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HomeMy WebLinkAboutFood Service Establishment Inspection 93 114 Establishment: Inspection Date: Time: �. Roins insp Address/City: �' Health Dept: Class: 1 2 3 Based on an inspection this day,the items marked DNC identify the violations in operation or facilities which must be corrected by the dat—eTpecified on page 2. RISK FACTOR ITEMS: Listing is not inclusive of all possible debitable items C N10 N/A JONC I KEY: C[complies] NIO[not observed] NIA[not applicable] 6Q +Qttalifjed FoodAperator „ 3 DNC[does not comply[ 0[other] RTE[ready-to-eat] 61 'AetlgnatedAfternate' 2 '02 JRersonnel !th infection restricted, Nib 62 '1[lffltten documentation of tra[ning program 2 have no exposed infected lesions 1 burns A Food workers Personnel with infection restricted Ae— 1 Approved source,wholesome,'nonadufterated `C'. OVA 4 011 Communicable disease of worker reported to local health director A Approved shellfish,finfish,meat& oult USDA a roved I Ptr andwashing;fac[Ifties provided,handswashed,clean C IVIQ Nl i4 B Food cans in good condition(notdented,rusty,bloated,leaking) Handwash facilities in all food prepidispensing&warewash areas C Wholesomelnonadulterated foods/safe B Handwash facilities in or immediately adjacent to toilet rooms D Commercial products(no home grownlcanned food) C Handwash facilities accessiblelco use E Potentially hazardous foods received at proper temperature D Personnel hands washed,c n I P er handwash procedure - r h ,< „ Handwash ' es at appro irate 3 otent[atiy°hao 400s ood meets temperature roquirements C N10 ftt! n hh during storage; reparati pon dis play,3ei�r3c1:end Transportation } t- 15 Good h gienia practices Y C: J/0 A w. ;.2 A Hot holding greater than or equal to 1400F. (Whole beef/pork meese 1300 F.) A ❑ No eating ❑ No smoking while working B Cold holding less than or equal to45'F. B wounds covered adequately C Proper Cooling Proper sink used for handwashing D Proper re-heating 1 E Pro er internal cookin 1 consumera viso )-,p g ryposted 124 4.' anatfza of weter=chemical CIVIO 2 R, .. A Approv s itizeravailablr eI eqLfate concentration ofsanitizer 4= dequate.facllltles to maintain 7r d 7c1k, Food-contac su aces and utensils used for potentially F: r mperature hermometers isovided 'g „ ,i ti I ti M I hazardous food sanitized at least every 4 hours A Food thermometer available and accurate C Adequate ❑dishwashersanitizer �inal rinse temp B Proper food thermometer for product D Proper sanitizin rocedure E aiiitl ing between rawanimal origin&ready-to-eat food C Thermometers appropriately placed in cooler units 0 x� �,. � � �,,� h � •25 t •„,�,an wiping=cloths�� � ti;: K C jN10'� 1 ¢f r Rood p�otj � upr�tg"storage,prplf�a o�ni .=# �Ci NIO N111 ;2u `A,x, x Cloths andlorsponges in good repairand clean 11 ... .. B X7 .. k.�t :wr k#+s k'r':s'+ ; �`A Produce washed Wiping cloths kept in sanitizer between uses 0 B Raw meats not stored/prepared near ready-to-eat foods 7 . , 1W a l r a ,2s rFood contact sur ac s,c[ean> �. y r , a 3C NIU1 Wi i'2 C Food covered properly A Food equipment clean,utensils clean,equipment interiors clean D Adequate splash guards I 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 floor30 ;Hat and cnld water.under pssdre,;prgvided as-requlre: ;C`` ' NA .2 0 IS i Handwashmg atcpories provided^ N10'< I1A7' 9� ¢Heh i�rigoffood minimized > 'C rN.10:'N1A't� 6 >_ I A Soap I paper towels/drying device available A No unnecessary handling RTE andlor000ked foods with bare hands Y B Dispenser(s)working: ❑Soap ❑Paper towel B Minimize food handling,other than ready-to-eat,with bare hands C Handwash sink(s)clean I 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 foods, FB[foodborne] PHFs are hot held at: F. PHFs 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 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 ra-heating procedures: Is there a written illness policy at requires the food worker to report specific illness conditions Are temperatures recordedllogged for cold holding foods/equipment? N and diseases to the QFO? N *Do you have a paid sick leave policy? Y N Are foods cooked in advance and cooled? Y N *Are leftover saved? Y N Is there a language barrio between inspector&QFO? Y N If yes indicate language spoken List products cooled: by QF01DA: *Can the QFOIDA read the inspection report? Y N Describe cooling methods: Indicate who answer the above questions: Name(print): Indicate the title of ove person(circle all that apply):QFO DA Mgr Cook Owner FIN Is cooling monitored for time&temp? Y N Is the moniooren, of cooling recorded? Y N .Obtain signature the erson who received the QFO, information at the time of the Is there a produce washing policy? Y N *Describe wl}t is washed and inspection: ! >a where: Note: This report is a two page form(total of 62 debitable items) Page 1 of 2 i IE TICUzf DAP/�RTMEhIT( 1=PlJBLIC`HEALTM 41p0APITOLsA11ENE1 S#51F I i�R�TdPO D;tGT �li4 4VA ' CC7SOOD` �'GE1SPC1IQ14V ilZEP4RT �� , � 6'a rya tr � - } ; ; r E r �� ,t�,Dl)RESSlCITYr : �_�: � � � �: �.� •- Establisiiinent:. i " A,te,o..f 11.4 tron:.' ddres's: �U�f dA' 1rJ� Owner.vr`Operator ADDITIONAL FOUR POINT ITEMS N KEY: DNC [DOES NOT COMPLY] � - 6 Foods not re-served. 44, Unwrapped foods not re served 31 Sewage disposal approved.-Operating as required 4. -Potentially hazardous foods not re-served No cross connections,back siiphonage,backflow 11 Toxic chemicals. 4' 4 -Stored properly,labeled properly,used properly PF�i�type/installationlbackflow prevention device/airgap t: -Sanitizerconcentration nottoexceed maximum permitted -Food equipment -Hose connections -Dish machines -Soda system carbonator -Beverage dispensers -Toilet tanks -No unnecessary toxics on the premises -Chemical dispensers -ice machines -Pesticideslrodenticides 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, -Water quality in compliance -Monitoring in compliance designed,properly installed OTHER ITEMS Z, KEY: DNC [DOES NOT COMPLY] 2 Sources of food:Original container,properly labeled 1' 0 Garbagelrubbishstoragearealrooms,enclosures-propedyconstructed,dean tentially hazardous food properly thawed r 1 Garbageirubbish disposed of in an approved manner,at approved frequency 10 od dispensing utensils properly stored 1 , 2 Vermin Control: No insects/rodents present 2 Food worker:Clean outer clothes,effective hair restraints 43 Outer openings protected against entrance of insectstrodents 4 Floors: Floor covering installed,constructed as required,good repair,clean 16 Food-contact surfaces designed,constructed, maintained,installed, ;4= 5 Floors graded,drained as required Gated 6 Floor,wall juncture covered 17 nfood-contact surface esigned,constructed maintained, 1? 7 Mats removable,good repair,clean installed,located 8 Exterior walking,driving surfaces,good repair,clean 1" 18 Single service articles,storage,dispensing 2, 19 No reuse of single service article 9 Walls,ceilings attached,equipment properly constructed,good 17 ; repair,clean.Wall&ceiling surfaces as required 20 Dishwashing facilities approved design,adequately constructed, 2; installed located 50 Dustless cleaning methods used,cleaning equipmentproperiystoretl maintained Equipment&Utensils* Cleanliness 1 51 Adequate lighting provided as required 1` 21 Preflushed,scraped,soaked and racked 52 Room free of steam,smoke odors 1 22 Wash waterclean,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 27 Nonfood-contact surfaces of utensils&equipment clean 1 55 Establishment and premises free of litter,noinsectlrodentharborage, 1' 28 Equipmentlutensils,storage,handling 1 no unnecessary articles 32 Proper disposal of waste water 1 = 56 Complete separation from livinglsleeping quarters and laundry 1 t � ®" 57 Clean/soiled linens stored properly 1; 33 Plumbing location,installation,maintenance 1 58 No live birds,turtles,or other animals(except guide dogs) 36 Toilet rooms enclosed with self-closing door 1F ' 59 Seats 75or more:Nonsmoking area provided,sign(s)posted at 37 Properfoiletfixtures provided,good repair,clean entrance(s),smoking area indicated by sign(s) i 39 1 Approved garbage/rubbish containers,adequate number,covered, L rodent proof,clean ❑Routine Inspection ❑Reinspection © Preoperational Inspection TS2B: PERSON IN CHARGE: Other Inspection: Demerit Score: *Include demerits from page 1 4 3 2 1 Total Rating y� signature signature 40 &42" � dnt na a print ame 41 one number title DATE CORRECTIONS DUE ;K : G Page 2 of 2 plus continuation pages Focnsedfnsp nn,rzoo2 Pap—L of INSPECTION REPORT STATE OF CONNECTICUT FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH CONTINUATION SHEET (a ' -1 NAME OF ESTABLISHMENT TOWN DATE OF INSPECTION INSPECTION REMARKS FORM# M / i ZJ 112 01 weA i� V / I- Emp: Fmpseado PASS WHEN BIDE BAR TURNS ORANGE EsAannu[V0.YWIABA4M NVEfAN.suACM.W7UA 41600 J.0 INITIAL(INSPECTOR) INITIAL(PERSON IN CHARGE) Distribution: 1st-White-Health Department 2nd-Yellow-Owner/Manager I a%t Page_,,,2of INSPECTION REPORT STATE OF CONNECTICUT FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH CONTINUATION SHEET NAME OF ESTABLISHMENT TOWN DATE OF INSPECTION ^, INSPECTION REMARKS FORM# L �1� f mc ZJ4;? 72-I GL -t- _� 1 m 4 t ff C INITIAL(INSPECTOR) INITIAL(PERSON IN CHARGE) Distribution: 1st-White-Health Department 2nd-Yellow- Owner/Manager Page.. °£a INSPECTION REPORT STATE OF CONNECTICUT FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH CONTINUATION SHEET NAME OF ESTABLISHMENT TO DATE OF INS ECTION �iJ,v�Sc�� �- Z-,&/� INSPECTION REMARKS FORM# Lo � 6 j �=_,4 jrzL /4 12v zc,�,4 !!!5 .-1 .4 A 0_�A ",4.4d 4 ge 2L:d le 44 INITIAL(INSPECTOR) INITIAL(PERSON IN CHARGE) Distribution: Ist-White-Health Department 2nd-Yellow-Owner/Manager