AT_ 10 - TB MED 531.pdf

TB MED 531

TECHNICAL BULLETIN

FACILITY SANITATION CONTROLS AND

INSPECTIONS

APPROVED FOR PUBLIC RELEASE; DISTRIBUTION IS UNLIMITED.

HEADQUARTERS, DEPARTMENT OF THE ARMY

1 March 2019

This page is intentionally left blank.

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Army Technical Bulletin, Medical TB MED 531

DEPARTMENT OF THE ARMY

WASHINGTON, DC, 1 March 2019

FACILITY SANITATION CONTROLS AND INSPECTIONS

You can help to improve this bulletin. If you find any mistakes or have a recommendation to improve procedures, please let us know. Mail a memorandum or DA Form 2028 (Recommended Changes to Publications and Blank Forms) directly to The Surgeon General (DASG-HS), 7700 Arlington Boulevard, Falls Church, VA 22042-5143.

The use of trademarked names does not imply endorsement by the U.S. Army but is intended only to assist in the identification of a specific product.

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Contents

CHAPTER 1 – INTRODUCTION

Purpose, 1–1, page 1 References, 1–2, page 1 Abbreviations and terms, 1–3, page 1 Applicability, 1–4, page 1 Guidance for using this publication, 1–5, page 1 Timeframe to correct violations, 1–6, page 1 Sources used to develop the sanitation standards, 1–7, page 3 Facilities requiring inspection, 1–8, page 3 Inspection documentation, 1–9, page 5 Report administration and distribution, 1–10, page 7 Privatized operations, 1–11, page 8

CHAPTER 2 – BARBER AND BEAUTY OPERATIONS

Section I – General Information Professional services, 2–1, page 11 Beauty operation hazards, 2–2, page 12 Restricted practices and instruments, 2–3, page 17

Section II – Facility Requirements and Approved Supplies Physical facilities, 2–4, page 18 Approved beauty products and antimicrobials, 2–5, page 19

Section III – General Sanitation Requirements Management controls, 2–6, page 20 Operational controls, 2–7, page 21 Instrument and equipment controls, 2–8, page 22 Beauty product controls, 2–9, page 23 Foot baths and pedicure spas, 2–10, page 24 Hair removal, 2–11, page 24 Hand and foot wax treatments, 2–12, page 26 Hair weaving, 2–13, page 27 Nail treatments, 2–14, page 27 Mud treatments and baths, 2–15, page 27 Spray tanning, 2–16, page 28 Laundry, 2–17, page 28 Other services and facilities, 2–18, page 29

Section IV – Field and Contingency Operation Environments Authorized operations, 2–19, page 29 Employee health and hygiene, 2–20, page 29 Facility controls, 2–21, page 30 iii

Sanitary practices, 2–22, page 30

CHAPTER 3 – GYM AND FITNESS CENTER OPERATIONS

Fitness operation characteristics, 3–1, page 31 Prohibited services, 3–2, page 33 Physical facilities, 3–3, page 33 Disinfectants, 3–4, page 33 General facility sanitation, 3–5, page 34 Equipment sanitation, 3–6, page 34 Sauna and steam rooms, 3–7, page 35 Showers, locker rooms, and toilet facilities, 3–8, page 36 Laundry, 3–9, page 36 Massage services, 3–10, page 36

CHAPTER 4 – MASSAGE OPERATIONS

Section I – General Massage operation characteristics, 4–1, page 37 Physical facilities, 4–2, page 37

Section II – Sanitation Requirements Management controls, 4–3, page 38 Disinfectants, 4–4, page 39 Massage tables, chairs, face rests, and mattresses, 4–5, page 39 Linens, barrier paper, and footwear, 4–6, page 39 Oils, creams, and lotions, 4–7, page 40 Therapy stones and equipment, 4–8, page 41 Shower and toilet facilities, 4–9, page 41 Custodial equipment, 4–10, page 41

CHAPTER 5 – TROOP HOUSING

General, 5–1, page 43 Habitability assessment guidelines, 5–2, page 43 Disease transmission, 5–3, page 44 Sleeping space allowances, 5–4, page 44 Surge and mobilization, 5–5, page 45 Sleeping configuration, 5–6, page 46 Plumbing fixtures, 5–7, page 48 Ventilation, 5–8, page 48 Sanitation and hygiene, 5–9, page 48 Inspection criteria, 5–10, page 51

CHAPTER 6 – MANUFACTURED HOME PARKS

General, 6–1, page 53 Location, 6–2, page 53 Manufactured home space, 6–3, page 53 iv

Design criteria, 6–4, page 53 Water supply, 6–5, page 54 Sewage and liquid waste disposal, 6–6, page 54 Service buildings, 6–7, page 54 Area sanitation, 6–8, page 55

CHAPTER 7 – RECREATIONAL AREAS

General, 7–1, page 57 Location, 7–2, page 57 Water supply, 7–3, page 58 Service buildings, 7–4, page 58 Sewage and liquid waste disposal, 7–5, page 60 Area sanitation, 7–6, page 60

CHAPTER 8 – CHILD, YOUTH, AND SCHOOL SERVICES FACILITIES

Section I – General Inspection management, 8–1, page 63 Facility design and review, 8–2, page 64

Section II – Child Development Centers Food safety, 8–3, page 65 Facility general maintenance, 8–4, page 68 Facility sanitation, 8–5, page 68 Health and hygiene controls, 8–6, page 71 Toys, 8–7, page 71 Mattresses, sleep mats, and other activity pads, 8–8, page 73 Bedding and linens, 8–9, page 74 Water play, 8–10, page 74 Pets, 8–11, page 75 Toxic plants, 8–12, page 76 Outdoor play areas, 8–13, page 76 Custodial and housekeeping services, 8–14, page 77

Section III – Family Child Care Homes Home inspection, 8–15, page 79 Home food safety, 8–16, page 79 Home sanitation and hygienic controls, 8–17, page 82 Pets and indoor plants, 8–18, page 83 Outside play area safety and sanitation, 8–19, page 83

Section IV – Youth Facilities, SAC, and Schools Environmental health sanitation and controls, 8–20, page 85

CHAPTER 9 – DETENTION FACILITIES

Background, 9–1, page 88 v

General facility requirements, 9–2, page 88 Confinement facility requirements, 9–3, page 89 Detention facility requirements, 9–4, page 89 Enemy combatant facilities, 9–5, page 90 Food and water, 9–6, page 90 Inspection guidelines, 9–7, page 90 Inspection procedures, 9–8, page 91

CHAPTER 10 – LAUNDRY OPERATIONS

Section I – General Information Laundry characteristics, 10–1, page 96 Laundry process, 10–2, page 97 Laundry supplied, 10–3, page 97

Section II – Laundry Operation Procedures Handling precautions and personal protection, 10–4, page 98 Medical facilities and facilities used to quarantine potentially infectious persons, 10–5, page 99 Norovirus in barracks, 10–6, page 100 Norovirus at lodging facilities, 10–7, page 100 Sanitary process controls, 10–8, page 100 Facility sanitation, 10–9, page 103 Ventilation, 10–10, page 103 Worker safety, 10–11, page 104

Section III – Inspecting Laundry Operations Inspection, 10–12, page 104

CHAPTER 11 – BODY ART OPERATIONS

Section I – General Information Body art practices, 11–1, page 106 Body art restrictions, 11–2, page 106

Section II – Ear Piercing Operations Physical facilities, 11–3, page 107 Operator qualifications, 11–4, page 107 Operator health and hygiene, 11–5, page 108 Sanitary controls and procedures, 11–6, page 108

Section III – Other Body Art Operations Hazardous conditions, 11–7, page 109 Body art operation controls, 11–8, page 110

CHAPTER 12 – ICE MACHINE SANITATION

Background, 12–1, page 112 vi

Administrative controls, 12–2, page 112 Cleaning ice machines with removable ice–contact surfaces, 12–3, page 113 Cleaning ice machines with nonremovable ice-contact surfaces, 12–4, page 114 Sanitation surveillance, 12–5, page 115

Table List

Table 1–1: Required minimum inspection frequencies, page 4

Table 2–1: Beauty services, page 12

Table 2–2: Beauty operation hazards, page 13

Table 2–3: Antimicrobial agents for beauty equipment and implements, page 20

Table 3–1: Fitness facility hazards, page 31

Table 5–1: Examples of tent living space and maximum occupancy for sleeping, page 45

Table 5–2: Recommended cleaning cycles and processes, page 49

Table 5–3: Troop housing inspection reference, page 52

Table 7–1: Minimum requirements for comfort stations, page 59

Table 8–1: Manual warewashing procedures, page 82

Table 9–1: Inspection equipment and supplies, page 91

Table 9–2: Detention/confinement facility inspection guide, page 92

Table 10–1: Laundry operation inspection guide, page 105

Table B–1: Chlorine solution mixing formulas, page 123

Table B–2: Chlorine test strip suppliers, page 124

Table C–1: Hazard severity characterization, page 129

Table C–2: Baseline values for beauty operations, page 130

Table C–3: Baseline values for fitness operations and independent massage concessions, page 130

Table C–4: Noncompliance levels and points, page 131

Table C–5: Risk assessment matrix, page 134

Table C–6: Inspection frequency, page 135

Table D–1: Child development center design standards related to health and sanitation controls, page 137

Table D–2: Child development center room finish schedule requirements, page 140

Table D–3: School-age care design standards related to health and sanitation controls, page 141

Figure List

Figure 5–1: Sleeping Configuration, page 46 vii

Appendices

A. References, page 116

B. Antimicrobial Agents, page 121

C. Facility Risk Assessment, page 127

D. Child Care Facility Design Criteria, page 137

Glossary, page 143

Chapter 1 1

CHAPTER 1

INTRODUCTION

1–1. Purpose The purpose of this publication is to establish sanitary control criteria for facility managers to mitigate the risk for communicable disease transmission and to provide guidance for Environmental Health personnel when conducting sanitation inspections.

1–2. References See appendix A.

1–3. Abbreviations and terms See the glossary.

1–4. Applicability This publication applies to—

a. The Active Army, Army Reserve, and Army National Guard.

b. Joint military installations, field training sites, and contingency operation sites where Army assets are responsible for providing preventive medicine support.

c. Privatized facilities operated on behalf of the Army to provide services to Army or DOD personnel, in accordance with leasing and contractual agreements.

1–5. Guidance for using this publication

a. The term “preventive medicine,” as used in this publication, is synonymous with “environmental health” and “public health” and refers to those individuals responsible for providing environmental health service support as specified in Department of the Army Pamphlet (DA Pam) 40–11.

b. Critical requirements are identified by a bold asterisk (*). Critical requirements are terminal controls that are applied to prevent or significantly reduce the potential for disease transmission.

(1) An asterisk immediately following the paragraph title indicates the entire paragraph contents are critical requirements. For example, in chapter 2, paragraph 2–3 is marked with an asterisk following the title “Restricted practices and instruments.” Thus, all content in paragraphs 2–3a through 2–3e are critical.

(2) An asterisk located immediately following a subordinate paragraph header or at the end of the paragraph indicates that only that paragraph and its associated subordinate paragraphs are critical. For example, in chapter 2, subparagraph 2–4c(1) is marked with an asterisk following the paragraph header “Water,” which indicates all of the contents of paragraph (1) and the subordinate paragraphs (1)(a) and (1)(b) are critical. In the second example, subparagraph 2–4c(2), Sinks, has four subordinate paragraphs. Only subparagraphs (2)(a) and (2)(e) are marked with an asterisk; therefore, subparagraphs (2)(b) through (d) are not critical.

c. Hazards and controls not addressed.

(1) If necessary to protect against public health hazards or nuisances, the medical authority or designated Preventive Medicine representative, or Command Surgeon, as applicable, may impose specific requirements or restrictions in addition to the controls contained in this publication.

(2) Additional requirements are formally documented and published in local policy specifying the conditions and underlying public health threat being controlled. A copy of the policy letter should be provided to all applicable facility managers within the regulatory authority’s inspection jurisdiction.

1–6. Timeframe to correct violations

a. All violations found during an inspection are expected to be corrected at the time of inspection. Some situations may require submission of a work order or other action to resolve the condition that contributed to the

Chapter 1 2 violation. Public health inspectors work with the facility manager and apply the following guidelines for violations that remain uncorrected at the time of inspection:

(1) The facility manager (or person in charge) takes immediate action at the time of inspection to mitigate the risk associated with a critical violation. Actions to reduce the risk may include—

(a) Temporarily discontinuing the specific service or practice associated with the violation until the hazard condition is resolved;

(b) Modifying the service to exclude activities that result in a critical violation; or

(c) Applying a temporary administrative or physical control to reduce the hazard severity until a more permanent solution is achieved.

(2) The facility manager takes formal actions to correct the conditions that resulted in the critical violation and to establish operational procedures for administering controls to prevent a similar violation from occurring in the future. Formal actions are initiated immediately following the inspection and, when possible, are completed within 5 business days. Actions requiring more time to complete should be achieved within a maximum period of 30 days.

(a) The temporary controls specified in subparagraph a(1), above, to mitigate a critical condition remain in place until the underlying factor or factors that contributed to the critical violation are resolved.

(b) Underlying factors contributing to a critical violation may require repair to physical facilities or equipment; development of a sanitation standard operating procedure (SOP); additional employee training; or other action to improve active managerial controls within the operation. The maximum time allotted for correcting a critical violation is determined jointly by Preventive Medicine and the person in charge and is based on the feasibility to resolve the condition in the time allotted.

(c) The Preventive Medicine inspector conducts a follow-up inspection within 5 business days to verify the corrective action was achieved for all critical violations that were not corrected at the time of inspection.

The date for the follow-up inspection is determined at the conclusion of the original inspection and annotated on the inspection report provided to the person in charge.

(d) The Preventive Medicine inspector conducts weekly, unannounced walk-through inspections to ensure temporary, agreed-upon controls remain in place when a permanent corrective action cannot be achieved within 30 days. Formal documentation using the inspection forms prescribed in paragraph 1–9 is not required for walk-through inspections. If the walk-through inspection reveals a critical violation due to a breakdown in the temporary control(s), the inspector reports the finding as specified in paragraph 1–10e. As a result of the reoccurring critical violation, additional operational restrictions, to include facility closure, may be imposed until the underlying factors contributing to the critical violation have been resolved.

(3) Corrective actions for noncritical violations should be achieved within 30 days.

(a) A follow-up inspection to assess completion of the corrective action is not required.

(b) One or more walk-through inspections should be conducted if the timeframe between scheduled routine inspections is greater than 90 days.

(c) Consistent failure to correct noncritical violations may result in accrual of detrimental conditions that, when combined with poor managerial controls, could increase the risk to public health and safety. The Preventive Medicine inspector reports, as specified in paragraph 1–10e, when a steady decline in the physical condition of a facility or the application of active managerial controls is noted over time.

b. Preventive Medicine applies an intervention to resolve the chronic occurrence of critical or noncritical violations. Interventions may include, but are not limited to, the following:

(1) Assisting the person in charge (or facility manager) in the development of sanitation SOPs to improve active managerial controls and employee practices.

(2) Assisting the person in charge (or facility manager) in the development of training materials to reinforce proper sanitation and hygienic practices by employees.

(3) Facilitating work order resolution for damaged physical facilities or equipment. This intervention requires contact with the Directorate of Public Works (DPW) or Engineers to help influence the priority level assigned to the work order. Some cases may require preparing a risk assessment and elevating the issue to the installation commander to raise the action priority.

(4) Incentivizing inspection performance through public notification. Examples include—

(a) Posting inspection reports or grades for public view at the inspected facility.

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(b) Reporting top-performing and under-performing facilities in the post newspaper or other media.

(c) Creating competition between similar facilities by recognizing the “Star” performer. A trophy or placard is presented to a facility for public display and is rotated quarterly. A permanent award may be presented for facilities that achieve four consecutive Star awards.

1–7. Sources used to develop the sanitation standards Unlike the Food and Drug Administration’s (FDA) Model Food Code or the Environmental Protection Agency’s (EPA) Model Aquatic Health Code, a national model has not been developed to standardize sanitary controls associated with the various types of operations identified in this publication. Accordingly, the standards presented in this bulletin were derived following an extensive review of infection prevention and control guidelines from the Centers for Disease Control and Prevention and the public health standards applied by health departments throughout the United States, United Kingdom, and Canada. The resulting collection of standards presented in this bulletin identifies prudent practices to protect public health.

1–8. Facilities requiring inspection

a. Periodic sanitation and health inspections are conducted to assess conformance to prescribed public health controls. Frequencies for conducting inspections are either directed by Army facilities management policy, other governing regulations, or are recommended in this publication based on the facility’s inherent risk for disease transmission if the risk is left uncontrolled. Table 1–1 identifies facilities requiring periodic sanitation and health inspections.

b. The interval between prescribed inspections may be reduced (conducted more frequently) based on identified risks but may not be conducted less frequently without approval from the medical authority, Command Surgeon, or designated Preventive Medicine representative.

c. Inspections of facilities that lack a directed inspection frequency are conducted based on the risk for contributing to an adverse health effect if sanitary controls are not applied. The recommended inspection frequencies depicted in table 1–1 were derived from representative baseline assessments of expected services and practices associated with each operation. Variables such as operation size, the types of services offered, and actual employee practices will further impact the risk potential and may necessitate increasing the inspection frequency for some operations.

d. A baseline and periodic facility risk assessment surveys are recommended where noted in table 1–1 to better align inspection frequencies with the operational risk. See appendix C for risk assessment procedures and calculations.

(1) Risk assessment for barber and beauty facilities is conducted using Department of the Army (DA) Form 7847 (Beauty Operations Risk Assessment Worksheet).

(2) Risk assessment for gymnasiums and fitness centers is conducted using DA Form 7851 (Fitness Facility Risk Assessment Worksheet).

(3) Risk assessment guidance for food establishments is provided in TB MED 530/NAVMED P-5010-

1/AFMAN 48-147_IP.

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Table 1–1. Required minimum inspection frequencies

Facility Type and Supporting Publication Prescribed Inspection

Frequency Recommended

Frequency1

Army Correction System Facilities (AR 190–47) Monthly –

– Detention Facilities (D-cell) Monthly –

– Field expedient D-cells Weekly –

Barber Shop (DA Pam 40–11) Risk-based Annual

Beauty Shop/Hair Salon (DA Pam 40–11) Risk-based Annual

– Day Spa/Beauty Shop with multiple services Risk-based Semiannual

– Nail Salon (no other services provided) Risk-based Annual

Child, Youth, and School Services (CYSS) Facilities Varies2 –

– Child care facilities; includes child development centers (CDC) and school-age care (SAC) (AR 608–10)

Monthly3 Monthly3

– Family Child Care (FCC) Homes (AR 608–10) Annual4 –

– Youth Program facilities (DODI 6060.4) Annual Quarterly5

Ear piercing (DA Pam 40–11) – Annual Food Establishments (TB MED 530/NAVMED P-5010-1/AFMAN

48-147_IP)

Risk-based Varies

Gyms & Fitness Centers (DA Pam 40–11) Risk-based Annual

Laundry Operations (garrison) (DA Pam 40–11) – situational

– Hospital – situational

– Field laundry; deployment (ATP 4–42) Monthly –

Manufactured Home Parks (DA Pam 40–11) – 2 years

Massage Operations (nonmedical) (DA Pam 40–11) – Annual

Recreational Areas (DA Pam 40–11) – Annual

Recreational Water Facilities (TB MED 575) Varies –

– Pools, spas, spray grounds, activity parks, natural bathing Weekly –

– Medical facility therapy pools – Monthly

– Sanitary survey of natural bathing areas Annual –

Unaccompanied Troop Housing (AR 420–1) – Annual

– Substandard conditions exist Monthly – ATP=Army Techniques Publication 1 The absence of a “recommended frequency” for the specified facility requires inspections to be conducted according to the “prescribed” frequency.

2 Required inspections to maintain certification of the CYSS Program are conducted annually according to DODI

6060.02. Routine “periodic” inspections are conducted according to AR 608–10.

3 All kitchens supporting programmed meal service are inspected monthly. The general facility sanitation inspection is conducted monthly for CDCs and quarterly for SAC.

4 The FCC Program Coordinator may direct more frequent inspections, which are conducted by FCC staff members who have been trained by Preventive Medicine. See AR 608–10, subparagraph 6–40a(1).

5 The kitchen supporting programmed meal service at a youth/teen facility is inspected monthly. A general facility sanitation inspection is conducted quarterly at youth/teen facilities.

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1–9. Inspection documentation

a. Requirement. Inspections are documented using prescribed DA forms or the corresponding survey record available in the Defense Occupational and Environmental Health Readiness System–Industrial Hygiene (DOEHRS- IH), Environmental Health business area (hereafter referred to as “DOEHRS”).

(1) DOEHRS general sanitation survey tools are available from the U.S. Army Public Health Center (APHC) Web site at https://phc.amedd.army.mil/topics/envirohealth/hrasm/Pages/DOEHRS_Resources.aspx.

(2) DA forms are available through the Army Publishing Directorate (APD) Web site at https://armypubs.army.mil/.

(3) Direct data entry in the DOEHRS, General Sanitation folder, at https://doehrs-ih.csd.disa.mil/, is required for all facilities in which a DOEHRS survey has been established. Data is entered in DOEHRS within 10 days following the facility inspection.

b. Barber and beauty. Barber and beauty operations are inspected according to the criteria provided in chapter 2 and documented on DA Form 5402 (Barber/Beauty Shop Inspection Report) or the DOEHRS survey record, Beauty/Barber Shop Sanitation Survey. Inspection findings for massage services performed by a day spa facility are also documented on these forms. Sanitation criteria for massage operations are provided in chapter 4.

c. Gyms and fitness centers. Gyms and fitness centers are inspected according to the criteria provided in chapter 3 and documented on DA Form 7850 (Gym/Fitness Facility Inspection Report) or the DOEHRS survey record, Gym and Fitness Center Survey.

(1) Massage facilities that are operated as a component of a fitness center are documented with the fitness center inspection. See chapter 4 for massage operation criteria.

(2) Recreational water facilities that are operated within a fitness center are inspected and documented separately in accordance with (IAW) TB MED 575.

(3) Food concessions operated within a fitness center are inspected and documented separately IAW TB

MED 530/NAVMED P-5010-1/AFMAN 48-147_IP.

d. Massage. Massage operations are inspected according to the criteria provided in chapter 4.

(1) Inspections of independently operated massage operations are documented on the gym and fitness operation inspection forms specified in paragraph 1–9c.

(2) Inspections of massage services performed within a day spa or beauty operation are documented as specified in paragraph 1–9b.

e. Housing. Troop housing inspections are conducted according to the criteria provided in chapter 5. Because there is no DA form available for documenting housing inspections, these inspection findings may be summarized in a memorandum or captured on the DOEHRS survey record, Habitability Survey Report.

f. Manufactured home parks. Manufactured home parks operated on installations are a component of family housing (see chapter 5) and operated according to AR 420–1. Health and safety inspections are generally conducted when requested by the installation commander. The criteria for ensuring safe and sanitary manufactured home parks are provided in chapter 6.

(1) Because there is no DA form available for documenting manufactured home park inspections, these findings may be summarized in a memorandum or captured on the DOEHRS survey record, Mobile Home/RV Park Sanitation Report.

(2) Inspection findings associated with the recreational area (playground) affiliated with a manufactured home park are documented separately, as specified in subparagraph 1–9g.

g. Recreational areas. Recreational area inspections are conducted according to the criteria provided in chapter

7. Inspection findings may be summarized in a memorandum or on the DOEHRS survey record, as specified below.

(1) Except as specified in subparagraphs (2) through (4) of this section, a recreational area comprised of playgrounds, picnic areas, and camping grounds with tents or cabins is inspected as a single site when these areas share a common parking lot or support facilities (shower or toilet facilities). The DOEHRS survey record, Public Facility Sanitation Report, is used to document recreational area inspections. The DOEHRS survey may also be used to document assessments of other recreational areas such as athletic fields, indoor recreation centers, horse stables, and archery ranges.

(2) Camping areas containing a recreational vehicle (RV) park are inspected as independent sites and documented on the DOEHRS survey record, Mobile Home/RV Park Sanitation Report.

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(3) Natural bathing beaches, which include the recreational water, beach area, and bathhouse, are inspected as specified in paragraph 1–9m.

(4) Food concessions operated in a recreational area are inspected independently IAW TB MED

530/NAVMED P-5010-1/AFMAN 48-147_IP.

h. Child, Youth, and School Services. Requirements for conducting health and sanitation inspections at CYSS program facilities are specified in Department of Defense Instruction (DODI) 6060.02, DODI 6060.4, and AR 608–

10. The health and wellness or “medical” aspects of child care and youth program operations are typically evaluated by a public health nursing representative. Environmental Health personnel conduct the sanitation component of the inspection, which examines general facility sanitation, food safety, and other environmental factors that impact health. The contents of this bulletin focus on the environmental health sanitation aspects of inspection.

Health/medical inspection components are specified in the referenced publications, above.

(1) Chapter 8 of this bulletin provides the Environmental Health criteria for CYSS operations.

(2) Food sanitation and general sanitation components of child care centers (such as CDC and SAC), youth or teen centers, schools, and other facilities used to provide child and youth program activities are documented on DA Form 7848 (Child, Youth, and School Facility Sanitation and Food Safety Inspection); FCC home inspections are documented on DA Form 7849 (FCC Home Environmental Health Sanitation Inspection).

(a) The food safety allowances and procedures specified in chapter 8 are approved exceptions to TB

MED 530/NAVMED P-5010-1/AFMAN 48-147_IP.

(b) At the time of this bulletin’s publishing, DOEHRS data entry was not available for CYSS program inspections. This capability is expected in the future.

(3) DODI 6060.02 and DODI 6060.4 require annual program-level inspections of key child care and youth program components, in addition to the periodic sanitation and hygiene inspections conducted by Preventive Medicine. A Comprehensive Health and Sanitation Inspection and a Multidisciplinary Team Inspection, which includes a health and sanitation component, are conducted unannounced once each year and are coordinated by the senior commander or designated representative using local public health representatives—both a Public Health Nurse and an Environmental Health professional. An Annual Higher Headquarters Inspection is also conducted once each year as part of the DOD Certification to Operate.

(a) Program-level inspections are performed according to standardized DOD guidelines and other forms or checklists prescribed by Installation Management Command or the Assistant Chief of Staff for Installation Management (ACSIM). The environmental health criteria presented in the CYSS program inspection checklist is written at the macro-level and outlines essential controls necessary to protect the health of children and staff.

(b) The sanitation inspection forms specified in subparagraph 1–9h(2) provide the micro-level assessment of the facility and are recommended for use, as applicable, in conjunction with other prescribed forms/checklists when annual program-level inspections are conducted.

(c) The Army Public Health Nurse and Environmental Health professional should assist the Garrison Commander in overseeing corrective actions and ongoing compliance with health and sanitation standards from all inspections.

(d) The food safety and sanitation components of the annual program-level inspections should be performed by a qualified subject matter expert such as an Environmental Science and Engineering Officer, Civilian Sanitarian, or a noncommissioned officer in the grade of E-6 or above with military occupational specialty 68S.

Applying this level of scrutiny in the program-level inspections serves to validate the quality of the periodic inspections conducted by junior Environmental Health personnel.

i. Confinement and detention facilities. AR 190–47 specifies the requirements for medical inspection of Army confinement and detention facilities.

(1) Inspection criteria and procedures are provided in chapter 9 of this publication.

(2) Inspection findings are documented on DA Form 1594 (Daily Staff Journal or Duty Officer’s Log) at the facility and are summarized in a memorandum for record (MFR) for retention at the Environmental Health office.

(3) The DOEHRS does not support survey data entry for garrison confinement and detention facilities. The DOEHRS EPW Detention Facility Sanitation Report is only used to evaluate enemy prisoner of war (EPW) facilities during combat or contingency operations.

Chapter 1 7

j. Laundry operations. Laundry and dry cleaning operations are governed under AR 210–130, which does not address hygiene and sanitation controls. ATP 4–42 addresses field laundry. Chapter 10 of this publication provides the sanitary requirements for water-based (traditional laundry) and chemical-based (dry cleaning) laundry operations.

(1) Laundry operations should follow commercial laundry processes. Hot water and heated mechanical drying are the primary mechanisms used to destroy harmful microorganisms deposited on fabrics.

(2) Application of an antimicrobial agent is recommended for laundry with high potential levels of microorganisms, such as gym towels and athletic clothing, and linens from transient quarters, hospitals, refugee camps, disaster relief operations, prisons, and field operations.

(3) Garrison laundry operations that support medical facility linens, linen issue at troop barracks, or clothing issue through a central issue facility should be inspected at least once every 2 years. Tactical laundry systems are inspected at least once each month when in operation. Inspections of these types of laundry operations are documented on the DOEHRS survey tool, Laundry Dry Cleaning Report.

(4) Laundry rooms operated in other inspected facilities such as gyms, beauty shops, and troop barracks are evaluated at the time the facility is inspected; the findings are documented on the applicable facility inspection report.

k. Body art operations. Ear piercing is the only authorized body art operation on Army installations. Chapter 11 provides the recommended sanitary controls and discusses the hazards associated with other types of body art.

(1) Ear piercing operations that use disposable applicators are inspected at least once annually. More frequent inspections are required for facilities that are approved to use reusable applicators or sterile needles.

(2) DOEHRS does not support survey data entry for ear piercing operations. Operations occurring within a day spa or beauty shop are documented as specified in paragraph 1–9b. Inspection findings for independently-operated ear piercing concessions are summarized in an MFR, and a courtesy copy is provided to the concession manager and as specified in paragraph 1–10e.

l. Recreational waters. DA Pam 40–11 and TB MED 575 provide the sanitation controls and inspection requirements for recreational water facilities.

m. Food service operations. TB MED 530/NAVMED P-5010-1/AFMAN 48-147_IP provides the sanitation controls and inspection requirements for food establishments.

1–10. Report administration and distribution

a. The person who conducts the inspection signs the inspection forms. His or her signature signifies that a formal inspection was conducted and affirms that he or she discussed the findings and recommended corrective actions with the person in charge of the facility or the designated representative at the time of the inspection.

(1) Handwritten inspection forms are signed at the time of inspection by the inspector and the person in charge of the facility.

(2) At the conclusion of the inspection, the inspector digitally signs any electronic forms completed on a tablet or notebook during the inspection. A digital or capture signature on the form should also be obtained from the person in charge. Creating a capture signature on military electronic devices may require assistance from the installation or command information technology representative.

(3) When a Web-based DOEHRS survey is completed in real time during the inspection, the survey is stamped “complete” by the inspector at the conclusion of the inspection and prior to his/her departing the facility.

Stamping the report “complete” prevents further alteration of inspection findings and serves as the inspector’s formal signature.

(a) A capture signature from the person in charge should be obtained in the DOEHRS survey before the report is stamped “complete.” This digital feature requires the use of specific hardware and software tools that have been programmed to support DOEHRS. For additional information or questions regarding DOERHS, contact the APHC at commercial 410-436-4375; DSN 584-4375; or toll free at 1-800-222-9698, or visit the APHC Web site at http://phc.amedd.army.mil/Pages/Contact.aspx.

(b) In the absence of DOEHRS capture signature capability, the inspector may use an electronic or handwritten copy of the DOEHRS Sanitation – Signature/Receipt Form (for DOEHRS mobile). The signed document is scanned and uploaded to the inspected facility’s DOEHRS survey file.

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b. A copy of the completed inspection report is provided to the person in charge of the facility at the conclusion of the inspection. If the inspection document cannot be reproduced onsite at the time of the inspection, a hard copy or electronic portable document format (.pdf) file is provided within 36 hours.

c. Inspections documented in a memorandum do not require a signature from the person in charge. A copy of the completed memorandum should be provided to the inspected facility’s manager within 72 hours following completion of the inspection.

d. All handwritten and electronic inspection forms, and the memorandums that document inspections, are scanned as a .pdf file and uploaded to the appropriate DOEHRS survey file to complete the archived record.

e. Report distribution protocols are established locally. At a minimum, reports from facilities receiving a “Noncompliant/Unsatisfactory” inspection rating, to include all associated follow-up inspection reports, are forwarded to the facility manager if different from the person in charge. Additional distribution includes the following, as appropriate:

(1) The next higher level manager having facility management oversight. This individual may be an installation-level coordinator, general manager, or commander.

(2) The Army and Air Force Exchange Service (AAFES) Headquarters Staff Veterinarian, via organizational e-mail account at food-drug.safety@aafes.com.

(3) The Morale, Welfare, and Recreation (MWR) facility’s general manager, or the installation’s Director of Family Morale, Welfare, and Recreation.

(4) The applicable Contracting Officer’s Representative (COR).

1–11. Privatized operations

a. Privatized facilities located on Army installations and providing services to DOD beneficiaries comply with state and local laws and the sanitation standards presented in this publication.

b. In general, inspection responsibility rests with the installation medical authority and Preventive Medicine. In accordance with the lease agreement, either the installation has exclusive Federal jurisdiction for regulatory compliance, or there is concurrent jurisdiction between the installation Preventive Medicine and the state or local health department.

(1) Privatized operators maintain an appropriate state or local license to operate, as required by law.

(2) Lease agreements generally specify notification is required at least 24 hours in advance prior to conducting a facility inspection. An exception applies to public health and safety inspections, which may occur at any time without prior notice or coordination with the inspected facility. Unannounced public health assessments are permitted if the purpose/effectiveness of the assessment would be adversely affected by advance notice. Consult with the installation contracting officer and legal representative, as needed, in cases where there are conflicting interpretations of jurisdiction or authorization to conduct inspections at privatized facilities. Questions may also be directed to the ACSIM, Privatized Housing and Lodging Programs points of contact, at commercial 703-545-2537 or 703-697-3832.

(3) Public health inspections conducted by an agent of the privatized facility or contracted by the privatized facility through an external inspection agency may not be substituted for official sanitation and health inspections conducted by Preventive Medicine or a local health department.

c. Preventive Medicine inspection personnel collaborate with the local health department when there is concurrent jurisdiction. Collaboration is essential to maintain situational awareness and continuity of public health services.

(1) Establish a memorandum of understanding (MOU) among the medical authority, Preventive Medicine, and the local health department if the health department relinquishes its inspection responsibility to the installation medical authority. The MOU should—

(a) Include signatures from the installation commander, the medical authority or designated representative, and the State or local health department director or designated representative.

(b) Emphasize the authorization for inspection personnel to access facilities unannounced during normal business hours to conduct public health inspections.

(c) Outline the privatized facility manager’s responsibility to apply recommendations following an inspection to correct deficiencies that present a risk to public health. Violations are corrected at the time of

Chapter 1 9 inspection, or immediate actions are applied to reduce the risk associated with a critical violation when corrective action to resolve the critical condition cannot be achieved at the time of inspection. Corrective actions for all critical and noncritical violations should be achieved within 30 days.

(d) Provide guidance for formal actions, as described in subparagraph 1–6a(2), that should be taken to prevent recurrence of critical violations.

(2) Sanitation inspections conducted by the local health department are included as part of the official military record and are entered in DOEHRS as specified in paragraph 1–9a.

(3) Separate inspections conducted by Preventive Medicine are not required if the local health department conducts a sufficient number of inspections.

(a) Inspection records are shared between the state/local health department and Preventive Medicine.

(b) Preventive Medicine may participate in the inspection process by conducting independent or joint inspections when needed.

(c) Additional sanitation inspections conducted by the installation public health authority are recommended when the interval between health department inspections is deemed too lengthy. For example, food operations should be inspected at a frequency prescribed in TB MED 530/NAVMED P-5010-1/AFMAN 48-147_IP or commensurate with the operation’s Facility Risk Assessment Survey rating. Public swimming pools operated in privatized housing should be inspected weekly during peak season. Note: Swimming pools located at guest lodging facilities may be inspected monthly or less frequently if (1) an annual risk assessment is performed which indicates there are no critical water quality violations and (2) the facility manager or designee is conducting appropriate water quality monitoring.

d. When a rating of “Noncompliant” or “Unsatisfactory” is awarded, a follow-up inspection is scheduled and is documented on the original inspection report that was provided to the person in charge. Follow-up inspections are conducted to confirm that actions have been taken to correct critical violations.

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CHAPTER 2

BARBER AND BEAUTY OPERATIONS

Section I – GENERAL INFORMATION

2–1. Professional services Disciplines within the beauty profession include Barbering, Cosmetology, Esthetics (skin care), Manicuring (nail care; includes pedicure), and Electrology (hair removal using galvanic current or thermolysis, that is, shortwave/radio frequency [RF]).

a. Licensing.* Barber and beauty professional services are performed by an employee possessing a valid license and specialty certificate, where applicable (see table 2–1). Licensing is required for each of the disciplines specified above and is renewed IAW the licensing state’s provisions, typically every 2 years. Licensure and renewal requirements for each state are available online at http://www.beautyschool.com/guide/licensing.

(1) A certification in Barbering limits the barber’s activity to hair cutting and shaving and does not allow the performance of chemical hair treatments or other beauty services.

(2) A certification in Cosmetology encompasses hair cutting, styling, and chemical treatments; hair removal by waxing or tweezing; and may include basic nail services, such as trimming and polishing.

(3) Specialty branches within Cosmetology include Manicurist, Nail Technologist, Esthetician, and Electrologist. Each of these specialties requires specific licensing to perform the associated services.

(4) The threading technique for hair removal is not a standard Cosmetology procedure regulated through licensing. Threading is commonly practiced in Eastern countries, such as Egypt and India, and is typically passed down through the generations; formal training is not common. The sanitary controls presented in this chapter for threading operations are evaluated by Preventive Medicine when the service is provided on Army installations.

(5) Barber and beauty shops may not operate an apprenticeship program except as specified in paragraph 2–19b for deployment settings. Unlicensed individuals in a training status may not perform barbering or cosmetology services, regardless of whether the individuals are under the direct supervision of a licensed employee.

b. Preoperational inspection. A request to operate a barber or beauty service or to expand the scope of services at an existing facility is submitted at least 30 days prior to the intended start date.

(1) Submit requests to Preventive Medicine. Approval to begin requested services is contingent upon passing a preoperational inspection conducted by Preventive Medicine.

(2) Include the following information when submitting a request to operate or to add professional services:

(a) Name and location of the operation.

(b) Manager’s contact information: email (if available), business address, and work phone.

(c) List of services (as characterized in table 2–1).

(d) List of employees and job title. Identify all of the specialty services conducted by each employee.

(e) Employee licensure information. A copy of each employee’s license and applicable certificate(s) is not required as part of the service request process but must be available for review at the facility during the preoperational inspection. Employee licensing data includes the license type, the licensing source (the institution name and State or country), the date licensed, and the license expiration date. The organization sponsoring (or contracting) the beauty operation is responsible for the initial validation of employee licensure, which is conducted prior to the preoperational inspection. A valid, unexpired license for each employee is retained at each facility where the employee works.

c. Request to increase services. Increasing the scope of services at an existing facility requires the facility manager to submit a new service approval request through the Preventive Medicine (Environmental Health) office having inspection jurisdiction. The service request should identify the new category or service(s) being added to the

Chapter 2 12 operation, as well as the new and existing employees who are qualified to perform the service(s). The service request should also include a copy of the appropriate licensure or certification data for the identified employees.

d. Special services approval. The facility sponsor (for example, AAFES) or manager requests approval from Preventive Medicine to provide services that are not addressed in this chapter.

(1) The sponsor or facility manager is responsible for providing to the supporting Preventive Medicine office all relevant technical information regarding the device, treatment process, and its associated cosmetics or products.

(2) Before approving specialty services, Preventive Medicine assesses its ability to provide adequate public health oversight for the operation. A beauty operation risk assessment is conducted to determine if an adjustment to the inspection frequency is required due to the added service(s).

Table 2–1. Beauty services

Category† Service Description Licensing Requirement

A Hair cutting Cut, shave, shampoo, dry (heat application) Barber or Cosmetology license

B Hair removal Tweeze, pluck, wax, threading Note: Threading is not a licensed activity.

Cosmetology license

C Hair treatment Chemical hair treatments: straightening, braiding, weaving, coloring, permanents

Cosmetology license

D Nail treatment Manicure/pedicure, hand/foot baths, polish, trim, color, nail extensions, nail jewelry application

Cosmetology license and certification as a Nail Technician or Manicurist

E Skin treatment

Facials; skin wraps; makeup application; head, neck, shoulder, hand/foot massage; mud bath;

hand/foot paraffin wax

Cosmetology license and certification as an Esthetician or

Skin Care Specialist

F Spray tanning Application of a skin-coloring chemical

Cosmetology license and certification to perform spray tanning

G Massage Therapeutic/relax treatments involving whole body or select regions (arms, legs, shoulders, or back)

Massage Therapist license

H Ear piercing Piercing the fleshy portion of the earlobe Operator training certificate

I Water or heat spa

Facility contains a hot tub (spa), sauna room, or steam room for whole body treatment. Does not include foot baths and foot spas (see nail treatment).

The water spa operator must have a pool/spa operator training certificate IAW TB MED 575 for recreational water.

† Beauty services are grouped into nine categories for the purpose of conducting a facility risk assessment. Refer to appendix C.

2–2. Beauty operation hazards Barbering and beauty services present a wide variety of biological, chemical, and physical hazards. Although all hazards are considered during a public health inspection, greater emphasis is placed on the control of biological threats. Table 2–2 presents the hazards commonly associated with barbering and cosmetology services, collectively referred to as “beauty operations.”

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Table 2–2. Beauty operation hazards

Description Hazards1 (to patrons and/or employees) Risk Level2 Residual Risk

Controls Applied

HAIR WASHING

BH1. Physical: hot water (scalding) BH2. Biological: Communicable diseases: respiratory (tuberculosis); parasites (lice); bacterial (impetigo, staphylococci); and fungal (Tinea captis, scalp ringworm; Tinea barbae, face/neck ringworm)

Low

(E-II)

Low

HAIR CUTTING:

Trim/cut; shave

BH3. Physical: minor skin abrasions (nicks, cuts) BH4. Biological: bloodborne viruses (Hepatitis B, HIV) BH5. Communicable diseases: See BH2.

BH6. Chemical: minor skin irritations from unauthorized skin antiseptics or improper use of disinfectants

Moderate

(D-III)

Low

HAIR

TREATMENTS:

Coloring;

permanents;

weaving;

extensions;

straightening

BH7. Biological: See BH2 and BH4.

BH8. Physical: Skin burns due to improper use of beauty supplies…