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DocuSign Envelope ID: DB33BBBD-6336-4169-BA22-EC80FA1149C6 <br /> Page 3 of 6 <br /> f) personal protective equipment(PPE) for staff. Gloves, masks, gowns, and other indicated <br /> PPE must be worn by anyone administering vaccine. Eye protection may be appropriate <br /> depending on the level of community transmission <br /> g) thermometers for checking each patient's temperature before entering the clinic <br /> h) PPE for patients, masks, tissues etc. <br /> 10. Know that CDC will provide a standard ancillary supplies kit. Kits will be included with the vaccine <br /> orders in amounts to match the vaccine orders. Each vaccine standard ancillary supplies kit contains: <br /> a) 105 needles <br /> b) 105 syringes <br /> c) 210 alcohol prep pads <br /> d) 4 surgical masks <br /> e) 2 face shields for vaccinators, and <br /> f) 100 COVID-19 vaccination record cards for vaccine recipients. <br /> 11. Provide appropriate vaccine storage and handling equipment, including refrigerators, freezers, <br /> portable storage units and temperature monitors to ensure appropriate vaccine storage and handling <br /> procedures are established and followed. Prepare COVID-19 vaccines for proper transport from the <br /> LHD to off-site clinics as required by CDC. COVID-19 vaccine products are temperature-sensitive <br /> and must be stored and handled correctly to ensure efficacy and maximize shelf life. Proper storage <br /> and handling practices are critical to minimize vaccine loss and limit the risk of administering <br /> COVID-19 vaccine with reduced effectiveness. <br /> 12. Follow manufacturer cold chain storage and handling requirements for COVID-19 vaccine products <br /> which will vary. Different temperature storage requirements for approved or authorized COVID-19 <br /> vaccines may affect which vaccine will be easily accessible to the LHD in the future. Furthermore, <br /> many COVID-19 vaccines with varying levels of refrigeration requirements are currently in Phase 3 <br /> trials. <br /> 13. Complete Attachments A and B with the signed Agreement Addendum. <br /> a. Attachment A is the Budget Statement. It should list the expected expenses by category, <br /> including the dollar amount and a brief justification. <br /> b. Attachment B is the Services Statement. It should: <br /> 1) Explain, in detail, how this funding will be used to develop and implement local <br /> solutions to plan and implement on-site, satellite, temporary, or off-site vaccination <br /> COVID-19 vaccination clinics. <br /> 2) Include information on how the LHD will implement its COVID-19 mass <br /> immunization services within the community. <br /> 3) State how the COVID-19 vaccination services are adapted both to include those <br /> populations at an increased risk of complications from COVID-19. Examples include: <br /> a) Mobile vaccine clinics that travel to hard-to-reach communities to provide <br /> vaccines <br /> b) Drive-through or curbside vaccination clinics <br /> c) Pop-up flu clinics at various community settings, such as COVID-19 testing <br /> sites, school nutrition sites, construction sites, migrant farm worksites, <br /> processing plants, churches, parking lots <br /> d) Immunization clinics to reach jails, homeless shelters, or other community <br /> organizations. <br /> Revised July 2019 <br />