Title Page

  • Site/Client

  • Date

  • Prepared by

  • Location

Planning Actions

  • Does your RCF have a respiratory outbreak plan that covers all the areas identified?

  • Has your RCF updated its respiratory outbreak plan this year?

  • Have the relevant health care providers/organisations in the community (e.g. associated GPs, infection control consultants) been involved in the planning process?

  • Are all RCF staff aware of the plan including their roles and responsibilities?

Staff, Resident and Family Education

  • Has your RCF staff undergone education and training in all aspects of outbreak identification and management, particularly competency in infection control?

  • Has your RCF run one or more staff education sessions?

  • Has your RCF provided resident families with information regarding prevention of transmission?

Staffing Actions

  • Does your RCF have a staffing contingency plan in case 20% to 30% of staff fall ill and are excluded for 14 days?

  • Has your RCF developed a plan for cohorting staff in an outbreak?

Stock Levels

  • Has your RCF acquired adequate stock of PPE, hand hygiene products, nose and throat swabs and cleaning supplies?

Outbreak Recognition Actions

  • Does your RCF routinely assess residents for respiratory illness, particularly for fever or cough (with or without fever)?

  • Does your RCF encourage staff to report COVID-19 symptoms during the pandemic?

  • Does a process exist to notify the facility manager and the state/territory Department of Health and Human Services as soon as practicable (and within 24 hours) of when a COVID-19 case is suspected?

Communication Actions

  • Does your RCF have a contact list for the state/territory health department and other relevant stake holders (e.g. facility GPs and infection control consultants)?

  • Does your RCF have a plan for communicating with staff, residents, volunteers, family members and other service providers (e.g. cleaners) during an outbreak?

  • Does your RCF have a plan to restrict unwell visitors entering the facility as well as limitation of well visitors during an outbreak to reduce risk of transmission both within the facility and externally (e.g. security, signage, restricted access)?

Cleaning

  • Does the plan identify who is responsible for overseeing increased frequency of cleaning, liaison with contractors or hiring extra cleaners as necessary?

Completion

  • 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.