Template Field Operations Guide



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Room Assessment Worksheet


Room Name: Capacity of Room:

Potential Use of the Room:

Number of Phone Ports Number of Internet ports

Number of Electrical Sockets Able to be divided Y/N

Number of Windows Lighting (Describe)

Type of Flooring:  Carpet  Tile  Linoleum  Cement  Wood  Other:



Notes:


Room Name: Capacity of Room:

Potential Use of the Room:

Number of Phone Ports Number of Internet ports

Number of Electrical Sockets Able to be divided Y/N

Number of Windows Lighting (Describe)


Type of Flooring:  Carpet  Tile  Linoleum  Cement  Wood  Other:



Notes:


Room Name: Capacity of Room:

Potential Use of the Room:

Number of Phone Ports Number of Internet ports

Number of Electrical Sockets Able to be divided Y/N

Number of Windows Lighting (Describe)


Type of Flooring:  Carpet  Tile  Linoleum  Cement  Wood  Other:



Notes:


Room Name: Capacity of Room:

Potential Use of the Room:

Number of Phone Ports Number of Internet ports

Number of Electrical Sockets Able to be divided Y/N

Number of Windows Lighting (Describe)


Type of Flooring:  Carpet  Tile  Linoleum  Cement  Wood  Other:



Notes:


Room Name: Capacity of Room:

Potential Use of the Room:

Number of Phone Ports Number of Internet ports

Number of Electrical Sockets Able to be divided Y/N

Number of Windows Lighting (Describe)


Type of Flooring:  Carpet  Tile  Linoleum  Cement  Wood  Other:



Notes:


Room Name: Capacity of Room:

Potential Use of the Room:

Number of Phone Ports Number of Internet ports

Number of Electrical Sockets Able to be divided Y/N

Number of Windows Lighting (Describe)


Type of Flooring:  Carpet  Tile  Linoleum  Cement  Wood  Other:



Notes:





Site Determination


Work with local Red Cross and/or local municipal partners to determine appropriate site for an assistance center. Considerations should include:



  • Type of event




  • Location in relation to event, if applicable




  • Neutrality of site







  • Availability of facility (immediate and long term)




  • Space and floor plan




  • Private room needs







  • Infrastructure, including but not limited to:




      • Power




      • Phone




      • Restroom Facilities




      • Controlled Temperature




      • Parking




      • Security/Safety Issues







      • Computer/Internet Access




      • Copier/Fax




      • Other




      • Other



Assistance Center Facility Agreement


This agreement is between the LOCAL JURISDICTION and a facility owner (“Owner”) so the LOCAL JURISDICTION can use the facility as an emergency assistance center during a disaster.

Facility Name:




Parties and Facility

Facility Owner:

Legal name:




Chapter:




24-Hour Point of Contact:




Name and title:




Work phone:




Cell phone:




Address for Legal Notices:




















Assistance Center Facility:

(Insert name and complete street address of building or, if multiple buildings, write “See attached Facility List” and attach Facility List including complete street address of each building that is part of this Agreement).





















LOCAL JURISDICTION:

Legal name:




Chapter:




24-Hour Point of Contact:




Name and title:







Work phone:




Cell phone:




Address for Legal Notices:


















Copies of legal notices must also be sent to:



The LOCAL JURISDICTION’s General Counsel Office

Terms and Conditions


  1. Use of Facility: Upon request and if feasible, the Owner will permit the LOCAL JURISDICTION to use the Facility on a temporary basis as an emergency public shelter.




  1. Shelter Management: The LOCAL JURISDICTION will have primary responsibility for the operation of the shelter and will designate a LOCAL JURISDICTION official, the Shelter Manager, to manage the sheltering activities. The Owner will designate a Facility Coordinator to coordinate with the Shelter Manager regarding the use of the Facility by the LOCAL JURISDICTION.




  1. Condition of Facility: The Facility Coordinator and Shelter Manager (or designee) will jointly conduct a pre-occupancy survey of the Facility before it is turned over to the LOCAL JURISDICTION. They will use the first page of the Facility Opening/Closing Form to record any existing damage or conditions. The Facility Coordinator will identify and secure all equipment that the LOCAL JURISDICTION should not use while sheltering in the Facility. The LOCAL JURISDICTION will exercise reasonable care while using the Facility as a shelter and will make no modifications to the Facility without the express written approval of the Owner.




  1. Food Services: Upon request by the LOCAL JURISDICTION, and if such resources exist and are available, the Owner will make the food service resources of the Facility, including food, supplies, equipment and food service workers, available to feed the shelter occupants. The Facility Coordinator will designate a Food Service Manager to coordinate the provision of meals at the direction of and in cooperation with the Shelter Manager. The Food Service Manager will establish a feeding schedule, determine food service inventory and needs, and supervise meal planning and preparation. The Food Service Manager and Shelter Manager will jointly conduct a pre-occupancy inventory of the food and food service supplies in the Facility before it is turned over to the LOCAL JURISDICTION.




  1. Custodial Services: Upon request by the LOCAL JURISDICTION and if such resources exist and are available, the Owner will make its custodial resources, including supplies and custodial workers, available to provide cleaning and sanitation services at the shelter. The Facility Coordinator will designate a Facility Custodian to coordinate the provision of cleaning and sanitation services at the direction of and in cooperation with the Shelter Manager.




  1. Security: In coordination with the Facility Coordinator; the Shelter Manager, as he or she deems necessary and appropriate, will coordinate with law enforcement regarding any public safety issues at the Shelter.




  1. Signage and Publicity: The LOCAL JURISDICTION may post signs identifying the shelter as a LOCAL JURISDICTION shelter in locations approved by the Facility Coordinator and will remove such signs when the shelter is closed. The Owner will not issue press releases or other publicity concerning the shelter without the express written consent of the Shelter Manager. The Owner will refer all media questions about the shelter to the Shelter Manager.




  1. Closing the Shelter: The LOCAL JURISDICTION will notify the Owner or Facility Coordinator of the closing date for the shelter. Before the LOCAL JURISDICTION vacates the Facility, the Shelter Manager and Facility Coordinator will jointly conduct a post-occupancy survey, using the second page of the Shelter/Facility Opening/Closing Form to record any damage or conditions. The Shelter Manager and Facility Coordinator or Food Service Manager will conduct a post-occupancy inventory of the food and supplies used during the shelter operation.




  1. Reimbursement: The LOCAL JURISDICTION will reimburse the Owner for the following:

    1. Damage to the Facility or other property of Owner, reasonable wear and tear excepted, resulting from the operations of the LOCAL JURISDICTION. Reimbursement for facility damage will be based on replacement at actual cash value. The LOCAL JURISDICTION will select from among bids from at least three reputable contractors. The LOCAL JURISDICTION is not responsible for storm damage or other damage caused by the disaster.

    2. Reasonable costs associated with custodial and food service personnel which would not have been incurred but for the LOCAL JURISDICTION’s use of the Facility for sheltering. The LOCAL JURISDICTION will reimburse at per-hour, straight-time rate for wages actually incurred but will not reimburse for (i) overtime or (ii) costs of salaried staff.

    3. Reasonable, actual, out-of-pocket operational costs, including the costs of the utilities indicated below, to the extent that such costs would not have been incurred but for the LOCAL JURISDICTION’s use of the Premises (both parties must initial all utilities to be reimbursed by the LOCAL JURISDICTION):







Owner initials




LOCAL JURISDICTION initials

Water










Gas










Electricity










Waste Disposal









The Owner will submit any request for reimbursement to the LOCAL JURISDICTION within 60 days after the shelter closes. Any request for reimbursement for food, supplies or operational costs must be accompanied by supporting invoices. Any request for reimbursement for personnel costs must be accompanied by a list of the personnel with the dates and hours worked at the shelter.




  1. Insurance: The LOCAL JURISDICTION shall carry insurance coverage in the amounts of at least $1,000,000 per occurrence for Commercial General Liability and Automobile Liability. The LOCAL JURISDICTION shall also carry Workers’ Compensation coverage with statutory limits for the jurisdiction within which the facility is located and $1,000,000 in Employers’ Liability.




  1. Indemnification: The LOCAL JURISDICTION shall defend, hold harmless, and indemnify Owner against any legal liability, including reasonable attorney fees, in respect to bodily injury, death and property damage arising from the negligence of the LOCAL JURISDICTION during the use of the Premises.




  1. Term: The term of this agreement begins on the date of the last signature below and ends 30 days after written notice by either party.









THE LOCAL JURISDICTION



Owner (legal name)




(legal name)









By (signature)




By (signature)









Name (printed)




Name (printed)









Title




Title









Date




Date
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