HomeMy WebLinkAboutFood Service Establishment Inspection 16 —e OQb'SE tV 1 P TIDN Iz� a p 'Afi tl�zlt[t;(3 'i s ,
Establishment: nspection Dater Time: S R sp insp
ddresslCity: Health Dept: _�ZO � A ZAZ>C-_wv
Based on an inspection this day,the items marked DING 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 C NIO NIA JDNC I KEY: C[complies] N!0[not observed] NIA[not applicable]
fi0 .411fied Food Operator g DNC[does not comply] 0[other] RTE[ready-to-eat]
12 i`Personnel with in#ection restricted'
fit iDeaignated Alternate 2 C NIQ, NIA„4 .
A Food workers have no exposed infected lesions f burns
62 Written doeutMritatl0h of training program 2
�. Personnel with infection restricted
9 +Approved sdurt�,wholesome,nonadulterated C N10 N/A; 4
y C Communicable disease of worker reported to local health director
A Approved shellfish,finfish meat&poultry USDA approved 73 ;.H ' d+nrashirig facitities,provided�hands'washed,clean ,C ;NlO° ilA .4
B Food cans in good condition(not dented,rusty,bloated,leaking) A Handwash fifties in all food pre ldls sing arewash areas
C Wholesomelnonaduiteratedfoods!safe B Handw acilities in or im .la o t rooms
D Commercial products(no home grownicanned food) C Han fa il''e cc lent e
E Potentially hazardous foods received at proper temperature D P sonne ,cle erIn procedure
0 E Han washing at appropr ime
3 ;Pdtgn'tally wardn us,.food meth!tempera�ure•requirements C NIO NIA .;4. 0
iWringfator�e,�preparatit3n,d><sgtay,servicaKand+transportation;
i15 Good'!ii ie�i�ic practices'.
y C Nf0 NIA':2:
A Hot holding greater than or equal to 140°F. (whole baef4Kdmasts 130'F.) A ❑No eating ❑ No smoking while working
B Cold holding less than or equal to455F. B Wounds covered adequately
C Proper cooling I IX I C Proper sink used for handwashing
D Proper re-heating 0
, NwatE Properinternal cooking I consumer advisory posted 24 Santtiration'ri 1WA 2'
0 A Approved sanitizeravailableladequatewncentrationofsanitizer
j 4 ABequatebfAc�ititie fo�nintatn produot� `Ct NO NIA .g- Food contact surfaces and utensils used for potentially
{ s ~ u h. [ B P Y
temperature,thermometers lovidsd, >� t b hazardous food sanitized at least every 4 hours AC
p p�
A Food thermometer available and accurate C Adequate Odishwasher sanitizes Afmal rinse temp
B Proper food thermometer for product
D Proper sanitizin rocedure
C Thermometers appropriately placed in cooler units E Sanitizing between raw animal origin&ready-to-eat food
0 i25 tC,lea> tPlR9,c[dths ; H r
f7 ood protected'dirltitrefge,preparation; ° C*N10 ,2x ti..._...t.4 ,..
' ;, u a N A Cloths andlor sponges in Dori repair and clean
display,service andikr�nsportation , w w :x. ,R, x :ry r=* 9 P
a �+ g k: •I+ w: r B Wiping cloths kept in sanitizer between uses
A Produce washed
0
B Raw meats not storedlprepared near ready-to eat foods �C b w.. ,* k
t3u Pee a
C Food covered properly A I
:A Food_ ,.:.—:-:.��.�.,..x .:� �. e*,�'�c. �'•�•� �� ��*< �Nl0' Nlt4y;2z.
equipment clean,utensils clean,equipment interiors clean
D Adequate splash guards 1 sneeze guard k 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 off the floor 40 Wot antl:dbld water utjder Sure,provided as require b IV1J<1• 2?
' � � '� � a4'ia' tF A5�C µ 4"l R'. ..G .pit 1�'•: i; 13...:.
0 I09 [Hand ognimm { P ICNizedx x (38 t:Handwas6irig,accesaories;prov(de(� ` " G N10 t�j;�.
NIA ,2;, A Soap 1 paper towels 1 drying device available
A No unnecessary handling RTE andlorcookedfoods with bare hands B Dispenser(s)working: ❑Soap ❑Paper towel
B Minimize food handling,other than ready-to-eat,with bare hands C Handwash sinks)clean!waste receptacle at handwasfi sink
C Adequate utensil(s)fordispensing foodlice 1101
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[potentially hazardous food],FB[feodborne]
PHFs are hot held at: OF. PHFs are cold held at: OF. Describe illness cc ions 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 ated to FB illness are you required to report to the local health department?
Roasts Other
Describe re-heating procedures: Is there a ritten illness policy that requires the food worker to report specific illness conditions
Are temperatures recordedllogged for cold holding foodslequipment? N and dise es 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 le fto rs saved? Y N Is there a language barrier between inspector&QFO? Y N If yes 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 abov rson(circle all tha apply): 0 DA Mgr ' ook Owner FW
Is cooling monitored for time&temp? Y Nis the monit mg of cooling recorded? Y N Obtain signature of th rson who sec 'ed e r onsibllities I ation at the time of the
Is(here a produce washing policy? ♦Describ what is washed and inspection:
where: Note: This report is a two page form(total of 62 debitable items) Page 1 of 2
iS�T�►TE OF HCO R � NTOFP EA PTb - M$#11 DPHAR C 4J SR ,
a�� � ,' � 2 �('1C�US�+b�00D�SERyTC� I1�SPECTIOI�f 12EP.OR°1'
iaOCAL HEALTH DEPT f�'T ADDRESSICITY:
EstablishmentDuT�f': Lz�iSald ��J,a;�r�aL pate of Inspection:
ddFess: / >/� L}r7/� tiS Owneror rotor Op L� e ldad
ADDITIONAL FOUR POINT ITEMS KEY- DNC [DOES NOT COMPLY] t
6 Foods not re-served.
-Unwrapped foods not re-served 4 31 Sewage disposal approved. ,
-Potentially hazardous foods not re-served -Operating as required
74 11 Toxic chemicals. No cross connections,back siphonage,backflow 4;
4 Pro ear type!_iDstallation/backflow preven fla device)air gap for:
-Stored properly,labeled properly,used properly -Food equipment -Hose connections -Dish machines
-Sanitizerconcentration not to exceed maximum permitted -Soda system carbonator -Beverage dispensers -Toilettanks
-No unnecessary toxics on the premises -Chemical dispensers -Ice machines
-Pesticides/rodenticides properly dispensed 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 designed,property installed
-Monitoring In compliance
OTHER ITEMS KEY: DNC [DOES NOT COMPLY]
Sources of food: Original container,properly labeled 0 Garbage/rubbish storage arealrooms,enclosures-properlyconstructed,dean 1:
5 Potentially hazardous food properlythawed 2`x 41 Garbage/rubbish disposed of in an approved manner,atapproved frequency lm
10 Food dispensing utensils properlystored i,; 42 Vermin Control: No insectslrodents present 23
14 Food worker:Clean outer clothes,effective hair restraints "', 3 Outer openings protected against entrance of insectslrodents 1
4 Floors: Floorcovering 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,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
S Exterior walking,driving surfaces,good repair,clean i
19 No reuse of single service article 9 Walls,ceilings attached,equipment properly constructed,good 1
repair,clean.Wall&ceiling surfaces as required
20 Dishwashing facilities approved design,adequately constructed, 2;.
maintained installed located 50 Dustless cleaning methods used,cleaning equipment properly stored
Equipment&Utensils: Cleanliness i = 51 Adequate lighting provided as required 1
21 Pretlushed,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
23 Accurate thermometers provided,dish basket,if used 54 Rooms adequate,clean,adequate lockers provided,facilities clean 1>.
7 Nonfood-contact surfaces of utensils&equipment clean 1 55 Establishment and premises freeof litter,no insectlrodentharborage, ;ix'
28 Equipmentlutensils,storage,handling i no unnecessary articles
32 Pro per disposal of waste water 5 61 Complete separation from Iivinglsleeptng quarters and laundry
57 Clean/soiled linens stored properly
33 Plumbing location,installation,maintenance
1 m
58 No live birds,turtles,orother animals(exceptguide dogs)
36 Toilet rooms enclosedwith self-closing door 1:
59 Seats 75 or more:Nonsmoking area provided,sign(s)posted at
37 Proper toilet fixtures provided,good repair,clean3z;.
entrance(s),smoking area indicated bysign(s)
39 Approved garbage/rubbish containers,adequate number,covered, 1
rodent proof,clean tine Inspection ❑Reinspection ❑ Preoperational Inspection
INSPECTOR: N CHARGE: other Inspection:
Demerit Score: *Include demerits from page 1
/"?,—," 4
4 3 2 1 Total Rating
ignature sl ture
p nt name print name ✓ f �l/(/
-phone number' umber DATE CORRECTIONS DUE:
a Page 2 of 2 plus
1' continuation pages FocuSeamspeceon r o2
Page of
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INSPECTION REPORT STATE OF CONNECTICUT
FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH
CONTINUATION SHEET
NAME OF ESTABLISHMENT TOWN DATE 0 INS PE TION
INSPECTION FORM# REMARKS
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PASS WHEN BLUE
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INITIAL(INSPECTOR) INITIAL(PERSON IN CHARGE)
Distribution: I st_White-Health Department 2nd-Yellow- Owner/Manager
Page�of
INSPECTION DEPORT STATE OF CONNECTICUT
FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH
CONTINUATION SHEET
NAME OF ESTABLISHMENT TOWN DATE OF INSP CTION
C-!;,f t I-�r'41 /e j 1.,51 D"�,C2&L_
INSPECTION REMARKS
FORM#
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INITIAL(INSPECTOR) INITIAL(PERSON IN CHARGE)
Distribution: Ist-White-Health Department 2nd-Yellow-Owner/Manager