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Home My WebLink AboutFood Service Establishment Inspection 53 (5) Establishment: Inspection Date: Time: oins R ' p ddress)City: in Health Dept: �) class: 1 2 3 d 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 CLWO I N/A JDNC I KEY: C[complies] N/O[not observed] N/A[not applicable] 60 Qualified Food Operator 3 1 DNC[does not comply] 0[other] RTE[ready-to-eat] 12 Personnel with infection restricted 61 Designated Alternate X 1 12 C I N/0 N/A 4 62 Written documentation of training program 2q Food workers have no exposed infected lesions/burns B Personnel with infection restricted 1 Approved source,wholesome,nonadulterated C N10 /A 4 C Communicable disease of worker reported to local health director A Approved shellfish,finfish,meat&poultry USDA approved 13 Handwashing 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/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 X ID Personnel hands washed,clean/Proper handwash procedure 0 E Handwashing at appropriate times 3 Potentially hazardous flood meets temperature requirements C N10 N/A 4 Q during storage,preparation,display,service and transportation 15 Good hygienic practices C N/0 NIA 2 A Hot holding greater than or equal to 1400F. (whole beeripork roasts 130e F.) A ❑ No eating ❑N6 smoking while working B Cold holding less than or equal to 450 F. 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 X24 Sanitizatton rinse(hot water-chemical) C NIO NIA 2 0 1A Approved sanitizeravailable/adequate concentration ofsanitizer 4 Adequate facilities to maintain product C I N10 N/A 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 L Proper sanitizin rocedure C Thermometers appropriately placed in cooler units E Sanitizing between raw animal origin&ready-to-eat food 0 Q t4?ems' A. 25 Glean wiping 6hfhs C N10` N/A 1 7 Food protected during storage,preparation, C N10 WA 2' display,service and transportation A Cloths and/or sponges in good repair and clean V. A Produce washed B Wiping cloths kept in sanitizer between uses 0 B Raw meats not stored/prepared near ready-to-eat foods 25 Food-contact surfaces clean C NI0' 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 personnel C Food--contact surfaces clean F No pooling of eggs not cooked immediately 0 8 Food containers stored off the floor 30 liot and cold water under pressure,provided as required' N/O NIA 2 0 36 Handwashing accessories provided C N10 NA 1 9 Handling of food minimized 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 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 alternate],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 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 es 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): Indicate the title of above person(circle all that apply):CFO DA Mgr Cook Owner FW Is cooling monitored for time&temp? Y N Is the monitoring of cooling recorded? Y N .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 r stbl�sitrtlerrt 1 I Date of inspection: 13 +t #ri ess 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. 4 -Potentially hazardous foods not re-served -Operating as required 11 T 34 No cross connections,back siphonage,backflow 4 .Stored chemicals.red properly,labeled properly,used properly 4 Proper type/installation/backflow prevention device/air gap for: -Sto-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 j Toilet facilities. Adequate,convenient,accessible, 4 -Monitoring in compliance -Water quality in compliance designed,properly installed OTHER ITEMS KEY: DNC [DOES NOT COMPLY] 2 Sources of food: Original container,properly labeled 1 Garbage/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 2 14 Food worker:Clean outer clothes,effective hair restraints 1 43 Outeropenings protected against entrance of insects/rodents 1 loors: Floor covering installed,constructed as required,good repair,clean 1 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, 1 47 Mats removable,good repair,clean installed,located 18 Single service articles,storage,dispensing 2 8 Exterior walking,driving surfaces,good repair,clean 1 19 No reuse of single service article 9 alls,ceilings attached,equipment properly constructed,good repair,clean.Wall&ceiling surfaces as required 20 Dishwashing facilities approved design,adequately constructed, 2 maintained installed,located 50 Dustless cleaning methods used,cleaning equipment properly stored 1 Equipment&Utensils: Cleanliness 1 51 Adequate lighting provided as required 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 231 Accurate thermometers provided,dish basket,if used 54 Rooms adequate,clean,adequate lockers provided,facilities clean i Nonfood-contact surfaces of utensils&equipment clean 55 Establishment and premises free of litter,no insect/rodent harborage, 1 28 Equipment/utensils,storage,handling 1 no unnecessary articles 32 Proper disposal of waste water 1 561 Complete separation from living/sleeping quarters and laundry i 33 Plumbing location,installation,maintenance 1 571 Clean/soiled linens stored properly 1 36 Toilet rooms enclosed with self-closing door 58 No live birds,turtles,or other animals(except guide dogs) 1 L 59 Seats 75 or more:Nonsmoking area provided,sign(s)posted at 37 Propertoiletfixturesgrovided,good repair,clean 3 entrance(s),smoking area indicated by sign(s) 39 Approved garbage/rubbish containers,adequate number,covered, i rodent proof,clean outine Inspection ❑Reinspection ❑ Preoperational Inspection 1AR Other Inspection: INSPECTOR: N IN CHARGE: Demerit Score: *Include demerits from page 1 4 3 2 1 Total Rating sig ure si u pfinfriame nt name phone number title DATE CORRECTIONS DUE: -� Page 2 of 2 plus continuation pages Focused Inspection 112002 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 - l -1 r � w CC)9 )�5� � l►("e 1 06 , * 1 f 4r/ ✓1 �YC�� Ire �✓� � C�� — c�.� -� �r �� L6 L-jf�IT-� ( !� INITIAL(INSPECTOR) INITIAL(PERSON IN CHARGE) Distribution: Ist-White-Health Department 2nd-Yellow-Owner/Manager 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 INITIAL(INSPECTOR INITIAL(PERSON IN CHARGE) Distribution: 1st-White-Health Department 2nd-Yellow-Owner/Manager