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Home My WebLink About2003 Champion Factory - Camp - Permits - 12/5/2019 NUMBER COMMONWEALTH OF MASSACHUSETTS BHP-2003-0072 North Andover FEE Board of Health $50.00 The Champion Factory May 02,2003 ---------------------------------------------------------------------------------- ------------- NAME 595 Chickering Rd. NORTH ANDOVER, MA 01845 - ---------------------------------------------------------------------------------------- ADDRESS IS HEREBY GRANTED A Recreational Camp LICENSE Recreational Camp This permit is granted in conformity with the Statutes and ordinances relating thereto,and expires--------------August 23, 2003-------------_-unless sooner suspended or revoked. -------------------------- S ----------------- -- ------------------------ Board NOTES:Receipt#6893 ----------------------------------------------- of Dates of Operation: July 7th- August 22nd --- --------------------------------- - ------------------ Health Hours: 9-12 and 14 APPLICATION FOR A LICENSE TO CONDUCT A -220 RECREATIONAL CAMP FOR CHILDREN Name of Camp: —TV �cz rv� �Q Ci'a� M Cirv� Site Address: �J 5 r\ Site Telephone: ��Lg) E63 — 71/ 9 3 Name of Camp Owner: Office Address: SCL Telephone Number: S vr, Name of Camp Operator(if different): Address: Telephone Number: Na me of Health Care Consultant: Address: ' &n Ca c-A� \� / V A- Telephone Number: 6720 r1 Type of Camp: Day Residential Hours of Operation:Dates of Operation: Opening: �A tj Closing: Aj Swimming Pool: Yes Pool Permit Number No X Bathing Reach: Yes No Meals Provided: Yes Food Permit-Number No. /\ Signature of Applicant: Official Title: ?lQ S,' �„r\ Date: See the next page for a list of documents that must be completed and submitted before your application for a license can be fully processed. You are strongly encouraged to complete these documents as soon as possible and submit them in advance. This will expedite the licensing process. Required Documents See the MA Regulations for Minimum Standards for Recreational Camps for Children, State Sanitary Code, Chapter IV - 105 CMR 430.000 and the guidance documents issued by the Department of Public Health, Division of Community Sanitation for additional assistance with developing the following documents. ■ Staff information forms (see attached) ■ Procedures for the background review of staff(105 CMR 430.090) ■ Copy of promotional literature (105 CMR 430.190(C)) ■ Procedures for reporting suspected child abuse or neglect (105 CMR 430.093) ■ Health care policy (105 CMR 430.159(B)) • Discipiline policy (105 CNIR 430.i91) ■ Fire evacuation plan—approved by local fire department (105 CMR 430.210(A)) ■ Disaster plan (105 CMR 430.210(B)) ■ Lost camper plan(105 CMR 430.210(C)) ■ Lost swimmer plan (105 CMR 430.210(C)) ■ Traffic control plan (105 CMR 430.210(D)) ■ Day Camps—contingency plan (105 CMR 430.211) ■ Primitive, Trip or Travel Camps—Written itinerary, including sources of emergency care, and contingency plans (105 CMR 430.212) ■ Current certificate of occupancy from local building inspector(105 CMR 430.451) ■ Written statement of compliance from the local fire department(105 CMR 430.215) ■ If applying for initial license after January 1,2000—lab analysis of private water supply (if applicable) (105 CMR 430.300, .303) Please note: If you are applying for an original camp license, that is, the original camp license in each community where the camp is located, you must file a plan showing the following with the board of health at least 90 days before your desired opening date (See MGL Ch. 140 s. 32A): ■ Buildings, structures, fixtures and facilities ■ Proposed source of water supply ■ Works for disposal or sewage and waste water Camp Director Name: Age: a` 1 Coursework in camping administration: Previous camp administration experience: as my Ca', n I a 2- S Ca--,g -DI(oCir in tI-IOLGr- �Qe%\n Health Care Consultant Name: Type of Medical License (mu s �t b-e�a physician,nurse practitioner, or physician assistant ,/ with pediatric training): _ 1 1 � Qki c t a n MA License Number: Z4c- a-jQ- - o LQ- - Ste`S 4 - &-oA UY' Health Supervisor Name: Age: Type of Medical License, Registration or Training (See 105 CMR 430.159(C): Aquatics Director Name: Age: Lifeguard Certificate issued by: Expiration date: American Red Cross CPR Certificate: Expiration date;• American First Aid Certificate: Expiration date: Previous aquatics supervisory experience: Firearms Instructor Name: National Rifle Association Instructor's card(or equivalent): Date certified: Expiration date: Horseback Riding Instructor Name: License Number: Expiration date: Stable Location: Licensed in accordance with MGL Ch.I 11 § 155, 158: Yes No Attach the names, ages, applicable current certifications (if any), such as First Aid, and the anticipated role at the camp of all supervisory staff(see below). Use as many pages as necessary to complete this. Supervisory staff means those persons'with the responsibility, authority and training to provide direct supervision to camper groups. This may include counselors,junior counselors, general activity leaders or other staff who provide supervision to campers without assistance. Brian Veth, Camp Director 29 years old. First Aid Certified Tina Veth, Health Care Supervisor, 27 years old, Registered Nurse Ellie Parnes, Instructor, 22 years old Amanda Hunter, Instructor, 19 years old, taking CPR & First Aid in early June Courtney Babin, Instuctor, 19 years old, taking CPR & First Aid in early June TOWN, OF NORTH ANDOV R o r� BOARD OF HEALTH Location Permit Food Service $ Retail Food $ Limited Retail $ Seasonal $ i Disposal Works Installers $ j Disposal Works Construction $ { Soil Testing $ _ i Design Approval Permit $ Dumpster Permit $ Burial Permit $ _ 1 Swimming Pool Permit $ Animal Permit $ 1 Recreational Camp Permit $ 1 Well Construction Permit $ Funeral Directors Permit $ I Massage Establishment License $ I Massage Practice License $ _ Suntanning Establishment $ Offal/Trash Hauler $ Other $ Health Agent White - Applicant Yellow - Dept. Pink - Treasurer Department of Public Health Division of Community Sanitation STATE SANITARY CODE: CHAPTER IV, MINIMUM SANITATION AND SAFETY STANDARDS FOR RECREATIONAL CAMPS FOR CHILDREN, 105 CMR 430.000 R REATIONAL CA P FOR CHILDREN I PPC ION EPORT NAME OF CAM ADDRES : (' 1 NER/OPE R: OFF SEASO�� ci ADDRESS: CAMP DIRECTOR: INSPECTED B TYPE OF CAMP: (Circle) WATER DATE OF INSPECTION: Day Residential SOURCE: (Sport/NoSport) CAMPER Trip Primitive Travel CAPACITY: "No"column = "�" marked below indicates a violation of 430.000. "Yes" column= "�"marked below indicates compliance with provision of 430.000. "N/A"column = "-l"marked below indicates that the provision of 430.000 is not applicable to this camp. Regulation Yes No N/A Comments Permits .451 Current Certificate(s)of Occupancy from local building inspector for sleeping/assembly areas. .215 Written compliance from local fire dept. .300(A)(2)(a) Private water supply- DEP approval (>25 people, >60 days r) 1� .300(A)(2)(b) Private water supply- BOH approval and chemical and bacterial analyses <25 people, <60da s/ r Plans and Policies- Written .090(A) Procedures for background review of staff and volunteers. 090(C) CORI and SORI , previous work history, 3 references, out of state/international criminal back round checks for staff and volunteers .091 Staff and volunteer orientation plan and review. .093 Abuse and neglect prevention/reporting procedures. I� .191(B)(C) Discipline Policy with: appropriate discipline methods and prohibitions. .210 A Fire evacuation plan and drills .210 B Disaster Plan ✓'-' .210 C Lost Camper Plan .210 C Lost Swimmer Plan lam^ .210 D Traffic Control Plan Contingency plans- Day Camp: .211 A Camper doesn't show up for day !� B Camper doesn't show up at point of pick u C Child not registered arrives Contingency plans-Primitive, Travel and Trip: ✓" .212 (A) Itinerary daily-copy to parents B Source of emergency care .190 Camper released only to parents or parent- designated individual in writing. Other plan approved in writing by BOH. Regulation Yes No N/A Comments Promotional literature/packet contains: .159(B)(2) Copy of policy re: care of mildly ill campers, administration of meds and emergency health care provision. 190(C) Statement re: regulatory compliance and licensing. .190(D) Inform parents of right to review background check, health care, discipline policies and grievance procedures upon request. Transportation .250 Vehicle must comply with MGLc.90 s7B&7D: <14 passengers AND driver is camp coach, director,etc. private vehicles may be used. >14 passengers,vehicle must be school bus All vehicles must be RMV compliant .253 Proper automobile insurance .251 Seatbelts must be worn and special needs of cam ers communicated to driver 2� .251 Camper<7yrs not transported longer than 1 hr to cam Staff Qualifications Camp Director .102(A) Residential Camp: 25 yrs, completed course in camp administration or at least 2 seasons ex erience. J/ .102(B) Day Camp: 21 yrs, completed camp administration course or 2 seasons experience. ✓� .102(C) Primitive, Travel, Trip: 21 yrs and proof of ex erience. �'^ .102(D) Designated substitute when director off-site >12 hrs. Sub must meet criteria above) Counselors/Junior Counselors .100 Day Camp, non-sport: Counselor= 16 yrs. Junior Counselor-- 15 yrs. V .100 Other camps: Counselors= 18 yrs or graduated from high school. Junior Counselors= 16 yrs .100 All counselors 3 yrs older than campers ✓ Required Counselor Ratios .101(A) Residential and Day Camps: 1 staff per 10 kids over 6 yrs 1 staff per 5 campers 6 yrs and under .101(B) Primitive,Travel, Trip: 1 counselor per 10 campers. 2 counselor min. ✓� .101(C) Special Needs: 1 counselor per 4 mildly disabled campers 1 counselor per 2 severely disabled campers Regulation Yes No N/A Comments .103 Aquatics Director: Name: None American Red Cross Lifeguard Trng cert., CPR for Professional Rescuer and First Aid Cert. or their equivalents. If supervise 2 staff, 21 yrs and experience w/mana ement .103 Lifeguard:American Red Cross Lifeguard Trng cert., CPR for Professional Rescuer cert. and First Aid Cert. or their equivalents. List names. .103 Certifications for other high-risk activities, eg: NRA instructor certification for firearms. List Names and Certifications: .252 Camp vehicle drivers: 18yrs, 2yrs driving experience, current license for type of vehicle First Aid certified if no other trained staff aboard. Medical Personnel/Records/Facilities .159(A) Health Care Consultant ;,� _ ,-Y MD .NP PA(w/pediatric training) Check for Health Care Consultant Agreement .159(C) Health Supervisor(on site at all times) Name: 18yrs, First Aid-and CPR certified OR, MD PA Nl ,, PN .1 59 B Health Care olic .1 60 A Medication stored in original containers. .160(B) Meds stored in secured cabinet and if necessary refrigerated in affixed box. .1 60(C) Medication administered by Health Supervisor .154 Injury Reports completed for fatality or serious in'u . Co y sent to MDPH. 155 Medical log book-bound, pre-numbered pages, ink entries, no skipped lines. 161(A) Infirmary provided-day and resident.camps Exterior li ht- resident. camps .453 Lighting rovided in infirmary .161 B Area for isolation of ill child .161(C) First Aid Kit: non-perfumed soap, sterile gauze squares, compresses, adhesive tape, bandage scissors, triangular and rolled bandages, CPR mask, tweezers, cold pack, gloves. .150 Health record for each camper and staff: -emergency contact info -camper<18 yrs must have written parental permission for meds and emergency care. Residential, Sport,Travel/Trip: Health History, Physical Exam(: 2yrs) Record of Immunizations(noted below) Day Camp Non-Sport: Health History, Record of Immunizations(noted below r Yes No N/A Comments Regulation Immunizations: .152(A) Campers and staff under 18yrs: Number of records checked: MMR: 1st dose = 12 mos or older, Measles: 2"d dose=grades K-12 or age equiv Polio: 3 doses IPV or OPV, or 4 doses mix IPV/OPV Diphtheria and Tetanus Toxoids and Pertussis*: 4 doses DTaP/DTP/DT or, 3 doses of Td (persons 7 yrs or older needing additional vaccines to comply with above, Td is to be used) *Booster dose of Td: -grades 7-10 need booster if>5yrs since last dose of DTaP/DTP/DT -grades 11-12 need booster if more than 10 yrs since last dose of DTaP/DTP/DT/Td Hep B: 3 doses if born on or after 1/1/92 .152(B) Campers and staff 18 yrs.or older: Number of records Measles: 2 doses(exempt if born before 1957) checked: Mumps: 1 dose (exempt if born before 1957) Rubella: 1 dose (exempt if born before 1957) Diphtheria and Tetanus Toxoids*: 3 doses DTaP/DTP/DT/Td 'Booster dose of Td required if more than 10 yrs since last dose. Activities .190 Activities and physical environment meet the needs of campers; do not pose hazard to health/safety. .163 Operator encourages sun protection for all. Aquatics .430 Swimming Pool: in compliance with 105 CMR 435.00- ermit posted. .204(B) Bathing Beach: in compliance with 105 CMR 445.00-weekly water sampling conducted. .103 Proper supervision at swimming venue: 1 lifeguard per 25 campers 1 counselor per 10 campers Plan to check swimmers-"buddy system" .204(C) Swim test to classify swimmers by ability. .204(A) Swimming areas clean and safe, no swimming at undesi nated sites or at night without lighting. .204E Piers and floats in good repair. .204(G) Watercraft: equipped with US Coast Guard approved flotation devices and worn by all campers and staff participating in watercraft activities. Regulation Yes No N/A Comments Aquatics cont'd .204(H) Campers must be certified by American Red Cross or equivalent for white water, hazardous salt or fresh water activities. .103(C) Minimum 2 counselors in separate watercraft supervising white water, hazardous salt or fresh water activities. Craft .205 Equipment in good repair, safety precautions taken. Playground/Athletic Equipment .206 Equipment properly maintained,fields/surfaces free of holes/accident hazards .206 Playground equipment secure, no concrete under/around it, pliable swing seats. Firearms .201 Single shot rifles only. .201 Shooting range away from other activity areas .201 Firearms in good condition, stored in locked cabinet. Ammunition locked in separate cabinet. Archery .202 Equipment in good condition, stored in locked area. .202 Range away from other activity areas, clearly marked as danger area. Must have common firing line and 25 yards clearance behind each target. 203 No personal weapons, bows, rifles allowed. Horseback Riding .208(A) 1 certified instructor per 10 campers(Min.2 counselors .208(A) Riders must wear hard hat 208 B Licensed stable Cabins/Structures: .457 Day Camp provide shelter for on-going camp activities. .216 Smoke detectors provided. .455/.456 Egresses comply with Bldg.Code and are free from obstruction .453 Lighting rovided for stairways .454 Floors maintained. Reside tial Camps/Sleeping Areas: .458 Provide adequate space: 40sgft/person in single bed 35sgft/person in bunk bed 50sgft/person in sleeping area requiring special equipment .470 Provide bed/cot per person with 6 feet between sleeper's heads and: 3 feet between single beds/41n feet between bunks Regulation Yes No N/A Comments Residential Camps/Sleeping Areas: .459 Campers and staff with limited mobility housed on ground level; egresses leading to grade or ramp provided. .452 Screens provided. Screen door self-closing. .454 Floors maintained. Tents: .217 Fire-retardant and non-toxic. No open flame nearby. .458 35 sgft/person in bunk bed Toilets/Showers .360 Proper sewage disposal .301 Plumbing in good working order .370 Adequate#of toilets: All camps: 2 toilets/privy seats for each sex Day Camp:>60 of one sex, provide 1 additional toilet per every 30 people of that sex. Non-Day Camp:>20 of one sex, provide 1 additional toilet per every 10 people of that sex. .372 Toilet less than 200 feet from sleeping rooms.Toilet paper provided.Windows/ openings screened. Screen doors self-closing. .373 Adequate#of sinks: Day Camp: 1 per every 30 people Residential Camp: 1 per every 30 .374 Adequate#of showers(residential camp): 1 shower/tub per 20 people .378/.380 Special needs campers provided facilities that meet their needs .453 Lighting rovided. .375 Toilets and shower rooms ventilated to outdoors .376 Hot water at sinks, showers/tubs not more than 112°F. .377 Sanitary facilities maintained in clean condition. Shower room floors washed daily. Laundry .162 Residential Camp: laundry facilities provided .472 Bedding and towels laundered; no common towels Grounds: .300 Potable water provided. .300/.304 Adequate and centralized drinking water facilities. No common drinking cups. .209 Telephone readily available with#s of HCC, EMS, police, fire. (Day and Residential Camps only) .213 Emerqency communications stem. .165 Tobacco use restricted to designated areas not accessible to campers. .350/.355 Proper storage and disposal of solid waste Regulation Yes No N/A Comments .207 Proper storage and operation of power equipment. .214 Flammable and hazardous materials labeled and stored in locked unoccupied building. .400 Rodent and insect control. .401 Weed and noxious plant control. .450 Site location does not cause undue traffic hazards and is accessible at all times. Food Service .320 Food service in compliance with 105 CMR 590.000, Minimum Standards for Food Establishments. Permit posted in food service facility. .330 Nutritious meals that include a variety of foods served. Menus posted. .331 Residential camps—Provide at least three nutritious meals. Foods must meet Recommended Dietary Allowances RDA .332 Day camps—Each meal provided must meet 1/3 of the RDA requirements. .334 Adequately trained staff and equipment provided to ensure handicapped campers are eating nutritious meals. .335 Proper methods for storing meals brought from home. Meals provided to campers who arrive without a bag lunch. .452 Screening provided for food preparation and food service areas. Screen doors must be self- closing. .453 Lighting rovided in kitchen and dining area. .471 Sleeping rohibited in food areas. REGULATION NO. THE SPACE BELOW DESCRIBES VIOLATIONS MARKED ABOVE Champ Camp Policies and Procedures 2003 Summer Camp 595 Chickering Rd North Andover, MA 01845 (978) 683-8493 414 Health Care Policy Health Care Consultant: Dr. Barnett 122 Lancaster W 11U . jo Je M (978) 686-2763 Health Care Supervisor Tina V. Veth, R.N. 655 West Lowell Ave #20 Haverhill, MA 01832 (978) 521-6987 Emergency Phone Numbers: All general emergencies - 911 Fire - 688-9590 Police - 683-3168 Ambulance - 911 Poison Control Center - 1-800-682-9211 Animal Control - 683-3168 Hospital utilized for emergencies: Lawrence General Hospital 1 General St. Lawrence, MA 01841 683-4000 OR Holy Family 70 East St. Methuen, MA 01844 (978) 687-0151 Emergency Procedures In the event of an emergency, the following procedures will be followed: 1. Camp Director and Staff members will clear the area away from the injured person. 2. Health Care Supervisor will assess the condition of the camper. 3. If a head or neck injury is suspected, care will be taken to not move the camper. 4. Camp Director will get emergency medical help by calling 911. 5. If camper is not breathing, Health Care Supervisor will begin CPR. 6. Camp Director will try every available contact number to reach the camper's parent/guardian. Procedures for Utilizing First Aid Equipment 1. Location of First Aid Kit The First Aid Kit will be located in the office. 2. Location of First Aid Manual The First Aid Manual will also be kept in the office. 3. First Aid is administered by All first aid will be administered by the Health Care Supervisor, Tina Veth, R.N. 4. First Aid Kit is maintained by The First Aid Kit will be maintained by the Camp Director, Brian Veth 5. Contents of First Aid Kit The First Aid Kit will contain the following: Band-Aids Hydrogen Peroxide Bacitracin 2X2's Paper Tape Ace Wraps Emergency Ice Packs Plan for Injury Prevention and Management The gym will be inspected for hazards and dangerous or faulty equipment each morning by the Camp Director prior to the campers arrival. Faulty equipment will be repaired or replaced before campers are allowed to use the equipment. If the faulty equipment cannot be repaired or replaced, that piece of equipment will have a sign prohibiting campers from using that equipment. In addition to the daily inspection for hazards by the Camp Director, staff members will visually check each piece of equipment to be used by the campers throughout the day. Any hazards that are found will be reported to, and handled by the Camp Director. Prnreriiires for Reporting Serious Injury, Hospitalization, and Death of a Camper or Staff Member to Department of Public Health In the event of a serious injury, hospitalization or death of a camper or staff member, the following procedures will be followed: 1. Camp Director will follow the Emergency Procedures described elsewhere in this Health Care Policy until the situation is resolved. 2. Camp Director will fill out an injury report form. 3. Camp Director make multiple copies of the injury report form and mail one copy to the Department of Public Health. 4. Camp Director will keep one copy on file at the location of the camp. Procedure for Informing Parents When First Aid is Administered to Their Child All first aid administered will be recorded in ink in the medical log book,to be kept in the office during the day. At the time of pick up, the Camp Director will have the medical log book to ensure that all parents are informed of the first aid administered to their child that day. Parents will be asked to sign the medical log book as acknowledgement of the fact they were informed of the first aid administered to their child. The medical log book, as well as all staff members will be available for parents who may want more information on the first aid administered to their child that day. Plan for Infection Control TREAT ALL INCIDENTS AS IF THERE IS AN INFECTIOUS DISEASE Handwashing - Handwashing is the single most effective method in stopping the transmission of contagious diseases. Procedure for the Clean Up of Blood Spills A Blood-Spill Kit will be kept in the office. The Blood-Spill Kit will contain the following equipment: Biohazard Red Bags Disposable gloves Paper Towels Fresh Solution of Bleach (1:10) Bleach: Common household bleach will be diluted 1:10 (1 part bleach, 9 parts tap water) Procedure: 1. Take equipment to area of spill. 2. Put on disposable gloves. 3. Pour or spray disinfectant on area to be decontaminated. 4. Allow one minute. 5. Clean up with damp paper towels. 6. Repeat as necessary. 7. Place everything in Red Biohazard Bag. 8. Remove gloves in such a way as to prevent touching the exterior of the gloves with your bare hands. 9. Discard the gloves into the Biohazard Bag. 10. Wash hands. 11. Look at area to make sure it is clean. Emergency Plan for Evacuation of Facility 1. Evacuation Plans are posted next to each exit. 2. Staff members will lead campers out the safest exit and gather on the side of the building. 3. The Camp Director will grab the attendance book and check for any campers that may have been separated from the group. 4. The Camp Director will do a roll call to ensure all campers are safe and accounted for. 5. Fire drills will be conducted on the first day of each camping week. 6. The Camp Director will keep records of each of the fire drills noting the date, time and effectiveness of each fire drill. Plan for Administering Medication All medications will be kept in a locked safe in the office. Medications prescribed for campers shall be kept in original containers bearing the pharmacy label, showing the date of filling, pharmacist's initials, serial number of the prescription, name of the patient, name of the prescribing physician, name of prescribed medication, directions for use, and if tablets or capsules, the number in the container. All over the counter medications for campers shall be kept in the original containers containing the original label, which shall include directions for use. Medication will only be administered by the parent in the presence of the Health Care Supervisor. Medication prescribed for campers brought from home shall only be administered if it is from the original container, and there is a parent/guardian to administer it. Plan for Returning or Destroying Unused Medication When no longer needed, or at the end of the campers stay at the camp, medications shall be returned to a parent/guardian whenever possible. If the medication cannot be returned, it shall be destroyed as follows: Medication shall be destroyed by the Health Care Consultant, witnessed by a second person and recorded in a log maintained by the camp for this purpose. The log entry will include the following information: the name of the camper, the name of the medication, the quantity of medication destroyed, and the date and method of destruction. The Health Care Consultant and the witness shall sign each entry in the medication destruction log. Plan for the Care of Mildly III Campers In the event that a camper becomes mildly ill, to the point that the camper cannot participate in the program, the camper's parent/guardian shall be notified. All available contact numbers shall be tried in order to contact the parent/guardian. The parent/guardian will be asked to bring the child home for the remainder of the day. Procedures for Identifying and Protecting Campers with Emergency Medical Information In the case of a camper with emergency medical information, all staff members will be made aware of all symptoms, and procedures to follow in the event of any emergency for that camper. Exclusion Policy for Serious Illnesses and Contagious Diseases Campers may be excluded from camp if any of the following criteria are not met: 1. A camper with an elevated temperature must return to a normal body temperature for at least 24 hours before returning to camp. 2. A camper with a rash must have a note from a doctor regarding the diagnosis and whether the rash is contagious or not. 3. A camper with head lice must be nit free before returning to camp. 4. A camper with a known medical condition which could affect their level of consciousness; ie, seizure disorders, CHD must have a note from their doctor with medical clearance. Procedures for the Background Review of Staff MR c.105 CMR 430.090 Employment Background Information (A) The operator shall develop and follow written procedures for the review of the background of each staff person who may have unsupervised contact with a camper. The Camp Director will review all staff. This will include checking former employers, contacting references, conducting a CORI and a SORI check for each prospective staff member. The Camp Director will require that all staff members be CPR and First-Aid certified. If the prospective staff member meets all of the requirements above, they will be given an interview for employment Contingency Plans MR c.105 CMR 430 2115pedal Contingency Plans for Day Camps Day camp operators,shall set forth procedures to be followed in dealing with the following contingencies (A)Children who are registered and on the camp roll but fail to arrive for a given days activities (B)Children who fail to arrive at the point of pickup following a given days activities (C)Children who appear at camp without ha ving registered and without prior notification. (A) Camper who is registered and fails to arrive for the day's activities: -The Camp Director will double check the attendance and the camper's registration form to ensure the camper should indeed be in attendance. Parents will be contacted using all available contact numbers. (B) Camper who is missing from the point-of-pickup at the end of the day: -Camp Director will double check attendance and roll call. Camp Director will check the office to see if the camper was picked up early. —If these aren't successful, we will follow lost camper plan. (C) Unregistered camper arriving at camp: -Staff will try to get child's parents if still on site. If the parent has left or cannot be found, staff will try to identify who the child arrived with. -Staff will call the child's parent if the phone number can be obtained. Disaster Plan N1GL c. 105 CMR 430.210(B)Disaster Plan (B)Each camp shall have a written disaster plan at the campsite. All campers and staff shall be advised of the procedures contained in the plan. Arrangements for transporting individuals from the camp to emergency facilities shall be included in the plan. In the event of a natural disaster, the following steps will be taken: 1. A whistle located at the Camp Director's desk will be blown to notify all campers and staff of an emergency. 2. Staff will bring campers to the middle of the gym floor and the Camp Director will do an attendance check to ensure all campers are present. 3. Instructions will be given to staff members at this point. Tornado In the event of a tornado, the initial steps will be taken to ensure all campers are present. Staff members will ask the campers to move to the back corner of the gym while the Camp Director checks all doors and windows. Li htnin In the event of lightning, the initial steps will be taken to ensure that all campers are inside the building and present. The phone will not be used except in the event of an emergency. Fire Evacuation Plan MR c. 105 CMR 430.210(A)Fire Drills (A)Fire drills shall be held within the first 24 hours of the beginning of each camping session. The fire evacuation plan shall be in writing and approved by the local fire department. The plan shall indicate the frequency of fire drills to be held during the camping season. Fire drills will be conducted on the first day of each camping week. The maximum number of students will be twelve. There will be three staff. There is an exit at each end of the gym. These exits will remain free of obstructions. A whistle that is kept at the Camp Director's desk will notify campers and staff in the event of afire. The Fire Department will be called or in the case of an emergency evacuation, the fire alarm (one at each door) will be pulled on the way out. The staff and campers will gather in the grassy area on the side of the building. An attendance check will be conducted to ensure all campers are present. In the event of a fire the Camp Director will sound an alarm and alert staff of the fire, the gym will be evacuated closing all doors. The Fire Department will be contacted and given the following info: Building name and address Nearest cross street — Salem and Abbott Location of the fire in the building Any known info about the fire Lost Camper Plan MGL c. 105 CMR 430.210(C)Lost Camper Plan -(C)A written lost camper plan shall be formulated and kept on file. All staff shall be trained in the procedures contained in these plans As soon as it is discovered that a camper is missing the staff will report the following to the Camp Director: Camper's name and age Last place the camper was seen What the camper was wearing The staff will then conduct a search of the main gym and bathroom. The Camp Director will gather the campers in the middle of the floor and do an accurate head count. One staff member will go out the front door, and one will go out the back door in search of the missing camper. The Camp Director shall check office records to determine if the camper was picked up by parents or made other such arrangements. If not, the parents will be contacted to determine if the camper was picked up without notifying the office. If not immediately found Police will be notified. The search will continue until all campers are accounted for. Protecting Campers from the Sun The Camp Director and all staff members will encourage the use of sunscreen with a solar protection factor of 15 or greater. The Camp Director and all staff members will also encourage the use of hats, long sleeve shirts and pants should we decide to be in the sun for an extended period of time. Procedures for reporting suspected child abuse or neglect MR c.105 CMR 430.093 Prevention of Abuse and Neglect (A) The operator shall have procedures in place which protect campers from abuse and neglect while in the camp'5 care and custody. (B) The operator shall develop and follow written procedures for reporting of any suspected incidents of child abuse and neglect in accordance with procedures described in MGL c. 119 section 5 M In the event that a staff member suspects child abuse or neglect, the Camp Director will be notified immediately. The Camp Director shall contact the Massachusetts Department of Social Services. The Camp Director shall contact the Board of Health if a 51 A report is filed. The Camp Director will assist in any way possible with an official investigation. STAFF ORIENTATION Agenda: 1. Discuss camp philosophy 2. Discuss health care policy 3. Discuss all policies and procedures 4. Discuss parents rights to request copies of background checks, health care and discipline policies and procedures for filing grievances. 5. Practice fire drill 6. Review CPR and First-Aid Procedures 7. Review and practice gymnastics spotting skills 8. Discuss Arts & Crafts projects for the summer Camp Philosophy To promote health and well-being through gymnastics in a safe, fun, and engaging environment. Gymnastics - Skills being taught as well as equipment will be age appropriate. Skills should be at a level where children can succeed, but still be challenged. Arts &Crafts - Projects will be age-appropriate,to be completed with care and safety. Every camper should get to bring something that he or she is proud of at the end of the week. Learning Activity- Activities shall be relevant to the world going on around them. The general concept is more important than specifics, as this is not school Traffic Control Plan ME c.105 CMR 430.210(D) Traffic Control A written plan relating to the control of the movement of vehicular traffic through the camp shall be on file. Parents will be reminded to drop off and pick up in the rear of the building where there is much less traffic. Parents are required to walk their child into the building thus reducing the number of kids alone in the parking lot. Parents are also reminded to come into the building to pick up their child from camp. Signed on this c2 day of 2003 Dr. Barnett `i t1 IV Name of City or TownO®� STATE SANITARY CODE: CHAPTER IV, MINIMUM SANITATION AND SAFETY STANDARDS FOR RECREATIONAL CAMPS FOR CHILDREN, 105 CMR 430.000 NAME OF CAM ° ADDRESS: ' OWOERATOR: OFF SEASON V)ao Uh ADDRESS: � CAMP DIRECTOR: INSPECTED BY I-EYPE OF CAMP: (Circle) WATER _ DATE OF INSPECTI N: QW Residential SOURCE: (Sp oSport) CAMPER e (Y Trip Primitive Travel CAPACITY: ` �O�x * "No"column = `� ' marked below indicates a violation of 430.000. "Yes"column = marked below indicates compliance with provision of 430.000. "N/A" column = marked below indicates that the provision of 430.000 is not applicable to this camp. Permits .451 Current Certificate(s)of Occupancy from local 7 buildin in ector for sleeping/assembly areas. .215 Written compliance from local fire dept. .300(A)(2)(a) Private water supply- DEP approval (>25 people, >60 da s/ r .300(A)(2)(b) Private water supply- BOH approval and chemical and bacterial analyses <25 peo le, <60da s Plans and Policies-Written .090(A) Procedures for background review of staff and volunteers. .090(C) CORI and SORI , previous work history, 3 references, out of state/international criminal background checks for staff and volunteers .091 Staff orientation plan. Reviewed with all. .. .093 Abuse and neglect prevention/reporting procedures. .191(13)(C) Discipline Policy with: appropriate discipline methods and prohibitions. .210 A Fire evacuation plan and drills .210 B Disaster Plan .210 C Lost Camper Plan .210 C Lost Swimmer Plan L-- .210 D Traffic Control Plan Contingency plans- Da Cam : f .211 A Camper doesn't show up for day B Camper doesn't show up at point of pick u C Child not registered arrives Contingency plans- Primitive, Travel and Trip: .212 A Itinerary daily-copy to parents B Source of emergency care .190 Camper released only to parents or parent- designated individual in writing. Other plan approved in writing by BOH. ,...la '.<'�.�'�I �Y.� �'�r.S '�CS-..R f ✓�, .n ' ��31� 1`dY p -•'i �.. �{ � ♦.r Promotional literature/packet contains: 715 9(B)((2) Copy of policy re: care of mildly ill campers, administration of meds and emergency health care provision. 190(C) Statement re: regulatory compliance and licensing. .190(D) Inform parents of right to review background check, health care, discipline policies and grievance procedures upon request. Transportation .250 Vehicle must comply with MGLc.90 s7B&7D: <14 passengers AND driver is camp coach, director,etc. private vehicles may be used. >14 passengers, vehicle must be school bus All vehicles must be RMV compliant .253 Proper automobile insurance .251 Seatbelts must be wom and special needs of campers communicated to driver l .251 Camper<7yrs not transported longer than 1 hr to cam Staff Qualifications Camp Director .102(A) Residential Camp: 25 yrs, completed course in camp administration or at least 2 seasons experience. .102(B) Day Camp: 21 yrs, completed camp administration course or 2 seasons experience. .102(C) Primitive, Travel, Trip: 21 yrs and proof of experience. .102(D) Designated substitute when director off-site r i3 >12 hrs. Sub must meet criteria above) Counselors/Junior Counselors .100 Day Camp, non-sport: Counselor-- 16 yrs. Junior Counselo - 15 yrs. .100 Other camps: Counselors= 18 yrs or graduated from high school. Junior Counselors= 16 yrs .100 All counselors 3 yrs older than campers Required Counselor Ratios .101(A) Residential and Day Camps: 1 staff per 10 kids over 6 yrs 1 staff per 5 campers 6 yrs and under .101(B) Primitive,Travel, Trip: 1 counselor per 10 campers.2 counselor min. .101(C) Special Needs: 1 counselor per 4 mildly disabled campers 1 counselor per 2 severely disabled campers a .103 Aquatics Director: Name: 21 yrs, American Red Cross Lifeguard Trng cert., CPR for Professional Rescuer and First Aid Cert. or their equivalents. Experience w/mana ement if supervise 2 staff. .103 Lifeguard: American Red Cross Lifeguard Tmg cert., CPR for Professional Rescuer cert. and First Aid Cert. or their equivalents. List names. .103 Certifications for other high-risk activities, eg: NRA instructor certification for firearms. List Names and Certifications: {/ .252 Camp vehicle drivers: 18yrs, 2yrs driving experience, current license for type of vehicle First Aid certified if no other trained staff aboard. Medical Personnel/Records/Facilities .159(A) Health Care Consultant f.e NP PA(w/pediatric training) Check for Health Care Consultant Agreement .159(C) Health Supervisor(on site at all times) Name:\,,",_ i 18yrs, First Aid and CPR certified OR, MD PA NP_.RN LPN .1 59 B Health Care Policy .160 Proper storage of medication .160 Medication administered by Health Supervisor or licensed medical professional .154 Injury Reports completed for fatality or serious injury. Copy sent to MDPH. .1 60 A Medications stored in original containers. .160(B) Meds stored in secured cabinet and if necessary refrigerated in affixed box. .155 Medical log book-bound, pre-numbered pages, .- ink entries, no skipped lines. .161(A) Infirmary provided-day and resident.camps Exterior light- resident. cams .453 Lighting rovided in infirmary .161 B Area for isolation of ill child .161(C) First Aid Kit: non-perfumed soap,sterile gauze squares, compresses, adhesive tape, bandage scissors, triangular and rolled bandages, CPR mask, tweezers, cold pack, gloves. .150 Health record for each camper and staff: -emergency contact info -camper<18 yrs must have written parental permission for meds and emergency care. •F,?'4 xw •,. Immunizations: .152(A) Campers and staff under 18yrs: Number of records MMR: 1s` dose = 12 mos or older, checked: _ Measles: 2Iddose=grades K-12 or age equiv Polio: 3 doses OPV or IPV, or 4 doses mix IPV and OPV Diptheria and Tetanus Toxoids and Pertussis*: 4 doses DTaP/DTP/DT *Booster dose of Td required if more than 10 yrs since last dose. He B: 3 doses if bom on or after 1/1/92 .152(B) Campers and staff over 18yrs: Number of records Measles: 2 doses(exempt if bom before 1957) checked: Mumps: 1 dose (exempt if bom before 1957) Rubella: 1 dose Diptheria and Tetanus Toxoids*: 3 doses DT/Td *Booster dose of Td required if more than 10 yrs since last dose. Activities .190 Activities and physical environment meet the needs of campers; do not pose hazard to health/safety. .163 Operator encourages sun protection for all. A uatics .430 Swimming Pool: in compliance with 105 CMR 411445.00 35.00- ermit osted. .432athing Beach: in compliance with 105 CMR -weeklywater sampling conducted. .103roper supervision at swimming venue: lifeguard per 25 campers counselor per 10 campers an to check swimmers-"buddy system" .204(B) Swim test to classify swimmers by ability. .204(A) Swimming areas clean and safe, no swimming at undesi nated sites or at night without lighting. L _- .204 E Piers and floats in good repair. �- .204(G) Watercraft: equipped with US Coast Guard approved flotation devices and worn by all campers and staff participating in watercraft activities. .204(H) Campers must be certified by American Red Cross or equivalent for white water, hazardous salt or fresh water activities. .103(C) Minimum 2 counselors in separate watercraft supervising white water, hazardous salt or fresh water activities. -v{i�oe;.<. {d4dxx.�-i3?ar - .. _k; : ,.k•.,...:.., 4rt,... a$s:�r, a•AaX ,3.3ck_-;..,. .: . .,:�::,r.N .f:i tid Crafts .205 Equipment in good repair, safety precautions taken. Playground/Athletic Equipment .206 Equipment properly maintained, fields/surfaces free of holes/accident hazards .206 Playground equipment secure, no concrete under/around it, pliable swing seats. Firearms .201 Single shot rifles only. r .201 Shooting range away from other activity areas .201 Firearms in good condition, stored in locked cabinet. Ammunition locked in separate cabinet. l Archery .202 Equipment in good condition, stored in locked area. .202 Range away from other activity areas, clearly marked as danger area. Must have common firing line and 25 yards clearance behind each target. .203 No personal weapons, bows, rifles allowed. Horseback Ridin ✓ .103(G) 1 certified instructor per 10 campers (Min.2 counselors .103 G Riders must wear hard hat .103 G Licensed stable Cabins/Structures: .457 Day Camp provide shelter for on-going camp , activities. v .216 Smoke detectors provided. E .456 Adequate egresses free from obstruction .453 Lighting rovided for stairways .454 Floors maintained. Residential Camps/Sleeping Areas: .458 Provide adequate space: N/A for primitive,trip and 40sgft/person in single bed travel camp. 35sgft/person in bunk bed 50sgft/person in sleeping area requiring special equipment .470 Provide bed/cot per person with 6 feet between sleeper's heads and: 3 feet between single beds/4112 feet between bunks .459 Campers and staff with limited mobility housed on ground level; egresses leading to grade or ramp provided. .452 Screens provided. Screen door self-closing. e1 .454 Floors maintained. Tents: .217 Fire-retardant and non-toxic. No open flame nearby. L� .458 35 s ft/ erson in bunk bed 102�03 " .470 Provide bed/cot per person with 6 feet between N/A for primitive, trip and sleeper's heads and: travel camp. 3 feet between single beds/41nfeet between bunks %-✓ Toilets/Showers 360 Proper sewage disposal .301 Plumbing in good working order .370 Adequate#of toilets: All camps: 2 toilets/privy seats for each sex Day Camp: >60 of one sex, provide 1 additional toilet per every 30 people of that sex. Non-Day Camp: >20 of one sex, provide 1 additional toilet per every 10 people of that sex. .372 Toilet less than 200 feet from sleeping rooms.Toilet paper provided. Windows/ openings screened. Screen doors self-closing. .373 Adequate#of sinks: Day Camp: 1 per every 30 people Residential Camp: 1 per every 30 .374 Adequate#of showers (residential camp): 1 shower/tub per 20 people .378/.380 Special needs campers provided facilities that meet their needs .301 Plumbing in good working order .453 Lighting rovided. .375 Toilets and shower rooms ventilated to outdoors .376 Hot water at sinks, showers/tubs not more than 112°F. .377 Sanitary facilities maintained in clean condition. Shower room floors washed daily. Laundry .162 Residential Camp: laundry facilities provided L/ .472 Bedding and towels laundered; no common towels Grounds: .300 Potable water supply rovided. .300/.304 Adequate and centralized drinking water facilities. No common drinking cups. .209 Telephone readily available with#s of HCC, local hospitals, police, fire, ambulance. (Day and Residential Cam sonl .213 Emergency communications stem. .165 Tobacco use restricted to designated areas not accessible to campers. .350/.355 Proper storage and disposal of solid waste .207 Proper storage and operation of power equipment. .214 Flammable and hazardous materials labeled and stored in locked unoccupied building. .400 Rodent and insect control. .401 Weed and noxious plant control. .450 Site location does not cause undue traffic hazards and is accessible at all times. MUM Food Service .320 Food service in compliance with 105 CMR 590.000, Minimum Standards for Food Establishments. Permit posted in food service facility. .330 Nutritious meals that include a variety of foods served. Menus posted. .331 Residential camps—Provide at least three nutritious meals. Foods must meet Recommended Dietary Allowances RDA .332 Day camps—Each meal provided must meet 1/3 of the RDA requirements. .334 Adequately trained staff and equipment provided to ensure handicapped campers are eatina nutritious meals. .335 Proper methods for storing meals brought from home. Meals provided to campers who arrive without a bag lunch. .452 Screening provided for food preparation and food service areas. Screen doors must be self- closing. .453 Lighting rovided in kitchen and dining area. .471 Sleeping rohibited in food areas. REGULATION NO. THE SPACE BELOW DESCRIBES VIOLATIONS MARKED ABOVE