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Home My WebLink AboutFood Service Establishment Inspection 65 (3) NOW Establishment: t � Inspection Date: Time: Roins REias Address/City: tosf \ 6�wa �;kC�. \��• Health Dept: S_ A1,�k6 J / class: 1 23 Based on an inspection this day,the items marked DNC identify th 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 Po NIA I NCI KEY: C[complies] NIO[not observed] NIA[not applicable] 3 DNC[does not comply] 0[other] RTE[ready-to-eat] gg 2 ,u. A Food workers h 2ave no exposed infected lesions/burns B Personnel with infection restricted V O NIA: 4 C Communicable disease of worker reported to local health director A Approved shellfish,finfish,meat&poultry USDA approved 131 Handwashing i'acililtlss provided,hands washed,clean C NtA, 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 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 A Hot holding greater than or equal to 1400F. (whole beef/pork roasts 130'F.) A ❑ No eating ❑k 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 sanitizer available/adequate concentration of sanitizer B Food-contact surfaces and utensils used for potentially hazardous food s 'tized at least every 4 hours A Footlthermometeravailable and accurate C Adequate Wishwashersanitizer ❑final rinse temp D Proper sanitizin procedure B Proper food thermometerfor product E Sanitizing between raw animal origin&ready-to-eat food C Thermometers appropriately placed in cooler units 0 0 A Cloths and/or sponges in good repair and clean Produce washed B Wiping cloths kept in sanitizer between uses A 0 B Raw meats not stored/prepared near ready-to-eat foods ME 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 A Soap p/ towels I 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 handling,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 0 0 •DESCRIBE DEFICIENCIES ON CONTINUATION SHEETS The following information is not debitable and does not affect your score. jgnr: QFO[qualified food operator],DA[designated altemate],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 Ifs indicate language spoken List products cooled: by QFO/DA: *Can the QFOIDA 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 r e a produce washing 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 ' qF a Establishment: Lle!J�,a: 3 q� R.0 Date of Inspection: Owner or Operator: , c)ts2 y ADDITIONAL FOUR POINT ITEMS J 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 11 Toxic chemicals. 34 No cross connections,back siphonage,backflow -Stored properly,labeled properly,used properly Proper typelinstallation/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] 2 Sources of food:Original container,properly labeled 0 Garbage/rubbish storagearea/rooms,enclosures-properly constructed,clean 5 otentially hazardous food properly thawed 41 Garbage/rubbish disposed of in an approved manner,at approved frequency 10 ,F6od 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 oors: Floor covering installed,constructed as required,good repair,clean 6 ood-contact surfaces designed,constructed,maintained,installed, 45Floors graded,drained as required located 6 Floor,wall juncture covered 17 onfood-contact surfaces designed,constructed,maintained, 471 Mats removable,good repair,clean i tailed,located 8 Exterior walking,driving surfaces,good repair,clean 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 27 Nonfood-contact surfaces of utensils&equipment clean 55 Establishment and premises free of litter,noinsect/rodentharborage, 28 Equipment/utensils,storage,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 Propertoiletfixturesprovirled,good repair,clean entrance(s),smoking area indicated by sign(s) 39 Approved garbage/rubbish containers,adequate number,covered, rodent proof,clean Woutine Inspection ❑Reinspection ❑ Preoperational Inspection Other Inspection: I PE T R: PERSON IN CHARGE: Demerit Score: *Include demerits from page 1 4 3 2 1 Total IRating nature si ` rin ame print name t /t , �C 64g —Z�(� L ' Z04�12a DATE CORRECTIONS DUI/E: �� 194 phone num er title ,�.. � ��L— Page 2 of 2 plus continuation pages Focused Inspection 1/2002 Page 3 of INSPECTION REPORT STATE OF CONNECTICUT FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH CONTINUATION SHEET NAME OF ESTABLISHMENT TOWN DATE OF INSPECTION Lew,' 5 PA A k S- W-U(-165 K 'Z INSPECTION FORM# REMARKS k�o Yn dCA�An'All d 0,0,A Lt v �d CAW V�k -5CkL4,0l �'� C c� I� �, ` , I d o� �lQ �Ut l cs -A YNa4U c!J SA N),e64 INITIAL(INSPECTOR) INITIAL(PERSON IN CHARGE) Distribution: 1st-White-Health Department 2nd-Yellow-Owner/Manager