Fillable Appendix A: Social Distancing Protocol (Mt. San Antonio College)

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Appendix A: Social Distancing Protocol (Mt. San Antonio College)

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COUNTY OF LOS ANGELES DEPARTMENT OF PUBLIC HEALTH
ORDER OF THE HEALTH OFFICER
Appendix A: Social Distancing Protocol
Business name:
Facility Address:
Approximate gross square footage
of space open to the public:
Businesses must implement all applicable measures listed below and be prepared to
explain why any measure that is not implemented is inapplicable to the business.
A. SIGNAGE
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Signage at each public entrance of the facility to inform all employees and customers that they should: avoid
entering the facility if they have a cough or fever; maintain a minimum six-foot distance from one another.
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Signage posting a copy of the Social Distancing Protocol at each public entrance to the facility.
B. MEASURES TO PROTECT EMPLOYEE HEALTH (CHECK ALL THAT APPLY TO THE FACILITY)
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Everyone who can carry out their work duties from home has been directed to do so.
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All employees have been told not to come to work if sick.
❑
Symptom checks are being conducted before employees may enter the workspace.
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All employees that have contact during their shift(s) with the public or other employees are offered,
at no-cost, a cloth face covering to be used at work when interacting with them.
❑
All desks or individual workstations are separated by at least six feet.
❑
Break rooms, restrooms, and other common areas are being disinfected frequently, on the following
schedule:
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Break rooms:
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Restrooms:
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Other:
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Disinfectant and related supplies are available to all employees at the following location(s):
❑
Hand sanitizer effective against COVID-19 is available to all employees at the following location(s):
❑
Soap and water are available to all employees at the following location(s):
❑
Employees are allowed frequent breaks to wash their hands.
❑
Copies of this Protocol have been distributed to all employees.
APPENDIX A: Safer at Home Order for Control of COVID-19: Page 1 of 3
Temporary Prohibition of All Events and Gatherings and Closure of Non-Essential Businesses and Areas
Revised 4/10/2020
DAILY
DAILY
PLEASE REFER TO PLAN SECTION B(H)
PLEASE REFER TO PLAN SECTION B(H)
PLEASE REFER TO PLAN SECTION B (I)
MT SAN ANTONIO COMMUNITY COLLEGE
1,670,586
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OCCUPIED SPACES - DAILY
COUNTY OF LOS ANGELES DEPARTMENT OF PUBLIC HEALTH
ORDER OF THE HEALTH OFFICER
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Optional—Describe other measures:
C. MEASURES TO PREVENT CROWDS FROM GATHERING
(CHECK ALL THAT APPLY TO THE FACILITY)
❑
Limit the number of customers in the store at any one time, which allows for customers and employees to
easily maintain at least six-foot distance from one another at all practicable times.
Maximum number of customers in the facility:
❑
Post an employee at the door to ensure the maximum number of customers in the facility is not exceeded.
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Placing per-person limits on goods that are selling out quickly to reduce crowds and lines. Explain:
❑
Optional-Describe other measures:
D. MEASURES TO KEEP PEOPLE AT LEAST SIX FEET APART
(CHECK ALL THAT APPLY TO THE FACILITY)
❑
Placing signs outside the store reminding people to be at least six feet apart, including when in line.
❑ Placing tape or other markings at least six feet apart in customer line areas inside the store and on
walkways at public entrances with signs directing customers to use the markings to maintain distance.
❑
Separate order areas from delivery areas to prevent customers from gathering.
❑ All employees have been instructed to maintain at least six feet distance from customers and from each
other, except employees may momentarily come closer when necessary to accept payment, deliver goods
or services, or as otherwise necessary.
❑ Optional—Institute one-way aisles to facilitate Social Distancing.
❑
Optional—Describe other measures:
E. MEASURES TO PREVENT UNNECESSARY CONTACT (CHECK ALL THAT APPLY TO THE FACILITY)
❑
Preventing people from self-serving any items that are food-related.
❑
All items are pre-packaged in sealed containers by staff.
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Bulk-item food bins are not available for customer self-service use.
❑ Food samples are prohibited.
❑ Providing for contactless payment systems or, if not feasible, sanitizing payment systems regularly. Describe:
❑
Optional-Describe other measures (e.g. providing senior-only hours):
APPENDIX A: Safer at Home Order for Control of COVID-19: Page 2 of 3
Temporary Prohibition of All Events and Gatherings and Closure of Non-Essential Businesses and Areas
Revised 4/10/2020
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NON APPLICABLE
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PLEASE REFER TO PLAN SECTION C
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PLEASE REFER TO PLAN SECTION D
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PLEASE REFER TO PLAN SECTION E
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PLEASE REFER TO PLAN SECTION E
COUNTY OF LOS ANGELES DEPARTMENT OF PUBLIC HEALTH
ORDER OF THE HEALTH OFFICER
F. MEASURES TO INCREASE SANITIZATION (CHECK ALL THAT APPLY TO THE FACILITY)
❑ Restrooms normally open to the public shall remain open to the public.
❑
Disinfecting wipes that are effective against COVID-19 are available near shopping carts and shopping
baskets.
❑
Employee(s) assigned to disinfect carts and baskets frequently, preferably after each use.
❑ Hand sanitizer, soap and water, or effective disinfectant is available to the public at or near the entrance of
the facility, at checkout counters, and anywhere else inside the store or immediately outside where people
have direct interactions.
❑ Disinfecting all payment portals, pens, and styluses after each use.
❑ Disinfecting all high-contact surfaces frequently.
❑ Optional- Describe other measures:
Any additional measures not included above should be listed on separate pages,
which the business should attach to this document.
You may contact the following person with any
questions or comments about this protocol:
Business
Phone number:
Contact Name
:
Date Last Revised
:
APPENDIX A: Safer at Home Order for Control of COVID-19: Page 3 of 3
Temporary Prohibition of All Events and Gatherings and Closure of Non-Essential Businesses and Areas
Revised 4/10/2020
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PLEASE REFER TO PLAN SECTION F
(909) 274-5508
DUETTA LANGEVIN
4/15/20
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Appendix A: Social Distancing Protocol (Mt. San Antonio College)

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Completed 25 July 2020

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