HomeMy WebLinkAboutFood Service Establishment Inspection 97 (2) .. .. •�.. > . ' ,. �: 3eS�O;U`)b��' ��' �� �Nt91� C� �+ F-' � ' _ ` -
Establishment: /C Inspection Date Timef:ld° o[nsp' Einsp
Address/City: �' vim, �ryrJ '¢-�� Health Dept: C,7 A,;�,,Z, Sn& Class: 1 2 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.
RI ITEMS:Listing is not inclusive of all possible debitable items C NIO NIA DNC KEY: C[complies] N/O[not observed] N/A[not applicable]
60 led Food Qperator', DNC[does not comply] 0[other] RTE[ready-to-eat]
2 Perstzri'nel with,irifection restricted ` C tN/0 NIA 4
61 D,estgnated Alternate 2 A Food workers have no exposed infected lesions/burns
61 Written documentation of training program. - 2
B Personnel with infection restricted
1 'Ap'ft ved source;wholesome,rionadu'fterated 'N/0 NIA 4 ommunicable disease of worker reported to local health director
A Approved shellfish,finfish,meat&poultry USDA approved 13 aridwa'shing,faciiitiesprovided, hands washed;ctearr:;C fN10 NIA '4
B Food cans in good condition(not dented,rusty,bloated,leaking) de Handwash facilities in all food prepJdispensing&warewash areas
C Wholesome/nonaduIterated foods/safe B Handwash facilities in or immediately adjacent to toilet rooms
D Commercial products(no home grown/canned food) jo, C Handwash facilities accessiblelconvenient to use
E Potentially hazardous foods received at proper temperature Personnel hands washed,clean J roper han t ash procedur
r Handwashing at appropriate
3 , Potentiallyihazardous food:meets}tempeiature reguiremenfa y C N10 ,NI '4 O
during storage,preparation display',servle and transportation _
y i, r15 l Good,hlygierYic_praat,ices C N10 �N!
A Hot holding greater than or equal to 140 F. (wholebaef1pork roasts 13e° ) A ❑ No eating ❑ No smoking while working
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0
e mg king
B Cold holding less than or equal to45°F. B Wounds covered adequately
C Proper cooling ki I I C Prppej sink used for handwashing
D Proper re-heating 0
E Proper internal cooking l consumer advisory posted �14 l°iinsea{hot water chern c0i ' : '. C,WO NIA 2
0 A Approved sanitizer available/adequate concentration ofsanitizer
s AegpOte;facilitlestb ma)nitar��pcoduct� C INlO �N1A t 2� g Food contact surfaces and utensils used for potentially
�terripterauehth�rmometers'psi�le „ a �` hazardous food sanitized at least every 4 hours
A Food thermometer available and accurate C Adequate ❑dishwashersanitizer ❑final rinse temp
L Pro er sanitizin
B Proper food thermometer for product Ad I
procedure
E Sanitizing between raw animal origin&ready-to-eat food �
C Thermometers appropriately placed in cooler units
0
8i a e - s k�k+�. s,1 ,, k ;j lean#wiping rcioths o .n,i�c INlty..
�CR Gted during dtt roger,preparat[on, x * Cf 'IV10 �N/ 2
rpla►,vservr .�rtdtrarlspt►>+#alti v ," � r r� Cloths and/or sponges in good repair ac n
A Produce washed B Wiping cloths kept in sanilizer between uses
0
B Raw meats not storedlpreparednear ready-to-eat foods [26Fobdcnt � u�f`cesclean k'r' C 10` IA:12A
C Food covered properly �_ ^� ��.� ,�.. `�-�
A Food equipment clean,utensils clean,equipment interiors clean
D Adequate splash guards/sneeze 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 150 ;Mot and so�ldi_walter,un of pr ssure;provided as_required 0 0A [2;E�
38-Handwashmg accessorres,proAded (C NIOr NIA 1
9� Hq{nino food mrntmitg! . , {C t�10 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 ❑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 food/ice 0
0 -DESCRIBE DEFICIENCIES ON CONTINUATION SHEETS
The following information is not debitable and does not affect your score. KEY: OFO[qualiked 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 y d required to report to the local health department?
Roasts Other
Describe re-heating procedures: Is there a written illness policy th requires the food worker to report specific illness conditions
Are temperatures recorded/logged for cold holding foods/equipment? Y and diseases to the QFO? Y *Do you have a paid sick leave policy? Y N
Are oads cooked in advance and cooled? Y N *Are leftove aved? Y N Is there a language bard between inspector&QFO? Y N !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(circle all that apply.QFO DA Mgr Cook Owner FW
Is cooling monitored for time&temp? Y N Is the monito ing of cooling recorded? Y N .Obtain signature of the p on who re ei 0 responsibilities inform ien= 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);agrTorm(total of 62 debitable items) Page 1 of 2
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ADDITIONAL FOUR POINT ITEMS KEY: DNC [DOES NOT COMPLY]
6 Foods not re-served.
-Unwrapped foods not re-served 4 t 31 Sewage disposal approved. 4;
-Potentially hazardous foods not re-served �..;
-Operating as required '
34 No cross connections,back siphonage,backflow
11 Toxic chemicals. 4 Proper typelinstallationl backflow prevention device/air gap for:
-Stored properly,labeled 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
-Pesticideslrodenticldes properly dispensed -Chemical dispensers -Ice machines
Proper drain for: ..
-Food equipment -Dish machines -Ice machines
29 Water source adequate,safe. �4
-Well 1 well head protected from contamination
-Water quality in compliance x'. 35 Toilet facilities. Adequate,convenient,accessible, •
-Monitoring in compliance designed,properly installed
OTHER ITEMS KEY: DNC [DOES NOT COMPLY]
2 Sources of food:Original container,properly labeled 40 Garbagelrubbish storage areatrooms,enclosures-properly constructed,clean
5 Potentially hazardous food properly thawed 2 41 Garbage/rubbish disposed of in an approved manner,at approved frequency
10 Food dispensing utensils properly stored 1 2 V rmin Control: No insects/rodents present
14 Food worker:Clean outer clothes,effective hair restraints ! 43 Outeropenings protected against entrance of insectslrodents
4 Floors: Floor covering installed,constructed as required,good repair,clean
16 Food-contact surfaces designed,constructed,maintained,installed, W .
'12; 45 Floors graded,drained as required
located a
6 Floor,wall juncture covered
17 Nonfood-contact surfaces designed,constructed,maintained, 7 Mats removable,good repair,clean '.
installed,located
.41 48 Exterior walking,driving surfaces,good repair,clean a1;
18 Single service articles,storage,dispensing tw
49 Walls,ceilings attached,equipment properly constructed,good i=1t
19 No reuse of single service article i- r.
repair,clean.Wall&ceiling surfaces as required
20 Dishwashing facilities approved design,adequately constructed, 2 1
maintained installed located 1 50 Dustless cleaning methods used,cleaning equipment properly stored
Equipment&Utensils: Cleanliness 51 Adequate lighting provided as required 1'
21 Preflushed,scraped,soaked and racked 52 Room free of steam,smoke odors
22 Wash water clean,proper temperature 53 Rooms&equipment hoods,ducts,vented as requiredI
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rpurate thermometers provided,dish basket,if used .. , . 54 Rooms adequate,clean,adequate lockers provided,facilities clean 1
onfood contactsurfacesofutensils&equipmentclean �l s 55 Establishment and premises free of litter,noinsecthodentharborage,
8 uipmentfutensils,storage,handling no unnecessary articles
Pr er disposal of waste water F low56 complete separation from living/sleeping quarters laundry i
bing location,installation,maintenance
57 Cleantsoiled linens stored properly
58 No live birds,turtles,or other animals(except guide dogs) °
36 Toilet rooms enclosed with self-closing door E710
w 59 Seats 75 or more:Nonsmoking area provided,sign(s)posted at3
37 Proper toiletfixturesprovided,good repair,clean entrance(s),smoking area indicated by signs)
39 1 Approved garbage/rubbish containers,adequate number,covered, L�
rodent proof,clean Ptoutine Inspection ❑Reinspection 13 Preoperational Inspection
INSPECTOR: PERSON IN CHARGE: Zither Inspection:
Demerit Score: *Include demerits from page 1
�L�4 _ 4 3 2 1 Total Rating
signature signature
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print name rrn name �'
S DUE: rJ�
phone number title
c_.6— , - Page 2 of 2 plus eontin 'on pager nmd ruspecHon U2002
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#
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INITIAL(INSPECTOR) INITIAL(PERSON IN CHARGE)
Distribution: 1st-White-Health.Department 2nd-Yellow-Owner/Manager C—C,
Page of
INSPECTION REPORT STATE OF CONNECTICUT
FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH
CONTINUATION SHEET
NAME OF ESTABLISHMENT TOWN DATE OF WSPEC ION
INSPECTION REMARKS
FORM#
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INITIAL(INSPECTOR) INITIAL(PERSON IN CHARGE)
Distribution: Ist-White-Health Department 2nd-Yellow- Owner/Manager (a