HomeMy WebLinkAbout2020-663-E Health-NC DHHS form 514 agreement addendumDivision of Public Health
Agreement Addendum
FY 20-21
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_____________________________________________ ____________________________________
Health Director Signature (use blue ink) Date
Local Health Department to complete:
(If follow-up information is needed by DPH) LHD program contact name:
Phone number with area code:
Email address:
Signature on this page signifies you have read and accepted all pages of this document. Revised July 2018
Orange County Health Department Epidemiology / PH Preparedness & Response
Local Health Department Legal Name DPH Section / Branch Name
514 NC Public Health Emergency Preparedness
Wayne Mixon, (919) 546-1831
wayne.mixon@dhhs.nc.gov
Activity Number and Description DPH Program Contact
(name, phone number, and email)
06/01/2020 – 05/31/2021
Service Period DPH Program Signature Date
(only required for a negotiable agreement addendum)
07/01/2020 – 06/30/2021
Payment Period
Original Agreement Addendum
Agreement Addendum Revision # 1
I. Background:
As of August 28, 2020, this Agreement Addendum Revision #1 adds the follow paragraph:
On August 28, 2020, the Centers for Disease Control (CDC) authorized Public Health Emergency
Preparedness (PHEP) funding recipients to suspend some PHEP grant deliverables to allow states to
focus on the COVID-19 response.
II. Purpose:
This Agreement Addendum Revision #1 suspends some of the requirements described in the original
Agreement Addendum in order to allow Local Health Department (LHD) staff to focus its time and
resources on the COVID-19 response. There is no funding change associated with this Revision.
III. Scope of Work and Deliverables:
As of August 28, 2020, this Agreement Addendum #1 suspends the Paragraphs as noted below, with all
of the Paragraphs’ language included here for clarity:
1. (No change)
Assign a member of its staff to act as a point of contact with the PHP&R Branch and to perform the
duties and functions as the Local Health Department’s Preparedness Coordinator. Those duties and
functions include:
a. (Suspended)
Participating in state and regional planning processes by attending, at minimum, 75% of the
PHP&R regional planning meetings in the Local Health Department’s PHP&R region. To
nbontrager@orangecountync.gov
919-245-2407
Natalie Bontrager
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9/23/2020
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Revised July 2019
receive credit for attendance at each regional planning meeting, the Preparedness Coordinator
must be present for a minimum of 75% of the time allotted for the meeting. Training and other
applicable meetings can count toward this requirement if approved by the Plans, Training,
Exercise and Evaluation Supervisor, in advance.
b. (Suspended)
Attending the annual North Carolina Public Health Preparedness & Response Symposium.
2. (No change)
Ensure the Health Director and Preparedness Coordinator possess a functional Government
Emergency Telecommunications Services (GETS) Card issued through PHP&R and return the
GETS Card when no longer employed as Health Director or Preparedness Coordinator.
3. Meet the following Public Health Emergency Preparedness (PHEP) requirements:
a. (Suspended)
Complete quarterly call-down drills, GETS Card checks, redundant communication platform and
system checks within the geographical boundaries of the county to which the radio is assigned.
b. (Suspended)
Complete Training and Exercise Planning Workshop (TEPW) and a Multi-Year Training and
Exercise Plan (MYTEP), as well as trainings and exercises with After Action Reports (AAR) and
Corrective Action Plans per Homeland Security Exercise Evaluation Program (HSEEP)
guidance.
c. (Suspended)
Complete and submit an annual Medical Countermeasure (MCM) Action Plan by May 31, 2021
and provide quarterly updates to the regional PHP&R Pharmacist.
d. (Suspended)
Complete an annual Public Health Emergency Preparedness Operational Readiness Review
(PHEP-ORR) self-assessment and submit all required forms and evidence to the North Carolina
Disease Event Tracking and Epidemiological Collection Tool (NC DETECT) database no later
than May 31, 2021.
e. (No change)
Provide updates and data for each Point of Dispensing (POD) and Local Receiving Site (LRS)
location, hospital information sheets, and other documents, as requested.
f. (No change)
Update jurisdictional points of contact twice during each service period (December 31 and May 31),
or as changes occur, on the Critical Contact tab within NC DETECT database to facilitate time -
sensitive, accurate information sharing within the jurisdiction and between CDC and the jurisdiction.
4. Maintain preparedness and response activities by:
a. (No change)
Maintaining a modality to receive reports of communicable diseases, environmental hazards or
other public health threats on a 24-hours-a-day, 7-days-a-week basis.
b. (No change)
Maintaining radio equipment, as assigned, to communicate with local, regional and state
emergency communication networks.
c. (No change)
Establishing and maintaining an Occupational Safety Health Administration (OSHA) compliant
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Revised July 2019
respiratory protection program in accordance with 29 CFR 1910.134. This may be done in
conjunction with other programs in the Local Health Department.
d. (No change)
Maintaining a current Incident Command System (ICS) and National Incident Management
System (NIMS) organizational capacity as guided by the North Carolina PHP&R ICS Training
Directive.
e. (No change)
Maintaining staff members to execute the duties and responsibilities of Public Information
Officer (PIO) and backup PIO. These staff members should be trained according to guidelines
listed in the North Carolina Public Health Public Information Training Directive.
f. (No change)
Maintaining the All-Hazards Base Plan, High Consequence Pathogens/Ebola Plan, Crisis
Emergency Risk Communications Plan, and Pandemic Influenza Plan by May 31, 2021, and
upload into the NC DETECT database.
5. (No change)
Ensure considerations for at-risk individuals with access and functional needs, as defined in the most
current edition of the Hospital Preparedness Program – Public Health Emergency Preparedness
(HPP-PHEP) Cooperative Agreement Guidance for At-Risk Populations, are integrated in all
planning, exercise and real-world responses.
6. (No change)
Complete an MCM Dispensing/Vaccination Full Scale Dispensing Exercise or real world event as
defined in the PHEP-Operational Readiness Review Guidance and MCM Full Scale Exercise Fact
Sheet.
IV. Performance Measures/Reporting Requirements:
No change.
V. Performance Monitoring and Quality Assurance:
No change.
VI. Funding Guidelines or Restrictions:
No change.
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