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HomeMy WebLinkAboutFood Service Establishment Inspection 17 (7) �G C�Pe 04 • Establishment: " Inspection Date: Time: � < R In Einsp ddress/City: IS gg; uG��"cl �00!4b Nealt Dept: a Class: 1 z Based on an inspection this day,the items marked DNC identify the violalions 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 Nl0 NIA DNC KEY: C[complies] N/O[not observed] NIA[not applicable] 130 qualfted.Food Operator g DNC[does not comply] 0[other] RTE[ready-to-eat] u R `•`• .. t .'. S1 Designated Alternate",, 2 1T PrsQ.nnei wtth infect]on restrlcted a* A Food workers have no exposed infected lesions/burns 82 i Written documentation of training,,program y B Personnel with infection restricted 1 Approved source,wholesome,nonadulterated C; N10 N/A .4 A. mmunicable disease of worker reported to local health director A Approved shellfish,finfish,meal&poultry USDA approved aridmiei I facilities provided, handswashed,clean:: C :NlO �f 4 B Food cans in good condition(not dented,rusty,bloated,leaking) A Handwash facilities in all food prep/dispensing&warewash areas C Wholesome/nonadulteratedfoods/safe B Handwash facilities in or immediately adjacent to toilet rooms 11 D Commercial products(no home grown/canned food) C Handwash facilities accessiblelconvenie E Potentially hazardous foods received at proper temperature D Personnel hands washed,cle Proper handwash proce Handwashing at appropriate P tentialiy hazardous",fgo�fi meats temperature requrresitierits :.G> during:storage,prepar`atron,display,seance and tr�asportation i :. .. oo'd hygienic practices C `fJ10 m, N! 2 a,0 r , A Hot holding greater than or equal to 1400F. (wholebeefrpAroadls faooe) ❑ No eating ❑No smoking while working B Cold holding less than or equal to 45o F. B Wounds covered adequately C Proper cooling C Proper sink used for handwashing D Proper re-heating E Proper internal cooking/consumer advisory posted n(tiz ion rinse(ho>'water,-:c�ejni.cal) !C^'N10},..0 A rovedsanitizeravail leladequateconcentrnofsanitrcert i4 Adocidi a facilltiew'to*marntsil �rrocluct �, A w' C ;IWO,!NIA g Food-c nta u aces and utensils used for potentially k teflrnpe�ature;theirmometers.provided :r hazardous food sanitized at least every 4 hours A Food thermometer available and accurate C Adequate Eldishwashersanitizer ❑final rinse temp D ProperB Properfood thermometerfor product sanitizinrocedure E Sanitizing between raw animal origin&ready-to-eat food C Thermometers appropriately placed in cooler units 0 �2$ X can wi rn scl•`hs� tCRINlOOx ? F.�ood prc� ce,during str#a$�,irp �ation; C�"Nr0 IIV�f1 I2 p, 9# dslyysseruror �4ratnspatrtatron k *:.. * 7 ax M Cloths and/or sponges in good repair and clean v1n i?, + �t xS b� E�R '1 e' B Wiping cloths kept in sanitizer between uses A Produce washed 01 B Raw meats not stored/prepared near ready-to-eat foods & htl contact«"sunfacesxcle'ari C 0'; C Food covered properly 1 . � � .e r ,n. ..Nut t Food equipment clean,utensils c n,a ipmentinteriors cl D Adequate splash guards 1 sneeze guard Ig Single use gloves changed vibe le _" E No unauthorized personnel C Food--contact surfaces clean Ake,I F No pooling of eggs not cooked immediately 0 8 Food containers stored off the floor $Da Not and cold water underopressure,pTo+tM�a4 requireta A. WA•'2,I „ •, c)Img.ofbo�d minimizedv w E3#S acce es;pio tV/Ai n -`.Wandwashing ssorr if[ eit 4 4 iNa" LM `'"' ' '"-`. T C I . - " A Soap/papertowels/drying device available A unnecessary handling RTE andlorcooked foods with bare hands B Dispenser(s)working: ❑Soap ❑Paper towel 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 food/ice 0 O 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: 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 poll at requires the food worker to report specific illness conditions Are temperatures recorded/logged for cold holding foodslequipmenl? Y N and diseases to the QFo? 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 language bar rJ r between inspector&QFO? Y N If yes indicate language spoken List products cooled: by QFOIDA: i *Can the QF01DA read the inspection report? Y N Describe cooling methods: Indicate who answered the above questions:Name(print): Is cooling monitored for time&temp? Y N Is the monitoring of oling recorded? Y N .ndicate the title of above person(circle all that apply):QFO DA Mgr Cook Owner FW Obtain signatLye of thp person who receive t e QFO responsibilities information at the time of the Is there a produce washing policy? Y N *Describe what is ashed and inspection: where: Note: This report is a two page form(total of 62 debitabl i(ems) Page f of 2 Tz- CdNPiEGTICUT OEPARTIVIENT OF PUBLIC HEALTH 410 CAPIT L AVENUE­M$#51 FDP-HARTFORD,CT 06134' f . "rs F+DCUSEI�FQ,OD S�'12trIGE T1�5P41i F w �+U- IA Ess ctTv � n ,r. Establishment t��� 'S7rG-(/ Date of tnspecfiion: ddre>s';__/ 3S' // ovG7`z .�a,t�7� Owner or gerator. U ADDITIONAL POUR POINT ITEMS � t KEY: DNC [DOES NOT COMPLY] 6 Foods not re served. `4 31 Sewage disposal approved. nwrapped foods not re-served 4. tentialiy hazardous foods not re-served -Operating as required -P I 1 T is chemic No cross connections,back siphonage,backf low :4; 4; Proper t peho5tallation acklow prevention devicel air gap for; -Stored prop*, abeled properly,used properly -Food equipment -Hose connections -Dish machines -Sanitizer concentration notto 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 qualify in compliance designed,properly installed -Monitoring in compliance OTHER ITEMS KEY: DNC [DOES NOT COMPLY] 2 ources of food; Original container,properly labeled 1, 0 Garbage/rubbish storage area/rooms,enclosures property constructed,clean 1 5 Potentially hazardous food properly thawed 1" 41 Garbage/rubbish disposed of in an approved manner,a1 approved frequency 10 Food dispensing utensils properly stored 1' ' 42 Vermin Control: No insects/rodents present 2 14 Food worker;Clean outer clothes,effective hair restraints 1 uter openings protected againstentranceofinsects/rodents 1 oors: Floor covering installed,constructed as requirq ,g r-r e 1 16 Food-contact surfaces designed,constructed,maintained,installed, 2. Floors graded,drained as required located 6 Floor,walliuncture covered 17 Nonfood-contactsurfacesdesigned,constructed, maintained, 1, 7 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 4eqair,clean.Wall&ceiling surfaces as required 0 Dshwashing facilities approved design,adequately constructed, 2;.. maintained installed located 50 D tless cleaning methods used,cleaning equipment properlystored : Equipment&Utensils: Cleanliness 1 Adequate lighting provided as required 21 Preflushed,scraped,soaked and racked 52 Room free of steam,smoke odors 1 22 Washwaterclean,proper temperature 53 Rooms&equipment hoods,ducts,vented as required 23Accurate thermometers provided,dish basket,if used Rooms adequate,clean,adequate lockers provided,facilities clean 1 food-contact surfaces of utensils&equipment clean 1 5 Establishment and premises tee of litter,no insect/rodent harborage,28- pl g pmentlutensils,storage,handling �" no unnecessary articles E 32 Proper disposal of wastewater 56 Complete separation from livinglsleeping quarters and laundry 33 Plumbing location,installation,maintenance Jr, 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 � 59 Seats 75or 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) 3 39 Approved garbagelrubbish containers,adequate number,covered, 1 rodent proof,clean JL2Routine Inspection ©Reinspection ® Preoperational Inspection Other Inspection: INSPE TOR: PERSON IN CHARGE: Demerit Score: *Include demerits from page 1 ` 4 3 2 1 Total Rating nature slgnature 7 >7— print name print name 7 DATE CORRECTIONS DUE: phone number �L title �1�7 (4,W_ Page 2 of 2 plus continuation pages Page / of INSPECTION REPORT STATE OF CONNECTICUT FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH CONTINUATION SHEET NAME OF ESTABLISHMENT TOWN DATE OF INSPE TION INSPECTION FORM# REMARKS 0- Lgc Lp d 01 120 all r INITIAL(INSPECTOR) INITIAL(PERSON IN CHARGE) Distribution: 1 st-White-Health partment 2nd-Yellow- Owner/Manager Pagef INSPECTION REPORT STATE OF CONNECTICUT FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH CONTINUATION SHEET NAME OF ESTABLISHMENT TOWN DATE OF INSPECT ON INSPECTION MARKS FORM# r �, . r' i Z� .✓ INITIAL(INSPECTOR) INITIAL(PERSON IN CHARGE) g Distribution: 1st-White-Health Department 2nd-Yellow- Owner/Manager