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Item No.:
*
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Site:
Medical-Clearance to Return to Work
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Violation:
Staff recently added the date that AGE crew cases were cleared to return to work; however, there was no time documented so it was unclear if the case isolated the full 24-hours or 48-hours as required.
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Recommendation:
Include the date and time an AGE crew case was released from isolation/cleared to return to work.
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Item No.:
01
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Site:
Medical-Acute Gastroenteritis (AGE) 24-Hour Report
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Violation:
There was no record of a 24-hour AGE report submitted before the vessel arrived in Petersburg, Alaska on 16 May 2023 after they visited a foreign port.
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Recommendation:
Ensure the master, medical staff, or other designated staff of a vessel destined for a U.S. port from a foreign port submits 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.
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Item No.:
02
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Site:
Medical-
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Violation:
There was no 3-day assessment documentation for crew members prior to boarding the vessel. Staff stated that corporate maintains documentation which is provided to the crew members and may get turned in up to 5 days prior to boarding. Staff had paper copies of a document which asked new and returning crew members if they have had any symptoms within the last 72-hours, but staff were not providing crew the document upon embarking.
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Recommendation:
Ensure the reportable cases 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 and retain this documentation for 12 months.
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Item No.:
02
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Site:
Medical-Acute Gastroenteritis (AGE) Surveillance Log
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Violation:
The crew AGE case on 4 July 2023 for voyage 102320 was missing their patient ID and age. The crew AGE case on 28 June 2023 for voyage 102319 was missing the date they reported to medical.
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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) Patient ID; (2) Date of the first medical visit or report to staff of illness; (3) time of the first medical visit or report to staff of illness; (4) person's last name; (5) person's first name; (6) person's age; (7) person's sex; (8) designation as passenger or crew member; (9) cabin number; (10) crew member position or job on the vessel, if applicable; (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) bloody stools (yes/no); (c) number of episodes of vomiting in a 24 hour period; (d) fever (yes/no); (e) abdominal cramps (yes/no); (f) headaches (yes/no); (g) myalgia (yes/no); (14) date of last symptom; (15) time of last symptom; (16) entry (yes/no) for whether a specimen was requested; (17) entry (yes/no) for whether a specimen was received; (18) entry (yes/no) for antidiarrheal medications sold or dispensed by designated medical staff; (19) entry (yes/no) for whether this was a reportable case; (20) presence of underlying medical conditions that may affect interpretation of AGE. If none, write ?none,? ?not applicable,? ?N/A,? or similar wording. Comments may also be added to the log in this column after the information about underlying illness. Ensure the AGE surveillance log contains the above information in the exact order and is entered in the template in Annex 13.2.2.
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Item No.:
02
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Site:
Medical-Close Contact Follow-Up
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Violation:
There was no follow-up documentation for any close-contacts of the acute gastroenteritis (AGE) case on 4 July 2023. There was only one follow-up documented for the close contact of the AGE case from 28 June 2023. The form only documented the date of 29 June and did not indicate the time.
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Recommendation:
When any crew member (food or nonfood employee) meets the case definition for AGE, take the following actions for the asymptomatic cabin mates or immediate contacts of symptomatic crew: (1) restrict exposure to symptomatic crew member(s); (2) 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; (3) complete a verbal interview daily with medical or supervisory staff until 48 hours after the ill crew members? symptoms began. Ensure that the first verbal interview is 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, ensure that he or she is contacted by medical or supervisory staff as soon as possible. Document the date and time of verbal interviews.
An immediate contact is someone sharing a cabin either full-time or part-time or sharing a cabin?s bathroom facilities. This includes boyfriends, girlfriends, spouses, and significant others. Ensure to document if the symptomatic crew member has or not cabin mate(s) or other immediate contact(s).
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Item No.:
02
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Site:
Medical-Reporting Definition
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Violation:
During voyage QT-102318, a crew member reported to medical on 13 June 2023 with a history of 'nausea and six plus episodes of non-bloody diarrhea, mild lower abdominal cramps'; however, this case was listed as 'GI-Non Reportable' in the Medical Logbook and was not listed on the Acute Gastroenteritis (AGE) log. During voyage QT-102317, a guest reported to medical on 7 June 2023 with a history of 'diarrhea'; however, this case was listed as 'GI Non-Reportable' in the Medical Logbook and was not listed on the AGE log. During voyage QT-102316, a guest reported to medical on 2 June 2023 with a history of 'abdominal pain, vomiting, diarrhea'; however, this case was listed as 'Guest Illness' in the Medical Logbook and was not listed on the AGE log.
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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.:
06
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Site:
Potable Water-Microbiologic Monitoring
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Violation:
For June 2023, there were no records of the four potable water samples being collected and analyzed for the presence of E. coli. The ship had been sailing to/from the United States since April 2023.
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Recommendation:
Collect and analyze a minimum of four potable water samples per month for the presence of E. coli. Collect samples from the forward, aft, upper, and lower decks of the vessel. Change the sample sites each month so that all of the potable water distribution system is effectively monitored. Conduct follow-up sampling for each positive test result. Maintain sample results onboard the vessel for at least 12 months and ensure they are available for review during inspections.
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Item No.:
06
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Site:
Potable Water-Microbiologic Monitoring
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Violation:
There were no microbiologic results listed in the report for bunkering in Juneau, Alaska on 11 June 2023. Microbiologic testing had not occurred in Juneau. AK within the previous 30 days.
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Recommendation:
Where available, ensure the vessel has a copy of the most recent microbiologic report from each port before bunkering potable water to verify that the water meets potable standards. Ensure the date of the analysis report is 30 days or less from the date of potable water bunkering, and include an analysis for Escherichia coli at a minimum. Maintain microbiologic sample report records on the vessel for 12 months and ensure they are available for review during inspections.
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Item No.:
08
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Site:
Potable Water-Pipe Striping
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Violation:
The pipe leading from the sea chest to the reverse osmosis system was striped blue/green/blue. Additionally, the pipe between the reverse osmosis system and the chemical injection point was striped blue/green/blue in multiple locations.
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Recommendation:
Stripe or paint potable water lines either in accordance with ISO 14726 (blue/green/blue) or blue only. Stripe or paint distillate and permeate lines directed to the potable water system in accordance with ISO 14726 (blue/gray/blue). Ensure no other lines have the above color designations. Stripe or paint these lines at 5 meters (15 feet) intervals and on each side of partitions, decks, and bulkheads, except where decor would be marred by such markings, including potable water supply lines in technical lockers.
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Item No.:
08
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Site:
Potable Water-Tanks
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Violation:
There were no sample cocks located on the potable water tanks. This was noted on the previous inspections. It was not determined how water is sampled from these tanks.
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Recommendation:
Ensure potable water tanks have labeled sample cocks that are turned down. Identify the sample cocks with the appropriate tank number.
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Item No.:
16
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Site:
Galley-Beverage Station
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Violation:
At 1100, eight small dishes filled with a potentially hazardous food (butter) were found by the inspector in the undercounter storage space at the beverage station. Crew stated the butter had been out-for-service at breakfast. The time-control plan stated breakfast hours were from 0600 to 1000.
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Recommendation:
If time only?rather than time in conjunction with temperature?is used as the public health control for a working supply of potentially hazardous food before cooking, or for ready-to-eat potentially hazardous food that is displayed or held for service for immediate consumption, ensure the food is discarded within 4 hours of placement on time control.
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Item No.:
20
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Site:
Galley-Espresso Machine
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Violation:
Three slotted fasteners were in the food splash zone of the counter-mounted espresso machine.
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Recommendation:
Use only low profile, nonslotted, noncorroding, and easy-to-clean fasteners on food-contact surfaces and in splash zones. Prohibit the use of exposed slotted screws, Phillips head screws, or pop rivets in these areas.
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Item No.:
20
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Site:
Galley-Standing Mixer
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Violation:
Two slotted fasteners were in the food splash zone of the standing mixer.
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Recommendation:
Use only low profile, nonslotted, noncorroding, and easy-to-clean fasteners on food-contact surfaces and in splash zones. Prohibit the use of exposed slotted screws, Phillips head screws, or pop rivets in these areas.
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Item No.:
21
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Site:
Galley-Flat-top Grill
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Violation:
There were eight open screw holes in the flat-top grill nonfood-contact area, making the area difficult to clean.
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Recommendation:
Ensure nonfood-contact surfaces are free of unnecessary ledges, projections, and crevices, and designed and constructed to allow easy cleaning and to facilitate maintenance.
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Item No.:
26
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Site:
Galley-Beverage Station
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Violation:
Five previously cleaned and sanitized teapots in the overhead storage compartment at the beverage station had visible debris on the inside. The debris was able to be removed with an alcohol pad.
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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.:
27
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Site:
Galley-Flat-top Grill
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Violation:
The grease trap for the flat-top grill was soiled with more than a day's accumulation of food debris.
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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-Forward Lounge Beverage Station
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Violation:
The inside edges around the garbage chute had more than one day's accumulation of food residue.
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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.:
30
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Site:
Buffet-Forward Lounge Beverage Station
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Violation:
The handwashing sink had cracks near the drain that were visibly discolored.
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Recommendation:
Keep handwashing facilities clean and in good repair.
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Item No.:
33
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Site:
Dining Room-Crew
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Violation:
There was more than a day's accumulation of debris on the deck in the crew food preparation/dining area. Additionally, there was visible debris on the deck in-between the benches.
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Recommendation:
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:
Buffet-
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Violation:
Three white tiles around the buffet station were chipped.
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Recommendation:
Ensure decks, bulkheads, and deckheads in food preparation, warewashing, pantries, bars, and food and equipment storage areas are constructed and maintained for easy cleaning.
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Item No.:
33
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Site:
Bar-
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Violation:
There was no coving at the cabinet and bulkhead to deck juncture. Sealant was used in some areas for coving and was in disrepair and/or missing along bulkhead/deck juncture below the windows.
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Recommendation:
Cove all bulkhead/deck, equipment/deck, cabinet/deck, and deck sink coaming/deck junctures (including galleys, pantries, buffets, bars, waiter stations, dining room work counters, provisions, food storage rooms, equipment/utensil storage rooms, and toilet rooms intended for use by galley personnel).
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Item No.:
33
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Site:
Bar-
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Violation:
A soiled towel was on the deck in the technical compartment below the utility sink. The towel was previously used to soak up water from a leak.
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Recommendation:
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.:
44
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Site:
Potable Water-Distribution System
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Violation:
Staff were not aware that disinfection records for the potable water distribution system (e.g., backflow prevention devices, potable water pipes) were required.
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Recommendation:
Ensure the supervisor or person in charge of potable water operations on the vessel demonstrates to VSP?during inspections and on request-knowledge of potable water operations, is able to demonstrate this knowledge by compliance with Section 5 of the VSP 2018 Operations Manual or by responding correctly to the inspector?s questions as they relate to the specific operation, and properly trains employees to comply with Section 5 of the VSP 2018 Operations Manual as it relates to their assigned duties.
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Item No.:
44
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Site:
Medical-
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Violation:
The person in charge of medical operations did not clearly demonstrate knowledge of the requirements per the VSP 2018 Operations Manual. Staff stated doctors rotate every week. The consistent crew member in charge of the medical center did not accurately state the definition of an acute gastroenteritis (AGE) case or time frames to follow up on close-contacts.
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Recommendation:
Ensure the supervisor or person in charge of medical operations related to AGE on the vessel demonstrates to VSP?during inspections and on request?knowledge of medical operations related to AGE, is able to demonstrate this knowledge by compliance with Section 4 of the VSP 2018 Operations Manual or by responding correctly to the inspector?s questions as they relate to the specific operation, and properly trains employees to comply with Section 4 of the VSP 2018 Operations Manual as it relates to their assigned duties.
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