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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.
7ad9d7a027b147c7a661537e2c770e4b Atlantic  
7ad9d7a027b147c7a661537e2c770e4b Bergen 
7ad9d7a027b147c7a661537e2c770e4b Burlington 
7ad9d7a027b147c7a661537e2c770e4b Camden 
7ad9d7a027b147c7a661537e2c770e4b Cape May 
7ad9d7a027b147c7a661537e2c770e4b Cumberland 
7ad9d7a027b147c7a661537e2c770e4b Essex 
7ad9d7a027b147c7a661537e2c770e4b Gloucester 
7ad9d7a027b147c7a661537e2c770e4b Hudson 
7ad9d7a027b147c7a661537e2c770e4b Hunterdon 
7ad9d7a027b147c7a661537e2c770e4b Mercer 
7ad9d7a027b147c7a661537e2c770e4b Middlesex 
7ad9d7a027b147c7a661537e2c770e4b Monmouth 
7ad9d7a027b147c7a661537e2c770e4b Morris 
7ad9d7a027b147c7a661537e2c770e4b Ocean 
7ad9d7a027b147c7a661537e2c770e4b Passaic 
7ad9d7a027b147c7a661537e2c770e4b Salem 
7ad9d7a027b147c7a661537e2c770e4b Somerset 
7ad9d7a027b147c7a661537e2c770e4b Sussex 
7ad9d7a027b147c7a661537e2c770e4b Union 
7ad9d7a027b147c7a661537e2c770e4b 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?
4edd1048c33a4a44a79eb78eb50162e8 Yes 
4edd1048c33a4a44a79eb78eb50162e8 No 
If you have had COVID-19 personnel deaths, have you reported them to the NJDOH / ESF 8 desk?
4edd1048c33a4a44a79eb78eb50162e8 Yes 
4edd1048c33a4a44a79eb78eb50162e8 No 
Resources
What other resources does your department forecast may become critical?
7ad9d7a027b147c7a661537e2c770e4b NONE 
7ad9d7a027b147c7a661537e2c770e4b Personal Protective Equipment (PPE) 
7ad9d7a027b147c7a661537e2c770e4b Medical Supplies 
7ad9d7a027b147c7a661537e2c770e4b Support Personnel 
7ad9d7a027b147c7a661537e2c770e4b Other (please list resource) 
Has your agency utilized, or are they currently utilizing, any of the following waivers?
7ad9d7a027b147c7a661537e2c770e4b NONE 
7ad9d7a027b147c7a661537e2c770e4b BLS Triage to Home 
7ad9d7a027b147c7a661537e2c770e4b ALS Triage to Home 
7ad9d7a027b147c7a661537e2c770e4b BLS Crewmember Requirements 
7ad9d7a027b147c7a661537e2c770e4b MICU Crewmember Requirements 
7ad9d7a027b147c7a661537e2c770e4b SCTU Crewmember Requirements 
7ad9d7a027b147c7a661537e2c770e4b Unlicensed Vehicle 
7ad9d7a027b147c7a661537e2c770e4b Out of State BLS Provider 
7ad9d7a027b147c7a661537e2c770e4b BLS Certification Extension 
7ad9d7a027b147c7a661537e2c770e4b Expired EMT Re-Entry - COVID19 
7ad9d7a027b147c7a661537e2c770e4b Authorization for Paramedics to Work in Hospital Setting 
7ad9d7a027b147c7a661537e2c770e4b ALS Certification Extension 
7ad9d7a027b147c7a661537e2c770e4b Inactive to Active Paramedic 
7ad9d7a027b147c7a661537e2c770e4b Expired Paramedic Re-Entry - COVID19 
7ad9d7a027b147c7a661537e2c770e4b Executive order of One Paramedic Pronouncement