Title Page

  • Organisation or business name

  • Owner name or site manager

  • Phone Number

  • Email address

  • Conducted on

  • Prepared by

  • Premises address

Other information

  • Public Health registration number (if applicable)

  • Australian Business Number (ABN)

  • Type of personal service premises *

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 clients? *

  • During stage 2, will all facial treatments be removed from your menu? *

  • Do you have protocols in place to ensure clients stay for 2 hours or less? *

  • Are you managing physical distancing when picking up goods or having goods delivered? *

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

Hygiene measures

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

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

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

  • Have you provided information on COVID-19 hygiene protocols and practices to clients? *

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

  • Have you identified high touch surfaces (for example door handles, service counters, equipment) 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 employees 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? *

  • Do you have protocols for notifying health authorities of suspect COVID-19 cases? *

  • 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.