HomeMy WebLinkAboutFood Establishment Inspection ReportsTOWN OF YARMOUTH BOARD OF HEALTH
1146 ROUTE 28
FOOD ESTABLISHMENT INSPECTION REPORT SOUTH YARMOUTH, MA 02664
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Name
Date
Type of Operation(s)
Type of Inspection
U Food Service
td Retail
Ll Residential Kitchen
� Routine
U Re -inspection
PreviDate: Inspection
G
Address _Z� ���
�
/
❑ 1. PIC Assigned / Knowledgeable / Duties
Telephone
EMPLOYEE HEALTH
LI Mobile
❑ Temporary
❑ Pre-operation
Owner
HACCP Y/N
0 15. Toxic Chemicals
FOOD FROM APPROVED SOURCE
❑ Caterer
❑ Bed &Breakfast
Permit No.
❑ Suspect Illness
U General Complaint
U HACCP
❑ Other
Person in Charge (PIC)
Time
In. (0. yp
Out:
Inspector {
; (j
❑ 18. Cooling
❑ 7. Conformance with Approved Procedures/HACCP Plans
❑ 19. Hot and Cold Holding
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.
PIC's Signature
FOOD PROTECTION MANAGEMENT
Cl 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
0 15. Toxic Chemicals
FOOD FROM APPROVED SOURCE
TIME/TEMPERATURE CONTROLS (Potentially Hazardous Foods)
❑ 4. Food and Water from Approved Source
O 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
Cl 8. Separation/Segregation/Protection
REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS (HSP)
❑ 9. Food Contact Surfaces Cleaning and Sanitizing
❑ 21. Food and Food Preparation for HSP
❑ 10. Proper Adequate Handwashing
CONSUMER ADVISORY
❑ 11. Good Hygienic Practices
0 22. Posting of Consumer Advisories
Violations Related to Good Retail Practices (Blue Items)
Number of Violated Provisions Related to
Critical (C) violations marked must be corrected immediately
Foodborne Illnesses Interventions and Risk
or within 10 days as determined by the Board of Health.
Factors (Red Items 1-22):
Non-critical (N) violations must be corrected immediately
or within 90 days as determined by the Board of Health.
Official Order for Correction: Based on an inspection today,
C N
the items checked indicate violations of 105 CMR 590.000/
23. Management and Personnel (FC -2)(590.003)
federal Food Code. This report, when signed below by a
Board of Health member or its agent constitutes an order of
24. Food and Food Protection (FC -3)(590.004)
the Board of Health. Violations not corrected are subject to
25. Equipment and Utensils (FC -4)(590.005)
fines per Yarmouth Board of Health. If aggrieved by this
26. Water, Plumbing and Waste (FC -5)(590.006)
order, you have a right to a hearing. Your request must be
27. Physical Facility (FC -6)(590.007)
in writing and submitted to the Board of Health atthe above
28. Poisonous or Toxic Materials (FC -7)(590.008)
address within 10 days of receipt of this order.
29. Special Require ents (590.009)
DATE OF RE -INSPECTION:
30. Other ! `s
Inspector's Signature _
Print
vl
PIC's Signature
Pri
D Other
U !
Page 0 of Pages
. I t
Item Code C -Critical Item DESCRIPTION OF VIOLATION / PLAN OF CORRECTION Date
No. Reference R - Red Item PLEASE PRINT CLEARLY Verified
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Discussion with Person in Charge: Correction Action Required: ❑ No Yes
❑ Voluntary Compliance ❑ Employee Restriction /
P Exclusion
❑ Re -inspection Scheduled ❑ Emergency Suspension
❑ Embargo O Emergency Closure
❑ Voluntary
Disposal
D Other
TOWN OF YARMOUTH BOARD OF HEALTH
1146 ROUTE 28
FOOD ESTABLISHMENT INSPECTION REPORT SOUTH YARMOUTH, MA 02664
Name
�� }
C nD S
Date
3
113
Type of Operation(s)
Type of Inspection
U Food Service
U Retail
❑ Residential Kitchen
❑ Mobile
❑ Temporary
❑ Caterer
LJ Bed &Breakfast
Permit No.
U Routine
U Re -inspection
Previous Inspection
Date:
❑ Pre-operation
U Suspect Illness
U General Complaint
U HACCP
❑ Other
Address 12-2, S xSH
Telephone n�[p�
C570e) '% G "" -3 j O -IO
Owner
HACCPY/N
Person in PIC
Charge (PIC) , \-),q(2/Ql j^
Time
In:
Out:
Inspector- l --�
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 ❑ 12. 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
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:
Inspect i atu e
Print -)
C - Critical Item
R - Red Item
PIC's,Signature / C
,\ �� c,
Page of j Pages
Item
No.
Code
Reference
C - Critical Item
R - Red Item
DESCRIPTION OF VIOLATION / PLAN OF CORRECTION Date
PRINT CLEARRL,Y" Verified
Disposal
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Discussion with Person in Charge:
Correction Action Required:
❑ No
❑Yes
❑ Voluntary Compliance ❑ Exclusyon Restriction /
❑ Re -inspection Scheduled ❑ Emergency Suspension
❑ Embargo ❑ Emergency Closure
❑ Voluntary
Disposal
❑ Other