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Home My WebLink AboutFood Service Establishment Inspection 17 (27) i Establishment: , Address/City: $ Inspection Date: Ir' Time: 1p Oins REinsp Based on an inspection this the items marked DNC identify the violations in operationeorifacilities which must be rrec�ted b the date s —� Ste: 1 2 3 RISK FAC 11 TOR ITEMS:Listing is not inclusive of all possible debatable items C /0 N/A DNC y specified on page 2. t ytali#f$s� ad Operator KEY: C[complies] NIO not observed] 61 9 3 DNC[does not comply] 0[other] t p A[no applicable] fadiAlt+trnta#e ,_; � wIG iora restrictd' RTE[ready-to-eat] fit 2 tlUxltten dec�mentafron of�� rp 9 p gym 2 A Food workers have no exposed infected lesions/burns C N/A 4 1 Approved source,wholesome,nonadulterated 0 N1A 4 B Personnel with infection restricted A A roved shellfish,finfish,meat& oult USDA a roved C Communicable disea I.se of worker reported to local health director B Food cans in good condition(not dented,rusty,bloated,leaking) 13' Nandwash fa facillales Provided,;bands wad",clean C fW410 NtA 4 C Wholesomel products'' It rated foods/Safe A Handwash facilities in all food prep/dispensing&warewash areas D Commercial products(no home grown/canned food) B Handwash facilities in or immediately adjacent to toilet rooms E Potentially hazardous foods received at Proper temperature C Handwash facilities accessible/convenient to use 0 D Personnel hands washed,clean/Proper handwash procedure 3 pt}tentlai#ir ha ardoUs rnej t E Handwashing of appropriate times € irtg storage,preparation,d4lai,�rvtc p 0 A Hot holding greater than or equal to 140°F. (Wnoio neanpo,k roars i3ooFl 1S yotrionte-pr tit , NA ;2' B Cold holding less than or equal to 45°F A No eating ❑ No smoking while working C Proper Cooling B Wounds covered adequately D Proper re-heating C Proper sink used for handwashing 0 E Proper internal cooking/consumer advisory posted t w 0 24 rriti`` �r�ttde W r 4 Adequate faellitfes to malrAi dtictA Approved sarnt¢eravailable/adequate concentration ofsanihzer teroltreritertoteterstA g Food-contact surtaces and utensils used for potentially �rovrd�#� t� hazardous food sanitized at least every 4 hours A Food thermometer available and accurate C Adequate �dishwashersanitizer nal rinse temp B Proper food thermometer for product D Pro ersanitizin rocedure C Thermometers appropriately placed in cooler units E Sanitizing between raw animal origin&ready-to-eat food 0 0r0f+ td1 . r dis Y.se,rvfee,antia tranapflrtation A Cloths and/or spo C l0 nges 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 0 C Food covered properly D Adequate splash guards/sneeze guard A Food equipment clean,utensils clean,equipment interiors clean` E No unauthorized personnel B Single use gloves changed when soiled F No pooling of eggs not cooked immediately C Food--contact surfaces clean 8 Food containers stored off the floor 0 0 1r.►t�lC w.c ,� r ' rrei3' d = 9 Harfood 9 of ro3 [trrized 3 No unnecessa "9a0cessartes provided C htf �tlA A ry handling RTE and/or cooked foods with bare hands !; 2 A Soap/paper towels/ drying device available 11 B Minimize food handling,other than ready-to-eat,with bare hands B Dispenser(s)working: ❑Soa p ❑Paper towel C Adequate utensil(s)fordispensing food/ice C Handwash sink(s)clean/waste receptacle at handwash sink 0 1 0 The following information is not debitable and does not affect your score. •DESCRIBE DEFICIENCIES ON CONTINUATION SHEETS BEY: QFO[qualified PHFs are hot held at: F PHFs are cold held at: food operator],DA[designated alternate],PHF[potentially hazardous food],FB[foodborne] Are internal cooking tem peratures taken? Y N o Pork F Describe illness conditions when you would exclude a d worker from working: Poultry ♦To what temper do you cook: Ground Beef Roasts Other What diseases related to FB illness are you r ired to report to the local health department? Describe re-heating procedures: Are temperatures recorded/logged for olding foods/equipment? Y N Is there a written illness policy th and diseases to the QFO? Y quires the food worker to report specific illness conditions Are foods cooked in advan nd cooled? Y ♦Do you have a paid sick leave policy? Y N List products cooled: N *Are leftovers saved? Y N Is there a language _ner between inspector&QFO? Y N I by QFO/DA: dyes indicate language spoken Describe co ng methods: *Can the QFO/DA read the inspection report? Y N 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 a I g Is there a produce washing y� ' apply):QFO DA Mgr Cook Owner FW Obtain signature of the person who received the CFO responsibilities information at the time of the g 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: ddress: Boo Date of Inspection: , ADDITIONAL FO POINT ITEMS Owner or Operator: 6 Foods not re-served. KEY: DNC [DOES NOT COMPLY] -Unwrapped foods not re-served 31 Sewage disposal approved. -Potentially hazardous foods not re-served -Operating as required 11 Toxic chemicals. No cross connections,back siphonage,backflow -Stored properly,labeled properly,used properly Wiper ne/installation/backflow prevention device/air gam: -Sanitizer concentration not to exceed maximum permitted Food equipment -Hose connections -Dish machines -No unnecessary toxics on the premises -Soda system carbonator -Beverage dispensers -Toilet tanks -Pesticides/rodenticides properly dispensed -Chemical dispensers -Ice machines 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, -Monitoring in compliance designed,properly installed OTHER ITEMS 2 Sources of food: Original container,properly labeled KEY: DNC [DOES NOT COMPLY] 0 Garbage/rubbish storage area/rooms,enclosures-properiyconstructed,clean Potentially hazardous food properly thawed 10 Food dispensin utensils properly stored 1 Garbage/rubbish disposed of in an approved manner,at approved frequency g 14 Food worker:Clean outer clothes,effective hair restraints 2 Vermin Control: No insects/rodents present 3 Outer openings protected against entrance ofinsects/rodents 16 Food-contact surfaces designed,constructed,maintained,installed, 4 Floors: Floor covering installed,constructed as required,good repair,clean located 5 Floors graded,drained as required 17 Nonfood-contact surfaces designed,constructed,maintained, 6 Floor,walljuncture covered installed,located 7 Mats removable,good repair,clean 18 Single service articles,storage,dispensing 8 Exterior walking,driving surfaces,good repair,clean 19 No reuse of single service article ails,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 Eauiom nt&Utensils: I anifnocc 21 51 Adequate lighting provided as required Preflushed,scraped,soaked and racked 22 Wash water clean,proper temperature 52 Room free of steam,smoke odors 23 Accurate thermometers provided,dish basket,if used 53 Rooms&equipment hoods,ducts,vented as required 27 Nonfood-contact surfaces of utensils&equipment clean 54 Rooms adequate,clean,adequate lockers provided,facilities clean 28 Equipment/utensils,storage,handling 55 Establishment and premises free of litter,no insect/rodent harborage, 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) 37 Proper toilet fixtures provided,good repair,clean 59 Seats 75 or more:Nonsmoking area provided,sign()posted osted at 39 Approved garbage/rubbish containers,adequate number,covered, entrance(s),smoking area indicated by sign(s) rodent proof,clean outine Inspection ❑Reinspection ❑ Preoperational Inspection PET PERSON I CH RGE: Other Inspection: Demeri core: *Include demerits from page 1 signature signatur 4 3 2 1 Total g Rating print name _ print a 1 U phone number _eAk� title�� DATE CORRECTIONS Page 2 of 2 plus�_continuation es a P g Focused Inspection 1@002 w w Paged of INSPECTION REPORT STATE OF CO' NNECTICUT CONTINUATION SHEET FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH NAME OF ESTABLISHMENT TOWN DATE OF INSPECTION INSPECTION FORM# REMARKS 6 � n � a 4 a -- o is - C� INITIAL(INSPECTOR) INITIAL(PERSON IN CHARGE) Distribution: 1st-White-Health Department 2nd-Yellow-Owner/Manager