CR 95-16 Environmental Health Services Agreement
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January 30th, 1995 Council Report No.95-016
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e ENVIRONMENTAL HEALTH SERVICES AGREEMENT FOR 1995
Proposed Action.
Staff recommends the following motion: Move to approve the
environmental health services aqreement with Hennepin County for
1995.
Approval of this motion will allow the Mayor and city Manager to
execute an agreement with Hennepin County to allow Hopkins to
receive financial support from the County for environmental
health services.
OVerview.
The State Health Department grants authority to Hennepin County
to provide for environmental health services in the County.
The County allows cities who wish to provide for their own health
services the authority to do so on a year by year basis. The city
has exercised this right and undertakes the inspection and I
licensing of establishments such as restaurants, hotels, swimming
pools, etc.
. Execution of the agreement with the County allows Hopkins to
continue to locally license certain establishments and the
County agrees to pay the city $2800.00 for direct support of the
activity.
The agreement is the standard agreement we execute with the
County each year.
Primary Issues to consider.
0 Should the city continue to provide its own Health
services.
The cost to the city to provide our own health inspection
program is approximately $13,000 per year. The city receives
revenue through licensing of restaurants, lodging
establishments and swimming pools. This revenue more than
covers the costs of administering the program. Local
administration of the program provides Hopkins residents
personal attention and service. Staff feels it is in the
city's best interest to continue to provide its own health
services.
Supportinq Information.
0 copy of health.lservices agreement
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Thomas Anderson
city Building Official
. AA Code:
Contract No: A04715
Tax 10 No./Soc. See No. :
Vendor No.: *000030010
ENVIRONMENTAL HEALTH SERVICES AGREEMENT
THIS AGREEMENT is made and entered into by and between the COUNTY
OF HENNEPIN, STATE OF MINNESOTA, hereinafter referred to as the
"county" , through its Community Health Department, hereinafter
referred to as the "Department II , and the city of Hopkins, A
Municipality organized and existing under the Laws of the State of
Minnesota, hereinafter referred to as the "Municipality".
WIT N E SSE T H:
WHEREAS, The Municipality wishes to provide Community Health
Services~ and
WHEREAS, County funds through the Department are available to
support such services and whereas Community Heal th Services subsidy
funds are available from the Minnesota Department of Health:
NOW, THEREFORE, 1n consideration of the mutual undertakings and
agreements hereinafter set forth, the County through the Department
. and the Municipality agree as follows:
l. TERM OF AGREEMENT
The term of this Agreement shall be from March I, 1995,
through December 31, 1995, subject to cancellation provision
contained herein.
2. CONDITIONS OF COUNTY SUPPORT
A. The County through the Department agrees to make payments
to the Municipality for the prov1s1on of local
environmental health services (maintenance) as described
in Exhibit A, such Exhibit attached hereto and made a
part hereof as though fully set forth herein.
B. The total 1995 cash payments shall not exceed $2,800.00.
C. Payments to the Municipal i ty will be made in two (2)
equal installments in the amount of $1,400.00 to be paid
on or about July 1, 1995, and January 1, 1996, upon
receipt of completed and signed Exhibits B and C,
attached hereto and made a part hereof as though fully
set forth herein. Payment shall be made within 35 days
from receipt of the 1nV01ce. If the 1nV01ce 1S
incorrect, defective, or otherwise improper, the County,
through the Department, will notify the Municipality
. within ten (10) days of receiving the incorrect invoice.
HCA Form No. 104, Rev. 12/94
. Upon receiving the corrected invoice from the
Municipality, the County, through the Department, will
make payment within 35 days. In the event that the
County withholds payment for failure to provide service
or failure to comply with any of the provisions of this
Agreement, then no interest penalty shall accrue against
the County through the Department. If claims are made by
the Municipality that the County, through the Department,
did not act in good faith in withholding payments as
provided above, then such claims shall be handled as a
dispute by the Contract Manager (pursuant to clause 13 of
this Agreement) . If an audit is required by the County,
through the Department, before payment 1S to be made,
then no interest penalty shall accrue against the County,
through the Department, until 35 days after the audit is
completed by the County.
D. The Municipality agrees to make expenditure of County-
provided payment only for the purpose of providing the
environmental health services as described in Exhibit A
attached hereto.
E. The Municipality agrees to provide semi-annual reports to
the County through the Department within thirty (30) days
of July I, 1995, and January 1, 1996, detailing revenues
. and expenditures 1n accordance with Exhibit B attached
hereto.
F. The Municipality agrees to maintain a Delegation of
Authority Agreement with the Minnesota Department of
Health pursuant to Minnesota statutes 145A.07 to act as
the agent of the Minnesota Department of Health to
provide food protection services, lodging, and boarding
serV1ces of children's camp inspections. The
Municipality agrees to regulate public swimming pools
pursuant to Minnesota Rules Chapter 4717 relating to
public swimming pools, including all subsequent
amendments thereto. A copy of the Delegation of
Authority agreement 1S attached hereto and marked and
made a part of Exhibit A.
3 . CONDITION OF THE PARTIES' OBLIGATIONS
A. It 1S understood and agreed that the Agreement between
the parties 1S conditional upon the County recelv1ng
sufficient funding from the state of Minnesota. If such
funding 1S not available, this agreement shall be
cancelled immediately upon written notice to the
Municipality, other prov1s1on for cancellation of this
Agreement notwithstanding. This Agreement may be
renegotiated to reflect any reduced funding.
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. B. Any material alterations, variations, modifications, or
waivers of provisions of this Agreement shall be valid
only when they have been reduced to writing as an
amendment to this Agreement signed by the parties hereto.
C. Upon cancellation or termination of this Agreement, the
Municipality will reimburse to the County through the
Department any and all unobligated funds as required by
the Minnesota Department of Health. This reimbursement
shall be made within sixty (60) days of the effective
date of such termination.
D. In the event of any policy changes which result in a
reduction of services or major inconsistencies with the
1992-1995 Hennepin County Health Services subsidy Plan
written pursuant to Minnesota Statutes 1987, 145A.10
Subdivisions 5 and 6, the Municipality will notify and
consul t with the County through the Department before
implementing the new policy.
E. The Municipality shall comply with the provisions of the
Communicable Disease Reporting Rules adopted by the
Minnesota Department of Health in accordance with the
provision of Minnesota Rules, Chapter 4605, Parts 7000-
7600.
. 4. AUDITS. REPORTS. MONITORING PROCEDURES, AND RECORDS
A. The Municipality will:
(1) Maintain a bookkeeping system which sufficiently
and properly reflects all direct and indirect costs
of any nature expended in the performance of this
Agreement.
(2) Provide a semiannual budget/expenditure report
within thirty (30) days of July 1, 1995, and
January 1, 1996, to the county through the
Department detailing all revenues and expenses as
described in Exhibit B attached hereto.
(3) Provide a semiannual program activity report within
thirty (30) days of July 1, 1995, and
January 1, 1996, to the County through the
Department as described in Exhibit C attached
hereto.
(4) Submit a copy of the 1 ist of I icensees to the
department which is furnished to the commissioner
of Health as requested by the delegation of
authority agreement. The list will be subdivided
. according to the definitions of risk level
3
~ specified in Minnesota statutes 157.01-.04.
B. The Municipality agrees that the County, the state
Auditor or legislative authority, or any of their duly
authorized representatives at any time during normal
business hours, and as often as they may deem reasonably
necessary, shall have access to and the right to examine,
audi t, excerpt, and transcribe any books, documents,
papers, records, etc., and accounting procedures and
practices of the Municipality which are relevant to the
Contract. Such material must be retained for five (5)
years by the Municipality.
C. The County through the Department will monitor and
evaluate the performance of the Municipality under this
agreement on an ongoing basis. The municipality will
make complete inspections of licensed establishments at
least at the frequency required by Minnesota statutes
157.01-.04.
5. DATA PRIVACY
A. All data collected, created, received, maintained, or
disseminated for any purpose by the activities of the
provider because of this Agreement 1S governed by the
Minnesota Government Data Practices Act, Minnesota
~ statutes Chapter 13 as amended by the laws of Minnesota
1993 Chapter 351, and all other statutory provisions
governing data privacy, Minnesota Rules implementing such
act now in force or hereafter adopted, as well as federal
regulations on data privacy.
B. In accordance with Minnesota statutes 1992, section
13.46, Subdivision 10, the Municipality shall appoint a
responsible authority who shall allow the responsible
authorities in the welfare system access to data
classified as restricted when access is necessary for the
administration and management of programs or as
authorized or required by State or Federal law. The
Municipality shall notify the County of the name of the
responsible authority.
6. EQUAL EMPLOYMENT OPPORTUNITY AND CIVIL RIGHTS
A. During the performance of this Agreement f the
Municipality agrees to the following: In accordance with
the Hennepin County Board of Commissioners Policies
Against Discrimination, no person shall be excluded from
full employment rights, denied access to or participa tion
1n the benefits of any programf serV1ce or activity on
the grounds of race, colorf creed, religionf agef sex,
. disability, marital status, affectional/sexual
4
. preference, public assistance status, ex-offender status
or national or1g1ns; and no person who 1S protected by
applicable Federal or state laws against discrimination
and all regulations implementing such laws, including but
not limited to the civil Rights Restoration Act of 1987,
Public Law No. 100-259, 102 stat 28-32, 1988 and 20 USC
1681 ET. SEQ., 42 USC 2000D and 29 USC 706 shall be
otherwise subjected to discrimination.
(1) The Municipality shall comply with all applicable
statutes, regulations, and licensing requirements
in the employment of personnel. To the extent that
any of the provisions of the applicable statutes,
regulations, or licensing requirements are
inconsistent with any of the prov1s1ons of this
clause, said statute, regulation, or requirement
shall prevail if it has a reasonable bearing upon
the applicant's fitness to be employed in any phase
of the program.
(2) The Municipality guarantees that no funds received
under this Agreement shall be used to provide
religious training and/or services to any
individual receiving Purchased Services.
. (3) No qualified handicapped person, as defined by the
united states Department of Health and Human
Services regulations, Title 45 Part 84.3 (J) and
(K) , which implements section 504 of the
Rehabilitation Act of 1973, 29 U.S.C. 704, under
Executive Order No. 11914 (4 FR 17871, April 28,
1976) :
a. Shall be denied access to or opportunity to
participate in or receive benefits from any
service offered by the Municipality under the
terms and provisions of this Agreement, nor
b. Shall be subj ect to discrimination in
employment under any program or activity
related to the services provided by the
Municipality.
(4) It 1S the policy of Hennepin County that no
applicant or client shall be subjected to testing,
removed from normal and customary status, or
deprived of any rights, privileges, or freedoms
because of his or her AIDS status except for
clearly stated, specific, and compelling medical
and/or public health reasons.
. (5) If during the term of this Agreement or any
5
. extension thereof, it 1S discovered that the
Municipality is not in compliance with the
applicable regulations as aforesaid, or if the
Municipality engages 1n any discriminatory
practices as described above, the County, through
the Department, may cancel said Agreement as
provided by the cancellation clause of this
Agreement.
7 . MALTREATMENT OF MINORS REPORTING ACT I VULNERABLE ADULTS
REPORTING ACT
A. The Provider will comply with all of the provisions of:
(1) The Maltreatment of Minors Reporting Act, Minnesota
statutes 1992, and Minnesota Rules, Chapter 9560,
Parts 0250-0300, as promulgated by the Minnesota
Department of Human Services implementing such Act
now ln force or hereafter adopted.
(2) The Vulnerable Adults Reporting Act, Minnesota
Statutes 1992, section 626.557, and all rules
promulgated by the Minnesota Department of Human
Serv ices implementing such Act now ln force or
hereafter adopted.
4It 8. FAIR HEARING AND GRIEVANCE PROCEDURE
The Municipality will establish a system through which
recipients of service may present grievances about the
operation of the service programs, and the Municipality will
advise recipients of service of this right.
9. INDEMNIFICATION AND INSURANCE
The Municipality agrees to defend, indemnify, and hold
harmless the County, its elected officials, officers, agents,
volunteers, and employees from any liability, claim, causes of
action, judgments, damages, losses, costs or expenses,
including reasonable attorney fees , resulting directly or
indirectly from an act or omission of the Municipality,
subcontractors, anyone directly or indirectly employed by
them, and/or anyone for whose acts and/or omissions they may
be liable in the performance of the services required by this
contract, and against all loss by reason of the failure of the
Municipality to perform fully, in any respect, all obligations
under this Agreement.
The Municipality warrants that it has sufficient insurance
coverage to meet the Municipality liability requirement of
Minnesota statutes 466.02 and 466.04, and to comply with the
~ foregoing indemnification provisions.
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~ 10. INDEPENDENT CONTRACTOR
It is agreed that nothing herein contained is intended or
should be construed in any manner as creating or establishing
the relationship of co-partners between the parties hereto or
as constituting the Municipality ln any manner whatsoever.
The Municipality is to be and shall remain an independent
contractor with respect to all service performed under this
Agreement. The Municipality represents that it has, or will
secure at its own expense, all personnel required in
performing services under this Agreement. Any and all
personnel of the Municipality or other persons, while engaged
in the performance of any work or services required by the
Municipality under this Agreement shall have no contractual
relationship with the County and shall not be considered
employees of the County, and any and all claims that mayor
might arise under the Unemployment Compensation Act or the
Workers' Compensation Act of the State of Minnesota on behalf
of said personnel arising out of employment or alleged
employment including, without limitation, claims of
discrimination against the Municipality, its officers, agents,
contractors, or employees shall in no way be the
responsibility of the County; and Municipality shall defend,
indemnify, and hold the County its officers, agents, and
employees harmless from any pertinent tribunal, agency, board,
. commlSSlon, or court. Such personnel or other persons shall
neither require nor be entitled to any compensation, rights,
or benefits, of any kind whatsoever from the County, including
without limitation, tenure rights, medical and hospital care,
sick and vacation leave, Workers' Compensation, Unemployment
Insurance, disability, severance pay and PERA.
11. MERGER AND MODIFICATION
It is understood and agreed that the entire Agreement between
the parties lS contained herein and that this Agreement
supersedes all oral agreements and negotiations between the
parties relating to the subj ect matter hereof. All items
referred to in this Agreement are incorporated or attached and
are deemed to be part of this Agreement.
Any material alterations, variations I modifications or waivers
of provisions of this Agreement shall only be valid when they
have been reduced to writing as an amendment to this Agreement
signed by the parties hereto.
12. SUBCONTRACTING AND ASSIGNMENTS
The municipality shall not assign, sublet, transfer, or pledge
this Agreement and/or the services to be performed hereunder,
whether ln whole or ln part, without the prlor written
~ approval of the County.
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. 13. NOTICE OF CANCELLATION
This Agreement may be terminated upon thirty (30) days written
notice of either party.
.
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_._ n.__
.
Municipality, having signed this Agreement, and the Hennepin County
Board of Commissioners having duly approved this Agreement on
, 19 -' and pursuant to such
approval and the proper County official having signed this
Agreement, the parties hereto agree to be bound by the provisions
herein set forth.
APPROVED AS TO FORM AND COUNTY OF HENNEPIN,
LEGALITY: STATE OF MINNESOTA
Assistant County Attorney
Date:
By:
Chairman of the County Board
APPROVED AS TO EXECUTION:
And:
Assistant County Attorney eputy/Associate County
Date: inistrator
. Clerk of the County Board
APPROVED AS HOPKINS
LEGALITY;
By:
City Attorney Its Mayor
And:
Its city Manager
city organized under:
Plan A
Plan B
Charter
HCA Form No. 104, Rev. 12/94
.
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EXHII1I1 A
. Program Title: Murdcip81 [nvironmenUd HC'Dlth Services - M~-1inlpnLHlcl: of Lxistinq
F)ro qr olTlS
Problems Addressc d:
ProbJem5 8ddressed by this program include the prevention of food-borne illness;
maintenance of lodging and boarding care facilities; community sanitation; children's
camp ~anitationj swimming pool sanitation and related activities performed by or
under the supervision of full or part-time environmental health specialists, public
tlcalPI sanitarianf. or other personnel approved b)' the Minnesota Department of
HEalth.
GO:1ls:
]. Prevent food-borne illness, and contamination and decomposition of food
during production, processing, distribution, storage, preparation and service.
2. Promote safe and sanitary environments in lodging and boarding care facilities
to prevent injuries and illnesses associate with such places.
). Prevent transmission of acute and chronic disease agents by ensuring quality of
on-site drinking water supplies, and safe and sanitary disposal of on-site
wastewater.
4. Pre vent irritations, illnesses, injuries and deaths associated with environmental
. conditions of SWI mmIng pools and the community environment, children's
c8rnp~: and other reereat ional facilities.
S. PrOVIde bClsic ernironrTIl:'ntal heCllth ::;erv:\'es cOilsistent with the characteristics
of t~-IE- geographic area and the population.
Oujectives;
1. 10 ['nwre, in those municipolities with full-time personnel, the provision of
environrnerltal hC:';~lth serVICE'S consistino of routine inspection, complaint
invest Igation, liccm~inql plan reviev.' and laborator)' testing services.
2. To ensure, ill th[l~e municip<'Jlities with part-time personnel, the provision of
b8Sic {';wironmental health services; continue to examine unmel problems and
expondr:: d programming to fill gaps in services or resources.
3. To develop appropriate agreements with the Minnesota Department of Health
for delegation (If authority to permit municipal responsibility for certain
Ii censin 9 and inspectional a cl i vi ties pursuant to rv1innesota Statutes 145.5) or
]45.918.
Lj. To continue the develof1ment and utilization of a County-wide information
system for environmental health services.
.
[>- l-J]f'.lT P.
DFn;-.,'JT]C,;~::["\F'L..\0J:\J'lC~~S for, FU'C'f..:.TJ\,'C F(~I,'.\\S
~- ~_. ---
. REVENUES, GENERAL: A,l\' cr,\"j,or,rTlCnI",l hCc.lth cOl\'!1:, fer \~~IJc)1 ,3 rt'rn~j:,
license. cr Sir.liL:J cC'ntr~,J CIC vice is rcq:.JireG 2nd for \\ r,Jch a f cc j~, f-'~i d. ~,hl)L.jU =,,_
:nGiG~lt:C~. ThlS incJuces f!:TS f~~n, 01::;e, munic:p...J de~Gr::T:(:nts fer which c:.n
E:nvjrCnrJlent~J f:'(penC::it~rE: l~. cJ2.jm(,c; I.e., feVCJlL!CS :rom "cte, bjlJjn~, for
txperll;:;:,urcs clcimec for chJc'rinc, fkc'rine, cr hou:int" r;,2ir.leil3rlce fet:"S/~l'rr;lj:s
for the provision of housing m2:nte:lc.nce inspect 1 (.'r,S. LiC;\Jor liceJlse iees de not to
be incJudec. ;\:;y other revenue; Le.. s;'ec221 E::anL e'f subsidy, shoulc be' rercr:es lri
this se c1 ion.
EXPL"'nITLRES7 GE"'F..JC\.L.: I:: exper:c'i:un.s cre c~ci mEd fe'r services/2civi1!E:S
WhiCh 2re rlo~ conG-JCeu b\' reg'~10r c:Jv2rCnr.le:-,:=..! hC3.hh personr.-:.' 1 (inclucir1;
c,verheo..d a',ei oi:he, cor,;fT;on cos,s1. :~en 1;'05e c12i:TlC:: ~Uo~ b~ sup~on.ec by:
2ppropr~alejy Gocumer,tec TiTTle oi~i:rjbutjon recorG~;
an c.ppro\t':c uni.:orm sy~,,::n :or 211cC21in[ ;ndirt::'C COS1S which is 2Fpli~c
2nd used on 21] city progrCfTl5; end
. other dOCl.;mentation c,n file .=:.nd up-tO-c'2cTE m ~L!pport cf 211 ether
cllOC3.1 ion b2Sis use G to cis;: r itJl..r;: e CJsts t.o the pr cgr 2m '..incer ::-,;5
2.greemene.
Fe, eXc.:T,ple, ".-\n estimc.te of 1 S r::ercer,t of 2 Sec.:!i person's tJr"e cevoTed to 2
?ro~rc.r:-JtI~ is ~JC: 2f~ c.cce~1:2t-le c.~~0c2:ic:n process.
PERSONNEL ?ersc:nnel not prO\':Clr,g 2 :fu!l-tir.-Ie equi\'alent work I02e in
enviroldTle;-;.tc.~ hec.lth s~culc hc\'t L::-~eir \\.'ork c.llocc..!lon 1~5tec on 2 sepc:'c."le p2.ge lrl
. 2.cdiTion tD the dcol12r 2.rTI0unt li5teo in thE expenditure .section. Personnel slCch eS
I-- I.' . C -. r - . . .-. ~ . c ~,.--.--- - I r . : ........ r \ - -, (1'.... - . C".. h"','~.
"ousn,g lr:_tA':~lor~, nUjS2nL~ In_,;e~,cr. .C1t? Cle.k,.C_,_} .,~cncce., eLc., mu~:. "c,O;::
LceqT.Jc...~e s:.Jppor~ C8CUrTlen~c.tlo~ ;=:ro\'1cea ~o CJ2.1ri. en\'ircr;ment31 expencJ:~res
(-!1rne reports: or stc.:is~icc..J c..]JGC27~:,rl).
FRINC:;E 5E~Ei-:-IT~ H-J~~':'U(':~-_ E::-.:.i-:","".~.:-r~ CC~.:~~:"~':~='f". :c P.E.F;,.;\~,!, F.I.{~'''.'':'H
:"'iCS~"l:2..;~2:' ::C:-I .::.::t..:r~r-J:::~. :~~'2 ~j.~:-,:,--:...~ cC' ~;~c \:';Gr~~jJl('~<::' ccr;-~;-.sc. :ic !._
OFFICE :::.li?PLIE:; )r,C~L'CE CC5i:.: :~,=_,-rC".j ~~,[ 1:o::::1~~~,C':-e. r:''';r::c:::.t>::1 "C:[V,Cc~.
~0::'L~t':~. ;;~:II:C =' =2:-;-r...r, c.riG ~Jj=c~~~c..~cc:;u,=- ~\:;.-,e,~,c~:'J~~. C:::~cc :':";~'pllt.~~
PROIESS;ONAl. ScRVJCES :~!r!L'_c FX;::E-:;G.~~'5e~. :'~r :'::'::(,,:=':'0;-', CC:l\'iL;t~ ,~,.-
cc'r-",'sL!l:..=. -;.~ ..'~. ~~';\ :~':: ,:-, ~clc.:cc T'"""\ :.-:f. o?:-c\'irc'r.,r:t'~l-:::~l hI:: _~~: -i ~,rl~g~ :::-1-:.
OPEJ\.I', TING SL' PPLIES Ir,cl u e'f: :~.:::l c tes L ec;u! pI, ,e It, ::;...,c:;-, iC2JS, :.:Ie ,,,,CITH"tE'rS,
sanpJing rTi2terlnJS~ film and cevelc,~.ing and rniscell2r!-.'<:us c~e:2ting su~pLes.
EQU!P~"ENT REPAIR Se 11-e:\~L:.rlc.", or:'.
M1SCELLANEOUS hc1ude epxer:ci,ures, :Of 2ttencclice 01 pro:kssic :,ei rr:t::e:iJJgs.
continumg educotion, dues and subscriptions, books one public2tions.
eAPiT AL OUTLAY Induct:' !Tl2jor expenditures for ('c;uipr:ler:,c end :iC.cjljlie~.
SPACE RENTAL SeJf-explcn21cry.
. TRANSPOR T A nON Include CDS;: of OPf';oling 2ge::cy vehic!e{s) or reimbur s('rr;c:-,t
for the use of person2J cuto.
OTH[j~ Fk2.se specify, in c:!ct2iJ, ......ha1 t;'e c(;:Jf..:'r,d;,Jrc'o 2rE: fer.
L'\HJE.IT 2" ccnrinulc.d
COi\1"lU~~ITY HEAL TH S[f, VICES SUi\L\\:\P Y OF REVENL'[ /'\I'\;D L\PE:'\'S.E:~
. ENVIRON;\IEr--.;T,;L HE:\L TH FOR THE PERJC'D
through
FOR THE CITY OF
E:'<\']RJJ:\.\;;::i.--.iT..\L HL\L TH EXPENDITURES
FL'LL :'\~D P,~RT-TL\!E ENVJROr\'i'\1ENTAL HEAL TH PROGRr".:-"\S* BUDGETED tiC Tt' ,~.L
P'O:rsonr;c) Suvices (Full-tifTie pro['c::.rns on~y)
Enviror~ent~J HE~lth*"
C leric21 Supporc"'-i(
Otller--"-
. Frir.E;E: 2eneii cS
Office SLCpplies
Proiessior:.::.l Services (including pert-time environmer.tc:.l
r,E21t,'1 se:-vices)
Opere L1:18 Supplies
Ec:uiPTiEnt Rep2lr
l\~i~celJc.~eCJus
Cc.piLcl Ou-::lc.v
.n~c"" Per,-::,1 '
yc. ~ "- .Io. L__
Trc.n5~c'r~~ rior,
C1L:;e.:- '~~=-,::c~ -:Y}
CT~~~: =.~<\ :~' 0~~\1 ;:?'.:T..'\L E..xFE~8r-;-;_:R.E5
C'r,-s;,~ S/::\'. ~t':c [\ispos::,] P;ogran
Cr,-::oj"::," \\ Cc lcr 5L'pply F;CErc.!il
. ~l:-. ~ ;-:-~ c.l C C' r. ::- ::-11
:"'~cxlcu::; \~'"2-:.-:i Control
~ou~jf:~ nygiene
.';,r, \J; .::.;:~~, :--;oise Pollution Cancrol
.\icnici;::'c.J \,\'c.:er Supply Chemic.3.1s (Chlorine c.nd Fluoride enly)
L2~or",,;:o:y .suFport Services (\1.'ell water, food, "testing)
Ot::<::, (specify)
TOTAL
. SeE: EX,'-iibit C for explan<::.tions.
.~On 2. "LT~1k'mentary sheet or on bottom of p2ge, plE'c.se providE. personnel brec.kc'own (i.E., r,c;Tlbu c:
personrl(] .=:r.c proEram crea ii appropric.re).
- ~ --
EXHlBlT B, continued
.
EN\'lEOt,,\\E~'T"'\L HEAL TH REVENUES
R E \' E ;\ L' E .5 E,L'DG ETf D /;. C Tl~J ..'.. L
Fead License Fees
Food Ve'lclfig :-iachine Fees
Sv.:immir.t; Pool License Fees
HOlel,/;\\o:el Lodging Fees --
PerTT,i:/License Fees :for C:1-SitE: Se'.;;age System:::- c.nd V/c.ter Supplie5
An.imci Centrol Fees or Service Charges
Air IWc !Er INoise Pollution Control Fees/Chages
Service Chages for Water Treatment Chemicals (Chlorine anc Fluoride)*
WeeG Cont;-ol Fees or Service Charges
Pest Comrol Fees 0; Charg'es
G2.r~2ge 2.nd Refuse Hc.ulers License Fees
Hccs:nt;/Rer.tc.l Property Inspecd.on Fees
Ot:.cr Fees. Grants or Sources of Reve;Jue (specify)
(inclucir'E: CHS iun.ds provided by Hennepin County)
.ocal 1" eX
TOT ?L
C ~r' Tl?~ CJ ,~., 7>~':",
1 ce::l:~': :;-jc1 to i:t-:e best oi ITI)" know'lecgE 2.r:d beliei "L7lct t;-Ie Gct2 repor:ec in t:~e c.bo\'e !~:12.:-:cic.j EX:-I~~j~
~s corree, end :h2 t all tr2.r\sacicns '>;,'ere T712.Ce 1n 2.cccrc2.nce with the P.greeme:.t provisions c.;,G 2.F'-pEc:.:,
2.SSUr~nCES.
,; m:-.Gr i:- ~ :::: (11ii ciel 02. te
Fisc2.1 1\12.n2gement Officer Dete
.F.evenuE'S for chemicals can be c1cimed to the extent that the municip2.1 wa:er c;-,c.r~es offset l~tc.J W2:'
ep2.rt:T.er'l expeneitures. It is assumed to be 100 percent unless otherwise inciicc.te::.
--.." -.
EXHIBJT C
. CHS Annual Report
- Face Sheet -
County/City Name:
Authorized Agent"': (Signature)
Date Signed:
'.'
',' ',',.' .:'::' .... ,.....:L ".:. '.. Offic~::U~' OnJin n
, . ,
. .. ...
.CountyfCit.yNuriiber:" ". .
. .. '(S~:,~gilDwnbet) , ""'"
n
, ,
f .. This form must be sif!;I1cd by the Chairperson or Vice-Chairperson of tbe Community Health
Board, or an appointed agent.
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. GENERAL INSTR UCTIONS FOR CHS REPORTING
One original and two copics of the completed forms must be submitted by April 1, 19R9, to the
Minnesota Department of Health District Office. For assistance in completing the forms, contact your
DL~tricl Representative. One set of these documents will be retained in the District OffICes. District
Representatives v.ill forward the original report and one copy to MDH.
COU!\'T\' AND CITI' REPORTING
A separate rchorting form must be completed for each county or city participating in the CHS program.
Each rcport s ould include data on all reportable activities that are mcluded in the CBS plan and
budget.
Reportable activities include those which were funded by the local agen't;through the use of CHS
subsidy, local funds, special prolcets grants, and other state and federal unds. If onc CHS agency
contracts for services \\~th anot er CHS agency, the agency that funds the services should report the
related activities. Additionally, information may also be requested of those agencies participating in a
special project grant.
REPORTING AcnVITlES AND EXPENDITURES BY PROGRAM CATEGORY
The CHS Reponing forms are organized around the CHS program categories:
. DL~ease Prevention and Control
. Emergency l'.1edical Care
. EmironmentaJ Health
. Family Health
. Health Promotion
. Home Health Care
. Not Allocated to Program
. This is done to improve the compatability of the CHS plan, budget, activity report and expenditure
report. This com~atabiJ::-y is intended to simplify the analysis and interpretation of the data at a
district and state evel. For clarification a~ to which program category subsumes which acti\ities, see
Apr~ndix J of the CHS Planning and Reporting Manual.
\'OLU]\''1ARY NARRA,TJYE REPORTS
Any additional information that CHS agencies would like to provide in the W<l\' uf nar rative reports is
wclo'IDe:. Such r('ports might include local i:lnnual reports, reports on local e\'aluali"n projects, or other
sp<:ciaJ rcpOrL~ regarding community hCL11[h services. If pn1\idcd, these repons should be in addition to
and distinel from the required forms. This is necessary to avoid confusion as to what data should be
keypunchc d and proccssc d as a part of the routinely r~ported data.
G[NI.:RAL DEflKfTlONS
DisellS(' Pn.V('lltion and Control; "Disease pre\'ention and control" means ae[i\itic~ intended [0 prevent
or control communicable disea~es; these activities include the coordination or pro\;sion of disease
survcillance, investit<l[ion, reporting, and related counseling, education, screening, immunization, ca.c.e
management and c inieal services.
EmergenC)' Medical Care: "Emergency medical care" means activities intended to pr ()lect the health of
persons suffering a medical emergency and to ensure rapid and effective emerfcncy medical treatment;
these activities include the coordination or provision of training, cooperation v,1th public safely agencies,
communications, life-support transportation as defined according to section 144.804, public information
and involvement, and system management.
Environmental Helllth: "Environmental health" means activities intended to achieve an environment
conducive to human health, comfort, safety and well-being; these activities include thc coordination or
provision of education, regulation, and consultation related Lo food protection, hazardous substances and
. roduct safety, water supply sanitation, waste disposal, environmental pollution control, occupational
ealth and safely, public health nuisance control, institutional sanitation, recreational sanitation including
swimming pool sanitation and safely, and housing code enforcement for health and safely purposes.
Reporting and Evaluation 49
rORM I. CHS STAFFING BY PROGRAM
. INSTRUCTIONS:
Enter the number of FULL-TIME EQUIVALENT (FTEl staff persons for each of the occupation titles
by program category. The number of FIE employees w 0 worked directly for the CHS agency,
regardless of source of funding, are entered in the .Positions Filled" column. The number of FfE
positions provided by contractors are entered in the "Positions Contracted" column. Enter any unlisted
occupation in the "Other" calegories and specify the position title in the space provided.
The occupation categories listed on lhis form arc intended to represent a slaff lierson's job litle. For
example, the full value of a Public Health Nurse's FTE should be reported on ine #12, "Public Health
Nurse: This FfE may, however, be allocated to more than one CHS program (i.e., .5 FTE Family
Health and ..5 FrE Health Promotion).
ITE Standards
Somc cflunties USe different standards for calculating full-time equivalent (FTE) employees. One
~encral defrnition is a 4O-hour week or 2,080 hours/year as 1 FIE; a vanation in some counties is 37.5
ours/week or 1,950 hours/year. Please state your county's defInition of FfE in hours per week on
the blank provided under the title .CHS Staffing by Program: Then use your county's FIE standard
to calculate the FrE's to be reported in each occupati(m by program category.
For contracted positions use the actual FTE figures from billings or end-of-year reports from
contractors. Estimate the FTE for fiat fee contracted positions such as a medical consultant. Roster
nurses are considered contracted positions.
In-Kind Starr Error!
Several CHS agencies monitor the FTE of in-kind staff effort and include the value of this effort in
their CHS budget and expenditure report. If your agency monitors in-kind staff effort, report it on line
. 15.
NOTE: All F!'Es should h:: rounded to the nearest hundredth (x.xx). If any of tbe FTEs total more
than zero, but less than .01, report as .01.
DEFINITIONS:
Administr,dive Stan: Individuab, such as an Accountant/Financial Manager, a CHS Adminislrarnr,
clcric~d support staff, a~ well a~ prot,'Tam director.', and supervisory staff. This occupation category
would also in,ludc the foJlmving. job titles:
Account Clerk Marketing Coordinator
Administrative Assistant Me dia Specialist
Administrative Manar,er Medicare, Consultant
Administrator of Nursin~', Medical Records Practitioner
Assist ant Biostatistician Nurse Pro/?ram 1\1anagcr
Assistant Director Public Health Nursing Nursing Director
Bookkeeper Nursing Supervisor
Business OffIce Staff Office Manager
Clinic Director (genera? Other Administration
Clinic Manager (genera) Planner
Comm unity Health Servlccs Supervisor Public Health Nurse Supcrvisor
County Health Dep!. Administrator Program Adm inist ration (gencral)
Custodian/M aintenance Program Development/Evaluation
Data Processing Officer Specialist
Delivery Worker Prowam Planners (general)
Director of Planning & Administration Pro~ect Assistant
Driver Project Director
Graphic Arlist Public Information Specialisl
Health Coordinator Records Speciali~t
. Health Planner Supervisor Administrative
Health Prof;Vam Analyst Services
Health Statistician Supervisor Public Health Services
Janitor Supply Manager
Storekeeper
Reporting, and Evaluation 5]
. a~ a phy~ican for the CHS agency should lx' recorded here..
I'ubllc lkalLh Nurse: A nur~c n:gistercd in State of Minnesota and certified as a Public Health Nurse.
.
OUu'r Nursin~ SUirr: This occupational category includes Registered Nurses and Licensed Practical
Nurses as weU as other positions which directly assist nursing activities, and are not cerLified as Public
Health Nurses. Other job titles for this occupational category would include:
Asst. Coord. Maternal and Child Health MCH Consultanl
Child Development Coordinator Manager Maternal and Child Health
Child Health Aide Nurse MidwiIe
Development Services Specialist Nursing Practitioner
Dial AIdes for PSS Nursing Consultant
EPS Coordinator PNA
EPS Outreach Worker Respite Care Coordinator
EPS Technician School/Community Health Aide
Family Plannins Personnel School Health Aide
Hospice Coordmator Youth Intake. Worker
Therapist: Any of the follo\\ing types of professional workers:
. Physical Therapist: A professional worker prepared to evaluate clients' neuromuscular and
functional ability and to initiate a treatment plan, in conference ",;tb a physician (see 42 CFR
(Code of Federal Regulations) 405.1201 (i) for required credentials).
41 Occupational Therapist: A professional worker prepared to help clients develop and maintain
tasks e!)Seotial to daily living (see 42 CFR 405.1212 (g) for required credentials).
. Speech Therapist: A professional worker prepared to treat clients who have a communication
problem relating to speech, language, or heanng (see 42 CFR 405.1202 (u) for required
. credentials).
In-Kind: Several agencies monilor the FTE of in-rind slaff effort and include the value of this errort
in their CBS Budgetj&-penditure report. If your agency monitors in-kind staff effort, report it on line
15.
Other: Any occupation titlc which cannot be included in the categoric, listed above. Please try to
include e\'ef}1hing possible in the listed categories and spcciry "other" entries,
.
Reporting and Evaluation 53
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. or chemical J?Oisonin~. For pLJr(Xlscs of thL~ re~rt, a single case of reactivated tuberculosis which has
not resulted m additIOnal infections should not considered an outbreak. Indicate in this column onty
those confirmed outbreaks in which the agcncy was the lead or principal investigator.
Probable FoodbonH'/\Vaterlwrne Outbreak5: A probable foodborne or w<lterhorne disease outbreak is
defined as an incident in which: 1) two or more persons experience a similar illness, usually
gastrointestinal, after infcstion of a common food or water product, and 2) data are insuffidcnt for
epidemiologic analysis; owever, a specific food or water item is suspected.
Non-Related Outbreaks: Nonfood or nonwater ingestion-associated outbreaks are defined ~~ two or
more cases of illness related by time aDd ~lace in which an epidemiologic investigation is conducled and
the results are inconclusi\'c or do nol implicate food or water as a source of the outbreak.
.
.
Reporting and Evalu:Hion 55
. FORM V. ENVIRONMENTAL HEAL TH ACTIVITIES
I NSTIWCTlONS:
Thi.~ form should be completed only for those acti\ilies which arc sUf,portcd by the agency. Enter the
numbers requested by tbe column headings for each of the types of aeilities and activities listed for the
fiast year. Lines 1, 2, 3, 4, 5, 6, 7, 8. and 9 should be reponed only by agencies ",ith authority to
icense and inspect under delegation agreement with MDH.
DEFINITIONS:
1\"Dl'S or Environmental He.alth Activities
Facilities in AgenC)"s Jurisdiction: Exact count, if kno"'TI, of the facilities in the Agency's jurisdiction,
including zero if none exisl. Lines 1, 2, 3, 4, 6, 7, 8, and 9 should be reported only by agencies with
authority to license, inspect or permit under delegation agreements ",ith MOl-I. For #1, 2, 3, 4, 6, and
7 use the number of licenses issued. If uncertain, write unkno\\'D or give a range, e.g., less than 25.
Inspections covering compliance with the Minnesota Clean Indoor Air Act (MClAA) must be recorded
on line 5. Facilities are in agency's jurisdiclion only when a dclettion agreement with MDH exists.
'Facilities Inspected by CHS: column 2, should be the same num r or less than "Inspections by CHS,"
column 3.
Facilities Inspected: The number of different individual facilities which were inspected. according to the
definition specified below.
Inspections: For items # 1 " #9, inspection means a complete full-scale planned inspection. It does
nol mean short follow-up inspections, e.g., to determine whether freezer temperature is now low
enough, or if NO SMOKING signs are properly posted.
For items # 19, #20, and #21 both systematic and scheduled inspections, e.g., appropriate housing
. maintenance inspection~, well or septic tank construction, and non-routine inspectIons should be added
together.
The difference between "new' and "cxisting" is made as foUows: A system or well is new if it has
ne\'CT been pu: to significant use; otherwise it is an existing system.
10 e\'cry case. there shou Id he al least ooe inspection for each "facility inspc cted."'
('omplaints Rffei\'ed: Anv ,ommunicalion concernin[! any of the aCli\ities or facililies listed in the left
hJ..d cC~;Jmn_ "Reccived" 'dl1e~. nol distinf':lish frivolo'Us from sincere, nor docs it inc1!Jdc resolution.
CnlllJllainb In\'estiglltl:d TIlrough an Inspection: The numher of complaints which rcsulted in an on-
sit c visit, [J() maltu how brieL Do not cnte r the num her of on-sit e inspections. The number of
C\lmplaints investigated throuf!.h an inspection is unlikely 10 be larger Ih;:m the Dumhcr entered under
"cnm plaint s reel' iV(' d."
Enforcement Action Any method (in \l,Titing) underlaken afler issuance of an impcetion repmt and
correction orders med to insure compliance, including letter of non-compliance, license revocalion or
suspen.<;ion, administrative hearing, fine, violation tag, or court action. II does not include field
investigalion where none of the foregoing action is taken. This same criterion would apply to
enforccmenl actions relative to the MCIAA.
Facilif)' Plans Rl'\i('Wt'd: Those reviewed pursuant to a stale law or rule, or a local ordinance.
Fadlitie~
Faeilih': Defined by the types of establishments listed. Each of the establishments listed (i.c., lodging
establi~hmenl, a swimming pool, ele.) is a facilily.
Food-Beverage Establishment: As governed by Minn. Stat. 157 (1986) and Minn. Rule, parts 4625,2400-
. 4625.5000 includes a restaurant, a har, or a restaurant/bar eomhinalion.
NOTE: Vending machine inspections are reported below on line # 14_
Reporting and Evaluation 59
. Privatr ~'Ug(' System: Consider private sewage systems as those systems ddincd in Minn. Rule, parts
7080.00]Q-.7080.0240, whether or not the standards have been adopted by rderence by the counly, and
whether or not the systems meet those standards.
Animal and FOl\1 Control: Activities undertaken to eliminate unsafe or disease enhancing conditions
caused by animals and/or fowl and violations of a local animal control ordinance. Examples arc animal
bite investigations; improper waste disposal; and keeping of any animal, fowl, or reptile where rrohibiteJ
by ordinance of any municipality or county or withoul a special pennie Do not include anima
impounding activities or pel leashing enforcement.
Waste Hauler (solid): As regulated under Minn. Rule 7035.0s00.
Other: Any activity which does not fit into a previous' category. Specify tbe type of acti";ly. Please
tr)' to include everything possible in the lisled categories and specify .other" entries.
NOTE: A CHS agency may want to describe in a shon narrative form any environmental health 1CHS
supportable) activity which the agency deems as being worthy of reporting, i.e.. it consumes morc t an
1 % of its resources or approximately three days' worth of work during one year's time, or it is an
activity which is cA.-peeted to rctuire significantly morc of the agency's resources in succeeding years.
Any reporting done under this earling is purely optional.
.
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Reporting and Evaluation (,]
. FORM VII. PRIVATE WELL WATER QUALITY
INSTRUCTIONS:
-
Enter:
1. the numher of private well water samples analywd for coliform bacteria and for nitrate
nitrogen,
'") the number of samples containing coliform bacteria and the number containing the specified
~.
levels of nitrate nitrogen.
3. the number of positive samJ;les for coliform bacteria and for the specified leve15 of nitrate
nitrogen which received folow-up contact.
Whut to Include
. The number of samples should include original and repeat samples from private domestic or
commercial wells, food processing plants, schools, licensed establishments, etc.
. If a sample contained both coliform and nitrate nitrogen, it should be counted in both
categories.
What to Exclude
. Do not include public community water supply samples.
. The samples reported as containing 10 mg/I or more (>) of nitrate nitro~en should not be
included in the counts for 1 mg/l or more (>) and less than (<) 10 mg I nitrate nitrogen.
. DEFINITIONS:
Samples Containing Colifonn Bacteria: A positive sample which contains one or more bacteria.
Sa rn pIes Containing Nitrate Nitrogen: A positive sample which contains at leas! one milligram Gf
nitrate nitrogen per liter of water.
r olln~-{Jp: Action specific to a particular sample resulL It docs not include routine attachment of a
!c!lcr or information brochure to a lob report which helps in interpretation of results or tells how to
di~inkct <I well.
Addendum for Enyironmental lIealth Data
Perhaps the best way to c).:plain the proper rccordin,L'. of environmental hCdlth inform3lioo in the CHS
Report is through answers (A) (0 a number of quesliom (Q) whieh have arisen or may arise.
1 0: H1li'll a pcr.;on representing an agency ha.\ been subpoenaed and appears ill court, how is the
acti\7ty recorded?
A: Only court appearances thaI resull from enforcement action takeD by the health agency should
be rcported. Form V, column 6 would 1)(: used. Appearances for any other purpose would
nol be reported.
2aO: Ho..... docs one report the time spent makiflf.; a site visit for purposes of discussing environmental
health matter.; such as remodeling a liccrurd facilit)' or building a facility that will be licensed?
A: An account of this type of activity is not requested.
2bO: If a person representing an organization without an appoimment came to an environmental health
. agency and discussed requirements for remodeling a licensed facility, how would the activity be
recorded?
A: An account of this type of aclivity is not requested.
Report in~', and Evalualion 6:1
. 7 0: Shollld COllnl;e5 wirh delegation (J!,'TCC!1/cnl.\ for non-commllflity PIlMic water sllpplies report Iheir
non-comml1nity p>.lblic water slIpply activities on lint' #9 MNon-Community Public Water Supplies"
I1..!JJt line #8 'lVcll Code Enforcement"?
A: Yes. The Well Code Enforcement program includes non-community public water supplies.
Line #9 gives MOB the information it Deeds that is unique to licensed and non-licensed non.
community public water supplies.
80: If a CHS agcncy does laboratory water analysis for other counties or other CHS agencies, who
should be responsible for reporting the !lumber of samples analyzed in Forni VII?
A: Information should be repOrled by the agency having jurisdiction where the water sample was
coUected, irrespective of where the analysis takes place.
9 0: Arc inspection scores for limited food and bel'eragc facilities to be recorded in Form VI? Arc
limited food and bCI'eragc facility activities to be recorded in Forni J".
A: Yes, the information is to be included in both forms.
lOQ: Fonn V. line 10, refers to swimming pools. 111e definition oj swimming pools is pools regulated
under Minn. Rule, parts 4717.0100-4717.3900, which means all public pools. Some enl'ironmenlal
health agencies arc also involved with private pools. Should Ihis work be recorded in Forni V?
A: No, on linc 10, only record swimming pool activities tbat involve public pools (tbose serving
many people, e.g., school, municipa~ apartment building, tov-nhouse, etc.).
11Q: How arc services provided to agribusiness to be recorded?
A: If a routine inspection is made of the hog farm because a feedlot permi! bas been issued, and
if time is spent discussing surface and ground water protection options, then the whole activity
. should be reported on line 24 of Form V under the heading "Inspections by CHS."
\\Then an investigation is made at the hog farm as a result of a complaint or im.Juiry
concernin~ possi Ie surfacc and ground water pollution, then the activity would again be
reparted tn Fonn V undcr the heading "Complaints Invesligated Through Inspection." The
ac(i\;ty would he reported on line 2..:1 and (he word "feedlot" would be addcd if (he acency
issues permits. Line 16 would be used if no permits arc issued.
.
Reponing and Evaluation 6S