Title Page
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Company
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Conducted on
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Prepared by
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Company Address
Control Site Traffic
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Does facility have controlled means of entrance (single point, multiple entrances, etc..)
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Once entered facility are there sign-in stations or check points restricting access to employee workstations or production areas
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Are there controlled measures in place to minimize visitor/contractor access to facility when entering the property – escorted, PPE requirements, etc.…
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Are the visitors/contractors allowed in the facility purposes mission critical
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Are employees restricted when entering facility to a staging area.
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Are temperatures or some form of wellness check being performed prior to working
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Are visitors/contractors required to fill out wellness check or subject to a screening (temperatures, questionnaire, etc.…) prior to entering facility
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Are commercial drivers refused entry to the facility and/or their access is limited to the shipping area and kept segregated from staff?
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Are enhanced hygiene protocols for shipping/receiving areas such as personnel protective gear and enhanced cleaning conducted?
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Are handwashing/sanitizing stations readily available in common areas?
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Are all common areas sanitized by staff or outside cleaning agency on a regular basis?
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Are common areas/breakroom seating reduced in accordance with current social distancing requirements?
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Are current coronavirus exposure protocols being enforced? These include the following:<br>• Preventing immediate reentry to sites for all returning travelers from outside the normal employee basin<br>• If a test is ordered by a medical professional, are RI DOH guidelines followed with a minimum requirement to reenter of a confirmed virus free test result? https://health.ri.gov/covid/<br>• If test is positive, are the medical professional’s direction and RI DOH guidelines followed to include no reentry? https://health.ri.gov/covid/
Hygiene
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Are promotional programs around hand washing and other best practices (“Do the 5”) being utilized?
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Are enhanced cleaning of common touch points (doors, stairwell handle, light switch, time clock’s, surfaces) being conducted?
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Have increased amounts of soap, hand sanitizer and cleaning materials been procured?
Social Distancing and Reduced Density
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Are social distancing and reduced density requirements being implemented in accordance with Federal, State and local directives?
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Have areas/schedules been altered to promote social distancing requirements (e.g. work areas, break rooms, work schedules, breaktimes, or blocations)?
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If possible, are employees who can telework allowed to do so providing they maintain appropriate levels of safety and support?
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Are breaks being staggered and seating in break rooms being reduced?
On-Site Emergency Response
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Upon identification of a suspected coronavirus case, is the individual quarantined in a designated location until health officials can be contacted or the individual can safely return home or to a health facility?
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Are all staff who come in contact with the individual asked to follow the latest RI DOH health guidelines for exposure?<br>https://health.ri.gov/covid/
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Are all workspaces contacted by the individual deep cleaned? If so by whom?
Communication to Employees, Community and Customers
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Are daily updates provided to all staff on the latest facts concerning the virus in our communities, how it impacts the business and their employment being provided?
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Have chains of communication to enable rapid transmission of information to all staff without large meetings been developed?
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Have the best practices from the CDC, WHO and RI DOH been promoted across the organization?<br>CDC: https://www.cdc.gov/coronavirus/2019-ncov/infection-control/control-recommendations.html<br>WHO: https://www.who.int/<br>RI DOH: https://health.ri.gov/covid/
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Has a crisis leadership team been formed to collect and respond to concerns from employees and the community?
Sign Off
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Name and Signature
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Title
