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Home My WebLink AboutFood Service Establishment Inspection 17 (23) Establishment: S Q Inspection Date: Time: 0130 o, ROins RE[nsp Address/City: l S Health Dept: S. t.�J:,(\AAtl✓ class; 1 2 30 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 /O N/A DNC KEY: C[complies] NIO[not observed] NIA[not applicable] 3 DNC[does not comply] 0[other] RTE[ready-to-eat] n n4re' C N/0 NIA: 4 *' 2 A Food workers have no exposed infected lesions/burns t rrrEb�o ofauuRg progi ae 2 B Personnel with infection restricted cr 1 i3lasOt Of Rpli,dultt'Iated C NIU,N!A' 4 C Communicable disease of worker reported to local health director A Approved shellfish,finfish,meat&poultry USDA approved 93' Hsndwashin facttities B Food cans in good condition(not dented,rusty,bloated,leaking) 9 C ' 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 I Proper handwash procedure 0 E Handwashing at appropriate times 0 Cs A Hot holding greater than or equal to 1400F. (whole beef/pork roasts 130e e) v A ❑ No eating ❑ No smoking while working B Cold holding less than or equal to 450 F. B Wounds covered adequately C Proper cooling C Proper sink used for handwashing D Proper re-heating 0 E Proper internal cooking I consumer advisory posted A Approved sanitizeravailable/adequate concentration of sanitizer B Food-contact surfaces and utensils used for potentially E hazardous food sanitized at least every 4 hours A Food thermometer available and accurate t10 C Adequate Sdishwashersanitizer ❑final rinse temp B Proper food thermometerfor product D Proper san tizin rocedure Sanitizing between raw animal origin&ready-to-eat food C Thermometers appropriately placed in cooler units 0 �,. w.�� .,f, -,-K ,• ,,,., „ A Cloths and/or sponges in good repair and clean . . ._.. B Wiping cloths kept in sanitizer between uses A Produce washed B Raw meats not stored/prepared near ready-to-eat foods 0 C Food covered properly A Food equipment clean,utensils clean,equipment interiors clean D I Adequate splash guards I 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 Ai I 0 I iA,,A- A No unnecessary handling RTE and/or cooked foods with bare hands Soap/paper towels/ drying device availableB Dispenser(s)working: ❑Soap ❑Papertowel 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 0 0 •DESCRIBE DEFICIENCIES ON CONTINUATION SHEETS The following information is not debitable and does not affect your score. KEY: 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 CFO? 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 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): 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 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 s u Establishment: nr�Q,r' c�'S Date of Inspection: Z ddress: t'/\A Owner or Operator:)('- in 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 -Potentially hazardous foods not re-served No cross connections,back siphonage,backflow 11 Toxic chemicals.-Stored properly,labeled properly,used properly Proper pe/installation/backflow prevention device/air gap for: -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 Prover 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] 2 Sources of food:Original container,properly labeled 40 Garbage/rubbish storagearea/rooms,enclosures-propedy 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 14 ors: 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,walljuncture covered 17 onfood-contact surfaces designed,constructed,maintained, 7 Mats removable,good repair,clean stalled,located 18 Agle 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 epair,clean.Wall&ceiling surfaces as required 20 Dishwashing facilities approved design,adequately constructed, maintained installed located 50 stless cleaning methods used,cleaning equipment properlystored Equipment&Utensils: Cleanliness 57 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 27 Nonfood-contact surfaces of utensils&equipment clean 55 Establishment and premises free of litter,no insect/rodent harborage, E uipment/utensils,storage,handling no unnecessary articles 32 roper disposal of waste water 56 Complete separation from living/sleeping quarters and laundry 35 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 Propertoilet fixtures provided,good repair,clean 59 Seats 75 or more:Nonsmoking area provided,sign(s)posted at entrance(s),smoking area indicated by sign(s) 39 Approved garbage/rubbish containers,adequate number,covered, rodent proof,clean Ukoutine Inspection ❑Reinspection ❑ Preoperational Inspection Other Inspection: INSPECTOR: PER SG"CHARGE: Demerit Score: *Include demerits from page 1 /)/)JA r - - �2_ � 4 3 2 1 Total Rating si ture rg pri t n e f printname 2< v � ` 1 1A�h� DATE CORRECTIONS DUE: p one number title 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 r-1 INSPECTION REMARKS `FORM# l 0 (y �7n� cS �— ✓-Q� c v ✓ c U✓ � ^ S- K0 CQJ3J — VI/l 7-6 18�eAov Leti (�-Ia L- 4i VIA I c Vb L4j d dl W A 4 Ltj A Z w v hcs m v-,eoic —ir, �1 - v �- — J / k,) U PA 11 INITIAL(INSPECTOR) INITIAL(PERSON IN CHARGE) Distribution: 1st-White-Health Department 2nd-Yellow-Owner/M ager .r.rr