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Home My WebLink AboutFood Service Establishment Inspection 46 (6) c4v�c"r� pos4er-- Establishrr>�nt: 6 Inspection Date: Time: Roinsp Einsp Address/City: LHealth Dept: S • (,�1 e rd/j Lj/ class: t 2 3 a Based on an inspection this day,the ems 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 N/0 N/A DNC KEY: C[complies] N/O[not observed] NIA[not applicable] 3 DNC[does not comply] 0[other] RTE[ready-to-eat] .,� 1 tip 2 A Food workers have no exposed infected lesions/burns - B Personnel with infection restricted v a hof Some,-nd� dH B #end C, N/A1 41, C Communicable disease of worker reported to local health director c� A Approved shellfish,finfish,meat&poultry USDA approved 93 HomWashiMg facilities provided,harKb washK cmn- NO NIA. 4 B Food cans in good condition(not dented,rusty,bloated,leaking) A Handwash facilities in all food prep/dispensing&warewash areas C Wholesomelnonadulteratedfoodslsafe 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 I i M 1� I E Handwashing at appropriate times M�W_ 1 ii aril$`ii`FactFces` C f/0 A Hot holding greater than or equal to 1400F. (whole beef/pork roasts 130e F.) A 1 ❑ No eating ❑ No smoking while working B Cold holding less than or equal to 450F. B Wounds covered adequately C Proper cooling C Proper sink used for handwashing D Proper re-heating 0 S " L E Proper internal cooking I consumer advisory posted y f * A Approved sanitizeravailable/adequate concentration ofsanitizer B Food-contact surfaces and utensils used for potentially ENEhazardous food sanitized at least every 4 hours A Food thermometer available ndaccurat C Adequate ❑dishwashersanitizer nal rinse temp Proper B Proper food thermometer f ro D rocedure E Sanitizing between raw animal origin&ready-to-eat food C Thermometers appropriately placed in cooler units 0 A Cloths and/or sponges in good xepair and clean A Produce washed � } B Wiping cloths kept in sanitizer between uses B Raw meats not stored/prepared near ready-to-eat foods 0 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 ood containers stored off the floor 0 A No unnecessary handling RTE and/or cooked foods with bare hands A Soap I paper towels I 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 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. Y: QFO[qualified food operator],DA[designated altemate],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&QFO? Y N If_y-u 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):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 form(tot o 62 debitable items) Page 1 of 2 ��d c -pompW" 01; 0 W" "' ' ; Establishment: Date of Inspection: ddress: Owner or Operator: >1 ADDITIONAL FOUR POINT ITEMS KEY: DNC [DOES NOT COMPLY] 6 1 Foods not re-served. -Unwrapped foods not re-served 4 j 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 ty"pe/installation/backflow prevention device/air gapfor: -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 ,desi ned properly in -Monitoring in compliance g p p y' stalled 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 Potentially hazardous food properly thawed 1 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 Outeropenings protected against entrance of insects/rodents 4 Floors:Floor covering installed,constructed as required,good repair,clean 6 od-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 18 Single service articles,storage,dispensing 8 Exterior walking,driving surfaces,good repair,clean 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 2 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 nfood-contact surfaces of utensils&equipment clean 27 55 Establishment and premises free of litter,no insect/rodent harborage, 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 57 Clean/soiled linens stored properly 58 No live birds,turtles,or other animals(except guide dogs) 36 Toilet rooms enclosed with self-closing door 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, . 1 :1 rodent proof,clean I Ekoutine Inspection ❑Reinspection ❑ Preoperational Inspection Other Inspection: M PERSON IN CHARGE. Demerit Score: •Include demerits from page 1 4 3 2 1 Total Rating st ature signature print print name C Q 6 kmq_Z�y-k- e_V1- YYIv{/l d p one number title DATE CORRECTIONS DUE: Page 2 of 2 plus continuation pages Focused Inspection 1/2002 E + Page of 3' a INSPECTION REPORT STATE OF CONNECTICUT FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH CONTINUATION SHEET *Q NAME OF ESTABLISHMENT TOWN DATE OF INSPECTION A S, �✓ 8' `� INSPECTION FORM# REMARKS w r1 � �t v✓ C ✓ � `✓ ed s: n k-- Ll t C1, r1 _ J �1At �t" Olja I,v u✓ �L - �Ic $yC,C - r A Z,0 C� 6� �� - 6 J �Q� U kc cy f— v U (N h U -LA-Q en INITIAL(INSPECTOR) -06 1 INITIAL(PERSON IN CHARGE) Distribution: 1st-White-Health Department 2nd-Yellow-Owner/Manager