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Home My WebLink AboutFood Service Establishment Inspection 57 (10) i Establishment: Inspection Date: Time: Oinsp REins Address/City: Health DeptS /., 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 DNC KEY: C[complies] Ill[not observed] NIA[not applicable] fibttrarar, 3 Dill[does not comply] 0[other] RTE[ready-to-eat] °P�':csia f w 'erufiirescted 61 Qesignated A terrxate' 2 G W 119A 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,rtanadulterated C N/0 !A 4 C Communicable disease of worker reported to local health director XI B o roved shellfish,condsh,ition meat&dented, USDA approved I iaiiduv h Rg 6 ,pr#ttided,handswashotl clean, N10, N/A 4 B Food cans in good condition(not dented,rusty,bloated,leaking) C Wholesome/nonadulterated foods/safe A Handwash facilities in all food prep/dispensing&warewash areas B Handwash facilities in or immediately adjacent to toilet rooms D Commercial products(no home grown/canned food) kiC 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 Poteitfielly hazardous food. S tem per tufe r a is l q during storage,preparation, i_61is,y,service a a o ,T aood"hyg%nt practices C N/0' WA 2 A Hot holding greater than or equal to 1400F. (whole beef/pork roans 1300 e) A ❑ No eating ❑ No smoking while working Cold holding less than or equal to 450F. B Wounds covered adequately C Proper cooling C Proper sink used for handwashing D Proper re-heating XI 0 E Proper internal cooking/consumer advisory posted fpttlre }t►#'wdt cltet #�tt} 0 A Approved sanitizeravailableladequate concentration ofsanitizer 4 Adequate facilllties to inain pit B Food-contact surfaces and utensils used for potentially ternperatlare,ttt rrrtomtetsrs ravided hazardous food sanitized at least every 4 hours A Food thermometer available and accurate C Adequate 00shwashersanitizer ❑final rinse temp B Properfoodthermometerforproduct D Proper sanitizin rocedure C Thermometers appropriately placed in cooler units E Sanitizing between raw animal origin&ready-to-eat food Food protected during sti`rae;prpa _ t 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 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 C Food--contact surfaces clean F No pooling of eggs not cooked immediately 0 8 Food containers stored off the floor 10 7-3 jV Hartidltttg of food rttnirnize! x A Soap/paper towels 1 drying device available A No unnecessary handling RTE and/or cooked foods with bare hands B Dispenser(s)working: ❑Soap ❑Paper towel B Minimize food handling,other than ready-to-eat,with bare hands C Handwash sinks)clean/waste receptacle at handwash sink C Adequate utensils)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 atemate],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 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 ff-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): 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 rIs there a produce washing policy? Y N ♦Describe what is washed and inspection:here: Note: This report is a two page form(total of 62 debitable items) Page 1 of 2 v,£ Establishment: Date of Inspection: t Address: 'S Owner or Operator: ADDITIONAL FOUR POINT ITEMS KEY: DNC [DOES NOT COMPLY] z 6 Foods not re-served. -Unwrapped foods not re-served 4 31 Sewage disposal approved. 4' -Potential)Y hazardous foods not re-served -Operating as required 11 Toxic chemicals. 34 No cross connections,back slphonage,backflow 4, -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 -Water quality in compliance 35 Toilet facilities. Adequate,convenient,accessible, 4, -Monitoring in compliance ' designed,properly installed OTHER ITEMS KEY: DNC [DOES NOT COMPLY] 2 Sources of food: Original container,properly labeled Garbage/rubbish storage area/rooms,enclosures-properly constructed,clean 5 Potential) hazardousfood ro erl thawed Y p p Y 1 Garbage/rubbish disposed of in an approved manner,at approved frequency Food dispensing utensils properly stored 42 Vermin Control: No insects/rodents present 4 hood worker:Clean outer clothes,effective hair restraints teropenings protected against entrance of insects/rodents 4 oors: Floor covering installed,constructed as required,good repair,clean 16 Food-contact surfaces designed,constructed,maintained,installed, 2r5 Floors graded,drained as required located or,17 Nonfood-contact surfaces designed,constructed,maintained, wall juncture covered 7 is removable,good repair,clean installed,located s ; 18 Single service articles,storage,dispensing Exterior walking,driving surfaces,good repair,clean f!' 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 ustless 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 54 Rooms adequate,clean,adequate lockers provided,facilities clean Nonfood-contact surfaces of utensils&equipment clean 55 Establishment and premises free of litter,no insect/rodent harborage, Equipment/utensils,storage,handling 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 58 No live birds,turtles,or other animals(except guide dogs) 36 Toilet rooms enclosed with self-closing door 59 Seats 75 or more:Nonsmoking area provided,sign(s)posted at 37 Propertoiletfixturesprov!ded,good repair,clean entrance(s),smoking area indicated by sign(s) .39 Approved garbage/rubbish containers,adequate number,covered, rodent proof,clean ❑Routine Inspect! einsp t'o ❑ Preoperational Inspection INSPECTOR: WIA : Other Inspection: Demerit Score. • nclude demerits from page 1 4 3 2 1 Total Rating s' ature � / 1/✓/Q `� 1pri t name , �> K—C91cl^2 S It (/ phone number f �j titl DATIt CORRECTIONS DUE: `'( a" UD 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 LISHM NT TOWN DATE OF INSP TION Tr t2 v t4 INSPECTION FORM# REMARKS n (� 1 /AlnL�J �Y • r(II-V r e lip VaJJ 0_)� 6�343L,_�e �►vh D� w INITIAL(INSPECTOR) INITIAL(PE C ARGE) Distribution: 1st-White-Health Department 2nd�_ erfflanager Page of / INSPECTION REPORT STATE OF CONNECTICUT FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH CONTINUATION SHEET NAME OF ESTABLISHMENT TOWN DATE OF INSPECTIO 1-1 MilkipezA LJl V/d-sj,-- INSPECTION REMARKS FORM# Zd, INITIAL(INSPECTOR) INITIAL(PERSON IN CHARGE) Distribution: 1st-White-Health Department 2nd-Yellow-Owner/Manager