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HomeMy WebLinkAboutFood Service Establishment Inspection 12 (3) I. a ' IN :.::T £ Establishment: by1j,i ;� ��,��—Inspecti0n Date: 5— 1- / Time: R 'nsp insp Address/City: i' / mil ([ Sr Health ept: -� TL �� class: 1 2 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 N/A JDNC I KEY: C[complies] N10[not observed] NIA[not applicable] 60 taualtftedrFogtlOpe�dtor g DNC[does not comply] 0[other] RTE[ready-to-eat] ` '12 Personnel with infection,restricted C NIQ;:NlA., 4 B1`;gestgnated Alternate,' 2 4 A Food workers have no exposed infected lesions 1 burns 62 Wr+tten dacumentat+ol+of trairitng program 2 ` Personnel with infection restricted 1 iApprpved source,wtiolesome,.eonaduiterated C iN10:NIA r4 C Communicable disease of worker reported to local health director _ .. A Approved shellfish,finfish meat& oult USDA approved •13 Handwashing facilities pr'ou(detl,.:.harids washed,clean =C .NIO NlA' 4 B Food cans in good condition(not dented,rusty,bloated,leaking) A Handwash facilities in all food prepfdispensing&warewash areas G Wholesomelnonadulteratedfoodslsafe AleB Handwash facilities in or immediately adjacent to toilet rooms D Commercial products(no home grown/canned food) -Ao C Handwash facilities accessibfelconvenient to use E Potentially hazardous foods received at proper temperature k D Personnel hands washed,clean I Proper handwash procedure Handwashing at appropriate times P" •ntialry.hazardous food meets z Wit .eria ure requ'i:ements �C y N10 ;4 k tlurupg.stora ,pr paratton,display='semice%end transportation_ = > . . , rid .g to c pro NUO` rii ctice C 2. A Hot holding greater than or equal to 140oF. (whole bserrpo k,Dews 130e F) A' ❑ No eating nµ ❑ No smoking while working B Cold holding less than or equal to450F. —AdB Wounds covered adequately C Proper cooling lVel 1 C Proper sink used for handwashing D Proper re-heating ? E Proper internal cooking/consumer advisory posted 24' itizat+onrinse (hotwater-clinical} i•6�INIO !A 2 Approved sanitizer available/adequate concentragonofsanitizer i s A equateacr+l+ ies3t�omainta+wn�prrol+c x Cri h!!0 [ 2 Food-contact surfaces and utensils used for potentially peraure tietometers;pnavtded++ �_ ` hazardous food sanitized at least every,4 hours a... .:.t G..u_.a is Yk a•:.SE.:k'r[' !.„L.i.. 7. 'h u,.kt. ..HY h.tw.A. t:.t Food thermometer available and accurate C Adequate ❑dishwashersanitizer final rinse temp D Proper sanitizinrocedure B Properfood thermometer for product C Thermometers appropriately placed in cooler units E Sanitizing between raw animal origin&ready-to-eat food :.n. ". Ynsvri+p�n9rcloth . k C tIV10=tN k good prote �rdurtng+storage; rep"I'Fatii3n,t IG INTO N! _ dls i +�f�setzvfce�a i J rprtsporitat;on � � �� r � ` "'` `` A lochs andlorsponges in good repair and clean A Produce washed B Wiping cloths kept in sanitizer between uses B Raw meats not stored/prepared near ready-to-eat foods d con�ftact�s� rsfa I . , WQ A9 2 C Food covered properly od equipmentclean,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 8 Food containers stored off the floor got tan old watertinder ressure rovJd�,d"as rkqu+r d EN[0-NIA �l 0 t !38; andwash+ng accessor+e§grov+ded � C a�.�; NI 7 9 andlin o ,W.. �maed x;;. , 'l.,. _ , [ ,,, ��. x C <I .,NIA Soap pa rtowels l drying device available A No unnecessary handling RTE 11or cooked foods with bare hands enser(s)working: ❑Soap ❑Paper towel B Minimize food handllngotKer than ready-to-eat,with bare hands C Handwash sink(s)clean/waste receptacle at handwash sink C Adequate utensil(s)for ciispensingfood/ice p 0 •DESCRIBE DEFICIENCIES ON CONTINUATION SHEETS The following information is not dabitable and does not affect your score. KEY: QFO[qualified food operator],DA[designated alternate],PHF[potenfially 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 a you cook: Poultry Ground Beef Par What diseases related to Fa illness are you required to report to the local health deparhnent? Roasts Other Describe re-heating pro edures: Is there a written illness policy that requires the food worker to report specific illness conditions Are temperatures recordedllogged for cold holding foodslequipme 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 *Are I cvers saved? Y N Is there a language barrier between inspector&QFO? Y N If-yes indicate language spoken List products cooled: by QFOIDA: *Can the QFO/DA read the inspection report? Y N Describe cooling methods: Indicate who an ered the above estions:Name(print): Is coaling monitored for time 8 temp? Y N Is 1h monitoring of cooling recorded? Y N *Obtain signature of a arson cei d t QF re onsl rlities information at the time of the Is there a produce washing policy? Y N *Describe what is washed and inspection: where: Note: This ' two page rm (total 0 62 debilable items) Page 1 of 2 STATE Olc CONINECTIOT NIP*RTMENT OF PUBLt� WEALTH 41i1CAPITOLAYE�IUE MS#51 FDI? HA►R f FORD,CT 06134° «� r F()C1]SEA&QO SE1iVIGE INNPZL 'FI©1Y 1[iEPf)I2T s . LOCAI,�HEALTH DEFT: it •—. ADDRES.SICITY: .�, Establishment: .r(,� (� ,v. ,t :: Date of lnspectlon' Address: ` - 1 � � ;Owner or Operator: ADDITIONAL POUR POINT ITEMS KEY. DNC [DOES NOT COMPLY] 6 Foods not reserved. ` -Unwrapped foods not re served 4 31 Sewage disposal approved. 4 -Potentially hazardous foods not re-served -Operating as required 74 11 Toxic chemicals. No cross connections,back siphonage,backflow 4 4 Proper typelinstallation/backflow prevention device/air gap for: -Stored properly,labeled properly,used properly -Food equipment -Hose connections -Dish machines -San itizer 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: 29 Water source adequate,safe. -Food equipment -Dish machines -Ice machines 4 -Well/well head protected from contamination 35 Toilet facilities. Adequate,convenient,accessible, 4 -Waterquality in compliance designed,properly installed -Monitoring in compliance OTHER ITEMS " KEY: DNC [DOES NOT COMPLY] ' 2 Sources of food:Original container,properly labeled 0 Garbagelrubbishstoragearealrooms,enclosures-properly constructed,clean fad 5 Potentially hazardous food properlythawed 2 Al Garbagelrubbish disposed of in an approved manner,at approved frequency I 10 Food dispensing utensils properlys#ored 1 C Ve 'in Control: No insects/rodents present <=2 14 Food worker:Clean outer clothes,effective hair restraints ;1 Ou eropenings protected against entrance of insectslrodents '1 Floors: Floor covering installed,constructed as required,good repair,clean 1 d-contact surfaces designed,constructed, maintained,install 45 Floors graded,drained as required '•� located 6 Floor,wall juncture covered 17 N f od-contactsurfaces designed,constructed,maintained, 1? 7 Mats removable,good repair,clean installed,located 48 Exterior walking,driving surfaces,good repair,clean 1 1$ 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, 2R maintained installed located 50 Dusflesscleaning methods used,cleaning equipment properlystared Equipment&Utensilsi Cleanliness 1 51 Adequate lighting provided as required 21 Preflushed,scraped,soaked and racked 52 Room free of steam,smoke odors .1:.` 2 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 NlY' 27 Nonfood-contact surfaces of utensils&equipment clean 1' 55 Establishment and premises free of litter,no insectlrodentharborage, 1 28 Equipment/utensils,storage,handling ; no unnecessary articles 32 Properdisposal of wastewater 1'; 56 Complete separation from livinglsleepingquarters and laundry ,t 33 Plumbing location,installation,maintenance 1 57 Clean/soiled linens stored properly 1` 58 No live birds,turtles,orother 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 toilet fixtures provided,good repair,clean entrance(s),smoking area indicated bysign(s) 39 Approved garbage/rubbish containers,adequate number,covered, 1 rodent proof,clean ❑Routine Inspection ❑Reinspection ❑ Preoperational Inspection Other Inspection: INSPECTOR: 'PERSON IN HARG : Demerit Score: •Include demerits from page 1 07 4 3 2 1 Total Rating signature r ure print name `rr n DATE CORRECTIONS DUE: ��� ,((( phone number title c41ky— l Page 2 of 2 plus continuation pages Focused specdon 112002 Page / of INSPECTION REPORT STATE OF CONNECTICUT FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH CONTINUATION SHEET NAME OF ESTABLISHMENT TOWN DATE OF NSPEQTION INSPECTION REMARKS FORM#f 16 d 07, d V/// .4 gg derG rE J 41 bo INITIAL(INSPECTOR) INITIAL(PERSON IN CHARGE) Distribution: 1st-White-Health Department 2nd-Yellow- Owner/Manager Page�,j INSPECTION REPORT STATE OF CONNECTICUT FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH CONTINUATION SHEET NAME OF ESTABLISHMENT TOWN DATE OF INSPECTION � v7h� Gv/auBS� INSPECTION REMARKS FORM# e s 44 AL-,el' ie, 77-,01 100, , A4 INITIAL(INSPECTOR) INITIAL(PERSON IN CHARGE) Distribution: 1 st-White-Health Department 2nd-Yellow-Owner/Manager