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Home My WebLink AboutFood Service Establishment Inspection 15 (13) � 4 Establishment: 1 Inspection Date: Time: Roins6, qfinsp Address/City: zS' Z O/M./ ;r-,o rmiff* h��Health ept: vT, Class: 1 2 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 N10 NIA DNC I KEY: C[complies] NIO[not observed] NIA[not applicable] 60 ; dalifled Food,Operator 3 DNC[does not comply] 0[other] RTE[ready-to-eat] z 12 Fersonnei vvith.infection restricted C 61 ;DestgnatedAlternate 2 A Food workers have no exposed infected lesions 1 burns IWO' N/A 4 €fit Written documentation oftrainitg program T.. B Personnel with infection restricted 1 Approved source,Wholesorrte,ronadulterated C 'N10 Nl. 4 C Communicable disease of worker reported to local health director A Approved shellfish,finfish,meat& oult USDA a roved 13 Haridvvashrng facilities proylded;..hpndsvJashed clean..: C U6 N1A� 4 B Food cans in good condition(not dented,rusty,bloated,leaking) A Handwash facilities in all food prepldispensing&warewash areas C Wholesomelnonaduiterated foods/safe D Commercial products(no home grownlcanned food) B Handwash facilities in orjw lately adjacent to toilet rooms ' C Handwash fa llitles a e . r J ient to use E Potentially hazardous foods received at proper temperature D Personnel h n ed,cl a !Proper handwash procedure 0 E HandwashinV`at2afe times 3 Potetttrallyy hiii,&Mou"s 6 meets temperature requirements C N10 NIA 4' 0 d`urrng<storage,•preparatibn,display, ervtce.and;•transportation [ [. 115 tt:ygisnI c praC Goad ctices NI0' NIA 2 r. . A Hot holding greater than or equal to 140oF. (whore beerrpork roasts 130e F.) A ❑ No eating ❑ No smoking while working B Cold holding less than or equal to45 F. B Wounds covered adequately C Proper cooling AC Pro er sink used for handwashing D Proper re-heating 24 al ` 2"E Proper internal cooking l consumer advisory posted t i m � N . 0 pproved sanitizeravailableladequate ooncentrationafsanitizer X4•ki Adegtrate;fA r,trtf0s:ftQ maintain produdIt '" " '" E i Food-contact surfaces and utensils used for potentially w � � � k * C N10 NJA 2 B P Y r ,tern rature�thermor►eters;jl"ed i.; hazardous food sanitized at least every hours C Adequate ❑dishwashersanitizer ❑final rinse temp A Food thermometer available and accurate D Proper sanitizing B Proper food thermometer for product pro cedure E Sanitizing between rawanimal origin&ready-to-eat food C Thermometers appropriately placed in coolerunits 0 0 x p a b g; `. i C NIO< NIA .1 Q2 ;CIO vtrr rn cloths r laodprstecateti iu�tng storae pre]arati�n, NIO ,NIA 12.C 1 ervrceandtra ortafiion�t = I = * i A Cloths and/or sponges in good repair and clean A Produce washed B Wiping cloths kept in sanitizer between uses 0 B Raw meats not stored/prepared near ready-to-eat foods c2 [Fgo�d icon a6i rifade rC aN/Q C Food covered properly #, WAS 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 61 0 8 Food containers stored off the floor �C i30 (Hof end„cold wa 616der pressure,provided'asFrequtred:tC,,x`IIOE'K/A 2- .' Handling=.of food mfnfmizedu CNIO IN1AZ washy -�N10 �N1A r . r38"-Hand ng acceasoies provrdetl= rC :1 A Soap I paper towels l drying device available A No unnecessary handling RTE andlorcooked foods with bare hands B Dispensers}working: ❑Soap ❑Paper towel B Minimize food handling,other than ready-to-eat,with bare hands t✓ yr C Handwash sink(s)clean!waste receptacle at handwash sink C Adequate utensil(s)fordispensing foodlice ) 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: IF. PHFs are cold held at: F. 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: I Is there a written illness polio that requires the food worker to report specific illness conditions Are temperatures recordedilogged for cold holding foodslequipment? Y N and diseases to the QFO?/ N *Do you have a paid sick leave policy? Y N Are foods cooked in advance and cooled? Y N Are leftovers aved? Y N Is there a language barri r between inspector&QFO? Y N If-yes 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 qu ' ns:Name(print): Is cooling monitored for time&temp? Y N Is the monitoring of cooling recorded? Y N Indicate the title of above person I t t apply};Q DA gr Cook 0 nor FW Obtain signature of the person h e v the QFO r nsi 't s information at a time of the Is there a produce washing policy? Y N *Describe wh is washed and inspection: where: Note: This report is wo pa form(total of 62 debitable it s] Page t of 2 �EPARTI4hIl QF P, BLIC�HIEae1l.TM 4 ' L A MS#51 f P FiA Tf=ORD,CT t}6134� FOGIJSI-D FOOD SERVICE Il�$PB `IrI�1 ItE�OR � LGLIiEALTHDEPT• GcJ/.U�b ��1 ADDRESSICITY �r. .tir• -a t ., P77 Establishment L.Lsi7_o4 'S l -S�-zv Date of Inspection: dress: ; Owne or or Operator: Ld�✓ ADDITIONAL FOUR POINT ITEMS o 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` '. 4 -Stored properly,labeled properly,used properly-Stored backffQw prevention device/air gap for: -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 -Pesticideslrodenticides properly dispensed -Chemical dispensers -Ice machines Proper drain for: 29 Water source adequate,safe. -Food equipment -Dish machines -Ice machines ;'4 -Well1 well head protected from contamination Ldesignfed, acilities. Adequa#e,convenient,accessible, 4 -Water quality in compliance-Monitoring in compliance properly installed Lp OTHER ITEMS KEY: DNC [DOES NOT COMPLY] 2 Sources of food: Original container,properly labeled 40 Garbagelrubbishstoragearea/rooms,enclosures-properly constructed,clean 1` 5 Potentiallyhazardous food pro perly th awed 2-` 41 Garbageirubbish disposed of in an approved manner,at approved frequency 10 Food dispensing utensils properly stored 42 Vermin Control: No insects/rodents present 2 14 Food worker:Clean outer clothes,effective hair restraints i 43 Outeropenings protected againstentrance of insects/rodents 1, 4 Floors: Floor covering installed,constructed as required,good repair,clean 116 F o �contactsurfaces designed,constructed,maintained,installed, 5 Floors graded,drained as required �. cated L;4 6 Floor,walljunclure covered Nonfo -contact surfaces designed,constructed, maintained, ] Mats removable,good repair,clean ailed,located 8 Exterior Ewalking,driving surfaces,good repair,clean 1 ingle service articles,storage,dispensing Cat 2 �� 2 n 19 No reuse of single service article 9 Walls,ceilings attached,equipment properly constructed,good 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 propertystored Equipment&Utensils: Cleanliness 51 Adequate lighting provided as required 1 21 Preflushed,scraped,soaked and racked 52 Room free of steam,smoke odors 1 2 Washwaterclean,proper temperature 53 Rooms&equipmenthoods,ducts,vented as required 231 Accurate thermometers provided,dish basket,if used 54 Rooms adequate,clean,adequate lockers provided,facilities clean I` 27 Nonfood-contact surfaces of utensils&equipment clean 1 55 Establishment and premises tee of lifter,noinsectlrotlentharborage, '1 28 Equipment/utensils,storage,handling 1 no unnecessary articles 32 Proper disposal of waste water xi; 56 Complete separation from living/sleeping quarters and laundry 1 Y. 57 Clean/soiled linens stored properly 1 33 Plumbing location,installation,maintenance 581 No live birds,turtles,orotheranimals(exceptguide dogs) l i 36 Toiletrooms enclosed with self-closing door 1` 59 Seats 75 or more:Nonsmoking area provided,sign(s)posted at 37 Proper toilet fixtures provided,good repair,clean entrance(s),smoking area indicated by sign(s) 3 39 Approved garbage/rubbish containers,adequate number,covered, 1` rodent proof,clean , outine Inspection ❑Reinspection ❑ Preoperational Inspection P PERSO ther Inspection: -ASDemerit Score: *Include demerits from page 1 c ' 4 3 2 1 Total Rating signature signature 774 1 /] print name print name CORRECTIONS DUE: r �) phone number title �� Page 2 of 2 plus continuation pages Focused Inspection V2002 Page of INSPECTION REPORT STATE OF CONNECTICUT FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH CONTINUATION SHEET NAME OF ESTABLISHMENT TOWN DATE OF INSPECTION r INSPECTION REMARKS FORM# asp-r.� 00, ik t e c rt's Q`,,d Ar vvv r7j C-®j.� •i� INITIAL(INSPECTOR) INITIAL(.PERSON IN CHARGE) Distribution: 1st-White-Health Department 2nd-Yellow- Owner/Manager