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HomeMy WebLinkAboutFood Service Establishment Inspection 83 s i t Establishment: i Inspection Date: Time: ILr~ itoinsp insp Address/City: Health Dept: t t.1�,(�d 4 d ;� class: 1 2 3 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 10 NIA DNC KEY: C[complies] NIO[not observed] NIA[not applicable] BG0 3 DNC[does not comply] 0[other] RTE[r y-to-eat] 1 Pe s 'ht� I ith'i` fe ion restricted 'W #i 2 - .4�.O'O-� �.a,n a Dtgnatetl Altgrnate a _ A Food workers have no exposed infected lesions!burns f6 Written,documentetton of training program . 2 B Personnel with infection restricted 1 proved sr urce;whglesoini;n(60 uXtetated� ��� �� " � ; �i NrA sA .. a C Communicable disease of worker reported to local health director A I Approved shellfish,finfish,meat&poultry USDA approved 15 '1 1 Elaiidaiv s ting�fa�1#rlot.Rr ided,,hands '- qd,Glean`„ t;' NOW, B Food cans in good condition(not dented,rusty,bloated,leaking} A Handwash facilities in all food prep/dispensing&warewash areas C Wholesomelnonadulteratedfoods/safe B Handwash facilities in or immediately adjacent to toilet rooms Ae D Commercial products(no home grownlcanned food) C Handwash facilities accessible/convenient to use E Potentially hazardous foods received at proper temperature D Personnel hands washed,clean I Proper handwash procedure 0 E Handwashing at appropriate times P ttfhfi lly,f@#rdg9j6d&rlr eit5�tetnnper�ttYrdfr' etr�merits� C� !0& N/A 4 0 luting storagg,Nprepatafi614100,a , §r�ric� dkt n p rfat8n .e; N/A r a � ;8 a fix > 1� 15� CaOtf)d'ilygl®nlCp�aCtlC@S �§ u C N� p 21 ' as§.- , �z..,U yr R,fi T%; .teal g.( A Hot holding greater than orequal to 140 F. (wholebeeopork roasts 1300F) A ❑ No eating 13 No smoking while working B Cold holding less than or equal to 45o F. B Wounds covered adequately C Proper cooling C Proper sink used for handwashing D Proper re-heating 0 E Proper consumer posted ��4 Satrift ion.rinse(taot�vyater��Achemical) Nf©';f�N1Ar 2E{ p g advisory a:,u t p A Approved sanitizeravailable/adequateconcentrationofsanitizerk f `®puate f$611.1es,t.9' tj C Food-contact surfaces and utensils used for potentially tempi�attit heltete proind�dt # hazardous food s itized at least every 4 h s .i � ft.T54it*io C Adequate ishwashersanitizer final rinse temp A Food thermometer available and accurate L Proper sanitizin B Properfood thermometer for product procedure E Sanitizing between raw animal origin&ready-to-eat food 411 C Thermometers appropriately placed in cooler units 0 �r { C25� i�� 'fpt_ qf � M ipof, tad d t%r ev t°n C !Q !A A Cloths and/or sponges n good repair and clean �� ! '� rsply seroiceand rrpctrtt t � ' B Wiping cloths kept in sanitizer between uses A Produce washed 0 B Raw meats not stored/prepared near readytoeatfoods 2 tF©odeon c&N Irt, ea .; - a -` C NIO A1;,2 C Food covered properly ., ., A Food equipment clean,utensils clean,equipment interiors clean D Adequate splash guards/sneeze guard B Single use gloves changed when soiled J E No unauthorized personnel C Food--contact surfaces clean � F No pooling of eggs not cooked immediately 0 8 Food containers stored off the floor N,u4ot 0 d�d�r'fer� iifr��essUre p$vrde�i.as`Y�qurr$ � `� N101�f/A? 2 C . :� �C N10' Nl 1 x O Hdrrduvashmg accessariesfprovided t nH!ndtingof fQodin1!1l!rGi� 0R12. .a A No unnecessary handling RTE and/or cooked foods with bare hands A Soap/paper towels/ drying device available B Dispenser(s)working: ❑Soap ❑Paper towel 4010 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 0 0 •DESCRIBE DEFICIENCIES ON CONTINUATION SHEETS The following information is not debitable and does not affect your score. JM: QFO[qualified food operator],DA[designated alternate],PHF[potentially hazardous food],FB[foodborne] PHFs are hot held at: OF. PHFs are cold held at: F. 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 hates 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 �d®N a s d � . l�! J�\'L¢ M �a�l�fl�aL�o►�/�N ' S.�(}/ F� �F� T f� A G (��6734 I"stabfishment e1 Cc4,'f` Date of Ittspection J14 �. Aaldress `%' ram;. Owner o'r, Operator.. u._ ADDITIONAL FOUR POINT ITEMS KEY: DNC [DOES NOT COMPLY] [a 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 No cross connections, back siphonage,backflow 11 Toxic chemicals. 4 -Stored properly,labeled properly,used properly 4 Pro eerrty,pe/installation/backflow prevention device/air gap f.Q -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 -Pesticides/rodenticides properly dispensed Proper drain for: 29 Water source adequate,safe. 4 -Food equipment -Dish machines -Ice machines " -Well Iwell head protected from contamination 35 Toilet facilities. Adequate,convenient,accessible, 4 -Water quality in compliance-Monitoring in compliance designed,properly installed OTHER ITEMS KEY: DNC [DOES NOT COMPLY] Ems_ 2 Sources of food:Original container,properly labeled 1` 40 Garbage/rubbish storage arealrooms,enclosures-properly constructed,clean 1 5 Potentially hazardous food properly thawed 41 Garbage/rubbish disposed of in an approved manner,at approved frequency 10 Food dispensing utensils properly stored 42 Vermin Control:No insectsirodents present 2' 14 Food worker:Clean outer clothes,effective hair restraints 1 i" 43 Outeropenings protected against entrance of insects/rodents 2 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 located 6 Floor,walljuncturecovered 17 Nonfood-contact surfaces designed,constructed,maintained, l 7 Mats removable,good repair,clean installed,located -- 2 48 Exterior walking,driving surfaces,good repair,clean 18 Single service articles,storage,dispensing 1. 19 No reuse of single service article 49 Walls,ceilings attached,equipment properly constructed,good repair,clean.Wall&ceiling surfaces as required 20 Dishwashing facilities approved design,adequately constructed, maintained installed located 50 Dustless cleaning methods used,cleaning equipment properlystored 1 Equipment&utensils: Cleanliness 51 Adequate lighting provided as required 1 21 Preflushed,scraped,soaked and racked 52 Room free of steam,smoke odors 1, 22 Wash water clean,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 27 Nonfood-contact surfaces of utensils&equipment clean 1j 55 Establishment and premisesfreeof lifter,noinsectlrodentharborage, 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 ,1 33 Plumbing location,installation,maintenance 1°' 57 Clean/soiled linens stored properly 1' 58 No live birds,turtles,or other animals(except guide dogs) 1. 36 Toilet rooms enclosed with self-closing door lh 59 Seats 75 or more:Nonsmoking area provided,sign(s)posted at 37 Propertoiletfixtures provided,good repair,clean 4 entrance(s),smoking area indicated by sign(s) 3 39 Approved garbagelrubbish containers,adequate number,covered, 1 rodent proof,clean Woutine Inspection ❑Reinspection 0 Preoperational Inspection Other Inspection: INSPECTOR: PE : Demerit Score: *Include demerits from page 1 10 t,4 4 3 2 1 Total Rating sl afore nature 'Z �-!Onles_ pr t name print name /1z Z Z S a bet) DATE CORRECTIONS DUE: p one number _ title Page 2 of 2 plus continuation pages Focused Snspecrion 112002 Page Of3 INSPECTION REPORT STATE OF CONNECTICUT FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH CONTINUATION SHEET NAME OF ESTABLISHMENT TOWN DATE OF INSPECTION t,,J 4 INSPECTION REMARKS FO # P u ✓cam `�� r ,sj� b IF a f 3 F 0,jF (..u� E-� C�'L/� (�:4 a In c L:14 -s 4-t, V'o Q� a�Q - Z� c� u is ou w Cs G.h LU'� CYO U INITIAL(INSPECTOR) INITIAL(PERSON IN CHARGE) Distribution: ist-White-Health Department 2nd-Yellow- Owner/Manager