HomeMy WebLinkAboutFood Service Establishment Inspection 59 (2) _ �
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Establishment: Pt,,A Inspection Date: Time: R01nsp Einsp
ddresslcity: Healt Yept Gc:! � r'2 lass: 2
Based on an inspi this day,the items marked DNC identify the violations in operation orfacilities 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 s QSalthLtlfr)t)i�Operator s g DNC[does not comply] 0[other] RTE[ready-to-eat]
` z 12 PersO inel with mfe'ction restricted ';
61 Designated�Altemate` C N!0 N!A 4.
x
A.
q Food workers have no exposed infected lesions!burns
r 62 Written documentetton of training prAgram 2
B Personnel with infection restricted
1 Approved source,wh6le:ocin 'nonadulte at,d C N/0 N/A `4
t ... .. ' C Communicable disease of worker reported to local health director
A Approved shellfish,finffsh meat&poultryUSDA approved 43 'Hand washing,facrlrties.provided, hands washed;clean C NlO NIA: 4
B Food cans in good condition(not dented,rusty,bloated,leaking) "
A Handwash facilities in all food prepldtsp nsing&warewash areas
C Wholesomelnonadulteraiedfoodslsafe B Handwas ecilities in or immedi t ad]a t to toilet rooms Af
D Commercial products(no home grown/canned food) C Handwa h fac i accessible/ venj t use
E Potentially hazardous foods received at proper temperature D Person el h d a d, I rop r a acedure
0 E Handw shi ap ropriate time
3 Pofentlally`hazarddi food meets tempeiature rot uu triezlts C
during storage,preparation,display,s€nilcle tend transportation
rcprIcesh V! 2 G
A Hat holding greaterthan or equal to 14ft (oolebearfporkroams nooF.) ' ❑No eating ❑No smoking while working
B Cold holding less than or eq ual to 45'F. B Wounds covered adequately
C Proper cooling C Proper sink used for handwashing
D Proper re-heating
S mtizatton"rinse� hat water chemical `' `C NIO 2
E Proper internal cooking/consumer advisory posted x . (.:. �... i
( A proved sanitizeravailableladequate concentration ofsanitizer
I4¢ Ads,cutora�.f(it(eslto}maintainprcduot y 1 .
,CN10 NlA 2 g Food contact surfaces and utensils used for potentially
t`jtemperature,tttiarrtyiSrteter�' p1ouil n' r a hazardous food sanitized at least every 4 hours
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. 'Yx}•+k k. _. ._ ..,.�....... ...._. •_.....,.....�
A Food thermometer available and accurate C Adequate Adishwasher sanitizer ❑final rinse temp
B Proper food thermometerfor product D Proper sanitizin rocedure
C Thermometers appropriately placed in cooler units
E Sanitizing between raw animal origin&ready-to-eat food
0 O
Kid r .n. a x a n j25�Ctean+wipmg+cloths ' w' r { ('. 1Nl0,. [�1JA ;1
7 Fond protot !lring atarege,epxeparation, r i :il(q i rZk Y r
r F r A Cloths and/orsponges in ood repair and clean
display,servrc �'art`drtransfp�o agro F ,J., i-r1.k ^f . F•F.n H 9 P
A Produce washed B Wiping cloths kept in sanitizer between uses
0
B Raw meats notstoredlprepared near ready to eatfoods � od nt',_t' t of
C Food covered properly 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 r7, 00d--contact surfaces clean
F No pooling of eggs not cooked immediately
8 Food containers stored off the floor $0'#Hof and coil wetgr under pressure, rovrded as required G iNfQ' ti 2'
:.
r t3; ;Haritlwathing accessiiries'provtded' : i = A !I.;
andlinglof fo "m[rtiiriized . g. " C:::N!0 r2 ,W t..
••• n " - [ A Soap!paper towels 1 drying device available
A No unnecessary handling RTEand/or cooked foods with bare handsA B Dispenser(s)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 utensils)for dispensing foodlice LedMO -
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: IF. PHFs are cold held at: IF. 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 reheating procedures: Is there a written illness policy the quires the food worker to report specific illness conditions
Are temperatures reowdedllogged for cold holding foods/equipment? N and diseases to the i Y *Do you have a paid sick leave policy? Y N
Are foods cooked in advance and cooled? Y N *Are left ers saved? Y N Is there a language barrio etween inspector&QFO? Y N If yes indicate language spoken
List products cooled: by QFOlDA: *Can the QFOIDA read the inspection report? Y N
O
Describe cooling methods: Indicate who ensTf=plerssvv��;
-tq bave questions: erne(print):
Indicate the titl R ircle all that apply):QF Mgr Cook Owner Fw
Is cooling monitored for time&temp? Y N Is the nitoring of cooling recorded? Y N .Obtain signat ei 0 respo s' tides:formation at the time of the
Is there a produce washing policy? Y N ♦Describe what is washed and inspection:
where: Note: This report is a two page form(total 04 ttable items) Page 1 of 2
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ADDITIONAL FOUR POINT ITEMS KEY: DNC [DOES NOT COMPLY]
6 Foods not re-served. -
I
31 Sewage disposal approved.-Unwrapped foods not re-served -Operating as required4-Potentially hazardous foods not re-served
k W
74 No cross connections,back siphonage,backflow
11 Toxic chemicals. �4
-Stored properly,labeled properly,used properly 4 Proper type)installation)__backfloAprewntian de cel air gap for;
-Senitizer concentration notto exceed maximum permitted -Food equipment -Hose connections -Dish machines
-No unnecessary toxics on the remises -Soda system carbonator -Beverage dispensers -Toilet tanks r�
ry p -Chemical dispensers -Ice machines
-Pesticideslrodenticides properly dispensed _ ': Proper drain for;
gt
-Food equipment -Dish machines -Ice machines
29 Water source adequate,safe.
-Well 1 well head protected from contamination 35 Toilet facilities. Adequate,convenient,accessible,
-Water quality in compliance
-Monitoring in compliance designed,properly installed
OTHER ITEMS KEY; DNC [DOES NOT COMPLY]
2 Sources of food:Original container,properly labeled 1W40 Garbage/rubbish storage area/rooms,enclosures-properly constructed,clean ]
5 Potentially hazardous food properlythawed 41 Garbagelrubbish disposed of in an approved manner,at approved frequency ,
10 Food dispensing utensils properly stored 42 Vermin Control: No insectslrodents present t ;
14 Food worker:Clean outer clothes,effective hair restraints i 43 Outeropenings protected against entrance of insects/rodents &1
4 Floors: Floor covering installed,constructed as required,good repair,clean
16 Food-contact surfaces designed,constructed,maintained,installed,
12', 45 Floors graded,drained as required �
cated r '
6 Floor,wall juncture covered
17 onfood-contact surfaces designed,constructed,maintained, u
7 Mats removable,good repair,clean
installed,located
48 Exterior walking,driving surfaces,good repair,clean
18 Single service articles,storage,dispensing 2e:
19 No reuse of single service article 49 Walls,ceilings attached,equipment properly constructed,good
repair,clean.Wall&ceiling surfaces as required
20 Dishwashing facilities approved design,adequately constructed,
maintained,installed located 50 Dustless cleaning methods used,cleaning equipment p roped y stored
Equipment&Utensils: Cleanliness1', 51 Adequate lighting provided as required
21 Preflushed,scraped,soaked and racked 52 Room free of steam,smoke odorsP.1
22 Wash water clean,proper temperature 53 Rooms&equipment hoods,ducts,vented as required
21 curate thermometers provided,dish basket,if used 5 54 Rooms adequate,clean,adequate lockers provided,facilitiesclean ;g
Nonfood-contact surfaces of utensils&equipment clean
Ems, 55 Establishment and premises free of litter,no insect/rodent harborage,
28 Equipmentlutensils,storage,handling no unnecessary articles
Po er disposal of waste water 6 Complete separation from living/sleeping quarters and laundry
i
33 Plumbing location,installation,maintenance , 571 Clean/soiled linens stored properly "I
58 Nolivebirds,turtles,or other animals(except guide dogs)
36 Toilet rooms enclosed with self-closing door
Ot 59 Seats 75 or more:Nonsmoking area provided,sign(s)posted at3
37 Proper toilet fixtures provided,good repair,clean entrance(s),smoking area indicated by sign(s)
39 Approved garbageirubbish containers,adequate number,covered,
rodent proof,clean I A Routine Inspection ❑Reinspection ❑ Preoperational Inspection
'. Other Inspection:
ININ Pam: E: Demerit Score: *Include demerits from page 1
4 3 2 1 Total Rating
signature signature
print name print name L;11z1;16
1�43 /17
DATE CORRECTIONS DUE:
phone number title
Page 2 of 2 plus continuation pages Focu2d..Ipelfl..1.002
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Page of
INSPECTION REPORT STATE OF CONNECTICUT
FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH
CONTINUATION SHEET
NAME OF ESTABLISHMENT TOWN DATE OF INSPECTION
L� 3 (1 !3
INSPECTION REMARKS
FORM#
1 ESQ'
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12
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INITIAL(INSPECTOR) 4&, 1 IN IAL(PERSON IN CHARGE)
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 TO DATE OF IN ECTI
"P-"�J7
v �3
INSPECTION REMARKS
FORM#
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INITIAL(INSPECTOR) INITIAL(PERSON IN CHARGE)
Distribution: 1st-White-Health Department 2nd-Yellow-Owner/Manager