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Staff and Personnel Impact

ICR 202205-0920-010 · OMB 0920-1317 · Object 121628701.

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Record metadata
File Type	application/vnd.openxmlformats-officedocument.wordprocessingml.document
File Title	Staff and Personnel Impact
Author	Wattenmaker, Lauren (CDC/DDID/NCEZID/DHQP)
Last Modified By	Writer
File Modified	2020-09-23
File Created	2026-10-30
Conversion State	complete

Extracted Text

COVID-19 Module
Long Term Care Facility: Staff and Personnel Impact 

NHSN Facility ID: 
CMS Certification Number (CCN):  
Facility Name:    

*Date for which responses are reported: ________/________/________

For the following questions, please collect data at the same time at least once a week (for example, 7 AM)


*Required for saving