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HomeMy WebLinkAboutFood Service Establishment Inspection 80 (3) � ,f MI Establishment:,_ inspection.Date: Time: / Oinsp Eins ddress/City: ,1 wr¢ _ ,Health Dept:'K�Z4 �1r,a�tJ tf class: 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 debatable items C WO WA DNC KEY: C[complies] NIO[not observed] NIA[not applicable] 0� FQuahfrgd Fobdtperafor, Irtf„. e. +� 3 DNC[does not comply] 0[other] RTE[ready to-eat] c ie.^ .wr Rr ac h t"' 61 D srgria a Alternate a f * 2 12� Pdr nhdl�wit infeetionarestrrcted ' 7 " ' ^' " ' Y A Food workers have no exposed infected lesions/bums �62 ,Wlitfen documentation trdin3ngp�dgram'< p w. B Personnel with infection restricted �1Ipproved source;who�esbm ,nTirfadutEeratdd b _ r, s C N/0 NIA` C Communicable disease of worker reported to local health director A Approved shellfish;finfish,meat&poultry USDA a roved 13, Ffandwashm ffaeUrtieS rbt��cie?ri khid.,tiisht tl,�tean C; f1O<lil/A�44e B Food cans in goad condition(not.dented,rusty,bloated,leaking) "` 9 P A I Handwash facilities in all food prepldispensing&warewash are s C Wholesome/nonadu[teratedfoodstsafe a Handwash facilities in or i ediately adjacent toilet r refs D Commercial products(no homegrownlcannedfood) oms C Handwash facilities acc sib c nvenient E Potentially hazardous foods received at proper temperature D Personnel hands washe Ilea P pe g roced4are E Handwashing at appropna Imes 43 Jhaiardous+food mee4stemperature t`eu sy 4 to [ 0ll 4'• O * t during s orage�prepafatlan,tlrsplali,�serVrce"an�tfpnsportaion�fi +: $ 7d ,x'k Vol K-` fit _ .. . 4, 2 gt A Hot holding greater than or equal to 140eF. (whole beefrporkroasts 1309F.) A ❑ No eating t]No smoking while working B Cold holding less than or equal to.45°F. B Wounds covered adequately C Proper cooling C Proper sink used for handwashing D Proper re-heating 0 hInse . .. 4 d, -&_R &W Nn1k0' NZleA k�2kE Proper internal cooking l consumer advisory posted g a 0 A Approved senitizerava[lableladequate concentration ofsanitizer }4 ACdegtrate;fiaartrres otma[ntarq P;odyctr�! e C° ;�VIAi g Food-contact surfaces and utensils used for potentially 4 +n' {lr.w,rfi WK 4"d'�!::*.Iit+F-� e#ey�lperatyre,thetrr�t �rtrs,sprivded' hazardous food sanitized at feast every 4 hours A Food thermometer available and accurate C Adequate ❑dishwashersanitizer ❑final rinse temp D Proper sanitizin 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 26 wC� a[n viping Cloths .� r ri ) Wt aFo+sd prbf tec �lyrm9 storage prt3para [on ?rw .a to+PfF �.w era.el#:" YK`''S"?f+a.., w a:f a r av rK- M,•tt . • " '• A A Cloths and/orsponges in oodre air and clean Fd p� y,serviceaidenspdatlon'" B Wiping cloths kept in sanilizer between uses A Produce washed 0 B Raw meats notstored/prepared near ready-to-eat foods ID NA , 2 t3 anod:+oni�ahisfacal r [ C Food covered properly 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 Wel -F o pooling of eggs not cooked immediately x 0 8 'Food containers stored off the floor S"0 k F"ptandtaoldwaterdnde� e ure,;rovided as require C .NjAe fn 0 sy .4 f< ' r„ per.,.:& �. t r� a q I ?� �38 aHn�wash`m a�cessanes provld�d° " Handling afa,9.9 prrirnrmtzec� N1�3 All Aa N vx Al Nl0 �Hf/Ay ql i .... ., A No unnecessary handling RTE and/or cooked foods with bare hands A Soap 1 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 1 waste receptacle at handwash sink C Adequate utensil(s)fordispensing foodlice 0 0 •DESCRIBE DEFICIENCIES ON CONTINUATIOW SHEETS The following information is not debatable and does not affect your score. KEY: QFO[qualified food operator],DA[designated alternate];PHF[potentially hazardous foodl,FB[foodborne] PHFs are hot held at: IF. PHFs are cold held at: QF. 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 k 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 poll, at requires the food worker to report specific illness conditions Are temperatures recorded/logged for cold holding foodslequipm nt? Y N and diseases to the QF0? N *Do you have-a paid sick leave policy? Y N Are foods cooked in advance and cooled? Y N *Are eftovers saved? Y N Is there a language b rfier between inspector&QFO? Y N If yes indicate language spoken List products cooled: by QFOIDA: *Can the CFO/DA read the Inspection report? Y N Describe cooling:methods: Indicate who swered the above questions:Name(print): " Indicate th Ne of above person(circle all that apply):QFO DA Mgr Cook Owner FW Is cooling monitored for time&temp? Y N Is the onitoring of cooling recorded? Y N .Obtain si nature of the arson who received the QFO res onsibilittes,information at the time of the Is there a produce washing policy? Y N ♦D tribe what is washed and inspection: .-- where: Note: This report is a two page form(total of 62 debitable items). Page 1 of 2 1 - ! Date of lnspection��� � � � � ��.�� A, � R A Owner or Qpl tio3 a? b rD �U ADDITIONAL FOUR POINT ITEMS OES NOT COMPLY] 6 Foods not re-served. q4 31 Sewage disposal approved. �� -Unwrapped foods not re-served -Potentially hazardous foods not re-served -Operating as required ; tom; 37 No cross connections,back siphonage,backflow 11 Toxic chemicals. "4' Proper voelinstallation/backflow prevention device/airgap 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 -Chemical dispensers -Ice machines � 4 -Pesticidesfrodenticides properly dispensed p MP3 dr i o: 29 Water source adequate,safe. 4 -Food equipment -Dish machines -Ice machines -Well l well head protected from contamination 35 Toilet facilities. Adequate,convenient,accessible, 4 -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 OA!�' 40 Garbage/rubbish storagearealrooms,enclosures-properly constructed,clean si:. S Rotially hazardous food properly thawed Garbagelrubbishdisposed of in anapproved manner,at approved frequency 0 I`Vbispensing utensils properly stored 2 Vermin Control:No insectslrodents present2 14 Food worker:Clean outer clothes,effective hair restraints 43 Outeropenings protected against entrance of insectsirodents tt 4 Floors:Floor covering installed,constructed as required,good repair,clean A 6 F d-contacisurfaces designed,constructed,maintained,installed, ' 5 Floors graded,drained as required r cated ` 6 Floor,wall juncture covered 17 nfood-contact surfaces designed,constructed,maintained, ' c 17 Mats removable,good repair,clean installed,located i1 18 Single service articles,storage,dispensing 481 Exterior walking,driving surfaces,good repair,clean g 49 Walls,ceilings attached,equipment properly constructed,good 19 No reuse ofsin le service article repair,clean.Wall&ceiling surfaces as required 20 Dishwashing facilities approved design,adequately constructed, 2 ' maintained,installed located 50 Dustless cleaning methods used,cleaning equipment properly stored ' Equipment&Utensils: Cleanliness 51 Adequate lighting provided as required a k 21 Prefiushed,scraped,soaked and racked 52 Room free of steam,smoke odors It 22 Wash water clean,proper temperature a 53 Rooms&equipment hoods,ducts,vented as required 23 curate thermometers provided,dish basket,if used 54 Rooms adequate,clean,adequate lockers provided,facilities clean 1 onfood-contact surfaces of utensils&equipment clean T �1�; SS Establishment and premisesfree of litter,no insectlrodentharborage, �1= 8 Equipmentlutensils,storage,handling • no unnecessary articles M_ ""_ 32 Proper disposal of wastewater atis 56 Complete separation from living/sleeping quarters and laundry I , 33 Plumbing location,installation,maintenance 57 Clean/soiled linens stored properly ' 58 No live birds,turtles,orotheranimats(except guide dogs) 36 Toilet rooms enclosed with self-closing door 59 Seats 75 or more:Nonsmoking area provided,sign(s)posted at 37 Proper toiletfixtures provided,good repair,clean 4 entrance(s),smoking area indicated by sign(s) 39 Approved garbagelrubbish containers,adequate number,covered, rodent proof,clean outine Inspection ©Reinspection E3 Preoperational Inspection INSPECTOR: PERSON IN CHARGE: Cher Inspection: Demerit Score: *include demerits from page 1 4 3 2 1 Total Rating 7 nature ignature pri e _ 2 print name phone numbeer� ;, title — DATE CORRECTIONS DUE: ;� it� Page 2 of 2 plus continuation pages Focused Inspection 112002 Page of ,a'.v INSPECTION REPORT STATE OF CONNECTICUT � FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH CONTINUATION SHEET NAME OF ESTABLISHMENT TOWN DATE OF INSPECTION INSPECTION REMARKS FORM# oo -f &ZZ �dP �. -41l INITIAL(INSPECTOR) !!tINITIAL(PERSON IN CHARGE) __. Distribution: Ist-White-Health Department 2nd-Yellow-Owner/Manager 1 I av Pag f�.. INSPECTION REPORT STATE OF CONNECTICUT FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH CONTINUATION SHEET NAM F ESTABLISHMENT TOWN DATE OF INSP CTION INSPECTION / REMARKS FORM n k If s 321 AA A.c zz— / � v vP� / � -� INITIAL(INSPECTOR) INITIAL(PERSON IN CHARGE) Distribution: Ist-White-Health Department 2nd-Yellow-Owner/Manager