New Jersey Department of Environmental Protection

Division of Parks and Forestry

State Park Service
PO Box 420
Mail Code 501-04
Trenton, NJ 0862509420

LIFEGUARD
MANUAL

ADMINISTRATION
&
PROCEDURES

May 2017
 TABLE OF CONTENTS

Chapter Page

1 Lifeguard Recruitment 3
2 Employment Test and Hiring Procedures 4
3 Lifeguard in Training Program 6
4 Lifeguard Training 8
5 Lifeguard Staffing 15
6 Records and Documents 20
7 Equipment, Supplies and Uniforms 30
8 Seasonal Opening and Closing/Temporary Closing 32
9 Communications 34
10 Flotation Devices for Disabled Persons 37
11 Water Sampling at Bathing Beaches 38
12 Hepatitis Vaccination And Pathogen Exposure Administration 339

APPENDIX 42

Recruitment Flyer A-1

Permission Slip for Applicants Under 18 A-2
Lifeguard Physical Form A-3
Hepatitis B Immunization Form A-4
Training Assignments A-5
Freshwater Daily Report A-6
Ocean Daily Report A-7
Year End Lifeguard Activity Report A-8
Lake Lifeguard Training Record A-9/A-10
Ocean Lifeguard Training Record A-11
Lifeguard Physical Training Record A-12
First Aid Report A-13
Lifeguard Evaluation A-14/A-15
Employment Test Score Sheet A-16
Bi-Weekly Time Sheet A-17
Death or Serious Injury Report A-18/A-19
First Aid Equipment Inventory A-20
First Aid Supplies Inventory A-21
Lifeguard Equipment A-22
PWC Maintenance Log A-23
Bathing Area Diagram A-24
USLA Roster A-25
Copies of First Aid, CPR, & USLA Cards A-26
Lifeguard Stand Blueprints A-27-A-29
Uniform Request A-30
Beach Wheelchair Sign-Out A-31
Bloodbourne Pathogen Exposure Control Plan CPR/FA Roster A-32

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 Chapter 1 – LIFEGUARD
1 RECRUITMENT

I. Recruiting Returning Lifeguards

A. All lifeguards should leave a winter address prior to termination. This will enable each
area to contact that lifeguard in January. The previous summer’s lifeguards should be
contacted with a letter that includes the following:

1. An offer of employment as a lifeguard for the upcoming season.

2. Pay Scale.

3. Upcoming season information and test dates if available.

B. Each returning lifeguard should be contacted again at the beginning of March with a
letter that includes test dates and an application.

C. Before sending letters offering a returning guard summer employment, be sure to review
his/her previous year’s evaluation.

II. Recruiting New Lifeguards

A. Recruitment posters and brochures should be sent to swim coaches, athletic directors
and guidance counselors in December. Sample flyer page A-1.

B. Lifeguard job information must be available to all employees answering phones in the
area office. This information will include the date, time, location, components of the
employment test and starting salary. In addition, it should be made clear to all
applicants under 18 years of age that a permission slip must be signed by a parent or
legal guardian prior to taking the lifeguard employment test. They should also be
informed that wetsuits are not permitted. This will make it easy for office personnel to
give lifeguard information over the telephone. This information should be in the
office and at www.njparksandforests.org starting January 1.

C. Office personnel should record names, addresses and telephone numbers of all the
interested parties. An application, permission slip and other pertinent information
should be sent to all interested candidates. These candidates should be contacted again
about two weeks prior to the lifeguard test to be reminded of the test.

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 Chapter 2 – EMPLOYMENT TEST AND HIRING PROCEDURES

All lifeguards and lifeguard officers must pass the NJ State Park Service Lifeguard Employment
Test prior to performing lifeguard functions each season.

I. Components of Test and Passing Scores

A. 500 Meter Swim

1. Open Water Test (Given when pool is not available)

Applicant starts on beach and runs into waist-deep water then swims to and touches a
marker 250 meters from the water line and returns to the starting point. Passing time
is 10 minutes or less.

2. Pool Test

Applicant starts in the pool (diving is not permitted) and swims 20 lengths in a 25
meter pool or 3 yards short of 22 lengths in a 25 yard pool. Flip turns are allowed.
Passing time is 10 minutes or less.

B. 400 Meter Run

Candidate will run 400 meters with sneakers on a track or other hard surface. Passing
time is 1 minute 40 seconds or less.

II. Testing Criteria

A. Test will be organized and administered by Water Safety Supervisor (WSS) or a Regional
Superintendent designee.
B. The two parts of the test must be taken and passed simultaneously.

C. If one part of the test is failed the whole test must be retaken.

D. Rest time and changing time between events is a maximum of 10 minutes.

E. Events will be timed by WSS or Superintendents.

F. No wetsuits can be worn during the test.

G. Returning guards will staff boats with rescue buoys and kayaks with rescue buoys for
safety during tests in open water.

H. Heats for open water testing should contain a number of applicants that can be
safely covered by boats and kayaks.

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 I. All candidates under 18 years of age must have an official State Park Service permission slip
signed by a parent or legal guardian in order to take the employment test. Candidates over
18 must have acceptable proof of age. Sample form page A-2.

J. Employment test record forms ( p a g e A - 1 6 ) will be completed by WSS and

forwarded to the appropriate Superintendent.

K. No exceptions.

III. Hiring Procedures

These procedures are for both new and returning lifeguards.

A. Applicants must be interviewed by the Superintendent.

B. Applicants hired must be given a lifeguard physical form with accompanying directions
about how it should be completed. This physical form may not be photocopied and
must have the physician’s seal or stamp affixed. If these conditions are not met, the
form will be considered invalid. All Lifeguards must have lifeguard physical form
completed by an M.D., D.O., nurse practitioner, or physician assistant prior to
performing lifeguard functions for the public. Training and maintenance functions are
permitted before physical form is completed. This form should be kept in the personnel
file at the area office. Sample form on page A-3.

C. Lifeguard must be notified of training requirements, scheduled classes, and the manual
test.

D. Lifeguards must get working papers from their high school if they are under 18 years of
age.

E. Hepatitis B Immunization Form (page A-4) must be sent to the Trenton Lifeguard
coordinator. All lifeguards regardless of whether they filled out this form in the past
must complete the form. If the Lifeguard is a minor, a parent or legal guardian must sign.

F. Employment package must be sent to the Office of Visitor Services and Program
Support.

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 Chapter 3 – LIFEGUARD IN TRAINING PROGRAM

This program is for parks that can not get enough lifeguards to complete their staff because
the applicants can not pass the lifeguard employment test. This program is not for returning
guards who are out of shape and can not pass the test.

1. The objective of the program is to hire candidates who fail the lifeguard
employment test but show potential to pass. When hired, these candidates will be
called “Lifeguard in Training”.

2. Returning lifeguards will train people hired for the lifeguard in training program.

3. The “Lifeguard in Training” will follow a structured program of stretching,

running, swimming and stroke instruction.

4. The program will be used when it appears the lifeguard staff will not be filled. If
it is early in the spring, pool time must be acquired.

5. This program will not work if an area does not recruit applicants.

6. The “Lifeguard in Training” will be hired at $8.38 per hour.

7. The “Lifeguard in Training” must meet and/or carry out the following criteria:

A. Failed lifeguard employment test but shows potential to pass. Swim

time is no more then 12 minutes and run time is no more then 2 minutes.

B. Willing to work up to 15 hours a week on swimming, running and endurance.

C. Show progress each week to a maximum of 3 weeks. If employee does not

pass the test after 3 weeks he/she will be terminated.

D. Successful completion of employment test will result in employment as a

lifeguard and employee will enter State Park Service Lifeguard Training
Program.

E. Will not be issued or wear a lifeguard uniform.

F. Will not perform any lifeguard duties or sit on a lifeguard stand.

G. Will adhere to a work schedule agreed to by head lifeguard and

Superintendent. Preferably during slow times of the day.

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8. When training “Lifeguard in Training”, make sure the public is adequately
protected. A guard must be in the stand when training takes place in the
water and kayaks should be used on buoy swims. Do not compromise
trainee’s or public’s safety.

9. If the guards working with the “Lifeguard in Training” do not have a positive
attitude and encourage these people, the program will fail!

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 Chapter 4 – LIFEGUARD TRAINING

This chapter will outline the training that must be completed by returning guards and new
guards prior to and during the recreational bathing season. The training program is
required by the New Jersey Department of Health and Senior Services and approved by
the United States Lifesaving Association (USLA).

Training of lifeguard procedures, water skills, physical training, and other related
material will be carried out by lifeguard officers in consultation with the Regional Water
Safety Supervisor (WSS).

I. Training Returning Guards-Lifeguard Skills

A. Essential skills and procedures which must be reviewed by all returning lifeguards and officers
prior to working as a lifeguard.

This training will be referred to as primary training. The material to be covered in

primary training is listed below and must be done to the satisfaction of a lifeguard
officer. Training sessions will be planned prior to opening day by lifeguard officers
and the WSS.

Primary training:
1. Rescue Procedures and All Related Procedures (Hand Signals, Telephone, Etc.)

2. Torpedo Buoy Rescues

a. Conscious Victim
b. Unconscious Victim (on surface and submerged), discuss in water rescue
breathing
c. Multiple Victims

3. Kayak/Rescue Board Rescues (Rescue Boards at Island Beach State Park Only)
a. Conscious Victim
b. Unconscious Victim, discuss in water rescue breathing
c. Multiple Victims

4. Non-equipment Rescue techniques as listed on lifeguard

training record.

5. Removal of victim from shallow water to beach

6. Mask, Fins and Snorkel

7. Sighted submersion

8. Water Search for a lost person not sighted by a lifeguard

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 9. Spinal Injuries

a. Backboard and related equipment

b. Skills needed to care for spinal injury in deep and shallow water

10. Scanning

a. Discuss what to look for

b. Previous experiences
c. Correcting problems observed

11. Personal Water Craft (Designated personnel at Island Beach State Park)

a. Handling and safety

b. Off beach use
c. Rescues

12. All Terrain Vehicle (Designated personnel at Island Beach State Park)

a. Handling and safety

b. Off beach use
c. Recommended uses

13. Off Beach Rescue Team Procedures (Designated personnel at Island Beach)

14. Review of Area (Facilities, Signs, Park Communications, Etc.)

B. A returning lifeguard is required to pass a written test on the lifeguard manual before
working as a lifeguard.

1. The manual test will be given by the WSS or his/her designee. Care must be taken to
insure the validity of these tests.

2. Any cheating on the manual test will result in the dismissal of all persons involved.

3. The passing grade on the Lifeguard Manual Test is 90. Incorrect answers must be
corrected.

C. Generally speaking, most returning guards will have current American Red Cross CPR
and First Aid certifications.

1. American Red Cross: First Aid and CPR textbooks must be read and reviewed by
returning guards prior to working as a lifeguard.

a. The Superintendent should ensure that a returning guard reviews this material
if recertification does not take place prior to the season.

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 D. Remainder of skills to be reviewed by returning guards (secondary training).

The secondary material is not part of the standard operating procedure and does not have
to be reviewed prior to working as a lifeguard. The material should be reviewed during
the first three (3) weeks of employment. The material should be reviewed before 10 a.m.
or during the day provided the bathing area is properly supervised. This secondary
material will be done to the satisfaction of a lifeguard officer. Secondary material to be
reviewed is listed below:

1. Boat handling and rescues. (Island Beach State Park Only)

E. Renewal of Red Cross, CPR/AED and First Aid by returning guards.

1. Superintendents should find out expiration dates on First Aid and CPR cards of
returning guards prior to their working as a lifeguard.

2. First Aid and CPR recertification courses will be scheduled as close to a guard’s
expiration date and as early in the season as possible. Red Cross CPR/AED,
First Aid and Oxygen Administration are valid for 2 years. Red Cross
Bloodbourne Pathogen training is valid for 1 year.

3. Arrangements for recertification courses will be made by the Superintendent with

WSS and Regional First Aid/CPR Trainer.

4. A lifeguard officer should see that the Red Cross textbooks are read by lifeguards
prior to taking the course.

5. Bloodbourne pathogen training and oxygen administration instruction will be

included in the CPR class.

II. Training New Lifeguards – Lifeguard Skills

When training new lifeguards, one must remember this may be their first job and they are
unfamiliar with the State Park Service and the job of lifeguarding. Everything must be taught
thoroughly.

A. The following skills, materials and procedures are to be accomplished with a new
lifeguard as soon as possible (primary training).

These skills may be learned while the beach is open under the direct supervision of
returning guards. A new lifeguard cannot work without direct supervision of experienced
guards until primary training is completed to the satisfaction of a lifeguard officer and the
lifeguard has passed the manual test. Training periods should be prior to 10 a.m. or
during the day provided the bathing area is properly supervised. A good method for
training new guards is to have them learn lifeguard skills and practice these skills at their
area for a few weeks and then have a day of training and skill testing with a maximum of

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10 new guards under the direction of the WSS and a lifeguard officer. Primary training
material is listed below.

1. General introduction to assigned area, chain of command, lifeguard training

program and Lifeguard Manual.

2. Reading

a. Lifeguard Manual and Seasonal Employee Manual

b. The passing grade on the Lifeguard Manual Test is 90. Incorrect answers must be
corrected.

3. Communications

a. Hand signals
b. Whistle signals
c. Summoning aid: i.e., State Park Police, area office, other lifeguards,
ambulances, etc. in accordance with emergency procedures
d. Telephone and radio procedures

4. Rules and Regulations

a. Beach and bathing area

b. Personnel
c. Uniform

5. Torpedo buoy rescues

a. Conscious Victim
b. Unconscious Victim (on surface and submerged) discuss rescue breathing
c. Multiple Victims
d. Leaving stand and entry into water

6. Kayak/Rescue Board Handling (Rescue Board at Island Beach State Park Only)

a. Paddling
b. Turning
c. Stopping
d. Careful Usage

7. Kayak/Rescue Board Rescues (Rescue Board at Island Beach State Park Only)

a. Conscious Victim
b. Unconscious Victim, discuss rescue breathing
c. Multiple Victim

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 8. Rescue procedures

Set up situations relative to your bathing area with one stand, two stands, deep water
patrol, etc., and have guards carry out their responsibility at different positions for
simulated rescues.

9. Masks, Fins and Snorkel

10. Sighted submersion by a lifeguard

11. Water Search for a lost person not sighted by a lifeguard

12. Backboard skills

a. Used as a stretcher
b. Used with related equipment in caring for a spinal injury in the water and on the
beach

13. Personal Water Craft (Designated personnel at Island Beach State Park)

a. Handling and safety

b. Off beach use
c. Rescues

14. All Terrain Vehicle (Designated personnel at Island Beach State Park)

a. Handling and safety

b. Off beach use
c. Recommended uses

15. Scanning

a. Discuss how to scan and what to look for

b. Practice scanning on the stand and on deep water patrol under direct supervision of
an experienced guard
c. Enforcing rules and regulations while scanning

16. Public Relations

a. Discuss being polite

b. Serving the public
c. Getting compliments, not complaints

17. Non-equipment Rescue Techniques listed on training record (A-9)

A. Remainder of material to be learned by new guards after they have completed primary
training satisfactorily. The remaining material to be accomplished with the new guards
will be referred to as secondary training. Secondary training must be completed to the
satisfaction of a lifeguard officer or WSS.
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 Secondary training for new guards is listed below:

1. Boat handling (Island Beach State Park Only)

2. Boat rescues (Island Beach State Park Only)

B. First Aid and CPR/AED training for new guards.

1. New guards will take CPR, First Aid, Bloodbourne Pathogen training and Oxygen
Administration courses as soon as possible.

2. Classes for CPR, First Aid, Bloodbourne Pathogen training and Oxygen
Administration will be scheduled by the Superintendent with the WSS and Regional
First Aid/CPR Trainer.

3. A lifeguard officer will see that new guards read the Red Cross textbooks prior to
their class.

4. A new lifeguard will not perform CPR or First Aid until properly certified.

III. In-service Training of All Lifeguards After Primary and Secondary Training Is Satisfactorily
Completed Shall Be As Follows:

A. Additional training in skills that a lifeguard officer and/or WSS feel are required for
individuals or entire lifeguard staff.

B. According to training assignments issued each week by the WSS. Training assignments
will start being issued approximately three (3) weeks into the season. Sample page A-5.

1. Training assignments will be completed between 9:30 a.m. and 9:55 a.m. each day or
during low usage periods when the bathing area is properly supervised.

2. Superintendents should periodically verify that training assignments are being

accomplished by the lifeguards.

IV. Physical Training of All Lifeguards

A. It is the responsibility of the lifeguard officer to see that physical training is carried out by
each lifeguard according to the physical training requirements outlined in the lifeguard
manual.

B. Physical training should be completed before 10:00 a.m. or on a lifeguard’s first break
from scanning provided the bathing area is properly supervised.

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C. Physical training as a group can be done prior to 10:00 a.m. provided no skill training is
necessary.

D. Additional physical training may be accomplished during low usage or on other breaks
provided the bathing area is properly supervised.

1. If a lifeguard works less then 5 days per week, a minimum of 2 physical

training requirements per day worked must be completed.

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 Chapter 5 – LIFEGUARD STAFFING

I. Determining the Number of Lifeguards at Each Public Recreational Bathing Area

Administered by the State Park Service

The WSS, area Superintendent and the Regional Superintendent will determine the number
of lifeguards needed to staff an area based on the criteria described below.

A. The length of the beachfront that is protected by lifeguards. SPS policy calls for one
lifeguard stand for approximately every 200 feet or less of freshwater beachfront and 300
feet or less of ocean beachfront that is guarded. (The length of the beach guarded is the
designated swim area in that park).

B. Bathing Area

1. Depth and slope

2. The distance from the shore to the outside boundary

C. Usage of the area based on number of buses and past attendance figures to forecast days of:

1. Maximum usage and the number of lifeguard stands and guarding positions needed.

2. Moderate usage and the number of lifeguard stands and guarding positions needed.

3. Low usage and the number of lifeguard stands and guarding positions needed.

D. Allowance for days off based on a 40 hour work week for each guard.

E. Time necessary for training requirements.

F. The lifeguard officer(s) should be considered a lifeguard when determining the number of
lifeguards needed to staff an area.

G. Time necessary for breaks and lunches.

II. Lifeguard Work Assignments and Position Rotations

The work assignments and rotations discussed in this section are a guide for
utilizing the lifeguard staff efficiently. The work assignments and rotations below
are based on the number of lifeguards needed to supervise the public. When
usage is low and the bathing area is properly supervised, lifeguards not needed
may use time to train or clean and maintain first aid rooms, locker rooms and
other lifeguard related equipment. It is important to remember supervising bathers
is a lifeguard’s first priority and other assignments are accomplished only during
low usage.
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A. Work assignments and rotation

1. Two (2) lifeguard rotation needed to supervise bathers

a. One stand open with one or two lifeguards. When one guard is in the stand, the
other guard must be in the vicinity of the beach and bathing area in the event help
is needed.
b. Two lifeguards are used only during very low usage periods.

2. Three (3) lifeguard rotation needed to supervise bathers

a. One stand open with two lifeguards

b. One lifeguard will be covering first aid room, training, on break or deepwater
patrol
c. Thirty minute rotation

3. Four (4) lifeguard rotation needed to supervise bathers

a. One stand open with two lifeguards and one lifeguard on deepwater patrol OR
b. Two lifeguards on stand one, one lifeguard on stand two and no deepwater patrol
c. One guard covering first aid room, training or on break
d. Thirty minute rotation

4. Five (5) lifeguard rotation needed to supervise bathers

a. Two stands open, two lifeguards on stand one, one lifeguard on stand two, one
lifeguard on deep water patrol OR
b. Two lifeguards on stand one, two lifeguards on stand two
c. One lifeguard covering first aid room, training or on break
d. Twenty minute rotation

5. Six (6) lifeguard rotation needed to supervise bathers

a. Two stands open, two lifeguards on stand one, two lifeguards on stand two
b. One lifeguard on deepwater patrol
c. One lifeguard covering first aid room, training or on break
d. Twenty minute rotation

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 6. Seven (7) lifeguard rotation needed to supervise bathers
a. Two stands open, two lifeguards on stand one, two lifeguards on stand two
b. One lifeguard on deepwater patrol
c. One lifeguard covering first aid room
d. One lifeguard on break or training
e. Thirty minute rotation

7. Eight (8) lifeguard rotation needed to supervise bathers

a. Two stands open, two lifeguards on stand one, two lifeguards on stand two
b. Two lifeguards on deepwater patrol
c. One lifeguard covering first aid
d. One lifeguard on break or training
e. Thirty minute rotation

8. Nine (9) lifeguard rotation needed to supervise bathers

a. Three stands open, two lifeguards on stand one, two lifeguards on stand two, one
lifeguard on stand three
b. Two lifeguards on deepwater patrol
c. One lifeguard covering First Aid Room
d. One lifeguard on break or training
e. Twenty minute rotation

9. Ten (10) lifeguard rotation to supervise bathers

a. Three stands open, two lifeguards on stand one, two lifeguards on stand two, one
lifeguard on stand three
b. Three lifeguards on deepwater patrol or two lifeguards on deepwater with two
lifeguards on stand three
c. One lifeguard covering First Aid Room
d. One lifeguard on break or training
e. Twenty minute rotation

B. Other information pertinent to work assignment rotation.

1. Shallow water patrol should be used when needed as determined by a lifeguard

officer. The guard on shallow water patrol should first come from a two-person
stand. When this is not possible, the guard may come from deep water patrol.
Shallow water patrol is useful when there are problems or potential problems in
shallow water or along the shoreline.

2. Lifeguard officers are included in work assignment rotation.

3. Level of training and skill of the lifeguard is taken into account when making work
assignment rotation for the day.

4. The work assignment rotation is assigned by a lifeguard officer.

5 . Thirty-minute rotations are preferred to twenty-minute rotations.

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 6. Lunch break is 30 minutes and should not be extended by other breaks immediately
before or after. No break will exceed 30 minutes.

7. All State Park Service bathing areas are not the same. If a work assignment rotation
other than the ones listed above is appropriate, it must be discussed with the WSS and
the Superintendent. The Superintendent is the final authority.

8. Work assignment rotations are only listed for up to 10 lifeguards and 3 lifeguard
stands. For more stands and lifeguards, work rotations should use the same logic and
patterns as described in section.

C. Island Beach will have a separate work assignment rotation.

III. Scheduling Lifeguards

Scheduling of lifeguards will be done by a lifeguard officer monthly, and then confirmed
by the officer approximately three days prior to the start of each workweek. The
schedule should be approved by the Superintendent and reviewed by the WSS.
Any changes needed in the schedule should be submitted in writing to the Superintendent
as soon as possible by a lifeguard officer. If there is a scheduling problem that cannot be
solved internally, it should be discussed with the WSS for possible assistance from other
areas in the region. When scheduling lifeguards, the following criteria must be taken into
consideration:

A. History of past attendance and buses scheduled. Using this information, the
Superintendent, lifeguard officer and WSS will forecast the days of low, moderate
and heavy usage then schedule the appropriate number of guards. Example: Staffing
is least on Mondays and most on Sundays.

B. Number of guards available to work.

C. Level of training of each guard.

D. Days guards will be training and not available to supervise the bathing area.

E. All lifeguard personnel are limited to 40 hours per week unless overtime is approved
by the area Superintendent.

F. A lifeguard officer or designee must be present when the area is open to public
recreational bathing.

G. At least two guards must be currently certified in professional CPR.

H. At least one guard must be certified in First Aid.

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 I.. Work assignment rotations are outlined in part II of this chapter. It is preferable to
schedule a number of guards to permit 30-minute rotations. This is not always
possible due to availability of guards, absenteeism, etc.

IV. Lifeguard Work Day

A. Lifeguards will begin work at 9:30 a.m. at a designated location.

B. A lifeguard’s day ends at 6:00 p.m. unless directed otherwise.

C. A lifeguard officer’s day sometimes begins at 9:00 a.m. as determined by the

Superintendent to:

1. Meet with Superintendent

2. Accomplish record keeping and other administrative duties.

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 Chapter 6 – RECORDS AND DOCUMENTS

The records and documents discussed in this chapter are important for the support and
credibility of the entire State Park Service Lifeguard Program. These are legal documents.
Therefore, it is necessary that the Superintendent, with the assistance of the WSS, check that
these records are kept up-to- date and accurate by the lifeguard officer. All entries into
lifeguard records must be made with a non-erasable pen.

According to NJAC 8:26 – 8.9 record keeping: accurate and complete records shall be
maintained and kept on the premises and shall be available upon request of the authorized
agent or health authority. Such records shall be kept for a minimum of one year, except
those records related to deaths, all injuries to the head, neck and spinal cord and any injury
rendering a person unconscious shall be kept for 10 years, and shall include:

1. Water analysis results;

2. Sanitary survey records;
3. Daily number of bathers;
4. Copies of all necessary credentials of personnel associated with the public
recreational bathing operation(s);
5. Accidents requiring external emergency services, including the patient’s name,
time, date, description of occurrence, treatment, action taken and name of person
on duty supervising the facility;
6. Deaths and/or drownings. The record shall include the name of the person, the
date and a description of the occurrence
7. Inspection logs of recreational equipment.

I. Types of Records and How to Maintain Them

This section will outline the records to be kept by the lifeguard officer, how to complete them
and their distribution upon completion. A computer disk of most blank records and forms will
be distributed by the Regional Office prior to opening day.

A. Daily Records

1. Daily records are to be completed every day between Memorial Day Weekend and
Labor Day. A record should also be completed on days the bathing area is closed so
there is a record of the closure. A lifeguard officer or his designee should complete
the record. All sections of the record are to be filled out. Comments and notes should
be objective and provide information on the day’s activities and incidents.

2. Preventative Actions are when a lifeguard directs a patron or advises them of a

bathing area rule that ensures the bather’s safety. Example: Directing a poor
swimmer to shallow water or advising a patron that tubes are not allowed. A
lifeguard officer should get the number of preventative actions from each guard at the
end of the day and total them up.

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 3. Objectionable behavior (Not a common occurrence)

a. An extraordinary problem with getting someone to obey the regulations

b. Disorderly person
c. Drunk

4. During the bathing season, the daily record should be kept in a 3-ring binder at a
desk where a lifeguard officer does the record keeping.

5. The daily records should be submitted to the Superintendent at the conclusion of the
bathing season.

6. When a lifeguard is involved with a serious incident, the Superintendent will request
the State Park Police Sergeant to investigate and prepare the necessary reports.
Statements from involved lifeguard personnel will be taken as needed.

7. Every Thursday, the oxygen regulator and AED should be checked along with the
pressure of the oxygen cylinder in use. This information should be recorded, along
with the status of the oxygen cylinder not in use, in the daily report.

8. Sample Freshwater Record page A-6 and Sample Ocean record page A-7

B. Year End Lifeguard Activity Record

1. The daily activity record (Rescues, First Aids, etc.) on the Daily Record are to be
totaled for the entire season by a lifeguard officer on Labor Day.

2. The season totals will be recorded on the Year End Activity Report.

3. This form will be submitted to the Superintendent at the conclusion of the

bathing season.

4. The Superintendent will submit a copy of this form to the Regional Water Safety
Supervisor by September 15th.

5. The Regional Water Safety Supervisor will submit a regional lifeguard activity report
to the Trenton Lifeguard Coordinator by October 1st, in order to prepare a statewide
report for the United States Lifesaving Association.

6. Sample form page A-8.

C. Lifeguard Skills Training Record

1. Each lifeguard and lifeguard officer will have a skills training record.

2. Skills training records must be kept up-to-date by the lifeguard officer.

21
 3. When a skill is worked on, the corresponding box should be marked with the date of
training.

4. When a skill has been practiced for an adequate length of time and completed to the
satisfaction of a lifeguard officer, the satisfactory box for that skill should be dated
and initialed by that lifeguard officer.

5. Information on testing and certifications should be completed as soon as possible on

the training record.

6. The training record should be taken into consideration when:

a. Scheduling lifeguards
b. Making work rotation assignments for the day

7. During the season, the training records should be secured at the record keeping desk.

8. At the conclusion of the bathing season this record must be submitted to the
Superintendent to be filed in the lifeguard’s personnel file.

9. Sample form for Lake page A-9 and for Ocean page A-11.

D. Lifeguard Physical Training Record

1. Every lifeguard and lifeguard officer will have a physical training record.

2. Physical training records must be kept current by a lifeguard officer.

3. When a physical training requirement is completed, the date should be recorded in the
appropriate box.

4. The comment boxes are also to explain why a lifeguard did not complete their
physical training in a given week. A lifeguard officer must complete this box.
Examples:

a. Guard only worked 2 days

b. Bathing area closed 3 days due to high bacteria

5. Guards who do not work a five day week must complete two activities for each day
worked.

6. During the bathing season, this record must be secured at the record keeping desk.

7. At the conclusion of the bathing season, physical training records must be submitted
to the Superintendent to be filed in the lifeguard’s personnel file.

22
 8. Sample form page A-12.

F. First Aid/Incident Reports

1. First Aid Reports must be completed by the lifeguard administering the first aid. This
form must be filled out. It is a legal record of your action.

2. Completed first aid reports must be kept on file in the first aid room.

3. Blank first aid reports and a pen must be kept in the first aid kit on the lifeguard
stand.

4. Completed first aid reports must be submitted to the Superintendent at the conclusion
of the season for review, analysis and filing purposes.

5. Sample form page A-13.

G. Lifeguard Evaluation

1. Each lifeguard will be evaluated by a lifeguard officer shortly before a guard leaves
for the season using the evaluation form.

2. All evaluations will be reviewed by the Superintendent prior to presenting the

evaluation to the lifeguard.

3. The evaluation will be presented to and discussed with the guard by the lifeguard
officer and/or the Superintendent. The evaluation will be signed at this time.

4. A lifeguard’s evaluation, when signed, will be submitted to the Superintendent to be

filed in the lifeguard’s personnel file.

5. Sample form page A-14.

6. Each item on the evaluation form is defined below:

a. General Ability

Promptness - Lifeguard is ready to start work at 9:30 a.m.

- Lifeguard completes tasks in a reasonable period of time.

Takes Order - Self-explanatory

Appearance - Lifeguard maintains uniform regulations and a

neat appearance.

23
 Compatibility - Lifeguard assists other guards in training and
with Other other related lifeguard responsibilities.
Lifeguards Lifeguard cooperates with fellow lifeguards
to provide an efficient beach operation.

Tact with - Lifeguard deals with patrons politely, impartially,

Patrons calmly and with sound reasoning to accomplish
an efficient beach operation.

Confidence - Lifeguard’s ability to understand and execute all

skills, procedures and enforcement of rules and
regulations.

Reliability - Lifeguard carries out assignments in a reasonable

length of time without unnecessary supervision.

Attendance - Lifeguard can be relied on to fulfill his/her weekly

schedule.

Punctuality - Lifeguard arrives at his/her work assignment

on Rotation on time.

b. Guarding Ability

Familiarity Lifeguard’s ability to use lifesaving and first

And aid equipment. Comments should be made
Utilization of on specific pieces of equipment.
Equipment

Attentiveness - Lifeguard is responsive to whistles and signals

On duty from other guards. Lifeguard has his/her
mind on the job.

Scanning - Lifeguard watches his/her assigned section

with the ability to detect distressed bathers
and regulation violations.

Reaction to - Lifeguard reacts quickly, calmly and

Emergency properly to a beach or bathing area emergency.

Rescue - Lifeguard can successfully affect a water rescue

Ability in an actual situation.

Procedural - Lifeguard consistently follows procedures in

Understanding various situations.

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 c. Physical Fitness

Progress - Lifeguard’s physical condition at the end of

season as compared to the beginning of the season.

Participation - A lifeguard completes the required program is

satisfactory.

Endurance - Self-explanatory

Swimming - Swim time for 500 meters is between 9 minutes

Ability and 10 minutes. Swimming ability is satisfactory.

Motivation - Lifeguard completes required physical

to Keep Fit fitness activities during the season without
excessive supervision.

H. Lifeguard Officer Evaluation

1. Lifeguard officer evaluation will be completed by the Superintendent in cooperation

with the WSS in a narrative report.

2. The lifeguard officer evaluation is based on:

a. Supervisory abilities necessary to achieve an efficient public recreational

area.

b. Duties outlined in the Lifeguard Manual, this manual and other documents
associated with the State Park Service Lifeguard Program.

c. Lifeguarding ability.

I. Employment Test Record

1. This record must be completed for each person taking the lifeguard test.

2. This form must be completed by the WSS.

3. Permission slip for applicants under 18 must be attached to employment test record.

4. WSS will give the employment test record to the assigned Superintendent. The
Superintendent will file this record in the lifeguard’s personnel file.

5. Sample form page A-16.

J. Bi-weekly Hourly Time Report

25
 1. Bi-weeklies are to be completed for each lifeguard by a lifeguard officer.

2. Bi-weeklies must be completed on a daily basis.

3. Bi-weeklies must be submitted to the Superintendent on a timely basis.

4. The following project activity codes should be used by lifeguard personnel:

V47K - Lifeguarding

V76A - Training (physical and skill) Received

V76E - Training Given

V47X - Maintenance – Building and Grounds

V48A - Maintenance – Equipment

V22K - Managerial – general administration

V76P - Travel Time

5. Sample form page A-17.

K. Death and/or Serious Injury in the Bathing Area Report

1. This report must be completed by a Park Superintendent when there is a death or serious
injury in the bathing area during operating hours. Serious injuries are defined as head,
neck, spinal cord and any injury which renders a person unconscious.

2. The report will be completed and faxed by the Park Superintendent to the New Jersey
Department of Health and Senior Services and to all others listed on the report within
24 hours of the incident.

3. Appropriate lifeguard personnel will provide t h e P a r k S u p e r i n t e n d e n t with

necessary information or statements for the report.

4. This report must be kept on file for 10 years.

5. Sample form page A-18.

6. If counseling is required for any lifeguards contact Regional Superintendent

L. First Aid Equipment and Supplies Forms

1. First Aid Equipment and Supplies should be checked daily and inventoried before the
season by a lifeguard officer and every 2 weeks thereafter.
26
 a. Any deficiencies that cannot be corrected by officer should be brought to the
attention of the Superintendent first and then the WSS if necessary.

2. The inventoried forms should be filed in the daily report binder under the
corresponding date.

3. Sample form page A-20 and 21.

M. Lifeguard Equipment and Supplies

1. Lifeguard equipment and supplies should be checked daily and inventoried before
the season by a lifeguard officer and every 2 weeks thereafter.

a. Any deficiencies that cannot be corrected by the lifeguard officer should be

brought to the attention of the Superintendent first then the WSS if necessary.

2. The inventoried list should be filed in the daily report binder under the
corresponding date.

3. Sample form page A-22.

N. Personal Watercraft Maintenance Log (Island Beach State Park Only)

1. Must be filled out by assigned lifeguard officer for each PWC at the start of each day.

2. Form must be filed with the daily lifeguard reports on the last day of each month.

3. Sample form page A-23.

II. Documents

A. The following documents should be available for all lifeguard personnel to easily
reference:

1. Bathing area diagram, sample page A-24.

2 . New Jersey State Sanitary Code Chapter 9, Public Recreational Bathing,

NJAC 8:26

3. This manual

B. The following documents must be given to all lifeguards:

1. A copy of the State Park Service Seasonal Employee Manual.

2. A copy of the State Park Service Lifeguard Manual is available at

www.njparksandforests.org. A hard copy must be in the Lifeguard office.

27
C. Lifeguard Officers and Superintendents should have and use the following documents:

1. This manual

2. Lifeguard Manual
3. New Jersey State Sanitary Code, Chapter 9, Public Recreational Bathing, NJAC
8:26.
4. Bathing area diagram (sample page A-24)

D. Aquatics supervision plan for each bathing area should be on file in the area office
as required by NJAC 8:26. The aquatics supervision plan must be kept in one file.
A new file is needed each year.

The Aquatics Supervision Plan must contain:

1. This manual

2. Area Emergency Plan

3. Seasonal Employee Manual

4. Lifeguard Manual

5. Beach and Bathing Area Diagrams

6. Pre-operational Assessment (NJAC 8:26 – 7.15)

E. Red Cross Professional CPR/AED, First Aid Cards:

1. Valid Professional CPR and First Aid, Bloodbourne Pathogen training and
Oxygen Administration for all lifeguard personnel must be photocopied
and kept in a 3-ring binder at the record keeping desk.

2. As new guards get certified and returning guards are recertified, the new cards
must be copied and filied in a binder at the records desk.

3. When a guard has successfully completed a CPR/AED, First Aid,

Bloodbourne Pathogen training and Oxygen Administration course and
is waiting for the card, the date of completion should be recorded on the
Skills Training Record. The Regional First Aid Trainer should supply a
copy of certification roster sent to Red Cross to lifeguard officers to show
that guards have successfully completed training until official certification
cards have arrived. This roster must be filed with photocopied First Aid
and CPR cards. When all certification cards are received and copied the
roster may then be discarded.

28
 4. Copies of the lifeguard’s First Aid, CPR/AED, Bloodbourne Pathogen training
and Oxygen Administration cards should be filed in the lifeguard’s personnel file
at the conclusion of the season.

5. First Aid Trainers must submit a roster of Lifeguards who have completed
Bloodbourne Pathogen training, First Aid and CPR/AED to Trenton Lifeguard
Coordinator. This roster should be titled “Bloodborne Pathogen Exposure
Control Plan, CPR/First Aid Training”. Sample form page A-32.

6. Sample page for photocopies of cards page A-26.

F. USLA Lifeguard Training Certification

1. Each swim area will submit a roster of it’s lifeguard staff to the Regional Water
Safety Supervisory by June 5th. The roster must include name, date of birth,
sex and class of lifeguard. This roster will be signed by the Regional Water
Safety Supervisor or Island Beach Lifeguard Supervisor then forwarded to the
Lifeguard coordinator in Trenton for his/her signature.

2. Sample Roster Page A-25.

3. The Lifeguard Coordinator will return signed rosters to the Water Safety
Supervisor. WSS will file roster at each swim area with copies of first aid and
CPR cards for Health Department inspections.

4. If additional lifeguards are hired and trained later in the summer an addendum
to the roster (identical to the original) with just the new names must be processed
the same as the original roster.

5. Lifeguard class on the roster is determined as follows:

a. Class P – first year lifeguard
b. Class B – second and third year lifeguard
c. Class A – fourth year and above lifeguard

6. The Lifeguard Coordinator in Trenton will send the signed rosters and
addendums with payment to:

United States Lifesaving Association

New Jersey Certification
PO Box 1
Avon, NJ 07717

In addition to mailing rosters a copy should be e-mailed to [email protected]

29
 Chapter 7 – EQUIPMENT, SUPPLIES AND UNIFORMS

I. Equipment and Supplies

A. Written report to the Superintendent is required for any damaged or missing equipment/
supplies.

B. If a problem with equipment or supplies cannot be resolved with the Superintendent, the
matter must be brought to the attention of the WSS or the Regional Office.

C. All lifeguard equipment and supplies must be packed properly for the next season. They
should be stored in an area where damage and theft are unlikely.

D. Lifeguard equipment, First Aid equipment and other supply requirements for the next season
must be submitted to the Regional Office by September 10th.

E. The Regional Office will handle distribution of supplies and equipment.

F. Bases of lifeguard stands made out of treated lumber must be painted. Areas of body contact
must be non-treated lumber. (This includes seats, foot platform, ladder, armrests, etc.)

G. Pictures of Lifeguard Stand design A-29. Contact High Point State Park for detailed
plans. Ocean Stand plans A-27 & A-28.

II. Uniforms

A. Uniforms are issued in accordance with the New Jersey Department of Health and Senior
Services Sanitary Code and the State Park Service Lifeguard Manual.

B. All State issued uniform items are considered “expendable” with the exception of the rain
parka.

1. The penalty for returnable items not returned or expendable items that must be replaced
is the current full price of that item. Price information may be obtained from the WSS or
the Regional Office. Returnable items or money must be accounted for by the
Superintendent.

2. All money collected will be in check form and made payable to: Treasurer, State of New
Jersey.

C. Uniform requirements for the next season must be submitted to the Regional Office by
September 15th. Regional office will submit regional uniform request to Trenton Lifeguard
coordinator by Oct. 10th. Sample form page A-30.

D. The Regional Office will handle distribution of uniforms.

30
 E. Lifeguards may purchase sweatsuits and hats through the area office. The area office will
obtain needed sweatsuits and hats through the Regional Office. Lifeguards will pay the
price determined at the beginning of each season. Money will be deposited in the State
Park Service revolving account.

F. Enforcement of all uniform policies is the responsibility of the Superintendent with

support and assistance of lifeguard officers and WSS.

III. Beach Wheelchair

A. Use and sign-out process are described in the lifeguard manual. The use and sign-out
procedures are in the lifeguard manuals even if the lifeguards do not handle the sign-
out. The reason is that lifeguards will get questions about wheelchairs and they may
have to correct improper use.

B. The manufacturer’s brochure must be on file in the area office. The brochure
contains requirements for assembly, safety, operation, maintenance and repair (such
as fixing a flat).

C. Signs denoting the availability of the beach wheelchair must be affixed to the
handicap parking sign posts near the bathing area.

D. Sample beach wheel chair sign-out sheet is on page A-31.

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 Chapter 8 – SEASONAL OPENING AND CLOSING AND TEMPORARY CLOSING

I. Opening Procedures – The Superintendent should verify the following are accomplished prior
to opening the bathing area for the season:

A. Bathing area, lifeguard stands and ropes are set up according to bathing area diagram,
Health Department Codes and State Park Service policy.

B. Bathing area and beach are checked for any hazards that may have developed over the
winter and take appropriate corrective actions.

C. Returning lifeguards have completed primary training for returning lifeguards (page 8)
and achieved a manual test score of 90 prior to their performance of lifeguard functions.

D. There are sufficient numbers of qualified lifeguard personnel employed to open and
comply with New Jersey Department of Health and Senior Services regulations and State
Park Service policies.

E. Returning guards have valid CPR/AED and First Aid Certifications. Photocopies of cards or
other verification of training must be available for inspection.

F. All lifeguards have medical physical form completed.

G. Necessary equipment and supplies must be working and ready to be used.

H. All signs are in place as required by State Park Service Policy and the New Jersey Public
Recreational Bathing Code. NJAC 8:26 – 5.10 a, 5.11 (Tyvek Sign “For Everyone’s
Health”) and 5.14 (Beach supervisor is the Park Superintendent with his/her office phone
number on sign).

I. Ambulance, Poison Control and other important phone numbers must be posted alongside
lifeguard phones.

J. Handouts with directions to the hospital should be available to patrons who need further
medical treatment but don’t require an ambulance.

K. All necessary record forms are available.

L. All required documents are in place.

M. A Pre Operational Assessment for bathing beaches see NJAC 8:26 – 7.15 (deals with water
pollution and water quality).

32
 N. Any problems opening a bathing area must be discussed with the Superintendent in
consultation with the WSS and Regional Superintendent.

II. Closing Procedures – The Superintendent should verify the following are accomplished when
the bathing area is closed for the season:

A. Bathing area ropes, lifeguard stands, signs and all other evidence of a supervised bathing
area are to be removed immediately after Labor Day.

B. All necessary forms and records are submitted and filed as outlined in Chapter 6.

C. Equipment and supplies are inventoried, inspected and stored in a safe place. Be sure all
water is drained from kayaks.

D. Aquatics supervision plan for the year must be filed.

III. Temporary Closing of Bathing Area Between Memorial Day Weekend and Labor Day
During the Bathing Hours of 10:00 am to 6:00 p.m.

Reasons:

A. High bacteria (as regulated by NJDOHSS).

B. Less then two lifeguards available that are fully trained.

C. Other reasons as determined by the chain-of-command in the State Park Service.

D. Lightning – these procedures are outlined in the lifeguard manual.

Only the Superintendent has the authority to close a public recreational bathing area to the
public. This decision will be made, whenever practical, after consultation with the lifeguard
officers and WSS. When closed for a short duration, lifeguard staff shall provide assistance
to keep the public from the area. If closure is greater then 24 hours and lifeguards are not
available to direct the public, the bathing area shall be secured with appropriate barricades,
signage, etc. Lifeguard staff shall be advised of reasons for bathing area closure
in order to correctly respond to public inquiries.

Area Superintendents must notify their Regional Office and the Trenton Office of details
pertaining to all temporary closings. Notify the Trenton office by fax 609-984-0503,
telephone 609-292-2776 or email [email protected]

33
 Chapter 9 – COMMUNICATIONS

I. Communication Between Lifeguard Officer and Superintendent

A. Superintendent and lifeguard officer should have weekly meetings to discuss the
following:

1. Lifeguard schedule

2. Training

a. Lifeguard skills
b. Physical training

3. Lifeguard Personnel

4. Equipment and supplies

a. Repairs necessary
b. Material or assistance needed to make repairs
c. Missing equipment or supplies

5. Records should be reviewed and discussed.

a. Daily records
b. Training records

6. General operation of bathing area and beach.

7. Interaction between guards and the public.

B. Superintendent and lifeguard officer must meet promptly to discuss and resolve:

1. A problem with a lifeguard that may require disciplinary action.

2. A serious incident in the bathing area or on the beach.

3. A safety hazard on the beach or in the bathing area.

4. An immediate staffing problem that will not allow the bathing area to open or a
problem that would require a reduced bathing capacity for the day.

5. Any problem that prevents the lifeguards from doing their job.

34
II. Communications Between the Superintendent and the Lifeguards

Early in the season, a meeting with all the lifeguards and the Superintendent will be
convened to discuss and reinforce:

A. Importance of the job of a lifeguard and the relationship to goals and objectives of the
State Park Service.

B. Area rules and regulations.

C. NJ Department of Health regulations.

D. Lifeguard rules and regulations

E. Seasonal Employee Manual

F. Legal aspect of a lifeguard’s job

G. Lifeguard must report to work at 9:30 a.m. and or report lateness or absence to park
office prior to that time. Park office is only to be notified by a phone call not
email, texting, etc.

H. Training will take place between 9:30 and 9:55 a.m. on a lifeguard’s first break from
scanning. Additional training will take place at other times when the bathing area is
properly supervised.

I. Explain rotations and breaks

J. Disciplinary policy

K. Evaluation process for rehire

L. Chain of command

M. Public Relations

N. Any other appropriate information

III. Communication with the Regional Office

A. The WSS is a seasonal staff member of the Regional Office reporting to the Regional
Superintendent.

B. The role of the WSS is to provide support and expertise for the efficient operation of all
public recreational bathing areas within the Region.

35
C. The WSS must ensure that lifeguard training procedures and standards are
consistent throughout the region.

D. WSS will make frequent visits to each bathing area and will assist with
problems, training, scheduling and other aspects of the lifeguard program.

E. WSS will observe lifeguard training and overall bathing operations to ensure
that it conforms to State Park Service policies.

F. WSS will advise lifeguard officer and/or Superintendent of any deficiencies observed
so they can be corrected.

G. If a lifeguard needs the assistance of the WSS immediately, this contact can be
made through the area Superintendent.

36
 Chapter 10 – FLOTATION DEVICES FOR PERSONS WITH DISABILITIES

Procedures to use non-Coast Guard approved flotation devices at freshwater bathing areas or
flotation devices other than approved body boards and rafts at Island Beach State Park.

I. The Superintendent must obtain the following information from the disabled person in order
for this person to use a non-approved flotation device:

A. Documentation from a qualified physician or medical professional to verify the person is

“disabled”and what the disability is.

B. Documentation from a qualified physician or medical professional as to what the

“functional limitations” are of the disabled person.

C. Documentation from a qualified physician or medical professional that the disabled

person does need special accommodations.

D. Proof/documentation from a qualified physician or medical professional of exactly what

type of special flotation (other than approved devices) is required. This documentation
must include a specific description of the device and the environment (lake, ocean) in
which it can be used.

II. When the above criteria is met, the Superintendent should notify the lifeguards that a
specific flotation device is permitted for the individual referenced in the documentation.

37
 Chapter 11 – WATER SAMPLING AT BATHING BEACHES

I. Lake bathing areas shall be sampled one week prior to opening the beach and at one week
intervals during the bathing season.

II. Island Beach shall be sampled in accordance with the Cooperative Coastal Monitoring
Program administered by DEP.

III. Sampling techniques for the bathing areas.

A. Water samples shall be taken in an area with a stabilized water depth between the
sampler’s lower thighs and chest with the optimum depth being at the sampler’s
waist.

B. The sample container shall be placed approximately 8 to 12 inches below the

water surface with the lid and stopper still attached.

C. With the collector’s arms extended to the front, the container shall be held
near it’s base and downward at a 45-degree angle. The cap shall be removed
and the container filled in one slow sweeping motion (downward or
horizontally, not upward). The mouth of the container shall be kept ahead of
the collector’s hand and the container recapped while it is still submerged.
The cap shall remain submerged during the sample collection and care shall
be taken not to touch the inner surfaces of the cap.

IV. When a sample fails (greater than 200 fecal coliform per 100 milliliters) the area must be
re-sampled. On failure of resample the bathing area must be closed to the public until
there is a satisfactory sample.

V. Upon an unsatisfactory sample or closure the Regional Office, Trenton Lifeguard

Coordinator and the NJ Department of Health and Senior Services must be notified.

38
CHAPTER 12- HEPATITIS B VACINATION AND PATHOGEN EXPOSURE
ADMINSTRATION
I. Hepatitis B Vaccination Procedures
A. Lifeguard paperwork required
1. As part of the employment paperwork, Superintendents must let lifeguards
know that they may be exposed to bloodbourne pathogens and can receive a
free Hepatitis B vaccination. A free titer (antibody test) is available if the
lifeguard has already received vaccination.
2. All lifeguards must complete the Hepatitis B vaccination form (Pg. A-4)
every year with their employment paperwork. If the lifeguard is a minor the
form must be completed and signed by a parent or guardian.
3. If lifeguard refuses the vaccination he or she may request one at a later
date.

B. Processing Hepatitis B forms and administrating vaccine

1. Forms are separated into 4 piles and 4 lists. List and Pile 1). Guards
requesting vaccination 2). Guards requesting Titer 3). Refusals and 4).
Guards who have already had received vaccination.
2. A copy of forms must be kept in a confidential file at park offices. Original
forms separated by option 1 to 4 must be sent to the OFFICE OF
OCCUPATIONAL HEALTH AND SAFETY (OOHS) PO Box 416
Trenton, NJ 08625

3. A copy of Hepatitis B form lists #1, #2, #3 and #4 must be sent to Regional
Superintendent highlighting lifeguards requesting vaccination.
4. For lifeguards requesting titers, lab slips and locations will be sent to park
superintendent from OOHS. Superintendents will send lifeguards with lab
slips to the nearest lab location as soon as possible for titer.
5. OOHS will contact Regional Superintendent. The Regional Superintendent
will contact park superintendents with dates and times for vaccination.
Regional superintendent will arrange transportation.
6. OOHS will inform the Trenton Lifeguard Coordinator of any lifeguards who
do not report for immunization injections 1, 2, or 3. The lifeguards will be
rescheduled or they will have to submit a new Hepatitis B Immunization
forms indicating immunization refusal.
7. The lifeguard is responsible to schedule the third injection and supply their
own transportation. There is no cost for the injection. Injection 3 is five
months after injection 2. Usually, the 3rd injection is scheduled in January.
He/she must call OOHS at 609-292-1408.

39
 8. Lifeguards may elect to have their own physician administer 3rd injection
at the Lifeguard’s expense. In this case documentation must be sent to:
OOHS
PO Box 416
Trenton, NJ 08625
II Bloodbourne Pathogens
OOHS Bloodbourne Pathogen Exposure Control Plan for State Lifeguards must be kept
on file at park offices for review or reference.

OSHA Bloodbourne Pathogen Regulation 29 CFR 1910. 1030 may be referenced at

www.state.nj.us/health/eoh/peoshweb/bbpsib.pdf.
A. Training

1. All lifeguards will be trained in accordance with Bloodbourne

Pathogen Exposure Control Plan and Red Cross Bloodbourne
Pathogen training every year.

2. Documentation of Bloodbourne Pathogen training will be sent to the

Trenton Lifeguard Coordinator by Regional FA/CPR Instructor using
Bloodbourne Pathogen Exposure Control Plan CPR/FIRST Aid
Training Form (Pg. A-32).

B. Reporting Exposure Incidents

An exposure is defined as any contact with bodily fluids of another person that may
enter the body through needle stick, open sore, or mucous membranes such as eyes or
oral cavity. Contact with saliva, urine, feces, vomit, or sputum visibly contaminated
with blood is considered an exposure. If such an exposure occurs, the following steps
must be taken:
1. When a lifeguard reports a Bloodbourne Pathogen exposure to the
superintendent, the superintendent must immediately send the lifeguard to
an approved hospital or medical facility for treatment. Inform the lifeguard
to tell the medical facility that this is Workmen’s Compensation.
2. Superintendent will report exposure within 8 hours, Monday through
Friday between 8:00am to 5:00pm to: DEP Division of Human Resources
609-984-3412, or Monday through Friday between 5:00pm and 8:00am as
well as weekends and holidays to: DEP communications Center 877-927-
6337

3. Superintendents must complete RM-2 and fax it Monday through Friday

from 8:00 am to 5:00 pm to: DEP Division of Human Resources/Leave
Management 609-292-6424, or Monday through Friday between 5:00pm
and 8:00am as well as weekends and holidays NJ DOL PEOSH 609-292-
3749.

4. Injury and Illness Incident Report must also be completed.

40
5. Lifeguards that had an exposure must supply OOHS with the following
documentation from their medical provider and submit by mail to OOHS at
PO Box 416 Trenton, NJ 08625.

a) Employee has been informed of any medical testing results

b) Employee has been educated about medical conditions that can result
from exposure.

41
Appendix

42
A-1
 New Jersey Department of Environmental Protection
Division of Parks and Forestry

STATE PARK SERVICE

PERMISSION FOR LIFEGUARD APPLICANTS

UNDER 18 YEARS OF AGE
TO TAKE THE LIFEGUARD EMPLOYMENT TEST

I, ____________________________ grant my child ___________________________

(Print Parent or Legal Guardian Name) (Print Name of Child)

permission to take the New Jersey State Park Service Pre-Employment Lifeguard Test. I am not
aware of or been informed by a physician of any medical or physical disability that would
prevent my child from completing this test.

________ ____________________________________
(Date) (Signature of Parent or Legal Guardian)

Freshwater and Ocean Test

The physical fitness test consists of:

• Swim 500 meters in an indoor pool in 10 minutes or less, using a swimming stoke performed
on the front only.

• Run 400 meters on a track or parking lot in 1 minute 40 seconds or less.

A-2
 New Jersey Department of Environmental Protection
Division of Parks and Forestry

State Park Service

Lifeguard Medical Certification Form

is medically qualified to perform the

(Name)
duties of a lifeguard for the New Jersey State Park Service for the
(Year)
season.

LIFEGUARD DUTIES INCLUDE:

Hearing
Observation of Bathers
CPR
First Aid
Swimming
Running
Rowing
Paddling Kayaks
Free Diving to Depths of 15 Feet
Water Rescue with Rescue Buoy, Kayak, Boat

(Date) (Signature of M.D. or D.O.)

THE PHYSICIAN’S STAMP OR SEAL MUST BE AFFIXED TO THIS FORM TO BE

VALID

NOTE: Employee must personally deliver this original form to the area
Superintendent prior to the start of employment.

A-3
 DEPARTMENT OF ENVIRONMENTAL PROTECTION
Office of Occupational Health and Safety
428 E. State Street PO Box 416
Trenton, NJ 08625
Phone (609) 292-1408
Fax (609) 984-2488

Hepatitis B Immunization

Immunization is offered and recommended to those employees who may come in contact with blood or other potentially infectious
materials. The immunization will not prevent hepatitis caused by other agents, such as Hepatitis A virus, Hepatitis C, or other viruses
known to infect the liver.

The immunization procedure consists of a regimen of three 1.0 ml intramuscular injections of Recombinant Hepatitis B Vaccine
(Remcombivax), to be given at one, two and six month intervals. Depending on your job duties completion of the series may be
followed by a blood titer to ensure development of immunity.

Common local reactions have included erythema, swelling and warmth. These signs and symptoms of local inflammation are generally
well tolerated and usually subside within two days of vaccination. Low grade fever (less than 101 °F) occurs occasionally and is usually
confined to the 48-hour period following vaccination. As with any immunization, there is the possibility of more serious side effect. Less
than every 100,000 person receiving the vaccine have had serious side effects including myelitis, seizures, meningitis and Gullian Barre
Syndrome.

I have read and understand the Hepatitis B immunization procedure.

Please check one of the following

I wish to participate in the Hepatitis B immunization program. Please provide forwarding

address: and Phone #
for notification of third shot in December or January.

I have already received the immunization. Date: Where_

I had all three shots and would like a Hepatitis B titer drawn.

I refuse to participate in the immunization program. (Must read below)

Hepatitis B Vaccination Refusal

I understand due to my occupational exposure to blood or other potentially infectious material I may be at risk of acquiring hepatitis B
virus (HBV) infection. I have been given the opportunity to be vaccinated with hepatitis B vaccine, at no charge to myself. However, I
decline hepatitis B vaccination at this time. I understand that by declining this vaccine, I continue to be at risk of acquiring hepatitis B, a
serious disease. If in the future I continue to have occupational exposure to blood or potentially infectious materials and I want to be
vaccinated with Hepatitis B vaccine I can receive the vaccination series at no charge to me.

Name (Print) Date State Park Area

*Signature Date

Signature of parent or guardian required if employee in under 18 years of age.

A-4
 Department of Environmental Protection

Northern Region Office

PO Box 1100
Andover, NJ 07821
Tel: 973-786-5210
FAX: 973-786-6356

TO: Lifeguard Officers

FROM: Art Clarke, Water Safety Supervisor

Northern Region Office

DATE: August 2, 2009

SUBJECT: Training Assignments for the Week of August 8, 2009

Saturday, August 8, 2009 - 9:40 a.m. Sighted Submersion Drill

Sunday, August 9, 2009 - 9:40 a.m. Water Search for a 4 Year Old Child

The following pages should be read and discussed during the week:

American Red Cross CPR/AED for Professional Rescuers and Health Care Providers. Read the entire
book. It is short.

These assignments should be done with all lifeguards in addition to any other skills the Lifeguard Officer thinks is
necessary to teach or review.

c: Regional Superintendent
Superintendents

New Jersey is an Equal Opportunity Employer

Recycled Paper

A-5
DPF-069 New Jersey Division of Parks and Forestry
5/09 State Park Service
Daily Lifeguard Record

Date Tuesday, August 4, 2009 Area Stokes State Forest

(Day and Date)

Weather Readings Time

Lifeguard Name In Out
Water Temperature: 75 degrees
Rick Smith 9:30 AM 6:00 PM
Air Temperature: 70 degrees AM
85 degrees PM Lisa Hall 9:30 AM 6:00 PM

Weather Conditions: Clear AM Mike Hart 9:30 AM 6:00 PM

Partly Sunny PM
Lance Gallo 9:30 AM 6:00 PM

Number of Bathers in Water

45 11:00 AM
100 2:00 PM
90 4:00 PM

Activity Report

First Aid: 3

Assist: 1

Rescues: 0

Drownings: 0

CPR and Rescue Breathing: 0

Ambulance Call: 0

Lost Children: 1

Objectionable Behavior: 0

Preventative Actions: 10 Name of Recorder Rick Smith

NOTES, COMMENTS, ETC.COMMENTS MUST BE FACTUAL - NOT OPINION

Examples: Lisa Hall has to care for a lost child for 1 1/2 hours.
Closed for thunderstorm 2:00 PM. Reopened at 4:00 PM.

A-6
A-7
 New Jersey Division of Parks and Forestry
State Park Service
Year End Lifeguard Activity Report

Date Area

First Aids

Assists

Rip Current Rescues:(IBSP)

All Other Rescues

Drownings

CRP or Rescue Breathing

Ambulance Calls

Lost Child/Person

*Objectionable Behavior

Preventative Actions

Lifeguard Officer Superintendent

*Objectionable Behavior is defined as "an extraordinary problem with getting

someone to obey the regulations.

A-8
A-9
A-10
A-11
A-12
A-13
DPF-092 New Jersey Division of Parks and Forestry
2/10 State Park Service

Lifeguard Evaluation Sheet

Area Hopatcong State Park Date 7/30/2010

Name Diane Smith

Topic of Evaluation Rating Comments

General Ability

Promptness 3
Takes Orders 3
Ambition 3
Appearance 3
Compatibility with Guards 3
Tact with Visitors 2
Confidence 2 Reluctant to Enforce Rules
Reliability 4
Attendance 5 Never Absent
Punctuality on Rotation 4

Guarding Ability

Familiarity and Utilization of Equipment 3 See attached paper.

Attentiveness on Duty 4
Scanning 3
Reaction to Emergency 4
Rescue Ability 4 Did well in drills, but no real rescue.
Procedural Understanding 3

Physical Fitness

Progress During Season 4

Participation in Physical Fitness Program 3
Endurance 3
Swimming Ability 5
Motivation to Keep Fit 4

Number of Years Expected to Return: 2

Lifeguard Title: Lifeguard 3

Recommended for Rehire: X Yes No

Rating Key: 1 Unsatisfactory

2 Needs Improvement
3 Satisfactory
4 Above Satisfactory
5 Outstanding

A-14
 Lifeguard Evaluation Sheet (Back)

General Comments (Rater):

Diane is a good lifeguard, but often ignores some of the less important
aspects of her job.

Rater Signature

Rater Title Lifeguard Lieutenant

Superintendent's Comments (Reviewer):

Superintendent Signature

I have had the opportunity to review my final rating.

Ratee Signature

Title Lifeguard 3

2/10

A-15
DPF-049 New Jersey Division of Parks and Forestry
2/10 State Park Service

Lifeguard Employment Test - Score Sheet

Use ball point pen. DO NOT use pencil.

Test Area: Ramapo College Pool

Name: Diane Smith
Area: Hopatcong State Park
Date: 5/3/06

PHASE ONE (500 Meter Swim - maximum 10 minutes)

Time: 9:14 Timer Initials: AC

Remarks:

PHASE TWO (400 Meter Run - maximum 1 minute 40 seconds)

Time: 1:37 Timer Initials: AC

Remarks:

PHASE THREE (Interview and Recommendation)

[ X ] Hire

[ ] Not Hired

[ ] Referred to Another Area

Remarks: EMT, College Sophmore

Uniform Sizes: T-shirt Large Swim Suit 36

Signature of Testing Officer

A-16
A-17
 New Jersey Division of Parks and Forestry
State Park Service

Designated Bathing Area

Death or Serious Injury Report

AREA: _________________________________________________________________________________________

DATE OF OCCURRENCE: ___________________________TIME: ______________________________________

VICTIM NAME: ________________________________________________________________________________

VICTIM ADDRESS: _____________________________________________________________________________

________________________________________________________________________________________________

AGE: __________ SEX: ___________ RACE: ______________________________________________________

NAME OF LIFEGUARDS ATTENDING TO VICTIM AND ON DUTY AT THE TIME OF OCCURRENCE:

________________________________________________________________________________________________

________________________________________________________________________________________________

________________________________________________________________________________________________

WITNESSES (INCLUDE NAMES AND ADDRESSES):

________________________________________________________________________________________________

________________________________________________________________________________________________

________________________________________________________________________________________________

RESCUE-EXACT LOCATION: ____________________________________________________________________

APPROXIMATE DEPTH OF WATER (IF APPLICABLE): ______________________________________________

WATER TEMP. SURFACE: ____________ WATER TEMP. BOTTOM ___________________________________

WEATHER CONDITIONS: ____________ UNDERWATER VISIBILTY: _________________________________

WATER SURFACE CONDITIONS: ________________________________________________________________

BRIEF DESCRIPTION OF INCIDENT:

________________________________________________________________________________________________

________________________________________________________________________________________________

________________________________________________________________________________________________

________________________________________________________________________________________________

________________________________________________________________________________________________

PREPARED BY: ______________________________________________________ DATE:_____________________

REVIEWED BY SUPERINTENDENT : __________________________________ DATE:_____________________

(See Reverse Side)

A-18
A-19
 NJ DIVISION OF PARKS ANF FORESTRY
STATE PARK SERVICES

LIFEGUARD FIRST AID EQUIPMENT

INVENTORY AND REQUEST

ITEM FIRST AID ROOM IN STORAGE REQUEST

BACKBOARD

BACKBOARD STRAP (5 PER BOARD) OR 1 SPIDER STRAP

CERVICAL COLLARS *BABY NO-NECK

PEDIATRIC

ADULT ADJUSTABLE

HEAD IMMOBILIZER

AED

AED Pads Adult (unexpired)

AED Pads Child (unexpired)

EXAMINATION LIGHT

EXAMINATION TABLE

FIRST AID KITS (EMPTY)

INSTRUMENT TRAY (WITH COVER)

POCKET MASKS ** ADULT OXYGEN INLET

POCKET MASKS ** CHILD OXYGEN INLET

PRIVACY SCREEN

WOOL BLANKETS

BAG VALVE MASK – CHILD

BAG VALVE MASK – ADULT

OXYGEN REGULATOR

OXYGEN D CYLINDERS

NASAL CANNULA – CHILD

NASAL CANNULA – ADULT

OXYGEN REBREATHER MASK – CHILD

OXYGEN REBREATHER MASK – ADULT

SET OF NASAL AIRWAYS

SET OF ORAL AIRWAYS

AED

MANUAL HAND HELD SUCTION UNIT

RED CROSS FIRST AID TEXT BOOK **

RED CROSS CPR/AED FOR PROFESSIONAL RESCUER TEXT BOOK

RED CROSS LIFEGUARDING BOOKS

OPEN WATER LIFESAVING USLA MANUAL

*BRAND LAERDAL
** REQUIRED BY NJ DEPARTMENT OF HEALTH & SENIOR SERVICES

________
AREA SUPT/HEAD LIFEGUARD DATE
A-20
 NJ DIVISION OF PARKS AND FORESTRY
STATE PARK SERVICE

LIFEGUARD FIRST AID SUPPLIES

INVENTORY AND REQUEST

ITEM FIRST AID ROOM IN STORAGE REQUEST

ALCOHOL WIPES ( FOR CLEANING INSTRUMENTS) 1 BOX *

BLEACH (FOR CLEANING INSTRUMENTS & FIRST AID ROOM)

BAND AID PLASTIC STRIPS 1” 100/BOX*
BAND AID PLASTIC STRIPS EX. LG. 50/BOX*
DISPOSABLE FACE SHIELD (5)*

DISPOSABLE PROTECTIVE GOWN (5)*

GAUZE STERI PADS 2” X 2” 100/BOX*

GAUZE STERI PADS 3” X 3” 100/BOX*

GAUZE STERI PADS 4” X 4” 100/BOX*

GAUZE-2” ROLL SOFT KLING N/S 12/BG.

GAUZE-3” ROLL SOFT KLING N/S 12/BG.*

EYE DRESSING PACKET*

TRIANGULAR BANDAGE 4 UNITS*

ADHESIVE TAPE 1”(1)*

ADHESIVE TAPE 2” 1 UNIT*

SCISSORS, BANDAGE 1 UNIT*

SCISSORS, STRAIGHT 1 UNIT*

TWEEZERS (SPLINTER FORCEPS) 1 UNIT*

SAM SPLINTS

GLOVES, NITRILE N/S MEDIUM 100/BOX*

GLOVES, NITRILE N/S LARGE 100/BOX*
COLD PACKS 16/CASE*
LIQUID SOAP (ANTI-BACTERIAL) 16 0Z. BTL.

FACIAL TISSUE BOXES

DRINKING CUPS BOXES
*REQUIRED BY NJ DEPARTMENT OF HEALTH & SENIOR SERVICES

_____________ ________________
AREA SUPT/HEAD LIFEGUARD DATE

A-21
 NJ DIVISION OF PARKS AND FORESTRY
STATE PARK SERVICE

LIFEGUARD EQUIPMENT
INVENTORY AND REQUEST

ITEM FIRST AID ROOM IN STORAGE REQUEST

AIR HORNS
AIR HORN CANISTERS
BATHING AREA LINE FLOATS
BEACH UMBRELLAS
BIMINI CANOPIES
BINOCULARS
BOAT WARNING BUOYS
BULL HORNS
LANYARDS (ELASTIC)
WHISTLES
LIFEGUARD STANDS
LIFEGUARD STAND CUSHIONS
LINE CLIPS
LINE SPLICING FIDS
MASK
MOORING BUOYS
OARS – 8 FOOT
OARS – 9 FOOT
POLYETHYLENE HOLLOW LINE 1,000’ 3/8 OR 1/4
POLYETHYLENE HOLLOW LINE 500’ 3/8 OR 1/4
RESCUE BOATS (IBSP)
RESCUE BOARD (IBSP)
SNORKELS
SWIM FINS – SMALL
SWIM FINS – MEDIUM
SWIM FINS – LARGE
SWIM FINS – EXTRA LARGE
THERMOMETERS
TORPEDO ( RESCUE) BUOYS*
KAYAK
KAYAK PADDLE
KAYAK BACKREST
KAYAK LEG STRAPS – (IBSP)
USCG LIFE JACKET (PFD)
LINE BOXES – IBSP
BOAT ROLLER – IBSP
ROLLEZE – IBSP
JETTY CLEATS – IBSP
*REQUIRED BY NJ DEPARTMENT OF HEALTH & SENIOR SERVICES

___________________________________ ____________
AREA SUPT/HEAD LIFEGUARD DATE

A-22
 New Jersey Division of Parks and Forestry
State Park Service
Island Beach State Park
Personal Watercraft Maintenance Log Checklist

Month: Year:

Type 3 P.F.D
Oil/Lubricate

Rescue Tube

Extinguisher
2 Lanyards
Radio Bag

Mask Fins
Tow Rope
Flush out

Compass
Helmets
F.A Kit
Inspection

Knife
Completed
Day

Fire
Gas

Hours/Use (Initial)
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
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A-24
A-25
A-26
A-27
A-28
 *** If you are interested in obtaining the plans for the
freshwater lifeguard stand please contact Supt. Rebecca
Fitzgerald at the High Point State Park office

A-29
 New Jersey Division of Parks and Forestry
State Park Service

Lifeguard Uniform Inventory and Request

ITEM SIZE ON HAND REQUEST ITEM SIZE ON HAND REQUEST

Rain Parka N/A EMT Shorts S

Lifeguard Swim Shorts M EMT Shorts M
Lifeguard Swim Shorts L EMT Shorts L
Lifeguard Swim Shorts XL EMT Shorts XL
Female Swim Suit 30 EMT Shorts XXL
Female Swim Suit 32 First-Aid T-Shirts (Long Sleeve) M
Female Swim Suit 34 First-Aid T-Shirts (Long Sleeve) L
Female Swim Suit 36 First-Aid T-Shirts (Long Sleeve) XL
Female Swim Suit 38 First-Aid T-Shirts (Long Sleeve) XXL
T-shirt (Short Sleeve) M First-Aid T-Shirts (Short Sleeve) M
T-shirt (Short Sleeve) L First-Aid T-Shirts (Short Sleeve) L
T-shirt (Short Sleeve) XL First-Aid T-Shirts (Short Sleeve) XL
T-shirt (Long Sleeve) M First-Aid T-Shirts (Short Sleeve) XXL

T-shirt (Long Sleeve) L

T-shirt (Long Sleeve) XL
Trainer Polo Shirt M
Trainer Polo Shirt L
Trainer Polo Shirt XL
Trainer Polo Shirt XXL
Sweat Pants M
Sweat Pants L
Sweat Pants XL
Sweat Pants XXL
Hooded Sweatsuit M
Hooded Sweatsuit L
Hooded Sweatsuit XL
Hooded Sweatsuit XXL
Hat - Baseball N/A
Hat - Wide Brim Standard
Hat - Wide Brim XL
Polarized Sunglasses N/A

Area

Superintendent/Head Lifeguard Date

A-30
 New Jersey Division of Parks and Forestry
State Park Service

Beach Wheelchair Sign Out Sheet

NAME ADDRESS PHONE # TIME OUT TIME IN

A-31
 DEPARTMENT OF ENVIRONMENTAL PROTECTION
Office of Occupational Health and Safety
428 E. State Street PO Box 416
Trenton, NJ 08625
Phone (609) 292-1408
Fax (609) 984-2488

Bloodbourne Pathogen Exposure Control Plan, CPR/First Aid Training

I, a lifeguard for State Park Service, received the following information concerning bloodbourne pathogens in my Lifeguard Training
class:

□ A copy or access links of the regulation, 29 CFR 1910.1030

□ An explanation of the Lifeguard Exposure Control Plan and how to access a copy of it.
□ An explanation of the epidemiology, symptoms and transmission of bloodbourne diseases.
□ An explanation of activities that may expose me to blood or OPIM
□ An explanation of how to protect myself from exposure.
□ Information on types, proper use, location, removal, handling, decontamination and disposal of personal protective equipment
(PPE)
□ An explanation of why the PPE was selected.
□ Information about the hepatitis B vaccine, including it efficacy, safety method of administration, benefits of vaccination, and
how it is offered free of charge.
□ Information of action to take and who to contact in emergencies involving blood or OPIM.
□ An explanation of procedures to follow in an exposure incident occurs, including how to report it and the medical follow-up that is
available.
□ Information on the post-exposure follow-up that the employee is required to provide to the employer.
□ An explanation of the signs and labels and/or color coding.
□ An opportunity for interactive questions and answers with the person conducting the training.
Work Location:________________________________________________________ Date:___________________

Lifeguard Name (Print) Lifeguard Signature

_______ CHECK HERE IF ADDITIONAL NAMES ARE ON THE BACK

I, the trainer for these lifeguards, certify that the above topics were covered in the training class.
________________________________________ _______________________________________________ ___________________
Name (print) Signature Date

A-32
 New Jersey Department of Environmental Protection
Division of Parks and Forestry
State Park Service
PO Box 420
Mail Code 501-04
Trenton, NJ 0862509420

I certify that I have read and understand the New

Jersey State Park Service Lifeguard Manual for
Administration and Procedures dated May 2017.

Name:

Signature:

Date:

SPS Area:

A-33