Food Establishment Inspection Report |
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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. |
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GOOD RETAIL PRACTICES |
Good Retail Practices are preventative measures to control the addition of pathogens, chemicals, and physical objects into foods. Mark "X" in the box if the numbered item is not in compliance Mark "X" in appropriate box for COS and/or R COS=corrected on site during inspectionR=repeat violation |
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Food Establishment Inspection Report |
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Establishment: EXMOOR COUNTRY CLUB - POOL CABANA | License/Permit #: 005291 | Date: 06/27/2025 |
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 | Not Setup | 0 | 0.00 |
Wiping Cloth Bucket | Chemical Sanitizer | Quaternary Ammonium | 200 | 0.00 |
LT Dish Machine | Chemical Sanitizer | Chlorine | 50 | 0.00 |
CFPM Verification (name, expiration date, ID#): | |||
RANDY BAUWENS 12/17/2029 26665259 |
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Presentation Type: | VISUAL | Number Attended: | 1 |
HACCP Discussed | HACCP Principle | Plan Onsite |
2. Determine the CCP | Discussed the HACCP principle of Conducting a Hazard Analysis of identifying a potential hazard as microbiological, physical or chemical. | No |
IL Requirements: | Use of non-latex gloves for food handling and preparation 410 ILCS 180/10. |
Appropriate default beverage for children's meal 410 ILCS 620/21.5. |
TEMPERATURE OBSERVATIONS |
Item/Location |
Temp |
Item/Location |
Temp |
Item/Location |
Temp |
MILK/REACH-IN COOLER | 40.00°F | MILK/WALK-IN COOLER | 40.00°F | ICE CREAM/REACH-IN FREEZER | 0.00°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. |
28 | PF | 7-102.11 |
Working containers used for storing POISONOUS OR TOXIC MATERIALS such as cleaners and SANITIZERS taken from bulk supplies shall be clearly and individually identified with the common name of the material. Spray bottles being used for cleaning agents are not labeled. A label was provided. The container was labeled as required. CORRECTED |
RANDY BAUWENS Person In Charge (Signature) |
Ami Verma Inspector |
Follow-up: Yes No | Follow-up Date: |