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Home My WebLink AboutTemp Food Inspection 150 Nevers Road Town of South Windsor - Health Department 1640 Sullivan Avenue, South Windsor, CT 06074 Phone: 860-644-2511 ext. 248 Fax: 860-644-7280 TEMPORARY FOOD EVENT INSPECTION SHEET Event Name: C11::hr::�M>r\ Qxx, y &L,X4s - Event Date: 1-7 4 -Zls I is Location of Event: A Applicant/Coord.: Ph.# `9 0-14- (- b355 Email Address: Fax# f QFO Name: Ph.# Email Address: Fag# METHOD: On-Site inspection Kitchen inspection (:�Interview (Circle one) Food/Water So ce Approved source of food,wholesome,free from spoilage Water source potable, from approved supply,food grade hoses utilized Temperature Control �Hot/cold holding equipment and temperatures adequate Food cooked/reheated to correct temperature _ " Metal probe food thermometer(0-220F range)available/sanitized between use Accurate thermometers for all refrigerators _Coolers(self draining)and ice packs/bags Hygiene/Handwashing ✓ Hats or effective hair restraints for food workers Hand washing station-warm water in jug w/spigot, liquid soap,paper towels Gloves for food handling,designated person to handle money Scoops to have handles Records Designated person in charge of food booth for each shift—logs kept General Food Protection No extensive food preparation/handling ✓ Food protected by wrapping, sneeze guards or other effective barriers V/ —Condiments single service,pump dispensers or squeeze bottles/shakers ZPHF hot held and not sold discarded daily or at end of event Food and single service food containers stored off floor Drinks stored in ice must be stored in self-draining storage containers N r Raw faits and vegetables used in food prep to be washed in potable water Toilet Facilities aste Disposal Tnilnt facilities adequate, clean and com'7eniently located Waste water disposal container-disposed of properly Container for grease collection-disposed of properly i" No garbage containers, fly tight covers,Dumpsters must be covered Garbage containers and plastic bags Cleaning/Sanitizing V Buckets/tubs for washing,rinsing, sanitizing food equipment(hot water) Z Nb,4 �—Bleach/Quat. for sanitizing,appropriate concentration,test strips available Utensils are to be sanitized every 4 hours or as needed Moist wiping cloths to be stored in container with clean sanitizing solution Storage/FB Construction Z All utensils/equipment to be properly stored to protect from contamination Chemicals to be stored separate from food products,bottles to be labeled N iN- Food booths constructed properly to protect food,adequate lighting provided COMMENTS: �0.v�SG�anl� 'tn A1i111 N\ J HEALTH INSPECTOR: �� 3 Signature: D e. EVENT COORDINATOR: Signature:(if applicable) Date: "A temporary food service establishment serving food or drink shall comply with all provisions of Public Health Code 19-13-B42 which are applicable to its operation." SOUTH WINDSOR HEALTH DEPARTMEN 1 f TEMPORARY FOOD PERMIT fi EVENT : CARTOON CHARACTER PANCAKE BREAKFAST LOCATION : S . W . COMMUNITY CENTER APPLICANT : S . W . PARKS & RECREATION VALID : FEBRUARY 179 2013 THE RECIPIENT OF THIS PERMIT SHALL OPERATE IN ACCORDANCE WITH THE " REGULATIONS OF THE SOUTH WINDSOR HEALTH DEPARTMENT AND THE CONNECTICUT PUBLIC HEALTH CODE. " SHERRY MC N, ENVIRONMENTAL HEALTH OFFICER DATE Sl GNED: THIS PERMIT MUST BE DISPLAYED IN AN AREA VISIBLE TO EVENT PATRONS AND IS NON TRANSFERABLE ,z ' PERMIT ONLY VALID IF SIGNED BY HEALTH OFFICIAL d " SOUTH WINDSOR HEALTH DEPARTMEN TEMPORARY FOOD PERMIT EVENT : CARTOON CHARACTER HOT DOG ROAST LOCATION : S . W . COMMUNITY CENTER APPLICANT : S . W . PARKS & RECREATION VALID : F' EBRUARY 189 2013 � THE RECIPIENT OF THIS PERMIT SHALL OPERATE IN ACCORDANCE WITH THE REGULATIONS OF THE SOUTH WINDSOR HEALTH DEPARTMENT AND THE CONNECTICUT PUBLIC HEALTH CODE. nAI 2 vs 13 ' SHERRY MCGANN, �+IRONMENTAL HEALTH OFFICER DATE SIGNED: THIS PERMIT MUST BE DISPLAYED IN AN AREA VISIBLE TO EVENT PATRONS AND IS NON TRANSFERABLE ' PERMIT ONLY VALID IF SIGNED BY HEALTH OFFICIAL < . REC(reation) Rats Let the Games Begin This busy class will surely make your day! Lots of fun and action Do you like baseball,football,and soccer?Each week we will enjoy with friends is our focus.New and old games will make us all want a new sport through stories,songs and art.Lace up your sneakers to come back for more! (Snack included) for fun in the gym too! Ages 3-Kindergarten,Mondays,1:00pm-3:00pm Ages 3-5,Tuesdays,1:00pm-3:00pm (1)Activity#156107A,9/10-11/5,NC 9/17&10/8,Fee:$75 (1)Activity#156142A,9/11-10/23,Fee:$75 (2)Activity#1561076,11/12-1/7,NC 12/24,12/31,Fee:$75 Instructor:Mrs.Rounce,Rm 215 (3)Activity#256207A,1/14-3/11,NC 1/21,2/18,Fee:$65 (4)Activity#25620713,3/18-5/13,NC 4/1,4/15,Fee:$65 ®Tasty Treats Instructor:Mrs.Gerber,Rm 214 Treat your child to some tasty fun. In addition to art, stories and play the children will get to eat a treat they make during class. Come Be An Explorer with Dora Ages 3-5,Tuesdays,1:00pm-3:00pm Do you love learning Spanish with Dora?Come join Dora,Swiper (1)Activity#1561426,10/30-12/18,N/C 11/6,Fee:$75 and all her pals as we continue their adventure with new Spanish Instructor:Mrs.Flounce,Rm 215 k words,crafts,and books.iVamonos!Let's Go!*All new explorations ` and fun!* Calling All Characters' Ages 3-5,Tuesdays,9:30am-11:00am Where are you Clifford?Where are you Curious George?Come to (1)Activity#156112A,9/11-10/23,Fee:$65 class and we'll enjoy stories and art projects featuring seven of our (2)Activity#15611213,10/30-12/18,NC 11/6,Fee:$65 favorite characters. (3)Activity#256112A,1/15-3/5,NC 2/19,Fee:$65 (4)Activity#25611213,3/19-5/7,NC 4/16,Fee:$65 Ages 3-5,Tuesdays,1:00pm-3:00pm ' Instructor:Mrs.Loomis&Mrs.Hatala,Rm 213 (3)Activity#256142A,1/15-3/5,NC 2/19,Fee:$75 To extend your child's morning of fun,sign up for Kids'Corner following Instructor:Mrs.Rounce,Rm 215 Come be an Explorer With Dora and our teachers will escort your child to Room 215 where he/she will enjoy more time with their friends and Mrs. ` Rounce and Mrs.Sivo. k r • r Cartoon Ctkaractmeso t Cartoon Character Pancake Breakfast join your favorite cartoon characters in this great family event.There will be music,dancing and pictures with the characters and breakfast for the entire family.Net proceeds to benefit Special Needs programming with the SWPRD.Breakfast includes;Pancakes,sausage,strawberry topping or syrup,coffee and juice. Sunday,February 17,8:00am-12:00pm $7/adult and$3/child(age 12 and under)at the SW Community Center r Cartoon Character Hot Dog Roast Round two of this-great event,the hot dog roast is a great family event and something for the entire family to enjoy on the their day off from school and work. There will music, dancing and pictures with your favorite cartoon characters and lunch for the entire family. Lunch includes;Hot dogs(grilled or steamed)with toppings,a bag of chips and soda or juice. Monday,February 18,1 1:00am-2:00pm $6/adult and$3/child(age 12 and under)at the SW Community Center 12 AboutJUI e Every child is special! In this class,each child will discover their -- - - individuality through fun projects like body tracing, handprints and more! Ages 3-5,Tuesdays,1:00pm-3:00pm ^ 4)Activity#2561426,3/19-5/7,NC 4/16,Fee:$75 Instructor:Mrs.Rounce,Rm 215 Rise and Shine A to Z What Do You See? This class is for the early riser.Rub the sleepies out of your eyes We will see lots of animals!Each week a new animal and letter will and come to class for two hours of fun.We will enjoy singing, be featured.Well have a roaring good time. marching,books,crafts and free play. Ages 3-5,Wednesdays 1:00pm-3:00pm Ages 3-5,Wednesdays,9:00am-11:00am ( (1)Activity#156101 G,9/12-10/31,NC 9/26,Fee:$75 1)Activity#156132A,9/12-10/31,NC 9/26,Fee:$75 (2)Activity#1561326,11/7-1/2,NC 11/21,12/26,Fee:$75 (2)Activity#156101 H,11/7-1/2,NC 11/21,12/26,Fee:$75 � ( (3)Activity#256101 G,1/16-3/6,NC 2/20,Fee:$75 3)Activity#256132A,1/16-3/6,NC 2/20,Fee:$75 1 (4)Activity#256132B,3/20-5/8,NC 4/17,Fee:$75 (4)Activity#256101 H,3/20-5/8,NC 4/17,Fee:$75 Instructor:Mrs.Rounce Instructor:Mrs.Rounce&Mrs.Sivo,Room 215 To extend your child's dayo f To extend your child's morning of fun,sign up forHappy Feet or School Days f fun,sign up For ZWhat Do You See. ol- following Rise and Shine and our teachers will escort your child to their class louring School Days so he/she will enjoy more time with friends and Mrs. where will continue their morning o Rounce. they g of fun with their friends and teachers. School Days Squeaky Sneakers � Line up for fun and games!You won't want to miss this class- Yeah it's Wednesday...a School Day!You and your classmates will some new activities and some new friends will surely please every- enjoy music,listening to stories,making a colorful project and hav- one!Don't forget your sneakers! ing lunch together too. School Days are fun days! (Due to aller- gies,please do not bring any products containing peanuts.) Ages 3-Kindergarten,Thursdays,9:30am-11:00am Ages3-5,Wednesdays 11:00am-1:00pm (1)Activity#156141A,9/13-10/25,Fee:$65 (1)Activity#156134A,9/12-10/31,NC 9/26 Fee:$75 (2)Activity#156141 B,11/1-1/3,NC 11/22,12/20,12/27,Fee:$65 (2)Activity#15613413,11/7-1/2,NC 11/21,12/26 Fee:$75 (3)Activity#256141 A,1/17-3/7,NC 2/21,Fee:$65 (3)Activity#256134A,1/16-3/6,NC 2/20,Fee:$75 (4)Activity#256141 B,3/21-5/9,NC 4/18,Fee:$65 Instructor:Mrs Gerber,Rm 214 In Activity# s.Rounce &Mrs./8,NC 4/17,Fee:$75 To extend your child's morning of fun,sign up for Lunch Bunch or The Fun Instructor:Mrs.Rounce&Mrs.Sivo Never Ends following Squeaky Sneakers and our teachers will escort your To extend your child's morning of fun sign up for School Days folowing Rise child to their class where they will continue their morning of fun with their &Shine or Two and Three Come Learn with Me and your child will enjoy friends and teachers. more time with their friends *Also sign up forA to ZWhat DoYou See?to continue your child's fun for the afternoon. Lunch Bunch Little Learners Bring your lunch and join our bunch for fun.We'll eat lunch,cre- ate art projects,sing songs,read stories and play.(Due to allergies, Come to school and you will see,we will learn our ABCs.Books please do not bring any products containing peanuts) and singing,paint and glue,lots of fun and learning too!A new let- ter will be featured each week. Ages 3-5,Thursdays,11:15am-12:45pm Ages 3-5,Thursdays,9:30am-11:00am (1)Activity#156114A,9/13-10/25,Fee:$65 (1)Activity#156113A,9/13-10/25,Fee:$65 (2)Activity#15611413,11/1-1/3,N/C 11/22,12/20,12/27,Fee:$65 (2)Activity#15611313,11/1-1/3,N/C 11/22,12/20,12/27,Fee:$65 (3)Activity#256114A,1/17-3/7,NC 2/21,Fee:$65 (3)Activity#25611 3A,1/17-3/7,NC 2/21,Fee:$65 (4)Activity#256114133 3/21-5/9,NC 4/18,Fee:$65 Instructor:Mrs.Rounce,Rm 215 In Activity# s.Rounce &Mrs./9,om s,R Fee:$65 To extend your child's morning of fun,sign up for Lunch Bunch following Instructor:Mrs.Rounce&Mrs.Loomis,Rm 215 Squeaky Sneakers or DiscoveryTimeforTwos and Areesor Little Learners To extend your child's morning of fun,sign up for Lunch Bunch or The Fun and your child will continue their morning of fun in Room 215 where he/she Never Ends following Little Learners and our teachers will escort your child will enjoy more time with their friends and Mrs.Rounce. to their class where they will continue their morning of fun with their friends and teacyem *Also sign up for one of the marry afternoon classes to continue your child's day of fun. 13 A V'9NDOR APPLICATION FOR TEMPORARY FOOD EVENT The VENDOR of each temporary food event must complete this application and m st be filed 14 days prior-to the opening ew lication must be submitted to the To, U-41, Department, 1540 Sullivan Avenue, South Windsor,CT 06074. �V�O (-14N Sou �2 Z0 rs 13 o" //VD This a0lication is not a license. Temporary food events will not exceed a period of Ito 5 days. Today's Date llilv3 Name of Event 1.OA6 C?n ktf k-6sl l - rt Date of Event Synpo-v Fcb. 17 l�on�w �L� . t gtl � t Time of Event Location of Event_ SW COMAVA'1j C�kr Event Coordinator RYUnc. Event Coordinator Address __ISO km Rd Event Coordinator Phone# Event Coordinator E-Mail Address r`Ean , o„i r'�Sa,N,t►rn�sa�.a�q Event Coordinator Phone#(cell,work&home) Name of Applicant RN or\ VDAG Name of Applicants Business(please indicate if mobile vendor) S\4 PorkS �taeoko* Applicants Address 1S0 Nowyl QU Applicants E-Mail Address SA,ft E Applicants Phone#(cell, work&home) Set up time Please provide the following: (If any of the following does not apply to you put NIA) 1. List all food and beverage items to be prepared and served(menu).Attach a separate sheet if NOTE: Any changes to the menu must be submitted to the Health Department 10 days prior to the event. 2. Describe specifically how frozen, cold, and hot foods will be transported to the event. 3. List all places(name&address)where meats,poultry, seafood, shellfish, and ice will be purchased. --�Rm`S Climb 4. List names,phone numbers, addresses, and shifts to be worked of all employees. See attachment#1. 5.Use Attachment#2 in this packet to sketch a drawing showing the event area and where your operation will be. w 6. Describe the number,location and set up of handwashing facilities to be used by employees. Na,dwask S�aNaq IoC�CQ Ko 7. Describe how and where utensil/equipment washing will take place. If no facilities are available, describe how alternate steps will be taken. WvA"'� fin =n KrFc @ C w,,. Ce,(-cr 8.Describe how wastewater will be collected, stored and disposed. 9. Describe the number and location of garbage containers. 10. Describe what heat source will be used to keep hot foods hot(140 degrees and above). 11.Describe how cold foods will be kept cold(45 degrees and below). (V Pr 12. Describe how food temperatures are monitored, cleaned and sanitized. 13.Will foods be prepared on site? If no,where will foods be purchased? (enclose copy of food license) NwvakLS sa.5&RL Cn SOJ l Awe- CO S��c 00V S '"boy 01 S►C NAME OF EMPLOYEE PHONE# ADDRESS SHIFT 1. 2. 3. .4. 5. 6. 7. 8. 9. 10. recreation.southwindsororg 4km South .Windsor Parks & Recreation low �Favosite A ot"n Ch"acters! Cartoon Character Pancake Breakfast Joii i your favorite cartoon characters in this great family event.There will d%Clifford be inusic,dancing and pictures with the characters and breakfast for the entire family.Net proceeds to benefit Special Needs programming with "' "At the SWPRD.Breakfast includes;Pancakes,sausage,strawberry topping or yrup,coffee and juice. Micky Sunday,February 17,8:00am-12:00pm $7/ dultand$3/child(age 12 and under)at the SW Community Center Cc,irtoon Character Hot Dog Roast Elmo Ro nd two of this great event,the hot dog roast is a great family event an something for the entire family to enjoy on the their day off from sch of-and work.'I'here will music,dancing and pictures with your fa- Cookie vor to cartoon characters and lunch for the entire family.Lunch includes, Ho dogs (grilled or steamed) with toppings,a bag of chips and soda or jui e. Mo iday,February 18,11:00am-2:00pm oo y $6/ dult and$3/child(age 12 and under)at the SW Community Center Sunday & Monday (President's Day) Fromm ate South Windsor Corn Center 1 o Never' s Road Ni Reservation Required