F fctpve
B cans in good condition(not dented,rusty,bloated,leaking) A Handwash facilities in all food prepldispensin &warewash areas
C Wholesomelnonadulteratedfoods!safe B Handwash facilities in or media ey d] cent to toilet rooms
D Commercial products(no home grownlcanned food) 4 C Handwash faci' es ac "IyAw6nieni to use
E Potentially hazardous foods received at proper temperature D Personnel h wa a handwash procedure
E Han dwashin propriate times
3 t?otehltlatl ti ftt�tte a�'ttte8f to Yam rQg4rlrerrte � 0 NIA 4 0
during4 Ora ge,pTparation display,srrvIt Intl transporiatrori'
A Hot holding greater than or equal to 140 F. (V r ois beefiPork roasts Sao°e) sG A ❑ No eating Q No smoking while working
B Cold holding less than or equal to45°F. B Wounds covered adequately
C Proper cooling C Proper sink used for handwashing
D Proper re-healing
E Proper internal cooking 1 consumer advisory posted
i#!lotion Yiriee h'fi`water; ° r ]NIp' NIA °?
p Approvedsanit;zeravailableladequate centrationofs niGze
[4 �,,ArdO-44k"F �ii% r i ¢� �(Jj�j tNJp � ) B Food-contact surfaces and utensils used for loo—telfMally
t t@ttit� ,herrnb�rne;tett; rovtt! hazardous food sanitized at least every 4 hours
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A Food thermometer available and accurate C Adequate ❑dishwashersanitizer ❑final rinse temp
D Proper sanitizin rocedure
B Properfood thermometer for product E Sanitizing between raw animal origin&ready-to-eat food
C Thermometers appropriately placed in cooler units
0
Cloths andlor sponges in good repair and clean
A Produce washed B Wiping cloths kept in sanitizer between uses
- � 0
B Raw meats not stored/prepared near ready-to-eat foods
C Food covered properly A Food equipment clean,utensils clean,equipment interiors clean
D Adequate splash guards I sneeze guard B Single use gloves changed when soiled
E No unauthorized personnel 64 C Food--contact surfaces clean
F No pooling of eggs not cooked immediately 0
8 Food containers scored off the floor0 #tee"antler prps ure,prbvtderi aS;fequ[r0tl<
f `. dw�s fting casssori�s provided: . F C i CI ttglA 1-
- r mir»tz ,: .�� '- „ -�- =_ �G.iN�O�NlQ¢ 2, A Soap I paper towels/ drying device available
A No unnecessary handling RTEandlorcooked foods with bare hands 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 p
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 allemate],PHF[potentially hazardous food],FB[feodborne]
PHFs are hot held at: IF. Pl are cold held at: OF. Describe illness conditions when you would exclude a food w from working:
Are internal cooking temperatures taken? Y N ♦To what temperature do you cook:
Poultry Ground Beef Pork 1hat diseases related to FB illness are you requ' o report to the local health deparlment?
Roasts Other
Describe re-heating procedures: Is there a written illness policy tha Tres the food worker to report specific illness conditions
Are temperatures recordedilogged for cold holding foods/equipment? Y and diseases to the QFO *Do you have a paid sick leave policy? Y N
Are foods cooked in advance and cooled Y ♦ re left saved? Y N Is there a language barrier between inspector&QFO? Y N l indicate language spoken
List products cooled: by QFOIDA: ♦Can the QFOIDA read the inspection report? Y N
Describe cooling methods: Indicate who answered the above questions: Name(print):
Indicate the title a person(circle all that apply):QFO DA Mgr Cook Owner FW
Is cooling monitored for Time&temp? Y N the monitoring of cooling recorded? Y N ,obtain at re of he person who received the QFO responsibilities information at the time of the
s there a produce washing policy? Y N ♦Describe what is washed and in
ction: �
where: Note: fhihereport is a two page form(total of 62 debitable items) Page 1 of 2
Establishment: Date.of Inspection
ddress '/ Owner,orOperl3tor;:. fN� �.•
ADDITIONAL SOUR POINT ITEMS #2KEY: DNC [DOES NOT COMPLY]
6 Foods not re-served.
4 31 Sewage disposal approved.
-Unwrapped foods not re-served 4;
-Potentially hazardous foods not re-served K. -Operating as required
11 Toxic chemicals. No cross connections,back siphonage,backflow 4,
4 Proper tyypelinstallation/backflow rreeyeniiQn device/airaaofor:
-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:
-Food equipment -Dish machines -Ice machines
29 Water source adequate,safe. 4
-Well/well head protected from contamination jd�esigoilet facilities. Adequate,convenient,accessible, 4
-Water quality in compliance
-Monitoring in compliancened,properly installed
OTHER ITEMS KEY: DNC [DOES NOT COMPLY]
2 Sourcesoffood: Original container,properly labeled 1 0 Garbagetrubbishstoragearealrooms,enclosures-properly constructed,clean
41
5 Potentially hazardous food properlythawed 2,, 41 Garbagelrubbish disposed of in an approved manner,atapproved frequency
10 Food dispensing utensils prop erly stored 42 Vermin Control: No insectstrodents present 2
14 Food worker,Clean outer clothes,effective hair restraints 43 Outeropenings protected against entrance of insects/rodents t:
4 Floors: Floor covering installed,constructed as required,good repair,clean 1
6 od-contact surfaces designed,constructed,maintained,installed,
g ,2; � 5 Floors graded,drained as required
located
6 Floor,wall juncture covered
17 Nonfood-contact surfaces designed,constructed,maintained, 1: ] Mats removable,good repair,clean
installed,located 1
8 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 €1
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 1
Equipment&Utensils: Cleanliness 1 ' 51 Adequate lighting provided as required1v;
21 Preflushed,scraped,soaked and racked 52 Room free of steam,smoke odors
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22 Washwaterclean,proper temperature 53 Rooms&equipment hoods,ducts,vented as required
231 Accurate thermometers provided,dish basket,if used 54 Rooms adequate,clean,adequate lookers provided,facilities clean 1'
7 Nonfood-contact surfaces of utensils&equipment clean 1
55 Establishment and premises tee of litter,noinsectlrodentharborage, 1
$ Equipmentlutensils,storage,handling 1 no unnecessary articles
32 Proper disposal of waste water 1 56 Complete separation from living/sleeping quarters and laundry
33 1 Plumbing location,installation,maintenance 1
57 Clean/soiled linens stored properly t"1
581 No live birds,turtles,or other animals(except guide dogs) 1
36 Toilet rooms enclosed with self-closing door 1 n
59 Seats 75or more:Nonsmoking area provided,signs)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, 1
rodent proof,clean ❑Routine Inspecti n Reinspects Preoperational Inspection
INSPECTOR: PERSON INCHARGE: Other Inspection:
QomffiL5_c_are: *Include demerits from page 1
C,�c _. 4 3 2 1 Total Rating
re signature
pr name print name & Z7 � 3 -
} DATE CORRECTIONS DUE; L /
phone number title
Page 2 of 2 plus continuation pages Focused Inspec on 112002
I a�vPage off
INSPECTION REPORT STATE OF CONNECTICUT
FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH
CONTINUATION SHEET
NAME OF ESTABLISHMENT TOWN DATE O INSPECTION
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INSPECTION REMARKS
FORM#
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INITIAL(INSPECTOR) INITIAL(PERSON IN CHARGE)
Distribution: 1st-White-Health Department 2nd-Yellow-Owner/Manager
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