EQM Sites: Child Care Services Status For Emergency and First Responders

Question Title

* 1. Child Care Program Name

Question Title

* 2. In what city is your program located?

Question Title

* 3. Your First and Last Name

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* 4. What is the best method to reach you?

phone:

email:

text:

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* 5. What are your program plans during the COVID-19 state of emergency?

We are planning to stay open

We are currently closed, but would consider re-opening during the state of emergency

We have closed or will be closing and could not reopen during the state of emergency

We are undecided

Question Title

* 6. If you are currently employed at a child care program that will be closed at this time, would you be willing to work at another child care site that will be open for first responders?

Yes

Other (please specify)

Question Title

* 7. Are you willing to stay open or reopen to help with the child care needs of hospital workers and first responders (fire/law enforcement) during this public health crisis?

Yes

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* 8. Are you willing to accept additional children to help with the child care needs of essential personnel during this public health crisis?

Yes

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* 9. What are your current child care hours of operation?

Days:

Time:

Evenings:

Weekends:

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* 10. If necessary, would you be willing to offer care for a 12 hour shift?

Yes

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* 11. There are families who cannot find care, either because their child care arrangements are no longer available or because school-age children are not in school. Please tell us what capacity you have, currently, by age.

	no openings	1-2 openings	3-4 openings	5+ openings
Infants	Infants no openings	Infants 1-2 openings	Infants 3-4 openings	Infants 5+ openings
Toddlers	Toddlers no openings	Toddlers 1-2 openings	Toddlers 3-4 openings	Toddlers 5+ openings
Preschoolers	Preschoolers no openings	Preschoolers 1-2 openings	Preschoolers 3-4 openings	Preschoolers 5+ openings
School Age	School Age no openings	School Age 1-2 openings	School Age 3-4 openings	School Age 5+ openings

Other (please specify)

Question Title

* 12. If licensing regulations were modified, would you be willing to offer infant/toddler care or increase infant/toddler care?

Yes

Question Title

* 13. Resources may be available in your area to help with staying open or expanding care within defined licensing and CDC regulations. Please respond to the following items if additional help would allow you to stay open or expand services.

	Yes	No	Maybe
Could you use temporary staff who have received a background check?	Could you use temporary staff who have received a background check? Yes	Could you use temporary staff who have received a background check? No	Could you use temporary staff who have received a background check? Maybe
If facilities (more physical space) were available, would you consider using another child care site to expand your services?	If facilities (more physical space) were available, would you consider using another child care site to expand your services? Yes	If facilities (more physical space) were available, would you consider using another child care site to expand your services? No	If facilities (more physical space) were available, would you consider using another child care site to expand your services? Maybe
Could you use additional supplies to serve more children?	Could you use additional supplies to serve more children? Yes	Could you use additional supplies to serve more children? No	Could you use additional supplies to serve more children? Maybe

Other (please specify)

Question Title

* 14. I give permission to be contacted to coordinate openings, referrals, and resources. I understand someone will be contacting me.

Yes

EQM Sites: Child Care Services Status For Emergency and First Responders

Question Title

* 1. Child Care Program Name

Question Title

* 2. In what city is your program located?

Question Title

* 3. Your First and Last Name

Question Title

* 4. What is the best method to reach you?

Question Title

* 5. What are your program plans during the COVID-19 state of emergency?

Question Title

* 6. If you are currently employed at a child care program that will be closed at this time, would you be willing to work at another child care site that will be open for first responders?

Question Title

* 7. Are you willing to stay open or reopen to help with the child care needs of hospital workers and first responders (fire/law enforcement) during this public health crisis?

Question Title

* 8. Are you willing to accept additional children to help with the child care needs of essential personnel during this public health crisis?

Question Title

* 9. What are your current child care hours of operation?

Question Title

* 10. If necessary, would you be willing to offer care for a 12 hour shift?

Question Title

* 11. There are families who cannot find care, either because their child care arrangements are no longer available or because school-age children are not in school. Please tell us what capacity you have, currently, by age.

Question Title

* 12. If licensing regulations were modified, would you be willing to offer infant/toddler care or increase infant/toddler care?

Question Title

* 13. Resources may be available in your area to help with staying open or expanding care within defined licensing and CDC regulations. Please respond to the following items if additional help would allow you to stay open or expand services.

Question Title

* 14. I give permission to be contacted to coordinate openings, referrals, and resources. I understand someone will be contacting me.

Question Title

* 15. Is there anything else you would like us to know to help you stay open or expand care to essential personnel during this state of emergency?