HomeMy WebLinkAboutFood Service Establishment Inspection 70 tal
Establishment: Inspection Date: N Time: Oinsp Einsp
Address/City: gaff Health D pt: ar /ciia0Sn ass: 1 2(
Based on an inspection this day, a 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 N10 !Aj DNC KEY: C[complies] N10[not observed] NIA[not applicable]
60 Qtzatrfied Foot!Operator 3 DNC[does not comply] 0[other] RTE[ready-to-eat]
fi 112 `Perso"'.nnei.witfi infct'ran.restricted:: C IN!A ;4
61 iDgstgnateAlternate z
q Food workers have no exposed infected lesions I burns
62 C W,citten documentation of trarntng program 2 B Personnel with infection restricted
E1 ;'Approved source,wholes oonaduiteratetl •C:NlO•NIA- 4,
C Communicable disease of worker reported to local health director
A Approved shellfish,Finfish,meat&poultry USDA approved .13 dvirashmg;factlIles provided; hands washed,clean C iPYO 'NIA':4.
B Food cans in good condition(not dented,rusty,bloated,leaking) DC A Handwash facilities in all food prep/dispensing&warewash areas
C Wholesome/nonadulteratedfoods/safe B Handwash faci'!as in or immediately adjacent to toilet rooms
D Commercial products(no home grown/canned food) C Handwash Ilties accessible/convenient to use
E Potentially hazardous foods received at proper temperatu re D Personnel nd s ed, clean 1 Proper handwash procedure
E Handwashing at appropriate times
3 iPatentta[)yy hazardous food meets temperature requirements C Nl0 NIA i 4 0
tluring sforage,preparation dlsplay,pservic%and It 0rortatlb [ :15 'Goocl',hjlgie yic practises', - ,
:�• C iN1Q. N1A 2
A Hot holding greater than or equal t 40 F (whale beef/pork roads 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 C Proper sink used for handwashing
D Proper re-heating
E ,Proper internal cooking I consumer advisory posted 424 ariit[za-111 .rinse (h t`±in a pr, chew i aa)` ' '.4 C`rNld l 2
Approved sanitizeravailableladequate concentration ofsanitlzer -�
x;adequate^facdhtres toFinaairi4a�npofup x.:�.x . „ .Ok.NIO r k2; Food-contact surfaces and utensils used for potentially
( :�., .:
ynQeratutfe,4hennometers provtdedl r r. K w w s hazardous food sanitized at least every 4 hours
Food thermometer available and accurate C Adequate ❑dishwashersenitizer ❑final rinse temp
B Proper food thermometer for product D Proper sanitlzlrl
ro ersanitlzin rocedure
E Sanitizing between raw animal origin&ready-to-eat food
C Thermometers appropriately placed in cooler units 0
0 25' aa la x1prmgici6ill �,vv y . v k 's -i �
x.,.x.nr a.. ._ .,,�. ,.... a •,.. ... C {N10g, N/A
�3 �Ft��tl pr�oe�c�ed du>•ingaa oratgd, e'��r�f;)on, „�., ICE-N10� N!A 2�
rtation air and clean
dlls�pia�l,��l��I�.tr�rispo r u' A Cloths andlors Pon 9 es in go reP
A Produce washed B Wiping cloths kept in sanitizer between uses
0
AIL
B Raw meats not stored/prepared near ready-to-eat foods [26 Egood c.r1 c 5 irfabeseles '" " C 11P I
aS w
C Food covered properly �! A Food equipment clean,utensils clean,equipment interiors clean
D Adequate splash guards 1 sneeze guard B Single use gloves changed when soiled
E No unauthorized personnel C Food--contact surfaces clean re
F No pooling of eggs not cooked immediately 0
8 Food containers stored off the floor 3p,• `k and cola waterxunderrpressure,piovidedas,,require «e 0 NIA 2
;o,
0 8? ndvtfasKin a'c'I 'Ies p ovrdt3d;.
ga, xHiertdllrr °ofr.. od minimized -s A
14 : ...w A K . ; 0Nh . i Soap 1 paper towels l drying device available
A No unnecessary handling RTE and/or cooked foods with bare hands
B Dispenser(s)working: ❑Soap ZPaper 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 utensils)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[potentially hazardous food],FB(foodborne]
HFs are hot held at: IF. 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 ou 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 poll that requires the food worker to report specific illness conditions
Are temperatures recorded/logged for cold holding foodslequipmentT N and diseases to the OF OT N ♦Do you have a paid sick leave policy? Y N
Are foods cooked in advance and cooled? Y N *Are left o -rs saved? Y N Is there a language tier between inspector&QFO? Y N iftf yes indicate language spoken
List products cooled: by QFOlDA: *Can the QFOIDA read the inspection report? Y N
Describe cooling methods: Indicate who a swered 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 molnitoring of cooling recorded? Y N .Obtain signature of the person who received the CFO responsibilities information at the time of the
Is there a produce washing policy Y N ♦Des vibe what is washed and inspection:
where: Note: This report is a two page form(total of 62 debitable items) Page 11 of 2
S Al"IWsOFCCiNN CTILUI' pI;PARTMENTOf�PUBLIC:,EAI"'fH 410 CAP TOLAVENUI=-MS#59E1 P-HARTFOIZp,CT Q6934'
s,�r FOCUSED40016'SERVICE tNSP,ECT1p i2EPOR
�LQ�G�pL HEALTH DEPT: � %l rT �rJi �/ ADDRESSIC�fTY
Establishment e s Date"of lnsptction:
ddress l� _ Owner or Operator:
ADDITIONAL FOUR POINT ITEMS KEY: DNC ^[DOES NOT COMPLY] c
6 Foods not re-served.
-Unwrapped foods not re-served 4 31 Sewage disposal approved. �4
-Operating as required
-Potentially hazardous foods not re-served
11 Toxic chemicals.
No cross connections,back siphonage,backflow
4 PfQper type/installation/backflow prevention device/air gapfor:
-Stored properly,labeled properly,used properly -Food equipment -Hose connections -Dish machines
-Sanitizer concentration not to 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
4
-Well/well head protected from contamination 35 Toilet facilities. Adequate,convenient,accessible, 4
-Water quality in compliance designed,properly installed
-Monitoring in compliance
OTHER ITEMS
KEY: DNC [DOES NOT COMPLY] to
2 Sources of food: Original container,properly labeled 40 Garbage/rubbish storage arealrooms,enclosures-properly constructed,clean
5 Potentially hazardous food properly thawed 2" 1 Garbagelrubbish disposed ofinan approved manner,at approved frequency
10 Food dispensing utensils properly stored to 2 Vermin Control: No insectslrodents present 2 _
14 Food worker:Clean outer clothes,effective hair restraints ;1:; 3 Outeropenings protected againstentrance of insects/rodents
4 Floors: Floor covering installed,constructed as required,good repair,clean
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 47 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 1
clean.Wall&ceiling surfaces as required
0 Dishwashing facilities approved design,adequately constructed, 2 1;
maintained installed located 4 50 D sfless 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
22 Wash waterclean,proper temperature 53 Rooms&equipment hoods,ducts,vented as required i "t-
curate thermometers provided,dish basket,if used 54 Rooms adequate,clean,adequate lockers provided,facilities clean Y
27 onfood-contact surfaces of utensils&equipment clean 1>
55 Establishment and premises free of litter,no insect/rodent harborage, zl<
8 ui ment/utensils,stora e,handlin '`
p g g no unnecessary articles
32 Prop rdisposal ofwastewater ,4;;-, 56 Complete separation from living/sleeping quarters and laundry 1
TT Plumbing location,installation,maintenance + 57 Clean/soiled linens stored properly f.
58 No live birds,turtles,orother animals(except guide dogs) 1
36 Toi let rooms enclosed with seif-closingdoor 1
59 Seats 75 or more:Nonsmoking area provided,signs)posted a1 k
37 Proper toilet fixtures provided,good repair,clean entrance(s),smoking area indicated by sign(s) 3,.
39 Approved garbage/rubbish containers,adequate number,covered, 1
rodent proof,clean [,Routine Inspection OReinspection O Preoperational Inspection
INSPECTOR: PERSON IN CHARGE: Other Inspection:
Demerit Score: •Include demerits from page I
0 4 3 2 1 Total Rating
�sfgnature signature �t
w- �print name print name
0�6 6� title
._� ��
phone number PATE CORRECTIONS DUE: '
Page 2 of 2 plus continuation pages Focused Inspection 1l2002
Page of
INSPECTION REPORT STATE OF CONNECTICUT
FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH
CONTINUATION SHEET
NAME OF ESTABLISHMENT TOWN DATE OF INSPECTION
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INSPECTION FORM# REMARKS
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INITIAL(INSPECTOR) INITIAL(PERSON IN CHARGE) !�
Distribution: 1 st-White-Health Department 2nd-Yellow-Owner/Manager
Page_,.2,of
INSPECTION REPORT STATE OF CONNECTICUT
FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH
CONTINUATION SHEET
NAME OF ESTABLISHMENT TOWN DATE OF INSPECTION
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INSPECTION REMARKS
FORM#
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INITIAL(INSPECTOR) INITIAL(PERSON IN CHARGE) W j
Distribution: 1st-White-Health Department 2nd-Yellow-Owner/Manager