COVID-19 Job Site Work Questionnaire

JOB SITE WORK QUESTIONNAIRE

 

We understand you may have concerns about working at another employer’s job site during the COVID-19 pandemic.

 

The following are the questions we are asking of the job site supervisor before we send you to that site:

 

  1. Is the use of applicable PPE required?
  2. Is ‘social distancing’ of at least 6 feet required?
  3. Are hand wipes and/or alcohol-based hand rubs available?
  4. Are individual water bottles in lieu of using a common source of drinking water available?
  5. Are employees advised to wash hands with soap and water for at least 20 seconds or, when soap and running water are unavailable, use an alcohol-based hand rub with at least 60% alcohol?
  6. Are employees required to follow appropriate respiratory etiquette, which includes covering for coughs and sneezes?
  7. Are in-person meetings limited and staggered breaks and lunches available?
  8. When tools must be shared, are alcohol-based wipes to clean tools provided?

 

  1. Who should employees inform when they become aware of an unsafe work condition?
  2. Who has ‘stop work’ authority?
  3. Are there hazardous chemicals on the job site?

 

  1. Where are first aid kits located?
  2. Where is the nearest location that an employee with a serious medical can go to be treated?
  3. Are any employees on the job trained in first aid or CPR?
  4. Is an Automated External Defibrillator (AED) available onsite?

 

The above questions were asked.

 

Job Site Location:    ______________________________________________

 

Date Asked:              ______________________________________________

 

Spoke To:                  ______________________________________________

 

Asked by:                   ______________________________________________


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