HRC Day Program Status Check 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. OK Question Title * 1. Agency Name OK Question Title * 2. Vendor Number OK Question Title * 3. Program Name OK Question Title * 4. Number of Clients you currently serve OK Question Title * 5. Are your staff being paid and working with you to serve clients in remote and creative methods? Yes No Tell us about how you are staying in contact with and supporting your clients. OK Question Title * 6. Have any of the clients served by your day program tested positive for the Corona Virus? YES NO If YES, How many, and where are they being cared for now? (eg in isolation at home, in the hospital) OK Question Title * 7. Are any of the clients that you have served considered high-risk (with medical conditions or compromised immune systems)? Yes No If Yes, how many and where are they being cared for now? (eg in isolation at home with family? or in a licensed home?) OK Question Title * 8. Are you adequately staffed? Yes No OK Question Title * 9. Do you have any staff that are symptomatic? Yes No If YES, how many? OK Question Title * 10. Do you have backup staff if you need them? Yes No OK Question Title * 11. Do you have ample supplies ? Yes No OK Question Title * 12. Do you serve any clients over age 65? Yes No If yes, how many, and where are they being cared for? (eg in isolation with family, licensed home, or with supported living services) OK Question Title * 13. Have you provided training to your staff on precautions to avoid exposure to illness and communicable disease? Yes No OK Question Title * 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? Yes No If no, do you have plans to provide this training remotely. OK Question Title * 15. Do you serve clients that have no involved family support? Yes No If yes, how many and are they receiving support (eg from licensed home, supported living provider, etc)? OK Question Title * 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? Yes No Please provide information about available direct care staff. OK DONE