An editable Infectious Disease Outbreak and Pandemic Response Plan template for non-medical home care agencies.

For owners and administrators who want a written plan for keeping services running when flu or another contagious illness spreads.

What’s included (11 pages; editable Word .docx):

• Pages 1-9: 16 sections: Purpose; Scope; Outbreak response team; Activation levels; Watching for outbreaks and following guidance; Staff health and protection; Communication plan; PPE and supplies; Client priority levels; Visits to homes where someone is sick; Reporting to the health department and others; Stepped-up infection control; Recovery and stand-down; Training and testing; Responsibility; Approval
• Appendix A: staff call-out list
• Appendix B: activation and decision log
• Page 11: Agency Instructions page (remove before use)

How to customize:

1. Open the Word file and use Home > Replace > Replace All to change [Agency Name] to your agency’s name.
2. Replace [City] and [State] in the letterhead the same way; [Agency Name] also sits in the gray page header from page 2 on, so check it there.
3. Fill each [State] spot and the blank trigger numbers, supply levels, contacts and names with your agency’s own choices.
4. Add your logo to the letterhead if you want one (there is no logo box), then delete the final Agency Instructions page before use.

Some lines cross-reference policy numbers from a companion Policy & Procedure Manual (sold separately); edit them to match your own policies.

Customizable template, not legal advice; check your state’s requirements. Not a license to operate, not HIPAA software, and no medical claims. It is not a clinical protocol, it is not a certification, and it does not promise that you meet any law or standard; review it against current public health guidance and your state’s rules before use.