Title Page

  • Name of Facility

  • Location
  • Conducted on

  • Prepared by

Social Distancing Plan

  • Facilities must implement all applicable measures listed below, and be prepared to explain why any measure that is not implemented is inapplicable to the facility.

Measures to Keep Protect Residents

  • Increase spacing so beds are at least 3-6 feet apart

  • Arrange beds so that individuals lay head-to-toe (or toe-to-toe), or use neutral barriers (foot lockers, curtains) to create barriers between beds

  • Move residents with symptoms into separate rooms with closed doors, and provide a separate bathroom if possible

  • Avoid housing older adults or people with underlying medical conditions in the same room as people with symptoms

  • Stagger mealtimes to reduce crowding in shared eating facilities

  • Stagger the schedule for use of common/shared kitchens

  • Create a staggered bathing schedule to reduce the amount of people using the facilities at the same time

  • Implement procedures to identify and update at least weekly the mental health resources (for example providers, pharmacies) that are available.

  • Prepare for cancellation of congregate day programs (schools, day care, senior day programs, and other day programs) and cancel them when directed to do so.

  • Reduce activities that congregate many residents at once such as “house meetings” and opt for smaller group activities

  • Describe other measures:

Measures to Protect Employee Health

  • Ensure staff are aware of sick leave policies and are encouraged to stay home if they have CLI:<br>– Feeling feverish or having a measured fever (greater than or equal to 100.4<br>Fahrenheit); OR<br>– A new (within the last 7 days) cough; OR<br>– New shortness of breath; OR<br>– New sore throat

  • Everyone who can carry out their work duties from home has been directed to do so<br>

  • All employees have been told not to come to work if sick

  • Symptom checks are being conducted before employees may enter the work space

  • All desks or individual work stations have been re-adjusted to be at least six feet apart

  • Reduce unnecessary assembly of staff (e.g., large meetings where information can be communicated by written guidance)<br>

  • Where appropriate, opt for conference calls instead of in-person meetings

  • Plan for staffing challenges

  • Instruct cleaning staff to avoid “hugging” laundry before washing it to avoid self-contamination and wash<br>their hands with soap and water or an alcohol-based hand sanitizer immediately after handling<br>infected laundry

  • Copies of this plan have been sent to employees

Measures to Improve Sanitation

  • Hand sanitizer, soap and water, or effective disinfectant is available to the public at or near the entrance of the facility, and anywhere else inside the facility or immediately outside where people have direct interactions<br>

  • If feasible, enhance ventilation in common areas such as waiting areas, TV rooms and reading rooms.

  • Disinfecting all high-contact surfaces frequently<br>

  • Describe other measures


  • Provide signages at designated entrance points to inform people that they should: avoid entering the facility if they have a cough or fever; maintain a minimum 6-feet distance from one another; and not shake hands or engage in any unnecessary physical contact.

  • Post a copy of the Social Distancing Protocol at the designated entrance points

  • Display posters within the facility promoting proper hand washing

  • Consider using bulletin boards, signs, posters, brochures, emails, phone, mailbox, or sliding information under someone’s door

Contact Person

  • You may contact the following person with any questions or comments about this plan.

  • Name

  • Contact Number

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.