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FOOD SAFETY / FOOD AND WATER DEFENSE PROGRAMS Maria Tatekawa, SMSgt Manager, Public Health and Prevention Branch Office of the Air Surgeon DSN/COM: (240) 612-8581 Email: [email protected] Current as of 13 July 2016 Guarding America - Defending Freedom Overview Tri-Service Food Code, AFMAN 48-147 Operational Rations Food Vulnerabilities Guarding America - Defending Freedom The Tri-Service Food Code (TSFC) TB MED 530/NAVMED P-5010-1/AFMAN 48-147_IP

Guarding America - Defending Freedom Overview Document Sources Applicability General Principles Major Changes DD Form 2973, Food Operation Inspection Report Guarding America - Defending Freedom Document Sources AFMAN 48-147_IP, Tri-Service Food Code (TSFC) http://static.e-publishing.af.mil/production/1/af_sg/publication

/afman48-147/afman48-147.pdf http ://armypubs.army.mil/med/DR_pubs/dr_a/pdf/tbmed530.pdf DD Form 2973, FOOD OPERATION INSPECTION REPORT http://www.dtic.mil/whs/directives/forms/eforms/dd2973.pdf Guarding America - Defending Freedom Applicability All Services CONUS & OCONUS Does not apply during OCONUS exercises where Food and Water Risk Assessments are conducted at commercial facilities or foreign military food operations. Does not replace veterinary regulations (e.g., AR 40657/NAVSUP 4355.4H/MCO P10110.31H; or the DOD MIL-HDBK 3006C) Guarding America - Defending Freedom General Principles

Categories of importance & other symbols Symbol Description Asterisk * Superscripted letter S Superscripted letter N Superscripted dagger Meaning Designates a CRITICAL provision Designates a SWING provision (may or may not be considered CRITICAL) Designates a NONCRITICAL provision Indicates the provision was added by the Uniformed Services and is not presented in the FDA Food Code Guarding America - Defending Freedom General Principles Category Definitions CRITICAL refers to a condition/provision that is likely to result in food

contamination, illness, or a significant environmental health hazard SWING provisions represent criteria that are generally critical, but may be considered a non-critical violation, depending on the circumstances. Regulators must apply professional judgment. Consistency among inspection team members will decrease frustration among food facility managers. Provisions containing Swing items: 3-202.11 Temperature* (food receiving) 3-301.11 Preventing contamination from hands* 5-205.15 System maintained in good repair* (plumbing) 7-201.11 Separation* (poisonous or toxic materials)

7-208.11 Storage* (first-aid supplies) 7-301.11 Separation* (retail sale/stock poisonous or toxic materials) Guarding America - Defending Freedom General Principles Risk Category Inspection Frequency Examples of Facilities Extremely High Monthly Shipboard; Hospital nutrition care serving in- or out-patients; Child Care Facilities1; Field foodservice (tactical) High Quarterly

Dining Facility (DFAC); Fast-food concessions; Community club High Quarterly Retail Store: Large retail store providing one or more of the following Advanced2 food services: rotisserie chicken; on-site macaroni, tuna, egg, or potato salad prep, sandwich prep/Panini; sushi bar; self-serve salad/soup/buffet bar; bakery (preparation by mixing raw ingredients); fresh seafood department Moderate 6 months Small food concession; Coffee shop (packaged food; not prepared on site); Ice cream shop; Mobile snack truck Moderate

6 months Retail Store: Retail stores providing Basic2 food services; characterized as retail stores providing typical grocer services (commercially packaged goods) and may include one or more of the following: limited bakery (bakes using frozen products or pre-mixed dough); deli that does not perform cooking or food prep from raw ingredients; self-serve sandwiches (hot breakfast or commercially packaged); hot dogs, pizza, or other pre-cooked foods held in hot holding for individual service. Examples include: Mini-mart, Shoppette/ Express, or gas station retail store. Low Annually Vending machine operations; Food establishments dispensing non-PHFs only Guarding America - Defending Freedom Major Changes Regulatory inspection types (8-400.20 [page 151] and 8-6)

Inspection Type Description Pre-operational conducted before a facility is authorized to open for business; new facility Routine planned inspection; unannounced and always comprehensive Complaint investigates specific issue/concern presented by a customer Follow-up conducted as a result of a non-compliant rating (shall be

conducted no later than 5 calendar days following the NonCompliant inspection) Other (specify) Walk-through, self-evaluation, or contract performance Guarding America - Defending Freedom Major Changes Food establishment self-evaluations (8-402.12 [page 156]) Performed & documented weekly by food establishment manager/PIC; Documented using the Food Operation Inspection Report or other appropriate self-evaluation checklist. Records retained on site for 1 year. Daily informal assessments do not require documentation. Documents reviewed by regulatory authority during routine inspections. Guarding America - Defending Freedom Major Changes

Inspection frequencies Minimum frequencies recommended for each type of food operation based on Assumed risk associated with operation complexity Primary population served Historical inspection performance Guarding America - Defending Freedom Major Changes Inspection Rating Criteria (page158) Process is no longer subjective Rating Fully Compliant Substantially Compliant Partially Compliant Non-Compliant 1 2

Criteria No deficiencies No Imminent Health Hazard (IHH)1; Two or less Critical findings Corrected on Site (COS)2; Five or less Non-Critical findings No IHH Three or more Critical findings COS; Six or more Non-Critical findings Any IHH present Any Critical findings not COS

Presence of any imminent health hazard results in a Non-Compliant rating. Presence of any Critical finding that cannot be corrected on site results in a Non-Compliant rating. Guarding America - Defending Freedom Major Changes Time frame for corrections and follow-up inspections (8-405.11 & 8-406.11 [page 160]) Critical findings shall be corrected on-site (COS) (i.e. during the inspection); Non-compliant inspection ratings require a formal follow-up within 5 calendar days. Critical findings not COS will result in a Non-Compliant inspection rating Follow-up inspections are documented on the Food Operation Inspection Report, DD Form 2973. Follow-up inspections will continue (within 5 calendar days of the last inspection) until the critical finding is completed

Non-critical findings must be corrected by a date & time agreed to or specified by the regulatory authority & no later than 30 calendar days. Follow-up inspection to verify correction of non-critical violations are at the discretion of the regulatory authority. Guarding America - Defending Freedom Major Changes Medical Authority vs. Regulatory Authority The designation of these roles was not consistently applied by each Service Medical authority is the medical commander or command surgeon whose authority is above the preventive medicine, public health, or veterinary activity performing food safety surveillance Regulatory authority is the public health, preventive medicine, or Vet asset with jurisdiction over the food establishment to conduct food

safety surveillance Highly susceptible population Definition broadened to include Service members during Initial Entry Training Military, DOD civilians, and contract personnel during deployments & afloat Personnel in field exercises lasting > 2 weeks Guarding America - Defending Freedom Major Changes Potentially hazardous food (PHF) Now called Potentially Hazardous Foods Time and Temperature Control for Safety Foods [PHF(TCS)]

Includes heat-treated plant foods, raw seed sprouts, cut melons, cut leafy greens, and cut tomatoes Safe Temperatures for holding PHF(TCS) food Cold holding temp changed from 40oF to 41oF (5oC) or below. Hot holding reduced from 140oF to 135oF (57oC) or above Temperature Danger Zone is 42oF (6oC) through 134oF (56oC) inclusive Cold Holding Temperature Danger Zone

Hot Holding Less than or equal to 41oF (5oC) 42oF (6oC) through 134oF (56oC) inclusive Greater than or equal to 135oF (57oC) Guarding America - Defending Freedom Major Changes Leftovers (3-501.110 [p. 580]) Cold hold up to 72 hours Hot hold until consumed or discarded Topping off hot hold items is prohibited

Retention of foods containing leftover items as an ingredient is prohibited (no leftover leftovers) Time Only as a Public Health Control (3-501.19 [p. 57]) 4-hour rule unchanged for hot & cold holding in temperature danger zone New 6-hour rule: Chilled PHF(TCS) food may be held for up to 6 hours outside of the safe temperature zone as long as the food does not exceed 70oF at any time during the 6hour period Facility must have a written procedure that is approved by the regulatory authority before Time Only may be employed. Does not include food prep time Guarding America - Defending Freedom DD Form 2973 Inspection form: DD Form 2973, Food Operation Inspection Report Used for ALL food service operation types (except Tactical Kitchens, which require DD Form 2974, Tactical Kitchen Food Sanitation Inspection)

Replaces: DA Forms 5161-R, 5161-1-R , 5162-R; MEDCOM Form 640-R; AF Form 977 (obsolete), and NAVMED 6240/1 (and all local variations). Customization of the DD Form 2973 without authorization is not permitted. Guarding America - Defending Freedom Operational Rations Guarding America - Defending Freedom Overview Purpose Types of Rations Location and Frequency of Local Rations Inspections Guarding America - Defending Freedom Purpose PLACE PURPOSE OF RATION INSPECTIONS

Guarding America - Defending Freedom MRE Meal Ready-to-Eat (MRE) Guarding America - Defending Freedom 31 Meal, Religious Meal, Religious, Kosher/Halal Guarding America - Defending Freedom 32 MCW/LRP Meal, Cold Weather/Long Range Patrol Guarding America - Defending Freedom

33 TOTEM Tailored Operational Training Meal Guarding America - Defending Freedom 34 HDR Humanitarian Daily Ration Guarding America - Defending Freedom 35 Survival, GP Survival, General Purpose, Improved (GP-I) Sustain an individual under all environmental conditions, including escape & evasion Contains 5 compressed bars, lemon tea, sugar,

and soup 1446 calories Individual prepares foodH2O needed for beverage Guarding America - Defending Freedom 36 Types and Scheduling of Inspections Receipt Inspections Surveillance Inspections Warranty Inspections Prior to Sale or Shipment (Surveillance) Special

Guarding America - Defending Freedom 37 Food and Water Vulnerability Assessment (FVA) Guarding America - Defending Freedom Overview Food Defense Goals References Roles and Responsibilities Procedures for conducting a FVA Reporting/routing

Guarding America - Defending Freedom Food Defense Goals Risk Management Deter Contamination Delay Contamination Detect Contamination Respond to Contamination Guarding America - Defending Freedom References

AFI 10-245, Antiterrorism AFI 10-246, Food and Water Protection Program AFI 48-116, Food Safety Program USAFSAM/PHR Guarding America - Defending Freedom Food Defense Food Defense - protecting the food supply from deliberate or intentional acts of contamination or tampering The World Health states that the contamination of terrorists is a real

threat and could impact Guarding America - Defending Freedom Organization malicious food by and credible have global Antiterrorism Officer (ATO) Core Vulnerability Assessment Management Program (CVAMP) DTRA Classifications Mitigation ATWG FPWG

TWG High Risk Vulnerability Medium Risk Concern Low Risk Concern Neutral Observation Positive Observation Guarding America - Defending Freedom Risk Management is a cyclic systematic process to address potential hazards. It is a structured, common sense approach that can be applied to reduce risks and ensure that the best security measures are applied to daily operations (in this context, the food and water supply)

RM Five-Step Process The RM five-step process is a continuous cycle and only works if all five steps are followed in sequence as each is a building block for the next step Guarding America - Defending Freedom DoD Risk Matrix for BW Threat (HAZARD PROBABILITY) Medical Risk GREATEST GREATEST Catastrophic

Anthrax Bot.Toxin Plague Ricin Critical Marginal LEAST LEAST Tularemia Staph. Enterotoxin Negligible Guarding America - Defending Freedom

Mycotoxins (Tricothecene) Q-Fever Cholera Brucellosis Facilities on and off Base Flight Meals, Water & Beverages for aircrews Emergency Rations delivery, prep and storage Off-base Assets (distributors, caterers & contract quarters) Prioritize (numbers served, key leaders, mission critical personnel, etc.)

Symbolic locations An accurate, current list of prime vendors and food product flow diagrams will help to pinpoint important points in each process! Guarding America - Defending Freedom Know who has access to the food and where it has been Distribution Center Distribution Center Receipt/ Inspection Produce Storage Meat Storage

Food Preparation Serving Line Self-Service Troop Pickup Packing /Pickup Area Dining Hall2 Guarding America - Defending Freedom Dining Hall3

Human Element Workers, Supervisors, Managers, Auditors, Drivers - Anyone who has access to the food is a risk Physical Security Secure exterior doors Eliminate places where intruders can hide Ensure restricted areas are monitored and have physical barriers such as lockable doors or roll down gates when appropriate Stored food products securely (including refrigeration units) Proper Lighting Control roof access Guarding America - Defending Freedom FDA and Department of Agriculture define food targets as items that are consistently at a higher risk for attack. Some factors that play into food targets are: Large Batches Uniform Production Short Shelf Life Ease of Access

Guarding America - Defending Freedom FVA Step 1: Lead must be PHO or NCOIC (7-lvl or 9-lvl) or 5-lvl with FVA training Coordinate with base Anti-Terrorism Officer (ATO) and Physical Security Managers (PSMs) Facilitate FVA schedule with ATO, MSG/CC, MDG/CC, facility managers, DeCA, FSS, SFS, and AAFES Review previous FVAs Review local threat brief Review all base food operation contracts Guarding America - Defending Freedom FVA Step 2: Develop a comprehensive list of food assets and contact facility mangers (On and Off-Base facilities, Distributors, Caterers, and Contract Establishments)

FVA Step 3: Conduct on-site assessment of facility (Begin five-step RM process using the appropriate DTRA checklist) Guided discussion with food facility/operation manager Example: What are the procedures for responding to food product tampering? Walk through Example: Are the procedures documented? Ask employees questions FVA Benchmarks and tools (Gumbo Site, https://gumbo2.area52.afnoapps.usaf.mil/epi-consult/foodprotection /fooddefense/ ) Guarding America - Defending Freedom FVA Step 4: Identify hazards (Step one of RM process) Potential aggressors? Possible threats? Hazardous agents? Guarding America - Defending Freedom

FVA Step 5: Assess the hazard (Step two of RM process) Use What If tool Consider Utility Protection Principles Deter, Delay, Detect, and Respond (DDDR) PROBABILITY SEVERITY CAT I- CATASTROPHIC complete mission failure, death. Example: Death or widespread severe illness. CAT II - CRITICAL Major mission degradation, severe injury, illness Example: Multiple food borne illnesses. CAT III - MODERATE Minor mission degradation, minor injury, illness Example: Sporadic food borne illness, loss of confidence in food supply safety.

PROBABILITY S E V E R I T Y Catastrophic I Critical II Moderate III Negligible

IV Frequent Likely Occasional Seldom Unlikely A B C D

E Extremely High High Medium Low RISK LEVELS CAT IV - NEGLIGIBLE less than minor, little or no adverse impact on mission capability or readiness. Guarding America - Defending Freedom A.FREQUENT - Occurs often in career to individuals , population is continuously exposed B. LIKELY Occurs several times in a career, population regularly exposed. C. OCCASIONAL Will occur in a

career, sporadic in a population. D. SELDOM May occur in a career, occurs seldom in a population. E. UNLIKELY Can assume it will not occur, occurs very rarely in a population. FVA Step 6: Determine and assign risk levels VULNERABILITY Medium Concern Low Concern A situation or circumstance that if left unchanged May result in the loss of life or damage to mission-essential resources. A situation that is exploitable and that can indirectly lead to loss of life or damage to missionessential resources. Neutral

A practice that is neither exploitable nor can be reasonably assessed as leading to the death of a service member, DoD civilian, family member or the destruction of mission essential resources, but is being identified to suggest consideration of modification or continuation. Positive A practice that contributes to a successful AT program and merits further analysis and dissemination. Guarding America - Defending Freedom FVA Step 7: Provide recommendations for controls (Step three and four of RM process)

Cost Factors Physical controls Engineering controls Procedures Feasibility will it work? Impact to mission Upcoming renovations Timing - When to implement Attitudes well received or not Political environment Stakeholders - outside interest Chain of command buy-in

Willingness to maintain Guarding America - Defending Freedom Wing Commander Unit Commander ATO Involve Stakeholders Facility Manager DECA AAFES SERVICES CE Fire Safety Security Forces Public Health FVA Step 8: Generate written report CONFIDENTIAL Provide to ATO and USAFSAM/PHR Food Protection via SIPR Discuss at Threat Working Groups within 60 days of report FVA Step 9: Supervise and evaluate (Step five of RM process)

Monitor effectiveness of control Track progress on mitigating strategies and fixes, compliance with procedures Provide updates to Force Protection Working Group, Threat Working Group, and Anti-Terrorism Working Group as needed Guarding America - Defending Freedom Retail Facility Benchmarks: A Person is assigned responsibility for security and procedures FS-FF-01 Access into building FS-FF-02 Potable water storage FS-FF-03

Contractors/visitors are supervised FS-FF-04 Hazardous chemicals FS-FF-05 Employees have FS-FF-06 Truck locks and seals FS-FF-08 Food products are inspected FS-FF-09

Customers have unrestricted Transportation Benchmarks: Drivers are required FS-FF-11 FS-TR-04 Guarding America - Defending Freedom YUTEC(45) MIJAS(98) HOMAS(184) KITE (250) TIGGER(50) ZONE(251)

OBDH(3000) SKYBAR(300) Benchmark Description CVAMP Benchmark GBAG(1500) CODE KEY: X = High Risk, Vulnerability. X = Medium Risk Concern X = Low Risk, Observation/Concern N = Neutral Observation P = Positive Observation QUESTIONS? Guarding America - Defending Freedom

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