HomeMy WebLinkAboutFood Service Establishment Inspection 19 (3) Establishment: �� 1z6L Inspection Date: Time: ROins insp
Address/City: Dhw i_� 4�o_)l 5S4 _Class: 1 2 3
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 N10 NIA DNC I KEY: C[complies] MID[not observed] NIA[not applicable]
A Quhilfietl Foad'dperator w 3 NC[does comply] D[other] RTE[ready to-eat]
12:;"Personnel with infe'ctton restricted `
61 ;Deal noted Alternate' 2
:. n
A Food workers have no exposed infected"lesions I burns
62` `Written documentation of training program 2
B Personnel with infection restricted
1 Approved source,wholesome,nonadtilteratetl !C. ;N10 NIA 4 C Communicable disease of worker reported to local health director
A Approved shellfish,finfish,meat&poultry USDA approved 113 '!+Wdwashrng;facrhtres'provided handtwasl ed,clean C Wo NIA '4
B Food cans in good condition(not dented,rusty,bloated,leaking) X A Handwash fAdliqes in all food prepldispe ing& arewash areas
C Wholesomelnonadul#eratedfoodslsafe B Handw h f lities in or imme a at to toilet rooms
D Commercial products(no home grown/canned food) C Hand cili'es a its O to use
E Potentially hazardous foods received at proper temperature p Per noel hanqj"hggljteTroVer handwash procedure
E Han mg at appropriate times
3 Qtebfially'rfiazardous*foal rtieets'.temperature requir'smenis C N10 0
# tlLrrng storage;pnepahafion,displays service�aiid'transportation
15 'Good hygienic praictrc. s - C N!0 'WA 2:
A Hot holding greater than or equal to 140°F. (wholebeeilpork roasts 1300 F.) A ❑ Na eating ❑ No smoking while working n
B Cold holding less than orequal to 45°F. A B Wounds covered adequately
C Proper cooling C Proper sink used for handwashing
D Proper re-heating 0
24 '5ani iaatiorrf rinse° halt'water-cheinic C x .. ,G NO 'NIA 2'E Proper internal cooking/consumer advisory posted „"..,;,. „ �..,,;x ,. .•.". .,. .,, ., ,,, , ,,
A Approved senitizer availableladequate concentration of sanitizer
degrtatiafc2lttis'to maint ICL:ain*"jar duct x .. C. €hUO iN B Food-contact surfaces and utensils used for potentially
[ttperature,Ktherriro rsu rovded' , . „, [ ;..� hazardous food sanitized at least eve 4 hours
sr4 p every
A Food thermometer available and accurate C Adequate ❑dishwashersanilizer ❑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 placedin cooler units
25•Clean wrptfig'01-Cil s "n C3 IVLO;,NIA ,I.,
di l ji,serwrae�aYtfd*rgnspQt?tatfon " A Cloths and/or sponges in good repair and clean
A Produce washed B Wiping clolhs kept in sanilizer between uses
0
B Raw meats not stored/prepared near ready-to-eat foods t �1-conlaot+.surfac s Iai;an 4 "�P,"Ok C 'WO .NIA,;
C Food covered properly +'sds'. +"tt `+ •� .
A Food equipment clean,utensils clean, uipmentinteriorscl
D Adequate splash guards!sneeze guard B Single use gloves changed when soile
E No unauthorized personnel C Food--coniac#surfaces clean
F No pooling of eggs not cooked immediately
8 Food containers stored off the floor r t
�30 ,Wot a d old"wa ecrunder resst.,r% urded asn utreti `C I N!A 2
0 38 lHandwshirg aidcessoftessprovidetl C V110. A�
k9 „Hitdtinrofodtinlntmizedk ` }" , C :NIA JWA 2
" `' I - A Soap!paper towels I drying device available
A No unnecessary handling RTEand/or cooked 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 utensil(s)fordispensing 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: F. Describe illness conditions when you would exclude a food worker from working:
Are internal cocking temperatures taken? Y N *To what temperature do you cook:
Poultry Ground Beef Pork What diseases related to FB illness are you re qui d to report to the local health department?
Roasts Other
Describe re-heating procedures: Is there a wdUen illness policy that requirayffie food worker to report specific illness conditions
Are temperatures recordedilogged for cold holding foedsleq " ment? Y N and diseases to the QFO? Y N Do you have a paid sick leave policy? Y N
Are foods cooked in advance and cooled? Y N ♦ re leftovers saved? Y N Is there a language barrier between i pector&QFO? Y N es indicate language spoken
List products coaled: 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 above person(circle all that apply):QFO DA Mgr Cook Owner FW
Is cooking monitored for time&temp? Y N Is monitoring of cooling recorded? Y N .Obtain signature e r �o received the QFO responsibilities information at the time of the
Is there a ce produ washing policy? Y N Describe what Is washed and inspection:
where: Note: This report is o ale form(total of 62 debitable items) Page 1 of 2
S ATE OF GO1�iNECTIC�IT DEPARTMEAIT OF PUik WEAI_T-W 41.t)CAPIT,bL AVENUE MS#51PDP-WARTFORD,CT Q 4
ha I OCUSEt3 FOOD'SEW CM,INSPECTI 112EPQ tT
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tOYALHEALTH,DEP1 -ADDRES5fCITY
Establishment L7'Z�rt:Iiutib5 Date of<inspedtion:
tltdess C%' ?6 Owner or Operator:
ADDITIONAL POUR POINT ITEMS
KEY: DNC [DOES NOT COMPLY] '
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 a
4 Proper ypelinstaliationl 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
-Pesticides/rodenticides properly dispensed Proper drain far;
29 Water source adequate,safe. -Food equipment -Dish machines -Ice machines
4
-Well l well head protected from contamination 35 Toilet facilities. Adequate,convenient,accessible, 4
-Water quality in compliance designed,properly installed
-Monitoring in compliance
OTHER ITEMS z_ KEY: DNC [DOES NOT COMPLY]
2 Sources of food:Original container,properly labeled 40 Garbage/rubbish storage arealrooms,enclosures-properly constructed,dean
5 Potentially hazardous food properly thawed 2` 1 Garbage/rubbish disposed of in an approved manner,at approved frequency
10 Food dispensing utensils properly stored 4 42 Vermin Control: No insects/rodents present '2':
14 Food worker:Clean outer clothes,effective hair restraints 43 Outeropenings protected againstentranceofinsectslrodents ;
4 Floors: Floor covering installed,constructed as required,good repair,clean 1
16 Food-contact surfaces designed,constructed,maintained,installed, 2 45 Floors graded,drained as required
located
6 Floor,wall juncture covered ;
17 Nonfood-contact surfaces designed,constructed,maintained, 1` "
Mats removable,good repair,clean r-
installed,located 7
18 Single service articles,storage,dispensing ,2 8 Exterior walking,driving surfaces,good repair,clean 1`
'
19 No reuse of single service article 9 Walls,ceilings attached,equipment properly constructed,good "
repair,clean.Wall&ceiling surfaces as required
20 Dishwashing facilities approved design,adequately constructed, 2 ' kl
maintained installed located 50 Dustless cleaning methods used,cleaning equipment properly stored
Equipment&Utensils: Cleanliness 1 51 Adequate lighting provided as required 1'
1 Preflushed,scraped,soaked and racked
P 52 Room free of steam,smoke odors r
22 Washwaterclean,proper temperature
53 Rooms&equipmenthoods,ducts,vented as required
23 Accurate thermometers provided,dish basket,if used 54 Rooms adequate,clean,adequate lockers provided,facilities clean 1`
27 Nonfood-contact surfaces of utensils&equipment clean i
55 Establishment and premises free of litter,no insect/rodent harborage, 1
28 Equfpmentlutensils,storage,handling 1 no unnecessary articles
32 Proper disposal of waste water 56 Complete separation from living/sleeping quarters and laundry
1
57
33 Plumbing location,installation,maintenance h%
Clean/soiled linens stored properly
581 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 37 Propertoiletfixturesprovtded,goad 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 ❑Reinspection ❑ Preoperational Inspection
R: PERSON INE; Other Inspection:
Demerit Score: +Include demerits from page 1
4 3 2 1 Total Rating
n fire Big - I
t�
print name��� print namerze
phone number title DATE CORRECTIONS DUE: 47�}
Page 2 of 2 plus continuation pages 1n P'ai/diRoo2
Page of
INSPECTION REPORT STATE OF CONNECTICUT
FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH
CONTINUATION SHEET
NAME OF ESTABLISHMENT TOWN DATE OF INSPECTION
'77, S 0,-, �s
INSPECTION REMARKS
FORM#
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INITIAL(INSPECTOR) INITIAL(PERSON IN CHARGE
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INSPECTION REPORT STATE OF CONNECTICUT
FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH
CONTINUATION SHEET
NAME OF ESTABLISHMENT TOWN DATE OF INSPECTI N
INSPECTION REMARKS
FORM#
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INITIAL(INSPECTOR) INITIAL(PERSON IN CH
Distribution: l st-White-Health Department 2nd-Yellow- Owne/Manager