COVID Risk Assessment Tool - Workplace Readiness

• Conducted on

  Date

• Prepared by

• Location
  Address

Monitor federal, state, and local public health communications about COVID-19.

• Ensure workers have access to current information.

  Select Completed Ongoing Not Started Not Applicable

  • Completed
  • Ongoing
  • Not Started
  • Not Applicable

• Check local public health information and the CDC COVID-19 website daily, or as needed depending on local conditions.

  Select Completed Ongoing Not Started Not Applicable

  • Completed
  • Ongoing
  • Not Started
  • Not Applicable

Reinforce how employees can protect themselves and others from COVID-19 by communicating the following:

• If you have symptoms, notify your supervisor and stay home.

  Select Completed Ongoing Not Started Not Applicable

  • Completed
  • Ongoing
  • Not Started
  • Not Applicable

• If you are sick, follow CDC-recommended steps, and do not return to work until you meet criteria to discontinue home isolation.

  Select Completed Ongoing Not Started Not Applicable

  • Completed
  • Ongoing
  • Not Started
  • Not Applicable

• If you are well, but have someone in your household who has COVID-19, notify your supervisor and follow CDC recommended precautions.

  Select Completed Ongoing Not Started Not Applicable

  • Completed
  • Ongoing
  • Not Started
  • Not Applicable

• Wash hands often with soap and water for at least 20 seconds, or use hand sanitizer with at least 60% alcohol if soap and water are not available.

  Select Completed Ongoing Not Started Not Applicable

  • Completed
  • Ongoing
  • Not Started
  • Not Applicable

• Avoid touching eyes, nose, and mouth.

  Select Completed Ongoing Not Started Not Applicable

  • Completed
  • Ongoing
  • Not Started
  • Not Applicable

• Cover mouth and nose with a tissue or inside of the elbow when coughing or sneezing, immediately throw tissue in trash, then wash hands.

  Select Completed Ongoing Not Started Not Applicable

  • Completed
  • Ongoing
  • Not Started
  • Not Applicable

• Develop a cleaning and disinfecting plan.

  Select Completed Ongoing Not Started Not Applicable

  • Completed
  • Ongoing
  • Not Started
  • Not Applicable

• Clean and disinfect frequently touched objects and surfaces at the beginning and end of each shift.

  Select Completed Ongoing Not Started Not Applicable

  • Completed
  • Ongoing
  • Not Started
  • Not Applicable

• Avoid using other employees’ phones, desks, offices, or other work tools and equipment. Clean and disinfect between employees if sharing occurs.

  Select Completed Ongoing Not Started Not Applicable

  • Completed
  • Ongoing
  • Not Started
  • Not Applicable

• Avoid large gatherings, and stay at least 6 feet from others when possible.

  Select Completed Ongoing Not Started Not Applicable

  • Completed
  • Ongoing
  • Not Started
  • Not Applicable

• Use cloth face coverings (if appropriate) when social distancing is not possible, and especially in areas of with high levels of cases.

  Select Completed Ongoing Not Started Not Applicable

  • Completed
  • Ongoing
  • Not Started
  • Not Applicable

Plan for conducting daily in-person or virtual health checks (e.g., symptom and/or temperature screening) before employees enter the facility:

• Use social distancing (about 6 feet distance), barriers or partitions, and/or personal protective equipment (PPE) to protect screeners.

  Select Completed Ongoing Not Started Not Applicable

  • Completed
  • Ongoing
  • Not Started
  • Not Applicable

• If taking temperatures, use touchless thermometers.

  Select Completed Ongoing Not Started Not Applicable

  • Completed
  • Ongoing
  • Not Started
  • Not Applicable

• Consider providing multiple screening entries.

  Select Completed Ongoing Not Started Not Applicable

  • Completed
  • Ongoing
  • Not Started
  • Not Applicable

• Consider designating doorways as “entry only” or “exit only.”

  Select Completed Ongoing Not Started Not Applicable

  • Completed
  • Ongoing
  • Not Started
  • Not Applicable

• Make employee health screenings as private as possible.

  Select Completed Ongoing Not Started Not Applicable

  • Completed
  • Ongoing
  • Not Started
  • Not Applicable

• Do not determine risk based on race or country of origin; be sure to maintain confidentiality of each individual’s medical status and history.

  Select Completed Ongoing Not Started Not Applicable

  • Completed
  • Ongoing
  • Not Started
  • Not Applicable

Conduct a hazard assessment of the workplace.

• Identify potential hazards that might expose workers to COVID-19.

  Select Completed Ongoing Not Started Not Applicable

  • Completed
  • Ongoing
  • Not Started
  • Not Applicable

• Use the Worker Protection Tool to identify appropriate engineering, administrative, and personal protective equipment (PPE) options for your workplace.

  Select Completed Ongoing Not Started Not Applicable

  • Completed
  • Ongoing
  • Not Started
  • Not Applicable

Plan for what to do if an employee is sick at work.

• Immediately separate employees who appear to have symptoms from others in the workplace.

  Select Completed Ongoing Not Started Not Applicable

  • Completed
  • Ongoing
  • Not Started
  • Not Applicable

• Have a procedure for safe transport of a sick employee to home or a healthcare facility.

  Select Completed Ongoing Not Started Not Applicable

  • Completed
  • Ongoing
  • Not Started
  • Not Applicable

Develop an action plan for suspected/confirmed cases.

• If it has been fewer than 7 days since the sick employee has been in the facility:

  Select Completed Ongoing Not Started Not Applicable

  • Completed
  • Ongoing
  • Not Started
  • Not Applicable

• - Close off areas that have been used by the sick person for long periods of time (e.g., their desk or workstation).

  Select Completed Ongoing Not Started Not Applicable

  • Completed
  • Ongoing
  • Not Started
  • Not Applicable

• - Wait 24 hours (or as long as possible), then clean and disinfect the area.

  Select Completed Ongoing Not Started Not Applicable

  • Completed
  • Ongoing
  • Not Started
  • Not Applicable

• - Open outside doors and windows to increase air circulation during the waiting period.

  Select Completed Ongoing Not Started Not Applicable

  • Completed
  • Ongoing
  • Not Started
  • Not Applicable

• If it has been 7 days or more since the sick employee used the facility, additional cleaning and disinfection beyond routine efforts is not necessary.

  Select Completed Ongoing Not Started Not Applicable

  • Completed
  • Ongoing
  • Not Started
  • Not Applicable

• Determine which employees may have been exposed to the virus and may need to take additional precautions:

  Select Completed Ongoing Not Started Not Applicable

  • Completed
  • Ongoing
  • Not Started
  • Not Applicable

• - Inform employees of their possible exposure to COVID-19 in the workplace, but maintain confidentiality.

  Select Completed Ongoing Not Started Not Applicable

  • Completed
  • Ongoing
  • Not Started
  • Not Applicable

• - Most workplaces can follow the Public Health Recommendations for Community-Related Exposure.

  Select Completed Ongoing Not Started Not Applicable

  • Completed
  • Ongoing
  • Not Started
  • Not Applicable

• - Critical infrastructure workplaces can follow appropriate safety practices.

  Select Completed Ongoing Not Started Not Applicable

  • Completed
  • Ongoing
  • Not Started
  • Not Applicable

Identify a coordinator who will be responsible for COVID-19 issues and their impact at the workplace.

• Inform employees who this person is and how to communicate with that person.

  Select Completed Ongoing Not Started Not Applicable

  • Completed
  • Ongoing
  • Not Started
  • Not Applicable

Implement sick leave policies and practices that are flexible and supportive.

• Ensure sick leave policies and practices are consistent with public health guidance, follow state and federal workplace laws and policies, and are shared with employees.

  Select Completed Ongoing Not Started Not Applicable

  • Completed
  • Ongoing
  • Not Started
  • Not Applicable

• Allow employees to stay home, without penalty, to care for a sick family member or take care of children due to closures.

  Select Completed Ongoing Not Started Not Applicable

  • Completed
  • Ongoing
  • Not Started
  • Not Applicable

• If you do not offer sick leave, consider implementing non-punishing “emergency sick leave” policies.

  Select Completed Ongoing Not Started Not Applicable

  • Completed
  • Ongoing
  • Not Started
  • Not Applicable

• Do not require a COVID-19 test result or a healthcare provider’s note for employees who are sick to validate their illness, qualify for sick leave, or to return to work.

  Select Completed Ongoing Not Started Not Applicable

  • Completed
  • Ongoing
  • Not Started
  • Not Applicable

Protect higher risk employees.

• Support and encourage telework, if available.

  Select Completed Ongoing Not Started Not Applicable

  • Completed
  • Ongoing
  • Not Started
  • Not Applicable

• Consider offering vulnerable workers duties that minimize their contact with customers and other employees (e.g., restocking shelves).

  Select Completed Ongoing Not Started Not Applicable

  • Completed
  • Ongoing
  • Not Started
  • Not Applicable

Communicate supportive workplace policies. You may need to communicate with non-English speakers in their preferred languages.

• Train workers on how new policies to reduce the spread of COVID-19 may affect existing health and safety practices.

  Select Completed Ongoing Not Started Not Applicable

  • Completed
  • Ongoing
  • Not Started
  • Not Applicable

• Communicate to contractors or on-site visitors about changes to help control the spread of COVID-19.

  Select Completed Ongoing Not Started Not Applicable

  • Completed
  • Ongoing
  • Not Started
  • Not Applicable

• Create and test communication systems that employees can use to self-report if they are sick that you can also use to notify employees of exposures and closures.

  Select Completed Ongoing Not Started Not Applicable

  • Completed
  • Ongoing
  • Not Started
  • Not Applicable

Assess essential functions and the reliance that others have on your services or products.

• Prepare to change your business practices, if needed, to maintain critical operations.

  Select Completed Ongoing Not Started Not Applicable

  • Completed
  • Ongoing
  • Not Started
  • Not Applicable

• Identify alternate supply chains for critical goods/services.

  Select Completed Ongoing Not Started Not Applicable

  • Completed
  • Ongoing
  • Not Started
  • Not Applicable

• When resuming onsite business operations, prioritize job functions for continuous operations. Resume business operations in phases.

  Select Completed Ongoing Not Started Not Applicable

  • Completed
  • Ongoing
  • Not Started
  • Not Applicable

Plan for employee absenteeism spikes.

• Monitor absenteeism at work.

  Select Completed Ongoing Not Started Not Applicable

  • Completed
  • Ongoing
  • Not Started
  • Not Applicable

• Implement plans to continue essential business functions.

  Select Completed Ongoing Not Started Not Applicable

  • Completed
  • Ongoing
  • Not Started
  • Not Applicable

• Cross-train employees to perform essential functions.

  Select Completed Ongoing Not Started Not Applicable

  • Completed
  • Ongoing
  • Not Started
  • Not Applicable

Establish social distancing policies and practices.

• Implement flexible worksites, work hours, and meeting and travel options.

  Select Completed Ongoing Not Started Not Applicable

  • Completed
  • Ongoing
  • Not Started
  • Not Applicable

• Modify the workplace to increase physical space between employees, and between employees and customers, to 6 feet or more, where feasible.

  Select Completed Ongoing Not Started Not Applicable

  • Completed
  • Ongoing
  • Not Started
  • Not Applicable

• Use signs, tape marks, or other visual cues to indicate where to stand when physical barriers are not possible.

  Select Completed Ongoing Not Started Not Applicable

  • Completed
  • Ongoing
  • Not Started
  • Not Applicable

• Have employees and customers wear cloth face coverings (if appropriate) when physical barriers or social distancing is not possible.

  Select Completed Ongoing Not Started Not Applicable

  • Completed
  • Ongoing
  • Not Started
  • Not Applicable

• Discourage handshaking or other close contact.

  Select Completed Ongoing Not Started Not Applicable

  • Completed
  • Ongoing
  • Not Started
  • Not Applicable

• Deliver services remotely.

  Select Completed Ongoing Not Started Not Applicable

  • Completed
  • Ongoing
  • Not Started
  • Not Applicable

• Move the electronic payment terminal/credit card reader farther away from the cashier, if possible.

  Select Completed Ongoing Not Started Not Applicable

  • Completed
  • Ongoing
  • Not Started
  • Not Applicable

• Shift primary stocking activities to off-peak or after hours, when possible.

  Select Completed Ongoing Not Started Not Applicable

  • Completed
  • Ongoing
  • Not Started
  • Not Applicable

• Delegate authority to local managers of your business locations to take appropriate actions outlined in their COVID-19 response plans based on their local conditions.

  Select Completed Ongoing Not Started Not Applicable

  • Completed
  • Ongoing
  • Not Started
  • Not Applicable

Implement controls according to the hierarchy of controls to protect employees and the public.

• Use the Worker Protection Tool to identify appropriate engineering, administrative, and personal protective equipment (PPE) options for your workplace.

  Select Completed Ongoing Not Started Not Applicable

  • Completed
  • Ongoing
  • Not Started
  • Not Applicable

Modify ventilation systems

• Work with building maintenance staff to determine if the ventilation system can be modified to increase ventilation rates or the percentage of outdoor air that circulates into the system.

  Select Completed Ongoing Not Started Not Applicable

  • Completed
  • Ongoing
  • Not Started
  • Not Applicable

• Ensure ventilation systems operate properly and provide acceptable indoor air quality.

  Select Completed Ongoing Not Started Not Applicable

  • Completed
  • Ongoing
  • Not Started
  • Not Applicable

• Disable demand-controlled ventilation (DCV).

  Select Completed Ongoing Not Started Not Applicable

  • Completed
  • Ongoing
  • Not Started
  • Not Applicable

• Further open minimum outdoor air dampers (as high as 100%) to reduce or eliminate recirculation.

  Select Completed Ongoing Not Started Not Applicable

  • Completed
  • Ongoing
  • Not Started
  • Not Applicable

• Improve central air filtration to MERV-13, or the highest compatible with the filter rack, and seal edges of the filter to limit bypass.

  Select Completed Ongoing Not Started Not Applicable

  • Completed
  • Ongoing
  • Not Started
  • Not Applicable

Ensure the safety of the water system of your building after a prolonged shutdown.

• Follow the CDC Guidance for Building Water Systems.

  Select Completed Ongoing Not Started Not Applicable

  • Completed
  • Ongoing
  • Not Started
  • Not Applicable

Supply employees, customers, and visitors with what they need to clean hands and cover coughs and sneezes.

• Provide tissues, no-touch trash cans, and touchless hand sanitizer stations.

  Select Completed Ongoing Not Started Not Applicable

  • Completed
  • Ongoing
  • Not Started
  • Not Applicable

• Provide soap and water. If soap and water are not readily available, provide alcohol-based hand sanitizer that is at least 60% alcohol.

  Select Completed Ongoing Not Started Not Applicable

  • Completed
  • Ongoing
  • Not Started
  • Not Applicable

• Direct employees to visit CDC’s coughing and sneezing etiquette and clean hands webpage.

  Select Completed Ongoing Not Started Not Applicable

  • Completed
  • Ongoing
  • Not Started
  • Not Applicable

• Place posters that encourage cough/sneeze etiquette and hand hygiene at the entrance to and throughout your workplace (e.g., bathrooms and kitchens). Include signs for non-English speakers, as needed.

  Select Completed Ongoing Not Started Not Applicable

  • Completed
  • Ongoing
  • Not Started
  • Not Applicable

Perform routine cleaning and disinfecting.

• Follow CDC’s Guidance for Cleaning and Disinfecting to develop, implement, and maintain a plan.

  Select Completed Ongoing Not Started Not Applicable

  • Completed
  • Ongoing
  • Not Started
  • Not Applicable

• Clean all frequently touched surfaces at the beginning and end of each shift, at minimum.

  Select Completed Ongoing Not Started Not Applicable

  • Completed
  • Ongoing
  • Not Started
  • Not Applicable

• Clean dirty surfaces using a detergent or soap and water before you disinfect them.

  Select Completed Ongoing Not Started Not Applicable

  • Completed
  • Ongoing
  • Not Started
  • Not Applicable

• Disinfect using EPA-registered disinfectant that is effective against SARS-CoV-2.

  Select Completed Ongoing Not Started Not Applicable

  • Completed
  • Ongoing
  • Not Started
  • Not Applicable

• Provide disposable disinfecting wipes so employees can wipe down commonly used surfaces before each use.

  Select Completed Ongoing Not Started Not Applicable

  • Completed
  • Ongoing
  • Not Started
  • Not Applicable

• Store and use disinfectants in a responsible and appropriate manner according to the label.

  Select Completed Ongoing Not Started Not Applicable

  • Completed
  • Ongoing
  • Not Started
  • Not Applicable

• Do not mix cleaning and disinfection products together.

  Select Completed Ongoing Not Started Not Applicable

  • Completed
  • Ongoing
  • Not Started
  • Not Applicable

• Advise employees to always wear gloves and other PPE appropriate for the chemicals being used.

  Select Completed Ongoing Not Started Not Applicable

  • Completed
  • Ongoing
  • Not Started
  • Not Applicable

Limit travel and advise employees who must travel to take additional precautions and preparations.

• Minimize non-essential travel.

  Select Completed Ongoing Not Started Not Applicable

  • Completed
  • Ongoing
  • Not Started
  • Not Applicable

• Check the CDC’s Traveler’s Health Notices.

  Select Completed Ongoing Not Started Not Applicable

  • Completed
  • Ongoing
  • Not Started
  • Not Applicable

• Advise employees to check for symptoms of COVID-19 before travel.

  Select Completed Ongoing Not Started Not Applicable

  • Completed
  • Ongoing
  • Not Started
  • Not Applicable

• Ensure employees who become sick while traveling or on temporary assignment know what to do, including:

  Select Completed Ongoing Not Started Not Applicable

  • Completed
  • Ongoing
  • Not Started
  • Not Applicable

• - Call a healthcare provider for advice, if needed.

  Select Completed Ongoing Not Started Not Applicable

  • Completed
  • Ongoing
  • Not Started
  • Not Applicable

• Notify their supervisor.

  Select Completed Ongoing Not Started Not Applicable

  • Completed
  • Ongoing
  • Not Started
  • Not Applicable

• - Follow company policy for obtaining medical care when traveling outside the United States

  Select Completed Ongoing Not Started Not Applicable

  • Completed
  • Ongoing
  • Not Started
  • Not Applicable

Plan meetings and gatherings to lower risk.

• Use videoconferencing or teleconferencing, when possible.

  Select Completed Ongoing Not Started Not Applicable

  • Completed
  • Ongoing
  • Not Started
  • Not Applicable

• Cancel, adjust, or postpone large work-related meetings or gatherings.

  Select Completed Ongoing Not Started Not Applicable

  • Completed
  • Ongoing
  • Not Started
  • Not Applicable

• When videoconferencing or teleconferencing is not possible:

  Select Completed Ongoing Not Started Not Applicable

  • Completed
  • Ongoing
  • Not Started
  • Not Applicable

• - Hold meetings in open, well-ventilated spaces.

  Select Completed Ongoing Not Started Not Applicable

  • Completed
  • Ongoing
  • Not Started
  • Not Applicable

• - Continue to maintain 6 feet between people.

  Select Completed Ongoing Not Started Not Applicable

  • Completed
  • Ongoing
  • Not Started
  • Not Applicable

• Wear cloth face coverings (if appropriate).

  Select Completed Ongoing Not Started Not Applicable

  • Completed
  • Ongoing
  • Not Started
  • Not Applicable

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