McHenry County Department of Health

2200 North Seminary Avenue

WoodstockIL 60098

815-334-4510

Pandemic Influenza Planning – Letter of Agreement

Point of Contact: Keri Zaleski, Emergency Response Coordinator 815-334-4893.

Date agreement application due: August 1st, 2006.

In an effort to encourage pandemic influenza planning, McHenry County Department of Health is offering planning support to (insert name of school, township, or municipality)in the amount of FIVE THOUSAND DOLLARS ($5,000.00) to be paid upon the execution of this Agreement. By signing this Agreement, (insert name of school, township, or municipality)agrees to complete the tasks listed in Sections 1, 2, and 3 by January 15th, 2007. If (insert name of school, township, or municipality)fails to complete these tasks by January 15th, 2007, (insert name of school, township, or municipality)agrees to return, at the sole discretion of the McHenry County Department of Health, a portion of or the full amount of the funds its receives from the McHenry County Department of Health.

By signing this agreement, (insert name of school, township, or municipality) agrees to complete the following by January 15th, 2007:

  1. Create a pandemic flu plan specific to the needs of (insert name of school, township, or municipality).
  2. Plan will follow guidelines as set forth by McHenry County Department of Healthin the attached template.
  3. Plan will incorporate information as provided by the McHenry County Pandemic Flu Steering Committee (to be made available at a later date).
  4. Plan will address at a minimum the following topics:
  5. Family and personal preparedness
  6. Continuity plan, including:
  7. Maintaining critical services.
  8. Distance learning/working from home.
  9. Sick leave policy for employees/students.
  10. Communications.
  11. One copy of the plan will be given to McHenry County Department of Health, and one copy will be given to McHenry County Emergency Services and Disaster Agency.
  1. Create and distribute to your constituents/employees/students educational brochures and materials regarding Pandemic Flu issues, family preparedness steps; and your plan. McHenry County Department of Health will provide educational material templates to assist with this.
  1. Host a “town hall” style meeting for your constituents/employees/students. The purpose of this meeting will be to inform them of the following:
  2. Steps they can take to be prepared
  3. The outline of your plan.
  4. The role of the CountyGovernment and Health Department in a flu pandemic.
  1. This agreement shall be terminated and cancelled without penalty in the event that funding, upon which the parties are dependent, fails to be appropriated or otherwise made available.
  1. The Agreement, including all documents attached thereto or to be provided at a later date thereunder, supersedes any and all other agreements, either oral or written, between the parties hereto with respect to the subject matter hereof, and contains all of the agreements between the parties hereto with respect to the matter contained herein. Each party to this Agreement acknowledges that no representations, inducements, promises or agreements, oral or otherwise, have been made by either party which is not embodied herein, and that no other agreements, statements or promises not contained within this Agreement, documents attached thereto or documents to be provided at a later date thereunder shall be valid or binding.
  1. Each person signing below on behalf of one of the parties hereto agrees, represents and warrants that he or she has been duly and validly authorized to sign the Agreement on behalf of their party.

Funds may be used for the following purposes: reimbursement to a planning consultant; meeting expenses; meeting promotion; graphic design and/or copy writing of educational materials; printing. If you desire to use funds for a pandemic flu planning purpose other than those listed, the written agreement of the McHenry County Department of Health Administrator is required.

Failure by (insert name of school, township, or municipality) to complete the above agreement by January 15th, 2007 will result in a full or partial return of funds to McHenry County Department of Health, at their sole discretion.

Signature of Organizational LeaderDate

Signature of McHenry County Department of HealthDate