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TOWN OF YARMOUTH BOARD OF HEALTH
1146 ROUTE 28
FOOD ESTABLISHMENT INSPECTION REPORT SOUTH YARMOUTH, MA 02664
Name
Date
Type of Operation(s)
Type of Inspection
�1 Food Service
g_,flcutine
i
Address ! i- _
j/n( /l
/y�']
4•ltetail
U Residential Kitchen
U Re -inspection
Previous Inspection
r
Telephone j` U
(
U Mobile
U Temporary
Date:
U Pre-operation
Owner
HACCP Y/N
U Caterer
U Bed &Breakfast
Permit No.
U Suspect Illness
U General Complaint
p
J HACCP
U Other____ --
Person in Charge (PIC)
Time
In. ti
Out:
Inspector ` , -..
Each
Each violation checked requires an explanationVon the narrative page(s) and a citation of specific provision(s) violated.
Non-compliance with:
Violations Related to Foodborne Illness Interventions and Risk Factors (Red Items) 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 PROTECTION FROM CHEMICALS
❑ 2. Reporting of Diseases by Food Employee and PIC ❑ 14. Approved Food or Color Additives
❑ 3. Personnel with Infections Restricted/Excluded ❑ 15. Toxic Chemicals
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/HACCP Plans
FROM CONTAMINATION
TIME/TEM PERATURE CONTROLS (Potentially Hazardous Foods)
LJ 16. Cooking Temperatures
❑ 17. Reheating
LJ 18. Cooling
❑ 19. Hot and Cold Holding
PROTECTION ❑ 20. Time as a Public Health Control
❑ 8. Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS (HSP)
❑ 9. Food Contact Surfaces Cleaning and Sanitizing ❑ 21. Food and Food Preparation for HSP
❑ 10. Proper Adequate Handwashing CONSUMER ADVISORY
❑ 11. Good Hygienic Practices ❑ 22. Posting of Consumer Advisories
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)
>_4. Food and Food Protection (FC -3)(590.004)
25. Equipment and Utensils (FC -4)(590.005;
26. Water, Plumbing and Waste (FC -5)(590.006;
27. Physical Facility (FC -6)(590.007;
28. Poisonous or Toxic Materials (FC -7)(590.008;
29. Special Requirements (590.009)
30. Other
Number of Violated Provisions Related to
Foodborne Illnesses Interventions and Risk
Factors (Red Items 1-22):
Official Orderfor 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's Signatufe >' ;
Print
I . , 1 (�
C - Critical Item DESCRIPTION OF VIOLATION / PLAN OF CORRECTION Date
R - Red Item PLEASE PRINT CLEARLY Verified
PIC's Signature
Print % �� /
Page off�w Pages
Item
No.
Code
Reference
C - Critical Item DESCRIPTION OF VIOLATION / PLAN OF CORRECTION Date
R - Red Item PLEASE PRINT CLEARLY Verified
_27) f`
w itA ` l"ll
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C
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Discussion with Person in Charge:
Correction Action Required:
❑ No
❑ Yes
❑ Compliance Li Employee Restriction
Voluntary /
rY Com p Exclusion
❑ Re -inspection Scheduled ❑ Emergency Suspension
❑ Embargo ❑ Emergency Closure
❑ Voluntary Disposal ❑ Other