HomeMy WebLinkAboutFood Service Establishment Inspection 17 (9) C/�_IWA
Establishment:�zye4 S f ,a 7�i-�i Inspection Date: r Time: /�►:/� R ins Einsp
Address/City: 3 //dt14l�79 .92 Health ept: i t 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 N!0 NIA JDNC I KEY: C[complies] NIO[not observed] N/A[not applicable]
'60: Quattfted Faod Operator 3 DNC[does not comply] 0[other] RTE[ready-to-eat}
;12 Personnel with in#ection restricted rylp NIA 34
61 Destgnated;lllfe�nake' 2 A Food workers have no exposed infected lesions!burns
42 Written documentation of training program z
B Personnel with infection restricted
1 Approved source,wholesome,nonl#Bulterated N10 NIA l4
f C Communicable disease of worker reported to local health director
A Approved shellfish,finfish,meat&poultry USDA a roved C N10 NIA 14 Handwshing;facliiesprovided;handswh�;,can
8 Food cans in good condition(not dented,rusty,bloated,leaking) ItA Handwash facilities in all food prop/dispensing&warewash areas
C Wholesome/nonadulteratedfoods/safe B Handwash facilities in or immediately adjacent to toilet rooms
D Commercial products(no home grown/canned food) C Handwash facilities access!blelconvenlent to use
E Potentially hazardousfoods received at proper temperature D Personnel hands washed,clean!Proper handwash procedure
0 E Handwashing at appropriate times
3 'Potentially haziirdotis food meets temperature rggmremente Cro NIA C. 0
during s orage,preparation display service antl trpriSportafion
{ ienic Goodzh ' r�cti;ces-:
Yg p C NlA 2
A Hot holding greater than or equal to 141ft. { oie ee ork roast a8 ) A ❑ No eating ❑No smoking while working
B Cold holding less than or equal to 45e F. 1,0B Wounds covered adequately
C Proper cooling C Proper sink used for handwashing
D Proper re-heating 0
E Pro erinternal cooking/consumeradvisoLoo :24 Sanitizatiorrrrtnsb hot utrater+-chem[cal kC 'N10.`NIA 2
p g advisory posted �. �,;
0 A Approvedsanitizerevailableladequateoonoentmtionofsanifizer
4 `Ai�equate facilitiesta marntitriri:p fgdpct < x. K C. I10 iNIA r.2 g Food-contact surfaces and utensils used for potentially
yr v
temti 6' it re tilsrmome s'provident€ 4 s hazardous food sanitized at least every 4 hours
`�_...':... ?...,..,.m.:.l..ai..w..a.,r.,?+.- -r. Y a 'w' e x N.•s
A Food thermometer available and accurate C Adequate ❑dishwashersanitizer ❑final rinse temp
Proper sanitizing
B Proper food thermometerfor product D rocedure
E Sanitizing between raw animal origin&ready-lo-eatfood
C Thermometers appropriately placed in cooler units 0
0
�.�r s as :. tr A: eon,wtpmgcloths41'. 4 w. IN10°;WA ',1
7 �Filtid.proti ted dunngts!. � ep�rstaon, C N10 lN1A 2
t K b A Cloths andlors
display, service and transpori�tior , x 1,, V.
• pongesin good repair and clean
.: [G i. d.^ta
B Wiping cloths kept in sanitizer between uses
A Produce washed
0
B Raw meats not stored/prepared near ready-to-eat foods a6; Food-cOrtta`r t s"Ci'fare G�eanr ?•�r '" r C 't lQ`
C Food covered properly n,i . �..
A Food equipment clean,utensils clean,equipment interiors clean
D Adequate splash guards Isneeze 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 i$,Q r f{ot and cold wa'6i6iriderp''Wre',pratiided•as,required l iG• NIO N!A 2
9 ,38 tfattdlw8so1,4g a�cessortes provided C 1VI0� N!A 1
Hntll�n' of food mrmmized«x A [1 r.
unn A Soap!paper towels/ drying device available
A No unnecessary handling RTE and/or cooked foods with barehands B Dispenser(s)working: ❑soap ❑Paper towel
B Minimize food handling,other than ready-to-eat,with bare hands C Handwash sink(s)cleanlwaste receptacle at handwash sink
C Adequate utensil{s)fordispensingfoodlice 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: F. 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 FS illness are you required to report to the local health department?
Roasts Other
j Describe re-heating procedures: is there a written illness policy that requires the food worker to report specific illness conditions
Are temperatures recorded/logged for cold holding foodsJequipment? 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 leftovers saved? Y N Is there a language barrier between inspector&QFO? Y N If ves indicate language spoken
List products cooled: by QFOIDA: *Can the QF01DA read the inspection report? Y N
Describe cooling methods: Indicate who answered the above questions: Name(print):
Is cooling monitored far time&temp? Y N Is the monitoring of cooling recorded? Y N Indicate the title of above person{circle all that apply}:qF0 A Mgr Cook Owner FW
*Obtain signature of the a'on who received a QFo respo ibilities information t the time of the
Is there a produce washing policy? Y N ♦Describe what is washed and inspection:
where: Note: This report is a wo age form( t of 6 ebita a items) Page t of 2
$ T OFGQNNEG�It✓IJT DEP�iRTMEfVT OF pUSLIC`�HEq TH 410 OA►fsITQLAV NUE ,M5#51FDP HARTf bRD,CT,06'134`
O01)k T,ION RERQR,
AI,H AITH UP�TADDRE55ICITY .
Es tablishment::ci�' . 5, i/Q` � � / Date of Inspection:.
ddress Owner or Operator: '
ADDITIONAL (FOUR POINT ITEMS z
ro: KEY: DNC [DOES NOT COMPLY]
6 Foods not re-served.
-Unwrapped foods not re-served 4 31 Sewage disposal approved.
-Potentially hazardous foods not re-served -Operating as required
11 Toxic chemicals, No cross connections,back siphonage,backflow 4
4' Proper typelinstallationl backflow prevention device/air gap for:
-Stored properly,labeled properly,used properly -Food equipment -Hose connections -Dish machines
-Sanitizerconcentration 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:
, -Food equipment -Dish machines -Ice machines
29 Water source adequate,safe. 4
-Well 1 well head protected from contamination 35 Toilet facilities. Adequate,convenient,accessible, 4.
-Water quality in compliance
-Monitoring incompliance designed,properly installed
OTHER ITEMS r
�$ KEY: DNC [DOES NOT COMPLY]
2 Sources of food: Original container,properly labeled 40 Garbage/rubbish storage area/roams,end osures-propedywnstructed,clean 1
5 Potentially hazardous food properly thawed 2 41 Garbage/rubbish disposed of in an approved manner,at approved frequency
10 Food dispensing utensils property stored 11` 42 Vermin Control: No insects/rodents present :2`
14 Food worker:Clean outer clothes,effective hair restraints 1 43 Outeropentngs protected against entrance of insects/rodents
4 Floors: Floor covering installed,constructed as required,good repair,clean 1
16 Food contact surfaces designed,constructed,maintained,installed, 2; 5 Floors graded,drained as required
located
6 Floor,wall juncture covered
17 Nonfood-contactsurfacesdesigned,constructed,maintained, 1 7 Mats removable,good repair,clean
installed,located
81 35Ztrstless
xterior walking,driving surfaces,good repair,clean 1
18 Single service articles,storage,dispensing 2
19 No reuse of single service article alls,ceilings attached,equipment properly constructed,good '1
air,clean.Wall&ceiling surfaces as required
20 Dishwashing facilities approved design,adequately constructed, 2:
maintained installed located cleaning methods used,cleaning equipment properly stored
Equipment&Utensils: Cleanliness I 51 Adequate lighting provided as required 1:
21 Preflushed,scraped,soaked and racked 52 Room free of steam,smoke odors 1
22 Washwalerclean,proper temperature 53 Rooms&equipment hoods,ducts,vented as required
231 Accurate thermometers provided,dish basket,if used 54 Rooms adequate,clean,adequate lockers provided,facilities clean t 1
27 Nonfood-contact surfaces of utensils&equipment clean
55 Establishment and premisesfreeoflitter,notnsectlrodentharborage, 1
28 Equtpmentlutensils,storage,handling 1" no unnecessary articles
32 Proper disposal of waste water 1- 56 Complete separation from livinglsleeping quarters and laundry 1T
33 Plumbing location,installation,maintenance 1
57 Clean/soiled linensstored properly
58 No live birds,turtles,or other animals(except guide dogs) ;1�
36 Toilet rooms enclosed with self-closing door 1 ; .
59 Seats 75 or more:Nonsmoking area provided,signs)posted at �-
37 Proper toilet Wures provided,good repair,clean entrance(s),smoking area indicated by sign(s) -3
39 Approved garbage/rubbish containers,adequate number,covered, 1
rodent proof,clean ARoutine Inspection ❑Reinspection ❑ Preoperational Inspection
Other Inspection:
Z_T60R,';Z PERSON IN G�9RCE: Demerit Score: *Include demerits from page 1
1� ;h Ldia) 4 3 2 1 Total Rating
i n �1re
_T4
print,name p nt n i ` � _ � c� ��
DATE CORRECTIONS DUE:
one number tltl
-2 Page 2 of 2 plus continuation pages Focused Inspection 1/2002
Paged 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#
14--e 05
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INITIAL(INSPECTOR) INITIAL(PERSON IN CH GE}
Distribution: lst-White-Health Department 2nd-Yellow-Owner/M g r