Attachment 5.
Environmental Health
FORM APPROVED
OMB No. 0920-0636
EXP DATE MM/DD/20YY
Public reporting burden of this collection of information is estimated to average 60 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to CDC/ATSDR Information Collection Review Office, 1600 Clifton Road NE, MS D-74, Atlanta, GA 30333; ATTN: PRA (0920-0636).
Environmental Health
What is the general epidemiologic and demographic description of this emergency?
What is/are the major illness(es)/ syndrome(s) or outcomes being reported and monitored during this emergency?
What are the operational challenges that (What are the operational challenges (lack of public health/medical personnel, lack of general volunteers, lack of adequate facilities, etc.) that hinder your operations for delivery of services?
What resource and/or personnel gaps are of concern to you during this public health incident response (e.g. epidemiology services, laboratory services, laboratory assays, laboratory technicians, ventilators, medications etc.)?
What additional funds or resources are needed to addresses these gaps?
What challenges have you encountered in working with your local health departments and/or private providers to establish the capacity to monitor disease outbreaks and health effects as a result of the public health incident?
What are the best practices related to your management of the current public health incident response?
Please describe the event?
Is the event likely to be intentional, unintentional, or unknown?
10. Is the public health emergency
A natural disaster
Chemical release
Radiologic release
Infectious disease
Other
11. Are resources from the strategic national stockpile required?
What existing systems are in place to conduct surveillance of health effects and are they sufficient?
What existing systems are in place to measure environmental contaminants of concern and are they sufficient?
What is the description of this chemical release emergency?
What is/are the toxic substances that was/were released?
How many people were exposed/affected and what are their demographic characteristics? What health services are being used as a result of the chemical release emergency?
Has the entire affected area been evacuated? If not what operational challenges (lack of HAZMAT, trained/public health/medical personnel, lack of PPE for responders, lack of general volunteers, lack of adequate facilities for decontamination or sheltering, etc.) hinder complete evacuation of the affected area?
Are all necessary decontamination sites operational?
How many (or what percentage) of your planned emergency shelters are operational? Is sheltering available for pets that were evacuated with their owners? How many special needs shelters are open?
Are there sufficient local resources to provide medical care to exposed individuals? Are there sufficient resources such as ventilators and medications to meet the needs of all injured persons?
What public health messaging are you implementing (e.g. carbon monoxide exposure, safe cleanup of debris/mood/etc)?
How are you handling the medical surge capacity? How many hospital beds are available in your district? Are you doing medical evacuations?
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
| Author | Radha Pennotti |
| File Modified | 0000-00-00 |
| File Created | 2021-02-01 |