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Home My WebLink AboutTemp Food Inspection 952 Sullivan Avenue �F Ce Cek+je-�� A ell7A Au" ° Egablishment: q,x i w's i 220, o t) Res , Inspection Date: 'o a Time: -- o[nsp REinsp w less/City: j5a 51NiVan Rye, Health Dept: Soul{ WxNDSb(Z .Class: 1 2 3 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 DNC KEY C[complies] NIO[not observed] NIA[not applicable] J 3 DNC[does not comply] 0[other] RTE[ready-to-eat] A Food workers have no exposed infected lesions/burns B Personnel with infection restricted fly C Communicable disease of worker reported to local health director A A roved shellfish,finfish,meat& oult USDA a roved B Food cans in good condition(not dented,rusty,bloated,leaking) J LN A Handwash facilities in all food prep/dispensing&warewash areas V C Wholesome/nonadulteratedfoods/safe B Handwash facilities in or immediately adjacent to toilet rooms J D Commercial products(no home grown/canned food) C Handwash facilities accessible/convenient to use J E Potentially hazardous foods received at proper temperature D Personnel hands washed,clean I Proper handwash procedure J 0 E Handwashing at appropriate timesR WIT �f 0 A Hot holding greater than or equal to 140 F. (whole beef/pork roasts 1300 F.) J A 19 No eating 8 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 J Ems 0 A Approved sanitizer available/adequate concentration ofsanitizer Milli— B Food-contact surfaces and utensils used for potentially J hazardous food sanitized at least every 4 hours A Food thermometer available and accurate J C Adequate Odishwashersanitizer Ofinal rinse temp J B Proper food thermometer for product D Pro ersanitizing procedure J 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 A Produce washed B Wiping cloths kept in sanitizer between uses �% 0 B Raw meats not stored/prepared near ready-to-eat foods r/ 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 J 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 No unnecessary handling RTE and/or cooked foods with bare hands A oa aper towel I drying device available B Dispenser(s)working: oap Paper towel B Minimize food handling,other than ready-to-eat,with bare hands C Handwash sin (s)clean/waste receptacle at hand wash k washh sink J C Adequate utensil(s)for dispensing food/ice J 0 O 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 altemate],PHF[potentially hazardous food],FB[foodbome] PHFs are at: IF. PHFs are cold held at: OF. Describe illness conditions when you would exclude a food worker from wor Are internal cooking to tures taken? Y N ♦To what temperature do you cook: Poultry eef Pork What diseases related to FB illness are you required to re a local health department? Roasts Other Describe re-heating procedures: Is there a written illness policy that r the food worker to report specific illness conditions Are temperatures recorded/logged for cold holding foods/equipment? and diseases to the QFO� *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 age barrier between inspector&QFO? Y N 1Lyes indicate language spoken List products cooled: y QFO *Can the QFO/DA read the inspection report? Y N Describe cooling methods: Indicate who answered the a stions: Name(print): Indicate the title of above person(circle all tha QFO DA Mgr Cook Owner FW Is cooling monitored for time&temp? s the monitoring of cooling recorded? Y N .Obtain signature of the person who received the QFOO re " s information at the time of the Is there a produ mg policy? Y N ♦Describe what is washed and inspection: wher Note: This report is a two p page form o of 62 debitable items) Page 1 of 2 PER SoAj =1V C'HAPGE; �MAo-- lddEstablishment: / I�x i�'s pf*Z-ZA Date of Inspections: li a q O`i ress: 9 Sa Av l,, Owner or Operator: ADDITIONAL FOUR POINT ITEMS KEY: DNC [DOES NOT COMPLY] 6 Foods not re-served. r} 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: -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 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 3)Outer openings protected against entrance ofinsects/rodents 4 Floors: Floor covering installed,constructed as required,good repair,clean 16 Food-contact surfaces designed,constructed,maintained,installed, 5 Floors graded,drained as required located 6 Floor,walljuncture covered 17 Nonfood-contact surfaces designed,constructed,maintained, 7 Mats removable,good repair,clean installed,located 18 Single service articles,storage,dispensing 481 Exterior walking,driving surfaces,good repair,clean 19 No reuse of single service article 9 Walls,ceilings attached,equipment properly constructed,good 0 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 2 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 I no unnecessary articles 32 Proper disposal of waste water 561 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 proof,clean 011outine Inspection OReinspection 0 Preoperational Inspection Other Inspection: INSPECTOR: PER I E. Demerit Score: *Include demerits from page 1 W" 00�0_ 4 3 2 1 Total Rating signature signature VrC � � (1aAl f k — yc 1 7 903 print name print e — — qq-pll phone num r title DATE CORRECTIONS DUE: CI o D A YS emw X4. Page 2 of 2 plus continuation pages Focused Inspection 1/2002 Page of AM „o>J INSPECTION REPORT STATE OF CONNECTICUT FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH CONTINUATION SHEET NAME OF ESTABLISHMENT TOWN DATE OF INSPECTION �1Z)4 W-1 pzzo,, 'Sc)L4 � wjo), P . 10), 06\ INSPECTION FORM# REMARKS 4kw JoDc LA covese) c�6�5e✓ o� b,>��bM s�ei�.. NbrE 7EmPs ok )W �o N2i. 4v Cat/7tt?izr 6KQPA6L414 cC9N7AC ('s,0 y4o-eJ4 Ltnd na, C�rnd/ 1�7�Fi D�S. JCC�e� js c✓1 ® CAvot 0_� 64+sib to q, �DUC'1. INITIAL(INSPECTOR) INITIAL(PERSON IN CHARGE) /` C Distribution: 1st-White-Health Department 2nd-Yellow-Owner/Manager Page a of 1. INSPECTION REPORT STATE OF CONNECTICUT FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH CONTINUATION SHEET NAME OF ESTABLISHMENT TOWN DATE OF INSPECTION r i0'5 `2,2 o,, Sou+� W l"45bc 7 2 0 INSPECTION REMARKS FORM# n R%A ei vin i�t 4-ojo Los ! Wall �7 SAnpw[G� Chi C�C�1 tYurN� iS �AMa 0 �CO ��Cel �li �IO�� G1it vt a LaG Pi�'s Z z INITIAL(INSPECTOR) INITIAL(PERSON IN CHARGE) Distribution: 1st-White-Health Department 2nd-Yellow-Owner/Manager Establishment: rci z? Date of of 7/ 1Jnq dtlress: Owner or Operator. ADDITIONAL FOUR POINT ITEMS KEY: DNC [DOES NOT COMPLY] 6 Foods not re-served. -Unwrapped foods not re-served ;4A 31 Sewage disposal approved. -Potentially hazardous foods not re-served 37 -Operating as required 11 Toxic chemicals. No cross connections,back siphonage,backflow Propertype/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 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 0 Food dispensing utensils properly stored 42 Vermin Control: No insects/rodents present 14 Food worker:Clean outer clothes,effective hair restraints 43 Outeropenings protected against entrance of insects/rodents 4 Floors: Floor covering installed,constructed as required,good repair,clean 6 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 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 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 23 Accurate thermometers provided,dish basket,if used 54 Rooms adequate,clean,adequate lockers provided,facilities clean 271 Nonfood-contact surfaces of utensils&equipment clean 55 Establishment and premisesfreeof litter,noinsect/rodentharborage, 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 XfRoutine Inspection I]Reinspection 0 Preoperational Inspection Otherinspection: INSPECTOR: PERSON IN CHARGE: Demerit Score: *Include demerits from page 1 QJ.W Q0 4 3 2 1 Total Rating signatur � signature — ��` _ prinname as G q� print name '�r phone number title DATE CORRECTIONS DUE: C10 Dhy.S Page 2 of 2 plus 2 continuation pages Focused Inspection 1/2002 Establishment: P i Z-z Inspection Date: : - OeA Time: 4QLns REinsp Address/City: S"LLavAN AvE Health Dept: Sdu'04 wstvtsDtz Class: 1 2 3 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 WA JDNC I KEY: C[complies] N/O[not observed] NIA[not applicable] f! ogdOperat+ar:, 3 DNC[does not comply] 0[other] RTE[ready-to-eat] 61 Designated Alternate :e f 2 12 Personnel Whit Infection restrt6ted C N/0 N/A 4 A Food workers have no exposed infected lesions/burns 62 Written documentation of training program 2 B Personnel with infection restricted 1 Approved source,wholesome,nonadulterated C N/0 N/A 4 C Communicable disease of worker reported to local health director A Approved shellfish,finfish,meat&poultry USDA approved 13 Handwashing facilities provided,hands washed,clean C N/0 N/A 4 B Food cans in good condition(not dented,rusty,bloated,leaking) A Handwash facilities in all food prep/dispensing&warewash areas C Wholesome/nonadu Iterated foods/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 JD Personnel hands washed,clean I Proper handwash procedure C E Handwashing at appropriate times 3 potentiefly hazardous food meets temperature require eats' ` c NfO N/A- 4, 0 during storage,preparation,display,service and transportation ` 15 Good hygienic practices C NI0 N/A 2 AHot holding greater than or equal to 140°F. (whole beef/pork roads 130°F.) A 19 No eating No smoking while working B Cold holding less than or equal to 450F. B Wounds covered adequately ,j C Proper cooling C Proper sink used for handwashing D Proper re-heating O E Proper internal cooking/consumer advisory posted off idi ,-* '77 c C N/O NfA 2 z 0 A Approved sanitizer available/adequate concentration ofsanitizer ¢ Adleqaats facries�ta rnpaHHi prt ,W [,} �� a g Food contact surfaces and utensils used for potentially 1 terrperire:the irarrteteisirovidetl' hazardous food sanitized at least every 4 hours A Food thermometer available and accurate J C Adequate 12dishwashersanitizer ❑final rinse temp J D Propersanitizin rocedure B Proper food thermometer for product f E Sanitizing between raw animal origin&ready-to-eat food C Thermometers appropriately placed in cooler units 0 00 t g s . * a, I A display,service aooi tratnsportation _ 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 I 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 j I 1 0 8 Food containers stored off the floor y *A 0 � o N/0 Nt4 i 9 Hawddng of food nifrl tied t; wo N/A -�N A A No unnecessary handling RTE and/or cooked foods with bare hands Soap aper towels drying device available J B Dispenser(s working: Soap PPaper towel J 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 f 0 O •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] P are hot held at: °F. PHFs are c do you cook: old held at: F. Describe illness conditions when you would exclude a food worker from working: Are inter in temperatures taken? Y N ♦To what temperature Poultry Ground Beef Pork What diseases related to FB illness are you required to report to the eff�paRment? Roasts Describe re-heating procedures: Is there a written illness polic es the food worker to report specific illness conditions Are temperatures recorded/logged for cold holding foods/equl N and diseases . 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 Is there a language barrier between inspector&QFO? Y N !-yes indicate language spoken List products cooled: by Q *Can the QFO/DA read the inspection report? Y N Describe cooling methods: Indicate who answered the above ques l riot): Indicate the title of above person(circle all that apply):QFO Cook Owner FW Is cooling monitored for ' emp? Y N Is the monitoring of cooling recorded? Y N .Obtain signature of the person who received the QFO responsibilities information aFtlae time of the Is th!5Ajff0uce washing policy? Y N *Describe what is washed and inspection: e: Note: This report is a two page form(total of 62 d t le items) Page 1 of 2 pez5ow =tv C NAB c ; :i Page of INSPECTION REPORT STATE OF CONNECTICUT FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH CONTINUATION SHEET NAME OF ESTABLISHMENT TOWN 5�,t��q„t, qv,� DATE OF INSPECTION ALxkt A, s INSPECTION FORM# REMARKS -�eye 4 .a ^nos �rLMr�v S'Z' F L4 LLA- -ram e—A t_L air A-!Z- Lt vU4-T C40v L(,j4' 2'7 C� s.� �.Sc r 3� �D �c. L�a o�.s 1, ^c..cc. o r- 2.3 i�s'i �� s �b '3s ,4vwR.,.�►��.� c.,a.�I 3.5 v 2c�S.c-1J i4�-' z c 4-Ac c C, 1 2-!o K) 2,1ae.A .�,► �c ')b r e-Lc A�.sd,*> 7T`O2 IQ `Tb 4.,zvt{ C"IT- of-- INITIAL(INSPECTOR) INITIAL(PERSON IN CHARGE) Distribution: 1 st-White-Health Department 2nd-Yellow-Owner/Manager .r > ,.. ., ,... _ �..>aa.� _......."vim.,.J....,..�.;,...... ..._......w.a.._�.._.. .. .. - Establishment: Date of Inspection: 2� ddress: %J,aay 4- 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 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 0 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 ood dispensing utensils properly stored 42 Vermin Control: No insects/rodents present 14 Food worker:Clean outer clothes,effective hair restraints 43 Outeropenings protected againstentrance 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 7 onfood-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 alls,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 ccurate thermometers provided,dish basket,if used 54 Rooms adequate,clean,adequate lockers provided,facilities clean 2 Nonfood-contact surfaces of utensils&equipment clean 55 Establishment and premises free of lifter,no insect/rodent harborage,28 Equipment/utensils,storgge,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 VRoutine Inspection ❑Reinspection ❑ Preoperational Inspection VM IN R: PERSON IN CHARGE: Inspection: - Demerit Score: *Include demerits from page 1 flit. 4 3 2 1 Total Rating sign ure signature print name print name v g 3 to#41.2 _qq phone number title DATE CORRECTIONS DUE: Page 2 of 2 plus continuation pages Focused Inspection I/2002 Establishment: ��. 5llt Inspection Date: SZ.v 09 Time: j0;3,-j s REinsp Address/City: , 41aE�� A.I%r_ Health ept: �� Class: 1 2 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 I C I N/0 N/A DNC I KEY: C[complies] N/O[not observed] NIA[not applicable] 3 DNC[does not comply] 0[other] RTE[ready-to-eat] 2 A Food workers have no exposed infected lesions/burns 2 B Personnel with infection restricted All R4 ti 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) '� 0 3 A Handwash facilities in all food prep/dispensing&warewash areas C Wholesome/nonadulteratedfoods/safe B Handwash facilities in or immediately adjacent to toilet rooms olT D Commercial products(no home grown/canned food) C Handwash facilities accessible/convenient to use E Potentially hazardous foods received at proper temperature 000, D Personnel hands washed,clean I Proper handwash procedure 0 E Handwashing at appropriate times .0000, 0 A Hot holding greater than or equal to 1400F. (whole beef/pork roasts 130e F.) A ❑ No eating ❑ No smoking while working oo 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/adequateconcentrationofsanitizer ol 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 Proper food thermometer for product D Proper sani izin rocedure E Sanitizing between raw animal origin&ready-to-eatfood C Thermometers appropriately placed in cooler units 0 O 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 C Food covered properly 7Food equipment clean,utensils clean, —ent interiors c D Adequate splash guards/sneeze guard g Single use gloves changed when soile E No unauthorized personnel C Food--contact surfaces clean F No pooling of eggs not cooked immediately ood containers stored off the floor *Nonnecessary handling RTE and/or cooked foods with bare hands A Soap I paper towels I drying device available B Dispenser's)working: ❑Soap ❑Papertowel B Minimize food handling,other than ready-to-eat,with bare hands _ C Handwash sink(s)clean/waste receptacle at handwash sink C Adequate utensils)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 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 QFOIDA: ♦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 debitable items) Page 1 of 2 Page_of_ INSPEC71ON REPORT STATE OF CONNECTICUT FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH CONTINUATION SHEET NAME OF ESTABLISHMENT TOWN DATE OF INSPECTION ►4(-,��C t s - - h- laspecdca / ,..ems �2 � 2 Form M Remarks: G��t �T3� M�v I►Y� `') � D C� v fv 4 7 \ l•v� TK=, 3-T 0—,C2 7 i 1N� r�4NaC t Z � y � `-�`e- �c�o...�,.sc a�„A-�`.ate�-•� o� i INITIAL(INSPECTOR) INITIAL(PERSON IN CHARGE) f V-N Distribution: 1st-White-Health Department 2nd-Yellow-Owner/Manager c:bert\Ansform2.crt Establishment: L� zS Date of Inspection: k '2 S( ;i ddress: Owner or Operator: VIA :a:cc ►k ADDITIONAL FOUR POINT ITEMS �' �' KEY: DNC [DOES NOT COMPLY]. 6 Foods not re-served. 4 31 Sewage disposal approved. -Unwrapped foods not re-served 4 -Operating as required -Potentially hazardous foods not re-served ` No cross connections,back siphonage,backflow 11 Toxic chemicals. Proper type/installation/backflow prevention device/air gam: -Stored properly,labeled properly,used properly -Food equipment -Hose connections -Dish machines -Sanitizer 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 35rdesig'nedlproperly lities. Adequate,convenient,accessible, -Water quality in compliance-Monitoring in compliance 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 Ybod 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 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 C> C 52 Room free of steam,smoke odors 22 Wash water clean,proper temperature �v C S 53 Rooms&equipment hoods,ducts,vented as required 23 curate thermometers provided,dish basket,if used 541 Rooms adequate,clean,adequate lockers provided,facilities clean 7 nfood-contact surfaces of utensils&equipment clean 55 Establishment and premisesfreeof litter,noinsect/rodentharborage, 28 Equipmentlutensils,storage,handling no unnecessary articles 32 Properdisposal 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 fixturesprovided,good repair,clean entrance(s),smoking area indicated by sign(s) 39 1 Approved garbage/rubbish containers,adequate number,covered, rodent proof,clean I KRoutine Inspection OReinspection 0 Preoperational Inspection T PERSON IN CHARGE: Other Inspection: Demerit Score: *Include demerits from page 1 ZZ, 4 3 2 1 Total Rating signature signature print name print name 2`f -�''"''�'� DATE CORRECTIONS DUE: p phone number title A tatZ• a `k""N ro Page 2 of 2 plus continuation pages Focused Inspection 1/2002 .I r Establishment: AL,gx%A. S. Inspection Date: i Z Tr Time: s Rli Address/City: e�,��atJ 4-< Health Dept: Class: 1 z 3 Based on an inspection this day,the items marked DNC identify the violations in operation or facilities which must be corrected by the date specified on page 2. RISK FACTOR ITEMS: Listing is not inclusive of all possible debitable items C WO 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] IT— tttk8 Food workers have no exposed infected lesions/burns n documemal of timing P>�� A B Personnel with infection restricted 1 tied S w owte, �toldsome,honadulterated C VO :WA 4 C Communicable disease of worker reported to local health director A Approved shellfish,finfish,meat&poultry USDA approved 113 HaFti�ig pa ,; conC N/0 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/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 M4171 x f0 A Hot holding greater than or equal to 140eF. (whole beef/pork roasts f3oe F.) oe do ❑ No eating ❑ No smoking while working B Cold holding less than or equal to 45e F. 0000l, B Wounds covered adequately C Proper cooling C Proper sink used for handwashing D Proper re-heating Q,,*7 eh 0 E Proper internal cooking/consumer advisory posted :' 0 A Approved sanitizeravailable/adequateconcentrationofsanitizer /01 B Food-contact surfaces and utensils used for potentially hazardous food sanitized at least every 4 hours 10 A Food thermometer available and accurate C Adequate tshwashersanitizer ❑final rinse temp B Proper food thermometerfor product L Proper sa itizin rocedure C Thermometers appropriately placed in cooler units E Sanitizing between raw animal origin&ready-to-eat food O 0 INS 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 00 C Food covered properly 000, Food equipment clean,utensils clean,equipment interiors clean D Adequate splash guards/sneeze guard 100, 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 rood containers stored off the floor f A Soap/paper towels I 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 10000, 0 0 1 I •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. I 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 !-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 debitable items) Page 1 of 2 J.. • • NAME OF I 9NT DATE OF • LM�oMA K"I A&M ,M& OA FMAM.-WE -Wdil ` L • f► WA „�,;'. M, WE 9-D MERMWAMM"I�ff,0%1 1 140 07M wzoz L/t_ _/� .• f v / ! 0, 9A, 7- 1 m j INITIAL(INSPECTOR) INITIAL(PERSON IN CHARGE) ,� z + . a. _ -• i '`"- x.. „krv�.. xi>..,.ea .<.v✓..„ _. ._asl_.._e.,..,,....^... 9 rz. .�<��..¢ .,...� _.._.d.,...n..u._ ..,....,. , 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 � No cross connections,back siphonage,backflow 11 Toxic chemicals.-Stored properly,labeled properly,used properly Pro per 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 Prover 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-propedy constructed,clean otentially hazardous food properly thawed 41 Garbage/rubbish disposed of in an approved manner,at approved frequency 10 ood dispensing utensils properly stored 42 Vermin Control: No insects/rodents present 4 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 tlocated ated6 Floor,wall juncture covered l onfood-contact surfaces designed,constructed,maintained, 7 Mats removable,good repair,clean installed,located 18 Single service articles,storage,dispensing xteriorwalking,driving surfaces,good repair,clean 19 No reuse of single service article 9 ails,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 Accurate thermometers provided,dish basket,if used 54 Rooms adequate,clean,adequate lockers provided,facilities clean 7 Nonfood-contact surfaces of utensils&equipment clean 55 Establishment and premises free of litter,no insect/rodent harborage, 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 Propertoiletfixturespmvided,good repair,clean entrance(s),smoking area indicated by sign(s) 39 Approved garbage/rubbish containers,adequate number,covered, rodent pro f,clean ORoutine Inspection einspection 0 Preoperational Inspection Otherinspection: R: PERSON IN CHARDemerit Score: *Include demerits from page 1 �C 4 3 2 1 Total Rating t e sign{a�ture print name Ve phone number title DATE CORRECTIONS DOE: Page 2 of 2 plus continuation pages Focused Inspection 1/2002 Establishment: Inspection Date: k --6 Time: ROinsp insp Address/City: Health Dept: class; 1 2 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 NW/0 N/A KEY: C[complies] NIO[not observed] NIA[not applicable] 3, DNC[does not comply] 0[other] RTE[ready-to-eat] rsI_ 61 DadAft+srnate = 2 fest �aed'° : 4 62- Wriften documentation of training program 2 A Food workers have no exposed infected lesions/burns B Personnel with infection restricted 1 Ap�71YPlhsOt9C8,Wito6Sottie,ngnadttiterated C° NIA + C Communicable disease of worker reported to local health director A I Approved shellfish,finfish,meat&p7ult —USDA approved 13 it - � yri �� q ) � C N/0' WA 4 B Food cans in good condition(not dented,rusty,bloated,leaking) oe— 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 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 O 2', A Hot holding greater than or equal to 140°F. (whole beef/pork roasts 1300 F.) A ❑ No eating ❑No smoking while working 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 Proper internal cooking/consumer advisory posted ; R! 101. SIT. a ' 0 A Approved sanitizer available/adequate concentration ofsanitizer 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 Proper food thermometerfor product D Proper sanitizin rocedure C Thermometers appropriately placed in cooler units E Sanitizing between raw animal origin&ready-to-eat food 0 O 0, ` t�s[PON 'NOwif 77 7 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 0/paper 0/ drying F No pooling of eggs not cooked immediately 0 8 Food containers stored off the floor 0 k.' v. A device availableA No unnecessary handling RTE and/or cooked foods with bare hands B 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)fordispensing food/ice 0 0 q�::FF •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: 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 th a food worker to report specific illness conditions Are temperatures recorded/logged for cold holding foods/equipment? Y N and diseases to the 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 guage barrier between inspector&QFO? Y N indicate language spoken List products cooled: FO/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 2;,WO&g 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 t is washed and inspection: where: Note: This report is a two page form(total of 62 debitable items) Page 1 of 2 � N fiA-VZ__ • I LIMKIN NAME OF i • DATE OF • 1 1 w4w, 1 1 W R Ar r%&W, -W-0 7 Y,wl. � _ ♦►i� _ •�� I � �.` � i�� //I� �i11 tea. L_� Fpc m-,- W R11, A W- 9 m4oll MMY�-,k MOW-AMA, !111�11 CAL= / -AW401ow S Em- 0 ft.�� t MA J !' _ L pqwzll PWA X,VA AMI L�i''� r i • 50 liq L/ • �j WVA " �� %tom � �� /� � / I�� 'LL♦ �l INITIAL �' �� (PERSONINITIAL Establishment: Inspection Date: — -� -Time: 7specified p Einsp Address/City: Health Dept: &J 1 2 4 Based on an inspection this day,the items marked DNC identify the violations in operation or facilities which must be corrected by the daage 2. RISK FACTOR ITEMS: Listing is not inclusive of all possible debitable items C N/O WA IDNC KEY: C[complies] N/O[not observed] NIA[not applicable] 3 DNC[does not comply] 0[other] RTE[ready-to-eat] :t�� E 2. ir i ,b t_u "C 77 N/A.4 W 0,-wpm Wtit#en d men#adott ofi#r ttiI t o program 2 A Food workers have no exposed infected lesions/burns B Personnel with infection restricted Appio sQf'e,YtfibleSO ,tonadEterafed C N/0 `A C Communicable disease of worker reported to local health director 0000 A Approved shellfish,finfish,meat&poultry USDA approved 73 drashirtg#0611ifies pravil&4-hands wastied,clean C. 4I B Food cans in good condition(not dented,rusty,bloated,leaking) Handwash facilities in all food prep/dispensing&warewash areas '100- C Wholesome/nonadulterated foods/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 0 �,.pop"I p C N/A A Hot holding greater than or equal to 1400F. (whole beeflpork roasts 130e e) 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 00, D Proper re-heating E Proper internal cooking/consumer advisory posted 0 proved sanitizer available/adequate concentration ofsanitizer ood-contact surfaces and utensils used for potentially azardous food sanitized at least every 4 hours A Food thermometer available and accurate Adequate^shwashersanitizer ❑final rinse temp B Proper food thermometer for product roper sanitizin rocedure C Thermometers appropriately placed in cooler units anitizing between raw animal origin&ready-to-eat food 0 A Cloths and/or sponges in good repair and clean A Produce washed B Wiping cloths kept in sanitizer between uses aw meaL000 ts not stored/prepared near ready-to-eat foods IC Food covered properly A 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 C Food--contact surfaces clean F No pooling of eggs not cooked immediately 0 8 Food containers stored off the floor 0 ` S I papr ow I drying available A No unnecessary handling RTE and/orr cooked foods with bare hands�3c A oap e t els deviceB 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. _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&QFO? Y N byes 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 CFO responsibilities information at the time of the Is there a produce washing policy? Y N *Describe what is washed and inspection: where: Nc Note: This report is a two page form(total of 62 debitable items) Page 1 of 2 f� 'D I D Nd Establishment: ut� Date of Inspection: 1^1 r Address: AOwner or Operator: ADDITIONAL FOUR POINT ITEMS :` KEY: DNC [DOES NOT COMPLY] ;k 6 Foods not re-served. Ak -Unwrapped foods not re-served 4 31 Sewage disposal approved. 4 -Potentially hazardous foods not re-served -Operating as required No cross connections,back siphonage,backflow 11 Toxic chemicals. Proper type/installation/backflow prevention device/air gap for: -Stored properly,labeled properly,used properly -Food equipment -Hose connections -Dish machines -Sanitizer 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 40 Garbage/rubbish storage arealrooms,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 3 uteropenings protected against entrance of insects/rodents )iFloors: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 18 Single service articles,storage,dispensing 8 Exterior walking,driving surfaces,good repair,clean 19 No reuse of single service article IM Malls,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 Accurate thermometers provided,dish basket,if used 54 Rooms adequate,clean,adequate lockers provided,facilities clean 7 Nonfood-contact surfaces of utensils&equipment clean 55 Establishment and premises free of litter,no insect/rodent harborage, 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 r5—& No live birds,turtles,or other animals(except guide dogs) 37 Proper toilet fixtures provided,good repair,clean tea; d,sign(s)posted at entrance(s), 39 Approved garbage/rubbish containers,adequate number,covered, rodent pro f,clean ORoutine Inspection OReinspection 0 Preoperational Inspection IN R: PERSON IN CHARGE: Other Inspection: Demerit Score: *Include demerits from page 1 4 3 2 1 _Total Rating i tur s ature _ 7)--,- 7 �prntn In print name phone umber title DAT CORRECTIONS DUE: Page 2 of 2 plus continuation pages Focused Inspection 1/2002 July 16,2008 Alexia's Pizza Restaurant Bobby Moutte&Ann Williams 952 Sullivan Avenue South Windsor,CT 06074 Re: Food Service Establishment inspection results for Alexia's Pizza Restaurant located at 952 Sullivan Avenue, South Windsor,Connecticut Dear Mr.Moutte&Ms.Williams: On July 16,2008,a food service re-inspection was conducted at Alexia's Pizza Restaurant located at 952 Sullivan Avenue, South Windsor,Connecticut. At the time of the inspection,the rating score was 78 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 with the exceptions given to as agreed to the installation of the hand sink for the front food preparation area, completing the course to become a qualified food operator,replacement of the defective magnetic gaskets for the cooling units,the dishwasher to have the proper chemical sanitizer connected and in use, and the installation of a screen door with door sweep on the bottom for the outside storage room which will be completed by August 16, 2008. 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 Page_of_ INSPECTION REPORT STATE OF CONNECTICUT FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH CONTINUATION SHEET NAME OF ESTABLISHMENT TOWN 9 S Z Sit-l.W IAr.I A.rS DATE OF INSPECTION A ,-cx I A '5. --1 -7/ 1 ' Impomm Form A Remuin: Z 7 ►Ns�� S-oD a. �et,,� S�^i.v.c-ter Cow W� ��2.� �f o u � � ��`r I ,u L� �s � 3.� �' I A-) s A r.) I i12 g 2 7L k G' S t I� 3 !-F ANi� S i Nam, at�C.�.-�'� t-�°v`tiJ S t ►.�K w�'��'� ��. �..�wsi- �2-s�A r �[ NA) P-tn I e blNf �.1�`� 2 `� staves p`�S � - �ts�►. mt�ce�,�� 142. 2- 4 VVo S A� i 1ZNL_ Avg t�,q 3 I"�vsr �l ts� A I`�- ACC ` �J rl�wDS V s�D �`p A'L avt C w,CY-SZ F-v_z..,` L-A+Z.4,,s- 3 I� �ZZ►� S'7�`1�� 7 ?i7/ ►da�'G�C �a�� +1� Sti L L.�EL 1 Z��C 0��,� 0202A� ��3>J O 2 t4�%,.3N S.Ntj< 2.Ce" 1 —11,Z) 71.' t©5°T p IIS'F Coa (gl !b 7,w zv-pL A,,vLt 3 C�bt-%iS A., a<t,s� yoor- /"M0.2c0%. AA s.a vcs I(ac> INITIAL(INSPECTOR) 16 t1- INITIAL(PERSON IN CHARGE) Distribution: Ist-White-Health Department Ind-Yellow-Owner/Manager c:tcerainsfotm1crt 7ddre t: / s�t�.5 Date of Inspection: Owner or Operator: ADDITIONAL FOUR POINT ITEMS KEY: DNC [DOES NOT COMPLY] 6 Foods not re-served. 31 Sewage disposal approved. -Unwrapped foods not re-served -Operating as required -Potentially hazardous foods not re-served 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-Water quality in compliance 3tdesigned,properly ilet facilities. Adequate,convenient,accessible, -Monitoring in compliance installed OTHER ITEMS KEY: DNC [DOES NOT COMPLY] 2 Sources of food: Original container,properly labeled 0 Garbage/rubbish storage area/rooms,enclosures-properly constructed,clean 5 Potentially hazardous food properly thawed 1 Garbage/rubbish disposed of in an approved manner,at approved frequency 10 Food dispensing utensils properly stored V rmin Control: No insects/rodents present 4 F�lnd worker:Clean outer clothes,effective hair restraints ropenings 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 required ocated 6 Floor,wall juncture covered 17 o od-contact surfaces designed,constructed,maintained, 7 Mats removable,good repair,clean stalled,located 18 Single service articles,storage,dispensing xteriorwalking,driving surfaces,good repair,clean 19 No reuse of single service article 9 Is,ceilings attached,equipment properly constructed,good pair,clean.Wall&ceiling surfaces as required 20 Dishwashing facilities approved design,adequately constructed, maintained installed located 50 r jAstiess cleaning methods used,cleaning equipment properly stored Equipment&Ut n its: Cleanliness �S 51 Adequate lighting provided as required 21 Preflushed,scraped,soaked and racked 52 Room free of steam,smoke odors water clean,proper temperature t�' PJprc� 53 Rooms&equipment hoods,ducts,vented as required 2 ;urate 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 litter,no insect/rodent harborage, 28 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 36 Toilet rooms enclosed with self-closing door 58 No live birds,turtles,or other animals(except guide dogs) 59 L93 Proper toilet fixtures provided,good repair,clean Seats 75 or more:Nonsmoking area provided,sign(s)posted at entrance(s),smoking area indicated by sign(s)Approved garbage/rubbish containers,adequate number,covered, 00, rodent proof,clean IpRoutine Inspection ❑Reinspection ❑ Preoperational Inspection PE T . ill I PERSON IN CHARGE: OtherInspection: /(�.7 `�� Demerit Score: *Include demerits from page 1 �(^, 4 3 2 1 Total Rating si na re �< signature vt e3 /��'T�l i f print name _ print name / f DATE CORRECTIONS DUE: '7 t 4 o phone number title Page 2 of 2 plus—t continuation pages Focused Inapm.00 ll1.1 i Establishment: At-cXk A s Inspection Date: 110 16 Time: -q n tnsp REinsp Address/City: Health Dept: Sg%s-r a Class: 1 2 3 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/O N/A I DNC I KEY: C[complies] N/0[not observed] N/A[not applicable] 3 DNC[does not comply] 0[other] RTE[ready-to-eat] � otl << A Food workers have no exposed infected lesions/burns t r1 B Personnel with infection restricted ..K r n.== a C C municable disease of worker reported to local health director A Approved shellfish flnfish,meat&poultryUSDA a roved y �R B Food cans in good condition(not dented,rusty,bloated,leaking) 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 olE Handwashing at appropriate times 0 F � No eati s,. < x r � , .��-'� A A Hot holding greater than or equal to 140°F. (wnoierinore roans Sao°F.) ng o smoking while working 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 Proper internal cooking/consumer advisory posted Approved sanitizer available/adequate concentration of sanitizer Food-contact surfaces and utensils used for potentially 000 hazardous food sanitized at least every 4 hours A Food thermometer available and accurate C Adequate dishwashers n'i ❑fi e .001 D Proper sani izin procedure'B Proper food thermometer for product E Sanitizing between raw animal origin&ready-to-eat food C Thermometers appropriately placed in cooler units 911 Cloths a .00 nd/or sponges in good repair and clean 00 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 8 F od containers stored off the floor No unnecessary handling RTE and/or cooked foods with bare hands 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 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: 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 If yes 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 Pu_-t-- L _ If tin i2�4-4 i s I , I WHBHD Fax:8605617918 Jul 2 2008 8:15 P. 01 Page of_ INSPECTION REPORT STATE OF CONNEMCUT FOOD SERVICE ESTAHLISInt•IMM DEPARTMENT OF PUBLIC HEALTH CONTIMATION StLW NAME OF ES'TABLISHIIUNT TOWN c;S Z DATE OF INSPECTION tropoalon Eam r tep�tin: ' Z7 tNs2&e Z St�io. '4 7-0 Lk G 1-4 AUK S i�� taG -came S t ►�3 K ►+�1'1'�.. ea, ev'L+"�j ,'`i 2 ( races, c 7.,,A 92, A :EPA G] 0 s c-b %to fit.zzbv;F c. -L s ' ,r•.. L .a e,C.'r 7-0 Z�( � �� G..�..�'A t� C i"�:� Qom' �a2 ��,��t2. � ��:.t►�.s.s ; INITIAL UNSPECTOR) INITIAL(PERSON IN CHARGE) Distribution: I st-White-Health Department 2nd-Yellow-OwncriMana@er v:%m1Vnsrbm2.an WHBHD Fax:8605617918 Jul 2 2008 8:15 P.02 Establishment: A%_CK DO ZSIC Inspection Date' Time' rns REins� I Address/City:_ CST L A -_-- —Health Dept: 'tea w•.-4s-,-jiL : t 2 3 4 Based on an inspection-this day,the items marked ANC Identify the violations in operatron or facilities which must be corrected by the date specified on page 2. DISK FACTOR ITEMS:Listing is not inclusive of all possible d®bitable items C Nlo YIA JONC I KEY: C(complies) NIO[net observadl NIA[not applicable] •1*' NC(do a campy) 0[other] RTE(ready to at] [ df r _ s A Food workers have no exposed infected lesions I bums ;. !, 2;�' -•• .� + :• - • 'V Personnel with infection raetriated B S w 'ME. . municable disease of worker reported to ktcal health director WOO A Aiproved Adifish,finfish meat&poultry USDA approved �. e Food cans in good condition(not dented,rusty,bloated,leaking) Handwash facilities in all food prep/dispensing&warewash areas 10.0 C Wholesamelnonadulteratedfocds/safe 6 Handwash facilities in or immediately adjacent to toilet rooms D Commercial products(no home grownicannedfood) C Handwash facilities accessible/convenient to use 00 E Potentially hazardous foods received at proper temperature 0 D Personnel hands washed,clean/Proper handwash procedure E Handwaahing at appropriate times Q ¢��' E• .'. ,. '• ,2. •• "• - .,° „ - ,-.. (-- A Hot holding greater than arequal to 14)F ( �n�vaA mmto i3o°fit A No satin 'o smoking while working B Cold holding less than or equal to 45°F. leo Wounds covered adequataly G Proper cooling C Proper sink used for handwashing D Proper re-heating 0 E Proper internal cooking/consumer advisory posted ;��ti F�" '�'� N �;i �;.;r,•1.:,� 1-0 Approved$ani#aeravallable/adequate concentration ofeanitizer Food-contact surfaces and utensils use or patenba ly ; ' " hazardous food sanitized at lea s#every 4 h urs A Food thermometer available and accurate C Adequate ishwasher D Proper sanfttn 9 Properfood thermometer for product rocedure C ' t Sanitizing between raw animal origin$ready-to-eat food Thermometers appropriately placed in cooler units Cloths and/or sponges in good repair and clean A Produce washed B Wiping cloths kept in sanitzer between uses B Raw meats not stored/prepared near ready-to-eatfoods ,• .:-: .•, C Food covered properly 'r A Food equipment clean,utensils clean,equipment interiors dean voo D Adequate splash guards!sneeze guard B Single use gloves changed when soiled E No unauthorized personnel C F No pooling of eggs not cooked immediately Food—cant acksurfaces clean 8 F od containers stored off the floor t MEN No unnecessary handling RTE and/or cooked foods with bare hands Soap/paper towels/.drying device available B Dlspenser(s)working: OSoap ❑Paper towel B Minimize food handling,other than ready-to-eat,with bare hands C Handwash sink(B)clean/waste receptacle at handwash sink C Adequate ulansil(s)fordispensing food/ice a D •DESCRIBE DEFICIENCIES ON CONTINUATION SHEETS The following information is not debitable and does not affect your score. KEY: QFO[quatlfied food operator],DA[designated alternate],PHF[oWlsilly hazardous food],FB(foodbome) N hs are Not held at: °F. PH s are odd hold at: uF, Discrive 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 reheating procedures: Is there a written illness policy that requires the food worker to report specific Illness conditions Are temperatures recordedilogged for cold holding foods/equipmenl7 Y N and diseases to the OF07 Y N ♦Do you have a paid sick leave policy? Y N Are foods cooked in advance and cooled! Y N *Are leftovers saved? is there a language barrier between inspector&QFO? in ca a nguage spo en 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 mvritared for time&temp? Y N Is the monitoring of cooling recorded? Y N `ndicate 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 ere a producD washing policy? Y N *Describe what is was and inspection: where: Note: This report is a two page form(total of 62 debitablo items) Page 9 at 2 WHBHD Fax:8605617918 Jul 2 2008 8:15 P.03 'd N-01 �,n.. .r c�• ^r.�:rlk��N; `.y,:.•. r •r,�Cr, Oax, y.y.;t..-, ��,.• 4 { � r . L r ',�'�j•' _{j�4n YY� ,}��'�1j{F .. ,�s9::��'t:`�; :' ;w '�'�4zi�,`., a'� ,�,.•. '�'.r�.�`rv, 3 •� .�.q�rk+'�p;: IR�."'�;4 j•..,', �p�t Y 3��,�,.[,,.i ADDITIONAL FOUR POINT 'ITEMS KEY: DNC DOES NOT COMPLY] 6 Foods not reserved. Unwrapped foods not re-served 31 Sewage disposal approved. -Potentially hazardous foods nat re-served 0perating as required 11 Toxic chemicals. 34 No cross connections,back siphonage,baC ow -Stared properly,labeledproperly,usedproperlyProper tyne/insfallatin/backflonrnti0n deviCts/;ir gp ; p yr texceed •Food equipment Hose connections -Dish machines •SanlGzer concentration not to exceed maximum permitted -Soda system carbanator -Beverage dispensers •Toss tanks -No unnecessary toxic-on the premises -Pesticides/rodenticides properly dispensed -Chemical dispensers -Ice machines 9 Water source adequate,safe. -Food equipment -Dish machines -Ice machines _ -Well I 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 0 Garbagehubbish storage areafrocros,enclosures.properly constructed,dean Potentially hazardous food properly thawed 1 Garbage/rubbish disposed of in an approved manger,at approved frequency 10 Food dispensing utensils properly stored V rmin Control:No insects/rodents present 4 d worker.Clean outer clothes,effective hair restraints r openings protected against entrance of insects/rodents Mors., Flooroovering installed,constructed as required,good repair,Clean 16 Food-contact surfaces designed,constructed,maintained,installed, 5 Floors graded,drained as required sated 6 Floor,wall juncture covered 7 No ontact surfaces designed,constructed,maintained, ] Ma#sremovabie -rnsta located ,good repair,dean 18 Single service articles,storage,dispensing kWrlarwalldng,driving surfaces,good repair,clean 19 No reuse of single service article q Is,ceilings attached,equipment properly constructed,good 0 Dishwashing facilities approved design,adequately constructed, pair,dean.Wall&ceiling surfaces as required maintained installed located 50 ties-deaning methods used,Cleaning equipment properly stared i �, I Adequate lighting provided as required 1 Preflushed,scraped,soaked and racked '+ ' lerdean,proper temperature }t✓ Pri S2 Room free of steam,smoke odors 3 Rooms&equipment hoods,ducts,vented as requiredIwae thermometers provided,dish basket,if used 54 Rooms adequate,dean,adequate lockers provided,facilities dean 7 &food-contact surfaces of utensils&equipment clean 5 Establishment and premises free of litter,noinsectrrodentharbarage, 8 Equipment/utensils,storage,handling no unnecessary articles 32 Proper disposal of waste water 56 Complete separation from living/sleeping quarters and laundry z' 3 Plumbing location,installation,maintenance 57 Cleanlsoiled linens stored properly 6 Totiet rooms enclosed with self-closing door 8 No live birds,turtles,or other animals(except guide dogs) 7 Proper toilet fixtures provided,good repair,dean 'S9 Seats 75 or more;Nonsmoking area provided,sign(s)posted at entrance(s),smoking area indicated bysign(s) Approved garbage/rubbish containers,adequate number,covered, rodent proof,clean Routine Inspection) 13Relnspaction 13 Preoperational Inspection 01itm Inspection: r tArvterit Score: *Include demerits from page I 4 3 2 1 Total Rating 6net re signature print name print name ,/ i _( ,Y(V-2'S-( phone number cue DATE CORRECTIONS DiJE: Rage 2 of 2 plus��-�,continuation pages Focused rnapeeNon snadt July 2,2008 Alexia's Pizza Restaurant Bobby Moutte 952 Sullivan Avenue South Windsor,CT 06074 Re: Food Service Establishment inspection results for Alexia's Pizza Restaurant located at 952 Sullivan Avenue, South Windsor, Connecticut Dear Bobby Moutte: On July 1,2008,a food service inspection was conducted at Alexia's Pizza Restaurant located at 952 Sullivan Avenue, South Windsor,Connecticut. At the time of the inspection,the rating score was 75 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)644-251 1. Sincerely, Robert De Vito,R.S. Environmental Health Officer - Y RIINI ��. MLiMu--a 77 Establishment: All 1zz.A _..__._ Date of Inspection- Address: Owner or Operator: 3�+s CA 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 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] Sources of food: Original container,properly labeled 40 Garbage/rubbish storage area/rooms,enclosures-propedy constructed,clean 5 Potentially hazardous food properly thawed 41 Garbage/rubbish disposed of in an approved manner,at approved frequency 10 ood 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 onfood-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 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 2 Accurate thermometers provided,dish basket,if used 54 Rooms adequate,clean,adequate lockers provided,facilities clean 2 onfood-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 wastewater 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 fixturesprovided,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 IN MTR: 0 PER IN HAR E: Ot Inspection: Demerit Score: *Include demerits from page 1 4 3 2 1 Total Rating signature signet �- V_ %N k Xr(-)Q o F- aL"L z `J X 1 print name print name (� �s 1,o141-25"it It m,,l e.l phone number title DATE CORRECTIONS DUE: tJ. C7 Page 2 of 2 plus--A—continuation pages Focused Inspection 1/2002 Page of INSPECTION REPORT STATE OF CONNECTICUT FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH CONTINUATION SHEET NAME OF ESTABLISHMENT TOWN '3S Z S,),-L,✓A-N Avlr DATE OF INSPECTION A�.�X►ma's ��2.z.1+. �.rc i��Rn,c' �C � l / oe INSPECTION FORM# REMARKS 'Z �\D %,.g- N 4k- e�z � +J L./►a2 � {�L c F 24.c-S — lcd-P si' p T'b ►�tt,S -n� %4- + 1 �A ► -ZZA^ K `ID i 7,jboj A%So2RA#Qf A-Pjb, CLC -+askr�LS L. 1 6 tM'rS Tv `� Caved A Ptso Arz- '7 fZoi> 7-0 N Cap L.�'L o e. +-1 A oJl�> S 1 N IC. ,� {�,� w,i� *A/'j Z� L Sj J: Z `3 A'-1 e-1 `C-4 S A N• 1 t S� WAS k d L' {.e L£ Ll l WDLITL pu INITIAL(INSPECTOR) �- re— INITIAL(PERSON IN CHARGE) I Distribution: 1st-White-Health Department 2nd-Yellow-Owner/Manager i Establishment: Inspection Date: 3. S bs!r Time: Co Rt)insp REinsp Address/City: 9 S-2_ Health Dept: Class: 1 2 3 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 JDNCI KEY: C[complies] N/0[not observed] N/A[not applicable] °d 5d 3 DNC[does not comply] 0[other] RTE[ready-to-eat] C ' 61 Designated Alternate � 2 0 WA 4 Written documentation of training program A Food workers have no exposed infected lesions/burns 2 tit B Personnel with infection restricted 1 Approved source,wholesome,nonadulterated C N N/A 4 C Communicable disease of worker reported to local health director A Approved shellfish,finfish,meat&poultry USDA approved 13 Mandvuashing facilities provided,handswashed, n C N0 WA 4 B Food cans in good condition(not dented,rusty,bloated,leaking) A I 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 f and 3 ofs [al�iaoas tl fee , 'r ui � clbttrg Sip:Ptparal P, i3ty�se r �# rispp e w i ., as ing a appropriate Imes a P li#►€1 `�t C ' ` 2 A Hot holding greater than or equal to 140oF. (whole beeoporkroasts 130o F.) A C] No eating ❑ No smoking while working B Cold holding less than or equal to 45o F. B Wounds covered adequately C Proper cooling C Proper sink used for handwashing D Proper re-heating V, 0 E Proper internal cooking/consumer advisory posted �? �!!? C htf0+ Nf�4 2 0 A Approved sanitizeravailable/adequate concentration of sanitizer e crittr t7tn at , h B Food-contact surfaces and utensils used for potentially pe aotete hazardous food sanitized at least eve 4 hours A Food thermometer available and accurate C Adequate Vishwashersanitizer ❑final rinse temp Vfl D Proper sani izin procedure B Proper food thermometer for product E Sanitizing between raw animal origin&ready-to-eat food C Thermometers appropriately placed in cooler unitsPoo 0, r � display service and transportation � 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 C Food covered properly or 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 r 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 0 O 1 •DESCRIBE DEFICIENCIES ON CONTINUATION SHEETS The following information is not debitable and does not affect your score. KEY: QFO[qualified food operator],DA[designated altemate],PHF[potentially hazardous food], FS[foodborne] 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 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): 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 EHS-106-Rev.06101 INSPECTION REPORT STATE OF CONNECTICUT GP ROUTINE INSPECTION ❑ REINSPECTION FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH ❑ PREOPERATIONAL ❑ OTHER 410 Capitol Avenue,MS#51 FDP,Hartford,CT 06134 NAME OF ESTABLISHMENT ESTABLISHMENT 49 A(e.-Y >` utl CLASS STREET TOWN ADDRESS j,;,,n a., �7� �•G!/t°� r/� OWNER or INSPECTION OPERATOR DATE and TIME Based on an inspection this day,the items marked below identify the violations in operation or facilities which must be corrected by the date specified below. SOURCES OF FOOD EQUIPMENT&UTENSILS:CLEANLINESS VERMIN CONTROL 1 Approved source,wholesome, 4 21 Preflushed,scraped,soaked and racked 42 Presence of insects/rodents 2 nonadulterated 22 Wash water clean,proper temperature 1 43 Outer openings protected against entrance of 1 2 Original container,properly labeled 1 23 Accurate thermometers provided,dish basket,if used insects/rodents 24 Sanitization rinse(hot water-chemical) 2 FOOD PROTECTION 25 Clean wiping cloths 1 FLOORS,WALLS&CEILINGS 3 Potentially hazardous food meets 4 26 Food-contact surfaces of utensils& 2 44 Floors:floor covering installed, temperature requirements during storage, equipment clean constructed as required,good repair,clean preparation,display,service,and transportation 27 Nonfood-contact surfaces of utensils& 45 Floors,graded,drained as required 1 equipment clean 46 Floor,wall juncture covered 4 Adequate facilities to maintain product 28 Equipment/utensils,storage,handling 1 47 Mats removable,good repair,clean temperature,thermometers provided 5 Potentially hazardous food properly thawed 2 48 Exterior walking,driving surfaces, 1 6 Unwrapped or potentially hazardous food 4 WATER SUPPLY good repair,clean not reserved 29 Water source adequate,safe q 4 49 Walls,ceilings attached,equipment properly 1 7 Food protected during storage,preparation, 30 Hot and cold water under pressure, 2 constructed,good repair,clean. Wall&ceiling 00 display,service&transportation provided as required surfaces as required. 8 Food containers stored off floor 19 50 Dustless cleaning methods used, 1 SEWAGE DISPOSAL I cleaning equipment properly stored 9 Handling of food minimized 2 31 Sewage disposal approved 4 10 Food dispensing utensils properly stored 1 32 Proper disposal of wastewater 1 LIGHTING&VENTILATION 11 Toxic items properly stored,labeled,used 4 51 Adequate lighting provided as required 1 PLUMBING 52 Room free of steam,smoke odors 1 PERSONNEL 33 Location,installation,maintenance 1 53 Room&equipment hoods,ducts,vented as required 12 1 Personnel with infection restricted 14 34 No cross connection,back siphonage,badcflow 4 DRESSING ROOMS&LOCKERS CLEANLINESS OF PERSONNEL TOILET FACILITIES 54 Rooms adequate,clean,adequate lockers 1 13 Handwashing facilities provided, 4 35 Adequate,convenient,accessible,designed, 4 provided,facilities clean personnel hands washed,clean installed 14 Clean outer clothes,effective hair restraints 0 L2 36 Toilet rooms enclosed with self-closing door 1 15 Good hygienic practices,smoking restricted 2 37 Proper fixtures provided,good repair,clean HOUSEKEEPING 55 Establishment and premises free of litter,no 1 EQUIPMENT&UTENSILS: DESIGN, HANDWASHING FACILITIES insect/rodent harborage,no unnecessary articles CONSTRUCTION &INSTALLATION 38 Suitable hand cleaner and sanitary towels or 56 Complete separation from living/sleeping quarters 1 16 Food-contact surfaces designed,constructed, 2 approved hand drying devices provided, and laundry maintained,installed,located tissue waste receptacles provided 57 Clean/soiled linens stored properly 1 17 Nonfood-contact surfaces designed, 1 58 No live birds,turtles,or other animals 1 constructed,maintained,installed,located GARBAGEIRUBBISH STORAGE&DISPO 1(except guide dogs) 18 Single service articles,storage,dispensing 2 39 Approved containers,adequate number, 1 19 No reuse of single service article covered,rodent proof,clean NONSMOKING AREAS 20 Dishwashing facilities approved design,adequately 2 40 Storage arealrooms,enclosures— 59 Seats 75 or more:Nonsmoking area provided, 3 constructed,maintained,installed,located properly constructed,clean sign(s)posted at entrance(s),smoking area 1 indicated by sign(s) 41 Garbage disposed of in an approved manner, at approved frequency QUALIFIED FOOD OPERATOR DEMERIT SCORE 60 Qualified Food Operator 3 4 3 2q 1 RISK FACTOR VIOLATIONS IN RED 61 Designated alternate 2 l q 62 Written documentation of training program 2 J Signature o erso rge / TOTAL RATING Date Corrections Due a f 1b&" a3 SIGN E nspector) �! POTf(b(` A DESCRIBE DEFICIENCIES ON ONTINUATION SHEETS Page_of_ INSPECTION REPORT STATE OF CONNECTICUT FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH CONTINUATION SHEET NAME OF ESTABLISHMENT TOWN f DATE OF INSPECTION �`CeUs . S'•Lv 1�wdJvr Z " —cam 7 Inspection Form M Remarks: t(?6 �nv�e i �� (�i� /r tM.l� � t !v•S'� }r E i z INITIAL(INSPECTOR) INITIAL(PERSON IN CHARGE) Distribution: 1st-White-Health Department 2nd-Yellow-Owner/Manager c:\cen\insfonn2.cn