Brooke County Health Department
Continuity of Operations Plan
BROOKE COUNTY HEALTH DEPARTMENT
CONTINUITY OF OPERATIONS PLAN
TABLE OF CONTENTS
X
Forward……………………………………………………………………………………………..
Record of Changes………………………………………………………………………………..X
Continuity of Operations Plan……………………………………………………………………X
Appendix 1: Telephone Notification Tree
Appendix 2: Staff Listing
Appendix 3: Continuity of Operations Flow Charts
Appendix 4: Internet Resources
Appendix 5: Forms
Message Form
Status Report Form
Resource Request Form
Appendix 6: Minimum Supplies Necessary for Relocated Operations
Appendix 7: Glossary
Appendix 8: Records
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Brooke County Health Department
Continuity of Operations Plan
FORWARD
Emergency situations come in all shapes and sizes. As such, it is important to prepare
for the major, “worst case scenario” events; however, it is equally important to address
those emergencies with less severity but a higher frequency rate. According to some
sources, 90% of emergencies are considered “quiet catastrophes”. These relatively
minor emergencies can wreak havoc on an agency’s ability to continue operations.
As a public service agency, the Brooke County Health Department must realize that the
public has generally been unwilling to overlook lapses in services, even in the wake of
disasters. The public expects good “customer service” from governmental agencies as it
does from any business. Further, as a public health agency, the health department is
involved in a variety of emergency functions to ensure the safety of the public and
emergency response resources that must be provided while simultaneously maintaining
routine services.
Without pre-planning, it is difficult for an organization to fulfill its mission during a crisis of
any magnitude. Continuity of Operations (COOP) planning is an effort to ensure the
stability of essential functions during a wide range of potential emergencies and events.
Today’s changing threat environment and many of the recent disasters throughout the
country underscore the need for COOP capabilities and plans.
This document presents guidelines for the Brooke County Health Department to ensure
the structured prioritization of services and the continued provision of high-priority
services. The plan relies on a “common sense” approach to not only fulfilling routine and
emergency responsibilities but also to ensuring the safety of its employees. This plan
recognizes the existence of resource shortfalls and offers a variety of options for
overcoming them.
i
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Brooke County Health Department
Continuity of Operations Plan
RECORD OF CHANGES
In order for any plan to remain viable and effective, frequent revisions and updates are
needed. This document serves as a record of the changes made to the Brooke County
Health Department Continuity of Operations Plan. All significant revisions should be
logged in this section (with the exception of the correction of typographical and other
such errors and the updating/addition of personnel names and contact information).
Date
February –
August 2008



June 2015
Description of the Change
Initials
Complete plan development
Regular meetings between BCHD and consultant to
determine priorities, capabilities, agency
interdependencies, etc.
Initial plan adoption and implementation
BCHD,
JHC
Reviewed plan and updated personnel
ii
MSB,
BCHD
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Brooke County Health Department
Continuity of Operations Plan
BROOKE COUNTY HEALTH DEPARTMENT
CONTINUITY OF OPERATIONS PLAN
I.
PURPOSE
These guidelines for business continuity describe the actions to be taken by
employees of the Brooke County Health Department during quick onset and/or
prolonged emergency situations to maintain, to the extent possible, the services
provided by the health department.
Discussions of Major COOP Concepts
The following is not a comprehensive list of the COOP concepts discussed in this plan. It is, however,
the major concepts. This list serves as a quick reference guide for the user of the plan.








Prioritization of Services – III.A.2.
Service Suspension and Consolidation – III.A.2.c. and d.
Plan Activation Levels – III.C.2.
Relocation – III.C.3.
Work from Home – III.C.4.
Lines of Succession for Key Personnel – III.D.
Records Protection – III.E.
Recovery – III.F.
II. SITUATION AND ASSUMPTIONS
A. Situation
1. The Brooke County Health Department provides services in three (3) broad
service areas: nursing, environmental health, and health education.
a. Environmental Health Services
i. Public Health Inspections and educational information
ii. Disease Prevention and Control
b. Nursing Division
i. Communicable Disease Prevention and Surveillance
ii. Immunizations and Health Promotion
c. Community Health Promotion
i. Provide information to the public
ii. Encourage health promotion
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Continuity of Operations Plan
2. Normal health department operations are from the courthouse located in
Wellsburg, WV.
3. Incident Command System (ICS) job descriptions with checklists have been
developed and are available during an emergency. Generalized emergency
responsibilities are listed in the Brooke County Emergency Operations Plan.
Other, specialized plans include the following:
a. All Hazards Response Plan
b. CERC Plan (Crisis Emergency Response Communication)
c. Environmental Response Plan
d. Strategic National Stockpile
e. Strategic National Stockpile Site Plan
f.
Epidemiological Response Plan
4. The following hazards may interrupt the operations of the Brooke County
Health Department.
a. Armed or unruly citizen
b. Biological concerns (flu, etc.)
c. Blizzard or ice storm
d. Bomb threat
e. Fire
f.
Extreme temperatures
g. Flood (although the health department office on the second floor does not
flood, the lower floors are affected, causing accessibility problems at the
courthouse)
h. Hazardous material release
i.
Power outage
j.
Utility failure (including HVAC failure)
5. The continuity of health department operations is necessary to ensure a
maintenance of services for the citizens of Brooke County as well as an
ability to maintain a capability (albeit potentially minimal) to respond to
emergencies. Continuity of operations planning is also important to ensure
that the resources of the health department can be re-distributed internally to
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Brooke County Health Department
Continuity of Operations Plan
handle “surge” type operations (and minimally maintain routine operations)
should mass prophylaxis or other emergency response be necessary.
6. The Internet (which is provided by a general line into the courthouse) is often
prone to disruption; due to the amount of resources located online and
reporting done online, the internet is essential to the efficient operations of
the health department. Should the internet go down, county representatives
coordinate with the state to restore service.
7. Electric service is also sporadically interrupted. A generator is available for
backup power; however, it is only suitable for full operations if the interruption
is projected to last less than a single working day. If the outage is projected to
be of longer duration, the generator should be relied upon only for
maintenance of vaccines (refrigeration), emergency lighting, computer
servers, etc.
B. Assumptions
1. Situations will occur that are beyond the planned scope of this procedure.
2. The health department may be requested to send a representative to the
Brooke County Emergency Operations Center to provide expertise regarding
the public health elements of a response. The Brooke County Health
Department is committed to sending a representative; however, the actual
individual sent is based on the incident itself, personnel availability, etc.
a. The health department has appropriate staff available to cover the regular
responsibilities of an individual who reports to the county EOC via
personnel cross-training, administrative delegations, etc.
b. It is also assumed that the health department will activate an internal
command structure to manage its response to an emergency incident.
c. The health department representative in the county EOC serves as a
liaison to this agency-specific “EOC” that is managing health department
operations.
3. Adequate warning of an incident will be received by the health department
administrator so as to implement this continuity of operations plan.
4. Health department personnel will understand their responsibilities as outlined
in this plan, the Brooke County Emergency Operations Plan, and other
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Continuity of Operations Plan
specialized emergency plans maintained by the health department (see
II.A.3. above).
5. A telephone notification tree maintained within the department is used to
contact staff during an emergency (especially after hours).
6. Existing
communications
systems
are
adequate
to
facilitate
the
implementation of this plan.
7. Other health departments in the region can be relied upon for external
support. Regional departments have the authority to refuse support based on
conditions present within their own jurisdiction. Further, such support is likely
to be diminished if all health departments in the region are affected by the
same hazard.
8. Backup power capabilities will offset any short-term power failures as long as
fuel is available. See II.A.7. above regarding generator capabilities.
9. On-going family planning will reduce employee shortages due to family
matters. (The assumption is that employees will only have to miss work for
major family situations.)
III. CONCEPT OF OPERATIONS
A. General
1. The Brooke County Health Department staff is comprised of fourteen (14)
individuals.
a. The health officer and clinic doctor are both medical doctors and
considered to be “staff members” of the Brooke County Health
Department.
b. The doctors, however, do not hold full-time office positions with the
department; they are on-call and utilized on an as-needed basis.
c. Tasks normally undertaken by the MDs are not considered in detail in this
COOP document. It is assumed that if MDs are needed during times
when this plan is activated, they will be called as normal. If they are
unavailable, normal protocols for backups to the position are followed.
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2. Delineation of High-Priority Services
a. During emergency situations, services provided by the Brooke County
Health Department will be maintained to the extent possible. Some
services may take precedence depending on the nature of the
emergency. Examples of those services that may ascend to a higher
priority include (but are not limited to):
i. Public health inspections
ii. Disease surveillance
iii. Disease prevention and control operations
iv. Immunizations
v. Provide emergency health information to the public
b. Prioritization of Services
i. Emergency response services
HIGHEST PRIORITY
ii. Environmental health/nursing
↓
iii. Administration
↓
iv. Community health promotion
LOWEST PRIORITY
c. Suspension of Services
i. Service suspension is a temporary measure.
ii. Service suspension can be implemented when the consolidation
option (see III.A.2.d. below) will not allow for the adequate provision of
services or when the safety of personnel is compromised if service
provision is continued. Examples of emergency situations that may
require suspension are as follows.

Emergency response duties require the attention of all department
personnel

Employee illness (related to epidemic or pandemic)

Significant damage to or destruction of the normal operating
facility

Short-term utility failure

Hazardous material release (including both releases external to or
within the office, such as a gas leak)

Other in-county or regional resources are exhausted
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iii. The decision to suspend services is made by the administrator. Items
to consider include the following.

Availability of in-house resources for consolidation (i.e. have
minimum staff levels been reached? – see III.A.2.c.v. below)

Potential for regional support

Duration of action

Location of the service on the health department’s priority listing
for services
iv. If any service is suspended, the administrator must:

Notify the board of health and the EOC.

Ensure
that
the
department’s
public
information
officer
disseminates appropriate information
 This information should include the estimated duration of the
suspension, where clients can obtain more information, and
how clients can handle emergencies until services can be
restored.
 If the emergency situation is large scale and the emergency
operations center and, subsequently, public information officer
for Brooke County (through the county office of emergency
management) has been activated, the health department
public information officer should coordinate the release of
public information with the county public information officer (to
ensure a single, consistent message as well as to keep a
record of all emergency activities).
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v. Feasibility of Service Suspensions

During
situations for
which this plan
is
activated,
daily
responsibilities may be suspended so as to ensure provision of
the above high-priority services.
 Samples of daily responsibilities include general office
management and grants administration.
 While not completely impractical, suspension of such tasks as
payroll and accounts payable/receivable is considered a last
resort, especially if the incident is expected to be of long
duration (i.e. in excess of five [5] work days). The administrator
should make every effort to see that these responsibilities are
fulfilled (if necessary).

Emergency response duties cannot be suspended. If the
department
is
unable
to
fulfill
emergency
response
responsibilities, notify the Brooke County Emergency Operations
Center. Staff at the emergency operations center will attempt to
locate resources from other county or regional agencies to ensure
that those emergency responsibilities are fulfilled.
 During emergency situations, the health department organizes
under an Incident Command System (ICS). One of the
fundamental components of an ICS is that the incident is
managed by an Incident Commander (IC) role that is filled at
all times. As such, a line of succession exists through the
structure of the ICS.
 Indicating an inability to fulfill emergency duties should only be
done after all routine services have been temporarily
suspended in an attempt to fulfill emergency responsibilities.
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Continuity of Operations Plan

Environmental Health Services
 Samples
-
Public health inspections
-
Disease prevention and control
-
Public interface/liaison
 Routine
environmental
health
services
should
not
be
suspended unless absolutely necessary (i.e. emergency
response duties obligate all local staff and no regional/state
resources are available to assist).
 Minimum
staff
levels
required
to
maintain
functional
environmental health services include a registered sanitarian
and support person.

Nursing Services
 Samples
-
Communicable disease prevention and surveillance
-
Immunizations
-
Health promotion
-
Public interface
 As with environmental health services, nursing services should
not be suspended until all other options have been exhausted
(i.e. the emergency response requires all staff and no
regional/state resources are available to assist).
 Minimum staff levels required to maintain functional nursing
services include a registered nurse and support person.
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Continuity of Operations Plan

Administrative Services
 For as long as the health department is maintaining operations
– even minimal operations – essential administrative services
cannot be suspended. Non-essential administrative services
can be suspended.
 Samples of Essential Services
-
Supervision/management
of
personnel
engaged
in
operations on behalf of the health department
-
Employee payroll and benefits
 Samples of Non-Essential Services
-
Accounts payable/receivable
-
Maintenance of essential records
-
Computer functions
 To
maintain
administrative
services,
either
the
health
department administrator or a designated backup must be
available.

Community Health Promotion
 Routine community health promotion services can be
suspended.
 While health promotion may not be suspended during a Tier I
activation of this plan (see III.C.2. below for a discussion of
activation levels), it will most likely be suspended during Tier II
and Tier III activations. As always, the administrator may
choose to suspend health promotion during any activation
level or not at all, depending on the individual incident.
 It is important to note that “routine community health
promotion” does not include emergency public information.
Information released to the public during an emergency
response is considered an “emergency response service”, is
not suspendable, and is detailed above.
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Continuity of Operations Plan
d. Consolidation of Services
i. Definition of Terms as They Relate to this Plan

The following definitions are provided in an effort to eliminate
confusion when describing inter-departmental continuity actions
and the employment of regional or other external assistance.

Consolidation: An in-house measure to ensure that all highpriority services are maintained for as long as possible. Includes
temporary consolidation of job titles, temporary re-assignment of
cross-trained personnel, etc. to fill deficiencies in the provision of
services.

Referral: The act of recommending that patients/clients report to
another health department (e.g. in a neighboring county) to
receive services. Usually implemented on a short-duration basis to
free departmental staff to address a localized emergency.

Combination: The actual combining of minimal staffs from two (2)
or more health departments (with regional affiliations) to continue
service delivery. May include the identification and opening of an
alternate facility in a central location so as not to inconvenience, to
the extent possible, any participating department’s clientele.
ii. Health department services could be consolidated to a degree as
personnel are cross trained to perform the basic aspects of each
other’s duties. Those duties requiring specific certifications may have
to be temporarily suspended until certified individuals can return.
iii. Consolidation of services is advantageous if personnel are absent for
any reason. Examples of emergency situations necessitating
consolidation are as follows.

Emergency response duties require a portion of the department’s
personnel

Employee illness (related to epidemic or pandemic)

An emergency prohibits a staff person from reporting to work (e.g.
snow drift blocking roads, flood waters crossing roads, etc.)
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iv. The decision to consolidate versus suspend services is made at the
time an incident occurs. The administrator has the authority to make
the decision.

Samples of Consolidated Roles
 Administrator – Nursing Director / PIO / SNS Coordinator
 Nurse – SNS Backup / Epi Response
 Sanitarian – Epi Response / Threat Preparedness Coordinator
 Clerical – Assistance (used as needed)
 Under minimal operations, a total of two (2) additional support
personnel would be available, one (1) each to assist the nurse
and sanitarian.

Lines of succession to ensure staffing of the essential positions
are presented in section III.D. below.

If the entire line of succession is exhausted for any one of the
above positions, the person serving as the administrator should
request regional/state assistance. (*NOTE: The administrator may
request regional support prior to full exhaustion of the line of
succession.)
v. Normal operations and minimum (i.e. fully-consolidated) operations
are presented in this plan. The administrator has the authority to
consolidate positions on an as-needed basis to address deficiencies
in service provision. The “middle stages” between normal operations
and minimum operations may, then, be different for every incident. As
such, these “middle stages” are left to the discretion of the
administrator and not listed in this plan.
vi. Necessary Notifications

Board of health members

Regional partners

WV Bureau for Public Health

It is generally assumed that customers would not readily
recognize a consolidation of services. Further, consolidation
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Continuity of Operations Plan
implies that all services are being provided at near-normal levels.
As such, a public notification of consolidation is not necessary.
e. A discussion on service referral and the combination of multiple health
departments is listed in section III.C. below.
3. Preparing for Alternate Operational Considerations
a. If an alternate operational arrangement such as relocation must be
implemented, the information under this heading can be used to prepare
a suitable alternate location for the health department’s minimum
operations.
i. Emergency response responsibilities are not suspendable. These
tasks can, however, be “relocated”, primarily because many
emergency response activities are “go to” or remote assignments.
Guidelines for performing emergency operations are listed in the
department’s All Hazard Response Plan. (The response plan is
exercised and updated on an annual basis.)
ii. Instructions for maintaining operations during emergency situations
will be provided by to the general health department staff by the
administrator. These requirements should be communicated to them
so as to ensure a smooth, efficient transfer of operations from the
normal operating facility to the alternate facility. (see III.C.3-6 below)
iii. If the health department decides to relocate its operations for any
reason, the administrator is responsible for obtaining access to the
alternate
facility
and
ensuring
that
the
following
minimum
requirements can be met.
iv. If a work-from-home arrangement is implemented, the administrator is
responsible for maintaining regular contact with all operating staff and
ensuring they have work assignments.
v. If service referral or the combining of two (2) or more health
departments is necessary, the administrators of all participating health
departments should coordinate extensively.
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b. Minimum Necessary Personnel: 6 – 8
c. Minimum Necessary Computers: 2
d. Minimum Necessary Telephones: 3
e. Essential Utilities: Telephone service (minimum three [3] phone lines),
cellular service, and electricity (at least 10 receptacles)
f.
Minimum Space Needs
i. 1,000 square feet (minimum) floor space with the ability to partition off
section for patient privacy.
ii. Restroom facilities for staff and public use.
4. Cross Training
a. As discussed above, personnel are cross trained so as to be able to
assist one another with the basic operations of the health department.
b. Mutual aid agreements exist between all of the health departments in the
northern panhandle region. As such, external resource support is
available, if needed. The administrator is responsible for notifying these
departments if resources are needed in Brooke County.
B. Notification and Warning
1. Notification of the Brooke County Health Department
a. The administrator will receive emergency notifications from a variety of
sources. These sources include:
i. County communications center
ii. County office of emergency management
iii. County sheriff
iv. Community emergency responders
v. Local hospitals and physicians’ offices
vi. West Virginia Bureau for Public Health
vii. Other health departments from the region
viii. Staff members
ix. Local media (e.g. television, radio, newspaper, etc.)
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b. If the administrator receives an emergency warning, he/she is to initiate
notifications of staff as soon as possible.
i. Staff members will be notified face-to-face or via telephone extension
during work hours. The after-hours telephone tree (see Appendix 1) is
to be used after hours to contact staff at home.
ii. Notifications should include the following information:

A brief description of the incident

Initial planned emergency response (see III.B.1.c. below)

Facility to which to report (if after hours)

Scheduling considerations (e.g. report home immediately, office
closed on next day, etc.)

Time status reports can be expected (if staff members are told to
remain/report home)

Additional information deemed necessary by the administrator.
c. Subsequent notifications of staff must include the initial planned
emergency response. As such, the administrator should compile a plan of
action as quickly as possible (even if the plan of action is to await further
information). Sample plans of action include:
i. Await further information
ii. Send all employees home (or tell them to remain home)
iii. Consolidate essential services and operate with a minimum staff
iv. Suspend non-essential services and operate with a minimum staff
v. Relocate the office
2. The administrator’s primary notification responsibility is to the departmental
leads.
3. Departmental leads are then responsible for contacting those individuals in
their chain of command.
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Continuity of Operations Plan
4. If a regular staff member receives the initial emergency notification, they
should first attempt to call the administrator.
a. If the administrator cannot be reached, the staff member should then
notify their department lead.
b. The department lead will attempt to contact designated backups (to the
administrator) until a person with proper authority can make the
determination to activate this plan.
c. If the plan is activated, that department lead initiates notifications of the
remainder of the health department staff.
5. All remote emergency messages will be communicated via telephone.
Cellular telephone numbers are utilized, if necessary.
a. Information includes scheduling for the remainder of a day or the order to
remain home, report to an alternate location, etc.
b. Appropriate telephone numbers should be included in releases of public
information so potential clients can reach the department to confirm the
continued provision of services.
C. Emergency Procedures
1. Initial Emergency Actions
a. During some emergency incidents, a health department representative
may be requested to report to the county emergency operations center
(see II.B.2. above).
b. Emergency incidents may occur when the administrator is unavailable.
i. The administrator is responsible for delegating supervisory duties to
an individual in the office prior to leaving.
ii. The administrator should also coordinate with the “second in
command” to establish a means of communication between the
department and the administrator (to handle routine operational
issues).

Such means of communication as cellular phones or electronic
mail are preferred for these types of messages during emergency
situations (in order to keep telephone land lines and radio
frequencies clear for emergency messages).
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Continuity of Operations Plan

If these communications systems are inoperable, radio usage or
landline telephone (to the operations center) may be used. Under
these circumstances, however, communications regarding routine
operational issues should be kept to a minimum.
c. Health department personnel should follow instructions given in the initial
emergency notification while activating this plan.
d. Any unusual occurrences or potential problems (either encountered while
activating this plan or those that are directly related to the emergency
situation) should be reported to the individual serving as the administrator
immediately. When these individuals are unavailable, problems should be
reported to the agency or individual that issued the initial emergency
notification.
2. Activation Levels
a. This plan can be activated to three (3) levels: a minimal activation to
handle a site-specific or short duration emergency situation, a mid-level
activation to respond to a long duration event that is not likely to cause
suspension of services or relocation, and a full activation during which
services are consolidated and may be suspended and/or a relocation has
been (or will imminently be) implemented.
b. Sample “activation triggers” are provided for each tier. These triggers are
guidelines that health department personnel can use when evaluating the
need to activate the plan. The administrator reserves the right to amend,
supplement, or ignore the suggested trigger (based on specific incident
circumstances).
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c. Tier I Activation
i. Tier I activations are the minimal activations of this plan.
ii. This level is used to respond to sitespecific or short duration events,
including (but not limited to) the
following.

Power or other utility outages

Computer or network failures

Bomb threats

Unauthorized intruder
iii. Consolidation of services may be
required
activation.
as
part
For
of
these
a
Tier
I
incidents,
Tier I Activation Triggers
- 50% of the total staff is
absent for a single day
- Utility outage for a
projected 24-72 hours
- Any situation that requires
the health department to
fulfill emergency
response duties
- Site-specific emergency
at the health dept. office
(e.g. minor fire, bomb
threat, intruder, etc.)
with projected resolution
in less than 24 hours
however, staffing levels are expected to remain high enough so as not
to require a suspension of any type of service or a request for mutual
aid to continue provision of services.
iv. The administrator makes the decision to activate to the Tier I level.
Such a decision can be made based on recommendations from other
emergency authorities or based on interoffice circumstances.
v. Tier I activations do not have to be reported to any emergency
authority as they may be called in response to an interoffice, nonemergency situation. The administrator may choose to notify the local
board of health.
vi. The administrator has the authority to extend a Tier I activation to a
Tier II or III based on the circumstances surrounding an incident.
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Continuity of Operations Plan
d. Tier II Activation
i. Tier
II
activations
are
mid-level
activations of this plan.
ii. The following types of incidents may
force a Tier II activation.

Escalating employee illnesses to
a significant percentage of staff

Long-term power or other utility
outage

An
emergency
situation
that
depletes the staff such that the
provision of routine services is
interrupted

An
emergency
is
Tier II Activation Triggers
- Only the minimum staffing
level is available for a
single day
- 50% of the total staff is
absent for 2 – 10 days
- Utility outage for a
projected 72+ hours
- Cascading hazard event
(e.g. flood, winter storm,
seismic event, tornado,
hazmat incident) is
imminent or occurring
anywhere within the
jurisdiction requiring
extensive resource
reassignment
occurring
elsewhere in the county or region that may result in cascading
effects that may affect the health department (in such an instance,
the Tier II activation is a kind of “on-call” or “stand-by” measure)
iii. Consolidation and service referral are possible as part of a Tier II
activation; however, service suspension (or combining health
departments) is not anticipated as part of a Tier II activation.
iv. The administrator makes the decision to elevate to a Tier II activation.
Such a decision is usually based on recommendations from other
emergency authorities.
v. The administrator must report a Tier II activation to the local board of
health and other health departments in the region (to alert them of the
potential to request resource support and/or service referral). Optional
notifications can be made to the West Virginia Bureau for Public
Health.
vi. The administrator has the authority to extent a Tier II activation to a
Tier III based on the circumstances surrounding the incident. The
most common instance will be when services go from being
consolidated to being temporarily suspended.
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Brooke County Health Department
Continuity of Operations Plan
e. Tier III Activation
i. Tier III activations are full activations of all parts of this plan.
ii. During Tier III activations, certain services are likely to be suspended
and
alternate
operational
considerations implemented.
Tier III Activation Triggers
iii. Sample situations that may force a
Tier III activation are as follows.

Emergency duties have depleted
the
staff
such
that
routine
operations must be suspended

Employee illness is so great that
some
services
must
be
suspended

The office has been adversely
impacted by an emergency (such
- Only minimum staffing
levels will be available
for 10+ days
- 75% of the total staff is
absent for more than a
single day
- Any situation requiring
service suspension
- Any situation requiring
relocation
- If the normal operating
location sustains significant damage and is
in need of major repairs
as a fire, roof collapse, etc.)
iv. The administrator makes the decision to elevate to a Tier III activation.
Such a decision is based on recommendations from other emergency
authorities.
v. A Tier III activation should be reported to the local board of health,
county
emergency
operations
center,
other
regional
health
departments, and the West Virginia Bureau for Public Health. Other
notifications may be necessary depending on the agencies that are
involved or are potentially involved in the response to the incident.
2015
Brooke County Health Department
Continuity of Operations Plan
3. Relocation
a. The following facilities may serve as alternate facilities from which the
health department could operate.
i. Bethany College Wellness Center

PROs: This facility is set up for health operations and includes
adequate general space as well as private areas for patient
consultation/examination.

CONs: The college is not centrally located. While college is in
session, the center would be required to maintain services to
students.

An MOU is in place to use the wellness center.

The health department administrator contacts the *** if use of the
wellness center is necessary.
ii. Brooke County Schools

The health department has developed an agreement with Brooke
County Schools to use school facilities (or portions of school
facilities) as alternate facilities.

PROs: Schools are large facilities with adequate general space,
sanitary facilities, kitchen facilities, etc. Also, some schools are
centrally located.

CONs: Usage is difficult when school is in session. Procuring
adequate space to ensure patient privacy is sometimes difficult.

The administrator contacts the superintendent if usage of one of a
county school is necessary.
iii. The health department could also coordinate with the Brooke County
Emergency Management Agency to identify other alternate sites.

EMA Director: Bob Fowler

Contact: 737-5002
2015
Brooke County Health Department
Continuity of Operations Plan
b. Generally, alternate sites are not considered “optimal” operational
arrangements. They do, however, provide the space necessary for the
health department to maintain a level of service to the community.
i. Often, equipment resources, such as telephones, computers, etc. will
need to be procured and delivered to the alternate site before
operations can be fully transferred.
ii. A relocation may require shared use of resources, such as internet
connections, telephone lines, etc.
c. “Partial relocation” is often implemented in response to hazards. For
example, the department may stand up a clinic comprised of two (2) to
three (3) staff persons to administer tetanus and other vaccinations while
the normal operating facility is unavailable. Such operations are generally
short duration. Such a clinic could not handle large-scale, emergency
operations. It would, however, allow the department to maintain its
operations during the resolution of the initial hazard.
d. The need to relocate will be determined by one of the following.
i. The normal operating location is directly threatened by a hazard
ii. Relocation will better serve the department’s clientele during an
emergency
iii. Other situations, as deemed necessary by the administrator or local
government
e. The administrator makes the determination to relocate department
operations. Such a decision may be based on a variety of information
regarding the potential or existing incident.
f.
If relocation is necessary, the administrator must provide the location of
the alternate facility in the initial notification.
g. If a relocation becomes necessary after the start of an incident (and,
associatively, a Tier I or Tier II activation has been implemented and
raised to a Tier III), the administrator will notify staff members per the
guidelines for initial notifications above.
2015
Brooke County Health Department
Continuity of Operations Plan
h. Transition
i. If
relocation
is
ordered,
health
department staff will report to the
alternate location to secure operating
space and ensure that the resources
necessary for operating the department
are available.
ii. The administrator designates one (1)
staff person to remain at the normal
A staff person remains
at the normal operating
location, even after
essential personnel
have relocated, until
operations can be fully
transferred so that
services provided to
clients are as seamless
as possible.
operating location (if it is safe) to
answer telephones, interact with any clients that may arrive there
before operations can be transferred (to reschedule appointments,
take messages, etc.), and take messages for distribution once
operations are transferred.
iii. Once equipment is procured and arranged and prior to transferring
operations, staff at the alternate facility should ensure that computers
and telephones are in working order. To obtain the numbers of
alternate telephones (if additional telephones are installed at an
alternate location), ask the service technician with the line tester to
retrieve the number or call a personal cellular phone.
iv. Once the alternate facility is prepared and operations can be
transferred, the administrator will notify the staff person at the regular
location and direct him/her to report to the alternate location. That
staff person will backup essential computer files and collect necessary
paper files to take to the alternate site.
v. The department’s public information officer (from the alternate
location) should then prepare public information releases to ensure
that clientele are aware of the relocation and change in the provision
of services. These releases should be coordinated through an
activated emergency operations center, if applicable.
2015
Brooke County Health Department
Continuity of Operations Plan
4. Work from Home
a. During certain Tier III activations (such as an escalating biological event),
allowing employees to work from home may be the safest, most effective
action.
b. If the decision is made to work from home, the administrator should direct
employees to save appropriate files to discs, flash drives, etc. The
administrator can take one of the portable radios home to maintain
contact with the department and other county agencies.
c. Only administrative and environmental health services could be
accomplished from employee homes, thus implying that examination,
immunization, and other public services are temporarily suspended or
referred. Under such circumstances, the physical office space is closed.
(See Appendix 3 for a list of hyperlinks to resources that are necessary
for operations.)
d. If operations are transferred to a “work from home” scenario:
i. The administrator is responsible for notifying appropriate persons,
agencies, etc. of the best ways to make contact with him/her. Email
and cellular phones are generally the preferred methods of contact.
ii. The administrator will determine how frequently employees should
provide status updates.
iii. The department’s public information officer should release appropriate
information outlining when and how the public can gain access to
services.
iv. In some instances, it may not be feasible to completely close the
office space. The administrator can develop a rotating schedule so
that at least one (1) employee reports to the office during normal work
hours to interface with the public. The administrator would then be
responsible for notifying employees of this schedule.
2015
Brooke County Health Department
Continuity of Operations Plan
5. Service Referral
a. For some minor emergencies affecting only the Brooke County Health
Department, clients can be referred to either the health department in
Hancock or Ohio County.
b. It is significant to note that referral is most likely not an effective option if
the entire region is affected by the same hazard event(s).
c. If clients are to be referred, the administrator should contact the
administrator of the “referred” health department to notify him/her of the
referral prior to sending clients. The purpose of such a call is as follows:
i. Describe the services that are being referred.
ii. Confirm that the referred health department can receive additional
clients.
iii. Provide an estimate of the duration of the referral.
iv. Determine if a support staff member from the Brooke County Health
Department should be sent to the receiving department to assist with
the influx of clients.
d. The administrator must also notify the administrator of the receiving
health department when referral is no longer needed.
6. Combination of Health Departments
a. In some situations, both the Brooke County Health Department and a
neighboring health department may be operating at minimum staffing
levels. In order to maintain a minimal level of service to both jurisdictions,
the two (2) departments may temporarily “combine”, thus utilizing staff
members from both departments to facilitate service delivery.
i. Such a scenario is most feasible between Brooke and Hancock
counties because the majority of the population served by both is
centralized in the Weirton area.
ii. If the Brooke and Hancock departments were to combine, the
establishment of an alternate site in the Weirton area would facilitate
the most efficient service delivery to the public in both counties.
2015
Brooke County Health Department
Continuity of Operations Plan
iii. Potential Site(s)

Millsop Community Center

Weir High School

Others, as deemed necessary and available
iv. The administrators
of both departments are responsible for
determining if a combination is appropriate.
v. Each health department is responsible for procuring its own resources
(i.e. the necessary equipment for its personnel to operate).
vi. Since equipment and supplies may be shared once operations begin,
it is necessary to develop inventory sheets so that proper resource
tracking is achieved. These sheets may be necessary should the
department attempt any cost recovery efforts post-incident.
b. Under a combination arrangement, both health departments would retain
their autonomy. Staff, however, would like be utilized as a single unit.
7. Employee Accountability
a. All employees within the Brooke County Health Department are
accountable to the administrator.
b. The administrator is ultimately responsible to the board of health.
c. Accountability During Continuity Operations
i. All employees within the health department are still accountable to the
administrator.
ii. Once an activation of this plan is implemented,
the administrator will notify all employees of
the activation of the plan.
For Tier I and Tier
II Activations, all
employees are
accountable to the
administrator.
iii. Immediately following this notification (most
likely as part of the same telephone call), the
administrator will obtain the status of the staff members within the
office, including tasks at hand and tasks planned.
iv. The administrator will coordinate planned tasks with appropriate staff
members based on which services, if any, are to be consolidated as
part of the activation.
2015
Brooke County Health Department
Continuity of Operations Plan
v. At the end of a workday during which this plan is activated, staff
members are responsible for notifying the administrator upon their
arrival at home. The administrator will keep record of these
messages. If the Brooke County Emergency Operations Center is
operational, the administrator will then notify the center of when all
employees are safe at home (including him/her).
vi. If the emergency necessitates consolidation of services and the
sending of employees home, those employees are responsible for
notifying the administrator upon their arrival at home. The
administrator will then notify the activated emergency operations
center.

During these situations, employees are to remain home until
further notice is given to return to work.

The administrator will notify employees of appropriate times to
return to work.
8. Communications
a. The Brooke County Health Department has several communications
capabilities within its office, including:
i. Telephone system with 4 lines
ii. One (1) dedicated fax line
iii. Two (2) portable radios (capable of talking to all agencies in Brooke
County)
iv. One (1) vehicle-mounted mobile radio capable of talking to all
agencies in Brooke County
v. 10 cellular phones with texting capabilities
vi. Six (6) personal pagers
vii. 10 walkie talkies with a two-mile range for clinic operations
2015
Brooke County Health Department
Continuity of Operations Plan
b. During an emergency, the primary form of communication will be by
telephone for as long as possible.
i. Communications during normal work hours will be face-to-face or by
telephone.

If telephone lines are down, interoffice communications will be
face-to-face, by cellular telephone, or by email (as long as
systems are available).

If telephones are unavailable, portable and mobile radios as well
as walkie-talkies can be used for communications.

Communications systems/methods may be changed on the
authority of the administrator depending on specific incident
circumstances. In such instances, the administrator must notify
regional health departments and the Brooke County Emergency
Operations Center. Notifications should also be made to any
regional, state, or federal resources that are involved in the
incident.
ii. After-hours communications will be by home or cellular telephone
(numbers are included on the telephone call down roster). Many
personnel will be notified by the automated telephone call-out system.
iii. Document transmittal will be by either facsimile or email, whichever is
most convenient and/or available.
c. The Brooke County Emergency Operations Center, State Emergency
Operations Center (SEOC), West Virginia Bureau for Public Health,
neighboring
health
departments,
neighboring
county
emergency
operations centers, and emergency response agencies within the county
have telephone capabilities.
2015
Brooke County Health Department
Continuity of Operations Plan
9. Reporting
a. Record-keeping guidelines for the purposes of cost recovery are
discussed in section IV.A.3. below.
b. Status Reporting
i. Periodic status reporting is important for several reasons, including
(but not limited to) tracking
operational progress, employee
accountability/safety, and resource tracking.
ii. When this plan (or other emergency operations) is activated, health
department personnel should provide a status report to the
administrator as follows:

At the start of the work day (8:30 a.m. – to report for work and
receive daily assignments)

At approximately the lunch hour (12 p.m. – to update status and
progress)

At the end of the day (4 p.m. – to update progress and sign off)

The administrator reserves the right to require more frequent
status updates and to determine the means of providing these
reports.
iii. Status reports should contain, at a minimum, the following
information.

Status of emergency operations (including progress, remaining
tasks, problems encountered, successes, etc.)

Personnel concerns (e.g. illness, fatigue, workload concerns, etc.)

Resources committed

Time and date
iv. If the county emergency operations center is activated, the
administrator should provide status reports on behalf of the health
department as requested or scheduled by the operations center
manager. If a status report has not been requested regarding routine
operations (for as long as they have not been suspended), the
administrator should report on operations at 0830, 1200, and 1600
2015
Brooke County Health Department
Continuity of Operations Plan
hours. (Such reporting is based on the assumption that relocated or
consolidated operations will maintain normal operating schedules.)
D. Lines of Succession
1. Full lines of succession are only developed for those positions that are
considered “essential” to the minimum operations of the health department
(see III.A.3. above).
2. Essential Positions
a. Administrator
i.
Karen McClain
ii. Mike Bolen
iii. Sandy Rodgers
b. Nurses
i.
Sandy Rodgers
ii. Norma Provenzano
c. Sanitarians
i.
Mike Bolen
ii. Howard Bertram
iii. Britney Hervey Farris
d. Clerical
i.
Jane Rush
ii. Billie Kins
iii. Lynn Shaw
iv. April Eltringham
e. To fill the “support” positions (to the nurse and sanitarian) identified as
essential, the next available person under the “nurse” and “sanitarian” list
above should be deployed. *NOTE: If the support role to the nurse has
not been filled with an individual on the above list (III.D.2.b.), deploy either
Ellie Evans or Joan Mitchell.
2015
Brooke County Health Department
Continuity of Operations Plan
3. If lines of succession are exhausted for the essential positions listed in
section III.A.2.d.iii. above or III.D.3. through III.D.7. below, support can be
requested from one of the other health departments in the region. As
described elsewhere in this plan, the other health departments may not have
personnel available to provide support. Under such a circumstance, the
administrator must consider service suspension.
E. Protection of Essential Records
1. The health department is tasked with the maintenance of four (4) different
categories of records including: food service files, sewage files, medical
records,
and
payroll/personnel
records.
Medical
records
and
payroll/personnel records are considered essential for minimum operations.
2. All files and records in the health department are available in both paper and
electronic formats.
3. Electronic files are backed up weekly by staff members. For those documents
created in the health department office, backups are saved to the local
server. These files are backed up to disk and then transferred to an off site
location weekly For records entered into state databases, weekly backups
are submitted on Tuesdays and saved to the state server.
4. A comprehensive list of the records and files maintained by the health
department is included as Appendix 8.
F. Recovery
1. “Recovery” refers to all processes that are necessary to restore the health
department’s operations to normal.
a. It may include the transition back to a normal operating facility, the
recovery of records from backup sources, re-deployment of personnel,
hiring new personnel, etc.
b. The recovery period may be relatively short (e.g. a matter of hours) or
extremely long (e.g. months or up to a year) depending on the situation.
For example, if operations were consolidated due to an influx of employee
illnesses but never relocated, recovery would be complete upon the
return of those employees to work. If the department relocated due to the
substantial damage or destruction of the office, recovery operations would
2015
Brooke County Health Department
Continuity of Operations Plan
extend until operations were transitioned into the “new” normal operating
location (even though operations may be proceeding, for all intents and
purposes, as normal from a long-term alternate location).
2. Emergency situations may necessitate repairs to the health department’s
facility at the courthouse. Necessary repairs (of a minor nature) will be
recorded by health department personnel during the initial recovery phase
and reported to the county maintenance department. Major repairs may be
reported to the administrator by maintenance or public works personnel. The
necessity of major repairs may force the health department to operate from
an alternate location for an extended period of time.
3. Resumption of IT capabilities is coordinated with the state.
4. If the county emergency operations center is activated, all recovery needs are
reported to the center.
IV. ADMINISTRATION AND LOGISTICS
A. Administration
1. The administrator coordinates with the local board of health to continue the
provision of medical insurance to health department employees. To the
extent possible, medical insurance will be provided for as long as personnel
work.
2. Payroll will also be maintained for as long as possible.
a. Under most circumstances, payroll will be maintained if staff is not
expected to miss more than two (2) weeks of work.
b. If staff members miss more than two (2) weeks of work, personnel may
have to use vacation time to continue to be paid for the days above ten
(10) working days.
c. The administrator will coordinate with the board of health regarding
payroll issues.
3. In general, the board of health will base their decision regarding
maintenance/suspension of payroll and medical benefits on the individual
circumstances surrounding the incident as well as state guidance.
2015
Brooke County Health Department
Continuity of Operations Plan
4. Reporting for Potential Cost Reimbursement
a. So as to request reimbursement for personnel overtime, resources
expended, etc., accurate records must be kept.
b. Reimbursement from the US Department of Homeland Security/Federal
Emergency Management Agency can only be requested if the county
government has declared a local state of emergency. Other requirements
(such as a declaration of a state “state of emergency”) may also have to
be met; however, the county declaration is the first necessary step.
c. Only resources expended as a direct result of the emergency situation
are eligible for reimbursement. Reporting must include a brief description
of the emergency tasks that affected a given resource.
d. In general terms, supplies and/or services that are needed as a result of
the emergency can be obtained from regular suppliers and vendors.
e. Cost reimbursement records should be submitted to the county
emergency manager within 30 days of the deactivation of this plan. If
another timeframe must be met, dates/times must be communicated by
either the emergency management agency director or other emergency
authorities.
B. Logistics
1. Telephone Service
a. If service must be transferred quickly, the administrator is responsible for
notifying the service provider.
b. The owner of an alternate facility may be available to assist in the
establishment of telephone service at the alternate location.
2. Internet Service
a. The internet is necessary for the maintenance of health department
operations.
b. Interruptions in internet service at the regular operating location are
reported to the state, who troubleshoots and attempts to resolve the
incident.
2015
Brooke County Health Department
Continuity of Operations Plan
c. The administrator should coordinate with the owner of a potential
alternate facility to ensure that internet access will be available for health
department employees.
d. Internet access is available at all potentially alternate facilities specifically
identified in this plan.
V. PLAN DEVELOPMENT AND MAINTENANCE
A. Updating the Document
1. This continuity of operations plan is an “operating guideline”; therefore, it is
updated continually because the information it contains is specific.
2. The plan is updated no less than annually.
3. The administrator is generally responsible for overseeing updates to this plan
as often as is necessary.
4. Revisions are provided to the agencies on this plan’s distribution list on an
annual basis by the administrator. (All revisions made during the year are
provided at one time rather than upon their completion.)
B. Training and Exercises
1. The health department conducts in-house training and practice sessions on a
monthly basis. The content of these sessions varies.
2. Due to the small staff and the amount of responsibilities that each staff
person shoulders, it is assumed that any type of emergency situation would
affect the regular operations of the department. As such, this plan would be
activated. Thus, this plan will be tested during each in-house drill.
3. During those situations, this plan would be activated as normal.
4. This plan may also be exercised within the scope of countywide or regionwide exercises. The analysis of the performance of this plan, however, may
be only done and recognized by Brooke County Health Department
personnel.
2015
Brooke County Health Department
Continuity of Operations Plan
VI. LIST OF APPENDICES
Appendix 1: Telephone Notification Tree
Appendix 2: Staff Listing
Appendix 3: Continuity of Operations Flow Charts
Appendix 4: Internet Resources
Appendix 5: Forms
Appendix 6: Minimum Supplies Necessary for Relocated Operations
Appendix 7: Glossary
Appendix 8: Records
2015