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Home My WebLink AboutFood Service Establishment Inspection 84 (3) i Establishment: Inspection Date: Time: Rol RE[nsp ddress/City: t a � Health Dept: SAk� Class: 1 2 3� 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] 3 DNC[does not comply] 0[other] RTE[ready-to-eat) r 2 4Dp � s►f#ra>nig pro�ars A Food workers have no exposed infected lesions/burns 1 pptovsd Sfi(rC@;VItFlC(BSt)1318; do i3�afetl - C A[/0 NIA ;4 B Personnel with infection restricted C Communicable disease of worker reported to local health director A A roved shellfish,finfish,meat&poultry USDA approved 13 Hand" B Food cans in good condition(not dented,rusty,bloated,leaking) C Wholesome/nonadulterated foods/safe A Handwash facilitiess in n a all food prep/dispensing&warewash areas lo 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 E Handwashing at appropriate times' INA: 4 0 flood> A Hot holding greater than or equal to 140°F. (whole beef/pork roasts 1300 F) A ❑ No eating ❑ No smoking while working ( B Cold holding less than or equal to 45°F. B Wounds covered adequately C Proper cooling C Proper sink used for handwashing D Proper re-heating t) E Proper internal cooking/consumer advisory posted t{) 2 Sal A Approved sanitizer available/adequate concentration ofsanitizer Q, NA 2' g Food-contact surfaces and utensils used for potentially hazardous food sanitized at least every 4 hours WE, A Food thermometer available and accurate 0,o,7 C Adequate ❑dishwashersanitizer ❑final rinse temp B Proper food thermometer for product D Proper sanitizin rocedure C Thermometers appropriately placed in cooler units 1011 E Sanitizing between raw animal origin&ready-to-eat food p 0 °25 `ClAati' y, +[+qe�1ts!ttltspfrFB �aini A Cloths and/or sponges in good repair and clean 00 A Produce washed B Wiping cloths kept in sanitizer between uses 000r B Raw meats not stored/prepared near ready-to-eat foods O 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 F No pooling of eggs not cooked immediately 7 Food--contact surfaces clean 8 Food containers stored off the floor O �S " I /A No unnecessary handling RTE and/or cooked foods with bare e hands A Soap paper towels drying device available B B Minimize food handling,other than ready-to-eat,with bare hands Dispenser(s)working: ❑Soap ❑Paper towel C C Adequate utensil(s)fordispensingfood/ice Handwash sink(s)clean/waste receptacle at handwash sink T o •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[foodbome] PHFs are hot held at: F. PHFs are cold held at: F. 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): 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 IF Establishment: Date of Inspection: Address: Fri v - owner or Operator: r ADDITIONAL FOUR POINT ITEMS IN KEY: DNC [DOES NOT COMPLY] a, 6 Foods not re-served. -Unwrapped foods not re-served 4 31 Sewage disposal approved. 4 -Operating required -Potentially hazardous foods not re-served p g as 11 Toxic chemicals. No cross connections,back siphonage,backflow W Proper type/installation/backflow prevention device/air gapfor: -Stored properly,labeled properly,used properly jff� G -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 -Chemical dispensers -Ice machines -Pesticides/rodenticides properly dispensed 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 d -Monitoring in compliance AN designed,properly installed OTHER ITEMS KEY: DNC [DOES NOT COMPLY] 2 Sources of food:Original container,properly labeled 401 Garbage/rubbish storage area/rooms,enclosures-properly constructed,clean �1 5 Potentially hazardous food properly thawed 41 Garbagelrubbish disposed of in an approved manner,at approved frequency 10 Food dispensing utensils properly stored 421 Vermin Control: No insects/rodents present 14 Food worker:Clean outer clothes,effective hair restraints 43 Outer openings protected against entrance of insects/rodents 1: 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 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 1, s equipment 19 No reuse of single service article 9 Walls,ceilings� g attached, properly constructed,goad 1- repair,clean.Wall&ceiling surfaces as required 20 Dishwashing facilities approved design,adequately constructed, maintained installed located 50 Dustless cleaning methods used,cleaning equipment properly stored Equipment&Utensils; Cleanliness 5 11 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 541 Rooms adequate,clean,adequate lockers provided,facilities clean 27 Nonfood-contact surfaces of utensils&equipment clean 55 Establishment and premisesfree 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 properly Clean/soiled linens stored ro 33 Plumbing location,installation,maintenance 57 Clean p p y 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 Propertoiletfixturesyrovided,good repair,clean entrance(s),smoking area indicated by sign(s) 39 Approved garbage/rubbish containers,adequate number,covered, rodent proof,clean I JWutine Inspection OReinspection [3 Preoperational Inspection Other Inspection: INSPECTOR: PERSON IN CHARGE: Demerit Score: *Include demerits from page 1 4 3 2 1 Total Rating si ure sig e t print name nam I l ZT C5> t&,-- VVV phone number tide DATE CORRECTIONS DUE: a Page 2 of 2 plus continuation pages Focused Inspection 1/2002 • Page '3 of INSPECTION REPORT STATE OF CONNECTICUT FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH CONTINUATION SHEET NAME OF ESTABLISHMENT TOWN DATE OF INSPECTION A-)l2 INSPECTIcK FORM# REMARKS � k" � �P INITIAL(INSPECTOR) INITIAL(PERSON IN CHARGE) Distribution: 1st-White-Health Department 2nd-Yellow-Owner/Manager