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Home My WebLink AboutFood Service Establishment Inspection 65 i Establishment: Inspection Date: 1 IS )0 Time: 012Lnsp REinsp Address/City: Health Dept: SO TO +-=NOS_Dg class: 1 2 3 a 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 I N/O N/A DNCI KEY: C[complies] N/O[not observed] N/A[not applicable] 3 1 oes not comply] 0[other] RTE[ready-to-eat] 2 A Food workers have no exposed infected lesions I burns 2 B Personnel with infection restricted C Communicable disease of worker reported to local health director J A A roved shellfish,finflsh,meat& oult USDA a roved1/1 B Food cans in good condition(not dented,rusty,bloated,leaking) 4 IN ZZI A Handwash facilities in all food prep/dispensing&warewash areas C Wholesomelnonadulterated 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 0 E Handwashing at appropriate times 0 y� A Hot holding greater than or equal to 140 F. (whole beeflporkroasts 130o F.) A ❑ No eating ❑ No smoking while working B Cold holding less than or equal to 450 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 0 A Approved sanitizeravailable/adequate concentration of sanitizer f B Food-contact surfaces and utensils used for potentially hazardous food sanitized at least every 4 hours A Food thermometeravailableandaccurate C Adequate ❑dishwashersanitizer ❑final rinse temp L 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 0 A Cloths and/or sponges in good repair and clean A Produce washed B Wiping cloths kept in sanitizer between uses 0 B Raw meats not stored/prepared near ready-to-eat foods f C Food covered properly A Food equipment clean,utensils clean,equipment interiors clean J D Adequate splash guards/sneeze guard B Single use gloves changed when soiled E No unauthorized personnel J C Food--contact surfaces clean F No pooling of eggs not cooked immediately 0 Food containers stored off the floor 0 A No unnecessary handling RTE and/orcooked foods with bare hands IC Soap/paper towels/ drying device available Dispenser(s)working: ❑Soap ❑Paper towel B Minimize food handling,other than ready-to-eat,with bare hands .� Handwash sinks)clean I waste receptacle at handwash sink `f C Adequate utensil(s)for dispensing food/ice j p 0 •DESCRIBE DEFICIENCIES ON CONTINUATION SHEETS The following information is not debitable and does not affect your score. _M: QFO[qualified food operator],DA[designated alternate),PHF[potentially hazardous food],FB[foodbome] P 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 required to report to the local health department? Roasts Other Describe re-heating procedures: Is there a written illness policy that requires t o report specific illness conditions Are temperatures recorded/logged for cold holding foods/equipment? Y N and diseases to the QFO? *Do you have a paid sick leave policy? Y N Are foods cooked in advance and cooled? Y N *Are leftovers saved? Y N I anguage barrier between inspector&QFO? Y N If yes indicate language spoken List products cooled: by QFO/DA: *Can the QFO/DA read the inspection report? Y N Describe cooling methods: Indicate who answered the above questions: •nt Indicate the title o hove person(circle all that apply):QFO Cook Owner FW Is cooling monitored for tim p. Y N Is the monitoring of cooling recorded? Y N .Obtain signatu f e person recei th FO res onsibilities forma he time of the Is there ce washing policy? Y N *Describe what is washed and inspection: Note: This report is a debitable items) Page 1 of 2 r NUR FIFF'TIF- ADDITIONAL FOUR POINT ITEMS KEY: DNC [DOES NOT COMPLY] 6 Foods not re-served. -Unwrapped foods not re-served h 31 Sewage disposal approved. -Potentially hazardous foods not re-served -Operating as required74 �<< 11 Toxic chemicals. No cross connections,back siphonage,backflow Proper type/installation/backflow prevention device/air gap for: ` -Stored properly,labeled properly,used properly -Food equipment -Hose connections -Dish machines Sanitizerconcentration not to exceed maximum permitted . -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 r, 41. -Well/well head protected from contamination 1351 Toilet facilities. Adequate,convenient,accessible, -Water quality in compliance -Monitoring in compliance designed,properly installed ; OTHER ITEMS KEY: DNC [DOES NOT COMPLY] Sources of food: Original container,properly labeled 40 Garbage/rubbish storage area/rooms,endosures-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 property stored m 2 Vermin Control: No insects/rodents present 14 Food worker:Clean outer clothes,effective hair restraints 43 Outer openings protected against entrance of insects/rodents 4 Floors: Floor covering installed,constructed as required,good repair,deanA} 16 Food-contact surfaces designed,constructed,maintained,installed, 5 Floors graded,drained as required ; located 6 Floor,wall juncture covered 17 Nonfood-contact surfaces designed,constructed,maintained, 7 Mats removable,good repair,clean installed,located , 8 Exteriorwalking,driving surfaces,good repair,dean 18 Single service articles,storage,dispensing 19 No reuse of single service article Walls,ceilings attached,equipment properly constructed,good repair,clean.Wall&ceiling surfaces as required : 0 Dishwashing facilities approved design,adequately constructed, „ maintained installed located 50 Dustless cleaning methods used,cleaning equipment properly stored Equipment&Utensils: Cleanliness r 51 Adequate lighting provided as required 1 Preflushed,scraped,soaked and racked 52 Room free of steam,smoke odors 2 Wash water clean,proper temperature � . 53 Rooms&equipment hoods,ducts,vented as required 23 Accurate thermometers provided,dish basket,if used 54 Rooms adequate,dean,adequate lockers provided,facilities dean 7 Nonfood-contact surfaces of utensils&equipment clean 55 Establishment and premises free of litter,no insed/rodent harborage, 8 Equipment/utensils,storage,handling no unnecessary articles 32 Proper disposal of wastewater 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) 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,dean entrance(s),smoking area indicated by sign(s) 9 Approved garbage/rubbish containers,adequate number,covered, rodent proof,clean MRoutine Inspection E3Reinspection U Preoperational Inspection INSPECTOR: PERSON IN CHARGE: Other Inspection: Demerit Score: •Include demerits from page 1 4 3 2 1 Total Rating signature si ur _ ram Ck�l�� ) a i CJ)7 print name print name C ail' DATE CORRECTIONS DUE: (40 04Y,S phone number title Page 2 of 2 plus continuation pages Focused Inspection VM Page .1- of 2 INSPECTION REPORT STATE OF CONNECTICUT FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH CONTINUATION SHEET NAME OF ESTABLISHMENT TOWN DATE OF INSPECTION INSPECTION REMARKS FORM# q C le�CV) h o o d s C,�Ov , 5+v25 , INITIAL(INSPECTOR) INITIAL(PERSON IN CHARGE) X 6V Distribution: I st-White-Health Department 2nd-Yellow-Owner/Manager