HomeMy WebLinkAboutFood Establishment Inspection ReportTOWN OF YARMOUTH BOARD OF HEALTH
1146 ROUTE 28
FOOD ESTABLISHMENT INSPECTION REPORT SOUTH YARMOUTH, MA 02664
Name_ �, +i
Date
9IJ."Food
Type of Operation(s)
Type of Inspection
Service
Q,Routine
PIC's Signature
Address LTJ
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i1
LI Retail
U Residential Kitchen
U Re -inspection
Previous Inspection
EMPLOYEE HEALTH
Telephone
p
Lf 2. Reporting of Diseases by Food Employee and PIC
U Mobile
U Temporary
U Caterer
❑Bed &Breakfast
Date:
U Pre-operation
U Suspect Illness
U General Complaint
Owner
HACCP Y/N
Person in Char PIC
a
9 (PIC)
Time
❑ 16. Cooking Temperatures
In:
Out:
Permit No.
U HACCP
U Other
Inspector 7 \t �` ,-
Each violation checked requires an explanation on the narrative page(s) and a citation of specific provision(s) violated.
Violations Related to Foodborne Illness Interventions and Risk
Non-compliance with:
Factors (Red Items) Anti -Choking Tobacco
Violations marked may pose an imminent health hazard and
require immediate 590.009 (E) J 590.009 (F) U
corrective action as determined by the Board of Health.
PIC's Signature
FOOD PROTECTION MANAGEMENT
❑ 12. Prevention of Contamination from Hands
U 1. PIC Assigned / Knowledgeable / Duties
❑ 13. Handwash Facilities
EMPLOYEE HEALTH
PROTECTION FROM CHEMICALS
Lf 2. Reporting of Diseases by Food Employee and PIC
❑ 14. Approved Food or Color Additives
❑ 3. Personnel with Infections Restricted/Excluded
❑ 15. Toxic Chemicals
FOOD FROM APPROVED SOURCE
TIME/TEMPERATURE CONTROLS (Potentially Hazardous Foods)
❑ 4. Food and Water from Approved Source
❑ 16. Cooking Temperatures
❑ 5. Receiving/Condition
❑ 17. Reheating
❑ 6. Tags/Records/Accuracy of Ingredient Statements
❑ 18. Cooling
❑ 7. Conformance with Approved Procedures/HACCP Plans
❑ 19. Hot and Cold Holding
PROTECTION FROM CONTAMINATION
❑ 20. Time as a Public Health Control
❑ 8. Separation/Segregation/Protection
REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS (HSP)
❑ 9. Food Contact Surfaces Cleaning and Sanitizing
P AdH d h
❑ 21. Food and Food Preparation for HSP
❑ 10. roper equate an was iIng
❑ 11. Good Hygienic Practices
Violations Related to Good Retail Practices (Blue Items)
Critical (C) violations marked must be corrected immediately
or within 10 days as determined by the Board of Health.
Non-critical (N) violations must be corrected immediately
or within 90 days as determined by the Board of Health.
C N
23. Management and Personnel (FC -2)(590.003)
24. Food and Food Protection (FC -3)(590.004)
25. Equipment and Utensils (FC -4)(590.005)
26. Water, Plumbing and Waste (FC -5)(590.006)
27. Physical Facility (FC -6)(590.007)
28. Poisonous or Toxic Materials (FC -7)(590.008)
29. Special Requirements (590.009)
30. Other
CONSUMER ADVISORY
❑ 22. Posting of Consumer Advisories
Number of Violated Provisions Related to
Foodborne Illnesses Interventions and Risk
Factors (Red Items 1-22):
Official Order for Correction: Based on an inspection today,
the items checked indicate violations of 105 CMR 590.000/
federal Food Code. This report, when signed below by a
Board of Health member or its agent constitutes an order of
the Board of Health. Violations not corrected are subject to
fines per Yarmouth Board of Health. If aggrieved by this
order, you have a right to a hearing. Your request must be
in writing and submitted to the Board of Health at the above
address within 10 days of receipt of this order.
DATE OF RE -INSPECTION:
Inspector's ature
Print
PIC's Signature
,.�.
Print
/ /I/
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Page of Pages
Item Code C - Critical Item DESCRIPTION OF VIOLATION / PLAN OF CORRECTION Date
No. Reference R - Red Item PLEASE PRINT CLEARLY Verified
C'Tv� Gi i.✓) fa rr i4 S5 LI", .-
� �F��t C✓ � � C7
LA-,'
Ct L 1 G_t -c-
Discussion with Person in Charge: Correction Action Required: ❑ No ❑Yes
L) Voluntary Compliance El Employee Restriction /
P Exclusion
❑ Re -inspection Scheduled ❑ Emergency Suspension
❑ Embargo ❑ Emergency Closure
❑ Voluntary
Disposal
❑ Other