Office of Head Start Survey on COVID-19 Mitigation Plan

Generic for ACF Program Monitoring Activities

COVID-19 Mitigation Plan Survey-July 2023

Office of Head Start Survey on COVID-19 Mitigation Plan

OMB: 0970-0558

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Office of Head Start Survey on
COVID-19 Mitigation Plan

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PAPERWORK REDUCTION ACT OF 1995 (Pub. L. 104-13) STATEMENT OF PUBLIC BURDEN: The purpose of this information collection is to gather information on Head Start grant recipient experiences in complying with Head Start requirements on implementing an evidence-based COVID-19 mitigation plan. Public reporting burden for this collection of information is estimated to average 5 minutes per response, including the time for reviewing instructions, gathering and maintaining the data needed, and reviewing the collection of information. This is a voluntary collection of information. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information subject to the requirements of the Paperwork Reduction Act of 1995, unless it displays a currently valid OMB control number. The OMB # is 0970-0558 and the expiration date is 11/30/2023. If you have any comments on this collection of information, please contact Jesse Escobar at [email protected].



  1. Does your program currently have an evidence-based COVID-19 mitigation plan1 in place?

    1. Yes

    2. No

    3. We have started this process but have not finalized a policy yet.


[If Q1 = B or C, then skip Q2 through Q6]


  1. Which best describes the role of your Health Services Advisory Committee (HSAC) in establishing an evidence-based COVID-19 mitigation policy?

    1. Our HSAC was significantly involved in developing our policy, we engaged with them frequently

    2. Our HSAC was consulted but did not play a significant role in developing our policy

    3. We did not consult our HSAC when developing our policy

    4. We do not have an established HSAC to consult with


  1. What strategies has your program utilized in the COVID-19 mitigation plan: [select all that apply]

    1. Ventilation and improvements to indoor air quality

    2. Additional outdoor time

    3. Staying up to date on COVID-19 vaccines

    4. Regular COVID-19 testing for staff, children, volunteers, and visitors

    5. Mask use

    6. Staying at home when sick

    7. Non-punitive paid sick leave policies and practices

    8. Infection control protocols (ex. respiratory etiquette, hand washing, cleaning, and disinfecting practices)

    9. COVID-19 exposure and case management protocols

    10. Conducting daily health checks

    11. Other, please specify: ____________


  1. What evidence-based sources did your program primarily use to inform the COVID-19 mitigation policy [select up to two]

    1. CDC guidance

    2. State, tribal, local, and territorial health departments, universities, and professional health organizations

    3. Caring for Our Children health and safety standards

    4. The National Center on Health, Behavioral Health, and Safety’s COVID-19: Health Considerations

    5. Other, please specify: _____________


  1. Is your COVID-19 mitigation policy adaptable to changing circumstances and conditions of COVID-19? For example, if there is a surge in the impact of COVID-19 in your community, does your policy allow you to scale up your mitigation strategies?

    1. Yes

    2. No

    3. Not sure


  1. Does your COVID-19 mitigation policy include a communication plan to help staff and families understand any changes in the specific mitigation strategies the program is using to respond to ongoing changing conditions of COVID-19 in the community?

    1. Yes

    2. No

    3. Not sure



  1. What challenges has your program experienced in the development or implementation of an evidence-based COVID-19 mitigation policy?

[text box]

1 As noted in the final rule, Mitigating the Spread of COVID-19 in Head Start Programs, evidence-based is an umbrella term that refers to using the best research evidence (e.g., found in health sciences literature) and clinical expertise (e.g., what health care providers know) in content development. Integrating the best available science with the knowledge and considered judgements from stakeholders and experts benefits Head Start children, families, and staff.

File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
AuthorHardie, Sarah (ACF) (CTR)
File Modified0000-00-00
File Created2023-08-01

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