Station 11 - Compliance Snapshot
COVID PA (Zone A)
Name:
*
First Name
Last Name
Date
*
-
Month
-
Day
Year
Date
Hour Minutes
AM
PM
AM/PM Option
Location:
*
Please Select
Art Department (Steinway Boulevard)
Costumes (Airport Road)
Hangar (Midfield Road)
Lock-Up (Cardiff Boulevard)
Production (Kestrel Road)
Terminal (Britannia Road)
Other:
If other, please specify location:
ADHERENCE TO PROTOCOLS - WEARING MASKS
Observed Individual(s) Wearing Masks:
Action Taken for Non-Compliance:
Non-Compliance was Addressed with Individual
Non-Compliance was reported to IPAC COVID Team
Other
Comments:
ADHERENCE TO PROTOCOLS - HAND HYGIENE
Observed Individual(s) Hand Hygiene:
Action Taken for Non-Compliance:
Non-Compliance was Addressed with Individual
Non-Compliance was reported to IPAC COVID Team
Other
Comments:
Hand Hygiene: End Time of Observation:
Hour Minutes
AM
PM
AM/PM Option
ADHERENCE PROTOCOLS - PHYSICAL DISTANCING
Action Taken for Non-Compliance:
Non-Compliance was Addressed with Individual
Non-Compliance was reported to IPAC COVID Team
Other
Observed Individual(s) Maintaining Social Distancing:
Other - Please Provide Further Explanation of Action Taken:
ADHERENCE TO PROTOCOLS - Eating in designated area
Observed Individual(s) Eating in Designated Area:
Other - Please Provide Further Explanation of Action Taken or Additional Notes:
ADHERENCE TO PROTOCOLS - People staying within their pods
Observed Individual(s) Staying within their Pods:
Other - Please Provide Further Explanation of Action Taken or Additional Notes:
Option to Upload Photos
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