HRC Day Program Service Provider Survey

We will use this survey to stay in contact with you and to share information about the status of our clients during the COVID-19 Pandemic.

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* 1. Agency Name

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* 2. Vendor Number

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* 3. Program Name

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* 4. Number of Clients you currently serve

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* 5. Are your staff being paid and working with you to serve clients in remote and creative methods?

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* 6. Have any of the clients served by your day program tested positive for the Corona Virus?

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* 7. Are any of the clients that you have served considered high-risk (with medical conditions or compromised immune systems)?

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* 8. Are you adequately staffed?

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* 9. Do you have any staff that are symptomatic?

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* 10. Do you have backup staff if you need them?

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* 11. Do you have ample supplies ?

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* 12. Do you serve any clients over age 65?

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* 13. Have you provided training to your staff on precautions to avoid exposure to illness and communicable disease?

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* 14. Prior to the Safer At Home order and while clients were attending your program in person, have you provided training to your clients on precautions to avoid illness?

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* 15. Do you serve clients that have no involved family support?

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* 16. Some of our residential service providers could experience a shortage of direct care staff at some point. Do you have any direct care staff who are background checked who might be available to work in a residential setting?

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