Cinema Salem FEIR 2-7-2019 Food Establishment Inspection Form Page - , of 2_
The Commonwealth of Massachusetts #Violations 2 Date_25r 1
City of Salem Board of Health Priority- Priority foundation-r Core- Time In ; �,h.,120 Washington Street,Salem MA 01970 j-
(978)741-1800 Score(optional) ! Time Out> f ;n
Establishment Name(-- . I I Risk Category Type of Operatlon(s) T e of Ins action
i -11 l _on c1 C c e Ai
Establishment Address f-- 1 ❑F..d Service ❑ outine
1 j-co '}- tA;1L �//i c.-![ !-etail Weinspection
Telephone n i7 maa HACCP V/N I Residential Kitchen Pre o s Inspection Date:
! /(� l L1i �(c�n ['Mobile 1 �Q 7
Owner t' / �/ Permit#:
1,/ \/G,n a.S S ❑TGutpoiaiy OPre-Operation
Person-In-Charge(PIC) Food Safety T ing/ Date ['Caterer ['Suspect Illness
�rtu„w, L.an vt�/.1 AIM'if+v'tt(nLb1� ['Bed&Breakfast ['General Complaint
Inspector ( � �, ['Farmer's Market ❑HACCP
)�4- ['Other [Other:
F ODBO E ILLNESS RISK FACTORS AND PUBLIC HEALTH INTERVENTIONS
Circle designated compliance status(IN,OUT,NO,N/A)for each numbered item Mark 7C in appropriate box for C05 and/or R
IN=in compliance OUT=not in compliance N/O=not observed N/A=not applicable COS=corrected on-site during inspection R=repeat violation
Compliance Status cos I R Corn liance Status cos R
Proper disposition of returned,previously
Supervision 17 IN OUT served reconditioned&unsafe food
1 IN OUT PIC present,demonstrates knowledge,and Throe/Temperature Control for Safety
porforms duties
2 IN OUT N/A Certified Food Protection Manager _ 18 IN OUT N/A N/O Proper molting time&temperatures
Employee Health 19 IN OUT N/A NO Proper reheating procedures for hot holding
Management,food employee and conditional
3 IN OUT employee;knowledge,responsibilities and 20 IN OUT N/A N/O Proper cooling lime and temperature
reporting _.
4 IN OUT Proper use of restriction and exclusion 21 IN OUT N/A N/O Proper hot holding temperature
5 IN OUT Procedures for responding to vomiting and 22 IN OUT N/A N/O Proper cold holding temperature
diarrhea/everts
Good Hygienic Practices 23 IN OUT N/A NO Proper date marldng and disposition
6 IN OUT WO Proper eating,tasting,drinldng,or tobacco use 24 IN OUT N/A WO Time as a Public Health Control
7 IN OUT WO No discharge front eyes,nose,and mouth Consumer Advisory
Preventing Contamination by Hands 25 I IN OUT NA I Consumer advisory provided for raw/
undercooked food
8 IN OUT WO Hands dean&properly washed Requirements for Hi111 hly Susceptible Populations(HSP)
9 IN OUT N/A WO No bare hand contact with RTE food 26 I IN OUT N/A ashrized foods used;prohibited foods not
10 IN OUT Adequate handwashing sinks properly supplied Food/Color Additives and Toxic Substances
and accessible
Approved Source 27 IN OUT N/A Food additives:approved&properly used
11 IN OUT Food obtained from approved source 28 IN OUT N/A }
Toxic sub.properly identified,stored&used
12 IN OUT N/A N/O Food received at proper temperature Conformance with roved Procedures
13 IN OUT Food received in good condition,safe,& 29 I IN OUT N/A I Compliance with variance/specialized process
unadulterated /HACCP Plan
14 IN OUT WA WO Required records available:shellstock tags,
parasite destruction Risk Factors ate important practices or procedures identified as the most
Protection from Contamination prevalent contributing factors of foodbome illness or injury. Public health
15 IN OUT N/A N/O Food separated and protected interventions are control measures to prevent foodbome illness or injury.
16 IN OUT N/A 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 IV in box if numbered item is not in compliance Mark X in e.rate box for COS and/or R COS=corrected on-site during inspection R=repeat violation
Compliance Status I 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:properly stored,dried,&handled
32 Variance obtained for specialized processing methods 45 Single-use/single service articles:properly stored&used
Food Temperature Control 46 Gloves used properly
33 Proper cooling methods used;adequate equipment for Utensils,Equipment and Vending
temperature control -.
34 Plant food properly cooked for hot holding 47 Food&non-food contact surfaces cleanable,property designed,
constructed&used
35 Approved thawing methods used 48 Warewashing facilities:installed,maintained,&used;test strips
36 I Thermometers provided&accurate 49 — Non-food contact surfaces dean
Food Identification (� Physical Facilities
1
37 I 1 Food properly labeled;original container 1 50 — Hot&cold water available;adequate pressure
Prevention of Food Contamination 51 Plumbing installed;proper backltow devices
38 Insects,rodents,&animals not present 52 Sewage&waste water properly disposed
Contamination prevented during food preparation,storage and
39 display 53 Toilet features:properly constructed,supplied,&cleaned
40 Personal cleanliness 54 Garbage&refuse properly disposed;facilities maintained
41 Wiping cloths:properly used&stored 55 Physical facilities installed,maintained,&clean
42 Washing fruits&vegetables f 56 Adequate ventilation&lighting;designated areas used
57 SfUIAt,REQUIREMENTS/OTHER I ['Anti-choking(590.009(EI) ['Tobacco(590.009(FJ) ['Allergen Awareness(590.009(G)) ['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/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 rece't of this order.
PIC's Si nature: l - Print: -;,-^ L.,:,v1 � `;.. Date: 2/'7 I�j /
Inspector's Si nature: , Follow-up: E NO (circle onq) Follow-up Date,if applicablerra h d ,c_d.
L Yi71^ l�f
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Food Establishment Inspection Form Page 2 of Z
The Commonwealth of Massachusetts
City of Salem Board of Health Establishment Name: .� 1��� �
120 Washington Street,Salem MA 01970 /' r Date'
(978)741-1800 L �j 1 i�yyi1G�l1►
TEMPERATURE OBSERVATIONS _
Item/Location Temp(°F) Item/Location Temp(°F) 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 / I
2- 2=In2 4) I k..uv1� L� v i ri ; S fn t1 ✓( S5
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f',-411 c 2i) r EJ.✓rtrt44711L / ! Dr D�irrcc4 f'h e_!Q
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L! ry74v,4 Qr+41' viAelrkficrlc J be .1 [�J1 teGf
Discussion with PIC: Corrective Action Required ❑No eyes
❑Voluntary Compliance ❑Employee Restriction/
Exclusion
❑Re-inspection Scheduled ❑Emergency Suspension
❑Embargo ❑Emergency Closure
❑Voluntary Disposal 0 Other
PIC's Signature: Date: z 7/ i ct
Inspector's gnaturey Date:n 6,7/201
Rev.11/2016