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Home My WebLink AboutFood Service Establishment Inspection 20 (4) i Establishment: h/ I1ppection Date: Time: Roinsp REinsp ddress/City: -3 Health D p : o O� class: 1 2�a Based on an inspection this y,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 N/O N/A JDNC I KEY: C[complies] NIO[not observed] NIA[not applicable] � 00' 3 DNC[does not comply] 0[other] RTE[ready-to-eat] 2 # s'66 un h infection restrrctetl A 4 61 Designated Alternate q01 62 Written documentation of training program 2 Food workers have no exposed infected lesions 1 burns B Personnel with infection restricted 1 Approved source,wholesome,nonadutterated Nl0 A C Communicable disease of worker reported to local health director A I Approved shellfish,finflsh,meat&poultry USDA approved 13 tiandwashirng facttties provided,hands washed,clean C NP, 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/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 00, D Personnel hands washed,clean I Proper handwash procedure 0 E Handwashing at appropriate times 3 'Pote`ntfattfr tfiaza-rd "1' d sri �t - 0 during storage,prefsarallon,'d�lay;servttse arid;tYapsporkad#fig 15''Coa�i�t fertii�practice., � �`Nld � ' A Hot holding greater than or equal to 140oF. (whole beef/pork roasts lsoe F.) A ❑ No eating ❑ No smoking while working B Cold holding less than or equal to 450 F. 4.0 B Wounds covered adequately C Proper cooling %000, C Proper sink used for handwashing D Proper re-heating 0 E Proper internal cooking consumer advisory postedL000a idbnft$e -; - ,. ., Q A Approved sanitizer available/adequate concentration ofsanitizer d, B Food-contact surfaces and utensils used for potentially trpera re, � x hazardous food sanitized at least every 4 hours : E,"' A Food thermometer available and accurate 0oo, C Adequate ❑dishwashersanitizer ❑final rinse temp Loo D Proper sanitizin rocedure B Proper food thermometer for product loo Sanitizing between raw animal origin&ready-to-eat food C Thermometers appropriately placed in cooler units 0 0 yE nip NVIN� dis=play,�srvice-O tr in o f RP A Cloths and/or sponges goad repair and clean B Wiping cloths kept in sanitizes between uses A Produce washed 0 B Raw meats not stored/prepared near ready-to-eat foods Nuffm C Food covered properly A Food equipment clean,utensils clean,equipment interiors clean D Adequate splash guards I 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 0 8 Food containers stored off the floor 918r1C17Fxg of food kT�ihiirnZE.'� f� ASoap x.e.k ...: " P ,; _ r a,.iA pi A No unnecessary handling RTE and/or cooked foods with bare hands I paper towels/ 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 I waste receptacle at handwash sink C Adequate utensil(s)for dispensing food/ice 01 p 0 •DESCRIBE DEFICIENCIES ON CONTINUATION SHEETS The following information is not tlebitable 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 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 port to the local health department? Roasts Other Describe re-heating procedures: Is there a 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 to the QFO? Y N o you have a paid sick leave policy? Y N Are foods cooked in advance and cooled? Y N *Are leftovers s d? Y N Is there a language barrier be n inspector&QFO? Y N tf_ves indicate language spoken List products cooled: by QFO/DA: *Can the QFO/DA read the inspection report? Y N Describe cooling methods: Indicate who swered the above questions: Name(print): Indic a title of above person(circle all that apply):QFO 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 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: INote: This report is a two page form(total of 62 tlebitable items) Page 1 of 2 s ,M: � .I Y:'k r' x .m .=sL �t2e .a i 2a t ADDRL b 2 Establishment: Date of Inspection: u Address: E Owner or Operator: ADDITIONAL VOUR POINT ITEMS z. N S a„ KEY: DNC [DOES NOT COMPLY] 6 Foods not re-served. -Unwrapped foods not re-served 4 31 Sewage disposal approved. 4; -Potentially hazardous foods not re-served -Operating as required No cross connections,back siphonage,backflow 11 Toxic chemicals. AMR 4 Proper type/installation/backflow prevention device/air gap for: -Stored properly,labeled properly,used properly4 -Sanitizer concentration not to exceed maximum permitted -Food equipment -Hose connections -Dish machines -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 r -Monitoring in compliance designed,properly installed OTHER ITEMS KEY: DNC [DOES NOT COMPLY] 2 Sources of food: Original container,properly labeled u = 0 Garbage/rubbish storage arealrooms,enclosures-properly constructed,clean 5 Potentially hazardous food properly thawed 1 Garbage/rubbish disposed of in an approved manner,at approved frequency 10 Food dispensing utensils properly stored 2 Vermin Control: No insects/rodents present 14 Food worker:Clean outer clothes,effective hair restraints Ig_ 3 Outeropenings protected against entrance ofinsectslrodents 4 Floors: Floor covering installed,constructed as required,good repair,clean 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, 47 Mats removable,good repair,clean installed,located 8 ' gle service articles,storage,dispensing 8 Exterior walking,driving surfaces,good repair,clean le 9 Walls,ceilings attached,equipment properly constructed,good 19 No reuse of sin service article g � 20 Dishwashing facilities approved design,adequately constructed, maintained installed located 50 repair,clean.Wall&ceiling surfaces as required Dustless cleaning methods used,cleaning equipment properly stored Equipment&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 free of litter,noinsect/rodentharborage, 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 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,clean entrance(s),smoking area indicated by sign(s) 39 Approved garbage/rubbish containers,adequate number,covered, rodent proof,clean ❑Routine Inspection ❑Reinspection ❑ Preoperational Inspection 41NT P R N A E: Other Inspection: Demerit Score: •Include demerits from page 1 4 3 2 1 Total Rating e s' to e r Ct le r� t v KA 2 Lcf prin name print name v/ y �IY�C'�Ol� DUE: phone number title � J DAT CORRECTIONS� Page 2 of 2 plus 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 a S� v+QA, u)L t,�.�VS E Qrf Z)A f( I INSPECTION REMARKS FORM# e v l CCU U S -S r S � V 6 Ic M 3 ° F to, ZJ _TPA-JSZA Ed w a.r 1eS Svc INITIAL(INSPECTOR) INITIAL(PERSON IN CHARGE) Distribution: 1st-White-Health Department 2nd-Yellow-Owner/Manager