Station 11 - Mini Assessment
Office Production Assistant (Zone B)
Name:
First Name
Last Name
Location:
Please Select
Art Department (Steinway Boulevard)
Costumes (Airport Road)
Hangar (Midfield Road)
Lock-Up (Cardiff Boulevard)
Production (Kestrel Road)
Terminal (Britannia Road)
DAILY PASS SCREENING AND TEMPERATURE CHECKS
PASS Screening completed and recorded for all people who have entered the building:
Yes
No
Have any PASS Screening confirmation emails NOT been received:
Yes
No
If yes, please advise the name of individual(s) who did not receive the confirmation email:
Temperature Check completed and recorded for all people who have entered the building:
Yes
No
High Temperature or Failure to Pass PASS Screening:
Yes
No
If yes, what action was taken: (Select all that apply)
First Temperature was Taken
Waited Five Minutes
Temperature Taken Again
Individual(s) were Instructed Not to Enter the Building
IPAC COVID Team was Notified
Additional Notes/Comments:
ADHERENCE TO PROTOCOLS - WEARING MASKS
Observation of Protocols: Adherence to Wearing of Masks
Please Select
Observation Session 1
Observation Session 2
Observation Session 3
Wearing of Masks: Start Time of Observation:
Hour Minutes
AM
PM
AM/PM Option
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
Other - Please Provide Further Explanation of Action Taken:
Comments:
Wearing of Masks: End Time of Observation:
Hour Minutes
AM
PM
AM/PM Option
ADHERENCE TO PROTOCOLS - HAND HYGIENE
Observation of Protocols: Hand Hygiene
Please Select
Observation Session 1
Observation Session 2
Observation Session 3
Hand Hygiene: Start Time of Observation:
Hour Minutes
AM
PM
AM/PM Option
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
Other - Please Provide Further Explanation of Action Taken:
Comments:
Hand Hygiene: End Time of Observation:
Hour Minutes
AM
PM
AM/PM Option
ADHERENCE PROTOCOLS - PHYSICAL DISTANCING
Was this Observed to be Compliant or Non-Compliant?
Compliant
Non-Compliant
Was this Observed or Reported by Staff?
Observed
Reported by Staff
Action Taken for Non-Compliance:
Non-Compliance was Addressed with Individual
Non-Compliance was reported to IPAC COVID Team
Other
Other - Please Provide Further Explanation of Action Taken:
ADHERENCE PROTOCOLS - FOLLOWING ONE-WAY DIRECTIONAL FLOW
Was this Observed to be Compliant or Non-Compliant?
Compliant
Non-Compliant
Was this Observed or Reported by Staff?
Observed
Reported by Staff
Action Taken for Non-Compliance:
Non-Compliance was Addressed with Individual
Non-Compliance was reported to IPAC COVID Team
Other
Other - Please Provide Further Explanation of Action Taken:
THIRD PARTY CLEANERS
Cleaners were in on Scheduled Days;
Yes
No
Were Logs Completed;
Yes
No
Were Garbage Cans Changed;
Yes
No
Comments/Notes;
SIGNAGE
Is all signage in good condition?
Yes
No
If no, please advise what signage needs to be replaced (and location);
Is additional signage required?
Yes
No
If yes, advise what signage is required;
Are additional Physical Distancing Stickers required?
Yes
No
If yes, please advise how many are needed
Are additional One-Way Stickers required?
Yes
No
If yes, please advise how many are needed
Additional Comments/Notes;
OTHER AREAS FOR CONCERN
Option to Upload Photos
Submit
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