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HomeMy WebLinkAboutFood Service Establishment Inspection 10 (15) "'ST T :' r i. + C'C INSPECT IO �. 3 • IYE A tT1Vi 1 x� 5 `ttl H 4' Establishment: C�i21e-1-,= Inspection Date: % Time: If 6 oins Einsp ddresslCity: r ��'7z— _c'r` i7! C� Health Dept: i lass; 1 z 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 NIO NIA JDNC I KEY: C[complies] N10[not observed] N/A[not applicable] 160 k.4.Qualified:F,oed:Qperatgr:';;. ':;';; 3 DNC[does not comply) 0[other] RTE[ready-to-eat] 12 i Personnel with infection restricted .. 61 Designated Alternate ' z :C.,N1Q; NIA "-4=. ... .. , 62 i Writfen'dosumenfatJon of training program 2 A Food workers have no exposed infected lesions 1 burns B Personnel with infection restricted 1 Approved'source,who[esmne,tsonadulterated :. C NlO N/A- 4". C Communicable disease of worker reported to local health director A Approved shellfish,finfsh,meat& cult USDA a roved 13 ,Haridvrashing facilities provided;-hands washed,clean C .NIO 'WA 4 B Food cans in good condition(not dented,rusty,bloated,leaking) A Handwash facilities in all food prepldispensing&warewash areas C Wholesomelnonadulterated foodsisafe B Handwash fa •it es in or im tely adjacent to toilet rooms D Commercial products(no home grown/canned food) AC Handwash acilities a cos ibl conv tent to use ds E Potentially hazardous foods received at proper temperature D Personn ha w'h I a an sh procedure E Handwas at appropriat -ti es 3 {Potentially hazardous Food meets temperature requirements":' D I during storage,prepa�atron;draplay,ssrvide arid Eran"sportation_ :;n t hyg-,Good ieme practices' C WO NIA 2 A Hot holding greater than or equal to 14eF. (whole beerlporkroasts i3ooF.) A ❑ No eating ❑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 E Proper internal cooking I consumer advisory posted i24 ;Samtizattondrinse;(hot water' ahemicel) E CN(Q,N!A '2 A Approved sanitizeravailableladequate concentration of sanitizer �4o it °"' 'ale fc: isfbmi.�tsngproduct b.x k `Y r. �;.iNj " ' ., . .; Food-contact surfaces and utensils used for potentially Y A. i l a mpe re,thermome#e�rs }�f�"de,d , w r. � hazardous food sanitized at least every 4 hours A Food thermometer available and accurate C Adequate ❑dishwashersanitizer ❑final rinse temp D Proper sanitizing B Properfocd ihermometerfor product rocedure E Sanitizing between raw animal origin&ready-to-eat food C Thermometers appropriately placed in cooler units D h25 ` sari wip[ g,cloths z r C,, N/0 pM/, t ..x ;Y,4•+lei YU-h.m+,•.. .. i 7�a Food*i3rtec# flltGi(gsttf4ge,preparation, �C° Nim NIA 2 IU t; ip[atf,as A Cloths and/or sponges in good repair and clean , A Produce washed I B Wiping cloths kept in sanitizer between uses 0 B Raw meats notstored/preparednearready-to-eatfoods r i26 rFFB­odwaontactjsurfaes ele�in* N/A .2' C Food covered properly ... . ,* M: .. ...... A Food equipment clean,utensils clean,equipment interiors clean D Adequate splash guards 1 sneeze guard IT Single use gloves changed when soiled E No unauthorized personnel C Food--contact surfaces clean F No pooling of eggs not cooked immediately D 8 Food containers stored offthefioor w x v 311 ;,Hound cgld wa#er under pressure;provided'a$ntqutr� NIA �2 11 D r38"Handwss4lo acc saortes:p owde ;Y iG NlCS< A" h Handim of}foocf minimized, : xt rt „� i 8 ' C tN/0 iNIA 2 A Soap 1 paper towels 1 drying device available A No unnecessary handling RTE and/or cooked foods with bare hands B SoDisp /paper working: ❑Soap fableI]Pa towel B Minimize food handling,other than ready-to-eat,with bare hands C Handwash sink(s)clean!waste receptacle at handwash sink 4_4 1 C Adequateulensil(s}for dispensing foodlice p O 1 •DESCRIBE DEFICIENCIES ON CONTINUATION SHEETS The following information is not debitable and does not affect your score. KEY: QFO[qual'died food operator],DA[designated alternate],PHF[potentially hazardous food],FB[foodbornej PHFs are hot held at: OF. PHFs are cold held at: F. Describe illness conditions when you Id exclude a food worker from working: Are internal cooking temperatures taken? Y N ♦To what temperature do you cook: Poultry Ground Beef Po IF What diseases related to FB inn are you required to report to the local health department? Roasts Other Describe re-heating procedures: Is there a written illness pe i y that requires the food worker to report specific illness conditions Are temperatures recorded/logged for cold holding foodslequipm t? Y 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 ♦Ar eftovers saved? Y N Is there a language bdreler between inspector&QFO? Y N If ves indicate language spoken List products cooled: by QFOIDA: *Can the QFOIDA read the inspection report? Y N Describe cooling methods: Indicate who answered r above questions:Name(print[: Indicate the title of a (Ltr.A all tha IyJ:QFO DA Mgr Cook Owner FW Is cooling monitored for time&temp? Y N Is a monitoring of cooling recorded? Y N .Obtain sh to f w FO responsibilities information at the time of the Is there a produce washing policy? Y N +Describe what is washed and inspection: where: Note: This r o i a two page rm(total of 62 debitable items) Page f of 2 3T1�T OF CONNECTICUT, DEPARTMENT OF l?ttSLIC.FfEALF}f 410 GAPIT©L AVEfyUE,MS#51 FDP-NARTFORD,CT Ot 13�, �'c�cs 1aQ1? St ICE IlySP CTION IIEFiDRF HE LADDRESSICITy Establishment..s Date:.of,lrispection: ddress ; - Owner.or Operator:^ _ ADDITIONAL POUR POINT ITEMS �o KEY: DNC [DOES NOT COMPLY] zk' 6 Foods not re-served. -Unwrapped foods not re-served 4. 31 Sewage disposal approved. -Potentially hazardous foods not re-served -Operating as required 11 Toxic chemicals. 34 No cross connections,back siphonage,backflow 4 4: Proper typelinstallation/backflow prevention device/air gap far: -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 -Pesticidesfrodenticides properly dispensed groper drain for: 29 Water source adequate,safe, -Food equipment -Dish machines -Ice machines 4' -Well 1 well head protected from contamination 35 Toilet facilities, Adequate,convenient,accessible, 4 -Water quality in compliance designed,properly installed -Monitoring in compliance OTHER ITEMS KEY: DNC [DOES NOT COMPLY] 2 5ourcesoffootl: Original container,properly labeled 1` 0 Garbage/rubbish storagearealrooms,enclosures-property constructed,dean 7" 5 Potentially hazardous food properly thawed 41 Garbagelrubbish disposed of in an approved manner,atapproved frequency 10 Food dispensing utensils property stored 421 Vermin Control: No insectslrodents present 2. 14 Food worker:Clean outer clothes,effective hair restraints 43 Outer openings protected against entrance of insects/rodents 1^ 4 Floors: Floorcovering installed,constructed as required,good repair,clean 16 Food-contact surfaces designed,constructed,maintained,installed, 5 Floors graded,drained as required located 6 Floor,walljuncture covered 17 Nonfood-contact surfaces designed,constructed, maintained, 1 7 Mats removable,good repair,clean , installed,located 8 Exterior walking,driving surfaces,good repair,clean 18 Single service articles,storage,dispensing 2 19 No reuse of single service article 9 Walls,ceilings attached,equipment properly constructed,good 1 repair,clean.Wall&ceiling surfaces as required 0 Dishwashing facilities approved design,adequately constructed, 2 maintained installed located 50 Dustless cleaning methods used,cleaning equipmentprcpertystored 1 Equipment&Utensils Cleanliness i 51 Adequate lighting provided as required 21 Preflushed,scraped,soaked and racked 52 Room free of steam,smoke odors 22 Washwaterclean,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 1 27 6nfood-contact surfaces of utensils&equipment clean le, 1 , 55 Establishment and premises free of litter,no insectlrodent harborage, 1 28 Equipment/utensils,storage,handling 1" no unnecessary articles t. 32 Pro perdisposaI of waste water 1 56 Complete separationtom living/sleeping quarters and laundry ' 33 Plumbing location,installation,maintenance 1` 57 Cleanlsoiled linens stored properly 1 58 No live birds,turtles,orotheranimals(except guidedogs) 36 Toilet rooms enclosed with self-closing door 1 59 Seats 75 or more:Nonsmoking area provided,signs)posted at 37 Proper toilet fixtures provided,good repair,clean 3' entrance(s),smoking area indicated by sign(s) 39 Approved garbagelrubbish containers,adequate number,covered, il:. rodent proof,clean >f. ❑Routine Inspection ❑Reinspection ❑ Preoperational Inspection Other Inspection: IN TOR: PERSON IN CHARGE: Demerit Score: *Include demerits from page 1 G 4 3 2 1 Total Rating Z.signature a I 1761P !s� print name prin�am phone number title DATE CORRECTIONS Page 2 of 2 plus continuation pages Focused Inspection 1/2002 Page of INSPECTION REPORT STATE OF CONNECTICUT FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH CONTINUATION SHEET NAME OF ESTABLISHMENT TOWN DATE OF INSP CTION INSPECTION MA � FORM# Z/11 49 T .�- m o INITIAL(INSPECTOR) INITIAL(PERSON IN CHARGE Distribution: 1st-White-Health Department 2nd-Yellow- Owner anager PaE�:�-O?Z �am INSPECTION REPORT STATE OF CONNECTICUT FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC IiEALT I �� � CONTINUATION SHEET NAME OF ESTABLISHMENT TOWN DATE OF SPE TION INSFORMION REMARKS �- pate'. Fec1a Y' Vim'' ' � PI •� /�9 � e�ppNAN��� �e d .mod r 4- 3,16 INITIAL(INSPECTOR) INITIAL(PERSON IN CHARGE) Distribution: 1 st-White-Health Department 2nd-Yellow- Owner/MP wwner/M naglr Page of/ I� INSPECTION REPORT STATE OF CONNECTICUT FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH CONTINUATION SHEET NAM,F*-QF ESTABLISHMENT TOWN DATE OF SPE ION INSPECTION REMARKS FORM d# _ �-- � Cam✓ ems" INITIAL(INSPECTOR) INITIAL(PERSON IN CHARGE) Distribution: 1 st-White-Health Department 2nd-Yellow-Owner/Mans r