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STATE OFCONNECTICUT 0,. FOCUSED FOOD SERVICE INSPECTION REPORT • DEPARTMENT OF PUBLIC HEALTH
Establishment: = i TL' E-1" . Inspection Date: REinsp
Address/City: <' Health Dept: G 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 DNC KEY: C[complies] NIO[not observed] N/A[not applicable]
60 Qualified Food Operator 3 DNC[does not comply] 0 lolherl RTE Iready-to-eal]
61 Designated Alternate 2 12 Personnel with infection restricted C NO WA 4
62 Written documentation of training program 2 A Food workers have no exposed infected lesions I burns l/
B Personnel with infection restricted
1 Approved source,wholesome,nonadulterated C N/0 NIA 4 C Communicable disease of worker reported to local health director
i/
A I Approved shellfish,f nfsh,meat&poultry USDA approved 13 Handwashing facilities provi , hands washed,clean C NIO WA 4
B Food cans in good condition(not dented,rusty,bloated,leaking) �'
W A Handwash facilities in all food drs ensin ash areas
C Wholesome/nonadulteratedfoods/safe Han a acAilieg or di enl tot let rooms
D Commercial products(no home grown/canned food) ✓ B B Ha, sn tti nvenient e
E Potentially hazardous foods received at proper temperature U D P rsonnel s w ed, clean I P r_t+ertQ" rocedure
0 E ertdvmShing at appropriate bn
3 Potentially hazardous food meets temperature requirements C NIO WA 4 0
during storage,preparation,display,service and transportation
15 Good hygienic practices C NIO WA 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 to45°F. I�' v B Wounds covered adequately r� '
C Proper cooling ✓ C Proper sink used for handwashing
D Proper re-heating
E Proper internal cooking I consumer advisory posted .'01 24 Sanitization rinse (hot water-chemical) C NIO WA 2
0 A Approved sanitizeravailable/adequate concentration of sanitizer t
4 Adequate facilities to maintain product C NIO WA 2 B Food-contact surfaces and utensils used for potentially
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 D Proper sanitizin rocedure I '
E Sanitizing between raw animal origin&ready-to-eat food v'
C Thermometers appropriately placed in cooler units 0
0 25 Clean wiping cloths C NIO N/A 1
7 Food protected during storage,preparation, C N/0 N/A 2 A Cloths and/orsponges in nod repair and clean
display,service and transportation9 P i \
A Produce washed t,
B Wiping cloths kept in sanitizer between uses
0
B Raw meats not stored/prepared near ready-to-eat foods ri 26 Food-contact surfaces clean C N/0 WA 2
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 it C Food--contact surfaces clean i
F No pooling of eggs not cooked immediately 0
8 Food containers stored off the floor 30 Hot and cold water under pressure,provided as required C WA 2
0 1 1 38 Handwashing accessories provided t NO WA 1
9 Handling of food minimized C NIO WA 2 A Soap I 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 li�
B Minimize food handling,other than ready-to-eat,with bare hands
1/ C Handwash sink(s)clean I waste receptacle at handwash sink v
C Adequate utensil(s)for dispensing foodlice j / 0
0 •DESCRIBE DEFICIENCIES ON CONTINUATION SHEETS
The following information is not debitable and does not affect your score KEY. CFO[q,91—d fug I DA[dc lgnat�d i,'ternate] PHF[polenliaily hazardous food], FB [foodborrel
PHFs are hot el d at: 'IF PHFs are cold held at: _ F 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 ar you required to report to the local health department?
Roasts Other
Describe re-heating procedures: Is there a written illness policy th requires the food worker to report specific illness conditions
Are temperatures recorded/logged for cold holding foods! prnent? Y N and diseases to the QFO? Y *Do you have a paid sick leave policy? Y N
Are foods cooked in advance and cooled? Y N • re 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):
FIN
cooling monitored For time&temp? Y N Is th monitoring of cooling recorded? Y N Indicate the title of above person(circle all that apply):QFO DA Mgr Cook Owner F
•Obtain signature/of t person wh receivi4 the QFO responsibilities information at the time of the
Is there a produce washing policy? Y N ♦D'escnbe what is washed and inspection:
where: Note: This report is a two il form 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: C7�7bO _ _ ADDRESS/CITY:
Establishment: G/ Tz"j2./L Date of Inspection:
ddress: 19 G/L/ FG ti ,�,� Owner or Operator:G+¢ux/z C�uTJ10s&
ADDITIONAL FOUR POINT ITEMS c KEY: DNC [DOES NOT COMPLY] c
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
11 Toxic chemicals.
No cross connections, back siphonage,backflow 4
4 PropefAypelinstafiMion/bacUoy�preyentionAeviceLair.gap for:
-Stored properly,labeled properly,used properly-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-Pesticideslrotlenticides properly dispensed -Chemical dispensers -Ice machines
Proper drain for:
29 Water source adequate,safe. 4 -Food equipment -Dish machines -Ice machines
-Well I well head protected from contamination .)5 Toilet facilities. Adequate,convenient,accessible, 4
-Water quality in compliance-Monitoring in compliance designed,properly installed
OTHER ITEMS z
G KEY: DNC [DOES NOT COMPLY] Z
0
2 Sources of food: Original container,properly labeled 1 40 Garbagelrubbishstoragearea/rooms,enclosures-properly constructed,clean 1
5 Potentially hazardous food properly thawed 2 41 Garbage/rubbish disposed of in an approved manner,at approved frequency
10 Food dispensing utensils properly stored 1 42 Vermin Control: No insects/rodents present 2
14 Food worker:Clean outer clothes,effective hair restraints 1 43 Outeropenings protected against entrance of insects/rodents 1
4 Floors: Floor covering installed,constructed as required,good repair,clean 1
16 Food-contact surfaces designed,constructed, maintained,installed, 2 45 Floors graded,drained as required
located
- 46 Floor,wall juncture covered
1 nfood-contact surfaces designed,constructed, maintained, f 47 Mats removable,good repair,clean
installed,located
48 Exterior walking,driving surfaces,good repair,clean I
18 Single service articles,storage,dispensing 2
19 No reuse of single service article TM.Walls,ceilings attached,equipment properly constructed,good k
20 Dishwashing facilities approved design,adequately constructed, 2 repair,clean.Wall&ceiling surfaces as required
maintained installed located 50 Dustless cleaning methods used,cleaning equipment properly stored I
Equipment&Utensils: Cleanliness I 51 Adequate lighting provided as required I
1 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
27 _Nonfood-contact surfaces of utensils&equipment clean ( 1 55 Establishment and premisesfree oflitter,no insect/rodentharborage, 1
28 EquipmenUutensils,stnrage,handling 1 no unnecessary articles
32 Proper disposal of waste water 1 5 61 Complete separation from living/sleeping quarters and laundry 1
33 Plumbing location,installation,maintenance 1 57 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 I i<) Seats 75 or more:Nonsmoking area provided,sign(s)posted at
37 Proper toilet fixtures provided,good repair,clean 3
entrance(s),smoking area indicated by sign(s)
39 Approved garbage/rubbish containers,adequate number,covered, 1
rodent proof,clean 1WRoutine Inspection ❑Reinspection ❑ Preoperational Inspection
INSPECTOR: � PERSON IN CHARGE Other Inspection:
0en1wit :) oi'e: *Include demerits from page 1
E 4 3 2 1 Total Rating
signature g ature U
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Cla /er
pri t name rint name
t LEA
one number l�tle DATE CORRECTIONS DUE
Page 2 of 2 plus continuation pages r.w, -d 1-1,.,11,,,1,241111
Page of
INSPECTION REPORT STATE OF CONNECTICUT
FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH
CONTINUATION SHEET
NAME OF ESTABLISHMENT TOWN DATE OF IINSPECTION
INSPECTION REMARKS
FORM#
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INITIAL(INSPECTOR) ;` INITIAL(PERSON IN CHARGE) C
Distribution: Ist-White-Health Department 2nd-Yellow- Owner/Manager