HomeMy WebLinkAboutFood Service Establishment Inspection 86 A)0MIX
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Establishment: IGf�N inspection Date: i 1-6 •Time: /'` b oin REfnsp
Address/City: Health Dept: � 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 N10 NIA JDNC I KEY: C[complies] NIO[not observed] NIA[not applicable]
i60 „Qualif 0p
ied Foo erator g DNC[does not comply] 0(other] RTE[ready-to-eat]N, �
' 12 :;Personnel with infect)on restricted C, N1ta;;NIA ;4
e�tgnated Alteniate 2-
6-
q Food workers have no exposed infected lesions/burns
2 fitten documentation oftraining prog w 2,
B Personnel with infection restricted
,Approved source,whoiesbme,'nonagl..e cited C NIO N/A 4 C Communicable disease of worker reported to local health director
A Approved shellfish,finfish,meat&poultry USDA approved
13: ;Handwashing facilities provided, hands washed clean C :N10 'NlA 4
B Food cans in good condition(not dented,rusty,bloated,leaking) A Handwash facilities in all food prepldis a s' ewash areas
C Wholesome/nonadulterated foods/safe B Handw fa li"es I mme d' c tet ooms
D Commercial products(no home grown/canned food) C Hand fi fac I ' s es n nt to use
E Potentially hazardous foods received at proper temperature p per(nnel an washed,clean I Pr andwash procedure
E shing at apprc r' t es
• Handwa
3 IPot'Wally hatatYloui adm ha"ktemperature requtremente-4. 'W N1A 4 0
during st"- l preparat+on display;t.service and transportatrgn
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1$ '.Good•'hygienic practices
A Hot holding greater than or equal to 140 F. (.holeheeHporkroaets 1300F.) k IA ❑ No eating ❑ No smoking while working
B Cold holding less than or equal to450F. kB Wounds covered adequately
C Proper cooling C Proper sink used for handwashing
D Proper re-heating
E Proper internal cooking/consumer advisory posted r �R, a tization rnse{hatwatert;Chemical) '. '`,C ,NI
A pprove dsaniflzeravailable/adequate concentration ofsanitizer
ABoc�,ya p,faid lltles IC NlO°' g Food-contact surfaces and utensils used for potentially
y i-temperatu�re�the meters;provided t ' hazardous food sanitized at least every 4 hours
;, . s ,.; 3. v....w ..
A Food thermometer available and accurate C Adequate pdishwashersanitizer ❑Final rinse temp
B Properfoodthermometerforproducl D Proper sanit zin rocedure
E Sanitizing between raw animal origin&ready-to-eat food
C Thermometers appropriately pieced in cooler units AL 0
Al,. . t,Clean;*Ipin'giclfStl s
ood protCted duringmstorage,pirepaltnn.'' ,`x iNO=) ! �I'2< C IN10 rNJq 1
.cl splay,service and-transportation : , : ::V ,,;f. �' l s A Cloths and/or sponges ingood repair and clean
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A Produce washed B Wiping cloths kept in sanitizer between uses
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B Raw meats not stored/prepared near ready-to-eatfoods 2fi F` d"cidtac> sutes c eon . = ; C„
C Food covered properly Food equipmentclean,utensils clean,a uipmer(Interiors clean 9
D Adequate splash guards!sneeze guard B Single use gloves changed when soiled
E No unauthorized personnel C Food--contact surfaces clean
F o pooling of eggs not cooked immediately ik C
8 ood containers stored off the floor 3t3 Hot and¢old wafer unddr presure�pto<rided'aisarequired i 0
0 B s mg accessories provided FC NfOA lIldhV.,i1
gL i'0Q1ingkafifoad;mtnlm zed ' ' C IN, (Nil.# 125Soa '! : 5 Y
A No unnecessary handling RTEand/or cooked foods with bare hands p per towels/drying available
- Ispenser(s)working: Soap p rowel
B Minimize food handling,other than ready-to-eat,with bare hands C I Handwash sinks)cl an I wasterrec6ptacle at handwas sink
C Adequate utensil(s)fordispensing food/ice p
0 •DESCRIBE DEFICIENCIES ON CONTINUATION SHEETS
The following information is not debitable and does not affect your score. KEY: CFO[qualified food operator],DA[designated altemate],PHF]potentially hazardous food],FB[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 writIs llness policy that requires the food worker to report specific illness conditions
Are temperatures recorded/logged for cold holding foods/equip ant? Y N and diseases t he QFO? Y N ♦Do you have a paid sick leave policy? Y N
Are foods cooked in advance and cooled? Y N *Are Hovers saved? Y N Is there a la uage barrier between inspector&QFO? Y N If yes indicate language spoken
List products coaled: by QFOID : *Can the QFOIDA read the inspection report? Y N
Describe cooling methods: Indicaliq who answered the above questions:Name(print):
Indica(e the title of a e person(circle all that apply):QFO DA Mgr Cook Owner FW
Is cooling monitored for time&temp? Y N Is the onitodng of cooling recorded? Y N .Obtain sig at re o er on who eived the QFO rep a titles information at the time of the
Is there a produce washing policy? Y N ♦D tribe what is washed and inspection
where: Note: This repot,is;-two p e farm(total 1- 2 debitable.item Page 1 of 2
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`�,'FA OF GQNNPCTIO�J�''DEPARTMENT P PUBLIC,,HEALTH 490 C,APITO AY NI MS#S P HA FARD,G �D6tti4+
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LOG,Al,HEALTH DEFTr ,.i .rr �pRESSICITY ° '
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Estabilshment Date of llhsp6ctilon '. .:
ddress; LCr".; fJ QWner,or Operator._
ADDITIONAL FOUR POINT ITEMS
2 KEY: DNC [DOES NOT COMPLY]
6 Foods not re-served. ''
-Unwrapped foods not re-served 4 ewage disposal approved.
-Potentially hazardous foods not re-served erating as required
o doss connections,back siphonage,backflow
11 Toxicchemicals. 4 Pro e�rtvnelihstallationlbackflowpreventiondevicelairgapfQ
-Stored properly,labeled properly,used properly -Food equipment -Hose connections -Dish machines
-Sanitizer concentration not to exceed maximum permitted -Soda system carbonator - �machine�
spensers -Toilet tanks
-No unnecessary toxics on the premises -Chemical dispensers -Pesticideslrodenticides properly dispensed Proper drainfor:
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 o' KEY: DNC [DOES NOT COMPLY]
2 Sources of food: Original container,properly labeled 1 40 Garbage/rubbish storagearea/rooms,enclosures-properly constructed,dean
5 Potentially hazardous food properly thawed 2 41 Garbageirubbish disposed of In an approved manner,at approved frequency
10 Food dispensing utensils properly stored 1 42 Vermin Control: No insectslrodents present 2
14 Food worker:Clean outer clothes,effective hair restraints 1 3 Outer openings protected againstentrance of insects/rodents 1:
oars: Floor covering installed,constructed as requir d,good repair, lean 1T
16 F od-contact surfaces designed,const cte maintained 'nstalled, �141Z4. �A.
located U, Floors graded,drained as required
�' 6 Floor,wall juncture covered
17 Nonfood-contact surfaces designed,constructed, maintained, 1, 7 Mats removable,good repair,clean
nstalled,located
8 mgle service articles,storage,dispen ' / 2 8 Exterior walking,driving surfaces,good repair,clean
19 No reuse of single service article Lc� 9 W�11 ,ceilings attached,equipment properly constructed,good
repair,clean.Wall&ceiling surfaces as required
20 Dishwashing facilities approved design,adequately constructed,
maintained installed located 50 Dustless cleaning methods used,cleaning equipment properly stored
Equipment&Utensils Cleanliness 1 ` 51 Adequate lighting provided as required <
21 Preflushed,scraped,soaked and racked 52 Room free of steam,smoke odors '
22 Wash waterclean,proper temperature 53 Rooms&equipment hoods,ducts,vented as required
23 Accurate thermometers provided,dish basket,if used j 54 Rooms adequate,clean,adequate lockers provided,facilities clean 1
27 Nonfood-contact surfaces of utensils&equipment clean i
55 Establishment and premisesireeof litter,no insect/rodent harborage, {1;
28 Equipmentlutensils,storage,handling 1' no unnecessary articles .
56 Complete separation from living/sleepinguarters and laundry
3 - per disposal of wastewater 1 p p q �1
33 Plumbing location,installation,maintenance 1 57 Clean/soiled linens stored properly 1;
58 No live birds,turtles,orother animals(except guide dogs) 1
36 oil trooms enclosed with self-closing door
59 Seats 75or more:Nonsmoking area provided,sign(s)posted at I
37 rof er toilet fixtures provided,good repair,clean 3>
entrance(s),smoking area indicated by sign(s)
39 Approved garbagelrubbish containers,adequate number,covered, 1"
rodent proof,clean outine Inspection ❑Reinspection ❑ Preoperational Inspection
IN OR: PERSON IN G_IiAAG Cher Inspection:
y� Demerit Score; *Include demerits from page 1
. <✓ 4 3 2 1 Total Rating
signs ure signature
inert name print name
phone number title DATE CORRECTIONS DUE: Z—r� J
�- Page 2 of 2 plus continuation pages F.—dJn peal..112002
I av Page/— Of
INSPECTION REPORT STATE OF CONNECTICUT
FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH
CONTINUATION SHEET
NAME OF ESTABLISHMENT ( TOWN DA4T,EjOF SPEECCT"I N
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 OF ESTABLISHMENT TOWN DATE OF IN PECTI
INSPECTION REMARKS
FORM#
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INITIAL(INSPECTOR) INITIAL(PERSON IN CHARGE)
Distribution: 1 st-White-Health Department 2nd-Yellow- Owner/Manager
Page of
INSPECTION REPORT STATE OF CONNECTICUT
FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH
CONTINUATION SHEET
NAME OF ESTABLISHMENT TOWN DATE OF INSPECTION
4f N
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INSPECTION REMARKS
FORM#
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INITIAL(INSPECTOR) AV INITI L(PERSON IN CHARGE)
Distribution: 'It-White-Health Department 2nd-Yellow-Owner/Manager