HomeMy WebLinkAboutFood Service Establishment Inspection 85 1I "E Il 11 zr ESQ i 'DFiPART1VIH71V s4..IJBLIG AST
Establishment: Inspection Date: Time: Roinsp [ns
Address/City: -r S (N v e Health Dept _ ✓ Class: 1 2- a
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 debatable items f C NIO NIA DNC I Kam: C[complies) NIO[not observed] NIA[not applicable]
60 Qualified Food Operator 3 DNC[does not comply] 0[other] RTE[r y-to-eat]
61 Designated Alternate Loo 012
12 Personnel with infection restricted C 'NIO 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/0 NIA 4 C Communicable disease of worker reported to local health director
A Approved shellfish,finfish,meat&poultryUSDA a roved 13 Handwashing facilities provided, hands washed,clean C.'N10, N/A 4
B Food cans In good condition(not dented,rusty,bloated,leaking) A Handwash facilities in all food prep/dispensing&warewash areas
C Wholesomelnonatlulteratedfoodslsafe B Handwash facilities in or immediately adjacent to toilet rooms LT
D Commercial products(no home grown/canned food) C Handwash facilities accessible/convenient 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 requirements, C 0`$NWtA', 4 0
during storage,preparation,display,service and transportation ,
15;Good hygienic practices C, WQ NIA 2
A Hot holding greater than or equal to 140°F. (whole beef/pork roasts 1300r.) A ❑No eating ❑ No smoking while working r
B Cold holding less than or equal to 45°F. B Wounds covered adequately
C Proper cooling C I Proper sink used for handwashing
D Proper re-heating 0
E Properinternal cooking I consumer advisory posted 24,Sanitization rinse-(hot water-chemical)_ c N10 N/A 2
0 A Approved sanitizeravailabfeladequate concentration ofsanitizer
4 Adequate facilities to maintain product C 0 `NIA 2, B 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 ❑dishwashersanitizer Ofinal rinse temp
B P rope rfoodthermometerfor prod uct L Proper sanitizinrocedure
E Sanitizing between raw animal origin&ready-to-eat food
C Thermometers appropriately placed in cooler units 0
0 25 Clean wiping-cloths C N10 ;N/A' 1,
T Food protected during.etorage;,preparation, C 'N10 NIA F
display,service and transportation A Cloths and/or sponges in good repair and clean
A
B Wiping cloths kept in sanitizer between uses
Produce washed
0
B Raw meats not stored/prepared near ready-to-eat foods 26 Food-contact surfaces_=_clean- N10 N1A. 2_:
Ay �Food equipment an utensilsclean,equipment interiors clean
C Food covered properly 4'ment clean,
D Adequate splash guards 1 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 immediately 0
8 Food containers stored offthe floor 30' Hot and,cold water under pressure,provided as required C NO NIA; 2`
0 Aa Soap towels l d accessories n dprovtded - NO NIA 1 -
9 Handling of food minimized C NO, NA 2
A No unnecessary handling RTE and/or cooked foods with bare hands p p p ry' g evice available
B Dispenser(s)working: ❑Soap ❑Papertowel
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. KEY: QFO[qualified food operator],DA[designated alternate],PHF[potentlally hazardous food],FIB[foodborne]
PHFs are hot held at: IF. 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 Lf ym 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
slfs�f1>en } $c t-{ off 'tCL; Date o lnspectton; 2' ZC1 I S
Owner or 0'00rator: A'.�i
ADDITIONAL FOUR POINT ITEMS '
cat KEY: DNC [DOES NOT COMPLY]
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 Proper type/installation/backflow prevention device/air gpfor: 4
-
-Stored properly,labeled properly,used properly -Food equipment -Hose connections -Dish machines
-Sanitizes 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 for:
29 Water source adequate,safe. 4 -Food equipment -Dish machines -Ice machines
-Well/well head protected from contamination 35 Toilet facilities. Adequate,convenient,accessible, 4
-Water quality in compliance designed,properly installed
-Monitoring in compliance
OTHER ITEMS a KEY; DNC [DOES NOT COMPLY]
2 Sources of food: Original container,properly labeled l; 401 Garbagelrubbish storagearea/rooms,enclosures-properly constructed,clean I`1,
5 Potentially hazardous food properly thawed 2, 41 Garbage/rubbish disposed of in an approved manner,at approved frequency
10 Food dispensing utensils properly stored i- 42 Vermin Control: No insects/rodents present 2
14 Food worker:Clean outer clothes,effective hair restraints 1 ' 43 Outeropenings protected against entrance of insects/rodents 1
4 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 46 Floor,wall juncture covered
17 onfood-contact surfaces designed,constructed,maintained, 47 Mats removable,good repair,clean
installed,located " --- a
48 Exterior walking,driving surfaces,good repair,clean
18 Single service articles,storage,dispensing 2', -
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 1
maintained installed located 50 Dustless cleaning methods used,cleaning equipment properiyslored
Equipment&Utensils: Cleanliness ln" 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
231 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 1' 55 Establishment and premises free of litter,no insectlrodent harborage, 1
2$ Equipment/utensils,stprage,handling 1 no unnecessary articles
32 Proper disposal of wastewater 1= 56 Complete separationfrom livinglsteeping quarters and laundry 1
33 Plumbing location,installation,maintenance 1' 571 Clean/soiled linens stored properly 1,
x` 58 No live birds,turtles,or other animals(except guide dogs) ^-1"
36 Toilet rooms enclosed with self-closing door lv
59 Seats 75 or more:Nonsmoking area provided,signs)pasted at -3
37 Proper toiletfixtures provided,good repair,-clean entrance(s),smoking area indicated by sign(s)
39 Approved garbage/rubbish containers,adequate number,covere 1
rodent proof,clean LJ ORoutine Inspection ffteinspection 13 Preoperational Inspection
N OR: PERSONIN GE: Other Inspection:
Demerit Score: *Include demerits from page I
' 4 3 2 1 Total Rating
sig ture sig ur
print dame
DATE CORRECTIONS DUE:
phone number ,tA title W f,� �
l.1 "G Page 2 of 2 plus__L_continuation pages Focused Inspection 1@002
Page Of
INSPECTION REPORT STATE OF CONNECTICUT
FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH
CONTINUATION SHEET
NAME OF ESTABLISHMENT TOWN / DA�7TE OF INSPECTION
L-
Al INSPECTION REMARKS
FORM#
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INITIAL(INSPECTOR) INITIAL(PERSON IN CHARGE)
Distribution: 1st-White-Health Department 2nd-Yellow-Owner/Manager