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Home My WebLink AboutFood Service Establishment Inspection 98 (6) i Establishment: Inspection Date: Time: >�� REinsp ddress/City: 6Health Dept: LJ 1 e/,y'011 Class: 1 2 Based on an inspection this day1he 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 DNC KEY: C[complies] N/0[not observed] N/A[not applicable] 66 AE 9fied Fecd Q, arator x g DNC[does not comply] 0[other] RTE[ready-to-eat] &S61bfiel With infectton restricted' 61 Designated AlternateAoo 2 C N/0: NIA 4 q Food workers have no exposed infected lesions/burns 62 Written documentation of training program 1 Approved source,wholesome,nrnadulterated C NIO NIA 4 B Personnel with infection restrictedC Communicable disease of worker reported to local health director A 1 Approved shellfish,finfish,meat&poultry USDA approved 13 Handwashing facilities provided,bands washed,clean ic NI0 NIA 4 B Food cans in good condition(not dented,rusty,bloated,leaking) ol A I Handwash facilities in all food prep/dispensing&warewash or areas C Wholesome/nonadulteratedfoodslsafe 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 potsrttt d hfd d mes#s tat � r 0 edng�raa� ppaonisg iYOfc i c tees �C N0' VA 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. 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 jkn611 M^ ;� :fia i z ti+Qri rtr se(t1c>#,water i al) I C {�' NI 0 A Approved sanitizer available/adequate concentration of sanitizer 4 Adequate facilities FQ ma ain'prei �t s� � "� J,� g Food-contact surfaces and utensils used for potentially temperature,thermometers provi 2hazardous food sanitized at least every 4 hours A Food thermometer available and accurate equate ❑dishwashersanitizer ❑final rinse temp B Proper food thermometer for product Proper sa itizin rocedure E Sanitizing between raw animal origin&ready-to-eat food C Thermometers appropriately placed in cooler units 0 0 FQad protected dur#ncg starag�, N a � : 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 0 B Raw meats not stored/prepared near ready-to-eat foods C Food covered properly Food equipment clean,utensils clean,equipment interiors glean 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 VJ � a warn cFi1,srcit ,m' 0 W Hindiingl of food minimized A Soap/paper towels/ drying device available A No unnecessary handling RTE and/or cooked foods with bare hands B Dispenser(s)working: ❑Soap ❑Papertowel B Minimize food handling,other than ready-to-eat,with bare hands 01 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. -KEY: QFO[qualified food operator],DA[designated alternate],PHF[potentially hazardous food], FB[foodborne] PHFs are hot held at: IF. PHFs are cold held at: OF. Describe illness conditions when you would exclude a food worker from working: Are intb�nal 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 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 Establish nt: Iftl Date of Inspection: Address: Owner or Operator: ADDITIONAL FOUR POINT ITEMS KEY: DNC [DOES NOT COMPLY] 6 Foods not re-served. 4 31 Sewage disposal approved. -Unwrapped foods not re-served 4' di ti Operang as required -Potentially hazardous foods not re-served - 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 machinesProper drain for: 29 Water source adequate,safe. -Food equipment -Dish machines -Ice machines -Well/well head protected from contamination rdesig tfacilities. Adequate,convenient,accessible, -Monitoring in compliance-Water quality in compliance ned,properly 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 Vermin Control: No insects/rodents present 14 Food worker:Clean outer clothes,effective hair restraints 43 Outer openings 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 7 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 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 ,Accurate thermometers provided,dish basket,if used 54 Rooms adequate,clean,adequate lockers provided,facilities clean 2 Nonfood-contact surfaces of utensils&equipment clean 55 Establishment and premises free of lifter,no insect/rodent harborage, 8 uipment/utensils,storoge,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 Propertoiletfixturesprovided,good repair,clean entrance(s),smoking area indicated by sign(s) 39 Approved garbage/rubbish containers,adequate number,covered, rodent proof,clean WRoutine Inspection ❑Reinspection ❑ Preoperational Inspection Other Inspection: INSPECTOR: N I HA E Demerit Score: *include demerits from page 1 4 3 2 1 Total Rating si �turej sig a 7W Orint name hone number title CORRECTIONS DUE: � r Page 2 of 2 plus continuation pages Focused Inspection 1/2002 Page o't' ` INSPECTION REPORT STATE OF CONNECTICUT FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH CONTINUATION SHEET NAME OF ESTABLISHMENT TOWN DATE OF INSPECTION INSPECTION FORM# REMARKS S — lit naQf--�-011 � .� i;(j f/)-z�3- 4,-X , , v, �k �w�i r l «r • pa" c--�- r , / V -46 dAW c INITIAL(INSPECTOR) INITIAL(PERSON IN CHARGE"), , Distribution: 1st-White-Health Department 2nd-Yellow-Owner nager Pa e of INSPECTION REPORT STATE OF CONNECTICUT FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH CONTINUATION SHEET NAME OF ESTABLISHMENTb TOWN DATE O IN ECTION i\� INSPECTION FORM# REMARKS Lf 4ZIr-l)L-Z r- - l �� INITIAL(INSPECTOR) INITIAL(PERSON IN CHARGE) Distribution: 1 st-White-Health Department 2nd-Yellow-Owner/Ma er