IGA AMD RE EMERGENCY PREPRDN WITH ADHS.PDF

ARIZONA DEPARTMENT
OF HEALTH SERVICES
INTERGOVERNMENTAL AGREEMENT (IGA)
1740 W. Adams, Room 303
AMENDMENT Phoenix, Arizona 85007
(602) 542-1040
(602) 542-1741 Fax
Procurement Officer
Contract No. ADHS12-007891 Amendment No. 11
Ana Shoshtarikj
Emergency Preparedness Program
Effective July 1, 2015, it is mutually agreed that the Intergovernmental Agreement referenced is amended as
follows:
1. Replace Amendment Ten (10) Price Sheet, with Price Sheet of this Amendment Eleven (11). The Public Health
Emergency Preparedness (PHEP) amount for the FY16 has been revised to $2,734,882.00.
2. Replace Amendment Eight (8) Attachment A with Attachment A, Budget Period Four (4), County Requirements
and Deliverables Document of this Amendment Eleven (11).
All other provisions of this agreement remain unchanged.
CONTRACTOR SIGNATURE
Maricopa County by and through its
Maricopa County Department of Public Health
Contractor Name Contractor Authorized Signature
Steve Chucri
4041 N. Central Ave. Suite 1400
Address Printed Name
Phoenix AZ 85012 Chairman, Maricopa County Board of Supervisors
City State Zip Title
CONTRACTOR ATTORNEY SIGNATURE This Intergovernmental Agreement Amendment shall be effective the date
Pursuant to A.R.S. § 11-952, the undersigned public agency attorney indicated. The Public Agency is hereby cautioned not to commence any
has determined that this Intergovernmental Agreement is in proper billable work or provide any material, service or construction under this
form and is within the powers and authority granted under the laws of IGA until the IGA has been executed by an authorized ADHS signatory.
the State of Arizona. State of Arizona
Signed this _________ day of _________________________ 20_______
Signature Date
Printed Name Procurement Officer
Attorney General Contract No. P00120143000078, which is an Reserved for use by the Secretary of State
Agreement between public agencies, has been reviewed pursuant to Under House Bill 2011, A.R.S. § 11-952 was
A.R.S. § 11-952 by the undersigned Assistant Attorney General, who
has determined that it is in proper form and is within the powers and amended to remove the requirement that
authority granted under the laws of the State of Arizona. Intergovernmental Agreements be filed with
the Secretary of State.
Signature Date
Assistant Attorney General
Printed Name:
ATTEST:
________________________________________________
Clerk of the Board Date Page 1 of 16

ARIZONA DEPARTMENT
OF HEALTH SERVICES
INTERGOVERNMENTAL AGREEMENT (IGA) 1740 W. Adams, Room 303
AMENDMENT Phoenix, Arizona 85007
(602) 542-1040
(602) 542-1741 Fax
Contract No. ADHS12-007891 Amendment No. 11 Procurement Officer
Ana Shoshtarikj
PRICE SHEET
Budget Period Four (4)
Effective: July 1, 2015 – June 30, 2016
Fixed Price
Description Quantity Unit Amount
CDC Deliverables for Public Health Emergency
1 YR $1,937,925.00
Preparedness - PHEP
Cities Response Initiative (CRI) FY16 Funds 1 YR $1,005,957.00
Less charges for the CEFO 1 YR - $209,000.00
Total Amount $2,734,882.00
EVD PRICE SHEET
Effective: March 25, 2015
Fixed Price Phase 1
No. Description UOM Amount
Ebola Virus Disease Investigation Guidelines and an Ebola
1 EA $50,912.60
Response Plan
Total $50,912.60
EVD PRICE SHEET
Effective: April 1, 2015 – August 30, 2016
Fixed Price Phase 2
No. Description UOM Amount
1 Ebola and Infectious Disease Preparedness and Response EA $700,000.00
Total $700,000.00
Page 2 of 16

ARIZONA DEPARTMENT
OF HEALTH SERVICES
INTERGOVERNMENTAL AGREEMENT (IGA) 1740 W. Adams, Room 303
AMENDMENT Phoenix, Arizona 85007
(602) 542-1040
(602) 542-1741 Fax
Contract No. ADHS12-007891 Amendment No. 11 Procurement Officer
Ana Shoshtarikj
ATTACHMENT A
PUBLIC HEALTH EMERGENCY PREPAREDNESS (PHEP)
COUNTY REQUIREMENTS & DELIVERABLES DOCUMENT
Budget Period Four (BP4)
Period of Performance:
(July 1, 2015 – June 30, 2016)
Page 3 of 16

ARIZONA DEPARTMENT
OF HEALTH SERVICES
INTERGOVERNMENTAL AGREEMENT (IGA) 1740 W. Adams, Room 303
AMENDMENT Phoenix, Arizona 85007
(602) 542-1040
(602) 542-1741 Fax
Contract No. ADHS12-007891 Amendment No. 11 Procurement Officer
Ana Shoshtarikj
1. INTRODUCTION
1.1 Approaching Budget Period Four (BP4), July 1st, 2015 through June 30th, 2016, continuous efforts are
made to expand the preparedness capabilities based on the Five (5) Year Plan and the Capability Planning
Guide (CPG) data. Based on the above, and the guidance set forth by the Center for Disease Control
(CDC), Arizona Department of Health Services (ADHS) has developed the Requirement and Deliverable
Document for the Counties.
1.2 The first section of this document outlines the requirements set forth by CDC and ADHS that all County
partners will need to address to ensure they are met during BP4. The County Deliverables section covers
the expected goals, objectives and outcomes for each capability within BP4. Progress on these goals and
objectives will be measured throughout the year, through frequent communication and mid-year reporting.
1.3 Deliverables Table and Appendix One (1) incorporated herein, provide additional information for the County
partners.
2. PROGRAM REQUIREMENTS
As a recipient of PHEP funds from the Arizona Department of Health Services (ADHS), you are required to
adhere to Federal and State grant requirements. Below you will find a list of the program requirements for the
PHEP grant.
3. GRANT MEETINGS
3.1 Grantee shall attend the following ADHS Sponsored Grant Meetings (two (2) events annually):
3.1.1 Attend semi-annual ADHS sponsored All-Partners Workshop;
3.1.2 Attend Regional ADHS sponsored Business Meeting
3.2 ADHS will hold one (1) business meeting in each of the four (4) Healthcare Coalition Regions within the
State.
4. HEALTHCARE COALITION MEETING
4.1 Grantee shall participate in quarterly Healthcare Coalition meetings in the appropriate region. Regions are
divided as follows:
4.1.1 Northern Region
4.1.1.1 County Representatives: Apache County, Coconino County and Navajo County;
4.1.1.2 Tribal Representatives: Hopi Tribe, Kaibab-Paiute Tribe and Navajo Nation.
4.1.2 Western Region
4.1.2.1 County Representatives: La Paz County, Mohave County and Yavapai County;
4.1.2.2 Tribal Representatives: Colorado River Indian Tribe and Fort Mojave Indian Tribe.
4.1.3 Central Region
4.1.3.1 County Representatives: Gila County, Maricopa County and Pinal County;
4.1.3.2 Tribal Representatives: Gila River Indian Community, San Carlos Apache Tribe and
White Mountain Apache Tribe.
Page 4 of 16

ARIZONA DEPARTMENT
OF HEALTH SERVICES
INTERGOVERNMENTAL AGREEMENT (IGA) 1740 W. Adams, Room 303
AMENDMENT Phoenix, Arizona 85007
(602) 542-1040
(602) 542-1741 Fax
Contract No. ADHS12-007891 Amendment No. 11 Procurement Officer
Ana Shoshtarikj
4.1.4 Southern Region
4.1.4.1 County Representatives: Cochise County, Graham County, Greenlee County, Pima
County, Santa Cruz County and Yuma County;
4.1.4.2 Tribal Representatives: Cocopah Tribe, Pascua Yaqui Tribe, Tohono O’odham Nation
and Fort Yuma Quechan Tribe.
5. FINANCIAL REQUIREMENTS
5.1 Match Requirement
The PHEP award requires a ten percent (10%) “in-kind” or “soft” match from all the grant participants.
Each recipient shall include in their budget submission, the format they will use to cover the match and
method of documentation. Failure to include the match formula will preclude funding.
5.2 Inventory
Inventory list shall be provided to ADHS, as part of the midyear report. Inventory List shall include all
capital equipment (items over five thousand dollars ($5,000.00) each).
5.3 Budget Allocation
5.3.1 Budget tool developed by ADHS shall be completed and returned to ADHS for review and
approval. ADHS will not release funding to the County prior to budget being approved.
5.3.2 All activities and procurements funded through the PHEP grant shall be aligned with the
budget/spend and work plan, what shall help in reaching the goals and objectives outlined in this
document. Any items and activities that are not specifically tied to the PHEP program capabilities
shall be approved by ADHS before PHEP funds can be utilized on those activities/items.
5.3.3 Counties shall follow the applicable Office of Management and Budget (OMB) Circulars and Cost
Principles when developing the budget and throughout the period of performance.
5.4 Grant Activity Oversight
Each County must maintain a full-time, part-time, or appointed PHEP Coordinator who shall have the
responsibility for oversight of all grant related activities. The PHEP Coordinator shall be the main point of
contact for ADHS in regards to the PHEP grant. The PHEP Coordinator shall work closely with ADHS to
ensure all deliverables and requirements are met. The individual shall also coordinate all activities
surrounding any onsite monitoring visits conducted by ADHS.
5.5 Employee Certifications
PHEP Recipients are required to adhere to all applicable federal laws and regulations, including
applicable OMB Circulars and semiannual certification of employees who work solely on a single federal
award. The certification forms shall be prepared at least semiannually and signed by the employee or a
supervisory official, having firsthand knowledge of the work performed by the employee. Employees that
are split funded are required to maintain Labor Activity Reports (to be provided as requested). These
certification forms must be retained in accordance with 45 Code of Federal Regulation, Part 92.42.
5.6 Performance
Failure to meet the deliverables and performance measures described in the Scope of Work may result in
withholding from a portion of subsequent awards.
Page 5 of 16

ARIZONA DEPARTMENT
OF HEALTH SERVICES
INTERGOVERNMENTAL AGREEMENT (IGA) 1740 W. Adams, Room 303
AMENDMENT Phoenix, Arizona 85007
(602) 542-1040
(602) 542-1741 Fax
Contract No. ADHS12-007891 Amendment No. 11 Procurement Officer
Ana Shoshtarikj
6. EXERCISE REQUIREMENTS
6.1 Emergency Operation Coordination
6.1.1 Maintain documentation of all collaborative efforts with local and State emergency management
6.1.2 The County PHEP program must establish and maintain a collaborative working relationship with
emergency management. This must include but not be limited to; Emergency communication
plan, strategies for addressing emergency events, including the management of the
consequences of power failures, natural disasters and other events that would affect public
health.
6.1.3 Jointly participate with emergency management in an ADHS sponsored table top, functional
exercise or other activity
6.2 Multi-Year Training and Exercise Workshop (MYTEP)
6.2.1 Each County shall participate in the annual ADHS Training and Exercise Planning Workshop.
6.2.1.1 Workshop date: TBD.
7. EXERCISE IMPLEMENTATION CRITERIA
7.1 Homeland Security Exercise and Evaluation Program
Sub-awardees shall conduct preparedness exercises in accordance with the HSEEP fundamentals
including:
7.1.1 Exercise Design and Development;
7.1.2 Exercise Conduct;
7.1.3 Exercise Evaluation; and
7.1.4 Improvement Planning.
More information on the April 2013 HSEEP guidelines and exercise policy is available at
https://hseep.preptoolkit.org/
7.2 At-Risk Individuals
Grantee shall include provisions for the needs of at-risk individuals within each exercise. HPP-PHEP sub-
awardees shall report on the strengths and areas for improvement identified though the coalition based
exercise After Action Report and Improvement Plan (AAR/IP). Information about the U.S. Department of
Health and Human Services’ definition of “at-risk” population may be obtained from the following website:
http://www.phe.gov/Preparedness/planning/abc/Pages/at-risk.aspx
7.3 Sub-awardees conducting joint exercises shall include participation from healthcare coalitions (including at
a minimum, hospitals, public health departments, emergency management agencies, and emergency
medical services) and public health jurisdictions. Joint exercises shall meet multiple program
requirements, including HPP, PHEP, and Strategic National Stockpile/Cities Readiness Initiative
requirement to help minimize the burden on exercise planners and participants.
7.4 Exercises conducted with funding from other preparedness grant programs with similar exercise
requirements may be used to fulfill the joint HPP-PHEP exercise requirements if HHS preparedness
capabilities are tested and evaluated.
Page 6 of 16

ARIZONA DEPARTMENT
OF HEALTH SERVICES
INTERGOVERNMENTAL AGREEMENT (IGA) 1740 W. Adams, Room 303
AMENDMENT Phoenix, Arizona 85007
(602) 542-1040
(602) 542-1741 Fax
Contract No. ADHS12-007891 Amendment No. 11 Procurement Officer
Ana Shoshtarikj
7.5 Exemption
County response and recovery operations supporting real incidents could meet the criteria for this annual
exercise requirement, if the response was sufficient in scope and the AAR/IPs adequately detail which
public health emergency preparedness (PHEP) capabilities were tested and evaluated. This shall be
addressed on an as-requested basis.
8. EXERCISE EVALUATION CRITERIA
8.1 PHEP exercises shall address Public Health Preparedness (PHP) Capabilities in all qualifying exercises. If
using FEMA Core Capabilities, a cross-walk shall be produced mapping PHP capabilities with core
capabilities.
8.2 At a minimum, each County shall demonstrate and validate Public Health’s ability to gain situational
awareness of their hospital network through participation in resource and information management as
outlined in the HPP-PHEP aligned capabilities.
8.2.1 These capabilities are:
8.2.1.1 Capability 3: Emergency Operations Coordination; and
8.2.1.2 Capability 6: Information Sharing.
9. INFORMATION SYSTEMS REQUIREMENT
The County shall:
9.1 Have access to a secure alerting system, that at a minimum has the ability to send email, faxes, and
phone/ text alerts;
9.2 Participate in the Communication Pathway scenarios developed and sent out by ADHS Information
Services Group; and
9.3 Utilize communication systems, which may include: HSP, EMResource, EMTrack, ESAR-VHP, AZHAN,
IRMS, 800 radios or WebEOC.
9.3.1 ADHS will provide training on the systems and platforms as needed.
10. REPORTING DELIVERABLES
Progress on the deliverables, performance measures, and activities funded through the PHEP grant shall be
reported on in a timely manner, to ensure ADHS has adequate time to compile the information and submit to
CDC.
10.1 Mid-Year Report
10.1.1 ADHS shall send out the Mid-Year report templates in advance of the Due Date.
10.1.1.1 Due Date: TBD
10.1.2 ADHS shall provide the CDC Performance Measures templates (if applicable) in advance of the
Due Date.
10.1.2.1 Due Date: TBD
Page 7 of 16

ARIZONA DEPARTMENT
OF HEALTH SERVICES
INTERGOVERNMENTAL AGREEMENT (IGA) 1740 W. Adams, Room 303
AMENDMENT Phoenix, Arizona 85007
(602) 542-1040
(602) 542-1741 Fax
Contract No. ADHS12-007891 Amendment No. 11 Procurement Officer
Ana Shoshtarikj
10.1.3 Each County shall provide ADHS with updated Public Health Emergency Contact list, template to
be provided by ADHS. The list should include contact information for the primary, secondary, and
tertiary individuals for the Public Health Incident Management System (e.g. Incident Commander,
Operations, etc.) and posted on the HSP.
10.1.3.1 Due Date: At time of midyear reporting.
10.2 Annual Report
10.2.1 ADHS shall send out the Annual Report template in advance of the Due Date.
10.2.1.1 Due Date: TBD
10.3 After Action Report/Improvement Plan
10.3.1 Each County shall submit an AAR/IP for any public health emergency exercise or real world event
in which the public health entity participates and has a role.
10.3.2 AARs shall be submitted to ADHS within sixty (60) days after the exercise.
11. CAPABILITY DELIVERABLES
11.1 CAPABILITY 1: COMMUNITY PREPAREDNESS
11.1.1 Definition: Community preparedness is the ability of communities to prepare for, withstand, and
recover — in both the short and long terms — from public health incidents. By engaging and
coordinating with emergency management, healthcare organizations (private and community-
based), mental/behavioral health providers, community and faith-based partners, state, local, and
territorial, public health’s role in community preparedness is to do the following:
11.1.1.1 Support the development of public health, medical and mental/behavioral health
systems which support recovery;
11.1.1.2 Participate in awareness training with community and faith-based partners on how to
prevent, respond to and recover from public health incidents;
11.1.1.3 Promote awareness of and access to medical and mental/behavioral health resources
that help protect the community’s health and address the functional needs (i.e.,
communication, medical care, independence, supervision, transportation) of at-risk
individuals;
11.1.1.4 Engage public and private organizations in preparedness activities that represent the
functional needs of at-risk individuals as well as the cultural and socio-economic,
demographic components of the community; and
11.1.1.5 Identify populations that may be at higher risk for adverse health outcomes.
11.1.2 COUNTY OUTPUT REQUIREMENTS:
11.1.2.1 Participate in review of HVAs, JRA and THIRAs and development of consolidated
regional report. Consolidated report shall review process and procedures in place to
mitigate the impact of an incident during a response and shall be integrated into
preparedness processes and planning; and
Page 8 of 16

ARIZONA DEPARTMENT
OF HEALTH SERVICES
INTERGOVERNMENTAL AGREEMENT (IGA) 1740 W. Adams, Room 303
AMENDMENT Phoenix, Arizona 85007
(602) 542-1040
(602) 542-1741 Fax
Contract No. ADHS12-007891 Amendment No. 11 Procurement Officer
Ana Shoshtarikj
11.1.2.2 Identify Geographic Information (GIS) resources utilized to assist in the identification of
at-risk populations to include access and functional needs in support of planning
activities, as part of the end of year report.
11.2 CAPABILITY 2: COMMUNITY RECOVERY
11.2.1 Definition: Community recovery is the ability to collaborate with community partners, (e.g.,
healthcare organizations, business, education, and emergency management) to plan and
advocate for the rebuilding of public health, medical, and mental/behavioral health systems to at
least a level of functioning comparable to pre-incident levels, and improved levels where possible.
11.2.2 This capability supports National Health Security Strategy Objective 8: Incorporate Post-Incident
Health Recovery into Planning and Response. Post-incident recovery of the public health, medical
and mental/behavioral health services, and systems within a jurisdiction is critical for health
security and requires collaboration and advocacy by the public health agency for the restoration of
services, providers, facilities, and infrastructure within the public health, medical and human
services sectors. Monitoring the public health, medical and mental/behavioral health infrastructure
is an essential public health service.
11.2.3 COUNTY OUTPUT REQUIREMENTS:
11.2.3.1 Ensure written plans include processes for collaborating with community organizations,
emergency management, and health care organizations to identify public health,
medical, and mental/behavioral health system recovery needs for the counties
identified hazards. Written plans should include the following elements (either as a
standalone Public Health Continuity of Operations plan or as a component of another
plan):
11.2.3.1.1 Definitions and identification of essential services needed to sustain
agency mission and operations;
11.2.3.1.2 Plans to sustain essential services regardless of the nature of the
incident; and
11.2.3.1.3 Scalable work force reduction.
11.3 CAPABILITY 3: EMERGENCY OPERATIONS COORDINATION
11.3.1 Definition: Emergency operations coordination is the ability to direct and support an event or
incident with public health or medical implications by establishing a standardized, scalable system
of oversight, organization, and supervision consistent with jurisdictional standards and practices
and with the National Incident Management System.
11.3.2 COUNTY OUTPUT REQUIREMENTS:
11.3.2.1 Participate in a functional exercise conducted within the respective region.
Recommend participation in at least one (1) functional exercise to test the ability to
stand up and operate an HEOC during a public health incident;
11.3.2.2 Maintain documentation of all collaborative efforts with local and State emergency
management;
11.3.2.3 County/Tribal PHEP program shall establish and maintain a collaborative working
relationship with emergency management. The relationship shall include, but not be
limited to: Emergency communication plan, strategies for addressing emergency
events, including the management of the consequences of power failures, natural
disasters and other events that would affect public health; and
Page 9 of 16

ARIZONA DEPARTMENT
OF HEALTH SERVICES
INTERGOVERNMENTAL AGREEMENT (IGA) 1740 W. Adams, Room 303
AMENDMENT Phoenix, Arizona 85007
(602) 542-1040
(602) 542-1741 Fax
Contract No. ADHS12-007891 Amendment No. 11 Procurement Officer
Ana Shoshtarikj
11.3.2.4 Jointly participate with emergency management in an ADHS sponsored table top,
functional exercise or other activity.
11.4 CAPABILITY 4: EMERGENCY PUBLIC INFORMATION AND WARNING
11.4.1 Definition: Emergency public information and warning is the ability to develop, coordinate, and
disseminate information, alerts, warnings, and notifications to the public and incident management
responders.
11.4.2 COUNTY OUTPUT REQUIREMENTS:
11.4.2.1 Provide ADHS a list of the top hazards identified within your jurisdictional risk
assessment, as part of the midyear report.
11.4.2.2 Information provided will be utilized by ADHS to develop new message maps for
inclusion in the CERC plan and for use by local health departments.
11.5 CAPABILITY 5: FATALITY MANAGEMENT
11.5.1 Definition: Fatality management is the ability to coordinate with other organizations (e.g., law
enforcement, healthcare, emergency management, and medical examiner/coroner) to ensure the
proper recovery, handling, identification, transportation, tracking, storage and disposal of human
remains and personal effects; certify cause of death; and facilitate access to mental/ behavioral
health services to the family members, responders and survivors of an incident.
11.5.2 COUNTY OUTPUT REQUIREMENTS:
11.5.2.1 Ensure Fatality Management plan identifies roles and responsibilities for county health
department and thresholds indicating when to activate public health fatality
management operations.
11.5.2.2 Fatality Management plan shall be submitted to HSP as part of the end of year report.
11.6 CAPABILITY 6: INFORMATION SHARING
11.6.1 Definition: Information sharing is the ability to conduct multijurisdictional, multidisciplinary
exchange of health-related information and situational awareness data among federal, state,
local, territorial, and tribal levels of government, and the private sector.
11.6.2 COUNTY OUTPUT REQUIREMENTS:
11.6.2.1 Participate in communication testing scenarios developed and administered by ADHS.
Each County shall ensure communication systems and platforms are capable of
receiving and disseminating information from multiple platforms.
11.6.2.2 Each County shall provide to ADHS a list of the system(s) that are utilized in EOC
operations and for information sharing during their midyear report.
11.7 CAPABILITY 7: MASS CARE
11.7.1 Definition: Mass care is the ability to coordinate with partner agencies to address the public
health, medical, and mental/behavioral health needs of those impacted by an incident at a
congregate location. This capability includes the coordination of ongoing surveillance and
assessment to ensure that health needs continue to be met as the incident evolves.
Page 10 of 16

ARIZONA DEPARTMENT
OF HEALTH SERVICES
INTERGOVERNMENTAL AGREEMENT (IGA) 1740 W. Adams, Room 303
AMENDMENT Phoenix, Arizona 85007
(602) 542-1040
(602) 542-1741 Fax
Contract No. ADHS12-007891 Amendment No. 11 Procurement Officer
Ana Shoshtarikj
11.7.2 COUNTY OUTPUT REQUIREMENTS:
11.7.2.1 Review and update County’s sheltering plan. County should review and update their
plan to support shelter operations in coordination with local Emergency Management.
Sheltering plans shall incorporate the needs for At-Risk Individuals and Functional and
Access Needs Individuals.
11.7.2.2 Review and update plans to address functional needs of at risk individuals to include:
medical caregivers, social services, utilization of universal design principals in signage
and accessibility, and language and sign language interpreters.
11.8 CAPABILITY 8: MEDICAL COUNTERMEASURE DISPENSING
11.8.1 Definition: Medical countermeasure dispensing is the ability to provide medical countermeasures
(including vaccines, antiviral drugs, antibiotics, antitoxin, etc.) in support of treatment or
prophylaxis (oral or vaccination) to the identified population in accordance with public health
guidelines and/or recommendations.
11.8.2 COUNTY OUTPUT REQUIREMENTS (CRI Counties):
11.8.2.1 Cities Readiness Initiative (CRI) Drill Requirement Maricopa County and Pinal County
shall conduct at least three (3) different SNS drills utilizing the templates provided by
DSNS/ADHS. An executive summary and an improvement plan shall be submitted for
each drill.
11.8.2.1.1 Provide ADHS with the drill results by March 30, 2016;
11.8.2.1.2 List of Drills that can be conducted: Staff notification, acknowledgement
and assembly;
11.8.2.1.3 Site activation: notification, acknowledgement and assembly;
11.8.2.1.4 Facility Setup;
11.8.2.1.5 Pick List Generation;
11.8.2.1.6 Dispensing Throughput; and
11.8.2.1.7 Public Health Decision Making Tool.
11.8.2.2 CRI jurisdictions not conducting an ORR in BP4 shall complete Jurisdictional
Worksheet as part of the midyear report.
11.8.3 COUNTY OUTPUT REQUIREMENTS (Non-CRI Counties):
11.8.3.1 Complete the POD Standards Worksheet (provided by ADHS) as part of the midyear
report;
11.8.3.2 Conduct at least two (2) different SNS drills utilizing the templates provided by
DSNS/ADHS.
11.8.3.2.1 Provide ADHS with the drill results as part of the end of year report.
11.8.3.2.2 List of Drills that can be conducted to meet the two (2) different drill
requirements include:
11.8.3.2.2.1 Staff notification, acknowledgement and assembly;
11.8.3.2.2.2 Site activation: notification, acknowledgement and assembly;
Page 11 of 16

ARIZONA DEPARTMENT
OF HEALTH SERVICES
INTERGOVERNMENTAL AGREEMENT (IGA) 1740 W. Adams, Room 303
AMENDMENT Phoenix, Arizona 85007
(602) 542-1040
(602) 542-1741 Fax
Contract No. ADHS12-007891 Amendment No. 11 Procurement Officer
Ana Shoshtarikj
11.8.3.2.2.3 Facility Setup;
11.8.3.2.2.4 Pick List Generation;
11.8.3.2.2.5 Dispensing Throughput; and
11.8.3.2.2.6 Public Health Decision Making Tool.
11.9 CAPABILTY 9: MEDICAL MATERIEL MANAGEMENT & DISTRIBUTION
11.9.1 Definition: Medical materiel management and distribution is the ability to acquire, maintain (e.g.,
cold chain storage or other storage protocol), transport, distribute, and track medical materiel
(e.g., pharmaceuticals, gloves, masks, and ventilators) during an incident and to recover and
account for unused medical materiel, as necessary, after an incident.
11.9.2 COUNTY OUTPUT REQUIREMENTS (CRI and Non-CRI Counties):
11.9.2.1 Participate in at least two (2) Inventory Management System drills conducted by
ADHS; and
11.9.2.2 Demonstrate the ability to accept, manage, and return medical materiel electronically
in coordination with ADHS.
11.10 CAPABILITY 10: MEDICAL SURGE
11.10.1 Definition: Medical surge is the ability to provide adequate medical evaluation and care
during events that exceed the limits of the normal medical infrastructure of an affected
community. It encompasses the ability of the healthcare system to survive a hazard impact
and maintain or rapidly recover operations that were compromised.
11.10.2 COUNTY OUTPUT REQUIREMENTS:
11.10.2.1 Each County shall participate in Crisis Standards of Care/Medical Surge on-line
training. Training shall be facilitated by ADHS and shall focus on the integration of
federal and state planning guidelines for medical surge and CSC.
11.11 CAPABILITY 11: NON-PHARMACEUTICAL INTERVENTIONS
11.11.1 Definition: Non-pharmaceutical interventions (NPI) are the ability to recommend to the
applicable lead agency (if not public health) and implement, if applicable, strategies for
disease, injury, and exposure control. Strategies include the following:
11.11.1.1 Isolation and quarantine;
11.11.1.2 Restrictions on movement and travel advisory/warnings;
11.11.1.3 Social distancing;
11.11.1.4 External decontamination;
11.11.1.5 Hygiene; and
11.11.1.6 Precautionary protective behaviors.
Page 12 of 16

ARIZONA DEPARTMENT
OF HEALTH SERVICES
INTERGOVERNMENTAL AGREEMENT (IGA) 1740 W. Adams, Room 303
AMENDMENT Phoenix, Arizona 85007
(602) 542-1040
(602) 542-1741 Fax
Contract No. ADHS12-007891 Amendment No. 11 Procurement Officer
Ana Shoshtarikj
11.11.2 COUNTY OUTPUT REQUIREMENTS:
11.11.2.1 Local health shall develop and/or review local NPI plans. Written plans should
include documentation which identifies public health roles and responsibilities
related to the jurisdiction’s identified risks, that was developed in conjunction
with partner agencies (e.g., state environmental health, state occupational health
and safety, and hazard-specific subject matter experts) and emergency
managers. This documentation should identify the protective equipment,
protective actions, or other mechanisms that public health responders shall have
to execute potential roles. Roles for consideration may include the following
elements:
11.11.2.1.1 Conducting environmental health assessments;
11.11.2.1.2 Potable water inspections; and
11.11.2.1.3 Field surveillance interviews.
11.11.2.2 Local Health Department shall complete the biannual performance measure
report form distributed by ADHS for use in identifying gaps in planning and
implementation of interventions in the jurisdiction.
11.12 CAPABILITY 13: PUBLIC HEALTH SURVEILLANCE AND EPIDEMIOLOGICAL INVESTIGATION
11.12.1 Definition: Public health surveillance and epidemiological investigation is the ability to create,
maintain, support, and strengthen routine surveillance and detection systems and
epidemiological investigation processes, as well as to expand these systems and processes
in response to incidents of public health significance.
11.12.2 COUNTY OUTPUT REQUIREMENTS:
11.12.2.1 Participate in State Testing of the Communicable Disease On-Call System.
Local Department of Health shall participate in tests of the communicable
disease on-call system, and shall ensure that sufficient staff are identified and
trained to participate in all system tests. Jurisdictions shall complete the disease
scenario evaluation form and return to ADHS.
11.12.2.2 Enter Information into MEDSIS as Required and Provide ADHS Staff with
Current Contact Information for MEDSIS Liaisons. Jurisdictions shall
maintain a primary and backup MEDSIS liaison; notify ADHS of any changes to
the liaison roles or their contact information at the time of the change. MEDSIS
liaison responsibilities include requesting/approving new users and notifying
ADHS when users no longer require access. The MEDSIS liaison shall
participate in the MEDSIS quarterly meetings.
11.12.2.3 Participate in Epidemiology Trainings and Exercises. Local Health
Department shall participate in the Epidemiology Surveillance and Capacity
(ESC) meetings (at least ten (10) out of twelve (12)), “How to” Presentations (at
least eighty percent (80%)) and the Arizona Infectious Disease Training and
Exercise.
11.12.2.4 Conduct Investigations of Reported Infectious Diseases and Public Health
Incidents. Local Health Departments shall investigate and report cases of
infectious disease as required by Arizona rules and statutes and MEDSIS
policies and procedures. Investigation actions should be documented and
include the following as necessary: case identification, specimen collection, case
investigation / characterization, and control measure implementation. Outbreak
investigations should begin within twenty four (24) hours of receipt of report. For
Page 13 of 16

ARIZONA DEPARTMENT
OF HEALTH SERVICES
INTERGOVERNMENTAL AGREEMENT (IGA) 1740 W. Adams, Room 303
AMENDMENT Phoenix, Arizona 85007
(602) 542-1040
(602) 542-1741 Fax
Contract No. ADHS12-007891 Amendment No. 11 Procurement Officer
Ana Shoshtarikj
outbreak cases with a focused questionnaire, interview shall be conducted
within forty-eight (48) hours.
11.12.2.5 Report All Identified Outbreaks Within twenty-four (24) Hours. Local Health
Departments shall report all identified outbreaks to ADHS within twenty-four (24)
hours utilizing the MEDSIS Outbreak Module; include documentation on
outbreak investigation activities as part of jurisdictional mid-year and end-of-year
reports to ADHS. At a minimum, include the following information: Outbreak
Name, Date Reported to Local Health, Morbidity, Type of Setting, and County of
Outbreak Exposure.
11.12.2.6 Submit Outbreak Summaries to ADHS. Outbreak summaries shall be
submitted to ADHS utilizing the MEDSIS Outbreak Module within thirty (30) days
of outbreak closure for all outbreaks investigated. Summary forms shall contain
all required minimal elements. *(See Appendix 1)
11.12.2.7 Complete the Monthly Performance Measure Report Form. Local Health
Departments shall complete the monthly performance measure report form
distributed by ADHS for use in identifying gaps in timeliness of reporting,
completeness of interviews and monitoring outbreaks in the jurisdiction.
Performance measure report information will be utilized for mid-year and end-of-
year grant reporting for both PHEP and ELC grant deliverables.
11.12.3 CAPABILITY 14: RESPONDER SAFETY AND HEALTH
11.12.3.1 Definition: The responder safety and health capability describes the ability to
protect public health agency staff responding to an incident and the ability to
support the health and safety needs of hospital and medical facility personnel, if
requested.
11.12.3.2 COUNTY OUTPUT REQUIREMENTS:
Review/update plans to include documentation of the safety and health risk
scenarios likely to be faced by public health responders, based on pre-identified
jurisdictional incident risks, which are developed in consultation with partner
agencies. Plans should include documentation that identifies public health roles
and responsibilities related to the jurisdiction’s identified risks developed in
conjunction with partner agencies and emergency managers. This
documentation should identify the protective equipment, protective actions, or
other mechanisms that public health responders will need to have to execute
potential roles.
11.12.4 CAPABILITY 15: VOLUNTEER MANAGEMENT
11.12.4.1 Definition: Volunteer management is the ability to coordinate the identification,
recruitment, registration, credential verification, training, and engagement of
volunteers to support the jurisdictional public health agency’s response to
incidents of public health significance.
11.12.4.2 COUNTY OUTPUT REQUIREMENTS
Review Volunteer Management plans to ensure processes are identified to
manage spontaneous volunteers to include communication pathways, and a
method to refer spontaneous volunteers to other organizations.
Page 14 of 16

ARIZONA DEPARTMENT
OF HEALTH SERVICES
INTERGOVERNMENTAL AGREEMENT (IGA) 1740 W. Adams, Room 303
AMENDMENT Phoenix, Arizona 85007
(602) 542-1040
(602) 542-1741 Fax
Contract No. ADHS12-007891 Amendment No. 11 Procurement Officer
Ana Shoshtarikj
DELIVERABLES TABLE
1 Participate in the All Partners Meeting
2 Attend ADHS Business Meeting
3 Participate in Region Healthcare Coalition Meetings
4 Submit Budget, Work Plan, and comply with PGO financial requirements
5 Participate in Multi-Year Training and Exercise Workshop (MYTEP)
6 Have or have access to an Alert System
7 Provide ADHS a list of systems utilized in your EOC and for information sharing
8 Participate in Communication Pathway testing scenarios on a regular basis
9 Submit PHEP Contact List, Mid-Year
10 Submit timely AAR/IPs to ADHS
11 Participate in Functional Exercise to test ability to stand up and operate EOC
12 Include a Top Hazards list in the Mid-Year Report to ADHS
13 Include a Fatality Management plan in the End of Year Report
14 Participate in ADHS administered communication testing
Review and update Mass Care/Sheltering Plans to incorporate additional measures to address At-Risk and
15
Functional & Access Needs
16 Submit executive summaries and improvement plans for three separate SNS drills conducted (CRI counties)
17 Complete SNS Jurisdictional Worksheet if ORR is not conducted (CRI counties)
18 Complete POD Standards Worksheet (Non-CRI counties)
19 Conduct two SNS drills and submit results (Non-CRI counties)
20 Participate in inventory Management System drills
21 Participate in Crisis Standards of Care/Medical Surge training
22 Complete w/ADHS on NPI plan reviews and to complete bi-annual performance measure report
23 Participate in Epidemiology Trainings and Exercises
Conduct investigations, report outbreaks, conduct outreach to delayed reporters, submit summaries of
24
outbreaks, complete monthly performance measure report, and enter information into MEDSIS
25 Review Responder Safety Plans and update to include jurisdictional risks
26 Validate that Volunteer Managements plans address spontaneous volunteers
Page 15 of 16

ARIZONA DEPARTMENT
OF HEALTH SERVICES
INTERGOVERNMENTAL AGREEMENT (IGA) 1740 W. Adams, Room 303
AMENDMENT Phoenix, Arizona 85007
(602) 542-1040
(602) 542-1741 Fax
Contract No. ADHS12-007891 Amendment No. 11 Procurement Officer
Ana Shoshtarikj
APPENDIX ONE (1)
OUTBREAK SUMMARY FORM MINIMAL ELEMENTS
For the minimal elements to be considered complete on the ADHS Outbreak Summary Report Form the
following elements need to be completed:
1. For CONTEXT:
1.1 County of Exposure
1.2 Case Information: # primary ill; # susceptible
1.3 Primary setting of exposure
1.4 Could etiology be determined
2. For INITIATION of INVESTIGATION:
2.1 Date LHD 1st notified
2.2 Date ADHS 1st notified
2.3 Date Investigation Started
3. For INVESTIGATION METHODS:
3.1 Case Definition: Confirmed case; Probable Case; Suspect case (at least one should be filled out)
3.2 Other Actions & Investigation methods: Interviewed cases; Interviewed controls; epi studies;
traceback; case/pt samples; environmental samples, environmental health assessment;
facility/establishment investigation (at least one should be filled out)
3.3 Were specimens collected
3.4 If yes, what is the confirmed etiology
4. For INVESTIGATION FINDINGS:
4.1 Were specimens collected
4.2 If yes, what is the confirmed etiology
4.3 Signs & Symptoms (at least one filled out)
4.4 Was a specific contaminated food, water or environmental vehicle/source identified?
5. For DISCUSSION and/or CONCLUSIONS:
5.1 Factors Contributing to an Outbreak: Foodborne; Waterborne; Nosocomial; Person to Person;
Zoonotic or Vector (at least one filled out)
6. For RECOMMENDATIONS for CONTROLLING DISEASE:
6.1 Outbreak Control section (at least one filled out)
7. For KEY INVESTIGATORS:
7.1 Key Investigator section
Page 16 of 16