OT20-2004_Att. 1_Work Plan and Progress Report Template.xlsx

XLSX spreadsheet 40 KB Posted Apr 1, 2020

Attached to: Supporting Tribal Public Health Capacity in Coronavirus Preparedness and Response
Opportunity number: CDC-RFA-OT20-2004
Issued by: Department of Health and Human Services Centers for Disease Control and Prevention

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OT20-2004 Workplan

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Other files

File	Type	Posted
OT20-2004 Application Checklist for OT20-2004.docx	DOCX document	May 1, 2020
OT20-2004_Att. 1_Work Plan and Progress Report Template.xlsx	XLSX spreadsheet	May 1, 2020
OT20-2004 - Extension.pdf	PDF	May 1, 2020
OT20-2004 5-1-20.pdf	PDF	May 1, 2020
PKG00260693-instructions.pdf	PDF	Apr 1, 2020
REVISED OT20-2004_Att. 1_Work Plan and Progress Report Template (v040720) (002).xlsx	XLSX spreadsheet	Apr 1, 2020
REVISED OT20-2004.pdf	PDF	Apr 1, 2020

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Instructions

Instructions to Complete "Supporting Tribal Public Health Capacity in Coronavirus Preparedness and Response" Work Plan
Overall Instructions
This file consists of ten worksheets (i.e., tabs across the bottom) you will use to complete your workplan: an instructions tab, cover sheet tab and strategy tabs. Each possible strategy from the NOFO has its own worksheet.
Worksheet Instructions
Cover sheet: Enter applicant name, year of performance, and the date this file is submitted.
Worksheets Numbered 1 - 8: Complete the sections highlighted in yellow for strategies you propose implementing with the grant funds. If you are not proposing to implement a particular strategy, you can leave that worksheet blank. These strategies should be based on local needs and priorities. See below for instructions on what to enter for each section. Do not complete the white sections in the worksheet. You will use the white sections to report progress on the strategies at a later date.
Title	Enter a title related to the corresponding strategy. For example, "COVID-19 Testing" could be a title associated with Strategy 4 "Laboratory Capacity."
Priority Population(s)	Describe who you will be serving with this strategy (e.g., healthcare workers, tribal community members)
Geographic Areas	Describe where this strategy will be implemented (e.g., urban neighborhoods, reservations)
Key Deliverables/Outputs Proposed	Describe the intended outputs or products of the strategy (e.g., disseminate 12 community messages that are accurate, timely, and reach the intended communities; update quarantine procedures)
In order to achieve the key deliverables/outputs proposed above, you will implement one or more activities. Include each activity in the worksheet tables with the following information. Add additional rows as needed.
Activity Number	Setting	Activity Description	Contributing Partners	Key Contracts & Consultants	Start Date	End Date
1	Indicate the type of setting in which the activity will take place (e.g., health clinic, community)	Describe the activity you will implement in support of the strategy.	Name the contributing partner in support of this activity, if any	Name key contracts or consultants in support of this activity, if any	Indicate the anticipated activity start date	Indicate the anticipated activity end date
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Cover Sheet

Supporting Tribal Public Health Capacity in Coronavirus Preparedness and Response

CDC-RFA-OT20-2004 Work Plan and Progress Report Template

OMB Approval Number: 0920-1132

Expiration Date: 10/31/2022

Recipient Name:

Performance Year:

Submission Date:

(1) Emergency Ops

Title
Strategy Description	(1) Emergency operations and coordination (activities may include, but are not limited to, establishing emergency operations centers, incident management systems, continuity of operations plans, volunteer management, surge staffing and procurement of supplies and equipment, surge staffing)
Priority Population(s)
Geographic Areas
Key Deliverables/Outputs Proposed

Progress Reporting

Key Deliverables/Outputs Produced

Successes

Barriers/Challenges

							Progress Reporting
Activity Number	Setting	Activity Description	Contributing Partners	Key Contracts & Consultants	Start Date	End Date	Status	Progress Notes
1
2
3
4
5
6
7
8
9
10

(2) Health Info Tech

Title
Strategy Description	(2) Health Information Technology (activities may include, but are not limited to supporting data systems necessary to support and focus on COVID-19 surveillance and reporting, population building, patient tracer, etc. It is not intended to support health information technology systems related to the direct healthcare delivery system).
Priority Population(s)
Geographic Areas
Key Deliverables/Outputs Proposed

Progress Reporting

Key Deliverables/Outputs Produced

Successes

Barriers/Challenges

							Progress Reporting
Activity Number	Setting	Activity Description	Contributing Partners	Key Contracts & Consultants	Start Date	End Date	Status	Progress Notes
1
2
3
4
5
6		(
7
8
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10

(3) Surv and Epi

Title
Strategy Description	(3) Surveillance and epidemiology (activities may include, but are not limited to, case identification, management and risk assessment of travelers and others with potential COVID-19 exposure, data management, reporting, surge staffing and procurement of supplies and equipment, etc.)
Priority Population(s)
Geographic Areas
Key Deliverables/Outputs Proposed

Progress Reporting

Key Deliverables/Outputs Produced

Successes

Barriers/Challenges

							Progress Reporting
Activity Number	Setting	Activity Description	Contributing Partners	Key Contracts & Consultants	Start Date	End Date	Status	Progress Notes
1
2
3
4
5
6
7
8
9
10

(4) Lab Capacity

Title
Strategy Description	(4) Laboratory capacity (activities may include, but are not limited to, procurement of equipment, supplies, shipping, and staffing associated with testing and other laboratory activities).
Priority Population(s)
Geographic Areas
Key Deliverables/Outputs Proposed

Progress Reporting

Key Deliverables/Outputs Produced

Successes

Barriers/Challenges

							Progress Reporting
Activity Number	Setting	Activity Description	Contributing Partners	Key Contracts & Consultants	Start Date	End Date	Status	Progress Notes
1
2
3
4
5
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7
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10

(5) Comms

Title
Strategy Description	(5) Communications (activities may include, but are not limited to, guidance, risk communication, and information sharing to tribal members, tribal organizations, responders, clinicians and others, information management, and surge staffing, procurement of supplies, and shipping in support of communications).
Priority Population(s)
Geographic Areas
Key Deliverables/Outputs Proposed

Progress Reporting

Key Deliverables/Outputs Produced

Successes

Barriers/Challenges

							Progress Reporting
Activity Number	Setting	Activity Description	Contributing Partners	Key Contracts & Consultants	Start Date	End Date	Status	Progress Notes
1
2
3
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5
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9
10

(6) Countermeasures

Title
Strategy Description	(6) Countermeasures and mitigation (activities may include, but are not limited to, infection control, quarantine and isolation, management and distribution of medical materiel, coordination with healthcare systems, surge staffing, shipping and procurement of supplies and equipment).
Priority Population(s)
Geographic Areas
Key Deliverables/Outputs Proposed

Progress Reporting

Key Deliverables/Outputs Produced

Successes

Barriers/Challenges

							Progress Reporting
Activity Number	Setting	Activity Description	Contributing Partners	Key Contracts & Consultants	Start Date	End Date	Status	Progress Notes
1
2
3
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10

(7) Recovery

Title
Strategy Description	(7) Recovery activities (activities may include, but are not limited to, activities related to restoring tribal communities to pre-event functioning, conduct of after action reviews, development of improvement plans).
Priority Population(s)
Geographic Areas
Key Deliverables/Outputs Proposed

Progress Reporting

Key Deliverables/Outputs Produced

Successes

Barriers/Challenges

							Progress Reporting
Activity Number	Setting	Activity Description	Contributing Partners	Key Contracts & Consultants	Start Date	End Date	Status	Progress Notes
1
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(8) Other

Title
Strategy Description	(8) Other preparedness and response activities related to COVID-19
Priority Population(s)
Geographic Areas
Key Deliverables/Outputs Proposed

Progress Reporting

Key Deliverables/Outputs Produced

Successes

Barriers/Challenges

							Progress Reporting
Activity Number	Setting	Activity Description	Contributing Partners	Key Contracts & Consultants	Start Date	End Date	Status	Progress Notes
1
2
3
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