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COVID-19 Preventing, Reporting and Mitigating Workplace and Non-Health Care, Non-Residential Facility Outbreaks July 2020 (updated 07/08/2020) ---PAGE BREAK--- Contents Purpose 3 Outbreak definitions 3 Preventing outbreaks 3 Reporting outbreaks 9 COVID-19 Outbreak Report Form and Line List Template 9 Mitigating outbreaks 9 Appendix: Checklists for Preventing, Reporting and Mitigating Workplace/Facility Outbreaks 14 COVID-19: Workplace Outbreak Guidance I July 2020 2 ---PAGE BREAK--- Purpose With Colorado’s phased re-opening, this comprehensive guidance (based on the best available infection-control evidence and practices) was developed to aid workplaces and non-health care/non-residential facilities (referred to collectively as workplaces/facilities) in preventing, reporting, and mitigating COVID-19 outbreaks in conjunction with public health. The COVID-19 virus is primarily transmitted through close person-to-person contact, largely through inhalation of infectious droplets at short-range feet). It may be transmitted in other ways as well, such as through short-to-medium range aerosols or through fomites and contaminated surfaces. This guidance seeks to help workplaces/facilities identify and break these transmission patterns. Note that this guidance is not specific for any one particular workplace/facility and can be adapted as necessary to specific circumstances. Guidance will be updated periodically as new guidelines and science becomes available. Outbreak definitions ● Confirmed outbreak: Two or more Confirmed cases of COVID-19 in a workplace/facility with onset in a 14 day period. ● Suspected outbreak: Two or more probable COVID-19 cases (or one confirmed COVID-19 case and one or more probable COVID-19 cases) in a workplace/facility with onset in a 14-day period. ● ● Additional details on individual case and outbreak definitions can be found here. Preventing outbreaks Workplaces/facilities can help prevent outbreaks by reducing transmission among staff, maintaining healthy business operations, and maintaining a healthy work environment per CDPHE and CDC general workplace guidelines and Colorado’s Safer-at-Home public health order. To prevent and reduce transmission among employees, workplaces/facilities should take the following actions: ● Encourage employees to self-monitor for COVID-19 daily: ○Employees should be aware of their health and monitor themselves for COVID-19 fever, cough, shortness of breath) daily. They should report any COVID-19 to their employer before entering the workplace/facility. ○Employees who have thermometers should take their temperature daily and not come to work if they develop a fever (≥100.4°F/38.0°C). ○If an employee reports any COVID-19 refer them to the CDPHE Tracker and encourage them to get tested. ● Actively encourage sick employees to stay home: ○ Employees who have COVID-19 should notify their supervisor and stay home. Sick employees should follow CDC-recommended steps to prevent the spread of COVID-19. ○ Sick employees should not return to work until the criteria to discontinue home isolation are met (generally 10 days after onset with improved respiratory and at least 3 days fever-free without fever-reducing medications). ○ Employers should implement flexible sick leave and supportive policies and practices (see details below). ● Consider actively screening employees for COVID-19 and recent COVID-19 exposure daily (in-person or virtually) before they enter the workplace/facility: COVID-19: Workplace Outbreak Guidance I July 2020 3 ---PAGE BREAK--- ○ Employers should implement protocols to conduct daily temperature checks and monitor for COVID-19 fever, cough, shortness of breath) and recent COVID-19 exposure among employees in the worksite to the greatest extent possible. Ideally, temperature, and exposure checks should happen before the individual enters the workplace/facility. ○ To prevent stigma and discrimination in the workplace, make employee health screenings as private as possible. Do not make determinations of risk based on race or country of origin and be sure to maintain confidentiality of everyone’s medical status and history. ○ Ensure any screening materials are provided in languages that employees understand. ○ Complete these screenings in a way that helps maintain social distancing guidelines, such as providing multiple screening entries into the building. ○ Document these daily temperature, and exposure checks using an employee health screening form. ○ As long as the employee doesn’t have a fever, or recent exposure, they should self-monitor under the supervision of their employer’s occupational health program. ○ If an employee reports any COVID-19 send them home and refer them to the CDPHE Tracker and encourage them to get tested. ○ Recent COVID-19 exposure is defined as having close contact feet) for a prolonged period of time (generally >15 minutes, depending on the exposure) without adequate PPE to a person with COVID-19 during their contagious period (a period from 2 days before their onset [or their positive confirmatory COVID-19 test if until they meet criteria to discontinue home isolation [generally 10 days assuming their fever has resolved, have improved, or they have not developed any new ● Identify where and how workers might be exposed to COVID-19 at work: ○ Conduct a thorough hazard assessment to determine if workplace hazards are present, or are likely to be present, and determine what type of controls or personal protective equipment (PPE) are needed for specific job duties. ○ When engineering and administrative controls cannot be implemented or are not fully protective, employers are required by OSHA standards to: ■ Determine what PPE is needed for their workers’ specific job duties, ■ Select and provide appropriate PPE to the workers at no cost, and ■ Train their workers on its correct use. ○ Consider keeping logs of where/with whom employees have been working who is working where and on what shifts) in case a workplace/facility outbreak occurs and contact tracing is needed. ● Encourage use of cloth face coverings among employees and customers in public settings where social distancing measures are difficult to maintain, especially in areas of significant community-based transmission. ○ CDC recommends wearing a cloth face covering as a measure to contain the wearer’s respiratory droplets and help protect their co-workers and members of the general public. ○ Cloth face coverings are not considered PPE. They may prevent workers, including those who don’t know they have the virus, from spreading it to others but may not protect the wearers from exposure to the virus that causes COVID-19. Workers who require PPE should wear appropriate PPE instead. ○ Wearing a cloth face covering does not replace the need to practice social distancing. ○ Certain employees who have trouble breathing or who are unable to remove the mask without assistance should not wear cloth face coverings, however. ○ Cloth face coverings may not be needed for employees working outside in isolation. ● Separate sick employees and send them home: COVID-19: Workplace Outbreak Guidance I July 2020 4 ---PAGE BREAK--- ○ Employees who appear to have COVID-19 upon arrival at work or who become sick during the day should immediately be separated from other employees, customers, and visitors and sent home. Sick employees should follow CDC-recommended steps and be encouraged to get tested. ○ Have a procedure in place for the safe transport of an employee who becomes sick while at work. The employee may need to be transported home or to a healthcare provider. ○ If an employee is confirmed to have COVID-19 infection, employers should inform fellow employees of their possible exposure to COVID-19 in the workplace but maintain confidentiality as required by the Americans with Disabilities Act (ADA). ○ Sick employees should not return to work until the criteria to discontinue home isolation are met (generally 10 days after onset with improved respiratory and at least 3 days fever-free without fever-reducing medications). ● Take action if an employee is suspected or confirmed to have COVID-19 infection: ○ In most cases, you do not need to shut down your workplace/facility. ○ If it has been less than 7 days since the sick employee has been in the facility, close off any areas used for prolonged periods of time by the sick person: ■ Wait 24 hours since the sick person used the area before cleaning and disinfecting to minimize potential for other employees being exposed to respiratory droplets. If waiting 24 hours is not feasible, wait as long as possible. ■ During this waiting period, open outside doors and windows to increase air circulation in these areas. ○ If it has been 7 days or more since the sick employee used the facility, additional cleaning and disinfection is not necessary. Continue routinely cleaning and disinfecting all high-touch surfaces in the facility. ○ Follow the CDC cleaning and disinfection recommendations. ● Educate employees about how they can reduce the spread of COVID-19 at work and at home: ○ Promote etiquette for coughing/sneezing and proper handwashing. Post signage for employees and customers on such etiquette and hygiene using easy to understand graphics. Ensure any signage is provided in languages that employees and customers understand. ○ Employees should wash their hands often with soap and water for at least 20 seconds or to use hand sanitizer with at least 60% alcohol if soap and water are not available. Inform employees that if their hands are visibly dirty, they should use soap and water over hand sanitizer. ○ Employees should avoid touching their eyes, nose, and mouth with unwashed hands. ○ Employees should cover their mouth and nose with a tissue when they cough or sneeze, or use the inside of their elbow. Throw used tissues into no-touch trash cans and immediately wash hands with soap and water for at least 20 seconds. If soap and water are not available, use hand sanitizer containing at least 60% alcohol. ○ Practice routine cleaning and disinfection of frequently touched objects and surfaces such as workstations, keyboards, telephones, handrails, and doorknobs. Dirty surfaces can be cleaned with soap and water prior to disinfection. To disinfect, use products that meet EPA’s criteria for use against SARS-CoV-2 (the virus that causes COVID-19) and are appropriate for the surface. ○ Avoid using other employees’ phones, desks, offices, or other work tools and equipment, when possible. If necessary, clean and disinfect them before and after use. ○ Practice social distancing by avoiding large gatherings (>10 people) and maintaining distance feet) from others whenever possible. ○ Employees should try to minimize unnecessary in-person contacts as much as possible at work, at home, and in their community as COVID-19 appears to spread easily along social networks. ● For employees who commute to work using public transportation, carpooling, or ride sharing, consider the following: COVID-19: Workplace Outbreak Guidance I July 2020 5 ---PAGE BREAK--- ○ Offer employees incentives to use forms of transportation that minimize close contact with others, such as offering reimbursement for parking or single-occupancy ride shares. ○ Allow employees to shift their hours so they can commute during less busy times. ○ Ask employees to clean their hands as soon as possible after their trip. ○ Discourage carpooling among employees of different households as much as possible. ○ Encourage employees to wear cloth face coverings if they do use public transportation or carpool with others. ● Provide accommodations for vulnerable employees at higher risk for serious illness, such as older adults and those with certain chronic medical conditions: ○ Vulnerable employees at higher risk for serious illness should still stay at home as much as possible in accordance with Colorado’s most recent Safer at Home order. ○ Prioritize teleworking for vulnerable employees as they cannot be compelled to go to work at this time. ● Take additional precautions for healthy employees with recent exposure to a person with COVID-19: ○ Healthy employees with recent exposure to a person with COVID-19 (whether at home or at work) may themselves become infected and develop within a 14-day incubation window. They may also be contagious in the 2 days before developing or even while ○ Recent COVID-19 exposure is defined as having close contact feet) for a prolonged period of time (generally >15 minutes, depending on the exposure) without adequate PPE to a person with COVID-19 during their contagious period (a period from 2 days before their onset [or their positive confirmatory COVID-19 test if until they meet criteria to discontinue home isolation [generally 10 days assuming their fever has resolved, have improved, or they have not developed any new ○ Non-critical infrastructure healthy workers with recent exposure to a person with COVID-19 should notify their supervisor immediately, quarantine at home for 14 days (thought to be the maximum incubation period for COVID-19 infection), self-monitor for possible development of fever and and maintain social distancing feet) from others. They may telework during quarantine if possible. ○ Critical infrastructure healthy workers with recent exposure to a person with COVID-19 should notify their supervisor immediately. While quarantining at home for 14 days is advised for these employees whenever feasible, it may not be feasible for certain critical infrastructure workers. In these cases, critical infrastructure workers with recent exposure may be permitted to work if they are pre-screened and regularly monitored for development for fever or wear a face mask at all times during work, social distance > 6 feet as work duties permit, and their work spaces are cleaned and disinfected routinely. If said employee becomes sick during the day, they should be sent home immediately and encouraged to get tested, surfaces in their workspace should be cleaned and disinfected, and contact tracing should be initiated to identify additional exposures. To maintain healthy business operations, workplaces/facilities should take the following actions: ● Deputize a workplace coordinator who will be responsible for COVID-19 issues and their impact at the workplace. ● Implement flexible sick leave and supportive policies and practices: ○ Ensure that sick leave policies are flexible and consistent with public health guidance and that employees are aware of and understand these policies. ○ Maintain flexible policies that permit employees to stay home to care for a sick family member or take care of children due to school and childcare closures. Teleworking is one option. Additional flexibilities might include giving advances on future sick leave and allowing employees to donate sick leave to each other. ○ Employers that do not currently offer sick leave to some or all of their employees may want to draft non-punitive “emergency sick leave” policies. COVID-19: Workplace Outbreak Guidance I July 2020 6 ---PAGE BREAK--- ○ Employers should not require a positive COVID-19 test result or a healthcare provider’s note for employees who are sick to validate their illness, qualify for sick leave, or to return to work. Health care provider offices and medical facilities may be extremely busy and not able to provide such documentation in a timely manner. ○ Employers should also not require a negative COVID-19 test to return to work. ○ Review human resources policies to make sure that policies and practices are consistent with public health recommendations and are consistent with existing state and federal workplace laws. ○ Connect employees to employee assistance program (EAP) resources (if available) and community resources as needed. Employees may need additional social, behavioral, and other services, for example, to cope with the death of a loved one. ○ Avoid any incentive programs that encourage sick employees to come to work. ● Communicate supportive workplace policies clearly, frequently, and via multiple methods: ○ Employers should communicate with non-English speakers in their preferred languages. ○ Place signs about policies and ensure such signs are in languages workers can understand. ○ Train workers on how implementing any new policies to reduce the spread of COVID-19 may affect existing health and safety practices. ○ Communicate to any contractors or on-site visitors about changes that have been made to help control the spread of COVID-19. Ensure that they have the information and capability to comply with those policies. ○ Create and test communication systems that employees can use to self-report if they are sick and that you can use to notify employees of exposures and closures. ○ Consider using a hotline or another method for employees to voice concerns anonymously. ● Assess your essential functions and the reliance that others and the community have on your services or products: ○ Be prepared to change your business practices if needed to maintain critical operations identify alternative suppliers, prioritize existing customers, stagger shifts, or temporarily suspend/reduce some of your operations if needed). ○ Identify alternate supply chains for critical goods and services. Some goods and services may be in higher demand or unavailable. ○ If other companies provide your business with contract or temporary employees, talk with them about the importance of sick employees staying home and encourage them to develop non-punitive leave policies. ○ Talk with business partners about your response plans. Share best practices with other businesses in your communities (especially those in your supply chain), chambers of commerce, and associations to improve community response efforts. ○ When resuming onsite business operations, identify and prioritize job functions for continuous operations. Minimize the number of workers present at worksites by resuming business operations in phases, balancing the need to protect workers with support for continuing operations. ● Determine how you will operate if absenteeism spikes from increases in sick employees, those who stay home to care for sick family members, and those who must stay home to watch their children if dismissed from childcare programs and K–12 schools. ○ Plan to monitor and respond to absenteeism at the workplace. ○ Implement plans to continue your essential business functions in case you experience higher than usual absenteeism. ○ Prepare to institute flexible workplace and leave policies. ○ Cross-train employees to perform essential functions so the workplace can operate even if key employees are absent. COVID-19: Workplace Outbreak Guidance I July 2020 7 ---PAGE BREAK--- ● Establish policies and practices for social distancing. Alter your workspace to help workers and customers maintain social distancing and physically separate employees from each other and from customers, when possible. Here are some strategies that businesses can use: ○ Implement flexible worksites telework). ○ Implement flexible work hours. ○ Phase or stagger work shifts and breaks to reduce the number of employees in one place at the same time. ○ Increase physical space between employees at the worksite by modifying the workspace rearranging workplace stations, placing distance markers, installing partitions, discouraging use of shared spaces). ○ Increasing physical space between employees and customers rearranging customer flow, drive-through service, placing distance markers, installing partitions, limiting the number of customers). ○ Use signs, tape marks, or other visual cues such as decals or colored tape on the floor, placed 6 feet apart, to indicate where to stand when physical barriers are not possible. Ensure any signs are easy to interpret and are in languages workers understand. ○ Implementing flexible meeting and travel options postpone non-essential meetings or events, teleconference). ○ Close or limit access to common areas where employees are likely to congregate and interact. ○ Discourage handshaking. Encourage employees to use other non-contact methods of greeting. ○ Downsizing operations to reduce the number of employees at the workplace at the same time. ○ Delivering services remotely phone, video, or web). ○ Adjust your business practices to reduce close contact with customers — for example, by providing drive-through service, click-and-collect online shopping, shop-by-phone, curbside pickup, and delivery options, where feasible. ○ Move the electronic payment terminal/credit card reader farther away from the cashier, if possible, to increase the distance between the customer and the cashier. ○ Use touchless payment options as much as possible, if available. Ask customers and employees to exchange cash or card payments by placing on a receipt tray or on the counter rather than by hand to avoid direct hand to hand contact. ○ Shift primary stocking activities to off-peak or after hours, when possible, to reduce contact with customers. ● Employers with more than one business location are encouraged to provide local managers with the authority to take appropriate actions outlined in their COVID-19 response plan based on local conditions. ● Consider sequestering critically important, healthy, unexposed workers in separate housing to keep them from being exposed in the community if resources allow: ○ Employees eligible to sequester must not be nor have recent exposure to a person with COVID-19 within the last 14 days. ○ Prior to sequestration, eligible employees should be interviewed to rule out potential exposures and should be pre-screened to rule out fever, COVID-19 or recent COVID-19 exposure. ○ During sequestration, sequestered employees should be re-screened for fever and other COVID-19 daily. Additionally, they should be re-screened for potential COVID-19 exposures daily. ○ Detailed sequestration guidelines can be requested from CDPHE. To maintain a healthy work environment, workplaces/facilities should take the following actions: ● Consider improving the engineering controls using the building ventilation system. This may include some or all of the following activities: ○ Increase ventilation rates. COVID-19: Workplace Outbreak Guidance I July 2020 8 ---PAGE BREAK--- ○ Ensure ventilation systems operate properly and provide acceptable indoor air quality for the current occupancy level for each space. ○ Increase outdoor air ventilation, using caution in highly polluted areas. With a lower occupancy level in the building, this increases the effective dilution ventilation per person. ○ Disable demand-controlled ventilation (DCV). ○ Further open minimum outdoor air dampers (as high as 100%) to reduce or eliminate recirculation. In mild weather, this will not affect thermal comfort or humidity. However, this may be difficult to do in cold or hot weather. ○ Improve central air filtration to the MERV-13 or the highest compatible with the filter rack, and seal edges of the filter to limit bypass. ○ Check filters to ensure they are within service life and appropriately installed. ○ Keep systems running longer hours, 24/7 if possible, to enhance air exchanges in the building space. ● Ensure the safety of your building water system and devices from mold and Legionella after a prolonged shutdown: ○ Follow the CDC Guidance for Building Water Systems, which describes 8 steps to take to ensure the safety of your water system and devices before you reopen your business or building. ● Give employees, customers, and visitors what they need to clean their hands and cover their coughs and sneezes: ○ Provide tissues and no-touch trash cans. ○ Provide soap and water in the workplace. If soap and water are not readily available, use alcohol-based hand sanitizer that is at least 60% alcohol. If hands are visibly dirty, soap and water should be chosen over hand sanitizer. Ensure that adequate supplies are maintained. ○ Place hand sanitizers (ideally touchless) in multiple locations to encourage hand hygiene. ○ Encourage employee breaks to wash hands or use hand sanitizer. ○ Place posters that encourage hand hygiene to help stop the spread at the entrance to your workplace and in other workplace areas where they are likely to be seen. This should include signs for non-English speakers, as needed, with easy to interpret graphics. ○ Discourage handshaking. Encourage employees to use other non-contact methods of greeting. ○ Encourage use of cloth face coverings among employees and customers in public settings where social distancing measures are difficult to maintain, especially in areas of significant community-based transmission. Workers who require PPE should wear appropriate PPE instead. ● Perform routine cleaning and disinfection, particularly on frequently touched surfaces: ○ Routinely clean and disinfect all frequently touched surfaces in the workplace, such as workstations, keyboards, telephones, handrails, and doorknobs. If surfaces are dirty, they should be cleaned using a detergent or soap and water prior to disinfection. For disinfection, use products that meet EPA’s criteria for use against SARS-CoV-2 (the virus that causes COVID-19) and are appropriate for the surface. Follow the manufacturer’s instructions for all cleaning and disinfection products concentration, application method and contact time, etc.). ○ Discourage workers from using other workers’ phones, desks, offices, or other work tools and equipment when possible. If necessary, clean and disinfect them before and after use. ○ Provide disposable wipes so that commonly used surfaces (for example, doorknobs, keyboards, remote controls, desks, other work tools and equipment) can be wiped down by employees before each use. To disinfect, use products that meet EPA’s criteria for use against SARS-CoV-2 (the virus that causes COVID-19) and are appropriate for the surface. ○ Store and use disinfectants in a responsible and appropriate manner according to the label. ○ Do not mix bleach or other cleaning and disinfection products together. This can cause fumes that could be very dangerous to breathe in. COVID-19: Workplace Outbreak Guidance I July 2020 9 ---PAGE BREAK--- ○ Advise employees to always wear gloves appropriate for the chemicals being used when they are cleaning and disinfecting and that they may need additional PPE based on the setting and product. ● Perform enhanced cleaning and disinfection after people or employees suspected/confirmed to have COVID-19 have been in the workplace or facility. ● Limit travel and advise employees if they must travel to take additional precautions and preparations: ○ Minimize non-essential travel. ○ Advise employees to check themselves for of COVID-19 before starting travel and to notify their supervisor and stay home if they are sick. ○ Ensure employees who become sick while traveling or on temporary assignment understand that they should notify their supervisor and call a healthcare provider for advice if needed. ● Minimize risk to employees when planning meetings and gatherings: ○ Use videoconferencing or teleconferencing when possible for work-related meetings and gatherings. ○ Cancel, adjust, or postpone large work-related meetings or gatherings that can only occur in-person in accordance with state and local regulations and guidance. ○ When videoconferencing or teleconferencing is not possible, hold meetings in open, well-ventilated spaces continuing to maintain a distance of 6 feet apart and wear cloth face coverings. Reporting outbreaks Workplaces/facilities that suspect an outbreak (knowledge of 2 or more employees with confirmed COVID-19 within a 14-day period) should immediately take the following actions: ● Fill out the CDPHE COVID-19 outbreak report form and send it to your local public health agency to report the outbreak in accordance with Colorado statute. ● Begin identifying staff with COVID-19-like using this CDPHE COVID-19 line list template. ● Work closely with your local public health agency to confirm whether an outbreak exists,determine the extent of the outbreak, and monitor for any additional outbreak cases. Mitigating outbreaks If two or more cases are confirmed within 14 days among employees, the workplace/facility should temporarily close, and the outbreak should be reported immediately to their local public health agency. The local public health agency can help confirm an outbreak exists, identify additional cases, and determine the extent of the outbreak. They can also work with the workplace/facility to determine what specific actions should be taken and when it would be safe to re-open. If a workplace/facility is working closely with public health, it may be possible to conduct a rapid risk assessment and implement immediate control measures in lieu of closure. During an outbreak, several mitigation actions should be taken in addition to the above outbreak prevention actions: ● Actively screen employees for COVID-19 and recent COVID-19 exposure daily (in-person or virtually) before they enter the workplace/facility: ○ Employers should implement protocols to conduct daily temperature checks and monitor for COVID-19 fever, cough, shortness of breath) and recent COVID-19 exposure among employees in the worksite to the greatest extent possible. Ideally, temperature, and exposure checks should happen before the individual enters the workplace/facility. ○ To prevent stigma and discrimination in the workplace, make employee health screenings as private as possible. Do not make determinations of risk based on race or country of origin and be sure to maintain confidentiality of everyone’s medical status and history. COVID-19: Workplace Outbreak Guidance I July 2020 10 ---PAGE BREAK--- ○ Ensure any screening materials are provided in languages that employees understand. ○ Complete these screenings in a way that helps maintain social distancing guidelines, such as providing multiple screening entries into the building. ○ Document these daily temperature, and exposure checks using an employee health screening form. ○ As long as the employee doesn’t have a fever, or recent exposure, they should self-monitor under the supervision of their employer’s occupational health program. ○ If an employee reports any COVID-19 send them home and refer them to the CDPHE Tracker and encourage them to get tested. ○ Recent COVID-19 exposure is defined as having close contact feet) for a prolonged period of time (generally >15 minutes, depending on the exposure) without adequate PPE to a person with COVID-19 during their contagious period (a period from 2 days before their onset [or their positive confirmatory COVID-19 test if until they meet criteria to discontinue home isolation [generally 10 days assuming their fever has resolved, have improved, or they have not developed any new ● Send sick employees home immediately for isolation: ○ Employees who appear to have COVID-19 upon arrival at work or who become sick during the day should immediately be separated from other employees, customers, and visitors and sent home. Sick employees should follow CDC-recommended steps and be encouraged to get tested. ○ Close off areas visited by the ill people. Open outside doors and windows and use ventilating fans to increase air circulation in the area. Wait 24 hours or as long as practical before beginning cleaning and disinfection. ○ Perform enhanced cleaning and disinfection. Cleaning staff should clean and disinfect all areas such as offices, bathrooms, common areas, shared electronic equipment (like tablets, touch screens, keyboards, remote controls, and ATM machines) used by the ill people, focusing especially on frequently touched surfaces. ○ Sick employees should not return to work until the criteria to discontinue home isolation are met (generally 10 days after onset with improved respiratory and at least 3 days fever-free without fever-reducing medications). ● Identify any healthy employees with recent exposure to a person with COVID-19: ○ Recent COVID-19 exposure is defined as having close contact feet) for a prolonged period of time (generally >15 minutes, depending on the exposure) without adequate PPE to a person with COVID-19 during their contagious period (a period from 2 days before their onset [or their positive confirmatory COVID-19 test if until they meet criteria to discontinue home isolation [generally 10 days assuming their fever has resolved, have improved, or they have not developed any new ○ Information on healthy employees with recent exposure should be compiled in case needed by your local public health agency. ○ Your local public health agency can assist with contact tracing for possible recent COVID-19 exposures occurring within or outside your workplace or facility. ● Send healthy employees with recent exposure to a person with COVID-19 home to quarantine for 14 days: ○ Healthy employees with recent exposure to a person with COVID-19 (whether at home or at work) may themselves become infected and develop within a 14-day incubation window. They may also be contagious in the 2 days before developing or even while ○ Non-critical infrastructure healthy workers with recent exposure to a person with COVID-19 should notify their supervisor immediately, quarantine at home for 14 days (thought to be the maximum incubation COVID-19: Workplace Outbreak Guidance I July 2020 11 ---PAGE BREAK--- period for COVID-19 infection), self-monitor for possible development of fever and and maintain social distancing feet) from others. They may telework during quarantine if possible. ○ While there are guidelines that may permit critical infrastructure healthy workers with recent exposure to a person with COVID-19 to continue to work (with a mask and other strict precautions), these may not be sufficient to mitigate an outbreak during widespread workplace/facility transmission. Quarantining certain exposed critical-infrastructure workers for 14 days may still be recommended in consultation with your local public health agency depending on level of exposure and extent of the outbreak. ● Exclude vulnerable employees at higher risk for serious illness from workplaces/facilities when outbreaks are ongoing: ○ Vulnerable employees at higher risk for serious illness should still stay at home as much as possible in accordance with Colorado’s most recent Safer at Home order. ○ Employers must provide work accommodations to such vulnerable employees (such as allowing telework or time off) during workplace/facility outbreaks. They cannot be compelled to go to work. ● Some workers are required to wear face coverings. Where optional, strongly consider requiring all employees to use cloth face coverings while in the workplace/facility: ○ Cloth face coverings limit transmission of the virus that causes COVID-19 by containing the wearer’s respiratory droplets. Cloth face coverings may prevent workers, including those who do not know they have the virus, from spreading it to others (but may not necessarily protect the wearers from exposure to the virus). ○ Consider pilot testing the use of cloth face coverings to ensure they do not interfere with work assignments or create a safety hazard. ○ Employers can issue face masks or can approve employees’ supplied cloth face coverings in the event of shortages. ○ Guidelines for making, wearing, and cleaning cloth face masks can be found here and here. ○ Cloth face coverings are not considered PPE nor replace the need for PPE if required for a specific job. ○ Cloth face coverings do not replace the need to practice social distancing. ○ Certain employees who have trouble breathing or who are unable to remove the mask without assistance should not wear face masks, however. ○ Cloth face coverings may not be needed for employees working outside in isolation. ● Implement stricter ventilation engineering controls using some or all of the following activities: ○ Increase ventilation rates. ○ Ensure ventilation systems operate properly and provide acceptable indoor air quality for the current occupancy level for each space. ○ Increase outdoor air ventilation, using caution in highly polluted areas. With a lower occupancy level in the building, this increases the effective dilution ventilation per person. ○ Disable demand-controlled ventilation (DCV). ○ Further open minimum outdoor air dampers (as high as 100%) to reduce or eliminate recirculation. In mild weather, this will not affect thermal comfort or humidity. However, this may be difficult to do in cold or hot weather. ○ Improve central air filtration to the MERV-13 or the highest compatible with the filter rack, and seal edges of the filter to limit bypass. ○ Check filters to ensure they are within service life and appropriately installed. ○ Keep systems running longer hours, 24/7 if possible, to enhance air exchanges in the building space. ● Increase frequency of cleaning and disinfecting commonly touched surfaces. ● Implement strict social distancing policies and practices wherever and whenever possible: COVID-19: Workplace Outbreak Guidance I July 2020 12 ---PAGE BREAK--- ○ Rearrange the workplace to keep employees more than 6 feet away from one another as much as possible. Consider installing partitions if this is not possible. ○ Further phase or stagger work shifts to reduce the number of employees present at the same time. This should also apply to workplace entry/exiting times. ○ Phase or stagger breaks and do not allow for employee congregation during breaks. ○ Close or modify any shared spaces that could encourage close employee congregation. ○ Strongly consider downsizing operations to reduce the number of employees present at the same time if the above measures do not lead to adequate social distancing. ● Be aware of the limitations of COVID-19 testing in the workplace. Testing by itself cannot “clear” employees to work: ○ COVID-19 testing could refer to either viral RT-PCR/nucleic acid or antigen detection) or serologic (antibody) tests. ○ Viral testing RT-PCR/nucleic acid or antigen detection) via an upper respiratory specimen is used to confirm current COVID-19 infection: ■ Employees with COVID-19 are encouraged to be tested for COVID-19. ■ Employees confirmed to have COVID-19 should stay at home until they meet the criteria to discontinue home isolation (generally 10 days after onset [or positive confirmatory test if assuming their fever has resolved, have improved, or they have not developed any new Risk of transmission after this time is thought to be low given the best currently available evidence. ■ CDPHE does not recommend re-testing people who have already been confirmed to have COVID-19 infection. ■ All positive viral test results must be reported to CDPHE in accordance with mandatory reporting requirements. Ensure that any contracted laboratory is aware of this requirement. ○ Viral testing RT-PCR/nucleic acid or antigen detection) should not routinely be used to test healthy employees in most circumstances: ■ Negative results do not rule out the potential for current or future infection and may offer a false sense of security. Negative results also do not necessarily “clear” employees to work nor obviate the need for quarantine when necessary. ■ Positive results may be difficult to interpret given lack of clear infection date and unclear contagious period. A positive result does not necessarily mean a person is still contagious. ○ However, viral testing RT-PCR/nucleic acid or antigen detection) of healthy employees may be considered in response to certain outbreaks or in certain high-risk settings as part of a targeted outbreak plan developed in conjunction with your local public health agency: ■ The goal of testing some workers is to identify positive workers who may be or but potentially contagious. ■ A positive test should be treated as a case of COVID-19 and investigated and isolated appropriately. ■ Any healthy worker who tests positive using a viral test RT-PCR/nucleic acid or antigen detection) must be isolated for 10 days from the date of their test, assuming they remain If they develop during their initial isolation, isolation time may need to be extended. ■ Anyone with recent exposure to a healthy worker who tests positive for COVID-19 using a viral test RT-PCR/nucleic acid or antigen detection) must be quarantined for 14 days from the time of last exposure. Recent COVID-19 exposure is defined as having close contact feet) for a prolonged period of time (generally >15 minutes, depending on the exposure) without adequate PPE to a person with COVID-19 during their contagious period (a period from 2 days before their onset [or their positive confirmatory COVID-19 test if until they meet criteria to discontinue COVID-19: Workplace Outbreak Guidance I July 2020 13 ---PAGE BREAK--- home isolation [generally 10 days assuming their fever has resolved, have improved, or they have not developed any new ■ All positive viral test results must be reported to CDPHE in accordance with mandatory reporting requirements. Ensure that any contracted laboratory is aware of this requirement. ■ A negative test cannot clear someone from quarantine or guarantee that they are not in their incubation period, nor does a negative test guarantee that a person will not develop COVID-19 at any point in the future. ■ Be aware testing capacity may still be limited in some settings. ○ Do not use serologic (antibody) tests to prove immunity or clear employees to work: ■ Some serologic (antibody) tests may be cross-reactive with other common coronaviruses and may not be specific for COVID-19, resulting in false positives. ■ Some serologic (antibody) tests have been removed from the FDA’s authorized list because of quality issues. ■ In areas with low prevalence, false positives can still occur even among serologic (antibody) tests with relatively good specificity and sensitivity. ■ Serologic (antibody) tests have not been proven to correlate with protective immunity yet. ■ Serologic (antibody) test results should not be used to make decisions about grouping persons residing in or being admitted to congregate settings, such as schools, dormitories, or correctional facilities. ■ Serologic test results should not be used to make decisions about returning persons to the workplace and cannot be used to clear employees to work. ■ Until more information is available about the dynamics of IgA detection in serum, testing for IgA antibodies is not recommended. ● Additional workplace/facility closure may be required by public health if widespread transmission continues to occur despite the above measures or if there are not enough staff available to run operations safely: ○ Consult with your local public health agency on when and how to re-open. ○ Closure may need to last until enough staff have finished their appropriate isolation (if infected) or quarantine (if healthy but exposed) to safely resume operations. ○ Perform enhanced cleaning and disinfection prior to re-opening. Cleaning staff should clean and disinfect all areas such as offices, bathrooms, common areas, shared electronic equipment (like tablets, touch screens, keyboards, remote controls, and ATM machines) used by the ill people, focusing especially on frequently touched surfaces. ● Additional outbreak mitigation recommendations may be required depending on specific situations in consultation with your local public health agency. COVID-19: Workplace Outbreak Guidance I July 2020 14 ---PAGE BREAK--- Appendix: Checklists for Preventing, Reporting and Mitigating Workplace/Facility Outbreaks Preventing outbreaks To reduce transmission among employees: ❏Encourage employees to self-monitor for COVID-19 daily. ❏Actively encourage sick employees to stay home. ❏Consider actively screening employees for COVID-19 and exposure daily (in-person or virtually) before they enter the workplace/facility. ❏Identify where and how workers might be exposed to COVID-19 at work. ❏Encourage use of cloth face coverings among employees and customers in public settings where social distancing measures are difficult to maintain, especially in areas of significant community-based transmission. ❏Separate sick employees and send them home. ❏Take action if an employee is suspected or confirmed to have COVID-19 infection: ❏Educate employees about how they can reduce the spread of COVID-19 at work and at home. ❏For employees who commute to work using public transportation, carpooling, or ride sharing, consider additional steps. ❏Provide accommodations for vulnerable employees at higher risk for serious illness such as older adults and those with certain chronic medical conditions. ❏Take additional precautions for healthy employees with recent exposure to a person with COVID-19. Precautions may differ between critical and non-critical infrastructure workers. To maintain healthy business operations: ❏Deputize a workplace coordinator who will be responsible for COVID-19 issues and their impact at the workplace. ❏Implement flexible sick leave and supportive policies and practices. ❏Communicate supportive workplace policies clearly, frequently, and via multiple methods. ❏Assess your essential functions and the reliance that others and the community have on your services or products. ❏Determine how you will operate if absenteeism spikes from increases in sick employees, those who stay home to care for sick family members, and those who must stay home to watch their children if dismissed from childcare programs and K–12 schools. ❏Establish policies and practices for social distancing. ❏Employers with more than one business location are encouraged to provide local managers with the authority to take appropriate actions outlined in their COVID-19 response plan based on local conditions. ❏Consider sequestering critically important, healthy, unexposed employees in separate housing to keep them from being exposed in the community if resources allow. To maintain a healthy work environment: ❏Consider improving the engineering controls using the building ventilation system. ❏Ensure the safety of your building water system and devices from mold and Legionella after a prolonged shutdown. ❏Give employees, customers, and visitors what they need to clean their hands and cover their coughs and sneezes. ❏Perform routine environmental cleaning and disinfection, particularly on frequently touched surfaces. COVID-19: Workplace Outbreak Guidance I July 2020 15 ---PAGE BREAK--- ❏Perform enhanced cleaning and disinfection after people or employees suspected/confirmed to have COVID-19 have been in the workplace or facility. ❏Limit travel and advise employees if they must travel to take additional precautions and preparations. ❏Minimize risk to employees when planning meetings and gatherings. Reporting outbreaks Workplaces/facilities that suspect an outbreak should immediately take the following actions: ❏Fill out the CDPHE COVID-19 outbreak report form and send it to your local public health agency. ❏Begin identifying staff with COVID-19-like using the CDPHE COVID-19 line list template. ❏Work with your local public health agency to confirm that an outbreak does exist and to determine the extent of the outbreak. Mitigating outbreaks ❏Temporarily close the workplace/facility once an outbreak is recognized and work with your local public health agency to determine what specific actions should be taken and when it would be safe to re-open. If a workplace/facility is working closely with public health, it may be possible to conduct a rapid risk assessment and implement immediate control measures in lieu of closure. ❏Actively screen employees for COVID-19 and exposure daily (in-person or virtually) before they enter the workplace/facility. ❏Send sick employees home immediately for isolation. ❏Identify any healthy employees with recent exposure to a person with COVID-19. Your local public health agency can assist with contact tracing for possible recent COVID-19 exposures occurring within or outside your workplace or facility. ❏Send healthy employees with recent exposure to a person with COVID-19 home to quarantine for 14 days. Exceptions may apply for critical infrastructure workers depending on the situation. ❏Exclude employees at higher risk for serious illness from workplaces/facilities when outbreaks are ongoing. ❏Strongly consider requiring all employees to use cloth face coverings while in the workplace/facility. ❏Implement stricter ventilation engineering controls. ❏Increase frequency of cleaning and disinfecting commonly touched surfaces. ❏Implement strict social distancing policies and practices wherever and whenever possible. ❏ Be aware of the limitations of COVID-19 testing in the workplace. Testing by itself cannot “clear” employees to work. ❏Additional workplace/facility closure may be required by public health if widespread transmission continues to occur despite the above measures or if there are not enough staff available to run operations. ❏Additional outbreak mitigation recommendations may be required depending on specific situations in consultation with your local public health agency. 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