Ministry of Education, Culture, Science and Technology

Green Light Standard Safety Checklist for Return to School

School: _____________________________________________ Managing Authority: _________________________________
Principal/Manager/Head Teacher (circle post; print name below): Level: ☐ Preprimary ☐ Primary ☐ Secondary ☐ TVET
__________________________________________________
If pre-primary, check one: ☐ Attached ☐ Unattached
Number of Teachers: _______M _______F _________ (Total) If primary, check one: ☐ Mono-grade ☐ Multi-grade
Student Enrollment: _______B _______G _________ (Total)
Type: ☐ Government ☐ Denominational ☐ Community
If pre-primary: _______Level 1 _______Level 2 _________ (Total)
☐ Specially-assisted ☐ Private
Target Classes/Groups Specify Grade Level(s): ________________________________________________________________
for Phased Reopening
# of Teachers: ______M ______F ________ (Total) # of Students: ______B ______G ________ (Total)
Place a check mark (√) under the respective column as appropriate based on the observations at the school. Insert comments/ actions to be taken where applicable.
Facilities Check Yes No Comments/Actions
Hand-washing and Sanitization Click or tap here to enter text.
i. Hand-washing facilities are functional and sufficient 1 for ☐ ☐
student enrollment (1.1.1)
ii. A hand-washing or sanitization station is arranged at the ☐ ☐
entrance of the school (1.1.2)
iii. Hand-washing stations have adequate supply of soap and ☐ ☐
means for hand drying (1.1.4, 1.1.5)
Classroom Arrangements
iv. Classroom seating arrangements allow for a minimum of 3 ☐ ☐
feet spacing in all directions (1.2.2)
v. All classroom seating/desks are arranged facing the same ☐ ☐
direction (1.2.3, 3.3.4)
vi. Classrooms are well-ventilated and allow for circulation of ☐ ☐
indoor and outdoor air (1.2.1)
vii. All classrooms are clean and sanitized (1.3.1) ☐ ☐
School Grounds and other Communal Spaces
viii. Physical guides or demarcation (i.e., tape or markers) are in place ☐ ☐
on floors or walls to enforce physical distancing (1.2.5)
ix. Signage/posters (i.e., wearing masks, hand-washing) are evident (at ☐ ☐
entrance/exits, on buildings/classrooms, danger zones, etc.)
x. Physical barriers or partitions are installed in offices or other ☐ ☐
communal spaces, if applicable (1.2.4)
xi. An isolation space has been identified for staff or students ☐ ☐
who are unwell (4.1.5, 4.2.2, 4.2.3)
xii. Bathrooms are functional and sufficient 2 (i.e., size-appropriate, ☐ ☐
gender-specific) for student enrollment
xiii. Sufficient and appropriate supplies and equipment for ☐ ☐
cleaning and disinfecting are available (1.3.2, 1.3.2)
xiv. Cafeteria or canteen (if applicable) is organized to ensure ☐ ☐
physical distancing (2.3.4)
Procedural/Operations Check Yes No
xv. Communication protocols are outlined and contact info (for ☐ ☐
parents/guardians, MoECST, MOHW) is easily accessible (3.3.4)
xvi. The school has adjusted its operational schedule, as necessary ☐ ☐
(i.e., staggered breaks/lunch, arrivals/departures, shift system, campus
permissions, etc.) to ensure proper physical distancing (1.2.7, 2.3.4)
xvii. Class time-tables reinforce routines such as respiratory ☐ ☐
etiquette, hand-washing, wearing masks, etc. (2.2.1/2/3, 3.3.1)
xviii. A practical schedule for monitoring students during ☐ ☐
play/break and lunch time has been established (2.3.4)
xix. Instructional plans support a combination of face-to-face, ☐ ☐
distance and blended learning, as necessary (3.3.1, 3.3.3)
xx. Garbage disposal arrangements for the school and individual ☐ ☐
classrooms are clearly outlined (1.1.7)
Endorsement by School Administration For Official Use (DEC)
I endorse this Phase-In Return to School Report, and I Approval for Return to School
commit to follow-up on the required actions on or before
________________________________ (indicate proposed date). ☐ No ☐ Yes

________________ ________________________ ______________ ______________________

(Date) (Principal’s signature) (Date) (DEC Manager’s signature)

1 Sufficient number of handwashing facilities: 1 for every 50 students

2 Sufficient number of bathroom facilities: 2 toilets for 50 girls; over 50, add 1 toilet for every 50 girls
1 toilet and 1 urinal for 50 boys; over 50, add 1 toilet and 1 urinal for every 100 boys