Network: 8 Oracle: 46181 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1.1 Clean and organize all offices, remove outdated posters/memos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
x Fail - Office has dust
x Fail - Clutter must be removed
x 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
x 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
x 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
x 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
x Fail - lounge area dusty/dirty needs cleaning
x 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
x 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
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
Fail - lockers are not clean/food present
x Fail - areas found to be dusty/dirty
x Fail - waste cans/pencil sharpeners are not dumped
x Fail - chalk rails/boards are not clean
x Fail - dirty/stinky mops, buckets, custodial carts in use.
x Fail - custodial closets dirty/dusty or in poor condition
x 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
x Fail -Teachers Lounge
Fail - Student Lunchroom
Fail - Under/Inside/Behind Food Equipment & Serving Lines
x Fail - Any classroom, office, closet, gym, auditorium, other
Fail - rodent droppings found around the loading dock/dumpster area
x Fail - evidence of rodent dropping found in the custodial closets
Fail - rodent droppings found in heating units
x 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
x 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
x Fail - pest evidence found in heating units, drains, exit doors, other
x 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
x Fail - openings around pipes need to be stuffed and sealed

15.Ceiling & Walls

15.1 x Fail - ceiling and walls have cracks and/or holes
x Fail - Ceiling and walls have chipping/peeling paint
x Fail - Ceiling and walls are leaking and/or have water marks
Fail - Ceiling and walls are not clean
x Fail - light shields missing/dirty/cracked
x Fail - ceiling tiles missing and/or stained
16. Floors
16.1 x Fail - floors are not clean
x Fail - floors under equipment are not clean and free of debris
x Fail - floor tiles missing or broken
Fail - stairs and stairwells not clean or free of clutter
x Fail - items stored 6" above the floor
x Fail - floor has holes or cracks
x Fail - baseboards are not clean and/or away from the wall
x 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
x 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
 x Fail - unused equipment needs to be removed
Fail - chemicals are not stored properly in the engineering areas
x Fail - basement/bolier areas need detailed cleaning
x Fail - water leaks observed in the basement/boiler area
x Fail - Seal all holes and cracks throughout the basement area
Fail - Elevator is dirty
x 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
x 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

Teachers lounge area - cabinets are dirty and dusty, corners dirty

2. Food Tempuratures

3. Food Storage & Handling

Expired seasonings
Expired seasonings

4. Dry Storage

5. Food Service Equipment & Vending Machines

Under serving line needs cleaning

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

8. General Cleaning & Sanitation Measures

Teacher lounge areas dusty and dirty

9. Garbage Storage & Disposal

10. Manager Sanitation Certificate & CDPH Report

Previous CDPH violation of peeling paint in kitchen staff locker room

Details/Findings Page
Instructions: Fill in details from inspection/walk through in each appropriate category below
11. All Rooms, Closets, Offices, Gym, Auditorium, Other

Milk crates in classrooms, microwaves and refrigerators were all dirty, cardboard boxes on the floor, remove excess clutter in
basement, custodial equipment in boiler room is a fire hazard, 361, 205 back room, 203. Remove all food from classrooms.
12. Pest Control
Droppings found in the following areas: 259A, 151A&B, 151F inside of piano, PR1 Pump room, 159, 160, 1B Storage, 154, Au
Computer lab, Digital media lab, 121, Media center. Library, Main office near refrigerator, basement areas, 301, 320 teachers
253A, 251A, 214B, boiler area

13. Pest Control

Door sweeps needed at Doors, 1, 2, 3, 7, 8, 9, 10, 11, 12. Droppings found in heating unit in auditorium and 160 (mouse caug
building

14. Pipes & Plumbing

Openings around pipes need to be sealed and stuffed in all rooms and closets

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

Replace missing, stained and cracked ceiling tiles in rooms 151A, 327, outside of 327, 303, 304 office, 318, 354, 355, 358, 36
shields throughout the school. Peeling/chipping paint in stage area, 107A, 111B, electrical closet near 111B, 121, boys locker
closets, 301, 309B, 315, 311, 318, Boys and Girls gym, IDF north, cracked tiles in kicthen area.

16. Floors

All items 6" off the floor in multiple rooms. Floor in room 116A needs repair, 118 (missing floor tiles covered with duct tape), flo
and floor meet are dirty, overall floors in classrooms are dirty
All items 6" off the floor in multiple rooms. Floor in room 116A needs repair, 118 (missing floor tiles covered with duct tape), flo
and floor meet are dirty, overall floors in classrooms are dirty

17. Restrooms

Boys restroom near 111B has a leak from a toilet

18. Restrooms

19. Basement / Engineering Facilities

salad bar cart in boiler room, excess custodial supplies, milk crates, around 100 unused computers, basement library area is
foundation, lots of unused chemicals, unused music and sporting equipment

20. Safety

expired fire extinguisher in serving line area dated 4/2016

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

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

Lunchroom Manager
Engineer
Other
Other

Additional Comments:
 "Keep Our Schools Clean"

Kelly High School

Jason Mojica, Daniel Guico, Arnold William

Receiving
Unmanned Site

of Public Health (CDPH) # of

Fail(s) Grade
Score: Serious 4 C

Score: Critical ($500) 0 A

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

Score: Critical ($500) 1 B

1 x $500
$500

original container
d between uses

Score: Serious ($250) A

x $250
$0
18" from the ceiling

Score: Serious ($250) 1 B

1 x $250
$250

nt needs cleaning

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

e lined with paper

Score: Critical ($500) A

x $500
$0

ing stored on top

Score: Critical ($500) 2 C

2 x $500
$1,000

Score: Critical ($500) A

x $500
$0

Score: Critical ($500) 1 B

1 x $500
$500
to all customers

Score: Critical ($500) 9 F

2 x $500
$1,000

and up windows closed.

Score: Critical ($500) 4 F
4 x $500
$2,000

mpster area

Score: Critical ($500) 3 F

3 x $500
$1,500
opped open

Score: Critical ($500) 1 B

1 x $500
$500
 Score: Critical ($500) 5 F
5 x $500
$2,500

Score: Critical ($500) 7 F

7 x $500
$3,500

Score: Serious ($250) 1 B

1 x $250
$250

Score: Critical ($500) A

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

Score: Critical ($500) 5 F

4 x $500
 $2,000

Score: Serious ($250) 1 B

1 x $250
$250

d over a year

te category below
Score: Serious 4 C

Score: Critical 0 A

Score: Critical 1 B
 Score: Serious 0 A

Score: Serious 1 B

te category below
Score: Serious 0 A

Score: Critical 0 A

Score: Critical 2 C

Score: Critical 0 A

Score: Critical 1 B
te category below
Score: Critical 9 F

d boxes on the floor, remove excess clutter in 259A, woodshop room sub storage, 302 vault,
om, 203. Remove all food from classrooms.
Score: Critical 4 F
R1 Pump room, 159, 160, 1B Storage, 154, Auditorium stage and balcony, 118, Kelly store, 116A,
rigerator, basement areas, 301, 320 teachers lounge, closet next to 320,361, 207, 204, 255A,

Score: Critical 3 F

eating unit in auditorium and 160 (mouse caught on 12/4). Seal cracks and holes throughout the

Score: Critical 1 B

te category below
Score: Critical 5 F

of 327, 303, 304 office, 318, 354, 355, 358, 361, 214B, 202A, 201, 207. Replace missing light
, electrical closet near 111B, 121, boys locker room near pool, basement, boiler room, custodial
in kicthen area.

Score: Critical 7 F

(missing floor tiles covered with duct tape), floors under equipment are dirty, corners where wall
(missing floor tiles covered with duct tape), floors under equipment are dirty, corners where wall

Score: Serious 1 B

Score: Critical 0 A

Score: Critical 5 F

unused computers, basement library area is cluttered. Water leaking in basement and through

Score: Serious 1 B

Grade Score Grade Score Fines

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

3.17 1.93

2.55 F

$15,750

-inspection must be completed

oring Page as follows:

ust be an F regardless of average

Signature Email