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HomeMy WebLinkAboutFood Service Establishment Inspection 84 (2) EHS-106-Rev.06101 INSPECTION REPORT STATE OF CONNECTICUT X ROUTINE INSPECTION ❑ REINSPECTION FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH ❑ PREOPERATIONAL ❑ OTHER j 410 Capitol Avenue,MS#51 FDP,Hartford,CT 06134 NAME M` D 11 ESTABLISHMENT ESTABLISHMENT To nv 5 1°SHMENT o CLASS STREET - TOWN ADDRESS A9 7j_o Ii) F'�A RIO . S®u��► w1ylaSbt OWNER or INSPECTION OPERATOR DATE and TIME '— 6 10 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 I VERMIN CONTROL 1 Approved source,wholesome, 4 21 Preflushed,scraped,soaked and racked 42 Presence of insects/rodents 2 nonadufterated 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 Sanifization 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 dean constructed as required,good repair,dean transportation splay,service,and 27 Nonfood-contact surfaces of utensils& 1 45 Floors,graded,drained as required equipment dean 1 46 Floor,wall juncture covered 4 Adequate facilities to maintain product 2 28 Equipmentlutensils,storage,handling 1 47 Mats removable,good repair,dean 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 4 49 Walls,ceilings attached,equipment property 1 7 Food protected during storage,preparation, 30 Hot and cold water under pressure, 2 constructed,good repair,clean. Wall&ceiling display,service&transportation 2 provided as required surfaces as required. 8 Food containers stored off floor 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 32 Proper disposal of waste water 1 LIGHTING&VENTILATION 11 Toxic Rem property 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 1 Roan&equipment hoods,duds,vented as required 12 1 Personnel with infection restricted 4 34 No cross connection,back siphonage,bacidlow 4 DRESSING ROOMS&LOCKERS CLEANLINESS OF PERSONNEL TOILET FACILITIES 54 Rooms adequate,dean,adequate lockers T 13 Handwashing facilities provided, 4 35 Adequate,convenient,accessible,designed, 4 provided,facilities clean personnel hands washed,clean installed 14 Clean outer clothes,effective hair restraints 1 36 Toilet rooms enclosed with self-closing door 1 15 Good hygienic practices,smoking restricted 2 37 Proper fixtures provided,good repair,dean HOUSEKEEPING 55 Establishment and Temises free of litter,no 1 EQUIPMENT&UTENSILS:DESIGN, HANDWASHING FACILITIES insect/rodent harborage,no unnecessary articles CONSTRUCTION&INSTALLATION 38 1 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 GARBAGEJRUBBISH STORAGE&DISPOS I(except guide dogs) 18 Single service articles,storage,dispensing 2 39 Approved containers,adequate number, 1 19 No reuse of single service article I covered,rodent proof,dean NONSMOKING AREAS 20 Dishwashing facilities approved design,adequately 2 40 Storage arealrooms,enclosures— 59 1 Seats 75 or more:Nonsmoking area provided, 3 constructed,maintained,installed,located properly constructed,dean 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 1 RISK FACTOR VIOLATIONS IN RED 61 Designated alternate 2 r s 62 Written documentation of training program 2 u o n TOTAL RATING Date Corrections Due Signat in charge SIGNED(Ins o DESCRIBE DEFICIEVIRS&CONTINUATION SHEETS ,av Page �- of INSPECTION REPORT STATE OF CONNECTICUT FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH CONTINUATION SHEET NAME OF ESTABLISHMENT TOWN DATE OF INSPECTION Tony,5 MQ I? W i ndsbc- INSPECTIo REMARKS FORM# 1�ccz� vnrcln;ne" comy IV�E v V odk'in coc`e, Oke) W 4-1 n Fczcrz" Cokny NaT6� n�' Nrj E I V o v 101"4i�/I S fvvu n u l� 1 ►'�e. a ��r✓ ` h PAC iG�. INITIAL(INSPECTOR) INITIAL(PERSON IN CHARGE) Distribution: Ist-White-Health Department 2nd-Yellow-Owner/Manager <°W" Se G 'J � F ° 1540 SULLIVAN AVENUE • SOUTH WINDSOR, CT 06074 soR•c° TELEPHONE (860) 644 2511 August 28, 2009 Mary Morelli Tony's Mobil 84 John Fitch Boulevard South Windsor,CT 06074 Re: Results of Food Service Establishment Inspection for Tony's Mobil located at 84 John Fitch Boulevard in South Windsor, Connecticut Dear Ms. Morelli: On August 27, 2009, a food service inspection was conducted at Tony's Mobil located at 84 John Fitch Boulevard, South Windsor,Connecticut. At the time of the inspection,the rating score was 89 with(1)4-demerit point item in violation. 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. The four(4)point item noted was due to the lack of labeling for the bagged ice.The bagged ice produced at the store must have labels that include the name and address of the establishment. In addition the ice machine must be professionally cleaned and a copy of the receipt must be supplied to a representative from this office at the time of the re-inspection. Please make every effort to ensure all corrections are made within two(2)weeks. If you feel more time is needed or you are having difficulty correcting any of the deficiencies, please contact me at (860) 644- 2511, extension 248. Sin ely, Robert De Vito,R.S. Environmental Health Officer Page i of INSPECTION REPORT STATE OF CONNECTICUT FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH CONTINUATION SHEET NAME OF ESTABLISHMENT TOWN DATE OF INSPECTION Too 's 1Y).� ll sU�'�� wlndSvr ��a7�o INSPECTIOd REMARKS FORM# d,6 CI�,A,, ir►��cioc a..�d c�X ��'►or a� �c� ��2�;.�e. MOW 1r.w44 s�e� . �cr� �"►�c I b,�, c�e�ane;c� b � ra�e6Siona� cl�,�„;„ coM a . 1c" n 1�oCL4r*7 fk�i�n �u�i c�ea ,beew/ CIO' 2,. l�ee✓l 4 z eelW fie, U�l �rj Io� 'C I�Qi 1C-V yy Roc 5ink Cc CkE�I Cov�t'i✓� on ��'IC.�Vj� j t,��.��r�in C�o�eC I of - Colo (3 �d C� �1�,k is r► � �,�- ��� s��� r4b �� lab�l�� ��, 46 su"ct9, t3k �Qi 1CQi �4i )�b�l n+�ecls lnr r�a�e� ��e, slow►� `-1�oh. �� m��• n vd . Sou V)W CT INITIAL(INSPECTOR) INITIAL(PERSON IN CHARGE) x �, Distribution: 1st-White-Health Department 2nd-Yellow-Owner/Manager cAcerNnsform1crt i Establishment: TC>NY Is Mo bz/- Inspection Date: a7 d A Time: Q12LnjsD REinsp Address/City: �'_ -Tol n �-4ch flvd. Health Dept: SO-r H krzND_y09 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. IMMONZ ebitable items C NIO WA DNC } C[complies] N/O[not observed] NIA[not applicable] J 3 DNC[does not comply] 0[other] RTE[ready-to-eat] 2 q Food workers have no exposed infected lesions/burns 2 IIB Personnel with infection restricted IC Communicable disease of worker reported to local health director A A roved shellfish,finfish,meat&poultry USDA approved .( B Food cans in good condition(not dented,rusty,bloated,leaking) A Handwash facilities in all food prep/dispensing&warewash areas C Wholesome/nonadulteratedfoods/safe B Handwash facilities in or immediately adjacent to toilet rooms D Commercial products(no home grown/canned food) �/ C Handwash facilities access!blelconvenlent to use E Potentially hazardous foods received at proper temperature D Personnel hands washed,clean/Proper handwash procedure 0 W7CT L $EL b N G E Handwashing at appropriate times 0 A Hot holding greater than or equal to 140°F. (whole beef/pork roasts 130'F.) A N No eating IN No smoking while working J B Cold holding less than or equal to 450 F. B Wounds covered adequately J C Proper cooling C Proper sink used for handwashing D Proper re-heating 0 E Proper internal cooking/consumer advisory posted N son 0 A Approved sanitizeravailableladequate 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 J B Proper food thermometer for product D Proper sanitizing procedure I I J I I I E Sanitizing between raw animal origin&ready-to-eat food J C 0 0 soon A Cloths and/or sponges in good repair and clean } A Produce washed J B Wiping cloths kept in sanitizer between uses 7 0 B Raw meats not stored/prepared near ready-to-eat foods C Food covered properly A Food equipment clean,utensils clean,equipment interiors clean D Adequate splash guards/sneeze guard B Single use gloves changed when soiled E No unauthorized personnel C Food--contact surfaces clean F No pooling of eggs not cooked immediately 8 Food containers stored off the floor if 0 A No unnecessary handling RTE and/or cooked foods with bare hands A Soa I aper towels/ drying device available B Dispensers wor Ing: -(Soap FrPaper 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. 1SEY: QFO[qualified food operator],DA[designated aftemate],PHF[potentially hazardous food],FB[foodbome] PHFs are Itl.3 OF. PHFs are cold held at: OF. Describe illness conditions when you would exclude a food worker from working: Are internal cooking temper�Ground ? Y N +To what temperature do you cook: Poultry Bee Pork What diseases related to FB illness are you required to report to the local health department? Roasts er 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 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 a e barrier between in f yes Indicate languag-e-s-p-oken List products cooled: by *Can the QFO/DA read the inspection report? Y N Describe cooling methods: Indicate who answered the above questions:Name(prin . Indicate the title of above person(circle all that apply):CFO DA Mgr Coo wner FIN Is cooling monitored for time&tem ? e monitoring of cooling recorded? Y N .Obtain signature of the person who received the QFO responsibilities information at the time of the Is there ce washing policy? Y N *Describe what is washed and inspection: whl5re: III Note: This report is a two page form(total of 62 debitable items) Page 1 of 2 Pig 5 o 0 :TV CHw r Establishment: T o N y'l M'6►� Date of Inspection: mv dtlress: 6' —JD F s TC R GLV, 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 Propertype/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 -No unnecessary toxics on the premises -Soda system carbonator -Beverage dispensers -Toilet tanks -Chemical dispensers -Ice machines -Pesticides/rodenticides properly dispensed Proper drain for: 29 Water source adequate,safe. -Food equipment -Dish machines -Ice machines -Well/well head protected from contamination 35 Toilet facilities. Adequate,convenient,accessible, -Water quality in compliance -Monitoring in compliance designed,properly installed OTHER ITEMS KEY: DNC [DOES NOT COMPLY] 2 Sources of food:Original container,properly labeled 40 Garbage/rubbish storage arealrooms,enclosures-properly constructed,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 14 Food worker:Clean outer clothes,effective hair restraints 43 Outer openings protected against entrance of insects/rodents )Floors:Floor covering installed,constructed as required,good repair,clean 16 Food-contact surfaces designed,constructed,maintained,installed, 45 Floors graded,drained as required located 6 Floor,wall juncture covered 17 Nonfood-contact surfaces designed,constructed,maintained, 7 Mats removable,good repair,clean installed,located 8 Exterior walking,driving surfaces,good repair,clean 18 Single service articles,storage,dispensing 19 No reuse of single service article 9 Walls,ceilings attached,equipment properly constructed,good 20 Dishwashing facilities approved design,adequately constructed, repair,clean.Wall&ceiling surfaces as required maintained installed located 50 Dustless cleaning methods used,cleaning equipment propedystored 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 7 Nonfood contact surfaces of utensils&equipment clean 55 Establishment and premises free of litter,no insect/rodent harborage, 8 Equipment/utensils,storage,handling no unnecessary articles 32 Proper disposal of waste water 56 Complete separation from living/sleeping quarters and laundry 33 Plumbing location,installation,maintenance 57 Clean/soiled linens stored properly 36 Toilet rooms enclosed with self-closing door 58 No live birds,turtles,or other animals(except guide dogs) 59 Seats 75 or more:Nonsmoking area provided,sign(s)posted at 37 Propertoiletfixturesprovicled,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 13 Preoperational Inspection Other Inspection: INSPECTOR: PERSON IN CHARGE: Demerit Score: *Include demerits from page 1 4 3 2 1 Total Rating signature signature / _ a 3 r �reL w '� 3 (83print name print nam M DATE CORRECTIONS DUE: phone number tit i / Gyq— 2�512 taS L.P_ Page 2 of 2 plus 2 continuation pages Focneed Impectlon 1/2002 EXT. ay$ NAME OF ESTABLISHMENT DATE OF • NVIRM,K '� 'C i I�wL.�. I�.rwtig WNW rl MY,W L MAUdErl- WINWAFArAW&AMEN"MR-1 W�W�, E 'd ZA I mo,o-fin L W- , 3 Awl =EWAl.,��� ! ; ,WA W 1E�7y , M, / E#79-M' -AMAO- -m ffff M 0"".1oWf.W INITIAL(INSPECTOR) ,� CHARGE) t Establishment: - �� Date of Inspection: '"r Z� Address: Q Owner or Operator: ADDITIONAL FOUR POINT ITEMS KEY: DNC [DOES NOT COMPLY] 6 Foods not re-served. -Unwrapped foods not re-served 4 31 Sewage disposal approved. 4 -Potentially hazardous foods not re-served -Operating as required 11 Toxic chemicals. No cross connections,back siphonage,backflow -Stored properly,labeled properly,used properly Proper type/installation/backflow prevention device/air gap for: -Food equipment -Hose connections -Dish machines -Sanitizes concentration not to exceed maximum permitted -Soda system carbonator -Beverage dispensers -Toilet tanks -No unnecessary toxics on thhe 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 401 Garbage/rubbish storage area/rooms,enclosures-properly constructed,clean 5 Potentially hazardous food properly thawed 41 Garbagelrubbish 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 44eropenings protected against entrance of insects/rodents 4 ors: Floor covering installed,constructed as required,good repair,clean 16 Food-contact surfaces designed,constructed,maintained,installed,l Floors graded,drained as required ocated 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 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 Adequate lighting provided as required 21 Preflushed,scraped,soaked and racked 52 Room free of steam,smoke odors 22 Wash water clean,proper temperature 53 Rooms&equipment hoods,ducts,vented as required 23 Accurate thermometers provided,dish basket,if used 54 Rooms adequate,clean,adequate lockers provided,facilities clean 27 Nonfood-contact surfaces of utensils&equipment clean 55 Establishment and premises free of litter,no insect/rodent harborage, 28 Equipment/utensils,storage,handling no unnecessary articles 32 roper disposal of waste water 56 Complete separation from living/sleeping quarters and laundry 3 umbing 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,Ilea outine Inspection ❑Reinspection ❑ Preoperational Inspection O the Inspection: PERSON IN CHARGE: Demerit Score: *Include demerits from page 1 4 3 2 1 Total Rating n re ure 6:WT �• sig a- `S print name pri t name DATE CORRECTIONS DUE: phone number title X� Page 2 of 2 plus continuation pages eused Inspection vzooz i Establishment: Inspection Date: Time: RO[nsp REinsp Address/City: Health Dept: Class: 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 IDPIC I KEY: C[complies] N/O[not observed] NIA[not applicable] DNC[does not comply] 0[other] RTE[ready-to-eat] 42 "`Vd ITat t vftit iifec l i rt ti'i�ted"7„ :a ' ' ry t+�A .4'. 61_ Ana Adntat@ �� 62 Witten documentation of training program 2 A Food workers have no exposed infected lesions I burns B Personnel with infection restricted 1 Approved SOUCe,wholesome,nonadulterated C N/0 tit/A C Communicable disease of worker reported to local health director A Approved shellfish,finfish,meat&poultry USDA approved 131 Handmshing facilities provided,hands washed,clean C 0? NfA 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 V IB Handwash facilities in or immediately adjacent to toilet rooms D Commercial products(no home grown/canned food) C Handwash facilities accessible/convenient to use E Potentially hazardous foods received at proper temperature D Personnel hands washed,clean/Proper handwash procedure E I Handwashing at appropriate times a . 5 o ifftF`°; dices¢ C N/A 2 A Hot holding greater than or equal to 1400F. (whole heei/pork roasts isoo F.) A ❑ No eating ❑ No smoking while working B Cold holding less than or equal to 450 F. 0o, B Wounds covered adequately C Proper cooling C Proper sink used for handwashing LZ D Proper re-heating ZA E Proper internal cooking/consumer advisory posted . �� roved sanitizer available/adequate concentration of sanitizer d-contactsurfaces and utensils used for potentially ardous food sanitized at least every 4 hours P= 00 A Food thermometer available and accurate C Adequate ❑dishwasher sanitizer ❑final rinse temp D Proper sanitizin rocedure B Properfood thermometer for product E Sanitizing between raw animal origin&ready-to-eat food C Thermometers appropriately placed in cooler units 01 Fa � s Cloths and/or sponges in good repair and clean 7- - 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 G� 0, 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 6100 01 C Food--contact surfaces clean F No pooling of eggs not cooked immediately 0 8 Food containers stored off the floor 0 �t: °N/4 2'' ak ' A No unnecessary handling RTE andlorcooked foods with bare hands A Soap/paper towels/ drying device available B Dispenser(s)working: ❑Soap ❑Paper towel B Minimize food handling,other than ready-to-eat,with bare hands C I Handwash sink(s)clean/waste receptacle at handwash sink C Adequate utensil(s)fordispensing food/ice 0 0 •DESCRIBE DEFICIENCIES ON CONTINUATION SHEETS The following information is not debitable and does not affect your score. KEY: QFO[qualified food operator],DA[designated alternate],PHF[potentially hazardous food],FB[foodbome] PHFs are hot held at: OF. PHFs are cold held at: OF. Describe illness conditions when you would exclude a food worker from working: Are internal cooking temperatures taken? Y N *To what temperature do yo k: coo Poultry Ground Beef Pork What diseases related to FB illness are you required to report t 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 nd diseas F ? 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 e a language een inspector&QFO? Y N If yes indicate language spoken List products cooled: y QFO *Can the QFO/DA read the inspection report? Y N Describe cooling methods: Indicate whoa ered the above questions: Name(print): Indicate the title of a ve person(circle all that apply):QFO DA Mgr Cook Owner FW Is cooling monitored for time&temp? Y N Is the oring of cooling recorded N .Obtain signature of the rson who received the QFO responsibilities information at the time of the Is there a produce washing policy? Y *Describe what is washed and inspection: where: Note: This report is a two page (total of 62 debitable items) Page 1 of 2 �J • I LOW NAME OF 1 1 • DATE OF • �r "R WJ,.-i Sm..A" _ I wedm AO mom INITIAL(INSPECTOR) i l Establishment: Inspection Date: —Z —6 Time: Ro[nsp Eins Address/City: Health Dept: Mass: I-M 3 4 Based on an inspection this day,the i ems arked D identify the violations in operation or facilities which must be corrected by the date specified on page 2. RISK FACTOR ITEMS: Listing is not inclusive of all possible debitable items C N/O N/A KEY: C[complies] N/O[not observed] NIA[not applicable] 3 DNC[does not comply] 0[other] RTE[ready-to-eat] r ort►e 81 �fes " i4 ` iA ebt bin r46ttidt6d NIA 4104tedAiker a ' 62 fit end©cufneon�ftrainig pr ram 2 A Food workers have no exposed infected lesions I burns B Personnel with infection restricted 1 A�ip ul/od ii tlr�e,Whq�C Tiii,nona eKa 6ti C NIO WA C Communicable disease of worker reported to local health director A I Approved shellfish,finfish,meat&poultry USDA approved 13 HiMMOWInig fadfftPes proM4 handswash9d,clean' C bY0 NIA 4 B Food cans in good condition(not dented,rusty,bloated,leaking) A Handwash facilities in all food prep/dispensing&warewash areas C Wholesomelnonatlulteratedfoods/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 P FRIP, , _C_ _ p r'eitie pr`adfic s' C W10 NIA` 2 A Hot holding greater than or equal to 1400F. (Whole beef/pork roasts 130e 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 postedlmm- . if,' 0 Approved sanitizer available/adequate concentration of sanitizer B Food-contact surfaces and utensils used for potentially all hazardous food sanitized at least every 4 hours A Food thermometer available and accurate C Adequate ❑dishwashersanitizer ❑final rinse temp B Properfocdthermometerforproduct D Proper sanitizin procedure E Sanitizing between raw animal origin&ready-to-eat food C Thermometers appropriately placed in cooler units Of RIM l * t_ 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 0 OWN C Food covered properly 00000 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 pooling of eggs not cooked immediately 0 d containers stored off the floor OF 411 A Soap/paper towels I drying device available A No unnecessary handling RTE and/or cooked foods with bare hands B Dispenser(s)working: ❑Soap ❑Paper towel B Minimize food handling,other than ready-to-eat,with bare hands C Handwash sink(s)clean/waste receptacle at handwash sink C Adequate utensil(s)for dispensing food/ice 0 0 *DESCRIBE DEFICIENCIES ON CONTINUATION SHEETS The following information is not debitable and does not affect your score. _KU: QFO[qualified food operator],DA[designated alternate],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 written illness policy that re 'res the food worker to report specific illness conditions Are temperatures recorded/logged for cold holding foods/equipment? Y N d ases to the QFO� *Do you have a paid sick leave policy? Y N Are foods cooked in advance and cooled? Y N *Are leftovers saved? Y her guage barrier between inspector&QFO? Y N lf_yes indicate language spoken List products cooled: y QFO/DA: *Can the QFO/DA read the inspection report? Y N Describe cooling methods: 1 icate 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 ®ring of cooling recorded? 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 1PEstablishment: Date of Inspection: 8^'2-, 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. � -Operating as required -Potentially hazardous foods not re-served 11 Toxic chemicals. No cross connections,back siphonage,backflow Pro per 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 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 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 ocated 6 Floor,wall juncture covered 17 onfood-contact surfaces designed,constructed,maintained, 47 Mats removable,good repair,clean installed,located 8 Exterior walking,driving surfaces,good repair,clean 18 Single service articles,storage,dispensing 19 No reuse of single service article 9 Walls,ceilings attached,equipment properly constructed,good repair,clean.Wall&ceiling surfaces as required 20 Dishwashing facilities approved design,adequately constructed, 50 Dustless cleaning methods used,cleaning equipment properly stored maintained installed located 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 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 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 pro ,clean ORoutine Inspection einspection 0 Preoperational Inspection R: PERSON IN CHAR Other Inspection: Demerit Score: *Include demerits from page 1 4 3 2 1 Total Rating S. r st ture p t name / print name DATE CORRECTIONS DUE: phone nu ber tit/ Page 2 of 2 plus continuation pages Focused Inspection 1/2002 August 8,2008 Tony's Mobil Mary Malina 84 John Fitch Blvd South Windsor,CT 06074 Re: Food Service Establishment inspection results for Tony's Mobil located at 84 John Fitch Blvd, South Windsor,Connecticut Dear Ms.Malina: On August 8, 2008, a food service inspection was conducted at Tony's Mobil located at 84 John Fitch Blvd South Windsor,Connecticut. At the time of the inspection,the rating score was 86 with 1,4 demerit point item in violations. According to the Connecticut Public Health Code, a food service establishment must maintain a rating score of 80 or higher with NO-4-demerit point items in violation. Corrections of the violations noted must be made within two(2)weeks. Continued inspection failures will result in orders issued by the Director of Health to cease food service operations. If you have any questions or require additional information about the inspection, please contact me at (860)644-2511. Sincerely, Robert De Vito,R.S. Environmental Health Officer Page of INSPECTION REPORT STATE OF CONNECTICUT FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH CONTINUATION SHEET - NAME OF ESTABLISHMENT TOWN �{ DATE OF INSPE TION c INSPECTION FORM# REMARKS Tb Lis cr. "-f s S c- 716-e-� 6A `/ia P C1 e^J (J scar a� INITIAL(INSPECTOR) INITIAL(PERSON IN CHARGE) Distribution: 1st-White-Health Department 2nd-Yellow-Owner/Manager Establishment: T6IIJ 0^.t3 Date of inspection: 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 No cross connections,back siphonage,backflow 11 Toxic chemicals. Proper type/installation/backflow prevention device/air gapfor: -Stored properly,labeled properly,used properly -Food equipment -Hose connections -Dish machines --No unn concentration not to exceed maximum permitted -Soda system carbonator -Beverage dispensers -Toilet tanks -No unnecessary toxics on the premises -Pesticides/rodenticides properly dispensed -Chemical dispensers -Ice machinesProper drain for: 29 Water source adequate,safe. -Food equipment -Dish machines -Ice machines -Well/well head protected from contamination 35 Toilet facilities. Adequate,convenient,accessible, -Water quality in compliance designed,properly installed -Monitoring in compliance OTHER ITEMS KEY: DNC [DOES NOT COMPLY] 2 Sources of food: Original container,properly labeled 40 Garbage/rubbish storage area/rooms,enclosures-properly constructed,clean 5O.Om%Potentially hazardous food properly thawed 41 Garbage/rubbish disposed of in an approved manner,at approved frequency 10 F d 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 insectstrodents 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 481 Exterior walking,driving surfaces,good repair,clean 18 Single service articles,storage,dispensing 19 No reuse of single service article 9 al ,ceilings attached,equipment properly constructed,good ir,clean.Wall&ceiling surfaces as required 20 Dishwashing facilities approved design,adequately constructed, maintained installed located 50 Dustless cleaning methods used,cleaning equipment properlystored Equipment&Utensils: Cleanliness 51 Adequate lighting provided as required 21 Preflushed,scraped,soaked and racked 52 Room free of steam,smoke odors 22 Wash water clean,proper temperature 53 Rooms&equipment hoods,ducts,vented as required 23 Accurate thermometers provided,dish basket,if used 54 Rooms adequate,clean,adequate lockers provided,facilities clean 27 Nonfood-contact surfaces of utensils&equipment clean 55 Establishment and premises free of litter,no insect/rodent harborage, 28 Equipment/utensils,storage,handling no unnecessary articles 32 Proper disposal of waste water 56 Complete separation from living/sleeping quarters and laundry 33 Plumbing location,installation,maintenance 57 Clean/soiled linens stored properly 58 No live birds,turtles,or other animals(except guide dogs) 36 Toilet rooms enclosed with self-closing door 59 Seats 75 or more:Nonsmoking area provided,sign(s)posted at 37 Proper toilet fixtures provided,good repair,clean entrance(s),smoking area indicated by sign(s) 39 Approved garbage/rubbish containers,adequate number,covered, rodent proof,clean Routine Inspection OReinspection ❑ Preoperational Inspection INMPE : PERSON IN CHARGE: other Inspection: Demerit Score: *Include demerits from page 1 i 4 3 2 1 Total Rating signat re ` signature G print name print name phone number title DATE CORRECTIONS DUE: t 0 Page 2 of 2 plus continuation pages Focused Inspection 1/2001 i Establishment: —1—b A►liml S, Iviiii-G3i il Inspection Date: Time: 3 ins E[nsp Address/City: �y � ty� Fi'T� 64 Health Dept: W,n�t�Ss2 class; 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 WA DNC KEY: C[complies] NIO[not observed] N/A[not applicable] ;III I III 3 DNC[does not comply] 0[other] RTE[ready-to-eat] Plin77 811eted [tosmate 2 A Food workers have no exposed infected lesions/burns 62 o4",kntsppn of#aiillpl t Irlt 2 B Personnel with infection restricted .11 4sYEdrCEI,tot4le$OnIB,.rigldi�itel#f�tl, C Nl{) /A 4 C Communicable disease of worker reported to local health director A Ap roved shellfish,finfish,meat&poultry USDA approved 13" �Fanilii B Food cans in good condition(not dented,rusty,bloated,leaking) A Handwash facilities in all food prep/dispensing&warewash areas C Wholesomelnonadulteratedfoods/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 I Proper handwash procedure Ai 40 Handwashing at appropriate times 0' ?A` 2i A Hot holding greater than or equal to 140°F. (whole beef/pork roasts 130°F.) A ❑ No eating ❑ No smoking while working B lCold holding less than or equal to 45°F. B Wounds covered adequately C Proper cooling C Proper sink used for handwashing D Proper re-heating E Proper internal cooking I consumer advisory posted proved sanitizer available/adequate concentration of sanitizer Food-contact surfaces and utensils used for potentially loo 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> a. _gibe .,. ,._ A Cloths and/or sponges in good repair and clean =111M.M.11i A Produce washed B Wiping cloths kept in sanitizer between uses 0 B Raw meats not stored/prepared near ready-to-eat foods C Food covered properly Food equipment clean,utensils clean,equipment interiors clean D Adequate splash guards/sneeze guard B Single use gloves changed when soiled E No unauthorized personnel C Food contact surfaces clean pooling of eggs not cooked immediately 0 8 F d containers stored off the floor 11 � . . A Soap I paper towels/ drying device available A No unnecessary handling RTE and/or cooked foods with bare hands B Dispenser(s)working: ❑Soap ❑Paper towel B Minimize food handling,other than ready-to-eat,with bare hands C Handwash sink(s)clean/waste receptacle at handwash sink C Adequate utensil(s)for dispensing food/ice 0 0 •DESCRIBE DEFICIENCIES ON CONTINUATION SHEETS The following information is not debitable and does not affect your score. _M: QFO[qualified food operator],DA[designated alternate],PHF[potentially hazardous food],FB[foodbome] Pl are hot held at: F. 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 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 ves 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 Is where: Note: This report is a two page form(total of 62 debitable items) Page 1 of 2 sP o Establishment: _T"r)^-1c5 Date of Inspection: 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 Prover drain for: 29 Water source adequate,safe. -Food equipment -Dish machines -Ice machines -Well/well head protected from contamination 35 Toilet facilities. Adequate,convenient,accessible, -Water quality in compliance -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 ofinsects/rodents 4 Floors: Floor covering installed,constructed as required,good repair,clean 16 Food-contact surfaces designed,constructed,maintained,installed, 45 Floors graded,drained as required located 6 Floor,wall juncture covered 17 Nonfood-contact surfaces designed,constructed,maintained, 47 Mats removable,good repair,clean installed,located 8 Exterior walking,driving surfaces,good repair,clean 18 gle 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, TU maintained installed located Dustless cleaning methods used,cleaning equipment properly 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 271 Nonfood-contact surfaces of utensils&equipment clean 55 Establishment and premises free of litter,noinsect/rodentharborage, 28 Equipment/utensils,storage,handling no unnecessary articles 32 Proper disposal of waste water 56 Complete separation from living/sleeping quarters and laundry 33 Plumbing location,installation,maintenance 57 Clean/soiled linens stored properly 58 No live birds,turtles,or other animals(except guide dogs) 36 Toilet rooms enclosed with self-closing door 59 Seats 75 or more:Nonsmoking area provided,sign(s)posted at 37 Proper toilet fixtures provided,good repair,clean entrance(s),smoking area indicated by sign(s) 39 Approved garbage/rubbish containers,adequate number,covered, rodent proof,clean t Routine Inspection ❑Reinspection ❑ Preoperational Inspection Other Inspection: A Z INSPECTOR: PERSON IN CHARGE: Demerit Score: *Include demerits from page 1 •V�I 4 3 2 1 Total Rating Sig a re si nature ZFV ►J P-CA,-rnA 1 !}N,4 8+rocJT_ - - � X q print name print name i � � 1 Z, Cc y Lf ' 25 f CQ ►eR DATE CORRECTIONS DUE: 2. 23 phone number title Page 2 of 2 plus continuation pages Focused Inspection 1/2002 Page of i " 3 INSPECTION REPORT STATE OF CONNECTICUT FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH CONTINUATION SHEET NAME OF ESTABLISHMENT TOWN " Sbv"-J r Tr- , 15 DATE OF INSPECTION -i-o►Jy S INSPECTION FORM# REMARKS FcstZttS ,ZN�v�S S cant TD g Uls Av+&.•c.A.?LS ►- D o„r B PS t i "� N a�� - '2Sw N-s� rj Tp 53.r a F- �t�.o� c.� LJ av O.N`it pL..,.�.13 ,�t� c��rr.�SZ-c`�a,.�s 71b Z4- 4f17F INITIAL(INSPECTOR) t--� INITIAL(PERSON IN CHARGE) Distribution: 1st-White-Health Department 2nd-Yellow-Owner/Manager Establishment: L Inspection Date: -2— 23 tag Time:"7t�S'� in REinsp Address/City: $�-( ��,� F,,�K `vim Health Dept: class 1 2 3 4 Based on an inspection this day,the items marked DNC identify the violations in operation or facilities which must be corrected by the date specified on page 2. RISK FACTOR ITEMS Listing is not inclusive of all possible debitable items C N/0 N/A DNC KEY: C[complies] N/O[not observed] NIA[not applicable] p 3 DNC[does not comply] 0[other] RTE[ready-to-eat] G1 DesignatedAlteirt e 2 'I .„ firs` "tiei ri °.inf tip h restri e C ' 0 N/A 4 fit Written documentation of training program 2 A Food workers have no exposed infected lesions/burns B Personnel with infection restricted 1 Approved source,wholesome,nonatlulteratetl C N/0 N/A 4 C Communicable disease of worker reported to local health director A Approved shellfish,finfish,meat&poultry USDA approved V1, I 1 13 Handwa$hirig%cllitfes provided,handswashed,clean. C N/0 N/A 4 B Food cans in good condition(not dented,rusty,bloated,leaking) A Handwash facilities in all food prep/dispensing&warewash areas C Wholesome/nonadulterated foods/safe B Handwash facilities in or immediately adjacent to toilet rooms D Commercial products(no home grown/canned food) C Handwash facilities accessible/convenient to use E Potentially hazardous foods received at proper temperature 0 D Personnel hands washed,clean/Proper handwash procedure p� E Handwa shing at appropriate times �tu � � � drattA�� fir ern{ce, (i n8�� 0 ices I�0 NSA 2 A Hot holding greater than or equal to 140°F. (whole beef/pork roasts 130o F.) A ❑ No eating ❑ No smoking while working B Cold holding less than or equal to 45°F. B Wounds covered adequately C Proper cooling C Proper sink used for handwashing D Proper re-heating 0 E Proper internal cooking/consumer advisory posted s: 0 A Approved sanitizeravailable/adequateconcentratonofsanitizer 1ea 9 F 4 pre � m 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 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 O IN FIR �.� _ . .� .w� .. Its lay,service and trartspo�tatie t Cloths and/or sponges in good repair and clean A Produce washed B Wiping cloths kept in sanitizer between uses 0 B Raw meats not stored/prepared near ready-to-eat foods C Food covered properly 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 V11C Food—contact surfaces clean F No pooling of eggs not cooked immediately 0 8 Food containers stored off the floor 0 y 797- e"d�` � . -,�_., aIN 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 V C Handwash sink(s)clean/waste receptacle at handwash sink C Adequate utensil(s)fordispensing 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 a. F. PHFs are cold held at: OF. Describe illness conditions when you would exclude a food worker from working: Are internal cooking tempera u ? 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 te. 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 ♦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 7 Y N If yes indicate language spoken List products cooled: by QFO/DA: *Can the QFO/DA r 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 •Obtain signature of the person who received the CFO responsibilities information at the time of the Is there a produce washing policy? Y N *Describe what is washed and inspection: where: Note: This report is a two page form(total of 62 debitable items) Page 1 of 2