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Home My WebLink AboutFood Service Establishment Inspection 85 (2) SfIATE§OlrwC�OIYNECTIGU � � I� i SiN �ICti� I aPUBI3IQ HEALTk Establishment: (led fWfA^ Inspection Date: Time: R Ins _ REinsp Address/City: �S� �,��iUAn A-jf - Health Dept' WiAL0 4 class: 1 2 3(fi Based on an inspection this day,the items marked DNC identify 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 0 NIA IDNC I M: C[complies] NIO[not observed] NIA[not applicable] 60 Qualified Food Operator 3 DNC[does not comply] 0[other] RTE[ready-to-eat] 2 12 Personnel with infection restricted N10' N/A 4 61 Designated Alternate A Food workers have no exposed infected lesions 1 burns 62 Written documentation of training program 2 B Personnel with infection restrictedoll 1 Approved source,wholesome,'nonadulterated C A10 NIA 4 C Communicable disease of worker reported to local health director A Approved shellfish,finfish,meat&-poultry USDA approved 13 Handwashing facilities provided,hands washed,clean C 10 NIA 4 B Food cans in good condition(not dented,rusty,bloated,leaking) A Handwash facilities in all food prepldispensing&warewash areas C Wholesome/nonadulteratedfoodslsafe B Handwash facilities in or immediately adjacent to toilet rooms D Commercial products(no home grownlcannedfood) C Handwash facilities accessiblelconvenient to use E Potentially hazardous foods received at proper temperature Q Personnel hands washed,clean 1 Proper handwash procedure O E Handwashing at appropriate times Potentially hazardous-food meets temperature requirements , C` NO, NIA' 4 0 during storage,preparation,display,service and transportation 15 'Good:hyglehic'practices C' 0' NIA 2 A Hot holding greater than or equal to 140°F. (whole beef/pork roasts 1300F) L11A ❑ No eating ❑ No smoking while working B Cold holding less than or equal to450F. B Wounds covered adequately C Propercooling C Proper sink used for handwashing D Proper re-heating V 0 E Proper internal cooking l consumer advisory posted 24 Sanitization`rinse(hot water-chemical) NIO N/A 2 lle 0 1 A Approved sanitizeravailableladequateconoentrationofsanitizer 4 Adequate facilities to maintain product C !N10,,, NIA, 2 B Food-contact surfaces and utensils used for potentially temperature,thermometers provided` hazardous foods 'ized at least every 4 hours A Food thermometer available and accurate C Adequate Wishwashersanitizer ❑final rinse temp D procedure B Proper food thermometer for product E Sanitizing between raw animal origin&ready-to-eat food C Thermometers appropriately placed in cooler units 0 0 25 Clean wiping cloths C 0 N/A 1, 7 Food protected during-storage,';preparation,. C` NIO NIA 2" display,service;`and transportation A Cloths and/or sponges in good repairand clean B Wiping cloths kept in sanitizer between uses A Produce washed B Rawmeais not storediprepared near ready-to-eat foods 26 ood-contact surfaces clean, C .N10 FN1 2 C Food covered properly A Food equipment clean,utensils clean,equipment interiors clean D Adequate splash guards I sneeze guard B Single use gloves changed when soiled E No unauthorized personnel 01 Cfood--contact surfaces clean F No pooling of eggs not cooked immediately 8 ood containers stored off the 30 -,Hot and cold water under,pressure,provided as.require TS N10 NIA 2 38 Handwashing accessories provided' N NIA 1 9 Handling of food minimized 0 NIA, 2 A Soap I paper towels I drying device available A No unnecessary handling RTE andlorcooked foods with bare hands B Dispenser(s)working: ❑Soap ❑Paper 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 Q •DESCRIBE DEFICIENCIES ON CONTINUATION SHEETS The following information is not debatable and does not affect your score. M: QFO[qualified food operator],DA[designated alternate],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 wok: 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 K_x%indicate language spoken List products cooled: by QFO/DA: *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: I I Note: This report is a two page form(total of 62 debitable items) Page 1 of 2 34 �bSt4i Ow r� ress ;lneofion er ,. perat ' atne� �� a � �� 4 � : ,n r, z � �: or��Oor, R. ADDITIONAL FOUR POINT ITEMS KEY: DNC [DOES NOT COMPLY] 6 Foods not re-served. -Unwrapped foods not re-served 31 Sewage disposal approved. 4 -Operating as required -Potentially hazardous foods not re-served No cross connections,back siphonage,backfiow 11 Toxic chemicals. 4 PCopPryrzefinstallafionl backfiow prevention device)airs for: 4 -Stored properly,labeled properly,used properly -Food equipment -Hose connections -Dish machines -Sanitizer concentration not to exceed maximum permitted -Soda system carbanator -Beverage dispensers -Toilet tanks -No unnecessary toxics on the premises -Chemical dispensers -Ice machines -Pesticidesfrodenticides properly dispensed Proper drain for: 29 Water source adequate,safe. -Food equipment -Dish machines -Ice machines 4 -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] 2 Sources of food: Original container,properly labeled 1. 401 Garbage/rubbish storage arealrooms,enclosures-properly constructed,clean 1 5 Potentially hazardous food properly thawed 2 411 Garbage/rubbish disposed of in an approved manner,at approved frequency 10 Aod dispensing utensils properly stored 1'; 42 Vermin Control:No insectslrodents present 2 14 Food worker:Clean outer clothes,effective hair restraints 1 43 Outer openings protected against entrance of insectslrodents t, 4 Floors:Floor covering installed,constructed as required,good repair,clean 1; 16 Food-contact surfaces designed,constructed,maintained,installed, 45 Floors graded,drained as required located 6 Floor,wall juncture covered 17 onfood-contact surfaces designed,constructed,maintained, l: 7 Mats removable,good repair,clean installed,located 1 18 Single service articles,storage,dispensing 2- 48 Exterior walking,driving surfaces,good repair,clean 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 x l maintained installed located 50 Dustless cleaning methods used,cleaning equipment properly stored Equipment&Utensils: Cleanliness 51 Adequate lighting provided as required t, 21 Preflushed,scraped,soaked and racked 52 Room free of steam,smoke odors 1 22 Wash waterclean,proper temperature 53 Rooms&equipment hoods,ducts,vented as required 23 Accu rate thermometers provided,dish basket,if used 54 Rooms adequate,clean,adequate lockers provided,facilities clean ,l 2 Nonfood-contact surfaces of utensils&equipment clean 1 55 Establishment and premises free of litter,no insectlrodentharborage, 1"` quipmenUutensils,storage,handling L+ no unnecessary articles 32 Proper disposal of waste water 17 56 Complete separation from living/sleeping quarters and laundry 33 Plumbing location,installation,maintenance 1 ; 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 1'( 59 Seats 75 or more:Nonsmoking area provided,sign(s)posted at 3 37 Propertoilet fixtures provided,good repair,clean entrance(s);smoking area indicated by sign(s) .39 Approved garbage/rubbish containers,adequate number,901 re ;1 ' rodent proof,clean 3 -0 outine Inspection ❑Reinspection 13 Preoperational Inspection INSPECTOR: PERSON! E: Other inspection: Demerit Score: •Include demerits from page 1 4 3 2 1 Total Rating s ure atu print 4l nanTe, r� print name (JbJ) j(,—f' DATE ORRECTIC DUE: phone number title �'t/VV Page 2 of 2 plus__A_continuation pages Focused Inspection 700t Page of INSPECTION REPORT STATE OF CONNECTICUT FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH CONTINUATION SHEET NAME OF ESTABLISHMENT TOWN DATE OF INSPECTION ed d a w kU 2 Is- INSPECTION REMARKS FORM# C� v vF P c, L ZuF S�t.A,01- &- im cf I- V� S S ✓ �� GIB �x d AA ( �c — r IL2 �-� S C U INITIAL(INSPECTOR) INITIAL(PERSON IN CHARGE) Distribution: 1st-White-Health Department 2nd-Yellow-Owner/Manager