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Thursday, August 16, 2018

Frequently Asked Questions (FAQs)

 Click on a category to the left to filter the list of FAQs below.

What is TB?

Transmission and Pathogenesis of TBTB is usually an infection of the lungs.  It is spread by sharing air with someone who is suffering from TB disease.  If you are healthy, your body puts the TB germs to sleep.  The germs are kept asleep forever unless your body becomes weak with age, disease or medical treatments.  If the TB germs wake up, they can start to do damage to the body.  When the damage starts, then you may have symptoms and spread the germs to others.
 

What are the symptoms of TB?

  • A bad cough lasting more than 3 weeks
  • Pain in the chest
  • Coughing up blood or phlegm from deep inside the lungs
  • Weakness or feeling very tired
  • Losing weight without trying
  • Having no appetite
  • Chills and fever
  • Sweating at night or when you are sleeping
  • Excessive fatigue

People with TB usually have more than one of these symptoms and the symptoms continue if not treated.

What do I need to know about TB?

TB presents in two ways - TB infection and TB disease.

People with TB infection are healthy and able to keep the TB germs "asleep". These folks cannot spread the TB germs. They may never develop TB disease.

People with TB disease are suffering from TB disease. The TB germs are "awake" and doing damage to lungs or other organs of the body. They can spread TB germs when they cough, sing or sneeze.

We can lessen the spread of TB and other germs with good respiratory hygiene.

For more information, please visit the following website: Centers for Disease Control and Prevention (CDC) - Tuberculosis.

Do I need to go through the Health Department to get TB clearance?

No, your private health care provider can also give you clearance.

Can I go to work with a positive skin test?

Yes, if your chest x-ray is normal and you do not have symptoms of TB.

Do I need to get yearly chest x-rays?

No, the CDC recommends chest x-rays when:

  • You have your first positive TB skin test
  • You have symptoms of TB disease

Why does it take almost a month to get the TB clearance?

Our county does not have very many cases of TB, so our clinics do not have doctors on staff to evaluate the TB histories and skin test results.  Our contracted physicians provide monthly review of the histories, x-rays and lab work done.  Following these reviews we follow up with patients as needed.

I am a contact of a TB patient. What do I need to do now?

  • Call the appointment line in Prescott or the Verde Valley
  • Bring the letter you received about being a contact with you to the appointment
  • We will figure out what testing you need and when.

I had the BCG TB vaccine. Won't my skin test be positive?

Not necessarily. The BCG vaccine (a TB vaccine given in many foreign countries) can produce a positive skin test result, but this fades after 5 years of receiving the vaccine. Many people with previous BCG vaccination will often have a negative TB result. People with a history of BCG are often from countries where TB is more common.  BCG reduces the rate of severe forms of TB disease in children and overall might reduce the risk for progression from infection to TB disease.  BCG is not thought to prevent TB infection.  Test results for TB infection for those with a history of BCG should be interpreted by using the same diagnostic points used for those without a history of BCG vaccination.

How do I get TB clearance for work?

  • Call the appointment line in Prescott or the Verde Valley.
  • Ask for an appointment for TB testing.
  • If you have proof of a previous positive TB skin test, bring it to the visit.

What does Environmental Health do?

Environmental Health is concerned with protecting the public's health and preventing disease, primarily through the regulation of those public facilities which can adversely affect the public by improper safety and hygienic practices. In Yavapai County, some of the establishments we regulate include restaurants, bars and certain food processors; public and semipublic swimming pools; hotels and motels; and school grounds. Additionally, we respond to situations involving mosquitoes, rodents and other animals which may be capable of spreading disease. Historically, Environmental Health is the oldest component of the public health movement and continues to be part of the county’s efforts building and maintaining healthier communities.

Where does Environmental Health receive its authority?

Most of the laws and codes Environmental Health enforces were written at the state level. It was long ago recognized that many health functions, such as inspecting restaurants, could be best done at the local level. Therefore, the state health department transfers many of its powers to us by entering into a delegation agreement with the Yavapai County Board of Supervisors. Some programs, such as food worker training, not specifically stipulated in the state health code, are the result of county ordinance.

How is Environmental Health funded?

In keeping with the wishes of the County administration, Environmental Health receives almost all of its funding from the fees we charge.

What are your fees? How are they set? Why did the fees recently go up?

The fees we charge vary considerably and depend upon the type and size of the establishment. The exact fees for an establishment can be obtained by speaking with one of our employees. Our fees are designed to cover the costs of performing a given service and must include employee time in performing inspections, traveling and performing administrative tasks such as filing. Additionally, our fees must reflect other costs such as supplies, vehicles and office space. We periodically perform studies to determine how much time our employees spend working in different programs. These time studies as well as other considerations such as increases in employee and equipment costs are used to recommend new fees designed to more fairly and accurately reflect the cost of performing our services. The new fees are put into place by a vote of the Yavapai County Board of Supervisors.

How can I become a health inspector?

Health inspectors must possess a credential as a Registered Sanitarian. Sanitarians are registered by the Arizona Department of Health Services. They can be contacted for more information at 602-364-3855. Registered Sanitarian candidates must have a significant background in college level sciences and then have to pass a comprehensive written examination. County job vacancies are posted in local newspapers and county buildings, and on-line.

Do you regulate septic tanks and water quality?

No. Wastewater regulation (including septic tanks) is performed by Yavapai County Development Services – Environmental Unit. They issue septic permits, perform septic inspections and respond to citizen complaints about wastewater problems. They have all the county records on septic systems and are who to call if you want to know where your septic tank is located.  Water quality is regulated by Arizona Department of Environmental Quality.

How can I get in contact with my Environmental Health inspector?

By calling one of our offices.  Inspectors are generally out of the office doing field work during the middle part of the day. The best time to try to contact an Inspector is early in the morning (8:00 to 9:00 a.m.) or leave a message.

What public facilities does Yavapai County Community Health Services not inspect?

We do not have authority to perform any activities on Indian land. This includes Frontier Village in Prescott, which is administered by the Yavapai Prescott Tribe (928-445-8790 ext. 123), and Cliff Castle in Camp Verde, which is under the jurisdiction of the Indian Health Service (602-364-5039). Inquiries on these establishments can be directed to the Arizona Department of Health Services at 602-364-3131.

What is a Food Worker Card? Who needs to get one? Why is the card needed?

A Food Worker Card is issued by the county to a food worker. It is documentation of the fact that the worker has received special training in basic food safety and has authorization to work with food in our county. Every employee who handles food or food-contact equipment is required to get one. This includes virtually every employee in a restaurant or bar with the possible exception of hostesses and bookkeepers provided they never handle food or utensils. Food Worker Cards are required by Yavapai County Ordinance as a way of ensuring that the people who serve food have a basic understanding of food safety and their role in keeping food safe and wholesome.

How much does the card cost? How long is it good for?

The Yavapai County Food Worker Card is offered for 2 years at $15.00 each.  The fee is waived for persons whose contact with food is exclusively limited to performing volunteer work for a verified charitable organization.  
American National Standards Institute (ANSI) approved online training agencies offer 3 year cards.  Prices vary, but some offer cards for $10.00 or less.  Please contact agencies for costs.  For more Food Worker Training information, click HERE.

What is Manager Certification? How do I get it?

The Yavapai County Health Code, which was adopted in Arizona in 2015, requires that every food establishment has at least one person who has obtained more extensive training in food safety. While the county does not offer this more advanced training, it is readily available through a number of private sources. Yavapai County Community Health Services will recognize any certificate from a test approved by the Conference for Food Protection.

What is the difference between a Food Worker Card and a Manager Certification?

Manager Certification is a much longer course of study than the Food Worker class. It involves greater depth and detail. Individuals who successfully complete the Manager Certification should be better equipped to successfully supervise a food service facility.

I want to open a new restaurant. What do I need to do?

If you are taking over an existing licensed establishment, you simply need to contact your Inspector and arrange for an opening inspection and new license application. If you are planning on performing a remodel of the existing business, you need to call your Inspector and discuss the project. If the remodel is significant, it may be necessary for you to file a plan review application. This is something for your Inspector to determine after consulting with you. If the establishment has been closed for a significant period of time (more than 30 days) or if you plan on starting an entirely new business in a facility which did not have that use before, you will need to do a plan review application. The plan review process involves providing Community Health Services with a set of plans, particularly the equipment layout, along with an application that details your menu and the nature of your operation. The Inspector reviews the application and determines if the proposal is in compliance with the Health Codes. If so, an Approval to Construct is issued and the applicant is notified by mail. If there are problems with the plans, the Inspector will be in contact with the applicant to work out a solution. Once the Approval to Construct is granted, and other necessary approvals from other agencies such as the Building Permit have been obtained, the applicant is authorized to proceed. We typically perform at least one interim construction visit when one of our inspectors is in that area. When the owner/applicant is ready to open for business, he or she should call our office about 3 working days before and we will arrange to meet with the owners at the business, perform an opening inspection and take care of all the paperwork for the operating license. A Construction Guide booklet is available from our offices and it offers a great deal of information about what is required and how the process works.

I’m only going to be doing a limited menu. Do I still need to do all that?

Yes. The plan review process is designed to evaluate your operation and its facility needs. If you are offering an extensive menu with a great deal of food processing, your equipment needs will be greater. If your operation is going to be limited, the equipment needs will be much reduced. The Construction Guide offers assistance in determining what your equipment needs will be.  Additionally, if you have any questions they can be answered by calling the Inspector who handles your district.

What is the minimum equipment needed for a food establishment?

This is a tough question because each establishment needs to be individually evaluated based upon the amount of food served and the types of food preparation processes involved. In general, though, the absolute minimum equipment needed for any food or beverage establishment is a hand wash sink in each work station, a three-compartment sink indirectly drained into a floor sink, a mop sink, sufficient hot and cold equipment for the operation, and all surfaces such as walls and ceiling need to be made of a smooth, durable, easily cleanable, light-colored material. Floors need to be smooth, easily cleanable and non-absorbent. If produce is to be washed or other food is to be prepared in a sink, then a separate food sink is needed and this also needs to be indirectly drained into a floor sink. The three-compartment sink is reserved for dishwashing and each compartment needs to be large enough to accommodate the biggest piece of equipment that will be washed.

 

 

 

What do I need to do if I take over an existing restaurant?

All of our licenses are only valid for the original applicant. When any establishment changes hands, the new owner must obtain a new operating license. If there is no change in the facility or the nature of the business, the new owner needs to call our office and arrange for an inspection and paperwork application review. If the new owner plans on expanding the operation or remodeling, he should contact us as soon as possible to discuss what needs to be done. It may be necessary to file plans for review on the intended changes. No one should take over an existing establishment without first contacting our department and obtaining a valid operating license.

My friends all rave about my salsa/baked goods. Can I make these and sell them from my home kitchen? Do I need a license for this?

The Health Codes prohibit vending of foods unless made in a licensed commercial kitchen facility. It is not lawful to sell foods made in a home kitchen. We cannot issue licenses for home kitchens even if an attempt is made to bring them up to commercial standards because the Health Codes call for a complete separation of living quarters from commercial kitchens. A home kitchen cannot be considered suitable for commercial food preparation because it is typically not possible to segregate the kitchen from children, pets and other extraneous people or things. If you wish to get a license to make and sell an item such as salsa, you should call one of our Inspectors to obtain guidance. One option worth considering is to get a written commissary agreement with a Community Health Services Licensed Facility giving you the right to use their kitchen for your operation. An exemption to using a home kitchen for preparing and selling food for the public may be available through the State Cottage Law, also known as the Home-baked Law.  Contact the Arizona Department of Health Services for information.

Does Community Health Services regulate potlucks?

Potlucks in private homes, churches and offices are not regulated by Community Health Services. Information on proper handling of food at private potlucks can be obtained from the Arizona Cooperative Extension Service in Prescott. Any food service which is open to the general public falls under our regulations. Because Health Codes prohibit serving food to the public which is not produced in a licensed commercial kitchen, the use of homemade foods at a potluck held in a public facility is not allowed.

My organization wants to do fundraising dinners. Is a Community Health Services permit/license needed?

The event organizer should call our office and speak to an inspector. The degree of Community Health Services involvement will depend upon the type of food proposed and the duration of the event. Organizations wanting to do fundraising dinners on a routine basis will need to work out of a commercial kitchen and obtain an operating license. Note: Foods prepared or cooked at home is not allowed to be served at this type of event.  One other option might be to contract with a licensed commercial caterer to provide food for your event.

What happens after I have been given approval to construct and I am ready to open?

Once you have received your letter informing you of the Approval to Construct, you are free to begin construction. If you have any questions or would like an interim inspection, you may call our office and we will be glad to help. We generally like to perform at least one construction inspection for every newly built facility. When your facility is built and the equipment is all in place, you should call our office about 3 working days prior to your opening date to arrange a meeting with your Inspector. At that time, we will perform an “opening” inspection and work with the owner to complete all application paperwork. If the owner or manager has not yet completed a Food Safety Plan, it must be completed, submitted, and approved before approval to operate will be given.

I am organizing a concert and art fair and we will have food booths. What does Community Health Services require me to do?

Food served at concerts, festivals, fairs and the like come under our regulation. If you are organizing such an event or wish to serve food there, you should contact your Inspector to discuss your plans and what will be required. For short events (under 4 hours duration including set-up and take-down) with limited food service (hot dogs, burgers, etc.), a special event permit is necessary but a fee may not be required
For longer events and those with more extensive food service, a Special Event permit is required. We have a Special Event Coordinator Application for the event organizer to complete which requires information about the event and its participants. We also have a Special Event Vendor Application for each individual vendor to describe their menu and operation.All of these applications must be completed and turned in to Community Health Services and approved prior to the event.  If vendor applications are not received 48 hours prior to the start of the event, a late fee will be assessed.  These application packets may be obtained by going to our website at yavapaihealth.com/environmental-health.

I have a mobile food unit. How can I get permission to operate in Yavapai County?

If you want to operate your mobile food unit at a single event in our county, you can submit a one-time special event vendor application. The application requires you to describe your menu, facility and operations. If you wish to operate in Yavapai County on a more routine basis, you may obtain an annual operating license with us. For complete information on how to obtain an annual MFU license, go to our website at yavapaihealth.com/environmental-health and look for our MFU Application Packet.  This first requires you to file a set of plans with a plan review application and fee, which we must review and approve to make sure your facility meets the minimum requirements of the Food Code. If you are going to be building the mobile unit yourself, you must have our approval on the plans before you begin. If your mobile is a commercially manufactured model, you will still need to provide plans for review; however, you can simply provide us with the manufacturer’s plans. Once the plan review has been done and construction approval granted, the process works the same as with any other licensed facility. When the construction is done or the mobile has been purchased, one of our Inspectors needs to physically examine the unit and make sure it meets the codes and then operating license paperwork must be completed.  All MFUs must operate from an approved commissary in Yavapai County.

Why are inspections done?

To ensure that minimum health and safety standards are met. Also, being in food establishments on a regular basis gives our staff opportunities to offer suggestions for improving safety and operating efficiency. We look upon each inspection not only as a regulatory tool but also to open dialogue and increase understanding and communication. We feel very strongly that our role in inspecting isn't simply to find problems and demand correction. It is equally important to identify areas in which operators are doing quality work and to provide positive feedback and encouragement.

What do you look for during an inspection?

The short answer is, "All sorts of things." The Food Code is quite extensive and covers everything from food handling practices to the quality of the food itself to the condition of the physical premises. Under the Food Code, we focus on those situations which have a direct bearing upon food safety. Examples of our highest priorities include food temperatures, hand washing and proper use of chemicals including sanitizers. Cleanliness of food contact surfaces such as cutting boards is considered very important. Cleanliness of the floors and walls is of less importance since these surfaces do not come into direct contact with food and are far less likely to contribute to a foodborne illness.

How often are inspections done?

Each food service establishment is given a rating based upon its menu, extent of food handling and overall food safety risk. Based upon the potential risk, each establishment is given from 2 to 3 routine inspections per year. For example, a large restaurant that prepares a variety of foods using complicated recipes might be inspected 3 or even 4 times per year while a convenience store that only serves hot dogs might only see an inspection twice a year. More frequent inspections are done for new establishments, when complaints are received or when an operation has had a history of unsatisfactory inspection reports.

When you are only in the restaurant a few times per year, how can the inspection program be effective?

Inspections are considered a form of sampling. We cannot be in all restaurants at all times so we conduct inspections to take a sort of "snapshot" of the restaurant operation. By examining this snapshot, we are able to draw conclusions about the way the restaurant is operated on a daily basis. For example, if employees are not washing their hands during our inspection, it is reasonable to conclude that adequate hand washing is not routinely done. One of the things that make inspecting a challenge is trying to discern what is a one-time occurrence from what is a routine problem. Because our time in each restaurant is limited, the ultimate responsibility for food safety rests squarely with each restaurant's management team.

The health inspector always seems to show up at the worst time. Why can’t you schedule inspections with the restaurant operators?

When we perform scheduled inspections, people tend to have the place "spiffed" and display their best behavior. Because of this, scheduled inspections don't tend to give us a good feel for the way a restaurant operates on a routine basis. One of our most effective regulatory tools, other than education, is the notion that we could show up at any time. This encourages employees to be doing their best all the time.

What happens if a problem is detected during an inspection?

A violation is documented on the inspection form and it is brought to the attention of the owner or manager. If the violation is minor, the Inspector will give the owner a reasonable time frame for correction, usually no more than 90 days. If the violation is serious and might potentially contribute to a foodborne illness, then an escalated schedule of responses is put into place. The first and best response is for the restaurant management to correct the problem right then and there. If this happens, the Inspector will mark the item as corrected on the inspection report. If more time is needed, the Inspector will give anywhere from 1 to 10 days for correction, depending upon the nature of the violation, and perform a follow-up inspection to determine compliance. If the re-inspection is good, the establishment is placed back on a regular inspection schedule. If the problem was not corrected, a second follow-up inspection is scheduled and a Program Compliance Re-inspection fee is charged to the license holder. All subsequent follow-up inspections are billed the re-inspection fee as well. Restaurant operators who are not able to achieve compliance through the re-inspection process are referred to the Environmental Health Section Manager for further administrative action that may lead to license revocation. Restaurants that experience repeated violations over an extended period of time may also be subject to such action.

Why are there different cooking temperatures? What are they?

Different foods tend to be susceptible to different kinds of bacteria and require different procedures. For example, chicken and other poultry products are at a higher risk of carrying Salmonella and Campylobacter than other foods. Ground meats are associated with higher risk of transmitting E. coli O157:H7 infections. Therefore, these products have higher cooking temperatures. Here is a quick outline of some of the more important cooking temperatures: Chicken, other poultry, and stuffed foods such as manicotti must be cooked to at least 165 °F. Ground meats require an internal cooking temperature of at least 155 °F. Fish, eggs, beef and pork must be cooked to at least 145 °F throughout. In addition to these cooking temperatures, there are a few other important temperatures to remember. All hot items such as gravy or soup on a steam table need to be kept at 135 °F or more (140 °F is recommended). All reheated foods such as refried beans prepared in advance need to be rapidly heated to at least 165 °F. Equipment (such as a steam table) designed for holding food at a certain temperature must never be used to heat the food. The food cannot be heated quickly enough. Another piece of equipment such as a stove or oven must be used to reheat the food which is then placed into a steam table to be kept hot. Finally, freezers should maintain a temperature of 0 °F or less (Fahrenheit) to freeze food solidly allowing for safe long-term storage. All cold foods such as tuna salad and cut melons need to be kept at 41 °F or less.

What if a customer requests over-easy eggs or a rare hamburger?

The Food Code allows most establishments to decide for itself whether to do this. Many restaurant owners and managers have made a decision to simply refuse all such requests and to only serve meats which have been cooked thoroughly (to “medium well” or better). Other food establishments that wish to honor their customers’ requests may do so only if they inform consumers of the significantly increased risk of consuming such food by way of disclosure and reminder.

What’s up with the new Food Code?

The new Food Code emphasizes safe food handling practices and places less concern on the restaurant’s physical facility. Most food establishments are required to employ at least one person who has obtained special certification and this “certified” manager is expected to oversee and be responsible for the safety of food. New establishments (those opened in 2001 or later) must develop and use a written Food Safety Plan. This generally involves the use of established procedures for safe food handling and keeping temperature charts on all critical pieces of equipment. The temperature for cold holding has been reduced from 45 to 41 degrees. Cooling of foods must now be achieved more rapidly during the first 2 hours of a 6 hour period. Direct bare hand contact with ready to eat foods (those not receiving additional cooking) is now prohibited. All repackaged and prepared foods held more than 1 day must be labeled as to contents and the date made. The new Food Code also established the use of the consumer advisory language advising patrons of the risks of consuming under-cooked foods.

Why do you no longer assign a numerical rating or use grade cards?

We found that ratings could be misleading. For example, an establishment operating with good food handling practices in an older building could rack up enough minor facility deductions to score in the 80’s (grade “B”) yet be a very safe bet for dining. Another establishment could have had many foods at bad temperatures and this would have only cost them 5 points for an acceptable sounding score of 95 (in the grade “A” range).

What are the Community Health Services approved methods for cooling foods?

Regardless of the method used, cooling must be done as quickly as possible. The first stage of cooling, from 135 down to 70 degrees or less, must be achieved within the first two hours, and to 41 degrees or less must be completed within a total of 6 hours. There are a variety of cooling methods which, when used properly, can effectively cool foods within the prescribed time. These methods include ice baths and chilling devices which are frozen and then inserted into the food. When simple refrigeration is used for cooling, the food must be transferred to shallow containers (preferably metal) and placed uncovered in the refrigerator with lots of air circulation available around the container. The depth of the food should never be greater than 3 inches. Thick foods such as refried beans or mashed potatoes may need to be placed into containers to a depth of only 1 or 2 inches. Once the food has cooled, you should place a cover and date label on it. Hot foods should never be placed at room temperature “to get the steam off” for more than a few minutes before going into a proper cooling procedure. Cooling should always be done in commercial equipment which has sufficient cooling capacity, never in home-style or beverage refrigerators.

How can I properly thaw frozen foods?

Never on a counter at room temperature and never in warm or standing water. The best way to safely thaw frozen foods is to place them in a refrigerator. This generally requires a little advance planning. When a quicker thawing process is needed, it can safely be done by placing the food item into a clean container and allowing cold water to continually run over it with proper drainage for the overflow. Finally, foods can be thawed as part of a cooking procedure, using a microwave oven or stovetop, if the product goes from frozen to fully-cooked in one continuous process.

Why are hotels and motels regulated?

Proper cleanliness and sanitary practices in hotels and motels are important in preventing disease and parasites from being spread. By licensing and inspecting hotels and motels, Community Health Services monitors these facilities for safe operation and cleanliness.

What do you look for in a hotel/motel inspection?

Overall cleanliness and soundness of construction, proper laundering of bed and bath linens, proper washing of cups and glasses, the absence of insects and rodents, and proper handling of trash.

How often are hotels/motels inspected?

At least one regular inspection is done each year. Additional inspections may be performed throughout the year in response to complaints from the public.

How does a hotel/motel become licensed?

The construction of a hotel or motel must be evaluated by the City or County Building Department for conformance to Building Codes. A plan review must also be performed by Community Health Services to determine compliance with the Health Codes. Once a plan review is done, approval to construct is granted and the construction is completed, an inspection with our department is arranged and, if the construction is approved, an application for an operating license is submitted.

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