Amazing Pizza FEIR 12-26-2018 Food Establishment Inspection Form Page 1, of
The Commonwealth of Massachusetts #Violations Date `
City of Salem Board of Health Priority- Priority foundation- Core- u Time In /
120 Washington Street,Salem MA 01970
978 741-1800 Score(optional) Time Out
Establishment Name11 / Risk Category Type of O orations T of Inspection
Establishment Address
ood Serviceoutine
❑Retail Reinspection
Telephone * Z HACCP Y/N []Residential Kitchen Previous Inspection Date:
Owner { �, Permit []MobileJ� ❑Temporary ❑Pre Operation
Person-In h (PIC) Food Safety Training �.rate []Caterer ❑Suspect Illness
CS +$ %••f L %�- []Bed&Breakfast []General Complaint
InspectorJ ❑Farmers Market ❑HACCP❑Other. ❑Other:
FOODBORAE ILLNESS RSC 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 compliance OUT=notincompliance N/O=not observed WA=notlipble COS=corrected on-site during inspection R=repeat violation
Com liance Status cos R Compliance Status
Supervision 17 IN OUT Proper disposition returned,previously
served,reconditionea d&unsafe food
1 I OUT PIC present,demonstrates knowledge,and Time/Temperature ConW for Safety
rforms duties
2 -IN, U WA Certified Food Protection Manager 18 1 OUT WA WO Proper cooking time&temperatures
lEmP[oYee Health 19 10 OUT WA N/O Proper reheating procedures for hot holding
Management food employee and conditional
3 I OUT employee;knowledge,responsibilities and 20 N OUT WA WO Proper coding time and temperature
reporting
4 I OUT Proper use of reWcfion and exclusion 21 bfiUT WA N/O Proper hot holding temperature
5 I OUT Procedure;for responding to vomiting and 22 OUT WA WO Proper cold holding temperature
diarrheal events
Good Hygienic Practices 23 Nour wA Wo I Proper date marking and disposition
6 IN Otrr /O) Proper eating,tasting,drinking,or tobacco use 1 24 IN OU WO I Time as a Public Health Control
7 tN OUT WO I No discharge from eyes,nose,and mouth Consumer AMsory
Preventing ContamINouT insi by Hands 25 uncle eaddfo ry Provided for raw I
g !1N
our Wo Hands dean&properly washed Re ubementg for Hi hl Susceptible Populations HSP
g OUT WAEN10 No bare hand contact with RTE food 26 IN OUT Pasteurved foods used;prohibited foods not
offered
1 Q U Adequate sable Shing sinks properly supplied Food 1 Ceclor Additives and Toxic Substances
APMand accessible
ved Source 27 1 IN OUT Food additives:approved&properly used
11 IVDLJT Food obtained from approved source 28 IN A Toxic sub.property identified,stored&used
12 1 UT NIA WO Food received at proper temperature Conformance with roved Procedures
13 I OUT Food received in good condition,safe,& 29 IN OUT A Compliance with variance/specialized process
unadulterated /HACCP Plan
14 IN OUT WO Required records available:shellstock tags,
rasite destruction Risk Factors are important practices or procedures identified as the most
Protection from Contamination prevalent contributing factors of foodbome illness or injury. Public healm
15 IN UT WA WO Food separated and protected interventions ane control measures to prevent foodbome illness or injury.
16 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 W in box if numbered item is not in compliance Mark W in appropriate box for COS and/or R COS=corrected on-site durigg inspection R=tapeat violation
Compliance Status COS R Compliance Status COS R
Saide Food and(Nater Proiler 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 methods 45 single-use/single-service articles:property stored&used
Food Temperature Control 46 Gloves used property
33 Peroperahaeincontrol
methods used;adequate equipment for Utensiits,Equipment and Vending
34 Plant food properly cooked for hot holding 47 Food&non-food contact surfaces cleanable,property designed,
censtrucbed&used
35 Approved thawing methods used 4$ Warewashing facilities:installed,maintained,&used;test strips
36 Thermometers provided&accurate 49 Non-food contact surfaces dean
Food Identification Physical Facilities
37 Food properly labeled;original container 50 Hot&cold water available;adequate pressure
Prevention of Food Contamination 51 Plumbing installed;proper backflow devices
3$ Insects,rodents,&animals not present 52 Sewage&waste water properly disposed
Contamination prevented during food preparation,storage and
39 d Iay 53 Toilet features:properly constructed,supplied,&cleaned
40 Personal cleanliness 54 Garbage&refuse property disposed;facilities maintained
41 Wiping cloths:properly used&stored 55Physical facilities installed,maintained,&dean
42 Washing fruits&vegetables 56 Adequate ventilation&lighting;designated areas
57 1 SPt-MAL REW-11REillleNTS I OT14 ❑Anti-chokin 590.00 ❑Toba000 .0 LIAJlergen Awareness 590.0 G oval law regulation []Other
Official Order for Correction:Based on an 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
Wcessation 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
10 calendar dof 't of this order. /
PIC's S' nature: : r - ,, I Print:, "�` +1: Date: tvlw E'
Inspector's Signature: Follow-u G4(circieone) ollow-u ate,if applicable:
Food Establishment Inspection Form Page_2.,,_of "
TheCommonwealth of Massachusetts
City of Salem Board of Health Establishment Name:
120 Washington Street,Salem MA 01970 , Date:
Ir
978 741-1800 r r f "'
TENIPEROURE OBSERVATIONS
Item 1 Location Temp Item/Location Tem Item/Location Tem °F
OBSERVATIONS AND/OR CORRECTIVE ACTIONS
Violations cited in this Mort 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
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Discussion with PIC: ICoff"li
ve action Regtdred No ❑Yes
Voluntary Compliance Employee Restriction
Exclusion
Re-inspection Scheduled ❑Emergency Suspension
❑Embargo ❑Emergency Closure
❑Voluntary Disposal Other
PIC's Signature: Date: I ��
Inspector's ftYiture Date•
Rev.11/2016 ////
Food Establishment Inspection Form Page of
The Commonwealth of Massachusetts
City of Salem Board of Health Establishment Name:
120 Washington Street,Salem MA 01970 , Date:
9781741-1800
OBSERVATIONS AMOR 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=Priori Foundation Item
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PIC's Signature:. ° Date: ( z
Inspector's Sig re Date,. 1
Rev.11/2016