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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.
a5a5194e81a0439e82f51f13ba83af7f Atlantic  
a5a5194e81a0439e82f51f13ba83af7f Bergen 
a5a5194e81a0439e82f51f13ba83af7f Burlington 
a5a5194e81a0439e82f51f13ba83af7f Camden 
a5a5194e81a0439e82f51f13ba83af7f Cape May 
a5a5194e81a0439e82f51f13ba83af7f Cumberland 
a5a5194e81a0439e82f51f13ba83af7f Essex 
a5a5194e81a0439e82f51f13ba83af7f Gloucester 
a5a5194e81a0439e82f51f13ba83af7f Hudson 
a5a5194e81a0439e82f51f13ba83af7f Hunterdon 
a5a5194e81a0439e82f51f13ba83af7f Mercer 
a5a5194e81a0439e82f51f13ba83af7f Middlesex 
a5a5194e81a0439e82f51f13ba83af7f Monmouth 
a5a5194e81a0439e82f51f13ba83af7f Morris 
a5a5194e81a0439e82f51f13ba83af7f Ocean 
a5a5194e81a0439e82f51f13ba83af7f Passaic 
a5a5194e81a0439e82f51f13ba83af7f Salem 
a5a5194e81a0439e82f51f13ba83af7f Somerset 
a5a5194e81a0439e82f51f13ba83af7f Sussex 
a5a5194e81a0439e82f51f13ba83af7f Union 
a5a5194e81a0439e82f51f13ba83af7f 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?
223229d2702a43a0888bfd8f96d38dc7 Yes 
223229d2702a43a0888bfd8f96d38dc7 No 
If you have had COVID-19 personnel deaths, have you reported them to the NJDOH / ESF 8 desk?
223229d2702a43a0888bfd8f96d38dc7 Yes 
223229d2702a43a0888bfd8f96d38dc7 No 
Resources
What other resources does your department forecast may become critical?
a5a5194e81a0439e82f51f13ba83af7f NONE 
a5a5194e81a0439e82f51f13ba83af7f Personal Protective Equipment (PPE) 
a5a5194e81a0439e82f51f13ba83af7f Medical Supplies 
a5a5194e81a0439e82f51f13ba83af7f Support Personnel 
a5a5194e81a0439e82f51f13ba83af7f Other (please list resource) 
Has your agency utilized, or are they currently utilizing, any of the following waivers?
a5a5194e81a0439e82f51f13ba83af7f NONE 
a5a5194e81a0439e82f51f13ba83af7f BLS Triage to Home 
a5a5194e81a0439e82f51f13ba83af7f ALS Triage to Home 
a5a5194e81a0439e82f51f13ba83af7f BLS Crewmember Requirements 
a5a5194e81a0439e82f51f13ba83af7f MICU Crewmember Requirements 
a5a5194e81a0439e82f51f13ba83af7f SCTU Crewmember Requirements 
a5a5194e81a0439e82f51f13ba83af7f Unlicensed Vehicle 
a5a5194e81a0439e82f51f13ba83af7f Out of State BLS Provider 
a5a5194e81a0439e82f51f13ba83af7f BLS Certification Extension 
a5a5194e81a0439e82f51f13ba83af7f Expired EMT Re-Entry - COVID19 
a5a5194e81a0439e82f51f13ba83af7f Authorization for Paramedics to Work in Hospital Setting 
a5a5194e81a0439e82f51f13ba83af7f ALS Certification Extension 
a5a5194e81a0439e82f51f13ba83af7f Inactive to Active Paramedic 
a5a5194e81a0439e82f51f13ba83af7f Expired Paramedic Re-Entry - COVID19 
a5a5194e81a0439e82f51f13ba83af7f Executive order of One Paramedic Pronouncement