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Home My WebLink AboutFood Service Establishment Inspection 46 (6) i Establishment: Inspection Date: Time: ' 1101ril RE]ns ddress/City: � �j��o�i)/�,A� Health Dept: 166`i), 2 a 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 N/A IONIC I KEY: C[complies] N/0[not observed] NIA[not applicable] v 3 DNC[does not comply] 0[other] RTE[ready-to-eat] 00 1: *dlil`With hyf4cHictl restricted: 'C t A 4 61 Designated Alterna 2 te A Food workers have no exposed infected lesions/burns 62 Wriften documentation of training program 2 B Personnel with infection restricted 1 Approved source,wholesome,nonadulterated C N10 N/A 4 C Communicable disease of worker reported to local health director A Approved shellfish,finfish,meat&poultry USDA approved 13 HarKmm Ling facilities proAded,ltandswashed,clean C No Nl °4 B Food cans in good condition(not dented,rusty,bloated,leaking) A Handwash facilities in all food prep/dispensing&warewash areas C Wholesome/nonaduIterated 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 Personnel hands washed,clean I Proper handwash procedure 0 E Handwashing at appropriate times 3 Pots rdi I AN req tilil w o diiOng s Otago preparifior�,'disptsl;seevice and baanalto 16 Good hyg1eniciil4A!cds; I W/0 RA 2 A Hot holding greater than or equal to 1400F. (whole beer/pork roasts 1300 F.) A ❑ No eating ❑ No smoking while working B Cold holding less than or equal to 45oF. B Wounds covered adequately C Proper cooling C Proper sink used for handwashing D Proper re-heating 0 E Proper internal cooking/consumer advisory posted p 'water,, w 0 A Approved sanitizeravailable/adequate concentration of sanitizer 4 Aet#eat tes; irn of a g Food-contact surfaces and utensils used for potentially tetnperir ,thertotc�tneters;,'p�ted {e every 4 hours hazardous foo A Food thermometer available and accurate C Adequat K2dishwaslhks L Proper sanitiz n rocedure B Proper food thermometer for product E Sanitizing between raw animal origin&ready-to-eat food C Thermometers appropriately placed in cooler units 0 c!prat®ctcd touring s�oragB,prepai�aon; ' h.� : N cusps service and transportation A Cloths and/or sponges in good repair and clean B Wiping cloths kept in sanitizer between uses A Produce washed 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--contact surfaces clean No pooling of eggs not cooked immediately 0 Food containers stored off the floorKill MIN , . 9 Ha"Ing of food rptn zed 0 rB Soap I paper towels I drying device available A No unnecessary handling RTE and/or cooked foods with bare hands Dispenser(s)working: ❑Soap ❑Paper towel B Minimize food handling,other than ready-to-eat,with bare hands Handwash n s c can 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] '+iFs are hot held at: OF. PHFs are cold held at: OF. Describe illness conditions when you would exclude a food worker from working: '+emal cooking temperatures taken? Y N *To what temperature do you cook: Ground Beef Pork What diseases related to FB illness are you required to report to the local health department? Other `tng procedures: Is there a written illness policy that requires the food worker to report specific illness conditions -,orded/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 ^e and cooled? Y N *Are leftovers saved? Y N Is there a language barrier between inspector&QFO? Y N If yes indicate language spoken by QFO/DA: *Can the QFO/DA read the inspection report? Y N Indicate who answered the above questions: Name(print): �� J5 Indicate the title of above person(circle all that apply):CFO DA Mgr Cook Owner FW �Q Y N Is the monitoring of cooling recorded.? Y N .Obtain signature of the person who received the CFO responsibilities information at the time of the ,y? 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 r Establishment: G�'� Date of inspection: � 1 Address: Owner or Operator- f ) 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 11 Toxic chemicals. No cross connections,back siphonage,backflow Proper type/installation/backflow prevention device/air gap fo -Stored properly,labeled properly,used properly r: -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 -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 -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,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 475 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, 2K Floors graded,drained as required located 6 Floor,wall juncture covered 1 Nonfood-contact surfaces designed,constructed, maintained, 47 Mats removable,good repair,clean installed,located 18 Single service articles,storage,dispensing Exterior walking,driving surfaces,good repair,clean 19 No reuse of single service article Walls,ceilings attached,equipment properly constructed,good repair,clean.Wall&ceiling surfaces as required 20 Dishwashing facilities approved design,adequately constructed, 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 3 Accurate thermometers provided,dish basket,if used 54 Rooms adequate,clean,adequate lockers provided,facilities clean Nonfood-contact surfaces of utensils&equipment clean 55 Establishment and premises free of litter,noinsect/rodentharborage, 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 property 58 No live birds,turtles,or other animals(except guide dogs) 36 Toilet rooms enclosed with self-closing door 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 lisMoutine Inspection ❑Reinspection ❑ Preoperational Inspection Other Inspection: INSPECTOR: PERSON IN CHARGE: -Demerit Score: *Include demerits from page 1 4 3 2 1 Total Rating sign re t / signature /' 1 print name print name /4?Z DATE CORRECTIONS DUE: phone number ' title Page 2 of 2 plus continuation pages Focused Inspection 1@002 Page o l INSPECTION REPORT STATE OF CONNECTICUT L'^"' 104"y► FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH CONTINUATION SHEET NAME OF ESTABLISHMENT TOWN DATE OF INSPECTION S3.1 INSPECTION REMARKS FORM# r tr ✓ w-- S csa t Lvv A. 'It Dt,-r 14 INITIAL(INSPECTOR) INITIAL(PERSON IN Distribution: I st-White-Health Department 2nd-Yellow-Owner/Manager I av Page of� INSPECTION REPORT STATE OF CONNECTICUT FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH CONTINUATION SHEET NAME OF ESTABLISHMENT TOWN DATE OF INSPECTION INSPECTION REMARKS FORM# J INITIAL(INSPECTOR)" INITIAL(PERSON IN CHARGE ' Distribution: 1st-White-Health Department 2nd-Yellow-Owner/Manager