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Home My WebLink AboutFood Service Establishment Inspection 12 (7) i Establishment: Inspection Date: 1 Time: RE[nsp ddress/City: 3 tj lI d& Health Dept: C,)^/, Class: 1 2 3 Based on an inspection this day,thbltems 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 I C I N/O NIA IDNC I KEY: C[complies] N/0[not observed] NIA[not applicable] 3 DNC[does not comply] 0[other] RTE[ready-to-eat] 2------------ 62 ritterrttsaumentaticn of traitrino program r 2 A Food workers have no exposed infected lesions/burns B Personnel with infection restricted A�3j1f 0X8tt SQUfOi Wh01wotnB,`rt6n�ftttttBratid N/0 t�/A , C Communicable disease of worker reported to local health director A Aporoved shellfish,finfish,meat&poultry USDA approved B Food cans in good condition(not dented,rusty,bloated,leaking) 13 ml ndw 1 f011 s � �_ P �. a + C Wholesome/nonadulterated foods/safe A Handwash facilities in all food prep/dispensing&warewash areas D Commercial products(no home grown/canned food) B Handwash facilities in or immediately adjacent to toilet rooms E Potentially hazardous foods received at proper temperature C Handwash facilities accessible/convenient to use 0 D Personnel hands washed,clean/Proper handwash procedure E Handwashing at appropriate times 0 A Hot holding greater than or equal to 140°F. (whole beeuporkroasts 1300 F.) A ❑ No eating ❑No smoking while working rr B Cold holding less than or equal to 45°F. B Wounds covered adequately C Proper cooling C Proper sink used for handwashing D Proper re-heating 00,0007 0 E Proper internal cooking/consumer advisory posted 0 A Approved sanitizeravailable/adequateconcentrationofsani zer B Food-contact surfaces and utensils used for potentially —1 JT hazardous food sanitized at I t every 4 hours A Food thermometer available and accurate C Ade shwashersaniti ❑final rinse temp B Proper food thermometer for product D Propersani i ' e ure C Thermometers appropriately placed in cooler units E Sanitizing between raw animal origin&ready-to-eat food 0 0 r %Elf A clean tp$rfa��on Cloths and/orsponges in good repairand g t, F, _ �. A Produce washed B Wiping cloths kept in sanitizer between uses B Raw meats not stored/prepared near ready-to-eat foods 0 C Food covered properly D Adequate splash guards/sneeze guard A Food equipment clean,utensils clean,equipment interiors clean E No unauthorized personnel B Single use gloves changed when soiled F No pooling of eggs not cooked immediately C Food—contact surfaces clean 0 ' ood containers stored off the floor 0 A Soap/ er to drying device available No unnecessary handling RTE and/or cooked foods with bare hands B B Dispens rs working: ❑Soap ❑Papertowel Minimize food handling,other than ready-to-eat,with bare hands C Adequate utensil(s)fordispensing food/ice C 1 Handwash sink(s)clean/waste receptacle at handwash sink 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[foodbome] PHFs are hot held at: F. PHFs are cold held at: F. 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 Iflf ves 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): Ewhere: onitored 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 roduce 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 Establishment: Date of Inspection. Address: ( LNtnAOwner or Operator: ADDITIONAL FOUR POINT ITEMS v $ � KEY: DNC [DOES NOT COMPLY] � 6 Foods not re-served. -Unwrapped foods not re-served 41 31 Sewage disposal approved. -Potentially hazardous foods not re-served -Operating as required 11 Toxic chemicals. 34 No cross connections,back siphonage,backflow -Stored properly,labeled properly,used properly Proper type/installation/backflow prevention device/air gap for: -Sanitizer concentration not to exceed maximum permitted -Food equipment -Hose connections -Dish machines -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 35 Toilet facilities. Adequate,convenient,accessible, -Water quality in compliance desi ned,properly in -Monitoring in compliance 9 p p y stalled OTHER ITEMS KEY: DNC [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 14 Food worker:Clean outer clothes,effective hair restraints 43 Outer openings protected against entrance of insects/rodents Flo :Floor covering installed,constructed as required,good repair,clean 16 Food-contact surfaces designed,constructed,maintained,installed, oors 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 47 Xalls,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 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 lifter,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 58 No live birds,turtles,or other animals(except guide dogs) 36 Toilet rooms enclosed with self-closing door 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 SWoutine Inspection ❑Reinspection ❑ Preoperational Inspection Other Inspection: INSPECTOR: P N H E: Demerit Score: *Include demerits from page 1 Of 4 3 2 1 Total Rating sig�e /�, ure D �- rin name print name d V DATE CORRECTIONS DUE: V ((! phone number title � Page 2 of 2 plus continuation pages Focused Inspection 1/2002 r Page Of-I INSPECTION REPORT STATE OF CONNECTICUT FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH CONTINUATION SHEET NA OF ESTABLISHMENT TOWN DATE OF IIVSP CTION INSPECTION FORM# REMARKS rIn ,1^ f S,C IV) � ll JtvvJSjA 4S tjc,flc-y pp INITIAL(INSPECTOR) INITIAL(PERSON IN CHARGE) Distribution: 1 st-Whit Health Department 2nd-Yellow-Owner/Manager