HomeMy WebLinkAboutFood Service Establishment Inspection 46 (5) L
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Establishment: 10 r,L i inspection Date:: Time: ROinsp Einsp"
Address/City: 6��1�4� � ;,� Health Dept: AaZW4A9%— Class: 1 2
Based on an inspection this day,the items marked D N C 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 ANIO NIA DNC KEY: C[complies] NIO[not observed] NIA[not applicable]
60 QuaI Food Operator 3 DNC[does not comply] 0[other] RTE[ready-to-eat]
led
Designated Alternate,
72 ° Persoinnel with infection restricted •C N10 NfA, :4
ritten documentation of training program 2
A Food workers have no exposed infected lesions I burns
B Personnel with infection restricted
t1 pproved source,wholesome,.nonedulterated rC N10 N1A ; rC Communicable disease of worker reported to local health director
A I Approved shellfish,finfish,meat&poultry USDA approved 13 Marl shrug facilities provided,handswashed,clSan C ;N/0 141A '4
B Food cans in good condition(notdanted,rusty,bloated,leaking) A Handwash facilities in all food pre di ensing&warewash areas
C Wholesomelnonedulteratedfoodsisafe B Handwash fa 'it s in or imm i ly adj nt to toilet rooms
D Commercial products(no home grown/canned food) C Handwash cil'' t to use
E Potentially hazardous foods received at proper temperature D Personnel WEAAWd,cle ro rocedure
0 E Handwashtng at appro '
3 ,Potentiallyy hazardous.food meets temperature Iequtremep sl iNIA A" p
dunfig sforage,preparation,drsptay,�ervti a and;transportatiori.: ;
75 Goodshygienic`practices't - { .IC, N]6 NiA' 2.
A Hot holding greater than or equal to 140°F. (whole beeUporkroasts U&F.) A ❑ No eating ❑No smoking while working
B lCold holding less than or equal to45"F. B Wounds covered adequately
C Proper cooling C Proper sink used for handwashing
D Proper re-heating PL 0
E Proper internal cooking lconsumer advisory posted 24 ':Sanitizatranrinse(hot`water=chemical)=."_.; >C NlON1A'2
0 A Approved sanitizeravailableladequateconcentrationofsanitizer
�4 g rAdepµar4e;iacllfties:to marntam prodc k x z > C h!!0` (/A;,'2a B Food-contact surfaces and utensils used for potentially
M terhperatur'e''th greeters 4provided ` ' hazardous f d sanitized at least eve 4 hours
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A Food thermometer available and accurate C Adequate ^lshwashersanitizer ❑f!nal rinse temp
B Proper food thermometerfor product Pro ersanitizin procedure D je
C Thermometers appropriately placed in cooler units E Sanitizing between raw animal origin&ready-to-eat food
0
w 4x ? ' S Clean wiping cloths kC. [410` NSA 1
7 6ddrote'�f.du}r[tag"s#o�age;prepka�attob, ,� NJO !NI 2
c dt1ptlay,s$m!rce "'dAtrans �.rt:�tjoi s �* -' i°' A Cloths and/or sponges in good repair and clean
B Wiping cloths kept in sanitizer between uses X.
A Produce washed
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B Raw meals not sforedlprepared near ready-to-eat foods 126 PR d cbhtact
C - Food covered properly €� V
A Food equipment clean,utensils clean,equipmentintedors clean
D Adequate splash guards sneeze guard 14 1 1 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 r �3s 4 °Foncwernersure,proveaequred NilA' i'2
0 8 °Handwasing accessories provided C iNIQWA< ;�'
9� 'Hated , .
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A No unnecessary handling RTE andlorcooked foods with bare hands A Soap J paper towels! drying device available
B Dispenser(s)working: ❑Soap ❑Paper towel
B Minimize food handling,other than ready-to-eat,with bare hands C Handwash sink(s)clean/waste receptacle at handwash sink
C Adequate utensil(s)for dispensing foodlice 0
1 tit
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]
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 a you required to report to the Iotal health department?
Roasts Other
Describe re-heating procedures: Is there a written illness policy th requires the food worker to report specific illness conditions
Are temperatures recorded/logged for cold holding foods/equipment? Y and diseases to the QFO? Y *Do you have a paid sick leave policy? Y N
Are foods cooked in advance and cooled? Y N *Are leftovers IV Y N Is there a language barrier b eon inspector&OF07 Y N K yes indicate language spoken
List products cooled: by QFOIDA: *Can the QFO/DA read the inspection report? Y N
Describe cooling methods: Indicate who answers the above questions:Name(print):
Indicate the title of above person]circle all that apply):QFO DA Mgr Cook Owner FW
Is cooling monitored for time&temp? Y N Is the monitoring of ooling recorded? Y N •01btain signature of the ho rec FO responsibilities information at the time of the
Is there a produce washing policy? Y N *Describe what linhA ashe and inspectio .
where: Note: This report is a two page form(total of 62 debitable items) Page 1 of 2
$ � 4 ' #, s
STpfiE OF CONIV CrIGUT AEPARTMENr OF PUBLIC FIEALTH r10,..AFITOL AVENUE'L IN�6#51 FDP-HARTFQRD,CT:06134'
Is(�C SEb FOOII SERVICE INPECTTCIf2EkUTtT
LOALNEALTH DEPTrf. i d,� ��2 °" ADDRESIt�Tlr:
Etablishrnent r'/a1u'`S' - �L te; iaz Date:;:;of Inspection: ".
ddress'. o`. '. uC F . Owner or Operator: (?4 J
ADDITIONAL FOUR POINT ITEMS Q3 KEY: DNC [DOES NOT COMPLY] z
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
11 Toxic chemicals. No cross connections,back siphonage,back#low 4.
4 Proper typetinstallation/backflow prevention devicel air gap#or:
-Stored properly,labeled properly,used properly -Food equipment -Hose connections -Dish machines
-Sanitizer concentration notto exceed maximum permitted -Soda system carbonator -Beverage dispensers -Toilet tanks
-No unnecessary toxics on the premises -Chemical dispensers -Ice machines
-Pesticides/rodenticides properly dispensed Proper drain for:
-Food equipment -Dish machines -Ice machines
29 Water source adequate,safe. 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 !TENS KEY: DNC [DOES NOT COMPLY]
Sources of food: Original container,properly labeled 1' 0 Garbagelrubbishstoragearealrooms,enclosures-properiywnstructed,clean
5 Potentially hazardous food properly thawed 2 1 Garbage/rubbish disposed of in an approved manner,at approved frequency
10 Food dispensing utensils properly stored 1: 42 Vermin Control: No inseclslrodents present .2
14 Food worker:Clean outer clothes,effective hair restraints 1< 3 Outer openings protected against entrance of insects/rodents 1
F rs: Floor covering installed,constructed as required,good repair,cle .:1'
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 1
1$ Single service articles,storage,dispensing 2 µ;
481 Exterior walking,driving surfaces,good repair,clean
19 No reuse of single service article 9 Walls,ceilings attached,equipment properly constructed,good !-
repair,clean.Wall&ceiling surfaces as required
20 Dishwashing facilities approved design,adequately constructed, 2 1
maintained installed located 50 Dustless cleaning methods used,cleaning equipment properly stored
Equipment&Utensils: Cleanliness 1°" 51 Adequate lighting provided as required 1`
21 Preflushed,scraped,soaked and racked 52 Room free of steam,smoke odors r
2 Washwaterclean,proper temperature 53 Rooms&equipment hoods,
ducts,vented as required
23 ate thermometers provided,dish basket,if used 54 Rooms adequate,clean,adequate lockers provided,facilities clean
2 food-contact surfaces of utensils&equipment clean
55 Establishment and premises free of litter,no insect/rodent harborage, 1
Equipmentlutensils,storage,handling no unnecessary articles
32 Properdisposal ofwaste water 56 Complete separation from living/sleeping quarters and laundry a
r l
33 Plumbing location,installation,maintenance i 57 Clean/sailed linens stored properly
58 No live birds,turtles,orother animals(except guide dogs) 1
36 Toilet rooms enclosed with self-closing door
59 Seats 75 or more:Nonsmoking area provided,sign(s)posted at
37 Proper toilet fixtures provided,good repair,clean `" entrance(s),smoking area indicated bysign(s) 3
."•F;..:
39 Approved garbagelrubbish containers,adequate number,covered, 1
rodent proof,clean poutine Inspection ❑Reinspection ❑ Preoperational Inspection
INSPECTOR: PERSON IN CHARGE: Other Inspection:
Demerit Score: *Include demerits from page 1
- 4 3 2 1 Total Rating
signature /� signature
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print nanv print name (�
phone number title DATE CORRECTIONS DU : _
Page 2 of 2 plus continuation pages Focused IosP F aooz
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