HomeMy WebLinkAboutFood Service Establishment Inspection 25 (2) 1 1
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Establishment: &0/&1-1404 s Inspection Date: Time: oins Einsp
ddress/City: 11gZ'r,& Health ept:_� `.��lam;/.r/?SSy� class: 1 a:''tt
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 JDNC I KEY: C[complies] NIO'[not observed] NIA[not applicable]
u V DNC[does not comply] 0[other] RTE(ready-to-eat]
.Qyallft ka 'MJ Operator x ,,le c 3
61 Destgnaled Alternate v 2 12 "4Perodjnae!w tttl tnfectid„n&rs;Erl�ted�
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62 z 1Nrittgn documentation of trainin pro ram A 4 A Food workers have no exposed infected lesions/burns
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B Personnel with infection restricted
1 Approvedsources,whole-, -e'noraddlte7atetl C; N/0 NIA ;�4, C Communicable disease of worker reported to local health director
A Approved shellfish tinfish,meat&poultry USDA approved
13 A Handwash facilities in all food prep/dispensing&warewash areas
`Handv asbin facrlrtfes,provtded;r"hands washed,�efeah N p" N1A� 4"
B Food cans in good condition(not dented,rusty,bloated,leaking) s "'
C Wholesomelnonadulteratedfoods/safe j B Handwash facilities in or immediately adjacent to toilet rooms
D Commercial products(no home grown/canned food) 1C C Handwash facilities accessiblelconvenient to use _
E 1 Potentially hazardous foods received at prop ertemperature D Personnel hands washed,clean 1 Proper handwash procedure
E Handwashing at appropriate times
3 JPotetltiatl hdz4d6 efood meets temperature requ►rements G N10 NlA� 4< 0
during stogpge,,,preparation,display,service°artd transportation m
G , "
1;5 Good.hY teriic raaft es k 11 NIX=I
9 g q o lea ° A ❑ No eating 13 No smoking"
A Hot holding greater than or equal to 144 F. (whole baaUpork roasts i3o F.t ing while working
B Cold holding less than or equal to45°F. Al B Wounds covered adequately
C Proper cooling C Proper sink used for handwashing
D Proper re-heating JC 0
E Proper consumer 4 'S'anit'° ton' sek(ho water chem cao) p �C'`N1� ITA 2
P 9 advisory posted � . .• �v� Q��� �
0 A Approved sanitizeravailable/adequateooncentrationofsanitizer
4� `,Adequat6acilltfesto mntarn,,�rp�dct4 ,N10 N1A�=2 g Food-contact surfaces and utensils used for potentially
° � *� x hazardous food sanitized at least eve 4 hours
;tt'rr�efzltuse,therfnometers providrd'`� everyAC
a._.«..� .r ti Pi.xt_Yti A c`y.:,'0'%J..�,fi €�: r -,'n..::� @.a'krii..a ^r ,,: ..
A Food thermometer available and accurate C Adequate ❑dishwashersanitizer ❑finsl rinse temp
D Proper sanitizing procedure
B Proper food thermometerfor product d(
E Sanitizing between raw animal Z3<ready-to-eatfootl
C Thermometers appropriately placed in cooler units 0
O� k r. �"�x _. 25 gkgeu wing cloths
t Food protected,dirrlrg s crag ,pep ra or "f; Nl N 1'k - u� . r �
�drsl3fajr service andiransportatlor j A Cloths and/or sponges in good repair and clean
B Wiping cloths kept in sanitizer between uses
A Produce washed Ali 1 0
B Raw meats not stored/prepared near ready-to-eat foods � � z
�16��ooct�gnntac surfaseshlean,
C Food covered properly .4, .. .,�.„ � -_ _a
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 C Food--contact surfaces clean
F No pooling of eggs not cooked immediately 0
8 Food containers stored off the floor
�. � ate, PP q
3 -, o an o�d°'wa rt�n er. ressure rovtded+as re Ulred'
0 38 Handwashing accr3sporjes'provtd�d"I , � �V ;'gC s Nl®'
A No unnecessary handling RTE and/or cooked f` 4
6,Ffandhng of food mints rzetl : . C °,N/0 A/A, 'Z' -
ry g foods bare hands A Soap!paper towels 1 drying device available
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 utensil(s)for dispensing food/ice 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],FS[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 r port to the local health department?
Roasts Other
Describe re-heating procedures: I Is there a written illness policy that requires the foo orker to report specific illness conditions
Are temperatures recorded/logged for cold holding foods/equipment? Y N and diseases to the QFO? Y N *Do yo ave a paid sick leave policy? Y N
Are foods cooked in advance and cooled? Y N *Are leftover saved? Y N Is there a language barrier between inspecto QFO? Y N If yes indicate language spoken
List products cooled: by QFOIDA: an the QFOIDA read the inspection report? Y N
Describe cooling methods: Indicate who answered the abLircle
Name(print):
Indicate the title of above persoat apply):QFO DA Mgr Cook Owner FW
Is cooling monitored for time&temp? Y N Is the monitoring f cooling recorded? Y N .Obtain signature of the p sothe QFO responsibilities information at the time of the
Is there a produce washing policy? Y N *Describe what is washed and inspection:
where: Note: This rep t e form(total of 62 debitable items) Page 1 of 2
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® �� k- °Owner ors ?ps 4-
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ADDITIONAL FOUR POINT ITEMS KEY: DNC [DOES NOT COMPLY]
6 Foods not re-served.
-Unwrapped foods not re-served 1
31 Sewage disposal approved. ;
-Potentially hazardous foods not re-served 'y -Operating as required
11 Toxic chemicals.
No cross connections,back siphonage,backflow
°�'' �4
4' P-m er elinstaltafion/backf ow prevention device/aircga for:
-Stored properly,labeled properly,used properly -Food equipment -Hose connections -Dish machines a
-Sanitizer concentration not to exceed maximum permitted -Soda system carbonator -Beverage dispensers -Toilet tanks
-No unnecessary toxics on the premises -Chemical dispensers -Ice machines
-Pesticides/rodenticides properly dispensed
8 Proper drain for:
29 Water source adequate,safe. -Food equipment -Dish machines -Ice machines
-Well/well head protected from contamination
-Water quality in compliance 35 Toilet facilities. Adequate,convenient,accessible,
designed,properly installed
-Monitoring in compliance
4,1
OTHER ITEMS KEY: DNC [DOES NOT COMPLY]
2 Sources of food:Original container,properly labeled 40 Garbage/rubbish storage arealrooms,enclosures-properly constructed,clean
5 Potentially hazardous food properly thawed 41 Garbagelrubbish disposed of in an approved manner,at approved frequency
10 Food dispensing utensils properly stored le+ 42., rmin Control: No insects/rodents present
14 Food worker:Clean outer clothes,effective hair restraints (1: 4 pteropenings protected against entrance of insects/rodents77
s 4 FI rs: Floor covering installed,constructed as require , od repair, lean Y b
16 Food-contact surfaces designed,constructed,maintained,installed, r2 5 Floors graded,drained as required L.*
located Floor,wall juncture covered
17 Nonfood-contact surfaces designed,constructed,maintained,
installed,located 7 hts removable,good repair,clean
t
Exterior walking,driving surfaces,good repair,clean
18 Single service articles,storage,dispensing
FU
49 Walls,ceilings attached,equipment properly constructed,good
19 No reuse of single service article a
repair,clean.Wall&ceiling surfaces as required
20 Dishwashing facilities approved design,adequately constructed, t2. 7
maintained installed located � 50 Dustless cleaning methods used,cleaning equipment properly stored0.
Equipment&Utensils: Cleanliness 51 Adequate lighting provided as required v
21 Preflushed,scraped,soaked and racked 52 Room free of steam,smoke odors
22 Wash water clean,proper temperature
( .; 531 Rooms&equipment hoods,ducts,vented as required i
23 Accurate thermometers provided,dish basket,if used WI
54 Rooms adequate,clean,adequate lockers provided,facilities clean 1
27 nfood-contact surfaces of utensils&equipment clean (1 1
IL-
55 Establishment and premises free of litter,no insect/rodent harborage,
S Equipmentlutensils,storage,handling no unnecessary articles
2 P per disposal of waste water 1 56 Complete separation from living/sleeping quarters and laundry
33 ,Plumbing location,installation,maintenance 57 Clean/soiled linens stored properly
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58 No live birds,turtles,or other animals(except guide dogs)
36 Toilet rooms enclosed with self-closingdoor
59 Seats 75 or more:Nonsmoking area provided,sign(s)posted at
37 Proper toilet fixtures provided,good repair,clean
�. � entrance(s),smoking area indicated by signs)
39 JApproved garbagelrubbish containers,adequate number,covered, 1
rodent proof,cleanRgoutine Inspection ❑Reinspection ❑ Preoperational Inspection
INSPgCTO PERSONOther Inspection:
Demerit Score: *Include demerits from page 1
vz _1/'41091va 4 3 2 1 Total Rating
signature signaiddV
414
print name Ifridt name L
— %nrr6L11 YI q q- DATE CORRECTIONS DUE:
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
6o e-L- a /
INSPECTION REMARKS
FORM#
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INITIAL(INSPdTOR) INITIAL(PERSON IN CHARGE)
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Dist- u tion: st-White-Health Depart �Yellow- caner/Marra'g r