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This form is to be completed by the responsible party or parties, i.e.: Owner, Operator and or Business hosting the event. This form is mandatory for events with 51 or more attendees or for any size event that allows dancing, entertainment, cocktail hour, etc. Capacity is based on 75% of the maximum room/tent certified occupancy or the State Social Gathering limit, whichever is less.

*** As of 3/22/2021
Covid-19 testing is required for any indoor event that has 101 to 150 guests maximum at this time. Covid-19 testing is not required for Outdoor events up to 200 guests. As of April 2, 2021 Covid-19 testing will be required for outdoor events of 201 to 500 guest maximum.

A separate form must be submitted for each event to the Westchester County Health Department at least five days in advance of your event. Failure to do so may result in the issuance of a notice of hearing, fines, and or revocation of your permit to operate. Please note that submittal of this form is not an approval of the event. By submitting the document you are attesting that you have completed an updated NY Forward Safety Plan specific to your facility and In-person/Catered Events, it is on file at your facility, and you are ensuring that all of the NYS required guidance will be followed and adhered to. If you have any questions or if there are any changes to this document between now and the time of the event, please contact us at 914-813-5000.

Required fields are marked with an asterisk* and must be completed.

Event/Location Information

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Food Service Facilities, Caterers, and Event Venues must have their NY Forward Safety Plan completed and available for review


Event Organizers/Contacts/Responsible Parties

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•All guests must be required to sign in, and provide full name, date of birth, address, email and phone #'s.

•All Support Staff (Florist, Photographer, DJ, Musicians, etc.) must be required to sign in, and provide full name, date of birth, address, email and phone #'s.

•Table seating chart (if applicable) must be retained.

Who will maintain guest sign in (and table seating chart) for 28 days in the event contact tracing is required?
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Please provide contact information for the person(s) conducting the mandatory Health Screening of the Employees, Event Staff and Attendees prior to the event, and who will be reviewing/checking for proof of negative diagnostic test results for Covid-19 or proof of immunization against Covid-19 at this event.
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The information below is provided as a reminder of some of the requirements. Please refer to the NYS Forward Phase 3 "Interim Guidance For Food Services During the COVID-19 Public Health Emergency" for full explanation of requirements.
https://www.governor.ny.gov/sites/governor.ny.gov/files/atoms/files/Indoor_and_Outdoor_Food_Services_Detailed_Guidelines.pdf

COVID Testing for Attendees

To attend the event, guests must have:
   • negative PCR or NAATS COVID test 72 hours prior to event, OR
   • negative FDA authorized antigen test within 6 hours of the event, OR
   • proof of completion of vaccine series at least 14 days prior to the event
COVID positive guests MUST NOT be allowed to attend the event

COVID Testing for Employees and Event Staff

Employees and event staff include anyone who may interact with attendees and other employees or event staff. Examples are venue staff, catering staff, bartenders, entertainers, photographers/videographers, security personnel, parking attendants, floral arrangers, etc

Employees and event staff must be tested, and test negative:
   • through a diagnostic (PCR or NAATS COVID) prior to working their first event, AND
   • be tested biweekly while continuing to work events, OR
   • provide proof of completion of vaccine series at least 14 days prior to the event
COVID positive employees and event staff MUST NOT be allowed to work the event

Health Screening of Attendees, Employees and Event Staff
(Must be conducted prior to entry to Event or Workplace)

Immediately before entering the event, employees, event staff and event attendees must be screened for the following:
   • COVID-19 symptoms, such as temperature above 100.4F, cough, loss of taste and smell, shortness of breath, etc
   • Recent positive COVID-19 test results
   • Recent contact with suspected or confirmed COVID-19 positive individuals
   • Compliance with NYS travel advisory
COVID symptom positive employees and event staff MUST NOT be allowed to work or attend the event

Seating

   • Limited to maximum 10 persons per table
   • Where possible, attendees should be seated at a table or area with members of their same immediate party, household or family
   • Tables must be spaced a minimum of 6 feet (from chair back to chair back)
   • Guests may only remove face coverings when seated at a table

Food Service

   • Sit Down Service - no restrictions
   • Buffet - facility must have designated food workers at each station in order to serve food items to the guests, queue line signage and floor markings must encourage social distancing
   • Bar Service - table service or guests must take beverages back to their table for consumption
   • Table Size - no table may exceed 10 attendees

Music / Dancing

   • Live music performers and other entertainers must be separated from attendees by either 12 feet of physical space or an appropriate physical barrier
   • Dancing is allowed with the following conditions:
      • Select attendees pre-designated to the responsible party or parties may participate in ceremonial dances with members of their immediate party/household or family
      • Non-ceremonial dancing is allowed, but attendees must wear face coverings and may only dance with members of their same immediate party/household/family who are seated at their table and can only dance in clearly marked areas or zones that are assigned specifically to them and spaced, at least, six feet apart from any other dancing areas or zones, and any tables.

General Reminders

Please refer to the NYS Forward Phase 3 "Interim Guidance For Food Services During the COVID-19 Public Health Emergency" for full explanation of requirements. https://www.governor.ny.gov/sites/governor.ny.gov/files/atoms/files/Indoor_and_Outdoor_Food_Services_Detailed_Guidelines.pdf    • In the event of a COVID positive employee, event staff, vendor or attendee, responsible parties must cooperate with Westchester County contact tracing staff to trace all affected contacts
   • Employees and event staff must wear appropriate face coverings at all times
   • Venue staff, event staff and/or responsible parties must ensure that attendees are not congregating , except when seated at their assigned table
   • Venue staff, event staff and/or responsible parties must ensure that attendees properly wear face coverings when standing, and are only standing when necessary
   • Facilities must conduct regular cleaning and disinfecting, and more frequent cleaning and disinfecting of frequently touched surfaces-see NYSDOH "Interim Guidance For Cleaning and Disinfection of Public and Private Facilities for COVID-19" for detailed instructions

Responsible Party

The responsible party submitting this form must affirm below that all applicable current NYS COVID-19 Executive Orders and Guidance will be followed.
Responsible Party Information

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