Local and Tribal Health Department COVID-19 Impact Assessment

In an effort to reduce the reporting burden on local and tribal health departments while understanding and documenting how local and tribal health departments’ operations, policies, partnerships, and workforce have been impacted by COVID-19 response activities, the Department of Health Services, Division of Public Health (DPH), Office of Policy and Practice Alignment (OPPA) requests that you complete this 25- to 30-minute survey.

This survey is designed to serve multiple purposes:

Identify how the pandemic has highlighted strengths and gaps in the public health system in Wisconsin and how the governmental public health system has changed in response.
End-of-year reporting for FY2019 (2019-2020) Preventive Health and Health Services (PHHS) Block Grant.
Contract negotiation for FY2020 (2020-2021) PHHS Block Grant contract negotiation.

This survey is separated into three sections:

End-of-year reporting
Contract negotiation
Impact Assessment
- Operations
- Policy and Partnerships
- Workforce
- Future Planning

Because this survey serves as your PHHS Block Grant end-of-year report and contract negotiation, all local and tribal health departments must complete this survey no later than November 15, 2020. For assistance completing the survey, please contact your DPH OPPA contract monitor.

1. Agency Information *This question is required.

Name of health department *This question is required.

First and last name of health department staff completing survey. *This question is required.

Title of staff completing survey. *This question is required.

Email address of staff completing survey. *This question is required. This question requires a valid email address.