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Home My WebLink About2020-01-23 Board of Health Minutes North Andover Board of Health Meeting Minutes Thursday—January 23, 2020 7:00 p.m. 120 Main Street,211 Floor Selectmen's Meeting Room North Andover, MA 01845 Present: Frank MacMillan Jr.,Joseph McCarthy,Patrick Scanlon,Brian LaGrasse,Stephen Casey Jr and Toni K.Wolfenden. I. CALL TO ORDER The meeting was called to order at 7:05pm. II. PLEDGE OF ALLEGIANCE III. APPROVAL OF MINUTES Meeting Minutes from December 19,2019 were presented for signature. Motion was made by Joseph McCarthy to approve the minutes,the motion was seconded by Patrick Scanlon,all were in favor and the minutes were approved.(3-0-0) IV. PUBLIC HEARINGS V. OLD BUSINESS Vl. NEW BUSINESS A. Brian LaGrasse has updated the food permits and food establishment plan review guides. The Health Department had twenty-three different types of food permits,which has been condensed to ten. There was one plan review guide for all types of establishments. The original guide was a twenty page application. This guide was broken into segments,which is more tailored for each individual use. The updates have been added to the new online permitting system,which is user friendly for businesses and staff. (See Appendix A.) The plan review guides are used for new businesses coming into the town or existing establishments that are transferring ownership or existing businesses that are upgrading the facility. The guides allow the Health Department to assist new and existing businesses throughout the permitting process. Brian LaGrasse has submitted a spreadsheet showing the new food permit fees, categories and classifications. (See Appendix B.) The spreadsheet allowed for the Health Department Director,Brian LaGrasse,with assistance from consultant,Sweet Safe,Megan Baldwin,to examine the permitting fee structure to ensure fairness and proper funding. There is some fluctuation. Health Department permits in the Commonwealth of Massachusetts are site specific but all similar categories and fee structures. Businesses have been receptive to the new guides and fee structures. 2019 North Andover Board of Health Meeting Page 1 of 3 Board of Health Members:Dr.Francis P.MacMillan,Jr.,MD,Chairman/Town Physician;Joseph McCarthy,Member/Clerk; Michelle Davis,RN,Member;Daphnee Alva-LaFleur,Member;Patrick Scanlon,DO,Member Health Department Staff: Brian LaGrasse,Health Director;Stephen Casey Jr.,Health Inspector;Caroline Ibbitson,Public Health Nurse;Toni K. Wolfenden,Health Department Assistant MOTION made by Patrick Scanlon to adopt the new food fee schedule,new food establishment plan review guides and new online food permit applications.Motion seconded by Joseph McCarthy.All were in favor and the motion was approved. (3-0-0) VII. COMMUNICATIONS,ANNOUNCEMENTS,AND DISCUSSION A. 2020 Mosquito Season—The Commonwealth of Massachusetts has been conducting seminars on mosquitos. This past season was a learning curve for the state and town/city level because of increase activity. There was a great deal of information being presented,but locating the proper correspondence was proved difficult. The Commonwealth has created a seventy-two point action plan to address the found issues. The action plan discusses location of information being presented to residents,ease of obtaining facts and best management practices. Brian LaGrasse will be meeting with Superintendent,Dr.Gregg T.Gilligan and Athletic Director,Laura Habacker in the beginning of February to address the upcoming season. The school department will be involved with decision- making,student notifications and potential issues with scheduling,especially with nighttime activities. The past fall had issues with cancellation and rescheduling which altered sports seasons. It was cumbersome and caused stress. Being cautious was the best approach;however,proper planning, would make things easier for future scheduling. The Childhood Prevention Acts for use of Toxic Chemicals and Spraying will be addressed. The 2020 season predictions are to be on the upswing for mosquito activity,specifically Eastern Equine Encephalitis(EEE). B. Brian LaGrasse will be attending as a guest speaker the National Association of County and City Health Officials 2020 Preparedness Summit—NACCHO. The meeting is in Dallas,TX at the end of March until early April. Brian LaGrasse will be discussing the public health response to the Merrimack Valley gas event. (See Appendix C.) C. Centers for Disease Control(CDC)response to the Coronavirus.(See Appendix D.) Brian LaGrasse and the Board discuss the Coronavirus. Patrick Scanlon encourages the public to continue to receive flu shots. The Regional Emergency Preparedness Coalition will meet on January 281 with upper- management,and department directors from eight different communities to have a table top discussion on emerging and infectious disease which is part of the response public health. D. Joseph McCarthy inquires about the new Body Art Regulations updated for 2020. The inspections have begun for the Body Art Establishments. With the new regulations,there have been some issues that needed to be addressed,but the establishments have be receptive. E. Joseph McCarthy inquires about the new Tobacco Regulations updated for 2020. Brian LaGrasse explains that there has been some push back,mostly due to frustration. Retailers are trying to disperse remaining products. Retailers are selling remaining products with strict orders not to re-order. They were worried about losing large amounts of money. The Commonwealth of Massachusetts ban on flavored cigarettes will begin on June 11,2020,therefore the towns businesses will be prepared for the state wide ban. VIII. CORRESPONDENCE/NEWSLETTERS IX. ADJOURNMENT MOTION made by Joseph McCarthy to adjourn the meeting.Patrick Scanlon seconded the motion and all were in favor.The meeting adjourned at 7:42 pm. Prepared by: Toni K. Wolfenden, Health Dept.Assistant Reviewed bv: All Board of Health Members&Brian LaGrasse, Health Director Signed bX: Jos h ^cCarthy Jerk of the Bo Date Signed North Andover Board of Health Meeting Minutes Thursday—January 23, 2020 7:00 p.m. 120 Main Street,2°d Floor Selectmen's Meeting Room North Andover, MA 01845 Documents Used At Meeting: Meeting Agenda—January 23,2020 Current Food Establishment Fees/Proposed New Fee List New January 2020 Food Permit Definitions and Fee Schedule Retail Prepackaged Food Plan Review Application Food Service Establishment Plan Review Application Mobile Food Establishment Plan Review Application Residential Kitchen Establishment Plan Review Application Limited Renovation Plan Review Application For Existing Food Establishments Food Establishment Permit Application Spreadsheet—Percent Change in Fees for North Andover Food Permits under New Proposed Fee Structure 2020 Preparedness Summit—NACCHO The Commonwealth of Massachusetts Correspondence—To Healthcare Providers and Institutions,Infection Preventionists,Emergency Departments,Hospital Laboratories,EMS,and LBOH regarding Coronavirus 2019 North Andover Board of Health Meeting Page 3 of 3 Board of Health Members:Dr.Francis P.MacMillan,Jr.,MD,Chairman/Town Physician;Joseph McCarthy,Member/Clerk; Michelle Davis,RN,Member;Daphnee Alva-LaFleur,Member;Patrick Scanlon,DO,Member Health Department Staff: Brian LaGrasse,Health Director;Stephen Casey Jr.,Health Inspector;Caroline Ibbitson,Public Health Nurse;Toni K. Wolfenden,Health Department Assistant North Andover Board of Health Meeting Agenda Thursday,January 23,2020 7:00 p.m. 120 Main Street,2nd Floor Selectmen's Meeting Room North Andover,MA 01845 I. CALL TO ORDER II. PLEDGE OF ALLEGIANCE III. APPROVAL OF MINUTES—December 19,2019 IV. PUBLIC HEARINGS V. OLD BUSINESS VI. NEW BUSINESS A. Review—New Food Establishment Plan Review Guides 1. Retail Prepackaged Only 2. Food Service 3. Mobile Food 4. Residential Kitchen 5. Limited Renovation B. Review—New Fee Schedule for 2020 C. Review—New Permit Application and Viewpoint VII. COMMUNICATIONS,ANNOUNCEMENTS,AND DISCUSSION VIII. CORRESPONDENCE/NEWSLETTERS IX. ADJOURNMENT 2019 North Andover Board of Health Meeting—Meeting Agenda Page 1 of 1 Note: The Board of Health reserves the right to take items out of order and to discuss and/or vote on items that are not listed on the agenda. Board of Health Members: Dr.Frank MacMillan,Jr.,Chairman/Town Physician;Joseph McCarthy,Member/Clerk,Michelle Davis,RN,Member;Daphnee Alva-LaFleur,Member,Patrick Scanlon,D.O.,Member Health Department Staff:Brian LaGrasse, Health Director;Stephen Casey Jr.,Health Inspector; Caroline Ibbitson,Public Health Nurse;Toni K.Wolfenden,Health Department Assistant Current Food Establishment Fees Proposed New Fee List PERMIT NAME FEE PERMIT NAME FEE 1 Non-profit $0.00 1 Non-profits $0 2 Home Cook $25.00 2 Residential Kitchen Establishment $25 3 Temporary $35.00 3 Temporary Food Establishment $35 4 Frozen Desserts $40.00 4 Seasonal Food Establishment $60 5 Seasonal $60.00 5 Mobile Food Establishment $115 6 Mobile Food $95.00 6 Catering $150 7 Day Care /Private School $110.00 7 Retail Prepackaged Only $160 8 Day care facility $110.00 8 Limited Food Service Establishment $180 9 Gas Station $110.00 9 Food Service Establishment $200 10 Gym, Health Club $110.00 10 Supermarket $500 11 Liquor Store $110.00 12 Small Retail Store $130.00 13 Caterer $140.00 14 Mobile Food (On-site Prep) $140.00 15 Club organization $160.00 16 Health Care <50 $160.00 17 Convenience store $185.00 18 Restaurant $185.00 19 Health Care 50+ $195.00 20 Pharmacy/Small Retail $280.00 21 Small Retail Store/Bakery $280.00 22 Supermarket $400.00 23 Superstore $530.00 y TOWN OF NORTH ANDOVER • Health Department 120 Main Street, North Andover, MA 01845 Tel: 978.688.9540 Fax: 978.688.9542 healthdept@northandoverma.gov New January 2020 Food Permit Definitions and Fee Schedule PERMIT NAME DEFINITION FEE Non-Profit An organization that serves food to the public at no charge. $0 A kitchen in a private home where non-temperature control for safety foods such as baked Residential goods,confectioneries,jams and jellies,are prepared to be served directly to the $25 Kitchen consumer. A food establishment that operates for a period of no more than 14 consecutive days in Temporary conjunction with a single event or celebration. Exemptions include stands selling only Food whole uncut produce, neighborhood bake sales,charity food donation centers,and events $35 Establishment defined as"potluck events" under Chapter 230 of the Acts of 2014. Seasonal Food A food establishment that provides food to the public for no more than 6 months out of Establishment the year and not necessarily associated with a special event. $60 A food establishment that serves food from a vehicle or cart. Exemptions include Mobile Food operations that transport only whole,uncut fresh fruits and vegetables, pure maple Establishment products, unprocessed honey or farm fresh eggs. Food delivery services or take out $115 delivery are also exempt. A food establishment that prepares,transports and serves food at another location,or who prepares and serves food at a food establishment,other than one for which they hold a Catering $150 permit,for service at a single meal, party or similar gathering. A food establishment that provides prepackaged foods for human consumption. No items Retail are cut, poured, repackaged or otherwise prepared on site. $160 Prepackaged Limited Food A food establishment that provides a limited number of low risk foods for human Service consumption. Food service may,for example, include heating and serving hot dogs. $180 Establishment A food establishment that stores, prepares, packages or serves food directly to the consumer,or otherwise provides food for consumption such as a restaurant. Establishments that conduct catering and manufacturing of frozen desserts are considered Food Service Food Service Establishments. Food preparation may include cooking,cooling or reheating $200 Establishment of exposed foods. Exemptions include any operation that only offers whole, uncut fresh fruits and vegetables, unprocessed honey, pure maple products, or farm fresh eggs which are stored and maintained at 457(7.2°C)or less. A large retail market that provides food to the public.Supermarkets may have various Supermarket operations in one market location,such as bakeries,deli,and/or seafood operations. $500 io TOWN OF NORTH ANDOVER Health Department 120 Main Street, North Andover, MA 01845 Tel: 978.688.9540 Fax: 978.688.9542 healthdept@northandoverma.gov Retail Prepackaged Food Plan Review Application This guide is for applicants planning to serve prepackaged foods only. No food items will be cut,poured, repackaged or otherwise prepared on site. Application must be submitted at least 60 days before the planned opening date. Applicant Establishment Name: Application Date: Establishment Address: Name of Owner: Name of Applicant(if not owner): Mailing Address: City: State: Zip: Phone: Email: Emergency/24 Hour Phone Number: Check One: : NEW REMODEL CONVERSION (New construction) (Renovating existing structure) (Purchasing existing establishment) Hours of Operation: Sun Mon Tues Wed Thurs Fri Sat Total Square Feet of Facility: Brief List of Prepackaged Items for Sale: Teckn-ical Re-view Committee The Town Planning Department offers the option of attending a Technical Review Committee(TRC)meeting to all applicants.As the applicant, I acknowledge that have received an explanation and understand that the purpose of the TRC meeting is to assist me in the various town processes needed to open my establishment. If declined, I understand that I have forfeited this opportunity to learn more about the North Andover permitting process. I wish to attend or decline (circle one)participation in the TRC process. Date of TRC(BOH only) ATTACHMENT CHECKLIST Please attach the following documents to your Plan Review Application Proposed list of prepackaged food items to be sold. Site plan showing location of business in building; location of building on site including alleys, streets; and location of any outside equipment (dumpsters, well, septic system). Establishment Floor Plan must be min 11x14 inches in size, '/4 in = 1 foot scale, drawn to scale showing location of equipment, plumbing, electrical services and mechanical ventilation. Commercial Equipment schedule must have NSF, ANSI or similar accreditation. Manufacturer Specification sheets for each piece of equipment shown on the plan. North Andover Retail Food Plan Review Application Page 2 FOOD STORAGE AND SAFETY 1. Please list the food items to be stored in or distributed from the Retail Food Establishment attach full menu). Check all that apply: ( ) Candy, chips ( ) Prepackaged Ice cream ( ) Bread ( ) Bottled soda or juice ( ) Prepackaged cheese or yogurt ( ) Milk ( ) *Bagged Ice ( ) Prepackaged sandwiches ( ) other *Ice must come from distributor in a bag. Ice may not be bagged on site. 2. Food Establishments restricted to the sale of pre-packaged food are encouraged, but not required, to have a Certified Food Protection Manager or Serve Safe certified person. Retail prepacked food establishments ARE required to have a Person in Charge (PIC), or responsible individual who is present and knowledgeable of food safety requirements at the time of inspection. Will a PIC be available during operation? ( ) YES ( ) NO 3. Are all toxics for use on the premise or for retail sale (this includes personal medications), stored away from food storage areas? YES ( ) NO ( ) 4. Are all packaged foods labeled with establishment name, address, ingredients, allergen information and sell-by date? Items behind the counter do not require labeling. ( ) YES ( ) NO What foods require labeling? • All packaged foods offered for retail sale must comply with state and federal labeling regulations. Packaged foods are foods that are bottled, canned, cartoned, securely bagged or securely wrapped. Exemptions: Foods in a carry-out box or other non-durable container used to protect the food during service and receipt by the consumer. "Penny Candy" does not require labeling. North Andover Retail Food Plan Review Application Page 3 What is required on a packaged food label? Name: Common or usual name of the product Ingredients: List of all ingredients Allergen Foods containing Milk, Fish, Egg, Crustacean, Shellfish, Peanuts,Tree Nuts, Soybeans,or listing: Wheat must include listing of allergens on label. Two options for listing: Option 1: Include the common or usual name of the food source,followed by the name of the allergen in parentheses. For example: Ingredients: Flour(wheat),whey(milk). Option 2: After the ingredient statement, place the word, "Contains:"followed by the name of the food allergen. For example: Ingredients: Flour,whey. Contains:Wheat, Milk. Business: Name and address of manufacturer, packager or distributor Quantity: Net quantity in terms of weight Dating: Perishable foods must have"sell-by date" FACILITIES 1. Light bulbs shall be shielded, coated, or otherwise shatter-resistant in areas where there is clean equipment, utensils, linens, or single use articles. (Food Code Sec. 6-202.11). Please indicate areas where lights will be shielded: 2. Are adequate and approved commercial grade freezers and refrigerators available to keep frozen foods frozen and refrigerated foods at 41 OF or less? ( ) YES ( ) NO 3. Are all freezers and refrigeration units equipped with a thermometer? ( ) YES ( ) NO 4. Are all shelving units installed to allow easy cleaning under/between shelves? ( ) YES ( ) NO North Andover Retail Food Plan Review Application Page 4 FINISH SCHEDULE Materials selected must be durable and appropriate to the area and its intended use. High moisture areas must be non-absorbent, smooth and easily cleanable. All openings must be tight fitting, properly sealed and without voids. Applicant must indicate which materials (i.e. quarry tile, stainless steel, 4" plastic coved molding, etc.) will be used in the following areas. FLOOR CURVED COVING2 WALL CEILING FINISH' SURFACE' Retail Area NA Dry Storage NA Room Walk-in Refrigerators and Freezers Toilet Rooms Dressing Rooms Garbage & Refuse Storage Mop Service Basin Area 1 Example floor materials are as follows: •Quarry tile,ceramic tile •SEALED curbed concrete •Seamless poured epoxy minimum 3/16-inch thick. • Commercial-grade sheet vinyl (no felt backing) • Commercial-grade vinyl composition tile (VCT) Pre-approval from the REGULATORY AUTHORITY should be obtained prior to use of carpet and/or wood (Food Establishment Plan Review Manual 2016, p.27). Z Coved flooring material should extend integrally up the walls. Integral coving is not required in areas used exclusively for dining, point-of-sale,or the storage of UTENSILS or FOODs contained in the original un-opened container(Food Establishment Plan Review Manual 2016, p. 28). 3 Example wall materials are as follows: •Stainless steel • Ceramic tile •Aluminum • Fiber-glassed reinforced panels(FRP) • SEALED Concrete blocks or bricks • Epoxy or glazed drywall (Food Establishment Plan Review Manual 2016, p.28). 4 Example ceiling materials may include wall finish material listed above along with the following: • EASILY CLEANABLE, non-absorbent ceiling tiles • Painted drywall (Food Establishment Plan Review Manual 2016, p. 27). North Andover Retail Food Plan Review Application Page 5 PLUMBING CONNECTIONS and SEWAGE DISPOSAL 1. Do all fixtures have backflow prevention devices? ( ) YES ( ) NO 2. Water source: ( Municipal Water ( ) Well 3. Sewer system: ( ) Municipal Sewer ( ) Septic System 4. Is a Mop sink present? ( ) YES ( ) NO 5. Are there hand sinks in lavatories? ( ) YES ( ) NO 6. Are grease traps provided? YES ( ) NO ( ) If so -where? 7. Plumbing Code 248 CMR 10.09 (m) requires that a laminated sign shall be stenciled on or in the immediate area of the grease trap or interceptor in letters one-inch high. The sign shall state the following in exact language: IMPORTANT The grease trap/interceptor shall be inspected and thoroughly cleaned on a regular and frequent basis. Failure to do so could result in damage to the piping system, and the municipal or private drainage system(s). CLEANING SCHEDULE — Please indicate cleaning plans below. Cleaning products Frequency Who is Responsible for Cleaning Floors I ' Retail Shelves Bathrooms I I Other Areas North Andover Retail Food Plan Review Application Page 6 INSECT & RODENT CONTROL APPLICANT. PLEASE CHECK APPROPRIATE BOXES. YES NO N/A 1. Will all outside doors be self-closing and rodent proof? 2. Are screen doors provided on all entrances left open to the outside? 3. Do all operable windows have a minimum #16 mesh screening? 4. Will all pipes & electrical conduit chases be sealed; ventilation systems exhaust and intakes protected? 5. Licensed Pest Control Company name: Describe frequency of inspection and type of service: North Andover Retail Food Plan Review Application Page 7 GARBAGE AND REFUSE YES NO N/A 1. Do all containers have lids? 2. Will refuse be stored inside? If so, where? 3. Will a dumpster or compactor be used outside? (Note: A Dumpster Permit may be required, see North Andover Health Department for information.) a. Number: b. Size of: c. Frequency of Pick-Up? Indicate days and how often. 4. Will garbage cans be stored outside? 5. Describe surface and location where dumpster/compactor/garbage cans are to be stored. Surface must be enclosed and impermeable. 6. Is there an area to store recycled containers? Please describe below: 7. Is there any area to store returnable, damaged goods? Please describe below: Please maintain garbage, refuse, and recycling areas in clean and sanitary condition, free of litter, and pests. Please keep receptacles closed at all times. North Andover Retail Food Plan Review Application Page 8 Additional Resources: • Please contact The North Andover Health Department with any questions 978-688-9540. • Retail Sale Regulations: 105 CMR 590.000: State sanitary code chapter X: Minimum sanitation standards for food establishments, as adopted on 10/5/2018. Copies available at mass.gov Food Protection Program. • Massachusetts Food Protection Program, Minimum Requirements for Packaged Food Labeling: http://www.mass.qov/eohhs/docs/dph/environmental/foodsafety/food-label-brochure.pdf • Massachusetts Wholesale Regulations: 105 CMR 500.000 Good Manufacturing Practices. Copies available at http://mass.gov/dph/fpp. • Food Establishment Plan Review Guide Manual, 2016 Version, Conference for Food Protection https://ehs.ncpublicheaIth.com/faf/food/planreview/docs/plan-review-for-food-establishments-guide-2016-final.pdf North Andover Retail Food Plan Review Application Page 9 Statement — Please Sign Below I hereby certify that the above information is correct, and I fully understand that any deviation from the above without prior permission from this Health Regulatory Office may nullify final approval. Signature (s)for Owner(s) or responsible representative (s) Print: Date: Thank-you for submitting your Plan Review Application. Please note that approval of these plans and specifications by this Regulatory Authority does not indicate compliance with any other code, law or regulation that may be required--federal, state, or local. This approval does not constitute endorsement or acceptance of the completed establishment(structure or equipment). A preconstruction inspection with equipment in place and a preopening inspection of the establishment will be necessary to determine if it complies with the local and state laws governing retail food establishments. For Board of Health Office Use Only Below: Date received Approved / Denied Date revised application received: Approved / Denied Inspection Date (s): Approved by: Date: North Andover Retail Food Plan Review Application Page 10 Lam, TOWN OF NORTH ANDOVER • Health Department • 120 Main Street, North Andover, MA 01845 Tel: 978.688.9540 Fax: 978.688.9542 healthdept@northandoverma.gov Food Service Establishment Plan Review Application This application is for establishments planning to prepare unpackaged foods for immediate service, take-out or catering. Food preparation may include cooking, cooling or reheating of exposed foods. This includes the manufacturing of frozen desserts. Application must be submitted at least 60 days before the planned opening date. Check all that apply: Sale of Frozen Dessert(ex: soft serve) ❑ Catering (Serving food off site) ❑ Applicant Establishment Name: Application Date: Establishment Address: Name of Owner: Name of Applicant(if not owner): Mailing Address: City: State: Zip: Phone: Email: Emergency/24 Hour Phone Number: Check One: : NEW REMODEL CONVERSION (New construction) (Renovating existing structure) (Purchasing existing establishment) Hours of Operation: Sun Mon Tues Wed Thurs Fri Sat Total Square Feet of Facility: Total No. of Seats: Vacuum packaging:Yes ( ) No ( ) Canning: Yes ( ) No ( ) Time as Health Control: Yes ( ) No ( ) Non-Continuous Cooking Y es ( ) No ( ) Brief Menu Description: Technical Review Committee The Town Planning Department offers the option of attending a Technical Review Committee(TRC)meeting to all applicants. As the applicant, I acknowledge that I have received an explanation and understand that the purpose of the TRC meeting is to assist me in the various town processes needed to open my establishment. If declined, I understand that I have forfeited this opportunity to learn more about the North Andover permitting process. I wish to attend or decline(circle one)participation in the TRC process. Date of TRC(130H only) t ATTACHMENT CHECKLIST Please attach the following documents to your Plan Review Application Proposed Menu (including seasonal, off-site and banquet menus) - Must include consumer advisory if serving raw or undercooked food. All menus must have allergen advisory stating "before placing your order please inform your server if you have a food allergy", or a notice at the point of service. Site plan - Must show location of business in building; location of building on site including alleys, streets; and location of any outside equipment (dumpsters, well, septic system). Establishment Floor Plan - Must be min 11x14 inches in size, '/4 in = 1 foot scale, drawn to scale showing location of equipment, plumbing, electrical services and mechanical ventilation. Commercial Equipment Schedule - Equipment must have NSF, ANSI or similar accreditation. See Attachment 1 for Anticipated Equipment Needs. Manufacturer Specification sheets - Required for each piece of equipment shown on the plan. Certified Food Protection Manager Certificate for at least one full time on- site employee (Serve Safe or similar certification). Allergen Awareness Certificate Choke Saver Certificate for Establishments with 25 seats or more. Example of Product Label for any items packaged on site and sold in grab & go or retail area, including Establishment Name, Ingredients, Allergen info and Sell-by date. Provide Hazard Analysis Critical Control Plan (HACCP) for any specialized processing methods such as Smoking food as method of preservation, 2) Curing food, 3) Using food additives or adding components such as vinegar to preserve food or render a food so that it is not a TCS Food (Time/Temperature Control of Safety Food) such as Sushi Rice. Provide Written Procedures for Time as a Public Health Control or Non-continuous Cooking of Raw Animal Foods. North Andover Food Service Plan Review Guide Page 2 FOOD SAFETY MANAGEMENT AND PERSONNEL 1. Serve Safe: At least one Full Time on-site Person-in- charge must complete a Certified Food Protection Manager Training such as Serve Safe Certification. List below all personnel with certification (attach copy): Employee Names: Date of Completion: 2. Choke Saver: Establishments with 25 or more seats must have on its premises, while food is being served, an employee trained in manual procedures to remove food lodged in an adult, child, or infant's throat. List below personnel with choke saving certification (attach copy). Employee Names: Date of Completion: 3. Allergen Certificate: Employee Names: Date of Completion: FOOD SUPPLIES 1. All food supplies must be obtained from approved sources. Please list primary suppliers below: 1. What are the projected frequencies (daily, weekly, etc.) of deliveries for: Frozen foods Refrigerated foods Dry goods 2. Adequate storage must be provided to store items in organized manner and allow for easy FIFO. Provide information on the amount of space (in cubic feet) allocated for: Dry storage Refrigerated Storage Frozen storage North Andover Food Service Plan Review Guide Page 3 FOOD PREPARATION REVIEW 1. Please list food items to be prepared in or distributed from the Food Establishment. attach full menu). 2. Time and Temperature Control for Safety JCS) Foods are foods that require time and temperature control to prevent bacteria growth. Please check any of the following TCS Foods to be handled, prepared, or served: CATEGORY (YES) (NO) 1. Thin meats, poultry, fish, eggs (hamburger; sliced meats; fillets) ( ) ( ) 2. Thick meats, whole poultry (roast beef; whole turkey, chickens, hams) ( ) ( ) 3. Cold processed foods (salads, sandwiches, vegetables) ( ) ( ) 4. Hot processed foods (soups, stews, rice/noodles, gravy, chowders, ( ) ( ) casseroles) 5. Bakery goods (pies, custards, cream fillings &toppings) ( ) ( ) 6. Sushi Rice (Requires HACCP and Variance) ( ) ( ) 7. Vacuum Packaging (Requires HACCP) ( ) ( ) 3. Frozen Dessert Manufacturing Please check all that apply to you: ❑ Sale of prepackaged frozen desserts. ❑ Sale of frozen desserts through a "dispensing only" machine that dispenses a prepackaged ready-to-use frozen dessert and does not mix or freeze the mixture. If the above are the ONLY type of frozen desserts for sale then you may skip the rest of the frozen dessert questions. ❑ Sale of soft serve ice cream, sherbet or frozen yogurt from a soft serve machine. ❑ Manufacturing ice cream using pasteurized mix. ❑ Wholesale dessert manufacturing plants pasteurizing raw milk and cream. ❑ Other: Name and address of frozen dessert product supplier: North Andover Food Service Plan Review Guide Page 4 What type of machinery is used to manufacture the frozen dessert? Describe how the dessert manufacturing machine will be cleaned and sanitized: Bacteriological testing is required for all dairy-based frozen desserts. Indicate the laboratory that will conduct monthly testing: 4. Does your menu include a complete Consumer Advisory? Yes ( ) No ( ) A complete "consumer advisory" warning notation must be printed on the menu and on menu boards where raw or undercooked foods are advertised. Font must be at least as large as smallest menu item. Advisory must include two parts: a. Disclosure of any menu items that are raw or undercooked. A disclosure is satisfied by clear menu item name indicating raw or undercooked, such as "Raw Oysters". Alternatively, an asterisk may be inserted to direct to the below footnote. Ex: Steak* b. Reminder of hazards of eating undercooked food may be satisfied through a footnote that states *These items may be served raw or undercooked. Consuming raw or undercooked meats, poultry, seafood, shellfish or eggs may increase your risk of foodborne illness. 5. Do all menus include an Allergen Advisory? Yes ( ) No ( ) All menus, including catering, specials, or online menus, must include the advisory "Before placing your order, please inform your server if you have a food allergy". Menu boards may have the advisory on the board or on a placard at the point of service. 6. Will your establishment have a Catering Operation? Yes ( ) No ( ) If no,please skip this catering section. a. Describe below the types of food items to be served off site (attach sample menu). b. Will some food be prepared at a permitted establishment before being transported to the catering function? Yes ( ) No ( ) c. Please describe how HOT food will be transported to the catering function location.: North Andover Food Service Plan Review Guide Page 5 t d. Please describe how COLD food will be transported to the catering function location. e. How will temperatures be monitored to ensure cold foods are maintained at or below 41 OF, and hot foods are maintained at or above 135 OF during transport? f. How will foods be maintained at temperature at the function location? What equipment will be used? g. Please describe how food contact surfaces will be sanitized while preparing food at the function location. Will you bring your own sanitizer or will it be provided? h. Please describe how and where Cambros and other equipment will be washed and sanitized after every function? i. Will hand wash stations be available next to prep areas at catering function locations, or will you bring your own portable hand wash sink? Catering Reminders: Catering staff preparing food must wear hair restraints. No bare hand contact with ready to eat foods Menus must comply with consumer advisory and allergen advisory requirements To follow please find a sample food temperature tracking log for Catering Operations: North Andover Food Service Plan Review Guide Page 6 Food Temperature Tracking Log for Catering Event Name: Date: FOOD ITEM (s) START TIME TEMP ARRIVAL TEMP Note any TIME corrective Time food Hot food must Hot food must actions (re- leaves hot or be>_ 135 OF Time food be >_ 135 OF heated, cold holding arrives at chilled or in base Cold food function Cold food discarded) establishment must be <_41 location must be<_41 OF OF Employees Initials North Andover Food Service Plan Review Guide Page 7 PREPARATION: 1. How will employees avoid bare hand contact with ready to eat foods during service? Examples of ready to eat foods include cooked pizza, baked goods, and prepared deli sandwiches. Check all that apply: ❑ Gloves ❑ Utensils ❑ Food Grade paper ❑ Other: 2. Is there a written policy to exclude or restrict food workers who are sick or have infected cuts and lesions? YES / NO Please describe briefly how employees are trained on illness policy: 3. How will cooking equipment, cutting boards, counter tops and other food contact surfaces which cannot be submerged in sinks or put through a dishwasher be sanitized? Chemical Type (ex Quat or Chlorine): Concentration (Quat = 200 ppm, Chlorine = 50 ppm): Test Kit: YES / NO 4. Will ingredients for cold ready-to-eat foods such as tuna, mayonnaise and eggs for salads and sandwiches be pre-chilled before being mixed and/or assembled? YES / NO If not, how will ready-to-eat foods be cooled to 41 OF? 5. Will all produce be washed on-site prior to use? YES / NO Is there a planned location used for washing produce? YES / NO Describe 6. Describe the procedure used for minimizing the length of time TCS Foods will be kept in the temperature danger zone (41°F - 135°F) during preparation. North Andover Food Service Plan Review Guide Page 8 7. Where raw meats, poultry and seafood are prepared in the same work area or using the same equipment as cooled/ready to eat foods, how will cross contamination be prevented? 8. Will the facility be serving food to a highly susceptible population? YES / NO If yes, list measures taken to comply with code requirements. COOKING: 1. What type of temperature measuring device will be used to confirm proper final cooking temperatures? 2. How frequently do you check cooking temperatures? 3. What other validation measures, if any, do you use to ensure proper cooking temperatures? Below please find important cooking temperatures! We suggest posting this near cooking area. Minimum cooking time and temperatures of product utilizing convection and conduction heating equipment: ➢ Beef roasts ➢ 130T (121 min) ➢ Solid seafood pieces ➢ 145°F (15 sec) ➢ Other TCS Foods ➢ 145°F (15 sec) ➢ Eggs: ■ Immediate service 145°F (15 sec) ■ Pooled eggs* 155T (15 sec) (*pasteurized eggs must be served to a highly susceptible population) ➢ Pork ➢ 145°F (15 sec) ➢ Burgers, comminuted meats/fish ➢ 155°F (15 sec) ➢ Poultry ➢ 165°F (15 sec) ➢ Reheated TCS Foods ➢ 165°F (15 sec) North Andover Food Service Plan Review Guide Page 9 COOLING: Please indicate by checking the appropriate boxes how cooked TCS Foods will be cooled: 1) Within 2 hours from 1350F to 70OF and 2) within a total of 6 hours from 1350F to 41 OF or less. Also, indicate where the cooling will take place. COOLING THICK THIN THIN SOUPS/ THICK RICE/ METHOD MEATS MEATS GRAVY SOUPS/ NOODLES GRAVY Shallow Pans Ice Baths Reduce Volume or Size [Rapid Chill Other (describe) REHEATING: 1. How will TCS Foods that are cooked, cooled, and reheated for hot holding be reheated so that all parts of the food reach a temperature of at least 165°F for 15 seconds. Indicate type and number of units used for reheating foods. HANDWASHING/TOILET FACILITIES 1. Is there a hand washing sink in each food preparation, cooking and ware washing area? YES ( ) NO ( ) 2. Do self-closing metering faucets provide a flow of water for at least 15 seconds without the need to reactivate the faucet? YES ( ) NO ( ) 3. Is hand cleanser available at all hand washing sinks? YES ( ) NO ( ) 4. Are hand drying facilities at all hand washing sinks? YES ( ) NO ( ) 5. Are hand washing signs and instructions posted in each employee restroom? YES ( ) NO ( ) North Andover Food Service Plan Review Guide Page 10 THAWING FROZEN TCS FOODS: Please indicate how Time and Temperature Control for Safety JCS) Foods will be thawed. More than one method may apply. Also, indicate where thawing will take place. Food Item Thawing Method (Ex. frozen shrimp, frozen chicken) (Ex. thaw in refrigerator, under running water, microwave, cooked from frozen). SINKS 1. Is a Prep Sink present? YES ( ) NO ( ) a. How many? 2. Are Hand Wash Sinks within easy access of each preparation, cooking and service area? YES ( ) NO ( ) a. How many? 3. Is there a 3-Bay Sink? YES ( ) NO ( ) 4. Is a Mop Sink Present? YES ( ) NO ( ) North Andover Food Service Plan Review Guide Page 11 FINISH SCHEDULE Materials selected must be durable and appropriate to the area and its intended use. High moisture and food splash areas must be non-absorbent, smooth and easily cleanable. All openings must be tight fitting, properly sealed and without voids. Applicant must indicate which materials (i.e. quarry tile, stainless steel, 4" plastic coved molding, etc.)will be used in the following areas. (Please be specific). FLOOR' CURVED WALLS' CEILING COVING2 Kitchen Food Storage Bar Ware washing Area Walk-in Refrigerators and Freezers Dining Area Toilet Rooms Garbage & Refuse Storage Dressing rooms Mop Service Basin Area 1 Example floor materials are as follows: • Quarry tile,ceramic tile •SEALED curbed concrete •Seamless poured epoxy minimum 3/16-inch thick. • Commercial-grade sheet vinyl (no felt backing) • Commercial-grade vinyl composition tile(VCT) Pre-approval from the REGULATORY AUTHORITY should be obtained prior to use of carpet and/or wood(Food Establishment Plan Review Manual 2016, p. 27). z Coved flooring material should extend integrally up the walls. Integral coving is not required in areas used exclusively for dining, point-of-sale,or the storage of UTENSILs or FOODs contained in the original un-opened container(Food Establishment Plan Review Manual 2016, p. 28). 3 Example wall materials are as follows: • Stainless steel • Ceramic tile •Aluminum • Fiber-glassed reinforced panels (FRP) • SEALED Concrete blocks or bricks • Epoxy or glazed drywall (Food Establishment Plan Review Manual 2016, p. 28). 4 Example ceiling materials may include wall finish material listed above along with the following: • EASILY CLEANABLE, non- absorbent ceiling tiles • Painted drywall(Food Establishment Plan Review Manual 2016, p. 27). North Andover Food Service Plan Review Guide Page 12 INSECT & RODENT CONTROL APPLICANT. PLEASE CHECK APPROPRIATE BOXES. YES NO N/A 1. Will all outside doors be self-closing and rodent proof? 2. Are screen doors provided on all entrances left open to the outside? 3. Do all operable windows have a minimum #16 mesh screening? 4. Will all pipes & electrical conduit chases be sealed; ventilation systems exhaust and intakes protected? 5. Licensed Pest Control Company name: Describe frequency of inspection and type of service: PLUMBING CONNECTIONS and SEWAGE DISPOSAL 1. Do all fixtures have backflow prevention devices? ( ) YES ( ) NO 2. Water source: ( Municipal Water ( ) Well 3. Sewer system: ( ) Municipal Sewer ( ) Septic System 4. Adequate hot water must be provided for the operation. What is the capacity of hot water generator? 5. Are grease traps provided? YES ( ) NO ( ) If so -where? 6. Plumbing Code 248 CMR 10.09 (m) requires that a laminated sign shall be stenciled on or in the immediate area of the grease trap or interceptor in letters one-inch high. The sign shall state the following in exact language: IMPORTANT The grease trap/interceptor shall be inspected and thoroughly cleaned on a regular and frequent basis. Failure to do so could result in damage to the piping system, and the municipal or private drainage system(s). North Andover Food Service Plan Review Guide Page 13 GARBAGE AND REFUSE YES NO N/A 1. Do all containers have lids? 2. Will refuse be stored inside? If so, where? 3. Will a dumpster or compactor be used outside? (Note: A Dumpster Permit may be required, see North Andover Health Department for information.) a. Number: b. Size of: c. Frequency of Pick-Up? Indicate days and how often. 4. Will garbage cans be stored outside? 5. Describe surface and location where dumpster/compactor/garbage cans are to be stored. Surface must be enclosed and impermeable. 6. Is there an area to store recycled containers? Please describe below: 7. Is there any area to store returnable, damaged goods? Please describe below: Please maintain garbage, refuse, and recycling areas in clean and sanitary condition, free of litter, and pests. Please keep receptacles closed at all times. North Andover Food Service Plan Review Guide Page 14 GENERAL 1. Are all toxics for use on the premise or for retail sale (this includes personal medications), stored away from food preparation and storage areas? YES ( ) NO ( ) 2. Are dressing rooms provided? YES ( ) NO ( ) a. Describe storage facilities for employees' personal belongings (i.e., purse, coats, boots, umbrellas, etc.) Personal items must not be stored in food storage or prep area. 3. Indicate all areas where exhaust hoods are installed: LOCATION FILTERS SQUARE FIRE AIR AIR WOR FEET PROTECTION CAPACITY MAKEUP EXTRACTION CFM CFM DEVICES 4. Hood Cleaning Company Name: Cleaning Frequency: DISHWASHING FACILITIES 1. How will dishes be washed? Check all that apply: Dishwasher 3 Bay Sink 2. Type of sanitation used in 3-Bay Sink (ex Quat or Chlorine): a. Concentration of Sanitizer: (ex Quat = 200 ppm, Chlorine = 50 ppm) 3. Is ventilation provided for Dishwasher? YES ( ) NO ( ) 4. Type of sanitization used in Dishwasher: Hot water Rinse Temp: Booster heater Chemical type Concentration: North Andover Food Service Plan Review Guide Page 15 5. Do dish machines have temperature gauges as required that are accurate? YES ( ) NO ( ) 6. Does the largest pot and pan fit into each compartment of the pot sink? YES ( ) NO ( ) If no, what is the procedure for manual cleaning and sanitizing? 7. Are there drain boards on both ends of the pot sink? YES ( ) NO ( ) 8. Are test papers and/or kits available for checking sanitizer concentration? YES ( ) NO ( ) VOMIT AND DIARRHEA CLEAN-UP PROCEDURE 1. A FOOD ESTABLISHMENT shall have procedures for EMPLOYEES to follow when responding to vomiting or diarrhea[ events that involve the discharge of vomitus or fecal matter onto surfaces in the FOOD ESTABLISHMENT. The procedures shall address the specific actions EMPLOYEES must take to minimize the spread of contamination and the exposure of EMPLOYEES, consumers, FOOD, and surfaces to vomitus or fecal matter. 2. Food Establishments must maintain a Clean-up Kit on site. Contents of Clean-up Kit may include: 1) Personal Protective Equipment (PPE): disposable gloves, nitrile or non-latex face and eye shields (clean and sanitize after use) disposable shoe covers, disposable aprons, masks, hair covers, 2) Paper towels. 3) Absorbent material: baking soda, Red Z powder, or kitty litter 4) Scoop or scraper, preferably disposable 5) Large plastic bags with twist ties 6) Caution tape for closing off areas North Andover Food Service Plan Review Guide Page 16 Attachment 1 —Anticipated Equipment Needs The following table is provided from the Conference for Food Protection Plan Review Committee Food Plan Review Manual published in 2016 based on the 2013 Food Code. This table is illustrative of the equipment anticipated in a food establishment based on the types of food processes conducted in the food establishment. To read the table, begin with the left column and select whether your establishment fits best into the categories "No Cook", "Same Day Service" or"Complex Processes". You will then read across the columns and down to view what equipment may be anticipated for Receiving, Storage, Preparation, etc. at your food establishment. FOOD Process and Steps Required Receive Store Prepare Cook Cool Reheat Hold Service NO COOK x x x x x SAME DAY SERVICE x x x x x x COMPLEX PROCESSES x x x x x x x x Receive Stare Prepare Cook Cool Reheat Hold Sens Preparation Preparation Cold TheFmometvr Dry Starige EQUIPMENT Fryers Refrigerators Holding Tables Sink Facilities Refrigerated Cutting Storage Boards Fryer Ice Bath Oven Ice U`rERSHA Frozen UTENSILS Sinks Preparation Grill Refrigerators Griddle WOO Sinks Warmers Storage Facilities CU Refrigerators Cook Top Chill Sticks Other Thermometer Z Hand Hand wash Griddle Thermometer wash Sink Sinks othe Hand wash Sink d {ter F W 0. w v re Hand wash Other Sink North Andover Food Service Plan Review Guide Page 17 Additional Resources: • Retail Sale Regulations: 105 CMR 590.000: State sanitary code chapter X: Minimum sanitation standards for food establishments, as adopted on 10/5/2018. Copies available at mass.gov Food Protection Program. • Massachusetts Food Protection Program, Minimum Requirements for Packaged Food Labeling: http://www.mass.gov/eohhs/docs/dph/environmental/foodsafety/food-label-brochure.pdf • Massachusetts Wholesale Regulations: 105 CMR 500.000 Good Manufacturing Practices. Copies available at http://mass.gov/dph/fpp. • Food Establishment Plan Review Guide Manual, 2016 Version, Conference for Food Protection https:Hehs.ncpublichealth.com/faf/food/planreview/docs/plan-review-for-food-establishments-guide-2016- final.pdf North Andover Food Service Plan Review Guide Page 18 Statement — Please Sign Below hereby certify that the above information is correct, and I fully understand that any deviation from the above without prior permission from this Health Regulatory Office may nullify final approval. Signature (s)for Owner(s) or responsible representative (s) Print: Date: Thank-you for submitting your Plan Review Application. Please note that approval of these plans and specifications by this Regulatory Authority does not indicate compliance with any other code, law or regulation that may be required—federal, state, or local. This approval does not constitute endorsement or acceptance of the completed establishment(structure or equipment). A preconstruction inspection with equipment in place and a preopening inspection of the establishment will be necessary to determine if it complies with the local and state laws governing food service establishments. For Board of Health Office Use Only Below: Date received Approved / Denied Date revised application received: Approved / Denied Inspection Date (s): Approved by: Date: North Andover Food Service Plan Review Guide Page 19 •. TOWN OF NORTH ANDOVER • Health Department 120 Main Street, North Andover, MA 01845 Tel: 978.688.9540 Fax: 978.688.9542 healthdept@northandoverma.gov Mobile Food Establishment Plan Review Application This application is for individuals planning to serve food from a vehicle or cart. Food home delivery service and transport of whole uncut fruits vegetables, maple products and farm fresh eggs are exempt. Application must be submitted at least 60 days before the planned opening date. Mobile Food applicants must also contact the Town Clerks office to request a Mobile Food License from the Board of Selectmen. See https://www.northandoverma.gov/health/pages/permits-and-regulations for more information. Ice Cream Truck vendors are required to obtain permit from the local police department per 520 CMR 15. Applicant Establishment Name: Application Date: Name of Owner: Type: (check one below) Occupied/Walk-on Mailing Address: Canteen Truck Push-Cart City: State: Zip: Email: Phone: Name of Applicant if not owner: Title: Phone: Email: Operators State Hawkers and Peddler License#: Expiration Date: Type of Vehicle: Plate#: Will seats be provided to customers? How Many? Max Meals Served per day(approx.): Hours of Operation: Sun Mon Tues Wed Thurs Fri Sat Description of locations or route in North Andover: Name of licensed base of operations or commissary: Address of base of operations or commissary: Menu description: Serving Soft Serve Ice cream? Yes No Technical Review Committee The Town Planning Department offers the option of attending a Technical Review Committee(TRC)meeting to all applicants.As the applicant, I acknowledge that I have received an explanation and understand that the purpose of the TRC meeting is to assist me in the various town processes needed to open my establishment.If declined, I understand that I have forfeited this opportunity to learn more about the North Andover permitting process. I wish to attend or decline(circle one)participation in the TRC process. Date of TRC(BOH only) ATTACHMENT CHECKLIST Please attach the following documents to your Plan Review Application Proposed Menu - Must include consumer advisory if serving raw or undercooked food. All menus must have allergen advisory stating "before placing your order please inform your server if you have a food allergy", or a notice at the point of service. Vehicle Design Plan - Must be min 11x14 inches in size, '/4 in = 1 foot scale, including refrigeration, hand wash sinks, three bay sink, and each area where food or beverages are stored, prepared observed. Commercial Equipment Schedule - Equipment must have NSF, ANSI or similar accreditation. Manufacturer Specification sheets - Required for each piece of equipment shown on the plan. Base of Operations Agreement- Mobile food operations shall operate from a fixed, licensed food establishment or food processing plant and shall report at least daily to such locations for all food, water and supplies and for all cleaning and servicing operations. Certified Food Protection Manager or Serve Safe Certificate for at least one full time on- site employee (Serve Safe or similar certification). Allergen Awareness Training Certification Massachusetts Hawkers & Peddlers License North Andover Mobile Food Establishment Plan Review Application Page 2 FOOD PREPARATION 1. Will the mobile food operation be equipped with hot water and waste systems to facilitate hand- washing and the cleaning and sanitizing of utensils? ❑ Yes: Menu may include Time and Temperature Control for Safety (TCS) foods requiring limited preparation for immediate service, provided that any advanced food preparation, if necessary, is conducted by the mobile operator in a licensed food establishment. ❑ No: Menu shall be limited to the preparation and service of frankfurters' and non-TCS foods and the sale of pre-packaged food prepared at a food processing establishment. 2. Please list the food items to be prepared or distributed in or from the Mobile Food Establishment or attach full menu 3. Time and Temperature Control for Safety (TCS) Foods are foods that require time and temperature control to prevent bacteria growth. Please check any of the following TCS Foods to be handled, prepared, or served: CATEGORY (YES) (NO) a. Thin meats, poultry, fish, eggs (hamburger; sliced meats; fillets) ( ) ( ) b. Thick meats,whole poultry(roast beef; whole turkey, chickens, hams) ( ) ( ) c. Cold processed foods (salads, sandwiches, vegetables) ( ) ( ) d. Hot processed foods (soups, stews, rice/noodles, gravy, chowders, casseroles) ( ) ( ) e. Bakery goods (pies, custards, cupcakes, cream fillings &toppings) ( ) ( ) 4. Is ice made on the premises?YES ( ) NO ( ) Describe provision for ice scoop storage: A Frankfurter(a.k.a. hot dogs)are cooked and/or smoked sausages.They may not contain more than 30%fat or no more than 10%water, or a combination of 40%fat and added water. Up to 3.5% non-meat binders and extenders(such as nonfat dry milk, cereal, or dried whole milk)or 2%isolated soy protein may be used, but must be shown in the ingredients statement on the product's label by its common name. (USDA Hot Dog Food Safety Advisory). North Andover Mobile Food Establishment Plan Review Application Page 3 5. Are there any raw or undercooked foods on the menu? YES ( ) NO ( ) Note: The menu in mobile food establishments may be limited by the regulating authority based on available equipment. Where raw or undercooked foods have been approved as menu items, a complete "consumer advisory" warning notation must be printed on menu and menu boards. Font must be at least as large as smallest menu item. Advisory must include two parts: a. Disclosure of any menu items that are raw or undercooked. A disclosure is satisfied by clear menu item name indicating raw or undercooked, such as "Raw Oysters". Alternatively, an asterisk may be inserted to direct to the below footnote. Ex: Steak* b. Reminder of hazards of eating undercooked food may be satisfied through a footnote that states *These items may be served raw or undercooked. Consuming raw or undercooked meats, poultry, seafood, shellfish or eggs may increase your risk of foodborne illness. 6. Do all menus include an Allergen Advisory? YES ( ) NO ( ) Note: All menus, including catering, specials, or online menus, must include the advisory "Before placing your order, please inform your server if you have a food allergy". Menu boards may have the advisory on the board or on a placard at the point of service. 7. Frozen Dessert Manufacturing Please check all that apply to you: ❑ Sale of prepackaged frozen desserts. ❑ Sale of frozen desserts through a "dispensing only" machine that dispenses a prepackaged ready-to-use frozen dessert and does not mix or freeze the mixture. If the above are the ONLY type of frozen desserts for sale then skip to question #5. ❑ Sale of soft serve ice cream, sherbet or frozen yogurt from a soft serve machine. ❑ Manufacturing ice cream using pasteurized mix. ❑ Wholesale dessert manufacturing plants pasteurizing raw milk and cream. ❑ Other: Name and address of frozen dessert product supplier: What type of machinery is used to manufacture the frozen dessert? Describe how the dessert manufacturing machine will be cleaned and sanitized: North Andover Mobile Food Establishment Plan Review Application Page 4 Bacteriological testing is required for all dairy-based frozen desserts. Indicate the laboratory that will conduct monthly testing: 8. Are all plates, utensils and other articles provided to the consumer single service? Yes / No 9. Are all condiments, cream and sugar served from a sanitary dispenser or individually wrapped servings? Yes / No 10. Is there any consumer self-service component to the operation? Yes / No Please describe self-service: o If yes, a sign shall be provided which states that the use of bare hands by consumers for self- service is prohibited by law. 11.Are effective shields provided to protect equipment and food from contamination by consumers? Yes / No COLD STORAGE 1. Is the mobile operation equipped to provide mechanical refrigeration to hold all Time and Temperature Control for Safety (TCS)foods at or below 41°F (5°C)? Yes / No 2. Will raw meats, poultry and seafood be stored in the same refrigerators and freezers with cooked/ready-to-eat foods? YES / NO If yes, how will cross-contamination be prevented? THAWING FROZEN TIME AND TEMPERATURE CONTROL FOR SAFETY FOODS: Please indicate how frozen TCS foods will be thawed. More than one method may apply. Also, indicate where thawing will take place. Food Item Thawing Method (Ex. frozen shrimp, frozen chicken) (Ex. thaw in refrigerator, under running water, microwave, cooked from frozen). North Andover Mobile Food Establishment Plan Review Application Page 5 Jr PREPARATION: 1. How will employees avoid bare hand contact with ready to eat foods during service? Examples of ready to eat foods include cooked pizza, baked goods, and prepared deli sandwiches. Check all that apply: ❑ Gloves ❑ Utensils ❑ Food Grade paper ❑ Other: 2. Is there a written policy to exclude or restrict food workers who are sick or have infected cuts and lesions? YES / NO Please describe briefly how employees are trained on illness policy: 3. How will cooking equipment, cutting boards, counter tops and other food contact surfaces which cannot be submerged in sinks or put through a dishwasher be sanitized? Chemical Type (ex Quat or Chlorine): Concentration (Quat = 200 ppm, Chlorine = 50 ppm): 4. Will all produce be washed on-site prior to use? YES / NO Is there a planned location used for washing produce? YES / NO Describe: 5. Describe the procedure used for minimizing the length of time TCS Foods will be kept in the temperature danger zone (41°F — 135°F) during preparation. 6. How will cross contamination be prevented where raw meats, poultry and seafood are prepared in the same work area or using the same equipment as cooled/ready to eat foods? 7. Will the facility be serving food to a highly susceptible population? YES / NO If yes, list measures taken to comply with code requirements. COOKING: 1. What type of temperature measuring device will be used to confirm proper final cooking temperatures? 2. How frequently will you check cooking temperatures? North Andover Mobile Food Establishment Plan Review Application Page 6 3. What other validation measures, if any, do you use to ensure proper cooking temperatures? COOKING TEMPERATURES: Note: Below please find important cooking temperatures. We suggest posting this near cooking area. Minimum cooking time and temperatures of product utilizing convection and conduction heating equipment: ➢ Beef roasts ➢ 130°F (121 min) ➢ Solid seafood pieces ➢ 145°F (15 sec) ➢ Other TCS Foods ➢ 145°F (15 sec) ➢ Eggs: ■ Immediate service 145°F (15 sec) ■ Pooled eggs* 155°F (15 sec) (*pasteurized eggs must be served to a highly susceptible population) ➢ Pork ➢ 145°F (15 sec) ➢ Burgers, comminuted meats/fish ➢ 155°F (15 sec) ➢ Poultry ➢ 165°F (15 sec) ➢ Reheated TCS Foods ➢ 165°F (15 sec) COOLING: Please indicate by checking the appropriate boxes how cooked TCS Foods will be cooled: 1) Within 2 hours from 1350F to 70OF and 2) within a total of 6 hours from 1350F to 41 OF or less. Also, indicate where the cooling will take place. COOLING THICK THIN MEATS THIN SOUPS/ THICK RICE/ METHOD MEATS GRAVY SOUPS/ NOODLES GRAVY Shallow Pans Ice Baths Reduce Volume or Size Rapid Chill Other (describe) North Andover Mobile Food Establishment Plan Review Application Page 7 1 REHEATING: 1. How will TCS foods that are cooked, cooled, and reheated for hot holding be reheated so that all parts of the food reach a temperature of at least 165T for 15 seconds? Indicate type and number of units used for reheating foods. FINISH SCHEDULE Materials selected must be durable and appropriate to the area and its intended use. High moisture and food splash areas must be non-absorbent, smooth and easily cleanable. All openings must be tight fitting, properly sealed and without voids. Applicant must indicate which materials (i.e. quarry tile, stainless steel, 4" plastic coved molding, etc.) will be used in the following areas. (Please be specific). DESCRIBE FINISH MATERIALS BELOW FLOOR WALLS CEILINGS FLOOR/WALL JOINT INSECT & RODENT CONTROL 1. Mobile food operations serving unpackaged foods must be sealed to prevent environmental contamination of equipment surfaces. Are all openings adequately sealed? YES ( ) NO ( ) 2. Will air curtains be used? YES ( ) NO ( ) a. Note location: North Andover Mobile Food Establishment Plan Review Application Page 8 WATER AND WASTE Note: It is essential that sufficient potable water, at appropriate temperatures, under pressure will be available at all times, including peak demand periods. Potable water must be obtained from your licensed commissary. 1. Is running potable hot and cold water provided? YES ( ) NO ( ) 2. What is the capacity of the fresh water tank? 3. How will the tank be cleaned and sanitized? a. At what frequency? 4. What is the capacity of the waste water tank? 5. What is the capacity of the hot water heater? PLUMBING CONNECTIONS Note: The FDA Food Code plumbing requirements do not replace or supersede the Plumbing Code; instead it highlights potential hazardous circumstances and particular types of equipment common to mobile food service establishments. Equipment Code Requirements Confirmed by Describe/ Operator Comments (please initial) Steam Jacketed Kettle Backflow prevention Device Indirect Waste Steamer Backflow prevention Device Indirect Waste At all hose connections Backflow prevention device Carbonated Beverage Carbonator backflow Dispenser prevention device Refrigerator condensate/ Indirect Waste drain lines All Sinks Air Gap Ice Cream Dipper Wells Air Gap Other, Describe North Andover Mobile Food Establishment Plan Review Application Page 9 VENTILATION Note: Ventilation systems must be correctly designed, sized, and installed to both satisfy the Fire Code requirements and to meet the specific needs of the operation and equipment selected in order to properly control/remove heat, humidity, odors, smoke, and grease laden air. Contact the North Andover Fire Department for details. Indicate all areas where exhaust hoods are installed: LOCATION FILTERS SQUARE FEET FIRE AIR CAPACITY AIR MAKEUP AND/OR PROTECTION CFM CFM EXTRACTION DEVICES Hood Cleaning Company Name: Cleaning Frequency: GENERATOR How many watts are required to effectively meet service demands? SINKS 1. Is a Prep Sink present? YES ( ) NO ( ) a. How many? 2. Are Hand Wash Sinks within easy access of each preparation, cooking and service area? YES ( ) NO ( ) a. How many? 3. Is there a 3-Bay Sink? YES ( ) NO ( ) North Andover Mobile Food Establishment Plan Review Application Page 10 DISHWASHING FACILITIES 1. List any utensils or dishes that will be washed, rinsed and sanitized: 2. If you have dishes, how will they be sanitized? Dishwasher 3 Bay Sink 3. Type of sanitation used in 3-Bay Sink (ex Quat or Chlorine): a. Concentration of Sanitizer: (ex Quat = 200 ppm, Chlorine = 50 ppm) 4. Type of sanitization used in Dishwasher: Hot water Rinse Temp: Booster heater Chemical type Concentration: 5. Is ventilation provided for Dishwasher? YES ( ) NO ( ) 6. Do dish machines have temperature gauges as required that are accurate? YES ( ) NO ( ) 7. Does the largest pot and pan fit into each compartment of the pot sink? YES ( ) NO ( ) If no, what is the procedure for manual cleaning and sanitizing? 8. Are there drain boards on both ends of the pot sink? YES ( ) NO ( ) 9. Are test papers and/or kits available for checking sanitizer concentration? YES ( ) NO ( ) HANDWASHING FACILITIES Note: Handwashing sinks must be dedicated to that use only, and designated with signage, (ex. Handwashing Only). 1. Are handwashing sinks conveniently located? YES ( ) NO ( ) 2. Do self-closing metering faucets provide a flow of water for at least 15 seconds without the need to reactivate the faucet? YES ( ) NO ( ) 3. Is hand cleanser available at all hand washing sinks? YES ( ) NO ( ) 4. Are hand drying facilities available at all hand washing sinks? YES ( ) NO ( ) 5. Operators of mobile food operations shall obtain the use of adequate and suitable toilet facilities where handwashing facilities are available. List location of suitable toilet facilities: North Andover Mobile Food Establishment Plan Review Application Page 11 Statement — Please Sign Below I hereby certify that the above information is correct, and I fully understand that any deviation from the above without prior permission from this Health Regulatory Office may nullify final approval. Signature (s)for Owner(s) or responsible representative (s) Print: Date: Thank-you for submitting your Plan Review Application. Please note that approval of these plans and specifications by this Regulatory Authority does not indicate compliance with any other code, law or regulation that may be required--federal, state, or local. This approval does not constitute endorsement or acceptance of the completed establishment (structure or equipment). A preoperational inspection with equipment in place and a preopening inspection of the establishment will be necessary to determine if it complies with the local and state laws governing mobile food service establishments. For Board of Health Office Use Only Below: Date received Approved / Denied Date revised application received: Approved /Denied Inspection Date (s): Approved by: Date: North Andover Mobile Food Establishment Plan Review Application Page 12 TOWN OF NORTH ANDOVER 4 io Health Department 120 Main Street, North Andover, MA 01845 Tel: 978.688.9540 Fax: 978.688.9542 healthdept@northandoverma.gov Residential Kitchen Establishment Plan Review Application This application is for individuals planning to prepare non-Time and Temperature Control for Safety(TCS) foods such as baked goods, confectioneries,jams and jellies,in a home kitchen, to be sold DIRECTLY TO THE CONSUMER. No permit is required for cottage food operations selling whole uncut fresh fruits and vegetables, unprocessed honey,pure maple products,or farm fresh eggs stored at 45°F or less. Application must be submitted at least 60 days before the planned opening date. Applicant Information Establishment Name: Application Date: Establishment Address: City: State: Zip: Name of Owner: Mailing Address: Phone: Email: Brief Menu Description: CommitteeTechnical Review The Town Planning Department offers the option of attending a Technical Review Committee (TRC) meeting to all applicants.As the applicant, I acknowledge that I have received an explanation and understand that the purpose of the TRC meeting is to assist me in the various town processes needed to open my establishment. If declined, I understand that I have forfeited this opportunity to learn more about the North Andover permitting process. I wish to attend or decline(circle one) participation in the TRC process. Date of TRC(BOH only) l ATTACHMENT CHECKLIST Please attach the following documents to your Plan Review Application Proposed Menu: All menus must have an allergen advisory stating "before placing your order please inform your server if you have a food allergy". Residential Kitchens are restricted to the sale of non-Time and Temperature Control for Safety (TCS)foods. Layout: Include a sketch of the kitchen including food preparation area, food storage area, dish washing areas, refrigerator, hand wash sink, garbage and toilet facility. Example of Product Label: Provide example label for any packaged items to be sold in a grab & go or retail area such as at a farmer's market stand or temporary event. Label must include establishment name and location, all ingredients, allergen information, weight and sell by date if required. Certified Food Protection Manager or Serve Safe Certificate Allergen Awareness Training Certification Copy of State Wholesale License: Wholesale license is applicable if your product is sold to a retail establishment for resale. Contact State of MA Food Protection Program for further information on Wholesale Licensing for Residential Kitchens. Please note: 105 CMR 500.015 (D) states that "Only non-potentially hazardous foods and foods that do not require refrigeration shall be prepared in or distributed from a residential kitchen for sale at wholesale. Ingredients that are potentially hazardous foods, such as milk, cream, and eggs, may be used in food preparation provided that the final product is not a potentially hazardous food." North Andover Residential Kitchen Plan Review Guide Page 2 a Food Preparation in a Massachusetts Residential Kitchen Massachusetts Residential Kitchens may prepare only non-Time and Temperature Control for safety (TCS) foods and foods which do not require refrigeration and/ or a variance. TCS foods such as eggs and milk may be used as ingredients so long as the final product is non-TCS. Foods that are ALLOWED include: • Baked goods • Confectionaries • Jams and Jellies. Foods that are PROHIBITED include: • Cream-filled pastries • Cheese cake and custard • Cut fruit and vegetables • Pickled products • Tomato and BBQ Sauce • Garlic in oil products • Salad Dressing • Salsa and Relish • Any foods using special processes such as acidification, vacuum packaging, hot filling and curing/smoking. The only exception is jams and jellies that are thermal — processed in hermetically sealed containers. Laboratory Analysis may be required to determine whether menu items may be considered non-Time and Temperature Control for Safety (TCS). Non-TCS foods would have a final pH of 4.6 or a water activity of 0.85 aw or below. See Resources list for information on certified laboratories. 1. List the food items to be prepared in or distributed from the Residential Kitchen 2. Who will prepare the food? Note that only household members may be employed in the operation. North Andover Residential Kitchen Plan Review Guide Page 3 3. Will food products be sold in state and directly to the consumer Yes No Retail Residential Kitchen operations are restricted to sales directly to the consumer. If the product is sold to retail stores, restaurants, etc. then a Wholesale License must be obtained from the Massachusetts Food Protection Program. Additionally, food manufactured in Massachusetts Residential Kitchens may not be sold out-of-state because the US FDA does not recognize these foods as coming from an approved source. 4. Do you have a MA Wholesale License? Yes No (please attach) 5. Will food be prepared on site? Yes No 6. Describe how ingredients will be stored separately from "private use" foods? 7. Where will equipment such as utensils, cutting boards and pots be washed, rinsed, and sanitized? Ensure that the largest pot, pan or cutting board can fit. Dishwasher (Equip this with a Maximum Registering Thermometer) Three compartment Sink Labeled bins 8. Which method of chemical sanitization will be used to sanitize food contact surfaces? Sponges may not be used to wipe food contact surfaces. Obtain a test kit to ensure that chemical sanitizers are maintained at proper concentration. Sanitizers must be labeled and stored away from food products. Chlorine, maintained at a concentration of 50 ppm Quaternary Ammonia, maintained at a concentration of 200 ppm 9. Do the kitchen and bathroom sinks have hand soap and paper towels? Yes No 10. Is a thermometer or thermal label available to measure the dishwasher rinse temperature?_Yes No Maximum registering thermometer or a heat thermal label must be used to determine that the dishwasher's internal temperature is a minimum of 150' F after the final rinse and drying cycle. 11.What methods will be used to prevent bare hand contact with ready-to-eat foods? 12.Will food be packaged on site? Yes No Please attach a sample label that includes establishment name and location, ingredients, allergen information, and sell-by and weight if applicable. North Andover Residential Kitchen Plan Review Guide Page 4 Additional Resources: • Retail Sale Regulations: 105 CMR 590.000: State sanitary code chapter X: Minimum sanitation standards for food establishments, as adopted on 10/512018. Copies available at mass.gov Food Protection Program. • Massachusetts Food Protection Program, Minimum Requirements for Packaged Food Labeling: http://www.mass.gov/eohhs/docs/doh/environmental/foodsafety/food-label-brochu re.pdf • Massachusetts Wholesale Regulations: 105 CMR 500.000 Good Manufacturing Practices. Copies available at http://mass.gov/dph/fpp. • State of MA Residential Kitchen Brochure: https://www.mass.gov/files/documents/2016/10/gz/residential-kitchens-brochure.doc • University of Massachusetts Extension list of Food Product Testing Laboratories: https:Hag.umass.edu/sites/ag.umass.edu/files/food-science/laboratories auq 2014.pdf North Andover Residential Kitchen Plan Review Guide Page 5 Statement — Please Sign Below I hereby certify that the above information is correct, and I fully understand that any deviation from the above without prior permission from this Health Regulatory Office may nullify final approval. Signature (s)for Owner(s) or responsible representative (s): Print: Date: Thank-you for submitting your Plan Review Application. Please note that approval of these plans and specifications by this Regulatory Authority does not indicate compliance with any other code, law or regulation that may be required--federal, state, or local. This approval does not constitute endorsement or acceptance of the establishment(structure or equipment). A preoperational inspection with equipment and supplies in place will be necessary to determine if it complies with the local and state laws governing Residential Kitchen establishments. For Board of Health Office Use Only Below: Date received: Approved / Denied Date revised application received: Approved / Denied Inspection Date (s): Approved by: Date: North Andover Residential Kitchen Plan Review Guide Page 6 y I(AW TOWN OF NORTH ANDOVER Health Department 120 Main Street, North Andover, MA 01845 Tel: 978.688.9540 Fax: 978.688.9542 healthdept@northandoverma.gov Limited Renovation Plan Review Application for Existing Food Establishments This application is for applicants with current permits to sell food in North Andover. Limited renovations may include menu changes, simple renovations or equipment replacement. Applicant Establishment Name: Application Date: Establishment Address: City: State: Zip: Name of Owner: Mailing Address: Phone: Emergency 24 Hr Phone: Email: Please Describe the nature of your minor renovation or menu change: Technical Review Committee The Town Planning Department offers the option of attending a Technical Review Committee (TRC) meeting to all applicants. As the applicant, I acknowledge that I have received an explanation and understand that the purpose of the TRC meeting is to assist me in the various town processes needed to open my establishment. If declined, I understand that I have forfeited this opportunity to learn more about the North Andover permitting process. I wish to attend or decline (circle one) participation in the TRC process. Date of TRC (BOH only) 1 ATTACHMENT CHECKLIST Attach all applicable documents to your plan review application. Note NA where not applicable. Proposed menu: List of any NEW types of foods to be served. New food processes such as rice acidification or reduced oxygen packaging require Health Department approval. Floor Plan (inside establishment): Show location of NEW equipment. Sketch on accompanying sheet or include plans. Manufacturer Specification sheets for each new piece of NEW equipment on the plan. Provide Hazard Analysis Critical Control Plan (HACCP)for any specialized processing methods such as 1) Smoking food as method of preservation, 2) Curing food, 3) Using food additives or adding components such as vinegar to preserve food or render a food so that it is not a TCS Food (Time/Temperature Control of Safety Food) such as Sushi Rice. Provide Written Standard Operation Procedures for processes including Time as a Public Health Control. North Andover Limited Renovation Application Page 2 FLOOR PLAN Attach plans or sketch establishment layout below. Include the location of all equipment including but not limited to hand sinks, 3 bay sinks, prep sink, mop sink, hot and cold holding units, dishwashers, prep tables, walk-ins, chemical storage area and dry storage area. Highlight areas where NEW equipment will be installed or replaced. North Andover Limited Renovation Application Page 3 i FINISH SCHEDULE Complete for any NEW areas of the facility Materials selected must be durable and appropriate to the area and its intended use. High moisture and food splash areas must be non-absorbent, smooth and easily cleanable. All openings must be tight fitting, properly sealed and without voids. Applicant must indicate which materials (i.e. quarry tile, stainless steel, 4" plastic coved molding, etc.)will be used in the following areas. (Please be specific). FLOOR CURVED WALLS3 CEILING COVING2 Kitchen Food Storage Bar Ware washing Area Walk-in Refrigerators and Freezers Dining Area Toilet Rooms Garbage & Refuse Storage Dressing rooms Mop Service Basin Area 1 Example floor materials are as follows: • Quarry tile,ceramic tile •SEALED curbed concrete • Seamless poured epoxy minimum 3/16-inch thick. • Commercial-grade sheet vinyl (no felt backing) • Commercial-grade vinyl composition tile(VCT) Pre-approval from the REGULATORY AUTHORITY should be obtained prior to use of carpet and/or wood (Food Establishment Plan Review Manual 2016, p.27). 2 Coved flooring material should extend integrally up the walls. Integral coving is not required in areas used exclusively for dining, point-of-sale,or the storage of UTENSILS or FOODS contained in the original un-opened container(Food Establishment Plan Review Manual 2016, p.24). 3 Example wall materials are as follows: •Stainless steel • Ceramic tile •Aluminum • Fiber-glassed reinforced panels(FRP) •SEALED Concrete blocks or bricks • Epoxy or glazed drywall (Food Establishment Plan Review Manual 2016, p. 28). 4 Example ceiling materials may include wall finish material listed above along with the following: • EASILY CLEANABLE, non-absorbent ceiling tiles • Painted drywall (Food Establishment Plan Review Manual 2016, p. 27). North Andover Limited Renovation Application Page 4 Statement — Please Sign Below 1 hereby certify that the above information is correct, and I fully understand that any deviation from the above without prior permission from this Health Regulatory Office may nullify final approval. Signature (s)for Owner(s)or responsible representative (s) Print: Date: Thank-you for submitting your Limited Renovation Application. Please note that approval of these plans and specifications by this Regulatory Authority does not indicate compliance with any other code, law or regulation that may be required-federal, state, or local. This approval does not constitute endorsement or acceptance of the completed establishment (structure or equipment). A preconstruction inspection with new equipment in place and preopening inspection of the establishment may be necessary to determine if it complies with the local and state laws governing food service establishments. For Board of Health Office Use Only Below: Date received Approved / Denied Date revised application received: Approved / Denied Inspection Date (s): Approved by: Date: North Andover Limited Renovation Application Page 5 TOWN OF NORTH ANDOVER Health Department 120 Main Street, North Andover, MA 01845 Tel: 978.688.9540 Fax: 978.688.9542 healthdept@northandoverma.gov Food Establishment Permit Application Application must be submitted at least 30 days before the planned opening date Check One: New Establishment Permit Renewal Establishment Information Establishment Name: Application Date: Establishment Address: i Total Square Feet of Facility: Total Number of Seats: _ .................. ..._..._..__............ ..._._..._. ___........ Total Number of Food Service Employees: .............. -_------------------ -------•--------------------_—_--------------� Contact Information (note NA if not applicable) Name of Owner: Phone: Email Name and Title of Applicant(if not owner): j a Phone: Email l Person Directly Responsible for Daily Operations: Phone: Email Emergency Emergency Contact Available 24/7 Name: ----------------------------------------- _--------------------------._...-----------------------------._...- -------------------- Phone: Email Preferred Business Mailing Address ----------------__._..___-.__-_._.---.--.._...._...___...___....-----_.___.___...-•----.-.----.._....---....___...... _...-----.----.----.____...____.__.... City: State: Zip: ------------ ---------------------------------_ ------_——_----------------------...------—_----- Establishment is Owned By: i An Association A Corporation An Individual A Partnership Other Legal Entity I Corporation Name: _ --_------------_- -------------------...------------------------------------------------------------ -----' Corporation Address: City: State- Zip: District or Regional Supervisor: -_-------------_ _ -__ --------------------—----------.._._-------------------- ----------------- ___ ----- _-._..._...... _.� Phone: Email Retail Prepackaged Food Only Residential Kitchen Limited Food Service Temporary Food Establishment Food Service Establishment Seasonal Food Establishment Catering Supermarket Food Operations (Check All That A. . DEFINITIONS ➢ TCS—Temperature Control for Safety Food.Time/temperature controls required. Ex: milk,chicken,cooked veg. ➢ Non-TCS—Non Temperature Control for Safety Foods. No time/temperature controls required. Ex: chips,bread. ➢ RTE—Ready to Eat Foods. Ex:sandwiches,salads, muffins and foods which need no further processing. Sale of commercially pre-packaged TCS Foods Sale of commercially pre-packaged Non-TCS Foods Delivery of packaged TCS Foods TCS Foods cooked to order Hot TCS Foods cooked and cooled or hot held for more than single meal service Preparation of TCS Foods for hot and cold holding for single meal service TCS Foods and RTE foods prepared for highly susceptible population facility Sale of raw animal foods intended to be prepared by consumer Vacuum packaging/cook chill Reheating of commercially processed foods for service within 4 hours Customer self-service Use of process requiring a variance and/or HACCP Plan (ex. bare hand contact alternative,time as a public health control) Customer self-service of non-TCS Foods and non-perishable foods only Ice manufactured and packaged for retail sale Offers raw or undercooked food of animal origin Preparation of non-TCS Foods Juice manufactured and packaged for retail sale Prepares food/single meals for catered events or institutional food service Offers RTE TCS Foods in bulk quantities Retail sale of salvage, out of date or reconditioned food Frozen Dessert Manufacturing such as soft serve machine Certified Staff(Attach Certifications) North Andover Food Establishment Permit Application Page 2 Check all that apply Certified Food Allergen Awareness Choke Saver Staff Name Protection Manager Certified, Certified (Serve Safe), a) Each food establishment shall employ at least one person in charge who shall be an on-site manager or supervisor and is at least 18 years of age and who by being a certified food protection manager has shown proficiency of required information through passing a certification examination that is part of an accredited program recognized by the Department.105 CMR 590.002,2-101.11(A). b) Food establishments that cook,prepare,or serve food intended for immediate consumption shall have on staff a certified food protection manager who has been issued a Massachusetts certificate of allergen awareness training by an allergen awareness training verification program recognized by the Department.105 CMR 590.001 Ch.11(C)3. c) Each food service establishments with a seating capacity of 25 or more seats shall have on its premises,while food is being served,an employee trained in manual procedures to remove food lodged in a person's throat.105 CMR 590.011 Ch.11, (A). Applicant I,the undersigned,attest to the accuracy of the information provided in this application and I affirm that the food establishment operation will comply with 105 CMR 590.000 and Article X of the State Sanitary Code,and all other applicable law. I have been instructed by the Board of Health on how to obtain copies of 105 CMR 590.000 and the Federal Food Code,. Signature of Applicant: Print Name: Pursuant to MGL Ch. 62C,sec.49A, I certify under the penalties of perjury that I,to my best knowledge and belief, have filled all state tax returns and paid state taxes required under the law. Signature of Applicant: Print Name: In Massachusetts the current Food Code is 105 CMR 590.This code references the FDA 2013 Food Code and is available through the Massachusetts Department of Public Health and at mass.gov.See links for the"Merged Food Code". North Andover Food Establishment Permit Application Page 3 .-1 ;Y113 - Percent Change in Fees for North Andover Food Permits under New Proposed Fee Structure Total Current Fee per Total New Fee per Dollar Change in %Change in Food Establishment Title Current Permit Types establishment New Permit Types Establishment Permit Total permit fee CVS Pharmacy#1239 Pharmacy;Small Retail $280.00 Retail $160 -$120.00 -43% CVS Pharmacy#209 Pharmacy;small Retail $280.00 Retail $160 -$120.00 -43% Rite Aid#10117 Pharmacy;Small Retail $280.00 Retail $160 $120.00 43°/a Wal reens#10209 Pharmacy;Small Retail $280.00 Retail $160 -$120.00 -43% Cakes by Design Edible Art Small Retail Bakery $280.00 Limited Food Service $180 -$100.00 -36% Frederick's Pastries Small Retail/Bakery $280.00 Limited Food Service $1 BO -$100.00 -36% Ye Olde Pepper Co.Candy Shoppe Small Retail Store $280.00 Limited Food Service $1 BO -$100.00 -36% Boston Hill Farm Stand Small Retail;Bake $280.00 Food Service $200 -$80.00 -29% Pomaire Boston Chilean Food Truck(Peter&Diana Varas 978.869.7851) Mobile Food On-Site Pre $140.00 Mobile Food $115 -$25.00 -18% Brooks School-Student Center Store Convenience store $185.00 Retail $160 -$25.00 -14% Joe's Variety Convenience Store $185.00 Retail $160 -$25.00 -14% Qule Plc Convenience Store $185.00 Retail $160 -$25.00 -14% Sam's Mobil Mart Gas Station $185.00 Retail $160 -$25.00 -14% Merrimack College-Mack Center front hockey Conc. Restaurant/frozen desserts $225.00 Food Service/Frozen desserts $200 -$25.00 -11% Brooks School-Wilder Dining Hall Restaurant/Fmzen Desserts $225.00 Food Service/Frozen Desserts $200 -$25.00 -11% Burger Kin #260 Restaurant/Frozen desserts $225,00 Food Service/Frozen Desserts $2DO -$25.00 -11% Dunkin Donuts-1018 Osgood Street Restaurant/frozen desserts $225.00 Food Service/Frozen desserts $2DO -$25.00 -11% Dunkin Donuts-129 Main Street Restaurant/Frozen desserts $225.00 Food Service/Frozen desserts $200 -$25.00 -11% Dunkin Donuts-1503 Osgood Street Restaurant I Frozen Desserts $225.00 Food Service/Frozen desserts $200 -$25.00 -11% Dunkin Donuts-535 Chickering Read Restaurant/Frozen Desserts $225.00 Food Service/Frozen desserts $200 -$25.00 -11% Dunkin Donuts-701 Salem Street Restaurant $225.00 Food service $200 -$25.00 -11% Dunkin Donuts-733 Turnpike Street Restaurant/Frozen Desserts $225.00 Food Service/Frozen desserts $200 -$25.OD .11% McDona Restaurant Restaurant/Frozen Desserts $225.00 Food Service/Frozen desserts $200 -$25.00 -11% Merrimackck College-Dunkin Donuts Restaurant/Frozen desserts $225.00 Food Service(Frozen desserts $200 -$25.00 -11% Sal's Just Pizza Restaurant/f ozen desserts $225.00 Food Service/Frozen desserts $200 -$25.00 -11% Taki's Pizza Restaurant/frozen desserts $225,00 Food Service/frozen desserts $200 -$25.00 -11% Zincla Restaurant(Frozen desserts $225.00 Food Service/Frozen desserts $200 -$25.00 -11% Market Basket Su store $530.00 Supermarket $500 -$30.00 -6% Stop&Shop Superstore $530.00 Supermarket $500 -$30.00 -6% Fuddrucker's Restaurant Restauranl/Caterer/Frozen Deserts $365.00 Food Service/Caterer/Frozen Dessrt $350 -$15.00 -4% Mad Ma ie's Ice Cream Restaurant/Calerer/Frozen deserts $365.00 Food Servlce/Caterer/Fmzen Dessrt $350 -$15.00 -4% Merrimack College S ar 's Place Main Dining&B Restaurant/Caterer/Frozen Deserts $365.00 Food Service/Caterer I Frozen desserts $350 -$15.00 -4% Merrimack Colle a-Mack Center back basketball Cot Restaurant $185.00 Limited Food Service $180 -$5.00 -3% North Andover Raceway Convenience Store $185.00 Limited Food Service $180 -$5.00 -3% Richdale#5 Convenience Store $185,00 Limped Food Service $180 -$5.00 -3% Richdale#52 Convenience Store $185.00 Limited Food service _ $180 -$5.00 -3% Atkinson School Tax Exempt $0.00 Tax Exempt $0 $0.00 0% Barkers Farm(inspect once a ear Seasonal $60.00 seasonal $60 $0.00 0% Brooks Camp Building-Seasonal(inspect once a Ye seasonal $60.00 seasonal $60 $0.00 0% Cake Talk(Nicole Lizotte 781.439.8627)Inspect once a year Residential Cook $25.00 Residential Kitchen $25 $0.00 0% Cookie Central 978-423-1215 (inspect once a yearq Residential Cook $25.00 Residential Kitchen $25 $0.00 0% First Calvary Baptist Church Church/Tax Exempt $0.00 Non-Profit $0 $0.00 0% First United Methodist Church Churohrrax Exempt $0.00 Non-Profit $0 $0.00 0% Franklin School Tax Exempt $0.00 Nor-Profit $0 $0.00 0% GKK Pushcarts(inspect once a ear seasonal $60.00 seasonal $60 $0.00 0% Johnny Cakes Residential Cook $25.00 Residential Kitchen $25 $0.00 0% Kittredge School Tax Exempt $0.00 Nom-Profit $0 $0.00 0% McEvoy Food Concessions Seasonal snack bar $60.00 seasonal $60 $0.00 0% North Andover Council on A I Senior Center Tax Exempt $0.00 Non-Profit $0 $0.00 0% North Andover CountryClub(inspect once a ear Seasonal Snack bar $60.00 Seasonal $60 $0.00 0% North Andover High School Tax Exempt $0.00 Non-Profit $0 $0.00 0% North Andover Middle School Tax Exempt $0.00 NonProfit $0 $0.00 0% North Parish Church Church/fax Exempt $0.00 Non-Profit $0 $0.00 0% Pi a Dream Cu cakes Residential Cook $25.00 Residential Kitchen $25 $0.00 0% Sargent School Tex Exempt $0.00 Non-Profit $0 $0.00 0% Pagel Percent Change in Fees for North Andover Food Permits under New Proposed Fee Structure Total Current Fee per Total New Fee per Dollar Change in %Change in Food Establishment Title Current Permit Types establishment New Permit Types Establishment Permit Total permit fee St.Gregory Armenian Apostolic Church Churchrrax Exempt $0.00 Non-Profit $0 $0.00 0% St.Michael's Church Churchrrax Exempt $0.00 Non-Profit $0 $0.00 0% St.Paul's Episcopal Church Churchrrax Exempt $0.00 NOn Prorit $0 $0.00 0% Tatiana's Treats 978-258-4734 once a ear Residential Cook $25.00 Residential Kitchen $25 $0.00 0% Stevens Estate Function Facilltv $0.00 Non--Profit $0 $0.00 0% Thomson School Tax Exempt $0.00 Non-Profit $0 $0.00 O% Ashland Farms Healthcare>50 $195.00 Food Service $200 $5.00 3 Bri htview North Andover Healthcare>50 $195.00 Food Service $200 $5.00 3 Ed ewood Retirement-Bistro/Pub Healthcare>50 $195.00 Food Service $200 $5.00 3 Ed ewood Retirement-Meadows Healthcare>50 $195.00 Food service $200 $5.00 3% Ed ewood Retirement Home Healthcare>50 $195.00 Food Service $200 $5.00 3 Prescott House Nursinq Home Healthcare>50 $195.00 Food service $200 $5.00 3% Sutton Hill Nursing&Rehab Center Healthcare>50 $195.00 Food service $200 $5.00 3% Smolak Farms Rest/Sm.Retal[lBake /Caterer/Frozen Des e $495.00 Food Service/Frozen Desserts I Caterer/Urnite $530 $35.00 7% Stache 's II Restaurant/Caterer $325.00 Food Service/Caterer $350 $25.00 8% Bollywood Grill Restaurant/Caterer $325.00 Food Service/Caterer $350 $25.00 8% Good Day Cafe Restaurant/Caterer $325.00 Food ServicelCaterer $350 $25.00 8% Green Apple Cafe Restaurant/Caterer $325.00 Food Service/Caterer $350 $25.00 8% Harrison's Roast Beef Restaurant/Caterer $325.00 Food Service/Caterer $350 $25.00 8% Jaime's Restaurant Restaurant/Caterer $325.00 Food Service/Caterer $350 $25.00 8% Orzo Restaurant Restaurant/Caterer $325.00 Food Service/Caterer $350 $25.00 8% Osgood Landing former) Luci's Caf/Retaii/Catering $325.00 Food service]Caterer $350 $25.00 8% Shadi'sRestaurant Restaurant/Caterer $325,00 Food Service/Caterer $350 $25.D0 8% Shun'u Chinese&Japanese Cuisine Restaurant/Caterer $325.00 Food Service/Caterer $350 $25.D0 8% Thyme Restaurant Restaurant $185.00 Food service $200 $15.00 8% Amid's Pizza&Subs Restaurant $185.00 Food Service $200 $15.00 8% b. ood Restaurant $185.00 Food Service $200 $15.60 8% Bertucci's Brick Oven Pizza Restaurant $185.00 Food service $200 $15.00 8% Boston Chowda Company Restaurant $185.00 Food Service $200 $15.00 8% Brooks School-Snack Bar Restaurant $185.00 Food Service $200 $15.00 8% Buono Bistro Restaurant $185.00 Food service $200 $15.00 8% Burton's Grill Restaurant $185.00 FoodServlce $200 $15.00 8% Captain Pizza Restaurant $185.00 Food service $200 $15.00 8% Casa Blanca Mexican Rest. Restaurant $185.00 Food service $200 $15.00 8% Chama Grill Restaurant $185.00 Food Service $200 $15.O0 8% China Blossom Restaurant $185.00 Food Service $200 $15.00 8% China Wok Restaurant Restaurant $185.00 Food service $200 $15.00 8% Chi olle Mexican Grill Restaurant $185.00 Food Servlca $200 $15.00 8% Cow's Rock Restaurant $185.00 Food Service $200 $15.00 8% Cul a er's Bar&Grille Restaurant $185.00 Food Service $200 $15.00 8% Dicor Restaurant Restaurant $185.00 Food Service $200 $15.00 8% Dominic's Diner Restaurant $185.00 Food Service $200 $15.00 8% Fari'sDiner Restaurant $185.00 Food service $200 $15.00 8 Heav'nly Donuts Restaurant $185.00 Food Service $200 $15.00 B% Hokkaido Restaurant Restaurant $185.00 Food Service $200 $15.00 8% House Pizza Restaurant $185.00 Food S-Ice $200 $15.00 8% J&M Subs,Seafood&Pizza Restaurant $185.00 Food Service $200 $15.00 8% Jimmy's Famous Pizza Restaurant $185.00 Food service $200 $15.00 8% Joe Fish Restaurant Restaurant $185.00 Food Service $200 $15.00 8% LaserCraze Family Entertainment $185.00 Food Service $200 $15.00 8% Lobster Tail Seafood Restaurant $185.00 Food Service $200 $15.00 8% Loft Steak and Chop House Restaurant $185.00 Food service $200 $15.00 8% Lots of Eats Restaurant $185.00 Food Service $200 $15.00 8% Merrimack College-AFC Sushi Restaurant $185.00 Food Service $200 $15.00 8% Merrimack College-Warrior's Den Restaurant $185.00 Food Service $200 $15.00 8% Merrimack College-Zime Retail new name Coll eCaM $185.00 IFood service $200 $15.00 8 Page 2 Percent Change in Fees for North Andover Food Permits under New Proposed Fee Structure Total Current Fee per Total New Fee per Dollar Change in %Change in Food Establishment Title Current Permit Types establishment New Permit Types Establishment Permit Total permit fee Merrimack College Residence @ Austin Field Restaurant $185.00 Food Service $200 $15.00 8% Merrimack College-Starbucks Restaurant $185.00 Food Service $200 $15,00 8% Nikl's Famous Roast Beef Pica and more Restaurant $185.00 Food Service $200 $15.00 8% Ninety-Nine Restaurant&Pub Restaurant $185.00 Food Service $200 $15.00 8% North Andover Country Club Restaurant $185.00 Food Service $200 $15.00 8 Panera Bread Restaurant $185.00 Food Service $200 $15.00 8% Perfecto's Cafd Restaurant $185.00 Food Service $200 $15.00 8% Pizza Factory Restaurant $185.00 Food Service $200 $15.00 8% ROlfs Restaurant $185.00 Food Service $200 $15.00 8% Shiny Sushi inside Market Basket Restaurant $185.00 Food Service $200 $15.00 8% Spectrum Adult Day Health Adult Day Health $185.00 Food Service $200 $15.00 8% Starbucks'Coffee Restaurant $185.00 Food Service $200 $1, 8% Subway Restaurant $185.00 Food Service $200 $15.00 8% Tripoli Bakery&Pizza Restaurant $185.00 Food Service $200 $15.00 6% Royal Crest Drive Dan 978-682-7200 Club;Organization $160.00 Limited Food Service $180 $20.00 13% VFW Club 2104 Club;Organization $160.00 Limited Food Service $180 $20.00 13% Butcher Boy Market Supermarket;Caterer $540.00 Supermarket/Caterer $650 $110.00 20% Pipe Dream Cupcakes Mobile Food no on-site r $95.00 Mobile Food $115 $20.00 21% Whoo ie Wagon Chris Bandereck 978.887.0795 Mobile Food no on site prep $95.00 Mobile Food $115 $20.00 21% J&M Convenience Store Small Retail Store $130.00 Retail $160 $30.00 23% Ka s Hallmark Small Retail Store $130.00 Retail $160 $30.00 23% La Botts a Wine and Beer Retail;Food;Takeout $130.00 Retail $160 $30.00 23% Merrimack College Book Store Small Retail Store $130.00 Retail $160 $30.00 23% Rockys Ace Hardware Small Retail Store $130.00 Retail $160 $30.00 23% Staples Small Retail Store $130.00 Retail $160 $30.00 23% T.J.Marx#442 Small Retail Store $130.00 Retail $160 $30.00 23% Brooks School-Frick Dining Hall Club;Organization $160.00 Food Service $200 $40.00 25% Cochichewick Lode Club;Organization $160.00 Food Service $200 $40.00 25% Rollinq Rid a Conference Center Function Facility $160.00 Food Service $200 $40.00 25% Van Otis Candies Small Retail Store $130.00 Limited Food Service $180 $50.00 38% Burke's Den Rock Mobil Gas Station $110.00 Retail $160 $50.00 45% Den Rock Wines&Spirits Liquor Store $110.00 Retail $160 $50.00 45% Infinity Fitness(formerly Fitness for You Gym;Health Club $110.00 Retail $160 $50.00 45% Main Street Liquors Liquor Store $110.00 Retail $160 $50.00 45% A.L.Prime Energy Gas station $110.00 Limited Food Service $180 $70.00 64% Choice Fitness Gym;Health Club $110.00 Limited Food Service $180 $70.00 64% Kindercare Learning Center Day Care Facility $110.00 Limited Food Service $180 $70.00 64% Legends Gymnastics Gym;Health Club $110.00 Limited Food Service $180 $70.00 64% Little Sprouts Day Care Facility $110.00 Limited Food Service $180 $70.00 64% Just Like Home(St Michael School DayCareFacilllyPrivate School $110.00 Food Service $200 $90.00 82% Mentor Academy Day Care Facility Private School $110.00 Food Service $200 $90.00 82% Totals Current Fees=> $26,990.00 $27, Difference=> $850.00 Total Establishments 36 Permit Fee Decreases 25 Permit Fee Stays the Same 91 Permit Fee Increases Updated May 20,2019 Page 3 About-2020 Preparedness Summit / ppe d 112312020 LOGIN fow how"* �. 2020 HILTON ANATOLE About the Preparedness summit About the Theme: Fixing Our Fault Lines: Addressing Systemic Vulnerabilities Disasters and emergencies expose the fault lines in our nation's health security. In these times of crisis, the vulnerabilities that exist in individual and community, infrastructure, health, and environmental systems intersect and become intensified — especially for the most at-risk www.preparednesssummit.org/about 1/4 1/23/2020 About-2020 Preparedness Summit communities. While much has bee and strengthen existin n done over the past decade to g systems, these systems have co build nt►nuously evolved to keep pace with the ever the underl in changing threat landscape. As Y g systemic vulnerabilities also lo° a result, did, and so must our a ng national k different than the nal o addressing those vulnera . once approach t A whole and fully functions bilities security system is only as str its weakest component. That's whythis °ng as is year's theme,Lines: Addressing System Fixing Our Fault i c Vulnerabilities, identify systemic weaknesses s� will focus on methods to and highlight tools and policies that can empower all communities, and particularly the ones that are vulnerable, to address those weaknesses and be most come more resilient. By bringing our hindsight to the table to assess how our preparedness and response efforts have fallen short in the past, we can create collective foresight that allows us to anticipate, address, and stabilize current fault lines to prevent them from shattering the communities we aim to protect. About the Preparedness Summit The Preparedness Summit is the first and longest running national conference on public health preparedness. Since its beginning in 2006, the National Association of County and City Health Officials (NACCHO) has taken a leadership role in convening a wide array of partners to participate in the Summit; presenting new research findings, sharing tools and resources, and providing a variety of opportunities for attendees to uww.preparednesssummit.org/about 2/4 /23/2020 About-2020 Preparedness Summit learn how to implement model practices that enhance the nation's capabilities to prepare for, respond to, and recover from disasters and other emergencies. Over the last decade, the nature of threats to our national health security have changed significantly. As professionals in the public health preparedness space, we can expect these threats to continue to evolve. It is imperative that we adapt our public health practices to meet the demands of an ever-evolving threat environment. But how do we, as preparedness leaders, help our communities become more prepared to respond to and recover from uncharted catastrophic events? We can start doing so by discovering new and creative solutions to address events like pandemic diseases, the opioid crisis, active shooter emergencies, and cybersecurity threats. Each year, the Preparedness Summit will feature experts from the healthcare and emergency management fields in addition to public health preparedness professionals to address the gaps between these life-saving industries in an effort to work more collaboratively and efficiently in the face of emerging threats. Reaching across these sectors will leverage diversity of thought and advance the capacity of our communities to respond to and recover from emergency events. We hope that this conference will provide an opportunity to build stronger partnerships and encourage us to find innovative solutions with our allies. 1/23/2020 About-2020 Preparedness Summit Copyright 2019. All rights reserved. American - Red Cross qQ IN NE ASP;- )14- s I a � tha STA LY C E V EPA HE4LTHCARE f EADY EliRiPrar1'� f+ir�v�■� �rs'o�.� 'FlueNtational SCIENCES, MEDICINE NACCHO Powered by Higher Logic G15 - Mobilizing Volunteers for Public Health Responses Session: Quick Hits Thursday April 2, 2020 10:30 AM — 12:00 PM Your Role: Speaker Speakers: Ellen Burgess, BA Virginia Beach Medical Reserve Corps Coordinator Virginia Beach Department of Public Health Email: ellen.burgess vdh.vir_ is inia.gov Office Telephone: (757) 518-2776 Cell Phone: (757) 326-1206 Jennifer E. Freeland, MA State Volunteer Coordinator 'Virginia Department of Health Email: Jennifer.free land(a)-vdh.virginia.gov Office Telephone: (804) 396-0543 Thomas G. Carbone, RS, CHO Director of Public Health Andover Health Division Email: tcarbone(aandoverma.gov Office Telephone: (978) 623-8640 Joanne Belanger, BS, RN Deputy Director of Public Health/ Director of Greater River Valley MRC Town of Andover Email: joanne.belanger(a-)-andoverma.us Office Telephone: (978) 623-8642 Cell Phone: (978) 799-8988 Brian J. LaGrasse, CEHT Town of North Andover Director of Public Health North Andover Health Department Email: blagrasseanorthandoverma.gov Office Telephone: (978) 688-9540 Cell Phone: (978) 265-4259 Session Descriptions: PART A: Mobilizing Mental Health Volunteers for Behavioral Health Recovery Quickly after the shooting in Virginia Beach on May 31, 2019, the need for mental health volunteers was realized. There were many details unknown, but the dedication, expertise and willingness of the volunteers exceeded all expectations. The VBSTRONG MRC team provided over 600 hours of support over 3 months. During the session, the speaker will share challenges and best practices in coordinating with partners, mobilizing volunteers and the long term utilization of volunteers. PART B: Public Health Response to the Merrimack Valley Gas Event The session will detail the immediate and long-term public health responses to the Sept. 13, 2018 natural gas disaster in the Merrimack Valley of Massachusetts. The event resulted in multiple structure fires, the evacuation of thousands of residents in three communities, the disruption of normal food service operations in businesses, and long term disruptions to residents dependent upon natural gas for heating, hot water, and cooking at home. The session will present information on the use of the Medical Reserve Corps to staff emergency shelters, temporary shower units, food distribution, and service centers set up to assist residents and businesses in recovery. Well over 100 food service establishments were impacted by the emergency curtailment of gas and power to the affected area, and how those businesses were supported and reopened in the following months will be presented. Finally, the event had a long-term effect on housing as thousands of families lived without heat, hot water, and gas for cooking, resulting in the relocation to temporary housing; the presentation will discuss the obstacles encountered, how they were overcome, and the impact the event had on landlord/tenant relations. Please let us know if you have any other questions. Best, Maeve Carey Speaker Manager 2020 Preparedness Summit SummitSpeakers(D-conferencemanagers.com (703) 964-1240 ext. 360 A It The Commonwealth of Massachusetts w Executive Office of Health and Human Services ' Department of Public Health '7M SV'v 250 Washington Street, Boston, MA 02108-4619 CHARLES D.BAKER MARYLOU SUDDERS Governor Secretary KARYN E.POLITO MONICA BHAREL,MD,MPH Lieutenant Governor Commissioner Tel:617-624-6000 www.mass.gov/dph January 22, 2020 To Healthcare Providers and Institutions, Infection Preventionists, Emergency Departments, Hospital Laboratories, EMS and LBOH Please see below for information from CDC about the outbreak of a novel coronavirus causing respiratory disease in Wuhan, China. On January 21, CDC announced the identification of the first case in the United States, in a Washington State resident with travel to Wuhan, China. At this time, the risk to residents in Massachusetts is low. CDC staff are screening passengers arriving from Wuhan into LAX, JFK and SFO which receive 74% of the flights from those areas. Over the next few days, screening will also start occurring at Atlanta and Chicago-O'Hare airports. CDC is working to have all travelers from Wuhan, China routed into one of those airports. There are no immediate plans to begin screening at Boston Logan International Airport. Patients who report recent travel to Wuhan who present to any facility or provider with a fever, lower respiratory tract symptoms (such as shortness of breath and cough), and/or contact with a known novel coronavirus patient should be asked to wear a surgical mask and be evaluated in a private room with the door closed, ideally an airborne infection isolation room if available. Healthcare personnel entering the room should use standard precautions, contact precautions, airborne precautions, and use eye protection (e.g., goggles or a face shield). Following the evaluation, contact the Massachusetts Department of Public Health (MDPH) 24/7 at 617-983-6800 for assistance in determining if the patient meets the criteria of a PUI requiring testing. Details about specimen types and collection methods are available here https://www.cdc.qov/coronavirus/2019-nCoV/guidelines-clinical-specimens.html. MDPH recommends that you contact MDPH to discuss the patient before collecting specimens for novel coronavirus testing. Shipping of specimens will be coordinated through the Massachusetts State Public Health Laboratory. While we are learning more about the transmission potential for this coronavirus, clinical and laboratory staff should follow the interim laboratory biosafety guidelines recommended by CDC: https://www.cdc.qov/coronavirus/2019-nCoV/lab-biosafety- quidelines.html. Facilities should ensure timely communication between clinical and laboratory staff to minimize risks associated with handling specimens. Information is still evolving rapidly and MDPH will update this information on an as needed basis. Update and Interim Guidance on Outbreak of 2019 Novel Coronavirus (2019-nCoV) in Wuhan, China Summary The Centers for Disease Control and Prevention (CDC)continues to closely monitor an outbreak of a 2019 novel coronavirus (2019-nCoV)in Wuhan City, Hubei Province, China that began in December 2019. CDC has established an Incident Management System to coordinate a domestic and international public health response. Coronaviruses are a large family of viruses. Some cause illness in people; numerous other coronaviruses circulate among animals, including camels, cats, and bats. Rarely, animal coronaviruses can evolve and infect people and then spread between people such as has been seen with Middle Eastern Respiratory Syndrome Coronavirus(MERS-CoV)(https://www.cdc.gov/coronavirus/mers/index.htmi)and Severe Acute Respiratory Syndrome Coronavirus (SARS-CoV) (https://www.cdc.gov/sars/index.htmi). Chinese authorities report most patients in the Wuhan City outbreak have been epidemiologically linked to a large seafood and animal market, suggesting a possible zoonotic origin to the outbreak. Chinese authorities additionally report that they are monitoring several hundred healthcare workers who are caring for outbreak patients; no spread of this virus from patients to healthcare personnel has been reported to date. Chinese authorities are reporting no ongoing spread of this virus in the community, but they cannot rule out that some limited person-to-person spread may be occurring. China has reported that two of the patients have died, including one with pre-existing medical conditions. Chinese health officials publicly posted the genetic sequence of the 2019-nCoV on January 12, 2020.This will facilitate identification of infections with this virus and development of specific diagnostic tests. Several other coutnries have confirmed additional cases of 2019-nCoV in travelers from Wuhan, China. It is possible that more cases will be identified in the coming days. This is an ongoing investigation and given previous experience with MERS-CoV and SARS-CoV, it is possible that person-person spread may occur.There is much more to learn about the transmissibility, severity, and other features associated with 2019-nCoV as the investigations in China, Thailand, and Japan continue. Additional information about this novel virus is needed to better inform population risk. This HAN Update provides a situational update and guidance to state and local health departments and healthcare providers that supersedes guidance in CDC's HAN Advisory 424 distributed on January 8, 2020. This HAN Update adds guidance for evaluation of patients under investigation (PUI)for 2019- nCoV, prevention and infection control guidance, including the addition of an eye protection recommendation, and additional information on specimen collection. Background An outbreak of pneumonia of unknown etiology in Wuhan City was initially reported to WHO on December 31, 2019. Chinese health authorities have confirmed more than 40 infections with a novel coronavirus as the cause of the outbreak. Reportedly, most patients had epidemiological links to a large seafood and animal market.The market was closed on January 1, 2020. Currently, Chinese health authorities report no community spread of this virus, and no transmission among healthcare personnel caring for outbreak patients. No additional cases of infection with 2019-nCoV have been identified in China since January 3, 2020. On January 13, 2020 public health officials in Thailand confirmed detection of a human infection with 2019-nCoV in a traveler from Wuhan, China.This was the first confirmed case of 2019-nCoV documented outside China. On January 17, 2020 a second case was confirmed in Thailand, also in a returned traveler from Wuhan City. On January 15,2020 health officials in Japan confirmed 2019-nCoV infection in a returned traveler from Wuhan City. These persons had onset dates after January 3, 2020. These cases did not report visiting the large seafood and animal market to which many cases in China have been linked. On January 11, 2020, CDC updated the level 1 travel health notice ("practice usual precautions")for Wuhan City, Hubei Province, China with additional information (originally issued on January 6, 2020): https://wwwnc.cdc.gov/travel/notices/watch/novel-coronavi rus-china. Recommendations for Healthcare Providers Limited information is available to characterize the spectrum of clinical illness associated with 2019-nCoV. No vaccine or specific treatment for 2019-nCoV infection is available; care is supportive. The CDC clinical criteria for a 2019-nCoV patient under investigation (PUI) have been developed based on what is known about MERS-CoV and SARS-CoV and are subject to change as additional information becomes available. Healthcare providers should obtain a detailed travel history for patients being evaluated with fever and acute respiratory illness. CDC guidance for evaluating and reporting a PUI for MERS-CoV remains unchanged. Criteria to Guide Evaluation of Patients Under Investigation (PUI)for 2019-nCoV Patients in the United States who meet the following criteria should be evaluated as a PUI in association with the outbreak of 2019-nCoV in Wuhan City, China. 1) Fever'AND symptoms of lower respiratory illness (e.g., cough, shortness of breath) —and in the last 14 days before symptom onset, • History of travel from Wuhan City, China -or- Close contact'with a person who is under investigation for 2019-nCOV while that person was ill. 2. Fever' OR symptoms of lower respiratory illness (e.g., cough, shortness of breath) —and in the last 14 days before symptom onset, • Close contact2 with an ill laboratory-confirmed 2019-nCoV patient. The above criteria are also available at https://www.cdc.gov/coronavirus/2019-nCoV/clinical-criteria.html. The criteria are intended to serve as guidance for evaluation. Patients should be evaluated and discussed with public health departments on a case-by-case basis if their clinical presentation or exposure history is equivocal (e.g., uncertain travel or exposure). Recommendations for Reporting, Testing, and Specimen Collection Healthcare providers should immediately notify both infection control personnel at their healthcare facility and their local or state health department in the event of a PUI for 2019-nCoV. State health departments that have identified a PUI should immediately contact CDC's Emergency Operations Center(EOC)at 770-488-7100 and complete a 2019-nCoV PUI case investigation form available at https://www.cdc.gov/coronavirus/2019-ncov/downloads/pui-form.pdf. CDC's EOC will assist local/state health departments to collect, store, and ship specimens appropriately to CDC, including during afterhours or on weekends/holidays. At this time, diagnostic testing for 2019-nCoV can be conducted only at CDC. Testing for other respiratory pathogens should not delay specimen shipping to CDC. If a PUI tests positive for another respiratory pathogen, after clinical evaluation and consultation with public health authorities, they may no longer be considered a PUI. This may evolve as more information becomes available on possible 2019 nCoV co-infections. For biosafety reasons, it is not recommended to perform virus isolation in cell culture or initial characterization of viral agents recovered in cultures of specimens from a PUI for 2019-nCoV.To increase the likelihood of detecting 2019-nCoV infection, CDC recommends collecting and testing multiple clinical specimens from different sites, including all three specimen types—lower respiratory, upper respiratory, and serum specimens.Additional specimen types (e.g., stool, urine)may be collected and stored. Specimens should be collected as soon as possible once a PUI is identified regardless of time of symptom onset.Additional guidance for collection, handling, and testing of clinical specimens is available at https://www.cdc.gov/coronavirus/2019-nCoV/. Interim Healthcare Infection Prevention and Control Recommendations for Patients Under Investigation for 2019-nCoV Although the transmission dynamics have yet to be determined, CDC currently recommends a cautious approach to patients under investigation for 2019-nCoV(_https://www.cdc.gov/coronavirus/2019- nCoV/clinical-criteria.html). Such patients should be asked to wear a surgical mask as soon as they are identified and be evaluated in a private room with the door closed, ideally an airborne infection isolation room if available. Healthcare personnel entering the room should use standard precautions, contact precautions, airborne precautions, and use eye protection (e.g., goggles or a face shield). Immediately notify your healthcare facility's infection control personnel and local health department. Additional Infection Control Practices Resources • Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings (htti3s://www.cdc.qov/infectioncontrol/quidelines/isolation/index.html) Notes F ve er may not be present in some patients, such as those who are very young, elderly, immunosuppressed, or taking certain fever-lowering medications. Clinical judgment should be used to guide testing of patients in such situations. Close contact with a person who is under investigation for 2019-nCOV. Close contact is defined as— a)being within approximately 6 feet(2 meters), or within the room or care area, of a novel coronavirus case for a prolonged period of time while not wearing recommended personal protective equipment or PPE (e.g., gowns, gloves, NIOSH-certified disposable N95 respirator, eye protection); close contact can include caring for, living with, visiting, or sharing a healthcare waiting area or room with a novel coronavirus case. —or— b) having direct contact with infectious secretions of a novel coronavirus case (e.g., being coughed on)while not wearing recommended personal protective equipment. See CDC's Interim Healthcare Infection Prevention and Control Recommendations for Patients Under Investigation for 2019 Novel Coronavirus (https://www.cdc.qov/coronavirus/2019-nCoV/infection- control.html). Data to inform the definition of close contact are limited. Considerations when assessing close contact include the duration of exposure(e.g., longer exposure time likely increases exposure risk)and the clinical symptoms of the person with novel coronavirus (e.g., coughing likely increases exposure risk as does exposure to a severely ill patient). Special consideration should be given to those exposed in healthcare settings.