HomeMy WebLinkAboutFood Service Establishment Inspection 85 (3) Establishment: � ection Date: Timeff Ofnsp E[nsp
Address/City: Health Dept: ass: 1 2
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 NIO N/A JDNC I KEY: C[complies] N10[not observed] NIA[not applicable]
;BO `Qualified Fol 3 DNC[does not comply] 0[other] RYE[ready-to-eat]
61 OeslgnafedAltemate]• 2
12 Persnn oel wtEh infection rest�lcted
A Food workers have no exposed infected lesions I burns
62 t Written documerdatfon of train[ngprog m 2
B Personnel with infection restricted
1 Approved Source,wholesome,rionadulterated C ,N10 ),IIA 4 C Communicable disease of worker reported to local health director
A Approved shellfish,finfsh,meat&poultry USDA approved
13 ,Handmithing fit. J. t3sprovided,handswaslied;clean:- C .NiO: N1A 4
B Food cans in good condition(not dented,rusty,bloated,leaking) -
A I Handwash facilities in all food prelpldispqrtong&wa ash areas 10
C 1 Wholesome/nonadulteratedfoods/safe k B Handwas ac ities in or imme ' ad]ac o toilet rooms
D Commercial products(no home grown/canned food) X C Handw chit'
E Potentially hazardous foods received at proper temperature D Perso net ha can roper h €ocedure
0 �. ,.... ...., E
Handwashing at appropdat i
;3 `PotertIt 11y I]a�iardous fdbtl meets,temperaturd�regirr emtf'nfs IC N10 N1A 4 0
tlurisg storage preparatrcn display,service afid,trartsportation
x. 5 r95,"Gpod tiygienicapractices C NiO `NIA. 2
A Hot holding greater than or equal to 146 F. (whole beeflporkroests 1309 F.) �( A ❑No eating ❑ No smoking while working
B Cold holding less than or equal to45°F. bL B Wounds covered adequately
C Proper Cooling C Proper sink used for handwashing
D Proper re-heating
2 ,a.',t zationwrinset ho..�water-01C tit.."al a "; ;;.E;C FNlQ.°'A..,.;.: :2;:
E Properinternal cooking/consumer advisory posted 4 - �. .;v T. �.,.
0 A A provedsanitizeravailableladequateconrtenbutionofsanitizer
�4'A ° ► equate„ ataliteE to mai�Str3in prgduet# ,4 x �fi Lw i[V11 ` B Food-contact surfaces and utensils used for potentially
teriper�ture,thermometerspr+ovlded l a y a hazardous food sanitized at least every 4 hours
A Food thermometer available and accurate C Adequate ❑dishwashersanilizer ❑final rinse tamp
D Proper sanitizin rocedure
B Properfood thermometerfor product
E Sanitizing between raw animal origin&ready-to-eatfood
C Thermometers appropriately placed in cooler units
0
r , �. >,�f: • 5 r Glean`n►� tng;cgtF]s*S, ?s CA 1N10 N/A 1,
c�RProtecteddur=ing�storegi ;'pFprdtiony v a C N/0
�Idispteys"e�ierrporstatiann} ¢ W T 1 -. �I + � A Cloths and/or sponges ingood repairandclean
i� t.L. ` .4_ ' B Wiping cloths kept in sanitizer between uses
A Produce washed
Raw meats not stored/prepared near ready-to-eat foods
ko �contac §urFacessglean r ' '�� l0{ i
)Food covered properly 4 s...;:u w.sas :,u m-as•en:: 41,� qg a.- e[I .a ,
dod equipment clean,utensils clean,equipment interiors clean
Adequate splash guards/sneeze guard Single use gloves changed when soiled
E No unauthorized personnel C Food--contact surfaces clean
No pooling of eggs not cooked immediately 0
8 co d containers stored off the floor
o ' :of<en I waef under press provided as requtrA iOr INW 2
x t tiredlin�ofr pd irillnimized.n ry " t . !vBaridwas�itn71kgacr:essones¢provtded: µ „ t iNlt7 A.l .';:
_ r x ,v . r:tCx iN10 IN! �,:? A Soap!paper towels 1 drying device available
No unnecessary handling RTE and/or cooked foods with bare hands B o p I pap r working: ❑Soap ❑Paper towel
B Minimize food handling,other than ready-to-eat,with bare Rands jL C Handwash sink(s)clean 1 waste receptacle at handwash sink
C Adequate utensil(s)for dispensing food/ice 0
O 1 1. •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[potentially hazardous foodl,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-healing procedures: Is there a written illness that requires the food worker to report specific illness conditions
Are temperatures recordedhogged for cold holding foods/equipment? N and diseases to the Q r Y N *Do you have a paid sick leave policy? Y N
Are foods cooked in advance and coaled? Y N *Are le fto ers saved. Y N Is there a longue barrier between inspector&QFO? Y N i yes indicate language spoken
List products cooled: by QFO/DA: *Can the QFOIDA read the inspection report? Y N
Describe cooling methods: Indicate u/ o answered the above questions:Name(print):
s cooling monitored for time&tamp? Y N 3s them itoring of cooling recorded? Y N Indicate the title of abov person(circle ail that4appl, QFO DA Mgr Cook Owner FW
Obtain signatur n who receive thesponsibilities information at the lime of the
Is there a produce washing policy? Y N ♦Describe what is washed and
inspection: l
where: Note: This report is a Iwo page form(total of 62 debitable items) Page 1 of 2
S,AfE t?I=C,ONNECTILUT; pEPARTMEIT QF PUBLIC`HEALTH 41 OiCAPITOI-AVENUE -MS#51FDP-HARTF01l7Q,CT 06134
t ,ocus D F.oan $ERV (
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Estabhshment uT 'SU &jvel, ,ate.of;Inspection: W%w
Address. o!;'4e) rGl Owner or Operator. .
ADDITIONAL FOUR POINT ITEMS KEY: Dill [DOES NOT COMPLY'
O
6 Foods not re-served.
4 31 Sewage disposal approved.
-Unwrapped foods not re-served 4
-Potentially hazardous foods not re-served -Operating as required
11 Toxic chemicals.
No cross connections,back siphonage,backflow
4"
4 Proper type/installation/backflow prevention device/airgafor:
-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 unnecessarytoxics on the premises -Chemical dispensers -Ice machines
-Pesticideslrodenticides properly dispensed Proper drain to
29 Water source adequate,safe. -Food equipment -Dish machines -Ice machines
4
-Well 1 well head protected from contamination 35 Toilet facilities. Adequate,convenient,accessible,
-Water quality in compliance-Monitoring in compliance designed,properly Installed
OTHER ITEMS KEY: DNC [DOES NOT COMPLY "
2 Sources of food: Original container,properly labeled 40 Garbagelrubbishstoragearealrooms,enclosures-properly constructed,dean
5 Potentially hazardous food properlyihawed ;2'; 41 Garbageirubbish disposed of in an approved manner,atapproved frequency
10 Food dispensing utensils properly stored 42 Vermin Control: No insects/rodents present 2' _
14 Food worker:Clean outer clothes,effective hair restraints 43 Outer openings protected ag a I nst entrance of insectslrodenis 1
I
oors: Floor covering installed,constructed as required,good r r,cl�ari`
6 F od-contact surfaces designed,constructed,maintained,installed, 2 Floors graded,drained as required
located
6 Floor,wall juncture covered
17 Nonfood-contact surfaces designed,constructed, maintained, 1 47 Mats removable,good repair,clean
installed,located
18 Single service articles,storage,dispensing 2
8 xtenorwalking,driving surfaces,good repair,clean 1'
19 No reuse of single service article 9 ails,ceilings attached,equipment properly constructed,good
�tpair,clean.Wall&ceiling surfaces as required n
20 Dishwashing facilities approved design,adequately constructed, 2
maintained installed located , ° ustlesscleaning methods used,cleaning equipment properly stored -�
51 equate lighting provided as required
1 Preflushed,scraped,soaked and racked Room free of steam,smoke odors
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 <;
onfood contact surfaces of utensils&equipment clean 57 E tablishmentand premises free of litter,no insect/rodent harborage, _
S Equipmentlutensils,storage,handling
- no unnecessary articles 1,
perdisposal of waste water ; 56 Complete separation from living/sleeping quarters and laundry 1
33 Plumbing location,installation,maintenance 1" 57 Clean/soiled linens stored properly 1
36 Toilet rooms enclosed with self-closing door
58 No live birds,turtles,or other animals(except guide dogs) 1
1
59 Seats 75 or more:Nonsmoking area provided,sign(s)posted at
37 Propertoilet5xturespsovided,good repair,clean 3
entrance(s),smoking area indicated by sign(s)
39 Approved garbagelrubbish containers,adequate number,covered,
rodent proof,clean Routine Inspection ❑Reinspection ❑ Preoperational Inspection
PERSON IN CHARGCHARGE: her Inspection:
Demerit Score: •Include demerits from page 1
4 3 2 1 Total Rating
sE nature L sl naVe
rint name print name
' one number title��L? /� rC DATE CORRECTIONS DUE: h r UCCCIII
p
Page 2 of 2 plus continuation pages Focused 1. �tlm 112002
Pag5/--of
INSPECTION REPORT STATE OF CONNECTICUT
FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH
CONTINUATION SHEET
NAME OF ESTABLISHMENT TOWN DATE OF INSPECTION
w ems . 3��
INSPECTION REMARKS,
FORM#
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INITIAL(INSPECTOR) INITIAL(PERSON IN CH GE)
Distribution: I.st-White-Health Department 2nd-YeIlow-Owner/Manager
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INSPECTION REPORT STATE OF CONNECTICUT
FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH
CONTINUATION SHEET
NAME OF ESTABLISHMENT TOWN s
DATE OF INSP CTION
INSPECTION REMARKS
FORM#
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INITIAL(INSPECTOR) INITIAL(PERSON IN CHARGE)
Distribution: 1st-White-Health Department 2nd-Yellow-Owner/Manager
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INSPECTION REPORT - STATE OF CONNECTICUT
FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH
CONTINUATION SHEET
NAME -F ESTABLISHMENT r� TOWN DATE OF INS ECTION
tRJ.�/?.>SC� J � l
INSPECTION REMARKS
FORM#
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INITIAL(INSPECTOR) INITIAL(PERSON IN CHARGE)
Distribution: lst-White-Health Department 2nd-Yellow-Owner/Manager