COVID-19 Safety Plan Template

COMPANY NAME:

PLACE OF BUSINESS:

ADDRESS:

BUSINESS OWNER:

SAFETY PLAN LEAD NAME

CONTACT INFORMATION:

DATE ISSUED:

DATE UPDATED:

In response to the novel coronavirus disease (COVID-19) pandemic,

(the Company) has developed a COVID-19 Safety Plan.

This Safety Plan relies on a common understanding of a “multiple barrier approach” to reduce
exposure and transmission of the COVID-19 virus. Simply put, people will be safer and
businesses will be stronger when multiple barriers separate them from the virus.

Barriers include:
• Personal health & hygiene – be aware & stay home if you are sick and avoid touching
your face
• Hand washing - effective and frequent
• Masking – face masks as recommended by CDC, required by Washington State and
Benton-Franklin Health District
• Social distancing – aware of yourself and others, maintain 6 feet of separation
• Cleaning of workspace – effective and frequent
• Work planning – to maximize social distancing
• Workplace health screening – a collective commitment to others in the workplace
• Personal Protective Equipment (PPE) – as appropriate
• Workplace policies & procedures – to support and encourage implementation of
multiple barriers
We are currently training all workers, contractors, subcontractors, suppliers, customers, and
others who visit our business on the “multiple barrier approach” and content of the plan along
with the guidelines issued by the State of Washington (Office of the Governor) and local public
health authorities (Benton-Franklin Health District). We will be actively updating and managing
the plan and our response as we receive new information or updated guidelines.

Our Safety Plan Lead (or designees) will be providing the training on the Plan and will be
posting additional information at the work sites. The training will also include information
from the Center for Disease Control and Prevention (CDC), Department of Labor and
Industries (LNI), Department of Health (DOH), and Benton-Franklin Health District.

Training and educational documents will be provided in other languages as needed to

ensure that our entire workforce will be trained in their native language. If additional
language needs cannot be met, the Benton-Franklin Health District may assist with this
request.

This Safety Plan follows the guidelines published by the Washington State Department of
Labor and Industries, Publication F414-164-000 (04-2020).

PURPOSE OF PLAN
The purpose of this Plan is to identify and communicate the Company’s COVID-19
Safety Plan for protecting the health of all workers, customers, and anyone who visits. This
Plan is effective immediately in response to the current COVID-19 pandemic.

RESPONSIBILITY OF MANAGERS AND SUPERVISORS

The Company will designate a Safety Plan Lead and site-specific COVID-19 supervisor. If there
are multiple locations, a lead will be designated for each site. The designated supervisor will
monitor the health of workers and enforce the COVID-19 Safety Plan.

Location Designated COVID-19 Lead

*See Appendix A for table to list additional sites.

All managers, supervisors, and the COVID-19 Safety Plan Lead must be familiar with this
plan and be ready to answer questions from workers. Managers must set a good example
by following this Plan. The COVID-19 Safety Plan Lead must practice active managerial
control to ensure employee compliance with this Plan, which includes the following
actions:
 • Train all current employees on this plan immediately and train new employees
before they begin their employment
• Visually monitor employee safety behavior at regular intervals throughout the day
• Immediately correct employee behavior when they do not adhere to the safety
steps laid out in the Plan. Re-train employees who require frequent correction
• Modify the plan or process as needed to increase compliance
• Provide written and graphic materials when available to increase visibility of
policies to employees

COMMUNICATION
The Safety Plan Lead (or others as designated) will direct all communications regarding
COVID-19 and the Company’s responses, both within the Company and externally. Internal
communications will be provided via (choose one or more):

☐Email ☐In-person meetings ☐Posting to website portal

Frequency:
Location:
☐Text messages ☐Posted in communal work ☐Other:
area

Educational resources about COVID-19 illness and preparedness measures to control

exposure and spreading of the illness are available (choose one or more):

☐Posted in communal work ☐Posting to website portal ☐Other:

area

The Safety Plan Lead or designee will provide notification to workers, customers,
contractors, subcontractors, suppliers, and others visiting the business of any operational
changes and will provide frequent updates throughout the course of the COVID-19
pandemic. They will monitor for public health updates and issue advisories and alerts as
conditions change. The Safety Plan Lead or designee will notify all affected parties when
the outbreak impacts our ability to perform services, and will provide updates when the
Company’s operations resume.

RESPONSIBILITY OF WORKERS
Please be responsible for your own health and ensure you participate in our “multiple
barrier” prevention efforts while at work. To minimize the spread of COVID-19 at our
worksites, everyone must play their part. We are instituting various housekeeping,
physical distancing, and other best practices at our worksite to prevent the spread of
COVID-19. All workers must follow these practices. Specific question about this plan or
COVID-19, should be directed to your manager or supervisor.
You are expected to report to your managers or site-specific COVID-19 Lead, if you are
experiencing signs or symptoms of COVID-19, as described below.
The following symptoms are consistent with COVID-19 and may be cause for heightened
safety measures. A display of these symptoms as identified below is called “COVID-like
illness” (CLI) until an official COVID-19 test and diagnosis is made. One of the following
symptoms:
• Cough
• Shortness of breath or difficulty breathing
Or at least two of the following symptoms:
• Fever(subjective or measured)
• Chills
• Repeated shaking with chills
• Muscle pain
• Headache
• Sore throat
• New loss of taste or smell
If you have any of these symptoms or a combination of these symptoms you must stay
home. Do not come to work until you are free of symptoms for at least 72 hours, without
the use of medicine, as recommended by the CDC.
Best practices for control and prevention, regardless of exposure risk are:
• Frequently wash your hands with soap and water for at least 20 seconds. When
soap and running water are unavailable, use an alcohol-based hand sanitizer with
at least 60% alcohol
• Avoid touching your eyes, nose, or mouth
• Cover your mouth and nose with a tissue when you cough or sneeze. If you don’t
have a tissue, cough or sneeze into your elbow, not your hands. Then wash hands
or use sanitizer
 • Avoid close contact (standing within 6 feet) with others at all times
• Use a face mask or covering when you must have close contact with others

Workers are encouraged to engage the Company directly to resolve any workplace safety
concerns. Workplace safety complaints about coronavirus or other issues can be filed by calling
L&I directly at 1-800-423-7233

WORKSITE PROTECTIVE MEASURES

GENERAL SAFETY POLICIES AND PROCEDURES

• Signs will be posted at the entrance discouraging any person who is showing symptoms
of COVID-like illness from entering the business. Customers who are symptomatic can
access our services in the following ways:

• Physical Distancing Policy:

All workers and volunteers must maintain at least six feet of physical distance from each
other, when feasible. Breaks and lunches will be staggered to prevent the groupings of
staff and require a least six-feet between workers.

All meetings will be held virtually, unless physical distancing can be maintained in the
meeting room. Virtual meetings will be held by phone or video conferencing.

If shift work is necessary, the Company will require workers to remain on their
dedicated shifts. If there is a legitimate reason for a worker to change shifts, this may or
may not be accommodated to ensure the safety of all workers.

In an office setting:
Where workstations cannot be separated, barriers to create an effective 6 foot
separation will be provided. Work schedules will be staggered so workers don’t crowd
when they arrive and leave work.

o Worker Hygiene Policy:

o The Company will provide hand washing stations and hand sanitizer in the
following locations:
 Service Location Maintenance frequency
EX: Hand sanitizer Second floor break room Once per day

o If you find maintenance or servicing is required, the COVID-19 Safety Lead will be
notified immediately.
o Employees must wash their hands with warm, soapy water for 20 seconds upon
entering the worksite, before and after eating or smoking, after visiting a public
area, after touching high-use equipment (such as copier), after blowing their
nose, and prior to leaving the job-site. If soap is not available, use hand sanitizer
with at least 60% alcohol.
o Cover your cough and sneeze with tissues, or cough and sneeze into your elbow
shirt sleeve.

Visitors to the Work Place

• Entrances to the business will be controlled and monitored. Customers will be screened
for COVID-19 symptoms and required to maintain physical distancing.
• Contractors or vendors must wash or sanitize their hands upon entering the work area.

Personal Protective Equipment and Engineering Controls

• The Company will provide and train employees on the use of personal protective
equipment (PPE) such as gloves and face coverings as appropriate, for the activity being
performed.
• The Company recommends workers wear a cloth face covering if they are required to
work within six feet of another employee or customer.
• The Company will provide physical barriers or marking to indicate physical distance of 6-
feet in areas where lines or gathering may occur. Break and lunch rooms will be have
marking to show the required spacing between workers.
• When feasible, the Company will provide physical barriers to separate employee work
stations.

Worker Health Screenings

The Company will screen all workers, contractors, and subcontractors to the worksite.
Workers will use a designated facility entrance. Screening will consist of the following
(example screening questions):
YES or NO, since your last day of work, or since your last visit to this facility, have you had any of
the following:
• A new fever (100.4°F or higher), or a sense of having a fever?
• A new cough you cannot attribute to another health condition?
• New shortness of breath you cannot attribute to another health condition?
• A new sore throat you cannot attribute to another health condition?
• New muscle aches (myalgia) you cannot attribute to another health condition, or may
have been caused by a specific activity (such as physical exercise)?
• New loss of taste or smell?
• Have you been near anyone diagnosed with COVID-19?

In addition, all employees will be required to measure their temperature prior to each
work day. The Company will provide an infrared digital thermometer for employees to
screen at the entrance.

If a worker or visitor answers YES to any of the screening questions, or has a measured body
temperature of 100.4°F or above, they must immediately notify the COVID-19 Safety Lead. The
designated screener, or COVID-19 Safety Lead must:
• Review of the screening results for accuracy. If a fever was measured, re-take the
employees body temperature to verify results.
• If results appear accurate, immediately exclude the employee from work (send them
home) and provide them guidance on isolation while they are ill.
• Remind the employee to continue monitoring symptoms and encourage them to visit
their health care provider when possible.
• Remind the employee to communicate with you during their isolation. Results of COVID-
19 tests should be communicated to the COVID-19 Safety Lead for follow up.

CLEANING AND DISINFECTION

The Company has instituted regular housekeeping, including cleaning and disinfection of
frequently used equipment and high touch surfaces (door knobs, railings, etc.). Workers
should regularly do the same in their personal work areas.
Chemicals capable of disinfection must be used on surfaces to eliminate COVID-19. All
disinfectants provided by the Company will be approved for use by the EPA and can be
found at https://www.epa.gov/pesticide-registration/list-n-disinfectants-use-against-sars-
cov-2. A Safety Data Sheet will be maintained at each site at <<provide location>>. The
following chemical disinfectants have been selected for use on shared equipment and high
touch surfaces:
 Chemical Name Manufacturer Storage location
Ex: CaviWipes XL Metrex First floor janitorial closet

Shared areas such breakrooms, lunchrooms, restrooms and conference rooms will be
cleaned at least (choose one of the following):

Location Maintenance frequency Assigned to

Ex: Second floor bathroom Once per day Safety supervisor

• Cleaning supplies are available for workers throughout the worksite at the above
listed locations.
• High-touch surfaces, such as handrails, doorknobs, keyboards, mice, telephones,
elevator buttons, shared equipment and tools, pens, and clipboards should be
cleaned using disinfectants listed above.
• Each chemical has an associated “contact time” listed on the directions. Surfaces
must remain wet for this amount of time to effectively disinfect. Employees
designated to disinfect will be trained on, and adhere to, listed contact times.

EXPOSURE PLAN

Recognizing COVID-19 Symptoms

COVID-19 symptoms include a fever, persistent cough, and shortness of breath, but may
also include headache, sore throat, chills, or loss in taste or smell. If you think you have
these symptoms, contact the Safety Plan Lead (or other designee) and go home, self-
isolate, and contact your health provider. If you think someone in your work place has
these symptoms, contact the Safety Plan Lead (or other designee) on follow-up
procedures.
NOTE: Work with the Human Resource Director and local public health officials to ensure
the completion of necessary required follow-up procedures in the event of suspected
COVID-19 individual.
Response Protocol for a confirmed COVID-19 Case
In the event a worker or customer tests positive for COVID-19, the Company will perform
cleaning and disinfection of areas and buildings frequented by this individual in
accordance with CDC guidelines. The Company will contact others who may have come
into contact with this individual and follow exposure follow up actions as stated above.

Except for circumstances in which the Company is legally required to report workplace
occurrences of communicable disease, the confidentiality of all medical conditions will be
maintained in accordance with applicable law and to the extent practical under the
circumstances. When it is required, the number of persons who will be informed that an
unnamed worker has tested positive will be kept to the minimum needed to comply with
reporting requirements and to limit the potential for transmission to others. We reserve
the right to inform other workers that an unnamed co-worker has been diagnosed with
COVID-19 if the other workers might have been exposed to the disease so the workers
may take measures to protect their own health. We also reserve the right to inform sub-
contractors, vendors, suppliers, customers or visitors that an unnamed worker has been
diagnosed with COVID-19 if they might have been exposed to the disease so those
individuals may take measures to protect their own health.
APPENDIX A. Site-specific COVID-19 supervisor at multiple locations

Location Designated COVID-19 Lead

Appendix B: COVID Exposure Definitions and Procedures

Workers who have been exposed to COVID-19

Steps for workers

Do Don’t
Take your temperature before work Stay at work if you become sick
Wear cloth face covering at all times Share headsets or objects used near
the face
Practice social distancing at workplace Congregate in the breakroom or other
as work duties permit crowded spaces

Steps for employers

DO
Take workers temperature and assess symptoms before starting work
If a worker gets sick during the day, send them home immediately
Test the use of cloth face coverings to make sure they do not interfere with
workflow Increase air exchange in the building
Increase the frequency of cleaning of commonly touched surfaces
 COVID-19 Exposure Definitions & Procedures
Potential Exposure: A potential exposure means being a household contact or having
close contact within 6 feet of an individual with confirmed or suspected COVID-19. The
timeframe for having contact with an individual include the period of time of 48 hour
before the individual became symptomatic.
Confirmed COVID: A person who is confirmed by local authorities as having COVID-19.
Probable COVID: A person displaying mild respiratory flu-like symptoms that had a known
contact with a confirmed COVID-19 case or has travelled to one of the high risk areas as
defined by the CDC.
Unrelated illness: A person displaying illness unrelated to COVIC-19

COVID Symptoms (may appear 2-14 days after exposure): Fever 100.4 or higher, cough,
shortness of breath or trouble breathing, chills, repeated shaking with chills, muscle pain,
headache sore throat, new loss of taste or smell.

Self-Quarantine: Quarantine is used to keep someone who might be have been exposed
to COVID-19 away from others. Someone in self-quarantine stays separated from others.

Close Contact: Being within approximately 6 feet of a COVID-19 case for 10 minutes or
more; close contact can occur while caring for, living with, visiting, or sharing a hospital
room or other with a COVID-19 case – or– having direct contact with infectious secretions
of a COVID-19 case (e.g. being coughed on).
Self-Monitor: Individuals monitor themselves for fever by taking their temperatures twice
a day and remain alert for cough or difficulty breathing. If they feel feverish or develop
measured fever (over 100.4 degrees), cough, or difficulty breathing during the self-
monitoring period, they should not report to work and contact their supervisor.

X Date:
Employee
 Benton-Franklin Health District

COVID-19 EXPOSURE SCENARIOS & ACTIONS

This is Jane. She is an employee.

A Jane has been in Close Contact with a Confirmed COVID-19. If Jane has no symptoms she
may return to work but must wear a cloth face covering for 14 days and Self-Monitor.

This is John. He is an employee.

B John has been in Close Contact with Lauren, Lauren has had Close Contact with a Confirmed COVID-19
Case. Yesterday, Lauren developed a fever (or other COVID symptoms). Lauren is now a Probable COVID
and John may remain at work but must wear cloth face covering for 14 days and Self-Monitor.

This is Fred. He is an employee.

C Fred has been in Close Contact with Mary. Mary has spent time with a Confirmed COVID-19
case. Mary is healthy. Fred can remain at work and must Self-Monitor.

This is Tom. He is an employee.

D Tom has been in Close Contact with Bob who has recently returned from international travel.
Yesterday, Bob developed a fever (or other COVID symptoms) Bob is now a Probable COVID and Tom
may remain at work but must wear cloth face covering mask for 14 days and Self-Monitor.

This is Shawn. He is an employee.

E Shawn has been in Close Contact with Mary. Mary has recently returned from international travel, is
under Self Quarantine and healthy. Shawn can remain at work and must Self Monitor for 14 days from
the day Mary returned home.

F
This is Suzy. She is an employee.

Suzy’s son is ill. He has an ear infection, but has not had any known contact with anyone who tested
positive or is being tested for COVID-19. This is an illness case and the worker has no identifiable risk
and can remain at work.

G
This is Lisa. She is an employee.
Lisa is a Symptomatic Confirmed or Probable COVID. Lisa must NOT return to work until both:
3 days after recovery (no fever and respiratory symptoms have improved)
10 days since symptoms first started

H
This is Joe. He is an employee.
Joe's employer recently tested all their employees for COVID-19. Joe was notified by his employer that he
tested positive for COVID-19. Joe never developed symptoms of COVID-like illness. Joe must stay home
from work for at least 10 days from the date of his first positive test and self-monitor.

This is Tyler. He is a supervisor.

I
Tyler has been notified by his employee Brad that Brad had contact with a Confirmed COVID-19 case and
has now developed a fever. Tyler should send Brad home immediately and:
Disinfect Brad's work space
Identify employees who had contact with Brad for the two days prior and notify those employees, while
following all privacy guidelines, that they need to self-monitor and report to him if they develop any
COVID-like symptoms.