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Name of Business*

Use your public facing name as you would like it posted on our website after you've been certified.

Entity Street Address*

Is the entity located in unincorporated Arapahoe County?*

To check if your business is in unincorporated Arapahoe County, please use this link

Yes

No

Tax Jurisdiction*

Zip*

Contact Name*

Phone Number*

Email*

Industry Type*

Restaurant, Bars, and similar special events

Recreation, including bowling alleys, gyms, recreation centers, indoor pools, and outdoor recreation facilities

Personal Services (Salon, etc.)

Office Based Industries

Other

Business Plan

Applicants must submit a formal, written policy to comply with the five star program. *

Choose file

Business Plan

The following questions identify requirements that all businesses should be following, consistent with the State of Colorado’s Public Health Orders and requirements of any Five-Star Certification Program. For more information on these requirements, please visit www.arapahoegov.com/fivestar.

The business has written a plan about how they are implementing or exceeding state and local prevention guidelines. This plan will have a clear compliance and enforcement plan. *

Yes

No

Signage explaining safety measures being taken by the business *

Yes

No

Copies of the COVID-19 plan have been distributed to all employees. *

Yes

No

Mask Wearing Protocols

The following questions identify requirements that all businesses should be following, consistent with the State of Colorado’s Public Health Orders and requirements of any Five-Star Certification Program. For more information on these requirements, please visit www.arapahoegov.com/fivestar.

Masks are required for everyone who enters the facility. *

Yes

No

There are signs posted at entrances, reminding people to maintain social distancing, emphasize wearing a mask, handwashing, coughing and sneezing etiquette and to not enter if they are sick. *

Yes

No

There are alternative options for people who refuse to wear a mask, and for vulnerable individuals (special hours, seating assistance, curbside, online delivery) *

Yes

No

Employee Requirements

The following questions identify requirements that all businesses should be following, consistent with the State of Colorado’s Public Health Orders and requirements of any Five-Star Certification Program. For more information on these requirements, please visit www.arapahoegov.com/fivestar.

Employees, contracted workers, and volunteers are required to wear a non-medical cloth face covering over the nose and mouth as well as do daily symptom checks. *

Yes

No

All employees have been instructed to maintain at least six feet distance from customers and from each other, except employees may momentarily come closer when necessary to accept payment, deliver goods or services, or as otherwise necessary. *

Yes

No

There is a system in place to monitor employee and volunteer symptoms such as temperature monitoring. Provisions are in place to send employees home when experiencing any of the following: dry cough, shortness of breath, difficulty breathing, fever, fatigue, or a recent loss of taste or smell. *

Yes

No

General Business Operations

The following questions identify requirements that all businesses should be following, consistent with the State of Colorado’s Public Health Orders and requirements of any Five-Star Certification Program. For more information on these requirements, please visit www.arapahoegov.com/fivestar.

Capacity Controls

Procedures are in place for limiting the number of people in a facility to meet current allowable capacity. *

Yes

No

Curbside drop off/pick-up is used whenever possible. *

Yes

No

The flow of people traffic has been modified where possible (doors for entry or exit only, one way aisles, etc.), while still maintaining safety such as emergency exits due to fire or other emergencies). *

Yes

No

Limit the number of customers in the store at any one time to make sure social distancing is attainable. *

Yes

No

Post an employee at the door to ensure that the maximum number of customers is not exceeded. If necessary designate employee monitors outside the store as well to assist and prevent crowds. *

Yes

No

Spacing Controls

Indoor and outdoor spaces are set up to promote at least six feet of distance between individuals and groups such as placing tape to mark the distancing in lines or on sidewalks. *

Yes

No

Chairs and desks are adequately spaced in work areas and waiting areas including staggering customer seating if waiting for services. *

Yes

No

Cleaning Controls

There is at least one handwashing facility or hand sanitizer station per 25 people and employees are encouraged to take breaks to wash hands. *

Yes

No

The facility is cleaned frequently, including disinfection of bathrooms, high-touch surfaces, and items shared between individuals (menus, tables, etc.). There are policies and procedures in place, along with a cleaning schedule. *

Yes

No

The facility has proper ventilation. *

Yes

No

Operational Controls

The use of digital files rather than paper is encouraged (invoices, agendas, forms, etc.). *

Yes

No

Signage on how to contact a store manager or person in charge with questions or concerns related to COVID-19 store practices for protecting employee and customer. *

Yes

No

Appropriate protective gear like disposable gloves and cloth masks are provided and used by all employees in close contact with other employees and/or the general public. *

Yes

No

Everyone who can carry out their work duties from home has been directed to do so i.e. Flexible and/or remote scheduling is provided for vulnerable employees that must continue to stay at home, who may have child or eldercare obligations, or who live with a person who needs to observe Stay-at-Home due to underlying condition, age, or other factor. *

Yes

No

Restaurant, Bars, and Similar Special Events

The following questions identify requirements that all businesses should be following, consistent with the State of Colorado’s Public Health Orders and requirements of any Five-Star Certification Program. For more information on these requirements, please visit www.arapahoegov.com/fivestar.

If the question does not apply, please answer "Yes".

Outdoor spaces such as patios or other expanded areas as granted by any municipality may be used as additional capacity for restaurants and bars. There must be at least 10 feet of space between all tables. *

Yes

No

There must be at least 10 feet of space between all freestanding tables, and between booth tables and any freestanding tables. *

Yes

No

Seating must not allow for more than 6 people from a single party. Multiple parties cannot be seated together at the same table. *

Yes

No

Allow only the number of people for which seating is available; no standing room space allowed. *

Yes

No

On-premise service and alcohol consumption must end by 10 PM. *

Yes

No

Dancing is not allowed; it is recommended that the dance floor be used as part of the overall seating space with tables spaced 10 feet apart. *

Yes

No

Do not provide live music or any other live performances. *

Yes

No

Recreation, including bowling alleys, gyms, recreation centers, indoor pools, and outdoor recreation facilities.

The following questions identify requirements that all businesses should be following, consistent with the State of Colorado’s Public Health Orders and requirements of any Five-Star Certification Program. For more information on these requirements, please visit www.arapahoegov.com/fivestar.

If the question does not apply, please answer "Yes".

Face coverings are required during group exercise classes and while bowling with a team and/or during league play. *

Yes

No

Face coverings are not required while exercising alone as long as personal exercise equipment is spaced 10 feet apart. *

Yes

No

Golf carts, go-karts, paddle boards, etc. must contain no more than one person, unless both riders are members of the same party. *

Yes

No

Swimming pools with an appropriate disinfectant (e.g. chlorine or bromine) are limited to 50% of the posted occupancy code or less as necessary to comply with social distancing requirements. *

Yes

No

Personal Services

The following questions identify requirements that all businesses should be following, consistent with the State of Colorado’s Public Health Orders and requirements of any Five-Star Certification Program. For more information on these requirements, please visit www.arapahoegov.com/fivestar.

If the question does not apply, please answer "Yes".

Personal services - reservations are required. *

Yes

No

Office Based Industries

The following questions identify requirements that all businesses should be following, consistent with the State of Colorado’s Public Health Orders and requirements of any Five-Star Certification Program. For more information on these requirements, please visit www.arapahoegov.com/fivestar.

If the question does not apply, please answer "Yes".

Employees are discouraged from using shared spaces (break rooms, meeting rooms, waiting areas, etc.). If use of shared space is necessary, consider the size of the room to maintain 6 foot distancing and no more than 10 people are permitted. *

Yes

No

All desks, individual work stations or work areas are separated by at least six feet and/or schedules are staggered to ensure six foot distancing. *

Yes

No

Employee breaks are staggered to reduce employee density.

Yes

No

Shields are installed between customers and employees where possible.

Yes

No

Certification Question: Previous Citations

Please answer the following question.

Check yes ONLY if you have received any public health citations received from the Tri-County Health Department after December 18, 2020. If you have not received any citations, please select No.

Has your business been cited any time after December 18, 2020 by the Tri-County Health Department?

Yes

No

Five Star Recovery Partner Program Acceptance Agreement

By submitting this application, the business (“business entity”) operating at the address listed has voluntarily elected to participate in the Arapahoe County Five-Star Recovery Partner Program (“Program”) offered by the Administrative Committee and acknowledges they will adhere to all the program requirements outlined in this submittal to be accepted as a participant. Additional, site-specific operational plans may be submitted following this application.

As a result, the Administrative Committee agrees to allow this business entity to operate at capacity restrictions one level less restrictive than the level Arapahoe County is currently assigned. In agreeing to participate in this Program the business entity also agrees to the following:

1. The business entity agrees to monitor conditions and Public Health Orders in effect for Arapahoe County and to meet all requirements in the Dial Level assigned to it by being a participant accepted in the Program. This may mean increased or decreased restrictions depending on Arapahoe County’s status on the Dial, and the business entity agrees to make changes as necessary to adjust to Dial Level changes.

2. Participation in the Program may be suspended or revoked by the Administrative Committee after providing notice of suspension or revocation to the business entity for any of the following:

a. The business entity fails to achieve compliance on future inspections made as a result of complaints or to verify continued compliance with requirements of the Program; or

b. The business entity fails to cooperate with Tri-County Health Department in investigation of possible cases of COVID-19 associated with customers, guests, or employees; or

c. The Committee determines that laws, regulations, or public health orders require termination or modifications to the Program.

3. If acceptance in the Program is revoked, the business entity agrees to comply with the applicable public health orders and restrictions in effect in Arapahoe County for all businesses not participating in the Program.

4. The Business Entity may voluntarily withdraw their participation in the program upon notifying the Committee.

Acknowledged

Requirements Not Met

Your organization did not meet the requirements for certification.

I understand that I may reapply for certification.

Acknowledged