E M E R G E N C Y T E M P O R A R Y S T A N D A R D

COVID-19 Healthcare Worksite 

Checklist & Employee Job Hazard Analysis

OSHA COVID-19 Healthcare Worksite Checklist

 Employers in settings where employees provide healthcare services or healthcare support services may use 

the following Worksite Checklist to implement worker protections from COVID-19 in compliance with the 

OSHA COVID-19 Healthcare Emergency Temporary Standard (ETS). 

 If employers choose to use this Worksite Checklist, there are 2 STEPS to complete:

o STEP 1: Determine if OSHA’s COVID-19 Healthcare ETS applies to your workplace or portions of 

your workplace.

o STEP 2: Use this Worksite Checklist to develop and implement worker protections from COVID-19 in 

your workplace.

STEP 1: Determine if the ETS applies to your workplace or portions of your workplace.

You may use the “Is your workplace covered by the COVID-19 Healthcare ETS?” flow chart to determine whether and 

how OSHA’s COVID-19 Healthcare ETS applies to your workplace. Note that this determination must be made for each 

workplace where your employees work.

STEP 2: If the ETS applies to your workplace or portions of your workplace, use this 

Worksite Checklist & Employee Job Hazard Analysis to develop and implement worker 

protections from COVID-19 in your workplace.

Use the sections of this Worksite Checklist & Employee Job Hazard Analysis that apply to your workplace or portions 

of your workplace to develop and implement worker protections from COVID-19. This checklist is intended to be used 

alongside OSHA’s COVID-19 Plan Template to help you develop and implement a COVID-19 plan, as required by the 

ETS, for your workplace. Seek the involvement of non-managerial employees and their representatives in completing 

this checklist and implementing the COVID-19 plan.

 Getting Started

Take these steps to get your workplace ready and ensure you have 

implemented policies and procedures to prevent the spread of 

COVID-19. Some specific controls against COVID-19 and a job hazard 

analysis are covered in the sections that follow.

YES NO Follow-up Action

o Do you have a COVID-19 plan that was developed in consultation with nonmanagerial employees? 

o If you are claiming exemption under 1910.502(a)(4) from providing controls for 

fully vaccinated employees in a well-defined area(s) of the workplace where 

there is no reasonable expectation that any person with suspected or confirmed 

COVID-19 will be present, do you have policies and procedures in place to 

determine employees’ vaccination status?

o Have you shared your COVID-19 plan with all other employers at your 

worksite(s) and coordinated to ensure all workers are protected? 

o Do you have policies to limit and monitor points of entry in settings where direct 

patient care is provided? 

(Note: Does not apply where emergency responders or other licensed healthcare 

providers enter a non-healthcare setting to provide healthcare services.)

o Do you have a policy to screen and triage all clients, patients, residents, delivery 

people, visitors, and other non-employees entering settings where direct patient 

care is provided for people who may have symptoms of COVID-19?
Take these steps to get your workplace ready and ensure you have 

implemented policies and procedures to prevent the spread of 

COVID-19. Some specific controls against COVID-19 and a job hazard 

analysis are covered in the sections that follow.

YES NO Follow-up Action

o Do you have a health screening protocol for screening employees before each 

work day and each shift?

o Do you have a log for recording all employee instances of COVID-19?

o Do you have a policy that requires employees to notify you when they are

COVID-19 positive or have been told by a licensed healthcare provider that they 

are suspected of having COVID-19?

o Does the policy require employees to notify you if they are experiencing 

COVID-19 like symptoms including:

 A recent loss of taste and/or smell with no other explanation

 A fever of at least 100.4°F with a new unexplained cough associated with 

shortness of breath

o Do you have a policy to notify employees within 24 hours, if required to do so,

when they have been exposed (through close contact or by working in the same 

well-defined portion of a workplace during a person’s potential transmission 

period) to a COVID-19 positive person who has been in the workplace?

o Do you have a policy for employee COVID-19 testing, including providing time 

off and payment for the test? (Note: employers are not required to conduct 

testing)

o Do you have policies to remove employees who have COVID-19, are suspected 

to have COVID-19, are experiencing certain symptoms of COVID-19, or have 

been in close contact with a COVID-19 positive person in the workplace, until 

they can return as provided for by the standard, and, for employers with more 

than 10 employees, to provide medical removal protection benefits to such 

employees where required to do so (see OSHA’s ETS Notification, Removal, 

and Return to Work Flow Chart for Employers and Employees)?

o Do you have policies and procedures for adhering to Standard and TransmissionBased Precautions in accordance with CDC’s “Guidelines for Isolation 

Precautions”?

o Have you considered the use of telehealth services where available and 

appropriate in order to limit the number of people entering the facility? (Note: 

employers are not required to, but are encouraged to, use telehealth where 

available and appropriate.)

o Do you have a plan to support COVID-19 vaccination by providing each 

employee reasonable time and paid leave for vaccination and any side effects 

experienced following vaccination?

(Note: Eligible employers, including businesses and tax-exempt 

organizations with fewer than 500 employees, can receive a tax credit for 

providing paid time off for each employee receiving the vaccine and for any 

time needed to recover from the vaccine. See 

www.irs.gov/newsroom/american-rescue-plan-tax-credits-available-tosmall-employers-to-provide-paid-leave-to-employees-receiving-covid-19-

vaccines-new-fact-sheet-outlines-details)

Identify COVID-19 Safety Coordinators to ensure compliance with all aspects of the COVID-19 plan.

Name: Position/Title/Campus: Contact Information:
 Physical Distancing in your Workplace

This section will assist you in implementing physical distancing measures at your workplace.

o Employers must ensure that employees are separated from other people by at least 6 feet when indoors, and install cleanable or

disposable solid barriers at fixed work locations outside of direct patient care areas where each employee is not separated from

other people by at least 6 feet, unless the employer can demonstrate that these measures are infeasible. Refer to the Fixed Work

Location and Job Task Inventory for Employees Outside of Direct Patient Care Areas Who Cannot Maintain Physical

Distancing and the Job Hazard Analysis (Controls) sections below.

o In evaluating how to implement physical distancing, employers should consider these measures as they build their

COVID-19 plans.

o Employers must implement physical distancing along with the other provisions required by the ETS as part of a multi-layered

strategy to minimize employee exposure to COVID-19.

o NOTE: The ETS exempts fully vaccinated workers from physical distancing and barrier requirements when in well-defined

areas where there is no reasonable expectation that any person with suspected or confirmed COVID-19 will be present.

Have you considered these measures when/where possible? YES NO Follow-up Action

o Have you taken steps to reduce crowding in facilities by asking patients to remain

outside if feasible until they are called into the facility for their appointment?

For example: Vehicle waiting area in parking lot, open air triage tents and

booths, etc.

o Have you limited visitors to the facility to only those essential for the patient’s

physical or emotional well-being and care, and restricted their visits to the

patient’s room or other designated areas?

o Have you implemented teleworking options?

o Are physical distancing floor markers and/or visible wall signs in place to remind

employees, patients, visitors, customers, clients, and all other non-employees to

maintain a minimum distance of 6 feet between them?

o Have you reconfigured the work environment to ensure physical distancing?

For example: Spacing out desks, etc.

o Have conference rooms and break area furnishings (tables, chairs, desks) been

adjusted to maintain physical distancing?

o Have you installed cleanable or disposable solid barriers at each fixed work

location outside of direct patient care areas (e.g., entryway/lobby, check-in desks,

triage, hospital pharmacy windows, bill payment) where each employee is not

separated from all other people by at least 6 feet of distance?

o Have work shifts and break times been staggered to reduce crowding in common

employee areas?

For example: Breakrooms, locker rooms, etc.

o Have you taken steps to minimize the number of people within choke points

(bottlenecks) at any time to ensure a minimum distance of 6 feet can be

maintained between them and reduce crowding?

For example: Outside of direct patient care areas (e.g., entryway/lobby, check-in

desks, triage, pharmacy windows, bill payment).

o Have you designated pickup/drop-off delivery areas away from high traffic areas?

o Have you used scheduling to separate workers into dedicated groups (i.e.

“bubbles” or “cohorts”) to work the same shift or work in a particular area to

reduce the number of individuals that each worker encounters?

o Have contactless payment systems been established?

o Have contactless scheduling systems been established?
 Ventilation in Your Workplace

This section will assist you in improving ventilation at your workplace.

o Employers who own or control buildings or structures with an existing heating, ventilation, and air conditioning (HVAC)

system(s) must ensure that the HVAC system(s) is used in accordance with manufacturer's instructions and the design

specifications of the system(s); the amount of outside air circulated through the system(s) and the number of air changes per

hour are maximized to the extent appropriate; air filters are rated Minimum Efficiency Reporting Value (MERV) 13 or higher, if

compatible with the HVAC system(s); air filters are maintained and replaced as necessary; intake ports are cleaned, maintained,

and cleared of debris; and airborne infection isolation rooms (AIIRs) are maintained and operated in accordance with their

design and construction criteria.

o Does your workplace have a HVAC system that you own or control?

o Who is responsible for maintaining the HVAC system(s) and can certify that it is operating in accordance with the

ventilation provisions of the OSHA COVID-19 ETS?

(e.g., Maintenance staff, HVAC service contractor)

Name/Contact Information:

Have you taken these measures where/when possible? YES NO Follow-up Action

o Is the HVAC system being checked, inspected, cleaned, and maintained on a

regularly scheduled basis?

o Is the HVAC system being used in accordance with the HVAC

manufacturer’s instructions and design specifications?

o Is the HVAC system set to maximize the amount of fresh outdoor air that is

supplied to the system within the system’s capabilities?

o Are the HVAC outdoor air intakes clean, are they in good working order, and

are they clear of obstructions?

o Are the HVAC air filters that are installed rated at least Minimum Efficiency

Reporting Value (MERV) 13, or the highest level compatible with the

system?

o Are all air filters maintained and changed as necessary in accordance with the

manufacturer’s instructions for proper HVAC system function?

o Are all air supply diffusers and return air grilles open, clean, and operating

properly?

o Are all existing AIIRs maintained in accordance with design and construction

criteria?

Additional Ventilation Strategies (Best Practices) to Consider YES NO Notes

o Are windows and doors opened when ambient air quality and temperature

allow, and if doing so would not pose other health or safety risks?

o Are automatic settings that reduce outside air intake disabled?

o Are HVAC system(s) operated at least two hours before people arrive and at

least two hours after everyone has left in order to help flush the building?
 Cleaning and Disinfection in Your Workplace

This section will assist you in implementing cleaning, disinfection, and hand hygiene measures at your workplace.

o In patient care areas, resident rooms, and for medical devices and equipment, employers must follow standard practices for

cleaning and disinfection of surfaces and equipment in accordance with CDC’s “COVID-19 Infection Prevention and Control

Recommendations” and CDC’s “Guidelines for Environmental Infection Control,” pp. 86–103, 147-149. In all other areas,

employers must clean high-touch surfaces and equipment at least once a day, following manufacturers’ instructions for

application of cleaners; and clean and disinfect, in accordance with CDC’s “Cleaning and Disinfecting Guidance” any areas,

materials, and equipment under the employer’s control that have likely been contaminated by a person who is COVID-19

positive and has been in the workplace within the last 24 hours.

o Employers must provide alcohol-based hand rub that is at least 60% alcohol or provide readily accessible hand washing facilities.

o After aerosol-generating procedures (AGPs) are performed on persons with suspected or confirmed COVID-19, employers

must clean and disinfect the surfaces and equipment in the room or area where the procedure was performed.

Have you taken these measures where/when possible? YES NO Follow-up Action

o Are patient care areas, resident rooms, and medical devices and equipment

cleaned and disinfected in accordance with the CDC’s “COVID-19 Infection

Prevention and Control Recommendations” and “Guidelines for Environmental

Infection Control”?

o Do you clean and disinfect areas, materials, and equipment (other than patient

care areas, resident rooms, and medical devices and equipment) that have likely

been contaminated by a person with COVID-19 who has been in the workplace

within the last 24 hours in accordance with the CDC’s “Cleaning and

Disinfecting Guidance”?

o Where AGPs are conducted, do you clean and disinfect the surfaces and

equipment in the room or area after the procedure is completed?

o Have you provided alcohol-based hand rub that is at least 60% alcohol or

provided readily accessible handwashing facilities for employees, patients,

visitors, customers, clients, and all other non-employees?

o Outside of patient care areas and patient rooms, are high-touch surfaces and

equipment (other than medical devices and equipment) cleaned at least once a

day following manufacturers’ instructions for application of cleaners?

o When disinfecting, do you use a disinfectant found on EPA’s List N;

Disinfectants for COVID-19?
 Personal Protective Equipment (PPE) in Your Workplace

This section will assist you in providing PPE and implementing PPE policies at your workplace.

o Employers must: provide and ensure employees wear facemasks that are FDA-cleared, authorized by an FDA EUA, or

otherwise offered or distributed as described in an FDA enforcement policy; ensure a facemask is worn by each employee over

the nose and mouth when indoors and when occupying a vehicle with other people for work purposes (with some exceptions,

e.g., when an employee is alone in a room); provide and ensure employees use respirators and other PPE for exposure to people

with suspected or confirmed COVID-19 and for AGPs performed on a person with suspected or confirmed COVID-19; provide

respirators and other PPE in accordance with Standard and Transmission-based Precautions in healthcare settings in accordance

with CDC’s “Guidelines for Isolation Precautions”; and allow employees to wear their own respirators instead of facemasks

(under the mini respiratory protection program at 29 CFR 1910.504).

o NOTE: PPE requirements for employees with exposure to a person with suspected or confirmed COVID-19 and for AGPs on a

person with suspected or confirmed COVID-19 are discussed in the Job Task Inventory for Employees with Potential for

Exposure to a Person with Confirmed or Suspected COVID-19 and Job Hazard Analysis (Controls) sections below.

o NOTE: The ETS exempts fully vaccinated workers from PPE requirements when in well-defined areas where there is no

reasonable expectation that any person with suspected or confirmed COVID-19 will be present.

The following questions apply when employees are required to wear employerprovided facemasks, respirators, or face shields:

YES NO Follow-up Action

o Do you ensure facemasks are worn by employees over the nose and mouth when

indoors and when occupying a vehicle with other people for work, unless one of

the exceptions in the ETS applies?

o When facemasks are required, have you provided to each employee a sufficient

number of facemasks that are FDA-cleared, authorized by an FDA EUA, or

otherwise offered or distributed as described in an FDA enforcement policy to

comply with the ETS and ensure that they are changed by employees at least once

a day, whenever they are soiled or damaged, and more frequently as necessary?

o If N95 respirators or a higher level of respiratory protection are provided to

employees, are they:

o used in accordance with the COVID-19 mini respiratory protection program

(29 CFR 1910.504) when used in place of a facemask in situations when a

respirator is not required by the ETS; or

o used in accordance with the respiratory protection standard (29 CFR 1910.134)

when a respirator is required by the ETS?

o For employees who are unable to wear facemasks (e.g., due to a disability), are

face shields provided to employees and

o certified to ANSI/ISEA Z87.1 (or do they cover the wearer’s eyes, nose, and

mouth, wrap around the face from temple to temple, and extend down below

the wearer’s chin)?

o cleaned at least daily?

o replaced when damaged?

o Instead of a facemask, are employees permitted to wear their own respirator used in

accordance with 29 CFR 1910.504 when a respirator is not required by the ETS?
Fixed Work Location and Job Task Inventory for Employees Outside of 

Direct Patient Care Areas Who Cannot Maintain Physical Distancing

Use this Fixed Work Location and Job Task Inventory and input from employees to identify any fixed work 

locations outside of direct patient care areas where employees cannot maintain at least 6 feet of physical 

distancing from all other people when indoors. Direct patient care means hands-on, face-to-face contact with 

patients for the purpose of diagnosis, treatment, and monitoring.

Note: The ETS exempts fully vaccinated workers from physical distancing and barrier requirements when in 

well-defined areas of the workplace where there is no reasonable expectation that any person with suspected or 

confirmed COVID-19 will be present.

Fixed work locations are workstations where an employee is assigned to work for significant periods of time. Protective measures 

can often be implemented at fixed workstations to minimize potential exposure to COVID-19. 

o Take an inventory of all fixed work locations outside of direct patient care areas where employees cannot maintain 6 feet of 

physical distance from all other people. Note the number of workers at each location.

For example: 5 administrative employees work at an outpatient medical office with fixed work locations at:

 The reception area

 Employee desk area not in direct patient care areas

o For each fixed work location, describe the job tasks where employees cannot maintain 6 feet of physical distance from all 

other people.

For example: For the outpatient medical office:

 2 employees in the reception area interact with patients, families, and the public to conduct administrative 

tasks at the reception desk

 3 employees work at their desks not in direct patient care areas

Fixed Work 

Location

No. of 

Workers Job Tasks and Descriptions

For example: 

Outpatient 

medical office

The 

reception 

area

2 Interact with patients, families, and the public to conduct administrative tasks at the 

reception desk

Employee 

desk area 3 Work at their desks not in direct patient care areas 
Job Task Inventory for Employees with Potential for Exposure to a Person

with Suspected or Confirmed COVID-19 

Use this Job Task Inventory and input from employees to identify any job tasks where employees have 

potential for exposure to a person with suspected or confirmed COVID-19.

Answer the following questions about employee exposure to COVID-19: YES NO Follow-up / Notes

 Do employee(s) provide direct care to or are they otherwise exposed to people with

suspected or confirmed COVID-19?

 Do employee(s) perform or assist in performing AGPs on a person with suspected or

confirmed COVID-19? The following medical procedures are considered AGPs:

 open suctioning of airways

 sputum induction

 cardiopulmonary resuscitation

 endotracheal intubation and extubation

 non-invasive ventilation (e.g., BiPAP, CPAP)

 bronchoscopy

 manual ventilation

 medical/surgical/postmortem procedures using oscillating bone saws

 dental procedures involving: ultrasonic scalers; high-speed dental handpieces;

air/water syringes; air polishing; and air abrasion

If you answered yes to any of the questions above, complete the table below indicating the location(s), number of workers, and 

job tasks and descriptions in which employees have potential for exposure to a person with suspected or confirmed COVID-19.

Location(s) No. of 

Workers

Job Tasks and Descriptions

For example: 

Surgical Suites

5 Perform or assist in surgical procedures using oscillating bone saws

Are there any well-defined areas of your workplace in which there is no reasonable expectation that any person with 

suspected or confirmed COVID-19 will be present? If yes, list here:

 For example: employee break room






Employee Job Hazard Analysis (Controls)

This form will help employers and their employees identify controls to implement to minimize potential employee exposure 

to COVID-19. Refer to the Fixed Work Location and Job Task Inventory for Employees Outside of Direct Patient Care 

Areas Who Cannot Maintain Physical Distancing as well as the Job Task Inventory for Employees with Potential for 

Exposure to a Person with Suspected or Confirmed COVID-19 sections above to complete this form for every fixed work 

location or job task identified in these sections.

At least one non-managerial employee should provide input on this Job Hazard Analysis. 

Employee Name(s), Position/Title, Shift

Facility Location (e.g., campus, building number)

Controls to implement (as appropriate and feasible) for employees outside of direct patient care areas 

who cannot maintain physical distancing 

Fixed Work Location(s) (refer to table above):

Job Tasks and Descriptions:

☐ Work processes or procedures have been adjusted to ensure that employees are as far apart as feasible from other people.

How:

 for example: using a lifting device instead of a co-worker





 Physical barriers have been installed where physical distancing is not feasible.

NOTE: Physical barriers are not required in direct patient care areas or resident rooms. The ETS also exempts fully vaccinated workers

from physical distancing and barrier requirements when in well-defined areas of the workplace where there is no reasonable expectation

that any person with suspected or confirmed COVID-19 will be present. Refer to list of well-defined areas above.

 Between employees and other people where possible

 Between co-worker workstations where possible

 Barriers are at height and width to block face-to-face pathways between persons

 Small pass-through openings for objects, if necessary, are located at the bottom of the barrier and away from users’

breathing zones

 Barriers are fixed or secured so they do not move excessively (secured to ground or surface; hanging barriers have bottoms

secured)

 Barriers are easily cleanable or disposable

o Barrier cleaning supplies are stocked and conveniently located

 Barriers do not block emergency exits and pathways

Controls to implement for employees with potential for exposure to a person with suspected or 

confirmed COVID-19 

Controls for AGPs performed on a person with suspected or confirmed COVID-19:

 The number of employees present during the procedure is limited to only those essential for patient care and procedure support

 The procedure is performed in an AIIR, if available

 All surfaces and equipment in the room or area where the procedure is performed are cleaned and disinfected after the procedure

is completed

PPE:

The employer must provide a respirator, gloves, an isolation gown or protective clothing, and eye protection to each employee with 

exposure to people with suspected or confirmed COVID-19. The employer must ensure that the respirator is used in accordance 

with the respiratory protection standard (29 CFR 1910.134) and that other PPE is used in accordance with 29 CFR 1910 subpart I. 

For AGPs performed on a person with suspected or confirmed COVID-19, employers are encouraged to select elastomeric 

respirators or PAPRs instead of filtering facepiece respirators. 
Use this form for each healthcare job task (refer to table above) with potential exposure to COVID-19.

Description of Job Task Employee Protections Provided by 

Employer

Follow-up / Notes 

For example: A nurse in the ICU must 

enter the patient’s room and draw 

three vials of blood once daily in the 

morning before breakfast. 

The patient is positive for COVID-19. 

The ICU nurses have been issued N95 

respirators. ICU nurses wear FDAauthorized facemasks when not in a 

COVID-19 positive patient’s room.

Gloves x

Isolation gown x

Facemasks cleared by the FDA, authorized by 

an FDA EUA, or offered or distributed as 

described in an FDA enforcement policy

x When not wearing N95 respirator

N95 respirator, or equivalent x

Goggles or face shield x

Powered air-purifying respirator (PAPR)

Airborne infection isolation room (AIIR)

Other, specify: 

Gloves

Isolation gown

Facemasks cleared by the FDA, authorized by 

an FDA EUA, or offered or distributed as 

described in an FDA enforcement policy

N95 respirator, or equivalent

Goggles or face shield

Powered air-purifying respirator (PAPR)

Airborne infection isolation room (AIIR)

Other, specify:

Gloves

Isolation gown

Facemasks cleared by the FDA, authorized by 

an FDA EUA, or offered or distributed as 

described in an FDA enforcement policy

N95 respirator, or equivalent

Goggles or face shield

Powered air-purifying respirator (PAPR)

Airborne infection isolation room (AIIR)

Other, specify:

Controls to implement for contact with other people while occupying a vehicle for work

Identify the protective measures taken when employees occupy a vehicle with another person for work purposes. 

Required by the ETS:

 Facemasks are worn over the nose and mouth

 Clean high-touch surfaces daily (e.g., steering wheel, door handles, seats)

Best practices for employee protection:

 Use fan at highest setting

 DO NOT use “Recirculate” for cabin heating/cooling

 Open window(s) whenever weather permits

 Separate workers as much as possible in the vehicle (e.g., avoid having persons sit side-by-side)

Action Items from Job 

Hazard Analysis:

Follow up to Action Items:
 Implementing a COVID-19 Training Program

Ensure that all employees receive training, in a language and at a literacy level that they can understand.

Have you trained each employee on COVID-19 health hazards including 

providing information about:

YES NO Follow-up Action

 How COVID-19 is transmitted (including pre-symptomatic and asymptomatic

transmission)

 The importance of hand hygiene to reduce the risk of spreading COVID-19

infections

 Ways to reduce the risk of spreading COVID-19 through the proper covering of

the nose and mouth

 The signs and symptoms of COVID-19

 The risk factors for severe illness

 When to seek medical attention

Have you reviewed your COVID-19 plan, policies, and procedures with your 

employees, including:

 Where to find the plan, and how to obtain copies

 Name(s) and Contact(s) of the COVID-19 Safety Coordinator(s)

 The completed Workplace Checklist, Fixed Work Location and Job Task

Inventory for Employees Outside of Direct Patient Care Areas Who Cannot

Maintain Physical Distancing, Job Task Inventory for Employees with Potential

for Exposure to a Person with Suspected or Confirmed COVID-19, and the

Employee Job Hazard Analysis (Controls), and how to obtain copies of each

 Your specific policies and procedures on patient screening and management

 Tasks and situations in the workplace that could result in COVID-19 infection

 Your specific policies and procedures to prevent the spread of COVID-19 that are

applicable to the employee’s duties (e.g., policies on Standard and TransmissionBased Precautions, physical distancing, physical barriers, ventilation, aerosolgenerating procedures)

 Your specific multi-employer workplace agreements related to infection control

policies and procedures, the use of common areas, and the use of shared

equipment that affect employees at the workplace

 Your specific policies and procedures for PPE for your workplace including:

o When PPE is required for protection against COVID-19

o Limitations of PPE for protection against COVID-19

o How to properly put on, wear, and take off PPE

o How to properly care for, store, clean, maintain, and dispose of PPE

o Any modifications to donning, doffing, cleaning, storage, maintenance, and

disposal procedures needed to address COVID-19 when PPE is worn to

address workplace hazards other than COVID-19

 Your specific policies and procedures for cleaning and disinfection

 Your specific policies and procedures on health screening and medical management

 Available sick leave policies, any COVID-19-related benefits to which the

employee may be entitled under applicable federal, state, or local laws; and other

supportive policies and practices (e.g., telework, flexible hours)

Training Requirements / Notes:

Employee Representative Name and Date: COVID-19 Safety Coordinator Name and Date:

This document is intended to provide information about the COVID-19 Emergency Temporary Standard. The Occupational Safety and Health Act requires employers to comply with safety and 

health standards promulgated by OSHA or by a state with an OSHA-approved state plan. However, this document is not itself a standard or regulation, and it creates no new legal obligations.