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Home My WebLink AboutFood Service Establishment Inspection 84 (4) i Establishment: Inspection Date: o ) Time: REIrap Address/City: OCHealth Dept: 5, class: 1 2 <24 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 I N/O I N/A I DNC tom: C[complies] N/O[not observed] NIA[not applicable] 60 Qualified food Operator 01 1 3 1 DNC[does not comply] 0[other] RTE[ready-to-eat] 61 Designated Alternate 2 12 Personnel with infection restricted C NIO N/A 4 s 62 Written documentation of training program A Food workers have no exposed infected lesions/burns 2 B Personnel with infection restricted 1 Approved source,wholesome,nonadulterated C N/0 NIA 4 C Communicable disease of worker reported to local health director loll B o roved shellfish,condition meat&poultry USDA approved 13 'Handwashing facilities provided,hands washed,clean' C WO WA 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 D Commercial products(no home grown/canned food) B Handwash facilities in or immediately adjacent to toilet rooms 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 transportation C N/p N/A 4 0 dewing storage,preparation,display,service and trartsportafran 15 Good hygienic practices C N/0' N/A 2 A Hot holding greater than or equal to 140°F. (whole beef/pork k roans 130o r.) A ❑ No eating ❑ No smoking while working B Cold holding less than or equal to45oF. 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 Unitization rinse(hot water-chemical) C WO NIA 2 0 A Approved sanitizeravailable/adequate concentration ofsanitizer 4 Adequate facilities to maintain product C N/0 WA 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 ❑dishwasher sanitizer ❑final rinse temp B Proper food thermometer for product 7 Proper sanitizin rocedure C Thermometers appropriately placed in cooler units E Sanitizing between raw animal origin&ready-to-eat food 0 0 lean wiping cloths C WO N/A 7 Food protected during storage,preparation, C N/0 N/A display,service and trans#ortation 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 26 Food-contact surfaces clean C NO 'NIA 2 C Food covered properly A 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 C Food--contact surfaces clean F No pooling of eggs not cooked immediately 0 joo ood containers stored off the floor 30 Not and cold water under pressure,provided as required' C N/0 N/A 2 0 Handwasiting accessories provided C N/0 'N/A 9 Handling of food minimized C N/0 N/A 2 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 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 Iflf ves 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 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 E t btisit xt ttt; 3 Otte Of fftspet wn' res5� Ouun� tir'Operatt. 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 KEY: DNC [DOES NOT COMPLY] 2 Sources of food:Original container,properly labeled 1 0 Garbage/rubbish storage area/rooms,enclosures-properly constructed,clean 1 Potentially hazardous food properly thawed 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 4a Outer openings 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, 2 ' S Floors graded,drained as required located 6 Floor,wall juncture covered 17 Nonfood-contact surfaces designed,constructed, maintained, 1 ` 7 Mats removable,good repair,clean installed,located 18 Single service articles,storage,dispensing p8 Exterior walking,driving surfaces,good repair,clean 1 19 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 properlystored 1 EEquipment&Utensils: Cleanliness1 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 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 Establishment and premises free of litter,no insect/rodent harborage, 1 28 Equipmentlutensils,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 1 57 Clean/soiled linens stored properly 1 58 No live birds,turtles,or other animals(except guide dogs) 1 36 Toilet rooms enclosed with self-closing door 59 Seats 75 or more:Nonsmoking 37 Proper toilet fixtures provided,good repair,clean ng area provided,sign(s)posted at 3` entrance(s),smoking area indicated by sign(s) 39 1 Approved garbage/rubbish containers,adequate number,covered, rodent proof,clean 'Woutine Inspection ❑Reinspection ❑ Preoperational Inspection INSPECTOR: PERSON IN CHARGE: Other Inspection: Demerit Score: *Include demerits from page 1 It 4 3 2 1 Total Rating IN ure prild name print ame phone number o� title DATE CORRECTIONS DUE: v� b Page 2 of 2 plus continuation pages Focused Inspectlon 1/2002 PageZof J INSPECTION REPORT STATE OF CONNECTICUT FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH CONTINUATION SHEET NAME OF ESTABLISHMENT TOWN DATE OF INSPECTION ��r INsrE # REMARKS FORM C--�' i Sit t� err c� INITIAL(INSPECTOR) i INITIAL(PERSON IN CHARGE) istribution: Ist-White-Health Department 2nd-Yellow-Owner/Manager