105 CMR 430.000 : Minimum Standards for Recreational Camps for Children

1. 105 CMR 430.000:Minimum Standards for Recreational Camps for Children MPHNA May 2019 Dave WilliamsSenior Analyst Amy Riordan, MPH Field Supervisor, EA III Kerry Wagner, MPH Environmental Health Inspector

2. Presentation Overview • Overview and Amendment Highlights • Updates to CSP web links/documents • New Guidance Documents on the CSP webpage • https://www.mass.gov/lists/recreational-camps-for-children-community-sanitation • Other Important Amendments made in 2018 • Compliance with Other Codes • Minimum Standards for Licensing: A Process Approach Massachusetts Department of Public Health mass.gov/dph

3. OVERVIEW and Amendment Highlights • Regulations apply to all day, residential, sports, travel, and trip camps, with some exemptions, such as programs sponsored by municipal recreation departments (statutorily-based) or those that are primarily classroom-based instructional programs with no high risk activities (regulatory-based). • Amended Definition: • Day Camp changed from 5 days in a two week period to 4 days • Sports Camp changed from 5 days in a two week period to 4 days • Residential Camp changed from 4 or more overnights to 3 or more overnights. • New Section added: 430.050 - License Required • No recreational camp for children shall operate without a license from the Board of Health.   Any person or program that promotes or advertises itself as a camp, even if it does not meet the criteria of a Recreational Camp as defined within 105 CMR 430.020, must be licensed as a recreational camp for children prior to operating. Massachusetts Department of Public Health mass.gov/dph

4. Amendments Highlights March 2018 • Additions to Specialized High Risk Activities (430.103): • List of activities to include Challenge Courses/Climbing Walls • Safety standards for Challenge Courses / Climbing Walls (Department of Public Safety code (520 CMR 5.00) and American Camping Association (ACA) • Waterfront and Boating Program Requirements (430.204): • Reference for compliance with Christian’s Law (M.G.L. c. 111, s.127A.5) that specifies requirement for swim ability tests and availability of personal flotation devices for campers that are non-swimmers or at-risk swimmers. • Swimming Pools (430.430): • Include the Pool Fence law (M.G.L. c.140, s 206) and a federal Virginia Graeme Baker (VGB) Pool and Spa Safety Act relating to pool drain cover safety. • Requirement for swim testing at pools Massachusetts Department of Public Health mass.gov/dph

5. Amendments HighlightsMarch 2018 • Staff Orientation and Training (430.091): • Applicable training for specialized activities or to meet camper needs. • Additional requirement for staff to take an online head injury safety awareness training (e.g. - CDC’s “Heads-Up”) as part of annual orientation. • Required Ratio of Counselors to Campers (430.101): • Clarify required staffing ratios of 1 staff to 5 campers if younger than age 7. • Clarify line of sight/close proximity that counselors must maintain with campers. • Communicable Disease Reporting and Parental Education Requirements (430.157): • Revised reporting requirements for communicable disease and food poisoning incidents to include MDPH and LBOH. • Additional parent education requirement regarding meningococcal disease and immunization (M.G.L. c. 111, s. 219). Massachusetts Department of Public Health mass.gov/dph

6. Amendments Highlights March 2018 • Health Care Staff (430.159): • Clarification of storage & administration of medications at camps and role of the camp’s Health Care Consultant • Advisory for Storage and Administration of Medications - revised and reference to new “Standards for Training Unlicensed Health Care Supervisors” • Storage and Administration of Medicine (430.160): • Revised to require medication to be kept secure, either in locked storage or in the possession of the individual responsible for administering medication. • Revised to allow for self-administration under certain conditions for specific medications, such as Epi-pens, inhalers and devices for monitoring blood sugar. • Tobacco Use (430.165): • Revised to prohibit any form of nicotine delivery device, including e-cigarettes, by staff or campers. Massachusetts Department of Public Health mass.gov/dph

7. Recreational Camp Web Links/Documents • Retained documents with few updates & revisions • Current FAQ for Parents and Tri-fold • Fire Prevention and other Emergency Plans (separate documents, now combined) • Policy Statement Regarding Background Information Checks (revised format) • Camp Inspection Form (based on amended code) • Camper/Staff/Volunteer Injury Form • (reference alleged Abuse & Neglect Report Notification) • New Documents added in 2018 • Important Amendments to 105 CMR 430.000 • Recreational Camp Operators Checklist • Memo to Camp Operators regarding Required Immunizations • Standards for Training Unlicensed Health Care Supervisors • Medication Administration Competency Skill Checklist Massachusetts Department of Public Health mass.gov/dph

8. Recreational Camp Web Links/Documents • Important Webpage Links regarding Recreational Camps for Children (topics below): • Required Immunizations for Children Attending Camp and for Camp Staff (Annual memo from Bureau of Infectious Disease and Immunization) Massachusetts Department of Public Health mass.gov/dph

9. Recreational Camp Web Links/Documents • NO Changes • Web link to DCJIS re: CORI & SORI • Meningococcal Disease and Immunization FAQ • Memo re: Camp Reporting / Annual Camp Licensed Reporting Form • Christian’s Law web link • Advisory to LBOH re: Municipal Program Exemption (Reissued 2018) • Updated Format ONLY • Application for a License • Health Care Consultant Agreement HCC • Acknowledgement of Medications • Parent Authorization to Administer Medications • Daily Log for Medication Administration Massachusetts Department of Public Health mass.gov/dph

10. Other Important Amendments made in 2018 • 430.090 - Background Information • MA CORI and SORI for all staff & volunteers. National background check OK in lieu of out-of-state background check. Permanent staff with no break in service must be done at a minimum every three years versus only once. • 430.091 - Staff Orientation and Training • Orientation and training for all applicable camp staff (e.g. - programmatic or other direct oversight). • Training components and attendance to be documented. • Staff will need to receive all necessary training specific to overseeing camp activities or any specialized training to meet the requirements of campers with unique physical or behavioral needs, as applicable. • As part of the orientation, all counselors, junior counselors, and other staff and volunteers shall complete one on-line head injury safety awareness training program, such as the Centers for Disease Control and Prevention’s “Heads-Up” training, or an equivalent training approved by the MDPH. Massachusetts Department of Public Health mass.gov/dph

11. Other Important Amendments made in 2018 • 430.093 - Prevention of Abuse and Neglect • Written policies and procedures for prevention. Abuse & neglect as defined per DCF. Notification to the LBOH and the Department if report filed pursuant to c 119, s 51A. 430.100 - Counselor & Jr Counselors Requirements • Allowable experience includes: 4 weeks minimum as Jr. Counselor or in supervisory role with children, OR participation in structured group camping. 430.101 - Counselor to Camper Ratios • Required ratio for campers with disabilities replaced with staffing plan to ensure adequate supervision of such campers. • Line of sight or close proximity for required ratios (1 to 10 or 1 to 5). 430.102 - Camp Director Requirements • Primitive, Travel and Trip Camp Director must be at least 25 yrs (vs. 21). Massachusetts Department of Public Health mass.gov/dph

12. Other Important Amendments made in 2018 • 430.103 - Supervision of Specialized Activities • Aquatics (swimming & watercrafts), along with Firearms, Archery, Equestrian, Challenge Courses & Climbing Walls are all considered “high risk”. • Aquatics Director, required on-site during any aquatic activity when two or more lifeguards are on duty, or 50 campers are in or near the water. • Lifeguards at the required ratio of 1 to 25 campers in or near the water, may be provided at an off-site location via a contractual agreement. • Counselors overseeing Watercraft Activities may be lifeguard orwatercraft safety/basic water rescue certified at 1 to 10 ratio. • All staff & campers participating in watercraft activities shall wear U.S.C.G. approved PFDs. • Challenge Courses and Climbing Walls – licensed and maintained pursuant to 520 CMR 5.00, as applicable; additionally, must follow requirements of ACA Standard PD 24.1. Both require an annual inspection by certified personnel who provides a written report. Massachusetts Department of Public Health mass.gov/dph

13. Other Important Amendments made in 2018 • 430.140 - Medical Waste • Any medical waste generated at a camp shall be managed in accordance with the requirements of 105 CMR 480.000. • 430.145 - Maintenance of Records • Camp operators shall maintain all records relating to campers, staff and volunteers for a minimum of three years. • 430.150 - Health Records • All health records whether electronic or hard copy need to be secured from unauthorized access, but “readily available”. • 430.151 - Physical Exams & Certificate of Immunization • All campers and full-time staff at residential, travel, trip or sports camps must provide a medical history, certificate of immunity, and a report of a physical exam conducted in the last 18 months. Massachusetts Department of Public Health mass.gov/dph

14. Other Important Amendments made in 2018 • 430.152 - Required Immunizations • Specific requirements removed from the amended code. Written documentation must be on file for all staff and campers based on current immunization schedules. • Annual memo to Camp Operators will continue to be provided by the Bureau of Infectious Disease and Laboratory Sciences listing current requirements. • 430.153 - Physical Exam & Immunization Exemptions • Exclusion allowed at a camp pursuant to105 CMR 300.000 of all susceptible children, including those with medical or religious exemptions in situations when vaccine-preventable or any other communicable diseases are present. • 430.154 - Injury Reports • Any serious injury to a camper, staff or volunteer who is sent home, or brought to the hospital or physician’s office with a positive diagnosis. • The MDPH form must be submitted within 7 days of occurrence to both the Department and the local BOH. Massachusetts Department of Public Health mass.gov/dph

15. CAMP Injuries for 2018 • Waterfront/Pool includes: • Hitting wall • Colliding with someone • Slipping and falling • Near drowning • Water rescue • Acting unusual • Consuming food/plant includes: • Allergic reaction to food • Consuming wild/poisonous mushrooms • Additional causes of injury: • Pushed by another camper/wrestling • Attempting cartwheels/splits • Cooking • Falling off golf cart • Chemical exposures • Hit by car • Previous medical conditions • Boating/Sailing • Illness • Walking/running around • Picnic table incidents • Falling on bus ride • Boating/Sailing • Falling off/hitting bunk beds Massachusetts Department of Public Health mass.gov/dph

16. Other Important Amendments made in 2018 • 430.155 - Medical Log • List date and timefor each incident. Must be “readily available” with each page signed by an authorized staff person. [OK to input electronically but periodic (i.e. – daily) hard copy print out needed for signature.] • 430.157 - Communicable Disease & Parental Education • Communicable Disease Reporting to both MDPH and the local BOH pursuant to 105 CMR 300.000 and in consultation with the Camp’s Health Care Consultant (HCC). • Information regarding meningococcal disease and immunization must be provided to parents/guardians when registering for camps in accordance with MGL c. 111, s. 219. • 430.159 - Health Care Staff to be Provided • All camps must have a Health Care Consultant (MA Physician or NP). • HCC must sign off on all of the camp’s health care policies. • Camps must provide list to HCC of all Health Care Supervisors (HCS). • Camps should designate an adequate number of HCS to meet need. • HCC must train all HCS who are not licensed. • Training & test of competency for unlicensed HCSs per 430.160. Massachusetts Department of Public Health mass.gov/dph

17. Other Important Amendments made in 2018 • 430.160 - Storage and Administration of Meds • All prescription medications shall be in compliance with applicable MGL. • Prescription medications must be stored in a secure manner or under the direct control of the HCC/HCS, or camper authorized to self-administer. • Written policy for administration of medications at the camp shall specify camp staff authorized either by “scope of practice” or a designated HCSs trained & instructed by the HCC to administer oral/topical medications only. • Written policy when HCSs or other employees may be allowed to administer epinephrine via an auto-injector if so designated by the HCC with documented training & test of competency. Parental/guardian sign-off is required. • Camp health policies shall specify procedures for blood sugar level monitoring of diabetic campers and self-monitoring & self-injection with written parental/guardian & HCC sign-off. • Camp must maintain a log for disposal according to the applicable state and federal laws of any prescription medication. Massachusetts Department of Public Health mass.gov/dph

18. Other Important Amendments made in 2018 • 430.161 - Healthcare Facilities and Equipment • Infirmaries at residential camps should have the ability to create an isolation room with negative pressure (i.e. - window fan blowing out) for campers with suspected communicable disease. • Parents/guardians should be notified as soon as possible when a child is isolated. • All First Aid Kits shall meet current ANSI Standards (see American National Standards Institute Z 308.1) including, at a minimum, one Class B kit and one or more Class A kits. • 430.165 - Tobacco Use • All tobacco use is prohibited at camps excluding FDA approved nicotine delivery systems (e.g. - transdermal patches, nicotine gum). • 430.166 - Alcohol and Recreational Marijuana Use • Use of alcohol and recreational use of marijuana, by campers or staff, in any form is prohibitedat recreational camps for children during all hours of operation. Massachusetts Department of Public Health mass.gov/dph

19. Other Important Amendments made in 2018 • 430.190 - General Program Requirements • New Section regarding an “unrecognized person” at the camp. “The operator shall maintain an effective protocol for the appropriate identification and handling” of such situations. • 430. 210 - Emergency Plans • Written emergency/disaster plans shall be in accordance with American Camp Association Standard OM 8.1 and made available at the campsite. • All staff shall be trained in emergency/disaster procedures. • 430. 212 - Field Trips • Written itineraries will be established before departure and a copy provided to parents/guardians. Whenever feasible notification shall be provided to parents/ guardians of any changes to the itinerary prior to departure. • A HCS shall accompany all field trips and have readily available access to health records and medications. First Aid Kits shall be provided as needed. Massachusetts Department of Public Health mass.gov/dph

20. Other Important Amendments made in 2018 • 430. 251 - Transportation Safety • New section: “A minimum of at least one staff person shall accompany and monitor campers during any bus or van transport either from the morning pickup to the camp or an afternoon return trip for off-site drop-off.” • 430. 430 - Swimming Pools • All pools used by recreational camps must comply with: • 105 CMR 435.000; • the Pool Fence Law, and the • federal VGB Pool & Spa Safety Act • At the first pool swimming session, a camp operator shall ensure a determination is made of each camper’s swimming ability. • Campers shall be confined to swimming areas consistent with the limits of their swimming ability or to swimming areas requiring lesser skills than those for which they have been classified. Massachusetts Department of Public Health mass.gov/dph

21. Other Important Amendments made in 2018 • 430. 451 - Certificate of Inspection Required • All camp structures used for sleeping or assembly purposes shall be inspected annually for compliance with 780 CMR: State Building Code. • 430. 454 - Structural and Interior Maintenance • All structural elements of camp facilities, including, but not limited to, foundations, cellars, floors, walls, doors, windows, ceilings, roofs, staircases, porches, and chimneys, shall be maintained in good repair, fit for the use intended, and in compliance with the requirements of 780 CMR. • The interior of the facility shall be maintained in good repair and in a safe, clean, and sanitary condition, free from accumulation of dirt and rubbish. • 430. 456 - Egresses • All egresses shall be in compliance with the requirements of 780 CMR and maintained free of obstructions. Massachusetts Department of Public Health mass.gov/dph

22. Other Important Amendments made in 2018 • 430. 432 - Bathing Beaches • All swimming conducted by a recreational camp at a freshwater or saltwater beach must be in compliance with 105 CMR 445.000: Minimum Standards for Bathing Beaches. • Documentation of water testing results pursuant to 105 CMR 445.000 should be maintained by the recreational camp even if the beach is operated by a third party. • Additionally, water visibility should be assessed by the camp operator prior to conducting swimming activities with the use of a black/white secchi disk to verify four foot visibility. • 430.800 – BOH may Grant Variance • The BOH may vary the application of any provisions of 105 CMR 430.000 with respect to any particular case when, in its opinion: • enforcement would do manifest injustice; • provides same degree of protection; and • when insurance is utilized, the applicant has provided written confirmation from the insurance carrier confirming the continuation of full coverage(s) if the minimum health and safety provision(s) are varied. Massachusetts Department of Public Health mass.gov/dph

23. Compliance with other CODES • Current requirement that Camps need to document compliance with: • Minimum Sanitation Standards for FOOD - 105 CMR 590.000 • Minimum Sanitation Standards for POOLS - 105 CMR 435.000 • Minimum Sanitation Standards for BEACHES - 105 CMR 445.000 • Minimum Sanitation Standards for PFDs - 105 CMR 432.000 • Additional Permits needed (current requirements) • Certificate of Inspection/Occupancy: Local bldg. inspector • Statement of compliance for facilities &approval of fire evacuation plan: Local fire dept. • Private water supply approval (if applicable): • DEP: >25 people AND >60 days/yr • BOH: <25 people AND <60 days/yr • bacterial and chemical testing results Massachusetts Department of Public Health mass.gov/dph

24. Part II: Minimum Standards for Rec Camp Licensing A Process Approach

25. Conducting a Rec Camp Inspection Recommend Camp develop Policy and Procedures Binder Food Service Inspection conducted permit issued? Review Policies/Procedures for completeness High Risk Activity Sites Infirmary/First Aid Facility Conduct File Review of Staff/Volunteers/Campers Letter of Compliance from Fire Dept? Sleeping/Assembly Areas Certificate of Inspection available? Conduct an on-site inspection of Camp Bathroom Facilities Massachusetts Department of Public Health mass.gov/dph

26. Reviewing Camp’s Written Policies and Procedures Did the camp develop: Abuse and Neglect Prevention policy including: • Immediately reporting suspected incidents to Camp Director and/or DCF • Incidents that occur at camp • Allegedly abusive/neglectful staff person does not have any unsupervised contact with campers • Notifying BOH and DPH that a 51A report was filed • Do not send actual report Discipline Policies including: • Describes behavior that warrants discipline • How campers will be appropriately disciplined at camp • Encourage camps to copy and paste prohibitions statement into policy Page 4-6 lists all required written policies and procedures Massachusetts Department of Public Health mass.gov/dph

27. Reviewing Camp’s Written Policies and Procedures Did the camp develop: • Protocols for unrecognized persons at camp • Procedures relative to releasing campers • Day Camp Contingency Plans • Sunscreen policy • Obtaining parent/guardian authorization • Disaster/Emergency Plans • Guidance document • Identify shelter location(s) • Can these locations accommodate the number of campers and staff/volunteers present at camp? • Transportation resources • Fire Evacuation Plan • Plan must indicate drill conducted within first 24 hours of EACH camp session Page 4-6 lists all required written policies and procedures Massachusetts Department of Public Health mass.gov/dph

28. Reviewing Camp’s Written Policies and Procedures For any Field Trips, did the camp: • Develop a written itinerary • Do they have a means to notify parents/guardians of changes • Provide at least 1 designated HCS • Did the HCS receive proper training and obtained proper authorization? • Maintain health records in a readily accessible format • Store medications in a secure manner and provide a First Aid Kit • Have contingency plans available For Primitive, Travel, Trip Camps: • Available emergency care and means to contact them identified on itinerary Massachusetts Department of Public Health mass.gov/dph

29. Requirements for Orientation • Did the camp create a written orientation plan with attendance list? • Date(s) of training • What was covered • Are all Counselors/Junior Counselors required to participate in orientation? • May need make-up sessions • Document these • Has everyone completed the Online Head Injury Safety Awareness Training? • Must be taken annually • Counselors cannot supervise, or be responsible for, a group of children until they have completed orientation Massachusetts Department of Public Health mass.gov/dph

30. Minimum Requirements for Staff/Volunteers Camp Director Day Camp • 21 years old • Camping administration trainingor sufficient experience Residential • 25 years old • Camping administration training or sufficient experience Primitive, Travel, Trip • 25 years old • Proof of experience Counselors and Junior Counselors Day Camp • Counselor: 16 years old with experience • Jr Counselor: 15 years old Residential, Primitive, Travel, Trip, Sport, and Medical Specialty • Counselor: 18 years old or HS graduate with experience • Jr Counselor: 16 years old Massachusetts Department of Public Health mass.gov/dph

31. Staff/Volunteer Background Information All camps are required to develop and follow written procedures for conducting background checks that specify: • What background information is collected and reviewed • Means of contacting references • Make sure this is documented • No one is allowed to work at camp until all information is obtained, reviewed, and determination on employment has been made • Start process of obtaining CORI/SORI reports early Massachusetts Department of Public Health mass.gov/dph

32. Staff/Volunteer Background Information Conducting a File Review Volunteers • 5 year work/volunteer history • CORI/Juvenile Report • Out-of-State/International Criminal background check • SORI • Not required if FIRST time in US Staff • 5 year work history • 3 references by those not related to applicant • CORI/Juvenile Report • Out-of-State/International Criminal background check • SORI • Not required if FIRST time in US Massachusetts Department of Public Health mass.gov/dph

33. Supervision and High Risk Activity Requirements Firearms Air rifles/BB guns are not considered firearms* Supervision: • Instructor – NRA instructor’s certification and compliance with applicable MGL’s? • 1:10 counselor to camper ratio Equipment and Range: • Firearms in good condition? • Stored in locked cabinet with ammunition stored in separate locked facility • Range in accordance with NRA standards? • Firing line in place? • Only cross with instructors permission *recommend NRA instructor certification to supervise air rifle activities Archery Supervision: • Appropriate training, certification, and experience • 1:10 counselor to camper ratio Equipmentand Range: • Equipment in good condition? • Ability to securely store equipment? • Clearly marked danger area behind targets? • 25 yards clearance behind each target • Common firing line in place? • “Ready line” in place behind firing line Massachusetts Department of Public Health mass.gov/dph

34. Supervision and High Risk Activity Requirements Horseback Riding • Instructors properly licensed? • Stable licensed by BOH? • All riders wearing hard hat? • Minimum 2 staff required on all excursions? • 1:10 counselor to camper ratio Challenge Courses 520 CMR 5.00: • Course Manager at least 21 years old • Course Staff at least 18 years old • DPS license posted at EACH element? • Annual inspection with written report available? • 1:10 counselor to camper ratio Massachusetts Department of Public Health mass.gov/dph

35. Supervision and High Risk Activity Requirements Pools • Is the pool inspected and permitted in accordance with 105 CMR 435.000? • CPO present? • Proper fencing around pool? • VGB compliant? • Testing kit and secchi disk available? • Document testing in log book • Safety equipment and emergency communication system in place? • 1:25 lifeguard to camper ratio AND 1:10 counselor to camper ratio Aquatics • Does the camp have an Aquatics Director? • At least 21 years old with experience • Certified Lifeguard • Does the camp have enough lifeguards? • Properly certified • At least 16 years old • Bring lifeguards for off-site aquatic activities or contractual agreement with venue • Buddy system developed and implemented? Massachusetts Department of Public Health mass.gov/dph

36. Supervision and High Risk Activity Requirements Watercraft • Counselors overseeing watercraft activities properly certified? • As a lifeguard or • Hold a certification in ARC Small Craft Safety and Basic Water Rescue • 1:10 counselor to camper ratio • All participants wearing USCG PFD’s? • Whitewater, hazardous salt/fresh water activity: • Campers swimming proficiency at least ARC level 4? • At least 2 counselors with sufficient experience present? Beaches • Is the beach permitted in accordance with 105 CMR 445.000? • Water sampling • 4 feet of visibility • In-state VS out-of-state • Proper signage at entrance? • Ring buoy with attached rope present? • 1:25 lifeguard to camper ratio AND 1:10 counselor to camper ratio Massachusetts Department of Public Health mass.gov/dph

37. Christian’sLaw Christian’s Law was enacted in 2012, and requires all municipal and recreational programs or licensed camps conducting swimming activities at fresh or saltwater beaches to: • Ensure that all minors are swim tested at the first swimming session, • Make available a Type I, II, or III personal flotation device (PFD) to all minor children determined to be either a non-swimmer or an at-risk swimmer, and • Allow parents or legal guardians to provide their own PFD to their child if they so choose. Massachusetts Department of Public Health mass.gov/dph

38. 432.000 This regulation went into effect on May 5, 2017 105 CMR 432.000Minimum Requirements for Personal Flotation Devices for Minor Children at Municipal and Recreational Programs and Camps Massachusetts Department of Public Health mass.gov/dph

39. 432.020 - Applicability Who has to Comply? • Municipal and Recreational Programs or Camps that use: • Public, • Semi-public, or • Private bathing beaches for bathing or swimming activities [432.020(A)] The regulation specifically EXCLUDES pools or other artificial bodies of water [432.020(B)] If a local bylaw restricts the use of PFD’s at the water – then those non-swimmers and at risk swimmers will not be allowed to swim [432.020(C)] Massachusetts Department of Public Health mass.gov/dph

40. Classification • All MINORS are swim tested at the first session [432.100(C)] • CIT’s; LIT’s; Volunteers; Staff • Re-tested at any point throughout the summer • Swim tests shall be conducted at the venue where the swimming will take place whenever possible [432.100(D)] • If a program or camp takes dedicated lifeguards with them or has a contract for dedicated lifeguards at the swimming venue, then swim testing may be done in a permitted pool ahead of time [432.100(D)] Massachusetts Department of Public Health mass.gov/dph

41. Swim Testing Swim Test: A swimming ability determination conducted at a minimum once per summer for every minor at each program or camp by a certified swim instructor or a swim assessor Certified Swim Instructor (CSI) Employed or contracted by a municipal and recreational program or camp and holds a current certificate from a nationally recognized swim instructor program: • American Red Cross Water Safety Instructor (WSI); or • AQ711B – YMCA Lifeguard 2011; or • An instructor with an equivalent certification, determined by the Department Swim Assessor 16 years of age, employed or contracted by a municipal and recreational program or camp • Lifeguard Training Certificate • CPR Training Certificate • First Aid Certificate • Has, at a minimum, observed one and participated in one annual swim test training conducted by a CSI Massachusetts Department of Public Health mass.gov/dph

42. Classification Non-Swimmers Program or camp participants (minors) that have not yet passed a Red Cross Level 3 or YMCA Minnow (level 4) swim proficiency test, or other equivalent classification as approved by the Department At-Risk Swimmers Program or camp participants (minors) that may or may not have passed a Red Cross Level 3 or YMCA Minnow (level 4) swim proficiency test, or other equivalent classification, but have been determined to have a physical, psychological, medical or cognitive disability that could have a negative impact on their swimming ability. Massachusetts Department of Public Health mass.gov/dph

43. Personal Flotation Devices (PFD) • Type I: Offshore Lifejacket • Rough open water • Turn unconscious person face up • Rescue is slow coming • Type II: Near Shore Buoyant Vest • “Classic” Style • Calm inland water • Fast rescue • Turn unconscious person face up • Type III: Flotation Aid • Boating activities and sports • Calm water • Fast Rescue • Will not turn an unconscious person face up Massachusetts Department of Public Health mass.gov/dph

44. Operator Responsibility and PFD’s • Operators must ensure that properly sized PFD’s are made available [432.120(A)] • All PFD’s shall be in serviceable condition [432.120(B)] • Operators shall ensure the PFD’s are properly sized and fitted for each minor prior to swimming activity [432.120(C)] • Operators must have an adequate number and range of sizes of PFD’s [432.120(D)] • Operators may contract with off-site bathing beach operators for supply of PFD’s [432.120(E)] Massachusetts Department of Public Health mass.gov/dph

45. PFD’s and Parents/Guardians • An operator shall notrefuse a PFD from a parent/guardian [432.130(A)] • Confirm with the parent/guardian that swim testing will be conducted without the use of that PFD prior to any swim testing • The minor shall wear the PFD at all times except during: • Swim tests; • Swimming lessons; • Diving Lessons; and • Closely supervised beach waterfront activities [432.130(B); Guidance for Implementing] • PFD must be clearly labeled with the child’s name and the parent/guardian emergency contact info [432.130(C)] Massachusetts Department of Public Health mass.gov/dph

46. PFD’s and Parents/Guardians • PFD that is being dropped off with the child is Type I, II, or III, and properly sized and fitted[432.130(D)] • If the PFD provided by a parent/ guardian is not properly fitting, or is damaged, or otherwise not in serviceable condition: [432.130(E)] • The child should not be allowed to swim, • The camp/program must gain permission from parent/guardian before providing a different properly sized and fitted PFD to that child • Ensure EVERYTHING is documented Massachusetts Department of Public Health mass.gov/dph

47. PFD Information • The Department recommends that all staff be trained for PFD fit testing by reviewing the short guidance video provided by the Department with assistance from the USCG: • https://www.mass.gov/service-details/christians-law Massachusetts Department of Public Health mass.gov/dph

48. Policies and Record Keeping • An orientation plan for all staff and volunteers; • Procedures for identifying non-swimmers and at-risk swimmers; • A daily check-in routine for reviewing and confirming proper swimming level identification; • A plan to ensure an adequate inventory of serviceable PFD’s and their proper storage; • Procedures for PFD distribution to participants; • Appropriate training for staff; and • Compliance with required recordkeeping. Massachusetts Department of Public Health mass.gov/dph

49. Guidance Tools • Swim and Fit Test Model Documentation Form • Guidance Checklist • Will help to ensure compliance with 432.000 • Guidance for Implementing Regulations • Swim Determinations • Identifying Non-Swimmers and At-Risk Swimmers • Suggested Methods • Confinement to Dedicated Swimming Areas Massachusetts Department of Public Health mass.gov/dph

50. Required Camp Healthcare Staff: Health Care Consultants and Health Care Supervisors Identify who: Assists in developing and approving Camp’s Health Care Policy Health Care Consultant (HCC) Is in charge of the day-to-day operation of the health program Health Care Supervisor (HCS) Must be present at the camp at all times Health Care Supervisor (HCS) Must be a Massachusetts licensed physician, certified nurse practitioner, or physician assistant with documented pediatric training Health Care Consultant (HCC) Must be available for consultation at all times, or provide appropriate coverage Health Care Consultant (HCC) Massachusetts Department of Public Health mass.gov/dph