DOH IRR on Massage Clinics and Sauna Baths

Sanitary permit to operate

No massage clinic or sauna bath establishment may open or operate for public patronage without a sanitary permit issued by the local health officer.
Any extension, additional construction, or alteration of an establishment requires a new sanitary permit before operation.
Sanitary permit applications and renewals must be filed with the city or municipal health office having jurisdiction over the establishment.
A sanitary permit is issued upon compliance to at least a satisfactory rating using EHS Form No. 103-B for sanitary inspection of public places establishments.
Fees for application, renewal, and noting of sanitary permits must be paid to the local government unit, and the amount is set through city or municipal ordinance.
If ownership changes, the new owner must apply within fourteen (14) working days to have the change noted in the records and permit certificate and must pay the corresponding fee.
A sanitary permit is valid for one (1) year, ending on the last day of December each year, and is renewed at the beginning of the year thereafter.
Upon recommendation of the local health officer to the local health authority, a sanitary permit may be suspended or revoked for violation of sanitary rules and regulations.
The sanitary permit must be posted in a conspicuous place in the establishment and must be available for inspection by authorized health and other regulatory personnel.
Every city or municipality must keep a record of all massage clinics and sauna bath establishments issued sanitary permits and renewals.
The record must show the holder’s name and address, establishment location, business type, first issuance date and renewal dates, every change of management since first issuance, sanitary conditions for issuance/renewal, and permit revocation.
The record must be available at all reasonable times for inspection by any authorized officer of the DOH or local government unit.

Personnel qualifications and hygiene rules

No masseur may practice without first securing a Certificate of Registration from the DOH Committee of Examiners for Masseurs.
The masseur and massage clinic attendant must possess an up-to-date Health Certificate (EHS Form No. 102-C; pink color) including STD clearances at least every two weeks from a DOH-accredited government clinic or hospital.
Other examinations such as hepatitis-B antigen (HBsAG), VDRL, and HIV may be required based on the local health officer’s discretion.
If an HIV examination is required, consent of the masseur/attendant must first be secured by the local health officer.
The Health Certificate must be visibly clipped in the upper left front portion of the uniform worn while working.
The masseur must wear a clean working garment when attending to customers or supervising clinic attendants.
Before and after massaging each customer, the masseur must wash hands thoroughly with soap, water, and 70% isopropyl alcohol.
The masseur is prohibited from taking a bath with customers in any form (shower, tub, or hydromassage shower/tub).
A registered masseur may supervise a maximum of fifty (50) massage attendants.
A registered masseur must render no less than six (6) hours of supervision per day.
A copy of the masseur’s Certificate of Registration (including renewals) must be displayed conspicuously in full view of the public in the massage clinic, and a copy must be furnished to the city/municipal health office.

Massage attendant requirements

A massage attendant must be at least eighteen (18) years of age.
The attendant must submit a medical certificate from a government physician, preferably the hospital/city/municipal health officer, that the person is physically and mentally fit.
The attendant must have a training certificate noted by the local health officer after completing at least sixty (60) hours of practical massage training under the supervision of a registered masseur.
The attendant must submit certification of attendance in seminars/lectures on sexually transmitted diseases including AIDS conducted by competent health authorities.
The attendant must possess an up-to-date Health Certificate meeting the same requirements as the masseur/attendant STD-clearance and renewal requirements.
The attendant’s Health Certificate must be clipped visibly in the upper left front of the uniform while working.
The attendant must wear a clean working uniform when attending to customers.
Before and after massaging, the attendant must wash hands thoroughly with soap, water, and 70% isopropyl alcohol.
The attendant is prohibited from taking a bath with customers in any form (shower, tub, or hydromassage shower/tub).
The attendant must be under the close supervision and control of a registered masseur.

Sauna bath attendant requirements

A sauna bath attendant must be at least eighteen (18) years of age.
The attendant must submit a medical certificate from a government physician, preferably the hospital/city/municipal health officer, that the person is physically and mentally fit.
The attendant must have a training certificate noted by the local health officer after completing at least sixty (60) hours of sauna bath techniques and procedures under the supervision of a registered masseur.
The attendant must submit certification of attendance in seminars/lectures on sexually transmitted diseases including AIDS conducted by competent health authorities.
The sauna bath attendant must possess an up-to-date Health Certificate meeting the same STD-clearance and interval requirements as the masseur/attendant Health Certificate.
The sauna bath attendant’s Health Certificate must be clipped in the upper left front of the uniform while on duty or inside the establishment.
Sauna bath attendants are strictly prohibited to take the sauna bath with customers.

Operator and other personnel duties

The operator must possess an up-to-date Health Certificate issued by the concerned local health officer.
The operator must hire a licensed masseur during the entire operation of the establishment in accordance with the recommended ratio of attendants to be supervised.
All personnel in the establishment other than those specifically mentioned must possess an up-to-date Health Certificate issued by the concerned local health officer.

Structural facilities and building standards

Floors must be constructed of concrete or other impervious materials; must be easily cleaned; and must use non-toxic materials.
Where floors are wood with dovetailed or tongue-and-groove boards, the boards must be laid on a firm foundation and clamped together.
Floor coverings such as vinyl tiles, wood parquet, linoleum, or similar materials may be used if fixed to the floor with cement or suitable materials.
If carpet is used, it must be cleaned and maintained in satisfactory condition.
Floors must be kept clean and dry at all times.

Walls, ceiling, lighting, and ventilation

Internal walls must have smooth, even, non-absorbent, easily cleaned surfaces made of non-toxic materials.
Toilet and bath walls must use impervious, non-absorbent materials with a height of not less than two (2) meters from the floor.
Walls must be painted with light color.
Wall coverings must be firmly adhered to avoid open spaces or cracks that provide harborage for vermin.
Light fixtures and wall/ceiling decorative materials must be kept clean.
Ceilings must use non-toxic materials.
Ceilings and the under-surface of rooms must be smooth, non-absorbent, and painted light color.
All rooms must have sufficient illumination to permit effective inspection and cleaning under DOH general illumination standards, including:
- Massage, reception, office, and other rooms: minimum ten (10) foot-candle (107.6 lux).
- Sauna bath rooms: minimum five (5) foot-candle (53.8 lux).
Lighting must be reasonably free from glare and distributed to avoid shadows.
Every room must have effective and suitable ventilation to maintain comfortable temperature.
Natural air supply in any room must not be less than 0.005 cubic meter per second per person.
Ventilation must prevent condensation and excess moisture on walls and ceilings and must remove objectionable odors and impurities.
If natural ventilation is used, massage, reception, office, and other rooms must have window openings of at least 10% of total floor area; windows must be kept clean and in good condition.
If effective natural ventilation is absent, mechanical ventilation must be provided from a clean area and discharged so it does not create a nuisance, with these capacities:
- Air-conditioning units: 1.50 horse power (6,000 BTU/hr) air conditioner for every 50 cubic meter room volume.
- Exhaust fans or blowers:
  - Massage rooms: 25.40 centimeter diameter blower fan per 35 cubic meter room volume.
  - Toilet and bathroom: 15.24 centimeter diameter exhaust fan per 10 cubic meter room volume.
- Mechanical exhaust systems must be connected to the light circuits of windowless bathrooms.
Air velocities must be controlled so personnel and customers are not subjected to air velocities exceeding 1.02 meter per second.

Changing, reception, and room layouts

Customers must have changerooms: at least one for each gender, located in the massage room or adjacent to toilet/shower or the sauna room.
Each customer changeroom must have individual lockers with lock.
Each customer changeroom must have chairs and lounges numbering at least 25% of the number of customers that could be accommodated at one time in the establishment.
Personnel changerooms must be provided for masseurs, massage attendants, and sauna bath attendants/helpers with lockers.
Personnel changerooms may be located adjacent to personnel shower and toilet rooms.
There must be separate personnel changerooms for each gender.
Chairs and lounges in each personnel changeroom must number at least 25% of the personnel using the changerooms.
Reception rooms must have lounges, easy chairs, or sofas, with numbers equal to at least:
- 10% of the number of massage tables in the establishment for massage clinics; and
- 10% of the number of customers that could be accommodated at one time for sauna bath establishments.
Reception rooms must be kept clean at all times.
Massage rooms must be of adequate size for easy movement of masseur/attendant, but in no case less than five (5) square meters floor area.
Massage room entrance must have a sliding curtain or swing type wooden door or equivalent material; doors with locks are not permitted.
Massage tables must be 1.80 meters long, 0.80 meter wide, and 0.70 meter high.
Each massage table must have a firm mattress, two (2) freshly laundered and clean sheets, two (2) bath towels, one (1) pillow, and one (1) pillow case for every customer.
Each room must provide massage needs such as alcohol, lotion, massage oil, tissue, and powder.
Every room must be disinfected with a water-based disinfectant after every use.

Sauna bath rooms and other floor spaces

Sauna bath rooms must be adequate to accommodate several customers at one time but in no case less than five (5) square meters floor area.
Sauna bath room doors must be of the automatic type that could be opened inside the room in an emergency.
Sauna bath rooms must have wooden plank benches or other non-heat retaining materials.
A thermometer must be provided inside every sauna room, and thermostat regulators must be well maintained to prevent accidental overheating.
When ice or cold water is served inside the room, it must be potable quality and placed in sanitized ice buckets or similar containers.
Establishments must maintain unobstructed working spaces, aisles or passageways, stairways, and customer-access areas with at least 1.20 meter width to allow movement without personal contacts.
Floor spaces must conform to the National Building Code of the Philippines and local ordinances.

Sanitary facilities, water, wastes, and vermin control

Toilet, bath, and handwashing facilities

Sanitary handwashing, bath, and toilet facilities must be available.
For every five (5) massage tables, there must be at least:
- one (1) handwashing facility with hot water (at least 48.9°C or 120°F) and cold water,
- one (1) shower room, and
- one (1) water closet.
For every five (5) customers in a sauna bath, there must be:
- one (1) shower room, one (1) water closet, one (1) lavatory, and one (1) urinal.
Each sauna bath customer must be provided with individual lockers.
Customers must be provided with soap, clean towels, sufficient clean bed linen, and sanitized rubber or plastic slippers.
Customers must be required to take a thorough bath before massage.
Cabinets for supplies must be provided adjacent to the toilet room.
All plumbing connections and fixtures must comply with the National Plumbing Code of the Philippines.

Water supply and ice

Water supply must be adequate and potable in accordance with the Philippine National Standards for Drinking Water.
Hot and cold running water must be provided.
If bottled drinking water is served, it must conform to DOH Administrative Order No. 18 s. 1993.
Ice must come from approved sources; if ice makers dispense within the establishment, adequate ice storage and dispensing utensils must be provided and properly used.
Steam water must contain no material or additive other than those specified by DOH.

Food and drink

Dispensing of food and drink must comply with Chapter III of P.D. 856 on Food Establishments and its implementing rules and regulations.

Sewage disposal and drainage

All sewage from massage clinics and sauna bath establishments must be disposed in a public sewerage system, or where none exists, must comply with Chapter XVII of P.D. 856 on sewage collection/disposal and excreta collection/drainage and its implementing rules and regulations.

Solid waste management

Each establishment room must have two (2) refuse receptacles/containers made of impervious materials: one for biodegradable and one for non-biodegradable wastes.
Containers must have tight-fitting lids/covers, be constructed and maintained as vermin-proof, and be easily cleaned.
Non-biodegradable wastes must be lined with black plastic trash bags; biodegradable wastes must be lined with green plastic trash bags.
After emptying, each container must be thoroughly cleaned inside and outside with water, soap, and brush.
Refuse storage must be inaccessible to vermin to avoid insect/rodent attractant and harborage and prevent nuisance.
Refuse storage areas must be maintained clean at all times.
Refuse must be disposed at least once a day, or more frequently through the collection system or by an approved method, to prevent nuisance.

Vermin control program

Owners, operators, or administrators must maintain a vermin control program.
If owners/operators/administrators fail, neglect, or refuse to maintain vermin abatement, the local health agency must undertake the work at the owners’/operators’/administrators’ expense.
Massage rooms, changerooms, bathrooms, and other openings to outdoor space must be effectively screened unless air-conditioned.
Below-grade openings (including windows, lighting, and ventilation) must be rat-proofed.
Openings in exterior walls, ground or first floor, and roof must be rat-proofed.
In cases of heavy rat infestation, wooden exterior doors must be covered with cuff and chain metal and equipped with an automatic closing device.
Bushes, weeds, and grass must be controlled to prevent harborage of ticks, bugs, and other insects.
The local health office determines and approves the vermin abatement procedure and frequency.

Evaluation, inspection, and permit enforcement

The city/municipal health officer must cause evaluation and inspection of every massage clinic and sauna bath establishment at least once every three (3) months.
Additional inspections and re-inspections may be conducted as deemed necessary for enforcement.
Inspection must be conducted within seven (7) days after payment of the inspection fee to the city/municipal treasurer concerned.
Fees payable for inspections must be prescribed by local ordinance.
A mission order (EHS Form No. 112) must be issued for every sanitary inspection by the city/municipal health officer or the chief of sanitation division/section/unit.
A mission order must contain the date, mission order number and series, inspector name and I.D. number, business name and address, establishment categories, and scheduled inspection dates.
The mission order must be shown to the owner/operator before any inspection is conducted, and the inspector’s immediate supervisor must monitor enforcement of the mission order.
Sanitary inspection conducted without a mission order is prohibited.
If an unauthorized inspection is executed, the owner/operator must report it to the local health officer or chief of sanitation division/section/unit.

Inspector equipment, recording, and ratings

A sanitation inspector must wear the prescribed office uniform and proper identification during inspections.
The inspector must bring required inspection equipment and supplies and copies of sanitation laws and other materials.
Inspectors must keep inspection/evaluation records using EHS Form-103-B and furnish the original report to the owner/operator.
The inspection form has twenty (20) items; non-complying items are indicated with an (X), each such item carries a demerit of 5, and the establishment rating is 100 less (number of demerits x 5) expressed as a percentage (%) rating.
Sanitation standard equivalencies are:
- 90% - 100% = EXCELLENT (Luminous Green),
- 70% - 89% = VERY SATISFACTORY (Luminous Yellow),
- 50% - 69% = SATISFACTORY (Luminous Red).
A sanitation standard rating sticker (SSRS, EHS Form No. 104 A/C) must be posted conspicuously, preferably at the door for customer guidance, and updated once every three (3) months unless revoked earlier.
The average sanitation standard must be evaluated by the local health officer/chief of sanitation division/section/unit every year end to determine improvement/maintenance of rating.

Correction notices, grace periods, and delivery

Inspectors must complete a sanitary inspection report, and when non-complying items exist, must notify the owner/operator of specific corrections and indicate a reasonable period for compliance.
The compliance/grace period must include Saturdays, Sundays and holidays.
A sanitary order (EHS Form No. 107) must be prepared for approval by the city/municipal health officer or chief of sanitation division/section/unit.
Within 48 hours of inspection/evaluation, the original inspection report (EHS Form No. 103-B) and the sanitary order must be furnished and acknowledged by the holder of the sanitary permit or owner/operator by personal delivery or by postal service registered with return card.

Re-inspection and revocation process

If corrections are not effected after the deadline upon re-inspection, the sanitary engineer/sanitation inspector must report to the local health officer, who recommends to the local health authority revocation of the sanitary permit.
Copies of inspection forms and any notice served must be filed and kept by the local health office and must be available for inspection by authorized officials.

Service of notice and show-cause hearing

When an inspection/evaluation form indicates non-complying items, the city/municipal health officer must serve a sanitary order requiring remedial action within the grace period stated.
If the first sanitary order is not complied with, a second sanitary order may be served only as follows:
- The owner may request in writing for an extension of the grace period before the first sanitary order expires; the local health officer acts upon the recommendation of the sanitary engineer/sanitation inspector who conducted the inspection.
- A Notice of Hearing (EHS Form No. 118) must call the holder of the sanitary permit to show cause at the time and place stated why the permit should not be revoked.

Revocation recommendations and finality

After prior notices and hearing, if not complied with and non-compliance is not excusable, the local health officer must recommend revocation of the permit.
After the second sanitary order on an extended grace period, if re-inspection shows continued failure to comply, the local health officer must recommend revocation to the local health authority without delay and must inform other related agencies in the city/municipality of the revocation.
Lifting of a suspension may be recommended when the owner/operator complies with the notices.
The owner may file a motion for reconsideration to the local health authority if not satisfied with the action of the local health officer.
The local health authority may file court proceedings against an establishment that continuously operates after revocation of its permit.

Summary suspension

When the local health officer finds unsanitary or unhealthy conditions that constitute a substantial hazard to public health, the local health officer must recommend immediate suspension of the sanitary permit.
Any person to whom such order is issued must be afforded a hearing within 48 hours after filing a written petition.

Appeals and entry powers

Hearings may be conducted by the person or panel conducting the hearing, which may confirm, modify, or reverse the appealed decision; the decision is final.
Sanitary engineers/sanitation inspectors or duly authorized DOH or provincial/city/municipal health officers, upon presentation of proper credentials, may enter premises at all reasonable times for inspection or other necessary actions to administer these rules.
Sanitary inspections must follow the mission order requirements and are preferably conducted while the establishment is in operation.
The local health authority may conduct hearings regarding erring establishments, including appeals, and the decision of the local health authority is final and executory.

DOH Committee of Examiners for Masseurs

The Committee of Examiners for Masseurs is created through a Department Order and is composed of:
- the Director of the Environmental Health Service,
- one medical officer from the Traditional Medicine Unit, DOH,
- one sanitary engineer,
- one legal officer,
- one representative from the Office for Public Health Services,
- one representative from masseurs association.
The Secretary of Health designates the committee chairman among the members.
The Environmental Health Service serves as the committee secretariat.
Committee membership terms are staggered: two members for three (3) years, two members for two (2) years, and two members for one (1) year; the Secretary of Health may re-appoint any member for another term of three (3) years.
The Committee announces, schedules, and holds examinations, approves/disapproves examination applications, and performs related duties.
The Committee issues licenses (Certificate of Registration) to successful examinees who comply with legal requirements.
The Committee may deny issuance or cancel a certificate of registration upon conviction for criminal offense involving moral turpitude, or on findings of immoral or dishonorable conduct, unsound mind or physical unfitness, or violation of existing laws/rules/regulations.
The Committee issues certified true copies of lost or damaged licenses for masseurs.
The Committee investigates sworn complaints against registered masseurs or the operation of massage parlors/clinics or sauna bath establishments and submits findings/recommendations to the Secretary of Health.
The Committee accredits institutions, associations, or trainers conducting training programs and review courses for masseurs and establishes accreditation criteria.
The Committee has visitorial powers over establishments and related matters under these rules.
The Committee regulates, standardizes, professionalizes, and uplifts the practice of massage through other functions assigned by the Secretary of Health.

Masseurs examination, qualifications, and certificates

Masseurs examinations are conducted any day of the first week of June and December each year, and in exceptional cases may be given on other dates outside prescribed ones.
Examinations are held at the Department of Health, Manila, or at any DOH regional health office determined by the Committee upon recommendation of the regional director.
Applicants for masseur examination must be Filipino citizens aged not less than twenty one (21) but not more than sixty (60).
Applicants must be of good moral character certified by the barangay captain where the applicant resides.
Applicants must submit clearance/certification from the National Bureau of Investigation (NBI) or provincial fiscal that the applicant is not convicted of any case involving moral turpitude.
Applicants must submit a medical certificate from a government physician that the applicant is physically and mentally fit.
Applicants must be at least high school graduates.
Applicants must submit training certificates showing basic instruction on Anatomy and Physiology, Microbiology and Parasitology, Ethics and Jurisprudence, Hygiene and Sanitation, and practical massage training from a registered masseur for at least sixty (60) hours, or equivalent instruction from a recognized school or college on the same subjects.
Applicants must submit a certificate of receiving at least five (5) hours lecture on sexually transmitted diseases including AIDS.
Applications must be submitted to the committee secretariat in two (2) copies of the prescribed application form duly accomplished, with two (2) passport-size photographs taken within the last six (months).
Applicants must pay an examination fee prescribed by the DOH.
Application forms, examination fees, and required documents must be filed two weeks before the examination date to be included in the list of examinees.

Examination format and passing requirements

The examination is conducted in English or Filipino and consists of theoretical and oral/practical questions.
The theoretical examination in writing covers Anatomy and Physiology; Microbiology and Parasitology;