HomeMy WebLinkAboutFood Service Establishment Inspection 96 Establishment: s Inspection Date: I Time: a in RE[nsp
Address/City: OttoS �kA�,1> 6}�. 1Pw Health Dept: : 1 2 3�
Based on an inspection this day,the items marked DNC identify a violations in operation or facilities which must be corrected by the date specified on page 2.
JR1,1!K FACTOR ITEMS:Listing is not inclusive of all possible debitable item C N10 NIA DNC KEY: C[complies] NIO[not observed] NIA[not applicable]
3 DNC[does not comply] 0[other] RTE[ready to-eat]
1 q l .P st nt wi i y# !f � #t e C2 A Food workers have no exposed infected lesions!burns
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B Personnel with infection restricted
dtsinrcet Whq 1(o u 6 ( ] la NTH CC Communicable disease of worker reported to local health director
A 1 Approved shellfish,finfish,meat& oult USDA approved "1 s i ffaciilttesipo [ Ifi dauiittshedcleanCQ
B Food cans in good condition(not dented,rusty,bloated,leaking) ' ' '` p�
A Handwash facilities in all food prep/dispensing&warewash areas
C Wholesome/nonadulterated foods/safe B Handwash facilities in or immediately adjacent to toilet rooms
D Commercial products(no home grown/canned food) C Handwash facilities accessiblelconvenient to use
E Potentially hazardous foods received at proper temperature D Personnel hands washed,clean/Proper handwash procedure
0 E Handwashing at appropriate times
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A Hot holding greater than or equal to 140°F. (wholebeaupork roasts 130oF.) A ❑ No eating ❑ No smoking while working
B Cold holding less than or equal to 450 F. B Wounds covered adequately
G I Proper cooling C Proper sink used for handwashing
D Proper re-heating 0
1IN �s 1trniatpl �lal CI 0�N1A
E Proper internal cooking l consumer advisory posted
0 A Ap proved sanifter available/adequate concentration ofsanitizer 401
i eor�a ndig g Food contact surfaces and utensils used for potentially
ice
hazardous food nitized at least eve ry 4 hours
A Food thermometer available and accurate C Adequate dishwashersanitizer ❑final rinse temp
D Pro ersanitizin procedure
B Proper food thermometer for product E Sanitizing between raw animal origin&ready-to-eat food
C Thermometers appropriately placed in cooler units O
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a A Cloths.and/or sponges in good repair and clean .
B Wiping cloths kept in sanit'izer between uses
A Produce washed 0
B Raw meats not stored/prepared near ready-to-eat foods Qp f i 4C ltA
C Food covered properly A Food equipment clean,utensils clean,equipment interiors clean
D Adequate splash guards sneeze guard B Single use gloves changed when soiled
E No unauthorized personnel C Food--contact surfaces clean
F No pooling of eggs not cooked immediatelyo
8 Food containers stored off the floor
adtc DH1od wd ttrs rovidedrasxrequ]re
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t r - Soap I paper towels 1 drying device available
A No unnecessary handling RTE andlor cooked foods with bare hands 60 Dispenser(s)working: ❑Soap ❑Paper towel
B Minimize food handling,other than ready-to-eat,with bare hands C Handwash sink(s)clean 1 waste receptacle at handwash sink
C Adequate utensil(s)for dispensing foodlice p
0 •DESCRIBE DEFICIENCIES ON CONTINUATION SHEETS
The following information is not debitable and does not affect your score. _M: 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 you required to report to the local health department?
Roasts Other
Describe re-heating procedures: Is there a written illness policy that requires the food worker to report specific illness conditions
Are temperatures recorded/logged for cold holding foods/equipment? 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 between inspector&QFO? Y N ff-M indicate language spoken
List products cooled: by QFOIDA: +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(circle all that apply):QFO DA Mgr Cook Owner' FW
Is cooling monitored for time&temp? Y N Is the monitoring of cooling recorded? Y N .Obtain signature of the person who received the QFO responsibilities information at the time of the
Is there a produce washing policy? Y N *Describe what is washed and inspection;
where: Note: This report is a two Wa farm(total of 62 debitable items) Page 1 of 2
-3 � •
Establishment w :S_ Q *4 4,.4 'o - 4 .9*4,Ghl peg on
ddress: b 2. Owner or OperatdHW'4 -fit k
ADDITIONAL FOUR POINT ITEMS KEY: DNC [DOES NOT COMPLY]
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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
77 No cross connections,back siphonage,backflow
11 Toxic chemicals. 4
-Stored properly,labeled properly,used properly Pro per backflow prevention devicel air gap for:
-Sanitizerconcentration notto exceed maximum permitted -Food equipment -Hose connections -Dish machines
-No unnecessary radontoxic on the premises -Soda system carbonator -Beverage dispensers -Toilet tanks
-Chemical dispensers -Ice machines
-Pesticideslrodenticides properly dispensed Prover drain for:
29 Water source adequate,safe. 4 -Food equipment -Dish machines -ice machines
.
-Well f well head protected from contamination 35 Toilet facilities. Adequate,convenient,accessible, 4
-Water quality in compliance designed,properly installed
-Monitoring in compliance ,
OTHER ITEMS o,'' KEY: DNC [DOES NOT COMPLY]
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2 Sourcesoffood: Original container,properly labeled 1" 40 Garbageirubbishstoragearea/roams,enclosures-properly constructed,clean
5 Potentially hazardous food properlythawed 2 1 Garbagelrubbish disposed of in an approved manner,at approved frequency tF
10 Food dispensing utensils properly stored 1 42 Vermin Control: No insectslrodents present
14 Food worker:Clean outer clothes.effective hair restraints 1 43 Outeropenings protected againstentranceofinsects/rodents
44 Floors: Floor covering installed,constructed as required,good repair,clean 1
16 Food-contact surfaces designed,constructed,maintained,installed, 2 45 Floors graded,drained as required
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6 Floor,wall juncture covered
17 No food-contact surfaces designed, constructed, maintained, 1 7 Mats removable,good repair,clean
nstalled,located
18 Single service articles,storage,dispensing 2
48 Exteriorwa[king,driving surfaces,good repair,clean
19 No reuse of single service article 49 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
Equipment&Utensils: Cleanliness 1 51 Adequate lighting provided as required
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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 required
231 Accurate thermometers provided,dish basket,if used 54 Rooms adequate,clean,adequate lockers provided,facilities clean
271 Nonfood contact surfaces of utensils&equipment clean 1 55 Establishment and premisesfreeoflitter,no insect/rodent harborage,
28 Equipmentlutensils,storage,handling 1` no unnecessary articles
56 Complete separation living/sleepinguarters and laundry
32 Proper disposal of waste wafer 1 '! P P q
33 Plumbing location,installation,maintenance 1 57 Clean/soiled linens stored properly t
581 No live birds,turtles,or other animals(except guide dogs)
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) pp
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39 Approved garbagelrubbish containers,adequate number,covered, 1:
rodent proof,clean IRRoutine Inspection ❑Reinspection ❑ Preoperational Inspection
INSPECTOR: PERSON
Other Inspection:
Demerit Score: •Include demerits from page 1
05— 4 3 2 1 Total Rating
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Acne number ties DATE CORRECTIONS DUE:
�' Page 2 of 2 plus continuation pages Focused Inspection 1/2002
Page ? of
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INSPECTION REPORT STATE OF CONNECTICUT
FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH
CONTINUATION SHEET
NAME,OF ESTABLISHMENT TOWN y DATE OF 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