Title Page

  • Conducted on

  • Prepared by

  • Location

Preventive/Control Measures Before Entry

  • Are there signages on COVID-19 safety measures in the premises?

  • Are the signages readable and in good condition?

  • Are workers entering the workplace wearing face masks?

  • Are health declaration forms available at the entrance?

  • Are visitors to the plant accomplishing the health declaration/questionnaire?

  • Are the health declaration forms completely and properly filled up?

  • What action is taken when there are issues in the health declaration form?

  • Are body temperature measurement equipment available at the entrance?

  • Are body temperatures being checked for everyone entering?

  • What action is taken when a person has temperature above 37.5 C?

  • Is there a hand washing facility at the entrance?

  • Is the hand washing facility functional (water supply, soap availability, and hand drier)?

  • Are all people washing their hands before entering?

  • Is handwashing properly done?

  • Is there alcohol or hand sanitizer available at the entrance?

  • Are people coming in using the alcohol and hand sanitizer?

  • Is there a disinfectant foot bath at the entrance?

  • Is the foot bath in good condition and with adequate disinfectant solution (wet)?

  • Are people coming in using the disinfectant foot bath?

  • Are the users of the foot bath observing the correct length of time of stepping on the foot bath?

  • Is there an isolation area at the entrance?

  • Are people coming in observing at least 1 meter of physical distancing?

  • Are there directional signages for human traffic in the area?

  • Are the signages clear and understandable?

Preventive/Control Measures Inside Facilities and<br>Workplace

  • Are there signages on COVID-19 safety measures in the premises?

  • Are the signages readable and in good condition?

  • Are common areas and frequently handled objects disinfected at an interval of not less than 2 hours?

  • Are people in the area doing regular hand washing?

  • Is clean running water and soap available in wash rooms and toilets?

  • Are sanitizers provided in strategic areas of the location?

  • Is physical distancing of at least 1 meter being observed by people in the<br>area?

  • Are people in the area wearing face masks or appropriate personal protection?

  • Are there directional signages in the area?

  • Are the signages clear and understandable?

  • Is one-way human traffic being observed in the area?

  • Are there transparent barriers between work spaces in the area?

  • Are shared tools being disinfected before used by another person?

  • Are wastes and trash properly disposed?

  • Is the disinfection schedule of this facility/area being followed?

Minimizing Contact Rate

  • Are meetings needing physical presence kept to a minimum number of participants, and of short duration?

  • Is video-conferencing being used for lengthy discussions or meetings?

  • Are people in enclosed spaces limited to observe at least 1 meter physical distancing?

  • Are people in enclosed spaces and proximate to each other wearing face masks or appropriate protection?

  • Are there online means to help clients and internal customers needing assistance?

Information, Education, Communication and<br>Employee Awareness

  • Are there information drives and communication materials on COVID-19 that promote safety for employees?

  • Are the info drive materials clear and understandable?

  • Are the siganges readable and in good condition?

  • Are emergency contact details widely distributed and posted in strategic areas?

  • Sample 5 employees in each site and ask this question: What is the purpose of wearing face masks? The answer should be: to protect myself from exposure to the virus AND to prevent spread of the virus if ever I am a carrier. Did all the employees answer correctly?

  • Sample 5 employees in each site and ask this question: Why do we require frequent hand washing or hand sanitation? The answer should be: to prevent spread of the virus to others and to myself through the objects that I touch. Did all the employees answer correctly?

  • Sample 5 employees in each site and ask this question: What is the purpose of physical distancing? The answer should be: to minimize close contact and prevent spread of the virus to other people. Did all the employees answer correctly?

Transportation

  • Do buses and hauling vehicles have covid-19 safety signages?

  • Are the signages clear, readable, and in good condition?

  • Are buses equipped with thermal scanners or thermometers?

  • Are the thermometers functional?

  • Are passengers checked for body temperature before boarding?

  • What action is taken when a person has a temperature above 37.5 C?

  • Are buses equipped with alcohol/ hand sanitizer?

  • Are passengers using the alcohol/ hand sanitizer at time of boarding?

  • Do buses have interior barriers between passengers?

  • Are the barriers of the correct material (plastic) and in good condition?

  • Are passengers wearing face masks while inside the bus/ transport?

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.