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Home My WebLink AboutFood Service Establishment Inspection 17 (25) Establishment: p Inspection Date: Time: R0[nsp Einsp Address/City: 0 k�( Z. Health Dept: A XA dg� Class: 1 2 3 Based on an inspection this day,the itetns 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 item C 40 N/A DNC I KEY: C[complies] NIO[not observed] NIA[not applicable] 3 DNC[does not comply] 0[other] RTE y-to- at] b FIR2 ?,° I A Food workers have no exposed infected lesions/burns Zt � � B Personnel with infection restricted ' �. tpSbrtt , [ ijf G;N10 X 4 t C Communicable disease of worker reported to local health director A I Approved shellfish,finfish,meat&poultry USDA approved ��td rash fa llill0i° rowid tta dg rvasbed,alert)' B Food cans in good condition(not dented,rusty,bloated,leaking) A Handwash facilities in all food prep/dispensing&warewash areas C Wholesomelnonadulterated 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 V D Personnel hands washed,clean I Proper handwash procedure 0 E Handwashing at appropriate times 0 - u 'YWertr r, t&W, A Hot holding greater than or equal to 1400F. (whole beef/pork roasts 130"el A ❑ No eating ❑ No smoking while working B Cold holding less than or equal to 450 F. k., 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 sanitizeravailable/adequate concentration of sanitizer B Food-contact surfaces and utensils used for potentially hazardous food sanitized at least every 4 hours A Food thermometer available and accurate L C Adequate dishwashersanitizer ❑final rinse temp B Proper food thermometer for product D Proper sanitizin rocedure E Sanitizing between raw animal origin&ready-to-eat food C Thermometers appropriately placed in cooler units 0 :' A Cloths andlor sponges in good repair and clean MAO 71 B Wiping cloths kept in sanitizer between uses co 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 I 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 No unnecessary handling RTE andlor cooked foods with bare hands A Soap I paper towels/ drying device available 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 _07— 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 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&CFO? Y N 1f_ygs 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 CFO 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: � � �� Date of Inspection: �. ddress: o Owner or Operator: 4 'J ADDITIONAL FOUR POINT ITEMS z KEY: DNC [DOES OMPLY] 6 1 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 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] 2 Sources of food: Original container,properly labeled 40 Garbage/rubbish storagearea/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, 45 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 20 Dishwashing facilities approved design,adequately constructed, repair,clean.Wall&ceiling surfaces as required maintained installed located 501 Dustless cleaning methods used,cleaning equipment properly stored Equipment&Utensils: Cleanliness 5 11 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 541 Rooms adequate,clean,adequate lockers provided,facilities clean 27 onfood-contact surfaces of utensils&equipment clean 55 Establishment and premises flee of litter,no insect/rodent harborage, 29 Equipment/utensils,storage,handling no unnecessary articles 32 Properdisposal 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 ffRoutine Inspection ❑Reinspection 13 Preoperational Inspection INSPECTOR: PERSON IN Other Inspection: CHARGE: Demerit Score: *Include demerits from page 1 Al 0 4 3 2 1 Total Rating Pprintnafffe- signature G print name �lX 3 phone n tuber. y� —Z�k` title DATE CORRECTIONS DUE: 2 �►^� t/`4r� Ltr'� Page 2 of 2 plus t 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 'S-�02 <� , W kA"v I?I INSPECTION REMARKS FORM# S� C v,� 0c) sj,"Of- P) Llo�� f U( 0 S -s6J,d v &C4 j / 1P w� �r- INITIAL(INSPECTOR) INITIAL(PERSON IN CHARGE) Distribution: 1 st-White-Health Department 2nd-Yellow-Owner/Manager