The URL can be used to link to this page

Home My WebLink AboutFood Service Establishment Inspection 96 (8) Establishment: e SS Inspection Date: Time: 10 r�E� o ROinsp REWK Address/City: Health Dept: So �W�nz�Jr� Class: 1 2 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 debitable items C N/0 N/A DNC KEY: C[complies] NIO[not observed] NIA[not applicable] ` Qp B DNC[does not comply] 0[other] RTE[ready-to-eat] 61 Designated Alternate 2 42 ersohhei With infe Alen restricted NO N/A 4 A Food workers have no exposed infected lesions/burns 62 Written documentation of training program 2 B Personnel with infection restricted 1 Approved SOFliCe,wholesome,rtonadUlterated Y N/0 NIA 4' C Communicable disease of worker reported to local health director B o roved shellfish, fonts,fish,meat&poultry USDA approved 13 Handwas ing facilities pnovvided,stands washed,clean C Wo NIA 4 B Food cans in good condition(not dented,rusty,bloated,leaking) A Handwash facilities in all food prep/dispensing&warewash areas C Wholesomelnonadulteratedfoods/safe B Handwash facilities in or immediately adjacent to toilet rooms D Commercial products(no home grown/canned food) C Handwash facilities accessible/convenient to use E Potentially hazardous foods received at proper temperature D Personnel hands washed,clean I Proper handwash procedure 0 E Handwashing at appropriate times 3 Potentia hazardous food ts ki" �t during storage,pteparatton,dispiair,sentltgdor#at nF Goad h rtic ractRces p c INVO I N/A 2' A Hot holding greater than or equal to 140eF. (Whole beef/pork roasts 1300 F) A ❑ No eating ❑ No smoking while working 01 B Cold holding less than or equal to 45e F. B Wounds covered adequately C Proper cooling J<orC Proper sink used for handwashing D Proper re-heating N E Proper internal cooking/consumer advisory posted ffAtstr 'et1�� ^ j Q . G17 0 Approved sanitizer available/adequate concentration of sanitizer 4 Ad'4ul facilities t ntcrw of t { B Food-contact surfaces and utensils used for potentially temperature,ttrerntornet piv rld6 -'' hazardous food sanitized at least every 4 hours A Food thermometer available and accurate C Adequate ❑dishwashersanitizer ❑final rinse temp Proper B Properfoodthermometerforproduct D E Sanitizing between raw animal origin&ready-to-eat food C Thermometers appropriately placed in cooler units yfy!y :- •:.� �.i E r�ru display,service add trar►epwtatitin A Cloths and/or sponges in good repair and cleanXF B Wiping cloths kept in sanitizer between uses A Produce washed 0 B Raw meats not stored/prepared near ready-to-eat foods C Food covered properly A Food equipment clean,utensils clean,equipment interiors clean D Adequate splash guards/sneeze guard B Single use gloves changed when soiled E No unauthorized personnel C Food--contact surfaces clean F No pooling of eggs not cooked immediately 8 Food containers stored off the floor 0 9 Handdin of food m nifntized g � I / A No unnecessary handling RTE and/or cooked foods with bare hands A Soap paper towels drying device availableB 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 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. JSE-Y: 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 If 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): Indicate the title of above person(circle all that apply):QFO DA Mgr Cook Owner FW Is cooling monitored for time&temp? Y N Is the monitoring of cooling recorded? Y N .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: I" S Date of Inspection: ddress: Owner or Operator: ADDITIONAL FOUR POINT ITEMS ` KEY: DNC [DOES NOT CO1%PLY] 6 Foods not re-served. -Unwrapped foods not re-served 4 31 Sewage disposal approved. -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: -Sanitizerconcentration 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 40 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 2 Vermin Control: No insects/rodents present 14 Food worker:Clean outer clothes,effective hair restraints 43 Outeropenings protected againstentrance of insects/rodents loors: 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 9 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 53 Rooms&equipment hoods,ducts,vented as required 23 Accurate thermometers provided,dish basket,if used Rooms adequate,clean,adequate lockers provided,facilities clean Nonfood-contact surfaces of utensils&equipment clean 12 55 Establishment and premises free of litter,noinsect/rodentharborage, 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 fixturesprovided,good repair,clean entrance(s),smoking area indicated by sign(s) 39 Approved garbage/rubbish containers,adequate number,covered, rodent proof,clean ❑Routine Inspection ❑Reinspection ❑ Preoperational Inspection INSPECTOR: PERSO A E: Other Inspection: Demerit Score: *Include demerits from page 1 4 3 2 1 Total Rating s' ture sig-n�re //gy�pp U4 L" Uo,d.,n '"rc. b�,1r-c�K lJ print name print�n me phone number I^� title DATE CORRECTIONS DUE: I Page 2 of 2 plus continuation pages Focused Inspection 1/2002 Page—? of INSPECTION REPORT STATE OF CONNECTICUT FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH CONTINUATION SHEET NAME OF ESTABLISHMENT TOWN DATE OF �SPEC ION p C&), ' t 3 INSPECTION FORM# REMARKS Ub nryy;, L 11\v�� i �h►°-� �ivex�r�il�� --dam� �/f� s�� u-��, �, _ �x�l� ��f l r rIA16 '— Y�d c Lf Zvi' ��- > jCV1� - l 4u-y\ —4� r w Q > 11) \ n INITIAL(INSPECTOR) INITIAL(PERSON IN CHARGE) Distribution: 1 st-White-Health Department 2nd-Yellow-Owner/Manager