DOEHRS-IH EHM: GYM AND FITNESS CENTER SANITATION REPORT 2
Page 1 of _____
1. FACILITY NAME: 2. FACILITY ADDRESS: 3. INSTALLATION: 4. START DATE (YYYYMMDD): TIME (HH:MM):
20241001 13:00
Main side gym 932 Hancock Ave, Lemoore, NAS LEMOORE
5. END DATE (YYYYMMDD): TIME (HH:MM):
CA 93246 20241001 13:43
6. INSPECTOR a. Name (Last, First, M.) and Rank: b. Phone: c. Email: d. Unit/Organization:
(Surveyor)
Matthews, Michael L LTJG 9915592500 [email protected]
7. PERSON IN a. Name (Last, First, M.): b. Phone: c. Email:
CHARGE (PIC)
8. CONTRACTOR OPERATED Yes 9. SWIMMING POOL PRESENT ✔ Yes 10. FOOD OPERATION PRESENT Yes
(Select one) ✔ No (Select one) No (Select one) ✔ No
11. INSPECTION TYPE
(Select one) ✔ a. Routine b. Follow-Up c. Complaint d. Pre-Opening e. Other (Specify):
Item Equipment Yes No N/A Item Locker Rooms and Toilet Facilities (Continued) Yes No N/A
Equipment of acceptable design and construction to prevent Nonskid, easy-to-clean, durable floor coverings that do not
1
injury due to structural defects?
✔ 22
support bacterial growth?
✔
Toilet and shower facilities maintained in a clean sanitary
2 Equipment maintained in safe operating condition? ✔ 23
condition free of plumbing defects?
✔
Common use items disinfected with a product approved by the Showers, locker room floors and benches, and toilet
3
medical authority and air-dried thoroughly between patrons?
✔ 24
facilities should be cleaned and disinfected at least daily? ✔
Whirlpool baths, steam cabinets, and other therapy-type
Towels and issued athletic clothing laundered before being re-
4
issued?
✔ 25 equipment disinfected between users using an approved ✔
disinfecting solution and concentration?
Item Structural Yes No N/A 26 Equipment rinsed with potable water after disinfection? ✔
Playing surfaces, running tracks, passageways, and other floors
5 maintained free of spills, debris, uneven surfaces, protrusions ✔ Item Saunas and Steam Rooms Yes No N/A
and obstacles that may increase the potential for injury?
Walls and ceilings reasonably smooth, easily cleanable, light Doors contain window(s) which allow observation of the
6
colored, and maintained in good repair?
✔ 27
entire room? ✔
Walls in close proximity to basketball and other similar spots
7
suitably padded to reduce physical injury?
✔ 28 Adequate lighting? ✔
Mats and other cushioning devices adequately maintained,
8
cleaned, and disinfected daily?
✔ 29 Walls, floors, and ceiling maintained in good repair? ✔
Athletic fields provided with adequate potable water supplies
9
and convenient restroom facilities?
✔ 30 Benches constructed and installed to permit easy cleaning? ✔
Gymnasiums adequately illuminated for spectator or
10
recreational sporting activities? ✔ 31 Saunas constructed of rot resistant synthetic woods? ✔
Lights adequately shielded to protect them from damage or Sauna floor covered with duckboards designed for easy
11
breakage from projectiles?
✔ 32
removal and cleaning? ✔
Mercury vapor and halide bulbs equipped with self-extinguishing Sauna benches maintained in good structural repair.
12 mechanisms or be completely enclosed by a shield that absorbs ✔ 33 Seating surfaces smooth without splintering, protruding ✔
ultraviolet radiation? nails, or other fasteners that may cause injury?
Drinking fountains provided to accommodate staff, patrons, and Steam rooms completely lined with impervious material
13
spectators?
✔ 34
which will not deteriorate under moist heat conditions? ✔
Interior clean and free of debris, foul odors, or other
14 Drinking fountains cleaned daily? ✔ 35
unsanitary conditions?
✔
Cleaned and disinfected according to manufacturers’
Item Locker Rooms and Toilet Facilities Yes No N/A 36
recommendations?
✔
Shower/locker rooms fitted with adequate lockers, showers, Thermostatic control device installed which prevents
15 water closets, urinals, and lavatories to accommodate the ✔ 37 saunas and steam rooms from exceeding 200°F (93°C)
maximum capacity? and 120°F (49°C) respectively?
Separate toilet facilities provided for male and female staff and Signs conspicuously posted listing rules for operation and
16 spectators? Facilities physically separated from patron shower ✔ 38 use and informing people of potential health problems from ✔
and locker rooms? heat stress?
If equipped with a door lock, the door cannot be locked
Handwashing facilities provided with disposable paper towels
17
and/or hand air dryers, and liquid, solid, or powdered soap?
✔ 39 from the inside the room but, if locked, can be easily ✔
opened from inside the room?
Steam outlets, piping, and heaters shielded to prevent
18 Suitable trash containers placed in all toilet and locker rooms? ✔ 40
burns?
✔
If located in remote site, equipped with an alarm or
Refuse containers emptied at sufficient intervals to prevent
19 ✔ 41 equivalent system which can be activated by patron in an ✔
overflow of refuse?
emergency?
20 Adequate ventilation and lighting? ✔
This space left Blank
21 Ventilation clothing lockers? ✔
FACILITY START DATE
DOEHRS-IH EHM: GYM AND FITNESS CENTER SANITATION REPORT 2
Page 2 of _____
Main gym 20241001
12. OVERALL REMARKS (Describe individual item deficiencies here)
Thermometer in womens locker room not functioning.
Rec: install working thermometer
Physical eyewash station in staff room near laundry machines not checked since August.
Red: check eyewash stations and log weekly
13. INSPECTION 14. FOLLOW-UP 15. FOLLOW UP NLT DATE:
RATING: ✔ Satisfactory Unsatisfactory
REQUIRED:
Yes ✔ No
(YYYYMMDD)
16. SIGNATURE: Signature on this form represents acknowledgment that the person in charge has been briefed on the deficiencies noted, corrective actions and timeframe to complete, the final
inspection rating, and the date scheduled for follow-up inspection (unsatisfactory inspections only).
b. DATE (YYYYMMDD):
a. Inspector Signature
c. Person in Charge d. DATE (YYYYMMDD):
Signature
