Fillable COVID19 School Guidance Checklist 2021

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COVID19 School Guidance Checklist 2021

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COVID-19 School
Guidance
Checklist
January 14, 2021
2021 COVID-19 School Guidance Checklist
Name of L
ocal Educational Agency or Equivalent: _____________________________
Number of schools: ________________
Enrollment: ________________________`
Superintendent (or equivalent) Name: ______________________________________
Address: ___________________________
_________________________
___________
Date of prop
osed reopening:
____________________________________
Phone Number: ___________________
Email: ___________________________
County: ____________________________
Current Tier: ________________________
(please indicate Purple, Red, Orange or
Yellow)
Type of LEA: ________________________
This form and any applicable attachments should be posted publicly on the
website of the local educational agency (or equivalent) prior to reopening or if
an LEA or equivalent has already opened for in-person instruction. For those in
the Purple Tier, materials must additionally be submitted to your local health
officer (LHO), local County Office of Education, and the State School Safety
Team prior to reopening.
The email address for submission to the State School Safety for All Team for LEAs
in Purple Tier is:
K12csp@cdph.ca.gov
LEAs or equivalent in Counties with a case rate >=25/100,000 individuals can
submit materials but cannot re-open a school until the county is below 25 cases
per 100,000 (adjusted rate) for 5 consecutive days.
For Local Educational Agencies (LEAs or equivalent) in ALL TIERS:
☐ I, _____________________________, post to the website of the local educational
agency (or equivalent) the COVID Safety Plan, which consists of two elements:
the COVID-19 Prevention Program (CPP), pursuant to CalOSHA requirements,
and this CDPH COVID-19 Guidance Checklist and accompanying documents,
Date: ___________
Grade Level (check all that apply)
☐ TK ☐ 2
nd
☐ 5
th
☐ 8
th
☐ 11
th
☐ K ☐ 3
rd
☐ 6
th
☐ 9
th
☐ 12
th
☐1
st
☐ 4
th
☐ 7
th
☐ 10
th
01/29/2021
Bethel Christian Schools
1
371
Michael Pangkee
951-359-1123
mpangkee@bethelchristianschools.com
09/27/2020
Riverside
Purple
None
■
Michael Pangkee
which satisfies requirements for the safe reopening of schools per CDPH
Guidance on Schools
. For those seeking to open while in the Purple Tier, these
plans have also been submitted to the local health officer (LHO) and the State
School Safety Team.
I confirm that reopening plan(s) address the following, consistent with guidance
from the California Department of Public Health and the local health
department:
☐ Stable group structures (where applicable): How students and staff will
be kept in stable groups with fixed membership that stay together for all
activities (e.g., instruction, lunch, recess) and minimize/avoid contact with
other groups or individuals who are not part of the stable group.
Please provide specific information regarding:
How many students and staff will be in each planned stable, group
structure? (If planning more than one type of group, what is the minimum
and maximum number of students and staff in the groups?)
_________________________
____________________________________________
If you hav
e departmentalized classes, how will you organize staff and
students in stable groups?
_________________________
_____________________________________________
If you ha
ve electives, how will you prevent or minimize in-person contact for
members of different stable groups?
_________________________
_____________________________________________
☐ Entrance, Egress, and Movement Within the School: How movement of
students, staff, and parents will be managed to avoid close contact and/or
mixing of cohorts.
☐ Face Coverings and Other Essential Protective Gear: How CDPH’s face
covering requirements will be satisfied and enforced for staff and students.
☐ Health Screenings for Students and Staff: How students and staff will be
screened for symptoms of COVID-19 and how ill students or staff will be
separated from others and sent home immediately.
☐ Healthy Hygiene Practices: The availability of handwashing stations and
hand sanitizer, and how their safe and appropriate use will be promoted
and incorporated into routines for staff and students.
32
Seat students at least 6 feet apart when practicable.
☐ Identification and Tracing of Contacts: Actions that staff will take when
there is a confirmed case. Confirm that the school(s) have designated staff
persons to support contact tracing, such as creation and submission of lists
of exposed students and staff to the local health department and
notification of exposed persons. Each school must designate a person for
the local health department to contact about COVID-19.
☐ Physical Distancing: How space and routines will be arranged to allow
for physical distancing of students and staff.
Please provide the planned maximum and minimum distance between
students in classrooms.
Maximum:
_______________
feet
Minimum:
________________
feet. If this is less than 6 feet, please explain why
it is not possible to maintain a minimum of at least 6 feet.
_________________________
_____________________________________________
☐ Staff Training and Family Education: How staff will be trained and families
will be educated on the application and enforcement of the plan.
☐ Testing of Staff: How school officials will ensure that students and staff
who have symptoms of COVID-19 or have been exposed to someone with
COVID-19 will be rapidly tested and what instructions they will be given
while waiting for test results. Below, please describe any planned periodic
asymptomatic staff testing cadence.
Staff asymptomatic testing cadence. Please note if testing cadence will
differ by tier:
____
___________________________________________________________________
☐ Testing of Students: How school officials will ensure that students who
have symptoms of COVID-19 or have been exposed to someone with
COVID-19 will be rapidly tested and what instructions they will be given
while waiting for test results. Below, please describe any planned periodic
asymptomatic student testing cadence.
Planned student testing cadence. Please note if testing cadence will differ
by tier:
____
___________________________________________________________________
6
4
A good faith effort will be made to seat students 6 feet apart when applicable due to classroom room size.
In the purple and red tier, staff will be tested every two months. In the orange and yellow tier, we will so symptomatic and response testing.
Testing cadence will not differ based on tier status.
☐ Identification and Reporting of Cases: At all times, reporting of confirmed
positive and suspected cases in students, staff and employees will be
consistent with
Reporting Requirements
.
☐ Communication Plans: How the superintendent will communicate with
students, staff, and parents about cases and exposures at the school,
consistent with privacy requirements such as FERPA and HIPAA.
☐ Consultation: (For schools not previously open) Please confirm
consultation with the following groups
☐ Labor Organization
Name of Organization(s) and Date(s) Consulted:
Name: ________________________________
Date: ________________________________
☐ Parent and Community Organizations
Name of Organization(s) and Date(s) Consulted:
Name: ________________________________
Date: ________________________________
If no labor organization represents staff at the school, please describe the
proce
ss for consultation with school staff:
________________
________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
For Local Educational Agencies (LEAs or equivalent) in PURPLE:
☐ Local Health Officer Approval: The Local Health Officer, for (state
County) ____
_
__________________________________
. County has certified
a
nd approved the CRP on this date:
__________________.
If more than 7
business days have passed since the submission without input from the
LHO, the CRP shall be deemed approved.
Additional Resources:
Guidance on Schools
Safe Schools for All Hub
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Completed 30 July 2021

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