Title Page
-
Name
-
Location
-
Conducted on
-
Prepared by
-
This checklist is derived from the Checklist for Individuals and Families by the Centers for Disease Control and Prevention (CDC).
https://www.cdc.gov/coronavirus/2019-ncov/community/home/checklist-household-ready.html
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*:<br>• Difficulty breathing or shortness of breath<br>• Persistent pain or pressure in the chest<br>• New confusion or inability to arouse<br>• Bluish lips or face<br>*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
Sign-off
-
Comments/Recommendations
-
Name & Signature