COVID 19 Employer Compliance Checklist

• Project Name

• Employee Name

• Date

  Date

• Health and Safety Officer

• Location
  Address

Employer Compliance Checklist

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

  Yes

  No

  N/A

• 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?

  Yes

  No

  N/A

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• 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?

  Yes

  No

  N/A

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• 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?

  Yes

  No

  N/A

• 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?

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• 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?

  Yes

  No

  N/A

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

Sign Off

• Name and Signature

  Sign