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					                                                                                                                 State Scoring


  Project Area:                                                                                                           Assessment Date:

        Reviewer:                                                                                                                Final Score:

                                                Baseline Data for Review                                                             Number                      Comments
    1               State population

    2               Total number of county and/or city health departments

    3               Number of jurisdictions required to develop mass prophylaxis planning

                    Number of validated Receive, Stage, Store facilities, both back-up and primary.
    4
                    4a-d relate to the specific types of RSS facilities within the project areas.

            a       Number of RSS sites that are government owned (e.g., state buildings, county buildings, etc.)

                    Number of RSS sites that are private business (e.g., professional warehousing company, logistics
            b
                    business, etc.)

            c       Number of RSS sites that are military installations (e.g., active duty base, National Guard assets)

            d       Number of RSS sites that are not listed in 4a-c (please explain in comments)

                    Number of Regional Distribution Sites, if applicable. If not applicable, put N/A.
    5
                    5a-d relate to the specific types of RDS facilities within the project areas.

            a       Number of RDS sites that are government owned (e.g., state buildings, county buildings, etc.)

                    Number of RDS sites that are private business (e.g., professional warehousing company, logistics
            b
                    business, etc.)

            c       Number of RDS sites that are military (e.g., active duty base, National Guard units)

            d       Number of RDS sites that are not listed in 5a-c (please explain in comments)

                    Which level of government is responsible for distribution to points of dispensing?
    6
                    6a-d relate to the specific types of distribution assets within the project area.
                    Distribution assets that are government assets (e.g., state public works, department of transportation,
            a
                    etc.)

            b       Distribution assets are military (e.g., active duty, National Guard)

                    Distribution assets are from private business (e.g., logistics company, warehousing company, delivery
            c
                    services, etc.)

            d       Distribution assets are from agencies other than those listed in 6a-c (please explain in comments)

    7               Which level of government is responsible for distribution to hospitals/alternate care facilities?

                    Indicate if distribution assets to hospitals/alternate care facilities differ from those answered in 6a-d
                    above
                    Estimated number of personnel needed to staff 100% of state-level functions for a mass prophylaxis
    8
                    campaign and/or medical supplies management and distribution.
                    Current number of personnel on hand to staff state-level functions for a mass prophylaxis campaign
    9
                    and/or medical supplies management and distribution.

   10               Number of Points of Dispensing (Statewide)

   11               Number of hospitals/alternate care facilities (Statewide)




9d0de67e-eee0-462d-ae60-1e96b6130d59.xls                                                                          Sensitive But Unclassified Information (SBU)              1
                                                                                                                                         State Scoring


   Section 1:        Developing SNS Plan (3%)
    1                State SNS planning elements are incorporated in the state’s all hazards-plan and the plan is NIMS-compliant.
    2                State SNS planning elements are updated annually based on deficiencies revealed during SNS Program Technical Assistance Reviews, and state/local trainings and exercises.
    3                Multi-discipline Planning/Advisory Group meets annually to review and updated the SNS planning elements in the all-hazards plan.
    4                Acknowledgement from state agencies/organizations with roles/responsibilities in SNS planning elements.
    5                Policies and procedures to support medical supplies management and distribution/mass prophylaxis operations are outlined in plan.
    6                Legal issues to support medical supplies management and distribution/mass prophylaxis operations are outlined (origin citations should be included) in plan.
              0.00             Total Points Scored Divided by 6 (Total Number of Elements) =                                       0.00


   Section 2:        Management of SNS(10%)
    1                The state SNS Coordinator and back-up are identified and has POC information.
    2                State personnel (primary and back-up) identified with documented contact information.
    3                Call-down rosters for personnel identified in item 2.2 are current and updated at least quarterly.
    4                State conducts and documents call-down exercises of all personnel identified in item 2.2 to test response rates quarterly.
    5                SNS functions are integrated within the State Incident Command System (ICS) structure and are NIMS compliant.
    6                The state has a plan to annually test and exercise notification and activation of volunteers below the state level positions identified in item 2.2.
              0.00             Total Points Scored Divided by 6 (Total Number of Elements) =                                       0.00


   Section 3:        Request SNS (3%)
    1                Signed MOA between CDC and state.
    2                Plan to communicate with the Governor and other key state officials to discuss incident to determine when to request SNS materiel.
    3                Personnel (one or more) authorized by the governor to request SNS materiel are identified in the plan with contact information.
    4                State plans and procedures contain initial request justification guidelines and procedures for state to request SNS materiel from CDC.
    5                State plans contain procedures to request resupply of SNS materiel from CDC.
    6                State plans contain the request procedures for locals to request SNS materiel from the state.
              0.00             Total Points Scored Divided by 6 (Total Number of Elements) =                                       0.00


   Section 4:        Communications Plan (Tactical) (3%)
    1                Tactical communication and/or IT support call-down lists are reviewed and updated quarterly.
    2                Communications/IT support has a job action sheet.
    3                Communication pathways are established between command and management locations and support agencies.
    4                Communication networks (equipment/hardware) between command and management locations and support agencies are tested and exercised at least quarterly.
    5                Redundant communications systems are in place to ensure communications in the event primary communication systems are unavailable and are tested at least quarterly.
    6                Designated personnel (identified in item 2.2) are trained in the use of redundant communications equipment.
              0.00             Total Points Scored Divided by 6 (Total Number of Elements) =                                       0.00




9d0de67e-eee0-462d-ae60-1e96b6130d59.xls                                                                                                  Sensitive But Unclassified Information (SBU)           2
                                                                                                                                          State Scoring


    Section 5:            Public Information & Communication (7%)
     1                    Public information and communication personnel (primary and back-up) have been identified and trained regarding responsibilities associated with a mass prophylaxis campaign.
     2                    Written communication plan includes messages, methods, and materials for use in a mass prophylaxis campaign or when medical supplies management and distribution efforts are required.
     3                    The state has developed mass prophylaxis campaign messages and provided guidance to the locals to ensure message consistency for the identified areas.
     4                    The state reviews local plans and provides guidance to locals on methods to disseminate the messages indicated in item 5.3 above.
     5                    The state reviews local plans and provides guidance to locals on developing materials to ensure consistent state-wide information.
     6                    The state reviews plans and provides guidance to locals on at-risk populations.
                   0.00              Total Points Scored Divided by 6 (Total Number of Elements) =                                  0.00


    Section 6:            Security (10%)
     1                    Overall security issues have been trained on the specific security requirements for medical supplies management and distribution operations.
     2                    Security plans for transportation of medical materiel have been developed.
     3                    Badging procedures are in place for all personnel responding to a public health event involving medical materiel and resources.
     4                    RSS site specific security plans have been developed.
     5                    Standardized security planning guidance and checklists (for PODs, regional distribution sites etc.) have been developed and distributed to local health departments.
                   0.00              Total Points Scored Divided by 5 (Total Number of Elements) =                                  0.00


    Section 7:            Receipt, Store, Stage (RSS) (14%)
     1                    The state RSS strategy expedites the movement of materiel to the sites designated in the state plan.
     2                    RSS facilities reviewed and validated by CDC SNS Consultant using RSS Site Survey Tool.
     3                    MOAs are in place for reviewed and validated RSS sites.
     4         0          The following RSS Managers/staff have been identified for each RSS facility:                                      Primary                  Back-up
                                                  RSS Manager/Leader
    Mark each positon identified with an "x"      Security Coordinator/Leader
                                                  Safety Manager/Leader
                                                   Communications/IT Manager/Leader
Each x is worth .5 points for a maximum total of 8 Inventory Control Manager/Leader
                      points.                      Shipping/Receiving Manager/Leader
                                              Pick Team Manager/Leader
                                              Quality Control Manager/Leader
     5                    RSS Leaders/Managers and back-ups have job action sheets and have been trained in RSS Operations.
     6                    Safety Manager/Leader and back-ups have job action sheet and have been trained in their RSS function.
     7                    Communications/IT Support and back ups have job action sheet and have been trained in their RSS function.
     8                    Inventory Manager/Leader and back-ups have job action sheet and have been trained in their RSS function.
     9                    Shipping/Receiving Manager/Leader and back-ups have job action sheet and have been trained in their RSS function.
    10                    Pick Team Manager/Leaders and back-ups have job action sheet and have been trained in their RSS function.
    11                    Quality Control Managers/Leaders and back-ups have job action sheet and have been trained in their RSS function.
    12                    Call-down rosters for 24/7 operations for all RSS Managers and staff/volunteers are reviewed for accuracy and tested at least quarterly.
    13                    Just-in-time (JIT) training materials have been developed for each of the RSS functions to familiarize personnel working within those functions.
    14                    An inventory of material handling equipment for each RSS site should be documented along with a list of materials/supplies that need to be procured and/or delivered at the time of event.
    15                    An inventory of office equipment for each RSS site should be documented along with a list of materials/supplies that will need to be delivered and/or procured at time of event.
    16                    The state plan lists individuals who are authorized to sign for SNS materiel.
    17                    The state plan addresses staff/volunteer management (for example, work breaks, shift schedules, meals/snacks, lodging, family care, etc.).
                   0.00             Total Points Scored Divided by 24 (Total Number of Elements) =                                  0.00




9d0de67e-eee0-462d-ae60-1e96b6130d59.xls                                                                                                    Sensitive But Unclassified Information (SBU)                               3
                                                                                                                                          State Scoring


   Section 8:        Controlling SNS Inventory (3%)
    1                Plan for Inventory Management System (IMS) in place with back-up.
    2                All inventory staff are trained in IMS functions.
    3                Chain of custody procedures are outlined in plan including the ability to track pharmaceutical lot numbers.
    4                The state plan lists DEA Registrant(s) to receive materiel from DSNS requiring DEA Form 222.
    5                Procedure for chain of custody involving controlled substances received from DSNS is outlined in plan.
    6                The state has registered with the DEA as a Distributor.
              0.00              Total Points Scored Divided by 6 (Total Number of Elements) =                                       0.00


   Section 9:        Repackaging (2%)
    1                Repacking Manager and back-up have a job action sheets and have been trained in their functions.
    2                Repackaging plan or contingent contracts have been developed.
    3                Just-in-time (JIT) training materials have been developed for the repackaging function.
              0.00              Total Points Scored Divided by 3 (Total Number of Elements) =                                       0.00


   Section 10:       Distribution (10%)
    1                Distribution Manager and back-up(s) have job action sheets and have been trained in their functions.
    2                Plan includes distribution strategy for delivery of medical materiel (such as delivery locations, routes, delivery schedule/frequency, fueling, repair, recovery, etc. ).
    3                Primary agency/organization has been assigned to distribute medical materiel and a written agreement is in place.
    4                Back-up agency/organization has been assigned to distribute medical materiel and a written agreement is in place.
    5                Resource needs have been identified and those resource needs are accessible to perform distribution activities.
    6                The state provides guidance for appropriate Material Handling Equipment (MHE) for sites that are designated to receive materiel.
    7                Just-in-time (JIT) training materials have been developed for the distribution functions.
              0.00              Total Points Scored Divided by 7 (Total Number of Elements) =                                       0.00


   Section 11:       Dispensing Prophylaxis (22%)
    1                The state has developed specific guidelines and templates for dispensing/POD management and disseminated to their local areas.
    2                The state coordinated the development of volunteer registries and tracks registration at the local level or provided volunteer registry development and tracking at the state level.
    3                The state can demonstrate that they have reviewed and provided annual feedback for all local and/or regional dispensing plans in the state.
    4                The state reviews local plans for appropriate numbers of dispensing sites/PODs to cover each jurisdiction’s population and has provided feedback to improve the jurisdiction’s coverage.
    5                The state reviews local plans to ensure adequate staffing (paid staff plus volunteers) for the identified dispensing sites/PODs and has provided feedback.
    6                The state reviews and provides feedback on local plans to ensure alternate methods of dispensing are being developed to augment POD shortages and supplement the POD system.
    7                The state reviews local plans to ensure procedures are in place to provide prophylaxis to local public health responders, local first responders, and other local critical infrastructure staff.
    8                The state has plans to provide prophylaxis to state-level public health responders, state-level first responders, and other state-level critical infrastructure staff.
    9                The state monitors local jurisdictions to ensure that yearly dispensing/POD training occurs or directly serves as the primary provider of dispensing/POD training to the local jurisdictions.
              0.00              Total Points Scored Divided by 9 (Total Number of Elements) =                                       0.00




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                                                                                                                                           State Scoring


   Section 12:              Hospitals and Alternate Care Facilities Coordination (3%)
     1                      Coordination exists between SNS Coordinator and Hospital Preparedness Coordinator to inform hospitals and alternate care facilities on how to procure emergency medical materiel.
     2                      Persons authorized to request emergency medical materiel on behalf of the hospitals and alternate care facilities have been identified and documented. Contact information is updated at least quarterly.
     3                      The state SNS plan includes documented procedures for hospitals and alternate care facilities to request emergency medical materiel.
     4                      Hospitals and alternate care facilities are trained on the emergency medical materiel request procedures.
     5                      Hospitals and alternate care facilities' request procedures have been exercised.
                     0.00             Total Points Scored Divided by 5 (Total Number of Elements) =                                     0.00


   Section 13:              Training, Exercise and Evaluation (10%)
     1                      Personnel have been assigned to lead, plan and oversee PHEP related training, exercise and evaluation.
     2                      The state has a training plan that incorporates mass prophylaxis, medical supplies management and distribution, and other SNS-specific topics.
     3                      Training plan components specific to mass prophylaxis and/or medical supplies management and distribution are implemented.
     4                      The state has an exercise plan developed in accordance with the Department of Homeland Security Exercise and Evaluation (HSEEP) that allows medical/mass prophy plans to be tested/evaluated.
     5                      The state has exercise plan components specific to mass prophylaxis and/or medical supplies management and distribution.
     6           0                                                                      Function                                         Trained (annually)     Exercised (annually)     After Action Report     Corrective Action Plan
                                                    Overall SNS Planning Elements
         Select the appropriate option from         Management of Operations
    the drop down menu for each section.            State-Federal Requesting SNS Procedures
                                                    Local-State Requesting SNS Procedures
 Each section is worth .5 points for a maximum      Communications Plan (Tactical)
               total of 24 points.                  Public Information and Communication
                                                    Security
           An unmarked section will be              RSS
              calculated as a zero.                 Inventory Management System
                                                    Distribution Methods
                                                    Local Dispensing Exercises Tracked
                                                    Hospitals and Alternate Care Facilities Coordination
                     0.00             Total Points Scored Divided by 29 (Total Number of Elements) =                                    0.00



                            Project Area:           0                                                                                                Date:          01/00/00                   Reviewer: 0

                                  Section                                      Function                                                  Earned Points          Section Points           Section Score            Section Weight          Weighted Score
                                                1   Developing a plan with SNS elements                                                      0.00                      6                      0.00                     0.03                    0.00
                                                2   Management of SNS                                                                        0.00                      6                      0.00                     0.10                    0.00
                                                3   Requesting SNS                                                                           0.00                      6                      0.00                     0.03                    0.00
                                                4   Communications Plan (Tactical)                                                           0.00                      6                      0.00                     0.03                    0.00
                                                5   Public Information and Communication                                                     0.00                      6                      0.00                     0.07                    0.00
                                                6   Security                                                                                 0.00                      5                      0.00                     0.10                    0.00
                                                7   Receipt, Store, Stage                                                                    0.00                     24                      0.00                     0.14                    0.00
                                                8   Controlling Inventory                                                                    0.00                      6                      0.00                     0.03                    0.00
                                                9   Repackaging                                                                              0.00                      3                      0.00                     0.02                    0.00
                                               10   Distribution                                                                             0.00                      7                      0.00                     0.10                    0.00
                                               11   Dispensing Prophylaxis                                                                   0.00                      9                      0.00                     0.22                    0.00
                                               12   Hospitals/Alternate Care Facilities                                                      0.00                      5                      0.00                     0.03                    0.00
                                               13   Training, Exercise and Evaluation                                                        0.00                     29                      0.00                     0.10                    0.00
                                                                                                                                                  Final TAR Score                             0.00
  Additonal Notes:




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                                                                                                             Local Scoring


        CRI MSA Affiliate:                                                                                                    Reviewer:
   County / Project Area /                                                                             Assessment
   Planning Jurisdiction:                                                                                 Date:                                               Final Score:

                                             Baseline Data for Review                                                         Number                                 Comments

    1           Local population covered by mass prophylaxis plan.


    2           Estimated hourly throughput to provide prophylaxis to 100% of the population in 48 hours.


    3           Total number of Points of Dispensing (PODs) needed to cover 100% of the population.


    4           Number of PODs identified with appropriate authorization.


    5           Number of PODs with documented site-specific plans.


    6           Number of POD sites with identified primary and back-up management teams.

                Estimated number of personnel needed to staff 100% of POD functions for a mass prophylaxis
    7
                campaign and/or medical supplies management and distribution.

                Current number of personnel on hand to staff POD functions for a mass prophylaxis campaign and/or
    8
                medical supplies management and distribution.
                Lines 9a-h relate to specific types of alternate dispensing modalities present in the project area.
                Line 9i relates to the estimated percentage of the population that will be served using alternate methods
    9
                of dispensing, relieving the burden on traditional POD sites. If no alternate forms of dispensing are
                identified in project area use N/A in the number column.
                Number of Closed PODs with healthcare entities/agencies (e.g., nursing homes, long term care facilities,
          a
                skilled nursing facilities, retirement homes, hospitals, etc.)

                Number of Closed PODs with private business (e.g., local chemical/power plant, grocery stores,
          b
                newspapers, banks, hardware stores, car companies, etc.)

                Number of Closed PODs with governmental agencies (e.g., local IRS offices, jails, juvenille detention
          c
                programs, county/city departments, tribal, etc.)

          d     Number of Closed PODs with military installations (e.g., active duty bases, National Guard units)

                Number of Closed PODs with academic institutions (e.g., universities, colleges, high schools, school
          e
                districts, elementary schools, etc.)

                Number of Closed PODs with community-based agencies (e.g., Meals on Wheels, agencies assisting
          f
                homeless, American Red Cross, United Way, VOAD, etc.)

          g     Number of drive-through PODs

                Number of PODS using other types of alternate dispensing modalities (please explain in comments
          h
                section)

          i     Percentage (estimated) of local population covered by all alternate dispensing modalities. (9a-h above)




9d0de67e-eee0-462d-ae60-1e96b6130d59.xls                                                                       Sensitive But Unclassified Information (SBU)                     6
                                                                                                                                 Local Scoring




  Section 1:      Developing a plan with SNS elements
    1             Local SNS planning elements are incorporated into the local all-hazards plan and are NIMS-compliant.
    2             Local SNS planning elements are updated annually based on deficiencies via assmnts, trngs, & exercs.
    3             Multi-discipline planning/advisory group meets annually.
    4             Documentation from local agencies/organizations with roles/responsibilities in SNS planning elements.
    5             State and local policies and procedures to support local operations referenced in plan.
    6             Legal issues to support operations are outlined in plan.
           0.00              Total Points Scored Divided by 6 (Total Number of Elements) =                                0.00


  Section 2:      Management of SNS (10%)
    1             Local POC information for SNS coordinator & back-up.
    2             Local planning leads identified & trained.
    3             Call-down rosters for personnel in 2.2 current and updated at least quarterly.
    4             Local jurisdiction conducts and documents call-down exercises of 2.2 quarterly.
    5             SNS functions integrated with local ICS and are NIMS compliant.
    6             Local jurisdiction has a plan to annually test and exercise volunteer notification and activation.
           0.00              Total Points Scored Divided by 6 (Total Number of Elements) =                                0.00


  Section 3:      Requesting SNS (3%)
    1             Plan to communicate with key local officials to request state assistance.
    2             POC(s) authorized by local health director in plan to request assistance from state.
    3             Local plan has initial request for SNS material from the state.
    4             Local plan has procedures to request re-supply of SNS material from state.
    5             Local plan has procedures for dispensing sites to request for SNS material.
           0.00              Total Points Scored Divided by 5 (Total Number of Elements) =                                0.00


  Section 4:      Communications Plan (Tactical) (3%)
    1             Communication/IT support call-down updated quarterly.
    2             Communication/IT support personnel have job action sheets.
    3             Communication pathways established between command and management .
    4             Redundant communication systems are in place.
    5             Communication networks, equipment & hardware are tested & exercised quarterly.
    6             Personnel in 2.2 trained in use of redunant communications equipment.
           0.00              Total Points Scored Divided by 6 (Total Number of Elements) =                                0.00




9d0de67e-eee0-462d-ae60-1e96b6130d59.xls                                                                                          Sensitive But Unclassified Information (SBU)   7
                                                                                                                                        Local Scoring


  Section 5:          Public Information & Communication (PIC) (7%)
      1               Local PIC personnel from 2.2 trained.
      2               Written PIC plan.
      3               PIC responsibilities appear on JAS of the PIC liaison or other designated dispensing staff.
      4               Messages have been developed at the local level.
      5               Methods to disseminate the messages in 5.4 have been developed at local level.
      6               Materials or templates have been developed and cleared.
      7               Local plan for communication needs of at-risk populations.
               0.00              Total Points Scored Divided by 7 (Total Number of Elements) =                                   0.00


  Section 6:          Security (10%)
      1               Local security coordinator trained, support agencies identified, oriented and contact information documented.
      2               Security plan for transportation of medical materiel have been developed.
      3               Security plans for RDS and/or dispensing sites have been developed.
      4               Badging procedures are in place for all personnel responding to public health event.
      5               Site-specific security plans developed for POD and/or RDS.
               0.00              Total Points Scored Divided by 5 (Total Number of Elements) =                                   0.00


  Section 7:          Regional/Local Distribution Site (14%) (Select NA from drop down if section is Not Applicable)
      1               RDS strategy expedites the movement of SNS material to PODs, hospitals, alternate care facilities.
      2               RDS facilities validated by state SNS Coordinator using RSS Site Survey Tool.
      3               MOAs are in place for validated RDS sites.
      4       0       POC & back-ups identified for each RDS facility:                                                                  Primary           Back-up
                                            RDS Manager
 Mark each positon identified with an "x"   Security Coordinator
                                            Safety Manager
                                            Communications/IT
 Each x is worth .5 points for a maximum    Inventory Control Manager
            total of 8 points.              Shipping/Receiving Manager
                                        Pick Team Manager
                                        Quality Control Manager
      5               RDS Managers & back-ups have job action sheets & are trained.
      6               Safety Managers & back-ups have job action sheets & are trained.
      7               Communications/IT Support & back-ups have job action sheets & are trained.
      8               Inventory Manager & back-ups have job action sheets & are trained.
      9               Shipping/Receiving Manager & back-ups have job action sheets & are trained.
    10                Pick Team Manager & back-ups have job action sheets & are trained.
    11                Quality Control Manager & back-ups have job action sheets & are trained.
    12                Call-down rosters for 24/7 operations are accurate & tested quarterly.
    13                Just-in-time (JIT) training materials developed for each of the RDS functions.
    14                Material handling equipment identified and inventoried at RDS.
    15                Office equipment identified and inventoried at RDS.
    16                Local plan list individuals who are authorized to sign for SNS materiel.
    17                Local plan addresses staff/volunteer management.
               0.00              Total Points Scored Divided by 24 (Total Number of Elements) =                                  0.00




9d0de67e-eee0-462d-ae60-1e96b6130d59.xls                                                                                                  Sensitive But Unclassified Information (SBU)   8
                                                                                                                                              Local Scoring


  Section 8:      Controlling Inventory (3%)
     1            Inventory management system (IMS) in place with back-up.
     2            All inventory staff are trained in IMS functions.
     3            Chain of custody procedures are outlined in plan, including ability to track pharmaceutical lot numbers.
     4            Procedure for chain of custody involving controlled substances received from DSNS outlined in plan.
     5            Local plan lists DEA registrant(s) to receive materiel from DSNS requiring DEA Form 222.
           0.00     Total Points Scored Divided by 5 (4 or 3 if NA) (Total Number of Elements) =                                     0.00


  Section 9:      Distribution (10%)                                                      (Select NA from drop down if section is Not Applicable)
     1            Distribution Manager & back-ups have job action sheets and are trained.
     2            Plan includes distribution strategy for delivery of medical materiel.
     3            Written plan & agreement for primary agency/organizaton to distribute medical materiel.
     4            Written plan & agreement for backup agency/organization to distribute medical materiel.
     5            Resource needs have been identified and are accessible to perform distribution activities.
     6            Guidance for material handling equipment (MHE) at regional distribution sites.
     7            Just-in-time (JIT) training materials developed for distribution functions.
           0.00              Total Points Scored Divided by 7 (Total Number of Elements) =                                           0.00


 Section 10: Dispensing Prophylaxis (24%)
     1            Local mass prophy/dispensing plan addressess procedures for operational issues.
     2            Local mass prophy/dispensing plan includes a rapid dispensing strategy for dispensing sites.
     3            Alternate dispensing modalities are included in the plan.
     4            Local mass prophy/dispensing plan has criteria to alter for increasing throughput.
     5            Procedures for providing prophy to first responders and critical personnel.
     6            Procedures for providing prophy to homebound and other at-risk populations.
     7            There are site specific plans for each of the dispensing/POD sites.
     8            Plan specifies how various items will be available at every dispensing/POD site.
     9            Core management teams have been identified and trained for each site.
    10            Personnel available to staff dispensing/POD sites.
    11            Volunteer/staff database is maintained and current.
    12            The plan includes job action sheets and JIT for all dispensing/POD roles identified.
    13            Local plan addresses staff/volunteer management.
           0.00              Total Points Scored Divided by 13 (Total Number of Elements) =                                          0.00




9d0de67e-eee0-462d-ae60-1e96b6130d59.xls                                                                                                        Sensitive But Unclassified Information (SBU)   9
                                                                                                                                             Local Scoring


 Section 11:                  Hospital/Alternate Care Facilities (3%)                         (Select NA from drop down if selection is Not Applicable)
      1                Process established where hospitals/ACF informed on procedures.
      2                POC(s) authorized to request materials for hospitals/ACF have been identified.
      3                Procedures for requesting SNS material documented for hospitals/ACF.
      4                Hospitals/ACF trained on emergency material request procedures.
      5                Hospitals/ACF exercised on request procedures.
               0.00               Total Points Scored Divided by 5 (Total Number of Elements) =                                      0.00


 Section 12: Training, Exercise and Evaluation (10%)
      1                Personnel have been assigned to lead, plan, and oversee PHEP related training, exercise and evaluation.
      2                Have a training plan that incorporates mass prophylaxis, medical supplies management and distribution, and other SNS-specific topics.
      3                Training plan components that are specific to mass prophylaxis and/or medical supplies management and distribution are implemented.
      4                Have an exercise plan developed in accordance with the Department of Homeland Security Exercise and Evaluation (HSEEP) that allows medical/mass prophy plans to be tested/evaluated.
      5                Exercise plan components that are specific to mass prophylaxis and/or medical supplies management and distribution.
      6       0                                                                    Function                                             Trained (annually)   Exercised (annually)   After Action Report   Corrective Action Plan
              0                             Overall SNS planning elements
   Select the appropriate option from       Management of SNS operations
  the drop down menu for each section.      Local to state requesting procedures
                                            POD to local requesting procedures
   Each section is worth .5 points for a    Communications plan (tactical)
      maximum total of 24 points.           Public information and communication
                                            Security
      An unmarked section will be           Inventory management system
         calculated as a zero.              Dispensing
                                            Hospitals and alternate care facilities coordination
                                            Regional/Local RDS plan
                                            Distribution methods


                                     0.00                                               With All Functions                                                     Divided By 29 (Total Elements)=                   0.00


                                 MSA: 0                                                                                                              Date:      01/00/00                    Reviewer: 0
                            Plan Area: 0

                            Section                                      Function                                                      Earned Points         Section Points         Section Score         Section Weight           Weighted Score
                               1            Overall SNS planning elements                                                                  0.00                   6.00                   0.00                  0.03                     0.00
                               2            Management of SNS operations                                                                   0.00                   6.00                   0.00                  0.10                     0.00
                               3            Requesting SNS                                                                                 0.00                   5.00                   0.00                  0.03                     0.00
                               4            Communications plan (tactical)                                                                 0.00                   6.00                   0.00                  0.03                     0.00
                               5            Public information and communication                                                           0.00                   7.00                   0.00                  0.07                     0.00
                               6            Security                                                                                       0.00                   5.00                   0.00                  0.10                     0.00
                               7            Receipt, store, stage                                                                          0.00                  24.00                   0.00                  0.14                     0.00
                               8            Inventory management system                                                                    0.00                   5.00                   0.00                  0.03                     0.00
                               9            Distribution                                                                                   0.00                   7.00                   0.00                  0.10                     0.00
                              10            Dispensing                                                                                     0.00                  13.00                   0.00                  0.24                     0.00
                              11            Hospitals and alternate care facilities coordination                                           0.00                   5.00                   0.00                  0.03                     0.00
                              12            Training, exercise and evaluation                                                              0.00                  29.00                   0.00                  0.10                     0.00
                                                                                                                                                Final TAR Score                          0.00                0.00000
Additonal Notes:




9d0de67e-eee0-462d-ae60-1e96b6130d59.xls                                                                                                        Sensitive But Unclassified Information (SBU)                                                        10

				
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Description: Volunteer Management Job Action Sheet Nims document sample