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Home My WebLink AboutFood Service Establishment Inspection 19 (2) i Establishment: Inspection Date: 91 ig "IMETime: q.'oo r- o_LspY RE[nsp Address/City: )1 q0 1rvVya _ SA, ,Le $— Health D pt: 5, �_,r C— Class: 1 2 3 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 11 N/O WA IDNC I i KEY: C[complies] NIO[not observed] NIA[not applicable] 3 DNC[does not comply] 0[other] RTE[ready-to-eat] 2 F'1 Persoi iiet'with"ittfcctio�"r"estrtc€ed c 44b NiA 4 A Food workers have no exposed infected lesions/burns 62 Written docamentation of training program2 B Personnel with infection restricted 1 Approved source,wholesome,nonadaiterated C 0 N/A 4 C Communicable disease of worker reported to local health director A Approved shellfish,finfish,meat&poultry USDA approved 13 Handwashlrtg faclftties provided,'handswasW clean C 0 NIA 4 B Food cans in good condition(not dented,rusty,bloated,leaking) A Handwash facilities in all food prep/dispensing&warewash areas C Wholesome/nonadulteratedfoods/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 0 D Personnel hands washed,clean/Proper handwash procedure E Handwashing at appropriate times s 0 is d66d hygtenic'practices C NIA 2 A Hot holding greater than or equal to 140°F. (whole beef/pork roasts 130'F.) A ❑ No eating ❑ No smoking while working V. 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 l consumer advisory posted 0 A Approved sanitizeravailable/adequateconcentrationofsanitizer dti Food contact surfaces and utensils used for potentially hazardous food sanitized at least every 4 hours ol A Food thermometer available and accurate C Adequate ❑dishwashersanitizer ❑final rinse temp Vol B D Proper sanitizin Properfootlthermometerforproduct procedure E Sanitizing between raw animal origin&ready-to-eat food C Thermometers appropriately placed in cooler units V Q 0 W N W ,a� A Cloths and/or sponges in good repair and clean A Produce washed B Wiping cloths kept in sanitizer between uses B Raw meats not stored/prepared near ready-to-eat foods O � 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 i 0 8 Food containers stored off the floor ee - A No unnecessary handling RTE and/or cooked foods with bare hands A Soap/paper towels l drying device available B 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 0 •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[foodborne] PHFs are hot held at: OF. PHFs are cold held at: OF. Describe illness conditions when you would exclude a food worker from g: 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 re the local health department? Roasts Other Describe re-heating procedures: Is there a written illness policy that require food worker to report specific illness conditions Are temperatures recorded/logged for cold holding fo quipment? Y N and diseases to the QFO? Y N *Do you have a paid sick leave policy? Y N Are foods cooked in advance and coole N *Are leftovers saved? Y N Is there a language barrier een 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 I' Describe cooling me s: Indicate who swered the above questions: Name(print): Indicat a title of above person(ci that apply):QFO DA Mgr Cook Owner FW Is coolin nit red for time&temp? Y N Is the monitoring of cooling recorded? Y N •0 In signature of h arson o re ' d the QEDresponsibilities 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) Page 1 of 2 7rEablish' LI10 exDate of Inspection:ess: ,"_• II- t��- Owner or Operator: ADDITIONAL FOUR POINT ITEMS KEY: DNC [DOES NOT COMPLY] 6 Foods not re-served. 4v 31 Sewage disposal approved. -Unwrapped foods not re-served -Operating as required 4 -Potentially hazardous foods not re-served 11 Toxic chemicals. No cross connections,back siphonage,backflow -Stored properly,labeled properly,used properly Propertype/installation/backflow prevention device/air gap for: -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 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 storage area/rooms,enclosures-properly constructed,clean 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 43 Outer openings 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 18 Single service articles,storage,dispensing Exterior walking,driving surfaces,good repair,clean 19 No reuse of single service article 9 alls,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 EEqui ment&Utensils: Cleanliness 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 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 premises flee oflitter,no insect/rodent harborage, 28 Equipment/utensils,storage,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 581 No live birds,turtles,or other animals(except guide dogs) 36 Toilet rooms enclosed with self-closing door ' 59 Seats 75 or ore:Nonsmoking area provided,sign(s)posted at 37 Proper toilet fixtures provided,good repair,clean entran ,smoking area indicated by sign(s) 39 1 Approved garbage/rubbish containers,adequate number,covered, rodent proof,clean I BRoutine Inspection ❑Reinspection ❑ Preoperational Inspection Other Inspection: INSPECTOR: PERSON I E: Demerit Score: *Include demerits from page 1 4 3 2 1 Total Rating sign ture 91 n ture JIM Y print name print name �- (� 0 .� 4 �� DATE CORRECTIONS DUE: phone number title Page 2 of 2 plus i continuation pages Focused Inspection 112002 Page of INSPECTION REPORT STATE OF CONNECTICUT FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH CONTINUATION SHEET NAME OF ESTABLISHMENT TOWN DATE OF INSPECTION vi-e-I INSPECTION FORM# REMARKS Q s Z 2 W; Ac — o �r7-cam. w� ` ART r INITIAL(INSPECTOR) INITIAL(PERSON IN CHARGE)/ Distribution: 1st-White-Health Department 2nd-Yellow-Owner/Manager