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Food Establishment Inspection Report - Town of Yarmouth Yarmouth Board Health
P P 1146 Route.28,South Yarmouth,MA 02664
r Date: �'j �-�:p� Page 1 of ,/..
Establishment: J �" -5 �� ��/,�� ) d�J
Address: ,/7/ R4G0s c 3 A/7- Time in: I Time out:
Telephone: 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
to Foodborne Illness Risk Factors
Inspector: I. ., .ILY p ?e,cA.Z.) and Interventions(Items 1 through 29):
Type of Operation(s): Type of Inspection: Other InformationAg
D i 'Food Service Establishment '-Routine
O Retail Food Store 0 Re-inspection
0 Residential:Cottage Foods 0 Pre-operational
O Residential:Bed& 0 Illness investigation
Breakfast 0 General complaint
O Mobile/Pushcart O HACCP
0 Temporary Food Estab. 0 Other
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 r 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 ✓ sanitized
Employee Health Proper disposition of returned, /
Management, food employee and 17 previously served, reconditioned &
3 conditional employee; knowledge, I/ unsafe food
responsibilities and reporting / TlmefTemperature Control for Safety,
/
4 Proper use of restriction and exclusion 18 Proper cooking time &temperatures
Procedures for responding to vomiting / 19 Proper reheating procedures for hot
5
and diarrheal events holding
Good Hygienic Practices / 20 Proper cooling time and temperature
Proper eating, tasting, drinking, or / 21 Proper hot holding temperature
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 25 Consumer advisory provided for raw/ .
9 food `� undercooked food
Adequate handwashing sinks properly Highly Susceptible Populations
10 Ij Pasteurized foods used; prohibited foods II
and accessible 26
not offered
Approved Source Food/Color Additives and Toxic Substances
11 Food obtained from approved source Lf Food additives: approved & properly
12 Food received at proper temperature - — 27 used
13 Food received in good condition, safe, & Toxic substances properly identified,
unadulterated 28
stored & used
Required records available: shellstock
Conformance with Approved Procedures 14 tags, parasite destruction
Compliance with variance/specialized
29 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 IN/O ICOSI R Compliance Status jOUTj N/A N/O cos R
Safe Food and Water 48 Warewashing facilities: installed,
Pasteurized eggs used where maintained, & used; test strips
30 required 49 Non-food contact surfaces clean
31 Water& ice from approved source Physical Facilities . ,
32 Variance obtained for specialized4
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 Sewage &waste water properly
temperature control 52 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,
37 Food properly labeled; original maintained, & clean
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 105 CMR 590.010
40 Personal cleanliness M3 Caterer
41 Wiping cloths: properly used & M4 Mobile Food Operation
stored M5 Temporary Food Establishment
42 Washing fruits & vegetables M6 Public Market; Farmers Market
Proper Use of Utensils M7 Residential Kitchen; Bed-and-
43 In-use utensils properly stored Breakfast Operation
44 Utensils, equipment& linens: M8 Residential Kitchen: Cottage Food
properly stored, dried, & handled Operation I
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
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:
`` 7 :-c ---sr�'�
Signature of Person-in-Charge.
• j A. T. Date: % �/-�
Signature of Inspector: + . //
MDPH report form-1 O/5/1 S version Yyc�/ „7��' -
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Food Establishment Inspection Report - Town of Yarmouth
Establishment: / 7�,, 9' �,G,c, .� Date: 3//3/.4;1-r Page of
Temperature Observations
Item 1 Location Temp(°F) Item 1 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 Inspector: /
MDPH report form—10/5/18 version 1 1,
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