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HomeMy WebLinkAboutFood Service Establishment Inspection 29 (2) Establishment: S uA) G /Ls Inspection Date: W&114o Time: I ; R0[nsp RE]nsp Address/City: ! 0eQ � %Q„�,,¢ Heath Dept: ZVI class: 1 2 36, 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 debatable items C N10 WA DNC KEY: C[complies] NIO[not observed] NIA[not applicable] 60 Quahfiedfoo�`Ope`raEot . :. 3 DNC[does not comply] 0[other] RTE[ready-to-eat) 12 Pere" nh T lth.infection restricted:: 91 Designated.Alternate 2 C ;N/Q'NrA.; 4 62 Written documentation of trainin ro ram 2 A Food workers have no exposed infected lesions 1 burns •-.9.P, g B Personnel with infection restricted 1 ,Approved source,wholesome,rionaduiterated C N!0 NIA :4 municable disease of worker reported to local health director A Approved shellfish,finfish,meat&poultry USDA approved = 1 S 'Ha.dwashing:facrlifies provided,hands washed,clean', C N10 A: 4 B Food Cans in good Condition(not dented,rusty,bloated,leaking) - 'Handwash facilities in all food prep/dispensing&warewash areas C WholesomelnonadulteratedfoodsJsafe AB Handwash facilities in or immediately adjacent to toilet rooms D Commercial products(no home grown/canned food) je C Handwash facilities accessiblelconveniant to use E Potentially hazardous foods received at proper temperature D Personnel hands washed, clean 1 Proper handwash procedure E' Handwashing at appropriate times 3 ote�nfially htiiai.dous;food meets temperattiro requirdm' „s N10 4 durrng storage,preparatfbn;display,service and t apspoo ion, hygte cxpra C NJO':'N1A 2 1.5' Good. nl ctrces A Hal holding greater than or equal to 14ft. (whole beeflparkroasts 1300F.) Ae A ❑ No eating ❑ No smoking while working B Cold holding less than or equal to45aF. B Wounds covered adequately C Proper cooling C Proper sink used for handwashing AL D Proper re-heating 2o wr-chemical]E Proper internal cooking/consumer advisory posted e 0 A Approved sanitizeravailableJadequateooncentrationofsanitizer 4 ' Adequate?ggiljtjes fo,mpiptain piroiiuct;; h' �C '�V10 NJA !;2 $ Food-contact surfaces and utensils used for potentially empera#ure;A1erm01'We#ers;provide I hazardous food sanitized at least every4 hours rw..tX RY':[{(}YK - A Food thermometer available and accurate 14 C Adequate ❑dishwashersanitizer ❑final rinse temp �. B Proper food thermometer for product D Proper sanitizin rocedure C Thermometers appropriately placed in cooler units J. E Sanitizing between raw animal origin&ready-to-eat food r ., .. .. .. , . 5 4 eah wl,ping�9'S a Y C ;N10 h p >zo d ro# cd duraigrtrage;prepaaattotr, C, Nl0 !N(* / s Jay a ,service and trap fi c Cloths and/or sponges in good repair and clean - p y B Wiping cloths kept in sanitizer between uses A Produce washed 0 > • B Raw meats not stored/prep a red near ready-to-eat foods a6° WW contacttsunfaces;.glean* a ° Ct NI® °NIA r2 C Food covered properly A Food equipment clean,utensils clean,equipment interiors clean D Adequate splash guards 1 sneeze guard B Single use gloves changed when soiled E No unauthorized personnel p C Food--contact surfaces clean F No pooling of eggs not cooked immediately 0 8 Food containers stored offthe floor 36'i " u`6 Cold wa#er_under pressure;provided as required,d tNl¢ WA .2 i.;t.. O $8�" dw shing q cessones pirov�ded' : C iN10, 9 HandIIn9 ck f, Irtiffil* 7G NIO;IwA OT oap p, er towels J drying device available A No unnecessary handling RTE and/or cooked foods with bare handsoir $ pennser(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)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 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 that requires the food worker to report speck illness conditions Are temperatures recorded/logged for cold holding foedslequip 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 ♦ e leftovers saved? Y Is there a language harrier etween inspector&QFO? Y N If ves indicate language spoken List products cooled: by QFO/CA: *Can the QFO/DA read the inspection report? Y N Describe cooling methods: Indicate who/reof ad the above questions:Name(print): Is cooling monitored for time&temp? Y N s the monitoring of cooling recorded? Y N Indicate the tive person(circle all that apply):QFO DA Mgr Cook Owner FW Obtain signate De on who received the QFO responsibilities information at the time of the Is there a produce washing policy? 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 ST T � C©NNECTICUT DEPARTMENT QF IRfJBLIG HEALTH 410 CAPS 1FDPHAiR�1=OR ;,CT�163 ' F,OC17SED FOOD,SERVIG ItVBPECTiQR13 t 1T fiW LOAL HEAI:7iilDEPTt ADDRESSICJTY: 4 , Establishment I Date of"Inspection. ,Address: At Qwner of Operator:.: G✓ / Gv ADDITIONAL FOUR POINT ITEMS Ya= KEY: DNC [DOES NOT COMPLY] x 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 11 Toxic chemicals. No cross connections,back siphonage,backflow 4 4 Proper tvoeliostallation!_backflow prevention device/air gap for: -Stored properly,labeled properly,used properly -Food equipment -Hose connections -Dish machines -5anitizerconcen#ration not to exceed maximum permitted -Soda system carbonator -Beverage dispensers -Toilet tanks -No unnecessary toxics on the premises -Chemical dispensers -Ice machines -Pest!cideslrodenticides 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 KEY: DNC [DOES NOT COMPLY] ®, 2 �s ces offood; Original ontainer,properly labeled >;• 0 Garbage/rubbish storage area/roorns,enclosures-properly constructed,clean f �_ f 5 Potentially hazardous food properly thawed 41 Garbage/rubbishdisposed of in an approved manner,at approved frequency 10 Food dispensing utensils properly stored 3; 2 Vermin Control: No insects/rodents present =2 14 Food worker:Clean outer clothes,effective hair restraints 1 43 Outeropenings protected againstentranceofinsects!rodents l' 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' 7 Mats removable,good repair,clean installed,located 8 Exterior walking,driving surfaces,good repair,clean 17 18 Single service articles,storage,dispensing 19 No reuse of single service article 9 alls,ceili s�att equipmen roperlyconstructed,good 1 repair,cle all&ceiling surfaces as re fired_ 0 Dishwashing facilities approved design,adequately constructed, wZ maintained installed located 50 Dustless cleaningg melho s use mng e,c eaquipment properly stored Equipment&Utensils: Cleanliness 1 51 Adequate lighting provided as required 21 Preflushed,scraped,soaked and racked r 1 A 52 Room free of steam,smoke odors - 22 Wash water clea n,p roper tem perature r ' 53 Rooms&equipment hoods,ducts,vented as required rate thermometers provided,dish basket,if used 54 Rooms adequate,clean,adequate lockers provided,facilities clean1;; 27 food-contact surfaces of utensils&equipment clean 1 55 Establishment and premisesfreeof litter,no Insect/rodent harborage, 8 Equipment/utensils,storage,handling 1: no unnecessary articles k. 32 Proper disposal of waste water Fly, 56 Complete separation from living/sleeping quarters and laundry k- N 33 Plumbing location,installation,maintenance 57 Clean/soiled linens stored properly 58 No live birds,turtles,or other animals(except guide dogs) i L 36 Toilet rooms enclosed with self-closing door 1 59 Seats 75 or more:Nonsmoking area provided,sign(s)posted at t ' 37 Proper toilet fixtures provided,good repair,clean •* entrance(s),smoking area indicated by sign(s) a 39 Approved garbage/rubbish containers,adequate number,covered, T rodent proof,clean ❑Routine Inspection ❑Reinspection ❑ Preoperational Inspection Other Inspection; PE OR: �� PERSON IN C.kIARU: Demerit Score; *Include demerits from page 1 4 3 2 1 Total Rating lure rint name t name ' DATE CORRECTIONS D E: i i . phone number titlg - c Q 5 r 7 G�c� Page 2 of 2 plus continuation pages Focused rnspe.Hon 1/2042 PageZ of INSPECTION REPORT STATE OF CONNECTICUT FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH CONTINUATION SHEET NAME OF ESTABLISHMENT TOWN DATE OF PECT ON INSPECTION REMARKS FORM# ell- 0 r (, //f r o� cal r O Le f INITIAL(INSPECTOR) INITIAL(PERSON IN CHARGE) Distri•ution: 1st-White-Health Department Department 2nd-Yellow- O er/Manager I am Pag L, INSPECTION REPORT STATE OF CONNECTICUT FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH CONTINUATION SHEET NAME OF ESTABLISHMENT TOWN DATE OF INSPE TION CL.� - & INSPECTION REMARKS FORM# 75 INITIAL(INSPECTOR) INITIAL(PERSON IN CHARGE) Distribution: 1st-White- ealth Department 2nd-Yellow- Owner/Manager