HomeMy WebLinkAboutFood Service Establishment Inspection 53 (3) MR—= Ella
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Establishment: Inspection Date: Time: ofnsp insp
Address/City: Health ept: Class. 2 3
Based on an inspection this day,this 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 IDNC I KEY: C[complies] NIO[not observed] NIA[not applicable]
Qualified Foo4lol%erator X g DNC[does not comply] 0[other] RTE[ready-to-eat]
} 12, Personnel with infection restricted
61 17e`ignated Alternate �_ ,� z C,,N1fJ' ,4
62 Written documentatlontof tratmng program A Food workers have no exposed infected lesions 1 burns
2 B Personnel with infection restricted
1 Approved source'wholesome nonaduiterated C IN! NIA '4.
f, m unicable disease of worker reported to local health director
A Approved shellfish,finfish meat&poultry USDA approved H dwashrng[facrhtiessprovided,handswashed,clears C NIQ 4
B Food cans in good condition(not dented,rusty,bloated,leaking) Handwash facilities in all food I.prep/dispensing&we rewash'
areas
C Wholesome/nonadulterated foods/safe B Handwash facilities in or immediately adjacent to toilet rooms
D Commercial products(no home grown/canned food) C Handwash facilities access!blelconvenient to use
E Potentially hazardous foods received at proper temperature D Personnel hands washed,clean/Proper handwash procedure jell
Handwashing at appropriate times
3 P entiall.6 hl us food.meets temperature.irequirements. '10 N10 IN. 4
tlrfrin $forage,preparationxdiaplay,aerv,ce and transportation
hygie c pro F C FN10
15 od: ni dices
A Hot holding greater than or equal to 140oF. (whole beertporkroasts 1300R) ❑ No eating ❑ No smoking while working
B lCold holding less than or equal to 45oF. B Wounds covered adequately
C Proper cooling C Proper sink used for handwashing
D Proper re-heating 0
E Properinternalcooking/consumer advisory pasted 24 nsttzatiotiriijste (hot water -chemical) rC kNl ' Z'
0 pproved sanitizeravailabieladequate conoentration ofsanitizer
I Lev
A( uae`lp I f s fp in"tain prod'u�t i' ;C� NI0 ' g ood-contactsurfaces and utensils used for potentially
to raturethermomeers providers r hazardous food sanitized at least every 4 hours
e t .
Feodiliermometeravailableandaccurate C Adequate �dishwashersanitizer ❑final rinse temp
D Proper san tizin rocedure
B I Proper food thermomelerforproduct E Sanitizing between raw animal origin&ready-to-eat food
C Thermometers appropriately placed in cooler units
0
0
i w 25 'i�Jean wiping rcot!IS� ;x n .' fi CN/Q} NIA 1
? rEI prteeiFifirerertibn; : rCK N10 Nl `i2 _..._ _ > A I
'dvodaytser�Ilee�artdetrransp.ortatler x A Cloths and/or sponges in good repair and clean
1 #' 'a* 'a' �* e s `` B Wiping cloths kept in sanitizer between uses
A Produce washed
0
B Raw meats not stored/prepared near ready-to-eatfoods 2f At=clad
-contaetsunfacesleanCf;WO N/A 2
"a. ��F 6 J C Food covered properly
A Food equipment clean,utensils clean,equipment interiors clean k
D Adequate splash guards/sneeze guard g Single use gloves changed when soiled
E No unauthorized personnel C Food contactsurfaces clean
F No pooling of eggs not cooked immediately 0
8 Food containers stored off thefioor f` `' " "
30., t and:cold water„under pressure,provided ss=requir 0 N!A 2X:
;., at y.4rdz Yu::'Y. 6' 4,
0 n"ftlHinghadcessories'O-ld d'; „ C P 0� U f!
>g E. m, x: :..� u..:a ,.I r x:
F,.i,0.0111ng of IL J"rrtfin�tmVze�1" x. 0 kN1.03 INK 2, Soap!paperlowei ryi evice available
A No unnecessary handling RTE and/orcooked foods with bare hands B
Dispensers)wor •ng; ❑ P.—Ma-per towel
B Minimize food handling,other than ready-to-eat,with bare hands C Handwash sinks)clean/waste receptacle at handwash sink
C Adequate utensil(s)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[potentially hazardous food],FB[foodborne]
PHFs are hot held at: IF. 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 ilines are you required to report to the local health department?
Roasts Other
Describe reheating procedures: Is there a written illness poll that requires the food worker to report specific illness conditions
Are temperatures recorded/logged for cold holding foods/equipment? 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 le ov rs saved? Y N Is there a language baler between inspector&QFO? Y N If ves indicate language spoken
List products cooled: by QFOIDA: *Can the QFOID read the inspection report? Y N
Describe cooling methods. Indicate who answered the above questio a rint):
Indicate the title of above person 5e /<eSpDnsibiI(Iies;
DA Mgr Cook Owner FW
Is cooling monitored for time&temp? Y N Is the mcni ring of cooling recorded? Y N .Obtain signature of the P.
oQ d information at the time of the
Is there a produce washing policy? Y N •Describ what is washed and inspection:
,vhere: Note: This report rs a two page form(total of 62 debitable items) Page 1 of 2
S 1ATI=dl?C4NNECTIC111' bEPAR TMEI T OF PU�L[G:H1=AL`TH- 10 C�4PITt)LAVENt -M 51 P-HAFtTIFORD,CT a6134
FbCUSED FOOD•SERVICE INSPECTION )2EP.OAt ,
LQGAL HEALTHbEPT - r,�175 ..;ADDRESSICITY. .
a
Establishment: ` = Date of Inspection:
ddress:' f Owner or Operator::
ADDITIONAL FOUR TPOINT ITEMA ;Q 1 KEY: DNC [DOES NOT COMPLY] d
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
11 Toxic chemicals. No cross connections,back siphonage,backflow :,4
4 Proper tvoe/installation/backflow prevention devicelairgapfor:
-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:
-Food equipment -Dish machines -Ice machines
29 Wafer source adequate,safe. 4
-Well/well head protected from contamination-Water quality in compliance 35 Toilet facilities, Adequate,convenient,accessible,
-Monitoring in compliance designed,properly installed
OTHER ITEMS KEY: DNC [DOES NOT COMPLY] o
2 Sources of food:Original container,properly labeled 1 0 Garbage/rubbish storage area/rooms,enclosures-properly constructed,clean ';
5 Potentially hazardous food properly thawed 2 41 Garbagelrubbish disposed of in an approved manner,at approved frequency
10 Food dispensing utensils properly stored 1 2 va7in Control: No insects/rodents present
14 Food worker:Clean outer clothes,effective hair restraints 1 aer openings protected against entrance ofinsects!rodents rl
4 Floors: Floorcovering installed,constructed as required,good repair,clea
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, 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 Walls,ceilings attached,equipment properly constructed,good 1
repair,clean.Wall&ceiling surfaces as required
20 Dishwashing facilities approved design,adequately constructed, 2= 1'
maintained installed located 50 Dustless cleaning methods used,cleaning equipment properlystored
Equipment&Utensils: Cleanliness 51 Adequate lighting provided as required 1
21 Preflushed,scraped,soaked and racked 52 Room free of steam,smoke odors / 1
2 was water clean,proper temperature 53 Rooms&equipment hoods,ducts,vented as required
23 urate thermometers provided,dish basket,if used 4 Rooms adequate,clean,adequate lockers provided,facilities clean 1
'. onfood-contact surfaces of utensils&equipment clean fi 55 Establishment and premises free of litter,no insectlrodentharborage, 1
28 EquipmenUutensils,stprage,handling 1 no unnecessary articles
32 Properdisposal of wastewater " 56 Complete separation from living/sleeping quarters and laundry 1
11
:.w: 57 Clean/soiled linens stored properly 1
33 Plumbing location,installation,maintenance :1M
58 No live birds,turtles,or other animals(except guide dogs) 1
36 Toilet rooms enclosed with self-closing door 1
59 Seats 75 or more:Nonsmoking area provided,sign(s)posted at 3
37 Proper toiletfxtures provided,good repair,clean entrance(s),smoking area indicated bysign(s)
39 Approved garbage/rubbish containers,adequate number,covered, 1
rodent proof,clean 011outine Inspection ❑Reinspection ❑ Preoperational Inspection
INSPECTOR: PERSON Other Inspection:
/ Demerit Score: *Include demerits from page 1
r /�Rzc. �kl_ 1 4 3 2 1 Total Rating
ignature sign'fure,
i t name print name l,,a
G�� �� / DATE CORRECTIO DUE:
phone number title
J Alf �� Page 2 of 2 plus o�nuation pages Focused Inspection V2
Page of
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INSPECTION REPORT STATE OF CONNECTICUT
FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH
CONTINUATION SHEET
NAME OF ESTABLISHMENT TOWN DATE OF INSPECTION )j
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INSPECTION REMARKS
FORM#
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INITIAL(INSPECTOR) INITIAL(PERSON IN CHARGE)
Distribution; 1st-White-Health Department 2nd-Yellow-Owner/Manager
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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)
Distribution: 1st-White-Health Department 2nd-Yellow-Owner/Manager