Disclaimer: This checklist was prepared by the City of Bloomington. The completed checklist is not to be shared with the City of Bloomington; it is
simply intended to be shared with trusted neighbors, friends or family members. The user(s) of this checklist personally assume all risks in
connection with this activity. Updated June 2020.
Considerations for Multi-Unit or Congregate Living Situations
Would you like help with accessing your mail
if you become sick and need to quarantine?
□ Yes □ No
If in an apartment building, consider having an extra mail key made. If
an individual is ill and provides a mail key to a person outside of their
household, refer to Centers for Disease Control and Prevention and
MN Department of Health guidelines for cleaning and disinfecting hard
surface items. The goal is to keep the COVID-positive resident safe in
their unit.
Do you have a plan in place to allow you to
stay in your home if you become ill?
People who might have been exposed, are
experiencing symptoms or have tested positive are
asked to separate from people to protect the public.
This is voluntary and important for slowing the spread
of the disease. More information is available at
https://www.cdc.gov/coronavirus/2019-ncov/if-you-
are-sick/quarantine-isolation.html
□ Yes □ No
COVID-19 Quarantine Plan Details:
Social Connectedness & Mental Health
How are you connecting with others in a
distancing environment (friends, family, and
neighbors)?
Details:
Are you interested in connecting with someone regularly? □ Yes □ No
Method (e.g., phone call, video chat): ___________________
How often (e.g., daily, weekly)? _____________
What is a good time of day? ________________
Are you comfortable using technology such
as Facetime, Zoom, Skype or Google
Hangouts to connect virtually?
□ Yes □ No
If no, can someone help walk you through how to use technology?
□ Yes □ No
Identify favorite hobbies and interests.
Hobbies:
Interest in movies, music, books, podcasts, etc. (favorites, genre, etc.):
Games:
Note: It is easy to find online resources for playing games virtually.
Additional Considerations
Pets: Pet-owners are encouraged to have a plan for their pet in case they are sick or have to leave the home.
Think about necessary items to have on hand including pet food and medications. Contact between a pet and
their owner should be limited when possible.
Transportation: People who are sick or experiencing symptoms are advised to avoid public transportation,
ride shares or taxis. If you don’t have a vehicle and need to be transported to the hospital, call 911.
