Attachment_5_-_COVID19_Non-Employee_Checklist_20200603_v1_LD19.pdf

Version Number Release Date Filename Changes Made v1 6/3/2020 COVID19.Non-EmployeeChecklist.20200603.v1 N/A

Appendix 5

Non-Employee Checklist to Prevent the Spread of Coronavirus Disease (COVID-19)

The purpose of this checklist is to facilitate non-employee awareness of the considerations required to access USGS facilities and minimize the risk of coronavirus transmission. Non-employees are encouraged to utilize this checklist to facilitate individual decision making prior to accessing a USGS facility and ensure that conversations take place between non-employees and their federal points of contact (ex: Contracting Officers Representative (COR), Project Chiefs, etc.).

Individual:

Organization:

For contractor and recipient employees, designate your employing organization and the USGS award number under which the individual is working.

Date: ____________________________________

Considerations Yes No

1. Am I currently exhibiting COVID-19 symptoms?

2. If I was symptomatic with suspected/confirmed COVID-19 has 3 days (72 hours) passed since recovery or has at least 10 days passed since symptoms first appeared? (Skip if not applicable.)

3. Have I been in recent contact with someone who has, or is suspected to have COVID-19?

4. Am I considered to be at a higher risk , based on currently available information (i.e. older adults and people of any age who have serious underlying medical conditions might be at higher risk for severe illness from COVID-19) and/or for serious complications from COVID-19 (CDC High

Risk Complications) and to CDC-identified special populations including pregnant women (CDC

Special Populations).

5. Is someone in my household in a high-risk category, or if someone works in an occupation that has increased levels of potential exposure to people with confirmed or suspected COVID19 cases.

6. Have I returned from travel (overnight, out of state, hot spot, etc.) in the past 14 days?

Note: If you marked yes to any questions above, discuss options with your Federal point-of-contact. If required to perform work in a USGS facility to complete mission essential functions, special considerations (additional engineering and administrative controls) should be implemented to protect vulnerable individuals also in the facility.

1. Can I assess myself for symptoms daily using the CDC Self Checker before reporting to the workplace?

2. Do I have a Face Covering as recommended by CDC guidance?

3. Do I have the ability to Social Distance in my workspace? (Maintain 6ft separation from other individuals.)

4. Do I have the ability to Wash My Hands or sanitize my hands in my workplace?

5. (N/A) Do I understand how to sanitize shared Office Equipment?

6. Are you familiar with and prepared to comply with USGS/USACE guidance for check-in/check-out procedures, accessing common spaces (lunchrooms, break rooms, conference rooms, etc.), and personal logs (days you worked in the building, the hours you were there, the room(s) you accessed, and any personal interactions)?

7. (N/A) If I work in the field or a laboratory, have I filled out the In Laboratory Work Checklist and

Best Practices or the Field Travel and Close Quarter Guidance

Note: This checklist does not supersede or negate the need for any other applicable guidance, including the Job Hazard

Analysis, Exposure Assessments, and other safety management methods of determining risk and the appropriate level of protection. This checklist is in addition to compliance with applicable safety requirements and plans based on the work being conducted, e.g., wearing personal floatation devices when working in or around water, confined space entries, or traffic control plans for bridge work.

https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/groups-at-higher-risk.html https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/groups-at-higher-risk.html https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/groups-at-higher-risk.html https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/other-at-risk-populations.html https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/other-at-risk-populations.html https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/other-at-risk-populations.html https://www.cdc.gov/coronavirus/2019-ncov/symptoms-testing/symptoms.html https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/diy-cloth-face-coverings.html https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/social-distancing.html https://www.cdc.gov/handwashing/when-how-handwashing.html https://doimspp.sharepoint.com/sites/usgs-emergency-management/COVID-19/C19MSP/Shared%20Documents/Forms/AllItems.aspx?viewid=2e0dc310%2D0a14%2D4f07%2Dad03%2De6fa6c72a6d3&id=%2Fsites%2Fusgs%2Demergency%2Dmanagement%2FCOVID%2D19%2FC19MSP%2FShared%20Documents%2FField%20Travel%20Guidance%5F8May%2Epdf&parent=%2Fsites%2Fusgs%2Demergency%2Dmanagement%2FCOVID%2D19%2FC19MSP%2FShared%20Documents https://doimspp.sharepoint.com/:b:/r/sites/usgs-emergency-management/COVID-19/C19MSP/Shared%20Documents/USGS%20Laboratory%20-%20Return%20to%20On-Site%20Operations%20Checklist%20and%20Guidance%2020200428%20for%20Fillable%20PDF.pdf?csf=1&web=1&e=IJJSoG https://doimspp.sharepoint.com/:b:/r/sites/usgs-emergency-management/COVID-19/C19MSP/Shared%20Documents/USGS%20Laboratory%20-%20Return%20to%20On-Site%20Operations%20Checklist%20and%20Guidance%2020200428%20for%20Fillable%20PDF.pdf?csf=1&web=1&e=IJJSoG