HomeMy WebLinkAboutFood Service Establishment Inspection 25 Establishment: tV/Z L,d,ns.s SSe rze&j= Inspection Date: /, Time: l6 j RO[ns REinsp
Address/City: tv Health Dept:_ , i.�J,u/.P.25At� class: 1 2�4
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 NA JDNC I KEY: C[complies] NIO[not observed] NIA[not applicable]
3k EfiQ 'Qaahfted Foad operator' 3 DNC[does not comply] 0[other] RTE[ready to-eat]
51 Designated=lllternate N
2 12 Personnel with Infection restricted N'0 N/A ,4...
A Food workers have no exposed infected lesions I burns
67 Written documentation of training program dl 2 B Personnel with infection restricted
1 ]Approved source,wholesome,noiiadulterated =.: :C nI10 N!A"4 C Communicable disease of worker reported to local health director .0
A Approved shellfish,finfish,meat 8,poultry USDA approved 13 Handwashing facilities provided;hands washed;clean:,C �NIQ NIA; 4
B Food cans in good condition(not dented,rusty,bloated,leaking) A Handwash facilities in all food prepldispensing&warewash areas
C Wholesomelnonadulterafedfoodslsafe B Handwash facilities in or immediately adjacent to toilet rooms
D Commercial products(no home grownicanned food) C Handwash facilities accessiblelconvenient to use
E Potentially hazardous foods received at proper temperature D Personnel hands washed,clean I Proper handwash procedure
E Handwashing at appropriate times
3 1Potentialiy hazardous food meets temperature requirements C t�l0 `N1A 4 p
darinstorage,preparitloii,display,service and fran'spartahon!
t' A , 15 Good=hygienic practices
r. 2
A Hat holding greater than or equal to140°F. (whole beef/pork masts 1309F.) A ❑No eating ❑ No smoking while working
B Cold holding less than or equal to45°F. At B wounds covered adequately
C I Proper cooling &I C I Proper sink used for handwashing
D Proper re-heating 0
E Proper internal cooking I consumer advisory posted E24):Sanitrzationririse�(htotbvat r .chemical),k C 1N10iIJlA.
0 T Approved sanitizeravailableladequate concentration ofsanitizer
4 �` Aiielcjga(te facilities t rtf intarn pteduct M-w v C 'N O INIA 2 g Food-contact surfaces and utensils used for potentially
Q;,.to
temperatures theniiometers prowled + 3 ,, k hazardous food sanitized at least every 4 hours k
k c..r..5�`X:: '"k:...•'L.rkt'.� +r,•4 1#J i x 0 C;::h
A Food thermometer available and accurate C Adequate ❑dishwashersanitizer ❑final rinse temp
D Proper sanitizin rocedure
B Proper food thermometerfor product �C E Sanitizing between raw animal origin&ready-to-eat food
C Thermometers appropriately placed in cooler units 0
0 25 GI .an wi~r�[q cloths I {;NIA 1... .. .. ,.•,• �y " c «,:- - ni�' ,:. is d°�, # F..v
7 Frood:irotect 'A.Fintatorage,�sp epavatlor 4:.t• r [C Nj0 NI t2a
k, rr. �x a���.,-. .. .,, ;. l s k F= A Cloths andlorsponges in good repairand clean
d�spl 00.0vice:andstt6 Vpor t B Wiping cloths kept in sanitizer between uses
a�. .:u s r
A Produce washed 0
B Raw meats not stored/prepared near ready-to-eat foods p� tat surfa 'cteartg ^� �* F �NIO 1 t
C Food covered properly
Food equipment clean,utensils clean,equipment interiors clean
D Adequate splash guards/sneeze guard B Single use gloves changed when soiled �r
E No unauthorized personnel C Food--contact surfaces clean
F No pooling of eggs not cooked immediately 0
8 Food containers storedofflhefleor 3o ndcioltlw'i runderpressure;providet�rti;r fired„; INtOr°PIl�4, r2:;
0 8 dwashin`g aq`easQries provided; ;k x < C M1IJQ ,31
v }r�IIQ NIA ._ M ..
i ., ndlIng of¢foodamm�tnixedi, W,.,s, t.: <r k,l f €: Soap!paper towels 1 drying device available
A No unnecessary handling RTE and/or cooked foods with bare hands B
Dispenser(s)working: ❑Soap jt"elrla per towel
B Minimize food handling,otherthan ready-to-eat,with bare hands C Handwash sink(s)clean I waste receptacle at handwash sink
C Adequate utensil(s)for dispensing food/ice 0
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: 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 y u required to report to the local health department?
Roasts Other
Describe re-heating procedures: Is there a written illness policy that r54Ires the food worker to report specific illness conditions
Are temperatures recordedllogged for cold holding foods le ipment? Y N and diseases to the QFO? Y N *Do you have a paid sick leave policy? Y N
Are foods cooked in advance and cooled? Y N Are leftovers saved? Y N Is there a language barrier betty n inspector&QFO? Y N If ves indicate language spoken
List products cooled: by QFOIDA: +Can the QFOIDA read the inspection report? Y N
Describe cooling methods: Indicate who answerj
a above questions: Name(print):
Indicate the title of aba person(circle all thatPQF
):QFO DA Mgr Cook Owner FW
Is cooling monitored for time 8 temp? Y Is the monitoring of cooling recorded? Y N .Obtain signatu tperson who rec ' d ttresponsibilitles information at the time of the
Is there a produce washing policy? Y N +Describe what is washed and inspection: /
where: to: This report is a two page form(total of 62 MbAble items) Page 1 of 7271
Page_of J_
INSPECTION REPORT STATE OF CONNECTICUT
FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH 6 F
CONTINUATION SHEET
NAME OF ESTABLISHMENT TOWN DATE OF INSPE TION
s
INSPECTION REMARKS
FORM#
3 1 Y3
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INITIAL(INSPECTOR) INITIAL(PERSON IN CHARGE)
Distribution: 1st-White-Health Department 2nd-Yellow- Owner/Manager
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w� 1540 SULLIVAN AVENUE• SOUTH WINDSOR, CT 06074
MOsOR•c0�� TELEPHONE(860)644 2511
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I
j February 18,2016
Alicia Forst,Store Manager
Williams Sonoma
200 Evergreen Way
South Windsor,CT 06074
Subject:Qualified Food Operator Requirements
Williams Sonoma,200 Evergreen Way,South Windsor, CT
Dear Alicia Forst:
On February 17,2016, 1 conducted an inspection of the above subject food service establishment.
During the course of my inspection I requested a copy of the Qualified Food Operator Certificate.
Chris DiPippo,the Assistant Manager, requested I contact you to determine who the current QFO
was for your establishment.
After speaking with you on the telephone that afternoon,you stated that one of your employees
was indeed ServSafe Certified,and you would send me a copy of the document as soon as you were
able.You also stated that your establishment only performs food demonstrations on Sundays;
however,this does not excuse you from meeting the requirements of the CT Public Health code
section 19-13-1342(s)(4), since you cook and serve potentially hazardous food at the
demonstrations.A copy of the QFO requirements were given to Chris DiPippo at the time of the
inspection. I have also enclosed a copy of the QFO and Designated Alternate forms with this letter.
Please submit a copy of the QFO's training document and QFO/DA forms by email or send by postal
mail as soon as possible. Also be sure to make the QFO and Designated Alternate documents and
training records available at your establishment upon request of the local health inspector.
Thank you for your attention to this matter,and if you have any questions or comments,do not hesitate
to contact me at this email address:diane.collelo@southwindsor.org,or call my office at 860-644-2511
ext.248.
Regards.,
�,� •.�° /
ane L. Collelo
Environmental Health Specialist
Enclosures