COVID-19 Preparedness Assessment

Thank you for completing the COVID-19 Preparedness Assessment. Please enter your CCN and select "Continue" in order to proceed to the questions.

CMS Certification Number (CCN) [6 characters]: *
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Name of Nursing Home: *

Name: *

Email Address: *

Please complete the following questions related to your efforts to prevent and mitigate COVID-19. By responding "Yes" to the questions below, you are attesting you have policies and procedures in place, that could be offered, if requested.

Questions

1. Do you have a COVID-19/infection control testing plan for staff?: *

Yes

2. Do you have a cohorting plan for COVID-19 positive residents?: *

Yes

3. Do you have a policy for keeping residents, staff, and visitors safe while visiting?: *

Yes

4. Do you have a completed emergency preparedness plan?: *

Yes

5. Do you have an Infection Preventionist on staff?: *

Yes

6. Are you committed to increasing your COVID-19 vaccination rates among residents and staff?: *

Yes

7. Have you, or someone from your facility ever attended a learning event (webinar, conference, or recorded event) related to COVID-19 Prevention, or COVID-19 Immunizations?: *

Yes

8. For each "Yes" response to questions 1-6 can you provide documentation to confirm compliance to the practice?: *

Yes

This material was prepared by Telligen, the Medicare Quality Innovation Network Quality Improvement Organization, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents presented do not necessarily reflect CMS policy. This material is for informational purposes only and does not constitute medical advice; it is not intended to be a substitute for professional medical advice, diagnosis or treatment. 12SOW-QIN-QIN-06/15/21-4133