In 2008, the University of OregonÕs Climate Leadership Initiative and the Oregon Coalition of Local Health Officials surveyed Oregon public health departments on their knowledge of climate change, the impacts on public health, actions being taken to prepare for these impacts, and resource needs to take action. Many respondents expressed an interest in taking action to prepare their departments and communities for climate change, but felt they did not have the knowledge, tools, financial or staffing capacity, or organizational commitment to do so. This manual is a response to those concerns. It provides guidance on how to prioritize and implement the operational changes that allow public agencies to prepare their employees and communities for climate change. Additionally, it provides guidance about how to demonstrate and communicate a commitment to reducing risks and building resilience. The following climate preparedness categories are discussed: Extreme heat, Disease patterns, Water, Food, Air quality, Mental health. Many public health departments are stretched for human and financial resources. This handbook identifies actions that can be implemented immediately and at low cost, as well as those that may need long-term planning and budget allocations. Each health topic is examined to describe how it will be affected by climate change and the populations most vulnerable to the health risks. Recommendations are provided to prepare employees as well as communities for these changes. Methods are included for estimating needed capacity to implement the recommended action and the costs associated with such actions. The operations of many health departments are shaped by program and budgeting decisions made at the state level. When facilities are shared with other agencies, operations are also shaped by the interests of other building tenants. This document therefore identifies actions that can occur internally as well as steps that can be taken for influencing decision-makers at the higher level. Because effective framing and communication with co-workers and constituents is key to incorporating the actions described in this handbook, advice on how to talk about these issues internally and externally is also included. The concluding section provides a number of resources for the public health sector on climate change.