HomeMy WebLinkAboutFood Service Establishment Inspection 96 (2) s �
Establishment: Inspection Date: {� Time: p'' dins REins
Address/City:_p SUL.�I Phu �� Health Dept: 44 i,4 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] N10[not observed] NIA[not applicable]
60r taualtfted Food dpe�ator 3 DNC[does not comply] 0[other] RTE[ready-to-eat]
*, „ 12 Personnel with infection restr[cted ; C �W tW
61 Designated Alternate. = 2
4,
q.
q Food workers have no exposed infected lesions 1 burns
62 Written documentation of framing program 2
B Personnel with infection restricted
1 A.pproved source,wholme;'eso noriadulterated " C.fdl0-NIA 4 C Communicable disease of worker reported to local health director
A Approved shellfish,finfish,meat&poultry USDA approved '13 Hlridvrashingifacilities provided,,:handswished,clean -C Nl N!A '4
B Food cans in good condition(not dented,rusty,bloated,leaking) A Handwash facil')es in all food prep/dispensing&warewash areas
C Wholesomelnonadulteratedfoods/safe -AlfB Handwash cilities in or lately adjacent to toilet rooms
D Commercial products(no home grown/canned food) C Handw f '' c le nvenient to use
E Potentially hazardous foods received at,proper temperature D Perso ne df had,clean andwash procedure
E Handwashing at app
5. 1Potentlally hazardop§;aood imeaas tf:mpe�ature requirement3 <F.`C;1!UO !NIA ,4 0
= . 1 t;dOrtng storage,preparation,dlaplay,service and trans o atlori
p ft..:
77
ib :Good':hyglenicpractices
:.
C N!d ;NIA 2
A Hot holding greater than or equal to 140°F. (whole be-efrporkroasts 130'F.) A ❑ No eating ❑No smoking while working
S Cold holding less than or equal to 45°F. B wounds covered adequately k
C Proper cooling C Proper sink used for handwashing
D Proper re-heating 0
ot Water
E Proper internal cooking lconsumer advisory posted [2:4 $a'nitgzatton in ,et(h cher�iiG:all). Fi;C MN(O kNIA 1
r a
0 A Approved sanitizeravailableladequateconcentrationofsanitizer
[ ,t Adequate.facifitresto marntm`,py ,cttc # r : C rN10 iN1A .2. B Food-contact surfaces and utensils used for potentially
r}_ tef pera ure,fhetnnomietersr�providedn " ' t hazardous food sanitized at least eve 4 hours
aIP a�u^$•?tf.<. E of c h t t..z f £ r�. every
A Food thermometer available and accurate C Adequate ❑dishwashersanitizer ❑final rinse temp
D Proper sanitizin
B Proper food thermometer.forproduct procedure
E Sanitizing between raw animal origin&ready-to-eat food
C Thermometers appropriately placed in cooler units
0
13 r 5 Glean wiping clokt s z C NI `tNIA: :1
r x g I
'7 od protected ciuringstbra'e r a[ation, a (Cz�N%0 NI p2
tr .;�s.a
displh►,a €vi n A Cloths and/or sponges in good repair and clean
. f. .4 ddd�transportati�on�
B Wiping cloths kept in sanitizer between uses
A Produce-washed
a
6 Raw meats notstoredlpreparetl near ready-to-eat foods dC Via.+pc �'�lict,1 1U1 A—-s learn d ,' t iIV!® lN1A 2
C Food cover o erl , _ ,:.� � �
A Food equipment clean,utensils clean,equipment inferiors clean ,
D A qu a splash guar sneeze guard B Single use gloves changed when soiled
E No hor' a nnel C Food--contact surfaces clean
F No pooling of eggs not cooked immediately 0
8 Food containers stored off the floor y3D ?Hor and cold wa4ar t ri er p"re'ssure,.provtded as requite ..' 0`N)A, 2 I�
A
0 3a.<Handwashing accessories proy[ded { .Al N!0
9g ri t`n ofnfood minrmized :. : C,(N10'N!A Z w . :. . ...r.. . r r.
et 9 ""' t A Soaplpapertowels! drying device available
A No unnecessary handling RTE and/or cooked foods with bare hands B o p I paper
towelsworkin OSoap ❑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 Adequateutensil(s)fordispensingfoodlice 0
0 *DESCRIBE DEFICIENCIES ON CONTINUATION SHEETS
The following information is not debatable and does not affect your score. KEY: QFO[qualified food operator],DA[designated alternate],PHF[potentially hazardous food],FS[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 wha emnnrature do you cook:
Poultry Ground Beef. Pork What diseases related to FB llinal you required to report to the local health department?
Roasts Other
Describe re-heating procedures: Jr Is there a written illness policy Y
requires the food worker to report specific illness conditions
Are temperatures recordedltogged for cold holding foodslequi nt? Y N and diseases to the QFO? Y ♦Do you have a paid sick leave policy? Y N
Are foods cooked in advance and cooled? Y N ♦Ar leftovers saved? Y N Is there a language barrier bpfween inspector&QFO? Y N f es 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):
Is coding monitored for time&temp? Y N Is the m nilodng of poling recorded? Y N Indicate the title of above person(circle all that al ):QFO DA Mgr Cook Owner FW
Obtain signet u a of the e n who ived the ssponslbilities information at the time of the
Is there a produce washing policy? Y N ♦noseri a what Is washed and inspection:
where: Note: This report is a two page form(total of 62 debatable items) Page 1 of 2
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FOCUSED FOOD SERVICE 1 5 ! O1V ]I2EPE)RT
L �AL HEALTH BEPT Y"�Jlt -_ AbBF71z5S1CiT -1110
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4
Establishment �5$G �S. ._• `� f .Date of Inspection.
ddress QCty /�L:L!'I/s?-rt./ =11 Owner or Opera#or: .1i4�1' �r = I'
1
ADDITIONAL FOUR POINT ITEMS KEY: DNC [DOES NOT COMPLY] c
6 Foods not re-served. l
-Unwrapped foods not re-served 4 31 Sewage disposal approved. '4,
-Potentially hazardous foods not re served -Operating as required
11 Toxic chemicals. No cross connections,back siphonage,backflow
4 Primer type/installation/backflow prevention device)aL g for:
-Stored properly,labeled properly,used properly -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
-Pesticides/rodenticides properly dispensed Proper drain for:
29 Water source adequate,safe. 4 -Food equipment -Dish machines -Ice machines
-Well Iwell head protected from contamination 35 Toilet facilities. Adequate,convenient,accessible, 4
-Water quality in compliance designed,properly installed
-Monitoring in compliance
OTHER ITEMS KEY: DNC [DOES NOT COMPLY]
2 Sources of food: Original container,properly labeled 40 Garbagehubbishstoragearea/rooms,enclosures-properly constructed,clean
5 Potentially hazardous food properly thawed 41 Garbagelrubbish disposed of roan approved manner,at approved frequency ,
10 Food dispensing utensils properly stored 42 vermin Control: No insectslrodents present
14 Food worker:Clean outer clothes,effective hair restraints _1 ; 3 Outer openings protected against entrance of insects/rodents 1
loors: Floorcovering installed,constructed as required otl repot clef
16 F d-contactsurfacesdesigned,constructed, maintained,installed,
5 Floors graded,drained as
required
located
-Floor,wall juncture covered
17 Nonfood-contact surfaces designed,constructed,maintained,
__F)
1.- �1ats remove 1 ,gone" tl repair,dean
installed,located
18 Single service articles,storage,dispensing �2
8 Exterior walking, i mg surfaces,good repair,clean
19 No reuse of single service article 9 Walls,ceilings attached,equipment properly constructed,good lx
repair,clean.Wall&ceiling surfaces as required
20 Dishwashing facilities approved design,adequately constructed,
maintained installed located 50 Dustless cleaning methods used,cleaning equipment property stored 1
Equipment&Utensils• Cleanliness 51 Adequate lighting provided as required 1
1 Preflushed,scraped,soaked and racked 52 Room free of steam,smoke odors 1
22 Wash water clean,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 premisesfreeof litter,noinsectlrodentharborage, i
28 Equipmentlutensils,storage,handling 1 no unnecessary articles
32 Proper disposal of waste water 1 56 Complete separation from livingisleeping quarters and laundry 1
33 Plumbing location,installation,maintenance 1' 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 1
59 Seats 75 or more:Nonsmoking area provided,sign(s)posted at
37 Proper toilet fixtures provided,good repair,clean 3 entrance(s),smoking area indicated by sign(s)
39 Approved garbagelrubbish containers,adequate number,covered, 1
rodent proof,clean ARoutine Inspection ❑Reinspection ❑ Preoperational Inspection
R., ,, PERSON I CHARGE: Other Inspection:
Qemerit S,=: *Include demerits from page 1
4 3 2 1 Total Rating
nature - sign ur
l r g _�-
p' t name print name �.� / g g
DATE CORRECTIONS DUE: r ,
phone number
' ( ( A Page 2 of 2 plus continuation pages Focused hq'd i..r ao2
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
9
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INSSPECTION PEMARKS
FORM#
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INITIAL(INSPECTOR) INITIAL(PERSON IN CHARGE)
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Distribution: 1 st-White-Health Department 2nd-Yellow- Owner/Manager