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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.
1501e614cae44f8fab91b6310b287e9b Atlantic  
1501e614cae44f8fab91b6310b287e9b Bergen 
1501e614cae44f8fab91b6310b287e9b Burlington 
1501e614cae44f8fab91b6310b287e9b Camden 
1501e614cae44f8fab91b6310b287e9b Cape May 
1501e614cae44f8fab91b6310b287e9b Cumberland 
1501e614cae44f8fab91b6310b287e9b Essex 
1501e614cae44f8fab91b6310b287e9b Gloucester 
1501e614cae44f8fab91b6310b287e9b Hudson 
1501e614cae44f8fab91b6310b287e9b Hunterdon 
1501e614cae44f8fab91b6310b287e9b Mercer 
1501e614cae44f8fab91b6310b287e9b Middlesex 
1501e614cae44f8fab91b6310b287e9b Monmouth 
1501e614cae44f8fab91b6310b287e9b Morris 
1501e614cae44f8fab91b6310b287e9b Ocean 
1501e614cae44f8fab91b6310b287e9b Passaic 
1501e614cae44f8fab91b6310b287e9b Salem 
1501e614cae44f8fab91b6310b287e9b Somerset 
1501e614cae44f8fab91b6310b287e9b Sussex 
1501e614cae44f8fab91b6310b287e9b Union 
1501e614cae44f8fab91b6310b287e9b 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?
0747fcfd8a904f27bc9f290f364c75aa Yes 
0747fcfd8a904f27bc9f290f364c75aa No 
If you have had COVID-19 personnel deaths, have you reported them to the NJDOH / ESF 8 desk?
0747fcfd8a904f27bc9f290f364c75aa Yes 
0747fcfd8a904f27bc9f290f364c75aa No 
Resources
What other resources does your department forecast may become critical?
1501e614cae44f8fab91b6310b287e9b NONE 
1501e614cae44f8fab91b6310b287e9b Personal Protective Equipment (PPE) 
1501e614cae44f8fab91b6310b287e9b Medical Supplies 
1501e614cae44f8fab91b6310b287e9b Support Personnel 
1501e614cae44f8fab91b6310b287e9b Other (please list resource) 
Has your agency utilized, or are they currently utilizing, any of the following waivers?
1501e614cae44f8fab91b6310b287e9b NONE 
1501e614cae44f8fab91b6310b287e9b BLS Triage to Home 
1501e614cae44f8fab91b6310b287e9b ALS Triage to Home 
1501e614cae44f8fab91b6310b287e9b BLS Crewmember Requirements 
1501e614cae44f8fab91b6310b287e9b MICU Crewmember Requirements 
1501e614cae44f8fab91b6310b287e9b SCTU Crewmember Requirements 
1501e614cae44f8fab91b6310b287e9b Unlicensed Vehicle 
1501e614cae44f8fab91b6310b287e9b Out of State BLS Provider 
1501e614cae44f8fab91b6310b287e9b BLS Certification Extension 
1501e614cae44f8fab91b6310b287e9b Expired EMT Re-Entry - COVID19 
1501e614cae44f8fab91b6310b287e9b Authorization for Paramedics to Work in Hospital Setting 
1501e614cae44f8fab91b6310b287e9b ALS Certification Extension 
1501e614cae44f8fab91b6310b287e9b Inactive to Active Paramedic 
1501e614cae44f8fab91b6310b287e9b Expired Paramedic Re-Entry - COVID19 
1501e614cae44f8fab91b6310b287e9b Executive order of One Paramedic Pronouncement