Sample Template
(updated August 6, 2020)
Point of Contact Name:
Name of Group/Organization/Business:
Activity Location(s):
Schedule of Activity(s) (Date/Time):
Activity Description: (Activity is defined as 1. A single, on-going program or service such as a youth camp or garden group
that follows a regular or structured pattern of delivery, 2. A series of similar programs or services that follow a regular or
structured pattern of delivery, 3. A single, one-time program, service, or event.)
Individual lease arrangements and activity requests will be reviewed in accordance with the Parks and Recreation Third-
Party Pandemic Operations Plan Policy.
What Park and/or Community Center facility access does your activity require?
What capacity does your Organization have to cover any expenses that may be incurred by the use of the park or
facility? (Ex: paying for water or electricity use, paying for or providing for garbage removal associated with your
facility use, providing your own portable toilet)
As of 5/20/2020, restroom facilities (permanent) are not available at any park facility and a limited number of portable
toilets will be placed throughout our parks at predetermined locations. Considering the location and duration of your
activity, do you need restroom facilities? No Yes
If yes, will you provide your own portable toilet(s)? No Yes
Do you need garbage amenities? No Yes
If yes, will you provide your own receptacles and disposal? No Yes
Do you need access to water? No Yes
Do you need access to electric? No Yes
Do you need additional support from Parks for the activity? No Yes - Describe:
Organizations may use this template and adapt as necessary for their activity
OR organizations may submit their own template that addresses the Guidelines set forth in the Parks and Recreation
Third-Party Pandemic Operations Plan Policy.
Plans will be reviewed by the City of Duluth - Parks and Recreation Division for general compliance with Federal, State,
and local guidelines applicable to the type of organization submitting a plan and with consideration for City-supported
facilities and maintenance.
1. Social Distancing: (How will you manage in reference to the current CDC and MDH guidelines)
a. Currently 6ft distance for anyone not living in the same household
2. Plan to manage group size: (How will you manage in reference to the current CDC and MDH gathering guidelines)
a. Currently 25 people or less
b. Select One: Sign-Up/Registration Event Drop-in Event Both
3. How will you promote hand hygiene practices?
4. How will you promote respiratory health practices?
Face mask use is required for arrival and departure of an event/activity
If social distancing cannot be achieved, face mask use is required for indoor and outdoor events/activities
5. Are there any restrictions to participation in your activity that may be necessary for your activity to comply with
social distancing and other health and safety guidelines? (Young children, dogs, etc.)
6. Will you provide any type of health screening for individuals at your gathering? (pre-gathering screening, taking
temperature upon arrival of gathering)
7. How will you respond to an individual showing signs/symptoms of illness?
If someone becomes symptomatic, they must leave along with anyone from their household.
8. What type of training will you provide before and/or during your gathering? (Staff, volunteers, participants…)
9. If you have shared use equipment, how will you keep it clean? (hand weights, gardening tools, tables, chairs,
picnic tables, recreation equipment, etc.)
10. Do you have areas with a high rate of touch? (door knobs, water spigot, light switch, etc) How will you keep
them clean?
11. Are there pinch points at your gathering space (standing in line, building entrance, portable toilets, trail or bridge)
that would make social distancing a challenge? If so, how will you mitigate this?
12. Will you have an attendance log or registration form? (this information is used to contact participants in the event
that someone falls ill during/after the event. required to retain this information for 60-days)
13. How will you communicate safety measures, processes, updates, reminders, etc. to those involved with your
15. Additional preparedness strategies applicable to your activity:
14. If this is a special event in a park such as a concert, community gathering, theater production, dance recital,
etc., you are required to delineate the event space as to only allow registered guests into the event space. This
reduces drop in participation which does not allow for contact tracing. How will you achieve this?
1. How will you establish a one direction flow of traffic through the market? Please provide a site map with your
2. Onsite food consumption is not allowed at a Farmer’s Market. If food trucks are invited to your market, how will
you designate space outside the market for food consumption?
3. What safety guidelines will be established for customers and how will you communicate these guidelines?
COVID-19 Preparedness Plan Guidance
Note: Active websites and links may be updated overtime.
CDC Coronavirus (COVID-19)
MDH Coronavirus
State of Minnesota COVID-19 response
CDC Resources for businesses and employers
CDC General business frequently asked questions
MDH Businesses and employers: COVID-19 Minnesota
Department of Employment and Economic Development (DEED) COVID-19 information and
DLI Updates related to COVID-19
Federal OSHA
Respiratory etiquette: Cover your cough or sneeze
Social distancing
Youth Sports
Employees exhibiting signs and symptoms of COVID-19
Hand Hygiene
• Hand washing available
• Hand sanitizer available
• Wearing gloves or other hand protection
Respiratory Etiquette
• Wearing masks
• Promote coughing and sneezing into a sleeve or tissue (announcements or signage)
Cleaning, disinfecting and ventilation of objects, facilities, transport vehicles
• Identify high touch objects/spaces and make a cleaning plan
• Clean spaces after every session/event
• Hold events outside if feasible
Social Distancing: Current guidelines are 6 ft
• Increase event space (move outdoors or to a larger room)
• Limit mixing between groups (cohorts)
• Stagger scheduling for the event as well as during pick-up/drop off times
• Install spacing reminders such as tape or chalk on the ground and plexi-glass barriers
Gathering Size: Current guidelines are 25 people or less
• Encourage gathering in cohorts (participants from the same family or household)
• Participants Sign Up OR Drop-in (how will gathering size be managed with drop ins?)
Reduce shared items
• Assign items to each participant
• Ask participants to bring their own equipment
• Assign specific areas for personal items to be stored
• Ask participants to bring their own filled water bottle or provide bottled water
• Make a plan for food distribution and disposal
Train all employees on health and safety protocols
• Ensure a safety training log is retained that includes employee name, training date, description of training
Develop and implement procedures to check for signs and symptoms in participants daily upon arrival
• Take temperature
• Ask about feeling ill, have a fever or have a cough
Participant Log
• Keep a sign-in log for 60 days in the event that contact tracking is needed
Require anyone who is sick to report to management and to stay at home
Make a plan to manage a participant that becomes sick while at the event
If someone becomes ill at the event, they must leave the event along with anyone from their household
Make a communications plan to communicate:
• Developments with local authorities
• With participants (guardians) regarding cases, exposures and updates to policies and procedures
• Share Pandemic Plan with participants to review before they arrive to the event site and update as needed