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Home My WebLink AboutFood Service Establishment Inspection 53 (2) . I Establishment: jU o e o Inspection Date: 9 --(2— Time: RO[ns RE[nsp ddress/City: Health Dept: �o t : 1 2 Based on an inspection this ,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 N1O1,WA JDNCJKEY: C[complies] N/0[not observed] N/A[not applicable] 3 DNC[does not comply] 0[other] RTE[ready-to-eat] 1 Designated Alternate 2 Rakcrrte n�rtft feel 4n restricted C WO NIA 4' 62 Written documentation of training program 2 A Food workers have no exposed infected lesions/burns B Personnel with infection restricted 1 Xpproved satires,wholesome,nonadttlterated C A C Communicable disease of worker reported to local health director A Approved shellfish,finfish,meat&poultry USDA approved 00 Fiartdwashing facilities p d;d,hands washed,clean WO A 4' B Food cans in good condition(not dented,rusty,bloated,leaking) A Handwash facilities in all food prep/dispensing&warewash areas C Wholesome/nonadulteratedfoodslsafe B Handwash facilities in or immediately adjacent to toilet rooms D I Commercial products(no home grown/canned food) C Handwash facilities accessible/convenient to use E Potentially hazardous foods received at proper temperature L.0 D Personnel hands washed,clean/Proper handwash procedure 0 —74 E Handwashing at appropriate times Lo 3 of t r rd fed t f C 31 0 during storage,prepalrstion, is Gro6t!by ferric,practices C N10 N'f1A 2'' A Hot holding greater than or equal to 1400F. (whole beef/pork roasts 130e F.) A ❑ No eating ❑ No smoking while working B Cold holding less than or equal to 45o F. B Wounds covered adequately C Proper cooling C Proper sink used for handwashing TO D Proper re-heating E Proper internal cooking/consumer advisory posted Ie r cmiaal) CA A Approved sanitizer available/adequate concentration ofsanitizer 4 "94006,#toftfilit, �lath g Food-contact surfaces and utensils used for potentially temparature,the—MI, istars'prov A hazardous food sanitized at least every 4 hours A Food thermometer available and accurate C Adequate ❑dishwashersanitizer ❑final rinse temp B Proper food thermometer for product D Proper sanitizin rocedure E Sanitizing between raw animal origin&ready-to-eat food C Thermometers appropriately placed in cooler units 0 Z{{ di-splay,service and transportation A Cloths and/or sponges in good repair and clean A Produce washed 000, B Wiping cloths kept in sanitizer between uses Ile 0 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 I sneeze guard B Single use gloves changed when soiled 7.11 E No unauthorized personnel C Food--contact surfaces clean F No pooling of eggs not cooked immediately 0 8 Food containers stored off the floor00, 0 t ► f 4 �9 Handling of toad prized A Soap I paper towels/ drying device available A No unnecessary handling RTE and/or cooked foods with bare hands B Dispenser(s)working: ❑Soap ❑Paper towel 0-1 B Minimize food handling,other than ready-to-eat,with bare hands C Handwash sinks)clean Iwaste receptacle at handwash sink C Adequate utensil(s)for d ispensing 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 working: Are internal cooking temperatures taken? Y N *To what temperature do you co 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 the food worker to report sRWAefness conditions Are temperatures recorded/logged for cold holding foods/equip Y N and diseases to the CFO? Y N *Do you have a paid ove policy? Y N Are foods cooked in advance and cooled? Y N re leftovers saved? Y N Is there a language barrier between inspector& N If yes indicate language spoken List products cooled: by QFO/DA: an the QFO/DA read the inspection report? Y N Describe cooling methods: Indicate who answered ove questions: Name(print): Indicate the title ove 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 si ure 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 ins ion: where: Note: This report is a two page form(total of 62 debitable items) Page 1 of 2 t.OGAI.1* H 1:"% .. ad -AIDDRIlitfthi, "I M, t . n Establishment: O e j- ' vie Date of Inspection: $� —/L /Z ddress: Owner or Operator- ADDITIONAL F04JR POINT IT S 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 11 Toxic chemicals. No cross connections,back siphonage,backflow -Storedproperly,labeledproperly,usedproperlyPro ear type/installation/backflow prevention device/air gap for: -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 a -Chemical dispensers -Ice machines -Pesticides/rodenticides properly dispensed Proper drain for: ' -Food equipment -Dish machines -Ice machines 29 Water source adequate,safe. -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 storagearea/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 2 Vermin Control: No insects/rodents present 14 Food worker:Clean outer clothes,effective hair restraints 1,w 3 Outer openings protected against entrance of insects/rodents �K_ ors: 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 onfood-contact surfaces designed,constructed,maintained, 7 Mats removable,good repair,clean installed,located 18 Single service articles,storage,dispensing 181 Exterior walking,driving surfaces,good repair,clean 19 No reuse of single service article 9 kalls,ceilings attached,equipment properly constructed,good repair,clean.Wall&ceiling surfaces as required [21 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 Preflushed,scraped,soaked and racked 521 Room free of steam,smoke odors Wash water clean,proper temperature 53 Rooms&equipment hoods,ducts,vented as required 23 Accurate thermometers provided,dish basket,if used 54 oms adequate,clean,adequate lockers provided,facilities clean 7 food-contact surfaces of utensils&equipment clean 55 Establishment and premises free 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 -� 58 No live birds,turtles,or other animals(except guide dogs) 36 Toilet rooms enclosed with self-closing door 37 Proper toilet fixtures provided,good repair,clean 59 Seats 75 or more:Nonsmoking area provided,sign(s)posted at entrance(s),smoking area indicated by sign(s) 39 Approved garbage/rubbish containers,adequate number,covered, `' rodent proof,clean utine Inspection ❑Reinspection 0 Preoperational Inspection N SPECT R: PER 1N H Other Inspection: Demerit Score: *Include demerits from page 1 4 3 2 1 Total Rating sig317 nature si - -7- a qco �J435 prin name print n me C( 49 —L,S 1l Z I DATE CORRECTIONS E: phone number title Page 2 of 2 plus__t 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 DATE OF INSPECTION INSPECTION FORM# REMARKS l S VIALIL o j o -A� (�,d o SG4/�cS i^P T�'f►-LZJ/ w ✓U P�•c� 6 — Miss 4 Sotr c 17,W Y eJ ..4 �5 c�,A � � C�(.� k �fl�►� S� i f �., ZFhi,441 �lsPc t S� s INITIAL(INSPECTOR) 7777- INITIAL(PERSON IN CHARGE) 1 ,7 Distribution: 1 st-White-Health Department 2nd-Yellow-Owner/Manager