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Home My WebLink AboutFood Service Establishment Inspection 17 J Establishment: ' , �; S �, �� f Inspection Date: t-i Time. Rt)insp REinsp Address/City: Health De t W, ca : S. P � �R C1r C ass: 1 2 3 Based on an inspection this day,thailems 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 /O NIA JDNC I KEY: C[complies] NIO[not observed] NIA[not applicable] 60 Quahfied"Footl 0 orator 3 DNC[does not comply] 0[other] RTE[ready-to-eat] P ] [ y ] 12 Personnel with infection restricted C 0 NIA,,:4 61 Designated Alternate = 2 n, " 62 Written documentation of training program 2 A Food workers have no exposed infected lesions I burns B Personnel with infection restricted 1 Approved source,wholesome,"nonadulter6ted � C, C Communicable disease of worker reported to local health director A Approved shellfish,finfish,meat&poultry USDA approved V 13 iHandwa'shing facilities provided;hands Washed;clean( C : 0 N/A "4 B Food cans in good condition(not dented,rusty,bloated,leaking) A Handwash facilities in all food prep/dispensing&warewash areas C Wholesome/nonadulterated foods/safe B Handwash facilities in or immediately adjacent to toilet rooms D Commercial products(no home grown/canned food) C Handwash facilities accessible/convenient to use E Potentially hazardous foods received at proper temperature D Personnel hands washed,clean/Proper handwash procedure Vr E Handwashing at appropriate times 3 Potentially,hazardous food meets temperature,requirements C NIO NIA 4 0 during storage;preparation,display,2service antl,transportation" 15 Good h�rgtenicpractices C, NIO NI 2 A Hot holding greater than or equal to 140°F. (whole beef/pork roasts 130°F.) 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 0 - E Proper internal cooking/consumer advisory posted 24 �Sanitizati nrinse(hotv✓ater=ctie'mical)" C NI0 NIA 0 A Approved sanitizeravailable/adequate concentration ofsanitizer 4 Aiiequate":facilities-'to;mainain pcoiuct "C NIO' NIA 2' g Food-contact surfaces and utensils used for potentially temperature-tfaermoineters-,provided hazardous food sanitized at least every 4 hours A Food thermometer available and accurate C Adequate ❑dishwashersanitizer al rinse temp B Proper food thermometerfor product D Propersanitizin procedure C Thermometers appropriately placed in cooler units V. E Sanitizing between raw animal origin&ready-to-eat food 0 Q 25=Clean yuipin'g sloths: " ; �C N/0� N/A'1 Food protected during storage,pi eparatron, A Cloths ansponges in ood repair and clean display,serwce aid trait"sportat�on9 P A Produce washed B Wiping cloths kept in sanitizer between uses B Raw meats not stored/prepared near ready-to-eat foods 6 ood"contacV'if cos glean C N10 N/A 2.: 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 F No pooling of eggs not cooked immediately V 0 8 Food containers stored offthe floor 30; ;Hot and cold wateCunder,pre ;provided 2 ssure 0 �� 38"":Handwashmg accessories^provided C N10 NIA1"' 9 Handling",of food'mmrmized" C`.;NIO"NIA" 2 A No unnecessary handling RTE and/or cooked foods with bare hands A Soap/paper towels/ drying device available B Dispenser(s)working: ❑Soap ❑Paper towel B Minimize food handling,other than ready-to-eat,with bare hands V_rC Handwash sink(s)clean/waste receptacle at handwash sink C Adequate utensil(s)for dispensing food/ice 0 0 1 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[potentitfrom ,FB[foodborne] PHFs are hot held at: OF. PHFs are cold held at: �_°F. Describe illness conditions when you would exclude a food : Are internal cooking temperatures taken? Y N +To what tempe drCs o you cook: Poultry Ground Beef Pork What diseases related to FB illness are you required to report Roasts Other Describe re-heating procedures: Is there a written illness policy that requires the r er to report specific illness conditions Are temperatures recorded/logged for co ding foods/equipment? Y N and diseases to the QFO? Y N o you have a paid sick leave policy? Y N Are foods cooked in advance cooled? Y N *Are leftovers saved? Y N Is there a langua e r between inspector&QFO? Y N If ves indicate language spoken List products cooled: by QFO/DA: *Can the QFO/DA read the inspecti eport? Y N Describe cooli ethods: Indicate who answered the above questions: Name(print): Indicate the title of above person(circle all that apply):QFO DA Mgr Cook Owner FW Is c ' g monitored for time&temp? Y N Is the monitoring of cooling recorded? Y N .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: .5(�e� Note: This report is a two page form(total of 62 debitable items) Page 1 of 2 i EstablishmentY,.. � Date of„Inspectton Owner or Operator ADDITIONAL FO POINT ITEMS KEY: DNC [DOES NOT COMPLY] 6 Foods not re-served. -Unwrapped foods not re served 4 31 Sewage disposal approved. 4i -Potentially hazardous foods not re-served -Operating as required 11 Toxic chemicals. No cross connections,back siphonage,backflow 4 Pro ertypelinstallation/backflow prevention device/air ga for: 4' -Stored properly,labeled properly,used properly -Food equipment -Hose connections -Dish machines -San itizer concentration notto exceed maximum permitted -Soda system carbonator -Beverage dispensers -Toilet tanks -No unnecessary toxics on the premises -Chemical dispensers -Ice machines -Pesticides/rodenticides properly dispensed Proper drain for: 29 Water source adequate,safe. 4 -Food equipment -Dish machines -Ice machines -Well/well head protected from contamination-Water quality in compliance 35 Toilet facilities. Adequate,convenient,accessible, 4 -Monitoring in compliance designed,properly installed OTHER ITEMS KEY: DNC [DOES NOT COMPLY] 2 Sources of food:Original container,properly labeled 1. 40 Garbage/rubbish storage area/rooms,enclosures-propedy constructed,clean 1 I 5 Potentially hazardous food properly thawed 2 41 Garbage/rubbish disposed of in an approved manner,at approved frequency 10 Food dispensing utensils properly stored 2 Vermin Control: No insects/rodents present 2. 14 Food worker:Clean outer clothes,effective hair restraints 1'. 43 Outeropenings protected against entrance of insects/rodents 4 Floors: Floor covering installed,constructed as required,good repair,clean 1 Food-contact surfaces designed,constructed, maintained,installed, 2': 45 Floors graded,drained as required located 46 Floor,wall juncture covered 17 Nonfood-contact surfaces designed,constructed, maintained, 47 Mats removable,good repair,clean installed,located 48 Exterior walking,driving surfaces,good repair,clean 1 18 Single service articles,storage,dispensing 2 19 No reuse of single service article 49 alls,ceilings attached,equipment properly constructed,good 1 repair,clean.Wall&ceiling surfaces as required i 20 Dishwashing facilities approved design,adequately constructed, 2 maintained installed located 50 Dustless cleaning methods used,cleaning equipment properly stored 1 Equipment&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 53 Rooms&equipment hoods,ducts,vented as required 23 Accurate thermometers provided,dish basket,if used 54 Rooms adequate,clean,adequate lockers provided,facilities clean 1= 27 Nonfood-contact surfaces of utensils&equipment clean 55 Establishment and premisesfreeof litter,no insect/rodent harborage, 1 8 Equipmentlutensils,storage,handling no unnecessary articles -777 32 Proper disposal of waste water Y = 56 Complete separation from living/sleeping quarters and laundry 57 Clean/soiled linens storedproperly 33 Plumbing location,installation,maintenance , 58 No live birds,turtles,or other animals(except guide dogs) 1; 36 Toilet rooms enclosed with self-closing door 59 Seats 75 or more:Nonsmoking area provided,sign(s)posted at 37 Proper toilet fixtures provided,good repair,clean 3 entrance(s),smoking area indicated by sign(s) 39 Approved garbage/rubbish containers,adequate number,covered, ` rodent proof,clean k Routine Inspection ❑Reinspection ❑ Preoperational Inspection Ot er Inspection: IN E T R: R N IN �: Demerit Score: *Include demerits from page 1 4 3 2 1 Total Rating signatur signature print name print name phone number title t� � �7'a' � DATE CORRECTIONS DUE. ca.A ('��1(JW..- EF[[��LLI Page 2 of 2 plus continuation pages Focused Inspection 1/2002 tl� rC.Xr vr`3,pQ.x'�'�1 L. Page of INSPECTION REPORT STATE OF CONNECTICUT FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH CONTINUATION SHEET NAME OF ESTABLISHMENT TOWN DATE OF INSPECTION �---iv-f-r\ems �t>. W; INSPECTION REMARKS FORM# c 1 I`r`p -,s 1 v C F n t. f � T I ,. 'ram S �` vim- rh fyn D y �O i oYlw s I YQ Y � o 1 - ovv INITIAL(INSPECTOR) INITIAL(PERSON IN CHARGE) ` Distribution: 1st-White-Health Department 2nd-Yellow-Owner/Manager