EMERGENCY PREPAREDNESS REVIEW TOOL
AGENCY:
REVIEWER:
ADMINISTRATOR:
PARTICIPANTS:
DATES OF REVIEW (mm/dd/yyyy):
I.
-
DATE OF REPORT (mm/dd/yyyy):
ADMINISTRATIVE
Compliant
Compliance
A.
Y
Comments/Documentation/Explanation/Timelines
N
LPHA is staffed at a level appropriate to complete the approved work plan. Personnel
who are funded under the PE-12 contract are working on preparedness activities in
accordance with their funding levels. PE-12.3.d.
1. Provide Position Description of any directly funded PHEP staff for review.
2. Evidence of training records of any directly funded PHEP staff.
Recommendations for Improvement
Quality Assurance
B.
By September 1 annually, the LPHA has drafted, submitted for review, revised as
needed, and submitted for final approval an annual work plan that includes all contractual
and statutory required elements and Public Health Capabilities sustaining and enhancing
elements. PE-12.3.b.
1. Written in clear and measurable objectives with timelines.
2. Has at least three broad program goals that address gaps and guide work plan
activities.
Emergency Preparedness Review Tool
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LE9803d Approved: 5/1/2015
II.
PLAN AND RESPONSE
Compliant
Compliance
Comments/Documentation/Explanation/Timelines
Y
N
A. LPHA completed Public Health Capability Performance Measure Analysis using the
assessment tool provided and approved by HSPR by August 15 of each year. PE-12.4.b.
Recommendations for Improvement
Quality Assurance
B. LPHA has developed and maintained an effective Public Health all hazards plan that
clearly identifies public health roles and responsibilities for responding to public health
emergencies. PE-12.4.j., CLHO Minimum Standards
1. Updates reflect changes identified in exercise improvement plans.
C. LPHA has adopted NIMS guidelines to ensure rules governing the development of
emergency plans and an incident management system. PE-12.3.j., ORS 431.266
D. LPHA uses an evaluation and improvement model to guide its planning efforts.
PE-12.4.h, CLHO Minimum Standards
1. Evidence of progressive exercise plan.
2. Evidence of After Action Report recommendations being built into work plan or
exercise plans.
III. COLLABORATION AND COMMUNITY OUTREACH
Compliant
Compliance
Y
Comments/Documentation/Explanation/Timelines
N
A. LPHA has coordinated with its local emergency management agency and/or law
enforcement agencies on its ESF-8 all hazards plan and the countywide emergency
operations plan. CLHO Minimum Standards
Emergency Preparedness Review Tool
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1. Plan approval signatures are recent within five years.
B. LPHA maintains a publicly available 24/7/365 system for reporting and responding to
public health emergencies. PE-12.4.f
1. Evidence of successful 24/7/365 phone testing.
2. Evidence of easily accessible public 24/7/365 phone number.
Recommendations for Improvement
Quality Assurance
C. LPHA coordinates and networks with its partners. CLHO Minimum Standards, PE-12.4.a.
1. Evidence of participation in monthly LPHA/Tribes calls.
2. Evidence of attendance at regional healthcare preparedness coalition meetings.
3. Evidence of attendance at local meetings.
4. Evidence of attendance at ECHO Preparedness conference.
D. LPHA maintains ability to inform citizens and response partners of actual and potential
health threats. CLHO Minimum Standards
1. Evidence of public health information templates.
2. Evidence of public information distribution protocols that include current contact
lists.
3. Evidence of effective public information delivery during any real or emerging
incidents that includes public health messages to the community, health care
providers, and media according to communication procedures.
Emergency Preparedness Review Tool
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LE9803d Approved: 5/1/2015
IV. TRAINING AND EDUCATION
Compliant
Compliance
Comments/Documentation/Explanation/Timelines
Y
N
A. LPHA personnel (to specifically include Reproductive Health) are trained for emergency
planning and response roles. PE-12.4.h-i. CLHO Minimum Standards; Title X
1. Evidence of training records.
2. Evidence of ICS org charts with specific positions identified for a public health
response.
V.
EXERCISES
Compliant
Compliance
Comments/Documentation/Explanation/Timelines
Y
N
A. Evidence of submission of at least two exercises or real life events AARs to liaison
within 60 days of exercise or real event completion. PE-12.4.h, CLHO Minimum Standards
Recommendations for Improvement
Quality Assurance
B. LPHA maintains a progressive exercise strategy. PE-12.4.h.
1. Evidence of a three-year exercise plan.
2. Evidence of participation with agency staff and community partners including
emergency management, county governance, and health care systems (i.e. sign in
sheets, planning committee membership, MSEL).
C. LPHA coordinates with local and regional health care partners. CLHO Minimum Standards
1. Evidence of local health care coordination including minutes/notes and exercise
reports.
Emergency Preparedness Review Tool
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LE9803d Approved: 5/1/2015
2. Evidence of submission of exercise objectives in advance of exercise.
Emergency Preparedness Review Tool
Page 5 of 5
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LE9803d Approved: 5/1/2015