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In response to the continued spread of COVID-19 within our agencies, NYDA is seeking your support in identifying the impact of COVID-19 on both your staff and individuals you support. We request that you complete the survey below once a week to ensure we have current data. This information will help inform advocacy efforts with local and state officials.

Please report ALL EMPLOYEES regardless of work location and ONLY individuals served in a residential program.
Arc Chapters are not to complete this survey. Please complete the survey distributed by the The Arc New York. 

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* Agency Name:

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* DDRO Region

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* Certified residential capacity:

Please indicate the CURRENT totals at your agency for the following:
       
Definitions below to ensure consistency of responses:
  • Employees under quarantine/isolation - self-imposed or physician/DOH-directed
  • Individuals under quarantine/isolation - physician/DOH-directed only
  • Confirmed COVID-19 - laboratory confirmed cases only
  • Presumed COVID-19 - Metro only at this time - febrile acute respiratory illness or clusters of acute respiratory illness (febrile or not)
  • Hospitalizations and recovery - please include confirmed COVID-19
Day Programs

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* Have you reopened your day program? (This includes both site-based and community services)

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* On what date did you reopen your first day program site?

Date

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* What is the total number of people receiving day services in all your day services as of the date of this survey response?

Note: The total individuals in the following three questions should equal the total number of people receiving day services in all your day services as of the date of this survey response (no duplicates).

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* How many of these people are receiving day services in certified residences as of the date of this survey? (Please include those that are receiving Community Habilitation-R (CH-R))

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* How many of these people are receiving services in day services in site-based day programs (e.g., Site-Based Day Habilitation and Prevocational Services, Day Treatment & Sheltered Workshops) as of the date of this survey response?

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* How many people are receiving your day services within community settings (i.e., outside your certified residences and site-based day programs such as Community Prevocational Services & Day Habilitation Without Walls) as of the date of this survey response?

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* What was your day program attendance pre-COVID (as of March 1)?

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* Have you had any confirmed COVID-19 cases in your day service program(s) conducted outside of the home?

Individual Information

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* Individuals CURRENTLY with directive to quarantine/isolate:

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* Individuals with confirmed COVID-19 diagnosis AT THIS TIME
(# of individuals who are currently infected):

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* Individuals CURRENTLY hospitalized for COVID-19:

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* Individuals recovered TO DATE from COVID-19
(total # of recoveries):

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* Individual deaths due to COVID-19 infection TO DATE
(total # of deaths):

Employee Information

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* Total # of employees:

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* Employees CURRENTLY under quarantine/isolation. Include staff affected by the travel quarantine:

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* Employees with confirmed COVID-19 diagnosis AT THIS TIME
(# of employees who are currently infected):

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* Employees CURRENTLY hospitalized for COVID-19:

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* Employees recovered TO DATE from COVID-19
(total # of recoveries):

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* Staff deaths due to COVID-19 infection TO DATE
(total # of deaths):

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* Questions or Comments:

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