Form 65.
RESTAURANTS, CAFES, ETC
INSPECTION OF
BOARD OF HEALTH
ERIHITE
CITY
OF HAVERHILL, MASS.
LED I6
Score by points on Equipment, Methods of preparing and serving food,
Materials used, Possible Contamination from surroundings.
UTED A CITY
Name of Res taurant
Address
Name of Proprietor
DETAIL
SCORE IN
Allowed
Perfect
Perfect Allowed
PANTRY OR STOREROOM
KITCHEN
General Cleanliness of room and
furniture ..
Openings screened. . .
2
3
A bsence of lies, roaches, rats and
rat holes from
2
Clean sink..
.
3
Clean dish pans, mops, towels
.
odors. . ..
Cleanliness of cook and
Washable suits for cook and assist-
METHODS OF WASHING
DISHES, ETC.
All utensils clean aud protected from
contamination ..
W
screened
Absence of dies, rosches and other
insects. .. .. . .
Steamed or boiled ..
2
4
doors effectually
and
Washed an
2
4
scalded
Simply washed.. :
owels tor drying, elean and abun-
4
1
ICE BOX
Quality of raw foods, meats, fresh
and sweet .
Sound, tight, well drained
4
2
.
Shelves and contents clean. ..
Separate compartment for milk and
butter. . . .. .
2
R
food pronerly kept and protect-
.
2
ed..
....
Milk and cream kept covered
4
DINING ROOM
as received from dairy ..
4
Cleanliness of floor, tables and chairs
2
.
Freedom from odor..
3
Linen. ..
.
..
ATTENDANTS
Counters, show cases
.
Cleanliness of all cooks, assistants
Freedom from flies-well screened..
Attendants free trom all infectious
SURROUNDINGS
Clean in their methods of handling
and preparing food. .. .
Any
5
en food
d miceg
2
ted . .
overed and
emptied daily
3
All plumbing in good condition...
Total
59
Total
4 1
.
.
Final Score.
Date of Inspection
Remarks:
Inspector of Meats and Provisions.
NOTE 1-If total score is below 50, particular attention will be called to the fact in the daily newspapers.
NOTR 2-If any particularly filthy condition
NOTE 3-All restaurants with a score of 8
practice is going on, the total score shall not be over 49.
or better will secure special mention in the newspapers.
