Checklist Library

Checklist – Social Distancing Plan Template for Workplaces

This social distancing plan template can serve as a pandemic planning tool for businesses/employers to help implement strict social distancing measures in workplaces, especially those that are categorized as essential businesses.

Labels and Posters

1.1 Provide signs at designated entry points to inform people to: avoid entering the facility if they have a cough or fever; maintain a minimum distance of 6 feet from each other; and not shake hands or engage in any unnecessary physical contact.

1.2 Post a copy of the Social Distancing Protocol at designated entry points

1.3 Display signs within the facility that promote proper hand washing.

1.4 Send digital versions of the posters by email.

Measures to keep people at least 6 feet apart

2.1 Place tape or other markings at least six feet apart in customer line areas inside the store and on sidewalks at public entrances with signs directing customers to use the markings to maintain distance

2.2 Separate order areas from delivery areas to prevent customers from congregating

2.3 Instruct employees to maintain a distance of at least six feet from customers and from each other, except that employees may move momentarily closer when necessary to accept payment, deliver goods or services, or when otherwise necessary

Measures to protect the health of employees

3.1 It has been indicated that all those who can carry out their work tasks from home do so

3.2 Reconsider non-essential business travel

3.3 All employees have been told not to come to work if they are sick.

3.4 Symptom checks are taking place before employees can enter the work space.

3.5 All individual desks or workstations have been realigned to be at least six feet apart

3.6 Promote regular teleworking (video conferencing) throughout your organization

3.7 Consider the social and mental health consequences of social distancing in the workplace or in the community and offer information and support

3.8 Plan to increase staff absence levels

3.9 Copies of this plan have been sent to employees.

Measures to improve sanitation

4.1 Hand sanitizer, soap and water, or an effective disinfectant are available to the public at or near the entrance of the facility, and at any other location within the facility or immediately outside where people have direct interactions.

4.2 Disinfect all high-touch surfaces frequently.



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