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    • 1 Licence/Permit Holder

Iowa Alcoholic Beverages Division

COVID-19 Compliance Plan ChecklistThe purpose of this tool is for the holder of an alcohol license/permit to indicate the operational measures the licensee/permittee is taking to comply with the requirements of the Governor’s Proclamation of Disaster Emergency to help mitigate the spread of COVID-19.

This worksheet is to be completed by the licensee/permittee. If a licensee/permittee holds additional licenses/permits for multiple establishments, a separate worksheet must be completed for each establishment.

The completed worksheet and any supplemental documents supporting the information in the completed worksheet must be submitted to ABD. A copy of the documentation must also be available for state and local investigators and other regulatory officials upon request.

License/Permit Holder Information

To be completed by a person listed as an owner on the alcohol/food license/permit

Establishment Information

Bar vs. Restaurant Determination

50% or more of my monthly revenues are from food my business prepares and sells.*

COVID-19 Compliance Information

I have arranged the seating at my establishment so that 6 feet of physical distance is present between each group or individual dining alone.*

- You will be able to submit pictures or diagrams demonstrating this prior to signing the document.

I understand that I must ensure all patrons have a seat at a table, booth, or bar and that all patrons must consume their food or beverage while seated at a table, booth, or bar.*

I understand that patrons are not allowed to congregate together closer than 6 feet and have implemented measures to ensure such social distancing.*

You will be able to submit pictures demonstrating this prior to signing the document.

I have implemented additional reasonable measures to ensure social distancing of employees and customers, increased hygiene practices, and other public health measures to reduce the spread of COVID-19 consistent with guidance issued by the Iowa Department of Inspections and Appeals and the Iowa Department of Public Health.*

- You will be able to upload pictures or documentation demonstrating this prior to signing the document.

All information I have provided in this worksheet or in any supplemental documentation to this worksheet is true and correct. I understand that any misrepresentation of the information I have provided or failure to maintain compliance with this information that is discovered through the course of an investigation by the Alcoholic Beverages Division, the Department of Inspections and Appeals, other state agencies, local law enforcement, public health officials and other entities responsible for enforcement of the Governor’s Proclamation of Disaster Emergency may result in criminal penalties or civil action against my alcohol or food license/permit.

I further understand that this document is a public record and will be shared with other state agencies, local law enforcement, public health officials, and other entities responsible for enforcement of the Governor’s Proclamation of Disaster Emergency.