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 - CLUBHOUSE | License/Permit #: 003494 | 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 | Hot Water | Not Setup | 0 | 0.00 |
Wiping Cloth Bucket | Chemical Sanitizer | Quaternary Ammonium | 200 | 0.00 |
HT Dish Machine | Hot Water | Not Setup | 0 | 180.00 |
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 |
4. Establish a Monitoring System | Discussed the HACCP principle of identifying critical control points such as hot holding at 135 degrees F or above and cold holding at 41 degrees F or below. | 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 |
CREAM/MOOSE/BAKERY WALK IN COOLER | 39.00°F | CUT FRESH TOMATOES/COOK'S LINE COOLER | 40.00°F | SOUR CREAM/COOK'S LINE COOLER | 40.00°F |
MILK/GLASS DOOR REACH IN COOLER | 40.00°F | COOKED ONIONS/PIZZA STATION LINE COOLER | 40.00°F | CHICKEN/WALK-IN COOLER | 40.00°F |
FISH/WALK-IN COOLER | 40.00°F | ICE CREAM/CHEST FREEZER | 0.00°F | PIZZA DOUGH/REACH-IN FREEZER | 0.00°F |
FRENCH FRIES/TWO-DOOR UPRIGHT FREEZER | 0.00°F | SOUP/STEAM TABLE | 154.00°F | POTATOES/COOLING - 2 HOURS | 41.00°F |
OBSERVATIONS AND CORRECTIVE ACTIONS |
P=Priority PF=Priority Foundation C=Core R=Repeat |
RANDY BAUWENS Person In Charge (Signature) |
Ami Verma Inspector |
Follow-up: Yes No | Follow-up Date: |