COVID-19 Preparedness Survey, Emergency Shelters

If any of this information changes once this survey is completed, please update in real time by emailing info@partnersforhome.org

Question Title

* 1. Your Information

Organization Name

Name and Type of Facility

How many unique client interactions do you have each day?

What percentage of your clients are over the age of 60?

How many intake staff do you have?

Name of person completing this form (first and last)

Title

Email Address

Phone Number

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* 2. What type(s) of beds does your facility have?

Mats on floor

Cots

Bunk beds in large communal room(s)

Bunk beds (2- 4) in small, shared rooms

Single beds in large communal rooms

Single beds (2- 4) in small, shared rooms

Private SRO units

N/A- Day shelter only

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* 3. Does your agency currently have a room that could be used to isolate symptomatic clients from other residents/clients?

Yes

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* 4. Does your agency have N95 Face Masks?

Yes

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* 5. Does your agency have other face masks?

Yes

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* 6. Does your agency have liquid hand soap?

Yes

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* 7. Does your agency have hand sanitizer (ethanol-based, at least 60%)?

Yes

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* 8. Does your agency have paper hand towels?

Yes

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* 9. Does your agency have facial tissues?

Yes

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* 10. Does your agency have gloves in a variety of sizes?

Yes

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* 11. Does your agency have thermometers?

Yes

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* 12. Does your agency have cleaning products for hard surfaces (viricide or bleach)?

Yes

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* 13. Does your agency currently have sufficient cleaning supplies for increased cleaning frequencies of office equipment and outreach vehicles? If not, what resources do you need in order to increase cleaning frequency?

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* 14. Is your agency providing food? If so, when?

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* 15. If your agency provides onsite food, does it have the capacity to stagger meal times to avoid large gatherings of people?

Yes

N/A

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* 16. Does your agency currently have sufficient hand washing space?

Yes

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* 17. If you answered no to question 16, please explain your need:

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* 18. Is your agency taking new intakes for shelter beds? If yes, when?

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* 19. Have service offerings changed at your agency and if so, please share what services you are offering and when?

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* 20. Is your agency actively using the symptom screening tool with all clients?

Yes