HomeMy WebLinkAboutFood Service Establishment Inspection 83 (3) �y + (3 alNa�„ CT* 2Fr i? o- E4
Establishment:-/L/!.,67" Inspection Date: Time: Ro` ins .-fiEin
Address/City: � � ,�i, 7j Health Dept: ,rz "IAj&SgC 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 1 N10 N/A DNC KEY: C[complies] NJO[not observed] N/A[not applicable}
841 Quaitited FoodKQperator a + v x 3 DNC[does not comply] 0[other] RTE[ready to eat]
BR' fit Regr."sRnnel tth i feCtivn r, r t d. r
k��5 �xti � t, *ax4nx ' n ea �r:r�..� _ °
�1i1 �DsignaedAlternate 2 A Food workers have no exposed Infected lesions!burns x
x 'x x. a a.
62 Written documentation offrain�ng�prog(r4am Y;;a s ,r
2 B Personnel with infection restricted
1 Approved source,wholesome,nbnadul# rated s t �, NTV N! C Communicable disease of worker reported to local health director
A Approved shellfish finfish meat&poultry USDA approved
3; 10
tslandwashino,facilities providald,shandswashea,clean; C Nl�l„!
B Food cans in good condition(not dented,rusty,bloated,leaking)
A Handwash facilities-in all food prepldi e &w wash areas
C Wholesomelnonadulleratedfoodslsafe B Handwash f s in or i me ' 1 ac oms
D Commercial products(no home grown/canned food) C Handwa 1, s s21 1 on use
1-1
E Potentially hazardous foods received at proper temperature D Perso el hands son!Proper and ash procedure
HandwiLshLngAt appropriate tim
3 P ntl lEy hiazardous foodxmeets tempeTBtur Pe uire�#ente* .#�! ,4
ling s orage,rpreparation,display*service*and trait;portatrnr
..�, rr Y' M. g .. �:r''f . 4 G J�" t
1Si GOOdahygtentGp�acti&es N "�z. .. ;
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A Hot holding.greater than or equal to 140 F. (whole beef1porkroasis it-,F} A ❑ No eating ❑No smoking while working
B Cold holding less than or equal to451F. 4f4l B Wounds covered adequately
C Proper cooling C Proper sink used for handwashing
D Proper re-heating IG 0
E Proper internal cooking lconsumer advisory posted i24 rSarrtti�fi nfr rise{hot water ,chertiioal 0 °C; t [ 2
0 A W Approved sanitizeravailableladequate concentration ofsanitizer
4 Y Adequate faarlltiese to tnair%tain,productm r ..a. x h .C3 NfO NlA�ro 2. g Food-contact surfaces and utensils used for potentially
k y kye tur�� hg!M ems p yid d hazardous food sanitized at least every 4 hours
A Food thermometer available and accurate C Adequate ❑dishwashersanitizer ❑final rinse temp
D Proper
B Proper food thermometer for product Pro ersanitizinrocedure
E Sanitizing between raw animal origin&ready-to-eat food
C Thermometers appropriately placed in coolerunits 0
.I I emp ..•,R.t k Y w:, f f �.m ;Ctean,�wr[�ing cloths W :: r % C f/Qa
OOtl rotected durrn ,store t3 spreparatfon dead l r(r NlO� r2' :� Y. 2._.:m a.t::..d w x.s w a m::.z r5..r, k 1 k IdVII ponces�°s �tvlce4a>7dxfrhnspo�taEtn w �Atr Of, # a x A Cloths antllorsponges in good repair and clean
he B Wiping cloths kept in sanitizer between uses
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A Produce washed 0
B Raw meats not sloredlprepared near ready-to-eat foods 26 Foofd'c�ont�Dt4s.I, b s 0,earl N10 WA'r r
C Food covered properly 4 a�A-+ # ++ t .
A Food equipmenlclean,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
Food containers stored off the floor '
311E Wot and3co#d water under pkessure,providetr d tite4utr 10' N/A 2
0 38 Handwasl]Ing�accessortesprovtded� _ � C N10 NIA 1
iFlzjndirng ofifood mtnimfzed •.�;.:,w A_ 0 �+ v C; I`UO NJAt . '
A No unnecessary handling RTEand/or cooked foods with bare hands A Soap!paper towels! drying device available
B Dispenser(s)working: Map. ❑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 utensi[(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[designaled 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 re-heating procedures: Is there a written illness icy that requires the food worker to report specific illness conditions
Are temperatures recordedllogged for cold holding foods/equipment? 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 *Are Is s saved? Y N Is there a language arrier between inspector&QFO? Y N iflf ves indicate language spoken
List products cooled: by QFOIDA: ♦Can the QFOIDA read the inspection report? Y N
Describe cooling methods: Indicate who nswered the above questions:Name(print):
Indicate the title ave person(circle all the a ly):QFO DA Mgr Cook Owner FW
Is coding monitored for time&temp? Y N Is the monito ng of cooling recorded? Y N .Obtain signs re o the person who received t FO res sibilities information at the time of the
Is there a produce washing policy? Y N Describe hat is washed and inspection:
where: Note: ThisreI16irt is a two page.form WtI 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. ax
31 Sewage disposal approved.
4`
-Unwrapped foods not re-served �
-Potentially hazardous foods not re-served # -Operating as requiredv
11 Toxic chemicals. No cross connections,back siphonage,backflow ;
-Stored properly,labeled properly,used properly
-Sanitizer concentration not to exceed maximum permitted -Food equipment -Hose connections -Dish machines
-Soda system carbonator -Beverage dispensers -Toilet tanks
-No unnecessary toxics on the premises .
-Pesticideslrodenticides properly dispensed -Chemical dispensers -Ice machines
E Proper drain for: ;
29 Water source adequate,safe. E -Food equipment -Dish machines -Ice machines `
-Well!well head protected from contamination . Adequate,convenient,accessible,
-Water quality in compliance ' q 4'
35 Toilet facilities Ade
-Monitoring in compliance designed,properly installed
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OTHER ITEMS KEY: DNC [DOES NOT COMPLY]
2 Sources of food: Original container,properly labeled 40 Garbage/rubbish storage arWrooms,enclosures-property constructed,cleanC r f
tentiatly hazardous food properly thawed 2 41 Garbage/rubbish disposed of in an approved manner,at approved frequency
Food dispensing utensils properly stored 1 a 42 Vermin Control: No insects/rodents present '
14 Food worker:Clean outer clothes,effective hair restraints i '; 43 Outer openings protected against entrance of insectslrodents1
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
®dated 6 Floor,wall juncture covered
17 hfcod-contact surfaces designed, constructed,maintained,
7 Mats removable,good repair,clean ,
installed,located
rfL
48 Exterior walking,driving surfaces,good repair,clean
18 Single service articles,storage,dispensing i
19 No reuse of single service article 49 Walls,ceilings attached,equipment properly constructed,good
g repair,clean.Wall&ceiling surfaces as required
20 Dishwashing facilities approved design,adequately constructed,
maintained installed located 50 Dustless cleaning methods used,cleaning equipment properly stored ,'.
EEquipment&Utensils: Cleanliness 51 Adequate lighting provided as required
1.
21 Preflushed,scraped,soaked and racked . 52 Room free of steam,smoke odors
22 Wash water clean,proper temperature t r
r 53 Rooms&equipment hoods,ducts,vented as required
23 Accurate thermometers provided,dish basket,if used ti 54 Rooms adequate,clean,adequate lockers provided,facilities clean 1
27 Nonfood-contact surfaces of utensils&equipment clean
55 Establishment and premises free of litter,no insecUrotleniharborage,
28 EquipmenUutensils,storage,handling no unnecessary articles
32 Proper disposal of waste water 56 Complete separation from livinglsleeping quarters and laundry
3 lumbing location,install on,maintenance
7 Clean/sailed linens stored properly
R 58 No live birds,turtles,or other animals(except guide dogs)
36 Toilet rooms enclosed with self closing door j
59 Seats 75 or more:Nonsmoking area provided,sign(s)posted at '
37 Proper toilet fixtures provided,good repair,clean entrances,smoking area indicated b sign(s)
( } g Y
39 Approved garbagelrubbish containers,adequate number,covered, 1
rodent proof,clean Routine Inspection ❑Reinspection ❑ Preoperational Inspection
INSPECTOR: fher Inspection:
Demerit Score: *Include demerits from page 1
4 3 2 1 Total Rating
ig re signature
r' t n me pr nt name _r4ZJ 7&
DATE CORRECTIONS DUE:
one number title
Page 2 of 2 plus continuation pages Focused Inspection WON
r
Page of
'A
INSPECTION REPORT STATE OF CONNECTICUT
FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH
CONTINUATION SHEET
NAME OF ESTABLISHMENT TOWN DATE OF INSPECTION
7-/� � /i6
INSPECTION REMARKS
FORM#
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INITIAL(INSPECTOR) INITIAL(PERSON IN CHARG )
Distribution: 1st-White -Health Department 2nd-Yellow-Owner alter
Page of
INSPECTION REPORT STATE OF CONNECTICUT
FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH
CONTINUATION SHEET
NAME OF ESTABLISHMENT TOWN DATE OF JNSPECT ON
A)QIZO '
INSPECTION REMARKS
FORM#
a
INITIAL(INSPECTOR) INITIAL(PERSON IN C GE)-W/
Distribution: 1 st-White-Health Department 2nd-Yellow- Owner/ a ger