HomeMy WebLinkAboutFood Service Establishment Inspection 18 EHS-106-4v.06/01 INSPECTION REPORT STATE OF CONNECTICUT I$ROUTINE INSPECTION ❑ REINSPECTION
FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH ❑ PREOPERATIONAL ❑ OTHER
410 Capitol Avenue,MS#51 FDP,Hartford,CT 06134
NAME OF ESTABLISHMENT
ESTABLISHMENT Nick a CLASS
STREET o �+ (�
ADDRESS $ 7 ti j Vq� /"IVQi TOWN So-4 Wl njSor
OWNER or INSPECTION
OPERATOR DATE and TIME 9 H 0 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 27 Nonfood-contact surfaces of utensils& 1 45 Floors,graded,drained as re uired transportation equipment clean 9 q 1
46 Floor,wall juncture covered
4: Adequate facilities to maintain product 2 28 Equipment/utensils,storage,handling 1 47 Mats removable,good repair,clean
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 F30
Water source ade uate safe
q � 4 49 Walls,ceilings attached,equipment properly 1
7 Food protected during storage,preparation,- Hot and cold water under pressure, 2 constructed,good repair,clean. Wall&ceiling
display,service&transportation provided as required surfaces as required.
Food containers stored off floor 2 50 1 Dustless cleaning methods used, 1
SEWAGE DISPOSAL cleaning equipment properly stored
9 Handling of food minimized 2 31 Sewage disposal approved 4
10 Food dispensing utensils properly stored 1 Pfl 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 14 34 No cross connection,back siphonage,backflow 4
DRESSING ROOMS&LOCKERS
CLEANLINESS OF PERSONNEL TOILET FACILITIES 5=Roadfequate,clean,adequate lockers13 Handwashing facilities provided, 4 35EAdequate,convenient,accessible,designed, 4 ities clean
— personnel hands washed.clean 14 Clean outer clothes,effective hair restraints 136ms enclosed with self-closing door15 Good hygienic practices,smoking restricted 2 37tures 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 1 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 GARBAGEIRUBBISH STORAGE&DISPOSAL (except guide dogs)
18 Single service articles,storage,dispensing 2 39 Approved containers,adequate number, 1
19 No reuse of single service article covered,rodent proof,clean NONSMOKING AREAS
20 Dishwashing facilities approved design,adequately 2 40 Storage 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 area
1 indicated by sign(s)
41 Garbage disposed of in an approved manner,
at approved frequency QUALIFIED FOOD OPERATOR
DEMERIT SCORE 60 Qualified Food Operator 3
4 — 3 _ 2 3 1 3 RISK FACTOR VIOLATIONS IN RED 61 Designated alternate 2
6 3 62 Written documentation of training program 2
V Signature of Pers in charge
TOTAL RATING Date Corrections Due X
9 n �9 �Pr,fs SIGNED(InMctor)
"� DESCRIBE DEFIC�NIPYE90N CONTINUATION SHEETS
Page of j.-
INSPECTION REPORT STATE OF CONNECTICUT
FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH
CONTINUATION SHEET
NAME OF ESTABLISHMENT TOWN DATE OF INSPECTION
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INSPECTION FORM# REMARKS
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INITIAL(INSPECTOR) INITIAL(PERSON IN CHARGE) X
Distribution: 1 st-White-Health Department 2nd-Yellow-Owner/Manager
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Establishment: Inspection Date: —/ Time: RO[nsp REinsp
Address/City: t Health Dept: �5' GrJ�/t/, Class: 103 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 WO N/A DqP I KEY: C[complies] N/0[not observed] NIA[not applicable]
3 DNC[does not comply] 0[other] RTE[ready-to-eat]
r OF—M `P± rit tifiTi ilificfiinsf rt4d t rah Raw 0 M W_
62 Written documentation of training program 2 A Food workers have no exposed infected lesions burns loor
B Personnel with infection restricted
1 Approved source,wholesome,nonaduiterated G N/0 N/A 4 C Communicable disease of worker reported to local health director 100,
B o roved shellfish,conditish,on
meat&poultry USDA approved 13 Handwashing facilities provided,hands washed,dean G ' 0 NIA 4
B Food cans in good condition(not dented,rusty,bloated,leaking) A Handwash facilities in all food prep/dispensing&warewash areas
C Wholesome/nonadulteratedfoods/safe B Handwash facilities in or immediately adjacent to toilet rooms of
D Commercial products(no home grown/canned food) 01
C Handwash facilities accessible/convenient to use
E Potentially hazardous foods received at proper temperature D Personnel hands washed,clean/Proper handwash procedure
0
t aa-
an wash ing at appropriate times
0
"1B' 0 jig er►ia'praetices:4 G N/0 N<A 2
A Hot holding greater than or equal to 140°F. (Whole beef/pork roasts 130'F.) A ❑ No eating ❑ No smoking while working
B Cold holding less than or equal to 450F. B Wounds covered adequately
C Proper cooling v1 C Proper sink used for handwashing
D Proper re-heating 0
e
E Proper internal cooking I consumer advisory posted 1 ' zr �i ep�tf1 , i ;
0 A Approved sanitizer available/adequate concentration of sanitizer
B Food-contact surfaces and utensils used for hazardous food sanitized at least every 4 hours otentially
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 O
oo A Cloths and/or sponges In good repair and clean ' or
"Produce washed B Wiping cloths kept in sanitizer between uses 101—B Raw meats not stored/prepared near ready-to-eat foods 0
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
090
/paper towels/gdrying device available
A No unnecessary handling RTE and/or cooked foods with bare hands oe A ScapB
Dispenser(s)working: ❑Soap ❑Paper towel
B Minimize food handling,other than ready-to-eat,with bare hands C Handwash sink(s)clean/waste receptacle at handwash sink
C Adequate utensil(s)for dispensing food/ice 0
0 •DESCRIBE DEFICIENCIES ON CONTINUATION SHEETS
The following information is not debitable and does not affect your score. KEY: OFO[qualified food operator],DA[designated alternate],PHF[potentially hazardous food],FB[foodbome]
PHFs are hot held at: 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 it a you required to report to the local health department?
Roasts Other
Describe re-heating procedures: Is there a v
jown11111-ness policy that requires the food worker to report specific illness conditions
Are temperatures recorded/logged for cold holding foods/equipment? Y N an ses 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 save Y Is t r barrier between inspector&QFO? Y N If yes indicate language spoken
List products cooled: 9' ate
IDA: *Can the QFO/DA read the inspection report? Y N
Describe cooling methods: fln 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 monitairna 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 ♦ cribe what is washed and inspection:
where: Note: This report is a two page form(total of 62 debitable items) Page 1 of 2
.. ti
Establishment: fl"4 Date of Inspection: ''
ddress: vim. 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 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
Pro per type/installation/backflow prevention device/air gap for:
-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 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 otentially hazardous food properly thawed 41 Garbage/rubbish disposed of in an approved manner,at approved frequency
0 ood dispensing utensils properly stored 2 Vermin Control: No insects/rodents present
4 Food worker:Clean outer clothes,effective hair restraints f 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
Gated
6 Floor,wall juncture covered
7 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 0 ustless cleaning methods used,cleaning equipment properly stored
Equipment&Utensils: Cleanliness Adequate lighting provided as required
21 Preflushed,scraped,soaked and racked 52 Room free of steam,smoke odors
22 Wash water clean,proper temperature 53 Rooms&equipment hoods,ducts,vented as required
23 Accurate thermometers provided,dish basket,if used 54 Rooms adequate,clean,adequate lockers provided,facilities clean
27 Nonfood-contact surfaces of utensils&equipment clean
5
28 Equipment/utensils,storoge,handling tablishment and premises free of litter,no insect/rodent harborage,
�. 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
6 ITbilet 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
Propertoiletfixturesprovirled,good repair,clean entrance(s),smoking area indicated by sign(s)
39 Approved garbage/rubbish containers,adequate number,covered,
rodent proof,c can outine Inspection ❑Reinspection ❑ Preoperational Inspection
they pection:
IN T R: PERSON IN CHARGE: Demerit Score: *Include demerits from page 1
4 3 2 1 Total Rating
tzt signatu
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®n�•,7) DATE CORRECTIONS DUE: [[[
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 ESTABLISHM� TOWN
liLJr DATE OF INSPECTION
0,
nvsr REMARKS
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INITIAL(INSPECTOR) INITIAL(PERSON IN CHARG
Distribution: 1 st-White-Health Department 2nd-Yellow-Owner/Manager
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NAW,OF ESTABLISHMENT DATE OF INSPECTION
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Establishment: Date of Inspection: l'
ddress: Owner or Operator:
ADDITIONAL FOUR POINT ITEMS KEY: DNC [DOES NOT COMPLY]
6 Foods not re-served. 3 1
4 31 Sewage disposal approved.
-Unwrapped foods not re-served
-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 for:
-Stored properly,labeled properly,used properly -Food equipment -Hose connections -Dish machines
-Sanitizer concentration notto exceed maximum permitted -Soda system carbonator -Beverage dispensers -Toilettanks
-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 designed,properly installed
-Monitoring in compliance
111111111
OTHER ITEMS KEY: DNC [DOES NOT COMPLY]
2 Sources of food:Original container,properly labeled 40 Garbage/rubbish storage area/rooms,enclosures-properly constructed,clean
5 Potentially hazardous food properly thawed 41 Garbage/rubbish disposed of in an approved manner,at approved frequency
10 Food dispensing utensils properly stored 42 Vermin Control:No insects/rodents present
14 Food worker:Clean outer clothes,effective hair restraints 43 Outer openings protected against entrance of insects/rodents
4 Floors: Floor covering installed,constructed as required,good repair,clean
16 Food-contact surfaces designed,constructed,maintained,installed, 45 Floors graded,drained as required
located
6 Floor,wall juncture covered
17 Nonfood-contact surfaces designed,constructed,maintained, 7 Mats removable,good repair,clean
installed,located
Single service articles,storage,dispensing
8 Exterior walking,driving surfaces,good repair,clean
18
19 No reuse of single service article 9 Walls,ceilings attached,equipment properly constructed,good
repair,clean.Wall&ceiling surfaces as required
20 Dishwashing facilities approved design,adequately constructed, -
maintained installed located �50 tstless cleaning methods used,cleaning equipment properly stored
Equipment&Utensils: Cleanliness 5 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
5 stablishment 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
35 oilet 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 Propertoiletfixturesprovlded,good repair,clean entrance(s),smoking area indicated by sign(s)
39 Approved garbage/rubbish containers,adequate number,covered,
rodent pro ,clean % outine Inspection ❑Reinspection ❑ Preoperational Inspection
INSPECIOR: P HAR Othe pection:
Demerit Score: *Include demerits from page 1
4 3 2 1 Total Rating
ur -skgripfuAA L11
reN
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print nam �/ print na
phone number title DATE CORRECTIONS DUE:
Page 2 of 2 plus continuation pages Focused Inspection I/2002
Establishment: 77 r Inspection Date: Time: Roinsp RE[nsp
Address/City: Health Dept: -GJjil/ r � Class' 1� 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 NIO N/A I D C I KEY: C[complies] NIO[not observed] N/A[not applicable]
3 DNC[does not comply] 0[other] RTE[ready-to-eat]-to-eat].N.�Yy 4v r. p a a - •.' .r...� i .F -e .N NIA
A Food workers have no exposed infected lesions I burns .000
2LX
B Personnel with infection restricted
if
00, ' � �.� fQ�id � . 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) , ,ie6tt Id10' tA 4:
A Handwash facilities in all food prep/dispensing&warewash areas
C Wholesome/nonadulterated foods/safe B Handwash facilities in or immediately adjacent to toilet rooms
D Commercial products(no home grown/canned food) C Handwash facilities accessible/convenient to use
E Potentially hazardous foods received at proper temperature D Personnel hands washed,clean/Proper handwash procedure
0 E Handwashing at appropriate times
0
ac C $ C Wo, N!
A Hot holding greater than or equal to 1400F. (whole beef/pork roasts 1300 F.) A ❑ No eating ❑ No smoking while working
B Cold holding less than or equal to 450F. B Wounds covered adequately
C Proper cooling Proper sink used for handwashing
D Proper re-heating
E Proper internal cooking consumer advisory posted
0 Approved sanitizer available/adequate concentration of sanitizer
B Food-contact surfaces and utensils used for potentially
!III IS hazardous food sanitized at least every 4 hours
A Food thermometeravailableandaccurate C Adequate ❑dishwashersanitizer ❑final rinse temp
B Proper food thermometer for product 000,
D Proper sanitizin rocedure
E Sanitizing between raw animal origin&ready-to-eat food
C Thermometers appropriately placed in cooler units O
Cloths and/or sponges in good repair and clean
A Produce washed
B Wiping cloths kept in sanitizer between uses
B Raw meats not stored/prepared near ready-to-eat foods
C Food covered properly Food equipment clean,utensils clean,equipment interiors clean 00,
Adequate splash guards/sneeze guard g Single use gloves changed when soiled
No unauthorized personnel C Food--contact surfaces clean
F No pooling of eggs not cooked immediately
ood containers stored off the floor
7"d MEN
per towe I drying device available
A No unnecessary handling RTE and/or cooked foods with bare hands B
Dispensers working: ❑Soap ❑Paper towel
B Minimize food handling,other than ready-to-eat,with bare hands I Handwash sink(s)clean/waste receptacle at handwash sink
C Adequate utensil(s)for dispensing food/ice 0
0 1 1 1 1 -DESCRIBE DEFICIENCIES ON CONTINUATION SHEETS
The following information is not debatable and does not affect your score. KEY: QFO[qualified food operator],DA[designated alternate],PHF[potentially hazardous food],FB[foodbome]
PHFs are hot held at: IF. PHFs are held at: OF. Describe illness conditions when you would exclude a food worker from working:
Are internal cooking temperatures taken? Y N *To wha mperature do you cook:
Poultry Ground Beef Pork at diseases related to FB i are you required to report to the local health department?
Roasts Other
Describe re-heating procedures: Is there a writte ss policy that requires the food worker to report specific illness conditions
Are temperatures recorded/logged for cold holding foods/equipment? Y N and di sea 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 ere a language barrier between inspector&QFO? Y N Iflf ves indicate language spoken
List products cooled: b O/DA: *Can the QFO/DA read the inspection report? Y N
Describe cooling methods: j0idtew swered the above questions: Name(print):
Is cooling monitored far time&temp? Y N Is the monitoring of ing recorded? Indicate,the title o ve person(circle all that apply):QFO DA Mgr Cook Owner FW
Obtain signature of the on who received the QFO responsibilities information at the time of the
Is there a produce washing policy? Y N ♦Describe at is washed and inspection:
where: Note: This report is a two page faPm4total of 62 debitable items) Page 1 of 2
7Establishment: tSXk� , AwAAL \A Avn\ �t C4^ ,,Z
Date of Inspection: 2- c7
l�v ��i-�-+� ' 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 .fi
11 Toxic chemicals. 34 No cross connections,back siphonage,backflow
-Stored properly,labeled properly,used properly Proper type/installation/backflow prevention device/air gap for:
-Sanitizer concentration not to exceed maximum permitted -Food equipment -Hose connections -Dish machines
-No unnecessary toxics on the premises -Soda system carbonator -Beverage dispensers -Toilet tanks
-Pesticides/rodenticides properly dispensed -Chemical dispensers -Ice machines
Proper drain for:
29 Water source adequate,safe. -Food equipment -Dish machines -Ice machines
-Well/well head protected from contamination 35 Toilet facilities. Adequate,convenient,accessible,
-Water quality in compliance designed,properly installed
-Monitoring in compliance
OTHER ITEMS KEY: DNC [DOES NOT COMPLY]
2 Sources of food: Original container,properly labeled 40 Garbagelrubbish 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.Outeropenings protected against entrance of insects/rodents
4 Floors: Floor covering installed,constructed as required,good repair,clean
16 Food-contact surfaces designed,constructed,maintained,installed, 45 Floors graded,drained as required
located 6 Floor,wall juncture covered
17 onfood-contact surfaces designed,constructed,maintained, 7 Mats removable,good repair,clean
installed,located
18
8 Exterior walking,driving surfaces,good repair,clean
ingle service articles,storage,dispensing
19 No reuse of single service article 9 Walls,ceilings attached,equipment properly constructed,good
20 Dishwashing facilities approved design,adequately constructed, repair,clean.Wall&ceiling surfaces as required
maintained installed located 50 Dustless cleaning methods used,cleaning equipment properlystored
Equipment&Utensils: Cleanliness 51 )dequate lighting provided as required
21 Preflushed,scraped,soaked and racked Room free of steam,smoke odors
22 Wash water clean,proper temperature 53 Rooms&equipment hoods,ducts,vented as required
ccurate thermometers provided,dish basket,if used 54 Rooms adequate,clean,adequate lockers provided,facilities clean
7 Nonfood-contact surfaces of utensils&equipment clean 55 Establishment and premises tee of litter,no insect/rodentharborage,
28 Equipmentlutensils,stnrage,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)
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,c vered,
rodent proof,clean Moutine Inspection OReinspection 0 Preoperational Inspection
INSPECTOR ON IN Other Inspection:
� Demerit Score: *Include demerits from page 1
4 3 2 1 Total Rating
signature si natu Q
M v,►Q kK A-MI re l I
print name print name
Cork y - ZS / 56A� DATE CORRECTIONS DUE: �- I Z- C $
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 C L A S S 2-
NAME OF ESTABLISHMENT TOWN iap S ocul v AtJ A Jff DATV OF INSPECTION
AL- NAMb, L-L C Sa0"M i.s ,.,isSa2 Z. c7 I 00A�
INSPECTION FORM# REMARKS
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INITIAL(INSPECTOR) INITIAL(PERSON IN CHARGE
Distribution: 1st-White-Health Department 2nd-Yellow-Owner/Manager
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Establishment:Cxkbtj , — A nn L-Le Inspection Date: z t z_ c) 6 Time: t it ac)o a^ oins REinsp
Address/City: 11:�o Svc-L- Av%g' Health Dept: Sum -�so 2 Class: 1 03 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 debatable items C N/O N/A JRNC I KEY: C[complies] NIO[not observed] NIA[not applicable]
DNC[does not comply] 0[other] RTE[ready-to-eat]
._ 3 1 �)P �`%ief 4trr ° i[tfC ie3nostri�te!° ,-C 0'NIA
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61 Designated Alternate 2 fit Wriften documentation of training program 2 A Food workers have no exposed infected lesions/burns
B Personnel with infection restricted
1 Approved source,wholesome,nonadulterated . C N10 N/A 4'' C Communicable disease of worker reported to local health director
A Approved shellfish,finfish,meat&poultry USDA approved 13 Flandwashing fact iities provided;hods washed,cart , C N10 NIA 4
B Food cans in good condition(not dented,rusty,bloated,leaking) A Handwash facilities in all food prep/dispensing&warewash areas
C Wholesome/nonadulteratedfoods/safe B Handwash facilities in or immediately adjacent to toilet rooms Vf -
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
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nr �sg'�ti t�fpirtehrtrerY�ce and �rtaffe
an as ing at appropriate times
0
Woot hygieSr ces Cx �� WA 2
A Hot holding greater than or equal to 1400F. (mole beef/pork roasts too°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 4 � Mori Mc rai) _ N �..
0 A Approved sanitizeravailable/adequateconcentrationofsanitizer
f ie3, ogA pro # $ B Food-contact surfaces and utensils used for potentially
tern ; ® rsYt A e P 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
E Sanitizing between raw animal origin&ready-to-eat food
C Thermometers appropriately placed in cooler units
0 r � ar Q
dtsptay;service and transportaticrt . A Cloths and/or sponges in good repair and clean
A Produce washed
B Wiping cloths kept in sanitizer between uses
0
B Raw meats not stored/prepared near ready-to-eat foods
C Foocovered properly A Food equipment clean,utensils clean,equipment interiors clean
D Adequate
uate 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 -
`W�re�grtg A Soap/paper towels/ drying device available
A No unnecessary handling RTE and/or cooked foods with bare hands VB
Dispenser(s)working: Soap Paper towel
B Minimize food handling,other than ready-to-eat,with bare hands IV_ro
Handwash sink(s)clean/waste receptacle at handwash sink
rC Adequate utensil(s)for dispensing food/ice
0 •DESCRIBE DEFICIENCIES ON CONTINUATION SHEETS
The following information is not debitable and does not affect your score. KEY: QFO[qualified food operator],DA[designated alternate],PHF[potentially hazardous food],FB[foodborne]
PHFs are hot held at: OF. PHFs are cold held at: OF. Describe illness conditions when you would exclude a food worker from working:
Are internal cooking temperatures taken? Y N *To what temperature do you cook:
Poultry Ground Beef Pork What diseases related to FB illness are you required to report to the local health department?
Roasts Other
Describe re-heating procedures: Is there a written illness policy that requires the food worker to report specific illness conditions
Are temperatures recorded/logged for cold holding foods/equipment? Y N and diseases to the QFO? Y N *Do you have a paid sick leave policy? Y N
Are foods cooked in advance and cooled? Y N *Are leftovers saved? Y N Is there a language barrier between inspector&QFO? Y N If yes indicate language spoken
List products cooled: by 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