HomeMy WebLinkAboutFood Service Establishment Inspection 65 (4) Establishment: ' , & Inspection Date: Time: 4 / Roins Eins
Address/City: S7 -2! ` Healt ept; , ev class: 1 2 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 WO NIA JDNC I KEY: C[complies] N/O[not observed] NIA[not applicable]
fllifledtfood Operator r
3 DNC[does not comply] 0[other] RTE[ready
8t]' to eat]
12 Perspnniti " et° st � r 0'NIA r4
esnateAenate r a3 -
z A ffi Food workers have no exposed infected lesions 1 burns
T27 of J1rat0irt#p-t"�o 2 g personnel with infection restricted
1 =Apprgveo source,wholesomeSnttieated _{ 4 N70$NIA'r4 C Communicable disease of worker reported to local health director
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A I Approved shellfish,iinfish,meat&poultry USDA approved 13� Mantlwashtng�faQi ttt�stp otul ted�Ijan�s w hetl area C 11Q NlU i
B Food cans in good condition(not dented,rusty,bloated,leaking)
A Handwash facilities'n all food prepldis nsing&warewash areas
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C Wholesomelnonadu Iterated foodsisafe k B Handwash facil' as in or immed' y adjacent to toilet rooms
D Commercial products(no home grownkanned food) C Handwash f ilitie ces ib nvenie to use
E Potentially hazardous foods received at proper temperature D Personnel haLhdtyagW,Min alwas procedure
0 E Handwashing at appropri
t otq$#dkly l t t rdohs'#dodjmeets temper ttt�e t r n rifs C� NJ sNIA 4 O
auring,storage,prepaiatinn,tl sp ay,vser�ic§randatran§part�tigq s + ,�, ,�. �. ,
A Hot holding greater than or equal l0140°F.�(W°e b�P k masts iso°Fs)� �� ��� � A�0❑°No eatyg0❑No smoking working v `�lQ N! #y
9 9 g
B Cold holding less than or equal toWF. B Wounds covered adequately
C 1 Proper cooling je I I I C Proper sink used for handwashing
D Proper re-heating 0
E Proper internal cooking lconsumer advisory posted 24, iztionrirje ( it f me .lcal . 0 Illt
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0 pprovedsanitizeravaiiabl! dequaTecondentrationofAnitizer
1 r AAdequatenfactIItfes4o�malnfa�����d C-t C Nl( � = B Food-contact surfaces and u ensr s use or potentially
"§ �te�11*1 i9ikd - 0 4 4' ,+; hazardous food sanitized at least every 4 hours
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A Food thermometer available and accurate C Adequate ❑dishwashersanitizer ❑final rinse temp
D Propersanitizin rocedure
B Proper food thermometer for product
E Sanitizing between raw animal origin&ready-to-eat food
C Thermometers appropriately placed in cooler units 0
- t f r m ,� mot : 7
f P �t[�rWC1(3t 15
00 r, tected d rtn stor a ion ,
Q . 9 � _
7 s A Cloths and/or sponges in good repair and clean
se�vtcle artdfitrarit;�Ia`r��tro" -;�
B Wiping cloths kept in sanitizer between uses
A Produce washed IV
0
B Raw meats not stored/prepared near ready-to-eat foods o°d-contacattsut
C Food covered properly A Food equipmentclean,utensils clean,equipment interiors clean ki
D Adequate splash guards!sneeze guard B Single use gloves changed when soiled
E No unauthorized personnel C Food--contact surfaces clean
F APooling of eggs not cooked immediately k 0
t9dd containers stored off the floor ' v '
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0 a bu s r o ssdrt sYr°�idecl� or lRa...
�440f. _ 3 :11 PI
A No unnelcesary.handling RTE aiolnii rd eS �N A Soap 1 paper towels 1 drying device available
lorcooked foods with bare hands B Dispenser(s)working: ❑Soap ]]Paper towel
B Minimize food handling,other than ready-to-eat,with bare hands k 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 Ifoodborne]
PHFs are hot held at: F. PHFs are cold held at: F 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 ork What diseases related to FB illn s are you required to report to the local health department?
Roasts Other
Describe re-heating procedures: Is there a written illness go icy that requires the food worker to report specific illness conditions
Are temperatures recordedllogged for cold holding foodslequi ant? Y N and diseases to the QF ? Y N *Do you have a paid sick leave policy? Y N
Are foods cooked in advance and cooled? Y N ♦ 6 leftovers saved? Y N Is there a langua barrier between inspector&QFO? Y N U M indicate language spoken
List products cooled: by QF01DA: *Can the QF01DA read the inspection report? Y N
Describe cooling methods: Indicate w o answered the above questions:Name(print):
Indicate the title of above person(circle all that ):CFO DA Mgr Cook Owner FW
Is cooling monitored for time&temp? Y N the monitoring of cooling recorded? Y N .Obtain signature of th he QFO responsibilities information at the time of the
Is there a produce washing policy? Y *Describe what is washed and inspection:
where: Note: This report is a wo page form(total of 62 debitable items) Page 1 of 2
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ADDITIONAL FOUR POINT ITEMS KEY: DNC [DOES NOT COMPLY]
6 Foods not re-served. ;4 31 Sewage disposal approved.
-Unwrapped foods not re-served ;k
-Potentially hazardous foods not re-served ,`t -Operating as required
No cross connections, back siphonage,backflow
11 Toxic chemicals. 4' Proper type/installation/backflow prevention device/air gap 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
-Pesticides/rodenticides properly dispensed -Chemical dispensers -Ice machines '.
,b
Proper drain for:
29 Water source adequate,safe. 4 -Food equipment -Dish machines -Ice machines
-Well/well head protected from contamination u
-Water quality in compliance 35 Toiletfacilities. Adequate,convenient,accessible, 4
-Monitoring in compliance designed,properly installed
OTHER ITEMS KEY: DNC [DOES NOT COMPLY]
7.7
2 Sources of food:Original container,properly labeled ( 40 Garbagelrubbish storage arealrooms,enclosures-propedy constructed,clean 1t.
5 Potential/ hazardous food properly thawed s 41 Garbage/rubbish a/rubbish disposed of in an approved manner,at approved frequency
Y p P Y �2,. 9 p PP PP q Y ,
10 Food dispensing utensils properly stored 42 Vermin Control: No insects/rodents present
14 Food worker:Clean outer clothes,effective hair restraints 43 Outeropenings protected againstentranceofinsects/rodents 1
4 Floors: Floorcovedng installed,constructed as required,good repair,clean
16 Food-contact surfaces designed,constructed,maintained,installed, > 4 `
�4 5 Floors graded,drained as required Vol
located 1*
6 Floor,wall juncture covered
17 Nonfood-contact surfaces designed,constructed,maintained,
installed,located 7 Mats removable,good repair,clean
48 Exterior walking,driving surfaces,good repair,clean
i
18 Single service articles,storage,dispensing
19 No reuse of single service article
49 Walls,ceilings attached,equipment pro p erly co n structe d,good
s
° repair,clean.Wall&ceiling surfaces as required 1 4
20 Dishwashing facilities approved design,ade q uately constru cted,
maintained installed located E 50 Dustless cleaning methods used,cleaning equipment properly stored
Equipment&Utensils: Cleanliness 51 Adequate lighting provided as required
21 Preflushed,scraped,soaked and racked 52 Room free of steam,smoke odors
22 Wash water clean,proper temperature 53 Rooms&equipment hoods,ducts,vented as required `
2 -Accurate thermometers provided,dish basket,if used �4 Rooms adequate,clean,adequate lockers provided,facilities clean i
27 food-contact surfaces of utensils&equipment clean
55 Establishment and premisesfreeof litter,noinsect/rodentharborage,
27 Equipmentlutensils,storage,handling �l no unnecessary articles .
32 Proper disposal of wastewater 56 Complete separation from living/sleeping quarters and laundry
33 Plumbing location,installation,maintenance 57 Cleantsoiled linens stored properly
i
58 No live birds,turtles,orother animals(except guide dogs)
36 Toilet rooms enclosed with self-closing door
37 Proper toiletfixtures provided,good repair,clean
59 Seats 75 or more:Nonsmoking area provided,sign(s)posted at
entrance(s),smoking area indicated by sign(s)
39 Approved garbage/rubbish containers,adequate number,covered, i
rodent proof,clean PRoutine Inspection OReinspection O Preoperational Inspection
R N IN CHARGE:
Other Inspection:
Demerit Score: *Include demerits from page 1
(� 4 3 2 1 Total Rating
nature si tore - r
ci t name _ print name
DATE CORRECTIONS DUE: rZeill., 4't—41
phone number title
��,� _ Page 2 of 2 plus continuation pages Focused Inspection 112002
Page of
INSPECTION REPORT STATE OF CONNECTICUT
FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH
CONTINUATION SHEET
NAME OF ESTABLISHMENT TOWN DATE OF INSPECTION
L ' S l -
INSPECTION REMARKS
FORM#
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INITIAL(INSPECTOR) INITIAL(PERSON IN CHARGE)
Distribution: 1st-White- ealth Department 2nd-Yellow-Owner/Manager