Network: 8 Oracle: 22891 School Name:

Date: 12/13/17 CPS Inspection Team Members:

Cooking X Sending
Conversion OKI

The bolded items reflect ticketable offenses with the Chicago Department of Public Health (CDPH)

1. Employee Facilities
1.1 Clean and organize all offices, remove outdated posters/memos
L/R Mgr, Engineers, Teachers, Main Office
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)
Fail - dust & debris in locker
Fail - clutter needs to be removed/organized
1.3 Tops/bottom of lockers clean & free of all materials
X Fail - remove all materials from top of lockers
Fail - dust/dirt observed
2. ***Food Temperatures
***IF CHECKED A REINSPECTION MUST BE CONDUCTED, AUTOMATIC "F"***
2.1 Fail - Cold food are not held at 40°F or below
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
3.1 There are no bulging or leaking canned goods or expired products in
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
4.1 Food is protected from contamination
Fail - food is not covered/labeled/dated
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
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
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
5. Food Service Equipment & Vending Machines
5.1 Dish machine is utilized, if not working repair or remove
Fail - dish machine not reaching 180°F final rinse
Fail - dish machine not working
Fail - dish machine area not clean and or cluttered
5.2 Fail - slicer not clean and sanitized
5.3 Fail - exhaust fans and/or covers need cleaning
5.4 Fail - vending machines dusty and need cleaning
5.5 Clean space fans/check under units
Fail - space fans need cleaning
Fail - clean base of space fans
5.6 All pieces of equipment are clean to sight and touch
Fail - Cooler/freezer gaskets need cleaning
Fail - Evidence of mold and or mildew
Fail - Units need to be clean/organized
Fail - behind, under, beside, tops and above all equipment needs cleaning
Fail - equipment and food contact surfaces are dirty
Fail - units thermometers are not working inside
Fail - motor housing and grates need to be cleaned
Fail - light shield needed
Fail - milk barrels, coleman coolers, cambros not clean
Fail - food transfer boxes not clean
Fail - speed racks and push carts
Fail - gum/graffiti found on equipment
Fail -Exhaust hood and or filters need cleaning
Fail -Exhaust hood and fire suppression serviced within a year
Fail - cleaning needed behind plates and panels on
equipment
Fail - ice build up in coolers/freezers
Fail - water leaking from unit
Fail - evidence of rust/slime observed in ice machine or other equipment
5.7 Clean range grease trap pans
Fail - grease trap pans are not clean
Fail - foil must be removed from pans
5.8 Remove and clean/vacuum/wash under serving line shelves & all ledges
Fail - serving line shelves and all ledges need cleaning
 Fail - Shelves, Cabinets & Drawers need cleaning
5.9 Food is stored 6 inches off floor in walk-ins
Fail - milk stored on floor of walk-in
Fail - milk crates used to elevate food
Fail - food boxes on floor in walk-in
5.10 Racks are clean and free of rust
Fail - evidence of rust on racks
Fail - racks need to be cleaned

6. Utensils and Equipment

6.1 Fail - pots and pans not inverted or protected against dust and/or
contamination
6.2 Fail - food transfer boxes are not in good/clean condition/gaskets missing or dirty
6.3 Drawers and racks are clean
Fail - drawers are dirty, cluttered, need to be organized, are lined with paper
Fail - kitchen racks need cleaning
7. General Cleaning and Sanitation Measures
7.1 Three-compartment sink is properly set up and used only to (wash, rinse,
sanitize)
Fail - 3 compartment sink not properly set up
Fail - Sanitizing solution is not at proper concentration
Fail - Solution water not at proper temp, 65-75 degrees
Fail - no sanitizer being used
Fail - Observed water backflow/sewage
Fail - Grease trap need to be cleaned, odor/rust free, nothing stored on top
7.2 Hand sink, hot water, soap, towels, hand wash sign
Fail - no hand sink in kitchen provided
Fail - no hand sink within 25ft of serving line
Fail - no observed handwashing/in between glove changing
Fail - no trash can, soap, towels, hand washing sign available
8. General Cleaning and Sanitation Measures
8.1 Kitchen and lunchroom areas kept clean
Fail - kitchen and lunchroom areas are not clean
Fail - Ala Carte areas are not clean
8.2 Teachers' lounge area kept clean
Fail - lounge area dusty/dirty needs cleaning
Fail - microwave & refrigerator dirty
9. Garbage Storage and Disposal
9.1 Kitchen garbage cans are clean and have lids
Fail - garbage cans dirty
Fail - garbage cans have lids available
Fail - garbage cans are over-flowing
Fail - boxes and containers are present in food prep area
9.2 Dumpster is closed, lids are in good shape
Fail - dumpster overflowing/area not clean
Fail - dumpster lids not closed. Lids are broken/missing
Fail - exterior grounds need to be clear of trash and in safe condition
10. Manager Sanitation Certificate & CDPH Report
 10.1 Current Sanitation and Food handlers Certificate
Fail - certified manager is not on the premises
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
Fail - previous CDPH violations not corrected by due dates

11. All Rooms, Closets, Offices, Gym, Auditorium, Other

11.1 All areas are clean, organized and free of clutter
Fail - missing lights
Fail - above areas are not clean/organized
Fail - clutter found, must be removed
Fail - food items are being stored in the classrooms/student desk
Fail - classrooms used for feeding are dirty/not maintained
Fail - lockers are not clean/food present
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.
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
***IF CHECKED A REINSPECTION MUST BE CONDUCTED, AUTOMATIC "F"***
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
***IF CHECKED A REINSPECTION MUST BE CONDUCTED, AUTOMATIC "F"***
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
14. Pipes and Plumb
 14.1 Fail - no hot water supplied for the lunchroom (110 degrees)
Fail - water leaking in the lunchroom (including restroom area)
Fail - Floor drains/Sinks/Equipment/ does not drain properly
Fail - water waste bubbling up from drain
Fail - drain covers needed
Fail - drains are clean, operational and odor free
Fail - water pressure is low
Fail - openings around pipes need to be stuffed and sealed

15.Ceiling & Walls

15.1 Fail - ceiling and walls have cracks and/or holes
Fail - Ceiling and walls have chipping/peeling paint
Fail - Ceiling and walls are leaking and/or have water marks
Fail - Ceiling and walls are not clean
Fail - light shields missing/dirty/cracked over food prep areas
Fail - ceiling tiles missing and/or stained
16. Floors
16.1 Fail - floors are not clean
Fail - floors under equipment are not clean and free of debris
Fail - floor tiles missing or broken
Fail - stairs and stairwells not clean or free of clutter
Fail - items stored 6" above the floor
Fail - floor has holes or cracks
Fail - baseboards are not clean and/or away from the wall
Fail - Corners where wall and floor meet are not clean
17. Restrooms
17.1 Fixtures, toilets & urinals, waste cans, floor, walls free of graffiti
Fail - observed gum/graffiti on walls, stall doors
Fail - toilets,urinals, and sinks are not clean or leaking
Fail - auto faucets do not stay on for 30 seconds
Fail - no trash cans
Fail - dust/dirt/odor observed in the restroom
18. ***Restrooms
***IF CHECKED A REINSPECTION MUST BE CONDUCTED, AUTOMATIC "F"***
18.1 Hot and cold water available
Fail - no hot and/or cold running water in the washroom
Fail - low water pressure in the restrooms
Fail - no soap, toilet paper, hand dryer, paper towels available
18.2 Employee/Staff restrooms clean
Fail - no soap, toilet paper, hand dryer, paper towels available
Fail - no hand washing sign in Foodservice Employee Restrooms
19. Basement / Engineering Facilities
19.1 Fail - closet and crawl spaces are not clean/organized
Fail - unused equipment needs to be removed
Fail - chemicals are not stored properly in the engineering areas
Fail - basement/bolier areas need detailed cleaning
Fail - water leaks observed in the basement/boiler area
Fail - Seal all holes and cracks throughout the basement area
Fail - Elevator is dirty
Fail - clutter in basement/boiler area
20. Safety
20.1 Fail - employees (food and custodial) not wearing slip resistant shoes
Fail - cut resistant gloves not in use (food service)
Fail - PPE's are not available or in use
Fail - Fire extinguisher tags are expired over a year
Fail - Fire extinguisher located 75 ft and inspected monthly by engineer.
Fail - fire suppression system is more than a year since last service
Fail - AED is not operational
Fail - EPI pen not available, in identifiable location, expired over a year
Fail - Wet floor signs are not available or in use
Fail - Evacuation plan posted in each classroom.

Details/Findings Page
Instructions: Fill in details from inspection/walk through in each appropriate category below
1. Employee Facilities

Materials need to be removed from the top of lockers.

2. Food Tempuratures

3. Food Storage & Handling

4. Dry Storage

Main- Notice of paint chipping in dry storage. There is a hole to the left of the fuse box that needs to be plugged up. Hole was
behind shelving that needs to be plugged. Opening outside of door #7 needs needs plugged. Utility sink needs to be cleaned
storage. School records stored and could possibly be removed.

5. Food Service Equipment & Vending Machines

Annex- Refrigerator #1 has evidence of mold on inside vents and needs to be cleaned. Coolers need to be swept out and cle
Cleaning needs to take place behind , under and above all equipment. Space fans need to be cleaned and free of dust. Milk c
office. Main-Cleaning needs to be done under steam tables and on the shelves. Equipment needs to be cleaned in the servic
kitchen enterance has mold on inside vents and needs to be cleaned.

Details/Findings Page
Instructions: Fill in details from inspection/walk through in each appropriate category below
6. Utensils and Equipment

7. General Cleaning & Sanitation Measures

Main- Grease traps need to be cleaned/ rust free and not leaking. Faucet on the 3 compartment sink is leaking and needs rep

8. General Cleaning & Sanitation Measures

In both buildings, cafeteria's need to be cleaned. Floor's are dirty and there is evidence of food from the day before. Window l
be cleaned. The annex had trash cans stored in the corner of the cafeteria with food in them and no garbage bags. The annex
in both buildings need to clean refrigerator's and microwaves. Walls were stained in the teacher's lounge in the annex and an
basement needs to clean out the refrigerators and the microwaves. Droppings were found behind the fridge near the microwa
be removed/ disposed.
9. Garbage Storage & Disposal

For bothe buildings, Garbage cans are dirty and need to be cleaned out regularly. Dumperster near the annex was overflowin
were not closed.
For bothe buildings, Garbage cans are dirty and need to be cleaned out regularly. Dumperster near the annex was overflowin
were not closed.

10. Manager Sanitation Certificate & CDPH Report

Details/Findings Page
Instructions: Fill in details from inspection/walk through in each appropriate category below
11. All Rooms, Closets, Offices, Gym, Auditorium, Other
Main- Clutter stored to the right of the main stair well through double doors in front of air handler room. Empty computer carts
Clutter is found by entrance #3 in the corner were unused garbage cans are stored and chairs. Clutter is found in the student
Rm010 has reading supplies stored on the floor. "Gas room" is cluttered and junk needs to be cleaned and cleared and out of
gym equipments stored on the floor. Room 030 has engineering supplies on the floor. 040 has extra chairs and boxes stored
stored on the floor, food stored inside, tables were dirty, old pear was found on the table. Annex- Many of the rooms had items
storage. The lunchroom had clutter in the corner were they are keeping sweepers/ brooms/ mops/ rakes.. The library has cha
that needs removed, stains on ceiling tiles, using milk crates as storage and it is also very dusty.
12. Pest Control

Not a lot of pest activity was found during the inspection, few droppings here and there in the classrooms and basement area
droppings were found near the 3 compartment sink in the main building. 1-2 droppings were found in most classrooms. Roach

13. Pest Control

Annex- The annex building could add doorsweeps to the classroom doors. Gaps were found in the corner of exterior door in r
cracks around the base on the 1st floor, door sweeps need to be put on. Kitchen exterior door has gaps that need to be seale
in the traps. Kitchen locker room had evidence of droppins.Main- Entrance #6 needs door sweeps added. Exterior door to bo
equipment is stored needs to have a door sweep put on.

14. Pipes & Plumbing

Main-Duct work is needed for the hole near camera in lunchroom A. Toilet is leaking in downstairs girls restroom(3rd stall). Ho
clock.Insulation coming off piping above steam tables. Insulation coming off above the exit of lunchroom B. Pipe insulation ne
a leak in the hose connected to the sink. Room 030 has a hole in the wall near electrical piping. Annex- In room #125 of the a
1st floor boiler room of the annex has a drain leak and is rusted. Cold water doesn't work in the Women's staff restroom by the
is leaking ( lower one) .
Details/Findings Page
Instructions: Fill in details from inspection/walk through in each appropriate category below
15. Ceilings & Walls

Main- Paint is chipping in the dry storage room. Peeling paint is seen at entrance #2. Light bulbs are out in the girls restroom
shiels are needed throughout most of the basement/boiler room area and lunchroom/ kitchen. Annex- #223 has chipping pain
can be found in the office. Walls are stained in the teacher's lounge. Kitchen is missing ceiling tiles in manager's office.

16. Floors

In both buildings, the lunchroom floors are noticeably dirty and debris/food particles can be found. Annex- 2nd floor boiler room
need to be vacuumed and cleaned regularly. Classroom floors in the main building and annex need to be cleaned more regul
and outside cafeteria doors.
In both buildings, the lunchroom floors are noticeably dirty and debris/food particles can be found. Annex- 2nd floor boiler room
need to be vacuumed and cleaned regularly. Classroom floors in the main building and annex need to be cleaned more regul
and outside cafeteria doors.

17. Restrooms

Schools auto faucets do not stay on for 30 seconds. In the annex, room 125 has water leaking from the base of the toilet. Boy
cover on the radiator. Left urinal had trouble flushing.

18. Restrooms

19. Basement / Engineering Facilities

Annex- Boiler room on the first floor has boxes stored on the ground and cluttered that needs to be organized. 2nd floor boiler
unorganized and has a lot of clutter. Sink needs to be cleaned, dirty mops are stored near entrance, computers are stored on
Main- Sweping needs done behing boilers. Old equipment needs to be picked up. A lot of clutter stored in basement that need
over, gym mats are stored directly on the floor. Milk crates are being used for storage.

20. Safety

SCORING PAGE

1. Employee Facilities
2. Food Temperatures (Critical: "A" or "F")
3. Food Storage & Handling
4. Dry Storage
5. Food Service Equipment & Vending Services
6. Utensils and Equipment
7. General Cleaning and Sanitation Measures (Critical)
8. General Cleaning and Sanitation Measures (Critical)
9. Garbage Storage and Disposal
10. Manger Sanitation & B.O.H. Report
11. Classrooms/ Library/ Hallways/ Offices
12. Pest Control (Critical: "A" or "F")
13. Pest Control (Critical: "A" or "F")
14. Pipes & Plumbing
15. Ceiling & Walls
16. Floors
 17. Restrooms (Serious)
18. Restrooms (Critical: "A" or "F")
19. Basement / Engineering Facilities
20. Safety

*Average Scores

**Total Score and Letter Grade

Total of Ticketable Offenses

X 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

Organization Name
School Administrator

NSS Inspector
Facilities Inspector Alex Hamp
Lunchroom Manager

Engineer Ossie Alvarado

Other FSD Jasan Kraus
Other

Additional Comments:
 "Keep Our Schools Clean"

Nathan Davis

Jasan Kraus/ Alex Hamp

Receiving
Unmanned Site

of Public Health (CDPH) # of

Fail(s) Grade
Score: Serious 1 B

Score: Critical ($500) 0 A

ONDUCTED, AUTOMATIC "F"*** x $500
$0

Score: Critical ($500) A

x $500
$0

original container
d between uses

Score: Serious ($250) B

1 x $250
$250
18" from the ceiling

Score: Serious ($250) 6

4 x $250
$1,000

nt needs cleaning

other equipment
 Score: Serious ($250) A
0 x $250
$0
gaskets missing or dirty

e lined with paper

Score: Critical ($500) 1 B

1 x $500
$500

ing stored on top

Score: Critical ($500) 3 D

3 x $500
$1,500

Score: Critical ($500) 3 D

3 x $500
$1,500

Score: Critical ($500) A

 x $500
$0

to all customers

Score: Critical ($500) 6 F

3 x $500
$1,500

and up windows closed.

Score: Critical ($500) 2 F
2 x $500
$1,000

mpster area

Score: Critical ($500) 3 F

3 x $500
$1,500
opped open

Score: Critical ($500) 2 C

 1 x $500
$500

Score: Critical ($500) 5 F

5 x $500
$2,500

Score: Critical ($500) 3 D

3 x $500
$1,500

Score: Serious ($250) 2 B

1 x $250
$250

Score: Critical ($500) A

, AUTOMATIC "F"*** x $500
$0
 Score: Critical ($500) 5 F
5 x $500
$2,500

Score: Serious ($250) A

x $250
$0

d over a year

te category below
Score: Serious 1 B

Score: Critical 0 A

Score: Critical 0 A
 Score: Serious 0 B

se box that needs to be plugged up. Hole was found in the floor/base next to electrical box
eds plugged. Utility sink needs to be cleaned and leak needs to be fixed. Dirty mop found in dry

Score: Serious 6 F

leaned. Coolers need to be swept out and cleaned. Milk was stored on the floor of the walk in.
ns need to be cleaned and free of dust. Milk crates are used to elevate food in the manager's
Equipment needs to be cleaned in the service area and free of dust. First freezer to the left of

te category below
Score: Serious 0 A

Score: Critical 1 B

e 3 compartment sink is leaking and needs repaired.

Score: Critical 3 D
vidence of food from the day before. Window ledges around the cafeterias are dirty and need to
food in them and no garbage bags. The annex had dirty walls and light shields.Teacher's lounge
d in the teacher's lounge in the annex and ants were found. Main- Staff breakroom in the
were found behind the fridge near the microwaves. Mini fridge on the floor is broken and needs to

Score: Critical 3 D

y. Dumperster near the annex was overflowing and the area had trash around it. Dumpster lids
y. Dumperster near the annex was overflowing and the area had trash around it. Dumpster lids

Score: Critical 0 A

te category below
Score: Critical 6 F
ont of air handler room. Empty computer carts and fans are stored in corner by lunchroom.
red and chairs. Clutter is found in the student records room, boxes are stored on the floor.
k needs to be cleaned and cleared and out of the way of the main gas line. Air handler room has
floor. 040 has extra chairs and boxes stored on the ground. 050 or parent room has boxes
he table. Annex- Many of the rooms had items stored on the floor and were using milk crates for
rs/ brooms/ mops/ rakes.. The library has chairs stored in the corner, shelves are dirty, tv on floor
also very dusty.
Score: Critical 2 F

d there in the classrooms and basement areas .Droppings found in boiler room of annex. 2
ppings were found in most classrooms. Roach spotted in room 227 of the annex.

Score: Critical 3 F

s were found in the corner of exterior door in room 126 of the annex. Boiler room has holes and
n exterior door has gaps that need to be sealed/ door sweeps to be put on. Roaches were found
eeds door sweeps added. Exterior door to boiler room where the winter snow removal

Score: Critical 2 C
king in downstairs girls restroom(3rd stall). Holes near piping in service area above cart and near
ve the exit of lunchroom B. Pipe insulation needs to be fixed above entrance #3.Boiler room has
electrical piping. Annex- In room #125 of the annex, water is leaking from the base of the toilet.
sn't work in the Women's staff restroom by the boiler room in the annex. Upstairs water fountaing

te category below
Score: Critical 5 F

e #2. Light bulbs are out in the girls restroom in the basement. Entrance #3 has light out. Light
room/ kitchen. Annex- #223 has chipping paint. #231 has stains on ceiling tiles. Ceiling tile stains
missing ceiling tiles in manager's office.

Score: Critical 3 D

cles can be found. Annex- 2nd floor boiler room, floor is coming up. Library floors are filthy and
ng and annex need to be cleaned more regularly. Broken tiles are found in the annex cafeteria
cles can be found. Annex- 2nd floor boiler room, floor is coming up. Library floors are filthy and
ng and annex need to be cleaned more regularly. Broken tiles are found in the annex cafeteria

Score: Serious 2 B

s water leaking from the base of the toilet. Boys restroom near 1st floor boiler room needs a

Score: Critical 0 A

Score: Critical 5 F

ed that needs to be organized. 2nd floor boiler room/ mechanical room is extrememly
ored near entrance, computers are stored on floor and need to be picked up for acid disposal.
p. A lot of clutter stored in basement that needs to be picked up or removed. Chairs are stored all
orage.

Score: Serious 0 A

Grade Score Grade Score Fines

B 3
A 4 $0
A 4 $0
B 3 $250
F 0 $1,000
A 4 $0
B 3 $500
D 1 $1,500
D 1 $1,500
A 4 $0
F 0 $1,500
F 0 $1,000
F 0 $1,500
C 2 $500
F 0 $2,500
D 1 $1,500
 B 3 $250
A 4 $0
F 0 $2,500
A 4 $0

2.83 1.71

2.27 C

$16,000

-inspection must be completed

oring Page as follows:

ust be an F regardless of average

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