	TITLE	Page
	Definition of Terms / Acronyms	2
	Introduction of the Guidelines	3
	Key Introduction to Health Care Facilities	5
I.	Assemble a WSP Team	6
II	Describe the Water Supply System	7
III	Identify Hazards and Hazardous Events, and Assess the Risk	13
IV	Determine and Validate Control Measures, Reassess and Prioritize the Risks	27
V	Improve/Upgrade Plan	50
VI	Define Monitoring of the Control Measures	52
VII	Verify the Effectiveness of the WSP	55
VIII	Develop Management Procedures	56
IX	Develop Support Programs	58
X	Conduct WSP System Review	59
XI	Revise WSP following an Incident	60
	Annex A

Definition of Terms/ Acronyms

Control Measure – any action or activity that can be used to prevent, reduce or eliminate a water supply quality/safety hazard to a tolerable level

Corrective Action – action to be taken when the results of monitoring at a control point indicate a loss of control

DENR – Department of Environment and Natural Resources

DOH – Department of Health

Hazard – physical, biological (microbiological) or chemical agents that can cause harm to public health

Hazardous Event – an event that introduces hazards to, or fails to remove them from, the water supply HCF – Health Care Facility

LGU – Local Government Unit

NWRB – National Water Resources Board

PNSDW – Philippine National Standard for Drinking Water

PoE – Point of Entry

PoU – Point of Use

Raw Risk – risk determined without considering existing control measures

Residual Risk – risk determined after considering/validating existing control measures

Risk – the likelihood of identified hazards causing harm in exposed populations in a specified timeframe including the magnitude of that harm and/or the consequence

SOP – Standard Operating Procedures

Support Programs – organization-wide programs which are required to support the delivery of quality water by the organization and any contractors used.

WSP – Water Safety Plan

WHO – World Health Organization

Introduction of the Guidelines

Water Safety Plan (WSP) is first introduced by the World Health Organization (WHO) to address issues and problems due to unsafe quality of drinking-water. The WSP approach involves the application of a comprehensive risk assessment and management approach that encompasses all steps in the water supply system from the catchment to consumers. This concept is a cost effective and preventive strategy that ensures safety and quality of drinking water(1) .

At present, the WHO has created a guiding document for the creation of WSP for buildings which includes water safety planning for hospitals (2). The need for the development and implementation of WSP in health care facilities is crucial due to the number of outbreaks recorded that were linked to ingestion of contaminated drinking-water. Moreover, hospitals cater vulnerable population who are immunocompromised that maybe exposed to unsafe drinking-water which further aggravates the patients' health condition (2). Some identified pathogens that caused these outbreaks were Legionella spp., and Pseudomonas aureginosa (3) .

Hospitals generally tapped with the municipal water service providers for their source of drinking-water. However, even though series of treatment was done prior to distribution of water among consumers, problems arise because of the faulty and corroded biofilm laden pipelines that serve as a point of entry for unwanted microorganisms (3). The contaminated water then may be consumed by patients through drinking, irrigation of wounds, or even inhalation (2). Hence, the need for WSP is very important.

In the Philippines, through the initiative of the Department of Health, issued a policy that requires all water service providers to devise and implement WSPs specifically designed on the existing water system (4). The evolving advancement on the medical practice in the country as evidenced by the increasing number of the different types of hospitals and health care facilities call for the need to a cautious monitoring of these establishments.

On an Administrative Order No. 2012-0012 issued by DOH, the different classification of hospitals and other health care facilities in the country were defined as to type of (1) ownership: government owned hospital and private which is established through donations, investments, etc. of any individual, corporations, and organizations; (2) scope of services: (1) general hospital which caters all forms of illnesses, diseases, injuries and deformities, and (2) specialty hospital that specializes in a particular disease or condition or in one type of patient.

Furthermore, the general hospitals are subdivided into three more levels which specifically describe the functional capacity of the facility. The development of WSP for healthcare facilities e.g. hospitals is a milestone on consistently addressing the need for the safe access to drinking-water. Thus, this guideline provides a step-by-step process on the formulation of WSP tailored fit on hospital setting which will also serve as a model for other health care facilities on the formulation of their own WSPs.

Key Introduction to Health Care Facilities (HCF)

In conducting a detailed and comprehensive assessment of a health care facility the following information are critical:

1. Description/Overview of the HCF
- a. Name of the HCF
- b. Location or Address
- c. Type of HCF (see Administrative Order 2012-0012a)
- d. Year established
- e. Bed capacity
- f. Number of staffs (regular and contractual)
- g. Floor and lot area
- h. Number of floors
1. Water sources (all which is applicable)
- a. Water district
- b. LGU-managed
- c. Community-managed
- d. HCF-owned deep well
- e. Privately- managed
1. Waste Management System
- a. Wastewater
- b. Solid waste
- c. Health care waste
1. Power Supply
- a. Two-phase
- b. Three-phase
- c. Stand-by-generator (include kVA)

1. Assemble a WSP Team

Convening a team is a critical requirement for the formulation and implementation of a WSP for the hospital. Identifying the roles and responsibilities of each of the team members is crucial on the success of WSP execution. A WSP coordinator must be identified to facilitate the overall coordination and monitoring of the WSP implementation. In order to signify management support for the WSP, an office order signed by the head of the Health Care Facility (HCF) must be included in the WSP.

Assigning a WSP coordinator is crucial for the success of the WSP implementation. Such person should be responsible in convening the selected members for the overall team. The coordinator must also have or acquire a good knowledge of the technical facilities in the building (in such case of the health care facility) and their daily work should be related to the facility. The primary task then of the coordinator is to coordinate the process of WSP development and implementation among the team members hence, technical knowledge in drinking-water and/or sanitation may be useful but not necessarily required. Moreover, the coordinator has the sole responsibility of ensuring the continuous monitoring and implementation of the WSP in place thus a building manager would be a good option for the WSP coordinator role.

On the other hand, the team members should be a mix of technical experts in various fields such as but not limited to design, operation, and management of drinking-water supplies, engineering, plumbing, and public health risk assessment. Also, the team should have been represented by people from the end users/consumers. The following are some of the stakeholders¹ that might contribute to the water quality: (1) Water supply providers; (2) Waste management service providers; (3) Suppliers; (4) LGU; (5) Concerned national agencies e.g., DOH, DENR, NWRB (6) Nearby community; (7) Water users in the HCF; and (8) Others.

Below is a sample of a WSP team structure which can serve as a guide in designating the roles and responsibilities of the selected WSP coordinator, technical experts, and team members.

¹ If water source is owned by HCF, the HCF will identify the stakeholder from source to user premises. If water is provided by water service provider, the HCF will identify the stakeholders from point of entry to user premises only.

2. Describe the Water Supply System

A detailed description of the water system is required to assist the succeeding risk assessment process. It must provide a comprehensive plan which covers the nature and quality of water supplied to the building up to the consumer. As part of describing the system, the HCFs must identify the different users of water in their facility. The users may include the patients, watchers, guests/visitor and employees. The different uses for which the users utilize the water must also be identified as different uses entails different level of water quality needed. The use may be for general purpose (e.g. drinking, cooking, flushing, washing, bathing, gardening, fire protection) or HCF-specific (e.g. dialysis, autoclaving).

In addition, the WSP should provide sufficient information to identify where the system is vulnerable to hazardous events, relevant types of hazard, and control measures. The following are critical information that must be included in the description:

a. Results of mandatory water quality parameters based on latest PNSDW² .
b. Known or suspected changes in source water quality relating to weather or other conditions;
c. Information relating to the water treatment such as:
- Type of treatment (filtration, sedimentation, coagulation, chlorination, reverse osmosis, ion exchange, UV, ozonation, etc.)
- Chemicals used (volume per month,
- Year installed per treatment facility
- Contaminants being removed per treatment facility
- Treatment facility location in the HCF
- Capacity of the water treatment facility
- Volume of water being treated per treatment facility;
d. Information relating to the storage of water such as:
- Type of storage (ground, elevated)
- Technology applied (fill and draw, floating, pneumatic)
- Height of storage (for elevated tank) Description of storage tank location Number, Volume and shape of storage tank
- Material composition of storage tank

² For water source owned by HCF, the HCF will be responsible for water quality testing of its water supply system based on the latest PNSDW and per level of water service. For water source from water service provider, the HCF will be responsible for testing from point of entry/after the meter to entire water supply system in the HCF premises based on the latest PNSDW (under Building category).

Frequency of cleaning;
e. Information relating to the water distribution network such as:
- Diameter, Length of pipe network
- Material used
- Water quality from the tap; and
f. Description of all the materials that comes in contact with water

2.1. Source Water Description

The following are the possible sources of water supply for the hospital HCF

a. Water district (Level III Water System)

It is a local corporate entity that operates and maintains a water supply system in one or more provincial cities or municipalities. It is classified as a government-owned and controlled corporation, existing under the authority of The Provincial Water Utilities.

b. LGU – managed water utility (Level III Water System)

It is a source of water in which the local government unit (municipal/city level) manages, controls, and maintains the operation of the water utility. It caters number of households up to the community level.

c. Privately-managed water utility (Level III Water System)

It is a source of water in which the private sector manages, controls, and maintains the operation of the water utility. It caters number of households up to the community level.

d. Community-managed water utility (Level III Water System)

It is a source of water in which the community association manages, controls, and maintains the operation of the water utility. It caters number of households up to the community level.

e. HCF- owned deep well

It is a well with depth greater than 20 meters constructed in areas characterized by aquifers or water-bearing formations generally located at a depth of more than 20 meters below ground surface.

f. Water refilling stations

This source of drinking water may come in the form of using the Jerry can as water container or through a water dispenser.

2.2. Typical components of water systems inside a typical HCF

The use of a schematic diagram is utilized using illustrations to show how water flows inside the HCF. This provides a simple understanding of the water supply system which shall be vital in the succeeding modules.

Figure. 2.2.1. Schematic layout of Components of water systems inside a typical HCF

The figure above shows the typical elements of the water system being utilized inside a HCF. The abovementioned water supply systems are to be described in full detail. The following are the information necessary to describe the system:

	Details to be provided (if applicable)
Water Source	a) Water supply provider (average volume billed/consumed per
	year, latest water quality results – Point of Entry)
	b) Deep-well information (depth, diameter, year constructed,
	casing material, water quality)
	c) Pumping equipment (capacity, horsepower rating, year installed)
Water Treatment	a) Type of treatment (filtration, sedimentation, coagulation,
	chlorination, reverse osmosis, ion exchange, UV,
	ozonation, etc.)
	b) Chemicals used (volume per month,
	c) Year installed per treatment facility
	d) Contaminants being removed per treatment facility
	e) Treatment facility location in the HCF
	f) Capacity of the water treatment facility
	g) Volume of water being treated per treatment facility
Storage	a) Type of storage (ground, elevated)
	b) Technology applied (fill and draw, floating, pneumatic)
	c) Height of storage (for elevated tank)
	d) Description of storage tank location
	e) Number, Volume and shape of storage tank
	f) Material composition of storage tank
	g) Frequency of cleaning
Distribution	a) Diameter, Length of pipe network
	b) Material used
	c) Water quality from the tap
User Premises	a) User practices on handling drinking water (e.g. storage,
	dispenser, tap)
Others	b) Hot and cold water system
	c) Non-drinking water system (e.g. flushing, cleaning, laundry)

2.3. Process Flow Diagram

In contrast, process flow diagrams utilize symbols to reflect the different stages in the water supply system. For simplicity and consistency, standard flow diagrams symbols are generally used (Tool 2.3.1) to construct the flow diagram.

Tool 2.3.1. Process Flow Diagram Symbols

Flow Diagram Symbol	Definition of Symbol
	Operation: Indicates when there is an operation or group of operations that result in intentional change in the water.
	Inspection: Represents an inspection or decision, for example, water supply is examined or is verified.
	Storage: Where water is stored.
	Transport: Occurs when the water is moved from one place to another.
	Combined activity: Indicates activities performed either concurrently or by the same operator at the same location. Any combination of symbols may be used. Example shown indicates a combined operation and inspection.

Tool 2.3.2. Process Flow Diagram Sample (Process Flow Diagram of Tapped Water From Water District)

Step Process	Description	Responsibility
$\overline{}$	WD source	BCWD
	Water Meter	Eng'g./BCWD
$\otimes$	Check Valve	Plumber
	Distribution line	Eng'g. /Plumber
	Booster pump	Electrician/operator
	Pressurized tank	Eng'g./pllumber
	Distribution line	Eng'g./Plumber
	Monitoring	Eng'g./Plumber
	Consumer	Plumber
	Filtration process	End user/plumber
	Reverse Osmosis Process	End user/Plumber

Step Process	Description	Responsibility
	UV Light	End user
	Distribution line	End user/ plumber
Ф	Monitoring	Dialysis (end user)/Outsource
	Consumer	End user
	Cistern Tank	Eng'g./Plumber
	Booster pump	Electician/plumber
$\otimes$	Manipulated Valve ( Note: Optional use when deep well pump busted)	Eng'g./plumber
	Overhead storage tank	Eng'g./plumber

3. Identify Hazards and Hazardous Events, and Assess the Risk

Based on the constructed flow diagram, the potential hazards and hazardous events that may take place on the water system form the source of water (PoE) up to the point of use must be identified by the WSP team. Several factors are considered in the identification of the hazards which include the quality of the raw water, and the equipment used on the water system. The identification of the hazards and hazardous event may be conducted through existing records, historical events, local knowledge, and onsite visits that can affect the safety of the water supply. The team should consider all the potential biological, physical, and chemical hazards (as discussed below) that could be linked with the water supply.

The hazards are classified into chemical and/or microbiological categories. After the identification of the hazards was done, hazard analysis is conducted to evaluate and prioritize the risks that may contribute to adverse health effects. The WSP team can utilize the semiquantitative risk assessment to calculate for the priority score for each of the identified hazard. The objective of this is to rank which hazardous events requires immediate intervention. The likelihood and severity was derived from the team's technical knowledge and expertise, historical data and relevant guidelines. Moreover, the WSP team determined a cut-off point, which is risk score of 5, above which all hazards will be retained for further consideration. There is little value in expending a great deal of effort considering very small risks.

Potential microbiological hazards indicated in the WSP may include:

Bacteria Salmonella, Shigella, V. Cholerae, Y. enterocolita, C. jejuni, E.coli, Legionella, Mycobacterium spp., Pseudomonas aeruginosa
Viruses – Hepatitis A & E, Norwalk, Rotavirus, Poliovirus
Protozoa – Entamoeba histolytica, Giardia lamblia, Cryptosporidium parvum
Helminths – roundworms, tapeworms, flukes
Fungi Aspergillus, Fusarium, Exophilia

Potential chemical hazards indicated in the WSP may include:

Inorganic constituents with health significance Antimony, Arsenic, Barium, Boron, Cadmium, Chromium, Cyanide, Lead, Mercury
Organic constituents with health significance Benzene, Toluene, Zylenes, Styrene, Polynuclear Aromatic Hydrocarbons (PAHs)
Organic constituents from agricultural pollution (pesticides)
Disinfectants and disinfectant by-products

Hazardous events arise from non-compliance of the hospital administration on the established sanitation standard operating procedures poor equipment maintenance as well.

Tool 3.1. Typical Hazards and Hazardous Events in Purified Water Process

Process Steps (Components of Water System)	Hazardous Event(s) (Source of Hazard)	Hazard Category
Point of Entry to the	Compromised and unsafe	Microbiological Chemical
Building (Source of raw	use of contaminated water
water)	from source

	Intrusion and use of	Microbiological Chemical
	contaminated water for
	processing due to use of
	non-food grade pipe and
	adhesive materials
	Contamination of water	Chemical
	due to deterioration of
	pipes
	Incorrect operation and	Microbiological
	interruption of treatment	Chemical
	on PoE
	Inadequate maintenance of	Microbiological Chemical
	PoE treatment
	Overdosing with treatment	Chemical
	chemicals or release of
	treatment chemicals into
	distribution systems
Possible building-specific	Contamination of water	Microbiological
sources of water and	from tank caused by
associated treatment (e.g.	accumulated dirt and
raw water storage)	microorganisms that grow
	from the tank


	from the tank such as lead
		Microbiological Chemical
drinking and non-drinking	contaminated water for
purposes	processing due to use of


	Cross connection of	Microbiological
Water pipelines both for	Contamination due to leaching toxic materials Intrusion and use of non-food grade pipe and adhesive materials	Chemical

Process Steps (Components of Water System)	Hazardous Event(s) (Source of Hazard)	Hazard Category
	different water quality	Chemical
	(drinking and non-drinking
	water supply) resulting to
	leakage of chemicals and
	possible intrusion of
	contaminated water

Devices for heating and supplying hot water	Insufficient maintenance and monitoring of the	Chemical Microbiological
	equipment Deterioration of materials	Chemical
	and fixtures leading to
	leaching of toxic materials
	such as lead
	Low water temperatures in	Microbiological
	hot-water storage vessels
	supports microbial growth
Hot water piping system	Poor temperature control	Microbiological
	supports microbial growth
	such as Legionella
	Insufficient maintenance of	Chemical
	the pipelines resulting to
	scaling and corrosion
	Deterioration of pipes	Chemical
	leading to leaching of lead
	to water supply
	Stagnation and low water	Microbiological
	flows (hot system)
Cold water piping system	Insufficient maintenance of	Chemical
	the pipelines resulting to
	scaling and corrosion
	Deterioration of pipes	Chemical
	leading to leaching of lead
	to water supply
	Stagnation and low water	Microbiological
	flows (cold system)
	Poor temperature control	microbiological
	supports microbial growth
Equipment for point of use	Poor maintenance of PoU	Microbiological
(PoU)	equipment supports
	microbial growth and/or
	corrosion
	Inadequate backflow	Chemical
	prevention on PoU
	equipment
	Aerosol formation	Microbiological
	providing potential

Process Steps (Components of Water System)	Hazardous Event(s) (Source of Hazard)	Hazard Category
	exposure to respiratory
	disease due to poor
	equipment maintenance
	Improper connection of	Microbiological
	PoU devices and
	equipment
Water treatment systems at	Incorrect installation of	Chemical
PoU	water treatment systems
	Insufficient maintenance	Chemical Microbiological
	and monitoring of the
	equipment
	Excessive doses of	Chemicals
	treatment chemicals e.g.
	chlorine

Tool 3.2. Risk Assessment Method

After all the potential hazards are identified, a hazard analysis should be conducted to evaluate the severity of the risks or health effects of the hazards. The risk assessment should take into account the number and vulnerability of exposed people and the type of exposure. A simple risk scoring matrix for prioritization is used.

The computed risk score in this module will be the raw risk scoring. Raw risk is defined as the risk before anything is done to mitigate or manage it (i.e. before controls are in place). The raw risk only takes into account the likelihood and severity of the hazardous event without taking into consideration any of the existing controls in the facility.

Table 3.2.1. Semi-Quantitative Risk Matrix (Source: Deere et. al. 2001)

			Severity / Consequence
Risk Factor Matrix		Insignificant No Impact/ Not Detectable Rating 1	Minor Compliance Impact Rating 2	Moderate Aesthetic Impact Rating 3	Major Regulatory Impact Rating 4	Catastrophic Public Health Impact Rating 5
	Almost Certain Once a day Rating 5	5	10	15	20	25
	Likely Once a week Rating 4	4	8	12	16	20
	Moderate Once a month Rating 3	3	6	9	12	15
	Unlikely Once a year Rating 2	2	4	6	8	10
	Rare Once every 5 years Rating 1	1	2	3	4	5
	Risk Score		<6	6-9	10-15	>15
Risk Rating		Low	Medium	High	Very High

Table 3.2.2. Examples of definitions of likelihood and severity categories that can be used in risk scoring

Item	Definition	Rating
Likelihood categories
Almost certain	Once per day	5
Likely	Once per week	4
Moderately likely	Once per month	3
Unlikely	Once per year	2
Rare	Once every 5 years	1
Severity categories

Catastrophic	Potentially lethal to all people using the building,	5
	including vulnerable groups e.g.
	immunocompromised patients, infants, ant the
	elderly), following acute exposure
Major	Potentially harmful to all people using the	4
	building following acute exposure
Moderate	Potentially harmful to vulnerable groups (e.g.	3
	immunocompromised patients, infants and the
	elderly) following chronic exposure
Minor	Potentially harmful to all people using the	2
	building following chronic exposure
Insignificant	No impact or not detectable	1

The next table shows a sample risk assessment method to identify which among the potential/existing hazards require immediate intervention. The matrix provides a quick overview of the impact that a certain hazard could contribute if not properly addressed or intervened.

Tool 3.3. Sample Template and Contents for Hazard Identification and Risk Assessment

Process Steps (Components of Water System)	Hazardous Event(s) (Source of Hazard)	Hazard Category	LIKELIHOOD	SEVERITY	RAW RISK SCORE	RAW RISK RATING
Point of Entry to the Building (Source of raw	Compromised and unsafe use of contaminated water from source	Microbiological Chemical	4	5	20	Very High
water)	Intrusion and use of contaminated water for processing due to use of non-food grade pipe and adhesive materials	Microbiological Chemical	4	5	20	Very High
	Contamination of water due to deterioration of pipes	Chemical	3	4	12	High
	Incorrect operation and interruption of treatment on PoE	Microbiological Chemical	3	5	15	High

Inadequate maintenance of PoE treatment	Microbiological Chemical	4	5	20	Very High
-----------------------------------------	-----------------------------	---	---	----	-----------

Process Steps (Components of Water System)	Hazardous Event(s) (Source of Hazard)	Hazard Category	LIKELIHOOD	SEVERITY	RAW RISK SCORE	RAW RISK RATING
	Overdosing with treatment chemicals or release of treatment chemicals into distribution systems	Chemical	4	4	16	Very High
Possible buildingspecific sources of water and associated treatment (e.g. raw water storage)	Contamination of water from tank caused by accumulated dirt and microorganisms that grow from the tank	Microbiological	5	5	25	Very High

	Contamination due to leaching toxic	Chemical	4	4	16	High
	materials from the tank such as lead	Cnemical	4	4	10	High
Water pipelines both for drinking and non-drinking purposes	Intrusion and use of contaminated water for processing due to use of non-food grade pipe and adhesive materials	Microbiological Chemical	4	5	20	Very High
	Cross connection of different water quality (drinking	Microbiological Chemical	1	5	5	Low
Process Steps (Components of Water System)	Hazardous Event(s) (Source of Hazard)	Hazard Category	LIKELIHOOD	SEVERITY	RAW RISK SCORE	RAW RISK RATING
	and non-drinking water supply) resulting to leakage of chemicals and possible intrusion of contaminated

water

Devices for heating and supplying hot water (Note: may or may not be	Insufficient maintenance and monitoring of the\nequipment	Chemical Microbiological	4	5	20	Very High
present)	Deterioration of materials and fixtures leading to leaching of toxic materials such as lead	Chemical	3	4	12	High
	Low water temperatures in hot-water storage vessels supports microbial growth	Microbiological	2	5	10	High
Hot water piping system (Note: may or may not be present)	Poor temperature control supports microbial growth such as Legionella	Microbiological	3	5	15	High
	Insufficient maintenance of the pipelines resulting	Chemical	4	4	16	Very High
Process Steps (Components of	Hazardous Event(s) (Source of Hazard)	Hazard Category	LIKELIHOOD	SEVERITY	RAW RISK SCORE	RAW RISK RATING

Water System)
	to scaling and corrosion
	Deterioration of pipes leading to leaching of lead to water supply	Chemical	1	4	4	Low
	Stagnation and low water flows (hot system)	Microbiological	4	5	20	Very High
Cold water piping system (Note: may or may not be present)	Insufficient maintenance of the pipelines resulting to scaling and corrosion	Chemical	4	4	16	Very High
	Deterioration of pipes leading to leaching of lead to water supply	Chemical	1	4	4	Low
	Stagnation and low water flows (cold system)	Microbiological	4	5	20	Very High

	Poor temperature control supports microbial growth	microbiological	4	5	20	Very High
Equipment for point of use (PoU)	Poor maintenance of PoU equipment supports microbial growth and/or corrosion	Microbiological	4	5	20	Very High
Process Steps (Components of Water System)	Hazardous Event(s) (Source of Hazard)	Hazard Category	LIKELIHOOD	SEVERITY	RAW RISK SCORE	RAW RISK RATING
	Inadequate backflow prevention on PoU equipment	Chemical	3	5	15	High
	Aerosol formation providing potential exposure to respiratory disease due to poor equipment maintenance	Microbiological	3	5	15	High
	Improper connection of PoU	Microbiological	3	5	15	High

	devices and equipment
Water treatment systems at PoU	Incorrect installation of water treatment systems	Chemical	1	5	5	Low
	Insufficient maintenance and monitoring of the equipment	Chemical Microbiological	4	5	20	Very High
	Excessive doses of treatment chemicals e.g. chlorine	Chemicals	3	4	12	High

4. Determine and Validate Control Measures, Reassess, and Prioritize the Risks

Once the raw risks for each hazardous event have been identified, the existing control measure will need to be verified to recalculate the raw risk resulting to the residual risk rating. In definition, control measures are any action of activity that can be used to prevent, reduce or eliminate a water supply quality/safety hazard to tolerable level. This may take the form of:

Preventing entry of contaminants to the water
Removal of hazards from water
Inactivation of pathogens
Maintaining quality of water during distribution

Once validation of effectiveness, these control measures help reduce the risk rating of the hazardous events leading to the new risk score termed as the residual risk score. This residual risk score serves as basis in prioritizing which of the hazardous events need to be addresses short-term, medium-term and long-term. The higher the residual risk score, the more it needs to be addressed immediately.

The tables below show the different control measures which may be adopted by the HCFs for each type of hazardous events and how the residual risk score is calculated.

Tool 4.1. Control Measures for the Identified Hazards in the Hospital Water System

Process Steps (Components of Water System)	Hazardous Event(s) (Source of Hazard)	Hazard Category	Raw Risks	Control Measure(s)
Point of Entry to the Building (Source of raw	Compromised and unsafe use of contaminated water from source	Microbiological Chemical	Very High	Use only of potable water that passed the PNSDW standards
water)	Intrusion and use of contaminated water for processing due to use of nonfood grade pipe and adhesive materials	Microbiological Chemical	Very High	Use DOH recommended pipelines and adhesive materials
	Contamination of water due to deterioration of pipes	Chemical	High	Replace pipes with DOH recommended materials
	Incorrect operation and interruption of treatment on PoE	Microbiological Chemical	High	Daily monitoring of operation Assign staff to perform maintenance Installation of alarms for key processes Provision of standby generator in case of power interruptions

Inadequate maintenance of PoE treatment	Microbiological Chemical	Very High	Assign staff to perform maintenance Ensure processes are maintained according to manufacturer's instructions
Overdosing with treatment chemicals or release of treatment chemicals into distribution systems	Chemical	Very High	Ensure dosing equipment and storages are maintained Avoid overdesigning chemical storage capacities

Process Steps (Components of Water System)	Hazardous Event(s) (Source of Hazard)	Hazard Category	Raw Risks	Control Measure(s)
Possible	Contamination of water from	Microbiological		Scheduled cleaning of water storage tanks
building	tank caused by accumulated
specific sources	dirt and microorganisms that		Very High
of water and	grow from the tank
associated	Contamination due to	Chemical		Replace storage tank with DOH approved material
treatment (e.g.	leaching toxic materials from
raw water	the tank such as lead		High
storage)
Water pipelines	Intrusion and use of	Microbiological		Use of DOH approved pipes and adhesive materials
both for drinking	contaminated water for	Chemical
and non-drinking	processing due to use of		Very High
purposes	nonfood grade pipe and
	adhesive materials

	Cross connection of different water quality (drinking and non-drinking water supply) resulting to leakage of chemicals and possible intrusion of contaminated water	Microbiological Chemical	Low	Ensure separation from water systems and appropriate labeling and marking of pipework and fittings
Devices for heating and	Insufficient maintenance and monitoring of the equipment	Chemical Microbiological	Very High	Assign staff to perform maintenance
supplying hot water (Note: may or may not be	Deterioration of materials and fixtures leading to leaching of toxic materials such as lead	Chemical	High	Replace materials and fixtures with DOH approved materials
present)	Low water temperatures in hot-water storage vessels supports microbial growth	Microbiological	High	Adjust heater temperature Ensure sufficient energy delivery

Process Steps (Components of Water System)	Hazardous Event(s) (Source of Hazard)	Hazard Category	Raw Risks	Control Measure(s)
--------------------------------------------------	------------------------------------------	--------------------	-----------	--------------------

				Check heater thermostat
				Maintain temperatures above 50 o C in distribution system
				Maintain temperatures above 60 o C in storage vessels
				Install temperature reduction devices as close as possible to PoU
				Insulate system
				Avoid stagnation and low flow areas
				Ensure sufficient capacity for maximum flows
Hot water piping	Poor temperature control	Microbiological		Insulate cold and hot water pipes
system (Note:	supports microbial growth		High
may or may not	such as Legionella			Keep systems physically separate
be present)	Insufficient maintenance of	Chemical		Assign staff to perform maintenance
	the pipelines resulting to		Very High
	scaling and corrosion
	Deterioration of pipes leading	Chemical		Replace pipes with DOH approve materials
	to leaching of lead to water		Low
	supply

	Stagnation	and	low	water	Microbiological		Avoid overdesigning capacities
	flows (hot system)					Very High	Isolate areas that are not used for extended periods

Process Steps (Components of Water System)	Hazardous Event(s) (Source of Hazard)	Hazard Category	Raw Risks	Control Measure(s)
				Remove dead legs and minimize length of branch pipes
Cold water	Insufficient maintenance of	Chemical		Assign staff to perform maintenance
piping system	the pipelines resulting to		Very High
(Note: may or	scaling and corrosion			Replace pipes with DOH approve materials
may not be	Deterioration of pipes leading	Chemical		Replace pipes with DOH approve materials
present)	to leaching of lead to water		Low
	supply

	Stagnation and low water flows (cold system)	Microbiological		Avoid overdesigning capacities
				Remove the causes of fluctuation (e.g. high peak water demand, fire drills)
			Very High	Prevent negative pressures
				Flush systems that are not used frequently
				Isolate areas that are not used for extended periods
				Remove dead legs and minimize length of branch pipes
	Poor temperature control	Microbiological		Insulate cold and hot water pipes
	supports microbial growth		Very High	Keep systems physically separate
Equipment for point of use (PoU)	Poor maintenance of PoU equipment supports microbial growth and/or corrosion	Microbiological	Very High	Assign staff to perform maintenance
	Inadequate backflow prevention on PoU equipment	Chemical	High	Minimize connections and provide backflow prevention where required
Process Steps (Components of Water System)	Hazardous Event(s) (Source of Hazard)	Hazard Category	Raw Risks	Control Measure(s)

	Aerosol contamination on sewerage or septic systems	Microbiological		Install water traps in sewage lines
	sewerage of septic systems		High	Filter double traps in high-risk environment
				Prevent contamination from septic tanks
	Improper connection of PoU devices and equipment	Microbiological	High	Ensure proper establishment of connection for all POU equipment and devices
Water treatment	Incorrect installation of water	Chemical		Choose quality materials
systems at PoU	treatment systems		Low	Follow local or international choice and construction rules
				Use active protection of pipes (e.g. sacrificial anodes, anticorrosion products)
	Insufficient maintenance and monitoring of the equipment	Chemical Microbiological	Very High	Assign staff to perform maintenance
	Excessive doses of treatment	Chemicals		Ensure dosing equipment and storages are maintained
	chemicals e.g. chlorine		High	Avoid overdesigning chemical storage capacities
				Minimize cross-connections and provide backflow prevention where required

Tool 4.2. Sample Template and Content for Determining and Validating Control Measures, Reassessing and Prioritizing Risks

Process	HAZARDOUS EVENT	TYPE OF HAZARD		RAW RISK		EXISTING CONTROL MEASURES	VALIDATION OF CONTROL MEASURES	RESIDUAL RISK
Steps (Component s of Water System)
Point of Entry to the Building (Source of raw water)	Compromised and unsafe use of contaminated water from source	Microbiolo gical Chemical	4	5	20	Use only of potable water that passed the PNSDW standards	Water supply tapped with service provider (water quality compliant)	1	5	5 Low
	Intrusion and use of contaminated water for processing due to use of nonfood grade pipe and adhesive materials	Microbiolo gical Chemical	4	5	20	Use DOH recommended pipelines and adhesive materials	Pipes and materials accredited by DOH	1	5	5 Low

	Contamination of water due to deterioration of pipes	Chemical	3	4	12	Replace pipes with DOH recommended materials	Pipes replaced with accredited materials	1	5	5 Low
Process	HAZARDOUS	TYPE OF		RAW RISK		EXISTING CONTROL	VALIDATION OF CONTROL			RESIDUAL RISK

Process	HAZARDOUS EVENT	TYPE OF HAZARD		RAW RISK		EXISTING CONTROL MEASURES	VALIDATION OF CONTROL MEASURES		RESIDUAL RISK
Steps (Component s of Water System)
	Incorrect operation and interruption of treatment on PoE	Microbiolo gical Chemical	3	5	15	Daily monitoring of operation Assign staff to perform maintenance Installation of alarms for key processes Provision of standby generator in case of power interruptions	Missing data on the monitoring sheet No assigned personnel to perform maintenance Alarms installed on key processes No generator for backup electricity	3	5	15 High

Inadequate maintenance of PoE treatment	Microbiolo gical Chemical	4	5	20	Assign staff to perform maintenance Ensure processes are maintained according to manufacturer's instructions	No assigned personnel to perform maintenance Missing information of the monitoring sheet	4	5	20 Very High
Overdosing with treatment chemicals or	Chemical	4	4	16	Ensure dosing equipment and storages are	Proper dose of chlorine recorded and maintained	1	5	5 Low

Process	HAZARDOUS	TYPE OF	R	AW RIS	SK	EXISTING CONTROL	VALIDATION OF CONTROL	RESIDUAL RISK
Steps	EVENT	HAZARD				MEASURES	MEASURES	_	l
(Component s of Water System)			LIKELIHOOD	SEVERITY	RAW RISK SCORE			LIKELIHOOD	RISK SCORE	RESIDUALRISK RATING
	release of treatment chemicals into					maintained Avoid
	distribution systems					overdesigning chemical storage capacities

Possible	Contamination	Microbiolo				Scheduled cleaning of	Cleaning schedule not	5	5
buildingspecific sources of water and associated treatment (e.g. raw water storage)	of water from tank caused by accumulated dirt and microorganism s that grow from the tank	gical	5	5	25	water storage tanks	properly done			25 Very High
	Contamination due to leaching toxic materials from the tank such as lead	Chemical	4	4	16	Replace storage tank with DOH approved material	Storage tank not approved by DOH	4	4	16 Very High
Water pipelines both for drinking and non	Intrusion and use of contaminated water for processing due	Microbiolo gical Chemical	4	5	20	Use of DOH approved pipes and adhesive materials	Pipes replaced with accredited materials	1	5	5 Low

Process		RAW RISK		RESIDUAL RISK

Steps (Component s of Water System)	HAZARDOUS EVENT	TYPE OF HAZARD				EXISTING CONTROL MEASURES	VALIDATION OF CONTROL MEASURES
drinking purposes	to use of nonfood grade pipe and adhesive materials
	Cross connection of different water quality (drinking and non-drinking water supply) resulting to leakage of chemicals and possible intrusion of contaminated water	Microbiolo gical Chemical	1	5	5	Ensure separation from water systems and appropriate labeling and marking of pipework and fittings	Proper labeling of systems noted	1	5	5 Low

Devices for	Insufficient	Chemical				Assign staff to perform	No definite staff assigned for
heating and	maintenance	Microbiolo				maintenance	maintenance			20
supplying	and	gical	4	5	20			4	5	Very
hot water	monitoring of									High
	the equipment

Process	HAZARDOUS	TYPE OF	RAW RISK			EXISTING CONTROL	VALIDATION OF CONTROL	RESIDUAL RISK
Steps	EVENT	HAZARD				MEASURES	MEASURES
(Component
s of Water
System)


	Deterioration	Chemical				Replace materials and	DOH materials used and in
	of materials					fixtures with DOH	place
	and fixtures					approved materials
	leading to		3	4	12			1	5	5
	leaching of									Low
	toxic materials
	such as lead

Low water	Microbiolo				Adjust heater
temperatures	gical				temperature
in hot-water
storage vessels					Ensure sufficient
supports					energy delivery
microbial
growth					Check heater
					thermostat
		2	5	10		2	4	8
					Maintain temperatures			Medium
					above 50 o C in
					distribution system

					Maintain temperatures
					above 60 o C in
					storage vessels

Process	HAZARDOUS	TYPE OF	RAW RISK		EXISTING CONTROL	VALIDATION OF CONTROL	RESIDUAL RISK
Steps	EVENT	HAZARD			MEASURES	MEASURES
(Component s of Water System)

Hot water piping system (Note: may or may not be present)	Poor temperature control supports microbial growth such as Legionella	Microbiolo gical	3	5	15	Install temperature reduction devices as close as possible to PoU Insulate system Avoid stagnation and low flow areas Ensure sufficient capacity for maximum flows Insulate cold and hot water pipes Keep systems physically separate	Insulation in place and properly separated	1	5	5 Low
	Insufficient	Chemical				Assign staff to perform	No definite staff assigned			16
	maintenance of the pipelines		4	4	16	maintenance		4	4	Very High

Process Steps	HAZARDOUS EVENT	TYPE OF HAZARD	RAW RISK			EXISTING CONTROL MEASURES	VALIDATION OF CONTROL MEASURES	RESIDUAL RISK
(Component s of Water System)
	resulting to scaling and corrosion
	Deterioration of pipes leading to leaching of lead to water supply	Chemical	1	4	4	Replace pipes with DOH approve materials	DOH approved materials in place	1	4	4 Low
	Stagnation and low water flows (hot system)	Microbiolo gical	4	5	20	Avoid overdesigning capacities Isolate areas that are not used for extended periods	Water flow design appropriately constructed	1	5	5 Low

						Remove dead legs and minimize length of branch pipes
Cold water piping system	Insufficient maintenance of the	Chemical	4	4	16	Assign staff to perform maintenance	No definite staff assigned for maintenance	4	4	16 Very
(Note: may or may not	pipelines resulting to					Replace pipes with DOH approve				High

Process	HAZARDOUS	TYPE OF
Steps	EVENT	HAZARD	MEASURES	MEASURES
(Component
s of Water
System)


be present)	scaling and		materials
	corrosion

Deterioration of pipes leading to leaching of lead to water supply	Chemical	1	4	4	Replace pipes with DOH approve materials	Pipes replace with DOH approved materials	1	4	4 Low
Stagnation and low water flows (cold system)	Microbiolo gical	4	5	20	Avoid overdesigning capacities Remove the causes of fluctuation (e.g. high peak water demand, fire drills) Prevent negative pressures Flush systems that are not used frequently Isolate areas that are not used for extended	Water flow design appropriately constructed	1	5	5 Low

Process		RAW RISK		RESIDUAL RISK

Steps (Component s of Water System)	HAZARDOUS EVENT	TYPE OF HAZARD				EXISTING CONTROL MEASURES	VALIDATION OF CONTROL MEASURES
						periods Remove dead legs and minimize length of branch pipes
	Poor temperature control supports microbial growth	Microbiolo gical	4	5	20	Insulate cold and hot water pipes Keep systems physically separate	Insulation in place and properly separated	1	5	5 Low
Equipment for point of use (PoU)	Poor maintenance of PoU equipment supports microbial growth and/or corrosion	Microbiolo gical	4	5	20	Assign staff to perform maintenance	No definite staff assigned for maintenance	4	4	16 Very High

Inadequate backflow prevention on PoU	Chemical	3	5	15	Minimize connections and provide backflow prevention where required	Connections minimized and adequately controlled	1	5	5 Low
equipment

Process	HAZARDOUS EVENT	TYPE OF HAZARD		RAW RISK		EXISTING CONTROL MEASURES	VALIDATION OF CONTROL MEASURES	RESIDUAL RISK
Steps (Component s of Water System)
	Aerosol contamination on sewerage or septic systems	Microbiolo gical	3	5	15	Install water traps in sewage lines Filter double traps in high-risk environment Prevent contamination from septic tanks	Water traps adequately and properly installed	1	5	5 Low
	Improper connection of PoU devices and equipment	Microbiolo gical	3	5	15	Ensure proper establishment of connection for all	Connection of POU devices secured	1	5	5 Low

						POU equipment and devices
Water treatment systems at PoU	Incorrect installation of water treatment systems	Chemical	1	5	5	Choose quality materials Follow local or international choice and construction rules Use active protection of pipes (e.g. sacrificial anodes, anticorrosion	Correct and recommended materials constituted the designed structure	1	5	5 Low

Process	HAZARDOUS	TYPE OF	EXISTING CONTROL	VALIDATION OF CONTROL
Steps	EVENT	HAZARD	MEASURES	MEASURES
(Component
s of Water
System)



			products)

Insufficient maintenance	Chemical Microbiolo				Assign staff to perform maintenance	No definite assigned staff for maintenance	4	5	20
and	gical	4	5	20					Very
monitoring of									High
the equipment
Excessive	Chemicals				Ensure dosing	Required doses administered	1	5	5
doses of					equipment and	correctly
treatment					storages are				Low
chemicals e.g.					maintained
chlorine
					Avoid overdesigning
		3	4	12	chemical storage
					capacities

					Minimize
					crossconnections and
					provide backflow
					prevention where
					required

5. Improve/Upgrade Plan

Devising an improvement or upgrade plan is important to ensure that the quality of the water in the system is a priority and always taken into consideration. It involves review of existing operating procedures for activities, implementation of new operating procedures or infrastructure changes to upgrade existing control measures. Example of an improvement plan is formulation of program to control cross connection problems e.g. contamination of water supply.

The initial step in the identification of an improvement and/or upgrade is to consider the following factors: (a) cost; (b) practicality; (c) timelines; and (d) likelihood of success. If there is more than one identified need for improvement, priorities should be selected considering the level of unaddressed risk. The plan should also establish a schedule of short, medium, and long term activities. Moreover, it is crucial to put in place a mechanism for monitoring and reporting on implementation of the plan.

Tool. 5.1. Sample Improvement/Upgrade Plan

Process Steps (Components of Water System)	ACTION	IDENTIFIED SPECIFIC IMPROVEMENT PLAN	RESPONSIBLE UNIT/PERSON	COST	FUNDING SOURCE	DUE	STATUS
Storage Tank	Implement measures to replace rusted steel storage tank	Replacement of storage tank from steel tank to stainless steel tank	Engineering Unit	P 50,000		1 ^st qtr 2017	On-going
Inadequate maintenance and monitoring of equipment due to insufficient staff	Additional staff for monitoring and maintenance of equipment	Hiring and training of additional staffs for monitoring and performance of maintenance (operational and preventive) of equipment	Administrative Unit	P 8,000 per month x 5-8 Staffs		1 ^st qtr of 2017	On-going

6. Define Monitoring of the Control Measures

Proper documentation and monitoring of the processes involved is critical on the implementation of WSP. The procedures are established to oversee existing deviations and facilitate immediate interventions. The monitoring scheme includes the following questions which should be thoroughly assessed and evaluated: (1) What will be monitored; (2) How it will be monitored; (3) Where it will be monitored; (4) When and how often will it be monitored; (5) Who will do the monitoring; (6) What corrective action should be done.

In conducting operational monitoring, a planned and structured approach should be in place to appropriately manage any deviations that might occur during operations. It might include simple field measurements such as monitoring of the disinfectant residuals, turbidity, color, temperature, odor and other physical characteristics. The principle of having the simple measurements rather than the complex laboratory based evaluation is that a quick assessment on possible deviations can help initiate immediate response for corrective action. Corrective actions are actions which need to be taken when the results of monitoring at a control point indicate to a loss of control.

In addition, definite critical limits should also be in place in order for the assessor to easily decide if a certain measure has exceeded or lose the normal recommended value for it. Most of the critical limits are based on the limits defined in the latest PNSDW though some may be established by the HCF.

The table below shows a sample template of what are supposed to be included in the formulation of a monitoring scheme/structure.

Tool 6.1. Monitoring Requirements and Corrective Action

Process Steps (Component s of Water System)	Critical Limits	What to Monitor	Where to Monitor	How	Frequency (When)	Who	Corrective Action
Source	PNSDW permissible limit	Microbial/ bacteriological water quality	Pumping Station	Microbial/ bacteriological tests	Monthly	Pump operator/ DOH accredited laboratory	Chlorination Investigate possible source
Treatment	Residual chlorine must be within 0.3ppm - 1.5ppm	Residual chloride monitoring	Source, midpoint and farthest point of the distribution network	Residual chlorine monitoring test kit	Daily	Pump Operator	Adjust chlorine dosage and retesting
Storage	Annual cleaning of reservoir / storage tanks	Cleaning of reservoir and storage facilities	Reservoir and storage tanks	Visual Inspection	Annually	Pump Operator	Regular cleaning

Distribution	0.4 ppm	Residual chlorine	Tap	Test kit	Daily	Maintenance	Adjustment
		testing					of chlorine
							dosage Re
							compute
							chlorine
							demand

7. Verify the Effectiveness of the WSP

Verification provides reassurance that the WSP is effective. Moreover, this step confirms that the support programs are implemented and the hazard analysis is updated. It also serves as evidence that the hazard levels are within the acceptable levels. Results of the verification procedures should be communicated among the team through meetings.

The verification procedure of the HCF water supply system includes three components; water quality testing³ , water safety plan internal auditing and user satisfaction. For the water quality testing, water samples are tested based from the latest PNSDW. On the other hand, WSP internal audits are necessary in preparation for an external audit by the regulatory agency or by an independent auditor. Internal audit shall cover the following items: (a) operational monitoring, (b) improvement plans, (c) compliance monitoring, (d) management plans, (e) supporting programmes, (f) responsible team and (g) frequency of internal audit. In addition, user's satisfaction may also be conducted to determine any feedback from the employees, patients, watchers, and visitors. The following shall be defined for user's satisfaction: (a) responsible unit, (b) frequency of monitoring and (c) methodology of getting information from user.

Below are sample templates on specific verification activities that may be conducted by the WSP team.

³ If source is owned by HCF, the HCF will be responsible for water quality testing of its water supply system. If source is from water service provider, the HCF will be responsible for testing from point of entry/after the meter to entire water supply system in the HCF premises.

8. Develop Management Procedures

Development of Standard Operating Procedures (SOPs) is crucial in order to provide the staffs and employees with guidelines for the performance of their day-to-day duties and responsibilities. There are different conditions from which procedures need to be established for the continuous operation of the water supply in the HCF namely for normal condition, incidents and emergency conditions.

For normal conditions, this involves the regular tasks and how these are conducted for the water supply system. Among some of the tasks which need procedures include maintenance of storage tanks, preparation of disinfectants, water sampling, etc.

Incident conditions are instances wherein the activity is not conducted regularly but occur immediately as part of the facilities' operation and will require quick response from the facility owner. Examples of this which will need establishment of procedures are repair of burst pipes and equipment malfunction.

Lastly, there are the emergency conditions which may be due to force majeure (e.g. disease outbreak, earthquake, flood, power outage, etc.) or man-made (e.g. sabotage, terrorist attack). In most instances, the procedures for these conditions have been established by various agencies (e.g. NDRRMC, DOH, Red Cross, etc.) and will just be adopted for sitespecific application.

Among the key items which need to be included when establishing and reviewing any of the standard procedures are the following:

Availability
Relation to defined control measure/s and significant risks
Accessibility of procedure
Responsible unit

Also, it is important that for every procedure, the communication plan is included to ensure that the procedure is made known to the responsible units and its intended stakeholders.

Tool 8.1. Sample Templates for Management Procedures

Required SOPs	Available Yes/No	Timeline for completion (if not yet available)	Responsible Unit	Location of the document
A. Normal Condition
1. Water source or point of entry			Laboratory/
1.1 Water sampling	Yes		Med Tech	Cabinet 1.2
2. Water treatment	No		Maintenance
2.1 Mixing chlorine		rd Quarter, 2016 3		-
3. Storage			Maintenance	Cabinet 2.5
3.1 Cleaning storage tank	Yes
4. Distribution lines	Yes		Maintenance/	Cabinet 3.1
4.1 Repair of leak			Plumber
B. Incidents/Corrective actions
1. Source	No	3rd quarter, 2016	To be identified	-
2. Treatment	No
3. Storage	No
4. Distribution	No
C . Emergency
1. Disease outbreak	Yes		Admin Office	Cabinet 4.4

9. Develop Support Programs

Support programs are activities that assist in the implementation of WSPs and essential to ensure the quality of water. These programs contribute to the overall safety of the hospital particularly on providing safe drinking-water for the consumers. Moreover, supporting programs provide knowledge and skills among staffs, operators, employees and users of the HCF, and commitment to the WSP approach and capacity to manage systems to deliver safe water. The key action for this step is for the WSP Coordinator and the team to identify the needed supporting programs for implementing the WSP approach, then reviews and if necessary revise the existing programs and develop additional supporting programs to address the identified gaps.

Examples of training may cover the following:

1. Hygienic use of water supplies
1. Hygienic practices in maintaining water supplies, water-using devices and equipment
1. Hygienic practices in performing repairs
1. Calibration of monitoring equipment
1. Instructions on access to equipment and modification of systems
1. Training requirement for maintenance staff

Tool 9.1. Sample Template for Developing a Support Program

Activities	Objective/ Targets	Schedule	Budget	Responsible
7 ICTI VICES	Objective, rangets	(2016)	Duager	Unit
Training/	HCF Staff	Quarterly	P 10,000	Admin
Orientation	• WSP			Office / HR
	members			Unit
Calibration of	• Measuring	Annual	P 20,000	Admin
equipment	devices			Office/
	Valves			O&M
Operation	• Equipment	Monthly	P 50,000	Admin
and	Pumps			Office/
maintenance	• Kits			O&M
	Generators

10. Conduct WSP Systems Review

One of the immediate responsibilities of the WSP coordinator is the periodic review of the WSP. Results based from the verification process of the WSP document should be thoroughly analyzed to apply accurate decisions on whether to change the existing WSP or not. Ideally, WSPs are reviewed ideally every three (3) to five (5) years and in cases where changes to the water system like repair of existing equipment or process is applied, change in the source of water, and in cases of emergencies, incident or near miss. The WSP system should also be critically reassessed for possible action to include in the improvement/upgrade plan section of the document.

Tool 10.1. Sample Template in Implementing a WSP Systems Review

Activity	Purpose or Reason	Schedule	Responsible unit
Review of WSP	- To evaluate level of risks from operational monitoring results, new changes in the water supply system and HCF organization, lessons learned from incidents, results of audit - To provide recommendations on whether to	Quarterly	WSP Team
	retain, revise or update WSP

11. Revise WSP Following an Incident

The implementation of a comprehensive WSP will help greatly on the reduction of the risk on the occurrence of waterborne diseases and/or other related complaints. Existence of a WSP does not give the assurance that incidents may not occur hence, the need for WSP review is vital after an emergency, confirmed incidents or near misses or for unforeseen events. The reassessment or investigation of the incident provide opportunities for improvement and therefore the team shall create new protocols or revised the existing WSP after the conduct of the review and investigation.

Tool 11.1 List of questions to ask following an emergency, incident or near miss ✓

What was the cause of the problem?

✓ Was the cause a hazard already identified in the WSP hazard & risk assessment?
✓ How was the problem first identified or recognized?
✓ What were the most essential actions required and were they carried out?
✓ If, relevant, was appropriate and timely action taken to warn consumers and protect their health?
✓ What communication problems arose and how were they addressed?
✓ What were the immediate and long-term consequences of the emergency?
✓ How can risk assessment / procedures / training / communications be improved?
✓ How well did the emergency response plan function?

Tool 11.2 Following an incident, emergency or near miss the following checklist may be useful to revise the WSP

✓ Accountabilities of WSP and key personnel are updated
✓ Review whether the management procedures were appropriate for the incident and if not, revise accordingly
✓ Standard operating procedures and required equipment are readily available and relevant
✓ Does the risk assessment need revise?
✓ Do procedures / training / communications need improving?
✓ Has the problem shown the need for an improvement of program?

Activity	Purpose or Reason	Schedule	Responsible unit

Revision of	To incorporate significant results	Normal condition:	WSP Team
WSP	of risk analysis derived from operational monitoring, new changes in the water supply system and HCF organization, lessons learned from incidents, and audit recommendations	Every second quarter of the year Following an incident: anytime

Annex A: Sample Templates for Steps 1-11

INTRODUCTION

Key Points to consider in making the Introduction, but should not be limited to the following:


1.		About the HCF
	a.	Name of HCF
	b.	Location or address
	c.	Type of HCF (see DOH Category)
	d.	Year established
	e.	Bed capacity
	f.	Number of staff (regular, contractual)
	g.	Floor Area and Lot Area
	h.	Number of Floors
2. Water Sources (all which is applicable)
	a.	Water district
	b.	LGU-managed
	c.	Community-managed
	d.	HCF-owned deep well
	e.	Privately-managed
3.		Waste Management System

	a.	Wastewater
	b.	Solid Waste
	c.	Health Care Waste
4.	Power supply
	a.	Two-phase
	b.	Three-phase
	c.	Stand-by Generator (include kVA)

I. WSP Team WATER SAFETY PLAN TEAM STRUCTURE

WATER SAFETY PLAN TEAM

Name	Organization / Department	Job Title / WSP Role	Responsibility	Telephone No.

Identify the stakeholders who might contribute to the water quality which may include the following:

1. Water supply providers
1. Waste management service providers
1. Suppliers
1. LGU (e.g. MHO/CHO, MENRO/CENRO, MEO/CEO, etc.)
1. Concerned national agencies (e.g. DOH, DENR, NWRB, etc.)
1. Nearby community
1. Water Users in the HCF
1. Others

II. WATER SUPPLY SYSTEM and PROCESS DESCRIPTION

Key Points to consider in making the Water Supply System and Process Description, but should not be limited to the following:

	Details to be provided (if applicable)
Water Source	d) Water supply provider (average volume billed/consumed per
	year, latest water quality results – Point of Entry)
	e) Deep-well information (depth, diameter, year constructed,
	casing material, water quality)
	f) Pumping equipment (capacity, horsepower rating, year
	installed)
Water Treatment	h) Type of treatment (filtration, sedimentation, coagulation,
	chlorination, reverse osmosis, ion exchange, UV,
	ozonation, etc.)
	i) Chemicals used (volume per month,
	j) Year installed per treatment facility
	k) Contaminants being removed per treatment facility
	l) Treatment facility location in the HCF
	m) Capacity of the water treatment facility
	n) Volume of water being treated per treatment facility
Storage	h) Type of storage (ground, elevated)
	i) Technology applied (fill and draw, floating, pneumatic)
	j) Height of storage (for elevated tank)
	k) Description of storage tank location
	l) Number, Volume and shape of storage tank
	m) Material composition of storage tank
	n) Frequency of cleaning
Distribution	d) Diameter, Length of pipe network
	e) Material used
	f) Water quality from the tap

(NOTE: Mention water quality targets if the source is HCF-owned water system. For supplied by water service provider, request a copy of their water quality targets.)

(Sample template only)

	Provide Average number per day
Users	a) Patients (admitted and out-patient)
	b) Watchers
	c) Guest / Visitor
	d) Employees (regular, contractual)
	State which of the uses are applicable
Uses	a) General use (drinking, cooking, flushing, washing, bathing,
	gardening, fire protection, etc.)
	b) Special use (dialysis, autoclaving, etc.)

TEMPLATE: FLOW DIAGRAM

Process Step	Symbol	Org./ Dept. Responsible

Legend:

Process step
Chemical process
Storage / Reservoir / Catchment
Transport step
Consumer
"As Needed" basis process step
Connector

HAZARD IDENTIFICATION AND RISK ASSESSMENT

TEMPLATE: HAZARD IDENTIFICATION AND RISK ASSESSMENT (identify as many hazardous events, per process step, as possible)

PROCESS	HAZARDOUS	TYPE OF	LIKELIHOOD	SEVERITY	RAW RISK	RAW RISK
STEP	EVENT	HAZARD	LIKELIHOOD	SEVERILI	SCORE	RATING

DETERMINE AND VALIDATE CONTROL MEASURES, REASSESS AND PRIORITIZE THE RISKS

TEMPLATE: Determine and Validate Control Measures, Reassess and Prioritize the Risk (all hazardous events in Module 3 must be reflected here in Module 4)


PROCESS STEP	HAZARDOUS EVENT	TYPE OF HAZARD	EXISTING CONTROL MEASURES	VALIDATION OF CONTROL MEASURES

IMPROVEMENT / UPGRADE PLAN

TEMPLATE: IMPROVEMENT / UPGRADE PLAN

(NOTE: Establish improvement plans for those hazardous events with significant residual risk ratings only)

PROCESS	IDENTIFIED	RESPONSIBLE	FUNDING
STEP	SPECIFIC	UNIT/PERSON	SOURCE
	IMPROVEMENT
	PLAN

MONITORING OF THE CONTROL MEASURES (OPERATIONAL MONITORING)

TEMPLATE: MONITORING OF THE CONTROL MEASURES

Process Step	Critical Limits	What to Monitor	Where to Monitor	How	Frequency (When)	Who	Corrective Action

VII. VERIFICATION

TEMPLATES: VERIFICATION

Verification Activity	Location of Activity	Type of Activity	Frequency of Activity	Analyst	Recipient of Analysis	Action on Failing Result	Recipient of Result (3 ^rd party)
1. Water Quality Parameters
2. Microbiological
3. Arsenic
4. Cadmium
5. Lead
6. Nitrate
7. Benzene
8. Color
9. Turbidity
10. Iron
11. pH
12. Manganese
13. Chloride
14. Sulfate
15. Total Dissolved Solids (TDS)

Type of Audit	Scope	Schedule	Who will conduct?	Documents to be checked
Internal
Audit

Methodology for determining user satisfaction	Frequency of feedback	Responsible unit	Records generated
Survey
Complaints

MANAGEMENT PROCEDURES TEMPLATE: MANAGEMENT PROCEDURES

Required SOPs	Available Yes/No	Timeline for completion (if not yet available)	Responsible Unit	Location of the document
A. Normal Condition
B. Incidents/Corrective actions
C. Emergency

SUPPORTING PROGRAMS

TEMPLATE: SUPPORTING PROGRAMS

Objective/ Targets	Schedule	Budget	Responsible Unit

REVIEW AND AUDIT TEMPLATE: REVIEW AND AUDIT

Activity	Purpose or Reason	Schedule	Responsible unit

VI. REVISE THE WSP FOLLOWING AN INCIDENT

TEMPLATE: REVISION OF WSP

Activity	Purpose or Reason	Schedule	Responsible unit