Title Page
-
Conducted on
-
Applicant Name and Title
-
Location
-
Establishment Name
-
Applicant Name
-
Establishment Mailing Address
-
Establishment Site Address
-
Establishment Number
Checklist
Establish protocols to maintain six feet of physical distance among employees and patrons.
-
Limit occupancy as necessary to maintain six feet physical distancing
-
Space tables appropriately apart to keep patrons six feet apart while seated and moving in and out of chairs
-
Reduce the use of waiting areas and lobbies as feasible
-
Continue to keep playground areas closed
-
Limit employee and patron contact by using a reservation or call ahead model and using contactless payment methods when possible
-
Other measure (specify)
Establish protocols to reduce the risk of sprea of the COVID-19 virus by training employees on cleaning and disinfection procedures, and protective measures.
-
Dedicate certain staff members to disinfection of high contact surfaces throughout the establishment and disinfection of tables between parties
-
Refrain from using pre-set tableware
-
Clean and disinfect coolers, to-go containers, and delivery vehicles often
-
Verify ware-washing machines are operating at the required wash and rinse temperatures and with the appropriate sanitizers each day
-
Require all employees in contact with patrons to wear cloth face coverings and gloves during their shift and change them after touching patron items
-
Recommend all employees in the dish washing room to wear face shields in addition to face coverings and gloves
-
Update employee illness policy and provide COVID-19 staff training.
-
Monitor employee health by screening employees for fever and symptoms before every shift
-
Check temperature with non-contact thermometer; if no fever, which is a temperature greater than 100.4°F, or COVID-19 symptoms are present, require workers to self-monitor and report onset of symptoms during their shift
-
Inform staff regarding when they should stay home or when they should leave work due to illness
-
Make sure a procedure is in place for contacting your local public health district if an employee is diagnosed with COVID-19
Identify how close interactions with patrons will be limited.
-
Offer online, digital, or phone-in ordering
-
Offer takeout or delivery service
-
Establish hours of operation for patrons at high-risk of severe disease
-
Limit the number of patrons in the restaurant at one time
-
Direct the flow of traffic in the restaurant to maximize space between people (e.g., lines)
-
Use signage and barrier protection to limit movement and maintain distancing
-
Describe other plans (Consider other strategies such as requiring noncash transactions, using disposable menus or menus that can be disinfected and increasing ventilation throughout the restaurant.)
Sign Off
-
Name and Signature
-
This document is a TEMPLATE EXAMPLE. Please contact your local Public Health District for the preferred form.