This checklist is derived from the Checklist for Individuals and Families by the Centers for Disease Control and Prevention (CDC).

Plan and Prepare

Get up-to-date information about local COVID-19 activity from public health officials

Create a household plan of action

Consider members of the household that may be at greater risk such as older adults and people with severe chronic illnesses.

Ask your neighbours what their plan includes.

Create a list of local organizations you and your household can contact in case you need access to information, healthcare services, support, and resources.

Create an emergency contact list including family, friends, neighbors, carpool drivers, healthcare providers, teachers, employers, the local public health department, and other community resources.

Choose a room in your house that can be used to separate sick household members from others.

Take everyday preventive actions

Wash your hands frequently

Avoid touching your eyes, nose, and mouth.

Stay home when you are sick.

Cover your cough or sneeze with a tissue, then throw the tissue in the trash.

Clean and disinfect frequently touched objects and surfaces. Be prepared if your child’s school or childcare facility is temporarily dismissed or for potential changes at your workplace.

Take Action

In case of an outbreak in your community, protect yourself and others

If you develop emergency warning signs for COVID-19 get medical attention immediately. In adults, emergency warning signs*:
• Difficulty breathing or shortness of breath
• Persistent pain or pressure in the chest
• New confusion or inability to arouse
• Bluish lips or face
*This list is not all inclusive. Please consult your medical provider for any other symptom that is severe or concerning.

Keep away from others who are sick

Limit close contact with others as much as possible (about 1.5 metres)

Put your household plan into action

Continue to practice everyday preventive actions

If someone in the household is sick, separate them into the prepared room

If caring for a household member, follow recommended precautions and monitor your own health

Keep surfaces disinfected

Avoid sharing personal items

If you become sick, stay in contact with others by phone or email

Stay informed about the local outbreak situation

Notify your work if your schedule needs to change

Take care of the emotional health of your household members, including yourself

Take additional precautions for those at highest risk, particularly older adults and those who have severe underlying health conditions.

Consider staying at home and away from crowds if you or a family member are an older adult or have underlying health issues

Make sure you have access to several weeks of medications and supplies in case you need to stay home

When you go out in public, keep away from others who are sick and limit close contact with others

Practice good hand hygiene

Take the following steps to help protect your children during an outbreak

Notify your child’s school if your child becomes sick with COVID-19

Keep track of school closures in your community

Discourage children and teens from gathering in other public places



Name & Signature
Please note that this checklist is a hypothetical example and provides basic information only. It is not intended to take the place of, among other things, workplace, health and safety advice; medical advice, diagnosis, or treatment; or other applicable laws. You should also seek your own professional advice to determine if the use of such checklist is permissible in your workplace or jurisdiction.