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Home My WebLink AboutFood Service Establishment Inspection 13 i ,s ress City: : Inspection Date: O Time: Ro[nsp RE]nsp ddress/City: .. . Health Dept: Class: 1 2 3 4 Based on an inspection this day,t items marked DNC identify the violations in operation or facilities which must be corrected by the date specified on page 2. FACTOR ITEMS:Listing is not inclusive of all possible debitable items C N/0 N/A D _ KEY: C[complies] N/O[not observed] N/A[not applicable] 3 DNC[does not comply] 0[other] RTE[ready-to-eat] Kv #)fp � fj�{�(Rttj pia I/E 2 q Food workers have no exposed infected lesions/burns B Personnel with infection restricted fi Aftp ayl3tf spurt ey wEialesome,uonadulterated C /fl N!A 4. A Approved shellfish,finfish,meat&Poultry USDA approved ommunicable disease of worker reported to local health director B Food cans in good condition(not dented,rusty,bloated,leaking) C Wholesome/nonadulterated foods/safe 100 Handwash facilities in all food prep/dispensing&warewash areas D Commercial products(no home grown/canned food) B Handwash facilities in or immediately adjacent to toilet rooms E Potentially hazardous foods received at proper temperature C Handwash facilities accessible/convenient to use D Personnel hands washed,clean/Proper handwash procedure E Handwashing at appropriate times I 0 A Hot holding greater than or equal to 1400F. (whole beef/pork roasts 1300 F.) J/ A ❑ No eating � �❑ No smoking while working B Cold holding less than or equal to 450F. B Wounds covered adequately C Proper cooling C Proper sink used for handwashing D Proper re-heating r 0 E Proper internal cooking/consumer advisory posted A fi- Approved sanitizeravailable/adequate concentration of sanitizer B Food-contact surfaces and utensils used for potentially hazardous food sanitized at least every 4 hours A Food thermometer available and accurate C Adequate ❑tlishwashersanitizer ❑final rinse temp B, Proper food thermometer for product D Pro er sanitizina Procedure C Thermometers appropriately placed in cooler units Sanitizing between raw animal origin&ready-to-eat food 0 0 A_ Cloths and/or sponges in good repair and clean A Produce washed B I Wiping cloths kept in sanitizer between uses >B Raw meats not stored/prepared near ready-to-eat foods JIM C Food covered properly 7- 7 n,utensils clean,equipment interiors clean D Adequate splash guards/sneeze guardE No unauthorized personnel hanged when soiled F No pooling of eggs not cooked immediately ces clean 9 Food containers stored off the floor CC A No unnecessary handling RTE and/or cooked foods with bare hands A Soap/paper towels/drying device available Minimize food handling,other than ready-to-eat,with bare hands B Dispenser(s)working: ❑Soap ❑Paper towel C Adequate utensil(s)for dispensing food/ice Handwash sink(s)clean/waste receptacle at handwash sink 0 ,0 •DESCRL&E DEFICIENCIES ON CONTINUATION SHEETS The following information is not debitable and does not affect your score. KEY: QFO[qualified ter [potentrapy hazardous food],FB[foodbomeJ PHFs are hot held at: IF. PHFs are cold held at: IF. Describe illness conditions when yo u ood worker from working: Are internal cooking tee ? Y N *To what temperature do you cook: Poultry Ground Bee Pork What diseases related to FB illness are you required to r to the local health department? Roasts Other Describe re-heating procedures: written illness policy that requires ood worker to report specific illness conditions Are temperatures recorded/logged for cold holding foods/equipment? Y N and diseases o Y N ♦Do you have a paid sick leave policy? Y N Are foods cooked in advance and cooled? Y N *Are leftovers saved? Y N Is there a langua etween 1rMwAZr&QFO? Y N If yes indicate language spoken List products cooled: DA: *Can the action report? Y N Describe cooling methods: Indicate who answered the above questions:Name(print): Is cooling monitored for time&temp? Y N e monitoring of cooling recorded? Y N Indicate the title of above person(circle all that apply):QFO DA Mgr Cook Owner FW •Obtain signature of the person who received the QFO responsibilities information at the time of the Is there a produce washing policy? Y N *Describe what is washed and inspection: where: Note: This report is a two page form(total of 62 debitable items) paw I of 2 M--M—M— I M_--m- 7ddrEstablishment- �� ,�-�� Date of inspection:ess: Owner or Operator: ADDITIONAL FOUR POINT ITEMS 6 Foods not re-served. KEY: DNC [DOES NOT COMPLY] -Unwrapped foods not re-served 4' 31 Sewage disposal approved. -Potentially hazardous foods not re-served -Operating as required 11 1111 chemicals. 34 No cross connections,back siphonage,backflow -Stored properly,labeled properly,used properly Proper typeAnstallationit backflow prevention device/air gap fo -Sanitizer concentration not to exceed maximum permitted -Food equipment -Hose connections -Dish machines -No unnecessary toxics on the premises -Soda system carbonator -Beverage dispensers -Toilet tanks -Pesticides/rodenticides properly dispensed -Chemical dispensers -Ice machines Proper drain for: 29 Water source adequate,safe. -Food equipment -Dish machines -Ice machines -Well/well head protected from contamination Tdesigoilet facilities. Adequate,convenient,accessible, -Water quality in compliance q -Monitoring in compliance ned,properly installed OTHER ITEMS KEY: DNC [DOES NOT COMPLY] 2 Sources of food: Original container,properly labeled 40 Garbage/rubbish storage area/rooms,enclosures-properly constructed,dean 5 Potentially hazardous food properly thawed 41 Garbage/rubbish disposed of in an approved manner,at approved frequency 10 Food dispensing utensils properly stored 42 Vermin Control: No insects/rodents present 14 Food worker:Clean outer clothes,effective hair restraints uteropenings protected against entrance of insects/rodents loors:Floor covering installed,constructed as required,good repair,clean 16 Food-contact surfaces designed,constructed,maintained,installed, located 5 Floors graded,drained as required 17 onfood-contact surfaces designed,constructed, maintained, 6 Floor,wall juncture covered installed,located 7 Mats removable,good repair,clean 18 Single service articles,storage,dispensing 8 Exterior walking,driving surfaces,good repair,clean No reuse of single service article I Walls,ceilings attached,equipment properly constructed,good 20 kishwashing facilities approved design,adequately constructed, repair,clean.Wall&ceiling surfaces as required maintained installed located 50 Dustless cleaning methods used,cleaning equipment properly stored Equipment&Utensils• Cleanlin ss 51 Adequate lighting provided as required 21 Preflushed,scraped,soaked and racked 52 Room free of steam,smoke odors 22 Wash water clean,proper temperature 23 Accurate thermometers provided,dish basket,if used 53 Rooms&equipment hoods,ducts,vented as required 54 Rooms adequate,clean,adequate lockers provided,facilities clean 27 Nonfood-contact surfaces of utensils&equipment clean 55 Establishment and premises free of litter,no insect/rodent harborage, 28 Equipment/utensils,storoge,handling no unnecessary articles 32 Proper disposal of waste water 56 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) Toilet rooms enclosed with self-closing door 3 Proper toilet fixtures provided,good repair,clean 59 Seats 75 or more:Nonsmoking area provided,sign(s)posted at entrance(s),smoking area indicated by sign(s) 39 Approved garbage/rubbish containers,adequate number,covered, rodent proof,clean 1311outine Inspection ❑Reinspection reoperational Inspection INSPECTOR: PERSON IN CHARGE: Other Inspection: Demerit Score: *Include demerits from page 1 n 4 3 2 1 Total Rating ' e signature in name // print name title TIO :E-Z ph a num er' v`� � � C O STCORREC/ NS DUE: "�' Page 2 of 2 plus continuation pages Focused lnspectlon ll2002 Page of INSPECTION REPORT STATE OF CONNECTICUT FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH CONTINUATION SHEET NAME OF ESTABLISHMENT TOWN DATE OF INSPECTION INSPECTION FORM# REMARKS • 69 1 S o 3 401 -7-' 45, ��i4- 71 6tv 014JO- /1-)0 p �( 10 IV INITIAL(INSPECTOR) INITIAL(PERSON IN CHARGE) Distribution: 1 st-White-Health Department 2nd-Yellow-Owner/Manager