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Home My WebLink AboutFood Service Establishment Inspection 51 i Establishment: � , i Inspection Date: Time: (_ROinspj REinsp Address/City: C rkf,� Healt De t: �;��r�e�gy r class: t 2 3 C4 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 0 N/A JDNC I I KEY: C[complies] NIO[not observed] NIA[not applicable] 3 DNC[does not comply] 0[other] RTE[ready-to-eat] 2 A Food workers have no exposed infected lesions/burns SftrrlBntEQt1!Q�n� � 2 B Personnel with infection restricted e' '�,. *. � flttdtrlNeniIW .�} N/A .4 '. C Communicable disease of worker reported to local health director A Approved shellfish,finfish,meat&poultry USDA approved t B Food cans in good condition(not dented,rusty,bloated,leaking) A Handwash facilities in all food prep/dispensing&warewash areas C Wholesomelnonadulteratedfoods/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 � z . ,•� •,. _ �. TC..NfO? A Hot holding greater than or equal to 1400F. (whole beef/pork roasts fsoo F) 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 0 E Proper internal cooking/consumer advisory posted 0 A Approved sanitizer available/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 V C Adequate ❑dishwashersanitizer ❑final rinse temp D Proper sanitizin rocedure B Proper food thermometer for product VE 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 L000 B Raw meats not stored/prepared near ready-to-eat foods 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 7 C Food—contact surfaces clean F No pooling of eggs not cooked immediately 0 8 Food containers stored off the floor 0 -,�M R W A No unnecessary handling RTE and/or cooked foods with bare hands B Soap I paper towels I drying device available Dispenser(s)working: ❑Soap ❑Paper towel B Minimize food handling,other than ready-to-eat,with bare hands C Handwash sink(s)clean/waste receptacle at handwash sink C Adequate utensil(s)for dispensing food/ice 0 ——7 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[potentially hazardous food],FB[foodbome] PHFs are hot held at: IF. 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 t ure d�: Poultry Ground Beef Pork What diseases related to FB illness are you required to report to the Roasts Other Describe re-heating procedures: Is there a written illness policy that re ood worker to report specific illness conditions Are temperatures recorded/logged old holding foods/equipment? Y N and diseases to the QFO? Y *Do you have a paid sick leave policy? Y N Are foods cooked in adv and cooled? Y N *Are leftovers saved? Y N Is there a langua rrier between inspector&QFO? Y N If yes indicate language spoken List products coole by QF *Can the QF01DA read the inspection re ort? Y N Describe c ng methods: Indicate who answered the above questions:Name(print): (, Indicate the title of above person(circle all that apply):fQfO DA Mgr Cook Owner FW Is cooling monitored for time&temp? Y N Is the monitoring of cooling recorded? Y N .Obtain signature of the pe n who received the QFO s ns' ilities inf ation 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(totof 62 debitable items) Page 1 of 2 7Estarbl'sishrnen't: `-�i.� Date of Inspection: 2 : _ � (�"v1 Owner or Operator: ADDITIONAL FOUR POINT ITEMS ' KEY: DNC [DOES NOT COMPLY] 6 Foods not re-served. 4 31 Sewage disposal approved. -Unwrapped foods not re-served 4 -Potentially hazardous foods not re-served -Operating as required No cross connections,back siphonage,backflow 11 Toxic chemicals. Proper type/installation/backflow prevention device/air gap for: -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 -Pesticides/rodenticides properly dispensed Proper drain for: 29 Water source adequate,safe. -Food equipment -Dish machines -Ice machines -Well/well head protected from contamination 35 Toilet facilities. Adequate,convenient,accessible, -Water quality in compliance designed,properly installed -Monitoring in compliance OTHER ITEMS KEY: DNC [DOES NOT COMPLY] 2 Sources of food:Original container,properly labeled 40 Garbage/rubbish storagearealrooms,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 3 uteropenings protected against entrance of insects/rodents 4 Floors: Floor covering installed,constructed as required,good repair,clean 16 Food-contact surfaces designed,constructed,maintained,installed, 45 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 Exterior walking,driving surfaces,good repair,clean 18 Single service articles,storage,dispensing 19 No reuse of single service article 9 yells,ceilings attached,equipment properly constructed,good 20 Dishwashing 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: Cleanliness 51 Adequate lighting provided as required 1 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 27 Nonfood-contact surfaces of utensils&equipment clean 55 Establishment and premisesfree oflitter,no insect/rodent harborage, 8 Equipment/utensils,storage,handling no unnecessary articles 32 Proper disposal ofwaste water 56 Complete separation from living/sleeping quarters and laundry 33 Plumbing location,installation,maintenance 57 Clean/soiled linens stored properly 36 Toilet rooms enclosed with self-closing door 58 No live birds,turtles,or other animals(except guide dogs) 59 Seats 75 o more:Nonsmoking area provided,sign(s)posted at 37 Proper toilet fixtures provided,good repair,clean entr (s),smoking area indicated by sign(s) 39 Approved garbage/rubbish containers,adequate number,covered, rodent proof,clean ZRoutine Inspection ❑Reinspection ❑ Preoperational Inspection Other inspection: I E T R: PERSON IN CHARGE: Demerit Score: *Include demerits from page 1 4 3 2 1 Total IRating si ature s ature X � Z print name print name � � o (°��'l-2 � DUE: phone number title DATE CORRECTIONS Page 2 of 2 plus--A continuation pag s Focused Iuspectlou -.02 Page of INSPECTION REPORT STATE OF CONNECTICUT FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH CONTINUATION SHEET NAME OF ESTABLISHMENT TOWN DATE OF INSPECTION W i � Z INSPECTI N FORM# REMARKS U- 01 I U (vJl` 13�0 U Lfv- / - Q� I o w� �1.�✓�! - ray.. `T 2S,6 L q`fi — c 34' fcu 'c bO• INITIAL(INSPECTOR) INITIAL(PERSON IN CHARGE) r� Distribution: 1 st-White-Health Department 2nd-Yellow-Owner/Manager