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COVID-19 Impact

Reporting Week
Please select the week you are reporting.
Agency Name
Please list your agency's official name (No abbreviations).
Contact Person
Please list the name and email address of the person completing this report.
County
Please list the county (or counties) your agency serves.
d992f3b420404d17b4f3cbd00fbd5d05 Atlantic  
d992f3b420404d17b4f3cbd00fbd5d05 Bergen 
d992f3b420404d17b4f3cbd00fbd5d05 Burlington 
d992f3b420404d17b4f3cbd00fbd5d05 Camden 
d992f3b420404d17b4f3cbd00fbd5d05 Cape May 
d992f3b420404d17b4f3cbd00fbd5d05 Cumberland 
d992f3b420404d17b4f3cbd00fbd5d05 Essex 
d992f3b420404d17b4f3cbd00fbd5d05 Gloucester 
d992f3b420404d17b4f3cbd00fbd5d05 Hudson 
d992f3b420404d17b4f3cbd00fbd5d05 Hunterdon 
d992f3b420404d17b4f3cbd00fbd5d05 Mercer 
d992f3b420404d17b4f3cbd00fbd5d05 Middlesex 
d992f3b420404d17b4f3cbd00fbd5d05 Monmouth 
d992f3b420404d17b4f3cbd00fbd5d05 Morris 
d992f3b420404d17b4f3cbd00fbd5d05 Ocean 
d992f3b420404d17b4f3cbd00fbd5d05 Passaic 
d992f3b420404d17b4f3cbd00fbd5d05 Salem 
d992f3b420404d17b4f3cbd00fbd5d05 Somerset 
d992f3b420404d17b4f3cbd00fbd5d05 Sussex 
d992f3b420404d17b4f3cbd00fbd5d05 Union 
d992f3b420404d17b4f3cbd00fbd5d05 Warren 
Personnel
What is your total number of personnel?
How many of your personnel are currently out sick due to testing positive for COVID-19?
How many of your personnel have been hospitalized due to COVID-19?
How many of your personnel are currently out due to self-quarantine for possible COVID-19 exposure?
How many of your personnel are currently out due to other reasons?
How many of your personnel were previously quarantined and have since returned to full duty?
Have any of your personnel succumbed to a COVID-19 related illness?
b537eae66a01483d946a0e8a57342b2f Yes 
b537eae66a01483d946a0e8a57342b2f No 
If you have had COVID-19 personnel deaths, have you reported them to the NJDOH / ESF 8 desk?
b537eae66a01483d946a0e8a57342b2f Yes 
b537eae66a01483d946a0e8a57342b2f No 
Resources
What other resources does your department forecast may become critical?
d992f3b420404d17b4f3cbd00fbd5d05 NONE 
d992f3b420404d17b4f3cbd00fbd5d05 Personal Protective Equipment (PPE) 
d992f3b420404d17b4f3cbd00fbd5d05 Medical Supplies 
d992f3b420404d17b4f3cbd00fbd5d05 Support Personnel 
d992f3b420404d17b4f3cbd00fbd5d05 Other (please list resource) 
Has your agency utilized, or are they currently utilizing, any of the following waivers?
d992f3b420404d17b4f3cbd00fbd5d05 NONE 
d992f3b420404d17b4f3cbd00fbd5d05 BLS Triage to Home 
d992f3b420404d17b4f3cbd00fbd5d05 ALS Triage to Home 
d992f3b420404d17b4f3cbd00fbd5d05 BLS Crewmember Requirements 
d992f3b420404d17b4f3cbd00fbd5d05 MICU Crewmember Requirements 
d992f3b420404d17b4f3cbd00fbd5d05 SCTU Crewmember Requirements 
d992f3b420404d17b4f3cbd00fbd5d05 Unlicensed Vehicle 
d992f3b420404d17b4f3cbd00fbd5d05 Out of State BLS Provider 
d992f3b420404d17b4f3cbd00fbd5d05 BLS Certification Extension 
d992f3b420404d17b4f3cbd00fbd5d05 Expired EMT Re-Entry - COVID19 
d992f3b420404d17b4f3cbd00fbd5d05 Authorization for Paramedics to Work in Hospital Setting 
d992f3b420404d17b4f3cbd00fbd5d05 ALS Certification Extension 
d992f3b420404d17b4f3cbd00fbd5d05 Inactive to Active Paramedic 
d992f3b420404d17b4f3cbd00fbd5d05 Expired Paramedic Re-Entry - COVID19 
d992f3b420404d17b4f3cbd00fbd5d05 Executive order of One Paramedic Pronouncement