HomeMy WebLinkAboutFood Service Establishment Inspection 28 (2) ."t?fisil�A,E;C}7iC+ P ` , otPBERVII+3iNPC,�[I P .. M in
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Establishment: 777727 Inspection Date: Time oin p Eins
Address/City: OA Oe,4Z Health Dept: : 1 2 3 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 debitable items C N/0 WA IDNC I KEY: C[complies] NIO[not observed] NIA]not applicable]
60 Qualified Food Operator. 3 DNC[does not comply] 0[other] RTE[ready-to-eat]
61 esignated'Alternate- f �/ 2 12 Personnel with infection restricted C ^N10�i 4
Food workers have no exposed infected lesions 1 burns
62 ,ritten.documentation of training program, 2
ersonnel with infection restricted k
Approved source,wholesome,"nonadulterated ;C N10 NIA 14 o municable disease of worker reported to local health director
A Approved shellfish,finfish,meat&poultry USDA approved 13 ndwashing facilities provided,hands washed,clean ,C N10 4
B 1 Food cans in good condition(not dented,rusty,bloated,leaking) Handwash facilities in all food prepldispensing&warewash areas
C Wholesome/nonadulterafedfoodslsafe B Handwash facilities in or immediately adjacent to toilet rooms
D Commercial products(no home grown/conned food) C Handwash facilities accessiblelconvenient to use
E Potentially hazardousfoods received at proper temperature D Personnel hands washed,clean/Proper handwash procedure
0 E Handwashing at appropriate times
3 061'entially',hazardous food meetsteinperature.re, ' ements C N/0 NIA 4 0
aunn#storage,preparation,display,service,and transportation
.
'15;`Good hygienic,practices C,N/CS_ NIA,2'
A Hot holding greater than or equal to 140°F. (whole beefloorkroasts 1300 F.) A ❑ Nc eating ❑No smoking while working
B Cold holding less than or equal to 450 F. B wounds covered adequately
C Proper cooling C Proper sink used for handwashing
D Proper re-heating 0
E Proper internal cooking I consumer advisory posted �24 Sanitizationrinse(hot'nrater-,chemi+cal), zC NIO'!N!
0 A Approved sanitizeravailable/adequate concentration ofsanitizer /
q Adeuatefaahties to;maintain product- C;,NIO N!A "2 g Food-contact surfaces and utensils used for potentially
temperature,thermometers`prgttll 0 k b s hazardous food sanitized at least every 4 hours
A Food thermom
eteravailableandaccurate C Adequate ❑dishwashersanifizer ❑final rinse temp
D Proper sanitizing procedure
B Proper food thermometer for product
E Sanitizing between raw animal origin&ready-to-eat food
C Thermometers appropriately placed in cooler units
0 # n S ' Isani4jptDg�cl s . ,. ¢ ;;d-,n ;j
F 6 d roi� v
ptected drjtrage,preparaytion, fC Nla fN! f ;
s Ipi,sefce and transportatonb = ., ' :, A Cloths and/or sponges in good repair and clean
: B Wiping cloths kept in sanitizer between uses
A Produce washed
B Raw meats not stored/prepared near ready-io-eatfoods. 26;-,F6 d-coritactsurfacesrctean K C 4fdll2" ;2_
C Food covered properly A �ood equipmentclean,utensils clean,equipment interiors clean
D Adequate splash guards/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 off the floor p 0 t nd cold water,under Dressili prs)vlded as,requ[red iC (N1b Ni(
0 t3 andwasfiing accessories.ptovided C TWO; N _ 1
9- ;Handling offood minimized ,C,'NiIA r
A No unnecessary handling RTE and/or cooked foods with bare hands A Soap 1 paperlowels! drying device available
B Dispenser(s)working: ❑Soap ❑Papertowel
B Minimize food handling,other than ready-to-eat,with bare hands C Handwash sink(s)clean 1 waste receptacle at handwash sink
C Adequate utensil(s)for dispensing food/ice 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[potentially hazardous food],FB[foodborne]
PHF,are hot held at: IF, Pli 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 temperatur a you cock:
Poultry Ground Beef ork What diseases related to FB illness are you required to report ca health department?
Roasts Other
Describe re-heating procedures: Is there a written illness policy that requires t od worker to report specific illness conditions
Are temperatures recorded/logged for cold holding f slequipment? Y N and diseases to the QFO? Y N o you have a paid sick leave policy? Y N
Are foods cooked In advance and 000fed? Y *Are leftovers saved? Y N Is there a language barrier be inspector&QFO7 Y N Iflf yes indicate language spoken
List products cooled: by QFOIDA: *Can the QF01DA rea the' spectionareport? Y N
Describe cooling methods: Indicate who answ d the above questions:Name(print
Indicate the title above person(circle all that apply):Q Or DA gr Cook Owner FW
Is coaling 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
s there a produce washing policy? Y N *Describe what is washed and tIwhere:
spection:
:Note: This report is a two page form(total of 62 debitable items) Page 1 of 2
+ , 7� r>, f'::Y �$ '4'"' '. a'i
jS'l'�►TE`OF"GONNECTIGUT DEPARTMENT QF IPUBL1G:"HEALTH- 47Q'C"A 1TOL,AVENUE:,.MS#51 FDP-HARTFOftI
FOCI,ISED FOOD SERVICE- IN PE IOI REFURT
ADDRESSICITy
Esta6hshme t r „Date of Inspection:
ddress Owner or'Operator: .
ADDITIONAL FOUR POINT ITEMS
o KEY: DNC [DOES NOT COMPLY]
6 Foods not re-served.
-Unwrapped foods not re-served 4 31 Sewage disposal approved. 4'
oten'tj Ily hazardous foods not re-served -Operating as required
34 No cross connections,back siphonage,backflow
1 To iechemicals. 4
4 Pro ear t e/inst II 'qp/backfiow prevention device/air gam:
-S pLferly labeled proper) ,used proper) -Food equipment -Hose connections -Dish machines
-Sanitizer concentration not to exceed maxEmum permitted _ -Soda system carbonator -Beverage dispensers -Toilet tanks
-"o unnecessary toxics on the premises
w� -Chemical dispensers -Ice machines
-Pesticides/rodenticides properly dispensed �p
Proper drain for:
q a!L
29 Water source adequate,safe. 4 -Food equipment -Dish machines -Ice machines
-Well/well head protected from contamination-Water quality in compliance 35 Toilet facilities. Adequate,convenient,accessible, 4
-Monitoring in compliance designed,properly installed
OTHER ITEMS KEY: DNC [DOES NOT COMPLY]
2 Sources of food:Original container,properly labeled I 0 Garbage/rubbish storage area/rooms,enclosures-property constructed,clean 1
5 Yotenlially hazardous food properly thawed 2 gelrubbish disposed of in an approved manner,atapproved frequency
0 1400d dispensing utensils properly stored 42 yermin Control: No insects/rodents present 2
4 Food worker:Clean outer clothes,effective hair restraints 43 0 eropenings protected against entrance of insectslrcdents ly
4 oors: Floor covering installed,constructed as req ed,good re air,c ea r ;
16 Food-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, 1 7 Mats removable,good repair,clean
installed,located ;
2
8 Exterior walking,driving surfaces,good repair,clean
18 Single service articles,storage,dispensing 1
19 No reuse of single service article alls,ceilings attached,equipment properly constructed,good
repair,clean.Wall&ceiling surfaces as required :.
20 Dishwashing facilities approved design,adequately constructed, 2
maintained installed located 50 Dustless cleaning melhods used,cleaning equipment properly stored ;
Equipment&Utensils Cleanliness 1' 1 Adequate lighting provided as required 17
21 Preflushed,scraped,soaked and racked 52 Room free of steam,smoke odors 1
22 Wash water clean, tem temperature r
proper p 53 Rooms&equipment hoods,ducts,vented as required
curate thermometers provided,dish basket,if used'T c S 54 Rooms adequate,clean,adequate lockers provided,facilities clean `1:
nfood-contact surfaces of utensils&equipment clean
55 Establishment and pre mises free of I itter,no insect/rode nt harborage, 1
q ipment/utensils,storage,handling 1 no unnecessary articles
Pr per disposal of waste water l 56 Complete separation from livinglsleeping quarters and laundry a 3~M
3 P bing locat' n,installati ,maintenance 7 E an/soiled linens stored properly 1
- 58 No live birds,turtles,oroiheranimals(except guide dogs)
36 Toilet rooms enclosed with self-closing door
1 59 Seats 75 ormore:Nonsmoking area provided,sign(s)posted a1 t3
37 Propertoilel fixtures provided,good repair,clean entrance(s),smoking area indicated by sign(s)
39 Approved garbage/rubbish containers,adequate number,covered, 1
rodent proof,clean outine Inspection ❑Reinspection ❑ Preoperational Inspection
R: PERSON IN CHARGE: her Inspection:
Demerit Score: +Include demerits from page 1
4 3 2 1 Total Rating
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1lignature � sl9
pr at name p name �� �� ,�� / 1/ ✓
phone number title DATE CORRECTIONS DUE: t�f� .3 f /(� 0
Page 2 of 2 plus continuation pages Focused Inspection 112002
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 OF INSPECT N
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FORM# REMARKS
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INSPECTION REPORT STATE OF CONNECTICUT
FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH
CONTINUATION SHEET
NAME OF ESTABLISHMENT TOWN DATE OF INSPECTION
INSPECTION REMARKS
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