COVID-19: VGM’s Next Steps Guide A blueprint guide preparing your business for the new environment
Table of Contents
INTRODUCTION.................................................................................................................. page 3 SAFETY Proper Hygiene ............................................................................................................. page 4 Equipping Your Employees With Personal Protective Equipment (PPE) ........................ page 8 Visitor Policy and Social Distancing............................................................................. page 10 Employee Monitoring .................................................................................................. page 12 FINANCIAL GUIDANCE AND RESOURCES FOR YOUR BUSINESS Loans and Stimulus Dollars (PPP and EIDL)................................................................... page 17 YOUR STATE LEVEL RESOURCES Third-Party Payer Updates.............................................................................................page 19 State by State Business Reopening Guidance.............................................................. page 20 POLICIES AND PROCEDURES Policies, Procedures, and Compliance..........................................................................page 21 HUMAN RESOURCES How to Handle Staffing................................................................................................. page 22
COVID-19: VGM’s Next Steps Guide
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Introduction COVID-19: VGM’s Next Steps Guide A blueprint guide preparing your business for the new environment. The purpose of this tool is to assist employers in making (re)opening decisions during the COVID-19 pandemic, especially to protect vulnerable workers. It is important to check with state and local health officials and other partners to determine the most appropriate actions while adjusting to meet the unique needs and circumstances of the local community. You can also find a brief decision tree put out by the Centers for Disease Control (CDC) at www.cdc.gov/coronavirus/2019-ncov/downloads/community/workplace-decision-tree.pdf.
We hope you find the information in this guide helpful. And as always, reach out to our team if you have any questions or concerns.
VGM Government Team
John Gallagher VP, Government Relations
Mark Higley VP, Regulatory Affairs
Ronda Buhrmester Senior Director, Payer Relations and Reimbursement
COVID-19: VGM’s Next Steps Guide
Emily Harken Government Relations Executive Administrator
Craig Douglas VP, Payer and Member Relations
Introduction | 3
Safety: Proper Hygiene
E
ducate employees about steps they can take to protect themselves at work and at home. Encourage employees to follow any new policies or procedures related to illness, cleaning and disinfecting, and work meetings and travel. Checklist: Training to Employees Check that employees were taught to: Stay home if they are sick, except to get medical care, and what to do if they are sick. Inform their supervisor if they have a sick family member at home with COVID-19 and what to do if someone in their home is sick. Wash their hands often with soap and water for at least 20 seconds or 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. Key times for employees to clean their hands include:
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 SARSCoV-2, the cause of COVID-19, and are appropriate for the surface. Avoid using other employees’ phones, desks, offices, or other work tools and equipment when possible. Clean and disinfect them before and after use. Practice social distancing by avoiding large gatherings and maintaining distance (at least 6 feet) from others when possible. Items to Provide 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. Ensure that adequate supplies are maintained.
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Before and after work shifts
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Before and after work breaks
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After blowing their nose, coughing, or sneezing
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After using the restroom
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Before eating or preparing food
Ideally, place touchless hand sanitizer stations in multiple locations to encourage hand hygiene.
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After putting on, touching, or removing cloth face coverings
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Avoid touching their eyes, nose, and mouth with unwashed hands
Discourage handshaking. Encourage employees to use other noncontact methods of greeting.
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. Learn more about coughing and sneezing etiquette on the CDC website.
COVID-19: VGM’s Next Steps Guide
Direct employees to visit CDC’s coughing and sneezing etiquette and clean hands webpage for more information. 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. See link below for posters. www.cdc.gov/coronavirus/2019-ncov/ communication/print-resources. html?Sort=Date%3A%3Ades Safety: Proper Hygiene | 4
Safety: Proper Hygiene continued... How to Safely Wear and Take Off a Cloth Face Covering Accessible: https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/diy-cloth-face-coverings.html
Please wear a cloth face covering.
WEAR YOUR FACE COVERING CORRECTLY • • • • •
Wash your hands before putting on your face covering Put it over your nose and mouth and secure it under your chin Try to fit it snugly against the sides of your face Make sure you can breathe easily Do not place a mask on a child younger than 2
LO TH
BA
RR IER
USE THE FACE COVERING TO HELP PROTECT OTHERS • Wear a face covering to help protect others in case you’re infected but don’t have symptoms • Keep the covering on your face the entire time you’re in public • Don’t put the covering around your neck or up on your forehead • Don’t touch the face covering, and, if you do, clean your hands
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FOLLOW EVERYDAY HEALTH HABITS
6 ft
PHARMACY
• Stay at least 6 feet away from others • Avoid contact with people who are sick • Wash your hands often, with soap and water, for at least 20 seconds each time • Use hand sanitizer if soap and water are not available
TAKE OFF YOUR CLOTH FACE COVERING CAREFULLY, WHEN YOU’RE HOME • • • • •
Untie the strings behind your head or stretch the ear loops Handle only by the ear loops or ties Fold outside corners together Place covering in the washing machine Wash your hands with soap and water
Maintain a distance of 6 feet whenever possible.
Cloth face coverings are not surgical masks or N-95 respirators, both of which should be saved for health care workers and other medical first responders.
For instructions on making a cloth face covering, see: CS 316488A 05/27/2020
Perform Routine Cleaning Follow the Guidance for Cleaning and Disinfecting to develop, implement, and maintain a plan to perform regular cleanings to reduce the risk of exposure to COVID-19. www.cdc.gov/coronavirus/2019-ncov/community/ reopen-guidance.htm Routinely clean all frequently touched surfaces in the workplace, such as workstations, keyboards, telephones, handrails, and doorknobs. If surfaces are dirty, clean them using a detergent or soap and water before you disinfect them. For disinfection, most common, EPA-registered, household disinfectants should be effective. A list of products that are EPA-approved for use against the virus that causes COVID-19 is available on the EPA website. Follow the manufacturer’s instructions for all cleaning and disinfection products (e.g., concentration, application method, and contact time). Discourage workers from using each other’s phones, desks, offices, or other work tools and equipment, when possible. Provide disposable disinfecting wipes so that employees can wipe down commonly used surfaces (e.g., doorknobs, keyboards, remote controls, desks, and other work tools and equipment) before each use. COVID-19: VGM’s Next Steps Guide
cdc.gov/coronavirus
cdc.gov/coronavirus CS 317176-B 05/27/2020
Store and use disinfectants in a responsible and appropriate manner according to the label. Many products recommend: Keeping surface wet for a period of time (see product label). Precautions such as wearing gloves and making sure you have good ventilation during use of the product. Tip: Diluted household bleach solutions may also be used if appropriate for the surface. Check the label to see if your bleach is intended for disinfection, and ensure the product is not past its expiration date. Some bleaches, such as those designed for safe use on colored clothing or for whitening, may not be suitable for disinfection. Unexpired household bleach will be effective against coronaviruses when properly diluted. Follow manufacturer’s instructions for application and proper ventilation. Never mix household bleach with ammonia or any other cleaners. Leave solution on the surface for at least 1 minute. For soft surfaces such as carpeted floor, rugs, and drapes: Clean the surface using soap and water or with cleaners appropriate for use on these surfaces. Safety: Proper Hygiene | 5
Safety: Proper Hygiene continued... Launder items (if possible) according to the manufacturer’s instructions. Use the warmest appropriate water setting and dry items completely.
Cleaning and disinfecting your building or facility if someone is sick Close off areas used by the person who is sick. •
OR Disinfect with an EPA-registered household disinfectant. These disinfectants meet EPA’s criteria for use against COVID-19. Vacuum as usual. For electronics such as tablets, touch screens, keyboards, remote controls, and ATMs: Consider putting a wipeable cover on electronics. Follow manufacturer’s instruction for cleaning and disinfecting. •
If no guidance, use alcohol-based wipes or sprays containing at least 70% alcohol. Dry surface thoroughly.
Open outside doors and windows to increase air circulation in the area. Wait 24 hours before you clean or disinfect. If 24 hours is not feasible, wait as long as possible. Clean and disinfect all areas used by the person who is sick, such as offices, bathrooms, common areas, shared electronic equipment like tablets, touch screens, keyboards, remote controls, and ATMs. Vacuum the space if needed. Use vacuum equipped with high-efficiency particular air (HEPA) filter, if available. •
Do not vacuum a room or space that has people in it. Wait until the room or space is empty to vacuum, such as at night, for common spaces, or during the day for private rooms.
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Consider temporarily turning off room fans and the central HVAC system that services the room or space, so that particles that escape from vacuuming will not circulate throughout the facility.
For clothing, towels, linens, and other items: Launder items according to the manufacturer’s instructions. Use the warmest appropriate water setting and dry items completely. Wear disposable gloves when handling dirty laundry from a person who is sick. Dirty laundry from a person who is sick can be washed with other people’s items. Do not shake dirty laundry. Clean and disinfect clothes hampers according to guidance above for surfaces. Remove gloves and wash hands right away.
COVID-19: VGM’s Next Steps Guide
Companies do not necessarily need to close operations if they can close off affected areas.
Once area has been appropriately disinfected, it can be opened for use. •
Workers without close contact with the person who is sick can return to work immediately after disinfection.
If more than 7 days since the person who is sick visited or used the facility, additional cleaning and disinfection is not necessary.
Safety: Proper Hygiene | 6
Safety: Proper Hygiene continued... •
Continue routing cleaning and disinfection. This includes everyday practices that businesses and communities normally use to maintain a healthy environment.
Wear disposable gloves and gowns for all tasks in the cleaning process, including handling trash. •
Outdoor areas, like playgrounds in schools and parks generally require normal routine cleaning but do not require disinfection.
Additional personal protective equipment (PPE) might be required based on the cleaning/ disinfectant products being used and whether there is a risk of splash.
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» Do not spray disinfectant on outdoor playgrounds—it is not an efficient use of supplies and is not proven to reduce risk of COVID-19 to the public.
Gloves and gowns should be removed carefully to avoid contamination of the wearer and the surrounding area.
Wash your hands often with soap and water for 20 seconds.
Cleaning and disinfecting outdoor areas •
» High-touch surfaces made of plastic or metal, such as grab bars and railings, should be cleaned routinely. » Cleaning and disinfection of wooden surfaces (play structures, benches, tables) or groundcovers (mulch, sand) is not recommended. •
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Always wash immediately after removing gloves and after contact with a person who is sick.
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Hand sanitizer: If soap and water are not available and hands are not visibly dirty, an alcohol-based hand sanitizer that contains at least 60% alcohol may be used. However, if hands are visibly dirty, always wash hands with soap and water.
Sidewalks and roads should not be disinfected. » Spread of COVID-19 from these surfaces is very low and disinfection is not effective.
Regular cleaning staff can clean and disinfect community spaces. •
Ensure they are trained on appropriate use of cleaning and disinfection chemicals.
COVID-19: VGM’s Next Steps Guide
Safety: Proper Hygiene | 7
Safety: Equipping Your Employees With Personal Protective Equipment (PPE) Checklist: Equipping Employees With PPE 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 PPE are needed for specific job duties.
COVID-19 Procedure: Protocol for Donning and Removing PPE: 1. Refer to related tables or graphics COVID-19 Procedures: Donning PPE
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. Encourage workers to wear a cloth face covering at work if the hazard assessment has determined that they do not require PPE, such as a respirator or medical facemask for protection. 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.
Source: Handbook of COVID-19 Prevention and Treatment (2020) produced by The First Affiliated Hospital, Zhejiang University School of Medicine (FAHZU)
COVID-19 Procedures: Removing PPE
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. Note: See the OSHA COVID-19 webpage for more information on how to protect workers from potential COVID-19 exposures and guidance for employers, including steps to take for jobs according to exposure risk. Related Links: www.osha.gov/SLTC/covid-19/ www.cdc.gov/coronavirus/2019-ncov/preventgetting-sick/how-covid-spreads.html
COVID-19: VGM’s Next Steps Guide
Source: Handbook of COVID-19 Prevention and Treatment (2020) produced by The First Affiliated Hospital, Zhejiang University School of Medicine (FAHZU)
Safety: Equipping Your Employees With Personal Protective Equipment (PPE) | 8
Safety: Equipping Your Employees With Personal Protective Equipment (PPE) continued... 2. Enter checklist details:
Related Checklists:
Who is responsible to implement?
COVID-19 Procedure: Isolation Area Management
Who is responsible to review?
COVID-19 Procedure: Disinfection Procedures for COVID-19 Isolation Ward Area
3. Protocol for Donning PPE: Put on special work clothes and work shoes
COVID-19 Procedure: Lung Transplantation Pretransplantation Assessment COVID-19 Procedure: Nursing Care During Treatment (ALSS)
Wash hands Put on disposable surgical cap Put on medical protective mask (N95) Put on inner disposable nitrite/latex gloves Put on goggles and protective clothing Put on outer disposable latex gloves 4. Protocol for Removing PPE: •
Wash hands and remove visible bodily fluids
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Replace outer gloves with new gloves
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Remove respirator or full-face mask
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Wash hands
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Remove disposable gowns along with outer gloves (if used)
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Wash hands and remove protective clothing
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Wash hands and remove goggles
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Wash hands and remove mask
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Wash hands and remove cap
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Wash hands and remove inner disposable latex gloves
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Wash hands
COVID-19 Procedure: Protocol for Donning and Removing PPE COVID-19 Procedure: Staff Management (Workflow and Health) COVID-19 Procedure: Daily Management and Monitoring of ECMO Audit COVID-19 Procedure: Digital Support for Epidemic Prevention and Control COVID-19 Procedure: Discharge Standards and Follow-Up Plan for COVID-19 Patients COVID-19 Procedure: Disinfection of COVID-19 Related Reusable Medical Devices COVID-19 Procedure: Disinfection Procedures for Infectious Fabrics of Suspected or Confirmed Patients COVID-19 Procedure: Disposal Procedures for COVID-19 Related Medical Waste COVID-19 Procedure: Disposal Procedures for Spills of COVID-19 Patient Blood/Fluids COVID-19 Procedure: Procedures for Handling Bodies of Deceased Suspected or Confirmed Patients COVID-19 Procedure: Procedures for Taking Remedial Actions Against Occupational Exposure to COVID-19 COVID-19 Procedure: Surgical Operations for Suspected or Confirmed Patients
COVID-19: VGM’s Next Steps Guide
Safety: Equipping Your Employees With Personal Protective Equipment (PPE) | 9
Safety: Visitor Policy and Social Distancing
D
uring these difficult times, visitors/vendors/ customers understand and expect that your business will be operating differently. However, they still expect transparency and timely updates as you establish a path forward. Follow these best practices when communicating with customers. Checklist: Enforcing a Visitor Policy and Social Distancing at the Workplace
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 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.
Use multiple channels to ensure your message is widely received and reinforced.
Wait 24 hours 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.
Demonstrate that customer interests are a priority and address their concerns directly.
During this waiting period, open outside doors and windows to increase air circulation in these areas.
Create and share an FAQ document outlining specific questions around your supply chain, your health and safety practices, and potential risks to your customers if they continue patronage of your business.
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.
Reach out to affected customers and offer assistance where appropriate. Consider the following when allowing visitors, customers, and vendors into the workplace:
Follow the CDC cleaning and disinfection recommendations: www.cdc.gov/coronavirus/2019ncov/community/organizations/cleaning-disinfection. html
Have all guests’ temperature taken (must be under 100.4).
Clean dirty surfaces with soap and water before disinfecting them.
Have all guests wear a mask. Ensure all of the below screening question be asked before the guest enters the building. All questions must be answered ‘NO’ in order to pass. •
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Have you experienced any COVID-19 symptoms (fever, cough, shortness of breath, chills, muscle pain, sore throat, new loss of taste or smell) within the past 14 days? Have you been in close contact with anyone with a presumed (as defined by a physician) or confirmed case of COVID-19?
COVID-19: VGM’s Next Steps Guide
To disinfect surfaces, use products that meet EPA criteria for use against SARS-COVID-19 virus that causes COVID-19 and are appropriate for the surface. Always wear gloves and gowns appropriate for the chemicals being used when you are cleaning and disinfecting. You may need to wear additional PPE depending on the setting and disinfectant product you are using. For each product you use, consult and follow the manufacturer’s instructions for use.
Safety: Visitor Policy and Social Distancing | 10
Safety: Visitor Policy and Social Distancing continued... Determine which employees may have been exposed to the virus and may need to take additional precautions: Inform employees of their possible exposure to COVID-19 in the workplace but maintain confidentiality as required by the Americans with Disabilities Act (ADA) external icon. Most workplaces should follow the Public Health Recommendations for Community-Related Exposure and instruct potentially exposed employees to stay home for 14 days, telework if possible, and self-monitor for symptoms.
Consider the following alternatives to delivery: •
Ship the item using a shipping service and provide education virtually with telemedicine.
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For direct deliveries, leave the item on the doorstep and have an in-depth phone conversation with the patient/caregiver explaining universal precautions that will be taking place as well as the education of the equipment.
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Give an estimated timeframe for education (time spent in the home).
Checklist for Delivering to Patients Evaluate your business model and determine the best way to effectively deliver goods and services to your clients. Evaluate your businesses capacity guidelines as to how many customers to allow in the retail lobby at once. Is curbside service an option while your waiting area or showroom remain closed? Will your restrooms be open to visitors? Ensure your delivery drivers are protected with necessary PPE (see above paragraphs on PPE for more information).
COVID-19: VGM’s Next Steps Guide
Safety: Visitor Policy and Social Distancing | 11
Safety: Employee Health Monitoring Asymptomatic Healthcare Workers and Employees Directions on how to manage and monitor all ASYMPTOMATIC healthcare workers for COVID-19, regardless of exposure in the community or healthcare setting. Check Employees’ Temperature: All healthcare workers and employees self-monitor by taking their temperature twice daily and assessing for COVID-19like illness. Signs and symptoms of COVID-19 include: •
Fever (temperature greater than 100° Fahrenheit)
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Shortness of breath
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New onset persistent cough
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Nasal congestion and runny nose not associated with seasonal allergies
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Sore throat
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New loss of taste or smell
OR at least two of these symptoms: •
Chills
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Muscle pain
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Headache
If you have recently traveled, and do not have mandated quarantine restrictions, and have no symptoms of COVID-19, you are able to return to work or school. •
Healthcare workers/employees who do not have any COVID-19 symptoms should report to work regardless of known COVID-19 exposure unless they have been instructed by their supervisor/ manager to work from home.
COVID-19: VGM’s Next Steps Guide
Use This Employee Monitoring Tool to screen employees before they enter a facility. Staff who are concerned that they may have the COVID-19 virus but have not developed symptoms, may request a nasopharyngeal swab (PCR) test. •
Staff are limited to one COVID-19 PCR test every 28 days
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Healthcare workers who are antibody positive against SARS CoV-2 (COVID-19) will not qualify for PCR testing unless they develop new symptoms for COVID-19
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Staff with previously positive PCR test are not eligible for retesting
The above guidance is subject to change based on local, state, and federal health authority guidelines. Asymptomatic Healthcare Workers and Employees With Positive PCR Test for COVID-19 If the healthcare worker is asymptomatic but was tested and found to be positive, they must not report to work for at least 10 days after the date of the positive test. If they develop symptoms during that time, they must not report to work for 10 days after symptom onset and must have been fever-free for at least 72 hours without taking fever reducing medications (e.g., aspirin, acetaminophen, etc.), along with resolving respiratory symptoms. Symptomatic Healthcare Workers and Employees If healthcare workers or other employees develop any of the above signs and symptoms, they should not report to work. If any signs and symptoms occur while working, the healthcare worker/employee MUST immediately leave the patient care area and inform their supervisor. Employees that have active COVID-19 symptoms are eligible for the nasopharyngeal swab (PCR test).
Safety: Employee Health Monitoring | 12
Safety: Employee Health Monitoring continued... HOW (to wash hands and manage germs)
PCR testing is indicated when someone has developed acute COVID-19 symptoms: a. One of the following: Fever [>100° F], cough, shortness of breath or difficulty breathing, sore throat, runny nose not associated with seasonal allergies, new loss of taste or smell, OR b. Two of the following: chills, muscle pain, headache
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Symptomatic employees should NOT enter their local sites and should follow the protocol outlined above.
]
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Clean your hands often. Wash your hands with soap and water for at least 20 seconds. If soap and water are not available, clean your hands with an alcohol-based hand sanitizer that contains at least 60% alcohol, covering all surfaces of your hands and rubbing them together until they feel dry. Soap and water should be used preferentially if hands are visibly dirty.
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Avoid touching your eyes, nose, and mouth with unwashed hands.
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Cover your mouth and nose with a tissue when you cough or sneeze. Throw used tissues into a lined trash can. Immediately wash your hands with soap and water or hand sanitizer
Symptomatic employees should NOT enter their local sites and should follow the protocol outlined above.
Employees and Healthcare Workers With Exposures in the Healthcare Setting
If someone has worsening symptoms, such as difficulty breathing, please contact a doctor and/or go to the nearest urgent care center or emergency department for immediate attention.
With the COVID-19 pandemic, at this time, contact investigations are not being performed in the hospital. In the event of a reported high-risk exposure (e.g., unprotected contact [> 10 minutes] with a confirmed COVID-19 patient or unprotected contact during an aerosolizing procedure performed on a COVID-19 patient), healthcare workers may report to work as long as they are asymptomatic and will be actively monitored by Environmental Health and Safety (EHS).
Personnel are able to return to work 10 days after symptom onset and being consistently afebrile (temperature <100° F) for at least 72 hours without taking fever-reducing medications (e.g., aspirin, acetaminophen), along with resolving respiratory symptoms. Advice for symptomatic employees WHAT (you should do) •
Rest, staying hydrated, and sleep are typically helpful in your recovery.
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Manage and treat your symptoms with fluids and medicines for fevers, cough, and other cold symptoms.
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Call your doctor if you start to feel worse (increased congestion, coughing, or fevers).
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Seek emergency medical treatment if you have difficulty breathing.
COVID-19: VGM’s Next Steps Guide
These personnel will be required to wear a surgical mask throughout their shift and self-monitor for 14 days by taking their temperature twice daily and assessing for COVID-19-like illness. Temperatures and symptom log must be submitted to EHS electronically. EHS will provide guidance on this process when the incident is reported. Additionally, employees will be eligible for COVID-19 serum antibody testing, as outlined in Section 6 below. The above guidance is subject to change based on local, state. and federal health authority guidelines.
Safety: Employee Health Monitoring | 13
Safety: Employee Health Monitoring continued... COVID-19 EMPLOYEE TESTING POLICY Category
Testing Type
Testing Time Frame
How to Schedule
Return to Work Policy
Symptomatic Employee Symptomatic1 Employee
Nasopharyngeal Typically 2-4 days (EXAMPLE Swab (PCR) after symptom onset ONLY – EDIT AS APPROPRIATE)
Option 1: No testing—furlough and return to work as soon as 10 days from symptom onset as per policy4 Option 2: Testing— furlough and return to work as soon as soon as 10 days from symptom onset as per policy4 Option 3: Employees that test negative can volunteer to return to work before the 10 days post-symptom onset (as long as afebrile for 72 hours without fever-reducing medications)
Asymptomatic Employee Report to work
Previously Serum Antibody Testing had COVID symptoms that were reported to EHS
Testing is performed when an individual is both asymptomatic for 14 days and at least 21 days after symptom onset
A member of the team will call all symptomatic employees who previously registered with EHS about 3 weeks after they first reported their symptoms to EHS to be scheduled for the test
Had high-risk Serum Antibody exposure in Testing the healthcare setting
Testing is performed at least 21 days from high-risk work exposure
A member of Report to work the team will call employees who have previously reported a new high-risk exposure to EHS, and have completed their 14 days of selfmonitoring to schedule the test
COVID-19: VGM’s Next Steps Guide
Safety: Employee Health Monitoring | 14
Safety: Employee Health Monitoring continued... COVID-19 EMPLOYEE TESTING POLICY Category
Testing Type
Testing Time Frame
How to Schedule
Return to Work Policy
Symptomatic Employee Asymptomatic Employee
Nasopharyngeal Upon request but Swab (PCR) no more than once every 28 days
Upon registration, a member of the team will contact them to schedule the test and provide testing site3 information within 24 hours.
Report to work while awaiting test results •
Results Positive: home isolation for at least 10 days from date of positive result
•
If symptoms1 develop during that time, employee does not report to work for at least 10 days after symptom onset (as long as afebrile for at least 72 hours without taking fever-reducing medication and respiratory symptoms have improved)
Asymptomatic Employee Asymptomatic Employee
Serum Antibody Testing
COVID-19: VGM’s Next Steps Guide
A one-time test is being offered to all employees between May and June 2020
Senior leadership Report to work will be announcing the testing schedule for their site. *Frontline staff (clinical and non-clinical) who have worked in high-risk areas will be given initial priority for testing.
Safety: Employee Health Monitoring | 15
Safety: Employee Health Monitoring continued... Notes: 1. Signs and symptoms of COVID -19 include: •
Fever (temperature greater than 100° Fahrenheit)
•
Shortness of breath
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New onset persistent cough
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Nasal congestion and runny nose not associated with seasonal allergies
•
Sore throat
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New loss of taste or smell
OR at least two of these symptoms: •
Chills
•
Muscle pain
•
Headache
2. The registration process outlined in Sections 1, 2, 3, and 4 above are the same process. If an individual completed a form as noted in Sections 2 and 3, they are eligible for testing, and they DO NOT need to register a second time for the same exposure. 3. COVID-19 testing is NOT performed at local sites— testing logistics and testing sites will be provided as outlined in the table above. 4. Staff are able to return to work 10 days after symptom onset and being consistently afebrile (temperature < 100° F) for at least 72 hours without taking fever-reducing medications (e.g., aspirin, acetaminophen, etc.), along with resolving respiratory symptoms. Employees and Healthcare Workers Return to Work
or healthcare workers cannot work for at least 10 days from the onset of symptoms. A person is able to return to work after 10 days of symptom onset, regardless of date of testing, if they have been consistently afebrile (temperature < 100° F) for at least 72 hours without taking fever-reducing medications (e.g., aspirin, acetaminophen, etc.), along with resolving respiratory symptoms. Check your local and state guidelines to verify whether repeat testing is required to return to work. Employees that have a negative PCR result can volunteer to return to work before the 10 days post symptom onset, as long as they have been afebrile for 72 hours without fever-reducing medications. EHS MUST clear all personnel before returning to duty; Clearance to return to work is done over the phone, and EHS will call the employee when they are eligible to return to duty. The above guidance is subject to change based on local, state, and federal health authority guidelines. References: Centers for Disease Control and Prevention (CDC), Interim U.S. Guidance for Risk Assessment and Public Health Management of Healthcare Personnel with Potential Exposure in a Healthcare Setting to Patients with Coronavirus Disease (COVID-19) April 30, 2020: www.cdc.gov/coronavirus/2019-ncov/hcp/guidancerisk-assesment-hcp.html www.cdc.gov/coronavirus/2019-ncov/symptomstesting/symptoms.html www.cdc.gov/coronavirus/2019-ncov/travelers/index. html www.cdc.gov/coronavirus/2019-ncov/hcp/return-towork.html
Employees and healthcare workers who are symptomatic and have had a PCR test for COVID-19 who are awaiting test results are required to selfisolate pending those results. If positive, the employee
COVID-19: VGM’s Next Steps Guide
Safety: Employee Health Monitoring | 16
Financial Guidance and Resources For Your Business:
Loans and Stimulus Dollars HHS Relief Payments These funds, regardless of what round of funding they stemmed from, were payments rather than loans, and they do not need to be paid back as long as they were used appropriately. You do need to keep accurate records of when and how the money was used, and there are reporting requirements associated with them. All of the terms and conditions and other guidance and requirements associated with these funds can be found at: www.hhs.gov/coronavirus/ cares-act-provider-relief-fund/index.html, and below are specific links and a brief description of the info that can be found at each one: •
FAQs for the $50B General Distributions Made to Healthcare Providers – www.hhs.gov/sites/ default/files/provider-relief-fund-generaldistribution-faqs.pdf
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Terms and Conditions for Various HHS Stimulus Programs » Round 1 ($30B distribution) – www.hhs.gov/ sites/default/files/terms-and-conditionsprovider-relief-30-b.pdf » Round 2 ($20B distribution) – www.hhs.gov/ sites/default/files/terms-and-conditionsprovider-relief-20-b.pdf » FFCRA Relief Fund – www.hhs.gov/sites/ default/files/terms-and-conditions-ffcra-relieffund.pdf » Uninsured Relief Fund – www.hhs.gov/sites/ default/files/terms-and-conditions-uninsuredrelief-fund.pdf » High Impact Relief Fund – www.hhs.gov/ sites/default/files/terms-and-conditions-highimpact-relief-fund.pdf » Rural Provider Relief Fund – www.hhs.gov/ sites/default/files/terms-and-conditions-ruralrelief-fund.pdf
COVID-19: VGM’s Next Steps Guide
•
Attestation Portal for Round 1 – covid19.linkhealth. com/#/step/1
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Application Portal for Round 2 – covid19. linkhealth.com/docusign/#/step/1
Paycheck Protection Program If you applied for and received funding from this program, the funds start out as loans but can be converted to forgivable grants if you can show you used the funds as they were intended to be used. The funding was intended to cover eight weeks of payroll for your staff, as well as other expenses such as rent, utilities, and mortgage interest. Throughout that eightweek period, you need to be documenting when and how you used the money, as well as the number of fulltime employees that you had during those eight weeks (you are supposed to keep your number of employees at the same level you were at prior to the pandemic). At the end of the eight-week period, you need to provide all of that documentation to the bank through which you received the loan, and they will then have 60 days to determine the level of loan forgiveness that you qualify for. Some important links for the Paycheck Protection Program include: •
Overview of entire program – www.sba.gov/ funding-programs/loans/coronavirus-reliefoptions/paycheck-protection-program
•
Program FAQs – www.sba.gov/sites/default/ files/2020-05/Paycheck-Protection-ProgramFrequently-Asked-Questions_05%2013%2020_2. pdf
Economic Injury Disaster Loans (EIDL) This long-standing SBA loan program was expanded due to the COVID-19 outbreak to include an upfront grant of up to $10,000 for each applicant. Businesses applying for an EIDL during the pandemic were also eligible to receive a forgivable grant of up to $10,000. While the $10,000 grant is forgivable, the EIDL itself is a traditional loan that does need to be repaid. The interest level for the loan is 3.75% for most businesses, and the length or term of the loan varies. Financial Guidance: Loans and Stimulus Dollars | 17
Financial Guidance and Resources For Your Business: Loans and Stimulus Dollars continued... For an overview of the EIDL Program, visit the following link: www.sba.gov/funding-programs/loans/ coronavirus-relief-options/economic-injury-disasterloan-emergency-advance Checklist for Financial Guidance for Economic Stimulus Programs: HHS Relief Payments – Round 1 •
Received Round 1 stimulus payment
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Reviewed Terms and Conditions associated with funds
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Completed Attestation Form
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Tracking how the money is being used by my company
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Preparing for upcoming reporting requirements as necessary
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Reached out to bank with appropriate documentation of # of employees and how money was used to determine loan forgiveness
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Repay any non-forgiven portion of the loan if applicable EIDL (Economic Injury Disaster Loan)
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Applied for EIDL and forgivable grant of up to $10,000 through SBA
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Received approval and loan/grant dollars
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Begin repaying the loan Uninsured Patient Relief Fund
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Enrolled in program
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Obtained Optum ID
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Verified patients have positive COVID-19 diagnosis and have no insurance
HHS Relief Payments – Round 2 •
Completed Round 1 attestation form
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Submitted claims
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Completed and submitted application for Round 2
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Received reimbursement
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Reviewed Terms and Conditions associated with funds
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Tracking how the money is to be used by my company
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Preparing for upcoming reporting requirements as necessary Paycheck Protection Program
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Applied for Paycheck Protection Program through bank
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Received loan dollars
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Tracking how the money was spent (how much for payroll, rent, utilities, etc.)
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Maintaining number of employees (rehiring or replacing any terminated or furloughed employees)
COVID-19: VGM’s Next Steps Guide
Financial Guidance: Loans and Stimulus Dollars | 18
Your State Level Resources: Third-Party Payer Updates
M
uch like CMS did, many payers made changes as a result of and during the COVID-19 public health emergency (PHE). There was not a mandate requiring them to make any specific changes, so not every payer made changes. Many payers did, however, but they didn’t all make the same changes, nor did they make the changes effective at the exact same time. Keeping up with and tracking those changes may seem like a daunting task—but it is certainly a critical one. Some of the most common changes we saw made by third-party payers fell into one of the following categories: 1. Prior authorization requirements
normal” in terms of these policies. It is imperative that you stay in touch with these changes and watch for notices from the payers that you work with. VGM has also created a tool that houses links to hundreds of payers. Right now, the links contained within the tool outline the changes that have been made by these various payers. Once they start returning to their standard policies, coverage criteria, etc., they will likely house information regarding that return on some of these same webpages. A link to VGM’s resource tool for third-party payer changes can be found at www.vgm.com/coronavirus under the heading of “Health Plan Policy Changes.” Checklist for Third Party Payer Changes
2. Signature requirements (proof of delivery)
Third Party Payer Changes Tracking
3. Face-to-face requirements 4. Allowing telehealth for certain services or to meet certain requirements
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Identify all payers to which my company submits claims
5. Allowing different levels of clinicians to write orders
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Identify what COVID-19 related changes the payer has made
6. Covering equipment under different circumstances than was previously allowed
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Determined whether changes are temporary or permanent
7. Reimbursement changes (especially for those payers that follow the Medicare fee schedule)
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For temporary changes, identify a start and end date for the policy changes
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Identify what the payer is responsible for to ensure proper claims processing and payment
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Identify what my company is responsible for doing to ensure proper claims processing and payment
[
Each payer could in fact decide on their own when to go “back to normal.”
]
Regardless of the type of change, and whether the policy was slightly relaxed/modified or waived entirely, the vast majority of these changes are temporary and will only last through the end of the PHE. Each payer could in fact decide on their own when to go “back to
COVID-19: VGM’s Next Steps Guide
Your State Level Resources: Third-Party Payer Updates | 19
Your State Level Resources: State by State Business Reopening Guidance
T
o help track the differences across each state and provide the latest guidance and information to America’s employers, the U.S. Chamber has launched the following interactive state map and state guides. Below, you will find the latest guidelines, timelines, and other critical information for businesses aiming to restart safely and sustainably amid the pandemic, as well as (at the bottom of each state profile) a link to the latest information for employers in that state. Click the link below and select any state to find guidelines and timelines for employers (updated daily): www.uschamber.com/article/state-by-state-businessreopening-guidance
Additional State Resources to Check Official Government Websites Click on your state’s official government website. State governments have been working hard to keep their websites up to date with the latest coronavirus-related guidance and regulations. Visit the state websites below and find information on COVID-19 updates and more. Your State or Governor’s Official Social Media Accounts Most states and their governors operate official accounts on Facebook, Twitter, and other social media platforms. In recent months, these accounts have been largely dedicated to real-time updates on coronavirus statistics and executive orders. Be sure to look for the blue “Verified” checkmark next to the account name to ensure it’s a legitimate page.
Links to Official State Websites Alabama
Kentucky
North Dakota
Alaska
Louisiana
Ohio
Arizona
Maine
Oklahoma
Arkansas
Maryland
Oregon
California
Massachusetts
Pennsylvania
Colorado
Michigan
Rhode Island
Connecticut
Minnesota
South Carolina
Delaware
Mississippi
South Dakota
District of Columbia
Missouri
Tennessee
Florida
Montana
Texas
Georgia
Nebraska
Utah
Hawaii
Nevada
Vermont
Idaho
New Hampshire
Virginia
Illinois
New Jersey
Washington
Indiana
New Mexico
West Virginia
Iowa
New York
Wisconsin
Kansas
North Carolina
Wyoming
COVID-19: VGM’s Next Steps Guide
Your State Level Resources: State by State Business Reopening... | 20
Policies and Procedures: Policies, Procedures, and Compliance
R
eview policies and procedures to ensure they are up to date and implemented.
Check your infection control practices and update them for any changes from CDC guidelines that need to be implemented to meet COVID-19 needs. If you are in a renewal status or are a new company that is in the process of accreditation or reaccreditation, ensure that you are survey-ready so that when travel is safe you are first in line for survey.
Review your infection prevention and control policies and CDC infection control recommendations for COVID-19 for: Assessment and triage of patients with acute respiratory symptoms Patient placement Implementation of standard, contact, and airborne precautions, including:
Check with your state agencies for specific state guidance regarding practices for COVID-19.
•
Use of eye protection
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Visitor management and exclusion
Follow safe social distancing within the office and with customers. Frequent handwashing, wear masks, maintain six-foot distances, and complete regular disinfection of your business.
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Source control measures for patients (e.g., put facemask on suspect patients)
Under Emergency/Disaster preparedness, document details regarding plan of action that took place during the pandemic •
Store hours
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Accommodating work from home for employees
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Working with referrals
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Setting up new patients with equipment
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Assisting recurring patients with equipment/ supplies
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Track any equipment that was lost, damaged, or destroyed due to pandemic
COVID-19: VGM’s Next Steps Guide
Be alert for patients who meet the persons under investigation (PUI) definition here: www.cdc.gov/ coronavirus/2019-nCoV/hcp/clinical-criteria.html. Know how to report a potential COVID-19 case or exposure to facility infection control leads and public health officials. Know who, when, and how to seek evaluation by occupational health following an unprotected exposure (e.g., not wearing recommended PPE) to a suspected or confirmed coronavirus disease patient.
Policies and Procedures: Policies, Procedures, and Compliance | 21
Human Resources: How to Handle Staffing Identify a workplace coordinator who will be responsible for COVID-19 issues and their impact at the workplace. Examine policies for leave, telework, and employee compensation. Leave policies should be flexible and non-punitive and allow sick employees to stay home and away from co-workers. Leave policies should also account for employees who need to stay home with their children if there are school or childcare closures, or to care for sick family members. When possible, use flexible worksites (e.g., telework) and flexible work hours (e.g., staggered shifts) to help establish policies and practices for social distancing (maintaining distance of approximately six feet or two meters) between employees and others, especially if social distancing is recommended by state and local health authorities. Review your leave policies with all employees and provide information about available employee assistance services. Share information on steps they can take to protect themselves at work and at home, and any available resources. Identify essential employees and business functions, and other critical inputs, such as raw materials, suppliers, subcontractor services/products, and logistics required to maintain business operations. Explore ways you can continue business operations if there are disruptions. Prepare business continuity plans for significant absenteeism, supply chain disruptions, or changes in the way you need to conduct business. Establish an emergency communications plan. Identify key contacts (with back-ups), chain of communications (including suppliers and customers), and processes for tracking and communicating about business and employee status. Share your response plans with employees and clearly communicate expectations. It is important to let employees know plans and expectations if COVID-19 occurs in communities where you have a workplace. COVID-19: VGM’s Next Steps Guide
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. 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 should consider drafting non-punitive “emergency sick leave” policies. Employers should not require a 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. Under the Americans with Disabilities Act, employers are permitted to require a doctor’s note from your employees to verify that they are healthy and able to return to work. However, as a practical matter, be aware that healthcare provider offices and medical facilities may be extremely busy and not able to provide such documentation in a timely manner. Most people with COVID-19 have mild illness and can recover at home without medical care and can follow CDC recommendations to determine when to discontinue home isolation and return to work. Read more at www.eeoc.gov/wysk/what-you-shouldknow-about-covid-19-and-ada-rehabilitation-act-andother-eeo-laws. The U.S. Equal Employment Opportunity Commission (EEOC) has established guidance regarding Pandemic Preparedness in the Workplace and the Americans with Disabilities Act. The guidance enables employers to take steps to protect workers consistent with CDC guidance, including requiring workers to stay home when necessary to address the direct threat of spreading COVID-19 to others.
Human Resources: How to Handle Staffing | 22
Human Resources: How to Handle Staffing continued... Read more at www.eeoc.gov/laws/guidance/ pandemic-preparedness-workplace-and-americansdisabilities-act#secB. Review human resources policies to make sure that your policies and practices are consistent with public health recommendations and with existing state and federal workplace laws (for more information on employer responsibilities, visit the Department of Labor’s and the Equal Employment Opportunity Commission’s websites). 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 help them manage stress and cope.
Communicate supportive workplace polices clearly, frequently, and via multiple methods. Employers may need to communicate with non-English speakers in their preferred languages. 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.
COVID-19: VGM’s Next Steps Guide
Human Resources: How to Handle Staffing | 23
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