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Home My WebLink AboutFood Service Establishment Inspection 60 (7) i Establishment: Inspection Date: l� Time: Roinsp RE[nsp Address/City: Health Dept: 1, �� ,/ Class: 1 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/0 I N/A JDNC I KEY; C[complies] N/O[not observed] N/A[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 [+y0 N1A 4'' 62 Written tlocamentatiod of training program 2 A Food workers have no exposed infected lesions/burns 1 Approved source,Wholesome,, Personnel with infection restrictedWholesome,,nortadulterated C N/0 N/A 4 C Communicable disease of worker reported to local health director A Approved shellfish,finfish,meat&poultry USDA approved B Food cans in good condition(not dented,rusty,bloated,leaking) 13 Handwashing facilities provided,hands washed,clean C N10 NIA 4 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 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 requirements C N10 N1A =4 0 during storage,preparation,display,service and transportation' 15 Good hygienic practises C N/0 NIA 2 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 450F. I B Wounds covered adequately C Proper cooling C Proper sink used for handwashing D Proper re-heating -HI p E Proper internal cooking/consumer advisory posted 24 Unitization rinse(hot water chemical) C N/0 N1A 2 0 A Approved sa nitizer available/adequate concentration of sanitizer 4 Adequate facilities to maintain product C NO N1A 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 /17 C Adequate ❑dishwashersanitizer ❑final rinse temp B Proper food thermometer for product L Proper san!izin rocedure C Thermometers appropriately placed in cooler units E Sanitizing between raw animal origin&ready-to-eat food 0 0 / _4� 7 Food protected during storage, Glean wiping cloths C N/0 .NIi 1 p g ag ,preparation, C N10 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 loll B Raw meats not stored/prepared near ready-to-eat foods O 26 Food-cot>itacf surfaces clean C N10 .N1A 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 F No pooling of eggs not cooked immediately C Food contact surfaces clean 0 8 ootl containers stored off the floor 30 Hut and cold water under pressure,provided as required N/0 9 Handling of food rrrrtirnized NIA 2 0 38 Handwashing accessories provided C N/0 NIA C N/O A 2 A No unnecessary handling RTE and/or cooked foods with bare hands A Soap/paper towels/ drying device available or B Dispenser(s)working: ❑Soap ❑Paper towel B Minimize food handling,other than ready-to-eat,with bare hands C 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: 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 1Lyes 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): Ewhere: onitored 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 roduce washing policy? Y N *Describe what is washed and inspection: Note: This report is a two page form(total of 62 debitable items) Page 1 of 2 Estabhshrn�nt bate of tntpcfilon, ddirss. f?wfter or`4peratau: 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 4 Proper type/installation/backflow prevention device/air gap for: -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 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, -Monitoring in compliance 4 -Water quality in compliance designed,properly installed OTHER ITEMS KEY: DNC [DOES NOT COMPLY] 2 Sources of food: Original container,properly labeled 40 Garbage/rubbish storage arealrooms,enclosures-properly constructed,clean 1 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 ermin Control: No insects/rodents present 14 Food worker:Clean outer clothes,effective hair restraints 1 43 Outeropenings protected against entrance of insects/rodents 1 Floors: Floor covering installed,constructed as required,good repair,clean fi 16 Food-contact surfaces designed,constructed,maintained,installed, 2 V9Floors graded,drained as required 61.1 located 6 Floor,wall juncture covered 17 Nonfood-contact surfaces designed,constructed, maintained, 47 Mats removable,good repair,clean installed,located 18 Single service articles,storage,dispensing 2 Exterior walking,driving surfaces,good repair,clean 1 19 No reuse of single service article Walls,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 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 ccurate thermometers provided,dish basket,if used 54 Rooms adequate,clean,adequate lockers provided,facilities clean 1 Nonfood-contact surfaces of utensils&equipment clean 1 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 56 Complete separation from living/sleeping quarters and laundry 1 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 3 59 Seats 75 or more:Nonsmoking area provided,sign(s)posted at 37 Proper toilet ' fixturesprovided,good repair,clean entrance(s),smoking area indicated by sign(s) 3 39 Approved garbage/rubbish containers,adequate number,covered, 1 rodent proof,clean tine Inspection ❑Reinspection ❑ Preoperational Inspection (Other Inspection: INSPECTOR: jPERS. I CH Demerit Score: *Include demerits from page 1 4 3 2 1 Total Rating nature / /k printtnnnaaa�mee' IT l��— � 1�1 t �2 ® � � � DATE CORRECTIONS DUE: phone number Iq � title�� flrE,S�- �fi "/ ,,�cu14;C.V, Page 2 of 2 plus continuation pages Facused Inspection 1/2002 Page of INSPECTION REPORT STATE OF CONNECTICUT FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH CONTINUATION SHEET NAME OF ESTABLISHMENT TOWN DATEOF INSPECTION ` INSPECTION REMARKS FORM# cc Id.A I. S-mQln i v� d7 � 1 � INITIAL(INSPECTOR) INITIAL(PERSON IN CHARGE) Cvi Distribution: 1st-White-Health Department 2nd-Yellow-Owner/Manager