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Home My WebLink AboutFood Service Establishment Inspection 76 (5) i Establishment: pw Inspection Date: Time: tins sp Address/City: E S (� �I CJgj�, Health Dept: ( ►1 _ 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 debitable items C I N/0 I N/A JDNC KEY: C[complies] N/O[not observed] NIA[not applicable] 3 1 DNC[does not comply] 0[other] RTE[ready-to-eat] f1ID - 1 �lt. ,, 2 1 Minn documetdadon of training program 2 A Food workers have no exposed infected lesions/bums B Personnel with infection restricted 1 Approved source,WhOl@some,nona6literated C N/0 N/A C Communicable disease of worker reported to local health director A Approved shellfish,finfish,meat&poultry USDA approved 101, 13 landwashing fdcilties provitled, p B Food cans in good condition(not dented,rusty,bloated,leaking) - ,. ° _ - 1 6 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) C Handwash facilities accessible/convenient to use 0 E Potentially hazardous foods received at proper temperature D Personnel hands washed,clean/Proper handwash procedure E Handwashing at appropriate times I_ N/a N/A 4' 0 ''t e A Hot holding greater than or equal to 1400F. (whole beef/pork roans 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 ' 'q' 0 A Approved sanitizer available/adequate concentrationof sanitize r s No MA :.2� ote B Food-contact surfaces and utensils used for pntially r hazardous food sanitized at least every 4 hours A Food thermometer available and accurate D Propersanitizin C Adequate ❑dishwashersanitizerrocedure rins B Proper food thermometer for product E Sanitizing between raw animal origin&ready-to-eat food C Thermometers appropriately placed in cooler units 0 0 xMINNIE �. . N/0 N/A 2 a r• . tf s yr s 4vtoe Bttd treatsportaitio t A Cloths and/or sponges in good repair and clean 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 45inees changed when soiled E No unauthorized personnel C urfaces clean F No pooling of eggs not cooked immediately 08 Food containers stored off the floor 0 ,°s, !; N/0 NIA 2 . _. .�. e A wels/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 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 aftemate],PHF[potentially hazardous food],FB[foodbome] 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 If yes 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: Nd Date of Inspection: Address: Owner or Operator: ADDITIONAL FOUR POINT ITEMS KEY: DNC [DOES NOT COMPLY] a' 6 Foods not re-served. -Unwrapped foods not re-served 4 31 Sewage disposal approved. 4, -Potentially hazardous foods not re-served = -Operating as required 11 Toxic chemicals. No cross connections,back siphonage,backflow Proper type/installation/backflow prevention device/air gap for: -Stored properly,labeled properly,used properly -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 4 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-propedy 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 3 Outer openings 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 6 Floor,wall juncture covered 17 Nonfood-contactsurfaces designed,constructed,maintained, 471 Mats removable,good repair,clean installed,located 8 rior walking,driving surfaces,good repair,clean 18 Single service articles,storage,dispensing 19 No reuse of single service article �pair, clean.Wall&ceiling surfaces as required ceilings attached,equipment properly constructed,good 20 Dishwashing facilities approved design,adequately constructed, 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 231 Accurate thermometers provided,dish basket,if used ms adequate,clean,adequate lockers provided,facilities clean 27 Nonfood contact surfaces of utensils&equipment clean pex 55, stablishmentand premises free of litter,no insect/rodent harborage, 28 Equipmentlutensils,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) 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) 39 Approved garbage/rubbish containers,adequate number,covered, rodent proof,clean 0Routine Inspection DReinspection 0 Preoperational Inspection Other Inspection: ./ INSPECTOR: PE I R E: Demerit Score: *Include demerits from page 1 4 3 2 1 Total Rating gna re / ,r signqtp print pn name phone number �i tide N� `DATE CORRECTI NS DUE: Page 2 of 2 plus continuation pages Focused Iuspectiou 1/2002 Page of--) iel Q�v INSPECTION REPORT STATE OF CONNECTICUT FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH CONTINUATION SHEET NAME OF ESTABLISHMENT TOWN DATE OF INSPECTION M(- )-0 INSPECTION FORM# REMARKS 416 ssLao 5 \ 1 INITIAL(INSPECTOR) INITIAL(PERSON IN CHARGE) Distribution: 1st-White-Health Department 2nd-Yellow-Owner/Manage