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Home My WebLink AboutItnerant Vendors Inspection 0000 Sulliva (2) Page_of INSPECTION REPORT STATE OF CONNECTICUT FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH CONTINUATION SHEET NAME OF ESTABLISHMENT TOWN DATE OF INSPECTION Impecd=Form M Remaks: r2L�' i INITIAL(INSPECTOR) INITIAL(PtRSON IN CHARGE) Distribution: Ist-White-Health Department 2nd-Yellow-Owner/Manager treat\iroform2.crt Establishment: _ Date of Inspection: ddress: Owner or Operator: ADDITIONAL FOUR POINT ITEMS 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 11 Toxic chemicals. , No cross connections,back siphonage,backflow -Stored properly,labeled properly,used properly Propertype/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 machinesProper drain for: 29 Water source adequate,safe. -Food equipment -Dish machines -Ice machines -Well/well head protected from contamination 35 Toilet facilities. Adequate,convenient,accessible, -Water quality in compliance designed,properly installed -Monitoring in compliance OTHER ITEMS KEY: DNC [DOES NOT COMPLY] 2 Sources of food: Original container,properly labeled 40 Garbage/rubbish storagearea/rooms,enclosures-propedy constructed,clean 5 Potentially hazardous food properly thawed 41 Garbage/rubbish disposed of in an approved manner,at approved frequency Food dispensing utensils properly stored 42 Vermin Control: No insects/rodents present 14 Aood 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 Single service articles,storage,dispensing 8 Exterior walking,driving surfaces,good repair,clean 18 19 No reuse of single service article 9 Walls,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 Preflushed,scraped,soaked and racked 52 Room free of steam,smoke odors 22 Wash water clean,proper temperature 53 Rooms&equipment hoods,ducts,vented as required 23 Accurate thermometers provided,dish basket,if used 54 Rooms adequate,clean,adequate lockers provided,facilities clean 27 Nonfood-contact surfaces of utensils&equipment clean 55 Establishment and premises free of litter,no insect/rodent harborage, 28 Equipment/utensils,storage,handling no unnecessary articles 32 Proper disposal of waste water 56 Complete separation from living/sleeping quarters and laundry 33 Plumbing location,installation,maintenance 57 Clean/soiled linens stored properly 36 Toilet rooms enclosed with self-closing door 58 No live birds,turtles,or other animals(except guide dogs) 59 Seats 75 or more:Nonsmoking area provided,sign(s)posted at 37 Propertoiletfixtures provided,good repair,clean entrance(s),smoking area indicated by sign(s) 39 Approved garbage/rubbish containers,adequate number,covered, rodent proof,clean Mh tine Inspection ❑Reinspection ❑ Preoperational Inspection Inspection: IN PERSON IN CHARGE: Demerit Score: *Include demerits from page 1 4 3 21 1 Total Rating gn rJ sign X print name G� p nt gaIne ` /Zf hone number title DATE CORRECTIONS D E: (,(� Page 2 of 2 plus continuation pages Focused Inspection 1/2002 i Establishment: Inspection Date: — Time: ROinsp REinsp Address/City: Health Dept:_ �: 4.Ji r✓/�p'L, ass: 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 . RISK FACTOR ITEMS:Listing is not inclusive of all possible debitable items I C I NI /A DNC I KEY: C[complies] NIO[not observed] N/A[not applicable] 3 DNC[does not comply] 0[other] RTE[ready-to-eat] s 2 A Food workers have no exposed infected lesions l burns 111"Mf tFatn �pro8 2 B Personnel with infection restricted pIAYB' � � t ' J N 4 C Communicable disease of worker reported to local health director 01 A Approved shellfish,finfish,meat&poultry USDA approved jA rr B Food cans in good condition(not dented,rusty,bloated,leaking) "w 6 f -' f ' . 1�Ibb� )JIA A Handwash facilities in all food prep/dispensing&warewash areas cf C Wholesome/nonadulteratedfoods/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 0 D Personnel hands washed,clean/Proper handwash procedure E Handwashing at appropriate times O A Hot holding greater than or equal to 140 F. (Whole beef/pork roasts 1300 F.) A ❑ No eating ❑ No smoking while wo 11 rking B Cold holding less than or equal to 45°F. B Wounds covered adequately C Proper Cooling C Proper sink used for handwashing D Proper re-heating 0 e IV E Proper internal cooking/consumer advisory posted or 0 Approved sanitizer available/adequate concentration of sanitizer B Food-contact surfaces and utensils used for potentially hazardous food sanitized at least every 4 hours A Food thermometer available and accurate C Adequate ❑dishwashersanitizer ❑final rinse temp Proper B Properfood thermometerfor product D rocedure E Sanitizing between raw animal origin&ready-to-eat food C Thermometers appropriately placed in cooler units 0 0 OWN= I IMMIN 11 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 C Food covered properly A Food equipment clean,utensils clean,equipment interiors cleanAK 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 7Z0 8 Food containers stored off the floor 0 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 utensil(s)for dispensing food/ice OF 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[foodbome] PHFs are hot held at: IF. 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 o report specific illness conditions Are temperatures recorded/logged for cold holding foods/equipment? Y N and diseases to the QFO? Y N 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 barri een inspector&QFO? Y N Iflf ves indicate language spoken List products cooled: by QFO/DA: *Can the QFO/DA read the inspection report? Y N Describe cooling methods: oicate 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 r ed? 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 wh ashed and inspection: where: Note: This report is a two page form(total of 62 debitable items) Page 1 of 2