"Keep Our Schools Clean"

Network: Oracle: 24661 School Name: Lewis Nettelhorst

Date: 2/1/18 CPS Inspection Team Members: David Wade/Alexander Hamp

Cooking Sending Receiving

Conversion OKI Unmanned Site

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

1. Employee Facilities Score: Serious

1.1 Clean and organize all offices, remove outdated posters/memos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
Fail - remove all materials from top of lockers
Fail - dust/dirt observed
2. ***Food Temperatures Score: Critical ($500)
***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 Score: Critical ($500)
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 Score: Serious ($250)
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 Score: Serious ($250)
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 Score: Serious ($250)

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 Score: Critical ($500)
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 Score: Critical ($500)
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 Score: Critical ($500)
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 Score: Critical ($500)
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
x 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 Score: Critical ($500)
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 Score: Critical ($500)
***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 Score: Critical ($500)
***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 Score: Critical ($500)
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 Score: Critical ($500)

 15.1 Fail - ceiling and walls have cracks and/or holes
x 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 Score: Critical ($500)
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 Score: Serious ($250)
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 Score: Critical ($500)
***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 Score: Critical ($500)

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 Score: Serious ($250)
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 Score: Serious

2. Food Tempuratures Score: Critical

3. Food Storage & Handling Score: Critical

4. Dry Storage Score: Serious

5. Food Service Equipment & Vending Machines Score: Serious

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

7. General Cleaning & Sanitation Measures Score: Critical

8. General Cleaning & Sanitation Measures Score: Critical

9. Garbage Storage & Disposal Score: Critical

10. Manager Sanitation Certificate & CDPH Report Score: Critical

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

12. Pest Control Score: Critical

13. Pest Control Score: Critical

14. Pipes & Plumbing Score: Critical

Details/Findings Page
Instructions: Fill in details from inspection/walk through in each appropriate category below
15. Ceilings & Walls Score: Critical

16. Floors Score: Critical

17. Restrooms Score: Serious

18. Restrooms Score: Critical

19. Basement / Engineering Facilities Score: Critical

20. Safety Score: Serious

SCORING PAGE

Grade
1. Employee Facilities A
2. Food Temperatures (Critical: "A" or "F")
3. Food Storage & Handling
4. Dry Storage A
5. Food Service Equipment & Vending Services A
6. Utensils and Equipment A
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) A
18. Restrooms (Critical: "A" or "F")
19. Basement / Engineering Facilities
20. Safety A

*Average Scores

**Total Score and Letter Grade

Total of Ticketable Offenses

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 Signature

School Administrator
NSS Inspector

Facilities Inspector
Lunchroom Manager
Engineer

Other

Other

Additional Comments:
ur Schools Clean"

ettelhorst

ade/Alexander Hamp

PH) # of
Fail(s) Grade
0 A

Critical ($500) 0 A
ATIC "F"*** x $500
$0

Critical ($500) 0 A
x $500
$0

Serious ($250) A
x $250
$0
Serious ($250) 0 A
0 x $250
$0
Serious ($250) A
x $250
$0

Critical ($500) A
x $500
$0

Critical ($500) 0 A
x $500
$0

Critical ($500) 0 A
x $500
$0

Critical ($500) A
x $500
$0
Critical ($500) 0 A
x $500
$0

Critical ($500) 0 A
x $500
$0

Critical ($500) 0 A
x $500
$0

Critical ($500) 0 A
x $500
$0

Critical ($500) 1 B
 1 x $500
$500

Critical ($500) A
x $500
$0

Serious ($250) 0 A
x $250
$0

Critical ($500) 0 A
x $500
$0

Critical ($500) 0 A
x $500
$0

Serious ($250) 0 A
x $250
 $0

0 A

0 A

0 A

0 A

0 A
0 A

0 A

0 A

0 A

0 A

0 A

0 A
0 A

0 A

1 B

0 A

0 A

0 A

0 A
 0 A

Score Grade Score Fines

4
A 4 $0
A 4 $0
4 $0
4 $0
4 4 $0
A 4 $0
A 4 $0
A 4 $0
A 4 $0
A 4 $0
A 4 $0
A 4 $0
A 4 $0
B 3 $500
A 4 $0
4 $0
A 4 $0
4 A 4 $0
4 $0

4.00 3.93

3.96 B

$500

s:
ss of average

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