Food Establishment Inspection Report
Page 1  of ????????? 
Lake logo Lake County Health Department
and Community Health Center
500 West Winchester Road Suite 102
Libertyville, IL 60048
Establishment
 FOREST GREENS JUICE BAR 		License/Permit #
 010461
Street Address
123 N WAUKEGAN RD
City/State
 LAKE BLUFF, IL 		ZIP Code
 60044
No. of Risk Factor/Intervention Violations 0
No. of Repeat Risk Factor/Intervention Violations 0
Date 05/19/2023
Time In 01:15 PM
Time Out 01:45 PM
Permit Holder/Person Interviewed/Person In Charge (PIC)
SERGIO SALDANA 		Risk Category
High
Purpose of Inspection   Routine

FOODBORNE ILLNESS RISK FACTORS AND PUBLIC HEALTH INTERVENTIONS
Circle designated compliance status (IN, OUT, N/O, N/A) for each numbered item
IN=in compliance    OUT=not in compliance    N/O=not observed    N/A=not applicable
Mark "X" in appropriate box for COS and/or R
COS=corrected on-site during inspection    R=repeat violation 		Risk factors are important practices or procedures identified as the most prevalent contributing factors of foodborne illness or injury. Public health interventions are control measures to prevent foodborne illness or injury.
 Compliance Status
 COS R

SUPERVISION

 
1 IN OUT     Person in charge present, demonstrates knowledge, and performs duties    
2 IN OUT N/A   Certified Food Protection Manager    

EMPLOYEE HEALTH

 
3 IN OUT     Management, food employee and conditional employee; knowledge, responsibilities and reporting    
4 IN OUT     Proper use of restriction and exclusion    
5 IN OUT     Procedures for responding to vomiting and diarrheal events    

GOOD HYGIENIC PRACTICES

 
6 IN OUT   N/O Proper eating, tasting, drinking, or tobacco use    
7 IN OUT   N/O No discharge from eyes, nose, and mouth    

PREVENTING CONTAMINATION BY HANDS

 
8 IN OUT   N/O Hands clean & properly washed    
9 IN OUT N/A N/O No bare hand contact with RTE food or a pre-approved alternative procedure properly allowed    
10 IN OUT     Adequate handwashing sinks properly supplied and accessible    

APPROVED SOURCE

 
11 IN OUT     Food obtained from approved source    
12 IN OUT N/A N/O Food received at proper temperature    
13 IN OUT     Food in good condition, safe, & unadulterated    
14 IN OUT N/A N/O Required records available: shellstock tags, parasite destruction    
 Compliance Status
 COS R

PROTECTION FROM CONTAMINATION

 
15 IN OUT N/A N/O Food separated and protected    
16 IN OUT N/A   Food-contact surfaces: cleaned & sanitized    
17 IN OUT     Proper disposition of returned, previously served, reconditioned & unsafe food    

TIME/TEMPERATURE CONTROL FOR SAFETY

 
18 IN OUT N/A N/O Proper cooking time & temperatures    
19 IN OUT N/A N/O Proper reheating procedures for hot holding    
20 IN OUT N/A N/O Proper cooling time and temperature    
21 IN OUT N/A N/O Proper hot holding temperatures    
22 IN OUT N/A N/O Proper cold holding temperatures    
23 IN OUT N/A N/O Proper date marking and disposition    
24 IN OUT N/A N/O Time as a Public Health Control; procedures & records    

CONSUMER ADVISORY

 
25 IN OUT N/A   Consumer advisory provided for raw/undercooked food    

HIGHLY SUSCEPTIBLE POPULATIONS

 
26 IN OUT N/A   Pasteurized foods used; prohibited foods not offered    

FOOD/COLOR ADDITIVES AND TOXIC SUBSTANCES

 
27 IN OUT N/A   Food additives: approved and properly used    
28 IN OUT N/A   Toxic substances properly identified, stored, & used    

CONFORMANCE WITH APPROVED PROCEDURES

 
29 IN OUT N/A   Compliance with variance/specialized process/HACCP    

GOOD RETAIL PRACTICES
Good Retail Practices are preventative measures to control the addition of pathogens, chemicals, and physical objects into foods.
Mark "X" in appropriate box for COS and/or R      
COS
=corrected on site during inspection  
R
=repeat violation  
 Compliance Status
 COS R

SAFE FOOD AND WATER

 
30   Pasteurized eggs used where required    
31   Water & ice from approved source    
32   Variance obtained for specialized processing methods    

FOOD TEMPERATURE CONTROL

 
33   Proper cooling methods used; adequate equipment for temperature control    
34   Plant food properly cooked for hot holding    
35   Approved thawing methods used    
36   Thermometers provided & accurate    

FOOD IDENTIFICATION

 
37   Food properly labeled; original container    

PREVENTION OF FOOD CONTAMINATION

 
38   Insects, rodents, & animals not present    
39   Contamination prevented during food preparation, storage & display    
40   Personal cleanliness    
41   Wiping cloths: properly used & stored    
42   Washing fruits & vegetables    

PROPER USE OF UTENSILS

 
43   In-use utensils: properly stored    
 Compliance Status
 COS R

PROPER USE OF UTENSILS

 
44 X Utensils, equipment & linens: properly stored, dried, & handled X  
45   Single-use/single-service articles: properly stored & used    
46   Gloves used properly    

UTENSILS, EQUIPMENT, AND VENDING

 
47   Food & non-food contact surfaces cleanable, properly designed, constructed & used    
48   Warewashing facilities: installed, maintained & used; test strips    
49   Non-food contact surfaces clean    

PHYSICAL FACILITIES

 
50   Hot & cold water available; adequate pressure    
51   Plumbing installed; proper backflow devices    
52   Sewage & waste water properly disposed    
53   Toilet facilities: properly constructed, supplied, & cleaned    
54   Garbage & refuse properly disposed; facilities maintained    
55   Physical facilities installed, maintained & clean    
56   Adequate ventilation & lighting; designated areas used    

EMPLOYEE TRAINING

 
57   All food employees have food handler training    
58   Allergen training as required    
IOCI 17-356

Food Establishment Inspection Report
Page 2  of ?????? 
Establishment: FOREST GREENS JUICE BAR License/Permit #: 010461 Date: 05/19/2023
Water Supply:   Community Non-Community Licensed Non-Community    Waste Water System:   Community On-Site IEPA System
Sanitizer: Temperature Logs in Use:
Location Method Sanitizer Type Concentration (PPM) Heat(F)
3-Compartment Sink Chemical Sanitizer Chlorine 100 0.00
Wiping Cloth Bucket Chemical Sanitizer Chlorine 100 0.00
CFPM Verification (name, expiration date, ID#):
SERGIO SALDANA
08/22/2027
21860365 		     
Presentation Type: VISUAL Number Attended: 1
HACCP Discussed HACCP Principle Plan Onsite
3. Establish the Critical Limit for the CCP Discussed the HACCP principle of identifying a critical control point such as cold holding at 41 degrees F or less. Not Applicable

TEMPERATURE OBSERVATIONS
Item/Location
Temp
Item/Location
Temp
Item/Location
Temp
CHICKEN/REACH-IN COOLER 40.00°F JUICE/REACH-IN COOLER 40.00°F JUICE/REACH-IN COOLER 41.00°F
CUT FRUIT/REACH-IN FREEZER 0.00°F SOUP/REACH-IN FREEZER 0.00°F SOUP/REACH-IN FREEZER 0.00°F
SOUP/STEAM TABLE 136.00°F        

OBSERVATIONS AND CORRECTIVE ACTIONS
P=Priority      PF=Priority Foundation      C=Core      R=Repeat
Item
Number 		P/PF/C/R Code Reference Violations cited in this report must be corrected within the time frames below.
44 C 4-901.11 (A) After cleaning and SANITIZING, EQUIPMENT and UTENSILS: (A) Shall be air-dried or used after adequate draining CFR Tolerance exemptions for active and inert ingredients for use in antimicrobial formulations (food-contact surface SANITIZING solutions), before contact with FOOD.
Equipment and utensils not air dried.
Air dry equipment and utensils before contact with food.
CORRECTED
SERGIO SALDANA
Person In Charge (Signature)  		Jacob Staples
Inspector 
Follow-up:  Yes   No   Follow-up Date: