Title Page

  • Conducted on

  • Prepared by

  • Location

Preventive/Control Measures Before Entry

  • Are there signages on COVID-19 safety measures in the premises?

  • Are the signages readable and in good condition?

  • Are there directional signages for human traffic in the area?

  • Are the signages clear and understandable?

  • Are health declaration forms available at the entrance?

  • Are employees and visitors to the plant accomplishing the health declaration/questionnaire?

  • Are the health declaration forms completely and properly filled up?

  • What action is taken when there are issues in the health declaration form?

  • Are body temperature measurement equipment available at the entrance?

  • Are body temperatures being checked for everyone entering?

  • What action is taken when a person has temperature above 37.5 C?

  • Is there a hand washing facility at the entrance?

  • Is the hand washing facility functional (water supply, soap availability, and hand drier)?

  • Are all people washing their hands before entering?

  • Is handwashing properly done?

  • Is there alcohol or hand sanitizer available at the entrance?

  • Are people coming in using the alcohol and hand sanitizer?

  • Is there a disinfectant foot bath at the entrance?

  • Is the foot bath in good condition and with adequate disinfectant solution (wet)?

  • Are people coming in using the disinfectant foot bath?

  • Are the users of the foot bath observing the correct length of time of stepping on the foot bath?

  • Are people coming in observing at least 1 meter of physical distancing?

  • Are workers entering the workplace wearing face masks?

  • Is there an isolation area at the entrance?

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.