• Questions are answered “yes/no”
  • This tool can be completed in 2-3 minutes
  • This tool is based on CDC’s Checklist for Healthcare Preparedness (https://www.cdc.gov/coronavirus/2019-ncov/hcp/hcp-personnel-checklist.html)
  • This tool will enable organizations to rapidly assess their preparedness and identify areas of weakness

If you have any questions or comments, please contact:

Dr. SreyRam Kuy, MD, MHS, FACS
Baylor College of Medicine
SreyRam.Kuy@bcm.edu

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* 1. How would you best describe your organization?

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* 2. How many employees are in your organization?

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* 3. What is the primary 5-digit zip code of your organization (e.g. 77054)?

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* 4. What is your role in your organization?

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* 5. What is your hospital's teaching status?

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* 6. What is your hospital's location?

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* 7. How many beds your facility has?

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