Location * Employee Name * 4.1 COVID-19 Work Place Preventive Measures Question 1. Does the work environment provide for safe distancing of 6 feet to prevent the spread of Covid-19? * 2. Is there an internal communications mechanism in place for all relevant COVID-19 updates (communication boards, visual displays, safety postings, Infodev COVID website)? * 3. Has the management team received training on the implications of COVID-19? * 4. Are employees aware of the symptoms of COVID-19? * 5. Have you reviewed the cleaning measures to ensure that high risk contact areas and touch points are being regularly disinfected? * 6. Have you alerted all team members to the hand washing protocols? * 7. Do you have readily available access to Hand Sanitizer for all team members? * 8. Does the Hand Sanitizer to contain at least 70 percent alcohol content? * 9. Are mask/respirators stored in an airtight re-sealable plastic storage container (when at workplace)? *
Please, when out of the workplace remove the masks/respirators from a the sealed storage, installed it in a safe place at room temperature in order to make sure they get proper ventilation and remove humidity.
10. Have you taken the time to comment on instances of employee compliance and provide positive reinforcement? * 4.2 Covid-19 Employee Prevention Questions 1. Do you have the necessary products to clean your work surface and work tools before leaving the work area? And more specifically, any surface outside of your work area that you have touched? * 2. Outside the workplace, do you think you have applied as much as possible a distance of at least 2 meters (about 6 feet) from other people who do not live under your roof and avoid gatherings and respect as much as possible other instructions from governments? * 3. Do you think you have participated in an activity, a meeting or a situation that would have exposed you for an average to prolonged period? * 4. When you are at the worksite, do you regularly wash my hands for more than 20 seconds, more specifically, before entering or leaving your workspace? * 4.3 Covid-19 Symptoms Questions 1. Do you currently have a fever of 38 degrees C (100.4 F) or greater? * 2. Are you experiencing any COVID-19 related symptoms? (e.g., fever, cough or shortness of breath, loss of taste or smell) * 3. In the past 14 days, have you tested positive for COVID-19? * 4. What is your body temperature today? * 5. What is your SpO2 level? (if available) 6. Did you take a nonsteroidal anti-inflammatory drug (NSAID) within 8 hours of your temperature measurement? * 7. Have you been in contact, you or a member of your close family or any other person you know, with a person suffering from covid-19 OR WAITING for results following a test on Covid19? * * Confirmation
Please note that the declaration will be send to multiple email addresses to both Infodev and Septa management.
* In order to ensure the protection of all our employees, management reserves the right to assess any false declaration or breach of protection instructions and to impose penalties up to and including dismissal. Confidential - For internal use only - ©2020 Infodev EDI Inc