In-Person Observation Report https://forms.gle/vd1AtDfyEAkEeFQ49 Loading… Observation Report Logistics Please fill in the information below. Program Name: * Observation Date: * Program Sponsor: * UYP Representative: * Location of Visit: * On-site Contact: Check-in process for visit: Required Documentation Please indicate if the following documents are on site and easily accessible. The documents are all required under Texas A&M University Rule 24.01.06.M1. Liability Waivers Accessibility * Yes No (Section 6.6.1) Notes on Liability Waivers: CPT Certificates Accessibility * Yes No (Section 4.1.3) TDSHS Form Submitted Prior to Program: Yes No (Section 4.1.1) Notes on CPT and TDSHS Form: Medication Distribution Forms Accessibility: * Yes No N/A (Section 6.10.1) Notes on Medical Forms: Background Check Verifications: * Yes No (Section 3.1) Verified that the following were background checked: Program Operations Supervision ratio observed: * (Section 6.2) Day or overnight CPM: * Age range of participants: * When does staff receive emergency protocol training? How does staff communicate emergency protocol? What is the protocol? (Section 6.4) Health and Safety How are staff and participants pre-screened prior to arrival at the program? How is that data stored? How frequently are staff and participants screened for symptoms of COVID-19? How are the daily health screenings conducted? What is the plan for if a staff member or participant shows symptoms of COVID-19? How many co-horts or small groups are present at the program? Are the co-horts appropriate for the age and university guidance? Yes No Notes on Co-horting: Notes on Altered Activities Can include check-in/check-out, transportation, dining, housing, inclement weather, etc. When are facemasks being worn and allowed to be taken off? Additional notes on PPE: What is the handwashing schedule? Notes on Ventilation of Indoor Spaces: How often are high-touch surfaces and shared equipment disinfected? How often are program facilities disinfected? Risk Management Directional Markers throughout Camp: Communication among Staff: Identification among staff, counselors, and participants: Outside influences during CPM? Event Review Strengths of the Event: Challenges of the Event: Opportunities for Future Events: Event Review Activities Observed: Submit
