THE COMMONWEALTH OF MASSACHUSETTS BURLINGTON BOARD OF HEALTH 61 Center Street, Burlington, MA 01803 Ph: (781) 270?1955 FOOD ESTABLISHMENT INSPECTION REPORT Fax: (781) 273-7687 Name Burlington High School Address 123 Cambridge St, Telephone (781)270-1885 Owner Burlington Public Schools? Person In Charge (PIC) Maiy L00 Govoni Inspector Marlene Johnson Date 09/14/2017 I Iype of Operation?Ts} ?Tr?yE?e? of inspection Food Service El RoutIne RISK RetaII ID Re?inspection Level Regidential Kitchen I I3 iritpegtign Mobile Date 03(06/2017 5? Temporary Pre operation HACCP [3 Caterer Suspect Illness Time [3 Bed SI Breakfast :000944 HACCP Out: 9:55 AM - Other I Each violation checked requires an exptanation on the narrative page(s) and a citation of specific provisionts) violated. Violations Related to Foodborne Illness Interventions and Risk Factors (Red Items) Non-compliance with. Violations marked may pose an imminent health hazard and require immediate corrective action as determined by the Board of Health. PROTECTION FROM CHEMICALS 0 Chemical-Test FOOD PROTECTION MANAGEMENT 1 PIC Assigned Knowledgeable /Duties EMPLOYEE HEALTH :5 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 :2 5 Receiving/Condition 6 Tagszecords/Accuracy of Ingredient Statements 7 Conformance with Approved Procedures/HACCP Plans PROTECTION FROM CONTAMINATION 8 9 Food Contact Surfaces Cleaning and Sanitizmg L3 10 PrOperAdequate Handwashing 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. 23 Management and Personnel 590 003 24 Food and Food Protection 590 004 25 Equipment and Utensils 590 005 26 Water. Plumbing, and Waste 590 006 27. Physical Facility 590 007 28 Poisonous or Toxic Materials 590.008 29 Special Requirements 590 009 30 Other BOH Regulation 31. Regulation Grease Trap Anti-Choking 530.009 (E) 3 Tobacco 590.009 (F) Allergen Awareness 590 009 (G) i] 11 Good Hygienic Practices 12 Prevention of Contamination from Hands E, 13 Handwash Facilities PROTECTION FROM CHEMICALS 14 Approved Food or Color Additives 15 Toxic Chemicals TIMEITEMPERATURE CONTROLS (PI-IFS) 16 Cooking Temperatures 17' Reheating 18 Cooling 19, Hot and Cold Holding 20 Time As a Public Health Control REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS 21 Food and Food Preparation for HSP CONSUMER ADVISORY if] 22 Posting ofConsumer Advisories I I 0 Official Order for Correction: Based on an Inspection today, the items checked Indicate violations of 105 0th 590 000lfedera Food Code This report. when signed below by a Board of Health member or its agent constitutes an order ofthe Board of Health Failure to correct violations cited in this report may result in suspension or revocation ofthe food establishment permit and cessation of food establishment operations It aggrieved by this order, you have a rightto 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: Number of Violated Provisions Related To Foodborne Illnesses Interventions and Risk Factors (Red Items 1-22): I Inspector?s Signature ?314 . Print: Marlene Johnson . Page 1 I of 2 Pages PIC's Signature IL, t" Print Mary Lou Govoni I FORM 734A Rev 9125123 A St.- ?5th BURLINGTON BOARD OF HEALTH 61 Center Street, Burlington, MA 01803 Ph: (781) 270?1955 Fax: (781) 273-7687 Establishment Name: Burlington High School Date: 09/14/2017 Page: of 2 Item Code 0F Viol/mom PLAN o?b?R?ia?C?iI?om 'bat?e" No. Reference - RecLIt?w Verified 27 590 007 Light shields missu?ng on thIee fluorescent lights Inside food dry ?storage room provide Note light shield on order for light bulb inside walk- -in ref unit - ..-. I Discussion With Person' In Charge".- Corrective Act?ion Re_q_uired: El No? Hand wash sink stocked and working hare via-sh sink (quats) 200 PPM test kit present equipment working: temperature oftuikey ham 40F (inside walk- In) Voluntary Compliance El Re-lnspection Scheduled Embargo EVoluntary DiSposal l] EmploQ?e Restriction}r Exclusion El Emergency Suspension El Emergency Closure Other. ?As noted THE COMMONWEALTH OF MASSACHUSETTS BURLINGTON BOARD OF HEALTH 61 Center Street, Burlington, MA 01803 Ph: (781) 270-1955 - Fax: (781) 273-7687 FOOD ESTABLISHMENT INSPECTION REPORT Name Burlington High School Date 02(05/2018 I Address 123 Cambridge St, BURLINGTON, MA 01803 Risk Level Medium Telephone (781)270-1885 Owner Burlington Public Schools HACCP Person in Charge (PIC) Marylou Govoni Time In: 9:05 AM Inspector Samantha Hardy Out: Iypgof Operation{s) Food Service Retail Residential Kitchen Mobile Temporary Caterer Bed 8 Breakfast Permit No. 000244 2 Type of Inspection Routine CI Re-inspection Previous inspection Date: 0914/2017 Pre-operation Suspect Illness General Complaint HACCP Other Each violation checked requires an explanation on the narrative page(s) and a citation of specific provision(s) violated. Violations Related to Foodborne Illness Interventions and Risk Factors (Red Items) Violations marked may pose an imminent health hazard and require immediate corrective action as determined by the Board of Health. PROTECTION FROM CHEMICALS 0 Chemical?Test FOOD PROTECTION MANAGEMENT 1 PIC AssignedlKnowledgeable/Duties 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 it} 5 Receiving/Condition C: 6. Tags/Records/Accuracy of Ingredient Statements 5:3 7. Conformance with Approved ProceduresIHACCP Plans PROTECTION FROM CONTAMINATION 8 I 9 Food Contact Surfaces Cleaning and Sanitizing 10 ProperAdequate Handwashing 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. 23. Management and Personnel 590.003 24 Food and Food Protection 590 004 25 Equipment and Utensils 590 005 26 Water, Plumbing, and Waste 590 006 27' Physical Facility 590 007 28. Poisonous or Toxic Materials 590.008 29. Special Requirements 590 009 30. Other BOH Regulation 31. Grease Trap BOH Regulation Allergen Awareness 11 Good Hygienic Practices 12 Prevention of Contamination from Hands If} 13 Handwash Facilities PROTECTION FROM CHEMICALS 14 Approved Food or Color Additives 15 Toxic Chemicals TIMEITEMPERATURE CONTROLS (PHFS) 16 Cooking Temperatures 17 Reheating 18 Cooling [3 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 If] 22 Posting of ConsumerAdvisories Number of Violated Provisions Related To Foodborne Illnesses Interventions and Risk Factors (Red Items 1-22): Non-compliance with: Anti-Choking Tobacco 590.009 (E) 590.009 (F) (3 590.009 (G) 0 Official Order for Correction: Based on an inspection today, the items checked indicate violations of 105 CMR 590 DOD/federal Food Code. This report, when signed below by a Board ofHeaIth member or its agent constitutes an order ofthe Board of Health Failure to correct violations cited in this report may result in suspension or revocation ofthe 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 10 days of receipt order. DATE OF RE-INSPECTION: 03/01/2018 Inspector?s Signature: i Print: Samantha Hardy Page PlC?s Signature: ~71? Print: Marylou Govoni 1 of 2 Pages FORM .734A Rev 92000 A Sulkin Co BURLINGTON BOARD OF HEALTH 61 Center Street, Burlington, MA 01803 Ph: (781) 270-1955 - Fax: (781) 273?7687 Establishment Name: Burlington High School Date: 02!05/2018 Page: 2 of 2 Item Code - Critical Item DESCRIPTION OF PLAN OF CORRECTION Date No. Reference - Red Item Verified 27 FC 6-501?11 Ceiling tiles missing in storage room, provide 27 FC 6-501. 12 I Dust buildup on fan in walkin. clean Discussion With Person in Charge: Corrective Action Required: No Yes Employee Restriction Exclusion Re-lnspection Scheduled l] Emergency Suspension Temperatures in compliance: taco beef 168F, smoothie 40F Three bay sanitizer 200ppm quats. in compliance. Restroom in compliance. Voluntary Compliance [j Embargo Emergency Closure Voluntary Disposal El Other: THE COMMONWEALTH OF MASSACHUSETTS BURLINGTON BOARD OF HEALTH 81 Center Street, Burlington, MA 01803 Ph: (781) 270-1955 - Fax: (781) 273?7687 FOOD ESTABLISHMENT INSPECTION REPORT Name Burlington High School Address 123 Cambridge St, BURLINGTON, MA 01803 Telephone (781) 270-1885 Owner Burlington Public Schools Person in Charge (PIC) Marylou Govoni inspector Samantha Hardy Date 03/01/2018 Type of Operationgs] Type of Insgection . Food Service Routine RISK LEVEI Retail Re-inspection 2 Residential Kitchen Previous inspection Mobile Date: 02/05/2018 Temporary Pre-operation HACCP Caterer Ci Suspect illness Time Bed 8 Breakfast General Complaint In: 9:15 AM .t 000244 HACCP Out: 9:25 AM em" Other Each violation checked requires an explanation on the narrative page(s) and a citation of Specific provision(s) violated. Violations Related to Foodborne Illness Interventions and Risk Factors (Red Items) Violations marked may pose an imminent health hazard and require immediate corrective action as determined by the Board of Health. PROTECTION FROM CHEMICALS 0 Chemical-Test FOOD PROTECTION MANAGEMENT 12 1. PIC Assigned Knowledgeable Duties 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 :5 5 Tags/Records/Accuracy of Ingredient Statements 5: 7 Conformance with Approved Procedures/HACCP Plans PROTECTION FROM CONTAMINATION 8 :2 9. Food Contact Surfaces Cleaning and Sanitizing 10. ProperAdequate Handwashing 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- criticai (N) violations must be corrected immediately or within 90 days as determined by the Board of Health. 23, Management and Personnel 590.003 24 Food and Food Protection 590.004 25. Equipment and Utensils 590.005 26 Water. Plumbing, and Waste 590 006 27 Physical Facility 590.007 28 Poisonous or Toxic Materials 590 008 29 Special Requirements 590.009 BOH Regulation BOH Regulation 30 31. Other Grease Trap Non-comp/iance with: Anti-Choking 590.009 (E) [1 Tobacco 590.009 (F) Allergen Awareness 590.009 (G) 11 Good Hygienic Practices i3: 12 Prevention of Contamination from Hands 13 Handwash Facilities PROTECTION FROM CHEMICALS 14. Approved Food or Color Additives LXI 15 Toxic Chemicals CONTROLS (PHFs) I3 16 Cooking Temperatures 17 Reheating Cl 18 Cooling 19. Hot and Cold Holding [Ii 20 Time As a Public Health Control REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS (HSP) [j 21 Food and Food Preparation for HSP CONSUMER ADVISORY 22. Posting of ConsumerAdvisories Number of Violated Provisions Related To Foodborne Illnesses Interventions 0 and Risk Factors (Red Items 1-22): Official Orderfor Correction: Based on an inspection today, the items checked indicate violations of 105 CMR 590 UGO/federal Food Code This report, when signed below by a Board of Health member or its agent constitutes an order ofthe Board of Health Failure to correct violations cited in this report may result in suspension or revocation ofthe 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 10 days of receipt of this order DATE OF RE-INSPECTION: Inspector's Signature: {emcgr' a? Print: Samantha Hardy Page 1 of 2 Pages PlC's Signature: M1. Print: Maiyiou Govoni FORM 734A Rev 9/2000 A Sulkin Co BURLINGTON BOARD OF HEALTH 61 Center Street, Burlington, MA 01803 Ph: (781) 270-1955 - Fax: (781) 273-7687 Establishment Name: Burlington High School Date: 03/Ol12018 Page: 2 of 2 Item Code - Critical Item DESCRIPTION OF VIOLATION I PLAN OF CORRECTION Date No. Reference - Red Item Verified Discussion With Person in Charge: Corrective Action Required: [a No TD Yes All violations corrected Employee Restriction I Voluntary Compliance Exclusion Re?Inspection Scheduled El Emergency Suspension Embargo El Emergency Closure El Voluntary Disposal El Other: THE COMMONWEALTH OF MASSACHUSETTS BURLINGTON BOARD OF HEALTH 61 Center Street, Burlington, MA 01803 Ph: (781)270-1955 - Fax: (781) 273-7687 FOOD ESTABLISHMENT INSPECTION REPORT Name Burlington High School Date 09/20/2018 Type of Operationisi Type of Inspection Food Service Routine Address 123 Cambridge St, BURLINGTON, MA 01803 Risk Level Retail [3 Re-inspection 2 l] Residential Kitchen Previous inspection Telephone (781) 270-1885 Mobile Date: 03/01/2018 . Tem orar Pre-o eration Owner Burlington Public Schools HACCP CateFrDer Suspgot Illness Person in Charge (PIC) Mary Lou Govoni Time Bed Bream? 322%?! C?mplamt In: 9:35 AM . Inspector Samantha Hardy Out: 10:10 AM Permit No! 000244 Other Each violation checked requires an explanation on the narrative page(s) and a citation of specific provision(s) violated. Non-compliance with: Anti-Choking 590.009 (E) Tobacco 590.009 (F) Allergen Awareness 590.009 (G) Viotations Rotated to Foodborne litrtess interventions and Risk Factors (Red items} Violations marked may pose an imminent health hazard and require immediate corrective action as determined by the Board of Health. PROTECTION FROM CHEMICALS 11 Good Hygienic Practices 0 Chemical-Test 12 Prevention ofContamination from Hands FOOD PROTECTION MANAGEMENT l] 13 Handwasn Facilities PROTECTION FROM CHEMICALS 14 Approved Food or Colo.- Additives 13 15 Toxic Chemicals TIMEITEMPERATURE CONTROLS (PHFs) El 1 Pic. Assigned linoi?riedgeab?e I Duties EMPLOYEE HEALTH CI ?2 Reporting of Deeases by Food Employee and PEG 3. Personnel with infections Restrictedrlixcloderi FOOD FROM APPROVED SOURCE 16 Cooking Temperatures 4 Food and Water from Approved Scurce 1,7 Reheating 5 Receiving/Condition [j 18 Cooling Tags/RecordsiAccuracy ct Ingredient Statements 10 Hot and Cold Holding T. Conformance with Approved Plans 20? Time As a Public Health Control PROTECTION FROM CONTAMINATION REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS 8 IHSPI 0 Food Contact Surfaces Cleaning and Sanitizing 21 and Preparation for CONSUMER ADVISORY ProperAciequate ~iandwashing 22 Posting ofConsumerAdvis-ories 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. Number of Violated Provisions Rotated To Foodborne ilinesses 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 GOO/federal 23. Management and Personnel 590 003 Food Code. This report. when signed below by a Board ofHealth 24 Food and Food protection 590004 member or its agent constitutes an order ofthe Board of Health 25 Equipment and Utensils 590 005 Failure to correct violations cited in this report may result in 25? Water, plumbing' and Waste 590.006 suspension or revocation ofthe food establishment permit and 27 Physical Facility 590 007 cessation of food establishment operations if aggrieved by this 28. Poisonous or Toxic Materials 590 008 order, you have a right to a hearing Your request must be in 29 Special Requirements 590009 writing and submitted to the Board of Health at the above address within 10 days of receipt of this order. 30 DATE OF RE-INSPECTION: 31 Other Grease Trap BOH Regulation BOH Regulation Inspector?s Signature: #V??'lif Print: Samantha Hardy Page 1 of 2 Pages PlC's Signature: Print: Mary Lou Govoni FORM 734A Rev 919.000 A Sillkir?i CD BURLINGTON BOARD OF HEALTH 61 Center Street, Burlington, MA 01803 Ph: (781) 270-1955 . Fax: (781) 273-7687 Establishment Name: Burlington High School Date: 09/20/2018 Page: 2 of 2 Item Code - Critical Item DESCRIPTION OF VIOLATION I PLAN OF CORRECTION Date No. Reference - Red Item Verified 25 FC 4-80213 Drawers soiled on bottom, clean COS Handles of storage unit near grill sticky. clean. COS Discussion With Person in Charge: Corrective Action Required: No IE Yes Temperatures in compliance: cooked hamburger 36F. Employee restroom stocked Handsinks stocked Three bay sanitizer 400ppm quats CI Voluntary Compliance Exclusion Employee Restriction I Res-Inspection Scheduled Emergency Suspension Embargo El Emergency Closure Voluntary Disposal Other: Corrected on Site BURLINGTON BOARD OF HEALTH 61 CenterStreet, Burlington, MA 01803 Ph: 781-270-1955 - Fax: 781-273-7687 Food Establishment Inspection Report Fame: Burlington High School Date 03/14/2019 Type of Operationis) Type of inspection: . - Food Service Establishment Routine Address. 123 Cambridge St . BURLINGTON, MA 01803 Level Retail Food Store Re-inspection Telephone (781) 270.1883 Residential: Cottage Foods [1 Pre-operational [3 Residential: Bed 8. Breakfast [1 Illness Investigation Owner: Burlington Public Schools HACCP El Mobile/Pushcart General Complaint Temporary Food Estab If] HACCP Person-In-Charge: Mary Lou Govoni Time [31 Other School Other In: 8:45 AM Inspector: Samantha Hardy Out: Number of Violated Provisions Related to Number of Repeat Violations Related to Date Of Re-Inspection Foodborne Illnesses Risk Factors and 0 Foodborne Illnesses Risk Factors and 0 Interventions (Items 1 though 29): interventions (Items 1 though 29): FOODBORNE ILLNESS RISK FACTORS AND PUBLIC HEALTH INTERVENTIONS IN in compliance OUT out of compliance NIO not observed MA not applicable COS corrected on-site during inspection repeat violatmn Compliance Status I IN Compliance Status I IN IourIii/AINioIcosI a Supervision Protection from Contamination 1 Person-in-charge present. demonstrates OUT 15 Food separated and protected OUT knowledge and performs duties . . 16 Food-contact surfaces: cleaned 8. sanitized DUT 2 Certi?ed Food Protection Manager OUT ii/A . 17 Proper disposition of returned, prewously OUT Employee Health served, reconditioned 8. unsafe food Management. food employee and Time/Temperature Control for Safety 3 conditional employee} knowledge. OUT . responsibilities and reporting 18 Proper cooking time temperatures OUT MA MD 19 Proper reheating procedures for hot holding OUT MA MD 4 Proper use of restriction and exclusion OUT 5 (Procedures for responding to vomiting and OUT 20 Proper time and temperature MA iarrheal events 21 Proper hot holding temperature IN OUT 900d Hygienic Practices 22 Proper cold holding temperature OUT MA MD 5 :29? eating, tasting, drinking ortobacco our two 23 Proper date marking and disposition OUT MA MD 7 No discharge from eyes, nose and mouth IN OUT mo 24 Time as a Public Health Control IN OUT Preventing Contamination by Hands Consumer Advisory 8 Hands clean properly washed OUT 2'5 ginifgeergzgifgrf?g?owded for OUT 9 No bare hand contact with ready-to-eat food OUT MA MD Highly Susceptible populations 10 sinks. properly OUT 26 Ezizzrized foods used, prohibited foods not OUT Approved Source Food/Color Additives and Toxic Substances 11 Food obtained from approved source OUT 27 Food additives. approved It properly used iN OUT 12 Food received at propertemperature IN OUT WA 28 Toxic substances properly identi?ed, stored OUT MA 13 Food received in good condition. safe 8: OUT 8? used . unadulterated Conformance With Approved Procedures 14 shellstock tags, OUT 29 OUT Official Order for Correction: Based on an inspection today: the items marked indicated violations of 105 CMR 590.000 and applicable sections of the 2013 FDA 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 you are subject to a notice of suspension, revocation. or non-renewal pursuant to 105 590 000 you may request a hearing before the board of health in accordance with 105 CMR Les Mia; I Signature of Person-In-Charge Mary Lou Govoni Dates 03,14,201 9 Date: 03/14/2019 I . ,1 Simature of Inspector Samantha Hardy :3 MDPH lepoii loim- 10/5/13 version Food Establishment Inspection Report - Town of Burlington, MA Establishment: Burlington High School IDate: 03/14/2019 Page 2 of GOOD RETAIL PRACTICES AND MASSACHUSETTS - ONLY SECTIONS An in box indicates numbered item is not in compliance An in appropriate box for DOS corrected on site during the inspection and/or repeat violation Compliance Status i OUT Compliance Status 1 OUT Icos Safe Food and Water Utensils. Equipment and Vending 30 Pasteurized eggs used where required 48 Warewashing facilities: installed, maintained 8: ussed; 31 test strips ater 8? we rom approved source 49 Non-food contact surfaces clean 32 2:22:25: obtained for specialized processing Physical Facilities 50 Hot 8: cold water available; adequate pressure Food Temperature Control . . I 51 Plumbing installed. proper backfiow deVices Proper cooling methods used; adequate equipment 33 for temperature control 52 Sewage waste water properly disposed 34 Plant food properly cooked for hot holding 53 :Iii?entefzcnities: properly constructed, SUpplled 8? 35 Approved thawing methods used 54 Garbage 8: refuse properly disposed; facilities maintained 36 Thermometers provided accurate 55 Physical facilities installed. maintained clean Food Identification I . I Adequate ventilation Enlightling; designated areas 37 Food properly labeled; original container I used Prevention of Food Contamination Additional Requirements tisted in 105 CMR 590.011 I 56 38 Insects. rodents 31 animals not present M1 Anti-choking procedure in 530d service . t' t' establishments 0 amine ion reven urin 00 re ara 39 storage and display 9 M2 Food allergy awareness 40 Personal cleanliness Review of Retail Operations listed in 105 590.010 . . M3 Caterer 41 Wiping cloths properly used stored . I 42 I M4 Mobile Food Operation Washing fruits Vegetables M5 Temporary Food Establishment Proper Use 0' M6 Public Market; Farmers Market 43 ln-use utenSiIs properly stored M7 Residential Kitchen; Bed-and-Breakfast Operation 44 equipment 3? linens: properly stored, dr'e?j 8? M8 Residential Kitchen Cottage Food Operation . I . M9 School Kitchen; USDA Nutrition Program 45 Singie-useismgIe-service articles: properly stored I I used M10 Leased CommerCiaI Kitchen 46 leoes used properly M11 Innovative Operation Local Requirements Utensils, Equipment and Vending L1 CFPM open to close Food non-food contact surfaces cleanebte, properly 47 designed, constructed used L2 Grease Trap Regulations Lea."- Iii-fr" . Signature of Person-in-Charge Mary Lou Govoni i? Date. 03/141201?! x" . Signature of Inspector. Samantha Hardy ?55! Date. 03i14l2019 MDPH report torm- 10mm verSion Food Establishment Inspection Report - Town of Burlington, MA [Establishment Burlington High School lDate: 03/14/2019 Page 3 of TEMPERATURE OBSERVATIONS ItemiLocation Temp ltemiLocation Temp ItemiLocation Temp Chicken/oven 174'?? Chicken/Walk-ln Cooler Item Number Section of Codei Description of Violation Discussion with Person-in-Charge: Signature of Inspector: Samantha Hardv iignature of Person-in-Charge: Mary Lou Govoni PflLosA?z?EW Date: 03l14l2019 Date: 031412019 THE COMMONWEALTH OF MASSACHUSETTS BURLINGTON BOARD OF HEALTH 81 Center Street, Burlington, MA 01803 Ph: (781) 270-1955 - Fax: (781) 273-7887 FOOD ESTABLiSHMENunseegguaeith Name Fox H?c?ioi' _Address 1 Fb?rii?E ciao? mar?one Owner Burlington Pubirc'schocrism? Person in Charge ?s?Ee?cErr Randall?S" rams D?afe defer/201.7 Type of?g?a?r??i Food Service Routine RISK . El Retail Re-inspection Level Medium El ResidentiaiKitchen Previous inspection El Mobile Date: 03/08/2017 Temporary Pre-operation HACCP El Caterer El Time Bed 8: Breakfast [1 General Complaint In: 11:55 AM . HACCP Out: 12:30 PM Permit No. 000248 Other Each violation checked ?tationgspecific Iiolations Related to Foodborne Illness Interventions and Risk Factors (Red Items) tiolations marked may pose an imanent health haZir?d?and rction as determined by the Board of Health. FROM CHEMICALS Chemical-Test OOD PROTECTION MANAGEMENT 3 1 PIC Assigned I Knowledgeable/Duties MPLOYEE HEALTH 2 Reporting of Diseases by Food Employee and PIC 3. Personnel with Infections Restricted/Excluded DOD FROM APPROVED SOURCE 4 Food and Water from Approved Source 3 5 Receiving/Condition 6 Tags/Records/Accuracy of Ingredient Statements 7, Conformance with Approved Procedures/HACCP Plans ROTECTION FROM CONTAMINATION 8 9 Food Contact Surfaces Cleaning and Sanitizing 10 ProperAdequate Handwashing olations Related to Good Retail Practices {Blue Items) 'itical violations marked must be corrected immediately within '10 days as determined by the Board of Health. Non- itical (N) violations must be corrected immediately or thin 90 days as determined by the Board of Health. 2 23. Management and Personnel 590 003 24. Food and Food Protection 590.004 25 Equipment and Utensils 590.005 26 Water, Plumbing, and Waste 590.006 27 Physical Facility 590.007 28 Poisonous or Toxic Materials 590 008 29 Special Requirements 590 009 30. 31 Other Grease Trap BOH Regulation BOH Regulation signaturZ? mgr??Ear;_ -- . ohm" C's Signature: 2M T34A Rev 912000 A Sulkin Co Farri- Randell?s. Term: WrinET/iastn' Non-compliance with: . . . . t-Ch k' 550.009 require immediate corrective $2132.?: mg Allergen Awareness 590.009 (G) 11 Good Hygienic Practices 12 Prevention ofContamination from Hands 13 Handwash Facilities PROTECTION FROM CHEMICALS 14 Approved Food or ColorAdditives [It 15. Toxic Chemicals TIMEITEMPERATURE CONTROLS (PHFS) 16 Cooking Temperatures 17 Reheating Ci 18, Cooling [Li 19 Hot. and Cold Holding 20. Time As a Public Health Control REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS [j 21. Food and Food Preparation for HSP CONSUMER ADVISORY 22 Posting of Consumer Advisories Number of Violated Provisions Related To Foodborne Illnesses Interventions 0 and Risk Factors (Red Items 1?22): Official_0rde_r_for Correction: Based on an. inspection today, the items ch??citeEiTn?di?aie Violations of105 CMR Food Code. This report. when signed below by a Board of Health member or its agent constitutes an order ofthe Board of Health Failure to conect vioiations cited in this report may result in suspension or revocation ofthe food establishment permit and cessation of food establishment operations lfaggrieved by this order, you have a right to a hearing Your request must be in writing and submitted to the Board ofi-ieaith at the above address within 10 days of receipt of this order DATE OF RE-INSPECTION: Page 1 of 2 Pages BURLINGTON BOARD OF HEALTH 61 Center Street, Burlington, MA 01803 Ph: (781) 270-1955 - Fax: (781) 273-7687 Establishment Name: Fox Hill School i'En?Eode Date: 09/07/2017 "it: - Critical Item VIOLATION i PLAN or coR?RE??rioN Page: 2 of 2 E?e?sw? Discussion With Person in Chargg 7 N0 violations noted. New walk in freezer and cooler. Olo' walk in used as equipment storage Holding temperatures all within regulations Kitchen needs better air circulation and ventilation to mitigate humidity. Verified Corrective Action Required: No ire?s . Cl Employee Restriction Cl Voluntary Compliance Exclusion Cl Re-lnspection Scheduled El Embargo Cl Voluntary Disposal El Emergency Suspension Cl Emergency Closure Other: THE COMMONWEALTH OF MASSACHUSETTS BURLINGTON BOARD OF HEALTH 61 Center Street, Burlington, MA 01803 Ph: (781) 270?1955 Fax: (781) 273?7687 FOOD ESTABLISHMENT INSPECTION REPORT Name Fox Hill School Address '1 FOX Rd BURLINGTON, MA 01803 Telephone (781) 270-1793 Owner Burlington Public Schools Person in Charge (PIC) Donnalee Mason Inspector Samantha Hardy Date 02/12/2018 Tyge of 09eration(s) Tyge of Insgection Food Service Routine Risk Level Retail El Re-inspection Medium [1 Residential Kitchen Previous inspection Mobile Date: 09/07/2017 Temporary El Pro-operation HACCP Caterer Suspect Illness Bed Breakfast General Complaint me In: 10:30 AM . a HACCP Out: Permit No. 000246 Other Each violation checked requires an explanation on the narrative page(s) and a citation of specific provision(s) violated. Violations Related to Foodborne Illness Interventions and Risk Factors (Red Items) AM Ch k?fmc?mp?iance Wgtg?a 009 Violations marked may pose an imminent health hazard and require immediate corrective Tog?; 9 5902009 action as determined by the Board of Health. PROTECTION FROM CHEMICALS 0. Chemical-Test FOOD PROTECTION MANAGEMENT 1 PIC Assigned Knowledgeable I Duties EMPLOYEE HEALTH 2 Reporting of Diseases by Food Employee and PIC 3. Personnel with Infections Restricted/Excluded FOOD FROM APPROVED SOURCE "d 4 Food and Water from Approved Source 5 Receivingl?Condition :5 6. Tags/Records/Accuracy of Ingredient Statements 2 7. Conformance with Approved Procedures/HACCP Plans PROTECTION FROM CONTAMINATION 8. :5 9 Food Contact Surfaces Cleaning and Sanitizing 10 Proper Adequate Handwashing 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. 23. Management and Personnel 590 003 24. Food and Food Protection 590.004 25. Equipment and Utensils 590.005 26 Water, Plumbing, and Waste 590.006 27. Physical Facility 590.007 28. Poisonous or Toxic Materials 590.008 29 Special Requirements 590 009 30 Other BOH Regulation 31, Grease Trap BOH Regulation Allergen Awareness 590.009 (G) 11. Good Hygienic Practices If) 12 Prevention ofContamination from Hands 13 Handwash Facilities PROTECTION FROM CHEMICALS 14. Approved Food or Color Additives If.) 15 Toxic Chemicals TIMEITEMPERATURE CONTROLS (PHFs) 16. Cooking Temperatures 17 Reheating CI 18 Cooling El 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 If.) 22. Posting ofConsumer 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 000lfederal Food Code This report, when signed below by a Board ofHeaIth member or its agent constitutes an order ofthe 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. tfaggrieved 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: 03/01/2018 Inspector?s Signature Print: Samantha Hardy Page __1_of 2 Pages PIC's Signature: ?q?wm Print: Donnalee L. Mason 734A Rev 912000 A Sulkin Co BURLINGTON BOARD OF HEALTH 61 Center Street, Burlington, MA 01803 Ph: (781) 270-1955 - Fax: (781) 273-7687 Establishment Name: Fox Hill School Date: 02/12/2018 Page: 2 of 2 Item Code - Critical Item DESCRIPTION OF VIOLATION I PLAN OF CORRECTION Date No. Reference - Red Item Veri?ed 27 FC 6-50142 Hood vents soiled with dust buildup, clean. Ceiling vents soiled with dust buildup, clean. Discussion With Person in Charge: Corrective Action Required: No Yes Three bay sanitizer 200ppm quats. Handsink in compliance. Restroom in compliance. Temperatures in compliance: cheese 37F. All frozen foods frozen solid. El Voluntary Compliance Exolusion Cl Employee Restriction Re-lnspection Scheduled Cl Emergency Suspension El Embargo El Emergency Closure Voluntary Disposal Other: THE COMMONWEALTH OF MASSACHUSETTS BURLINGTON BOARD OF HEALTH 61 Center Street, Burlington, MA 01803 Ph: (781) 270-1955 - Fax: (781) 273-7687 FOOD ESTABLISHMENT INSPECTION REPORT Name Fox Hill School Address 1 Fox Hill Rd BURLINGTON. MA 01303 Telephone Owner Burlington Public Schools Person in Charge (PIC) Donnaiee L. Mason Inspector Samantha ardy Date 03/01/2018 Type of Operation(s) Type of Inapection Food Service Routine Retail Re-inspection 2 Residential Kitchen Previous inspection Mobile Date: 02/12/2018 Temporary Pre-operation HACCP Caterer Suspect Illness Bed 8 Breakfast General Complaint ime In: 9:40 AM . oo ?3 HACCP Out: Permit No. 0246 other Each violation checked requires an explanation on the narrative page(s) and a citation of specific provisionis) violated. Violations Related to Foodborne Illness Interventions and Risk Factors (Red Items) Violations marked may pose an imminent health hazard and require immediate corrective action as determined by the Board of Health. PROTECTION FROM CHEMICALS 0. Chemical-Test FOOD PROTECTION MANAGEMENT a: 1. PIC Assigned Knowledgeable Duties EMPLOYEE HEALTH 2 Reporting of Diseases by Food Employee and PIC if; 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 3 7 Conformance with Approved Procedures/HACCP Plans PROTECTION FROM CONTAMINATION 8. :5 9. Food Contact Surfaces Cleaning and Sanitizing 10 ProperAdequate Handwashing .I'iolations Related to Good Retail Practices (Blue Items) 3ritical (C) violations marked must be corrected immediately 3r within 10 days as determined by the Board of Health. Non- :ritical (N) violations must be corrected immediately or within 90 days as determined by the Board of Health. (2 23 Managementand Personnel 590.003 24. Food and Food Protection 590.004 25 Equipment and Utensils 590.005 26. Water, Plumbing: and Waste 590.006 27. Physical Facility 590.007 28. Poisonous or Toxic Materials 590.008 29. Special Requirements 590.009 30. Other 31 Grease Trap BOH Regulation BOH Regulation Non-compliance with: Anti-Choking 590.009 (E) [3 Tobacco 590.009 (F) El Allergen Awareness 590.009 (G) [j 11. Good Hygienic Practices If]. 12 Prevention of Contamination from Hands [1 13 Handwash Facilities PROTECTION FROM CHEMICALS 14 Approved Food or ColorAdditives 15. Toxic Chemicals CONTROLS (PHFs) 16. Cooking Temperatures 17 Reheating 18. Cooling 19. Hot and Cold Holding [Ii 20 Time As a Public Health Control REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS (HSPI 21. Food and Food Preparation for HSP CONSUMER ADVISORY Ill 22. Posting of Consumer Advisories Number of Violated Provisions Related To Foodborne Illnesses Interventions 0 and Risk Factors (Red Items 1-22): Official Orderfor Correction: Based on an inspection today. the items checked indicate violations of 105 CMR 5.90 DUO/federal Food Code. This report, when signed below by a Board of Health member or its agent constitutes an order ofthe 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. Ifaggrieved by this order, y0u 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: Inspector's Signature: ?are few Print: Samantha Hardy Page 1 of 2 Pages PIC's Signature: sage Print: Donnaiee Mason ORM 734A Rev 9/2000 A Sulkin CD BURLINGTON BOARD OF HEALTH 61 Center Street, Burlington, MA 01803 Ph: (781) 270-1955 - Fax: (781) 273-7687 Establishment Name: Fox Hill School Date: 03/01/2018 Page: 2 of 2 Item Code - Critical Item DESCRIPTION OF VIOLATION I PLAN OF CORRECTION Date No. Reference - Red Item Veri?ed Discussion With Person in Charge: Corrective Action Required: No If] Yes All violations corrected. El Voluntary Compliance El Re-lnspection Scheduled Embargo Voluntary Disposal El Employee Restriction I Exclusion Emergency Suspension El Emergency Closure Other: THE COMMONWEALTH OF MASSACHUSETTS BURLINGTON BOARD OF HEALTH 61 Center Street, Burlington, MA 01803 Ph: (781) 270-1955 - Fax: (781) 273-7687 FOOD ESTABLISHMENT INSPECTION REPORT Name Fox Hill School Date 09/18l2018 Type of Operationts] Type of Inspection El Food Service Routine Address 1 Fox Hill Rd., BURLINGTON, MA 01803 Risk Level El Retail El Re?inspection 2 Residential Kitchen Previous inspection Te'ephm?e (731)270?1793 l:l Mobile Date: 03/01/2018 Owner Burlington Public Schools HACCP Person in Charge (PIC) Donnalee Mason Time In Bed 8? Breakfast 3 322%? Complaint 9505 AM Permit No 000246 om Inspector Marlene Johnson om; 950 AM - 9" 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 RiskAFactors (Red Items) Anti_Choking 590.009 (EIEI Violations marked may pose an health hazard and requtre immedlate corrective Tobacco 590.009 (F) action as determined by the Board of Health. Allergen Awareness 590.009 (6) PROTECTION FROM CHEMICALS [j 11. Good Hygienic Practices [3 0. Chemical?Test El 12. Prevention of Contamination from Hands FOOD PROTECTION MANAGEMENT 13. Handwash Facilities l] 1. PIC Assigned .1 Knowledgeable Duties PROTECTION FROM CHEMICALS EMPLOYEE HEALTH El 14. Approved Food or Color Additives 2. Reporting of Diseases by Food Employee and PIC Cl 15. Toxic Chemicals 3. Personnel with Infections Restricted/Excluded CONTROLS (PHFs) FOOD FROM APPROVED SOURCE 16, Cooking Temperatures [j 4. Food and Water from Approved Source 17. Reheating [j 5, ReceivinglCondition j 18. Cooling Cl 6 Tagisecords/Accuracy of Ingredient Statements 19, Hot and Cold Holding 7. Conformance with Approved Procedures/HACCP Plans 20, Time As a Public Health Control PROTECTION FROM CONTAMINATION REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS l] 8. El 9. Food Contact Surfaces Cleaning and Sanitizing I: 21' and Preparation for HSP CONSUMER ADVISORY El 10. Proper Adequate Handwashing 22. Posting of Consumer Advisories Violations Related to Good Retail Practices (Blue Items) Number of Violated provisions Related Critical (C) violations marked must be corrected immediately To Foodborne Illnesses Interventions 0 or within 10 days as determined by the Board of Health. Mom and Risk Factors (Red Items 1_22): critical (N) violations must be corrected immediately or . within 90 days as determined by the Board of Health. Official Order for Correction: Based on an inspection today. the items checked indicate violations of 105 CMR 590.000lfederal 23. Management and Personnel 590.003 Food Code. This report. when signed below by a Board of Health 24. Food and Food protection 590,004 member or its agent constitutes an order of the Board of Health. 25_ Equipment and Utensils 590.005 Failure to correct violations cited in this report may result in 26. Water. Plumbing. and Waste 590.005 suspension or revocation of the food establishment permit and 27. Physical Facility 590.007 cessation of food establishment operatlons. lf aggrieved by this 28 Poisonous or Toxic Materials 590.008 order, you have a to a hearlng. Your request must be In . . 590 009 writing and to the Board of Health at the above address 29' SpeClal Requirements BOH I within 10 days of receipt of this order. 3? 82:26 Trap BOH nzgitztigi DATE OF RE-INSPECTION: 10l02l20ts Inspector 5 Signature. ??um?eg, MW Print. Marlene Johnson Page Pages PlC?s Signature: 57?: ?Lem Print: Donnalee Mason FORM 734A Rev 9/2000 A.M. Sulkln Co. BURLINGTON BOARD OF HEALTH 61 Center Street, Burlington, MA 01803 Ph: (781) 270-1955 - Fax: (781) 273-7687 Establishment Name: Fox Hill School Date: 09l18/2018 Page: 2 of i Item Code - Critical Item DESCRIPTION OF VIOLATION I PLAN OF CORRECTION Date No. Reference - Red Item Verified 25 FC 4-60213 Two portable fan units very dusty, clean. 25 FC 4-501.11 Hood ?lter out of place, replace so it stays in place when unit is turned on. CORRECTED ON SITE. 26 FC 5601.113 Outside dumpster unit found open, close lids after each use. CORRECTED ON SITE 2? FC (ti-501.12 Dust. cobwebs. soils found on floor under shelves inside food/paper storage room. clean. 27 FC 6-501.111* Mouse droppings found on floor under shelf where chemicals are stored (next to walk-in ref. unit), contact pest control service so they can treat area then clean to remove drOppings. Provide a copy of pest control service report. Discussion With Person in Charge: Corrective Action Required: No Ii'EW?es Note: new serving line installed over summer. Found in compliance this day; . El Employee Restriction i hand wash sink (1 on site). stocked and working. temp. canned pears cold Voluntary Compliance Exclusion holding 37F, temp. packaged sliced cheese (temp. taken between unopened [El Re-Inspection Scheduled i] Emergency Suspension packages) 37F. warewash sink (quats) 200 PPM, milk carton ref. unit 32F El Embargo Emergency Closure (air temp). El Voluntary Disposal Cl Other: THE COMMONWEALTH OF MASSACHUSETTS BURLINGTON BOARD OF HEALTH 61 Center Street, Burlington, MA 01803 - Fax: (781)273-7687 FOOD ESTABLISHMENT INSPECTION REPORT Name Fox Hill School Date 10t02r2018 1 Type of Operationgs} Type of Inspection *1 Food Service Routine Address 1 FOX Hill Rd MA 01803 RISK LEUEI. Reta? Re_inspection 2 El Residential Kitchen Previous inspection Telephone {78112r0-1i?93 a Mobile Date: 09/18/2018 Temporary Pre-operation Owner Burlington Public Schools HACCP Ci Caterer Ci Suspect Illness Person in Charge Donnalee Mason Time Bed 8? Breakfast [3 Complaint In'. 9:30 AM . Inspector Marlene Johnson Out: 000245 Other Each violation checked requires an explanation on the narrative pagets} and a citation of specific provisionls) violated. Violations Related to Foodborne Illness Interventions and RiskFactors (Red Items) ?$5.009 Violations marked may pose an imminent health hazard and require immediate corrective Tobacco 550.005 (FIIZI action as determined by the Board of Health. Allergen Awareness sauces (Gllj PROTECTION FROM CHEMICALS ?I?ll Good Hygienic Practices 2 O. Chemical-Test 12. Prevention ofContamination from Hands FOOD PROTECTION MANAGEMENT 13. Handwash Facilities PIC Assigned I Knowledgeable I Duties PROTECTION FROM CHEMICALS EMPLOYEE HEALTH 14 Approved Food or Color Additives :3 2 Reporting of Diseases by Food Employee and PIC lj 15, Toxic Chemicals Ci 3. Personnel with Infections Restricted/Excluded TIMEITEMPERATURE CONTROLS (PHFs) FOOD FROM APPROVED SOURCE If] 16, Cooking Temperatures 4. Food and Water from Approved Source 17_ Reheating CI: 5 Receiving/Condition 18 Cooling 6 Tags/Records/Accuracy of Ingredient Statements 19 Hot and Cold Holding if} 7 Conformance with Approved Procedures/HACCP Plans Ci 20_ Time As a Public Health Control PROTECTION FROM CONTAMINATION REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS 8. (HSPI 9. Food Contact Surfaces Cleaning and Sanitizing 21 and Preparation for HSP CONSUMERADVISORY [j 22 Posting of ConsumerAdvisories if; 10 ProperAdequate Handwashing 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 Number of Violated Provisions Related To Foodborne Illnesses Interventions 0 and Risk Factors (Red Items 1-22}: within 90 days as determined by the Board of Health. Official Ordertor Correction: Based on an inspection today the items checked indicate violations of 105 CMR 590 000i?tederal 23. Management and Personnel 590003 Food Code. This report, when signed below by a Board of Health 24 Food and Food Protection 590004 member or its agent constitutes an order ofthe Board of Health 25. Equipment and Utensils 590005 Failure to correct violations cited in this report may result in 26. Water, Plumbing. and Waste 590006 suspension or revocation of the toad establishment permitand 27' Physical Facility 590.007 cessation of food establishment operations. It aggrieved by this 28. Poisonous or Toxic Materials 590.008 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 :3 33:38] Requirements BO Regiiggi within 10 days of receipt of this order. a 31 Grease Trap BOH Regulation DATE OF Inspector's signature: cm?wlgh? (93WMH, Print: Marlene Johnson -. Page _?I_of_2_Pages PIC's Signature ?5.53. Print: Donnalee Mason 724A Pm! 912000 A Sulkln Co BURLINGTON BOARD OF HEALTH 61 Center Street, Burlington, MA 01803 Ph: (781) 270?1955 - Fax: (T81) 273-7687 Establishment Name: Fox Hill School Date: 1010212018 Page: 2 of 2 Item Code - Critical Item DESCRIPTION OF VIOLATION I PLAN OF CORRECTION Date No. Reference - Red Item Veri?ed Discussion With Person in Charge: Corrective Action Required: No ID Yes El Employee Restriction I Exclusion Re-Inspection Scheduled El Emergency SuspenSIon All violations corrected, copy of pest control service report obtained, droppings were remoVed Voluntary Compliance Embargo Emergency Closure Voluntary Disposal Other: BURLINGTON BOARD OF HEALTH 61 Center Street, Burlington, MA 01803 Ph: 781-270-1955 - Fax: 781-273-7687 Food Establishment Inspection Report Name: FOX Hi? Date 03/12/2019 Type of Operation(s): Type of Inspection: . . . j Food Service Establishment Routine Address. 1 Fox Hill Rd.. BURLINGTON. MA 01803 EISK Level Ci Retail Food Store Cl Re-inspection Telephone: (781) 270-1793 lj Residential: Cottage Foods Pro-operational Residential: Bed Breakfast illness Investigation Owner: Burlington Public Schools HAccp [j Mobile/Pushcart General Complaint Temporary Food Estab. HACCP Person-in-Charge: Donnalee Mason Time Other Ci Other In: 900 AM Inspector: Marlene Johnson Out: 9:30 AM Number of Violated Provisions Related to Number of Repeat Violations Related to Date Of Re-lnSpection: Foodborne Illnesses Risk Factors and 0 Foodborne Illnesses Risk Factors and 0 Interventions (Items 1 though 29): Interventions (Items 1 though 29): FOODBORNE ILLNESS RISK FACTORS AND PUBLIC HEALTH INTERVENTIONS IN in compiianca OUT 2 out of compliance NIO not observed NIA not applicable COS corrected on-suo during inspection repeal violation Compliance Status 1 IN [ourLNiAINroicosi Compliance Status Lir?ominm Nio cosi Supervision Protection from Contamination 1 Person-in-charge present, demonstrates OUT 15 Food separated and protected OUT NIO knowledge and performs duties . 16 Food-contact surfaces: cleaned sanitized OUT NIA 2 Certi?ed Food Protection Manager OUT NIA . 17 Proper di5p05ition of returned. prevrously our Employee Health served. reconditioned 8i unsafe food Management. food employee and Timei?Temperature Control for Safety 3 conditional employee; knowledge. OUT . . responsibilities and reporting 18 Proper cookingtime temperatures IN our (MO) 4 Proper use of restriction and exclusion OUT 19 Proper reheating procedures for hot holding OUT NIA 5 Procedures for responding to vomiting and OUT 20 Proper cooling time and temperature IN OUT diarrheal events 21 Proper hot holding temperature IN our NIA 600d Hygienic P73611085 22 Proper cold holding temperature (E) OUT N10 5 Propereating. tasting. drinking or tobacco IN OUT N10 23 Proper date marking and disposition OUT NIA we use 24 a bl'o ntrol IN our N10 7 No discharge from eyes. nose and mouth OUT NIO ime a I ea 0 . Consum rA viso Preventing Contamination by Hands Consumer advise rovided for 8 Hands clean 8. property washed OUT MIC 25 rawlundercookedrfyogd OUT 9 No bare hand contact with ready-to-eat food OUT NIA Highly Susceptible Populations Adequate handwashing sinks. properly Pasteurized foods used. prohibited foods not 10 supplied and accessible OUT 26 offered IN OUT Approved Source Foodi'CoIor Additives and Toxic Substances 11 Food obtained from approved source OUT 27 Food additives: approved Ii properly used IN OUT 12 Food received at proper temperature IN OUT NA 28 Toxic substances properly identified. stored OUT NIA 13 Food received in good condition. safe OUT 8? used unadulterated Conformance with Approved Procedures Required records available: shelistock tags. Compliance with variance/specialized IN 0 14 parasite destruction IN OUT N10 2 process/HACCP plan UT Official Order for Correction: Based on an inspection today. the items marked indicated violations of 105 CMR 590.000 and applicable sections of the 2013 FDA 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 you are subject to a notice of suspension. revocation. or non-renewal pursuant to 105 CMR 590.000 you may request a hearing before the board of health in accordance with 105 CMR . . . 019 Signature of Person-in-Charge: Donnalee Mason Da 9 0312/2 WW4, WW Date: 03/1 212019 Signature of Inspector: Martens Johnson MLIPH report form - t?isrt? version Foo?d Establishment Inspection Report - Town of Burlington, MA Establishment: Fox Hill School IDate: 03/12/2019 Page 2 of i GOOD RETAIL PRACTICES AND MASSACHUSETTS - ONLY SECTIONS An In 110! indicates numbered item is not in compliance. An "it? in appropriate box for (:05 corrected on site during the inspection and/or repeat violation Compliance Status OUT 1005i Compliance Status I OUT lcos[ Safe Food and Water Utensils, Equipment and Vending 30 Pasteurized eggs used where required 48 Warewashing facilities: installed. maintained ussed; - test strips 31 Water ice from approved source 49 Non-food contact surfaces clean 32 zeartiraggs obtained for specialized processing Physical Facilities 50 Hot 8. cold water available; adequate pressure Food Temperature Control . . . 51 Plumbing Installed; proper backflow dewces 33 Proper cooling methods used; adequate equrpment for temperature centre] 52 Sewage waste water properly disposed 34 Plant food properly cooked for hot holding 53 preperly constructed, supplied 8? 35 Approved thawing methods 54 Garbage refuse properly disposed; facilities 36 Thermometers provided is accurate maintained . . . 55 Physical facilities installed, maintained clean Food Identification . . . Adequate ventilation lightling; de5ignated areas 37 Food properly labeled; original container I 55 used Prayention of Food Contamination Additional Requirements listed in 105 CMR 590.011 38 Insects, rodents animals not present M1 Anti-choking procedure in food service . . . . establishments 39 Contamination prevented during food preparation, storage and display M2 Food allergy awareness 40 Personal cleanliness Revrew of Retail Operations listed in 105 590.010 . . M3 Caterer 4?l Wiping cloths: properly used stored . 2 . M4 Mobile Food Operation 4 Washing fruns 8? vegetables M5 Temporary Food Establishment Proper Use Of Utensds M6 Public Market; Farmers Market 43 In?use utensils properly stored M7 Residential Kitchen: Bed-and-Breakfast Operation 44 equipment 8? linens: properly stored, dried 8' M8 Residential Kitchen: Cottage Food Operation M9 School Kitchen; USDA Nutrition Program articles: properly stored at . 45 used M10 Leased Commemial Kitchen 45 leoes used properly M11 Innovative Operation Utensils. Equipment and Vending Local Requirements 47 Food 8. non-food contact surfaces cleanable. properly L1 CFPM open to close deSIgned. constructed used I L2 Grease Trap Regulations . Date: 03/12/2019 Signature of Person-in-Chargs Donnalee Mason Signature of Inspector: Marlene Johnson Date. 0311712019 MDFH report form - 1015118 version Food Establishment Inspection Report - Town of Burlington, MA [Establishment Fox Hill School TDate: 03/12/2019 Page 3 of i TEMPERATURE OBSERVATIONS ltemlLocation Temp lleml?Location Temp ltemILocation Temp CheeseiWaIk-ln Cooler I item . . . . . Number Section of Code Description of Violation Discussion with Person-in-Charge: . . Date: 03/12/2019 Signature of Person-In-Charge: Donnalee Mason ?mm M?aw Date:03/1212019 Signature of Inspector: Marlene Johnson THE COMMONWEALTH or MASSACHUSETTS BURLINGTON BOARD OF HEALTH 61 Center Street Burlington, MA 01803 Ph: (781) 270-1955 - Fax: (781) 273?7687 ECT - grunt; lime}! I Name Fransis Wyman School A ?Hall-rig. i_ I . nr-h-r-a tar-Jr?s; i} I- - Address 41 Terrace Halt Ave mA 07803 Telephone (781) 270-1704 i Person in Charge (PIC) Car-3' Shaw-a i I Inspector Randall Phelps Owner Burlington Public Schools Date 7 Type of Operaticnis) Typiofin'spectign Food Service Routine RISR Retail Re-inspection Level Medium E. ReSIdentiai Kitchen Previous inspection Mobile Date: 03/06/2017 Temporary re?operaticn HACCP Caterer [1 Suspect Illness Time - Bed Breakfast General Comptairt 1000 AM itNo 00024? HACCP Out: 10:45 AM Other Each violation checked requires an explanation on the narrative page(s) and a citation of specific provision(s) violated. Violations Related to Foodborne Illness Interventions and Risk Factors (Red Items) Ant. Ch ?(5?Violations marked may pose an Imminent health hazard and reqUIre immediate corrective Tobe?: action as determined by the Board of Health. PROTECTION FROM CHEMICALS Chemical-Test FOOD PROTECTION MANAGEMENT PIC Assigned (Knowledgeable (Duties 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 :3 6 Tags/Records/Accuracy of Ingredient Statements .3 7 Conformance with Approved Procedures/HACCP Plans PROTECTION FROM CONTAMINATION 8 :3 9 Food Contact Surfaces Cleaning and Sanitizing 10, Proper Adequate Handwashing 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- :ritical (N) violations must be corrected immediately or Nithin 90 days as determined by the Board of Health. 23 Management and Personnel 590 003 24 Food and Food Protection 590 004 25 Equipment and Utensils 590 005 26 Water, Plumbing. and Waste 590 006 27 Physical Facility 590 00? 28. Poisonous or Toxic Materials 590.008 29 Special Requirements 590 009 30 Other BOH Regulation 31. Grease Trap BOH Regulation Allergen Awareness 590.009 if] 11 Good Hygienic Practices if} 12 Prevention of Contamination from Hands {Ti 13 Handwash Facilities PROTECTION FROM CHEMICALS [Ii 14 Approved Food or ColorAdditives 15 Toxic Chemicals CONTROLS (PHFs) {j 16 Cooking Temperatures 17 Reheating 18. Cooling iffi 19 Hot and Cold Holding if.) 20. Time As a Public Health Control REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS (HSP) 21. Food and Food Preparation for HSP CONSUMER ADVISORY if] 22 Posting ofConsumer Advisories Number of Violated Provisions Related To Foodborne Illnesses Interventions 0 and Risk Factors (Red Items 1-22): Officiat 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 ofthe Board of Health Failure to correct violations cited in this report may result in suspension or revocation ofthe food establishment permit and cessation of food establishment operations Ifaggrieved bythis 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 ofthis order. DATE OF RE-INSPECTION: Page 1 of 2 Pages Inspector's Signature: ?ber?lawn. Print: Randall Phelps Signature Print: Carol Ciampa 734A Rev A Suikin C0 BURLINGTON BOARD OF HEALTH 61 Center Street, Burlington, MA 01803 Ph: (781) 270-1955 - Fax: (781) 273-7687 Establishment Name: Francis Wyman School Date: 09/07/2017 Page: 2 of 2 Item Code - Critical Item DESCRIPTION OF VIOLATION PLAN OF CORRECTION Date No. Reference - Red Item Verified Discussion With Person in Charge: Corrective Action Required: No [El Yes Clean facility No rodent activity noticed Good usage oftemperature and . Cl Employee Restriction I sanitizer logs No violations noted. Voluntary Compliance Exclusion El Re-Inspection Scheduled Emergency Suspension Embargo Emergency Closure [3 Voluntary Disposal Other: THE COMMONWEALTH OF MASSACHUSETTS BURLINGTON BOARD OF HEALTH 61 Center Street. Burlington, MA 01803 Fax: (781) 273-7687 Ph: (781) 270?1955 FOOD ESTABLISHMENT INSPECTION REPORT Kg 55 2L- Name Francis Wyman School Date 02/08/2018 rType of Operation(s) of Ins ectio_n Food Service Routine Address 41 Terrace Hall Ave . BURLINGTON. MA 01803 Risk Level Retail Re-inspection Medium Residential Kitchen Previous inspection (781)270'1704 Mobile Date: 02/05/2018 . Owner Burlington Public Schools HACCP SLZSECetr?ltrg?s Person in Charge (PIC) Carol CiamPa Time 56d 8? Breakfast 322%: Complaint In: 10:05 AM 't 000247 Inspector Samantha Hardy Out: 1045 AM erml 0' El Other Each violation checked requires an explanation on the narrative page(s) and a citation of specific provision(s) violated. Violations Related to Foodborne Illness Interventions and Risk Factors (Red Items) Violations marked may pose an imminent health hazard and require immediate corrective action as determined by the Board of Health. PROTECTION FROM CHEMICALS Chemical-Test FOOD PROTECTION MANAGEMENT 1 PIC Assigned Knowledgeable I Duties EMPLOYEE HEALTH 2 Reporting of Diseases by Food Employee and PIC 3. Personnel with Infections Restrictedexcluded FOOD FROM APPROVED SOURCE 4. Food and Water from Approved Source 5. Receiving/Condition :5 8. Tags/Records/Accuracy of Ingredient Statements 3 7 Conformance with Approved Procedures/HACCP Plans PROTECTION FROM CONTAMINATION 8 C: 9. Food Contact Surfaces Cleaning and Sanitizing 10. Proper Adequate Handwashing 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. 23. Management and Personnel 590 003 24 Food and Food Protection 590,004 25. Equipment and Utensils 590.005 26 Water, Plumbing, and Waste 590 006 27. Physical Facility 590 007 28 Poisonous or Toxic Materials 590 008 29 Special Requirements 590.009 30 Other 31 Grease Trap BOH Regulation BOH Regulation Non-compliance with: Anti-Choking 590.009 (E) Tobacco 590.009 (F) Allergen Awareness 590.009 (G) I 11 Good Hygienic Practices 12 Prevention ofContamination from Hands F3 13 Handwash Facilities PROTECTION FROM CHEMICALS 14 Approved Food or Color Additives 15 Toxic Chemicals TIMEITEMPERATURE CONTROLS (PHFs) El 16 Cooking Temperatures if] 17 Reheating 18 Cooling 19 Hot and Cold Holding 20. Time As a Public Health Control REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS (HSP) [j 21. Food and Food Preparation for HSP CONSUMER ADVISORY if] 22 Posting of Consumer Advisories Number of Violated Provisions Related To Foodborne Illnesses Interventions 0 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 ofthe Board of Health Failure to correct violations cited in this report may result in suspension or revocation ofthe food establishment permit and cessation offood establishment operations lfaggrieved 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: Page 1 of 2 Pages Inspector's Signature: Print: Samantha Hard wig 3/ P'C?SS?gnaturs aroma 4. PM CaroICiampa - FORM 734A Rev 92000 A Sulkin Co BURLINGTON BOARD OF HEALTH 61 Center Street, Burlington, MA 01803 Ph: (781)270-1955 - Fax: (781) 273-7687 Establishment Name: Francis Wyman School Date?. 02/06/2018 Page: 2 of 2 39F. Three bay sanitizer 500ppm quats, PIC added water to dilute to 200ppm. Warewash machine not in use Re-Inspection Scheduled El Embargo Voluntary Disposal Item Code - Critical Item DESCRIPTION OF VIOLATION I PLAN OF CORRECTION Date No. Reference - Red Item Verified Discussion With Person in Charge: Corrective Action Required: No Yes Handsinks in compliance Restroom in compliance Storage organized - Employee Restriction,I Frozen foods frozen solid Temperatures in compliance: mozzarella cheese Voluntary Compliance Exclusion CI Emergency Suspension [3 Emergency Closure El Other: Corrected on Site THE COMMONWEALTH OF MASSACHUSETTS BURLINGTON BOARD OF HEALTH 61 Center Street. Burlington, MA 01803 Ph: (781) 270-1955 - Fax: (781) 273-7687 FOOD ESTABLISHMENT INSPECTION REPORT Name Francis Wyman School Address 41 Terrace Hall Ave, BURLINGTON, MA 01803 Telephone (781) 270-1704 Owner Burlington Public Schools Person in Charge (PIC) Patrice Wolk Inspector Marlene Johnson Date 09/18/2018 Type of Operationts) Type of Inspection . Food Service Routine RISK Level Retail Re-inspection 2 Residential Kitchen Previous inspection Mobile Date: 02/06/2018 Temporary Pro-operation HACCP El Caterer Suspect Illness Time Bed Breakfast General Complaint In: .mo 000247 EACCP Out: em" Cl Each violation checked requires an explanation on the narrative page(s) and a citation of specific provision(s) violated. Violations Related to Foodborne Illness Interventions and Risk Factors (Red Items) Non-compliance witht?-Ch 590.009 Violations marked may pose an immanent health hazard and reqmre Immediate corrective Tgbiaccgking 590.009 IEIB action as determined by the Board of Health. Allergen Awareness 590.009 (6) PROTECTION FROM CHEMICALS El 0. Chemical-Test FOOD PROTECTION MANAGEMENT El 1. PIC Assigned Knowledgeable Duties EMPLOYEE HEALTH [3 2. Reporting of Diseases by Food Employee and PIC CI 3. Personnel with Infections Restricted/Excluded FOOD FROM APPROVED SOURCE El 4 Food and Water from Approved Source 5. Receiving/Condition 6. Tags/Records/Accuracy of Ingredient Statements CI 7. Conformance with Approved Procedures/HACCP Plans PROTECTION FROM CONTAMINATION l] 8. 9. Food Contact Surfaces Cleaning and Sanitizing 10. Proper Adequate Handwashing 11. Good Hygienic Practices 12. Prevention of Contamination from Hands 13. Handwash Facilities PROTECTION FROM CHEMICALS 14. Approved Food or Color Additives El 15. Toxic Chemicals CONTROLS (PHFs) 18. Cooking Temperatures 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 Violations Related to Good Retail Practices (Blue Items) Number of Violated Provisions Related Critical (C) violations marked must be corrected immediately To Foodborne Illnesses Interventions 1 or within10 days as determined by the Board of Health. Non- and Risk Factors (Red Items 1_22)_ critical (N) violations must be corrected immediately or within 90 days as determined by the Board of Health. Official Order for Correction: Based on an inspection today. the items checked indicate violations of 105 CMR 590.000/federal 23. Management and Personnel 590.003 Food Code. This report. when signed below by a Board of Health 24. Food and Food Protection 590004 member or its agent constitutes an order of the Board of Health. 25, Equipment and Utensils 5901005 Failure to correct violations cited in this report may result in suspension or revocation of the food establishment permit and 26. Water, Plumbin . and Waste 590.006 . . 27 Physical Facility? 590 007 cessation of food establishment operations. If aggrieved by this . . . order. you have a right to a hearing. Your request must be in 33? gorsonlogs Materials 2:333: writing and submitted to the Board of Health at the above address 30- 03:83 me" 5 BOH Re ma?a? within 10 days of receipt of this order. 31' Gregg Trap 80H Regma?on DATE OF RE-INSPECTION: 10/02/2018 Inspector's SI nature: . t: Marlene Johnson 9 9"4? ., rin Page LofiPages Signature: 61-1 1? (?3142' Print: Patrice FORM 734A Rev. 9/2000 A.M Sulkln CD. BURLINGTON BOARD OF HEALTH 61 Center Street, Burlington, MA 01803 Ph: (781) 270-1955 . Fax: (781) 273?7687 Establishment Name: Francis Wyman School Date: 09/18/2018 Page: 2 of 2 Item Code - Critical Item DESCRIPTION OF VIOLATION I PLAN OF CORRECTION Date Reference - Red Item Verified 19 FC 3-50116 Temp. potato patties 120F - 131 (warmer closest to hand wash sink)and potato patties 110F (warmer closest to small tabletop mixer), maintain food requirement temperature control for safety (TCS) at or above 135F. Check food temperatures for the rest of week, have unit repaired if necessary. Lunch period is 2 hours, discard TCS foods out of temperature control if not sold after last lunch period. 27 FC 6?501.111* Mouse droppings found under shelves and behind water heater in paper storage room, contact pest control for service then clean to remove dust. cobwebs, mouse droppings and soils throughout this room. Mouse droppings also found in old unused warewash (dish wash) room under shelves and equipment. contact pest control for service then clean ?oor throughout. 30 FC Food permit posted but it covers the certi?ed food protection manager (CFPM) certi?cate, post separate so both can be seen. Discussion With Person in Charge: Corrective Action Required: No Yes Found In compliance: temp. sausage patties 166E 158F. packaged sliced El Voluntary Compliance Employee Restriction] cheese (between unopened package) 39F, hand wash sink (1 on site) Exclusion stocked and working, warewash sink (quats) 200 PPM. Re-Inspection Scheduled CI Emergency Suspension Embargo Emergency Closure El Voluntary Disposal Other: BURLINGTON BOARD OF HEALTH 61 Center Street, Burlington, MA 01803 Ph: 781-270?1955 - Fax: 781-273-7687 Food Establishment Inspection Report Name: Francis Wyman Date 03/12/2019 Type of Operationis): Type of Inspection: - . El Food Service Establishment Routine Address. 41 Terrace Hall Ave . BURLINGTON, MA 01803 Elsk Level Retail Food Store Re-inspeotion Residential: Cottage Foods Pro-operational Telephone: (781) 270-1704 . . Residential: Bed Breakfast Illness Investigation Owner: Burlington Public Schools HACCP Mobile/Pushcart General Complaint Temporary Food Estab HACCP Person-in-Charge: Carol Ciampa Time Other School Other In: 11:00 AM Inspector: Marlene Johnson Out: 11:45 AM Number of Violated Provisions Related to Number of Repeat Violations Related to Date Of Re-Inspection: Foodborne Illnesses Risk Factors and 2 Foodborne Illnesses Risk Factors and 0 Interventions (Items 1 though 29): Interventions (Items 1 though 29): FOODBORNE ILLNESS RISK FACTORS AND PUBLIC HEALTH INTERVENTIONS IN in compliance OUT out cl compliance mo not observed NIA not applicable COS corrected on-site during inspection repeat violation Compliance Status IN outl Compliance Status IN [cos] Supervision Protection from Contamination 1 Person-in-charge present. demonstrates IN 15 Food separated and protected OUT NIO knowledge and performs duties . . 18 Food-contact surfaces: cleaned sanitized OUT MA 2 Certified Food Protection Manager OUT NIA . . . . 17 Proper disposmon of returned. prewously OUT Employee Health served. reconditioned unsafe food Management. food employee and TImeITemperature Control for Safety 3 conditional employee; knowledge. OUT . . responsibilities and reporting 18 Proper cooking time temperatures IN OUT 4 Preper Use of restriction and exclusion OUT 19 Proper reheating procedures for hot holdIng OUT N10 5 Procedures forresponding to vomiting and OUT 20 Proper coolIngtIme and temperature IN OUT NIA diarrhea] events 21 Proper hot holding temperature IN NIA 900d Hygienic Practices 22 Proper cold holding temperature our NIO 6 eating. tasting. drinking or tobacco our NIO 23 Proper date marking and disposition our NIA as a blic Heath Control IN OUT NIO No discharge from eyes. nose and mouth OUT N10 24 1m I . Consumer Adv'so Preventing Contamination by Hands I Consumer adviso rovided for 8 Hands clean properly washed OUT MIC 25 raw/undercooked :?gd OUT 9 N0 bare hand contact with ready-to-eat food OUT NIA NIO Highly Susceptible populations Adequate handwashing sinks. properly Pasteurized foods used. prohibited foods 10 supplied and accessible OUT 25 not offered OUT Approved Source FoodlCoIor Additives and Toxic Substances 11 Food obtained from approved source IN OUT 27 Food additives: approved properly used IN OUT 12 Food received at proper temperature IN OUT NIA Toxic substances properly identi?ed, stored 28 used our NIA 13 Food received in good condition. safe OUT unadulterated Conformance with Approved Procedures Required records available: shellstook tags. Compliance with variancefspecialized I 14 parasite destruction IN OUT W0 2 processlHACCP plan UT Official Order for Correction: Based on an inspection today. the items marked indicated violations of 105 CMR 590.000 and applicable sections of the 2013 FDA 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 you are subject to a notice of suspension. revocation, or non-renewal pursuant to 105 CMR 590.000 you may request a hearing before the board of health in accordance with 105 CMR 590.015iB). Signature of Person-in-Charge. Carol Ciampa 2: :2 Date: 03/12/2019 Ma?a Date: 0311212019 Signature of Inspector: Marlene Johnson MDPH repon term - torsrta verslen Food Establishment Inspection Report - Town of Burlington, MA Establishment: Francis Wyman School IDate: 03/12/2019 Page 2 of i GOOD RETAIL PRACTICES AND MASSACHUSETTS ONLY SECTIONS An "it" in box indicates numbered item is not in compliance. Ari "lit" in appropriate box for COS corrected on site during the inspection andror repeat violation Compliance Status OUT Compliance Status I OUT Safe Food and Water Utensils. Equipment and Vending 3o Pasteurized eggs used where required 48 Warewashing facilities: installed, maintained ussed; . test strips 31 Water ice from approved source 49 Non-food contact surfaces clean 32 X13223: obtained for specialized processing Physical Facilities 50 Hot cold water available; adequate pressure Food Temperature Control . . 51 Plumbing installed; proper backflow devices 33 Proper cooling methods used; adequate eqUIpment for temperature control 52 Sewage 8. waste water properly disposed 34 Plant food properly cooked for hot holding 53 llgi?ejgjcililies: properly constructed, SUPplied 8? 35 Approved thawing methods used 54 Garbage refuse properly disiposed; facilities 36 Thermometers provided accurate maintained . Food Identi?cation 55 PhySical faculties installed, maintained clean . . Adequate ventilation lightling; deagnated areas 37 Food properly labeled; original container I 56 used Prevention of Food Contamination Additional Requirements listed in 105 CMR 590.011 38 Insects, rodents animals not present M1 Anti-choking procedure in food service . . . . establishments 39 Contamination prevented during food preparation, storage and display M2 Food allergy awareness 40 Personal cleanliness Review of Retail Operations listed In 105 590.010 . . M3 Caterer 41 Wiping cloths: properly used stored 4 M4 Mobile Food Operation 2 h' 't Was mg vegetables M5 Temporary Food Establishment Proper Use Of M6 Public Market; Farmers Market 43 ln-use utensns properly Stored M7 Residential Kitchen; Bed-and-Breakfast Operation 44 2327:: eqUipment 8? linens: properly dried 8? M8 Residential Kitchen: Cottage Food Operation . . 1 M9 School Kitchen; USDA Nutrition Program 45 Single-use/smgle-semce articles: properly stored 8. . used M10 Leased Commemial Kitchen 46 leoes used properly M11 Innovative Operation Utensils, Equipment and Vending Local Requirements 47 Food non-food contact surfaces cleanable. properly L1 CFPM open to close designed. constructed used L2 Grease Trap Regulations Signature of Person-in-Charge; Carol Clamps Date: 03/12/2019 - MAW . Signature of Inspector: Marlene Johnson we Dates 03/122019 MDPH report form - 10/5l18 version Food Establishment Inspection Report - Town of Burlington, MA Establishment: Francis Wyman School I Date: 03/12/2019 Page 3 of i TEMPERATURE ltemlLocation Temp ItemlLocation Temp Item/Location Temp chicken nuggeUHot-Hold Unit chicken nugget/Other hot hold unit French fries/HobHold Unit Potato puff/Hot-Hold Unit ButterNValk-ln Cooler Item . . . . . Number Section of Code Description of Violation 1 2-102.11 PIC tasted French fry to determine it hot enough, PIC instructed to use food thermometer. Chicken nuggets found at 119F. potato puffs 111F (inside warming cabinet located by tabletop mixer. French fries found at 109F (inside warming cabinet located by 2 door True ref. unit). it was observed employees were serving the hot food directly from the hot holding cabinets instead of utilizing the steam tables. Opening the cabinets introdUCes cool air which causes hot food to decrease in temperature. Keep temperature control for safety (TCS) foods hot at or above 135F. Use appropriate equipment when serving food. PIC reheated out of temperature foods in the oven to 165F. 21 Discussion with Person-in-Charge: Post most recent food inspection report with food permit as required for school foodservice. Sanitizer water was cold, keep sanitizer water between 75F - 110E Signature of Person-in-Charge: Carol Ciampa (gm?L Date: 03/12/2019 ?We, marsh?e Date: 03/12/2019 Signature of Inspector: Marlene Johnson 03/13/2019 09 44 FAX 1&1 COMMERCIAL SERVICESOxford. MA0154O Fax (508) 949-9172 1-800-982-4722 SALES - SERVICE 0 INSTALLATION I001 MEMOS all To: 13mm: MW Frames} Mar-nun Bur?mgk-on hum-n nun-T We Hum-d Romano by C. Tun}: Mthatizid In Wm Euubmant mu- 1;:erth Modal genie? VDNIDI I 3C1 Fm Ul?d Du- Smicll FMW (maths! Pm No. Diuriplion Pm. 3'wa Dad's 5h! gag-re aim-crew me: unr" l3 swam um waved am": 9m: W- @J-mlt a: .MLHD HM IEOD 11.13 941' Prm??bdd .Egutgh Igg'l' t; Eur-nor- @15sz and WW ?x TRAVEL LABOR Duo 1 Lum [can Om. HR. MIN. SandiAPPROVED BY if a: :3 immanent luau-hm ??1meme Minimum. uni . til SIGNATURE (H THE COMMONWEALTH OF MASSACHUSETTS BURLINGTON BOARD OF HEALTH 61 Center Street, Burlington, MA 01803 Ph: (781) 270?1955 - Fax: (781) 273?7687 FOOD ESTABLISHMENT INSPECTION REPORT Name Marshall Simonds Middle School Address 114 Winn St BURLINGTON. MA 01803 Telephone (781) 270-1771 Owner Burlington Public Schools Person in Charge (PIC) Kristine Libby Inspector Marlene Johnson Date 09/14/2017 Type of Operationts) 13 Food Service Reutine RISK I3 Retail Re-inspection LEVEI Medium El Residential Kitchen Previous inspection [3 Mobile Date: 03077201? I3 Temporary [3 Pre?operation HACCP )3 Caterer Suspect Illness Bed Breakfast General Complaint ime In: 10:05 AM . HACCP Out: 10:55 AM Permit No. 000245 Other Each violation checked requires an explanation on the narrative page(s) and a citation of specific provision(s) violated. Violations Related to Foodborne Illness Interventions and Risk Factors (Red Items) A t. or kM?gn'co?m?Iance ??Violations marked may pose an Imminent health hazard and reqUIre immediate corrective Tobacco 590.009 action as determined by the Board of Health. PROTECTION FROM CHEMICALS 3 0 Chemical-Test FOOD PROTECTION MANAGEMENT 1 PIC Assigned Knowledgeable Duties EMPLOYEE HEALTH 3 2. Reporting of Diseases by Food Employee and PIC i3 3 Personnel with Infections Restrictedexcluded FOOD FROM APPROVED SOURCE 4. Food and Water from Approved Source 3 5 Receiving/Condition ES. Tagisecords/Accuracy of Ingredient Statements 7. Conformance with Approved Procedures/HACCP Plans PROTECTION FROM CONTAMINATION I 8 9 Food Contact Surfaces Cleaning and Sanitizing 2' 10 Proper Adequate Handwashing 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. 23 Management and Personnel 590.003 24. Food and Food Protection 590.004 25. Equipment and Utensils 590 005 25 Water, Plumbing, and Waste 590.006 27. Physical Facility 590 007 28 Poisonous or Toxic Materials 590.008 29 Special Requirements 590.009 30 Other BOH Regulation 31 Grease Trap BOH Regulation Allergen Awareness 590.009 11 Good Hygienic Practices 12 Prevention ofContamination from Hands 13 Handwash Facilities PROTECTION FROM CHEMICALS 14 Approved Food or Color Additives 15 Toxic Chemicals TIMEITEMPERATURE CONTROLS (PHFs) TI 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) If] 21. Food and Food Preparation for HSP CONSUMER ADVISORY 22 Posting ofConsumerAdvisories . DEED Number ofVioIated Provisions Related To Foodborne Illnesses Interventions 0 and Risk Factors (Red Items 1-22): Official Order for Correction: Based on an inspection today. the items checked indicate violations of 105 CMR 590.000iifederal Food Code This report, when signed below by a Board of Health member or its agent constitutes an order ofthe Board of Health Failure to correct violations cited in this report may result in SUSpension or revocation ofthe food establishment permit and cessation of food establishment operations Ifaggrieved 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: 09126/2017 Ins pector? 5 Signature cm .1- Print Marlene Johnson Page1_of 2 Pages Signature: sigma Ag?aigf- Print: Kristine Libby FORM 734A Rev 90000 A Sulkln CG BURLINGTON BOARD OF HEALTH 61 Center Street, Burlington, MA 01803 Ph: (781) 270-1955 - Fax: (781) 273-7687 Establishment Name: Marshall Simonds Middle School Date: Page: 4 of 2 Discussion With Person Hand wash sinks stocked and working warenisgh's?ink (quats). 200 PPM, test kit present, mechanical dishwasher wash 156E rinse 181E equipment in working order food temperatures fried chicken at various hot holding units; 170E, 164f, 155E 176E, 148F Voluntary Compliance El Rte-Inspection Scheduled Emergency Suspension [3 Embargo CI Emergency Closure Voluntary Disposal El Other: Item Code - Critical item? DESCRIPTION or VIOLATISE PLAN OF CORRECTION Date No. Reference Item?. Verified 2? 590 007 Dust build up on wall and ceiling at kitchen entrance by hand wash sink next to produce prep sink, clean to remove Dust build up on many ceiling tiles and calling vents. clean No IIE Yes ?'il Employee Restriction! Exclusion THE COMMONWEALTH or MASSACHUSETTS BURLINGTON BOARD OF HEALTH 61 Center Street, Burlington, MA 01803 Ph: (781) 270-1955 - Fax: (781) 273-7687 FOOD ESTABLISHMENT INSPECTION REPORT (Tame Marshall Simonds Middle School Address 114 Winn St. BURLINGTON. MA 01803 Telephone (7'81) 270-1771 Owner Burlington Public Schools Person in Charge (PIC) Kristine Libby Inspector Marlene Johnson Date 09/26/2017 Type of Operatrenfg Food Service Routine RISK Level [3 Retail Re-inspection Medium Residential Kitchen PreVlous inspection . Mobile Date 09/14/2017 I 1] Temporary El Pro-operation HACCP Caterer 1] Suspect Illness 1] Bed a Breakfst General Complaint lme . HACCP In. 1000 AM 't ?00"4' Out: em" Other Each violation checked requires an explanation on the narrative page(s) and a oration of specific provision(s) violated. Violations Related to Foodborne Illness Interventions and Risk Factors (Red Items) Non-compliance withAnti-Cho'-ln 590.009 Violations marked may pose an imminent health hazard and require immediate corrective Tobacco? 9 590.009 IFIE action as determined by the Board of Health. Allergen Awareness 590.009 (G) El PROTECTION FROM CHEMICALS 1:3 0 Chemical-Test FOOD PROTECTION MANAGEMENT 1 PIC Assigned r? Knowledgeable Duties EMPLOYEE HEALTH ?3 2 Reporting of Diseases by Food Employee and PIC 3 Personnelwith Infections Restricted/Excluded FOOD FROM APPROVED SOURCE 4 Food and Water from Approved Source 5 Recelving/Condition 6. Tags/Records/Accuracy Statements if} 7. Conformance with Approved Procedures/HACCP Plans PROTECTION FROM CONTAMINATION C: 8 9 Food Contact Surfaces Cleaning and Sanitizing 10. ProperAdequate Handwashing 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. 11 Good Hygienic Practices [3 12. Prevention ofContamination from Hands [Li 13 Handwash Facilities PROTECTION FROM CHEMICALS 14 Approved Food or Color Additives if] 15 Toxic Chemicals TIMEITEMPERATU RE CONTROLS (PHFs) 16. Cooking Temperatures 17 Reheating 18 Cooling If] 19 Hot and Cold Holding 20 Time As a Public Health Control REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS (HSP) If] 21 Food and Food Preparation for HSP CONSUMER ADVISORY 22. Posting of Consumer Advisories Number of Violated Provisions Related To Foodborne Illnesses Interventions 0 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 23. Management and Personnel 590003 Food Code This report, when signed below by a Board of Health 24 Food and Food Protection 590.004 member or its agent constitutes an order ofthe Board of Health 25 Equipment and Utensils 590.005 Failure to correct violations cited in this report may result in 26 Water, Plumbing, and Waste 590.006 suspension or revocation ofthe food establishment permit and 27 Physical Facility 590.007 cessation of food establishment operations lfaggrieved bythis 28 Poisonous orToxic Materials 590.008 order you have a right to a hearing. Your request must be in 29 Special Requirements 590 009 writing and submitted to the Board of Health at the above address 30 Other BOH Regulation Within 10 days of receipt order. 31. Grease Trap BOH Regulation DATE OF Inspector's Signature: Print: Marlene Johnson I Signature . x" A .4 ?uff-?ew I Print: Kristine Libby fear; my, 54:" stablishment Name: Marshall Simonds Middle School BURLINGTON BOARD OF HEALTH 61 Center Street, Burlington, MA 01803 Ph: (781)270-1955 - Fax: (781)273-7687 Date: 09/26/2017 Page: of 2 Fem Code - Critical Item DESCRIPTION OF VIOLATION I PLAN OF CORRECTION Date No. Reference - Red ltem Veri?ed Discussion With Person in Charge: Corrective Action Required: No Yes Dust was removed from ceiling, ceiling vents and walls were needed CI Voluntary Compliance El Re-lnspeotion Scheduled El Embargo Voluntary Disposal Employee Restriction;I Exclusron Emergency Suspension El Emergency Closure El Other: THE COMMONWEALTH OF MASSACHUSETTS BURLINGTON BOARD OF HEALTH 61 Center Street, Burlington, MA 01803 Ph: (781)270-1955 - Fax: (781) 273-7687 FOOD ESTABLISHMENT INSPECTION REPORT Name Marshall Simonds Middle School Date 0272772018 Type of Operatignjs} Type of inspej?on Food Service Routine Address 114 Winn St. BURLINGTON, MA 01803 Risk Level Retail Re-inspection 2 E) Residential Kitchen Previous inspection Telephone (781) 270-1771 Mobile Date: 02/26/2018 . Temporary Pre-operation Owner Burlington Public Schools HACCP CI Caterer CI Suspect Illness Person in Charge (PIC) Kristine Libby Time Bed 3? BreakfaSt 3 gig: comp'a'm 9115 AM Permit No 000245 om Inspector Samantha Hardy Out: 9:45 AM er Each violation checked requires an explanation on the narrative page(s) and a citation of specific provisionis) violated. Violations Related to Foodborne Illness Interventions and Risk Factors (Red Items) . {Von-compliance ?VimAnti-Choking 590.009 (E) Violations marked may pose an Imminent health hazard and reqUIre immediate corrective Tobacco 590009 (F) action as determined by the Board of Health. Allergen Awareness 690.009 (G) [i PROTECTION FROM CHEMICALS 11 Good Hygienic Practices 0 Chemical-Test 12 Prevention ofContamination from Hands FOOD PROTECTION MANAGEMENT 13 Handwash Facilities 3 1 PIC Assigned r? Knowledgeable Duties PROTECTION FROM CHEMICALS EMPLOYEE HEALTH if] 14 Approved Food or ColorAdditives 2 Reporting of Diseases by Food Employee and PIC 15? Toxic Chemicals [Ii 3 Personnel with Infections Restricted/Excluded TIMEITEMPERATURE CONTROLS (PHFs) FOOD FROM APPROVED SOURCE 18 Cooking Temperatures 4 Food and Water from Approved Source 17 Reheating 5. Receiving/Condition 18 Cooling :5 6 Tags/Records/Accuracy of Ingredient Statements CI 19 Hot and Cold Holding :3 7 Conformance with Approved Procedures/HACCP Plans CI 20 Time As a Public Health Control PROTECTION FROM CONTAMINATION REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS 1'3 8 IHSP) ?j 9 Food Contact Surfaces Cleaning and Sanitizing Ll 21? and Preparation for HSP CONSUMER ADVISORY if] 22 Posting of ConsumerAdvisories 10, Proper Adequate Violations Related to Good Retail Practices (Blue Items) Number of Violated provisions Related Critical (C) violations marked must be corrected immediately To Foodborne Illnesses Interventions or within 10 days as determined by the Board of Health. Non- and Risk Factors (Red Items 1_22). 0 critical (N) violations must be corrected immediately or Nithin 90 days as determined by the Board Of Health. Official Order for Correction: Based on an inspection today, the items checked indicate violations of 105 CMR 590.000/federal 23. Management and Personnel 590003 Food Code This report, when signed below by a Board of Health 24 Food and Food Protection 590 004 member or its agent constitutes an order ofthe Board of Health. 25 Equipment and Utensils 590,005 Failure to correct violations cited in this report may result in 26. Water, Plumbing, and Waste 590.006 suspension or revocation of the food establishment permit and 27 Physical Facility 590 007 cessation of food establishment operations, If aggrieved by this 28 Poisonous or Toxic Materials 590.008 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 29' Requirements 590 0.09 within 10 days of receipt of this order 30 Other 50? Regu'at'o" TE RE 31. Grease Trap BOH Regulation DA 0 Inspector's Signature: .1 Kiwi-Ft Print: Samantha Hardy 1 2 Page of Pages PiC's Signature: Print: Kristine Libby 3ORM 734A Rev 9/2000 A C0 BURLINGTON BOARD OF HEALTH 61 Center Street, Burlington, MA 01803 Ph: (781) 270-1955 - Fax: (781) 273-7687 stablishmergt Name: Marshall Middle School Date: 02/27/2018 Page: 2 of_2__ tem Code - Critical Item DESCRIPTION OF VIOLATION I PLAN OF CORRECTION Date lo. Reference - Red Item . Verified 27 FC 6-501112 Light shield has dead insects inside in dry storage room, remove. COS Discussion With Person in Charge: Corrective Action Required: No I. Yes femperatures in compliance: cheese between packages 41F. Dishwasher trash 1521:, rinse 184F Three bay sink 200ppm quats Handsinks in :ompliance Employee restroom in compliance Voluntary Compliance Cl Re?lnspection Scheduled El Embargo El Voluntary Disposal El Employee Restriction Exclusion El Emergency Suspension El Emergency Closure El Other Corrected on Site THE COMMONWEALTH OF MASSACHUSETTS BURLINGTON BOARD OF HEALTH 61 Center Street, Burlington, MA 01803 Ph: (781)270-1955 - Fax: (781)273-7687 FOOD ESTABLISHMENT INSPECTION REPORT Name Marshall Simonds Middle School Date 09/25/2018 Type of ?perationgst Type of Inspection . Food Service Routine Address 114 Winn St.. BURLINGTON, MA 01803 Risk Level El Retail El Re_inspec?on 2 Residential Kitchen Previous inspection Te'eph?me [3 Mobile Date: 09/10/2018 . . Temporary Pre-operation Owner Burlington Public Schools HACCP El Caterer El Suspect Illness Person in Charge (PIC) Kristine Libby Time '3 Bad 8? Bream? General C0mp'a'm . . El HACCP In. 10.10 AM Inspector Samantha Hardy Out: 10:40 AM Permit 000245 Other Each violation checked requires an explanation on the narrative pagels} and a citation of speci?c provisionts) violated. Non-compliance with: . . A t'-Ch kl . Violations marked may pose an imminent health hazard and require immediate corrective "9 3933:: IFI action as determined by the Board of Health. Allergen Awareness 590.009 (G) l: 3 1* l_l ii in?: .i?1?iilf Hm: '3 i . r. ?in it?lIUHh"? . PROTECTION FROM CHEMICALS Li ?i4 3i :1 :1 fight" [?xllti?Ii?V-Z?H El 111 toxic tin haunt.) TIMEITEMPERATURE CONTROLS (PHFs) ll 2ft tanking in liit urta?ili: i1: it?r't! lime in. 2. ?31:2? 'rl ?irri REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS (HSP) {1.31531 fliH'J ail thii?i i?wi. ?mi lint? CONSUMER ADVISORY l: it? mien Violations Related to Good Retail Practices (Blue items] Heather Visitateiz? imitated Critical ICI violations marked "?153 be corrected immediately to Foridtiorne ?tness-m. sentient: or within 10 days as detennlned by the Board of Health. Non- 21m; 321mg Factors; {Red items i 32}; critical (N) violations must be corrected immediately or within 90 days as determined by the Board of Health. Official Order for Correction: Based on an inspection today. .3 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. Failure to correct violations cited in this report may result in suspension or revocation of the food establishment permit and 23 Managementand Personnel 500003 24 Food and Food Protection 590 004 25. Equipment and Utensils 590 005 {58? Water, P'Lim?ng' and Waste ?9303? cessation of food establishment operations. It aggrieved by this 57? Fac' ?y :9 0 orderI you have a right to a hearing. Your request must be in 2-5- Materials "90 008 writing and submitted to the Board of Health at the above address 29. Requirements 590.009 within 10 days Of receipt Of order. 30. Other BOH Regulation DATE OF RE-INSPECTION: 31. Grease Trap BOH Regulation InshBEIOr?s Signature: 14? 474'? print Samantha Hardy page 1 of 2 Fag a PlC's Signature: AW Print: Kristine Libby FORM 734A Rev. 912000 A M. Sulkln Co. BURLINGTON BOARD OF HEALTH 61 Center Street, Burlington, MA 01803 Ph: (781) 270?1955 Fax: (781) 273-7687 Establishment Name: Marshall Simonds Middle School Date: 09/25/2018 Page: _2_of_2_ Code No. Reference Item - Critical Item - Red Item DESCRIPTION OF VIOLATION I PLAN OF CORRECTION Date Vb??ed 25 FC 44302.13 Ice machine soiled inside. corrected on site. Discussion With Person in Charge: Corrective Action Required: [3 No ][31Yes 140F, cucumber 41 F. Three bay sanitizer 200ppm quats, Handsinks in compliance. Employee restroom in compliance. Temperatures in compliance: green bean 175F, mac cheese 163E hot dog Voluntary Compliance Re?lnspection Scheduled Embargo Voluntary Disposal 1] Employee Restriction I Exclusion Emergency Suspension El Emergency Closure Other: Corrected on Site BURLINGTON BOARD OF HEALTH 61 Center Street, Burlington, MA 01803 Ph2781-270-1955 . Fax: 781-273-7687 Food Establishment Inspection Report NameSmg'rIS, 1? Type of Operationts): Type of Inspection Address RI It! J?m? E?od Service Establishment B?Routine Ji?? 5 I El Retail Food Store DRe-inspection TelephoneResidential: Cottage Foods Pro-operational Residential; Bed 8. Illness investigation Owner: HACCP YIN BtEEkfaSt El General complaint 4 . - MobiIeIPushcart HACCP Person-in?Charge: ye at LIE is} f) UTemporary Food Estab. Other I I .. Out}? is?; Other I nspector. pix/?r ?lam/ x? H. Number of Violated Provisions Related I Number of Repeat Violations Related Date 0 Rte-Inspection: lto Foodborne Illness Risk Factors and to Foodborne Illness Risk Factors and (a )0 - Ilnterventions (Items 1 through 29): Interventions (Items 1 through 29): . I FOODBCIRNE ILLNESS RISK FACTORS AND PUBLIC HEALTH INTERVENTIONS IN in compliance out of compliance NIO not observed NIA not applicable COS corrected on-site during inspection repeat violation I Compliance Status Compliance Status [w Supervision Protection from Contamination 1 Person-in-charge present, demonstrates VA 15 Food separated and protected Jr knowledge, and performs duties 1 Food-contact surfaces; cleaned L31: 2 Certified Food Protection Manager If sanitized I Employee Health . Proper disposition of returned, Management, food emp 0yee and 17 previously reconditioned 8t 3 conditional employee; knowledge. unsafe f00d responsibilities and reporting TimeI'I'emperature Control for Safety 4 Proper use of restriction and exclusion 1" 18 Proper cooking time temperatures Procedures for responding to vomiting Proper reheating procedures for hot 5 . 19 . if and diarrheal events holding Good Hygienic Practices . 20 Proper cooling time and temperature 6 prer eatlng. or v? 21 Proper hot holding temperature y? :13 acco use 22 Proper cold holding temperature Jf 7 from eyes, nose. and t/ 23 Proper date marking and disposition 1' . . . 24 Time as a Public Health Control y?r Preventing Contamination by Hands) . Consumer Advisory 8 Hands clean properly washed . . . -. 'th 25 Consumer advrsory provrded for rawrea y-o-ea undercooked food fOOd Highly Susceptible Populations Adequate handwashing sinks properly 4 . p, !10 supplied and accessible if 26 Pasteurized foods used, prohibited foods VIE I Approved source not offered Foodi'CoIor Additives and Toxic Substances ?11 Food obtained from approved source . . . Food additives: approved properly 12 Food received at proper temperature 27 used 13 F003 r'eceiye?t 900d condition. safe. 8? 28 Toxic substances properly identified, r" una era . stored used 14 Requtred records available. shellstock Conformance with Approved Procedures tags, parasrte destruction . . . . . 29 Compliance variance I specralized process HACCP Plan Official Order for Correction: Based on an inspection today, the items marked indicated violations of 105 CMR 590 000 and applicable sections of the 2013 FDA 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 you are subject to a notice of suspension, revocation, or non-renewal pursuant to 105 CMR 590 000 you may request a hearing before the board of health in accordance with 105 CMR I.- .i 1 s. 3 :f Ignature of Person In Charge ?f?r-i-L fr ?525?? Date 3/ fjf/ fl . urea nspec or ?fig? as .: Food Establishment lnspection Report Town of Burlington, MA EStab'iShmentl? hf bit ccli M?lqll Emmi?: . 3 Date: Page 2 of . ?23. GOOD RETAIL PRACTICES AND MASSACHUSETTS-ONLY SECTIONS IN In compliance out of compliance N10 not observed MA not applicable COS corrected on-site during inspection repeat violation I IN JOLIT Compliance Status Nl?. .Jn Compliance Status in our mo cos Safe Food and Water Pasteurized eggs used where 30 required 48 Warewashing facilities: installed, maintained, 8: used; test strips 49 Non-food contact surfaces clean 31 Water& ice from approved source Physical Facilities Variance obtained for specialized Hot cold water available; 32 processing methods 50 adequate pressure ,.Food Temperature Control 51 Plumbing installed; proper backflow . Proper cooling methods used; 33 adequate equipment for l? 52 Sewage waste water properly temperature control disposed 34 rli?lsiicriit food properly cooked for hot 53 Toiletfaciilittjies: prcipgrl? I 0 ing cons ruc supp ie . eane 35 Approved thawing methods used 54 Garbage refuse properly 36 Thermometers provided accurate faCl'lt'e? maintained Food Identification 55 installed, 37 Food properly labeled; original ventilatifonn lighting, container Prevention of Food Contamination 56 desrgnated areas used - ~34 Insects rodents animals not Additional Requirements listed in 105 Clg'lR 590. 011 38 present M1 Anti choking procedures In food Contamination prevented during servrce establishment ,4 39 food preparation. storage and M2 allergy awareness display 5: -. Review of Retail Operations listed in 105 CMR 590.010 40 Personal cleanliness 1; M3 Caterer 41 Wiping cloths: properly used stored 42 Washing fruits vegetabies Proper Use of Utensils 43 ln-use utensils preperly stored 44 Utensils, equipment linens: properly stored, dried, 8. handled Single-use single-service articles: properly stored used 46 Gloves used properly Utensils, Equipment and Vending Food non? food contact surfaces 47 cleanable, properly designed, constructed used 45 M4 Mobile Food Operation M5 Temporary Food Establishment M6 Public Market; Farmers Market M7 Residential Kitchen; Bed?and- Breakfast Operation M8 Residential Kitchen: Cottage Food Operation M9 School Kitchen; USDA Nutrition Program M10 Leased Commercial Kitchen M11 Innovative Operation Local Requirements L1 CFPM Open to Close if, L2 Grease Trap Regulations; 3! Discussion with Person-in-Charge: Signature of Person-in-Charge; 21 Signature of Inspector: A. . a. Date: ?K/wl! Date. Food Establishment inspection Report Town of Buriington,IMA Establishment: {Bus ixfgjin gt?mlg ML gi-Al Date: 23/! 1 Page 5} of .5 Tem rature Observations item i Location Item i Location Tem item r' Location item Number Section of Code Description of Violation Signature of Person-in-Charge: Date: 31/ I f?mf Date: THE COMMONWEALTH OF MASSACHUSETTS BURLINGTON BOARD OF HEALTH 61 Center Street, Burlington, MA 01803 Ph: (781) 270?1955 FOOD ESTABLISHMENT INSPECTION REPORT Fax: (781) 273-7687 Name Memorial School Date 09/141257: yg of O-Eeratior?s) I CI Food Service R3i.: Address 125 Winn St. BURLINGTON, MA 01803 Risk a Retail ac- i .. Level Medium ReSIdential Kitchen I Telephone (7'81) 270-1723 Mobile Date {Iain-)ipmv lo'S hu'I'T: -- Temporary I P's operatic wner Burington ubic oos ACC IIZI Caterer (D Suspec' ?we? Person in Charge Christine Stevens? Time I3 06d 8? Bieamas? IE :3222; Tampa": i In: 1045 AM . H. Inspector Marlene Johnson Out: 1115 AM Permit i utner . . Each violation checked requires an explanation on the narrative page-sh and a citation of specific irioiated. Violations Related to Food_borne Illness Interventions and Risk Factors (Red items) AN 009 Violations marked may pose an imminent h?eaith hazard and require immediate corrective Ta'iiazc: 'g E93009 5 action as determined by the Board of Health. PROTECTION FROM CHEMICALS L: Chemical-Test FOOD PROTECTION MANAGEMENT If} 1 PIC Assigned I Knowledgeable i? Duties EMPLOYEE HEALTH 2 Reporting of Diseases by Food Employee and PIC ?53 Personnel with Infections RestrictedlExcluded FOOD FROM APPROVED SOURCE 4 Food and Water from Approved Source 1? 5 Receivingi'Condition 6 Tags/Records/Accuracy of Ingredient Statements 7 Conformance with Approved Procedures/HACCP Plans PROTECTION FROM CONTAMINATION 8 9 Food Contact Surfaces Cleaning and Sanitizing L: 10 ProperAdequate Handwashing 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. Allergen Awareness sec 009 to) 11 Good Hygienic Practices of from Hands ?g 13 Haiidwain Facilities PROTECTION FROM CHEMICALS [ii 14 Approved Food or Color Additives 1:3 15 Toxic Chemicals TIMEITEMPEFIATURE CON LS (PHFS) 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) [Li 21 Food and Food Preparation for HSP CONSUMER ADVISORY Ci 22 Posting of ConsumerAdvisories L3 E: Number of Violated Provisions Related To Foodborne Illnesses Interventions and Risk Factors (Red Items 1-22): O?icial Order for Correction: Based on an inspection today, the items checked indicate violations of 105 CMR 590 GOO/federal 23 Management and Personnel 590003 Food Code This report, when signed. beioyv by a Board of Health 24 Food and Food Protection 590.004 member or its agent constitutes an order ofthe Board of Health 25 Equipment and 590 005 Failure to correct violations cited in this report may result in 25 Water, Plumbing, and Waste 590 006 suspensron or revocation of the food establishment permit and 27. Physical Facility 590 007 cessation offood establishment operations ?aggrieved by this 28 Poisonous or Toxic Materials 590.008 order you have a right to a hearing Your request must be in 29 Special Requirements 590 009 writing and submitted tot he Board of He aiih at i i-d_ ._ibc; .re adiji-CSJ 30 Other BOH Regulation within 10 days of receipt of this order. 31 Grease Trap BOH Regulation DATE OF Inspector's Signature "IV-Laughs- ?Print Marlene Johnson?:? Page LofLPages Signature Print Christine Stevens 't Iik II 7,34) BURLINGTON BOARD OF HEALTH 61 Center Street, Bunington, MA 01803 Ph: (781) 270-1955 - Fax: (781) 273-7687 Establishment Name: Memorial School Date: 09/14/2017 Page: 2 of 2 Item Code - Critical Item DESCRIPTION OF VIOLATION I PLAN OF CORRECTION Date No. Reference Red Item V?EEified Discussion With Person in Charge: Corrective Action Required: No [El Yes__ Hand wash sinks stocked and working equipment in working order. were wash sink (quats), 200 PPM, test kit present, mechanical dishwasher wash rinse 184f, food temperatures, mashed potatoes 16oF, fried chicken 184F. 185F, tunafish 39F [3 Voluntary Compliance [3 Re-lnspection Scheduled El Embargo CI Voluntary Disposal CI Employee Restriction-l Exclusion Cl Emergency Suspension El Emergency Closure Other: THE COMMONWEALTH OF MASSACHUSETTS BURLINGTON BOARD OF HEALTH 61 Center Street, Burlington, MA 01803 Ph: (781)270-1955 - Fax: (781) 273-7687 FOOD ESTABLISHMENT INSPECTION REPORT rName Memorial School Date 02/27/2018 Type of Operationts} Food Service Address ?125 Winn 8t BURLINGTON MA 01803 Telephone (781} 270?1723 Owner Burlington Public Schools Person in Charge Christine Stevens Inspector Samantha Hardy Risk Level Retail 2 Residential Kitchen El Mobile Ci Temporary HACCP Caterer Time Bed 8 Breakfast In: 9:50 AM Out: Permit No. 000248 Type of lnsoection l3} Routine El Re-inspection Previous insoection Date: 02/28/2018 Pre-operation Suspect Illness El GeneraiCompIaint CI HACCP Other Each violation checked requires an explanation on the narrative pageis) and a citation of specific provisionls) violated. Violations Related to Foodborne Illness Interventions and Risk Factors (Red Items) Violations marked may pose an imminent health hazard and require immediate corrective action as determined by the Board of Health. PROTECTION FROM CHEMICALS 0. Chemical-Test FOOD PROTECTION MANAGEMENT 1. PIC Assigned Knowledgeable Duties EMPLOYEE HEALTH 2. Reporting of Diseases by Food Employee and PIC t2! 3. Personnel with Infections Restricted/Excluded FOOD FROM APPROVED SOURCE 4 Food and Waterfrom Approved Source 5 Receiving/Condition 6. TagisecordslAccuracy of Ingredient Statements 5: 7. Conformance with Approved Procedures/HACCP Plans PROTECTION FROM CONTAMINATION 8. 2 9. Food Contact Surfaces Cleaning and Sanitizing 10 Proper Adequate Handwashing Violations Related to Good Retail Practices (Blue Items} :ritical violations marked must be corrected immediately at within ?10 days as determined by the Board of Health. Non- :ritical (N) violations must be corrected immediately or within 90 days as determined by the Board of Health. 0 23. Management and Personnel 590.003 24. Food and Food Protection 590.004 25 Equipment and Utensils 590.005 26. Water. Plumbing. and Waste 590 006 27. Physical Facility 590 007 28 Poisonous or Toxic Materials 590.008 29. Special Requirements 590.009 30 Other 31. Grease Trap BOH Regulation BOH Regulation Non-compliance with: Anti-Choking 590.0139 (E) El Tobacco 590.005 (F) Allergen Awareness 590.009 (G) [j 11. Good Hygienic Practices 12 Prevention of Contamination from Hands [3 13 Handwash Facilities PROTECTION FROM CHEMICALS 14. Approved Food or Color Additives [It 15 Toxic Chemicals CONTROLS (PHFs) [j 18. Cooking Temperatures [Ii 17. Reheating El 18. Cooling 19. Hot and Cold Holding 20 Time As a Public Health Control REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS 21, Food and Food Preparation for HSP CONSUMER ADVISORY [Ii 22 Posting of ConsumerAdvisories Number of Violated Provisions Related To Foodborne Illnesses Interventions 0 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/federai Food Code. This report, when signed below by a Board of Health member or its agent constitutes an order ofthe Board of Health Failure to correct violations cited in this report may result in suspension or revocation of the food establishment permit and cessation offood 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 days of receipt of this order DATE OF RE-INSPECTION: Inspector's Signature: acted Print: Samantha Hardy Page 1 of 2 Pages Signature: P??F?ba 1" Print: Christine Stevens DRM 734A Rev 9/2000 A Sulkin C0 BURLINGTON BOARD OF HEALTH 61 Center Street, Burlington, MA 01803 Ph: (781)270-1955 - Fax: (781) 273-7687 Establishment Name: Memorial School Date: 02/27/2018 Page: 2 of 2 item Code - Critical Item DESCRIPTION OF it PLAN OF CORRECTION 'Date No. Reference - Red Item Verified Discussion With Person in Charge: Corrective Action Required: [31 No ID Yes Temperatures in compliance. ham 29F, hotdog 161F, meatballs 182E Dishwasher wash 152F, rinse 182F. Three bay sink 200ppm quats. Employee restroom in compliance. Handsinks in compliance [3 Voluntary Compliance [3 Re-lnspectlon Scheduled Embargo Voluntary Disposal Employee Restriction Exclusion Emergency SuSpension El Emergency Closure Other: THE COMMONWEALTH OF MASSACHUSETTS BURLINGTON BOARD OF HEALTH 61 Center Street, Burlington, MA 01803 - Fax: (781)273-7687 FOOD ESTABLISHMENT INSPECTION REPORT Name Memorial School Date 09/25/2018 Address 125 Winn St, BURLINGTON, MA 01803 Risk Level 2 Telephone (781) 270-1723 Owner Burlington Public Schools HACCP Person in Charge (PIC) Christine Stevens Time In: 9:30 AM InSpector Samantha Hardy Out: 10:10 AM TEE of Operation(s) Food Service Retail Residential Kitchen Mobile Temporary Caterer Bed 8 Breakfast Permit No. 000248 Type of Inspection 3 Routine Re-inspection Previous inspection Date: 09/10/2018 Pre-operation Suspect Illness General Complaint HACCP CI Other Each violation checked requires an explanation on the narrative page(s) and a citation of specific provision(s) violated. Violations Related to Foodborae interventions and Risk Factors {Red items) Violations marked may pose an imminent health hazard and require immediate corrective action as determined by the Board of Health. PROTECTION FROM CHEMICALS O. Chemical?Test FOOD PROTECTION MANAGEMENT 1 PEC Assigned Knowledgeabie i" Duties EMPLOYEE HEALTH [3 2 Reporting of Diseases by Food Employee and El 3 Personnel with infections Restricted/Excluded FOOD FROM APPROVED SOURCE 4 Food and Water from Approved Source 5 Receiving/Condition CI 6 Tags/Records/Acouracy of Ingredient Statements El Conformance with Approved Procedures/HACCP Plans PROTECTION FROM CONTAMINATION El 8 9 Food Contact Surfaces Cleaning and Sanitizing CI 10 Proper Adequate Handwashing Violations Related to Good Retail Practices (Blue Items) Critical (C) vioiations 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. 23. Management and Personnel 590.003 24. Food and Food Protection 590.004 25. Equipment and Utensils 590.005 26. Water, Plumbing, and Waste 590.006 27. Physical Facility 590.007 28. Poisonous or Toxic Materials 590.008 29 Special Requirements 590.009 30. Other 31. Grease Trap BOH Regulation BOH Regulation Non-compliance with: Anti-Choking 590.009 (E) Tobacco 590.009 (F) Allergen Awareness 590.009 (G) 11. Good Hygienic Practices 13 12 Prevention ofContamination from Hands 13 Handwash Facilities PROTECTION FROM CHEMICALS 14. Approved Food or Color Additives 15 ToxicChemicaIs CONTROLS (PHFs) 16 Cooking Temperatures El Reheating 18 Cooling CI '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 El 22 Posting ofConsumerAdvisories Number of Vicia?ted Provisions Reiated To Foodborne illnesses Interventions and Risk Factors (Red items 1-22): 0 Official Order for Correction: Based on an inspection today, the items checked indicate vioiatrons of 105 CMR 590.000/federal Food Code This report, when signed below by a Board ofHealth member or its agent constitutes an order ofthe 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. It 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: Inspector?s Signature: Print: Samantha Hardy 2 Pages PIC's Signature: Print: Christine Stevens ORM 734A Rev 9/2000 A Sulkin CO BURLINGTON BOARD OF HEALTH 61 Center Street, Burlington. MA 01803 Ph: (781) 270-1955 - Fax: (781)273-7687 Establishment ame: Memorial School Date: 09/25/2018 Page: 2 of 2 quats. Employee restroom in compliance. Handsinks in compliance El Re-lnspection Scheduled CI Embargo Voluntary Disposal Item Code - Critical Item DESCRIPTION OF VIOLATION I PLAN OF CORRECTION Date No. Reference - Red Item Veri?ed Discussion With Person in Charge: Corrective Action Required: No Yes Temperatures in compliance: carrots 40F, green beans 33F, cheese sauce . Employee Restriction/ 174E Dishwasher: wash 155F, rinse 182E Three bay sanitizer 300ppm Voluntary Compliance Exolusion Emergency Suspension CI Emergency Closure El Other: BURLINGTON BOARD OF HEALTH 61 Center Street, Burlington, MA 01803 Ph: 781-270?1955 - Fax: 781-273-7687 Food Establishment Inspection Report Name: Memorial School Date 03/13/2019 a of Operation 5 pe of Inspection I: I'rb Cab-ood Sen. oe if"; Rovine Address. 125 Winn SL, BURLINGTON. MA 01803 EISR Level Retail Food Store Re-inspection Residential: Cottage Foods Pre-operational Teie hone: 781 270-1?23 . . I I Residential: Bed 8. Breakfast Illness investigatlon Owner: Burlington Public Schools HACCP El Mobileipushca? El Gene?a' Comp'aint Temporary Food Estab. HACCP Person-in-Charge: Christine Stevens Time Other El Other In: 9:05 AM Inspector: Marlene Johnson Out: 10:00 AM Number of Violated Provisions Related to Number of Repeat Violations Related to Date Of Re-Inspectlon: Foodborne Illnesses Risk Factors and 0 Foodborne Illnesses Risk Factors and 0 interventions (items 1 though 29): Interventions (Items 1 though 29): FOODBORNE ILLNESS RISK FACTORS AND PUBLIC HEALTH INTERVENTIONS IN in compliance OUT out of compliance NIO not observed MIA nol applicable COS corrected on-site during inspection repeat violation Compliance Status UN ICOSI Compliance Status I Supervision Protection from Contamination 1 Person-in-charge present. demonstrates OUT 15 Food separated and protected OUT NIA NIO i rf t' nowe ge an p8 orms les 16 Food-contact surfaces: cleaned sanitized OUT MIA 2 Certi?ed Food Protection Manager (El) OUT NIA .. . 17 Proper disposition of returned. preVlously OUT Employee Health served. reconditioned unsafe food Management, food employee and Timel'Temperature Control for Safety 3 conditional employee; knowledge. OUT . . responsibilities and reporting 18 Proper cooking time temperatures OUT MO 4 Proper use of restriction and exclusion OUT 19 Proper reheating procedures for hot holding OUT NIA Ni'o 5 Procedures for responding to vomiting and OUT 20 Proper cooilng time and temperature IN OUT diarrheal events 21 Proper hot holding temperature our NIA Nlo 500d Hygienic Practices 22 Proper cold holding temperature OUT NIA N10 5 Proper eating. tasting, drinking or tobacco OUT N10 23 Proper date marking and disposition OUT NIA we use 24 Time as a Public Health Control IN OUT (Rm N10 7 No discharge from eyes, nose and mouth OUT . Consumer Advisory Preventing Contamination by Hands onsumer a viso provi ed or 8 Hands clean 81 properly washed OUT NIO 25 raw/undercooked rfI?od OUT 9 No bare hand contact with ready-to-eat food OUT NIO Highly Susceptible Papulations Adequate handwashing sinks, properly OUT Pasteurized foods used, prohibited foods not 10 supplied and accessible 26 offered OUT Approved Source FoodiColor Additives and Toxic Substances 11 Food obtained from approved source (ED OUT 2? Food additives: approved Ii properly used IN OUT 12 Food received at proper temperature IN OUT NIA 28 loicegubstances properly identi?ed] stored OUT MA 13 Food received in good condition. safe OUT unadulterated Conformance with Approved Procedures Required records available: sheiistock tags. Compliance with variance/specialized parasite destruction 0 29 process/HACCP plan - Official Order for Correction: Based on an inspection today. the items marked indicated violations of 105 CMR 590.000 and applicable sections of the 2013 FDA 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 you are subject to a notice of suspension, revocation, or non-renewal pursuant to 105 CMR 590,000 you may request a hearing before the board of health in accordance with 105 CMR . . 75' - 1 :03/13/2019 Signature of Person-in-Charge? Christine Stevens g,?mm a M?mw 4 Date: 03/13/2019 SI nature of Inspector Marlene Johnson MDPH report Imm - version Food Establishment Inspection Report - Town of Burlington, MA Establishment: Memorial School Date: 03/13/2019 Page 2 of 3; GOOD RETAIL PRACTICES AND MASSACHUSETTS - ONLY SECTIONS Art in box indicates numbered item is not in compliance. Ari in appropriate box for COS corrected on site during the inspection andlor 1 repeat violation Compliance Status OUT Compliance Status OUT Safe Food and Water Utensils. Equipment and Vending 30 Pasteurized eggs used where required 48 Warewashing facilities: installed. maintained 8. ussed; . .. . . test strips 31 Water 8? Ice from approved source 49 Non-food contact surfaces clean 32 #313: obtained for specialized processing Physical Facilities 50 Hot cold water available; adequate pressure Food Temperature Control 51 Plumbing installed; proper backflow devrces 33 Proper cooling methods used; adequate equment I for temperature control 52 Sewage 8. waste water properly disposed 34 Plant food properly cooked for hot holding 53 Toilet facilities: properly constructed, supplied it cleaned 3?5 Approved thawing methods 54 Garbage refuee properly disposed; facilities 36 Thermometers provided accurate maintained Food Identi?cation 55 Physical facilities installed. maintained clean . I Adequate ventilation lightling; de5ignated areas 37 Food properly labeled; original container 56 used Prevention of Food Contamination Additional Requirements listed in 105 CMR 590.011 38 Insects. rodents animals not present M?l Anti-choking procedure in food service . . . . establishments 39 Contamination prevented during food preparation. storage and display M2 Food allergy awareness 40 Personal Cleanliness Review of Retail Operations listed in 105 590.010 . . M3 Caterer 41 Wiping cloths; properly used stored . 42 M4 Mobile Food Operation . . as ing l'Lll'tS vegetables M5 Temporary Food Establishment Proper Use Of M6 Public Market; Farmers Market 43 In-use utens?s properly stored M7 Residential Kitchen; Bed-and-Breakfast Operation 44 eqUIpment 8? linens: properly stored. dried 8? M8 Residential Kitchen: Cottage Food Operation . . M9 School Kitchen; USDA Nutrition Program 45 Single-use/smgle-semce articles: properly stored I I used M10 Leased CommerCIal Kitchen 46 leoes used properly M11 Innovative Operation Utensils. Equipment and Vending Local Requirements 47 Food non- -food contact surfaces cleanable, properly L1 CFPM open to close designed, constructed 8. used Grease Trap Regulations Signature of Person- -in-Charge: Christine Stevens gm Date: 03/132019 Signature of inspector: Marlene Johnson ?9 Date. 03?13/2019 MUPH report form - 1015118 version Food Establishment Inspection Report - Town of Burlington, MA leases/1312019 Page3 of .1 rEstablishment: Memorial School TEMPERATURE OBSERVATIONS Item/Location Temp ItemlLocation Temp ItemlLocation Temp cook temp. Hotdongot-Hold Unit Ranch dressing/Cold-Hold Unit Item Description of Violation Number Discussion with Person-in-Charge: An under-counter high temperature mechanical dishwasher is used on site; provide an irreversible registering and test the mechanical dishwasher rinse temperature daily when used. if purchasmg strips ensure you purchase Section of Code temperature indicator (hand out given) strips for 160F testing. When strip turns black (or color indicated on strip) then rinse water i maximum reading. waterproof thermometer: when temperature hits or above inside the machine. then machine is in compliance. Signature of Person-in-Charga' Christine Stevens Date: 03l13/2019 8AM Date: 03/13r2019 160F inside machine and is in compliance. If using a Signature of inspector: Marlene Johnson THE COMMONWEALTH OF MASSACHUSETTS BURLINGTON BOARD OF HEALTH 81 Center Street, Burlington, MA 01803 Ph: (781) 270?1955 Fax: (781) 273-7687 FOOD ESTABLISHMENT INSPECTION REPORT Narma? Eine Date Gen?" 23"- Ty olf- Operation-{s} Type of inspection .. . . . CI Food Servrce Routine Address Pine Glen Way MFA 3-53:} Reta? [j Re-inspection I . LOVOI MOO Residential Kitchen Prevrous inspection TeIePh?We I17 4 Mobile Date: 03/08/2017 I a 1- - - Temporarv Pre-oneration - Owner Burlington Schools HAC Caterer Suspect Illness . Get" it It Person in Charge Carol Keene Time ?ed 8 HACEOCP [pia In?. 11:45 AM rmit No 000249 Oth Inspector Randall Phelps Out: 12:30 PM or Each violation reqLiires an explanation on the narrati?ve pager's) and aIrzitation of Specific'provisionts) violated. Violations Related to F0_o_dborne Illness Interventions and Risk Factors (Red Items) Airti-Chokin 590.009 (E) Violations marked may pose an imminent health hazard and require immediate corrective Tobacco 9 590.009 (HE action as determined by the Board of Health. Allergen Awareness 590.009 (G) PROTECTION FROM CHEMICALS {3 11. Good Hygienic Practices 0. Chemical-Test 12 Prevention ofContamination from Hands FOOD PROTECTION MANAGEMENT If] 13 Handwash Facilities :3 1 PIC Assigned Knowledgeable IDuties PROTECTION FROM CHEMICALS EMPLOYEE HEALTH 14 Approved Food or Color Additives 2 Reporting of Diseases by Food Employee and PIC 15 Toxic Chemicals CE 3. Personnel with Infections Restricted/Excluded TIMEITEMPERATURE CONTROLS FOOD FROM APPROVED SOURCE ?f 16 Cooking Temperatures 4 Food and Water from Approved Source 17 Reheating if} 5 Receiving/Condition If] 18 Cooling 5 Tags/RecordS/Accuracy of ingredient L3 19 Hot and Cold Holding ?2 7 Conformance with Approved Procedur?eerACCP Plans 20 Time As a Public Health Control PROTECTION FROM CONTAMINATION REQUIREMENTS FOR HIGHLY SLISCEPTIBLE POPULATIONS (HSPI If} 8 9 Food Contact Surfaces Cleaning and Sanitizing 21 FOOG and Preparation for HEP CONSUMERADVISORY 22 Posting ofConsumerAdvisories 10 ProperAdequate Handwashing Violations Related toG ood Retail Practices (Elue' Critical 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. Number of Violated Provisions Related To Foodborne Illnesses Interventions 0 dRikFct 1-22: an a or Iems Official Order for Correction. Based on an inspection today the itelris checked indicate violations of 10;) Clle 590 GOO/tierie at 23. Management and Personnel 590.003 Food Code This report, when signed below by a Board oi Health 24' Food and Food Protection 590 004 member or its agent constitutes an order ofthe Board of Health 25 Equipment and Utensils 590 005 Failure to conect violations cited in this report may re5uit in 28 Water, Plumbing, and Waste 590005 suspension or revocation ofthe Food establishment permit and 27_ Physical Facility 590 007 cessation of Food establishment operations. it aggrieved by this 28 Poisonous or Toxic Materials 590 008 oroer, yOu have a right to a hearing, Your request must be in 29 Special Requirements 590 009 writing and submitted to the Board of Health at the above address within 10 days of receipt of this order. 30 Other DATE OF IRE-INSPECTION: 31 Grease Trap BOH Regulation BOH Regulation InsTpEEtor's sr?g?n?tdr'e. prim; 'Randalls ph?e?s Page 1 of 2 Pages Ergnature nun-Er: I Elm; Carol Ree ne? -d FORM 734A Rev 0I2000 A Co BURLINGTON BOARD OF HEALTH 61 Center Street, Burlington, MA 01803 Ph: (781) 270-1955 - Fax: (781) 273-7887 Establishment Name: Pine Glen School Date: 09/07/2017 Page: 2 of 2 Item Code - Critical Item' DESCRIPTION OF VIOLATION PLAN OF'c'oRRecnom Date l_\lo. ?Reference .R - Red Item Verified ??ssip??ith Person in_ c519; ?Corrective A?iibn?R??r?d; Good cleanliness throughout All certs an iding and . Employee Restriction storage within regulations Good chemical storage procedures No violations Voluntary Compliance Exclusion noted. 5 Re-irisrreotion Sclieduieo? [3 Emergency Suspension 1 Cl Embargo [3 Emergency Closure Other: Voluntary Disposal THE COMMONWEALTH OF MASSACHUSETTS BURLINGTON BOARD OF HEALTH 61 Center Street. Burlington, MA 01803 Ph: (781) 270?1955 - Fax: (781) 273-7687 FOOD ESTABLISHMENT INSPECTION REPORT 'Tame Pine Glen School Date 02r?12r'2018 Type of Operationts} Type of Inspection . El Food Service Routine Address Plne Gian Way. BURLINGI ON MA 01803 Risk Level Retail Re-inspection 1 7 Medium El Residential Kitchen Previous inepection TEIePhone (is 330-1114 Mobile Date: 09/07/2017 Owner Burlingmn Public Schools HACCP E11 gilt-[grimy SLZ-sgcir??ggs Person in Charge (PIC) Kathleen Time Bed 3? Breakfast El] Slings: Complaint In: 9:45 AM . I Inspector Samantha Hardy Out: 10:15 AM Permit No. 000249 CI Other Each violation checked requires an explanation on the narrative page(s) and a citation of specific provision(s) violated. Violations Related to Foodborne Illness Interventions and Risk Factors (Red Items) Ami Chokmgn'cmp?lance nga 009 (EIEI Violations marked may pose an imminent health hazard and require immediate corrective Tobacco 590009 (FIB action as determined by the Board of Health. Allergen Awareness 590.009 (G) PROTECTION FROM CHEMICALS 11 Good Hygienic Practices 0. Chemical-Test [Ti 12. Prevention ofContamination from Hands FOOD PROTECTION MANAGEMENT 1 PIC Assigned Knowledgeable/Duties EMPLOYEE HEALTH 2 Reporting of Diseases by Food Employee and PIC 3. Personnel with Infections Restricted/Excluded FOOD FROM APPROVED SOURCE 4. Food and Waterfrom Approved Source 5 Receiving/Condition :3 6. Tags/Reoords/Accuracy Statements 9:3 7. Conformance with Approved Procedures/HACCP Plans PROTECTION FROM CONTAMINATION if} 8 9 Food Contact Surfaces Cleaning and Sanitizing if; 10 Proper Adequate Handwashing Related to Good Retail Practices {Blue Items) Critical violations marked most 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. 23. Managementand Personnel 590.003 24. Food and Food Protection 590.004 25 Equipment and Utensils 590 005 26 Water, Plumbing. and Waste 590 008 27 Physical Facility 590.007 28 Poisonous or Toxic Materials 590 008 29 Special Requirements 590.009 30. Other BOH Regulation 31. Grease Trap BOH Regulation 13. Handwash Facilities PROTECTION FROM CHEMICALS 14 Approved Food or Color Additives 15. Toxic Chemicals TIMEITEMPERATURE CONTROLS (PHFs) [3 16. Cooking Temperatures 17 Reheating 18 Cooling [3 19. Hot and Cold Holding I'll 20 Time As a Public Health Control REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS 21 Food and Food Preparation for HSP CONSUMER ADVISORY LII 22. Posting of ConsumerAdvisories 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 DOD/federal Food Code. This report, when signed below by a Board of Health member or its agent constitutes an order ofthe 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 10 days of receipt ofthis order DATE OF RE-INSPECTION: inspector's Signature Print: Samantha Hardy Page 1 of 2 Pages PlC's Signature: ?Ea-Ef?? Print' Kathleen Gillingham FORM 734A Rev QJQODO A CO BURLINGTON BOARD OF HEALTH 61 Center Street, Burlington, MA 01803 Ph: (781) 270-1955 - Fax: (781) 273-7687 Establishment Name: Pine Glen School Date: 02/12/2018 Page: 2 of 2 Item Code No. Reference - Critical Item - Red Item DESCRIPTION OF VIOLATION I PLAN OF CORRECTION Date Veri?ed E'Eiscussion With Person in Charge: Corrective Action Required: No IEI Yes Temperatures in compliance: cheese 41F, peas 204F Handsink in compliance Restroom in compliance All frozen foods frozen solid. Voluntary Compliance Re-Jnspection Scheduled Embargo El Voluntary Disposal El Employee Restriction! Exclusion El Emergency Suspension CI Emergency Closure CI Other: THE COMMONWEALTH OF MASSACHUSETTS BURLINGTON BOARD OF HEALTH 61 Center Street, Burlington, MA 01803 Ph: (781) 270-1955 - Fax: (781) 273?7687 FOOD ESTABLISHMENT INSPECTION REPORT Name Pine Glen School Address Pine Glen Way. BURLINGTON. MA 01803 Telephone (781) 270-1714 Owner Burlington Public Schools Person in Charge (PIC) Carol Keene Inspector Marlene Johnson Date 09/18/2018 Type of Operatic-Ms] Type of Inspection Food Service Routine RISK Level Retail Re-inspection 2 Residential Kitchen Previous inspection Cl Mobile Data: 02/12l2018 El Temporary El Pro-operation HACCP Caterer Suspect Illness Ti Bed Breakfast El General Complaint me In: 10:00 AM . HACCP Out: Permlt No. 000249 Other Each violation checked requires an explanation on the narrative page(s) and a citation of specific provision(s) violated. Violations Related to Foodborne Illness Interventions and Risk Factors (Red Items) Non-compliance withViolations marked may pose an Imminent health hazard and require Immediate corrective going: mg 2:333: ("Egg action as determined by the Board of Health. Allergen Awareness 590.009 (G) PROTECTION FROM CHEMICALS El 0. Chemical-Test FOOD PROTECTION MANAGEMENT 1. PIC Assigned I Knowledgeable Duties EMPLOYEE HEALTH l3 2. Reporting of Diseases by Food Employee and PIC l3 3. Personnel with Infections Restricted/Excluded FOOD FROM APPROVED SOURCE 4. Food and Water from Approved Source 5. Receiving/Condition El 6. Tags/RecordS/Accuracy oi Ingredient Statements 7. Conformance with Approved Procedures/HACCP Plans PROTECTION FROM CONTAMINATION 8 i ..I I i- 9. Food Contact Surfaces Cleaning and Sanitizing Ci 10. Proper Adequate Handwashing 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. 23. Management and Personnel 590.003 24. Food and Food Protecti0n 590.004 25. Equipment and Utensils 590.005 26. Water. Plumbing. and Waste 590.006 27. Physical Facility 590.007 28. Poisonous or Toxic Materials 590.008 29. Special Requirements 590.009 30. Other BOH Regulation 31. Grease Trap BOH Regulation 11. Good Hygienic Practices Cl 12. Prevention of Contamination from Hands 13. l-Iandwash Facilities PROTECTION FROM CHEMICALS 14. Approved Food or Color Additives 15. Toxic Chemicals CONTROLS (PHFs) 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 El 22. Posting of Consumer Advisories DECIDE 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. 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. It 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: 10/02/2018 Inspector?s Signature: Print: Marlene Johnson Page 1 of 2 Pages PlC's Signature: .34 Print: Carol Keene FORM T34A Rev. AM. Sulkin Co BURLINGTON BOARD OF HEALTH 61 Center Street, Burlington, MA 01803 Ph: (781) 270-1955 - Fax: (781) 273-7687 Establishment Name: Pine Glen School Date: 091'181'2018 Page: 2 of 2 Item Code - Critical item DESCRIPTION OF VIOLATION PLAN OF CORRECTION Date No. Reference - Red Item Verified 26 FC 5-205.15* Slow drain to hand wash sink in ladies restroom. repair. 27 FC 6-501.12 Floor under shelves in food/paper storage room has cobwebs. dust and soils, clean. 27 FC 6601.113 Dumpster missing top cover on one half of unit. repair. Discussion With Person In Charge: Corrective Action Required: 1] No Yes Note: during inspection this day. the walk-in rel. unit (in rear) was reading 53F. no TCS foods were inside. only prepackaged juice cups and bottled water inside until unit is repaired. Found in compliance: New walk-in ref. unit at 39F (air temp), temp. tomato 37F. temp. potato patty (hot holding) 141 F. temp. sausage link (hot holding) 160F. handwash sink (1 on site) stocked and working. warewash sink (quats) 200 PPM. El Voluntary Compliance Re?lnspection Scheduled El Embargo Voluntary Disposal [3 Employee Restriction i' Exclusion Cl Emergency Suspension El Emergency Closure Other: THE COMMONWEALTH or MASSACHUSETTS BURLINGTON BOARD OF HEALTH 61 Center Street, Burlington, MA 01803 Ph: (781) 270-1955 - Fax: (781) 273?7687 FOOD ESTABLISHMENT INSPECTION REPORT Name Pine Glen School Address Pine Glen Way, BURLINGTON. MA 01803 Telephone (781) 270-1714 Owner Burlington Public Schools Person in Charge (PIC) Carol Keene Inspector Marlene Johnson Date 10/02/2018 Type of Operation(s) Food Service Risk Level Retail 2 Residential Kitchen [3 Mobile Temporary HACCP El Caterer Time Bed 8t Breakfast In: 9:55 AM . Out: Permit No. 000249 Type of Inspection Routine El Re-lnspection Previous inspection Date: 09/18/2018 Pro-operation Suspect Illness General Complaint El HACCP Other Each violation checked requires an explanation on the narrative page(s) and a citation of specific provision(s) violated. Violations Related to Foodborne Illness Interventions and Risk Factors (Red Items) Violations marked may pose an imminent health hazard and require immediate corrective action as determined by the Board of Health. PROTECTION FROM CHEMICALS 5:3 0 Chemical-Test FOOD PROTECTION MANAGEMENT 1 PIC Assigned Knowledgeable Duties EMPLOYEE HEALTH 2 Reporting of Diseases by Food Employee and PIC 13 3 Personnel with Infections Restricted/Excluded FOOD FROM APPROVED SOURCE 4. Food and Water from Approved Source 1: 5 Receiving/Condition 6 Tags/Records/Accuracy of Ingredient Statements if} 7 Conformance with Approved Procedures/HACCP Plans PROTECTION FROM CONTAMINATION 8. 9. Food Contact Surfaces Cleaning and Sanitizing 2: 1O Proper Adequate Handwashing 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. 23. Management and Personnel 590 003 24 Food and Food Protection 590.004 25. Equipment and Utensils 590 005 26. Water, Plumbing, and Waste 590 006 27, Physical Facility 590.007 28 Poisonous or Toxic Materials 590.008 29. Special Requirements 590.009 30. Other BOH Regulation 31 Grease Trap BOH Regulation Non-comp/iance with: Anti-Choking 590.009 (El El Tobacco 590.009 (F) Allergen Awareness 590.009 (G) Ill 11. Good Hygienic Practices 12 Prevention of Contamination from Hands 13 Handwash Facilities PROTECTION FROM CHEMICALS 14 Approved Food or Color Additives 15 Toxic Chemicals TI CONTROLS (PHFs) 16. Cooking Temperatures 17 Reheating 18 Cooling If.) 19 Hot and Cold Holding El 20. Time As a Public Health Control REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS (HSP) 21 Food and Food Preparation for HSP CONSUMER ADVISORY El 22. Posting ofConsumer Advisories Number of Violated Provisions Related To Foodborne Illnesses Interventions 0 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 ofHealth member or its agent constitutes an order ofthe Board of Health Failure to correct violations cited in this report may result in suspension or revocation ofthe food establishment permit and cessation of food establishment operations. If aggrieved bythis 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: Inspector's Signature: 43:1,th 4.- grawi?ihf Print: Marlene Johnson Page 1 of 2 Pages PIC's Signature: 1, IL ?m Print: Carol Keene FORM 734A Rev 9/2000 A Sulkln C0 BURLINGTON BOARD OF HEALTH 61 Center Street, Burlington, MA 01803 Ph: (781) 270-1955 - Fax: (781) 273-7687 Establishment Name: Pine Glen School Date: 10/02/2018 Page: 2 of 2 Item Code - Critical Item DESCRIPTION OF VIOLATION I PLAN OF CORRECTION Date No. Reference - Red Item Verified Discussion With Person in Charge: Corrective Action Required: El No Yes All Violations corrected, lid to dumpster was repaired Voluntary Compliance Employee Restriction/ Exclusion Re-lnspection Scheduled El Emergency Suspension El Embargo Emergency Closure Voluntary Disposal Other: BURLINGTON BOARD OF HEALTH 61 Center Street, Burlington, MA 01803 Ph: 781?270-1955 - Fax: 781-273?7687 Food Establishment Inspection Report Name: Pine Glen School Date 03t12i2019 Type of Operationisi: Type of Inspection: . - . Food Service Establishment Routine Address. Pine Glen Way, BURLINGTON, MA 01803 2Risk Level [1 Retail Food Store CI Re-inspection Residential: Cottage Foods Pro-Operational Telephone: (781) 270-1714 . . - Reeldentlal: Bed Breakfast Illness Investigation Owner: Burlington Public Schools HACCP Mobile/Pusher?? General Complaint Temporary Food Estab. HACCP Person-In-Charge: Carol Keene Time Other School [1 Other In: 10:00 AM Inspector: Marlene Johnson Out: 10:35 AM Number of Violated Provisions Related to Number of Repeal Violations Related to Date Of Re-lnspectlon: Foodborne Illnesses Risk Factors and 0 Foodborne illnesses Risk Factors and 0 Interventions (Items 1 though 29): Interventions (Items 1 though 29): FOODBORNE ILLNESS RISK FACTORS AND PUBLIC HEALTH INTERVENTIONS IN in compliance OUT out oicolnptience NIO not obsarved MIA not applicable (:05 Corrected on-site during Inspection repeat violation Compliance Status ilN outi oos Compliance Status IN Iour NIAINIOEOSLR Supervision Protection from Contamination 1 Person-in-charge present, demonstrates OUT 15 Food separated and protected OUT NIO knowledge and performs duties . . 16 Food-contact surfaces: cleaned sanitized OUT MIA 2 Certified Food Protection Manager our mm . .. 17 Proper diSpOSlth? of returned. preVIously OUT Employee Health served, reconditioned 8r unsafe food Management. food employee and Timefl?emperature Control for Safety 3 conditional employee; knowledge, OUT responsibilities and reporting 18 PrOper cooking time 8r temperatures IN OUT 4 Proper use of restriction and exclusion OUT 19 Proper reheating procedures for hot holding IN OUT 5 Procedures for responding to vomiting and OUT 20 Proper cooling time and temperature OUT diarrheal events 21 Proper hot holding temperature OUT NIA 900d Hygienic Practices 22 Proper cold holding temperature OUT NIA NIO 5 Egzper eating, tasting, drinking or tobacco OUT pro 23 Pr0per date marking and disposition OUT NIA NIO 4 IN OUT NIO 7 No discharge from eyes, nose and mouth OUT N10 2 Ime as a '3?th Health . Consu rAd i Preventing Contamination by Hands me 50?, Consumer adviso rovided for 8 Hands clean properly washed OUT N10 25 raw/undercooked 223d ?1 OUT 9 NO bare hand contact with ready-to-eat food OUT NIA NIO Highly Susceptible populations Adequate handwashing sinks, properly Pasteurized foods used, prohibited foods not 10 supplied and accessible OUT 2'5 offered IN OUT Approved Source FoodIColor Additives and Toxic Substances 11 Food obtained from approved source OUT 2? Food additives: approved properly used IN OUT 12 Food received at proper temperature IN OUT NA 28 properly Identified, stored OUT 13 Food received in good condition. safe (ED OUT unadulterated Conformance with Approved Procedures Required records available: shellstock tags. . Compliance with variance/specialized . 14 parasite destruction IN OUT N?o 29 process/HACCP plan OUT MA Official Order for Correction: Based on an inspection today, the items marked indicated violations of 105 CMR 590.000 and applicable sections of the 2013 FDA 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 you are subject to a notice of suspension, revocation, or non-renewal pursuant to 105 CMR 590.000 you may request a hearing before the board of health in accordance with 105 CMR lip?TA if pr. . Signature of Person-in-Charge. Carol Keene Date. 03/12/2019 . "Wedge-?e gems?a 4 Date: 03/12/2019 Slgnature of Inspector Marlene Johnson report iorm - versmn Food Establishment Inspection Report - Town of Burlington, MA Establishment: Pine Glen School Date: 03/12/2019 Page 2 of GOOD RETAIL PRACTICES AND MASSACHUSETTS - ONLY SECTIONS An in D07: Indicates numbered item is not In compliance. An "it? in appropriate box for 005 corrected on site during the inspection andior repeal violation Compliance Status our [cos] Compliance Status our cos Safe Food and Water Utensils. Equipment and Vending 30 Pasteurized eggs used where required 48 Warewashing facilities: installed. maintained 8. ussed; . test strips 31 Water 8? ice from approved source 49 Non-food contact surfaces clean 32 $3235: obtained for specialized processing Physical Facilities 5 Idwaterav ii bl; Food Temperature Control 0 Ho a a a equa pressure . A 51 Plumbing installed; proper backfiow devices 33 Proper cooling methods used; adequate equipment . for temperature control 52 Sewage waste water properly disposed 34 Plant food properly cooked for hot holding 53 Liliggcmuea properly constructed. supplied 8? 35 Approved thawing methods used 54 Garbage refuse properly disposed; facilities 36 Thermometers provided accurate maintained Food Identi?cation 55 igysmatl 81 ctljean areas 37 Food properly labeled; original container I 55 used] 9 9 Prevention of Food Contamination Additional Requirements listed in 105 CMR 590.011 38 Insects. rodents animals not present M1 Anti-choking procedure in food service . . . establishments 39 Contamination prevented during food preparation. storage and display M2 Food allergy awareness 40 Personal cleanliness Review of Retail Operations listed in 105 590.010 . . M3 41 Wiping cloths: preperly used stored a erer 42 h? M4 Mobile Food Operation as In ru tabl I 5 vege es M5 Temporary Food Establishment Proper Use Of M6 Public Market; Farmers Market 43 'n'use ?tens'ls ?0?36er ?med M7 Residential Kitchen; Bed-and-Breakfast Operation 44 [3:333 equipment 8? linens: properly stored, dried 8? M8 Residential Kitchen: Cottage Food Operation . . . . M9 School Kitchen; USDA Nutrition Program 45 articles: properly stored 8 used M10 Leased Commercral Kitchen Utensils. Equipment and Vending Local Requirements 47 Food 8. non-food contact surfaces cleanableA. properly L1 CFPM open to close designed, constructed used L2 Grease Trap Regulations QM WJW . Signature of Person-in-Charge: Carol Keene ii Date. 0311212019 ?rho: -. . . Signature of Inspector: Marlene Johnson 1 Date. 03/12/2019 MIJPH repon form - 10f5/1B version Food Establishment Inspection Report - Town of Burlington, MA IEstablishment: Pine Glen School IDate: 03/12/2019 Page 3 of i TEMPERATURE OBSERVATIONS ltemeocatlon Temp ItemlLocation Temp ItemILocatlon Temp Chicken fingerlHot-Hold Unit Uncut tomatolCold-Hold Unit ?em Section or Code Description of Violation Number Fratern?ch?ken?nu?gesls and potato smiles [smiliar to potato pulls} lhawing at room temperature. thaw temperature 35 $501.13 control for safety (TCS) foods under refrigeration. Discussion with Person-in-Charge: Signature of Person-in-Charge: Carol Keene mi? Date: 03/12/2019 (1 (Team - Signature of InSpector: Marlene Johnson Date. 03/12/2019