The URL can be used to link to this page

Home My WebLink AboutFood Service Establishment Inspection 86 (6) Establishme Inspection Date: =/zT- 1 ROinsp REinsp ddress/City: Health Dept: S 2 3 4 Based on an inspection thi day,the items marke DNC identify�Viions 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 WO NIA DNC : C[complies] N/O[not observed] NIA[not applicable] va DNC[does not comply] 0[other] RTE[ready-to-eat] 1 Datedlklternafe`. �" 2 f2l''" �� a firth efecian restricted C Nf0 WA 4 62 Written docUmerttation of training program 7 Food workers have no exposed infected lesions/burns 2 1 Approved Personnel with infection restricted source,uultc3Jeserme, ortad>�ftetated C N/4 /A 4 C Communicable disease of worker reported to local health director A Approved shellfish,finfish,meat&poultryUSDA approved B Food cans in good condition(not dented,rusty,bloated,leaking) 13 $hjng faCWj es provided,''handswaghed,cle'" C WA 4 C Wholesome/nonadulterated foods/safe A Handwash facilities in all food prep/dispensing&warewash areas B Handwash facilities in or immediately adjacent to toilet rooms D Commercial products(no home grown/canned food) E Potentially hazardous foods received at proper temperature C Handwash facilities accessible/convenient to use 0 D 1 Personnel hands washed,clean/Proper handwash procedure 3Poillorit ! ISzardo s� E Handwashing at appropriate times g ego a tdo t pi'� �1n rnn da t1 6t€t pr pa r . .�;. 15'.• iotl'a tiic" g practices C WQ WA° A Hot holding greater than or equal to 140°F. (whole beef/pork roasts 130°E) A ❑ No eating ❑ No smoking while working B Cold holding less than or equal to 450F. B Wounds covered adequately C Proper cooling %oolC Proper sink used for ha I'llndwashing D Proper re-heatingLoo ;Approved /� j''I� 4 E Proper internal cooking/consumer advisory posted tt 0 ? ►x` them eal�, G N/b hlfA 2 sanitizeravailable/adequateconcentratlonofsami.zer 4 AraeJories t° toou c# g Food-contact surfaces and utensils used for potentially t@Iytj�BrtUr ;t}1@ttit9t e{@I ''' 9 hazardous food sanitized at least every 4 hours A Food thermometer available and accurate C Adequate ❑dishwashersanitizer ❑final rinse temp B Properfood thermometer for product D Proper sanitizin rocedure C Thermometers appropriately placed in cooler units E Sanitizing between raw animal origin&ready-to-eat food 0 0 ,< r , display,service and 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-to-eat foods 0 C Food covered properly A Food equipment clean,utensils clean,equipment interiors clean D Adequate splash guards/sneeze guard E No unauthorized personnel B Single use gloves changed when soiled F No pooling of eggs not cooked immediately C Food--contact surfaces clean 8 Food containers stored off the floor 0 0 s � 9 Hanttffng of illtl m(rtirriized Nf0 hl6A' 2 p 0' N6A A No unnecessary handling RTE and/or cooked foods with bare hands A Soap paper towels I drying device available g B Dispensers)working: ❑Soap ❑Paper towel Minimize food handling,other than ready-to-eat,with bare hands C Handwash sink(s)clean/waste receptacle at h C Adequate uteandwash sink utensils)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: °F. 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 report to the local Ith department? Roasts Other Describe re-heating procedures: Is there a written illness policy that requires the food work report specific illness conditions Are temperatures recorded/logged for cold holding foods/equipment? Y N and diseases to the QFO? Y N *Do you a paid sick leave policy? Y N Are foods cooked in advance and cooled? Y N *Are leftovers saved? N Is there a language barrier between ins IF&QFO? Y N tf-m indicate language spoken List products cooled: by QFO/DA: *Can the QFO/DA read the inspection report? Y N Describe cooling methods: IndicateZwhoansthe above questions: Name(print): Is cooling monitored for time&temp? Y N Is th onitoring of cooling recorded? Y N IndicateI le 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 r � SIMON LOCAL'HEALTM I)fPT:. "► 14DDRi_SS1tTY = Establishment: A_ - Date of Inspection: ddress: Owner or Operator: ADDITIONAL FOUR POIN ITEMS n' KEY: DNC [DOES NOT COMPLY] 6 Foods not re-served. 4': 31 Sewage disposal approved. -Unwrapped foods not re-served ' -Operating as required -Potentially hazardous foods not re-served M No cross connections,back siphonage,backflow 11 Toxic chemicals. Proper typelinstallation/backflow prevention device/air gap for: -Stored properly,labeled properly,used properly 'Ml_ -Food equipment -Hose connections -Dish machines -San itizer concentration notto exceed maximum permitted E -Soda system carbonator -Beverage dispensers -Toilet tanks -No unnecessary toxics on the premises -Chemical dispensers -Ice machines -Pesticideslrodenticides properly dispensed 2 Proper drain for: 29 Water source adequate,safe. -Food equipment -Dish machines -Ice machines XX -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,clean 5 Potentially hazardous food properly thawed 41 Garbage/rubbish disposed of in an approved manner,at approved frequency 101 Food dispensing utensils properly stored 42 Vermin Control: No insects/rodents present 14 Food worker:Clean outer clothes,effective hair restraints 43 Outeropenings protected againstentrance of insects/rodents ,` 44 Floors: Floor covering installed,constructed as required,good repair,clean 16 Food-contact surfaces designed,constructed,maintained,installed, 5 Floors graded,drained as required a located 6 Floor,wall juncture covered 17 Nonfood-contact surfaces designed,constructed,maintained, r 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 Walls,ceilings attached,equipment properly constructed,good repair,clean.Wall&ceiling surfaces as required 20 Dishwashing facilities approved design,adequately constructed, y =� 50 Dustless cleaning methods used,cleaning equipment properly stored maintained installed located 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 s 53 Rooms&equipment hoods,ducts,vented as required 23 Accurate thermometers provided,dish basket,if used 41 Rooms adequate,clean,adequate lockers provided,facilities clean 27 Nonfood-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 5 71 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 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 Other Inspection: IN PE T PERSON IN CHARGE: Demerit Score: *Include demerits from page 1 / v L' 4 3 2 1 Total Rating signature signature print name print name 3)��/ bVL—2 r(/ Y24 A&c_,-, e_ DATE CORRECTIONS DUE: r9•a phone number title 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 DATE OF INSPECTION s bj INSPECTION REMARKS FORM# INITIAL(INSPECTOR) INITIAL(PERSON IN CHARGE) 4 Distribution: 1st-White-Health Department 2nd-Yellow-Owner/Manager