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Home My WebLink AboutFood Service Establishment Inspection ch i Establishment: Inspection Date: $ j Time: ,'3,5-" REins ddress/City: ti� Health Dept: Class: 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 /0 N/A IDNC jam; C[complies] N/O[not observed] N/A[not applicable] 3 DNC[does not comply] 0[other] RTE[ready-to-eat] _01,61 Designated A t irnat8' All�' 2 `fr►�fton ras is ! C N10 1 4; 62 iltfrttten doctrmentation of tralrAng program A Food workers have no exposed infected lesions/burns 2 B Personnel with infection restricted t Approved source,wholesome, C N10 iA 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) T ng provided, ! !! t: 1+1t(} 1f 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 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 Rat0 al r haUrd s Rood ntee - � appropriate Handwashing at a prate times dttring orage,preparation,display,s®rvfC� d - g. Tv 0 r F pra6ffEes C N/0 NA Z A Hot holding greater than or equal to 140°F. (whole beef/pork roasts 1300 F.) A ❑ No eating ❑ No smoking while working B Cold holding less than or equal to 45°F. B Wounds covered adequately 001, C Proper Cooling C Proper sink used for handwashing D Proper re-heating 0 E Proper internal cooking/consumer advisory posted _.�l� L,roti �: r t 4 0 A Approved sanitizeravailable/adequateconcentrationofsanitizer et Ado quae,,fa1 bt t g Food-contact surfaces and utensils used for potentially tertaperai4trp n no tern >�root hazardous food sanitized at least every 4 hours d ,a N , A Food thermometer available and accurate C Adequate ❑dishwashersanitizer ❑final rinse temp B Proper food thermometer for product D Proper sanitizin rocedure C Thermometers appropriately placed in cooler units E Sanitizing between raw animal origin&ready-to-eat food 0 7 d piofi ct8ri'cliirirag sftstag ;'p n, C' wo display,service and transportation 17 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 10 0 �F T C Food covered properly UMENSIMEd A Food equipment clean,utensils clean,equipment interiors clean D Adequate splash guards I sneeze guard g Single use gloves changed when soiled E No unauthorized personnel 000 F No pooling of eggs not cooked immediately C 0 Food—contact surfaces clean 8 Food containers stored off the floor kk � x a f Wknclff of food rrriirtliftfzed°` A t �;, �. a , A No unnecessary handling RTE and/or cooked foods with bare hands ►- 10 A Soap/paper towels/ drying device available B Minimize food handling,other than ready-to-eat,with bare hands 1100 B Dispenser(s)working: ❑Soap ❑Papertowel C Adequate utensil(s)for dispensing food/ice C Handwash sink(s)clean/waste receptacle at handwash sink 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 aftemate],PHF[potentially hazardous food],FB[foodborne] PHFs are hot held at: OF PHFs are cold held at: °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 Is there a language barrier between inspector&QFO?_Y N If-yes 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): Lwhere: 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 CFO responsibilities information at the time of the there a produce 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 Establishment: Date of Inspection: Address: Ck b 1 H ( �J t '�'- � Owner or Operator:. ADDITIONAL FOUR POINT ITEMS KEY: DNC [DOES NOT COMPLY] 6 Foods not re-served. -Unwrapped foods not re-served 4 31 Sewage disposal approved. A -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 Proper type/installation/backflow prevention device/air gap for: -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. -Food equipment -Dish machines -Ice machines -Well/well head protected from contamination 35 Toilet facilities. Adequate,convenient,accessible, -Water quality in compliance : 1! ac ro erl i -Monitoring in compliance 9 p p y installed OTHER ITEMS KEY: DNC [DOES NOT COMPLY] 2 Sources of food:Original container,properly labeled 40 Garbage/rubbish storage area/rooms,enclosures properly constructed,clean 5 Potentially hazardous food properly thawed 41 Garbage/rubbish disposed of in an approved manner,at approved frequency 10 Food dispensing utensils properly stored 42 Vermin Control: No insects/rodents present 14 Food worker:Clean outer clothes,effective hair restraints 43 Outeropenings protected against entrance of insects/rodents 4 Floors: Floor covering installed,constructed as required,good repair,clean 16 Food-contact surfaces designed,constructed,maintained,installed, 45 Floors graded,drained as required located 6 Floor,wall juncture covered 17 Nonfood-contact surfaces designed,constructed, maintained, 7 Mats removable,good repair,clean installed,located 18 Single service articles,storage,dispensing 8 Exterior walking,driving surfaces,good repair,clean 19 No reuse of single service article 49 Walls,ceilings attached,equipment properly constructed,good 20 Dishwashing facilities approved design,adequately constructed, repair,clean.Wall&ceiling surfaces as required maintained installed located 50 Dustless cleaning methods used,cleaning equipment properly stored Equipment&Utensils: Cleanliness 51 Adequate lighting provided as required 21 Preflushed,scraped,soaked and racked 52 Room free of steam,smoke odors 22 Wash water clean,proper temperature 531 Rooms&equipment hoods,ducts,vented as required 23 Accurate thermometers provided,dish basket,if used 54 Rooms adequate,clean,adequate lockers provided,facilities clean 27 Nonfood-contact surfaces of utensils&equipment clean 55 Establishment and premises free of litter,no insect/rodent harborage, 28 Equipment/utensils,storage,handling no unnecessary articles 32 Proper disposal of waste water 56 Complete separation from living/sleeping quarters and laundry 33 Plumbing location,installation,maintenance 57 Clean/soiled linens stored properly 36 Toilet rooms enclosed with self-closing door 58 No live birds,turtles,or other animals(except guide dogs) 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) 39 Approved garbagelrubbish containers,adequate number,covered, rodent proof,clean utine ins 1711einspection 13 Preoperational Inspection INSPECTOR: ERN HA E: Other Inspection: Demerit Score: •Include demerits from page 1 IAN 4 3 2 1 Total Rating si ture print name pant nam@, phone number tits DATE ORRECTIONS DUE: Page 2 of 2 plus—L continuation pages Focused Inspection 1/2002 r • Pag _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 cl rIAC( C2 r2c—� ,lot L7 INITIAL(INSPECTOR) INITIAL(PERSON IN CHARGE) Distribution: 1st-White-Health Department 2nd-Yellow-Owner/Manager