Evaluation Tool: Youth Camps Program
STANDARD
1:
Regulatory
Foundation
Ordinances
Source
Materials
STANDARD
2: Trained
February 11, 2011 Version
Evaluation Criteria
Comments
Rating
(0-2)
O
a. Has the Board passed ordinances
referring to statutes and rules, as listed
in the SCOPE of the Delegation
Agreement?
b. Have ordinances been revised as
needed to be consistent with current
statutes and rules?
c. If applicable ordinances were
changed since the previous program
evaluation, were they sent to MDH for
review prior to their passage?
d. Do ordinances describe enforcement
tools and procedures, and grant
authority for enforcement?
e. Do ordinances reference plan review
requirements if adult programs are
provided (e.g. – Dual license)?
f. (MDH only) Has MDH reviewed and
responded in writing to its delegated
partners regarding proposed ordinances
or language changes to existing
ordinances, within 30 days of receipt of
those changes?
Y
Y
Y
Y
Y
a. Current, signed and dated ordinances
b. Delegation Agreement application
Evaluation Criteria
ORANGE: Essential Program Elements defined in statute and/or rule and in the Delegation
Agreement
Comments
YELLOW: Required Program Elements required by the Delegation Agreement
1
Rating
(0-2)
WHITE: Value-Added Program Elements - not required
by law or the Delegation Agreement, but can help support core
functions
Evaluation Tool: Youth Camps Program
February 11, 2011 Version
Regulatory
Staff
O
a. Does the Board employ qualified
inspection staff as defined in the
Delegation Agreement?
1. Inspection b. Are any less qualified staff (as
Staff
described in the Delegation
Agreement) limited to performing
inspections that are not mandated by
the Delegation Agreement?
If the Board has entered into
2. Agreements agreements with other qualified
persons to carry out its regular,
with Other
delegated duties, did the Board obtain
Qualified
MDH’s written approval before
Parties
entering into such an agreement?
Describe the percentage of staff that
have taken ICS classes (minimum of
3. Additional ICS 100 & 200.)
Training
Describe other training that staff have
received (e.g., MNTrac courses
completed).
a. Does the Board have a written plan
that is submitted annually to MDH, to
assure adequate program coverage and
to address staffing transition in the
4. Staffing
event of unexpected staffing changes?
Transition
b. Has that written plan has worked
Plan
effectively during staffing transitions
within the evaluation period?
c. Has the Board notified MDH within
10 business days of staff departures,
ORANGE: Essential Program Elements defined in statute and/or rule and in the Delegation
Agreement
Y
Y
W
W
Y
W
Y
YELLOW: Required Program Elements required by the Delegation Agreement
2
WHITE: Value-Added Program Elements - not required
by law or the Delegation Agreement, but can help support core
functions
Evaluation Tool: Youth Camps Program
February 11, 2011 Version
when staffing is insufficient to perform
the obligations of the Delegation
Agreement?
Source
Materials
STANDARD
3: Risk-Based
Inspection
Program
1. Inspection
Forms
2. Inspection
Frequency
3. Written &
Implemented
Policies
a. Position descriptions for all program staff
b. Organizational charts, with RS numbers, if applicable
c. Staff standardization documentation
d. Written staffing transition plan
e. Staff credentials and certifications (e.g., RS/REHS, CPO, CP-FS, CEHT)
f. Training records (e.g., MN Train records, if used)
Evaluation Criteria
Comments
Y
a. Do the Board’s inspection
documents identify health and safety
hazards and interventions?
Is inspection frequency based on MN
Statute (annual inspection) being met?
a. Has the Board developed a
documented procedure to address
corrective action?
b. Has the Board developed a
documented procedure that requires
discussion of options for long-term
control of health and safety hazards?
c. Has the Board developed a
documented procedure that requires
follow-up activities on health and
safety violations?
d. Has the Board developed a
documented, implemented procedure
on variance requests related to health
ORANGE: Essential Program Elements defined in statute and/or rule and in the Delegation
Agreement
Rating
(0-2)
O
Y
W
Y
Y
YELLOW: Required Program Elements required by the Delegation Agreement
3
WHITE: Value-Added Program Elements - not required
by law or the Delegation Agreement, but can help support core
functions
Evaluation Tool: Youth Camps Program
February 11, 2011 Version
and safety hazards, and interventions?
e. Has the Board submitted to MDH
any copies of variances granted, within
30 days of issuance?
Source
Materials
STANDARD
4: Uniform
Inspection
Program
1. Plan
Review
2. Licensing &
Data
Management
3. Inspections
& Written
Reports
Y
a. Copies of inspection reports/forms
b. List of licensed facilities
c. Inspection frequency data for the past three years
d. Documented procedures referenced in 3.a-d above
e. Other compliance forms or documents
f. Copies of variances, as requested
Evaluation Criteria
Comments
Y
a. Does the Board conduct and
adequately document plan review for
each new construction, renovation, or
conversion of Youth Camps, including
zoning approval if needed?
b. Is documentation regarding plan
review maintained in each file?
c. Is documentation maintained for
water and sewer system approval as
reviewed by the appropriate authority?
a. Are establishments issued licenses
as required in MN Statute 144.72?
b. Does the Board maintain a current
list of establishments (including
establishment name and address)?
a. Are inspections conducted by
qualified inspection staff, as described
in the Delegation Agreement?
ORANGE: Essential Program Elements defined in statute and/or rule and in the Delegation
Agreement
Rating
(0-2)
W
W
Y
Y
O
YELLOW: Required Program Elements required by the Delegation Agreement
4
WHITE: Value-Added Program Elements - not required
by law or the Delegation Agreement, but can help support core
functions
Evaluation Tool: Youth Camps Program
February 11, 2011 Version
Y
b. Does the Board incorporate
education into the inspection process?
c. Are written reports complete and
accurate, and do they describe
compliance activities?
d. Are statutes, rules and ordinances
interpreted accurately and
consistently?
Source
Materials
STANDARD
5: Illness &
Injury
Investigation
& Response
1. Protocol for
Investigating
Complaints
2. Complaints
Y
Y
a. Files for randomly selected facilities
b. List of licensed establishments with assigned risk
c. Description of licensing category definitions and descriptions, including for all permanent and temporary establishments
d. Relevant ordinances, policies and guidance documents
e. Plan review reports, as requested
f. Educational or training materials relevant to uniform inspection that the Board wishes reviewed
Evaluation Criteria
Comments
Y
Does the Board utilize a procedure to
investigate, respond to, and document
Youth Camp complaints and injury?
a. Does the Board maintain a log or
database for all complaints alleging
injury, or health and safety hazards?
b. Does the Board follow-up on all
injury, or health and safety hazard
complaints within one business day?
c. Are investigation reports filed or
linked to the records of the
establishment?
d. (MDH only) Does MDH refer to its
ORANGE: Essential Program Elements defined in statute and/or rule and in the Delegation
Agreement
Rating
(0-2)
W
W
W
Y
YELLOW: Required Program Elements required by the Delegation Agreement
5
WHITE: Value-Added Program Elements - not required
by law or the Delegation Agreement, but can help support core
functions
Evaluation Tool: Youth Camps Program
3. Program
Coverage
Source
Materials
February 11, 2011 Version
delegated partners any complaints that
MDH receives concerning matters
under their jurisdiction?
Does the Board have qualified staff
available for emergency coverage on a
24-hour a day basis and have they
provided an after-hours contact
number to MDH?
a. Procedures for responding to injury, or health and safety hazard complaints
b. Complaint log and relevant materials
c. After hours staffing policy and after-hours contact number
STANDARD
6: Compliance
&
Enforcement
Evaluation Criteria
Compliance &
Enforcement
a. Does the Board identify and
document violations according to
statute, rule and ordinance?
b. Does the Board address the
identified hazards by: (1) following up
or using appropriate enforcement tools,
including revocation or suspension,
and (2) by maintaining adequate
documentation throughout the
enforcement process?
c. Does the Board resolve identified
violations within a reasonable time?
d. Does the Board maintain records
according to its records retention
policy?
Source
Y
Comments
Rating
(0-2)
O
O
Y
Y
a. Records for randomly selected licensed establishments
b. Enforcement policies, procedures and tools
ORANGE: Essential Program Elements defined in statute and/or rule and in the Delegation
Agreement
YELLOW: Required Program Elements required by the Delegation Agreement
6
WHITE: Value-Added Program Elements - not required
by law or the Delegation Agreement, but can help support core
functions
Evaluation Tool: Youth Camps Program
February 11, 2011 Version
Materials
STANDARD
7: Industry &
Community
Relations
Evaluation Criteria
Comments
Rating
(0-2)
Y
Does the Board participate in
workgroups, advisory boards, task
forces or committees that work to
1. Work
identify, correct, and prevent risk
Groups
factors and health and safety hazards
in licensed establishments?
a. Does the Board lead or participate in
activities that increase awareness of
risk factors, health and safety hazards,
and control methods to prevent illness
2. Educational
or injury?
Outreach
b. (MDH only) Has MDH been
available to advise its delegated
partners regarding issues covered
under the Delegation Agreement?
Any relevant materials the Board wishes to be reviewed.
Source
Materials
STANDARD
8: Program
Resources
1. Inspection
Ratio
(sufficient
staffing)
Evaluation Criteria
Y
Comments
Rating
(0-2)
W
a. Describe the current ratio of
qualified inspection staff to the
number of licensed establishments.
b. (MDH only) Does MDH evaluate
its delegated partners’ compliance
ORANGE: Essential Program Elements defined in statute and/or rule and in the Delegation
Agreement
W
Y
YELLOW: Required Program Elements required by the Delegation Agreement
7
WHITE: Value-Added Program Elements - not required
by law or the Delegation Agreement, but can help support core
functions
Evaluation Tool: Youth Camps Program
2. Inspection
Equipment
3. Funding
4. Data
Sharing
5.
Professional
Development
6. Staff Safety
Source
Materials
February 11, 2011 Version
with the Delegation Agreement to
ensure that their programs are
adequate to assure compliance by
regulated parties to requirements in
statutes and rules?
Does the Board provide the
appropriate inspection equipment to its
qualified inspection staff?
Describe the source(s) of funding for
this program. (Fees, General Fund,
etc.)
Does the Board maintain all licensing
and inspection information in an
electronic format and make it available
to MDH upon request?
Is funding provided for staff training,
conference attendance, and other
professional development activities?
Does the Board provide staff with
appropriate safety training and
equipment?
W
Y
W
W
a. Electronic licensing and inspection data
b. Staff credentials and certifications (e.g., RS/REHS, CPO, CP-FS, CEHT)
c. Organizational charts, with RS numbers, if applicable
ORANGE: Essential Program Elements defined in statute and/or rule and in the Delegation
Agreement
YELLOW: Required Program Elements required by the Delegation Agreement
8
WHITE: Value-Added Program Elements - not required
by law or the Delegation Agreement, but can help support core
functions