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Home My WebLink AboutFood Service Establishment Inspection 76 (4) i Establishment: Inspection Date: Lp Time.4 I Ins REinsp Address/City: tu Health Dept- 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 JDNC I KEY: C[complies] N/O[not observed] N/A[not applicable] 6Q et#F �� " " P g DNC[does not comply] 0[other] RTE[ready-to-eat] 42 ' er§�r tat with i�fec#ion restricted 61 Dis(gnated Alternate 2 C` Nti NIA 4 62 Written documentafton of traitg program 2 A Food workers have no exposed infected lesions/burns B Personnel with infection restricted 1 Approved Source,wholesome,rtanadltiterated C 0 N1A 4 C Communicable disease of worker reported to local health director A Approved shellfish,flnfish,meat&poultry USDA approved 13 Handwastting facilities provided, hands washed,clean C N10 NIA 4 B Food cans in good condition(not dented,rusty,bloated,leaking) A Handwash facilities in all food prep/dispensing&warewash areas C Wholesome/nonadulterated 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 I 0 D Personnel hands washed,clean/Proper handwash procedure E Handwashing at appropriate times 3 P c ily haza�us food meet to 3��e�� 0 darlsrage,PrsparaEiora,dispiy,aicl� tra_ } r, rioi`l'hgtenic praefiees C WO NIA 2 A Hot holding greater than or equal to 1400F. (whole beef/pork roasts 1300 F) A ❑ No eating ❑ No smoking while working11 B Cold holding less than or equal to 450 F. B Wounds covered adequately or C Proper cooling C Proper sink used for handwashing D Proper re-heating 0 E Proper internal cooking/consumer advisory posted _ hit }se water`-ch ij CNN;=' NIA 14 0 A Approved sanitizeravailableladequate concentration of sanitizer 4 AdectuatO facifitior ot ae g Food contact surfaces and utensils used for potentially tern pecdtt�re,thacnnif 'prtivi# r �� r f .� hazardous food sanitized at least every 4 hours A Food thermometer available and accurate loe C Adequate ❑dishwashersanitizer a rinse t B Proper food thermometer for product D Proper sa itizin rocedure C Thermometers appropriately placed in cooler units E Sanitizing between raw animal origin&ready-to-eat food 0 0 7taoci" rrsGt®c!iturEn n , ,r _ >. r, Iirtg ` .C`'NUS NIA` . p #f �psps tin, - F� o display,service and transportation JA Cloths and/or sponges in good repair and clean A Produce washed Wiping cloths kept in sanitizer between uses B Raw meats not stored/prepared near ready-to-eat foods rN � f C Food covered properly A Food equipment clean,utensils clean,equipment interiors clean D Adequate splash guards/sneeze guard E No unauthorized personnel g Single use gloves changed when soiled C Food--contact surfaces clean oer F No pooling of eggs not cooked immediately 0 8 Food containers stored off the floor g li 'regt+rd 0 � 9 Handling of food ntnirnize ` 0 NIA ' dtdt%#t aesorirss•�rd� = C. WU A ,9 A No unnecessary handling RTE and/or cooked foods with bare hands A Soap/paper towels I drying device available B Dispenser(s)working: ❑Soap ❑Paper towel B Minimize food handling,other than ready-to-eat,with bare hands C Handwash sinks)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. Y: QFO[qualified food operator],DA[designated alternate],PHF[potentially hazardous food],FB[foodborne] PHFs are hot held at: IF. PHFs are cold held at: F. Describe illness conditions when you would exclude wrker 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 vas indicate language spoken List products cooled: by CFO/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):QFO DA Mgr Cook Owner FW *Obtain signature of the person who received the QFO responsibilities information at the time of the [where: there a produce 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 ha�—� empwdo PABTU NS ONuuAO B ��A p�tppNl�A �1�OCF jS2°t _ E Establishment Vt t 13� Date of Inspection. Address: e. Owner or Operator: ADDITIONAL FOUR POINT ITEMS KEY: DNC [DOES NOT COMPLY] 6 Foods not re-served. -Unwrapped foods not re-served 4 31 Sewage disposal approved. -Operating as required 4 -Potentially hazardous foods not re-served k' 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: -Sanitizerconcentration 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 q -Monitoring in compliance designed,properly installed OTHER ITEMS KEY: DNC [DOES NOT COMPLY] 2 Sources of food: Original container,properly labeled 0 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 1 102 loors:Floor covering installed,constructed as required,good repair,clean` Food-contact surfaces designed,constructed,maintained,installed, 5 Floors graded,drained as required located 6 17 Nonfood-contact surfaces designed,constructed,maintained, Floor,wall juncture covered installed,located 7 Mats removable,good repair,clean 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 0 shwashing facilities approved design,adequately 10constructed, 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 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,no insect/rodent harborage, 28 Equipmentlutensils,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) 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 1 Approved garbage/rubbish containers,adequate number,covered, rodent proof,clean AlrRoutine Inspection ❑Reinspection 13 Preoperational Inspection INSPECTOR: P N IN H E: Other Inspection: Demerit Score: *Include demerits from page 1 4 3 2 1 Total Rating ure signature print name rint nam one number x title DATE CORRECTIONS DUE: Page 2 of 2 plus continuation pages Focused Inspection 1@002 Page of INSPECTION REPORT STATE OF CONNECTICUT FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH CONTINUATION SHEET NAME OF ESTABLISHMENT TOWN DATE OF INSPECTION INSPECTION FORM# REMARKS to L4L ale Iol- r � 0 �Ll --� b► d44 ,14 sue,, r a INITIAL(INSPECTOR) INITIAL(PERSON IN CHARGE) Dis n: 1st-White-Health Department 2nd-Yellow-Owner/Manager