HomeMy WebLinkAboutFood Service Establishment Inspection 86 (2) i 4
Establishment: G' NG Ins ection Date: r (p a� Time:� R01nsp ms
Address/City: U Health Dept:_ _ � ie,Y-4;4 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 N/0 N/A DNC KEY: C[complies] Nf0[not observed] NIA[not applicable]
�$0 �fluailfled FOOftOpe�ator 3 DNC[does not comply] 0[other] RTE[ready-to-eat]
" i !12 Persort;nel wtti infection restricted. G WO'`N1A .4
61 Designated Alternate a 2
;fit .Written documentation of training prograM A Food workers have no exposed infected lesions!bums
B Personnel with infection restricted Zell
1 IL"PprQVLd source,wholesome,*nonadulterated C NIO NIA C Communicable disease of worker reported to local health director
A Approved shellfish,finfish meat&poultry USDA approved 13: iarrdwashtng facilities provided,hands washed,clean C N10 Nik 4
B Food cans in good condition(not dented,rusty,bloated,leaking) A Handwash facilities in all food prepldispensing&warewash areas
C Wholesomelnonadulteratedfoods/safe B Handwash facilities in or immediately adjacent to toilet rooms
D Commercial products(no home grown/canned food) C Handwash facilities access lblelconven!ant to use
E Potentially hazardous foods received at proper temperature D Personnel hands washed,clean 1 Proper handwash procedure
a
E Handwashing at appropriate times
iPotentially haz'$rdous food meets temperature requirements C N10 N1A ;4; 0
t dunri$stofpga,preparation,drs`play„sarvrce and traiisgortation;
15 i GoocGtiygienic;prract(ces 'WA: 2..
i..
A Hot holding greater than or equal to 140°F. (Mole beef/pork roasts 1300 F.) A ❑No eating ❑ No smoking while working
B Cold holding less than or equal to 45 F. B Wounds covered adequately
C Proper cooling C Proper sink used for handwashing
D Proper re-heating 0
E Proper internal cooking/consumer advisory posted �24`43a�ijtiation;nnsea{hQtswater-.cfiQmieal) CNlf]E<'NlA 2
0
_Kr A Approved senitizeravaflableladequateooncentrationofsanitizer
kq Adequate'facilit eo malriteinMpbdut :; r; m:t A[Jjp [N1A>,2° B Food-contact surfaces and utensils used for potentially
a a
temperature,,�thermernii.;P dvlded�; hazardous food sanitized at feast every 4 hours
A Food thermometer available and accurate C Adequate Odishwashersanitizer ❑final rinse temp
B Properfoodthermometerforproduct D Proper sanitizin rocedure
4 E Sanitizing between raw animal origin&ready-to-eat food
C Thermometers appropriately placed in cooler units 0
a
e , l25hC�Igan wiping;c[gths
!, 00dapFotced df t ra a re oration , [C NIO N
�[ 'ily secs d nspogrtatorf � :a A Cloths and/or sponges in good repair and cfean
B Wiping cloths kept in sanitizer between uses
A Produce washed
0
B Raw meats nat stored/prepared near ready-to-eat foods
FLt7��QQd.�CO #aCt&Ilml?fl,'�e3�.o, lean ;., ' r.,:�C.
C Food covered properly 1� A Food equipment clean,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 stared off the floor 36;'Hot to coCd water indeC piessiire;proyfdec)as niqu1re' iC NIDi iN/l4 f2
0 38 Ha
ndwastlIng accessories prgvidetl ;' lC IV/0 'NUA
jg 1 j f di rni C N10 VIfm�o m _ , , LL,
A No unnecessary handling R7E andlorcooked foods with bare hands A Soap 1 paper towels 1 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)fordispensing food/ice 0
01 H *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: OF, 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 written bss policy that requires the food worker to report specific illness conditions
Are temperatures recordedllogged for cold holding foodslequipment? N and diseases to thill QF0? Y N *Do you have a paid sick leave policy? Y N
Are foods cooked in advance and cooled? Y N *Are ieftove saved? Y N Is there a tangAge barrier between inspector&QFO? Y N It ves indicate language spoken
List products cooled: by QFO/DA: *Can the QFOIDA read the inspection report? Y N
Describe cooling methods: Indicate o answered the above questions: Name(print):
Indfcat 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 monitori 0of cooling recorded? Y N *Obi in signature of the erson who received QFO responsibilities' mation at the time of the
Is there a produce washing policy? Y N ♦Describe at is washed and inspection:
where: Note: This report i a tw page for of debita a ite Page 1 of 2
STAT, OF CONNEfwTIGIJT,IRhARIIIENT OF Pl)SI.IG"F�EATH 4 t01 �-AYNUE 1VlS#5IDP-HARI"�OFtL7,CT t}G13
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LbCALNEALTWbEPi /�TF /�tJ�j: ,�C�:' ADDRESS/CITY
Establishment: NO of Inspection:, 2v
Address:;" rlfl 9u 1 r✓. I ' Owner or;.Operator:"
ADDITIONAL FOUR POINT ITEMS Z' t�
Q, KEY: DNC [DOES NOT COMPLY]
6 Foods not re-served. "A
-Unwrapped foods not re served 4 31 Sewage disposal approved. 4
-Potentially hazardous foods not re-served -Operating as required
37 No cross connections,back siphonage,backflow
11 Toxic chemicals. 4:,
4 Proper type/installation/backflow prevention devicel air gap for:
-Stored properly,labeled properly,used properly -Food equipment -Hose connections -Dish machines
5anitizer concentration not to 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:
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
-Monitoring in compliance designed,properly installed
OTHER ITEMS KEY: DNC [DOES NOT COMPLY]
2 Sources of food: Original container,properly labeled 1 0 Garbagelrubbishstoragearealrooms,enclosures-properly constructed,clean
�'A"
5 Potentially hazardous food properly thawed 2 41 Garbage/rubbish disposed of in an approved manner,at approved frequency
10 Food dispensing utensils properly stored 42 Vermin Control: No insectslrcdents present °2
14 Food worker:Clean outer clothes,effective hair restraints 1 3 Outeropenings protected against entrance ofinsects/rodents 3
'Floors: Floor covering installed,constructed as requir d,good repa clean
16 Food-contact surfaces designed,constructed,maintained,installed, ;2; 5 'Floors graded,drained as required
located
6 Floor,wall juncture covered
17 Nonfood-oontact surfaces designed,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 j311s,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 w r
Equipment&Utensils: Cleanliness A 51 Adequate lighting provided as required
21 Preftushed,scraped,soaked and racked 52 Room free of steam,smoke odors -3 i
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.
27 Nonfood-contact surfaces of utensils&equipment clean
55 Establishment and premises free of lifter,no insect/rodent harborage, 1"
28 Eouipm7tfutensils,storage,handling T no unnecessary articles
P.r a disposalofwastewater 56 Complete separation from living/sleeping quarters and laundry 1;
tµ .j77
X
Plumbing location,installation,mainteh�nce 57 Clean/soiled linens stored properly x�;
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 sX
37 PropertoiletfixturesprovIded,good repair,clean entrance(s),smoking area indicated by sign(s) s
39 Approved garbage/rubbish containers,adequate number,covered, €"1:
rodent proof,clean Moutine Inspection ❑Reinspection ElPreoperational Inspection
To Other Inspection:
PERSON IN CJ1A_R_GE:
Demerit Score: *Include demerits from page 1
4 3 2 1 Total Rating
signature sig ture 7
print name� `��
�n a print name
Y` �T" � � DATE CORRECTIONS tttD���UE���: t
phone number title
Page 2 of 2 plus continuation pages Focused Inspecdo v.02
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