HomeMy WebLinkAboutFood Service Establishment Inspection 53 Ah
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Establishment: Inspection Date: Time: Oinsp Eins
Address/City: '' l'� E - Health Dept: }�& �,� ass: z s a
Based on an inspection this day,the items marked DNC identi 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 NIO WA JDNC I KEY: C[complies] NIO[not observed] NIA[not applicable]
�6 all}ied,F00d�Operator g DNC[does not comply] 0[other] RTE[ready-to-eat)
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g _ g p g 2• 2 Person net with infection restricted C ;N10,iN1A
6 si nated Alternate
2 ntten documentation of tralnin ro ram Food workers have no exposed infected lesions/burns
B Personnel with infection restricted
ill. Approved source,;wholesome,nonadulterated C ';N10 N
C Communicable disease of worker reported to local health director
A Approved shellfish,finfish,meat&poultry USDA approved 131<Handwashing,faciiittes provided,he washed,clean °C ;N10 NIA :4
B Food cans in good condition(not dented,rusty,bloated,leaking)
K A Handwash facilities in all food prep/dispensing&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 accessible/convenient to use
E Potentially hazardousfoods received at proper temperature D Personnel hands washed,clean I Proper ha, wash procedure
0 E Handwashing at appropriate times
3 Pdte�hbally hazardous food meets temperature requirements C N10 NIA' 4' O
during:storage,preparation,display,serrr3ce and transportation
g 15 Good�hygieriic practices C N10 NIA 2
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A Hot holding greater than or equal to 14ft (whole beeffporkroaels 1300F.) A ❑No eating ❑xNo 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
arittization=rinse- howater^-cherriicmal NlOiNI
E Proper internal cooking 1 consumer advisory posted t f
Approved sanitizeravailableladequate concentration ofsanitizer
- ,adequate facilitties tb maintain�pr.aduct, 4. r-. n C,, N10 2 Food-contact surfaces and utensils used for potentially
eetnpVrature the ometers provlddd ;, -s hazardous food sanitized at least every 4 hoursIle
A Food thermometer avail � P
ableandaccurate "C Adequate ❑dishwashersanitizer ❑final rinse temp
B Proper food thermometer for product
L Proper sanitizin rocedure
C Thermometers appropriately placed in cooler units
E Sanitizing between raw animal origin&ready-to-eat food 0 O
125 �Cleait wiping cloths $ k
i s s r C i[VlQ- NIA €1
7 Fpoc ro ected�cEuring�s o age;pr$parat[on, t }C} NIO ,N1Ar r 2` � '. '_
A Cloths on es in oodre airand clean
t Et:tlissy,srvlcapd traiasport�tfon P 9 9 p
m''5e:.i t s` i j...
A Produce washed B Wiping cloths kept in sanitizer between uses
0
B Rawmeats not stored/prepared near ready-to-eat foods � s'. oo�l c n acf surfaisea gle2ln °` "' C` JIQ / 't2"
C Food covered properly k A Food eqll uipmentclean,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 IFood containers stored off the floor X,Hot and co[d'w erAnder pte s8re;.provided as require rN10 NIA t2,i
0 ' 8 i,Handwashing accessories provided C NJO-iN1A 1
9 [lndling #400d•minimized tC<<Nf0 1NlA _2 A Soap l paper towels! drying device available
A No unnecessary handling RTE and/or cooked foods with bare hands B
B Dispenser(s)working: ❑Soap ❑Paper towel
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 foodlice 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[potenlially 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 illness policy th requires the food worker to report specific illness conditions
Are temperatures recordedllogged for cold holding f dslequipment? Y N and diseases to the QFO? Y *Do you have a paid sick leave policy? Y N
Are foods cooked in advance and cooled? Y *Are leftovers saved? Y N Is there a language barn%N elween inspector&QFO? Y N If vas indicate language spoken
List products cooled: by QF01DA: / ♦Can the QFOIDA read the inspection report? Y N
Describe cooling methods: % Indicate who answered the above questions: Name(print[:
Is cooling monitored for time&temp? Y r N Is the monitoring of cooling recorded? Y N Indicate the title of above per (circle all that ply]:QFO DA Mgr Cook Owner FW
Obtain signature of a pal n ho received th�FO responsibilities i ormation of the time of the
Is there a produce washing policy? Y N *Describe what is washed and inspection:
where: Note: This report is a two page form(total of 62 'able items) Page 1 of 2
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5TA1fE QF CONNECTICUT QEPARTMENT OF'pWBLIC:HE 416 CAPITOL AVENUE_VS#51FDP 7,HARTFORD,CT 66134
'FOCUSED FOOD,SER�'IGE INS]PEC fiIfll# REP,fl2T
LOCALHEALTHDEPTE'r � ADDRESICITY.'
Establishment. ". . ` '���� .65
Date of,lnsptctlon: T
ddress: Lrr�" - owner.or:Operator:
ADDITIONAL FOUR POINT ITEMS KEY; DNC [DOES NOT CjO11�PLY]
6 Foods not re-served.
4 31 Sewage disposal approved.
.Unwrapped foods not re-served 4
-Potentially hazardous foods not re-served -Operating as required
No cross connections,back siphonage,backflow
11 Toxic chemicals. 4 V
4 Proper typelinstallationl backflow prevention deyiCel air gap for:
-Stored properly,labeled properly,used properly -Food equipment -Hose connections -Dish machines
-Sanitizer concentration not to exceed maximum permitted -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, 74
-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 I 0 Garbagehubbish storage arealrooms,enclosures-properlyconstructed,dean
5 Potentially hazardous food properly thawed 1 Garbage/rubbish disposed of in an approved manner,at approved frequency
Pood dispensing utensils properly stored 1 2 Vermin Control: No insects/rodents present v2
14 Food worker:Clean outer clothes,effective hair restraints X'' 3 Outer openings protected againstentrance of insects/rodents 1.
fors: Floor covering installed,constructed as required,good repair,clean Vy
16 Food-contact surfaces designed,constructed, maintained,installed, 45 Floors graded,drained as required
located
6 Floor,wall juncture covered r
17 Nonfood-oontact surfaces designed,constructed, maintained, 47 Mats removable,good repair,clean
installed,located 1
8 Exterior walking,driving surfaces,good repair,clean
18 Single service articles,storage,dispensing 2
19 No reuse of single service article 9 aMceattached,equipment properly constructed,good
II&ceiling surfaces as required
20 Dishwashing facilities approved design,adequately constructed, 2
maintained installed located 50 Dustless cleaning methods used,cleaning equipment properly stared
..< 1
Equipment&Utensils: Cleanliness �' 51 Adequate lighting provided as required
21 Preflushed,scraped,soaked and racked 52 Room free of steam,smoke odors t 1
22 Washwaterclean,proper temperature
53 Rooms&equipment hoods,ducts,vented as required
I .ka
23 Accurate thermometers provided,dish basket,if used
54 r
Rooms adequate,clean,adequate lockers provided,facilities clean L
7 onfood-contaci surfaces of utensils&equipment clean 1= 55 Establishment and premises free of litter,no insect/rodent harborage, 1'
8 Equipmentlutensils,storage,handling :1` no unnecessary articles
32 Proper disposal of wastewater 1, 56 Complete separation from living/sleeping quarters and laundry
3 robing location,installation,maintenance 1 57 Clean/soiled linens stored properly
PI t
58 No live birds,turtles,or other animals(except guide dogs)
36 Toilet rooms enclosed with self closing door 1
59 Seats 75 or more:Nonsmoking area provided,sign(s)posted at ¢`,
37 Proper toilet fixtures provided,good repair,clean 3
entrance(s),smoking area indicated by sign(s)
39 1 Approved garbage/rubbish containers,adequate number,covered, 1'
rodent proof,clean AR7outine Inspection ❑Reinspection 0 Preoperational Inspection
PERSON IN CHARGE; Other Inspection:
I CTOR:
Demerit Score: +Include demerits from page 1
,� cG.� ��(�_ 4 3 2 1 Total Rating
signature sig at re f r
print name printme
Phone number title DATE CORRECTIONS D E:
_61J Ad( Page 2 of 2 plus continuation pages Focused lnspe un 1/2002
Page of
INSPECTION REPORT STATE OF CONNECTICUT
FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH
CONTINUATION SHEET
NAME OF ESTABLLIIS�HM�E�NT✓ TOWN �j T DATE OF INSPECTI N /
INSPECTION REMARKS
FORM#
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INITIAL(INSPECTOR) INITIAL(PERSON IN CHARGE)
Distribution: 1st-White-Health Department 2nd-Yellow-Owner/Manager
Pageof
INSPECTION REPORT STATE OF CONNECTICUT
FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH
CONTINUATION SHEET
NAME OF ESTABLISHMENT TO ? DATE OF INSPECTION
7 —
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INSPECTION REMARKS
FORM#
44
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INITIAL(INSPECTOR) INITIAL(PERSON IN CHARGE)
Distribution: I st-White-Health Department 2nd-Yellow- Owner/Manager