Health & Safety Check Sheet for COVID - 19 Risk Reduction

Signature with Name & Designation : (Digital Signature / Only Name &
Company Name :
Designation is ok for submission by mail)
Company Location :

Vendor Code : Date : Approved by Checked by Prepared by

Name :
Inspection by : Designation :

Guidelines for fill up the check sheet :

1- If you agree & will plan / continue planning / already planned to implement / already implemented of check point then please use " O " (English Alphabet) on
status. 2- If you
disagree / not want to implement of check point then please use " X " (English Alphabet) on status. 3- Please
mention the cause / difficulties / issue on remarks where the status come " X ". 4- If any
check point is not applicable as per organization nature please mention " NA " in status. 5-
Please clarify the " NA " reason in remarks.
S.N. Topic Activity Check Point Option Status Remarks
Is there any company wide emergency
1 response organization structure develop for Mandatory
fight against COVID 19 ?
Is it approved by head of the organization /
2 Mandatory
CEO / MD/Plant Manager ?
Is everyone clearly understand their
3 Mandatory
responsibility ?
Is daily telephonic / online management review
4 Mandatory
meeting conducted ?
Are everybody able to join on daily
5 Mandatory
management review meeting ?
Are there discussing the local status, district
6 status, national status & global status of COVID Mandatory
19 ?
Are there discussing the local, district, national
7 & global COVID 19 status & update information Mandatory
?
Are the members clearly aware about the
8 Central, State & Local Government guidelines Mandatory
& keep updating daily ?

9 Is daily monitoring the health status of all Mandatory

employees and reporting to Top Management ?

Are organization regularly provide awareness to

10 Mandatory
prevent COVID 19 to all employees ? (Please
share the details if yes)
Is / are there any person/s conformed COVID19
11 Mandatory
? (Please share the details if yes)
Is / Are all employee's recent international /
domestic travel history tracked / continue
12 Mandatory
tracking ? (Please share the last two month if
any)

13 Mandatory
Are SOP made for each operation dept. wise ?
Is awareness provided / will plan to provide to
Management Control

14 all employees before coming to plant after Mandatory

lockdown ?
Monitoring, Updatation,
Awareness,
15 Ensure all employees should clearly understand Mandatory
Communication
the SOP and committed to follow .
Is management keep regular updating about
16 Mandatory
the hotspot area ?
Are all employee's update location data
17 Mandatory
available in company ?

18 Is regularly analysis the employee's location Mandatory

and hotspot area as declared by Government ?
Is there any system / guidelines develop for self
19 declaration / reporting of employee to Mandatory
management ?
Is there any column available for mention the
20 employer's family members international or Mandatory
domestic travel history ?

Are management ensure / employee declared

21 that he/she follow the govt. guidelines regarding Mandatory
the isolation rule if any International / domestic
travel history available ?
Are emergency contact number release by
22 Mandatory
organization ?
Are all employees aware about the emergency
23 contact number which is released by Mandatory
organisation ?
Is audit team developed to audit all the sitution
24 Mandatory
lead by Top Management ?
 Is audit team directly reporting to Top
25 Management / MD / Plant Head / CEO directly Mandatory
on daily basis?
Is audit team have rights to stop the operation /
activity immediately incase of any abnromality
26 Mandatory
found and operation should start only after
needful action taken ?

Top Management should guide all TMs &

27 ensure the COVID-19 risk reduction activity is Mandatory
smothly going on, gap analysis for further
improvement & support to all team members?

28 Have you updated regarding the recent central Mandatory

government notice and regularly touch with
government website regarding COVID19 ?
Organization shall be prepare for maintain
social distancing in their workplace, offices,
29 Mandatory
meeting rooms. (Minimum 6ft between two
person)
Is you organization / any of your organization
30 came under hotspot area as per government Mandatory
declaration ?

Is organization/s planning / already planned for

31 Mandatory
frequently cleaning of common surface and
mandatory hand washing in your organization ?
Is organization/s planning so that No overlap of
32 shifts and staggered lunch with social Mandatory
distancing in canteens ?
Is organization/s planning / already planned
33 regarding the intensive communication and Mandatory
training on good hygiene practice ?
Is organization/s planning / already planned
regarding completely disinfect in the all of
premises including entrance gate of building,
office, cafeteria, canteen, meeting room,
34 conference halls, open area, verandah, Mandatory
entrance gate of site, bunkers, porta cabins,
building, equipment, washroom, toilet, sink,
water point, locker, wall and other surface daily
Central Government Guidelines

?
Is organization/s planning / already planned
regarding the employee's transportation facility
35 Mandatory
without any dependency on the public transport
system ?
Health of Employee
Is organization/s planning / already planned
36 regarding disinfect of all vehicles, machinery Mandatory
and parts entering the premise ?
Is organization/s planning / already planned
regarding the 100% thermal scanning of
37 Mandatory
everyone entering and exiting the work place
daily?
Are all employee covered on medical insurance
38 Mandatory
?
Are there provision available for hand wash &
sanitizer at all entry and exit points and
39 common areas ( Be ensure the quantities Mandatory
should be sufficient) ? Touch free mechanism
will be preferable.
Is there any system develop for maintain one
hour gap between shifts and will stagger the
40 Mandatory
lunch break of staff, to ensure social distancing
?
Is there any system develop for maintain the
41 social distancing in meetings, training sessions Mandatory
? (at least 6ft away from others)
Avoid to use lifts or hoist to travel if possible,
otherwise ensure not more than 2/4 persons as
42 Mandatory
well as not talking with each other and shall
wear mask mandatory all time.
Encourage to use staircase for climbing to all
43 Mandatory
employee.
Are organization strictly ban of gutka, tobacco
44 etc. and spitting here and there should be Mandatory
prohibited?
Are organization identified hospitals / clinics in
the nearby areas, which are authorized to treat
45 Mandatory
COVID19 patients and list should be available
at work place all the times?
a) Employee should immediately inform to their
supervisor / superior / manager if any symptom
46
found regarding COVID 19 in his/her health. /
not feel well due to any condition.
 b) Employee should keep maintain their daily
temperature record and immediately inform to
47 his / her supervisor / superior / manager if
there is any major variation observe, Manager
should randomly check to ensure all employees Mandatory
are maintain record or not daily.
c) Employee should ensure their family
48 member's health condition that everybody is in
healthy condition if staying with him/her.
d) Employee shall immediately inform to
supervisor / superior / manager if he/she
observe any symptom of COVID 19 in his/her
49
family member and immediately contact to
doctor. - In that case, employee to remain in
self quarantine .
e) Employee should daily test their family
50 Suggestion
Employee Tracking and Planning:-

member's temperature by thermometer.

f) All employee shall be strictly follow all
51 government / organizations guidelines with zero
- Health Tracking

tolerance policy.
- Attendance

- Transport

Assignment of g) Instruct all employees to install Aarogya Setu

52
employees for Effective App related to Covid monitoring. Mandatory
Communication,
Planning & Education h) Prepare list of employees in hot-spot area
53
and closely monitoring their health condition
and strictly maintain the government guidelines.

i) Selection of employees for duty must

54
have a priority after skill set is determined:-
55 - Nearby
Suggestion
56 - Company transportation
57 - Special pick-up arrangements
- Last option, public transportation (Should
58
not preferred)
j) Prepare employee attendance instruction
related to employee wise - Shift allocation.
59 Suggestion
HR and Guardian to freeze attendance and
transportation list.
k) Map employee wise transportation mode
and plan bus-numbers requirement and
60
routes keeping in mind social distancing
norm.
l) Ensure all employee shall wear proper
PPE (cap/mask/gloves/goggles) before Mandatory
61
leave from home transportation staffs like
drivers & helpers.
n) Plan for disinfectant and spray device to
62 be used by transporter for sanitizing buses
(seats, rails, window etc.)
63 Driver and attendant to:-
a) Check each other's temperature before
64 start of the trip and report to designated
Company official.
b) Wear PPE’s (Cap, Mask, gloves,
65
goggles)
c) Ensure availability of prescribed PPE’s in
66
bus before start of journey
67 d) Disinfect bus before and after each trip
Company
e) Check employee boarding for availability Mandatory
68 Transportation
as per attendance list given by company
f) Dispense sanitizer and mask to boarding
69
employee
g) Ensure social distancing during seating
70
and boarding/alighting
71 Other Points:
72 -No use of AC & windows open
-Driver and attendant temperature check
73 after reaching company premises and
report to designated company official
a) Mode of transport to be approved by
74
company “Guardian”
b) Attendance based on company
75
communication for shift/day schedule.
c) Mode of transport-Bicycle, 2 wheeler or
Car.
If car pool -
76 -Maximum 2 pax (5 seater vehicle) or 3 pax
(7 seater vehicle) in alternate seat positions
for social distancing. ---AC to be turned off
and window open.
77 d) For 2 wheeler pillion rider not allowed.
 e) Mask to be worn throughout journey by
78
all pax.
Private Transportation Mandatory
f) If using 2 wheeler wear helmet with visor
79
or goggles.
g) Use E-wallets or exact change at the fuel
80
station.
h) Get temperature check at designated
81
Transportation

location during entering factory.

i) Avoid personal driver. If unavoidable,
82 temperature check of driver at designated
location during entering factory.

j) Driver should stay in the car after parking

83 or in driver room subject to social distancing
norm. Movement only during meal timing.

a) Public transport usage to be

prohihibited.
-Only in exceptional case, when presence
of employee is critical and alternate safe
mode of transport is not feasible, should
84
public tranport usage be allowed.
- Permission of company senior
management is necessary for each Mandatory
employee who is allowed to come by public
transport

85 b) Alternate avenues advised as below:-

1) Employee movement-pick up by
86
company arranged vehicle.
87 2) Travel by walking.
88 3) Provision of company loan for bicycle. Suggestion
c) In exceptional circumstance, when
89 Public Transportation public transport is permitted, following
should be ensured:-
a. Company Senior managent approval to
90
be taken
b. Monitoring of Health of employees and
91 family and Temperature record of such
employees to be tracked in advance.
c. Employees to be assigned to specific
92 work areas for easy tracking and limited Mandatory
contact.
d. Education of employees by respective
93
Company “Guardian” wrt-
94 - Social distancing expectation
95 - Use of mask or cloth as face covering.
96 - Wear full sleeves clothes.
97 - Avoid conversation/mobile.
- Avoid loitering and directly reaching
98
factory gate.
99 - Entry by designated gate.
a) Mask wearing is mandatory as per
100
designated norms (3 ply / washable)
b) Social distancing of >1.0 mtrs between
101
two employees wearing mask.
102 Entering c) Security frisking to be avoided. Mandatory
d) Entry strictly only to employees who have
103
been assigned duty/shift.
104 e) No biometric / finger print during entry.
105 f) No bags except laptop bags allowed.
a) Thermal Scanners (where employee
106 Temperature strength high) or thermal gun to be used for
Checking at the Time fever screening. Mandatory
of Plant Entry b) Calibration of thermal gun should be
107
done regularly.
a) Employee to pass through Sanitization
108 Tunnel (applicable Government Guidelines
Disinfection – through
to be adhered) Suggestion
Sanitization Tunnel
b) Social distancing norm to be followed
109
while passing through sanitization tunnel.
a) Sanitizer should be sprayed by security
110 guard and rubbed thoroughly across hands
Plant Entry/ Exit

Hand Sanitization by employee Mandatory

b) Hand sanitizer should be having
111
minimum 70% IPA.
a) Security office Associates should always
112
Security Office & wear prescribed PPE's.
Mandatory
Receptiom b) Visitors strictly not allowed in the
113
premises.
a) Security Guard prescribed PPE's for the
114
complete duty duration:
115 - Washable Face Mask
116 - Disposable Hand Gloves
117 - Cap or head gear
118 - Safety Goggles
Security Guard Mandatory
- Hazmat suit (optional as per
119
requirement)
b) PPE's usage protocol should be 100% of
120 all the above (no deviation is allowed) and
procurement planning to be done by HR
121 a) All employees must be wearing mask.
b) Separate exit gate for employees to
122
prevent crowding.
Exit from Security
c) Maintain social distancing at 1 m while Mandatory
123 Gate
wearing mask.
d) No Security frisking of employees.
124
Explore alternatives to prevent pilferage.
No biometric a) Manual attendance or Facial recognition
125 Mandatory
attendance or card with out touch anywhere
126 a) Mask to be worn by every employee. Mandatory
b) Persons having such jobs where they
come in contact with many people ( eg.
127 Suggestion
Security Guard) are advised to wear
Hazmat suits (Body suits).
c) Ensure minimum distance of 1m being
128 maintained between two people working Mandatory
next to each other.
d) Sideway standing is to be used rather
129 than face to face standing while working on Suggestion
line ( If width is less than 1.0 meter).
e) Hand sanitization setup to be available in
close proximity. Clean your hands often by
washing them with soap and water for at
130 Mandatory
least 20 seconds or using an alcohol-based
hand sanitizer that contains 60%–95%
alcohol.
f) Avoid mixing of people during shift
131 Mandatory
changeover.
g) No operator change in a same process
Human disinfection until shift is over. If needed for any
132 Suggestion
and distancing replacement please Sanitize the work
station once again.
h) Movement on shop floor by designated
members only and not by the line operator.
During Fixture/Machine breakdown
133 Suggestion
Associate should report to line leader who
should further contact to team leader to
allocate the task
i) Assembly stations, fixtures, should be
134 cleaned every evening before closing Mandatory
activities or start of activities.
Production Area

j) Minimize the Movement on shop floor and

only by designated members. Only
135 identified member (GL / LL) should be Suggestion
update the all line related document (To
avoid the multi people contact)
k) Minimize or ZERO meetings. Face to
136 Face meeting/Discussion to be avoided (if Suggestion
needed, maintain gap of > 2 m)
l) Document filling/ Data entry to be done by
137 Suggestion
define only.
a) Making acrylic partition where distance
138 Compartmentalisation Suggestion
between two person < 1m.
a) Fresh air circulation to be used. (Use Air
139
Ventilation handling units with fresh air circulation). Suggestion
140 b) Ensure regular airing with windows.
a) Only one inspection person allowed to
141 Suggestion
work at Inspection table.
Inspection area
b) Hand sanitization before operating /using
142 Mandatory
any Inspection instrument.
a) No accumulation of Operator in Wash
143 Mandatory
basin area, drinking area.
Tea / Washbin area
b) Use only disposable cups/glass or
144 Suggestion
personal Cups/glass.
a) Make foot arrangement for doors ( No
145 handle use) of meeting room, toilets,
Door opening inspection room, store etc. Suggestion
b) No handles in Doors or all doors to
146
remain open.
a) All touching to be done by Gloves. Even
147 Handling materials receiving area, incoming inspections need Mandatory
gloves.
148 a) Forklift, carrier handle must be sanitized. Mandatory
Receiving Truck/
Loading/unloading
 Loading/unloading b) Locate the fixed and limited person for
149 Suggestion
the work.
a) Do not touch material immediately after
150 Incoming Material receipt from supplier. Cool down time for Mandatory
incoming material (Minimum 6 hours)
a) Always wear mask and maintain safe
151 Mandatory
distance ( >1m).
Personal Protection b) Ventilate well. Fresh air circulation to be
152 Suggestion
used.
153 c) Avoid unnecessary touch. Mandatory
a) Vehicle, Driver, Material sanitization
154 Mandatory
before gate entry.
Canteen: Receiving
b) Food Grade Antimicrobial washing for
155 and cleaning of Mandatory
>3min followed by water rinsing.
Vegetables, Material
c) Tools, Equipments sanitization before
156 Mandatory
use
157 a) Encourage home-made food.
158 Canteen: Cooking b) Limit food variety. Suggestion
159 c) No uncooked food (salad)
a) Only canteen staff provides cutlery,
160 Canteen: Serving Mandatory
touches serving spoons.
a) Staggered timings, 20 mins for every
161 Suggestion
batch.
162 b) Marking for waiting queue positions.
163 c) Seats marking for safe distance >1.5m.
Office, Canteen, Washroom, Common areas

Canteen: Dining
164 d) No talking.
Mandatory
e) Sanitization of Table, chair after every
165
turnaround.
166 f) No Saunf serving point; pouches ok.
167 g) Take away packaging option.
168 Canteen: Hand Wash a) Marking for waiting queue positions.
169 / Utensils cleaning / b) Drying hands with paper tissue. Mandatory
170 Exit c) Utensil cleaning with soap & hot water.
a) Daily Health monitoring for all chef,
171 Canteen Staff Health Mandatory
serving staff.
a) Keep doors open or Make foot
172
arrangement for doors ( No handle use)
173 Washroom b) Paper usage for all touch points. Mandatory
174 c) Wipe clean Commode / paper seat cover.
a) PPEs & training must: Disposable long
175 Housekeeping sleeve, full body overall, gloves & mask; Mandatory
Handling trash as bio-hazard.
a) Sanitize all common touch points every
176 day e.g. chair, table, keyboard, phone, door
handle, etc.
b) Always wear mask and wash hand /
177
sanitise frequently ( every 2 hrs).
178 c) Use personal marker pen, duster, etc.
d) Avoid physical gathering meeting;
Office area/ Meeting Promote virtual meetings over
179 Mandatory
area phone/internet OR open area standing
meetings.
e) Limit seats in meeting rooms for safe
180
distance.
f) Visitor entry only with permission; limited
181
area exposure if must.
g) Light switches ON/OFF by defined
182
person only
a) Use Personal water bottles/glass/cup or
183
Water/Tea use disposable. Suggestion
184 b) Staggered tea break timings.
a) Do not share cigarette
185
/Lighter/matchbox.
Smoking Mandatory
b) Ensure all person maintaining social
186
distancing during smoking
Identify people critical
a) Ensure that list of critical people is
187 for starting the
ching workforce from their home town

available.
operations
a) Tracking Travel history & Current health
188
Online health survey conditions.
on daily basis (in their b) Indicate clearly that lack of transparency /
189 hometown) wrong information of health will call for
disciplinary actions.
Mapping the critical
190 a) Discourage taking people from hotspots.
workforce with the hot
spots of pandemic b) Taking people from closest to the factory Mandatory
191
with Govt data must be given priority.
192 Co-arrange transport a) Ensure distance seating pattern.
193 on select routes for b) Hand sanitizing while entry
194 critical workers & c) Masks are mandatory for all.
195 avoid public transport d) Temperature check at bus entry.
196 a) Audit hostel living conditions
 Reaching workf
197 b) Ensure disinfection of hostels
Health inspection at
198 c) Fill the self declaration form
working hostels
d) Carry the health history card daily to
199
factory
a) 1st time after Lockdown, all Suppliers
trucks should be sanitized and then it
200
should be repeated after every trip. All
suppliers to be informed.
b) 1st time after Lockdown, Driver/ Co-
Driver should fill up the Self Declaration
201
Form that they strictly follow the
government lockdown guidelines.
c) Daily Health Check and temperature
202
check up of Driver/ Co-Driver.
d) Daily health check and temperature
Material Receipt at
report of Driver/Co-Driver and also truck Mandatory
Main Gate
203 sanitisation report to be carried during each
trip . This should be checked by security at
entry.
e) Driver/ Co-Driver and Security Guards
204
should wear PPEs all the time.
f) At entry Driver and Co-Driver to be
205 checked as per procedure for entry of other
employees-is Temperature Scanning
Material Handling – Incoming & Outgoing

g) All Tier-2 suppliers to be informed of and

206
other requirements.
a) Sanitization of Trolleys, Bins, Cartons,
207 Cans Bottles containing RM/RM
Material Handling at Consumable/ BOPs
b) Quarantine incoming materials for 24 Mandatory
208 Stores
hours.
b) All the empty Trolleys/ Bins should be
209
sanitized.
a) After Lockdown restart All WIP/ SFG/FG
210
trolleys/ Bins should be sanitized.
Material Handling
Mandatory
(WIP/SFG/FG) b) Tagging/Visual Identification &
211 traceability of Sanitized/Checked material to
be ensured as per Standard.
a) All Drivers and Co-Driver to submit self
declaration on health of self , family ,
212 location of stay during lockdown and also Mandatory
that he has no contact with any person with
COVID19
b) 1st time after Lockdown, all the FG trucks
213 should be sanitized and then it should be Mandatory
repeated after every trip.
c) Daily Health Check and temperature
214 Material Handling Mandatory
check up of Driver/ Co-Driver.
(Exit)/ Customer
d) Daily health check and temperature
Returned Packaging
report of Driver /Co-Driver and also truck
215 Material Mandatory
sanitisation report to be carried during each
trip .
e) All Drivers and Co-Drivers should wear
216 Mandatory
PPEs at all times (cap,mask, gloves,shoes)

217 f) All Bins , trolleys to be sanitised on return Mandatory

g) Education & awareness for drivers to
218 Mandatory
follow social distancing during transit.
a) Allocate the Group Leader to carryout the
219 Mandatory
inspection activities in staggered manner.
Common
b) Members involved should wear PPEs at
220 Mandatory
all times.
Overall Remarks by Organization if any :