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Food Establishment Inspection Report 1146 R- Town of Yarmouth 1146 R Board o thalth
pouu Board
28,South Yarmouth,MA 02664
Establishment: „ (i/t<y�)At- Date: "/� :i Page 1 of .�2. -
Address: jig6ww r Time in: Time out:
/
Telephone: Permit No.: Number of Violated Provisions Related
to Foodborne Illness Risk Factors
Owner: Tie ,c, 1 and Interventions(Items 1 through 29):
Person-in-char e: Number of Repeat Violations Related
9
to Foodborne Illness Risk Factors
Inspector: f i t ( Q^,-- -/ and Interventions(Items 1 through 29):
Type of Operation(s): Type of Inspection: Other Information:
57.Food Service Establishment O Routine
t Retail Food Store O Re-inspection / !�
O Residential:Cottage Foods I:(Pre-operational 4370.41
O Residential;Bed& 0 Illness investigation
Breakfast 0 General complaint
0 Mobile/Pushcart O HACCP
0 Temporary Food Estab. 0 Other /�/� ,/�•�.
0 Other DC7/�-406-/tom
FOODBORNE ILLNESS RISK FACTORS AND PUBLIC HEALTH INTERVENTIONS 5 POINTS
IN=in compliance OUT=out of compliance N/O=not observed N/A=not applicable COS=corrected on-site during inspection R=repeat violation
Compliance Status INOUT N/A N/O COS R Compliance Status IN OUT N/A N/O COS R
Supervision Protection from Contamination j
1 Person-in-charge present, demonstrates v 15 Food separated and protected v
knowledge, and performs duties 16 Food-contact surfaces; cleaned &
2 Certified Food Protection Manager if sanitized , Av
Employee Health Proper disposition of returned,
Management, food employee and 17 previously served, reconditioned &
3 conditional employee; knowledge, unsafe food
responsibilities and reporting Time/Temperature Control for Safety
4 Proper use of restriction and exclusion 18 Proper cooking time&temperatures
5 Procedures for responding to vomiting /' 19 Proper reheating procedures for hot
`
and diarrheal events . holding
Good Hygienic Practices 20 Proper cooling time and temperature _
6 Proper eating, tasting, drinking, or 21 Proper hot holding temperature ,„,r'
tobacco use +*r
No discharge from eyes, nose, and 22 Proper cold holding temperature
7 mouth 23 Proper date marking and disposition
Preventing Contamination by Hands 24 Time as a Public Health Control y,'
8 Hands clean & properly washed v, Consumer Advisory
No bare hand contact with ready-to-eat 25 Consumer advisory provided for raw/ .
9 food undercooked food
10 Adequate handwashing sinks properly / Highly Susceptible Populations
supplied and accessible „` 26 •
Pasteurized foods used; prohibited foods
Approved Source not offered
11 Food obtained from approved source Food/Color Additives and Toxic Substances
12 Food received at proper temperature 7 27 Food additives: approved & properly
, used
13 Food received in good condition, safe, & .� Toxic substances properly identified,
unadulterated 28
stored & used
14 Required records available: shellstock Conformance with Approved Procedures
tags, parasite destruction k-z.�v t-
r11� 29 Compliance 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=not applicable COS=corrected on-site during inspection R=repeat violation
Compliance Status I IN IOUT N/A IN/O ICOS I R Compliance Status
1OUTIN/AIN/OICOS R
Safe Food and Water 48 Warewashing facilities: installed,
30 Pasteurized eggs used where maintained, & used; test strips
4
required 49 Non-food contact surfaces clean
31 Water& ice from approved source Physical Facilities
32 Variance obtained for specialized Hot& cold water available;
processing methods 50 adequate pressure
Food Temperature Control51 Plumbing installed; proper backflow
Proper cooling methods used; devices
33 adequate equipment for52 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 Garbage& refuse properly
36 Thermometers provided & accurate 54 disposed; facilities maintained
Food Identification 55 Physical facilities installed,
IVFood properly labeled; original maintained, & clean
37II
container ® 56 Adequate ventilation & lighting;
Prevention of Food Contamination designated areas used
38 Insects, rodents, & animals not Additional Requirements listed in 105 CMR 590.011
Hit
present M1 Anti-choking procedures in food
Contamination prevented during service establishment
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 J
41 Wiping cloths: properly used & M4 Mobile Food Operation I
stored M5 Temporary Food Establishment /
42 Washing fruits & vegetables M6 Public Market; Farmers Market t
Proper Use of Utensils M7 Residential Kitchen; Bed-and-
43 In-use utensils properly stored Breakfast Operation
44 Utensils, equipment& linens: M8
properly stored, dried, & handled Operation
Residential Kitchen: Cottage Food j
45 Single-use/single-service articles: M9 School Kitchen; USDA Nutrition
l
46 Gloves used properly M10 Leased Commercial Kitchen t
properly stored & used Program
Utensils,Equipment and Vending M_ 11 Innovative Operation
Food & non-food contact surfaces ® ® _ Local Requirements
47 cleanable, properly designed, L1 Local law or regulation
constructed & used LO_ttzer n � •
Official Order for Correction: Based on an inspection today, the items marked"OUT"indicat d violations of 105 CMR 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-Charge:• -
Date:
Signature of 1 •- torn
MDPH report forth-X10 /5/113 ver t' y i
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Food Establishment Inspection Report - Town of Yarmouth
Establishment: oP}-e,S, .5; lye _ c'j oeoy,Co6,4 , Date: 57.1 ,/,,, ."'h Page hof
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TemperatureObservations
Item I Location Temp(°F) Item I Location--_ 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 of Person-in-Charge: :77--
Date:
Signature of Inspector: Q Date: .`
MDPH report form-10/5/18 versio
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