HomeMy WebLinkAboutFood Service Establishment Inspection 10 (11) 6- G
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Establishment: ' Inspection Date: Time: R insp Einsp
Address/City: /�(� f"f.�� ,�T 1..�. HealthDept:��,,� A.,/.y,6�j/LClass: t 4
Based on an inspection this day,the items marked DNC identify the violations in operation or facilities which must be corrected bythe date specified on page 2.
RISK FACTOR ITEMS:Listing is not inclusive of all possible debitable items C NIO N!A DNCI KEY: C[complies] N10[not observed] NIA[not applicable]
DNC
61); ..Qualifiecly eod Operator; 3
F .. w ., ;. .. ..
(does not campy [other] RTE[ready-to-eat]
6t 2
Desrdnated'Alternate
12 Personnel with infedtion restricted:
A Food workers have no exposed infected lesions 1 burns C
NlO N/A 4
6Z 'Wnttep documentation of.training program 2 B Personnel with infection restricted
,t APPMY-Ad Source,wholesome,nonitdulterafed. ; `. C:. NlO N/A 4 C Communicable disease of worker reported to local health director
A Approved shellfish finfish meat&poultry USDA approved 13 Handwas' ing,facilities provided,hands washed;clean IC :N10 NIA 4
B Food cans in good condition(not dented,rusty,bloated,leaking) A Handwash facilities in all food prepidispensing&warewash areas
C Wholesome/nonadulteratedfoods/safe I B Handwash facilities in or immediately adjacent to toilet rooms
D Commercial products(no home grown/canned food) C Handwash faciliti accessiblelc enient to use
E Potentially hazardous foods received at proper temperature D Personnel hand h r-tandwash procedure
0
E Handwashing at priate ti
r3 Potentraliy hazardous food meets temperature requrreinents C N/0 NIX%4 0
ditring 6to►;3ge;preparation,draplay,servtpe agdtransportatton
13 Good,hygrentcpractfces' C:iN10 .N1A. 2
A Hot holding greater than or equal to 140eF. (whole beeffpork roasts 1300 F.) A ❑ No eating ❑ No smoking while working
B Cold holding less than or equal to 45'F. B Wounds covered adequately
C Proper cooling k C Proper sink used for handwashing
D Proper re-heating jel 1 0
Sanittza - . a)
E Proper internal cooking 1 consumeradvisary posted
24 fiiorE,rinse';hiot;w tdr"-CFie pin" f: ``. ":; ,.:NIO. ,tJIA 2
Approved sanitizer availableladequate concentration of sanitizer
i4 Adequa a ifacilftles o maintain product: k.w : g [�0 ;[� 2 B Food-contact surfaces and utensils used for potentially
"ternperatUre, he r ofrtetersj,proytt3.a i `k hazardous food sanitized at[east every 4 hours
A Food thermometer available and accurate C Adequate ❑dishwashersanilizer ❑final rinse temp de
B Proper food thermometer for product D Proper sanitizing procedure
E Sanitizing between raw animal origin&ready-to-eat food
C Thermometers appropriately placed in cooler units O
0 25 i, an wl in ciotrhs s
f7; E Rgdtproteq,ed during storage,preparations C NIO N1A� 2
* drspia ,sserviee ar1d transport t o� � ' p A Cloths and/or sponges in good repair and clean
A Produce washed B Wiping cloths kept in sanitizer between uses
0
B Raw meats not stored/prepared near ready-to-eat foods
Y Fbod° ontact sufaces clgan, ]rNJA '2
a.>>
C Food covered properly - -A Food equipment clean,utensils clean,equipment interiors clean
D Adequate splash guards 1 sneeze guard Q[ 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 a s tn eqird 1C it) o te rp6nBad 1N A 2
tardlQ0 ro a A �if Ing
l9 t 1i ndil C N10 NIA E 2 4 0 y„]•rg rpf. asi minimized , r ,� A A Soap!paper towels 1 drying device available
A No unnecessary handling RTE and/or cooked foods with bare hands B Dispenser(s)working: ❑Soap ❑Papertowel
B Minimize food handling,other than ready-to-eat,with bace hands C Handwash sink(s)clean/waste receptacle at handwash sink
C Adequate utensil(s)for dispensing foodlice 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: 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 re la to FB Illness are you required to report to the local health department?
Roasts Other
Describe re-heating procedures: Is there a writte illness policy that requires the food worker to report specific illness conditions
Are temperatures recorded/logged for cold holding fo slequipment? Y N and diseases the QFO? Y N *Do you have a paid sick leave policy? Y N
Are foods cooked in advance and cooled? Y N +Are leftovers saved? Y N Is there a nguage barrier between 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 answered the above questions:Name(print):
Indicate the title of above person(circleQ
t apply] QFO DA Mgr Cook Owner FW
Is cooling monitored for time&temp? N Is the monitoring of cooling recorded? Y N Obtain signature of e r who ree " 11es onsibiliti s information at the time of the
Is there a produce washing polic . Y N *Describe what is washed and inspection:
where: Note: This report is a two page form(total of 62 debitable items) Page 1 of 2
S ►TE OF Co NECTICIJT QEPARTMENT OF PUBLIC Ft ALTH .4'Ifl CAPITOL AVENt)E-MS#51 FDP-HAFtTFORD,CT,06134
r FOCTSED FOOD SERVICE INSPECTt?N RESORT
LOCrAL HEALTH ADDRES5ICITY
Esfabltshment .Jez G,442p Date of;Inspeation:
ddr"etas A,6Owner or.Operator; . Al J
ADDITIONAL FOUR POINT ITEMS KEY: Dill [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
4 Proper ypelinstallation/backflow prevention device!air cga fifoor:
-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:
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-Monitoring in compliance designed,property installed
OTHER ITEMS
® KEY: DNC [DOES NOT COMPLY] ®
2 Sources of food: Original container,properly labeled 41
. 40 Garbage/rubbish storagearea/rooms,enclosures-properly constructed,dean
5 Potentially hazardous food properly thawed Z 41 Garibagelrubbish disposed of in an approved manner,at approved frequency
10 Food dispensing utensils properly stored 1 2 Vermin Control: No insects/rodents present 2
14 Food worker:Clean outer clothes,effective hair restraints 1 3 Outeropenings protected againstentrance of insectslrodents 1"
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, 7 Mats removable,good repair,clean
installed,located
8 Exterior walking,driving surfaces,good repair,clean
IS Singleservice 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
maintained installed located 50 Dustless cleaning methods used,cleaning equipment prop edy stored
Equipment&Utensils: Cleanliness 1 51 Adequate lighting provided asrequired 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
St :.
231 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 1
55 Establishment and premises free of litter,no insect/rodent harborage, ;1
28 Equipmentlutensils,storage,handling 1 no unnecessary articles ;
32 Properdisposal of wastewater 1 56 Corn plete separation from livinglsleeping qua rlers and laundry
Lt
33 Plumbing location,installation,maintenance 1
57 Clean/soiled linens stored properly1
58 No live birds,turtles,orother animals(except guide dogs) 1J9
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
entrance(s),smoking area indicated by sign(s)
39 Approved garbage/rubbish containers,adequate number,covered,
rodent proof,clean ❑Routine Inspection ❑Reinspection ❑ Preoperational Inspection
T PERSON IN.CHARGE: Other Inspection:
Demerit Score: *Include demerits from page 1
4 3 2 1 Total Rating
signa ure l signature
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p inintt,name rint name ✓ � �
D210 �ZZ 1
phone number title
DATE CORRECTIONS UE:
,
` � i Page 2 of 2 plus_/ _continuation pages F'oeused Inspection 112002
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
INSPECTION REMARKS
FORM#
3d.AA-1 -11f, -
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INITIAL(INSPECTOR) INITIAL(PERSON IN CHARGE)
Distribution: 1st-White-Health Department 2nd-Yellow- Owner/Manager
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U\hiile many locally grown agricultural products are available for consumers to purchase directly
for use in their own home, foods intended for use in retail establishments must comply with
applicable regulations of CTState Agencies. Regulations require all foods utilized in foodservice
establishments to originate from an approved source. Generally, except for raw, fresh produce, all
food must originate from a regulated, inspected facility. Those that do not are considered to be
unapproved and are subject to embargo and destruction by the local health authority. To avoid
this, the Food Protection Program has developed the list below. If you are ever unsure if a specific
food item is approved for use, please contact the Food Protection Program and ask!
Disclaimer: THIS LIST IS NOTALL-ENCOM PASSING
Unapproved Foods
❑ Raw milk
❑ Dairy products not produced under licensure and inspection by the Department
of Agriculture (including cheeses and yogurt)
❑ Jams,jellies, preserves produced under the CT regulatory exemption
❑ Eggs which have not been inspected and graded by a USDA program or
equivalent
❑ Jerky produced under a USDAexemption
❑ Custom-slaughtered poultry and meats which were not slaughtered, butchered,
and packaged within a USDAfacilityand not bearing the official USDAseal
❑ Home-canned products of any type
❑ "value-added" food items not produced in a commercial facility and not having
the approval of the Department of Consumer Protection
❑ Shellfish harvested from sources not approved by the CT Dept of Agriculture,
Bureau of Aquaculture
❑ Fnfish that were not commercially caught
❑ Mild game or other exotic species not processed and packaged under a USDA
regulatory program.
❑ Hunted game of any sort
Food Protection Program
410 Capitol Avenue
MS#11 FDP wm.ct.gov/ dph/food protection
Hartford, CT06134
Phone: 860-509-7297
Fax: 860-509-8071