HomeMy WebLinkAboutFood Service Establishment Inspection 51 (2) Establishment: Inspection Date: Time: ,4` r 1101 Einsp
ddre,ss/City: s--Ito &e_iGy(A_) 7j Health Dept: Class: 1 2
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 N/A DNC KEY: C]complies] N!0[not observed] NIA[not applicable]
60a °Qualified Ad. r" 3 DNC[does not comply] 0[other] RTE[ready-to-eat]
Degnaedl Alternate g m y_'. 2 q yFo d workers havetno exposed n fectedes onsd/burns N1 ` ,
tten documentation of training progtao y
b B Personnel with infection restricted
Approved source,who_lesoma;noha ilie to l��, ,_ _ C,, N/0 N'A "4 C Communicable disease of worker reported to local health director
A A roved shellfish,Bnfish;meat& cult USDA approved A3� Handwash Handwashing�FFacilitis'p¢vfdeet,hnc(swas)ted,�lean
B Food cans in good condition(not dented,rusty,bloated,leaking) a
h facilities in all food prep/dispensing&warewash areas b
C Wholesomelnonadulterated#oodslsafe B Handwash facilities in or immediately adjacent to toilet rooms
D Commercial products(no home grownkannedfood) C Handwash facilities accessiblelconvenienl to use
E Potentially hazardous foods received at proper temperature D Personnel hands washed,clean/Proper handwash procedure
Handwashing at appropriate times
1 tdntially°hazardous food meets temperature requrrehnents ' C fV10�N 4` 0
t during s orage,preparation,display service and tansptd�flon
a s Ygienic practr� 3 * aC N/ NSA
r 15ood�h- x a
.w �,,, -
A Hot holding greater than or equal to 140°F. {whole beef/pork roasts 1300F.) A Y❑No eating ❑ No smoking while working
old holding less than or equal to 450 F. B Wounds covered adequately
Proper cooling C Proper sink used for handwashing
D Proper re-heating 0
E Proper internal cooking/consumer advisory posted i24 'Saniel ation rinse hoti vff #e `_c to n1,C C 4Nlb 1/, ;24
A Approved sanitizer available/adequate concentration OfsaniUzer
4equatdacihtr�i,to maartaig pr,9,c)9,c�.; C i Nl0 iN/ i Food-contact surfaces and utensils used for potentially
pera><ure;thermometeW provided
�° *' hazardous food sanitized at least every 4 hours
.tm = _v *+ srx�'rt�.. x� m.
A Food thermometeravailableandaccurate ' C Adequate dishwashersanitizer ❑final rinse temp k
D Proper sanitizing procedure
B Proper food thermometer for product
E Sanitizing between raw anima!origin&ready-to-eatfood
C Thermometers appropriately placed in cooler units 0
20;lrloain nripir,,ri the
<Foodaprotetcted,]d�frijnj;store[p p eparat�lor1; Ci I IO J',A.? y
y °dis to s rviee and transpottat[br '. A Cloths and/or sponges in good repair and clean
a4#-;' ..' ' _ l kh N
- -- B Wiping cloths kept in sanitizer between uses
A Produce washed I( 0
JL
B Raw meats notstoredlprepared near ready-to-eat foods 3 fdocl-d"_ °. _ � " ;2s U
C Food covered properly _ C r
_
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 °30 `1lot and'coll water under pre sUF�e�p�'ovlded asiequired 46i'N/A 02
fft
0 x r 3g 'Hatldiera;hmg aessories provided `rC
cc N1A=sP lAa 1
a . HendCrng of#oodl-nlmizeii z k N10 NlA .2
A Soap 1 paper towels/drying device available
A No unnecessary handling RTEandlorcooked 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 utensils)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], FB(foodborne]
PHFs are hot held at: OF. 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 Pork What diseases related to FS illne are you required to report to the local health department?
Roasts Other
Describe re-heating procedures: f Is there a written illness poi y that requires the food worker to report specific illness conditions
Are temperatures recorded/logged for cold holding foodslequipmen. Y 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 left ers saved? Y N Is there a language b tier between inspector&QFO? Y N If Yes indicate language spoken
List products cooled: by QFOIDA: +Can the QFOIDA read the inspection report? Y N
Describe cooling methods: Indicate who answered the above question ame tint):
Is cooling monitored for time&temp? Y N Is the moot ring of cooling recorded? Y N Indicate the title of a ev�pp€rson(circl all tha,�0pily):QFO DA Mgr Cook Owner FW
Obtain signatur ohe'persbq, received ti'ie.,QF sponsibilities information at the time of the
Is there a produce washing policy? Y N *Describe what is washed and inspection: '
where: Note: This r ort!;;?to page form(to 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. ffi
-Unwrapped foods not re-served '' 31 Sewage disposal approved.
-Operating as required
-Potentially hazardous foods not re-served
No cross connections,back siphonage,backflow ..1
11 Toxic chemicals. 4 Proper tpr
evention
ypelinstallation/backflow devicel air gap for: -4
-Stored properly,labeled properly,used properly a -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 -Chemical dispensers -Ice machines
-Pesticideslrodenticides properly dispensed Prover drain for:
-Food equipment -Dish machines -Ice machines
29 Water source adequate,safe.
4`_
-Well1 well head protected from contamination
}_ 351 Toilet facilities. Adequate,convenient,accessible, 47
-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 _ '
9 P P y Fes, 40 Garbage/rubbish constructed,clean ��"•
5 Potentially hazardous food properly thawed It 41 Garbage/rubbish disposed of in an approved manner,at approved frequency
10 Food dispensing utensils properly stored 1 2 Vermin Controk No insects/rodents present F
14 Food worker:Clean outer clothes,effective hair restraints 1 3 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,
5 Floors graded,drained as required
located ;
6 Floor,wall juncture covered l
17 Nonfood-contactsurfaces designed,constructed,maintained, 47 Mats removable,good repair,clean
installed,located
8 Exterior walking,driving surfaces,good repair,clean
18 Single service articles,storage,dispensing N2 �1
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, 02
maintained installed located
50 Dustless cleaning methods used,cleaning equipment properly stored r .
i .
Equipment&Utensils: Cleanliness 51 Adequate lighting provided as required
21 Preflushed,scraped,soaked and racked 52 Room free of steam,smoke odors1
22 Wash water clean,proper temperature
53 Rooms&equipment hoods,ducts,vented as required
urate thermometers provided,dish basket,if used 54 Rooms adequate,clean,adequate lockers provided,facilities clean
27 food contact surfaces of utensils&equipment clean —(g 55 Establishment and premises free of litter,no insectlrodent harborage,
28 Equipmentlutensils,storage,handling no unnecessary articles
56 Complete separation from living/sleepinguarters and laundry
32 Proper disposal of wastewater P p q 1�
33 Plumbing location,installation,maintenance Y 57 Clean/soiled linens stored properly
` 58 No live birds,turtles,or other animals(except guide dogs) s
36 Toilet rooms enclosed with self-closing door ' .'.
37 59 Seats 75 or more:Nonsmoking area provided,sign(s)posted at
Proper toilet fixtures provided,good repair,clean ;
entrance(s),smoking area indicated by sign(s) t
f
39 Approved garbage/rubbish containers,adequate number,covered, 1'
rodent proof,clean )@Routine Inspection 13Reinspection 13 Preoperational Inspection
Other Inspection:
INSPECTOR: PE E;,_
Demerit Score: *Include demerits from page 1
4 3 2 1 Total Rating
nature n ure
p mt nam �
e �F int name
`/' 7 �a 4 �'� DATE ORRECTIONS DUE:
I-Plione number title16
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Page 2 of 2 plus continua on pa s Focused I---ectia-
Page Of
INSPECTION REPORT STATE OF CONNECTICUT
FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH
CONTINUATION SHEET
NAME OF ESTABLISHMENT TOWN DATE OF SPECTION
INSPECTION REMARKS
FORM#
r�
INITIAL(INSPECTOR) & INITIAL(PERSON IN CHARGE)
Distribution: I st-White-Health Department 2nd-Yellow-Owner/Manager
Pag of
INSPECTION REPORT STATE OF CONNECTICUT
FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH
CONTINUATION SHEET
NAME 0 ESTABLISHMENT TOWN DATE OF INSPECT ON
INSPEC ION REMARKS
FORM#
f
c
INITIAL(INSPECTOR) INITIAL(PERSON IN CHARGE)
Distribution: 1st-White-Health Department 2nd-Yellow- Owner/Manager