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Home My WebLink AboutFood Service Establishment Inspection 57 (8) i Establishment: Inspection Date:_1 o Time: Address/City: " 1�it��s�a Health Dept: (�' �ra2Basedonan inspection this day,the items marked DNC identify the violations in operation or facilities which must be corrected by the date specifie RISK FACTOR ITEMS: Listing is not inclusive of all possible debatable items C N/0 N/A DNC KEY: C[complies] NIO[not observed] NIA[not applicable] 60 Qualified Food Operator 3 DNC[does not comply] 0[other] RTE[ready-to-eat] 61 Designated Alternate 2 12 Personnel with infection restricted C N/0 N/A 4 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,nonadalt aced C N/0 WA 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 Hantlwashing facilities provided,hands washed,clean C N/0 N/A 4' C Wholesome/nonadulterated foods/Safe A Handwash facilities in all food prep/dispensing&warewash areas B Handwash facilities in or immediately adjacent to toilet room 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 requirements C N/O N/A 4 E Handwashing at appropriate times 100 daring storage,preparation,display,service and transportation 15 'Good hygienic practices C N/0 N/A 2.' A Hot holding greater than or equal to 1400F. (Whole bee6pork roasts 130o F.) A ❑ No eating ❑ No smoking while working B Cold holding less than or equal to 450 F. d 70 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 Sanitization rinse(hot water=chemical) C N/0 N/A 2 0 N A Approved sanitizeravailable/adequate concentration ofsanitizer 4 Adequate facilities to maintain product C NO 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_ di ❑final rinse temp B Proper food thermometer for product D Proper san tizin rocedure C Thermometers appropriately placed in cooler units E Sanitizing between raw animal origin&ready-to-eat food 0 0 7 Food protected during storage, 25 Clean wiping cloths C N/0 N/A 1 P 9 a8e,preparation, C N/0 N/A 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 B Raw meats not stored/prepared near ready-to-eat foods O ood-contact surfaces clean C N/0' 2 C Footl covered properly A Food equipment clean,utensils clean,equipment interiors clean D Adequate splash guards/sneeze guard E No unauthorized personnel B Single use gloves changed when soiled F No pooling of eggs not cooked immediately C Food--contact surfaces clean 0 8 Food containers stored off the floor 30 Hot and cold water under pressure,provided as required 0 0 6 andwast/ing accessories provided C wo N/A 9 Handling of food minimized C N N/A 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 hantlwash sink C Adequate utensil(s)fordispensing food/ice 0 0T_ 1-4— *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 Roasts Other What diseases related to FB illness are you required to report to the local health department? 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 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):CFO DA Mgr Cook Owner FW •Obtain signature of the person who received the CFO 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 �' tN ��3er3tt3i. ADDITIONAL FOUR POINT ITEMS 3 KEY: DNC [DOES NOT COMPLY] 6 Foods not re-served. -Unwrapped foods not re-served 4 31 Sewage disposal approved. -Potentially hazardous foods not re-served -Operating as required 4' 11 Toxic chemicals. No cross connections,back siphonage,backflow Proper t e/installation/backflow prevention device/air a for: 4 -Stored properly,labeled properly,used properly type/installation/ Pgap -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 machines Proper drain for: 29 Water source adequate,safe. 4 -Food equipment -Dish machines -Ice machines -Well/well head protected from contamination -Water quality in compliance 35 Toilet facilities. Adequate,convenient,accessible, 4 -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 5 Potentially hazardous food properly thawed 2 1 Garbage/rubbish disposed of in an approved manner,at approved frequency 10 Food dispensing utensils properly stored 1 2 ermin Control: No insects/rodents present 14 Food worker:Clean outer clothes,effective hair restraints I Outeropenings protected againstentrance of insects/rodents 1 4Moors: Floor covering installed,constructed as required,good repair,clean 16 Food-contact surfaces designed,constructed,maintained,installed,located 2 ' S Floors graded,drained as required 6 Floor,wall juncture covered 17 Nonfood-contact surfaces designed,constructed, maintained, 1 installed,located 7 Mats removable,good repair,clean 8 Exterior walking,driving surfaces,good repair,clean 18 Single service articles,storage,dispensing 2 1 19 No reuse of single service article 49 Ails,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 properly stored 1 Equipment&Utensils: Cleanliness l 51 Adequate lighting provided as required 1 21 Preflushed,scraped,soaked and racked 52 Room free of steam,smoke odors 22 Wash water clean,proper temperature 1 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 7 onfood-contact surfaces of utensils&equipment clean 55 Establishment and premises free of litter,no insect/rodent harborage, 1 Equipment/utensils,stprage,handling >( no unnecessary articles 32 Proper disposal of waste water 56 Complete separation from living/sleeping quarters and laundry 1 33 Plumbing location,installation,maintenance 1 57 Clean/soiled linens stored properly 1" 36 Toilet rooms enclosed with self-closing door 77, 58 No live birds,turtles,or other animals(except guide dogs) 1 59 Seats 75 or more:Nonsmoking area provided,sign(s)posted at 37 Proper toilet fixtures provided,good repair,clean _ 3 entrance(s),smoking area indicated by sign(s) 39 Approved garbage/rubbish containers,adequate number,covered, rodent proof,clean outine Inspection ❑Reinspection ❑ Preoperational Inspection INSPECTOR: f GE: Other Inspection: Demerit Score: *Include demerits from page 1 4 3 2 1 Total Rating nature / 41 print name phone number title DATE CORRECTIONS DUE: �C 0 Page 2 of 2 plus continuation pages Focused Inspection 1/2002 ' Page 3 Of 3 INSPECTION REPORT STATE OF CONNECTICUT FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH CONTINUATION SHEET NAME OF ESTABLISHMENT TOWWNy DATE OF IINSPECCTRIONN Vc 26 INSPECTION FORM# REMARKS v � S , ti n.A— �,Lf �4 INITIAL(INSPECTOR) INITIAL(PERSON IN CHA Distribution: 1st-White-Health Department 2nd-Yellow-Owne anag r