HomeMy WebLinkAboutSchool Inspection 949 Avery Street ,.jSTTE t)F(ONtvE(TItJq � A1I E1IN9I'- � 1OF.:xPUBI'IG HEA{{LIxH
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Establishment: Inspection Date: Time:lZ� ROi sp Einsp
Address/City: Health Dept: `A class: 1 2 3
Based on an inspection this day,the ifLems 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 debatable items CIO NIA DNC I thy; C[complies] NIO[not observed] NIA[not applicable]
60 _Qualified Food Operator 3 DNC[does not comply] O[other] RTE[ready-to-eat]
61 Designated`Alternate 2
12 Personnel with infection restricted N10 NIA 4
A Food workers have no exposed infected lesions I burns
62 Written documentation of training program 2
B Personnel with infection restricted
1 Approved source,wholesome,.nonadulterated C N/O N1A 4 C Communicable disease of worker reported to local health director
A I Approved shellfish,finfish,meat&poultry USDA approved 13; Handwashing facilities provided,hands washed,clean C !0 NIA 4
B Food cans in good condition(not dented,rusty,bloated,leaking) A 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 accessiblelconvenlent to use
E Potentially hazardous foods received at proper temperature D Personnel hands washed,clean 1 Proper handwash procedure
0 E Handwashing at appropriate times
3 Potentially hazardous food meets temperature regulrements ` C 0 N/A 4 0
during storage,preparation,display,service and transportation
15 `'Good hygle" practices C NIO N/A 2
A Hot holding greater than or equal to 140°F. (whole beef/pork roasts 130'F.) A ❑ No eating ❑ No smoking while working
B Cold holding less than or equal to450F. B Wounds covered adequately
C Proper cooling C Proper sink used for handwashing
D Proper re-heating 0
E Proper internal cooking I consumer advisory posted 24',Sanitization;r rise(hot water-chemical) N10: NIA 2
0 A Approved sanitizer avaifable/adequate concentration of sanitizer
4 Adequate facilities to rnalntain',pioduct N10 N1A` 2 g Food-contact surfaces and utensils used for potentially
temperature,thermometers provided` hazardous food sanitized at least every 4 hours
A Food thermometer available and accurate C Adequate ffdishwashersanitlzer ❑final rinse temp
L Proper sanitizing procedure
B Properfoodthermometeriorproduct
E Sanitizing between raw animal origin&ready-to-eat food
C Thermometers appropriately placed in cooler units
0 O
25 Clean wiping,cloths N10 NIA 1
7 Food protected during storage,preparation, C N10- NIA 2
display, service'and transportation A Cloths and/or sponges in good repair and clean
A Produce washed B Wiping cloths kept in sanilizer between uses
0
B Raw meats not stored/prepared near ready-to-eat foods 26 Food=contact;surfaees;clean : N10 NIA 2
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 C Food--contact surfaces clean
F 1 No pooling of eggs not cooked immediately 0
8 Food containers stored off thefloor 30. Hot and-sold water under pressure,provided as required C -Pll0 NIA 2
0 38 Handwashing accessories provided C NIO N/A 1
9 Handling of food minimized N10 NIA ;:2,
A No unnecessary handling RTE andlorcookedfoods with bare hands L A Soap 1 paper towels 1 drying device available
B Dispenser(s)working: ❑Soap ❑Paper towel
$ Minimize food handling,other than ready-to-eat,with bare hands IC Handwash sink(s)clean/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. M; QFO[qualified 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 foods/equipment? 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 saved? Y N Is there a language barrier between inspector&QFO? Y N 9-M 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 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 page form(total of 62 debitable items) Page 1 of 2
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ADDITIONAL FOUR POINT ITEMS KEY: DNC [DOES NOT COMPLY]
6 Foods not re-served.
-Unwrapped foods not re-served 4= 31 Sewage disposal approved. 4a
-Potentially hazardous foods not re-served M1 -Operating as required
No cross connections,back siphonage,backflow '
11 Toxic chemicals. d; Proper typelinstallationl backflow prevention device/air gap for. `5
-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 ioxics on the premises -Chemical dispensers -Ice machines v
-Pesticideslrodenticides properly dispensed Proper drain for.
-Food equipment -Dish machines -Ice machines E `;
29 Water source adequate,safe. ;z r
-Well/well head protected from contamination ,
35 Toilet facilities. Adequate,convenient,accessible, �?
-Water quality in compliance
-Monitoring incompliance designed,properly installed
OTHER ITEMS KEY: DNC [DOES NOT COMPLY]
2 Sources of food:Original container,properly labeled 40 Garbage/rubbish storagearea/rooms,enclosures-properly constructed,clean
5 Potentially hazardous food properlythawed 2; 41 Garbage/rubbish disposed of in an approved manner,at approved frequency i
10 Food dispensing utensils properly stored 1 2 Vermin Control: No insects/rodents present i
14 Food worker:Clean outer clothes,effective hair restraints ;1�' 43 Outer openings protected against entrance of insects/rodents 1{
44 Floors: Floor covering installed,constructed as required,good repair,clean ) '
16 Food-contact surfaces designed,constructed,maintained,installed, 2 5 Floors graded,drained as required
located
n 46 Floor,wall juncture covered
17 Nonfood-contact surfaces designed,constructed, maintained, -1
47 Mats removable,good repair,clean �
installed,located
48 Exterior walking,driving surfaces,good repair,clean
18 Single service articles,storage,dispensing L
49 Walls,ceilings attached,equipment properly constructed,good
19 No reuse of single service article '1
repair,clean.Wall&ceiling surfaces as required i
20 Dishwashing facilities approved design,adequately constructed, !,,I
maintained installed located ,� 50 Dustless cleaning methods used,cleaning equipment properly stored
P7\
Equipment&Utens'lsi Cleanliness51 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 required �v
23 Accurate thermometers provided,dish basket,if used
541 Rooms adequate,clean,adequate lockers provided,facilities clean
27 Nonfood-contact surfaces of utensils&equipment clean '
� 55 Establishment and premisesfreeof litter,noinsectlrodentharborage,
28 Equipmentlutensils,storage,handling 1 no unnecessary articles
Complete arationfromliving/sleepinguartersandlaund
32 Properdisposal of waste water 56 P P q ry W,
57 Clean/soiled linens stored properly
33 Plumbing location,installation,maintenance41581 Noiivebirds,turtles,orotheranimals(except guide dogs) 1
36 Toilet rooms enclosed with self-closing door 1
Is 59 Seats 75 or more:Nonsmoking area provided,sign(s)posted at ,
37 Propertoilet fixtures provided,good repair,clean
entrance(s),smoking area indicated by sign(s) ,
39 Approved garbagelrubbish containers,adequate number,covered, 1
rodent proof,clean 4.
'J VIRoutine Inspection OReinspection 0 Preoperational Inspection
INSPECTOR: PE N IN CHARGE: Other Inspection:
A Demerit Score: *Include demerits from page 1
4 3 2 1 Total Rating
si ature � sign
pr nt name l pr t n
YjCaRRECTI NS DUE:
phone number, title
2 Page 2 of 2 plus continuation pages Focused Inspection 1l2002
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INSPECTION REPORT STATE OF CONNECTICUT
FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH
CONTINUATION SHEET
NAME OF ESTABLISHMENT TOWN DATE OF INSPECTION
QWfiio (L.Sm4 (160AO, IPI J1.A
INSPE #
FORM REMARKS
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INITIAL(INSPECTOR) INITIAL(PERSON IN CHARGE)
Distribution: 1 st-White-Health Department 2nd-Yellow- Owner/Mana