LIL ZITELLE PRE-OPERATION FEIR 8-27-26 Food Establishment Inspection Form Page�_of
The Commonwealth of Massachusetts #Violations Date -211
City of Salem Board of Health Priority- Priority foundation- Core- Time In 11`�'9d'
98 Washington Street,Salem,MA 01970
(978 741-1800 Score(optional) Time Out J/ 7 a
Establishment Name) Risk category T e of Ci eration s Type of Inspection
L-- - Food Service ❑Routine
Establishment Address
❑Retail Reinspection
Telephone HACCP YIN []Residential Kitchen Previous Inspection Date:
#: - ❑Mobile
owner Permit ❑Temporary _ Pre-Operation
Person-In-Charge(PIC) Food Safety Training/Ems.Date ❑Caterer USuspect Illness
❑Bed&Breakfast []General Complaint
Inspector V []Farmer's Market ❑HACCP
�A
r ❑Other. ❑Other
FOODBORNE ILLNESS RISK FACTORS AND PUBLIC HEALTH INTERVENTIONS
Circle designated compliance status(IN,OUT,WO,WA)for each numbered item Mark w in appropriate box for COS and/or R
IN=in com wv,e OUT=not in mm nonce N/O=not observed WA=not a ' ble COS=corrected on-site duringinspection R=re ation an viol
Core liance Status cos R _Compliance Status cos R
Supervision 17 IN OUT Proper d'ispcsitlon of retuned, food sty
served,reconditioned&unsafe food
1 IN OUT PIC present demonstrates knowledge,and Time f Temperature Control for.Safety
ortns duties
2 IN OUT WA Certified Food Protection Manager 18 IN OUT WA WO Proper cooling time&temperatures
Employee Health 19 IN OUT WA N/O Proper reheating procedures for hot holding
Management,food employee and conditional
3 IN OUT employee;hxwAedge,responsibrTities and 20 IN OUT WA WO Proper cooling time and temperature
mporting
4 IN OUT Proper use of restriction and exclusion 21 IN OUT WA WO Proper hot holding temperature
5 IN OUT Procedures for responding to vomiting and 22 IN OUT WA WO Proper cold holding temperature
diantmal events
Good HY91MI11C Practices 23 IN OUT WA N/O Proper date 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 WO I No discharge from eyes,nose,and mouth Consumer AuMsory
Preventing Contamination by Hands 25 IN OUT WA undyed advisory
provided for raw r
8 IN OUT WO Hands clean&property washed Requirements for Highly Susce ible PO ubWons HSP
eur¢ed foods used;prohibited foods not
g IN OUT WA WO No bare hand contact with RTE food 26 IN OUT WA Prrst
altered
10 IN our Adequate handw ashig sinks property supplied Food f Color Additives and Toxic Substances
and accessible
Approved Source 27 1 IN OUT WA Food additives:approved&properly used
11 IN OUT Food obtained from approved source 28 IN OUT WA Toxic sub.prnperty identified,stored&used
12 IN OUT WA WO Food received at proper temperature CoMormanee with roved Procedures
13 IN OUT Food received in good condition,safe,& 29 IN OUT WA conptiance'�variance/specialized process
unadulterated I /HACCP Plan
14 IN OUT WA WO Regkrired records available:shellstodctags,
n 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 OUT WA Food-contact surfaces;cleaned&sanitized
GOOD RETAIL PRACTICES _
Good Retail Practices are preventative measures to control the addition of pathogens,chemicals,and physical objects into foods.
Mark'X"in box if numbered item is not in compliance Mark Win approrxmte box for COS and/or R COS=connected on-site during inspecticin R= violation
Compliance Status COS R Compliance Status cos R
Safe Food and Water r Use of Utensils
30 Pasteurized eggs used where required 43 In-use utensils property stored
31 Water&ice from approved source - 44 Utensils,equipment&linens:property stored,dried,&handled
32 Variance obtained for specialized processing rrrcthods 45 Single use!single-service articles:property stored&used
Food Temperature Control 46 Gloves used property
Proper coding methods used;adequate equipment for Utensils,Equipment and Vending
33 tenporature control
47 Food&non-food contact surfaces cleanable,property designed,
34 Plant food properly cooked for hot holding constructed&used
35 Approved thawing methods used 48 Warewashing facilities:installed,maintained,&used;test strips —
36 Thermometers provided&accurate 49 Non-food contact surfaces dean
Food identification Physical Facilities
37 Food property labeled;original container 50 Hot&cold water available;adequate pressure
Prevention of Food Contamination 51 Plumbing installed;proper baddbw devices
38 Insects,rodents,&animals not present 52 Sewage&waste water property disposed
Contamination prevented during food preparation,storage and 53 Toilet features:property constructed,supplied,&cleaned
39 display
40 Personal cleanliness 54 Garbage&refuse properly disposed;facilities manntakied
41 coping cloths:property used&stared 55 Physical faaTrties insraled,maintained,&dean
42 Washing fruits&vegetables F 56 1 Adequate ventilation&righting;designated areas used
57 1 SPECIAL REQUIREMENTS I OTHER I ❑Antchokin 590.009 ❑Tobacco 590.009 ❑Allergen Awareness(590.0091GI) ❑Local law regulation []Other
Official Order for Correction:Based on an inspection today,the items checked indicate violations of the Board of Health Food Regulation 12013 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. Fa1Wre to conact 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 rice t of this order.
PIC's Signature: T' Print: 6 A,/ Date: 2
Inspector's Signature: �� Follow-u : YES NO (circle one) Follow-up Date,if applicable:
Food Establishment Inspection Form Page 2 of 2-
The Commonwealth of Massachusetts
City of Salem Board of Health Establishment Name: L)L Zile s? Date: P12-1k2�
98 Washington Street,Salem,MA 01970
978 741-1800 _
TEMPERATURE OBSERVATIONS
Item/Location Tern Item/Location Tem 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 8405.11 of the Food Code
Item Code Section P=Priority Item Description of Violation
Number PF=Priority Foundation Item
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Discussion with PIC: TCon-
vettve Action Required []No es
oluntary Compliance [IEmployee Restriction
/
Exclusion
❑Re-inspection Scheduled ❑Emergency Suspension
❑Embargo ❑Emergency Closure
❑Voluntary Disposal ❑Other
PIC's Signature: (/ • Date:
Inspector's Signature Date:
Rev.11/2016