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Home My WebLink AboutFood Service Establishment Inspection 65 (6) i Establishment: of s Inspection Date: c7 ZZ L Tim Address/City: ROinsp REinsp Health Dept: class: 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 N/0 p IDNIC ; C[complies] NIO[not observed] NIA[not applicable] fir k a s " . g DNC[does not comply] 0[other] RTE 2 :t 'Ff ., [ready-to-eat] G "Wd " A" 4"` 62 Written documentation of training program A Food workers have no exposed infected lesions I burns 2 B Personnel with infection restricted Approved source,wholesome,nonadr3iterated C i A 4 C Communicable disease of worker reported to local health director TEPotentially roved shellfish,finfish,meat& oult USDA a roved d cans in good condition(not dented,rusty,bloated,leaking) 3 Ha»ttyu Itfing faCtl ies.P ceded, anc�.t asbed,cleat ,[{ olesome/nonadulterated foods/safe A Handwash facilities in a!1b p/dispensing&warewash areas mmercial products(no home grown/canned food) B Handwash facilities iniately adjacent to toilet rooms hazardous foods received at proper temperature C Handwash facilities a /convenient to use 0 D Personnel hands washe Proper handwash procedure 1t fQd tNtetf to E Handwashmg at appropriate times J31- ddRnj�rae,ppar�don,dt?iay;f R )' 0 s prs C Rti£ 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 45°F. 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 W 0 # �: 0 . . ) ttff( A u A Approved sanitizeravailable/adequate con centrationofsanitizer 4a 'art #aa °mast` 4 Food contact surfaces and utensils used for potentially t a r tire,th+ ti rf�et�r *P t t a4 k B 11Vhazardous food sanitized at least every 4 hours A Food thermometer available and accurate C Adequate ❑dishwashersanitizer >Vinal rinse temp B Proper food thermometer for product D Propersanitizin rocedure C Thermometers appropriately placed in cooler units 0, E Sanitizing between raw animal origin&ready-to-eat food 71 0 0 VT 'C N/A disPtay,service and transportatten A Cloths andlor 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 O C Food covered properly D Adequate splash guards/sneeze guard Food equipment clean,utensils clean,equipment interiors clean 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. "Ffa£rLllxr�g of fa ad g 1 A No unnecessary handling RTE and/or cooke�foods �barends A Soap I paper towels/drying device available B Minimize food handling,other than readhands B Dispenser(s)working: ❑Soap ❑Paper towel C Handwash sink(s)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: °F. PHFs are cold held at: °F. 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 healt artment? Roasts Other Describe re-heating procedures: Is there a written illness policy that requires the food worke port specific illness conditions u a Are temperatures recorded/logged for cold holding foods/equi nt? Y N and diseases to the QFO? Y N *Do yo paid sick leave policy? Y N Are foods cooked in advance and cooled? Y N *Are leftovers saved? Y N Is there a language barrier between ins r&QFO? 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 the above questions: Name(print): Is cooling monitored for time&temp? Y N Is the monitoring of cooling recorded? Y N Indicate t e ' of above person(circle all that apply):CFO 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? 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 L C HEA1 F�'t)EP f: t' ADDRESS/CI =' Establishment: 6 5 Date of Inspection. 0 Zzf 2e ddress: c U Owner or Operator: ADDITIONAL FOUR POINT ITEMS o KEY: DNC [DOES NOT COMPLY] 6 Foods not re-served. -Unwrapped foods not re-served 4 ffSewa-,edisposal approved. -Potentially hazardous foods not re-served perating as required 11 Toxic chemicals. z 34 No cross connections,back siphonage,backflow -Stored properly,labeled properly,used properly 4 Proper type/installation/backflow prevention device/airr an for: -San itizer concentration not to exceed maximum permitted -Food equipment -Hose connections -Dish machines -No unnecessary toxics on the premises -Soda system carbonator -Beverage dispensers -Toilet tanks -Pesticides/rodenticides properly dispensed -Chemical dispensers -Ice machines Proper drain for: 29 Water source adequate,safe. 4 -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 eciurcesof food: original container,properlylabeled 1 0 Garbage/rubbish storage area/rooms,enclosures-properly constructed,clean 5 Potentially hazardous food properly thawed 2. 1 Garbage/rubbish disposed of in an approved manner,at approved frequency 10 Food dispensing utensils properly stored i 2 ve n Control: No insects/rodents present 14 Food worker:Clean outer clothes,effective hair restraints 3 Out 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, 2,k located _ 5 Floors graded,drained as required 17 Nonfood-contact surfaces designed,constructed,maintained, 1�r 6 Floor,wall juncture covered 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 Walls,ceilings attached,equipment properly constructed,good 20 Dishwashing facilities approved design,adequately constructed, repair,clean.Wall&ceiling surfaces as required 2 maintained installed located 50 Dustless cleaning methods used,cleaning equipment properly stored Eq�aipment&Utensils; CI anlin 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 01 54 Rooms adequate,clean,adequate lockers provided,facilities clean 7 food-contact surfaces of utensils&equipment clean 3 28 Equipment/utensils,storoge,handling 55 Establishment and premises free of litter,no insect/rodent harborage, no unnecessary articles 32 Proper disposal of wastewater 1`Y 56 Complete separation from living/sleeping quarters and laundry 33 Plumbing location,installation,maintenance 1# 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 E entrance(s),smoking area indicated by sign(s) 39 Approved garbage/rubbish containers,adequate number,covered, rodent proof,clean ❑Routine Inspection \,RRteinspection ❑ Preoperational Inspection PET PE S IN HAR E: Other Inspection: Demerit Score: •Include demerits from page 1 4 3 2 1 Total Rating signature - L0 print namet'( }� �{ phone number title DATE CORRECTIONS DUE: 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 Or SPE TION Gt (S Ste ( ((,( lb ( bZ (L INSP CTION FORM# REMARKS Lk tA�j S kJ 26 �- L > L12- co OE L10 ( � - r o 2 u,/\ ((I LD J c ey1eA3 1. INITIAL(INSPECTOR) INITIAL(PERSON IN CHARGE) Distribution: 1st-White-Health Department 2nd-Yellow-Owner/Manager