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City of West Allis COVID-19 Business Safety Plan Template

  1. Business Information
  2. I. Social Distancing
  3. A. To ensure employees comply with social distancing requirements, you agree to do the following:
  4. Ensure 6 ft. distancing between personnel unless safety or core function of the work activity requires a shorterdistance. Any time personnel are less than 6 ft. apart from one another, personnel must wear acceptable face coverings.
  5. Ensure 6 ft. distancing between customers.
  6. Post social distancing markers using tape or signs that imply 6 ft. of spacing in common areas and other areas such as clock in/out stations, cashier areas, etc.
  7. Establish designated areas for pick-ups and deliveries, limiting contact to the extent possible. B.List
  8. Is a reservation process used to help prevent people from gathering?
  9. II. Personal Protective Equipment (PPE)
  10. A.To ensure employees comply with protective equipment requirements, you agree to do the following:
  11. We will provide employees with an acceptable face covering at no cost to the employee and have an adequate supplyof coverings in case of replacement.
  12. Face coverings will be cleaned or replaced after use or when damaged or soiled, may not be shared and should be properly stored or discarded.
  13. Limit the sharing of objects and discourage touching of shared surfaces; or when in contact with shared objects or frequently touched areas, wear gloves, sanitize or wash hands before and after contact.
  14. III. Hygiene and Cleaning
  15. A.To ensure employees comply with hygiene and cleaning requirements, you agree to do the following:
  16. Adhere to hygiene and sanitation requirements from the Centers for Disease Control and Prevention (CDC) andDepartment of Trade and Consumer Protection (DATCP) and maintain cleaning logs on site that document date, time, and scope of cleaning.
  17. Provide and maintain hand hygiene stations for personnel and customers, 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.
  18. Conduct regular cleaning and disinfection at least after every shift, daily, or more frequently as needed, and frequent cleaning and disinfection of shared objects (ex. Utensils, condiments, menus) and surfaces, as well as high traffic areas, such as restrooms and common areas must be completed.
  19. IV. Communication
  20. A. To ensure the business and its employees comply with the communication requirements you agree to do the following:
  21. Post signage throughout the business to remind personnel and customers to adhere to proper hygiene, socialdistancing requirements, proper use of PPE, and cleaning and disinfecting protocols.
  22. Consistently inform employees and customers of any updated changes to policy and/or procedures.
  23. If a worker tests positive for COVID-19, employers will immediately notify the local health department and cooperate with contact tracing efforts, including notification of potential contacts, such as workers or customers who came in close contact with the individual, while maintaining confidentiality required by state and federal law regulations.
  24. V. Process
  25. A. Screening. To ensure the business and its employees comply with screening requirements, you agree to do the following:
    Implement mandatory COVID-19 screening (e.g. questions, temperature checks) before employees begin work each day and for essential visitors, asking about (1) COVID-19 Symptoms in the past 14 days. (2)
  26. B. Testing. Individuals who carry the COVID-19 virus may or may not have symptoms. Testing helps to identify those with the virus. To help control the spread of disease, testing is important. The objective is a sustainable system of screening, and testing identifies ill employees. Do you require or recommend employees be tested for COVID-19?
    Please check one:
  27. C. Contact tracing and disinfection of contaminated areas due to exposure. To ensure the business and its employees comply with contact tracing and disinfection requirements, you agree that you will do the following:
  28. VI. Other
  29. Leave This Blank:

  30. This field is not part of the form submission.