1. Name of Public Health Department:
2. Jurisdiction(s) covered (select all that apply):
3. 24/7 contact for your agency - Name (can enter name of 24/7 phone line, if applicable):
4. 24/7 contact for your agency - Phone:
5. 24/7 contact for your agency - E-mail:
6. 24/7 alternate contact for your agency - Name:
7. 24/7 alternate contact for your agency - Phone:
8. 24/7 alternate contact for your agency - E-mail:
9. Do you have staff that can administer vaccines to adults?
10. Do you have staff that can administer vaccines to children?
11. Please upload your medical related cache inventory list(s), and locations, to the following Google folder: https://drive.google.com/open?id=16JKuq8H-62E7NUd6fVduUUADuAQsT73f Rename your document with your organization name in the title. If you are unable to access the Google Drive, please e-mail your medical cache inventory list to SWCHCC@gmail.com
12. Please describe your medical related supply cache mobilization processes, including: activation process, chain of custody, restocking requirements, etc. If already documented, please upload to the following Google folder: https://drive.google.com/drive/folders/1gY177DdMlsXpwzV6J2rtbPWc4lVu4Y8E?usp=sharing Rename your document with your organization name in the title. If you are unable to access the Google Drive, please e-mail your mobilization process to SWCHCC@gmail.com.
13. Please upload a spread sheet of your transportation resources to the following Google folder: https://drive.google.com/drive/folders/19UnEKcgGBsM5W8cDPUXShHwdJGidiIQe?usp=sharing Rename your document with your organization name in the title. Please include the following in your spreadsheet for each transportation resource: type of vehicle, capacity, if it is ADA compliant, and the total number of staff trained to drive the vehicle. If you are unable to access the Google Drive, please e-mail your spread sheet to SWCHCC@gmail.com.
14. Does your agency have any pre-identified sites for Alternate Care System(s)/Site(s)?
15. If you answered yes above, please specify how many potential Alternate Care System(s)/Site(s) could be set up in your jurisdiction based on current plans and materials:
16. What are the current gaps that your agency has identified in Alternate Care Site planning (staffing, resources, a adopted plan)?
17. How many pre-identified, open Points of Dispensing (POD) sites are within your jurisdiction(s)?
18. Approximately how many closed Points of Dispensing (POD) sites are designated within your jurisdiction(s)?
19. Which communication modalities currently exist within your agency (select all that apply)?
20. Please select all radio capabilities currently available within your facility:
21. Number of portable or mobile radios programmed to be interoperable within the Southwest region:
22. Please upload a list of physical assets that support Chempack, antidote, vaccination/prophylaxis operations and distribution of other countermeasures from SNS and state and local assets that may include databases and electronic systems as well as physical resources (m-95 masks, signage, badging systems, coolers, etc.), regional supply cache inventory list(s), AND LOCATIONS to the following Google folder: https://drive.google.com/drive/folders/1k35bd6XdjTBl2hu4zFbHLq_BtpGHeNyH?usp=sharing. Rename your document with your organization name in the title. If you are unable to access the Google Drive, please e-mail your list to SWCHCC@gmail.com.
Dolores County Public Healh
|Dolores County||Mary Randolph|
We would utilize the Regional plan and request regional help if we depleted our supplies.
We will utilize the Senior trasport system and I do not have that information at this time.
Staffing is the major one.
Analog phone lines (Landline), Cell phones, Fax
800MHz radio(s), VHF/UHF radio(s), handheld walkie talkies.
It is included in my EPR supply list.
San Juan Basin Public Health
Archuleta County, La Plata County
Emailed list to gmail account!
Potential sites have been discussed, however I do not believe we have an MOU with any of the possible alternate locations.
Staffing, getting to secondary location, MOU's with possible second location.
Analog phone lines (Landline), Cell phones, Internet-Based (e.g., e-mail, messaging systems), Mass notification system, Fax
Have been emailed as one long excel sheet