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Home My WebLink AboutFood Service Establishment Inspection 85 (16) Establishment: bLA W; r nspection Date: Time:LlRotns Min S Address/City: zs )aHy'. k R w A• Health ept: class: 1 2 3 Based on an inspection this day,the items marked DNC identify a 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 iterV6 C /O WA IDNC I KEY: C[complies] NIO[not observed] NIA[not applicable] 3 1 DNC[does not comply] 0[other] RTE[ready-to-eat] A Food workers have no exposed infected lesions I burns " dD # 1iRi >ti titplltPog(dttl 2 B Personnel with infection restricted , � , .,a Act 5tJ1J ,_ rhtrtspme,, d N/A 4 C Communicable disease of worker reported to local health director A Approved shellfish,finfish,meat&poultry USDA approved 131 Handwashing facilities prodded,hands wa hed,clean 0 N/A 4 B Food cans in good condition(not dented,rusty,bloated,leaking) A Handwash facilities in all food prep/dispensing&warewash areas C Wholesome/nonadulterated foods/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 O E Handwashing at appropriate times 0 1 trod te(ntc`'pra" IdO AHot holding greater than or equal to 1400F. (whole beef/pork roasts 130e F) A ❑ No eating ❑ No smoking while working B Cold holding less than or equal to 45o F. IX B Wounds covered adequately C Proper cooling C Proper sink used for han ing D Proper re-heating C E Proper internal cooking/consumer advisory posted A Approved sanitizer available/adequate concentration of sanitizer B Food-contact surfaces and utensils used for potentially hazardous food sa ''zed at least every 4 hours A Foodthermometer available and accurate L.0r C Adequate gTishwashersanitizer ❑final rinse temp D Proper sanitizin procedure B Properfood thermometer for product E Sanitizing between raw animal origin&ready-to-eat food C Thermometers appropriately placed in cooler units 0 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 Single use gloves changed when soiled E No unauthorized personnel C Food--contact surfaces clean F No pooling of eggs not cooked immediately 0 Food containers stored off the floor A Soap I paper towels I drying device available 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 k Ell' 0 0 •DESCRIBE DEFICIENCIES ON CONTINUATION SHEETS The following information is not debitable and does not affect your score. _M: 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&CFO? Y N ILM indicate language spoken List products cooled: by CFO/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 CFO responsibilities information at the time of the Is there a produce washing policy? Y N *Describe what is washed and inspection: where: I I Note: This report is a two page form(total of 62 debitable items) Page 1 of 2 Room Establishment: tJ✓ Date of Inspection: *-\ ( -ZA(N Address: 8" � 1� }C k �2 ly Owner or Operator: tS fh&k 1 Ptd g rv,i ADDITIONAL FOUR POINT ITEMS .�k KEY: DNC [DOES NOT COMPLY] 6 Foods not re-served. -Unwrapped foods not re-served 41 31 Sewage disposal approved. -Potentially hazardous foods not re-served -Operating as required No cross connections,back siphonage,backflow 11 Toxic chemicals. Proper type/installation/backflow prevention device/air gap for: -Stored properly,labeled properly,used properly -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 35 Toilet facilities. Adequate,convenient,accessible, -Water quality in compliance -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-properly constructed,clean 5 Potentially hazardous food properly thawed 41 Garbage/rubbish disposed of in an approved manner,at approved frequency 1 >d dispensing utensils properly stored 42 Mrmin Control: No insects/rodents present 14 Food worker:Clean outer clothes,effective hair restraints 43 Outer openings protected against entrance of insects/rodents rs: Floorcovering installed,constructed as required,good repair,clean 16 Food-contact surfaces designed,constructed,maintained,installed, 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 S gle service articles,storage,dispensing 8 Exterior walking,driving surfaces,good repair,clean 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 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 271 Nonfood-contact surfaces of utensils&equipment clean 55 Establishment and premisesfreeof litter,noinsect/rodentharborage, 28 Equipment/utensils,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 Proper toilet fixtures provided,good repair,clean entrance(s),smoking area indicated by sign(s) 39 1 Approved garbage/rubbish containers,adequate number,covered, 11 rodent proof,clean Woutine Inspection OReinspection 0 Preoperational Inspection IN PET PERSON IN CHARGE: Other Inspection: Demerit Score: *Include demerits from page 1,-�Z A::�_ 4 3 2 1 Total Rating nature si nature p i t nai print name `2 pi- p one number title DATE CORRECTIONS DUE: �� 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 ESTABLISHMENT TOWN DATE OF INSPECTION INSPECTION REMARKS FORM# ��J Q/i,.J goeC ✓ �5' k, o wl ✓�e_e - s b �vC, W(v cko �J b nj v1Lj-e,4ed n -,7ff a �S d � ( 4( A in (2:e('01l (�- lbnuwn� �l k v-P✓ i C iN,V1 ►� S v INITIAL(INSPECTOR) INITIAL(PERSON IN CHARGE) Distribution: Ist-White-Health Department 2nd-Yellow-Owner/Manager