ABC OrganizationCOVID-19 Safety Plan Sample – New York

DATEVersion

This template is provided by Lisa Olszak Zumstein of Olszak ConsultingThere is no cost for use or adaptation. However, before adapting for your organization, please consult the CDC, New York

Department of Health and Human Services (or your state department of health and human services) and OSHA for updates to COVID-19 information and safety practices.

If you have found this template helpful, please let Lisa know at lolszak@olszak.com

ABC OrganizationCOVID-19 Safety Plan

TABLE OF CONTENTS

INTRODUCTION.....................................................................................................................................................1

1. IDENTIFY DESIGNATED REPRESENTATIVE (TITLE AND/OR NAME).............................................1A. RESPONSIBLE FOR COMPLIANCE.........................................................................................................................................B. IDENTIFY PROCEDURE WHICH THE DESIGNATED REPRESENTATIVE WILL IMPLEMENT TO SCREEN EMPLOYEES

FOR POTENTIAL COVID-19 EXPOSURE..............................................................................................................................C. LIST AVAILABLE KEY PERSONNEL, CHAIN OF COMMAND AND CONTACT INFORMATION...................................................

2. PERSONAL (EMPLOYEE) RESPONSIBILITIES........................................................................................1A. ORGANIZATION POLICY ADDRESSING EMPLOYEE HYGIENE, ILLNESS OR COVID-19 EXPOSURE.......................................

3. SOCIAL DISTANCING.....................................................................................................................................2

4. JOBSITE/OFFICE BEST PRACTICES...........................................................................................................3A. PROJECT SITE CLEANING PROTOCOL..................................................................................................................................B. OPERATION SPECIFIC PROTOCOLS AS NEEDED WHERE SOCIAL DISTANCING IS NOT FEASIBLE (I.E. ENGINEERED

SOLUTION OR OTHER METHODOLOGY TO COMPLY WITH CDC GUIDELINES)....................................................................C. WORK AT PARTNER SITES..................................................................................................................................................

5. MANAGING SICK EMPLOYEES...................................................................................................................4A. PROCESS ADDRESSING EMPLOYEES THAT DEVELOP POTENTIAL COVID‐19 SYMPTOMS WHILE AT WORK

(FEVER, COUGH, SHORTNESS OF BREATH)..........................................................................................................................B. PROCESS FOR MANAGING EMPLOYEES BEFORE RETURNING TO WORK...............................................................................C. PROCESS FOR RESPONSE TO EMPLOYEE NOTIFYING EMPLOYER OF POSITIVE TEST RESULT FOR COVID‐19.....................D. SAME PROCESS AS SECTION 5.C ABOVE IS TO BE FOLLOWED IF AN EMPLOYEE IS EXPOSED TO A PERSON WITH

A POSITIVE TEST RESULT OUTSIDE OF THE PROJECT SITE AND/OR OFFICE.........................................................................

6. TRAINING, EDUCATION, AND COMMUNICATION................................................................................5A. PROCESS TO INFORM AND EDUCATE ALL EMPLOYEES OF INFORMATION CONTAINED IN THE SUPPLEMENTAL

COVID‐19 SAFETY PLAN PRIOR TO CONTINUATION OF PROJECT DELIVERY FIELD ACTIVITIES. INCLUDE PROPOSED TRAINING..........................................................................................................................................................

7. RESOURCES.......................................................................................................................................................5A. CENTERS FOR DISEASE CONTROL & PREVENTION (CDC), OCCUPATIONAL SAFETY & HEALTH

ADMINISTRATION (OSHA), PENNSYLVANIA DEPARTMENT OF HEALTH...........................................................................

LIST OF APPENDICES

APPENDIX A – COVID-19 Employee Daily ChecklistAPPENDIX B – Mandatory Safety Talk: Wearing Mask, Corona Virus (COVID-19)APPENDIX C – General COVID-19 Safety Guidance Return to Work Guidelines APPENDIX D – New York Department of Health Printable Materials

This template is provided by Lisa Olszak Zumstein of Olszak ConsultingThere is no cost for use or adaptation. However, before adapting for your organization, please consult the CDC, New York

Department of Health and Human Services (or your state department of health and human services) and OSHA for updates to COVID-19 information and safety practices.

If you have found this template helpful, please let Lisa know at lolszak@olszak.com

i

ABC OrganizationCOVID-19 Safety Plan

APPENDIX E – Employee Acknowledgement

This template is provided by Lisa Olszak Zumstein of Olszak ConsultingThere is no cost for use or adaptation. However, before adapting for your organization, please consult the CDC, New York

Department of Health and Human Services (or your state department of health and human services) and OSHA for updates to COVID-19 information and safety practices.

If you have found this template helpful, please let Lisa know at lolszak@olszak.com

ii

ABC OrganizationCOVID-19 Safety Plan Sample – New York State

Introduction

ABC Organization (ABC) COVID-19 Safety Plan is designed to guide staff, board and other stakeholders with whom with have interaction (residents, businesses, vendor, community partners, etc.,) on our commitment to decrease the spread of the COVID-19 virus.

This Safety Implementation Plan is intended as a detailed guide but is not all inclusive. Each ABC employee must exercise their best judgement to align with the intent of this document to avoid risk of exposure to the COVID‐19 virus and to help prevent the transmission of the virus to others. This Plan is based on the current available information from the CDC, OSHA and New York Department of Health.

1. Identify Designated Representative (Title and/or Name)

a. Responsible for compliance.

Ms. John Smith, Office and Property Manager (jsmith@abc.org) is designated as the COVID‐19 Designated Representative for these guidelines and will be responsible for compliance of ABC staff, board and other stakeholders.

b. Identify procedure which the designated representative will implement to screen employees for potential COVID-19 exposure.

Prior to departing from home, each employee is to complete a self‐ assessment utilizing the COVID-19 Employee Daily Checklist (see Appendix A).

If any staff answers “Yes” to any of the questions in the COVID-19 Employee Daily Checklist, they should remain home and contact their immediate supervisor, followed by Ms. Smith, and follow the procedures in Section 5, Managing Sick Employees.

c. List available key personnel, chain of command and contact information.

i. Ms. Tamara Jones, Executive Director, tjones@abc.org

ii. Mr. John Smith, Office and Property Manager (jsmith@abc.org) COVID-19 Designated Representative

2. Personal (Employee) Responsibilities

a. ABC policy addressing employee hygiene, illness or COVID-19 exposure.

Prior to departing from home, each employee is to complete a self‐ assessment utilizing the COVID-19 Employee Daily Checklist (see Appendix A).

If any staff answers “Yes” to any of the questions in the COVID-19 Employee Daily Checklist, they should remain home and contact their immediate supervisor, followed by Ms. Smith, and follow the procedures in Section 5, Managing Sick Employees.

Each employee physically present at the home office and/or at a project site will be required to review the following, and be requested to perform Self‐ Monitoring, including:

i. Remind and encourage frequent hand washing (or use of hand sanitizer when soap and water are not available) and good hygiene practices. Refer to Appendix I, COVID-19 Hygiene and Cleaning Best Practices.

P a g e 1 | 19

ABC OrganizationCOVID-19 Safety Plan Sample – New York State

ii. Face coverings will be required when interacting with other employees or individuals in close proximity (greater than 6 feet).

Employees can use their own face coverings (i.e. bandanas, cloth mask)

ABC will make face coverings available to its employees or consumers.

iii. Cough or sneeze into a tissue, fold and dispose immediately. If tissue is not available, use your elbow. Wash elbow and/or clothing immediately upon access to soap and water or laundry.

iv. Wash hands often with soap and water for at least 20 seconds. Use an alcohol‐based hand sanitizer, containing minimum 60% alcohol, if soap and water are not available.

v. Avoid touching your eyes, nose, and mouth.

vi. Clean surfaces frequently touched such as equipment, cell phones, computers, and tablets.

vii. If you are at home and display flu like symptoms (fever, cough, breathing difficulty, vomiting, diarrhea, etc.), stay home and follow the procedures in Section 5, Managing Sick Employees.

viii. If you are at work and display flu like symptoms (fever, cough, breathing difficulty, vomiting, diarrhea, etc.), inform your supervisor, go home, and follow the procedures in Section 5, Managing Sick Employees.

ix. For any employees who are higher risk for serious illness from COVID-19 because of age or because of a serious long-term health problem, it is important for them to take actions to reduce the risk of getting sick with the disease as per CDC guidance - https://www.cdc.gov/coronavirus/2019-ncov/specific-groups/high-risk-complications.html.

3. Social Distancing

ABC employees will be required to review the following and be requested to follow Social Distancing: Staying Away from Close Contact in public places, including the home office and project sites, as noted below.

i. Limit your exposure and keep your distance (at least 6 feet) from others (co‐workers, consumers, vendors, contractors, residents and business owners, project delivery drivers from material suppliers, etc.).

ii. Avoid physical contact such as hand-shaking and other contact greetings.

iii. Do not use other workers’ phones, desks, offices, or other work tools and equipment unless required due to emergency. Use hand sanitizer or disinfectant wipes, if available.

iv. Perform as much work as possible at your assigned work area when at the home office. Charge your electronic devices (laptop, cell phone, etc.) every night so that they are available when conducting off-site work.

v. Until directed otherwise, staff and other organizational meetings should be virtually hosted (conference or video calls). If a meeting must occur, it should occur outside or in a large conference room where appropriate social distancing guidelines can be followed.

P a g e 2 | 19

ABC OrganizationCOVID-19 Safety Plan Sample – New York State

vi. Review and be aware of other stakeholders’ health and safety guidelines specific to COVID‐19 and be sure all appropriate measures are being followed.

4. Jobsite/Office Best Practices

Install "COVID-19 Safety Plan in effect" sign at location office(s) and jobsite. Jobsite may include community gardens, vehicles, job sites, or other off-site work areas.

Install CDC posters that encourage staying at home when sick ( https://www.cdc.gov/nonpharmaceutical-interventions/pdf/stay-home-youre-sick-item5.pdf ), cough and sneeze etiquette ( https://www.cdc.gov/flu/pdf/protect/cdc_cough.pdf ) , and hand hygiene (https://www.cdc.gov/handwashing/materials.html), where applicable.

a. Project site cleaning protocol.

i. Prior to starting off-site work each day, the project manager shall hold a pre‐activity/safety talk to discuss the COVID‐19 Safety Guidance and ask if anyone is feeling ill. If “yes”, follow the directions listed under Section 5, Managing Sick Employees.

ii. All off-site personnel shall maintain social distancing guidelines set by the CDC as much as practical. Where possible, employees shall travel separately the project site.

iii. All equipment and any surfaces that are used regularly during the day should be cleaned with disinfectant wipes during the course of the day.

iv. Off-Site cleaning operations should include the following at a minimum:

Personal vehicle cleaning will be performed by each individual at the end of each shift.

Utilize disinfecting wipes to clean high contact areas such as: steering wheel, gear shift knob, radio dials, door handle, seat belts, buckles, etc.

Personal protection equipment (PPE) should not be shared between team members.

PPE, at a minimum, should be fully disinfected, inside and outside, after the end of each shift.

Work clothes should be removed as soon as practical after each shift and properly washed prior to being used again. If additional safety equipment is required, contact your supervisor

Shared equipment, such as program tools or aids, shall be disinfected before and after every use using disinfectant wipes.

b. Operation specific protocols as needed where social distancing is not feasible (i.e. Engineered solution or other methodology to comply with CDC Guidelines).

i. Vehicle occupancy should be limited to one person per vehicle when possible. If required, two people may occupy a vehicle but use diagonal seating to maximize distance between individuals and do not use recirculating ventilation.

ii. All project or program documentation is to be completed electronically, if feasible, and sent via email to necessary personnel.

P a g e 3 | 19

ABC OrganizationCOVID-19 Safety Plan Sample – New York State

iii. Electronic paperwork can be forms filled in on the computer, scans, photos of documents or other methods as necessary. If electronic paperwork is not practical, contact with the hard copy documentation (such as forms that need signed) shall be limited to the employee responsible for preparing the documentation. This employee should make all necessary scans of the hard copy documentation and where an original signature is not needed, distribute them electronically. Minimize the number of paper copies.

iv. Paper copies of and other physical documents should not be shared.

v. Any required meetings should be held in a virtual setting. If a field meeting is required, the meeting should be held outdoors practicing social distancing protocol

vi. If any operation is identified that requires two people to be within 6 feet of each other (i.e. to perform plantings or outdoor camp activities), PPE will be required based on the hazard.

c. Work at Partner Sites.

i. Prior to leaving the home or office, ABC employees must contact the partner site representative and obtain an electronic copy of their COVID-19 safety plan or practices.

ii. ABC employees must review and assure compliance with the Partner specific COVID-19 safety plans and practices

5. Managing Sick Employees

a. Process addressing employees that develop potential COVID‐19 symptoms while at work (fever, cough, shortness of breath).

i. If any staff member develops COVID‐19 symptoms while at work they should immediately separate themselves from the work area, return to their vehicle and immediately report the symptoms to their supervisor, followed by Mr. Smith via phone (888-333-4444).

The Supervisor will gather the following information at a minimum:

What symptoms is the employee experiencing?

When did symptoms begin?

What operations has the employee been near?

What other individuals has the employee been in close proximity to within the past 14‐days?

ii. Employee will be sent home and asked to be tested for COVID‐19 and report results to their supervisor, followed by Mr. Smith.

iii. Mr. Smith will notify the Executive Director.

iv. Employees identified as having been in proximity to symptomatic employee will be notified and asked to self‐quarantine for 14 days. The identity of symptomatic employees will not be disclosed, in accordance with HIPAA requirements.

v. The employee shall coordinate with their supervisor for managing time-off related to COVID-19, as necessary.

P a g e 4 | 19

ABC OrganizationCOVID-19 Safety Plan Sample – New York State

b. Process for managing employees before returning to work.

i. Employee may return to work after 14‐day quarantine or after 72 hours with negative test result and symptom free. The employee must submit documentation from a healthcare provider clearing their return to work.

ii. If an employee has tested positive for COVID‐19, a doctor’s note of release is required in addition to 72 hours of symptom free status.

c. Process for response to employee notifying employer of positive test result for COVID‐19.

i. Employee to notify their supervisor, followed by Ms. Smith, immediately upon receipt of test result.

ii. ABC Executive Director will be informed of the positive test and will then notify other outside agencies, consumers and partners, as necessary.

d. Same process as Section 5.c above is to be followed if an employee is exposed to a person with a positive test result outside of the project site and/or office.

6. Training, Education, and Communication

a. Process to inform and educate all employees of information contained in the COVID‐19 Safety Plan. Include proposed training.

i. Install CDC posters that encourage staying at home when sick, cough and sneeze etiquette, and hand hygiene, where applicable.

ii. ABC will provide employees with key CDC recommendations, including:

How to Protect Yourself & Others (https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/prevention.html)

If You Are Sick or Caring for Someone , https://www.cdc.gov/coronavirus/2019-ncov/if-you-are-sick/index.html

COVID-19 Frequently Asked Questions , https://www.cdc.gov/coronavirus/2019-ncov/faq.html

People Who Are at Higher Risk for Severe Illness , https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/people-at-higher-risk.html

iii. Training will be conducted by the Designated Representative and include:

Identify Designated Representative

Personal (Employee) Responsibilities

Social Distancing

Off-Site/Office Best Practices

Managing Sick Employees

P a g e 5 | 19

ABC OrganizationCOVID-19 Safety Plan Sample – New York State

And where to obtain additional information on COVID‐19

iv. Employees will need to review this plan and complete the Acknowledgement letter (see Appendix I) prior to resuming work at the home office and/or jobsite.

7. Resources

a. Centers for Disease Control & Prevention (CDC), Occupational Safety & Health Administration (OSHA), New York Department of Health.

i. Throughout development of this Supplemental COVID-19 Safety Plan, ABC has used CDC, OSHA and New York Department of Health guidelines to dictate project specific protocols that are to be followed. ABC will continue to reference the guidelines along with local mandates to stay current with the COVID‐19 guidelines and mitigation methods. Current references to various guidelines can be found at the following links:

Hand Washing: https://www.youtube.com/watch?v=d914EnpU4Fo&feature=youtu.be

CDC Handout: https://www.cdc.gov/coronavirus/2019-ncov/downloads/stop-the-spread- of-germs.pdf

If sick: https://www.cdc.gov/coronavirus/2019-ncov/downloads/sick-with-2019-nCoV-fact-sheet.pdf

Full List of EPA Disinfectants: https://www.epa.gov/pesticide-registration/list-n-disinfectants-use-against-sars-cov-2

CDC: Cleaning and Disinfecting Surfaces: https://www.cdc.gov/coronavirus/2019-ncov/prepare/cleaning-disinfection.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fcoro navirus%2F 2019-ncov%2Fcommunity%2Fhome%2Fcleaning- disinfection.html

Coronavirus Q&A from the World Health Organization (WHO): https://www.who.int/news-room/q-a-detail/q-a-coronaviruses

Department of Labor OSHA Guidance on Preparing Workplaces for COVID-19: https://www.osha.gov/Publications/OSHA3990.pdf

OSHA Issues New COVID-19 Preparedness Guidance for Employers: https://www.osha.gov/pls/publications/publication.searchresults?pSearch=3990

OSHA reminds employers COVID-19 is a recordable illness: https://www.businessinsurance.com/article/20200311/NEWS06/912333495/OSHA-reminds-employers-COVID-19-is-a-recordable-illness-coronavirus

New York Department of Health Information on Novel Coronavirus, https://coronavirus.health.ny.gov/home

Governor Cuomo announced "Matilda’s Law" – a guideline – to protect New Yorkers age 70+ and those with compromised immune systems https://coronavirus.health.ny.gov/protect-yourself-and-your-family-coronavirus-covid-19

NYS COVID-19 Hotline: 1-888-364-3065

P a g e 6 | 19

ABC OrganizationCOVID-19 Safety Plan Sample – New York State

New York Department of Health Department Protect Yourself from COVID-19 Translations Posters (See Translations on this page, https://coronavirus.health.ny.gov/protect-yourself-and-your-family-coronavirus-covid-19)

COVID-19 Testing in New York, https://coronavirus.health.ny.gov/covid-19-testing

New York State COVID-19 Information for Providers, https://coronavirus.health.ny.gov/information-healthcare-providers

New York State Printable Materials and Posters, https://coronavirus.health.ny.gov/system/files/documents/2020/04/13067_coronavirus_protectyourself_poster_042020.pdf

New York State Local Health Departments, www.nysacho.org/directory/

New York Department of Health COVID-19 Frequently Asked Questions 4/15/20, (https://coronavirus.health.ny.gov/system/files/documents/2020/04/doh_covid19_faqs_updated_041720_2.pdf

P a g e 7 | 19

ABC OrganizationCOVID-19 Safety Plan Sample – New York State

APPENDIX A – COVID-19 Employee Daily Checklist

Questions: Yes/No

1. Have you experienced any cold or flu-like symptoms within the last 14 days?

2. Have any of your immediate family members experienced any cold or flu-like symptoms

within the last 14 days?

3. Have you, or anyone in your family or anyone you have been in close contact with, been in

contact with a person that has tested positive for COVID-19?

4. Have you been medically directed to self-quarantine due to possible exposure to COVID-19?

5. Are you having trouble breathing or have you had flu-like symptoms within the past 48

hours, including: fever, cough, or shortness of breath?

Comments:

If you answered “Yes” to any of the above questions, immediately do the following:

1. Do not report to your work site and leave the workplace immediately.

2. Call your supervisor to inform them of your situation.

3. Do not return to work until 72-hours after you are free from a fever or signs of a fever without the use of fever reducing medication.

Additional safety reminders:

1. Do not share any items with any fellow employees under any circumstances.

2. Stay a minimum of 6 feet away from any other person.

3. Do not congregate with others.

4. Work remotely when possible.

P a g e 8 | 19

ABC OrganizationCOVID-19 Safety Plan Sample – New York State

APPENDIX B – Mandatory Safety Talk: Wearing Mask, Corona Virus (COVID-19)

My Mask Protects You, Your Mask Protects Me

Wearing a mask alone is not effective in reducing transmission of COVID-19, but the recommendations should be followed by every employee who potentially could be pre-symptomatic to help slow the spread of and minimize exposure to COVID-19.

How to obtain a mask

ABC is currently working to procure bandanas as well as cloth masks to be distributed to employees Employees may choose to provide their own covering (mask, bandana, gaiter/buff, etc.) Employees may reference the CDC website on how to make a mask

https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/diy-cloth-face-coverings.html Employees may check with community centers/groups that may be making masks

NOTE: All face coverings must follow working rule protocols in representing ABC in a positive manner. Employees will be responsible for cleaning masks or bandanas.

Why wear a homemade mask

Homemade masks protect everyone else from the droplets created by the wearer, it is important that as many people as possible wear these masks when leaving their homes. This helps prevent those who may be infectious but are only mildly symptomatic or not symptomatic from spreading the virus to others in the workplace and in the community. When in the office or a work site, masks:

o Must be worn when in a vehicle with anothero Must be worn while in group of other individuals or in close proximity of other workerso May be removed when driving separately or physically separated

Best Practices for homemade masks (fabric or cloth):

o Consider buying materials online to avoid exposure in public places;o Purchase masks made by small businesses, save medical masks for health care workers;o Before putting on a mask, clean hands with alcohol-based hand rub or soap and water;o The mask should fit snugly around the mouth and nose;o If the mask has a metal wire it should be fitted snuggly to the bridge of the nose.o Avoid touching the mask while using it,o Made out of two layers of tightly woven 100% cotton fabric;o Be discarded or washed after every use;o Should not be worn damp or when wet from spit or mucus;o To remove the mask: remove it from behind, do not touch the front of mask;o The wearer should immediately wash their hands with soap and water for 20 seconds after removing the

mask.How to wear face cover

o fit snugly but comfortably against the side of the faceo be secured with ties and ear loopso include multiple layers of fabrico allow for breathing without restrictiono be able to be laundered and machine dried without damage or change to shape

P a g e 9 | 19

ABC OrganizationCOVID-19 Safety Plan Sample – New York State

APPENDIX C – General COVID-19 Safety Guidance Return to Work Guidelines

COVID-19 Safety Guidelines: As the Commonwealth responds to the unprecedented disruptions being caused by the COVID-19 outbreak, the following information represents the minimum requirements for return to work guidance:

A. Personal Responsibilities:• It is critical that employees NOT report to work while they are experiencing illness symptoms such as

fever, cough, or shortness of breath. Employees should seek medical attention if they develop symptoms.

Employees developing emergency warning signs for COVID-19 should get medical attention immediately. Emergency warning signs include*: Trouble breathing, 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 symptoms that are severe or concerning.

B. Wearing Masks• All employees must secure a mask to wear in the workplace. Surgical masks are for health care

professionals and should not be worn in the work environment. ABC is in the process of procuring cloth masks and/or bandanas for employees working in office and field operations. Employees may choose to provide their own covering (mask, bandana, gaiter/butt, etc.) When wearing masks, they must:o Fit snug but comfortably against the side of the faceo Be secured with ties and ear loopso Include multiple layers of fabrico Allow for breathing without restrictiono Be able to be laundered and machine dried without damage or change to shape

Wearing a mask alone is not effective in reducing transmission of COVID-19, but the recommendations should be followed by every employee who potentially could be pre-symptomatic to help slow the spread of and minimize exposure to COVID-19.

C. COVID19 Hygiene and Cleaning Best Practices: Cover your mouth and nose with a tissue or your elbow when coughing or sneezing. This may prevent

those around you from getting sick. The Avoid touching your face with unwashed hands. COVID-19 is commonly spread when a person

touches something that is contaminated with the virus and then touches their eyes, nose, or mouth. Upon arrival at the worksite and prior to departing clean hands as recommended. Instruct all employees to clean their hands often with an alcohol-based hand sanitizer that contains at

least 60-95% alcohol or wash their hands with soap and water for at least 20 seconds. It is recommended to use soap and water when hands are visibly dirty.

Do not congregate in lunch areas or in groups of more than ten (10) people and continue to maintain ideally six (6) feet of social distancing.

Use proper disinfecting methods between staff if work/office tools are shared. Personal Protection Equipment (PPE)

o Do not share personal protection equipment (PPE).o Sanitize reusable PPE per manufacturer’s recommendation prior to each use.o Throw away disposable PPE

Utilize disposable gloves where appropriate; instruct workers to wash hands before putting on the gloves and after removing the gloves.

P a g e 10 | 19

ABC OrganizationCOVID-19 Safety Plan Sample – New York State

Disinfect reusable supplies and equipment. Provide routine cleaning on frequently touched surfaces (such as: doorknobs, keyboards, counters, first

aid kits, interior cab of vehicles/equipment, door handles and other surfaces). Do not drink directly from water fountains. Utilize hand towels and wipe down all water coolers after

use. Identify specific locations and practices for daily trash such as: paper, hand towels, food containers,

hand rubs, etc. Instruct workers responsible for trash removal in proper PPE/hand washing practices. Utilize disposable hand towels and no-touch trash receptacles. It is recommended that employees limit stops when traveling between their home and their worksite.

D. Workplace Cleaning Clean and disinfect shared workspaces and surfaces often. Routinely clean all frequently touched

surfaces in the workplace, such as tools, workstations, countertops, doors, and doorknobs. Below is a list of a few common cleaners that the EPA has determined are strong enough to ward off

COVID-19. Reference SDS sheets and utilize appropriate PPE when mixing chemicals:o Clorox Multi Surface Cleaner + Bleacho Clorox Disinfecting Wipeso Clorox Commercial Solutions® Clorox® Disinfecting Sprayo Lysol Brand Heavy-Duty Cleaner Disinfectant Concentrateo Lysol Disinfectant Max Cover Misto Lysol Brand Clean & Fresh Multi-Surface Cleanero Purell Professional Surface Disinfectant Wipeso Sani-Prime Germicidal Spray

If disinfecting wipes are not available, a bleach water mixture can be sprayed and wiped down to clean all flat surfaces.

The CDC recommends preparing a bleach solution by mixing (use appropriate PPE):o 5 tablespoons (1/3rd cup) bleach per gallon of water oro 4 teaspoons bleach per quart of watero 1 cup bleach per 3 gallons of water

Disinfecting Procedures for Common ItemsSurface Object Procedure Special

ConsiderationsFrequency Cleaner Type

Horizontal Surfaces Clean surfaces touched by hands at least daily Clean when soiled

Use soap and water or a detergent/ disinfectant depending on the nature of the surface and the type and degree of contamination

At least twice a day and when known to be contaminated.

Surface Disinfectant Spray or Hard Surface wipes

Walls, Blinds, Curtains

Should be cleaned regularly with a detergent especially when visibly soiled.

Clean when visibly soiled

Surface Disinfectant Spray

Floors Thorough regular cleaning. Clean when soiled.

Use double bucket moping method (e.g. one bucket clean and one to rinse)

Clean daily Hot Water with 50:1 Bleach mixture

P a g e 11 | 19

ABC OrganizationCOVID-19 Safety Plan Sample – New York State

Surface Object Procedure Special Considerations

Frequency Cleaner Type

Carpets, Upholstery Should be vacuumed regularly and shampooed as necessary

Vacuum daily Regular filtered vacuum sweeper.

Tools Should be regularly cleaned, disinfected with low level disinfectant, thoroughly rinsed and dried

Consider implementation of limited tool sharing.

Clean after every use.

Surface Disinfectant Spray or Hard Surface wipes

Toilets Thorough regular cleaning Clean when soiled.

Special cleaning procedures are not necessary.

Clean daily Surface Disinfectant Spray

Vehicles, Equipment

Clean after each use of a vehicle. Concentrate on steering wheel, hand brake, gear shift lever, door handles etc.

Air conditioner/ heater should be turned off during cleaning.

Clean daily or each time someone new uses vehicle

Surface Disinfectant Spray or Hard Surface wipes

Electronic Devices Thoroughly wipe all surfaces paying particular attention to knobs, buttons, microphones and surfaces that are touched frequently

Consider implementation procedure to limit sharing of radios and other electronic devices.

Clean after each use or between use if passed between employees

Hard Surface Wipes

E. Workplace/Office Practices Install "COVID-19 Safety Plan in effect" sign at building entrance and reasonable site locations. Designated representatives should ask the following questions to employees prior to entering the

workplace. If they answer “yes” to any, they should be asked to leave the workplace immediately. Anyone asked to leave should not return to work until 72-hours after they are free from a fever or signs of a fever without the use of fever-reducing medication.o Have you, or anyone in your family or any one you have been in close contact with, been in contact

with a person that has tested positive for COVID-19?o Have you been medically directed to self-quarantine due to possible exposure to COVID-19?o Are you having trouble breathing or have you had flu-like symptoms within the past 48 hours,

including: fever, cough, or shortness of breath? Using an infrared medical thermometer is optional. If a thermometer is available at the workplace,

the employee shall take their own temperature and advise the observer of the reading. If an infrared thermometer is being utilized in an office setting, all office employees entering the building should have their temperature taken. The observer taking the temperatures should stand to the side of employees and be at least arms length away. While not required, exam gloves for the observer can be

P a g e 12 | 19

ABC OrganizationCOVID-19 Safety Plan Sample – New York State

utilized. A contact thermometer must be cleaned between each use (an oral or an ear thermometer is not recommended). If the reading is 100.4 or higher, the employee will be directed to go home and contact their medical provider for further guidance. In an acute case where the employee requires transportation, isolate the employee and call 911 for assistance.

Communicate key CDC recommendations (and post signage where appropriate) to your staff as potential safety talks:o How to protect yourself you are sicko COVID-19 Frequently Asked Questionso Place posters that encourage staying home when sick, cough and sneeze etiquette, and hand

hygiene at the entrance to your workplace, lobbies, restrooms and in other workplace areas where employees and the public will likely view.

F. Material Deliveries and Anyone Entering the Workplace Anyone entering the workplace including all outside vendors and truck drivers are to practice social

distancing. Staff receiving deliveries will collect daily delivery tickets in a sealable container or baggie and

quarantine it for a minimum of 24 hours before providing to staff.

G. Managing Sick Employees Employees who have symptoms of acute respiratory illness are recommended to stay home, seek

medical assistance and not return to work until they are free of fever (100.4° F [38.0° C] or greater using a thermometer), signs of a fever, and any other symptoms for at least 72 hours, without the use of fever-reducing or other symptom-altering medicines (e.g. cough suppressants) and follow current CDC guidelines. Employees should notify their supervisor and stay home if they are sick.

Isolate sick employees. CDC recommends that employees who appear to have acute respiratory illness symptoms (i.e. cough, shortness of breath) upon arrival to work or become sick during the day should be separated from other employees and be sent home or told to seek medical assistance immediately.

If an employee shows visible signs of an illness and refuses to leave the work site, a fitness for duty evaluation should be completed by a supervisor/manager and normal procedures should be followed to remove the employee from the premises.

If an employee is diagnosed with COVID-19 or shows symptoms of COVID-19, consult your health care provider and your employer before returning to work.

Communicate with Human Resources for managing sick time related to COVID-19. After notification from an employee that tests positive for COVID-19 the employer will take the

following steps and follow current CDC guidelines:o Facility will initiate a safety stand-down for a minimum of 24 hours or until compliance with

CDC guidelines for return to work. Communication of positive test to appropriate management. o Supervisor to investigate additional potential exposure while maintaining patient confidentiality

(HIPPA).

Should you need additional support services during this self-monitoring and social distancing period, call the NYS COVID-19 Hotline: 1-888-364-3065

On April 15, 2020, Governor Andrew M. Cuomo issued Executive Order 202.17. As a result, effective at 8 p.m. on Friday, April 17, 2020, any individual who is over age two and able to medically tolerate a face covering shall be required to cover their nose and mouth with a mask or cloth face-covering when in a public place and unable to maintain, or when not maintaining, social distance.

P a g e 13 | 19

ABC OrganizationCOVID-19 Safety Plan Sample – New York State

• Hand washing:https://www.youtube.com/watch?v=d914EnpU4Fo&feature=youtu.be • CDC Handout: https://www.cdc.gov/coronavirus/2019-ncov/downloads/stop-the-spread-of-germs.pdf • If sick: https://www.cdc.gov/coronavirus/2019-ncov/downloads/sick-with-2019-nCoV-fact-sheet.pdf • Full List of EPA disinfectants: https://www.epa.gov/sites/production/files/2020-03/documents/sars-cov-2-list_03-03-2020.pdf • CDC: Cleaning and Disinfecting Surfaces:https://www.cdc.gov/coronavirus/2019-ncov/prepare/cleaning-disinfection.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fcoronavir us%2F2019-ncov%2Fcommunity%2Fhome%2Fcleaning-disinfection.html Coronavirus Q&A from the World Health Organization (WHO): https://www.who.int/news-room/q-a-detail/q-a-coronaviruses

P a g e 14 | 19

ABC OrganizationCOVID-19 Safety Plan Sample – New York State

APPENDIX D – New York Department of Health Printable Materials The posters and printable materials are available for download athttps://coronavirus.health.ny.gov/information-healthcare-providers?f%5B0%5D=filter_term%3A46

P a g e 15 | 19

ABC OrganizationCOVID-19 Safety Plan Sample – New York State

P a g e 16 | 19

ABC OrganizationCOVID-19 Safety Plan Sample – New York State

APPENDIX E – Employee Acknowledgement

To whom it may concern,

I have read and acknowledge the guidelines and employee responsibilities as detailed in ABC Organization COVID‐19 Safety Plan.

I will adhere to the above guidelines to the best of my ability.

Employee: Date: Supervisor: Date:

P a g e 17 | 17