HomeMy WebLinkAboutFood Service Establishment Inspection 17 (10) �y
Establishment: L+.S Inspection Date: Time: oinsp RBinsp
ddress/City: j l j ,el viu117— r Health opt: Gur` An ass: 12 3
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 passible debitable items C I NIO NIA JONC I KEY: C[complies] NIO[not observed] NIA[not applicable]
' DNC[does not comply] 0[other] RTE[ready-to-eat]
60'.-Aahhed Food Operator 3 3
ail 'DeeignatedAlternate 2 Personnel with in ecti.on restricted G 121r f WJ�' N1A `4
A Food workers have no exposed infected lesions 1 burns
62 r 1Nritten documeatatron of training program 2 B Personnel with infection restricted
1 tApproved source,wholesome,nonttdultsrated !C-No NIA 4" C Communicable disease of worker reposed to local health director
_ ._
A Approved shellfish,finfish,meat&poultry USDA approved :13 Aandwashtng faculties provided;hands washed,clean ;C ,NIO NA 34
B Food cans in good condition(riot dented,rusty,bloated,leaking) 4q Handwash facilities in all food prep/dispensing&warewash areas
C Wholesomelnonadulteraledfoodslsafe B Handwash facilities in or immediately adjacent to toilet rooms
D Commercial products(no home grown/canned food) C Handwash facilities accessib I venient to use
E Potentially hazardous foods received at proper temperature D Personnel hands washed,clea Pfe dwash procedure
0
E Handwa hin s at a ro note q
9 Pp P
S Potentially hazardous food metals temperaturetregarfetnepts" EC NIO N!A 4 0
during stgre,tpreparatron,display,servrce antl transportation r...• i
'" r 115 ,Good'h ion c practices ,C,•ry10` 'N!A 2
A Hot holding greater than or equal to 140eF. (whole beeapork roasts 13CPF.) A ❑ No eating ❑No smoking while working
B Cold holding less than or equal to46oF. B Wounds covered adequately
C Proper cooling C Proper sink used for handwashing
D Proper re-heating 0
' tizorseo4l C" NlO N
,eiE Proper intemalcooking lconsumer advisory posted 1
A blpprovedsanitizerevellableladequate concentration o sanitizer
i Adao)QQ facllit)es tohmein�talh�oixd c w, C �N10u l "" B Food-contact surfaces and utensils used for potentially
I Temperature,therrr[ometersMprovided h' ; i:." I hazardous food sanitized at feast every 4 hours
A Food thermometer available and accurate C Adequate ❑dishwashersanitizer ❑final rinse temp
B Properfoodthermomeierforproduct
D Proper sanitizin racedure
E Sanitizing between raw animal origin&ready-to-eatfood
C Thermometers appropriately placed in cooler units 0
0 •25`1 Glean' i"�rf cloths +. ry r s
¢ } a• x 1 R 9 C ,NIQ N1A �1
7 Fondpro ,cet[ uring storal9et; r+3�pat�on, .: C M1UO tNIA" Z �• ° v E
i Y e`dts `,set -,Ic `a"nntt i�n p rtatl.on ? ' - A Cloths and/or sponges in good repairand clean
yc5x.,ice ': •A7k::.4 x *x ilk{hi .•a:¢r k Y.x 6• a :.,
_'" " `� " B Niing cloths kept in sanitizer between uses
A Produce washed
B Raw meats not stored/prepared near ready-to-eat foods I o" acesleai Al iNlt7"tl {2'
C Food covered properly A ood a ulpmentclean�u ensils clean,equipment interiors clean
D Adequate splash guards/sneeze guard B logic use g! s changed when soiled
E No unauthorized personnel C Food--contact surfaces clean
F No pooling of eggs not cooked immediately 0
8 ood containers stored off the Floor 3o'°Hot and;Z r under pressure,pioir►c(ea s6,?equtredl. N%Aa 2.
i9 i ' .. �.v x t nd ,Crewashing acsr ##ovrded
t, andin o 'nrmzed n C N101N
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No unnecessary handling RTE and/or cooked foods with bare hands Soap I paper towels 1 drying device available
B Dispenser(s)working: ❑Soap ❑Paper towel
B Minimize food handling,other than ready-to-eat,with bare hands C Hoes sink(s)clean! aste 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[quart5ed food operator],DA[designated alternate],PHF[potentially hazardous food], FB[foodborne]
PHFs are hot het at: F. 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 port to the local health department?
Roasts Other
Describe re-heating procedures: Is there a written illness policy that requires the od worker to report specific illness conditions
Are temperatures recordedllogged for cold h ding foods/equipment? Y N and diseases to the QFO? Y N *D ou 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 ins for&QFO? Y N If yes indicate language spoken
List products cooled: by QFOIDA: Can the QF01DA read the inspection report? Y N
Describe cooling methods: Andicate who answered the aboo questions: Name(print):
Is coding monitored for time&temp Y N Is the monitoring of coaling recorded? Y N Indicate the title of above per 6n(circle all that apply):QFO DA Mgr Cook Owner FW
Obtain signature of the p 6n wh ceived the FO 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 two page form(total of 62 debitable items) Page t of 2
'a # `
STATE t�F CONNECTICUT DIEPARTMENT OF PUBLIC`HEALTH 410 CAPITOL A'1I NtJE-M5#51 FDP-HARTFORD,CT 0613 '
LQCAL HEAL`TIiDEPT t' FOCIfSED i OQ ;SERVICE INskk TT(JL! REPORT
t17' �pGCr ADDRESSICITY,
Establishment ': fr
�Sf Date of Inspection: !
Gi
Owner or Operator:, - t Z
ADDITIONAL FOUR POINT ITEMS c' KEY: DNC [DOES NOT COMPLY] {
6 Foods not re-served. 4 31 Sewage disposal approved.
-Unwrapped foods not re-served 4
-Potentially hazardous foods not re-served -Operating as required
74 No cross connections,back siphonage,backflow
11 Toxic chemicals. 4';
4 Proper type/installation/backflow prevention device/air gap for:
-Stored properly,labeled properly,used properly -Food equipment -Hose connections -Dish machines
-Sanitizerconcentraiion 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 Ldes
cilities. Adequate,convenient,accessible, 4-Water quality in compliance ,properly installed
-Monitoring in compliance
OTHER ITEMS KEY: DNC DOES NOT COMPLY]
Sores of food:Original container,properly labeled 0 Garbage/rubbish storage area/rooms,enclosures-properly constructed,dean _
Potentially hazardous food properly thawed 41 Garbagelrubbish disposed of in an approved manner,at approved frequency
10 Food dispensing utensils properly stored 42 Vermin Control: No insects/rodents present 2
14 Food worker:Clean outer clothes,effective hair restraints 1:" 3 Outer openings protected against entrance of insectslrodenis 1
4 F(o rs: Floor covering installed,constructed as required,good re air, can
16 Food-contact surfaces designed,constructed,maintained,installed, 45 Floors graded,drained as required
located
6 Floor,walljuncture covered
17 Nonfood-contact surfaces designed,constructed,maintained, 1 7 Mats removable,goad repair,clean
installed,located
8 Exteriorwalking,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
20 Dishwashing facilities approved design,adequately constructed, 2
maintained installed located ,..k 50 Dustlesscleaning methods used,cleaning equipment properly stored 1
Equipment&Utensils Cleanliness 51 Adequate lighting provided as required 1'
21 Preflushed,scraped,soaked and racked 52 Room free of steam,smoke odors l
22 Washwaterclean,proper temperature 53 Rooms&equipment hoods,ducts,vented as required
23 Accurate thermometers provided,dish basket,if used 54 Rooms adequate,clean,adequate lockers provided,facilities clean 1
271 Nonfood-contact surfaces of utensils&equipment clean 1 r
55 Establishment and premisesfreeof litter,noinseetlrodentharb Drag a,
28 Equipmentlutensils,storage,handling I no unnecessary articles
32 Proper disposal of waste water 1 56 Complete separation from livinglsleeping quarters and laundry 1
33 Plumbing location,installation,maintenance 1 57 Clean/soiled linens stored properly 1
36 Toilet rooms enclosed with self-closing door
58 No live birds,turtles,or otheranimals(except guide dogs) 1
1
59 Seats 75or more:Nonsmoking area provided,sign(s)posted at
37 Prppertoiletfixturesprpvided,good repair,clean 3
entrance(s),smoking area indicated by sign(s)
39 Approved garbage/rubbish containers,adequate number,covered, 1
rodent proof,clean Routine Inspection ❑Reinspection ❑ Preoperational Inspection
aNCOR: PERSON IN CHARGE: Other Inspection:
Demerit Score: *Include demerits from page 1
' 4 3 2 1 Total Rating
signature signature �-
prl t name print e -�'
phone number title DATE CORRECTIONS DUE: /
Page 2 of 2 plus continuation pages roe sEa laspeceuo�raooz
Page of�
INSPECTION REPORT STATE OF CONNECTICUT
FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH
CONTINUATION SHEET
NAME OF ESTABLISHMENT TOWN DATE OF INSPECTION
.v
INSPECTION REMARKS
FORM#
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INITIAL(INSPECTOR) INITIAL(PERSON IN CHARGE)
Distribution: 1st-White-Health Department 2nd-Yellow-Owner/Manager