00000001TOWN OF YARMOUTH
FOOD ESTABLISHMENT INSPECTION REPORT
BOARD OF HEALTH
1146 ROUTE 28
SOUTH YARMOUTH, MA 02664
Name
Print r N
DESCRIPTION OF VIOLATION / PLAN OF CORRECTION Date
PLEASE PRINT CLEARLY Verified
PIC's Signa ur� t
Date
Type of Operation(s)
Type of Inspection
�1Food Service
� Routine
Address
wi
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�7U
r
U Retail
❑ Residential Kitchen
U Re -inspection
Previous Inspection
Telephone
rag 2 /
GG
T W 39
U Mobile
U Temporary
Date:
U Pre-operation
Owner
HACCPY/N
U Caterer
LJ Bed &Breakfast
U Suspect Illness
U General Complaint
U HACCP
Person in Charge (PIC) S
Time
In:
Inspector
.�
�a
Out:
Permit No.
U Other
Gaon-�S 6rs � �
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 Factors (Red Items) Non-compliance with:
Anti -Choking Tobacco
Violations marked may pose an imminent health hazard and require immediate 590.009 (E) ❑ 590.009 (F) ❑
corrective action as determined by the Board of Health.
FOOD PROTECTION MANAGEMENT W, Prevention of Contamination from Hands
❑ 1. PIC Assigned / Knowledgeable / Duties ❑ 13. Handwash Facilities
EMPLOYEE HEALTH
❑ 2. Reporting of Diseases by Food Employee and PIC
❑ 3. Personnel with Infections Restricted/Excluded
FOOD FROM APPROVED SOURCE
❑ 4. Food and Water from Approved Source
❑ 5. Receiving/Condition
❑ 6. Tags/Records/Accuracy of Ingredient Statements
❑ 7. Conformance with Approved Procedures/HACCP Plans
PROTECTION FROM CONTAMINATION
❑ 8. Separation/Segregation/Protection
❑ 9. Food Contact Surfaces Cleaning and Sanitizing
❑ 10. Proper Adequate Handwashing
❑ 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
PROTECTION FROM CHEMICALS
❑ 14. Approved Food or Color Additives
❑ 15. Toxic Chemicals
TIME/TEMPERATURE CONTROLS (Potentially Hazardous Foods)
❑ 16. Cooking Temperatures
❑ 17. Reheating
❑ 18. Cooling
❑ 19. Hot and Cold Holding
❑ 20. Time as a Public Health Control
REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS (HSP)
❑ 21. Food and Food Preparation for HSP
CO UMER ADVISORY
2. Posting of Consumer Advisories
Number of Violated Provisions Related to
Foodborne Illnesses Interventions and Risk
Factors (Red Items 1-22):
Official Orderfor 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:
InspS Efo s ignature
Print r N
DESCRIPTION OF VIOLATION / PLAN OF CORRECTION Date
PLEASE PRINT CLEARLY Verified
PIC's Signa ur� t
Print,
Page 1_ of L Pages
Item
No.
Code C -Critical Item
Reference R - Red Item
DESCRIPTION OF VIOLATION / PLAN OF CORRECTION Date
PLEASE PRINT CLEARLY Verified
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Disposal
❑ Other
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Discussion with Person in Charge:
Correction Action Required:
❑ No
❑Yes
❑ Voluntary Compliance ❑ Employee Restriction /
Exclusion
O Re -inspection Scheduled ❑ Emergency Suspension
❑ Embargo ❑ Emergency Closure
❑ Voluntary
Disposal
❑ Other