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Home My WebLink AboutFood Service Establishment Inspection 76 (2) N rl C �s � Establishment: %C,Uo `s Inspection Date: Z, ► Time: _ R linsp REi sp dress/City: �j f 8hh � C Ql�ii Health Dept: . j f 1 2�4 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 N/O N/A DNC KEy: C[complies] N/O[not observed] N/A[not applicable] g DNC[does not comply] 0[other] RTE r ady-to-eat] Ch 4 S ftfn4ft A Food workers have no exposed infectedlesions/burns p B Personnel with infection restricted „ ► ,n"i�r► ifi�late� ' t): /At C Communicable disease of worker reported to local health director A Approved shellfish,finfish,meat&poultryUSDA approved B Food cans in good condition(not dented,rusty,bloated,leaking) 13 'Nandw siri g fagUffies provided, t+lras�ed,clean C, ' 3 N/A 4' C Wholesome/nonadulterated foods/safe A Handwash facilities in all food prep/dispensing&warewash areas D Commercial products(no home grown/canned food) B Handwash facilities in or immediately adjacent to toilet rooms E Potentially hazardous foods received at proper temperature C Handwash facilities accessible/convenient to use 0 D Personnel hands washed,clean/Proper handwash procedure E Handwashing at appropriate times Os� A Hot holding greater than or equal to 140°F. (whole beef/pork roasts 1300 F.i o A ❑ No eating ❑ No smoking while working 01 B Cold holding less than orequal to 45 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 sanitizeravailabl777t trationofsanitizer B Food contact surfaces a for potentiallyhazardous food s nitized oursA Food thermometer available and accurate C Adequate ishwasheal rinse temp B Proper food thermometer for product D Proper sanitizin Procedure C Thermometers appropriately placed in cooler units E Sanitizing between raw animal origin&ready-to-eat food k c�3�f{Y _ y yF A Cloths and/or sponges in good repair and clean A Produce washed 77 B Wiping cloths kept in sanitizer between uses B Raw meats not stored/prepared near ready-to-eat foods O C Food covered properly A Food equipment clean,utensils clean,equipment interiors clean D Adequate splash guards/sneeze guard E No unauthorized personnel B Single use gloves changed when soiled F No pooling of eggs not cooked immediately C Food—contact surfaces clean 8 Food containers stored off the floor 0 0 A No unnecessary handling RTE and/or cooked foods with bare hands A Soap/paper towels/ drying device available B Dispenser(s)working: ❑Soap ❑Paper towel B Minimize food handling,other than ready-to-eat,with bare hands 7 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 aftemate],PHF[potentially hazardous food],tFB[foodbomel PHFs are hot held at: F. PHFs are cold held at: F. Describe illness conditions when you would exclude a food worker from workingAre 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 d 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 If 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): Is cooling monitored for time&temp? Y N Is the monitoring of cooling recorded? Y N Indicate the title of above person(circle all that apply):OF DA Mgr Cook Owner FW •Obtain signature of the person who received the QF n i i ' 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 V mod/ 7istablish�ment: c�� A D � 1� Date of Inspection. 1 l�,ai) G;k{ � (a Owner or Operator: �- ADDITIONAL FOUR POINT ITEMS 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 s -Operating as required 11 Toxic chemicals. 34 No cross connections,back siphonage,backflow -Stored properly,labeled properly,used properly roper type/installation/ba kflow prevention device/air gapfo[: -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/wellhead protected from contamination 35 Toilet facilities. Adequate,convenient,accessible, -Water quality in compliance -Monitoring in compliance designed,properly installed OTHER ITEMS KEY: DNC [DOES NOT COMPLY] 2 Sources of food: Original container,properly labeled 40 Garbage/rubbish storage area/rooms,enclosures-propedy constructed,dean Potentially hazardous food properly thawed 41 Garbagelrubbish 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 17 Nonfood-contact surfaces designed,constructed,maintained, 6 Floor,wall juncture covered installed,located 7 Mats removable,good repair,clean 18 Single service articles,storage,dispensing 8 Exterior walking,driving surfaces,good repair,clean 19 No reuse of single service article 49 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: CI anlin 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 23 Accurate thermometers provided 53 Rooms&equipment hoods,ducts,vented as required,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, 8 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) 37 Proper toilet 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 IRRoutine Inspection ❑Reinspection 17 Preoperational Inspection .NSPE T R: ER N HA E: Other Inspection: Demerit Score: *Include demerits from page 1 4 3 2 1 Total Rating signature r nt ame P pri name I � vew ie l, C� one number title DATE CORRECTIONS DUE: If,ITU Page 2 of 2 plus continuation pages Focused Inspection I/2002 Page of 3 INSPECTION REPORT STATE OF CONNECTICUT FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH CONTINUATION SHEET NAME OF ESTABLISHMENT TOWN DATE OF INSPECTION INSPECTION FORM# REMARKS \r, b L \ 6-in 8c, rk CkZ 4 &Lg2 C' r,[.,) I ET V)A, 6�/% ITO C INITIAL(INSPECTOR) INITIAL(PERSON IN CHARGE) Distribution: 1st-White-Health Department 2nd-Yellow-Owner/Manager