COVID-19 Preparedness Survey, Outreach & Housing Navigation

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

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* 1. Your Information

Organization Name

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. Does your agency have N95 Face Masks?

Yes

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* 3. Does your agency have other face masks?

Yes

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* 4. Does your agency have liquid hand soap?

Yes

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

Yes

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* 6. Does your agency have paper hand towels?

Yes

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* 7. Does your agency have facial tissues?

Yes

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

Yes

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* 9. Does your agency have thermometers?

Yes

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

Yes

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* 11. 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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* 12. How many outreach teams or staff people do you currently have?

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* 13. Are your outreach teams able to do conduct street outreach to unsheltered and encampments? If yes, what is your availability?

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* 14. What supplies are needed to provide outreach to unsheltered and encampments?

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

Yes