0920-1282 Form 5 - HAI/AR Program Staffing Directory

HAI/AR Program Staff Directory Tool
Jurisdiction

HAI/AR Program Staffing Directory
Page 1

__________________________________

HAI/AR Program Staffing Directory
This directory should include all staff affiliated with the HAI/AR program, regardless of
funding source. This includes staff engaged in HAI/AR Program activities that are partially or
fully funded by the Epidemiology Laboratory and Capacity (ELC) cooperative agreement (G1,
CARES, Enhancing Detection, Healthcare IPC Training (Project Firstline), American Rescue Plan
(SHARP and Nursing Home and Long Term Care Strike Teams) as well as staff engaged in
HAI/AR Program activities funded by other sources (state funds, etc.).
Instructions: 
One form should be completed for each staff member affiliated with the HAI/AR Program.
When adding or editing a staff members information, please use these instructions.
Enter the staff member’s first and last name. If entering something other than a staff
member name, such as an organizational mailbox, please use the comment box at the bottom
of the form to explain. Enter a nickname or preferred name, if applicable. Enter the applicable
contact email address.Note: If you would like to enter an organizational mailbox, please enter
that email address and enter a comment in the comment box explaining. You do not need to
complete the rest of the form, just save and leave the form as incomplete. Select the funding
source(s) of this staff member. If “other” was selected, please enter the appropriate funding
source in the specify field that appears in the row below. Enter the date that the staff member
was onboarded or hired in the format MM/YYYY. Select whether or not this staff member is a
contractor. Select “Yes” if the staff member is not a health department employee but is
employed separately and is embedded at the agency, and this staff member is included in the
Personnel” section of your budget. Select “No” if the staff member is a health department
employee, or if the staff member is hired by a contracting organization that is included in the
“Other” section of your budget. Indicate whether or not this staff member is the HAI/AR
Program Coordinator. If not, please indicate if this person should have the same access and
rights to sensitive information as a HAI/AR coordinator on question 7a. Selecting “Yes” on 7a
will designate this staff member as a HAI/AR Program Coordinator Alternate. If this staff
person is listed as a HAI/AR Program Coordinator Alternate, they will have the same access as
the HAI/AR Program Coordinator and receive the same sensitive communications. Note: all
HAI/AR Program Coordinators and Alternates will be granted access to all HAI/AR REDCap
Performance Measure projects regardless of their selections made on the Staffing Directory.
Select “Yes” if this staff member is temporarily actingin a role to cover a vacancy. If the staff
member is temporarily acting to cover a vacancy, please indicate which role they are covering
in the specify field that appears as 8a. Indicate whether or not this staff member can perform
onsite and/or remote healthcare infection control assessments. Indicate if this staff member
has a clinical or non-clinical background. Indicate whether or not this staff member should
have
access to the HAI/AR Programs SharePoint Note: SAMS authentication
is required for
04/24/2023 10:53am
projectredcap.org

access. If an entered staff member does not yet have SAMS, or the appropriate activities in
SAMS, access will be delayed depending upon when the SAMS processes have been completed
by the staff member. If a SAMS invitation is needed, please email [email protected]. Please see
the SAMS section in the HAI/AR Program Staffing Directory User Guide for more information.
Please indicate whether or not this person should be given rights to your jurisdiction’s HAI/AR
Staffing Directory REDCap project to be able to add, edit, and remove staff members. Note:
SAMS authentication is required for access. If an entered staff member does not yet have
SAMS, or the appropriate activities in SAMS, access will be delayed depending upon when the
SAMS processes have been completed by the staff member. If a SAMS invitation is needed,
please email [email protected]. Please see the SAMS section in the HAI/AR Program Staffing
Directory User Guide for more information. Please indicate which SHARP project(s) this staff
member supports. Note: additional project specific sections will appear below for each project
selected, including those necessary to request REDCap access for project specific Performance
Measures. The project specific sections include, but are not limited to, additional items
related to the following: Part-time or full-time support Project specific roles Note: if none of
the roles listed apply, please select “Other” and type in the appropriate title. Contact lists
Project specific Performance Measure REDCap projects Note: SAMS authentication is required
for REDCap access. Please see the SAMS section for more information.

The AR Lab Network

does not utilize the HAI/AR Program Staffing Directory to manage their contact list, collect
staffing information, or manage access requests to their SharePoint site or REDCap
Performance Measures. AR Lab Network maintains their own contact list on their SharePoint
site, which can be updated directly by users with access. If you are unable to access this
SharePoint site, please email [email protected]. To request access to the AR Lab Network
(G2/SHARP Project 2) Performance Measure REDCap project, please email [email protected].
Regarding which G2-funded staff or lab staff should be included in the Staffing Directory,
please consider the following: If a staff member is funded by G2 and works on epi activities
(e.g., an epi-lab coordinator), they should be included in the Staffing Directory. If a staff
member is only working on laboratory activities, they should not be added to the staffing
directory.

We would like for this directory to be useful to all HAI/AR programs. If your

program is comfortable sharing this staff member’s information with all HAI/AR programs,
please select “Yes”. If your program does not wish to share this information, please select
“No”. The data collected from this question (e.g., name, email address, and role) will be
uploaded to a report that will be available on our HAI/AR SharePoint site and updated
regularly. This report will not be accessible by the public. The primary contact for other
jurisdictions is the person(s) in your HAI/AR program that regularly communicates with other
states. Select “Yes” for this field if this staff member should be considered the point of
contact for other jurisdictions. If so, please enter the best phone number where this person
can be reached. This phone number will also be published in the report that will be housed in
the HAI/AR SharePoint site as part of the directory for all HAI/AR programs to have access to.
Select “No” if this person should not be listed as the point of contact for other jurisdictions.
Note: Please do not list more than 3 people as primary contacts for other jurisdictions. If you
need to remove a staff member from the directory, please check the box in the “Remove this
staff member from the directory?” question. Once this box has been checked, we will remove
that person’s access to data and systems, then we will delete their data from the staffing
directory. Note: Please be mindful when selecting this box, as this action is not easily undone.
Also, please do not attempt to delete or overwrite any forms yourself; we need to be informed
for our internal processes. If you need to remove staff, please check this box and feel free to

not complete the remainder of the form. When you save the form as complete, you will get an
alert, but you can select "Ignore and leave record" to bypass this alert. Once everything in
the form has been edited or entered, please scroll down to the bottom of the page, change the
form status to “Complete” and click the “Save & Exit Form” button. For more information
about the form status’, please see step 3 of the REDCap section of the user guide.

HAI/AR Program Staffing Directory User Guide:
[Attachment: "HAIAR Program Staffing Directory User Guide.pdf"]
1. Staff Name (provide legal first and last name; or
organization)
2. Nickname or preferred name:

3. Email Address

4. This position is fully or partially funded by which
of the following sources (Select all that apply):

4a. If "other", please specify the other source

5. Date of onboarding/hire to the HAI/AR Program
(mm/yyyy):
6. Is this staff member a contractor (i.e., an
individual who is not a health department employee,
but is employed separately and is embedded in the
agency. This staff member would be included in the
"Personnel" section of the budget)?

__________________________________

__________________________________

__________________________________
ELC Core G1
ELC Core G2
ELC CARES
ELC Enhancing Detection (or Expansion)
ELC Healthcare IPC Training (Project Firstline)
ELC Strengthening HAI/AR Program Capacity (SHARP)
ELC Nursing Home Strike Teams (NHST)
Other

__________________________________

__________________________________
Yes
No
(This question relates to the Project Firstline
SHARP 5.1 Performance Measure)

Note: Staff hired by contracting organizations listed
under the "Other" section of the budget do not need to
be included in the staffing directory.
7. Is this staff member the HAI/AR Program
Coordinator?

Yes
No

7a. Should this staff member be listed as a HAI/AR
Program Coordinator Alternate (See instructions
above)?

Yes
No

8. Is this staff member acting in this position to
cover a vacancy?

Yes
No

Page 4

8a. Please specify which role this staff member is
covering:

__________________________________

9. Please indicate if this staff member can perform
any of the following healthcare infection control
assessments (Select all that apply):

Onsite Infection Control Assessments
Remote Infection Control Assessments
None of the above
(This question relates to the Response and
Prevention E.23 Performance Measure)

10. What type of background does this staff member
have?

Clinical
Non-Clinical
(This question relates to the Response and
Prevention E.23 Performance Measure)

11. Does this staff member need access to the HAI/AR
Program SharePoint site?

Yes
No

12. Should this person have access to add and remove
people from the HAI/AR Program Staffing Directory?

Yes
No

13. Which project areas does this staff member
support? (Select all that apply):

HAI/AR Response and Prevention (e.g. G1, SHARP
Project I)
Antibiotic Stewardship (e.g. G1, SHARP Project
III)
NHSN (e.g., DUAs, sentinel sites, validation, G1,
SHARP Project IV)
Project Firstline (e.g. G1, SHARP Project V)
Nursing Home Strike Teams

Please note - Selections for this question reveal
additional project specific sections below, including
access to Performance Measure projects.

HAI/AR Response and Prevention Details
Does this person support Response and Prevention
part-time or full-time?

Part-Time
Full TIme

Role(s):

Response and Prevention Lead
HAI Outbreak Lead
HAI Epidemiologist
AR Epidemiologist/AR Expert (as described in ELC
G1)
Infection Prevention and Control Expert
HAI/AR Dialysis Expert
Data Analyst
Administrative Support
Other

Please select all roles that apply. If a role is not
reflected in the options available, please select
"Other" and specify in the text field that appears.

If other, please specify:

04/24/2023 10:53am

__________________________________

projectredcap.org

Page 5

Does this person fulfill any of the following roles
for SHARP Project 1 optional activities?

Analytics & Evaluation Project point of contact
(Activity A4)
Outbreak Reporting Pilot point of contact
(Activity A5)
MDRO Prevention Epidemiologist (Activity B3)
MDRO Prevention Coordinator (Activity B3)
HAI Outbreak Response Capacity point of contact
(Activity C3)
Setting-specific Prevention Project point of
contact (Activity D2)
Device/Procedure Prevention point of contact
(Activity D3)
Injection Safety point of contact (Activity D4)
Health Equity Project point of contact (Activity
D5)
HAI/AR Strategic Planning point of contact
(Activity D6)
None of the above

How would you classify this staff member based on the definitions below (choose the one that best describes this
individual)?

Regional
Local
Central
From our perspective, this includes public health staff who primarily focus on HAI/AR response and prevention
activities in specific region(s) AND are either:
located at the regional office, OR strategically located in or near their assigned region(s) of the state
include:
government employees (state, regional, local) or contractors

This could

This does not include:

staff who are assigned to a single local health dept/jurisdiction (see LOCAL option), OR staff whose geographic
location is not related to their primary role (see CENTRAL option), OR staff who remotely provide support to facilities
or health departments but are not located in or near that region (see CENTRAL option) From our perspective, this
includes public health staff who primarily focus on HAI/AR response and prevention activities in a single local
jurisdiction AND are either:
located at the local health department, OR strategically located in or near their assigned local jurisdiction
could include:
government employees (state, regional, local) or contractors

This

This does not include:

regional staff (see LOCAL option), OR staff whose geographic location is not related to their primary role (cee
CENTRAL option)

From our perspective, this includes public health staff who primarily focus on HAI/AR response and prevention
activities AND are either:
located at the central office of the state health department, OR located somewhere other than the central office,
but whose geographic location is not related to their primary role
This could include:
government employees (state, regional, local) or contractors
(This question relates to the Response and Prevention E.23 and SHARP 1.2 Performance Measure)
04/24/2023
10:53am
Regional

Local

Central

projectredcap.org

Page 6

Does this central staff member support public health
HAI/AR expertise among local or regional public health
staff?
This could take the form of consulting on outbreak
responses or prevention activities, conducting
trainings or webinars, providing mentorship, or other
forms of capacity building to strengthen public health
HAI/AR capacity throughout the jurisdiction
Which Local Health Department?

Yes, this is the primary responsibility of this
staff member
Yes, this staff member has some responsibility
(but it is not their primary responsibility)
No, this is not the responsibility of this staff
member
(This question relates to the Response and
Prevention SHARP 1.2 Performance Measure)

__________________________________
(This question relates to the Response and
Prevention SHARP 1.2 Performance Measure)

Should this staff member be added to the HAI/AR
Response and Prevention contact list to receive
general, non-sensitive communications?

Yes
No

Should this staff member be invited to the MDRO
Containment call?

Yes
No

Should this staff member be added to the HAI/AR
Response and Prevention REDCap Performance Measures
project?

Yes
No

This staff member should be considered the Response
and Prevention primary point of contact
Antibiotic Stewardship Details
Does this person support Antibiotic Stewardship
part-time or full-time?

Part-Time
Full TIme
(This question relates to the Antibiotic
Stewardship SHARP 3.1 Performance Measure)

Role(s):

Antibiotic Stewardship Lead/Co-Lead
AS Expert (as described in ELC G1)
Pharmacist
Physician
Nurse/Nurse Practitioner
Epidemiologist/Analyst
Administrative Support
Other
(This question relates to the Antibiotic
Stewardship SHARP 3.1 Performance Measure)

Please select all roles that apply. If a role is not
reflected in the options available, please select
"Other" and specify in the text field that appears.

If other, please specify:

Is this staff member affiliated with or employed by
any partners:

04/24/2023 10:53am

__________________________________
(This question relates to the Antibiotic
Stewardship SHARP 3.1 Performance Measure)
Academic Institution
Healthcare System
Other partner
None of the above
(This question relates to the Antibiotic
Stewardship SHARP 3.1 Performance Measure)

projectredcap.org

Page 7

If other, please specify:

__________________________________
(This question relates to the Antibiotic
Stewardship SHARP 3.1 Performance Measure)

Should this staff member be added to the Antibiotic
Stewardship contact list to receive general,
non-sensitive communications?

Yes
No

Should this staff member be added to the Antibiotic
Stewardship REDCap Performance Measures project?

Yes
No

This staff member should be considered the Antibiotic
Stewardship primary point of contact
NHSN Details
Does this person support NHSN part-time or full-time?

Part-Time
Full TIme
(This question relates to the NHSN SHARP 4.1
Performance Measure)

Role(s):

NHSN Coordination Lead
Infection Preventionist
Pharmacist
Public Health Analyst
Administrative Support
Other
(This question relates to the NHSN SHARP 4.1
Performance Measure)

Please select all roles that apply. If a role is not
reflected in the options available, please select
"Other" and specify in the text field that appears.

If other, please specify:

Which activities does this staff member participate
in? Select all that apply

__________________________________
(This question relates to the NHSN SHARP 4.1
Performance Measure)
Provide technical assistance
Establishing and updating data use agreements
Forming sentinel sites for validation
Conduct HAI data validation
Financial support to AUR reporting
Identify and provide EHR incentive
None of the above
(This question relates to the NHSN SHARP 4.1
Performance Measure)

Should this staff member be added to the NHSN contact
list to receive general, non-sensitive communications?

Yes
No

Should this staff member be added to the NHSN REDCap
Performance Measures project?

Yes
No

This staff member should be considered the NHSN
primary point of contact
Project Firstline Details

04/24/2023 10:53am

projectredcap.org

Page 8

Does this person support Project Firstline part-time
or full-time?

Part-Time
Full TIme
(This question relates to the Project Firstline
SHARP 5.1 Performance Measure)

Is this person the Project Firstline lead for your
Jurisdiction?

Yes
No
(This question relates to the Project Firstline
SHARP 5.1 Performance Measure)

Role(s):

Clinician
Communication Specialist
Epidemiologist
Health Educator/Education Specialist
Infection Preventionist
Information Technology (e.g., Data Manager, Web
Administrator, etc.)
Consultant
Administrative Support (e.g., Receptionist,
Clerical Staff, Administrative assistant, etc.)
Other
(This question relates to the Project Firstline
SHARP 5.1 Performance Measure)

If a role is not reflected in the options available,
please select "Other" and specify in the text field
that appears.

Please specify the type of Clinician:

If other, please specify:

__________________________________
(This question relates to the Project Firstline
SHARP 5.1 Performance Measure)

__________________________________
(This question relates to the Project Firstline
SHARP 5.1 Performance Measure)

Should this staff member be added to the Project
Firstline contact list to receive general,
non-sensitive communications?

Yes
No

Should this staff member be added to the Project
Firstline REDCap Performance Measures project?

Yes
No

This staff member should be considered the Project
Firstline primary point of contact
Nursing Home Strike Team Details
Does this person support Nursing Home Strike Teams
part-time or full-time?

Part-Time
Full TIme

Should this staff member be added to the Nursing Home
Strike Team contact list to receive general,
non-sensitive communications, and access to the
Nursing Home Strike Team specific SharePoint site?

Yes
No

Should this staff member be added to the Nursing Home
Strike Team REDCap Performance Measures project?

Yes
No

04/24/2023 10:53am

projectredcap.org

Page 9

This staff member should be considered the Nursing
Home Strike Team primary point of contact

14. May we publish this person's information to a list
accessible to all HAI/AR programs?

Yes
No

15. This is the primary contact for other
jurisdictions to reach the [record-name] HAI/AR
Program

Yes
No

15a. Please provide this individuals phone number:

__________________________________

16. Remove this staff member from the directory?
Note: If you need to remove staff, please check this
box and feel free to not complete the remainder of the
form. When you save the form as complete, you will get
an alert, but you can select "Ignore and leave record"
to bypass this alert.
16a. Reason for removal:

Retired
Left the HAI/AR Program, but still works at the
Health Department
Left the Health Department
No available funds for this position
None of the above

Comments:
__________________________________________
Feedback on the Staffing Directory:
__________________________________________

04/24/2023 10:53am

projectredcap.org