Prepared by the ND Department of Health and the Department of Commerce in conjunction with the Governor’s Office

This response aims to protect the lives and livelihoods of the citizens of North Dakota. The data and measures that inform this plan will be monitored daily and the recommendations will be updated as required.

January 7, 2021 VERSION 210106-15.1-07:45

ND Smart Restart Current as of 01/07/2021 1 Economic Reactivation North Dakota faces the likely reality of significant economic disruption until herd immunity occurs or a vaccine and treatment are discovered. These expected economic “stops and starts” could come in waves as the contagious path of the virus picks its course. Without intervention, these interruptions will do tremendous harm to North Dakota businesses, individuals, and families. For this reason, state leaders agree that the COVID-19 crisis is not a short-term problem, but rather a new risk North Dakota must learn to manage. Managing the public health risk requires the state to identify, contain, and mitigate the spread of the virus, while simultaneously reactivating the economy step-by-step. Assessment, testing, proactive tracing, and field testing instruct this process. Guided by a carefully developed operational dashboard and a color-coded health guidance system, the state can focus public health measures on specific areas and individuals and avoid blunt, statewide economic disruptions. Color-coded Health Guidance System The state will provide specific direction to North Dakota residents and businesses through a color-coded health guidance system. The guidance system includes five levels of risk: red, orange, yellow, green, and blue. Each level of guidance after red becomes progressively less restrictive and more economically engaged. Every level protects public health and outlines necessary mitigation strategies. Each level is guided by a measurement system, based on criteria such as, but not limited to, number of cases reported, positivity rates and testing capacity. This allows community leaders, business leaders, policymakers and the general public to safely determine when a different color of health guidance applies. North Dakotans should think of the guidance system as a dial that can be turned up or down by area based on the health risk. Red / Critical Risk is the area with the highest disease burden and level of significant and uncontrolled community transmission, multiple outbreaks resulting in increased deaths, surge capacity of hospitals are threatened, and there is lack of adequate PPE supplies available for healthcare workers. The most significant mitigation strategies are implemented at the Red / Critical Risk level. Orange / High Risk is the level of significant transmission and high risk for exposure due to widespread community spread of infections. There are significant mitigation strategies in place emphasizing “Stay Home. Stay Healthy. Stay Connected” (only essential work and travel is recommended, wear a face covering, avoid crowds and large gatherings). Increased cleaning on high touch surfaces and avoid shared spaces at work or in public settings. Yellow / Moderate Risk is the level of heightened exposure risk and transmission is controlled in these areas. Cases are reported but contained by rapid testing and robust contact tracing. Social distancing and precautions are needed (maintain six feet of distancing, avoid shaking hands, work from home when possible, reconsider unnecessary travel, wear a face covering). Increased cleaning on high touch surfaces and cleanings on shared spaces should be routine.

ND Smart Restart 2 Current as of 01/07/2021 Green / Low Risk for exposure or transmission, low case counts are reported, public health and private health care are able to safely diagnose, treat, and isolate COVID-19 cases and their contacts. During this level, businesses can reopen, and much of normal life can begin to resume. However, physical distancing measures and limitations on gatherings will still be recommended to prevent transmission from accelerating again. For older adults (those over age 65), those with underlying health conditions, and other populations at heightened risk from COVID-19, continuing to limit time in the community will be important. State and community leaders should prepare health alerts, communicate risk and symptoms, review plans, prepare for public health capacity if needed for spikes in cases. Blue / New Normal is when most normal activity can resume, with standard precautions and awareness of health guidelines such as routine hand washing, stay home when sick, cover your cough, education, stockpiling, planning, routine health alerts, etc. Monitoring for illness and outbreaks will continue. Even under new normal conditions, those found to be ill will be asked to self-isolate and contacts will be asked to remain at home. This color-coded guidance can be applied during the levels of ND Smart Restart to protect health, bolster confidence, and provide more economic certainty. It is possible for one area of the state to be under the orange guidance and another under the yellow. Figure 5 provides an explanation of the color-coded health guidance. The color-coded guidance system was put together utilizing the hard work and framework created by the State of Utah and modified to meet the needs of North Dakota under the leadership of the North Dakota Department of Commerce and the North Dakota Department of Health to provide specific direction to North Dakota residents and businesses. Each level recommends North Dakotans to adhere to ND Smart Restart Standards Across All Industries and these universal standards: 1. Common Sense and Personal Accountability – Public health guidance cannot anticipate every unique situation. Residents and businesses must take personal accountabliity to be informed and take actions based on common sense and wise judgment that will protect health and support economic reactivation. 2. Protective Hygiene and Cleaning – North Dakotans must continue to practice good hygiene and cleaning regimens to minimize the risk of the virus. These include but are not limited to the following: • Stay home when sick • Wash hands with soap and water for at least 20 seconds as frequently as feasible • Use hand sanitizer after interactions with people or objects • Cough or sneeze into the sleeve or elbow, not hands • Clean high-touch surfaces (buttons, door handles, counters, etc.) regularly • Avoid touching your face • Use a face covering in public places where social distancing cannot be maintained • Refrain from hand shaking 3. Follow Guidance – Public health and economic opportunity are intrinsically linked. North Dakotans must strictly follow the health guidance of each color or risk backtracking and causing greater harm. 4. High-risk / Vulnerable Populations – High-risk populations and those around them must follow a specific set of instructions issued by the Governor, the North Dakota Department of Health and the North Dakota Department of Human Services.

With these universal standards in place, Figure 6 provides the general characteristics of each color of guidance. Refinements to this guidance can, and most likely will, be made by the Governor with input from the North Dakota Department of Commerce and the North Dakota Department of Health. For greater detail on the protocols created for industries directly impacted by the Executive orders, please visit BeLegendary.link/NDSmartRestart.

ND Smart Restart Current as of 01/07/2021 3 Guidance for Decision Making: North Dakota Health Criteria and Health Indicator Measures The ND health criteria and health indicator measures will be used to guide decisions regarding county risk levels. The Department of Health and the Governor’s Office, in conjunction with other state agencies, will use these measures to provide a framework for decision making. Additional factors will be taken into consideration to determine the county risk level on a recurring basis. Additional factors may include, but are not limited to, population density, hospitalization rates, current active cases within a county, etc.

Gating Criteria Critical High Risk Moderate Risk Low Risk New Normal 14 Day

Active Cases/10K (14 Over 40 30-39 20-29 10-19 10 or less Day Rolling Average)

Tests/10K (14 Day Under 20 21-30 31-40 41-45 46 or more Rolling Average)

14 Day Rolling Average Percent Over 15% 10-14.99% 5-9.99% 2-4.99% Under 2% Positive Tests

ND Smart Restart 4 Current as of 01/07/2021 Figure 5: Risk Levels and Health Guidance The color-coded health guidance system is designated by the State Health Officer and the Statewide Emergency Operations Center (SEOC) with input from the North Dakota Economic Resiliency Team, North Dakota Department of Commerce and the North Dakota Department of Health. The SEOC has access to a detailed dashboard of monitoring, testing, and hospital utilization data. This data includes health, social, and economic measures. The guidance can be applied anytime and anywhere to address virus flareups or hotspots. This versatile system will help North Dakota manage the health and economic risk or until a medical solution is discovered. It is possible and even likely that multiple guidance colors will be designated by region, county, city, or community at the same time. It is also possible that areas within the state will move through this spectrum of orange to yellow to green to blue and back again based on the characteristics of the virus and our actions. North Dakota has not reached the red level and through monitoring and mitigation measures, does not plan to hit the critical stage. The maps below show hypothetical examples of how the public health guidance colors could be applied.

Figure 5. KEY Red means critical risk and severe threat to public health. Orange means high risk for everyone as well as high-risk individuals. Yellow means moderate risk for everyone but high-risk individuals. Green means low risk for everyone, but high-risk individuals. Blue means a new normal baseline for everyone but high-risk individuals.

In every color of guidance, high-risk individuals are asked to operate under specific instructions issued by the Governor and the North Dakota Department of Health.

ND Smart Restart Current as of 01/07/2021 5 Figure 6: Industry Summary of Color-Coded Health Guidance Select Industry Critical High Risk Moderate Risk Low Risk New Normal Employers are encouraged to allow flexible working arrangements (rotating shifts, remote, etc.). Pre-screen and See DOH Essential Workers Fact Sheet* monitor employees for Employers of functioning critical infrastructure sectors exercise caution, with employees symptoms. Follow social working remotely when possible, evaluating workforce concerns, implementing policies Operate under distancing guidelines. Ensure informed by industry best practices, and enacting strategies to minimize economic impact. heightened hygiene and Essential* Workplaces/ workers use face coverings in Businesses that necessitate on-site work should pre-screen and monitor employees for cleaning standards. Manufacturing accordance with CDC and symptoms; comply with social distancing guidelines; ensure workers use face coverings in Monitor employees for OSHA guidance and Smart accordance with CDC and OSHA guidance and Smart Restart protocols; and follow cleaning symptoms. Restart protocols. Follow guidelines. Restrict unnecessary visitors from entering the workplace. Encourage testing for cleaning guidelines. symptomatic employees and close contacts identified in the workplace. Encourage testing for symptomatic employees and close contacts identified in the workplace. Only essential services are Non-essential services may recommended. Employers exercise reopen. Employers exercise caution, with employees working caution, with employees working remotely when possible, evaluating remotely, evaluating workforce Employers are encouraged to workforce concerns, implementing concerns, and enacting allow flexible working policies informed by industry best strategies to minimize economic arrangements (rotating shifts, practices, and enacting strategies impact. Businesses that remote, etc.). Pre-screen and to minimize economic impact. Only Essential necessitate on-site work pre- monitor employees for Businesses that necessitate on-site, General Employer Services Open screen and monitor employees symptoms. Follow social essential work pre-screen and Standards for All for symptoms; comply with distancing guidelines. Operate under monitor employees for symptoms; Industries social distancing guidelines; Limit occupancy to 80% heightened hygiene and Shelter in Place comply with social distancing require use of face coverings; capacity but no more than 300 cleaning standards. guidelines; require use of face and follow cleaning guidelines. persons. Monitor employees for Specific Types of coverings; and follow cleaning expanded ~~~~~~~~~ Limit occupancy to 65% capacity symptoms. Employers guidelines. Strongly recommend or below This is due to the but no more than 200 persons. Limit occupancy to 50% capacity require use of face coverings. level of Restrict unnecessary visitors but no more than 150 persons. Follow cleaning guidelines. significant and from entering the workplace. Restrict unnecessary visitors from Encourage testing for uncontrolled Encourage testing for entering the workplace. Encourage symptomatic employees and widespread symptomatic employees and testing for symptomatic employees close contacts identified in the COVID-19 close contacts identified in the and close contacts identified in the workplace. disease across workplace. Cancel work-related workplace. Cancel work-related the state that gatherings (staff meetings, after- gatherings (staff meetings, after- resulted in work functions). work functions). increased deaths, surge capacity of Curbside pickup, takeout, and hospitals being delivery options preferable. threatened and a Dine-in service limited to 65% of Employers are encouraged to lack of adequate normal capacity but no more allow flexible working PPE supplies than 200 persons. No standing Curbside pickup, takeout, and arrangements (rotating shifts, available for room options; dine-in seating delivery is recommended. No dine- remote, etc.). Dine-in service is healthcare only. Customer self-service of in service, no customer self-service limited to 80% of normal workers. food and beverage (salad bars, capacity with caution but no and caution taken in food prep. If buffets, fountain drinks, coffee) is ~~~~~~~~~ more than 300 persons. dine-in service is open, limit to restricted following Smart Standing room options may 50% of normal capacity but no Restart protocols. be considered with caution Operate under more than 150 persons. No Pre-screen and monitor while maintaining social heightened hygiene and standing room options. No employees for symptoms; distancing. Limited customer cleaning standards. customer self-service of food or comply with social distancing self-service of food and beverage (salad bars, buffets, guidelines; require use of face Monitor employees for fountain drinks, coffee). Pre-screen beverage (salad bars, buffets, symptoms. Restaurants, Bars & Food coverings; and follow cleaning and monitor employees for fountain drinks, coffee) may Service guidelines. Resume to normal symptoms, comply with guidelines be considered following Smart Strongly recommend dine-in capacity and operations for social distancing, require use of Restart protocols. Pre-screen seating customers follow CDC’s (dance floors, standing, face coverings, follow cleaning and monitor employees for guidance for wearing face blackjack) while guidelines. symptoms; comply with social coverings before and after meal continuing to follow new Only Essential Contactless payment encouraged. distancing guidelines; strongly service. protocols. Services Open Create a safe environment for staff. recommend or require use of Contactless payment No blackjack, gaming tables, or face coverings; and follow encouraged. Blackjack and cleaning guidelines. gaming machines. No use of hand- gaming tables are closed. held entertainment or reservation Blackjack and gaming Limited use of gaming machines notification devices. Dance floors tables can resume with may be considered following are closed. precautions taken for social distancing guidance and Smart distancing while minimizing Restart protocols. No use of transmissible moments. hand-held entertainment or reservation notification devices. Dance floors are closed.

ND Smart Restart 6 Current as of 01/07/2021 ;l, Select Industry Critical High Risk Moderate Risk Low Risk New Normal Employers exercise caution, with employees working remotely Employers are Employers exercise caution, with when possible. Businesses that encouraged to allow employees working remotely when necessitate on-site work pre- flexible working possible, evaluating workforce screen and monitor employees for arrangements (rotating concerns, managing risk, symptoms. Non-essential services shifts, remote, etc.). Pre- Operate under implementing policies informed by may consider opening following screen and monitor heightened hygiene & industry best practices, and enacting Smart Restart protocols with employees for symptoms; cleaning standards. strategies to minimize economic social distancing guidelines; comply with social Monitor employees for Retail* (Including grocery impact. Businesses that necessitate require use of face coverings; and distancing guidelines; symptoms. stores, C-stores & on-site work pre-screen and monitor follow cleaning guidelines. Restrict strongly recommend or Resume to normal pharmacies) employees for symptoms; comply unnecessary visitors from entering require use of face capacity of foodservice with social distancing guidelines; the workplace. Encourage testing Only Essential coverings; and follow operations while require use of face coverings; and for symptomatic employees and Services Open cleaning guidelines. continuing to follow new follow cleaning guidelines. Restrict close contacts identified in the Retail stores with protocols. unnecessary visitors from entering. workplace. Cancel work-related foodservice must follow Retail stores with foodservice must gatherings (staff meetings, after- Smart Restart protocols follow Smart Restart protocols for work functions). Retail stores with for restaurants and bars restaurants and bars (above). foodservice must follow Smart (above). Restart protocols for restaurants

and bars (above).

Hotels with amenities such Limited operations. Take as foodservice, fitness precaution for staff & guests. No Hotels with amenities such as rooms, and recreational customer self-service of food or foodservice, fitness rooms, and pool facilities follow Smart beverage (continental breakfast, Restart protocols. For recreational pool facilities may Operate under heightened coffee). Pre-screen and monitor resume following Smart Restart gatherings, limit occupancy hygiene & cleaning

employees for symptoms, comply protocols. to 80% of rated room standards. Monitor with guidelines for social For gatherings, limit occupancy to capacity but no more than employees for symptoms. distancing, require use of face 65% of rated room capacity but stated in the ND Smart Conventions and large coverings, follow cleaning no more than stated in the ND Restart Large Gathering events are permitted with guidelines. Smart Restart Large Gathering Tiered Capacity Document. safety guidance and For gatherings, limit occupancy to Tiered Capacity Document. Pre-screen and monitor procedures. 50% of rated room capacity but Businesses that necessitate on-site employees for symptoms; Resume to normal capacity no more than stated in the ND Hotel, Tourism, & work pre-screen and monitor comply with social of foodservice operations Smart Restart Large Gathering Accommodations Only Essential employees for symptoms; comply distancing guidelines; while continuing to follow Tiered Capacity Document. Cancel Services Open with social distancing guidelines; strongly recommend or proper safety guidance and gatherings of any size where require use of face coverings; and require use of face procedures. distancing cannot be maintained. follow cleaning guidelines. Cancel coverings; follow cleaning Dance floors are closed. gatherings of any size where guidelines. Hotels with amenities of distancing cannot be maintained. Limit occupancy of foodservice must follow Dance floors are closed. gatherings where guidelines for restaurants and distancing cannot be bars. Amenities such as fitness Pools may open following social maintained. rooms, and recreational pool distancing guidelines, CDC facilities must follow guidelines recommendations, aquatic health Pools may open following for fitness centers and codes, and pool operator social distancing, CDC recreational pools and water protocols. recommendations, aquatic venues. health codes, and pool operator protocols. Expanded operations. Take Limited operations. Take precaution precaution for staff & for staff & guests. Gatherings in guests. Gatherings in facilities can be up to 50% of facilities can be up to 75% For gatherings, limit occupancy certified occupancy for that room of certified occupancy for to 25% of rated room capacity but no more than stated in the ND that room but no more than Operate under heightened but no more than stated in the Smart Restart Large Gathering stated in the ND Smart hygiene & cleaning standards. ND Smart Restart Large Tiered Capacity Document. Restart Large Gathering Monitor employees for Gathering Tiered Capacity Businesses that necessitate on-site Tiered Capacity Document. symptoms. Large groups Only Essential Document. Cancel gatherings of work pre-screen and monitor Events & Gatherings Strongly recommended or allowed such as festivals and Services Open any size where distancing cannot employees for symptoms; comply require face coverings for all sporting events. Mass be maintained. with social distancing guidelines; workers and attendees. gatherings are permitted Require face coverings. Catering require use of face coverings; and Limit occupancy where when following proper safety and foodservice must follow follow cleaning guidelines. Cancel social distancing cannot be guidance and procedures. Smart Restart protocols for gatherings of any size where maintained. restaurants and bars (see above). distancing cannot be maintained. Catering and foodservice must Catering and foodservice comply with restaurant and Smart must comply with restaurant Restart protocols (see above). Smart Restart protocols (see above).

ND Smart Restart Current as of 01/07/2021 7 Select Industry Critical High Risk Moderate Risk Low Risk New Normal Personal care services may open if face coverings are required for both Personal care services may consider Operate under strict hygiene clients and staff. If necessary, opening following Smart Restart protocols. Operate under increase 6-ft distance between protocols. Operate under strict Pre-screen and monitor heightened Personal Care Services workstations. Keep records of clients hygiene protocols. employees for symptoms; hygiene & (Salons, Barbers, Tanning, for contact tracing purposes if Pre-screen and monitor employees comply with social cleaning Tattoo/Body Art, Message needed. Set specific for symptoms; comply with social distancing guidelines; standards. Therapists) shopping/business hours for only distancing guidelines; require use require use of face Monitor employees customers that are at higher risk. of face coverings; and follow coverings; and follow for symptoms. Screen clients and employees for cleaning guidelines. cleaning guidelines. symptoms that includes temperature Only Essential checks. Services Open Fitness centers, gyms and Fitness centers, gyms and indoor/outdoor sporting events indoor/outdoor sporting events may consider opening following may open with social distancing Smart Restart protocols. protocols & cleaning guidance. See DOH COVID-19 See DOH COVID-19 Recommendations for Sports. Recommendations for Sports. Limit number of people to 65% of Limit number of people to 80% rated occupancy of the facility or of rated occupancy of the facility See DOH COVID-19 up to 200 people for using tracks, or up to 300 people for using Recommendations for Sports. courts, fitness equipment, tracks, courts, fitness equipment, For Fitness centers & gyms: strength training, etc. Pre-screen strength training, etc. Pre-screen Face coverings required. and monitor employees for and monitor employees for Group fitness classes with symptoms; comply with social symptoms; comply with social high inhalation/exhalation distancing guidelines; require use distancing guidelines; require use exchange in confined spaces of face coverings; and follow of face coverings; and follow (e.g. high-impact aerobics, cleaning guidelines. Coaches, cleaning guidelines. Coaches, spin) are not recommended. players not in play, and fans must players not in play, and fans must Operate under Limit number of people to comply with guidelines for social comply with guidelines for social heightened 50% of rated occupancy of distancing. Require face coverings distancing. Strongly recommend hygiene & the facility or up to 150 for coaches, staff and fans. Fitness Centers / Gyms and or require use of face coverings cleaning people for using tracks, Require face coverings for players Sporting Events for coaches, staff, and fans. standards. courts, fitness equipment, not in play. Enhanced cleaning Strongly recommend or require Monitor employees strength training, etc. protocols. Limit the number of face coverings for players not in for symptoms. fans and spectators to 65% of Limit the number of fans and play. Enhanced cleaning rated occupancy of the facility but Only Essential spectators to 50% of rated protocols. Limit the number of no more than ND Smart Restart Services Open occupancy of the facility but no fans and spectators to 80% of Large Gathering Tiered Capacity more than stated in the ND Smart rated occupancy of the facility Restart Large Gathering Tiered Document (LINK).. but no more than ND Smart Capacity Document. Outdoor playgrounds and Restart Large Gathering Tiered

Pools follow guidelines for sporting events may open Capacity Document (LINK).. following CDC guidelines. fitness centers and Outdoor playgrounds and recreational pools and water Cancel gatherings of any size sporting events may open venues where social distancing cannot be following CDC guidelines. maintained. Limit occupancy where social Hot tubs and saunas may operate distancing cannot be maintained. following protocols. Pools may Hot tubs, pools, and saunas may open following social distancing, open following social distancing, CDC recommendations, aquatic CDC recommendations, aquatic health codes, and pool operator health codes, and pool operator protocols. Close off gathering protocols. areas.

See DOH COVID-19

Recommendations for Sports.

Strict hygiene & reduced group See DOH COVID-19 interactions. Monitor symptoms Recommendations for Sports. of staff. May open with Strict hygiene. Monitor See DOH COVID- modifications to ensure visitors symptoms of staff. Strongly 19 can maintain social distancing, recommend or require face Recommendations and practice proper hand coverings, follow social Outdoor walking and biking for Sports. hygiene. Require use of face distancing guidance. paths preferred. Monitor Operate under Only Essential coverings. Enhance cleaning of Indoor/outdoor playgrounds and Parks and Recreational symptoms of staff. Face heightened Services Open public restrooms. Cancel or sports may operate following facilities coverings required. Follow hygiene & postpone events and gatherings CDC guidelines. Limit occupancy guidance for fitness centers and cleaning where social distancing cannot where social distancing cannot schools. standards. be maintained. be maintained. Monitor employees Outdoor playgrounds and sports Pools may open following social for symptoms. may open following CDC distancing, CDC

guidelines. Pools may open recommendations, aquatic health following social distancing, CDC codes, and pool operator recommendations, aquatic protocols. health codes, and pool operator protocols.

ND Smart Restart 8 Current as of 01/07/2021

Select Industry Critical High Risk Moderate Risk Low Risk New Normal See child care provider See child care provider guidance. See child care provider guidance. May remain open for essential guidance. See child care provider Enhanced cleaning and services. Enhanced cleaning and guidance. distancing protocols. No distancing protocols. No Enhanced cleaning & Operate under symptomatic employees or symptomatic children. Close distancing protocols. No heightened hygiene & children. Congregate areas are Child Care communal use spaces such as symptomatic employees or cleaning standards. closed. Require employees to cafeteria and playgrounds if children. Stagger arrival and Monitor children and use face coverings. Maintain possible, or stagger use and drop off times. Employees are employees for enhanced social distancing. clean/disinfect between use. Stagger strongly recommended or symptoms. Stagger arrival and drop off arrival and drop off times. Require required to wear face times. Require use of face use of face coverings for employees. coverings. coverings for employees.

See Schools and University See Schools and University See Schools and University See Schools and University Schools K-12 and guidance guidance guidance guidance Universities

Long Term Care, Basic Care, and Assisted Living VP3 LINK VP3 LINK VP3 LINK VP3 LINK (VP3)

Stay Home. Stay Healthy. Stay Stay Home. Stay Healthy. Stay Use caution; avoid large Connected. Avoid crowds. Connected. Avoid crowds. crowds when communities Members of households with Take every day public health Vulnerable Individuals in Members of households with have resurgence of cases. Shelter in place vulnerable residents take and hygiene precautions and public places vulnerable residents take Public places should strongly precautions. Public places stay home when sick. precautions. Public places should recommend or require face should require use of face require use of face coverings. coverings. coverings.

Source: North Dakota Department of Health.

Further details on protocols created for individual industries available at BeLegendary.link/NDSmartRestart If your business is not on this list, we thank you for exercising your best judgement and taking responsibility for keeping your customers and employees healthy

ND Smart Restart Current as of 01/07/2021 9