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HomeMy WebLinkAboutFood Service Establishment Inspection 19 1 Establishment: w inspection Date: (,fflq Time: o[nsp RE[nsp Address/City: �� -}6'n,, 1( �f [; \,j� . Health Dept: '�_ W ; r\ j r : 1 z 3( Based on an inspection this day,the items marked DNC identify t 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 G 0 1 NIA JDNC I KEY: C[complies] NIO[not observed] NIA[not applicable] � .#' , � DNC[does not comply] 0[other] RTE[ready-to-eat] t eEQpstof - 3 412s�Rerso'nnel=withtnfection re`trip# d`"; " &IQndt@d'Alt@Fndt@?r �r #A ,a -'. xy� ,i 2 411 .x. n, a V, 46� � � �" A Food workers have no exposed infected lesions 1 burns %Wriften=documentatirfn of trainingspro ram 2 B Personnel with infection restricted +� approverllsource,wholesnnte,nonedulterat�d� w � N10 N1Ai -4 l t:k, C Communicable disease of worker reported to local health director A I Approved shellfish,finfish,meat&poultry USDA approved 1� i Wandwashtng fao$lit�es pt-ovrde ,'h nds�washed,glean.", .G 1 � NIA:Ca= B Food cans in good condition(not dented,rusty,bloated,leaking) A e Handwash facilities in all food prep/dispensing&warewash areas C Wholesomelnonadulteratedfoodslsafe B Handwash facilities in or immediately adjacent to toilet rooms D Commercial products(no home grown/canned food} C Handwash facilities accessible/convenient to use E Potentially hazardousfoods received at proper temperature D Personnel hands washed,clean I Proper handwash procedure 0 E Handwashing at appropriate times Rotentid If t aSardotis bdd beet§taet tp�atuF re"u i eii 0O"� '` O drrf� s Rr&P6r�at-ron,�ispl4Yr 88 '"R airs � p .. - , r15 ootl8Y9ienicpracticesC A Hot holding greater than or equal to 140°F. (wholeheaupork roasts 1300F) ❑No eating ❑No smoking while working B Cold holding less than or equal to450F. B wounds covered adequately C Proper cooling V C Proper sink used for handwashing D Proper re-heating 0 s E Proper internal cooking consumer advisory posted 2 San"i i a io'r!ri s , i4t water ,cheinicai) +, C, :Q' N1Au 2_. 0 A Approved sanitizeravailableladequate concentration ofsanitizer SIXe fy t .10101 ie� p,mgi itdir T l j]�NjA B Food contact surfaces and utensils used for potentially tetr perature;tF etTnbfntster&plrb�iid 1 r '4 hazardous food sanitized at least every 4 hours ➢1f # � ffi� s a h - _ - t 9 � 1 i v, A Food thermometer available and accurate C Adequate shwashersanitizer ❑final rinse temp B Properfood thermometer for product L Proper san tizing procedure C Thermometers appropriately placed in cooler units E Sanitizing between raw animal origin&ready-to-eat food 0 0 25 4Cle infwipirigkcloths N1A 00 rdtectetlrditrrn��{{Mora�{e�'` e irate bit u/ a;�. � iceandstran5perta A Cloths and/or sponges In good repairand clean I—V` f B Wiping cloths kept in samtizer between uses A Produce washed 0 B Raw meats not stored/prepared near ready-to-eat foods gt tl G. c`s s :'l� C Food covered properly A Food equipment clean,utensils clean,equipment interiors clean D Adequate splash guards 1 sneeze guard B Single use gloves changed when soiled E No unauthorized personnel 6. C Food--contact surfaces clean F No pooling of eggs not cooked immediately 0 Food containers stored off the floor o d waerunder pressure*prGVided�as re�Uird, NfO YVlA, 1 4 0 .s g38F,anduah[ gaac4s&s0riea'provrdedLL� N10# N1A( � of �.. -. - k . .. .-. .- 9." �p6cf�minimizecf A ° . . ° tN1.( T 4 ' A No unnecessary handling RTE and/or cooked foods with bare hands A Soap l paper towels! drying device availableB 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 foodlice p 0 *DESCRIBE DEFICIENCIES ON CONTINUATION SHEETS The following information is not debitable and does not affect your score. fir: QFO[qualfied food operator],DA[designated alternate],PHF[potentially hazardous food[,FB[foodborne] PHFs are hot held at: IF. 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 foodslequipment? 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 ILM indicate language spoken List products cooled: by QFO/DA: *Can the QFOIDA 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: Thisreport is a two page form(total of 62 debitable ltems) Page 1 of 2 t Establishm(ennt: V1W—D6te of l isp tlbn: Address: - ��-- ,� � �y`_�_.___- --- Owner or Operator 6 6t ADDITIONAL FOUR POINT ITEMS Q KEY: DNC [DOES NOT COMPLY] 6 Foods not re-served. -Unwrapped foods not re-served 4 31 Sewage disposal approved. -Potentially hazardous foods not re-served -Operating as required :;; No cross connections,back siphonage,backflow 11 Toxic chemicals. 4 Pro per type/insiallation/backflow prevention device/air ga for: -Stored properly,labeled properly,used properly -Food equipment -Hose connections -Dish machines -Sani nn 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 far: 29 Water source adequate,safe. 4 -Food equipment -Dish machines -Ice machines -Well/well head protected from contamination 35 Toilet facilities. Adequate,convenient,accessible, -Water quality in compliance -Monitoring in compliance designed,properly installed OTHER ITEMS ot;' KEY: DNC [DOES NOT COMPLY] 2 Sources of food: Original container,properly labeled 1 40 Garbage/rubbish storage area/rooms,enclosures-properly constructed,clean " I 5 Potential/ hazardous food properly thawed 2 41 Garba elrubbish disposed of in an approved manner,at roved frequency Y P P Y 9 P PP PP q Y 10 Food dispensing utensils properly stored 1 42 Vermin Control: No insectslrpdents present 2 14 Food worker:Clean outer clothes,effective hair restraints 1 3 Outeropenings protected against entrance of insectslrodents 1 4 Floors: Floorcovering installed,constructed as required,good repair,clean 1 ood-contact surfaces designed,constructed,maintained,installed, 5 Floors graded,drained as required ocated 46 Floor,wall juncture covered 17 onfood-contact surfaces designed,constructed, maintained, 7 Mats removable,good repair,clean installed,located 1$ Single service articles,storage,dispensing 2 48 Fxteriorwalking,driving surfaces,good repair,clean 3 19 No reuse of single service article 9 Walls,ceilings attached,equipment properly constructed,good ' 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 21 Preflushed,scraped,soaked and racked 52 Room free of steam,smoke odors 22 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 1 271 Nonfood-contact surfaces of utensils&equipment clean 1 55 Establishment and premisesfree of litter,no insect/rodent harborage, 1 28 Equipmentlutensils,storage,handling 1- no unnecessary articles 32 Proper disposal of waste water 1' 56 Complete separation from living/sleeping quarters and laundry 33 Plumbing location,installation,maintenance 1' 57 Cleanlsoiled linens stored properly 58 No live birds,turtles,or other animals(except guide dogs) 1 36 Toilet roomsenclosedwith self-closing door 1 59 Seats or more:Nonsmoking area provided,sign(s)posted at 37 Propertoiletfixturesprovided,good repair,clean entrance( s),smoking area indicated by sign(s) 39 Approved garbagelrubbish containers,adequate number,covered, 1 rodent proof,clean 911outine Inspection ❑Reinspection ❑ Preoperational Inspection Other Inspection: IN PECTOR: PERSON IN CHARGE: Demerit Score: *Include demerits from page 1 4 3 2 1 Total Rating si ature slgnatur I pr n me print name Cone nu m er title �r DATE CORRECTIONS DUE: [� Page 2 of 2 plus continuation pages Focused Inspection112002 Page,3 Of INSPECTION REPORT STATE OF CONNECTICUT FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH CONTINUATION SHEET NAME OF ESTABLISHMENT TOWN DATE OFF INSiP[ECTION INSPECTION REMARKS FORM# irl3l \Yl cow 1L `ceol E'� Ca © cdot DID ac(c Ac V s 0a h_ QAA l INITIAL(INSPECTOR) INITIAL(PERSON IN CHARGE) Distribution: I st-White-Health Department 2nd-Yellow-Owner/Manager