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Home My WebLink AboutFood Service Establishment Inspection 10 (13) i Establishment: -Inspection Date: h3 Time: j1 CO 110[nsp RE[nsp Address/City:_ \M NA,, ,a Q-1 Health De t: S. W I I door' Class: 1 2 3 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 N/0 NIA DNC tom: C[complies] N/O[not observed] N/A[not applicable] # {�tt��41 FQ(ikJtaOS r d f .- ak O dil 3 DNC[does not comply] 0[other] RTE[ready-to-eat] 61 Designated Alternate 2 errst�inne i41fecti�sn restricted'` C 0 NX 4 62 Written documentation of training program 2 A Food workers have no exposed infected lesions/burns 1 Approved source,wholesome,rionadclterated C /A 4 B Personnel with infection restricted C Communicable disease of worker reported to local health director A Approved shellfish,finfish,meat&poultry USDA approved 13 Handthrashing facilit[es provided,hands washed,clean C WO NIA 4' B Food cans in good condition(not dented,rusty,bloated,leaking) A Handwash facilities in all food prep/dispensing&warewash areas C Wholesome/nonadulterated foods/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 D Personnel hands washed,clean/Proper handwash procedure E Handwashing at appropriate times Po>) t[ail hrdotls ttapd �r�t °� do iI o fage,Ore.saradan,d�a pRi s1� 5' gte nic'practises C 0 NIA 2 A Hot holding greater than or equal to 1400F. ("mole beeflpork roasts 130e F.) A ❑ No eating ❑ No smoking while working B lCold holding less than or equal to 47 B Wounds covered adequately C Proper cooling VC Proper sink used for handwashing D Proper re-heating 0 Ro E Proper internal cooking/consumer advisory posted r watQh 1 i) N 0 A Approved sanitizeravailable/adequate concentration of sanitizer 4 Acate.#acidities to mainaln prpet �,. B Food-contact surfaces and utensils used for potentially tf!mperatums,the' eters,-j01rbvri hazardous food sanitized at least every 4 hours t tPE: ekt ;e. A Food thermometer available and accurate C Adequate ❑dishwashersanitizer ❑final rinse temp B Proper food thermometer for product D Pro er salI Procedure C Thermometers appropriately placed in cooler units E Sanitizing between raw animal origin&ready-to-eat food 0 r can plrt t;6to Ei . �� pdopfcrtcted dri display,service and transportaticrrt 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 V I C Food covered properlyI bllA Food equipment clean,utensils clean,equipment interiors clean D Adequate splashguards/sneeze guard B Single use gloves changed when soiled E No unauthorized personnel V7 Food--contact surfaces clean F No pooling of eggs not cooked immediately V0 8 Food containers stored off the floor i P � H , NIA 9 Handling of food minimized C 'l�if(3 N(A .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: ❑ ❑Paper towel B Minimize food handling,other than ready-to-eat,with bare hands C Handwash sinks)clean aste receptacl at handwash sink C Adequate utensils)for dispensing food/ice 0 0 1 4 *DESCRIBE DEFICIENCIES ON CONTINUATION SHEETS The following information is not debitable and does not affect your score. KEY: QFO[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 What diseases related to FB illness are you required to report to cal health department? Roasts Other Describe re-heating procedures: Is there a written illness policy that requir ood worker to report specific illness conditions d for colding f Are temperatures recorded/loggeoods/equipment? Y N and diseases to the QFO? Y ♦Do you have a paid sick leave policy? Y N Are foods cooked in advan nd cooled? Y N Are leftovers saved? Y N Is there a Ian rrier between inspector&QFO? Y N Eyes indicate language spoken List products cooled- by QFOI *Can the QFO/DA read the inspection report? Y N Describel methods: Indicate who answered the above questions: Name(print)cl 2 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 signatur a is who r ' d the esponsibilities' rmati at the time of the a produce washing policy? Y N *Describe what is washed and inspection: Note: This report is a two page form(total of 62 debitable items) Page 1 of 2 Est lishment: 2d8 �cr» Date of Inspection: 2 t�- ddress: 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 -Operating as required -Potentially hazardous foods not re served 11 Toxic chemicals. 34 No cross connections,back siphonage,backflow . -Stored properly, :beed proper) ,used properly Proper type/installation/backflow prevention device/air gap for: --Stored zerco properly, a 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: Dill [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 4 Food worker:Clean outer clothes,effective hair restraints 43 Outeropenings protected against entrance of insects/rodents 4 loors: Floor covering installed,constructed as required,good repair,clean located ontactsurfacesdeslgned 6 o ,constructed,maintained,installed, 5 Floors graded,drained as required l 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 8 Exterior walking,driving surfaces,good repair,clean 19 No reuse of single service article Walls,ceilings attached,equipment properly constructed,good 20 Dishwashing facilities approved design,adequately constructed, repair,clean.Wall&ceiling surfaces as required maintained installed located 50 Dustless cleaning methods used,cleaning equipment properly stored Equipment&Utensils: Cleanliness 51 dequate lighting provided as required 21 Preflushed,scraped,soaked and racked 2 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 271 Nonfood-contact surfaces of utensils&equipment clean 55 Establishment and premises free of litter,no insect/rodent harborage, 28 Equipment/utensils,storage,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) 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 1311einspection 13 Preoperational Inspection Other Inspection: IN PET PERSON IN CHARGE: Demerit Score: *Include demerits from page 1 4 3 2 1 Total Rating si nature s' ature print name print name oZY5 1914-0 —79 phone number title DATE CORRECTIONS DUE: �oei� Page 2 of 2 plus _continuation pages FocusedIuspectlou 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 I �UwaoQ�S (fib"� S W C,,AS4 r 20 (3 INSPECTION REMARKS FORM# r Ckt-f C'1 l c F`ee.�e.� a7�''�'k�✓SI✓►fit, , \ o � ate. 1 l� ID - ►c9 ov, c`s INITIAL(INSPECTOR) INITIAL(PERSON IN CHARGE) Distribution: I st-White-Health Department 2nd-Yellow-Owner/Manager Page of 9 INSPECTION REPORT STATE OF CONNECTICUT FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH CONTINUATION SHEET NAME �OF ESTABLISHMENT TOWN DATE OF INSPECTION INSPECTION REMARKS FORM# �,QWj'� J r \te-c w. Y\o \ Cam- a� INITIAL(INSPECTOR) INITIAL(PERSON IN CHARGE) < ` Distribution: 1st-White-Health Department 2nd-Yellow- Owner/Manager