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Home My WebLink AboutFood Service Establishment Inspection 95 (4) S��iTE',tSFGfRNI`lEfaTl(flT • hQ�U_SEDOQASI+'RV+�C ECrTI4?1�J•R+ k : i1 . �r Establishment:' id Ak , Inspection Date: 440 Time: R Insp REinsp ddresslCity: 9,5-7 Health Dept: Class: 1 2 s 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 WO NIA JDNC I KEY: C[complies] NIO[not observed] NIA[not applicable] 60 i Quahfted Food Operator f 3 DNC[does not comply] 0[other] RTE read to eat !2 , Personnel with infection restricted hUD WA 61 Designated Alternate :. z C 4 42 Written documentation of.trairiing program 2 A Food workers have no exposed infected lesions 1 burns B Personnel with infection restricted N %d source,wholesome,nonadGlFerated C N/0°NIA C Communicable disease of worker reported to local health director _ . A Approved shellfish finfish,meat&poultry USDA approved 1.3; Handwashing facilities provided,,handswashed,clean C V NIA.4 B Food cans in good condition(not dented,rusty,bloated,leaking) A Handwash facilities in all food prepldispensing&warewash areas C Wholesomelnonadulteratedfoodslsafe L., B Handwash facilities in or immediately adjacent to toilet rooms JL D Commercial products(no home grownicanned food) C Handwash facilities access!blelconvenient to use , E Potentially hazardous foods received at proper temperature D Personnel hands washed,clean I Proper handwash procedure 0- E Handwashing at appropriate times entiallyhaiz;trdous#ottd;ffitlo temperature`requtrements. C N10 E4 wring storage,preparatron,,display,servree,and transportatrom i . . ... :. t `7$ 'Gaod,ilygtenla_practices 4` ;C<Nib NIA :2 Hot holding greater than or equal to 14ft. (whore heatipork roasts 13&F.) v A ❑ No eating ❑ No smoking while working B Cold holding less than or equal to45'F. C B Wounds covered adequately C Proper cooling C Proper sink used for handwashing D Proper re-heating 0 E Proper internal cooking l consumer advisory posted 41.0ni}matron rtnset(fiot water-chemical}; ;�C;;N1Q 2 pApproved sanitizer avaitableladequata concentration of sanitizer ,q i�Addouate,faellltlesXto malntaln prod t iNrw � ' K ,C r(W0 NIA r 2 g Food contact surfaces and utensils used for potentially terrrpe�ahtfs,t4�erryfgmeters provided a i hazardous food sanitized at least every 4 hours A Food thermometer available and accurate C Adequate ❑dishwasher sanitizer ❑final rinse temp D Proper sanitizin rocedure B Proper food thermometer for product E Sanitizing between raw animal origin&ready-to-eat food C Thermometers appropriately placed in cooler units 0 0onn n vrfptng,clo hi t x i�.v• r C iN/0''N! .1'; scto xdu It n fstairag�e;�pIr ri tton,° , rC'rN102: f. x„gw _ " 7 r A oths andlor sponges m ood repairand clean �prvti:attdr�ispgi� tiila a St >}. 9 • A Produce washed B Wiping cloths kept in sanitizer between uses 0 B Raw meats not storediprepared near ready-to-eat foods 2G�; ogd�contact=s fac le n � EN1 Il C C Food covered properly A Food equipment clean,utensils clean,equipment interiors clean D Adequate splash guards!sneeze guard I 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 �•n 3 o.° ".".w.`d:"�e.r.:.un.:'.d"..'?.,h lxpress`u"r e;p roid,e.dasrequireoa " " v , Ed: t 'P 4 aF�a;ntl l(n gof food it�tnt de tl ;`N..6s:tJ fA, lir' Mandwashing a ssortes pte mtz C ID iNIA 29 x e _ . A Soap!paper towels! drying device available A No unnecessary handling RTE and/or cooked 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!waste receptacle at handwash sink C Adequate utensil(s)for dispensing foodlice 0 . ,M 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[foodbornel PHFs are hot held at: F. PHFs are cold held at: DF. 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: jr Is there a written illness olicy that requires the food worker to report specific illness conditions Are temperatures recordedllagged for cold holding foodslequipment? Y N and diseases to the Q ? Y N *Do you have a paid sick leave policy? Y N Are foods cooked in advance and cooled? Y N Are leftovers vad? Y N is there a language errier between inspector&QFO? Y N If yes indicate language spoken List products cooled: by QF01DA: *Car the QF01DA read the inspection repo•Y N Describe cooling methods: Indicate w o answered the above questions: Name(print): � s Indicate the 'tie of above person cirr a that a I �F�DA Mgr Cook Owner FW is cooling monitored for time&temp? Y N is the monitoring of voting recorded? Y N *Obtain signal f-t person who received the OFO responsibilities information at the time of the Is there a produce washing policy? Y N *Describe what is ashed and inspectio - where: Note: T rs a Iwo page form(total of 62 debitable items) Page 1 of 2 „ OVYller Or O erator'�f�1/�J' f ADDITIONAL FOUR POINT ITEMS KEY: DNC [DOES NOT COMPLY] 6 Foods not re-served. 31 Sewage disposal approved. -Unwrapped foods not re-served ' -Potentially hazardous foods not re-served -Operating as required34 , 11 Toxic chemicals. v No cross connections,back siphonage,backflow4.; 4 Proper type/installation/backflow prevention device/air goo for: -Stored properly,labeled properly,used properly k -Food equipment -Hose connections -Dish machines -Sanitizer concentration not to exceed maximum permitted a z -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. 4` -Food equipment -Dish machines -ice machines ` -Well 1 well head protected from contamination ; , -Water quality in compliance 35 Toilet facilities. Adequate,convenient,accessible, 4 ' designed,properly installed -Monitoring in compliance OTHER ITEMS KEY: DNC [DOES NOT COMPLY] 27 urcesoffood: Originalcontainer,properly(abeled ` 40 Garbage/rubbish storage area/rooms,enclosures-properly constructed,clean 5 Potentially hazardousfood properly thawed 2 41 Garbage/rubbish disposed of in an approved manner,at approved frequency ' 10 Food dispensing utensils properly stored P1 2 Vermin Control: No insects/rodents present2 14 Food worker:Clean outer cloches,effective hair restraints 43 Outeropenings protected against entrance of insects/rodents 4 Floors: Floor covering installed,constructed as required,good repair,clean 16 Food-contact surfaces designed,constructed,maintained,installed, 5 Floors graded,drained as required led 6 Floor,wail juncture covered 7 N food-contact surfaces designed,constructed,maintained, m 7 Mats removable,good repair,clean installed,located ! a `--- K, 48 Exterior walking,driving surfaces,good repair,cleanL 18 Single service articles,storage,dispensing ( EA 9 Walls,ceilings attached,equipment properly constructed,good l p 19 No reuse ofsingle service article � .i repair,clean.Wall&ceiling surfaces as required 20 Dishwashing facilities approved design,adequately constructed, ?u maintained installed located 50 Dustless cleaning methods used,cleaning equipment properly stored .: Equipment&Utensils: Cle nla iness 51 Adequate lighting provided as required IVA 21 Preflushed,scraped,soaked and racked � 52 Room free of steam,smoke odors i 22 Wash water clean,proper temperature ° 53 Rooms&equipment hoods,ducts,vented as required t'° Accurate thermometers provided,dish basket,if used 54 Rooms adequate,clean,adequate lockers provided,facilities clean 1 7 onfood-contact surfaces of utensils&equipment clean1 f 55 Establishment and premises free of flitter,noinsecthodentharborage, 8 Equipmentlutensils,storage,handling no unnecessary articles 32 Proper disposal of wastewater c 56 Complete separation from living/sleeping quarters and laundry 33 Plumbing location,installation,maintenance k 57 Clean/soiled linens stored property 58 No live birds,turtles,or other animals(except guide dogs) 36 Toilet rooms enclosed with self-closing door � E -` 59 Seats e(or more:ngNonsmoking are a n i area provided,sign(s)posted at 3 37 Propertoiletfixturesprvvided,good repair,clean entrance(s),smoking area indicated by sign(s) 39 Approved garbage/rubbish containers,adequate number,covered, 51d rodent proof,clean ❑Routine Inspection ❑Reinspection ❑ Preoperational Inspection -- Other Inspection: -ASPEC T R: A Demerit Score: *Include demerits from page I 4 3 2 1 Total Rating ignature pap t name print Ane woJ6� �. 5` DATE CORRECTIONS DUE: ' -phone number��- title .� ' -% Page 2 of 2 plus continuation pages Focused Inspection 112002 Page / of INSPECTION REPORT STATE OF CONNECTICUT FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH CONTINUATION SHEET NAME OF ESTABLISHMENT TOWN DATE OF INSPECTION '�L U LA INSPECTION R.EML4RKS FORM# or ZZ o 1 I I _ I�JLt� '1 07-f 6 3 /, C' 21-4 12 .d. r 'ILA �- INITIAL(INSPECTOR) r..._ INITIAL(PERSON IN C GE) Distribution: 1st-White-Health Department 2nd-Yellow- Owner/Manager Pagej--Of . INSPECTION REPORT STATE OF CONNECTICUT FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH CONTINUATION SHEET NAME OF ESTABLISHMENT TOWN DATE OF INSPECTI N -e INSPECTION REMARKS FORM# Ab Zez. i INITIAL(INSPECTOR) INITIAL(PERSON IN CH E Distribution- I st-White-Health Department 2nd-Yellow- wner/Manager Attachment 4 FOOD DESTRUCTION FORM DATE: Cry f (Firm) 9"-P (Location) (Town) I have on the day of 20Y,voluntarily destroyed, or caused to be destroyed,the food items described below. Said food items were found to be from an unapproved source, unwholesome, adulterated or otherwise unfit for human consumption. Destruction and final dispo �tion of said food items has been done in a manner approved by: (Name 1 hereby release the 7 Lui SG , and its members, agents, and representatives from any and all liability. Quantity Volume/Weight Name and Description of Reason Destroyed Food Items u G j Z�r 3 /Z se By: I"spector's Signature Title: Attachment 4 FOOD DESTRUCTION FORM DATE: (Firm) (Location) (Town) I have on the O day of 20_j_b voluntarily destroyed, or caused to be destroyed,the food ite ' ed below. Said food items were found to be from an unapproved so rce, unwt eso e, adulterat . or otherwise unfit for human consumption. Destruction and final dis osition of said fo -item�h s been done in a manner approved by: rl ° (N m ) ( e) I hereby release the ,4 W �b A*fV , and its members, agents, and representatives from any and all liability. Quantity Volume/Weight Name and Description of Reason Destroyed Food Items y7, � �� 2 tz pector's Sign re Title:�st