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Home My WebLink AboutFood Service Establishment Inspection 29 (5) i Establishment: Inspection Date: 3 Time: REinsp Address/City: U ALAO t6t Health Dept: 5u4-64t 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 debitable items C WO I N/A JDNC I KEY: C[complies] N/O[not observed] N/A[not applicable] 69 'dlt ®dgi3p �#1. F,�n r 3 DNC[does not comply] 0[other] RTE[ready-to-eat] o_ 9 " peisor# i with infection restricted ' C NO WA 4' 61 Designated Alternate 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,nonaduiterated C Nla tddA C Communicable disease of worker reported to local health director A Approved shellfish,finfish,meat&poultry USDA approved 13 Hancimshing facilities prrideck,hands washed,cl� C WO NA 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 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 o#�t tmliuda < od meets�? gr f o €mite's 8rege, ratro t dt 5 yr Nice brad. . �o .f N � 4."E� �,� N. 1S`!Gbcid tr fgiertiic`j radices ' C N10 MA 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 24, aoi3Sidt on sef(t watgr'-cherri tcal). C Wb WA 2 A Approved sanitizeravailable/adequate concentration of sanitizer 4 de�ua�te facilities anain#am prtaifaaGt � B Food-contact surfaces and utensils used for potentially teirapeare,�Qrpetals'prgyidet! '� hazardous food sanitized at least every 4 hours . :. x oodthermometeravailableandaccurate C Adequate 0dishVIT9MTsanitizer ❑final rinse temp Aeyvj B Proper food thermometer for product D Pro ersanitizin rocedure C Thermometers appropriately placed in cooler units E Sanitizing between raw animal origin&ready'to-eat food C 77 .• .; PffS t+rfA '' 7 0ocd protecte d'during serge;prep MIRK A Cloths and/orsponges in ood repair and clean display,service and transportation9 P B Wiping cloths kept in sanitizer between uses A Produce washed op 0 B Raw meats not stored/prepared near ready-to-eat foods 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 contactsurfacesclean F No pooling of eggs not cooked immediately p Food containers stored off the floor a t '] ep .„r,z Handling qng of food adirii d .QA Soap I paper towels/ drying device available A No unnecessary handling RTE and/or cooked foods with bare hands 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 feodlice �t 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 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 indicate language spoken List products cooled: by QFO/DA: ♦Can the CFO/DA read the inspection report? Y N Describe cooling methods: 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: Note: This report is a two page form(total of 62 debitable items) Page 1 of 2 .. ; . x Establishment: Snin skn Date of Inspection: Address: ;L'�N'l �j4�C�a►,� ��- CJ�+ctxj, Owner or Operator 1'ZkJ4� 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 No cross connections,back siphonage,backflow 11 Toxic chemicals. Proper type/installation/backflow prevention device/air gap for: -Stored properly,labeled properly,used properly -Food equipment -Hose connections -Dish machines -San itizer concentration not to exceed maximum permitted -Soda system carbonator -Beverage dispensers -Toilet tanks -No unnecessary toxics on the premises -Chemical dispensers -Ice machines -Pesticides/rodenticides properly dispensed 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 79 ood dispensing utensils properly stored d 51 Ifermin Control: No insects/rodents present 4 Food worker:Clean outer clothes,effective hair restraints 43 Outer openings protected against entrance of insects/rodents 4 F s: Floor covering installed,constructed as required,good repair,clean 16 Food-contact surfaces designed,constructed,maintained,installed, Floors graded,drained as required located 6 Floor,wall juncture covered nfood-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 Is,ceilings attached,equipment properly constructed,good 20 Dishwashing facilities approved design,adequately constructed, repair,clean.Wall&ceiling surfaces as required maintained installed located stless 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 Accurate thermometers provided,dish basket,if used 544 Rooms adequate,clean,adequate lockers provided,facilities clean onfood-contact surfaces of utensils&equipment clean 55 Establishment and premises free of litter,no insect/rodentharborage, 28 Equipment/utensils,storage,handling no unnecessary articles 32 Proper disposal of wastewater 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) Propertoiletfixturesproyided,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 ❑Reinspection ❑ Preoperational Inspection INSPECTOR: PERSON I HAR E: Other Inspection: Demerit Score: *Include demerits from page 1 4 3 2 1 Total Rating s' nature si lure ' _^ m�- c6ri 'print /name print name ° 0 W` t S p - `� DATE CORRECTIONS DUE: phone number title 11 Page 2 of 2 plus continuation pages Focused Inspection II2002 Page o .am INSPECTION REPORT STATE OF CONNECTICUT __FOOD SERVICE_ESTA13LISHMENTS_ -DEPARTMENT-OF PUBLIC HEALTH- -- - - -- -- - - - ---- CONTINUATION SHEET NAME OF ESTABLISHMENT TOWN DATE OF INSPECTION INSPECTION REMARKS FORM# XLD 6eh. - r {✓ I u-.� �j CyI� v r �� akil, // r w4-" 4-7J INITIAL(INSPECTOR) INITIAL(PERSON IN CHARGE) Distribution: 1st-White-Health Department 2nd-Yellow-Owner/Manager Page�q of INSPECTION REPORT STATE OF CONNECTICUT --_ FOOD SERVICE ESTABLISHMENTS_ DEP-ARTMEN- T OF-PUBLIC-HEALTH — - —- -- - - --- CONTINUATION SHEET NAME OF ESTABLISHMENT TOWN DATE OF INS ECTION —�� a- —So Lj, INSPECTION FORM# REMARKS --Kow 14 7-76/ J 4 ) &&e2 4e= All � ft!�, INITIAL(INSPECTOR) INITIAL(PERSON IN CHARGE) Distribution: 1st-White-Health Department 2nd-Yellow-Owner/Manager