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Home My WebLink AboutFood Service Establishment Inspection 65 (8) Establishment: Inspection Date: /cam v/ Time: Roans REinsp ddress/City:[ Health Dept:_, G`/j nI Class: 1 2 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 N/A JDNC KEY: C[complies] N/0[not observed] N/A[not applicable] 60 Qualified Food Operator 3 DNC[does not comply] 0[other] RTE[ready-to-eat] 61 Designated Alternate 2 12' Rersonn A with infection restricted C N(0 NIA 4 62 Wrfffen documentation of training program 2 A Food workers have no exposed infected lesions/burns 1 Approved source,wholesome,nonadulterated C N10 /A 4 B Personnel with infection restricted A A roved shellfish finfish meat& roved C Communicable disease of worker reported to local health director , , oult USDA a B Food cans in good condition(not dented,rusty,bloated,leaking) 13 Handwashing facilities provided,hands washed,clean C N/0 NIA 4' C Wholesome/nonadulterated foods/safe A Handwash facilities in all food pre 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 3 Potentially hazardous flood meets tern erature re sir E Handwashing at appropriate times p q ements C N/0 NIA 4 0 during storage,preparation,display,service and transportation 'A Hot holding greater than or equal to 140°F. (whole beeffpork roasts 130°F.) is Good hygienic practices C ITO NIA 2 A ❑ No eating ❑ No smoking while working B Cold holding less than or equal to45°F. 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 SanMzation rinse(hot water>chem.ical) C p N/A 0 A Approved sanitizer avail able/adequatecon centrationof onitizer 4 Adequate facilities to maintain product C N10 NZA 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 sanitize final p B Proper food thermometer for product D Pro ersanitizin roce lure C Thermometers appropriately placed in cooler units E Sanitizing between raw animal origin&ready-to-eat food 0 0 7 Food protected during storage a,Preparation, C NI0 NIA 25 dean wiping cloths C WO NIA 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 0 C Food covered properly 26 Food-contact surfaces clean C WO 'NIA 2 D Adequate splash guards/sneeze guard A Food equipment clean,utensils clean,equipment interiors clean E No unauthorized personnel B Single use gloves changed when soiled F No pooling of eggs not cooked immediately C Food--contact surfaces clean Food containers stored off the floor 0 30 Hot and cold water under pressure,provided as required NIO NIA 2 0 , 9 Handling of food minimized 36 Handwashing accessories provided C N10 N/A 1 ' ' C N/0 NIA 2,' A No unnecessary handling RTE and/or cooked foods with bare hands A Soap/paper towels/drying device available B Minimize food handling,other than ready-to-eat,with bare hands B Dispenser(s)working: []Soap ❑Paper towel C Handwash sinks)clean/waste receptacle at handwash sink C Adequate utensil(s)for dispensing food/ice 0 0 •DESCRIBE DEFICIENCIES ON CONTINUATION SHEETS PHFs are hot held at: °F. PHFs are cold held at: The following information is not debatable and does not affect your score. KEY: QFO[qualified food operator],DA[designated alternate],PHF[potentially hazardous food], FB[foodborne] F. 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 I Is there a language barrier between inspector&QFO? Y N 1f—M 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 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 ddre s, " t Owner or ootitor: 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 -Stored properly,labeled properly,used properly 4 Proper type/installation/backflow prevention device/air gap for: 4-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 1470 Garbage/rubbish storagearea/rooms,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 42 Vermin Control: No insects/rodents present 2 14 Food worker:Clean outer clothes,effective hair restraints 1 43 Outeropenings protected against entrance 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 5 Floors graded,drained as required located 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 Walls,ceilings attached,equipment properly constructed,good i 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 Eguipm nt&Utensils: Cleanlines 1 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 27 Nonfood-contact surfaces of utensils&equipment clean 1 55 Establishment and premises free of litter,no insect/rodent harborage, i 28 Equipment/utensils,storage,handling 1 no unnecessary articles 2 Proper disposal of waste water 1 56 Complete separation from living/sleeping quarters and laundry 1 lumbing location,installation,maintenance 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 1 37 Proper toilet fixtures provided,good repair,clean 59 Seats 75 or more:Nonsmoking area provided,sign(s)posted at 3 entrance(s),smoking area indicated by sign(s) 39 Approved garbage/rubbish containers,adequate number,covered, 1 rodent proof,clean ❑Routine Inspection ❑Reinspection ❑ Preoperational Inspection INSPECTOR: PERSON IN CHARGE: Other Inspection: 01. Demerit Score: *Include demerits from page 1 signs 4 3 2 1 Total Rating ign42in,4 tint a e p print name A �Y phone number /� title �� DATE CORRECTIONS DUE: "! Page 2 of 2 plus continuation pages =Inspection Page of INSPECTION REPORT STATE OF CONNECTICUT FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH CONTINUATION SHEET NAME OF ESTABLISHMENT TOWN DATE OF INSPECTION INSPECTION FORM REMARKS �zG J c, INITIAL(INSPECTOR) INITIAL(PERSON IN CHARGE) Distribution: 1st-White-Health Department 2nd-Yellow-Owner/Manager