Title Page

  • Site/Client

  • Date

  • Prepared by

  • Location
  • This checklist is provided to assist workplaces and workers by providing best practice information for the prevention and management of COVID-19 outbreaks. This checklist captures the knowledge of experienced professionals and provides guidance on good practice based upon the available evidence at the time of completion. Readers should not rely solely on the information contained within this checklist. The checklist information is not intended to be a substitute for advice from other relevant sources including, but not limited to, advice from a health professional. Clinical judgment and discretion may be required in the interpretation and application of this checklist.


  • Identify if your facility has an outbreak using the definition in your guidelines

Implement Infection Control Measures

  • Isolate ill workers

  • Implement contact precautions

  • Provide PPE outside room

  • Display sign outside room

  • Exclude ill staff until symptom free (or if confirmed case of COVID-19, until they meet the release from isolation criteria)

  • Reinforce standard precautions (hand hygiene, cough etiquette) throughout facility

  • Display outbreak signage at entrances to workplace

  • Increase frequency of environmental cleaning (minimum twice daily)


  • Notify the appropriate Management Team

  • Notify the Human Resources Team

  • Inform all relevant workers on site or within bubble of outbreak


  • Restrict movement of staff between areas of workplace

  • Restrict visitors where practical

  • Cancel non-essential group activities during the outbreak period


  • Update the case list daily at the workplace and provide updates to the public health unit daily

  • Add positive and negative test results to case list


  • Declare the outbreak over when there are no new cases 14 days from the date of isolation of the most recent case.


  • Review and evaluate outbreak management – amend outbreak management plan if needed


  • Additional Notes

  • Sign Off

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.