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TOWN OF YARMOUTH BOARD OF HEALTH
1146 ROUTE 28
FOOD ESTABLISHMENT INSPECTION REPORT SOUTH YARMOUTH, MA 02664
Name- S k0 AO
Date
Type of Operation(s)
Type of Inspection
U Food Service
*Routine
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❑ 12. Prevention of Contamination from Hands
Address S i , � U # �7
Y
� Retail
❑ Residential Kitchen
U Re -inspection
Previous Inspection
Tele hone
P
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❑ Mobile
❑ Temporary
Date:
❑ Pre-operation
Owner
HACCP YIN
❑ 16. Cooking Temperatures
❑ 5. Receiving/Condition
❑ Caterer
❑Bed &Breakfast
Permit No.
U Suspect Illness
U General Complaint
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U HACCP
U Other
Person in Charge (PIC)
Time
In: 7.,30
Out:
Inspector �� ��
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
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
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
❑ 21. Food and Food Preparation for HSP
❑ 10. Proper Adequate Handwashing
CONSUMER ADVISORY
❑ 11. Good Hygienic Practices
❑ 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/
C 1./
23. Management and Personnel (FC -2)(590.003)
federal Food Code. This report, when signed below by a
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Board of Health member or its agent constitutes an order of
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24. Food and Food Protection (FC -3)(590.004)
the Board of Health. Violations not corrected are subject to
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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
--1
27. Physical Facility (FC -6)(590.007)
in writing and submitted to the Board of Health atthe above
\ Poisonous or Toxic Materials (FC -7)(590.008)
address within 10 days of receipt of this order.
'-Requirements (590.009)
DATE OF RE -INSPECTION:
�.' Print
60 .. .
Page ? of Pages
Item
No.
Code
Reference
C -Critical Item DESCRIPTION OF VIOLATION / PLAN OF CORRECTION Date
R - Red Item PLEASE PRINT CLEARLY Verified
Disposal
❑ Other
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Discussion with Person in Charge:
Correction Action Required:
❑ No
� Yes
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❑ Employee Restriction!
-CEJ Voluntary Compliance Exclusion
'6 Re -inspection Scheduled ❑ Emergency Suspension
❑ Embargo ❑ Emergency Closure
❑ Voluntary
(
Disposal
❑ Other