09/06/2006
i
• New Hanover County Health Department
Revenue and Expenditure Summaries for July 2006
Cumulative: 8.33% Month 1 of 12
Revenues
Current Year Prior Year
Type of Budgeted Revenue Balance % Budgeted Revenue Balance %
Revenue Amount Earned Remaining Amount Earned Remaining
Federal & State $ 1,881,139 $ 500 $ 1,880,639 0.03% $ 1,814,456 $ 137,407 $ 1,677,049 7.57%
AC Fees $ 611,161 $ 61,150 $ 550,011 10.01% $ 659,496 $ 52,599 $ 606,897 7.98%
Medicaid $ 1,839,994 $ 97,678 $ 1,742,316 5.31% $ 1,484,368 $ 163,040 $ 1,321,328 10.98%
Medicaid Max $ 17,000 $ - $ 17,000 0.00% $ - $ - $
EH Fees $ 310,000 $ 23,576 $ 286,424 7.61% $ 300,212 $ 20,371 $ 279,841 6.79%
Health Fees $ 234,200 $ 19,759 $ 214,441 8.44% $ 128,000 $ 20,013 $ 107,987 15.64%
Other $ 2,637,125 $ 10,695 $ 2,626,430 0.41% $ 2,420,969 $ 46,278 $ 2,374,691 1.91%
Totals $ 7,530,619 $ 213,358 $ 7,317.26-1-T--2-8-3-%l $ 6,807,501 $ 439,708 $ 6,367,793 6.46%
Expenditures
Current Year Prior Year
Type of Budgeted Expanded Balance % Budgeted Expended Balance %
• Expenditure Amount Amount Remaining Amount Amount Remaining
Salary & Fringe 12,077,735 $ 457,814 $ 11,619,921 3.79% $ 11,205,722 $ 702,855 $ 10,502,867 6.27%
Operating $ 2,014,443 $ 114,413 $ 1,900,030 5.68% $ 1,577,178 $ 77,497 $ 1,499,681 4.91%
Capital Outlay $ 81,400 $ 7,185 $ 74,215 8.83% $ 181,200 $ 9,815 $ 171,385 5.42%
Totals $ 14,173,578 $ 579,413 $ 13,594,165 4.09% $ 12,964,100 $ 790,167 $ 12,173,933 6.10%
Summary
Budgeted Actual %
FY 06-07 FY 06-07
Expenditures:
Salaries & Fringe $ 12,077,735 $ 457,814
Operating $ 2,014,443 $ 114,413
Capital Outlay $ 81,400 $ 7,185
Total Expenditures $ 14,173,578 $ 579,413 4.09%
Revenue: $ 7,530,619 $ 213,358 2.830M
Net County $ 6,642,959 $ 366,054 5.51 °k
• Revenue and Expenditure Summary
For the Month of July 2006
6
NHCHD BOARD OF HEALTH APPROVED GRANT APPLICATION STATUS FY 05-06
Date BOH Grant Requested Pending Received Denied
6/212006 No Activi for August 2006
• 71512006 ervIf oor Ina ion am y
Counseling Program (Cape Fear Memorial
Foundation) - Funding for Licensed Clinical
Social Worker for 3 years $260,000 $260,000
Eat Smart Move More - ommun ty rant
(NC Dept of Public Health Physical Activity
and Nutrition Branch $16,495 $16,495
61712006 Living Well (Cape Fear Memor al
Foundation) Ratify grant received to produce
Living Well publication $0 $12,000
513/2006 Diabetic Supplies (Cape Fear Memorial
Foundation $21,000 $21,000
NHCDHHS - Division of Medical Assistance
- Health Check Coordination Funding $33,873 $33,873
4/5/2006
NC Pandemic Influenza Planning Funds -
Pandemic Influenza planning. Ratification of
grant application submitted for 3/2/06 deadline
Note: Full funding expected per State
notification; currently partial funding
confirmed with additional award to follow. $49,030 $49,030
31112006 - No Activity for March 2006- - " . .
Child Care Nursing (Smart Start)
Continuation funding for existing grant
2/1/2006 program $186,600 $160,000 $26,600
• Health Check Coord. (Smart Start)
Continuation funding for existing grant
program $45,800 $12,000
aml y Assessment oor . mart tart
Continuation funding for FAC portion of
Navigator program `NOTE: May receive
$44,000 In 2nd phase If funds avail. $113,000 $44,000 $69,000
NC Institute for Public Health - Accreditation
- assistance with improvement in areas
(policies/procedures & continuing ad training
log). $17,034 $4,150 $12,884
Tabled by BOH Pediatric Primary Care (United
not approved Way/NHRMC) Start-up funds to support new
for submission prima care program for pediatric patients $30,000 $0
Cape Fear Memorial Foundation- Obesity
1/4/2006 Grant (3 year period) $300,000 $225,000 $75,000
Cape Fear United Way- Panorex Grant $38,000 $38,000
NC Office of Minority Health & Health
Disparities- Interpreter Grant $20,000 $20,000
NACCHO Grant-Addressing Disability in
Local Public Health. Collaboration with
12/7/2005 UNCW. $25,000 $25,000
• Office of Research, Demonstrations and
11/212005 Rural Health- Pediatric Prima Care Grant $50,000 $50,000
Health Carolinians-Contract Coordinator $5,000 $5,000
10/1212005 No activity for October 2005.
9!12005 No activity for September 2005. '
As of st3012006 7
• NOTE: Notification received since last report.
Program did not apply for grant.
NHCHD BOARD OF HEALTH APPROVED GRANT APPLICATION STATUS FY 05-06
Date BOH Grant Requested Pending Received Denied.
Wolfe-NC Public Health Association -
Prenatal Grant for FY 05.06 and FY 06-07- •
8/3/2005 assistance for diabetic prenatal patients. $5,000 $5,000
"allocating
North Carolina Alliance(NCAH) for $5,000 from
Secondhand Smoke- Local Control existing PA
Initiative-if approved and awarded PA funds • allocating budget- • Grant was
to be used for educational and $5,000 from approved try not approved
purposes existing PA NHC-CC by RWJ
media campaigns only. budget 9/19105 Foundation
7/6/2005 No activity for Jul 2005. -
NC Dept of Insurance- Office of State Fire
6/1/2005 Marshall- Risk Watch Continuation Grant $ 25,000 $ 25,000
HUD (partnership with City of Wilmington)
Lead Outreach and Education Program (3
year funding) $ 275,000 $275,000
Ministering Circle- Good Shepherd
Ministries Clinic supply & Equipment 15,000 $ 15,000 $ -
No activity for May 2005.
Cape Fear Memorial Foundation- Living
4/6/2005 Well Program $ 20,000 $ 20,000 $
National Safe Kids Coalition- Mobile Van for
3/2/2005 Car Seat Checks $ 49,500 $ 49,500 $ -
Smart Start- Child Care Nursing Program $ 239,000 $ 170,000 $ 69,000
Smart Start- Health Check Coordination
Program $ 43,800 $ 43,800
Smart Start- Navigator Program $ 155,000 $ 44,000 $111,000
2/2/2005, ' No activity for February 2005. -
Champion McDowell Davis Charitable
1/5/2005 Foundation - Good Shepherd Clinic $ 56,400 $ 56,400 •
12/1/2004. No activity for December 2004. -
March of Dimes- Maternity Care Coordination
Program educational supplies and incentives
11/7/20D4 for pregnant women. $ 3,000 $ 3,000 $
10/6/2004 No activity to report for October 2004.
9/1/2004 No activity to report . for September 2004. - -
Office of the State Fire Marshal- NC
Department of Insurance- Risk Watch
8/4/2004 continuation funding (3 ears $ 25,000 $ 25,000
NC Physical Activity and Nutrition Branch-
Eat Smart Move More North Carolina $ 20,000 $ 20,000
NC March of Dimes Community Grant
7/7/2004 Program- SmokinCessation- $ 50,000 $ - $ - $ -
Wolfe-NGPHA Prenatal Grant- Diabetic
Supplies for Prenatal Patients $ 5,000 $ 5,000
Totals $2,197,532 $297,495 $1,054,753 .$743,484
13.54% 48.00% 33.83%
Pending Grants 3 10%
Funded Total Request 14 47%
Partial) Funded 7 23%
Denied Total Request 6 20%
Numbers of Grants A lied For 30 100%
•
As of 81302006 8
' NOTE: Notification received since last report.
Program did not apply for grant.
• NEW HANOVER COUNTY BOARD OF COMMISSIONERS
Request for Board Action
Agenda: 1 Consent Meeting Date: 09/06/2006
A enda: ?
Department: Health Presenter: David E. Rice, Health Director
Contact: David E. Rice 798-6591
Subject: Health Director Performance Appraisal Process
Brief Summary: On July 5, 2006, the New Hanover County Board of Health reviewed
the current process for evaluating the Health Director's job performance. At that time,
Mr. Andre' Mallette, Assistant County Manager, was asked to review the current form
and make a recommendation to the Board of Health based on his research. On August
16, 2006, Mr. Mallette submitted his recommendation. Mr. Mallette's recommendation is
included with this agenda item.
Recommended Motion and Requested Actions: It has been recommended that the New
Hanover County Board of Health continue its use of the Health Director Performance
Appraisal form. In addition, the Executive Committee recommends the Board of Health
approve the policy on Employee Contact with Board of Health.
Funding Source:
Will above action result in:
?New Position Number of Position(s)
?Position(s) Modification or change
®No Change in Position(s)
Ex lanation:
Attachments: 1. Email recommendation from Mr. Andre' Mallette
2. Health Director Performance Appraisal form
3. Policy - Employee Contact with Board of Health
•
9
Andre To David E Rice/NHC@NHC
Mallette/NHC cc donblake@aol.com, mroberts@nhcgov.com
08!
AM 16/2006 09:23 hoc
Subject Re: Performance Appraisal Tool - Health Director
• F History This message has been replied to
Dave,
Based on the limited response we received for sample evaluation forms, I would
recommend the continued use of the county's form. I will again reiterate that the
concerns expressed about the deficiency of the county form would exist with any of the
others.
I can be available for the NHCBH Executive Committee meeting if they would like me to
attend.
?»»m»mm»»»»mwm»»e:~»emmwmm+e~~
Andres R. Mallette, Assistant County Manager/
Human Resources Director
Human Resources Department
New Hanover County
320 Chestnut Street, Suite 405
Wilmington, NC 28401
910.798.7178
David E RiceINHC
David E
Rice/NHC To Andre Mallette/NHC@NHC
08/15/2006 02:08 cc donblake@aol.com, mroberts@nhcgov.com
• PM Subject Performance I Appraisal Tool -Health Director
Hi Andre':
The NHCBH Executive Committee packet deadline is August 22, 2006. Based on your
research, please send me your recommendation by then so I can include it for their
consideration.
The NHCBH Executive Committee will meet on Tuesday, August 29 at 5:45 p.m. Please
let me know if you can attend.
Thanks, Dave
NOTICE: E-Mail correspondence to and from this address may be subject to the North Carolina Public Records
Law
NOTICE: E-Mail correspondence to and from this address may be subject to the North Carolina Public Records
Caw.
•
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NEW HANOVER COUNTY HEALTH DEPARTMENT
Policies and Procedures _
14
Ev
0
NEW XNNOYER COVXTY NENS~
•
Subject: Employee Contact with Board of Health
Date of Origin: 08/30/2006 - Draft
Date Revised:
Policy Number: GS-ADM-058
PURPOSE AND SCOPE:
The purpose of this policy is to establish guidelines regarding communication between a New
Hanover County Health Department employee and members of the New Hanover County Board
of Health when the employee has a complaint or concern regarding personnel practices or
procedures. This policy applies to all staff and Board of Health members.
CHANGE SUMMARY:
Original Document
POLICY/PROCEDURE:
• Generally, an employee who has a grievance, complaint or concern regarding personnel
practices or procedures, which do not fall under the New Hanover County Health Department
Appeals Process Policy, and Procedures should follow the New Hanover County grievance
policy, which can be found in the County Personnel Policy. However, an employee may request
an informal meeting with Board of Health members at any point to present concerns. The Board
of Health will require at least two (2) Board members to attend such a meeting with an
employee.
Examples of alleged issues which may be addressed include but are not limited to: staff
morale, safety or health hazards, unsatisfactory physical facilities, surroundings, material or
equipment, unfair supervisory practices, unjust treatment by fellow workers, unreasonable work
quotas, or any other grievance relating to conditions of employment. Issues related to
demotion, suspension, reduction-in-pay or dismissal or to alleged discrimination based on age,
race, sex, religion, color, national origin, disability, pregnancy, or political opinions or affiliations
should be addressed through the established Appeal Policy.
OTHER INFORMATION: N/A
REFERENCES: N/A
CHANGE HISTORY:
• Version Date Comments
j A ;08/30/20060riginal Document - Draft
B
21
• NEW HANOVER COUNTY BOARD OF COMMISSIONERS
Request for Board Action
Agenda: Consent Meeting Date: 09/18/2006
Agenda:
Depart nent: Health Department Presenter: Kim Roane, Business Mana er
Contact: Kim Roane, Business Manager 798-6522
Subject: Budget Amendment-Lead Prevention Program-Personal Health Services-$8,700
Brief Summary: The New Hanover County Health Department has received notification
from the North Carolina Department of Environmental and Natural Resources
confirming state childhood lead prevention program funding of $13,200 for the New
Hanover County Health Department. This is an increase of $8,700. Our budgeted
revenues and expenditures for this program for FY 06-07 amount to a total of only
$4,500, split between the Environmental Health and Child Health budgets. This increase
of $8,700 in lead prevention program funding may be used to support salaries, fringe and
operating expenditures for lead prevention program activities.
We request an increase in budgeted revenues in the Child Health program of $3,800, and
an increase in budgeted revenues in the Environmental Health program of $4,900.
We request an associated increase in the expenditure budget for Environmental Health
travel and training of $1,900. The balance of the increase in expenditures is requested to
be added to the salary budgets for Environmental Health ($3,000 increase) and Child
Health $3,800 increase to offset salary lag.
Recommended Motion and Requested Actions: To accept and approve the $8,700
additional State funds and the associated budget amendment to increase revenues and
expenditures in the Health Department's Environmental Health and Child Health budgets
for FY 06-07 and to submit to the New Hanover County Commissioners for their
consideration. Funds will be used to support the New Hanover County Health
Department Environmental Health and Child Health lead prevention program.
Funding Source: N.C. State Department of Environmental and Natural Resources
Childhood Lead Prevention Program.
Will above action result in:
?New Position Number of Position(s)
?Position(s) Modification or change
®No Change in Position(s)
Ex lanation: No Count match is required for receipt of these funds.
• Attachments: State Agreement Addenda
22
N:C. Department of Health and Human Services
• LOCAL HEALTH DEPARTMENT BUDGET
SFY 0 ' Revision Number
_ I t_l
Division of Environmental Health P.O. Number
07/01/06 06/30/07 476065
Effective Date Termination Date Contract Number
Contractor: NewHanover Activity: Childhood Lead Poisoning Prevention
Project Director: David E. Rice, Health Director Total Budget: $13.200.00
EXPENDITURES AMOUNT
STATE $13,200.00
LOCAL $
TOTAL - equal to Total Receipts $13,200.00
• RECEIPTS AMOUNT
LOCAL FUNDS: $
Appropriations APPROP 101
TXD( TXDC 102 $
Other Receipts OTHER REC 103 $
Subtotal Local Funds $
STATE/FEDERAL)SPECIAL FUNDS:
$13,200.00
Subtotal State/Federal/Special $13,200.00
TOTAL RECEIPTS - equal to Total Expenditures $13,200.00
D
Authorized Official Signature Branch Head ivision/sec n Signature
Finance Officer Signature Date Accountant i on Budget cErSignature Dal
Initials
DHHS 2948 (Revised 2/98)
23
I,
r
•
•
•
• NEW HANOVER COUNTY BOARD OF COMMISSIONERS
Request for Board Action
Agenda: Consent Meeting Date: 9/18/2006
Agenda:
Department: Health Presenter: Kim Roane, Business Manager
Contact: Kim Roane 798-6522
Subject: New Hanover Count Health Department Administrative Approval
Brief Summary: Approval is requested to revise the New Hanover County Health
Department Fee Policy to include a statement to allow Health Director approval of minor
changes to codes or fees for services. The statement requested to be added to the fee
policy is:
"New services may be added upon approval of the Health Director if the annual revenues
for the services are not expected to exceed $5,000."
This action will expedite the deliver of services to Health Department customers.
Recommended Motion and Requested Actions: To approve the revision to the New
Hanover County Health Department Fee Policy to allow Health Director approval for
minor coding and fee modifications or additions as listed and submit to the New Hanover
• Count Commissioners for their consideration.
Funding Source: N/A
Will above action result in:
?New Position Number of Position(s)
?Position(s) Modification or change
®No Change in Position(s)
Ex lanation:
Attachments: (1) New Hanover County Health Department Fee Policy Change; and
(2) Email - Threshold for Taking Fee Policy Items to Board of Health and County Commissioners
for Approval
•
24
•
•
•
NEW HANOVER COUNTY HEALTH DEPARTMENT
FEE POLICY
,A
• REQUEST FOR CHANGE
Fee Policy page 11, item R.
Currently reads: "Fees, based on current cost or purchase of supplies, may be adjusted by the
Health Director."
Proposed change: "Fees, based on current cost or purchase of supplies, may be adjusted by
the Health Director. New services may be added upon approval of the Health Director if
the annual revenues for the services are not expected to exceed $5,000."
•
•
25
F.
• Kim Roane/NHC To Marilyn Roberts/NHC@NHC
WIMP 08/22/2006 07:07 AM cc
bcc
Subject Fw: Threshold for Taking Fee Policy Items to Board Of
Health & Co Comm for Approval
Please submit the Request for Board Action.
Thank you,
Kim
Kim Roane
Business Manager
New Hanover County Health Department
(910) 798-6522
fax(910)341-4146
- Forwarded by Kim Roane/NHC on 08/22/2006 07:07 AM
Cam Griffin/NHC
08/21/2006 09:17 AM To Kim RoanelNHC@NHC
cc Donna Seal/NHC
Subject Re: Threshold for Taking Fee Policy Items to Board Of
Health & Co Comm for Approval
• Sounds like a good idea.
We had talked about doing something like this before with grants.
Small amount would not need cc approval.
Kim Roane/NHC
Kim Roane/NHC
08/05/200612:53 PM To Cam Griffin/NHC@NHC
cc Donna SeaVNHC
Subject Threshhold for Taking Fee Policy items to Board Of Health &
Co Comm for Approval
Hi,
Cam, I know you won't be able to respond to this for a couple of weeks, but wanted to be sure to ask you
both before we proceed any further. No rush... it can be dealt with at any of our upcoming Board
meetings.
• We're planning to request a modification to our Health Dept. Fee Policy language which will allow the
Health Director the authority to approve small changes to the Fee Policy without processing requests
26
through the Board of Health and County Commissioners for approval. This will make us better able to •
respond quickly to occasional needs for adding new tests or minor services. For example, we see
patients at our Good Shepherd Clinic, and from time to time the nurse identifies a new test or procedure
that she needs to administer based on how the client has presented... it may be an injury she's treating
that hasn't ever popped up before. We would need a new CPT (medical procedure) code added to our
fee policy, but there would not be any revenues received from the homeless clients at Good Shepherd,
which is grant funded. Another example is the new TDap vaccine we have recently had approved by the
BOH and County Commission, which will only result in minimal revenue increases if demand is at the
levels they expect ( I think we've collected $80 in a month). By adding a new service code to the list, we'd
normally process that through the Board of Health and Co Commissioners as a new service that must be
added to our Fee Policy. This delays the addition of these services by up to two months, depending on
whether we make the submission deadlines in time.
I want to instead suggest a language modification that will allow the Health Director the authority to
approve changes on his own, as long as the revenues generated by the change are not significant enough
to require BOH and Co Comm approval. Of course, if the service is controversial, the Health Director may
still opt to present it to the Board for approval and support before proceeding, regardless of the threshhold
we set.
I was pondering a $5,000/year threshhold.... if we don't expect the revenues from the new service to
exceed $5,000/year, we would not need to submit as a Board Action for approval but could allow the
Health Director the right to approve. The majority of our changes result in far less than $5,000 in
revenues, or even no revenue effect (such as the Good Shepherd tests and procedures). Most of our new
services that we plan to offer that would exceed $5,000/year in revenues are presented during the budget
process (such as Travel Shots, which were included for the 07 budget).
Of course, this is all presuming the new service does not require any changes to the expenditure budget,
which will always require Board approval and would result in a request for a BA to increase both the •
expenditures and the reveneus. That is understood.
What do you think of this approach, and the dollar amount of the threshhold?
Thanks in advance for your insight,
Kim
Kim Roane
Business Manager
New Hanover County Health Department
(910) 798-6522
fax (910) 341-4146
•
27
• NEW HANOVER COUNTY BOARD OF COMMISSIONERS
Request for Board Action
Agenda: Consent Meeting Date: 09/06/2006
A enda: ?
Department: Health Presenter: Jean P. McNeil , Animal
Control Services Manager
Contact: Jean P. McNeil 798-7505
Sub'ect: Animal Control Services Advisor Committee Appointment
Brief Summary:
Appointment of new committee member to fill the member-at-large vacancy
Recommended Motion and Requested Actions:
This is a request to fill the member-at-large vacancy of the Animal Control Services
Advisory Committee with Ms. Dianne Connor. Ms. Connor is known in the animal
community as a reputable pet owner, who is knowledgeable about animal matters. I
believe she will be an asset to the committee if appointed.
• Her request is as follows:
"Dear Dr. McNeil, I am very interested in serving on the Animal Control Advisory
Board if a vacancy should become available. I served on the Board for a number of years
in the 1980's and early 90's. I am an active member of the Hanover Kennel Club and have
been involved in numerous animal activities in the community. My time is less restricted
now and I feel I could contribute a great deal to the Advisory Board. Thank you for
considering m request. Dianne Connor 4801 Oriole Dr. Wilmin on,N.C."
Funding Source: N/A
Will above action result in:
?New Position Number of Position(s)
?Position(s) Modification or change
®No Chan a in Position(s)
Ex lanation: See above.
Attachments: N/A
•
28
• David E Rice/NHC To Jean McNeil/NHC@NHC
08/16/2006 03:55 PM cc mroberts@nhcgov.com
bcc
Subject Re: Animal Control Services Advisory Committee
Appointmentd
Hi Jean,
Please prepare a packet item (including Request for Board Action) and submit it to Marilyn. Marilyn please
check the wording on a past agenda regarding the appointment to the ACSAC.
Thanks,
David E. Rice, Health Director
New Hanover County Health Department
2029 South 17th Street
Wilmington, NC 28401
Phone: 910-798-6591 Fax: 910-3414146
drice@nhcgov.com
http://www.nhchd.org
Jean McNeil/NHC
+C 9- 4 C3 Jean McNeil/NHC
~i 08116/2006 03:44 PM To David E Rice/NHC@NHC
p cc "John R Boozer, III" <pell-mellsmoothfox@juno.com>
Subject Animal Control Services Advisory Committee Appointment
Hi Dave
Please present this request to the Executive Committee of the Board of Health for consideration to fill the
vacant member-at-large position of the Animal Control Services Advisory Committee with Ms. Dianne
Connor. Ms. Connor is known in the animal community as a reputable pet owner, who is knowledgeable
about animal matters. I believe she will be an asset to the committee if appointed.
Thanks, Jean
Jean P. McNeil, DVM
New Hanover County
Animal Control Services Manager
(910) 798-7500
(910) 341-4349 fax
Forwarded by Jean McNeil/NHC on 08/16/2006 03:43 PM
Oriolekennel@aol.com To: jmcneil@nhcgov.com
OA 08/16/2006 03:27 PM cc:
Subject: (no subject)
• Dear Dr. McNeil, I am very interested in serving on the Animal Control Advisory Board if a vacancy
should become available. I served on the Board for a number of years in the 1980's and early 90's. I am
• 29
an active member of the Hanover Kennel Club and have been involved in numerous animal activities in •
the community. My time is less restricted now and I feel I could contribute a great deal to the Advisory
Board. Thank you for considering my request. Dianne Connor 4801 Oriole Dr. Wilmington,N.C.
NOTICE E-Maii correspondence to aria ;rum this address may be subject to the North Carolina Public Records Law.
NOTICE E-Mai/ corresuondence to and from this address may be subject to the North Carolina Public Records Law.
•
•
e
30
a'
NEW HANOVER COUNTY
HEALTH DEPARTMENT _
2029 SOUTH 17TH STREET
WILMINGTON, NC 28401-4946 ° HEW
TELEPHONE (910) 798-6500 FAX (910) 341-4146
NHCBH - NHCHD Strategic Planning Update
September 6, 2006
Access to Health Care
Implemented open access scheduling for clinic services to increase capacity for additional patient
visits, improving revenues for health services and improving staff efficiency to reduce the need to
add staff to handle increased patient load. Transformed counseling rooms in to patient treatment
rooms to accommodate more patients. The amount of clients served was doubled with the same
level of staffing.
Actively sought private grant funding for programs needed in the community, to include (but not
limited to) Diabetes education, maternity and early childhood care, dental services for children,
smoking cessation programs, and nursing services.
Utilized competitive bidding for contract services to satisfy mandated interpreter needs, reducing the
hourly rate paid for mandated services and increasing availability of contractors to avoid lost time
waiting for interpreters busy with other clients.
Implemented mass flu clinics to improve service to the community, increase staff efficiency and
maximize revenues for flu and pneumonia shots
Implemented North Carolina Immunization Registry - computer entry of immunizations saves staff
time (no patient signatures required, no nurse written documentation, ordering state vaccine
. electronically) - producing more efficiency among staff.
Good Shepherd Clinic (GS), which is funded by several grants, is a cost savings for the county.
From Jan 05 - Sept 05 - according to our survey of clients at GS 68 ER visits were saved based
on the question asked at time of service "What would you have done about this problem if the clinic
had not been here?" The 68 stated that they would have gone to the ER. This is 5% of all the
patients that were seen at the clinic during those 9 months (1302 patients seen). The majority of the
population do not have any type of insurance or income so their medical expenses fall on the
taxpayer and those paying patients at the hospital.
Implementation of Directly Observed Therapy (DOTS and DOPT's) for homeless TB patients at the
GS clinic is more efficient use of our time/resources - TB nurses do not have to locate these patients
in the community daily. The expense of treating an outbreak of TB or other CD in this homeless
population is costly to the community as well as a health consideration. Having a part time nurse
there helps with communicable disease control.
Expanded clinic hours to include one night per week for late appointments to improve access to
services for those unable to get to the Health Department during normal work hours.
Applied for and received grant funding to add one additional interpreter to increase ability to provide
services to Hispanic population.
Utilized grant funding from Kate B. Reynolds Charitable Trust and Cape Fear Memorial Foundation
to purchase, staff and implement new Mobile Dental Unit to provide dental care to children in New
Hanover and Brunswick Counties.
Implemented new services in clinic to offer limited physical examinations on a flat rate basis for
employment, sports, foster care, camp, college, kindergarten, day care, scouts and Head Start
programs.
Worked with Cape Fear Healthy Carolinians to develop Access to Healthcare committee. The
priority area for this committee is affordable quality medical care for poor and uninsured. Cape Fear
Area United Way funded the Committee in the amount of $225,000 for 3 years 2006-2009
Animal Control Services staff conducted numerous visits to partner animal control agencies to share
ideas on procedures for our county's agency. Their desire is to bring their group up to the standards
set by our team by implementing such practices as animal licensing ad other successful methods.
State standards will more readily address animal needs as other animal control agencies learn best
practices for their area of jurisdiction.
31
1
Biannual no cost animal rabies vaccination clinics continue to be held, including one in the inner city
community for clients unable to travel to area veterinarians.
• Added new CSC and MCC positions for 06-07, to address the need for case management in
Maternal Child population.
Obesity
• Partnered with Cape Fear Healthy Carolinians to develop an Obesity Prevention committee to raise
awareness about importance of healthy weight, reduce Body Mass Index of children 2-18 and adults
• Kate B. Reynolds funded projects for Obesity Prevention Committee in the amount of $387,478.00.
• NC Fit of Health and Wellness Trust fund provided $30,000 for 2 years 2006-2008- (fiscal entity is
City of Wilmington Parks and Recreation).
Cape Fear Memorial Foundation awarded $75,000 for 2006 and is committed to pay an additional
$75,000 for each year (2007 and 2008) contingent upon finding a funding match (fiscal entity is
New Hanover County Health Department).
• An Obesity Coordinator has been hired through UNCW to implement the action plans of the Obesity
Prevention committee for our area.
• A multi-million dollar bond referendum was passed in may 2006 to increase monies for Parks and
Recreation opportunities, including trails, bike lanes and paths, and community focused fitness
opportunities. (fiscal entity is City of Wilmington)
• YMCA is promoting lifestyle changes in middle school-aged children, by offering more after school
activities (with transportation)), based on a management team business plan that our staff wrote.
• Our Women's Health Services Program is addressing obesity by using Body Mass index and giving
educational literature on weight control to women in clinic; nutrition referrals are also made.
• Our staff serve on the School Health Advisory Council (SHAC), that is promoting the "30 minutes of
physical activity/day" in K-8. Some schools have incorporated activities into the classroom by using
instructional time that is getting the children up and moving. Also through the SHAC, NHCS have •
eliminated fried foods from the elementary school cafeterias, and made other improvements in the
dietary menus.
• Child Care Nurses are participating in the "Nutrition and Physical Activity Self-Assessment for Child
Care Project". The project goal is to improve the nutrition and physical activity in child care.
• WIC staff is trained in "Eat Smart Move More" program and are beginning to implement.
Emer ing Health Risks
Developed comprehensive purchasing strategy to ensure vaccine availability throughout periods of
national shortages, resulting in the Health Department's ability to protect the health of the community
and increase revenues.
The Pandemic Flu Team was formed out of the health department epidemiology team to develop a
plan for a potential bioterrorist attack in this field.
A mass dispensing exercise is being planned for Fall 2006.
• EpiTeam members attended the 2005 and 2006 NC Epidemiology Teams Conference
Conducted Smallpox Vaccination Training for the SMAT II conference April 2005
• Completed their "Introduction to Bioterrorism Preparedness" training in conjunction with Coastal
AHEC and the NC Center for PH Preparedness. May 2005
Attended a meeting to discuss issues related to methamphetamine labs. NC DENR rules became
effective January 1, 2005 May 2006
• Participated in the Regional Homeland Security Table Top Exercise in Morehead City May 2005
Attended Community Emergency Response Team (CERT) Training May 2005
• Attended the ATF sponsored training on Terrorist Bombings at UNCW May 2005
Walk through the school shelters with EM, DSS, and Red Cross June 2005
Attended the Wilmington International Airport Exercise Planning Committee June 2005
• Attended the IC3 Team Meeting on June 21, 2005 in preparation for the Hurricane Drill
Attended the Mobile Chernobyl Regional Exercise Planning Committee meeting in Morehead City
June 2005
• Met with Hospital-Based Public Health Epidemiologist June 2005
32
I
• Attended the Military Civilian Task Force (MCTFER) meeting July 2005
Coordinated with NC OPHP&R PIO and AHEC to organize ICCE Net training for the Wilmington
area July 2005
Attended the SERAC Disaster Preparedness meeting July 2005
• Met with BT Coordinators and Planners form various parts of NC. Recommendation that position be
expanded to encompass All Hazard Preparedness, and title change of Preparedness
Coordinator/Planner. July 2005
• Distributed, for review and comment, draft Computer Training Schedule, North Carolina Public
Health Workforce NIMS Training Plan with requirements August 2005
• Assisted in the development of Plague "playcards" for the upcoming Homeland Security Exercise.
August 2005
• Participated in the NC Dept. of Homeland Security Force Protection Exercise 2005 (Mobile
Chernobyl), the largest preparedness exercise in eastern North Carolina's history. August 2005
• Assisted Carteret County Health Department staff in conducting a Rapid Needs Assessment. August
2005
• Hurricane Ophelia: After action discussion was held by the Management Team September 2005
• Sent out numerous emails regarding Hurricane Katrina response, evacuees, and health issues.
September 2005
• ICS Training: The Management team discussed who needed to attend future Incident Command
System trainings. We decided that Health Department employees involved with the EpTeam, NHC
EOC, and the IC3 should attend. September 2005
• Worked with the NC Dept. of Agriculture and Consumer Services to coordinate mass vaccination flu
clinic exercises with poultry workers. October 2005
• As part of North Carolina's contribution to Hurricane Katrina relief, through Emergency Management
Assistance Compact (EMAC), members of PHRST-2 were deployed to Waveland, Mississippi, in
support of MED-ONE along with SMAT II. October 2005
• Assisted with the facilitation of a Region 2 BT Planners meeting aimed specifically at SNS planning
November 2005
• Developed an Avian Influenza PowerPoint presentation for the general public December 2005
Conducted a Smallpox Vaccination Training workshop with the NHC Health Department. Gave a
Personal Protective Equipment (PPE) presentation for the NHC Health Department annual OSHA
training January 2006
• Attended the New Hanover County Local Emergency Planning Committee (LEPC) meeting Jan 06
• Collected revised information from the Region 2 health departments for EPI-X. January 2006
• Participated in the Local Health Information Team (LHIT) meeting January 2006
• Discussed the upcoming TallShips Event this summer in Carteret County January 2006
• Participated in Avian Flu Seminar and Tabletop February and March 2006
• Consulted with US Coast Guard regarding incoming ships and considerations about Pandemic and
Avian Flu. February 2006
• Consulted with State HAN Administrator regarding HAN issues. February 2006
• Consulted with NC OPHP&R regarding KI issues. Consulted with a local ID physician regarding non-
tuberculosis diseases not reportable to the state or county health departments February 2006
Participated in an After Action Review conference call on Operation 8-ball, the recent statewide Pan
Flu exercise March 2006
• Attended the New Hanover County Pandemic Flu Tabletop Exercise March 2006
Consulted with NC Emergency Management regarding needs assessment for the upcoming
"TallShips" event in Carteret County March 2006
• Attended the Governor's Pan Flu Summit. NHCHD Website updated March 2006
Assisted With "White Powder Protocol" training at the Regional Response Team - 2 March 2006
• Disseminated information about the SNS 50-ton inventory to PHRST Team Leaders, RN's, regional
pharmacists, and SMAT 11 Coordinator April 2006
• participated in a deployment exercise sponsored by NC OPHP&R. The scenario involved a
• "Botulism outbreak April 2006
• Met with NC GCDC, to discuss North Carolina's Quarantine Ports Response Plan draft for airports
and seaports. May 2006
• Attended Epi Info Training at the NE Library June 2006
33
• Hurricane Exercise: The New Hanover County Department of Emergency Management hosted a
hurricane exercise on June 27, 2006. The purpose of the exercise was to evaluate the functions of
the Emergency Operations Center (EOC) and Emergency Public Information Center (EPIC) June
2006
• Met with NHCHD's SNS Site Review Committee regarding selection of mass vaccination 'drive by'
sites June 2006
• Participated in the US Coast Guard Maritime Security (MARSEC) tabletop exercise which involved
multi-agency participation June 2006
• Worked at the °TallShips° event in Carteret County as part of PHRST-2's public health response.
Provided leadership, collaboration, and liaison between PHRST, OPHP&R, Federal, Local and State
Agencies July 2006
• Responded to an incident per the request of the Regional Response Team - 2 (RRT-2). Assisted
with evaluating possible patients and determining credibility of the agent. Assisted NC GCDC so
that a determination could be made on a sick passenger from Singapore arriving on a flight at
Wilmington International Airport July 2006
• Prepared Region 2's SNS plans to be forwarded to the state August 2006
Attended the "Suspicious Letter" After Action meeting with the Regional Response Team (RRT-2).
August 2006
• Participated in the statewide "Field Days" exercise in Freedom Park, Charlotte, NC August 2006
• Community increase in pertussis disease is being addressed with addition of a new vaccine to boost
immunity- Tdap.
• Pandemic Flu plans and Strategic National Stockpile plans either are being continuously worked on.
• Mandated Incident Command Systems/National Incident Management System (ICS/NIMS) trainings
being provided for all staff. Deadline of 8/31 from state will be met. ICS training worked into
orientation for new employees.
• Epi Team members took training on use of a software program called Epi Info, to be used during
outbreaks. Epi Info has already been used in one outbreak.
• Updated Epi Team response protocol including improving knowledge of after hours notification •
• Worked with other agencies (USCG, ILM Airport) for training and identification of weak areas.
• Incorporated using WebEOC as a medium for reporting, collaborating, communication, and
requesting materiel during incidents and planned events.
• Developed procedural protocols for petting zoos and other venues where people have close contact
with animals and potential risk for zoonotic infections. (ex: E. coli 0157:H7)
Environmental Health Risks
• Installation of laptop computers in Animal Control Services (ACS) and Environmental Health
Services (EHS) vehicles improves staff efficiency, quality of work and eliminates travel to the office.
• Received grant from Duke University for GIS hardware/software/training. Very successfully used
these & other IT resources particularly from efficiencylnfornation viewpoint in response to citizen
concerns/inquiries.
• Encouraged NHC administrators & officials to educate legislators on the need to repeal legal
restrictions prohibiting local health department's from instituting appropriate fees for services, i.e.
restaurants.
• Decline requests for small group talks on environmental health issues, due to drain on personnel
resources & time it takes away from meeting duties prescribed by state law & administrative code.
• Added five (5) new Environmental Health Specialist positions to meet the increased demand for
evaluating and monitoring food service operations.
• Sought food science training venues so as to enhance staff competency/focus on HACCP analysis
and risk assessment.
• Equipped all Environmental Health Specialists with updated copies of FDA Food Code and new
thermocouples. •
Structured EHS staff assignments with multidimensional scale to accomplish: (1) development of
increased expertise levels in complex program areas, eg. food service catering, identifying mosquito
species, interpretation of water quality analyses; (2) reduced cost and time lost to trafrrcJtravel within
the county; and, (3) cross-training of staff/greater capacity to effectively use available personnel
resources at an given time including disaster/emergency response scenarios.
34
• Through specialized training from NCDENR entomologists, increased staff competency in mosquito
taxonomy.
Established communication/protocol with municipal and NHC Public Information Officers to assure
prompt notification of the public when sewage spills pose imminent risk to users of recreational
waters in the county.
• Purchased signage for posting notice of sewage spills adjacent to recreational waters when
NCDENR officials identify imminent risks to users, but are not available to assume/perform this
function and task.
• Successfully acquired NHC budget funds to construct an additional building for Vector Control
Program staff to use as a workshop/equipment storage area.
• Successfully acquired NHC budget funds to purchase a large commercial scale tractor with various
peripherals for mosquito control tasks on Eagle Island.
• Provide enhanced reporting of mosquito control activities to the USACE using digital photographs
along with GPS data and ArcMap tools.
NHCHD Intemal Issues
• Took advantage of privately funded training opportunities, such as the UNC-CH Management
Academy for Public Health, to provide management development and staff training.
• Utilized volunteers to perform a wide variety of duties, including nursing services, computer data
entry and clerical tasks.
• Negotiated tum-key contracts as often as practical, which in just one case alone avoided $5,000 in
implementation costs that the vendor provided when met with technical installation issues.
• Centralized billing and fiscal operations to improve efficiency, reduce cost of items purchased and
specialize position duties.
Sought and successfully obtained approval for national Public Health Pricing to purchase drugs at a
significantly reduced cost, even lower than state contract pricing.
Implemented a more restrictive travel policy for the Health Department to reduce travel expenses.
• Utilized county vehicles rather than employee mileage reimbursement for routine courier duties to
reduce cost of transportation.
• Utilized third party insurers to maximize revenues by ensuring billing comprehensive billing..
• Pursuing debt set off to reduce the bad debts and increase collections for past-due accounts.
• Purchased automated foldingfinserting equipment that is estimated to save over 400 staff hours/year
through automation.
• Centralized department courier duties to eliminate multiple trips by multiple staff for deliveries/pick-
ups of mail, bank deposits and supply items.
• Implemented PHTIN video training in our facility for live video conferencing for trainings/meetings to
reduce travel costs for mileage and hotels/meals.
Laboratory savings/cost avoidance via changes implemented 05-06, such as changing vendors for
the pregnancy test kit, resulting in a $4000 annual savings in those supplies, which will offset the
increases in other areas of supplies. The Laboratory Information System will improve staff efficiency
and enhance customer service.
• Staff events occurring outside normal work hours & weekends through flexing of time during normal
work hours @ hour for hour rate, i.e. during affected pay period so as to limit/prohibit time & a half
accruals.
QI plan developed with a general 10 step process. Performance standards for the entire department
are being compiled to assure accountability.
• Began the Service Excellence customer service program for all staff and will incorporate customer
service In to the work plan of each employee. The plan will Include staff trainers for all internal
customers. The effort brought attention to customer service for the entire county, as a new position
for this function will soon be added in Human Resources.
• • Staff training and programming have led to improved reporting for clinical services and Community
Health. Our supervisors can run queries that produce reports for 1 day, 1 week or monthly.
• Revised the NHCHD 2005 and 2006 New Employee Orientation Schedule
• Operational Definition of a Functional Local Public Health Agency April 2005
Reviewed Annual Marketing Plan for NHCHD May 2005
35
t
The lab consolidated operations into fewer rooms by contracting out some lab work, rather than
replacing an expensive broken machine, and then freed up a room that will be used by WIC soon.
Initiated internal customer service training.
Reclassified a position to create a Quality Assurance Nurse position to continue the efforts related to
medical record audits, preparing for state audits, OSHA compliance, Infection control, etc.
Human Sexuality
• Applied for and received additional vasectomy funds - reduces costs of unwanted pregnancies;
successfully requested permission from State to utilize unused vasectomy funds to purchase
department supplies for women's preventive health program.
• Implementation of Family Planning Waiver (Medicaid) - makes services available for individuals that
may have been self-pay on a sliding fee scale or who were unable to pay at all - increasing
revenues.
• Use of lower-priced oral contraceptives (added Ortho Tricyclen Lo to our formulary)
Animal Control and Rabies
• Installation of laptop computers in Animal Control Services (ACS) and Environmental Health
vehicles improves staff efficiency, quality of work and eliminates travel to the office.
• ACS increased individual and kennel pet licensing fees, the breeder permit, and boarding fees in FY
2001-2002.
• Completion of an on-site spay/neuter facility at ACS, which has resulted in greater efficiency of
animal adoptions and better usage of Animal Control Officers. Officers no longer must transport
pets for next day surgeries from area veterinarians, enabling them to respond to field complaints
more rapidly. •
On-site surgeries have resulted in a decreased cost of performing the procedure by utilizing
contracted employees. Area veterinarians had agreed to do next-day surgery based on the size and
type of the animal. Their fees on a per animal basis are considerably higher than on-site
procedures. The facility was built without use of county funds, but it greatly benefits every citizen.
• ACS has gone from using a private collection agency to utilizing County Legal to do general
collections and debt set-off for completion of the pet licensing process. The collection agency kept
30% of monies collected, and County Legal does not. Legal is also able to do government agency
debt set-off procedures on every offender who does not pay through the routine collection process.
• ACS currently utilizes an in-house appeals process for all citations issued. Prior to this being
implemented, violators were taken to small claims court, at considerable cost to the division.
• Purchase of two climate-controlled vans for animal transport in ACS is directly linked to reduced fuel
cost for officers working further from the shelter. During months of inclement weather, such as
extreme summer heat, the animals may be carried for longer periods of time before unloading at
Division Drive.
• Recent (2006) revisions to the New Hanover County Code, Section Five, will enable ACS to write
citations for animals that are not walked on lead with their owners. Other changes included
neutering of dogs that have been declared dangerous or potentially dangerous found in violation of
the ordinance, and one aimed at reduction in the number of unwanted litters in the community. It
stipulates that animals adopted in this county must be neutered.
Health Disparities
• Collaborative effort of Cape Fear Healthy Carolinians netted grant funding from the Kate B.
Reynolds Charitable Trust, a philanthropic organization that focuses on financially needy and
disparate populations. Obesity prevention efforts will largely target communities of low socio-
economic and educational levels.
Guidelines for Limited English Proficiency (LEP) Interpreter/Translation Services
• Biannual no cost animal rabies vaccination clinics continue to be held, including one in the inner city
community for clients unable to travel to area veterinarians.
36
I
• Latino speaker (professor form UNCW) brought in several times over last 2 years, to talk to staff
regarding cultural diversity/Latino population and health care.
• WIC has added additional appointments for Hispanics, as the caseload has continued to increase
every year.
• Evening clinic hours allow staff to reach a client population that may have had difficulty obtaining
time away from work to receive services.
Violence
• Worked with the Cape Fear Healthy Carolinians to develop a Violence Prevention committee with
the following priority areas: youth and gang violence, intimate partner violence and reduction of
Intentional Injuries.
• Collaboration between Animal Control Services (ACS) and other law enforcement agencies to
protect the community from dangerous/potentially dangerous dogs. Wilmington Police Department
sought assistance in patrolling downtown neighborhoods in a preventative measure to identify
households with aggressive dogs.
• ACS also has partnered with members of their Advisory Committee to do school education on
proper methods to protect yourself against an attack by a vicious dog. This includes dog behavior
recognition and general safety measures.
• A second Management Academy of Public Health ACS team (composed of ACS and Health
Promotion staff) completed a business plan directed towards education of children in bite prevention
methods.
• ACS staff joined the Community Child Protection Team overseen by Social Services to add
information on the connection of animal abuse to future human violence and abusive tendencies.
• Staff attending training on violence and its impact on families
• Staff involved in several community committees/boards that address violence- Community Child
. Protection Team and Juvenile Crime Prevention Council; these groups promoted the re-institution of
the Gang Task Force. Task Force is now receiving grant funds and staffed with 3 deputies, and
counselors/case managers; staff have also participated in trainings related to gangs.
• Many of the school nurses are involved with "bullying task forces" at their schools.
37
•
Y
•
ABSTRACT
A Comparison of Sanitation Scores in Food Service Establishments
in New Hanover County, North Carolina
by
Alicia E. Pickett
B.S., Western Carolina University, 1991
•
Thesis Submitted in Partial Fulfillment
of the Requirements for the Degree of
Master's of Science
Public Health
Walden University
August 2006
• ABSTRACT
Lack of food safety education can lead to decreased levels of sanitation in food service
establishments. This study examined food service establishment inspection reports from
New Hanover County, North Carolina, from July 2000 through June 2004 to determine
whether food service establishments that have managers certified in proper food handling
procedures actually received higher sanitation scores than did food service establishments
that did not. Of 8,649 inspection reports, 4,224 (48.8%) were establishments with
certified managers and 4,425 (51.2%) were establishments without a certified manager.
The results indicate the scores were statistically similar (p= 0.78) with an overall mean
score for establishments with a certified manager of 96.9 (SD 18.59) (actual inspection
score of 94.9) as compared to an overall mean score for establishments without a certified
• trained manager 94.2 (SD 14.28) independent of certified training status of the manager.
The evidence does not support that a managerial certification has a significant effect on
the score. Therefore, it is recommended that North Carolina public health officials
consider the discontinuation of their 2-point incentive program, commonly referred to as
the Food Safety Managers' Education program. Further research may provide valid
reasons to continue this program, but the data from this study does not support that the
sanitation scores alone are sufficient to merit placing public health resources into this
incentive.
•
•
•
e New ano~rer ounty
I-Iealt~h Departrr~ent
Public Health U1lor~Cforce
nIIMS raining Plan
~ 2006
August 1, 2006
August 2006
The New Hanover County Health Department
Public Health Workforce
NIMS Education/Training Plan
1. NIMS and ICS Training Program requirements for Public Health Workforce ..........................3
Executive Level .........................................................................................................................3
Managerial Level ......................................................................................................................3
Responder Level .......................................................................................................................3
How to Access Online Training .............................................................................................4
2. NIMS and ICS Credential Records of the Public Health Workforce .........................................4
3. Summary .................................................................................................................................5
•
New Hanover County Health Department 2
August 2006
1. NIMS and ICS Training Program requirements for Public Health Workforce
• The Public Health (PH) Workforce includes personnel from diverse professions. Any of these
responders may perform functions within an Incident Command System and, therefore, require some
level of understanding of ICS and its relationship to NIMS. The NIMS Integration Center has defined
three levels of response personnel requiring NIMS training. Specific training is required at each level to
prepare individuals to perform within the Incident Command System.
Executive Level
NIMS Definition: Political and government leaders, agency and organization administrators and
department heads; personnel that fill ICS roles as Commanders, Incident Commanders, Command
Staff, General Staff in either Command or single incidents; senior level Multi-Agency Coordination
System personnel; senior emergency managers; and Emergency Operations Center or General
Staff.
NHCHD Personnel: Local Health Department Directors, Assistant/Deputy Health Director, and
Personal Health Services Manager.
NHCHD Training: These individuals are required to complete all six training programs: IS-100, ICS-
200, ICS-300, ICS-400, IS-700, and IS-800. Executive level public health professionals required to
complete the ICS-300 and ICS-400 courses in the classroom may choose to complete IS-200 online
as an independent study course instead of taking it in a classroom.
Managerial Level
• NIMS Definition: Agency and organization management between the executive level and first level
supervision; personnel who fill ICS roles as Branch Directors, Division/Group Supervisors, Unit
Leaders, technical special strike team and task force leaders, single resource leaders and field
supervisors; midlevel Multi-Agency Coordination System personnel, EOC Section Chiefs, Branch
Directors, Unit Leaders; and other emergency management/response personnel who require a
higher level of ICS/NIMS Training.
NHCHD Personnel: Division Managers, supervisors and Epi Team members.
PH Training: These individuals are required to complete IS-100, ICS-200, ICS-300, IS-700, and
IS-800. Managerial level public health professionals are required to complete the ICS-300 course in
the classroom.
Responder Level
NIMS Definition: Emergency response providers and disaster workers, entry level to managerial
level including Emergency Medical Service personnel; firefighters; medical personnel; police officers;
public health personnel; public works/utility personnel; and other emergency management response
personnel.
NHCHD Personnel: All Staff.
PH Training: These individuals are required to complete IS-100, ICS-200, and IS-700.
• Employees that are not expected to report for duty following activation of the Public Health Emergency
Response Plan and/or employees who do not have emergency response roles documented in their job
descriptions are not required, but encouraged to complete NIMS training.
3
August 2006
a
NIMS ICS training will be integrated into the orientation process for all appropriate new public health •
employees.
• New employees must complete IS-100, ICS-200 and IS-700 by the end of orientation.
• ICS-300, ICS-400, and IS-800 may also be a requirement depending on the employee position.
These courses must be completed within the first year of employment.
There are six ICS and NIMS training programs available through DHS and developed by FEMA, the
Emergency Management Institute (EMI), and the National Fire Academy (NFA) that provide the
knowledge and skills for responders at all jurisdictional levels and across all disciplines to work together
more effectively and efficiently. This is a nationwide approach to prepare for, prevent, respond to and
recover from domestic incidents, regardless of cause, size or complexity.
ICS training must be consistent with the concepts, principles and characteristics of the ICS training
offered by the various DHS training entities. The ICS and NIMS training programs available through
DHS, FEMA and EMI are:
• IS-100 Introduction to the Incident Command System for Federal Disaster Workers
• ICS-200 Basic Incident Command System for Federal Disaster Workers
• ICS-300 Intermediate Incident Command System
• ICS-400 Advanced Incident Command System
• IS-700 National Incident Management System (NIMS), An Introduction
• IS-800 National Response Plan (NRP), An Introduction
How to Access Online Training •
Online independent study courses, including IS-100, IS-700, and IS-800, may be accessed on the
Department of Homeland Security, FEMA, U.S. Fire Administration, Emergency Management Institute
website:
http://training.fema.gov/EMlWeb/IS/crsIist.asp
2. NIMS and ICS Credential Records of the Public Health Workforce
The NHCHD will maintain a NIMS/ICS training programs database for credential record keeping.
Quarterly Reports will be sent to PHP&R to provide documentation of progress in completing required
NIMS training.
The following programs will be included in this database:
• IS-100 Introduction to the Incident Command System for Federal Disaster Workers
• ICS-200 Basic Incident Command System for Federal Disaster Workers
• ICS-300 Intermediate Incident Command System
• ICS-400 Advanced Incident Command System
• IS-700 National Incident Management System (NIMS), An Introduction •
• IS-800 National Response Plan (NRP), An Introduction
The following demographic information will be included in this database:
4
August 2006
• Name and Job Position
• • County
• Last four digits of SSN
• Home mailing address
• Daytime Telephone Number
Any ICS or NIMS training program not offered by DHS will be reviewed individually to ensure that the
course is consistent with the NIMS to be accepted as an equivalent to the ICS programs from DHS.
Public Health Workforce individuals are responsible to send copies of all certificates of completion for
ICS and NIMS training programs to their appropriate database administrator. If certificates of completion
for ICS and NIMS training programs are not available, the individual must successfully complete the
training program again.
3. Summary
This implementation plan has defined an approach to the delivery of training to ensure that the workforce
of New Hanover County Health Department successfully meets that requirement. More importantly, this
plan will ensure that New Hanover County Health Department personnel are adequately prepared to
fulfill their response role in a unified command environment.
•
i
5
Addressing the Problem of Pet Overpopulation:
The Experience of New Hanover County Animal
Control Services
Jean McNeil and Elisabeth Constantly
Pet overpopulation is a problem for humans not only the number of unwanted companion animals in the
because of the increased rabies exposure risk but also community.
because it puts a strain on animal control agencies, which
must care for, house, and often euthanize the unwanted animals. 0 Background
New Hanover County, North Carolina, Animal Control Services
saw the need.to control this problem and developed a plan to New Hanover County is an area on the southern coast
diminish the number of unwanted companion animals in its of North Carolina with a rapidly expanding popula-
tion. Wilmington, the county seat, is a 250-year-old city
located between the Cape Fear River and the Atlantic
Management Academy for Public Health, they created a Ocean. Home to almost 175,000 people, it comprises
• Successful business plan to build an on-site spay/neuter facility. military installations, a state port, historic Civil War
The facility began operations in 2004. As of January 31, 2006, a sites, and beautiful beaches. As the community has
g
total of 1,108 surgeries had been completed in the new facility, grown, so has the number of pets residing in the county.
Now into its third century of public health ser-
with no added cost to taxpayers. The facility has been a success vice, the New Hanover County Health Department
for Animal Control Services, the Health Department, and the (NHCHD) is a modern facility with almost 200 em-
community as a whole, ployees. Unlike many health departments, the NHCHD
provides animal control services as well as traditional
KEY WORDS: animal control, management development, public human population health and safety services, partly
administration, public health, training because of the public health threat of rabies virus ex-
posure. The health director serves as the agency link
to county government and directly oversees an assis-
tant health director, personal health services manager,
Pet overpopulation increases rabies exposure risk to business manager, environmental health services man-
humans, and this risk isgrowing in North Carolina. Ac- ager, NHCACS manager, and a regional dental health
cording to the North Carolina Division of Public Health contact.
State Center for Health Statistics, the state of North In April 1999, a study of NHCACS outcomes and
Carolina was free of diagnosed rabies cases as recently staff concerns identified the animal adoption process
as 1989; yet in 2000, 91 of the 100 counties had docu- at the shelter as a possible contributing factor to pet
mented cases of rabies in animals. Pet overpopulation overpopulation in the county. At the time, pets were
also puts a strain on animal control agencies, which
must care for, house, and often euthanize millions of
unwanted animals annually. New Hanover County, Corresponding author: Jean McNeil, DVM, Animal Control Services Manager,
North Carolina, Animal Control Services (NHCACS) New Hanover County Health Department, 180 Division Or, Wilmington, NC 28401
saw the need to control this problem proactively by in- (e-mail. jmcneil®nhcgov.com).
creasing rates of pet sterilization, and thus reducing
• Jean McNeil, DVM, is Animal Control Services Manager, New Hanover County
Health Department, Wilmington, North Carolina.
JPublic Health Management Practice, 2006.12(5),452-455 Elisabeth Constantly, MS, is Health Education Supervisor, New Hanover County
Q 2006 Lippincott Williams 8 Wilkins, Inc. Health Department, Wilmington, North Carolina.
452
r f
Addressing the Problem of Pet Overpopulation 1 453 , .
Y
sent to their new homes with a certificate that would TABLE 1 6 Business plan: Key assumptions'
cover the cost of neutering the animal at a local veteri-
nary hospital. The study uncovered that 50 percent of Personnel
the approximately 650 animals adopted each year did Shelter attendant (part time)
not undergo this surgery. Extrapolating from Humane Veterinarians and veterinary technicians on an as-needed basis, some as
Societv of the United States estimates that a fertile dog unpaid volunteers
or cat will produce about 12 to 20 offspring per year, Key expenses
unsterilized animals from NHCACS could have been Facility expansion
producing as many as 5,000 to 8,500 offspring per year Surgery equipment
after being adopted.' In response to this problem, the Financing
shelter implemented transport of animals for off-site Start-up funding projections
sterilization surgery in October 1999. By undertaking Trust funds (approximately $38,000 as of December 31, 2001)
the responsibility for getting the animals neutered, the Community funding and donations (approximately $16,900)
shelter went from 50 percent to 100 percent surgery In-kind donations for all equipment and furnishings
compliance in a single month. In-kind donation for labor to complete the interior of the building addition
Transporting animals to off-site surgery, however, Operational funding
proved to be an inefficient use of staff time. The Adoption fees will cover operation costs and provide "excess" revenues
NHCACS needed a business plan to make possible in- to help offset other NHCACS operations
house sterilization of all adopted animals. To develop Other assumptions
the skills to create such a plan, a group of key individ- This is a cash-basis operation
uals were sent to the UNC Management Academy for Revenues and expenditures are accounted for on a cash basis
Public Health, a program that teaches public health pro- No credit is extended for adoption fees; therefore, there are no accounts
fessionals how to integrate business models into their receivable
initiatives. Volunteer time from the veterinary community is expected. Full estimate of
costs for veterinarian time is calculated in procedure costs to be
conservative in net revenue projections •
® Methods All officer positions will remain
Any revenue impact from officer redirection is expected to be negligible
Business plan development at the Management 5% salary increases per year (including both market adjustments and merit
Academy for Public Health increases)
The 2002 NHCACS Management Academy team mem- 3% inflation increases per year for nonsalary items
bers were strategically selected to include relevant staff Benefits = 30% of salaries
and viable community partners. Because the veterinary 'NHCACS indicates New Hanover County, North Carolina, Animal Control Services.
community was a potential competitor-veterinarians
could have construed the 'spay/neuter facility as a mental stakeholders who would have to approve the
threat to their hospital income-a prominent local vet- project and the capital campaign that would fund its
erinarian was chosen to participate on the team, both to start-up. External customers included adopters and the
add his expertise to the planning of the facility and to general public, area veterinarians, and area animal res-
advocate for the facility among his colleagues. The team cue or retail operations. The project would target both of
included a manager. from the county finance depart- these market groups, using social marketing and pub-
ment, to help identify strategies for funding the project. lic relations efforts to build public support for animal
A health educator rounded out the group. At the Man- control efforts in general and financial support of the
agement Academy, the NHCACS team received train- on-site spay/neuter facility in particular.
ing in three basic areas of management skill: managing The business plan budget, shown in Table 2, ad-
people, managing data, and managing finances. Pulling dressed the costs and planned means of funding the
together these elements, the team produced a business facility
plan to (1) build an addition to the current NHCACS
building to house an on-site spay/neuter facility; (2) Implementation of the business plan
staff the facility; (3) finance start-up of the facility; and
(4) finance ongoing expenses. Table 1 illustrates the key The Management Academy team returned to Wilming-
assumptions that the team members made as they cre- ton with a comprehensive business plan to build and
ated their business plan. operate an on-site spay/neuter facility at the NHCACS
As part of the project, the NHCACS team identified Division of the NHCHD. Besides laying out the pro-
the internal and external target market for its planned posed operations, its plan summarized the industry,
facility. The internal market included county govern- presented marketing strategies, and forecast key risks
454 1 Journal of Public Health Management and Practice
TABLE 2 e Business plan: Budget' $28,000 gift willed to NHCACS by a New Hanover
O.................................................. County animal lover.
tart. up expenditures
Buildings
Construction $65,000 Facility design and construction
Fence expansion $1,500 Construction of the 1,020-sq It building was completed
Total buildings $66,500 in June 2004. The facility utilized technologies that opti-
Capital equipment mized efficiency, including, for example, a central sup-
Furniture $2,500 ply of oxygen for anesthetic machines with a delivery
Equipment $15,000 system in the ceiling. This system both saved space
Total capital equipment $17,500 and proved more economical than using small tanks
Reserve for contingencies (10%) $8,400 attached directly to the machines. Other space- and
Total start-up expenditures $92.400 time-saving elements included having two tables in
Revenue sources the operating room, so the surgeon could go directly
NHCACS Trust Fund $38,000 from one procedure to the next, and installing a "tub
Monetary donations $16,900 table" in the preparation area to facilitate the cleaning
In-kind donations $37,500 and preparation of the patients. New Hanover County
Total revenue $92,400 Property Management served as the project manager,
'NHCACS indicates New Hanover County, North Carolina, Animal Control Services. and the facility was erected without the use of taxpayer
monies. Equipment was added and tested by 2004. To-
tal
and success factors. Results of the implementation of building cost was $58,000, paid from the NHCACS
this plan are detailed below. Trust Fund.
Operations
® Results The veterinarian member of the Management Academy
team that had conceived of the program and writ-
Securing support ten the business plan performed the first surgery on
County Commissioners approved the project on September 22, 2004.` Five local veterinarians have vol-
August 19, 2002, as part of the consent agenda, meaning unteered or contracted their time; two have regular con-
that the business plan created by the team at the Man- tracted hours at the facility. As of January 31, 2006, a
agement Academy answered all questions that may total of 1,108 surgeries had been completed, possibly
have arisen about the project. Their approval autho- preventing from 3,325 to 5,000 unwanted offspring, as-
rized NHCACS managers to undertake a capital cam- suming that only half of those animals would havebeen
paign for the NHCACS Trust Fund, which would fund sterilized under the old voucher system. Also, since the
the start-up of the facility; it also authorized them to opening of the facility, there has been an unanticipated
operate the facility on a fee-for-service basis. 22 percent increase in animal adoptions and a favor-
For 2 years, NHCACS managers and partners rallied able public response to the convenience and speed with
political support, raised money, and planned the new which adoptions are now handled.
wing of their facility. To rally support, they presented In summer 2005, the facility was put to the test by
local veterinarians with"data showing that a public a large search and seizure operation of a single res-
spay/neuter facility would not decrease their busi- idence housing 137 Dachshunds in unsanitary con-
ness appreciably because it would primarily involve ditions. These animals became the property of New
animals that were the property of NHCACS, not of Hanover County to be placed for adoption. More than
the general public. The veterinarian partner on the 100 dogs needed surgery and new homes. Because the
team was instrumental in communicating with the department had the functioning spay/neuter facility,
local veterinarians and bringing them on as partners. and a contracted veterinarian willing to increase her
NHCACS managers also applied social marketing hours during this time, staff efficiently sterilized these
techniques they had learned at the Management
Academy-public relations advertising and strategic *Dr Bob Weedon went on to earn his master of public health
redesign of their current facilities to make them more degree from the University of North Carolina School of Pub-
inviting and user friendly-to enhance the public lic Health and is currently the veterinarian member of the New
• perception of NHCACS. The department published Hanover County Board of Health. He has remained instrumental
to the success of the spay/neuter facility, not only volunteering
a news release describing the project and soliciting his time but also bringing in his veterinary students to help as
donations to NHCACS Trust Fund, which received a part of their training.
r
Addressing the Problem of Pet Overpopulation 1 455
TABLE s ® New Hanover County Management Academy teams and their outcomes
Year Project focus Outcome
2000 Diabetes prevention and treatment Developed "Diabetes Today" Coalition, which coordinates classes,
screening, and awareness events for those living with, and those
trying to prevent, diabetes.
2001 Adolescent obesity (first team to involve community member) Partnerships developed with local schools' nursing and nutrition
professionals. Resulted in the county's having one of the most
comprehensive and active school health advisory councils in North
Carolina, co-chaired by a member of that team.
2002 Hand washing in childcare facilities County schools and daycare facilities benefited from education
developed in the business plan. Blue Ribbon Winner at the
Management Academy.
2002 Animal control pet overpopulation On-site spay/neuter facility opened in 2004. No taxpayer dollars used to
fund project.
2005 Injury prevention safety village Team members included two representatives from the county fire
department. Project being explored with area architects, parks and
recreation offices, and potential corporate sponsors.
animals, making them available for adoption within nity, which helped assure that the program was uncon-
1 month. Thus, an efficient and effective solution was troversial and thus attractive to funders. The Manage-
found for what could have been a lengthy and cumber- ment Academy program strongly suggests that public
some problem. health teams come with a community partner, and sev-
In its planning, the Management Academy team had eral New Hanover County participants have included
avoided estimating savings or earnings on the basis of partners (Table 3). The NHCHD as a whole has bene-
the redirection of staff activities (see Table 1). It was fited greatly from community partnerships, especially
assumed that although staff would probably be do- with organizations the department may not have con- •
ing tasks that earned money (such as writing citations) sidered traditional allies.
rather than those that, cost money (transporting ani- Specific marketing and data and personnel manage-
mals to off-site surgery), the earnings from such ac- ment skills were also key to the success of this project.
tivities would be negligible, or at least indeterminate. The ability to analyze data effectively and use it to
However, the facility is realizing a $5,000 per year sav- make better presentations to county and other officials,
ings when calculating hourly contract fees on-site ver- for example, helped facilitate the spay/neuter facility's
sus the cost of individually contracted services off-site. easy passage through the county commissioners' re-
This savings translates into a reimbursement of the trust view process. These same skills, used with different
fund in about 10 years. partners and sponsors, applied to creating other pro-
grams that could be sustained without added public
® Discussion monies, have helped the health agency become more
financially independent as state and federal funding
The creation of the NHCACS on-site spay/neuter facil- has diminished steadily.
The on-site spay/neuter program has resulted in a
ity serves as anezample of'bestpractice for an organi- 100 percent sterilization rate of adopted pets in New
zation. A need was identified; a group of dedicated pro- Hanover County with no added cost to taxpayers,
fessionals was convened and given the skills necessary at a great savings of NHCACS staff time, and with
to bring about the solution; a comprehensive business the added benefit of increasing customer satisfaction
plan was completed; and -.the , needed facility was built among adopters. Further evaluation will determine the
and has begun to serve the comm unity.
A critical success, factor for this project was the broader benefit to the pet and human population -
strategic partnering with the-community that allowed large, including, ideally, lower rates of rabies and a de-
strategic
Management Academy. team to fully understand crease in the number of euthanized animals.
its target market, competition;*and long-term oppor-
tunities. The veterinary member of the Management •
Academy team, besiaes'providing practical assistance REFERENCE
in designing the facility and performing surgeries, lent 1. The Humane Society of the United States. Statistics. Available
his valuable connections with the veterinary commu- at: www.hsus.org, Accessed on February 20, 2006.
C
SANITATION TIPS FOR FOOD WORKERS SUMMER 2006 '
Can YOU Use HACCP 4® CoMv 0 Rhk?
~ 1 / OK, so you know HACCP is a system that can be used for improving food
safety. You may even know the letters stand for Hazard Analysis and Critical Con-
trol Point. But you are not sure how HACCP would
apply in a busy retail or foodservice establishment,
especially when there is so little time for record- / Managing Food Safety:
? A Manual for the
keeping or other paper work ( Voluntary Use of
Don't worry, you are not alone.t HACCP Principles for
Operators of Food
After studying the issue for years, the Food and 31 Service and Retail
Drug Administration recently released a manual on Establishments
how to apply HACCP at the retail and foodservice v
stages. The federal officials worked hard to set the
Source; ron groundwork for a system that would not be too C time-consuming for a busy establishment to use. NY
FDA says HACCP can help you increase em-
ployee participation in food safety. It can also
help reduce product loss, increase quality, bet-
Also in this issue...
ter manage inventory, increase consistency in m.~m "M .,a .
Cool tips for a hot season product preparation, and-if all those are not
enough-even increase profit.
Page 2 HACCP involves taking action to control risk factors instead of just waiting for
something to go wrong. Creating a HACCP plan involves the following steps:
Grease: what you should know 1) Performing a hazard analysis to find out what food safety hazards are likely to
Page 2 occur. It involves breaking down the operation into steps such as receiving,
storage, preparation, cooking, and so on. This step also involves identifying
Tips for new (and old) what control measures can be used to control the food safety hazards. Con-
employees trol measures could include proper handwashing and implementing employee
t Page 3 health policies to restrict or exclude ill employees; deciding on critical control
points (CCPs); determining critical limits; establishing corrective actions, in-
Handwashing basics cluding a hazard analysis.
2) Deciding on the critical control points at which control measures are abso-
Page 3 lutely essential to ensure safe food. A typical HACCP plan might only have two
or three critical points.
Keep single service sanitary 3) Finding the critical limits for control points. For example, when cooking pork
Page 4 chops, the FDA Food Code sets the critical limit at 145 degrees F for 15
seconds. When critical limits are not achieved, the food may not be safe.
4) Keeping track of the CCPs as the food moves through the establishment. This
r involves making observations or measurements to make sure the CCPs are
Copyright 2006 maintained.
Setanta Publishing, LLC 5) Next are corrective actions, which kick in when the monitoring finds that the
1-703-548-3146 critical limits are not being achieved. This is the heart of HACCP. Problems will
www.foodtalkcom see HACCP... page 2
FOOD TALK SUMMER 2006
Cool Tips for a Hot Season
Improper cooling and cold holding of potentially haz-
ardous foods lead to many outbreaks of foodborne ill-
ness-especially during the warm summer weather. Here
are some tips for getting foods quickly out of the tem- g 4
perature danger zone and keeping them cool: xcmos
1) Shallow four-inch pans cool best. I; 2
2) Check the cooler thermometer often. 1
~r~r,iuurri , "
3) Thawing in the cooler is best. Never thaw at room]
temperature. i V
4) Keep the cooler door firmly closed. 5 6~
t) Store cooked foods on top shelves, so raw foods won't 4 _ + 7
drip onto cooked items.
6) Cooling in large containers takes too long and enables
bacteria to grow. 3 8
7) Cover food only when it reaches 41 degrees
Fahrenheit.
8) Stacked pans prevent air circulation and they are slow
to cool.
9 Keep eggs refrigerated until ready to use.
I
HACCP (Continued) The manual, Managing Food Safety: A Manual for the
Voluntary Use of HACCP Principles for Operators of Food
arise, but you need to find and correct them before Service and Retail Establishments, is available online at
they cause illness or injury. www.dsan.fda.gov.
6) Next, you need a way to verify that the system is oper-
ating according to plan. For example, the manager might
periodically make observations of employees' monitor-
ing activities, calibrate equipment, review records, and
discuss procedures with employees. Grease: What
You
7) Lastly, HACCP, involves written records-as well as the
written plan itself-to show that the system is working. Should Know
This record keeping should be as simple as possible,
so that employees wile Have the time to keep the There are three main problems with grease. One is
records, FDA says. that it is a food for insects and germs. Cockroaches just
The federal officials believe the implementation of love it. And bacteria thrive in it.
HACCP by retail and foodservice establishments will vary Another is that grease is the cause of many acci-
as much as the products produced. Because of their di- dents in the workplace, with workers falling because of
versity, it is impractical for most retail and foodservice es- slippery floors. -
tablishments to use "textbook" HACCP, they say. Grease is also a fire hazard. Next to pouring gasoline
HACCP can provide a complete food safety manage- around your premises, grease is the best fire feeder
ment system, when combined with good basic sanitation, you can find, especially when it is layered on floors,
a solid employee training program, and other prerequisite walls, and ceilings and there is no routine cleaning: Ou
programs, the agency says. of the 20,000 or so fires each year in eating establis~
"You and your regulatory authority have a common ob- ments, many are caused or made worse by grease.
jective in mind-providing safe, quality food to consum- The bottom line is that the health inspector will check
ers," but "the ultimate responsibility for food safety at the for grease because it's.a triple health hazard. How about
retail level lies with you." trying three times as hard to keep it out of the kitchen?
SUMMER 2006 FOOD TALK
P o o e e o o e o 0 0 v~ v r v v v v v v v v ~`o c~
IPS Gov flow. u Handwashing Basics o
Food service establishments often wt
hire a lot new employees at this
time of year. Gettingthem quickly up ~
to speed on proper sanitation can
beg challenge. Here are some tips slll4~
to et them started: ~
• Always wash your hands, utensils
and work areas with hot, soapy
water after contact with raw meat 0 ~
and poultry. Q
• Always refrigerate or freeze per-
ishable foods (foods that will spoil 1. Wet hands with warm water 2. Rub hands with soap
quickly at room temperature). Q
• Always serve cooked food using 0 Q
clean plates and utensils.
• Never thaw food on the counter n
or let it sit out of the refrigerator )
for more than two hours.
• Never use wiping cloths to removeI 0 4 Gt
perspiration. ~ t(r J O
Never wash your hands in a sink
that is used to prepare food. ~~q 1
• Never cough or sneeze in a food
preparation area without covering Q 0
your mouth.
• Never pick up bread, rolls, butter 3. Rub hands briskly for 20
pats or ice with bare hands. seconds, including fingertips 4. Rinse soap from hands
• When handling knives, forks and and between fingers
other tableware, do not touch the 0
food contact surfaces. Use the
handle.
• Do not taste food with your finger Il[
or use the same spoon for o C\
tasting more than once. Q
0
Food Talk is available in 0 oa
an all-Spanish edition.
0 0
See www.foodtalk.com p >
or call (703) 548-3146 6. Throw used papers towels 0 .
for details. 0 5. Dry hands with paper towel in the trash 0
b o o e o o v o 0 0 0 0 o v o 0 0 0 0 0 0 0 0 0 0 0 o c9
c o
FOOD TALK SUMMER 2006
Keep Single Service
Sanitary!
Disposable utensils can be very useful in keeping a n p
foodservice establishment sanitary, but only if the /1
utensils are kept sanitary. Here are some useful tips for A
how to store, use and dispose of them:
Storage:
• Store bulk single-service supplies in a cool, dry area,
away from pipes or moisture. "I'm all out of napkins and
• Do not store_ cartons in toilet rooms, compressor or utensils. Here, use this notice
-
bdiler areas or vestibules. --from. the health department."
• After taking out items you need for current use, keep
the remainder in the original case and reseal or cover
it to prevent contamination. Dispensing:
Service: • Handle single-service products as little as possible.
• Hold cups by the side or bottom surfaces or handles,
• Lay out in the service area only the supplies you are without fingering the lip edge.
likely to need for a given service period. • If nested cups do not separate easily, hold the stack
• Store the items on a clean, dry shelf-a protected by the plastic wrapping with one hand, and pull off a
place away from foods and other contamination single cup by the bottom with the other hand.
sources. • Pick up forks, knives, and spoons by the handles, not
• Stack the items bottom up for easy removal and to by the parts that touch food.
avoid fingering the food contact surfaces.
• For best sanitation, use individually wrapped knives, Disposing:
forks, spoons, straws, and toothpicks. If flatware is • Avoid touching soiled surfaces of used paper and
in bulk, place items carefully in clean containers with plastic items.
eating surfaces facing down and handles up, to make • Keep enough waste containers near the point of use,
them easier to grasp. with visible signs to encourage use by customers.
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