HomeMy WebLinkAboutFood Service Establishment Inspection 60 (2) .i'• �a:; few _,., ...�,,..�.�..�� �d .A'S
Establishment: Inspection Date: Time: insp REinsp
Address/City: p ,C5/ �,� t! L a¢y Heai h Dept: 2j z_t��_4 Z SLK Class: 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 NIA JONC KEY: C[complies] N/0[not observed] NIA[not applicable]
fiQ (uel]fled:Food Operator , 3 DNC[does not comply] 0[other] RTE(ready-to-eat]
12 Persohnel with infection restricted
61 stgnated Alternate C N!0 'NJA A
:
ritten docutnentatton of tramtng program 2 A Food workers have no exposed infected lesions/burns
B Personnel with infection restricted
}Approved source;wholesome,rionaddlterated C N10,NIA C Communicable disease of worker reported to local health director
A Approved shellfish linflsh,meat&poultry USDA approved ki 13 Handwashingfacflities provided,hands washed,clean C NIO NIA 4
B Food cans in good condition(not dented,rusty,bloated,leaking) A Handwash facilities in all food prep/dispensing&warewash areas Id
C Wholesome/nonadulteratedfoods/safe B Handwash facilities in or immediately adjacent to toilet rooms
D Commercial products(no home grown/canned food) C Handwash facilities access iblelconvenlent 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
3 Po`>lentlallyhazardousfio6d',meeistemperature`requirements C Nl NIA 4 p
during storage,pfeparatlon=display sgrvI6e and transportation!
]15Good'hygienic practices
C N10` N/A 2..
y -
A Hot holding greater than or equal to 140°F. (whole beerrporkrossls iso°F.) I V1A ❑ No eating ❑No smoking-,
mokirig while working
B Cold holding less than or equal to45°F. IL B Wounds covered adequately
C Proper cooling C Proper sink used for handwashing
D Proper re-heating 0
E Pro erinternalcookingifconsumeradvisoryposted :;Ii z Santtization(r`irise-(h'ot waI6,r'i chemical NiO N!A �2
pproved sanitizer availableladequate concentrationof sanitizer
4 A ecratgfacilitiestolirrniir(tarnnproduet b C 'Nl0 /Ail B Pood-contact surfaces and utensils used for potentially
rffiperature't eirtlometers itledr _ = k azardous food sanitized at least every 4 hours
a mpK e ,; .n.
Food thermometer available and accurate C Adequate ❑dishwashersanitizer ❑final rinse temp
D Proper sanitizin
B Proper food thermometer for product
procedure
E Sanitizing between raw animal origin&ready-to-eat food
C Thermometers appropriately placed in cooler units 0
0 `25 CI an,wi in e p gxcloths
i Food gr it tetl durin§�s orage,� rep2tFatid►n, C 1V10 �N/A 2
� % payser�Yicertditranscratra ° a < A Cloths and/or s on sponges oodre air and clean
1 � u Y„ K k~ Y P 9 9 p
B Wiping cloths kept in sanitizer between uses
A Produce washed
0
B Raw meats nofstored/prepared near ready-to-eat foods )26 PofDtt�cc i�ct%st rfa¢es dleiar Cr 1NIA f2
C Food covered properly a ,. .- I . .t. €
A Food equipment clean,utensils clean,equipment interiors clean
D Adequate splash guards/sneeze guard B Single use gloves changed when soiled
E No unauthorized personnel bzC Food--oontact surfaces clean
F No pooling of eggs not cooked immediately 0
8 Food containers stored off the floor 30 "Hot andfcold Watec undeC pressure;pQirided as�equir Of NItC C2,�
0 38 'Handwarsftm accessories
g pkovtded - N10,1 NlA 1
9�' andl�ng of foodrminiinized ���_ � CN10 iNlq ;? �A� Soap 1 paper towels drying device available 1 �
A No unnecessary handling RTE and/or cooked foods with bare hands k B
Dispensers)working: ❑Soap ❑Paper towel
B Minimize food handling,other than ready-to-eat,with bare hands C Handwash sinks)clean/waste receptacle at handwash sink
C Adequate utensi[(s)for dispensing foodlice 0
0 •DESCRIBE DEFICIENCIES ON CONTINUATION SHEETS
The following information is not debitabte and does not affect your score. KEY: QFO[qualified food operator],DA[designated alternate],PHF[potentially hazardous food],FS[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 As the food worker to report specific illness conditions
Are temperatures recorded/logged for cold holding foodsle hment? Y N and diseases to the QFO? Y N req *Do you have a paid sick leave policy? Y N
Are foods cooked in advance and cooled? Y N ♦ re leftovers saved? Y N Is there a language barrier belweh inspector&QFO? Y N Iflf ves indicate language spoken
List products cooled: by QFO/DA: ♦Can the OFO/DA read the inspection report? Y N
Describe cooling methods: _ / Indicate who answereZla;bov_q estion�ame-(priIndicate the title of abon(circle ail the apply): r Cook Owner FW
Is cooling monitored for time&temp? Y N Is� e monitoring of cooling recorded? Y N .Obtain signature of thho- ceiv)a QF espo bif ieffformation 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 tw ge form(total of 62 debitable items) a f 2 .,
STAGE�F'G'ON1�1ECTfC�U�T I� P 1'lUI 1 T 0 �UHLIC HEALT�i 41Q CI�PIT,QI�A1lEIVL1E `MS#S1�FDP I�ARTFORD�CT-06134'
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s FUCfJSED FOOD:SERVIC INSPECT1U1rT RE}1'O
L�OALjHEALtH`DepT° v! r ri� Lt� D DRiSS,Il1f. .
Esfiabhshment �✓GL�:.L��/ 1 Date of-Inspection,
ddress, ner dr..OpeGator.
ADDITIONAL FOUR POINT ITEMS c` KEY: DNC [DOES NOT COMPLY] lit
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
34 No cross connections,back siphonage,backflow
11 Toxic chemicals. 4 4;
-Stored properly,labeled properly,used properly Propertype/installation(backflow prevention devi cal air-gap for:
-Sanitizer concentration not to exceed maximum permitted -Food equipment -Hose connections -Dish machines
-No unnecessary toxics on the premises -Soda system carbonator -Beverage dispensers -Toilet tanks
-Pesticideslrodenticides properly dispensed -Chemical dispensers -Ice machines
Proper drain for:
29 Water source adequate,safe. -Food equipment -Dish machines -Ice machines
4
-Well/well head protected from contamination 35 Toilet facilities. Adequate,convenient,accessible, 4
-Water quality in compliance
-Monitoring in compliance designed,properly installed
OTHER ITEMS 5 KEY: DNC [DOES NOT COMPLY]
2 Sources of food:Original container,properly labeled X 0 Garbagelrubbishstoragearealrooms,enclosures-properly constructed,dean G
4
5 Potentially hazardous food properly thawed 21. 41 Garbage/rubbish disposed of in an approved manner,at approved frequency r.
10 Food dispensing utensils properly stored ;1" 42 Vermin Control: No insectslrodenls present 2.
14 Food worker:Clean outer clothes,effective hair restraints 1 43 Outeropenings protected against entrance ofinsects/rodents
4 Floors: Floor covering installed,constructed as required,good repair,clean 1 v
6 F d-contact surfaces designed,constructed,maintained,installed, 2: 5 Floors graded,drained as required
located
6 Floor,wall juncture covered
17 Nonfood-contact surfaces designed,constructed,maintained, 47 Mats removable,good repair,clean
installed,located
8 Exterior walking,driving surfaces,good repair,clean r 1
18 Single service articles,storage,dispensing 2
19 No reuse of single service article 9 Walls,ceilings attached,equipment properly constructed,good r
ir, lean.Wall&ceiling surfaces as required
20 Dishwashing facilities approved design,adequately constructed, 2:
maintained installed located 50 Dust ss cleaning methods used,cleaning equipment properly stored
Equipment&Utensils Cleanliness 1 5-1- Adequate lighting provided as required
21 Preflushed,scraped,soaked and racked 52 Room free of steam,smoke odors
22 Wash water clean,proper temperature <js
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
4S £'
27 Nonfood-contact surfaces of utensils&equipment clean 1
55 Establishment and premises free of Jitter,no insert/rodent harborage, %1
28 Equipmentlutensils,storage,handling Y1* no unnecessary articles
32 Proper disposal of waste water 1 56 Complete separation from livinglsleeping quarters and laundry Iv
57 Clean/soiled linens stored properly
33 Plumbing location,installation,maintenance �'1 f
58 No live birds,turtles,orotheranimals(except guide dogs) P1
36 Toilet rooms enclosed with self-closing door 1
59 Seats 75 or more:Nonsmoking area provided,sign(s)posted at 3
37 Prope r to ilet fixtures provided,good repair,clean 1: entrance(s),smoking area indicated by sign(s)
39 Approved garbageirubbish containers,adequate number,covered, 1"
rodent proof,clean outine Inspection ❑Reinspection ❑ Preoperational Inspection -
NSP CTOR: PE 'OtherqG Inspection:
_ Demerit Score: *Include demerits from page 1
C 4 3 2 1 Total Rating
signature slgna —�
print name
phone num e
Tnu her ` title DATE CORRECTIONS
ar� �
Page 2 of 2 plus continuation pages Focused n pecdon 1/2002
Page of
INSPECTION REPORT STATE OF CONNECTICUT
FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH
CONTINUATION SHEET
NAME OF ESTABLISHMENT TOWN DATE OF SPECTION
1lDLe✓?-ic� � .�� � �
INSPECTION REMARKS
FORM#
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INITIAL(INSPECTOR) INITIAL(PERSON IN CHARGE)
Distribution: Ist-White-H-e-altk Department 2nd-Yellow-Owner/Manager