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Home My WebLink AboutFood Service Establishment Inspection 60 (8) Establishment: Inspection Data (j Time: T ROinsp Rt Insp Address/City: 6 \ Aa%��-\ l (�\� l, Health ept: g . W AA 6Z 2 s 4' Based on an inspection this day,the items marked DNC identify a 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 /0 N/A NCI KEY: C[complies] N/O[not observed] N/A[not applicable] 3 DNC[does not comply] 0[other] RTE r ady-to-eat] 0 r ` A Food workers have no exposed infected lesions I burns tf�n Qf initT�program 2 B Personnel with infection restricted # tUT ,kYif Sfl� , 18dq �Tdfed 0 N/A' 4= C Communicable disease of worker reported to local health director A Approved shellfish,finfish,meat&poultry USDA approved 13.-Haiul[Washilno facillWas provided,baadsvvasbred,Chan, C . q 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 Wholesomelnonadulteratetl foods/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 .:' r A Hot holding greater than or equal to 1400F. (whole beeflpork roasts 130e F.) 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/consumer advisory posted 0 A Approved saniuzeravailable/adequate concentration ofsanitizer B Food-contact surfaces and utensils used for potentially hazardous food nitized at least every 4 hours A Foodthermometer available and accurate C Adequate Irdishwashersanitizer ❑final rinse temp D Propersanitizin procedure B Properfood thermometerfor product E Sanitizing between raw animal origin&ready-to-eat food C Thermomeiers appropriately placed in cooler units 0 O A Cloths and/or sponges in good repair and clean A Produce washed W a WIN" � " �'`}°` _ '-`�177 B Wiping cloths kept in sanitizer between uses 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 Ems A Soap/paper towels I drying device available A No unnecessary handling RTE and/orcooked foods with bare hands B Dispenser(s)working: ❑Soap ❑Paper towel 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 11 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[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 Ryes 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): 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 QFO responsibilities information at the time of the =where: hing policy? Y N *Describe what is washed and inspection: Note: This report is a two page form(total of 62 debitable items) Page 1 of 2 Establishment: Date of Inspection: at ��( ddress: tl-.7CS \ in ArC L. y Owner or Operator: ADDITIONAL FOUR POINT ITEMS KEY: DNC [DOES NOT COMPLY] 6 Foods not re-served. 31 disposal Sewage dis approved. -Unwrapped foods not re-served 4= g p pP -Operating as required -Potentially hazardous foods not re-served 11 Toxic chemicals. 34 No cross connections,back siphonage,backflow -Stored properly,labeled properly,used properly Proper type/installation/backflow prevention device/air gap for: -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 35 Toilet facilities. Adequate,convenient,accessible, -Water quality in compliance designed,properly installed -Monitoring in compliance OTHER ITEMS KEY: DNC [DOES NOT COMPLY] urces of food: Original container,properly labeled 40 Garbage/rubbish storage area/rooms,enclosures-propedy constructed,clean 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 ted 6 Floor,walljuncturecovered 7 on od-contact surfaces designed,constructed,maintained, 7 Mats removable,good repair,clean talled,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 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 Equipment&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 23 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 premises free of lifter,no insect/rodentharborage, 8 Equipmentlutensils,stnrage,handling 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) 59 Seats 75 or more:Nonsmoking area provided,sign(s)posted at 37 Propertoiletfixturesprnvided,good repair,clean entrance(s),smoking area indicated by sign(s) 39 Approved garbage/rubbish containers,adequate number,covered, rodent proof,clean 13Routine Inspection 1311einspection 0 Preoperational Inspection Other Inspection: INSPE T R: PERSON IN CHARGE:I Demerit Score: *Include demerits from page 1 CK4 i A-It A^m 4 3 2 1 Total Rating si ture signatur prhifniffid print name Ole.4 �94 21R1CORRECTIONS DUE: one number title Z Page 2 of 2 plus__k—continuation pages Focused Inspection 1/2002 Page 3 ofJ INSPECTION REPORT STATE OF CONNECTICUT FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH CONTINUATION SHEET NAME OF ESTABLISHMENT TOWN DATE OF INSPECTION INSPECTION REMARKS FORM# fig �S 6L S \ v\CAC, INITIAL(INSPECTOR) INITIAL(PERSON IN CHARGE) VA-JA Distribution: 1st-White-Health Department 2nd-Yellow-Owner/Manager