Title Page

  • Conducted on

  • Prepared by

  • Location

Contents of Written Worksite Specific Plan

  • The person(s) responsible for implementing the plan.

  • A risk assessment and the measures that will be taken to prevent the spread of the virus.

  • Training and communication with employees and employee representatives on the plan.

  • A process to check for compliance and to document and correct deficiencies.

  • A process to investigate COVID-cases, alert the local health department, and identify and isolate close workplace contacts of infected employees until they are tested.

Topics for Employee Training

  • Information on COVID-19, preventing spread, and who is especially vulnerable.

  • Self-screening at home, including temperature and/or symptom checks using CDC guidelines.

  • The importance of not coming to work if employees have a frequent cough, fever, difficulty breathing, chills, muscle pain, headache, sore throat, the recent loss of taste or smell, or if they or someone they live with has been diagnosed with COVID-19.

  • When to seek medical attention.

  • The importance of hand washing.

  • The importance of physical distancing, both at work and off work time.

Individual Control Measures & Screening

  • Symptom screenings and/or temperature checks.

  • Encourage workers who are sick or exhibiting symptoms of COVID-19 to stay home.

  • Encourage frequent handwashing and use of hand sanitizer.

  • Provide disposable gloves to workers using cleaners and disinfectants if required. Consider gloves a supplement to frequent handwashing for other cleaning, tasks such as handling commonly touched items, or conducting symptom screening.

  • Strongly recommend cloth face covers.

  • Close or increase the distance between tables/chairs in breakrooms or provide break areas in open space to ensure physical distancing.

  • Communicate frequently to customers that they should use face masks/covers.

Cleaning and Disinfecting Protocols

  • Perform thorough cleaning in high traffic areas.

  • Frequently disinfect commonly used surfaces and personal work areas.

  • Clean and sanitize shared equipment between each use.

  • Clean touchable surfaces between shifts or between users, whichever is more frequent.

  • Equip shared spaces with proper sanitation products, including hand sanitizer and sanitizing wipes and ensure availability.

  • Ensure that sanitary facilities stay operational and stocked at all times.

  • Use products approved for use against COVID-19 on the Environmental Protection Agency (EPA)-approved list and follow product instructions and Cal/OSHA requirements.

  • Provide time for workers to implement cleaning practices before and after shifts and consider third-party cleaning companies.

  • Install hands-free devices if possible.

  • Consider upgrades to improve air filtration and ventilation.

Physical Distancing Guidelines

  • Implement measures to physically separate workers by at least six feet using measures such as physical partitions or visual cues (e.g., floor markings, colored tape, or signs to indicate to where workers should stand).

  • Reconfigure office spaces, cubicles, etc. and decrease the maximum capacity for conference and meeting areas.

  • Adjust in-person meetings, if they are necessary, to ensure physical distancing.

  • Stagger employee breaks, in compliance with wage and hour regulations, if needed.

  • Reconfigure, restrict, or close common areas and provide an alternative where physical distancing can be practiced.

  • Limit the number of individuals riding in an elevator and ensure the use of face covers.

  • Utilize work practices, when feasible and necessary, to limit the number of employees at the office at one time, such as telework and modified work schedules.

Sign Off

  • Name and Signature

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.