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COVID-19 Vaccine Administration Site Survey

The WV Department of Health and Human Resources is conducting a survey to better gauge the community preparedness for future SARS-CoV-2/COVID-19 vaccine distribution. WV DHHR is taking a proactive approach to ensure we have a comprehensive plan and system in place to efficiently and equitably distribute a vaccine when it is available. Please complete this survey to assist in our efforts. We look forward to your valued feedback – it is greatly appreciated! .
1.Contact Information
2.Select the best description of your facility
3.Does your facility have a pandemic vaccination plan?
4.What is your facility’s plan for delivery of COVID-19 vaccine?
5.Have you identified any shortfalls in your vaccination plan that may require additional resources? If yes, please explain. If no, type N/A.
6.Does your facility currently possesses Ultra-Low Cold Chain storage equipment (Storage Temp -80 C)?
7.If yes to Q6, how many ultra low cold chain vials can you store?
8.Can you store/operate a portable ultra low cold shipping container at your facility? 
9.If no to Q8, what is the most significant challenge area(s)?
10.Is your facility currently enrolled in the West Virginia Statewide Immunization Information System (WVSIIS)?
11.Do you need assistance enrolling your facility in WVSIIS?
12.How many staff members are enrolled/trained in WVSIIS?
13.Do you feel this number is adequate to facilitate SARS-CoV-2 vaccinations? If no, what assistance do you require?
14.Does your facility’s EHR communicate with WVSIIS via HL7 messaging? 
15.What population assessment tools are available or are currently in use for your facility?
16.Does your facility utilize the Vaccine Adverse Event Reporting System (VAERS) through US Health and Human Services?
17.Please describe your current ability to administer COVID-19 testing. Check all that apply.
18.How will implementing a COVID vaccination plan affect your current ability to continue normal daily operations?
19.Would you need additional personnel to deliver vaccine for SARS-CoV-2? If yes, explain what type of assistance would be needed?
20.Are there any additional concerns you have regarding COVID vaccine distribution and delivery? Please explain.