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HomeMy WebLinkAboutFood Service Establishment Inspection 29 Establishment: Q") Rowd 3 Date of Inspection: h oh0 Address: 1-A :n-o'no Fikch 6trd. 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 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 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 -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 43 Outer openings 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, 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 Single service articles,storage,dispensing 8 Exterior walking,driving surfaces,good repair,clean 19 No reuse of single service article 9 I 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 1 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 7 Nonfood-contact surfaces of utensils&equipment clean 55 Establishment and premisesfreeof litter,noinsect/rodentharborage, 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 57j 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 RfRoutine Inspection OReinspection 0 Preoperational Inspection Other Inspection: INSPECTOR: PERSON IN CHARGE: Demerit Score: *Include demerits from page 1 QJ'. o" 'A'e J)=nnC Le CL_ 4 3 2 1 Total Rating signature ylZ'Aq COAA) ignature print name print name LVL�m"P'� DATE CORRECTIONS DUE: 010 phone number title '9RYS Page 2 of 2 plus continuation pages Focused Inspection 1/2002 t. Page � of INSPECTION REPORT STATE OF CONNECTICUT FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH CONTINUATION SHEET NAME OF ESTABLISHMENT TOWN DATE OF INSPECTION [5 Q,�W (�o�rJls So�}�, (A/) ndsur 1 '1©l10 INSPECTION REMARKS FORM# r00A C-6cl"C+5 6(1 4�-Intx �/� w�� M� Opvckn MOW 0. ccndv-.,15W in c 0;J f"c. IY15; 1c), ,c-q, J�� C)0, n C 1� X ice, Q a4nA O v OkC1a N oTG T r--W)rs ok HW Cok INITIAL(INSPECTOR) INITIAL(PERSON IN CHARGE) Distribution: 1st-White-Health Department 2nd-Yellow-Owner/Manager Establishment: _11+we," R AAds Inspection Date: ► o /o Time: _ ROinsp REinsp Address/City: lot -JOh10 J-';}cl, (3)vJ- Health Dept: S0Llro w:CfJpSb{t 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 I N/O N/A DNC ; C[complies] NIO[not observed] NIA[not applicable] J 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 11 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) A Handwash facilities in all food prep/dispensing&warewash areas C Wholesome/nonadulteratedfcodslsafe 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 140eF. (whole beef/porkroasls 1300 F.) J A ❑ No eating ❑ No smoking while working B Cold holding less than or equal to W F. J B Wounds covered adequately C Proper cooling C Proper sink used for handwashing D Proper re-heating J 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 j hazardous food sanitized at least every 4 hours A Food thermometer available and accurate C Adequate ❑dishwashersanitizer ❑final rinse temp J B Properfood thermometer for product L Proper sanitizing procedure E Sanitizing between raw animal origin&ready-to-eat food C Thermometers appropriately placed in cooler units O 0 A Cloths and/or sponges in good repair and clean A Produce washed I 1A I I B Wiping cloths kept in sanitizer between uses 0 B Raw meats not stored/prepared near ready-to-eat foods C Food covered properly ly I I A Food equipment clean,utensils clean,equipment interiors clean D Adequate splash guards/sneeze guard f Single use gloves changed when soiled E No unauthorized personnel Food--contact surfaces clean F No pooling of eggs not cooked immediately 0 8 Food containers stored off the floor 0 7777777777 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 0 •DESCRIBE DEFICIENCIES ON CONTINUATION SHEETS following information is not debitable and does not affect your score. _M: QFO[qualified food operator],DA[designated alternate],PHF[potentially hazardous food],FB Ifoodbome] PHFs are d at: IF. PHFs are cold held at: OF. Describe illness conditions when you would exclude a food worker from work' Are internal cooking atures taken? Y N *To what temperature do you cook: Poultry Beef Pork What diseases related to FB illness are you required to o the local health department? Roasts Othe Describe re-heating procedures: Is there a written illness requires the food worker to report specific illness conditions Are temperatures recorded/logged for cold holding foods/equip Y N and disease 0? Y N *Do you have a paid sick leave policy? Y N Are foods cooked in advance and cooled? I Y N *Are leftovers saved? Y s there a language barrier between inspector&QFO? Y N If ygs indicate language spoken List products cooled: DA: *Can the QFO/DA read the inspection report? Y N Describe cooling methods: Indicate who answere ve questions: Name(print): Indicate the title of above person(circ e t apply):QFO DA Mgr Cook Owner FW Is cooling monitored for ' temp? Y N Is the monitoring of cooling recorded? Y N .Obtain signature of the person who received the onsibilities information at the time of the Is ther oduce washing policy? Y N ♦Describe what is washed and inspection: re: Note: This report is a two page form(total of 62 debitable items) Page 1 of 2 Page of INSPECTION REPORT STATE OF CONNECTICUT FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH CONTINUATION SHEET NAME-OF ESTABLISHMENT TOWN ii 11 DATE OF INSPECTION ggAVjq e,y) f 6`''/id s G��f+� W 104 Sa c INSPECTION FORM# REMARKS 03� �00A Oat-C�-s k)oo•c In WJk-ie7 Co o,e.�. q i„i� -i c�z P-c Lq� Des Cvvz'rs Co Q,C I L w�, -;n Coo ems. S �iT �tCQi %i 0 H W 51 II 66"a,iA P CPi 0 Gf�V�i��hC�r C,51"lk �C HVJenl a Ne � -(� s� �G C IZ/an lAzo6or a� �c Cb���,;, Scot ��c��( t 5 �fi,C�� INITIAL(INSPECTOR) INITIAL(PERSON IN CHARGE) Distribution: 1st-White-Health Department 2nd-Yellow-Owner/Manager cAcer6insform1crt ! y Establishment: ETWEeN PouFUflS Date of Inspection. Ct ddress: DIVA. 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 kki No cross connections,back siphonage,backflow 11 Toxic chemicals. I -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 -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-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 43 Outeropenings protected againstentrance of insects/rodents 4 Floors: Floorcovering 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 properlystored EEquipment&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 231 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 lifter,noinsect/rodentharborage, 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 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 13 Preoperational Inspection Other Inspection: INSPECTOR: PERSON IN CHARGE: Demerit Score: *Include demerits from page 1 4 3 2 1 Total Rating signature tgnatur �a Z -3 print name print name I ma--y-Ch DATE CORRECTIONS DUE: DAYS phone number title Page 2 of 2 plus 1- continuation pages Focused Inspec�1/2002 ���4c CAS-Ir2'f T J°�nl"tAc�a l Establishment: c Awn (Zo..,,as Inspection Date: ct di Time: Al)[nsp RE[nsp Address/City: -, ohs F' -c 131 VA. Health Dept: So,-'rH VaNDSbcc Class: 1 2 (P4 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 JDNC I KEY: C[complies] NIO[not observed] NIA[not applicable] 60 Sid�oqd Qpta Or e g DNC[does not comply] 0[other] RTE[ready-to-eat] " � - �' 1§' `P+srsa#tnel irffectitii�restricted C N/0 N/A 4 61 designated Alternate 2 62 Written documentation of training program 2 A Food workers have no exposed infected lesions I burns J B Personnel with infection restricted 1 Approved source,wholesome,nonadulteraled C N/0 NIA 4 C Communicable disease of worker reported to local health director J A Approved shellfish,flnfish,meat&poultry USDA approved JI I 1 13 Handwashing facilities provided,hands washed,clean C NIO NIA 4 B Food cans in good condition(not dented,rusty,bloated,leaking) A Handwash facilities in all food prep/dispensing&warewash areas 4 C Wholesome/nonadulteratedfoods/safe .� B Handwash facilities in or immediately adjacent to toilet rooms 4 - D Commercial products(no home grown/canned food) J 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 f 3 Retentiail hazardousl -od meets temper tare regarrem nts NIA :4 O dtr7)pg sfar�ge,prrar i►on,display;:service arrd tisrisportatrta : w6 ' 6otl`it` i'�faic 3f prnctids C N/0' NIA 2 A Hot holding greater than or equal to 1400F. (whole beef/porkroasts 130e F) J A a No eating No smoking while working Se 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 E Proper internal cooking/consumer advisory posted off) C I/0' NIA 2;p 9 ry p ./ _ #t �. O � a � 0 A Approved sanitizeravailable/adequate concentration of sanitizer 4 Ad e f arir6€es maid pro ct e . F B Food contact surfaces and utensils used for potentially t®hiper�trE theistl ne#er*prGffl hazardous food sanitized at least every 4 hours A Food thermometer available and accurate C Adequate ®dishwashersanitizer Ofinal rinse temp B Proper food thermometer for product L Proper sanitizin rocedure E Sanitizing between raw animal origin&ready-to-eat food C Thermometers appropriately placed in cooler units O `Or tft a " @ -reA ya Y r- display,service and transportation A Cloths and/or sponges in good repair and clean J B Wiping cloths kept in sanitizer between uses A Produce washed O B Raw meats not stored/prepared near ready-to-eat foods I s C Food covered properly A Food equipment clean,utensils clean,equipment interiors clean D Adequate splash guards/sneeze guard 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 } i_Wk 0it 9" Handling cf food ttsnintized _ N/0 NAA` Z �( A No unnecessary handling RTE and/or cooked foods with bare hands A I Soapaper towels/ tying device available B ispenser(s)working: Moap 19Paper towel B Minimize food handling,other than ready-to-eat,with bare hands JI C lHandwash sink(s)clean/waste receptacle at handwash sink j C Adequate utensil(s)for dispensing food/ice J0 0 •DESCRIBE DEFICIENCIES ON CONTINUATION SHEETS T 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 Id at: OF. PHFs are cold held at: OF. Describe illness conditions when you would exclude a food worker from working: Are internal cooking iMnipecalures taken? Y N *To what temperature do you cook: Poultry Gro Pork What diseases related to FB illness are you required to report to the local heal t meat? Roasts Other Describe re-heating procedures: Is there a written illness polic t e food worker to report specific illness conditions Are temperatures recorded/logged for cold holding foods/equipment? Y N an o t 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 be ctor&QFO? Y N If yes indicate language spoken List products cooled: by QFO/DA: ♦Can t e 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 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 at the time of the Is th roduce washing policy? Y N *Describe what is washed and inspection: ere: Note: This report is a two page form(total of 62 debitable items) Page 1 of 2 r Establishment: Wean ou Inspection Date: 6 100c) Time: — oinsp REinsp Address/City: 770hA F;+AC CRC. S Health Dept: o'r'W WT(vDSb\t Class: 1 2 3 Q 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] N/0[not observed] NIA[not applicable] 60W116,10)ftdd o' 3 DNC[does not comply] 0[other] RTE[ready-to-eat] 12 ltirsoignel with fnfecticin restricted 1 Designated Afternate 2 C NIO N/A 4- tQh q Food workers have no exposed infected lesions/burns 62 Written documentation of training program 2 ✓ B Personnel with infection restricted 1 Approved source,wholesome,nonadutterated C N10 N/A 4 C Communicable disease of worker reported to local health director J A Approved shellfish,finfish,meat&poultry USDA approved 13 Handwashing facilities provided,hands washed,Mean C NO 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/nonadulteratedfoods/safe Ji IB Handwash facilities in or immediately adjacent to toilet rooms D Commercial products(no home grown/canned food) J 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 3 Poteafrahza�tltius d #eefs f� epntremefils C NIp 4 O aiitrrig rage,pepare{in,disslayrasersricg at�cl transpefitadeir :;: 15'Gootl"Itygieni ' acticas C N/0 NSA 2',: A Hot holding greater than or equal to 140oF. (wnoie beef/porkroasts 130o Ft J A 'tr No eating I&No smoking while working f B Cold holding less than or equal to 45o F. �/ B Wounds covered adequately J C Proper cooling C Proper sink used for handwashing J D Proper re-heating _j 0 E Proper internal cooking/consumer advisory posted ✓ " rf icaij C N/0 NIA, 2'- 0 A Approved sanitizeravailable/adequate concentration of sanitizer ''Aide hate cjl Ile fio mnint in pr�idµrot e C /Q N6A 2 g Food-contact surfaces and utensils used for potentially teFnj�etw rnttefspr�vtcfed , hazardous food sanitized at least every 4 hours A Food thermometer available and accurate f C Adequate ❑dishwashersanitizer ❑final rinse temp L Proper sanitizin procedure B Proper food thermometer for product J E Sanitizing between raw animal origin&ready-to-eat food C Thermometers appropriately placed in cooler units .J 0 O PUO` � . 0o e g s ctrage p para C A Cloths and/orsponges in good repair and clean display,service and transportation9 p B Wiping cloths kept in sanitizer between uses A Produce washed �/ O B Raw meats not stored/prepared near ready-to-eat foods f C Food covered properly J 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 J C Food--contact surfaces clean F No pooling of eggs not cooked immediately J 0 8 Food containers stored off the floor 9 P iih►dl `o f� �i' irtnnt�ed A ',Y r ft lf. A No unnecessary handling RTE and/or cooked foods with bare hands A Soap/paper towels I drying device available J B Dispensers)working: HSoap JVPaper towel B Minimize food handling,other than ready-to-eat,with bare hands 41 C Handwash sink(s)clean I waste receptacle at handwash sink C Adequate utensil(s)for dispensing food/ice 0 J 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] RKS are hot held at: IF. PHFs are cold held at: OF. Describe illness conditions when you would exclude a food worker from working: Are interna 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 ea department? Roasts Describe re-heating procedures: Is there a written illness pol'xy quires the food worker to report specific illness conditions Are temperatures recorded/logged for cold holding foods a t? Y 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 Tthere a language barrier between inspector&QFO? Y N Iflf ves indicate language spoken List products cooled: *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 that a O DA Mgr Cook Owner FW Is cooling monitored for time Y N Is the monitoring of cooling recorded? Y N .Obtain signature of the person who received the QFO response formation at the time of the Is there a ce washing policy? Y N *Describe what is washed and inspection: pNote: This report is a two page form(total of 62 debitable items) Page 1 of 2 S i\/ �1-1 iZG� —. ''' Establishment: Inspection Date: C ' ;'r: N Time: - ROinsp REinsp Address/City: j ,h, ; �, i. Health De t• Y P f t,.•i n s ,� 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 I N/0 I WA JDNCFA EY: C[complies] N10[not observed] N/A[not applicable] 3 DNC[does not comply] 0[other] RTE[ready-tout] Oesrg a arc:. �' 'Z C N/0 NiA 4 . Y Food workers have no exposed infected lesions/burns tit Written docurner�tion.of training program 2 B Personnel with infection restricted 1 Appro SOurce,wl1Gt@Soltie;ftowatfuf�fated C•t0 WAC Communicable disease of worker reported to local health director v A Approved shellfish,finfish,meat&poultry USDA approved ,j 13 ti B Food cans in good condition(not dented,rusty,bloated,leaking) ) _ Y8811*1 C N/0 WA .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 J 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 4i 0 NSA Z A Hot holding greater than or equal to 140°F. (Whole beef/pork roasts 1300 F.) i All No eating El 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 v 0 E Proper internal cooking/consumer advisory posted t _M j 0 A Approved sanitizeravailable/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 J B Proper food thermometer for product ; D Pro ersa itizing procedure r C Thermometers appropriately placed in cooler units E Sanitizing between raw animal origin&ready-to-eat food 0 ,C NJO N/ tl b ►rn # nit# fi A Cloths and/or sponges in good repair and clean B Wiping cloths kept in itizer bet A Produce washed ed san between uses N; B Raw meats not stored/prepared near ready-to-eat foods / 0 C Food covered properly J 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 J 8 0; Food containers stored off the floor 0 Filillin ' � A Soap/paper towels/ drying device available A No unnecessary handling RTE and/or cooked foods with bare hands ry g B B Dispenser(s)working: OSoap OPaper towel Minimize food handling,other than ready-to-eat,with bare hands C Handwash sink(s)clean/waste receptacle at handwash sink C Adequate utens' 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 altemate],PHF[potenfially hazardous food],FS Ifoodborne] 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 rep Roasts -Other 2rt.to-the local health department? _ 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/equlpment? Y N and diseases.tathe-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 @FO/DQ *Can the QFO/DA read the inspection report? Y N Describe coolingmethods: ~ Indicate who answered the aTiove-questioons:`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 appW:-4EO DA Mgr Cook Owner FW *Obtain signature of the person who received the QFO responsibilities informationat the time of the Is there a_prodGce 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 Establishment: �' e�t ©knd's Date of Inspection: o Address: 110 c, �E i Bch R4. 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 34 No cross connections,back siphonage,backflow 11 Toxic chemicals. Proper type/installation/backflow prevention device/air gap-Stored properly,labeled properly,used properly - -Sanitizer concentration not toexceed maximum permitted Food equipment -Hose connections -Dish machines -No unnecessary toxics on the premises -Soda system carbonator -Beverage dispensers -Toilet tanks-Pesticides/rodenticides properly dispensed -Chemical dispensers -Ice machinesProper drain for: 29 Water source adequate,safe. -Food equipment -Dish machines -Ice machines -Well/well head protected from contamination 35 Toilet facilities. Adequate,convenient,accessible, -Water quality in compliance designed,properly installed -Monitoring in compliance OTHER ITEMS KEY: DNC [DOES NOT COMPLY] 2 Sources of food:Original container,properly labeled 40 Garbage/rubbish storagearea/rooms,enclosures-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 2 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, 7 Mats removable,good repair,clean installed,located 8 Exterior walking,driving surfaces,good repair,clean 8 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 properly stored Equipment&Utensils: Cleanliness 51 Adequate lighting provided as required 21 Preflushed,scraped,soaked and racked 5 5 2 Room free of steam,smoke odors 22 Wash water clean,proper temperature 3 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/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 36 Toilet rooms enclosed with self-closing door 58 No live birds,turtles,or other animals(except guide dogs) 59 37 Proper toilet fixturesprovided,good repair,clean 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 )ITRoutine Inspection ❑Reinspection ❑ Preoperational Inspection Other Inspection: INSPECTOR: PERSON IN CHARGE:II—n Score: *Include demerits from page 1 � ,, 4 3 2 1 Total Rating signatu ignat e e, cam. 1 C (� '`3 yl� y a� �s print name print name phone number nipP i DATE CORRECTIONS DUE Lvg6kS 6 title Page 2 of 2 plus continuation pages lFocused Inspection 1/2002 Page of INSPECTION REPORT STATE OF CONNECTICUT FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH CONTINUATION SHEET NAME OF ESTABLISHMENT TOWN DATE OF INSPECTION BQj+wz/�>-)o �o�lnds SoLgi� Uv1,0A5vc INSPECTION REMARKS FORM# 8 No a 0-,c t., s e,� Nw sl,17k o%cK'b55Cba"► �L-114i �@'s �X¢�S oo� tb�u��-� are vl cbn �r �eJow n 6�4,Cb,''7. SCon e,cJ2rz�s n 1A L b��c woM. A W4 e55t 1"7 b,.ck'<b,o,. 6 �cibc 6\ r'►1 ��i.av�5 Off; CuS��i� 1/1 C c4t� 5 -z e:s' ,�j 1'567,2�n4. (66 6 0� 0 �Cn m Q� dal S Ce^f Ck1�1A vu c�� oh-�l�a a.l- 4)r�e SG�CV)A � n cek cxcal °�ECc ) Cif INITIAL(INSPECTOR) INITIAL(PERSON IN CHARGE) Distribution: 1st-White-Health Department 2nd-Yellow-Owner/Manager Establishment: -C/V, Rom Inspection Date: ja ii Time: — Win REins Address/City: 7`V12 Health Dept So I-f'rN VrADS4Z 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 N/0 WA DNC KEY: C[complies] NIO[not observed] N/A[not applicable] 3 DNC[does not comply] 0[other] RTE[ready-to-eat] "Persarinel with tnfectn restricted 61 Designated Alternate 2 C WO WA 4 62 Written documentation of training program A Food workers have no exposed infected lesions/burns 2 B Personnel with infection restricted 1 Approved source,wholesome,nonaduiterated C WO NIA 4 C Communicable disease of worker reported to local health director J A Approved shellfish,finfish,meat&poultryUSDA approved 13 Handwashing facilities provided,handswashetl,clean; C W0 WA 4 B Food cans in good condition(not dented,rusty,bloated,leaking) C Wholesome/nonadu Iterated 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 0 D Personnel hands washed,clean/Proper handwash procedure ✓ E Handwashing at appropriate times J 3 PotenttafFy hazardous fcad meets temperatrrre r®gtiiroments' C ii�t(A .4: o daring stor g�;"prepara#+on;tllspHiy,sstv€ca and transportdtion Ti Goon hygienic practices C N10 I WA 2 A Hot holding greater than or equal to 140°F. (whole beef/porkroasts 1300 F.) A No eating a No smoking while working B Cold holding less than or equal to 45°F. J B Wounds covered adequately C Proper cooling J C Proper sink used for handwashing D Proper re-heating J 0 E Proper internal cooking/consumer advisory posted 24 °San# z tr+��n it a rho wa f crhe i all) C W0 Wq 2.s 0 A Approved sanifizeravailable/adequate concentration of sanitizer ,4 At# gaate faclFr€cees#°mat!staie,Prc xr ►/(3 B Food-contact surfaces and utensils used for potentially terrtperat�Via rtttc a rs,plroVided' hazardous food sanitized at least every 4 hours s.._- A Food thermometer available and accurate C Adequate Odishwashersanitizer ❑final rinse temp B Proper food thermometer for product J D Proper sanitizF rocedure C Thermometers appropriately placed in cooler units E Sanitizing between raw animal origin&ready-to-eat food 0 0 5 C' W0 N/A 1 �,. �, ,. �.. o prdfe ® nrtitig storage;ptreparat�on,' 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 �J B Raw meats not stored/prepared near ready-to-eat foods 0 ��� - a 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 7 Food--contact surfaces clean F No pooling of eggs not cooked immediately 0 8 Food containers stored off the floor t0 0 9 tltiaaiitli fio ` " ltirieitl° k1 1 1`: ' A No unnecessary handling RTE and/or cooked foods with bare hands A oa I aper towels I prying device available B Dispensers working: IRSoap PPapertowel B Minimize food handling,other than ready-to-eat,with bare hands .J C Handwash sink(s)clean/waste receptacle at handwash sink �f C Adequate utensil(s)for dispensing food/ice J 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 hatdotdepartment? odborne] held at: °F. PHFs are cold held at: °F. Describe illness conditions when you would exclude a food worker Are internal cooking es taken? Y N �To what temperature do you cook: Poultry Grou Pork What diseases related to FB illness are o o report to the l Roasts Other Describe re-heating procedures: Is there a w ss policy that requires the food worker to report specific illness conditions Are temperatures recorded/logged for cold holding foods/equipment? Y N eases 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 N Is there a language ector&QFO? Y N If yes indicate language spoken List products cooled: by QFO/DA: *Can Mwo the inspection report? Y N Describe cooling methods: Indicate who answered the above questions: Name(print): Is cooling monitored fo &temp? Y N Is the monitoring of cooling recorded? Y N Indic 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 th roduce washing policy? Y N *Describe what is washed and inspection: Mere: Note: This report is a two page form(total of 62 debitable items) Page 1 of 2 �E95W sN Vr Establishment: _ -E .; I Inspection Date: -Time: RO[nsp REinslili Address/City: - ?, , '+, ), ( Health Dept: Class: 1 2~341 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/O WA JDNC I KEY: C[complies] N/O[not observed] N/A[not applicable] 3` DNC[does not comply] 0[other] RTE[ready-to-eat] P �° i tYq-1 C WOWA 4 6 rgnatetl A temate '` m 2"' A Food workers have no exposed infected lesions/bums 6 Written docamenta bri of fining program 2 B Personnel with infection restricted 1: Approvedsofrre,xrhOtesome,F►Op8dgltr3terl C°° N/A 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) ow oww C d''' 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 / t D Personnel hands washed,clean/Proper handwash procedure j 0 E Handwashing at appropriate times 0 �.. O r 1t_, _ C, PdQ, N/A A Hot holding greater than or equal to 1400F. (whole beer/pork roasts r3oo F.) A EI No eating El 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 t D Proper re-heating 0 E Proper internal cooking/consumer advisory posted 1} r 2 0 A Approved sanifizeravailable/adequate concentration ofsanitizer B Food-contact surfaces and utensils used for potentiallyMEr Y hazardous food sanitized at least every 4 hours A Food thermometer available and accurate C Adequate ❑dishwashersanitizer ❑final rinse temp D Proper sa itizin B Properfood thermometer for product procedure E Sanitizing between raw animal origin&ready-to-eat food 4; C Thermometers appropriately placed in cooler units 0 0 �m A Cloths and/or sponges in good repair and clean y 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 �J 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 Food containers stored off the floor 0 0 A No unnecessary handling RTE and/or cooked foods with bare hands A -Soap/paper towels P drying device available B Dispenser(s)working: ❑Soap -OPaper 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 foodfice 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] PHF&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 ygu,requireti fo report to the local health department? Roasts Other — Describe re-heating procedures: Is there a written-illrRiss 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 '9rrierbetweeo' s for&QFO? Y N If yes indicate language spoken List products cooled: by QFO/DA: ♦Can th`e-QFOMreed_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 &where: 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 produce washing policy? Y N *Describe what is washed and inspection: Note: This report is a two page form(total of 62 debitable items) Page 1�of 2 Establishment: gown,ts Date of Inspection: ddress: :to),nich (1.'t 5�' 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 -Potentially hazardous foods not re-served -Operating as required No cross connections,back siphonage,backflow 11 Toxic chemicals. 34-Stored properly,labeled properly,used properly Proper t foype/installation/backflow prevention device/air gap -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 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 2 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 6 i Food-contact surfaces designed,constructed,maintained,installed, 45 Floors graded,drained as required located 6 Floor,wall juncture covered 7 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 1 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 premisesfree of litter,no insect/rodent harborage, 28 Equipment/utensils,storage,handling no unnecessary articles 32 Proper disposal of wastewater 56 Complete separation from livingisleeping 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 outine Inspection ❑Reinspection ❑ Preoperational Inspection Other Inspection: INSPECTOR: PERSON IN H Demerit Score: *Include demerits from page 1 lQi'Od� G4— A le(�yl 4 3 2 1 Total Rating signs a &-� C �(Jcp_kk si ure print name print name phone number title ` � SC�C �2 ,ta � DATE CORRECTIONS DUE: qa pRYS .11 Page 2 of 2 plus 1— continuation pages Focused Inspection ll20. • Page 1- of INSPECTION REPORT STATE OF CONNECTICUT FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH CONTINUATION SHEET NAME OF ESTABLISHMENT TOWN DATE OF INSPECTION 8(Z/+we,QA-) o%Arj ds 'SO LA Wind 5bc C a LI G INSPECTION REMARKS FORM# {- .J_�7 EKL \ot' bT I GQ;l Vnckc�rnP, cA oc (-'r i Al . ei5 w14ne sed 1 b�o�Yoow►. nI e%z10r III Icrbwo-vQL$ 1n G�C�vQ,,-+hGA acQ'da. 1. 6 No Q�b l� �FU -�cb-�nin m carp INITIAL(INSPECTOR) INITIAL(PERSON IN CHARGE) Distribution: 1st-White-Health Department 2nd-Yellow-Owner/Manager Page g�r., f -' INSPECTION REPORT STATE OF CONNECTICUT FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH CONTINUATION SHEET N OF ESTABLISHMENT TOWN DATE OF INSPECTION S P tom , DS- l- INSPECTION FORM# REMARKS s `- 1/t�e :7ZZIX 1A&u� _h (M� J Ll INITIAL(INSPECTOR) INITIAL(PERSON IN CHARGE) Distribution: 1st-White-Health Department 2nd-Yellow-Owner/Manager i• • • � � � 1 ' 1 / 1 1 7 • i D • DATE OF • WNINA mAd /1Vr.:�� �. IWEMIN1Pill ml4w"JLmmvd.-7 W- � //� /��,� �,i� WrZ K s Ill mi ! tll - Y �.•�, 1r�..!� 111 Z &=IgMa . =pm. FA WA." MA _i, CIA..I i wlA.--.w-- INITIAL(INSPECTOR) INITIAL(PERSON IN CHARGE) ��i Establishment: I Date of Inspection: 31 ddress: '-' L A..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: -Sanitizerconcentration 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 storagearea/rooms,enclosures-properly constructed,clean 5 Potentially hazardous food properly thawed 41 Garbage/rubbish disposed of in an approved manner,at approved frequency 10 Food dispensing utensils properly stored 42 Vermin Control: No insects/rodents present 14 Food worker:Clean outer clothes,effective hair restraints 43 Outer openings protected against entrance of insects/rodents 4 Floors: Floor covering installed,constructed as required,good repair,clean 6 1 Food-contact surfaces designed,constructed,maintained,installed, 45 Floors graded,drained as required located 6 Floor,wall juncture covered nfood-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 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 7 onfood-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 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 581 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) alodent pproved garbage/rubbish containers,adequate number,covered,proof,cl an outine Inspection E3Reinspection 0 Preoperational Inspection Oth Inspection: M PERSON IN CHARGE: Demerit Score: •Include demerits from page 1 4, -e� ft 4 3 2 1 Total Rating note signature rint name rint name phone number DATE CORRECTIONS DUE: title Page 2 of 2 plus continuation pages Focused Inspection 1/2002 i Establishment: 40, , In pection Date: Time: ins RE[nsp Address/City: AA Health Dept: S.(,J.gyp$ 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 NIO WAD KEY: C[complies] NIO[not observed] NIA[not applicable] 3 DNC[does not comply] 0[other] RTE[ready-to-eat] 2 Written dQcamentattcn of training program 2 q Food workers have no exposed infected lesions I burns B Personnel with infection restricted 1 Approved source,wholesome,nEttEBdtltterdted C N/0 NIA 4 C Communicable disease of worker reported to local health director A Approved shellfish,finfish,meat&poultry USDA approved HandWw;h1Ag fheifties Prov,1&d,harKlswashed,dean' NA4 B Food cans in good condition(not dented,rusty,bloated,leaking) A Handwash facilities in all food prep/dispensing&warewash areas C Wholesome/nonaduIterated foods/safe B Handwash facilities in or immediately adjacent to toilet rooms D Commercial products(no home grown/canned food) 0I C Handwash facilities accessible/convenient to use74— E Potentially hazardous foods received at proper temperature 0 D Personnel hands washed,clean/Proper handwash procedure E Handwashiing at appropriate times �5 A Hot holding greater than or equal to 1400F. (whole beef/pork roasts 130'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 E Proper internal cooking/consumer advisory posted , 0 Approved sanitizes 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 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 RIM, x d_s O tb P0, Cloths and/or sponges in good repair and clean iy` >s B Wiping cloths kept in sanitizes between uses A Produce washed Of 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 0101 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 ..A No unnecessary handling RTE andlorcooked foods with bare hands A Soa per we rying device available B Dispensers)working: ❑Soap ❑Paper towel BMinimize 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 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' ess 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 seases related to FB illness are you required to report to the local health department? Roasts Other Describe re-heating procedures: 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 o 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 coolin 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 w ad and inspection: where: 11 Note: This report is a two page fo total of 62 debitable items) Page 1 of 2 / jo M J Page____of INSPECTION REPORT STATE OF CONNECTICUT FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH CONTINUATION SHEET Z OF ESTABLISHMENT TOWN DATE OF INSPECTION :04.1-1—�W—Z, S CCJ vY•r.�0�, �--�-� �" INSPECTION FORM REMARKS Pj vv t — a uJ v - t e INITIAL(INSPECTOR) (Ayj INITIAL(PERSON IN CHARGE) Distribution: 1st-White-Health Department 2nd-Yellow-Owner/Manager r sa r � •"sP t '% .. ems. s ,_,m_t,a ,_..�..._'_...,..... � Establishment: Z AA Date of Inspection: Address: Z�vhji 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 11 Toxic chemicals. No cross connections,back siphonage,backflow -Stored properly,labeled properly,used properly Proper type/installation/backflow prevention device/air gapffor:-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-propedy 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 ter openings 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, 2r5 Floors graded,drained as required located 6 Floor,wall juncture covered 17 Nonfood-contact surfaces designed,constructed,maintained, 7 Mats removable,good repair,clean 'nstalled,located 18 Single service article=article ensing8 Exterior walking,driving surfaces,good repair,clean 19 Noreuseofsingles 9 alls,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 2 Accurate 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 litter,no insectlrodent 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 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,clean ORoutine Inspection einspection 0 Preoperational Inspection 1. Other Inspection: P PERSON IN CHARGE: Demerit Score: *Include demerits from page 1 4 3 2 1 Total Rating ture signs ure print name print name 1 6 f mGe.>r DATE CORRECTIONS D E: / phone number title Page 2 of 2 plus continuation pages• Focused Inspection 1/2002 Establishment: Inspection Date: Time: RO[nsp RE�61, Address/City: Health Dept: . �i AAKd L 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 NI IA DNC KEY: C[complies] N/O[not observed] NIA[not applicable] $ DNC[does not comply] 0[other] RTE[ready-to-eat] $ _ - A Food workers have no exposed infected lesions/burns B Personnel with infection restricted - _ a _4 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) ,1 _. 00 `'� � A Handwash facilities in all food prep/dispensing&warewash areas 0000 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 70e 0 D Personnel hands washed,clean/Proper handwash procedure E Handwashing at appropriate times o r A Hot holding greater than or equal to 140 F. (whole beef/pork roasts 1300 F.) A El 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 E Proper internal cooking/consumer advisory posted 0 Approved sanitizeravailable/adequate concentration ofsanitizer WWI g 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 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 C Food covered properly Food equipment clean,utensils clean,equipment interiors clean D Adequate splash guards/sneeze guard 01 ZB 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 A No unnecessary handling RTE and/or cooked foods with bare hands 4 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 sinks)clean/waste receptacle at handwash sink rl C Adequate utensil(s)fordispensing food/ice 0 0 1 4_� •DESCRIBE DEFICIENCIES ON CONTINUATION SHEETS The following information is not debitable and does not affect your score. JIM: QFO[qualified food operator],DA[designated altemate],PHF[potentially hazardous food],FB[foodbome] PHFs are hot held at: IF. PHFs are cold held at: OF. Describe illness conditions when you would exclude a food worker from working: Are internal cooking temperatures taken? Y N *To what temperature do you cook: Poultry Ground Beef Pork What diseases related to FB illness are you required to report to the local health department? Roasts Other Describe re-heating procedures: Is there a written illness requires the food worker to report specific illness conditions Are temperatures recorded/logged for cold holding foods/equipment? Y N and diseases 0? 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 re a language barrier between inspector&QFO? Y N Ifs 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 mo ' ng 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 escribe what is washed and inspection: where: Note: This report is a two page form(total of 62 debitable items) Page 1 of 2 4 • Page_of INSPECTION REPORT STATE OF CONNECTICUT FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH CONTINUATION SHEET NAME OF ESTABLISHMENT TOWN -SL-.,,°}4.4 S-t-m•a DATE OF INSPECTION 93� '��U Y��+w�Ss S S��i lad L.� ,r.�31 Z"/Z Impectm Form M Ren ub: T"a �� S-ova-P �-•. `-Ib t, ��s `� 3 �'� C���-•s �Esc��� ,to+, t n� `�--s�rz� `v" S� avJ� yc�sct_ ati` �c `��.s�n-.�t.� e Z$ 2.lo C.�f�.I S?O 2.�� °cs �° ���2 i a.l c�lL-•�-+,.sue� E C L- aNs t I'S s I hS gtilL 1 �\,_1 C-Cq �7 C.t nt it t t), Z� l 5� �n/�Cle1.S1) t��� �.Vj1C>.. r� S i N I N LM�tZF1^� N�� F► J 2t-,rv— S t C'C t43j tv.. t S.<-k `i 0 Lb, U r'2 Mr: t S re !.� �-� s •� �' S3�.e Ae.�, 'i�c t`roS" �2,�-�*v s Lj �I 2 � fz v eve�G �z4�,.t, �. ,sue ip '�. G ,•.-,a `�, 2 7 f"-� 222C 1'— S IIt' U ht A L-j 4 A4- 'HoSs 3 >g A� �� S ,�., I t s i�J �3�t v (1.�,.r` INITIAL(INSPECTOR) M INITIAL(PERSON IN CHARGE) Distribution: Ist-White-Health Department 2nd-Yellow-Owner/Manager c:butVnsfbm2.cn Establishment= ` '*3 �+•x Date of Inspection: ddress: Owner or Operator: 13o ADDITIONAL FOUR POINT ITEMS KEY: DNC [DOES NOT COMPLY] 6 Foods not re-served. 31 Sewage disposal approved. -Unwrapped foods not re-served erating as required -Potentially hazardous foods not re-served 11 Toxic chemicals. o ross connections,back siphonage,backflow -Stored properly,labeled properly,used properly roper type/installation/backflow prevention device/air gap for: -Sanitizer concentration not to exceed maximum permitted -Food equipment Jiose 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,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 Doors: 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 Angle service articles,storage,dispensing 19 No reuse of single service article alls,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 �P� `, 53 Rooms&equipment hoods,ducts,vented as required 23>ccurate thermometers provided,dish basket,if used S 54 Rooms adequate,clean,adequate lockers provided,facilities clean onfood-contact surfaces of utensils&equipment clean 55 Establishment and premises free of litter,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 lumbing 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 PRoutine Inspection ❑Reinspection ❑ Preoperational Inspection 'Other Inspection: INSPECTOR:/�� PERSON IN CHARGE: Demerit Score: *Include demerits from page 1 /�, 4 3 i�do 1 Total Rating signature signature �U U(.Ar,�1 JA print name print name L &;,q Y- 2§ t t X 2�!� DATE CORRECTIONS DUE: 4_ phone number title 1(0Q: �s 17U Page 2 of 2 plus # continuation pages Focused Inspection l/2002 i Establishment: a Inspection Date: f2 z2 ft Time: + REinsp Address/City: ,ow.ws FA'r-..4 %wa Health Dept: L-->, -,{s`,t,rt Class; 1 2 3 a 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 ; C[complies] N/0[not observed] NIA[not applicable] 3 DNC[does not comply] 0[other] RTE[ready-to-eat] t Food workers have no exposed infected lesions I burns a. Personnel with infection restricted 1!!p ! �' : ' - Communicable disease of worker reported to local health director A Approved shellfish,flnfish,meat&poultry USDA approved B Food cans in good condition(not dented,rusty,blo ted,leaking) Handwash facilities in all food prep/dispensing&warewash areas holesome/nonadulterated foods/safe ! T1#j t�k 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 v-.b r­&h.s w 44 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 O Tz- 4'.J­f.Jr E Proper internal cooking/consumer advisory posted 1000, Q_L 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 D Proper sanitizin procedure ,� 4a� ` B Properfood thermometer for product 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 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 Food equipment clean,utensils clean,equipment interiors clean D Adequate splash guards/sneeze guard g Single use gloves changed when soiled E No unauthorized personnel C Food--contact surfaces clean F No pooling of eggs not cooked immediately 0 8 Food containers stored off the floor 0 A No unnecessary handling RTE and/or cooked foods with bare hands A Soap I 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 I waste receptacle at handwash sink C Adequate utensil(s)for dispensing food/ice 0 O 1 1 •DESCRIBE DEFICIENCIES ON CONTINUATION SHEETS The following information is not debitable and does not affect your score. _M: QFO[qualified food operator],DA[designated alternate],PHF[potentially,hazardous food],FB[foodbome] PHFs are hot held at: OF. PHFs are cold held at: OF. Describe illness conditions when you would exclude a food worker from working: Are internal cooking temperatures taken? Y N *To what temperature do you cook: Poultry Ground Beef Pork What diseases related to FB illness are you required to report to the local health department? Roasts Other Describe re-heating procedures: Is there a written illness policy that requires the food worker to report specific illness conditions Are temperatures recorded/logged for cold holding foods/equipment? Y N and diseases to the QFO? Y N *Do you have a paid sick leave policy? Y N Are foods cooked in advance and cooled? Y N *Are leftovers saved? Y N Is there a language barrier between inspector&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 J ••• iI I • J. I U. is • i o • DATE OF • 141, �W—m—W�a WAffA#-,/-A WAM ® i '_ Wuz &ffirvi w- ,Now0l, W WE WWI- WIN M—RAM I_ _ �. FAAF WPM KIM M �. : r MIR Wd X TAM r1A ME I MMJA d I IT,1 0 W Z'Al 91 Ml A AME AM I M J F K W—Q OAF INITIAL(INSPECTOR) INITIAL(P&SON IN CHARGE) Page 7,6f INSPECTION REPORT STATE OF CONNECTICUT FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH CONTINUATION SHEET NAME O EST LIS TO DATE OF INSPECTION 3� �76(f ImpecUon Form# Remarks: s a INITIAL(INSPECTOR) INITIAL(PERSON IN CHARGE) Distribution: Ist-White-Health Department 2nd-Yellow-Owner/Manager c:4endnsfortn2.crt Establishment: Date of Inspection: �7 ddress: 29 Water source adequate,safe. 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 4„ -Potentially hazardous foods not re-served -Operating as required 11 Toxic chemicals. 74 No cross connections,back siphonage,backflow -Stored properly,labeled properly,used properly Proper type/installation/backflow prevention device/air glop 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 94 Proper drain for: -Food equipment -Dish machines -Ice machines -Well/well head protected from contamination Idesig ilet facilities. Adequate,convenient,accessible, -Water quality in compliance-Monitoring in compliance ned,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 otentially 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 ood 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 PN 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 1 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 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 premisesfree of litter,no insect/rodent harborage, Equipment/utensils,storage,handling no unnecessary articles 32 Proper disposal of waste water Complete separation from living/sleeping quarters and laundry 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 Propertoiletfixturesprpvided,good repair,clean entrance(s),smoking area indicated by sign(s) 39 Approved garbage/rubbish containers,adequate number,covered, rodent proof,cyan I INO—wine Inspection OReinspection 0 Preoperational Inspection Other nspection: PERSON IN CHARGE: Demerit Score: *Include demerits from page 1 4 3 2 1 Total Rating ur signature' L v4- �' 1 P.rint naipe ( print name Z /_V_C�'el ' 1'7 �'`� �`- DATE CORRECTIONS DUE: phone number title JJPage 2 of 2 plus continuation pages Focused Inspection 1/2002 i Establishment: Inspection Date: — Time: R [ REinsp Address/City: Health Dept: S.CZ /f4 StSL Class: 1 z 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 DNC I KEY: C[complies] N/O[not observed] NIA[not applicable] S DNC[does not comply] 0[other] RTE[ready-to-eat] �.., am, z F rs e. s ,��E 1 X( 4 69 Ytt t a doculllte boil of trofning program 2 A Food workers have no exposed infected lesions I burns B Personnel with infection restricted 1 ApproYpd source,tNtfoTesorrte,n aedt erated C N10 N/A 4 C Communicable disease of worker reported to local health director A Approved shellfish,finfish,meat&poultry USDA approved 13 yandwa6hingfuellftles provided,handsw0sW,elean C IWO NIA 4 i 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 I Potentially hazardous foods received at proper temperature D Personnel hands washed,clean/Proper handwash procedure O E Handwashing at appropriate times _ A Hot holding greater than or equal to 1400F. (whole beef/pork roasts 1300 F) ❑ 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 E Proper internal cooking/consumer advisory posted A Approved sanitizeravailable/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 D Proper sanitizin procedure B Proper food thermometer for product E Sanitizing between raw animal origin&ready-to-eat food C Thermometers appropriately placed in cooler units OEM= ow ,=� t I Cloths and/or sponges in good repair and clean m 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 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 Food--contact surfaces clean No pooling of eggs not cooked immediately 0 8 Food containers stored off the floor L BMW FIRM"WIN WIM A No unnecessary handling RTE and/or cooked foods with bare hands Soap/paper towels I drying device availableB 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)fordispensing food/ice p 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: F. 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 illnes at requires the food worker to report specific illness conditions Are temperatures recorded/logged for cold holding foods/equipment? Y N and diseases 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 I e a language barrier between inspector&QFO? Y N tf-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 monitorin oolong 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 ♦De what is washed and inspection: where: N/ twote: This repo is a page f (tot o 62 debitable items) Page 1 of 2 t i • e • DATE OF • WE ,: - All WA-, PV M I=WA 0-; MUMIM W a�91 P—v Ar Am a ffo AIMS 950o-AW—ff tra-'4r.��wdO, MMIA .�_' !/l�� PA I M I WIA KIM, "PA PRA-1 I �. >i_,L V�m IN I aw- I I 'M, �r 1.1 I i I"AM-2 NOW W-94TWINIMM R"Wr i Establishment: A Date of Inspection: 1f ` ddress: Owner or Operator: ADDITIONAL FOUR POINT ITEMS KEY: DNC [DOES NOT COMPLY] ' 6 Foods not re-served. -Unwrapped foods not re-served 4 31 Sewage disposal approved. 4 -Potentially hazardous foods not re-served -Operating as required 11 Toxic chemicals. No cross connections,back siphonage,backflow 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-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 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 loors: Floor covering installed,constructed as required,good repair,clean 16 Food-contactsurfaces designed,constructed,maintained,installed, 5 Floors graded,drained as required located 6 Floor,wall juncture covered Nonfood-contact surfaces designed,constructed,maintained, 471 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 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 1 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 litter,no insect/rodent harborage, 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 Seats 75 or more:Nonsmoking area provided,sign(s)posted at 37 Propertoiletfixturesprovided,good repair,clean entrance(s),smoking area indicated by sign(s) 39 Approved garbage/rubbish containers,adequate number,covered, rodent proof,clean E3Routine Inspectio Reinspection 0 Preoperational Inspection R PERSON IN CHARGE: Other Inspection: Demerit Score: •Include demerits from page 1 0a; LJ41 4 3 2 1 Total Rating `iJ/ -sighattyl prin am ^ � � print name l� �s p one number title DATE CORRECTIONS DUE: k Page 2 of 2 plus continuation pages Focused Inspection 1/2002 Establishment: Inspection Date: Time: ROins Einsp Address/City: Health Dept: �' td/hf b,$�_ Class: 1 2 4 Based on an inspection this day,the items marked DNC id ntify the viola'ons 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/A DNC �; C[complies] NIO[not observed] NIA[not applicable] $ DNC[does not comply] 0[other] RTE[ready-to-eat] Vir'i h f Kf 6&M 1 fi 6V 7TV r� 4 A Food workers have no exposed infected lesions I burns +343BBtt of trafirfgrogl , - 2 B Personnel with infection restricted 1f0YBdSpt 'NF1o4Spt4!'= 1< 1U)8rfed C N/Q C Communicable disease of worker reported to local health director A Approved shellfish,finfish,meat&poultry USDA approved 13, Hafll WMhirng facttftfes'pr6dded,-hmowtstted,than C 4 [IA 4 B Food cans in good condition(not dented,rusty,bloated,leaking) A Handwash facilities in all food prep/dispensing&warewash areas C Wholesome/nonaduIterated foods/safe B Handwash facilities in or immediately adjacent to toilet rooms D Commercial products(no home grown/canned food) L.00 C Handwash facilities access iblelconvenlent to use E Potentially hazardous foods received at proper temperature D Personnel hands washed,clean/Proper handwash procedure 0 E Handwashing at appropriate times 00, A Hot holding greater than or equal to 1400F. (whole beef/pork roasts 1300 F.) 01 A ❑ No eating ❑ No smoking while working B Cold holding less than or equal to 450 F. B Wounds covered adequately C Proper cooling Proper sink used for handwashing D Proper re-heating E Proper internal cooking I consumer advisory posted proved sanitizer available/adequate concentration of sanitizer 00, ood-contact surfaces and utensils used for potentially 000l azardous food sanitized at least every 4 hours A Food thermometer available and accurate C Adequate ❑dish was hersanitizer ❑final rinse temp in B Proper food thermometer for product Pro ersanitiz rocedure C Thermometers appropriately placed in cooler units E Sanitizing between raw animal origin&ready-to-eat food 0 - IF A Cloths and/or sponges in good repair and clean B A Produce washed Wiping cloths kept in sanitizer between uses Q. B Raw meats not stored/prepared near ready-to-eat foods V/OF Mill) C Food covered properly Food equipment clean,utensils clean,equipment interiors clean Adequate splash guards/sneeze guard Single use gloves changed when soiled No unauthorized personnel C Food contact surfaces clean F No pooling of eggs not cooked immediately 8 Food containers stored off the floor 0 rtcS Q NV� 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 I 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 altemate],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 K-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 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 i.0 AJd_7_1k11_ •• � I • I i am • DATE OF • / f / RrMo .!l y AmFj 7.-WA VA I A M N _ I` Fo a W. —W,702 WIRM is FF4 p/i,r-"M 11:4 WAM.—4 �TAOW pavo-01-105 MAV •, ON N�_�.� INITIAL ' � � INITIAL(PERSON IN CHARGE) DATE OF INSPECTION -/W-�, -mf ter :, MID � MA ,MR.M W.1 M wl%=�L' r► %' �.�_ � ��1�w L It _'' ./'_. �� rMANA " WMV Elf I kwjj B2 WAW- • L. M, INITIAL(PERS(61 IN CHARGE) Establishment: Inspection Date: d Time: ____(1To5i­ns0 REinsp ddress/City: Health Dept: S, l.4)1)UdQ56 Z— cars: 1 2 3 a 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. FACTOR ITEMS:Listing is not inclusive of all possible debitable items C N/0 N/A DN KEY: C[complies] N/O[not observed] N/A[not applicable] DNC[does not comply] 0[other] RTE[ready-to-eat] ssn a � '4 Wtan dot utt�atatrob of tratnin�}�ragrartt A Food workers have no exposed infected lesions I burns B Personnel with infection restricted Aflp�rved a0 ;1M�014S4t>L,>tOt3lttte �edNIA C Communicable disease of worker reported to local health director A Approved shellfish,finfish,meat&poultry USDA approved 13 Nariciwashing facia f"pro�c�i hands ShW,d c a 4 B Food cans in good condition(not dented,rusty,bloated,leaking) 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 7, Personnel hands washed,clean/Proper handwash procedure E Handwashing at appropriate times MINOR I F;,144 ---------- A Hot holding greater than or equal to 1400F. (whole beefloork roasts 1300 e) ❑ No eating ❑ No smoking while working Cold holding less than or equal to 451F. Wounds covered adequately Proper cooling C Proper sink used for handwashing tDE Proper re-heating Proper internal cooking/consumer advisory posted Approved sanitizeravailable/adequate concentration of sanitizer Food-contact surfaces and utensils used for potentially 00, hazardous food sanitized at least every 4 hours 0000 Food thermometer available and accurate W Adequate ❑dishwashersanitizer ❑final rinse temp BM D Pro ersanitizin 001 Proper food thermometer for product procedure C Thermometers appropriately placed in cooler units E Sanitizing between raw animal origin&ready-to-eat food 3 Rp Cloths and/or sponges in good repair and clean MY 19F Lood ce washed Wiping cloths kept in sanitizer between uses ats not stored/prepared near ready-to eatfoods overed properly Food equipment clean,utensils clean,equipment interiors clean te splash guards/sneeze guard Single use gloves changed when soiled uthorized personnel C Food--contact surfaces clean ing of eggs not cooked immediately ntainers stored off the floor all 3`` *� " 'VMT PROMP- A Soap/paper towels/ drying device available _A 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 01 O 1 •DESCRIBE DEFICIENCIES ON CONTINUATION SHEETS The following information is not debitable and does not affect your score. JKII QFO[qualified food operator],DA[designated alternate],PHF[potentially hazardous food],FB[foodborne] PHFs are hot held at: IF. I 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):CFO 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 [where: there a produce washing policy? Y N *Describe what is washed and inspection: Note: This report is a two page form(total of 62 debitable items) Page 1 of 2 =Mo Establishment: Date of Inspection: W,,') Address: 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 -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 -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 fSources of food:Original container,properly labeled 40 Garbage/rubbish storage arealrooms,enclosures-propedy constructed,dean 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 6 1 od-contact surfaces designed,constructed,maintained,installed, 5 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 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 propedy 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 onfood-contact surfaces of utensils&equipment clean 55 Establishment and premises free of litter,no insect/rodent harborage, uipment/utensils,storage,handling no unnecessary articles 2 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 fixtures provided,good repair,clean entrance(s),smoking area indicated by sign(s) 39 Approved garbage/rubbish containers,adequate number,covered, rodent proof,clean outine Inspection ❑Reinspection ❑ Preoperational Inspection IN PERSON IN CHARGE: Other Inspection: Demerit Score: *Include demerits from page 1 4 3 2 1 Totaf Rating to signatu print name, riot name 71 L(or Zy- DATE CORRECTIONS DUE:phone number r.—M. title Page 2 of 2 plus continuation pages Focused Inspection I/2002 t, Establishment: WDate of Inspection: 2 0 ,i� Address: t 9 7® 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. Proper type/installation/backflow prevention device/air gap for: -Stored properly,labeled properly,used properly-Sanitizer concentration not to exceed maximum permitted -Food equipment -Hose connections -Dish machines-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 Toiletfacilities. 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,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 4 F od worker:Clean outer clothes,effective hair restraints 43 Outeropenings protected againstentrance of insects/rodents 4 oors: 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 Ingle 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 less cleaning methods used,cleaning equipment properly stored Equipment&Utensils; Cleanliness I A uate 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 541 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, 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 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 1 Approved garbage/rubbish containers,adequate number,covered, rodent proof,clean outine Inspection ❑Reinspection ❑ Preoperational Inspection Oth Inspection: IN PE PERSON IN CHARGE: Demerit Score: *Include demerits from page 1 4 3 2 1 Total Rating sign u e ature, Sv�1.1 NL A r&621 (1GL ( — l Gr print name p' t nam_e ', n ,, �4 _ (.O b i��— 2 S l UtX A DATE CORRECTIONS DUE: -"Z. —0 phone number title Page 2 of 2 plus continuation pages Focused Inspection 112002 Page of INSPECTION REPORT STATE OF CONNECTICUT FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH CONTINUATION SHEET NAME OF ESTABLISHMENT TOWN , ;'i t L-rt DATE OF INSPE TION Z Zj Ob INSPECTION FORM# REMARKS �+�r2+vwM T-0 Ij au coax Ltfcc T%4A ,.+ s ui` Z S Vj 7 P!N L G5 -t-b r�'l� v iYIJS t l S 7b i3 l,M 6 l-i-�a,�b W vvv— -M 1pa-S,rcz-r 1`( v-kf-�nrt- tAj I t"� A k ty�✓1 ��is � ;,� ►�� ��2 �f�,+�,N� INITIAL(INSPECTOR) ),:f>V^, INITIAL(PERSON IN CHARGE) Distribution: 1st-White-Health Department 2nd-Yellow-Owner/Manager i Establishment: U Inspection Date: Time:4=�(RO[nsp) REinsp Address/City: Health Dept: rVA v31-rt�C,.32 Class: 1 2 kE 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/A DNCI KEY: C[complies] N/O[not observed] NIA[not applicable] ;6© �( Re sae `ref �� i# 3 DNC[does not comply] 0[other] RTE[ready-to-eat] 61 Designated Alternate z 12Ftersongl`i�iif l' isCtisit"re3treted G NIA 4 62 Written docuimentation'of training program 2 A Food workers have no exposed infected lesions I burns ol B Personnel with infection restricted 1 Approved source,wholesome,n©nadulterated C N/0 NIA 4' C Communicable disease of worker reported to local health director A Approved shellfish,finfish,meat&poultry USDA approved 13 Mandwashing facilities provided,hands washed,clean C WO 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/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 Pn�ty � tie diplsysdfit stand tstta tos `r�� #43 09 O#� 1 7't N10 141A 2 A Hot holding greater than or equal to 1400F. (whoiebeefiporkroasts 1300F.) A ❑ No eating ❑ No smoking while working B Cold holding less than or equal to450F. el 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 ' rat rrt; grslG �N1Ct N!A 2 A Approved sanitize ravailable/adequate con centrationofsanitizer a fac a �txaarrdai ptOetakw Q B Food contact surfaces and utensils used for potentially r HraxE inxdlhtcrvtd keffl hazardous food sanitized at least every 4 hours ` A Food thermometer available and accurate C Adequate ❑dishwashersanitizer ❑final rinse temp D Proper sanitizin B Proper food thermometer for product procedure C Thermometers appropriately placed in cooler units E Sanitizing between raw animal origin&ready-to-eat food display,service and transportation -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 -20 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 0 ooling of eggs not cooked immediately 0 8 Footl ontainers stored off the floor 0 "wow �. iU a .��. A Soap/paper ..max _�.�,�... .,.. "_. �� A No unnecessary handling RTE and/or cooked foods with bare hands p p r towels drying device available B Dispenser(s)working: ❑Soap ❑Paper towel B Minimize food handling,other than ready-to-eat,with bare hands o7 C Handwash sink(s)clean/waste receptacle at handwash sink C Adequate utensil(s)for dispensing food/ice 010 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] 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 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 CFO/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: Note: This report is a two page form(total of 62 debitable items) Page 1 of 2 EHS-106-Rev.06/01 INSPECTION REPORT STATE OF CONNECTICUT ZJA�TINE INSPECTION ❑ REINSPECTION FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH ❑ PREOPERATIONAL ❑ OTHER 410 Capitol Avenue,MS#51 FDP,Hartford,CT 06134 NAME OF ESTABLISHMENT ESTABLISHMENT -e,4 CA—Ft!a0.. CLASS STREET /l TOWN ff ADDRESS 0`/,(_, �� Li/c f&�' t ic4av' OWNER or INSPECTION OPERATOR DATE and TIME —a 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& 1 45 Floors,graded,drained as required 1 equipment clean 46 Floor,wall juncture covered 4 Adequate facilities to maintain product 2 28 1 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 Food protected during storage,preparation, 30 Hot and cold water under pressure, 2 constructed,good repair,clean. Wall&ceiling display,service&transportation provided as required surfaces as required. 8 Food containers stored off floor L Dustless cleaning methods used, 1 SEWAGE DISPOSAL cleaning equipment properly stored 9 Handling of food minimized 2 73ilq Sewage disposal approved 4 10 Food dispensing utensils properly stored 1 32 1 Proper disposal of waste water 1 LIGHTING&VENTILATION 11 Toxic items properly stored,labeled,used 4 51 Adequate lighting provided as required 1 PLUMBING 52 1 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 1 No cross connection,back siphonage,backflow 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 ersonnel hands washed clean installed 14 Clean outer clothes,effective hair restraints 1 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 1 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 GARBAGE/RUBBISH STORAGE&DISPOSAL (except guide dogs) 18 Single service articles,storage,dispensing 2 39 1 Approved containers,adequate number, 1 19 No reuse of single service article covered,rodent proof,clean NONSMOKING AREAS 0 Dishwashing facilities approved design,adequately J 40 Storage area/rooms,enclosures— 59 Seats 75 or more:Nonsmoking area provided, 3 constructed,maintained,installed,located properly constructed,clean sign(s)posted at entrance(s),smoking a 2 reaa 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 2 / 1 RISK FACTOR VIOLATIONS IN RED 61 Designated alternate 2 62 Written documentation of training program 2 Sign ure of Person in charge 4 ., TOTAL RATING Date Corrections Due (pl/L AZ of Jfim q 4j SIGNED(Inspector) .19A 4� Ro Aa�e DESCRIBE DEFICIENCIES ON cWrINUATION SHEETS Page_of_ INSPECTION REPORT STATE OF CONNECTICUT FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH CONTINUATION SHEET NAME OF ESTABLISHMENT TOWN DATE OF INSPECTION Impeam Fonn M Remarks: i INITIAL(INSPECTOR) INITIAL(PERSON IN CHARGE) Distribution: 1st-White-Health Department 2nd-Yellow-Owner/Manager cacentinsfonm2.cn