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Home My WebLink AboutFood Service Establishment Inspection 17 (16) Establishment: Inspection Date: Time: 1r, U of p REinsp Address/City: 1"? Health Dept: LLL==== _SOl Class: 1 2 3 Based on an inspection this day,th 't s marked DNC identify the violations in operation or facilities w2. RISK FACTOR ITEMS Listing is not inclusive of all possible debitable items C N/0 N/A DNC �; C[complies] N/0[not observed NIA not aoDlicablel "TV g [does not comply] 0[other] RTE[ready-to-eat] r= ; tr£1; i F` e� T[C�1Dted Aiteraate 2 C 6 N/A 4 62 Written documentation of training program A Food workers have no exposed infected lesions I burns 1 Approved source,wholesome,n®nadditerated 2 B Personnel with infection restricted to NfA 4C Communicable disease of worker reported to local health director A Approved shellfish,finfish,meat&poultry USDA approved VV B Food cans in good condition(not dented,rusty,bloated,leaking) � arwd ashtng fa0111ttes pvotintled,hands washed,cion Q Q tdfA 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) C Handwash facilities accessible/convenient to use E Potentially hazardous foods received at proper temperature 0 D Personnel hands washed,clean/Proper handwash procedure Pritti�} zarrkots fi�gpe to Handwashing at appropriate times mpr dardng s ,preparnuoe sirs y sar li 'r ,r O caiiic�practs C WOP 2 A Hot holding greater than or equal to 140oF. (wnole beef/pork roasts 130e F.) A ❑ No eating ❑ No smoking while working B Cold holding less than or equal to 450F. B Wounds covered adequately C Proper cooling C Proper sink used for handwashing D Proper re-heating 0 E Proper internal cooking I consumer advisory posted � � � e , A Approved sanitizeravailable/adequate concentration ofsanitizer tYres to �aii�prodat B Food-contact surfaces and utensils used for potentially temperature t enromet8{s aYf i d hazardous food sanitized at least every 4 hour A Food thermometer available and accurate C Adequate ❑dishwashersanitizer ❑final rinse temp B Properfood thermometerfor product D Proper sanitizin rocedure C Thermometers appropriately placed in cooler units be E Sanitizing between raw animal origin&ready-to-eat food JZ 0 Q ON iod ptiste�ctdd°rig #i ,rpr M °t display,service and transpot tation 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 C Food covered properly A Food equipment clean,utensils clean,equipment interiors clean D Adequate splash guards/sneeze guard B 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 floor 0 9 Ha ng of food �� , _ . . _ X;2 " : a d-,"' , .. � � A No unnecessary handling RTE and/or cooked foods with bare hands A Soap/paper towels/ drying device available B B Minimize food handling,other than ready-to-eat,with bare hands Dispenser(s)working: ❑Soap ❑Paper towel C equate utensil(s)for C Handwash sinks)clean/waste receptacle at handwash sink Ad 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 u cook: Poultry Ground Beef ork What diseases related to FB illness are you require a local health department? Roasts Other Describe re-heating procedures: Is there a written!lines hat requires the food worker to report specific illness conditions Are temperatures recorded/logged d holding foods/equipment? Y N and diseases QFO? Y N *Do you have a paid sick leave policy? Y N Are foods cooked in Owrce and cooled? Y N *Are leftovers saved? Y N Is the a language barrier between inspector&QFO? Y N indicate language spoken List products c by CFO/DA: *Can the QFO/DA read the inspection report? Y N Describe cooling methods: Indicate who answered the above questions:Name(print): C CArtSc., 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 theperson wwho, received the QFO responsibilities information at the time of the Is there a produce washing policy? Y N *Describe what is washed and inspection: o / 1 where: Note: This report is a two page form(total of 62 debitable items) Page 1 of 2 r - TEstablislim7entt: !!!!','�AA, Date of Inspection: FS 1 1 Z_ Owner or Operator: ADDITIONAL FOUR P NT ITEMS 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. 34 No cross connections,back siphonage,backflow -Stored properly,labeled properly,used properly Proper type/installation/backflow prevention device/air gap for: -Sanitizer 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. -Food equipment -Dish machines -Ice machines -Well/well head protected from contamination 35 Toilet facilities. Adequate,convenient,accessible, -Water quality in compliance-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 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 43 Outeropenings protected against entrance of insects/rodents 4 Floors: Floor covering installed,constructed as required,good repair,clean 6 ood-contact surfaces designed,constructed, maintained,installed, located 5 Floors graded,drained as required 6 Floor,wall juncture covered 17 Nonfood-contact surfaces designed,constructed, maintained, 7 Mats removable,good repair,clean installed,located 18 Single service articles,storage,dispensing 81 Exterior walking,driving surfaces,good repair,clean 19 No reuse of single service article alls,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 17 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,storage,handling no unnecessary articles 32 Proper disposal of wastewater 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 581 No live birds,turtles,or other animals(except guide dogs) 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 ❑ Preoperational Inspection IN PET PERSON IN CHARGE: Other Inspection: Demerit Score: *Include demerits from page 1 �°. �0, �c ., 4 3 2 1 Total Rating sigrdture signature G D, Canis print name I print name O yo 00 '$L6-6o Al 'DLSII O�E C.i A-d+v1; s DATE CORRECTIONS DUE: � t phone number title Page 2 of 2 plus continuation pages Focused Inspection 1/2002 Page of E_ INSPECTION REPORT STATE OF CONNECTICUT FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH CONTINUATION SHEET NAME OF ESTABLISHMENT TOWN DATE OF INSPECTION lS� � • W��GJ' S $ 2 INSPEC N FORM# REMARKS YU �O41e U \ V3 CT c a- - ` _q INITIAL(INSPECTOR) S INITIAL(PERSON IN CHARGE) j Distribution: 1 st-White-Health Department 2nd-Yellow-Owner/Manager