ORANGE COUNTY DEPARTMENT OF HEALTH
COVID-19 Large Gathering Event Notification Form
 
Please complete and submit the following form for each event you are requesting approval for. You will be contacted by the Orange County Department of Health to set up an inspection date and time. Thank you.
 
 
*Event Name
 
*Date of Event
 
*Days of Event
 
*Start Time of Event
 
*End Time of Event
 
*Event Location/Facility Name
 
*Room or Area Name/Description
 
*Room Listed Capacity (at 100%)
 
*Room Listed Capacity (at 50%)
 
*Event Location Additional Details
 
*Location Address
 
*Location City/Town
 
*Location State
 
*Location ZIP/Postal Code
 
*Location Contact First Name
 
*Location Contact Last Name
 
*Location Contact Telephone
 
*Location Contact Email
 
**Food Service Facilities must have NY Forward Safety Plan completed and available for review**
Event Organizers/Contacts/Responsible Parties
 
*First Name of 1st Contact
 
*Last Name of 1st Contact
 
*Telephone for 1st Contact
 
*Email for 1st Contact
 
*First Name of 2nd Contact
 
*Last Name of 2nd Contact
 
*Telephone for 2nd Contact
 
*Email for 2nd Contact
 
**Expected # of Attendees must be the lesser of 150 persons or 50% of venue capacity**
 
*Expected # of Attendees
 
*Expected # of Event Staff
 
*All guests 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.
 
*First Name of Contact for Guest Sign In
 
*Last Name of Contact for Guest Sign In
 
*Telephone of Contact for Guest Sign In
 
*Email of Contact for Guest Sign In
 
 
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.
Indoor and Outdoor Foood Sevices 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 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
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:
Ceremonial dances by selected attendees 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
Dancing zones or areas must be clearly marked, and dancers must remain in their designated zone/area
 
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.
Indoor and Outdoor Foood Sevices Detailed Guidelines.pdf
In the event of a COVID positive employee, event staff, vendor or attendee, responsible parties must cooperate with Orange 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
 
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
I am the responsible party for the business, organization or event listed. I have reviewed all applicable New York State interim guidance for event activities and operations during the COVID-19 public health emergency and I affirm that I have read and understand my obligation to operate this event in accordance with such guidance.
I understand that my event may be subject to inspection by the Orange County Department of Health to ensure compliance with all provisions of the guidance.
 
 
*Responsible Party First Name
 
*Responsible Party Last Name
 
*Association with event (organizer, facility operator, etc)
 
*Date
 
*Email Address
 
*Telephone Number
 
*Alternate Telephone