HomeMy WebLinkAboutFood Service Establishment Inspection 28 (4) Establishment: ' / ZInspection Date: Time: h0insp Einsp
Address/City: Health Dept: "7 L u 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 alf possible debitable items C NIO NIA DNC I KEY: C[complies] NIO[not observed] NIA[not applicable]
160 Qualified Food Operator 3 DNC[does not comply] 0(other) RTE[ready-to-eat]
12 a?ersodrietnt''„lnfectlorl*" %Glad= �' "r signated Alternate . .. .... t _ �.. w a.t C WO N/A' 4-
ritten docmentation of tralning program
A Food workers have no exposed infected lesions 1 burns
` Personnel with infection restricted
,A proved°soyrci;,.wholesome,nohadulttirated , • C N10 N 4'
o municable disease of worker reported to local health director
A "Approved shellfish,finfish meat 8 poultry USDA approvedklm facihtles rovtded handsWeshe clean C N/r3' IA
B Food cans in good condition(not dented,rusty,bloated,leaking) g ? ••_.-W ..-
Handwash facilities in all food prepldispensing&warewash areas
C Wholesomelnanadulteratedfoodslsafe B Handwash facilities in or immediately adjacent to toilet rooms
D Commercial products(no home grown/canned food) C Handwash facilities access!b lelconveni ant to use
All
E Potentially hazardousfoods received at proper temperature D Personnel hands washed,clean 1 Proper handwash procedure
0
r w �.y•....: � , x n f ng appropriate
;3 P,fftendal -hazardbUs neat temperature regtirrh ai2!& " Njp NI 4 E a at times
dui s ore a'prepare Ion,ad[splay sarvrce and tfa�ispbrtatton
5
'1 '' +d:�5 'x 9fi. # sp #�,."r, ' S a,rvn r•i• z t� ._- 1
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4 k ... W y. 1 :Gd rygie�;E=pract�cs, aka+>x.. C NI0 N 2-
A Hot holding greater than or equal to 140 F. (whore beef/pork masts lsooe) ❑ No eating ❑No smoking while working
B Cold holding less than or equal to45oF. B Wounds covered adequately
C Proper Cooling C Proper sink used for h washing
D Proper re-heating 0
E Proper internal cooking l consumer advisory posted -24 -_ii antt zatlon rinse(Htit"a]uater A�h�emi alb fi Cx I O NIA 2
ZZ
0 A Approvedsanitizeravailableladequateconcentrationofsanitizer
q Y p't$i j0pfaoHi�tles to malinfarri gro uct C :N/0 NlA 4 B Food-contact surfaces and utensils used for potentially
Ilpertii% „thermometers pwvldei hazardous food sanitized at least every 4 hours
A Food thermometer available and accurate C Adequate 0dishwashersanitizer 01al rinse temp
.L Proper sanitizing procedure
B Properfood thermometer for product
E Sanitizing between raw animal origin 8 ready-to-eat food
C Thermometers appropriately placed in cooler units
t=bodpoeated du.mg skor�ge,peparation 5. C N/O N! 7-4, laths andlor sponges in ood re art and clean
dlspia ,�e� d transportation' 9 P
B Wiping cloths kept in sanitizer between uses
A Produce washed
B Raw meats not stored/prepared near ready-to-eat foods Xg PotWt+s-ta clean Ih7Tpi iZ
C Food covered properly - _
IR
A - cod equipment clean,utensils clean,equipment interiors clean
D Adequate splash guards/sneeze guard g Single use gloves changed when soiled
E No unauthorized personnel C Food--contact surfaces clean
No pooling of eggs not cooked immediately
8 Food containers stored off the Floor
t and cold water under pressure,provided as require j IAS
0 ti andWasfitag apcessories provided
g Hx dlt r :. r W.- .ur .::. ,,.:..
, i„ ftg�o=food;minlmixecr) INTO NIA "2f Soaplpapertowelsl drying device available
A No.unnecessary handling RTE and/or cooked foods with bare hands B Dispenser(s)working: ❑Soap Paper tow
B Minimize food handling,other than ready-to-eat,with bare hands C Handwash sinks)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[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 quired to report to the local health department?
Roasts Other
Describe re-heating procedures: Is there a written illness policy that uires the food worker to report specific illness conditions
Are temperatures recorded/logged for cold holding foods/equip V Y • N and diseases to the QFO? Y *Do you have'a paid sick leave policy? Y N
Are foods cooked in advance and cooled? Y N leftovers saved? Y. N Is there a language harder tween 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 ans red the above questions- ame(print-
Is cooling monitored for time&temp? Y N Is the monitoring of cooling recorded? Y N Indicate the till of aho perso circl I a ply): 0 Mgr Cook Owner FW
Obtain signature of p o ece the QF espon ' dies information at the time of the
Is there a produce washing policy? Y N Describe what is washed and inspection:
where: Note: This rep is two pa form(total of 62 debitable items) Page 1 of 1
4 +' ;' ,: ryes :$'24•.Mb;$ 1
- bade%d 4,nspection F
. 4 eroOpr�tr -
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ADDITIONAL FOUR POINT ITEMS KEY: DNC [DOES NOT COMPLY]
6 Foods not re-served. ,a
-Unwrapped foods not re-served 4` 31 Sewage disposal approved. 4
-Potentially hazardous foods not re-served -Operating as required
`> 34 No cross connections,back siphonage-,backflow
11 Toxic chemicals. ,rK 04"
4 Proper type/installation/backflow prevention device/air gap for. m
-Stored properly,labeled properly,used properly A
-Sanitizer concentration not to exceed maximum permitted -Food equipment -Hose connections -Dish machines
-Na unnecessary toxics on the premises -Soda system carbonator -Beverage dispensers -Toilet tanks o
-Pesticideslrodenticides properly dispensed -Chemical dispensers -Ice machines
Rmper drain for:
29 Water source adequate,safe. 1 -Food equipment -Dish machines -Ice machines
4: �.A
-Well/well head protected from contamination 35 Toilet facilities. Adequate,convenient,accessible, 4"
-Water quality in compliance
designed,properly installed
-Monitoring in compliance s
OTHER ITEMS KEY: DNC [DOES NOT COMPLY]
2 Sources of food: Original container,properly labeled 1 40 Garbage/rubbish storagearea/rooms,enclosures-properly constructed,dean
5 otentially hazardous food properly thawed 41 agelrubbish disposed of in an approved manner,at approved frequency
0 ood dispensing utensils properly stored 42_ygAin Control:No insects/rodents present
14 Food worker-Clean outer clothes,effective hair restraints Outer openings protected against entrance of insects/rodents At
k
4 oors: Floor covering installed,constructed as required od c can
6 od-contact surfaces designed,constructed,maintained,installed, 5 Floors graded,drained as required
located g
6 Floor,wall juncture covered `
onfood-contaclsurfaces designed,constructed,maintained, s 7 Mats removable,good repair,clean
installed,located ,
2
4 Exterior walking,driving surfaces,good repair,clean
18 Single service articles,storage,dispensing
19 No reuse of single service article 49Malls,ceilings attached,equipment properly constructed,good
= ' 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
Equipment&Utensils: Cleanliness V 51 Adequate lighting provided as required
21 Preflushed,scraped,soaked and racked ' 52 Room free of steam,smoke odors V
22 Wash water clean,proper temperature _� t
53 Rooms&equipmenthoods,ducts,vented as required
3 Accurate thermometers provided,dish basket,if used `
54 Rooms adequate,clean,adequate lockers provided,facilities clean t Iz
7 Nonfood-contact surfaces of utensils&equipment clean 55 Establishment and premises tee of liter,noinsectlrodentharborage, �
28 Equipmentlutensils,storage,handling a)
� - no unnecessary articles
1704per disposal of waste water 6 Complete separation from living/sleeping quarters and laundry
33 Plumbing location,installation,maintenance 57 Clean/soiled linens stored properly
58 No live birds,turtles,or other animals(except guide dogs)
36 Toilet rooms enclosed with self-closing door i
r.
59 Seats 75 or more:Nonsmn g area prov e ,sign(s)posted at
37 Proper#oiletfixtures provided,good repair,clean 3
entrance s),smo ' a dicated
39 Approved garbagelrubbish containers,adequate number,covered,
rodent proof,clean Rein ction Preoperational Inspection
Ot t'
INSPECTOR: PERSON IN CHARGE; D Sore. •include demerits from page 1
c.G _ 4 3 2 1 Total Rating
gnature signature � rd
pri name print name
phone number title
DATE CORRECTIONS DUE:
Page 2 of 2 plus continuation pages Focused Inspection 7l2002
Page r of
04�-
INSPECTION REPORT STATE OF CONNECTICUT
FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH
CONTINUATION SHEET
NAME OF ESTABLISHMENT TOWN DATE OF IN PEC ION
INSPECTION FORM# REMARKS
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INITIAL(INSPECTOR) INITIAL(,PERSON IN CHARGE)
� Distrib t��lst-White-Health Department 2nd-Yellow- Owner/Manager
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INSPECTION REPORT STATE OF CONNECTICUT
FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH
CONTINUATION SHEET
NAM�9_F ESTABLISHMENT TOWN ) DATE OF INSPECTIO
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INSPECTION FORM REMARKS
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INITIAL(INSPECTOR) INITIAL(PERSON IN CHARGE)
Distribution: 1st-White-Health Department 2nd-Yellow- Owner/Manager