HomeMy WebLinkAboutInspection Forms Food Establishment Inspection Report - Town of Yarmouth Yarmouth Board Health
28
p p 1146 Route.28,South Yarmouth,MA 02664
Establishment: / t 11G.2SC 'P ,,,i 1 IPS=Date: w NEMEMIMIZMIEMI
Address: C
_ _��r a Time in: Time out:
Telephone: A Permit No.: Number of Violated Provisions Related
to Foodborne Illness Risk Factors
Owner: and Interventions(Items 1 through 29):
Person-in-charge: Number of Repeat Violations Related
p �� �, to Foodborne Illness Risk Factors
Inspector: and Interventions(Items 1 through 29):
,r pe of Operation(s): Type of Inspection: Other Information:
Food Service Establishment O Routine
O Retail Food Store D Re-inspection
O Residential:Cottage Foods ASCPre-operational
O Residential;Bed& 0 Illness investigation 1
Breakfast D General complaint J
O Mobile/Pushcart D HACCP 111111
D Temporary Food Estab. O Other 4- � t i.
0 Other n
FOODBORNE ILLNESS RISK FACTORS AND PUBLIC HEALTH INTERVENTIONS 5 POINTS
IN=in compliance OUT=outs of compliance N/O=not observed N/A=not applicable COS=corrected on-site during inspection R=repeat violation Status tatus IN OUT N/A N/O COS R Compliance Status IN OUT N/A N/O COS R
Supervision Protection from Contamination
1 Person-in-charge present, demonstrates 15 Food separated and protected iki
knowledge, and performs duties V/ 16 Food-contact surfaces; cleaned &
2 Certified Food Protection Manager sanitized
Employee Health Proper disposition of returned,
Management, food employee and f 17 previously served, reconditioned &
3 conditional employee; knowledge, J _unsafe food
responsibilities and reporting j __ Time/Temperature Control for Safety/
4 Proper use of restriction and exclusion i/ 18 Proper cooking time & temperatures
Procedures for responding to vomiting ,f 19 Proper reheating procedures for hot til
5 and diarrhea) events v holding
Good Hygienic Practices / 20 Proper cooling time and temperature i. i
Proper eating, tasting, drinking, or 21 Proper hot holding temperature y/
6 tobacco use 22 Proper cold holding temperature ‘,/,7 No discharge from eyes, nose, and 23 Proper date marking and disposition /,
mouth
Preventing Contamination by Hands 24 Time as a Public Health Control
8 Hands clean & properly washed Consumer Advisory
No bare hand contact with ready-to-eat 25IConsumer advisory provided for raw/ .
9 food (undercooked food
Adequate handwashing sinks properly Highly Susceptible Populations
10 Pasteurized foods used; prohibited foods
supplied and accessible 26
Approved Source not offered
_ Food/Color Additives and Toxic Substances
11 Food obtained from approved source
Food additives: approved & properly
12 Food received at proper temperature 27
used
Food received in good condition, safe, &
13 unadulterated 28 Toxic substances properly identified,
Required records available: shellstock stored & used
14 Conformance with Approved Procedures
tags, parasite destruction ---1 with variance/specialized
process/ HACCP Plan
GOOD RETAIL PRACTICES AND MASSACHUSETTS-ONLY SECTIONS 2 POINTS
IN=in compliance OUT=out of compliance N/O=not observed N/A=net Il:pr cable COS=corrected on-site during inspection R=repeat violation
Compliance Status IN OUT N/A N/O co::I a Compliance Status
1OUTI N/A N/0 COS R
Safe Food and Water 48 Warewashing facilities: installed,
Pasteurized eggs used where maintained, & used; test strips
30 required r 49 Non-food contact surfaces clean
31 Water& ice from approved source Physical`Facilities
32 Variance obtained for specialized �. 50 Hot&cold water available;
processing methods adequate pressure
Food Temperature Control % 51 Plumbing installed; proper backflow
Proper cooling methods used; devices
33 adequate equipment for 52 Sewage &waste water properly
temperature control disposed
34 Plant food properly cooked for hot 53 Toilet features: properly
holding constructed, supplied, & cleaned
35 Approved thawing methods used 54 Garbage & refuse properly
36 Thermometers provided & accurate i disposed; facilities maintained
Food Identification 55 Physical facilities installed,
Food properly labeled; original maintained, & clean
37 container ® ® 56 Adequate ventilation & lighting;
Prevention of Food Contamination designated areas used
Insects, rodents, & animals not Additional Requirements listed in 105 CMR 590.011
38 presentM1 service
gce establishment procedures in food
i
Contamination prevented during II"
39 food preparation, storage and M2 Food allergy awareness
display Review of Retail Operations listed in 105 CMR 590.010
40 Personal cleanliness M3 Caterer
•
Wiping cloths: properly used & M4 Mobile Food Operation
41 stored
M5 Temporary Food Establishment
42 Washing fruits &vegetables M6 Public Market; Farmers Market
Proper Use of Utensils Residential Kitchen; Bed-and-
M743 In-use utensils properly stored Breakfast Operation
44 Utensils, equipment & linens: M8 Residential Kitchen: Cottage Food
properly stored, dried, & handled Operation
45 Single-use/single-service articles: M9 School Kitchen; USDA Nutrition
properly stored & used Program
46 Gloves used properly M10 Leased Commercial Kitchen
Utensils,Equipment and Vending M11 Innovative Operation t
Food & non-food contact surfaces ■ Local Requirements
47 cleanable, properly designed, L1 Local law or regulation
constructed & used L2 Other I It
Official Order for Correction: Based on an inspection today, the items marked"OUT" indicated violations of 105 CMR 590.000 and
applicable sections of the 2013 FDA Food Code. This report, when signed below by a Board of Health member or its agent constitutes
an order of the Board of Health. Failure to correct violations cited in this report may result in suspension or revocation of the food
establishment permit and cessation of food establishment operations. If you are subject to a notice of suspension, revocation, or non-
renewal pursuant to 105 CMR 590.000 you may request a hearing before the board of health in accordance with 105 CMR 590.015(B).
Date of Reinspection: Discussion with Person-in-Charge:
Signature of Person-in-Charg.L'
, Date-
i e� 1
Signature I.-pe ,: r !- .t• •a
MDPH repo form-10/5/18 ersion /
Food Establishment Inspection Report - Town of Yarmouth
Establishment: ,_/2�-y- Avc.)SF (%, Date: /--231 / Page of
Temperature Observations
Item I Location Temp(°F) Item I Location _ i Temp(°F) Item I Location Temp(°F)
Observations and/or Corrective Actions
Violations cited in this report must be corrected within the time frames stated below or in Section 8-405.11 of the Food Code
Item Section of Code Description of Violation Date to Correct By
Number
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Signature ofPerson-in-Charge: Date: 2?
Signature of Inspector:
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