Green Criteria

Physical distancing maintained during break times

Satellite break rooms are established

Time clock is sanitized after each use with appropriate signage to encourage physical distancing (Visibly verified and account for a best practice)

Leadership and team meetings are coordinated with physical distancing practices

Shift exchange and cross over with proper physical distancing in place (can articulate the location of discussion)

Physical distancing in common spaces, activities, and dining room observed

Screening and Declaration

Proper use of PPE at all times

Screener asks visitors role (ex. ECP, designated caregiver, other) and has an updated list of designated caregivers/ visitors

Screener is verbally asking the questions

Temperature checks are completed (entry and exit)

One primary entry point with a dedicated screener during peak hours

Resident Temperature and Symptoms Checks

Teams can provide evidence that ALL residents temperature and symptoms checks done according to provincial directives (ON - min 2X daily; AB - with care - min 1x daily done by TM, without care - self check for symptoms at least daily, isolation - min 1x daily; BC - min 1x daily unless suspected COVID then 2x daily)

Amica Directives PPE Universal Protocols

Teams are able to articulate their practice

Daily education to LL and TMs

Leaders are monitoring proper use and informing where gaps exist, progressive discipline measures are documented

Proper PPE use is maintained outside the residence (on breaks, carpooling, waiting for screener, etc) following Amica PPE guide by role

Proper use of PPE has been communicated and signed off by all TMs (can produce evidence of such)

PPE signage throughout building; all TM break rooms, time clock, washrooms, etc.

Through contact mapping exercises, no impact to Team or residents identified due to inappropriate PPE use

PPE education and audits provided to ECPs (including private companions, designated caregivers) to support proper PPE usage across all shifts across all neighborhoods

TMs list pulled to audit all TMs over time

PPE and Hand Hygiene

PPE and HH audits submitted monthly via outbreak preparedness form in collaboration with DOW

Evidence at a minimum of 1 audit/ week per shift of days, evenings, nights in each dept completed with outcomes identified; including weekends

TM list pulled to audit all TMs over time. Team able to demonstrate audits on different TMs.

ECPs, visiting health professionals, LE vendors, salon operators, designated caregivers, etc included in hand hygiene and PPE audits

Hand Hygiene

Hand sanitizers available at all entry points to common spaces and care areas including but not limited to - front entry, screening station, concierge, bistro, entry and exit to dining room, entry to care floors, elevators, break areas, time clock, and spaced throughout care areas

*MC - if inappropriate for ABHR to be left out, process to ensure ABHR is available to all TMs and residents (ex. Personal ABHR on all TMs)

Residents are being cued to complete hand hygiene prior to dining, activities, and on entry/exit

Education on proper hang hygiene is completed regularly noting the 4 moments for hand hygiene across all depts and each shift including weekends

Hand washing is completed when ABHR is not available or when appropriate

Hand washing observed to be completed properly (at least 20 seconds, washing using warm water and soap, using paper towel to dry and turn off taps, etc)

Signage noted at all ABHR stations providing visual cues to complete hand hygiene; visible to both TMs and residents

Daily PPE inventory and secure management system

PPE tracker submitted by residence every Thursday end of day via connect form. If COM is not submitter, reviews and approves for accuracy and submits

Each week, GM/COM reviews submission for accuracy and validity with regional team

Minimum inventory level at least = to 3 days (as outlined by dashboard)

Usage within 10% of average use

Level 1 masks within 5% of expected use

Locked storage with no more than 2 people (non-wellness) managing inventory

Dedicated wellness TM 24/7 has access and is accounting for inventory with process owner

Contact mapping exercise

Each LL has proficiency in contact mapping exercise and demonstrated ability to coordinate and lead contact mapping exercises

Contact mapping exercise completed minimum of 2/month; lead by a different leader in each dept.

Effective contact mapping tool is followed which outlines all of the tools one can pull and interview techniques

Regional teams review finalized contact mapping, probing deep for commonalities and fulsome contact mapping and confirms they are using most up to date version of the effective contact mapping tool

Teams can articulated learnings, impact, and opportunities and have seminar action items on opportunities

Contact mapping results show no impact to TM and Residents due to weakness in 5 lines of defence (inappropriate PPE, lack of physical distancing, inadequate screening)

Enhanced Cleaning

Documentation of infection control cleaning (can provide evidence of)

7 days a week schedule in place

Can articulate ‘outbreak’ cleaning procedures and are executing for line listed residents

Common area 3x minimum per day

LE, bus, dining room, and bistro enhanced cleaning completed prior to/after programs and/or dining services

Shared equipment disinfected between individual use

Proper use of chemical (disinfecting solution for all surface cleaning, exception being food prep areas)


Attendance being tracked and logged for 100% of activities/ outings in provided template

Evidence of enhanced cleaning prior to programs and between programs

LE outing checklist completed including evidence of enhanced cleaning

Limit of 5 participants per outing OR as directed by bus capacity to ensure proper physical distancing guidelines

Program limits do not exceed space limits or government guidelines and ensure proper physical distancing

Process in place to disinfect equipment that may be shared outside of programming times (ex. Cards, games, library books, etc)

Resident cohort plan completed in the event we move to a high risk scenario

Common Spaces

Each common space capacity is identified and signage posted at the door

Physical distancing reminders/ signage visible for residents

Furniture is arranged to promote physical distancing

Enhanced cleaning evident 3x/day or after common space has been used (schedule for use of common areas)

Signage at elevators indicating max capacity

Dining Room/Bistro

Residents dine with the same dining partner selected. Only 2 people per table

Tables set up to support physical distancing

No communal items in dining rooms and on tables

Proper use of PPE by entire team

Enhanced cleaning of all surfaces occurring prior and after each services

Bistro staffed by TM while open

No Self Serve items available in Bistro

All bistro items individually wrapped

Physical distancing is observed in bistro with signage/reminders or decals for residents with only 1 chair per table

Evidence of enhanced sanitization

All kitchen deliveries are 'tailgate drops'. No delivery person permitted inside the building

Resident Coming and Going

Education provided to residents for coming and going - at minimum, monthly ongoing education provided to residents on physical distancing and actions to take to keep themselves safe

Mask provided to residents at frequency directed by Amica. Any additional are made available at cost

Resident Interaction Journal provided to Residents


Visitor education provided to all visitors on onsite protocols, PPE, and hand hygiene

Visitors wear PPE, physical distancing, and follow onsite protocol

Screener provides visitor education toolkit, if visit indicates. If visitor does not understand protocols at point of declaration, able to articulate the protocols

Screener able to instruct visitor on proper use of PPE

TM instructs visitors on proper donning/doffing of PPE as necessary

TM Case Management & Testing

LL contacts any isolated TMs every other day to see if their condition has changed and how they are doing

Updates TM Case Mgmt Form within shift

TMs returning to work on anticipated RTW dates

Regional Team always consulted on RTW protocol discussions and decisions

100% of symptomatic TMs immediately tested and placed in isolation

Hard copies of ALL positive TM test results are collected and place in TM medical files

Interval testing completed per regional guidelines

Saliva and Panbio Study consent for TMs

Panbio pilot and saliva based study are voluntary alternatives to the PH NP swab for routine asymptomatic surveillance testing. Consent forms are available at residence (Saliva based study)

Team is able to describe the process of obtaining consent and ensuring the consent forms are submitted with samples

Team is able to describe the process for managing testing refusal


DS recruitment: postings closed within 20 days; # of new hires in month > or = # of terms in month

Maintaining relationship with COVID contract TMs that have left; keeping them warm in case we need to recall them

Building plan on how to incrementally reduce surge labour hours, overtime; sensible, logical and able to maintain dedicated staffing within the parameters

TMs available to work hrs & hrs being scheduled as per surge labour dashboard results

Have all TMs identified in Commitment Tracker and know who can extend shifts if necessary; schedule template prepared in case of need

ECP Management

Contingency plan in place to staff for ECP hours if needed

Conversations had up front with Agencies, private companions, etc in event of outbreak

Meet at minimum monthly with Agency provider to work through staffing, troubleshoot issues, and discuss payment in case of missed care. ECP missed visit incident connect form completed. Contingency planning conversations had with resident/POA

A list of ECPs/Private companions are kept at the residence for easy contact mapping

ECPs have been trained on all COVID protocols; offered/ encouraged to participate in interval testing when available

ECP Dashboard is reviewed with Wellness Team, GM, and LL monthly


100% enrollment - all Dept schedules are published in WAA for 4 weeks upcoming

Cohorting Plans

Cohorting plan prepared in the event of outbreak

This should include a schedule/TM assignment where primary TMs are assigned to care for ill residents and well residents separately

In outbreak scenario, to the best of ability, we reduce movement of TMs between neighborhoods/floors in collaboration with PH

New Hire/LOAs Return to Work

100% of new hires and TMs returning to work have been fully trained on COVID directive and any changes to protocols

50% reduction in staffing plan

3+ agency agreements in place

Continually recruiting and receiving referrals from TMs

Received commitments from TMs of max availability if we were to suffer reduction in staffing

Schedule is prepared in event of Outbreak and/or reduction of staffing occurs

Essential tasking duties list prepared in case of non-care related duties need to be stripped away from Wellness positions and given to UTMs

TM Culture and Communication

Physically distancing daily stnd up occurring using stand up tool and being disseminated to TMs to review during crossover

Communicating updates to FAQs and TM letters, showing videos

Weekly acts of recognition/appreciation

Physician/ Medical Director Collaboration

Physician and Medical Director proactively communicated with regarding approach and treatment in the event of CV positive residents to ensure up to date treatment given as appropriate

Communication regarding our swabbing efforts and expectations around ordering physycian (all swabs must have submitter information completed)

Expectations are set up front with our physicians and the availability of emergency calls to support CV positive resident

Line List Review with Wellness/LL and CV scenario form completed

2x daily review and CV scenario connect form completed

PN review/symptom search report review

Reviewed 7 days a week by wellness team leaders for aggressive case finding (more often in case of outbreak)

PH Management and CV Testing Readiness

100% of symptomatic residents swabbed (if POA - consent received)

Swabs available onsite (max amount of swabs allowed onsite as determined by PH)

Administration prepared in advance and includes pertinent information including submitter information

Pending swabs reviews (able to articulate resident and date of swab) regularly with PH.

Daily Assessment of Isolated Residents

Symptomatic residents assessed at each shift (3x/day)

Asymptomatic - Process in place to communicate to Wellness any changes in status noted and 2x symptoms check

Health status updated to LL daily 7 days a week

Residents on Droplet Precautions

All residents as per Amica scenarios or government directives (contact mapping, exposure risk, return from hospital, move in or any atypical symptoms)

PPE signage outlining PPE requirements on the door and caddie prepared and placed in approved area

Line list is updated and all TMs made aware (communication, crossover, and daily stand up)

Please note that this checklist is a hypothetical example and provides basic information only. It is not intended to take the place of, among other things, workplace, health and safety advice; medical advice, diagnosis, or treatment; or other applicable laws. You should also seek your own professional advice to determine if the use of such checklist is permissible in your workplace or jurisdiction.