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Home My WebLink AboutFood Service Establishment Inspection 19 (7) i Establishment: Inspection Date: O mm Time: V Roans REinsp Address/City- �, Health Dept: it Ic ass: 1 2 3 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 debdable items C N/O NIA DNC KEY: C[complies] N/O[not observed] NIA[not applicable] 60 Qualified Food Operator 3 DNC[does not comply] 0[other] RTE[ready-to-eat] 61 Designated Alternate 2 12 'Personnel with infection restricted C t? NIA 4'' 62 Written documentation of training program A Food workers have no exposed infected lesions/burns 2 1 Approved source,wholesome,nonadulterated C N/0 N/A 4 B Personnel with infection restricted C Communicable disease of worker reported to local health director A Approved shellfish,conditish,on meat a poultry USDAa roved 13 Handwashing facilities provided,hands washed,clean' C N/0 NIA 4 B Food cans in good condition(not dented,rusty,bloated,leaking) 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 room 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 3 Potentially hazardous food meets temperature requirements C NIO NIA? 0 during storage,preparation,display,service and transportation' ' 15 Goad hygienic practices C N/0 NIA 2 A Hot holding greater than or equal to 1400F. (Whole beef[pork roasts 130e FI 1011A ❑ No eating ❑ No smoking while working B Cold holding less than or equal to 450 F. 000 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 24 Sanitization rinse(hot water-chemical) C 0' NIA 2 0 A Approve dsanitizeravailable/ad equate concentration ofsanitizer ool 4 Adequate facilities to maintain product C NJ NIA 2' B Food-contact surfaces and utensils used for potentially temperature,thermometers provided hazardous food sanitized at least every 4 hours A Food thermometer available and accurate C Adequate ❑dishwashersanitizer .final rinse temp B Proper food thermometer for product D Proper sanitizir rocedure C Thermometers appropriately placed in cooler units 10 E Sanitizing between raw animal origifreadyE-to-eat ood 0 O 7 Food protected during storage,preparation, C NIA 25 Clean wiping cloths C NO NIA 1 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 B Raw meats not stored/prepared near ready-to-eat foods 0 26 Food-contact surfaces clean C N10 NIA 2 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 personnelool F No pooling of eggs not cooked immediately C Food--contact surfaces clean 0 ood containers stored off the floor 36 Not and cold water under pressure,provided as required NIO NIA 2 0 38 Handwashing accessories provided C N/0 NI 9 Handling of food minimizedr C N10' NIA 2 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 Adequate utensil(s)for dispensing food/ice C Handwash sink(s)clean/waste receptacle at handwash sink 0 0 •DESCRIBE DEFICIENCIES ON CONTINUATION SHEETS The following information is not debatable and does not affect your score. KEY: QFO[qualified food operator],DA[designated alternate],PHF[potentially hazardous food], FB[foodborne] PHFs are hot held at: IF. 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 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 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): 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 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 ettshreent Die bf tnspecfion- dress tlwnetf o.4per, tar: gl 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. 34 No cross connections,back siphonage,backflow 4 Proper type/installation/backflow prevention device/air gap for: 4 -Stored properly,labeled properly,used properly-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 machinesProper drain for: 29 Water source adequate,safe. 4 -Food equipment -Dish machines -Ice machines -Well/well head protected from contamination 35 Toilet facilities. Adequate,convenient,accessible, 4 -Water quality in compliance -Monitoring in compliance designed,properly installed OTHER ITEMS EY: DNC [DOES NOT COMPLY] 2 Sources of food: Original container,properly labeled 1 arbage/rubbish storagearea/rooms,enclosures-properly constructed,clean 5 Potentially hazardous food properly thawed 2 41 Garbage/rubbish disposed of in an approved manner,at approved frequency 10 Food dispensing utensils properly stored 1 42 Vermin Control: No insects/rodents present 14 Food worker:Clean outer clothes,effective hair restraints 1 3 Outeropenings protected against entrance of insects/rodents 1 4 loors: Floorcovering installed,constructed as required,good repair,clean 16 Food contact surfaces designed,constructed,maintained,installed, 2 45 Floors graded,drained as required located 6 Floor,wall juncture covered 17 food-contact surfaces designed,constructed, maintained, 1 7 Mats removable,good repair,clean installed,located 18 ingle service articles,storage,dispensing 8 Exterior walking,driving surfaces,good repair,clean 1 No reuse of single service article 49 Walls,ceilings attached,equipment properly constructed,good 1 20 Dishwashing facilities approved design,adequately constructed, 2 repair,clean.Wall&ceiling surfaces as required maintained,installed located 50 Dustless cleaning methods used,cleaning equipment properly stored 1 Equipment&Utensils; Cleanliness 51 Adequate lighting provided as required 1 1 21 Preflushed,scraped,soaked and racked 52 Room free of steam,smoke odors 1 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 1_ 27 Nonfood-contact surfaces of utensils&equipment clean 1 55 Atablishment and premises free of litter,no insect/rodent harborage, 28 Equipment/utensils,storage,handling 1 no unnecessary articles 32 Proper disposal of waste water 1 ' 56 Complete separation from living/sleeping quarters and laundry 1; 33 Plumbing location,installation,maintenance 2 57 Clean/soiled linens stored properly 1 58 No live birds,turtles,or other animals(except guide dogs) 36 Toilet rooms enclosed with self-closing door 1".' 37 Proper toilet fixtures provided,good repair,clean °"° 59 Seats 75 or more:Nonsmoking area provided,sign(s)posted at 3 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: PE IN HARGE: Other Inspection: 0, Q Demerit Score: *Include demerits from page 1 4 3 2 1 Total Rating si ture �� nat e O print name f pr ame phone number title DATE CORRECTIONS DUE: �`�i�j•Gf�( f�(G Page 2 of 2 plus continuation pages Focused Inspection 1/2002 am ' PagZ? 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 cj c on �-- / n Loa OA CPS,, 0/1 S h re-CACi INITIAL(INSPECTOR) INITIAL(PERSON IN CHARGE) Distribution: 1st-White-Health Department 2nd-Yellow- Owner/Manager