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STAY LUCKY BAKERY PRE-OPERATION FEIR 9-8-26 Food Establishment Inspection Form Page-J—Of .Z The Commonwealth of Massachusetts #Violations Date Z City of Salem Board of Health Priority_ Priority foundation- Core- Time In 11 Oo �✓`� 98 Washington Street,Salem,MA 01970 (978)741-1800 Soon:(opSonal) Time Out Establishment Name ,�� wsk L;ate9ay T toe of Operation(s) Type of Inspection FstablishmentAddress IFood Service ❑Routine 24 �9, Pt;1.P_.S � Retail ❑Reinspection Telephone c/ 5,��Z HACCP Y/N ❑Residential Kitchen Previous Inspection Date: 7 1 ��#' []Mobileowner(__, V,9ZV1 V) []TemporaryPre-Operation Person-In-Charge(PIC) n Food Safety Training/Exp.Date []Caterer ❑Suspect Illness ❑Bed&Breakfast []General Complaint []Farmer's Market ❑HACCP Inspector `ate ❑Other. ❑Other. FC?ODBORNE ILLNESS RISK FACTORS AND PUBLIC HEALTH INTERVENTIONS Currie designated compliance status(IN,OUT,WO,WA)for each numbered item Mark-r in appropriate box for COS and/or R IN=in corn OUT=not in ce N10=not observed WA=not a Fcable COS=corrected on-site durin i R=r violation Compliance Status cos R Compliance Status ously Cos R Supervisiom 17 IN Our Prefer disposition of defamed, food served reconditioned 8 unsafe food 1 IN OUT PIC present,demonstrates knowledge,and Tine f Temperature Control for Safety pahxms dutiest -- 2 IN OUT WA Certified Food Protection Manager 18 IN OUTWA WO Proper cooling time&temperatures Employee Health 19 IN OUT WA WO Proper reheating procedures for hot holding Management,food employee and conditional 3 IN OUT I employee;knowledge,responsibilities and 20 IN OUT WA N/O Proper coding time and temperature re xtin cj 4 IN OUT Proper use of restriction and exclusion 21 IN OUT WA N/0 Proper hot holding temperature 5 IN OUT Procedures for responding to vomiting and 22 IN OUT N/A WO Proper cold holding temperature diarrheal events Good Hygienic Practices 23 IN OUT N/A N/O Proper data marking and disposition 6 IN OUT WO Proper eating,tasting,drinking,or tobacco use 24 IN OUT WA WO Time as a Public Health Control 7 IN OUT N/O No discharge from eyes,nose,and mouth Consumer PAMs'ory Preventing Contalminaftn by Hands 25 IN OUT wA Consundercooked��provided for raw! undercooked food 8 IN OUT N/O Hands dean&property washed Reguhmnents for Highly Suu*ptible Populations HSP 9 IN OUT WA WO No bare hand contact with RTE food 26 J IN OUT WA Pasteunzed foods used;prohibited foods not offered 10 IN OUT Adequate handwashing sinks properly supplied Food f Color Additives and Toxic Substances and accessible Approved Source 27 IN OUT WA Food additives:approved&property used 11 IN OUT Food obtained from approved source 28 IN OUT WA Tobc sub.properly iderNied,stored&used 12 IN OUT WA WO Food received at proper temperature Conformance with roved Procedures Food received in good condition,safe,& 29 IN OUT WA ce with variance/specialized process 13 IN OUT unadulterated !HACCP Plan 14 IN OUT WA WO Required records available:shellstock tags, to destruction Risk Factors are important practices or procedures identified as the most Protection from Contamination prevalent contributing factors of foodbome illness or injury. Public health 15 IN OUT WA WO Food separated and protected interventions are control measures to prevent foodbome illness or injury. 16 IN our WA Food-contact surfaces;cleaned&sanitized P�l GOOD RETAIL PRACTICES Good Retail Practices are preventative measures to control the addition of pathogens,chemicals,and physical objects Into foods. Msrk'X"in box if numbered item is not in compAiance, Mark in appropnote box for COS and/or R COS=corrected on-site during inspection R=repeat violation Compliance Status COS R Compliance Status COS R Safe Food and Water Proper Use of Utensils 30 Pasteurized eggs used where required 43 In-use utensils properly stored 31 water&ice from approved source 44 Utensils,equipment&linens:property stored,dried,&handled 32 Variance obtained for specialized processing mdhods 45 Single use/single service articles:properly stored&used Food Ten ratum Control 46 Gloves used property 33 Proper cooling s used;adequate equipment for Utensils,Equipment and Vending temperature control 34 Plant food properly cooked for hot holding 47 Food ru non food tooted surfaces cleanable,properly designed, constructed&used 35 Approved thawing methods used 48 Warewashing fadkies:installed,maintained,&used;test strips 36 Thermometers provided&accurate 49 Non-food contact surfaces clean Food Identification Physical Fatuities 37 Food Properly labeled;original contaaner 50 Hot&cold water available;adequate pressure Prevention of Food Contamination 51 Plumbing installed;proper backdiow devices 38 Insects,rodents,&animals not present 52 Sewage&waste water property disposed 39 Contamination prevented during food preparation,storage and 53 Toilet features:property constructed,supplied,&cleaned display 40 Personal cleanliness 54 Garbage&refuse properly disposed;facilities maintained 41 wiping cloths:property used&stored 55 Physical facilities installed,maintained,&dean — — 42 Washing fruits&vegetables 56 Adequate ventilation&lighting;designated areas used 57 1 SPECtpt,REQUIREMENTS I OTHER 1 ❑Anti�holdn 590.0091E1) ❑Tobacco(590.00919) ❑Allergen Awareness(590.0091G ❑Local law regulation ❑Other Offlclal Order for Correction:Based Won inspection today,the items checked'indicate violations of the Board of Health Food Regulation/2013 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. 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 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 ten 10 calendar days of of this order. PIC'sSignature: !/' Print: CQr-01 - ,1 d n/k erg Date: `r/V2 b Ins s Signature: Follow-up: YES NO (circle one) Follow-Up Date,if applicable: Food Establishment Inspection Form Page Z of Z The Commonwealth of Massachusetts City of Salem Board of Health Establishment Name: S]73y L\j64 y l�K)X; L � Date: _�7 Z 98 Washington Street,Salem,MA 01970 978 741-1800 _ TEMPERATURE OBSERVATIONS Item/Location Tern Item/Location Temp Item/Location Temp °F OBSERVATIONS AND/OR CORRECTIVE ACTIONS Violations cited in this report must be corrected within the time frames or as stated in Section 8-405.11 of the Food Code Item Code Section P=Priority Item Description of Violation Number PF=Priority Foundation Item �e ^lDa_�- e;E L4 Ord L L}9� b*7T W Ti�1 �a vJ 1'7 Z. Gely Slur F__�rIZ 9g_nV) Discussion with PIC: Corrective Action Required o ©Yes -- ❑Voluntary Compliance ❑Employee Restriction/ Exclusion ❑Re-inspection Scheduled ❑Emergency Suspension ❑Embargo ❑Emergency Closure Voluntary Disposal ❑Other PIC's ig�re� Date: ���2 Inspector's Signatu� Dom' Rev.11/2016