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Home My WebLink AboutFood Service Establishment Inspection 19 (6) Establishment: \ spection Date: \ Time: o[nsp EZ Address./City: I C( juna (i Y1- Health Dept: tl class: z 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 0 N/A DNCI KEY: C[complies] N/O[not observed] N/A[not applicable] 3 DNC[does not comply] 0[other] FIT[ready-to-eat] rya s .a,f t _ A Food workers have no exposed infected lesions/burns 2 B Personnel with infection restricted ' f "d /A ` C Communicable disease of worker reported to local health director A1 Approved shellfish,finfish,meat&poultry USDA approved I I 93z FtatldtM i9,f il9hes. ro hiiiii � a ,clean B Food cans in good condition(not dented,rusty,bloated,leaking) ' 4 A Handwash facilities in all food prep/dispensing&warewash areas C Wholesome/nonadulteratedfoodslsafe 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 I Proper handwash procedure 0 E Handwashing at appropriate times AB 0 60tl Hot holding greater than or equal to 1400F. (wholebeef/pork roasts 13o°F) A El No eating ❑ No smoking while working pal, Cold holding less than or equal to 450 F. B Wounds covered adequately C Proper cooling C Proper sink used for handwashing D Proper re-heating 01 0 E Proper internal cooking I consumer advisory posted 0 A Approved sanitizeravailable/adequate concentration ofsanitizer� if!It Ij g Food-contact surfaces and utensils used for potentially hazardous food s nitized at least every 4 hours A Food thermometer available and accurate C Adequate Erdishwashersanitizer ❑final rinse temp Ill B Proper food thermometer for product D Proper sanitizin procedure C Thermometers appropriately placed in cooler units E Sanitizing between raw animal origin&ready-to-eat food 0 0 } _ A Cloths and/or sponges in good repair and clean B Wiping cloths kept in sanitizer between uses A Produce washed 0 B Raw meats not stored/prepared near ready-to-eat foods C Food covered properly A Food equipment clean,utensils clean,equipment interiors clean D Adequate splash guards/sneeze guard g 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 10, 0 n WWI.. . ., a / / A No unnecessary handling RTE and/or cooked foods with bare hands A Soap paper towels drying device available 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 uteri for dispensing food/ice 0 0 1 1 1 •DESCRIBE DEFICIENCIES ON CONTINUATION SHEETS The following information is not debitable and does not affect your score. _M: QFO(qualified food operator],DA[designated alternate],PHF[potentially hazardous food],FB[foodbome] 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 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&CFO? Y N If ves indicate language spoken List products cooled: by QFO/DA: *Can the CFO/DA 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 r IEblishmfi Date of Inspection: g ess; I j �)_�r k L�A el"k Owner or Operator: An" ADDITIONAL FOUR POINT ITEMS KEY. DNC [DOES NOT COMPLY] 6 Foods not re-served. -Unwrapped foods not re-served �' 31 Sewage disposal approved. -Potentially hazardous foods not re-served -Operating as required 11 Toxic chemicals. 34 No cross connections,back siphonage,backflow -Stored properly,labeled properly,used properly Pro ear type/installation/backflow prevention device/air gap for: -Sanitizer concentration not to exceed maximum permitted -Food equipment -Hose connections -Dish machines -No unnecessary toxics on the premises -Soda system carbonator -Beverage dispensers -Toilet tanks -Pesticides/rodenticides properly dispensed -Chemical dispensers -Ice machines Proper drain for: 29 Water source adequate,safe. -Food equipment -Dish machines -Ice machines -Well/well head protected from contamination Ides -Water quality in compliance oiletfacilities. Adequate,convenient,accessible, -Monitoring in compliance igned,properly installed OTHER ITEMS KEY: DNC [DOES NOT COMPLY] Sources of food:Original container,properly labeled 40 Garbage/rubbish storagearea/rooms,enclosures-properly constructed,clean 5 Potentially hazardous food properly thawed 41 Garbage/rubbish disposed of in an approved manner,at approved frequency 10 Food dispensing utensils properly stored 42 Vermin Control: No insects/rodents present 14 Food worker:Clean outer clothes,effective hair restraints 43 Outer openings 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, 45 Floors graded,drained as required located 6 Floor,wall juncture covered 17 Nonfood-contact surfaces designed,constructed, maintained, 7 Mats removable,good repair,clean installed,located 8 Exterior walking,driving surfaces,good repair,clean 18 Single service articles,storage,dispensing 19 No reuse of single service article 9 W Is,ceilings attached,equipment properly constructed,good 20 Dishwashing facilities approved design,adequately constructed, repair,clean.Wall&ceiling surfaces as required maintained installed located 50 Dustless cleaning methods used,cleaning equipment properly stored Equipment&Utensils: Cleanliness 51 Adequate lighting provided as required 21 Pref ushed,scraped,soaked and racked 52 Room free of steam,smoke odors 2 Wash water clean,proper temperature 53 Rooms&equipment hoods,ducts,vented as required )Accurate thermometers provided,dish basket,if used 54 Rooms adequate,clean,adequate lockers provided,facilities clean 27 onfood-contact surfaces of utensils&equipment clean 55 Establishment and premisesfreeof lifter,noinsect/rodentharborage, uipmentlutensils,storage,handling no unnecessary articles 32 Yroper disposal of waste water 56 Complete separation from living/sleeping quarters and laundry 33 Plumbing location,installation,maintenance 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 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) 39 Approved garbage/rubbish containers,adequate number,covered, rodent proof,clean outine Inspection ❑Reinspection ❑ Preoperational Inspection Other Inspection: INSPECTOR: _,TN R Demerit Score: *Include demerits from page 1 4 3 2 1 Total Rating _ si nature ture 1<print na a pri a ek phone number title 2 // Z`�1� — DATE CORRECTIONS DUE: . �� Page 2 of 2 plus continuation pages Focused Inspection M02 Page3 of INSPECTION REPORT STATE OF CONNECTICUT FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH CONTINUATION SHEET NAME OF ESTABLISHMENT TOWN DATE OF INSPECTION J)r,'J�V\1-4 4V9—TrA-f_r INSPECTION FORM# REMARKS ID cj dtA 60-Wa-1� o A-t Av, Vvd 0� A ()(I/ 1_.j 0 _\��k)XA4 loot C; Z k� w ✓ �- -�> ✓ Z INITIAL(INSPECTOR) INITIAL(PERSON IN CHARGE) Distribution: 1 st-White-Health Department 2nd-Yellow-Owner/Manager