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CR 93-216 Environmental Health Review " \ "{ Y 0 .'" - ~ .-",December 14, 1993 ~ 0 ~ ~ Council Report No. 93-216 P K I ENVIRONMENTAL HEALTH SERVICES AGREEMENT FOR 1994 prooosed Action. staff recommends the following motion: Move to aoorove the environmental health services aareement with Henneoin County for 1994. 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 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. o 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. 4IJ agreement is available Thomas Anderson City Building Official "f- ~. .' City of Hopkins Contract No. ,A01994 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", 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 Municipali ty wished to provide Communi ty Health Services; and WHEREAS ,county funds through the Department are available to support such services and whereas Community Health Services subsidy funds are available from the Minnesota Department of.Health: ~ NOW, THEREFORE, in consideration of the mutual undertakings and agreements hereinafter. set forth, the County through the Department and the Municipality agree as follows: .. 1. TERM OF AGREEMENT The. term of this Agreement shall be from January 1,.. 1994, through December 31, 1994, 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 provision 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 1994 cash payments shall not exceed $2,800.00. C. Payments to the Municipality will be made in two (2) equal installments in the amount of $1,400.00 to be paid on or about July 1, 1994, and . January 1, 1995, upon receipt of completed and signed Exhibits Band C,. attached hereto .and made. a part hereof as though fully . set .forth herein. Payment shall be made within (35 days) HCA Form No. 104, Rev. 11/93 ,'"'''''' -'c" "h"~ , . .. ~ '. '.. .' 0' '-J .. ., ,> '. 2 from receipt of the invoice. If the invoice is incorrect, defective, or otherwise improper, the County, through the Department, will notify the Municipality within ten (10) days of receiving the incorrect invoice. 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 is to be made, then no interest penalty shall accrue against the County, through the Department, until after (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 wi thin thirty (30) days of July 1, 1994, and January 1, 1995, detailing revenues and expenditure in 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 Heal th to provide food protection services, lodging, and boarding - services 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 is attached hereto and marked and made a part of Exhibit A. 3. CONDITION OF THE PARTIES' OBLIGATIONS A. It is understood and agreed that the Agreement between 4ID the parties is conditional upon the County receiving sufficient funding from the State of Minnesota. If such - funding is not available, this agreement shall be --~------ ',," -.. . 3 cancelled immediately upon written notice to the Municipality, other provision for cancellation of this Agreement notwithstanding. This Agreement may be renegotiated to reflect any reduced funding. 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, 1994, and January 1, 1995, 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, 1994, and January 1, 1995, to the County through the Department as described in Exhibit C attached hereto. '"to j 4 . (4) Submit a copy of the list of licensees 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 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, audit, 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 moni tor 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 is 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, the Municipality agrees to the following: ~.. ~ . , . 5 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 participation in the benefits of any program, service or activity on the grounds of race, color, creed, religion, age, sex, disability, marital status, affectional/sexual preference, public assistance status, ex-offender status or national origins; and no person who is 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 20000 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 provisions 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. l- .~ 6 . (4) It is 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 extension thereof, it is discovered that the Municipality is not in compliance with the applicable regulations as aforesaid, or if the Municipality engages in 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 , 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 in 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 Services implementing such Act now in force or hereafter adopted. 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. INDEMNITY The Municipality agrees to defend, indemnify, and hold the County, its officers, and employees harmless from any liability, claims, damages, costs, judgments, or expenses, .- including reasonable attorney's fees, resulting directly or indirectly from an act or omission of the Municipality, its agents, employees, or contractors in the performance of the < . . 7 services provided by this Agreement and against all loss by reason of the failure of said Municipality fully to perform, 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. 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 cp-partners between the parties hereto or as ,constituting' the Municipality in 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 .'Municipali ty 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, commission, 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 is 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, modifications or waivers of provisions of this Agreement shall only be valid when they 1, 8 . 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 in whole or in part, without the prior written approval of the County. 13. NOTICE OF CANCELLATION This Agreement may be terminated upon thirty (30) days; written notice of either party. . . . m. -- ~... , '. . 9 Municipali ty, 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 legality, form, and execution. COUNTY OF HENNEPIN, STATE OF MINNESOTA By: Chairman of Its County Board .' Assistant County Attorney Date: And: Associate County Administrator ATTEST: Deputy/Clerk of the County. Board CITY OF HOPKINS . By: Its Mayor . And: Its City Manager City organized under: Plan A Plan B . Charter_ HCA Form No. 104, Rev. 11/93 -'. "" " " 0__"' '._""_ ",'___'-----------" '"cc__~~-'... "_J. ""'; eXHIBIT A . Program Tille: fv1unicipnl Environmental Henlth Sefvicer. - Maint pnance of Existinq Pr'oqrams Problems Addressed: Problems addressed by this program include the preventianof-faad-borne illness; maintenance af ladging and boarding care facilities; cammunity sanitatian; children's camp sanitatian; swimming poal sanitatian and related activities perfarmed by ar under the supervision of full or part-time enviranmental health specialists, public health sanitarians ar other personnel appraved by the Minnesota Department of Health. Goals: 1. Prevent faod-borne illness, and cantamination and decompasition af foad during production, processing, distribution, storage, preparation and service. 2. Promate safe and sanitary environments in lodging and boarding care facilities to. prevent injuries and illnesses assaciate with such places. 3. Prevent transmission of acute and chranic disease agents by ensuring quality af on-site drinking water supplies, and safe and sanitary disposal af an-site wastewater. 4. Prevent irritations, illnesses, injuries and deaths assaciated with environmental '. canditians af swimming paols and the co.mmunity environment, children's car:nPs and ather recreational facilities. 5. Provide basic envil'onmentall,ealth services cansistent with the characterbtics af the geagraphic area and PIe papulation. Objectives: 1. To ensure, in those municipalities with full-time personnel, the provisian af environmental health services cansisting of routine inspection, complaint in\'8stigation, licensing, plan review and labaratory testing services. . 2. To ensure, in those municipalities with part-time perso.nnel, the provisian af basic environmental health services; continue to examine unmet problems and expanded pragramming to fill gaps in services ar resources. 3. To. develop apprapriate agreements with the Minnesota Department of Health for delegation of authority to permit municipal respansibility for certain licensing and inspectio.nal activities pursuant to Minnesota Statutes 145.55 or 145.918. 4. To. continue the development and utilization of a County-wide infarmation system for enviranmental health services. . _~_~~~m~.."",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,=,__...~_ ~ E)\HlBlT e. D EFJ:-~lTK\"\5.'EX PL..\N r\ Tj0~S PC'[\' f-:Ef'OR TJ:'\C FOR.\ \5 . . R [VENUES, GENERAL: Any environrrltntc.lhechh activity for which a permit, lict'r'.~.c'; cr sir:lila control device is required and for which a fee is paid. should be :ncilC.:lt.'G. This includes fees irom other munidp<::.l depar-:.rrlents for which an (.nvire'rlment.::.l expenditure i~. claimed; i.e., revenues from water biUing for \:;~;Pt:ncl,ut os c1aimec for chlorine, fluorine, orhoudng maintenance iees/permi:s :for .he provision of housing m.=.lntenance inspec:jons. Liquor license fees are ~ to be. incJud.€:c. Ar.y other revenue; i.e., special ftantor subsidy, shoulc be reponed in :r-.15 sectwil. C~PC,"'1)rR"R F,,= GE.."t:.....zl-"L: Ii expencii-:ures are claimedicr services/activiTies ......-... -- ~. ~~', . . h, t",1-~ ,.,.:_- ~~-l h -'-h ...- ""1 (' c' c.l.n.... V".._.. c.€: .Ic~ CI...oIcuc,eu _'~ re;:;_lC.' e..\.,,-nme.\,c.. e;:.H. pe.::.onr._ 1n lU 6 C\ err.e::..c 2,;',C 0'the: common cos.s): then these claims mus: be su?portec by; . 2ppropri2'teJy documented time distribution records; C.n c.pprC'\'ed Lmliorm sys-::em for alloc2'tlng indireCT COStS which is applied 2.nc used on 2.11 dty prcgr=.ms; and . orher coCt.:mentation or. iile .=.r.d up-to-dc.te in s:..:pport of all other 2.1locatioil b2.sis used :0 dlstriDL:te c:::sts to the program under this 2.8reemen;:. Fe" cX2.;-:-.ple: ".....n estll.12.te of 10 percent of a sTe-if person's tirr.e devoted to a ~'r:-fr c.:";"ln~is rJC: ai, 'a,~cept2.ble alloc2.tlonproce.ss.. .' . PERS::)NNEL ?ers;:;nnel f.Ot providing 2. :ull-time equiv2.1ent work 10cd in .. ,:,:-\,::---""''''-'''', he,:::'",.., sl-,"'u1d 1..,-\,,,,, -~",,;~ "'or" -!loc:::-ion Ii,,-"""" "'il - se.-,----e -"',,'" in , ~'I. .:~,:,",',.'j'-'I"'-:-_ '~,:_~~I\ l4t.,; __ ~.c::. .,,",,_ l..):\;;;.._. ~ :"\~. .:-:.... l _....1."':- \..<1 a. ,!"'""G.c.1. ~~c.-" aCC;':10r: ::: :;-;e Gc..Jar 2.mOur.t Lstea III the expenanure SeCi:lon. Personnel sUCr! as ~K:u~lr:g lr:s;:;ectors, ~l!jsance in~?eC'tor, .~;ry Cler~, CIty ,~2.n2ger, etc., mus~. h2.ve c.Gt:q''';.=.:e s:.:;::;:or: cocumen-::at;on PiO\'lcec -::.:) Cl2.1m ennrcnmental expencri:ures !:liT;~ r~por:s (;r ::c:Is!lcc.l alJccc.tion). FRl~C::: S2.NEFITS Incluce: employer's ccr..~,:bu.lon ~o P.E.R.,;.: r.LC.."'.., ~...::,~; ~:2....::;::c~, ~rL~'...1r2..r.ce, lii-e: insurance 2.ne \~;orkmer~'sccrr:;:'e~sa!icn. OrTICE SUPFLIES Ir:cluce costs lncu:-red fx tele.phone: duplic:::.tion services: ;:c:::!Ec. ~~:II:~ -: ~c.:-rr;~, ~r1G mi;.c::lla~e~L!s €:x?e~ccble oi:lce s\..:pplles.. FROFESS;CN;,.L 5~ V~CES l:lc2uce ex;:;endi-rures lor lc.::C':-:::.:ory cc:jvitio or ::':~..:.~~~c ~:'1 ~sE:.r\'ic=s rE=lated 10 :he environrne!l!a.l'hEaJ:h prog~2:.:T:. OPERP.TING SUPPLIES Induce fiek test equiplT:e:'H, c;-;er.-.lcals, :hermome;:ers, sam;::,jjnf materiels, film and developing and misceE2ntOl!S ope:-cting supplies. EQU1PMENT REPAIR Scli-expkna!ory. MISC8-L.A.NEOUS bclude epxenditures f~r a:.enG2.nce of professionel meetings, t.:or,tirl\JinE educetion, dues end subscriptions, books end public2.tions. eArn AL OUUA Y Include m2jor expendjtures for equipmen:and facilities. . SP ACE RENTAL 5eli-explc.n2tory. TKANSPCR T A TION Include cost of opere ting 2.gency vehlc2e{s) or reimbursement for the u~e of personel aUlO. OTH[j~ P1eese spe-ciiy, in cct2.il, ",,"hat the eXj)er.ditures are- :fer. " ~ EXHIBIT B, continued COMf.-IUNITY HEAL TH SER VICES SUt,I:-'.IAR Y OF REVENUE AND EXPENSES . ENVIRONi\IENT AL HEALTH FOR THE PERIOD through FOR THE CITY OF ENVIRON~,IENT.';L HEAL TH EXPENDITURES FULL AND ?:\R T - Tli\IE ENVIRON~~ENT AL HEAL TH PROGR~.!\'1S* BUDGETED ACTU?-.L Personnel Services (Full-time pro~rams only) . Environmental Health,.,..... . Clerical Support** . Other"""" . Fringe BenefiTs Office Supplies Professional Services (including part-time environmental health services) Operating Supplies Equipment Repair Miscellaneous . CaplLal Outlay Space Rental Transpor:2.Tlon Other (specify) OTH=:? =-0:VIRO!\~\ENTAL EXPENDIT\.-'RES On-siTe Sewage Disposal Program On-she \J;.'2.ter Supply P:-ogr2.m :~.nlmal Cont:-ol Noxious ';" eed Control Housing Hygiene Air, Water, Noise Pollution Cont1'ol Municipal '~'a:er Supply Chemicals (Chlorine and Fluoric!e only) Laboratory Suppon Services (well water, food, LeS!ing) Other (specify) - - TOTAL . ""See Exhibit C for explanations. ""*On 2. supplementary sheet or on bottom of page, please provide personnel breakdown (i.e., number of personnel and program area ii appropriate). .~ -- " , . EXHIBIT B,continued ENVIRON~IENTAL HEAL TH REVENUES REVENUES BUDGETED A.CTUAL Food Li cense Fees Food Vending ~1achine Fees Swimming Pool License Fees Hoteln.iotel Lodging Fees Pe,mit/License Fees for On-Sj~e Se..;;age Sys1:ems and Water Supplies Animal Control Fees or Service Charges Air/WaT.er /Noise Pollution Control Fees/Charges Service Charges for Water Treatment Chemicals (Chlorine anc Fluoride)* \reed Conuol Fees or Service Charges Pes! Control Fees or Charges Garbage and Refuse Haulers License Fees Housing/Rental Property Inspec:ion Fees Ot:.er Fees, Grants or Sources of Revenue (spediy) ecluding CHS funds provided by Hennepin County) . Local Tax TOTA.L CERTiF7C,:., TI0N I cer:iiy :hat to the best of my knowledge and belle! that the data reported in the above financial exhibii: is correct and that all transactions were made in accordance with the Agreement provisions and appl1catl-:: assurances. AU!hoilzed Official Date Fiscal ~lanagement Ofiicer Date . +Revenues for chemicals can be claimed to the extent that the municiDal 'y;a;:er char~es offset total watc:- department expenditures. It is assumed to be 100 percent unless other'v,'ise indicate:~ _.,- ~-. EXHIBIT C . CHS Annual Report - Face Sheet - County/City Name: Authorized Agent*: (Signature) Date Signed: . ~ ... . - .' . " --".. ~ . , . This form must be, signed by the Chairperson or Vice-Chairperson of the Community Health Board, or an appomled agent. , ~ . ~ 1l -E e aa c =e 8 , <~ 00 "0 z- .!! it , ] -= u .. E , ] c 8 . ... E "0 ,.g .!! - I~ , , "0 ... c ti .2 e <5 c e 8 e ,~ .c "0 < c t;;J , ' . 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'" u; ,!!l - Q.. 0 '" u Il.l :5 0; 0; z " c- OJ ~ ~ lI'l ;:\\\~\\~~i.\\~\: Q. E . ~ ..... - <<l E .. ~ OJ V'l 0; 0; :~ttWWl: Vl .. l c C '0 " - " u .~ c E E 0 '8 -' c c '0 1:. 8 - z ::>.. -::l -.. . . '!> ';> .... co c:: .. c c u E " u <" " -= -= .0 W u.l '< " u Z V 'Q "0 <.":I 0; < :> II.) ~ - ~ c: ~ ~ '" . II.) " " - c c CO -= -= - - . II.) - co u .. ! < c 8 -< Vl V'l > g .. E E ::: ... 0 ~ ~ 0- b - ~ - 'B ~ ~ c.. ~ '" e '" 8 u ;3 Vl ... &. c:!> I- .... Q. 2 0 '" . 0 e cO J:i t.l... c ~ - ....: N ..; ..r '" .0 . . u.. ...: ... . . . . ~~ j: . GENERAL INSTRUCTIONS FOR CHSREPORTING One original and two copies of the completed forms must be submitted by April 1, 1989, to the Minnesota Department of Health District Office. For 'aSsistance in completing the forms, contact your District Representative. One set of these documents will be retained in the District. Offices. District Representatives will forward the original report and one copy to MDH. COUNTI' AND CITI' REPORTING A separate rehorting form ma"t be completed for each county or city participating in the CHS program. Each report s ould include data on all reportable activities that are mcluded in the CHS plan and budget. Reportable activities include those which were funded by the loeal agen% through the use of CHS subsidy, local funds, special pro~ects grants" and other state and federal nds. If one CHS agency contracts for services withanot er CHS agency, the agency that funds the services should report the related activities. Additionally, information may also be requested of tbose agencies participating in a spccialproject grant. REPORTING ACfIVITIES AND EXPENDITURES BY PROGRAM CATEGORY The CHS Reporting forms are organized around the CHS program categories: . Disease Prevention and Control . Emergency Medical Care . Environmental Health . Familh Health . . Healt Promotion . . Home Health Care . Not Allocated to Program This is done to improve the compatabilityof the CHS plan, budget, activity report and expenditure report. This comreatability is intended to simplify the analysis and interpretation of the data at a district and state eve!. For clarification as to which program category subsumes which acthities, see Appendix I of the CHS Planning and Reporting Manual. VOLUNTARY NARRATIVE REPORTS Any additional information that CHS agencies would like to provide in the way of narrative reports is welcome. Such reports might include local annual reports, reports on local evaluation projects, or other special reports regarding community health services. If provided, these reports should be in addition to and distinct from the required forms. This is necessary to avoid confusion as to what data should be keypunched and processed as a. part of the routinely reported data. GE!'l'ERAL DEFINITIONS Disease Prevention and Control: "Disease prevention and control" means activities intended to prevent or control communicable diseases; these activities include the coordination or provision of disease surveillance, investi\ktion, reporting, and related counseling, education, screening, immunization, case management and c' ical services. , " Emergency Medical Care: "Emergency medical care" means activities. intended to protect the health of persons suffering a medical emergency and to ensure rapid and effective emer~ency medical treatment; these activities include the coordination or provision of training, cooperation WIth public safety agencies, communications, life-support transportation as defined according to section 144.804, public' information and involvement, and ,system management. . Environmental Healtb: "Environmental health" means activities intended to achieve an environment . conducive to human health, comfort, safety and well-being; tbese activities include the coordination or provision of education, regulation, and consultation related to food protection, bazardous substances and roduct safety, water supply sanitation, waste disposal, environmental pollution control, occupational ealth and safety, public health nuisance control, institutional sanitation, recreational sanitation including swimming pool sanitation and safety, and housing code enforcement for health and safety purposes. Reporting and Evaluation 49 . . ~ ,;' . Family Health: "Family health" means activities intended to promote optimum health outcomes related to human reproduction and child growth and development; these activities include the coordination or rovision of education, counseling, screening, clinical services, school health services, nutrition services, amily hlanning services as defined in section 145.925, and other interventions directed at improving family eallh. Family Health services must not include arrangements, referrals, or counseling for, or provision of, voluntary termination of pregnancy. Health Promotion: "Health promotion" means activities intended to reduce the {'revalcnce of risk conditions or behaviors of individuals or communities for the purpose of preventmgclrronic disease and effecting other defmable advances in health status; these activities include the. coordination or provision of comrnu~ organization, regulation, targeted screening and education, as well as informational and other scien . lcally supported interventions to foster bealth by affecting related conditions and behaviors. Home Health Care: "Home health care" means activities intended to reduce the ill effects and complications of existing disease conditions and to 'provide suitable alternatives to inpatient care in a health facility; these activities include the coordination or provision of health assessment, nursing care, """ education, counseling, nutrition services, delegated medical and ancillary services, case management, referral and follow-up. Not Allocated to Program: "Not allocated to program" means CHS activities conducted for a purpose other than tbose included in the CHS program category defmitions. General administrative activity and costs that are not alloCated to a CHS program category belong in this category. . ..",'''r' "::'." . . 50 Reporting and Evaluation .' "3 ,- . FORM I. CHS STAFFING BY PROGRAM INSTRUCTIONS: Entcr the number of FULL-TIME EQUIVALENT (FfE~ staffpcrsons for each of the occupationtilles by program category. The number of FfE 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" categories and specify the position title in the space provided. The occupation categories listed on this form are intended to represent a staff tcrson's job tille. For . example, the full value of a Public Health Nursc's FfE should be reported on ine #12, .Public Health Nurse." This FfE may, however, be allocated to morc. than one CHS program (i.e., .5 FfE Family Health and .5 FrE Health' Promotion). FTE Standards Some counties use different standards for calculating full-time equivalent (FfE) employees. One ticneral defmition is a 4O-hour week or 2,080 hours/year as 1 FrE; a vanation in some counties is 37.5 ours/week or 1,950 hours/year. Please state your county'sdefmition of FfE in hours per week on the blank provided under the title "CHS Staffing by Program." Then use your county's FrE standard to calculate the FrE's to be reported in each occupation by program category. For contracted positions use the actual FTE figures from billings or end-of-year reports from contractors. Estimate the FTE for flat fee contracted positions such as a medical consultant. Roster nurses are considered contracted positions. In-Kind. Starr Effort . 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 FfEs should be rounded to the n~:!.!'est hundredth (x.xx). If any of .the FTEs total more than zero, but less than .01,' report as .01. DEFINITIONS: Administrative StaO': Individuals, such ;J.S an Accountant/Financial Manager, a CHS Administrator, clerical support staff, as well as program directors and supervisory staff. . This. occupation category . would also include the following jc,b titles: Account Clerk Marketing Coordinator Administrative. Assistant Media Specialist Administrative Manager Medicare Consultant Administrator of Nursing Medical Records Practitioner Assistant Biostatistician Nurse Prowam Manager Assistant Director Public Hcallh Nursing Nursing Dlfector Bookkeeper Nursing Supcrvisor Business Office Staff Office Manager Clinic Director (general? Other Administration Clinic Manager (genera) Planner Community Health SeTVlces Supervisor Public Health Nurse Supervisor County Health Dept. Administrator Program Administration (general) Custodian /Maintenance Program Development/Evaluation Data Processing Officer Specialist Delivery Worker Pro~am Planners (general) Director of Planning & Administration Pro~ect Assistant Driver Project Director . Graphic Artist Public Information Specialist Health Coordinator Records Specialist Health Planner Supervisor Administrative Health Pro~am Analyst Services Health StatIstician Supervisor Public Health Services Janitor Supply Manager Storekeeper Reporting and Evaluation 51 . " 'eJ ~C'j . Dental SUI(l: Dentists or other persons staffing the dental health program including licensed dental hygienists or registered dental assistants a'\ defined by the Minnesota Board of Dentistry. EMS Staff: Individuals responsible for thc EMS activities of the CHS agency. The individuals should havc a background in EMS either through training or experience. Job titles may include: EMS Coordinator Emergency Preparedncss Paramcdic~ Safety Coordinator Em'ironmelltal Health Specialist/Sanitarian: A person who is so registered by the Statc of Minnesota. Epidemiol~ist: Interprets the factors thaI influence thc patler~ of disease occurrence in a population, determines the significance of the pattern by making biological and statistical inferences and when necessary initiates control measures to prevent the spread of disease. ,.-;Jt< Other DP&C Staff: A person, other than an epidemiologist, whose primary work responsibilities are to investigate reports of disease, institute control programs or consult on such matters. Job titles may include: -,,\., Communicable Disease Investigator STD Program Supervisor STD Specialist "''f.~:-- Health Educator: The person {>rimarily responsible for planning, 'implementing, coordinating, and evaluating the agency's informatIOnal, educational, training and intervention programs and materials. This individual must be professionally prepared and competent to carry out all health education activities. Other job titles would include: H caltb Education Coordinator Health Education Director . Health Education Specialist Hearing And Vision Technician: An indi\~Jual trained b" Minnesota Department of Health Hearing and Vision Con.c,ultants for the specific purpose of conducting hearing and vision screening programs. She IhL will havc succcssfully completed Level I, II and III training whicb includes: anatomy and physiology of the ear and eye; equipment types, use and care; screening and techniques, procedures and st:md:lrds~ program organization;. a.nd training and supen~sjon of volunteer screcncrs. To maintain skills ,,,,_ thc techmcIan should serve a mInimUm of three programs per year. ' Homl' Helllth Aide/Homemaker: A trainc.d memhcr of a health team whose primary work is assisting clients either (1) .,..;th hersonal hygiene and other care sen~ces a::. assigned and clinically supenrised by a professional nurse or t t:rapist or (2) with home management, child care and other seniees as assigned and cliniC<JJly supeniscd hy a professional workcr. Joh titles may include: Chore Home Maintcnance Home Care Nursing Assistant Homemahl Home Health Aide Home Care Nurse's Aide Home Health Program Staff Nutrition Starr: A registered dietitian, a public health nutritionist or othcr persons, employed to provide information to agency clients. Food/Nutrition Specialists or Home Economists should be counted here.. A Food/Nutrilion Specialist or Home Economist is defined as a (lrofessional ",ith a Bachelors DegTce in Food Science, Nutrition or Home Economics. This occupal1on category would !nclude person<, who assist in the agency's operation of WIC clinics. Job titles in this category would mcludc: Assistant NUl ritionist Nutrition Educator Diet Technician WIC Administrator Food/Nutrition Specialist WIC Aide Nutrition Aide WIC Coordinator . Nutrition Assistant Physician: A registered medical doctor who serves on the staff of thc CHS agency. This physician could be directly involved in providing medical, non-psychiatric services or serve as the agency Medical Consultant. If a CHS Administrator is also a physician, only that portion of the person's time serving 52 Reporting and Evaluation , '," .\.... . as a physicin for the CHS agency should be recorded here. Public Health Nurse: A nurse registered in State of Minnesota and certified ac; a Public Health Nurse. . Other Nursing Staff: This occupational category includes Registered Nurses and Licensed Practical Nurses as well as other positions which directly assist nursing activities, and are not. certified as Public Health Nurses. Other job titles for this occupational category would include: Assl. Coord. Maternal and Child HeaIlh MCH Consultant Child Development Coordinator Manager Maternal and Child Health Child Health Aide Nurse Midwife Development Services Specialist Nursing Practitioner Dial AJdes for PSS Nursing Consultant EPS Coordinator PNA EPS Outreach Worker Respite Care Coordinator EPS Technician School/Community Health Aide Family Plannin~ Personnel School Health Aide Hospice Coordinator Youth Intake Worker Therapist: Any of the following 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 with a physician (see 42 CFR (Code of Federal Regulations) 405.1201 (i) for required credentials). . Occupational Therapist: A professional worker prepared to help clients develop and maintain tasks essential to daily living (see 42 CFR 405.1212 (g) for required credentials). . . Soeech Therapist: A professional worker prepared to treat clients who have a communication problem relating to speech, language, or hearmg (see 42 CFR 405.1202 (u) for required credentials) . In. Kind: Several agencies monitor the FfE of in-kind staff effort and, include the value of this effort in their CHS Budget/Expenditure report. If your agency monitors in-kind staff effort, report it on line 15. Other: Any occupation title which cannot be included in the categories listed above. Please try to include everything possible in the listed categories and specify "other" entries. . Reporting and Evaluation 53 , . ',- i..; <i . FORM II. SUMMARY OF DISEASE INVESTIGATIONS INSTRUCTIONS: This form contains three separate Iarts. One rart deals with foodbornc and waterborne outbreaks. A second part deals \\ith reportable isease inveshgations. And a third part deals with non-reportable diseases. Foodborne and Wuterborne Outbreaks Complete this part only when the agency is the lead agency in the investigation. It should not be completed for the agency when the MDH is the principal or . lead investigator of the outbreak. A confIrmed foodborne/waterborne disease outbreak is defmed as an incident in which: 1) two or more persons experience a similar illness, such as a gastrointestinal illness after ingestion of a common food or water product, and 2) epidemiologic analysis implicates the food or water as the source of illness. There are exceptions, e.g.., one case of botulism or chemical poisoning constitutes an outbreak. ~ Tht:se outbreaks may be either: g . Laboratory confirmed - outbreaks in which laboratory evidence of a specific etiologic agent is i obtained and specified criteria are met, or I Undetermined etiologY - outbreaks in which the epidemiologic evidence implicates a food or ~ . ~ water source l but adequate laboratory confirmation was not obtained. - Reportable Diseases ,,"~ ,. This part should be completed only when the agency has investigated a reportable disease (Minn. Rule . ~ 4605.7040). An example of how this part should be completed: An agency may investigate 35 cases of Hepatits A; however, of these investigations only 20 may be confirmed by laboratory analysis. The number 2D should go under confirmed cases and the agency should complete and submit 20 of the special 'Hepatitis Surveillance Forms' to the MDH. In addition, of the 20 confirmed cases, 10 of the cases may have been rebted to a single outbreak of Hepatitis A. If this Is. so, then under the number of 'confirmed outbre:'ks: a "}" should be placed to indicate the agency worked up an outbreak of, Hepatitis A. Note that tbe agency should only indicate, in this column, those outbreaks in which it was 'f,,, in charge of the investigation. Thus, if the agency assisted the MDH in the outbreak investigation, thcre would be nothing placed in the column; only the: numbel of cases investigated and confirmed should be reported. Non~Reportable Diseast' Investigations Thi~ ~art is to be used by the agency 10 indicate disease investigations undertaken for diseases not spcci led in Minn. Rule 4605.7040. Such investigations include lice. scabies, chickenpox, rash-like illnesses, including those caused by staphylococcal and streptococcal organism, etc. Note that these diseascs are not reportable by rule, and there are no report forms needed, DEFINITIONS: Reports/Complaints: Indicate the number of reports of complaints that are received by the agency regarding illness among those people exposed to a contaminated food or water product. Cases Investigated: Indicate the number of disease case investigations for each disease which were conducted by the CHS agency. Cases Confinned: Indicate, for each disease in which there was an investigation, the number that were eventually confirmed. Note: all disease investigations do not necessarily result in the disease being . confirmed either by clinical symptoms or by laboratory analysis. Confinned Outbreak.c;: A disease occurrence with more cases than expected when the etiologic agent is identified or when epidemiologic analysis implicated the etiologic agent. A single case of a communicable disease lon~ absent from a population or the first confirmation of a disease not previously recognized in t at area is to be considered an outbreak, e.g., one case of measles, botulism, 54 Reporting and Evaluation _ffi~' "~"""~-_;/~m_"'-"'~__~k~- . . ~:) , _t . . or chc,mica1 {>Oisori.in~. For purposes of this rekrt, a single case of reactivated tuberculosis which has Dot resulted m additional infections should not considered an outbreak. Indicate in this column only those confIrmed outbreaks in which the agency was the lead or principal investigator. Probable FoodbornefWaterborneOutbreaks: A probable foodborne or waterborne disease outbreak is defmed as an incident in which: ' 1) two or more persons experience a similar illness, usually gastrointestinal, after in'!estion of a common food or water product, and 2) data are insufficlcnt for epidemiologic anaJysis;however, a specific food or water item is suspectcd. Non-Related Outbreaks: Nonfood or nonwater ingestion-associated outbreaks are defmed as two or more cases of illness related by time and place in which an epidemiologic investigation is conducted and , the results are inconclusive or do not implicate food or water as a source of the outbreak. . - . Reporting and Evaluation 55 ., -~._.... . "<t . j' .. . FORM V. ENVIRONMENTAL HEAL TH ACTIVITIES INSTRUCfIONS: This form should be completed only for those activities which are sUfPorted by the agency. Enter the numbers requested by the column headings for each of thetypcs of acilities and activities listed for the liast year. Lines 1, 2, 3, 4, 5, 6, 7, 8, and 9 should be reportcd only by agencics with authority to icensc and inspect under delegation agreemcnt with MDH. DEFINITIONS: Tvpes of Environmental Health Activities Facilities in AgeDC)"'S Jurisdiction: Exact count,if known, of the facilities in the Agency's jurisdiction, including zero if none exist. Lincs 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 v.ith MDH. For #1, 2, 3, 4, 6, and 7 use Ihe number of licenses issued. If uncertain, V'oTite unknown or give a range, e.g., less than 25. Inspections covering compliance with the Minnesota Clean Indoor Air Act (MCIAA) must be recorded On line 5. Facilities are in agency's jurisdiction only when a delettion 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 not 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, #2JJ, and #21 both systematic and scheduled inspections, e.g., appropriate housing maintenance inspections, well or septic tank construction, and non-routine inspections should be added together. '. The difference between "new" and "existing" is made as follows: A system Or well is new if it has never been put to significant use; otherwise it is an existing system. In every case, there should be at least one inspection for each ''facility inspected." Complaints Received: Any communication concerning any of the activities or facilities listed in the left hand column. "Receiv(:d" does not distinguish frivolous from zincere, nor does it include resolution. Complaints Investigated Through an Inspection: The number of complaints which resulted in an on- site visit, no matter how brief. Do not entcr the number of on-site inspections. The number of complaints investigated through an inspection is unlikely to be larger than the number entered under "complaint~ received." Enforcement Action: Any mcthod (in writing) undertaken after issuance of an inspection report and correction orders used to insure compliance, including letter of non.compliance, license revocation or suspension, administrative hearing, fine, violation tag, or court action. It does not include field investigation where none of the foregoing action is taken. This same criterion would apply to enforcement actions relative to the MCIAA. Facility Plans Reviewed: Those reviewed pursuant to a state law or rule, or a local ordinance. Facilities Facility: Defined by the types of. establishments listed. Each of the establishments listed (i.e., lodging . establishment, a swimming pool, etc.) is a facility. Food-Beveritge Establishment: As governed by Minn. Stat. 157 (1986) and Minn. Rule, parts 4625.2400. 4625.5000 includes a restaurant, a bar, or a restaurant/bar combination. NOTE: Vending machine inspections are reported below on line #1~. Reporting and Evaluation 59 . . c .- "{ . <~; . Lodging Eswblishml.'nt: ~!. r~verne~ by. Minn. Stat. 157 ~86) and Minn. Rule., parts '!62..'i.0lf>9- 4625.2300. Any of these tacllt1es which lllclude food and veragcmay be duphcated With the Food- Beverage Establishment" above. - Manufactured Home Purk. RecjCamp Area: As governed by Minn. Stat. 327.14-327.28 (1986) and Minn. Rule, parts 4630.0200-4630.2200. Children's Camp: As governed by Minn. Stat. 144.71-144.76 (1986) and Minn. Rule, parts 4630.2300- 4630.4700. Minnesota Clean Indoor Air Act: Minnesota Clean Indoor Air Act (MClAA) as governed by Minn. Stat. 144.4]-144.417 (1986) and Minn. Rule, parts 4620.0100-4620.1500. EnCorcement and consultation activities relevant to the MCIAA in licensed and non-licensed facilities as sho\\'ll on line #5. Examples of non-licensed facilities include office buildings, retail stores, schools, and factories. Institutions: Inspections of food service operations at schools,' and group day care centers su~ect to .', licensure under Minn. Rule, parts 9445.0310 to 9545.0670 (DPW rule #3) and food service an general sanitary conditions at correctional facilities at the request of DOC as governed by Minn. Stat. 642.09. ,'. . Temporal")' Facilities: As governed by Minn. Stat. 157 (1986) and Minn. Rule, parts 4625.2400 to ! 4625.5000. Include mobile food operations and temporary Cacilities which operate for 14 days or less at anyone location, such as concession stands at fairs, carOlvals, circuses and special events. Well Code Enforcement: As governed by Minn. Slat. 156A and Minn. Rule, parts 4725.0100-4725.7600. To ~e reported by a~encies under delelation wi~h .MDH .Co~ v.:at7r well program and covering activities.. relatmg to new, repaned, or abandone wells wlthm the JunsdlctlOn. :,.': Non-Community Public Water Supply: As governed by Minn. Stat. 144.382 (1986) and Minn. Rule, . parts 4720.0010-4720.4600. S~imming Pool: As regulated under Minn. Rule, parts 4717.0100-4717.3900. Permitted Solid Waste Landfill: As governed by Minn. Stat. 400 (1986) and S.W. 1-11. ke Arena: As regulated under Minn. Rule, parts 4635.1100-4635.2000. Hazardous Waste: As ~overned by Minn. Stat. 116.07 and Minn. Rule, parts 7045.0010-7045.1260; . "'" include inspection activitle5 for site requirements conlainers, generators, labeling and identification, ''<,- transporters, etc. ......;;Y<; Food Vending Machines: As governed by Minn. Stat. 28A.09 and Minn. Rule, part 4635.1000 (sanitarian rc.quirements for vending machine operation$) (formerly MHD 232). '~ Other: Any facility which does nol fit into a previous category and for which the agency conducted '.- signi~cant environmental health activities, Specify the type of facility. Examples: Fraternity and soronty houses, halfway houses, group homes, etc. Public Health Nuisance Control: Activilies undertaken to eliminate unsafe or disease-enhancing conditions ~utside the home) which endanger the public. Examples of these are bacJ.:yard collection of refuse whic can attract vermin; allowing water to collect and stand in (man-made) places in which mosquitoes can breed, disposal of any waste Cor which no permit has been issued. NOTE: housing code violations are reportable as a separate activity. Minn. Stat. 145.22 (1986). Vector Control: Measures to eliminate any living carrier that transports an inCectious agent from an infected individual or its waste to a susceptible individual, its food or immediate surroundings. Minn. Stat. 145.22 (1986). Housing Code: As governed by Minn. Stat. 16.83-16.868 (1986) and State Building Code. Housing . Hygiene activities would be included here if the health department has been given the enforcement responsibility for health violations. Private Well: As governed by Minn. Stat. 156A (1986) and Minn. Rule, parts 4725.0100-4725.7600. 60 Reporting and Evaluation _________~,_.....n ~l i!'~:""lif'ii_,,~'~ " c, t C' . Privat~ SeWage System: Consider private sewage systems as those systems defined in Minn. Rulc, parts 7080.0010-7080.0240, whcthcr or not the standards have been adopted by reference by the county, and . whether or not the systems meet those standards. Animal and Fowl- 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 are animal bite investigations; improper waste disposal; and keeping of any animal, fowl, or reptile where frohibitcd by ordinance of any municipality or county or without a special permit. Do not include anima impounding activities or pet leashing enforcement. Waste Hauler (solid): As regulated under Minn. Rule 7035.0800. Other: Any activity which does not fit into a previous' category. Specify the type of activity. Please try to include everything possible in the listed categories and specify "other" entries. NOTE: A CHS agency may want to describe in a short narrative form any environmental health ~CHS supportable) activity which the agency deems as being worthy of reporting, i.e., it consumes more 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 expected to retuire significantly more of the agency's resources in succeeding years. Any reporting done under this. eadingis purely .optional. . . II; . Reporting and Evaluation 61 . ~.c? .' ""'!,. ?) . FORM VI. FOOD, BEVERAGE & lODGING. ESTABLISHMENT INSPECTION SCORES INSTRUCfIONS: Enter the number of food, beverage and lodging establishment inspections in the rast year which resulted in each of the five groupings of scores. Report only those inspection!' w ich were supported by the CHS Agency through either staff time or funding, and. which were complete inspections, according to the following defInitions: Inspection means a complete full-scale planned inspection. It docs not mean short follow-up inspections, e.g., to determine whether a freezer teikrature is now low enough, if NO SMOKING signs are properly posted, or to determine whether oor, wall, and ceiling repairs of a guest room have been completed. If a facility received more than one complete inspection during the year, count each inspection ,.., separately in its proper score category. . NOTE: The total number of inspection scores reported in this form should be equal to the Dumber reported in Form V, Column 3, lines 1 and 2 . the number of Inspections by CHS for Food, Beverage, and Lodging Establishments. DEFINITIONS: Food & Beverage Establishment Scores: Scores obtained by use of the FDA inspection form, as modilled by the Minnesota Department of Health. LOOging Establishment Scores: Scores obtained by use of the 1986 MDH inspection form or a . comparable score sheet developed by the local agency. . 62 Reporting and Evaluation -~.-~......~ c, ~:l ~ :' .. . FORM, VII. PRIVATE WELL WATER QUALITY INSTRUCTIONS: ~ Enter: 1. the number of private well water samples analyzed for coliform bacteria and Jornitrate nitrogen, " ' 2. the number of samples containing coliform bacteria and the number containing the specified levels of nitrate nitrogen; '" .' " 3. th7 number .ofposit!ve sa"lkles for coliform bacteria and for the specified levels of nitrate mtrogen which receIved fo ow-up contact. What 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. "''bat to Exclude ". Do not include public commUnitY,water supply samples. .. ' , . " The samples reported as containing 10 mgjl or more (>) of nitrate nitro~en should not be . included in the counts for 1 mgjl or more (>) and less than (<) 10 mg I nitrate nitrogen. DEFINITIONS: , Samples Containing Coliform Bacteria: A positive sample which contains one or more bacteria. ' , " A positive sample which contains at least one milligr::l,m of Samples Containing Nitrate Nitrogen: nitrate nitrogen per llter' of water. " , Follow-Up: Aclion specific to a particular sample result, It does not include routine attachment of a ", letter M information, brochure to a lab report which helps in interpretation of results or tells how to disinfect' a well. ' ' Addendum for Environmental' Health Data Perhaps the best way lo explain the proper recording of environmental health information in the CHS Report ,is through answers (A) to a number of questions (Q) which have arisen or may arise. 1 Q: Jt'1ten a person representing an agency has been subpoenaed and appears ill court", how is the activity recorded? A: Only court appearances that result from enforcement action taken by the health agency should be reported. Form V, column 6 would be used. Appearances for any other purpose would, not be reported. 2aQ: How does one report' the time spent making a site visit for purposes of discussing environmental health matters such as remodeling.a licensed facility or building a facility that will be licensed? A: ' An account of this type of activity is, not requested. . 2bQ: If a person representing an organization without an appointment 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 activity is not requested. Reporting and Evaluation 63 " . .' .: '(;. <t ~ If the organization in question 2b !lad already submitted plan.r for rrmodding or submits the . 2cO: plans and discusses the rrmode/ing as pan of the plan submission, how would the acti~'ity be rrcordcd? A: In these instances any exchange of -:information, verbal or wrilten, would be considered part of the plan revic.w proccs&. \\Thcn the proccss is completc, Form Y, column 7 would be used to record thc activity. 30: A health agency should request that 0 home o....ner resample his well if a wotcr analysis indica.tes the presence of co/ifoml bactcria. If thc home OJ.i'ner does not respond and a second request IS mode to resample, does this situation constitute a follow-up contact? (Fonnl/ll) A: No. Follow-up contact only refers to activities such as interpretation, investigation or recommendation provided for the home owner and specific to a particular water analysis... 4 0: For purposes of clarification, what constitutes a "complete inspection?" Does the definition hold true for both FornI V and VI? A: A 'complete inspection occurs when an object such as a septic tank or facility such a<; a resort is thoroughly looked at, and an inspection report is issued. It would not be a follow-up check nor a special limited investigation. The term, however, does not distinguish number of orders within nor does it imply that nothing has escaped scrutiny. For purposes of filling out Forms Y and VI, the inspection would be a typical insbction where a score is assigned. The number of inspections recorded for food, beverage, and odging establishments in Form Y should equal the number of insl?ections recorded in Form VI. Inspections covering skcialcircumstances where no score IS assi~ed are not requested to be reported. For examp e: An inspection to determine that a facilIty was properly constructed and is ready to open, or to determine damage following a flTe. . - 5 Q: Are environmental health activities exempt from being reponed if they have not been provided by a CBS agency either directly or by delegation of agreement (contract)? A: As far as the CHS reporting process is concerned, they ate exempt. 6 0: H?IO( is the difference between line #8 "lVe/l Code Enforcement," and line #20 "Private Wells _ New and Existing"? 'd''''hflo A: The difference has to do with whether or not the agency is under delegation with MDH for the water well proram and is responsible for activities relating to the construction, alteration, or abandonment 0 wells within the jurisdiction. If the agency is under delegation for the water well program: 1) The agency should report all activiry relating to the construction, alteration. or . ahandonment of all wells on line #8 "Well Code Enforcemenl." -. 2) Report the rourine inspection of existing private wells (that arc not being altered or abandoned~ on line #2Oa "Private Wells - Existing." Any activity relating to "new" wells shou d be reported on line # 8. If the agency is not under delegation for the water well program: 1) The agency should report all activity relating to private wells on line # 20 "Private Wells - New" and #20a .Private Wells - Existing: 2) Agencies not under delegation for the water well program should not report any data on line #8 "Well Code Enforcement: If the agency is involved in the construction, alteration, or abandonment of wells, but is not under delegation for these activities, it . should be reported on line #24 "Other" and be specified. 64 Reporting and Evaluation -.""""""", ~' .. )< ~-;-, " . 70: Should counties with delegation agreenu:nts for non-conimunity public water supplies repontllcir non-community public water supply actil'ities on line #9 'Won-Community Public Water Supplies" ami. line #8 "Well Code Enforcement"? . . A: Yes. The Well Code Enforcement program inCludes non.:community public water supplies. Line #9 gives MDH the information it needs that is unique to licensed and non-licensed non- community public water supplies. 80: If a CHS agency does laboratory watcr analysis for other .counties or other CHS agencies, who should be responsible Ior reporting the number of samples analyzed in Form VII? . A: Information should be reported. by the agency. having jurisdiction where the water sample was collected, irrespective of where the analysis takes place.. .. 90: Arc inspection scores for limited food and beverage facilities to be recorded in Form VI? Are limited food and beverage facility activities to be recorded in F ormV: . A: Yes, the information is to be included in both forms. 100: Form V, line 10, refers to swimming pools. TIle definition of swimming pools is pools regulated under Minn. Rule, pans 4717.0100-4717.3900, which means all public pools. Some environmental health agencies are also involved with private pools. Should this work be recorded in Form V? A: No, on line 10, only record swimming pool acti~ties that involve public pools (those serving many people, e.g., schoo~ municipa~ apartment building, townhouse, etc.). . 110: H ow arc services provided to agribusiness to be recorded? . A: If a routine inspection is made .of the hog fann because a feedlot permit has 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.... When an investi~ation is made at .the hog. farm as a result of a complaint or inquiry coDcernin~ possi Ie. surface and ground water. pollution, then. tbe activity would a~ain be reported m Form V under the heading "Complaints Investigated Through InspectIon: The I activity would be reported on line 24 and the word "feedlot" would be added if tbe agency issues permits. Line 16 would be. used if no permits are issued. . Reporting and Evaluation 65 . ---_._~--~--- '" ',. " ,...~-.,. .._-~ , '"-. . ",. - ", ~ '.'v _~ ..", - ,- .. ... -. <; <'j . . FORM VIII. FAMILY HEALTH CLIENTS BY AGE, RACE, SEX, AND ~ ETHNICITY . Tbis fonn requests an unduplicated count (except for Hispanic clients) of those clients who have received FamIly Health semces provided by the CHS agency during the reporting period and for whom a client chart existed. NOTE: The total number of clients reported under the MRace" categories should equal the tolal number of clients reported under the "Sex" categories. Persons of mixed race should be reported as "Unknown/Others." Since persons of Hispanic ethnicily may be while, black, or of other racial heritage, they should be counted twice; once by their racial heritage, and again by theirelhnicity (Hispanic). Clients seen only as a part of the Wle program should not be included in this report. , '., . '.too. . 66 Reporting and Evaluation - - ;-_,_, ",,,,-,,.~ "~ k . ,~=y,,,,