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["Disclaimer: The Yearly Checklist was not developed and is not maintained by the N.C. Local Health Department Accreditation (NCLHDA) program. It is provided as an example of a resource that can be adapted by local health departments to support their accreditation efforts. The user is responsible for ensuring the validity and accuracy of all information in the document."]
[null,null,null,"Date Accredited:  8/10/2016",null,"Legend"]
[null,null,null,"Date of Next Notification:  3/1/2020",null,"Complete ( C )"]
[null,null,null,"Date HDSAI due:  6/1/2020",null,"In-Progress (I)"]
[null,null,null,null,null,"No Evidence (N)"]
[null,"Activities with Annual Requirements"]
[null,"Activity","Between Cycle Work","Year 1\n08/11/2016 - 08/10/17","Year 2\n08/11/2017-08/10/2018","Year 3\n08/11/2018- 8/10/2019","Year 4\n08/11/2019- 06/01/2020"]
["Health Education Director",1.2,"Create SOTCH report each year since the last site visit, with exception of year CHA is conducted",null,null,"CHA YEAR"]
["Nursing Director",2.2000000000000002,"Report annual childhood immunization data as required by statue and rule.\n\nMost recent Annual Immunization Assessment Report conducted by NCDPH required for evidence"]
["CD Nurse",2.4,"Analyze and note reportable events occurring within the community and report atypical incidence, if any, to the Division and the local board of health on an annual basis (Annual CD Reports; Report to NCDPH atypical; Annual report to BOH"]
["IT\nLeadership",3.2,"Records of Data System Evaluation & QI for each year since the last site visit"]
["EH Director",4.2,"EH Risk Reports & Follow-up for each year since the last site visit.  Reports must come from the following:\nwell sampling\non-site wastewater survey\nchildhood blood lead levels\na meth lab investigation\nfood and lodging inspections\ngeneral inspection data\nFDA Standard 9 Risk Factor Study\nwater quality monitoring\nair quality monitoring"]
["CD Nurse",5.0999999999999996,"24/7 Call down list Distribution & Education of partners\n\nCall down list should include those working in CD, EH and emergency response"]
["EH Director",7.3,"Records of EH Complaint logs for each year since the last site visit","Year will be selected for on-site review; Staff should assess annually to ensure each year's documents are compliant"]
["Health Director\nPreparedness Coordinator",7.5,"Conduct annual ongoing communication with local emergency managers ( at least 2 per year)"]
["Preparedness Coordinator",7.6,"Records of Preparedness & Response Plan Exercises for each year since the last site visit"]
["Health Education Director",9.1,"Dissemination records for local health issue information public AND policy leaders for each year since the last site visit"]
["Health Director\nHealth Education Director",15.1,"Strategic Plan Implementation and Update Records for each year since the last site visit"]
["Leadership",15.3,"Records of Policy Review for each year since the last site visit","Year will be selected for on-site review; Just make sure each year documents are compliant"]
["Health Director\nNursing Director\nEH Director\nCD Nurse",16.100000000000001,"The local health director and unit directors, such as directors of communicable disease, nursing, clinical services and environmental health, shall receive ongoing training in current public health law and its application. (at least 2 each since previous site visit)"]
["CD Nurse",17.3,"Annual summary of implemented control measures, isolation/quarantine orders, or arrest orders\n\nMost recent annual summary requried for evidence."]
["Health Education Director",19.100000000000001,"Annual review of data of public health program use by underserved AND at-risk populations AND vulnerable populations "]
["Supervisors\nAdministrative Officer/HR",23.2,"Evidence of up-to-date registration, certification or licensure for staff as required for position","Will be part of personnel record review\nAssess annually to ensure current registration, certifcation or licensure is in file"]
["Administrative Officer",26.3,"Records of Cultural Sensitivity and Competency Staff Training for each year since the last site visit\n\nNote:  Accreditation requirement is once since previous site visit but our policy states annually, thus we will be held to our policy\n"]
["Supervisors\nAdministrative Officer/HR",31.4,"Conduct annual review and update of staff job descriptions - YOU MUST COMPLETE THE JOB DESCRIPTION PORTION OF THE CHECKLIST","Will be part of personnel record review\nAssess annually to ensure JD review complete at evaluation "]
["Supervisors\nAdministrative Officer/HR",31.5,"Conduct annual performance evaluations for all staff","Will be part of personnel record review\nAssess annually to ensure annual evals have been completed"]
["Health Director",33.299999999999997,"Annual Audit -(Accounting) \n\nMost recent required for evidence"]
["Health Director",34.1,"Current Board of Health operating procedures","Not an annual requirement for accreditation - just a current copy"]
["Health Director",36.1,"Board of Health Handbook - should include regularly updated and info replaced as appropriate.\n\nUpdate within 12 months prior to HDSAI must be submitted for evidence"]
["Health Director",36.200000000000003,"New BOH members receive training and reference materials on the authorities and responsibilities of the BOH within 1st year after appointment to BOH"]
["Health Director\nBOH",37.4,"Review and approval by Board of Health of local health director job description - must be signed, dated and review within 12 months prior to HDSAI submission\n\nEvidence that BOH has reviewed and approved at least once since previous site visit"]
["Health Director\nBOH",37.5,"Health Director Annual Performance Review and evidence of BOH input (BOH Agenda/Minutes)"]
["Health Director",38.1,"Annual review by Board of Health of reports provided by local health department  on the community's health (2 per year - CANNOT use CD report, CHA or SOTCH)"]
["Health Director\nHealth Education Director\nBOH",38.200000000000003,"BOH review of SOTCH reports\nBOH review of specific aspect of CHA data"]
["Health Director",39.299999999999997,"Annual review and approval by Board of Health of local health department budget and fees"]
[null,"For/during the past two years"]
[null,"Activity","Between Cycle Work","Past 2 years/24 months\n06/01/2018- 05/31/2020"]
["Health Director\nPreparedness Coordinator",6.2,"Copy of County Emergency Operations Plan(s) with the local health department role defined and current.  Note: If county emergency operations plan has not been revised since the previous site visit to reflect the health department’s current role, provide evidence which indicates efforts have been made to request such updates, within past 24 months. "]
["Preparedness Coordinator",7.7,"Records of Preparedness & Response Team (EPI) activity at least once in the two years prior to the notification date","Only \"Since Previous Site Visit\""]
["CD Nurse\nEH Director\nOthers??",30.6,"Monthly records of Cleaning & Maintenance for the 24 months prior to notification date (Must have records for each year but one year in the previous 24 months will be selected for review)"]
["Health Director",37.1,"Board of Health assurance of local health director qualifications within the past 24 months","Only need copy of qualifications - no timeframe"]
[null,"Within/for the past 12 months"]
[null,"Activity","Between Cycle Work","Past 12 months\n06/01/2019 - 05/31/2020"]
["Nursing Director",2.2000000000000002,"Keep all copies of annual Immunization Assessment Reports since last site visit.  Most recent is required for review.\n"]
["CD Nurse",2.2999999999999998,"Keep all copies of Communicable Disease Report Records since last site visit.  De-identified event line list from NCEDSS covering the past 12 months required. "]
["CD Nurse",4.0999999999999996,"3 examples of evidence of communication with surveillance participants within the 12 months prior to notification letter date"]
["Health Director\nPreparedness Coordinator",6.1,"Evidence confirming agency involvement in LEPC within past 12 months.  If LEPC is not active evidence indicating efforts to request LEPC become active."]
["Health Director\nLab Supervisor",8.3000000000000007,"Current contracts or evidence of agreement with external laboratories (other than state lab) dated within past 12 months"]
["Administrative Officer",15.5,"List of all employees hired in the previous 12 months.\n\nEvidence of orientation and PROGRAM policy training for all employees hired in the past 12 months"]
["EH Director",17.100000000000001,"Letters from appropriate monitoring offices of NCDPH verifying EH program compliance dated within 1 year of 90 day notification AND evience of performance improvement activities as indicated by CAPs or program letters"]
["CD Nurse",17.3,"Provide most recent annual summary of communicable disease control activity (e.g., isolation/quarantine orders, control measures etc.)"]
["Health Director",36.1,"Assure Board of Health members have a Board handbook developed or updated within the past 12 months."]
["Health Director ",37.4,"Current Health Director job description that has been signed, dated and reviewed within the last 12 months"]
["Health Director",37.5,"Conduct Health Director performance review that has been signed, dated and reviewed each year since the last site visit - one completed in within last 12 months\n\nEvidence of BOH input in most recent HD performance review "]
[]
[null,"NOTES:"]
[null,"See the Interpretation Guide for Full Explanation and Requirements"]