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(TrineOperation’s Name COVID-19 Infectious Disease Preparedness and Response Plan ContentsSection 1: Purpose	3Section 2: Indian Gaming Regulatory Act	3Section 3: National Indian Gaming Commission Regulations	3Section 4: (Tribe) Approved Gaming Ordinance	4Section 5: (Optional)(List related Tribal Internal Controls)	4Section 6: Threats and Vulnerability	4Section 7: EPHS Committee [Insert Person / Group charged with monitoring environmental, public health and safety]	4Section 8: Risk Levels Associated to COVID-19	5Section 9: COVID-19 Operational Phases	6Section 10: Employee and Guest Health	9Section 10.1: Employee Arrival and Temperature Check Policy	9Section 10.2: Guest Health and Temperature Check Policy	10Section 11: Maintaining Healthy Environments for Guest and Employee Safety	11Section 11.1: Physical and Social Distancing Measures	11Section 11.2: Social Distancing Measures:	12Section 11.3: Back of the House Employee Considerations	12Section 12: Cleanliness Hygiene	13Section 12.1: Cage Operations:	15Section 12.2: Food Service Area Considerations	15Section 12.3: Retail	16Section 12.4: Table Games Department	17Section 12.5: Pool Area	18Section 12.6: Receiving Department	18Section 12.7: Sales & Catering	18Section 12.8: Spa	19Section 12.9: Bingo Operations	19Section 12.10: Transportation Department	20Section 12.11: Slot Department	20Section 12.12: Other Departments not already listed	21Section 13.00: Human Resources	21Section 13.1: Contact Tracing	21Section 13.2: Employee Infectious Disease Hygiene Training	23Section 13.3: Work Return Procedures for Affected Employees	23Section 14.0: Isolation Room	24

# Section 1: Purpose

[Tribal Gaming Operation / Authority] is serious about the health and safety of its employees and patrons. Consequently, we have created an Infectious Disease Preparedness and Response Plan with an emphasis on the COVID-19 pandemic. The plan supports the efforts of the [Tribal Gaming Operation / Authority] to provide a safe and healthy workplace environment. 

Infectious diseases represent a threat to both employees and patrons that could potentially result in illness, and even death. COVID-19 may be transmitted in several ways, including but not limited to the following:

· Close physical contact 

· Contaminated objects or surfaces 

· Airborne inhalation 

[Tribal Gaming Operation / Authority] policy requires sick employees to stay at home during illness to prevent the spread of diseases.  Compliance with this policy is mandatory and shall be strictly enforced.  Failure to comply may result in progressive discipline, up to and including termination.  

For employees who are unable to work due to quarantine or due to a positive test result, the [insert Operation Name] will maintain [e.g. flexible work from home, sick leave, and vacation time] policies.

This plan complies with regulations of the [e.g. Occupational Safety and Health Administration (OSHA)], National Indian Gaming Commission Environmental Health and Safety requirements and guidance and the recommended practices from the Centers for Disease Control (CDC). Compliance of the plan with certain regulations that do not apply to the [Tribal Gaming Operation/Authority] is voluntary. 

This plan is subject to modifications as directed by the [Tribal Gaming Operation / Authority]. 

# Section 2: Indian Gaming Regulatory Act 

25 U.S.C. §2710(b)(2)(E) The Chairman shall approve any tribal ordinance or resolution concerning the conduct, or regulation of class II gaming on the Indian lands within the tribe's jurisdiction if such ordinance or resolution provides that the construction and maintenance of the gaming facility, and the operation of that gaming is conducted in a manner which adequately protects the environment and the public health and safety.  

# Section 3: National Indian Gaming Commission Regulations

25 U.S.C. §559.1 - What is the scope and purpose of this part? 

(a) The purpose of this part is to ensure that each place, facility, or location where class II or III gaming will occur is located on Indian lands eligible for gaming and obtains an attestation certifying that the construction and maintenance of the gaming facility, and the operation of that gaming, is conducted in a manner that adequately protects the environment and the public health and safety, pursuant to the Indian Gaming Regulatory Act. 

(b) Each gaming place, facility, or location conducting class II or III gaming pursuant to the Indian Gaming Regulatory Act or on which a tribe intends to conduct class II or III gaming pursuant to the Indian Gaming Regulatory Act is subject to the requirements of this part. [77 FR 58772, Sept. 24, 2012, as amended at 80 FR 31994, June 5, 2015]       

# Section 4: (Tribe) Approved Gaming Ordinance

(list citation to tribal gaming ordinance and its requirements)

# Section 5: (Optional)(List related Tribal Internal Controls)

(list citation to tribal internal control and its requirements)

# Section 6: Threats and Vulnerability

Infectious diseases are illnesses caused by germs (such as bacteria, viruses, and fungi) that enter the body, multiply, and can cause an infection. If not addressed properly, employees and patrons are at risk of being exposed, and/or contracting infectious diseases as sizable groups of people gather throughout the facility in close proximity. The gaming operation has implemented proactive measures to mitigate such risks. 

Although not an exhaustive list, this Infectious Disease Preparedness and Response Plan seeks to reduce risks and assist in the prevention of spreading COVID-19 and may also be useful for controlling the spread of the following infectious diseases: 

· Influenza Viruses 

· Severe Acute Respiratory Syndrome (SARS) 

· Middle East Respiratory Syndrome (MERS) 

· Other Viral Infectious Diseases 

· Bacterial Infectious Diseases 

· Fungal Infectious Diseases         

# Section 7: EPHS Committee**[**Insert Person / Group charged with monitoring environmental, public health and safety**]**

The [Tribal Gaming Operation / Authority] has an Environment, Public and Health Safety (EPHS) Committee (Team, Group, or Individual) that is led by the [Insert Individual Title/department/position]. EPHS committee members are comprised of all department heads throughout the facility and the tribal gaming regulatory authority. 

The EPHS committee meets, at minimum, on a monthly basis to discuss all pertinent issues and incidents, review cleaning logs, employee complaints related to health and safety practices, and to develop, modify and implement safety procedures. EPHS Committee members are also required to completely review all issues related to the gaming operations’ ability to operate in a manner that protects the health and safety of employees and patrons. The EPHS Committee shall meet more frequently if warranted by local conditions to review issues such as: 

· Conduct ongoing risk assessments and recommendations for phased reopening or closure based on local conditions to the TGRA or Tribe;

· Monitor current rates of infection within the county, state and local community; 

· Review and recommend inventory levels of: 

· Personal Protective Equipment (PPE); and

· CDC recommended cleaning and sanitization supplies. 

· Review current health and safety guidance from local, state, federal, and tribal resources to appropriately develop, modify and/or implement policies and submit changes for approval to TGRA;  

· Liaise with appropriate department heads at local, county, state, federal, and tribal health officials to assist in the evaluation of current environmental, public health and safety standards;     

· Maintain meeting minutes; 

· Review inspection logs detailing areas and condition of inspected areas, and 

· Review cleaning logs from all departments to ensure compliance with EPHS standards.

# Section 8: Risk Levels Associated to COVID-19

There are multiple factors that can increase the risk of an employee or patron contracting an infectious disease such as COVID-19. Front line employees are at an increased level of risk due to more prolonged and consistent contact with patrons and other employees of the gaming operation. This risk increases as the level of occupancy increases within the facility. Current CDC guidelines[footnoteRef:2] highlight four (4) levels of risk ranging from Lowest Risk to Highest Risk: [2:  https://www.cdc.gov/coronavirus/2019-ncov/community/organizations/business-employers/casinos-gaming-operations.html] 

**Lowest Risk**

· Gaming activities are only available in virtual or online format.

**More Risk**

· Casinos are open but with limitations to allow social distancing and disinfection of machines between uses;

· Activities are limited to gaming machines and equipment that do not require a dealer and that can be played by one customer at a time and disinfected between uses;

· Individuals remain spaced at least 6 feet apart (two arms’ length) while seated or standing; and

· Sharing of gaming materials and equipment is not allowed.

**Even More Risk**

· Casinos are open but with limitations to allow social distancing;

· Games that require a dealer and that allow multiple players at the same time are offered, but the number of players is limited;

· Individuals remain spaced at least 6 feet apart while seated or standing;

· When possible, casino limits customers’ sharing of objects such as dice, card shoes, shufflers, and roulette wheels, Pai Gow tiles, pit podiums, blackjack discard holders, and toke boxes; Casino cleans and disinfects these objects between uses as much as possible; and

· When possible, casino limits sharing of items that are difficult to clean and disinfect, such as cards, and holds items for 72 hours before reuse of these items.

**Highest Risk:**

· Casino and gaming operations are open at full capacity;

· Games that require a dealer and that allow multiple players at the same time are offered;

· Individuals are not spaced apart while seated or standing; and

· Sharing of gaming materials and equipment is permitted with no restrictions.

# Section 9: COVID-19 Operational Phases

The [Tribal Gaming Operation / Authority] recognizes that social distancing is one of the primary measures to help mitigate the risk of spread of viruses such as COVID-19. As social distancing measures are eased, the risk of transmission may increase.  The health and safety of our employees and patrons is of the utmost importance to [Tribal Gaming Operation / Authority] so the operation, in conjunction with the EPHS Committee, Tribe, and TGRA, will continually assess the perceived risk. As local conditions change, the [Tribal Gaming Operation / Authority] will assess whether certain venues may need to temporarily close, reduce occupancy, or, as conditions allow, whether to increase occupancy. Those decisions will be made based on recommendations from the EPHS Committee, Tribe, Local, State, and [public health agency/official] with approval from the TGRA. 

During all Phases, the operation will have hand-sanitizing stations available for guest and employee use. Additional hand sanitizing stations (preferably touchless) will be installed throughout the facility, especially in line queuing areas such as the cage, ATMs, Ticket Redemption Kiosks, Restaurants, Players Club, and entry and exit doors. While in Phases 2, 3, and 4, the operation will post notices (electronic and/or paper) and utilize the Public Address (PA) system to communicate periodic reminders about proper social distancing policy, hand washing, coughing/sneezing etiquette, and use of hand sanitizer. 

The below diagram describes the [Tribal Gaming Operation / Authority] phases of operation. These phases are designed to help protect the health and welfare of customers and employees and are based on local conditions and assessments. Based on current conditions, the EPHS Committee, Tribe, Local, State, and [public health agency/official] with approval from the TGRA will determine which operational phase is appropriate.

The Four (4) phase approach allows the [Tribal Gaming Operation / Authority] to adjust occupancy and implement mitigation standards to promote the maximum balance of safety and operational capability. In the event that the operation needs to adjust immediately, the [Tribal Gaming Operation / Authority] will notify employees by email, phone, or text message as appropriate. Additionally, the [Tribal Gaming Operation / Authority] will notify patrons as they arrive and the operation will conduct notification of status change through emails and social media to ensure patrons are made aware of the current phase and latest information.

**Phase 1**

Under Phase One (1) the operation will operate as normal with all appropriate policies and regulatory measures in place.

**Phase 2**

Under Phase Two (2) the operation begins to implement additional mitigation measures:

· Occupancy is reduced to 50 - 75%;

· Patrons will enter through designated entrance(s) and exit through a separate designated exit; Prior to entry, patrons will be required to wear an approved face covering and must pass a temperature screening;

· Social distancing queues (such as stickers on the ground) are spaced at least 6 feet between guests throughout the casino wherever lines can typically form (Insert operation specific areas);

· Employees are required to wear approved face coverings; 

· Employee temperatures are checked and logged prior to entry; as conditions allow, employee screening will take place outside the designated employee entrance just prior to entry. If conditions do not allow outdoor screening, the screening will take place inside the employee entrance;

· Operation will place signs and play reminders on PA system requesting patrons practice social distancing (allowing 6 feet between guests), practice good hand hygiene, and wear approved face coverings consistent with guidelines issued by CDC;[footnoteRef:3] [3:  https://www.cdc.gov/coronavirus/2019-ncov/community/organizations/business-employers/casinos-gaming-operations.html ] 

· Tables Games reduces number of players to allow for social distancing;

· Acrylic dividers are installed on card games;

· Gaming Machines will remain operational with either every other machine turned off or banks restructured in a way to allow for 6 feet social distancing between players;

· See specific departments for specific increased health and safety standards;

· Operation continues to operate on a 24-hour basis with enhanced cleaning and mitigation practices consistent with current CDC guidance;[footnoteRef:4] and [4:  https://www.cdc.gov/coronavirus/2019-ncov/community/cleaning-disinfecting-decision-tool.html ] 

· Convention Center, concerts, and large gatherings of (insert # of people) or more are prohibited.

**Phase 3**

Under Phase Three (3) the operation implements all Phase Two (2) restrictions and imposes additional health and safety mitigation practices:

· Occupancy is reduced to 25-50%;

· Operational hours reduced and operation closes for (insert hours here) for enhanced cleaning and sanitization of the operation;

· Due to the increased risk environment, security personnel will perform random mid shift and end of shift temperature screens on approximately 20% of the employees currently on duty;

· Gaming Activity is limited to areas with the lowest risk such as: 

· Mobile or Kiosk based Sports Betting;

· Gaming Machines; and

· The [Tribal Gaming Operation / Authority] may permit Table Games to remain open with reduced players and use of additional mitigation measures noted in the Table Games Section below.

· Restaurants continue to operate with reduced seating capacity;

· Managers of customer facing employees shall encourage them to take short breaks on an hourly basis to wash their hands using soap and water consistent with CDC guidelines;[footnoteRef:5] and [5:  https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/prevention.html ] 

· High risk areas, including but not limited to: Buffets, Hotel Gyms, Spas, Massage Parlors, Pools, Table and Card Games, Valet, Tour Buses, Courtesy Shuttles, Paper Bingo, etc., are temporarily closed.

**Phase 4**

Phase Four (4) is the strictest of all phases. The operation implements all Phase Three (3) restrictions and imposes additional health and safety mitigation practices:

· The Tribe and TGRA may elect to close parts of the operation, most of the operation, or the entire operation;

· Only essential staff are allowed inside the building and must wear an approved face covering and are subject to a temperature check prior to entry; 

· Curbside food delivery may occur; 

· The Operation/Tribe may elect to utilize the parking lot for activities that allow for appropriate social distancing;

· Hotel may remain open with enhanced cleaning and safety procedures implemented; access to closed areas prohibited; and

· The operation may work with the TGRA to allow approval for other activities that can be conducted with enhanced safety procedures. 

The [Tribal Gaming Operation / Authority] in consultation with the EPHS Committee, and with approval from the TGRA, may offer the flexibility to close or reopen certain parts of the facility in any phase. This decision will be based on guidance from Federal, Tribal, or State Health officials, as well as guidance issued by the National Indian Gaming Commission. 

If it is determined that the operation must move to Phase 4 (or a complete closure of all activities) the following will occur prior to reopening or moving back to Phases 1-3:

· The TGRA must attest that the licensed gaming facility will operate in a manner that protects the public health and safety;

· The [Tribal Gaming Operation / Authority] will require that all employees be tested for the infectious disease causing the closure and present a negative test result immediately prior to returning to work; and  

· As the EPHS Committee monitors the current local and national pandemic conditions it may require that [Insert # or %] of employees be tested randomly for the infectious disease every two weeks until pandemic conditions abate. 

# Section 10: Employee and Guest Health 

*****Employees must conduct a self-screening prior to coming to work. If an employee has any of the commonly identified symptoms of COVID-19, they must notify their supervisor and consider seeking medical attention.

# Section 10.1: Employee Arrival and Temperature Check Policy

During Phases 2, 3 and 4, the following will apply to all employees entering the facility:

Employee/Department arrival times will be staggered to allow for greater social distancing

· All employees will be required to enter through one designated employee entrance [Insert specific entrance] and exit through [Insert specific employee exit]

· Upon entry, Security Officers will take temperatures of employees (describe method and sanitation measures) and ensure that employees wear an approved face covering.  Security Officers will maintain a log of employee names and employee numbers with temperatures below 97.5 and above 100.4 degrees.

· Any temperatures below 97.5 will require a secondary test as this is abnormal and could indicate a malfunctioning temperature-scanning device or a bad test. Operation will retest with a secondary device if continued low temperatures exist below 97 degrees.

· Those employees with a temperature over 100.4 degrees will require a secondary test. 

· It is possible that environmental conditions such as sitting in a warm vehicle or standing in line on a hot day could cause the employee's temperature to be high.

· Employees who present two immediate high temperature scans will be taken to the isolation room (See section 14) and given approximately 15 minutes to cool down. 

If the employee still presents a temperature of 100.4 degrees or more on the 3rd and final attempt, they shall be advised to seek the advice of a medical professional and prohibited from returning to work until: 

· At least 10 days have passed *since symptoms first appeared;***and**

· At least 24 hours have passed *since last*fever without the use of fever-reducing medications, **and**

· Symptoms (e.g., cough, shortness of breath) have improved[footnoteRef:6]. [6:  https://www.cdc.gov/coronavirus/2019-ncov/hcp/disposition-in-home-patients.html  ] 

· The operation recognizes that there are increased risks to employees and patrons during Phases 3 and 4. As such a [insert #] of employees will be selected at random for additional temperature checks each day just prior to lunch or at the end of their shift before clocking out. These temperature check requirements are in addition to those listed above. All other associated temperature screening procedures will apply to the additional checks in this section; 

· Team or Department meetings will be held in areas that allow for the recommended social distancing or be conducted virtually;

· Prior to clocking in employees will certify that they do not have any new or recent onset of symptoms that are consistent with the following CDC listed common symptoms] for COVID-19[footnoteRef:7]: [7: https://www.cdc.gov/coronavirus/2019-ncov/symptoms-testing/symptoms.html] 

•	Fever or feeling feverish (chills, sweating)

•	New cough

•	Difficulty breathing

•	Sore throat

•	Muscle aches or body aches

•	Vomiting or diarrhea

•	New loss of taste or smell

# Section 10.2: Guest Health and Temperature Check Policy

The following will apply during Phases 2, 3, and if allowed Phase 4:

· All patrons will enter the facility through [Insert specific limited number of Doors]; 

· Security will coordinate patron entry numbers to ensure maximum occupancy numbers are not exceeded;  

· Patrons will be required to wear a protective face mask or cloth face covering before entering the facility;

· Patron temperature checks will be required. Attention given to those temperatures below 97.5 and above 100.4 degrees;

· Any temperatures below 97.5 will require a secondary test as this is abnormal and could indicate a malfunctioning temperature scanning device or a bad test;

· Those patrons with a temperature over 100.4 degrees or higher will require a secondary test 

· It is possible that environmental conditions such a sitting a in a warm vehicle or standing in line on a hot day could cause the employee's temperature to be high. 

· Patrons who present two immediate high temperature scans should be taken to a cool room and given approximately 15 minutes to cool down. The cool down period should take place in an isolation room with social distancing measures in place. After each use, the isolation room shall be thoroughly cleansed with practices that are consistent with CDC guidance[footnoteRef:8]. [8:  https://www.cdc.gov/coronavirus/2019-ncov/community/disinfecting-building-facility.html  ] 

· If the patron presents a temperature of 100.4 degrees or more on the 3rd and final attempt, they shall be denied entry and advised to seek the advice of a medical professional and not return until:

·  At least 10 days have passed *since symptoms first appeared,***and**

· At least 24 hours have passed *since last*fever without the use of fever-reducing medications, **and**

· Symptoms (e.g., cough, shortness of breath) have improved; and 

· Only those patrons with a temperature below 100.4 degrees will be allowed entry to the operation. 

# Section 11: Maintaining Healthy Environments for Guest and Employee Safety

# Section 11.1: Physical and Social Distancing Measures

In an attempt to mitigate the risk of spread of infectious disease, the operation has implemented many protective measures.  These measures are designed utilizing industry advice from the CDC[footnoteRef:9] and the National Indian Gaming Commission[footnoteRef:10] and [insert applicable public health agency].  Social Distancing and face covering protocols are primary methods for mitigating that risk and taking proactive measures to protect staff and guests, and includes the installation of physical barriers, such as clear plastic sneeze guards at all cashier stations. The [Tribal Gaming Operation / Authority] will install clear plastic barriers throughout the operation at the following areas:  [9:  https://www.cdc.gov/coronavirus/2019-ncov/community/organizations/business-employers/casinos-gaming-operations.html ]  [10:  https://www.nigc.gov/commission/nigc-guidance-regarding-covid-19 ] 

· At all cashier stations including but not limited to gaming cashier areas & all cashier stations in all respective outlets 

· Hotel Front Desk 

· Players Club 

· Gift Shop 

· Security Check Points 

· Human Resources Reception Desk 

· Table / Card Games 

· Between Slot / Video Gaming Machines and Devices 

· Between dealers and each patron at card and table games

# Section 11.2: Social Distancing Measures:

Throughout the facility we will meet or exceed federal, tribal, state and local health authority guidelines on proper physical distancing.

· Queuing 

· Hotel Front Desk, Business Center and Concierge. Employees will utilize every other workstation to ensure separation between employees whenever possible. In all areas where lines typically form, the [Tribal Gaming Facility / Authority] will place 6 feet social distancing markers on the floor to indicate where patrons should wait; and

· Restaurants and Bars. Restaurants and bars will reduce seating capacities and/or reconfigure seating to allow for a minimum of 6 feet between each seated group/party of patrons.

· Slot Operations 

· The [Tribal Gaming Facility / Authority] will turn off Slot machines or reconfigure banks and remove chairs to allow for physical separation between patrons. Casino Supervisors and managers will ensure that patrons do not congregate around slots.

· Table Games Operations

· Table games will have chairs removed and every other table will be open. The [Tribal Gaming Facility / Authority] will place acrylic dividers between all patrons and dealers. Casino Supervisors and managers will ensure that patrons do not congregate in groups. 

# Section 11.3: Back of the House Employee Considerations

The facility has created signage that will be placed throughout the facility that encourages proper respiratory hygiene relating to coughing and sneezing to reduce droplet exposure. 

The proper etiquette for coughing and sneezing is as follows: 

· Please turn away from others when you feel the need to cough or sneeze; 

· Ensure that you cover your mouth by coughing into your elbow or disposable tissue – NOT YOUR HAND(S); and 

· Immediately dispose of any used tissue; and wash your hands with soap and water for a minimum of twenty (20) seconds and/or use alcohol-based sanitizers.

# Section 12: Cleanliness Hygiene 

The entertainment provided at our establishment is touch intensive, and as a result, our patrons will be encouraged through posted signage to practice good hygiene. The [Tribal Gaming Operation / Authority] will place disinfectant wipes throughout the operation so that each patron will have the opportunity to clean the video machine prior to use or clean any other touch based equipment utilized.  This practice will not replace the daily periodic cleaning of video machines and other equipment performed by the sanitation department of the [Tribal Gaming Operation / Authority]. 

The sanitation department has updated their cleaning methodology to include the use of electrostatic sprayers, which will contain a high-grade disinfectant that will be sprayed on all frequent touch surfaces during designated intervals. It should be noted that this method will be used in addition to traditional cleaning methods. 

Additionally, the sanitation department has expanded their cleaning scope to include more frequent cleanings of public and employee area touchpoints in addition to their routine daily cleaning schedule. The sanitation department shall increase trash pick-up which will include wiping down receptacles. 

The sanitation department is responsible for cleaning, disinfecting, and sanitizing the facility on a daily basis during regular routine scheduled intervals. The sanitation department utilizes chemical disinfectant(s) that are Environmental Protection Agency (EPA)[footnoteRef:11] approved to protect against emerging viral pathogens.  [11:  https://www.epa.gov/pesticide-registration/list-n-disinfectants-use-against-sars-cov-2-covid-19 ] 

The sanitation department will continue to routinely clean and sanitize guest rooms utilizing the deep cleaning method on items that are frequently touched which includes but is not limited to: room keys, room locks, television remotes, alarm clocks, toilet handles and seats, light switches, temperature control panels, and the like. Vending machines, ice machines, valet trolleys, and wheelchairs will be routinely sanitized.

The sanitation department will continue to launder based on best practice recommendations from the Centers for Disease Control and Prevention which include using the proper water temperature, and EPA approved detergents and disinfectants. If conditions warrant, guest linens will be delivered and removed in single use sealed bags.

While operating under Phase 3, the operation will be closed for [insert number of hours or time open] deep cleaning. During the deep cleaning process all previously listed sanitation procedures will be conducted. The cleaning process will be complete and thorough by utilizing cleaners approved by the EPA[footnoteRef:12] as effective against the respective infectious disease. The sanitation department shift supervisor will maintain and update a log on an hourly basis of all areas the sanitation department has cleaned and sanitized.  The logs will be maintained in a file and available for review by the EPHS Committee, TGRA, and Casino Compliance Departments.  [12:  https://www.epa.gov/pesticide-registration/list-n-disinfectants-use-against-sars-cov-2-covid-19 ] 

In the event that a hotel room is determined to have been utilized by a patron with a presumptive or confirmed case of COVID-19, or any other infectious disease, the room will be placed temporarily out of service until a deep cleaning is conducted. 

In the event the operation identifies an area visited by a patron with a presumptive or confirmed case of COVID-19, Sanitation Management must immediately close off the area to the public and ensure that the area is deep cleaned. CDC guidance indicates that the area should be kept unoccupied for at least 24 hours prior to cleaning. If it is not possible to close the area for that length of time, Sanitation Management should wait as long as possible prior to cleaning.   

In addition to the cleaning provided by the Sanitation Management, department heads in every department will be responsible to ensure that their respective areas are cleaned frequently. Each department head will be responsible for ensuring that their work areas are frequently cleaned, especially public areas` and employee areas including but not limited to treasury cages, hotel front desk, banquet rooms, work stations and desk areas. These areas should be cleaned at least every two (2) hours. 

The sanitation department will continue to routinely clean the gaming floor area, including: slot machine / video machine touchpoints such as buttons and levers, video machine surfaces and screens, kiosk machines, ATM machines, and the like. 

In accordance with CDC guidance, the operation will utilize high efficiency air filters[footnoteRef:13] and run the air exchange systems at maximum capacity. Air filters should be changed with the highest recommended frequency and all filter changes should maintained on a log sheet and available for review by the TGRA, EPHS Committee, and Casino Compliance Staff. [13:  https://www.cdc.gov/coronavirus/2019-ncov/community/organizations/business-employers/casinos-gaming-operations.html ] 

# Section 12.1: Cage Operations:

· Acrylic dividers will be installed at every cage window;

· Only every other cage window will be open to help ensure recommended social distancing between employees;

· The floor in front of the cages will be clearly marked in a manner to create social distancing

· The work area will be cleaned and disinfected at least hourly;

· Electronic Key box will be cleaned and disinfected by cage staff and cage staff will assist in cleaning and disinfecting the mantrap area; 

· Shared equipment in the cage will be cleaned and sanitized both before and after each use;

· All cleaning activities in the cage will be logged and the log made available to the TGRA, EPHS Committee, and the casino compliance department upon request; 

· When exiting the cage for breaks or end of shift, cage personnel will follow safety protocols regarding removal of gloves. Gloves will be placed in the trash bin inside the mantrap; Employees will also briefly lower and tilt the face covering in view of the surveillance camera. Employees are to utilize hand sanitizer before and after touching the face covering;[footnoteRef:14] and  [14:  https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/how-to-wear-cloth-face-coverings.html  ] 

· No hand-to-hand exchanges of cash or cheques; guests and cashier should place exchanges on the counter. 

# Section 12.2: Food Service Area Considerations 

Best practices and procedures include but are not limited to[footnoteRef:15]:  [15:  https://www.fda.gov/food/food-safety-during-emergencies/food-safety-and-coronavirus-disease-2019-covid-19] 

· All Food & Beverage personnel must wear gloves and approved face coverings when preparing, serving or handling food; 

· Food & Beverage personnel must adhere to proper and frequent handwashing procedures; 

· Food & Beverage personnel routinely clean all surfaces and areas with an EPA[footnoteRef:16] approved sanitizer & chemical disinfectant to protect against emerging viral pathogens (cleaning schedule/log will be maintained)  [16:  https://www.epa.gov/pesticide-registration/list-n-disinfectants-use-against-sars-cov-2-covid-19 ] 

Food & Beverage personnel must clean and sanitize all cooking utensils prior to use and supplementary best practices and procedures will include but are not limited to: 

· Food & Beverage personnel will be spread out, in an attempt to socially distance, as much as possible; 

· Food & Beverage personnel will routinely sanitize frequent touchpoints such as doorknobs, backs of chairs, faucet handles, tabletops, trays, and condiment serving stations (cleaning schedule will be maintained); 

· Food & Beverage personnel will change utensils used in self-serve condiments areas (schedule will be maintained); 

· Food & Beverage personnel will serve patrons in areas that were previously designated as self-serve areas; 

· Indoor dining service areas will be restructured to place table seating at least six (6) feet apart when functioning under Phase 2, 3, and 4; 

· Under Phase 3 conditions, buffet food areas will be suspended and patrons will be directed to other food & beverage outlets for service; 

· It should be noted that the best practices outlined in this section will not replace the cleaning services provided by the sanitation department, these procedures will be implemented in addition to the cleaning services provided by the sanitation department; 

· Sneeze guards are to be installed in all food areas that were previously designated as self-serve to aid in the prevention of food contamination; 

· Disposable or one time use menus will be utilized;

· POS terminals to be assigned to a single server where possible and sanitized between each user, before, and after each shift. If multiple servers are assigned to a POS terminal, servers will sanitize their hands after each use; and 

· Kitchens to be deep cleaned and sanitized at least once per day.

# Section 12.3: Retail 

Every retail outlet will comply with the appropriate Phase policies and procedures for casino patrons and employees. When the operation is at Phase 3 or 4 (or as directed by the [Insert]), the Gift Shop may be closed until it is deemed that the department can safely operate and adhere to all recommendations made by government authorities and the Centers for Disease Control and Prevention.

In the event that the Gift Shop remains open while functioning under Phase 4 conditions only one (1) patron will be allowed in the store at a time. 

When functioning under Phases 1-3, the Gift Shop and other retail outlets will utilize the given maximum occupancy percent listed for the appropriate Phase. 

Gift Shop personnel are responsible for ensuring that the gift shop is routinely cleaned and disinfected. In all cases, frequently touched surfaces should be cleaned using the manufacturer’s recommended cleaning instructions. If no instructions are available, the retail outlet will utilize alcohol-based wipes or spray containing at least 70% alcohol to disinfect machine buttons and touch screens. Other frequently touched surfaces to be cleaned, include but are not limited to: counters, credit card machines, writing instruments, gift shop entrance door handles, cash register buttons, calculators, etc. 

The cleaning conducted by gift shop personnel does not replace the regularly scheduled cleaning intervals that are conducted by the sanitation department. All cleaning should be completed on an hourly basis and logs should be maintained for review by the TGRA, EPHS Committee, and Casino Compliance Officers.

# Section 12.4: Table Games Department 

When the operation is moved to Phase 3 or 4, all Table Games may be closed for the Health and Safety of our patron and employees. While the TGRA will review a recommendation, based on local assessments of current conditions by the EPHS Committee, the ultimate approval must come from the TGRA for the Table Games Department to remain open during periods of higher risk. 

When functioning under Phases 2 or 3, the operation will utilize all available recommendations or guidance from the CDC and the National Indian Gaming Commission. These recommendations include social distancing and increased Cleaning and Sanitization measures. 

**A**.  **Social Distancing:**

Current Guidance indicates that social distancing has shown to be one of the most effective ways to prevent the spread of many infectious diseases including COVID 19; therefore, the operation will take the following steps to increase social distancing within the Table Games Pit:

· Reduce table occupancy; 

· Restructure the pit to allow for greater distance between tables;

· Install acrylic dividers between individual patrons and dealers;

· Alternate player stations: (i.e. Table 1 may have First base, Short Stop, and Third Base and Table 2 may have Position Two and Four or Three and Five.);

· Consider which games can have no touch "Face Up" cards;

· Dealers will no longer physically "tap" in when relieving a dealer, the new employee will verbally announce they are ready to swap; and

· Casino Supervisors and managers will ensure that patrons do not congregate in groups.

**B.  Cleaning and Sanitization:**

Social Distancing may be difficult to accomplish for the Table Games Department. This makes the policy considerations for cleaning and sanitization all the more important. CDC guidance indicates that wearing of approved face coverings, use of hand sanitizer, and hand washing are effective ways to help diminish the spread of the COVID-19. Some recommended mitigation techniques for consideration include:

· Ensure patrons and employees are utilizing approved face coverings;

· Have patrons use hand sanitizer prior to beginning play and periodically thereafter;

· After patrons leave the table, ensure that spot is cleaned and sanitized;

· Utilize EPA List N disinfectants[footnoteRef:17] to periodically sanitize cheques; [17:  https://www.epa.gov/pesticide-registration/list-n-disinfectants-use-against-sars-cov-2-covid-19 ] 

· Whenever possible, use a chip mucker to gather lost chips and sanitize prior to reuse;

· Assign additional pit personnel to sanitize hard surfaces including table rail, discard rack, drop box, balls, wheels, dice, sticks, automatic shufflers, Pai Gow Tiles, toke boxes and other high touch surfaces as appropriate; 

· Consider decreasing staff table time to allow for more frequent breaks;

· Use multiple decks of cards and switch decks out with greater frequency; new decks should implemented after 30-60 minutes of play; and  

· Store cards and equipment that is not easily cleaned and disinfected for 72 hours prior to reuse as CDC guidance recommends. When canceling cards and dice, operators and regulators should review existing policies to determine if revisions need to be made to allow for 72-hour storage. If 72-hour holds are not possible ensure staff examining/canceling cards have proper Personal Protective Equipment. 

On a daily basis, at scheduled intervals, the Table Games Department is responsible for ensuring that all pits and poker rooms are routinely disinfected, including but not limited to: tables, table game rails, chairs, card shoes, pit podiums, and drop box slots. The frequently touched items utilized by the dealers must be cleaned and disinfected prior to a new dealer coming into contact with such items. 

Additionally, plastic playing cards and chips will be routinely exchanged as well as cleaned, disinfected, and oiled. The chips or cheques will be cleaned using an EPA[footnoteRef:18] approved cleaning detergent and oiled with mineral oil as recommended by the manufacturer.  [18:  https://www.epa.gov/pesticide-registration/list-n-disinfectants-use-against-sars-cov-2-covid-19 ] 

The cleaning conducted by table games personnel does not replace the regularly scheduled cleaning intervals that are conducted by the sanitation department. Pit Personnel shall maintain a cleaning log indicating all activities within the pit and/or Poker room and made available to TGRA, EPHS Committee, and casino compliance staff for review. 

# Section 12.5: Pool Area 

When functioning under Phase 3 or Phase 4, the pool area may be subject to closure consistent with CDC Guidance[footnoteRef:19]. During Phase 2, the pool area can be transformed into a designated place for smoking and eating.  All seating will be placed six (6) feet in distance from each other to adhere to all recommendations made by government authorities and the Centers for the Disease Control and Prevention in regards to social distancing.  [19:  https://www.cdc.gov/coronavirus/2019-ncov/community/parks-rec/aquatic-venues.html ] 

# Section 12.6: Receiving Department 

Effective immediately, under Phases 2, 3, and 4 and/or as directed by [Operation Name], all vendors making deliveries to the operation are required to pass through a temperature check station and wear an approved face covering, if exiting their delivery vehicle. If vendors remain inside their vehicle and only need to have conversations with staff, they are required to wear an approved face covering while on the premises. 

# Section 12.7: Sales & Catering 

When functioning under Phases 2, 3, 4 and/or as directed by the [Operation Name], events held in the banquet rooms may be discontinued until such a time it is deemed that the department can safely operate and adhere to all recommendations made by government authorities, including the National Indian Gaming Commission and the Centers for Disease Control and Prevention. 

When banquet events are in operation, it is the responsibility of Sales & Catering Management to ensure compliance with social distancing and employee/guest safety recommendations outlined by this plan, the CDC, and other applicable government authorities.

At all times, Sales & Catering Management personnel are responsible for ensuring that the banquet rooms are routinely cleaned and disinfected including but not limited to: tables, chairs, doors, door handles, dishes, writing utensils, and etc. 

The cleaning conducted by banquet personnel does not replace the regularly scheduled cleaning intervals that are conducted by the sanitation department. If specific events are allowed, the event staff are required to keep and maintain a cleaning log detailing all cleaning and sanitization efforts. This log shall be made available for inspection by the TGRA, EPHS Committee, and casino compliance staff.

# Section 12.8: Spa 

When functioning under Phases 2, 3, and 4 or as directed by the [Operation Name], the Spa may be closed until it is deemed that the department can safely operate and adhere to all recommendations made by government authorities, including but not limited to the Centers for Disease Control and Prevention. 

It is the responsibility of Spa Management to ensure that social distancing and procedural recommendations outlined by the government authorities and the Centers for Disease Control and Prevention are adhered to when the Spa is in operation. 

At all times Spa Management personnel is responsible for ensuring that the Spa area is routinely cleaned and disinfected, including but not limited to: tables, chairs, doors, door handles, dressing rooms, spa equipment and etc. A log of all cleaning and sanitization efforts made by staff will be maintained and available to the TGRA, EPHS Committee, and the casino compliance staff upon request.

The cleaning conducted by spa personnel does not replace the regularly scheduled cleaning intervals that are conducted by the sanitation department. 

# Section 12.9: Bingo Operations 

When functioning under Phases 3 and 4 or as directed by the [Operation Name], traditional (manual/paper) bingo operations may be designated as closed until such a time it is deemed that the department can safely operate and adhere to all recommendations made by government authorities, including but not limited to the National Indian Gaming Commission and the Centers for Disease Control and Prevention. 

When functioning under Phase 2 or as directed by the [Tribal Gaming Operation / Authority], the chairs within the bingo area will be rearranged to comply with social distancing guidelines. All staff are to follow all safety guidelines in this plan, including, but not limited to social distancing and wearing an approved face covering.  

When in operation, Bingo Management is responsible for ensuring that the bingo area and equipment is routinely cleaned and disinfected, including, but not limited to, tables, chairs, electronic handhelds, bingo windows, bingo window countertops, bingo caller area, and etc. Additionally, frequently touched items utilized by bingo personnel must be cleaned and disinfected, including, but not limited to, writing utensils, computer keyboards, computer mouse, staplers, cash register buttons, calculators, etc. 

The cleaning conducted by bingo personnel does not replace the regularly scheduled cleaning intervals that the sanitation department performs. The sanitation department will maintain a log of all cleaning and sanitization activities in this area and have it readily available to the TGRA, EPHS Committee, and the Casino Compliance Department upon request. 

# Section 12.10: Transportation Department 

When functioning under Phase 2, 3, or 4, or as directed by the [Operation Name],Valet Services may be temporarily suspended until such a time it is deemed that the services can be provided safely by adhering to all recommendations made by government authorities and the Centers for Disease Control and Prevention. 

Effective immediately, it is the established process that transportation personnel will clean and sanitize each respective vehicle in accordance with CDC recommended standards[footnoteRef:20] after use regardless of designated condition level assigned.  [20:  https://www.cdc.gov/coronavirus/2019-ncov/community/organizations/business-employers/casinos-gaming-operations.html ] 

# Section 12.11: Slot Department 

When functioning under Phases 2, 3, 4, or as directed by the [Operation Name], the Slot Department must adhere to all recommendations made by government authorities, including but not limited to the National Indian Gaming Commission and the Centers for Disease Control and Prevention. 

Upon receiving a scheduled date to reopen, Management must establish a baseline of the machine floor layout plan taking into consideration current social distancing requirements. The slot department may wish to alter existing machine bank layouts to increase the ability of patrons to socially distance themselves from one another. In cases where it is impractical to move machine banks, the operation will create appropriate social distancing by turning off every two (2) slot video machines between every one (1) video machine turned on, and the chairs will be removed from each video machine that is turned off to ensure compliance with the six (6) feet social distancing recommendation. The operation may also add acrylic dividers as hard barriers between the machines. This will allow the operation to turn on additional machines. Consideration should be given to slot technicians requesting a patron move to a safe distance prior to working on a machine. 

At all times, Management is responsible for ensuring that the video work area(s) are routinely cleaned and disinfected, including frequently touched areas such as: acrylic dividers, ticket redemption stations, podiums, video stations on the gaming floor, all shared equipment such as radios, telephones, computer equipment, frequently used and shared objects such as writing instruments, staplers, etc. Additional safety considerations are given to jackpot payouts by utilizing a cart to place the cash on so as not to be handing cash back and forth.

All cleaning conducted by slot video personnel shall not replace the regularly scheduled cleaning intervals that are conducted by the sanitation department. The Slot Floor Supervisor shall maintain a cleaning log that indicates when they have cleaned and sanitized slot specific equipment. This log will be made available to staff from the TGRA, EPHS Committee, and Casino Compliance Department. 

# Section 12.12: Other Departments not already listed 

For all departments not specifically listed, the following procedures are in place:

· All employees are encouraged to maintain a 6 feet distance from other staff and guests. 

· All staff should wear an approved face mask if they share an office or are moving somewhere outside of their private office(s).

· Use of shared equipment is discouraged. If possible, supervisors should assign individual pieces of equipment to employees. If not possible, all shared equipment should be cleaned and sanitized before and after use by both employees. 

· All equipment should be cleaned and sanitized following the manufacturer's instructions. If no specific instructions are available, utilize alcohol-based wipes or spray containing at least 70% alcohol to disinfect machine buttons and touch screens. Dry surfaces thoroughly to avoid pooling of liquids;

· If workstations are guest facing, they must be cleaned and sanitized at least hourly and as often as feasible between uses. 

# Section 13.00: Human Resources

All employees shall have the responsibility of reporting any confirmation or contact of highly contagious infectious diseases to Human Resource personnel [add time frame within 24 hours from first notification]. Failure to comply will result in disciplinary action up to and including termination.

It is the responsibility of Human Resources as well as the applicable department head to take appropriate action to protect employees who may have come in contact with the affected employee. Human Resources personnel will have the responsibility of notifying fellow employees of their possible exposure, however, confidentiality must be maintained regarding the affected employee.

In the event that a confirmed case of a highly infectious disease is reported to Human Resources, Human Resources will notify the appropriate department head while maintaining confidentiality to ensure that the area in which the affected employee frequented is thoroughly cleaned according to the plan.   

# Section 13.1: Contact Tracing

Contact tracing is the process of identifying individual(s) that may have come into contact with an infected person. A close contact is someone who was within six (6) feet of an infected person for at least fifteen (15) minutes starting from forty-eight (48) hours before illness onset until the patient is isolated. These persons are at risk for becoming infected with COVID-19 and contacts should self-monitor for fourteen (14) days (the maximum incubation period) from the last date they had exposure to the confirmed case and cannot return to work until employee provides valid testing results confirming a negative diagnosis, and a health care professional provides a medical clearance. COVID-19 and contacts should self-monitor for fourteen (14) days (the maximum incubation period) from the last date they had exposure to the confirmed case and cannot return to work until employee provides valid testing results confirming a negative diagnosis, and a health care professional provides a medical clearance.

Timely and thorough contact tracing can effectively interrupt the chain of disease transmission and is an important intervention to contain an outbreak. The following persons are subject to contact tracing: 1) persons exhibiting symptoms consistent with COVID-19, which are considered presumptive confirmed cases; 2) persons with confirmed positive cases; and 3) persons that may have encountered an infected person. 

This contact tracing protocol applies to all employees and is meant to trace those employees that have come into close contact with an employee that has been diagnosed with COVID-19. The goals of this protocol are to:

· Rapidly identify all potential contacts;

· Ensure immediate isolation precautions are taken; and

· Minimize spread to other employees and customers..

The [Tribal Gaming Operation / Authority] will direct employees that are feeling ill and feel that they are displaying some of the symptoms associated with COVID-19 to inform their department manager and Human Resources. The employee will be directed to stay home and monitor their symptoms.

The [Tribal Gaming Operation / Authority] will utilize all available resources for contact tracing of employees and patrons, including Surveillance and Players Club tracking information. [consult with legal counsel for the appropriate handling of HIPAA and other privacy laws].

The designated [insert department/position/title] will consult with local public health officials on local procedures for contact tracing.  

When an employee is confirmed positive for COVID-19, the following steps shall be taken:

· The employee will contact HR and inform it of the positive test for COVID-19;

· HR will work with the COVID-19 positive employee to recall every employee with whom he/she have had close contact during the timeframe they may have been infected (defined as the date the COVID-19 positive employee developed symptoms to the time the employee stopped reporting to work). To facilitate this process, HR will work with various casino departments including, but not limited to, security, surveillance, player’s club to assist with tracing;

· HR will take measures to notify employees that they came into close contact with an employee who tested positive and inform them of their potential exposure as rapidly and sensitively as possible and adhere to the following:

· Notice will only be provided to those who had close contact with the positive employee during the timeframe they may have been infected;

· To protect patient privacy, contacts are only informed of exposure with a positive employee whose identity will not be revealed;

· Employees will be provided with information to understand their risk and potential risk to others by spreading COVID-19 even if they do not feel ill and that they are required to self-isolate until they have not expressed any symptoms and complete the self-monitoring process or test negative for COVID-19;

· Employees will be instructed how to self-monitor for symptoms including checking their temperature twice daily, monitoring for cough or shortness of breath and any other COVID-19 related symptoms for fourteen (14) days from the date of last contact with the positive COVID-19 employee; and

· Employees will be informed to contact a physician if they express any symptoms of COVID-19.

· HR will check-in with employees to make sure they are self-monitoring and have not developed symptoms.

# Section 13.2: Employee Infectious Disease Hygiene Training

The [Tribal Gaming Operation / Authority] will require each employee to attend infectious disease hygiene training. The HR department will provide the training and the training will include, but not be limited to the following topics:

· Proper etiquette for social distancing relating to patrons and co-workers;

· Responsibility for routine cleaning of personal work environment (In addition to cleaning provided by the sanitation department);

· Office personnel and persons that work on the floor should be aware that surfaces, equipment, telephones, frequently used and shared objects such as writing instruments, staplers, etc. must be routinely cleaned and disinfected;

· Respiratory Hygiene including proper process for hand washing;

· Identification of ill patron/employees and action required;

· How to self-monitor for viral infectious diseases such as COVID-19, Influenza A, etc;

· Appropriate use of personal protective equipment; and how to properly dispose of personal protective equipment; and 

· Provide training to Food &Beverage personnel regarding infectious disease prevention recommendations.

The HR department shall require each employee to attest by signature that training was completed, and the HR department shall maintain such documentation.

# Section 13.3: Work Return Procedures for Affected Employees

Any employee found to have COVID-19 symptoms, is considered a presumptive confirmed COVID-19 case, or has a confirmed case of COVID-19, will be provided with paperwork that outlines CDC recommendations on steps sick employees can take to prevent the spread of COVID-19[footnoteRef:21], when they can discontinue home isolation[footnoteRef:22]and contact information for the Human Resources Department to assist them with any other additional work related documentation they may need.  Employees are highly encouraged to seek medical guidance as needed throughout the isolation period and prior to returning to work.   [21:  https://www.cdc.gov/coronavirus/2019-ncov/if-you-are-sick/steps-when-sick.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fcoronavirus%2F2019-ncov%2Fabout%2Fsteps-when-sick.html ]  [22:  https://www.cdc.gov/coronavirus/2019-ncov/hcp/disposition-in-home-patients.html ] 

Once the employee is scheduled to return to work the following requirements must be adhered to for the next fourteen (14) days subsequent of their return:

· The employee must have their temperature checked on a daily basis prior to being allowed within the premises; and

· The employee must wear a mask throughout the duration of their scheduled work shift.

# Section 14.0: Isolation Room

As noted in the Employee and Patron screening sections the operation has created an isolation room.  The isolation room shall only be utilized as a cool off room to give patrons and employees time to cool off if it is suspected that environmental conditions may have contributed to a high temperature reading. In addition, in the event that employees encounter a patron or another employee who is exhibiting symptoms of a viral infectious disease similar to those of COVID-19, and the patron/employee is unable to depart the operation on their own, the [Tribal Gaming Operation / Authority] has designated an isolation room to be used until such time when the person can safely depart from the premises.

Every attempt to ensure the room is sufficiently ventilated will be made. Whenever possible, windows shall be opened and the HVAC exchange system shall be operated at its maximum capabilities for the room. 

Access to the isolation room will be limited to Security Management (dressed in appropriate personal protective equipment) and Emergency Responder personnel. Security Management will notify Emergency Responder personnel that personnel protective equipment is required for such emergencies.

Sanitation personnel will routinely clean all surfaces and areas with an EPA[footnoteRef:23] approved sanitizer & chemical disinfectant to protect against emerging viral pathogens (cleaning schedule/log will be maintained):  [23:  https://www.epa.gov/pesticide-registration/list-n-disinfectants-use-against-sars-cov-2-covid-19 ] 

· The symptoms for COVID-19, as outlined by the Centers for Disease Control, include but are not limited to[footnoteRef:24]: [24:  https://www.cdc.gov/coronavirus/2019-ncov/symptoms-testing/symptoms.html ] 

· Fever or chills

· Cough

· Shortness of breath or difficulty breathing

· Fatigue

· Muscle or body aches

· Headache

· New loss of taste or smell

· Sore throat

· Congestion or runny nose

· Nausea or vomiting

· Diarrhea

Or at least two of the symptoms noted below:

· Fever equal to or greater than 100.0 ̊ F;

· Chills; or

· Repeated shaking with chills, muscle pain, headache, sore throat.

The emergency warning signs that require immediate medical attention relating to COVID-19 include but are not limited to:

· Trouble breathing;

· Persistent pain or pressure in the chest;

· New confusion;

· Bluish lips or face; or

· Inability to wake or stay awake.

End of Document

* This is a model infectious disease preparedness and response plan provided by the National Indian Gaming Commission, with a focus on COVID-19 and the gaming operation environment. It is meant to be used as a starting point for to assist tribes, their gaming operations, and their tribal gaming regulatory authorities in developing their own infectious disease response plan in collaboration with health and safety experts. This model plan was developed based on currently known and accepted best practices for COVID-19. However, given the novel nature of COVID-19, this plan may need to evolve as new information is learned about COVID-19 and other infectious diseases. Other resources such as the Center for Disease Control and Indian Health Services should be utilized to supplement and updated the plan.   

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