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HomeMy WebLinkAboutFood Service Establishment Inspection 46 (6) i sFIRM � "li It 42T. ' b CRY i� Establishment: / nspec#ion Date: Time: f,/ ofn REinsp Address/City: alth Dept. lass: f z 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 possible debitable items C NIO WA JDNC I KEY: C[complies] N/O[not observed] N/A[not applicable] 60+ Q afrfied Fapd,6perator # "; ; , k... 3 DNC[does not comply] o[other] RTE[ready-to-eat] 54 DesignatedA#ternate ; 2 12 'Personriel with Anfection restricted ;,C N/U KYAr 4: A Food workers have no exposed infected lesions I bums 62' 4 UI(ritten documentation of training program 2 B Personnel with infection restricted 1 `Approved source,wholesome;;nonadulferated ;C NIO N1A 4 C Communicable disease of worker reported to local health director ,[ A Approved shellfish,finfish,meat&poulL7 USDA approved 43 Aindwa1.shinct facllit'ies,p*11ded, hands washed,clean: C N10 N/A 4 B Food cans in good condition(not dented,rusty,bloated,leaking) A Handwash facilities in all food prep/dispensing&warewash areas jV C Wholesomelnonadulteratedfoods/safe 1C B Handwash facilities in or imme iately adjacent to toilet rooms D Commercial products(no home grown/canned food) OC C Handwash facilities ace lconvenie t to use E Potentially hazardous foods received at proper temperature dC D Personnel hands washed,cl an 1 Eppfr handwash procedure E Handwashing at appropria i es a PoteflttetlyUzardousfood-meetsiit ffi i;b it requirerner ts< C N/Oa NIA: 4 0 ,dunQg storage,preparation,dlsptay,s6rvice and transportation E , i v ..,••• u .. 15'Good hygienic practices iC t 4? k w [ ,nuQ IAA 2 A Hot holding greater than or equal to 140 F. (whole beeflpft roasts 1300F.) A 0 No eating ❑No smoking while working B Cold holding less than or equal to 450F. B Wounds covered adequately C Proper cooling C Proper sink used for handwashing D Proper re-heating 0 E Proper internal cooking lconsumeradvisoryposled 24 �Ss`nittzatton,;rinseM{hdtwater ;chemical}+ CN1QIIA'2; 0 - A Approved sanitizeravailable/adequate concentration ofsanitizer �s 4 'Adiigld 8;facilities to maintain product M g Food-contact surfaces and utensils used for potentially # . axe kph.•. _ ' to eratu � re #herinornet I' 'SPers providk hazardous food sanitized at least every 4 hours f ? .'" sz,.J:,':. ., .. �„._....a...v...ib:ao e i•:1 k••k cY! ,° �` !!X�. �...3. 6.i.. A Food thermometer available and accurate C Adequate kdishwashersanitizer ❑final rinse temp D Proper sanitizin B Properfood thermometerfor product procedure E Sanitizing between raw animal origin&ready-to-eat food C Thermometers appropriately placed in cooler units 0 O he i a x r x:. 5;GxOR !+�[pi Al,g �:�� � � � � � , .:.rG�N1Q +N/A IV, °d pFO9asto�rage,prepaatibr �s N0 NI 2 1°. �:. , . 1dirsly,senrloeiad t#ash"f .t a Wx A Cloths and/or sponges in good repair and clean A Produce washed B Wiping cloths kept in sanitizer between uses 0 B Raw meats not stored/prepared near readytoeat foods s;! goi��Qn`tarrfaoeesIen ';E NIOU�'12 C Food covered properly X _ "` A Food equipment clean,utensils clean,equipment interiors clean D Adequate splash guards/sneeze guard DC g Single use gloves changed when soiled ;< E No unauthorized personnel C Food--contact surfaces clean F No pooling of eggs not cooked immediately 0 Food containers stored off the S,0 'Htit gnu ojd�wa e��un'eer pressure,pr vftldd;sYrequire ',` r [Qa IVIPt- i2. k i :.. �. �. �.., 0 , i38 a.Fiandwashing accessories provided t �IVIQ` ; : v : :�.:. f. °. r _�, . an�ilmg of fodd4rYlrri'Imized -, ,� ,r„v #C , y IN! 2' A Soap!paper towels/drying device available Nounnecessa andlingRT and/orcoe ed odswithbarehands B Dispenser(s)working: ❑Soap ❑Paperiowel B Minimize food han ing,o er an ready-to-eat,with bare hands C Handwash sink(s)clean!waste receptacle at handwash sink C Adequate utensil(s)ford ispensing foodlice 0 0 •DESCRIBE DEFICIENCIES ON CONTINUATION SHEETS The following information is not debitable and does not affect your score. KEY: QFO[quail 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 you required to report to the local health department? Roasts Other Describe re-heating procedures: Is there a written illness policy that re5wifes the food worker to report specific illness conditions Are temperatures recorded/logged for cold holding foodslequlpment? N and diseases to the QFO? Y N *Do you have a paid sick leave policy? Y N Are foods cooked in advance and cooled? Y N *Are lefto rs saved Y N Is there a language barrier be en inspector&QFO? Y N If yes indicate language spoken List products cooled: by QFO/DA: *Can the QFOIDA read the inspection repod? 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 mcqgoring of cooling recorded? Y N •Obtain si natttre oft e o r i�e e�,F�f�gg��Sjbilities information at the time of the [where: there a produce washing policy? Y N ♦Describe what is washed and inspection: ap '� `/ �"'�" i" Note: This report is a two page form (total of 62 debitable items) Page 1 of 2 . a iiba tof ADDITIONAL FOUR POINT ITEMS KEY: DNC [DOES NOT COMPLY] 6 Foods not re-served. f 4 - '4: 31 Sewage disposal approved. -Unwrapped foods not re-served 4§ -Potentially hazardous foods not re-served ar<; -Operating as required f 11 Toxic chemicals. 74 No cross connections,back siphonage,backflow ��� kfl 4, Proper ypelinstallationl bacow prevention device/air g� fpfoor: -Stored properly,labeled properly,used properly = -Food equipment -Hose connections -Dish machines -Sanitizer concentration not to exceed maximum permitted 4 -Na unnecessary toxics on the premises �,� -Soda system carbonator -Beverage dispensers -Toilet tanks -Pesticideslrodenticides properly dispensed 41 -Chemical dispensers -Ice machines � Proper drain for: -Food equipment -Dish machines -Ice machines 29 Water source adequate,safe. R w -Well I well head protected from contamination 4 -Water quality in compliance 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 rbagelrubbish storage arealrooms,enclosures-proper) constructed,clean 5 entially hazardous food properly thawed 1 Garbage/rubbish disposed of in an approved manner,at approve r cy © d dispensing utensils properly stored in Control: No msectslr'ents present d Food worker:Clean outer clothes,effective hair restraints 43 outer openings protected against entrance of insects/rodents iv. i oors:Floor covering installed,constructed as required,good rep r;clean`4MA 16 Food-oontact surfaces designed,constructed,maintained,installed, 11 5 Floors graded,drained as required located , �- 6 Floor,wall juncture covered 17 Nonfood contact surfacesdesigned,constructed, maintained, `,N : installed,located 7 Mats removable,good repair,clean �'A 48 Exterior walking,driving surfaces,good repair,clean kIx 18 Single service articles,storage,dispensing 19 No reuse of single service article 4 ails,ceilings attached,equipment properly constructed,good 1. ,�. repair,clean.Wall&ceiling surfaces as required 20 Dishwashing facilities approved design,adequately constructed, installed located 4,.4 50 Dustless cleaning methods used,cleaning equipment properly stored maintained 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 1 '4 53 Rooms&equipment hoods,ducts,vented as required 23 Accurate thermometers provided,dish basket,if used 54 Rooms adequate,clean,adequate lockers provided,facilities clean1 27 Nonfood-contact surfaces of utensils&equipment clean L_ 55 Establishment and premises free of litter,no insect/rodent harborage, 28 Equipmentlutensils,storage,handling no unnecessary articles j 32 Proper disposal of waste water 4,14 56 Complete separation from livinglsleeping quarters and laundry 33 Plumbing location,installation,maintenance I 57 Clean/soiled linens stored properly.IN N16 ': 58 No live birds,turtles,or other animals(except guide dogs) 36 Toilet rooms enclosed with self-closing door 59 Seats 75 or more:Nonsmoking area provided,sign(s)posted at 54 37 Proper toilet Mures provided,good repair,clean a entrance(s),smoking area indicated by sign(s) t a 39 Approved garbagelrubbish containers,adequate number,covered, t rodent proof,clean outine Inspection [3Reinspection D Preoperational Inspection PERSON IN CHARGE: Sher Inspection: Demerit Score: *Include demerits from page 9 4 3 2 1 1 Total: Rating Signature Signature/�-- I D/AV5- n f name print nam 77-k- DATE CORRECTIONS DUE: phone number title Page 2 of 2 plus continuation pages Focused Inspection 212UO2 Page—Z of INSPECTION REPORT STATE OF CONNECTICUT FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH CONTINUATION SHEET NAME OF ESTABLISHMENT TOWN DATE OF INSPECTION INSPECTION REMARKS FORM# al [r � INITIAL(INSPECTOR) INITIAL(PERSON IN CHARGE) ZFV—, Distribution: 1st-White-Health Department 2nd-Yellow-Owner/Manager Page of INSPECTION REPORT STATE OF CONNECTICUT FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH CONTINUATION SHEET NAME OF ESTABLISHMENT TOWN DATE OF INSP CTION d jAd,'X, S INSPECTION REMARKS FORM# VIC a:Z�L t r Q f i T l�� INITIAL(INSPECTOR) INITIAL(PERSON IN CHARGE) , Distribution: 1st-White-Health Department 2nd-Yellow-Owner/Manager