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Home My WebLink AboutFood Service Establishment Inspection 17 (26) a Establishment: Inspection Date: o J Time: ROinsp RE sp ddress/City:/ l' Health Dept: IJw 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/O N/A IDNC I IKy: C[complies] N/O[not observed] N/A[not applicable] 3 DNC[does not comply] 0[other] RTE[ready-to-eat] ^° " �� 12 sore aid ct obi"retit�cted 61 Des)gnated a41#emote 2 W'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,nonadulterated C N1 /A 4 C Communicable disease of worker reported to local health director A Approved shellfish,finfish,meat&poultry USDA approved 13 Handilivelshing facilities provided,hands washed,clean' WO; i A q B Food cans in good condition(not dented,rusty,bloated,leaking) A Handwash facilities in all food prep/dispensing&warewash areas C Wholesome/nonadulterated foods/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/Proper handwash procedure 0 E Handwashing at appropriate times 3 Rotegtiafly hazardous fad meets,#emmperatttra ietrem�fs; tfq NiA 4 Q d�rriag sf,srag@,preparation„dif�iay,serrrlcs.aritl#raiPti4q �st 715 0tiuct Ivolenid.pradtlt" C N10 NA 2 A Hot holding greater than or equal to 1400F. (whole beef/pork roasts 1300 F.) A ❑ No eating ❑No smoking while working B Cold holding less than or equal to 450 F. KI IB Wounds covered adequately C Proper cooling C Proper sink used for handwashing D Proper re-heating E Proper internal cooking/consumer advisory posted PA 0 t( ' Approved sanitizeravailable/adequateconcentrationofsanitizer Afegt+ate fcilides.t 'nasihtln P�dt ( p � B Food-contact surfaces and utensils used for potentially tprrtpe, orii Y ett3fs. i �t1 xgn �� hazardous food sanitized at least every 4 hours , ^ . 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 Q i . " `Food plcrod'durrtg " eµ r dra{ibtl s. .""r $ i 'rfiptng tfZst C N/0 NVA 1 2l� A Cloths and/ors display,service and transportation sponges in good repair and clean A Produce washed B Wiping cloths kept in sanitizer between uses 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 g Single use gloves changed when soiled E No unauthorized personnel C Food--contact surfaces clean F No pooling of eggs not cooked immediately 0 8 Food containers stored off the floor 0 =z i` 9` fi d161i'o# 5� and mi i tizeE � N/ ESA ;t A No unnecessary handling RTE and/or cooked foods with bare hands Soap I paper towels/ drying device available B B Minimize food handling,other than ready-to-eat,with bare hands Dispenser(s)working: ❑Soap ❑Papertowel C Adequate utensil(s)for dispensing food/ice Handwash sink(s)clean/waste receptacle at handwash sink 01 1 1 •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: F. 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 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 A � Establishment: Date of Inspection: [Address: } Owner or Operatcr: ADDITIONAL FOUR POINT ITEMS KEY: DNC [DOES NOT COMPLY] z' 6 Foods not re-served. 4 31 Sewage disposal approved. 0.11 -Unwrapped foods not re-served 4 -Operating required -Potentially hazardous foods not re served 10� P g as 11 Toxic chemicals. No cross connections,back siphonage,backflow 77 -Stored properly,labeled properly,used properly AM Proper type/installation/backflow prevention device/air gap for: ` gm -Food equipment -Hose connections -Dish machines -Sanitizer concentration not to exceed maximum permitted -Soda system carbonator -Beverage dispensers -Toilet tanks -No unnecessary toxics on the premises _ -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 �-Monitoring in compliance designed,properly installed t� OTHER ITEMS KEY: DNC [DOES NOT COMPLY] 2 Sources of food: Original container,properly labeled 0 Garbage/rubbish storage area/rooms,enclosures-properly constructed,clean 5 Potentially hazardous food properly thawed 1 Garbage/rubbish disposed of in an approved manner,at approved frequency 10 Food dispensing utensils properly stored P 9 p P Y 2 Vermin Control: No insects/rodents present 14 Food worker:Clean outer clothes,effective hair restraints 3 Outeropenings protected against entrance 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, 471 Mats removable,good repair,clean installed,located 8 Exterior walking,driving surfaces,good repair,clean 18 Single service articles,storage,dispensing 19 No reuse of single service article 9 Walls,ceilings attached,equipment properly constructed,good repair,clean.Wall&ceiling surfaces as required 20 Dishwashing facilities approved design,adequately constructed, maintained installed located 501 Dustless cleaning methods used,cleaning equipment properly stored . EEquipment&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 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 insectlrodent harborage, 28 Equipment/utensils,storage,handling no unnecessary articles 32 Properdisposal 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 581 No live birds,turtles,or other animals(except guide dogs) 59 Seats 75 or more:Nonsmoking area provided,sign(s)posted at 37 Propertoiletfixtures provided,good repair,clean entrance(s),smoking area indicated by sign(s) 39 Approved garbage/rubbish containers,adequate number,covered, rodent proof,clean Otoutine Inspection ❑Reinspection ❑ Preoperational Inspection Other Inspection: INSPECTOR�://� p7ENIN CHARGE: Demerit Score: *Include demerits from page 1 /Y \ 4 3 2 1 Total Rating si ature 2print name l.�or i ��/ /��:K� �T(O phone number "! title DATE CORRECTIONS Page 2 of 2 plus continuation pages Focused Inspection 1/2002 Page PILAJ INSPECTION REPORT STATE OF CONNECTICUT FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH CONTINUATION SHEET NAME OF ESTABLISHMENT TOWN DATE OF INSPECTION r � INSPECTION FORM REMARKS # /rf, o Gc- I h L, 36PA J �► � lvn r .0 ° jam / y . L INITIAL(INSPECTOR) INITIAL(PERSON IN CHARGE) /Distribution: Ist-White-Health Department 2nd-Yellow-Owner/Manager