Completion of this form does not represent any agreement or guarantee to contract or service. This form is merely exploratory in nature. A representative working on behalf of this initiative may inquire for further details if deemed appropriate. Thank you.

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* 1. What is the name of your hotel?

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* 2. What is the physical address of your hotel?

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* 3. What are the procedures for on-site check-in to maintain social distancing?

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* 4. How many rooms are on the property?

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* 5. What is your nightly rate per room? (Please provide rate for any type that applies)

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* 6. Is this hotel willing to act as an isolation facility and/or host medical facilities? (isolation facilities will maintain public health ordinances: good social distancing practices, regular cleaning and disinfecting, limited gatherings to 10 people)

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* 7. Would you be willing to devote an entire floor or wing to isolation?

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* 8. If yes, what services are available on the floor or wing (e.g. laundry machines, vending, etc)?

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* 9. How many rooms are available for isolation purposes? (isolation rooms would be a floor or block of rooms used only for this purpose)

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* 10. Is this hotel open to become a virus-test site? (ex. drive-up testing)

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* 11. What procedures are in place or planned to ensure proper sanitation if an infection occurs on the property?

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* 12. Does your hotel have meeting facilities on site?

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* 13. If yes, how many and what is the approximate square footage?

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* 14. Are you willing to allow meeting space to be used for medical purposes?

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* 15. Do you have room service delivery available on site? Or are open to having an outside service deliver to rooms?

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* 16. If yes, what are the procedures in place or planned to ensure safety of employees and patients/residents in the room?

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* 17. Who should we contact for further information?

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