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Home My WebLink AboutFood Service Establishment Inspection 10 (17) Establishment: Inspection Date:WAIWJ Ti e: / RO[n REinsp Address/City: t � Health Dept: tji class; 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 debitable items C N/0 I N/A JOINC Key; C[complies] N/O[not observed] NIA[not applicable] 66 Qualified Food Operator 3 DNC[does not comply] 0[other] RTE[ready-to-eat] 61 Designated Alternate 2 12 Personnel with infection restricted C 1410 NIA 4 62 Written documentation of training program 2 A Food workers have no exposed infected lesions/burns 1 Approved source,wholesome,nonadulterated C NI N/A _4 B Personnel with infection restricted A A C Communicable disease of worker reported to local health director roved shellfish,finfish,meat&poultry USDA a roved B Food cans in good condition(not dented,rusty,bloated,leaking) 13 Handwashin g facilities provided,hands washed,clean, C NI NIA 4 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 0 D Personnel hands washed,clean/Proper handwash procedure E Handwashing at appropriate times Potentially hazardous food meets temperature requirements C NO N/A 0 during storage,preparation,display,service and transportation 15 Good hygienic practices C 0' WA 2 A Hot holding greater than or equal to 1400F. (whole beef/pork roasts 130o F.) 10, A ❑ No eating El No smoking while working B Cold holding less than or equal to450F. IB 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 N/0 N/A 2+ 0 d"V, A Approved sanitizer available/adequate concentration of sanitizer 4 Adequate facilities to maintain product C N/0 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 s washersani i ❑final rinse temp B Proper food thermometer for product D Proper san tizin rocedure C Thermometers appropriately placed in cooler units 100, E Sanitizing between raw animal origin&ready-to-eat food 0 0 Food protected during storage,preparation, C WO N/A 25 Glean wiping cloths C N10 Ni 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 odd-contact surfaces clean C" INtA C Food covered properly IIiiPA Food equipment clean,utensils clean,equipment interiors clean D Adequate splash guards/sneeze guard B Single use gloves changed when soiled E No unauthorized personnel ZC Food--contact surfaces clean F No pooling of eggs not cooked immediately 0 Food containers stored off the floor 30 Hot and cold water render pressure,provided as required N/0 t/A 2 0F Handwashing accessories provided T N/0 'NI 9 Handling of food minimized C Igo MA 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 I 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. KEY: OFO[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): 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: 11 Note: This report is a two page form(total of 62 debitable items) Page 1 of 2 s bl,shfient: Date of inspection: t3 dtltres Owner or Operator:Amw 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. 74 No cross connections,back siphonage,backflow 4 4 Proper type/installation/backflow prevention device/air gap for: -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 KEY: DNC [DOES NOT COMPLY] 2 Sources of food: Original container,properly labeled 1 ` 0 Garbage/rubbish storage area/rooms,enclosures-properly constructed,clean i 5 Potentially hazardous food properly thawed 2 41 Garbage/rubbish disposed of in an approved manner,at approved frequency Food dispensing utensils properly stored 42 Vermin Control: No insects/rodents present 2 14 Food worker:Clean outer clothes,effective hair restraints 1 43 Outeropenings protected againstentrance of insects/rodents 1 4 Floors: Floor covering installed,constructed as required,good repair,clean 1, 16 Food-contact surfaces designed,constructed, maintained,installed, 2 45 Floors graded,drained as required located 6 Floor,wall juncture covered 17 Nonfood-contact surfaces designed,constructed,maintained, 1 471 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 Walls,ceilings attached,equipment properly constructed,good 1 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 i 51 Adequate lighting provided as required 1 21 Preflushed,scraped,soaked and racked 52 Room free of steam,smoke odors l 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 l 27 Nonfood-contact surfaces of utensils&equipment clean i 55 Establishment and premises free of litter,no insect/rodent harborage, 11 Equipment/utensils,storage,handling no unnecessary articles Proper disposal of waste water 1 56 Complete separation from living/sleeping quarters and laundry 1 Plumbing location,installation,maintenance 1 + 57 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 1 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) 3 39 Approved garbage/rubbish containers,adequate number,covered, 1 rodent proof,clean Mftutine Inspection ❑Reinspection ❑ Preoperational Inspection Other Inspection: INSPECTOR: PERSONA CHARGE- Demerit Score: *Include demerits from page 1 4 3 2 1 Total Rating Sig re s ature . �M', S 44&0- prim name print name (� �Y Cs``phone number tit DATE CORRECTIONS DUE: _-- Page 2 of 2 plus continuation pages Focused Inspection 1_02 � R I am- Pag� of INSPECTION REPORT STATE OF CONNECTICUT FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH CONTINUATION SHEET NAME OF ESTABLIS MENT TOWN DATE OF INSPECTION fia�4� , 'd sljl?� INSPECTION REMARKS FORM# o-y,)c, ef --4 lc� C. i 1460C' 's INITIAL(INSPECTOR) INITIAL(PERSON IN CHARGE) Distribution: 1st-White-Health Department 2nd-Yellow-Owner/Manager