Fillable WORKSITE SPECIFIC PLAN TEMPLATE (City of Garden Grove)

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WORKSITE SPECIFIC PLAN TEMPLATE (City of Garden Grove)

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GARDEN GROVE
ggcity.org
Business name, Garden Grove address(es), brief description
Names, titles, contact numbers
Person(s) responsible for plan
Provide summary here: awareness of state guidelines, training sessions, signs
Summary of employee training and communication
Describe plans here: check schedules for others on duty at time, check work assignments
Describe plans to trace anyone in contact with infected employee
GENERAL INFORMATION
PLAN SUMMARY
Provide summary here: Physical distancing, sanitizing, other measures
Summary of measures to prevent coronavirus spread
WORKSITE SPECIFIC PLAN TEMPLATE
Describe procedure here: Follow up with sick employees, alert OC with confirmed cases
Procedure for alerting Orange County Health Care Agency to any Covid-19 cases
(833) 426-6411
Alert OC Health
WORKSITE SPECIFIC PLAN TEMPLATE
Summary of information provided to employees about coronavirus
Answer here: state guidelines, CDC information, city information, posters, flyers, signs, training sessions
Summary of employee prevention measures
Staying home when sick, self-screening at home, taking temperature, frequent hand washing,
use of face masks and coverings and proper cleaning
Signs, partitions, floor markings, Plexiglass, minimizing contact between customers and employees,
staggering breaks, dedicated entrances or exits
Summary of physical distancing measures
EMPLOYEE TRAINING
PHYSICAL DISTANCING
WORKSITE SPECIFIC PLAN TEMPLATE
Summary of cleaning, disinfecting
Cleaning of high traffic areas, disinfecting of commonly used services, cleaning shared equipment, touchable
surfaces, sanitizer at entrances and exits, use EPA disinfectants, adjust shifts or business operations for
regular cleaning
CLEANING, DISINFECTING
ggcity.org
Screening employees for symptoms, temperature checks, keeping sick workers home, hand sanitizer,
require or recommend face coverings, use of gloves as needed, spacing out seating
Summary of control and screening measures
CONTROL MEASURES, SCREENING
This template is a general guide for documenting a
Worksite Specific Plan. All businesses are encouraged
to access the Garden Grove Business Toolkit at
ggcity.org for additional reopening information from
the State and County of Orange.
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WORKSITE SPECIFIC PLAN TEMPLATE (City of Garden Grove)

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Completed 30 May 2021

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