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HomeMy WebLinkAboutFood Service Establishment Inspection 95 ` Establishment: wnd G Loun Inspection Date: o pq Time: ROinsp REinsp ddress/City: �{$N $�Ilivo,n Avg Health Dept: So�7H Wrrypso(Z 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 N/A NCI KEY: C[complies] N/0[not observed] N/A[not applicable] DNC[does not comply] 0[other] RTE[ready-to-eat] A Food workers have no exposed infected lesions/burns ✓ 2 B Personnel with infection restricted r C Communicable disease of worker reported to local health director A Approved shellfish,finfish,meat&poultry USDA approved J B Food cans in good condition(not dented,rusty,bloated,leaking) Nam C Wholesome/nonadulterated foods/safe J A Handwash facilities in all food prep/dispensing&warewash�areas D Commercial products(no home grown/canned food) J B Handwash facilities in or immediately adjacent to toilet rooms o/ C Handwash facilities accessible/convenient to use E Potentially hazardous foods received at proper temperature 0 D Personnel hands washed,clean/Proper handwash procedure J E Handwashing at appropriate times 0 A Hot holding greater than or equal to 140°F. (whole beer/pork roasts i�o°F) J A No eating No smoking while working B Cold holding less than or equal to 45°F. B Wounds covered adequately C Proper cooling I j I IC Proper sink used for handwashing D Proper re-heating 0 E Proper internal cooking/consumer advisory posted 0 1 A Approved sanitizer available/adequate concentration of sanitizer B Food-contact surfaces and utensils used for potentially hazardous food sanitized at least every 4 hours J A Food thermometer available and accurate ✓ C Adequate ❑dishwashersanitizer ❑final rinse temp J B Properfood thermometer for product D Proper sanitizin rocedure C Thermometers appropriately placed in cooler units E Sanitizing between raw animal origin&ready-to-eat food 0 1 O A Cloths andlor sponges in good repair and clean A Produce washed f B Wiping cloths kept in sanitizer between uses B Raw meats not stored/prepared near ready-to-eat foods f 0 C Food covered properly A Food equipment clean,utensils clean,equipment interiors clean SD Adequate splash guards/sneeze guard B Single use gloves changed when soiled No unauthorized personnel Q C Food--contact surfaces clean F No pooling of eggs not cooked immediately 0 8 Food containers stored off the floor 0 IN min 11 A No unnecessary handling RTE and/or cooked foods with bare hands A Soa paper towels drying device available `� B Dispensers)working: KSoap tPaper towel B Minimize food handling,other than ready-to-eat,with bare hands J C Handwash sink(s)clean I 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. KKEY: QFO[qualified food operator],DA[designated alternate],PHF[potentially hazardous food],FB[foodbome] PHFs of held at: IF. PHFs are cold held at: OF. Describe illness conditions when you would exclude a food worker from working: Are internal c3althvamperatures taken? Y N *To what temperature do you cook: Poultry and Beef Pork What diseases related to FB illness are you required to repo ocal health department? Roasts Describe re-heating procedures: Is there a written illness policy that a food worker to report specific illness conditions Are temperatures recorded/logged for cold holding foods/equipmen. N and diseases to the ♦Do you have a paid sick leave policy? Y N Are foods cooked in advance and cooled? Y N *Are leftovers saved? Y N a language barrier between inspector&QFO? Y N flues indicate language spoken List products cooled: by *Can the QFO/DA read the inspection report? Y N Describe cooling methods: Indicate who answered the uestions:Name(print): Is cooling monitored for time Y N Is the monitoring of cooling recorded? Y N Indicate the title of above person(circle a ply):QFO DA Mgr Cook Owner FW *Obtain signature of the person who received the Q onsibilities information at the time of the Is there a ce washing policy? Y N *Describe what is washed and inspection: Note: This report is a two page form(total of 62 debitable items) Page 1 of 2 i Establishment: 6 mn d G L aL4 n� Date of Inspection: Address: 5L4 Sui VII, Avg 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 Pwperrtype/installation/backfow prevention device/air gapfor: -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-Water quality in compliance Toilet facilities. Adequate,convenient,accessible, -Monitoring in compliance designed,properly installed OTHER ITEMS KEY: DNC [DOES NOT COMPLY] Sources of food:Original container,properly labeled 40 Garbage/rubbish storage area/rooms,enclosures-properly constructed,clean 5 Potentially hazardous food properly thawed 41 Garbage/rubbish disposed of in an approved manner,at approved frequency 10 Food dispensing utensils properly stored 42 Vermin Control: No insects/rodents present 14 Food worker:Clean outer clothes,effective hair restraints 43 Outer openings protected against entrance of insects/rodents 4 Floors: Floor covering installed,constructed as required,good repair,clean 16 Food-contact surfaces designed,constructed,maintained,installed, 5 Floors graded,drained as required located 1 Nonfood-contact surfaces designed,constructed,maintained, 6 Floor,wall juncture covered installed,located 7 Mats removable,good repair,clean 18 Single service articles,storage,dispensing 8 Exterior walking,driving surfaces,good repair,clean 19 No reuse of single service article 49 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 Equipm nt&Utensils: CI anlin 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 531 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 lifter,no insect/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) 37 Propertoilet fixtures provided,good repair,clean 59 Seats 75 or more:Nonsmoking area provided,sign(s)posted at entrance(s),smoking area indicated by sign(s) 39 Approved garbage/rubbish containers,adequate number,covered, rodent proof,clean gkoutine Inspection ❑Reinspection ❑ Preoperational Inspection INSPECTOR: PERSON IN CHARGE., Other Inspection: Qb_ .� Demerit Score: *Include demerits from page 1 4 3 2 1 Total Rating signatureq3&C-, L_Aov�A- L,7S_c-At,-yv� signature print nar q q—Rs2 print name 9 �� 3 ((�, phone number title DATE CORRECTIONS DUE: Tiny W�1EkS Page 2 of 2 plus--I—continuation pages Focused Inspection 1/2002 Page 2 of INSPECTION REPORT STATE OF CONNECTICUT FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH CONTINUATION SHEET NAME OF ESTABLIIS�HMENT TOWN C J DATE OF INSPEC/T�ION BAnol lJ- L 0An e� �) oVt7 vV 1n��� 10 INSPECTION FORM# REMARKS 1 1 `�D ��t?✓rr�oh Pic In (sh Cicst� � 'jfre1ZeC_ U-71 CAI e e.c5 6z bon-co M(b0cc`" '.,3 u ho� ww� H u or 10.aPlc wEJs 1,7 O r+w.r��✓a6��„ �^/CI'n act , All 5 e, ni7 4); 6V)oLN i•�,)� Ca Ned \t, 7 k AJ n Te b-,C N[b Q�_O o e A . Q� 5A--51 1 ASP INITIAL(INSPECTOR) INITIAL(PERSON IN CHARGE) Distribution: 1 st-White-Health Department 2nd-Yellow-Owner/Manager Page of INSPECTION REPORT STATE OF CONNECTICUT FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH CONTINUATION SHEET NAME OF ESTABLISHMENT TOWN DATE OF INSPECTION -t INSPECTION FORM# REMARKS (o to 600Z/6I/9 S - ,"TO)0, r 7-re. rh�1�f IYt S • Gt � �,lcL . fee- INITIAL(INSPECTOR) 7 INITIAL(PERSON IN CHARGE) Distribution: 1st-White-Health Department 2nd-Yellow-Owner/Manager Page 2-of 2- INSPECTION REPORT STATE OF CONNECTICUT FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH CONTINUATION SHEET NAM OF ESTABLIS MENT TOWN DATE OF INSPECT.-IOONfa �� INSPECTION REMARKS FORM# 1 aLA vo INITIAL(INSPECTOR) INITIAL PERSON IN CHARGE Distribution: 1 st-White-Health Department 2nd-Yellow-Owner/Mager t v Establishment: Date of Inspection: Address: 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 ., -Operating as required -Potentially hazardous foods not re-served To c chemicals. No cross connections,back siphonage,backflow -Stored properly,labeled properly,used properly Proper type/installation/backflow prevention device/air gap for: -Sanitizer concentration not to exceed maximum permitted -Food equipment -Hose connections -Dish machines -No unnecessary toxics on the premises -Soda system carbonator -Beverage dispensers -Toilet tanks -Pesticides/rodenticides properly dispensed -Chemical dispensers -Ice machines Proper drain for: 29 Water source adequate,safe. -Food equipment -Dish machines -Ice machines -Well/well head protected from contamination 35 Toilet facilities. Adequate,convenient,accessible, -Water quality in compliance designed,properly installed -Monitoring in compliance OTHER ITEMS KEY: DNC [DOES NOT COMPLY] 2 Sources of food: Original container,properly labeled 40 Garbage/rubbish storagearea/rooms,enclosures-properly constructed,clean 5 Potentially hazardous food properly thawed 41 Garbage/rubbish disposed of in an approved manner,at approved frequency ood dispensing utensils properly stored 42 Vermin Control: No insects/rodents present 4 F od 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 F d-contact surfaces designed,constructed, maintained,install 45 Floors graded,drained as required located 6 loor,wall juncture covered Nonfood-contact surfaces designed,constructed,maintained, 7 Mats removable,good repair,clean installed,located 18 Single service articles,storage,dispensing 8 Exterior walking,driving surfaces,good repair,clean 19 No reuse of single service article IM Zils,ceilings attached,equipment properly constructed,good ishwashing facilities approved design,adequately constructed, air,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 ooms&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 5 tablishment and premises free of litter,no insect/rodent harborage, Equipment/utensils,stomge,handling no unnecessary articles 32 Proper disposal of wastewater 56 Complete separation from living/sleeping quarters and laundry 33 Plumbing location,installation,maintenance 57 Clean/soiled linens stored properly 58 No live birds,turtles,or other animals(except guide dogs) 6 oilet rooms enclosed with self-closing door 59 Seats 75 or more:Nonsmoking area provided,sign(s)posted at 7 Proper toilet fixtures provided,good repair,clean entrance(s),smoking area indicated by sign(s) 39 Approved garbage/rubbish containers,adequate number,covered, ON rodent proof,lean NPRoutine Inspection ❑Reinspection ❑ Preoperational Inspection IIMSON IN CHAR9E. rDtfteHnspection: Demerit Score: *Include demerits from page 1 4 3 2 1 Total Rating st url, tg ature print name print name pho a number title nOJQ__f DATE CORRECTIONS UE: O Page 2 of 2 plus continuation pages Focused Inspection 1/2002 i Establishment: Inspection Date: /�5 t2r Time: Roinsp REinsp Address/City: Health Dept: class: 2 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 NIO N/A DNC KEY: C[complies] NIO[not observed] NIA[not applicable] DNC[does not comply] 0[other] RTE[ready-to-eat] A Food workers have no exposed infected lesions I burns B Personnel with infection restricted C Communicable disease of worker reported to local health director A Approved shellfish,finfish,meat&poultry USDA approved B Food Cans in good Condition(not dented,rusty,bloated,leaking) Handwash facilities in all food prep/dispensing&warewashmareas C Wholesomelnonadulteratedfoodslsafe 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 IM 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 450 F. B Wounds covered adequately C Proper cooling C Proper sink used for handwashing D Proper re-heating 0 E Proper internal cooking/consumer advisory posted Approved sanitizer available/adequate concentration of sanitizer B Food-contact surfaces and utensils used for potentially hazardous food sanitized at least every 4 hours A Food thermometer available and accurate C Adequate ❑dishwashersanitizer ❑final rinse temp B Proper food thermometer for product D Proper sanitizin rocedure C Thermometers appropriately placed in cooler units E Sanitizing between raw animal origin&ready-to-eat food 0 0 ZWiping d/or sponges i:repair nd clean A Produce washedoths kept in sanuses B Raw meats not stored/prepared near ready-to-eat foods C Food covered properly qpment clean,utensils clean,equipment interiors clean ;; D Adequate splash guards/sneeze guard IVB Single use gloves changed when soiled F jE No unauthorized personnel C Food—contact surfaces clean o pooling of eggs not cooked immediately ood containers stored off the floor 0 A No unnecessary handling RTE and/or cooked foods with bare hands 7�A Soap I paper towels I drying device available Dispenser(s)working: ❑Soap ❑PapertowelB Minimize food handling,other than ready-to-eat,with bare hands 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: CFO[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 Iflf v indicate language spoken List products cooled: by QFO/DA: *Can the QFO/DA read the inspection report? Y N Describe cooling methods: Indicate who answered the above questions:Name(print): Indicate the title of above person(circle all that apply):QFO DA Mgr Cook Owner FW Is cooling monitored for time&temp? Y N Is the monitoring of cooling recorded? Y N .Obtain signature of the person who received the CFO responsibilities information at the time of the Is there a produce washing policy? Y N *Describe what is washed and inspection: where: I I Note: This report is a two page form(total of 62 debitable items) Page 1 of 2 SOWN sc4 C� U.S. Postal Service,,, CERTIFIED ° .1540 SULLIVAN AVENUE • SOL Ln J�OSOR-CO (Domestic • • . For delivery information visit our website at www.uspsxom�, TELI � fU Postage $ —0 fU Certified Fee C3 Return Receipt Fee Postmark November 13,2008 Certified MaiM i= (Endorsement Required) Here 7008 0150 000: Restricted Delivery Fee B&G Lounge o (Endorsement Required) to Pat Iacino r-1 Total Postage&Fees $ 954 Sullivan Avenue 0 Sent To South Windsor,CT 06074 0 u p h- I L !7 -- � Re: Food Service Establishment inspection results for B&G crty re,z-P+a,, South Windsor,Connecticut PS Form = UUJJ Dear Ms. Iacino: On November 13, 2008, a food service inspection was conducted at B&G Lounge located at 954 Sullivan Avenue South Windsor,Connecticut. At the time of the inspection,the rating score was 72 with,no 4 demerit point item in violations. According to the Connecticut Public Health Code, a food service establishment must maintain a rating score of 80 or higher with NO 4-demerit point items in violation. Corrections of the violations noted must be made within two(2)weeks. This office has been working with this establishment since March of this year attempting to resolve the continual violations with no success. Unfortunately we now are left with no other alternative but to have you submit a written plan explaining how you will bring the B&G Lounge into compliance within the two (2)week period mentioned above.Failure to comply will result in orders issued by the Director of Health. If you have any questions or require additional information about the inspection, please contact me at (860)644-2511. Sincerely Robert De Vito,R.S. Environmental Health Officer i • • DATE OF • AD _. &nl4p FM/ F Or I ORMAN ffv / - Q.o,; M- ri-ORM / 31 1! M Mv �� s L No L L _'_III.iL�-- MI II; ,VI M I ����' �2 .w R Page_of INSPECTION REPORT STATE OF CONNECTICUT FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH CONTINUATION SHEET NAME OF ESTABLISHMENT TOWN DATE OFJNSPE9TlON Inspection Form N Remarks: D c CArP,N� A ^p i e-,rp 6 i IQ l L 3F e i,"Ib, l'R a F/'- � {v�.� �,� � o►J 3� 5 t aS' ew�- S�-r,fJv S��.crs o 11.c►-� S� A u` iv"E ti -I ► , owl vs,;�-b T'tl 51Z tT S G"•e -v — �.1 (sue-,'� `►O %3� ry Lc7o(4-S Av, INITIAL(INSPECTOR) L 5 '71 INITIAL(PERSON IN CHARGE Distribution: 1 st-White-Health Department 2nd-Yellow-Owner/Manager c:\cen\imform2.cn �EHS-106-Rev.11105 INSPECTION REPORT STATE OF CONNECTICUT WRROUTINE INSPECTION ❑ REINSPECTION FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH ❑ PREOPERATIONAL ❑ OTHER 410 Capitol Avenue,MS#11 FDP,Hartford,CT 06134 NAME OF r ESTABLISHMENT ez— ESTABLISHMENT V s L'7 L pV t�.fl.o S CLASS STREET (�, /� _ N ADDRESS OWNER or INSPECTION OPERATOR DATE and TIME 17ao 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 V RMIN CONTROL 1 Approved source,wholesome, 4 21 Preflushed,scraped,soaked and racked X42 resence of insects/rodents 2 nonadulterated ash water clean,proper temperature 1 Outer openings protected against entrance of 1 — kV2 Oiginal container,properly labeled t rate thermometers provided,dish basket if used insects/rodents anitization rinse(hot water-chemical) 2 FOOD PROTECTION lean wiping cloths 1 FLOORS,WALLS&CEILINGS 3 Potentially hazardous food meets 4 F od-contact surfaces of utensils& 44 Floors:floor covering installed, temperature requirements during storage, uipment clean constructed as required,good repair,clean preparation,display,service,and transportation 4 _.Donfood-contact surfaces of utensils& 45 Floors,graded,drained as required 1 quipment clean 46 Floor,wall juncture covered 4 Adequate facilities to maintain product 2 28 Equipmentlutensils,storage,handling P 47 Mats removable,good repair,clean tern erature 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 re-served 29 Water source adequate,safe 4 49 Walls,ceilings attached,equipment properly 1 7 Xod protected during storage,preparation, 30 Hot and cold water under pressure, 2 constructed,good repair,clean. Wall&ceiling I8 '!splay,service&transportation 2 provided as required surfaces as required. ood containers stored off floor 50 Dustless cleaning methods used, 1 SEWAGE DISPOSAL cleaning equipment properly stored 9 Handling of food minimized 2 311 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 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 4 34 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 SEKEEPING 55 tablishment and premises free of litter,no 1 EQUIPMENT&UTENSILS: DESIGN, WASHING FACILITIES sect/rodentharborage,no unnecessary articles CONSTRUCTION&INSTALLATION 3Kila blehand cleaner and sanitary towels or 1 56 Complete separation from living/sleeping quarters 1 16 Food-contact surfaces designed,constructed, 2 oved hand drying devices provided, and laundry maintained,installed,located e waste receptacles provided 57 Clean/soiled linens stored properly 1 17 Nonfood-contact surfaces designed, 1 58 1 No live birds,turtles,or other animals 1 constructed,maintained,installed,located GEIRUBBISH STORAGE&DISPOS (except guide dogs) 18 Single service articles,storage,dispensing 2 39 A roved containers,adequate number, 1 19 No reuse of single service article ofovered,rodent proof,clean ING PROHIBITED 20 Dishwashing facilities approved design,adequately 2 40 Storage area/rooms,enclosures— 59 1 S king prohibited,signs posted at each 3 constructed,maintained,installed,located properly constructed,clean entrance 1 41 Garbage disposed of in an approved manner, at approved frequency QUALIFIED FOOD OPERATOR DEMERIT SCORE 60 Qualified Food Operator 3 4�— X3: 2 � RISK FACTOR VIOLATIONS IN RED 61 Designated alternate 2 r _ 62 Written documentation of training program 2 TOTAL RATING Date Corrections Due Sig lure of arson' ch g Cj SIGNED(I act r) DESCRIBE DEFICIENCIES ON CONTINUATION SHEETS DISTRIBUTION:I"-White—Health Department 2nd—Yellow—Owner/Operator . K '77777, =� ....... : , Establishment: ~Ji Date of Inspection: 3 b� ddress: S f S vet J # ✓ 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,backffow -Stored properly,labeled properly,used properly Pro ear type/installation/backffow 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 35rdesnfed lities. Adequate,convenient,accessible, -Water quality in compliance ro erl In-Monitoring in complianceproperly y' stalled OTHER ITEMS KEY: DNC [DOES NOT COMPLY] 2 Sources of food: Original container,properly labeled 40 Garbage/rubbish storagearea/moms,enclosures-properly constructed,clean 5 Potentially hazardous food properly thawed 41 Garbagelrubbish disposed of in an approved manner,at approved frequency 1 ood dispensing utensils properly stored 2 Vermin Control: No insects/rodents present 4 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, 5 Floors graded,drained as required located 6 Floor,wall juncture covered 17 Nonfood-contact surfaces designed,constructed,maintained, 7 Mats removable,good repair,clean installed,located 18 Single service articles,storage,dispensing 8 Exterior walking,driving surfaces,good repair,clean 19 No reuse of single service article 49 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 4dequate lighting provided as required 21 Preflushed,scraped,soaked and racked 52 Room free of steam,smoke odors 22 Wash water clean,proper temperature 53 Rooms&equipment hoods,ducts,vented as required 23 Accurate thermometers provided,dish basket,if used 54 Rooms adequate,clean,adequate lockers provided,facilities clean 27 Nonfood-contact surfaces of utensils&equipment clean 5 ablishmentand premises free of litter,noinsect/rodentharborage, 28 EquipmenUutensils,-storage,handling no unnecessary articles 32 Proper disposal of waste water 56 Complete separation from living/sleeping quarters and laundry 33 Plumbing location,installation,maintenance 57 Clean/soiled linens stored properly 58 No live birds,turtles,or other animals(except guide dogs) 36 Toilet rooms enclosed with self-closing door 59 Seats 75 or more:Nonsmoking area provided,sign(s)posted at 37 Proper toilet fixtures provided,good repair,clean entrance(s),smoking area indicated by sign(s) 39 Approved garbage/rubbish containers,adequate number,covered, rodent proof,clean Routine Inspection OReinspection 0 Preoperational Inspection N�E TOR: V� PERSON IN CHARGE: Ot er Inspection: Demerit Score: *Include demerits from page 1 4 3 2 1 1 Total Rating signature si t re V l N N(� �1 /1� 77 print name _ print nameJZ '2 i cfl4m -ZS t ( `mil DATE CORRECTIONS ryl phone number title Page 2 of 2 plus continuation pages Focused Inspection 1/2002 Page of INSPECTION REPORT STATE OF CONNECTICUT FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH CONTINUATION SHEET NAME OF ESTABLISHMENT TOWN �j 5'-( ,��Sv L�.►�tN A v-S DATE OF INSPECTION t cs 2 3 �® INSPECTION REMARKS FORUM# -i ce w�2�G�r-+2 5 Tp t�i,All� t+A (2 9-,J-c,T2 O 1 C S c ,C' 7b }�� S,va s� ; saw C_4_z + ^A-^..rNj-v-Z D+ f µA, .,.A.c Ar 7b n,3-C 4-r s�.A,Z^ s,,,► Li ALA4 Sav U id ce,oC c_ P,sT- � S t_i C6 64 i S -J A PACE. 1--b S INITIAL(INSPECTOR) (V\— INITIAL(PERSON IN CHARGE) Distribution: 1 st-White-Health Department 2nd-Yellow-Owner/Manager i Establishment: G Loves Inspection Date: 3 Time: l,-LZ P"__0i_ns0j REinsp Address/City: g Sq A-N) >4 Health Dept: S,-5vT -V\ i"%ce e_ Class: 1 2©1 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/O[not observed] NIA[not applicable] §1°� ;� 3 DNC[does not comply] 0[other] RTE[ready-to-eat] f � ._ ,.A t2 �Peeott [ tt1�ic rdnttt 61 t}e ignated Alternate i C WA 4 62 Written doontnen#a#ion of training program q Food workers have no exposed infected lesions I burns B Personnel with infection restricted 1 Approved source,wholesome,nonadulterated C N/t3 /A 4' C Communicable disease of worker reported to local health director A Approved shellfish,finfish,meat&poultryUSDA approved 13 Handwashht facilli�g rovided hanitsu a§ 9 P __C' G 0' 1V/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 ashin ate times Zw y� v }, fi �pt aty v, E t 9 tSS�ce g appropriate 4k�N S Nti an a approp o � 3 Yg `c pr tree G W0" WA 2 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 C Proper sink used for handwashing D Proper re-heating 0 E Proper internal cooking/consumer advisory posted ,� vAf1` 2, A Approved sanitizer available/adequate concentration of sanitizer 3 4 ; rode B Food-contact surfaces and utensils used for potentially " vid hazardous food sanitized at least eve hours A Food thermometeravailableandaccurate C Adequate ❑dishwashersanitizer final rinse temp Proper B Proper food thermometer for product D rocedure E Sanitizing between raw animal origin&ready-to-eat food C Thermometers appropriately placed in cooler units 0 0 I 44 410 lays service d trSpttrtattcrl . r A Cloths and/or sponges in good repair and clean �. B Wiping cloths kept in sanitizer between uses A Produce washed 0 B Raw meats not stored/prepared near ready-to-eat foods C Food covered properly A Food equipment clean,utensils clean,equipment interiors clean D Adequate splash guards/sneeze guard B Single use gloves changed when soiled E No unauthorized personnel C Food contact surfaces clean F No pooling of eggs not cooked immediately 0 8 Food containers stored off the floor - 7 0 MIMI-MR, VM W Tfri_ f` a. : . s A No unnecessary handling RTE and/or cooked foods with bare hands WSoap/paper towels/ drying device available 4- 1B Dispenser(s)working: ❑Soap ❑Papertowel B Minimize food handling,other than ready-to-eat,with bare hands C Handwash sink(s)clean/waste receptacle at handwash sink C Adequate utensil(s)for dispensing food/ice 0 0 *DESCRIBE DEFICIENCIES ON CONTINUATION SHEETS The following information is not debitable and does not affect your score. KEY: QFO[qualified food operator],DA[designated alternate],PHF[potentially hazardous food],FB[foodborne] PHFs are hot held at: OF. /s re cold held at: U F. Des n e illness conditions when you woul exclude a food worker from working: Are internal cooking temperatures taken? Y To what temperature do you cook: Sazn Lb. Poultry Ground Beef Pork What diseases related to FB illness are you required to report to the local health department? Roasts Other I SALAV`pr tat.-.ram Describe re-heating procedures: Ca<t PDT_ r 1(0— I Is there a written illness policy r�_�r uires the food worker to report specific illness cons Are temperatures recorded/logged for cold holding foods/equipment? Y and diseases to the QFO? Y L� *Do you have a poi sick leave policy? Y(N ) Are foods cooked in advance and cooled? X Iiiiii N Are leftovers saved? Y N Is there a language barrier between inspector&QFo? es indicate Ianguag ken List products cooled: by QFO/DA: *Can the QFO/DA read the inspection repo . Y N Describe cooling methods: Indicate who answered the above questions:Name(print). cdh Is cooling monitored for time&temp? Y N Is t e o itoring of cooling recorded? Y N Indicate the title of ab er n(cir le all that apply):QFO DA Mg Cook Ownei FW Obtain sig re erso c ad t 0 responsibilities in ormation at the time o Is there a produce washin olicy. Y *Describe what is washed and inspection. where: 0"tf40c ►may li�(l2Lt ^'SNP Note: This rep is a two page form(total of 62 debitable items) Page 1 of 2