How It Works

This Toolkit is designed to assist employers in welcoming employees back into
non-healthcare business settings while reducing the spread of COVID-19.

Step 1

CDC Guidelines

Visit the latest return to work criteria as set forth by the CDC to assist you in determining the right time to reopen your business.

Step 2

Return to Work Guidelines

Use this checklist (for non-healthcare employers) as a guide to resuming business operations as safely as possible for you, your employees, and the public.

Step 3

ROI Product Calculator

Use the ROI calculator to determine the cost of implementing your COVID-Safe plan by yourself or through InXite 360, the pandemic-fighting experts.

Step #1

Center for Disease Control (CDC) Guidelines

Criteria for Return to Work for Healthcare Personnel with SARS-CoV-2 Infection (Interim Guidance)

Summary of Recent Changes as of August 10, 2020

  • For HCP with severe to critical illness or who are severely immunocompromised1, the recommended duration for work exclusion was changed to at least 10 days and up to 20 days after symptom onset.
  • Recommendation to consider consultation with infection control experts.
  • Added example applying disease severity in determining duration before return to work.
  • Added hematopoietic stem cell or solid organ transplant to severely immunocompromised conditions.

CDC guidance for SARS-CoV-2 infection may be adapted by state and local health departments to respond to rapidly changing local circumstances.

Who this is for: Occupational health programs and public health officials making decisions about return to work for healthcare personnel (HCP) with confirmed SARS-CoV-2 infection, or who have suspected SARS-CoV-2 infection (e.g., developed symptoms of COVID-19) but were never tested for SARS-CoV-2.

HCP with symptoms of COVID-19 should be prioritized for viral testing with approved nucleic acid or antigen detection assays.  When a clinician decides that testing a person for SARS-CoV-2 is indicated, negative results from at least one FDA Emergency Use Authorized COVID-19 molecular viral assay for detection of SARS-CoV-2 RNA indicates that the person most likely does not have an active SARS-CoV-2 infection at the time the sample was collected. A second test for SARS-CoV-2 RNA may be performed at the discretion of the evaluating healthcare provider, particularly when a higher level of clinical suspicion for SARS-CoV-2 infection exists.  For HCP who were suspected of having COVID-19 and had it ruled out, either with at least one negative test or a clinical decision that COVID-19 is not suspected and testing is not indicated, then return to work decisions should be based on their other suspected or confirmed diagnoses.

Decisions about return to work for HCP with SARS-CoV-2 infection should be made in the context of local circumstances. In general, a symptom-based strategy should be used as described below.  The time period used depends on the HCP’s severity of illness and if they are severely immunocompromised.1

A test-based strategy is no longer recommended (except as noted below) because, in the majority of cases, it results in excluding from work HCP who continue to shed detectable SARS-CoV-2 RNA but are no longer infectious.

Other Resources:

For guidance about assessment of risk and application of work restrictions for asymptomatic HCP with potential exposure to patients, visitors, or other HCP with confirmed COVID-19, refer to the Interim U.S. Guidance for Risk Assessment and Work Restrictions for Healthcare Personnel with Potential Exposure to COVID-19.

Return to Work Criteria for HCP with SARS-CoV-2 Infection

Symptom-based strategy for determining when HCP can return to work.

HCP with mild to moderate illness who are not severely immunocompromised:

  • At least 10 days have passed since symptoms first appeared and
  • At least 24 hours have passed since last fever without the use of fever-reducing medications and
  • Symptoms (e.g., cough, shortness of breath) have improved

Note:  HCP who are not severely immunocompromised and were asymptomatic throughout their infection may return to work when at least 10 days have passed since the date of their first positive viral diagnostic test.

HCP with severe to critical illness or who are severely immunocompromised1:

  • At least 10 days and up to 20 days have passed since symptoms first appeared
  • At least 24 hours have passed since last fever without the use of fever-reducing medications and
  • Symptoms (e.g., cough, shortness of breath) have improved
  • Consider consultation with infection control experts

Note:  HCP who are severely immunocompromised but who were asymptomatic throughout their infection may return to work when at least 10 days and up to 20 days have passed since the date of their first positive viral diagnostic test.

As described in the Decision Memo, an estimated 95% of severely or critically ill patients, including some with severe immunocompromise, no longer had replication-competent virus 15 days after onset of symptoms; no patient had replication-competent virus more than 20 days after onset of symptoms. The exact criteria that determine which HCP will shed replication-competent virus for longer periods are not known. Disease severity factors and the presence of immunocompromising conditions should be considered in determining the appropriate duration for specific HCP. For example, HCP with characteristics of severe illness may be most appropriately managed with at least 15 days before return to work.

Test-Based Strategy for Determining when HCP Can Return to Work.

In some instances, a test-based strategy could be considered to allow HCP to return to work earlier than if the symptom-based strategy were used. However, as described in the Decision Memo, many individuals will have prolonged viral shedding, limiting the utility of this approach. A test-based strategy could also be considered for some HCP (e.g., those who are severely immunocompromised1) in consultation with local infectious diseases experts if concerns exist for the HCP being infectious for more than 20 days.

The criteria for the test-based strategy are:

HCP who are symptomatic:

HCP who are not symptomatic:

Return to Work Practices and Work Restrictions

After returning to work, HCP should:

  • Wear a facemask for source control at all times while in the healthcare facility until all symptoms are completely resolved or at baseline. A facemask instead of a cloth face covering should be used by these HCP for source control during this time period while in the facility. After this time period, these HCP should revert to their facility policy regarding universal source control during the pandemic.
    • A facemask for source control does not replace the need to wear an N95 or equivalent or higher-level respirator (or other recommended PPE) when indicated, including when caring for patients with suspected or confirmed SARS-CoV-2 infection.
  • Self-monitor for symptoms, and seek re-evaluation from occupational health if symptoms recur or worsen.

Strategies to Mitigate Healthcare Personnel Staffing Shortages

Maintaining appropriate staffing in healthcare facilities is essential to providing a safe work environment for HCP and safe patient care. As the COVID-19 pandemic progresses, staffing shortages will likely occur due to HCP exposures, illness, or need to care for family members at home. Healthcare facilities must be prepared for potential staffing shortages and have plans and processes in place to mitigate them, including considerations for permitting HCP to return to work without meeting all return to work criteria above. Refer to the Strategies to Mitigate Healthcare Personnel Staffing Shortages document for information.

Definitions

Cloth face covering: Textile (cloth) covers are intended to keep the person wearing one from spreading respiratory secretions when talking, sneezing, or coughing. They are not PPE, and it is uncertain whether cloth face coverings protect the wearer. CDC has guidance available on design, use, and maintenance of cloth face coverings.

Facemask: Facemasks are PPE and are often referred to as surgical masks or procedure masks. Use facemasks according to product labeling and local, state, and federal requirements. FDA-cleared surgical masks are designed to protect against splashes and sprays and are prioritized for use when such exposures are anticipated, including surgical procedures. Facemasks that are not regulated by FDA, such as some procedure masks, which are typically used for isolation purposes, may not provide protection against splashes and sprays.

Respirator: A respirator is a personal protective device that is worn on the face, covers at least the nose and mouth, and is used to reduce the wearer’s risk of inhaling hazardous airborne particles (including dust particles and infectious agents), gases, or vapors. Respirators are certified by the CDC/NIOSH, including those intended for use in healthcare.

SARS-CoV-2 Illness Severity Criteria (adapted from the NIH COVID-19 Treatment Guidelinesexternal icon):

Note:  The studies used to inform this guidance did not clearly define “severe” or “critical” illness. This guidance has taken a conservative approach to define these categories. Although not developed to inform decisions about when HCP with SARS-CoV-2 infection may return to work, the definitions in the National Institutes of Health (NIH) COVID-19 Treatment Guidelinese are one option for defining severity of illness categories. The highest level of illness severity experienced by the HCP at any point in their clinical course should be used when determining when they may return to work.

Mild Illness: Individuals who have any of the various signs and symptoms of COVID 19 (e.g., fever, cough, sore throat, malaise, headache, muscle pain) without shortness of breath, dyspnea, or abnormal chest imaging.

Moderate Illness: Individuals who have evidence of lower respiratory disease by clinical assessment or imaging and a saturation of oxygen (SpO2) ≥94% on room air at sea level.

Severe Illness: Individuals who have respiratory frequency >30 breaths per minute, SpO2 <94% on room air at sea level (or, for patients with chronic hypoxemia, a decrease from baseline of >3%), ratio of arterial partial pressure of oxygen to fraction of inspired oxygen (PaO2/FiO2) <300 mmHg, or lung infiltrates >50%.

Critical Illness: Individuals who have respiratory failure, septic shock, and/or multiple organ dysfunction.

Footnotes

The studies used to inform this guidance did not clearly define “severely immunocompromised”. For the purposes of this guidance, CDC used the following definition that was created to more generally address HCP occupational exposures.

  • Some conditions, such as being on chemotherapy for cancer, being within one year out from receiving a hematopoietic stem cell or solid organ transplant, untreated HIV infection with CD4 T lymphocyte count < 200, combined primary immunodeficiency disorder, and receipt of prednisone >20mg/day for more than 14 days, may cause a higher degree of immunocompromise and require actions such as lengthening the duration of HCP work restrictions.
  • Other factors, such as advanced age, diabetes mellitus, or end-stage renal disease, may pose a much lower degree of immunocompromise and not clearly affect occupational health actions to prevent disease transmission.
  • Ultimately, the degree of immunocompromise for HCP is determined by the treating provider, and preventive actions are tailored to each individual and situation.
Back To Top

1. Determining Who Should Return to Work When

Reopening is essential to regaining a sense of normalcy, but that doesn’t mean recalling your entire team at once is necessarily the best practice. Staggering returns reduces the risk of person-to-person transmission within your office in the early weeks of your reopen and also prevents your IT and HR teams from becoming overwhelmed providing support.

Strategies to Determine Who Should Return to Work

  • Essential vs. non-essential roles
  • Required onsite vs. able to work remotel
  • Volunteers—employees that want to return
  • Percentage of department (to allow for cross-departmental collaboration)
  • Rotation of leadership team (business continuity concerns)
  • Two week intervals (a certain percentage of employees return every two weeks)
  • Special accommodations for high-risk individuals (for example: those who have or are caring for high-risk family members)

The Checklist

✓ Identify professionals or teams are essential to enabling return-to-office for others

✓ Determine which roles are essential to core office function (i.e. who else needs to be there for reopening to be meaningful?)

✓ Identify professionals able to completely fulfill work responsibilities from home

✓ Identify professionals who will require extended work-from-home as an accommodation

✓ Conduct an interest survey to see which team members feel strongly about returning and which feel strongly about not returning

✓ Consider creating an “A Team” and “B Team” to prepare for a mass exposure event, including leadership

✓ Set dates for “waves” of returns based on the above data

✓ Identify a long-term strategy for reintegrating employees with immunodeficiencies and other high-risk conditions

2. Setting a Communication Strategy

Before you can recall your employees and reopen, it’s crucial to have a communication strategy in place for needs and concerns related to COVID-19. By creating official channels for certain concerns and responsibilities, you reduce uncertainty for your employees and headaches for your HR team members on the frontline of employee concerns.

The Checklist

✓ Select official channels for reopening-related communications and inform employees of them

✓ Create a written explanation of your reopen plan, answering employee frequently asked questions

✓ Determine channels and strategies you’ll use to inform employees of new company policies and educate them about COVID-19 best practices in the workplace

✓ Provide clear rationale for who is returning to the traditional workplace and why

✓ Establish channels for accommodation or leave requests and make employees aware of those channels

✓ Establish channels for concerns and individualized questions and communicate these procedures to employees

✓ Establish points-of-contact for all returning employees

✓ Provide clear expectations for employees upon their return (more on this topic later within the toolkit)

✓ Provide employees with a list of their rights under the ADA and FFCRA (more on this topic later within the toolkit)

✓ Tell employees what you are doing to protect them during this time

3. Preparing & Modifying Your Physical Workspace

While reopen orders are allowing businesses to return to work in the traditional setting, for most businesses, the physical space of the office or workplace will need to be significantly modified to align with CDC and WHO best practices for social distancing. Being thoughtful about the ways you group or separate people and use space has never been more important.

The Checklist

✓ Determine how you can best de-densify workstations based on the data you uncovered in terms of essential staffing

✓ Install partitions between workstations, especially in areas where maintaining the recommended 6’ of physical distance is challenging

✓ Install partitions or “sneeze guard”-style shields to protect public-facing employees

✓ Create foot traffic plans to reduce congestion and close contact in hallways, show rooms, common spaces, etc.

✓ Create and install signage to provide social distancing reminders for everyone, inform employees about CDC guidance and company policies, etc.

✓ Mark the floor with colored tape to indicate proper spacing

✓ Consider closing or limiting the use of all common spaces

✓ Remove bulk, sharable, or “grab-and-go” style food from common areas

✓ Modify/update custodial and building maintenance plans to address new needs

✓ Install dispensers for hand sanitizer and PPE (masks, gloves, etc.) as needed

4. Identifying & Updating Effected Policies

COVID-19 has created the need for a variety of new ad-hoc and long-term policies and procedures (we will cover these in detail later within the toolkit), but what many employers are forgetting is that the new conditions and recommendations may contradict or effect your existing policies. Before you bring employees back to the office, you need to ensure you’re ready for the new reality by reviewing your policy handbook and making updates to relevant sections.

The Checklist

✓ Review and address policies about communal spaces and food

✓ Review and address policies about employee report and break times, with an eye toward staggering these

✓ Review and address policies about in-office gatherings and celebrations

✓ Review and address policies about in-person meetings and reviews

✓ Review and address policies about business travel (non-essential vs. essential)

✓ Review and address policies about guests and visitors

✓ Review and address policies related to work-from-home

✓ Review and address policies about paid sick time (best practices include sick time policies that highly incentivize employees to stay home when they’re not feeling well)

✓ Review and address your emergency response plans (be sure to account for modified/reduced headcounts and ensure you’re always prepared)

5. Building Social Distancing & Employee Cleaning/Disinfecting Protocols

We previously addressed the need to modify your physical workspace, but it’s equally important that you create a clear, enforceable social distancing policy and cleaning/disinfection protocol for your employees as well. When you’re providing a safe space and your team members are each doing their individual parts as well, your business will be best poised to reduce the risk of COVID-19 spreading.

The Checklist

✓ Establish clear expectations for physical distance between employees

✓ Communicate how employees in a variety of different roles are expected to comply with social distancing (consider the differences between customer-facing, sales, and back-office roles, etc.)

✓ Inform employees of modifications to shifts/report times/break times/etc.

✓ Inform employees of modifications to common space usage, office foot traffic patterns, etc.

✓ Provide employees with a clear vision for how previously in-person meetings will be restructured to comply with social distancing best practices

✓ Communicate which cleaning/disinfecting responsibilities fall to the individual employee and which will be covered by the employer/custodial staff

✓ Provide clear expectations in terms of how often each cleaning protocol should be carried out

✓ Provide a list of approved and expected cleaning products/methodologies as well as guidance for how to access those products at work

✓ Provide guidelines for cleaning/disinfecting shared spaces following use (i.e. the bathroom sink or break room microwave)

✓ Create an accountability system and communicate consequences for non-compliance with new company policies

✓ Ensure employees sign off on social distancing & cleaning policies as well as other handbook updates before or immediately upon returning to work

6. PPE Policies & Key Considerations

Cleanliness and social distancing represent two corners of a powerful triangle of best practices for COVID-19 in the workplace. The third piece is personal protective equipment (commonly called PPE). Proper PPE protects employees from catching COVID-19 or transmitting it if they themselves are unknowingly sick. Before reopening, it’s crucial to outline your expectations and policies for PPE use.

The Checklist

✓ Communicate expectations for masks at work ( Who should wear them? what kind of masks should they be? How do you put on and take off a mask safely?)

✓ Communicate expectations for the use of gloves at work (Who should wear them? What kinds of gloves are appropriate for different types of work? How do you put on and take off gloves safely?)

✓ Clarify how PPE requirements vary depending on role and physical setting

✓ Determine if employees will be required to provide their own PPE or if your organization will provide it for employees

✓ Establish what other forms of PPE you comfortable with employees bringing in and using (face shields, gowns, etc.)

✓ Communicate modifications to PPE expectations for employees who already use PPE on a daily basis (for example, if you were already wearing gloves for work, should you now be wearing a mask as well?)

✓ Establish expectations for returning PPE for reuse/sanitization/etc. or if all PPE will be single-use only

7. Building a Proactive Employee Engagement Strategy

Reopening in an effective way isn’t just about recalling employees into the physical workspace; it’s a full reboot of your team with an eye towards doing business in new ways. That means you’ll need to motivate your employees in different ways that you were before COVID-19 and building buy-in for new policies and initiatives. The success of all that comes down to employee engagement.

The Checklist

✓ Identify and leverage intuitive, easy tools for employee communication

✓ Establish ways in which you will substitute group gatherings for equally authentic, engaging team-building activities

✓ Create new employee incentives that don’t rely on communal food or social distancing violations

✓ Think of new ways to “rally the troops” or create shared purpose and alignment with your organizational mission/vision

✓ Invite employees to engage socially in new ways and make time for it within their work week (video happy hours, taking online fitness classes together, etc.)

✓ Find ways to keep employees in the loop regarding office updates, the organization’s evolving approach to COVID-19, etc. (remember to plan for how you’ll prevent employees from feeling like they’re being kept in the dark, communicating early and often is crucial)

8. Empowering Employees with their Rights

It’s the most uncertain time in recent memory for the average American professional. One way you can provide your employees with psychological support and help them feel ready to return to the workplace in a safe manner is by providing them with a quick reminder of their rights as an employee. The more empowered and enfranchised employees feel, the more likely they are to buy into your reopen and hit the ground running.

The Checklist

✓ Provide employees with an explanation of paid sick time/FMLA leave expansion under the FFCRA

✓ Remind employees of accommodation eligibility via the ADA

✓ Provide safe workplace reassurance including specific breakdowns of what you’re doing to protect employees (including social distancing, sanitation practices, PPE, etc.)

✓ Inform employees of official channels to communicate if they are uncomfortable with returning to work, or have questions on any of the new policies, etc.

✓ Reassure employees of non-discrimination protections, including discrimination based on COVID-19 status (also important to emphasize to employees they cannot discriminate against teammates based on diagnosed or suspected COVID-19 infection or exposure)

✓ Help employees understand how shutdowns/furloughs have affected their accrued paid time off based on your state labor laws and company policies

✓ Provide a general refresher of all employee rights established within your handbook

9. Protocols for Employee Re-Entry & Health Screening

So, you’ve updated your policies, articulated a vision, and communicated with your team in a transparent, empowering way about reopening the office and returning to some semblance of normalcy. What’s next on your action plan for return to work? Putting into place effective procedures to ensure returning employees are not exposing your workforce to potential COVID-19 infection. Establishing employee screening protocols is crucial, so you must take careful note of the next steps outlined here.

What about testing?

What about testing? Businesses must become an ac tive participant in the effort to expand testing for COVID-19 and its antibodies. From looking at countries such as Singapore and S outh Korea that managed to control the outbreak, the key to stopping the spread of the disease once the quarantine is lifted and people go back to work is consistent and readily available testing, coupled with “contact tracing” – tracking interactions to identify people who might have been exposed. While the US is not necessarily set up to implement the kind of regimented, centralized testing and contact tracing system that Singapore used to great effect, employers can implement similar systems in their offices. Namely, through testing and keeping track of employee interactions such as meetings in order to isolate employees who may have been exposed if an employee tests positive.

There are many tests being developed and employers will have to work with their brokers and insurers to get the tests their team needs. The US is working to make testing more available, so it’s likely by the time your employees are coming back into work the tests may be much more widely available. Once you acquire the tests, you will have to decide on a testing cadence, testing your team as frequently as necessary without becoming overly burdensome. You can also use screenings such as temperature readings to identify candidates for testing. And don’t forget to test for antibodies as well as infections: it can be almost as useful to know who is already immune as it is to identify employees who might be carriers of the virus.

The Checklist

✓ Establish where and when employee temperature checks/health screenings will take place

✓ Establish who will administer temperature checks/ health screenings (HR professionals, medical professionals, etc.)

✓ Establish clear standards for temperature check/ screening results (i.e. what is the threshold to send someone home for suspected COVID-19 infection?)

✓ Establish clear standards for who will be screened (Just employees? Just public visitors? Everybody who enters your office space? What about visiting clients?)

✓ Create screening questions based on CDC/WHO guidance and specific concerns related to what you do and how you do business

✓ Create a clear, simple pathway for transitioning employees who are sick or at-risk onto medical leave

✓ Provide your employees with clear information about what information is being gathered and how it is being stored or shared with local public health officials

✓ Create a work-from-home enablement plan for employees who have a fever or do not pass the screening but still feel they can work

✓ Articulate an official protocol on the minimum number of days employees with a fever must be out from work before returning without risk of infecting others

10. Addressing Workforce Anxiety About Returning to Work

It’s important to acknowledge the fact that many individuals are uneasy about returning to work. Simply put, employees are scared of being infected and are unsure of what the future holds in a post-COVID business world. As much as sanitation, screening procedures, and PPE are important, your team’s physical, emotional, and psychological readiness to return to work is equally important.

Keep these best practices in mind

Lead with compassion:
Remind yourself of what employees are going through. Many have their children home and are attempting to balance work with childcare. Many others are facing unprecedented levels of stress and fear due to the increasing number of infections in the US. Have compassion and reiterate to your team that returning to work with be a joint effort, with a high level of consideration being put in to ensure employee safety.

Communicate early and often:
Even if you don’t feel you have all the answers, some information is better than no information. Keeping employees in the loop as much as possible is crucial reducing workforce anxiety around COVID-19.

Solicit employee feedback:
Leverage surveys to understand your team’s thoughts and feelings during COVID-19, and put their feedback into action.

Remain flexible:
The best thing you can as a leader during COVID-19 is grant your team the flexibility they need    ato ensure their families are taken care of, while also balancing their work.

11. Identifying Leadership Planning Priorities

Getting businesses opened back up isn’t the end of the road; it’s actually the beginning of a new, much longer one. Moving forward, our approach to work is going to need to evolve in ways that none of us could’ve imagined just a few months ago. That means that the coming months of leadership planning will be some of the most crucial in the history of our business world.

The Checklist

✓ Examine how continued expansion of remote work and work-from-home can power your organization for years to come

✓ Prioritize articulating new HCM strategies and providing the training and technology support to make them work

✓ Focus on employee engagement and teambuilding, almost as though you were starting fresh

✓ Plan proactively to prepare for the next major disruption to productivity (consider the possibility of a second large wave of infections)

✓ Create an accountability system within your leadership team to assess the success of reopening procedures and make recommendations moving forward

✓ Create a think-tank within your leadership team to brainstorm new and innovative approaches moving forward

Step #3

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