Title Page

  • Project Name

  • Employee Name

  • Date

  • Health and Safety Officer

  • Location

Employer Compliance Checklist

  • 1. Have the COVID-19 guidelines been posted in a location for workers to observe?

  • 2. Have all required PPE been made available to all on-site personnel? Have all personnel been instructed on the best practices for the use of PPE prior to the start of the work shift?

  • 3. Have handwashing instructions been posted on the project site?

  • 4. For site specific project locations, have wash stations been installed?

  • 5. Has a procedure been established for workers to certify their health to their supervisor prior to the start of each shift and identify the responsible person on site to manage this provision?

  • 6. Has signage been posted to prohibit unauthorized visitors to enter the contractor field offices?

  • 7. Have jobsite cleaning and decontamination procedures been established? Have these been shared with contractor/subcontractor employees?

  • 8. Has a "No Congregation" policy been put into effect that states that individuals must implement social distancing by maintaining a minimum distance of six feet from other individuals?

  • 9. Are meetings being held via electronic means, and any required on-site meetings being held following social distancing practices including limiting attendance to 10 persons?

  • 10. Are individual crew meetings being held outdoors and following social distancing requirements?

  • 11. Are all restroom and portable restroom stations being sanitized consistent with guidance, and are these locations provided with soap, hand sanitizers and paper towels?

  • 12. Have all field office common areas been cleaned in the last 24 hours, and soap, hand sanitizer and paper towels provided?

  • 13. Have workers been instructed to bring food from home and practice appropriate hygiene while eating lunch and at breaks, including social distancing?

  • 14. Have employees been instructed about appropriate personal hygiene and staying home when either they or a family member is feeling sick?

  • 15. Are all employees driving to the jobsite/parking area in a single occupant vehicle?

  • 16. Are all employees utilizing the proper PPE for conditions where required social distancing is not achievable?

Sign Off

  • Name and Signature

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