EP - Operational Status Reporting - 2022

Please take a moment to tell us your operational status for the incoming event. Please be sure to enter information for each of your site locations. We ask that status updates be submitted before 6am and 1pm for reporting purposes.

If the information you enter here changes, you can re-enter this survey and update your information.

Should you have any questions or concerns, please do not hesitate to contact League staff (twright@massleague.org, jbroderick@massleague.org or the emergency duty officer emergency@massleague.org). Thank you.

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* 1. Your info:

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* 2. Which region is this site in? For those with multiple sites, please feel free to check all regions you are reporting on.
(Unsure what region you are in, visit: https://matracking.ehs.state.ma.us/hmcc_regions/hmcc_regions.html)

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* 3. Based on the forecast for the pending event, will your health center be operational for the next few days (please check starting with whatever day tomorrow is, e.g. if today is Wednesday, report tomorrow's operational status by checking Thursday, and so on. You may check more than one if applicable):

  Mon Tues Wed Thurs Fri Sat Sun
Uncertain at this time
FULLY OPERATIONAL all day
MODIFIED SERVICES / TELEHEALTH only, switching to remote operations
REDUCED SERVICES / STAFFING for urgent care needs only
DELAYED OPENING / Reduced hours of operations
CLOSING EARLY / Reduced hours of operations
CLOSED due to event
CLOSED - as per normal schedule, not event related

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* 4. Has your health center sustained any damage? (Skip if not applicable)

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* 5. Have you communicated any changes in operations to anyone else? (Skip if not applicable.)
Please note that in order to reduce your reporting burden, the League will use the information collected in this survey to inform regional Health & Medical Coordinating Coalitions (HMCCs) and MDPH Office of Preparedness and Emergency Management (OPEM) of your operational status, as appropriate.

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* 6. Do you need any assistance, from the League or other agencies? If yes, we will contact you directly.

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* 7. What are your top priorities at this time?

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* 8. As a precaution, please provide us with your health center's emergency contact information (if different from above):

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* 9. Please share any other information that you feel is important for us to know. Thank you.

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