COMPREHENSIVE REVIEW

Question 1

Distillation:***

Answer 1

The total process the distilling plant forms, including evaporation and
condensation.

Question 2

Free Available Chlorine (FAC):***

Answer 2

Chlorine available (after demand is met) in the forms of Hypochlorous acid and Hypochlorite ions

Question 3

Reverse Osmosis (RO):***

Answer 3

The reverse of the natural osmosis achieved by external application of
sufficient reverse pressure to cause the solvent to flow in its unnatural
direction.

Question 4

Colilert

Answer 4

(a) Test used to detect total coliform and E-coli in the potable water.

Question 5

Total Coliform:***

Answer 5

Are a group of closely related, mostly harmless bacteria that live in soil and water as well as the guts of animals. The extent to which total coliforms are
present in the source water can indicate the general quality of that water and the likelihood that the water is contaminated with fecal matter. The presence
or absence of total coliform bacteria is the drinking water standard.

Question 6

Command Responsibilities:

Naval Sea Systems Command (NAVSEASYSCOM)

Answer 6

responsible for the shipboard potable water systems, including treatment facilities and processes
to assure that safe drinking water is available at all times:
(a) Design*
(b) Construction*
(c) Maintenance***

Question 7

Command Responsibilities:

Naval Facilities Engineering Command (NAVFACENGCOM)***

Answer 7

promulgating instructions for ship-to-shore potable water connections and for providing potable water from an approved source when the ship is berthed at a naval facility.

Question 8

Command Responsibilities:

Chief, BUMED***

Answer 8

(a) Responsible for establishing and promulgating health standards for water quality afloat.***
(b) Promulgate appropriate instructions, notices, or other publications to reflect afloat water quality requirements.
(c) Establish the shipboard requirements for medical surveillance of potable water systems.

Question 9

Area, Fleet and subordinate commanders

Answer 9

Responsible for issuing the necessary implementing directives to ensure that adequate water sanitation standards are provided and enforced in each ship within the command

Question 10

Commanding Officers***

Answer 10

water sanitation bill to ensure that procedures for receipt, transfer, treatment, storage, distribution, and
surveillance are provided and followed.

Question 11

Engineering Department

Answer 11

responsible to the commanding officer for implementing the requirements of the NAVSEASYSCOM
(1) Supply and treatment of Potable water*
(2) Potable water system components that:
(a) Receive
(b) Store
(c) Distribute
(d) Produce
(e) Treat
(3) Ensure that all ship-to-shore and ship-to-ship
connections are made only by authorized
personnel, when available, or in their absence,
ship personnel who are properly supervised by
authorized personnel.*
(4) Halogen and pH testing
(5) Ensure minimum halogen residuals are
maintained at a potable water tank before placing
the tank on-line to the potable water distribution
system.

Question 12

Medical Department Representative (MDR)

Answer 12

conducting a medical surveillance program of the potable water system:
(1) BACTI Testing*
(2) Daily Halogen Testing*
(3) MDR shall notify the commanding officer of any
discrepancies observed in the potable water
distribution system.***

Question 13

For new ship construction, 50 gallons per man per day is specified by
NAVSEASYSCOM for design considerations.***

Answer 13

Does not apply to “Water Hours
Not less than 2 gallons per man per day.
Sea water is used for marine sanitation device systems.***

Question 14

Approved Sources

Answer 14

Distillation, Reverse Osmosis (RO), or other NAVSEA approved water production technology.
Avoid making water while operating in:
1) Harbors or from polluted seawater.
2) When ships are operated in close formation.
3) When stripping or discharging waste or bilge
water forward of the saltwater intakes.

Question 15

Shore-to Ship delivery from an approved source.

Answer 15

(a) Environmental Protection Agency (EPA) (state and territory) approved
public water system.*
(b) U.S Military sources including establishments under the cognizance of:
1) British Royal Navy*
2) Canadian Forces*
3) Royal Australian Navy*
4) Other OCONUS locations may be obtained from
U.S. Militaryrepresentatives ashore or Navy
Environmental Preventive Medicine Units (NEPMU)
having area responsibility.***

Question 16

Types of Water Production Plants

(1) Distillation Plants

Answer 16

(1) Distillation Plants - three general types, depending on the source of heat used to evaporate seawater.
(a) Steam Distilling Plants - uses steam supplied by
power plant or auxiliary boiler.*
(b) Waste Heat Distilling Plant - uses heat derived
from Diesel Engine jacket water.*
(c) Vapor Compression Type - uses Electrical Energy.***

Question 17

Reverse Osmosis (RO)

Answer 17

(a) Single or triple pass*
(b) Removes suspended particles as small as 1 micron in some cases.
(c) Through a high-pressure pump, the filtered water is boosted up in pressure to as much as 1000 psi where it is introduced into the RO membranes. A portion of the filtered water, typically 20-25 percent, permeates through the membrane to become fresh water.
(d) For single pass RO plants, additional disinfection such as chlorination or bromination is required.*
(e) For triple pass RO plants (usually in submarine), additional disinfection is not required. The water quality in often better than distilled water.

Question 18

DESCRIBE the shipboard water system components. (Ref: NAVMED P-5010,
Chapter 6, Section III)

Answer 18

a. Shipboard Water System Components:
(1) Potable Water Tanks
(a) Necessary for maximizing space utilization
(b) Requires careful monitoring to prevent contamination
(c) Potable water tanks should never be filled with ballast water
1) Unless necessary for survival of ship
(d) Potable Water tank coating
1) NSF/ANSI standard*
(2) Vents and Overflows lines
(a) Located to reduce accidental contamination*
(b) Openings screened with 18 gauge or finer, non-corrosive mesh*
(c) Unauthorized termination points:
1) Food Service Spaces
2) Medical Spaces
3) Toilets
4) Electrical or electronic rooms
5) Exterior of the ship
(3) Manholes
(a) Construction and location should minimize the possibility of contamination.
(b) If top of tank is also a deck
1) 1/2” curb or coaming above deck
(c) If on side of tank
1) Flush mount okay
(4) Water Level Measurement
(a) Automatic level gauges
1) Direct read gauge
(b) Petcocks
1) Valves at various intervals
(c) Sounding tubes
1) Some carry a measuring rod
a) Sounding rods will remain in the sounding tubes
2) Others require a steel tape that requires disinfection prior to use
a) 100 ppm FAC for 2 minutes
3) Must be labeled “POTABLE WATER USE ONLY”*
(5) Filling Lines
(a) Filling Connections (hose valve, Risers)
1) Clearly labeled
2) Color coded Dark blue*
3) 18 inches from the deck*
4) Turned facing downward
5) Screw caps with keeper chains
(b) Potable water lines/piping must never be cross connected to any non-potable
piping or system.
(c) Potable water filling lines which distribute potable water to non-potable
water tanks must have an air gap or approved and appropriate backflow
prevention device.
(6) Piping
(a) Potable water piping passing through non-potable water tanks must have
the pipe surrounded by a sloped self-draining pipe tunnel
(b) Potable hot water settings should be set so the temperature at the fixture
is 120 degrees F at the water tap.

Question 19

STATE the sanitary requirements for maintaining shipboard potable water
equipment. (Ref: NAVMED P-5010, Chapter 6, Section III)

Answer 19

a. Sanitary Requirements
(1) Potable Water Hose Lockers
(a) Vermin proof*
(b) Locked*
(c) 18 inches off the deck (When located on weather decks and sponsons).*
(d) Printed, step by step instructions for disinfection of hoses and risers posted conspicuously inside the locker*
(2) Potable water Hose
(a) Approved for potable water use.
(b) Examined routinely.
(c) Removed from use when cracks develop in the lining or leaks occur.***
(d) Capped or coupled and stored in hose locker when not in use.
(e) Shall not be used for any other purpose.

Question 20

STATE labeling requirements for potable water equipment. (Ref: NAVMED P-5010,
Chapter 6, Section III)

Answer 20

a. Labeling Requirements:
(1) Hoses
(a) Clearly labeled : “POTABLE WATER ONLY” with
1 inch high letters every 10 feet*
(b) Couplings color-coded dark blue.
(2) Valves for receiving or supplying potable water (Risers)
(a) Clearly labeled with warning plate “POTABLE WATER ONLY” in 1/4
inch high letters.*
(b) Valves or valve handles must be color-coded dark blue.*
(3) Sounding tubes
(a) Clearly labeled with ID plate
(b) Sounding tube cap will be color-coded dark blue
(4) Potable Water Hose Lockers
(a) Labeled “POTABLE WATER HOSE”
11. DESCRIBE the procedures for the transfer of potable water from a supply point to a
Navy ship. (Ref: NAVMED P-5010, Chapter 6, Section II and Table 6.1)
a. Potable Water Transfer
(1) When receiving or transferring water via approved source, proper procedures
must be followed to prevent contamination.*
(a) Halogen shall be tested prior to the initial transfer of water.
1) If halogen residual is not within minimum standard (0.2 ppm), the
ship must boost halogen residual to the appropriate level.
2) If halogen residual is within standards (0.2 ppm), no further
treatment is required.
(b) Potable water connections between shore and ship must be made or
supervised by authorized shore station personnel or properly trained ship
personnel.
(c) Engineering will notify MDR prior to making potable water hose connection.
(d) MDR will test the Halogen residual and make recommendation to the
engineering department representative.
(e) Potable water hose shall not be submerged in harbor water.
(2) Potable water from sources of doubtful quality shall be investigated and
examined thoroughly as possible.
(a) Commanding Officer must be advised relative to the necessary
procedures, safeguards, and disinfection.
1) The minimum halogen residual requirements for water with doubtful quality
is 2.0 PPM.***
(3) Ship-to-Shore Procedures
(a) Remove shore cap and flush pier side potable water outlet for 15-30 seconds.
(b) Immerse outlet and rinse fitting in solution containing 100-ppm FAC (free
available chlorine) for at least 2 minutes.
(c) Flush water to waste for 15-30 seconds.
(d) Deliver a clean disinfected potable water hose to the outlet just before the
connection is made (potable water hoses should be provided by the shore
facility).
(e) Remove hose caps or uncouple hose ends and disinfect if not previously
disinfected.
(f) Connect hose to pier side outlet and flush.
(g) Disinfect shipboard riser connections with 100-ppm FAC solution.
(h) Connect hose to the potable water shipboard riser and deliver potable water.
(i) Other FDA listed food contact surface disinfectants such as iodine may be
used if approved by the MDR.
(j) When the transfer is completed, secure the shore water source; remove the ship connection, then the shore connection.
(k) Thoroughly flush the potable water outlet and recap.
(l) Drain the potable water hose thoroughly and properly store in the
potable water hose storage locker.
(4) Ship-to-Ship
(a) Both ships disinfect their respective potable water riser connections.
(b) The leading potable water hose shall have the hose cap in place during the
high-line procedure.
(c) When the receiving ship secures the potable water hose, the cap is removed
and the hose coupling is disinfected.
(d) The supplying ship connects its end and flushes the hose.
(e) When the transfer is completed, the receiving ship removes the potable
water hose and replaces the caps on the receiving connection and the
potable water hose.
(f) The supplying ship then retrieves, couples or caps, and properly stores the
potable water hose.

Question 21

STATE the purpose of potable water testing (Ref: NAVMED P-5010 Chapter 6, Section
XI)

Answer 21

a. Halogen residual (Chlorine/Bromine)
(1) As a quick indication of water that may have been improperly treated or handled.*
(2) Absence of Halogen in the ship’s potable water may indicate contamination.*
b. Bacteriological Testing
(1) Ensure fitness for human consumption.*
(2) To assess adequacy of disinfection process.*

Question 22

DESCRIBE the potable water testing requirements (Ref: NAVMED P-5010Chapter 6, Sections XI, XIII)

Answer 22

a. Testing Requirements:
(1) Conform to the latest edition of “Standard Methods for the Examination of
Water and Wastewater”.
(a) Published by:
1) American Public Health Association (APHA)
2) American Water Works Association (AWWA)
3) Water Pollution Control Federation (WPCF)
(2) Chemical Quality
(a) Naval vessels are exempt
(b) Chemical analysis is complex
(c) If assistance is required, notify the nearest NEPMU
(3) Temperature/pH
(a) Routinely performed by Engineering Department
(b) Halogenation is more effective at warmer water temperatures
(4) Salinity
(a) Chloride shall not exceed 0.065 Equivalent per Million (epm) or 2.3 ppm
(b) Salinity testing must not be conducted on halogenated water.
1) Halogenated water will provide false results
(5) Halogen residual
(a) Surface ship must maintain a 0.2 ppm FAC or TABR in the potable water
system after initial treatment.
(b) Ships with large potable water distribution systems such as aircraft
carriers shall maintain at least a trace level of chlorine in the distal ends of the distribution systems
(c) If water is received from an unapproved source, a source of doubtful
quality, the halogen residual at point of consumption shall be a minimum
of 2.0 ppm FAC.
(d) Routinely performed by MDR
1) Daily
2) In conjunction with bacterial analysis
3) Prior to receipt of potable water
(e) The Engineering Department is responsible for checking the Halogen level
of the potable water tanks after 30 minute contact time.
(6) Microbiological Quality
(a) MCL (maximum contaminant level) for coliform bacteria:
1) Follow the EPA established Maximum Contaminant Level (MCL).
(b) Frequency of monitoring:
1) Performed weekly according to a written plan.
2) Shall represent sites through-out the distribution system.
3) Number of weekly samples is population dependent.
a) 400 personnel or less, no less than 4 samples.
b) Over 400 - 800 personnel, require 8 samples.
c) More than 800 require 12 samples.
d) Samples will include ¼ of ship’s ice machines & ¼ of the ship’s potable
water tanks.
e) Emergency Potable Water Tank will be tested monthly.
(c) Approved methods:
1) Any EPA approved method may be used
2) Generally Colilert or Colisure is used by the fleet.
(d) Repeat monitoring:
1) Each positive sample will require three repeat samples.
a) Original service connection source
b) One upstream (no more than 5 service connections)
c) One downstream (no more than 5 service connections)
d) Collect samples within 24 hours of positive sample

Question 23

LIST the procedures for testing potable water. (Ref: NAVMED P-5010, Chapter 6, Section
XI)

Answer 23

a. Potable Water Testing Procedures:
(1) Halogen
(a) Chlorine or bromine residuals are determined by using the DPD
(diethyl-p- phenylene diamine) test.
1) DPD #1 - test for FAC or TBR*
2) DPD #4 - test for chloramines (total chlorine) residual*
(b) Halogen testing can be accomplished using the Color comparator test kit or using the Portable Spectrophotometer.
1) Color comparator accuracy is (+) or (-) 10 percent.*
2) Portable Spectrophotometer accuracy is (+) or (-) 2 percent.*
(2) Color comparator test kit procedure.
(a) Open potable water tap and allow water to flow for 2-3 minutes.***
(b) Rinse test tube with tap water
(c) Fill the test tube with 10-ml tap water
(d) Add appropriate test tablet, cap tube, shake to dissolve
(e) Remove cap, compare sample with comparator
1) Within sixty seconds after addition of test tablet.
(f) Rinse tube of any residual
(g) Record the value of the matching color standard.
1) If the color falls between consecutive color standards record the lowest
value.
2) If the color is deeper than 5.0 ppm chlorine or 11.0 ppm
bromine color standards.
a) Add an additional DPD #1 tablet.
b) Read and record.
(h) Continual absence of halogen residuals in potable water systems must be
reported to Commanding Officer with a copy to Chief Engineer.
(3) Portable Spectrophotometer procedure.
(a) Open potable water tap and allow water to flow for 2-3 minutes.
(b) Fill a clean sample cell with 10 ml tap water (blank solution)
(c) Fill another sample cell with 10 ml tap water (sample solution)
(d) Add appropriate tablet or reagent to the sample solution.
(e) Place blank solution in the cell compartment and close the cover.
(f) Press ZERO key. After 2 seconds the display will read 0.00
(g) Remove blank solution and place sample solution into the cell
compartment. Close the cover.
(h) Press READ key. After 2 seconds the instrument will display the result.
(i) Rinse all sample cells and record the result.
(j) Advantage over Color comparator
1) Eliminates human visual subjectivity.
(k) Specific sample volumes, reagents, sample cells, and timing intervals depend
on the make and model of the instrument.
(l) Also called Portable Colorimeters.
b. Bacteriological Testing Procedures:
(1) Bacteriological testing frequency.
(a) Weekly - on samples collected at representative points throughout the
distribution system (same location and number of samples as Halogen
testing).
1) Includes 1/4th of the ice machines and 1/4th of the potable water tanks.
(b) Whenever abnormal halogen demand is present
(c) Suspicion of contamination
(d) After repairs to potable water system
(2) Shipboard EPA approved methods for bacteriological testing.
(a) Colilert
(b) Colisure
(3) Bacteriological testing procedures
(a) Collection and preparation of sample should be conducted in a manner that
will not contaminate the test samples.
(b) Collect bacteriological test sample after halogen testing.
(c) Label sample bottle or bag with the following:
1) Location
2) Date and time
3) Sampler’s initial
(d) Collect 100ml tap water in sample bottle or bag containing sodium thiosulfate.
(e) Add the Colilert or Colisure reagent in the sample bottle or bag.
(f) Incubate samples for 24 hours at 35º C.
(g) After 24 hours:
1) Examine samples and place under 365 nm UV lamp.
a) Colilert:
(1 Clear is negative
(2 Yellow is positive for total coliform
(3 Fluorescent yellow (under UV light) is positive for fecal coliform
b) Colisure
(1 Yellow is negative
(2 Magenta is positive for total coliforms
(3 Fluorescent light blue is positive for E. Coli
(h) Positive and negative control should be conducted on the day of
bacteriological testing.
(i) Record the result in the potable water log and/or TMIP including the
positive and negative controls.

Question 24

DETERMINE sources of contamination. (Ref: NAVMED P-5010, Chapter 6, Section VIII)

Answer 24

a. Sources of Contamination:***
(1) Cross connections with non-potable systems.
(2) Leaks in common bulkheads between potable water tanks and fuel tanks, ballast
tanks, bilges, and wastewater tanks.
(3) Leaks in non-potable piping through water tanks.
(4) Improper disposal of chemicals or liquids through potable water-sounding tubes.
(5) Potable water hoses used for non-potable liquids.
(6) Excessive storage time of water in tanks.
(7) Shipboard water production from contaminated raw water source.
(8) Inadequate disinfection procedures resulting in development of chlorine by
products.
(9) Transfer of water from shore facilities or barges, which have taste and odor
problems.
(10) Potable water tanks used for non-potable water liquids.
(11) Deteriorated, improperly applied (cured/vented) tank coatings.
(12) Shipboard water treatment plants producing potable water while stripping fuel
tanks, pumping oily bilges overboard forward of the distilling plant feed
pumps suction or when in close proximity to other ships.

Question 25

DESCRIBE the procedures for disinfecting water (Ref: NAVMED P-5010, Chapter 6,
Section IV)

Answer 25

a. Water Disinfection Procedures:
(1) Chlorine and Bromine are approved methods for disinfecting shipboard potable
water.
(2) Automatic chlorine disinfection*
(a) In-line Chlorinators
1) Injects hypochlorite into system in proportion to the flow of water.
(3) Brominator*
(a) Bromine is dispensed via resin impregnated cartridge
(b) Two types of brominators
1) In-line (Proportioning) Brominator.
a) Preset to deliver 0.7 ppm bromine to water during normal
operating procedures.
b) Can deliver 2.0 ppm bromine to water when necessary.
c) Required for each water plant.
2) Recirculation Brominator
a) Designed to boost bromine residual in potable water tank.
b) Draws water from the tank, injects bromine, and returns water to
the same tank (recirculating).
c) Delivers 0.7 ppm bromine to water being recirculated.
(4) Manual chlorine disinfection (Batch Method)*
(a) Least desirable method of water disinfection.
1) May result in over-chlorination.
(b) Disinfectant of choice is usually Calcium Hypochlorite (HTH)*
(c) Steps:
1) Determine the correct amount of HTH using the chlorine dosage calculator
2) Add the HTH to a plastic mixing container filled with water
3) Container may range anywhere from a quart size to five-gallon
bucket depending on the size of the job.
4) Stir the HTH gently for 1-2 minutes to allow all the calcium granules to
release chlorine into the water.
5) Allow the mixture to settle
6) After awhile the calcium granules will have settled on the bottom of the bucket and the water may tint slightly yellow, once again depending on
the size of the job.
7) The clear, slightly yellow liquid is now referred to as “Supernatant.”
8) Pour the supernatant into to the source to be disinfected
9) Pour only the supernatant and leave the calcium granules in the mixing
container
10) If small amounts of calcium are allowed to enter potable water tanks,
this may cause problems later on
a) Excess calcium in the water will:
(1 always demand more chlorine or bromine than water without
calcium
(2 clog valves and screens in the distribution system
11) Allow for proper contact time
12) When the required contact time has elapsed and the correct residual
has been obtained, the source will be ready for use.
(d) Chlorine dosage calculator
1) Select desired ppm
2) Calculate the amount of water to be treated
3) Select the strength & type of chlorine used
a) 5% Sodium Hypochlorite (liquid measurement)
b) 10% Sodium Hypochlorite (liquid measurement)
c) 65-70% Calcium Hypochlorite (dry measurement)
4) Chlorine dosage rule of thumb:
a) One ounce HTH Per 5,000 gallons of water equals 1.0 ppm FAC***

Question 26

LIST the required halogen residuals used for disinfection of potable water
afloat. (Ref: NAVMED P-5010, Chapter 6, Section IV)

Answer 26

a. Halogen Residuals:
(1) Water from approved source: 0.2 ppm FAC/TBR after 30 minute contact time.*
(2) Water from Unapproved source: 2.0 ppm FAC/TBR after 30 minute contact time.
(a) If the ships brominator cannot achieve a TBR of 2.0 ppm, the water must be chlorinated by “Batch Method”.*

Question 27

DESCRIBE the steps to disinfect the potable water system. (Ref: NAVMED P-5010,
Chapter 6, Section IV, Table 6-2)

Answer 27

a. Disinfection Steps:
(1) Method 1
(a) Fill tank to over flow level
(b) Add chlorine to achieve 10ppm FAC through the tank
1) Hold solution for 24 hours
(c) Drain tank
(d) Refill tank with potable water with required halogen residual level
(e) Perform bacteriological testing
1) If test comes back negative use water
(2) Method 2
(a) Spray/apply directly 200ppm FAC to all tank surfaces
(b) Flush inlet/outlet pipes with 10ppm FAC
(c) Disinfected surfaces shall remain in contact with chlorine solution for a
minimum of 30 minutes
(d) Refill tank with potable water with required halogen residual level
(e) Perform bacteriological testing
1) If test comes back negative use water
(3) Method 3
(a) Fill 5% of tank volume with 50ppmFAC Solution
(b) Hold solution for 6 hours
(c) Add potable water to chlorine solution to fill tank; hold this water for 24 hours
(d) Drain tank
(e) Refill tank with potable water with required halogen residual level
(f) Perform bacteriological testing
1) If test comes back negative use water

Question 28

STATE the procedures for controlling taste and odor in potable water. (Ref:
NAVMED P- 5010, Chapter 6, Section VIII)

Answer 28

a. Controlling Taste and Odor:
(1) Try to identify the source of the taste and odor problem.*
(2) If the source of taste and odor problem cannot be identified use the following
method:
(a) Chlorination Method*
1) Chlorinate to 5.0 ppm FAC*
2) Distribute at 2.0 ppm FAC*
(b) Steam Method
1) Use of steam requires NAVSEASYSCOM approval*
2) Boil sample water for one minute to ensure proper effect
a) If the taste and odor have been resolve then the use of steam might be feasible.
b) If the taste and odor have not been resolve then steam treatment will most likely not work.
(3) Requesting outside assistance*
(a) Contact NEPMU via TYCOM Medical Officer***
(b) If problem cannot be resolved, or is suspected to involve tank coatings,
the recommendation will be to notify NAVSEASYSCOM via chain of command.
1) Includes Naval Sea Support Center (NAVSEACEN) or In-Service Engineering Agent (ISEA)

Question 29

LIST the storage requirements of potable water disinfecting agents. (Ref: NAVMED
P-5010, Chapter 6, Section IV)

Answer 29

a. Storage Requirements:
(1) Storing Calcium Hypochlorite (HTH) 65%-70% available chlorine (Ready-use stock)
(a) 6 ounce bottles.*
(b) Has a corrosive and chemically active nature
(c) Contact with another oxidizable material may result in spontaneous combustion.
(d) Store in cool, dry, well - ventilated place
(e) Stow in a locked box mounted on a bulkhead
(f) Preferably in the Engineering office space
(g) Metal box such as a first aid locker
1) Three ¼ ” holes drilled in the bottom of the box to allow release of chlorine gas*
(h) Box must not be installed in:
1) Machinery space
2) Flammable liquids storeroom
3) Berthing space
4) Paint storeroom
5) Oil and water test lab areas
(i) No more than a seven day supply shall be maintained in ready use stock at any
time.
(2) Storing Calcium Hypochlorite (HTH) 65%-70% available chlorine (Storeroom
Stocks)
(a) Storeroom (Bulk) stocks of calcium hypochlorite must be stowed in
labeled, ventilated lockers or bins.
(b) Located where the maximum temperature will not exceed 100 degrees F
and not subject to condensations or water accumulation.
(c) The locker or bin must not be adjacent to a magazine and located at least
five feet away from any heat source or surface which may exceed 140
degrees Fahrenheit.
(d) Must not be stored in an area where paints, oils, grease, or other
combustible organic materials are stored.
(e) No more than 48 six ounce bottles shall be stored in any individual locker or
bin.
(f) Issue will only be made to personnel designated by Medical or Engineering
Officer.
(g) All lockers, bins and enclosures containing HTH shall be labeled with
“Hazardous material, calcium hypochlorite” on red letters with a white background***
(3) Storing Bromine Cartridges
(a) Slightly corrosive and requires proper handling and storage procedures
(b) Must be stored in a clean, dry, well ventilated storeroom.
(c) Bromine storage lockers must have a hazardous warning plate IAW NSTM
Chapter 533.
(d) Has a normal shelf life of two years from the date of manufacture.

Question 30

LIST the elements of a Water Sanitation Bill (Ref: NAVMED P-5010, Chapter 6,
Sections XII and XIII)

Answer 30

a. Water Sanitation Bill
(1) Water Sanitation Bill shall be posted conspicuously in areas where potable
water and associated materials are processed, treated, or stored.
(2) Water Sanitation bill should consist of the following:
(a) Responsibility (The CO promulgates the Water Sanitation Bill and ultimately responsible)***
(b) Sources
(c) Connection procedures for:
1) Ship to shore
2) Ship to ship
(d) Potable Water Hoses
(e) Storage Tanks
(f) Disinfection Procedures
(g) Halogen Residual Testing
(h) Bacteriological Testing
(i) Temperature, pH and Salinity Testing
(j) Disinfection of Tanks and Distribution System
(k) Distribution System
(l) Records

Question 31

DESCRIBE the reporting requirements for potable water testing (Ref: NAVMED
P-5010, Chapter 6, Section XI, 6-54)

Answer 31

a. Potable Water Log
(1) MDR will maintain a 2-year chronological record of potable water surveillance.*
(2) The log must include the following:*
(a) Time and date each water sample
(b) Location of ship
(c) Sampling site
(d) Source
(e) Halogen Residual
(f) Bacteriological test result
1) Presence or absence
2) Include +/- controls
3) Purpose of test
a) Weekly
b) Special
c) In connection with disinfecting tanks, pipes or systems.
(g) Include action taken for any discrepancies found.
1) Taste and odor problem
2) Inspection and survey results

Question 32

DESCRIBE the command element responsibilities in regards to potable water in the field.
(Ref: NAVMED P-5010- 10, Chapter 18, Section 18-2)

Answer 32

a. Command Responsibilities:
(1) Unit Commander:
(a) Ensures that there are sufficient quantities of safe water for drinking, cooking, and bathing.*
(b) Enforcement of water discipline.*
(c) Inform troops about the dangers of consuming untreated water.*
(d) Know the proper methods of disinfection of personal drinking water.
(2) Engineering Officer
(a) Provides sufficient potable water quantities for the population.
(b) Construction, operation, and maintenance of all facilities used for collection,
treatment, and distribution of potable water.
(c) Selecting sources of raw water
(3) Medical Department
(a) Advises the Commanding Officer on water quality issues.*
(b) Assists the engineers with the following:*
1) Selection of water sources.*
2) Surveying the potable water system.*
(c) Conduct routine bacteriological examination of the potable water supplies.*
(d) Test water for halogen levels.*
(e) Inform engineers of water quality and type of treatment required.*
(f) Chemical analysis of field water supplies made on a case by case basis assigned by medical and engineering personnel.***

Question 33

DETERMINE the sources of acceptable water supply in the field. (Ref: NAVMED P-5010-
10, Chapter 2, Section 2-3)

Answer 33

a. Acceptable Water Supply Sources:
(1) All water sources in the field should be considered
unsafe until they have been evaluated and
approved by the Medical department.
(2) Influences on water choice.*
(a) Quality*
(b) Quantity*
(c) Accessibility*
(3) Potential water sources
(a) Public water supply
1) Easiest and safest sources
2) Water has been treated to some extent
3) Unsafe until approved for consumption.
4) Evaluate and treat to make water safe.
(b) Surface water
1) More accessible than other sources.*
2) Quality may be a problem.*
3) More contaminated than other sources.
4) Capable of supplying adequate quantities.
5) Rivers, streams, lakes, ponds, seas, and
oceans*
6) Water intakes should be screened and
carefully positioned in the body of water to
avoid areas of likely contamination
(c) Ground water
1) Existing wells and springs
2) Wells constructed by military engineers or local
contractors*
3) Usually less contaminated than surface
water*
4) Difficult to determine what quantities are
available.*
5) Located at least 30 yards upgradient from
known contamination.
(d) Commercial bottled water
1) Drinking water that is sealed in bottles,
packages, or other containers by
commercial interest.
2) It may or may not have been treated prior to
bottling.
3) Must be tested and determined to be potable.

Question 34

DESCRIBE the methods of water treatment for potable water in the field. (Ref: NAVMED
P- 5010-10, Chapter 2, Sections 2-4; 2-5; 2-7)

Answer 34

a. Typical field water treatment process include
(1) Straining
(2) Chemical addition
(3) Coagulation
(4) Sedimentation
(5) Various kinds of filtration
(a) Multimedia
(b) Cartridge
(c) Microfiltration
(d) Ultra filtration
(e) Reverse osmosis
(f) Carbon adsorption
(g) Ion exchange
b. Military ROWPU (Reverse Osmosis Water Purification Unit).
(1) Most common*
(2) Can be used to produce potable water from:
(a) Fresh water*
(b) Brackish water*
(c) Sea water*
(3) A multi-process system that will remove all
waterborne infectious microorganism such
as parasites, bacteria, and viruses.
c. Marine Corps Lightweight Medium Tactical (LMT) freshwater purification unit.
(1) Non-Reverse osmosis water treatment unit
(2) Only used in treating fresh water
d. Lightweight water purifier (LWP)
(1) Used to purify water for small military units and
detachments, Special Operations Forces, and
temporary medical facilities during a range of
contingency operations.*
(2) 125 gallon per hour*
(3) Provides a more mobile, further-forward deployed
water production.
e. Tactical water purification system
(1) An International Organization for Standardization
(ISO) - compatible flat rack and is
transportable by the load handling system or
palletized load system trucks.
(2) Produces 1500 gallons of water per hour.*
(3) Replacing reverse osmosis water purification unit.*
f. Disinfection of field water
(1) Chlorination
(a) Most common method*
(b) Sufficient chlorine is added to the water to
achieve the desired free available
chlorine (FAC) after a 30 minute contact time.
(c) Different types of disinfectants
1) Calcium Hypochlorite (HTH), 65% to 70% (most
common, granular form).
2) Sodium Hypochlorite 5% or 10% (unscented
bleach).
3) Chlorine dioxide
4) Chlorine gas
5) Bromine
6) Chloramines ozone
7) UV radiation
(d) Required chlorine residuals.
1) Point of production and initial distribution –
2ppm
FAC after 30 minute contacT time.
2) Delivery to secondary storage and unit level
storage (water buffaloes, 5 gaL containers) –
1ppm FAC.
a) If between 0.2ppm and 1ppm FAC – re-
chlorinate to 1ppm and deliver.
b) If less than 0.2ppm FAC- re-chlorinate to
2ppm and ensure that at least 1ppm FAC
remains after 30 minutes.*
3) Filling canteens, personal hydration system, or
other individual-use containers – 0.2ppm FAC.
4) Bottled water – no requirements.
5) Ground water approved for drinking – 2ppM
FAC
after 30 minutes contact time.*
6) Disinfecting natural surface water or well water
under the direct influence of surface water for
drinking, no other treatment available – 5ppm
FAC
after 30 minute contact time.*
a) EMERGENCY ONLY***
(2) Water purification tablets (Iodine tablets).
(a) For disinfecting water contained in small
containers
such as canteens or water jugs.
(b) Usually composed of Iodine.
(c) Steel-gray in color
(d) Discard if:
1) Color turned completely yellow or brown.
2) Stick together or crumble easily.
(e) Water in Canteens
1) Fill with clear water
2) Two iodine tablets to each 1 quart canteen.
3) Four for 2 quart canteens.
4) Put the cap on the canteen. Shake the canteen
to dissolve the tablets.
5) Wait 5 minutes. Loosen the cap slightly and tip
the canteen over to allow leakage around the
canteen thread.
6) Tighten the cap and wait an additional 25 minutes
before drinking.
(f) Five gallon cans (water jugs).
1) Fill with clear water.
2) Dissolve 40 iodine tablets in a canteen cup full
of water.
3) Add the solution to the 5 gallon container and
agitate the solution
4) Place the cap loosely
5) Wait 5 minutes then shake vigorously allowing
leakage to rinse the thread.
6) Tighten the cap and wait an additional 25
minutes before using.
(g) Personal Hydration System
1) Add four (4) iodine tablets for 70 or 72 ounces
water reservoirs and six (6) for 100 or 102 ounces
reservoirs.
2) Allow 30 minutes of contact time before drinking
the water.
3) If the water to be treated is cloudy or discolored,
double the amount of iodine tablets.

Question 35

5. DESCRIBE the types of containers used for storing potable water in the field. (Ref:
   NAVMED P-5010-10, Chapter 6, 6-1)

Answer 35

a. Potable water storage and distribution systems (PWS/DS)
(1) Primary means for the receipt and storage of bulk
drinking water and for issue to
combat forces under tactical conditions.
(2) Total capacity is dependent of the number and
size of fabric tanks assigned and used.
b. 3,000-gallon tank*
(1) Highly mobile, easily transportable manually
inflatable/collapsible fabric water tank.
c. Load handling system (LHS) water tank rack (Hippo).
(1) Compatible with ARMY’s LHS
(2) 2,000 gallon*
(3) Hard wall tank rack with stainless steel interior and a
recirculation water pump.
d. Forward Area Water Point Supply System (FAWPSS)
(1) Portable, self contained
(2) Gas or diesel operated unit
(3) Employs centrifugal pump to distribute water.
e. Semitrailer-Mounted Fabric Tank (SMFT)
(1) Transport only drinking water.
(2) Collapsible rubberized tanks.*
(3) 3,000 or 5,000 gallons*
f. Tactical Water Distribution system (TWDS)
(1) Highly mobile
(2) Designed to distribute water for distance up to 10
miles on level terrain.
g. Water distribution and waste management system (WDWMS)
(1) Three modules
(a) Water distribution set
(b) Hospital
(c) Deployable Medical System (DEPMEDS)
(2) Primary means for the receipt and storage of bulk
potable water and for wastewater management for
the DEPMEDS hospital under tactical conditions.
h. 400-gallon water trailer
(1) Used to distribute drinking water to field units.
i. 5-gallon water can
(1) Unit water storage
j. Individual water storage equipment.
(1) 1-2 quarts canteen
(2) Personal hydration system
(a) 45-100 oz capacity
k. 800-gallon unit water pod system (Camel).***
(1) The 800-gal Camel was under development at the
time this publication was prepared. It will replace
the M107, M149, and M1112 series water trailers. It
sits on an M1095 trailer which allows for better
transportability on and off the road than its
predecessors, using the Family of Medium Tactical
Vehicles Truck.

Question 36

DESCRIBE the disinfection procedures for potable water containers in the field. (Ref:
NAVMED P-5010-10, Chapter 7, 7-1)

Answer 36

a. Disinfection Procedures:
(1) Mechanical Cleaning Procedures
(a) Drain system or container.
(b) Scrub the interior surfaces with a soft brush and
detergent solution taking care not to damage
the interior lining..
(c) High pressure water or steam should be used, if
available, to rinse the container.
(d) Open all valves, lids, and spigots and allow the
detergent solution to drain out through the
system.
(e) Rinse all surfaces thoroughly with potable water.
(f) Continued rinsing may be required.
(g) Super-chlorinate the container or system.
(2) Disinfecting Method 1 (GENERAL)*
(a) Chlorinate the water in the container to at least
100 ppm FAC.*
(b) Run some solution through the valves and
spigots.
(c) Keep all interior surface wet with the solution for
at least 60 minutes.**
(d) Drain the disinfecting solution into a sanitary
sewer or other approved location.
(e) Rinse the container and spigots twice with
potable water.
(3) Disinfecting Method 2
(a) If either water or the required chemical are in
short supply, use the following method.*
(b) Prepare 5 gallon of water with a 100ppm
chlorine solution.
(c) Using a long-handled brush, stick, or rod with a
cloth secured to the end, swab the interior of
the tank every 10 minutes or as often as
necessary to keep the walls wet for 1 hour.
(d) Run some solutions through the valves and
spigot.
(e) Drain the accumulated solution.
(f) Rinse the container and spigots twice with
potable water.
(4) Alternative procedure (OR METHOD 3)
(a) Chlorinate the water to 10ppm FAC.
(b) Hold for 24 hours
(c) Drain the disinfecting solution into a sanitary
sewer or other approved location.
(d) Rinse the container and spigots twice with
potable water.

Question 37

DEFINE terms associated with sanitation and habitability. (Ref: OPNAVINST 9640.1C)

Answer 37

a. Sanitation and Habitability Terms
(1) Accommodations - Denotes the number of
personnel to be permanently supported
in a given ship by, habitability spaces, systems,
fixtures and equipment.*
(2) Surge - Refers to personnel embarked aboard
ship for short duration during special**
operations or exercises, and mobilizations.
(3) Transients - Refers to personnel embarked for
short duration who do not contribute
to the host ship operational capability.***
(4) Ship’s Company - All personnel assigned to a
ship.
(5) Hot Bunking - Assigning more than one person to
a single berth.

Question 38

DESCRIBE shipboard sanitation and habitability requirements for living spaces. (Ref:
OPNAVINST 9640.1C and NAVMED P-5010, Chapter 2, Section I)

Answer 38

Habitability Factors*
(1) Floor area
(2) Ventilation
(3) Heating
(4) Sanitary fixtures
(5) Water Supply
(6) Lighting
(7) Color
b. Minimum Standards
(1) Due to the demands for combat effectiveness,
minimum standards are not always attainable.
(a) Commanding officers must strive to achieve,
within practicable limits, the minimum standards
necessary for optimize sanitation.
c. Air Conditioning and Ventilation.
(1) Intakes for ventilation and air conditioning located
to minimize introduction of contaminated air:
(a) Topside exhausts
(b) Stacks
(c) Water spray
(2) Air conditioning*
(a) Berthing, messing, and medical shall be air-
conditioned to maintain a maximum
temperature of 80 degrees Fahrenheit dry bulb.
(3) Heating*
(a) Berthing, messing, normal working spaces and
medical shall be maintained at a minimum of 65
°F dry bulb temperature.
(4) Ventilation
(a) Designed to minimize humidity and odors.*
(b) Exchange rate of 15 changes per hour.*
(c) Specific ventilation/exhaust required:
1) Galley
2) Scullery
3) Laundry
4) Each shower group
5) Each water closet group
d. Personnel Grouping Standards
(1) Officers, CPOs and crew shall be accommodated
in separate berthing compartments.
(2) Embarked forces will be placed in separate
berthing compartments.
(3) Female accommodations shall be separate from
those of their male counterparts.
e. Privacy Standards
(1) One bunk light per berth.
(2) Full privacy partitions.
(a) Between berths.
(b) End partitions used where berth opens into
passageway.
(3) Privacy curtains per berth.
(4) Individually controlled ventilation terminal.
(5) Main passageways shall not bisect berthing areas.
(6) When unfeasible, berthing spaces shall be
isolated from main passageways by joiner
bulkheads.
f. Bedding
(1) Pillows
(a) Polyurethane is prohibited.*
(2) Mattresses
(a) Mattress foam inserts must be “low smoke”
foam rubber.*
(b) Hot bunking is prohibited.*
g. Sanitary Standards
(1) Separate sanitary facilities for men and women.
h. Water heaters
(1) Located outside sanitary and berthing spaces.
(2) Properly insulated to prevent high space temperatures.
i. Major Sanitary Fixtures
(1) Lavatories (washbasins)
(a) At least one lavatory in each water closet space.
(b) Each lavatory shall have:*
1) One mirror
2) One shelf.
3) Two electrical outlets.
(2) Urinals
(a) Must have privacy partitions.
(3) Water closet (Toilet)
(a) Enclosed in cubicle with a privacy door.
(4) Showers
(a) Individual stall with privacy door or curtain.
(b) Separated from washroom and water closet by
joiner bulkheads and door.
j. Food Service Spaces
(1) Designed to support recreation and training
(including movies) as well as the primary function.
(2) Mess lines
(a) Designed to prevent crewmembers from
standing on the weather decks and passing
through garbage disposal areas.
(3) Separate dining facilities shall be provided for:
(a) Officers
(b) Chief Petty Officers
(c) Crew
k. Lounge, Recreation, Religious, and Welfare Spaces
(1) Lounge areas are designed to satisfy personal
needs for passive, quiet pursuits, and
personal entertainment:
(a) Reading
(b) Writing
(c) Off-duty education
(d) Listening to music
(e) Hobbies
(2) Recreational areas are designed to satisfy
personal needs for:
(a) Physical fitness.
(b) Active social events.
(3) Religious spaces are required so personnel can
satisfy their spiritual needs.
l. Barbershop
(1) Ships with less than 100 accommodations will
have portable barber facilities with a designated
storage locker.*
(2) Ships with 101-300 accommodations will have a
barbershop with one chair.*
(3) Ships with over 300 accommodations will have a
barbershop and additional shop for each 300
increment.*
m. Ship’s Store:
(1) All ships shall have a store for items of personal
necessity and hygiene.
(2) A snack bar will be provided on ships having
greater than 500 personnel.***
(3) Vending machines shall be placed in designated
areas and secured to prevent tipping.
n. Laundry Facilities
(1) Ships with 100 or fewer accommodations will be
supplied with:
(a) One 16 LB capacity washer.
(b) One 16 LB capacity dryer.
(c) Three hand irons.
(d) Three ironing boards.
(2) Ships with more than 100 accommodations will be
supplied with:
(a) Laundry facilities capable of processing 24
pounds per week per accommodation.
(b) Ironing boards and irons will be provided in all
berthing spaces.

Question 39

LIST personnel requirements for conducting shipboard sanitation inspections. (Ref: NAVMED P-5010, Chapter 2, Section I)

Answer 39

a. Inspection Personnel
(1) The following personnel will make routine sanitary
inspections of toilets, lavatories, and berthing
spaces.*
(a) Executive Officer.
(b) Medical Department Representative.
(c) Officer of the Deck (OOD).
(d) Junior Officer of the Deck (JOOD).
(e) Chief Master at Arms.
(f) Division Officer.
(g) Division Chief Petty Officers.
b. Personnel Requirements
(1) All surfaces of water closets, showers, lavatories,
and urinals are cleaned and disinfected daily.*
(2) Shower curtains and mats are sanitized to
prevent mildew, odor, and soap accumulations.
(3) Sewage:
(a) Sewage backflow constitutes unsanitary
conditions.
1) Space must be secured immediately until the
situation is corrected and the space is cleaned
and sanitized.*
(4) Head to foot sleeping arrangements unless
privacy curtains are installed.*
(a) Sufficient supply of clean bed linen must be
maintained.
(b) Bedding changed frequently to prevent odor
accumulation.***
(5) Cleaning gear stowage:
(a) Stowage area must be well ventilated, neat and
clean.
(b) Swabs must be rinsed and stowed “head up”
after each use.
(6) Cleaning supplies should be in appropriate
containers.
(a) Must be labeled properly if removed from
original container.
(7) Trash cans will be emptied and cleaned daily.
(8) All berthing spaces, common rooms and head
facilities should be cleaned “Daily”.
(9) Plumbing discrepancies will be reported
immediately and corrected as soon as possible.
(10) All spaces should be well ventilated.

Question 40

STATE responsibilities of the IDC for conducting sanitation and habitability inspections. (Ref:
NAVMED P-5010, Chapter 2, Section I)

Answer 40

a. Sanitation and Habitability Inspection Responsibilities
(1) The IDC will ensure inspections are performed at
least quarterly.*
(a) Identify problems that may affect the health of
personnel.
(b) Submit inspection reports to the Commanding
Officer via chain of command.*
1) Identify discrepancies.
2) Recommend corrective action.
3) Perform onsite training while conducting the
inspections.
(c) Promptly notify the person in charge of the
space:
1) Prior to conducting the inspection.
2) Results of the inspection.
3) Person in charge should accompany the
inspector.***

Question 41

DEFINE terms associated with barber shops (Ref: NAVMED P-5010, Chapter 2, Section II)
A. Disinfectant
B. EPA
C. FDA

Answer 41

a. Barber Shop Terminology
(1) Disinfectant: An agent that destroys or removes
pathogenic organisms.
(2) EPA: Environmental Protection Agency
(3) FDA: Food and Drug Administration

Question 42

STATE health and hygiene requirements for barber shop employees. (Ref: NAVMED P-5010,
Chapter 2, Section II)
A. Health Requirements
B. Hygiene Requirements

Answer 42

a. Barber Shop Health Requirements
(1) Employees must be medically screened and
determined to be free of communicable
disease prior to their initial assignment.*
(2) Medical screening should be comprehensive
enough to detect diseases based on locality.
(3) Annual evaluations are not required unless
deemed necessary by the local medical authority.*
b. Barber Shop Hygiene Requirements
(1) Hands must be thoroughly washed with soap and
warm water.
(a) Between patrons
(b) After touching objects that are likely to be
contaminated
(c) Before leaving the shop
(2) A clean smock or other freshly laundered over
garment must be worn while attending patrons***.

Question 43

STATE medical conditions that prohibit barbers from rendering services. (Ref: NAVMED P-
5010, Chapter 2, Section II)

Answer 43

a. Barber Shop Prohibitive Medical Conditions
(1) Serving patrons with inflamed or infectious
conditions of scalp, face and neck is prohibited
without a note from the Medical Officer.

Question 44

10. STATE sanitation requirements for barber shops. (Ref: NAVMED P-5010, Chapter 2, Section
II)
A. Location
B. Hot/Cold WAter
C. Lighting/Ventilation
D. Cosemetics, tonics, lotions, bleaches, dyes, disinfectants and sanitizing agents meet what standard
E. Therapeutic Practices
F. Headrests
G. Commons Brushes, dusters, and Shaving Mugs
  Can you shave? Why or why not?
H. Sanitary neck straps
I. Operators Street Clothing
J. Eating, Drinking, smoking
K. Trash
L. How is hair removed
M. Other methods of removing hair, what level of PSI
N. Post a copy of what

Answer 44

a. Barber Shop Sanitation Requirements
(1) Cannot be located in food service areas or
berthing areas. (They can be in BOQ/BEQ or
officer or enlisted clubs but it must be in a
separate room)*
(2) Must have hot and cold running water*
(a) Lavatory fixtures*
(b) Waste disposal*
(3) Adequate lighting and ventilation
(4) Must use FDA/EPA approved cosmetics, tonics,
lotions, bleaches, dyes, disinfectants, and
sanitizing agents.*
(5) Therapeutic practices are prohibited.*
(a) Treating pimples
(b) Removing ingrown hair
(6) Headrest must be covered with clean towel or
paper towel for each patron.
(7) Common brushes, dusters and shaving mugs are
prohibited.
(a) Shaving is not permitted due to possible
transmission of bloodborne pathogens.*
(8) Individual sanitary neck straps must be used for
each patron.
(9) Covering must be changed daily or as needed.
(10) Operators’ street clothing shall not be stored in
barber shop spaces.
(11) Eating, drinking, or smoking is not authorized
while attending patrons.
(12) Trash receptacles should be clean with tight
fitting lids and the contents should be disposed
daily.
(13) Barbershops should be kept clean with all
surfaces and equipment hair free.
(14) Hair should be removed from the decks by a
dustless method.
(15) Removal of hair clippings from the patrons:
(a) Vacuum equipped clippers.
(b) Compressed air not to exceed 15 PSI.*
(16) Each barber shop must post a copy of the
sanitary regulations.

Question 45

11. STATE procedures for disinfecting barber shop instruments. (Ref: NAVMED P-5010, Chapter
    2, Section II)
    A. How do you clean/disinfect after each patron
    B. The Disinfectant must be what standard
    C. How often is disinfectant changed
    D. Non-Removable Clipper Head
    E. Removable Clipper Heads

Answer 45

a. Barber Shop Instrument Disinfection Procedures
(1) All instruments that come in direct contact with
patrons will be cleaned and disinfected after each
patron.*
(a) Washed with soap and water.
1) Do not wash electric hair clippers
(b) Disinfect with EPA registered disinfectant for
use in barber shops:
1) Formaldehyde cabinets and ultraviolet light are
not acceptable method of disinfecting.
2) Disinfecting solution must be changed at least
weekly.*
(c) Rinse thoroughly with potable water prior to
use.
(2) Non-removable clipper head.
(a) Wipe or dust
(b) Spray with EPA registered disinfectant spray
between each patron.
(c) Allow to dry prior to use.
(3) Removable clipper heads
(a) Remove
(b) Wipe or dust
(c) Wash and rinse
(d) Disinfected using EPA registered disinfectant
solution
(e) Rinse with running water prior to use.

Question 46

12. STATE requirements for conducting barber shop sanitation inspections. (Ref: NAVMED P-
    5010, Chapter 2, Section II)
    A. Frequency of Inspections
    B. Conducting Barber Shop Inspection

Answer 46

a. Frequency of Inspections
(1) Each barber shop must be inspected at least
quarterly.***
(a) Conducted by MDR
b. Conducting Barber Shop Inspection
(1) Ensure the sanitary regulations are posted.
(2) Visually check to ensure the barber has current
physical cards.
(3) Look for general cleanliness.
(4) Floor free of hair clippings.
(5) Trash cans not over flowing and are clean.
(6) Countertops/drawers free of hair clippings.
(7) Check disinfecting solution for hair clippings
buildup.
(8) Ensure all personnel have clean smocks and are
well groomed.

Question 47

STATE health and hygiene requirements for laundry facility employees. (Ref: NAVMED P-
5010, Chapter 2, Section IV)
A. Physicals
B. Hygiene

Answer 47

a. Laundry Facility Employee Requirements
(1) Personnel exposed to dry cleaning solvents must
have physical examinations:
(a) Pre-employment
(b) Periodic physicals as determined by the
Medical Officer or higher authority.*
(2) Personnel working in the processing area must
wear clean, washable outer garments in lieu of
street clothing.
(3) Hand washing after toilet use or handling of
soiled linen is mandatory.*
(4) Personal hygiene must be stressed.

Question 48

14. STATE sanitation requirements for laundry facilities. (Ref: NAVMED P-5010, Chapter 2,
    Section IV)

a. Floors
B. Paper and Trash
C. Lint
D. Plumbing
E. Sanitary Angle
F. Receiving and Issue
G. Eating, Smoking, Storage of food/drinks or Smoking

Answer 48

a. Laundry Facility Sanitation Requirements
(1) Clean and sanitary conditions must be maintained.
(a) Free from infestation by rodents and insects.
(2) Floor shall be cleaned at least once daily by
dustless methods.*
(3) Paper and trash placed in covered containers.
(4) Lint removed as necessary from:
(a) Bulkheads*
(b) Overheads*
(c) Structural support*
(5) Plumbing fixtures:
(a) Maintained in sanitary, working condition.
(b) Connected to prevent backflow or cross
connections with potable water supply.*
(c) Seawater may be used when the ship is outside
the 50 fathom curve (or 25 miles from shore).*
1) Never in polluted waters*
(6) Sanitary angle jet type water fountains must be
provided to supply drinking water.
(7) Receiving and issue
(a) Must be designated as Receiving or Issue
(b) Separate flow of clean and soiled garments.
(c) Separate contact surfaces such as tables.
(d) Carts and shelves for clean and soiled linen.
(e) Ventilation must move air from clean to soiled
areas.*
(8) Eating, smoking, storage of food, drinks or
smoking materials is prohibited in rooms where
clothing is handled.

Question 49

STATE safety requirements for laundry facilities. (Ref: NAVMED P-5010, Chapter 2, Section
IV)

Answer 49

a. Laundry Facility Safety Requirements
(1) Workrooms associated with laundry and dry
cleaning operations must be properly ventilated.
(2) Ventilation system of dry cleaning equipment
must be designed to automatically draw air into
the machine when opening the door.
(3) Steam and hot water pipes must be insulated.
4) Control measures must be initiated when air dry
cleaning chemical concentrations exceed
permissible exposure levels:
(a) Engineering
(b) Administrative
(c) Personal Protective Equipment
(5) Personal protective equipment (PPE) must be
worn in the event of an accidental spill.
(a) Respiratory protection
(b) Gloves
(c) Aprons
(d) Eye Protection
(6) Noise hazardous machinery must be marked.*
(a) Hearing protection must be worn over 84 dbs.
(7) Eye protection is required in all operations where
splashes occur.
(a) Eye wash stations must be located in or near the
laundry space, capable of providing 0.4 gallons/
per minute for 15 minutes.
(8) Automatic safety devices:
(a) Clearly identified
(b) Properly maintained
(c) Must not be removed/tampered with
(9) Guardrails must be constructed near dangerous
equipment:
(a) Ironers
(b) Compressors
(10) Drive shafts, belts and gears must be enclosed
with a safety flange or shield.
(11) Safety signs must be conspicuously posted to
warn unauthorized personnel to stay
clear of dangerous or restricted areas.
(12) First aid kits for emergency use must be
provided.
(a) OSHA requirement**.
(13) Slip or trip hazards are prohibited.
(14) Personnel must be trained prior to using any
laundry/dry cleaning equipment.
(a) Training must be provided:
1) Safety
2) First-aid
3) Personal protective equipment.
(15) Hazardous materials must be properly stored.
(16) Fire regulations must be displayed and enforced

Question 50

STATE requirements for making laundry hygienically safe. (Ref: NAVMED P-5010, Chapter
2, Section IV)

Answer 50

a. Hygienically Safe Laundry
(1) Washed in warm water (without bleach)
(a) 120 to 140 degrees Fahrenheit.*
(2) Hot air dryers are a necessary step when chlorine
bleach is not included in the formulation.*
(3) Laundered articles must be free of harmful
substances:***
(a) Chemicals.
(b) Biological agents.

Question 51

STATE requirements for handling soiled or contaminated laundry. (Ref: NAVMED P-5010,
Chapter 2, Section IV)

Answer 51

a. Handling Soiled Linen
(1) Use individual impervious laundry bags in each
area.*
(2) Linen carts must be lined with washable material
that can be easily removed and replaced.
(3) Linen must only be sorted in the laundry sorting
room.*
(4) Trained personnel wearing clean uniforms,
masks, and gloves must do sorting prior to
washing.
(5) Sharp objects must be carefully removed.
b. Handling Contaminated Laundry
(1) Received in impervious, double sealed bags.*
(2) Outer bag must be red and labeled with:*
(a) Universal biohazard symbol*
(b) The word “Biohazard”*
(3) The inner bag must be hot water soluble
(4) Contaminated linen must not be sorted.***

Question 52

6-17-1
STATE purpose of quarantine regulations in regards to the internationally
quarantinable diseases. (Ref: OPNAVINST 6210.2)
A. Purpose
B. Quarantine Regulations prevent introduction of what
C. List of quarantinable diseases

Answer 52

a. Purpose
(1) The movement of DoD equipment and DoD
personnel (ships, aircraft, and other modes
or methods of transport) entering or departing the
United States or foreign countries/ports may
introduce undesirable non-native species and
disseminate communicable diseases.
(2) Quarantine regulations are intended to prevent
the introduction and dissemination, domestically
or internationally, of diseases affecting:
(a) Humans, plants, and animals;
(b) Prohibited or illegally taken wildlife;
(c) Arthropod vectors;
(d) Pests of health and agricultural importance.
b. Quarantinable Diseases
(1) Cholera*
(2) Diphtheria*
(3) Infectious Tuberculosis*
(4) Plague*
(5) Smallpox*
(6) Yellow Fever*
(7) Viral Hemorrhagic Fevers*
(8) SARS*
(9) Influenza caused by novel or reemergent
influenza viruses that are causing, or have the
potential to cause, a pandemic.***

Question 53

DESCRIBE disease process of cholera (Ref: Heymann, D. L. (2014). Control of Communicable Disease Manual, 20th Edition); Cholera and Other Vibrioses, pgs
102-114)
FOR CHOLERA
A. What is it?
B. Sx
C. Without tx
d. How do you get it
E. Methods of control

Answer 53

a. Cholera
(1) An acute, diarrheal illness caused by infection of
the intestine with the bacterium Vibrio cholerae.*
(2) The infection is often mild or without symptoms,
but sometimes it can be severe.
(3) Approximately one in 20 infected persons have
severe disease characterized by profuse
watery diarrhea, vomiting, and leg cramps.*
(a) In these persons, rapid loss of body fluids leads
to dehydration and shock.
(b) Without treatment, death can occur within
hours.
(4) A person may get cholera by drinking water or
eating food contaminated with the cholera
bacterium.
(5) In an epidemic, the source of the contamination
is usually the feces of an infected person.
(6) The disease can spread rapidly in areas with
inadequate treatment of sewage and
drinking water.
(a) The cholera bacterium may also live in the
environment in brackish rivers and
coastal waters.*
(7) Shellfish eaten raw have been a source of
cholera, and a few persons in the United
States have contracted cholera after eating raw or
undercooked shellfish from the Gulf of Mexico.*
(8) The disease is not likely to spread directly from
one person to another;
(a) Casual contact with an infected person is not a
risk for becoming ill.*
b. Methods of control
(1) Active immunization with oral vaccines provide
high levels of protection for several months.*
(2) Case report universally required by World Health
Organization (WHO), and Medical Event Report
(MER).*
(3) Isolation with enteric precautions of severely-ill
patients, hand-washing and fly control.
(4) Concurrent disinfection of feces and vomitus of
linens and articles used by patients.

Question 54

DESCRIBE disease process of plague (Ref: Heymann, D. L. (2014). Control of Communicable Disease Manual, 20th Edition); Plague, pgs 456-464)
FOR PLAGUE
A. What causes the plague
B. How do you get it?
C. How is it Treated
D. Sxs of Bubonic
E. Sxs of Pneumonic
F. Methods of Control
G. Specific Methods of Control

Answer 54

a. Plague
(1) An infectious disease of animals and humans
caused by a bacterium named Yersinia pestis.*
(2) People usually get plague from being bitten by a
rodent flea that is carrying the plague bacterium
or by handling an infected animal.
(3) Millions of people in Europe died from plague in
the Middle Ages, when human homes and places
of work were inhabited by flea-infested rats.
(4) Modern antibiotics are effective against plague,
but if an infected person is not treated promptly, the
disease is likely to cause illness or death.
b. Clinical forms.
(1) Bubonic:
(a) Lymphadenitis develops in lymph nodes receiving
drainage from the site of the flea bite, where there
may be an initial lesion.
(b) Fever is usually present.
(2) Pneumonic:
(a) Extensive involvement of lungs, sputum loaded
with causative agent.
(b) Respiratory droplets may serve as source of
propagation, leading to outbreaks or epidemics.
c. Methods of control.
(1) The basic objective is to reduce the likelihood of
people being bitten by fleas, having contact with
infective tissues or exudates, or exposure to patients
with pneumonic plague.
(2) Specific methods include:
(a) Education.
(b) Rat-proofing of buildings and/or ships.
(c) Storage and disposal of food and garbage.
(d) Patient isolation and concurrent disinfection.
(e) Clothing repellants.
(f) Case report universally required by WHO, and
MER.

Question 55

DESCRIBE disease process of yellow fever (Ref: Heymann, D. L. (2014). Control of Communicable Disease Manual, 20th Edition); Yellow Fever pgs 683-689)
For Yellow Fever
A, Traveling with Yellow Fever
B. What transmits it
C. Methods of Control

Answer 55

a. Yellow fever
(1) Very rare cause of illness in travelers, but most
countries have regulations and requirements for
yellow fever vaccination that must be met prior to
entering the country.*
(2) A viral disease transmitted between humans by a
mosquito. (Aedes Egypti)*
b. Methods of control.
(1) General precautions to avoid mosquito bites
should be followed.
(a) These include the use of insect repellent,
protective clothing, and mosquito netting.
(2) Immunization (including contacts)
(a) Yellow fever vaccine is a live virus vaccine
which has been used for several decades.
(b) A single dose confers immunity lasting 10 years
or more.
(c) Adults and children over 9 months can take this
vaccine.
(d) Administration of immune globulin does not
interfere with the antibody response to yellow
fever vaccine.
(e) This vaccine is only administered at designated
yellow fever vaccination centers; the locations of
which can usually be given by the local health
department.
(3) Isolation.
(a) Blood and body fluid precautions.
(b) Clothing, bednets, and repellants.
(c) Case report universally required by WHO, and
MER.

Question 56

DESCRIBE disease process of smallpox (Ref: Heymann, D. L. (2014). Control of Communicable Disease Manual, 20th Edition); Small Pox pgs 561-569
FOR SMALL POX
A. When was the last case of SmallPox
B What Causes Small Pox
C. Methods of Control

Answer 56

a. Small pox (Variola Virus) NOT varicella
(1) The last naturally acquired case of smallpox in the
world occurred in October 1977 in Somalia;*
(a) Global eradication was certified two years later
by the WHO. (1979)*
(b) All known variola virus stocks are held under
security at the CDC Atlanta, Georgia, or at
Centre of Virology and Biotechnology, Koltsovo,
Russia.
(2) Systemic viral disease generally presenting with
a characteristic skin eruption.*
(3) Infection usually occurred via the respiratory tract
(droplet spread) or skin inoculation.*
* after 2-4 days the fever begins to fall and a deep seated rash develops with lesions containing the infectious virus*
b. Methods of control.
(1) Immunization with vaccinia virus.
(2) Should a non-varicella, smallpox-like case be
suspected, immediate telephone communication
with local and state health authorities is obligatory.

Question 57

STATE instruction outlining the quarantine regulations ( Ref: OPNAVINST 6210.2, BUMEDINST 6210.4 Series)
A. OPNAVINST 6210.2***
B. NAVMED P-5010, Chapter 8***
C.  BUMEDINST 6210.4 ***
D. NAVMED 6210/1
E. NAVMED 6210/2
F. NAVMED 6210/3

Answer 57

a. Instructions
(1) OPNAVINST 6210.2 (Quarantine Regulations of the Navy)*
(a) Provides guidance on Navy’s responsibilities, liaisons, foreign quarantine and
Public Health Service requirements.
(2) NAVMED P-5010, Chapter 8, Navy Entomology and Pest Control Technology*
(3) BUMEDINST 6210.4 Series Shipboard Sanitation Certificate Program*
(a) Identifies Navy preventive medicine personnel delegated authority in accordance
with OPNAVINST 6210.2 and the World Health Organization, International Health
Regulations (IHRs) to:
1) Inspect and issue appropriate Ship Sanitation Certificates (SSC)
2) Provide related standard procedures and policy for the Ship Sanitation
Certificate Program (SSCP).
(b) Replaces previous Deratting/Deratting Exemption Certificates which are no longer
valid.
(c) NAVMED 6210/1 U.S. Navy Ship Sanitation Control Exemption / Ship Sanitation
Control Certificate*
(d) NAVMED 6210/2 Notification of 30 Day
Extension*
(e) NAVMED 6210/3 U.S. Declaration of Health Certificate*

Question 58

STATE quarantine requirements for ships ( Ref: OPNAVINST 6210.2)
A. Ships, aircraft, or other conveyances of the navy proceeding to a foreign port must meet what requirements
B. Can Foreign Health officials be received on board
C. Can Foreign Officials conduct inspections
D: Publis Health Qurantine
E: Quarantine Symptoms

Answer 58

a. Foreign port- quarantine requirements:
(1) Ships, aircraft or other conveyances of the Navy
proceeding to a foreign port must meet the
quarantine requirements published by the proper
authority for such port.
(2) Ships and aircraft will comply with sanitary
measures prescribed by health authorities in
the port of departure to prevent the embarking of
personnel infected or the introduction of agent or
vector of a quarantine disease.
(3) Foreign health officials may be received on board
for receiving certification compliance but only with
the approval of the Commanding Officer.*
(4) Foreign officials can not conduct inspections of
military vessels.*
b. U.S. Port - quarantine requirements.
(1) Public health quarantine: In the last 15 days prior
to arrival in the U.S. or since departure from the
last U.S. port has any passengers or crew on
board presented with the following conditions and
illness:
(a) Patient has temperature of 100ºF (38ºC) or
greater accompanied by rash, glandular
swelling, or jaundice, or which has persisted for
more than 48 hours.
(b) Patient has diarrhea, defined as the occurrence
in a 24 hour period of three or more loose stools
or of a greater than normal (for that person)
amount of loose stool.
(2) Death due to illness other than battle casualties
or physical injuries.
(3) When one or more of the stated conditions exist
the Commanding Officer must notify higher
authorities of quarantine conditions aboard their
vessels prior to arrival in U.S. ports.
(a) The Commanding Officer will between 12 and
72 hours prior to entering the port,
message/radio the following:***
1) Senior Naval Officer in command of port to be
entered.
(b) Copy of the message will also be sent to:
1) Military quarantine inspector.
2) Responsible preventive medicine service in
the port area.
(c) Quarantine instructions will be radioed back to
the command as circumstances require.
(d) Unless otherwise indicated in the reply, a ship
may proceed directly to berth and
begin normal business activity.

Question 59

E. Coli:

Answer 59

A type of fecal coliform bacteria commonly found in the intestines of
animals and humans. E. coli is short for Escherichia coli. The presence of
E. coli in water is a strong indication of recent sewage or animal waste
contamination. Sewage may contain many types of disease-causing
organisms.

Question 60

LIST the elements of the TB Control Program. (Ref: BUMEDINST 6224.8C, 25 Apr 18)

Answer 60

a. Elements of the TB Control Program***
(1) Tuberculosis Screening
(2) Preventive Therapy
(3) Tuberculosis Case Identification
(4) Tuberculosis Patient Management
(5) Contact Investigation

Question 61

STATE tests to identify individuals exposed to mycobacterium tuberculosis. (Ref:
BUMEDINST 6224.8C, 25 Apr 18, Mantoux Tuberculin Skin Test Facilitator Guide,
http://www.cdc.gov/tb/education/Matoux/images/mantoux.)
A. Whats PPD Stand for
B. Whats the preferred product
C. Which ones are the FDA approved ones.

Answer 61

Tuberculin Skin Test – Mantoux Method*
(1) Approved material.
(a) Tuberculin, Purified Protein Derivative
(PPD)*
1) Tween-80-stabilized intermediate strength
PPD (5TU).
a) Tubersol – preferred product*
b) Aplisol – alternate product
(b) Disposable 1 ml tuberculin syringe.
1) Fitted with a ¼ to ½ inch, 27 gauge needle
with a short bevel.
b. Interferon Gamma Release Assays (IGRA) to detect mycobacterium tuberculosis infection*
(1) U.S. Food and Drug Administration approved
IGRA, QuantiFERON®-TB Gold (QFT),
QuantiFERON®-TB Gold Plus (QFT-PLUS), and
T-SPOT ®. TB (T-SPOT), is available as a
diagnostic aid for M. tuberculosis infection***
(2) QFT testing is approved for use in all
circumstances in which the TST is used.
(3) QFT is designed for use in place of, not in
addition to, a TST

Question 62

DEFINE the terms associated with the TB Control Program. (Ref: CDC, Basic TB Facts,
http:///www.cdc.gov/tb/topic/basics/glossary.htm)
A. Which latent TB infection causes Active TB
B. What does TB usually efftc
C. Can latent individuals spread TB
D.

Answer 62

a. TB Control Program Terminology
(1) Mycobacterium tuberculosis*
(a) Bacteria that cause latent TB infection and
active TB disease.
(2) Active TB disease.*
(a) An illness in which TB bacteria are multiplying
and attacking a part of the body,
usually the lungs.
(3) Latent TB infection
(a) A condition in which TB bacteria are alive but
inactive in the body.
(b) People with latent TB infection have no
symptoms, don’t feel sick, can’t spread TB to
others, and usually have a positive skin test
reaction.*
(4) TB skin test
(a) A test that is often used to find out if you are
infected with TB bacteria.
(5) TB blood test*
(a) A new test that uses a blood sample to find out
if you are infected with TB bacteria.
(6) BCG
(a) A vaccine for TB named after the French
scientists who developed it, Calmette and
Guérin.
(b) BCG is rarely used in the United States, but it is
often given to infants and small children in other
countries where TB is common.
(7) Directly observed therapy (DOT)***
(a) A way of helping patients take their medicine
for TB.
(b) If you get DOT, you will meet with a health care
worker every day or several times a week.
(8) Negative TB skin test
(a) Usually refers to a test result.
(b) If you have a negative TB skin test reaction,
you probably do not have TB infection.
(9) Positive TB skin test
(a) Usually refers to a test result.
(b) If you have a positive TB skin test reaction, you
probably have TB infection.

Question 63

STATE effective therapy to prevent the development of tuberculosis disease in newly infected
persons. (Ref: BUMEDINST 6224.8C, 25 Apr 18)

Answer 63

Latent Tuberculosis Infection (LTBI) Treatment
(1) The antibiotic regimen of choice for tuberculosis
preventive therapy is Isoniazid (INH) and
Rifapentine (RPT) in an oral weekly dose of 15
mg/kg (900mg max) of INH* and RPT based off
weight* 10.0-14.0 kg; 300mg, 14.1-25.0 kg; 450mg, 25.1-32.0 kg; 600mg, 32.1-49.9 kg; 750mg, ≥50.0 kg; 900mg (max) for 3 months.***
(2) An alternate regimen is Rifampin (RIF) in an oral
daily dose of 10 mg/kg (600mg max) for 4 months.
(3) Another alternate regimen is INH and Rifampin in
an oral daily dose of INH 5mg/kg; (300mg max) and
RIF 10 mg/kg; (600mg max) for 3 months.

Question 64

LIST the frequency of Purified Protein Derivative (PPD) testing. (Ref: BUMEDINST 6224.8C,
25 Apr 18)

Answer 64

Initial screening (TB Testing)
(1) All personnel entering active duty.*
(2) All individuals beginning employment as CIVMAR
for the MSC.
(a) When the person has past history of active
disease, reaction to skin test, or a history
of INH therapy, they must provide adequate
documentation of:
1) Clinical evaluations.
2) Hospitalizations
3) Diagnosis
4) Treatments
(b) Adequate medical documentation includes
copies of pertinent medical records treatment
records, or a physician statement on letterhead
stationery.
(c) If documentation is not provided, proceed with
skin testing.
b. Periodic screening (LTBI Screening)
(1) All active duty and Reserve personnel.
(a) Annual screening during Periodic Health
Assessment (PHA).
(b) Document on NAVMED 6224/8*
(2) CIVMARs
(a) During periodic physical examination***
(3) Individuals deemed to be at risk of acquiring TB.
(4) Additional screening and subsequent testing may be
done:
(a) As directed by combatant command.
(b) As part of a contact or outbreak investigation.
(c) If clinically indicated by an individual practitioner
based on history or physical.
(d) As recommended by cognizant NEPMU.

Question 65

STATE importance of a chest x-ray during tuberculosis screening. (Ref: BUMEDINST
6224.8C, 25Apr 18)

Answer 65

Chest radiograph requirements.

(1) If clinically indicated*
(2) To rule out active TB or fiberotic changes*

Question 66

STATE significance of BCG status in the Navy’s TB Control Program. (Ref: CDC, Basic TB
Facts, http:///www.cdc.gov/tb/topic/basics/glossary.htm, BUMEDINST 6224.8C, 25 Apr 18)

Answer 66

Bacillus Calmette Guerin (BCG)
(1) Vaccine for tuberculosis that is often given to infants and small children in other
countries where TB is common.
(2) Tuberculin Skin Test (TST) can be administered to people who have previously
received BCG immunization.
(3) A Positive TST reaction in BCG Immunized individuals should be regarded as
indicative of TB infection.

Question 67

LIST requirements for initial Isoniazid (INH) preventive therapy evaluation. (Ref:
BUMEDINST 6224.8C, 25 Apr 18)

Answer 67

a. Initial Isoniazid (INH) preventive therapy evaluation
(1) High Risk*
(a) Induration of 5mm* or greater is considered positive in.
1) Recent close contacts of active TB disease
patients.
2) Persons with fibrotic or other changes on chest
radiograph consistent with prior TB.
Patients suspected of having active TB disease.
(2) Medium Risk:(
(a) Induration of 10mm or greater is considered positive in.
1) Recent immigrants (within 5 years) from high TB prevalence countries.
2) Healthcare workers and others at risk of occupational exposure to TB.*
3) Persons with clinical conditions that place them at increased risk.
(3) Low Risk:*
(a) Induration of 15mm or greater* is considered positive in:
1) Persons with no risk factors for TB.
b. Initial evaluation of persons with positive IGRA or TST. Evalution
(1) Prior to therapy, the reactor must be evaluated by an MO, NP, PA, or IDC to rule out*
active TB disease.
(2) The evaluation must include:*
(a) Appropriate clinical history
(b) Physical exam
(c) Chest X-Ray
(d) Sputum Examination (only if radiographic shows signs of Active TB)*
(e) Baseline liver function tests (SGOT/SGPT) and bilirubin.
1) Only performed on patients with elevated risk for liver disease or INH-induced hepatoxicity.
(3) Questions to address:
(a) Is active disease present?
(b) Any contraindications to INH present?
(c) Should INH be prescribed and for what duration?

Question 68

STATE requirements for INH preventive therapy follow-up evaluation. (Ref: BUMEDINST
6224.8C, 25 Apr 18)

Answer 68

Monthly Evaluation

(1) Physical assessment to check for indication of active TB.
(2) Counseling on potential adverse drug reaction
(3) Discuss when to discontinue medication(s).
(4) Discuss when to report for prompt medical evaluation.
(5) Document on NAVMED 6224/9.***

Question 69

State requirements for non-compliance extended doses of INH therapy.. (Ref: BUMEDINST
6224.8C, 25 Apr 18 and CDC Latent Tuberculosis Infection, A Guide for Primary Healthcare
Providers)

Answer 69

Non Compliance

(1) Consult with NEPMU for management guidance when LTBI treatment has been interrupted prior to completion of an adequate treatment course.*
(2) Direct Observed Therapy:*
(a) Must be used for patients on INH regimens given twice weekly.
(b) Those having difficultly with treatment adherence.

Question 70

STATE relationship between INH therapy to elevated liver enzyme blood levels. (Ref:
BUMEDINST 6224.8C, 25 Apr 18)

Answer 70

Serum Glutamic Oxaloacetic Transaminase (SGOT)/Serum Glutamic-Pyruvic
Transaminase (SGPT) Blood Levels*
(1) INH therapy may increase the liver enzyme (SGOT/SGPT) blood levels.*
(a) Consider withholding INH if patient’s transaminase levels exceed three times the
upper limit of normal if associated with symptoms or five times the upper limit of normal if patient is asymptomatic.***

Question 71

STATE requirements in conducting tuberculosis contact investigations. (Ref: BUMEDINST
6224.8C, 25 Apr 18)

Answer 71

TB Contact Investigations
(1) Procedure
(a) Upon discovery of a suspected or confirmed case of active TB, the responsible medical department representative must notify the cognizant NEPMU, and the local health department as soon as possible.*
1) Cognizant NEPMU will conduct a TB contact investigation, assisted by command medical personnel IAW CDC guidelines.
2) Personnel who are enrolled in a contact investigation but are separating from the service must be identified to the local public health department for follow-up testing. Patients will have to follow up with the VA for medications.*
(2) Responsibility
(a) The medical department representative for the individual diagnosed with active TB
disease is responsible for ensuring the contact investigation is initiated rapidly.*
(b) The CO or OIC is responsible for the continuation and completion of contact investigations initiated among personnel assigned to or transferred from their command.
(3) Reports
(a) Investigation report will be provided by cognizant NEPMU to the Command, cognizant FLEET/TYCOM surgeon, and Navy Marine Corps Public Health Center (NMCPHC).*
(b) MERs.
1) Submitted within 24 hours for all known or suspected cases of active TB.***

Question 72

STATE the methods for administering PPD tests. (Ref: Mantoux Tuberculin Skin Test
Facilitator Guide, http://www.cdc.gov/tb/education/Matoux/images/mantoux. BUMEDINST
6224.8C, 25 Apr 18)

Answer 72

a. Skin Testing
(1) Skin testing procedures.
(a) The Mantoux method of administering Purified Protein Derivative (PPD) is the standard method for detecting latent TB.*
(2) Syringe preparation.
(a) A tuberculin syringe with single dose of 0.1 ml intermediate strength PPD.*
(b) Fill syringe immediately before use.
(3) PPD administration.
(a) Aseptically prepare skin.
(b) Make an intradermal injection of 0.1 mL of intermediate strength (5 tu) PPD on the
volar aspect of the forearm.*
1) The bevel of needle is in the up position.
2) The injection site should be clean and dry.
3) Perform intradermal injection at 5 to 15° angle so that a tense, pale wheal that is 6 to 10mm appears on the skin.*
a) If the wheal is less than 6mm in diameter, the test should be administered again.*
(1 The needle may have been inserted too deeply.
(2 An adequate dose was not administered
(a If the tuberculin test must be repeated, use another site at least 2 inches from the original site, or use the opposite forearm.
(4) Interpretation (Measuring and Recording).
(a) Examined by an MDR trained and experienced in interpreting skin tests.
1) 48 to 72 hours after the administration.*
2) Measure induration in the nearest whole mm at its widest diameter.
a) Redness without induration = ignore!
3) Measure/record any induration.
a) Find margins of induration by moving fingertips across reaction.
b) Use a millimeter ruler to measure the induration at its widest point.
c) Record the lower reading between marks.
b. Recording Results Form:
(1) Record result on NAVMED 6230/4 or DD Form 2766 and enter into AHLTA, MRRSor SAMS.
(a) Date.
(b) Tuberculin type.
(c) Dose
(d) Route
(e) Site
(f) Results (diameter of indurations in mm)
(g) Date Read
(h) Reader name
(i) Reader signature
c. Recording Results Issues:
(1) Absence of induration reported as 0 mm or zero mm
(2) Failure to read results recorded as not read*
(3) Record any size induration in mm*
(a) Not recorded as:*
1) Negative
2) Positive
(4) Ensure to document the presence or absence or adverse effects.
d. Failure to return for test interpretation.
(1) Returning more than 72 hours:
(a) Record the result as “not read” and apply a TST on the opposite arm.*
(2) If person does not return:
(a) Record the result as “not read”, recall the person and apply TST on opposite arm.*
e. Possible reasons of false negative TST results
(1) Immunosuppression due to TB infection or disease.
(2) Receipt of immunosuppressive medications.
(3) General immunosuppression due to the presence of immune system compromising
conditions.
(4) TST is administered within a short period after receiving parenteral live attenuated virus
vaccines.
(a) TST maybe placed on the same day parenteral live attenuated virus vaccines are
given. (if given first)*
(b) At least four weeks after live attenuated vaccines are given.**

Question 73

STATE the requirements when treating active tuberculosis (Ref: BUMEDINST 6224.8C, 25
Apr 18; Heymann, D. (2014, Control of Communicable Disease Manual, 20th Edition)

Answer 73

Patients with Active Tuberculosis Disease

(1) Characteristics.
(a) Often asymptomatic until late stage occurs.*
1) Symptoms include cough, weight loss, fatigue, fever, loss of appetite, chills and night sweats.
2) Other symptoms of TB disease depend on the location of infection in the body.
a) If in the lungs (pulmonary TB), the symptoms may include a bad cough, chest pain, dyspnea, coughing up blood or sputum.
(2) Treatment.
(a) Chemotherapy is extremely effective and usually curative if the full course is taken.
1) Isoniazid (INH) 300 mg/day for 6 to 9 months.
(b) Antituberculous drugs are classified as bactericidal (Isoniazid, Rifampin, Pyrazinamide) and bacteriostatic (Ethambutol, Streptomycin).
(c) To prevent development of resistance, clinical TB must always be treated with at least two drugs that act through different mechanisms.
(d) The preferred treatment for ACTIVE TB infection is INH daily (300 mg for adults, 10– 20 mg/kg for children) for 9 months and should be used unless there is a specific reason to use another regimen.*
1) INH 900 mg twice weekly for 9 months*
2) For drug regimens other than INH, consult with a TB specialist.
(3) Complications.
(a) Extrapulmonary TB infection.
(b) Adverse effects secondary to treatment.
1) INH associated hepatitis.
(c) Superinfections/Resistance to treatment.
(4) Disposition.
(a) Reporting requirements to health agencies.
(b) Contact investigation and management.
(c) Isolation and specific treatment protocols.
(d) Periodic liver function tests (LFTs) to monitor hepatotoxicity.

Question 74

LIST primary objectives of Medical Event Reports. (MER) (Ref: NMCPHC-TM-PM
6220.12)

Answer 74

a. Enables Navy public health experts to be aware of:
(1) Important medical events when they occur
(2) Prevention and control actions already taken by or being considered by local level medical staff
(3) Impact to potentially affect large numbers of people
b. Enables Navy public health experts to be proactive in offering their assistance to local level medical staff.***

Question 75

LIST uses of MERs. (Ref: NMCPHC-TM-PM 6220.12)

Answer 75

a. Any diagnosis, case or medical event that has been identified in a DON health care beneficiary and classified are reportable.
b. Research Labs that identify a case/medical-event, sufficiently enough to classify it as reportable.*
(1) Findings shall be reported to cognizant Navy Environmental and Preventive Medicine Unit (NEPMU).
(a) Primary consultant resource*

Question 76

LIST types of correspondence in which a MER may be submitted. (Ref: NMCPHC-TMPM
6220.12)

Answer 76

a. Disease Reporting System internet (DRSi)
(1) Official system to capture, store and communicate information related to RMEs.**
(2) DRSi account can be requested through NDRSi helpdesk at NDRS@nmcphc.med.navy.mil
(3) Mandatory where there is internet connection
b. When internet is unavailable routine reports should be submitted to their nearest NEPMU by U.S. Mail*
(1) Report format can be found on Appendix D of the NMCPHC-TM-PM 6220.12
(2) Operational units in a command directed communications condition that prohibits all external communications may delay reports until the condition is lifted.
c. Urgent reports may be made by:*
(1) Phone
(2) Priority Naval Message
(3) Encrypted e-mail
d. Use of SAMS to submit MER is no longer authorized*
e. Reports can either be Urgent or Routine
(1) Urgent- must be submitted within 24 hours*
(2) Routine- for all non-urgent events must be submitted no later than 7 calendar days after their identification.*

Question 77

LIST diseases that are to be reported within 24 hours. (Ref: NMCPHC-TM-PM 6220.12,
Appendix C)

Answer 77

a. The following communicable diseases are required to be reported within 24 hours.***
(1) Anthrax
(2) Botulism
(3) Diphtheria
(4) Hemorrhagic FEVER
(5) Influenza A, Novel
(6) Malaria (All)
(7) Measles (Rubeola)
(8) Meningococcal Disease
(9) Outbreak or Disease Cluster
(10) Plague
(11) Poliomyelitis
(12) Rabies, Human
(13) Severe Acute Respiratory Syndrome (SARS)
(14) Smallpox
(15) Tuberculosis, Pulmonary
(16) Tularemia

Question 78

LIST incidences requiring submission of MERs. (Ref: NMCPHC-TM-PM 6220.12)

Answer 78

a. Any dagnosis listed on the RME list
b. Outbreaks
(1) Outbreak report need not include identifying information about individual patients*
(2) Individual MER not requires for each patient
(3) Submit only one MER per outbreak unless instructed otherwise by NEPMU*
(4) Report format can be found on Appendix B of the NMCPHC-TM-PM 6220.12

Question 79

LIST distribution requirements for MERs. (Ref: NMCPHC-TM-PM 6220.12)

Answer 79

a. MER are generally unclassified*
b. Reporters who are concerned that their MER might have an adverse impact on their operational unit or national security should consult their information security or commanding officer for classification decision*
c. All MERs should be marked “For Official Use Only”

Question 80

STATE requirements for Communicable Disease Reporting. (Ref: NMCPHC-TM-PM
6220.12)

Answer 80

a. The medical officer, command surgeon, or designated staff responsible for the healthcare/treatment of that individual is required to submit the report.*
b. A diagnosis, case, or medical-event becomes reportable once it has been classified as:*
(1) Suspected
(2) Probable
(3) Confirmed
c. Those conditions which require a report for either suspected or probable must ultimately be
confirmed in the medical event reporting system*
(1) Follow-up MER*

Question 81

DISCUSS a Disease & Injury Report (Ref: DODI 6490.03)

Answer 81

a. Definition
(1) Disease and Injury Surveillance involves monitoring the incidence of specific prediagnostic
syndromes and injuries occurring in a unit.
b. Purpose
(1) To rapidly troubleshoot Force Health Protection efforts
(2) Identify deficiencies
(3) Take corrective action
(4) Request service reach back assistance as soon as possible
c. Policy
(1) Requires units deployed outside the continental United States (OCONUS) for more than 30 days to places absent a fixed MTF conduct disease and injury surveillance as part of the DOD deployment health surveillance program.
(2) Navy ships are exempt from this requirement.
d. Template
(1) Templates are available for use depending on type of class of ship located on the Navy and Marine Corps Public Health Center website

Question 82

DESCRIBE immunizations managed under the Immunization Program. (Ref:
BUMEDINST 6230.15 Series, Chapter 4; Vaccine Healthcare Centers Network
Immunization Tool Kit)

Answer 82

a. Adenovirus Types 4 and 7
(1) Administer to military enlisted basic trainees
(2) Dosage: 2 tablets
(a) 2 separate oral tablets (1 white/1 peach in color)*
(3) Route: Oral*
(4) Booster: None
b. Anthrax vaccine.
(1) Administer based on the policy set by the Anthrax Vaccine Immunization Program. DOD or US Coast Guard sets the policy for implementation plans.
(2) Dosage: 5 shots over 18 months.
(a) 0.5 mL given at:
1) 0
2) 4 weeks (1 month)
3) 6 months
4) 12 months
5) 18 months
6) Annual booster
(3) Route – Intramuscular (IM)*
(4) Booster - subsequent booster injections at one year intervals to sustain immunity (if needed based on deployment requirements)*
c. Haemophilus Influenzae Type B (HIB)
(1) Administer HIB vaccine to those who are immunocompromised, have sickle cell disease, or do not have a spleen or a functional spleen.
(2) Dosage - single dose of 0.5 mL.
(3) Route – Intramuscular (IM)
(4) Booster - Healthcare provider will determine if second dose is needed.
d. Hepatitis A.
(1) Unless seroimmune administer to trainees and accessions during initial entry training.*
(a) Havrix (SmithKline Beecham).
1) Dosage for: 6 months to 18 years old
a) Primary - One dose of 720 EL.U/(0.5mL).*
b) One dose of 720 EL.U/(0.5mL).
c) Give at 0, 6 month interval*
2) Dosage for 19 years and older:*
a) Primary - One dose of 1440 EL.U/(1.0mL)*
b) One dose of 1440 el.uEL.U/(1.0mL)
c) Give at 0, 6 month interval
(b) Vaqta
1) Dosage for 6 month -18 years old:
a) One dose of ~25 u/(0.5mL).
b) One dose of ~25 u/(0.5mL).
c) Give at 0, 6 month interval
2) Dosage for 19 years and older:*
a) One dose of ~50 u/(1.0mL).
b) One dose of ~50 u/(1.0mL).
c) Give at 0, 6 month interval 6 months after the primary.
(2) Route: Intramuscular (IM) in deltoid muscle.
(3) IM in the deltoid muscle. Consult with NEPMU for guidance concerning interchangeability.
NOTE: If dose #2 is delayed, do NOT repeat dose #1; just given dose #2.*
e. Hepatitis B
(1) Unless seroimmune administer to trainees and accessions during initial entry training. *
(a) Required for high risk personnel:*
1) Occupational exposure to blood products, or other body fluids.
2) All healthcare workers.
3) All students in hospital corps and dental technicians school.
4) Any person who contact a sexually transmitted disease.
5) Anyone entering a high-risk area where Hepatitis B is endemic for a significant period of time.
(2) Dosage
(a) Engerix- B (three doses)
1) Dosage for 0-19 years old
a) 0.5mL
2) 20yrs
b)1.0mL
b) Give at 0, 1 month, 8 weeks minimum and at least 16 weeks after dose #1
(b) Recombivax HB (3 doses)
1) Dosage for 0-19 years old
a) 0.5mL
b) Give at 0, 1 month, 8 weeks minimum and at least 16 weeks after dose #1
2) Dosage for 20 years and older
a) 1.0mL
b) Give at 0, 1 month, 8 weeks minimum and at least 16 weeks after dose #1
(3) Route: Intramuscular (IM)*
(4) Immunity.
(a) Immunity should be checked at 1 - 2 months after the completion of the
vaccine series. to 6 months after the 3rd dose.
(b) Individuals who fail to demonstrate a protective level of anti-HBs require
careful evaluation and follow-up with possible further immunizations.
f. Hepatitis A/B (Twinrix)
(1) Dosage: 3 doses
(a) 1.0mL
(b) 0, 4 weeks, 5 months
(c) Route: intramuscularly
g. Influenza
(1) Administer annually
(2) Dosage: 1 dose
(a) 0.5mL
(3) Route: Intramuscular (IM) given over the deltoid
(4) Contraindications: Do not give if they have experienced a serious systemic or anaphylactic reaction to a prior dose. Those with egg allergy may receive vaccine depending on medical evaluation.*
h. Japanese Encephalitis (JE).
(1) Required for personnel going to endemic areas.
(a) Personnel should complete the series prior to departure.
(b) If not completed prior to departure, must be started prior to departure and then completed upon arrival.
(2) Dosage - 2 doses of 0.5 mL each on day(s) 0 and 7-28 days.*
(a) The last dose should be administered 7 days before international travel to ensure adequate immunity.
(3) Route – Intramuscular (IM)
(4) Booster - A one time booster dose may be given at least 11 months after the completion of the primary immunization series if ongoing exposure or re-exposure to JE virus is expected.*
i. Measles, Mumps and Rubella (MMR) (live virus).
(1) Unless seroimmune to both measles and rubella, administer to all active duty personnel, ensure healthcare workers have received tow documented doses or have positive serologic test results. All active duty personnel and DOD health care providers (military or civilian), will be given one dose of MMR vaccine regardless of year of birth.
(2) All women should be advised to avoid becoming pregnant for at least 28 days after immunization.
(3) Dosage: 0.5mL.
(a) Given at 0, 4 weeks
(4) Route – Subcutaneous (SQ)*
(5) Exception:
(a) Two documented age appropriate MMR vaccinations
(b) Pregnancy (or planned pregnancy within next month)
j. Meningococcal A/C/W/Y-Inactivated, bacterial polysaccharide conjugate.
(1) All active duty (nNew accessions) if no evidence of vaccination within the last 5 years. Additionally, administer to those deploying to endemic areas as required by DoD and USCG policy.
(2) Dosage – single dose of 0.5mL
(a) Two doses, 2 months apart for adults at high risk
(3) Route - Intramuscular (IM)*
(4) Periodicity: Booster- People with persistent risk need a booster every 5 years for as long as risk is present.*
k. Pneumococcal Conjugate (PCV 13)
(1) Administer to military personnel who are in a high risk category per ACIP recommendations.
(2) Dosage: 0.5mL
(3) Route - – Intramuscular (IM)
(4) Booster- Administer a second dose to persons without spleens or severely immunocompromised 5 years after initial dose.
l. Poliomyelitis (Inactivated Poliovirus Vaccine – IPV)
(1) Administer 1 time booster to all active duty personnel during basic training if primary series was completed. Inactivated poliovirus vaccine (IPV)
(2) Dosage - 0.5 mL
(3) Route – Subcutaneous (SQ) or Intramuscular (IM).*
(4) Booster - None*
m. Rabies
(1) Post exposure prophylaxis*
(a) Consideration:
1) Species of biting animal
a) Wild
b) Tame
2) Circumstances of the incident
a) Provoked
b) Unprovoked
3) Type of exposure
a) Bite
b) Non bite (scratch/abrasion)
c) Exposure to saliva.
(b) Dosage: (4 doses)
1) Four 1.0 mL of human diploid cell vaccine (HDCV):*
a) Doses given on days 0, 3, 7, 14 days*
b) If immunocompromised give 5th dose on day 28.*
2) Human Rabies Immune Globulin (HRIG):
a) Give with first dose of HDCV
(c) Route:
1) HDCV
a) Intramuscular (IM)
2) HRIG
a) 20 international units of RIG per kg body weight. If anatomically feasible, infiltrate the full dose around the wound.*
b) Additional amount IM at site distant from vaccine
n. Smallpox (live virus) Made by vaccina*
(1) Vaccinate designated military and civilian personnel according to DoD and other designed personnel in accordance with USCG policy and Service-specific implementation plans. Immunize personnel based on geographical areas at higher risk for release of small pox as a weapon or in occupational roles as designated by the Services, Chairman of the Joint Chiefs, or the Office of the Secretary of Defense.
(a) Training and Education
1) Before administering smallpox vaccine to military or civilian personnel who are eligible, provide education on the criteria for exemption from immunization,
expected response at the vaccination site, vaccination-site care, risks of spreading vaccinia to close contacts, adverse events following immunizations.
2) Do not administer vaccine without patient receiving education and medical screening for contraindications and/or precautions, including consideration of close contact risk factors.
(2) Dosage: 15 jabs using bifurcated needle*
(a) Assess 6-8 days later for “Major Reaction vs. No Take”.
(b) If “No Take” repeat vaccination procedure in primary vaccinne only once with 15 jabs.
(3) Route- Percutaneous (scarification)*
(4) Booster: Every 10 years if repeated or continued exposure
o. Tetanus, diphtheria, and pertussis – (Tdap)
(1) Required for all active duty personnel, recruits and reserve components.
(2) Dosage - 0.5 mL.
(3) Route – Intramuscular (IM)
(4) Booster: Every 10 years*
p. Typhoid.
(1) Required for personnel before overseases deployment/assignment to typhoid endemic
areas.
(2) Dosage: 0.5 mL
(3) Route – Intramuscular (IM).
(4) Booster - Every 2 years (if repeated or continued exposure to the typhiorganism)
q. Varicella
(1) Required for basic trainees, new accessions, and healthcare workers
(2) Dosage (2 doses)
(a) 0.5mL*
(b) 0, 4-8 weeks later*
(3) Route: Subcutaneous (SC)*
(4) Booster: None
r. Yellow fever (live virus).
(1) Required for all alert forces, active duty personnel or reserve components traveling to yellow fever endemic areas*
(2) Dosage - 0.5 mL
(3) Route – Subcutaneous (SC)
(4) Booster: Every 10 years only if going to high risk areas based on season, location, activities, and duration of travel.*
s. Storage, reconstitution, administration, and disposal procedures for biological products:
(1) Yellow fever.
(a) Store between 36 to 46 ºF (2 to 8ºC).*
(b) Multidose vial of reconstituted vaccine must be discarded after 1 hour of reconstitution.*
(2) Measles, Mumps and Rubella vaccine.
(a) Store between -58 ºF +/-5º F*
(b) Store in dark place.
(c) Discard vaccines if not used within 8 hours following reconstitution.
(3) Varicella
(a) Refrigerator - 36-46º F
(b) Freezer - -58 to +/-5° F
(c) Must be used within 30 minutes of reconstitution.
(4) All other biologicals.
(a) Store between 36-46ºF (2-8°C)*
(b) Store as recommended by manufacturer.
(c) Dispose of if frozen during storage or shipment.*

Question 83

STATE requirements for required immunizations when a member must deploy to an
endemic area on very short notice. (Ref: BUMEDINST 6230.15 Series)

Answer 83

a. Short Notice Deployment
(1) For short notice travel or deployments, administer the first dose in a required basic series.
(2) Make arrangements to receive additional doses to complete the series as close to the proper schedule as possible.
b. Yellow fever immunization is required for Navy personnel assigned to Navy units subject to deployment within 10 days of notification into land areas where yellow fever is endemic.

Question 84

DESCRIBE vaccine information materials. (Ref: BUMEDINST 6230.15 Series)

Answer 84

Vaccine Information Sheet

(1) All personnel must be provided information regarding immunizations prior to receiving them.*
(2) Information may be provided immediately before the immunization or days before.*
(3) Providers will only use vaccine information sheets prepared by the U.S. Department of Health and Human Services, Centers for Disease Control and Prevention.***

Question 85

DESCRIBE safety procedures to be followed prior to immunizing patients. (Ref:
BUMEDINST 6230.15 Series)

Answer 85

Documentation of allergies and hypersensitivities.

(1) Screen each patient for allergies, health status, recent vaccinations, and previous vaccine adverse events before immunization. Prior to immunization, check to see if patient has any allergies or hypersensitivities.
(a) Refer to appropriate medical specialist for evaluation, unless the health record contains documentation of prior consultation or a specialist’s
recommendations. Be sure to document hypersensitivity and any recommended exemption(s).*
b. Routine pregnancy tests are not required prior to administration of vaccines or toxoids, including live virus vaccines.
(1) Ask the female if they are pregnant.
(a) If the answer is “yes” or “maybe”, exclude from immunization. Refer to PCM.*
(b) If “no”, immunize.
(c) Inform them about nominal fetal risk.
(2) Live virus vaccines should not be routinely administered to any pregnant female.***
(a) Can be given if ordered by attending physician for specific prevention or for international travel.
(b) Polio and yellow fever vaccine may be administered if risks of contracting illness outweigh potential complications.
* **

Question 86

STATE the necessary equipment to treat anaphylactic shock. (Ref: BUMEDINST
6230.15 Series)

Answer 86

a. Anaphylactic Shock Treatment Equipment***
(1) A person capable of treating anaphylaxis should be present at immunization site.
(2) Type Commanders will determine types of health care personnel and their level of
certification in CPR and life support.
(3) Physician, Independent Duty Corpsman (IDC), Dentist, Physician Assistant (PA),
Nurse.
(a) Minimum qualified in BCLS, but ACLS is preferred.
(b) May be one of the people administrating the vaccine.
(4) Immunization clinics should be located near ER or sickbay.
(a) If not, a ready ambulance should be available with a physician staffed medical
treatment facility (MTF) within an acceptable transport distance of <10
minutes.
(5) During all immunization procedures, an emergency medical treatment cart or
appropriately stocked kit will be immediately available, containing:
(a) Oxygen.
(b) Administration apparatus.
(c) Airways.
(d) IV fluid apparatus.
(e) Appropriate medications required for adequate ACLS.
(f) Defibrillator/cardiac monitor.

Question 87

STATE importance of Advisory Committee on Immunization Practices (ACIP) to the
Navy Immunization Program.

Answer 87

a. Advisory Committee on Immunization Practices (ACIP)*
(1) Consists of experts in fields associated with immunization, who have been selected by
the Secretary of the U.S. Department of Health and Human Services (HHS)* to provide
advice and guidance to the Director, Center for Disease Control and Prevention (CDC)* regarding use of vaccines and related agents for effective control of vaccine-preventable diseases. The CDC Director will inform the Secretary and Assistant Secretary, HHS, on immunization recommendations.*
(a) The role of the ACIP is to provide advice* that will lead to a reduction in the incidence of vaccine preventable diseases in the United States, and an increase in the safe use of vaccines and related biological products.
(b) Committee develops written recommendations for the routine administration of vaccines to children and adults in the civilian population; recommendations
include:
1) Age for vaccine administration
2) Number of doses and dosing interval
3) Precautions and contraindications
(c) The ACIP is the only entity in the federal government that makes such recommendations*
(2) Vaccine administration policies of the Navy Immunization Program must follow the recommendations of the CDC and the current ACIP recommendations unless there is a militarily relevant reason to do otherwise.
(a) Available at the CDC Website (http://cdc.gov/nip) or the Military Vaccine Office Web site (http://www.vaccines.mil)

Question 88

LIST immunizations that are not to be given while underway. (COMNAVSURFORINST
6000.1, Section 5606)

Answer 88

a. Immunizations not given underway*
(1) All immunizations, except yellow fever, may be given at sea or ashore at the discretion of the MDR with the concurrence of the Commanding Officer.*
(2) Yellow fever immunizations on IDC ships shall only be conducted in port during normal working hours after prior notification and concurrence of local. Regional Medical Representative (RMR) unless a Medical Officer is present.***

Question 89

STATE provisions for granting immunization exemptions. (Ref: BUMEDINST 6230.15
Series)

Answer 89

a. Medical Exemptions
(1) Includes any medical contraindication relevant to specific vaccine
(2) May be temporary (up to 365 days) or Permanent*
(3) General examples are:
(a) Underlying health condition of the vaccine candidate
(b) Evidence of immunity based on:
1) Serologic Test
2) Documented infection
(c) Individuals clinical case is complex or not readily definable
1) Consult appropriate medical specialists
(4) Primary care provider may grant temporary or permanent medical exemptions
b. Administrative Exemptions
(1) Separation or retirement
(a) May be exempt from deployment immunization 180 days before separation or retirement if:*
1) Not currently assigned or deployed in area where the immunization is indicated*
2) Not mission essential*
(2) Religious
(a) Command decision made with medical, judege advocate and chaplain advice. Waivers are granted on a case basis by the Chief, Bureau of Medicine, and
Surgery.***

Question 90

STATE required documentation procedures for patient immunization. (Ref:
BUMEDINST 6230.15 Series)

Answer 90

a. Forms utilized in the record keeping of immunizations
(1) NAVMED 6230-4 – adult health record immunization record*
(2) CDC 731 - International Certificate of Vaccination
(a) Required for each member of the armed forces and for nonmilitary personnel*
(b) Remains in custody of the individual
(3) DD Form 2766- Adult Preventive and Chronic Care Flowsheet***
(4) Immunization Roster
(a) To identify and notify personnel due for required/specific vaccinations.
b. The Shipboard Non-tactical ADP Program (SNAP) automated medical system (SAMS) will
be the interim system for immunizations administered to service personnel at medical
treatment facilities.
(1) Ships will continue to use SAMS to collect and report immunization data.
c. Required immunization information
(1) Date
(2) Manufacturer/Name of Immunization
(3) Lot Number
(4) Dose given
(5) Site and route of administration
(6) VIS edition given (if required)
(7) Name, address and title of the person administering the vaccine
(8) MTF or other facility
d. If recruits do not receive an immunization due to either evidence of prior immunization or
serological immunity
(1) Record the information on:
(a) NAVMED 6230/4 (rev. 10-2007)
(b) CDC 731 (International Certificate of Vaccination)
(c) Electronic database