The Centers for Disease Control and Prevention (CDC) established the Vessel Sanitation Program (VSP) in the 1970s as a cooperative activity with the cruise ship industry. The program assists the cruise ship industry in fulfilling its responsibility for developing and implementing comprehensive sanitation programs to minimize the risk for acute gastroenteritis. Every vessel that has a foreign itinerary and carries 13 or more passengers is subject to twice-yearly inspections and, when necessary, reinspection. VSP operated continuously at all major U.S. ports from the early 1970s through 1986, when CDC terminated portions of the program. Industry and public pressures resulted in Congress directing CDC through specific language included in CDC appropriations to resume the program. CDC's National Center for Environmental Health (NCEH) became responsible for VSP in 1986. NCEH held a series of public meetings to determine the needs and desires of the public and cruise ship industry and on March 1, 1987, a restructured program began. In 1988, the program was further modified by introducing user fees to reimburse the U.S. government for costs. A fee based on the vessel's size is charged for inspections and reinspections. A VSP Operations Manual based on the Food and Drug Administration (FDA) 1976 model code for food service and the World Health Organization's Guide to Ship Sanitation was published in 1989 to assist the cruise ship industry in educating shipboard personnel. In 1998, it became apparent that is was time to update the 1989 version of the VSP Operations Manual. Changes in the FDA Food Code, new science on food safety and protection, and newer technology in the cruise ship industry contributed to the need for a revised operations manual. Over the next 2 years, VSP solicited comments from and conducted public meetings with representatives of the cruise industry, general public, FDA, and international public health community to ensure that the 2000 manual would appropriately address current public health issues related to cruise ship sanitation. A similar process was followed to update the VSP 2000 Operations Manual in 2005. Although the VSP 2005 Operations Manual was in use for almost 6 years, new technology, advanced food science, and emerging pathogens require updates to the manual. The VSP 2011 Operations Manual reflects comments and corrections submitted by cooperative partners in government and private industry as well as the public. We would like to thank all those who submitted comments and participated throughout this process. As new information, technology, and input are received, we will continue to review and record that information and maintain a public process to keep the VSP Operations Manual current. The VSP 2011 Operations Manual continues the 40+-year tradition of government and industry working together to achieve a successful and cooperative Vessel Sanitation Program that benefits millions of travelers each year.#
VSP would like to acknowledge the following organizations and companies for their cooperative efforts in the revisions of the VSP 2011 Operations Manual. The cover art was designed by Carrie Green.

# Cruise Lines

# Introduction

# Cooperation
The program fosters cooperation between the cruise ship industry and government to define and reduce health risks associated with vessels and to ensure a healthful and clean environment for vessels' passengers and crew. The industry's aggressive and ongoing efforts to achieve and maintain high standards of food safety and environmental sanitation are critical to the success of protecting public health.

# Activities

# Prevention

# Inspections
VSP conducts a comprehensive food safety and environmental sanitation inspection on vessels that have a foreign itinerary, call on a U.S. port, and carry 13 or more passengers.

# Surveillance
The program conducts ongoing surveillance of acute gastroenteritis (AGE) and coordinates/conducts outbreak investigations on vessels.

# Information

# Training
VSP provides food safety and environmental sanitation training seminars for vessel and shore operations management personnel.
Introduction;

# Plan Review
The program provides consultative services for reviewing plans for renovations and new construction.

# Construction Inspections
The program conducts construction inspections at the shipyards and when the vessel makes its initial call at a U.S. port.

# Information
The program disseminates information to the public.

# Operations Manual

# Revisions

# Manual
The VSP 2011 Operations Manual has been modified as a result of emerging public health issues, industry recommendations, introduction of new technologies within the industry, new guidance from sources used in the previous edition, and CDC's experience.

# Program Guidance
The program operations and inspections are based on this manual.

# Periodic Review
The VSP 2011 Operations Manual will be reviewed annually in the public meeting with written submissions for revision based on emerging public health issues and new technologies that may better address the public health issues on vessels.
Authority; 3 The VSP Operations Manual requires several records to be maintained on board for periods of 30 days to 1 year, including - medical,

# Authority
- potable water,
- recreational water,
- food safety, and - housekeeping.
These records are reviewed during operational inspections. VSP has and will continue to cite violations identified in the record review, even if the ship was not sailing in U.S. waters when the violation occurred. If the record review reveals violations that could result in illness when the ship arrives in a U.S. port, points may be deducted according to the violations identified during the inspection. One example of these violations is ships producing water in ports, harbors, and polluted waterways.

# Definitions
This section includes the following subsections: 3.1 Scope 3.2 Definitions 3.3 Acronyms

# Scope
This VSP 2011 Operations Manual provides definitions to clarify commonly used terminology in this manual. The definition section is organized alphabetically.
Where a definition specifically applies to a section of the manual, that will be noted in the definition.
Terms defined in section 3.2 are identified in the text of these guidelines by SMALL CAPITAL LETTERS, or SMALL CAPS. For example, section 5.7.1.1.4 states "A CROSS-CONNECTION control program must include at a minimum: ..." CROSS-CONNECTION is in SMALL CAPS and is defined in section 3.2.

# Definitions
Accessible: Exposed for cleaning and inspection with the use of simple tools including a screwdriver, pliers, or wrench. This definition applies to use in FOOD AREAS of the vessel only.

# Accredited program:
A food protection manager certification program that has been evaluated and listed by an accrediting agency as conforming to national standards for organizations that certify individuals.
An accredited program refers to the certification process and is a designation based on an independent evaluation of factors such as the sponsor's mission; organizational structure; staff resources; revenue sources; policies; public information regarding program scope, eligibility requirements, recertification, discipline and grievance procedures; and test development and administration.

# Accredited program does not refer to training functions or educational programs.
Activity pools: Include but are not limited to the following: wave pools, activity pools, catch pools, water slides, INTERACTIVE RECREATIONAL WATER FACILITIES, lazy rivers, action rivers, vortex pools, and continuous surface pools.

# Acute gastroenteritis (AGE):
Irritation and inflammation of the digestive tract characterized by sudden onset of symptoms of diarrhea and/or vomiting, as well as other constitutional symptoms such as fever, abdominal cramps, headache, or muscle aches.

# AGE case: See REPORTABLE AGE CASE.
AGE outbreak: Cases of ACUTE GASTROENTERITIS, characterized by diarrhea and vomiting, that are in excess of background rates. For the purposes of this manual, more than 3% is considered in excess of background rates. In addition, an AGE outbreak may be based on two or more laboratory-confirmed cases associated with food or water consumption during the cruise. Adequate: Sufficient in number, features, or capacity to accomplish the purpose for which something is intended and to such a degree that there is no unreasonable risk to health or safety.

# Additive

# Adulterated:
As stated in the Federal Food, Drug, and Cosmetic Act, 402.

# Air-break:
A piping arrangement in which a drain from a fixture, appliance, or device discharges indirectly into another fixture, receptacle, or interceptor at a point below the flood-level rim (Figure 1).

# Air gap (AG):
The unobstructed vertical distance through the free atmosphere between the lowest opening from any pipe or faucet supplying water to a tank, PLUMBING FIXTURE, or other device and the flood-level rim of the receptacle or receiving fixture. The air gap must be at least twice the inside diameter of the supply pipe or faucet and not less than 25 millimeters (1 inch) (Figure 2). Backpressure: An elevation of pressure in the downstream piping system (by pump, elevation of piping, or steam and/or air pressure) above the supply pressure at the point of consideration that would cause a reversal of normal direction of flow.

# Barometric loop:
A continuous section of supply piping that rises at least 35 feet above the supply point and returns back down to the supply. Typically the loop will be in the shape of an upside-down "U." A barometric loop only protects against BACKSIPHONAGE because it operates under the principle that a water column cannot rise above 33.9 feet at sea-level pressure.

# Backsiphonage:
The reversal or flowing back of used, contaminated, or polluted water from a PLUMBING FIXTURE or vessel or other source into a water supply pipe as a result of negative pressure in the pipe.
Beverage: A liquid for drinking, including water.

# Chemical disinfectant:
A chemical agent used to kill microbes.

# Child activity center:
A facility for child-related activities where children under the age of 6 are placed to be cared for by vessel staff.

# Children's pool:
A pool that has a depth of 1 meter (3 feet) or less and is intended for use by children who are toilet trained.
Child-sized toilet: Toilets whose toilet seat height is no more than 280 millimeters (11 inches) and the toilet seat opening is no greater than 203 millimeters (8 inches).

# CIP (cleaned in place):
Cleaned in place by circulating or flowing mechanically through a piping system of a detergent solution, water rinse, and sanitizing solution onto or over EQUIPMENT surfaces that require cleaning, such as the method used-in part-to clean and sanitize a frozen dessert machine. CIP does not include the cleaning of EQUIPMENT such as band saws, slicers, or mixers that are subjected to in-place manual cleaning without the use of a CIP system.

# Confirmed disease outbreak: A FOODBORNE or WATERBORNE DISEASE
OUTBREAK in which laboratory analysis of appropriate specimens identifies a causative agent and epidemiologic analysis implicates the food or water as the source of the illness.
Consumer: A person who takes possession of food, is not functioning as an operator of a food establishment or FOOD-PROCESSING PLANT, and does not offer the food for resale.

# Contamination:
The presence of an infectious agent on a body surface, in clothes, in bedding, on toys, on surgical instruments or dressings, or on other inanimate articles or substances including food and water.

# Continuous pressure (CP) backflow prevention device:
A device generally consisting of two check valves and an intermediate atmospheric vent that has been specifically designed to be used under conditions of continuous pressure (greater than 12 hours out of a 24-hour period).
Coving: A concave surface, molding, or other design that eliminates the usual angles of 90 or less at deck junctures (Figures 3, 4, and 5).

# Critical item:
A provision of these guidelines that, if in noncompliance, is more likely than other deficiencies to contribute to food or water CONTAMINATION, illness, or environmental health hazard. These are denoted in these guidelines in bold red underlined text in parentheses after the section number and keywords; for example, 7.5.5.1 Food-contact Surfaces (24 C) . The number indicates the individual inspection report item number.

# Critical control point:
A point or procedure in a specific system where loss of control may result in an unacceptable health risk.

# Critical limit:
The maximum or minimum value at a CRITICAL CONTROL POINT to which a physical, biologic, or chemical parameter must be controlled to minimize the occurrence of risk from an identified safety hazard.

# Cross-connection:
An actual or potential connection or structural arrangement between a POTABLE WATER system and any other source or system through which it is possible to introduce into any part of the POTABLE WATER system any used water, industrial fluid, gas, or substance other than the intended POTABLE WATER with which the system is supplied. Fish: Fresh water or saltwater finfish, crustaceans, and other forms of aquatic life (including alligator, frog, aquatic turtle, jellyfish, sea cucumber, sea urchin, and the roe of such animals) other than birds or mammals, and all mollusks, if such animal life is intended for human consumption. Fish includes an edible human food product derived in whole or in part from fish, including fish processed in any manner.
Food: Raw, cooked, or processed edible substance; ice; BEVERAGE; or ingredient used or intended for use or for sale in whole or in part for human consumption. Chewing gum is also classified as food.
Food area: Includes food and BEVERAGE display, handling, preparation, service, and storage areas; warewash areas; clean EQUIPMENT storage areas; and LINEN storage and handling areas.
Food-contact surface: Surfaces (food zone, splash zone) of EQUIPMENT and UTENSILS with which food normally comes in contact and surfaces from which food may drain, drip, or splash back into a food or surfaces normally in contact with food (Figure 6).

# Food display areas:
Any area where food is displayed for consumption by passengers and/or crew. Applies to displays served by vessel staff or self service. Food-handling areas: Any area where food is stored, processed, prepared, or served.

# Food preparation areas:
Any area where food is processed, cooked, or prepared for service.

# Food-processing plant:
A commercial operation that manufactures packages, labels, or stores food for human consumption and does not provide food directly to a CONSUMER.
Food service areas: Any area where food is presented to passengers or crew members (excluding individual cabin service).
Food storage areas: Any area where food or food products are stored.

# Food transportation corridors:
Areas primarily intended to move food during food preparation, storage, and service operations (e.g., service lift  vestibules to FOOD PREPARATION service and storage areas, provision corridors, and corridors connecting preparation areas and service areas). Passenger and crew corridors, public areas, individual cabin service, and dining rooms connected to galleys are excluded. Food loading areas used solely for delivery of food to the vessel are excluded.
Food waste system: A system used to collect, transport, and process food waste from FOOD AREAS to a waste disposal system (e.g., pulper, vacuum system).
Foodborne disease outbreak: An incident in which two or more persons experience a similar illness resulting from the ingestion of a common food. Halogen: The group of elements including chlorine, bromine, and iodine used for the DISINFECTION of water.
Hand antiseptic: Antiseptic products applied to human skin.
Harbor: The portion of a port area set aside for vessel anchorage or for ports including wharves; piers; quays; and service areas, the boundaries are the highwater shore line; and others as determined by legal definition, citation of coordinates, or other means.
Hazard: A biological, chemical, or physical property that may cause an unacceptable CONSUMER health risk.

# Hermetically sealed container:
A container designed to be secure against the entry of microorganisms and, in the case of low-acid canned FOODS, to maintain the commercial sterility of its contents after processing.

# Hose bib connection vacuum breaker (HVB):
A BACKFLOW PREVENTION DEVICE that attaches directly to a hose bib by way of a threaded head. This device uses a single check valve and vacuum breaker vent. It is not APPROVED for use under CONTINUOUS PRESSURE (e.g., when a shut-off valve is located downstream from the device). This device is a form of an AVB specifically designed for a hose connection.

# Imminent health hazard:
A significant threat or danger to health that is considered to exist when evidence is sufficient to show that a product, practice, circumstance, or event creates a situation that requires immediate correction or cessation of operation to prevent injury.
Injected meats: Manipulating MEAT so that infectious or toxigenic microoganisms may be introduced from its surface to its interior through tenderizing with deep penetration or injecting the MEAT such as with juices, which may be referred to as injecting, pinning, or stitch pumping. This does not include routine temperature monitoring.

# Integrated pest management (IPM):
A documented, organized system of controlling pests through a combination of methods including inspections, baits, traps, effective sanitation and maintenance, and judicious use of chemical compounds.
Interactive recreational water facilities: Facilities that provide a variety of recreational water features such as flowing, misting, sprinkling, jetting, and waterfalls. These facilities may be zero depth.

# Isolation:
The separation of persons who have a specific infectious illness from those who are healthy and the restriction of ill persons' movement to stop the spread of that illness. For VSP's purposes, isolation for passengers with AGE symptoms is advised and isolation for crew with AGE symptoms is required.
Kitchenware: Food preparation and storage UTENSILS.
Law: Applicable local, state, federal, or other equivalent international statutes, regulations, and ordinances.
Linens: Fabric items such as cloth hampers, cloth napkins, tablecloths, wiping cloths, and work garments including cloth gloves.
Making way: Progressing through the water by mechanical or wind power.

# Meat:
The flesh of animals used as food including the dressed flesh of cattle, swine, sheep, or goats and other edible animals, except FISH, POULTRY, and wild GAME ANIMALS.
Mechanically tenderized: Manipulating MEAT with deep penetration by processes that may be referred to as blade tenderizing; jaccarding; pinning; needling; or using blades, pins, needles, or any mechanical device. It does not include processes by which solutions are injected into MEAT.
mg/L: Milligrams per liter, the metric equivalent of parts per million (ppm).
Molluscan shellfish: Any edible species of fresh or frozen oysters, clams, mussels, and scallops or edible portions thereof, except when the scallop product consists only of the shucked adductor muscle.
Noncorroding: Material that maintains its original surface characteristics through prolonged influence by the use environment, food contact, and normal use of cleaning compounds and sanitizing solutions.
Nonfood-contact surfaces (nonfood zone): All exposed surfaces, other than FOOD-CONTACT SURFACES, of EQUIPMENT located in FOOD AREAS (Figure 6).
Outbreak: See AGE OUTBREAK. ITEMS that may be deleterious to health. - Substances that are not necessary for the operation and maintenance of the vessel and are on the vessel, such as petroleum products and paints. Pollution: The presence of any foreign substance (organic, inorganic, radiologic, or biologic) that tends to degrade water quality to create a health HAZARD.
Portable: A description of EQUIPMENT that is READILY REMOVABLE or mounted on casters, gliders, or rollers; provided with a mechanical means so that it can be tilted safely for cleaning; or readily movable by one person. PHF includes an animal food (a food of animal origin) that is raw or heat-treated; a food of plant origin that is heat-treated or consists of raw seed sprouts; cut melons; CUT LEAFY GREENS; cut tomatoes or mixtures of cut tomatoes; and garlic and oil mixtures that are not acidified or otherwise modified at a food processing plant in a way that results in mixtures that do not support growth as specified under Subparagraph (a) of this definition or any food classified by the FDA as a PHF/TCS.

# PHF does not include
a) An air-cooled hard-boiled egg with shell intact, or a shell egg that is not hard-boiled, but has been treated to destroy all viable Salmonellae. b) A food with an A W value of 0.85 or less. c) A food with a PH level of 4.6 or below when measured at 24C (75F). d) A food in an unopened HERMETICALLY SEALED CONTAINER that is commercially processed to achieve and maintain commercial sterility under conditions of nonrefrigerated storage and distribution. e) A food for which laboratory evidence demonstrates that the rapid and progressive growth of infectious or toxigenic microorganisms or the growth of S. enteritidis in eggs or C. botulinum cannot occur, such as a food that has an A W and a PH above the levels specified under Subparagraphs (b) and (c) of this definition and that may contain a preservative, other barrier to the growth of microorganisms, or a combination of barriers that inhibit the growth of microorganisms. f) A food that may contain an infectious or toxigenic microorganism or chemical or physical contaminant at a level sufficient to cause illness, but that does not support the growth of microorganisms as specified under Subparagraph (a) of this definition.
Poultry:

# Pressure vacuum breaker assembly (PVB):
A device consisting of an independently loaded internal check valve and a spring-loaded air inlet valve. This device is also equipped with two resilient seated gate valves and test cocks.
Primal cut: A basic major cut into which carcasses and sides of MEAT are separated, such as a beef round, pork loin, lamb flank, or veal breast.

# Quarantine:
The limitation of movement of apparently well persons who have been exposed to a case of communicable (infectious) disease during its period of communicability to prevent disease TRANSMISSION during the incubation period if infection should occur.

# Ratite:
A flightless bird such as an emu, ostrich, or rhea.
Readily accessible: Exposed or capable of being exposed for cleaning or inspection without the use of tools.
Readily removable: Capable of being detached from the main unit without the use of tools.
Ready-to-eat (RTE) food: Food in a form that is edible without washing, cooking, or additional preparation by the food establishment or the CONSUMER and that is reasonably expected to be consumed in that form.

# RTE food includes
- POTENTIALLY HAZARDOUS FOOD that is unpackaged and cooked to the temperature and time required for the specific food. - Raw, washed, cut fruits and vegetables.
- Whole, raw fruits and vegetables presented for consumption without the need for further washing, such as at a buffet. - Other food presented for consumption for which further washing or cooking is not required and from which rinds, peels, husks, or shells are removed. - Fruits and vegetables that are cooked for hot holding, as specified under section 7. - Therapeutic pools.
- WADING POOLS.
- WHIRLPOOLS.
Recreational water facility (RWF) seawater: Seawater taken onboard while MAKING WAY at a position at least 12 miles at sea and routed directly to the RWFs for either sea-to-sea exchange or recirculation.

# Reduced pressure principle backflow prevention assembly (RP assembly):
An assembly containing two independently acting internally loaded check valves together with a hydraulically operating, mechanically independent pressure differential relief valve located between the check valves and at the same time below the first check valve. The unit must include properly located resilient seated test cocks and tightly closing resilient seated shutoff valves at each end of the assembly.
Refuse: Solid waste not carried by water through the SEWAGE system.
Registered design professional: An individual registered or licensed to practice his or her respective design profession as defined by the statutory requirements of the professional registration LAWS of the state or jurisdiction in which the project is to be constructed (per ASME A112. 19.8-2007).
Regulatory authority: Local, state, or federal or equivalent international enforcement body or authorized representative having jurisdiction over the food processing, transportation, warehousing, or other food establishment.
Removable: Capable of being detached from the main unit with the use of simple tools such as a screwdriver, pliers, or an open-end wrench.

# Reportable AGE case (VSP definition):
A case of AGE with one of the following characteristics:
- Diarrhea (three or more episodes of loose stools in a 24-hour period or what is above normal for the individual, e.g., individuals with underlying medical conditions) OR - Vomiting and one additional symptom including one or more episodes of loose stools in a 24-hour period, or abdominal cramps, or headache, or muscle aches, or fever (temperature of 38C ); AND - Reported to the master of the vessel, the medical staff, or other designated staff by a passenger or a crew member.

# Nausea, although a common symptom of AGE, is specifically excluded from this definition to avoid misclassifying seasickness (nausea and vomiting) as ACUTE GASTROENTERITIS.
Restricted-use pesticide: A pesticide product that contains the active ingredients specified in 40 CFR 152.175 Pesticides classified for restricted use, and that is limited to use by or under the direct supervision of a certified applicator.
Sanitizer: Chemical or physical agents that reduce microorganism CONTAMINATION levels present on inanimate environmental surfaces.

# Two classes of sanitizers:
- Sanitizers of NONFOOD-CONTACT SURFACES: The performance standard used by the EPA for these sanitizers requires a reduction of the target microorganism by 99.9% or 3 logs (1000, 1/1000, or 10 3 ) after 5 minutes of contact time. - Sanitizers of FOOD-CONTACT SURFACES : The EPA performance standard for these sanitizers requires a 99.999% or 5-log reduction of the target microorganism in 30 seconds.

# Sanitization:
The application of cumulative heat or chemicals on cleaned foodcontact and NONFOOD-CONTACT SURFACES that, when evaluated for efficacy, provides a sufficient reduction of pathogens.
Scupper: A conduit or collection basin that channels liquid runoff to a DECK DRAIN.
Sealant: Material used to fill SEAMS.
Seam: An open juncture that is greater than 0.8 millimeters (1/32 inch) but less than 3 millimeters (1/8 inch).
Sewage: Liquid waste containing animal or vegetable matter in suspension or solution and may include liquids containing chemicals in solution.
Shellstock: Raw, in-shell MOLLUSCAN SHELLFISH.
Shucked shellfish: MOLLUSCAN SHELLFISH with one or both shells removed.
Single-service articles: TABLEWARE, carry-out UTENSILS, and other items such as bags, containers, placemats, stirrers, straws, toothpicks, and wrappers that are designed and constructed for one-time, one-person use.
Single-use articles: UTENSILS and bulk food containers designed and constructed to be used once and discarded.
Single-use articles includes items such as wax paper, butcher paper, plastic wrap, formed aluminum food containers, jars, plastic tubs or buckets, bread wrappers, pickle barrels, ketchup bottles, and number 10 cans that do not meet materials, durability, strength, and cleanability specifications.
Slacking: Process of moderating the temperature of a food such as allowing a food to gradually increase from a temperature of -23C (-10F) to -4C (25F) in preparation for deep-fat frying or to facilitate even heat penetration during the cooking of previously block-frozen food such as spinach.

# Smooth:
- A FOOD-CONTACT SURFACE having a surface free of pits and inclusions with a cleanability equal to or exceeding that of (100-grit) number 3 stainless steel. - A NONFOOD-CONTACT SURFACE of EQUIPMENT having a surface equal to that of commercial grade hot-rolled steel free of visible scale. - Deck, bulkhead, or deckhead that has an even or level surface with no roughness or projections to make it difficult to clean.

# Spa pool:
A POTABLE WATER or saltwater-supplied pool with temperatures and turbulence comparable to a WHIRLPOOL SPA.
General characteristics are - Water temperature of 30C-40C or 86F-104F,
- Bubbling, jetted, or sprayed water effects that physically break at or above the water surface, - Depth of more than 1 meter (3 feet), and - Tub volume of more than 6 tons of water.

# Spill-resistant vacuum breaker (SVB):
A specific modification to a PVB to minimize water spillage.

# Spray pad:
The play and water contact area that is designed to have no standing water.

# Suction fitting:
A fitting in a RECREATIONAL WATER FACILITY under direct suction through which water is drawn by a pump.
Swimming pool: A RECREATIONAL WATER FACILITY greater than 1 meter in depth. This does not include SPA POOLS that meet this depth.

# Table-mounted equipment:
EQUIPMENT that is not PORTABLE and is designed to be mounted off the floor on a table, counter, or shelf. Tableware: Eating, drinking, and serving UTENSILS for table use such as flatware including forks, knives, and spoons; hollowware including bowls, cups, serving dishes, and tumblers; and plates.
Technical water: Water that has not been chlorinated or PH controlled on board the vessel and that originates from a bunkering or condensate collection process, or SEAWATER processed through the evaporators or reverse osmosis plant and is intended for storage and use in the technical water system.

# Temperature-measuring device (TMD):
A thermometer, thermocouple, thermistor, or other device that indicates the temperature of food, air, or water and is numerically scaled in Celsius and/or Fahrenheit.

# Time/temperature control for safety food (TCS): See POTENTIALLY HAZARDOUS FOOD (PHF).

# Transmission (of infection):
Any mechanism by which an infectious agent is spread from a source or reservoir to another person. These mechanisms are defined as follows:
- Direct transmission (includes person-to-person transmission)
- : Direct and essentially immediate transfer of infectious agents to a receptive portal of entry through which human or animal infection may take place. Indirect transmission : Occurs when an infectious agent is transferred or carried by some intermediate item, organism, means, or process to a susceptible host, resulting in disease. Included are airborne, foodborne, waterborne, vehicleborne (e.g., fomites) and vectorborne modes of transmission.
Turnover: The circulation, through the recirculation system, of a quantity of water equal to the pool volume. For BABY-ONLY WATER FACILITIES, the entire volume of water must pass through all parts of the system to include filtration, secondary ultraviolet (UV) DISINFECTION, and halogenation once every 30 minutes.
Utensil: A food-contact implement or container used in storing, preparing, transporting, dispensing, selling, or serving food. Examples: KITCHENWARE or TABLEWARE that is multiuse, single-service, or single-use; gloves used in contact with food; food TEMPERATURE-MEASURING DEVICES; and probe-type price or identification tags used in contact with food.
Utility sink: Any sink located in a FOOD SERVICE AREA not intended for handwashing and/or WAREWASHING.
Variance: A written document issued by VSP that authorizes a modification or waiver of one or more requirements of these guidelines if, in the opinion of VSP, a health HAZARD or nuisance will not result from the modification or waiver.
Wading pool: RECREATIONAL WATER FACILITY with a maximum depth of less than 1 meter.

# Warewashing:
The cleaning and sanitizing of TABLEWARE, UTENSILS, and FOOD-CONTACT SURFACES of EQUIPMENT.

# Waterborne outbreak: 
An outbreak involving at least two people who experience a similar illness after ingesting or using water intended for drinking or after being exposed to or unintentionally ingesting or inhaling fresh or marine water used for recreational purposes and epidemiological evidence implicates the water as the source of illness. A single case of chemical poisoning or a laboratory-confirmed case of primary amebic meningoencephalitis is considered an outbreak. Whirlpool spa: A freshwater or SEAWATER pool designed to operate at a minimum temperature of 30C (86F) and maximum of 40C (104F) and equipped with either water or air jets.
Whole-muscle, intact beef: Whole-muscle beef that is not injected, MECHANICALLY TENDERIZED, reconstructed, or scored and marinated; and from which beef steaks may be cut.

# Acronyms

# AGE

# Onset Time (02)
The reportable cases must include crew members with a symptom onset time of up to 3 days before boarding the vessel. Maintain documentation of the 3-day assessment for each crew member with symptoms on the vessel for review during inspections. Retain this documentation for 12 months.

# Definition Purpose
These case definitions are to be used for identifying and classifying cases, both of which are done for reporting purposes. They should not be used as criteria for clinical intervention or public health action. For many conditions of public health importance, action to contain disease should be initiated as soon as a problem is identified; in many circumstances, appropriate public health action should be undertaken even though insufficient information is available to determine whether cases meet the case definition.

# Responsibility (02)
A standardized AGE surveillance log for each cruise must be maintained daily by the master of the vessel, the medical staff, or other designated staff.

# Required Information (02)
The AGE surveillance log must list - The name of the vessel, cruise dates, and cruise number.
- All reportable cases of AGE.
- All passengers and crew members who are dispensed antidiarrheal medication from the master of the vessel, medical staff, or other designated staff.

# Log Details (02)
The AGE surveillance log entry for each passenger or crew member must contain the following information in separate columns:
- Date of the first medical visit or report to staff of illness.
- Time of the first medical visit or report to staff of illness.
- Case identification number.

# Medications Sold or Dispensed (02)
Antidiarrheal medications must not be sold or dispensed to passengers or crew except by designated medical staff.

# Questionnaires

# Food/Beverage Questionnaire (02)
Questionnaires detailing activities and meal locations for the 72 hours before illness onset must be distributed to all passengers and crew members who are AGE CASES. The self-administered questionnaires must contain all of the data elements that appear in the questionnaire found in Annex 13.2.2. Completed questionnaires must be maintained with the AGE surveillance log.
To assist passengers and crew members with filling out the self-administered questionnaires, the following information for the most current cruise may be maintained at the medical center:
- Menus, food, and drink selections available at each venue on the vessel, from room service, and on private islands. - Menus, food, and drink selections available for each vessel-sponsored excursion. - Organized activities on the vessel or private islands.
- Cruise line sponsored pre-embarkation activities.
To assist memory recall for guests and crew completing the 72hour self-administered questionnaire, an electronic listing of the above information on an interactive system available via an onboard video system can be substituted for the package in the medical center.

# Retention

# Retention and Review (02)
The following records must be maintained on board for 12 months and available for review by VSP during inspections and outbreak investigations:
- Medical log/record.
- AGE surveillance log.
- 72-hour self-administered questionnaires.
- Interviews with cabin mates and immediate contacts of crew members with AGE (initial, 24-, and 48-hour). - Documentation of the 3-day assessment of crew members with AGE symptoms before joining the vessel. - Documentation of the date and time of last symptom and clearance to return to work for FOOD and nonFOOD EMPLOYEES.
- Documentation of the date and time of verbal interviews with asymptomatic cabin mates and immediate contacts of symptomatic crew.
Electronic records of these documents are acceptable as long as the data are complete and can be retrieved during inspections and outbreak investigations.

# Confidentiality

# Privacy
All personal medical information received by CDC personnel must be protected in accordance with applicable federal LAW, including 5 U.S.C. Section 552a. Privacy Act -Records maintained on individuals and the Freedom of Information Act 5 U.S.C. Section 552. Administrative Procedure -Public information; agency rules, opinions, orders, records, and proceedings.

# Notification

# Routine Report

# Routine Report Timing

# 24-hour Report (01)
The master, medical staff, or other designated staff of a vessel destined for a U.S. port from a foreign port must submit at least one standardized AGE report based on the number of reportable cases in the AGE log to VSP no less than 24 hours-but not more than 36 hours-before the vessel's expected arrival at the U.S. port.

# 4-hour Update Report (01)
If the number of cases changes after submission of the initial report, an updated report must be submitted no less than 4 hours before the vessel's arrival at the U.S. port. The 4-hour update report must be a cumulative total count of the reported crew and passengers during the entire cruise, including the additional cases.

# Report Submission (02)
Submit routine 24-hour and 4-hour update reports electronically.
In lieu of electronic notification, the reports may be submitted by telephone or fax. The vessel must maintain proof onboard that the report was successfully received by VSP.

# Report Contents

# Contents (01)
The AGE report must contain the following:
- Name of the vessel.
- Port of embarkation.
- Date of embarkation.
- Port of disembarkation.
- Date of disembarkation.
- Total numbers of reportable cases of AGE among passengers, including those who have disembarked because of illness-even if the number is 0 (zero reporting). - Total numbers of reportable cases of AGE among crew members, including those who have disembarked because of illness-even if the number is 0 (zero reporting). - Total number of passengers and crew members on the cruise.

# Cruise Length
For cruises lasting longer than 15 days before entering a U.S. port, the AGE report may include only those reportable cases and total numbers of passengers and crew members for the 15 days before the expected arrival at a U.S. port.

# Special Report

# Special Report Timing

# 2% and 3% Illness Report (01)
The master or designated corporate representative of a vessel with an international itinerary destined for a U.S. port must submit a special report at any time during a cruise, including between two U.S. ports, when the cumulative percentage of reportable cases entered in the AGE surveillance log reaches 2% among passengers or 2% among crew and the vessel is within 15 days of expected arrival at a U.S. port.
A telephone notification to VSP must accompany the special 2% report.
A second special report must be submitted when the cumulative percentage of reportable cases entered in the AGE surveillance log reaches 3% among passengers or 3% among crew and the vessel is within 15 days of expected arrival at a U.S. port.

# Daily Updates (01)
Daily updates of illness status must be submitted as requested by VSP after the initial submission of a special report. Daily updates may be submitted electronically, by telephone, fax, e-mail, or as requested by VSP.

# Routine Reporting Continues (01)
Routine reports (24-hour and 4-hour) must continue to be submitted by the master or designated corporate representative of a vessel that has submitted a special report.

# Report Retention

# Retention

# Retention (02)
The 24-hour, 4-hour, and special reports must be maintained on the vessel for 12 months.

# Review (02)
The reports must be available for review by VSP during inspections and outbreak investigations.

# Clinical Specimens

# Clinical Specimen Submission
See Annex 13.4 for a list of recommended specimen collection supplies.

# Specimen/Shipping Containers (02)
The medical staff will be responsible for maintaining a supply of at least 10 clinical specimen collection containers for both viral and bacterial agents (10 for each), as well as a shipping container that meets the latest shipping requirements of the

# Hygiene and Handwashing Facts (02)
Advise symptomatic crew of hygiene and handwashing facts and provide written handwashing and hygiene fact sheets.

# Cabin Mates/Contacts (02)

# Asymptomatic Cabin Mates or Immediate Contacts of Symptomatic Crew
FOOD and nonFOOD EMPLOYEES:
- Restrict exposure to symptomatic crew member(s).
- Undergo a verbal interview with medical or supervisory staff, who will confirm their condition, provide facts and a written fact sheet about hygiene and handwashing, and instruct them to report immediately to medical if they develop illness symptoms. - Complete a verbal interview daily with medical or supervisory staff until 48 hours after the ill crew members' symptoms began. The first verbal interview must be conducted within 8 hours from the time the ill crew member initially reported to the medical staff. If the asymptomatic immediate contact or cabin mate is at work, he or she must be contacted by medical or supervisory staff as soon as possible. The date and time of verbal interviews must be documented.

# Passengers

# Isolate Ill Passengers (11 C)
Symptomatic and meeting the case definition for AGE:
- Advise them to remain isolated in their cabins until well for a minimum of 24 hours after symptom resolution. - Follow-up by infirmary personnel is advised.

# Hygiene and Handwashing Facts (02)
Advise symptomatic passengers of hygiene and handwashing facts and provide written handwashing and hygiene fact sheets.

# Potable Water
This section includes the following subsections: 5.

# Microbiologic Sample Reports

# Water Report (06)
Where available, the vessel must have a copy of the most recent microbiologic report from each port before bunkering POTABLE WATER to verify that the water meets potable standards. The date of the analysis report must be 30 days or less from the date of POTABLE WATER bunkering and must include an analysis for Escherichia coli at a minimum.

# Onboard Test (06)
Water samples collected and analyzed by the vessel for the presence of E. coli may be substituted for the microbiologic report from each port water system. The samples must be analyzed using a method accepted in Standard Methods for the Examination of Water and Wastewater. Test kits, incubators, and associated EQUIPMENT must be operated and maintained in accordance with the manufacturers' specifications. If a vessel bunkers POTABLE WATER from the same port more than once per month, only one test per month is required.

# Review (06)
These records must be maintained on the vessel for 12 months and must be available for review during inspections.

# Water Production

# Location

# Polluted Harbors (03 C)
A reverse osmosis unit, distillation plant, or other process that supplies water to the vessel's POTABLE WATER system must only operate while the vessel is MAKING WAY. These processes must not operate in polluted areas, HARBORS, or at anchor.

# Technical Water
A reverse osmosis unit or evaporator with a completely separate plant/process, piping system, and connections from the POTABLE WATER system, may be used to produce TECHNICAL WATER while in polluted areas, HARBORS, at anchor, or while not MAKING WAY.

# Bunkering and Production Halogenation and pH Control

# Procedures

# Residual Halogen and pH

# Halogen and pH Level (03 C)
POTABLE WATER must be continuously HALOGENATED to at least 2.0 MG/L (ppm) free residual HALOGEN at the time of bunkering or production with an automatic halogenation device. Adjust the PH so it does not exceed 7.8.
The amount of HALOGEN injected during bunkering or production must be controlled by a flow meter or a free HALOGEN analyzer.

# Within 30 Minutes (08)
The free HALOGEN residual level must be adjusted to at least 2.0 MG/L (ppm) within 30 minutes of the start of the bunkering and production processes.

# Monitoring

# Bunkering Pretest (08)
A free HALOGEN residual and PH test must be conducted on the shore-side water supply before starting the POTABLE WATER bunkering process to establish the correct HALOGEN dosage.
The results of the pretest must be recorded and available for review during inspections.

# Bunkering/Production Test (08)
After

# Records (08)
Accurate records of this monitoring must be maintained aboard for 12 months and must be available for review during inspections.

# Analyzer-chart Recorders (06)
HALOGEN and PH analyzer-chart recorders used in lieu of manual tests and logs must be calibrated at the beginning of bunkering or production, and the calibration must be recorded on the chart.

# Construction (06)
HALOGEN and PH analyzer-chart recorders used on bunker water systems must be constructed and installed according to the manufacturer's guidelines.

# Data Logger
Electronic data loggers with certified data security features may be used in lieu of chart recorders.

# Halogen Injection (08)
Water samples for HALOGEN and PH testing must be obtained from a sample cock and/or a HALOGEN analyzer probe located on the bunker or production water line at least 3 meters (10 feet) after the HALOGEN injection point and before the storage tank.
A static mixer may be used to reduce the distance between the HALOGEN injection point and the sample cock or HALOGEN analyzer sample point. If used, the mixer must be installed per the manufacturer's recommendations. A copy of all manufacturers' literature for installation, operation, and maintenance must be maintained.

# Tank Sample
In the event of EQUIPMENT failure, bunker or production water HALOGEN samples may also be taken from POTABLE WATER TANKS that were previously empty. For SCUPPER lines, factory assembled transition fittings for steel to plastic pipes are allowed when manufactured per American Society for Testing and Materials (ASTM) F1973 or equivalent standard.

# Coatings (08)
Interior coatings on POTABLE WATER TANKS must be APPROVED for POTABLE WATER contact by a certification organization. Follow all manufacturers' recommendations for application, drying, and curing.
The following must be maintained on board for the tank coatings used:
- Written documentation of approval from the certification organization (independent of the coating manufacturer). - Manufacturers' recommendations for application, drying, and curing. - Written documentation that the manufacturers' recommendations have been followed for application, drying, and curing.

# Tank Construction

# Identification (08)
POTABLE WATER TANKS must be identified with a number and the words "POTABLE WATER" in letters at least 13 millimeters (0.5 inch) high.

# Sample Cocks (08)
POTABLE WATER TANKS must have labeled sample cocks that are turned down. They must be identified and numbered with the appropriate tank number.

# Vent/Overflow (08)
The POTABLE WATER TANKS, vents, and overflows must be protected from CONTAMINATION.

# Level Measurement (08)
Any device for determining the depth of water in the POTABLE WATER TANKS must be constructed and maintained so as to prevent contaminated substances or liquids from entering the tanks.

# Manual Sounding (08)
Manual sounding of POTABLE WATER TANKS must be performed only in emergencies and must be performed in a sanitary manner.

# Potable Water Piping

# Protection

# Identification (08)
POTABLE WATER lines must be striped or painted either in accordance with ISO 14726 (blue/green/blue) or blue only.
DISTILLATE and PERMEATE lines directed to the POTABLE WATER system must be striped or painted in accordance with ISO 14726 (blue/gray/blue).
Other lines must not have the above color designations.
These lines must be striped or painted at 5 meter (15 feet) intervals and on each side of partitions, decks, and bulkheads except where decor would be marred by such markings. This includes POTABLE WATER supply lines in technical lockers.
POTABLE WATER lines after reduced pressure assemblies must not be striped or painted as POTABLE WATER.

# Striping is not required in FOOD AREAS of the vessel because only POTABLE WATER is permitted in these areas.
All refrigerant brine lines in all galleys, pantries, and cold rooms must be uniquely identified to prevent CROSS-CONNECTIONS.

# Protection (07 C)
POTABLE WATER piping must not pass under or through tanks holding nonpotable liquids.

# Bunker Connection (08)
The POTABLE WATER bunker filling line must begin either horizontally or pointing downward and at a point at least 460 millimeters (18 inches) above the bunker station deck.

# Cap/Keeper Chain (08)
The POTABLE WATER filling line must have a screw cap fastened by a NONCORRODING cable or chain to an adjacent bulkhead or surface in such a manner that the cap cannot touch the deck when hanging free.
The hose connections must be unique and fit only the POTABLE WATER hoses.

# Identification (08)
Each bunker station POTABLE WATER filling line must be striped or painted blue or in accordance with the color designation in ISO 14726 (blue/green/blue) and clearly labeled "POTABLE WATER FILLING" in letters at least 13 millimeters (0.5 inch) high, stamped on a noncorrosive label plate or the equivalent, and located at or near the point of the hose connection.

# Technical Water (08)
If used on the vessel, TECHNICAL WATER must be bunkered through separate piping using fittings incompatible for POTABLE WATER bunkering.

# Different Piping (08)
TECHNICAL WATER must flow through a completely different piping system.

# Potable Water Hoses

# Construction

# Fittings (08)
POTABLE WATER hoses must have unique fittings from all other hose fittings on the vessel.

# Identification (08)
POTABLE WATER hoses must be labeled for use with the words "POTABLE WATER ONLY" in letters at least 13 millimeters (0.5 inch) high at each connecting end.

# Construction (08)
All hoses, fittings, and water filters used in the bunkering of POTABLE WATER must be constructed of safe, EASILY CLEANABLE materials APPROVED for POTABLE WATER use and must be maintained in good repair.

# Other Equipment (08)
Other EQUIPMENT and tools used in the bunkering of POTABLE WATER must be constructed of safe, EASILY CLEANABLE materials, dedicated solely for POTABLE WATER use, and maintained in good repair.

# Locker Construction (08)
POTABLE WATER hose lockers must be constructed of SMOOTH, nontoxic, corrosion resistant, EASILY CLEANABLE material and must be maintained in good repair.

# Locker Identification (08)
POTABLE WATER hose lockers must be labeled "POTABLE WATER HOSE AND FITTING STORAGE" in letters at least 13 millimeters (0.5 inch) high.

# Locker Height (08)
POTABLE WATER hose lockers must be mounted at least 460 millimeters (18 inches) above the deck and must be self draining.

# Locker Closed (08)
Locker doors must be closed when not in use.

# Locker Restriction (08)
The locker must not be used for any other purpose than storing POTABLE WATER EQUIPMENT such as hoses, fittings, sanitizing buckets, SANITIZER solution, etc.

# Handling

# Limit Use (08)
POTABLE WATER hoses must not be used for any other purpose.

# Handling (08)
All hoses, fittings, water filters, buckets, EQUIPMENT, and tools used for connection with the bunkering of POTABLE WATER must be handled and stored in a sanitary manner.

# Contamination Prevention (08)
POTABLE WATER hoses must be handled with care to prevent CONTAMINATION from dragging their ends on the ground, pier, or deck surfaces, or from dropping the hose into contaminated water, such as on the pier or in the HARBOR.

# Flush/Drain (08)
POTABLE WATER hoses must be flushed with POTABLE WATER before being used and must be drained after each use.

# Storage (08)
POTABLE WATER hoses must be rolled tight with the ends capped, on reels, or on racks, or with ends coupled together and stowed in POTABLE WATER hose lockers.

# Potable Water System Contamination

# Cleaning and Disinfection

# Disinfecting (07 C)
POTABLE WATER TANKS and all affected parts of the POTABLE WATER distribution system must be cleaned, disinfected, and flushed with POTABLE WATER:
- Before being placed in service;
- Before returning to operation after repair, replacement; or - After being subjected to any CONTAMINATION, including entry into a POTABLE WATER tank.

# Annual Inspection (08)
POTABLE WATER TANKS must be inspected, cleaned, and disinfected during dry docks and wet docks, or every 2 years, whichever is less.

# Record Retention (08)
Documentation of all inspections, maintenance, cleaning, and DISINFECTION must be maintained for 12 months and must be available for review during inspections.
Records must include method of DISINFECTION, concentration and contact time of the DISINFECTANT, and a recorded HALOGEN value of less than or equal to 5 ppm before the tank is put back into service.

# Disinfection Residual (07 C)
DISINFECTION after potential CONTAMINATION must be accomplished by increasing the free residual HALOGEN to at least 50 MG/L (ppm) throughout the affected area and maintaining this concentration for 4 hours or by way of another procedure submitted to and accepted by VSP.
In an emergency, this contact time may be shortened to 1 hour by increasing free residual HALOGEN to at least 200 MG/L (ppm) throughout the affected area.

# Documentation (08)
The free HALOGEN residual level must be documented.

# Flush (08)
The disinfected parts of the system must be flushed with POTABLE WATER or otherwise dechlorinated until the free residual HALOGEN is  5.00 MG/L (ppm). The free HALOGEN test result must be documented.

# Alternative Method (08)
An alternative POTABLE WATER tank cleaning and DISINFECTION procedure that is ONLY APPROVED for routine cleaning and DISINFECTION and is NOT APPROVED for known or suspected contaminated tanks follows: 1) Remove (strip) all water from the tank.
2) Clean all tank surfaces, including filling lines, etc., with an appropriate detergent. 3) Thoroughly rinse surfaces of the tank with POTABLE WATER and strip this water. 4) Wet all surfaces of the tank with at least a 200 MG/L (ppm) solution of chlorine (this can be done using new, clean mops, rollers, sprayers, etc.). The chlorine test to ensure at least 200 MG/L (ppm) chlorine must be documented. 5) Ensure that tank surfaces remain wet with the chlorine solution for at least 2 hours. 6) Refill the tank and verify that the chlorine level is  5.0 MG/L (ppm) before placing the tank back into service. The chlorine test result must be documented.
Potable Water System Chemical Treatment 5.4.1 Chemical Injection Equipment

# Construction and Installation

# Recommended Engineering Practices (06)
All distribution water system chemical injection EQUIPMENT must be constructed and installed in accordance with recommended engineering practices.

# Operation

# Halogen Residual (04 C)
The halogenation injection EQUIPMENT must provide continuous halogenation of the POTABLE WATER distribution system and must maintain a free residual HALOGEN of  0.2 MG/L (ppm) and  5.0 MG/L (ppm) throughout the distribution system.

# Controlled (08)
The amount of chemicals injected into the POTABLE WATER system must be analyzer controlled.

# Halogen Backup Pump (06)
At least one backup HALOGEN pump must be installed with an active, automatic switchover feature to maintain the free residual HALOGEN in the event that the primary pump fails, an increase in demand occurs, or the low chlorine alarm sounds.

# Potable Water

# Distant Point (06)
A HALOGEN analyzer-chart recorder must be installed at a distant point in the POTABLE WATER distribution system where a significant water flow exists and represents the entire distribution system. In cases where multiple distribution loops exist and no pipes connect the loops, there must be an analyzer and chart recorder for each loop.

# Data Logger
Electronic data loggers with certified data security features may be used in lieu of chart recorders.

# Operation

# Maintenance (06)
The HALOGEN analyzer-chart recorder must be properly maintained and must be operated in accordance with the manufacturer's instructions.
A manual comparison test must be conducted daily to verify calibration. Calibration must be made whenever the manual test value is > 0.2 ppm higher or lower than the analyzer reading.

# Calibration (06)
The daily manual comparison test or calibration must be recorded either on the recorder chart or in a log.

# Accuracy (05)
The free residual HALOGEN measured by the HALOGEN analyzer must be  0.2 MG/L (ppm) of the free residual HALOGEN measured by the manual test.

# Test Kit (06)
The Ensure that all reagents used with the test kit are not past their expiration dates.
Where available, ensure that appropriate secondary standards are onboard for electronic test kits to verify test kit operation.

# Halogen Analyzer Charts

# Chart Design

# Range (06)
HALOGEN analyzer-chart recorder charts must have a range of 0.0 to 5.0 MG/L (ppm) and have a recording period of-and limited to-24 hours.

# Data Logger (06)
Electronic data loggers with certified data security features used in lieu of chart recorders must produce records that conform to the principles of operation and data display required of the analog charts, including printing the records.

# Increments (06)
Electronic data logging must be in increments of  15 minutes.

# Operation

# Charts (06)
HALOGEN analyzer-chart recorder charts must be changed, initialed, and dated daily. Charts must contain notations of any unusual events in the POTABLE WATER system.

# Retention (06)
HALOGEN analyzer-chart recorder charts must be retained for at least 12 months and must be available for review during inspections.

# Chart Review (06)
Records from the HALOGEN analyzer-chart recorder must verify the free residual HALOGEN of  0.2 MG/L (ppm) and  5.0 MG/L (ppm) in the water distribution system for at least 16 hours in each 24hour period since the last inspection of the vessel.

# Manual Halogen Monitoring

# Equipment Failure

# Every 4 hours (06)
Free residual HALOGEN must be measured by a manual test kit at the HALOGEN analyzer at least every 4 hours in the event of EQUIPMENT failure.

# Recording (06)
Manual readings must be recorded on a chart or log, retained for at least 12 months, and available for review during inspections.

# Limit (06)
Repairs on malfunctioning HALOGEN analyzer-chart recorders must be completed within 10 days of EQUIPMENT failure.

# Alarm (06)
Provide an audible alarm in a continuously occupied watch station (e.g., the engine control room) to indicate low and high free HALOGEN readings at the distant point analyzer.

# Microbiologic

# Samples (06)
A minimum of four POTABLE WATER samples per month must be collected and analyzed for the presence of E. coli. Samples must be collected from the forward, aft, upper, and lower decks of the vessel.
Sample sites must be changed each month ensure that all of the POTABLE WATER distribution system is effectively monitored.
Follow-up sampling must be conducted for each positive test result.

# Protection (07 C)
The - Beauty and barber shop spray-rinse hoses.
- Spa steam generators where essential oils can be added.
- Hose-bib connections.
- Garbage grinders and FOOD WASTE SYSTEMS.
- Automatic galley hood washing systems.
- Food service EQUIPMENT such as coffee machines, ice machines, juice dispensers, combination ovens, and similar EQUIPMENT.
- Mechanical WAREWASHING machines.
- Detergent dispensers.
- Hospital and laundry EQUIPMENT.
- Air conditioning expansion tanks.
- Boiler feed water tanks.
- Fire system.
- Public toilets, urinals, and shower hoses.
- POTABLE WATER, bilge, and pumps that require priming.
- Freshwater or saltwater ballast systems.
- International fire and fire sprinkler water connections. An RP ASSEMBLY is the only allowable device for this connection. - The POTABLE WATER supply to automatic window washing systems that can be used with chemicals or chemical mix tanks. - Water softeners for nonpotable fresh water.
- Water softener and mineralizer drain lines including backwash drain lines. The only allowable protections for these lines are an AIR GAP or an RP ASSEMBLY.
- High saline discharge line from evaporators. The only allowable protections for these lines are an AIR GAP or an RP ASSEMBLY.
- Chemical tanks.
- Other connections between the POTABLE WATER system and a nonpotable water system such as the GRAY WATER system, laundry system or TECHNICAL WATER system. The only allowable forms of protection for these connections are an AIR GAP or an RP ASSEMBLY. - BLACK WATER or combined GRAY WATER/BLACK WATER systems. An AIR GAP is the only allowable protection for these connections.
- Any other connection to the POTABLE WATER system where CONTAMINATION or BACKFLOW can occur.

# Log (08)
A CROSS-CONNECTION control program must include at a minimum: a complete listing of CROSS-CONNECTIONS and the BACKFLOW prevention method or device for each, so there is a match to the PLUMBING SYSTEM component and location. AIR GAPS must be included in the listing.

# AIR GAPS on faucet taps do not need to be included on the CROSS-CONNECTION control program listing.
The program must set a schedule for inspection frequency. Repeat devices such as toilets may be grouped under a single device type.
A log documenting the inspection and maintenance in written or electronic form must be maintained and be available for review during inspections.

# Device Installation

# Air Gaps and Backflow Prevention Devices (08)
AIR GAPS should be used where feasible and where water under pressure is not required.
BACKFLOW PREVENTION DEVICES must be installed when AIR GAPS are impractical or when water under pressure is required.

# 2X Diameter (08)
AIR GAPS must be at least twice the diameter of the delivery fixture opening and a minimum of 25 millimeters (1 inch).

# Flood-level Rim (08)
An ATMOSPHERIC VACUUM BREAKER must be installed at least 150 millimeters (6 inches) above the flood-level rim of the fixtures.

# After Valve (08)
An ATMOSPHERIC VACUUM BREAKER must be installed only in the supply line on the discharge side of the last control valve.

# Continuous Pressure (08)
A continuous pressure-type BACKFLOW PREVENTION DEVICE must be installed when a valve is located downstream from the BACKFLOW PREVENTION DEVICE.

# Backflow Prevention Devices (08)
BACKFLOW PREVENTION DEVICES must be provided on all fixtures using POTABLE WATER and that have submerged inlets.

# Vacuum Toilets (08)
An ATMOSPHERIC VACUUM BREAKER must be installed on a POTABLE WATER supply that is connected to a vacuum toilet system. An ATMOSPHERIC VACUUM BREAKER must be located on the discharge side of the last control valve (flushing device).

# Diversion Valves (08)
Lines to divert POTABLE WATER to other systems by valves or interchangeable pipe fittings must have an AIR GAP after the valve.

# Location (08)
BACKFLOW PREVENTION DEVICES and AIR GAPS must be accessible for inspection, service, and maintenance.

# Air Supply Connections

# Air Supply (08)
A compressed air system that supplies pressurized air to both nonpotable and POTABLE WATER pneumatic tanks must be connected through a press-on (manual) air valve or hose.

# Separate Compressor
A fixed connection may be used when the air supply is from a separate compressor used exclusively for POTABLE WATER pneumatic tanks.

# Backflow Prevention Device Inspection and Testing

# Maintenance

# Maintained (08)
BACKFLOW PREVENTION DEVICES must be maintained in good repair.

# Inspection and Service

# Schedule (08)
BACKFLOW PREVENTION DEVICES should be periodically inspected and any failed units must be replaced.

# Test Annually (08)
BACKFLOW PREVENTION DEVICES requiring testing (e.g., reduced pressure BACKFLOW PREVENTION DEVICES and PRESSURE VACUUM breakers) must be inspected and tested with a test kit after installation and at least annually. Test results showing the pressure differences on both sides of the valves must be maintained for each device.

# Records (08)
The inspection and test results for BACKFLOW PREVENTION DEVICES must be retained for at least 12 months and must be available for review during inspections.

# OR
The RWF SEAWATER filling system must be shut off 20 kilometers (12 miles) before reaching the nearest land or land-based discharge point, and a recirculation system must be used with appropriate filtration and halogenation systems.

# Halogen and pH (09 C)
When switching from flow-through operations to recirculation operations, the RWF must be closed until the free residual HALOGEN and PH levels are within the acceptable limits of this manual. The sample must be taken from the body of the RWF, not from the pump room. An RWF slide that is combined with a pool must have a TURNOVER rate that matches the rate for the pool.
While

# Filtration Systems

# Filtered (10)
Recirculated RWF water must be filtered.

# Filter Backwash and Cleaning (10)
Filter pressure differentials must be monitored. Granular filter media must be backwashed until the water viewed through a sight glass runs clear and at the following frequency:
- WHIRLPOOL SPA and SPA POOL: every 72 hours, or sooner if the WHIRLPOOL SPA is drained. - BABY-ONLY WATER FACILITY: daily.
- All other RWFs: at a frequency recommended by the manufacturer.
For automatic backwashing systems, an individual must be present in the filter room to ensure that backwashing is repeated as necessary until the water runs clear.
Cartridge filters must be cleaned according to the manufacturer's recommendations.
A written or electronic record of the filter backwashing and cleaning must be available for review during inspections.

# Granular Filter Inspection, Core Sample Test, and Filter Change (10)
Granular filter media must be examined for channels, mounds, or holes. A core sample of the filter media must be inspected for excessive organic material accumulation using a recommended sedimentation method.
For WHIRLPOOL SPAS and SPA POOLS, inspections and sedimentation tests must be done monthly. For all other RWFs, inspections and sedimentation tests must be conducted quarterly.

# Inspection method:
Drain the water from the filter housing and inspect the granular filter for channels, mounds, or holes.

# Core sample method:
1. After inspection, take a sand sample from the filter core and place it in a clear container. A core sample can be taken by inserting a rigid hollow tube or pipe into the filter media. 2. Add clean water to the container, cover, and shake. 3. Allow the container to rest undisturbed for 30 minutes. 4. If, after 30 minutes of settling, a measurable layer of sediment is within or on top of the filter media or fine, colored particles are suspended in the water, the organic loading may be excessive, and media replacement should be considered.
Granular filter media for WHIRLPOOL SPAS and SPA POOLS must be changed based on the inspection and sedimentation test results or every 12 months, whichever is more frequent. For all other RWFs, granular filter media must be changed based on the inspection and sedimentation results or per the manufacturer's recommendations, whichever is more frequent.
Results of both the filter inspection and sedimentation test must be recorded.

# Cartridge Filter Inspection and Filter Change (10)
Cartridge or canister-type filters must be inspected weekly for WHIRLPOOL SPAS and SPA POOLS. For all other RWFs, cartridge filters must be inspected every 2 weeks, or in accordance with the manufacturer's recommendation, whichever is more frequent.
The filters must be inspected for cracks, breaks, damaged components, and excessive organic accumulation. Cartridge or canister-type filters must be changed based on the inspection results, or as recommended by the manufacturer, whichever is more frequent.
At least one replacement cartridge or canister-type filter must be available.

# Other Filter Media (10)
Inspect and change filters based on the manufacturer's recommendations.

# Filter Housing Cleaning and Disinfection (10)
The filter housing must be cleaned, rinsed, and disinfected before the new filter media is placed in it. DISINFECTION must be accomplished with an appropriate HALOGEN-based DISINFECTANT.
for review during inspections.

# Record of Fecal and Vomit Accidents (10)
A written or electronic record must be made of all accidents involving fecal material or vomit. The record must include the name of the RWF, date and time of the accident, type of accident, response steps taken, and free residual HALOGEN level and contact time reached during DISINFECTION. For a fecal accident, the record must also include whether the fecal material was formed or loose.

# pH (9 C)
The PH level in all RWFs must be maintained between 7.0 and 7.8.
Facilities not maintained within these HALOGEN and PH ranges must be immediately closed.

# Maintenance (10)
Halogenation and PH control systems must be maintained in good repair and operated in accordance with the manufacturer's recommendations. Reagents must not be not past their expiration dates.

# Test Kit Maintenance and Verification (10)
Where available, appropriate secondary standards must be onboard for electronic test kits to verify test kit operation. Manual readings must be recorded on a chart or log, retained for at least 12 months, and available for review during inspections.

# Automated Free Halogen Residual and pH
Repairs on malfunctioning HALOGEN analyzer-chart recorders must be completed within 30 days of EQUIPMENT failure.
Provide an audible alarm in a continuously occupied watch station (e.g., the engine control room) to indicate low and high free HALOGEN and PH readings in each RWF.

# Whirlpool and Spa Pool Probes (10)
For WHIRLPOOL SPAS and SPA POOLS, the analyzer probes for dosing and recording systems must be capable of measuring and recording levels up to 10 MG/L (10 ppm).

# Analyzer-chart Recorder (10)
The HALOGEN  For RWFs open longer than 24 hours, a manual comparison test must be conducted every 24 hours.

# Data Logger (10)
If an electronic data logger is used in lieu of a chart recorder, it must have certified data security features. For RWFs open longer than 24 hours, a manual comparison test must be conducted every 24 hours.

# Charts (10)
HALOGEN analyzer-chart recorder charts must be initialed, dated, and changed daily.
Strip recorder charts must be initialed and dated daily and 24-hour increments must be indicated.

# Logs (10)
Logs and charts must contain notations outlining actions taken when the free HALOGEN residual or PH levels are outside of the acceptable ranges in this manual.
Additionally, the records must include any major maintenance work on the filtration and halogenation systems and UV DISINFECTION systems.
A written or electronic log of RWF filter inspection results, granular filter sedimentation test results, backwashing frequency and length of backwashing, and date and time of water dumping must be available for review during inspections.

# Retention (10)
Logs and charts must be retained for 12 months and must be available for review during inspections.

# Whirlpool Spas and

# Replacement (10)
At least one replacement cartridge or canister-type filter must be available.

# Water Quality

# Changed (10)
The WHIRLPOOL SPA water, including compensation tank, filter housing, and associated piping, must be changed every 72 hours, provided that the system is operated continuously and that the correct water chemistry levels are maintained during that period, including daily shock halogenation.
SPA POOL water must be changed as often as necessary to maintain proper water chemistry. The water must be changed at least every 30 days.
The date and time of WHIRLPOOL SPA and SPA POOL water changes must be recorded in the log.

# Halogenation

# Residual Halogen

# Prolonged Maintenance (10)
For facilities undergoing maintenance for longer than 72 hours, the free HALOGEN residual and PH levels must be maintained or the entire system must be drained completely of all water. This includes the WHIRLPOOL SPA and SPA POOL tubs, compensation tanks, filter housings, and all associated piping and blowers.
Records must be maintained for the free HALOGEN and PH levels or the complete draining of the system.

# Shock Halogenation (10)
The free residual HALOGEN must be increased to at least 10.0 MG/L (ppm) and circulated for at least 1 hour every 24 hours.
The free residual HALOGEN must be tested at both the start and completion of shock halogenation.
The water in the entire RWF system must be superhalogenated to 10 ppm to include the WHIRLPOOL SPA/SPA POOL tub, compensation tank, filter housing, and all associated piping before starting the 1hour timing.
Batch halogenation of the tub and compensation tank may help in reaching the minimum 10 ppm residual quickly.
Facilities filled only with SEAWATER are exempt from this requirement.

# Records (10)
A written or electronic record of the date and time of water dumping and shock halogenation (concentration in ppm at the start and completion and time) must be available for review during inspections.

# Retention (10)
Records must be retained on the vessel for 12 months.

# Maintenance and Operating Standards for Combined Facilities

# Pool with Attached Whirlpool Spa (10)
For any pool with an attached WHIRLPOOL SPA where the water, recirculation system EQUIPMENT, or filters are shared with the spa, all elements of the WHIRLPOOL SPA standards must apply to the pool.

# Fecal Accidents (10)
For combined facilities subject to fecal accidents, fecal accident procedures must include all features of these combined facilities.

# Maintenance (10)
Manufacturer's operation and maintenance instructions must be available to personnel who service the units.

# Records (10)
A record must be maintained outlining the frequency of cleaning and DISINFECTION. The record must include the type, concentration, and contact time of the DISINFECTANT.
Records must be retained on the vessel for 12 months.
Individual Hydrotherapy Pools 6.6.1 Maintenance

# Cleaning (10)
Individual hydrotherapy pools must be cleaned and disinfected, including associated recirculation systems, between customers. DISINFECTION must be accomplished with an appropriate HALOGEN-based DISINFECTANT at 10 ppm for 60 minutes, or an equivalent CT VALUE.

# Maintenance (10)
Manufacturer's operation and maintenance instructions must be available to personnel that service the units.

# Records (10)
A record must be maintained outlining the frequency of cleaning and DISINFECTION. The record must include the type, concentration and contact time of the DISINFECTANT.
Records must be retained on the vessel for 12 months. The signs at a minimum must include the following words:
- Do not use these facilities if you are experiencing diarrhea, vomiting, or fever. - No children in diapers or who are not toilet trained.
- Shower before entering the facility.
- Bather load #.

# Pictograms may replace words, as appropriate or available.
For children's RWF signs, include the exact wording "TAKE CHILDREN ON FREQUENT BATHROOM BREAKS" or "TAKE CHILDREN ON FREQUENT TOILET BREAKS."

# It is advisable to post additional cautions and concerns on signs.
See section 6.2.1.5 for bather load calculations.

# Depth Markers (10)
The depth of each RWF that is deeper than 1 meter (3 feet) must be displayed prominently so that it can be seen from the deck and in the pool. Depth markers should be labeled in both feet and meters. Additionally, depth markers must be installed for every 1 meter (3 feet) change in depth.

# Spas (10)
In addition to the safety sign requirements in section 6.7.1.1.1, install a sign at each WHIRLPOOL SPA and SPA POOL entrance listing precautions and risks associated with the use of these facilities.
Include, at a minimum, cautions against use by the following:
- Individuals who are immunocompromised.
- Individuals on medication or who have underlying medical conditions such as cardiovascular disease, diabetes, or high or low blood pressure. - Pregnant women, elderly persons, and children.
Additionally, caution against exceeding 15 minutes of exposure.

# Vessels can submit existing signs for review by VSP.
It is advisable to post additional cautions and concerns on signs.

# Equipment

# Life Saving (10)
A rescue or shepherd's hook and an APPROVED flotation device must be provided at a prominent location (visible from the full perimeter of the pool) at each RWF that has a depth of 1 meter (3 feet) or greater. These devices must be mounted in a manner that allows for easy access during an emergency.
- The pole of the rescue or shepherd's hook must be long enough to reach the center of the deepest portion of the pool from the side plus 2 feet. It must be a light, strong, nontelescoping material with rounded, nonsharp ends. - The APPROVED flotation device must include an attached rope that is at least 2/3 of the maximum pool width. Testing of manufactured drain covers must be by a nationally or internationally recognized testing laboratory.
The information below must be stamped on each manufactured ANTIENTRAPMENT drain cover:
- Certification standard and year.
- Type of drain use (single or multiple).
- Maximum flow rate (in gallons or liters per minute).
- Type of fitting (suction outlet).
- Life expectancy of cover.
- Mounting orientation (wall, floor, or both).
- Manufacturer's name or trademark.
- Model designation. A letter from the shipyard must accompany each custom/shipyard constructed (field fabricated) drain cover fitting. At a minimum the letter must specify the shipyard, name of the vessel, specifications and dimensions of the drain cover, as detailed above, as well as the exact location of the RWF for which it was designed. The name of and contact information for the REGISTERED DESIGN PROFESSIONAL and signature must be on the letter. - Alarm = the audible alarm must sound in a continuously manned space AND at the RWF. This alarm is for all draining: accidental, routine, and emergency. - GDS (GRAVITY DRAINAGE system) = a drainage system that uses a collector tank from which the pump draws water. Water moves from the RWF to the collector tank due to atmospheric pressure, gravity, and the displacement of water by bathers. There is no direct suction at the RWF. - SVRS (safety vacuum release system) = a system which stops the operation of the pump, reverses the circulation flow, or otherwise provides a vacuum release at a suction outlet when a blockage is detected. System must be tested by an independent third party and found to conform with ASME/ANSI A112.19.17 or ASTM standard F2387. - APS (automatic pump shut-off system) = a device that detects a blockage and shuts off the pump system. A manual shut-off near the RWF does not qualify as an APS.

# Temperature (10)
A temperature-control mechanism to prevent the temperature from exceeding 40C (104F) must be provided on WHIRLPOOL SPAS and SPA POOLS.

# Restrictions

# Diapers (10)
Children in diapers or who are not toilet trained must be prohibited from using any RWF that is not specifically designed and APPROVED for use by children in diapers.
Specifications and requirements for BABY-ONLY WATER FACILITIES can be found in Annex 13.7.
Recreational Water Facilities Knowledge

# Demonstration of Knowledge (44)
The supervisor or PERSON IN CHARGE of recreational water facilities operations on the vessel must demonstrate to VSP-on request during inspections-knowledge of recreational water facilities operations. The supervisor or PERSON IN CHARGE must demonstrate this knowledge by compliance with this section of these guidelines or by responding correctly to the inspector's questions as they relate to the specific operation. In addition, the supervisor or PERSON IN CHARGE of recreational water facilities operations on the vessel must ensure that employees are properly trained to comply with this section of the guidelines in this manual as it relates to their assigned duties.

# Food Safety
This section includes the following subsections:

# Restrictions Removal (11 C)
The restriction must not be removed until the supervisor or PERSON IN CHARGE of the food operation obtains written approval from the vessel's physician or equivalent medical staff.

# Record of Restriction and Release (02)
A written or electronic record of both the work restriction and release from restriction must be maintained onboard the vessel for 12 months for inspection review.

# Employee Cleanliness

# Hands and Arms

# Hands and Arms Clean (12 C)
FOOD EMPLOYEES must keep their hands and exposed portions of their arms clean.

# Cleaning Procedures (12 C)
FOOD EMPLOYEES must clean their hands and exposed portions of their arms with a cleaning compound in a handwashing sink by vigorously rubbing together the surfaces of their lathered hands and arms for at least 20 seconds and thoroughly rinsing with clean water. Employees must pay particular attention to the areas underneath the fingernails and between the fingers.

# When to Wash Hands (12 C)
FOOD EMPLOYEES must clean their hands and exposed portions of their arms immediately before engaging in food preparation, including working with exposed food, clean EQUIPMENT and UTENSILS, and unwrapped SINGLE-SERVICE and SINGLE-USE ARTICLES and - After touching bare human body parts other than clean hands and clean, exposed portions of arms. - After using the toilet room.
- After coughing, sneezing, using a handkerchief or disposable tissue, using tobacco, eating, or drinking. - After handling soiled EQUIPMENT or UTENSILS.
- During food preparation (as often as necessary to remove soil and CONTAMINATION and to prevent cross-CONTAMINATION when changing tasks). - When switching between working with raw food and working with READY-TO-EAT FOOD. - Before putting on gloves for working with food or clean EQUIPMENT and between glove changes. - After engaging in other activities that contaminate the hands.

# Hand Antiseptic (14)
A

# Sound Condition (15 C)
Food must be safe and unadulterated.

# Food Sources

# Lawful Sourcing

# Comply with Law (15 C)
Food must be obtained from sources that comply with applicable local, state, federal, or country of origin's statutes, regulations, and ordinances.

# Food from Private Home (15 C)
Food prepared in a private home must not be used or offered for human consumption on a vessel.

# Fish for Undercooked Consumption
FISH-other than MOLLUSCAN SHELLFISH-that are intended for consumption in their raw form may be served if they are obtained from a supplier that freezes the FISH to destroy parasites, or if they are frozen on the vessel and records are retained. INTACT BEEF, and prepared so they remain intact.

# Hermetically Sealed Container (15 C)
Food in a HERMETICALLY SEALED CONTAINER must be obtained from a FOOD-PROCESSING PLANT that is regulated by the food regulatory agency that has jurisdiction over the plant.

# Wild Mushrooms (15 C)
Mushroom species picked in the wild must be obtained from sources where each mushroom is individually inspected and found to be safe by an APPROVED mushroom identification expert.
This requirement does not apply to - Cultivated wild mushroom species that are grown, harvested, and processed in an operation that is regulated by the food regulatory agency that has jurisdiction over the operation. - Wild mushroom species if they are in PACKAGED form and are the product of a FOOD-PROCESSING PLANT that is regulated by the food regulatory agency that has jurisdiction over the plant. A GAME ANIMAL must not be received for service if it is a species of wildlife listed in 50 CFR 17 Endangered and Threatened Wildlife and Plants.

# Receiving Condition

# Receiving Temperatures (16 C)
Receiving temperatures must be as follows:
- Refrigerated, POTENTIALLY HAZARDOUS FOOD must be at a temperature of 5C (41F) or below when received. - If a temperature other than 5C (41F) for a POTENTIALLY HAZARDOUS FOOD is specified in LAW governing its distribution, such as LAWS governing milk, MOLLUSCAN SHELLFISH, and shell eggs, the food may be received at the specified temperature. - POTENTIALLY HAZARDOUS FOOD that is cooked and received hot must be at a temperature of 57C (135F) or above. - A food that is labeled frozen and shipped frozen by a FOOD-PROCESSING PLANT must be received frozen. - Upon receipt, POTENTIALLY HAZARDOUS FOOD must be free of evidence of previous temperature abuse.

# Food Additives (15 C)
Food must not contain unapproved food ADDITIVES or ADDITIVES that exceed amounts specified in LAW, as specified in the current version of the FDA Food Code, including annexes.

# Shell Eggs (15 C)
Shell eggs must be received clean and sound and must not exceed the restricted egg tolerances specified in LAW, as specified in the current version of the FDA Food Code, including annexes.

# Egg and Milk Products (15 C)
Eggs and milk products must be received as follows:
- Liquid, frozen, and dry eggs and egg products must be obtained pasteurized. - Fluid and dry milk and milk products complying with GRADE A STANDARDS as specified in LAW must be obtained pasteurized.
- Frozen milk products, such as ice cream, must be obtained pasteurized as specified in 21 CFR 135 Frozen Desserts. - Cheese must be obtained pasteurized unless alternative procedures to pasteurization are specified in the CFR, such as 21 CFR 133 Cheeses and Related Cheese Products, for curing certain cheese varieties.

# Package Integrity (15 C)
Food packages must be in good condition and protect the integrity of the contents so that the food is not exposed to adulteration or potential contaminants. Canned goods with dents on end or side SEAMS must not be used.

# Ice (15 C)
Ice for use as a food or a cooling medium must be made from DRINKING WATER.

# Shucked Shellfish (15 C)
Raw SHUCKED SHELLFISH must be obtained in nonreturnable packages that bear a legible label as specified in the FDA National Shellfish Sanitation Program Guide for the Control of MOLLUSCAN SHELLFISH.

# Shellstock Shellfish (15 C)
SHELLSTOCK must be obtained in containers bearing legible source identification tags or labels that are affixed by the harvester and each dealer that depurates (cleanses), ships, or reships the SHELLSTOCK, as specified in the National Shellfish Sanitation Program Guide for the Control of MOLLUSCAN SHELLFISH.

# Shellstock Condition (19)
SHELLSTOCK must be reasonably free of mud, dead shellfish, and shellfish with broken shells when received by a vessel. Dead shellfish or SHELLSTOCK with badly broken shells must be discarded.
- Physically separating raw animal foods during storage, preparation, holding, and display from raw READY-TO-EAT FOOD (including other raw animal food such as FISH for sushi or MOLLUSCAN SHELLFISH, or other raw READY-TO-EAT FOOD such as vegetables, and cooked READY-TO-EAT FOOD) so that products do not physically touch and so that one product does not drip into another.
- Separating types of raw animal foods from each other such as beef, FISH, lamb, pork, and POULTRY-except when combined as ingredients-during storage, preparation, holding, and display by using separate EQUIPMENT for each type, or by arranging each type of food in EQUIPMENT so that cross-CONTAMINATION of one type with another is prevented, or by preparing each type of food at different times or in separate areas.
Frozen, commercially processed and PACKAGED raw animal food may be stored or displayed with or above frozen, commercially processed and PACKAGED, READY-TO-EAT FOOD.
- Cleaning and sanitizing EQUIPMENT and UTENSILS.
- Storing the food in packages, covered containers, or wrappings.
- Cleaning visible soil on HERMETICALLY SEALED CONTAINERS of food before opening.
- Protecting food containers that are received PACKAGED together in a case or overwrap from cuts when the case or overwrap is opened.
- Separating damaged, spoiled, or recalled food being held on the vessel.
- Separating unwashed fruits and vegetables from READY-TO-EAT FOOD.
Storage exceptions: storing the food in packages, covered containers, or wrappings does not apply to - Whole, uncut, raw fruits and vegetables and nuts in the shell that require peeling or hulling before consumption.
- PRIMAL CUTS, quarters, or sides of raw MEAT or slab bacon that are hung on clean, sanitized hooks or placed on clean, sanitized racks. - Whole, uncut, processed MEATS such as country hams, and smoked or cured sausages that are placed on clean, sanitized racks. - Food being cooled.
- SHELLSTOCK.

# Container Identity (19)
Containers holding food or food ingredients that are removed from their original packages for use on the vessel, such as cooking oils, flour, herbs, potato flakes, salt, spices, and sugar must be identified with the common name of the food.
Containers holding food that can be readily and unmistakably recognized such as dry pasta need not be identified. Ingredients located at active cooking or preparation stations need not be identified.

# Pasteurized Eggs (18 C)
Pasteurized eggs or egg products must be substituted for raw shell eggs in the preparation of foods such as Caesar salad, hollandaise or bearnaise sauce mayonnaise, eggnog, ice cream, and eggfortified BEVERAGES or dessert items that are not cooked.

# Wash Fruits/Vegetables (19)
Raw fruits and vegetables must be thoroughly rinsed in water to remove soil and other contaminants before being cut, combined with other ingredients, cooked, served, or offered for human consumption in READY-TO-EAT form.

# Vegetable Washes
Fruits and vegetables may be washed by using chemicals specified under 21 CFR 173.315 (Annex 13.10).

# Ice as Coolant

# Ice Used as a Coolant (19)
After use as a medium for cooling the exterior surfaces of food such as melons or FISH, PACKAGED foods such as canned BEVERAGES, or cooling coils and tubes of EQUIPMENT, ice must not be used as food.

# Coolant (19)
PACKAGED food must not be stored in direct contact with ice or mashed potatoes); - In a clean, protected location (if the UTENSILS, such as ice scoops, are used only with a food that is not POTENTIALLY HAZARDOUS); or - In a container of water (if the water is maintained at a temperature of at least 57C  and the container is frequently cleaned and sanitized).

# Linen/Napkins (19)
LINENS and napkins must not be used in contact with food unless they are used to line a container for the service of foods and the LINENS and napkins are replaced each time the container is refilled for a new CONSUMER.

# Wiping Cloths (25)
Wiping cloths must be restricted to the following:
- Cloths used for wiping food spills must be used for no other purpose. - Cloths used for wiping food spills must be dry and used for wiping food spills from TABLEWARE and SINGLE-SERVICE ARTICLES OR wet and cleaned, stored in a chemical SANITIZER, and used for wiping spills from food-contact and NONFOOD-CONTACT SURFACES of EQUIPMENT. - Dry or wet cloths used with raw animal foods must be kept separate from cloths used for other purposes. Wet cloths used with raw animal foods must be kept in a separate sanitizing solution. - Wet wiping cloths used with a freshly made sanitizing solution and dry wiping cloths must be free of food debris and visible soil.

# Glove Use (19)
Gloves must be used as follows:
- Single-use gloves must be used for only one task such as working with READY-TO-EAT FOOD or with raw animal food, used for no other purpose, and discarded when damaged or soiled or when interruptions occur in the operation. - Slash-resistant gloves used to protect hands during operations requiring cutting must be used in direct contact only with food that is subsequently cooked (such as frozen food or a PRIMAL CUT of MEAT).

# Slash-resistant gloves may be used with READY-TO-EAT
FOOD that will not be subsequently cooked if the slashresistant gloves have a SMOOTH, durable, and nonabsorbent outer surface OR if the slash-resistant gloves are covered with a SMOOTH, durable, nonabsorbent glove or a single-use glove. - Cloth gloves must not be used in direct contact with food unless the food is subsequently cooked (such as frozen food or a PRIMAL CUT of MEAT).

# Second Portions and Refills (19)
Procedures for second portions and refills must be as follows:
- Except for refilling a CONSUMER'S drinking cup or container without contact between the pouring UTENSIL and the lip-contact area of the drinking cup or container, FOOD EMPLOYEES must not use TABLEWARE soiled by the CONSUMER-including SINGLE-SERVICE ARTICLES-to provide second portions or refills. - Except as specified in the bullet below, self-service CONSUMERS must not be allowed to use soiled TABLEWARE-including SINGLE-SERVICE ARTICLES-to obtain additional food from the display and serving EQUIPMENT.
- Drinking cups and containers may be reused by selfservice CONSUMERS if refilling is a CONTAMINATION-free process.

# Food Storage and Preparation

# Storage Protection (19)
Food must be protected from CONTAMINATION by storing the food as follows:
- Covered or otherwise protected;
- In a clean, dry location;
- Where it is not exposed to splash, dust, or other CONTAMINATION; and - At least 15 centimeters (6 inches) above the deck.

# Prohibited Storage (19)
Food must not be stored as follows:
- In locker rooms.
- In toilet rooms.
- In dressing rooms.
- In garbage rooms;
- In mechanical rooms;
- Under sewer lines that are not continuously sleeve welded.
- Under leaking water lines, including leaking automatic fire sprinkler heads, or under lines on which water has condensed.
- Under open stairwells.
- Under other sources of CONTAMINATION from nonfood items such as ice blocks, ice carvings, and flowers. - In areas not finished in accordance with 7.7.4 and 7.7.5 for FOOD STORAGE AREAS.

# PHF Packages in Vending Machines (19)
POTENTIALLY HAZARDOUS FOOD dispensed through a vending machine must be in the package in which it was placed in the galley or FOOD-PROCESSING PLANT at which it was prepared.

# Preparation (19)
During preparation, unpackaged food must be protected from environmental sources of CONTAMINATION such as rain.

# Food Display and Service

# Display Preparation (19)
Food on display must be protected from CONTAMINATION by the use of packaging; counter, service line, or salad bar food guards; display cases; self-closing hinged lids; or other effective means.
Install side protection for sneeze guards if the distance between exposed food and where CONSUMERS are expected to stand is less than 1 meter (40 inches).

# Condiments (19)
Condiments must be protected from CONTAMINATION by being kept in one of the following:
- Dispensers designed to provide protection.
- Protected food displays provided with the proper UTENSILS.
- Original containers designed for dispensing.
- Individual packages or portions.
Condiments at a vending machine location must be in individual packages or provided in dispensers that are filled at an APPROVED location, such as the galley that provides food to the vending machine location, a FOOD-PROCESSING PLANT, or a properly equipped facility located on the site of the vending machine location.

# Self Service (19)
CONSUMER self-service operations, such as salad bars and buffets, for unpackaged READY-TO-EAT FOODS must be - Provided with suitable UTENSILS or effective dispensing methods that protect the food from CONTAMINATION. - Monitored by FOOD EMPLOYEES trained in safe operating procedures.
Where there is self service of scooped frozen dessert, service must be out of shallow pans no deeper than 4 inches (100 millimeters) and no longer than 12 inches (300 millimeters).
Utensils, Consumer Self-service A food-dispensing UTENSIL must be available for each container of food displayed at a CONSUMER self-service unit such as a buffet or salad bar.

# Utensil Protected (19)
The food contact portion of each self-service food dispensing UTENSIL must be covered or located beneath shielding during service.
Dishware, glassware, and UTENSILS out for service must be inverted or covered.

# Food Reservice (15 C)
After being served and in the possession of a CONSUMER or being placed on a buffet service line, food that is unused or returned by the CONSUMER must not be offered as food for human consumption.

# Exceptions:
- FISH that are exempt from freezing requirements based on section 7.3.4.2.1 must have a letter stating both the species of FISH and the conditions in which they were raised and fed.

# Reheating

# Immediate Service
Cooked and refrigerated food prepared for immediate service in response to an individual CONSUMER order (such as a roast beef sandwich au jus) may be served at any temperature.

# 74C/165F (16 C)
POTENTIALLY HAZARDOUS FOOD that is cooked, cooled, and reheated for hot holding must be reheated so that all parts of the food reach a temperature of at least 74C (165F) for 15 seconds.
- Completely submerged under running water at a water temperature of 21C (70F) or below, with sufficient water velocity to agitate and float off loose particles in an overflow, and for a period of time that does not allow thawed portions of READY-TO-EAT FOOD to rise above 5C (41F).
- Completely submerged under running water at a water temperature of 21C (70F) or below, with sufficient water velocity to agitate and float off loose particles in an overflow, and for a period of time that does not allow thawed portions of a raw animal food o The time the food is exposed to the running water and the time needed for preparation for cooking, OR requiring cooking to be above 5C (41F) for more than 4 hours, including o The time it takes under refrigeration to lower the food temperature to 5C (41F).
- As part of a cooking process if the frozen food is cooked or thawed in a microwave oven.
- Using any procedure if a portion of frozen READY-TO-EAT FOOD is thawed and prepared for immediate service in response to an individual CONSUMER'S order.

# Food Cooling

# Cooling Times/Temperatures (16 C)
Cooked POTENTIALLY HAZARDOUS FOOD must be cooled - From 57C (135F) to 21C (70F) within 2 hours and - From 21C (70F) to 5C (41F) or less within 4 hours.

# Cooling Prepared Food (16 C)
POTENTIALLY HAZARDOUS FOOD must be cooled within 4 hours to 5C (41F) or less if prepared from ingredients at ambient temperature (such as reconstituted foods and canned tuna).

# Cooling Received Food (16 C)
A POTENTIALLY HAZARDOUS FOOD received in compliance with LAWS allowing a temperature above 5C (41F) during shipment from the supplier must be cooled within 4 hours to 5C (41F) or less.

# Shell Eggs
Shell eggs need not comply with the cooling time if, on receipt, they are placed immediately into refrigerated EQUIPMENT capable of maintaining food at 5C (41F) or less.

# Cooling Methods (17)
Cooling must be accomplished using one or more of the following methods based on the type of food being cooled:
- Placing the food in shallow pans.
- Separating the food into smaller or thinner portions.
- Using BLAST CHILLERS, freezers, or other rapid cooling EQUIPMENT.
- Stirring the food in a container placed in an ice water bath.
- Using containers that facilitate heat transfer.
- Adding ice as an ingredient.
- Other effective methods.
When placed in cooling or cold-holding EQUIPMENT, food containers in which food is being cooled must be arranged in the EQUIPMENT to provide maximum heat transfer through the container walls and must be loosely covered-or uncovered if protected from overhead CONTAMINATION-during the cooling period to facilitate heat transfer from the surface of the food.

# Cooling Logs (17)
Logs documenting cooked POTENTIALLY HAZARDOUS FOOD cooling temperatures and times from the starting points designated in 7.3.5.2.1 through the control points at 2 and 6 hours must be maintained onboard the vessel for a period of 30 days from the date the food was placed in a cooling process. Logs documenting cooling of POTENTIALLY HAZARDOUS FOODS prepared from ingredients at ambient temperatures, with the start time to the time when 5C (41F) is reached, must also be maintained for a 30-day period, beginning with the day of preparation.

# Food Holding Temperatures and Times

# Holding Temperature/Time (16 C)
Except during preparation, cooking, or cooling, or when time is used as the public health control, POTENTIALLY HAZARDOUS FOOD must be maintained at - 57C (135F) or above, except that roasts may be held at a temperature of 54C (130F); or - 5C (41F) or less.

# RTE PHF Shelf-life: Date Marking (16 C) Refrigerated, READY-TO-EAT, POTENTIALLY HAZARDOUS FOOD
- Prepared on a vessel and held refrigerated for more than 24 hours must be clearly marked at the time of preparation to indicate the date or day by which the food must be consumed (7 calendar days or fewer from the day the food is prepared). The day of preparation is counted as day 1.
- Prepared and PACKAGED by a FOOD-PROCESSING PLANT and held on the vessel after opening for more than 24 hours must be clearly marked at the time the original container is opened to indicate the date by which the food must be consumed (7 calendar days or fewer after the original container is opened). The day of opening is counted as day 1.
The date marking requirement can be accomplished with a calendar date, day of the week, color-code, or other system, provided it is effective.
The date marking requirement does not apply to the following foods prepared and PACKAGED by a food processing plant inspected by a REGULATORY AUTHORITY:
- Deli salads (such as ham salad, seafood salad, chicken salad, egg salad, pasta salad, potato salad, and macaroni salad) manufactured in accordance with 21 CFR 110. - Hard cheeses containing not more than 39% moisture as defined in 21 CFR 133 (such as cheddar, gruyere, parmesan and reggiano, and romano). - Semisoft cheeses containing more than 39% moisture, but not more than 50% moisture, as defined in 21 CFR 133 (such as blue, edam, gorgonzola, gouda, and monterey jack). - Cultured dairy products as defined in 21 CFR 131 (such as yogurt, sour cream, and buttermilk). - Preserved FISH products (such as pickled herring and dried or salted cod) and other acidified FISH products defined in 21 CFR 114. - Shelf stable, dry fermented sausages (such as pepperoni and Genoa salami) that are not labeled "keep refrigerated" as specified in 9 CFR 317 . - Shelf stable salt-cured products (such as prosciutto and Parma ) that are not labeled "keep refrigerated" as specified in 9 CFR 317.

# Consumer Information

# Advisory

# Consumer Advisory (16 C)
If an animal food such as beef, eggs, FISH, lamb, milk, pork, POULTRY, or shellfish that is raw, undercooked, or not otherwise processed to eliminate pathogens is offered in a READY-TO-EAT form or as a raw ingredient in another READY-TO-EAT FOOD, the CONSUMER must be informed by way of disclosure as specified below using menu advisories, placards, or other easily visible written means of the significantly increased risk to certain especially vulnerable CONSUMERS eating such foods in raw or undercooked form. The advisory must be located at the outlets where these types of food are served.
Raw shell egg preparations are prohibited in uncooked products as described in 7.3.3.2.3.
Disclosure must be made by one of the two following methods:
- On a sign describing the animal-derived foods (e.g., "oysters on the half-shell," "hamburgers," "steaks," or "eggs"); AND that they can be cooked to order and may be served raw or undercooked; AND a statement indicating that consuming raw or undercooked MEATS, seafood, shellfish, eggs, milk, or POULTRY may increase your risk for foodborne illness, especially if you have certain medical conditions. The advisory must be posted at the specific station where the food is served raw, undercooked, or cooked to order.

# OR
- On a menu using an asterisk at the animal-derived foods requiring disclosure and a footnote with a statement indicating that consuming raw or undercooked MEATS, seafood, shellfish, eggs, milk, or POULTRY may increase your risk for foodborne illness, especially if you have certain medical conditions.
It is acceptable to limit the list of animal-derived foods in the CONSUMER advisory to only the type(s) of animal-derived food served raw, undercooked, or cooked to order at a specific location. For example, at a sushi counter, the CONSUMER advisory might only refer to seafood.
directly above the container receiving the food must be designed in a manner (such as with barriers, baffles, or drip aprons) so that drips from condensation and splash are diverted from the opening of the container receiving the food.
- The delivery tube, chute, and orifice must be protected from manual contact (such as by being recessed).
- The delivery tube or chute and orifice of EQUIPMENT used to vend liquid food or ice in unpackaged form to selfservice CONSUMERS must be designed so that the delivery tube or chute and orifice are protected from dust, insects, rodents, and other CONTAMINATION by a self-closing door if the EQUIPMENT is located in an outside area that does not otherwise afford the protection of an enclosure against the rain, windblown debris, insects, rodents, and other contaminants present in the environment, or if it is available for self service during hours when it is not under the full-time supervision of a FOOD EMPLOYEE.
- The dispensing EQUIPMENT actuating lever or mechanism and filling device of CONSUMER self-service BEVERAGE dispensing EQUIPMENT must be designed to prevent contact with the lip-contact surface of glasses or cups that are refilled.

# Bearings/Gears (21)
EQUIPMENT containing bearings and gears that require lubricants must be designed and constructed so that the lubricant cannot leak, drip, or be forced into food or onto FOOD-CONTACT SURFACES.

# Beverage Line Cooling (20)
BEVERAGE tubing and cold-plate BEVERAGE cooling devices must not be installed in contact with stored ice. This guideline does not apply to cold plates that are constructed integrally without SEAMS in an ice storage bin.

# Equipment Drainage (21)
EQUIPMENT compartments subject to accumulation of moisture because of conditions such as condensation, food or BEVERAGE drip, or water from melting ice must be sloped to an outlet that allows complete draining.

# Drain Lines (20)
Liquid waste drain lines must not pass through an ice machine or 7.5.4.5 Alternative Manual Warewashing Procedures

# Alternative Warewashing Procedures (23)
If washing in sink compartments or a WAREWASHING machine is impractical (such as when the EQUIPMENT is fixed or the UTENSILS are too large), washing must be done by using alternative manual WAREWASHING EQUIPMENT in accordance with the following procedures:
- EQUIPMENT must be disassembled as necessary to allow access of the detergent solution to all parts. - EQUIPMENT components and UTENSILS must be scrapped or rough-cleaned to remove food particle accumulation. - EQUIPMENT and UTENSILS must be washed.

# Sponges Limited (22)
Sponges must not be used in contact with cleaned and sanitized or in-use FOOD-CONTACT SURFACES.

# Rinsing Procedures

# Rinsing (23)
Washed EQUIPMENT and UTENSILS must be rinsed so that abrasives are removed and cleaning chemicals are removed or diluted with water by using one of the following procedures:
- Use of a distinct, separate water rinse after washing and before sanitizing if using a three-compartment sink, alternative manual WAREWASHING EQUIPMENT equivalent to a three-compartment sink, or a three-step washing, rinsing, and sanitizing procedure in a WAREWASHING system for CIP EQUIPMENT.
- Use of a nondistinct water rinse integrated in the application of the sanitizing solution and wasted immediately after each application (if using a WAREWASHING machine that does not recycle the sanitizing solution, or if using alternative manual WAREWASHING EQUIPMENT such as sprayers).
- Use of a nondistinct water rinse integrated in the application of the sanitizing solution if using a WAREWASHING machine that recycles the sanitizing solution for use in the next wash cycle.
7.5.5 Sanitizing 7.5.5.1 Food-contact Surfaces (24 C) FOOD-CONTACT SURFACES of EQUIPMENT and UTENSILS must be sanitized.

# Sanitizing Temperatures

# Manual Hot-water Sanitizing (24 C)
In a manual operation, if immersion in hot water is used for sanitizing,
- The temperature of the water must be maintained at 77C (171F) or above and - The FOOD-CONTACT SURFACE must be immersed for at least 30 seconds.

# Warewasher Hot-water Sanitizing (24 C)
In a mechanical operation, the temperature of the fresh hot water sanitizing rinse as it enters the manifold must not be more than 90C (194F) or less than - 74C (165F) for a stationary rack, single-temperature machine. - 82C (180F) for all other machines.
The UTENSIL surface temperature must not be less than 71C (160F) as measured by an irreversible registering temperature indicator.
The maximum temperature of 90C (194F) does not apply to the high pressure and temperature systems with wand-type, hand-held spraying devices used for the in-place cleaning and sanitizing of EQUIPMENT such as MEAT saws.

# Warewasher Hot-water Sanitizing Pressure (22)
The flow pressure of the fresh hot water sanitizing rinse in a WAREWASHING machine must not be less than 34.5 kilopascals (5 pounds per square inch or 0.34 bars) or more than 207 kilopascals (30 pounds per square inch or 2.07 bars) as measured in the water line immediately downstream or upstream from the fresh hot water sanitizing rinse control valve.

# Sanitizing Concentrations

# Chemical Sanitizing Solutions (24 C)
A chemical SANITIZER used in a sanitizing solution for a manual or mechanical operation must be listed in 40 CFR 180.940 Sanitizing Solutions.
designed and installed so that make-up air intake and exhaust vents do not cause CONTAMINATION of food, FOOD-CONTACT SURFACES, EQUIPMENT, or UTENSILS.

# Labeled (38)
The locker must be labeled "CLEANING MATERIALS ONLY."

# Orderly Manner (38)
Maintenance tools such as mops, brooms, and similar items must be stored in an orderly manner that facilitates cleaning of the area used for storing the maintenance tools.

# Mop Drying (38)
After use, mops must be placed in a position that allows them to air dry without soiling walls, EQUIPMENT, or supplies.

# Bucket Storage (38)
Wash, rinse, and sanitize buckets or other containers may be stored with maintenance tools provided they are stored inverted and nested.

# Integrated Pest Management (IPM)
This section has two subsections: 8. Each vessel must have an IPM plan to implement effective monitoring and control strategies for pests aboard the vessel.

# Monitoring (40)
The IPM plan must set a schedule for periodic active monitoring inspections, including some at night or during periods of no or minimal activity.

# Logs (40)
The IPM plan must include provisions for logs for active monitoring of pest sightings in operational areas of the vessel. The IPM plan also must include provisions for training of crew members in charge of log completion. The time of the active monitoring inspections must be recorded in the log.

# Passive Surveillance (40)
The IPM plan must include passive surveillance procedures such as glue traps or other passive monitoring devices and must include the location of each. A passive device monitoring log must be maintained.

# Action and Follow Up (40)
When pests are observed during an inspection, the log must include action taken as well as follow-up inspection results.

# Plan Evaluation

# Evaluation (40)
The vessel's IPM plan must be evaluated for effectiveness periodically or whenever there is a significant change in the vessel's operation or structure (e.g., renovation).
The evaluation may be required more frequently in areas where pest infestations exist but cannot be controlled.
and insect fragments must be prevented from falling on clean items.

# Cleaning (40)
Dead or trapped insects, rodents, and other pests must be removed from control devices and the vessel at a frequency that prevents their accumulation or decomposition or the attraction of other pests.

# Integrated Pest Management Knowledge

# Demonstration of Knowledge (44)
The supervisor or PERSON IN CHARGE of IPM operations on the vessel must demonstrate to VSP-on request during inspections-knowledge of IPM operations. The supervisor or PERSON IN CHARGE must demonstrate this knowledge by compliance with this section of these guidelines or by responding correctly to the inspector's questions as they relate to the specific operation. In addition, the supervisor or PERSON IN CHARGE of IPM operations on the vessel must ensure that employees are properly trained to comply with this section of the guidelines in this manual as it relates to their assigned duties.
for required action at each step.
At a minimum, triggers must address a graduated approach to outbreak management in response to increasing case counts. Additionally, triggers may be based on events, such as reports of public vomiting/diarrhea, increased room service requests, meal or excursion cancellations, missed events, or others.
Cruise ship AGE surveillance data has shown that a 0.45% daily ATTACK RATE is indicative of a pending outbreak.
- DISINFECTANT products or systems used, including the surfaces or items the DISINFECTANTS will be applied to, concentrations, and required contact times. The DISINFECTANT products or systems must be effective against human norovirus or an acceptable surrogate (e.g., caliciviruses).
- Procedures for informing passengers and crew members of the outbreak. This section should address the procedures for notification of passengers embarking the vessel following an outbreak voyage. In the case of an extended voyage separated into segments, such as a world cruise, this requirement applies to passengers embarking for the segment after an outbreak segment.
- Procedures for returning the vessel to normal operating conditions after an outbreak. Air handling unit condensate drain pans and collection systems must be able to be accessed for inspection, maintenance, and cleaning. Installation of sight windows or other effective methods for full inspection of condensate collection pans must be used when original EQUIPMENT access makes evaluation during operational inspections impractical.

# Self Draining (43)
Condensation collection pans must be self draining.

# Potable Water (43)
Only POTABLE WATER can be used for cleaning the HVAC distribution system.

# Maintenance

# Air Handling Units (43)
Air handling units must be kept clean.

# Condensers (43)
Evaporative condensers must be inspected at least annually and cleaned as necessary to remove scale and sediment. Cooling coils and condensate pans must be cleaned as necessary to remove dirt and organic material.

# Inspection and Maintenance Plan (43)
Vessels must have a plan to inspect and maintain HVAC systems in accordance with the manufacturer's recommendations and industry standards. The written inspection, cleaning, and maintenance plan for the HVAC system must be maintained on the vessel and available for review during inspections.
Documentation of the inspection, cleaning, and maintenance plan must be available for review during inspections.
An electronic maintenance tracking system is acceptable for both the plan and the documentation if the work description and action completed are available.

# Sprays (43)
Only POTABLE WATER can be used for water sprays, decorative fountains, humidifiers, and misting systems. The water must be further treated to avoid microbial buildup in the operation of water sprays, fountains, humidifiers, and misting systems.

# Fountains and Misting Systems

# Clean (43)
Decorative fountains and misting systems must be maintained free of Mycobacterium, Legionella, algae, and mold growth.
For systems installed after the adoption of the VSP 2011 Operations Manual,
- Provide an automated treatment system (halogenation, UV, or other effective DISINFECTANT) to prevent the growth of Mycobacterium and Legionella in any decorative fountain, misting system, or similar facility. - Ensure that nozzles are REMOVABLE for cleaning and DISINFECTION.
- Ensure that pipes and reservoirs can be drained when the fountain/system is not in use.
PORTABLE units must be maintained clean.

# Shock Treatment (43)
For misting systems and similar facilities,
- Ensure that these systems can also be manually disinfected (halogenation, heat, etc.). - If heat is used as a DISINFECTANT, ensure that the water temperature, as measured at the misting nozzle, can be maintained at 65C (149F) for a minimum of 10 minutes.

# Inspectors
VSP EHOs will be trained in the interpretation and application of the current VSP Operations Manual.

# Boarding
The VSP EHO will board the vessel and immediately inform the master of the vessel or a designated agent that a vessel sanitation inspection is to be conducted.

# Sequence
The VSP EHO will then conduct the inspection in a logical sequence until the EHO has completed the inspection of all areas identified in this manual.

# Imminent Health Hazard Detection
The VSP EHO will contact the master of the vessel or a designated agent and the VSP Chief immediately during an inspection about a possible recommendation that the vessel not sail, if an IMMINENT HEALTH HAZARD as specified in section 12.9.1 is found to exist on the vessel, and if these deficiencies possibly cannot be corrected before the inspection is completed.

# Incomplete Inspections
Once an inspection has begun, it will be completed in that same visit. If the inspection cannot be completed, the results of an incomplete inspection will be discussed with the vessel's staff. A complete inspection will be conducted at a later date.

# Inspection Report

# Draft Report

# Provided
The VSP EHO will provide a draft inspection report to the master of the vessel, or a designated agent, at the conclusion of the inspection.

# Information
The draft inspection report will provide administrative information, AGE log review details, and inspection score.

# Deficiency Descriptions
The draft inspection report will provide a written description of the items found deficient and where the deficiency was observed.

# Final Report

# Report Form
The VSP EHO will use the Vessel Sanitation Inspection Report (Annex 13.15) to summarize the inspection score. The inspection report will contain the elements in 12.2.2.2 through 12.2.2.5.

# Administrative
The inspection report includes administrative information that identifies the vessel and its master or designee. It also includes the inspection report score, which is calculated by subtracting credit point values for all observed deficiencies from 100.

# Deviations
The item number and the credit point value for that item number will be indicated if the vessel does not meet the current VSP Operations Manual standard for that item.

# Medical Review
The medical documentation (e.g., GI logs, medical logs, special reports, etc.) will be available for review by VSP for accuracy and timeliness of reporting.

# Report Detail
A written description of the items found deficient will be included. The deficiencies will be itemized with references to the section of the current VSP Operations Manual. The description will include the deficiency location and citation of the appropriate VSP Operations Manual section.

# Risk-based Scoring and Correction Priority

# Scoring System

# Weighted Items
The inspection report scoring system is based on inspection items with a total value of 100 points.

# Risk Based
Inspection items are weighted according to their probability of increasing the risk for an AGE OUTBREAK.

# Critical Items
CRITICAL ITEMS are those with a weight of 3 to 5 credit point values on the inspection report.

# Critical Designation
CRITICAL ITEMS are designated in this VSP Operations Manual in bold red underlined text. In addition, the text CRITICAL ITEM appears in parentheses after the section number and keywords; for example, 7.5.5.1 Food-contact Surfaces (24 C)

# Noncritical Items
. The section numbers of the CRITICAL ITEMS in this manual are also provided in red text.
Noncritical items are those with a weight of 1 to 2 credit point values on the inspection report.

# Scoring
Each weighted deficiency found on an inspection will be deducted from 100 possible credit points.

# Risk-based Correction Priority

# Critical Correction Time Frame
At the time of inspection, a vessel will correct a critical deficiency as defined in the current VSP Operations Manual and implement a corrective-action plan for monitoring the CRITICAL ITEM for continued compliance.

# Extension
Considering the nature of the potential HAZARD involved and the complexity of the corrective action needed, VSP may agree to, or specify, a longer time frame (not to exceed 10 calendar days after the inspection) for the vessel to correct critical deficiencies.
12.4 Closing Conference

# Procedures

# Closing Conference
The results of the inspection will be explained to the master or a designee before the VSP EHO leaves the vessel.

# Report Copy
The VSP EHO will leave a copy of the draft inspection report with the master or designee. The report will be reviewed in detail and opportunity provided for discussions of the findings. The draft report is provided so that the vessel personnel can begin correcting deficiencies immediately.

# Invoice
The VSP EHO will provide the master or a designee with a payment invoice for signature. The VSP EHO will provide one copy of the signed invoice to the master or designee and will forward one copy to the vessel's company office along with the final inspection report.

# Fee Schedule
The fee for inspections is based on the existing fee schedule for routine inspections of passenger cruise vessels. The schedule is published annually in the Federal Register.
12.5 Inspection Review

# Inspection Report Review Requests

# Contested Results
If the master disagrees with the findings, the master can notify the VSP EHO during the closing conference of the intent to request a review of the specific items being contested and the substantive reasons for disagreement.
If a designated corporate official disagrees with the findings, the corporate official may submit a request to review the inspection. This request must be submitted to VSP within 48 hours of the closing conference.

# Interim Report
At the request of the owner or operator, the VSP EHO will complete an interim report if an inspection is under review. The interim report will indicate the item(s) under review. VSP will modify the final inspection report, as necessary, after the review by the VSP Chief.

# Report Remarks
After receiving a request for review, the VSP EHO will mark the vessel's inspection report as under review at the request of the vessel owner or operator.

# Written Request
The vessel owner or operator must make a written request for review within 2 weeks of the inspection with specific reference and facts concerning the contested deficiencies that the VSP EHO documented during the inspection.

# Review
The VSP Chief will review the matter and respond within 2 weeks of receiving the request for a review. In the response, the VSP Chief will state whether the inspection report will be changed.

# No Score
No numerical score will be published before the VSP Chief makes a final determination on the review. Publication of inspection results will indicate the vessel's status as under review at the request of the vessel owner or operator.

# Report Copies
Copies of the contested inspection results that are released before the VSP Chief makes a final determination on the review will have each contested deficiency clearly marked as under review at the request of the vessel owner or operator.

# Final Report
The interim report will be issued as a final report if the written request for review is not received within 2 weeks of the inspection.

# Appeal
If the ship owner does not agree with the review and decision of the VSP Chief, he or she may appeal the decision to the Director, Division of Emergency and Environmental Health Services, National Center for Environmental Health.

# Other Recommendations Review

# Review
A vessel owner or operator has the right to request a review of recommendations made during a technical consultation or inspection if the owner or operator believes that VSP officials have imposed requirements inconsistent with or beyond the scope of this manual.

# Written Request
The owner or operator must send a written statement explaining the problem in detail to the VSP Chief within 30 days of the date the recommendation was made.

# Review
The VSP Chief will review the issue and respond within 2 weeks of receiving the statement, advising whether the recommendation will be revised.

# Conditions
At least one of the following conditions must apply for an item to qualify for an affidavit of correction:
- It must be a longstanding deficiency that has not been identified during previous inspections. - It must be a deficiency in which the function of the EQUIPMENT is being accomplished by an alternative method.

# Requested at Inspection
After the inspection, but before the VSP EHO leaves the vessel, the vessel's master or a representative must provide notification of the intent to submit an affidavit of correction. This notice must specify the deficiency or deficiencies to be corrected and the corrective action to be taken. The draft inspection report will include a notation of the items to be corrected.

# Final Inspection Score
After acceptance of the affidavit, the final inspection score will be recalculated to include credit for the items corrected.

# Data
The announcement will include, at a minimum, the names of the vessels in the inspection program, the dates of their most recent inspections, and the numerical score achieved by each vessel.

# Public Record
Reports, including corrective-action statements, are available on the VSP Web site. Paper copies are available to the public on request.
Recommendation That the Vessel Not Sail 12.9.1 Imminent Health Hazards

# Imminent Health Hazard
An IMMINENT HEALTH HAZARD will be determined to be, but not limited to, one of the following situations:
- Free HALOGEN residual in the POTABLE WATER distribution system is less than 0.2 MG/L (ppm) and this deficiency is not corrected before the inspection ends.
- Inadequate facilities for maintaining safe temperatures for POTENTIALLY HAZARDOUS FOOD.
- Inadequate facilities for cleaning and sanitizing EQUIPMENT.
- Continuous problems with liquid and solid waste disposal, such as inoperative or overflowing toilets or shower stalls in passenger and crew member cabins.
- Infectious disease outbreak among passengers or crew, and where it is suspected that continuing normal operations may subject newly arriving passengers to disease.
12.9.2 Procedures

# Notify VSP Chief
The VSP EHO will immediately notify the VSP Chief when any of these IMMINENT HEALTH HAZARDS or similar imminent threats to public health are found aboard a vessel.

# No Sail
CDC will recommend or direct the master of a vessel not to sail when an IMMINENT HEALTH HAZARD is identified and cannot be immediately corrected. Such a recommendation will be signed by the VSP Chief, with concurrence of the Director, National Center for Environmental Health, or the Director's designee.
Reinspection and Follow-up Inspections 12.10.1 Reinspection Procedures

# Failing Vessels Reinspections
A reinspection is a complete sanitation inspection performed on vessels that did not score at least 86 on the previous inspection.

# Reasonable Time
Vessels that fail a routine inspection will be reinspected within a reasonable time, depending on vessel schedules and receipt of the corrective-action statement from the vessel's management.

# Unannounced
Reinspections will be unannounced.

# No-sail Reinspections
If a no-sail recommendation is made, a follow-up inspection will be conducted as soon as requested.

# Scheduling Priority
In scheduling inspections, VSP will give priority to the reinspection of vessels that failed routine inspections.

# One Reinspection
Vessels that fail a routine inspection will undergo only one reinspection.

# Written Requests
Exceptions may be made when the owner or operator submits a written request for an additional reinspection to the VSP Chief stating the reasons why the additional reinspection is warranted.

# Unannounced/Inspection Fee
Additional reinspections are unannounced and the vessel will be charged the standard inspection fee.

# Follow-up Inspection Procedures

# Follow Up
A follow-up inspection is a partial inspection to review the status of deficiencies identified during the previous periodic inspection or reinspection.

# Not Periodic or Reinspection
A follow-up inspection cannot be a substitute for a periodic inspection or reinspection.

# Follow-up Reasons
Follow-up inspections may be conducted to resolve a contested inspection or to inspect IMMINENT HEALTH HAZARDS that resulted in a recommendation to prohibit the vessel from sailing.

# Next Arrival
These inspections will be conducted as soon as possible after the routine inspection or reinspection, preferably the next time the vessel arrives at a U.S. port.

# Limited
Follow-up inspections will be limited to inspection of deficiencies in question. For example, if an item under the refrigerator section of the inspection was a deficiency and was the only item contested, only refrigeration would be checked during the follow-up inspection.

# Other Items
Any other problems noted during the follow-up inspection will be brought to the attention of the vessel's master or designee so that the deficiencies can be corrected.

# No Score
No inspection score will be provided and no fee will be charged for these follow-up inspections.
12.11 Construction/Renovation Inspections 12.11.1 Procedures

# Construction
Whenever possible, the VSP staff will conduct inspections of vessels being constructed or undergoing major retrofits on request of the vessel owner or operator.

# Requesting Inspection
An official written request will be submitted to the VSP Chief requesting a voluntary construction renovation inspection. CDC's ability to honor these requests will be based on the availability of the VSP staff.

# Time Frame
Construction/renovation inspections are normally be conducted at the shipyard 4 to 6 weeks before completion. An additional inspection may also be conducted on completion of the work and before the vessel enters operational status.

# Construction Compliance
Construction/renovation inspections will document the vessel's compliance with CDC's VSP Construction Guidelines, which provide a framework for consistency in the sanitary design, construction, and construction inspections of cruise vessels.

# New Vessels
The CDC VSP 2011 Construction Guidelines will apply to all new vessels in which the keel is laid after September 15, 2011.

# Major Renovations
The construction guidelines will also apply to major renovations planned after September 15, 2011. A major renovation is a renovation where a new FOOD AREA (e.g., galley, bar, buffet) is installed, a new facility (e.g., recreational water, CHILD ACTIVITY CENTER) is installed, or an existing FOOD AREA or facility is changed by size or EQUIPMENT by 30% or more from the original. It also includes the addition of or change to an area/facility or a technical system (e.g., POTABLE WATER, wastewater, air systems) through the introduction of new technology.

# Minor Renovations
These guidelines will not apply to minor renovations.

# Fee Schedule
The fee for construction/renovation inspections is based on the existing fee schedule for routine inspections.

# Construction/Renovation Inspection Reports

# Report
A written report will be issued by VSP after a construction/renovation inspection. These reports will summarize any changes recommended to ensure conformity with CDC guidelines.

# Guides
The reports prepared by VSP personnel in the shipyards during construction will be used as guides if VSP conducts a final construction/renovation inspection on the vessel before the vessel enters operational service.

# No Score
There is no score for construction/renovation inspections.
12.12 Other Environmental Investigations 12.12.1 Procedures 12.12.1.1 Environmental Investigations VSP may conduct or coordinate other activities such as investigating disease outbreaks, checking a specific condition such as HALOGEN residual in the POTABLE WATER distribution system, or investigating complaints of unsanitary conditions on a vessel.

# Problems Noted
Public health problems noted during other environmental investigations will be brought to the attention of the vessel's master or designee when these investigations are performed.

# No Score
No inspection score will be provided and no fee will be charged for other environmental investigations.
- Additional scientific data or other information as required to support the determination that public health will not be compromised by the proposal. - Maintain and provide to VSP, on request, records to demonstrate that procedures monitoring critical-control points are effective, monitoring of the critical-control points are routinely used, necessary corrective actions are taken if there is failure at a critical-control point, and periodic verification of the effectiveness of the operation or process in protecting public health.

# Rescinding Variance
VARIANCE approval may be rescinded at any time for noncompliance with these conditions or if it is determined that public health could be compromised.

# Areas Not Identified (44)
Procedures, systems, equipment, technology, processes, or activities that are not identified in the scope of this manual must not be tested or introduced operationally onboard any vessel until the concept is submitted in writing to the VSP Chief for review. If the review determines the concept is within the scope of the VSP Operations Manual, written procedures, control measures, or a complete variance submission may be required.

# Annexes
This section includes the following subsections: 13.  The Surgeon General, with the approval of the Secretary, is authorized to make and enforce such regulations as in his judgment are necessary to prevent the introduction, transmission, or spread of communicable diseases from foreign countries into the States or possessions, or from one State or possession into any other State or possession. For purposes of carrying out and enforcing such regulations, the Surgeon General may provide for such inspection, fumigation, disinfection, sanitation, pest extermination, destruction of animals or articles found to be so infected or contaminated as to be sources of dangerous infection to human beings, and other measures, as in his judgment may be necessary.

# (b) Apprehension, detention, or conditional release of individuals
Regulations prescribed under this section shall not provide for the apprehension, detention, or conditional release of individuals except for the purpose of preventing the introduction, transmission, or spread of such communicable diseases as may be specified from time to time in Executive orders of the President upon the recommendation of the National Advisory Health Council and the Surgeon General.

# (c) Application of regulations to persons entering from foreign countries
Except as provided in subsection (d) of this section, regulations prescribed under this section, insofar as they provide for the apprehension, detention, examination, or conditional release of individuals, shall be applicable only to individuals coming into a State or possession from a foreign country or a possession.

# (d) Apprehension and examination of persons reasonably believed to be infected
On recommendation of the National Advisory Health Council, regulations prescribed under this section may provide for the apprehension and examination of any individual reasonably believed to be infected with a communicable disease in a communicable stage and (1) to be moving or about to move from a State to another State; or (2) to be a probable source of infection to individuals who, while infected with such disease in a communicable stage, will be moving from a State to another State. Such regulations may provide that if upon examination any such individual is found to be infected, he may be detained for such time and in such manner as may be reasonably necessary. For purposes of this subsection, the term "State" includes, in addition to the several States, only the District of Columbia. Except as otherwise prescribed in regulations, any vessel at any foreign port or place clearing or departing for any port or place in a State or possession shall be required to obtain from the consular officer of the United States or from the Public Health Service officer, or other medical officer of the United States designated by the Surgeon General, at the port or place of departure, a bill of health in duplicate, in the form prescribed by the Surgeon General. The President, from time to time, shall specify the ports at which a medical officer shall be stationed for this purpose. Such bill of health shall set forth the sanitary history and condition of said vessel, and shall state that it has in all respects complied with the regulations prescribed pursuant to subsection (c) of this section. Before granting such duplicate bill of health, such consular or medical officer shall be satisfied that the matters and things therein stated are true. The consular officer shall be entitled to demand and receive the fees for bills of health and such fees shall be established by regulation.

# (b) Collectors of customs to receive originals; duplicate copies as part of ship's papers
Original bills of health shall be delivered to the collectors of customs at the port of entry.
Duplicate copies of such bills of health shall be delivered at the time of inspection to quarantine officers at such port. The bills of health herein prescribed shall be considered as part of the ship's papers, and when duly certified to by the proper consular or other officer of the United States, over his official signature and seal, shall be accepted as evidence of the statements therein contained in any court of the United States.

# (c) Regulations to secure sanitary conditions of vessels
The Surgeon General shall from time to time prescribe regulations, applicable to vessels referred to in subsection (a) of this section for the purpose of preventing the introduction into the States or possessions of the United States of any communicable disease by securing the best sanitary condition of such vessels, their cargoes, passengers, and crews. Such regulations shall be observed by such vessels prior to departure, during the course of the voyage, and also during inspection, disinfection, or other quarantine procedure upon arrival at any United States quarantine station.

# (d) Vessels from ports near frontier
The provisions of subsections (a) and (b) of this section shall not apply to vessels plying between such foreign ports on or near the frontiers of the United States and ports of the United States as are designated by treaty.

# (e) Compliance with regulations
It shall be unlawful for any vessel to enter any port in any State or possession of the United States to discharge its cargo, or land its passengers, except upon a certificate of the quarantine officer that regulations prescribed under subsection (c) of this section have in all respects been complied with by such officer, the vessel, and its master. The master of every such vessel shall deliver such certificate to the collector of customs at the port of entry, together with the original bill of health and other papers of the vessel. The certificate required by this subsection shall be procurable from the quarantine officer, upon arrival of the vessel at the quarantine station and satisfactory inspection thereof, at any time within which quarantine services are performed at such station.
(July 1, 1944, ch. 373, title III, Sec. 366, 58 Stat. 705.)

# Sec. 271. Penalties for violation of quarantine laws (a) Penalties for persons violating quarantine laws
Any person who violates any regulation prescribed under sections 264 to 266 of this title, or any provision of section 269 of this title or any regulation prescribed thereunder, or who enters or departs from the limits of any quarantine station, ground, or anchorage in disregard of quarantine rules and regulations or without permission of the quarantine officer in charge, shall be punished by a fine of not more than $1,000 or by imprisonment for not more than one year, or both.

# (b) Penalties for vessels violating quarantine laws
Any vessel which violates section 269 of this title, or any regulations thereunder or under section 267 of this title, or which enters within or departs from the limits of any quarantine station, ground, or anchorage in disregard of the quarantine rules and regulations or without permission of the officer in charge, shall forfeit to the United States not more than $5,000, the amount to be determined by the court, which shall be a lien on such vessel, to be recovered by proceedings in the proper district court of the United States. In all such proceedings the United States attorney shall appear on behalf of the United States; and all such proceedings shall be conducted in accordance with the rules and laws governing cases of seizure of vessels for violation of the revenue laws of the United States.

# (c) Remittance or mitigation of forfeitures
With the approval of the Secretary, the Surgeon General may, upon application therefore, remit or mitigate any forfeiture provided for under subsection (b) of this section, and he shall have authority to ascertain the facts upon all such applications. (a) The master of a ship destined for a U.S. port shall report immediately to the quarantine station at or nearest the port at which the ship will arrive, the occurrence, on board, of any death or any ill person among passengers or crew (including those who have disembarked or have been removed) during the 15-day period preceding the date of expected arrival or during the period since departure from a U.S. port (whichever period of time is shorter).
(b) The commander of an aircraft destined for a U.S. airport shall report immediately to the quarantine station at or nearest the airport at which the aircraft will arrive, the occurrence, on board, of any death or ill person among passengers or crew.
(c) In addition to paragraph (a) of this section, the master of a ship carrying 13 or more passengers must report by radio 24 hours before arrival the number of cases (including zero) of diarrhea in passengers and crew recorded in the ship's medical log during the current cruise. All cases of diarrhea that occur after the 24 hour report must also be reported not less than 4 hours before arrival. (a) Whenever the Director has reason to believe that any arriving person is infected with or has been exposed to any of the communicable diseases listed in paragraph (b) of this section, he/she may detain, isolate, or place the person under surveillance and may order disinfection or disinfestation as he/she considers necessary to prevent the introduction, transmission, or spread of the listed communicable diseases.
(b) The communicable diseases authorizing the application of sanitary, detention, and/or isolation measures under paragraph (a) of this section are: cholera or suspected cholera, diphtheria, infectious tuberculosis, plague, suspected smallpox, yellow fever, or suspected viral hemorrhagic fevers (Lassa, Marburg, Ebola, Congo-Crimean, and others not yet isolated or named).
(c) Whenever the Director has reason to believe that any arriving carrier or article or thing on board the carrier is or may be infected or contaminated with a communicable disease, he/she may require detention, disinsection, disinfection, disinfestation, fumigation, or other related measures respecting the carrier or article or thing as he/ she considers necessary to prevent the introduction, transmission, or spread of communicable diseases.
Sec. 71.33 Persons: Isolation and surveillance.
(a) Persons held in isolation under this subpart may be held in facilities suitable for isolation and treatment.
(b) The Director may require isolation where surveillance is authorized in this subpart whenever the Director considers the risk of transmission of infection to be exceptionally serious.
(c) Every person who is placed under surveillance by authority of this subpart shall, during the period of surveillance:
(1) Give information relative to his/her health and his/her intended destination and report, in person or by telephone, to the local health officer having jurisdiction over the areas to be visited, and report for medical examinations as may be required;
(2) Upon arrival at any address other than that stated as the intended destination when placed under surveillance, or prior to departure from the United States, inform, in person or by telephone, the health officer serving the health jurisdiction from which he/she is departing.
( (b) All food and potable water taken on board a ship or aircraft at any seaport or airport intended for human consumption thereon shall be obtained from sources approved in accordance with regulations cited in paragraph (a) of this section.
(c) Aircraft inbound or outbound on an international voyage shall not discharge over the United States any excrement, or waste water or other polluting materials. Arriving aircraft shall discharge such matter only at servicing areas approved under regulations cited in paragraph (a) of this section.

# Sec. 71.48 Carriers in intercoastal and interstate traffic.
Carriers, on an international voyage, which are in traffic between U.S. ports, shall be subject to inspection as described in Secs. 71.31 and 71.41 when there occurs on board, among passengers or crew, any death, or any ill person, or when illness is suspected to be caused by insanitary conditions. required): .

# Telephone Call Required
A telephone notification to VSP at the telephone numbers listed above must accompany a special 2% report required when the vessel is within 15 days of expected arrival at a U.S. port, even when the special 2% report is submitted via fax, electronic mail or Web site.
Acute Gastroenteritis Outbreak Investigation 13.4.1 Introduction

# Introduction
Outbreaks of AGE aboard cruise ships are relatively infrequent occurrences. Since implementation of the cooperative program between the cruise industry and VSP, the outbreak rate on vessels has steadily declined each year.

# Vigilance
Ongoing vigilance and rapid outbreak detection and response are still warranted. Because so many people share the same environment, meals, and water, disease can often spread quickly to passengers and crew members on the vessel and overwhelm the vessel's medical system. The infection can also continue unabated between cruises if proper interventions are not instituted.

# Consultation
An outbreak of AGE occurs aboard a vessel when the number of cases is in excess of expected levels for a given time period. When the cumulative proportion of reportable cases of AGE reaches 2% among passengers or 2% among crew and the vessel is within 15 days of arrival at a U.S. port, the vessel must submit a special report to VSP. This provides an early opportunity for consultation to potentially avert more illness among passengers and crew members.

# Monitoring
In most instances, a 2% proportion of illness will not lead to an investigation aboard the vessel but will provide the opportunity to discuss and monitor illness patterns and collaboratively develop intervention strategies. Members of the VSP staff are always available to discuss disease transmission and intervention questions.

# Investigation
Outbreaks of AGE aboard cruise ships are relatively infrequent occurrences. Since implementation of the cooperative program between the cruise industry and VSP, the outbreak rate on vessels each year has steadily declined.

# Special Circumstances
Under special circumstances, when an unusual AGE pattern or disease characteristic is found, an investigation may be conducted when the proportion of cases is less than 3%. These special circumstances may include a high incidence of illness in successive cruises, unusual severity of illnesses or complications, or a large number of persons reporting the illness over a brief period of time.

# Rapid Response
Conducting an outbreak investigation aboard a vessel demands a rapid, organized, and comprehensive response. Because of the TURNOVER of passengers, and sometimes crew members, the investigation must be rapid to be able to collect data needed to identify the cause.

# Collaboration
The investigation is a collaborative effort of the cruise line, passengers and crew members aboard the vessel, and VSP. Therefore, an organized plan drafted between the organizations and individuals involved is crucial in conducting a successful investigation-a comprehensive effort that includes epidemiologic, environmental, and laboratory studies.
Recommendations based on the success of the investigation can then be implemented to prevent a recurrence on the following cruise.

# Objectives
The objectives of an investigation are to - Determine the extent of the AGE among passengers and crew.
- Identify the agent causing the illness.
- Identify risk factors associated with the illness.
- Formulate control measures to prevent the spread of the illness.

# Outbreak Investigation Procedures

# Contingency Plan
The early stages of an investigation are usually coordinated aboard the vessel by the vessel's medical staff in cooperation with engineering and hotel staff. It is important to have a coordinated contingency plan in place on board the vessel before implementation is needed. All staff with a potential for involvement in an investigation should be familiar with the contingency plan.

# Periodic Review
This preliminary preparation will assist the vessel with the necessary rapid implementation of investigation and response measures before the arrival of the VSP team. The outbreak contingency plan should be periodically reviewed to ensure it will still meet the vessel's needs in dealing with an outbreak.

# Specimens and Samples
Timely collection of medical specimens and food and water samples is important in the disease investigative process. The proper materials and techniques for collection and preservation are a part of the planning. It is important to periodically review these to make sure they are on hand and ready to use in the event they are needed.

# Ready to Use
A list of recommended medical specimen and food sample collection supplies for investigating AGE OUTBREAKS can be found in sections 13.4.5 and 13.4.6 of this annex. Vessels with no medical staff aboard may choose to stock only the starred items in 13.4.5.1 unless there is a qualified staff member aboard who is capable of performing venipuncture for collection of serum specimens.

# Useful Information
To assist in the rapid evaluation of the extent of illness among passengers and crew and identify the causative pathogen and associated risk factors, VSP may request the following items:
- The AGE surveillance log for the duration of the current cruise.
- Self-administered 72-hour food and activity questionnaires completed by cases. - Daily newsletters distributed to passengers. - A complete list of food items and menus served to both crew and passengers for the 72-hour period before the peak onset of illness of most cases. - A complete list of ship and shore activities of passengers for the cruise.

# Survey
VSP may also request distribution of a survey to all passengers and crew members. VSP will provide this survey to the vessel. Completed surveys should be held in the infirmary until collection by the VSP staff for epidemiologic analysis.

# Interviews
Interviews with cases may also be useful for identifying the etiology and associated risk factors of an outbreak. When distributing the surveys, the medical staff should advise the cases that interviews may be requested when VSP arrives at the vessel.

# Report

# Preliminary Report
After an outbreak investigation, a preliminary report of findings based on available clinical and epidemiologic information, environmental inspection reports of the investigation, and interim recommendations will be presented to the master of the vessel. Based on preliminary findings, additional materials (including additional passenger and crew information) may be requested from the cruise line or the vessel and follow-up studies It is recommended that specimens be requested from patients during clinical evaluation in the infirmary or after infirmary visits by direct contact with or a letter from medical staff. Individuals asked to provide specimens should each be provided with disposable gloves, two specimen cups, a disposable spoon, and plastic wrap. The following is suggested language for a letter to passengers for request of stool specimens as well as instructions to passengers and crew for collection of stool: 2) Wash and dry your hands.
Request
3) Lift the toilet seat. Place sheets of plastic wrap over the toilet bowl, leaving a slight dip in the center. Place the toilet seat down. Pass some stool onto the plastic wrap. Do not let urine or water touch the stool specimen, if possible. 4) Using the spoon given to you, place bloody, slimy, or whitish areas of the stool into the container first. Fill the cup at least 2/3 full, if possible. 5) Tighten the cap. 6) Wash your hands. 7) Label the specimen jar with your name, the date, and your cabin number.

# Medical Staff Instructions Specimen Labeling
Please ensure that each specimen is properly labeled with the following:
- Date of collection.
- Passenger or crew member name and date of birth (or a unique identifying number with a separate log linked to name and date of birth). - Notation on use of antidiarrheal or antibiotic medication.

# Collection, Storage, and Transport
Complete guidelines for collection and storage of specimens for viral, bacterial, and parasite analysis are listed below, although it may not be necessary to implement all procedures during each investigation. Transport of specimens will be arranged in collaboration with VSP. 3) Use storage tubes containing no anticoagulant (tubes with red tops) for collection.

# Guidelines for
4) If a centrifuge is available, centrifuge the specimen for 10 minutes and remove the serum using a pipette. If no centrifuge is available, the blood specimens can sit in a refrigerator until a clot has formed; remove the serum using pipettes, as above.
5) Place the serum into an empty nunc tube, label, then refrigerate. Do not freeze.

# Other Specimens for Viral Diagnosis Water, Food, and Environmental Samples
Viruses causing gastroenteritis cannot routinely be detected in water, food, or environmental samples. Viruses have been successfully detected in vomitus specimens. These should be collected and sent using same methodology as for stool specimens.

# Guidelines for Collecting Fecal Specimens for Bacteriologic Diagnosis
Before use, the transport media should be stored in a refrigerator or at room temperature. If the transport media is stored at room temperature, it should normally be chilled for 1 to 2 hours by refrigeration before use.
At least two rectal swabs or swabs of fresh stools should normally be collected for bacterial analysis and placed in refrigerated Cary-Blair transport media.
It is recommended that the swabs be inserted initially into the transport media to moisten, then inserted about 1 to 1-1/2 inches into the rectum, gently rotated, and removed for insertion individually into the same tube of transport media.
If possible, there should be visible fecal material on the swabs.
Both swabs should be inserted into the same tube of media and the swabs pushed completely to the bottom of the tube.
The top portion of the stick touching the fingers should be broken off and discarded.
Refrigeration during transport may be accomplished by shipping in an insulated box with frozen refrigerant packs. The specimens must never be frozen during storage or transport.

# Water Chlorination
Tables 1 and 2   The amount of chlorine required for 50 ppm is determined as follows:

# Amounts of chlorine compound shown in
- Use the 70% chlorine compound columns in Table 1.
- Find the 70% row that corresponds to 100 metric tons of water.
- Follow this 70%/100 ton row across until you reach the "50 ppm" column (7,150 grams). - Do the same using the 50, 10, 5, and 1 metric ton columns to determine the totals for 166 metric tons. In this example, the amount of 70% chlorine compound required for 166 tons of water at 50 parts per million is 11,869.0 grams or 11.87 kilograms.

# Equipment Disinfection
Figure 1 lists the various chlorine compounds and the amount of the compound required in grams per liter of water to produce a solution containing 100 ppm of chlorine. The 100-ppm chlorine solution should be applied as outlined in this manual. 200.00 400.00 1,000.00 2,000.00 10,000.00 20,000.00 25% 400.00 800.00 2,000.00 4,000.00 20,000.00 40,000.00 to the listing. An example of required information can be found later in this outline. Connections that unprotected or inadequately protected must be addressed as quickly as possible, especially if the connection is a health HAZARD.

# Backflow Protection Methods
All graphics in this section are provided courtesy of the U.S. Environmental Protection Agency (EPA).

# Recirculation
Fill water must be provided only to the compensation tank and not directly to the BABY-ONLY WATER FACILITY.

# TURNOVER Rate
The entire volume of water must pass through all parts of the system to include filtration, secondary UV DISINFECTION, and halogenation at least once per half hour.
The filtration, UV DISINFECTION, and HALOGEN and PH control systems must be operated 24 hours a day. This is required even when the facilities are not in use. The systems may only be shut down for required maintenance or cleaning of system components.

# Filtration
BABY-ONLY WATER FACILITY water must be filtered.
At least one replacement cartridge or canister-type filter must be available.
Cartridge or canister-type filters must be inspected weekly for cracks, breaks, damaged components, and accumulation of excessive organic material.
Granular filters must be backwashed daily. Backwashing must be repeated until the water viewed through the sight glass or discharge point is clean flowing.
The granular filters must be opened monthly and examined for channeling, mounds, or holes in the filter media. Inspection method: Drain the water from the filter housing and inspect the granular filter for cracks, mounds, or holes.
A core sample must be examined monthly for accumulation of excessive organic material. Core sample method: 1) After inspection, take a sand sample from the filter core and place it in a clear container. A core sample can be taken by inserting a rigid hollow tube or pipe in to the filter media. 2) Add clean water to the clear container, cover, and shake.
3) Allow the container to rest undisturbed for 30 minutes. 4) Evaluate sample: if, after 30 minutes of settling, a measurable layer of sediment is within or on top of the filter media or fine, colored particles are suspended in the water, the organic loading may be excessive and media replacement should be considered. 5) Record results of filter inspection and sedimentation test in a log.
Cartridge filters must be replaced based on inspection results or manufacturer's recommendations, whichever is sooner.
The granular filter media must be replaced at least every 6 months. Filter pressure gauges and valves must be replaced when they are defective.
The operating manuals for all components such as filters, pumps, HALOGEN and PH control EQUIPMENT, and UV DISINFECTION systems must be maintained aboard the vessel in a location that is accessible to crew members who are responsible for the operation and maintenance of these facilities.

# Halogen and Ph Control
Automated HALOGEN dosing and PH control systems must be installed and maintained.
Halogenation must be by use of chlorine or bromine. A free residual of HALOGEN must be maintained between 3.0-10.0 ppm for chlorine and 4.0-10.0 ppm for bromine.
The PH levels must be maintained between 7.2 and 7.6.

# UV Disinfection
A UV DISINFECTION system must be installed after filtration and before HALOGEN-based DISINFECTION.
The UV DISINFECTION system must be maintained at an intensity that inactivates Cryptosporidium parvum and Giardia.
The UV DISINFECTION system must be maintained and operated in accordance with the manufacturer's recommendation.
At least one spare UV lamp must be available.

# System Shutdown
An automatic shutdown must be maintained whereby any failure in maintaining the required free residual HALOGEN level, PH level, or UV lamp intensity must cause the water to completely divert from the BABY-ONLY WATER FACILITY and instead loop back to the compensation tank. Additionally, this system must be equipped with an audible alarm that sounds in a continuously manned space, such as the bridge or engine control room.

# Shutdown and Alarm Testing
The emergency shutdown and alarms systems must be tested monthly.
Testing procedures and results must be recorded.

# System Cleaning and Disinfection

# Daily Cleaning of Spray Pad Surface
Every 24 hours, the SPRAY PAD surface and any associated features must be cleaned with an appropriate cleaner. The surface must be rinsed and disinfected at 50 ppm free residual HALOGEN for 1 minute, or the equivalent CT VALUE. Ensure that the liquid waste from this process is not directed to the compensation tank.
At least every 72 hours, the facility must be shut down and these procedures must be followed:
- The entire volume of water within the system must be discharged. This includes the BABY-ONLY WATER FACILITY, compensation tank, filter housing, and all associated piping. - The BABY-ONLY WATER FACILITY, compensation tank, and filter housing (cartridge filter) must be cleaned with an appropriate cleanser, rinsed, and disinfected (chlorine or bromine). DISINFECTION must be accomplished with a solution of at least 50 MG/L (ppm) free residual HALOGEN for 1 minute, or the equivalent CT VALUE.

# Monitoring and Record Keeping
An automated analyzer-chart recorder capable of recording free residual HALOGEN levels in MG/L (ppm) and PH levels must be installed.
The system must be checked for calibration before opening the facility for use, and then every 3 hours thereafter with a test kit accurate to within 0.2 MG/L (ppm) free residual HALOGEN and 0.2 PH.
- Charts must be reviewed and signed daily by trained supervisory staff.
- Charts must be dated and changed daily.
- Records must be retained for 12 months.
In the event of a failure in the automated analyzer-chart recorder, manual tests must be conducted and recorded for each required parameter on an hourly basis.
A maximum of 72 hours will be allowed for manual tests while repairs are under way. If more than 72 hours pass, the facilities must be shut down from operation until repairs are completed.
A log must be kept to detail all maintenance activities, including the following:
- Filter changes including filter housing cleaning and DISINFECTION (including ppm and contact time). - Backwashing time.
- Fecal accidents.
- Injury accidents.
- Facility opening and closing times.
One test must be conducted at the end of each day for the presence of Escherichia coli (E. coli) using a test in accordance with the latest edition of Standard Methods for the Examination of Water and Wastewater. Test kits, incubators, and associated EQUIPMENT must be operated and maintained in accordance with the manufacturers' specifications.
For positive E. coli tests, follow this procedure:
- The entire volume of water within the system must be discharged. This includes the BABY-ONLY WATER FACILITY, compensation tank, filter housing, and all associated piping. - The BABY-ONLY WATER FACILITY, compensation tank, and filter housing (cartridge filter) must be cleaned with an appropriate cleanser, rinsed, and disinfected (chlorine or bromine). DISINFECTION must be accomplished with a solution of at least 50 MG/L (ppm) for 1 minute, or the equivalent CT VALUE. - Follow-up testing must be performed. The facility must not be put back in operation unless follow-up test results are negative for the presence of E. coli.
A record of the test results must be maintained onboard the vessel and must be available for review during inspections. Retain records for 12 months.
The maintenance logs, records, and charts must be kept for 12 months.

# Training
At least one person who is trained in the maintenance and operation of RWFs must be on the vessel and available at all times the facility is open for use. Such training includes the requirements of this manual, prevention of recreational water illnesses and injuries, HALOGEN  It is important to remember that the DISINFECTION capabilities of chlorine diminish as PH increases. Operators should ensure that PH levels are maintained between 7.2 and 7.5 during this DISINFECTION process.
Record all fecal/vomit accidents in a log with all of the following information:
- Name of RWF.
- Date of event.
- Time of event.
- Number of bathers.
- Formed stool, loose stool, or vomitus.
- Chlorine residual for DISINFECTION.
- Contact time for DISINFECTION.
- PH level for DISINFECTION.
- Chlorine residual for reopening.
- PH for reopening.

# Blood Response Q and A
Excerpt from .

# Blood in Pool Water
Germs (e.g., Hepatitis B virus or HIV) found in blood are spread when infected blood or certain body fluids get into the body and bloodstream (e.g., by sharing needles and by sexual contact). CDC is not aware of any of these germs being transmitted to swimmers from a blood spill in a pool.
Q: Does chlorine kill the germs in blood? A: Yes. These germs do not survive long when diluted into properly chlorinated pool water.
Q: Swimmers want something to be done after a blood spill. Should the pool be closed for a short period of time? A: There is no public health reason to recommend closing the pool after a blood spill. However, some pool staff choose to do so temporarily to satisfy patrons.
Food Cooking Temperature Alternatives

# Introduction
To be effective in eliminating pathogens, cooking must be adjusted to a number of factors. These include the anticipated level of pathogenic bacteria in the raw product, the initial temperature of the food, and the food's bulk, which affects the time to achieve the needed internal product temperature. Other factors to be considered include postcooking heat rise and the time the food must be held at a specified internal temperature.
To kill microorganisms, food must be held at a sufficient temperature for the specified time. Cooking is a scheduled process in which each of a series of continuous TIME/TEMPERATURE combinations can be equally effective. For example, in cooking a beef roast, the microbial lethality achieved at 112 minutes after it has reached 54C (130F) is the same lethality attained as if it were cooked for 4 minutes after it has reached 63C (145F).
Cooking requirements are based in part on the biology of pathogens. The thermal destruction of a microorganism is determined by its ability to survive heat. Different species of microorganisms have different susceptibilities to heat. Also, the growing stage of a species (such as the vegetative cell of bacteria, the trophozoite of protozoa, or the larval form of worms) is less resistant than the same organism's survival form (the bacterial spore, protozoan cyst, or worm egg).
Food characteristics also affect the lethality of cooking temperatures. Heat penetrates into different foods at different rates. High fat content in food reduces the effective lethality of heat. High humidity within the cooking vessel and the moisture content of food aids thermal destruction.
Heating a large roast too quickly with a high oven temperature may char or dry the outside, creating a layer of insulation that shields the inside from efficient heat penetration. To kill all pathogens in food, cooking must bring all parts of the food up to the required temperatures for the correct length of time.
The TEMPERATURE AND TIME COMBINATION CRITERIA specified in Annex 13.9.2 is based on the destruction of Salmonellae. This section includes temperature and time parameters that provide "D" values (decimal log reduction values) that may surpass 7D. For example, at 63C (145F), a time span of 15 seconds will provide a 3D reduction of Salmonella enteritidis in eggs. This organism, if present in raw shell eggs, is generally found in relatively low numbers.
Other foods, FISH, and MEATS that have not been ground or mincedincluding commercially raised GAME ANIMAL MEAT specified as acceptable for cooking at this temperature and time parameter-are expected to have a low level of internal CONTAMINATION. The parameters are expected to provide destruction of the surface contaminants on these foods.  Chemicals may be safely used to wash or to assist in the peeling of fruits and vegetables in accordance with the following conditions:
(a) The chemicals consist of one or more of the following:
(1) Substances generally recognized as safe in food or covered by prior sanctions for use in washing fruits and vegetables.
(2) Substances identified in this subparagraph and subject to such limitations as are provided:

# Adduct Mixture
Substance: A mixture of alkylene oxide adducts of alkyl alcohols and phosphate esters of alkylene oxide adducts of alkyl alcohols consisting of: -alkyl (C 12 -C 18 )-omega-hydroxy-poly (oxyethylene) (7.5-8.5 moles)/poly (oxypropylene) block copolymer having an average molecular weight of 810; -alkyl (C 12 -C 18 )omega-hydroxy-poly (oxyethylene) (3.3-3.7 moles) polymer having an average molecular weight of 380, and subsequently esterified with 1.25 moles phosphoric anhydride; and -alkyl (C 10 -C 12 )-omega-hydroxypoly (oxyethylene) (11.9-12.9 moles)/poly (oxypropylene) copolymer, having an average molecular copolymer, having an average molecular weight of 810, and subsequently esterified with 1.25 moles phosphoric anhydride.
Limitations: May be used at a level not to exceed 0.2 percent in lye-peeling solution to assist in the lye peeling of fruit and vegetables. at plate level in the final sanitizing rinse spray for at least 8 seconds. The maximum-registering TEMPERATURE-MEASURING DEVICE may also be checked at the end of each part of the cycle to verify that the wash and rinse temperatures have not been in excess of 71C (160F).

# Effective Sanitation
Evaluate effective SANITIZATION by noting that in a mechanical operation, the temperature of the fresh hot water sanitizing rinse as it enters the manifold must not be more than 90C (194F) or less than - 74C (165F) for a stationary rack, single-temperature machine. - 82C (180F) for all other machines. - 71C (160F) at the UTENSIL surface, as measured by an irreversible registering temperature indicator.

# Indirect Methods
The final rinse spray temperature may be indirectly evaluated by using a nonreversible thermolabel attached to the manifold or final rinse spray arm near hub or by using calibrated melting temperature wax crayons. Make a mark on a dry portion of the final sanitizing rinse manifold or supply line with a crayon that melts at 82C (180F) and another that melts at 91C (195F).
Another acceptable test to establish the final sanitizing rinse temperature (manifold) is to dry the final sanitizing rinse spray arm as near to the manifold entry into the machine as possible and affix a 82C (180F) thermolabel. The thermolabel should be left in place through one full warewash cycle. There may be slight temperature decreases at positions distant from the manifold entry into the machine.
A third method is to attach a maximum registering thermometer to the end of a rod and hold the thermometer in the final rinse spray at plate level for 8 seconds.
Following the any of the three of the indirect method tests above, make an assessment of the spray pattern from the final rinse spray arm to ensure that the spray pattern is effective.
For a stationary rack machine, the final rinse temperature can be evaluated by running the machine with a maximum registering thermometer at plate level. Stop the machine at the end of the wash cycle to check the temperature, and again at the end of the final rinse cycle. The following actions have been taken to correct each of the deficiencies noted during the inspection of (Name of Vessel) on (Date) at (Port).

# Item Number
Deficiency/Corrective Action 1.
(Continue list until all violations have been listed.)
Sincerely,

# Name Title Company
Inspection report data are also searchable from the VSP database for the following search categories:
- Ship name.
- Cruise line.
- Inspection date.
- Most recent date.
- All dates.
- Range of dates.
- Score (all scores, scores of 86 or higher , and scores of 85 or lower ).

# Contact Information
Further information on VSP, inspection results, and vessels' corrective action statements may be obtained on the VSP Web site (), through e-mail at (vsp@cdc.gov), by telephone (800-323-2132), and by fax (770-488-4127).