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HomeMy WebLinkAboutFood Service Establishment Inspection 5 NIM MOM s 1. Establishment: ,tc aC A, Inspection Date: Slj ' Time: // . a gbinspL5tinsp ddresslCity: vlfifJ �� — , L- Health Dept: class: 1 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 Nle NIA JDNC I KEY: C[complies] NIO[not observed] NIA[not applicable] 1 DNC[does not comply] 0[other] RTE[ready-to-eat] 60 'QualdtedTood Operator _ r 3 12 Personnel with'infe'ction restricted C N1©'NIA. 4 61 Designated:Alternafe 2 A Food workers have no exposed infected lesions I burns -- - 82 Writfen:documentation of training program 2 B Personnel with infection restricted 1 Approved source,wholesome,nonadulterated C ';NIO NIA i4 C Communicable disease of worker reported to local health director A Approved shellfish,flnflsh,meat&poultry USDA approved 13, Handwashing facillities provided,.hands washed,clean C :N10 NIA '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 grownlcannedfood) 40, C Handwash facilities accessiblelconvenlent to use E Potentially hazardous foods received at proper temperature D Personnel hands washed,clean I Proper handwash procedure 0 E Handwashing at appropriate times .3. ,;Potentially'fia7ardo duringds�,food meetsaetrtperature requirements 'C` NIQ' ,NIA ;4', 0 storage,.:pre paratronj display,servicexand transportati on ' 15 Good hygienic practtaies C°�NlQ N1A . ,E A Hot holding greater than or equal to 1400F. (wholebeerlpork roasts 130e F.) )c A ❑ No eating ❑ No smoking while working B Cold holding less than or equal to45eF. B Wounds covered adequately C Proper cooling C Proper sink used for handwashing D Proper re-heating 0 E Proper internal cooking 1consumer advisory posted 24 Sanitization�ririse,(hot wateh';chertii al) -> C-�N1®rN1A ;2 0 A Approved sanitizeravailableladequate concentration ofsanitizer tg i'Ad'qquate,facilitiewto,rrialn"twin roduc G,=N10 lNlA r>2 Food-contact surfaces and utensils used for potentially t K, B hazardous food sanitized at least eve 4 hour �terltparat�re„t�iermpmeters�provided every A Food thermometer available and accurate C Adequate ❑dishwashersanitizer ❑final rinse temp B Proper food thermometer for product D Proper sanitizin rocedure E Sanitizing between raw animal origin&ready-to-eat food C Thermometers appropriately placed in cooler units 0 0 '25 '':Clean„tniprng cioths t r N 7 �',fd'od"profected tlitring stiorage�pfrepa a ipn; ' iC `N!0 NIA a2 N1A� 1- tpa ric a dot �z A Cloths and/orsponges in ood re airand clean } Y �espprtation� 9 P A Produce washed B Wiping cloths kept in sanitizer between uses � 0 B Raw meats not stored/prepared near ready-to-eat foods ,26 aFood cbn�ta t sr% ace cl h�g` "" �C N10= QUA 7 C Food covered properly A Food equipment clean,utensils clean,equipment interiors clean D Adequate splash guards I 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 40;! rid=cold4aterunder pressure,provided 2i regiiir` , �. ,. a:1 T 0 8 r Ha dwashin`acce"ssorres:provided,: C N1d01 NI 9 ,-Handltn'g 0j,f06d:hiintm1zed °' '- C N/0'NIA L2 - A No unnecessary handling RTE and/or cooked foodswith bare handsoa d pap tow s-1` tying device available 7—Dis enser s working: ❑Soo aper towe B Minimize food handling,otherthan ready-to-eat,with bare hands Handwash sink(s)c e Este receptacle at handwash sink C Adequate utensil(s)for dispensing food/ice 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] 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 yo cook: Poultry Ground Beef Pork What diseases related to FB ass are you required to report to the local health department? Roasts Other Describe re-heating procedures: Is there a written illness p icy that requires the food worker to report specific illness conditions Are temperatures recordedllogged for cold holding foods/equipment? Y N and diseases to the QF . Y N ♦Do you have a paid sick leave policy? Y N Are foods cooked in advance and cooled? Y N Are leftover saved Y N Is there a language b rrier between inspector&QFO? Y N If ves indicate language spoken List products cooled: by QFOIDA: ♦Can the QFOIDA read the inspection report? Y N Describe cooling methods: Indicate who answered the abov ua tions:Name(print): Indicate the title of above6oNn " aC ty):QFO DA Mgr Cook Owner FW Is cooling monitored for time&temp? Y N Is the mon' ring of cooling recorded? Y N .Obtain signalur of theive a QFO responsibilities information at the time of the Is there a produce washing policy? Y N ♦Desc' a what is washed and inspection: where: Note: This report is a two p farm(total of 62 debitable items) Page 1 of 2 SfiATE OF`CONtVECTICU7' DEPARTMENT OF Pl1BLIG.HR�11-TFi 4I{1 CAPITQ� AI/EIVUL MS#51F'DP-HARTF'ORD,CT Q6134 �QCTIS B FOOD ERv1 CE INSPEC Ta0 REPORT z IiF-AL fH DE T ADDRES.51C[TY.. Establishment, Dafe of lnspectior�: nerOeratorr' /ddress -? ADDITIONAL FOUR POINT ITEMS z a KEY: DNC [DOES NOT COMPLY] 1 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 34 No cross connections,back siphonage,backflow 11 Toxicchemicals. 4 4' Proper type/installation/backflow prevention device/airgaofor: -Stored properly,labeled properly,used properly -Food equipment -Hose connections -Dish machines -San itizer concentration notto 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. ;42 -Food equipment -Dish machines -Ice machines -Well!well head protected from contamination 35 Toilet facilities. Adequate,convenient,accessible, -Water quality in compliance designed,properly installed -Monitoring in compliance OTHER ITEMS a` KEY: DNC [DOES NOT COMPLY] 2 Sources of food:Original container,properly labeled 40 Garbage/rubbish storage area/rooms,enclosures-properly constructed,clean 1 5 Potentially hazardous food properlyihawed 41 Garbagelrubbish disposed of in an approved manner,at approved frequency i 10 Food dispensing utensils properly stored 42 vermin Control: No insecislrodents present 2 14 Food worker:Clean outer clothes,effective hair restraints 43 Outer openings protected against entrance ofinsects!rodents •1'' 4 Floors: Floor covering installed,constructed as required,good repair,clean „1 16 Food-contact surfaces designed,constructed, maintained,installed, 2 ` 5 Floors graded,drained as required located 6 Floor,walljuncture covered '7 17 Nonfood-contact surfaces designed,constructed,maintained, 1. ats removable,good repair,clean installed,located 8 Exterior walking,driving surfaces,good repair,clean 1 18 Single service articles,storage,dispensing 19 No reuse of single service article ails,ceilings attached,equipment properly constructed,good 1 repair,clean.Wall&ceiling surfaces as required r 20 Dishwashing facilities approved design,adequately constructed, 2 maintained installed located 50 Dustless cleaning methods used,cleaning equipment properly stored Equipment&Utensils: Cleanliness 51 Adequate lighting provided as required 21 Preflushed,scraped,soaked and racked 52 Room free of steam,smoke odors 1' 22 Washwaierclean,proper temperature 53 Rooms&equipment hoods,ducts,vented as required 23 Accurate thermometers provided,dish basket,if used1 54 Rooms adequate,clean,adequate lockers provided,facilities clean 1 27 Nonfood-contact surfaces of utensils&equipment clean 1 55 Establishment and premises free of litter,noinsect/rodent harborage, 1 28 Equipmentlulensils,storage,handling no unnecessary articles 32 Properdisposalofwastewater Y 56 Complete separationfromlivinglsleeping quarters and laundry 1 33 Plumbing location,installation,maintenance 57 Clean/soiled linens stored properly 1 58 No live birds,turtles,or other animals(except guide dogs) 1= 36 Toilet rooms enclosed with self-closing door 59 Seals 75 or more:Nonsmoking area provided,sign(s)posted at 37 Proper toilet fixtures provided,good repair,clean 3 enirance(s),smoking area indicated by sign(s) 39 Approved garbageirubbish containers,adequate number,covered, 12 rodent proof,clean ine Inspection ❑Reinspection ❑ Preoperational inspection Other Inspection: TOR: PERSON A E: Demerit Score: *Include demerits from page 1 k 4 3 2 1 Total Rating signature slgnat re Fallr �l pri name print name •� U C ' DATE CORRECTIONS DUE: c phone number title c 1�,� Page 2 of 2 plus continuation pages FoeuwdPnspec&un r ooz Page of INSPECTION REPORT STATE OF CONNECTICUT FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH CONTINUATION SHEET NAME OF ESTABLISHMENT TOWN DATE OF INSPECTION G-v S U 7r GcJ oti�s t INSPECTION REMARKSFORM# � � L ef A 1. INITIAL(INSPECTOR) INITIAL(PERSON IN CHARGE) Distribution: 1 st-White-Health Department 2nd-Yellow-Owner/Manager