HomeMy WebLinkAboutFood Service Establishment Inspection 43 YA
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Establishment: c1 9-r4L),:�4 spection Date: TA Time: oinsp E[ns
Address/City: y �,���C `�' ' Health epf: r.>';r�'-�v����'S Ci sr 12
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 JONC I KEY; C[complies] N!0[not observed] NIA[not applicable]
40, Qualified,Food40perator 3 DNC[does not comply] 0[other] RTE[ready-to-eat]
12`° Personnel with infection restticted'�- C rN10 NIA 4=
61 'Designated Alternate ' 2 -
- A Food workers have no exposed infected lesions 1 burns
62 °*Written documentation of tramingprogram 2
B Personnel with infection restricted
f Approved source,wholesomi,'nonatlu[terated C N10 N/A 4 C Communicable disease of worker reported to local health director
A Approved shellfish,finfish,meat&poultry USDA approved 13 "Handwashing facilities provided;hands washed,clean i C 'U0 N/A 4
B Food cans in good condition(not dented,rusty,bloated,leaking) A Handwash fa fill s in all food pre dis ensing&warewash areas
C Wholesomelnonadulterated foods/safe B Handwa f ties i or im t y dj t oilet rooms
D Commercial products(no home grown/canned food) C Hand sh facili' s i 1 e t to use
E Potentially hazardous foods received at proper temperature D 0 Perso el ha a an!Proper ffandwash procedure
E Handwas ing of appropriate times
3 Potenttallyy'haza"rdous#ootl=meets<tempeattrre're,'puirefner(ts C N10 NIA- 4 0
i d'urin sforage,preparation,display,srvi5b and.trns o{tafronh
p i 15'GgQdahygienic.practices C N10 NIA 2
A Hot holding greater than or equal to 1400F. (wholebeatipork roasts 1300 F.) A ❑No eating ❑ No smoking while working
IL
B Cold holding less than or equal to450F. B Wounds covered adequately
C Proper cooling b4 C Proper sink used for handwashing
D Proper re-heating 0
E Proper internal cooking I consumer advisory posted �d ;S'adltization�rnse(hctWatef che[nical)`.; �G ;NIIQ NIA(2
0 A Vp-r vedsanitizeravailableladequateconcentrationofsanitizer
4�[4:Adequat fPcrJ,rt eaao maintain products s = g C Nl05, 1 'N1A i B Food-contact surfaces and utensils used for potentially
I ,tg>(�tpBrature,thetm`orrieesprovrdetl I w 4 hazardous food sanitized at least every 4 hours
A Food thermometer avail able and accurate C Adequate ❑dishwashersanitizer final rinse temp
B Proper food thermometer for product
L Proper sanitizin rocedure
C Thermometers appropriately placed in cooler units E Sanitizing between raw animal origin&ready-to-eat food
PA
NIO; N,/A 1.
0ding;stprageo.preparat on l,Ci y,-service end't� nsibt�to�n ;� Cloths and/or sponges in good repair and clean
B Wiping cloths kept in sanitizer between uses
'A Produce washed 0
B Raw meals not storediprepared near ready-to-eat foodscod-awntaCtrsurfab
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 clean
o pooling of eggs not cooked immediately 0
old containers stored off the floor 79, 3ok:yot and;cold�water under pressureP provided as`require i N/A� z',
0/
i 38 Handwa h,lh§acce'worjeseprovided 41 N10-i NIA 1
9� Handling 9f� 'minimized�.� �� M Y= � 5 � C Q.N/Q NNIA 2 �3 ,
A No unnecessary handling RTEand/or cooked foods with bare hands A Soap/paper towels I drying device available
B Dispenser(s)working: ❑Soap ❑Papertowel
B Minimize food handling,other than ready-to-eat,with bare hands 1A C Handwash sink(s)clean/waste receptacle at handwash sink
C Adequate utensil(s)for dispensing food/ice p
0 1 *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 you 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 policy th requires the food worker to report specific illness conditions
Are temperatures recorded/logged for cold holding foodslequipm t? Y N and diseases to the QFO? Y *Do you have a paid sick leave policy? Y N
Are foods cooked in advance and cooled? Y N eftovers saved? Y N Is there a language barrier tween inspector&QFO? Y N If yes indicate language spoken
List products cooled: by QFO/DA: +Can the QFOIDA read the inspection report? Y N
Describe cooling methods: Indicate who answer d the above questions: Name(print):
Indicate the title of above per p(circle all that apply):QFO DA Mgr Cook Owner FW
Is cooling monitored for time&temp? Y N the monitoring of cooling recorded? Y N .Obtain signet u f the of, If who received th 0 responsibilities information at the time of the
Is there a produce washing policy? Y N ♦Describe what Is washed and inspection:
where: Note: This re a two page form(total of 62 debitable items) Page 1 of 2
rS�7):OFCQI�NECTICUTFI VIE PARTMEN, OF pU�3LIC.'HEALTH 41U CAPITOLAVENUE-MS#51FDP-HARTFORD,CT 06134
6BED FOOD jSERVI E INSPECTICIN I2EPOItT
LOG#L HEAL f H€DEPT .Se) ADDRI SSICLTY~..
Establishment. &sew—Date of,lnspedion:.
ddresh �{ ,r 'L �(f` / Owner or Operator. L�:c
. ... .,a. � ,. ..
ADDITIONAL FOUR POINT ITEMS KEY: DNC [DOES NOT COMPLY] i*
,cad
6 Foods not re-served. 4 31 Sewage disposal approved.
-Unwrapped foods not re-served -Operating as required 4
-Potentially hazardous foods not re-served
34 No cross connections,back siphonage,backflow
11 Toxic chemicals. 4
4 Proper typelinstallation/backflow prevention device/air gap for:
-Stored properly,labeled properly,used properly -Food equipment -Hose connections -Dish machines
-San itizerconcentration notto exceed maximum permitted -Soda system carbonator -Beverage dispensers -Toilet tanks
-No unnecessary toxics on the premises -Chemical dispensers -Ice machines
-PesticidesJrodenticides properly dispensed Proper drain for:
29 Water source adequate,safe. -Food equipment -Dish machines -Ice machines
4<
-We ll1well head protected from contamination 35 Toilet facilities. Adequate,convenient,accessible, 4
-Water quality in compliance-Monitoring in compliance designed,properly installed
OTHER ITEMS c' KEY: DNC [DOES NOT COMPLY]
2 Sources of food: Original container,properly labeled 40 Garbage/rubbish storagearealrooms,enclosures-properly constructed,clean h,
5 Potentially hazardous food properly thawed 41 Garbagelrubbish disposed of in an approved manner,at approved frequency X ;'
10 Food dispensing utensils properly stored 42 Vermin Control: No insectsirodents present 2•)
14 Food worker:Clean outer clothes,effective hair restraints 1= 43 Outeropenings protected againslentranceofinsects/rodents
4 Floors:Floorcovering installed,constructed as required,good repair,clean
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 7 Mats removable,good repair,clean
lied,located
1$ .
8 Exterior walking,driving surfaces,good repair,clean
Si gle service articles,storage,dispensing
9 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
maintained installed located 50 Dustless 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 1
22 Wash waterclean,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 I
27 Nonfood-contact surfaces of utensils&equipment clean i
55 Establishment and premises free of litter,no insect/rodent harborage, 1
28 Equipment/utensils,storage,handling l no unnecessary articles
32 Proper disposal of waste water 561 Complete separation from living/sleeping quarters and laundry 1
33 Plumbing location,installation,maintenance 1 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 1
59 Seats 75 or more:Nonsmoking area provided,sign(s)posted at
37 Proper toilet fixtures provided,good repair,clean 3
en#rance(s),smoking area indicated by sign(s)
39 Approved garbage/rubbish containers,adequate number,covered, I
rodent proof,clean outine Inspection ❑Reinspection ❑ Preoperational Inspection
CT R: PERSON IN CHARGE: 0 er Inspection:
17!�
Demerit Score: *Include demerits from page 1
4 3 Z 1 Total Rating
signature ,�jgr� re f�
print name print name / �-
�� ��� � "�� DATE CORRECTIONS DUE:
p onon—der title
= ) Page 2 of 2 plus continuation pages Focused I.pe do ,zouz
Page of
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INSPECTION REPORT STATE ®F CONNECTICUT NGEFOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH &UWwwCONTINUATION SHEEET -c.
NAME OF ESTABLISHMENT TOWN DATE OF INSPECTION
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INSPECTION FORM# REMARKS
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INITIAL(INSPECTOR) INITIAL(PERSON IN CHARGE)
istribution: Ist-White-Health Department 2nd-Yellow-Owner/Manager