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Home My WebLink AboutFood Service Establishment Inspection 57 (13) t � Establishment: I/� _ Inspection Date: / Time: ;A oinsp insp ddresslCity: .T6qv ealth l ept: Class: 1 2 3 a Based on an inspection this day,the items marked DNC identify the violations in operation orfacilities 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 IONIC I KEY: C[complies] NIO[not observed] NIA[not applicable] + a a x f DNC[does not comply] 0[other] RTE[ready to-eat] y8ag a Qu°iified�aQdOperator 3 , + 3 T F x �12 F Aefs`,o net with Infection rest icted 61 ICeslgnafed Alternate . ' 2 62 'Written documentation of training=program a 2 A Food workers have no exposed infected lesions 1 burns B Personnel with infection restricted 1 iA6"Y"d. tirce wholesoiite nonadulterated iG:NIO NIA 4 s C Communicable disease of worker reported to local health director A Approved shellfish,finfsh,meat&poultry USDA approved Ff Y tlwashmgrfacilities provided handswastied,clean C 'N/0 NI r4 B Food cans in good condition(not dented,rusty,bloated,leaking) Handwash facilities in all food prepldispensing&warewash areas C Whole some/nonadu Iterated 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 D Personnel hands washed,clean/Proper handwash procedure 0 E Handwashing at appropriate times 3 iPotenXlallyhazardous�foodmmeets empgrfure reajittrefnens tC N1OA" 4 t during atorage,�prepar�tlonpolaplay,service andfitransportation ., k s, M hygleriic.pr4C t ais t. w r:: C�iNl A E 2 U ,(K...yy'�j:y is Mn v.'y ... .......... .......::. r � ~" A Mot holding greater than or equal to 140 F. (whale beef/po k roasts 730e F.I A No eating ❑No smoking while working B Cold holding,less than or equal to450F: B Wounds covered adequately C Proper cooling k I I C Proper sink used for handwashing AA D Proper re-heating 0 �ii ' anftalggrir (Fio Ater-'chemical G '= C E Proper internal cooking/consumer advisory posted .. , , 0 A Approved sanitizeravailableladequateconoentrationofsanitizer Ad re_ II t e to mat tale roduct + r C �NiO N!A 2` B Food-contact surfaces and utensils used for potentially a + ; tetnp�ra#ure theMrtrometersr provlded e r , , hazardous food sanitized at least every 4 hours C Adequate ❑dishwashersanitizer ❑final rinse temp A Food thermometer available and accurate D Proper sanitizin rocedure B Properfootl thermometerfor product � E Sanitizing between raw animal origin&ready-to-eat food C Thermometers appropriately placed in cooler units 0 25 Clean wiping-cloths I t ti M:' 4Y Fond of a �� s �, 'te aratton CI;N1O t �� A Cloths andlor sponges in good repair and clean B Wiping cloths kept in sanitizer between uses A Produce washed Q B Raw meats not stored/prepared near ready-to-eat foods 126 toa ,sAKER n [ik I OC Ak 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 r p� ot § r dWhingaC rye srs%Idxed ass eged kfiCr�,9 jiIaridlingof.food minimized C N10 Soaplpapertowelsl dryingdeviceavailable A No unnecessary handling RTE and/or cooked foods with bare hands B Soap /paper toweworkls I OSoap aper towel B Minimize food handling,other than ready-to-eat,with bare hands C Handwash sink(s)clean 1 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 alternate],PHF[potentdlly hazardous food],FB[foodbarnel PHFs are hot held at: F. 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 P rk 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 requir the food worker to report specific illness conditions Are temperatures recorded/logged for cold holding food slequipment? N and diseases to the CFO? Y N ♦Do you have a paid sick leave policy? Y N Are foods cooked in advance and cooled? Y N *Are leftov, rs saved? Y N Is there a language barrier betwe inspector&QFO? Y N Iflf ves indicate language spoken List products cooled: by QFO/DA: ♦Can the QFOIDA read the inspection report? Y N Describe cooling methods: Indicate who answered�thalbov@ questions: Name(print): Indicate the title of abovon(circle all that apply):CFO DA Mgr Cook Owner FW Is cooling monitored for time&temp? Y N Is the monito ng of cooling recorded? Y N .Obtain signature of the'person who received the QFO responsibilities information at the time of the rwhere- Fe a produce washing policy? Y N *Describe hat is washed and inspection: ote: This report is a two page form(total of 62 debitable items) Page 1 of 2 SPATE OF" QNNECTICf1�=D RPiRTMEl1tTlOF PQl3Ll,C`HEALTH a o"cAP1Tr 1r i�uENUE-MS#511=DP"-HARTFORD,CT OS134 f •, FQCUSTY FOQD.SER�TC INSPECTIQtQRT LOCAL HEALTH DEP,T G+ i rGsJ..✓ �SLWz_ . ADDR<:3SICITY_ . Establishment: ' Ll i4-` - Date-.of.lnspectJon: : ddress: Owner"..or,Operator: ADDITIONAL FOUR POINT ITEMS KEY: DNC [DOES NOT COMPLY] o 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 4 Propert Ivoeinstal fio 1backflQ+�ventiondeylce/airga for: -Stored properly,labeled properly,used properly -Food equipment -Hose connections -Dish machines -San itizer concentration notto exceed maximum permitted -Soda system carbonator -Beverage dispensers -Toilettanks -No unnecessary toxics on the premises -Chemical dispensers -Ice machines -Pesticideslrodenticides properly dispensed Proper drain for: 29 Water source adequate,safe. -Food equipment -Dish machines -Ice machines q.. -Well Iwell head protected from contamination-Water quality in compliance 35 Toilet facilities. Adequate,convenient,accessible, 4 -Monitoring in compliance designed,properly installed OTHER ITEMS KEY: DNC [DOES NOT COMPLY] o}' 2 Sources of food:Original container,properly labeled 1 " 40 Garbage/rubbish storage arealrooms,enclosures-properly constructed,dean f ; 5 Potentially hazardousfood properly thawed 41 Garbage/rubbish disposed of in an approved manner,at approved frequency 10 Food dispensing utensils properiystored 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, 44 Floors: Floorcovering installed,constructed as required,good repair,dean 6 F -contact surfaces designed,constructed, maintained,installed, 2y 5 Floors graded,drained as required located floor,wall juncture covered No fgod-contact surfaces designed,constructed, maintained, 47 is removable,goo rp ir,clean y. stalled,located $ Exterior walking,driving surf ood repair,clean 1 $ _Single service articles,storage,dispensing ,i 19 No reuse of single service article - 9 alls,ceilings attached,equipment properly constructed,good repair,clean.Wall&ceiling surfaces as required 1 20 Dishwashing facilities approved design,adequately constructed, maintained installed located 50 Dustless cleaning methods used,cleaning equipment propedy stored Equipment&Utensils: Cleanliness 1 fi 51 Adequate lighting provided as required 21 Preflushed,scraped,soaked and racked 52 Room free of steam,smoke odors 1.. 22 Wash water clean,pro per tem perature 53 Rooms&equipment hoods,ducts,vented as required 23 AQpurate thermometers provided,dish basket,if used 54 Roomsadequate,clean,adequate lockers provided,facilities clean =1; 2 ehfcod-contact surfaces of utensils&equipment clean 1 55 Establishment and premisesfreeoflitter,noinsect/rodentharborage, 1 28 Equipmentlutensils,storage,handling I no unnecessary articles 32 Properdisposal of waste water 1 , 56 Complete separation from livinglsleeping quarters and laundry 1; 33 Plumbing location,installation,maintenance 1 57 Clean/soiled linens stored properly ll. 58 No live birds,turtles,or other animals(except guide dogs) i 1 36 Toilet room s enclosed with self-closing door 1 59 Seats 75 or more:Nonsmoking area provided,signs)posted at 37 Proper toilet fixtures provided,good repair,clean3< entrance(s),smoking area indicated by sign(s) r 39 Approved garbage/rubbish containers,adequate number,covered, 1 rodent proof,clean r outine Inspection ❑Reinspection ❑ Preoperational Inspection Other Inspection: S OR: PERSO IN H Rdf: - � Demerit Score: •Include demerits from page 1 c� 4 3 2 1 Total Rating si nature si nature J (>�pr' name 4& pri m phone number — title DATE CORRECTIONS DUE: Page 2 of 2 plus continuation pages Focused Inspudon 112002 t„r • • 1 NAME OF DATE OF • mg , WIN Willm-2MAW M1 __ y MOM I 1 WAM y � RAI s WON a ' • �� (PERSONINITIAL Pagef INSPECTION REPORT STATE OF CONNECTICUT FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH CONTINUATION SHEET NAME OF ESTABLISHMENT TOWN, DATE OF INSP CTI I INSPECTION REMARKS FORM# T 1 op, Ile' ye �-, S - - z I I e I "Zzmezz �.� INITIAL(INSPECTOR) INITIAL(PERSON IN CHARGE) Distribute n: 1st-White-Health Department 2nd-Yellow- Owner/Manager Page of i)9�v A INSPECTION REPORT STATE OF CONNECTICUT FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH CONTINUATION SHEET NAME OF ESTABLISHMENT TOWN DATE OF TPECTION INSPECTION REMARKS FORM# �-�- .� 4 INITIAL(INSPECTOR) INITIAL(PERSON IN CHARGE) Distribution: 1st-White-Health Department 2nd-Yellow-Owner/Manager