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Item No.:
02
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Site:
Medical-Acute Gastroenteritis (AGE) Surveillance Log
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Violation:
The AGE surveillance log could not be exported into a spreadsheet with the required information in the exact order as Annex 13.2.2 of the 2011 VSP Operations Manual.
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Recommendation:
Ensure the AGE surveillance log entry for each passenger or crew member contain the following information in separate columns: (1) Date of the first medical visit or report to staff of illness; (2) time of the first medical visit or report to staff of illness; (3) case identification number; (4) person?s name; (5) person?s age; (6) person?s sex; (7) designation as passenger or crew member; (8) crew member position or job on the vessel, if applicable; (9) cabin number; (10) meal seating information; (11) date of illness onset; (12) time of illness onset; (13) illness symptoms, including the presence or absence of the following selected signs and symptoms, with a separate column for each of the following: (a) number of episodes of diarrhea in a 24-hour period; (b) number of episodes of vomiting in a 24-hour period; (c) bloody stools; (d) recorded temperature; (e) abdominal cramps; (f) headaches; (g) muscle aches; (14) entry (yes/no) for whether this was a reportable case; (15) entry (yes/no) for antidiarrheal medications sold or dispensed by designated medical staff; (16) presence of underlying medical conditions that may affect interpretation of AGE. Ensure the AGE surveillance log contains the above information in the exact order and is entered in the template in Annex 13.2.2. Ensure that the log data is exported in the exact order as in the example template in Annex 13.2.2 with analyzable formats such as Excel or Access. Ensure that any additional data fields are entered only outside of the form margins when exported to VSP.
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Item No.:
02
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Site:
Medical-Acute Gastroenteritis (AGE) Case Definition
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Violation:
The written AGE case definition used by the ship did not consider the number of diarrhea episodes that was above normal to certain individuals. This definition did not allow individuals to be reportable cases with fewer than 3 loose stools and individuals with pre-existing medical conditions, such as irritable bowel syndrome, who reach 3 loose stools to be considered non-reportable cases. No cases appeared to be reported incorrectly.
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Recommendation:
Ensure a reportable case of AGE is a case reported to the master of the vessel, the medical staff, or other designated staff by a passenger or a crew member and meets the case definition based on the following symptoms: (1) Diarrhea (three or more episodes of loose stools in a 24 hour period or what is above normal for the individual. See section 4.1.2.1.3, illness symptoms); or (2) 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 greater than or equal to 38C [100.4F]).
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Item No.:
08
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Site:
Potable Water-Production Records
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Violation:
Manual water production records from evaporators did not document pH readings from 15 October 2011 to 20 March 2012. The staff member explained that these pH tests were not performed. The ship installed analyzer chart recorders and from 21 March 2012 both pH and chlorine are recorded continuously.
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Recommendation:
After the free residual halogen level of at least 2.0 mg/L (ppm) and pH level not exceeding 7.8 have been reached, monitor the free residual halogen and pH at least hourly during the bunkering of potable water. After the free residual halogen level of at least 2.0 mg/L (ppm) and pH level not exceeding 7.8 have been reached, monitor the free residual halogen and pH at least once every 4 hours during the production of potable water.
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Item No.:
10
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Site:
Recreational Water Facilities-Chart Recorders
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Violation:
There were chart recorders with security features to record pH and halogen measurements for each individual recreational water facility but they were not operational. Staff members were measuring free residual halogen and pH with a manual test kit and documenting these accordingly.
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Recommendation:
Install chart recorders or electronic data loggers with security features that record pH and halogen measurements for each individual RWF. Ensure the sample line for the analyzer probe (monitoring) is either directly from the RWF or on the return line from each RWF and before the compensation tank. Install appropriate sample taps for analyzer calibration. In the event of equipment failure, measure free residual halogen and pH by a manual test kit at the RWF or return line at least hourly for whirlpool spas, spa pools, children?s pools, and wading pools and every 4 hours for all other RWFs. Record manual readings on a chart or log, retain for at least 12 months, and ensure that they are available for review during inspections. Complete repairs on malfunctioning halogen analyzer-chart recorders within 30 days of equipment failure. Provide an audible alarm in a continuously occupied watch station to indicate low and high free halogen and pH readings in each RWF.
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Item No.:
10
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Site:
Recreational Water Facilities-Safety Signs
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Violation:
The safety signs posted at the pools and whirlpools did not contain all elements of the 2011 VSP Operations Manual sign requirements.
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Recommendation:
Ensure the signs, at a minimum, include the following words: (1) do not use these facilities if you are experiencing diarrhea, vomiting, or fever; (2) no children in diapers or who are not toilet trained; (3) shower before entering the facility; and (4) bather load #. For children?s RWF signs, include the exact wording ?TAKE CHILDREN ON FREQUENT BATHROOM BREAKS? or ?TAKE CHILDREN ON FREQUENT TOILET BREAKS.? 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: (1) individuals who are immunocompromised; (2) individuals on medication or who have underlying medical conditions such as cardiovascular disease, diabetes, or high or low blood pressure; and (3) pregnant women, elderly persons, and children. Additionally, caution against exceeding 15 minutes of exposure.
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Item No.:
10
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Site:
Recreational Water Facilities-Water Chemistry
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Violation:
Staff explained that the RWF's flow rates and combined halogen were not monitored. There were no flow meters installed in the RWFs.
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Recommendation:
Install flow meters. Monitor and adjust the RWF?s flow rates and combined halogen levels as recommended by the manufacturer and to maintain optimum public health protection and water chemistry.
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Item No.:
10
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Site:
Recreational Water Facilities-Bather Loads & Turnover Rates
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Violation:
Bather loads and turnover rates were calculated by the staff using the manufacturer's pump flow rates.
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Recommendation:
Use actual flow rates from the flow meters to calculate bather loads and turnover rates.
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Item No.:
10
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Site:
Recreational Water Facilities-Antientrapment/Antientanglement Requirements
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Violation:
The gravity drains for the Lido swimming pool did not meet the antientrapment drain requirements per the 2011 VSP Operations Manual. The swimming pool had standard design gravity drains greater than 3 feet apart and no alarm.
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Recommendation:
For RWFs with gravity drainage and multiple drains (2 or more drains greater than 3 feet apart), provide either a standard design (not compliant with ASME A112.19.8) drain cover and an alarm, or an ASME A112.19.8 compliant antientrapment/antientanglement drain cover. Ensure the alarm is audible and sounds in both a continuously manned space and at the RWF. Ensure this alarm is for all draining: accidental, routine, and emergency.
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Item No.:
11
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Site:
Medical-Crew Acute Gastroenteritis (AGE) Reporting
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Violation:
The review of the AGE logs revealed that there was a warranty technician who experienced AGE symptoms with an onset on 15 May 2012 at 1600 but reported to the medical center on 18 May 2012 at 0941. It was verified that the employee worked between the onset of symptoms and the time he reported to the medical center.
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Recommendation:
Ensure that employees having AGE symptoms are restricted from work and report to the medical center as soon as having their first AGE symptom.
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Item No.:
16
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Site:
Galley-Forward Hot Service Line
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Violation:
Inside the Alto-Sham combination oven #2, one hotel pan of cooked chicken sausage had internal temperatures ranging from 118F to 122F. This oven was turned off. The staff explained that the sausage was just cooked and held in the oven before it was placed on the hot service line but there were no labels indicating time control. According to the time control plan, this oven was not a time control unit. The sausage was placed immediately on the hot service line.
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Recommendation:
Except during preparation, cooking, or cooling, or when time is used as the public health control, maintain potentially hazardous foods at 57C (135F) or above, except that roasts may be held at a temperature of 54C (130F); or 5C (41F) or less.
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Item No.:
16
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Site:
Galley-Forward Hot Service Line
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Violation:
Undercounter reach-in refrigerator #755 was listed on the time control plan as being a time control unit, but there was no sign posted on this refrigerator indicating it was for time control only. Staff corrected this during the inspection.
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Recommendation:
Maintain a written time control plan(s) that ensures compliance with these guidelines on the vessel and make it available for review during inspections. Post a time control plan at each outlet where time control is used. Ensure plan(s): (1) Includes set-up and discard times for each outlet. (2) List refrigeration and hot holding units (compartments and cabinets) on time control (the physical units must also be labeled as such).
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Item No.:
19
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Site:
Galley-Soup Station
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Violation:
A total of 5 out of 6 working soup kettles with their lids fully open were partly filled with water and foods were under a full boil. The steam from these open kettles was condensing on the surfaces throughout the canopy exhaust hood above and condensate was observed dripping from the front and side edges of the hood. The chef explained that none of these foods or liquids required the kettle lids to be fully open.
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Recommendation:
Ensure food is protected from condensate. Ensure staff are instructed on the proper cooking methods for foods in this area, and that they practice proper procedures for controlling steam inside the canopy hoods. If open cooking is required, staff should periodically close the kettles and wipe down excess condensate from the deckhead to prevent that from dripping into food.
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Item No.:
19
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Site:
Galley-Pastry
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Violation:
Inside the two door reach-in freezer #945 was one unwrapped sheet pan of Bitter and Blanc bread pudding dessert. The individual servings were overloaded along the pan's surface and several pieces along the outer perimeter of the sheet pan were visibly damaged and in contact with the shelf supports inside the refrigerator. Staff removed the pan and discarded those desserts in contact with the refrigerator shelf supports.
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Recommendation:
Protect food from contamination by storing the food: (1) Covered or otherwise protected; (2) In a clean, dry location; (3) Where it is not exposed to splash, dust, or other contamination; and (4) At least 15 centimeters (6 inches) above the deck.
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Item No.:
21
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Site:
Galley-Forward Coffee Station
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Violation:
There were large gaps where the power cables to the two counter model coffee machines penetrated the rear bulkhead panel in the technical compartment below the machines. In one case a foil type tape was used to cover only part of this opening.
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Recommendation:
Profile with stainless steel or provide gaskets or grommets on these large openings.
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Item No.:
21
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Site:
Galley-Forward Coffee Station
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Violation:
The power cables and water tubing for the WMF coffee machine on the starboard counter were draped on the counter top, making cleaning difficult.
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Recommendation:
Shorten and/or support the power cables and water tubbing above the counter to allow for easy cleaning.
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Item No.:
24
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Site:
Bar-Paris Bar
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Violation:
The full bucket of sanitizer solution found on the deck behind the bar, which was open at the time, was over 1,000 ppm. This was the only sanitizing solution for this bar, suggesting that the solution on the deck could be used on food contact surfaces. Staff stated this solution was used to sanitize bar surfaces according to the ship's outbreak prevention and response plan.
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Recommendation:
Ensure sanitizing solutions are used with the following concentrations: (1) A chlorine solution with a concentration between 50 mg/L (ppm) and 200 mg/L (ppm).
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Item No.:
24
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Site:
Bar-Port Pool Bar
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Violation:
The full bucket of sanitizer solution found on the front bar counter, which was open at the time, was over 1,000 ppm. This was the only sanitizing solution for this bar, suggesting that the solution on the counter could be used on food contact surfaces. Staff stated this solution was used to sanitize bar surfaces according to the ship's outbreak prevention and response plan.
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Recommendation:
Ensure sanitizing solutions are used with the following concentrations: (1) A chlorine solution with a concentration between 50 mg/L (ppm) and 200 mg/L (ppm).
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Item No.:
24
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Site:
Bar-Lobby Bar
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Violation:
The full bucket of sanitizer solution found on the front bar counter, which was open at the time, was over 1,000 ppm. This was the only sanitizing solution for this bar, suggesting that the solution on the counter could be used on food contact surfaces. Staff stated this solution was used to sanitize bar surfaces according to the ship's outbreak prevention and response plan.
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Recommendation:
Ensure sanitizing solutions are used with the following concentrations: (1) A chlorine solution with a concentration between 50 mg/L (ppm) and 200 mg/L (ppm).
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Item No.:
26
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Site:
Buffet-Aft Port/Starboard Beverage Stations
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Violation:
There was heavy juice concentrate residue inside the juice dispensing heads for the two left dispensers in both juice machines. There were no juice concentrate bottles installed for these beverage machines, but the two right side dispensers were full and ready for passenger self-service.
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Recommendation:
Ensure food contact surfaces of equipment and utensils are clean to sight and touch.
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Item No.:
26
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Site:
Buffet-Forward Beverage Station
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Violation:
There was heavy juice concentrate residue inside the juice dispensing heads for the two left dispensers in both juice machines. There were clean and empty concentrate containers installed in these two dispensers, indicating that the dispenser heads were not cleaned after use.
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Recommendation:
Ensure food contact surfaces of equipment and utensils are clean to sight and touch.
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Item No.:
26
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Site:
Galley-Appetizer Pantry
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Violation:
There was food residue around some of the plastic prongs on the previously cleaned meat slicer's gray plastic food guide.
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Recommendation:
Ensure food contact surfaces of equipment and utensils are clean to sight and touch.
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Item No.:
26
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Site:
Galley-Port/Forward Beverage Station - Ice Machines #772 and #773
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Violation:
There was corrosion on the interior surfaces of the double cuber panels inside the two in-use ice machines. The brown corrosion was visible thru the actual ice cubes being made at the time and along the upper and lower edges of the two panels in each machine. Both machines were emptied and cleaned during the inspection.
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Recommendation:
Ensure food only contacts surfaces of equipment and utensils are cleaned and sanitized. Ensure food contact surfaces of equipment and utensils are clean to sight and touch.
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Item No.:
27
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Site:
Galley-Port/Forward Beverage Station
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Violation:
A layer of dust and some metal debris were on the top exterior surface of the two juice dispensers at the beverage counter. Staff cleaned them during the inspection.
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Recommendation:
Ensure nonfood-contact surfaces of equipment are kept free of an accumulation of dust, dirt, food residue, and other debris.
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Item No.:
27
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Site:
Buffet-Deli & Pizzeria - Indoor Buffet Counters
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Violation:
The decorative glass and light plant type display placed at the corners of nearly all the buffet counters, including pantries, dessert, deli, and pizzeria were heavily soiled with dust and in some cases extended partly over the adjacent counters where food or clean china or trays were displayed/stored.
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Recommendation:
Ensure nonfood-contact surfaces of equipment are kept free of an accumulation of dust, dirt, food residue, and other debris.
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Item No.:
33
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Site:
Galley-Aft Hot Service Line
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Violation:
There were numerous deck tiles with recessed grout, leaving difficult-to-clean gaps between tiles.
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Recommendation:
Ensure decks, bulkheads, and deckheads in food preparation, warewashing, pantries, and storage areas are maintained in good repair.
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Item No.:
33
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Site:
Other-Lido Deli
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Violation:
There were difficult to clean gaps between the decorative deckhead panels over the forward counter in this preparation area. There was dust and grease along the brace pieces and the deckhead over this counter.
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Recommendation:
Profile gaps between deckhead panels. Ensure decks, bulkheads, deckheads, and attached equipment in food preparation, warewashing, pantries, and storage areas are cleaned as often as necessary.
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Item No.:
33
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Site:
Other-Lido Pizzeria
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Violation:
There were difficult-to-clean gaps between some of the decorative deckhead panels over the front counter preparation/plating area.
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Recommendation:
Profile gaps between deckhead panels.
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Item No.:
33
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Site:
Bar-Paris Bar
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Violation:
There were difficult-to-clean gaps between some of the decorative deckhead panels over the front bar counter.
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Recommendation:
Profile gaps between deckhead panels.
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Item No.:
36
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Site:
Pantry-Starboard Pool Bar Pantry
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Violation:
The light intensity behind and around the double ice machine was less than 110 lux.
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Recommendation:
Ensure the light intensity is at least 110 lux (10 foot candles) behind and around mounted equipment, including counter-mounted equipment.
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Item No.:
36
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Site:
Galley-Aft Beverage Station
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Violation:
The light intensity behind the various beverage dispensers in this area were less than 110 lux.
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Recommendation:
Ensure the light intensity is at least 110 lux (10 foot candles) behind and around mounted equipment, including counter-mounted equipment.
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Item No.:
36
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Site:
Buffet-Officer and Petty Officer Messes
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Violation:
The light intensity behind and around the WMF coffee machines was less than110 lux.
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Recommendation:
Ensure the light intensity is at least 110 lux (10 foot candles) behind and around mounted equipment, including counter-mounted equipment.
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Item No.:
36
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Site:
Buffet-Crew Mess
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Violation:
The light intensity behind the coffee machine and adjacent Cornelius ice maker/dispenser in the beverage station was less than 110 lux.
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Recommendation:
Ensure the light intensity is at least 110 lux (10 foot candles) behind and around mounted equipment, including counter-mounted equipment.
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Item No.:
36
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Site:
Buffet-Aft Port/Starboard Beverage Stations
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Violation:
The light intensity was less than 220 lux on the counters in front of the beverage and ice dispensing units. The light intensity behind the beverage counter equipment was less than 110 lux.
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Recommendation:
Ensure the light intensity is at least 220 lux (20 foot candles) on food preparation surfaces, and at a distance of 75 centimeters (30 inches) above the deck in food preparation areas, handwashing facilities, warewashing areas, equipment, and utensil storage, pantries, toilet rooms, and consumer self-service areas. Ensure the light intensity is at least 110 lux (10 foot candles) at a distance of 75 centimeters (30 inches) above the deck when in use, in walk-in refrigerator units and dry storage areas, and in other areas and rooms during periods of cleaning. Ensure the light intensity is at least 110 lux (10 foot candles) behind and around mounted equipment, including counter-mounted equipment.
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Item No.:
36
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Site:
Buffet-Port/Starboard Dessert Counters
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Violation:
The light intensity at the cone dispensing counters at the dessert counters was less than 220 lux.
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Recommendation:
Ensure the light intensity is at least 220 lux (20 foot candles) on food preparation surfaces, and at a distance of 75 centimeters (30 inches) above the deck in food preparation areas, handwashing facilities, warewashing areas, equipment, and utensil storage, pantries, toilet rooms, and consumer self-service areas.
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Item No.:
36
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Site:
Galley-Port/Forward Beverage Station
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Violation:
The light intensity behind and around the toasters at the counter was less than 110 lux. The light intensity behind the three ice machines opposite the toaster counter was also less than 110 lux.
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Recommendation:
Ensure the light intensity is at least 110 lux (10 foot candles) behind and around mounted equipment, including counter-mounted equipment.
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Item No.:
37
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Site:
Galley-Soup Station
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Violation:
Condensate was collecting along the entire surface (upper and side panels) of the two canopy hoods over the in-use soup kettles. Dripping was observed on the side and front edges of the exhaust hood.
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Recommendation:
Ensure ventilation hood systems and devices are sufficient in number and capacity to prevent grease or condensation from collecting on bulkheads and deckheads.
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Item No.:
40
|
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Site:
Integrated Pest Management-Mooring Lines
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Violation:
The rat guards on the mooring lines were not closed and some were touching the vessel, making them ineffective to prevent the passage of vermin crawling along the lines from the pier to the ship.
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Recommendation:
Install rat guards on the mooring lines according to the recommendations of the manufacturer.
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Item No.:
41
|
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Site:
Housekeeping-Public Toilet Room Signs
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|
Violation:
The toilet room located in the bridge did not have a sign advising users to wash hands or sign advising users to use hand towels, paper towel, or tissue to open the door when exiting. This was corrected.
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Recommendation:
Provide the passenger and crew public toilets with a handwashing station that includes a sign advising users to wash hands. Post a sign advising users of toilet facilities to use hand towel, paper towel, or tissue to open the door unless the exit is hands free.
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Item No.:
41
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Site:
Housekeeping-Outbreak Prevention and Response Plan (OPRP)
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Violation:
The OPRP did not include procedures for informing current and embarking passengers and crew members of an outbreak or procedures for returning the vessel to normal operating conditions after an outbreak or procedures to minimize respiratory and dermal exposures to both passengers and crew. The plan was not specific to the surfaces or items where the disinfectants were to be applied. Also, the plan detailed the use of the sanitizer TOR HB which was replaced with HB QUAT. Concentrations and contact times for the current sanitizer were not detailed in the plan.
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Recommendation:
Ensure each vessel has a written OPRP that details standard procedures and policies to specifically address AGE onboard. Include the following in the written OPRP: (3) Disinfectant products or systems used, including the surfaces or items the disinfectants will be applied to, concentrations, and required contact times. Ensure the disinfectant products or systems are effective against human norovirus or an acceptable surrogate (e.g., caliciviruses); (4) Procedures for informing passengers and crew members of the outbreak. Ensure this section also includes procedures for notification of passengers embarking the vessel following an outbreak voyage or segment of a voyage; (5) Procedures for returning the vessel to normal operating conditions after an outbreak; (6) Procedures to protect the passengers and crew from exposure to disinfectants, if not already included in the vessel's safety management system. Ensure this protection includes: (a) Material safety data sheets (MSDSs); (b) Personal protective equipment for crew; (c) Health and safety procedures to minimize respiratory and dermal exposures to both passengers and crew.
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