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HomeMy WebLinkAboutFood Service Establishment Inspection 94 �:+my S:llvil�BllS:`:lhJl��" Rr # Establishment: U� Inspection Date: 1 Time: ROinsp REinsp ddresslCity: (� f �� ,,� ✓ Health Dep: i ss. f z A 4 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 NIO NIA JDNC I KEY: C[complies] NIO(not observed[ NIA[not applicable] 60 f Qualt#led Fd4�Qerator e k s 3 DNC[does not comply] 0[other] RTE[ready-to-eat] , 12 ;Personne­11,1l uvth rnfection reStldtod xIQ;EN1A'`4 61 �f)esignated+Alternate a> x ; ; z 62 Written documentation o€tralnipg pogratei A Food workers have no exposed infected lesions I burns 2 B Personnel with infection restricted 1 ;Ap}�roved'source;whrilesome,nonadu e�`rafed ;';E tC' N10'NIA;A v, C Communicable disease of worker reported to local health director A Approved shellfish,fnfish,meat& Dull USDA a roved 13 rf�andw shmg faciiftles provided,handswasl ed;.clean jNld N!A` 4 B Food cans in good condition(not dented,rusty,bloated,leaking) A A Handwas facilities in all food prepldlspen g&warewash areas C Wholeso me/no naduIte rated feods!safe B an h facilities in or i ately cilet rooms D Commercial products(no home grownlcanned food) !C C Ha tl sh faciliti acc i 1 ! v le use E Potentially hazardousfoods received at proper temperature D Pe el lean an procedure CI r.ixy v a a.o i E Ha dwas irrg at appropriate times 3 Poten rally hazardQu,00 meets e1n eYature t rernents 6C N10 NlA� 4 0 during storage,prgpargtron,drsplayyerrlce"al°tr nsppo�ri�ation'I a' " 1°5 rvGOOd h le IC", ra•Ctflde's u " x , Yg ! C N10 "NlA, ? 7r �, r?fit A Hot holding greater than or equal to 140 F. (whole beerlporkroasts 130oF.) K I A ❑ No eating L] No smoking while working 13 Cold holding less than or equal to 45 F. B Wounds covered adequately C Proper cooling C Proper sink used for handwashing D Proper re-heating 0 E Proper internal cooking!consumer advisory posted 2 Saritfzation rinse(h]ot watetttertlial} #E CN!® IVlA 2 p A Approved sa n ifter ava ilableladequate con centration of sa nitizer 4 Ac!6446e filbifities to maintain product C N10 NIA 2 B Food-contact surfaces and utensils used for potentially temperature,thermometers provided hazardous food sanitized at least every 4 hours A Foedthermolr:eieravailableandaccurate C Adequate ❑dishwashersanitizer ❑final rinse temp JAL D Proper sanitizin rocedure B Proper food thermometerfor product C Thermometers appropriately placed in cooler units E Sanitizing between raw animal origin&ready-to-eatfootl PX 0 0 i25.Clean wiping cloths ,C NIO NIA 11 7 .Po d prtltected during_storage, preparati+�p ��l� N!� tspslayf i i r sportation � [ A Cloths and/or sponges in good repairandclean B Wiping cloths kept in sanitizer between uses A Produce washed A B Raw meats not stored/prepared near readytoeatfoods 26 c tsu�#a a In �;t X0 !NIA 2 I AM C Food covered properly t 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 C Food--contact surfaces clean F No pooling of eggs not cooked immediately k 0 8 Food containers stored off the floor �30 `kot and cold watk under pressure,provrdedaas4epufr&r41C iNIO iN1A 2n� 0 rHatid+ asit�g aessories provided,," F� NlQ INIA i 1, [9 Handling;©€Mood mrngttfec!' ; NIA 2 ._PC; NIO A Soap 1 paper towels 1 drying device available A No unnecessary handling RTE andlorcooked foods with bare hands B Dispenser(s)working: ❑Soap ❑Paper towel B Minimize food handling,other than ready-to-eat,with bare hands k C Handwash sink(s)clean 1 waste receptacle at handwash sink C Adequate utensil(s)for dispensing foodlice 1< p 0 •DESCRIBE DEFICIENCIES ON CONTINUATION SHEETS The following information is not debitable and does not affect your score. KEY: QF0[qualified food operator],DA[designated alternate],PHF[potentially hazardous food],FB[foodborne] PHFs are hot held 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 report to the local health department? Roasts Other Describe re-heating procedures. Is there a written ill ss policy that requires the food worker to report specific illness conditions Are temperatures recordedllegged for cold holding foodslequipment? Y N and diseases to e QFO? Y N ♦Do you have a paid sick leave policy? Y N Are foods cooked in advance and cooled? Y N Are le ers saved? Y N Is there a laq uage barrier between inspector&QFO? Y N If vas indicate language spoken List products cooled: by QFOIDA: *Can the QFOJDA read the inspection report? Y N Describe coaling methods: Indicate who answered the above questions: Name(print): Indicate the Lille of above er (cin;Ia al apply}:OFO Cook Owner FW Is cooling monitored for time&temp? Y N Is monitoring of coaling recorded? Y N .Obtain signature of the h received QFO respon ilities i ien at the time of the Is there a produce washing policy? Y N ♦Describe what is washed and inspection: ' where Note: This repo �t two page form otal of 62 debitable items) Page 1 of 2 STATE O>r CQNNJELTICUT DEPARTMENT OF RU LIC HEALT}i 41Q.CAPITOL AVENUE MS#51 FDP-WARTFOR©,CT D§134` r' �AoCYISEb FOOD SERVICE 1fYSPEC��Q�lT REPOT2T LOC�IL HEALTH©EPT: Lc�/ �f`Sb _. .ADI]RESSICITY, Establishment.-&015 f i �. gate of Inspection:. F ddress 9Cv �yt :rAt1 Quuner or Operator: ADDITIONAL FOUR POINT ITEMS KEY: DNC [DOES NOT COMPLY] o. � 6 Foods not re-served. -Unwrapped foods not re-served 4 31 Sewage disposal approved. -Potentially hazardous foods not re-served -Operating as required No cross connections,back siphonage,backflow 1 t Toxic chemicals. 4 4 2ro ear typelinstallation(backflow prevention device!air gap for: -Stored properly,labeled properly,used properly 1 -Food equipment -Hose connections -Dish machines Sanitizer concentration 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-Water quality in compliance 35 Toilet facilities. Adequate,convenient,accessible, 4. -Monitoring in compliance designed,properly installed OTHER ITEMS a KEY: DNC [DOES NOT COMPLY] 2 Sources of food:Original container,properly labeled 1 0 Garbagelrubbish storagearealrooms,enclosures-properly constructed,dean 1 5 Potentially hazardous food property thawed 2 41 Garbagelrubbish disposed of in an approved manner,at 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 43 Outer openings protected againstentranceoflnsects!rodents 4 Floors: Floor covering installed,constructed as required,good repair,clean 16 Food-contactsurfaces designed,constructed, maintained,installed, 45 Floors graded,drained as required located 6 Floor,wall juncture covered 17 Nonfood-contact surfaces designed,constructed, maintained, 47 Mats removable,good repair,clean installed,located 18 Single service articles,storage,dispensing 2 8 Exterior walking,driving surfaces,good repair,clean 1 19 No reuse of single service article 9 Walls,ceilings attached,equipment properly constructed,good 1. repair,clean.Wall&ceiling surfaces as required k 20 Dishwashing facilities approved design,adequately constructed, maintained installed located 50 Dustless cleaning methods used,cleaning equipment properly stored a Equipment&Utensils Cleanliness I"; 51 Adequate lighting provided as required1` 21 Preflushed,scraped,soaked and racked 52 Room free of steam,smoke odors j 22 Wash walerclean,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- 27 Nonfood-contact surfaces of utensils&equipment clean 1 ), 55 Establishment and premises free of litter,noinsectlrodentharborage, �1 28 Equip mentlu ten sils,storage,handling 1: no unnecessary articles a.. 32 Properdisposal of wastewater ,1 561 Complete separation from livinglsleeping quarters and laundry 1 33 Plumbing location,installation,maintenance 1 57 Clean/soiled linens stored properly 58 No live birds,turtles,or otheranimals(except guide dogs) 1a 36 ToiIat rooms en closed with setf-clos1ngdoor 1 59 Seats 75 or more:Nonsmoking area provided,sign(s)posted at F ' 37 Proper toilet fixtures provided,good repair,clean 3„ enlrance(s),smoking area indicated bysign(s) u 39 Approved garbagelrubbish containers,adequate number,covered, 1 rodent proof,clean Agoutine Inspection OReinspection O Preoperational Inspection INSPECTOR: R CHARGE: Other Inspection: Demerit Score: *Include demerits from page 1 4 3 2 1 Total Rating signature ,si nature mt name print name &/j—/,� � _�� i/ ►QC"c'I phon ` title i—�® C7 DATE CORRECTIONS ® ram- 2 1 1,1 Page 2 of 2 plus continuation pages Focused Inspection v2002 Page / of INSPECTION REPORT STATE OF CONNECTICUT FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH CONTINUATION SHEET NAME OF ESTABLISHMENT TOWN DATE OF INSPECTIO v15 f ot� f INSPECTION REMARKS FORM# X C 1-0 4� 9 y e r A -' - a INITIAL(INSPECTOR) INITIAL(PERSON IN CHARGE) c Distribution: 1 st-White-Health Department 2nd-Yellow-Owner/Manager