NZ COVID-19 Level 3 Work Daily Checklist - Team / Site Leader

• Conducted on

  Date

• Prepared by

• Location
  Address

• Please remember, these are not normal times. However excessive these measures may seem, they allow our business to operate, and our economy to grow.
  
  They also save lives and are the legal requirements for working at Alert Level 3. If there is another outbreak, the entire country will return to Alert Level 4, meaning many people, our business and the economy will continue to suffer.
  
  Please answer these questions daily as honestly and accurately as possible, regardless of how it may reflect on us as your employer. We are in a battle against an invisible enemy. Therefore, it is better to err on the side of caution as much as possible.

Workplace conditions

• As far as you can see, are all work surfaces being disinfected at least once per day?

  Yes

  No

  N/A

• Are your employees washing their hands as much as is practicably possible?

  Yes

  No

  N/A

• Does your workplace have sufficient hand wash liquid or soap in the bathrooms?

  Yes

  No

  N/A

• Does your workplace have sufficient hand drying facilities in the bathrooms?

  Yes

  No

  N/A

• Does your workplace have sufficient hand sanitiser that is easily accessible for all employees outside the bathrooms?

  Yes

  No

  N/A

• Does the hand sanitiser to contain at least 60 percent alcohol content?

  Yes

  No

  N/A

• Are ANY of your employees ever working within 1 metre of a work colleague?

  No

  Yes

  N/A

• Are ANY employees having close interactions between groups of workers?

  No

  Yes

  N/A

• Are these group interactions necessary for work?

  Yes

  No

  N/A

• Please record the names of your work colleagues you are working closely with today?

  Select Employee 1 (John Smith) Employee 2 (Ian Brown) Employee 3 (Andy Johnson) Employee 4 (Sarah Green) Employee 5 (Anna Simpson) Employee 6 (Michelle Taylor) Other employee

  • Employee 1 (John Smith)
  • Employee 2 (Ian Brown)
  • Employee 3 (Andy Johnson)
  • Employee 4 (Sarah Green)
  • Employee 5 (Anna Simpson)
  • Employee 6 (Michelle Taylor)
  • Other employee

• Please list the names of the "Other" worker(s) who you are working with today?

• Have any customers been on your premises today?

  No

  Yes

  N/A

• Did ANY employees have any physical contact with these customers?

  No

  Yes

  N/A

• Did / will ANY employees go to a customer's site / residence for work today?

  No

  Yes

  N/A

• Did / will they get within 2 metres of the customer at any point in time?

  No

  Yes

  N/A

• Did / will ANY employees have to travel outside your city for work today?

  No

  Yes

  N/A

• Did / will ANY employees use public transport today to or from work today?

  No

  Yes

  N/A

• Did / will they likely sit or stand within 2 metres of another person on that public transport?

  No

  Yes

  N/A

Health

• Answer these questions for EACH employee in your team by clicking "Add Employee".

Employee

• Do you have ANY of the following 7 symptoms?<br>- cough<br>- runny nose<br>- sneezing a lot<br>- an unusually high temperature (above 38 degrees)<br>- shortness of breath<br>- sore throat<br>- temporary loss of smell

  No

  Yes

  N/A

• Please follow immediate steps for testing your employees for COVID-19.

  

• Has anyone you live with shown ANY of the following 7 symptoms in the past 24 hours?<br>- cough<br>- runny nose<br>- sneezing a lot<br>- an unusually high temperature (above 38 degrees)<br>- shortness of breath<br>- sore throat<br>- temporary loss of smell

  No

  Yes

  N/A

• Please follow immediate steps for testing your employees for COVID-19.

  

• Has anyone you work with shown ANY of the following 7 symptoms in the past 24 hours?<br>- cough<br>- runny nose<br>- sneezing a lot<br>- an unusually high temperature (above 38 degrees)<br>- shortness of breath<br>- sore throat<br>- temporary loss of smell

  No

  Yes

  N/A

• Please follow immediate steps for testing your employees for COVID-19.

  

• Has anyone you have been in contact with in the past 24 hours shown ANY of the following 7 symptoms in the past 24 hours?<br>- cough<br>- runny nose<br>- sneezing a lot<br>- an unusually high temperature (above 38 degrees)<br>- shortness of breath<br>- sore throat<br>- temporary loss of smell

  No

  Yes

  N/A

• Please follow immediate steps for testing your employees for COVID-19.

  

• As far as you know, has anyone you have been in contact with in the past two weeks tested positive for COVID-19?

  No

  Yes

  N/A

• Please follow immediate steps for testing your employees for COVID-19.

  

Sign Off

• I confirm that my answers above are 100% true and honest to the best of my knowledge and the knowledge of my team members. Please sign here with your full name and signature.

  Sign