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Food Establishment Inspection Report�- Town of Yarmouth 1146 Route.28,South Yarmouth,MA 02664
Establishment: /`�_ } zz.e C .'_ 0 �J� Date: g��i/c+t.� Page 1 of
Address: /'y -r Time in: / Time out:
Telephone: J 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
�-2 to Foodborne Illness Risk Factors
Inspector: / //; l ?.l.' ,, .,,cal. and Interventions(Items 1 through 29):
Type of Operations): Type of Inspection: Other Information.'
Food Service Establishment Routine
❑ Retail Food Store D Re-inspection
❑ Residential:Cottage Foods ❑ Pre-operational
❑ Residential;Bed& ❑ Illness investigation
Breakfast ❑ General complaint
❑ Mobile/Pushcart ❑ HACCP
❑ Temporary Food Estab. ❑ Other 6,,2je4-0
❑ Other
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 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
knowledge, and performs duties 16 Food-contact surfaces; cleaned &
2 Certified Food Protection Manager i,r sanitized ' ' A
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 d' 18 Proper cooking time&temperatures
Procedures for responding to vomiting 19 Proper reheating procedures for hot
5 and diarrhea) events ✓ holding
Good Hygienic Practices 20 Proper cooling time and temperature
Proper eating, tasting, drinking, or 21 Proper hot holding temperature
6 tobacco use :i 22 Proper cold holding temperature
7 No discharge from eyes, nose, and 23 Proper date marking and disposition ,,j'
mouth Preventing Contamination by Hands 24 Time as a Public Health Control / t 2
8 Hands clean & properly washed ✓/J Consumer Advisory:. Consumer advisory provided for raw/ f
No bare hand contact with ready-to-eat l 25 .
food /
9 undercooked food
Adequate handwashing sinks properly / Highly Susceptible Populations
10 G/ Pasteurized foods used; prohibited foods
supplied and accessible 26 not offered
Approved Source / Food/Color Additives and Toxic Substances
11 Food obtained from approved source
12 Food received at proper temperature . 27 Food additives: approved & properly
r
used
13 Food received in good condition, safe, & vi Toxic substances properly identified,
unadulterated 28 stored & used
Required records available: shellstock Lie
14 tags, parasite destruction / Conformance with Approved Procedures
29 Compliance with variance/specialized ell
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 I OUT I N/A I N/O I COS I R Compliance Status IN OUT N/A N/O COS R
Safe Food and Water 48 Warewashing facilities: installed,
Pasteurized eggs used where maintained, & used; test strips
304 -required 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 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 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 10'CMR 590.010
40 Personal cleanliness M3 Caterer
41 Wiping cloths: properly used & M4 Mobile Food Operation )
stored M5 Temporary Food Establishment i
42 Washing fruits& vegetables M6 Public Market; Farmers Market
Proper Use of Utensils Residential Kitchen; Bed-and-
43 In-use utensils properly stored M7 Breakfast Operation
44 Utensils, equipment& linens: Residential Kitchen: Cottage Food
properly stored, dried, & handled M8 Operation
45 Single-use/single-service articles: School Kitchen; USDA Nutrition f
properly stored & used M9 Program
46 Gloves used properly M10 Leased Commercial Kitchen
Utensils,Equipment and Vending M11 Innovative Operation
Food & non-food contact surfaces , Local Requirements
47 cleanable, properly designed, L1 Local law or regulation
constructed & used L2 Other
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-Charge:
Date:
Signature of Inspector: A- / �' ' Date:: 7'L - / --,- Gr.
MDPH report forrne-q6/5/18 version/7 f4 r>•
Food Establishment Inspection Report - Town of Yarmouth
Establishment: -,! cip, CC``+ t �S e .�. Date: , c9/ ,3 Page Hof .2
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Temperature Observations
Item 1 Location Temp(°F) Item I Location Temp(°F) Item 1 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: �f? _ Date:
Signature of Inspector: /4'
/ Date:
MDPH report form—10/5118 versio