HomeMy WebLinkAboutFood Service Establishment Inspection 10 (10) u MTNS ,.4,t �IMN
Establishment: i67— Inspection Date: Time: X -__30koinsp Einsu
ddressIC[ty: j��.�, �,qy,�� S� Health Dept: w Class: f 2 3l�
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 DNC KEY: C[complies[ NIO[not observed] NIA[not applicable]
Y ' DNC[does not comply] 0[other] RTE[ready-to-eat]
ti0lta"itfied•Folid Ole
rator y 3
r 12 Personnel witit infection reStticted
61 IDestgnatedAlternate 2 .0 ;NIO NIA �4 -
62 i Written documentatibn of training program 2
A Food workers have no exposed infected lesions I burns
B Personnel with infection restricted ,
1 Approvedligrce,w8olesome;nonadul#stated C :N10 NIA i 4 C Communicable disease of worker reported to local health director
A Approved shellfish,finfish,meat&poultry USDA approved 73;"Handwa"ndi a lities p�ovidedr:hands washed,clean C N10 INiA14.
B Food cans in goad condition(not dented,rusty,bloated,leaking) A Handwash facilities in all food prepldispensing& arewash areas
C Wholesomelnonadulterated foodsisafe
D Commercial products(no home grownlcanned food) B Handwash fo&idp in or immedja;4f)KAjgQejt to toilet rooms
C Handwas f hies accessible) e
E Potentially hazardous foods received at proper temperature D Personne s ,e oper ha awash procedure
0 E andwe nu la,a hate times
k a r s:
3„ ,#potentially hazardous fold meets temperature requirements C Vlb NIA. 4 0
durm istorage,preparation;dispiaypservic6 and ttansbortat]ori
.,
thygienic practice C: " i
1 W,
A Hot holding greater than or equal to 1400F. (,hole beef/pork roasts 1300 F.) ALf ❑ No eating ❑ No smoking while working
B Cold holding less than or equal to 450F. Ile, B Wounds covered adequately
C Proper cooling C Proper sink used for handwashing
D Proper re-heating
e C N10 zl 4SatonriE Properinternalceoking lA'Z
0 A Approved sanitizeravailableladequate concentration ofsanitizer
4 p�deq late;:acltrties#o+marntam product 4,- w INjp �N�A E Z` B Food-contact surfaces and utensils used for potentially
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r temperature,t,�emtometerst provided l x t Y, hazardous food sanitized at least every 4 hours
�'ts.,
A Food thermometer available and accurate C Adequate ❑dishwashersanitizer 9final 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 coolerunits 0
0 125 a Cledn�"i+i `sclaths
? Food r'tev t" sdu�in stbr$ .: K r C "WE) NIA ...
p g p �Pra#ini n 1C NIOpjlA
display, service and transportatiors ' ' '"` tsax +;+ A Cloths andlor sponges in good repair and clean
w B Wiping cloths kept in sanitizer between uses Ail
A Produce washed 0
B Raw meats not stored/prepared near ready-to-eat foods
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C Food covered properly - '
A Food 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 � KM
3b Teque a•e � t.
H K � a , A,44A
N1A 2•
/� ]]�� reHandwathmg acessories provided
.. XV.,i IVlO I r.2 .ii .:,:.... F. AS .4„'f k ..<:. .L 0: . , t r .15 .: ..• L
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°''` Soap!paper towels! drying device available
No unnecessary RTE and/or fends 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 Iwaste receptacle at handwash sink
C Adequate utensil(s)for dispensing foodlice 0
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]
Pli are hot held at: OF. PHFs are cold held at: F. 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 re you required to report to the local health department?
Roasts Other
Describe re-heating procedures: Is there a written illness policy at requires the food worker to report specific illness conditions
Are temperatures recorded/logged for cold holding foodslequi ent? 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 ♦Ar leftovers saved? Y N Is there a language barite etween inspector&QFO? Y N If vas indicate language spoken
List products cooled: by QFOIDA: *Can the QFOIDA read the inspection report? Y N
i
i Describe cooling methods: Indicate who answ/ed the above questions: Name(print):
Is cooling monitored for time&temp? Y N Is th monitoring of cooling recorded? Y N Indicate the title of above person(circle all that apply):QFO DA Mgr Cook Owner FW
Obtain signature of th rs o received the QFO responsibilities information at the time of the
Is there a produce washing policy? Y N scribe what is washed and inspection:
where: Note: This repo is a two page form(total of 62 debitable items) Page 1 of 2
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A CUNf�ICT10'�JT- �lEPAR`I"MEIT OF PEJI LIC HEALTH 49.O, AP1Tt3L AVE1LiiI �FDP-H,4RTFdRD,CT f16134
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ADD ESSICITY: :
Establish Da4e-of,Inspection:
dtiress� :l d hv=.� i u S7— Owner or Operator:, AIA4. .v _
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ADDITIONAL FOUR POINT ITEMS KEY: DNC [DOES NOT COMPLY]
6 Foods not re-served. '
-Unwrapped foods not re-served 4 31 Sewage disposal approved. 4
-Potentially hazardous foods not re-served -Operating as required
No cross connections,back siphonage,backflow
11 Toxic chemicals. 4`< Propertype/installation/backflow prevention device!air gap for: 4
-Stored properly,labeled properly,used properly -Food equipment -Hose connections -Dish machines
--No unn 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 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
-Water quality in compliance designed,properly installed
-Monitoring in compliance
OTHER ITEMS z
o; KEY: DNC [DOES NOT COMPLY] ,
2 Sources of food: Original container,properly labeled 1 0 Garbagelrubbish storage area/rooms,enclosures-properly constructed,dean
5 Potentially hazardous food properlythawed 42 1 Garbag efru bbish disposed of in an approved manner,at approved frequency
10 Food dispensing utensils properly stored 1 2 V r in Control: No insectslrodents present
14 Food worker,Clean outer clothes,effective hair restraints 1 3 Outeropenings protected against entrance of insectslrodents
4 Faools, Floor covering installed,constructed as required,good rep it clean- 1
16 Food-contact surfaces designed,constructed, maintained,installed,
5
Floors graded,drained as required
located
6 Floor,wall juncture covered
17 Nonfood-wntactsurfaces designed,constructed,maintained, 1 471 Mats removable,good repair,clean
installed,located
8 Exterior walking,driving surfaces,good repair,clean 1
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
D Dishwashing facilities approved design,adequately constructed, 2, "
maintained installed located 50 Dustless cleaning methods used,cleaning equipment properly stored 1"
Equipment&Utensil& Cleanliness1 51 Adequate lighting provided as required1"
21 Preflushed,scraped,soaked and racked 771
p 52 Room free of steam,smoke odors ,1:
22 Wash water clean,proper temperature 53 Rooms&equipment hoods,ducts,vented as required
curate thermometers provided,dish basket,if used 4 Rooms adequate,clean,adequate lockers provided,facilities clean 1
27 n# od-contact surfaces of utensils&equipment clean
5 Establishment and premises free of litter,no insect/rodent harborage, 1:
28 Equip ment/ulensils,storage,handling `s"� 1 no unnecessary articles
32 Proper disposal ofwaste water 1 56 Complete separation from livingisleeping 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 Toiletroomsenclosedwilhself-closing door 1
59 Seats 75 or more:Nonsmoking area provided,signs)posted at
37 Proper toilet fixtures provided,good repair,clean entrances smoking area indicated b sign(s)
f ) 9 Y 9 ( )
39 Approved garbage/rubbish containers,adequate number,covered, 1
rodent proof,clean outine Inspect'qif ❑Reinspection Preoperational Inspection
her Inspection:
TOR: PERSON IN CHARGE: Demerit Score: •Include demerits from page 1
4 3 2 1 Total Rating
i nature S. ature
print name pnnt name
&2 '2 DATE CORRECTIONS DUE:
phone number titl IZe
e
C� j , Page 2 of 2 plus continuation pages xo usva 3nspe�so�vzoo:
Page_jof
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INSPECTION REPORT STATE OF CONNECTICUT
FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH
CONTINUATION SHEET
NAME OF ESTABLISHMENT TOWN DATE OF PECTIO
4
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INSPECTION REMARKS
FORM#
r
v Ae S-0
-67
INITIAL,(INSPECTOR) INITIAL(PERSON IN CHARGE)
Distribution: Ist-White-Health Department 2nd-Yellow- Owner/Manager