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Home My WebLink AboutFood Service Establishment Inspection 12 (11) Establishment: A Inspection Date: ddress/City. 1� Time: t5 ROir RNsp Health Dept: 0"" Class: 1 2 4' Based on an inspection this day,the items marked DNC identify he 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 itemfl C V410 N/A III KEY: C[complies] N/O[not observed] NIA[not applicable] $ DNC[does not comply] 0[other] RTE[ready-to-eat] 2 . .4 1111tlu Kim rrt 2 A Food workers have no exposed infected lesions/burns /A 4 u B Personnel with infection restricted C Communicable di 11 sease of worker reported to local health director A A roved shellfish,finfish meat&poultry USDA a roved B Food cans in good condition(not dented,rusty,bloated,leaking) '-' Bn� it 'Pdd ;lta► ls ,glean ,C` t+1f13 N/A ;4°' C Wholesome/nonadulterated foods/Safe A Handwash facilities in all food prep/dispensing arewash 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 E Handwashing at appropriate times 0 .,..� ,,. A Hot holding greater than or equal to140°F. (wnaeneeri�orer°a5rs�so°F.I ``'' °t a ° A ❑ No eating ❑ No smoking while working B Cold holding less than or,qual 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 sanitize,availablwadequate concentration ofsanitizer B Food-contact surfaces and utensils used for potentially hazardous food sanitized at least every 4 hours A Food thermometer available and accurate C Adequate ishwashersanitizer Ofinal rinse temp B Proper food thermometer for product D Pro ersanitizin roce lure C Thermometers appropriately placed in cooler units E Sanitizing between raw animal origin&ready-to-eat food 0 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 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 Famm In A No unnecessary handling RTE and/or cooked foods with bare hands A Soap/paper towels/ drying device available B Minimize food handling,other than ready-to-eat,with bare hands B Dispenser(s)working: ❑Soap ❑Paper towel C Adequate utensil(s)for dispensing food/ice Handwash sink(s)clean/waste receptacle at handwash sink 0 0 The following information is not debitable and does not affect your score. JSEY: QFO ua f lBE DEFICIENCIES ON CONTINUATION SHEETS [qified operator],DA[designated aftemate],PHF[potentialty hazardous food],FB[foodborne] PHFs are hot held at: °F. 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 Roasts Other What diseases related to FB illness are you required to report to the local health department? 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 IL yes 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): 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: Sa,r ono k C Inat c a� r i Address: Date of Inspection: Owner or Operator: ADDITIONAL FOUR POINT ITEMS 6 Foods not re-served. KEY: DNC [DOES NOT COMPLY] -Unwrapped foods not re-served 4 31 Sewage disposal approved. -Potentially hazardous foods not re-served -Operating as required 11 Toxic chemicals. No cross connections,back ,Iphonage,backflow -Stored properly,labeled properly,used properly Pr r tvoe/installation/ba kflow prevention device/air gap f„�• -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 ChAical dispensers -Ice machines -Proper drairi 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 storagearea/rooms,enclosures-properly constructed,clean 5 Potentially hazardous food properly thawed 1 Garbage/rubbish disposed of in an approved manner,at approved frequency 10 Food dispensing utensils properly stored 2 Vermin Control:No insects/rodents p 14 Food worker:Clean outer clothes,effective hair restraints resent 3 Outeropeningsprotectedagainstentranceofinsects/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,wall juncture 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 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 Eauinm nt&Utensilsi Cleanlinesc 21 Preflushed,scraped,soaked and racked 51 Adequate lighting provided as required 2 Wash water clean,proper temperature 52 Room flee 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 8 Equipment/utensils,storage,handling 55 Establishment and premises tree 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(s) entrance(s),smoking area indicated by sign(s) posted at 39 Approved garbage/rubbish containers,adequate number,covered, rodent proof,clean outine Inspection ❑Reinspection ❑ Preoperational Inspection I T R: p I Other Inspection: Demerit Score: *Include demerits from page 1 sig ture sign ure 4 3 2 1 Total Rating pri am f ir^_ print ie � [ UU Phone number title DATE CORRECTI NS DUE: Page 2 of 2 plus I continuation pages Focused Inspection 1/2002 Page of 3 �r INSPECTION REPORT STATE OF CONNECTICUT FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH CONTINUATION SHEET NAME OF ESTABLISHMENT TOWN i OF INSPECTION INSPECTICO l -\ �� I FORM# REMARKS —Ln Vk C-) CI ✓ INITIAL(INSPECTOR) INITIAL(PERSON IN CHARGE) Distribution: 1st-White-Health Department 2nd-Yellow- Owner/Manager