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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.
f960d0792eb0438fb0440fc765de967e Atlantic  
f960d0792eb0438fb0440fc765de967e Bergen 
f960d0792eb0438fb0440fc765de967e Burlington 
f960d0792eb0438fb0440fc765de967e Camden 
f960d0792eb0438fb0440fc765de967e Cape May 
f960d0792eb0438fb0440fc765de967e Cumberland 
f960d0792eb0438fb0440fc765de967e Essex 
f960d0792eb0438fb0440fc765de967e Gloucester 
f960d0792eb0438fb0440fc765de967e Hudson 
f960d0792eb0438fb0440fc765de967e Hunterdon 
f960d0792eb0438fb0440fc765de967e Mercer 
f960d0792eb0438fb0440fc765de967e Middlesex 
f960d0792eb0438fb0440fc765de967e Monmouth 
f960d0792eb0438fb0440fc765de967e Morris 
f960d0792eb0438fb0440fc765de967e Ocean 
f960d0792eb0438fb0440fc765de967e Passaic 
f960d0792eb0438fb0440fc765de967e Salem 
f960d0792eb0438fb0440fc765de967e Somerset 
f960d0792eb0438fb0440fc765de967e Sussex 
f960d0792eb0438fb0440fc765de967e Union 
f960d0792eb0438fb0440fc765de967e 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?
e442d7bde2f94ecf9cc57c49081a183c Yes 
e442d7bde2f94ecf9cc57c49081a183c No 
If you have had COVID-19 personnel deaths, have you reported them to the NJDOH / ESF 8 desk?
e442d7bde2f94ecf9cc57c49081a183c Yes 
e442d7bde2f94ecf9cc57c49081a183c No 
Resources
What other resources does your department forecast may become critical?
f960d0792eb0438fb0440fc765de967e NONE 
f960d0792eb0438fb0440fc765de967e Personal Protective Equipment (PPE) 
f960d0792eb0438fb0440fc765de967e Medical Supplies 
f960d0792eb0438fb0440fc765de967e Support Personnel 
f960d0792eb0438fb0440fc765de967e Other (please list resource) 
Has your agency utilized, or are they currently utilizing, any of the following waivers?
f960d0792eb0438fb0440fc765de967e NONE 
f960d0792eb0438fb0440fc765de967e BLS Triage to Home 
f960d0792eb0438fb0440fc765de967e ALS Triage to Home 
f960d0792eb0438fb0440fc765de967e BLS Crewmember Requirements 
f960d0792eb0438fb0440fc765de967e MICU Crewmember Requirements 
f960d0792eb0438fb0440fc765de967e SCTU Crewmember Requirements 
f960d0792eb0438fb0440fc765de967e Unlicensed Vehicle 
f960d0792eb0438fb0440fc765de967e Out of State BLS Provider 
f960d0792eb0438fb0440fc765de967e BLS Certification Extension 
f960d0792eb0438fb0440fc765de967e Expired EMT Re-Entry - COVID19 
f960d0792eb0438fb0440fc765de967e Authorization for Paramedics to Work in Hospital Setting 
f960d0792eb0438fb0440fc765de967e ALS Certification Extension 
f960d0792eb0438fb0440fc765de967e Inactive to Active Paramedic 
f960d0792eb0438fb0440fc765de967e Expired Paramedic Re-Entry - COVID19 
f960d0792eb0438fb0440fc765de967e Executive order of One Paramedic Pronouncement