Introduction:

This checklist template is part of our Coronavirus Workplace Processes pack.

It was built following the procedures outlined in the CDC Coronavirus Disease Daily Life & Coping Checklist.

This checklist provides a step-by-step guide on how to plan and protect yourself and loved ones, as a family, during a COVID-19 outbreak. Following this checklist will help to limit the survival of the virus in the household setting and provide you with the steps to take if you or a household member contracts the virus. 

Though this checklist has all the foundational information you need, you can also edit it to best suits your specific needs. When you're finished working on the template and would like to follow the checklist, all you have to do is run this template as a checklist.

You can also add/edit form fields and widgets throughout the checklist to help gather necessary information and sync your Process Street account with other software you may be already using to easily store and utilize the information you've gathered in your checklists.

Process Street is not a medical institution and the items contained in this process template are illustrative and not intended to be understood as medical advice. Please refer to the attached PDF document for any and all medical or operational recommendations.

Record basic details

Use the form fields below to record basic information first.

Stay informed:

Get up-to-date information

Seek out up-to-date information about your local COVID-19 activity from public health officials.

Talk to your neighbors

Keep in communication with your neighbors and ask what their plan entails. 

Create a list of local organizations

Put together a list of local organizations you can contact if you're in need of information, healthcare services, support, or resources.

Create an emergency contact list

In addition to the list of local organizations, put together a list of emergency contacts.

This list could include:

  • family
  • friends
  • neighbors
  • carpool drivers
  • healthcare providers
  • teachers, employers
  • the local public health department
  • other community resources

Prepare for possible illness:

Consider higher risk household members

Be mindful of household members that may be at greater risk, such as elderly and people with compromised immune systems.

Designate a room for quarantine

Select a room in your house that can be used to separate household members who are ill from others to minimize spread.

Take everyday preventative steps:

Wash your hands

Wash your hands often with soap and water for at least 20 seconds.

Avoid touching your face

Try your best to avoid touching your eyes, nose, and mouth areas with unwashed hands.

Stay home if you're sick

If you're experiencing any COVID-19 symptoms, call off from work and stay home to avoid further spread.

These symptoms include:

  • Fever 
  • Cough
  • Shortness of breath

Use a tissue when coughing

Always cover your face with a tissue when coughing or sneezing, and throw the tissue away after each use.

Clean and disinfect objects/surfaces

Make sure to regularly clean and disinfect frequently touched objects and surfaces.

Make childcare preparations

Make the necessary preparations in the event that your child’s school/childcare is temporarily dismissed or for potential changes at your work.

Watch for symptoms:

Stay home if you develop symptoms

Stay home and contact your healthcare provider if you contract any of these symptoms:

  • Fever 
  • Cough
  • Shortness of breath

If someone is showing any of the symptoms below, seek emergency medical care immediately.

  • Trouble breathing
  • Persistent chest pain/pressure
  • Confusion
  • Inability to wake or stay awake
  • Bluish lips or face

Call 911 or call your local emergency facility: Let the operator know that you are seeking care for someone who has or may have COVID-19.

Keep away from others who are sick

Avoid contact with people who are sick to avoid potential spread.

Practice social distancing

Limit all close contact with other people as much as possible, and keep about 6 feet apart.

If someone in your home is sick:

Continue to practice everyday preventive actions

Continue to practice the preventative measures detailed earlier in this checklist.

Keep the ill person in a separate room

Make sure to keep the ill household member in a separate room from others to avoid further spread.

[Conditional] Stay in contact with others

If you become sick, keep in contact with others by phone or email.

Keep surfaces disinfected

Make sure to regularly clean and disinfect frequently touched objects and surfaces.

Avoid sharing personal items

If possible, avoid sharing personal items with others to minimize spread.

Stay informed

Keep up-to-date about the local outbreak situation.

Notify your work if your schedule needs to change

If your work is interfering with caring for your ill household member, contact them and request a change in schedule.

Take care of your household member's emotional health

Make sure not to neglect the emotional health of your household members, including yourself.

Those at higher risk of severe illness:

Stay home

If you're at higher risk, the safest thing you can do is stay home and self-isolate as much as possible.

Stock up on medications and supplies

Make sure you have access to several weeks of medications and supplies in case you need to stay home.

Practice social distancing

When you go out in public, keep away from crowds and others who are sick and limit close contact with others.

It's recommended to keep at least 6 feet apart from others to prevent potential spread.

Practice good hand hygiene

Wash your hands often with soap and water for at least 20 seconds.

Children:

Keep your children's school informed

If your child becomes sick with COVID-19, make sure to notify your child’s school.

Keep track of school dismissals in your community

Keep track of local school dismissals.

Your child’s school/childcare may be temporarily dismissed to prevent further spread of the virus.

Encourage social distancing amongst children and teens

If you come upon a gathering of children/teens in a public place, do your best to encourage them to practice social distancing.

Sources:

Sign up for a FREE account and
search thousands of checklists in our library.

Sign up for a FREE account and search thousands of checklists in our library.