Title Page

  • Organisation or business name

  • Owner name or site manager

  • Phone Number

  • Email address

  • Conducted on

  • Prepared by

  • Premises address

Other information

  • Australian Business Number (ABN)

  • Provide a short overview of what your business or organisation does *

Workplace physical distancing measures

  • You need to consider what measures are implemented to ensure staff and customers maintain appropriate physical distancing of 1.5 metres

  • Have you provided education on physical distancing to staff? *

  • Have you provided clear guidance on physical distancing to customers? *

  • Can physical distancing be managed in staff and common areas? *

  • Have you considered the use of technology to assist with physical distancing where possible (for example ordering online)? *

  • Will physical distancing be managed as part of any delivery service? *

  • Will physical distancing be managed when delivering or picking up goods? *

  • List the measures you will use to manage physical distancing *

Hygiene measures

  • You need to consider what measures are implemented to ensure staff and customers maintain appropriate hygiene within the business

  • Have you provided education or information on COVID-19 hygiene protocols and practices to staff and volunteers? *

  • Have you provided clear guidance on COVID-19 hygiene protocols and practices to customers? *

  • Do you have adequate supplies of cleaning and sanitiser products? *

  • Can your staff and customers wash or sanitise their hands regularly? *

  • Have you identified high touch surfaces (for example door handles, service counters) and increased your regular cleaning schedule? *

  • Do you have adequate waste management facilities including rubbish bins? *

  • List the measures you will use to manage hygiene *

Monitoring and identification of unwell staff

  • You need to consider what measures are implemented to ensure staff remain well at work.

  • Have you provided education or information about COVID-19 transmission and symptoms to staff? *

  • Do you have protocols for staff to not attend work if they are unwell? *

  • Have you provided direction to staff to seek medical advice if they have symptoms of COVID-19? *

  • List the measures you will use to manage the health of your staff *

Sign Off

  • Prepared by

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.