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Home My WebLink AboutFood Service Establishment Inspection 99 (2) Establishment: Inspection Date: Time: I Dam _ Ro[nsp REins Address/City: h ';:iv vA. Health Dept: a (s�J' 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 item C /0 WA DNC KEY: C[complies] N/O[not observed] NIA[not applicable] 3 DNC[does not comply] 0[other] RTE ady-to-eat] 2 <� A Food workers have no exposed infected lesions/burns 2 B Personnel with infection restricted / , � H � !) C:N/A ��_ C Communicable disease of worker reported to local health director A Approved shellfish,finfish,meat&poultry USDA approved 13; Ft�tdt+ithtn 40�;towtdel,tBnt ,ws#(ed,tom`, ` ► qq q B Food cans in good condition(not dented,rusty,bloated,leaking) Pr A Handwash facilities in all food prep/dispensing&warewash areas C Wholesome/nonadulteratedfoods/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 0 E Handwashing at appropriate times 0 A Hot holding greater than or equal to 1400F. (wholebee6porkroastsl3l)'l A ❑ No eating ❑ No smoking while working B Cold holding less than or equal to 450F. B Wounds covered adequately Loo C Proper cooling C Proper sink used for handwashing D Proper re-heating too 0 E Proper internal cooking/consumer advisory posted _ how t 0 A Approved sanitizes available/adequate concentration ofsanitizer B Food-contact surfaces and utensils used for potentially IMF,I hazardous food sanitized at least every 4 hours A Foodthermometer available and accurate C Adequate ❑dishwashersanitizer ❑final rinse temp f 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 0 w I `: A Cloths and/or sponges in good repair and clean ce washed (� B Wiping cloths kept in sanitizer between uses A Produ 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 8 Food containers stored off the floor to mail NOW NE" `a � I I No unnecessary handling RTE and/or cooked foods with bare hands W.` A Soap paper towels drying device available B Dispensers)working: ❑Soap ❑Paper towel B Minimize food handling,other than ready-to-eat,with bare hands C I Handwash sink(s)clean/waste receptacle at handwash sink C Adequate utensils)for dispensing food/ice 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[foodbome] 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 Iflf ves indicate language spoken List products cooled: by QFOl *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):CFO 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: Note: This report is a two page form(total of 62 debitable items) Page 1 of 2 DEP - Establishment: -J -'r Date of Inspection:® Address: Q _ Owner or Operator: I t ADDITIONAL FOUR POINT ITEMS KEY: DNC [DOES NOT COMPLY] 6 Foods not re-served. 4 31 Sewage disposal approved. -Unwrapped foods not re-served 4 -Operating as required -Potentially hazardous foods not re served 11 Toxic chemicals. No cross connections,back siphonage,backflow 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-Water quality in compliance rdesg t fned,properly installedacilities. Adequate,convenient,accessible, -Monitoring in compliance OTHER ITEMS KEY: DNC [DOES NOT COMPLY] 2 Sources of food: Original container,properly labeled 40 Garbage/rubbish storage area/rooms,enclosures-properly 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 43 Outer openings 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 18 Single service articles,storage,dispensing 8 Exterior walking,driving surfaces,good repair,clean 19 No reuse of single service article 9 alls,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 EEquipment&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 54 Rooms adequate,clean,adequate lockers provided,facilities clean 7 Nonfood-contact surfaces of utensils&equipment clean 55 Establishment and premisesfree of litter,noinsect/rodentharborage, 28 Equipment/utensils,storage,handling no unnecessary articles 32 Proper disposal of wastewater 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 4 11 BRoutine Inspection ❑Reinspection ❑ Preoperational Inspection Other Inspection: IN E T R: - E R SON IN OAR GE: Demerit Score: *Include demerits from page 1 4 3 2 1 Total Rating si ature I p in na p' n m Tl"d '77({plro&—number title DATE CORRECTIONS DUE: Page 2 of 2 plus continuation pages Focused Inspection 1/2002 - Pagq 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# OIL- Aqo " p x c bO , C. - 44 I Al D INITIAL(INSPECTOR) INITIAL(PERSON IN CHARGE) VP Distribution: 1st-White-Health Department 2nd-Yellow-Owner/Manager