Polk County Public Health Emergency Plan
Table of Contents
Unclassified, Confidential, and Top Secret Sections
0.0 - (v )
0.0 - (v )
0.0 - (v )
1.0 - Front Matter (v 4.2)
1.1 - Record of Changes (v 3.0)
1.2 - Promulgation Statement (v 2.0)
1.3 - Document Security Levels (v 2.1) 
1.4 - Plan Activation and Authority (v 1.0)
1.4.1 - Pandemic Alert Phases (v 1.0)
1.4.2 - Homeland Security Advisories (v 1.0)
1.5 - Planning Committee (v 1.3)
1.5.1 - 2006 Meetings (v 1.0)
1.5.1.1 - September 14th, 2006 Pandemic Influenza Planning Meeting (v 1.0)
1.5.1.2 - November 9th, 2006 Pandemic Influenza Planning Meeting (v 1.0)
1.5.2 - 2007 Meetings (v 1.0)
1.5.2.1 - January 11th, 2007 Pandemic Influenza Planning Meeting (v 1.0)
1.5.2.2 - March 9th, 2007 Pandemic Influenza Planning Meeting (v 1.0)
1.5.2.3 - May 10th, 2007 Pandemic Influenza Planning Meeting (v 1.5)
1.5.2.4 - July 2nd, 2007 Multi-Agency Emergency Planning Meeting (v 1.0)
1.5.2.5 - September 10th, 2007 Multi-Agency Emergency Planning Meeting (v 1.0)
1.5.2.6 - November 5th, 2007 Multi-Agency Emergency Planning Meeting (v 1.0)
1.5.3 - 2008 Meetings (v 1.0)
1.5.3.1 - January 21st, 2008 Multi-Agency Emergency Planning Meeting (v 1.0)
1.5.3.2 - March 3rd, 2008 Multi-Agency Emergency Planning Meeting (v 1.0)
1.5.3.3 - May 5th, 2008 Multi-Agency Emergency Planning Meeting (v 1.0)
1.5.3.4 - July 7th, 2008 Multi-Agency Emergency Planning Meeting (v 1.0)
1.5.3.5 - November 3rd, 2008 Multi-Agency Emergency Planning Meeting (v 1.0)
1.5.4 - 2009 Meetings (v 1.0)
1.5.4.1 - January 5th, 2009 - Health Planning Sub-Committee Meeting (v 1.5)
1.5.4.2 - March 2nd, 2009 - Health Planning Sub-Committee Meeting (v 2.0)
1.5.4.3 - May 4th, 2009 - Health Sub-Committee Meeting (v 2.0)
1.5.4.4 - July 6, 2009 Health Sub-Committee Meeting (v 2.0)
1.5.4.5 - September 14, 2009 Health Sub-Committee Meeting (v 2.0)
1.5.4.6 - October 13, 2009 Health Sub-Committee Interim Meeting (v 1.0)
1.5.4.7 - November 2, 2009 Health Sub-Committee Meeting (v 1.0)
1.5.5 - 2010 Meetings (v 1.0)
1.5.5.1 - January 4th, 2010 Health Sub-Committee Meeting (v 1.0)
1.5.5.2 - March 1st, 2010 Health Sub-Committee Meeting (v 2.0)
1.5.5.3 - May 2nd, 2010 Health Sub-Committee Meeting (v 1.0)
1.6 - Plan Updates and Exercises (v 2.0)
1.6.1 - Annual Exercises (v 1.0)
1.6.1.1 - 2003-08-27 Smallpox Tabletop Exercise - Bolivar, MO (v 1.0)
1.6.1.2 - 2003-10-02 Mass Prophylaxis Functional Exercise - Bolivar, MO (v 1.0)
1.6.1.3 - 2004-04-08 Mass Prophylaxis Functional Exercise - Wheatland, MO (v 1.0)
1.6.1.4 - 2005-03-31 Regional Public Health Emergency Training and Exercise - Bolivar, MO (v 1.0)
1.6.1.5 - 2006-04-27 Infuenza Tabletop Exercise - El Dorado Springs, MO (v 1.0)
1.6.1.6 - 2006-06-14 Mass Prophylaxis Functional Exercise - Stockton, MO (v 1.0)
1.6.1.7 - 2006-08-15 Pandemic Influenza Tabletop Exercise - Bolivar, MO (v 1.0)
1.6.1.8 - 2009-02-03 SNS TAR Tool Self-Assessment (v 1.0)
1.6.1.9 - 2009-04-01 Spontaneous Volunteer Credentialing Exercise (v 1.0)
1.6.2 - Weekly Amateur Radio Net (v 1.5)
1.6.3 - Monthly Update/Exercise Results (v 2.0)
1.6.4 - Staff Training (v 1.1)
1.7 - Security Clearance Request (v )
1.8 - Sunshine Law Disclosure (v 2.0)
2.0 - Internal Planning (v )
2.1 - Internal Communications Sub-Plan (v 1.0)
2.1.1 - Staff Contact Information (v 1.0)
2.1.1.1 - Staff Group Pager (v 1.0)
2.1.2 - Codes and Passwords (v 1.0)
2.1.2.1 - Wireless Network (v 1.0)
2.2 - Staff Sub-Plan (v )
2.2.1 - Roles and Responsibilies Chart (v 1.5)
2.2.1.2 - Expenditure Authorization (v 1.0)
2.2.2 - Public Health Competencies (v 1.0)
2.2.2.1 - Public Health Leaders (v 1.0)
2.2.2.2 - Communicable Disease Staff (v 1.0)
2.2.2.3 - Clinical Staff (v 1.0)
2.2.2.4 - Environmental Health Staff (v 1.0)
2.2.2.5 - Laboratory Staff (v 1.0)
2.2.2.6 - Medical Examiner / Coroner (v 1.0)
2.2.2.7 - Public Information Staff (v 1.0)
2.2.2.8 - Other Professional Staff (v 1.0)
2.2.2.9 - Technical and Support Staff (v 1.0)
2.3 - Internal Emergency Sub-Plan (v 1.0)
2.3.1 - Staff Family Emergency (v )
2.3.2 - Tornado (v )
2.3.3 - Fire (v )
2.3.4 - Winter Weather (v )
2.3.5 - Vital Record Protection (v )
2.3.6 - Earthquake (v )
2.4 - Surveillance Sub-Plan (v 2.0)
2.4.1 - Reportable Diseases (v 1.0)
2.4.2 - Dead Bird Surveillance (v 1.0)
2.4.3 - Syndromic Surveillance (v 1.0)
2.4.4 - Medication Surveillance (v 1.0)
2.4.5 - Water Testing (v 1.0)
2.5 - Investigation Sub-Plan (v 1.0)
2.5.1 - Lab Submission Protocol (v 1.0)
2.5.2 - Biological Agents (v 1.0)
2.5.3 - Chemical Agents (v 1.0)
2.5.4 - Ionizing Radiation (v 1.0)
2.5.5 - Suspicious Powdery Substances (v 1.0)
2.6 - Public Information Sub-Plan (v 1.1)
2.6.1 - Guiding Principles (v 1.0)
2.6.2 - Concept of Operations (v 1.0)
2.6.3 - Language Barriers (v 1.0)
2.6.4 - Organization and Assignment of Responsibilities (v 1.0)
2.6.4.1 - Spokesperson (v 1.0)
2.6.4.2 - Lead PIO (v 1.0)
2.6.4.3 - Other Agencies (v 1.0)
2.6.5 - PIO and Support Staff Responsibilities (v )
2.6.5.1 - Mitigation (Pre-Event) / Education (v 1.0)
2.6.5.2 - Preparedness (Immediately Pre-Event) / Warning (v 1.0)
2.6.5.3 - Response (Event) / Risk Communications (v 1.0)
2.6.5.4 - Recovery (Post-Event) / Reassurance (v 1.0)
2.6.6 - Public Information Systems (v )
2.6.6.1 - PolkCountyHealth.net Website (v )
2.6.6.2 - Polk County Information Hotline (777-7411) (v )
2.6.6.3 - Windstream Channel 44 (v 1.1)
2.6.6.4 - Region D Media Contacts (v 1.1)
2.6.6.5 - Region D Spokespersons and PIOs (v 1.0)
2.6.7 - Public Information Forms (v )
2.6.7.1 - Daily Event Schedule (v 1.0)
2.6.7.2 - Media Sign-In (v 1.0)
2.6.7.3 - Media Requests Log (v 1.0)
2.6.7.4 - Media Coverage Log (v 1.0)
2.6.7.5 - Key Officials Interview Log (v 1.0)
2.6.7.6 - Rumor Control Log (v 1.0)
2.6.8 - Prepared Messages and Talking Points (v )
2.6.8.1 - Anthrax Messages (v 1.0)
2.6.8.2 - Botulism Messages (v 1.0)
2.6.8.3 - Plague Messages (v 1.5)
2.6.8.4 - Smallpox Messages (v 1.0)
2.6.8.5 - Tularemia Messages (v 1.0)
2.6.8.6 - Viral Hemorrhagic Fever Messages (v 1.0)
2.6.8.7 - Children Messages (v 1.0)
2.6.8.8 - Emergency Management FAQ (v 1.0)
2.6.8.9 - Shelter In Place Alert (v 1.0)
2.6.8.10 - Evacuation Alert (v 1.0)
2.6.8.11 - Health Department Messages (v 1.0)
2.6.8.12 - Isolation and Quarantine Messages (v 1.0)
2.6.8.13 - Mass Medication Distribution Messages (v 1.0)
2.6.8.14 - School Messages (v 1.0)
2.6.8.15 - Self Protection Messages (v 1.0)
2.6.8.16 - Miscellaneous Messages (v 1.0)
2.6.8.17 - Winter Storm Messages (v 1.0)
2.6.8.18 - E. Coli O157:H7 Messages (v 1.0)
2.6.8.19 - Pandemic Flu Messages (v 1.0)
2.6.8.20 - Salmonellosis Messages (v 1.0)
2.6.8.21 - SARS Messages (v 1.0)
2.6.8.22 - West Nile Virus Messages (v 1.0)
2.6.8.23 - Chemical Emergency Messages (v 1.0)
2.6.8.24 - Radiation Emergency Messages (v 1.0)
2.6.8.25 - H1N1 and Seasonal Flu - Fall Education Campaign (v 1.0)
2.7 - Disease Containment Sub-Plan (v 1.5)
2.7.1 - Laws and Ordinances (v )
2.7.1.1 - State and Federal Laws (v 1.0)
2.7.1.1.1 - Public Readiness and Emergency Preparedness Act (v 1.0)
2.7.1.2 - Sample Isolation/Quarantine Ordinance (v 1.0)
2.7.2 - Isolation Guidelines (v 1.0)
2.7.2.1 - Sample Template for Order of Isolation (v 1.0)
2.7.2.2 - Sample Template for Area Isolation Order (v 1.0)
2.7.3 - Quarantine Guidelines (v )
2.7.3.1 - Sample Template for Order of Quarantine (v 1.0)
2.7.3.2 - Sample Template for Area Quarantine Order (v 1.0)
2.7.4 - Social Distancing Guidelines (v 1.0)
2.8 - Mass Prophylaxis Sub-Plan (v 1.5)
2.8.1 - SNS Ordering Procedures (v 1.0)
2.8.1.1 - Mass Medication Distribution Checklist for Health Department (v 1.0)
2.8.1.2 - Mass Medication Distribution Checklist for Site Managers (v 1.0)
2.8.2 - Materiel Transportation (v 1.5)
2.8.3 - Site Command Chart and Job Descriptions (v 2.0)
2.8.3.1 - Site Manager (Incident Commander) (v 2.0)
2.8.3.2 - .....A - Safety Officer (v 1.0)
2.8.3.3 - .....B - Health Department Liaison Officer (v 2.0)
2.8.3.4 - .....C - Law Enforcement Liaison Officer (v 0.1)
2.8.3.5 - .....D - Public Information Officer (v 1.0)
2.8.3.6 - .....E - Operations Chief (v 2.0)
2.8.3.8 - ...............E11 - Triage Supervisor (v 1.5)
2.8.3.9 - ....................E111 - Greeting Leader (v 1.0)
2.8.3.10 - ....................E112 - Forms Leader (v 1.7)
2.8.3.11 - ...............E12 - Fast-Track Supervisor (v 0.1)
2.8.3.12 - ....................E121 - Dispensing Leader (v 1.7)
2.8.3.13 - ...............E13 - Symptomatic Supervisor (v 1.7)
2.8.3.14 - ....................E131 - Treatment Leader (v 1.0)
2.8.3.15 - ....................E132 - Transport Leader (v 0.1)
2.8.3.16 - ..........E2 - Special Needs Director (v 2.3)
2.8.3.17 - ...............E21 - Medical Needs Supervisor (v 1.0)
2.8.3.18 - ...............E22 - Language Needs Supervisor (v 0.1)
2.8.3.19 - ...............E23 - Mobility Needs Supervisor (v 0.1)
2.8.3.20 - ...............E24 - Emotional Needs Supervisor (v 1.0)
2.8.3.21 - ..........E3 - Security Director (v 2.0)
2.8.3.22 - ...............E31 - Exterior Supervisor (v 1.0)
2.8.3.23 - ....................E311 - Vehicle Traffic Leader (v 0.1)
2.8.3.24 - ...............E32 - Interior Supervisor (v 2.2)
2.8.3.25 - ....................E321 - Medication Security Leader (v 0.1)
2.8.3.26 - ....................E322 - Security Staff (v 1.0)
2.8.3.27 - .....F - Planning Chief (v 1.0)
2.8.3.28 - .....G - Logistics Chief (v 1.6)
2.8.3.29 - ..........G1 - Volunteer Services Director (v 1.7)
2.8.3.30 - ..........G2 - Runner Director (v 1.5)
2.8.3.31 - ...............G21 - Runner (v 0.1)
2.8.3.32 - ...............G22 - Floater (v 1.0)
2.8.3.33 - ..........G3 - Medication Director (v 2.0)
2.8.3.34 - ..........G4 - Facilities Director (v 1.0)
2.8.3.35 - ...............G41 - Information Technology Supervisor (v 1.0)
2.8.3.36 - ....................G411 - Communications Center Staff (v 1.0)
2.8.3.37 - ....................G412 - Message Center Staff (v 1.0)
2.8.3.38 - ...............G42 - Cleaning Supervisor (v 0.1)
2.8.3.39 - ...............G43 - Maintenance Supervisor (v 0.1)
2.8.3.40 - ..........G5 - Transportation Director (v 1.0)
2.8.3.41 - ...............G51 - Transportation Security Supervisor (v 1.0)
2.8.3.42 - ...............G52 - Drivers (v 1.0)
2.8.3.43 - .....H - Administrations Chief (v 1.0)
2.8.4 - POD Sites (v 3.0)
2.8.4.1 - Bolivar R-I School District (v )
2.8.4.1.1 - Bolivar High School (v 1.0)
2.8.4.1.2 - Bolivar Middle School (v 1.0)
2.8.4.1.3 - First Assembly of God Church (v 1.0)
2.8.4.1.4 - PRIVATE POD - Citizen's Memorial Healthcare (v 1.0)
2.8.4.1.5 - PRIVATE POD - Southwest Baptist University (v 1.0)
2.8.4.1.6 - PRIVATE POD - Polk County Jail (v 1.0)
2.8.4.1.7 - PRIVATE POD - Duck Creek Technologies (v 1.0)
2.8.4.2 - Fair Play R-II School District (v 1.0)
2.8.4.3 - Halfway R-III School District (v 1.0)
2.8.4.4 - Humansville R-IV School District (v 1.0)
2.8.4.5 - Marion C Early R-V School District (v 1.0)
2.8.4.5.1 - PRIVATE POD - Good Samaritain Boys Ranch (v 1.0)
2.8.4.6 - Pleasant Hope R-VI School District (v 1.0)
2.8.5 - Physicians Orders (v 1.0)
2.8.6 - Medication Allocation (v 2.0)
2.8.6.1 - Prioritization (v 1.5)
2.8.7 - Household History Form (v 2.5)
2.8.8 - Medication Chain of Custody Form (v 2.5)
2.8.9 - Site Signage (v 1.6)
2.8.10 - Emergency Equipment List (v 1.1)
2.8.11 - Nerve Agent Prophylaxis (Chempack) (v 1.0)
2.9 - Volunteer Sub-Plan (v 1.0)
2.9.1 - Record of Changes (v 2.0)
2.9.2 - Purpose of the Recruitment and Retention Plan (v 2.0)
2.9.2.1 - Recommendations on Utilization of Volunteers (v 1.0)
2.9.2.2 - Role of the Regional Volunteer Coordinator (v 1.0)
2.9.2.3 - Role of Local Volunteer Manager (v 1.0)
2.9.2.4 - Definition of a Public Health Volunteer (v 1.0)
2.9.2.5 - Criteria for a Public Health Volunteer (non-compensated) (v 1.0)
2.9.2.6 - Agency staff as volunteers/employee compensation (v 1.0)
2.9.3 - Recruitment Plan (v 1.0)
2.9.3.1 - Broad-based Recruitment (v 1.0)
2.9.3.2 - Targeted Recruitment (v 1.0)
2.9.3.3 - Word of Mouth Recruitment (v 1.0)
2.9.4 - Individual Volunteer Procedures (v 1.0)
2.9.4.1 - Application (v 1.0)
2.9.4.2 - Background checks (v 1.0)
2.9.4.3 - Interview (v 1.0)
2.9.4.4 - Placement (v 1.0)
2.9.4.5 - Training (v 1.0)
2.9.4.6 - Evaluation and Debriefing (v 1.0)
2.9.4.7 - Identification (v 1.0)
2.9.5 - Group Volunteer Procedures (v 1.0)
2.9.6 - Code of Conduct (v 1.0)
2.9.7 - Disqualification of Volunteers (v 1.0)
2.9.8 - Nondiscrimination (v 1.0)
2.9.9 - Dismissal of Volunteers (v 1.0)
2.9.10 - Worker’s Compensation and Liability (v 1.0)
2.9.11 - Health and Safety (v 1.0)
2.9.12 - Call Down Procedures for Volunteers (v 1.0)
2.9.13 - Staff/Volunteer Management (v 1.0)
2.9.14 - Donations Management (v 1.0)
2.9.16 - Retention (v 1.0)
2.9.17 - Spontaneous Volunteer Plan (v 1.0)
2.9.17.1 - Volunteer Reception Center (v 1.0)
2.9.17.2 - Volunteer Reception Center Job Descriptions (v 1.0)
2.9.17.3 - Safety Training for Volunteers (v 1.0)
2.9.18 - Appendix A - Forms (v 1.0)
2.9.18.1 - Volunteer Application (v 1.0)
2.9.18.2 - Volunteer Interview Tip Sheet (v 1.0)
2.9.18.3 - Interview Form (v 1.0)
2.9.18.4 - Interview Assessment Form (v 1.0)
2.9.18.5 - Volunteer Placement Form (v 1.0)
2.9.18.6 - Community Hero Application Process (v 1.0)
2.9.18.7 - Training Sign In Sheet (v 1.0)
2.9.18.8 - Community Hero Training Record (v 1.0)
2.9.18.9 - Performance Evaluation (v 1.0)
2.9.18.10 - Media Release and Consent Form (v 1.0)
2.9.18.11 - Request for Volunteers (v 1.0)
2.9.18.12 - Individual Unaffiliated Volunteer Registration Form (v 1.0)
2.9.18.13 - Group/Service Organization Volunteer Registration Form (v 1.0)
2.9.18.14 - VOLUNTEER REFERRAL (v 1.0)
2.9.18.15 - Expenses Incurred by VRC Coordinating Agency in Response to Disaster (v 1.0)
2.9.18.16 - VRC Staff/Volunteer Sign In (v 1.0)
2.9.19 - Appendix B - Polk County New Volunteer Orientation Manual (v 1.0)
2.9.20 - Appendix C - Dispensing Site Job Training (v 1.0)
2.9.21 - Appendix D - Volunteer Reception Center Training Manual (v 1.0)
3.0 - External Planning (v )
3.1 - External Communications Sub-Plan (v 1.0)
3.1.1 - Local Contact Information (v 1.0)
3.1.2 - State and Federal Contact Information (v 1.0)
3.1.3 - Wireless Communications (v 1.5)
3.2 - Mutual Aid Agreements (v 1.0)
3.2.1 - Cedar County Health Department Mutual Aid Agreement (v 1.0)
3.2.2 - Dade County Health Department Mutual Aid Agreement (v )
3.2.3 - Dallas County Health Department Mutual Aid Agreement (v )
3.2.4 - Springfield-Greene County Health Department Mutual Aid Agreement (v )
3.2.5 - Hickory County Health Department Mutual Aid Agreement (v 1.0)
3.2.6 - St Clair County Health Center Mutual Aid Agreement (v )
3.2.7 - First Assembly of God Church Mutual Aid Agreement (v )
3.2.8 - Bolivar R-I School District Mutual Aid Agreement (v )
3.2.9 - Fair Play R-II School District Mutual Aid Agreement (v )
3.2.10 - Halfway R-III School District Mutual Aid Agreement (v )
3.2.11 - Humansville R-IV School District Mutual Aid Agreement (v )
3.2.12 - Marion C Early R-V School District Mutual Aid Agreement (v )
3.2.13 - Pleasant Hope R-VI School District Mutual Aid Agreement (v )
3.2.14 - Bolivar Technical College Mutual Aid Agreement (v )
3.2.15 - Citizens Memorial Healthcare Mutual Aid Agreement (v )
3.2.16 - Polk County Sheriff Deparment Mutual Aid Agreement (v )
3.2.17 - Southwest Baptist Univeristy Mutual Aid Agreement (v )
3.3 - Community Profile (v 1.0)
3.3.1 - Special Needs Population (v 2.0)
3.3.2 - Facilities Map (v )
3.3.3 - Emergency Services Map (v )
4.0 - Appendicies (v )
4.1 - Glossary (v )
4.1.1 - Numbers (v )
4.1.2 - A (v 1.0)
4.1.3 - B (v 1.0)
4.1.4 - C (v 1.0)
4.1.5 - D (v 1.0)
4.1.6 - E (v 1.0)
4.1.7 - F (v 1.0)
4.1.8 - G (v 1.0)
4.1.9 - H (v 1.0)
4.1.10 - I (v 1.0)
4.1.11 - J (v 1.0)
4.1.12 - K (v 1.0)
4.1.13 - L (v 1.0)
4.1.14 - M (v 1.0)
4.1.15 - N (v 1.0)
4.1.16 - O (v 1.0)
4.1.17 - P (v 1.0)
4.1.18 - Q (v 1.0)
4.1.19 - R (v 1.0)
4.1.20 - S (v 1.0)
4.1.21 - T (v 1.0)
4.1.22 - U (v 1.0)
4.1.23 - V (v 1.0)
4.1.24 - W (v 1.0)
4.1.25 - X (v 1.0)
4.1.26 - Y (v 1.0)
4.1.27 - Z (v 1.0)