Tracking 341i1r10e Proposed NSF 341 © 2008 NSF Issue 1, Revision 10e (September 2008) This document is part of the NSF International standard development process. This document is subject to change and may be a draft and/or non-final version. Committee members may reproduce, quote from, and/or circulate this document to persons or entities outside of their organization after first providing NSF International with written notice of to whom and for what purpose this document is to be shared. NSF International Standard for Health/Fitness Facilities ― Health/Fitness Facilities 1 General 1.1 Scope David Herbert Comment: What of tennis clubs, golf clubs, etc. ACSM standards perhaps defined too broadly? Only just written? Policies? Why? This Standard covers health/fitness facilities that offer activity-based health and fitness programs/services or that promote moderate- to vigorous-intensity recreational physical activity. It also covers written emergency policies and procedures for health/fitness facilities. This Standard contains requirements related to pre-activity screening; orientation, education, and supervision; risk management and emergency policies; professional staff and independent contractors; facility design and construction; equipment; operating practices; and signage for health/fitness facilities. It is intended to assist in providing a safe environment for those who engage in the activities and programs offered by the health/fitness facility. David Herbert Comment: This Standard contains requirements related to pre-activity screening; orientation, education, and supervision; risk management and emergency policies; professional staff and independent contractors; facility design and construction; equipment; operating practices; and signage for health/fitness users and/or facilities. It is intended to assist in providing a relatively safe environment for those who engage in the activities and programs offered by the health/fitness facility facilities. 1.2 Normative references David Herbert Comment: Should it not be foundational source materials? If it states requirements then is everything really a standard? Isn’t this as it is titled a standard? If so, state standard. The following documents contain provisions that constitute requirements of this Standard. At the time of publication, the indicated editions were valid. All standards are subject to revision, and parties are encouraged to investigate the possibility of applying the recent editions of the standards indicated below. ACSM’s Health/Fitness Facility Standards and Guidelines were used as the basis of this guideline Standard. For further detail on the documentation on the requirements herein, consult ACSM’s Health/Fitness Facility Standards and Guidelines. ACSM1 Health/Fitness Facility Standards and Guidelines, 3rd edition Health Insurance Portability and Accountability Act of 1996 (HIPAA) 1 American College of Sports Medicine (ACSM), 401 West Michigan Street, Indianapolis, Indiana 46202-3233. 1 Tracking 341i1r10e Proposed NSF 341 © 2008 NSF Issue 1, Revision 10e (September 2008) Occupational Safety and Health Standards 29 CFR 1910.1200 Hazard Communication Occupational Safety and Health Standards 29 CFR 1910.1030 Bloodborne pathogens 21 CFR 801.109 Prescription devices ASTM F1749-02 Standard specification for fitness equipment and fitness facility safety signage and labels 1.3 Definitions 1.3.1 accredited certifying organization: a certifying organization that has received third-party approval of its certification procedures and practices from an appropriate agency, such as the National Commission for Certifying Agencies (NCCA). David Herbert comment: What is an appropriate agency? Can lead to confusion – include NCCA, or an accrediting organization recognized by USDE and/or CHEA. Graham Melstrand comment: 1.3.1 It is important to differentiate between organizations that accredit academic programs vs. those that accredit certification programs. The suggestion to include USDE and CHEA accredited EDUCATION programs would be inconsistent with nearly all professions that provide a firewall between academic preparation and demonstration of competence via a CREDENTIALLING (certification or licensure exam) which are typically accredited through the NCCA. It would be unwise to encourage the fitness industry to follow a path that deviates so significantly from other industries and professions. 1.3.2 automated external defibrillator (AED): an electronic device that can detect certain life- threatening cardiac arrhythmias and then administer an electrical shock that can restore the normal sinus rhythm 1.3.3 barrier protection apparel: Gowns, gloves, masks, and eye shields worn to help protect the staff person from bodily fluids and chemicals. David Herbert comment: barrier protection apparel: Gowns, preventive clothing, gloves, masks, and eye shields worn to help protect the staff person from bodily fluids and chemicals. 1.3.4 BCLS (Basic Cardiac Life Support): Includes recognition of signs of sudden cardiac arrest (SCA), myocardial infarction (MI) or heart attack, stroke, and foreign body airway obstruction; performance of cardiopulmonary resuscitation (CPR); and performance of defibrillation with an AED, all in accordance with current guidelines of the American Heart Association. David Herbert comment: Does this definition contemplate staff ability to differentiate between these events? 1.3.5 health/fitness facility: a facility that offers exercise-based health and fitness programs/services or that promotes moderate- to vigorous-intensity physical activity and has supervised exercise spaces. David Herbert comment: What does this mean? At all times? 1.3.6 Health/fitness facility member: an individual who pays either monthly dues or annual dues for the privilege of engaging in the activities, programs, and services of the facility. David Herbert comment: an individual health/fitness facility user who pays either monthly dues or 2 Tracking 341i1r10e Proposed NSF 341 © 2008 NSF Issue 1, Revision 10e (September 2008) annual dues for the privilege of engaging in the activities, programs, and services of the facility. 1.3.7 Health/fitness facility user: an individual who accesses a facility on one and possibly more than one occasion without purchasing a membership to the facility. David Herbert comment: an individual who accesses a facility on one and possibly or more than one occasion times with or without purchasing a membership to the facility. 1.3.8 health history questionnaire (HHQ): a pre-activity screening tool that reflects a member’s health history David Herbert comment: Define these – HHQ, HRA - one is self-administered – one is interpreted by qualified staff. 1.3.9 health risk appraisal (HRA): a pre-activity screening tool designed to give members an indication of their overall health status 1.3.10 material safety data sheet (MSDS): Documentation that contains information such as physical data (melting point, boiling point, flash point, etc.), toxicity, health effects, first aid, reactivity, storage, disposal, protective equipment, and spill/leak procedures for handling or working with a particular substance. 1.3.11 physical activity readiness questionnaire (PAR-Q): a simple one-page questionnaire that asks questions that allow the user or a facilitator easily to identify major health conditions: signs or symptoms suggestive of coronary heart disease; risk factors for cardiovascular disease; medications; or other major medical conditions that may elevate the participant’s risk of medical complications during exercise. 1.3.12 Public Access Defibrillator (PAD) program: a program for responding to cardiac arrest using automated external defibrillators staffed (facility): Any facility with 1 or more persons on duty during any part of the facilities operating hours. Steve Tharett’s Comments: staffed (facility): Any facility with 1 one or more persons on duty during at least 50% any part of the facilities operating hours. 2 Pre-activity screening 2.1 All health/fitness facilities offering exercise equipment and/or staffed services shall offer a general pre-activity cardiovascular risk screening, e. g., Physical Activity Readiness Questionnaire (PAR-Q) and/or a specific pre-activity screening tool, e. g., health risk appraisal (HRA), or health risk questionnaire (HRQ) to all new members and prospective users: – a general pre-activity cardiovascular risk screening questionnaire, e. g., Physical Activity Readiness Questionnaire (PAR-Q); and/or All screening procedures should be quick, simple, and easy to perform; the process should encourage acceptance of the opportunity to participate in the pre-activity screening. David Herbert comment: a general pre-activity cardiovascular risk screening questionnaire tool, e. g., Physical Activity Readiness Questionnaire (PAR-Q); and/or Make consistent in definitions. 3 Tracking 341i1r10e Proposed NSF 341 © 2008 NSF Issue 1, Revision 10e (September 2008) – a specific pre-activity screening tool, e. g., health risk appraisal (HRA) or health history questionnaire American Heart Association / American College of Sports Medicine Health/Fitness Facility Pre-participation Screening Questionnaire (HHQ). Prospective members and/or users who fail to complete the pre-activity screening procedures on request should be permitted to sign a waiver or release that allows them to participate in the program offerings of the facility. In those instances where such members and/or users refuse to sign a release or waiver, they should be excluded from participation to the extent permitted by law. Members and Users shall be offered the pre-activity screening prior to their participation. If a member or user declines the pre-activity screening, s/he shall sign a waiver for the screening. David Herbert comment: Shouldn’t waivers be signed anyway? The pre-activity screening may should be repeated at appropriate on annual intervals and may should be either general (e. g., a Physical Activity Readiness Questionnaire [PAR-Q]), or specific (e. g., a health risk appraisal [HRA] or health history questionnaire [HHQ]). Screenings may be either self-administered, or conducted by a fitness or healthcare professional. 2.2 All specific pre-activity screening tools (e. g., HRA, HHQ) shall be interpreted by qualified staff (see 5), and the results of the screening shall should be documented. Information should be collected on whether participation in physical activity presents a heightened cardiovascular and/or medical risk for a prospective member or user of a health/ fitness facility; this information should include known cardiovascular risk factors as set forth by the American Heart Association and/or ACSM such as including blood pressure, resting heart rate hypertension, family history of heart disease, age, gender, cigarette smoking, dyslipidemia, pre-diabetes, physical inactivity and body mass index as enumerated within the current edition of ACSM’s Guidelines for Exercise Testing and Prescription. In the event a risk factor is unknown or if there is no answer to a question on the PAR-Q or HHQ, the response shall be treated as though it was an affirmative answer (for example, if the cholesterol is unknown, it is treated as though the cholesterol was > 200 mg/dL). A user’s health information shall be kept in accordance with current standard practices outlined by the Health Insurance Portability and Accountability Act of 1996 (HIPAA; Public Law 104-191, enacted on August 21, 1996). 2.3 If, as a result of pre-activity screening, a facility becomes aware that a member or user has a known cardiovascular, metabolic, or pulmonary disease, or two or more major cardiovascular risk factors, or any other major self-disclosed medical concern; two or more major cardiovascular risk factors; or any other major self-disclosed medical concern, as a result of a pre-activity screening, then that member or user shall be advised in writing to consult with a qualified healthcare provider such as a physician before beginning a physical activity program. The American College of Sports Medicine (ACSM) has developed a practical approach to risk stratification that can be used to classify individuals as low, moderate, or high risk (see ACSM’s Guidelines for Exercise Testing and Prescription). Based on this classification, the facility shall recommend that a high-risk members or users identified as such by the facility-administered pre-activity screening protocol see a qualified healthcare provider. ACSM’s stratification can be subsequently used to provide recommendations for receiving further evaluation. David Herbert comment: The American College of Sports Medicine (ACSM) has developed a practical approach to risk stratification that can be used to classify individuals (or users?) as low, moderate, or high risk (see ACSM’s Guidelines for Exercise Testing and Prescription). Based on this classification, the facility shall recommend that a such high-risk members or users identified as such by the facility- administered pre-activity screening protocol see a qualified healthcare provider. ACSM’s stratification can be subsequently used to provide recommendations for receiving user’s further evaluation. 4 Tracking 341i1r10e Proposed NSF 341 © 2008 NSF Issue 1, Revision 10e (September 2008) If a user needs to receive medical clearance before participating in a particular activity program, the facility shall provide the appropriate forms to the user to take to a qualified health-care professional such as a physician. David Herbert comment: Which are? – All members and users who are identified as having cardiovascular or medical risk factors that merit medical consultation should be provided with appropriate information concerning the importance of obtaining such consultation from a qualified healthcare provider before beginning an exercise program. – All members or users who have been identified (either through pre-activity screening or by self-disclosure) as having cardiovascular, metabolic, or pulmonary disease or symptoms or any other potentially serious medical concern (e.g., orthopedic problems) and who subsequently fail to get consultation should be permitted to sign a waiver or release that allows them to participate in a facility’s program offerings. In those situations where such members or users refuse to sign a waiver or release, they should be excluded from participation to the extent permitted by law. 3 Orientation, education, and supervision Once a new member user has completed a pre-activity screening process, all staffed facilities shall offer the member user a general orientation to the facility, covering topics that may include, but are not limited to: Steve Tharett’s Comments: Once a new member/user has completed a pre-activity screening process, all staffed facilities shall offer the member/user a general orientation to the facility, covering topics that may include, but are not limited to:. – basic instructions concerning use of the various pieces of physical activity equipment available in the facility; – resources available within the facility to help with developing suitable physical activity programs (e. g., personal training services, special fitness classes, fitness media library, online personal training experts); and – introduction to a general physical activity regimen that members and users can follow. Steve Tharett’s Comments: introduction to a general physical activity regimen that members/ and users can follow. 4 Risk management and emergency policy standards NOTE – Records shall be maintained for the policies and procedures describe in 4. For examples of documentation see Annex A. 4.1 Emergency response policy 4.1.1 Facilities shall have written emergency response system policies and procedures, which shall be reviewed regularly and rehearsed quarterly. These policies shall enable staff to handle respond to basic first-aid situations and emergency cardiac events. 5 Tracking 341i1r10e Proposed NSF 341 © 2008 NSF Issue 1, Revision 10e (September 2008) David Herbert comment: Do we exclude pulmonary events? What of instances of serious injury – bleeding –terrorist activities, etc.? NOTE – If facilities need assistance beyond the requirements in this section in matters of preparing emergency policies, procedures, and practices relevant to their setting, they will find the contents of the 1998 and 2002 ACSM/AHA publications to be helpful resources. Aspects of a facility’s emergency response system shall include, but are not limited to, the following: Steve Tharett’s Comments: Aspects of a facility’s emergency response system policies and procedures shall include, but are not limited to, the following. – addressing the major emergency situations that might occur. Among the situations are medical emergencies that are reasonably foreseeable with the onset of moderate or more intense exercise, such as hypoglycemia, sudden cardiac arrest, heart attack, stroke, heat illness, and injuries that are orthopedic in nature; – addressing other foreseeable emergencies not necessarily associated with physical activity, such as fires, natural disasters, hostage situations or chemical accidents; Steve Tharett’s Comments: addressing other foreseeable emergencies not necessarily associated with physical activity, such as fires, natural disasters, hostage situations or chemical accidents. David Herbert comment: addressing other foreseeable emergencies not necessarily associated with physical activity, such as weather, fires, natural disasters, hostage situations or chemical accidents; David Herbert comment: Need better language. – explicit steps or instructions on how each emergency situation will be handled and the roles that should be played by first, second, and third responders to an emergency. In addition, the emergency response system shall provide locations for all emergency equipment (e. g., contact information for EMS, the most favorable access ways for the EMS personnel, as well as the steps necessary for contacting the local EMS; and signage required in 11a); Steve Tharett’s Comments: explicit steps or instructions on how each emergency situation will be handled and the roles that should be played by first, second, and third responders to an emergency. In addition, the emergency response system policies and procedures shall provide locations for all emergency equipment (e. g., contact information for EMS, the most favorable access ways for the EMS personnel, as well as the steps necessary for contacting the local EMS; and signage required in 11a);. – full documentation of the system via staff training and emergency instructions, kept in an area that can be easily accessed by the facility staff. In addition, the emergency response system shall be reviewed with each staff member on a regular basis; Steve Tharett’s Comments: full documentation of the system policies and procedures via staff training and emergency instructions, kept in an area that can be easily accessed by the facility staff. In addition, the emergency response system policies and procedures shall be reviewed with each staff member on a regular basis – physical rehearsal, at least two times per year, of a cardiac emergency event with notations maintained in a log book that indicate when the rehearsals were performed and who participated; 6 Tracking 341i1r10e Proposed NSF 341 © 2008 NSF Issue 1, Revision 10e (September 2008) David Herbert Comment: physical rehearsal, at least two times per year, of a cardiac emergency event with notations maintained in a log book that indicate when the rehearsals were performed and who participated and the results and recommendations as may be available; – first-aid kits; – an automated external defibrillator (AED); – an on-site coordinator (i. e., a staff member who is responsible for a facility’s overall level of emergency readiness). NOTE – Facilities should use local healthcare or medical personnel to help them develop their emergency response programs. 4.1.2 Facilities shall should have a written self-inspection (safety audit) that routinely inspects all areas to reduce or eliminate unsafe hazards that may cause injury to employees and users. Steve Tharett’s Comments: Facilities shall should have a written self-inspection (safety audit) that routinely inspects all areas of the facility to reduce or eliminate unsafe hazards that may cause injury to employees and member/users. NOTE - The likelihood of a severe injury or the probability minor injury with a high frequency of a occurrence shall require a higher frequency of inspections. 4.2 Handling of potentially hazardous materials Facilities shall have a written system for sharing information with users and employees or independent contractors regarding the handling of potentially hazardous materials, including the handling of bodily fluids by the facility staff in accordance with the guidelines of the Occupational Safety and Health Administration (OSHA). To comply with OSHA guidelines and reduce the risk to users and staff, facilities shall perform the following actions: – Make sure that the Maintain a current material safety data sheet (MSDS) for every chemical and agent used in the facility is posted in a location for all workers to see binder that is readily available to all staff members; Steve Tharett’s Comments: Make sure that the Maintain a current material safety data sheet (MSDS) for every chemical and agent used in the facility is posted in a location for all workers to see binder document (e.g., written and/or electronic) that is readily available to all staff members – Provide, at a minimum, an annual MSDS binder that each staff member shall review for all staff and specific training for workers in the handling of chemicals and agents, and maintain a signed record of that review documentation for each staff member; NOTE – MSDS training shall be provided for new hires during orientation. – Store all chemicals and agents in properly locked locations off limits to users and ensure that chemicals and agents are stored off the floor; Steve Tharett’s Comments: Store all chemicals and agents in properly locked locations off limits to members/users and ensure that chemicals and agents are stored off the floor; 7 Tracking 341i1r10e Proposed NSF 341 © 2008 NSF Issue 1, Revision 10e (September 2008) – Ensure that chemicals and agents are stored off the floor and in an area that is off limits to users and has locks to prevent accidental or inappropriate entry Provide proper safety equipment to prevent and address accidents; e.g., eye wash stations; (an approved eye wash station shall have a minimum 7 0.4 GPM flow rate and a 15 min water supply flow); – Provide regular training to workers in the handling of chemicals and agents; – Post the appropriate signage to warn users that they may be exposed to hazardous agents (see 11a); – Provide training for staff regarding how to handle bodily fluids; NOTE – OSHA provides training materials, as do other organizations. – Provide literature that each staff member shall review on the proper handling of bodily fluids, and maintain a signed record of that review for each staff member; – Make sure that the staff members who are handling towels, bar soap, or razors; cleaning or picking up papers; or cleaning exercise equipment wear surgical-style gloves; – Provide training and maintain documentation for staff regarding how to properly handle bodily fluids, including preventative measures for handling towels, bar soap, razors and other potential hazards; and – Follow a documented system for cleaning contaminated surfaces and disposing of items containing bodily fluids. If blood is visible on a surface, it shall be cleaned off immediately with bleach or a similar agent by a staff member wearing barrier protection apparel (e. g., impermeable gloves, protective facewear). All cleaning materials and all fluids shall be disposed of in biowaste containers. 4.3 Public access defibrillation (PAD) program In addition to complying with all applicable federal, state, and local requirements relating to AEDs, each facility, staffed facilities shall have as part of their written emergency response system a public access defibrillation (PAD) program (see annex B) in accordance with this section. Steve Tharett’s Comments: In addition to complying with all applicable federal, state, and local requirements relating to AEDs, each facility, staffed facilities shall have as part of their written emergency response system policies and procedures a public access defibrillation (PAD) program (see annex B) in accordance with this section 4.3.1 AEDs in a facility should be located within a 1.5-minute walk of any potential collapse site. NOTE – The intent of this requirement is to encourage facilities to achieve a response time from collapse caused by cardiac arrest from defibrillation to four minutes or less. 4.3.2 A skills review, and practice sessions, and a practice drill with the AED shall be held a minimum of every six months, as recommended by the AHA’s Emergency Cardiac Care Committee and a number of international experts. The sessions shall cover special types of cardiac emergencies including, but not limited to, those involving water; children; transdermal medication; and implanted pacemakers or implanted cardioverter defibrillators (ICDs). AED practice drills every six months are recommended for health/fitness facilities. 4.3.3 Each facility shall have an AED program coordinator who is responsible for all aspects of the emergency plan and the use of the AED. 8 Tracking 341i1r10e Proposed NSF 341 © 2008 NSF Issue 1, Revision 10e (September 2008) 4.3.4 The program coordinator shall monitor and maintain the AED according to the manufacturer’s specifications,. and maintenance records Records relating to the monitoring and maintenance of the AED shall be maintained as part of the facility’s emergency response system records. Steve Tharett’s Comments: The program coordinator shall monitor and maintain the AED according to the manufacturer’s specifications,. and maintenance records Records relating to the monitoring and maintenance of the AED shall be maintained as part of the facility’s emergency response system records 4.3.5 The facility shall record all incidents involving the administration of an AED and report them to the physician who is providing oversight as soon as possible, no more than one day within 24 h after the incident. Steve Tharett’s Comments: The facility shall record all incidents involving the administration of an AED and report them to the physician who is providing oversight as soon as possible, no more than one day within 24 h hours after the incident. 4.3.6 All fitness staff and support staff members who are likely to be put in a situation where they may have to administer an AED shall should be appropriately trained and certified in a course that incorporates the administration of the AED from an accredited training organization. Records of training and retraining shall be maintained in staff personnel records or as part of the documentation of the facility’s emergency response system. 4.3.6 The location of each AED shall have the following characteristics: – easily accessible (e.g. placed at a height so those shorter individuals can reach and remove, unobstructed access, etc.); – secure, likely to prevent or minimize the potential for tampering, theft, and/or misuse, and precluding access by unauthorized users; – well marked, publicized, and known among trained staff; and – near a telephone that may be used to call backup, security, EMS, or 911. 4.3.7 Facility staff requirements 4.3.7.1 A staffed facility shall have assign at least one staff member to be on duty during all facility operating times who is currently trained and certified in Basic Cardiac Life Support (BCLS) and administration of an AED. Steve Tharett’s Comments: A staffed facility shall have assign at least one staff member to be on duty during all facility operating times hours who is currently trained and certified in Basic Cardiac Life Support (BCLS) and administration of an AED. 4.3.7.2 A partially-staffed facility shall assign at least one staff member to be on duty, during staffed operating times who is currently trained and certified in BCLS and administration of an AED. 5 Professional staff and independent contractors 5.1 The health/fitness professionals who have supervisory responsibility for the physical activity programs (i. e., who supervise and oversee members and users, staff, and independent contractors) of the facility shall have an appropriate level of professional education, work experience, and/or certification. 9 Tracking 341i1r10e Proposed NSF 341 © 2008 NSF Issue 1, Revision 10e (September 2008) The health/fitness professionals who serve in a supervisory role are the fitness director, group exercise director, aquatics director, and program director. Table 5.2 provides examples of what might be considered an appropriate blend of professional education, certification, and work experience for some of the primary supervisory positions within the health and fitness industry. Steve Tharett’s Comments: The Examples of health/fitness professionals who serve in a supervisory role are include the fitness director, group exercise director, aquatics director, and program director. Table 5.2 provides examples of what might be considered an appropriate blend of professional education, certification, and work experience for some of the primary supervisory positions within the health and fitness industry. Graham Melstrand comment: 5.1 Most professions require that practitioners pass a credentialing exam in addition to earning a degree as a means of demonstrating minimum competence. While a degreed professional may be more desirable, particularly in a leadership role, it is still important for those individuals to demonstrate their proficiency against a standardized exam. Suggestion would be to hold a minimum of: an accredited certification, or a four-year degree and accredited certification + appropriate experience as necessary for the front line or more senior positions Table 5.2Recommended competency criteria for program supervisors in the health and fitness industry Professional position Professional Professional Professional education certification experience Aquatics director 4-year degree in fitness, Certification in Minimum of 3 years’ exercise science, or advanced lifesaving and experience as a related field from an water safety from a lifeguard, water safety accredited college or nationally recognized instructor, or swim university is organization is instructor is recommended, but not recommended. recommended. required. Certification as a pool operator from either a national (NSPI) or local organization or governmental agency is recommended. Fitness director 4-year degree in fitness Fitness instructor or Minimum of 3 years’ or health related field personal trainer experience as a fitness from an accredited certification from professional working in college or university. nationally recognized the fitness and health and accredited certifying industry in a organization. health/fitness facility is recommended. Group exercise director 2 years post-high school Group exercise Minimum of 3 years’ education in fitness, instructor certification experience as a group health, recreation, or from a nationally exercise instructor related field from an recognized and working in the fitness accredited college or accredited certifying and health industry in a university is organization. health/fitness facility is recommended but not recommended. required. Program director 4-year degree in fitness, Certification in fitness, Minimum of 3 years’ exercise science, or group exercise, or experience working as related field is related recreational field an instructor or recommended but not from a nationally supervisor of physical required. recognized and activity or recreation 10