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Home My WebLink AboutFood Service Establishment Inspection 60 (4) Establishment: le Inspection Date: -fL Time: ROinsp REinsp Address/City: _p X(.,.ZFi -k3-,J/-X Health Dept: class: 1 2 63 4 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 debatable items C I N/Oj.WA IDNC I KEy; C[complies] N/O[not observed] NIA[not applicable] DNC does not comply) 0 other RTE[ready-to-eat] $Q � $ Qper6for _ i 3 [ p Y] [other] 61 1 gnatedAlternate 2 17-Pertc ref wlth'ilifeittidh:i restrttetl C I N/0 MA 4` 62 Written documentation of training program A Food workers have no exposed infected lesions I burns LK 2 B Personnel with infection restricted 1 Approved source,wholesome,nOtYdtlUit®feted C N/0 /A 4' C Communicable disease of worker reported to local health director A Approved shellfish,finfish,meat&poultry USDA approved 13 Handwashing facilities provided,hantlsv�ashed,clean C 0 NIA 4 I' 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 D Commercial products(no home grown/canned food) B Handwash facilities in or immediately adjacent to toilet rooms E Potentially hazardous foods received at proper temperature C Handwash facilities accessible/convenient to use 0 D Personnel hands washed,clean/Proper handwash procedure 70 E Handwashing at appropriate times 3 potpnti-fly haz da w ootl tom oi`a404, store prePstian disp) r,setce a fm s�otot{ �j O a . , <�' -� , 1°15 t d ti rgt ic`Oraaicies C N10 WA 21 A Hot holding greater than or equal to 140oF. (whole beef[porkroasts 130o F) 000' A ❑ No eating ❑ No smoking while working B Cold holding less than or equal to45oF. B Wounds covered adequately C Proper Cooling C Proper sink used for handwashing D Proper re-heating 0 Lo E Proper internal cooking/consumer advisory posted : : 0 A Approve dsanitizeravailable/adequate concentration ofsanitizer `RC�Ote lLoo °trsaiatfln ptodt g Food-contact surfaces and utensils used for potentially tertaperaturre,thertnornaters pratei> hazardous food sanitized at least every 4 hours Loo A Food thermometer available and accurate C Adequate ❑dishwashersanitizer ❑final rinse temp B Proper food thermometer for product Proper sanitizin procedure C Thermometers appropriately placed in cooler units E Sanitizing between raw animal origin&ready-to-eat food 0 O r mod tsri# i !`ttirig `` of t: M1f%0' I 1 display,service artd transportation 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-toeatfoods C Food covered properly A food equipment clean,utensils clean,equipment interiors clean D Adequate splash guards/sneeze guard g Single use gloves changed when soiled E No unauthorized personnel C Food--contactsurfacesclean F No pooling of eggs not cooked immediately 8 Food containers stored off the floor 0 _ T-M! a _ FMandting of'food nt€nttni�eti A No unnecessary handling RTE and/or cooked foods with bare hands A Soa /p r towel I drying device available B B Minimize food handling,other than ready-to-eat,with bare hands Dispenser(s)working: ❑Soap ❑Papertowel C Adequate utensil(s)for dispensing food/ice C Handwash sink(s)clean/waste receptacle at handwash sink 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: F. De ' i Iness 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 to department? Roasts Other Describe re-heating procedures: Is there a written illness policy that requires the fo er to report specific illness conditions Are temperatures recorded/logged for cold holding foods/equipmen N and diseases to the QFO? Y N ♦ ou have a paid sick leave policy? Y N Are foods cooked in advance and cooled? Y N ♦ eftovers saved? Y N Is there a language barrier be inspector&QFO? Y N If-Ws indicate language spoken List products cooled: by QFO/DA: *Can the QFO/DA read the inspection report? Y N Describe cooling methods: Indicate who nswered the above questions: Name(print): Is cooling monitored for time&temp? Y N Is the monitoring of cooling recorded? Y N Indicate the title of above person(circle all that apply):QFO DA Mgr Cook Owner FW *Obtain signature of the person who received the QFO responsibilities information at the time of the Is there a produce washing policy? 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 REt9t v-I r. hY yK'eV�, Establishment: VtwieS x Date of Inspection: ddress: u Owner or Operator: ADDITIONAL FOUR POINT ITEMS c` KEY: DNC [DOES NOT COMPLY] r 6 Foods not re-served. -Unwrapped foods not re-served 4 31 Sewage disposal approved. -Potentially hazardous foods not re-served -Operating as required 11 Toxic chemicals. " No cross connections,back siphonage,backflow -Storedproperly,labeledproperly,used properly Proper type/installation/backflow prevention device/air gap for: p p y -Food equipment -Hose connections -Dish machines -Sanitizer concentration not to exceed maximum permitted4 -Soda system carbonator -Beverage dispensers -Toilet tanks -No unnecessary toxics on the premises -Pesticides/rodenticides properly dispensed -Chemical dispensers -Ice machines Proper drain for: 29 Water source adequate,safe. 777 -Food equipment -Dish machines -Ice machines -Well/well head protected from contamination -Water quality in compliance 35 Toilet facilities. Adequate,convenient,accessible, -Monitoring in compliance designed,properly installed 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 't' 1 Garbage/rubbish disposed of in an approved manner,at approved frequency 10 Food dispensing utensils properly stored 1, 2 ermin Control: No insects/rodents present 14 Food worker:Clean outer clothes,effective hair restraints 3 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, installed,located 7 Mats removable,good repair,clean 18 Single service articles,storage,dispensing 8 Exterior walking,driving surfaces,good repair,clean 19 No reuse of single service article 9 I Walls,ceilings attached,equipment properly constructed,good repair,clean.Wall&ceiling surfaces as required 20 Dishwashing facilities approved design,adequately constructed, maintained installed located 50 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 2 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 tee of litter,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 36 Toilet rooms enclosed with self-closing door 58 No live birds,turtles,or other animals(except guide dogs) 59 Seats 75 or more:Nonsmoking area provided,sign(s)posted at 37 Proper toilet fixturesprovided,good repair,clean entrance(s),smoking area indicated by sign(s) 39 1 Approved garbage/rubbish containers,adequate number,covered, rodent proof,clean outine Inspection ❑Reinspection ❑ Preoperational Inspection Other Inspection: INSPECT R: PERSON IN CHARGE: Demerit Score: *Include demerits from page 1 mao 4 4f 3 2 1 1 Total Rating si nature g attire Vrint name print name OA 6Y��tS(lf}CZ ZZ phone number title DATE CORRECTIONS DUE: p(' 11 Page 2 of 2 plus__ continuation pages Focused Inspection 1/2002 Page of INSPECTION REPORT STATE OF CONNECTICUT FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH CONTINUATION SHEET NAME OF ESTABLISHMENT TOWN nn DATE OF INSPECTION P ¢_ INSPECTIO FORM# REMARKS v djj -( to ��f� s 3 _ 3 � . - P s .O. A I --- LW4A A-((,S 2-6 M,tV[�&Ssm k- //0 -F •� NOD VS� !'o c fb v� INITIAL(INSPECTOR) INITIAL(PERSON IN CHARGE) Jr Distribution: 1st-White-Health Department 2nd-Yellow-Owner/Manager