Title Page

  • Conducted on

  • Prepared by

  • Location

Required

  • Adhere to Required COVID-Safe Practices for All Employers (p. 9).

  • Adhere to maximum occupancy and staffing limits per the State's Public Health Order.

  • If establishment also operates a space that provides in-person services to the public, adhere to Required COVID-Safe Practices for Retail Establishments (p.11).

  • Utilize signs, stanchions and/or floor decals to support 6-foot social distancing, including one-way traffic and separate entry/exit wherever possible.

  • Maintain a schedule of stringent daily cleaning and sanitizing. Clean and sanitize shared workstations between shifts.

  • Restrict use of communal dishware and provide single-use items in break rooms and cafeterias.

Best Practices

  • Install large plexiglass sneeze guards where regular interaction is common.

  • Install large dividers between workstations.

  • Provide face coverings and gloves to visitors.

  • For employees who cannot work entirely remotely, stagger work schedules to lower workplace density. Divide employees into static teams and arrange for each team to be in the office one week and working remotely for the following two weeks, for example. Avoid in-person interaction between teams.

Sign Off

  • Name and Signature

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.