HomeMy WebLinkAboutFood Service Establishment Inspection 12 (4) .*
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Establishment:�(,J Inspection Date: Time: Roirtsp REiris
ddresslCity: Heath apt: Qu7� z-vIx Meme__ Class: 1 2 3 a
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 N10 NIA jDNr I KEY: C[complies] NIO[not observed] NIA[not applicable]
60 j Qtlaltfted Fodd'O�ergtor 3 DNC[does not comply] 0[other] RTE[ready-to-eat]
67 'pestgllatedAlternate k f 2 12.';'Personnelwrthrnfec#'rori'restricted G N10 NIA 4
62 I Writtert,documentation of training program 2 A Food workers have no exposed infected lesions 1 burns
B Personnel with infection restricted
1 Ap'proved source,wflolesome,tionadultorated C 'N10 NIA 14 C Communicable disease of worker reported to local health director
A Approved shellfish,finfish,meat&poultry USDA approved k I I 731; Hindw §hrng Yacrittles provi d, ha was clean C" N10;NIA' 4
B Food cans in good condition(not dented,rusty,bloated,leaking)
A Handwash cllllles in all food "r di ensi warewash areas
C Wholesomelnonadulterated foodslsafe B Handwa acilities nor' ant to toil rooms
D Commercial products(no home grown/canned food) B Han sh t a onvenienl t
E Potentially hazardous foods received at proper temperature D Perso 1 I h nds washed,clean ra er handwash procedure
C E Handwashing at appropriate 'roe
3 ` Potentfellyy ha I rdoueafood{meets terttp'�rature requirements, C NPO"IV1A 4
l bttring sfgrage,preparatlon,dtsptayl;Fsenc ce and trarisportatidn' , i
5 `Good hygienic ptacthces NI
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A Hot holding greater than or equal to 140 F. (Whole beafrporkmasta 130°F) A ❑No eating ❑No smoking while working
B Cold holding less than or equal to45°F. B Wounds covered adequately'
C Proper cooling C Proper sink used for handwashing
D Proper re-heating
E Proper internal cooking l consumer advisory posted 24 '$anitratron�r'rnse(hotwte =chemical) F. _10`NIA.2
0 A Approved sanitizer availableladequate concentration of sanitizer
fe� Adegrtate facirrwatc inafntatnproduct a iN/0 NIA i 2 g Food-contact surfaces and utensils used for potentially
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a t temperature;thermometers providfldl� rx r t F hazardous food sanitized at least every 4 hours
AS Food thermometer available and accurate C Adequate ❑dishwashersanitizer OTinalrinsetemp
B Proper food thermometerforproduct
D I Proper sanitlzlnq procedure
C Thermometers appropriately placed in cooler units
E Sanitizing between raw animal origin&ready-io-eat food
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to .x+ ,¢; Ciesrri`wl'"1 C it S,s 1:'k w '' �.t M Yr 4 *- ,.',' a s
t7av F � rpIrO iiiec d Y r g storage, P p ratto[t x NIOr�IUTA� 2* r Q a t��?.w ::. x v 1.y . t.`:�C lN1Q;&N!A 9 :
A y *. arm 0� A Cloths and/or
rsrplhy, nrtce.and tran'spaier �k # 41 t v S t sponges in goad repair and clean
B Wiping cloths kept in sanitizer between uses
A Produce washed
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B Raw meals not stored/prepared near ready-to-eat foods
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C Food covered properly � ,. . a ..,«'• L. •;`
A Food equipment clean,utensilsclean,equipment interforsclean
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 'S 3o I Q an i,nold fro rii e�j ressure, rpvtd'd�s required,: C €N/0 NfA
C $8 wFtandwashing acesror�es;piavided� IwO.FNIA:f�
9xri Haritlllrtg of food mrntmraji o] i s X r tC' N(0'([VIA.i 2 fl ° Y
_ .. .
A Soap I paper towels 1 drying device available
A No unnecessary handling RTE and/or cooked foods with bare hands B
Dispensers)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)fordispensing foodlice Q
0 •DESCRIBE DEFICIENCIES ON CONTINUATION SHEETS
The following information is not debitable and does not affect your score. KEY: CFO[qualifed 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! ass are you required to report to the local health department?
Roasts Other
Describe re-heating procedures: Is there a written illness olicy that requires the food worker to report specific illness conditions
Are temperatures recorded/logged for cold holding foods/equipment Y N and diseases to the ? Y N *Do you haveynid sick leave policy? Y N
Are foods cooked in advance and cooled? Y N *Are le vers saved? Y N Is there a langua barrie efwean inspector&QFO? N If as indicate language spoken
List products cooled: by QFOIDA: *Can the 9 IDA read the inspection report? Y N
Describe cooling methods: Ind/nSign.,
answered the abo a questions:Na a(print):
Indtle of above pars n 'role all4hat p I ]:QFO D Mgr oo er FW
Is cooling monitored for time&temp? Y N Is th menitodng of cooling recorded? Y N ,Oure of t e perso who calve th Q sp ll'le for a e time of the
Is there a produce washing policy? Y N ♦ ascribe what is washed and
where: Note: This repo `a two ilWdrrm(total of 62 ebitable items) Page 1 of 2
sT JE"FCO�INE TICUT_ DEpAR71VIEI '1 GP:OUBLIC,HEALTH 410-GARI7QLA11ENUE-MS#51FOP-HARTFORD,CT 06134.
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L�3PGALH>:at-TH DEPT �. G 7 r`- /�-?l• 7 SC'�L : ADDRESSICITY:
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Estibli'sh'ment:1., Date of Inspection:
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ddress._ Ownerr Operator: Z? ,i4L� / 09f i
ADDITIONAL FOUR POINT ITEMS KEY: DNC [DOES NOT COMPLY]
6 Foods not re-served.
-Unwrapped foods not re-served 4 31 Sewage disposal approved. 4
-Operating as required
-Potentially hazardous foods not re-served
34 No cross connections,back siphonage,backflow
11 Toxic chemicals. 4
4 Proper typelinstallationl ackflow prevention device/air ga for:
-Stored properly,labeled properly,used properly -Food equipment -Hose connections -Dish machines
-Sanitizer concentration not ta exceed maximum permitted -Soda system carbonator -Beverage dispensers -Toilettanks
-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
-Well I well head protected from contamination 35 Toilet facilities. Adequate,convenient,accessible, 4
-Water quality in compliance
-Monitoring in compliance designed,properly installed
OTHER ITEMS `
KEY: DNC [DOES NOT COMPLY] o;
2 Sources of food: Original container,properly labeled 1 0 Garbagelrubbishstoragearealrooms,enclosures-property constructed,clean
5 Potentially hazardous food properly thawed 41 Garbage/rubbish disposed of in an approved manner,at approved frequency
10 Food dispensing utensils properly stored 1 2 Vermin Control: No insects/rodents present 2
14 Food worker:Clean outer clothes,effective hair restraints 1 3 Outer openings protected againstentrance of insects/rodents 1"
4 Floors: Floor covering installed,constructed as required,good repair,clean
16 Food-contact surfaces designed,constructed,maintained,installed, 2; 5 Floors graded,drained as required
located
6 Floor,wall juncture covered
17 Nonfood-contact surfaces designed,constructed,maintained, 1;:. 7 Mats removable,good repair,clean
installed,located 1
8 Exterior walking,driving surfaces,good repair,clean
18 Single service articles,storage,dispensing
19 No reuse of single service article 9 Walls,ceilings attached,equipment properly constructed,good 1
repair,clean.Wall&ceiling surfaces as required
0 Dishwashing facilities approved design,adequately constructed, 2
maintained installed located 50 Dustless cleaning methods used,cleaning equipment properly stored
Equipment&Utensils Cleanliness 1 51 Adequate lighting provided as required 1,
21 Preflushed,scraped,soaked and racked 52 Room free of steam,smoke odors
22 Wash waterclean,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 I
55 Establishment and premisesfreeof lifter,no insect/rodent harborage, 1'
28 Equipmentlutensils,storage,handling 1 no unnecessary articles
32 Proper disposal of waste water ;1` 56 Complete separation from livinglsleeping quarters and laundry
33 Plumbing location,installation,maintenance lh_ 57 Clean/soiled linens stored properly
f. 58 No live birds,turtles,or other animals(except guide dogs)
36 Toilet rooms enclosed with self-closing door 1-
59 Seats 75 or more:Nonsmoking area provided,signs)posted at 3
37 Propertoiletfixiures provided,good repair,clean entrance(s),smoking area indicated by sign(s)
39 Approved garbagelrubbish containers,adequate number,covered, 1
rodent proof,clean ❑Routine Inspection Reinspection ❑ Preoperational Inspection
P ON I HARGE. Other Inspection:
Demerit Score: *Include demerits from page 1
( 4 3 2 1 Total Rating
ignature � -si ur
rrint name
DATE CORRECTIONS DUE: 41
phone number title
n�l`�� Page 2 of 2 plus continuation pages FoeuSed rn5 echoa V:007
Page Of
INSPECTION REPORT STATE OF CONNECTICUT
FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH
CONTINUATION SHEET
NAME OF ESTABLISHMENT TOWN DATE OF INSPECTION
B /.
INSPECTION REMARKS
FORM#F
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INITIAL(INSPECTOR) INITIAL(PERSON IN CHARGE)
Distribution: Ist-White-Health Department 2nd-Yellow-Owner/Mana
Collelo, Diane
From: Collelo, Diane
Sent: Tuesday,June 21, 2016 3:14 PM
To: 'dapolczer@att.net'
Subject: Training Docs,Willowbrook Cafe
Attachments: Employee Training Records.pdf
Good Afternoon,
Here is the training documents required for your employees to be kept on file at your establishment. Please feel free to
copy as many as you need.
Should you have any further questions, do not hesitate to contact me.
Regards,
Diane L. Collelo
Environmental Health Inspector
Town of Windsor, Health Department
1540 Sullivan Avenue
South Windsor, CT 06074
Ph. 860-644-2511 ext.248
Fax 860-644-7280
Website: www.southwindsor.org
i.