| A | B | C | D | E | F | |
|---|---|---|---|---|---|---|
1 |  | Standard Clinic Checklist (Feel free to copy and use!) | ||||
2 | Set the following variables to calculate supplies: | Usually, it takes the clinic 1 hour to get up and going. It is strongly recommended to gradually increase the # of appointments slowly at the beginning of the day, starting at 10 per 10 mins and increasing to full capacity. Otherwise, there will be long lines. | ||||
3 | 200 | Total Number of Doses | 67 | Average per hour capacity | ||
4 | 3 | Duration of Clinic (in hours) | 100 | Recommended capacity per hour | ||
5 | ||||||
6 | Qty | Item | Role responsible | Person responsible | Status | Notes |
7 | MEDICAL ITEMS | |||||
8 | 200 | Doses of vaccine, syringes, etc. | Medical Provider | Need Status Update | ||
9 | 1 | EMS / Ambulance | Public Safety | Need Status Update | ||
10 | 1 | Anaphylaxis kit | Medical Provider | Need Status Update | ||
11 | 200 | CDC Vaccine cards | Medical Provider | Need Status Update | ||
12 | Stickers for Vaccine card (with date) | Medical Provider | Need Status Update | |||
13 | VOLUNTEERS PER SHIFT | |||||
14 | 3 | Vaccinators per shift recommended (who can do 30/hr) | Must be licensed and actively employed recommended | |||
15 | 3 | Vaccination stations managers (including band-aids, wipes, sanitizer, sharps container) | ||||
16 | 3 | Welcome volunteers recommended | ||||
17 | 3 | Registration volunteers recommended | ||||
18 | 1 | Scanning volunteers recommended | ||||
19 | 3 | Observation volunteers recommended | ||||
20 | 4 | Queue volunteers for flow control | ||||
21 | 1 | Data entry volunteers recommended | ||||
22 | 1 | Physician for medical consultation | ||||
23 | 2 | Additional RNs or MDs for observation area | ||||
24 | ON-SITE TECHNOLOGY ITEMS | |||||
25 | 1 | iPads and Chargers | IT | Need Status Update | ||
26 | 3 | Laptops and Chargers | IT | Need Status Update | ||
27 | 1 | Multifunction (scanner/copier) printers w/plenty of toner | IT | Need Status Update | ||
28 | 2 | MiFis (for registration, data entry) | IT | Need Status Update | ||
29 | 2 | Large TVs or projectors for Dashboards (with computers or iPads that can open the dashboard webpage) | IT | Need Status Update | ||
30 | 10 | Walkie-talkies / radios for communication, ability to call doctor or interpreters | IT | Need Status Update | ||
31 | PRINTED ITEMS | |||||
32 | 220 | Printed Consent forms (VX) in various languages per registration printed on white paper | Site host | Need Status Update | https://www.equivax.org/consent-forms | |
33 | 220 | Printed Vaccine info forms on color paper (Pfizer=pink, Moderna=green, J&J=yellow) | Site host | Need Status Update | https://www.equivax.org/vaccine-fact-sheets | |
34 | 2 | Printed set of lane numbers (for reg and discharge) and paint stirring sticks | Volunteer lead | Need Status Update | Template (with tips and instructions) | |
35 | 1 | Language ID Flashcard | Site host | Need Status Update | From US Census | |
36 | 2 | Flow-chart / Floor plan | Volunteer lead | Need Status Update | https://www.equivax.org/clinic-design-model | |
37 | 3 | Vaccination Standards Sheets for Vaccinators | Volunteer lead | Need Status Update | Link | |
38 | 1 | Volunteer Registration/ Medical Consult Signs | Volunteer lead | Need Status Update | Link | |
39 | 1 | ScanJig scanning stands | Volunteer lead | Need Status Update | ||
40 | 8 | Volunteer consent form | Site host | Need Status Update | Only if needed by site | |
41 | 2 | Walk-in sign-up sheet | Volunteer lead | Need Status Update | Link to template | |
42 | 4 | What to do if they can't be vaccinated (info sheet) | Volunteer lead | Need Status Update | Link to info | |
43 | 2 | Volunteer sign in sheet | Volunteer lead | Need Status Update | Recommended that you print a list of your volunteers by shift for quick sign-in. | |
44 | 4 | Printed Volunteer lists (with unique vaccinator IDs for each vaccinator) | Volunteer lead | Need Status Update | Helpful to have around, especially during shift changes, so people know where to go | |
45 | 8 | Printed registration appt lists (as backup) | Volunteer lead | Need Status Update | After registration closes at midnight | |
46 | OFFICE SUPPLY ITEMS | |||||
47 | 1 | Reams of paper (500 each) | Site host | Need Status Update | In case you need to print more consent forms or info forms in case of an emergency last-minute vaccine type shift or a need to print more of a particular language | |
48 | Tape for hanging signs | Volunteer lead | Need Status Update | |||
49 | Orange Dots (for use by medi-consult to indicate extended observation time needed). This generally applies to only about 1% of patients. | Volunteer lead | Need Status Update | |||
50 | Green Dots (for use by medi-consult to indicate "OK" for vaccination) This generally applies to only about 5% of patients. | Volunteer lead | Need Status Update | |||
51 | Red Stop Sign Dots (for use by medi-consult to indicate cannot be vaccinated), optional | Volunteer lead | Need Status Update | |||
52 | 6 | Sharpies | Site host | Need Status Update | ||
53 | 100 | Clipboards | Site host | Need Status Update | ||
54 | 200 | Pens | Site host | Need Status Update | ||
55 | 26 | Name tags (big, to allow room to list languages spoken) | Site host | Need Status Update | ||
56 | 1 | Box of kitchen timers for extended observation (optional) | Volunteer lead | Need Status Update | Amazon Link | |
57 | SAFETY ITEMS | |||||
58 | Neon "staff" vests worn by volunteers | Site host | Need Status Update | |||
59 | 4 | Lighted traffic wands | Volunteer lead | Need Status Update | Amazon Link | |
60 | 400 | Santizing wipes | Site host | Need Status Update | ||
61 | Spray surface sanitizer for chairs | Site host | Need Status Update | Here's a cool way to do this efficiently: video | ||
62 | 2 | Thermometer (and extra batteries!) | Site host | Need Status Update | ||
63 | 40 | Nitrile gloves (vinyl gloves/latex free) | Site host | Need Status Update | ||
64 | Bottles of hand sanitizer for various tables (good for approx. 100 uses per bottle) | Site host | Need Status Update | |||
65 | 200 | Masks (both light disposable masks and N95s, face shields if requested) | Site host | Need Status Update | ||
66 | Isolation gowns (if needed) | Site host | Need Status Update | |||
67 | SITE ITEMS | |||||
68 | Signage (Welcome, Appt Only, Please Have ID and Insurance Ready (it's OK if you don't have insurance), Medical Consultation Area, Thank you!, Volunteer Registration) | Site host | Need Status Update | Nice to have, not critical! | ||
69 | 0 | Tents (if needed) | Site host | Need Status Update | ||
70 | Tables for Welcome, Medi-Consult, Reg, Discharge, Data Entry, and Volunteer Reg, Vax Prep | Site host | Need Status Update | |||
71 | 25 | Observation area chairs (in a spaced grid) | Site host | Need Status Update | ||
72 | Wheelchairs for ADA patients (may vary depending on demographic served) | Site host | Need Status Update | |||
73 | Cardboard boxes for consent collection (to hold 8.5x11 papers) | Site host | Need Status Update | |||
74 | Cones / stanchions for interior pathway routing (varies depending on floor plan) | Site host | Need Status Update | |||
75 | Cones / signs for outdoor traffic control (as needed) | Site host | Need Status Update | |||
76 | HOSPITALITY ITEMS | |||||
77 | Coffee | Site host | Need Status Update | For the early mornings | ||
78 | Breakfast items | Site host | Need Status Update | For the volunteers who didn't get a chance to eat breakfast | ||
79 | 220 | Small bottles of water | Site host | Need Status Update | For inside the clinic area, for volunteers, and at exit | |
80 | 220 | Fruit (mandarin oranges most effective) | Site host | Need Status Update | Durable and good for patients to grab-and-go at the end. | |
81 | Lunch/snacks for volunteers | Site host | Need Status Update | |||
82 | 220 | "I got vaccinated" stickers | Site host | Need Status Update | Can buy from Amazon | |