The URL can be used to link to this page

Home My WebLink AboutFood Service Establishment Inspection 86 (7) i Establishment: Inspection Date: Time: f ROins REinsp Address/City: Health ept:_ j � l uOrA�r Class: 1 2 3 a 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 debitable items C IV N/A IDNC I KEY: C[complies] N/O[not observed] NIA[not applicable] .al Q BE3&t 3 DNC[does not comply] 0[other] RTE[ready-to-eat] # g1 Designated kiternate 2 2" If�ersoi»riB Mth i d "o t restricted C 0 WA 4 � " Written documentation of training program A Food workers have no exposed infected lesions I burns B Personnel with infection restricted 1 pproved source,wholesome,nonadtdterated C � 4 C Communicable disease of worker reported to local health director Approved shellfish,finfish,me t USDA a roved 13 Handwashing facilities prodded,hands washed,ciea C (} NIA 4' B Food cans in good conditio not dented,r sty,bloated,leaking) A Handwash facilities in all food prep/dispensing&warewash areas C Wholesomelnonadulterate sa e B Handwash facilities in or immediately adjacent to toilet rooms I If 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 E Handwashing at appropriate times 3 Potgntlli hazaogs"fiot rsp, t Q durtny at e,pfapsratiot3, r ,serve ! 15 ood iy C WO 4A 2 A Hot holding greater than or equal to 140eF. (whole beef/pork roasts 1300 F.) A ❑ No eating ❑ No smoking while working B Cold holding less than or equal to 45e F. B Wounds covered adequately C Proper cooling C Proper sink used for handwashing D Proper re-heating E Proper internal cooking/consumer advisory posted 15"ga t Q 0 Approved sanitizeravailable/adequate concentration ofsanitizer 4 Agtequate facUitles to mainitt, # B Food-contact surfaces and utensils used for potentially ll�htsnrmcirnave hazardous foods itized at least every 4 hours A Food thermometer available and accurate C Adequate .01 ishwashersanitizer ❑final rinse temp B P roper food th ermomete r fo r p rod u ct L Proper sanitizin rocedure C Thermometers appropriately placed in cooler units E Sanitizing between raw animal origin&ready-to-eat food 7 ` " of d ri ectsd" 9� m F .�,t A ", 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 Raw meats not stored/prepared near ready-to-eat foods C r Food covered properly A Food equipment clean,utensils clean,equipment interiors clean Adequate splash guards I 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 floor �. 8 `psvied C NIA: 9 Hartdling of food minimized No unnecessary handling RTE and/or cooked foods with bare hands A Soap I 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 C Handwash si s)clean aste 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: IF. 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 t epartment? Roasts Other Describe re-heating procedures: Is there a written illness policy that re a food worker to report specific illness conditions Are temperatures recorded/logged for cold holdingequipment? Y N and diseases to the QFO? Y *Do you have a paid sick leave policy? Y N Are foods cooked in advance andWQ40M Y N *Are leftovers saved? Y N Is there a Z��spector&QFO? Y N Iflf ves indicate language spoken List products cooled: by QFO/D *Can the QFO/DA read the inspection report? Y N Describe c 1' ethods: Indicate who answered the above questions: Name(print): Indicate the title 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: FN.tT This report is a two page form(total of 62 debitable items) Page 1 of 2 Establishment: w Date of Inspection: T! I ddress: 5, WYASu,— Owner or Operator: ADDITIONAL FOUR POINT 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 -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 designed,properly installed -Monitoring in compliance OTHER ITEMS KEY: DNC [DOES NOT COMPLY] 2 Sources of food:Original container,properly labeled 40 Garbage/rubbish storage area/rooms,enclosures-propedyoonstructed,clean Potentially hazardous food properly thawed arbage/rubbish disposed of in an approved manner,at approved frequency 10 Food dispensing utensils properly stored ermin Control: No insects/rodents present 14 Food worker:Clean outer clothes,effective hair restraints Outer openings protected against entrance of insects/rodents 4 loors: Floor covering installed,constructed as required,good repair,clean 6 ood-contact surfaces designed,constructed,maintained,installed, Floors graded,drained as required T1/ d located 6 Floor,w 7Nonfood-contact surfaces designed,constructed,maintained, T1" , ,go c can installed,located -Mats removable 18 Single service articles,storage,dispensing riorwalking,driving surfaces,good repair,clean 19 No reuse of single service article 9 Xalls,ceilings attached,equipment properly constructed,good 0 ishwashing facilities approved design,adequately constructed, 11011 repair,clean.Wall&ceiling surfaces as required maintained installed located 50 Dustless cleaning methods used,cleaning equipment properly stored Equipment&Utensils: Cleanliness 5 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 Accurate thermometers provided,dish basket,if used 541 Rooms adequate,clean,adequate lockers provided,facilities clean F2 Nonfood-contact surfaces of utensils&equipment clean 55 Establishment and premises free of litter,no insect/rodent harborage, 8 Equipment/utensils,storage,handling no unnecessary articles 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 36 Toilet rooms enclosed with self-closing door 58 No live birds,turtles,or other animals(except guide dogs) 3 59 Seats 75 0 ore:Nonsmoking area provided,sign(s)posted at 7 Propertoiletfixturesprnvided,good repair,clean entra (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 R: ER N N HAR E: Demerit Score: *Include demerits from page 1 4 3 2 1 Total Rating si 5��,V`Vj sign n 2k print name print name M1190 t 73 t1mber 'nGc'e� DATE CORRECTIONS DUE: ` phone number title v �V Page 2 of 2 plus continuation pages Focused IuspecHou 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 3 INSPECTI N .REMARKS FORM# 6 Co� n C.a) C� In c U t j �/Z X 'ck—, 6 1 z. txk"\ ztv. 5 �c �hv� r 2 �t TO o "Z�2 �1r �7b-bl t3 s (F- S(s SG..,� IVrocA s 6,.r,1-.car Ac) A vA4S INI IAL(INSPECTOR) INITIAL(PERSON IN CHARGE) ,`Z Distribution: 1st-White-Health Department 2nd-Yellow-Owner/Manager Page f- of INSPECTION REPORT STATE OF CONNECTICUT FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH CONTINUATION SHEET NAME OF ESTABLISHMENT TOWN DATE OF INSPECTION so 3 INSPECTION FORM# REMARKS O 5 UfarZ�r1 — tr\ 1 110 b b - C' LP bn H Aeo.,,c & l `� - � 1 vv INITIAL(INSPECTOR) S` INITIAL(PERSON IN CHARGE) Z Distribution: 1 st-White-Health Department 2nd-Yellow-Owner/Manager