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Home My WebLink AboutFood Service Establishment Inspection 58 (5) Establishment: s spection Date: )' Time: R0[nsp RE'ns ddress/City: y,,�, Health Dept: t�,yill&, class: 1 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 debatable items C IWO INA IDNC I KEY: C[complies] N/0[not observed] NIA[not applicable] 6Q toted Fob Opex '.( �`" ' DNC[does not comply] 0[other] RTE[ready-to-eat] 61 Designated Alternate 92 `P rs6f I With infection restricted C WQ WA 4 62 Written documentation of training program 2 A Food workers have no exposed infected lesions/burns B Personnel with infection restricted 1 Approved source,wholesome,nonadntterated C N/0 /A 4 C Communicable disease of worker reported to local health director A Approved shellfish,flnfish,meat&poultry USDA approved 13 Handwashing faciirties provided,hantlswashed,clean C WO WA 4 B Food cans in good condition(not dented,rusty,bloated,leaking) A Handwash facilities in all food prep/dispensing&warewash areas C Wholesome/nonadulteratedfoods/safe B Handwash 000 facilities in or immediately adjacent to toilet room 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 Ptgetttf�i,,hazardous and�d tenrp� dnrieg sftsrage,preparation,display setwlt aad�nS � r 0 ` ` 15 food`Fig�eriic'practFGes C Nib WA �,' A Hot holding greater than or equal to 1400F. (whole beef/pork roasts 1300 F.) A ❑ No eating ❑ No smoking while working B Cold holding less than or equal to 450 F. B Wounds covered adequately 000000 C Proper cooling C Proper sink used for handwashing D Proper re-heating 0 E Proper internal cooking/consumer advisory posted AljX 0 A Approved sanitizer available/adequate concentration of sanitizer Adequate hies to mairrtair►proe#lxct A.° B Food-contact surfaces and utensils used for potentially r .- temperature,thermometers provided hazardous food sanitized at least every 4 hours A Food thermometeravailableandaccurate C Adequat s s ersani iz ❑final rinse temp B Proper food thermometer for product D Pro er sanitizinprocedure C Thermometers appropriately placed in cooler units E Sanitizing between raw animal origin&ready-to-eat food Q 0 Food pro tacted`during s#I rage-,trrrep410t asn, P display,service and transportation A Cloths and/or sponges in good repair and clean B Wiping cloths kept in sanitizer between uses A Produce washed 0 B Raw meats not stored/prepared near ready-to-eat foods , , r s t C Food covered properly A Food equipment clean,utensils clean,equipment interiors clean D Adequate splash guards/sneeze guard g Single use gloves changed when soiled E No unauthorized personnel C Food--contact surfaces clean 1100 F No pooling of eggs not cooked immediately 0 8 Food containers stored off the floor �� C # '.' Handfing of food minimized D X/0 1 1 A No unnecessary handling RTE and/orcooked foods with bare hands A Soap I paper towels/ drying device available of000B 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)fordispensing 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 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 the local health department? Roasts Other Describe re-heating procedures: Is there a written illness policy that requires the food worker to report specific illness conditions Are temperatures recorded/logged for cold holding foods/equipment? Y N and diseases to the QFO? Y N *Do you have a paid sick leave policy? Y N Are foods cooked in advance and cooled? Y N *Are leftovers saved? Y N Is there a language barrier between inspector&QFO? Y N f 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 answered the above 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):CFO DA Mgr Cook Owner FW •Obtain signature of the person who received the CFO 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 Establishment: LJ%1`_OSy Oit44Date of Inspection: Address: 5 1377 `�—i J� INLjJ4 ,�,r-�, �.��t✓, Owner or Operator: �J ADDITIONAL FOUR POINT ITEMS 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 ll Toxic chemicals. No cross connections,back siphonage,backflow 0 -Stored properly,labeled properly,used properly Proper type/installation/backflow prevention device/air gap for: -Food equipment -Hose connections -Dish machines -Sanitizer concentration not to exceed maximum permitted -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 Garbagelrubbish 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: Floorcovering installed,constructed as required,good repair,clean 6 od-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 18 Single service articles,storage,dispensing 8 Exterior walking,driving surfaces,good repair,clean 19 No reuse of single service article 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 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 231 Accurate thermometers provided,dish basket,if used 541 Rooms adequate,clean,adequate lockers provided,facilities clean 27 Nonfood-contact surfaces of utensils&equipment clean 55 Establishment and premisesfree 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 Propertoiletfixturespvovided,good repair,clean entrance(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: INSPECTOR: P N IN R E: Demerit Score: *Include demerits from page 1 4 3 2 1 Total Ratingsi ture signature ( � D print name �j�J p n name Y 2&- " ^' V- ° DATE CORRECTIONS DUE: phone number tle `�� Page 2 of 2 plus continuation pages Focused Inspection VUR Page_3of INSPECTION REPORT STATE OF CONNECTICUT _— FOO_D SERVICE ESTABLISHMENTS S __DEFA-ItT-M] NT--OF-P--U$LIC-HE+ALT-H ------ ----------- - ------ -- - -- CONTINUATION SHEET NAME OF ESTABLISHMENT TOWN DATE OF INSPECTION tn &J,od_ t S3 ktl� INSPECTION REMARKS FORM# cCz,/t / �'1 I Zs� INITIAL(INSPECTOR) INITIAL(PERSON IN CHARGE) Di bution: -White-Health Department 2nd-Yellow-Owner/Manager