HomeMy WebLinkAboutConCon Amendment 2 SOW'sExhibit A, Statement of Work Page 1 of 4 Contract Number CLH31015
Exhibit A
Statement of Work
Contract Term: 2022-2024
DOH Program Name or Title: Climate & Health Wildfire Smoke Indoor Air Quality
Project - Effective January 1. 2022
Local Health Jurisdiction Name: Kittitas County Public Health Department
Contract Number: CLH31015
SOW Type: Revision Revision # (for this SOW) 1 Funding Source
Federal Subrecipient
State
Other
Federal Compliance
(check if applicable)
FFATA (Transparency Act)
Research & Development
Type of Payment
Reimbursement
Fixed Price Period of Performance: January 1, 2022 through August 31, 2022
Statement of Work Purpose: The purpose of this statement of work is two-fold and is being done as part of the Center of Disease Contol and Prevention's original and
supplemental grant “Strengthening environmental health capacity (EHC) to detect, prevent, and control environmental health hazards in through data-driven, evidence-based
approaches” initially awarded to DOH on September 1, 2020.
1) The first is to respond to declared wildfire disasters in Washington state by identifying the most vulnerable populations , assessing ambient wildfire smoke infiltration into
indoor air in places where vulnerable populations reside, and providing resour ces to protect those populations in areas where indoor air quality needs improvement. This statement
of work provides KCPHD $21,00 to continue this work of the original grant.
2) The second is to increase readiness to apply ventilation practices that reduce wildfire smoke exposure and transmission of airborne COVID-19 and, while considering extreme
heat, in residences or facilities used by vulnerable populations. This work will include distributing wildfire smoke interven tions to vulnerable individuals and repeating the
residential cleaner air room project from the original grant with improvements and incorporation of heat. This statement of w ork provides KCPHD $83,000 to perform these
activities of the supplemental grant that was awarded to DOH on September 1, 2021.
Revision Purpose: The purpose of this revision is to add the unspent funding from the 2018-21 contract for task 12.
DOH Chart of Accounts Master Index Title
Master
Index
Code
Assistance
Listing
Number
BARS
Revenue
Code
LHJ Fund
Start Date
ing Period
End Date
Current
Allocation
Allocation
Change
Increase (+)
Total
Allocation
FFY20 ENVIRO HEALTH CAPACITY-C (CDC) NCE 25440100 93.070 333.93.07 01/01/22 08/31/22 21,000 14,719 35,719
FFY22 CDC EHC EHR SUPPLEMENTAL 25450222 93.070 333.93.07 01/01/22 08/31/22 83,000 0 83,000
0 0 0
0 0 0
0 0 0
0 0 0
TOTALS 104,000 14,719 118,719
Exhibit A, Statement of Work Page 2 of 4 Contract Number CLH31015
Task
# Activity Deliverables/Outcomes Due Date/Time
Frame
Payment
Information
and/or Amount
1 Collaborate with DOH to identify larger facilities for indoor air quality
consultation pilot within the selected target vulnerable population to
include:
• Identify and secure commitment of two (2) long-term care
facilities and two (2) schools for consultation (consultation
consists of identifying current practices, assessing barriers to
improve and training best practices)
• Help develop protocol for consultation of cleaner indoor air in
larger facilities
LHJ presents selected long-term care facility (2)
and school (2)
A written protocol for conducting consultation in
larger facilities
August 31, 2022 Reimbursement
for actual costs
not to exceed
$21,000 on
Master Index
Code 25440100.
2 Collaborate with DOH to provide indoor air quality consultation pilot
to include:
• Conduct consultation in two (2) long-term care facilities
• Conduct consultation in two (2) schools
# of consultation sessions provided to long-term
care facilities on best practices for indoor air quality
# of consultation sessions provided to schools on
best practices for indoor air quality
August 31, 2022
3 Collaborate with DOH to assess the ability to achieve cleaner indoor
air during wildfire smoke events by serving as the main contact with
residences using the protocol established by DOH to include:
• Collect air quality measurements to evaluate intervention strategy
• Assess ten (10) residences
Collaborate with DOH to assess cleaner indoor air in larger facilities to
include:
• Assess current practices in two (2) long-term care facilities and
two (2) schools
• Assess barriers to improving indoor air quality practices in two (2)
long-term care facilities and two (2) schools
# of residences assessed by DOH and LHJ, and
summary of air quality measurements collected
# of scores of current practices in long-term care
facilities
# of scores of current practices in schools
# of long-term care facilities with obstacles to
indoor air quality improvements characterized
# of schools with obstacles to indoor air quality
improvements characterized
August 31, 2022
4 Collaborate with DOH as lead of qualitative assessment to estimate the
effectiveness and efficacy of the intervention to reduce exposures
through access to cleaner indoor air spaces to in residences include:
• Quantifying the number of people impacted by the intervention
# of vulnerable people in residences impacted by
the intervention
# of people completing qualitative assessment
August 31, 2022
5 Adapt intervention and local communication resources for local use
based on information from evaluation to include:
• Developing a plan for revising local communication resources
• Incorporating revisions in local communication resources
Submit a copy of revised local communication
resources based on information from the evaluation
August 31, 2022
6 Identify vulnerable individuals for distribution of wildfire smoke
intervention (HEPA portable air cleaner) to include:
• Establishing selection criteria for recipients
• Developing method to collect demographics of recipients
LHJ presents to DOH selection of priority at-risk
target population and criteria for recipients
LHJ presents to DOH method to collect
demographics of recipients
August 31, 2022 Reimbursement
for actual costs
not to exceed
$58,000 on
Master Index
Code 25450222. 7 Distribute wildfire smoke intervention (HEPA portable air cleaner) to
vulnerable individual to include:
• Establishing a plan for distribution
A copy of distribution plan
# of HEPA portable air cleaners purchased
August 31, 2022
Exhibit A, Statement of Work Page 3 of 4 Contract Number CLH31015
Task
# Activity Deliverables/Outcomes Due Date/Time
Frame
Payment
Information
and/or Amount
• Purchasing HEPA portable air cleaners
• Distributing HEPA portable air cleaners (target 100)
• Collect demographics of recipients with developed method
• Developing summary report of intervention distribution
# of vulnerable individuals receiving intervention
# of recipients with reported demographics
LHJ presents to DOH summary report and
presentation
8 Collaborate with DOH to identify residences for participation in a
repetition of residential cleaner air room project to include:
• Identifying vulnerable population based on health risk and
county need
• Establishing selection criteria for participation
• Identifying individuals for intervention and enrolling
participants in project
• Project staff taking human subjects research training
• Summarizing recruitment process
LHJ presents to DOH selection of priority at-risk
target population and criteria for participation
A recruitment plan for participation in residential
cleaner air room project
LHJ presents a list of selected households for
residential cleaner air room project
# of people providing informed consent for
participation in residential cleaner air room project
Certification of completion for human subjects
research training
A copy of recruitment summary
August 31, 2022 Reimbursement
for actual costs
not to exceed
$25,000 on
Master Index
Code 25450222.
9 Collaborate with DOH to develop training and protocol for repetition
of residential cleaner air room project to include:
• Updating communication resource to train residences on creating
cleaner air rooms
• Updating protocol for applying intervention and implementing
project in residences
• Incorporating heat intervention into protocol
A copy of updated communication resource
An updated protocol for applying interventions in
residences
August 31, 2022
10 Collaborate with DOH to implement intervention strategy for
repetition of residential cleaner air room project by serving as main
point of contact for participants to include:
• Implementing intervention strategy in ten residences, such as
establishing the intervention in homes and notifying participants
when to implement it
• Purchasing HEPA portable air cleaners for participants
• Managing and communicating with residences throughout project,
including addressing technical difficulties, coordinating visits,
etc., as needed
• Summarizing implementation of intervention
# of HEPA portable air cleaners purchased
# of residences receiving intervention
Summary of implementation of intervention
August 31, 2022
11 Collaborate with DOH as lead of qualitative assessment for repetition
of residential cleaner air room project to include:
• Updating qualitative intervention assessment tool
Copy of qualitative assessment tool
# of residences completing qualitative assessment
August 31, 2022
Exhibit A, Statement of Work Page 4 of 4 Contract Number CLH31015
Task
# Activity Deliverables/Outcomes Due Date/Time
Frame
Payment
Information
and/or Amount
• Leading dissemination of qualitative assessment to residences
• Analyzing qualitative assessment data
Summary of qualitative assessment results
12 Continue collaboration with DOH to pilot test implementation of the
intervention strategy for creating cleaner indoor air in residences by
serving as main point of contact for participants to include:
• Implementing intervention strategy in ten (10 residences)
Intervention equipment purchased (i.e. portable air
cleaners)
# of residences receiving interventions from DOH
and LHJ
August 31, 2022 TBD $14,719 on
Master Index
Code 25440100.
DOH Program and Fiscal Contact Information for all ConCon SOWs can be found on the DOH Finance SharePoint site. Questions related to this SOW, or any other
finance-related inquiry, may be sent to finance@doh.wa.gov.
Federal Funding Accountability and Transparency Act (FFATA)
This statement of work is supported by federal funds that require compliance with the Federal Funding Accountability and Transparency Act (FFATA or the Transparency Act).
The purpose of the Transparency Act is to make information available online so the public can see how the federal funds are spent.
To comply with this act and be eligible to perform the activities in this statement of work, the LHJ must have a Data Univers al Numbering System (DUNS®) number.
Information about the LHJ and this statement of work will be made available on USASpending.gov by DOH as required by P.L. 109-282.
Restrictions on Funds:
The funds can be used to complete the activities outlined above to conduct community engagement and implement and evaluate the pilot study. Restrictions on funds imposed by
the CDC include:
• Sub-recipients may not use funds for research.
• Sub-recipients may not use funds for clinical care except as allowed by law.
• Sub-recipients may use funds only for reasonable program purposes, including personnel, travel, supplies, and services.
• Generally, sub-recipients may not use funds to purchase furniture or equipment. Any such proposed spending must be clearly identif ied in the budget.
• Reimbursement of pre-award costs generally is not allowed, unless the CDC provides written approval to the sub-recipient.
• Other than for normal and recognized executive-legislative relationships, no funds may be used for:
o publicity or propaganda purposes, for the preparation, distribution, or use of any material designed to support or defeat the enactment of l egislation before any
legislative body
o the salary or expenses of any grant or contract sub-recipient related to any activity designed to influence the enactment of legislation, appropriations, regulation,
administrative action, or Executive order proposed or pending before any legislative body
• In accordance with the United States Protecting Life in Global Health Assistance policy, all non-governmental organization (NGO) applicants acknowledge that foreign
NGOs that receive funds provided through this award, either as a prime recipient or sub recipient, are strictly prohibited, r egardless of the source of funds, from
performing abortions as a method of family planning or engaging in any activity that promotes abortion as a method of family planning, or to pro vide financial support to
any other foreign non-governmental organization that conducts such activities. See Additional Requirement (AR) 35 for applicability
(https://www.cdc.gov/grants/additionalrequirements/ar-35.html).
Monitoring Visits:
Project staff from Kittitas County Public Health and DOH will have at a minimum monthly phone or video calls to check-in on the progress of the grant for the duration of the
project period. These may be substituted for in person meetings in the event that COVID restrictions are lifted during the pr oject period.
Exhibit A, Statement of Work Page 1 of 7 Contract Number CLH31015
Exhibit A
Statement of Work
Contract Term: 2022-2024
DOH Program Name or Title: DCHS - ELC COVID-19 Response -
Effective January 1, 2022
Local Health Jurisdiction Name: Kittitas County Public Health Department
Contract Number: CLH31015
SOW Type: Original Revision # (for this SOW) Funding Source
Federal Subrecipient
State
Other
Federal Compliance
(check if applicable)
FFATA (Transparency Act)
Research & Development
Type of Payment
Reimbursement
Fixed Price Period of Performance: January 1, 2022 through December 31, 2022
Statement of Work Purpose: The purpose of this statement of work (SOW) is to provide supplemental funding for the LHJ to ensure adequate culturally and lingquistically
responsive testing, investigation and contract tracing resources to limit the spread of COVID-19. This funding is the actual carryforward amount.
Revision Purpose: N/A
DOH Chart of Accounts Master Index Title
Master
Index
Code
Assistance
Listing
Number
BARS
Revenue
Code
LHJ Fund
Start Date
ing Period
End Date
Current
Allocation
Allocation
Change
Increase (+)
Total
Allocation
FFY19 ELC COVID ED ALLOCATION 1897129G 93.323 333.93.32 01/01/22 10/18/22 0 14,588 14,588
FFY20 ELC EDE LHJ ALLOCATION 1897120E 93.323 333.93.32 01/01/22 12/31/22 0 754,494 754,494
0 0 0
0 0 0
0 0 0
0 0 0
TOTALS 0 769,082 769,082
Task
# Activity Deliverables/Outcomes Due Date/Time Frame Payment Information
and/or Amount
Participate in public health emergency preparedness and response activities for COVID -19. This may include surveillance, epidemiology, laboratory capacity, infection control,
mitigation, communications and or other preparedness and response activities for COVID-19.
Examples of key activities include:
• Incident management for the response
• Testing
• Case Investigation/Contact Tracing
• Sustainable isolation and quarantine
• Care coordination
• Surge management
• Data reporting
Exhibit A, Statement of Work Page 2 of 7 Contract Number CLH31015
Task
# Activity Deliverables/Outcomes Due Date/Time Frame Payment Information
and/or Amount
NOTE: The purpose of this agreement is to supplement existing funds for local health jurisdictions to carry out surveillance, epidemiology, case investigations and contact
tracing, laboratory capacity, infection control, mitigation, communications, community engagement, and other public health preparedness and response activities for COVID-19.
DCHS COVID-19 Response
1 Establish a budget plan and narrative to be submitted to the
Department of Health (DOH) Contract Manager. DOH will
send the “Budget narrative Template”, “Budget Guidance” and
any other applicable documents that may be identified.
Submit the budget plan and narrative using
the template provided.
Within 30 days of
receiving any new award
for DCHS COVID-19
Response tasks.
Reimbursement of actual
costs incurred, not to
exceed:
$14,588 FFY19 ELC
COVID ED LHJ
ALLOCATION Funding
(MI 1897129G)
Funding end date
10/18/2022
$754,494 FFY20 ELC
EDE LHJ ALLOCATION
Funding (MI 1897120E)
Funding end date
7/31/2023
2 1) LHJ Active monitoring activities. In partnership with WA
DOH and neighboring Tribes, the LHJ must ensure
adequate culturally and linguistically responsive testing,
investigation and contact tracing resources to limit the
spread disease. LHJs must conduct the following activities
in accordance with the guidance to be provided by DOH.
a. Allocate enough funding to ensure the following
Contact Tracing and Case Investigation Support: Hire a
minimum of 1.0 data entry FTE to assure system
requirements for task 2.1.a.
i. Contact tracing
1. Strive to maintain the capacity to surge a
minimum of five (5) contact tracers for every
100,000 people in the jurisdiction, as needed,
based on disease rates. DOH centralized
investigations will count towards this
minimum.
2. Have staff that reflect the demographic
makeup of the jurisdiction and who can
provide culturally and linguistically
competent and responsive services. In
addition, or alternatively, enter into an
agreement(s) with Tribal, community-based
and/or culturally-specific organizations to
provide such services. DOH centralized
investigations will count towards this
minimum.
3. Ensure all contact tracing staff are trained in
accordance with DOH investigative guidelines
and data entry protocols.
4. Coordinate with Tribal partners in conducting
contact tracing for Tribal members.
Data collected and reported into DOH
systems daily.
Enter all contact tracing data in CREST
following guidance from DOH.
Enter performance metrics
daily into DOH identified
systems
Quarterly performance
reporting updates
Exhibit A, Statement of Work Page 3 of 7 Contract Number CLH31015
Task
# Activity Deliverables/Outcomes Due Date/Time Frame Payment Information
and/or Amount
5. Ensure contact tracing and case investigations
activities meet DOH case and Contact Tracing
Metrics. (Metrics to be determined
collaboratively by DOH, LHJs and Tribes.)
Work with DOH to develop a corrective
action plan if unable to meet metrics.
6. Perform daily monitoring for symptoms
during quarantine period of contacts
ii. Case investigation
1. Strive to maintain the capacity to surge a
minimum of five (5) case investigators and
contact tracers for every 100,000 people in the
jurisdiction, as needed, based on disease rates.
DOH centralized investigation will count
toward this minimum.
2. Enter all case investigation and outbreak data
in WDRS following DOH guidance.
a) Strive to enter all case investigation and
outbreak data into CREST as directed by
DOH.
b) Ensure all staff designated to utilize
WDRS have access and are trained in the
system.
c) Include if new positive cases are tied to a
known existing positive case or indicate
community spread.
d) Conduct case investigation and monitor
outbreaks.
e) Coordinate with Tribal partners in
conducting case investigations for tribal
members.
3. Ensure contact tracing and case investigation
activities meet DOH Case and Contact
Tracing Metrics. (Metrics to be determined
collaboratively by DOH, LHJs, and Tribes.)
Work with DOH to develop a corrective
action plan if unable to meet metrics.
b. Testing
i. Work with partners and Tribes to ensure testing is
available to every person within the jurisdiction
meeting current DOH criteria for testing and
other local testing needs.
Enter all case investigation data in WDRS
following guidance from DOH.
Exhibit A, Statement of Work Page 4 of 7 Contract Number CLH31015
Task
# Activity Deliverables/Outcomes Due Date/Time Frame Payment Information
and/or Amount
ii. Work with partners and Tribes to ensure testing is
provided in a culturally and linguistically
responsive manner with an emphasis on making
testing available to disproportionately impacted
communities and as a part of the jurisdiction’s
contact tracing strategy.
iii. Maintain a current list of entities providing
COVID-19 testing and at what volume. Provide
reports to DOH on testing locations and volume
as requested.
c. Surveillance FTE support at a minimum of .5 FTE
Epidemiologist to support daily reporting needs below.
i. Ensure all COVID positive lab test results from
LHJ are entered in to WDRS by 1) entering data
directly in to WDRS, 2) sending test results to DOH
to enter, or 3) working with DOH and entities
conducting tests to implement an electronic method
for test result submission.
ii. Maintain records of all COVID negative lab test
results from the LHJ and enter into WDRS when
resources permit or send test results to DOH.
iii. Collaborate with Tribes to ensure Tribal entities
with appropriate public health authority have
read/write access to WDRS and CREST to ensure
that all COVID lab results from their jurisdictions
are entered in WDRS or shared with the LHJ or
DOH for entry.
d. Tribal Support. Ensure alignment of contact tracing
and support for patients and family by coordinating
with local tribes if a patient identified as American
Indian/Alaska Native and/or a member of a WA tribe.
e. Support Infection Prevention and control for high-risk
populations
i. Migrant and seasonal farmworker support.
Partner with farmers, agriculture sector and
farmworker service organizations to develop and
execute plans for testing, quarantine and
isolation, and social service needs for migrant and
seasonal farmworkers.
Maintain a current list of entities providing
COVID-19 testing and at what volume.
Provide reports to DOH Contract manager
on testing locations and volume as
requested.
Ensure all COVID positive test results are
entered into WDRS within 2 days of
receipt
Quarterly performance updates related to
culturally and linguistic competency and
responsiveness, tribal support, infection
prevention and control for high-risk
populations, community education and
regional active monitoring activities.
Performance update should include status
of all projects listed.
Exhibit A, Statement of Work Page 5 of 7 Contract Number CLH31015
Task
# Activity Deliverables/Outcomes Due Date/Time Frame Payment Information
and/or Amount
ii. Congregate care facilities: In collaboration with
the state licensing agency (DSHS), support
infection prevention assessments, testing.
Infection control and isolation and quarantine
protocols in congregate care facilities.
iii. High risk businesses or community-based
operations. In collaboration with state licensing
agencies and Labor and Industries, partner with
food processing and manufacturing businesses to
ensure adequate practices to prevent COVID-19
exposure, conduct testing and respond to
outbreaks.
iv. Healthcare: Support infection prevention and
control assessments, testing, cohorting, and
isolation procedures. Provide educational
resources to a variety of healthcare setting types
(e.g., nursing homes, hospitals, dental, dialysis).
v. Non-healthcare settings that house vulnerable
populations: In collaboration with state
corrections agency (DOC) and other state
partners, support testing, infection control,
isolation and quarantine and social services and
wraparound supports for individuals living or
temporarily residing in congregate living settings,
including detention centers, prisons, jails,
transition housing, homeless shelters, and other
vulnerable populations.
vi. Schools: In collaboration with OSPI and local
health jurisdictions, support infection prevention
and control and outbreak response in K-12 and
university school settings.
f. Ensure adequate resources are directed towards H2A
housing facilities within communities, fishing
industries and long-term care facilities to prevent and
control disease transmission. Funds can be used to hire
support staff, provide incentives or facility-based
funding for onsite infection prevention efforts, etc.
g. Community education. Work with Tribes and partners
to provide culturally and linguistically responsive
community outreach and education related to COVID-
19.
Exhibit A, Statement of Work Page 6 of 7 Contract Number CLH31015
Task
# Activity Deliverables/Outcomes Due Date/Time Frame Payment Information
and/or Amount
h. Establish sustainable isolation and quarantine
measures.
i. Have at least one (1) location identified and
confirmed through contract/formal agreement that
can support isolation and quarantine adequate to
the population for your jurisdiction with the
ability to expand; alternatively, establish with an
adjacent jurisdiction a formal agreement to
provide the isolation and quarantine capacity
adequate to the population for your jurisdiction
with the ability to expand.
ii. Maintain ongoing census data for isolation and
quarantine for your population.
iii. Planning must incorporate transfer or receipt of
isolation and quarantine patients to from adjacent
jurisdictions or state facilities in the event of
localized increased need.
Planning must incorporate triggers and coordination to request
state isolation and quarantine support either through mobile
teams or the state facility to include site identification and
access
Quarterly performance updates to include
name, address and capacity of identified
location that can support isolation and
quarantine, and confirmation of
appropriate planning and coordination as
required.
Report census numbers to include historic
total by month and monthly total for
current quarter to date
DOH Program and Fiscal Contact Information for all ConCon SOWs can be found on the DOH Finance SharePoint site. Questions related to this SOW, or any other
finance-related inquiry, may be sent to finance@doh.wa.gov.
Federal Funding Accountability and Transparency Act (FFATA)
This statement of work is supported by federal funds that require compliance with the Federal Funding Accountability and Transparency Act (FFATA or the Transparency Act).
The purpose of the Transparency Act is to make information available online so the public can see how the federal funds are s pent.
To comply with this act and be eligible to perform the activities in this statement of work, the LHJ must have a Data Universal Numbering System (DUNS®) number.
Information about the LHJ and this statement of work will be made available on USASpending.gov by DOH as required by P.L. 109-282.
Restrictions on Funds (what funds can be used for which activities, not direct payments, etc.)
CDC Funding Regulations and Policies: https://www.cdc.gov/grants/documents/General-Terms-and-Conditions-Non-Research-Awards.pdf
Monitoring Visits (frequency, type)
The DOH program contact may conduct monitoring visits during the life of this project. The type, duration, and timing of visit will be determined and scheduled in cooperation
with the subawardee. The DOH Fiscal Monitoring Unit may conduct fiscal monitoring site visits during the l ife of this project
Program Specific Requirements/Narrative
Exhibit A, Statement of Work Page 7 of 7 Contract Number CLH31015
All work will be performed in accordance with the revised and approved project plans to be submitted to DOH.
Special Billing Requirements
Payment: Upon approval of deliverables and receipt of an invoice voucher, DOH will reimburse for actual allowable costs incurred. Billings for services on a monthly fr action of
the budget will not be accepted or approved.
Submission of Invoice Vouchers: The LHJ shall submit correct monthly A19-1A invoice vouchers for amounts billable under this statement of work to DOH by the 25th of the
following month or on a frequency no less often than quarterly.
Other: Required activities, deliverables, and funding is for the entire project period: January 2021 through specified date above. Unspent funds and tasks not completed by
December 31, 2021 were reauthorized for work in this new consolidated contract term beginning January 1, 2022. It is the LHJ’s responsibility to assure that the unspent funding
amount carried forward to this statement of work does not exceed the remaining available balance from the 2018 -2021 contract.
Exhibit A, Statement of Work Page 1 of 2 Contract Number CLH31015
Template September 2021
Exhibit A
Statement of Work
Contract Term: 2022-2024
DOH Program Name or Title: ELC COVID-19 - Effective January 1, 2022 Local Health Jurisdiction Name: Kittitas County Public Health Department
Contract Number: CLH31015
SOW Type: Original Revision # (for this SOW) Funding Source
Federal Subrecipient
State
Other
Federal Compliance
(check if applicable)
FFATA (Transparency Act)
Research & Development
Type of Payment
Reimbursement
Fixed Price Period of Performance: January 1, 2022 through April 22, 2022
Statement of Work Purpose: The purpose of this statement of work is to build and strengthen epidemiology, laboratory and health information systems capacity in local health
jurisdictions. The funding allocation is the actual carryforward amount.
Revision Purpose: N/A
DOH Chart of Accounts Master Index Title
Master
Index
Code
Assistance
Listing
Number
BARS
Revenue
Code
LHJ Fund
Start Date
ing Period
End Date
Current
Allocation
Allocation
Change
Increase (+)
Total
Allocation
FFY19 COVID CARES 1891029B 93.323 333.93.32 01/01/22 04/22/22 0 174 174
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
TOTALS 0 174 174
Task
# Activity Deliverables/Outcomes Due Date/Time
Frame
Payment
Information
and/or Amount
1 Establish a spending plan and staffing proposal to support the work of COVID-19 case
investigation and contact tracing. The spending plan and staffing proposal should include
proposed positions and define roles.
Submit spending plan and
staffing proposal summary to the
DOH Contract Manager.
August 15,
2020 – update if
necessary
Payment for all
tasks will be
reimbursement for
actual expenses
up to the
maximum
available within
the funding
periods for each
source described
in the Funding
Table above.
2 Hire, orient and/or train staff based on the negotiated staffing proposal. Develop a training
plan in consultation with DOH that is consistent with the DOH COVID-19 guideline.
Training plan will be flexible depending on staff experience and based on for onboarding
into new systems.
Staff summary and training plan September 30,
2020
3 Conduct case investigations, contact tracing and monitoring in accordance with DOH
COVID-19 Infection Reporting and Surveillance Guidelines (DOH 420-107), Appendix 1:
Case and Contact Investigation, pages 16-21:
https://www.doh.wa.gov/Portals/1/Documents/5100/420-107-Guideline-COVID-19.pdf
Data collected and reported into
DOH systems
Daily
Exhibit A, Statement of Work Page 2 of 2 Contract Number CLH31015
Template September 2021
DOH Program and Fiscal Contact Information for all ConCon SOWs can be found on the DOH Finance SharePoint site. Questions related to this SOW, or any other
finance-related inquiry, may be sent to finance@doh.wa.gov.
Federal Funding Accountability and Transparency Act (FFATA)
This statement of work is supported by federal funds that require compliance with the Federal Funding Accountability and Transparency Act (FFATA or the Transparency Act).
The purpose of the Transparency Act is to make information available online so the public can see how the federal funds are s pent.
To comply with this act and be eligible to perform the activities in this statement of work, the LHJ must have a Data Universal Numbering Syste m (DUNS®) number.
Information about the LHJ and this statement of work will be made available on USASpending.gov by DOH as required by P.L. 109-282.
Restrictions on Funds (what funds can be used for which activities, not direct payments, etc)
CDC Funding Regulations and Policies
https://www.cdc.gov/grants/documents/General-Terms-and-Conditions-Non-Research-Awards.pdf
Monitoring Visits (frequency, type)
The DOH program contact may conduct monitoring visits during the life of this project. The type, duration, and timing of visit will be determined and scheduled in cooperation
with the subawardee. The DOH Fiscal Monitoring Unit may conduct fiscal monitoring site visits during the l ife of this project
Program Specific Requirements/Narrative
All work will be performed in accordance with the revised and approved project plans to be submitted to DOH.
Special Billing Requirements
Payment: Upon approval of deliverables and receipt of an invoice voucher, DOH will reimburse for actual allowable costs incurred. Billings for services on a monthly fraction of
the budget will not be accepted or approved.
Submission of Invoice Vouchers: The LHJ shall submit correct monthly A19-1A invoice vouchers for amounts billable under this statement of work to DOH by the 25th of the
following month or on a frequency no less often than quarterly.
Other: Required activities, deliverables, and funding is for the entire project period: June 1, 2020 through April 22, 2022. Unspent funds and tasks not completed by December
31, 2021 were reauthorized for work in this new consolidated contract term beginning January 1, 2022. It is the LHJ’s responsibility to assure that the unspent funding amount
carried forward to this statement of work does not exceed the remaining available balance from the 2018-2021 contract.
Exhibit A
Statement of Work
Contract Term: 2022-2024
DOH Program Name or Title: Emergency Preparedness. Resilience & Response -
PHEP - Effective January 1, 2022
SOW Type: On�alal Revision # (for this SOW)
Period of Performance: January 1 202 through June 30, 2022
Local Health Jurisdiction Name: Kittitas County Public Health Department
Contract Number: CLH31015
Funding Source Federal Compliance Type of Payment
® Federal Subrecipient (check if applicable) ® Reimbursement
❑ State 0 FFATA (Transparency Act) ❑ Fixed Price
❑ Other ❑ Research & Development
Statement of Work Purpose: The purpose of this statement of work is to establish funding and tasks to supportand sustain LHJ public health emergency preparedness as partof
statewide public health emergency preparedness, resilience and response.
Revision Purpose: NA
Master
Index
DOH Chart of Accounts Master Index Title Code
Assistance
Listing
Number
BARS
Revenue
Code
LHJ Funding Period
Start Date End Date
Current
Allocation
Allocation
Chan e
g
Increase (+)
Total
Allocation
FFY21 PHEP BP3 LHJ Funding 31102380
93.069
333.93.06
01/01/22 06/30/22
0
29,492
29,492
for actual costs
Complete reporting templates as requested by DOH to comply with program and federa Igra nt
0
0
0
requirements, including mid -year and end -of -year reports.
Additional reporting maybe
totalfunding
0
0
0
consideration
0
0
0
2
Across Domains and Capabilities
Submit any changes to contact
Within 30
0
0
0
days of the
0
0
0
0
0
0
TOTALS
0
1 29,492
1 29,492
Task
#
Activity
Deliverables/Outcomes
Due
Date/Time
Frame
Payment
Information
and/or Amount
1
Across Domains and Capabilities
End-of-yearreport on template
June 30, 2022
Reimbursement
provided by DOH.
for actual costs
Complete reporting templates as requested by DOH to comply with program and federa Igra nt
not to exceed
requirements, including mid -year and end -of -year reports.
Additional reporting maybe
totalfunding
required if federal requirements
consideration
change.
amount.
2
Across Domains and Capabilities
Submit any changes to contact
Within 30
information (submitted in 202 1)
days of the
within 30 days of the change.
change.
Exhibit A, Statement of Work Page 1 of 6 Contract NumberCLH31015
Template September2021
Task
Due
Payment
#
Activity
Deliverables/Outcomes
Date/Time
Information
Frame
and/or Amount
2.1 Submit names, position titles, email addresses and phone numbers of key LHJ staff
End-of-yearreport on template
responsible for this statement of work, including management, Emergency Response
provided by DOH. Note any
June 30, 2022
Coordinator, and accounting and/or financial staff.
changes or no change.
2.2 Submit emergency contacts to be published in the confidentialYellow Book, including but
not limited to Administrator, Health Officer, and Emergency Response Coordinator. For each
contact include name, role, email, daytime phone number and after-hours phone number.
3
Across Domains and Capabilities
DOH will maintain
Upon request
documentation of site visit
from DOH.
Participate in a site visit with DOH staff to discuss LHJ response capabilities, upon request from
participation.
DOH. Site visit may be held virtually due to pandernic restrictions.
4
Across Domains and Capabilities
Budget, using template provided
Upon request
by DOH.
from DOH.
Develop a budget demonstratinghow the LHJ plans to spend funds during this period of
performance, using a budget template provided by DOH.
Note: 20% of the LHJ's annual allocation will be withheld until this requirement is met. Failure
to meet this requirement may result in DOH redirecting funds from the LHJ.
5
Across Domains and Capabilities
End-of-yearreport on template
June 30, 2022
provided by DOH.
Review and provide input to DOH on public health emergency preparedness plans developed by
DOH, upon request from DOH.
Input provided to DOH upon
request from DOH.
6
Domain 1 Community Resilience
End-of-yearreport on template
June 30, 2022
Capability 1 Community Preparedness
provided by DOH.
Participate in emergency preparedness events (for example, tra inings, meetings, conference
Documentation of training
calls, and conferences) to advance LHJ, regional, or statewide public health preparedness.
available upon request.
7
Across Domains and Capabilities
End-of-yearreport on template
June 30, 2022
provided by DOH. Note training
DOH/EPR anticipates many changes in the next months to years as we incorporate lessons
and briefly describe key learning
learned from the COVID-19 response. In preparation forthese changes, the LHJ may use PHEP
and any resulting changes in
funding to participate in training and/orleaming discussions in the following areas:
practice and/orpolicy.
• Adaptive Leadership
• Change Management
• Trauma -Informed Change Management
• Outward Mindset
• Growth Mindset
• RacialEquity and/orSocial Justice
• Community Resilience
• Related topics — prior approval from EPR required.
Exhibit A, Statement of Work Page 2 of 6 Contract NumberCLH31015
Template September2021
Task
Due
Payment
#
Activity
Deliverables/Outcomes
Date/Time
Information
Frame
and/or Amount
Note: Prior approval from DOH/EPR is required for any out-of-state travel.
8
Domain 1 Community Resilience
End-of-yearreport on template
June 30, 2022
Capability 1 Community Preparedness
provided by DOH. Briefly
Connect with new and/orexisting partners in order to develop working relationships that
describe connections, lessons
promote capabilities, capacity and community resilience, including, but not limited to:
learned, and any changes made.
• Local and/orregional Emergency Manager(s).
• Local and/orregional hospitals.
• Local and/orregional elected officials.
• Local and/orre conal organizations that work with vulnerable populations.
9
Domain Incident Management
End-of-yearreport on template
June 30, 2022
Capability 3 Emergency Operations Coordination - Training & Exercise
provided by DOH.
Based on availability of training, participate in at least one Foundational Public Hea lth
Emergency Preparedness Training provided by region, DOH, DOH -contracted partner, or DOH -
approved trainer in person or via webinar.
Notes:
• This is one or more specific trainings coordinated by DOH. DOH will work with LHJ to
implement.
• Participation in an activation, exercise or real-world event may be considered additional
training, but does not take the place of the requirement to participate in at least one training as
described above.
10
Domain 2 Incident Management
Participation in IPPW unless
As requested
Capability 3 Emergency Operations Coordination - Training & Exercise
cancelled.
by DOH.
Participate in Integrated Preparedness Planning Workshop (IPPW) unless cancelled. The
Workshop is planned for January 2022.
11
Domain Incident Management
End-of-yearreport on template
June 30, 2022
Capability 3 Emergency Operations Coordination
provided by DOH. Indicate that
this was done or that no response
11.1 Provide immediate notification to DOH Duty Officer at360-888-0838 or
incident occurred.
hanalert&doh.wa.aov forall response incidents involving use of emergency response plans
and/or incident command structures.
11.1 Notification to DOH Duty
Officer within 60 minutes of
11.2 Produce andprovide situation reports (sitreps) documentingLHJ activity during all
activation.
incidents. Sitrep maybe developed by the LHJ or anotherjurisdiction that includes input from
LHJ.
11.2 Sitreps submitted to DOH
Duty Officer
Exhibit A, Statement of Work Page 3 of 6 Contract NumberCLH31015
Template September2021
Task
Due
Payment
#
Activity
Deliverables/Outcomes
Date/Time
Information
Frame
and/or Amount
12
Domain Incident Management
End-of-yearreport on template
June 30, 2022
Capability 3 Emergency Operations Coordination
provided by DOH. Briefly
describe key lessons learned and
Complete or participate in After Action Reports (AARs) after each incident or exercise.
changes made and/orplanned —
or note that no AARs were
Note: An AAR may be completed part-way through an extended response, for example,
completed. Submit AAR(s).
COVID-19.
13
Domain Incident Management
End-of-yearreport on template
June 30, 2022
Capability 3 Emergency Operations Coordination
provided by DOH. Briefly
describe key lessons learned and
Convene a county Emergency Support Function (ESF) 8 AAR for COVID-19. Participants
changes made and/orplanned.
include, but not limited to:
Submit AAR(s).
• Local Health Officer
• Public Health Official(s)
• Emergency Manager
• Regional Health Care Coalition
• Local and regional hospitals
• Federally Qualified Health Center(s) if they are in your county
• Accountable Community of Health
• Emergency Medical Services Medical Program Director
• County Coroner or Medical Examiner
Notes:
• Follow Homeland Security Exercise and Evaluation Program (HSEEP) guidelines for
process and documentation.
• Include name, title, and organization of each participant in documentation (AAR).
• Outreach may need to be conducted to gatherinput from entities not able to participate
in an AAR meeting.
• This may be completed part-way through the COVID-19 response
• This AAR maybe used to meet the requirement above as well Task #12 .
14
Domain 3 Information Management
Capability 4 Emergency Public Information and Warning - Communication
End-of-yearreport on template
June 30, 2022
provided by DOH.
14.1 Participate in Monthly Public Health CommunicatorCall/Webinarby joining call/webinar
and/or following information on the public health communicator online collaborative workspace
(e.g. Basecamp).
14.3 and 14.4 Hotwash or After
14.2 Participate in at least one risk communication drill offered by DOH between July 1, 2021
Action Review (AAR) OR
and June 30, 2022. Drill will occur via webinar, phone and email. DOH will offerone in July 1 —
summary of communication
December 31, 2021 and one drill between January 1— June 30, 2022.
activities and one sample.
14.3 Conduct a hot wash evaluatingLHJ participation in the drill.
Exhibit A, Statement of Work Page 4 of 6 Contract NumberCLH31015
Template September2021
Task
Due
Payment
#
Activity
Deliverables/Outcomes
Date/Time
Information
Frame
and/or Amount
14.4 Identifyingand implementing communication strategies in real world incident will satisfy
need to participate in drill. Conduct a hot wash or After Action Review (AAR) evaluating LHJ
participation in communication strategies during the incident.
If, the real-world event response is ongoing, LHJ may opt to conduct a hot wash or AAR
evaluating communication strategies to date OR include a summary of communication activities
in mid -year and/or end -of yearreports and one sample of communication.
Note: Participation in a real-world event may meet the requirement for 14.2, 14.3 and 14.4.
15
Domain 3 Information Management
End-of-yearreport on template
Capability 6 Information Sharing
provided by DOH.
15.1 Maintain Washington Secure Electronic Communications, Urgent Response and Exchange
June 30, 2022
System (WASECURES) as primary notification system.
15.2 Participate in DOH -led notification drills.
15.3 Conduct at least one LHJ drill using LHJ-preferred staff notification system.
Notes:
• Registered users must login quarterly at a minimum.
• DOH will provide technical assistance to LHJs on using WASECURES.
• LHJ may choose to use another notification system in addition to WASECURES to alertstaff
during incidents.
16
Domain 3 Information Management
Provide EEls upon request.
Upon request.
Capability 6 Information Sharing
Note in end -of -year report that
June 30, 2022
Provide Essential Elements of Information (EEls) during incident response upon request from
EEls were provided or none
DOH.
were requested.
Note: DOH will request specific data elements from the LHJ during an incident response, as
needed to inform decision making by DOH and state leaders, as well as federalpartners when
requested.
17
Domain 4 Countermeasures and Mitigation
Capability 8 Medical Countermeasures Dispensing
End-of-yearreport on template
Capability 9 Medical Countermeasures Management and Distribution
provided by DOH.
June 30, 2022
Update and maintain Medical Countermeasure (MCM)Plans for LHJ and/orRegion.
If there is a regional plan,
provide input to the RERC.
Notes:
U datedMCM lan
Exhibit A, Statement of Work Page 5 of 6 Contract NumberCLH31015
Template September2021
Task
#
Activity
Deliverables/Outcomes
Due
Date/Time
Frame
Payment
Information
and/or Amount
* MCM plans include numberof local distribution sites and number for which a detailed point-
to-point distribution plan from RSS to distribution site has beenjointly confirmed by LHJ and
DOH.
• MCM plans include numberof local points of dispensing (PODS) and numberforwhich a
detailed point-to-point distribution plan from local distribution site to dispensing site has been
jointly confirmedby LHJ and POD operator (nursing home, local agency, public POD, and
independent pharmacy).
• LHJs are not required to maintain a hub. LHJs may partnerwith other organizations to
centralize distribution. If LHJs opt to maintain a hub, this should be included in the MCM
plan.
• DOH will provide technical assistance to LHJs on core elements of an MCM plan.
18
Domain 5 Surge Management
Capability 10 Medical Surge
End-of-yearreport on template
June 30, 2022
provided by DOH.
Engagement with regional Health Care Coalition (HCC)
Participate in:
- At least one regional HCC meeting, in person or virtually.
- The information sharing process during incidents.
- At least one planning process or exercise conducted to inform on the roles and
responsibilities of public health.
- Reviewing HCC plans for alignment with local ESF8 plans.
DOH Program and Fiscal Contact Information for all ConCon SOWS can be found on the DOH Finance SharePoint site. Questions related to this SOW, or any other
finance -related inquiry, may be sent to financeadoh.wa.gov.
Federal Funding Accountability and Transparency Act (FFATA) (Applies to federal subrecipient funding.)
This statement of work is supported by federa I funds that require compliance with the Federal Funding Accountability and Trans parency Act (FFATA or the Transparency Act).
The purpose of the Transparency Act is to make information available online so the public can see how the federal funds are spent.
To comply with this act and be eligible to perform the activities in this statement of work, the LHJ must have a Data Univers al Numbering System (DUNS®) number.
Information about the LHJ and this statement of work will be made available onUSASpending_gov by DOH a s required by P.L. 109-282.
Special Requirements:
Any subcontract/s must be approved by DOH prior to executing the contract/s.
Submit deliverables to the Emergency Preparedness, Resilience & Response ConCon deliverables mailbox at concondeliverablesCudoh.wa.eov, unless otherwise specified.
Restrictions on Funds (i.e., disallowed expenses or activities, indirect costs, etc.):
Please reference the Code of Federal Regulations:
httns://www.ecfr.eov/cei-bin/retrieveECFR?eD=1 &SID=58ffddb5363a27f26e9dl2ccec462549&tv=HTML&h=L&mc=true&r=PART&n=nt2.1.200#se2.1.200 1439
Exhibit A, Statement of Work Page 6 of 6 Contract NumberCLH31015
Template September2021