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Home My WebLink AboutFood Service Establishment Inspection 46 (10) L' Establishment: Inspection Date: ( Time: (U:3 da Will Einsp Address/City:i_4;� Q ,� Health Dept: Z1,n class: 1 2 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 LdJN10 N/A III KEY; C[complies] N/0[not observed] NIA[not applicable] 3 DNC[does not comply] 0[other] RTE r ady-to-eat] 2 fir 't1n cif t it Pi�A 4' m A Food workers have no exposed infected lesions I burns �tltfEiBtKN1 OfCSinitfgpfOgietl B Personnel with infection restricted Loo r/ t 3 3 fN Scnt ;` it tT ferdt8d C Nf0 NIA 4 C Communicable disease of worker reported to local health director A I Approved shellfish,finfish,meat&poultry USDA approved 13= H1*WWash n9 faci ies provided,frasdswow,cbm N/0 N/A 4 B Food cans in good condition(not dented,rusty,bloated,leaking) A Handwash facilities in all food prep/dispensing&warewash areas C Wholesome/nonadulteratedfoods/safe L4 I I 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 0 D Personnel hands washed,clean/Proper handwash procedure E Handwashing at appropriate times O Y ptF c des A Hot holding greater than or equal to 140eF. (whole beefleork roasts 130'F.) V A ❑ No eating ❑ No smoking while working B Cold holding less than or equal to 45e F. B Wounds covered adequately C Proper cooling 01 C Proper sink used for handwashing D Proper re-heating 0 E Proper internal cooking I consumer advisory posted 0 A Approved sanitizeravailable/adequate concentration ofsanitizer B Food-contact surfaces and utensils used for potentially hazardous food pnitized at least every 4 hours A rthermometmeravailableandaccurate C Adequate dishwashersanitizer ❑final rinse temp D Proper sanitizing procedure B meterfor product E Sanitizing between raw animal origin&ready-to-eat food C ppropriately placed in cooler units 0 O s �.! A Cloths and/or sponges in good repair and clean B Wiping cloths kept in sanitizer between uses A Produce washed 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 0 ofi"WRIM "``o ' a o � A Soap/paper towels/ drying device available A No unnecessary handling RTE and/or cooked foods with bare hands B Dispenser(s)working: ❑Soap ❑Paper towel B Minimize food handlin7 g,other than ready-to-eat,with bare hands C Handwash sink(s)clean I waste receptacle at handwash sink C Adequate utensil(s)for dispensing food/ice 60 0 O 1 •DESCRIBE DEFICIENCIES ON CONTINUATION SHEETS The following information is not debitable and does not affect your score. JSEY: 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 Il 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): 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 BOOM, i is �� z Establishment: (-loVt�iZ.2 Date of Inspection: ddress:(.. ��_ R � i Owner or Operator:CAIM ni o ADDITIONAL FOUR POINT ITEMS o KEY: DNC [DOES NOT COMPLY 6 Foods not re-served. -Unwrapped foods not re-served 4 31 Sewage disposal approved. -Potentially hazardous foods not re-served -Operating as required 74 No cross connections,back siphonage,backflow 11 Toxic chemicals. 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 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 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, 5 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 8 Exterior walking,driving surfaces,good repair,clean 18 Single service articles,storage,dispensing 19 No reuse of single service article 9 Walls,ceilings attached,equipment properly constructed,good i 20 Dishwashing facilities approved design,adequately constructed, repair,clean.Wall&ceiling surfaces as required maintained installed located 50 Dustless cleaning methods used,cleaning equipment properlystored Equipment&Utensils: Cleanliness 51 Adequate lighting provided as required 1 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, 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 571 Clean/soiled linens stored properly 36 Toilet rooms enclosed with self-closing door 581 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 fixturesprovided,good repair,clean entrance(s),smoking area indicated by sign(s) 39 1 Approved garbage/rubbish containers,adequate number,covered, 74 rodent proof,clean ❑Routine Inspection IgReinspection 0 Preoperational Inspection Other Inspection: INSFOCTO PERSON IN CHARGE: Demerit Score: *Include demerits from page 1 4 3 2 1 Total Rating vt6tkP A sr re si nature 'k,zK[ n 1 pr�arn 0 l�U C1 i"1 M e 6� DATE CORRECTIONS DUE: ne number � _ �,` title "/w\ U Page 2 of 2 plus continuation pages Focused Inspection 1/2002 r Page 3 of am INSPECTION REPORT STATE OF CONNECTICUT FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH CONTINUATION SHEET NAME OF ESTABLISHMENT TOWN DATE OF INSPECTION Cam MA,0 INSPECTIOAREMARKS FORM Nc c cx `l G -t duz LQ C4 1 u(= -fin v tJ c),- tbw U O( tS 1� -- U Y'" v V� cL=Q,\ J C> T _ U zA / J cum g/ L ed w eJ O INITIAL(INSPECTOR) INITIAL(PERSON IN CHARGE) Distribution: 1st-White-Health Department 2nd-Yellow-Owner/Manager