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Home My WebLink AboutFood Service Establishment Inspection 26 (3) i Establishment: R,q,N Inspection Date: Time: ROinsp RE[nsp Address/City: e Healt A n,7 :So -Wt C tjiXL- I • z 3 4 Based on an inspectiofi 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 N/0 N/A DNC KEY; C[complies] N/O[not observed] NIA[not applicable] 3 DNC[does not comply] 0[other] RTE[ready-to-eat] f2 `'1116rsc el w"ith!n edtltsn restritted 61 Designated Alternate 2 C 4 62 Written documentation of training program 2 A Food workers have no exposed infected lesions/burns B Personnel with infection restricted 1 Approved source,wholesome,nonadulterated C N10 N/A 4 C Communicable disease of worker reported to local health director A A roved shellfish,finfish,meat&poultry USDA approved 13 Handwashing facilities provided,hands washed,clean C N/0 A 4 B Food cans in good condition(not dented,rusty,bloated,leaking) A Handwash facilities in all food prep/dispensing&warewash areas C Whofesomelnonadulteratedfoods/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 I Proper handwash procedure LOE Handwashing at appropriate times 3 34tentia haz6rdogi`feed Meats tamp rye �r � � 0 Ming pre}sahation, ll� er amlat � , #iioif°l�y$ie to pt actives C N10 _WA 2'' A Hot holding greater than or equal to 1400F. (Whole beef/pork roasts 1300 F.) A ❑ No eating ❑ No smoking while working B Cold holding less than or equal to 450F. 000, B Wounds covered adequately C Proper cooling C Proper sink used for handwashing D Proper re-heating 0 E Proper internal cooking/consumer advisory posted ! esilion t rose(ht# ►ater ; Chni N(f N/A 2'` 0 A Approved sanitizeravailable/adequate concentration ofsanitizer 4' kd�t+e feci3Yfiee to ern puts "c} as B Food-contact surfaces and utensils used for potentially ternperat�re;t#ter orueters ppoyatkad k `� hazardous food sanitized at least every 4 hours A Food thermometer available and accurate C Adequate ❑dishwashersanitizer ❑final rinse temp D Propersanitizin procedure B Proper food thermometer for product E Sanitizing between raw animal origin&ready-to-eatfood C Thermometers appropriately placed in cooler units D 7`` Fbd�Sraf+ ctec fi �> � 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 0 B Raw meats not stored/prepared near ready-to-eat foods a C Food covered properly11610 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--contact surfaces clean F No pooling of eggs not cooked immediately 0 8 Food containers stored off the floor01 0 !_ :11 a;istiee°pr4vrded _ N/A--'°1 9 Handling of food rrfiniratzed C 2 A No unnecessary handling RTE and/or cooked foods with bare hands A Soap/paper towels I drying device available B Dispenser(s)working: ❑Soap ❑Paper towel B Minimize food handling,other than ready-to-eat,with bare hands too C Handwash sinks)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 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 health department? Roasts Other Describe re-heating procedures: Is there a written illness policy that requires the food worker to report specific illness conditions Are temperatures recorded/logged for cold holding foods/equipment? Y and diseases to the QFO? Y N *Do you have a p_,4W sick leave policy? Y N Are foods cooked in advance and cooled? Y N *Are le s saved? Y N Is there a language barrier between inspector Y N Iflf 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 answ a above questions: Name(print): Indicate the t e 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: Note: This report is a two page form(total of 62 debitable items) Page 1 of 2 Establishment: � sS Date of Inspection 2'2 Z ddress: Owner or Operator: ADDITIONAL VOUR POINT ITEMS Q KEY: DNC [DOES NOT COMPLY] 6 Foods not re-served. -Unwrapped foods not re-served 4 31 Sewage disposal approved. -Potentially hazardous foods not re-served -Operating as required Yq A 11 Toxic chemicals. 7,7 34 No cross connections,back siphonage,backflow -Stored properly,labeled properly,used properly "= Proper type/installation/backflow prevention device/air gapffor: -Food equipment -Hose connections -Dish machines -San itizer concentration not to exceed maximum permitted -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-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 1 0 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 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, 5 Floors graded,drained as required located 4,' 6 Floor,wall juncture covered 17 Nonfood-contact surfaces designed,constructed, maintained, installed,located 471 Mats removable,good repair,clean 18 Single service articles,storage,dispensing 2=E 8 Exterior walking,driving surfaces,good repair,clean 19 No reuse of single service article 49 Walls,ceilings attached,equipment properly constructed,good repair,clean.Wall&ceiling surfaces as required 20 Dishwashing facilities approved design,adequately constructed, maintained installed located ; A 50 Dustless cleaning methods used,cleaning equipment properly stored Equipment&Utensils: I anlin s 51 Adequate lighting provided as required k 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,storoge,handling no unnecessary articles 32 Proper disposal of waste water I 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 , Routine Inspection ❑Reinspection 0 Preoperational Inspection IN PET PERSON IN CHARGE: -Other Inspection: Demerit Score: *Include demerits from page 1 4 3 2 1 Total Rating e,� s' ure t s al+nS Ma '"'A K � I VTnt name print name � vy-2-5-8 S` vt DATE CORRECTIONS DUE: J (ll phone number title , Page 2 of 2 plus continuation pages Focused Inspection 1/2002 Page of'-3 INSPECTION REPORT STATE OF CONNECTICUT FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH CONTINUATION SHEET NAME O ESTABLISHMENT TOWN DATE O INSPE TION INSPECTION REMARKS FORM# C� Uv S INITIAL(INSPECTOR) INITIAL(PERSON IN CHARGE) Distribution: 1st-White-Health Department 2nd-Yellow-Owner/Manager