Marsh - New Normal Self Assessment

• Facility Name

• Prepared by

• Date

  Date
• Location
  Address

General

• Where are you doing this self-assessment?

  Home

  School/Campus

  Social Event

Awareness & Preparation

• PPE Readiness & Preparation

  

• What PPE is available to you?

  Select Masks & Face Shields Gloves Eye Protection (visors or goggles) Protective suit, gowns or coveralls Hand sanitizers & alcohol-based rubs None

  • Masks & Face Shields
  • Gloves
  • Eye Protection (visors or goggles)
  • Protective suit, gowns or coveralls
  • Hand sanitizers & alcohol-based rubs
  • None

• Physical Interaction & Distancing

  

• Keep in mind and exercise physical/social distancing (1-2 meters) from another person.

  Yes

  No

• Hand Hygiene Guidelines

  

• Are you aware of proper hand hygiene?

  Yes

  No

• You may wear gloves before touching objects/surfaces. If not, REMEMBER to observe proper hand hygiene.

  Yes

  No

• Respiratory Hygiene Guidelines

  

• Are you aware of proper respiratory hygiene?

  Yes

  No

• Communication

• Device(s) used for communication at WORK

  Select Radios Personal devices Company-issued devices Property-installed devices Laptops or desktops Other device(s)

  • Radios
  • Personal devices
  • Company-issued devices
  • Property-installed devices
  • Laptops or desktops
  • Other device(s)

• Device(s) used for communication at HOME

  Select Radios Personal devices Company-issued devices Property-installed devices Laptops or desktops Other device(s)

  • Radios
  • Personal devices
  • Company-issued devices
  • Property-installed devices
  • Laptops or desktops
  • Other device(s)

• As much as possible, try to avoid sharing devices to lessen physical contact.

  Yes

  No

• Regularly disinfect COMMUNAL USE devices

  Yes

  No

Other measures to consider

• Are you regularly disinfecting hands, feet & clothing after coming from any outdoor activity (work, social events & etc)?

  Yes

  No

• Indicate any symptoms you experienced in the last 48 hours.

  Select Fever or fever-like symptoms (100 F; 37.8 C or above) Cough Trouble breathing, shortness of breath or severe wheezing Chills or repeated shaking with chills Muscle aches Sore throat Congestion or Runny Nose Nausea or vomiting Diarrhea

  • Fever or fever-like symptoms (100 F; 37.8 C or above)
  • Cough
  • Trouble breathing, shortness of breath or severe wheezing
  • Chills or repeated shaking with chills
  • Muscle aches
  • Sore throat
  • Congestion or Runny Nose
  • Nausea or vomiting
  • Diarrhea

Acknowledgement

• The purpose of this assessment is to raise awareness within school grounds as well as in each home.

• I hereby confirm that I am aware of potential exposure risks and agree to follow and practice the new normal guidelines that help avoid/mitigate potential infection.

  Sign