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Home My WebLink AboutFood Service Establishment Inspection 17 (19) Establishment: 2 Inspection Date: 1 Time: �} of REinsp Address/City:. 1� alth Dept-C! tip 7 Class: 1 2 3 4 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 I N/0 I WA DNC I KEy: C[complies] N/O[not observed] NIA[not applicable] 6. Ff1 ftperti�rtr - 3 DNC[does not comply] 0[other] RTE[ready-to-eat] 61 Designated Alternate' 2 vifi l th ecttan'res riot C WO N/A 4 62 Written documentation of training program A Food workers have no exposed infected lesions/burns 2 B Personnel with infection restricted 1 Approved source,wholesome,nonadulterated C Nl N/A 4 C Communicable disease of worker reported to local health director A Approved shellfish,finfish,meat&poultry USDA approved 3, HandwasnlIn fadl(tties rovided aandsatras B Food cans in good condition(not dented,rusty,bloated,leaking) 9 P cieen';; C NO WA 4 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 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 Pote' tially haardots'' od,meets temperature4p #t '$ r [ r 0 durin g s#orae papariy dfep seruhs aad fps>t4tl4p= , 7 toadletiraices C N/0 WA 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 450F. 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 S ri fi Joh 0 P Approved sanitizeravailable/adequate concentration of sanitizer 4'` � tritttir ►etltt Food rfa -contact suces and utensils used for potentially tBtpQwdt�tFB ittrotto =� idet� a � B hazardous food sanitized at feast every 4 hours r A Food thermometer available and accurate C Adequate ❑dishwashersanitizer ❑final rinse temp B Proper food thermometer for product L Proper sanitizin rocedure C Thermometers appropriately placed in cooler units E Sanitizing between raw animal origin&ready-to-eat food 0 0 � �, M 7 Fond prtife ed driring`stDrag ,`prepay ttc n; "W N/ 2" Cloths and/or C' 1d/6J A A 1 display,service and transportatio�� sponges in good repair clean A Produce washed B Wiping cloths kept in sanitizer between uses 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 g Single use gloves changed when soiled E No unauthorized personnel 100, F No pooling of eggs not cooked immediately C Food contact surfaces clean 0 8 Food containers stored off the floor Y • Hradtt offcia�iiltiized'; t d �� C j A No unnecessary handling RTE and/or cooked foods with bare hands oa pe owe / drying device available B aspen working: ❑Soap ❑Paper towel 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 altemate],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 Roasts Other What diseases related to FB illness are you required to report to the local health department? 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 tf ves 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): 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 a mig r- Establishment: Date of Inspection: Address: Owner or Operator: fc 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 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 -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 g p P y' ailed OTHER ITEMS KEY: DNC [DOES NOT COMPLY] 2 Sources of food: Original container,properly labeled R3Outer Garbage/rubbish storage area/rooms,enclosures-properly constructed,clean 5 Potentially hazardous food properly thawed Garbage/rubbish disposed of in an approved manner,at approved frequency 10 Food dispensing utensils properly stored Vermin Control: No insects/rodents present 14 Food worker:Clean outer clothes,effective hair restraints openings protected against entrance of insects/rodents loors: Floor covering installed,constructed as required,good repair,clean 16 Food-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 49 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 Eq iipment&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 aa 55 Establishment and premises free of litter,no insect/rodent harborage, 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 59 Seats 75 or more:Nonsmoking area provided,sign(s)posted at 37 Propertoiletfixturesprovirled,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 INSPECTOR: PERSON IN CHARGE: Other Inspection: eri re: *Include demerits from page 1 Z L �� 4 3 2 1 Total Rating sig ture Z.4� signature print name ^O;ri/, print name / NS DUE:phone number DATE CORRECTIO title 1°to Page 2 of 2 plus continuation pages Focused Inspection 1/2002 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# /^ r ` Y r v Li cJC e J �' , y c �J s woo INITIAL(INSPECTOR) INITIAL(PERSON IN CHARGE) Distribution: 1st-White-Health Department 2nd-Yellow-Owner/Manager