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Home My WebLink AboutFood Service Establishment Inspection 85 (17) h` STar �►FvIv� t _ � IIrI® n�rAx�T. °N >I�»,. A� Establishment: Inspection Date: Time: ROinsp41ns Address/City: _r S 1 '� v-e, . Health Dept _ ✓ Class: 1 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 debatable items C NIO NIA DNC Kam: C[complies) N10[not observed] NIA[not applicable] 60 Qualified Food Operator 3 DNC[does not comply] 0[other] RTE[r y-to-eat] 61 Designated Alternate 2 12 Personnel with infection restricted C 'NIO NIA 4 A Food workers have no exposed infected lesions I burns 62 Written documentation of training program 2 B Personnel with infection restricted 1 Approved source,wholesome;°nonadulterated C N/0 NIA 4 C Communicable disease of worker reported to local health director A Approved shellfish,finfish,meat&poultryUSDA a roved 13 Handwashing facilities provided, hands washed,clean C.'N/0 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 Wholesomelnonatlulteratedfoods!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 1 Proper handwash procedure 0 E Handwashing at appropriate times 3 Potentially hazardous food meets temperature requirements, C 0`$NWtA', 4 0 during storage,preparation,display,service and transportation . 15 Qood,hygfen[c practices C, WO NIA 2 A Hot holding greater than or equal to 140°F. (whole beef/pork roasts 1390r.) A ❑No eating ❑ No smoking while working r B Cold holding less than or equal to 45°F. B Wounds covered adequately C Proper cooling C I Proper sink used for handwashing D Proper re-heating 0 E Proper internal cooking I consumer advisory posted 24 Sanitization rinse.(hot water-chemical)_ C N10 NIA 2 0 A Approved sanitizeravailabfeladequate concentration ofsanitizer 4 Adequate facilities to maintain product C 0 °NIA 2 B Food-contact surfaces and utensils used for potentially temperature;thermometers provided hazardous food sanitized at least every 4 hours A Food thermometer available and accurate C Adequate ❑dishwashersanitizer Ofinal rinse temp B P rope rfoodthermometerfor prod uct L Proper sanitizing procedure C Thermometers appropriately placed in cooler units E Sanitizing between raw animal origin&ready-to-eat food 0 0 25 Clean wiping-cloths C N10 ,NIA 1 T Food protected during.etorage;,p7eparation, 1 1 C 'N10 NIA r display,service and transportation A Produce washed A Cloths and/or sponges in goad repair and clean B Wiping cloths kept in sanitizer between uses 0 B Raw meats not stored/prepared near ready-to-eat foods 26 Food-contact surfaces_=clean• NO' N/A. 2_: y �Foodequipmentclean utensilsc A equipment mentinteriors C Food covered properly clean D Adequate splash guards 1 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 30' Hot artd:cold water under pressure,provided as required C NO NIA; 2` 0 38 Handwaehing accessories provided - NO NIA -1 9 Handling of food minimized C N10, NfA 2 A No unnecessary handling RTE and/or cooked foods with bare hands A Soap/papertowels 1 drying device available B Dispenser(s)working: ❑Soap ❑Papertowel 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 foodlice 0 0 1 •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[potentlally hazardous food],FIB[foodborne] PHFs are hot held at: IF. 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 Lf ym indicate language spoken List products cooled: by QFOIDA: *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 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 qglrlo bD , t �. * � :> a t a . iz ssen "x 4fat � nt�L Date o Inspection: Owner or 0'00rator: 1�m A..� ADDITIONAL FOUR POINT ITEMS _a KEY: DNC [DOES NOT COMPLY] 6 Foods not re-served. -Unwrapped foods not re-served 4 31 Sewage disposal approved. 4} -Potentially hazardous foods not re-served -Operating as required No cross connections,back siphonage,backflow 11 Toxic chemicals. 4 Proper type/installation/backfiow prevention device/air gap for: 4 -Stored properly,labeled properly,used properly -Food equipment -Hose connections -Dish machines -Sanitizer concentration not to exceed maximum permitted -Soda system carbonator -Beverage dispensers -Toilet tanks -No unnecessary toxics on the premises -Chemical dispensers -ice machines -Pesticideslrodenticides properly dispensed Proper drain for: 29 Water source adequate,safe. 4 -Food equipment -Dish machines -Ice machines -Well/well head protected from contamination 35 Toilet facilities. Adequate,convenient,accessible, 4 -Water quality in compliance designed,properly installed -Monitoring in compliance OTHER ITEMS a KEY; DNC [DOES NOT COMPLY] n;: 2 Sources of food: Original container,properly labeled 401 Garbagelrubbish storagearea/rooms,enclosures-properly constructed,clean 5 Potentially hazardous food properly thawed 2 1 Garbage/rubbish disposed of in an approved manner,at approved frequency 10 Food dispensing utensils properly stored 1- 42 Vermin Control: No insects/rodents present 2 14 Food worker:Clean outer clothes,effective hair restraints 1 ' 43 Outeropenings protected against entrance of insects/rodents 1 4 Floors: Floor covering installed,constructed as required,good repair,clean 1 16 Food-contact surfaces designed,constructed,maintained,installed, 2 45 Floors graded,drained as required located 46 Floor,walljuncturecovered 17 onfood contact surfaces designed,constructed,maintained, 47 Mats removable,good repair,clean installed,located 18 Single service articles,storage,dispensing 48 Exterior walking,driving surfaces,good repair,clean 2', - 19 No reuse of single service article 49 Walls,ceilings attached,equipment properly constructed,good 1 repair,clean.Wall&ceiling surfaces as required 20 Dishwashing facilities approved design,adequately constructed, 2 1, maintained installed located 50 Dustless cleaning methods used,cleaning equipment properly stored Equipment&Utensils: Cleanliness 1 51 Adequate lighting provided as required 1, 21 Preflushed,scraped,soaked and racked 52 Room free of steam,smoke odors 1 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 1 27 Nonfood-contact surfaces of utensils&equipment clean l ' 55 Establishment and premises free of litter,no insectlrodent harborage, 1 2$ Equipment/utensils,stprage,handling 1 no unnecessary articles 32 Proper disposal of wastewater 1 56 Complete separation from livinglsteeping quarters and laundry J 33 Plumbing location,installation,maintenance 1 57 Clean/soiled linens stored properly 1. 58 No live birds,turtles,or other animals(except guide dogs) ^1 36 Toilet rooms enclosed with self-closing door 1v, 59 Seats 75 or more:Nonsmoking area provided,sign(s)pasted at "3 37 Proper toiletfixtures provided,good repair,-clean entrance(s),smoking area indicated by sign(s) 39 Approved garbage/rubbish containers,adequate number,covere 1 rodent proof,clean ORoutine Inspection ffteinspection 13 Preoperational Inspection N ECTOR: PERSON IN GE: Other Inspection: Demerit Score: *Include demerits from page I 4 3 2 1 Total Rating sig ture sig ur print dame\ _ pr Z 1 _Val DATE CORRECTIONS DUE: 1 phone number ,tA title W f,� G� 1.1 "G Page 2 of 2 plus__L_continuation pages Focused Inspection 1/2002 Page Of INSPECTION REPORT STATE OF CONNECTICUT FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH CONTINUATION SHEET NAME OF ESTABLISHMENT TOWN / DA�7TE OF INSPECTION �J 0 ni V L- INSPECTION REMARKS FORM# t1 v 5�'IiJ.P ��.✓ � �r- C� u o6V7 INITIAL(INSPECTOR) INITIAL(PERSON IN CHARGE) Distribution: 1st-White-Health Department 2nd-Yellow-Owner/Manager