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Home My WebLink AboutFood Service Establishment Inspection 76 (3) i F lishment: oti Inspection Date: Time: a REinsp ss/City: (paj ,ih � �,,Z Health Dept: G,J�, � -- Class—.: 1 �4 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 N/0 N/A DNC �; C[complies] N/0[not observed] NIA[not applicable] 6 id9C � -_ $ DNC[does not comply] 0[other] RTE[ready-to-eat] �s a a Ia jai t 61 Designatedatiternate 2 2°`'Petr ° i t et vvrtft i fk:11 ty restricted C N/0 N/A 4 62 Written docdmentatiion of training programs A Food workers have no exposed infected lesions/burns 2 B Personnel with infection restricted 1 Approved source,wbaiesorn e,nonadulterated C N 0 f+f/A 4 C Communicable disease of worker reported to local health director qEPotentially A roved shellfish,finfish,meat& oult USDA a roved Food cans in good condition(not dented,rusty,bloated,leaking) 13 Hah4w,ashring fames p ded,ha washed,clean' [1IQ Wholesome/nonadulterated foods/safe A Handwash facilities in all food prep/dispensing&warewash areas Commercial products(no home grown/canned food) B Handwash facilities in or immediately adjacent to toilet rooms hazardous foods received at propertemperature C Handwash facilities accessible/convenient to use 0 D Personnel hands washed,clean/Proper handwash procedure Potence d a'�F1S food 0 tinilp r � E Handwashing at appropriate times deInog age,preparatroa tlfs iay,serve e� d p¢ O x `$ t(fr ' pa*rt9 $. A Hot holding greater than or equal to 140°F. (whole beef/pork roans Sao°e> C N/0' WA 2 ° A ❑ No eating ❑ No smoking while working B Cold holding less than or equal to 45 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 postedg � tatr77 t; 2 0 A Approve dsanitizeravailableladequateconcentrationofsanitizer 01 4 Adegaa'te,faoil � B Food contact surfaces and utensils used for otentiall temperature,therinometire . ` hazardous food sanitized at least eve 4 hours y A Food thermometer available and accurate c Adequate ❑dishwashersanitiz final ri B Proper food thermometer for product D Pro ersanitizin rocedure C Thermometers appropriately placed in cooler units E Sanitizing between raw animal origin&ready-to-eat food 0 Co i pr6t8ctetl irr s + 0 ig ii CN/0 ay,serice and traportatiott A Cloths and/orspongesin good repair and clean ce washed B Wiping cloths kept in sanitizer between uses ats not stored/prepared near ready-to-eat foods0 overed properlyA Food equipment clean,utensils clean,equipment interiors clean te splash guards/sneeze guarduthorized personnel B Single use gloves changed when soiled ling of eggs not cooked immediately C Food--contact surfaces clean ntainers stored off the floor 0 0 ._. 9` HaradUng of fbod millrnmized C Nam"WA 2 F�t/tF N/ A No unnecessary handling RTE and/or cooked foods with bare hands Soa per / drying device available B Minimize food handling,other than ready-to-eat,with bare hands B Dis nser(s)working: []Soap ❑Paper to 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: CFO[qualified food operator],DA[designated aftemate],PHF[potentially hazardous food],FB[foodborne] PHFs are hot held at: °F. 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 Roasts Other 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):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 Establishment: Date of Inspection. a �, Address: i S1 Owner or Operator: e ADDITIONAL FOUR POINT ITEMS 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 RK 11 Toxic chemicals. 34 No cross connections,back siphonage,backflow -Storedproperly,labeledproperly,used ro properly Proper type/installation/backflow prevention device//air a for: p P Y gap -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 -Water quality in compliance 35 Toilet facilities. Adequate,convenient,accessible, -Monitoring in compliance designed,properly installed OTHER ITEMS KEY: DNC [DOES NOT COMPLY] 2 Sources of food: Original container,properly labeled 0 Garbage/rubbish storagearea/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 4 eropenings protected against entrance of insects/rodents oors: Floor covering installed,constructed as required,good repair,clean 16 Food-contact surfaces designed,constructed,maintained,installed,located 5 Floors graded,drained as required 17 Nonfood-contact surfaces designed,constructed,maintained, 6 Floor,wall juncture covered Installed,located 7 Mats removable,good repair,clean 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 0 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 EEquipment&Utensil I anlin ss 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 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 Nonfood contact surfaces of utensils&equipment clean 28 Equipment/utensils,storage,handling 55 Establishment and premises free of litter,no insect/rodent harborage, no unnecessary articles 32 Proper disposal of wastewater 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 otheranimals(except guide dogs) 37 Proper toilet fixtures provided,good repair,clean 59 Seats 75 or more:Nonsmoking area provided,sign(s)posted at entrance(s),smoking area indicated by sign(s) rl Approved garbage/rubbish containers,adequate number,covered,roden tt proof,clean utine Inspection ❑Reinspection ❑ Preoperational Inspection INSPECTOR: P R N IN HARGE Other Inspection: Imo, Demerit Score: *Include demerits from page 1 l si ture s nature 4 3 2 1 Total Rating i print name int rdb lna ✓ � � � �� phone number title �r DATE CORRECTIONS DOE: Page 2 of 2 plus continuation pages Focused Inspection 1/2002 Page of 2 INSPECTION REPORT STATE OF CONNECTICUT FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH CONTINUATION SHEET NAME OF ESTABLISHMENT TOWN DATE OF INSPECTION kn,v).,tfj'11 S ��su, INSPECTION FORM# .REMARKS Vf e i ^ r 4 l Ij l r f (// 1 LA/ G ck 4 Cn ,r INITIAL(INSPECTOR) INITIAL(PERSON IN CHARGE) Distribution: 1st-White-Health Department 2nd-Yellow-Owner/Manager