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Home My WebLink AboutFood Service Establishment Inspection 19 (3) i Establishment: Inspection Date: Time ROinsp RE• sp Address/City: ,� �t r 3 Health D pt: o 0 Fz ; 2 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/O N/A KEY: C[complies] N/O[not observed] NIA[not applicable] Sf Op DNC[does not comply] 0[other] RTE[ready-to-eat] ers�� ne `t�action restricted 61 !®esgr�eted Alternate 40 A Food workers have no exposed infected lesions/burns Lo 62 Written documentation of training program 2 B Personnel with infection restricted 1 Approved source,wholesome,tt4rtadtaiteTeted C NIO 4 C Communicable disease of worker reported to local health director A Approved shellfish,finfish,meat&poultry USDA approved 13 Handwasiting faciii#ies Provided,hands washed,clean Cry{} q; B Food cans in good condition(not dented,rusty,bloated,leaking) A Handwash facilities in all food prep/dispensing&warewash areas C Wholesomelnonadulterated 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 0 D Personnel hands washed,clean/Proper handwash procedure E Handwashing at appropriate times 3 Rotegdaatiyy hazardous ficsat!ntbib pre.ce#f � t �r ; dedngTLU sfiarae, pal ,V 15 ; o d #>ygierric practices C WO NIA ff A Hot holding greater than or equal to 1400F. (whole beet/pork roasts 130e F.) A ❑ No eating ❑ No smoking while working B Cold holding less than or equal to 450 F. B Wounds covered adequately C Proper cooling C Proper sink used for handwashin D Proper re-heating 0 E Proper internal cooking I consumer advisory posted Loo Q Wawa• Cheml A Approved sanitizeravailable/adequate concentration of sanitizer 4 Aelectett ctfiftes fip tintHq Rf� } � g Food-contact surfaces and utensils used for potentially teperatiir ,tit�ciro�£tertssrcvitf hazardous food sanitized at least every 4 hours A Food thermometer available and accurate C Adequate ❑dishwashersanitizer ❑final rinse temp B Proper food thermometer for product D Proper sanitizin rocedure E Sanitizing between raw animal origin&ready-to-eat food C Thermometers appropriately placed in cooler units 0 0 7Aod pi atl,r, iti c. �-, � 7. r , , A display,service and transportation 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 MENE C Food covered properly A Food equipment clean,utensils clean,equipment interiors clean D Adequate splash guards I 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 d t 0 : r 9 Harrdiing O#fend rnfrtttniZed #. s VIA G 0 , �. . A No unnecessary handling RTE and/orcooked foods with bare hands A Soap/paper towels/ drying device available B Dispenser(s)working: ❑Soap ❑Paper towel B Minimize food handling,other than ready-to-eat,with bare hands 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: 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 at di 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 report specific!lines ons Are temperatures recorded/logged for cold holding foods/equipment? Y N and diseases to the QFO? Y N *Do you have a paid sick leav . Y N Are foods cooked in advance and cooled? Y N #Are Iefto saved? Y N Is there a language barrier between inspector&QFO? Y indicate language spoken List products cooled: by QFO/DA: ♦Ca FO/DA read the inspection report? Y N Describe cooling methods: Indicate who answered the a questions: Name(print): 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 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 a Establishment: P � V Date of Inspection. L ddress: ` 1 Owner or Operator: ADDITIONAL FOUR POINT ITEMS z= ' a KEY: DNC [DOES NOT COMPLY] 6 Foods not re-served. -Unwrapped foods not re-served 4 31 Sewage disposal approved. -Potentially hazardous foods not re-served -Operating as required 'I No cross connections,back siphonage,backflow 11 Toxic chemicals. 50 Proper type/installation/backflow prevention device/air gap for: -Stored properly,labeled properly,used properly -Food equipment -Hose connections -Dish machines -Sanitizer concentration not to exceed maximum permitted _ -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 -Water quality in compliance 35 Toilet facilities. Adequate,convenient,accessible, -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,dean 5 Potentially hazardous food properly thawed 41 Garbage/rubbish disposed of in an approved manner,at approved frequency 10 Food dispensing utensils properly stored 2 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 Floors: Floor covering installed,constructed as required,good repair,clean 16 Food-contact surfaces designed,constructed,maintained,installed, 5 Floors graded,drained as required located ., 6 Floor,wall juncture covered 17 onfood-contact surfaces designed,constructed,maintained, 1;t 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 g 9 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 properlystored EEquipment&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 54 Rooms adequate,clean,adequate lockers provided,facilities clean 27 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) 59 Seats 75 or more:Nonsmoking area provided,sign(s)posted at 37 Proper toilet fixtures provided,good repair,clean entrance(s),smoking area indicated by sign(s) 39 Approved garbage/rubbish containers,adequate number,covered, rodent proof,clean It P,Routine Inspection ❑Reinspection ❑ Preoperational Inspection Otherinspection: I PET PERSON I"HA : Demerit Score: *Include demerits from page 1 m 4 3 2 1 Total Rating si ature nature !� `� �Q�S i Cc� 1'J(1 Gl [r 0— Or' t nagre ./ print name O —t l DATE CORRECTIONS DUE: 111 p one number title Page 2 of 2 plus continua ages Focused Inspection 1/2002 �. Page Of,3 INSPECTION REPORT STATE OF CONNECTICUT FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH CONTINUATION SHEET NAME OF ESTABLISHMENT TOWN DATE OF INSPECTION ?,:L� 4�� ,*& W I Af 3 Q-- INSPECTION FORM# REMARKS -CkAiAA- Y - "� f Jr e I- c , L ?J J U iC F:�A- cjcis S L 0 .� � aAa*A ar-teli sa-tLA htn, 0.,,U CAP INITIAL(INSPECTOR) INITIAL(PERSON IN CHARGE) Distribution: 1st-White-Health Department 2nd-Yellow-Owner/Manager