HomeMy WebLinkAboutFood Service Establishment Inspection 58 (2) s. E r7T ri' b��TSD OD SEa INSPE T ION IZb '' iJBLIC, AI1F_ _ bR • n AI�TMNT ?n' _
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Establishment: 7— ,�,z�� , •ill—Inspection Date: j Time: ;� �Roingp E[ns
ddress/City: '' Health Dept: y/.mob Irv. _Class: 1 2 3 d
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 NIO NIA JDNC I KEY: C[complies] N10[not observed] NIA[not applicable]
'64 Qualified Food Operator g DNC[does not comply] 0[other] RTE[ready-to-eat]
fit Designated Alternate 2
112 Personnel with rttfection restricted i C; NIA .4:
A Food workers have no exposed infected lesions I burns
62 Written documentafion of training program ,YJ 2 B Personnel with infection restricted
1 FApproved source;wholesome,nonaduiterated C N1! N!A '4
r C Communicable disease of worker reported to local ealth director �[
A Approved shellfish finfish meat&poultryUSDA approved 111. 13 Handwashtng facilities provide ,hand aS ed-clean ;C ;NIQ "WA ;4
B Food Cans in good condition(not dented,rusty,bloated,leaking) '91 A Handwash facrl es in all food pre a sin & arewash eas
C Wholesomelnonadulteratedfoods/safe B Handwash fgoties in or rrW i ent to_1 et ms
D Commercial products(no home grown/canned food) OL C Handwa ocilit ac,e si n nient
E Potentially hazardous foods received at proper temperature D Perso net hams ashed,clean 1 Pro d procedure
O E HanclAshirfat appropriate time (�
3 ;Potentially hazardous food'meets tetperature r. �eiiteitts" " 1.110 !NIA 4; 0
t during storage,preparation;display,servicesand trpnspoitattom [ E,
s.: t, • 1S Good hygEienic ,ra{ctices
p G WO ,NIA; 2.
A Hot holding greater than or equal to 140 F. (whore beef/pork roasts 1300F.) 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
rlinseD Propene-heating 2A nttizatran E Proper internal cooking I consumer advisory posted hot water.-che`,m cal ; C . t 2':
. r }
0 Approved sanitizeravailableladequate concentration of sanitizer
r4 *Ade�uef�.fayrlrfties;to.=.maintain product> t h:• C:;N10 `NIA -.2 g Food contact surfaces and utensils used for potentially
I - x: t µ +v+ c ;.p. § t t
A i temperature therrnbrteters provide hazardous food sanitized at least every 4 hours
A Food thermometer available and accurate C Adequate ❑dishwashersanitizer ❑final rinse temp
B Proper food thermometer for product L Proper sanitizin rocedure
C ermometers appropriately placed in coolerunits
E Sanitizing between rawanimal origin&ready-to-eat food
0
t C�eanwiping.cloths cC ,iVfQ: NIA;• 1
?w. 5F ti: re tl ..
•` w od pr�ta�ct &ring storage,rprepar�atian, = [ IVlO NI�;,:
5 "" A Cloths and/or sponges in ood repairand clean
fs�,tai�r,service and transporta`�rs ,� `r st .. g
ey.asttl..-�.,t a:f r, ,t4•� ..�.: ..- r. ..a.;..:.sa n.:. i':Y..,y i;P:Ei S:;:.
A Produce washed
B Wiping cloths kept in senitizer between uses
' 0
B Raw meats not stored/prepared near ready-to-eat foods 2fi ;Food=contalct surtV.ade's clean" " C' Nl fJIA 2
C Food covered properly 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
Food containers stored off the Floor i
30 I.Flo,#an ,ca1d water.under pressure,provided as required N/O :NIA 2
.;.N^' N:f'e,Y. :�t 'G#. h`5 k
36 Haedwasl�fng acc sttor]es"p aurded 'G 'N/0 ?NIA 1$
'F�andlFn of fold '`i iml "d ,.4.ti• £ M 4 x r aC N/0;NlR. 2 . ,. . F
A Soap 1paper towels I drying device available
A No unnecessary handling RTE and/orcooked foods with bare hands 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 utensils)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[poten&ally hazardous food],FB[foodborne]
PHFs 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 you cook:
Poultry Ground Beef Pork What diseases related to FB illness re you required to report to the local health department?
Roasts Other
Describe re-heating procedures: Is there a written illness policy at requires the food worker to report specific illness conditions
Are temperatures recorded/fogged for cold holding foods/equipment? Y 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 leftovers aved? Y N Is there a language_barLrr between inspector&QFO?sY N We indicate language spoken
List products cooled: by QFOIDA: *Can the QFOIDA read the inspection report? Y N
Describe cooling methods: Indicate who answered the above questions:Name(print):
Indicate the title I ab a person(circle all t at apply):CFO DA Mgr Cook Owner FW
Is cooling monitored for time&temp? Y N Is the monitod of cooling recorded? Y N .Obtain sign atur pe on w received the QFO r ibilities information at the time of the
r1sth—ere a produce washing policy? Y N ♦Describe w t is washed and inspection:re: 1. Note: This report is a two page form(total of 62 debitable items) Page 1 of 2
i ?U'T MJJt:: TMENT OE ,, L[C HEALT, *410 CAPITOLAVE IJE $01 EDP-HARTFORD,CT 06134
>�ocu a }2ERnzm
Lt CAL IEALTH`I3EQT 4 F Gu l�ub 2` iC}I?2 ^S/CITY, '
Establlshment'�50 Date of Inspection.
or
orator,
Add { Y `". �"aNxJ f i'ir � �f Owner orMOpr, .
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ADDITIONAL FOUR POINT ITEMS
KEY: DNC [DOES NOT COMPLY]
6 Foods not reserved.
-Unwrapped foods not re-served 31 Sewage disposal approved. 4
-Potentially hazardous foods not re-served -Operating as required
34 No cross connections,back siphonage,backflow ,'
11 Toxic chemicals. :.::4'.
4 Proper type/Installation/backflow prevention device/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 Prover drain for:
-Food equipment -Dish machines -Ice machines
29 Water source adequate,safe, 4
-Well l well head protected from contamination Ldesi'gtnfed,
acilities. Adequate,convenient,accessible,-Water quality in compliance
-Monitoring in compliance properly installed
OTHER ITEMS z
KEY: DNC [DOES NOT COMPLY]
2 Sources of food:Original container,properly labeled 40 Garbage/rubbish storagearealrooms,enclosures-properly constructed,dean 1
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 ;1; 2 Vermin Control: No insects/rodents present 2
14 Food worker:Clean outer clothes,effective hair restraints t puteropenings protected against entrance ofinsects/rodents l
4 ors: Floorcovering installed,constructed as re fired,god repair,clean
16 Food-contact surfaces designed,constructed,maintained,installed, 5 Floors graded,drained as required —--
located
6 Floor,wall juncture covered
17 Nonfood-contact surfaces designed,constructed,maintained, 17 Mats removable,good repair,clean
installed,located
8 Exterior walking,driving surfaces,good repair,clean 1
18 Singleservice articles,storage,dispensing
19 No reuse of single service article 9 i rings af{aclsd,equipment properly constructed,good 1}p
rep: clean-Wa71&ceiling surfaces as required
20 Dishwashing facilities approveddesign,adequately constructed, 2
maintained installed located 50 Dustless cleaning methods used,cleaning equipment properlystored
Equipment&Utensils: Cleanliness 1 51 Adequate lighting provided as required
21 Preflushed,scraped,soaked and racked 52 Room free of steam,smoke odors
22 Washwaterdean,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-
7 Nonfood-contact surfaces of utensils&equipment clean
55 Establishment and premises free of litter,noinsectlrodentharborage, X:.
8 Equipmentlutensils,storage,handling 1 no unnecessary articles
32 Properdisposal ofwaste water Ff, 561 Complete separation from living/sleeping quarters and laundry 1;
33 Plumbing location,installation,maintenance 57 Clean/soiled linens stored properly
58 No live birds,turtles,or other 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 3
37 Proper toilet fixtures provided,good repair,clean entrance(s),smoking area indicated by sign(s)
39 Approved garbage/rubbish containers,adequate number,covered, 1
rodent proof,clean Routine Inspection 17111einspection 0 Preoperational Inspection
TOR: PERSON IN Ham: Other Inspection:
Demerit Score: *Include demerits from page 1
4 3 2 1 Total Rating
slgnature signature
print name. � � print name
` 2�4 �� r` DATE CORRECTIONS DUE:
phone number title
�_ Page 2 of 2 plus continuafion pages Focused Ins a don 112002
Page of
+ems ej
INSPECTION REPORT STATE OF CONNECTICUT °
FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH
CONTINUATION SHEET
NAME OF ESTABLISHMENT TOWN DATE OF INSPECTION
4L✓
INSPECTION REMARKS
FORM# 62
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INITIAL(INSPECTOR) INITIAL(PERSON IN CHARGE)
Distribution: 1st-White-Health Department 2nd-Yellow- Owner/Manager
Page� Of
INSPECTION REPORT STATE OF CONNECTICUT
FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH
CONTINUATION SHEET
NAME OF ESTABLISHMENT TOWN DATE OF INSPECTION
INSPECTION REMARKS
FORM.#
INITIAL(INSPECTOR) INITIAL(PERSON IN CHARGE) /
Distribution: 1 st-White-Health Department 2nd-Yellow- Owner/Manager