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O u�i OO � Df� LX�O a ODOO U �z° � � � a TOWN OF YARMOUTH FOOD ESTABLISHMENT INSPECTION REPORT BOARD OF HEALTH 1146 ROUTE 28 SOUTH YARMOUTH, MA 02664 Name -f t•' i; u:, fp n y Dat Type of Operations) Type of Inspection u Food Service ✓Retail Routine i tj E' j�j , " ,Ir �r 1;1 j''t t k ►1 r f - of sp I !�I Address( t, elv U Residential Kitchen U Re -inspection Previous Inspection Telephone U Mobile U Temporary U Pre-operation Owner HACCPY/N R GJ;✓✓ fry r)o U Caterer U Bed & Breakfast U Suspect Illness U General Complaint U HACCP Person in Charge (PIC) Time In: Inspector �Ivi i�� ISI Out: Permit No. U Other______ -Nj,[I 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 O 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/Condifion 0 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)(590.0061 27. Physical Facility (FC -6)(590.007) 28. Poisonous or Toxic Materials (FC -7)(590.008) 29. Special Requirements (590.009) 30. Other ❑ 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 0 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 O 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: Inspector's Signature,"-', Print C -Critical Item R - Red Item PIC's Signature i L ` ! Print _ t ` Page 4_ of Pages Disposal C] Other i tj E' j�j , " ,Ir �r 1;1 j''t t k ►1 r f - of sp Item No. Code Reference C -Critical Item R - Red Item DESCRIPTION OF VIOLATION / PLAN OF CORRECTION PLEASE PRINT CLEARLY Date Verified Disposal C] Other i tj E' j�j , " ,Ir �r 1;1 j''t t k ►1 r f - of sp .� n" Jlsa�t� 1 l i I✓l e R GJ;✓✓ fry r)o Ca Cir% Discussion with Person in Charge: Correction Action Required: ❑ No ❑Yes El Voluntary Compliance ❑ Employee Restriction / P Exclusion ❑ Re -inspection Scheduled U Emergency Suspension ❑ Embargo ❑ Emergency Closure LI Voluntary Disposal C] Other TOWN OF YARMOUTH FOOD ESTABLISHMENT INSPECTION REPORT BOARD OF HEALTH 1146 ROUTE 28 SOUTH YARMOUTH, MA 02664 Name Date Type of Operationfsl Type of Inspection U Food Service Routine �i Address )y ),4 )d -Retail U Residential Kitchen U Re -inspection Previous Inspection Tel phone g U Mobile U Temporary r U Caterer r Date: U Pre-operation U Suspect Illness Owner HACCPY/N Person in Charge (PIC) Time In: U Bed Breakfast U General Complaint U HACCP Inspector Out: Permit No. U Other_ Each violation cheolfed 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) a 590.009 (F) I corrective action as determined by the Board of Health. FOOD PROTECTION MANAGEMENT 0 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 O 8. Separation/Segregation/Protection ❑ 9. Food Contact Surfaces Cleaning and Sanitizing 0 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. Q14er ❑ 12. Prevention of Contamination from Hands 13. Handwash Facilities a K, PROTECTION FROM CHEMICALS 0 14. Approved Food or Color Additives ❑ 15. Toxic Chemicals TIME/TEMPERATURE CONTROLS (Potentially Hazardous Foods) O 16. Cooking Temperatures ❑ 17. Reheating ❑ 18. Cooling 0 19. Hot and Cold Holding ❑ 20. Time as a Public Health Control REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS (HSP) O 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: '? Item Code C -Critical Item DESCRIPTION OF VIOLATION / PLAN OF CORRECTION Date No. Reference R - Red Item I PLEASE PRINT CLEARLY I Verified l SV Correction Action Required: ❑ No 70 4&1,44Z - ❑ Voluntary Compliance ❑ Exclusion Restriction / ❑ Re -inspection Scheduled U Emergency Suspension ❑ Embargo ❑ Emergency Closure U Voluntary Disposal ❑ Other Cn� C 'sS F77c� Ste_ 4�` � CSC %O:,c�rCQ 4e�; %Y 71171IF-2-Z L-24, Discussion with Person in Charge: Correction Action Required: ❑ No ❑ Yes - ❑ Voluntary Compliance ❑ Exclusion Restriction / ❑ Re -inspection Scheduled U Emergency Suspension ❑ Embargo ❑ Emergency Closure U Voluntary Disposal ❑ Other