NY forward safety plan template

Ensure 6 ft. distance between personnel, unless safety or core function of the work activity requires a shorter distance. Any time personnel are less than 6 ft. apart from one another, personnel must wear acceptable face coverings.

• Yes
• No

Tightly confined spaces will be occupied by only one individual at a time, unless all occupants are wearing face coverings. If occupied by more than one person, will keep occupancy under 50% of maximum capacity.

• Yes
• No

Post social distancing markers using tape or signs that denote 6 ft. of spacing in commonly used and other applicable areas on the site (e.g. clock in/out stations, health screening stations)

• Yes
• No

Limit in-person gatherings as much as possible and use tele- or video-conferencing whenever possible. Essential in-person gatherings (e.g. meetings) should be held in open, well-ventilated spaces with appropriate social distancing among participants.

• Yes
• No

Establish designated areas for pick-ups and deliveries, limiting contact to the extent possible.

• Yes
• No

List common situations that may not allow for 6 ft. of distance between individuals. What measures will youimplement to ensure the safety of your employees in such situations?

• Yes
• No

How you will manage engagement with customers and visitors on these requirements (as applicable)?

• Yes
• No

How you will manage industry-specific physical social distancing (e.g., shift changes, lunch breaks) (as applicable)?

• Yes
• No

Employers must provide employees with an acceptable face covering at no-cost to the employee and have an adequate supply of coverings in case of replacement.

• Yes
• No

Do you have an adequate supply of face protectors - and other PPE for staff and visitors?

• Yes
• No

Face coverings must be cleaned or replaced after use or when damaged or soiled, may not be shared, and should be properly stored or discarded.

• Yes
• No

Limit the sharing of objects and discourage touching of shared surfaces; or, when in contact with shared objects or frequently touched areas, wear gloves (trade-appropriate or medical); or, sanitize or wash hands before and after contact.

• Yes
• No

Provided security measures for employees when using common equipment.

• Yes
• No

Adhere to hygiene and sanitation requirements from the Centers for Disease Control and Prevention (CDC) and Department of Health (DOH) and maintain cleaning logs on site that document date, time, and scope of cleaning.

• Yes
• No

A cleaning log is maintained. Responsible for its management have been identified.

• Yes
• No

Provide and maintain hand hygiene stations for personnel, including handwashing with soap, water, and paper towels, or an alcohol-based hand sanitizer containing 60% or more alcohol for areas where handwashing is not feasible.

• Yes
• No

Provided employees with access to personal hand hygiene products and / or disinfectants in the workplace.

• Yes
• No

Conduct regular cleaning and disinfection at least after every shift, daily, or more frequently as needed, and frequent cleaning and disinfection of shared objects (e.g. tools, machinery) and surfaces, as well as high transit areas, such as restrooms and common areas, must be completed.

• Yes
• No

What policies will you implement to ensure regular cleaning and disinfection of your worksite and any shared objects or materials, using products identified as effective against COVID-19?

• Yes
• No

Are policies in place to ensure that your workplace and general items or materials are regularly cleaned and disinfected using products that have been shown to be effective against COVID-19?

• Yes
• No

Establish a communication plan for employees, visitors, and customers with a consistent means to provide updated information.

• Yes
• No

Maintain a continuous log of every person, including workers and visitors, who may have close contact with other individuals at the work site or area; excluding deliveries that are performed with appropriate PPE or through contactless means; excluding customers, who may be encouraged to provide contact information to be logged but are not mandated to do so.

• Yes
• No

If a worker tests positive for COVID-19, employer must immediately notify state and local health departments and cooperate with contact tracing efforts, including notification of potential contacts, such as workers or visitors who had close contact with the individual, while maintaining confidentiality required by state and federal law and regulations.

• Yes
• No

If an employee tests positive for COVID-19, there is an employee (s) who will notify state and local health authorities?

• Yes
• No

Mandatory health screening assessment implemented (e.g. questionnaire, temperature check) before employees begin work each day and for essential visitors, asking about (1) COVID-19 symptoms in past 14 days, (2) positive COVID-19 test in past 14 days, and/or (3) close contact with confirmed or suspected COVID-19 case in past 14 days. Assessment responses must be reviewed every day and such review must be documented.

• Yes
• No

Have a plan for cleaning, disinfection, and contact tracing in the event of a positive case.

• Yes
• No

In the case of an employee testing positive for COVID-19, how will you clean the applicable contaminated areas? What products identified as effective against COVID-19 will you need and how will you acquire them?

• Yes
• No

In the case of an employee testing positive for COVID-19, how will you trace close contacts in the workplace? How will you inform close contacts that they may have been exposed to COVID-19?

• Yes
• No