HomeMy WebLinkAboutFood Establishment Inspection ReportsTOWN
BOARD OF HEALTH
OF i ARMOUTH
1146 ROUTE 28
FOOD ESTABLISHMENT INSPECTION REPORT
SOUTH YARMOUTH, MA 02664
Name ; T� k'� N) �t t1t 7
Date
Q /
;
Type of Operation(s)
Type of Inspection
Food Service
U Retail
U Residential Kitchen
U Mobile
U Temporary
U Caterer
U Bed 8 Breakfast
Routine
U Re -inspection
Previous Inspection
Date:
U Pre-operation
U Suspect Illness
U General Complaint
U HACCP
Address
Telephone
Owner
HACCP Y/N
Person in Charge (PIC) h /i`l�
Time
In:
Inspector Y ;t' -t h - ,, �
Out:
Permit No.
U Other____
Each violation checked requires an explanation on the narrative page(s) and a
citation of specific provision(s) violated.
Non-compliance with:
Violations Related to Foodborne Illness Interventions and Risk Factors (Red Items) Anti -Choking Tobacco
Violations marked may pose an imminent health hazard and require immediate
590.009 (E) U 590.009 (F) J
corrective action as determined by the Board of Health.
FOOD PROTECTION MANAGEMENT
❑ 1. PIC Assigned / Knowledgeable / Duties
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)
?4. 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. 011a r `Ni�C
❑ 12. Prevention of Contamination from Hands
❑ 13. Handwash Facilities
PROTECTION FROM CHEMICALS
❑ 14. Approved Food or Color Additives
❑ 15. Toxic Chemicals
TIMEITEMPERATURE 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:
Inspector% -&gnat
Print t Q
C -Critical Item
R - Red Item
PIC's Si 9 nature a
Print
Pag`{ of APages
Pagel-
-
Item
No.
Code
Reference
C -Critical Item
R - Red Item
DESCRIPTION OF VIOLATION / PLAN OF CORRECTION Date.
PLEASE PRINT CLEARLY Verified
Disposal
e
'Tv,
S - 1500 +(2 25P ram
Zy-
%". `i "Jct
' O
Te"
�-
tic-
�M i 6 uKJ
Discussion with Person in Charge:
Corr tion Action Required:
❑ No
Ye -
❑s
Cl Employee Restriction /
❑ Volunta Com liance
rY P Exclusion
❑ Re -inspection Scheduled U Emergency Suspension
❑ Embargo ❑ Emergency Closure
CI Voluntary
Disposal
❑ Other
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