Fillable Phase 3 Safe Start Plan Template (Washington)

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Phase 3 Safe Start Plan Template (Washington)

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Each business or entity operating in Phase 3 of Safe Start Washington, must develop a written Safety
Plan outlining how its workplace will prevent the spread of COVID-19 that is at least as protective as
the requirements from the Department of Labor & Industry found here. A business may ll out this
template to fulll the requirement, or may develop its own Safety Plan. This plan does not need to be
submitted to a state agency or County Public Health Department for approval but must be retained on
the premises of the business and must be made available to the Washington State regulatory agencies or
local health or safety authorities in the event of an inspection.
Businesses are still required to follow the State’s industry-specic guidance, if issued for your specic industry.
For a list of regions and sectors that are authorized to re-open, as well as detailed guidance for each sector,
please see Safe Start Washington — Phased Reopening County-by-County.
Maintain minimum six-foot separation between all employees (and customers) in all interactions at all
times. When strict physical distancing is not feasible for a specic task, other prevention measures are
required, such as use of barriers, minimizing sta or customers in narrow or enclosed areas, and
staggering breaks and work shift starts.
Tightly enclosed spaces or small rooms will be occupied by only one individual at a time, unless all
occupants are wearing cloth face coverings, masks or respirators. If occupied by more than one person,
will keep occupancy under 50% of maximum capacity.
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)
COVID-19 Reopening Safety Plan
I. PEOPLE
A. Physical Distancing. To ensure employees comply with physical distancing requirements, you agree
that you will do the following:
Phase 3 Safe Start Plan Template
Name of Business:
Industry:
Address:
Contact Information:
Owner/Manager of Business:
Human Resources Representative and Contact Information, if applicable:
1
Provide (at no cost to employees) and require the wearing of personal protective equipment (PPE),
such as gloves, goggles, face shields and facemasks as appropriate or required for the work activity
being performed. Cloth face coverings must be worn by every employee not working alone on the job
site unless their exposure dictates a higher level of protection under L&I safety and health rules and
guidance. Refer to Washington Coronavirus Hazard Considerations for Employers (except COVID-19 care
in hospitals and clinics) Face Coverings, Masks, and Respirator Choices for additional details. Cloth face
coverings are described in the Department of Health guidance.
Beginning June 8, all employees will be required to wear a cloth facial covering, with the following
exceptions: when working alone in an oce, vehicle, or at a job site; if the individual is deaf or hard of
hearing, or is communicating with someone who relies on language cues such as facial markers and
expression and mouth movements as a part of communication; if the individual has a medical condition
or disability that makes wearing a facial covering inappropriate; or when the job has no in-person
interaction. Employers must provide cloth facial coverings to employees, unless their exposure dictates
a higher level of protection under the Department of Labor and Industries’ safety and health rules and
guidance. Refer to Coronavirus Facial Covering and Mask Requirements for additional details. Employees
may choose to wear their own coverings at work, provided it meets the minimum requirements.
II. PLACES
A. Protective Equipment. To ensure employees comply with personal protective equipment
requirements, you agree that you will do the following:
2
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.
Establish designated areas for pick-ups and deliveries, limiting contact to the extent possible.
List common situations that may not allow for 6 ft. of distance between individuals. What measures will
you implement to ensure the safety of your employees in such situations?
How you will manage engagement with customers and visitors on these requirements (as applicable)?
How you will manage industry-specic physical social distancing (e.g., shift changes, lunch breaks)
(as applicable)?
Establish an increased frequency house keeping schedule that includes frequent cleaning and
sanitizing with a particular emphasis on commonly touched surfaces. Adhere to hygiene and sanitation
requirements from the Centers for Disease Control and Prevention (CDC) and Department of Health
(DOH).
Who will be responsible for establishing a schedule? Where will it be kept?
B. Hygiene and Cleaning. To ensure employees comply with hygiene and cleaning requirements, you
agree that you will do the following:
3
What quantity of face coverings – and any other PPE – will you need to procure to ensure that you always
have a sucient supply on hand for employees and visitors? How will you procure these supplies?
Post a sign requiring customers to wear cloth facial coverings in compliance with the state-wide facial
covering order
and Proclamation 20-25. Ensure signage is prominently displayed at the entrance to
the business so that it is immediately noticeable to all customers entering the store.
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.
What policy will you implement to ensure that PPE is appropriately cleaned, stored, and/or discarded?
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.
List common objects that are likely to be shared between employees. What measures will you
implement to ensure the safety of your employees when using these objects?
C. Communication. To ensure the business and its employees comply with communication
requirements, you agree that you will do the following:
4
Ensure frequent and adequate hand washing with adequate maintenance of supplies. Use disposable
gloves where safe and applicable to prevent virus transmission on tools or other items that are shared.
Where on the work location will you provide employees with access to the appropriate hand hygiene
and/or sanitizing products and how will you promote good hand hygiene?
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.
What policies will you implement to ensure regular cleaning and disinfection of your worksite and any
shared objects or materials, using products identied as eective against COVID-19?
Educate workers in the language they understand best about coronavirus and how to prevent
transmission, and the employer’s COVID-19 policies. Post signage throughout the site to remind
personnel to adhere to proper hygiene, social distancing rules, appropriate use of PPE, and cleaning
and disinfecting protocols.
Establish a communication plan for employees, visitors, and customers with a consistent means to
provide updated information.
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.
Which employee(s) will be in charge of maintaining a log of each person that enters the site
(excluding customers and deliveries that are performed with appropriate PPE or through contactless
means), and where will the log be kept?
5
No employer may operate unless it notifies the employer’s local health jurisdiction within 24 hours if
the employer suspects COVID-19 is spreading in the employer’s workplace, or if the employer is aware
of 2 or more employees who develop confirmed or suspected COVID-19 within a 14-day period.
If a worker tests positive for COVID-19, which employee(s) will be responsible for notifying state and
local health departments?
Screen employees for signs/symptoms of COVID-19 at the start of their shift. Make sure sick employees
stay home or immediately go home if they feel or appear sick. Cordon o any areas where an employee
with probable or conrmed COVID-19 illness worked, touched surfaces, etc. until the area and
equipment is cleaned and sanitized. Follow the cleaning guidelines set by the Centers for Disease
Control to deep clean and sanitize.
What type(s) of daily health and screening practices will you implement? Will the screening be done
before employee gets to work or on site? Who will be responsible for performing them, and how will
those individuals be trained?
If screening onsite, how much PPE will be required for the responsible parties carrying out the
screening practices? How will you supply this PPE?
III. PROCESS
A. Screening. To ensure the business and its employees comply with protective equipment
requirements, you agree that you will do the following:
B. Disinfection of contaminated areas. To ensure the business and its employees comply with
disinfection requirements, you agree that you will do the following:
Have a plan for cleaning, disinfection, and contact tracing in the event of a positive case.
6
IV. OTHER
Please use this space to provide additional details about your business’s Safety Plan, including anything to
address specic industry guidance.
Consult the Washington State Coronavirus Response website and applicable Proclamations on a
periodic basis or whenever notied of the availability of new guidance.
Specically, follow requirement in Governor Inslee’s Proclamation 20-46 High-Risk Employees –
Worker’s Rights.
Check frequently for updated resources for businesses.
A. Staying up to date on industry-specic guidance and resources: To ensure that you stay up to date
on the guidance that is being issued by the State, you will:
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Completed 14 May 2021

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