Title Page
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Conducted on
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Prepared by
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Location
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DATE:
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CONTRACT / LOCATION:
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PURPOSE:
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To confirm that all appropriate precautions are implemented to prevent and control COVID-19 infection in the workplace
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DESCRIPTION
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Self-Assessment – Process in place for employees/ contractors/ visitors to self-assess for COVID-19 symptoms?
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Risk Assessment – Potential COVID-19 infection risks assessed for the site and included on site Hazard Register?
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Workplace Hygiene – Controls in place to regularly clean and disinfect high touch work surfaces and equipment (e.g. shared items, workstations, vehicles, etc.)?
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Personal Hygiene - Employees observed following basic personal hygiene measures e.g. washing hands, coughing/sneezing into a tissue etc.?
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PPE Availability - Specified PPE and designated sanitiser stations available in the workplace?
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Communications - COVID-19 awareness posters including hygiene posters placed around the workplace and toolboxes/awareness topics communicated?
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Social Distancing - Social distancing measures have been implemented in the workplace? (e.g. 2mx2m in enclosed spaces and 1.5m social distancing)
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Vehicles - Passenger restrictions have been implemented in vehicles or different transport arrangements supported by a risk assessment?
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Risk Control - Workers aware of and implementing key risk controls, including correct wearing and removing of PPE?
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Training - Employees trained in infection control processes, including correct fitting of face masks for designated tasks?
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Incident Response - Workers understand what to do with people who have potentially been exposed to a confirmed case, either close or casual contact?
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Note: All items with an assessment of “No” need 1 or more observations/actions noted in the table below. Any additional concerns/observations noted during the assessment should be noted also
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COMMENTS / OBSERVATIONS / ACTIONS REQUIRED
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ACTION LOGGED / #
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All required corrective & improvement actions are appropriate and have been responded to or raised in the relevant tracking register for further actioning
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Responsible Manager:
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Position:
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Name:
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Signature:
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Date:
