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SP.SLEIFOODtAERVICE INSPECTION REP( RT • UEPARTNF.NT OF PU
Establishment: �> 9 - Inspection Date: Time: sp' Einsp
Address/City: /MI�, S U Lt It/,q� �C� Health apt: Class: 1 2 b4
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 JDNC I KEY: C(complies] NIO[not observed] N/A[not applicable]
60 Qualified Food Operator 3 DNC[does not comply] 0 lotherl RTE[ready-to-eat]
61 Designated Alternate 2 12 Personnel with Infection restricted C N/0 NIA 4
iicA Food workers have no exposed infected lesions I burns
62 Written documentation of training program p
B Personnel with infection restricted
1 Approved source,wholesome,nonadulterated C NIO N/A 4 C Communicable disease of worker reported to local health director -C
A I Approved shellfish,finfsh,meat&poultry USDA approved 4 13 Handwashing facilities provided, hands washed,clean C N/0 WA 4
B Food cans in good condition(not dented,rusty,bloated,leaking) A I Handwash facilities in all food prep/dispensing&warewash areas
C Wholesome/nonadulteratedfoods/safe k B Hand f cilities in or immWigqly adla nt to toilet rooms
D Commercial products(no home grown/canned food) X C Ha wash facilltI Cass nve use
E Potentially hazardous foods received at proper temperature D Pers than procedure
E HandkubA at appropriate t
3 Potentially hazardous food meets temperature requirements C WO WA 4 0
during storage,preparation,display,service and transportation
15 Good hygienic practices C WO WA 2
A Hot holding greater than or equal to 140°F. (whole beef/pork roasts 1300F.) k 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 1 24 Sanitization rinse(hot water-chemical) C WO WA 2
0 A Approved sanitizeravailable/adequate concentration of sanitizer
4 Adequate facilities to maintain product C WO N/A 2 B Food-contact surfaces and utensils used for potentially C
temperature,thermometers provided hazardous food sanitized at least every 4 hours
A Food thermometer available and accurate C Adequate ❑dishwashersanitizer ❑final rinse temp
B Proper food thermometer for product L Proper sanitizinprocedure
E Sanitizing between raw animal origin&ready-to-eat food
C Thermometers appropriately placed in cooler units
0
0 25 Clean wiping cloths C N/0 WA 1
7 Food protected during storage,preparation, C N/0 N/A 2 on es A Cloths and/or sponges in good repair and clean
display,service and transportation p g g p
A Produce washed B Wiping cloths kept in sanitizer between uses
0
B Raw meats not stored/prepared near ready-to-eat foods 26 Food-contact surfaces clean C NIO WA 2
C Food covered properly A Food equipment clean,utensils clean,equipment interiors clean
D Adequate splash guards/sneeze guard Ac B Single use gloves changed when soiled
E No unauthorized personnel k C Food--contact surfaces clean
F No pooling of eggs not cooked immediately _ v _ 0
8 Food containers stored off the floor / 30 Hot and cold water under pressure,provided as requirek C kO WA 2
0 1 381 Handwashing accessories provided C N/0 NIA 1
9 Handling of food minimized C WO WA 2
A No unnecessary handling RTE and/or cooked foods with bare hands A Soap/paper towels I drying device available
Dispenser(s)working: ❑Soap ❑Paper towel
B Minimize food handling,other than ready-to-eat,with bare hands C Handwash sink(s)clean I waste receptacle at handwash sink
C Adequate utensil(s)for dispensing food/ice
0 •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[foodbcrne]
PHFs are hot held at: f. PHFs are cold held at: OF. Describe illness con ikons 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 t Or the f rke t r c as
Are temperatures recorded/logged for cold holding foods/equl nt? Y N and diseases to the OF07 Y Do u V.@ a 'I , I a I
Are Dods cooked in advance and cooled. Y N ♦ overs saved? Y N Is there a language bame etwee inspe O? 11 N !WndidRe bngunge spolken
List products cooled: by QFO/DA: ♦Can the CFO/DA read the inspection report? Y N
Describe cooling methods: 1 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 onitoring of cooling recorded? Y N .Obtain signatujeflfihe person who received the QFO resnnnsibilitiepOftrialtion at the time of the
rIsherre:e a produce washing po icy Y ♦Describe what is was a an inspection:
e Note: This report is a two page form(total of 62 debitable items) Page 1 of 2
STATE OF CONNECTICUT-DEPARTMENT OF PUBLIC HEALTH-410 CAPITOL AVENUE-MS#51 FDP-HARTFORD,CT 06134
FOCUSED FOOD SERVICE INSPECTION REPORT
LOCAL HEALTHDEPT: '�.5auT21 ADDRESS/CITY:
Establishment: TZ�t 'J Date of Inspection: I to,
ddress: /A�(� i(_ �tl i��r/ r' Owner or Operator:
ADDITIONAL FOUR POINT ITEMS M KEY: DNC [DOES NOT COMPLY] o
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 4
-Stored properly,labeled properly,used properly
4 Proper typelinstallation/backflow preventlonsleYicel.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
-Pesticideslrodenticides properly dispensed Proper drain for:
29 Water source adequate,safe. 4 -Food equipment -Dish machines -Ice machines
-Well I well head protected from contamination ; Toilet facilities. Adequate,convenient,accessible, 4
-Water quality in compliance
-Monitoring in compliance designed,properly installed
OTHER ITEMS z
KEY: DNC [DOES NOT COMPLY] c
2 Sources of food: Original container,properly labeled 1 40 Garbagelrubbishstoragearea/rooms,enclosures-property constructed,clean 1
5 Potentially hazardous food property thawed 2 41 Garbage/rubbish disposed of in an approved manner,at approved frequency
10 Food dispensing utensils property stored 1 42 Vermin Control: No insects/rodents present 2
14 Food worker:Clean outer clothes,effective hair restraints 1 43 Outer openings protected against entrance of insects/rodents 1
4 ors: Floor covering installed,constructed as required,good red ir,cle n 1
16 d-contact surfaces designed,constructed, maintained,installed,,Wo 5 Floors graded,drained as required
located
6 Floor,wall juncture covered
17 Nonfood-contact surfaces designed,constructed, maintained, 1 47 Mats removable,good repair,clean
installed,located
8 Exterior walking,driving surfaces,good repair,clean
18 Single service articles,storage,dispensing 2 1
19 No reuse of single service article 9 Walls,ceilings attached,equipment properly constructed,good 1
20 Dishwashing facilities approved design,adequately constructed, 2 repair,clean.Wall&ceiling surfaces as required 1
maintained,installed,located 50 Dustless cleaning methods used,cleaning equipment properly stored
Equipment&Utensils• Cleanliness 1 51 Adequate lighting provided as required 1
21 Preflushed,scraped,soaked and racked 52 Room free of steam,smoke odors 1
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 1
food-contact surfaces of utensils&equipment clean 1
55 Establishment and premises free of litter,no insect/rodent harborage, 1
8 Equipmentlutensils,storage,handling 1 no unnecessary articles
32 Proper disposal of waste water 1 56 Complete separation from living/sleeping quarters and laundry 1
33 Plumbing location,installation,maintenance 1 571 Clean/soiled linens stored properly 1
58 No live birds,turtles,or other animals(except guide dogs) 1
36 Toilet rooms enclosed with self-closing door 1
59 Seats 75 or more:Nonsmoking area provided,sign(s)posted at
37 Proper toiletfixtures provided,good repair,clean entrance(s),smoking area indicated by sign(s) 3
39 Approved garbage/rubbish containers,adequate number,covered, 1
rodent proof,clean ARRth'erInspection:outine Inspection ❑Reinspection 0 Preoperational Inspection
f Pif:;�OiV IN Il�nr�.;
!,: :,i *Include demerits from page 1
4 3 2 1 Total Rating
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�" �J Page 2 of 2 plus continuation pages
EA Page J of�
INSPECTION REPORT STATE OF CONNECTICUT Q
FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH
CONTINUATION SHEET
NAME OF ESTABLISHMENT TOWN DATE OF INSPECTION
INSPECTION REMARKS
FORM#
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INITIAL(INSPECTOR) INITIAL(PERSON IN CHARGE)4ez
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Distribution: 1 st-White-Health Department 2nd-Yellow-Owner/Manager