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The bolded items reflect ticketable offenses with the Chicago Department of Public Health (CDPH) # of
Fail(s) Grade
1. Employee Facilities Score: Serious 3 c
1.1 Clean and organize all offices, remove outdated posters/memos
L/R Mgr, Engineers, Teachers, Main Office
x Fail - Office has dust
Fail - Clutter must be removed
Fail - Office needs to be organized
1.2 Employee lockers clean in/out (no food storage-designated areas only)
x Fail - dust & debris in locker
Fail - clutter needs to be removed/organized
1.3 Tops/bottom of lockers clean & free of all materials
Fail - remove all materials from top of lockers
x Fail - dust/dirt observed
2. ***Food Temperatures Score: Critical ($500) 1 F
***IF CHECKED A REINSPECTION MUST BE CONDUCTED, AUTOMATIC "F"*** 1 x $500
2.1 x Fail - Cold food are not held at 40°F or below $500
Fail - Hot foods are not held at 140°F or above
Fail - Frozen foods are not held at 0°F or below
3. Food Storage & Handling Score: Critical ($500) A
3.1 There are no bulging or leaking canned goods or expired products in x $500
storage
Fail - bulging, dented or leaking canned goods
Fail - expired products in storage
3.2 Fail - canned foods stored in remarked containers, not in original container
3.3 Fail - small equipment and utensils are not being sanitized between uses
Fail - small equipment is not air dried
4. Dry Storage Score: Serious ($250) 3 C
4.1 Food is protected from contamination 3 x $250
Fail - food is not covered/labeled/dated $750
X Fail - dirt/dust observed under and behind racks
4.2 Racks are clean and free of rust and/or painted shelves in good condition
Fail - racks dirty to sight and touch
Fail - rust on racks
x Fail - exposed wood on painted shelves
4.3 Light shields and fixtures are in good condition and clean
Fail - light shields dirty and/or cracked.
Fail - light shields missing
4.4 Storage areas are kept clean
Fail - area dusty/dirty
Fail - not organized/remove all clutter
4.5 Chemicals are stored away from food and other supplies
Fail - chemicals stored with food are not separated
X Fail - food and supplies are not 6"from floor and wall and 18" from the ceiling
Fail - food stored in non-designated food service areas
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10. Manager Sanitation Certificate & CDPH Report Score: Critical ($500) 1 B
10.1 Current Sanitation and Food handlers Certificate 1 x $500
Fail - certified manager is not on the premises $500
Fail - expired manager sanitation certificate
Fail - staff does not have food handlers certificate
Fail - original sanitation license is not on the premises
Fail - CDPH Summary Report is not displayed and visible to all customers
x Fail - previous CDPH violations not corrected by due dates
11. All Rooms, Closets, Offices, Gym, Auditorium, Other Score: Critical ($500) 5 F
11.1 All areas are clean, organized and free of clutter 5 x $500
Fail - missing lights $2,500
X Fail - above areas are not clean/organized
X Fail - clutter found, must be removed
X Fail - food items are being stored in the classrooms/student desk
Fail - classrooms used for feeding are dirty/not maintained
X Fail - lockers are not clean/food present
X Fail - areas found to be dusty/dirty
Fail - waste cans/pencil sharpeners are not dumped
Fail - chalk rails/boards are not clean
Fail - dirty/stinky mops, buckets, custodial carts in use.
X Fail - custodial closets dirty/dusty or in poor condition
Fail - water leaking/stains
Fail - First floor windows open no more than 6". Second floor and up windows closed.
12. ***Pest Control Score: Critical ($500) A
***IF CHECKED A REINSPECTION MUST BE CONDUCTED, AUTOMATIC "F"*** x $500
12.1 Pest infestation signs were observed in the following areas:
Fail - Food Prep Area
Fail - Food Storage
Fail -Teachers Lounge
Fail - Student Lunchroom
Fail - Under/Inside/Behind Food Equipment & Serving Lines
Fail - Any classroom, office, closet, gym, auditorium, other
Fail - rodent droppings found around the loading dock/dumpster area
Fail - evidence of rodent dropping found in the custodial closets
Fail - rodent droppings found in heating units
Fail - evidence of rodent activity in the basement areas
13. ***Pest Control Score: Critical ($500) A
***IF CHECKED A REINSPECTION MUST BE CONDUCTED, AUTOMATIC "F"*** x $500
13.1 Fail - burrows found around exterior of the building
Fail - doors need to be rodent proof (light observed) or propped open
Fail damaged windowscreens
Fail - dock area has debris, clutter, not clean
Fail - Dock/dumpster area has leaking liquid waste
Fail - pest evidence found in heating units, drains, exit doors, other
Fail - cracks and holes need to be sealed to prevent rodent entry
Fail - holes and cracks observed around the foundation
Fail - no pest control and or log book on premises
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Details/Findings Page
Instructions: Fill in details from inspection/walk through in each appropriate category below
1. Employee Facilities Score: Serious 3 c
Offices and school lockers are dirty and dusty - needs a deep cleaning
Food items tempted on the cold line were not below 41.
diced peach cup - 48F; chickpeas 53F.
Suggest using ice blankets on line between serving periods and not double stacking items in the cold wells, causing them to lose temperature. Spoke with pool manager onsite
Food in dry storage area not stored 18" from ceiling. Floors in dry storage area needs cleaning. Bag of onions sitting on floor, needs to be elevated onto a rack. Milk crates used
to elevate food product off the ground.
Empty milk crates being used to store additional full food cases off floor in walk-in freezer. Many wooden cabinets/drawers in lunchroom and there is chipping. Used to store
food, paper goods, chemicals, and other kitchen supplies
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Details/Findings Page
Instructions: Fill in details from inspection/walk through in each appropriate category below
6. Utensils and Equipment Score: Serious A
Needs deep cleaning behind and below ovens - prior CDPH violation
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Details/Findings Page
Instructions: Fill in details from inspection/walk through in each appropriate category below
11. All Rooms, Closets, Offices, Gym, Auditorium, Other Score: Critical 5 F
1. Classrooms need cleaning - floors, smartboards, window sills, above doors, classroom rugs, remove vent covers and clean.
2. Food items found in following classrooms - 304, 305, Gym office, 318, 200, 314
3. All cardboard boxes need to be off floors or contents placed in plastic containers
4. Multiple rooms have peeling and chipped paint
5. Custodial closets needs heat detector, have holes in wall, need ceiling repairs, have peeling paint
6. Auditorium - all exit lights out, exposed wiring on stage, limited access from stage to stairwell, peeling paint, missing lights above stage, need de-cluttering
behind curtains. Upstairs auditorium has trash on floors, needs cleaning overall.
7. Gym - offices needs cleaning and decluttering, office have peeling paint, door sweep needs replacing, fridge and microwave in office
8. MDF room - needs deep cleaning, opening in ceiling around pipe that needs to be sealed, boxes sitting directly on floor, missing doorknob.
9. Elevator room needs lense cover
10. 218 - missing heat detector
11. 209 - no door threshold, missing receptacle covers
12. 309 and 310 - water damage visible on walls
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Details/Findings Page
Instructions: Fill in details from inspection/walk through in each appropriate category below
15. Ceilings & Walls Score: Critical 3 D
floors need cleaning, observed peeling and cracked paint on walls and ceilings
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SCORING PAGE
Check here if failures were marked in sections 2, 12, 13 and 18. A re-inspection must be completed
1) Assign a score for each grade under Serious and Critical on the Scoring Page as follows:
A=4
B=3
C=2
D=1
*Average scores for Serious and Critical colums will auto calculate
2) Assign a total letter grade using the chart below based on the total score:
A=4
B = 3-3.9
C = 2-2.9
D = 1-1.9
F = 0-0.99
**If you grade an F in sections 2, 12, 13 and 18, final grade must be an F regardless of average
** Total score will auto calculate
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NSS Inspector
Facilities Inspector
Lunchroom Manager
Engineer
Other
Other
Additional Comments:
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