HomeMy WebLinkAboutPandemic Influenze Mortuary Guidelines Appendix M: Certificate of Receipt
State of Wisconsin - Winnebago County
Pandemic Influenza Mortuary Guidelines
Certificate of Receipt and Acceptance Agreement
These guidelines have been prepared with input and representation from the health departments within the cities of
Oshkosh, Neenah, and Menasha, and Winnebago County, along with Winnebago County Emergency Management, local
funeral homes, the coroner's office, and local hospitals. These guidelines represent the collective knowledge and expertise
of the before - mentioned organizations. These guidelines will be used during an influenza pandemic, as able, and will
provide the needed guidance for the proper processing of human remains while providing respect and dignity to the
deceased.
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Funeral Home Owner /Representative:
Owner /Representative 24 -Hour Phone Number:
Funeral Home Name:
Address:
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I have reviewed the attached guidelines and agree to all aspects thereof. I further acknowledge participating and
complying, as able, with all county, city, and state directives during an influenza pandemic.
Funeral Home Director /Owner /Representative Date
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I have reviewed these guidelines and agree to all aspects thereof. I further acknowledge implementing said guidelines, as
able, in consultation with the State of Wisconsin and local agencies and organizations.
Public Health Agency Date
Please Return To: Oshkosh Health Services Division
215 Church Avenue
PO Box 1130
Oshkosh WI 54903 -1130
XII. Plan Review and Approval
The undersigned have hereby reviewed and approved the Pandemic Influenza Mortuary
Guidelines for the Winnebago County Area. These guidelines will be incorporated into each of
the jurisdictions Emergency Operating Plans. These guidelines shall be reviewed yearly.
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Menasha Health Officer Date
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ealth Officer Date
Oshkosh Health Officer Date
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neb o County Health ffic Date
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enasha Em -rgenc . nagement Director Date
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Neenah Emergency Management Director Date
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Winnebago County Emergency Management Director Date
Winnebago County Coroner Date
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Wisconsin,Mpital Region 6 ate
Program Emergency Preparedness Coordinator
Winnebago County Area Mortuary Plan for Pandemic Influenza
Page 13 of 72
MEMORANDUM OF UNDERSTANDING
BETWEEN WINNEBAGO COUNTY PUBLIC HEALTH AGENCIES
AND
OSHKOSH CHEESE SALES AND STORAGE
This agreement is made and entered into between Oshkosh Cheese Sales and Storage (a /k/a
Oshkosh Storage Company, Inc.), 1110 Industrial Avenue, Oshkosh, Wisconsin; and the Public
Health Agencies within Winnebago County, Wisconsin.
I. PURPOSE AND SCOPE
The purpose of this Memorandum of Understanding (MOU) is to reach an understanding that will
result in making the Oshkosh Cheese Sales and Storage facility located at 1110 Industrial
Avenue, Oshkosh, Wisconsin (Parcel Number 018006401) available to Winnebago County Public
Health Agencies (WCPHA) for use as a Unified Mortuary Storage and Preparation Facility
(UMSPF) in the event of a declared Public Health Emergency (e.g. influenza pandemic).
In particular, this MOU is an agreement between the WCPHA and the Oshkosh Cheese Sales
and Storage for use of the buildings, equipment, and property located at the above address. This
single facility known as the UMSPF will be used to enhance the ability to process fatalities and
maximize available resources.
II. BACKGROUND
In the event of an influenza pandemic, the potential exists for an overwhelming number of
fatalities causing the capabilities of individual funeral homes to be exceeded, and requiring an
alternative location and method for fatality management.
III. WCPHA RESPONSIBILITIES UNDER THIS MOU
1. Cooperatively, WCPHA Directors will declare a Public Health Emergency.
2. In cooperation with the WCPHA Directors, Winnebago County Emergency Management will
contact an identified Oshkosh Cheese Sales and Storage representative and advise of the
need to open the UMSPF.
3. The WCPHA agrees that reasonable care will be used while conducting its activities in such
facility. Winnebago County further agrees to replace or reimburse Oshkosh Cheese Sales
and Storage for any custodial staff time and /or supplies that may be used in operating the
UMSPF.
IV. IT IS MUTUALLY UNDERSTOOD AND AGREED UPON BY THE PARTIES THAT
1. Either Party may terminate this agreement upon written notification.
2. Costs for mortuary services at the UMSPF will be the responsibility of the individual family
members of the deceased.
V. EFFECTIVE DATE AND SIGNATURES
This MOU shall be in effect upon the signatures of WCPHA Directors and the Oshkosh Cheese
Sales and Storage authorized official. It shall be in force from January 1, 2009, and will
automatically renew annually on December 31 unless either party gives a 30 -day notice of intent
to terminate or revise the agreement.
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SIGNATURES TO THE AGREEMENT:
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Representative, Oshkosh Cheese Sales and Storage Date
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Dir " or, ' , nebago Coun He th Department Date
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Director, City of Oshkosh ealth S ices Division Date
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Director, City of Menasha Health Department Date
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Dir tor, 1 of Neenah Department of Public Health Date
THIS IS NOT A LEGALLY BINDING CONTRACT
Winnebago County Area Mortuary Plan for Pandemic Influenza Page 19 of 72