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256819228700DOCUMENTATION COVER SHEET TEMPLATESFor use with PHAB Standards and Measures v1.5March 2020DOMAIN 5For each example submitted as documentation, complete the appropriate cover sheet template. Ensure that each required element for the measure is specified with a PDF page number and include any brief explanatory notes, if needed. The documentation cover sheet templates do not take the place of the Standards and Measures. Remember, each example must fit within the context of the Domain and standard and meet the intent of the measure, as described in the Purpose and Significance statements. Throughout the templates, specific words and phrases are underlined. These words and phrases are requirements that have been frequently missed. These underlines are intended to direct the reader to the element, but do not indicate that the word or phrase is more important than any other element of the requirement. Some measures include a “NOTE.” These notes are from PHAB’s Accreditation Specialists and are intended to help with the interpretation of the requirement.Please direct any measure interpretation questions to your assigned Accreditation Specialist. PHAB Documentation Cover PageMeasure # 5.1.1The monitoring and tracking of public health issues that are being discussed by individuals and entities that set policies and practices that impact on public healthRD # 1Monitoring/tracking of policies under consideration by the governing entity, elected officials, government officials, and/or other entities that set policies and practices that impact public healthExample # 1Required Elements from Guidance (including bulleted items)PDF Page Number(s) Explanatory Notes 1The health department must document that the department stays informed of the public issues that are being discussed by the health department’s governing entity, and by elected officials, individuals, and/or other entities that set policies and practices that impact on the health department or public health.Evidence of Authenticity and Date are required within the documentation itself. If this evidence is difficult to locate or is found within supporting documentation, please provide a brief explanation of the location here and/or provide the supporting documentation to demonstrate the date and/or evidence of authenticity. PHAB Documentation Cover PageMeasure # 5.1.1The monitoring and tracking of public health issues that are being discussed by individuals and entities that set policies and practices that impact on public healthRD # 1Monitoring/tracking of policies under consideration by the governing entity, elected officials, government officials, and/or other entities that set policies and practices that impact public healthExample # 2Required Elements from Guidance (including bulleted items)PDF Page Number(s) Explanatory Notes 1The health department must document that the department stays informed of the public issues that are being discussed by the health department’s governing entity, and by elected officials, individuals, and/or other entities that set policies and practices that impact on the health department or public health.Evidence of Authenticity and Date are required within the documentation itself. If this evidence is difficult to locate or is found within supporting documentation, please provide a brief explanation of the location here and/or provide the supporting documentation to demonstrate the date and/or evidence of authenticity. PHAB Documentation Cover PageMeasure # 5.1.2Engagement in activities that contribute to the development and/or modification of policy that impacts public healthRD # 1Contribution to deliberations concerning public policyExample # 1Required Elements from Guidance (including bulleted items)PDF Page Number(s) Explanatory Notes 1The health department must document that it has contributed to deliberations concerning public policy and practice and its impact on public health.The health department must engage with those who set policies, as well as with other stakeholders who can influence those who set policies.Identify which bullet the example relates to:*Each example must address one item listed in the guidance. The two examples must address two different items of the items listed rmational materials, for example, issue briefs, media statements, talking points, fact sheets, white papers, and other official written documents.Health department staff providing official department public testimony.Health department staff participation in an advisory or work group appointed by the governing entity, elected officials, or the health department director. The group must have a stated purpose or intent of providing advice or influencing health policy. Evidence of Authenticity and Date are required within the documentation itself. If this evidence is difficult to locate or is found within supporting documentation, please provide a brief explanation of the location here and/or provide the supporting documentation to demonstrate the date and/or evidence of authenticity. PHAB Documentation Cover PageMeasure # 5.1.2Engagement in activities that contribute to the development and/or modification of policy that impacts public healthRD # 1Contribution to deliberations concerning public policyExample # 2Required Elements from Guidance (including bulleted items)PDF Page Number(s) Explanatory Notes 1The health department must document that it has contributed to deliberations concerning public policy and practice and its impact on public health.The health department must engage with those who set policies, as well as with other stakeholders who can influence those who set policies.Identify which bullet the example relates to:*Each example must address one item listed in the guidance. The two examples must address two different items of the items listed below. Informational materials, for example, issue briefs, media statements, talking points, fact sheets, white papers, and other official written documents.Health department staff providing official department public testimony.Health department staff participation in an advisory or work group appointed by the governing entity, elected officials, or the health department director. The group must have a stated purpose or intent of providing advice or influencing health policy. Evidence of Authenticity and Date are required within the documentation itself. If this evidence is difficult to locate or is found within supporting documentation, please provide a brief explanation of the location here and/or provide the supporting documentation to demonstrate the date and/or evidence of authenticity. PHAB Documentation Cover PageMeasure # 5.1.3Informed governing entities, elected officials, and/or the public ofpotential intended or unintended public health impacts from current and/ or proposed policiesRD # 1Information provided to policy makers and/or the public about potential public health impacts of policies that are being considered or are in placeExample # 1Required Elements from Guidance (including bulleted items)PDF Page Number(s) Explanatory Notes 1The health department must document that it has informed policy makers and/or the public about potential public health impacts of policies that are being considered or are in place.Identify which bullet the example relates to:* Each example must address one of the items listed below. Examples must address different items listed.Impact statement or fact sheet that addresses current or proposed policies. The impact statements must be science-based. The health department must show to whom the statement or fact sheet was distributed.The distribution of correspondence, emails, briefing statements, or reports on policy impacts. If there is a discussion of policy issues and impacts, the documentation must include who in the health department participated, who was invited to participate, participant listing, what was discussed, meeting materials or agenda, and any follow- up to be completed.A presentation of evaluations or assessments of current and/or proposed policies. The presentation or the evaluation/assessment report and an agenda for the presentation. Evidence of Authenticity and Date are required within the documentation itself. If this evidence is difficult to locate or is found within supporting documentation, please provide a brief explanation of the location here and/or provide the supporting documentation to demonstrate the date and/or evidence of authenticity. PHAB Documentation Cover PageMeasure # 5.1.3Informed governing entities, elected officials, and/or the public of potential intended or unintended public health impacts from current and/ or proposed policiesRD # 1Information provided to policy makers and/or the public about potential public health impacts of policies that are being considered or are in placeExample # 2Required Elements from Guidance (including bulleted items)PDF Page Number(s) Explanatory Notes 1The health department must document that it has informed policy makers and/or the public about potential public health impacts of policies that are being considered or are in place.Identify which bullet the example relates to:* Each example must address one of the items listed below. Examples must address different items listed.Impact statement or fact sheet that addresses current or proposed policies. The impact statements must be science-based. The health department must show to whom the statement or fact sheet was distributed.The distribution of correspondence, emails, briefing statements, or reports on policy impacts. If there is a discussion of policy issues and impacts, the documentation must include who in the health department participated, who was invited to participate, participant listing, what was discussed, meeting materials or agenda, and any follow- up to be completed.A presentation of evaluations or assessments of current and/or proposed policies. The presentation or the evaluation/assessment report and an agenda for the presentation. Evidence of Authenticity and Date are required within the documentation itself. If this evidence is difficult to locate or is found within supporting documentation, please provide a brief explanation of the location here and/or provide the supporting documentation to demonstrate the date and/or evidence of authenticity. PHAB Documentation Cover PageMeasure # 5.2.1 S (State only)A process to develop a state health improvement planRD # 1State health improvement planning process that included:1 processRequired Elements from Guidance (including bulleted items)PDF Page Number(s) Explanatory Notes 1The state health department must document the collaborative state health improvement planning process.The state health department must document that the state health improvement planning process included all of the following:1aParticipation by a wide range of community partners representing various sectors of the community.1bData and information from the community health assessment provided to participants in the state health improvement planning process to use in their deliberations.1cEvidence that stakeholder discussions were held and that they identified issues and themes. The list of issues must be provided as documentation.1dAssets and resources identified and considered in the state health improvement planning process.1eA description of the process used by participants to develop a set of priority state health issues.Evidence of Authenticity and Date are required within the documentation itself. If this evidence is difficult to locate or is found within supporting documentation, please provide a brief explanation of the location here and/or provide the supporting documentation to demonstrate the date and/or evidence of authenticity. PHAB Documentation Cover PageMeasure # 5.2.1 L (Local only)A process to develop a community health improvement planRD # 1Community health improvement planning process that included:1 processRequired Elements from Guidance (including bulleted items)PDF Page Number(s) Explanatory Notes 1The local health department must document the collaborative community health improvement planning process.The local health department must document that the community health improvement planning process included all of the following:1aParticipation by a wide range of community partners representing various sectors of the community.1bData and information from the community health assessment provided to participants in the community health improvement planning process to use in their deliberations.1cEvidence that community and stakeholder discussions were held and that they identified issues and themes. Community members’ definition of health and of a healthy community must be included.The list of issues identified by the community and stakeholders must be provided as documentation.1dCommunity assets and resources identified and considered in the community health improvement planning process.1eA description of the process used by participants to develop a set of priority health issues.Evidence of Authenticity and Date are required within the documentation itself. If this evidence is difficult to locate or is found within supporting documentation, please provide a brief explanation of the location here and/or provide the supporting documentation to demonstrate the date and/or evidence of authenticity. PHAB Documentation Cover PageMeasure # 5.2.1 T (Tribal only)A process to develop a Tribal community health improvement planRD # 1Tribal community health improvement planning process that included:1 processRequired Elements from Guidance (including bulleted items)PDF Page Number(s) Explanatory Notes 1The Tribal health department must document the collaborative community health improvement process.The Tribal health department must document that the Tribal health improvement planning process included all of the following:1aParticipation by a wide range of community partners.1bData and information from the Tribal community health assessment provided to participants in the Tribal health improvement planning process to use in their deliberations.1cEvidence that stakeholder discussions were held and that they identified issues and themes. Community members’ definition of health and of a healthy community must be included.The list of issues must be provided as documentation.1dAssets and resources identified and considered in the Tribal community health improvement planning process.1eA description of the process used by participants to develop a set of priority Tribal health issues.Evidence of Authenticity and Date are required within the documentation itself. If this evidence is difficult to locate or is found within supporting documentation, please provide a brief explanation of the location here and/or provide the supporting documentation to demonstrate the date and/or evidence of authenticity. PHAB Documentation Cover PageMeasure # 5.2.2 S (State only)State health improvement plan adopted as a result of the health improvement planning processRD # 1State health improvement plan that includes:1 SHIPRequired Elements from Guidance (including bulleted items)PDF Page Number(s) Explanatory Notes 1The state health department must provide a state health improvement plan that includes all of the following:1aThe desired measurable outcomes or indicators of the health improvement effort and the priorities for action, from the perspective of the population of the state.The plan must include statewide health priorities, measurable objectives, improvement strategies and activities with time-framed targets that were determined in the community planning process.In establishing priorities, the plan must include consideration of addressing social determinants of health, causes of higher health risks and poorer health outcomes of specific populations, and health inequities.1bPolicy changes needed to accomplish the identified health objectives must be included in the plan.Policy changes must include those that are adopted to alleviate the identified causes of health inequity.1cDesignation of individuals and organizations that have accepted responsibility for implementing strategies outlined in the state health improvement plan.1dStates must demonstrate that they considered both Tribal and local health department health improvement priorities.Evidence of Authenticity and Date are required within the documentation itself. If this evidence is difficult to locate or is found within supporting documentation, please provide a brief explanation of the location here and/or provide the supporting documentation to demonstrate the date and/or evidence of authenticity. PHAB Documentation Cover PageMeasure # 5.2.2 L (Local only)Community health improvement plan adopted as a result of the community health improvement planning processRD # 1Community health improvement plan that includes:1 CHIPRequired Elements from Guidance (including bulleted items)PDF Page Number(s) Explanatory Notes 1The local health department must provide a community health improvement plan that includes all of the following:1aThe desired measurable outcomes or indicators of the health improvement effort and the priorities for action, from the perspective of community members.The plan must include community health priorities, measurable objectives, improvement strategies and activities with time-framed targets that were determined in the community planning process.In establishing priorities, the plan must include consideration of addressing social determinants of health, causes of higher health risks and poorer health outcomes of specific populations, and health inequities.1bPolicy changes needed to accomplish the identified health objectives must be included in the plan.Policy changes must include those that are adopted to alleviate the identified causes of health inequity.1cDesignation of individuals and organizations that have accepted responsibility for implementing strategies outlined in the community health improvement plan.1dLocal health departments must demonstrate that they considered both national and state health improvement priorities where they have been established.Evidence of Authenticity and Date are required within the documentation itself. If this evidence is difficult to locate or is found within supporting documentation, please provide a brief explanation of the location here and/or provide the supporting documentation to demonstrate the date and/or evidence of authenticity. PHAB Documentation Cover PageMeasure # 5.2.2 T (Tribal only)Tribal community health improvement plan adopted as a result of the health improvement planning processRD # 1Tribal health community improvement plan that includes:1 CHIPRequired Elements from Guidance (including bulleted items)PDF Page Number(s) Explanatory Notes 1The Tribal health department must provide a Tribal community health improvement plan that includes all of the following:1aThe desired measurable outcomes or indicators of the health improvement effort and the priorities for action, from the perspective of the population of the Tribe.The plan must include Tribal health priorities, measurable objectives, improvement strategies and activities with time-framed targets that were determined in the planning process.In establishing priorities, the plan must include consideration of addressing social determinants of health, causes of higher health risks and poorer health outcomes of specific populations, and health inequities.1bPolicy changes needed to accomplish the identified health objectives must be included in the plan.Policy changes must include those that are adopted to alleviate the identified causes of health inequity.1cDesignation of individuals and organizations that have accepted responsibility for implementing strategies outlined in the Tribal health improvement plan.1dTribes must demonstrate that they considered state, local and national health improvement priorities.Evidence of Authenticity and Date are required within the documentation itself. If this evidence is difficult to locate or is found within supporting documentation, please provide a brief explanation of the location here and/or provide the supporting documentation to demonstrate the date and/or evidence of authenticity. PHAB Documentation Cover PageMeasure # 5.2.3Elements and strategies of the health improvement plan implemented in partnership with othersRD # 1A process to track actions taken to implement strategies in the community health improvement plan1 report or a group of reportsRequired Elements from Guidance (including bulleted items)PDF Page Number(s) Explanatory Notes 1The health department must provide a tracking process of actions taken toward the implementation of the community health improvement plan.The tracking process must specify the strategies being used, the responsible partners involved, andthe status of the effort or results of the actions taken.Evidence of Authenticity and Date are required within the documentation itself. If this evidence is difficult to locate or is found within supporting documentation, please provide a brief explanation of the location here and/or provide the supporting documentation to demonstrate the date and/or evidence of authenticity. PHAB Documentation Cover PageMeasure # 5.2.3Elements and strategies of the health improvement plan implemented in partnership with othersRD # 2Implementation of the planExample # 1Required Elements from Guidance (including bulleted items)PDF Page Number(s) Explanatory Notes 2The health department must document areas of the plan that were implemented by the health department and/or its partners.Examples must identify a specific achievement and describe how it was accomplished.Evidence of Authenticity and Date are required within the documentation itself. If this evidence is difficult to locate or is found within supporting documentation, please provide a brief explanation of the location here and/or provide the supporting documentation to demonstrate the date and/or evidence of authenticity. PHAB Documentation Cover PageMeasure # 5.2.3Elements and strategies of the health improvement plan implemented in partnership with othersRD # 2Implementation of the planExample # 2Required Elements from Guidance (including bulleted items)PDF Page Number(s) Explanatory Notes 2The health department must document areas of the plan that were implemented by the health department and/or its partners.Examples must identify a specific achievement and describe how it was accomplished.Evidence of Authenticity and Date are required within the documentation itself. If this evidence is difficult to locate or is found within supporting documentation, please provide a brief explanation of the location here and/or provide the supporting documentation to demonstrate the date and/or evidence of authenticity. PHAB Documentation Cover PageMeasure # 5.2.4Monitor and revise as needed, the strategies in the community health improvement plan in collaboration with broad participation from stakeholders and partnersRD # 1Report on progress made in implementing strategies in the community health improvement planExample # 1Required Elements from Guidance (including bulleted items)PDF Page Number(s) Explanatory Notes 1The health department must provide an annual report on the progress made in implementing strategies in the community health improvement plan.*Note: If the plan was adopted within the year, a report of a previous plan may be provided or detailed plans for assessment and reporting may be submitted.Note: Annual report of progress must be for all CHIP strategies; reports of progress on individual strategies does not meet the intent.Note: If report is based on a previous CHIP, the previous CHIP must also be submitted.The report will consider the feasibility and the effectiveness of the strategies and/or changing priorities, resources, or community assets.Evidence of Authenticity and Date are required within the documentation itself. If this evidence is difficult to locate or is found within supporting documentation, please provide a brief explanation of the location here and/or provide the supporting documentation to demonstrate the date and/or evidence of authenticity. PHAB Documentation Cover PageMeasure # 5.2.4 Monitor and revise as needed, the strategies in the community health improvement plan in collaboration with broad participation from stakeholders and partnersRD # 2Review and revision, as necessary, of the health improvement plan strategies based on results of the assessmentExample # 1Required Elements from Guidance (including bulleted items)PDF Page Number(s) Explanatory Notes 2The health department must document that the health improvement plan has been reviewed and revised as necessary based on the report required in 1 above.*Note: If the plan was adopted less than a year before it was uploaded to PHAB, the health department may provide (1) revisions of an earlier plan or (2) detailed plans for a revision process.Evidence of Authenticity and Date are required within the documentation itself. If this evidence is difficult to locate or is found within supporting documentation, please provide a brief explanation of the location here and/or provide the supporting documentation to demonstrate the date and/or evidence of authenticity. PHAB Documentation Cover PageMeasure # 5.3.1Department strategic planning processRD # 1Use a planning process to develop the organization’s strategic plan:1 strategic planning processRequired Elements from Guidance (including bulleted items)PDF Page Number(s) Explanatory Notes 1The health department must document the process that it used to develop its organizational strategic plan.1aA list of the individuals who participated in the strategic planning process and their titles must be provided.Participants must include various levels of staff as well as representatives of the health department’s governing entity.Note: Representatives of the governing entity must be involved in the strategic planning process; review/approval of the strategic plan by the governing entity does not meet the intent.1bDocumentation must include a summary or overview of the strategic planning process, including the number of meetings, duration of the planning process, and the methods used for the review of major elements by stakeholders.Steps in the planning process must be described.Evidence of Authenticity and Date are required within the documentation itself. If this evidence is difficult to locate or is found within supporting documentation, please provide a brief explanation of the location here and/or provide the supporting documentation to demonstrate the date and/or evidence of authenticity. PHAB Documentation Cover PageMeasure # 5.3.2 Adopted department strategic planRD # 1Health department strategic plan that includes:1 strategic planRequired Elements from Guidance (including bulleted items)PDF Page Number(s) Explanatory Notes 1The health department must provide a strategic plan.The strategic plan must include all of the following:1aThe health department’s mission, vision, and guiding principles/values for the health department.1bThe health department’s strategic priorities.1cThe health department’s goals and objectives with measurable and time-framed targets (expected products or results). 1dThe strategic plan must consider capacity for and enhancement of information management, workforce development, communication (including branding), and financial sustainability.1eThe identification of external trends, events, or other factors that may impact community health or the health department.1fThe analysis of the department’s strengths and challenges.1gLinkages with the health improvement plan and the health department’s quality improvement plan. The strategic plan need not link to all elements of the health improvement plan or quality improvement plan, but it must show where linkages are appropriate for effective planning and implementation.Evidence of Authenticity and Date are required within the documentation itself. If this evidence is difficult to locate or is found within supporting documentation, please provide a brief explanation of the location here and/or provide the supporting documentation to demonstrate the date and/or evidence of authenticity. PHAB Documentation Cover PageMeasure # 5.3.3Implemented department strategic planRD # 1Progress towards achievement of the goals and objectives contained in the planExample # 1Required Elements from Guidance (including bulleted items)PDF Page Number(s) Explanatory Notes 1The health department must provide reports developed since the plan’s adoption showing that it has reviewed the strategic plan and has monitored and assessed progress towards reaching the goals and objectives.The reports must include how the targets are monitored.Reports must be completed no less frequently than annually.If the plan has been adopted within the year, progress reports of a previous plan may be provided or detailed evaluation plans may be submitted.Note: if reports of a previous plan are provided, the previous plan must also be submitted.Evidence of Authenticity and Date are required within the documentation itself. If this evidence is difficult to locate or is found within supporting documentation, please provide a brief explanation of the location here and/or provide the supporting documentation to demonstrate the date and/or evidence of authenticity. PHAB Documentation Cover PageMeasure # 5.3.3Implemented department strategic planRD # 1Progress towards achievement of the goals and objectives contained in the planExample # 2Required Elements from Guidance (including bulleted items)PDF Page Number(s) Explanatory Notes 1The health department must provide reports developed since the plan’s adoption showing that it has reviewed the strategic plan and has monitored and assessed progress towards reaching the goals and objectives.The reports must include how the targets are monitored.Reports must be completed no less frequently than annually.If the plan has been adopted within the year, progress reports of a previous plan may be provided or detailed evaluation plans may be submitted.Note: if reports of a previous plan are provided, the previous plan must also be submitted.Evidence of Authenticity and Date are required within the documentation itself. If this evidence is difficult to locate or is found within supporting documentation, please provide a brief explanation of the location here and/or provide the supporting documentation to demonstrate the date and/or evidence of authenticity. PHAB Documentation Cover PageMeasure # 5.4.1Process for the development and maintenance of an All Hazards Emergency Operations Plan (EOP)RD # 1Collaborative planning with other government agenciesExample # 1Required Elements from Guidance (including bulleted items)PDF Page Number(s) Explanatory Notes Note: This measure is about the All Hazards EOP for the County/Region as a whole (i.e. one that works with people outside the HD). The public health EOP is required by measure 5.4.2 and is often an annex of the larger EOP provided in 5.4.1; however, these are not one in the same. 1The health department must document that it participates in preparedness meetings with other government agencies and other levels of health departments (Tribal, state, and local).Evidence of Authenticity and Date are required within the documentation itself. If this evidence is difficult to locate or is found within supporting documentation, please provide a brief explanation of the location here and/or provide the supporting documentation to demonstrate the date and/or evidence of authenticity. PHAB Documentation Cover PageMeasure # 5.4.1Process for the development and maintenance of an All Hazards Emergency Operations Plan (EOP)RD # 1Collaborative planning with other government agenciesExample # 2Required Elements from Guidance (including bulleted items)PDF Page Number(s) Explanatory Notes Note: This measure is about the All Hazards EOP for the County/Region as a whole (i.e. one that works with people outside the HD). The public health EOP is required by measure 5.4.2 and is often an annex of the larger EOP provided in 5.4.1; however, these are not one in the same. 1The health department must document that it participates in preparedness meetings with other government agencies and other levels of health departments (Tribal, state, and local).Evidence of Authenticity and Date are required within the documentation itself. If this evidence is difficult to locate or is found within supporting documentation, please provide a brief explanation of the location here and/or provide the supporting documentation to demonstrate the date and/or evidence of authenticity. PHAB Documentation Cover PageMeasure # 5.4.1Process for the development and maintenance of an All Hazards Emergency Operations Plan (EOP)RD # 2Collaborative testing of the All Hazards EOP:Example # 1Required Elements from Guidance (including bulleted items)PDF Page Number(s) Explanatory Notes 2The health department must document that it participates in drills, exercises, or actual implementation of the All Hazards Emergency Operations Plan in order to test its implementation.Note: Drill/exercise must test the All Hazards EOP.2aThis description must include documentation of how the health department coordinated with emergency response partners during the emergency or drill/exercise.2bDocumentation must include debriefing or evaluation reports from the emergency or drill/exercise.Evidence of Authenticity and Date are required within the documentation itself. If this evidence is difficult to locate or is found within supporting documentation, please provide a brief explanation of the location here and/or provide the supporting documentation to demonstrate the date and/or evidence of authenticity. PHAB Documentation Cover PageMeasure # 5.4.1Process for the development and maintenance of an All Hazards Emergency Operations Plan (EOP)RD # 2Collaborative testing of the All Hazards EOP:Example # 2Required Elements from Guidance (including bulleted items)PDF Page Number(s) Explanatory Notes 2The health department must document that it participates in drills, exercises, or actual implementation of the All Hazards Emergency Operations Plan in order to test its implementation.Note: Drill/exercise must test the All Hazards EOP.2aThis description must include documentation of how the health department coordinated with emergency response partners during the emergency or drill/exercise.2bDocumentation must include debriefing or evaluation reports from the emergency or drill/exerciseEvidence of Authenticity and Date are required within the documentation itself. If this evidence is difficult to locate or is found within supporting documentation, please provide a brief explanation of the location here and/or provide the supporting documentation to demonstrate the date and/or evidence of authenticity. PHAB Documentation Cover PageMeasure # 5.4.1Process for the development and maintenance of an All Hazards Emergency Operations Plan (EOP)RD # 3Collaborative revision of the All Hazards EOP that includes:1 exampleRequired Elements from Guidance (including bulleted items)PDF Page Number(s) Explanatory Notes Note: This measure is about the All Hazards EOP for the County/Region as a whole (i.e. one that works with people outside the HD). The public health EOP is required by measure 5.4.2 and is often an annex of the larger EOP provided in 5.4.1; however, these are not one in the same. 3The health department must document collaboration in revising emergency plans including:3aA collaborative review of the All Hazards Emergency Operations Plan by those responsible for its implementation.3bA contact list of responders.3cThe delineation of roles and responsibilities in the Emergency EOP and the various roles that partners play in responding to a public health emergency or hazard.3dA copy of the revised emergency operations plan to document the result of the work to maintain the plan and ensure that it is up-to-date and reflects current practice and information. Updates must be indicated in some way (e.g., underlined) and the date of the change must be noted.Evidence of Authenticity and Date are required within the documentation itself. If this evidence is difficult to locate or is found within supporting documentation, please provide a brief explanation of the location here and/or provide the supporting documentation to demonstrate the date and/or evidence of authenticity. PHAB Documentation Cover PageMeasure # 5.4.2Public health emergency operations plan (EOP)RD # 1EOP, as defined by Tribal, state, or national guidelines that includes:1 EOPRequired Elements from Guidance (including bulleted items)PDF Page Number(s) Explanatory Notes 1The health department must provide its public health emergency operations plan.The plan must be written as defined by national, Tribal, or state guidelines.The plan must address emergency operations for the entire population (including special needs and vulnerable populations).The public health EOP must include all of the following:1aThe health department staff position responsible for coordinating a response within the department in an emergency.1bThe roles and responsibilities of the health department and its partners.1cA health department communication network that addresses communication with other members of emergency networks or organizations that are also responders; or an emergency communication plan.1dDescription of how the health department will manage continuity of operations during an emergency.Evidence of Authenticity and Date are required within the documentation itself. If this evidence is difficult to locate or is found within supporting documentation, please provide a brief explanation of the location here and/or provide the supporting documentation to demonstrate the date and/or evidence of authenticity. PHAB Documentation Cover PageMeasure # 5.4.2 Public health emergency operations plan (EOP)RD # 2Testing of the public health EOP, through the use of drills and exercisesExample # 1Required Elements from Guidance (including bulleted items)PDF Page Number(s) Explanatory Notes 2The health department must document that the plan has been reviewed or tested through the use of exercises and drills, and revised as needed and must include:2aA description of the process for testing and evaluating the Emergency Operations Plan.2bAn After-Action Report (AAR) developed after an emergency or exercise/drill.Note: Drill/exercise must test the public health EOP.Evidence of Authenticity and Date are required within the documentation itself. If this evidence is difficult to locate or is found within supporting documentation, please provide a brief explanation of the location here and/or provide the supporting documentation to demonstrate the date and/or evidence of authenticity. PHAB Documentation Cover PageMeasure # 5.4.2 Public health emergency operations plan (EOP)RD # 2Testing of the public health EOP, through the use of drills and exercisesExample # 2 Required Elements from Guidance (including bulleted items)PDF Page Number(s) Explanatory Notes 2The health department must document that the plan has been reviewed or tested through the use of exercises and drills, and revised as needed and must include:2aA description of the process for testing and evaluating the Emergency Operations Plan.2bAn After-Action Report (AAR) developed after an emergency or exercise/drill.Note: Drill/exercise must test the public health EOP.Evidence of Authenticity and Date are required within the documentation itself. If this evidence is difficult to locate or is found within supporting documentation, please provide a brief explanation of the location here and/or provide the supporting documentation to demonstrate the date and/or evidence of authenticity. PHAB Documentation Cover PageMeasure # 5.4.2 Public health emergency operations plan (EOP)RD # 3Revision of the public health EOP including:1 exampleRequired Elements from Guidance (including bulleted items)PDF Page Number(s) Explanatory Notes 3The health department must document that the public health emergency operations plan has been revised as indicated by review of the AAR.3aDocumentation of a review meeting.3bA public health EOP that has been revised as indicated through review, evaluation, and/or drills.Evidence of Authenticity and Date are required within the documentation itself. If this evidence is difficult to locate or is found within supporting documentation, please provide a brief explanation of the location here and/or provide the supporting documentation to demonstrate the date and/or evidence of authenticity. PHAB Documentation Cover PageMeasure # 5.4.3 S (State only)Consultation and/or technical assistance provided to Tribal and local health departments in the state regarding evidence-based and/or promising practices/templates in EOP development and testingRD # 1The provision of consultation and/or technical assistanceExample #1Required Elements from Guidance (including bulleted items)PDF Page Number(s) Explanatory Notes 1The state health department must document the provision of expert consultation, advice, and/or information provided to Tribal or local health departments concerning the development and testing of emergency operations plans. Evidence of Authenticity and Date are required within the documentation itself. If this evidence is difficult to locate or is found within supporting documentation, please provide a brief explanation of the location here and/or provide the supporting documentation to demonstrate the date and/or evidence of authenticity. PHAB Documentation Cover PageMeasure # 5.4.3 S (State only) Consultation and/or technical assistance provided to Tribal and local health departments in the state regarding evidence-based and/or promising practices/templates in EOP development and testingRD # 1The provision of consultation and/or technical assistanceExample #2Required Elements from Guidance (including bulleted items)PDF Page Number(s) Explanatory Notes 1The state health department must document the provision of expert consultation, advice, and/or information provided to Tribal or local health departments concerning the development and testing of emergency operations plans. Evidence of Authenticity and Date are required within the documentation itself. If this evidence is difficult to locate or is found within supporting documentation, please provide a brief explanation of the location here and/or provide the supporting documentation to demonstrate the date and/or evidence of authenticity. ................
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