HEF

LTC Staffing and Resource Form

Agency Name(Required)

Evaluator Name(Required)

First Last

Evaluator Email(Required)

2. What percentage did your agency achieve in notifying your staff, resident’s families, and local emergency agencies within 30 minutes, that there was an active emergency response?(Required)

3. How long did it take to relocate all residents and staff to a designated safe area along with ensuring all emergency supplies were accessible, after being notified to shelter in place?(Required)

4. How long did it take your facility to move all residents and critical supplies from the affected wing to a designated safe zone after receiving the notification to partially evacuate?(Required)

5. How long did it take your facility to prepare for a 10% influx of patients after you received the notification?(Required)

6. Did your facility update your facility status on the significant events board in the state-wide communications system, WebEOC?(Required)