Make the Pledge

We commit to making our organization and community safer by implementing the following guidelines:

  • Mask up: Require our staff to wear masks at all times, and post signage encouraging our customers to wear masks (per Emergency Order #1).
  • Monitor employee health: Promote employee health by implementing a monitoring system for COVID-19 symptoms prior to each workday and require employees to remain at home when symptomatic (even if mild).
  • Stay home: Ask all customers who develop symptoms of COVID-19—or know they have been exposed to someone with COVID-19—to remain at home.
  • Clean surfaces: Implement increased safe sanitation practices regularly by following the CDC guidelines for business.
  • Physical distance: Ensure my organization meets physical distance guidelines of six feet or more, and post signage encouraging my customers to observe physical distancing. When physical distancing cannot be met, proper protocols are in place to ensure safety of employees and customers (e.g. face masks required, physical barriers in place, etc.).
  • Wash hands: Provide hand sanitizer at all entrances, and handwashing stations for my employees and customers.

By filling out this Commitment Form, you have reviewed and understand COVID-19 guidelines and recommendations from the Trempealeau County Health Department, WEDC, and the CDC, and commit to staying informed as future information is released.  Additional precautions should be taken based on our risk status and your type of organization. See the Organization Resources section.


* Indicates a Required Field

Organization Name: *

Owner Name: *

Organization Point of Contact: *

Organization Contact Email: *

Organization Contact Phone Number: *

Organization Website:

Address: *

City: *

State: *

Zip Code: *

Organization Social Media Pages (if applicable)


After submitting this form, the Trempealeau County Health Department will email you the COVID-19 graphics and communications plan.

For additional questions, contact the Trempealeau County Health Department at 715-538-2311 ext 220 or email us at

Adapted from the La Crosse County Health Department Check the Spread initiative.

Contact Us
715-538-2311 ext 220
Trempealeau County Health Department