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Home My WebLink AboutMansfield Summer Camp 6/23/2017Commonwealth of Massachusetts Town of Mansfield Town of Mansfield 6 Park Row Mansfield, MA 02048 Board of Health License to Operate a Recreational Camp This is to certify that: TOWN OF MANSFIELD -RECREATION DEPARTMENT •_[1 G• 1 MANSFIELD MA 02048 Is hereby granted a TOWN OF MANSFIELD- SUMMER CAMP permit for: at 111 HOPE STREET -MEMORIAL PARK MANSFIELD ZT-1100 1=1 This permit is granted in conformity with 105 CMR 430.000, Minimum Standards for Recreational Camps for Children, State Sanitary Code, Chapter IV, Department of Public Health, and expires on closing date of each session unless sooner suspended or Date(s) of Operation: OPENING: JUNE 26, 2017, CLOSING: AUGUST 25, 2017 Hours of Operation. 8:00 AM to 4:00 PM Date Approved BOARD OF HEALTH Michae[McCCean, Chairman Department of Public Health - Division of Community Sanitation STATE SANITARY CODE: CHAPTER IV, MINIMUM SANITATION AND SAFETY STANDARDS FnD 7?r4 PDF ATlnlvAr. PAXXPQ FnR P"T111UFN 1n9;rnnu A1n nnn NAMEOF CAMP: OWNER/OPERATOR: CAMP DIRECTOR: Gr) rC wap PHONE #: C o o '�Co TYPE OF—CAMP: / Non -Sport ADDRESS: l �A� C_(A OFF SEASON ADDRESS: kT (E/TIME OF INSPECTION: WATER SOURCE: INSPECTED BY: CAMPER CAPACITY: "No" column = ✓ marked below indicates a violation or 430,000. "Yes" column= ✓ marked below indicates compliance with provision of 430.000. "N/A" column = ✓ marked helnw indicates that the provision of 430 000 is not annlicable to this camn_ ;._ -kms �:- _..�..a, ,✓,.- �',`-^-Viz;=... st..,-"'-s> =< ,r'" "x Current Certificate(s) of Occupancy from .451 local building inspector for sleeping/assembly areas .215 Written compliance from local fire dept. .300(A)(2) Private water supply (a) DEP a roval >25 people, >60 days/yr) Private water supply .300(A)(2) (h) BOH approval, chemical & bacterial analyses (<25 people, <60da s/ r a Procedures for Background Review of .090(A) Staff/Volunteers Staff— CORI and SORI .090(C) —Previous Work History -3 References — Out-of-state/Intemational Criminal Background Checks Volunteer Staff— CORI and SORI .090(D) —Previous Work History— 3 References — Out-of-state/Intemational Criminal Background Checks All Background Info - Received, reviewed, & made .090(F) determination required pursuant to .090 C&D .091 Staff/Volunteer Orientation Plan & Review .093 Abuse & Neglect Prevention/Report procedures Discipline Policy: Appropriate Discipline Methods & .191 Prohibitions: (1) Corporal Punishment, including spanking, is (B) prohibited; (2) No camper shall be subjected to cruel or severe (C) punishment, humiliation, or verbal abuse; (3) No camper shall be denied food or shelter as a form of punishment; (4) No child shall be punished for soiling, wetting or not using the toilet .210(A) Fire Evacuation Plan and Drills .210(B) Disaster Plan .210(C) Lost Cam er Plan / Lost Swimmer Plan .210(D) Traffic Control Plan 430 -Inspection Sheet 5-10-16.docx Page 1 430 -Inspection Sheet 5-10-16.doex Page 2 I ISf .211(A) Camper doesn't show up for day �r .211(B) Camper doesn't show up at point of pick u .211(0) Child not registered arrives Pramohanall if raturelGe'nera� tie_ tinrei iot- - Copy of Policy (Parents/Staff): Care of Mildly ill .159(B)(2) Campers, Administration of Meds & Emergency Health Care Provision Camper released only to Parents or Parent - .190(B) Designated Individual in writing Statement: Regulatory Compliance & Licensing .190(C) "This camp must comply with regs of the iv1DPH & be licensed by the LBOH" .190(D) Inform parents of right to review background (at time of check, health care, discipline policies and application) grievance procedures upon re nest _ x�rt i ��1[l:Y ..SiA_' _ _ _ � I � -� � .212(A) Daily Itinera - Copy to Parents .212(B) Source of Emergency Care Contingency Plans (natural disasters, missing campers, .212(C) lost swimmers, illness and injury) shall Travel with Campers & Staff t yy FEW BEMIS PIT, M Vehicle must comply with MGLe.90 s7B&7D: <14 passengers & driver is camp coach, director, etc. private Cfj�w.LG'�b�-g s r c%r .250 vehicles may be used >14 passengers, vehicle must be school bus All vehicles must be RMV compliant .253 Proper automobile insurance .251(C) Seatbelts must be wom v\ Camper <7yrs not transported longer than 1 hr to .251(fl) cam Camp vehicle drivers: 18yrs, 2yrs driving experience, .252 current license for type of vehicle First Aid certified if no other trained staff aboard. aim .R� Camp Airector: Residential Camp: 25 yrs, completed course in .102(A) camp administration or at least 2 seasons ex erience Day Camp: 21 yrs, completed camp administration .102(B) course or 2 seasons experience 102(C) Primitive, Travel, Trip: 21 yrs & proof of ex erience. .102(D) esrgnated,,Sutisfitufe - _ when director off-site >12 hrS.(Sub must meet criteria above) Gounsetors/Junioir' Counselors =_ Day Camp, Non -Sport: .100 Counselor= 16 yrs. Junior Counselor= 15 yrs. Other camps: Counselors= 18 yrs or graduated .100 from high school. Junior Counselors= 16 yrs .100 All counselors 3 yrs older than campe 430 -Inspection Sheet 5-10-16.doex Page 2 Residential / Day Camps: .101(A) I staff per 10 kids over 6 yrs v 1 staff per 5 campers 6 yrs and under ,\ 101(B) Primitive,Travel, Trip: 1 counselor per 10 campers. 2 counselor min. Special Needs: .101(C) I counselor per 4 mildly disabled campers 1 counselor net 2 severelv disabled campers American Red Cross Lifeguard Trng cert., CPR .103 for Professional Rescuer & First Aid Cert, or their equivalents. ifsuper isine 2+staff must be 21ws&experience w/manaeement American Red Cross / Lifeguard Tmg cert. / CPR .103 for Professional Rescuer cert. & First Aid Cert. or their equivalents. .16U(A) I ALL 1vicincatlons Stored In VTI mat uontamers '{�, t v Meds stored in Secured Cabinet tv\ .160(B) & if necessary refrigerated in box affixed in refrigerator if no secondary lock �A .161(A) Injury Reports completed for fatality or serious tv\ �)\``V� .154 injury. Copy sent to MDPH.; 160(C) Medication administered by Health Supervisor or v\ h .161(B) Licensed Health Care Professional V\A 160(C) written list of all meds administered at cam „ ,. � .- p r -1--' t v\ ��C- VA .160(B) I Refrigerator temperature 38 to 42"F Medical Log Book �, .155 bound, pre -numbered pages, ink entries, no skipped lines. �A .161(A) Day / Residential Camps - Infirmary provided Residential Camps - Exterior light .453 Lighting provided in infirmary .161(B) Residential Camp - Area for isolation of ill child First Aid Kit: non -perfumed soap, sterile gauze t v\ ��C- VA squares, compresses, adhesive tape, bandage .161(C) scissors, triangular and rolled bandages, CPR mask, tweezers, cold pack, gloves. 430 -inspection Sheet 5-10-16.docx Page 3 430-hispection Sheet 5-10-16.docx Page 4 Health Record for each Camper & Staff: IM Staff/Camper > 18 yrs - Emergency Contact Info 150 Camper < 18 yrs must have Written Parental Permission for Meds/Emergency Care Campers and Staff under 18yrs: Number of records checked: MMR: 1't dose =12 mos or older, Measles: 2°d dose = grades K-12 or age equiv Polio: 3 doses IPV or OPV, or �_ Vl 4 doses mix IPV/ OPV Diphtheria and Tetanus Toxoids and Pertussis*: 4 doses DTaP/DTP/DT or,: .152(A) 3 doses of Td (persons 7 years or older needing additional vaccines to comply with above, Td is to be used) *Booster dose of Td: -grades 7-10 need booster if>5yrs since last dose of DTaP/DTP/DT -grades 11-12 need booster if more than 10 yrs since last dose of DTaP/DTP/DT/1'd He B: 3 doses if born on or after 1/1/92 Campers and Staff over 18Vrs: Number of records Measles: 2 doses (exempt born before 1957) checked: * _ Mumps: 1 dose (exempt born before 1957) Rubella: 1 dose It 152(B) Diphtheria and Tetanus Toxoids*: 3 doses DT/Td *Booster dose of Td required if more than 10 yrs since last dose. Activities and physical environment meet the .190 needs of campers; do not pose hazard to health/safety. .163 Operator encourages sun protection for all. Swimming Pool: in compliance with 105 CMR .430 435.00 -permit posted **VBG Compliance Letter" Bathing Beach: in compliance with 105 CMR .432 445.00 - weekly water sampling conducted. Proper supervision at swimming venue: .103 1 lifeguard per 25 campers 1 counselor per 10 campers Plan to check swimmers- "buddy system" .204(B) Swim test to classify swimmers by ability. Swimming areas clean and safe, no swimming at .204(A) undesignated sites or at night without lighting. .204(E) Piers and floats in good repair. 430-hispection Sheet 5-10-16.docx Page 4 430 -Inspection Sheet 5-10-16.docx Page 5 Watercraft: equipped with USCG approved .204(G) flotation devices and worn by all campers and staff participating in watercraft activities. Campers must be certified by ARC level 3 .204(11) swimmers or equivalent for white water, hazardous salt or fresh water activities. Minimum 2 counselors in separate watercraft .103(C) supervising white water, hazardous salt or fresh water activities. CRAF'T'S Equipmenti n good repair, safety precautions _TT .205 taken. Equipment properly maintained, fields/surfaces 206 free of holes/accident hazards Playground equipment secure, no concrete .206 under/around it, pliable swing seats. aures/Certs: .201 Single shot rifles only .201 Shooting range away from other activity areas Firearms in good condition, stored in locked .201 cabinet. Ammunition locked in separate cabinet Certifications for other high-risk activities, eg: .103 NRA Instructor Certification for Firearms aures/Certs: .202 Equipment in good condition, stored locked Range away from other activity areas, clearly .202 marked as danger area. Must have common firing line and 25 yards clearance behind each target. Personal weapons, bows, rifles allowed w/camp .203 o erator's written eermission -Names/Certs: .103(G) 1 Certified Instructor per 10 campers (minimal 2 counselors) .103(G) Riders must wear hard hat .103(G) Licensed stable 457 Day Camp provides shelter for on-going camp activities a <; .216 Residential - Smoke detectors provided .456 Adequate egresses free from obstruction .453 Lighting provided for stairways .454 Floors maintained. 430 -Inspection Sheet 5-10-16.docx Page 5 430 -Inspection Sheet 5-10-16.docx Page 6 IMM 9 TIM: I WWI Provide adequate space: 40sgft /person in single bed; 35sgft/person in .458 bunk bed; 50sgft/person in sleeping area requiring special equipment Provide bed/cot per person with 6 feet between .470 sleeper's heads and: 3 feet between single beds/ 41�2 feet between bunks Campers and staff with limited mobility housed on .459 ground level; egresses leading to grade or ramp provided. .452 Screens provided. Screen door self-closing. .454 Floors maintained. 217 Fire -retardant and non-toxic. No open flame nearby. TOILETS/SITO VS ERS .360 Proper sewage disposal .301 Plumbing in good working order Adequate # of toilets: All camps: 2 toilets/privy seats for each sex Day Camp: >60 of one sex, provide 1 additional .370 toilet per every 30 people of that sex Residential: >20 of one sex, provide additional toilet per every 10 people of that sex. Toilet less than 200 feet from sleeping rooms. .372 Toilet paper provided. Windows/ openings screened. Screen doors self-closing.' Adequate # of sinks: .373 Day / Residential Camp: 1 per every 30 people Adequate # of showers: 374 Residential Camp: 1 shower/tub per 20 people Special needs campers provided facilities that .378/.380 meet their needs .453 Lighting provided .375 Toilets and Shower rooms ventilated to outdoors Hot water at sinks, showers/tubs not more than 376 112°F Sanitary facilities maintained in clean condition 377 Shower room floors washed daily L�4T.JNDRY .162 Residential Camp: Laundry facilities provided .472 Bedding and towels laundered; no common towels 430 -Inspection Sheet 5-10-16.docx Page 6 430 -Inspection Sheet 5-10-16.docx Page 7 .�5 N'�%k. �. �-.7 ,.-�... "L _ .. _ ,_..�„_ ....... ::. ��,, x'_"wfi„ , „,ti=+✓s"^,�.,s..._ � ..r�.. z. _ _ , �_'„-?�.r,..,��r' ��d,�^ �sd- .�=�.....+.:_ �. ary-""= .300 Potable water provided 1wiltzcJw�fer ,� �� Adequate and centralized drinking water facilities .300/.304 - No common drinking cups Day / Residential Camps: Telephone readily .209 available with #s of HCC, Local Hospitals, Police, Fire, Ambulance .213 Emergency Communication System/Procedure Tobacco use restricted to designated areas not .165 accessible to campers. .350/.355 Proper storage and disposal of solid waste .207 Proper storage and operation of power equipment Y Flammable and hazardous materials labeled and .214 stored in locked unoccupied building.` .400 Rodent and insect controlcfo-_ C h .401 Weed and noxious plant control Site location does not cause undue traffic hazards .450 and is accessible at all times tmm Elm, r: WIN I -..;..'sx.,�3'sz`z�^^�FkvLJ---^""y,rt� Food service in compliance with 105 CMR \w� 320 590.000, Minimum Standards for Food Establishments. Permit posted in food service facility. Nutritious meals that include a variety of foods .330 served. Menus posted. Residential camps — Provide at least three .331 nutritious meals. Foods must meet Recommended Dietary Allowances (RDA) Day camps — Each meal provided must meet 1/3 .332 of the RDA requirements. Adequately trained staff and equipment provided .334 to ensure handicapped campers are eating nutritious meals. Proper methods for storing meals brought from .335 home. Meals provided to campers who arrive without a bag lunch. Screening provided for food preparation and food .452 service areas. Screen doors must be self-closing. .453 Lighting provided in kitchen and dining area. .471 Sleeping prohibited in food areas. 430 -Inspection Sheet 5-10-16.docx Page 7 .�5 430-Inspection Sheet 5-10-16.docx Page 8