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HomeMy WebLinkAboutFood Establishment Inspection FormsTOWN OF YARMOUTH BOARD OF HEALTH 1146 ROUTE 28 FOOD ESTABLISHMENT INSPECTION REPORT SOUTH YARMOUTH, MA 02664 NameDate G� Type of Operation(s) Type of Inspection U Food Service A Retail ❑ Residential Kitchen ❑Mobile LJ Temporary ❑ Caterer ❑Bed &Breakfast Permit No. �d Routine U Re -inspection Previous Inspection Date: Ll Pre-operation U Suspect Illness U General Complaint LI HACCP ❑ Other_ Address S Telephone <�i� 3g - G Owner V S/r/�< Sy>L �d HACCP Y/N PIC Person in Charge 9 (PIC) � Time In: 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 ❑ 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/HACCPPlans 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 (F(3-3)(590.004; 25. Equipment and Utensils (FC -4)(590.005; 26. Water, Plumbing and Waste (FC -5)(590.006; 1 27. Physical Facility (FC -6)(590.007; 28. Poisonous or Toxic Materials (FC -7)(590.008; 29. Special Requirements (590.009) 0 \ 30. ©th27 -rrA-sr, PROTECTION FROM CHEMICALS ❑ 14. Approved Food or Color Additives ❑ 15. Toxic Chemicals TIME/TEMPERATURE CONTROLS (Potentially Hazardous Foods) ❑ 16. Cooking Temperatures Cl 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 Cl 22. Posting of Consumer Advisories Number of Violated Provisions Related to Foodborne Illnesses Interventions and Risk O 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' 'gn ture AA �J Print In C - Critical Item R - Red Item PI Signature I i� Print Page /of Pages t Item No. Code Reference C - Critical Item R - Red Item DESCRIPTION OF VIOLATION / PLAN OF CORRECTION Date PLEASE PRINT CLEARLY Verified Disposal /U26 e-1-- A<, A - 3' t ZZ wAs 2, --G SCI_ cy �./ - s - i r �- CW L c) "'' - - O L. ' Gtt s l.G IF GC �G�S GaG Discussion with Person in Charge: Correction Action Required: ❑ No ❑Yes El Employee Restriction / Ll Voluntary Compliance Exclusion ❑ Re -inspection Scheduled ❑ Emergency Suspension ❑ Embargo ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other