PHEP Progress Report

2021 - 2022 Budget Period Deliverable Requirements

Fourth Quarter     Due July 15  

                                            

Note: Your privacy is very important to us. To better serve you, the form information you enter is recorded in real time.

Instructions: Please Read

1.  Complete this progress report for your quarterly PHEP deliverables. Report ONLY on this quarter's progress. Deliverables not due this quarter are not displayed.

2.  Refer to the written guidance provided to you at the beginning of the grant year (Attachment A) for instruction on completing each of the deliverable elements. A copy of this guidance is available on the PHEP Deliverables Resource (PDR) webpage. PHEP will inform you of any changes or adjustments in deliverable requirements or guidance during the year.  If you have questions, please contact the subject matter expert for the appropriate section. 

3.  If a field asks for a number, please use the numerical form. Do not use text.

4.  Required fields have a red asterisk.  Attempting to submit the form with an invalid field entry or a blank required field will take you to the top of the form and display an error message. You will have to scroll back to the entry to correct it.

5.  You do not need to complete the form in one session, but rather work on it throughout the quarter or year. To save your work and come back to it later, scroll to the bottom and click "Save and Resume Later." If you do not, you will lose your information. DO NOT close your browser without performing this step. The form will display a unique link that will take you to your saved form. You may also choose to have it emailed to you. This link is the ONLY way to retrieve your form.

6.  You MUST log in to your saved report with your unique link EVERY 30 DAYS at a minimum to keep it active. Your form will be deleted from the server if you do not and you will have to start over.

Uploading Documents:  

NOTE:  Documents added to the form are not saved when you use the "Save and Resume Later" feature. You must upload required documents for deliverables as the last task before submitting the progress report. The documents will submit at that time.

PLEASE start any file name for documents you submit with your jurisdiction’s name.

Combine files if there is only one field for uploading a required document. We prefer PDF files, but scanned documents can be placed into a single Word file as images if necessary.

We recommend saving the progress report to your computer as a PDF file as a backup before submitting it. However, you will receive an email response to your submission with all of the information you provided for your records.

Please begin by providing the following information:

Name

Administration

Gerry Wheat, (406) 444-6736,gwheat@mt.gov

A1 Maintain the Montana Public Health Directory

Maintain and update contact information for all staff listed in the public health directory. Verify all specimen collection kit locations.

A1 Complete?*


A2 End of Year Report 

Write a brief description of your jurisdiction's health preparedness activities.

Contact Kevin O'Loughlin at koloughlin@mt.gov or (406) 444-1611 with questions about this deliverable.

A2 Complete? *

Submit a brief narrative to describe preparedness activities during the budget period that are performed outside of the deliverable requirements set forth in the cooperative agreement.  The purpose of this requirement is to begin a record of accountability for the use of PHEP grant funding.  Also describe how PHEP funding has improved your preparedness during the last budget period.  Refer to Attachment A for further guidance.


Access & Functional Needs

Ian Thigpen, (406) 444-0931, ithigpen@mt.gov

AFN1 Engage AFN Stakeholders 

Meet with AFN stakeholders to build relationships and discuss AFN within an incident management context.

AFN1 Complete?*

Please provide the required documents.

No File Chosen
File uploads may not work on some mobile devices.
Upload a copy of the meeting sign-in sheet.
No File Chosen
File uploads may not work on some mobile devices.
Upload a copy of the meeting minutes or summary.


AFN2 Assess Key Mass Care and Emergency Assistance Facilities 

Assess key mass care and emergency assistance facilities for accessibility.


Rescinded 


Budget & Miscellaneous

Dan Synness, (406) 444-6927, dsynness@mt.gov 

B1 Actual Line Item Expenses

Provide the actual expenses in the listed line item categories.  


Guidance has minor changes.  A web form takes the place of the spreadsheet.  

B1 complete?*

Complete and submit the Budget Form at this link:  https://PHEP.formstack.com/forms/b1_actual_line_item_expenses 

Budget

Dan Synness, (406) 444-6927, dsynness@mt.gov

B2 Workforce Development Crisis Supplemental Funding

Submit the required information at the end of the 2nd and 4th quarters as a condition to receive funding from the Workforce Development Crisis Supplemental Funding grant.

Report period for January 1, 2022 to June 30, 2022 ONLY. 

(Quarters 3 and 4)

Is your jurisdiction participating in this grant program?

Thank you.  Please click the next button to continue to the next category.

Did your program hire a new public health employee or were there any changes to the employment of your public health workforce?

Thank you.  Please click the next button to continue to the next category.

Please provide the following information.

1.  Please provide the working title of the employee.

Date of Hire
Date of Departure
Leave blank if not applicable.
Name

2.  Is this person a contractor?

2a.  Please provide the name of the vendor/contractor's name and ID.

3.  Indicate the FTE for this person.

4.  What is the hourly rate or salary pay amount for this position?


Do you have another position to report?

Thank you. Please continue completing the progress report.

Please provide the following information for the second employee.

1.  Please provide the working title of the employee.

Date of Hire #2
Date of Departure #2
Leave blank if not applicable.
Name #2

2.  Is this person a contractor?

2a.  Please provide the name of the vendor/contractor's name and ID.

3.  Indicate the FTE for this person.

FTE for #2

4.  What is the hourly rate or salary pay amount for this position?


Do you have another position to report?

Thank you. Please continue completing the progress report.

Please provide the following information for employee #3.

1.  Please provide the working title of the employee.

Date of Hire #3
Date of Departure #3
Leave blank if not applicable.
Name #3

2.  Is this person a contractor?

2a.  Please provide the name of the vendor/contractor's name and ID.

3.  Indicate the FTE for this person.

FTE for #3

4.  What is the hourly rate or salary pay amount for this position?



Please contact Dan Synness if you have more positions to report.  He will provide you with another link that allows you to fully report information for your Workforce Development Crisis Supplement Funding grant.

(406) 444-6927

dsynness@mt.gov


B3 Supplemental Funding - Disease Intervention Specialist

Submit the required information at the end of the quarter as a condition to receive funding to support this position in your jurisdiction.

Report period for April 1, 2022 to June 30, 2022 ONLY (4th Quarter). 

Is DPHHS supporting a DIS position in your jurisdiction?

Thank you.  Please continue to B4.

Did your program hire a new DIS employee or were there any changes to the employment of your public health workforce?

Thank you.  Please continue to B4.

Please provide the following information.

1.  Please provide the working title of the employee.

DIS Date of Hire
DIS Date of Departure
Leave blank if not applicable.
DIS Name

2.  Is this person a contractor?

2a.  Please provide the name of the vendor/contractor's name and ID.

3.  Indicate the FTE for this person.

4.  What is the hourly rate or salary pay amount for this position?


Do you have another DIS position to report?

Thank you. Please continue to B4.

Please provide the following information for the second DIS.

1.  Please provide the working title of the employee.

Date of Hire for DIS #2
Date of Departure for DIS #2
Leave blank if not applicable.
Name of DIS #2

2.  Is this person a contractor?

2a.  Please provide the name of the vendor/contractor's name and ID.

3.  Indicate the FTE for this person.

FTE for DIS #2

4.  What is the hourly rate or salary pay amount for this position?


Do you have another DIS position to report?

Thank you. Please continue to B4.

Please provide the following information for DIS #3.

1.  Please provide the working title of the employee.

Date of Hire for DIS #3
Date of Departure DIS #3
Leave blank if not applicable.
Name of DIS #3

2.  Is this person a contractor?

2a.  Please provide the name of the vendor/contractor's name and ID.

3.  Indicate the FTE for this person.

FTE for DIS #3

4.  What is the hourly rate or salary pay amount for this position?



Please contact Dan Synness if you have more positions to report.  He will provide you with another link that allows you to fully report information for your DIS supplement funding.

(406) 444-6927

dsynness@mt.gov



B4 Supplemental Funding - Congregate Living Coordinator

Submit the required information at the end of the quarter as a condition to receive funding to support this position in your jurisdiction.


Contact Erika Baldry with CLC questions at erika.baldry@mt.gov or 406-444-0275

Report period for April 1, 2022 to June 30, 2022 (4th Quarter) ONLY. 

Is DPHHS supporting a CLC position in your jurisdiction?

Thank you.  Please click the Next button to continue to the next deliverable category.

Did your program hire a new CLC or were there any changes to the employment of your public health workforce?

Thank you.  Please click the Next button to continue to the next deliverable category.

Please provide the following information.

1.  Please provide the working title of the employee.

CLC Date of Hire
CLC Date of Departure
Leave blank if not applicable.
CLC Name

2.  Is this person a contractor?

2a.  Please provide the name of the vendor/contractor's name and ID.

3.  Indicate the FTE for this person.

4.  What is the hourly rate or salary pay amount for this position?


Do you have another CLC position to report?

Thank you.  Please click the Next button to continue to the next deliverable category.

Please provide the following information for the second CLC.

1.  Please provide the working title of the employee.

Date of Hire for CLC #2
Date of Departure for CLC #2
Leave blank if not applicable.
Name of CLC #2

2.  Is this person a contractor?

2a.  Please provide the name of the vendor/contractor's name and ID.

3.  Indicate the FTE for this person.

FTE for CLC #2

4.  What is the hourly rate or salary pay amount for this position?


Do you have another CLC position to report?

Thank you.  Please click the Next button to continue to the next deliverable category.

Please provide the following information for CLC #3.

1.  Please provide the working title of the employee.

Date of Hire for CLC #3
Date of Departure for CLC #3
Leave blank if not applicable.
Name of CLC #3

2.  Is this person a contractor?

2a.  Please provide the name of the vendor/contractor's name and ID.

3.  Indicate the FTE for this person.

FTE for CLC #3

4.  What is the hourly rate or salary pay amount for this position?



Please contact Erika Baldry if you have more positions to report.  She will provide you with another link that allows you to fully report information for your CLC supplement funding.

(406) 444-0275

erika.baldry@mt.gov 



Community Resilience

Luke Fortune, (406) 444-1281, lfortune@mt.gov

CR1 Capability Workplan Progress

Each quarter write a synopsis of the progress made on your jurisdiction’s PHEP Capabilities Gap workplan.

CR1 Complete?*

Did you accomplish all of your objectives described in your workplan this quarter?

Because you didn't accomplish all of your objectives, did you readjust your entire work plan or just the next quarter?

Briefly describe your work this quarter to cover the capability gaps outlined in your workplan. (250 character limit)

Please include the adjustments you have made in the description for the quarter.


CR2 Contribute to Growth of Regional Healthcare Coalitions       

Participate in Regional Healthcare Coalition (RHCC) activities.

CR2 Complete?*

Did your jurisdiction participate in the selection of any public health representatives on the executive committee in your Regional Healthcare Coalition during this quarter?

Briefly describe any activities in your jurisdiction this quarter that involved your regional healthcare coalition. (250 character limit)

Refer to guidance in Attachment A for example activities.


Emergency Medical Countermeasures

Taylor Curry, (406) 444-6072, taylor.curry@mt.gov

EMC3 Update and Share POD Plan

Upload a reviewed and updated POD Plan to the progress report.  Provide the date reviewed, signed, and dated by all identified partners.

EMC3 complete?*

Upload a copy of your jurisdiction's POD plan.

No File Chosen
File uploads may not work on some mobile devices.

Is the jurisdiction's list of POD locations and the contact information included in the POD plan, or is it a separate document?

Upload a copy of the list for POD locations and contact information.

No File Chosen
File uploads may not work on some mobile devices.
Upload the list of POD locations.

Provide a list of partners in your jurisdiction with whom you shared the updated POD plan and the date you distributed it to them.  There are two options for submitting this information.  Either write in the space provided or upload a current document.

Option 1: List partners with whom you shared the POD plan.
EMC3 Upload Partner List
No File Chosen
File uploads may not work on some mobile devices.
Option 2: Upload a current record listing partners with whom you shared your POD plan.


Epidemiology

Danny Power, (406) 444-0273,danny.power@mt.gov

E1 Collaborative Activities with Key Surveillance Partners (KSP)

Identify, engage, and report activities with your jurisdiction’s Key Surveillance Partners.


E1 complete?*

Provide the number of KSPs in your jurisdictions that are 

Providers
Laboratories
Schools
Senior Care Facilities
Other partners

Did you update your log of active surveillance calls this quarter?

How frequently do you disseminate information to KSPs?


E3 Reconcile Communicable Disease Cases with DPHHS Staff

Reconcile all communicable disease investigations performed in the past quarter in order to meet the timeliness and completeness standards set forth by DPHHS and the Administrative Rules of Montana. 

E3 complete?*

Record the date that cases were reconciled with DPHHS staff. (Please refer to Attachment A for guidance.)


E4 Maintain 24/7 Communication System

Participate in the regular testing of the 24/7 notification system initiated by the CDEpi section.


Suspended for the Quarter 

E4 complete?

Was your jurisdiction's response to the initial 24/7 test call successful this quarter?


E6 Review the Pandemic Influenza Plan

Review and update your jurisdiction's Pandemic Influenza Plan.  Upload your plan review worksheet to the progress report and upload your latest version of your plan if edits were made over the previous year.

E6 complete?*

Upload your completed pandemic influenza plan assessment tool here.  

Please clearly save it as your jurisdiction’s 2021 Pan Flu Assessment, beginning with your jurisdiction's name.

Pan Flu assessment
No File Chosen
File uploads may not work on some mobile devices.
Upload your completed plan assessment here.
Pan Flu Plan (if changed)
No File Chosen
File uploads may not work on some mobile devices.
Upload your completed plan assessment here.


Food & Water Safety

Staci Evangeline, (406) 444-2089,staci.evangeline@mt.gov

F1 Sanitarian Participation in LEPC

A registered sanitarian (RS) from your jurisdiction’s environmental health office attends at least one LEPC or TERC meeting annually.

F1 complete?*

Did your jurisdiction's sanitarian attend the TERC or LEPC meeting, or did a designated representative?

Provide a summary of what information was communicated and the name of the representative.

Enter the date the of the TERC or LEPC meeting your jurisdiction's sanitarian or designee attended.


F3 After-Hours Contact Information for Sanitarians Integrated into 24/7 System

Ensure that environmental health sanitarians are integrated into your jurisdictions 24/7 communication system (see E4).


Suspended for the Quarter

F3 complete?

Did your jurisdiction's on-call sanitarian or other public health representative respond to the test call within 15 minutes?


Health Alert Network

Gerry Wheat, (406) 444-6736, gwheat@mt.gov

H1 HAN Distribution

Test your HAN System once each quarter. 

H1 complete?*
What was the total number of recipients?
How many recipients responded within 25 hours?


H2 Local HAN Contacts

Provide the total number of  HAN contacts.

H2 complete?*

Count and report the total number of contacts in your jurisdiction who are local HAN Contacts.


H3 Redundant Tactical Communications Test (Part 2)

Conduct a communications test to maintain connectivity with PHEP.

H3 4th Q complete?*

Record the date of your test call to the DPHHS Duty Officer.

NOTE: The number has changed to 406-444-3075.


H4 DPHHS HAN Coordinators

List direct number and email for primary, secondary, and tertiary HAN coordinators in the Public Health Directory.

H4 complete?*


Immunization

Michelle Funchess, (406) 444-2969, mfunchess@mt.gov. 

IZ1 Immunization Off-Site Influenza Clinics

Report the total number of off-site influenza immunization clinics and the total number of influenza vaccine doses administered at the off-site clinics.

IZ1 complete?*

Use the IZ1 worksheet to track off-site clinics and doses of influenza vaccine administered.

What was the total number of off-site influenza clinics conducted this quarter?

What was the total number of influenza vaccine doses administered this quarter?


IZ2 Influenza Partners & Communication

Report influenza vaccination planning with your jurisdiction’s influenza partner agencies or groups and types of media outreach used to advertise influenza prevention messaging and your influenza clinics.

IZ2 complete?*

Use the IZ2 worksheet to track vaccine partner meetings and influenza prevention messaging and clinic advertising.

Did your jurisdiction have any meetings with influenza partner agencies or organizations this quarter? Influenza partner agencies might include pharmacies, long-term care (LTC) facilities, allergists, healthcare providers, etc.

Did your jurisdiction use media outreach for influenza prevention messaging or advertising your influenza clinics this quarter? Examples may include Facebook, newspaper, radio, brochure, etc.

Select the types of media outreach used for influenza prevention messaging or advertising influenza clinics this quarter. 

If you select "Other," please describe it in the comment box.


Risk Communications

Ian Thigpen, (406) 444-0931, ithigpen@mt.gov

RC3 CERC Training 

Complete a Crisis and Emergency Risk Communications training or refresher training.


This requirement moved to the 2022-2023 (BP1901-04) year.

Surge Management

Kevin O’Loughlin, (406) 444-1611, koloughlin@mt.gov

SM2 Volunteer Registry Promotion and Recruitment 

Introduce and promote the new version of the Volunteer Registry.


Rescinded

SM2 complete?

Describe how and to whom you promoted the Volunteer Registry over the past budget period.


SM3 Volunteer Registry Activation Plan

Develop a plan on how you will activate your volunteers using the following guidance.


Rescinded

SM3 complete?


Training

Jake Brown, (406) 44-1305, jacob.brown@mt.gov

T1 ICS/IS Training

Ensure public health staff have passed FEMA training courses for the incident command structure, at a minimum, in ICS 100, 200, and 700.

T1 complete?*

Part 1 - List the names, courses and dates of completion for your staff who have completed ICS training during THIS budget period.

A) These staff completed IS/ICS 100, 200, 700 (new and refresher). Enter the date of completion.

Need More?
Still More?


B) These staff completed (new and refresher) additional or advanced FEMA IS/ICS training courses (e.g. ICS 300, ICS 400, IS 230, IS 2905, etc.).  Enter the date of completion.

More?


Part 2 - Record Keeping

Did you keep a record of staff completing FEMA IS/ICS courses?

Do you scan the certificates of completion your staff earn?

Did you create a backup file for staff training records?


Completion of this Progress Report

Required Fields

Be sure that you have marked each deliverable to indicate if it is complete or not before you attempt to submit this report. Also make sure that you have completed all the elements that are required for the deliverables due for the quarter. 

 

Upload Files

As the last step before submitting this progress report, upload all the documents for the required deliverables for this quarter. Uploaded documents are not saved with the "Save and Resume Later" feature. 

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