HomeMy WebLinkAboutTobacco Sales CheckTOWN OF YARMOUTH BOARD OF HEALTH
1146 ROUTE 28
FOOD ESTABLISHMENT INSPECTION REPORT SOUTH YARMOUTH, MA 02664
Name 1) lie, ,.R r
Date
TypeofOoeration(s)
Type of Inspection
U Food Service
Routine
�i YO
_> /
FOOD PROTECTION MANAGEMENT
Address C.f�` "11�r y4
f j eft
Retail
U Residential Kitchen
U Re inspection
Previous Inspection
PROTECTION FROM CHEMICALS
Telephone
0 14. Approved Food or Color Additives
U Mobile
U Temporary
Date:
U Pre-operation
Owner
HACCPY/N
❑ 4. Food and Water from Approved Source
❑ 16. Cooking Temperatures
U Caterer
U Bed & Breakfast
Permit No.
U Suspect Illness
U General Complaint
J HACCP
U Other____ _
Person in Charge (PIC)
Time
In:
Out:
Al
Inspector `U ,i i � Dtiii (f 7 ;
Each violation checked requires an explanation on the narrative page(s) and a citation of specific provision(s) violated.
Print ,fes �e
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) U
corrective action as determined by the Board of Health.
Print 7 ,,i
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
0 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/Conddion
❑ 17. Reheating
❑ 6. Tags/Records/Accuracy of Ingredient Statements
❑ 18. Cooling
❑ 7. Conformance with Approved Procedures/HACCP Plans
O 19. Hot and Cold Holding
PROTECTION FROM CONTAMINATION
❑ 20. Time as a Public Health Control
❑ 8. SeparatiordSegregation/Protection
REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS (HSP)
❑ 9. Food Contact Surfaces Cleaning and Sanitizing
O 21. Food and Food Preparation for HSP
❑ 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)(590.000
28. Poisonous or Toxic Materials (FC -0(590.008)
29. Special Requirements (590.009)
30. Other
CONSUMER ADVISORY
❑ 22. Posting of Consumer Advisories
Number of Violated Provisions Related to
Foodborne Illnesses Interventions and Risk
Factors (Red Items 1-22):
OfficialOrder 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 Signatures
Print ,fes �e
C - Critical Item
R - Red Item
DESCRIPTION OF VIOLATION / PLAN OF CORRECTION
PLEASE PRINT CpLEAALY
Date
Verified
PIC's Signature / ' �%�:
Print 7 ,,i
Page I_ of �. Pages
,l.
Item
No.
Code
Reference
C - Critical Item
R - Red Item
DESCRIPTION OF VIOLATION / PLAN OF CORRECTION
PLEASE PRINT CpLEAALY
Date
Verified
Disposal
❑ Other
?e
�? vov-,ed V cr - or
L
�
Discussion with Person in Charge:
Correction Action Required:
❑ No
LJ Yes
El Employee Restriction /
Ll Voluntary Compliance Exclusion
❑ Re -inspection Scheduled U Emergency Suspension
❑ Embargo ❑ Emergency Closure
CI Voluntary
Disposal
❑ Other