HomeMy WebLinkAboutFood Service Establishment Inspection 57 (3) a�w/-
Establishment: y1 pig �. Inspection Date: / Time: / ;0,1 oinsp insp
ddresslCity: 'T'm; Fa/� �i'�l/'j Health Dept, 22 e Class: 1 z 3 a
Based on an inspection this day,the items marked DNC identify the violations in operation orfacilities 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 N/A IDNC I KEY: C[complies] NIO[not observed] NIA[not applicable]
'tig Qu;°I[fied�aQdOpe`rator ` f 3 3 DNC[does not comply] 0[other] RTE[ready to-eat]
t o d 3 x ar. :+ - -
x 12 F Aers`,o net with Infection rest iicted :` C N10' N/A 4
61 ICeslgnated Alternate K ` : ` 2
lit 'Written documentation oftraining�pragram, r> 2 A Food workers have no exposed infected lesions/burns
.. �.. _ a _.:.: B Personnel with infection restricted
1 rdVed source wholesolite rionaduttsrated iGr IVIO NIA. 4
r. >�.: .,,�. C Communicable disease of worker reported to local health director
A Approved shellfish,finfsh,meat&poultry USDA approved
tlwashmgrfacilities provlded�haitdswastied,clean�;C 4''N10 NI r
B Food cans in good condition(not dented,rusty,bloated,leaking)
Handwash facilities in all food prepldispensing&warewash areas
C Whole some(nonadu Iterated foods/safe B Handwash facilities in or immediately adjacent to toilet rooms
D Commercial products(no home grown/canned food) C Handwash facilities access ible/convenlent to use
E Potentially hazardous foods received at proper temperature D Personnel hands washed,clean 1 Proper handwash procedure
0 E Handwashing at appropriate times
�» w.„sue .s ns�„ . . . i
3 iPotenXlally haz'ardous�foodamee`tZ empgrwture reajiltrefnen s tC NOA" 4
t J'rmngsstorage,�rreparatron;dlaplay,service Andfitransportation .,
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hygienic practipes t. w M r s CNlQ` A E 2'
A Hot holding greater than or equal to 1400
F. (whele beeflpork roasts isco F.) A No eating ❑No smoking while working
B lColdholding,less than or equal to450F. 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
2"A ' anftajlggrlre�(Fio Ater"•chemical` C rN14 N!A£ 2-=-'
0 A Approved sanitizer avail ableladequateconcentrationofsanitizer
Ad e. II I e to mat 01in jeadkitt�4�'% jG �NiO N!A 2` g Food-contact surfaces and utensils used for potentially
� ". ", '; '� n �` n " x hazardous food sanitized at least every 4 hours
tempgrature thermometers¢provided tr M., x �, ,,� ,
Adequate ❑dishwashersanitizer ❑fina€rinse temp
A Food thermometer available and accurate
D Pro ersanitizinq procedure
B Properfood thermometerfor product E Sanitizing between raw animal origin&ready-to-eat food
C Thermometers appropriately placed in cooler units
0
25 :Clean wiping-cloths C 'NIO, NIA 1
7 t Food dY e tl st ra a Fe oration Q N1.5 ! i
�� ' r A Cloths andlor sponges in good repair and clean
B Wiping cloths kept in sanitizer between uses
A Produce washed Q
B Raw meats not stored/prepared near readytoeatfoods i26 ronta, tsu ae f n ��rE07 Air,
C Food covered properly ., l <.
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 stored off the floor �'' Hot and col w4#er { I� esrf', %Ided ass egedC IIA
0 3ndWd$hing,dCSSaneSpra�idedrsx ':ter' PIP, e: i '
9 '.H.sidling of food minimized C N10 NIA Soap!papertowels!drying device available
A No unnecessary handling RTE and/or cooked foods with bare hands B Dispenser(s)working: OSoap aper 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 p
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[potentlally hazardous food],FB[foodbornel
PHFs are hot held at: F. 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 P rk 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 that requir the food worker to report specific illness conditions
Are temperatures recorded/logged for cold holding food slequipment? N and diseases to the CFO? Y N ♦Do you have a paid sick leave policy? Y N
Are foods cooked in advance and cooled? Y N *Are leftov, rs saved? Y N Is there a language barrier betwe inspector&QFO? Y N Iflf ves indicate language spoken
List products cooled: by QFO/DA: I ♦Can the QFOIDA read the inspection report? Y N
Describe cooling methods: Indicate who answered th above questions: Name(print):
Indicate the title of abov person(circle all that apply):CFO DA Mgr Cook Owner FW
Is cooling monitored for time&temp? Y N Is the monito ng of cooling recorded? Y N .Obtain signature of the person who received the QFO responsibilities information at the time of the
rwhere-
Fe a produce washing policy? Y N *Describe hat is washed and inspection:
ote: This report is a two page form(total of 62 debitable items) Page 1 of 2
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FvQC D l icP1T.6 AVENLj -MS451 FDP-HARTFORD CT 06134TAT M [ ;F
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FQCUS TY FOQD.SE TION'
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LOCAL HLQLTH DEP,Ts7'fi� rs . ADDRE3SICITY_ .
EstatiGshmerd: ` /Ll i4-` - Date-.6f.lnudctidn: : '1'
dd ess: �1 Owner..or Operator: W, /tv
ADDITIONAL FOUR POINT ITEMS KEY: DNC [DOES NOT COMPLY] o
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
No cross connections,back siphonage,backflow
11 Toxic chemicals. 4
4 Propert Ivoeinstal fio 1backflQ+�ventiondeylce/airga for:
-Stored properly,labeled properly,used properly -Food equipment -Hose connections -Dish machines
San itizer concentration notto exceed maximum permitted -Soda system carbonator -Beverage dispensers -Toilettanks
-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
q..
-Well Iwell head protected from contamination-Water quality in compliance 35 Toilet facilities. Adequate,convenient,accessible, 4
-Monitoring in compliance designed,properly installed
OTHER ITEMS E KEY: DNC [DOES NOT COMPLY] o}'
2 Sourcesoffood:Original container,properly labeled 1 40 Garbage/rubbish storage arealrooms,enclosures-properly constructed,dean f ;
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 insects/rodents present 2
14 Food worker:Clean outer clothes,effective hair restraints 1:, 43 0uteropenings protected against entrance of insects/rodents
44 Floors: Floorcovering installed,constructed as required,good repair,dean
6 F -contact surfaces designed,constructed, maintained,installed, 2y 5 Floors graded,drained as required
located
floor,walliuricture covered
No fgod-contact surfaces designed,constructed, maintained, 17
47 is removable,goo rp ir,clean y.
gc
stalled,located
$ Exterior walking,driving surf ood repair,clean 1
$ Single service articles,storage,dispensing
19 No reuse of single service article - 9 ails,ceilings attached,equipment properly constructed,good }
repair,clean.Wall&ceiling surfaces as required a >
20 Dishwashing facilities approved design,adequately constructed,
50
maintained installed located Dustless cleaning methods used,cleaning equipment propedy stored
Equipment&Utensils: Cleanliness I 51 Adequate lighting provided as required1r
21 Preflushed,scraped,soaked and racked 52 Room free of steam,smoke odors
22 Wash water clean,proper temperature 53 Rooms&equipment hoods,ducts,vented as required
23 AQpurate thermometers provided,dish basket,if used 54 Rooms adequate,clean,adequate lockers provided,facilities clean 1
2 ehfcod-contact surfaces of utensils&equipment clean 1"
55 Establishment and premisesfreeoflitter,noinseci/rodentharborage, 1
28 Equipmentlutensils,storage,handling .i no unnecessary articles
32 Proper disposal of waste water 1 56 Complete separation from I[vinglsleeping qua rters and laundry 1;
33 Plumbing location,installation,maintenance 1
57 Clean/soiled linens stored properly 1.
58 No live birds,turtles,or other animals(except guide dogs) i 1
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 entrance(s),smoking area indicated by signs) 3'.
39 Approved garbage/rubbish containers,adequate number,covered, 1
rodent proof,clean r outine Inspection ❑Reinspection ❑ Preoperational Inspection
Other Inspection:
S OR: PERSO IN N RISE:
f Demerit Score: •Include demerits from page 1
4 3 2 1 Total Rating
si nature si nature
prjAt,narne /<{�,J �l��Lt pri m
phone number — title DATE CORRECTIONS DUE:
Page 2 of 2 plus continuation pages Focused Inspudon 112002
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INSPECTION REPORT STATE OF CONNECTICUT
FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH
CONTINUATION SHEET
NAME OF E/STA�}BLISHMENT TOWN ,M• DATE OF INSP CTI
INSPECTION FORM# REMARKS
L D r s� r
T 1 op, � 12iV- Ile'
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AV
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INITIAL(INSPECTOR) INITIAL(PERSON IN CHARGE)
Distribute n: 1st-White-Health Department 2nd-Yellow- Owner/Manager
Page_of
A
INSPECTION REPORT STATE OF CONNECTICUT
FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH
CONTINUATION SHEET
NAME OF ESTABLISHMENT TOWN DATE OF TPECTION
INSPECTION REMARKS
MA RKSs
FORM#
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INITIAL(INSPECTOR) INITIAL(PERSON IN CHARGE)
Distribution: 1st-White-Health Department 2nd-Yellow-Owner/Manager