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Home My WebLink AboutFood Service Establishment Inspection 19 (5) .3 Establishment: Inspection Date: Time: oin Kin Address/City: q e�int� \J He Dept: lei iV� A d, Class: 1 2 3 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 /0 N/A DNC �: C[complies] N/0[not observed] N/A[not applicable] 3 DNC[does not comply] 0[other] RTE[ready-to-eat] 2 W� � n r r60111 . p t o 4 A Food workers have no exposed infected lesions I burns 62 rrt nation of frainhg pmgram 2 B Personnel with infection restricted Apits► e� fce,t+uho)esd e,rttiliadtlltSCat�d C- 0 NIA 4 C Communicable disease of worker reported to local health director A Approved shellfish,finfish,meat&poultryUSDA approved 13 MamWashing facilities provided,'hands washed,clan C B Food cans in good condition(not dented,rusty,bloated,leaking) '' NIA 4' A Handwash facilities in all food prep/dispensing&warewash areas C Wholesome/nonaduIterated 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 temperature1-4-11 0 D Personnel hands washed,clean/Proper handwash procedure 011E Handwashing at appropriate times 0 1 ciotl hjfgiiiti;pr 'ti es' a, C 0 N/A 2 A Hot holding greater than or equal to 140°F. (whole beef/pork roasts 1300 E) 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 0 E Proper internal cooking/consumer advisory posted A Approved sanitizeravailable/adequate concentration ofsanitizer g Food-contact surfaces and utensils used for potentially hazardous food sa 'tized at least every 4 hours A Food thermometer available and accurate C Adequate Vshwashersanitizer ❑final rinse temp B Properfood thermometer for product D Proper sanitizin rocedure C Thermometers appropriately placed in cooler units oo E Sanitizing between raw animal origin&ready-to-eat food 0 a Cloths and/or sponges in good repair and clean A Produce washed B Wiping cloths kept in sanitizer between uses B Raw meats not stored/prepared near ready-to-eat foods oo, 0 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 8 ood containers stored off the floor 0 A No unnecessary handling RTE and/or cooked foods with bare hands A Soap/paper towels/ drying device available B Dispenser(s)working: ❑Soap ❑Papertowel B Minimize food handling,other than ready-to-eat,with bare hands LC Handwash sink(s)clean/waste receptacle at handwash sink A2dequate utensil(s)for dispensing food/ice 0 0 C •DESCRIBE DEFICIENCIES ON CONTINUATION SHEETS The following information is not debitable and does not affect your score. 19Y: QFO[qualified food operator],DA[designated alternate],PHF[potentially hazardous food],FB[foodbome] PHFs are hot held at: IF. 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 CFO/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 Establishment: Q4PAA J Qt,, ko�.4,A" Date of Inspection..In 7Z ddrt ss: -0— S�Miej C�kck, R\0-X-. Owner or Operator: �;�O_n ihclo ADDITIONAL FOUR POINT ITEMS KEY: DNC [DOES NOT COMPLY] 6 Foods not re-served. 4 31 Sewage disposal approved. -Unwrapped foods not re-served -Operating as required 4' -Potentially hazardous foods not re-served 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-No unnecessary toxics on the premises -Soda system carbonator -Beverage dispensers -Toilet tanks-Pesticides/rodenticides properly dispensed -Chemical dispensers -Ice machinesProper 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 designed,properly installed -Monitoring in compliance OTHER ITEMS KEY: DNC [DOES NOT COMPLY] Sources of food: Original container,properly labeled 401 Garbage/rubbish storage area/rooms,enclosures-properly constructed,clean 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 43 Outer openings protected against entrance of insects/rodents 4 Floors: Floor covering installed,constructed as required,good repair,clean 16 ood-contact surfaces designed,constructed,maintained,installed, 45 Floors graded,drained as required located 6 Floor,wall juncture covered 17 onfood-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 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 MH maintained installed located stless cleaning methods used,cleaning equipment pro rlyst e Equipment&Utensils: Cleanliness 1 Adequate lighting provided as required 21 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 231 Accurate thermometers provided,dish basket,if used 54 Rooms adequate,clean,adequate lockers provided,facilities clean 7 Nonfood-contact surfaces of utensils&equipment clean 55 Establishment and premises free of lifter,no insect/rodent harborage, 8 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 Approved garbage/rubbish containers,adequate number,covered, rodent proof,clean 12Routine Inspection ❑Reinspection ❑ Preoperational Inspection Other Inspection: INSPECTOR: PERSON IN CHARGE: Demerit Score: *Include demerits from page 1 4A& oz, ' 4 3 2 1 Total Rating signature signatu _TZ-7 ` rint name L print name 1 t iy-Zsi► g -� p no number title DATE CORRECTIONS DUE: Page 2 of 2 plus continuation pages Focused Inspection inoo2 Pages ofAl 3 INSPECTION REPORT STATE OF CONNECTICUT FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH CONTINUATION SHEET NAME OF ESTABLISHMENT TOWN DATE OF INSPECTION U ; ✓ INSPECTION FORM# REMARKS 0 rn 3 ✓ - �pcuwlx o � cJ s sku sect � �� ✓�2a l tl CA S\ :e e O dF S � L �� Z S Y"0 A ✓4 1n 1 W a J�- U L \o ova \c INITIAL(INSPECTOR) INITIAL(PERSON IN CHARGE) Distribution: 1 st-White-Health Department 2nd-Yellow-Owner/Manager ��U S�AA✓Un yv\cb0 , ,.Q j