Emergency Plan
Same month every year (annually)
Complete the Agreement with another Agency. (Fax to us the information to complete/submit the Plan)
Same month every year (annually)
Complete the Agreement with another Agency. (Fax to us the information to complete/submit the Plan)
The following templates, must be used for the Agency Pandemic Management Plan documentation
Vaccination full package: Covid-19 Vaccination Package ACHC Approval
Pandemic Management Plan: CMS Guidelines Coronavirus Vaccination Policy Mask Use guidelines
Pandemic Mgm Plan Coronavirus CMS guidelines Vaccination Policy Mask Use
Vaccine Info: Vaccine English info Vaccine Spanish info Total staff vaccination report
Staff Vac. Attestation: Vaccine attestation Staff vaccination log control: Vaccine log control
Vaccine Medical Exeption: Vaccine Medical Exp. Religious Exeption: Vaccine Religious Exep.
Emerging Infections Disease Policy: EID Policy Covid-19 Policy: Covid-19 Policy
Contingency Plan for ALF, Nursing Home staff testing: Contingency Plan
Letter to staff on restricted areas: Letter to Staff Bio Waste Disposal: Disposal
Goverment COVID-19 resources
ACHC COVID-19 resources
CHAP COVID-19 resources
JCHO COVID-19 resources
Emerging Infectious Disease (EID) report
EID Report (forward copy to Board of Director & Infection Prev. Committee - monthly)
Assessing Covid-19 Risks in the Workplace (monthly): Staff Risk Report
Preventing Nosocomial COVID‐19 Infections: Preventing Nosocomial Infections (monthly)
Pandemic Management Plan Compliance Report (Ibfection prevention) Pandemic Infec. Prev. Report Monthly
Pandemic Log Control: Patients Staff
Caring for COVID-19 Patient documentation Caring for Covid19 documentation (Add to progress note)
Staff Weekly Screening Protocol: WeeKly Screening (must be completed daily to all Agency visitors)
Pandemic screening tool (patients): Pandemic Screening (must be complete weekly for patient/staff)
Caring for COVID-19 Patient guide (CHAP) Caring for Covid19
Pandemic Agency Actions Pandemic Response Roles
Pandemic Actions Pandemic Roles
Pandemic Infection Prevention Pandemic Home Care Planning
Pandemic Infection Prev. Pandemic Agency HC planning report
Covid-19 QAPI Report (Quarterly): COVID-19 PI Report
Person Under Investigation (PUI) and Case Report Form: Coronavirus PUI
COVID-19 Resources National Emergency Waivers: 2023 Waivers CHAP Video waivers FL Waivers
We encouraging organizations (CHAP and non-CHAP accredited) to participate in CHAP weekly COVID-19 conference calls. They have those calls on Tuesdays at 10:30 AM EST, Wednesday at 11:00 AM EST, and Thursday at 3:00 PM EST. The call in number is 646-307-1479, participant code 246854#. In addition, CHAP have a COVID-19 hotline for immediate questions 202-862-3416 (Monday-Friday 8:30 AM-5:30 PM EST).
CHAP Video: COVID19 tips Patient/family Instructions: COVID19 English COVID19 Spanish
JCHO Surveys Video: COVID19 CDC Infection prevention recommendation CDC video
ACHC Instructions COVID19 General Instructions Posters: Poster English Poster Spanish
Covid-19 Pamplet for your Staff and Patients Covid-19 Pamplet $ 1.25 each, minimal order 25
Disclaimer: Every template is only your guide to complete Pandemic Management Documentation, your Agency Officials must assure that task were completed, the quorum is acceptable, and every member had active participation in the discussion, activities.
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