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Home My WebLink AboutFood Service Establishment Inspection 17 (16) i Establishment: f Inspection Date: 2— ,F Time: RO[ns REinsp Address/City: 3,,S` <;_rffiAc4n-D Health 6ept: � ,h�n \'6�f— Class: t 2 4 Based on an inspection this day,the item 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 PA JDNC I KEY: C[complies] NIO[not observed] NIA[not applicable] 4P ]�r DNC[does not comply] 0[other] RTE[ready-to-eat] 3 61 Designated Alternate 2 12' 'Personnel with infection restricted > C N10 4 62 Wriifien documentation of training program 2 A Food workers have no exposed infected lesions/burns B Personnel with infection restricted 1 Approved source,wholesome,nonadu[terated C N/0 4 ommunicable disease of worker reported to local health director A 1 Approved shellfish,finfish,meat&poultry USDA approved 13 fiandlwashing facilhies provided,hands washed,clean C N/p JIM0 4 B Food cans in good condition(not dented,rusty,bloated,leaking) L Handwash facilities in all food prep/dispensing&warewash areas C Wholesome/nonadulteratedfoods/safe GB 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 propertemperature D Personnel hands washed,clean/Proper handwash procedure 0 a E Handwashing at appropriate times Lo 3 Potentially hazardous food meets taiinpe tCrerat retrErn„ I1s V {+ o during storage,preparation,disp}ay,se6tce and a►isptarta do 15 Good hhy#leniC practices C N/0 oYA 2' A Hot holding greater than or equal to 1400F. (Whoie beeUpork roasts 130o F.) A ❑ No eating ❑ No smoking while working B Cold holding less than or equal to 450 F. L 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 osted04 hi on"i - e water=there( C NtA, t' ,. . h 0 A Approved sanitizer availableladequate concentration of sanitizer 4 Adequate facilities to maistatnisr5dart° B Food-contact surfaces and utensils used for potentially temperature,thermometers proWda� hazardous food sanitized at least every 4 hours A Food thermometer available and accurate C Adequate ❑dishwashersanitizer ❑final rinse temp Proper sanitizin rocedure B Proper food thermometer for product E Sanitizing between raw animal origin&ready-to eat food C Thermometers appropriately placed in cooler units 0 Food protected'd«rtrtg-storm ,"' ep t� ; o 3 i ipt Est s, G: R0, Aw 7 display,service and transportation J 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 11 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 y9 0 r Handling of food ntinimfzed T< O fir. o M1, s rti _ C Wi A No unnecessary handling RTE and/or cooked foods with bare hands fDispenser(s) p/ aper towels/ drying device available working: ❑Soap ❑Papertowel B Minimize food handling,other than ready-to-eat,with bare hands C Handwash sink(s)clean I 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: OFO[qualified food operator],DA(designated aftemate),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 Wh ses 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 reports ss conditions Are temperatures recorded/logged for cold holding foods/equipment? Y and diseases to the QFO? Y N *Do you have_a pal ' ave policy? Y N Are foods cooked in advance and cooled? Y N ♦ overs saved? Y N Is there a language barrier between inspector Y N Lf_yes indicate language spoken List products cooled: by QFO/DA: Can the QFO/DA read the inspection report? Y N Describe cooling methods: Indicate who answe a above questions: Name(print): Indicate t e of above person(circle all that apply):QFO DA Mgr Cook Owner FW Is cooling monitored for t' e&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? 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 ' 3a fl ADDRESS�`CITY: ��` �i . y t. x Establishment: S Date of Inspection. ddress: 173 Owner or Operator: ADDITIONAL FOUR iPOINT ITEMS 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 . 11 Toxic chemicals. 34 No cross connections,back siphonage,backflow -Stored properly,labeled properly,used properly 1,11 Proper type/installation/backflow prevention device/air gap for: -Food equipment -Hose connections -Dish machines -Sanitizer concentration not to exceed maximum permitted M -Soda system carbonator -Beverage dispensers -Toilet tanks -No unnecessary toxics on the premises -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 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 43 Outer openings protected against entrance of insects/rodents 4 FI rs: Floor covering installed,constructed as required,good repair,clean 6 ood-contact surfaces designed,constructed,maintained,installed, 45 Floors graded,drained as required located 6 Floor,wall juncture covered 17 Nonfood-contact surfaces designed,constructed, maintained, € 7 Mats removable,good repair,clean installed,located Single service articles,storage,dispensing 2 8 Exterior walking,driving surfaces,good repair,clean 18 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, 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 23 Accurate thermometers provided,dish basket,if used 27 onfood-contact surfaces of utensils&equipment clean 54 oms adequate,clean,adequate lockers provided,facilities clean 31 Establishment and premises flee of litter,no insect/rodent harborage, 28 Equipment/utensils,stnrage,handling no unnecessary articles 32 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) 59 Seats 75 or more:Nonsmoking area provided,sign(s)posted at 37 Propertoiletfixturesprovided,good repair,clean entrance(s),smoking area indicated by sign(s) 39 Approved garbage/rubbish containers,adequate number,covered, rodent proof,clean ORoutine Inspection ❑Reinspection 13 Preoperational Inspection Other Inspection: IN E T R: PERSON IN CHARGE: Demerit Score: *Include demerits from page 1 4 3 2 1 Total Rating si n lure n � sig to print name nKii / 7 3 !l Z� (phone number title ' d DATE CORRECTIONS DUES o 3 Page 2 of 2 plus continuation pages Focused Inspection 112002 Page of INSPECTION REPORT STATE OF CONNECTICUT FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH CONTINUATION SHEET NAME OF ESTAALISHMENT TOWN Wj DATE OF INSPECTION A Ljj4w� &Z&� �0 INSPECTION REMARKS FORM# o q2- 2 3T Z6 Tte Autklb s - sq S o o -��'Z sI ge 1(1�A 0s C10 �t C -D�10A INITIAL(INSPECTOR) INITIAL(PERSON IN CHARGE) Distribution: 1st-White-Health Department 2nd-Yellow-Owner/Mana er