Montgomery County Health Department 11191
185 62049
Illinoi s Ro ute
Hillsboro IL
Division of En vironm enta l Hea lth
(217) 532-2001
Retail Food San itary Inspection Report Establishment / '
Date
\
j~:1f'~\ f" U. \....~~~l
Address
Establishment Code
Risk
f\
Grade
'I l.-S-\\
M
3
Iscor~ ~-;!:' meritS)
I
\\.AJ
City Owner/Agent
Compliant with the Smoke-Free Illinois Act? (
purpos~ (circle
-
..
1
L B.Qujir1~
(circl~one)
Follow-up
Pre- opening
Smoking
Complaint
Educational
Other
- -...... _ _~_""'-'-' F...;:; Oo...;: O".;;;D";;;: B;..;;; O,.:...:. RNE ILLNESS RISK FACTORS AND PUBLIC HEALTH INTERV ENTIONS Circie designated compliance status (IN, OUT, N/O, N/A) for each numbered ite; - . - -Mark "X';;jn appropriai~ b~x for C and/or R IN=in compliance OUT=out of compliance N/O=not observed N/A=not applicable C=corrected on-site during inspection R=repeat violation (2X demerits) Compliance Status I CI R Compliance Status ICIR 5·points 9 points Demonstration of Knowledge P~ntially Hazardous Food TimelTemperature IN ' OUT f'J /A' )
Compliance with Certified Manager Requirement
16 IN
Employee Health
5 pOints
Employee health policy and procedures
2llNJOUT IN OUT NA
Jl;:i,o iproper glove use
4
ill
( Ng
OUT
5\ IN)o UT
6 points
W:l
~ OU1)lIlf.
Proper cold holding temperature
21 IN Olft{ N;
NO
Preventing Contamination by Hands
Consumer Advisory
NO Hands clean, handwashing procedures
23 IN
out N/"
24 IN
out N/q
7 ( ~ OUT N/A NO No bare hand contact with RTE foods
Approved Source
5 points
Food obtained from approved source
1 ~ IN) OUT
Food in good condition, safe, unadulterated
12 IN OU l\.N~'
Required records available; shellstock tags
_....
Highly Susceptible Populations
5 pOints
Proper foods used for susceptible populations
"...,..
Chemical
2\Ll1::!)' OUT N/A NO
10 IN OUT N/A ( N ~ Food received at proper temperature
3 points
Consumer advisory provided for raw or undercooked foods
,."
Adequate handwashing facilities supplied & accessible
INl oUT
Proper date marking & disposition of PHF
22 IN O W ~ NO Time as a public health control: approved procedure & record s
NO Personal hygiene and cleanliness
8\ It'f 0UT
Properreheating procedures for hot holding
OUfli17", NO Proper cooling time & temperature
1~ IJ..N OUTlilIA NO Proper hot holding temperature
I~
Proper eating, tasting, drinking, tobacco use
N~ NO Proper cooking time & temperature
oL(T
17 IN ouf~ NO 18
__Good HygieniC Practices 3
9
Y E §) NO
one)
~ IN OUT
5 points
Sanitizing solutions in excess of allowable limits Toxic items properly identified, stored & used Approved Procedures
Protection from Contamination
3 points
Compliance wi th variance, HACCP, policy
27 IN OUl(N/,f 6 points
13 IN OUTt NtP
Food separated & protected
14 ~OUT N/A 151 IN)lUT
Food contact surfaces clean & sanitized No re-use of foods or single service previously served
Risk factors are improper pra ctices or procedures identified as the most prevalent contributing factors of foodbome illness and injury. Public Health Interventions are control measure s to prevent foodbome illness or injury. Greater weight is given to these violations.
-
GOOD RETAIL PRACTICES/STANDARD OPERATING PROCEDURES . . Good Retail Practicas and Standard Operating Procedures are preventative measures to control the addition of pathogens, chemicals, and physical objects into food. Mark "X" in appropriate box for C and/or R Mark "X" in box if numbered item IS NOT in compliance C=corrected on-site during inspection R=repeat viola tion (2X demerits) I Pts I
I Pts I
ICIR
ICIR
Safe Water & Sewage Disposal
Proper Use of Utensils
28
3
Water & ice from approved source
40
1
29
3
Plumbing installed; backflow protection
41
1
Utensils, equipment & linens; properly stored, washed & handled
30
3
Sewage & wastewater disposal
42
1
Single-service articles: storage & dispensing
Food Equipment
43
2
Food (ice) contact surfaces: constructed, installed, maintained
31
1
Facilities to maintain product temperature
44
1
Non-food contact surfaces: constructed, installed, maintained
32
2
Approved thawing methods
45
1
Warewashing facilities: installed, maintained & used; test strips
33
1
Thermometers/guages provided, used & accurate
46
1
Non-food contact surfaces clean
47
3
Hot & cold water available, adequate pressure
Food Identification.
-"'-
In-use utensils; properly stored
,.
Physical Facilities
34
1
Food properly labeled; original container Prevention from Contamination
48
1
Physical facilities clean
35
3
Insects/rodents/animals present; unauthorized persons; openings
49
1
Cleaning equipment properly stored
36
2
Food protection during food preparation, storage & display
50
1
Toilet facilities constructed, supplied & cleaned, self-closing doors
2
Personal cleanliness (presentation)
51
1
Refuse properly disposed; facilities maintained
38
1
Wiping cloths: properly used & stored
52
1
Physical facilities properly installed & maintained
39
1
Fruits & vegetables properly washed before use
53
1
Adequate ventilation & lighting; designated areas used
37
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