Workplace Readiness for Covid-19

WORKPLACE READINESS

FOR COVID-19

I N T E R I M G U I D E

PART 3 as of MAY 26, 2020

PHILIPPINE COLLEGE OF OCCUPATIONAL MEDICINE, INC.

TABLE OF CONTENTS

HAZARD IDENTIFICATION, RISK ASSESSMENT AND DETERMINATION OF CONTROL (HIRADC) 10

Philippine College of Occupational Medicine, Inc.

1

NEW CLASSIFICATION OF INDIVIDUALS FOR COVID-19

The following are the new DOH case definitions for notification which transitions the reporting of PUI and PUM to Suspect, Probable, and Confirmed COVID-19 cases. These definitions are consistent with the latest WHO Global Surveillance for COVID-19 disease interim guidance (as of March 20, 2020). Thus, the COVID-19 Surveillance System, through the DOH Epidemiology Bureau, will capture and detect cases through the enhanced influenza-like illness (ILI) and expanded severe acute respiratory infection (SARI) sentinel surveillance systems, notification from hospital and laboratory facilities, and event-based surveillance and response.

SUSPECT CASE is a person who is presenting with any of the conditions below: a. All SARI cases where NO other etiology fully explains the clinical presentation. b. Individuals with influenza-like illness (ILI): a. With no other etiology that fully explains the clinical presentation AND history of travel to or residence in an area that reported local transmission of COVID-19 disease during the 14 days prior to symptom onset OR b. With contact* to a confirmed or probable case of COVID-19 disease during the 14 days prior to the onset of symptoms

c. Individuals with fever or cough or shortness of breath or other respiratory signs or symptoms and under any of the following conditions:
(i) aged 60 years and above, (ii) with a comorbidity, (iii) assessed as having high-risk pregnancy, or (iv) a health worker.

PROBABLE CASE

A. Suspect case whom testing for COVID-19 is inconclusive B. Suspect case who tested positive for COVID-19 but whose test was not conducted in a national or subnational reference laboratory, or an officially accredited laboratory

CONFIRMED CASE

A. Any individual irrespective of the presence of clinical signs and symptoms who was laboratoryconfirmed for COVID-19 in a test conducted at the national reference laboratory or subnational reference laboratory, or a DOH-certified laboratory testing facility

*Contact as defined by the WHO Global Surveillance for COVID-19 disease interim guidance (as of March 20, 2020) is a person who experienced any one of the following exposures during the 2 days before and the 14 days after the onset of symptoms of a probable or confirmed case:

1. Face-to-face contact with a probable or confirmed case within 1 meter and for more than 15 minutes; 2. Direct physical contact with a probable or confirmed case; 3. Direct care for a patient with probable or confirmed COVID-19 disease without using proper PPE; OR 4. Other situations as indicated by local risk assessments

Note: For confirmed asymptomatic cases, the period of contact is measured as the 2 days before through the 14 days after the date on which the sample was taken which led to confirmation.

2

WORKER EXPOSURE RISK TO COVID-19

LOW EXPOSURE RISK

• Individuals that are only in contact for a brief period of time (≦ 2minutes)

• Jobs that do not require contact with people known to be or suspected of being infected. Workers have minimal occupational contact with the public and other coworkers.
• Practice physical distancing at all times

*Follow applicable engineering, administrative and PPE controls in your workplaces

MEDIUM EXPOSURE RISK

• Individuals are in contact for a longer period of time and are fairly distant from each other.

• Jobs that require frequent/close contact with people who may be infected, but who are not known or suspected patients or close contacts of the same. Workers may have contact with the general public (e.g. restaurants, high-population-density work environments, some high-volume retail settings) including individuals returning from locations with widespread COVID-19 transmission.
• Practice physical distancing at all times

HIGH EXPOSURE RISK

• Individuals are in prolonged close (more than 15 minutes) contact and may not be able to practice physical distancing at all times. Large group of individuals in a given time (inmates)
• Jobs with a high potential for exposure to known or suspected sources of COVID-19. Healthcare delivery, healthcare support, medical transport, and mortuary workers exposed to known or suspected COVID-19 patients or bodies of people known to have, or suspected of having, COVID-19 at the time

of death.

VERY HIGH EXPOSURE RISK

• Healthcare workers, morgue workers, performing aerosol-generating procedures on or collecting / handling specimens from potentially infectious patients or bodies of people known to have, or

suspected of having, COVID-19 at the time of death.

3

DUTIES OF THE OCCUPATIONAL HEALTH PHYSICIAN

The Occupational Health Physician, whether part-time or full-time, who shall be responsible for promoting and maintaining the health and well-being of the workers, shall have the following duties and functions:

1. Organize, administer and maintain an occupational health service program integrating therein an occupational safety program;
2. Continually monitor the work environment for health hazards through periodic inspection of the workplace;
3. Prevent diseases or injury in the workplace by establishing proper medical supervision over substances used, processes, and work environment;
4. Conserve the health of the workers through physical examinations, proper advice for placement and health education;
5. Provide medical and surgical care to restore health and earning capacity of injured workers; 6. Maintain and analyze records of all medical cases and to prepare and submit to the employer annual medical reports, using form DOLE/BWC/OH-47, as required by this Standards;
7. Conduct studies on occupational health within his means and resources; 8. Act as adviser to management and labor on all health matters; 9. And report directly to top management in order to be effective.

DUTIES OF THE OCCUPATIONAL HEALTH NURSE

The duties and functions of the Occupational Health Nurse are:
1. In the absence of a physician, to organize and administer a health service program integrating occupational safety, otherwise, these activities of the nurse shall be in accordance with the physician;
2. Provide nursing care to injured or ill workers; 3. Participate in health maintenance examination. If a physician is not available, to perform work activities which are within the scope allowed by the nursing profession, and if more extensive examinations are needed, to refer the same to a physician;
4. Participate in the maintenance of occupational health and safety by giving suggestions in the improvement of working environment affecting the health and well-being of the workers; and
5. Maintain a reporting and records system, and, if a physician is not available, prepare and submit an annual medical report, using form DOLE/BWC/HSD/OH-47, to the employer, as required by this Standards.

DUTIES OF THE FIRST AIDER

The duties of the First Aider are to:
1. Give immediate temporary treatment in case of injury or illness, before the services of a physician becomes available. If the case needs a physician, the first aider shall immediately call or refer the injured to one;
2. Participate in the maintenance of occupational safety and health programs, if a member of the
Safety Committee; and
3. Maintain medical services and facilities.

DUTIES OF THE OCCUPATIONAL HEALTH PRACTITIONER

The duties of the occupational health practitioner are to:
1. Advise the employers, the workers and their representatives in the workplace the necessary requirements in establishing and maintaining a safe and healthful working environment which will facilitate optimal physical and mental health for workers;

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2. Conduct periodic inspection of the workplace as required under Rule 1961.04; 3. Act as adviser to the employer, workers and their representatives in matters concerning the organization, administration and maintenance of an occupational health program; and
4. Maintain a reporting and records system and prepare and submit an annual medical report for the employer, using form DOLE/BWC/HSD/OH-47, as required by this Standards.

DUTIES OF THE HEALTH AND SAFETY COMMITTEE

The Health and Safety Committee is the planning and policymaking group in all matters pertaining to safety and health. The principal duties of the Health and Safety Committee are:

1. Plans and develops accident prevention programs for the establishment. 2. Directs the accident prevention efforts of the establishment in accordance with the safety programs safety performance and government regulations in order to prevent accidents from occurring in the workplace.
3. Conducts safety meetings at least once a month. 4. Reviews reports of inspection, accident investigations and implementation of program. 5. Submits reports to the manager on its meetings and activities. 6. Provides necessary assistance to government inspecting authorities in the proper conduct of their activities such as the enforcement of the provisions of this Standards.
7. Initiates and supervises safety training for employees. 8. Develops and maintains a disaster contingency plan and organizes such emergency service units as may be necessary to handle disaster situations pursuant to the emergency preparedness manual for establishments of the Office of Civil Defense.

DUTIES OF THE EMPLOYERS

Health and Safety committees play very important roles in eliminating work hazards. Developing workers’

interest and participation in the planning and development of safety program is the responsibility of the employer. The employer must exercise the necessary leadership and provide support to make the program work. The principal duties of the employer are:

1. Establishes and adopts in writing administrative policies on safety in conformity with the provisions of this Standards outlining therein his responsibility and authority delegated.
2. Reports to the enforcing authority in two (2) copies of the policies adopted and the health and safety organization established to carry out the program on safety and health within one month after the organization or reorganization of the health and safety committee.
3. Reports to the enforcing authority having jurisdiction at least once in every three (3) months, counting from January, the health and safety program of the organization outlining the activities undertaken including its safety performance, health and safety committee meetings and its recommendations and measures taken to implement such recommendations.
4. Acts on recommended measures by the health and safety committee by adopting the elements of the health and safety program in the production process or workplace and in case of non-adoption

of the Health and Safety Committee’s recommendation, to inform the committee of his reasons.

SHARED ACCOUNTABILITY

a. Health is a key development objective that is the shared accountability of the government, communities, households, and individuals. b. A whole-of-system, whole-of-government, whole-of-society approach is essential to develop cohesive solutions to current and future challenges to public health and national security.

c. All efforts shall espouse the government’s strategic directions of national government-enabled,

local government-led, and people-centered response to the COVID-19 health event.

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HIERARCHY OF CONTROLS

The Hierarchy of Controls is a system used to deploy effective controls within an organization, workplace, or community to identify the most effective ways to control a hazard. Occupational safety and health

professionals use a framework called the “hierarchy of controls” to select ways of controlling workplace

hazards. In other words, the best way to control a hazard is to systematically remove it from the workplace, rather than relying on workers to reduce their exposure. During a COVID-19 outbreak, when it may not be possible to eliminate the hazard, the most effective protection measures are (listed from most effective to least effective): engineering controls, administrative controls, safe work practices (a type of administrative control), and PPE. There are advantages and disadvantages to each type of control measure when considering the ease of implementation, effectiveness, and cost. In most cases, a combination of control measures will be necessary to protect workers from exposure to SARS-CoV-2.

ELIMINATION SUBSTITUTION

Installation of

MOST

EFFECTIVE

Requires a

physical change

to the physical barriers, sneeze guards, HEPA filters, workplace

ventilation etc.

Protocols, policies on physical distancing,
Change the

way people

work

handwashing etc.

Depending on
Requires worker

to wear

the worker’s risk

based on HSC recommendation something

LEAST EFFECTIVE

mmc

I.

ENGINEERING CONTROLS

Isolating workers from work-related hazards. In workplaces where they are appropriate, these types of controls reduce exposure to hazards without relying on worker behavior and can be the most costeffective solution to implement. Engineering controls for SARS-CoV-2 includes:

••••

Installing High Efficiency Particulate Air(HEPA) Filter Increasing ventilation rates in the work environment Installing physical barriers such as clear plastic sneeze guards Specialized negative pressure ventilation in some settings, such as for aerosol generating procedure

••

Installing permanent walled or temporary screened isolation rooms for suspect cases in the worksites Installing additional hand washing/disinfecting facility or equipment in the worksite

ELIMINATION and SUBSTITUTION are the most effective under the engineering controls. However, they tend to be the most difficult to implement and challenging as it may not be possible to eliminate and substitute as this time.

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ELIMINATION: Completely eliminating exposure to the hazard. Example: vaccine or cure SUBSTITUTION: Replacing the hazard with a non-hazardous object, device or substance. (none currently identified)

II.

ADMINISTRATIVE CONTROLS

Administrative controls require action by the worker and employer. Changes made to the way that people work. Typically, administrative controls are changes in work policy or procedures standards, and processes to reduce or minimize exposure to a hazard. Examples of administrative controls for SARS-CoV-2 include:

••••

Identification of vulnerable workers based on Occupational Health Services data Encouraging sick workers to stay at home. Isolation area (not the clinic) preferably with good ventilation Minimizing contact among workers, clients, and customers by replacing face-to-face meetings with virtual communications and implementing telework if feasible. Establishing alternating days or extra shifts that reduce the total number of employees in a facility at a given time, allowing them to maintain distance from one another while maintaining a full onsite work week.

•••

Discontinuing nonessential travel to locations with ongoing COVID-19 outbreaks.

Developing emergency communications plans, including a forum for answering workers’ concerns

and internet-based communications, if feasible.

••

Providing workers with up-to-date education and training on COVID-19 risk factors and protective behaviors (e.g., cough etiquette and care of PPE). Training workers who need to use protecting clothing and equipment how to put it on, use/wear it, and take it off correctly, including in the context of their current and potential duties. Training material should be easy to understand and available in the appropriate language and literacy level for all workers.

•••••••••

Site specific preventive materials in place and with adequate supply Sanitation, disinfection and disposal measures and protocols Physical distancing protocols Health screening protocol with health screening daily Self-quarantine and return to work protocol Labor relations alignment and education on the pandemic response plan for their cooperation Communication and employee trainings and education Facility Signages Virtual meetings, site visits, and training through the use of web conferencing applications or video calls.