The URL can be used to link to this page

Home My WebLink AboutFood Service Establishment Inspection 84 (4) Establishment: ' C1,., Inspection Date: Time: Roinsp REinsp ddress/City: &f , Health Dept: Class: 1 2 <41 Based on an inspection this day,the items marked DNC identifoe 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 0 NIA NCI KEY: C[complies] N/O[not observed] NIA[not applicable] 3 DNC[does not comply] 0[other] RTE[re -to-eat] 2KY A Food workers have no exposed infected lesions I burns B� din 2 B Personnel with infection restricted 'xtf►Qtf od ` C10 �f C Communicable disease of worker reported to local health director AI Approved shellfish,finfish,meat&poultry USDA approved 13 llarldweshin *gJjWes provided �htul0Waslwd, B Food cans in good condition(not dented,rusty,bloated,leaking) NfA A A Handwash facilities in all food prep/dispensing&warewash areas C Wholesome/nonadulteratedf0ods/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 E Handwashing at appropriate times 0 g t o A Hot holding greater than or equal to 1400F. (whole beeflpork roasts 130o F.) A ❑ No eating ❑ No smoking while working B Cold holding less than or equal to 450 F. B Wounds covered adequately jZ C Proper cooling C Proper sink used for handwashing D Proper re-heating 0 E Proper internal cooking/consumer advisory posted 0 A Approved sanitizeravailableladequate concentration ofsanitizer B Food-contact surfaces and utensils used for potentially hazardous food st d at least every 4 hours A Food thermometer available and accurate C Adequate ' washersanitizer ❑final rinse temp D Proper sanitizin rocedure B Proper food thermometer for product E Sanitizing between raw animal origin&ready-to-eat food C Thermometers appropriately placed in cooler units 0 Rol A Cloths and/or sponges in good repair and clean , B Wiping cloths kept in sanitizer between uses A Produce washed 0 B Rawmeatsnot stored/prepared near readytoeatfoods C Food covered properly A Food equipment clean,utensils clean,equipment interiors clean D Adequate splash guards/sneeze guard V B Single use gloves changed when soiled E No unauthorized personnel C Food--contact surfaces clean F No pooling of eggs not cooked immediately 0 ood containers stored off the floor 0 i 6 �n iMIN a: _ _z� A No unnecessary handling RTE and/or cooked foods with bare hands A Soap/paper towels/ drying device available B Dispenser(s)working: ❑Soap ❑Paper towel B Minimize food handling,other than ready-to-eat,with bare hands C j 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: OF. 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 Jf_=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 Establ`tshtnent:`Z) ✓mil L.ev, �N R C(�+ I( Date of Inspection: ( ((� � u. Address: R K t— y pan Rv e . Owner or Operator: J ADDITIONAL FOUR POINT ITEMS KEY: DNC [DOES NOT COMPLY] 6 Foods not re-served. r -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 -Stored properly,labeled properly,used properly Proper type/installation/backflow prevention device/air gap for: -Food equipment -Hose connections -Dish machines -Sanitizer concentration not to exceed maximum permitted -Soda system carbonator -Beverage dispensers -Toilet tanks -No an 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 35 Toilet facilities. Adequate,convenient,accessible, -Water quality in compliance -Monitoring in compliance designed,properly installed OTHER ITEMS KEY: DNC [DOES NOT COMPLY] Sources of food: Original container,properly labeled 40 Garbage/rubbish storagearea/rooms,enclosures-properly constructed,clean 5 Potentially hazardous food properly thawed 41 Garbage/rubbish disposed of in an approved manner,at approved frequency IT F od dispensing utensils properly stored 42 Vermin Control: No insects/rodents present 14 Food worker:Clean outer clothes,effective hair restraints 43 Outeropenings 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 17 Nonfood-contact surfaces designed,constructed,maintained, 7 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 20 Dishwashing facilities approved design,adequately constructed, repair,clean.Wall&ceiling surfaces as required maintained installed located 50 Dustless cleaning methods used,cleaning equipment properlystored Equipment&Utensils: Cleanliness 51 Adequate lighting provided as required 1 Preflushed,scraped,soaked and racked 52 Room free of steam,smoke odors 2 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 insecUrodent 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) 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 garbagelrubbish containers,adequate number,covered, rodent proof,clean lZRoutine Inspection ❑Reinspection ❑ Preoperational Inspection Other Inspection: IN T R: PERSON IN CHARGE: Demerit Score: *Include demerits from page 1 4�"4L ()alA 4 3 2 1 Total Rating i natur signs a Gj na Ib punt name � pri t name .41— YZ GN � ' DATE CORRECTIONS DUE: p o e num er"� title X Z Page 2 of 2 plus�_continuation pages Focused Inspection 1/2002 R Page-3 of 3 INSPECTION REPORT STATE OF CONNECTICUT FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH CONTINUATION SHEET NAME OF ESTABLISHMENT TOWN DATE OF INSPECTION ILIlam' iu S, L.'Ji k IKSP-ECTFORM# REMARKS FORM t' K--1 1 vh b � v1 �e i W i �� j ✓ rA, A Ok 6n oub✓- � O'n t4 16 C) CIS r-I J v V' INITIAL(INSPECTOR) INITIAL(PERSON IN CHARGE) Distribution: 1 st-White-Health Department 2nd-Yellow-Owner/Manager