Level Up Business Application

Level Up Business Application

Submitting this form does not guarantee acceptance into the program. All applications are subject to Colorado Open Records Act and may be available to the media upon request. Incomplete applications will not be reviewed.
Name *

First Name Last Name
Email (This is the email we will send any follow up to) *
example@example.com
Business Name *
Business Address *

Street Address

Street Address Line 2

City

Postal / Zip Code
Phone Number *
Please enter a valid phone number.
Masks are mandatory and enforced. Businesses must have mask wearing protocols for staff and customers. Businesses must have methods for enforcement of mask wearing & accommodating those not wearing masks. Describe how you will meet this requirement. *
6’ Distancing - Signs, decals, and staff all must be used to ensure people from different households remain at least 6’ apart. Describe how you will meet this requirement. *
Attach pictures of the signage required for 6 foot distancing and informing customers to wear masks posted in your business. *

Cancel of
Businesses must have plans for regular sanitation and cleaning of high touch surfaces. Describe how you will meet this requirement. *
Businesses must have daily employee symptoms and exposure checks. Describe how you will meet this requirement. *
Businesses must screen customers for symptoms of COVID-19. How will you do this for customers and what is your plan if people do not pass symptom screening? *
Record Customer Names and Contact info to support contact tracing - What tool will you use to collect contact info? At minimum it is required to collect first name, last name, phone, email address and the date and time they were in your facility. If you utilize an electronic reservation system, you can export that data to be shared. All contact information must be submitted in an electronic format to be accepted. (Acceptable formats include CSV, Xlsx, google sheets. Photos of hand written contact info cannot be accepted) *
Contact Tracing info (Client information) is required to be submitted weekly. If this information is not received in an electronic format including first name, last name, phone number and email, approval for the Level Up program will be suspended. My business will submit this information weekly as required. *

Yes
Business specific plans for outbreak detection, reporting and response. Find more details on the specifics needed for the outbreak plan under the outbreak guidance on the larimer.org/LevelUp page. Describe how you will meet these requirements. *
Per state's outbreak guidance, if two or more cases are confirmed within 14 days among employees, the workplace/facility could be ordered to temporarily close. Managers must report the suspected outbreak to Larimer County Public Health. Businesses could be reported to the state as an outbreak and that information publicly shared. *

Yes I understand my business could be ordered to close for a period of time if I have two employee cases in 14 days and I will report my cases to the health department.
Businesses must have sufficient quality ventilation - what is the ventilation in your facility and how does it meet the state required guidelines? (Filters upgraded, continuous operation of HVAC systems, limit recirculation. Maximize outdoor air supply through open doors and windows when possible.) *
Businesses are required to have an exposure notification service promotion & a way to complete outreach to employees and customers. Describe how you will meet this requirement. *
Businesses must have publicly displayed instructions for a customer to lodge compliance complaints to the administrative committee. Describe how you will meet this requirement. *
Special hours or accommodations for at risk populations. Describe how you will meet this requirement. *
In order to qualify for this program, you must have zero prior citations of noncompliance. A citation of noncompliance is either a state or local citation for a business that despite warnings and educational efforts, willfully violated the public health order. Please confirm that is the case here. If you have been cited for noncompliance you are not eligible for the Level Up program unless the application has been reviewed and approved by the Administrative Committee. *

Yes
Industry specific requirements *

Restaurants/Bars/Breweries Specific Requirements
While Larimer County is in Level Red, all tables must be spaced a minimum of 10 feet apart. Increasing this table to table distance to 10 feet ensures that guests seated at the tables are spaced more than 6 feet apart. Describe how you will meet this requirement.
At this point, there cannot be more than 25% capacity, up to 50 people, in an establishment at one time. Please provide the maximum number of patrons, not including staff, that will be allowed in your establishment at any given time.
Signage or other measures must be taken to inform customers that seating is limited to a single household. Describe how you will meet this requirement.
Reservations help to alleviate crowds arriving at the same time, especially in levels where seating capacities are limited. If reservations are not used other systems must be used to prevent crowding into waiting areas, entries, or bar areas. Having customers wait for a text or notification when a table is ready, placing signage where individual parties should stand should be used to prevent crowding. Describe how you will meet this requirement.

Gyms & Fitness Centers
Reservation systems must be used to prevent overcrowding of the facility and to maintain correct capacities for each room that has been designated within the facility. Describe how you will meet this requirement.
Diagrams submitted to show room layouts and capacities planned for each room. A room is a separate area of an establishment where people in one space do not interact with occupants of another, or move among the separate spaces. Rooms do not need separate entrances/exits or restrooms, but having these is preferred. Examples; A rec center with a lap pool and a gym can treat these as two separate ‘rooms’ if people utilizing the lap pool and the gym do not interact or switch areas. A facility (gym, church) with seating/activities on multiple floors where the two do not interact.

Cancel of

Personal services
Reservation systems must be used to prevent overcrowding of the facility and to maintain correct capacities for each room that has been designated within the facility. Describe how you will meet this requirement.
Diagrams submitted to show room layouts and capacities planned for each room. Each area designated as a room within the facility must be separated from others and not require guests to move between rooms or interact.

Cancel of

Indoor Events
Measures are taken to inform customers that seating is limited to a single household. Describe how you will meet this requirement.
Diagrams submitted to show room layouts and capacities planned for each room.A room is a separate area of an establishment where people in one space do not interact with occupants of another, or move among the separate spaces. Rooms do not need separate entrances/exits or restrooms, but having these is preferred. Examples; A facility (gym, church) with seating/activities on multiple floors where the two do not interact. An event center with two separate venue sites or rooms where guests of one venue do not interact with occupants of the other venue.

Cancel of

We require a COVID contact for each business

This must be an employee and contact info must be for someone who is available nights and weekends as well.
COVID contact name *

First Name Last Name
COVID contact phone *
Please enter a valid phone number.
COVID contact Email *
example@example.com
Should be Empty:

Level Up Business Application

Restaurants/Bars/Breweries Specific Requirements

Gyms & Fitness Centers

Personal services

Indoor Events

We require a COVID contact for each business