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AMEC International Health Commission COVID-19 Vaccine Distribution Site Registration

COVID-19 vaccination distribution sites

The AMEC International Health Commission is joining a collaborative that is proposing to support or provide sites for COVID-19 vaccination distribution throughout the United States and its Territories. We are hoping that this model can also be used across the Connection.
1.Contact Information
2.AME Church Information
3.Please describe your proposed site/location
4.Please provide the dimensions of the proposed space (s). Include __wide x __ long (Example: 12' x 16' means it's 12 feet wide (from side to side) by 16 feet long (from top to bottom)
5.Timeframe for notice: How much time will your site(s) need in order to be available ?
6.Does your site have:
Yes
No
Sufficient supply of PPE for staff is available, including face masks, gloves, and, if appropriate, eye shields.
Sufficient supply of face coverings is available for visitors and patients who may not have one.
Sufficient hand sanitizer is available so that staff and patients can repeatedly practice hand hygiene.
Cleaning supplies are available so workspaces can be cleaned      regularly (note the amount needed may be more than normally required). 
Additional controls, such as counters and plastic shields, are in place to minimize contact where patients and staff interact (e.g.,   registration or screening areas).
Signs, barriers, and floor markers to instruct patients to remain 6 feet apart from other patients and clinic staff have been set up
before the clinic.
Sufficient supply of thermometers to check patient temperatures prior to entering the vaccination clinic and COVID symptom checklists.
Staff that has been trained on proper hygiene techniques.
If your site is in a building, have you completed the AMEC International Health Commission Guidelines for Reopening and Returning to Church Buildings Checklist?