HomeMy WebLinkAboutFood Service Establishment Inspection 60 (3) `/- e
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Establishment: &4,v ' S Inspection Date: Time: 0[nsp E[nsp
ddress/City: oT Health ept: class. 1 2 64
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] N10[not observed] N/A[not applicable)
�fi0« Quahfled F40d Operator 4 �` *�'� 3 DNC[does not comply] 0[other] RTE[ready-to•eat]
e lid,
12 'Rersonnet w[th ]nfe ton restricted .k _
I esjgnat6d Altt:rnate n �� 2
_. A Food workers have no exposed infected lesions/burns
,fit ',Written dodumentation of trainirigaprog am, w a4o 2
B Personnel with infection restricted
�1g llpproved"sbUrce,wholesomesnonadult-sated ;r a ;_ ] C NI
Or, _ 4. C Communicable disease of worker reported to local health director
A Approved shellfish,finfish;meat& oult USDA a roved 13, Handwashinggfaeihtres prowde!`hinds washed clean =C cP116 �N/A: 4
B Food cans in good condition(not dented,rusty,bloated,leaking) ' h ��l _
A Handwash facilities in all food pr spensing&warewash areas
C Wholesomelnonadulterated foods/safe B Handw facilities i or i eI latent to toilet rooms
D Commercial products(no home grown/canned food) C Han sh fa ii on nie use
E Potentially hazardous foods received at proper temperature D Perso nel hands washe el 1 Proper wash procedure
0 E Handwashing a ppropriate times
'I PF,Otentially hazardnus:food rrn6ets temperature regutr$ en#s C ti6 kA 4p
during storage preparation ,diipiay, trans anon ,
t s t service and po
Li00d�h rgien1c=preCtiC@S J ° 'a=rC4 Nib' 1,U 2
g g q (whole o A ❑ No eating '. ❑.No smoking
A Hot holding realer than or equal to 140°F. ( olebeerlpoA;rossls 130 F.) � g while w �orking
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 X 0
d u h
E Proper internal cooking l consumer advisory posted 24 'Notizatroniq a(hot�water, the rli al) a C #N10 t lA 2
Approved sanitizer available/adequate concentration of sanitizer
dequate#adtitig to,rr)ainEain product C d,N py k„ Food contact surfaces and utensils used for potentially
f .. hazardous food sanitized at least every 4 hours
mperatu ,theYmometersr rovided p ,' ry0.
A Food thermomeieravailableandaccurale C Adequate ❑dishwashersanitizer ❑final rinse temp
L Proper sanitizin rocedure
B Proper food thermometer forp'roduc#
E Sanitizing between raw animal origin&ready-to-eat food
C Thermometers appropriately placed in cooler units 0
�eana,vp46 clC ry ost h, x.:.. lA
trao ,�pe aiaon A Cloths and/or sponges in good repair and clean;fed na e ._
efylct
ditilonR
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B Wiping cloths kept in sanitizer between uses - -
A Produce washed �C 0
B Raw meats not stored/prepared near ready-lo-eatfoods 26t: qo�-� sfi ale clean '`�� N3e N1t7 ��
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 IC C Food--contact surfaces clean
F No pooling of eggs not cooked immediately p
8 Food containers stored off the Floor "
30� t a id c slfl Wafer uin r�pressurer p ovide l as ie urred�� a
0 3t3 �Handwashmg accessrisprcvtded �1 `
w C 1 2 A Soap1 a. g e o ry 4
y , �
paper towels 1 drying device available
A No unnecessary handling RTE and/
or cooked foods with bare hands B
Dispenser(s)working: ❑Soap. ❑Papertowel
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 foodlice 0
0 •DESCRIBE DEFICIENCIES ON CONTINUATION SHEETS
The following information is not debitable and does not affect your score. KEY: QFO[qualified 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 F6 illness ar you required to report to the local health department?
Roasts Other
Describe re-heating procedures: Is there a written illness policy tha equires the food worker to report specific illness conditions
Are temperatures recordedilogged for cold holding foods1equipmen6V Y N and diseases to the QFO? Y 1K ♦Do you have a paid sick leave policy? Y N
Are ods cooked in advance and cooled?--Y N *Are le vers saved? Y N Is there a language barrier etween inspector&QFO? Y N If yes indicate language spoken
List products cooled: by QFOIDA: 1Z *Can the QF01DA read the inspection report? Y N
Describe cooling methods: Indicate whom wered the above questions:Name(print):
Indicate the title of above person( re all that apply):QFO DA Mgr Cook Owner FW
Is cooling monitored for time&temp? Y N Is ttidmonitodng of cooling recorded? Y N .Obtain signal of th arson w r eived the QFO responsibilities information at the time of the
Is there a produce washing policy7 Y N *Describe what is washed and inspection:
where: Note: This report is a two fte form(total of 62 debitable items) Page i of 2
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ADDITIONAL FOUR POINT ITEMS KEY: DNC [DOES NOT COMPLY]
6 Foods not re-served.
31 Sewage disposal approved.
-Unwrapped foods not re-served
-Potentially hazardous foods not re-served It -Operating as required
No cross connections,back siphonage,backflow
11 Toxic chemicals. 4 Proper typelinstallation/backflow prevention device/air gap for:
-Stored properly,labeled properly,used properly
-Food equipment -Nose 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: b
-Food equipment -Dish machines -Ice machines
29 Water source adequate,safe. ji
-Well!well head protected from contamination r 35 Toilet facilities. Adequate,convenient,accessible, 4
-Water quality in compliance 0
designed,
-Monitoring in compliance ��, properly installed
OTHER ITEMS KEY: DNC [DOES NOT COMPLY]
2 Sources of food:Original container,properly labeled 40 Garbageirubbishstoragearea/rooms,enclosures-properly constructed,clean *ls
5 Potentially hazardous food properlythawed 41 Garbage/rubbish disposed of in an 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 43 0 ter openings protected against entrance ofinsectsirodents
Odors:Floor covering installed,constructed as requiye , o d repair clean
16 Food-contact surfaces designed,constructed, maintained,installed, 45 Floors graded,drained as required
located E
6 Floor,wall juncture covered p
17 nfood-oontacl surfaces designed,constructed,maintained, ;;, 7 Mats reFnovable,good repair,clean
installed,located it it
f�p 8 Exterior walking,driving surfaces,good repair,clean �t
18 Single service articles,storage,dispensing 2�: u
19 No reuse of single service article
0 49 Walls,ceilings attached,equipment properly constructed,good1
repair,clean.Wall&ceiling surfaces as required „
20 Dishwashing facilities approved design,adequately constructed, ZPo i
installed located
50 Dustless cleaning methods used,cleaning equipment properlystored
maintained
Equipment&Utensils: Cleanliness IV 51 Adequate lighting provided as required
21 Prefushed,scraped,soaked and racked 52 Room free of steam,smoke odors
22 Wash water clean,proper temperature t
53 Rooms&equipment hoods,ducts,vented as required
231 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 55 Establishment and premises fraeof fitter,no insectlrodentharborage, 1.
28 Equipmentlutensils,storage,handling 4: no unnecessary articles
32 Proper disposal of waste water % 56 Complete separation from living/sleeping quarters and laundry
57 Clean/soiled linens stored properly
33 Plumbing location,installation,maintenance
58 No live birds,turtles,orolher animals(except guide dogs)
3 Toilet rooms enclosed with self-cfo ' door !'r -
59 Seats 75 or more:Nonsmoking area provided,sign(s)posted at
37 Proper toilet fixtures provide ,good repa' clean ;
entrance(s),smoking area indicated by sign(s)
39 Approved garbagelrubbish containers,adequate number,covered, 7.',
rodent proof,clean Routine Inspection ❑Reinspection ❑ Preoperational Inspection
PERSON IN C A E: Other Inspection:
/ Demerit Score: *Include demerits from page 1
4 3 2 1 Total Rating
signature ignature
�- ��p' me print name / - S
L� DATE CORRECTIONS DUE:
-phone number f title ,
Page 2 of 2 plus_L-continuation pages Focused Inspection 1l2002
Pagel 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 SPECTI N
INSPECTION REMARKS
FORM#
t_ T
A n /S73
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INITIAL(INSPECTOR) INITIAL(PERSON IN CHARGE)
Distribution: 1st-White-Health Department 2nd-Yellow-Owner/Manager