Long-term Care Facility Component
Instructions for Completion of the COVID-19 Long-term Care Facility (LTCF): Staff and Personnel Impact Form (CDC 57.145)
Data Field |
Instructions for Data Collection |
NHSN Facility ID # |
The NHSN-assigned facility ID will be auto-entered by the computer. |
CMS Certification Number (CCN) |
Auto-generated by the computer if the facility has previously entered the CCN number during NHSN registration. See NHSN CCN Guidance document for instructions on how to add a new CCN or edit an entered CCN. |
Facility Name |
Auto-generated by the computer if the facility has previously entered facility name during registration. |
Date for which “staff and personnel Impact” responses are reported |
Required. Select the date on the calendar for which the responses are being reported in the NHSN COVID 19-Module. |
Important: While daily reporting will provide the timeliest data to assist with COVID-19 emergency response efforts, retrospective reporting of prior day(s), unless otherwise specified, is encouraged if daily reporting is not feasible. At a minimum, facilities should report data at least once per week. |
Data Field |
Instructions for Data Collection |
CONFIRMED COVID-19 Staff and facility personnel with new laboratory-positive COVID-19
|
Notes:
|
SUSPECTED COVID-19 Staff and facility personnel with new suspected COVID-19 |
Notes:
|
COVID-19 DEATHS Staff and facility personnel with new suspected or laboratory-positive COVID-19 who died |
Notes:
|
STAFFING SHORTAGE Does your organization have a shortage of staff and/or personnel?
Select “YES” or “NO” for each group. (Select one answer for each group)
|
On the date responses are reported in in the Module, has your facility identified a shortage of staff and/or facility personnel in any of the following staff and facility personnel groups? Note: Each facility should identify staffing shortages based on their facility needs and internal policies for staffing ratios.
Select “YES” for each group in which there is currently a staff shortage
OR
“NO” for each group in which there is not currently a staff shortage: (Select one answer for each group)
|
April 2020
File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
File Title | TOI Staff and Personnel Impact |
Subject | NHSN LTCF Table of Instructions |
Author | CDC/NCEZID/DHQP |
File Modified | 0000-00-00 |
File Created | 2021-01-13 |