HomeMy WebLinkAboutFood Establishment Inspection ReportsTOWN OF i ARMOUTH BOARD OF HEALTH
1146 ROUTE 28
FOOD ESTABLISHMENT INSPECTION REPORT SOUTH YARMOUTH,.MA 02664
Name 7
Print
f�
�G n�
Date
/��
j
Type of Operation(s)
Type of Inspection
Food Service
U Retail
❑ Residential Kitchen
El Mobile
Ll Temporary
Caterer
❑Bed &Breakfast
Permit No.
U Routine
U Re -inspection
Previous Inspection
Date:
I KPre-operation
U Suspect Illness
U General Complaint
U HACCP P
U Other
^'�
Address U Uv� ;��j
Telephone r 5v
Owner �J nG Cil fI-A `
�1
HACCPY/N
-Ll
Person in Charge (PIC)
Time
In.
Out:
Inspector , r �P ^
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 iinprked may pose an imminent health hazard and require immediate 590.009 (E) Cl 590.009 (F) ❑
corrective action as determined by the Board of Health.
FOOD PROTECTION MANAGEMENT ❑ 12. Prevention of Contamination from Hands
❑ 1. PIC Assigned / Knowledgeable / Duties ❑ 13. Handwash Facilities
EMPLOYEE HEALTH PROTECTION FROM CHEMICALS
❑ 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
❑ 4. Food and Water from Approved Source
❑ 5. Receiving/Condition
❑ 6. Tags/Records/Accuracy of Ingredient Statements
❑ 7. Conformance with Approved Procedures/HACCPPlans
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)viol ations marked must be corrected immediately
or within 10 days as determined bt-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
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
CONSUMER ADVISORY
❑ 22. 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:
Inspect Si ature
Print
f�
DESCRIPTION OF VIOLATION / PLAN OF CORRECTION Date
PLEASE PRINT CLEARLY Verified
PI 's.S gna a jf f
Piot
Page J__ of J_ Pages
cs�A
❑ Other
fno
0
Item
No.
Code C - Critical Item
Reference R - Red Item
DESCRIPTION OF VIOLATION / PLAN OF CORRECTION Date
PLEASE PRINT CLEARLY Verified
-C ly H rt j 7'0 L Yi n o
Disposal
❑ Other
fno
(�
S S
aQ.
i
� .Sty1
Sit ncsz
Discussion with Person in Charge:
Correction Action Required:
❑ No
L3 Yes
Ll Employee Restriction /
❑ Voluntary Compliance
P Exclusion
❑ Re -inspection Scheduled ❑ Emergency Suspension
❑ Embargo ❑ Emergency Closure
❑ Voluntary
Disposal
❑ Other