Social Services Custom Policy Manual Order Form
Name of Organization/Location
*
Name
Location
Name of Individual Completing the Form;
*
First Name
Last Name
Email
*
example@example.com
Phone Number
Please enter a valid phone number.
Do you want your Company Logo included in the Policy Manual?
Yes
No
Add Company Logo
*
Please select the types of services that are offered at this location; (check all that apply)
*
Congregate Living/ Long-Term Stay (14+ days)
Childcare/ Daycare Services
Mental Health/ Counselling
Addiction Services
Food Preparation
In-Home Services
Please provide the name/type of disinfectants for the following areas;
Wipes;
Sprays;
Floors;
Bathrooms;
Hard Surfaces;
Toys/ Shared Items;
How are groceries brought to this location?
*
Delivery
Dedicated Staff for Pick-up
No specific grocery policy
Not Applicable
Do you currently have a specific procedure for the following (click all that apply); if not, a generic policy will be included in your manual.
Blood/ Body Fluid Clean-up and Exposure
Preparation/ Administration of Medication
Food Preparation
Boil Water Advisory
Please describe your procedure for Blood/ Body Fluid Clean-up and Exposure;
*
You may upload a copy of your Blood/ Body Fluid Clean-up and Exposure policy;
Please describe your procedure for Preparation/ Administration of Medication;
*
You may upload a copy of your Preparation/ Administration of Medication policy;
Please describe your procedure for Food Preparation;
*
You may upload a copy of your Food Preparation policy;
Please describe your procedure for Boil Water Advisory;
*
You may upload a copy of your Boil Water Advisory policy;
Who is responsible for Environmental Cleaning at this location?
*
Third-Party/ Hired Cleaners
Dedicated Cleaning Staff
Site Staff perform Cleaning Duties
Is there fabric upholstered furniture on-site?
*
Yes
No
Please describe the procedure for cleaning the surfaces of the upholstered furniture noted above (including frequency);
*
Do you currently have a specific procedure for the following (click all that apply); if not, a generic policy will be included in your manual.
Cleaning of Offices
Cleaning of Bathrooms
Cleaning of Common/ Recreation Areas
Cleaning of Kitchens
Cleaning of Dining Areas
Cleaning of Bedrooms
Cleaning of Other Areas
Cleaning of Linens
Please describe your procedure for Cleaning of Offices (including frequency);
*
You may upload a copy of your Cleaning of Offices policy;
Please describe your procedure for Cleaning of Bathrooms (including frequency);
*
You may upload a copy of your Cleaning of Bathrooms policy;
Please describe your procedure for Cleaning of Common/Recreation Areas (including frequency);
*
You may upload a copy of your Cleaning of Common/Recreation Areas policy (including frequency);
Please describe your procedure for Cleaning of Kitchens (including frequency);
*
You may upload a copy of your Cleaning of Kitchens policy;
Please describe your procedure for Dining Areas (including frequency);
*
You may upload a copy of your Cleaning of Dining Areas policy;
Please describe your procedure for Cleaning of Bedrooms (including frequency);
*
You may upload a copy of your Cleaning of Bedrooms policy;
Please describe your procedure for Cleaning of Other Areas (including frequency);
*
You may upload a copy of your Cleaning of Other Areas policy;
Please describe your procedure for Cleaning of Linens;
*
You may upload a copy of your Cleaning of Linens policy;
Any additional notes/information;
Submit
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