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Home My WebLink AboutFood Service Establishment Inspection 10 (18) i Establishment: Insp tion Date: 1 �v/ Ti e: tl REinsp Address/City: J Health Dept: ( class; 2 Based on an inspection this day,the items marked D 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 N/0 N/A JDNC I KEY: C[complies] N/O[not observed] N/A[not applicable] 66 F77,7, 77 3 DNC[does not comply] 0[other] RTE[ready-to-eat] ''F►erstsi nef With infection restricted 61 Designated Alternate 2 G NIQ NIA 4 62 Written documentation of training program 2 A Food workers have no exposed infected lesions/burns 9 Approved source,wholesome,ncrtadulterated C N(p /A 4 B Personnel with infection restricted C Communicable disease of worker reported to local health director A Approved shellfish,finfish,meat&poultry USDA approved 13 Handveashing faciYrfies provided,hands was ,clean C WO [(A, 4 B Food cans in good condition(not dented,rusty,bloated,leaking) A Handwash facilities in all food prep/dispensing&warewash areas C Wholesomelnonadulterated 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 D Personnel hands washed,clean/Proper handwash procedure 0 E Handwashing at appropriate times 3 Potentially hazardous food meets temperature no ujre G tU ' 0 during storage,preparation,t, ptay,se r tce ar�d tran iiiiialilloOl•I 15 fsatid hygienic practices C WO NZA 2 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 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 ? 'A ' ho{"4 „p a �, G ( 2 a2 , , _ .,f. z ,., 0 A Approved sanitizeravailable/adequate concentration ofsanitizer 4 All achrtiedt main pradcet g Food-contact surfaces and utensils used for potentially tentperatare;fhotefers"plrbv idi, hazardous food sanitized at least every 4 hours a A Food thermometer available and accurate 000, C Adequat dishwas ersan r ❑final rinse temp B Proper food thermometer for product D Proper sanitizin rocedure C Thermometers appropriately placed in cooler units E Sanitizing between raw animal origin&ready-to-eat food 0 eo Food ro#ect�tl tluNo si a'4; re arctic n � � WAq`' G�` ' � .t 4 display,service and transportation A Cloths and/or sponges in good repair and clean A Produce washed B Wiping cloths kept in sanitizer between uses 0 B Raw meats not stored/prepared near ready-to-eat foods C Food covered properly Food equipment clean,utensils clean,equipment interiors clean D Adequate splash guards/sneeze guard B Single use gloves changed when soiled ol 100, E No unauthorized personnel C Food--contact surfaces clean F No pooling of eggs not cooked immediately 0 8 Food containers stored offthe floor , 0 low �•R 9 tfandfing of food inninfinizeid � `#}0 NIA ` A No unnecessary handling RTE and/or cooked foods with bare hands A Soap/paper towels/ drying device available B Dispenser(s)working: ❑Soap ❑Paper towel B Minimize food handling,other than ready-to-eat,with bare hands C Handwash sink(s)clean I waste receptacle at handwash sink C Adequate utensil(s)for dispensing food/ice 0 1 ;t 0 •DESCRIBE DEFICIENCIES ON CONTINUATION SHEETS The following information is not debitable and does not affect your score. elf: QFO[qualified food operator],DA[designated alternate],PHF[potentlally hazardous food],FB[foodborne] PHFs are hot held at: OF. PHFs are cold held at: OF. Describe illness conditions when you would exclude a ATfood 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 If 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 QFO responsibilities information at the time of the s there a produce washing policy? Y N *Describe what is washed and inspection: rIwhere: Note: This report is a two page form(total of 62 debitable items) Page 1 of 2 �.; I I mv Establishment: ' Lk Date of Inspection: <--bt Address: Owner or Operator: C' hz ADDITIONAL FOUR POINT ITEMS KEY: DNC [DOES NOT COMPLY] 6 Foods not re-served. -Unwrapped foods not re-served 4 31 Sewage disposal approved. Al -Potentially hazardous foods not re-served -Operating as required v� 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 ry -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 desi ned,properly -Monitoring in compliance g installed OTHER ITEMS KEY: DNC [DOES NOT COMPLY] 2 Sources of food:Original container,properly labeled 0 Garbage/rubbish storagearea/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 eropenings protected against entrance of insects/rodents oors: 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 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 ooms&equipment hoods,ducts,vented as required -Accurate thermometers provided,dish basket,if used nfood-contact surfaces of utensils&equipment clean ooms adequate,clean,adequate lockers provided,facilities clean %quipmerittutensils, 55 Establishment and premises free of litter,no insect/rodent harborage, 8 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 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 u ine Inspection ❑Reinspection ❑ Preoperational Inspection Other Inspection: INSPECTOR: PERSON IN CHARGE: _ Demerit Score: *Include demerits from page 1 iggh4 3 2 1 Total Rating ature Y1� ;�� _ x I print npme print narqe a. A DATE CORRECTIONS DUE: phone mber title �� Page 2 of 2 plus continuation pages Focused Inspection 1/2002 Page of-3 INSPECTION REPORT STATE OF CONNECTICUT FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH CONTINUATION SHEET NAME OF ESTABLISHMENT TOWN DATE OI�PE�� J� L Z INSPECTION FORM REMARKS # -�F31z �f � r A----,L-)3 " I ,- 2,U INITIAL(INSPECTOR) INITIAL(PERSON IN CHARGE) - M istribution: 1st-White-Health Department 2nd-Yellow-Owner/Manager