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TOWN OF YOu HARM T BOARD OF HEALTH
1146 ROUTE 28
FOOD ESTABLISHMENT INSPECTION REPORT SOUTH YARMOUTH, MA 02664
Item Code C Critical Item DESCRIPTION OF VIOLATION / PLAN OF CORRECTION Date
Name � Date Type of Operation(s) Type of Inspection No. Reference R Red Item y " PLEASE PRINT CLEARLY Verified
� �r�� � Food Service Routine
Address (,�1 / 7) C ' c rj>) d5J c p c z e y_
576 e U Retail U Re-inspection
�C
❑ Residential Kitchen gbousrevInspection ke
Telephoneate: i ' ' /1.4.,1 I C /PCS C rc ��7 --j' C)
6508) 2. o I
Ll Mobile .
Owner HACCP YIN CI Temporary ❑ Pre-operation
❑ Caterer U Suspect Illness
Person in Char a PICvi ,2\:stisiski., Time kA-CiN - SCX:Li)
U General Com laintV-VA.�S s, F�
g ( ) s _0 Bed & Breakfast p
In: U HACCP ‘°.-1-jeCe"'
- 51) .5' CD11
Inspector r
J'"/?i � • f � Out: Permit No.- U Other
Each violation checked requires an explanation on the narrative page(s) and a citation of specific provision(s).violated.
i N on-compliance with: Ve c � C` '"7 0 t- ..,...-
c,:7470e:41
Violations Related to Foodborne Illness Interventions and Risk FactorsRed Items)) Anti- hbkin Tobacco 1
Violations marked may pose an imminent health hazard and require immediate 590.009 (E) 0 490. 009 (F) ❑ ' -"`
corrective action as determined by the Board of Health. .
FOOD PROTECTION MANAGEMENT
❑ 12. Prevention of Contamination from Hands 3 , f 53. j
Li1. PIC Assigned / Knowledgeable / Duties 0 13. Handwash Facilities �, *�...
"r. '444'8.'' ''"'' Lii,44c-41 ) 9. cvst? k ....,-‘ k-k-N-7,...0 G ccA>
EMPLOYEE HEALTH PROTECTION FROM CHEMIC LS ` ^ �z
❑ 2. Reporting of Diseases by Food Employee and PIC 0 14. Approved Food of Color Additives • k
0 3. Personnel with Infections Restricted/Excluded ❑ 15. Toxic Chemicals �t-i 4>•
FOOD FROM APPROVED SOURCE TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods)
GI 4. Food and,Water from Approved Source ❑ 16. Cooking Temperatures ,
❑ 5. Receiving/Condition N4 t«,,' e,.-+�- i� t�`, . C"..�r•a - C�62,�,..\
9/ ❑ 17. Reheating
❑ 6. Tags/Records/Accuracy of Ingredient Statements ❑ 18. Cooling ,C ".a 1
❑ 7. Conformance with Approved Procedures/HACCP.Plans ❑ 19. tlot and Cold Holding • "` 1
PROTECTION FROM CONTAMINATIONoff,
❑ 20. =Time as a Public Health C rol .
CI8.8. Separation/Segregation/Protection , REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS (HSP) Lc ' Cr
❑ 9. Food Contact Surfaces Cleaninc3,:afid Sanitizing 0 21 . Food and Food Preparation for HSP _
El10. Proper Adequate Handwashirrg CONSUMER ADVISORY 4,,';
❑ 11 . Good Hygienic Practices" '
❑ 22. Posting of Consumer Advisories
Violations Related to Good Retail Practices (Blue Items) Number of Violated Provisions Related :to
' Critical(C)violations marked must be corrected immediately Foodborne Illnesses Interventions and Risk
or within 10 days as determined by the Board of Health. Factors (Red Items 1-22): ; ,
Non-critical (N) violations must be corrected immediately 4 4't
or within 90 days as determined by the Board of Health. Official Order for Correction: Based on an inspection today,
C N the items checked indicate violations of 105 CMR 590.000/ W .
23. Management and Personnel (Fc-2)(590.003) federal Food Code. This report, when signed below by a
Board of Health member or its agent constitutes an order of
24. Food and Food Protection (FC-3)(590.004) the Board of Health. Violations not corrected are subject to
25. Equipment and Utensils (FC-4)(590.005) fines per.Yarmouth Board of Health. If aggrieved by this
26. Water, Plumbing and Waste -, (FC-5)(590.006) order, you have a right to a hearing. Your request must be
27. Physical Facility (FC-6)(590.007) in writing and submitted to the Board of Health at the above Discussion with Person in Charge: Correction Action Required: 0 No GI Yes
28. Poisonous or Toxic Materials (FC-7)(590.008) address within 10 days of receipt of this order.
29. Special Requirements (590.009) DATE OF RE-INSPECTION: o Voluntary Compliance ❑ Employee Restriction /
Exclusion
30. Other "
O Re-inspection Scheduled 0 Emergency Suspension
Inspect• • i • ure a Print f O Embargo' ❑ Emergency Closure
!1f :. ._.1', _ ,, , 4 - 4. • i AO/ i , ,
PIC' *gnP0 Priy,s Page L of , Pages 0 Voluntary Disposal O Other
/�d4..._3"--
i
TOWN OF YARMOUTH
FOOD ESTABLISHMENT INSPECTION REPORT
BOARD OF HEALTH
1146 ROUTE 28
SOUTH YARMOUTH, MA 02664
Name %
Date
F
Type of Operation(s)
Type of Inspection
Food Service
XRoutine:
Address cj� !'
'y
U Retail
❑ Residential Kitchen
U Re -inspection
Previous Inspection
REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS (HSP)
Telephone
❑ Mobile
❑ Temporary
Date:
U Pre-operation
Owner
HACCPY/N
Number of Violated Provisions Related to
❑ Caterer
EI Bed &Breakfast
Permit No.
U Suspect Illness
U General Complaint
U HACCP
U Other
Person in Charge (PIC) f %�� �� `
Time
In:
Out:
Inspector �^?
Each violation checked Mquires an explanation on 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
O 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
PROTECTION FROM CONTAMINATION
❑ 8. Separation/Segregation/Protection
❑ 9. Food Contact Surfaces Cleaning and Sanitizing
❑ 10. Proper Adequate Handwashing
❑ 11. Good Hygienic Practices
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)
24. 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. Physicai Facility (FC -6)(590.007)
28. Poisonous or Toxic Materials (FC -7)(590.008)
29. Special Requirements (590.009)
30. Other
TIME/TEMPERATURE CONTROLS (Potentially Hazardous Foods)
❑ 16. Cooking Temperatures
❑ No
❑ 17. Reheating
Pr
r�t�� F% f I / P' D ,0- L
❑ 18. Cooling
❑ 19. 'Hot and Cold Holding
❑ 20. Time as a Public Health Control
REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS (HSP)
❑ 21. Food and Food Preparation for HSP
CONSUMER ADVISORY
❑ 22. Posting of Consum8r Advisories
Number of Violated Provisions Related to
Foodborne Illnesses Interventions and Risk
Factors (Red Items 1-22):
Official Order for 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:
Inspe nature
�. � �L��„C,c✓
Print
�`"�?J �/ . J�-t-tel Ci
❑ No
Pl�s SIg t
_.,�.t` j
Pr
r�t�� F% f I / P' D ,0- L
Page / of,� Pages
J
Item Code C - Critical Item DESCRIPTION OF VIOLATION / PLAN OF CORRECTION Date
No. Reference R - Red Item PLEASE PRINT CLEARLY Verified
Discussion with Person in Charge:
Correction Action Required:
❑ No
: ❑ Yes
Compliance ❑ Employee Restriction
❑ Voluntary/
Com P Exclusion
❑ Re -inspection Scheduled ❑ Emergency Suspension
❑ Embargo ❑ Emergency Closure
❑ Voluntary Disposal ❑ Other
TOWN OF YARMOUTH BOARD OF HEALTH
1146 ROUTE 28
FOOD ESTABLISHMENT INSPECTION REPORT SOUTH YARMOUTH, MA 02664
Name y ti
Date
J
//
Type of Operation(sl
Type of Inspection
Food Service
U Retail
U Residential Kitchen
U Mobile
U Temporary
U Caterer
❑ Bed & Breakfast
Permit No.
Routine
U Re -inspection
Previous Inspection
Date:
U Pre-operation
U Suspect Illness
U General Complaint
U HACCP
U Other_ ._
Addressfj�
/_
Telephone9b 8 6 2 5'6
Owner
HACCP Y/N
Person in Charge (PIC)
Time
In:
Out:
Inspector("
Each violation checktd requires an explanation on 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) U 590.009 (F) ❑
corrective action as determined by the Board of Health.
FOOD PROTECTION MANAGEMENT ❑ 12. Prevention of Contamination from Hands
Ll 1. PIC Assigned / Knowledgeable / Duties ❑ 13. Handwash Facilities
EMPLOYEE HEALTH
❑ 2. Reporting of Diseases by Food Employee and PIC
J 3. Personnel with Infections Restricted/Excluded
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
PROTECTION FROM CONTAMINATION
❑ 8. Separation/Segregation/Protection
❑ 9. Food Contact Surfaces Cleaning and Sanitizing
❑ 10. Proper Adequate Handwashing
Ll 11. Good Hygienic Practices
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)
24. 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
PROTECTION FROM CHEMICALS
❑ 14. Approved Food or Color Additives
❑ 15. Toxic Chemicals
TIME/TEMPERATURE CONTROLS (Potentially Hazardous Foods)
❑ 16. Cooking Temperatures
❑ 17. Reheating
❑ 18. Cooling
❑ 19. Hot and Cold Holding
❑ 20. Time as a Public Health Control
REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS (HSP)
❑ 21. Food and Food Preparation for HSP
CONSUMER ADVISORY
J 22. Posting of Consumer Advisories
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:
Inspectoi Siginatur
Print e.
PIC's Signature l `_ '
Print
Page _ of Pages
Item Code C - Critical Item DESCRIPTION OF VIOLATION / PLAN OF CORRECTION Date
No. Reference R - Red Item PLEASE PRINT CLEARLY Verified
L �
�'. r
41Z
c
Discussion with Person in Charge: Correction Action Required: ❑ No ❑Yes
L3 Voluntary Compliance ❑ Employee Restriction!
Exclusion
❑ Re -inspection Scheduled ❑ Emergency Suspension
❑ Embargo ❑ Emergency Closure
❑ Voluntary
Disposal
❑ Other
TOWN OF YARMOUTH
FOOD ESTABLISHMENT INSPECTION REPORT
BOARD OF HEALTH
1146 ROUTE 28
SOUTH YARMOUTH, MA 02664
NameDate
Print (7 �� _
C - Critical Item
R -Red Item
PIC'sSig�tur
Type of Operation(s)
Type of Inspection
-a Food Service
Jlr;Routine
Address
V
`!) I
I lq
U Retail
U Residential Kitchen
U Re -inspection
Previous Inspection
Telephone
Tele P
56
ID og - U%U
U Mobile
U Temporary
Date:
J Pre-operation
Owner
HACCPY/N
U Caterer
❑ Bed & Breakfast
Permit No.
U Suspect Illness
U General Complaint
U HACCP
U Other
Person in Charge (PIC)
Time
In:
Out:
Inspector C'� •I `^LcA
Each violation checked requires an explanation on 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
❑ 2. Reporting of Diseases by Food Employee and PIC
3. Personnel with Infections Restricted/Excluded
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
PROTECTION FROM CONTAMINATION
❑ 8. Separation/Segregation/Protection
❑ 9. Food Contact Surfaces Cleaning and Sanitizing
❑ 10. Proper Adequate Handwashing
❑ 11. Good Hygienic Practices
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)
24. 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
PROTECTION FROM CHEMICALS
❑ 14. Approved Food or Color Additives
❑ 15. Toxic Chemicals
TIME/TEMPERATURE CONTROLS (Potentially Hazardous Foods)
❑ 16. Cooking Temperatures
❑ 17. Reheating
❑ 18. Cooling
❑ 19. Hot and Cold Holding
20. Time as a Public Health Control
REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS (HSP)
❑ 21. Food and Food Preparation for HSP
CONSUMER ADVISORY
❑ 22. Posting of Consumer Advisories
Number of Violated Provisions Related to
Foodborne Illnesses Interventions and Risk
Factors (Red Items 1-22):
Official Order for 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 suhject 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:
Ins e�tor's I natu a
P . �g �'�
Print (7 �� _
C - Critical Item
R -Red Item
PIC'sSig�tur
Print �( �
y: c.
Page of Pages
v
Item
No.
Code
Reference
C - Critical Item
R -Red Item
DESCRIPTION OF VIOLATION / PLAN OF CORRECTION
PLEASE PRINT CLEARLY
Date
Verified
Disposal
❑ Other
C,c -
L -ac) S U0od
Discussion with Person in Charge:
Correction Action Required -.TU
No
❑Yes
❑ Voluntary Compliance ❑ Employee Restriction /
Exclusion
❑ Re -inspection Scheduled U Emergency Suspension
❑ Embargo ❑ Emergency Closure
❑ Voluntary
Disposal
❑ Other