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Home My WebLink AboutFood Service Establishment Inspection 43 (5) Establishment: AO. Inspection Date: r Time: /oM OMW REinsp Address/City: gk� Health Dept: Saws.i4_0 r .far- Class: t 2 3 a 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 LO N/A DNC I KEY: C[complies] N/O[not observed] NIA[not applicable] 60 Qualified Ford Operator 3 DNC[does not comply] 0[other] RTE[ready-to-eat] 12 'Personnel with infection restricted 61 Designated Alternate 2 C 0 N/A 4 62 Written documentation of training program 2 B Personnel with infection restricted A Food workers have no exposed infected lesions/burns 1 Approved source,wholesome,nonadulterated C /0 ,NIA L C Communicable disease of worker reported to local health director A Approved shellfish,finfish,meat&poultry USDA approved V 13 Handwashing facilities provided,hands washed,clean, C lX0 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/nonadu Iterated 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 0 D Personnel hands washed,clean/Proper handwash procedure 3 Potentially hazardous food meets temperature regyirerrtents C 110 NIA 4! E Handwashing at appropriate times 0 during storage,preparation,display,service and transportation' 15>ood hygienic practices C N/0'. NIA Vf 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 450 F. B Wounds covered adequately C Proper cooling C Proper sink used for handwashing D Proper re-heating E Proper internal cooking/consumer advisory posted Vf 124 Saniti atio;,rinse(Foot water chemical) C1 N/0 NIA 2 0 1 A Approved sanitizeravailable/adequate concentration ofsanitizer 4 Adequate facilities to maintain product C WO NIA 2 B Food-contact surfaces and utensils used for potentially temperature,thermometers provided hazardous food sanitized at least every 4 h9grs A Food thermometer available and accurate C Adequate ❑dishwashersanitizer Vinal rinse temp B Properfood thermometerfor product D Proper sanitizin rocedure E Sanitizing between raw animal origin&ready-to-eat food C Thermometers appropriately placed in cooler units 0 0 25 Glean wiping cloths C N/0 NIA 1 7 Fond protected during storage,preparation, C N/0 NIA 2 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 Food-contact surfaces clean C WO A(,C Food covered properly A Food equipment clean,utensils clean,equipment interiors clean D I Adequate splash guards/sneeze guard AlB Single use gloves changed when soiled E No unauthorized personnel C Food--contact surfaces clean F No pooling of eggs not cooked immediately V0 8 Food containers stored off the floor 30 Hot and cold water under pressure,provided as requite G N/0 +WA 12 0 €t andwasiung accessories provided C NIO 'NIA 9 Handling of food minimized G /0 NIA 2' A No unnecessary handling RTE and/or cooked foods with bare hands A Soap/paper towels/ drying device available B B Minimize food handling,other than ready-to-eat,with bare hands Dispenser(s)working: ❑ Paper towel C Handwash sink(s)clean/ aste receptacl t 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 fo dborne] PHFs are hot held at: F. PHFs are cold held at: OF Describe illness conditions when you would exclude a food worker fro ng: 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 require port to the local health department? Roasts Other Describe re-heating procedures: Is there a written illness policy th fires the food worker to report specific illness conditions Are temperatures recorded/logged for cold ng foods/equipment? Y N and diseases to the Ql O *Do you have a paid sick leave policy? Y N Are foods cooked in advance cooled? Y N *Are leftovers saved? Y N Is there a langu arrier between inspector&QFO? Y N ff-m indicate language spoken List products cooled: by QFO/DA: *Can the QFO/DA read the inspection report? Y N Describe cool in 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 v 41�' ADDITIONAL FOUR POINT ITEMS KEY: DNC [DOES NOT COMPLY] 6 Foods not re-served. -Unwrapped foods not re-served 31 Sewage disposal approved. , -Potentially hazardous foods not re-served -Operating as required 11 Toxic chemicals. 34 No cross connections,back siphonage,backflow 4. Proper type/installation/ba kflow prevention device/air gap for: 4 -Stored properly,labeled properly,used properly -Food equipment -Hose connections -Dish machines -Sanitizer concentration not to exceed maximum permitted-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. 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 KEY: DNC [DOES NOT COMPLY] Sources of food: Original container,properly labeled T 40 Garbage/rubbish storage area/rooms,enclosures-properly constructed,clean Jl Potentially hazardous food properly thawed 41 Garbage/rubbish disposed of in an approved manner,at approved frequency I€ 10 Food dispensing utensils properly stored 1 ermin Control: No insects/rodents present 14 Food worker:Clean outer clothes,effective hair restraints T1 Outer openings protected against entrance of insects/rodents " 1 4 loors: Floor covering installed,constructed as required,good repair,clean - 16, Food-contact surfaces designed,constructed,maintained,installed, 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 ails,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 stored1 Equipment&Utensils• Cleanliness 51 Adequate lighting provided as required V 21 Preflushed,scraped,soaked and racked 52 Room free of steam,smoke odors ' 22 Wash water clean,proper temperature 566 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 55 Establishment and premises free of litter,no insect/rodent harborage, 8 Equipmentlutensils,stnrage,handling Rno 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 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 entr nu r ce(s),smoking area indicated by sign(s) 39 Approved garbage/rubbish containers,adequate ,covered, rodent proof,clean Routine Inspection ❑Reinspection ❑ Preoperational Inspection INSPECTOR: PER CHARGE: Other Inspection: Demerit Score: *Include demerits from page 1 4 3 2 1 Total Rating tname Sigit tt print name Q r j <ao� . `l f Con J phone number title DATE CORRECTIONS DUE: Page 2 of 2 plus_ `continuation pages V Focused Inspection 1/2002 Page_of �A INSPECTION REPORT STATE OF CONNECTICUT FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH CONTINUATION SHEET NAME OF ESTABLISHMENT TOWN DATE OF INSPECTION 111`i O A—47c,k/t.1F�,.( � - w�f s. (.448 Gr— INSPECTION FORM# REMARKS lC -7o �Zo 1 /`t�t� O i� Cl�is✓ Z� 14e v 3� 0Me- C Y'LC iw--- LALi w 4�, Z- 7z� ra-c& -\t-(A'&- (3" ram' CZ SIB C5AJ V—b,\�— c ` _ 1^ Caj� � &b W1\ INITIAL(INSPECTOR) cSAI INITIAL(PERSON IN CHARGE) Distribution: 1 st-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 S Ll�!►rr� cao �d i INSPECTION FORMREMARKS \�# c�' .,•J ti�, llArl. f �v. o ;1 INITIAL(INSPECTOR) `�„/� INITIAL(PERSON IN CHARGE) Distribution: 1st-White-Health Department 2nd-Yellow- Owner/Manager