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  • Faith Based & Community Organization Planning Checklist

    Faith-Based & Community Organizations Pandemic Influenza Preparedness Checklist

    http://www.pandemicflu.gov/plan/faithcomchecklist.html

    Please note that documents in PDF format require Adobe's Acrobat Reader
    <TABLE cellSpacing=0 cellPadding=0 width="100%" summary="This table is used to format the page content"><TBODY><TR vAlign=top><TD class=padding10>Faith-Based & Community Organizations Pandemic Influenza Preparedness Checklist [PDF - 48KB] [En EspaŮol (PDF) (268KB)]
    Faith-Based & Community Organizations Pandemic Influenza Preparedness Checklist is also available for download in PDF format.

    The collaboration of Faith-Based and Community Organizations with public health agencies will be essential in protecting the publicís health and safety if and when an influenza pandemic occurs. This checklist provides guidance for religious organizations (churches, synagogues, mosques, temples, etc.), social service agencies that are faithbased, and community organizations in developing and improving influenza pandemic response and preparedness plans. Many of the points suggested here can improve your organizationís ability to protect your community during emergencies in general. You can find more information at www.pandemicflu.gov.
    <!-- top of page
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    Checklist Sections <TABLE summary="This table is used to format the page content"><TBODY><TR vAlign=top><TD width="50%"></TD><TD vAlign=top width="50%"></TD></TR></TBODY></TABLE><!-- top of page
    --><HR width="98%" SIZE=1>1. Plan for the impact of a pandemic on your organization and its mission:
    <TABLE class=MyTable cellSpacing=2 cellPadding=2 summary="This table is used to format the page content" border=0><TBODY><TR class=colorhead><TH>Task
    </TH><TH noWrap>Not Started
    </TH><TH noWrap>In Progress
    </TH><TH>Completed
    </TH></TR><TR id=color1 vAlign=top align=middle><TD scope="Key Staff" align=left>
    • Assign key staff with the authority to develop, maintain and act upon an influenza pandemic preparedness and response plan.
    </TD><TD vAlign=center scope="Not Started"><INPUT type=radio value="Not Started" name=status01>
    </TD><TD vAlign=center scope="In Progress"><INPUT type=radio value="In Progress" name=status01>
    </TD><TD vAlign=center scope=Completed><INPUT type=radio value=Completed name=status01>
    </TD></TR><TR id=color2 vAlign=top align=middle><TD scope="Planning Ahead" align=left>
    • Determine the potential impact of a pandemic on your organizationís usual activities and services. Plan for situations likely to require increasing, decreasing or altering the services your organization delivers.
    </TD><TD vAlign=center scope="Not Started"><INPUT type=radio value="Not Started" name=status02>
    </TD><TD vAlign=center scope="In Progress"><INPUT type=radio value=Completed name=status02>
    </TD><TD vAlign=center scope=Completed><INPUT type=radio value="In Progress" name=status02>
    </TD></TR><TR id=color1 vAlign=top align=middle><TD scope="Supply Interruption Plan" align=left>
    • Determine the potential impact of a pandemic on outside resources that your organization depends on to deliver its services (e.g., supplies, travel, etc.)
    </TD><TD vAlign=center scope="Not Started"><INPUT type=radio value="Not Started" name=status03></TD><TD vAlign=center scope="In Progress"><INPUT type=radio value="In Progress" name=status03></TD><TD vAlign=center scope=Completed><INPUT type=radio value=Completed name=status03></TD></TR><TR id=color2 vAlign=top align=middle><TD scope="Key Staff Hierarchy" align=left>
    • Outline what the organizational structure will be during an emergency and revise periodically. The outline should identify key contacts with multiple back-ups, role and responsibilities, and who is supposed to report to whom.
    </TD><TD vAlign=center scope="Not Started"><INPUT type=radio value="Not Started" name=status03></TD><TD vAlign=center scope="In Progress"><INPUT type=radio value="In Progress" name=status03></TD><TD vAlign=center scope=Completed><INPUT type=radio value=Completed name=status03></TD></TR><TR id=color1 vAlign=top align=middle><TD scope="Training on Plan" align=left>
    • Identify and train essential staff (including full-time, part-time and unpaid or volunteer staff) needed to carry on your organizationís work during a pandemic. Include back up plans, cross-train staff in other jobs so that if staff are sick, others are ready to come in to carry on the work.
    </TD><TD vAlign=center scope="Not Started"><INPUT type=radio value="Not Started" name=status04></TD><TD vAlign=center scope="In Progress"><INPUT type=radio value="In Progress" name=status04></TD><TD vAlign=center scope=Completed><INPUT type=radio value=Completed name=status04></TD></TR><TR id=color2 vAlign=top align=middle><TD scope="Practice Plan" align=left>
    • Test your response and preparedness plan using an exercise or drill, and review and revise your plan as needed.
    </TD><TD vAlign=center scope="Not Started"><INPUT type=radio value="Not Started" name=status05></TD><TD vAlign=center scope="In Progress"><INPUT type=radio value="In Progress" name=status05></TD><TD vAlign=center scope=Completed><INPUT type=radio value=Completed name=status05></TD></TR></TBODY></TABLE>top of page
    <HR width="98%" SIZE=1>2. Communicate with and educate your staff, members, and persons in the communities that you serve:
    <TABLE class=MyTable cellSpacing=2 cellPadding=2 summary="This table is used to format the page content" border=0><TBODY><TR class=colorhead><TH>Task
    </TH><TH noWrap>Not Started
    </TH><TH noWrap>In Progress
    </TH><TH>Completed
    </TH></TR><TR id=color1 vAlign=top align=middle><TD scope="Disseminate Current Information" align=left>
    • Find up-to-date, reliable pandemic information and other public health advisories from state and local health departments, emergency management agencies, and CDC. Make this information available to your organization and others.
    </TD><TD vAlign=center scope="Not Started"><INPUT type=radio value="Not Started" name=status08></TD><TD vAlign=center scope="In Progress"><INPUT type=radio value="In Progress" name=status08></TD><TD vAlign=center scope=Completed><INPUT type=radio value=Completed name=status08></TD></TR><TR id=color2 vAlign=top align=middle ?><TD scope="Disseminate Health Information" align=left>
    • Distribute materials with basic information about pandemic influenza: signs and symptoms, how it is spread, ways to protect yourself and your family (e.g., respiratory hygiene and cough etiquette), family preparedness plans, and how to care for ill persons at home.
    </TD><TD vAlign=center scope="Not Started"><INPUT type=radio value="Not Started" name=status09></TD><TD vAlign=center scope="In Progress"><INPUT type=radio value="In Progress" name=status09></TD><TD vAlign=center scope=Completed><INPUT type=radio value=Completed name=status09></TD></TR><TR id=color1 vAlign=top align=middle><TD scope="Targeted Information" align=left>
    • When appropriate, include basic information about pandemic influenza in public meetings (e.g. sermons, classes, trainings, small group meetings and announcements).
    </TD><TD vAlign=center scope="Not Started"><INPUT type=radio value="Not Started" name=status10></TD><TD vAlign=center scope="In Progress"><INPUT type=radio value="In Progress" name=status10></TD><TD vAlign=center scope=Completed><INPUT type=radio value=Completed name=status10></TD></TR><TR id=color2 vAlign=top align=middle ?><TD scope="Disseminate Preparedness Plan" align=left>
    • Share information about your pandemic preparedness and response plan with staff, members, and persons in the communities that you serve.
    </TD><TD vAlign=center scope="Not Started"><INPUT type=radio value="Not Started" name=status11></TD><TD vAlign=center scope="In Progress"><INPUT type=radio value="In Progress" name=status11></TD><TD vAlign=center scope=Completed><INPUT type=radio value=Completed name=status11></TD></TR><TR id=color1 vAlign=top align=middle><TD scope="Communications Plan" align=left>
    • Develop tools to communicate information about pandemic status and your organizationís actions. This might include websites, flyers, local newspaper announcements, pre-recorded widely distributed phone messages, etc.
    </TD><TD vAlign=center scope="Not Started"><INPUT type=radio value="Not Started" name=status12></TD><TD vAlign=center scope="In Progress"><INPUT type=radio value="In Progress" name=status12></TD><TD vAlign=center scope=Completed><INPUT type=radio value=Completed name=status12></TD></TR><TR id=color2 vAlign=top align=middle ?><TD scope=Reliability align=left>
    • Consider your organizationís unique contribution to addressing rumors, misinformation, fear and anxiety.
    </TD><TD vAlign=center scope="Not Started"><INPUT type=radio value="Not Started" name=status13></TD><TD vAlign=center scope="In Progress"><INPUT type=radio value="In Progress" name=status13></TD><TD vAlign=center scope=Completed><INPUT type=radio value=Completed name=status13></TD></TR><TR id=color1 vAlign=top align=middle><TD scope="Following Emergency Servicesí Directions" align=left>
    • Advise staff, members, and persons in the communities you serve to follow information provided by public health authorities--state and local health departments, emergency management agencies, and CDC.
    </TD><TD vAlign=center scope="Not Started"><INPUT type=radio value="Not Started" name=status14a></TD><TD vAlign=center scope="In Progress"><INPUT type=radio value="In Progress" name=status14a></TD><TD vAlign=center scope=Completed><INPUT type=radio value=Completed name=status14a></TD></TR><TR id=color2 vAlign=top align=middle><TD scope="Information Appropriateness" align=left>
    • Ensure that what you communicate is appropriate for the cultures, languages and reading levels of your staff, members, and persons in the communities that you serve.
    </TD><TD vAlign=center scope="Not Started"><INPUT type=radio value="Not Started" name=status14b></TD><TD vAlign=center scope="In Progress"><INPUT type=radio value="In Progress" name=status14b></TD><TD vAlign=center scope=Completed><INPUT type=radio value=Completed name=status14b></TD></TR></TBODY></TABLE>top of page
    <HR width="98%" SIZE=1>3. Plan for the impact of a pandemic on your staff, members, and the communities that you serve:
    <TABLE class=MyTable cellSpacing=2 cellPadding=2 summary="This table is used to format the page content" border=0><TBODY><TR class=colorhead><TH>Task
    </TH><TH noWrap>Not Started
    </TH><TH noWrap>In Progress
    </TH><TH>Completed
    </TH></TR><TR id=color1 vAlign=top align=middle><TD scope=Absences align=left>
    • Plan for staff absences during a pandemic due to personal and/or family illnesses, quarantines, and school, business, and public transportation closures. Staff may include full-time, part-time and volunteer personnel.
    </TD><TD vAlign=center scope="Not Started"><INPUT type=radio value="Not Started" name=status14></TD><TD vAlign=center scope="In Progress"><INPUT type=radio value="In Progress" name=status14></TD><TD vAlign=center scope=Completed><INPUT type=radio value=Completed name=status14></TD></TR><TR id=color2 vAlign=top align=middle ?><TD scope="Flu Vaccinations" align=left>
    • Work with local health authorities to encourage yearly influenza vaccination for staff, members, and persons in the communities that you serve.
    </TD><TD vAlign=center scope="Not Started"><INPUT type=radio value="Not Started" name=status15></TD><TD vAlign=center scope="In Progress"><INPUT type=radio value="In Progress" name=status15></TD><TD vAlign=center scope=Completed><INPUT type=radio value=Completed name=status15></TD></TR><TR id=color1 vAlign=top align=middle><TD scope="Mental Health" align=left>
    • Evaluate access to mental health and social services during a pandemic for your staff, members, and persons in the communities that you serve; improve access to these services as needed.
    </TD><TD vAlign=center scope="Not Started"><INPUT type=radio value="Not Started" name=status16></TD><TD vAlign=center scope="In Progress"><INPUT type=radio value="In Progress" name=status16></TD><TD vAlign=center scope=Completed><INPUT type=radio value=Completed name=status16></TD></TR><TR id=color2 vAlign=top align=middle ?><TD scope="Special Needs" align=left>
    • Identify persons with special needs (e.g. elderly, disabled, limited English speakers) and be sure to include their needs in your response and preparedness plan. Establish relationships with them in advance so they will expect and trust your presence during a crisis.
    </TD><TD vAlign=center scope="Not Started"><INPUT type=radio value="Not Started" name=status17></TD><TD vAlign=center scope="In Progress"><INPUT type=radio value="In Progress" name=status17></TD><TD vAlign=center scope=Completed><INPUT type=radio value=Completed name=status17></TD></TR></TBODY></TABLE>top of page
    <HR width="98%" SIZE=1>4. Set up policies to follow during a pandemic:
    <TABLE class=MyTable cellSpacing=2 cellPadding=2 summary="This table is used to format the page content" border=0><TBODY><TR class=colorhead><TH>Task
    </TH><TH noWrap>Not Started
    </TH><TH noWrap>In Progress
    </TH><TH>Completed
    </TH></TR><TR id=color1 vAlign=top align=middle><TD scope="Leave Policies" align=left>
    • Set up policies for non-penalized staff leave for personal illness or care for sick family members during a pandemic.
    </TD><TD vAlign=center scope="Not Started"><INPUT type=radio value="Not Started" name=status20></TD><TD vAlign=center scope="In Progress"><INPUT type=radio value="In Progress" name=status20></TD><TD vAlign=center scope=Completed><INPUT type=radio value=Completed name=status20></TD></TR><TR id=color2 vAlign=top align=middle ?><TD scope="Mandatory Sick Leave" align=left>
    • Set up mandatory sick-leave policies for staff suspected to be ill, or who become ill at the worksite. Employees should remain at home until their symptoms resolve and they are physically ready to return to duty (Know how to check up-to-date CDC recommendations).
    </TD><TD vAlign=center scope="Not Started"><INPUT type=radio value="Not Started" name=status21></TD><TD vAlign=center scope="In Progress"><INPUT type=radio value="In Progress" name=status21></TD><TD vAlign=center scope=Completed><INPUT type=radio value=Completed name=status21></TD></TR><TR id=color1 vAlign=top align=middle><TD scope="Flexible Work Hours" align=left>
    • Set up policies for flexible work hours and working from home.
    </TD><TD vAlign=center scope="Not Started"><INPUT type=radio value="Not Started" name=status22></TD><TD vAlign=center scope="In Progress"><INPUT type=radio value="In Progress" name=status22></TD><TD vAlign=center scope=Completed><INPUT type=radio value=Completed name=status22></TD></TR><TR id=color2 vAlign=top align=middle><TD scope="Daily Work Habits" align=left>
    • Evaluate your organizationís usual activities and services (including rites and religious practices if applicable) to identify those that may facilitate virus spread from person to person. Set up policies to modify these activities to prevent the spread of pandemic influenza (e.g. guidance for respiratory hygiene and cough etiquette, and instructions for persons with influenza symptoms to stay home rather than visit in person.)
    </TD><TD vAlign=center scope="Not Started"><INPUT type=radio value="Not Started" name=status22a></TD><TD vAlign=center scope="In Progress"><INPUT type=radio value="In Progress" name=status22a></TD><TD vAlign=center scope=Completed><INPUT type=radio value=Completed name=status22a></TD></TR><TR id=color1 vAlign=top align=middle><TD scope="Travel Restrictions" align=left>
    • Follow CDC travel recommendations during an influenza pandemic. Recommendations may include restricting travel to affected domestic and international sites, recalling non-essential staff working in or near an affected site when an outbreak begins, and distributing health information to persons who are returning from affected areas.
    </TD><TD vAlign=center scope="Not Started"><INPUT type=radio value="Not Started" name=status22b></TD><TD vAlign=center scope="In Progress"><INPUT type=radio value="In Progress" name=status22b></TD><TD vAlign=center scope=Completed><INPUT type=radio value=Completed name=status22b></TD></TR><TR id=color2 vAlign=top align=middle><TD scope="When to Effect Policies" align=left>
    • Set procedures for activating your organizationís response plan when an influenza pandemic is declared by public health authorities and altering your organizationís operations accordingly.
    </TD><TD vAlign=center scope="Not Started"><INPUT type=radio value="Not Started" name=status22c></TD><TD vAlign=center scope="In Progress"><INPUT type=radio value="In Progress" name=status22c></TD><TD vAlign=center scope=Completed><INPUT type=radio value=Completed name=status22c></TD></TR></TBODY></TABLE>top of page
    <HR width="98%" SIZE=1>5. Allocate resources to protect your staff, members, and persons in the communities that you serve during a pandemic:
    <TABLE class=MyTable cellSpacing=2 cellPadding=2 summary="This table is used to format the page content" border=0><TBODY><TR class=colorhead><TH>Task
    </TH><TH noWrap>Not Started
    </TH><TH noWrap>In Progress
    </TH><TH>Completed
    </TH></TR><TR id=color1 vAlign=top align=middle><TD scope="Health Imperatives" align=left>
    • Determine the amount of supplies needed to promote respiratory hygiene and cough etiquette and how they will be obtained.
    </TD><TD vAlign=center scope="Not Started"><INPUT type=radio value="Not Started" name=status23></TD><TD vAlign=center scope="In Progress"><INPUT type=radio value="In Progress" name=status23></TD><TD vAlign=center scope=Completed><INPUT type=radio value=Completed name=status23></TD></TR><TR id=color2 vAlign=top align=middle><TD scope="Focus on Service Imperatives" align=left>
    • Consider focusing your organizationís efforts during a pandemic to providing services that are most needed during the emergency (e.g. mental/spiritual health or social services).
    </TD><TD vAlign=center scope="Not Started"><INPUT type=radio value="Not Started" name=status24></TD><TD vAlign=center scope="In Progress"><INPUT type=radio value="In Progress" name=status24></TD><TD vAlign=center scope=Completed><INPUT type=radio value=Completed name=status24></TD></TR></TBODY></TABLE>top of page
    <HR width="98%" SIZE=1>6. Coordinate with external organizations and help your community:
    <TABLE class=MyTable cellSpacing=2 cellPadding=2 summary="This table is used to format the page content" border=0><TBODY><TR class=colorhead><TH>Task
    </TH><TH noWrap>Not Started
    </TH><TH noWrap>In Progress
    </TH><TH>Completed
    </TH></TR><TR id=color1 vAlign=top align=middle><TD scope="Emergency Services Expectations" align=left>
    • Understand the roles of federal, state, and local public health agencies and emergency responders and what to expect and what not to expect from each in the event of a pandemic.
    </TD><TD vAlign=center scope="Not Started"><INPUT type=radio value="Not Started" name=status30></TD><TD vAlign=center scope="In Progress"><INPUT type=radio value="In Progress" name=status30></TD><TD vAlign=center scope=Completed><INPUT type=radio value=Completed name=status30></TD></TR><TR id=color2 vAlign=top align=middle><TD scope="Collaboration with Emergency Services" align=left>
    • Work with local and/or state public health agencies, emergency responders, local healthcare facilities and insurers to understand their plans and what they can provide, share about your preparedness and response plan and what your organization is able to contribute, and take part in their planning. Assign a point of contact to maximize communication between your organization and your state and local public health systems.
    </TD><TD vAlign=center scope="Not Started"><INPUT type=radio value="Not Started" name=status31></TD><TD vAlign=center scope="In Progress"><INPUT type=radio value="In Progress" name=status31></TD><TD vAlign=center scope=Completed><INPUT type=radio value=Completed name=status31></TD></TR><TR id=color1 vAlign=top align=middle><TD scope="Emergency Services Coordination" align=left>
    • Coordinate with emergency responders and local healthcare facilities to improve availability of medical advice and timely/urgent healthcare services and treatment for your staff, members, and persons in the communities that you serve.
    </TD><TD vAlign=center scope="Not Started"><INPUT type=radio value="Not Started" name=status32></TD><TD vAlign=center scope="In Progress"><INPUT type=radio value="In Progress" name=status32></TD><TD vAlign=center scope=Completed><INPUT type=radio value=Completed name=status32></TD></TR><TR id=color2 vAlign=top align=middle><TD scope="Lessons Learned" align=left>
    • Share what youíve learned from developing your preparedness and response plan with other Faith- Based and Community Organizations to improve community response efforts.
    </TD><TD vAlign=center scope="Not Started"><INPUT type=radio value="Not Started" name=status33></TD><TD vAlign=center scope="In Progress"><INPUT type=radio value="In Progress" name=status33></TD><TD vAlign=center scope=Completed><INPUT type=radio value=Completed name=status33></TD></TR><TR id=color1 vAlign=top align=middle><TD scope="Local Organizational Networking" align=left>
    • Work together with other Faith-Based and Community Organizations in your local area and through networks (e.g. denominations, associations, etc) to help your communities prepare for pandemic influenza.
    </TD><TD vAlign=center scope="Not Started"><INPUT type=radio value="Not Started" name=status34></TD><TD vAlign=center scope="In Progress"><INPUT type=radio value="In Progress" name=status34></TD><TD vAlign=center scope=Completed><INPUT type=radio value=Completed name=status34></TD></TR><TR id=color2 style="LINE-HEIGHT: 2px" height=2><TD scope=""></TD><TD scope=""></TD><TD scope=""></TD><TD scope=""></TD></TR></TBODY></TABLE>top of page
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