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Home My WebLink AboutRecreational Camp for Children Inspection Reports Department of Public Health Division of Community Sanitation STATE SANITARY CODE: CHAPTER IV,MINIMUM SANITATION AND SAFETY STANDARDS FOR RECREATIONAL CAMPS FOR CHILDREN, 105 CMR 430.000 NAME OF CAMP: S T5 ADDRESS: �r� �.S"�d- OWNER/OPERATOR: OFF SEASON ADDRESS: CAMP DIRECTOR: INSPECTED BY: .�� • .1: /c� ��E OF CAMP: (Circle) WATER DATE OF INSPECTION: 7�7 Residential SOURCE: �J (Sport/No ort) CAMPER �/�S/� Trip mitiv Travel CAPACITY: "No"column= "�"marked below indicates a violation of 430.000. "Yes"column = "�"marked below indicates compliance with provision of 430.000. "N/A"column= "�l"marked below indicates that the rovision of 430.000 is not a licable to this cam . Permits .451 Current Certificate(s)of Occupancy from local l buildin ins ector for slee in /assembl areas. v .215 Written com liance from local fire de t. .300(A)(2)(a) Private water supply-DEP approval(>25 people, ,,,,/ >60 da s/ r � .300(A)(2)(b) Private water supply-BOH approval and chemical and bacterial analyses <25 eo le, <60da s/ r Plans and Policies-Written .090(A) Procedures for background review of staff and . / volunteers. 1� .090(C) CORI and SORI , previous work history, p� c.��-+�`L 3 references, out of staterntemational criminal � G�,�iz� �y7 c�;'i�u back round checks for staff and volunteers s'�' .091 Staff and volunteer orientation lan and review. .093 Abuse and neglect prevention/reporting � rocedures. .191(B)(C) Discipline Policy with: appropriate discipline / methods and rohibitions. �� .210 A Fire evacuation lan and drills .210 B Disaster Plan .210 C Lost Cam er Plan .210 C Lost Swimmer Plan .210 D Traffic Control Plan ontin en lans-Da Cam : .211 A Camper doesn't show u for da B Cam er doesn't show u at int of ick u C Child not re istered arrives � Contin enc lans-Primifive,Travel and Tri : .212 A Itinera dail -co to arents B Source of emer enc care .190 Camper released only to parents or parent- � designated individual in writing. Other plan � � approved in writing by BOH. i , i r Promotional literature/ acket contains: .159(B)(2) Copy of policy re:care of mildly ill campers, / administration of ineds and emergency ✓ health care rovision. .190(C) Statement re: regulatory compliance and � licensin . .190(D) Inform parents of right to review background check, health care, discipline policies and � rievance rocedures u on re uest. Trans ortation .250 Vehicle must comply with MGLc.90 s7B8�7D: <14 passengers AND driver is camp coach, / director,etc. private vehicles may be used. ✓ >14 passengers,vehicle must be school bus All vehicles must be RMV com liant .253 Pro er automobile insurance .251 Seatbelts must be wom and special needs of cam ers communicated to driver .251 Camper<7yrs not transported longer than 1 hr / to cam �� Staff Qualifications Cam Director .102(A) Residential Camp: 25 yrs, completed course in � camp administration or at least 2 seasons ex erience. .102(B) Day Camp: 21 yrs,completed camp � �o-►�� '�- administration course or 2 seasons ex erience. C3s� �e�Fe� � .102(C) Primitive,Travel,Trip: 21 yrs and proof of � p��,,o ��r,r�.,rlc ex erience. �4 ce a .102(D) Designated substitute when director off-site �- c�2o� yv�c�a'� >12 hrs. Sub must meet criteria above � �- -To� Gr�rA�.ck Counselors/Junior Counselors .100 Day Camp, non-sport: ✓ Counselor- 16 rs. Junior Counselor- 15 rs. .100 Other camps: Counselors= 18 yrs or �i� graduated from high school. Junior I/ Counselors= 16 rs ��2 GL,� .100 All counselors 3 rs older than cam ers Re uired Counselor Ratios .101(A) Residential and Day Camps: 1 staff per 10 kids over 6 yrs °� � ' � 1 staff r 5 cam ers 6 rs and under �S�v .101(B) Primitive,Travel,Trip: , � � 1 counselor er 10 cam ers.2 counselor min. � �' S � .101(C) Special Needs: � 1 counselor per 4 mildly disabled campers � � 1 counselor er 2 severel disabled cam ers ; ;I � .103 Aquatics Director; � C��o Name: sa � None � �� ,� ; American Red Cross Lifeguard Tmg cert., CPR / .�4 for Professional Rescuer and First Aid Cert.or � their equivalents. If supervise 2 staff,21 yrs and experience w/mana ement .103 Lifeguard:American Red Cross Lifeguard Tmg >- �a�� ^' cert., CPR for Professional Rescuer cert.and y/ 3 '`�� First Aid Cert.or their e uivalents. List names. .103 Certiflcafions for other high-risk activities,eg: � �y � NRA instructor certification for firearms. +/ �i/�"�rG{- List Names and Certfications: N�'¢ �'�� .252 Camp vehicle drivers: 18yrs,2yrs driving experience, current license for type of vehicle First Aid certified if no other trained staff aboard. Medical Personnel/Records/Facilities .159(A) Health Care Consultant � �.a-,,,�, �k�sc�+�.- e: p�a.S�s.1ya MD NP PA(w/pediatric training) eck for Health Care Consultant A reement .159(C) Health Supervisor(on site at all times) a��n s�'�' Name: No�m<► �e� / 18yrs, First Aid CPR certified OR, V F� �� MDPAN PN .159 B Health Care Polic .160 A Medication stored in ori inal containers. .160(B) Meds stored in secured cabinet and if � necessa refri erated in affixed box. .160 C Medication administered b Health Su ervisor .154 Injury Reports completed for fatality or serious � in'u . Co sent to MDPH. .155 Medical log book-bound, pre-numbered pages, � ink entries, no ski ed lines. .161(A) Infirmary provided-day and resident.camps � Exterior li ht-resident.cam s .453 Li htin rovided in infirma .161 B Area for isolation of ill child .161(C) First Aid Kit: non-perfumed soap, sterile gauze � squares, compresses, adhesive tape, bandage scissors,triangular and rolled bandages, CPR mask,tweezers,cold ack, loves. .150 Health record for each camper and staff: -emergency contact info -camper<18 yrs must have written parental permission for meds and emergency care. Residential,Sport,TraveUTrip: Health History, Physical Exam(<2yrs) Record of Immunizations(noted below) Day Camp Non-Sport: Health History, Record of Immunizations(noted below i fl i i Immuniaations: .152(A) Campers and staff under 18yrs: Number of records checked: MMR: 1St dose = 12 mos or older, �� Measles: 2nd dose=grades K-12 or age equiv Polio: 3 doses IPV or OPV,or 4 doses mix IPV/OPV ✓ �,,¢ �''�' Diphtheria and Tetanus Toxoids and Pertussis*: �s 4 doses DTaP/DTP/DT or, ��,r,;ti'� 3 doses of Td (persons 7 yrs or older needing additionai vaccines to comply with above,Td is to be used) *Booster dose of Td: -grades 7-10 need booster if>5yrs since last dose of DTaP/DTP/DT -grades 11-12 need booster if more than 10 yrs since last dose of DTaP/DTP/DT/Td Hep B: 3 doses if bom on or after 1/1/92 .152(B) Campers and staff 18 yrs.or older: Number of records Measles: 2 doses(exempt if bom before 1957) checked: �? Mumps: 1 dose (exempt if born before 1957) � Rubella: 1 dose (exempt'rf born before 1957) Diphtheria and Tetanus Toxoids*: 3 doses DTaP/DTP/DT/Td *Booster dose of Td required if more than 10 yrs since last dose. Activities .190 Activities and physical environment meet the needs of campers; do not pose hazard to health/safe . .163 O erator encoura es sun rotection for all. A uatics .430 Swimming Pool: in compliance with 105 CMR 435.00- ermit osted. .204(B) Bathing Beach: in compliance with 105 CMR 445.00-weekl water sam lin conducted. .103 Proper supervision at swimming venue: 1 lifeguard per 25 campers 1 counselor per 10 campers Plan to check swimmers-"budd s stem" I'� .204(C) Swim test to classify swimmers by ability. i � .204(A) Swimming areas clean and safe, no swimming at undesi nated sites or at ni ht without li htin . i .204 E Piers and floats in ood re air. .204(G) Watercraft: equipped with US Coast Guard approved flotation devices and wom by all campers and staff participating in watercraft activities. , � ! A uatics cont'd .204(H) Campers must be certified by American Red Cross or equivalent for white water, hazardous salt or fresh water activities. .103(C) Minimum 2 counselors in separate watercraft supenrising white water, hazardous salt or fresh water activities. Crafts .205 Equipment in good repair,safety precautions taken. Pla round/Athletic E ui ment .206 Equipment properly maintained,fields/surfaces free of holes/accident hazards .206 Playground equipment secure, no concrete under/around it, liable swin seats. Firearms .201 Sin le shot rifles onl . .201 Shootin ran e awa from other activi areas .201 Firearms in good condition, stored in locked cabinet.Ammunition locked in se arate cabinet. Arche .202 Equipment in good condition,stored in locked area. .202 Range away from other activity areas, clearly marked as danger area. Must have common fi�ing line and 25 yards clearance behind each tar et. .203 No ersonal wea ons, bows, rifles allowed. Horseback Ridin .208(A) 1 certified instructor per 10 campers(Min.2 counselors .208 A Riders must wear hard hat .208 B Licensed stable Cabins/Structures: .457 Day Camp provide shelter for on-going camp activities. .216 Smoke detectors rovided. .455/.456 Egresses comply with BIdg.Code and are free from obstruction .453 Li htin rovided for stairwa s .454 Floors maintained. Residential Cam s/Slee in Areas: .458 Provide adequate space: � 40sqft/person in single bed 35sqft/person in bunk bed 50sqff/person in sleeping area requiring special III ui ment .470 Provide bed/cot per person with 6 feet befinreen / sleeper's heads and: �� 3 feet befinreen sin le beds/4'�feet beiween bunks , i � � � I � • � . � � Residential Cam s/Slee in Areas: .459 Campers and staff with limited mobility housed / on ground level; egresses leading to grade or �� ram rovided. .452 Screens rovided. Screen door self-closin . .454 Floors maintained. Tents: .217 Fire-retardant and non-toxic. No open flame nearb . .458 35 s ft/ erson in bunk bed Toilets/Showers .360 Pro er sewa e dis osal .301 Plumbin in ood workin order .370 Adequate#of toilets: All camps:2 toilets/privy seats for each sex � Day Camp:>60 of one sex,provide 1 additional Itoilet per every 30 people of that sex. I Non-Day Camp:>20 of one sex,provide 1 additional toilet er eve 10 eo le of that sex. .372 Toilet less than 200 feet from sleeping rooms.Toilet paper provided.Windows/ o enin s screened. Screen doors self-closin . .373 Adequate#of sinks: Day Camp: 1 per every 30 people �, Residential Cam : 1 er eve 30 .374 Adequate#of showers(residential camp): 1 shower/tub er 20 eo le .378/.380 Special needs campers provided facilities that meet their needs II'� .453 Li htin rovided. .375 Toilets and shower rooms ventilated to outdoors ' .376 Hot water at sinks,showers/tubs not more than 112°F. .377 Sanitary facilities maintained in clean condition. Shower room floors washed dail . Laund .162 Residential Cam : laund facilities rovided .472 Bedding and towels laundered; no common towels Grounds: .300 Potable water rovided. .300/.304 Adequate and centralized drinking water facilities. No common drinkin cu s. .209 Telephone readily available with#s of HCC, EMS, police,fire. Da and Residential Cam s onl .213 Emer enc communication s stem. .165 Tobacco use restricted to designated areas not accessible to cam ers. .350/.355 Pro er stora e and dis osal of solid waste , , i � .207 Proper storage and operation of power � equipment. { .214 Flammable and hazardous materials labeled and stored in locked unoccu ied buildin . .400 Rodent and insect controi. .401 Weed and noxious lant control. .450 Site locafion does not cause undue traffic hazards and is accessible at all times. Food Service .320 Food service in compliance with 105 CMR 590.000, Minimum Standards for Food Establishments. Permit posted in food service facili . .330 Nutritious meals that include a variety of foods � served. Menus osted. � .331 Residential camps—Provide at least three ; nutritious meals. Foods must meet ' Recommended Dieta Allowances RDA � .332 Day camps—Each meal provided must meet 1/3 of the RDA re uirements. .334 Adequately trained staff and equipment provided to ensure handicapped campers are eatin nutritious meals. .335 Proper methods for storing meals brought from home. Meals provided to campers who arrive without a ba lunch. .452 Screening provided for food preparation and food service areas. Screen doors must be self- closin . .453 Li htin rovided in kitchen and dinin area. .471 Slee in rohibited in food areas. REGULATION NO. THE SPACE BELOW DESCRIBES VIOLATIONS MARKED ABOVE � II � � �.A-��O�t�l D�partrr�:nt of PuWic Heal� Division of Community Sanitation STATE 3ANITARY CODE:CHAPTER IY,MINIMUM SANITpT1UN AND SAFETY STANDARDS�OR RECREAl10NAL CAMPS FOR CHILDREN 105 GMR 430.000 NAME OF CAMP: P+DDRESS: — , OWNER/OPERATOR: OFF SEASON �.5� ��,C��`I�k2c� ��2l. �� ADDRESS: ��7 fir/J7/�r��'�� CAMP DIRECTOR: INSPECTED BY: stiG, ' � TYPE OF CAMP: (Circ�e) WATER �-�� DATE OF tNSPECTION: Day Residerrtial SOU�tCE: � + (SpartlNoSport) CAMPER �//� C.�o Trip Primitive Travel CAPACITY: I(�� "No"cdumn= "-�"marked be)ow indicates a viola�tion of 430.000. "Y'es'column= "�"marked below indicates compliance wrth provision of 430.000. i "N/A"c:olumn= "�"marked below indicate�that the 's'ion of 430.40U is nat a icabl�to this cam . Permi�s .451 Curr�ent Ce[tific2te(s)of Occupancy from la:al buildi i or for slee ' assem a�as. .215 Wn`tten com t�nce from(ocal fire .3�(A}(2)(a) Private water supp�-DEP appmval(>25 people, >60 d .3Q0(A)(2)(b) Private water suppy-BOH approval and � chemical and bacterial analyses <25 le,�60da Plans and Policies-Wt�itten .090{A} Procedures for background review of staff and volunteers. .090(C) CORI and SORI ,pr�evio�rs waic history, / 3 refenenoes,out of statefirrtemational criminal y i ba round checks for staff and vdunteers .091 Staff and volurrteer orierrtation an and review. .093 Abuse and negle�t preverrtioNreporting rocedures. .191(B}(C) Disapline Policy w�h:apprnpriate disapline methods and rohibitions. .210 A Fire evacuation lan and drills .210 Disa�er Plan .210 C L,ost Cam r Ptan .210 C Lost Slivimmer Plan .21 Tra�ic Co�frol Plan Corrtin n lans-D Cam : .211 Cam r doesn't shovrr u for d Cam r doesn"t shaw u at iM of ick u C Chik!not istered a[rives Corrtin e lans-Primitive,Tr�vel and Tri : 212 Itinera dai -co to r�er�ts Souroe of en care .190 Camper relea�ed only to panerrts ar par+erft � designated ind'nridual in writing,O�ter plan � approved in writing by BOH. ` f I \ r Promotional iiteratex+e! cke�coMains: _159(B)(2) Copy af policy re:car�of mildly iil campers, administration of ineds and emergency health care vision. ; .190(C) Statemerrt r�e: neguNatory campliance and ✓ + licensin . ' .190(D) Irrform par+errts of right to review background check,hea�h car�e,disc��line policies and � rievance ra:edures u n uest. Trans rtation j .250 Vehide must compy with MGLc.90 s7B87D: ; <14 passengers AND driver is camp caach, � � director,efc.private vehicies may be used. � >1�4 passengers,vehicle must be school bus ; All vehicles must be RMV iatrt � .253 Pm r automobile insurance � .251 Seatbelts must be wa�n and special r�eeds of cam rs communicated to driver � � .251 Campe�-�7yrs not transpated longer than 1 hr i to cam i St�ff Qualifications � � Cam Dir�eetor � .102(A} Residerrtial Camp:25 yrs,c�mpleted caurse in / camp administration or at leask 2 seasans ✓ � e 'ence. .102(B) day Camp: 21 yrs,complete.cf camp administra6on course or 2 seasons e ' ce. .102{C) Primi�ve,Travel,Trip: 21 yrs and proof of / e rience. V .102{D) Designated substitute when diredor off-site / p�� r rc¢,� >12 hrs. Sub must mee�arteria abav�e V i7xi,v�� T,e,�. CounselorsJJunior Counselors .100 Day Camp,non-spart: � Counse�r- 16 . Juniar Counsela= 15 .100 Other camps: Counselcus= l8 yis or � �v�re 2( graduated from high school. Junior ✓ � � Counse� 16 -1 t� AII counselors 3 s older than cam rs R uired Cour�elor Ratios .101(A) Resi�ntial and Day Camps: �.�� a�-,� 1 staff per 10 kids over 6 yrs 1 staff 5 ca rs 6 and under / = 'ej` .101(B) Primfive,Tra�el,Trip: �/ 3=/b i counselor 14 cam rs.2 counselor min. .101(C) Special Needs 1 counselor per 4 mildly disabled campers � ��►<� p/'av�5��►S 1 counsek�r 2 seve disabted c�n ► . , � � � � ± .103 Aquatics Director: � Name: ¢ None American Red Lifeguard Tmg cert.,CPR � for Professionai Rescuer and First Aid Cert.or their equivalerrts. If supervise 2 staff,21yrs and experience w/mana smerrt � .103 Lifeguard:American Red Cr�ss Lii�eguard Tmg cert.,CPR for Professional Rescuer c�rt.and ✓ First Aid Cert.or their uivalerrts. List names. .1U3 Certfications for other high-risk activities,eg: pv� ��¢ NRA instructor certfication fior firearms. U List Names and Certifications � �C�UNJ 252 Camp vehiGe drivers: 18yrs,2yrs driving experience,cumerrt I"�cense for type of vehide ✓ First A�f certified if no other#rained statf aboard. Medical PersonneURecorcls/Facilities .159(A} Health Cane Consuttar� � rr�e: OQ r�+D / NP PA{w/pediatric training) 1/ � eck for Hea�h Care Consultarrt A reement .159(C) Heatth Su ervisor(on site af all times) �p j�,9- ,Q G Name: �re l� . / ��.� � �2/1/ 18yrs,First Aid and CPR�fied OR, 1/ MD PA NP RN LPN .15 Health Care Pol' .160 A Medication stored in ai "nal containers. .160(� Meds stored in securEd cabin�t and if � necessa ' erated in afF�ced�x .160 C Medication administererl Health Su " r .154 Injury Reports com{�e#ed for fatalit�r or serious in' .Co serrt tv MDPH. .155 Medical tog baok bound,pre-number�ed pages, / ink errtries,no ski liries. v .161(A) Infirmary provided-day and riesiderrt.camps / Exterior ti ht-residerrt.cam s �i .453 Li htin ovided in in .161 Area for isalation of iN ch�d .161(C) First Aid Kit: non-perfumed soap,sterile gauze squares,compr�ses,adhesive tape,bandage sassors,triartgular and rol�d bandages,CPR mask,tweezers,cold , lov�es. .150 Health r�ec:ord for each camper and staff: -emergency contad info -camper<18 yrs must have written parerrtal permissi�for rr�eds and emer�gency care. � Residentiat,Sport,TravettTtip: Health History, Physical ExamL2yrs) Record of Immunizations{npted bebw) Day Camp Non�Sport: Health History,Record of lmmun¢ations{no�ed below , � i i ' I � I Immun'�tatior�: .152(A) Camp�rs and staff under 18yrs: Num�l��rds chedced: MMR: i�dose= 12 mos or older, IVl�sies: 2 n ddose=grades K-12 cx age equiv Polio:3 doses IPV or OPV,or � � 4 doses mix IP1//OPV � Diphtl�eria and Tetanus Toxoids and Pertussis*: ' 4 doses DTaP1DTPtDT or, 3 doses of Td (persons 7 yrs or older r�eeding additio�ai vaccines to compy with�ove,Td is to be used� 'Booster dose of Td: -grades 7-1 Q need booster if>5yrs since last dose of DTaPtDTPlDT -grades 11-12 need booster if more than 10 yrs since last dose of DTaP/DTP/QT/Td B: 3 doses if bom on or after 1hl92 .152(B} Campers and staff 18 yrs.or older. Number o#racor�ds Measles: 2 doses(exempt if bom befare 1957) / chet:ked: ( Mum�: 1 dose {exemp�if bom before 1957) (/ Rubelha: 1 dose (euempt if bom before 1957) Diphtheria and Tetanus Toxoicts*: 3 dose5 DTaP/DTPiDTlTd 'Booster dose of Td required if more than 10 yrs since last dose. AC�IVttl@S .190 Ac�ies and physical environment meet the ne�ds of campers;do not pose hazard to t� health/ .163 O or encou sun ection f�r all. A tk1tiC8 .43Q Swimming Pool:in canptiance with 105 CMR 435.OQ- R ed. .204(B} Bathing Beach:in compfiaar�ce wi�t 10.�CMR / 445.OQ-w water s�n i conducted. V .103 Proper supervision at sw�nming�nue: 1 tifeguard per 25 campers � I%/d 1 counselor per 10 campers Plan to chedc sarimmersr"bud s stem° .2Q4{C) Swim test to classify swimmers by abi�ty. .204(� Swimming areas clean and safe,no sw�nming at un ' nated sites or at ni wrthout ' htin . .204 Piers and t�ats in ood ir. .204(G) Waterc.raft:equipped wiit�US Coast Guand approved flotation devic:es and vrom by aU campers and staff partiapating in watercxaft ac�i�rities. A uatics(cont'd .204(F� Campers must be certified by American Red F/�r wurP� Cross or equivalent for white water,hazardous ✓ �G.��,1c.� salt or fresh water ac�ivides. .1 Q3(C) Minimum 2 counsebrs in separate watercraft supervising white water,hazartlous sait or fr+esh water ac�iv�iies. Crafts .205 Equipmerrt in good repa�,safetY precautions taken. Pla round/Athle�ic E u' .206 Equipmerrt properly mairrta�ed,fieldsisurfac:es � fi ee of holes/acxider�t hazards 206 Piayground equ�ment secure,no c�ncrete / ' under/around i�, iable sw� seats. �/ Firearms .201 Sin le shat rifles on . � .201 Shooti ra e aw from ather ' areas ,� .201 Firearms in good cond�iion,stc�red in locked sng[`e s� cabinet.Ammunit�n bdced in se rate cabin�t. '�`F�� arcne �+ � 1z e a .202 Equipmerrt in good condition,storeti in locked / area. V .202 Range away irom other adivity ar�eas,dearly �� marlced as danger area.Mu�have common � � ,Na�� firing line and 25 yards ctearanc:e behind e�ach tar et. .203 No ersonal wea ns,bows,rifles�low�. Horseback Ridin '' .208(A) 1 certified instnu:tor per 10 campers(Min.2 counselors .208 Riders must wear har,d hat Licensed st�le Cabins/Structures: .457 Day Camp provide shelterfor on-going camp activihes. .216 Smoke detectors ro�. A551.456 Egresses comply witt�BIdg.Code and are free #rom abstructibn .453 Li htirt ovided for staitw .454 Floors mairrtained. Residential Cam Slee in Ar�s: + .458 Provide adequate space: 40sqft/persan in single bed 35sqfFlperson in bunk bed 50sqftlpersan in sleeping ara�a requiring special u errt .470 Provide bed/cot per person with 6 feet between sleeper's heads and: 3 feet betw�een s' le beds/4'R feet betwneen bunks ,, r ( f i Reside�tial Cam n Areas: . .459 Campers and staff w�h Gm�ed mo��y housed ' on ground iev�i;egresses leading to grade or ' ram rovided. .452 Screens rovide�d.Scr�een tfoa'sel� ' .454 Floors mairrt�ained. � Tents: � ' .217 Fire-natardard and non-toxic.No open ftame nea .458 35 s rson in bunk bed ToiletsJShow�s ,360 R r sew e dis I .301 Plumbin in wo ' order .370 Adequate#of ta�ts: AII camps:2 toiletslprivy seats for each sex / Day Gamp:>60 of one sex,pravide 1 addihor►al � talet per every 30 peopfe of that s+ex. : Non-Day Camp:>20 of�e se�c,provide 1 �di�o�rai toilet ev 10 of that sex. .372 Toilet I�ss than 200 feet fivm sleeping rooms.Toilet paper pravided.Wmdaws/ ' o nin s screened.Screen doors seff-Gosin . ' .373 Adequate#of sinks Day Camp: 1 per every 30 people Residential Cam : 1 ev 30 .374 Adequake#of shawers(nesiderrtial camp}: 1 shovwer/h� r 20 .378J.380 Special nseds campers provided facilkies that / me�ti�eeir needs y .453 Li htin rovided. .375 Toil�ts and shower roams verrtilated to outdaors .376 Hot water at sinks,stwwersltubs not more than 112°F. .377 Sanitary faal�ies mairrtained in dean cond�ion. Shawer room fl�rs washed da . Laund .162 Residential Cam :laund facilities rovided .472 Beddirtg and tawels I�ndered;no common towels Grounds: .30p Patable water rovided. .3�/.3Q4 Adequate and c:er�tralized drinking water / facilities.No common drin ' cu s. �� ,2pg Telephone r+eadily availabfe with#s of HCC, � EMS,police,fire. and Resid�tia!Ca�n on ' .213 Eme n communicakion s em. a� � .165 Tobaa�use restric;ted to designated areas not � accessible to cam rs. ,35p/.355 P r sto and di 1 of soGd waste � � 1 i i ! i I 1 ' 207 Proper storage and operation of power ; equipmerrt. � ; � .214 Fiammable�nd hazardaus materi815 labeled / and stored in locked unoccu ' bu�din . t/ � .4� Roderrt and insed corrtrol. � � .401 Weed and no�tiaus rrt controL i .450 Site I�ation d�s not cause undue traffic , / � hazards and is accessibfe at atl times. V FOOt� $@NIC@ � .320 Food service in compliance with 105 CMR f 590.0�,Minimum Standards for Food / � E�ablishmerrts.Permit posted in food service 1/ � facil . � .330 Nutritious meals that inch�de a varie�tyy of foods / /� � served. Menus ed. ✓ !",QtNtn � � .331 Residerrtia!camps—Prnvide at least three � nutritious meals. Foods must meet � • ; Recommended Dieta A�avvances RDA � .332 Day camps—Each meal pro�must megt ✓ 1/3 ofthe RDA uirements. .334 Adequately tra�tted staff and e+quipment / provided to ensure han�capped campers ane 1/ eati nutrtiitfious meals. .335 Proper methods for storing me�s brought from hane. Meals proui�d to campers who amve r�vithout a ba lunch. .452 Scr�eening provided for food preparation and / f�od service at�eas. Screen doors must be seff- �/ closi .453 Li htin ovided in kitchen and din�n area. .471 Slee in roh�ited in food areas. REt3ULAT10N NO. THE SPACE BELOW DESCRIBES VIOLA'flONS MARKEDASOYE ; o �i� s ; { i ca ; ; � i � � j ` � i + `/A rt r�nu-r w ' Name of City or Town � STATE SANITARY CODE:CHAPTER IV,MINIMUM SANRATION AND SAFETY STANDARDS FOR � RECREATIQNA�CAMPS FOR CHILDaEN,105 CMR 430.000 � NAME OF CAMP: � .,� 6r�G�r�v ADDRESS: �� 7 P ��+ � OWNER/OPERATOR: �'a1� FF SEASON a�,7 �.fli//��5�' ��►�y 7S � e Go�d S .�S/qnr,�s �ri�sto/_7..� pDDRESS: ; CAMP DIRECTOR: 1�qviq� C�1pG�yn' INSPECTED BY: i' � PE OF CAMP: (Ciricle) WATER 7aGie DATE OF tNSPECTiON; a Residerttial SOURCE: _, ; portMo ) CAMPER ��/v��Q� Trip rimitiv Travel CAPACITY: �� ; "No"column= "�I"marked bebw indicates a violation of 430.00p. °Yes"column= "�l"marked t�bw indicates oomplianoe with provision of 430.000. "N/Ap column= "�"rr�riced bebw indicates that the rovision of 430.OQ0 is not a licable to this cam . Permits .451 Current Certificate(s)of Occupancy from local buildin iris orforslee i assembl ar�eas. .215 Written com liance irom local fi�de t. .300(A){2xa) Private water supply-DEP appmval(>25 people, >60 da .300(A)(2�b} Private water supply-BOH approval and � d�emical and bacterial analyses <25 ,<60da Plans and Policies-Written .Q9Q(A) Procedur�es tor background review af staff and volunteers. .090(C) CORI and SORI , previous work history, / 3 references,out of statelintemati�onal criminal y bac round checks for staff and volurrteers .091 Staff orientaaon n.Reviewed with all. .093 Abuse and negl�t prever�tioNreporting roc�edures. .191(B}(C) Discipline P�iey wid�:appropriate discipline - /' methods and rohibitions, v .210 A Fire evacuation lan and driNs .210 B Disaster Plan .210 C Lost Cam r Pfan .210 C Lost Swimmer Plan .210 D Traffic Control Plan Conti lans-Da Cam : .211 A Cam r doesn't show for da B Cam r doesn't show u at irrt of ick u C Child not istered arrives Conti en �ns-Primitirre,Travel and T' : .212 A Itinera da' - to nts B Sourr.e of eme en care .190 Camper reieased only to pareMs or�rent designated individual in writing.Other plan a roved in w '' b BOH. i , i Promotional literatur�e/ cket contains: ' .159(B)(2) Copy of policy re:care of mildy ill campers, / � admin�tration of ineds and emergency � ; hea�h care rovision. { .190(C) Statement re:regulatory c�ompiiance and � licensi . � .190{D} irfform parents af right to review badcground /' chedc, health care,disapiine policies and ,/ rievance rocedures u n r uest. Trans rtation .250 Vehide must comply with MGLc.90 s76&7D: <14 passengers AND driver is camp coach, � director,etc.prnrate vehides may be used. � >14 pas�er�gers,vehide must be school bus Ail vehicl�must be RNN compliant .253 Pro r automobile insuranae �c .251 Seatbelts must be wom and special needs of cam rs communicated to driver .251 Camper<7yrs not transported bnger than 1 hr to cam Staff'Qualifications Cam Director .102(A) Residential Camp:25 yrs,completed course in � ' camp administrafion or at ke�ast 2 seasons ' e rienoe. .102(B) Day Camp: 21 yrs,comp�ted camp administration course or 2 seasons e ' ce. .102(C) Primitive,Travel,Trip: 21 yrs and proaf of ex 'enoe. .102(D) Designat�substitute when dir�r off-site >12 hrs. Sub must meet criteria above � (�I, �t LIeN Cour�selorsJJunior Counselors .10Q Day Camp, non-sport: Counsebr- 16 rs. Junior Counselor-15 .10Q Other camps: Counsebrs= 18 yrs or graduated from high school. Junior � Counselors-16 rs '.100 All counsebrs 3 rs older than cam rs R uired Counsetor Ratios .101(A} Residenfial and Day Camps: 1 staff per 10 kids over 6 yrs � � � � 1 staff er 5 cam rs 6 and under .101(B) Primitive,Travel,Trip: 1 counsebr r 10 cam rs.2 counselor min. .101(C) Special Needs: / 1 counselor per 4 mildly disabled campers � 1 counsebr r 2 sever�l disabled cam rs 1 ; ; � .103 Aquatics Directa: , Name: ��i e N2�17 American Red Cross Lifeguard Tmg cert.,CPR / for Professional Rescuer and First Aid Cert.or � their equivalents. if superoise 2 staff,21 yrs and experience � wJman ement , .103 Lifeguard:American Red Cr�s Lifeguard Tmg Joti� Go�o2t � cert.,CPR for Professional Rescuer cert.and � J��e C'��ss f3�6 G� � First Aid Cert.or their uiwalents.�ist names. bcc��ct �� ', .103 Cefifications for other high-risk actNifies,eg: � NRA instructar esrtifit�don#or firearms. � dfl 1 /'�J d�� List Names and Cefifications: .252 Camp vehic�e drnrers: 18yrs,2yrs driving / experienoe,current lic�nse for type of vehicle �/ First Aid certfied iF no other trained s�afF abaard. Medical PersonneURecords/Facilities .159(A} Healkh Car�e Consultant �Na e: �'D�1'�'►e-� ✓ NP PA(w/pediatric training) Check for Health Care Consultarrt reement .159(C) Health Supervisor(on site at all times) Name: Oav Ga�2j�� 18yrs, �rst Aid and ' ed OR, MD PA NP RN LPN .159 B Health Care Po` .160 Pro r sto e of ined�an .16Q Medication administer�ed by Health Supervisor � or licensed medical rofessional .154 lnjury Reports comp�ted for fatality or serious � in'u .C sent to MDPH. .16Q A Medications stored in ' 'nal containers. .160(B) Meds stored in secured cabinet and iF necessa re ' erated in affnced box. .155 Medical bg book-bound,pr�numbered pages, ink entries, no ski lines. .161{A) Ir�firmary provided-day and residerrt.camps F�cterior I' ht-resident.cam .453 L" ttfi rovided in irii'irrrra .161 B Area far isolatian of ill child .161(C) First Aid K'�t: non-perfumed soap,sterile gauze squares,oompresses,adhesive tape, bandage � scissors,triangular and rolled bandages,CPR mask,tweezers,coki ck, ves. .150 Health recorcl for each cam�and stafF. �mergency oontact ir�fn �amper<18 yrs must have wrilten parental permission for meds and emergency care, � � • ; � � ' immunizations: � .'!52(A) Campers and staff under 18yrs: Number of reaords � MMR: 1�`d�e= 12 mos orol�r, chedced:�� ! Measies: 2'�dose=grades K 12 or age equiv � Polio:3 doses OPV or IPV,or � 4 doses mbc IPV and OPV Diphtheria and tetanus Toxoi�and ` � Pertussis*: l/ j 4 doses DTaPIDTP/DT ! *Booster dose of Td requir�ed if more than 10 yts sir�ce last do�e. He B: 3 doses if bom on or after 1/1/92 .152(B) Campers and staff over 18yrs: Number of recar� � Measles: 2�ses(exempt if bom before 1957} chedced: � � Mumps: 1 dose (exempt if bom bek�re 1957) Rubella: 1 dose / Diph�eria and Tet�nus Toxoids"': �/ � 3 doses DTlfd "Booster dose of Td required if more than 10 yrs sirx:e tast dose. /QCtIVI'�@S .1� Activities and physical environment meet the � � ne�eds of campers;do not pose hazard to health/safe . � .163 O rator encou es sun raatectian for all. A uatics .430 Swimming Pool:in compl'rance wikh 105 CMR i 435.OQ- rmit ed. � .432 Bathing Beach:in compGance with 105 CMR ��„a /G� 445.00-w water sam li conducted. �,s'�� .103 Proper supervision at swimming venue: / 1 lifeguard per 25 campers ✓ 1 counselor per 1 a campers � Plan to ch�k swimmers-"b s tem" � .204(B) Swim test to dassi(y swimmers by abiliiy. i .2Q4(A) S�nrimming ar�dean and safe,no swimming � at undes' nated sites or at n' ht without f h6 . .2Q4 E Piers and ito�ts in r� ir. � .2Q4(G} Watercraft:�uipped with US Coast Guarc1 approv�ftatation devices and wom by all � camper�and staff participating in watercraft acfivities. .204(H) Campers must be certified by American Red � Cross or equivalent for white wafier,hazardous � salt or fresh water ac�ivities. ' .103(C) Minimum 2 counsebrs in separate watercraft supervising wh�e water,hazar�dous sa�or fr�esh water activities. � � _ Crafts a .205 Equipment in good r+epair,safety precautions i #aken. � Pla roundlAthletic E ui rr�nt i� .206 Equipment properly mairitained,fields/surFaces ; free of holes/accident haaards � .206 Playground�uipment secure,no concrete ! under/around it, liab�swi seats. ; Firearms ' .201 Si le shot rifles on . r; .201 Shooti ra e awa from other acti ' areas .201 Firearms in good c�nditiort,stored in lodced � cabinet.Ammunidon bcked in se rate cabinet. Arche .202 Equipment in good condifiion,stored'm lacked ; area. ' .202 Range away irom other a�+ar+e�as,cleariy mark�t as danger area.Must have common ✓ firing line and 25 yards dearance behind each ta et. .203 No rscmal wea ns,l�rnnrs, rifles allawed. Horseback Ric�n j .'tE)3(G) 1 oerdfied instruc�or per 10 campers(Min.2 ! counselors � .103 G Riders must wear hand hat ' .1D3 G Licensed st�bfe Cabins/Structures: ' .457 Day Camp provide shelter ior on-gang camp ac�ivifie.s. .216 Smoke deteetors vided. .456 A uate re.sses free from obstruction .453 L' hti rovided for stairwa s .454 F�maintained. Resider�tial Cam S Areas: .458 Provide adequate space: / N/A for primitive,fip and 40sqft lperson in single bed ✓ travel camp- 35sqfF/person in bunk bed 50sq(�lperson in sleeping at+ea nequiring speaal ui ment .470 Provide bed/cot per person with 6 fe+et between sleeper's heads and: 3 fest between si le beds/412 feet befinreen bunks .459 Campers and staff with limited mobiGty housed on ground level;egr�ses leading to grade or � ram rovided. .452 Scneens rovided.Screen dorn-setf-dosi . •�54 Floors maintained. Tents: .217 Fire-retardarrt and r�n-toxic.No o�n flame nearb . -458 35 rson in bunk bed � f { f t T - ; • ; ; i � � .470 Provide bed/cot per persan with 6 feet between N/A for primitive,trip and s�eper's heads and: � travel camp. � 3 feet beMreen si le bedsJ 412feef between bunks Toilets/ShovMers � .360 Pro r e d' 1 � .301 Plumbin in wo ' ortler .370 P►dequate#af talets: � AII camps:2 toiletslprivy s�ts for each sex Day Camp:�60 of one sex,Provide 1 addition� / toilet per every 3d people of that sex. 1/ Non-Day Camp:>2Q of one sex,Pr�vide 1 additional toilet 10 afi that sex. i .372 Toilet less than 200 feet from sleeping � rooms.Talet PaPe�"Provided.�ndows/ o nin screened.Scr�n doors self-closi . .373 Adequate#of sinks: / � Day Camp:1 per every 3Q people / Residential Cam : 1 ewe 3d V .374 �equate#of showers(r�e.sidential camp): 1 sho�w�er/tub r 20 � .3781.380 Speaal needs campers provicted facilit�s that ✓ meet their needs .301 Plumbi in ' order .453 L' hti r�vided. i .375 Toilets and shower rooms verrti�ted to outdoors � .376 Hot water at sinks,showersttubs not more than 112°F. .377 Sanitary facilities mairrtained in dean condition. � � Shower room fbors washed dai . Laund .162 Residential Cam :faund faalities rovided .472 Bedding and tawels laundered;na c�mmon towels ✓ Grounds• .300 Potable water rovided. .300/.304 Adequa#e ar�centralized drinking water � facilities. No common drinld cu . .209 Telephone readily avaiNable with#s of HCC, � local hospitals,police,fire,ambulance. D and Residenfial Cam .213 Eme n communication s tem. �.�lu/l�j�� u/ ��l .165 Tobac�o use re.stricted to designated areas not / acxessible to cam rs. v .350/.355 Pro r sto and d� t of solid waste 207 Proper storage and aperation of pawer ui ent. � .214 Flammable and hazarrious materials labeted / and stored in bcked unoccu ied buildin . � .4tm Rodent and insec�oorrtrol. .401 Weed and no�us nt control. .450 Site location does not cause undue traffic hazarcls and is accessible at all times. ► A i i I � Food Service ' .320 Food service in compliance withh 105 CMR ! 590.000, Minimum Standarrls for Food ✓ Establishments.Permit posted in food service facili . .330- Nutrifious meals that indude a variety of f�oods served. Menus ted. ,331 Residen6al camps—Provide at least three / nutrfious meals. Foods must meet � Recommended Qieta Altowances RDA .332 Day camps—Each m+eal provided must meet 1/3 of the RDA r uir1ements. .334 Ad�uat�ty trained staff and equipment � provided to ensure handicapped campers are eati nutridaus meals. .335 Proper methods for storing meals brought from / S'�,R,� �y Di��j �-'' home. Meals provided to campers who amve � without a iunch. .452 Screening provided for i�od prBparation and / iood service areas. Screen doors must be sel� 1/ cl�i .453 L' hti vid�in kit,c�n and din' area. .471 SI� i rohibited in f�ood areas. REGULATION NO. THE SPACE BELOW DESCRIBES VIOLATIONS MARKED ABOVE � � � G \ \ :' Departmerrt of Pubiic I�Ith Division af Community Sanitation STATE SANITARY CODE:CHAPTER N,MINIMUM SANITATtON AND SA�ETY STANDARDS FOR RECREATIt3NAL CAMPS FOR CHIIDREN 1�CMR+430.000 NAME OF CAMP: ADDRESS: Z r`�7� OWNER/OPERATOR: goy Scav�S r� OFF SEASON��,� ��6� S t" �(� ?� C� C�o lA��[r�l �c_ ADDRESS: CAMP DI CTOR: �2Gc GoL INSPECTED BY: ' `T p:(CirCle) WATER � DATE OF INSPECTION: a sidenti CAMPER. � � C� ( PQ � G�� Trip rimif Trav�el CAPACITI( �No' n= "�I"mariced beiaw indicates a vialation of 4�.000. � `Yes"calumn= "�"marked below indicates cAmplrance w�h provision of 43Q.000. °N/R"column= "�1"marked belcyw indicates that the ' ion of 430.�is not a icable to#his cam . Pertni�s .451 Currerrt Certificate(s)of Occupancy from local � buildi i or for ' assem at�eas. .215 Written cam ' nce irom local fire .300(P�(2}(a} Private water supply-DEP approval(>25 people, � �60 d •300(A)(2)(b) Private water suppy-BOH approval and / chemical artd baderial analyses 1� <25 le, Plans and Policies-Written .090(A) Procedures for background neview of staff and voiurrteers. .090(C) CORI and SORI ,pneviaus work hi�ory, / 3 referenc:�s,out of statefi►rtemational criminal ✓ back round checks for stafF and wturrtcers .091 Staff and�rolurxteer orientation lan and revi�w. .093 Abuse and negled preventioNr+eporting / rocedures. � .191(B)(C) D"isciptine Policar w�h:appropriate disapline methods and hib�ions. .210 A Fire evacuation n and drills .21 Disaster Plan .210 C Lost Cam r Plan .210 C Lost S1�vimmer Plan .210 Traffic Contrai Plan Contin e lans-D Cam : .217 Cam r doesn't shaw u for da i Cam r doesn"t sh+avn u at 'rrt af ' u � C Child not istered arrives Corrtin en lans-Primitive,travel and Tri : ' 212 Itinera dai - to rents Source of e en +care .190 Campe�released only to par�nts or par�ertt � designated individual in writing.Other plan approved in writing by BOH. ; I Prorratior�l literat�e! cket corttains: .159(B){2) Copy of policy r+e:care of mikdly iil campers, ✓' administration of ineds and emergency heaith care ovision. .190(C} 5tatemerrt re: regulatory compHance and licensin . .190(D) Iriform parerrts of right#o review background che�ic,t�aRh care,disc�piine poliaes and rievance rocedures u uest. Trans rtation .250 Vehide must compiy wi�th MGLc.90 s7687D: <14 passengers AND drirrer is camp coach, diredor,etc.private vehides may be used. � >14 passengers,veli�cle must be school bus All vehicles must be RMV iant 253 Pro r automobile insurance .251 Seatbetts must be wom and special needs of cam rs communicated to driver .251 Camper<7yrs not transported lo�ger than 1 hr to cam St�tf Qualifications Cam Director .102(� Residerrtial Camp:25 yrs,completed+course in camp administration�at least 2 seasons e rience. .102(B) Day Camp: 21 yrs,compfeted camp admin'�stration course or 2 seasons e 'ence. .142{C} Primitive,Tra�t,Trip: 21 yrs and proof of � e ' nce. .102(D) Designated subst�ute when director of�site 1zf�' >12 hrs. Sub must meet aiteria abov�e � B`M`� �P CounselorsJJunior Counselors .10Q Day Gamp,non-spcxt: � Counselor= 16 . Juniar Counsebr- 15 s. .100 Other camps: Counselo�s=18 yrs or graduated fiom high school. Junior � Counselor� 16 .100 All counselors 3 alder than cam rs . R uired Cour�elor Ratios .101(P� Residerrtial and Day Camps: 1 statf per 10 kids over 6 yrs ✓ /� �l 1 staff 5 ca 6 and under .141{B) Primifive,Travel,Trip: / 1 counselor 10 cam .2 c�unselor min. v .101{C) Special Needs: ✓ 1 counseior per 4 mildly disabled campers 1 c�unselor 2 se disabled c�n I I I i , • i � l .�03 aqua� o��ector: Name: ^' `None Rmerican Red ross Lifeguarci Tmg ceert.,CPR ' for Professional Rescuer and Fitst Aid Cert.or � their equivalents. ! If supervise 2�aff,21yrs and experience ` w/ma ment """�`� .103 Lifeguard:American Red Cross Lif+eguard Tmg cert.,CPR for Professionai Rescuer cert.and ✓ �c� �t t� s �rst Aid Cert.or their uivalents. List names. : .103 Certifications fior other high-r�k adivities,eg: � �"ortrv �1+�+bYaS� NRA instructor cerffication forfir�earrns. ��1�� f ��- List Names and Certificatiorts: 252 Camp vehide drivers: 18yrs,2yrs driving , e�erience,curnent lioense fer type of vehide ✓ First Aid certified if no othe�r trained staff aboand. Medical PersonnellRecords/Facil'rties .159(A) H+eafth Care Consultartt N11'11e: pR_ '(3(�yp � �NP PA(w/pediatrictra�ing} eck for Hea�h Care Consuttarrt A reemer�t .159(C) Heatth Suaenrisor(on site at all times) Name: Sl�_N�1'� / 18yr�,E"irst ' and C , V � MD PA NP RN LPN ' .1 Health Car+e Pol' .1 Medication sta+ed in ` 'nal coMainers. .1�{� Meds stored in secured cabinet and if ' necessa rB ' rated in affxed box ' .1 C Medication administeted Hea�h Su "sor .154 Injury Repats c�npleted far fatality or serious ' in' .Co sent to MDPH. .155 Medical la,�book bcwnd,pre-numbened pages, ✓ : ink errtries,na ski (ir�es. .161(A) Ir�firmary provirJeed-day and residerrt.camps �/ F�derior ' ht-resident.carn s .433 Li ' vided in ir�firm .161 Area for isalation of iN ch�d .161(C) Firs�Aid IUt: non-perfumed saap,sterite gauze squares,compresses,adhesnre tape,bandage � scissors,�iar�yular and rolled bandages,CPR mask,tweezers,cold tov�es. .150 Health rEcord for each camper and staff: �I -emergency contact iMo ! -camper<78 yrs must have wrilten parental � peimissiort fnr meds and emetgency care. � ; Residerrtial,SporkTraveUFrip: Heafth History,Physica�l Exarr�2yrs? Record of Immunizations(noted belaw) Day Camp Non-Sport: � Health History,R�of Immun¢ations(rroted 1 below i i � ; Imm�nizaHons' .152(P� Campers and staif un�r 18yrs: Number of reoords chedced: MMR 1�close= 12 rrws ar older, �._ Me�ts�s: 2"d dose=grades K 12 or age equiv / Polio:3 c}oses iPV or OP'V,or 1� �H T 4 doses miu IPV/OPV Diphtheria and T�anus Toxoids a�xt �S-r O ay 6� ' Pertussis*: 4 dases DTaP/DTP/DT or, G G-�o 3 dases of Td � (persons 7 yrs or oider ne�ding additional vaccines to compy with abov�e,Td is�be uset� 'Booster dose of Td: -grades 7-10 need booster if>5yrs since iast da�e of ' DTaPiDTP1DT ' -grades 11-12 need booster if more tiran 10 yrs since last dose of DTaPtDTP/DTlfd ' He B: 3 dc�ses if bom on or after 1/1/92 .152(B} Carr�pers and�18 yrs.or older: Number of records Measies: 2 doses(exempt if bom bef�re 1957} chedced: S Mumps: 1 dase (exemp�if bom b�Fore 1957) � Rubella: 1 dose (exempt if bom before 1957) Diphtheria and Tetan�Toxoids": 3 doses DT�IDTPIDTlTd *Booster c�se of Td r�qui�ed if more than 10 yrs ' sir�ce Yast dose. ' ACtiVItI@S .190 Ac�ies and physical e�vironment rr�the needs of campers;do nat pose hazard to heaith/ .163 O rator encou sun ection for aq. A uatiCs .430 Swimming Pool:in compliance with 105 CMR 435.00- � ed. .2t34(B) Battting Beach:in c�ompGance w�'t 105 CMR 445.�-w water in c�nduded. .103 Proper supeNisian at sw�nming v�enue; 1 lifegu�'d per 25 campers �/ �=�� 1 Counselor per 10 campers V Plan to chedc swimmer�"bud em" .�4(C) S1+vim test to clas�tjr snrimmers by abi�ty. .204(A) S'�rimming areas ciean and safe,nt�swimming at undes' nated si�es or at n without t' htin . .204 Piers and floats in re �. .204(G} Watercraft:equipped w�h US Coast Guard approved flotation devices and wom by alt campers and sta�paitic�ating in wa�ercraft ac�nrities. A uatics corrt'd .204(H} Cam{�rs must be certified by Amer�can Red � Cross or equivalerrt for white water,hazardaus sa�or fresh water adivities. .103(C) Minimum 2 counselors in separate watercralt supervising white water,hazardous sa�or iresh ✓ ' water adivities. Crafls ' .205 Equipmerrt in good nepai�,safie�ty precautions � taken. round/Athletic E u' mer�t .Za6 Equipment properiy mairrtained,fieldsJsurfaces free of hdes/aociderrt hazards .206 Piayground equ�mer�t secur�e,no concr�te undeNaround�, iable ' seats. Fir+earrrrts '' .201 Si �shot rittes on . .201 Shooti ra awa irom other ' areas ✓� .201 F�earms in good cond�ion,stored ir�lodced cabinet.Ammunition lodced in se rate cabin�t. ✓ ' .202 Equipmerrt in gc�od c:ondition,stored'm locked � ar+ea. ' .202 Range away from other adivity areas,cleatiy marked as danger area.Must have common ,� ' firing line and 26 yards clearance behind each ta .203 No rsanat wea ns,bows,rifles allowed. Horseback Ridin 208{� 1 certif�d instructor per 10 campers{Min.2 ,/ counselors V Riders must wear harcl hat L.icensed stable CabinstStructures: .457 Day Camp provide shetter for on-going camp /' actirtitieS. � .216 Smoke detectors vided. .455I.456 Egresses compy with BIdg.Code and are free ✓' from�bstruc:tion .453 Li ttf vided for stairw .454 Floors maiMained. Residerr�aal Cam 'n Areas: .458 Provide adequate space: 40sqft tpe�son in sing�bed � 35sqft/person in t�unk bed 50sqftlperson in sleeping area requiring speaal u � .470 Provide bed/cot per persa�w�h 6�eet b�tween ✓ sleeper's heads and: 3 feet beiw�een ' le bedsJ 4'a feet belvNeen bunks � 4 Residential Cam in Areas: :459 Campers and staff wi�timRed mobilily housed / i • on ground lev�el;egresses leading to grade or ✓ ; ram rovided. I .452 Screens vided.Scr�een dc�or selF dosin . .454 Floors mair�tained. TeMs: .217 Fire-retardant and nor�-toxic.No open flame � nea .458 35 rson in bunk bed � ToiletstShowers , .360 Pro r sew e dis I .301 Plumbin in worki order .370 Adequate#of toilets: AII camps:2 toilets/privy seats for�aach sex / Day Camp:�60 of one sex,provide 1 additwnal �/ toilet per every�peopie of that se�c. Non-0ay Camp:>20 of one s�ac,Exauide 1 additional toilet r ev 10 of tfiaR sex. .372 Talet Isss than 200 feet from sleeping �ms.Toilet paper provided.Windows/ o nin s scx�eened.Screen doors sel�c:iasi . .373 Attequate#of sinks: Day Camp: 1 per every 30 p�ople Resider�ti�al Cam : 1 ev 30 .374 Adequate#of showers(residerrtial camp): 1 shovwerltub r 20 � .378/.380 Special needs campers provided facc:i'1'�ies that meet their needs .453 Li htin rovided. .375 To�eets and shower roams ventik�ted to outdoors .376 Hat water at sinks,showers/tubs no#m4re than 112°F. .377 Sanitary faaldies mairrtained in dean ca�d�ion. Shower room flc�ors washed dai . laultd .162 Residential Cam : laund facilities rovided .472 Bedding and towels laundered;no common � towels Grounds• .300 Patable wa#er rovided. .300t.304 Adequate and cer�tra�zed drinking water ✓ facilities.No common drin ' cu s. .209 Telephone readiiy available with#s of HCC, � � EMS,poiice,fire. , and Residential Cam s on ' 213 Eme communication stem. .165 Tabacco use r�e�ted to desagnated areas nat accessible to cam rs. 3 .35Q/.355 Pro er stora e and di I of so6d waste "i � � i ! � ' ► . � 207 Proper storage and operation of power equipmer�t. ; .214 Fiammable and hazardous materiais labeled � and storeci in locked u buiirdin . ' .4t� Roderrt and insed corrtrol. � .401 Weed and na�dous k�nt corrtrol. � .450 Site location does not cause untiue traffic i hazaMs artd is accessible at all times. �± FOOd $@NIC@ .320 Food service in compl�nce with 105 CMR i 590.0�,Minimum Standards for Food ! Establishmetrfs.Permit posted in fo�service � � facil. ; .330 Nutrritious meals that inck�de a variety of foais � ; � served. Menus � ed. {! .331 Residential camps—Provide at least three � nutri��ious meals. Foads must meet ,/ Recommended Dieta ANowances RDA � .332 Day camps—Each meal provided must mee� � 9/3 of the RDA ui�ements. .334 �uately trained staff and equipmerrt � provided to ensure han�capped campers ane eatin nutritiaus meals. .335 Proper methods for stor�g meaFs brought fnnm � i home. Meals pro�to campers who arrive without a ba lunCh. .452 Screening provided for food preparation and � food serv�e areas. Screen doors mus�t be self- cbsi .453 hfi vided in kitchen and dinin area. .471 Slee in ra�fiited in food areas. REGULATION NO. THE SPACE BELOW DESCWBES VIOLATIONS MA(�CED ABOYE t. � yA�.�n�T� � Name of Cily or Town STATE SANITARY CODE:CHAPTER N,MINIMUM SANITATI(?N AND SAFETY STANDARDS FOR RECREATIONA�CAMPS fOR CHILDREN 105 CMR 430.QOQ �. NRME OF CAMP: C .,� 6rG��hc3 ADDRESS: �� 7 P n� / OWNER/OPERATOR: �a'� FF SEASON t � e Coa� g -�S'/qnc►�S" �.Cri�sto/-� ADDRESS: a'y 7 �i//cxt�$J� �J�✓p 7.5 ' CAMP DIRECTOR: 1�qv�t.Y CbGcY�' INSPECTED BY: �' i ' PE OF CAMP: (Circle) • WATER ?d�ii� DATE�F INSPEGTION: a Residential SOURCE: ��a�Q,S port/No rt) CAMPER Trip rimitiv Travel CAPACITY: �� "No"column= "�'°marked below indicates a violation of 430.000. "YesA column= "�"marked bebw indicates complianoe with provision of 430.000. "N/AA column= "�l"rr�rked bebw indicates that the rovision of 430.000 is not a licable to this cam . Permits .451 Current Certificate(s)of Qccupancy from locai buildin ir�s or for siee i assembl areas. .295 Written com liance from local fine de . .30U(A}(2xa) Private water sup�y-DEP approvai(>25 p�ple, >60 da .300(A}(2xb} Private water supply-B�H approval and � chemical and bacterial analyses <25 e4 ,�60da Plans and Rolicies-Written .090(A) Procedures#or bacl�yround review of staff and volunteers. .090(C) CORI and SORI ,previous work history, � 3 references,out of stat�ntemational criminal badc round checks for staff and volunteers .Q91 Staff orientation lan.Revie�nred with aIL .093 Abuse and negl�t prevenfioNrepofing rooedures. .191(B)(C) Discipline Poliey with:appropriate discip�ne �' methods and rohibitions. .210 A Fire evacuation lan and drills .210 B Disaster Plan .210 C Lost Cam r Plan .210 C L�t Swvimmer Plan .210 D Traffic Control Plan Conti en lans-Da Cam : .211 A Cam r doesn't show u for da B Cam r doesn't show u at int of ick u C Child not istered artives Contin en lans-Primitive,Travel and Tri : .212 A Itinera dail -co to rents B Source of eme en care .190 Camper released only to parents or parent- designated individual in wrrting.Other plan a roved in writin b BOH. j , _._ _ 1 . � I i Promotional literature/ cket contains: .159{B){2) Copy of policy re:care of mildly ili cam�rs, / administration of ineds and emergency � heaith care rovision. .190{C) Statement re:regulatory compiiance and licensin . .1�(D} Inforrn parents of right to review badcground /' chedc,health care,disapline policies and �/ rievance rocedures u n re uest. Trans ortation .250 Vehide must comply with MGLc.90 s7B�7D: <14 passergers AND driver is camp coach, direc�or,etc.private vehide.s may be used. >14 passengers,vehide must be school bus All vehides must be RNN compliant .253 Pro r automobile insurance �c .251 Seatbelts must be wom and speaal needs of � cam rs communicated to driver � � .251 Camper<7yrs not transported bnger than 1 hr to cam , Staff Qualifications � Cam Director .102(A) Residential Camp:25 yrs,completed course in � camp administration or at least 2 seasons e rience. � .102(B) Day Camp: 21 yrs,completed camp � administration course or 2 seasons e ' nce. I .102(C) Primitive,Travel,Trip: 21 yrs and pmof of � ex 'ence. .102(D) Designated substitute when direc�or off-site >12 hrs. Sub must meet criteria above I 1�1, �`t Ll2N CounselorslJunior Counselors .100 Day Camp, non�port: Counsebr- 16 rs. Junior Counselor-15 rs. .10Q Other camps: Counselors= 18 yrs or � graduated from high school. Junior Counselors=16 rs { .1� All counselors 3 rs older than cam rs R uired Counselor Ratios .101(A) Residential and Day Camps: ! 1 staff per 10 kids over 6 yrs � � : .j 1 stafF r 5 cam rs 6 and under .101(B) Primitive,Travei,Trip: 1 counselor r 10 cam rs.2 counselor min. .101(C) Special Needs: � 1 counselor per 4 mildly disabled campers 1 c�unselor r 2 severel disabled cam ers i I � I I � :,: .:. , hr.,.- _. . _,..�. _ _ _ _ ! 1 a ; ; .103 Aquatics Director: , Name:�j,�2 /V2417 � American Fted Cross LiFeguard Tmg cert.,CPR / for Professional Rescuer and First Aid Cert.or v their�uivalents. If supervise 2 staff,21 yrs and experience w/man ement .103 Lifeguard:American Red Cross Lifeguard Tmg Joh� GoLn2r cert.,CPR for Professionai Rescuer cert.and ✓ Jess►e G�� First Aid Cert.or tt�ir uivalents.List names. bcc�� E3�6 �•� .103 Certifications fior other t�igh-risk activities,eg: �� n�� NRA instructor certification for firearms. � � List Names and Certific�ations: .252 Camp vehicle drivers: 18yrs,2yrs drnring / experienoe,current license for type of vehide �/ First Aid cerkified if no other trained staff aboard. Medical PersonneURecordsfFacilities .159(A) Health Care Consultant � Na e: �30�'Q�Ker�n�.'�'11 � � NP PA(w/pediatric training) � Chedc for Health Care Consultarrt reement � .159(C} Health Supervisor(on site at all tirr�s) � Name; Oav Goto2tc.� /' i �� 18yrs, 'rst Aid and �OR, ' MD PA NP RN LPN ; .159 B Health Car�e Poli � .160 Pro r sto e of inedication � .160 Medication administeced by Health Supervisor ✓ or licensed medical rofe.ssional ; .154 lnjury Reports comp�t�for fataliiy or serious ✓ i in u . sent to MDPH. .16Q A Medications stored in o ' 'nal containers. .160(B) Meds stored in secxired cabinet and if ✓ necessa re ' erated in affixed box. .155 Medical bg book bound,pre-numbered pages, ink entries,no ski lines. .161(A) Irrfirmary provided-day ar�residerrt.camps ' Exterior I" ht-resident.cam .453 L' htin rovided in ir�firrrr� .161 B P►rea for isolation of ill child .161(C) First Aid Kit: non-perfum�soap,sterile gauze squares,compresses,adhesive tape, bandage , /� scissors,tri�ngular and r�lled bandages,CPR � � mask,iweezers,cold ck, oves. .150 Health r�corcl for eac�c�nper and staff: �mergency contact irrfo �amper<18 yrs must have written parental ; permission for meds and emergency care. � � i , � Immunizatior�s: .152{A) Campers and staff under 18yrs: Number of recflrds MMR: 1�`dose=12 mos orolder, chedced:�� Measles: 2nd dose=grades K-12 or age equiv Polia:3 doses OPV or IPV,or 4 doses moc IPV and OPV Diphtheria and Tetanus Toxoids and ` Pertussis": . V 4 doses DTaPiDTP/DT *Booster dase of Td required if more than 10 yrs since last dose. He B: 3 doses if bom on or after 1/1/92 .152(B) Campers and staff over 18yrs: Number of records Measles: 2 doseS(exempt iF bom before 1957) chedted: - '�'�' Mumps: 1 dose (exempt iF bom be�ore 1957) Rubelta: 1 dose / Diphtheria and Tet�nus Toxads": 1/ 3 doses DTITd *Booster dose of Td required if more than 10 yrs since last dose. Activities .19Q Activities and physical environment meet the � needs of campers;do not pose hazarcJ to health/safe . .163 O rator encou es sun rotection for all. A uatics .430 Swimming Pool:in compl'ranoe with 105 CMR 435.OQ- rmit ed. .432 Bathing Beach:in comptiance with 105 CMR ,�i+a /G� 445.00-wee water sam li conduded. i'Sf� .103 Proper superv�ion at swimming venue: / 1 lifeguarcl per 25 campers ✓ 1 counselor per 10 campers Pian to chedc swimmers-°budd s tem" .204(B) Swim test to dassify swimmers by ability. .204(A) Slivimming areas dean and safe,no swimming � at undes' nated sites or at ni ht without li htin . ' .204 E Piers and flo�ats in ood re air. .204(G) Watera•aft:equipped with US Coast Guard approved flotation devices and wom by all � campers and staff participating in watercraft activities. 204(H) Campers must be oertfied by American Red Cross or equivalent for white water,hazardous saft or fresh water activities. � .103(C) Minimum 2 counselors in separate watercraft � supervising white water,hazardous salt or fresh j water activities. , � � , � , Crafts .205 Equipment in good r�epair,safety precautions taken. Pia round/Athletic E ui ment .206 Equipment properly mair�ined,fiekiis/surFaces free of hotes/accident hazards .206 Playground equipment secure,no concrete under/around•it, liable swi seats. Firearms .201 Sin le shot rifles onl . r► 201 ShooY ra e awa from ottier ac�ii ' areas .2Q1 Firearms in good conditiar�,stored in lodced / cabinet.Ammunition locked in se rate cabinet. �� Arche .202 Equipment in good condiiti�on,storeci in la:ked area. .202 Range away from other activity areas,deariy marked as danger ar�. Must have common ✓ firing line and 25 yards clearanc:e behind each ta et. .203 No rsonal wea ns, bows,rifles allowed. Horseback Ridin .1�3(G) 1 ce�tified instructor per 1Q campers(Min.2 counselors � .103 G Riders must wear har�d hat .1D3 G �icensed stable Cabins/Structur,es• .457 Day Camp provide she�er for ort-going camp { activities. .216 Smoke detectors rovided. .456 uate resses free from obstruction A53 L' hti rovidad for stairwa .454 Floors maintain�. Resider�tial Cam 1� i Ar+eas: .458 Provide adequate spaoe: N/A for primitive,trip and 40sqftlperson in single bed ✓ travel camp. 35sqftlperson in bunk bed 50sqft/person in sleeping area r�ec�airing speaal ui ment ; .470 Provide bed/cat per peirsson with 6 feet befinreen sleeper's heads and: 3 feet between si le beds/412 feet beiween bunks .459 Campers and staff with limited mabi�ity housed � on ground�vel;egresses leadir�g to grade or 1 ram vided. � .452 Screens rovided.Screen door setF-dosin . .454 Floors maintained. Tents: � .217 Fire-retarrlant and non-taxic.No open flame � nearb . � .458 35 erson in bunk bed i i 1 � , ' .470 Provide bed/cot per person with 6 feet between N/A for primitive,trip and sleeper's heads and: � travel camp. 3 feet beiween sin le beds/412feef beMreen bunks Toilets/Showers .360 Pro er sewa e d' I .301 Plumbin in ood workin order .370 Adequate#of toilets: AII camps:2.toiletslprivy seats for each sex Day Camp:�60 of one sex,provide 1 additional / toilet per every 30 peopie af that sex. \/ Non-Day Camp:>20 of one sex,provide 1 addition�toilet r eve 10 afi that sex. .372 Toilet less than 200 feet from sleeping � rooms.Talet paper provided.�ndovvsJ o ni scxeened.Scr�n doors setf-closi . .373 Ad�uate#of sinks: / �y Camp:1 per every 30 people . / Residential Cam : 1 r e 3(? V .374 Adequate#of showers(residential camp): � 1 showe�'/tub r 2d .378/.380 Speaal needs campers provicied faalit�s that meet their needs .3Q1 Plumbi in wqrki order .453 L' hti rovided. � .375 Toilets and shower rooms venti�ted to outdoors � .376 Mot water at sinks,sh�vers/tubs not more than 192°F. .377 Sanitary i�'lities mairrtained in dean condition. � Shower room floors washed dai . Laund .162 Residential Cam :laund faalities rovided .472 Bedtling and towels laurxiered;no common ✓ tcnnrelS Grounds: .300 Potable water rovided. .300I.304 Adequate and centralized drinking water � facilities.No c�mmon drinki cu . .209 Telephone readily available writh#s of HCC, local hospitals,pdice,fire,ambulance. � D and Residential Cam n � .213 Em en oommunication s m. t�la/1-ji� u!� ��ct .165 Tabacao use restrict�to designat�areas not _/ accessible to cam rs. � .350/.355 Pro r sto e and dis 1 of solid waste .207 Proper storage and operatian of power � e ui ment. � � .214 Flammable and hazarrious materials labeled / and stor+�in locked unoccu ' buildi . V � .400 Rodent and insect controL .401 Weed ar�noxious ant c+�ntrol. � .450 Site location does not cause undue traffic hazarcis and is accessible at all times. ; ; T � _,_ � I � � ! { ` Food Service ; .320 Food service in campiianc:e with 105 CMR j 590.t�Q, Minimum Standards for Food ✓ ; Establishments.Perrnit posted in food service � facili . ; ', .330- Nutritious meals that indude a variety of foods ; served. Menus ted. .331 Residen�al camps—Provide at least three / � nu�-itious meals. Foods must meet � � Recommended Dieta Allowances RDA ; � .332 Day camps—Each m+eai provided must meet � �/3 of the RDA uirements. .334 Adequately trained staff and�uipment / provided to ensure handicapped campers are � eati nutritiaus meals. .335 Proper methods for sboring meals brought from / �'�,2� ��, O.�r� �-'- home. Meals provided to campe►s who arrive � without a lunch. � j .452 Sc�eening provided for food preparation and _ / � food service ar�eas. Screen doors m�t be seff- V � closi � .453 ' hti rovided in ki�hen and dini area. .471 Slee i mhibited in food areas. REGULATION � NO. THE SPACE BELOW DESCWBES'UIOLA770NS MARl�D AB01fE � � � � i I � I G �. _ -�..mr�. .....� . . r � i i s Department of Public Heatth pivisioq of Community Sanitation ; STATE SANITARY CC?DE:CHAPTER N,MINIMUM SANITATION AND SAFETY STANDARDS FOR ; RECREATIONAI CAMPS FOR CHILDREN,105 CMR 430.00Q ; NAME�F CAMP: �CN ADDRESS: pWNER/OPERATO / OFF SEASON �+ ADDRESS: �/� G A�o7"' �. �' CAMP L3lRECTC3R: � 3 INSPECTED BY: t D � '�' , OF C�►MP: (Ci►�c�) WA R DATE OF INSPEC N:� UZ��{E ;; y 'a� SOURCE: /G/Gy PO OSpO CAMPER ,. Trip Pnmfive Travei CAPACITY: "NoA column= "�1"marked beMw indicates a violation of 430.0�. .�' "YesA column= "�'marked below indicates comptiancs with provision crF 430.00U. "N/A"column= °�"marked bebw indicates that the of 430.U00 is not licable to th�s cam . Permits .451 Curcent Gertificate(s}of Oocu�ancy from laca� buildi ir� for sl ' assembt areas. .215 Writter►c�m lianoe from laca!fire d t. .300(A){2�a) Private water supply-DEP approvaf(�25 people, r �60 d .3�(Aj(2�b) Prnra#e water supply-BOH appmval and - chemicat and bacterial analyses <25 ,�60da ,,,,� Pfans and Poiicies-Written .090(A) Pra�dur�s�badcground review of staff and ✓ volunt+eers. .090(C) CORI and SORI , previous vvaric history, 3 references,out of state/intemational criminal back round d�ec�i�r'staff ar�v�rrte,ers .091 Staff and volunteer orientafion !an and rBviev++- .093 Abuse and neglect prev�Nreporrting _ rocedur�es. .191(B)(C) Discipline Pa�icy wi�t:appropria#e�ne methods and 'bitions. .21 A Fire evacuation lan and dri�s .210 B Disaster Plan .21 C Lost Cam P�n .210 C Lost Slrvimmer Plan .21 D Traffic Cor�bnl Plan Co 'n lans- Cam .211 A Cam r doe�sn't show for . B Cam r doesn't show u at ' u C Chiki nat is#ered arrives Conti en ns-Primitive, and T : ✓ � 212 A Itinera da' - to rents B Source of eme en cane .1 gp Camper rele�ased only to pare�ts or parent I designated indiv�ual in writir�.Ot1�er pian approved in�+riting by BOH. r I i i �I ! � i ; f Promotiona!literaturel dce#contains. •1�tB)t2) �PY�i�icy re:care of mikily�t campers, administration af ineds and emergency health care v�ion. .190(C) Statement re:reguiatory c�a�npliar�ce and licensi .190(D) IM�orm parents of right to review background chedc,healtl�care,disc�pline potiaes�nd rievance ures u n r uest. Trans rtation .250 Vehide must oomply w�h MGLc.9Q s7B&7D: <14 passengers AND driver�camp coach, director,etc.priv�te veh+d�may be us�. >14 passengers,vehide must be school bus All vehic�s must be RNN com iant .253 P automobile insurance .251 SeatbeRs must be wom and speciai needs of , cam rs oommunicated to driver .251 Camper<7yrs not#ranspc�ed bnger than 1 hr to cam St�ff Qualifications Cam Direchcr .102(A} ResideMial Camp:25 yrs,c�mp�ted cour�in camp admi�istration or at least 2 seasons e rience. .102(B) Day Camp: 21 yrs,completeci camp / admin�tra#ion c:flurse or 2 seasons ' nce. 1/ .102(C) Pr�ni#ive,Travel,7rip: 29 yrs and pinof of ex 'ence. .102(D} Designated substitute when di�or of�site >12 hrs. Sub must meet criteria above Courtselws/Junior Counselors .10Q Day Camp,non-sport: Counsebr-16 . Junior Counselor-15 .1 Ga Other camps: Counsebrs=18 yrs or / graduat�from high sd�l, Junior '% Couns�ors=16 .1 QQ All counselor5 3 older than cam R uir�i Counselor'Ratios .101(A) Residenfi�and Day Camps: �( S�� (O 1 staff per 1 Q kids over 6 yrs �� ¢Nt�rc 9 staff r 5 cam rs 6 and under .101(B) Primitive,Travel,Trip: 1 counselor 70 cam rs.2 counsebr mi�. .101(C) Speaal Needs: 7 counselor per 4 mildty ciisabied c�npers 1 c�nseior r 2 seve disabled cam rs i i � .103 �lquati Name k n ross ' rd Tmg CPR r es.sionai � .or tt►eir equiwalents. If superuise 2 staff,21 yrs and experience w/ma merrt .103 Li#eguard:American Red Cross Lif�ard Tmg rG1.0'�K� f'd 4Lc!- cert.,CPR inr Professiona!Rescuer cert.and � First Aid Cert.or tt�r uivalents.L�st rtiames. .103 Certfications��her high-risk activifies,�: NRA instn�or cer6ificatian for f�-earms. List Names arxi Certifications: 252 Camp vehide drivers: 18yrs,2yrs dri+►ing expe�ence,�urrent�se for typ�e of vehide Firs#Aid certified if no other trained staff aboard. Medicaf PersonneURecardsJFaci!'�ties .159(A) Health Care Cor�ssu�ant ti e: �C�l Co �c�t. D IVP PA(wtpedia#ric training) for Health Care Cor�sultarrt rr�errt .159(C) Hea� Su ervisor'( site at a�N tirnes) Name: �f?�/+� ��/i�� 18yrs, irst A�i and OR, MDPANPR P .15 B Hea�h Care P .160 A Medication stared in inai oonta��rs. .160(Bj Meds storr�d in se�cureci t�binet and i� n�essa ted in affixed box. .1�3 C Nledication�ministered b Healtl�Su ' r .154 Injury Reports compl+eted for iat�l�yy or seric�us in` s�nt to MDPH. .155 Medical k�g bo�c bouncl,Pre-numbered p�es, ink entries,no ski line.s. .169(A) Infirmary prov�ded-day arxl resident.camps F�cterior I' ht-r�ident cam .453 L,' ti vided in i�tfim�a .161 B Area i�r isolatior+of iU c�iki .1&1(C) First Aid K'�t: non-perfumed soap,ster�e gauze squares,campresses,adhesive tape,bar�ge I scissars,triangular and ro�d bantlages,CPR mask,tweezers,c� dc, ves. � .15U Healtt►record f4r ead�camper and sta�f: � -emergency contat�irr�a �amper<18 yrs must have writtert parental permissic�n for'r�teds and emergency car1e. Resident'ra�,Sport,TraveUTrip: ' Healtl�History,Physical Exam(�2yrs) j Rec:ord of Irrrrttnnuniza4ons(no#ed below} i Daj/CK1mp t+br�Sport: / � Hea!#M History,Rac�d o#{mmuni�tiaris(noted �/ below � i Immunizafions: .152(A) Campers and staff under 18yrs: Numbe�of r�ecords checked: MMR 1�dose=12 mos or older, �� M�Sles: 2'"'d�e=g�K-12 br age�u�v Polia:3 doses IPV cu OPV,or 4 cioses rrrix IPV/OPY DipMheria and Tetanus Toxads and Pertussis*: 4 doses DTaP�TP/DT or, 3 doses of Td (Per�ns 7 yrs tx c�der na�ciing adcii�onal vac�ir�s to comply with above,Td is to t� used) '`Bo�ter dose of td: -grades 7-10 r�esd booster�>5yrs since last dose of DTaP/DTPJDT -grades 11-12 need booster�'mcxe tl�an 10 yrs since last dose of D7aP/DTP/DT/Td He B: 3 doses if bom on or after 111/92 .152(B) Campers and st�ff 18 yrs.ar okler. Number of reco Measies: 2 doses(e�aernpt�bom be�ore 1957� ch�lced: Mumps: 1 dc�se {�acem�#bom befic�r�1957} Rubeila: 1 dose ($xempt#bom befiore 1'�'i� Diphtheria and Tetanus Toxac�": 3 doses DTaP/DTP/i?T/Td "B�oster dose of Td required if more than 10 yrs sirK�last dose. ACtiV1�S .190 At�ivi�#ies��ysicai env�-onmen#rrteet tfie n�ds of campers;do r�t pose hazard to / heal�Usafe . \/ .163 O rafi�r encou sun ' frn all. A uatics .430 Swimming Pooi:in compliance vvith 145 CMR 435.�- � ed. 204{B) Bathirtg Beach:in carnpl�ance vvith it)5 CMR / 445.00- water sam c�nduc;t�. 1/ .103 Prope�r supervision at swimming ve�ue: , � �zl 1 lifegu�d per 25 campers � G-•l�( 1 counselor per 9 t}qmpers � ' �� Plan to ch+�cic swvimmers-" s mA .204(C� SKrim test to classifjr sw�nnrners by ability. � .204(A) Swimming are.as dean and sa#e,no swimming ; at ur�d ' nated sites or at ' ht withc�ut ' hti - ' E Piers and flcrats in ir. .204(G) Water'cx�ft:equipped with US Caast Guard approved flotaticm devices and wom by all � campers and staff par#iagating in watercraft / ac�vities. V � 1 � � A uatics cont'd � .204{H} Cam�rs must be c:ertfied by American R� j Cross or equivalen#for white water, hazar�us J sa�or fresh water activities. � .103(C) Minimum 2 counsebrs in sep�arate watercxaf� supervising white water,hazar+dous salt or fresh water activfies. CraftS .2Q5 Equipment in gOod repair,sa#ety precautions taken. Pla roun�d/Ath�tic E i ment � .206 Equipment properly mair�tair�d,fields/surf�es ✓ free ofi holesJacadent hazards � .206 Rlayground equipment secure, no�ncre#e � underlarounti�, liable swi seats. Firearms ; .241 S' le shot rifles onl . 2U1 Shooti ra awa #rom c�ther ' ' areas � .201 �irearms in yood conditiat,stored in la�ced cabinet.Ammunifion lodced in se rate cat»net. Arche .202 Equipment in good condition,stor�in I�ked ; ar�a. � .202 Range away from other activity areas,dearty j mariced as danger area.Must have common � firing line and 25 yards dearance behind each � } ta et .203 No rsonal wea ns,bows, rifles atfowed. Harseback Ridi .208(A) 1 cer�fied instructor per 10 campers(Min.2 counsslors .208 A Riders must wear hard hat .208 B Licensed�able Cabins/Structur,es; � .457 Day Camp provide sh�er for on-going carop � activities. , .216 Smoke detec�ors rovided. ' .455/.456 Egresses comply with BIdg.Code aruf are free � from obstrudion � � .453 L" hti vided far stairv�ra .454 Fbors maintained. � Residential Cam • Ar�eas: .458 Provide adequate space: 40sqR/perscm in sirx�le bed 35sqft/persan in bunk bed 5Us�ft/person in sleeping area t�equiring special i tnent � .470 Provide bed/cflt per person with 6#eet between ; sleeper's heads and: � 3 fieet betrnreen si bedsJ 4"�feet between bunks � i � i I i i � , Resider�t3ai Cam i Aneas: .459 Campers and staff vv�i�rriited mot�`�ty hc�used on ground�vel;�resses leading to grade or • � ram vided. .452 Screens vided.Scr'een door seif-c�i . .454 Flaors m�tintained. rents: .217 Fire,retardant and non-toxic.No open flame nearb . ,q�5g 35 rson in bunk bed Tt�iietSiShow+ers .3gp r di I .301 Piumbi in w ' order .370 A�lequate#of#oilets: AIt camps:2 tflilets/prnry se�ats for each sex Day Camp:>60�one sex,provide 1 additior� toilet per every 30 people a#that sex. / Non-Day Carnp:>24 aF one se�4 Provide 1 N addiaonal toilet eve 10 afi tt�at sex. .372 Toiiet less than 2�ie�from slee¢ir�g / rooms.T�let pa�r provided.�ndow+sl � i scr�rfed.Sa�n doors sel#-c�osi . .373 Adequate#af sinks: Day Camp:1 per every 3Q people Resident�l Cam : 1 30 .374 �uate#of showers(residen�al camp): 1 showerflub r 20 .378/.38Q Speaal needs campers provided fac�ities that meet their needs .453 L' hti vided. .375 Talets and shower rooms veMilate�d to ouhioors .376 Hot water a#sinks,shovvers(t�s riot morre th� 112°F. .377 Sanitary facilities mair�aireed in dean c�ndition. Shower roorn floot�washed dai . L.aund .162 Residentiad Cam :laund fac�titi�s .472 �edding and towels iaur�dened;no oommon towels Grounds• .300 Pohable water rovided. .3Q0/.3a4 Adequate ar�d centraliz�ed drinking water facili6es.No common drinki cu . .2pg Telephone readify ava�aable writh#s of HCC, ' EMS,polic�e,fir+e. Da and Residen4al Cam on .213 Em communication s tem. .165 Tobacco use r�;tricted to�Ssignated at�a.s not i accessible to cam rs. i .35Q1.355 Pro s e and d�s 1 of solid vvaste � � � a 1 ; ; i � � i��' • .�.f' f •-��O �. 1�� • •• . �• • ' .i�` . �• . �•• ' � :*� �'i .■� _ • f �•.� '��M '�• �•MF •-�:-� f �! ; • � 1/ - ts` . • ' :- r• i • ==� � 1+ ■ a• . ♦ ,• s • _ r• • � - •r.i• •�:.. • r. • i = .■�' . �� _ • . .r c.. • - � .- '• • • - _-� 1 •�• r- r� • _ ►- i / i! •1 /Ii . •. • • •r• � ,� ��. �• •�• ,/� ( I ��. .� i . r • - s �•�•• �� • . ��. c• ��- i. r. •�� • �_��- E � �t• � •��ti a►� �a• � -r_ • t' ' � ' � . r. •. � � '� � �■� • 1 - ' � � :• o - � •.• a• �r. ' • -• � • • •a� s - . + r:��>� r: ea -. r • i e �.. i f��' '1 ��f�.. "i� t• �• �:: � •• •� i • • - . + • • r-r s r. •- � . • . �.• � M .:+ �f • f �f�.i •� •f.• • '!: . I�.f �• •.��t ��M' . rt h L. •�•� �. •.' i � , � �i �_ • i • ! :�}:i h i • '� _ __�'� '! .t i ! f' �• !�Y _-�- � . f •�� 1 'i : ��i ;• � ' � 1 � :i .. __ -�.�� / .ir iI� -L�t� I I � r r �- ��_��'i,.� �/L ��A`�?�' ' i/' r,_ ��I �� //,i�'/ n�r►i�r,,r��►� �_��'_. . ,. _ ..�•�r� 1'"��r��!!l��!�i(�i/''.a/�i w---• - - I .�!s � - • _- i i . : Department of PuWic Health Division af Community Sanitation STATE SANITARY CODE:CHAPTER N,MINIMUM SANITATION AND SAFETY STANDARDS FOR RECREATIONAI.CAMPS FOR CHILpREN 105 CMR 430.0�0 NAME OF CAMP: RCfDRESS: OWNER{�PERATOR• � � OFF SEASON /'/ �> ADDRESS: W�� v;r 24 f S CAMP DIRECTOR: � INSPECTED B : p OF CAMP:(Cir�cle} WATER �. r� DATE OF fNSPE Day es�entiai SUURCE: r uw ��y�y ) CAMPER Trip 'mitive Travel CAPACITY: �p � °No"column= "�1'°ma�ked bebw indicates a violafiort of 43Q.000. "YesA colucnn= "�"marked bek�w indir.ates compliant�e vwth prov�ion of 43Q.000. "N/A'°cc�llumn= "�"marked bebw indicates that the visicm af 430.400 is not licable to this cam . Permits .451 Current Certificate(s}of Occupancy fnom loc:al lwikfi ins for s assem �reas. .215 Written com iance from k�cai fir�e de .300(A}(2xa) Private wate�supply-DEP approval(>25 people, �60 da � .300(A}(2�b) Private water supply-BOH approvai and � chemical and bacteri�al ana� � �� Plans and Poticies-Written .09Q(A} Procedures i�or background review of staff and volunteers. .Q90(C) CORI and SOR1,previous work histary, 3 refer�ence.s,out of sta�ntemational criminal back round c�ecks for staff and volunteers .091 S'taff and valunteer orier�ta�on n and review. .093 Abuse and negleet prsventioNreporting roo�ur�.s. � .191(B)(G) Disapline Policy with:appropriate disapGne methods and rohibi6�ons. .21 A Fir+e evacuation lan and dri�s .21 B Disaster PI� ' .21 C Last Cam r(�han .210 C Lost S1�vimmer Plan � .210 a Traffic Contr�ol'Ptan '� Ctin� en Yans- Cam � .211 A Cam r doesn't shovr for da B Cam r doesn't show u at rrt of idc u C Child not i�ered artives Conti -Primitive,Travel artd T' .212 A Itinera da' - to � B Source of eme cane .190 Camper released only to�reMs or p�rer►t � designated individual�wr�ing.Ott�plan � aPproved in wriWig by BCN-t. � , Promotional l'�bQrafu dcet contains: .159(Bx2) CoPY of paticy re:care of mildly�i campers, administr�afion of ineds snd emerger�cy health care v�ion. .1�(C) Statement re:regulatory ccxn�iar�ce and I�ens' .190(D) irifarm parents of right to review badcgrourid , checic,healtl�care,disc;ipGne polici�s and � rievance ures u u�t. Tra .250 Vehide must cornpiy wr�h MGLa9d sTB8�7D: <14 passengers AND driver�camp coach, � diredor,etc.private vehid�s may be used. I >1�passer�gers,vehide must be scha�ol bus All vehicles must be RII�V c�m iant .253 auborr�ot�ile ir�.suranc� .251 Seatbelts must be wom ar�d specc:fial needs of pe cam rs communicated to driver .251 Camper<7yrs rrot b�ar�sported bnger than 1 hr to cam Staff Quat�fications Cam Director .102(A) Residenfiaf Camp:25 yrs,completed c�ourse in camp administratian or at least 2 seasons ex 'enoe. .102(B) Day Camp: 21 yrs,c�ompl�i camp admin�stratron caurse�2 seasons e IS .102(C) Primitive,Travei>Trip: 21 yrs and proaF of ce. .102(D} Designated substitute whert diree�or off-�ite � �/c, � >12 hrs. Sub must meet criteria above �'-��•• CounselarsJJuniwr Ccwnseiors .10U Day Camp, non-sport: Counsebr=l6 . Junior Counsetor-15 .100 Other camps: Counselar� 18 yrs or 9 raduated from high�. Junior / Courrtisselors=16 rs ✓ e .1 QO All counsebrs 3 ol�r than cam R uired Counselor Ratios .101(A) Residenti�and Day Camps: , 1 s#aff p�10 kids over 6 yrs t ' � 1 staff 5 cam rs 6 and under .1 Q1(B) Primfive,Trav�el,Trip: r 1 counselor r 10 cam .2 c�unsebr m�. ' .101(C) Sp�cial Neecis: 1 counselor per 4 m�lyr d'+sabled campets / 1 caunselor r 2 sev d'�sal�ed cam rs �� .103 Aqu Qi � Name• � �ilJone Amerir.an Red Cross Lifeguaat Tmg cert.,CPR for Professionai R�'and First Aid Cert.or fheir eguivaleMs. If supervis�e 2 staff,21yrs ar�d experieru�e w/ma ment .103 Lifeguard:Arr�erican Red Cr+�s Lifeguarcl Tmg �' cert.,CPR for Professional Rescuer c�t.and / 7'�r h ��,��r`� First Aid Cert.or their ivalents.List names. �� .103 Certficatians fof other hi�-risk activities,eg: g�` y{, NRA insfivc�or certificaiion ior fireamu. � List Names and Certfications: S .252 Camp vehicie drivers: 18�ns,2yrs driving experi+ence,cutrent kc�ens�:ir�r type of vehide First Aid c:ertified iF no other trair�d st�aff aboard. Medical PersonneURecordslFacilities .159(A) Heakh Ca Cor�sulta � � PA f+v( Ipedi�tric training) edc�oir Fiealth Car�e Consultar�t reemertt .159(C) Hea� u rvisor(o site$t aN times) Name: �� /� 18y irst Rid and OR, ✓ MD N LPN .1 B Hea�h Care Po� .160 A Medicat�n stored in " inal c�ntainers. .160(B) Meds stoned in secured cabmet and i� neoes.sa in affixed kaax. .160 C M�fion admini�ened b Heaith Su ' r ,154 Injury Reports oompleted�or fatality or serious / in" sent to MDPH. �� .155 Medical bg book bound,pre-numbered pages, ink errtries,�s(d I�. .161{A) Infirmary provided-day snd residerrt.camps Exteri�I' ht-resici�nt c�n .453 ' hti rovided in ir�fimia .161 B Are�a for isal�atian of�i child .161 C First Aid� r� rned soa ,ster�e�uze ( � P� p uat+�s,cx�m �,adhesive tape, bar�dage sq pr �da sassors,tr'rangular and r�a��ed barxfages,CPR . mask,iweezers,c�fCl ves. .150 Health rec�rd ier e�h c�nper ar�d stsff: -emer�gency con#ad ir�fo -camper<18 yrs must ha�ne written parentai permission fiar meds and ernergency c;ar+e. Residential,Sport,TraveltTrip: Heatth History,Physicat Exam(<2yrs} Recarc!of Immuniza�(nofied belonnr) � Day Caimp Non-Spor� 3 Health W�ay,Re�cor+d c�Immunizations(noted ' below � I � ; ; , , { � � � . � � tmmunizafions: .152(A) Cam�ers and staff under 48yrs: Nu rec�ords c�edced: � MMR: 1�`dase=12 mas or nlder, M+easles: 2nd d�e=grades K-12 or age equiv Polio:3 dose.s iPii or OP'V,or 4 doses moc IPVI OPV piphtheria ar�1 Tsfi��Toxoid4 and Pe�tussis*: � 4 doses DTaPtDTPR3T or, - 3 doses of Td (persons 7 yrs c�r olde�-needing additionai waa�r�s ta comply wit�►above,Td is�o be us�i} *Booster dose�Td: �rades 7-10 need booster iF>5yrs s�ce last dose of DTaP/DTPtDT �rades 11-12 n�d booster fi mo�e than t0 yrs since last t�se�DTaP/QTPlDTffd B: 3 d�e.s if bom on a-after 1i1l92 .152(B} Campers and st�aff 18 y►s.or older. Number of Measles: 2 dose4(e�rript iF ban beiore 1957) chedced: Mumps: 1 dose (exempt�bom befi�e 195?} Rubetla: 1 dc�se (exempt�bom betorae 195� DipMheria artd Tetanus toxads*: 3 dases DTaPIQTPIDT(Td "Boos�er dose of Td r�quired if mone th�e t Q yrs j sirx:e IasE tiose. � Activities � .1� ac�iuities ar�a pnysical ernironment►�et the ; � needs of campers;do not pc�se hazard to heal�/saf . .163 O rator enc�u sun rotectian ftx aq. uatics � .430 Swimming P�t:in compfiance with 105 CMR ; 435.00- � .204(B) Bathing Beac�:in c�ornplianc:e wifh 1(}5 CMR / 5,4�.,✓�� t/ 445.tK}-wee water cc�ducted. i/ �� .103 Proper supervisicron at s�nrimm�g ven�: 1 lifeguard per'25 campers i c:ounsebr per 1Q campers Pfan fio chedc swimmers- " . .204(C) Swim test to elassify�mers by abdit�r. 204(A) Swimming aneas dean anci safiee,rx�saimming at u rr�ted sttes or at ri vvitt�out ' hti E Piers artd floais in .204(G) Watercxait:equipped w�th US Coast Guar�d ' appr�oved flotation cfevioes and wam by aH � � campers and�ff Pa�R��J in watercraf� � activities. ; I � � , � A uatics cont'd .204(H) Campers must be oertified by American Red Cross or equivalent for wtmte water,hazardous t"t salt or fresh water actnrities. � .103(C) Minimum 2 counselars in separate watercx�ft supervising wh�e wat�r,hazardaus salt or fiesh water adivfies. Craffs .205 Equipment in�od repair,safety pr�cautia�ns �ken. PI roundfAtltietic E i t .206 Equiprnent properly rr�air�tained,i'ieldslsurFac�es free of holes/acx.ident hazards .206 Playgrourxi equiprr��rt secure,no cancrete under/around it, isble swi s�ats. Firearms .201 Si le shot rfiNes on . .201 Shooti ra awa from other ' areas .201 Fir+earnis in good c�rxlfion,stared in ioc�ced cabinet.Ammunition bcfceti in se rate cabir�t. Arche .202 Equipment in goc�d condition,stored in ladced area. .202 Range away from other activity areas,t�earfy mariced as danger area.Mu.st ttave cbmmon firing 6ne and 25 yards dearance beh�each ta et. .203 No al wea ns,bcwvs,rifles albwed. Horseback Ri�n .20$(A) 1 certified inshuctar per 10 campers(Min2 counsekNs .208 A Riders must wear hanl hat .208 B Licensed stable Cabins/Structures: .457 Day Camp provide she�er for on-gaing qmp acdvities. .216 Smoke detec�ors .455J.456 Egresses camply with BIdg.Code and are f�+ee from obstn,dion .453 L' hti rovided far stai�va .454 F�ma�tained. Residential Cam ' Ar�eas: .458 Provide adequate spac�e: 40sqft/perscm in s�e bed 35sqft/persan in bunk bed 5Qsqft/person in sleeping a�requiring speaal nt .470 Provide bed/cot per person witli fi feet beivveen sleeper's heads and: 3 feet betrn�een si le beds/4'�feet between bunks -- ..��:� ♦.: r . �� . ,:.._:�� :• ` : ,`= _-_ - • �.� :� rY ' �•� ��-.♦ �•�h ' �� !.L• • • • • � '� `�.`�:-. '.�i �� i • .,� • •. � � � V':• •Y r i •' •3.� Y ;- i�i.f '�'. 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''.l�i�� i�'a�.i��r1 " ,L��.� � �� 1 Gt/I�'��1.0�/� i Name of City or Town :STATE SANITARY CODE:CHA ER N,MINIMUM SANITATION AND SAFETY STANDARDS FOR RECREATIOHLe►L CAMPS FOR CHILDREN,1Q5 CMR d30.000 REC EATI� AL CAMP FOR CHtLQRE PECTI4N PORT � NAME OF CAMP: ADDRE : i £ ( � OWNER/OPERATOR: � OFF SEAS ��r��S/• �,�� /! 4 /'�'-• ADDRESS: �� ' CAMP DIRECTOR: Q / 1NSPECTED BY: D � OF CAMP: ( ncle) ATER DATE OF INSPECTION: � �S-/�� a esidential SOURCE: �G�� po rt CAMPER � Trip nmitive ravel CAPACITY: "No"column= "�l"marked below indicates a violation of 430.000. � "Yes"column= "�"marked below indicates comptiance with provision of 430.000. � "N/A�column= "�1"marked bebw indicates that the rovision of 430.�0 is not a licable to this cam . R lation Yes No I�IA C�c�� Permits � .451 Current Cefificate(s)of Occupancy frarn local " buildin ins or for slee i assembl areas. .215 Written cam liance from local fine de t. .300(A)(2xa) Private water sup�y-DEP approval(>25 people, � �60 da � .300(A}(2�b) Private water supply-BOH approval and j cnemical and bacterial analyses � 4 <25 le,<60da ; Plans and Policies-Written i .0�(A} Procedures for backgnourfd review of staff and j vo{unteers. i .090(C) CORI and SORI , previous woric history, ' 3 references,out of stat�rrtemational criminal ' badc round c�edcs for staff and valurrteers � .091 Staff orientation lan.Reviewed vvith all. r .093 Abuse and n�l�t prevent�oNreporting ; rot�dures. I .191(B)(C) Discipline Policy wiNi:appropriate discipline . methods and rohibitions. : .210 A Fire evacuation lan and drills .210 B Disaster Plan .210 C Lost Cam r Plan .210 C L�t Slrvimmer Plan ' 210 D Traffic Control Plan Conti en lans-Da Cam : .211 A Cam r doesn't show u fpr da B Cam doesn't show u at irrt of ick u C Child not istered arrives Conti �ns-Primitive,Travel and T ' : � .212 A Itinera da' - to rents B Sour+ce of eme en cane .7gp Camper rel�sed only to parents or parent designated indiv�ual in wririting.Other plan - / a roved in wr'rtin b BOH. v \ f Ysg l�i N/A Gc�mmw�'1iS � s Promotional literature/ cket contains: � .159(B)(2) CflpY of policy re:care of miidly ili campers, i administration of ineds and emergency ! heatth care rov�sion. E .1�(C) Statement re:regulatory compiiance and ; I '�inJm . � .190(D} Inform parents of right fio review badcground � chedc,health care,disapline pol'�cies and ' rievance rocedures u n r uest. Tran rtation .250 Vehide must compiy with MGLc.94 s7B87D: <14 passengers AMD driver is camp cflach, dir�ector,etc.private vehides may be used. >14 passengers,vehide must be schoo!bus All vehicles must be RNN com iant .253 Pro r automobile insurance .251 Seatbelts must be wam and special needs of cam rs communicated to driver .251 Camper<7yrs not transporked bnger than 1 hr to cam � Staff Qualifications Cam Director � .102(A) Re.sidential Camp:25 yrs,completed oourse in ; camp administration or at least 2 seasons ex 'enoe. .1 Q2(B) Day Camp: 21 yrs,campleted camp administration course or 2 seasons e rience. .102(C) Primitive,Travel,Trip: 21 yrs and proof of ex rience. .102(D) Designated substitute when dir+�or off-site ��; �j�i >12 hrs. Sub must meet cxiteria above � i Counselors/Junior Counselors : .1� Day Camp, non-sport: ' Counsebr-16 rs. Junior Counselor= 15 .100 Other camps: Counsebr�18 yrs or graduated from high school. Junior Counselors=9 fi rs .1 pp All counsebrs 3 rs older than cam rs R uir8d Counselor Ratios .101(A) Residential arxi Day Camps: / 1 staff per 10 kids over 6 yrs CO - � 1 st�ff r 5 cam rs 6 arxi under .1 Q1(B) Primitive,Travel,Trip: � � 1 counselor r 10 cam rs.2 counselor min. ' .101(C) Speaal Needs: / 1 counselor per 4 rr�ildly d'isabled c�mpers ✓ 1 counselor r 2 severe disabled cam ers i � 1 � 1 � � 1 � ; � Yes Nv NiA Comrne�tits I .103 Aquati Direct : � � Name:� (/f- �°~'f -- American Red Cross LiFeguard Tmg cert.,CPR � for Professional Rescuer and First Aid Cert.or ` their equivalents. � � ff supervise 2 staff,21 yrs and experience w/man ement . .103 Lifeguard:American Red Cross lifeguard Tmg '�f'�- ' cert.,CPR for Professional Rescuer cert.and � ,3� � �� First Aid Cert.or their uiva�nts.List names. .103 Certifications for other high-risk activities,eg: � b�— NRA instruc�or certificakion for firearms. ^ / �,� 1,1�.�� List Names and Certifications: Y r�G 252 Camp vehicle drnrers: 18yrs,2yrs driving experienoe,currerrt ficense for iype of vehicle � First Aid cefified if no other trained staff aboard. Medical PersonneURecords/Facilities .159(A) Health Care Consultant N e: R- A D NP PA(w/pediatric training) i for Health Car�e Consultant reement ` .159(C) Health Su ervisar(o sitee at all times) Name: � 18y First ' a CP rtified OR, MDPANPRNL PN � ' .159 B Heaith Care Poli .160 Pro r stor e of inedication .160 Medication administered by Hea�h Supervisor � or licensed medical ' rral .154 Injury Reports comp�ted i�r fiatality or serious / in'u . sent to MDPH. � , .160 A Medications stored in o ' 'nal oontainers. ; .160(B) Meds stored in secx�r�cabinet and if ' necessa ' erated in affi�ced box. .155 Medical bg book-bound,pr�e-number�ed pages, ink entries,no ski lines. .161(A) I rifirmary provided-day and resident.camps / F�cterior I' ht-resident.cam 1� .453 L' hti rovided in i►�firrrra - .161 B Area for isolation of ill child .161(C) First Aid IC�t: non-�fumed soap,sterile gauze squares,compresses,adhesive tape, bandage scissors,tr"rangular and rolled bandages,CPR ' mask,iweezers,coki ck, loves. .150 Heafkh r�cord for each camper and staff: -emergency contact irifo -camper<18 yrs must have wr�ilten parental �rtr�ission for meds and err�rgency care. ( � � � Y� I�o 1�A C+ammenis� ! Imrnunizations• ' .152(A} Campers and staff under 18yrs: Number of rds MMR: 1�`dose=12 mos ar older, �� Measles: 2"°c�se=grades K-12 or age equiv Polio:3 doses OPV or IPV,or 4 doses mix IPV and OPV Diphtheria and Tetanus Toxac�s and Pertussis": 4 doses DTaP/DTPtDT "Booster dose of Td required if more than 10 yrs sirx:e last dOse. He B: 3 doses if bom on or after 1/1192 .152(B) Campers and shaff over 18yrs: Number of re ords Measles: 2 doses(e�cempt if bom before 1957) chedced. Mumps: 1 dose (exempt if bom before 1957) Rubelfa: 1 dos� Diphtheria and Tetanus Toxads'�: 3 doses DTlt'd "Booster dose of Td requiretl iF more than 10 yrs since last dc�se. Activities .1� Activi�s and physir.al errvironmerrt meet the needs of campers;do not pose hazarr!to health/safe . .163 O rator encou es sun rotection for aIL A uatics .q�30 Swimming Pool:in complianoe with 105 CMR 435.OQ- rmit ed. ,432 Bathing Beac�:in compliance with 105 CMR (�,,� 445.OQ- water sam li cranducted. � �"' "N�` .103 Proper supenrision at swimming venue: 1 IiPeguard per 25 campers 1 counselor per 10 campers Plan to diedc swimmers-"b s tem" 204(B} Swim test to classify swimmers by ability. .204(A) Swimming ar+�as dean and safe,no swimming at undes' nated sites or at n' ht withou# ' hti . .204 E Piers and floats in re ir. .204(Gj Wateraaft:equipped with US Coast Guard �a��fi'� approved flotation device�and wom by all = campers and sta�ff participating in watercraft / ac�ivities. V .204(H} Cam�rs must be certified by American Red Cross or equiva�nt for white water,hazardous sa�or fresh water activities. .103(C) Minimum 2 c�nselors�separate vva�ercraft supenrising wttitce water,hazardous salt or fresh water ac�nrides. i�tiart Y� !+� N1A Ct��l� Crafts .2t)5 Equipment in good repair,safety precautions taken. PI round/Athletic� ui ment .206 Equipment properly mairrtained,fields/surtaces fr�of h�es/accidertt hazards .206 Playground equipment secure, no cancrete underlaround�, iable swi seats. Firearms .201 Si le shot rifles on . n/S .201 SF�ooti ra e awa fr�an other " areas .201 Firearms in good conditi�,stored in i�iced cabinet.Ammunition lodced in se rate cabinet. Arct�e .202 Equipment in good condition,stored in lodced area. .202 Range away irom other ac�ivity areas,cleariy marked as danger arBa.Must have common firing line and 25 yarsds dearanr�behind each / ta et. t� .203 No rsonal wea ns,bows,rifles allanred. Horseback Ridin .103(G) 1 c:ertified ins�vctor per 10 campers(Min.2 counsebrs .10 G Riders must wear hard hat .103 G Lic:�nsed st�able Cabins/Structures: .457 Day Camp provicle she�er far on-gang camp ac�ivifies. .216 Smoke detectors rovided. .456 Ad uate resses fi�ee from obstruction .453 L' hti vided for stai�wa .454 Floors maintained. Residentiat Cam in ArBas: .458 Provide adequate spaoe: N/A for primfive,trip and 40sqft tperson in single bed travel camp. 35sqltlperson in bunk bed �' 50sqftJperson in sleeping area requiring speaal ; u' ment ; .470 Provide bed/cot per�tson with 6 feet between ' slee�r's heads and: 3 feet beiween si le beds/4"�feet betw�en bunks � .459 Campers and staff with limited mobiMy housed on ground level;egr�sses leading to grade or ram vided. .452 Screer�.s vided.Sareen door setf-dasi . .454 Floors maintained. Tents: .217 Fire-retarclarrt and non-toxic.No open flame nearb . j .458 35 rson in bunk bed i � � � � � 1 � 1 i � i YeS l�a� RU�1 Camment� .470 Provide bed/cot per person with 6 feet beiween N/A for primitive,trip and ' s�pers heads and: travel camp. � 3 feet between si le be�J 4'�feet between bunks � Toilets/Sho�rs .360 Pro r e dis I � .301 Plumbi in w order .370 Adequate#o#toilets: ' AH camps:2 toilets/prnry�for each sex ! Day Camp:>60 of one sex,Provide 1 addition� toilet per every 30 people of tt�at sex. Non-Day Camp:>20 aF one sex,provic�1 � additior►al toilet e 10 of tha#sex. j .372 Toilet less tl�an 2Q0 feet fram sleeping ; rooms.Talet PaPe�"Provided.�ndows/ i o ni scxeened.Scxeen doors setf-cbsi . � .�73 Adequate#of sinks: � Day Camp:1 per every 30 p�ple / � R+esidential Cam : 1 r ev+e 30 �� .374 �equate#of showers(r�esidenfial camp): 1 shovuer/tub r 2Q .378/.380 Speaal needs campers provided facilities that meet their needs a .301 Plumbi in worki order ' .453 L' h6 rovided. .375 Toilets and shower rooms verrti�ated to outdoors .376 Hot water at sinks,showers/t�s not more than 112°F. .377 Sanitary facilities mairrtained in dean condition. Shower roam floors washed dai . Laund .162 Residential Cam : laund facilities rovided .472 Bedding and t�nrels laur�dered;no common towels Grounds� .300 Potable water rovided. .3�/.304 Ad�uate and cerrtralized drinking water / facilities.No common drinld cu . r/ .209 Tefephone neadily avai�ble with#s of HCC, � I�ai hospitals,p�ioe,fire,ambulanoe. Da and Residen6al Cam .213 Eme en c�mmunicatian s tem. .165 Tobacco use reshicted to des�nateci areas not � accessible to cam ers. .35Q/.355 Pro r sto and dis I of solid waste .207 Proper storage and opera#ion of power ui ment. " .214 Flammab�and hazarrJous materials labeled and stored in bdced unoccu ' buildi . .400 Rodent and insect control. .401 We�and no�tious lant a�ntrol. .450 Site location does not cause undue traffic hazards arxi�s accessible at all fimes. � i 1 Y+� N� l�UA C4mrrleritS � Food Service � .320 Food service in compGance with 105 CMR 590.000,Minimum StandarcJs far F'ood � Estabiishments.Permit posted in food service facil' .330 Nutritious meals that indude a variety of foods served. Menus ed. .331 Residential camps—Provide at least thr� nutritious meals. Foods must meet Recommended Dieta Altowances RDA .332 Day camps—Each meal provided must meet 113 af the RDA r uir�ements. .334 Adequately trained staff and equipment " provided to ensure handicapped campers are ' eaati nutritious meals. .335 Proper methods for sfioring meals brought fram � home. Meals provided to campers who arrive j without a lunch. � .452 Screening provid�for food preparation and ; food service areas. Sa�een doors m�t be self- � cbsi . .453 L' hti vided in kitchen ar�d din' area. .471 SI� i rohibited in food areas. RE6ULATION NO TWE SPACE BELOW DESCitIBES V�LATIONS MARKED ABOVE . � ; r I s � YARIAOUTH HEALTH DEPT. 11�t�U'fE 28 • BQ:Y�JTH.IiAA 0� i 7 � N E OF CITY OR TOWN ': STATE SANITARY CODE: CHAPTER IV, MINIMUM SANITATION AND Ss0.FETY ; STANDARDS FOR RECRERT�ONAL CAMP� �OR CHILDREN, 105 CMR 430.000 ---�- � , • ; �. � �- � � NAME OF CAMP ADDRESS 1�� , �, �y�— , OWNER OFF SEASON � ADDRESS CAMP DIRECTOR INSPECTED BY � �� Y�� , CAPACITY ATER SOUR E NS ECTION �� Q�- Regulation 105.C R 430.000 The items marked below with an "X" indicate the violated rovisions of 105 CMR 430.000. Items marked with a"✓"are satisfacto . r �... . . , -> � �� , �� , ��; ,� ,�� . _L g - � .: . .. .. . . . .a . ... _ : . � . .� s.. . r.,;�.. .. ..a_ . .. �, r. ,. , .. ��-.c n ,... ..�.... .....: .:: � �.f.i� � -.:a. . . ., ._ ..: � . . . t.-. ��..... .... �i�'_ Written procedures available fo�the review of badcground of staff. Prior wo�lc history,references, ��'�� '" and CORI and SORi information. Documents � �#'�.,,-:� verifying background cheGc being mairrtained. �.e.- Staff have no unsupervised co�tact with cam rs until bacicground chedc is approved.unless� member whose badcground chedc�s aPPro�►ed is present. •R . .X � . ��` All persons and staff receive orientation before � . �: workin with chiidren . Orientation an in writin . y ''�� Written procedures for reporting suspeded .�: incidents of child abuse and negle�. �� i.ounselors have required training and experience. � /� � g �=� � Ade quate ratio of counselors to campers. � �'��; ge. ��; Camp Diredor is on premises at all times. Staff Training,;,,, � �� aware of person who is responsible for the U�v � � > administration of the cam . � � ;t Specialized ar high risk ac�ivities supervised by � : c:ounselors with evidence of appropriate training, I - experience and cert'rf'ication. Counselors present at � �; j =�� . � ge: 1 ��-` Aquatics activities supervised by an aquatic Certificatiqn: �� j � director with proper current certifications. � '�"�( � � ;� � 'A Adequate ratio of properly certfied counselors to ` � ' � '��.�` campers to supervise swimming. � ' �� ;p Adequate ratio of cert'�ied counselors to campers Names: -� � foi`the supervision of watercraft activities. All staff �j � �� and partiapants wear U.S.Coast Guard approved f ��;`� personal flotation devices. � Certfication: �` Minimum of two counselors each in separate waterr.raft for white water,hazardous saft water or �!� j ' ' �� hazardous fresh water. Campers possess prior IU �' � training certficate before participating in these � ::; watercraft activities. a . `I 1Q�; ` Properly certified individuals provided for scuba f� Certification: ; diving activibes. ; i�1�,: Health Records �s Required health records maintained for each � ` � `�s camper and staff member. ,.7�1;�` Maintainin medical lo . Lo readil available. � 1�� Injury report form compteted for each fatality or � x; senous m�ury. Copy of repo.rt sent to MDPH. �Y 1�1 > Residential Camp:.Health history,report of �:.,;: physical exam, and immunization record,prepared � ,°;' and signed by licensed health care provider, _ fumished to camp by each camper and staff '` member prior to attending camp. ' ��; Day Camp: Current medical history signed by � ��'� `� �parent or guardian,or by licensed health care � � �"�'��- rov�der rovided to cam rior to attendin cam �;��r P P P P 9 P• 4 'N��qy� ��4- _` ,� �' MMR 1 Measles 2* ': � Measles 2nd dose uired Mumps 1` ��"� Polio(OPV or e-IP� 3 Rubella � 1 < � 4 doses required if Diphtheria and 3 � �° mixed schedule vaccine �� Tetanus Toxoids � � �y a�: iven(IPV and OP� 'unless bom before 1957 ,� � Diphtheria and 4 . �� Tetanus Toxoids DTaP/DTP/DTlTd �� and Pertussis � ' _�r�� ` Booster dose of Tetanus/diphtheria,(td)required �`�t��' if reater than 10 ears since last dose. � �,�: 9 � r�<� _s;., Hepatitis B:(for 3. � � � children bom (effective 1-1-99) ��"�� after 1/92) j - � "��' Number of records checked Number of records checked � ��,�` Camp health care consultant. Signed written Name: �- � S�D� �-f�f S , •� ��:: orders for use by heaith care superv�sor. 0'N �� ,� �.� Written camp medical policy. All staff provided with �'�`�� copy of such policy and trained in the program's �` #� Infedion control procedures and implementation of �h� �` � the policy during staff orientation. �;`��,�. �� ;= Parents provided with�py of the policar pertaining � •�'� s to the care of mildly iil campers,administration of � �� ;` medication and procedures for emergency care �,��- Name: { `l�9 . Health superviso�provided. rainin : :;'!�D .;, Proper storage of inedication. � ��0 ' Written approval from health care provider to , <��"�°�� administer medications. :1�9 •' Infirtnary provided. Designated area provided for �'' �-� .� isolation of child ill with commurncable disease �,.x�J � separate from the regular living quarters. �,+�. , .,,� �;,�. (Residential Camp) �v �i�°' Laundry facilities. � ;:y� , Operator encourages campers and staff to reduce �' exposure to ultraviolet exposure trom the sun. Y:;...�.:,.. :.�)�a-. Tobacco use, if any,restricted to designated areas �d a'�ij-4 v/v J�� `: not accessible to campers. Designated area � Y �.�,,�� appropriate. ,��0 ; Pro�ram adivities and physical environment :;;'�tt� provided to meet needs of campers and does not <,�.,�`. pose a hazard to their health and safe ty. d �` ' � o � � > � o c m l." � �` N o � ' ' a�i c% U w � >, �, � � o c c o'� rn rn � � � Q V N N L � , W W W W O Z ' f� '� � � ❑ � � r � a � ' � � z , ' � fC L t� � � '� � Q N N W I ' �` ;; U � � c� � i Q ' �' aUi o � s � n rn � � � � m ; � � � � � � � ' v ,' > � W > � o ' ` � , � ,Q IJ; ' � '' � � � � o J b I w �, a�i �- !c�i E � � aj p � � a � J � .,�,�i � � Q O ':a: m r � W L� _ ) � : : o - � \� � � a p� p ' � a a t�'i. � m � ' J � � � � 1 _ Z � � � � � � m l, , U Z Z W � d � � 3 L � '. _ � � /+ .....:�..: v m m: m V�. C � � � •C = U C�C O � t 1 i Z t�ct: a °o ''' ' � � C a� � � > L � ,y�► p � f/1 �� •� m � 7 r lC V W �Z' C o �