Public Health Department Policy & Procedure Manual Example

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Stage Two Conflict

A “we-they” attitude where there are winners and losers; conflict has escalated to the point where there are “camps” and it is affecting morale as well as productivity in the department. It is critical that a neutral third party intervene to help resolve the conflict.

    1. The neutral third party outlines the process. This person will be responsible for guiding the discussion, making sure both parties have a chance to share their views, finding a solution that works for both parties, and maintaining a safe and respectful focus to the discussion.

    2. One party explains the situation as they see it. The story of one party – including facts, feelings, and actions – should be shared. Emphasis should be placed on the fact that this is one view or perception of the problem. Interruptions by the other party should not be allowed. The facilitator should summarize the views of this party.

    3. The other party explains the situation as they see it. This step confirms that both parties’ views will be respected and valued. The facts, feelings and actions of this party should be shared and the first party should be encouraged to listen and remain open. The facilitator should summarize the views of this party.

    4. The parties should be encouraged to agree on goals. The facilitator should help the parties agree on goals, which can include finding a solution that works for both parties and creating a respectful working relationship for the future. The facilitator should summarize these goals before moving on to problem solving.
    5. The parties explore and discuss possible solutions. It is important that the parties come up with their own solutions to the conflict so they have ownership in implementing the solutions. The facilitator can push the parties to come up with more ideas or explore the consequences of the potential solutions, but he or she should not try to impose solutions on the parties.

    6. The parties agree on what each will do to resolve the issue. Each party should clearly understand their role in the conflict and accept responsibility as a person and team member to make it work. The facilitator should develop an agreement that clearly outlines the understandings and the actions that will be taken by each party.

    7. Set a date for follow-up and meet to assure progress. People are more likely to follow through on actions/obligations if they know they are accountable. A follow-up meeting or meetings allow the parties involved to assess progress and make adjustments as needed.

Stage Three Conflict

Conflict has escalated from wanting to win to wanting to hurt the other party; morale and productivity have plummeted and there may be talk about legal options. It is critical to bring in an outside mediator. The employees will be encouraged to work with either a member of the management team or someone from the employee assistance program, and will be expected to follow through with this.



  • Employee Assistance Program

POLICY TITLE: Cultural and Linguistic Assurance Policy



AUTHORIZED BY: Heidi Stewart, BSN, Health Officer /Director
To assure communications, programs and interventions are culturally and linguistically appropriate.


When developing programs, interventions, and communications, social, cultural, and linguistic characteristics of the populations served will be considered. Ensuring that the Pepin County Health Department’s services, materials, and processes address social, cultural, and language differences is essential to successfully providing the most effective services to meet the needs of our population.


  1. All policies and programs are reviewed during the development phase to ensure cultural competency principles are included:

  1. Analyze the intervention/program/communication related to local demographics and trends, including cultural programs by age, gender, language, poverty and other relevant criteria.

  2. When appropriate, hold focus groups to share information and gather feedback from the community.

  3. Review and recommend ways to enhance consumer and family input.

  4. Develop opportunities to increase community partnerships and collaboration

  1. Assure the interpreter/translator Policy and Procedure is followed for client interactions.

  2. Assure appropriate signage at reception informing clients of the availability of interpreter and translator services.

  3. Assure regular and ongoing training for all agency staff on cultural competency issues. The following resources are helpful for staff:




  1. Assure written communications intended for clients and public education are developed a Flesh-Kinkaid Reading Level of 5th to 9th grade. To check the reading level of documents in Microsoft Word, Click on Review (Word 2007) or Tools (Word 2003), then click Spelling and Grammar, then click Options, then make sure “Show Readability Statistics” is checked. Run spelling and grammar check on document. When finished, Readability Statistics box will appear with data.

Additional Health Literacy Guidance:

    • Literacy and intelligence are not necessarily correlated. Individuals with low literacy skills may be highly intelligent, and simply need to be taught in ways supported by their strengths.

    • Our culture values literacy, so people often do not want to admit to low or no literacy skills, and may go to some lengths to keep this information hidden. It is very important that the healthcare professional remain non-confrontational, non-judgmental and supportive when making any assessment of the client’s literacy abilities.

    • Make no assumptions about literacy level based on the client’s appearance, race, age, financial status, religion, culture or place of origin. Assess carefully.

    • Reading level assessment of text (and there are many indices) is based largely on these characteristics.

      1. average number of words per sentence

      2. average number of syllables per word

      3. difficulty of vocabulary

    • Most commercially available client education materials (including many on the internet) are written at a 9th-10th grade level or higher. Many clients may not be able to read and comprehend these materials.

    • It is far too easy for healthcare professionals to underestimate the impact of low health literacy. Literacy has been defined as “more than just the ability to read”.
    • It encompasses comprehension, problem-solving skills, synthesis and analysis of information, abstract thinking and reasoning, the capacity to recognize patterns and the ability to generalize from them, and the development of a broad general knowledge base. Clients with low literacy skills may not be willing to express lack of understanding; may not have the vocabulary to ask pertinent questions; and may not use explicit adjectives in describing symptoms and development of their health concerns. Unexpected problems can arise, based on assumptions the healthcare professional may make about the client’s basic knowledge concerning anatomy, physiology, basic health and hygiene, and skills such as telling time, calculating simple measures, using a telephone or pager, understanding numbers, etc.

    • Assessment of literacy skills should be low-key and gentle:

    • Look – does the client read? What is being read?

    • Listen – does the client ask questions indicating material has been read and understood?

    • Get to know the client – Ask what the client enjoys doing for relaxation?

    • Is reading mentioned? Does the client regularly need help with items that need to be read, such as menus, brochures, labels, directions, etc.?

When teaching clients with low literacy skills:

  • Teach in small increments of time (a few minutes to no more than 30 minutes).

  • Present one idea or topic at a time.

  • Teach essential information first

  • Teach at a time when the client is interested – the ‘golden moment’.

  • Repeat key information.

  • Be consistent in the terms used (use ‘operation’ or ‘surgery’, not both).

  • Use short, simple words, avoiding medical jargon and slang terms.

  • Use short, simple sentences.

  • Use easily understood analogies.

  • Evaluate learning often (have the client restate and/or demonstrate).

  • When choosing or writing materials for clients with low literacy skills, the following characteristics (very succinctly) facilitate reading and comprehension:

    • large print

    • simple serif font

    • clear headings and sub-headings

    • lots of white space

    • pertinent, simple line-drawings (these serve as landmarks and reminders).



POLICY TITLE: Delegation of Authority



AUTHORIZED BY: Heidi Stewart, BSN, Health Officer / Director
To assure authority is clearly delegated so that all health department functions, requirements, and duties can be carried out in the absence of the appointed health officer.

Pepin County Health Department is designated a Level II health department and is in compliance with all applicable state statutes and administrative rules. The appointed Pepin County Health Officer meets all qualifications and performs all duties as required. In the absence of the appointed Pepin County Health Officer, the Assistant Director will serve as acting Health Officer, possessing all authorities granted to a local Health Officer by law.


  1. If the appointed Pepin County Health Officer is unavailable due to illness, extended leave, vacation or other reasons, the Assistant Director will serve as acting Health Officer until the return of the appointed Health Officer.

  2. In circumstances requiring immediate action by the Health Officer, the Health Department staff will take all reasonable actions to reach the appointed Health Officer. This includes calling the Health Officer’s cell phone and home phone. If staff is unable to reach the appointed Health Officer, the Assistant Director will serve as the acting Health Officer to meet the immediate needs.

  3. If the appointed Health Officer plans an extended leave for any reason, the Pepin County Board of Health will approve such leave and the Assistant Director will serve as the acting Health Officer during the leave.
  4. For unplanned circumstances where the appointed Health Officer becomes unavailable or unable to function as Health Officer, the Assistant Director will assume such duties and the Board of Health will be notified as soon as feasible.



  • Wisconsin Statues 250/251

  • Administrative Rules DHS 139/140

POLICY TITLE: Employee Safety



AUTHORIZED BY: Heidi Stewart, BSN, Health Officer / Director

  1. Pepin County Health Department will work to assure a safe and healthy environment for employees throughout their workday.

  2. Employees will be trained in safety and self-defense to handle possible threats in home/worksite environments.

  3. Employees will remain knowledgeable in personal behaviors to minimize alarm in clients.

  4. Supervisors will remain abreast of current threatening situations. Proper documentation will assure communication to others to prevent future exposure to threatening clients.

Assuring staff safety during home visitation is a top priority of the Pepin County Health Department. Workplace violence is violence or the threat of violence against workers. It can range from verbal threats to physical assaults. Pepin County maintains a zero tolerance policy toward workplace violence against their employees.
Safety and Self-defense Training:
  • The Health Department will keep abreast of training opportunities available in safety and self-defense. All employees doing public home visitation or environmental health inspections that could potentially place them at risk to hostile or threatening situations will be offered training, as it becomes available.

  • As an added precaution, employees may consider removing their first names from their home telephone directory listing.

Documentation of Employee Schedules:

Employees will maintain individual appointments on the Health Department sign-out board.

  • Information included will be date, time, location/address and phone number of meetings, home visitation and inspection appointments.

  • Employees will assure the board is updated for any out of the office activities.


Visitation/Inspection Safety:

Home nursing visits are a benefit to families.  They are not mandated services.

Employees shall not enter any location where there is risk to safety. Employees have the right to refuse to provide services in hazardous situations. The Health Department will attempt to determine the behavioral history of new and transferred clients to learn any past assault type behaviors.

  • All incidents of clients who threaten physical harm will be documented in a nursing client record.

  • Client records will be marked with an identifying sticker to avoid future home visitation.

  • All home visitations will be conducted during daylight hours.

  • Employees are to avoid traveling into unfamiliar locations or situations when possible.

  • A buddy system is encouraged when the employee questions personal safety.

  • Employees should carry minimal money and required identification into community settings.

Environmental Human Health Hazard complaints require a mandatory response from the Pepin County Health Department. All threats to personal safety will be documented in the environmental health inspection complaint file and reported as soon as possible. To assure an employee’s safety if a threat exists:

  • An inspection warrant will be obtained.

  • Law enforcement will be requested for the on-site inspection.

Be Prepared:

  • Wear appropriate clothing and sturdy shoes that allow free movement in the event you need to leave abruptly.

  • Do not carry loose personal belongings into the home that might restrict rapid exit.

  • Know the address in case emergency services need to be called.

  • Be aware of the surroundings as you approach the home/worksite.

Be Alert:

  • Evaluate each situation for potential violence when you enter a room.

  • Be vigilant throughout the encounter.

  • Don't isolate yourself with a potentially violent person.

  • Keep an open path for exit both in the home and when parking your vehicle.

  • Take notice of alternative exit routes in the home/worksite.

  • Keep automobiles well maintained and locked at all times.


Watch for signs that may be associated with impending violence:

  • Verbally expressed anger and frustration.

  • Body language such as threatening gestures.

  • Signs of drug or alcohol use.

  • Presence of a weapon.


Maintain behavior that helps diffuse anger:

    • Present with a calm, caring attitude.

    • Don't match threats.
    • Don't give the impression that you are giving orders.

    • Acknowledge the person's feelings (i.e. “I know you are frustrated”).

    • Avoid behavior that may be interpreted as aggressive (i.e. moving rapidly, getting too close, touching, and speaking loudly).


If a client threatens physical harm to an employee during a home/worksite visit, or if there are visible signs of drug activity, the employee:

  • Will leave the home/worksite immediately. End the visit.

  • No further home/worksite visits should be attempted.

  • The situation will be reported to the immediate supervisor or, if unavailable, another department supervisor.

  • All threats should be documented in writing in the nursing client record or environmental health complaint file.

  • Records of clients who have a history of threatening an employee will be marked with a distinguishing sticker as an alert future visitation.

  • The employee will complete Workplace Violence Incident Report Form (Appendix A) and return to the supervisor. This completed form will be sent to the Safety Department.


Clients who do not directly threaten harm but whose mannerisms or home/worksite environment make the employee feel uneasy:

  • Situation will be discussed with the immediate supervisor before home visit is attempted. If the immediate supervisor is unavailable notify another supervisor.

  • The supervisor may recommend the visit should be done with two workers for safety. Depending on the situation this may be done with 2 Registered Nurses (RN), and police escort.
  • Clients may be offered office-based assistance. Two workers may be present for the visit if the nurse or environmental health inspector feel uneasy about the intent of the client. 

  • Clients may be seen at public off-site locations if it is the home environment posing the threat and not directly the client (i.e. vicious animals or visible drug dealing).

Animal Bites:

Employees bitten by dogs or other aggressive pets should seek an immediate place of safety. Seek imminently needed medical care if needed. Contact Pepin County Dispatch at (715)672-5944 and request assistance from the Humane Officer. Contact your immediate supervisor or, if unavailable, another department supervisor to report the incident. The Incident Report Form should be completed and returned to the supervisor.
Office Building Security Plan:

The office building can have increased security when an employee is feeling a direct threat by persons coming to the office.  Contact your immediate supervisor, or if unavailable, another department supervisor of the threat.

  • Receiving clerical employees will be alerted to the situation.

  • Employees may be temporarily relocated to a different office.  

  • The lobby doors can be locked to limit entrance when requested. Office keys open the doors when locked.

Employee Security Plan:

  • Office cellular phones are available for use in the field.  Employees may reserve the phones for upcoming scheduled appointments to assure their availability. Safety needs supersede convenience for phone reservations.
  • Employees using the cellular phones at the end of the day will be cognizant of the need by others for phones in the early AM; returning the phone for proper charging and availability for the next scheduled employee.

  • Clerical employees will maintain the cellular phones so they are properly charged and ready for use.

  • Employees will alert their immediate supervisor, or if unavailable another department supervisor, if there is an unfilled need for phones.

  • The Pepin County Health Department will refer the employee to the Clerk of Courts to obtain restraining orders when recommended by law enforcement.

  • Employees returning to the office later than expected will be responsible for calling in their whereabouts/status before the office closes for the day. 

  • Supervisors will maintain contact availability by cell phone, home phone or pager as needed during office hours. Supervisors rotate on call availability on weekends and during non-office hours. There is not adequate cell phone service in the entire county. Response time will be dependent on the location of the supervisor and cell phone/pager service. Response time should not exceed one hour from time of contact. If the employee’s direct supervisor does not respond, the employee should seek another supervisor for assistance.

  • During non-business hours, Pepin County Sheriff Dispatch can be called at (715)672-5944.

Evaluation will be conducted by annual review of the policy by supervisory staff and number/types of reported incidents.


  • OSHA Guidelines for Workplace Violence for Health Care and Social Workers

  • OSHA General Duty Clause Section 5(a)(1) and 5(a)(2)

POLICY TITLE: Fee Policy for Public Health Services



AUTHORIZED BY: Heidi Stewart, BSN, Health Officer / Director
To assure appropriate fees are charged for services received.
A fee schedule will be established for all Health Department programs and services.

  • Nursing secretary shall collect fees as appropriate for various public health clinics and services.

  • All monies collected shall be recorded in the program database and given to the Administrative Assistant.

  • Administrative Assistance will document as revenue and prepare for deposit to County Treasurer.

The Director, Administrative Assistant and Board of Health during the budget process will evaluate public health fees annually.
See office charges sheet regarding medical costs: S:\PUBLIC HEALTH\Updated Policies and Procedures 2012\Administration\Fee Policy Forms\office charges.doc


POLICY TITLE: Flexible Schedule



AUTHORIZED BY: Heidi Stewart, BSN, Health Officer / Director

  1. To allow staff the opportunity to work a non-traditional, flexible schedule.
  2. To enhance employee satisfaction, thereby having a positive impact on employee retention.

Pepin County Health Department takes great pride in fostering a positive work environment where employees are satisfied and productive. In an effort to enhance employee satisfaction and retention, Health Department employees may be allowed to work a non-traditional, flexible schedule. In order to assure adequate office coverage, employees may need to rotate flexible scheduling opportunities with other employees. In some circumstances and with some positions, flexible scheduling may be difficult. While the agency operations take priority in flexible scheduling decisions, the Director will make every effort to meet employee requests.

  • Employees interested in working a flexible schedule can inform the Director of this desire.

  • Adequate office coverage, as defined by the Director for his/her staff, will be maintained between 8:00 a.m. and 4:30 p.m. each day, Monday through Friday.

  • The Director retains the right to cancel or alter an employee’s schedule to ensure adequate staffing for the department.

  • Work assignments take priority over choosing a day to flex off. If an employee typically has Wednesdays off and a work-related meeting is scheduled for a Wednesday, the employee must choose a different day to flex off.

  • If several employees express interest in a flexible schedule, the director will hold a team meeting to develop a schedule to assure adequate coverage. This schedule will then be reviewed and approved by the group as a whole. Employees may switch with other employees upon notification of the director.

  • Employees may not start their scheduled workday before 6:00 a.m. unless dictated by their job assignment and approved by their supervisor in advance.
  • Participation in flexible scheduling is voluntary.

  • As a means of assuring fairness and transparency, as well as enhancing communication, employees will be informed when co-workers modify their schedules.

  • As a reminder, employees are also able to take unpaid time off per the Unpaid Time off Policy.

Evaluation will be conducted annually by supervisory staff by review of the policy and utilization of flexible scheduling. Success will be measured by adequate staffing coverage, no negative impacts on office operations or productivity, and no fiscal consequences.
POLICY TITLE: Medical Advisor



AUTHORIZED BY: Heidi Stewart, BSN, Health Officer / Director
To assure medical advisor selection is in compliances with all state statutes and rules and is in the best interest of the Pepin County Health Department.
Voluntary medical advisors to the local health department help assure the safe delivery of health care services and public health services to individuals, families, and communities. Medical advisors provide formal delegation of medical acts nurses and lesser skilled assistants perform where required by Wisconsin Statute, Chapter 448, Medical Practices, and Wisconsin Statute, Chapter 441, Board of Nursing.

Physicians who are currently licensed and whose license is in good standing with the Wisconsin Department of Regulation and Licensing are eligible. Such physician advisors will be first sought from within the jurisdiction of the local health department, shall not be an employee of the Pepin County Health Department, and shall service in an uncompensated, voluntary position. Such physicians shall become state agents of the Wisconsin Department of Health Services for the purposes of Wisconsin Statutes, S. 165.25(6), s. 893.82(3), and s.895.46 for the services of Pepin County Health Department that require medical oversight. The designation of agent status authorizes the State to provide legal representation to the volunteer medical advisor and to indemnify him or her from liability arising from the medical advisor’s performance of duties.


  1. A local, currently licensed primary care physician is identified who possesses the following attributes:

  • Has an interest and expertise in public health and prevention

  • Supports the legal and societal role of the local health department

  • Possesses capacity to provide routine and urgent medical advice and direction using medical and public health science and evidence. (Note: urgent in this case usually pertains to communicable threats to the health of the population.)

  • Willing to meet with the Board of Health and staff within the health department to build relationships and work on identified and emerging public health issues and concerns in Pepin County.

  • Willing to Develop and help implement the local community health improvement plan.

  • Willing to help build collaborative relationships between the health department and medical and health care providers in Pepin County.

  1. Physician agrees to become the voluntary, uncompensated medical advisor.

  2. Health Officer verifies current licensure of the physician and assures his/her medical license is in good standing with the Wisconsin Department of Regulation and Licensing.

  3. Health Officer assures orientation of the voluntary medical advisor.


POLICY TITLE: Orientation



AUTHORIZED BY: Heidi Stewart, BSN, Health Officer / Director

To assure new staff members are oriented to the philosophy, services, and policies/procedures of the Pepin County Health Department. To orient new staff to individual roles.

New members of the Pepin County Health Department staff will complete a basic and individualized orientation program.

  1. The director will assure that all prerequisites for employment have been met prior to hiring an individual and scheduling orientation.

  2. The director will assure a basic and individualized orientation program will be completed for each new staff member. There is no set timeframe for the orientation process. It will start on the employee’s first day of employment and will continue until such time that the employee is able to safely and effectively perform his or her job functions.

  3. The director or designee will conduct a basic orientation, consisting of: introduction to fellow employees, a tour of the office and building, job orientation, county personnel policies, position description, probationary period, performance evaluations, dailies, etc.

  4. The medical secretary will assist the new employee with completion of TB, Hepatitis B, and background check forms. These forms can be found on the S drive under the personal folder within the public health folder: S:\PUBLIC HEALTH\Personnel

  5. The personnel office conducts orientation regarding affirmative action, personnel code, drug-free and infection control policies, payroll forms, health insurance, retirement benefits, flex plan, deferred compensation plan, and state withholding forms.

  6. Documentation is completed on the Pepin County Orientation Checklist. The orientation checklist can be found in the Personnel Department.

  7. Individualized and more in-depth orientation is completed over several weeks of work. Individualized checklists for public health nurses, licensed practical nurses, and clerical staff are completed by the director or designee.


POLICY TITLE: Policy and Procedure Access and Annual Review



AUTHORIZED BY: Heidi Stewart, BSN, Health Officer / Director
To assure policies and procedures are reviewed and updated annually so they remain appropriate and applicable and new evidence based practices can be considered, to assure that all staff have ready access to the most current version of policies and procedures.
Pepin County Health Department will assure that all policies and procedures are readily accessible to all staff and that each is reviewed annually.

In the first quarter of each year, the Health Department Director/Health Officer will facilitate the review of all agency policies and procedures. This will be documented on the Policy and Procedure Review Log. Lead staff will be asked to review their applicable policies/procedures and provide updates to the Director. The Director will review all administrative policies/procedures. Changes will be documented in a summary on the review log.
In addition, the Director will assure that all policies and procedures are accessible to all staff on the agency shared drive. This method will facilitate rapid access to the most current policies, without the risk of staff referring to an outdated hard copy policy that was inadvertently kept.



POLICY TITLE: Professional Staff Licensure



AUTHORIZED BY: Heidi Stewart, BSN, Health Officer / Director

To assure each employed licensed professional has a current and valid Wisconsin license to practice his/her profession.

All professional staff of the Pepin County Health Department will maintain current certification or licensure with the State of Wisconsin as required by their employment.
1. Upon hiring a new employee, the supervisor will request a copy of the individual’s current license to practice his/her profession.

2. The professional staff shall be reminded to provide the director with a copy of the license each time the license is renewed.

3. A professional without proof of current licensure as of the first of the month it is due shall not be allowed to practice as a professional, and shall receive a verbal and written warning.

4. The individual shall be required to use any paid leave available while unable to practice.

5. A professional without proof of licensure without paid leave due shall be granted a temporary leave of absence without pay, but only with approval from the Pepin County Board of Health.

6. Further disciplinary action, if necessary, shall follow the standards outlined in the Pepin County Personnel Handbook.

7. Short-term, temporary employment for professional replacement personnel shall be arranged, if necessary.

8. Once the professional is able to show current, valid licensure, he or she will be returned to his or her regular duties following approval from the director of the Pepin County Board of Health.



POLICY TITLE: Public Health Supply Ordering

EFFECTIVE DATE: 01/01/2000


AUTHORIZED BY: Jen Rombalski, Health Officer
To assure public health unit supplies are reordered in a timely manner so there is an adequate supply on hand at all times.
Public Health Nurse (Vaccine reordering)

WIC Technician


  1. Notify WIC Technician via email, note, or personal communication stating item(s) needed.

  2. Verify actual need by checking Wisconsin Immunization Registry (WIR) and/or visually inspecting refrigerator and supply closets for any missed item(s).

  3. Check Ordering Information Binder for quantity of item(s) previously ordered.

  4. Use Ordering Information Binder to identify appropriate source for reordering item(s) and reorder item(s) accordingly.

  5. Complete appropriate Ordered/ Received Log located in the Ordering Information Binder at the time of placing the order.

  6. Upon receiving VFC vaccinations accept and add into inventory in WIR.

  7. Upon receiving all item(s) document in appropriate Ordered/Received Log and place item(s) in appropriate location.

Wisconsin Immunization Registry

POLICY TITLE: County Vehicle for Work-Related Travel



AUTHORIZED BY: Heidi Stewart, BSN, Health Officer /Director

To assure work-related travel is done as economically as feasible.
In order to conserve resources and facilitate employee travel in the most economical way, this policy was created to guide employees in deciding under what circumstances to utilize the county vehicle for work-related travel. This policy takes into consideration the cost of the rental vehicle, gas, and staff time to pick up and drop off the vehicle, compared with the cost of mileage reimbursement if an employee uses his/her personal vehicle for work-related travel.
Whenever a county owned vehicle is available for business related purposes, employees use the county owned vehicle in place of a personally owned vehicle. If you do not intend to make use of a county vehicle for a county business related trip, you must inform your department director, in writing, in advance of your trip, of the specific reason you wish to be exempted from the use of a county vehicle. The department director will review the request and determine if the request for exemption is to be allowed, based on the merits of the request, and inform the employee, in writing, of their decision.

Maintenance of the county owned vehicles will be the complete responsibility of the Health Department.


Reservations for the county vehicle will be posted in the Health Department. Reservation priority will be given to business related trips outside the county or for extended-periods/distance traveled for meetings, training, conferences or the transport of multiple authorized passengers.

All requests for reservation of a county owned vehicle must contain:

  • employee name

  • departure date and time

  • destination

  • estimated return date and time

When multiple duplicated date and time requests are received, preference will be given to the trip(s) which will incur the most mileage during a given period of time, and/or when multiple employees (or authorized passengers) will be attending the same meeting. The Health Department will not notify individuals of any changes made to vehicle reservations. It is best to periodically verify that a vehicle has been reserved for you by checking the calendar. Schedule your vehicle reservation as far in advance as possible to eliminate confusion.

Use of County Vehicle:

Prior to your departure, obtain the vehicle keys from the Health Department. A mileage log is kept in the vehicle to be completed prior to departure.

Fill the county vehicle with fuel, before returning keys, if the tank is less than ¾ full. Fuel should be obtained at the Pepin County Highway Department using the Health Department Key. If the need for fuel arises while out of town, fuel the vehicle and provide a receipt for reimbursement.
Upon your return, please assure the mileage log sheet is accurately completed; return the vehicle keys, and any documents related to the vehicle trip (including any fuel receipts) to the Health Department. A petty cash slip must be filled out and submitted to billing for reimbursement.

Inform the Health Department Director of any problem(s) you encounter with a county vehicle, to allow for corrective action to be taken/maintenance completed.

Vehicle rental costs vs. mileage reimbursement will be monitored for all continuing education events. Evaluation will be conducted quarterly by supervisory staff. Success will be a measure by financial cost savings.


POLICY TITLE: Workforce Development



AUTHORIZED BY: Heidi Stewart, BSN, Health Officer / Director
1. To assure a competent and confident workforce

2. To facilitate opportunities to obtain continuing education to build on core competencies.

3. To help inform curricula development and focus training on identified competency gaps

In order to realize our mission to maximize the quality of life across the lifespan by promoting health, protecting the environment, and preventing disease and injury, we need a well-trained and competent workforce that strives for excellence. Pepin County Health Department will make every effort to effectively identify training and education needs for core competencies and to carry out the 10 Essential Public Health Services.
As our health care system evolves, a variety of forces are driving changes in the practice of public health. In addition, the changing ethnic, racial, immigrant, age, and economic groupings within our communities require an increasingly skilled body of public health professionals. This raises the importance for training, continuing education, and related skill development. In addition, the public looks to the Government for leadership in times of public health emergencies, such as floods and communicable disease outbreaks. A trained and competent workforce is essential to be adequately prepared to deal with such emergencies.
Over recent years, major training and continuing education challenges have emerged. As we have moved away from providing individual level services to more community and systems approaches, it is clear that new skills are needed. These include the ability to develop policies, advocate, build partnerships and coalitions, use new information technology, engage in a comprehensive community health improvement planning process, find and implement evidence-based strategies to address priorities, and implement evaluation and quality improvement practices. It is the goal of the Pepin County Health Department to assure that our workforce encompasses the full range of public health core competencies identified by the Council on Linkages Between Academia and Public Health Practice.

Employees are encouraged to regularly review the Core Competencies regularly, and to use them as a guide in developing annual objectives discussed with their directors during annual performance evaluations. Administration will make every effort to support attendance at continuing education events that build on employee competencies.


  1. Conference and continuing education flyers will be reviewed by the director. Information about relevant learning opportunities will be forwarded to employees. Employees may also see out their own learning opportunities.

  2. Employees who are interested in attending a conference, class or workshop, will make the request to the director utilizing the staff development/training request form found on the shared drive. A link to the form can be found here: S:\TRAINING REQUEST FORM 09012009.xlsx

It is recommended that this request be made as far in advance of the learning event as possible to assure adequate time for the registration process.

  1. If the learning opportunity is relevant and there are adequate resources, the director will approve attendance. The director will also consider whether other employees might benefit from the training and if additional staff should register.

  2. The director will inform the employee and administrative assistant that approval was granted. The employee will give registration materials to the Accounting Clerk to complete the registration process.

  3. The administrative assistant will process for payment. If the learning event does not allow for registration via credit card a check will be processed through the Accounts Payable system.

  4. If the learning event does not allow for registration via credit card and the event is less than two weeks away, bring completed necessary paperwork to administrative assistant as soon as possible.

  5. If the learning event requires overnight accommodations, see the administrative assistant for the hotel stay form and he/she will make the necessary accommodations.
  6. Overnight stays require Board of Health Approval. Out of state travel must be approved by Finance Committee and County Board.


  • Core Competencies for Public Health Professionals

  • Council on Linkages Between Academia and Public Health Practice

POLICY TITLE: Blood Pressure Screening for Adults



AUTHORIZED BY: Heidi Stewart, BSN, Health Officer / Director

1. To assure the availability of blood pressure screening for Pepin County residents

2. to facilitate early detection of high blood pressure and adequate control of hypertension in order to reduce negative effects of chronic high blood pressure.

Pepin County Health Department offers blood pressure screening and monitoring to residents of Pepin County as a means of early detection of hypertension and control of high blood pressure. Along with screening services, public health staff also issue recommendations for follow-up according to blood pressure results. American Heart Association referral guidelines will be used.

  1. Regular blood pressure screening clinics are not offered by the health department, but individuals at risk for high blood pressure may call for an appointment with a public health nurse to have their blood pressure checked. Focus is also placed on individuals who have diagnosed hypertension and are in the process of having medications adjusted by their health care provider to gain control of the hypertension.
  2. Individuals who are interested in ongoing monitoring without medication adjustment or other ongoing activities not meant for new diagnosis should be referred to an alternate location for this monitoring.

  3. Have client complete the Cardiovascular Screening Form.

  4. Review the form for risk factors and other areas of needed education. Provide education as needed.

  5. Explain the procedure to the client.

  6. Have the client sit in a comfortable position with back supported, legs uncrossed, and both feet flat on the floor. The arm to be used should be supported on a firm surface at heart level, with elbow slightly flexed.

  7. Bare the upper arm and snugly apply an appropriate-sized blood pressure cuff. Be sure the center of the cuff bladder is over the brachial artery and the lower margin of the cuff is one inch above the antecubital space.

  8. Instruct client not to talk during blood pressure measurement.

  9. Insert stethoscope ear pieces.

  10. Palpate the radial pulse.

  11. Inflate the cuff until you can no longer palpate the radial pulse. Then, inflate the cuff 30 mm Hg more.

  12. With head of stethoscope positioned over the brachial artery in the medial aspect of the antecubital fossa, open the valve on the sphygmomanometer and release the air slowly and evenly, at about 2-4 mm Hg per second.

  13. Note systolic and diastolic blood pressures.

  14. Discuss blood pressure results with the client and provide education regarding what the results mean. Provide any other information necessary, such as risk factor reduction education, medication teaching, and suggested follow-up based on Blood Pressure Referral Guidelines Form recommendations

  15. Complete the lower potion of the Cardiovascular Screening Form.

16. Document the visit in Nightengale Notes and dispose of screening form.



  • American Heart Association,

  • 2009 CDC NHANES Health Tech/Blood Pressure Procedures Manual,

  • Wisconsin Heart Disease and Stroke Prevention Program Blood Pressure Measurement Toolkit




(mm Hg)1


(mm Hg)1

1st Visit

2nd Visit

(After elevated reading)

3rd Visit

(After 1 elevated and 1 normal reading)


Less than 120

Less than 80

Re-check in 2 years.2




Schedule 2nd visit in 3-30 days.3

Refer to health care provider within 2 months.

Refer to health care provider within 2 months.

Stage 1




Schedule 2nd visit in 3-30 days.3

Refer to health care provider within 2 months.

Refer to health care provider within 2 months.

Stage 2




Schedule 2nd visit in 3-30 days.3

Refer to health care provider within 1 month.

Refer to health care provider within 1 month.

Stage 3




Immediate referral to health care provider.

Immediate referral to health care provider.

Immediate referral to health care provider.

Adapted from guidelines described by the American Heart Association in the Blood Pressure Measurement Education Program Manual.

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