HRC Licensed Home 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. Vendor Name

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* 2. Vendor Number

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* 3. Are there any clients in your home that have tested positive for the Corona Virus?

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

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* 5. Are any of your residents symptomatic?

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* 6. If one of your residents become ill, do you have a area to keep them separate from other residents? 

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* 7. Are any of your residents still participating in day program, such as through remote contact with their day program provider?

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* 8. Are you adeequately staffed? 

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

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* 10. Do you have enough medication on hand for each resident?

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* 11. Do you have ample supplies for your residents?

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* 12. Do you have available capacity and are you willing to accept more residents?

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* 13. Has your staff received training on Center for Disease Control (CDC) precautions for avoiding exposure to illness and contagious disease?

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* 14. Have your clients received training on how to avoid illness?

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* 15. Do you have a masks? 

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