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Home My WebLink AboutTemp Food Inspection 700 Ellington Road Establishment: -12 Date of Inspection: ddress: '30 C in- Po 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. 34 No cross connections,back siphonage,backflow -Stored properly,labeled properly,used properly Proper 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 35rdesigtnfediproperly lities. Adequate,convenient,accessible, Water quality in compliancein-Monitoring in compliance ' stalled OTHER ITEMS KEY: DNC [DOES NOT COMPLY] 2 Sources of food:Original container,properly labeled 40 Garbage/rubbish storage area/rooms,enclosures-property 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 Walls,ceilings attached,equipment properly constructed,good repair,clean.Wall&ceiling surfaces as required 20 Dishwashing facilities approved design,adequately constructed, 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 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 routine Inspection ❑Reinspection ❑ Preoperational Inspection Other Inspection: INSPECTOR: 00u, PERSON IN CHARGE:QJ14 Demerit Score: *Include demerits from page 1 -� 4 3 2 1 1 Total Rating signature signature , 'Vc� Cake - a — y 01G print name print name .. phone number title DATE CORRECTIONS DUE: Page 2 of 2 plus_�continuation pages Focused Inspection 1/2002 i Establishment: 7 — 1L Inspection Date: tl Is o1) Time: -- Ains REinsp Address/City: 76 4 E 1I,n R.o d•d Health Dept: S o w_TF/ W A*SVIZ Class: 1 2 0 4 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 N/0 N/A DNCI KEY: C[complies] NIO[not observed] NIA[not applicable] 66 4i`ied Food Ope�aEmt `. - ,_ 3 DNC[does not comply] 0[other] RTE[ready-to-eat] 61 Designated Alternate 2 12 `Rer'sornel with infectiurt restricted C WO WA 4 62 irlGra#ten documentation of training program 2 q Food workers have no exposed infected lesions/burns ' 1 Approved Source,wholesome,n@naduiterated C N10 NIA 4 B Personnel with infection restricted '' C Communicable disease of worker reported to local health director A Approved shellfish,finfish,meat&poultry USDA approved A 1 1 13 Handwashing facilities provided,hands washed,dean. C WO WA 14 B Food cans in good condition(not dented,rusty,bloated,leaking) A Handwash facilities in all food prep/dispensing&warewash areas C Wholesome/nonadulterated foods/safe B Handwash facilities in or immediately adjacent to toilet rooms ,4 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/Proper handwash procedure 0 E Handwashing at appropriate times 3- Pa#etti6ltyy,liazar'dous fad rteets#emp'eraure¢egttrer>xe�s C NO,Nt1. 4 0 ddq�tg'sforage,p�paia ipB�dE$ptaq,senuia+g and-transportattiOn 4s Goo'd lli fgiertic practices� C WOE WA 2. A Hot holding greater than or equal to 140eF. (Whole beef/pork roasts 1300 F.) A ❑ No eating ❑ No smoking while working B Cold holding less than or equal to 450F. J B Wounds covered adequately J C Proper cooling I J1 C Proper sink used for handwashing U D Proper re-heating J 0 E Proper internal cooking I consumer advisory posted 3¢ � ktri c d N(0 WA 2 0 A�Approved sanitizeravailable/adequate concentration ofsanitizer 4 gdee faicriltles tc►ioaintta pr©duct ._ C W4 ,2 B Food contact surfaces and utensils used for potentially teperiiieeons fers,.provioed hazardous food sanitized at least every 4 hours A Food thermometer available and accurate _ C Adequate ❑dishwashersanitizer ❑final rinse temp B Properfood thermometerfor product L Proper sanitizin rocedure C Thermometers appropriately placed in cooler units E Sanitizing between raw animal origin&ready-to-eat food J 0 O 25 <( caii prg,ciifis _` C WO WA 1 t`'" oo °pr ed rliilr'ing's4torage;`preptir'ation, C's M1llt) t%A ;4 display,service and transportation 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 I IA Food equipment clean,utensils clean,equipment interiors clean D Adequate splash guards/sneeze guard I IB Single use gloves changed when soiled E No unauthorized personnel J C Food-contact surfaces clean F No pooling of eggs not cooked immediately 0 8 Food containers stored off the floor 3BAr4 iittg ,gpre�ftdet�. == C W `NfA >. trtan �" food hill liw C V0 WA 2 A Soap I paper towels/ drying device available .1 A No unnecessary handling RTE and/or cooked foods with bare hands J 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 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 ho OF. PHFs are cold held at: OF. Describe illness conditions when you would exclude a food worker from working: Are internal cooking temper to aken? Y�N+To what temperature do you cook: Poultry Groun Pork What diseases related to FB illness are you required to report to ealth department? Roasts Other Describe re-heating procedures: Is there a written illness policy that r e food worker to report specific illness conditions Are temperatures recorded/logged for cold holding foods/equipment? and diseases to the *Do you have a paid sick leave policy? Y N Are foods cooked in advance and cooled? Y N *Are leftovers saved? Y N a anguage barrier between inspector&QFO? Y N If yes indicate language spoken List products cooled: by QFO/ *Can the CFO/DA read the inspection report? Y N Describe cooling methods: Indicate who answered the above s: Name(print): Indicate the title of above person(circle all that ap 0 DA Mgr Cook Owner FW Is cooling monitored for time . Y N Is the monitoring of cooling recorded? Y N .Obtain signature perso who r ceived the 0 resp nsl '' formation at the time of the Is there ce washing policy? Y N *Describe what is washed and inspection: Note: This report is a two page form(total of 62 debitable items) Page Page �- of INSPECTION REPORT STATE OF CONNECTICUT FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH CONTINUATION SHEET NAME OF ESTABLISHMENT TOWN DATE OF INSPECTION 7- 1/3- S0,ATN 1NsnJpsa� i I Is oq INSPECTION FORM# REMARKS C mltl ej On a;,Ver- e�5 010 �'DtiC 1 �J�Ik'1/i C001 FN-0 c1n, CA-i CLP25 o -F)bor i ✓T NoT� �� ►� ok 13Z V��A —D- H�- o Cok INITIAL(INSPECTOR) INITIAL(PERSON IN CHARGE) Distribution: 1 st-White-Health Department 2nd-Yellow-Owner/Manager , Page l of INSPECTION REPORT STATE OF CONNECTICUT FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH CONTINUATION SHEET NAME OF ESTABLISHMENT TOWN DATE OF INSPECTION 7-// INSPECTION FORM# REMARKS w 1 � � P r INITIAL(INSPECTOR) INITIAL(PERSON IN CHARGE) Distribution: 1 st-White-Health Department 2nd-Yellow-Owner/Ma ager ME lEarblishment: !7-/ /. Date of Inspection: ess: Owner or;Operator; ADDITIONAL FOUR P INT ITEMS KEY: DNC [DOES NOT COMPLY] 6 Foods not re-served. 4 31 Sewage disposal approved. -Unwrapped foods not re-served 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 Proper type/installation/backflow prevention device/air gap for:-Sanitizes 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 storage area/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 18 Single service articles,storage,dispensing 8 Exterior walking,driving surfaces,good repair,clean 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 i m n I nli A quate lighting provided as required reflushed,scraped,soaked and racked 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 Propertoiletfixturespsovided,good repair,clean entrance(s),smoking area indicated by sign(s) 39 Approved garbage/rubbish containers,adequate number,covered, rodent proof,c an ❑Routine Inspection einspection ❑ Preoperational Inspection PERSON IN CHARGE: Other Inspection: I T Demerit Score: *Include demerits from page 1 4 3 2 1 Total Rating e signature in a print name t� 67 DATE CORRECTIONS DUE: �J p one nu ber We III Page 2 of 2 plus continuation pages Focused Inspection 1/2002 i Establishment: Inspection Date: er2<Z2 Time: Ruins REM Address/City: Health Dept: Class: 1 20 Based on an inspection this day,the itenp marked DNC identify the violations in operation or facilities which must be corrected by the date specified on page I RISK FACTOR ITEMS: Listing is not inclusive of all possible debitable items C N/0 N/A DNC KEY: C[complies] N/O[not observed] NIA[not applicable] $ DNC[does not comply] 0[other] RTE[ready-to-eat] pq A Food workers have no exposed infected lesions/burns B Personnel with infection restricted �' d3dtlBE) � " C Communicable disease of worker reported to local health director s A Approved shellfish,finfish,meat&poultry USDA approved z B Food cans in good condition(not dented,rusty,bloated,leaking) N� �� A Handwash facilities in all food prep/dispensing&warewash areas 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 D Personnel hands washed,clean/Proper handwash procedure 0 E Handwashing at appropriate times 0 r A Hot holding greater than or equal to 1400F. (whole beef/porkroasts fsoo F.) A ❑ No eating ❑ No smoking while working B 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 0 E Proper internal cooking/consumer advisory posted 0 A Approved sanitizeravailable/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 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 0 nA ths and/or sponges in good repair and cleanping cloths kept in sanitizer between usesA Produce washed 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 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 0 d f' 00 A X No unnecessary handling RTE and/or cooked foods with bare hands A oap I per towels/ drying device available B penser(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 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: 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 i quire to report to the local health department? Roasts Other Describe re-heating procedures: I written illness policy that requires the food worker to report specific illness conditions Are temperatures recorded/logged for cold holding foods/equipment? Y N Iand 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 s Y N Is there a language barrier between inspector&CFO? Y N If yes indicate language spoken List products cooled: by QFO/DA: *Can the QF0/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&I=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 icy? 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 NAME OF DATE OF ' • ua -M-'A r4MOVE f DoFMKJV7�' �,JA-ffft 1IIII!il MAO' y i ICI � q will rRaw '_ 11.E m ram VC91 VIP/ VMMMIFIR , W O.IWAI W-A019 P11 Mlg/ ` WIMP' ..�� .dr in Ell I 1plfill I :'- INITIAL •• • .a Establishment: Date of Inspection: �! ddress: Owner or Operator: ADDITIONAL FOUR INT ITEMS KEY: DNC [DOES NOT COMPLY] 6 Foods not re-served. -Unwrapped foods not re-served 4 31 Sewage disposal approved. 4' -Operating as required -Potentially hazardous foods not re served 11 Toxic chemicals. � No cross connections,back siphonage,backflow Proper type/installation/backflow prevention device/air gap for: -Stored properly,labeled properly,used properly -Food equipment -Hose connections -Dish machines -San itizer concentration not to exceed maximum permitted -Soda system carbonator -Beverage dispensers -Toilet tanks -No unnecessary toxics on the premises -Chemical dispensers -Ice machines -Pesticides/rodenticides properly dispensed Proper 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 -Monitoring in compliance designed,properly installed OTHER ITEMS KEY: DNC [DOES NOT COMPLY] 2 Sources of food: Original container,properly labeled 410 Garbage/rubbish storage area/rooms,enclosures-properly constructed,d r 5 Potentially hazardous food properly thawed rbage/rubbish disposed of in an approved manner,at approved frequency 10 Food dispensing utensils properly stored 2 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 ors: Floor covering installed,constructed as required,good repair,clean 16 Food-contact surfaces designed,constructed,maintained,installed, 5 Floors graded,drained as rbquired atetl 6 Floor,wall juncture covered 17 nfood-wntactsurfaces designed,constructed,maintained, 7 Mats removable,good repair,clean installed,located 8 Exterior walking, 18 Single service articles,storage,dispensing driving surfaces,good repair,clean 19 No reuse of single service article 9 Ils,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 t n it : Cleanliness Adequate lighting provided as required 2 Preflushed,scraped,soaked and racked Room free of steam,smoke odors Wash water clean,proper temperature 53 Rooms&equipment hoods,ducts,vented as required Accurate thermometers provided,dish basket,if used 54 oms adequate,clean,adequate lockers provided,facilities clean ' 7 onfood-contact surfaces of utensils&equipment clean 5 tablishmentand premises free of litter,no insect/rodent harborage, Equipment/utensils,stnrage,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) 37 Proper toilet fixtures provided,good repair,clean 59 Seats 75 or more:Nonsmoking area provided,sign(s)posted at entrance(s),smoking area indicated by sign(s) 39 Approved garbage/rubbish containers,adequate number,covered, rodent profclean PRoutine Inspection OReinspection 0 Preoperational Inspection Ot nspection: I R: PERSON IN CHARGE: Demerit Score: *Include demerits from page 1 4 3 2 1 Total Rating ur sigdatureUTV L_ AI— print name print name YCtf� DAT CORRECTIONS DUE: 1[4z. ) 4 phone number title Page 2 of 2 plus continuation pages Focused Inspection_02 i Establishment: Inspection Date: Time: ROinsp RE[nsp Address/City: Health Dept: � Class: 1 Based on an inspection this day,the items rked DNC identify the viola!! 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 V N/A IDNC I KEY: C[complies] N/0[not observed] NIA[not applicable] g` 3 DNC[does not comply] 0[other] RTE[ready-to-eat] � ' "1 ers6WKei"i tf�i t tiara"restrktod ` 1 C N/4 IAA 4 61` flsetatediEteiiaa A Food workers have no exposed infected lesions/burns 62 Written documentation of twining program 2 B Personnel with infection restricted 1 Approved Source,wholesome,nonadutterated C N/0 NIA C Communicable disease of worker reported to local health director A Approved shellfish,finfish,meat&poultry USDA approved 131 Handwashing WIllfies provided,hands washed,clean C NIA 4 B Food cans in good condition(not dented,rusty,bloated,leaking) A Handwash facilities in all food prep/dispensing&warewash areas 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 00 100 0Y, ta ==ff- i re. ! 0010 5 ad hygisrti 'pra`cces cip' 2" A Hot holding greater than or equal to 140oF. (whole beeFlpork roasts 1300 F.) V ❑ No eating ❑ No smoking while working B Cold holding less than or equal to 450F. B Wounds covered adequately 01 C Proper cooling C Proper sink used for handwashing D Proper re-heating 0 E Proper internal cooking/consumer advisory posted 24. ! � -; {ho�rar c.Fioret►c€ai) C 0 A Approved sanitzeravailable/adequateconcentrationofsanitizer wn B Food-contact surfaces and utensils used for potentially Ml hazardous food sanitized at least every 4 hours A Food thermometer available and accurate C Adequate ❑dishwashersanitizer ❑final rinse temp B Proper food thermometer for product OF D Proper sanitizin rocedure C Thermometers appropriately placed in cooler units E Sanitizing between raw animal origin&ready-to-eat food 0 Mr wl t display,service and transportation A Cloths and/or sponges in good repair and clean A Produce washed B Wiping cloths kept in sanitizer between uses B Raw meats not stored/prepared near ready-to-eat foods 0 C Food covered properly so= Emma 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 00 od containers stored off the floor90 �� 1� a bo "tn rihrzE:d` C N A 2 ptgka , driesr" dsd _ , A No unnecessaryhandling RTE and/or cooked foods with bare hands A Soap I paper towels/ drying device available B Dispenser(s)working: ❑Soap ❑Papertowel B Minimize food handling,other than ready-to-eat,with bare hands 001, 10 C Handwash sink(s)clean/waste receptacle at handwash sink C Adequate utensil(s)for dispensing food/ice 0 0 •DESCRIBE DEFICIENCIES ON CONTINUATION SHEETS The following information is not debitable and does not affect your score. KEY: QFO[qualified food operator],D [designated alternate],PHF[potentially hazardous food],FB[foodborne] PHFs are hot held at: OF. PHFs are cold held at: OF. Describe illness con diti s 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 r ed to FB illness are you required to report to the local health department? Roasts Other Describe re-heating procedures: Is there ritten illness policy that requires the food worker to report specific illness conditions Are temperatures recorded/logged for cold holding foods/equipment? Y N and ' ases 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 there a language barrier between inspector&QFO? Y N If yes indicate language spoken List products cooled: by QFO/DA: +Can the QFO/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 re ded? 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 was d and inspection: where: Note: This report is a two page form(total of 62 debitable items) Page 1 of 2 i 9 Ajej Establishment: Inspection Date: — Time: Ro[nsp REinsp Address/City: Health Dept: !l C/1 , Class: 1ic� Based on an inspection this day,the items m&ked DNC identi 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 N/O WA DNC I KEY: C[complies] N/0[not observed] NIA[not applicable] 3 DNC[does not comply] 0[other] RTE[ready-to-eat] 2 m ¢ x A Food workers have no exposed infected lesions/burns 2 B Personnel with infection restricted !�P ►� ! +�n ��tl � :I+f/0 �IIA 4 C Communicable disease of worker reported to local health director A Approved shellfish,finfish,meat&poultry USDA approved 1 - B Food cans in good condition(not dented,rusty,bloated,leaking) - fsstrttli,mta '=NKS NFA`=4 C Wholesome/nonadulterated foods/safe A Handwash facilities in all food prep/dispensing&warewash areas 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/Proper handwash procedure E Handwashing at appropriate times qj ot holding greater than or equal to 140 F. (whole beef/pork roasts 130e F.) ❑ No eating ❑ No smoking while working oldholdinglessthanorequalto450F. B Wounds covered adequately C Proper cooling C Proper sink used for handwashing 1000 D Proper re-heating 0 E Proper internal cooking/consumer advisory posted A Approved sanitizer available/adequate concentration of sanitizer g Food-contact surfaces and utensils used for potentially hazardous food sanitized at least every 4 hours A Food thermometer available and ac:cooler Adequate ❑dishwashersanitizer ❑final rinse temp B Proper food thermometer for produc Propersanitizin procedure C Thermometers appropriately placed Sanitizing between raw animal origin&ready-to-eat food 0 0 A Cloths and/or sponges in good repair and clean A Produce washed B Wiping cloths kept in sanitizer between uses B Raw meats not stored/prepared near ready-to-eat foods 0 C Food covered properly A Food equipment clean,utensils clean,equipment interiors clean D Adequate splash guards/sneeze guard VfB Single use gloves changed when soiled E No unauthorized personnel 7 Food--contact surfaces clean No pooling of eggs not cooked immediately 0 8 Food containers stored off the floor 71— 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 I Handwash sink(s)clean/waste receptacle at handwash sink C Adequate utensil(s)for dispensing food/ice lo, 0 OId •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: 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 r ocal health department? Roasts Other Describe re-heating procedures: Is there a written illness . a requires the food worker to report specific illness conditions Are temperatures recorded/logged for cold holding foods/equipment? Y N and disease FO? 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 ere a language barrier between inspector&QFO? Y N If yes indicate language spoken List products cooled: by CFO/DA: *Can the QFO/DA read the inspection report? Y N Describe cooling methods: Indicate who answered the above questions: Name(print): Is cooling monitored for time&temp? Y N I monitoring of cooling recorded? Y N Indicate the title of above person(circle all that apply):QFO DA Mgr Cook Owner FW Is cooling monitored for time&temp? Y N I monitoring of cooling recorded? Y Nd •Obtain signature of the person who received the CFO responsibilities information at the time of the Is there a produce washing policy? Y ♦Describe what is washed and inspection: where: Note: This report is a two page form(total of 62 debitable items) Page 1 of 2 s NAME OF DATE OF • "=40 . . MWi < <, ,T WA 1:-m R rod,M m- -,MR14 W04, mil" _/ / "�! �1 � � �// •�.,, / �'J, WA AM �-4 'N WA Eli,-11 /M' �,WA ff WA A—0�PW4 IWAA A wo/A 'IF(, —�9-1�M2---4 b If INITIAL (INSPECTOR) /`� • r, W M!, Establishment: / Date of Inspection: ddress: Owner or Operator: ADDITIONAL FOUR P INT ITEMS KEY: DNC [DOES NOT COMPLY] 6 Foods not re-served. -Unwrapped foods not re-served 4 31 Sewage disposal approved. 4 -Operating as required -Potentially hazardous foods not re served 11 Toxic chemicals. � No cross connections,back siphonage,backflow Proper type/installation/backflow prevention device/air gap fo -Stored properly,labeled properly,used properly r: -Sanitizerconcentration not to exceed maximum permitted -Food equipment -Hose connections -Dish machines the premises -Soda system carbonator -Beverage dispensers -Toilet tanks -No unnecessary radon ofon -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-Water quality in compliance 35 Toilet facilities. Adequate,convenient,accessible, -Monitoring in compliance designed,properly installed OTHER ITEMS KEY: DNC [DOES NOT COMPLY] 2 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 g Duteropenings protected against entrance of insects/rodents 4 oors: Floor covering installed,constructed as required,good repair,clean 16 Food-contact surfaces designed,constructed,maintained,installed, 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 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 properlystored 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 541 Rooms adequate,clean,adequate lockers provided,facilities clean ' Nonfood-contact surfaces of utensils&equipment clean 55 Establishment and premises free of litter,noinsect/rodentharborage, Equipment/utensils,storage,handling no unnecessary articles 32 Proper disposal of wastewater 56 Complete separation from living/sleeping quarters and laundry 33 Plumbing location,installation,maintenance 57 Clean/soiled linens stored properly 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 7 ropertoiletfixturesprovirled,good repair,clean entrance(s),smoking area indicated by sign(s) 39 Approved garbage/rubbish containers,adequate number,covered, rodent proof,Ilean ❑Routine Inspection einspection ❑ Preoperational Inspection Other Inspection: IN PERSON IN CHARGE: Demerit Score: *Include demerits from page 1 4 3 2 1 Total Rating signa ure rint n m print n e. ZPX�/— - phone number title DATE CORRECTIONS DUE: ZZ 4 Page 2 of 2 plus continuation pages Focused Inspection 1/2002 r � Page of INSPECTION REPORT STATE OF CONNECTICUT FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH CONTINUATION SHEET NAME OF ESTABLISHMENT TOWN DATE OF INSPECTION 7-1 ( S .c,J , Jose\- v(Z"", INSPECTION REMARKS FORM# j ,37 44 T- k/J0 JOHN GLADU E •�® Area Facilities Manager New England Region Northeast Division 7-Eleven,Inc. Fax No.860-269-6900 7-E7-E Ellington Road Email John.Gladu@7-11.com South Windsor,CT 06074 Office 860-291-6912 INITIAL(INSPECTOR) INITIAL(PERSON IN CHARGE) Distribution: 1st-White-Health Department 2nd-Yellow-Owner/Manager tAc Establishment: —7--t Date of Inspection Address: L) 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 Proper 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 L Toilet facilities. Adequate,convenient,accessible, -Water quality in compliance -Monitoring in compliance designed,properly installed rolo OTHER ITEMS KEY: DNC [DOES NOT COMPLY] 2 Sources of food:Original container,properly labeled 40 Garbage/rubbish storagearea/rooms,enclosures-property constructed,dean 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 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, 47 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 ails,ceilings attached,equipment properly constructed,good repair,clean.Wall&ceiling surfaces as required 20 Dishwashing facilities approved design,adequately constructed, maintained installed located 50 Dustless cleaning methods used,cleaning equipment property 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 ooms adequate,clean,adequate lockers provided,facilities clean 27 Nonfood-contact surfaces of utensils&equipment clean 55 Establishment and premisesfreeof litter,noinsectlrodentharborage, 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 58 No live birds,turtles,or other animals(except guide dogs) 36 oilet rooms enclosed with self-closing door P '4 59 Seats 75 or more:Nonsmoking area provided,sign(s)posted at 7 ropertoiletfixturesprpvided,good repair,clean entrance(s),smoking area indicated by sign(s) 39 Approved garbage/rubbish containers,adequate number,covered, rodent prolpf,clean [311outine Inspection Reinspection 13 Preoperational Inspection PERSON IN CHARGE: Other Inspection: Demerit Score: *Include demerits from page 1 4 3 2 1 Total Rating u l ��` signatur y I N 00 10&7rE_C_ rin n me print name :7 Z X � q�o _J E RA N C t-►I_c tG DATE CORRECTIONS DUE: 8 phone number title Page 2 of 2 plus continuation pages Focused Inspection 1/2002 Establishment: —! Inspection Date: Time: ROinsp V24 Address/City: Q Health Dept: .s./`/oa/QS"�L Class; t Based on an inspection this day,the iterrOmarked 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 NIO N/A DNC KEY; C[complies] N/O[not observed] N/A[not applicable] 3 DNC[does not comply] 0[other] RTE[ready-to-eat) a A� Food workers have no exposed infected lesions I burns B Personnel with infection restricted C Communicable disease of worker reported to local health director A Approved shellfish,finfish,meat&poultry USDA approved B Food cans in good condition(not dented,rusty,bloated,leaking) 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/Proper handwash procedure 0 E Handwashing at appropriate times 0 A Hot holding greater than or equal to 1400F. (whole beetipork roasts 13De F.) A ❑ No eating ❑ No smoking while working - B 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 0 E Proper internal cooking/consumer advisory postedEms 0 A 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 B Properfood thermometerfor product L Proper sanitizin rocedure E Sanitizing between raw animal origin&ready-to-eat food C Thermometers appropriately placed in cooler units 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 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 0 No unnecessary handling RTE and/or cooked foods with bare hands A Soap/paper towels/ drying device available B Dispenser(s)working: ❑Soap ❑Papertowel B Minimize food handling,other than ready-to-eat,with bare hands A7C Handwash sink(s)clean/waste receptacle at handwash sink C Adequate utensil(s)for dispensing food/ice 0 0 •DESCRIBE DEFICIENCIES ON CONTINUATION SHEETS The following information is not debitable and does not affect your score. JSEY: 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&QFO? Y N ff-M 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): Is cooling monitored for time&temp? Y N Is the monitoring of cooling recorded? Y N .Indicate the title of above person(circle all that apply):QFO DA Mgr Cook Owner FW Obtain signature of the person who received the CFO 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 a form(total of 62 debitable items) Page 1 of 2 ao J / 4 t0WN Sfq o r � n 0-ps� �• c ° 1540 SULLIVAN AVENUE • SOUTH WINDSOR, CT 06074 r�OsoR•CO TELEPHONE (860) 644-2511 December 3,2008 7-11 Rutul Patel 700 Ellington Road South Windsor,CT 06074 Re: Food Service Establishment inspection results for 7-11 located at 700 Ellington Road, South Windsor,Connecticut Dear Mr.Patel: On December-.1, 2008, a food service inspection was conducted at 7-11 located at 700 Ellington Road, South Windsor,Connecticut. At the time of the inspection,the rating score was 87 with 1,4 demerit point item in violations. According to the Connecticut Public Health Code, a food service establishment must maintain a rating score of 80 or higher with NO 4-demerit point items in violation. Corrections of the violations noted must be made within two(2)weeks. If you have any questions or require additional information about the inspection, please contact me at (860)644-2511,extension 248. Sincerely, Robert De Vito,R.S. Environmental Health Officer .. Page_of INSPECTION REPORT STATE OF CONNECTICUT FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH CONTINUATION SHEET NAME OF ESTABLISHMENT TOWN �Z�u �".,�rbb,s M—b, DATE OF INSPECTION Impeaim Form N Remarks: 13 Y'T 3 ter• c.a--A- C�h t.c c .t clec S t7"f- �t_, Get i.�� u st A•- `L ,�t� �oZ"� Ma c-4 �2.sc �v Ca�G�L CoZJ F A-cA- u� b s c.ae 3 A LA.- w.<< G. ti.. - cam- 5 S°r 3.,,N-e t<- S ib e—v "b 34;- o C►�� 1> Aj � c �s �� s le INITIAL(INSPECTOR) tL INITIAL(PERSON IN CHARGE) Distribution: 1st-White-Health Department 2nd-Yellow-Owner/Manager cAccMinsform2.crr Establ : --ishment7 —L 1 Date of Inspection: t 2 J Y ddress: -Z cc�. psi-t-, Owner or Operator: ADDITIONAL FOUR POINT ITEMS KEY: DNC [DOES NOT COMPLY] 6 Foods not re-served. 4 31 Sewage disposal approved. -Unwrapped foods not re-served -Potentially hazardous foods not re-served &i -Operating as required 11 Toxic chemicals. No cross connections,back siphonage,backflow -Stored properly,labeled properly,used properly Proper 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-Water quality in compliance 35 Toilet facilities. Adequate,convenient,accessible, -Monitoring in compliance designed,properly installed OTHER ITEMS KEY: DNC [DOES NOT COMPLY] Sources of food:Original container,properly labeled 40 Garbage/rubbish storage area/rooms,enclosures-property constructed,dean 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 d worker:Clean outer clothes,effective hair restraints 7 43 Outer openings protected against entrance of insects/rodents 44 rs: Floor covering installed,constructed as required,good repair,clean 16 Food-contact surfaces designed,constructed,maintained,installed, 5 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 481 Exterior walking,driving surfaces,good repair,clean 18 Single service articles,storage,dispensing 19 No reuse of single service article 9 Walls,ceilings attached,equipment property constructed,good repair,clean.Wall&ceiling surfaces as required 20 Dishwashing facilities approved design,adequately constructed, maintained installed located :5V Vustiess 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 nfood-contact surfaces of utensils&equipment clean 55 Establishment and premises free of lifter,no insect/rodent harborage, quipment/utensils,storage,handling no unnecessary articles 32 Proper disposal of wastewater 56 Complete separation from living/sleeping quarters and laundry 33 Plumbing location,installation,maintenance 571 Clean/soiled linens stored properly 36 Toilet rooms enclosed with self-closing door 58 No live birds,turtles,or other animals(except guide dogs) 37 Propertoilet fixtures provided,good repair,clean 59 Seats 75 or more:Nonsmoking area provided,sign(s)posted at entrance(s),smoking area indicated by sign(s) 39 Approved garbage/rubbish containers,adequate number,covered, rodent proof,clean I I Woutine Inspection ❑Reinspection ❑ Preoperational Inspection 7r: PERSON IN CHARGE: Other Inspection: Demerit Score: •Include demerits from page 1 AT i ajge� 4 3 2 1 Total Rating signature print name print name 5 15 S-7 C.�{�{� Z5�(� �'Zy� V I A!p,Z /71 DATE CORRECTIONS DUE: ,y- phon number title 1� £Vl Z� �R �(-� r E �, Page 2 of 2 plus pages Focused Inspection 1/2002 continuation Establishment: '"7—it Inspection Date: r atoy Time: ns REinsp Address/City: �� yt`�,�—o� pj Health Dept: "�.� Wc� ~� Class: 1 2 3 Based on an inspection this day,the items marked DNC identify the 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 N/0 N/A DNC KEY: C[complies] N/0[not observed] NIA[not applicable] 3 DNC[does not comply] 0[other] RTE[ready-to-eat] 2 t e C A 4. 2 do�a ept on of trarrtijtg p rate 2 A Food workers have no exposed infected lesions/burns B Personnel with infection restricted d,ii rice,whoa"ate-,'F1tl�t0001#4 C N/0 N/A C Communicable disease of worker reported to local health director A Approved shellfish,finfish,meat&poultryUSDA approved i3 Haidviiaiin B Food cans in good condition(not dented,rusty,bloated,leaking) " p d'; i+ ed, `, C WO W A Handwash facilities in all food prep/dispensing&warewash areas 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 D Personnel hands washed,clean/Proper handwash procedure E Handwashing at appropriate times ro— le A' MM MOM A Hot holding greater than or equal to 1400F. (whole beeNpork roasts tsoo F.)" A ❑ No eating ❑�No smoking while working B Cold holding less than or equal to 450F. B Wounds covered adequately C Proper cooling C Proper sink used for handwashing D Proper re-heating 0 E Proper internal cooking/consumer advisory posted 0 A Approved sanitizeravailable/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 100.0, C Adequate ❑dishwashersanitizer ❑final rinse temp B Properfood thermometerfor product D Pro ersanitizin rocedure C Thermometers appropriately placed in cooler units E Sanitizing between raw animal origin&ready-to-eat food .0000 0 O 1 10 z .. __, Cloths and/orsponges in good repair and clean 11 T—'s I'll B Wiping cloths kept in sanitizer between uses A Produce washed 0 B Raw meats not stored/prepared near ready-to-eat foods 0000 C Food covered properly 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 o pooling of eggs not cooked immediately 0 od containers stored off the floor ,�:. I CA oap/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 food/ice 0 0 •DESCRIBE DEFICIENCIES ON CONTINUATION SHEETS The following information is not debitable and does not affect your score. KEY: OFO[qualified food operator],DA[designated alternate],PHF[potentially hazardous food],FB[foodbome) PHFs are hot held at: OF. 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: 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 If yes indicate language spoken List products cooled: by QFO/DA: *Can the QFO/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 debbble items) Page 1 of 2 Establishment: Date of Inspection: ddress: Cl Owner or Operator: ADDITIONAL FOUR POINT ITEMS KEY: DNC [DOES NOT COMPLY] 6 Foods not re-served. RL 4 31 Sewage disposal approved. -Unwrapped foods not re-served 4 -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 Proper 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 35 Toilet facilities. Adequate,convenient,accessible, -Water quality in compliance -Monitoring in compliance designed,properly installed OTHER ITEMS KEY: DNC [DOES NOT COMPLY] 2 Sources of food:Original container,properly labeled 40 Garbage/rubbish storage area/rooms,enclosures-properly constructed,dean 5 Potentially hazardous food properly thawed 41 Garbage/rubbish disposed of in an approved manner,at approved frequency 10 od dispensing utensils properly stored 2 Vermin Control:No insects/rodents present 4 F d worker:Clean outer clothes,effective hair restraints 43 Outer openings protected against entrance of insects/rodents 4 FI rs: Floor covering installed,constructed as required,good repair,clean 16 Food-contact surfaces designed,constructed,maintained,installed, Floors graded,drained as required t located 6 Floor,wall juncture covered 17 Nonfood-contact surfaces designed,constructed,maintained, 47 Mats removable,good repair,clean installed,located 481 Exterior walking,driving surfaces,good repair,clean 18 Single service articles,storage,dispensing 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, 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,p roper temperature 53 Rooms&equipment hoods,ducts,vented as required 2 Accurate thermometers provided,dish basket,if used 54 Rooms adequate,clean,adequate lockers provided,facilities clean onfood-contact surfaces of utensils&equipment clean 55 Establishment and premises free of litter,no insecUrodent harborage, 8 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 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,cl n ❑Routine Inspection Reinspection ❑ Preoperational Inspection IN PERSON IN CHARGE: Other Inspection: Demerit Score: *Include demerits from page 1 4 3 2 1 Total Rating aturel signature tv iL�. �/ LI pr nt am print name A Xu �p� � 'y{ N c� P19TLZ_- DATE CORRECTIONS DUE: phone number title Page 2 of 2 plus continuation pages Focused inspection 1/2002 i Establishment: i Inspection Date: —7 3 (M Time: ROinsp REinsp Address/City: O Health Dept: Q)1�J O& 2� 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 N/O N/A DN KEY: C[complies] NIO[not observed] NIA[not applicable] nowlimi"ri W $ DNC[does not comply] 0[other] RTE[ready-to-eat] 2 R qativ�neno1 Q#t�aft►�ng RcVt_ risri� N/A 4 A Food workers have no exposed infected lesions/burns 6� W�te � E�9r�an B Personnel with infection restricted 4 lkppted SOtCR,wh05oe,non�durted C NIO N A C Communicable disease of worker reported to local health director A 1 Approved shellfish,finfish,meat&poultry USDA approved 131Hant sklin9 faOities ProV1�y handsuwasW'dwh C NtA 4 B Food cans in good condition(not dented,rusty,bloated,leaking) A Handwash facilities in all food prep/dispensing&warewash areas C WholesomelnOnadulteratedfootls/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 -10 E Potentially hazardous foods received at proper temperature dd 00o, D Personnel hands washed,clean I Proper handwash procedure 0 E Handwashing at appropriate times 0 REP N/A 2'` A Hot holding greater than or equal to 1400F. (Whoie beef/pork roasts 1300F.) A ❑ No eating ❑ No smoking while working B Cold holding less than or equal to 450 F. OF B Wounds covered adequately C Proper cooling C Proper sink used for handwashing D Proper re-heating 0 E Proper internal cooking/consumer advisory posted A Approved sanitizeravailable/adequateconcentrationofsanitizer Ooo 0' B Food-contact surfaces and utensils used for potentially hazardous food sanitized at least every 4 hours A Food thermometer available and accurate orC Adequate ❑dishwashersanitizer ❑final rinse temp B Proper food thermometer for product 40 D Pro er sanitizing procedure E Sanitizing between raw animal origin&ready-to-eat food C Thermometers appropriately placed in cooler units 0 .10 0 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 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 F od containers stored off the floor ;in0 a Impfflp '"' M � ' 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 or C Adequate utensil(s)for dispensing food/ice 0 0 1 *DESCRIBE DEFICIENCIES ON CONTINUATION SHEETS The following information is not debitable and does not affect your score. KEY: QFO[qualfied food operator],DA[designated aftemate],PHF[potentially hazardous food], FB[foodborne] PHFs are hot held at: OF. 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: 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 CFO? 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 if-yes indicate language spoken List products cooled: by QFO/DA: *Can the QFO/DA read the inspection report? Y N Describe cooling methods: Indicate who answered the above questions: Name(print): Is cooling monitored for time&temp? Y N Is the monitoring of cooling recorded? Y N .Indicate the title of above person(circle all that apply):QFO DA Mgr Cook Owner FW 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: A Note: This report is a two age form(total of 62 debitable items) Page 1 of 2 1.0 Ak Page_of_ INSPECTION REPORT STATE OF CONNECTICUT FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH CONTMUATION SHEET NAME OF ESTABLISHMENT TOWN DATE OF INSPECTION Impecum Form M Remarks: lie- ✓V O , r _ 1 INITIAL(INSPECTOR) INITIAL(PERSON IN CHARGE) Distribution: I st-White-Health Department 2nd-Yellow-Owner/Manager c cm\msform2.cn 11 NAME OF • DATE OF • i Fff)m 0 W_Wo AAA olcml wEm�ww A'WWA a f?,pWo-;dAE'n W--.4 WWWA llm,"_.,W- c rk".�� I �- � .9—___ - - __ LUAINIMET Ova EM WAKPA-I MEW_4r47 j FAWOAWWQ��Md . W►.0_ J Room. MLam.WAA93 ! _,.�i�i' �I i.�1i � ail _./� , v . .�• ' i-�� PON,, - _ m 1gpil ,iiR&FAY, IW—A INITIAL �. / (PERSON IN CHARGE) s •• I r • • NAME OF ESTABLISHMENT DATE OF INSPECTION Wo "-mw 1 pm AW ILA _ � �JL� _�.�_ � �l" !G.%A - • INITIAL • All,, • 1 t Establishment: Date of Inspection: 7-6 ddress Owner or Operator: ADDITIONAL FOUR OINT ITEMS '01 KEY: DNC [DOES NOT COMPLY] o 6 Foods not re-served. gm'` -Unwrapped foods not re-served 4 31 Sewage disposal approved. 4 -Potentially hazardous foods not re-served -Operating as required 11 xic chemicals. Jo cross connections,back siphonage,backflow 1-1 -Stored properly,labeled properly,used properly o 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 -Chemical dispensers -Ice machines -Pesticides/rodenticides properly dispensed , n Prover drain for: 29 Water source adequate,safe. -Food equipment -Dish machines -Ice machines -Well/well head protected from contamination-Water quality in compliance 35 Toilet facilities. Adequate,convenient,accessible, -Monitoring in compliance designed,properly installed OTHER ITEMS KEY: DNC [DOES NOT COMPLY] 2 Sources of food: Original container,properly labeled 40 Garbage/rubbish storage area/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 ermin Control: No insects/rodents present 14 Food worker:Clean outer clothes,effective hair restraints 3 Outer openings protected against entrance of insects/rodents loors: Floor covering installed,constructed as required,good repair,clean 16 Food-contact surfaces designed,constructed,maintained,installed, 41 Floors graded,drained as required located 6 Floor,wall juncture covered 17 Nonfood-contact surfaces designed,constructed,maintained, 47 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 Walls,ceilings attached,equipment properly constructed,good 20 Dishwashing facilities approved design,adequately constructed, repair,clean.Wall&ceiling surfaces as required maintained installed located 0 ustless cleaning methods used,cleaning equipment properly stored Equipment&Utensils: Cleanliness 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 iii7 Nonfood-contact surfaces of utensils&equipment clean 55 Establishment and premises free of litter,no insect/rodentharborage, Equipment/utensils,storage,handling no unnecessary articles 32 Proper disposal of waste water 56 Complete separation from living/sleeping quarters and laundry 3 lumbing location,installation,maintenance 57 Clean/soiled linens stored properly 8 No live birds,turtles,or other animals(except guide dogs) 3 oilet rooms enclosed with self-closing door 59 Seats 75 or more:Nonsmoking area provided,sign(s)posted at 37 roper toilet fixtures provided,good repair,clean entrance(s),smoking area indicated by sign(s) 39 Approved garbage/rubbish containers,adequate number,covered, rodent pro clean outine Inspection ❑Reinspection ❑ Preoperational Inspection I PERSON IN CHARGE: Other Inspection: Demerit Score: *Include demerits from page 1 4 3 2 1 Total Rating a re signature ZZ print name print name Tu 20 phone number tie DATE CORRECTIONS UE: Page 2 of 2 plus continuation pa es Focused Inspection 1/2002 Establishment: —1 I pection Date: — 7 Time: Roins REirl ddress/City: Health Dept: (,i//�+/G�S�L : 1 204 Based on an inspection this day,the items markfy DNC identify the ftlations in operation or facilities which must be corrected by the date specified on page 2. K FACTOR ITEMS: Listing is not inclusive of all possible debitable items C N/O NIA DNC KEY: C[complies] NIO[not observed] NIA[not applicable] DNC[does not comply] 0[other] RTE[ready-to-eat] °rs, ` wtt in ion rest � � A Food workers have no exposed infected lesions I burns � �1� tliYie�t iOtiQftr�#ti[f proorB►tt B Personnel with infection restricted plroved so l"'p-"t+homome,r►oriadde►Iterated C Nf0; A C Communicable disease of worker reported to local health director A Approved shellfish,finfish,meat&poultryUSDA approved ihidwa ping facilities proWded hands wasW,mat C Nf A h " B Food cans in good condition(not dented,rusty,bloated,leaking) V Handwash facilities in all food prep/dispensing&warewash areas C Wholesome/nonadulteratedfoods/safe V 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/Proper handwash procedure E Handwashing at appropriate times 0 4 a ygr�rtrc' ties' C Ni ril 2 of holdin g greater than or equal to 140°F. (whole neerlpork roasts iao°el ❑ No eating ❑ No smoking while working B old 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 E Proper internal cooking/consumer advisory posted A Approved sanitizeravailable/adequate concentration of sanitizer B Food-contact surfaces and utensils used for potentially hazardous food sanitized at least every 4 hours A' ood thermometer available and accurate Adequate ❑dishwashersanitizer ❑final rinse temp 01 Proper sanitizin rocedure Proper food thermometer for product anitizing between raw animal origin&ready-to-eat food C hermometers appropriately placed in cooler units r R Cloths and/or sponges in good repair and clean ping cloths kept in sanitizer between uses A Produce washed 0 B Raw meats not stored/prepared near ready-to-eat foods C Food covered properlyVOFood equipment clean,utensils clean,equipment interiors clean D Adequate splash guards/sneeze guard g Single use gloves changed when soiled E No unauthorized personnel Food—contact surfaces clean F No pooling of eggs not cooked immediately 8 Food containers stored off the floor 0 Soa paper els/ drying device available A No unnecessary handling RTE and/or cooked foods with bare hands B i penser s)working: Map In aper towel B Minimize food handling,other than ready-to-eat,with bare hands C I Handwash sin clean Iwaste receptacle at handwash sink C Adequate utensil(s)for dispensing food/ice sinks)clean 0 •DESCRIBE DEFICIENCIES ON CONTINUATION SHEETS The following information is not debitable and does not affect your score. M: QFO[qualified food operator],DA[designated altemate],PHF[potentially hazardous food],FB[foodbomej 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 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 ff-M indicate language spoken List products cooled: by QFO/DA: ♦Can the QFO/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 s there a produce washing policy? Y N *Describe what is washed and rIwhere: inspection: Note: This report is a two page form(total of 62 debitable items) Page 1 of 2 July 17,2008 7-11 Rutul Patel 700 Ellington Road South Windsor,CT 06074 Re: Food Service Establishment inspection results for 7-11 located at 700 Ellington Road, South Windsor,Connecticut Dear Mr.Patel: On July 17, 2008, a food service inspection was conducted at 7-11 located at 700 Ellington Road, South Windsor,Connecticut. At the time of the inspection,the rating score was 60 with 4,4 demerit point item in violations. According to the Connecticut Public Health Code, a food service establishment must maintain a rating score of 80 or higher with NO 4-demerit point items in violation. Corrections of the violations noted must be made within two(2)weeks. If you have any questions or require additional information about the inspection, please contact me at (860)644-2511. Sincerely, Robert De Vito,R.S. Environmental Health Officer a Establishment: t Date of Inspection: ddress: L->—,1Z-.S lzl> 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. -Potentially hazardous foods not re-served -Operating as required No cross connections,back siphonage,backflow 11 Toxic chemicals. Proper type/installation/backt1ow prevention device/air gap for: -Stored properly,labeled properly,used properly -Food equipment -Hose connections -Dish machines --No unn concentration not to exceed maximum permitted -Soda system carbonator -Beverage dispensers -Toilet tanks -No unnecessary toxics on the premises -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 ourcesof food: Original container,properly labeled 40 Garbage/rubbish storage area/rooms,enclosures-properly constructed,clean 5 Potentially hazardous food properly thawed 41 Garbage/rubbish disposed of in an approved manner,at approved frequency 0 ood dispensing utensils properly stored 2 Vermin Control: No insects/rodents present 4 F d worker:Clean outer clothes,effective hair restraints 3 Outeropenings protected against entrance of insects/rodents 4 loors: Floor covering installed,constructed as required,good repair,clean 16 Food-contact surfaces designed,constructed,maintained,installed, 5 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 18 Single service articles,storage,dispensing 8 Exterior walking,driving surfaces,good repair,clean 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 properlystored Equipment&Utensils: Cleanliness 511 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 ccurate thermometers provided,dish basket,if used 54 Rooms adequate,clean,adequate lockers provided,facilities clean 27 nfood-contact surfaces of utensils&equipment clean 55 Establishment and premises free of litter,no insect/rodent harborage, 8 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 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 Routine Inspection ❑Reinspection ❑ Preoperational Inspection IN PE T R: PERSON IN CHARGE: Other Inspection: Demerit Score: *Include demerits from page 1 1 I i 4 3 2 1 Total Rating signature signature print name print name (yy4 -ZSt( Z'___X'__ phone number tide r DATE CORRECTIONS DUE: C^ )i Page 2 of 2 plus 9 continuation pages Focused Inspection I/2002 Page of INSPECTION REPORT STATE OF CONNECTICUT FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH CONTINUATION SHEET NAME OF ESTABLISHMENT TOWN DATE OF INSPECTION INSPECTION FORM# REMARKS v� 1� r2,/v�.�'�^ Z S► 20">> Arl.cS%4SZ L A —CC 14,�V 3 S-D-A (' +t»fl A;o -L-S Tb VZ 4-T- 4-� AA-A- L L C,44-('5 0V-C-2 1RT0-SJ A✓-. Tt� P�I�ctits� `��i( F',.0- • \) ?S FZTD T�, T% G'r o fi`- cf,5D Lzie , TWc NCe MAt yjr A-c,A� nA_P w -'ro JCA e— k A'T' (.�-e 44 q__ (� Z o.j CSt c2 o°r "c •N 3y-•r' C �5� ct+,�•��®® �yl'F +-+o, �oZ� � I of INITIAL(INSPECTOR) K A/\_ INITIAL(PERSON IN CHARGE) Distribution: 1st-White-Health Department 2nd-Yellow-Owner/Manager i Establishment: 'I —t I, Inspection Date: -i I Time: 6oins REinsp Address/city: "lono Health Dept: S,,,na 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 I NO I WA JDNC I KEY: C[complies] N/O[not observed] NIA[not applicable] 3 DNC[does not comply] 0[other] RTE[ready-to-eat] 6. si °d et s�otE'vtritlt` rifec n°fires Sr--he 0 ,"',- C Q WA 4 61 Designated Altars e a 2 62 Written documentation'of training program 2 A Food workers have no exposed infected lesions/burns B Personnel with infection restricted Approved sauce,wholesome,wouadutterated C N/O N/A 4' C Communicable disease of worker reported to local health director A Approved shellfish,finfish,meat&poultry USDA approved 13 -Handwashing faailWes provided,WCI$ aaEied,can C N/0' N/A 4 B Food cans in good condition(not dented,rusty,bloated,leaking) A Handwash facilities in all food prop/dispensing&warewash areas C Wholesome/nonadulteratedfootls/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 appropria z fit' ?t s 0 an was ing a e Imes 3 A Hot holding greater than or equal to 1400F. (whole beef/porkroasts 1300 F.) A ❑ No eating ❑ No smoking while working B 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 0 A S � +�- Fug b "VX E Proper internal cooking/consumer advisory posted s ( � .,, v�� A Approved sanitizeravailable/adequate concentration ofsanitizer 3 es� riaa ro B Food-contact surfaces and utensils used for potentially tpere eotteterstgrrdl' �� hazardous food sanitized at least every 4 hours A Food thermometer available and accurate C Adequate ❑dishwashersanitizer ❑final rinse temp D Proper sanitizin B Properfood thermometer for product procedure C Thermometers appropriately placed in cooler units E Sanitizing between raw animal origin&ready-to-eat food MR �°a.., .- ffl� t �. die{lay,service and.#ransportatlion A Cloths and/or sponges in good repair and clean B Wiping cloths kept in sanitizer between uses A Produce washed B Raw meats not stored/prepared near ready-to-eat foods 0 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 Food containers stored off the floor t 0 Z A No unnecessary handling RTE and/or cooked foods with bare hands Soap/paper towels I`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 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: o PHFs are cold held at: OF. Describe illness conditions when you would exclude a food worker from working: Are internal cooking temperatures take . Y N *To what temperature do you cook: e'—N t-, Zc£ Poultry y_;_�,�- and Pork What diseases related to FB illness are you required to report to the local health department? Roasts r Describe re-heating procedures: 6" i+-�r 'tD 0-0 .n C Is there a written illness policy quires the food worker to report specific illness co ditions Are temperatures recorded/logged for cold holding foods/equipment? Y and diseases to the QFO? Y *Do you have a paid sick leave policy? Y Are foods cooked in advance and cooled? Y Are leftovers save Is there a language barrier between inspector&QFO? Y ves indicate langua e�oken List products cooled: by QFO/DA: *Can the QFO/DA read the inspection/reA� Describe cooling methods: Indicate who answered the above questions:Name(print): - +-, Indicate the title of above person(circle all that apply):QFO DAAiEZOno k 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 responsibiliti at the time of the Is there a produce washing y inspection: ,�/ p g policy? / N ♦Describe what is washed and I,a where: W A Note: This report is a two page form(total of 62 debitable items) Page 1 of 2