Planning form for Group Gatherings/Sporting Events Question Title * 1. Governor Bullock's 5/19/20 Directive states that gatherings of over 50 people may occur with adequate and maintained social distancing beginning June 1st. As stated in the directive, "If you are planning an event with more than 50 people you should consult with your local public health office on a plan to implement adequate social distancing." Please submit your plan for your gathering using the form below. A health department employee will contact you within 5-7 business days. * I have read the above disclaimer. OK Question Title * 2. All fields need to be completed in order to submit this form. I agree to complete the following form to the best of my ability. OK Question Title * 3. Contact Information Name Organization/Company Address Address 2 City/Town State/Province -- select state -- AL AlabamaAK AlaskaAS American SamoaAZ ArizonaAR ArkansasCA CaliforniaCO ColoradoCT ConnecticutDE DelawareDC District of ColumbiaFM Federated States of MicronesiaFL FloridaGA GeorgiaGU GuamHI HawaiiID IdahoIL IllinoisIN IndianaIA IowaKS KansasKY KentuckyLA LouisianaME MaineMH Marshall IslandsMD MarylandMA MassachusettsMI MichiganMN MinnesotaMS MississippiMO MissouriMT MontanaNE NebraskaNV NevadaNH New HampshireNJ New JerseyNM New MexicoNY New YorkNC North CarolinaND North DakotaMP Northern Mariana IslandsOH OhioOK OklahomaOR OregonPW PalauPA PennsylvaniaPR Puerto RicoRI Rhode IslandSC South CarolinaSD South DakotaTN TennesseeTX TexasUT UtahVT VermontVI Virgin IslandsVA VirginiaWA WashingtonWV West VirginiaWI WisconsinWY Wyoming ZIP/Postal Code Email Address Phone Number OK Question Title * 4. Type of Event Non-profit/Fundraising Wedding Graduation Funeral Family Reunion Concert Rodeo Sporting Event Other (please specify) OK Question Title * 5. Name of Event OK Question Title * 6. Date of Event Date / Time Date Time AM/PM - AM PM OK Question Title * 7. Brief description of event OK Question Title * 8. Location of Event OK Question Title * 9. Expected Number of Attendees OK Question Title * 10. Are attendees required to have a ticket to enter the event? Yes No If yes, what is your plan to allow for social distancing during the ticket entry process? OK Question Title * 11. Seating: what is your plan to allow for social distancing between attendees? OK Question Title * 12. Entry and Exit: What is your plan for allowing social distancing in ingress and egress areas? OK Question Title * 13. Will your event be provding food and beverage services? Yes No OK Question Title * 14. Are you or will you be using a licensed food establishment? Yes No OK Question Title * 15. Is this a private event? Yes No OK Question Title * 16. Do you fall under the category of a non-profit operating less than 4 times per year? Yes No OK Question Title * 17. If you answered "No" to being a private event or a non-profit, answer question 18. If you answered "Yes" to either of those questions, answer question 19. I will answer 18 I will answer 19 OK Question Title * 18. If your event will have food or drink, use the space below to provide a plan to provide social distancing while providing these services. Please note that Governor Bullock’s directive currently prohibits self-serve buffets and bar services. • If you are a licensed retail food establishment, continue to follow state and local regulation in addition to your social distancing plan. • If your event will have food or drink and the following do NOT apply: 1. Your event is a private event (examples: wedding, funeral or private party where members of the public are not allowed) or 2. You are a currently licensed as a food establishment. You may be required to obtain a temporary event food permit. Contact the Environmental Health Department at 271-4020 for permitting requirements. OK Question Title * 19. If your event is private or for a non-profit organization which will hold less than 4 events per year, please provide a plan for these services to include the following: (Food(s) to be served, handwashing set-up, illness plan for food workers, social distancing plan for lines/service area, utensil types.) OK Question Title * 20. Restrooms: What is your plan to avoid restroom congestion? Please describe your plan to prevent crowding in these areas and your cleaning process. OK Question Title * 21. Cleaning: Please describe your plan for cleaning of the facility. (Consider the following: who is cleaning, how often is cleaning occurring, how are you ensuring that the cleaning occurs?) * OK Question Title * 22. Hand Hygiene: Please check all of the following places you plan to offer hand washing or hand sanitizer for attendees. Entry of facility Restrooms Anywhere food is served Common spaces Other (please specify) OK Question Title * 23. Masking: On 7/15/20 Governor Bullock issued a directive for the mandatory use of face coverings in public spaces. The directive can be found here: https://covid19.mt.gov/Portals/223/Documents/Mask%20Directive%20FINAL.pdf?ver=2020-07-15-140109-633 Please provide information on how you plan to ensure this directive is met during your event. * OK Question Title * 24. Any additional details you would like us to know about. OK Question Title * 25. If attaching additional files to your plan submission. PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only. Choose File Choose File No file chosen Remove File If attaching additional files to your plan submission. OK DONE