Title Page
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Conducted on
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Prepared by
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Location
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ECC-H&S-PR-012-09 Version 3 19/2/19 approved by QSHE
Process & Procedures
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Are relevant Covid-19 updates posted on staff noticeboards?
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Ask your Supervisors have they been adequately trained on the implications of Covid-19?
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Who did you ask - Supervisors name
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Ask some of you staff member ask have you been given accurate information about ways to prevent the spread of infection?
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Who did you ask - name
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Are your staff members aware of the symptoms of Covid-19? And can they tell you them
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Symptoms of Covid-19:
The main symptoms to look out for are:
1. A cough
2. A high temperature (100.4° F or greater)
3. A shortness of breath -
Name of employee asked
Cleaning and Disinfecting Surfaces
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Have you reviewed the cleaning measures to ensure that high risk contact areas and touch points are being regularly disinfected? Is there evidence of this and do you supervisors feel it is effective
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Name of supervisor
Personal Protective Equipment (PPE) and Hand Hygiene
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Are staff members following the recommended hand washing protocol? and can they tell you the steps
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Follow these five steps every time.
1. Wet your hands with clean, running water (warm or cold), turn off the tap, and apply soap.
2. Lather your hands by rubbing them together with the soap. Lather the backs of your hands, between your fingers, and under your nails.
3. Scrub your hands for at least 20 seconds. Need a timer? Hum the “Happy Birthday” song from beginning to end twice.
4. Rinse your hands well under clean, running water.
5. Dry your hands using a clean towel or air dry them. -
Employee name
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Are staff members wearing disposable gloves or masks in the control room
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Who did you see
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Are staff members following normal preventive actions while at work including cleaning hands and avoiding touching eyes, nose, or mouth with unwashed hands?
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Do you have readily available access to Hand Sanitizer for all staff members?
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Does the Hand Sanitizer contain at least 60% alcohol content?
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Is there sufficent hand sanitizer stations avalible
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Is there sufficent signage on site
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Is there sufficnent stock of masks, gloves and sanatizer avalible
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In office areas is there sufficnet screening in place between desks and staff
Comments and Sign-off
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Any comments or issues to report?
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Add comments or issues here:
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Name & Signature