Dir 2021-02 CPL 02

U.S.
DEPARTMENT OF LABOR Occupational Safety and Health Administration
DIRECTIVE NUMBER: DIR 2021-02 (CPL 02) EFFECTIVE DATE: June 28, 2021
SUBJECT: Inspection Procedures for the COVID-19 Emergency Temporary Standard
ABSTRACT
Purpose: This Direction establishes inspection procedures and enforcement

policies for the COVID-19 Emergency Temporary Standard, 29 CFR §
1910.502, and 29 CFR § 1910.504.
Scope: This Direction applies OSHA-wide.
References: Presidential Executive Order on Protecting Worker Health and Safety,

January 21, 2021.
Federal Register, 86 FR 32376, 29 CFR § 1910, Emergency

Temporary Standard for COVID-19; Final Rule, June 21, 2021.
OSHA Instruction, CPL 02-00-164, Field Operations Manual (FOM),

April 14, 2020.
OSHA Instruction, CPL 02-00-158, Inspection Procedures for the

Respiratory Protection Standard, June 26, 2014.
OSHA Direction, DIR 2021-01 (CPL-03), National Emphasis

Program – Coronavirus Disease 2019 (COVID-19), March 12, 2021
(or successor directive).
(See Section III for additional references.)
Cancellations: None.
State Impact: Notice of intent required. States are expected to have accessible
enforcement policies and procedures in place which are at least as
effective as those in this Direction.
Action Offices: OSHA National, Regional and Area Offices, and On-Site Consultation
Programs.
Originating Office: Directorate of Enforcement Programs
ABSTRACT - 1
Contact: Office of Health Enforcement
Directorate of Enforcement Programs
200 Constitution Ave., NW, Room N-3119
Washington, DC 20210
(202) 693-2190
By and Under the Authority of
James S. Frederick
Acting Assistant Secretary
ABSTRACT - 2
Executive Summary
In response to the Presidential Executive Order on Protecting Worker Health and Safety, January
21, 2021, the Occupational Safety and Health Administration (OSHA) considered and
determined that additional measures could be taken to prevent occupational exposures to SARS-
CoV-2 and the spread of the resulting disease, COVID-19, that results in illnesses and death.
OSHA examined, among other things, COVID-19 inspection and violation history, worker
complaints and Hazard Alert Letters (HALs) issued, and petitions from stakeholders requesting
that OSHA issue an ETS, and determined that specific requirements aimed at controlling
COVID-19 hazards in the healthcare industry, i.e., beyond the general duty clause, would
improve worker protections.
Thus, OSHA issued an emergency temporary standard (ETS) to protect healthcare workers from
occupational exposure to COVID-19. The ETS was published in the Federal Register on June
21, 2021, and became effective the same day. The ETS has multiple sections – healthcare (29
CFR § 1910.502), mini respiratory protection program (29 CFR § 1910.504), severability (29
CFR § 1910.505), and incorporation by reference (29 CFR § 1910.509).
During the period of the ETS, covered healthcare employers must develop and implement a
COVID-19 plan to identify and control COVID-19 hazards in the workplace. As part of their
COVID-19 plan, these employers must address and implement various requirements to reduce
transmission of COVID-19 in their workplaces, including patient and non-employee screening
and management requirements, standard and transmission-based precautions, controls for
aerosol-generating procedures, physical distancing, physical barriers, personal protective
equipment (PPE), cleaning and disinfection, ventilation, employee health screening and medical
management, vaccination, training, anti-retaliation, recordkeeping, and reporting.
This new Directive establishes OSHA’s field inspection and enforcement procedures designed to
ensure uniformity in enforcing the ETS when addressing workplace exposures to SARS-CoV-2,
the virus that causes COVID-19 disease.
Significant Changes
Not applicable. This is a new enforcement program.
ABSTRACT - 3
Table of Contents
Chapter Page
I. Purpose. ................................................................................................................................ 1
II. Scope. ................................................................................................................................... 1
III. References. ........................................................................................................................... 1
IV. Cancellations. ....................................................................................................................... 3
V. Action Offices. ..................................................................................................................... 3
VI. Federal Program Change. ..................................................................................................... 3
VII. Expiration. ............................................................................................................................ 4
VIII. Significant Changes. ............................................................................................................. 4
VIII. Background. ......................................................................................................................... 4
IX. Inspection Procedures........................................................................................................... 5
A. Scope and Application.......................................................................................................... 5
B. Definitions. ........................................................................................................................... 7
C. General Inspection Procedures. ............................................................................................ 9
D. COVID-19 Plan .................................................................................................................. 14
E. Patient / Non-employee Screening and Management. ....................................................... 19
F. Standard and Transmission-Based Precautions. ................................................................. 22
G. Personal Protective Equipment. ......................................................................................... 23
H. Aerosol-Generating Procedures. ........................................................................................ 26
I. Physical Distancing. ........................................................................................................... 27
J. Physical Barriers................................................................................................................. 29
K. Cleaning and Disinfecting. ................................................................................................. 30
L. Ventilation. ......................................................................................................................... 32
M. Employee Health Screening and Medical Management. ................................................... 33
N. Vaccination. ........................................................................................................................ 39
O. Training. ............................................................................................................................. 40
P. Anti-Retaliation. ................................................................................................................. 42
Q. Requirements at No Cost. ................................................................................................... 44
R. Recordkeeping. ................................................................................................................... 45
S. Reporting to OSHA. ........................................................................................................... 48
X. Mini Respiratory Protection Program. ............................................................................... 50
XI. Drafting OSHA Citations for COVID-19 Violations. ........................................................ 53
XII. Training for OSHA Personnel. ........................................................................................... 54
XIII. Medical Examinations for OSHA Personnel...................................................................... 54
XIV. Protection of OSHA Personnel........................................................................................... 55
XV. Dates. .................................................................................................................................. 57
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XVI. OSHA Information System (OIS) Coding Instructions. .................................................... 57
Appendix A: Additional Specifications for AIIRs and Ventilation References

Appendix B: Respiratory Protection Guidance by Activity and Standard
Appendix C: Additional Guidance for Determining Medical Removal Benefits
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I. Purpose.
The purpose of this Direction is to provide guidelines and establish uniform inspection
and enforcement procedures for the (COVID-19 emergency temporary standard, hereafter
referred to as the ETS. The two main sections of the ETS, 29 CFR § 1910.502 and 29
CFR § 1910.504, published in the Federal Register, became effective on June 21, 2021.
Compliance with most provisions is required by July 6, 2021, and with training,
ventilation, and barrier provisions by July 21, 2021.
II. Scope.
This Direction applies OSHA-wide.
III. References.
A. Presidential Executive Order on Protecting Worker Health and Safety, January 21,
2021, www.whitehouse.gov/briefing-room/presidential-
actions/2021/01/21/executive-order-protecting-worker-health-and-safety.
B. Federal Register, 86 FR at 32376, 29 CFR § 1910, Emergency Temporary

Standard for COVID-19; Final Rule, June 21, 2021,
https://www.govinfo.gov/content/pkg/FR-2021-06-21/pdf/2021-12428.pdf
C. OSHA Instruction, CPL 02-00-164, Field Operations Manual (FOM), April 14,
2020, www.osha.gov/enforcement/directives/cpl-02-00-164.
D. OSHA Instruction, CPL 02-00-158, Inspection Procedures for the Respiratory

Protection Standard, June 26, 2014, www.osha.gov/enforcement/directives/cpl-
02-00-158.
E. OSHA Instruction, CPL 02-02-078, Enforcement Procedures and Scheduling for

Occupational Exposure to Tuberculosis, June 30, 2015,
www.osha.gov/enforcement/directives/cpl-02-02-078.
F. OSHA Direction, DIR 2021-01 (CPL-03), National Emphasis Program –

Coronavirus Disease 2019 (COVID-19), March 12, 2021 (or successor directive),
www.osha.gov/enforcement/directives/dir-2021-01cpl-03.
G. OSHA Instruction, CPL 02-02-072, Rules of agency practice and procedure

concerning OSHA access to employee medical records, August 22, 2007,
www.osha.gov/enforcement/directives/cpl-02-02-072.
H. OSHA Instruction, ADM 04-00-003, Safety and Health Management System,

May 6, 2020, www.osha.gov/enforcement/directives/adm-04-00-003.
I. CDC, Hospital Preparedness Checklist, ww.cdc.gov/coronavirus/2019-

ncov/hcp/hcp-hospital-checklist.
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J. CDC, Interim Infection Prevention and Control Recommendations for Patients
with Suspected or Confirmed Coronavirus Disease 2019 (COVID-19) in
Healthcare Settings, www.cdc.gov/coronavirus/2019-ncov/hcp/infection-control-
recommendations.
K. CDC, How to Wash Masks, www.cdc.gov/coronavirus/2019-ncov/prevent-

getting-sick/how-to-wash-cloth-face coverings.
L. CDC, Cleaning and Disinfecting Your Facility, www.cdc.gov/coronavirus/2019-

ncov/community/disinfecting-building-facility.
M. CDC, Symptoms of COVID-19, www.cdc.gov/coronavirus/2019-ncov/symptoms-

testing/symptoms.
N. CDC, Healthcare Facilities: Managing Operations During the COVID-19

Pandemic, www.cdc.gov/coronavirus/2019-ncov/hcp/guidance-hcf.
O. CDC, Burn Rate Calculator, www.cdc.gov/coronavirus/2019-ncov/hcp/ppe-

strategy/burn-calculator.
P. Food and Drug Administration (FDA), Emergency Use Authorization (EA) for
Respiratory Protection Equipment, www.fda.gov/medical-devices/coronavirus-
disease-2019-covid-19-emergency-use-authorizations-medical-devices/personal-
protective-equipment-euas#respirators.
Q. FDA, Umbrella EUA for Surgical Masks, www.fda.gov/medical-

devices/coronavirus-disease-2019-covid-19-emergency-use-authorizations-
medical-devices/personal-protective-equipment-euas#appendixasurgicalmasks.
R. FDA, Face Masks, Including Surgical Masks, and Respirators for COVID-19,
www.fda.gov/medical-devices/coronavirus-covid-19-and-medical-devices/face-
masks-including-surgical-masks-and-respirators-covid-19.
S. FDA, Authorized Surgical Masks and Surgical Masks Removed from Appendix A,
www.fda.gov/medical-devices/coronavirus-disease-2019-covid-19-emergency-
use-authorizations-medical-devices/personal-protective-equipment-
euas#appendixaremoved.
T. CDC, NIOSH-Approved Particulate Filtering Facepiece Respirators,

www.cdc.gov/niosh/npptl/topics/respirators/disp_part.
U. CDC, Counterfeit Respirators / Misrepresentation of NIOSH-Approval,

www.cdc.gov/niosh/npptl/usernotices/counterfeitResp.
V. See 29 CFR § 1910.509 for additional guidelines and standards incorporated by

reference. These guidelines and standards are also listed on the following
webpage: www.osha.gov/coronavirus/ets/ibr.
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IV. Cancellations.
None.
V. Action Offices.
A. Responsible Office.
Directorate of Enforcement Programs (DEP), Office of Health Enforcement
(OHE).
B. Action Offices.
National, Regional and Area Offices, State Plan and OSHA On-Site Consultation
programs.
C. Information Offices.
OSHA National Office.
VI. Federal Program Change.

Notice of Intent and Equivalency Required. This Direction describes a federal program
change that updates OSHA’s field inspection and enforcement procedures designed to
ensure uniformity in enforcing the ETS when addressing workplace exposure to SARS-
CoV-2, the virus that causes COVID-19 disease. State Plans have the option of adopting
identically or of adopting different, but at least as effective, enforcement policies as those
contained in this Direction. State Plans must provide for their own comparable internal
administrative procedures and processes.
Within 15 days of the effective date of this Direction, a State Plan must submit a notice of
intent indicating whether the State Plan will adopt or already has in place policies and
procedures that are identical to or different from the federal program. State adoption,
either identical or different, should be accomplished within 30 days. Under OSHA’s
regulation for Federal Program changes at 29 CFR 1953.4(b)(5), the date for adopting
Federal Program changes is generally six months from the date of notification, but the
Assistant Secretary may determine that the nature or scope of the change requires a
different time frame. OSHA’s Assistant Secretary has determined that the nature of
OSHA’s ETS requires that State Plans adopt this Direction within 30 days.
If adopting identically, the State Plan must provide the date of adoption to OSHA within
60 days of adoption. If the State Plan adopts or maintains policies that differ from those
in this Direction, the policies must be available for review. Within 60 days of adoption,
the State Plan must provide OSHA with an electronic copy of the policies or a link to
where their policies are posted on the State Plan’s website. The State Plan must also
provide the date of adoption and identify differences, if any, between their policies and
OSHA’s. OSHA will provide summary information on the State Plan responses to this
Direction on its website at: www.osha.gov/dcsp/osp.
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VII. Expiration.
This Direction is effective for no more than 12 months from the effective date of the
Emergency Temporary Standard for COVID-19; Final Rule, June 21, 2021, unless
canceled or extended by a superseding directive.
VIII. Significant Changes.

N/A.
VIII. Background.
The World Health Organization declared the COVID-19 pandemic on March 11, 2020.
COVID-19 has killed over 600,000 people in the United States in barely over a year, and
infected millions more, and the impact of this new illness has been borne
disproportionately by the healthcare and healthcare support workers tasked with caring
for those infected by this disease. Nearly 500,000 healthcare workers have contracted
COVID-19, and more than 1,600 of those workers have died.
Exposures may depend on a variety of factors including the physical environment of the
workplace, the type of work activity, the health and vaccination status of the worker, the
ability of workers to wear facemasks and abide by current CDC guidelines, and the need
for close contact (within 6 feet for a cumulative total of 15 minutes or more over a 24-
hour period) with any person, including those known to have or suspected of having
COVID-19, and those who may be infected with—and able to spread—SARS-CoV-2
without knowing it. Workers face a particularly elevated risk of exposure to SARS-CoV-
2 in settings where patients with suspected or confirmed COVID-19 receive treatment or
where patients with undiagnosed illnesses come for treatment (e.g., emergency rooms,
urgent care centers), especially when providing care or services directly to those patients.
Other factors, such as conditions in communities where employees live and work, their
activities outside of work, and individual health conditions, may also affect workers’ risk
of getting COVID-19 and/or developing complications from the illness.
OSHA and several public health agencies have developed recommendations to assist
employers in preparing their workplaces to minimize transmission of the virus. On April
13, 2020, OSHA issued an Interim Enforcement Response Plan for COVID-19 as a first
step at establishing an emphasis on very high- and high-risk workplaces. Subsequently,
on May 19, 2020, and March 12, 2021, Updated Interim Enforcement Response Plans for
COVID-19 were issued. Soon after the issuance of this ETS CPL, OSHA expects to
issue a further update to its interim enforcement response plan, pursuant to the ETS.
In addition, per the Presidential Executive Order on Protecting Worker Health and Safety,
January 21, 2021, OSHA developed and implemented a National Emphasis Program
(NEP) for COVID-19, DIR 2021-01 (CPL-03), that became effective March 12, 2021.
Soon after the issuance of this ETS CPL, OSHA expects to issue a revised NEP, pursuant
to the ETS, and which will remain in effect for one year unless canceled or extended by a
superseding directive. Under the NEP, OSHA is prioritizing COVID-19-related
inspections involving deaths or multiple hospitalizations due to occupational exposures to
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COVID-19. This NEP includes the added focus of ensuring that workers are protected
from retaliation.
The Presidential Order also directed OSHA to consider issuing an ETS for COVID-19.
OSHA considered and determined that healthcare workers face a grave danger from
COVID-19 and the requirements of the ETS were necessary to protect these workers.
The ETS was issued on June 21, 2021. This directive provides instructions and guidance
to Area Offices and compliance safety and health officers (CSHOs) for enforcing the
COVID-19 ETS.
IX. Inspection Procedures.

A. Scope and Application.
The ETS establishes new requirements to protect healthcare and healthcare
support workers across the nation from COVID-19.
With some exceptions, the Healthcare COVID-19 ETS, 29 CFR § 1910.502,

applies to all settings where any employee provides healthcare services or
healthcare support services.
29 CFR § 1910.502 does not apply to the following tasks and locations:
1. the provision of first aid by an employee who is not a licensed healthcare
provider;
2. the dispensing of prescriptions by pharmacists in retail settings;
3. non-hospital ambulatory care settings where all non-employees are
screened prior to entry and people with suspected or confirmed COVID-19
are not permitted to enter those settings;
4. well-defined hospital ambulatory care settings where all employees are
fully vaccinated and all non-employees are screened prior to entry and
people with suspected or confirmed COVID-19 are not permitted to enter
those settings;
5. home healthcare settings where all employees are fully vaccinated and all
non-employees are screened prior to entry and people with suspected or
confirmed COVID-19 are not present;
6. healthcare support services not performed in a healthcare setting where
direct patient care occurs (e.g., off-site laundry, off-site medical billing);
or
7. telehealth services performed outside of a setting where direct patient care
occurs.
The applicability of 29 CFR § 1910.502 is also limited in the following situations:
1. Where a healthcare setting is embedded within a non-healthcare setting
(e.g., medical clinic in a manufacturing facility, walk-in clinic in a retail
setting), this section applies only to the embedded healthcare setting and
not to the remainder of the physical location.
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2. Where emergency responders or other licensed health care providers enter
a non-healthcare setting to provide health care services, this section
applies only to the provision of the healthcare services by those
emergency responders or other health care providers. For example, if an
unvaccinated nurse provides in-home healthcare while an electrician
happens to be working separately in the house, the ETS applies to the
nurse’s activities but not those of the electrician.
3. In well-defined areas where there is no reasonable expectation that any
person with suspected or confirmed COVID-19 will be present,
paragraphs (f), (h), and (i) of this section do not apply to employees who
are fully vaccinated.
Notes to paragraphs (a)(2)(iv) and (a)(2)(v):
1. OSHA does not intend to preclude employers of employees who are
unable to be vaccinated from falling within the scope exemption in
paragraphs (a)(2)(iv) and (a)(2)(v). Under anti-discrimination laws,
workers who cannot be vaccinated because of medical conditions, such as
allergies to vaccine ingredients, or certain religious beliefs, may ask for a
reasonable accommodation from their employer. Accordingly, where an
employer reasonably accommodates an employee who is unable to be
vaccinated in a manner that does not expose the employee to COVID-19
hazards (e.g., telework, working in isolation), that employer may be within
the scope exemption in paragraphs (a)(2)(iv) and (a)(2)(v).
2. Nothing in these sections is intended to limit state or local government
mandates or guidance (e.g., executive order, health department order) that
go beyond the requirements of and are not inconsistent with these sections.
3. Employers exempted under paragraph (a) of the ETS are encouraged to
follow public health guidance from the Centers for Disease Control and
Prevention (CDC) even when not required by this section.
4. 29 CFR § 1910.502(l)(5)(iii) – (l)(5)(iv) and (q)(2)-(q)(3) do not apply
where the employer has 10 or fewer employees on the effective date of the
ETS. Although the number of employees may change after the effective
date of the ETS, the number of employees on the effective date determines
the employer’s compliance obligations for the duration of the ETS.
The size of the employer is based on the total number of employees for the
company nationwide and not per establishment. All individuals who are
“employees” under the OSH Act are counted in the total; the count
includes all full-time, part-time, temporary, and seasonal employees. For
businesses that are sole proprietorships or partnerships, the owners and
partners would not be considered employees and would not be
counted. Other individuals who are not considered to be employees under
the OSH Act are uncompensated volunteers, except for those working in a
federal agency (see 29 CFR 1975.4(b)(2), and 66 Fed. Reg. 5916, 6038).
5. The Mini Respiratory Protection Program, 29 CFR § 1910.504, applies
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only to respirator use in accordance with § 1910.502(f)(4)(i) and (ii). See
corresponding sections in this Direction.
6. The ETS includes provisions to ensure employees are aware of their rights
under the standard, and that they are protected from retaliation for
exercising those rights.
B. Definitions.
Some terms used in the preamble and regulatory text of the respective standard
are presented below.
1. Aerosol-generating procedure means a medical procedure that generates
aerosols that can be infectious and are of respirable size. For the purposes
of this section, only the following medical procedures are considered
aerosol-generating procedures: open suctioning of airways; sputum
induction; cardiopulmonary resuscitation; endotracheal intubation and
extubation; non-invasive ventilation (e.g., BiPAP, CPAP); bronchoscopy;
manual ventilation; and medical/surgical/postmortem procedures using
oscillating bone saws; and dental procedures involving: ultrasonic scalers;
high-speed dental hand-pieces; air/water syringes; air polishing; and air
abrasion.
2. Airborne infection isolation room (AIIR) means a dedicated negative
pressure patient-care room, with special air handling capability, which is
used to isolate persons with a suspected or confirmed airborne-
transmissible infectious disease. AIIRs include both permanent rooms and
temporary structures (e.g., a booth, tent or other enclosure designed to
operate under negative pressure).
3. Ambulatory care means healthcare services performed on an outpatient
basis, without admission to a hospital or other facility. These services are
provided in settings such as: offices of physicians and other health care
professionals; hospital outpatient departments; ambulatory surgical
centers; specialty clinics or centers (e.g., dialysis, infusion, medical
imaging); and urgent care clinics. Ambulatory care does not include home
healthcare settings for the purposes of this section.
4. Clean/cleaning means the removal of dirt and impurities, including germs,
from surfaces using soap and water or other cleaning agents. Cleaning
reduces germs on surfaces by removing contaminants and may also
weaken or damage some of the virus particles, which decreases risk of
infection from surfaces.
5. Close contact means being within 6 feet of any other person for a
cumulative total of 15 minutes or more over a 24-hour period during that
person’s potential period of transmission. The potential transmission
period starts 2 days before the person feels sick (or, for asymptomatic
people, 2 days prior to test specimen collection) until the time the person
is isolated.
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6. Common areas means indoor or outdoor locations under the control of the
employer that more than one person may use or where people congregate
(e.g., building lobbies, reception areas, waiting rooms, restrooms, break
rooms, eating areas, conference rooms).
7. COVID-19 (Coronavirus Disease 2019) means the respiratory disease
caused by SARS-CoV-2 (severe acute respiratory syndrome coronavirus
2). For clarity and ease of reference, this section refers to “COVID-19”
when describing exposures or potential exposures to SARS-CoV-2.
8. COVID-19 positive and confirmed COVID-19 refer to a person who has a
confirmed positive test for, or who has been diagnosed by a licensed
healthcare provider with, COVID-19.
9. COVID-19 symptoms mean the following: fever or chills; cough; shortness
of breath or difficulty breathing; fatigue; muscle or body aches; headache;
new loss of taste or smell; sore throat; congestion or runny nose; nausea or
vomiting; diarrhea.
10. COVID-19 test means a test for SARS-CoV-2 that is cleared or approved
by the U.S. Food and Drug Administration (FDA) or is authorized by
Emergency Use Authorization (EUA) or Notification from the FDA to
diagnose current infection with the SARS-CoV-2 virus; and administered
in accordance with the FDA clearance or approval or the FDA EUA as
applicable.
11. Direct patient care means hands on, face-to-face contact with patients for
the purpose of diagnosis, treatment, and monitoring.
12. Disinfect/disinfection means using an EPA-registered disinfectant on
EPA’s “List N,” (incorporated by reference, 29 CFR § 1910.509), in
accordance with manufacturers’ instructions to kill germs on surfaces.
13. Facemask means a surgical, medical procedure, dental, or isolation mask
that is FDA cleared, authorized by an FDA Emergency Use Authorization
(EUA), or otherwise offered or distributed as described in an FDA
enforcement policy. Facemasks may also be referred to as “medical
procedure masks.”
14. Fully vaccinated means 2 weeks or more following the final dose of a
COVID-19 vaccine.
15. Hand hygiene means the cleaning and/or disinfecting of one’s hands by
using standard handwashing methods with soap and running water or an
alcohol-based hand rub that is at least 60% alcohol.
16. Healthcare services mean services that are provided to individuals by
professional healthcare practitioners (e.g., doctors, nurses, emergency
medical personnel, oral health professionals) for the purpose of promoting,
maintaining, monitoring, or restoring health. Healthcare services are
delivered through various means including: hospitalization, long-term
care, ambulatory care (e.g., treatment in physicians’ offices, dentists’
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offices, medical clinics), home health and hospice care, emergency
medical response, and patient transport. For the purposes of this section,
healthcare services include autopsies.
17. Healthcare support services mean services that facilitate the provision of
healthcare services. Healthcare support services include patient
intake/admittance, patient food services, equipment and facility
maintenance, housekeeping services, healthcare laundry services, medical
waste handling services, and medical equipment cleaning/reprocessing
services.
18. High-touch surfaces and equipment means any surface or piece of
equipment that is repeatedly touched by more than one person (e.g.,
doorknobs, light switches, countertops, handles, desks, tables, phones,
keyboards, tools, toilets, faucets, sinks, credit card terminals, touch-screen
enabled devices).
19. Physical location means a site (including outdoor and indoor areas, a
structure, or a group of structures) or an area within a site where work or
any work-related activity (e.g., taking breaks, going to the restroom,
eating, entering, or exiting work) occurs. A physical location includes the
entirety of any space associated with the site (e.g., workstations, hallways,
stairwells, breakrooms, bathrooms, elevators) and any other space that an
employee might occupy in arriving, working, or leaving.
20. Respirator means a type of personal protective equipment that is certified
by the National Institute for Occupational Safety and Health (NIOSH)
under 42 CFR part 84 or is authorized under an Emergency Use
Authorization (EUA) by the FDA. Respirators protect against airborne
hazards by removing specific air contaminants from the ambient
(surrounding) air or by supplying breathable air from a safe source.
Common types of respirators include filtering facepiece respirators,
elastomeric respirators, and powered air-purifying respirators (PAPRs).
Face coverings, facemasks, and face shields are not respirators.
21. Screen means asking questions to determine whether a person is COVID-
19 positive or has symptoms of COVID-19.
22. Surgical mask means a mask that covers the user’s nose and mouth and
provides a physical barrier to fluids and particulate materials. The mask
meets certain fluid barrier protection standards and Class I or Class II
flammability tests. Surgical masks are generally regulated by FDA as
Class II devices under 21 CFR § 878.4040 – Surgical apparel.
23. Vaccine means a biological product authorized or licensed by the FDA to
prevent or provide protection against COVID-19, whether the substance is
administered through a single dose, or a series of doses.
C. General Inspection Procedures.
1. Inspection procedures in FOM Chapter 3 shall be followed, except as
modified in this Direction. CSHOs should also consult other OSHA
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directives, e.g., National Emphasis Program – Coronavirus Disease 2019
(COVID-19) (or successor directive); OSHA Field Safety and Health
Manual, ADM 04-00-003; and other interim guidance, unless superseded,
such as the Updated Interim Enforcement Response Plan for COVID-19,
and references cited in this Direction for further guidance. Inspections
shall be conducted using either on-site or a combination of on-site and
remote methods, except under circumstances where an on-site inspection
cannot be conducted safely. In such cases, Area Offices will document the
unsafe condition(s) preventing an on-site inspection and with Area
Director (AD) approval, an alternate inspection process may be used so
that the inspection can be done safely within the context of the situation.
2. Inspection Scheduling. In most cases, in accordance with the FOM, the

highest inspection priority should be given to fatality inspections, and then
to other unprogrammed inspections (i.e., complaints and referrals) alleging
employee exposure to COVID-19 related hazards. Programmed
inspections are to be conducted as described in the COVID-19 NEP. Area
Offices may schedule follow-up inspections related to COVID-19 hazards
that contribute to meeting the goals of the NEP.
a. Expansion of inspections to areas involving occupational

exposures to SARS-CoV-2 should be performed when
information/evidence gathered or plain-view observations indicate
deficiencies complying with OSHA requirements set forth in 29
CFR § 1910.502 and 29 CFR § 1910.504.
3. Opening Conference. CSHOs shall request to speak to the employer’s

representative or safety director, COVID-19 safety coordinator(s),
infection control director, and other persons responsible for implementing
COVID-19 protections or occupational health hazard control. Other
individuals responsible for providing records pertinent to the inspection
should also be included in the opening conference or interviewed early in
the inspection (e.g., facility administrator, training director, facilities
engineer, director of nursing, human resources). Also, designated
employee representatives and union officials, may participate in the
opening conference and may accompany CSHOs during the inspection
(see also, FOM, Chapter 3, describing CSHO authority to ensure fair and
orderly inspections).
4. CSHO Safety. Inspections shall be conducted in a manner that ensures the

CSHO’s safety, especially CSHOs not protected by vaccination, and that
of all personnel with whom they come in close contact. This includes
instituting all appropriate precautions for physical distancing, PPE use,
and hygiene. When on site, CSHOs must take other necessary
precautions, such as requesting to conduct opening conferences in a
designated, uncontaminated administrative area or outdoors, while always
wearing at least a N95 Filtering Facepiece Respirator, in accordance with
10
the most recent Updated Interim Enforcement Response Plan for COVID-
19 (and any Regional policies) and other necessary PPE (e.g., gloves, eye
protection). Note that OSHA’s internal policies relative to CSHO
protections during inspections may be updated based on current CDC
guidance and COVID-19 vaccination status. See also, Section XIV,
Protection of OSHA Personnel of this Direction, for more information.
5. If an inspection is conducted under the COVID-19 NEP, the CSHO shall
initially verify the correct North American Industrial Classification
System (NAICS) code for the establishment with the employer and
determine whether work practices conducted at the facility or worksite are
exempted under the standard.
Verifying exemptions under 29 CFR § 1910.502(a):
a. Determine if any of the exemptions outlined in sections 29 CFR §
1910.502(a) apply to the whole facility or to well-defined portions
thereof. A well-defined portion of the facility could be an entire
department (e.g., radiology unit) or a section of a building (e.g.,
room, floor, wing). An employer whose workforce is fully
vaccinated with no reasonable expectation that any person with
suspected or confirmed COVID-19 will be permitted entry does
not have to comply with paragraphs (f), (h) and (i) of 29 CFR §
1910.502. CSHOs may verify the employer’s assertions by
interviewing employee(s) at the site regarding their vaccination
status. If available, CSHOs may also request documentation that
further supports the employees’ vaccination status. A previously
exempt area should be re-evaluated upon hiring of any new,
unvaccinated employees.
NOTE: Where the only employees who are not vaccinated cannot
be vaccinated because of medical conditions or certain religious
beliefs, the employer may still be (partially) exempt from the
requirements of the standard if they provide reasonable
accommodations. The reasonable accommodation must be
accomplished in such a manner that does not expose unvaccinated
employees to COVID-19 hazards: e.g., through telework, solitary
work, or implementation of controls only in an area exclusively
dedicated to unvaccinated employees.
b. CSHOs should request the establishment’s Injury and Illness Logs
(OSHA 300, 301 and OSHA 300A) for calendar years 2020 and
2021 to identify work-related cases of COVID-19. Document
whether any such cases were entered on the log. CSHOs should
also request the COVID-19 log and inquire whether employees are
aware of any recent COVID-19 cases among fellow employees.
c. In cases involving programmed COVID-19 NEP inspections, and
CSHOs verify that the employer is exempt from the standard based
on any of the provisions in section 29 CFR § 1910.502(a)(2); (a)(3)
11
and (a)(4), and where there is an absence of recent or active work-
related COVID-19 infections, CSHOs should document such
findings, discontinue the inspection and exit the facility. The
inspection shall be marked NO INSPECTION. However, pursuant
to the COVID-19 NEP, if the inspection was initiated by an
unprogrammed or follow-up activity, or the establishment is
targeted under another NEP, or the Site-Specific Targeting (SST)
Program, and/or a local or regional emphasis program, then the
CSHO should proceed with the inspection in order to address any
additional hazards alleged or those covered by another emphasis
program.
NOTE: The exemptions and limited exceptions outlined in the ETS
section (a), Scope and Application, do not apply if the
establishment is not fully compliant with the terms of the particular
exemption or exception (e.g., a non-hospital ambulatory care
setting that screens but permits entry to suspected or confirmed
COVID-19 visitors, patients, or residents is covered by the ETS.)
In such cases, an employer may be cited for any deficiencies under
this standard.
6. Program and Document Review. All COVID-19-related inspections
should include a review of the employer's COVID-19 plan and related
documents, and interviews with employers and employees. CSHOs
should make the following assessments:
a. Determine whether the employer has a written COVID-19 plan (or

elements thereof) which may be part of a safety and health plan
that includes contingency planning for emergencies and natural
disasters. For example, in healthcare, the employer should already
have a pandemic plan, as recommended by the CDC. 1 If the
0F
COVID-19 plan is a part of another emergency preparedness plan,

conduct a limited review of sections related to SARS-CoV-2
exposure(s).
b. Review evidence or documentation that a hazard assessment was

conducted.
c. Determine whether the employer has established administrative

and engineering control measures to facilitate physical distancing
(e.g., barriers or administrative measures to encourage 6-foot
distancing).
d. Review information such as medical records related to worker

exposure incident(s), OSHA-required recordkeeping, and any other
pertinent information or documentation deemed appropriate by the
1
For hospitals, see www.cdc.gov/coronavirus/2019-ncov/hcp/hcp-hospital-checklist.
12
CSHO. This includes gathering documentation on COVID-19-
related fatalities, employees who have contracted COVID-19, have
been hospitalized, or have been placed on precautionary
removal/isolation as a result of work-related exposure to SARS-
CoV-2.
e. For assistance with accessing medical records, CSHOs are

encouraged to use the online Medical Access Order (MAO)
Request Application or contact the Office of Occupational
Medicine and Nursing (OOMN) in the National Office. Area and
Regional Offices in need of an OOMN consultation are
encouraged to use the online OOMN consultation request form.
Consider issuing a subpoena duces tecum for medical records to
compel production of the records by employers, as necessary.
f. Review the respiratory protection program and any modified

respirator policies related to COVID-19 (e.g., policies modified to
accommodate use of respirators authorized by an EUA from the
FDA for healthcare employers) and assess compliance with 29
CFR § 1910.504 and 29 CFR § 1910.134 where applicable.
g. Review employee training records, including any records or

instructional materials related to SARS-CoV-2 exposure
prevention or in preparation for a pandemic, if available.
h. Review any documented efforts made by the employer to obtain

and provide appropriate and adequate supplies of PPE.
i. Review documentation of maintenance and use of engineering

controls such as HVAC systems and AIIRs according to
manufacturers’ instructions, where appropriate.
j. Where appropriate, determine if the facility has airborne infection

isolation rooms/areas (AIIRs), and gather information about the
employer’s use of air pressure monitoring systems and any
periodic testing procedures.
k. Review any procedures for assigning patients to AIIRs and
procedures used to limit AIIR access to employees who are trained
and adequately outfitted with PPE. See also Section IX.L on
ventilation requirements.
l. Review procedures for accepting COVID-19 patients transferring
from other facilities.
m. Establish the numbers and placements, i.e., room assignments or
designated area (cohorting) assignments, of confirmed and
suspected COVID-19 patients under isolation at the time of
inspection.
13
n. Establish the pattern or practice of placements for confirmed and
suspected COVID-19 patients.
7. Walkaround.
a. CSHOs, in consultation with supervisors or ADs where needed,
should determine which areas of a facility will be inspected (e.g.,
emergency rooms, hospital morgue, respiratory therapy areas,
bronchoscopy suites, locker rooms, break rooms, time clocks).
b. CSHOs should not enter occupied patient rooms or treatment areas
during high-hazard procedures. CSHOs, ADs and AADs should
evaluate and determine the need to enter an occupied patient room.
Photographs or videotaping where practical should be used for
case documentation, such as recording smoke-tube testing of air
flows inside or outside AIIR. However, under no circumstances
shall CSHOs photograph or take video of patients, and CSHOs
must take all necessary precautions to assure and protect patient
confidentiality. Throughout their inspection of facilities treating
COVID-19 patients, CSHOs should avoid interfering with the any
ongoing medical services.
D. COVID-19 Plan.
29 CFR § 1910.502(c) establishes the requirements for a COVID-19 plan. Where
there are more than 10 employees on the effective date of the ETS, the plan must
be in writing. These requirements are applicable to all covered entities.
1. Inspection Guidance.
a. Written COVID-19 Plan: CSHOs must request and review the
employer's written COVID-19 plan to determine that it includes
each of the required elements in paragraphs (c) 1-7. If the
employer has multiple facilities with substantially similar
operations, its COVID-19 plan may be developed by facility type
rather than by individual workplace so long as all required site-
specific information is included in the plan. Employers may also
develop a single comprehensive plan in instances where employees
are performing the same task(s) at different facilities as long as any
required site-specific information is included.
b. In order for an employer to be exempt from providing controls
(e.g., facemasks, physical distancing, physical barriers) in a well-
defined area of the workplace on the basis that employees are fully
vaccinated, the employer must have policies and procedures in its
COVID-19 plan to determine employees’ vaccination status.
These policies and procedures may exist independently of any
formal written COVID-19 response; may be part of an HR (Human
Resources) portfolio; and may be accomplished in multiple ways,
including, but not limited to, a verbal instruction to employees; a
staff meeting discussing vaccination; a written staff memo or a
14
formal change to conditions of employment. CSHOs should verify
the existence and effectiveness of these procedures for determining
vaccination status by reviewing relevant proof or records, if
available, or through interviews of employer and employees
representatives.
c. If it is not possible to physically define or delineate a dedicated
area where all employees are vaccinated, then the employer is
required to implement all elements of the COVID-19 plan. See
Section IX.C.6, Verifying exemptions under 29 CFR §
1910.502(a), for further information on verification of exemptions.
d. Employers have latitude in how they determine vaccination status.
They may choose to verbally ask the employee and document the
status, may keep photocopies of the vaccination card or may
request that the employee provide other evidence of vaccination
such as a letter from a physician or vaccination provider (e.g.,
retail pharmacy). Depending on the nature of the evidence
maintained by the employer (e.g., photocopies of vaccination
cards), CSHOs may need a Medical Access Order (MAO) to verify
vaccination status.
e. CSHOs should interview a sufficient number of affected
employees on multiple shifts (where applicable) as part of the
overall assessment of the employer’s COVID-19 plan and, in cases
where an employer makes an exemption claim, to verify that the
employer assessed the vaccination status of the affected workforce.
As defined in the standard, “Fully vaccinated” means 2 weeks or
more following the final dose of a COVID-19 vaccine. CSHOs
should inquire about each element of the program and document
the employee’s answers to determine whether the employer’s
COVID-19 plan follows the prescribed guidelines.
f. COVID-19 Safety Coordinator(s): CSHOs should inquire if
employers designated one or more COVID-19 safety coordinators
to implement, monitor, and report on the COVID-19 plan
developed under this section. CSHOs should review the written
COVID-19 plan (where required) to ensure that the safety
coordinator(s) is identified in writing and has the authority to
ensure compliance with all aspects of the COVID-19 plan
including to implement and update the plan as needed. The CSHO
should interview the COVID-19 safety coordinator(s) regarding
their professional knowledge and background in infection control
principles and practices applied to the workplace and employee job
operations. This facilitates in determining if they are qualified
through training, education, work experience or a combination
thereof. Management of the COVID-19 plan may be performed by
a team of infection control personnel.
15
g. Employee input: CSHOs should determine through private
interviews if non-managerial employees and their representatives if
any, had input into the hazard assessment and plan’s development,
whether the plan was provided to employees for input and whether
a mechanism for feedback and continuous improvement exists.
h. CSHOs must make a determination whether the COVID-19 plan
contains adequate workplace-specific policies and procedures to
address potential workplace hazards related to COVID-19 at the
worksite being inspected.
i. Monitoring and updating: CSHOs should establish, through
employee interviews, the means by which the employer ensures the
continued effectiveness of its plan, and how quickly corrective
actions are taken if/when necessary. The standard does not define
the frequency with which to update the COVID-19 plan. However,
the workplace must be monitored and, as needed, updates must be
made to ensure continued effectiveness of the COVID-19 plan. At
a minimum, updates may be necessary when changes in tasks or
processes create new or previously unidentified exposures or the
vaccination status (including any possible booster shots
recommended by the CDC) of the affected workforce changes.
Through interviews, document review, and walkaround
observations, CSHOs should determine whether there are any
unaddressed hazards not covered in the COVID-19 plan. CSHOs
should discuss observed deficiencies in the plan with the
employer’s designated COVID-19 safety coordinator(s) to
determine what previous efforts, if any, may have been made to
evaluate the plan and update it.
j. Workplace Specific Hazard Assessment: A workplace-specific
hazard assessment must be conducted. This requirement extends
to the employer’s own employees and to employees of other
employers when multiple employers share the same physical
location. Employers should follow basic and well-known hazard
assessment techniques including:
• Identify potential risks and sources of exposure: Identify worker
categories or job tasks with exposure, and classify the risk of
worker exposure.
• CSHOs should determine whether all reasonably anticipated
workplace hazards related to COVID-19 have been identified.
Exposure risk depends in part on the physical environment of the
workplace, the type of work activity, the health status of the
worker, the ability of workers to wear facemasks and abide by
CDC guidelines, and the need for close contact (within 6 feet for a
total of 15 minutes or more over a 24-hour period) with other
people, including those known to have or suspected of having
16
COVID-19, and those who may be infected with—and able to
spread—SARS-CoV-2 without knowing it.
• The hazard assessment and classification of risk should include all
of the employees’ duties in the workplace, such as: patient-facing
tasks; the need to share tools or medical equipment (e.g., radios or
computer terminal); and sharing common areas. In healthcare,
risks are typically associated with direct patient care including but
not limited to patient screening (e.g., at the hospital or clinic
entrance); patient medical care (e.g., in the dedicated COVID-19
ward); the type of care (e.g., assistance with feeding or bathing) or
the type of medical procedures to be performed (e.g., intubation,
bronchoscopy); etc. See also www.osha.gov/coronavirus/hazards.
k. Minimizing Risks: 29 CFR § 1910.502 requires employers to
establish policies and procedures to minimize the risk of
transmission of COVID-19 for each employee through a multi-
layered approach of engineering and administrative controls as
discussed in paragraphs (d) through (n) of the 29 CFR § 1910.502
standard, except where this section does not apply under
paragraphs (a)(2)-(a)(4) of the standard. The plan does not need to
address each employee individually; it may address employees
generally.
• CSHOs should determine whether employers rely on use of face
masks by affected employees as the only protective measure or if
employees are protected from exposure to COVID-19 through
additional engineering control measures including physical
distancing and physical barriers.
l. Communication with other employers: CSHOs should determine
whether the COVID-19 plan includes policies and procedures on
how to effectively communicate and coordinate with other on-site
employers or contractors. This requirement may be accomplished
through a combination of formal or informal procedures. For
example, employers may use pre-planned meetings with document
exchanges; a joint agreement to a common set of rules and work
practices; contractual obligations; coordination of schedules / tasks
to minimize personnel overlap and maximize physical distancing;
erecting permanent or temporary barriers to restrict access, etc.
The plan must also include a mechanism for notifications between
employers on multi-employer sites whenever any employees of
any employer are exposed to conditions that do not meet the
requirements of the standard. (See also Section XI. of the
Bloodborne Pathogens Directive for more information on multiple
employer scenarios in healthcare).
• CSHOs should determine whether the COVID-19 plan addresses
the protection of non-vaccinated employees who, in the course of
17
their employment (e.g., home health), enter into private residences
or other physical locations controlled by a person not covered by
the OSH Act (e.g., homeowners, sole proprietors). CSHOs should
assess whether such employees have been trained to recognize
hazards and possible mitigation solutions (e.g., requesting the
homeowner to maintain a 6-foot distance; re-positioning a chair to
create additional distance; requesting that doors be left open to
minimize touching knobs; request opening of windows to increase
ventilation). CSHOs should also determine if employees have
been encouraged to discuss deficiencies with their supervisors and
seek mitigating solutions. In circumstances where COVID-19
protections are insufficient or lacking, the affected employee(s)
must be given the opportunity to withdraw from that location,
without fear of retaliation.
2. Citation Guidance.
a. If the employer has not developed and/or implemented a COVID-
19 plan for each worksite in its jurisdiction, the Area Office should
issue citations for 29 CFR § 1910.502(c)(1). If a facility is lacking
a COVID-19 plan and other requirements of the standard have not
been implemented, those paragraphs should be cited as separate
violations in addition to paragraph (c).
b. If the employer has failed to make the COVID-19 plan either site-
specific (or task-specific), the Area Office may issue a citation for
29 CFR § 1910.502(c)(1).
c. Where the employer has more than 10 employees on the effective
date of the ETS, 29 CFR § 1910.502(c)(1), for lack of a COVID-
19 plan, may be grouped with 29 CFR § 1910.502(c)(2),for lack of
a written plan . These violations should normally be classified as
serious.
d. If the employer has more than 10 employees on the effective date
of the ETS, and if no written COVID-19 plan exists, but all other
provisions of the standard have been met, and it is unlikely that the
deficiency would result in a serious hazard, the Area Office may
consider the lack of the written program to be other-than-serious.
Also, see the general citation guidance.
e. If the employer developed and implemented a site-specific (or
task-specific) COVID-19 plan but the written plan failed to address
one or more of the elements under 29 CFR § 1910.502(c)(3) -
(c)(7), respectively, the Area Office may issue citations for the
specific provisions as appropriate.
Violations for deficiencies or omissions of one or more elements of
the COVID-19 plan should normally be grouped, where
appropriate.
18
For example, in circumstances such as multi-employer worksites,
violations of 29 CFR § 1910.502(c)(4), for failure to identify all
COVID-19-related exposure hazards in the workplace, would
normally be grouped with violations for failure to communicate
and coordinate with other employers, i.e., 29 CFR §
1910.502(c)(7)(ii).
f. If the employer has not designated a COVID-19 safety coordinator
in its plan, the Area Office may consider a citation for 29 CFR §
1910.502(c)(3). If deficiencies in the COVID-19 safety
coordinator(s)’ knowledge and expertise in infection control
practices and principles are established, but all other provisions of
the standard have been met, and it is unlikely that this deficiency
would result in a failure to follow proper practices, the Area Office
should generally not issue any citations for these deficiencies.
g. Violations for deficiencies or omissions in the workplace-specific
hazard assessment which fail to identify workplace hazards,
exposures, job tasks or worker categories may be cited under 29
CFR § 1910.502(c)(4)(i). For failure to include policies and
procedures to determine employee vaccination status in the
COVID-19 plan, the Area Office may issue a citation for 29 CFR §
1910.502(c)(4)(ii).
h. If an employer claims an exemption from the standard based on
workforce vaccination status and if during the course of the
inspection CSHOs document the presence of unvaccinated
employees, the Area Office may issue citations for all deficiencies
found, including the COVID-19 plan and applicable (feasible)
controls.
i. If policies and procedures are included in the written plan but not
implemented, then the specific requirement that has not been
implemented should be cited, per 29 CFR § 1910.502(d)-(n).
E. Patient / Non-employee Screening and Management.
29 CFR § 1910.502(d) requires patient screening and management where direct
patient care (as defined in the standard) is provided. Employers must limit the
number of entrances to the facility, screen patients, residents and non-employees
for symptoms of COVID-19, and follow CDC’s COVID-19 Infection Prevention
and Control Recommendations. These screening and management procedures
must be included in the COVID-19 plan.
a. This paragraph is in addition to health screening for employees
required under paragraph 29 CFR § 1910.502(1)(1). Note: 29 CFR
§ 1910.502(d) does not apply to licensed health care providers and
emergency responders entering a non-healthcare setting or private
residence to provide healthcare services. This paragraph applies to
19
home healthcare unless they meet the exemption in § 29 CFR
1910.502(a)(2)(v).
b. CSHOs should review a copy of the facility’s COVID-19 plan to
ensure screening and management procedures are included.
c. CSHO should document procedures used to limit and monitor
major points of entry (e.g., the main entrance(s) to the building, the
emergency department, the entrance to receptionist, appointment
desk, registration, or check-in, connecting entrances from the
parking garage, receiving areas, and other entrances where non-
employees enter the facility). CSHOs should interview employees
from various entry points (i.e., either in-person or through remote
means) to verify adherence to the procedures.
• Methods to limit entrance to the facility are flexible but may
include posting signs at the door instructing patients with fever,
respiratory symptoms or other symptoms of COVID-19 to return to
their vehicle (or remain outside if they are pedestrians) and call the
telephone number for the healthcare center so that triage can be
performed prior entering.
d. CSHOs should determine how patients, residents or non-employee
visitors are screened and document the findings. CSHOs should
interview management (e.g., the person in charge of infection
control) when making this determination.
e. Review documents used as guidance for determining the screening
procedures implemented. CSHOs should obtain a copy of any
checklist or protocol being used to screen non-employees coming
into the facility.
f. CSHOs should investigate to determine if any group of non-
employees may be excluded from the employer’s screening
program and document that screening is done on all shifts.
• All individuals entering the facility must be screened for COVID-
19 symptoms including clients, patients, residents, delivery people,
and other visitors, and other non-employees.
• Screening methods may be flexible and may include in person or
self-monitoring temperature or health surveys, upon arrival.
Screening policies could include requiring hand hygiene at
screening stations and mandatory use of source control (such as
face coverings) in accordance with CDC’s Infection Prevention
and Control Recommendations (See also bullet h, below ) if in-
person screening is performed. Screening may also include an
electronic monitoring system that require non-employees self-
report symptoms or exposures (e.g., absence of fever and
symptoms of COVID-19, absence of a diagnosis of SARS-CoV-2
infection in the prior 10 days, and confirm they have not been
20
exposed to others with SARS-CoV-2 infection during the prior 14
days), prior to arrival at the facility.
g. In addition to screening, paragraph 29 CFR § 1910.502(d)(2)
requires triage of any individual who may be experiencing
COVID-19 symptoms. CSHOs should inquire about any existing
triage protocols and decision-making following triage.
• Triage enables the facility to make decisions about access
restriction, isolation, and/or referral of symptomatic persons for
further medical evaluations, testing or treatment. Triage also
assures more effective implementation of the appropriate level of
personal protective equipment and other protections for employees.
Patient segregation in healthcare settings also reduces nosocomial
(healthcare-acquired) infections for employees.
h. CSHOs should document patient management strategies including
those listed below. Patient management strategies must be in
accordance with the CDC’s COVID-19 Interim Infection
Prevention and Control Recommendations for Healthcare
Personnel During the Coronavirus Disease 2019 (COVID-19)
Pandemic, dated February 23, 2021, at
https://www.osha.gov/sites/default/files/CDC's_COVID-
19_Infection_Prevention_and_Control_Recommendations.pdf,
which has been incorporated by reference in 29 CFR § 1910.509,
and may include:
• Advising patients that they should put on their own well-fitting
form of source control before entering the facility and taking steps
to ensure that everyone adheres to source control measures (see
www.cdc.gov/coronavirus/2019-ncov/hcp/infection-control-
recommendations.html#source-control) and hand hygiene practices
while in a healthcare facility.
• Screening and then isolating patients showing symptoms of
COVID-19 in an examination room with the door closed to prevent
close contact with healthcare workers who are not providing direct
care to that patient; designating a well-ventilated space as a waiting
area to allow waiting patients and waiting room employees to
separate by 6 or more feet, with easy access to respiratory hygiene
supplies (e.g., tissues and trash cans);
• For inpatient or residential care of a COVID-19 positive or
suspected COVID-19 patients, placing the patient in a single-
patient room, if available, or, where single-patient rooms are not
available, cohort patients with COVID-19 to prevent close contact
with healthcare workers who are not providing direct patient care
to those COVID-19 patients.
21
NOTE: The standard encourages employers to use telehealth as a
means to limit the number of people in the facility. Telemedicine
or Telehealth is the use of electronic information and
telecommunication technology to get the health care needed while
practicing physical distancing. This often involves a phone or a
device with internet capabilities. While telehealth minimizes the
risk of transmission for healthcare personnel and patients, it also
can reduce the strain on personal protective equipment supplies. If
the employer needs assistance with telehealth, CSHOs should
direct them to the CDC website: www.cdc.gov/coronavirus/2019-
ncov/hcp/guidance-hcf.
a. If CSHOs find deficiencies in any portion of paragraph 29 CFR §
1910.502(d) (except for telehealth), cite the applicable provision in
paragraph 29 CFR § 1910.502(d).
NOTE: The telehealth recommendation is an optional portion of
the standard and thus cannot be cited. However, it may be a form
of abatement for a citation of 29 CFR § 1910.502(d)(2) if the
employer is not adequately managing patients to minimize risk of
transmission to employees.
b. If the employer did not include patient screening and management
in the written COVID-19 plan, the Area Office may cite for that
deficiency and group this citation with specific deficiencies of this
paragraph if patient screening and/or management was not
provided.
c. If employees with direct patient care responsibilities are not trained
on patient screening and management, 29 CFR §
1910.502(n)(1)(ii) should be cited.
F. Standard and Transmission-Based Precautions.
29 CFR § 1910.502(e) establishes the requirements for employers to develop and
implement policies and procedures for Standard and Transmission-Based
Precautions.
a. In accordance with 29 CFR § 1910.502(e)(1), employers in
settings where healthcare services or healthcare support services
are provided, must develop and implement policies and procedures
to adhere to Standard and Transmission-Based Precautions in
accordance with “CDC's Guidelines for Isolation Precautions,”
dated 2007, which is incorporated by reference as specified in 29
CFR § 1910.509.
• Each Area Office should ensure that CSHOs are familiar with the
above referenced guidelines prior to conducting inspections.
22
b. CSHOs should request the transmission-based policies and
procedures and conduct interviews with the designated employer
representative(s). Conduct employee interviews to determine
whether the employer has developed and implemented these
policies and procedures. Document whether or not the employer
has developed and implemented the policies and procedures.
If CSHOs determine that the policies and procedures required by 29 CFR
§ 1910.502(e) have not been developed or implemented, the Area Office
may consider issuing a citation for 29 CFR § 1910.502(e).
G. Personal Protective Equipment.
29 CFR § 1910.502(f) establishes the requirements for healthcare employers to
provide and ensure the use of PPE, such as facemasks, goggles, gowns in
accordance with Subpart I. This section also covers respiratory protection
requirements and the applicability of 29 CFR § 1910.134.
29 CFR § 1910.502(f)(1) requires a sufficient number of facemasks meeting the
standard’s definitions to be provided and worn by each employee over the nose
and mouth when indoors, and when riding in a vehicle with another person for
work purposes. Employers may permit employees to wear their own facemasks
as long as they meet the same specifications.
The employer may provide or allow employees to provide their own respirators in
lieu of using facemasks. Where respirators are used in lieu of required facemasks,
29 CFR § 1910.504 will apply.
a. CSHOs should determine whether the use of facemasks is required
under the standard, i.e., where healthcare employees work indoors
around other individuals, or ride in a vehicle with another person
for work purposes. This does not include commuting.
NOTE: Paragraph 29 CFR § 1910.502(f)(3)(1)(iii) allows
exceptions to the required use of facemasks in the following
circumstances: (A) where a worker is alone in a room; (B) where
employees are eating and are separated at least 6 feet apart or with
barriers; (C) where workers wear respirators; (D) when masks
impede communication (e.g., communication with deaf or hearing
impaired persons); (E) when employees have medical
contraindications; or (F) when the mask creates a greater hazard.
Where feasible, alternative measures such as use of a clear face
shield must be used where these exceptions exist. However, for
the exceptions D-F, if other infection control concerns exist that
limit an employer’s ability to implement use of a clear face shield
as an alternative to facemasks, other alternative options such as
PAPRs should be considered and provided.
23
b. CSHOs should consider requesting the employer to provide a
sample facemask for examination. CSHOs should refer to product
labeling for evidence of the type(s) of facemasks in use at the
facility along with the brand, model number(s), size, and any
notable approval language. Purchase invoices or unopened
inventory (boxes) of the product may also satisfy this requirement.
c. Where employers are allowing employees to use their own
facemasks, CSHOs should ensure that they meet the required
specifications. Note that employers are not required to reimburse
for employee-provided facemasks. However, CSHOs should
determine if and how the employer ensured that employee-
provided facemasks are compliant with the requirements.
d. CSHOs should observe facemask positioning during the walk
around portion of the inspection noting any instances of
improperly positioned facemasks.
e. Where facemasks are provided/used, CSHOs should determine if
the employer is ensuring that employees change facemasks at least
daily and whether the employer replaces them if soiled or
damaged. In workplaces where facemasks may become wet,
soiled or damaged and require replacement more frequently,
employers may provide face shields to be worn over facemasks to
reduce the frequency of changes throughout the workday.
f. Where the employer requires the use of face shields, CSHOs
should determine if face shields are cleaned at least daily and are
not damaged, with cracks or voids.
g. CSHOs should evaluate the use of respirators to assure they are
used in accordance with 29 CFR § 1910.134 and other PPE (e.g.,
gloves, isolation gowns or protective clothing, eye protection), to
assure it is used in accordance with Subpart I, when employees are
exposed to a suspected or known COVID-19 positive person as
required by 29 CFR § 1910.502(f)(2).
• If document(s) and/or interview(s) provide evidence that
employees are not protected in accordance with the standard while
exposed to suspected or known COVID-19 positive individuals,
CSHOs should note the finding(s) and gather evidence regarding
specific task description(s), frequency, and duration.
h. CSHOs should evaluate whether the protective equipment required
by 29 CFR § 1910.502(f)(3) (respirator, gloves, isolation gown or
protective clothing, and eye protection) are provided and used for
aerosol-generating procedures.
• When aerosol-generating procedures are performed on a patient
who is suspected or confirmed to be COVID-19 positive, the
employer must provide respiratory protective equipment in
24
accordance with 29 CFR § 1910.134.
NOTE: Refer to 29 CFR § 1910.502(g) for additional requirements
during aerosol-generating procedures.
i. 29 CFR § 1910.502(f)(4) allows the employer to provide a
respirator (or permit the employee to provide his/her own) instead
of a facemask for conditions covered under in 29 CFR §
1910.502(f)(1)(i) or 29 CFR § 1910.502(f)(1)(ii). However, the
employer must follow requirements for a Mini-Respiratory
Protection Program found in 29 CFR § 1910.504.
j. 29 CFR § 1910.502(f)(5) requires that employers provide
respirators and PPE for Standard and Transmission-Based
Precautions in accordance with CDC’s guidelines for Isolation
Precautions and Subpart I.
NOTE 1: Facemask, as defined in paragraph (b) of the standard, is a term used by
OSHA and is not synonymous with the same term when used by the FDA. It is
important to note the differences when verifying the supplied facemask is cleared
or authorized by an FDA EUA for use in accordance with paragraph (b) of this
section. OSHA refers to these cleared or authorized surgical masks as facemasks.
See also www.fda.gov/medical-devices/coronavirus-covid-19-and-medical-
devices/face-masks-including-surgical-masks-and-respirators-covid-19.
NOTE 2: The term “suspected,” for purposes of this standard, follows CDC’s
Interim Infection Prevention and Control Recommendations for Healthcare
Personnel During the Coronavirus Disease 2019 (COVID-19) Pandemic:
www.cdc.gov/coronavirus/2019-ncov/hcp/infection-control-recommendations.
a. A serious violation may be considered when evidence supports
deficiencies associated with any 29 CFR § 1910.502(f)(1)
subparagraphs and may be grouped. For example:
• When facemasks are required, if employer-provided facemasks (or
ones permitted employees to optionally provide their own) do not
meet the required specifications, a citation for 29 CFR §
1910.502(f)(1) should be issued.
• Where reusable facemasks are provided by the employer, if
CSHOs determine that employees are unable to obtain clean units
at least daily, and replacements if their current units get soiled or
damaged, and replacements at the frequency specified by the
manufacturer, the Area Office may issue a citation for 29 CFR §
1910.502(f)(1)(ii).
b. The Area Office may cite 29 CFR § 1910.502(f)(2)(i) when
respirator(s) are not provided when employees are exposed to
suspected or confirmed COVID-19 people. In situations where
respirators are not used in accordance with 29 CFR § 1910.134, the
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Area Office may group 29 CFR § 1910.502(f)(2)(i) with the
applicable 29 CFR § 1910.134 paragraph(s).
c. When employee exposures to suspected or confirmed COVID-19
individuals are documented and the employer fails to provide PPE
such as gloves, isolation gowns or protective clothing and/or eye
protection the Area Offices may cite 29 CFR § 1910.502(f)(2)(ii).
If employees are provided personal protective equipment, but the
personal protective equipment is not used or maintained in
accordance with 29 CFR § 1910 Subpart I, the Area Office may
cite 29 CFR § 1910.502(f)(2)(ii) and group the respective Subpart I
paragraph.
d. In accordance with 29 CFR § 1910.502(f)(4), where respirators are
not required but the employer provides or allows employees to
provide their own respirators instead of required facemasks, the
employer must comply with 29 CFR § 1910.504. In most
situations where an employer does not permit an employee to use
their own respirators in lieu of facemasks, violations of 29 CFR §
1910.502(f)(4)(ii) would result in an other-than-serious violation
(i.e., where employees are provided with and use facemasks.) The
respective 29 CFR § 1910.504 standards may be cited and grouped
accordingly. Note: While 29 CFR § 1910.504 does not require a
separate written respirator program, optional use of respirators,
instead of required facemasks must be addressed in the COVID-19
plan.
e. Where respirators and/or other PPE are required by this standard,
the employer’s failure to provide or ensure their use should
normally be classified as serious.
H. Aerosol-Generating Procedures.
29 CFR § 1910.502(g) describes the requirements for limiting personnel, use of
AIIRs, and cleaning/disinfection for aerosol-generating procedures on a person
with suspected or confirmed COVID-19. Aerosol-generating procedures present
a very high-risk for exposure to respiratory infections. Workers in a wide range
of settings, such as emergency responders, healthcare providers, lab technicians,
and mortuary workers, are at risk during aerosol-generating procedures. Aerosol-
generating procedures covered by the scope of the standard, are described 29 CFR
§ 1910.502(b) Definitions.
a. 29 CFR § 1910.502(g)(1): CSHOs should determine whether the
number of personnel present during aerosol-generating procedures
on suspected or confirmed COVID-19 patients is limited such that
only employees essential to patient care and procedure are present.
b. 29 CFR § 1910.502(g)(2): CSHOs should document the
availability of an AIIR during an aerosol-generating procedure.
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The employer must offer justification if an available AIIR is not
used during an aerosol-generating procedure on a suspected or
confirmed COVID-19 patient.
• The Area Office, in coordination with the Regional Office, should
consult the Office of Occupational Medicine and Nursing
(OOMN), as necessary to make determinations about limitations in
medical personnel during aerosol-generating procedures or
appropriate use of AIIRs.
• See additional AIIR guidance found in sections IX.C.7, General
Inspection Procedures, and IX.L, Ventilation, of this Direction.
c. CSHOs should verify cleaning and disinfection procedures are
performed in the room or area following aerosol-generating
procedures on COVID-19 patients. Such cleaning and disinfection
should be in accordance with 29 CFR § 1910.502(j)(1).
a. If CSHOs determine that the number of personnel present during
aerosol generating procedures on suspected or confirmed COVID-
19 patients is not limited, then a citation of paragraph 29 CFR §
1910.502(g)(1) may be issued.
b. If CSHOs determine that aerosol generating procedures on
suspected or confirmed COVID-19 patients are not done in
available AIIRs, then a citation of paragraph 29 CFR §
1910.502(g)(2) may be issued.
c. With the exception of 29 CFR § 1910.502(g)(3), generally
violations issued for these subparagraphs will result in single, non-
grouped violation. Violations issued for 29 CFR § 1910.502(g)(3)
may be grouped with the appropriate subparagraph in 29 CFR §
1910.502(j).
I. Physical Distancing.
a. 29 CFR § 1910.502(h) requires employers to create physical
distancing between employees. CSHOs shall establish, through
employer and employee interviews, the means by which the
employer ensures that physical distancing is maintained between
employees, and how quickly corrective actions are taken if/when
necessary. This provision does not apply to momentary exposure
while people are in movement (e.g., passing in hallways or aisles)
or for brief interactions dictated by operational necessities (e.g.,
checking patient vitals or monitoring equipment). The employer
must ensure that each employee is separated from all other people
by at least 6 feet unless the employer can demonstrate that such
physical distancing is not feasible for a specific activity (e.g.,
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direct patient care).
Physical distancing can include methods such as: telework or
other remote work arrangements; reducing the number of people,
including visitors, in an area at one time; visual cues such as signs
and floor markings to indicate where employees and others should
be located or their direction and path of travel; staggered arrival,
departure, work, and break times; and adjusted work processes or
procedures, to allow greater distance between employees.
b. CSHOs should determine whether the employer has designated
eating and drinking areas with sufficient space to accommodate
physical distancing or install appropriate physical barriers.
c. For activities other than direct patient care, if an employer claims it
is infeasible to separate employees, the CSHOs should interview
the employer to determine why physical distancing is not feasible
and what alternative measures were implemented. The CSHOs
should request any relevant documentation, which supports the
employer’s position regarding infeasibility and document this in
the casefile.
d. When the employer establishes it is not feasible for an employee to
maintain a distance of at least 6 feet from all other people, the
employer must ensure that the employee is as far apart as feasible
and implement the remaining layers of overlapping controls,
including physical barriers, source control, hand hygiene, and
ventilation, required by the standard to reduce the risk of COVID-
19 transmission.
CSHOs should obtain photos and measurements during the
walkaround of the affected area as necessary to document the
workspace layout, and the physical distance between people.
CSHOs must ensure that the privacy of residents/patients is taken
into account prior to taking any photos during the walk-around.
e. Where the AD has authorized a remote only inspection, CSHOs
should request from the employer the relevant measurements and
photographs of work areas along with the workspace layout (e.g.,
from an emergency escape plan diagram or a floor plan), CSHOs
should follow up with employee interviews to verify
implementation of physical distancing measures.
a. If the employer has not instituted any feasible physical distance
measures, or if the measures taken are inadequate, consider issuing
a citation for 29 CFR § 1910.502(h)(1).
b. If, during the course of the inspection, the CSHO determines that
employees were not physically distanced and the employer was not
complying with other sections of the standard, such as wearing
28
facemask or respiratory protection, then the Area Office should
issue a citation for 29 CFR § 1910.502(h) and may consider
grouping it with the other section(s) of the standard that was/were
not implemented if abatement is the same. Note: Source controls
(such as facemasks and face coverings) are not a substitute for
physical distancing. Both practices should be used together, where
feasible, with other protective measures as part of a multi-layered
infection prevention strategy.
J. Physical Barriers.
29 CFR § 1910.502(i) establishes the requirements for creating physical barriers
between employees at fixed workstations to block face-to-face pathways between
individuals based on where each person would normally stand or sit. Physical
barriers are not required in direct patient care areas or resident rooms.
a. At each fixed work location in outside of direct patient care areas
where each employee is not separated from all other people by at
least 6 feet of distance, the employer must install cleanable solid
barriers, except where the employer can demonstrate it is not
feasible at the worksite.
CSHOs shall establish, through employee interviews and
observations, that barriers are present where appropriate. CSHOs
should assess whether barriers are at an appropriate height and
positioned to block anticipated face-to-face pathways between
individuals.
b. Barriers may not create another hazard such as hindering employee
egress from an area during an emergency. See part 29 CFR §1910
Subpart E – Exit Routes and Emergency Planning - for additional
considerations.
c. Where the Area Director has authorized remote-only inspections,
CSHOs should request the relevant measurements and photographs
of the area and follow up with employee interviews to verify and
document implementation of barriers.
d. If an employer is claiming it is not feasible to separate employees
with barriers in fixed locations where employees are not separated
by physical distancing, CSHOs should determine what alternative
measures were implemented, and document that in the casefile.
CSHOs should request any relevant documentation that supports
the employer’s position regarding infeasibility.
a. Where physical distancing is not feasible, and if an employer has
not installed feasible barriers, the Area Office may cite 29 CFR §
1910.502(i).
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b. In rare situations where both physical distancing and physical
barriers are not feasible, employers can still implement the
remaining layers of overlapping controls, including facemasks or
respirators, hand hygiene, and ventilation, required by the standard
to reduce the risk of COVID-19 transmission.
c. If the CSHO determines that physical barriers were not installed
where feasible and the employer was not complying with other
sections of the standard, such as wearing facemasks or respiratory
protection, then the Area Office may issue a citation for 29 CFR §
1910.502(i). In some cases, the Area Office may group it with the
other appropriate section(s) of the standard.
K. Cleaning and Disinfecting.
29 CFR § 1910.502(j) establishes the requirements for cleaning and disinfecting.
Cleaning and disinfecting are not the same. See the definitions section. High
touch surfaces and equipment are required to be cleaned at least once a day
following manufacturers’ instructions for application of cleaners. In addition,
when a COVID-19 positive person has been in the workplace within the last 24
hours, the employer must clean and disinfect. The employer must also provide
alcohol- based hand rub that is at least 60% alcohol or provide readily accessible
hand washing facilities.
a. CSHOs should determine whether the employer is cleaning high-
touch areas and equipment at least once per day, and must
determine if cleaning is in accordance with CDC guidance and
with the manufacturers’ instructions for the cleaners used. Some
examples of high touch surfaces include but are not limited to
tables, doorknobs, light switches, countertops, handles, desks,
phones, keyboards, toilets, faucets, and sinks, and touch screens.
b. CSHOs should determine whether cleaning and disinfecting are
performed when a COVID-19 positive person has been in the
workplace within the last 24 hours, and must determine whether
this is done in accordance with CDC’s “Cleaning and Disinfecting
Guidance” (incorporated by reference, 29 CFR § 1910.509(b)(1)).
CSHOs should request documentation such as the employer’s
COVID-19 log or verify through interviews when determining
whether COVID-19 positive persons have been in the workplace.
c. CSHOs should interview a sufficient number of affected
employees on multiple shifts (where applicable) as part of the
overall assessment of the employer’s efforts to ensure cleaning and
disinfecting (where appropriate) are taking place.
d. In a healthcare setting, cleaning and disinfecting may be needed on
a frequent basis throughout the day. This section requires that in
patient care areas, resident rooms, and for medical devices and
30
equipment, the employer must follow standard practices for
cleaning and disinfecting surfaces and equipment in accordance
with CDC’s “COVID-19 Infection Prevention and Control
Recommendations” and CDC’s “Guidelines for Environmental
Infection Control,” pp. 86–103, 147-149 (both incorporated by
reference, 29 CFR § 1910.509(b)(4)). CSHOs should determine
whether employers follow manufacturers’ instructions for
application of cleaners and disinfectants.
e. CSHOs should determine if hand washing facilities are readily
available at the worksite or that alcohol-based hand rubs that
contain at least 60% alcohol are provided.
a. If CSHOs document that the employer took no steps to clean and
disinfect the facility in accordance with the standard, the Area
Office should issue a citation for 29 CFR § 1910.502(j)(1) and
(j)(2), as appropriate.
b. If the employer was aware of a COVID-19 positive person in the
work area within the last 24 hours and did not conduct cleaning
and disinfecting in accordance with CDC guidelines, a citation for
29 CFR § 1910.502 (j)(2)(ii) may be issued. In accordance with
the CDC guidance, if more than three (3) days have passed since
the person who was sick or diagnosed has been in the workplace,
then the cleaning and disinfection would not be necessary. A
violation would not exist if the employer isolated the affected work
area and restricted access to that area for at least three days
following the presence of a COVID-19 positive person.
c. Where disinfection is required, if CSHOs document that the
employer did not use an EPA “List N” disinfectant for Coronavirus
or a bleach solution, the Area Office should issue a citation for 29
CFR § 1910.502(j)(1) and/or (j)(2)(ii).
d. If CSHOs determine that the employer did not follow standard
practices and CDC’s COVID-19 Infection Prevention and Control
Recommendations and Guidelines for Environmental Infection
Control when cleaning and disinfecting surfaces and equipment in
patient care areas, resident rooms, and medical devices, the Area
Office should cite 29 CFR § 1910.502(j)(1).
e. If CSHOs determine that cleaning and disinfecting was inadequate,
i.e., did not follow the cleaning/disinfecting chemical
manufacturers’ instructions for lapse time on surfaces, the Area
Office should cite 29 CFR § 1910.502(j)(2)(i).
f. If CSHOs document that the employer did not provide appropriate
hand washing facilities or alcohol-based hand rubs that contained
at least 60% alcohol, the Area Office should cite 29 CFR §
31
1910.502(j)(3).
L. Ventilation.
29 CFR § 1910.502(k) establishes requirements for ventilation systems and apply
to employers who own or control buildings or structures with an existing heating,
ventilation, and air conditioning (HVAC) system(s). This section does not require
installation of new HVAC systems or AIIRs for healthcare to replace or augment
functioning systems. See Section H on Aerosol Generating procedures and
Appendix A for additional information on AIIRs.
a. Where employers own or control buildings or structures with an
existing heating, ventilation, and air conditioning (HVAC)
system(s), and AIIRs, CSHOs should evaluate if employers have
implemented and maintained the ventilation controls in order to
meet the requirements of this section. Facility industrial
hygienists, building maintenance and facility engineering
personnel, should be interviewed to determine if these systems are
being operated and maintained in accordance with the
manufacturers’ instructions and design specifications.
b. In healthcare, facility engineering personnel maybe certified by the
American Society of Heating, Refrigerating and Air-Conditioning
Engineers (ASHRAE) as a certified health care facility design
manager, and/or certified healthcare physical environment worker,
and should be interviewed. CSHOs should review documents to
verify maintenance and testing of AIIRs in healthcare when
necessary.
c. Employers must ensure that existing HVAC systems including in
exam rooms and AIIRs are used in accordance with the HVAC
manufacturers’ instructions and specifications. Employers must
maximize outside air, use air filters rated MERV 13 or higher where
required and compatible with HVAC systems, maintain and replace
filters, and ensure that intake ports are clear of debris. CSHOs
should request and examine documentation, such as HVAC system
maintenance and filter change schedules and records, to ensure
systems are properly maintained and air filters are replaced as
necessary. CSHOs should also request and review purchase orders,
which may indicate the compatible types of filters and filter
efficiency ratings.
d. CSHOs should visually inspect air intake ports for cleanliness and
debris and CSHOs should consult the Salt Lake Technical Center
(SLTC) for assistance in evaluating the adequacy of ventilation
systems, as necessary. CSHOs may also consult ASHRAE guidance
on the topic available at https://www.ashrae.org/technical-
resources/filtration-disinfection#replacement.
32
NOTE: In addition to the requirements for existing HVAC systems,
all employers should also consider other measures to improve
ventilation in accordance with “CDC’s Ventilation Guidance,”
www.cdc.gov/coronavirus/2019-ncov/community/ventilation. This
could include maximizing ventilation in buildings without HVAC
systems or in vehicles.
a. If CSHOs determine that the employer is not adequately
implementing and/or maintaining its ventilation system and filters,
violations for the specific paragraph of this section should be cited.
This includes observations of HVAC systems that are not
maintained according to manufacturer’s instructions, use of
inadequate filtration, and/or intakes that are blocked with debris.
b. Violations may be grouped if more than one deficiency in the
HVAC system or AIIRs were identified. Citations for this
paragraph should normally be classified as serious where
employees have tested positive for COVID-19. See also sections
on Patient Management, on Aerosol Generating Procedures, and
Appendix A - Additional Specifications for AIIRs.
M. Employee Health Screening and Medical Management.
1. Inspection Guidance for Screening and Notification of symptoms:
a. Screening: In accordance with 29 CFR § 1910.502(l)(1)(i)-(ii),
employers must screen each employee before each workday and
each shift. Through interviews and records review, CSHOs should
determine if COVID-19 symptom screenings are being conducted
before each workday and each shift.
• Each workday refers to an 8-hour day or shift. For example if an
employee enters the facility in the morning, works for 8 hours then
leaves, but returns at a later time during the same 24 hour period to
work a night shift, then two screenings are required, one for each
time the employee begins a new workday or shift.
• Screening methods can be flexible. Employers may screen
employees in-person or ask employees to self-monitor before
reporting to work. Some acceptable methods of COVID-19
screening and self-monitoring include temperature checks,
employee questionnaires, and electronic screening apps.
• Health screening personnel may need to be in close physical
proximity to employees during in person screening. To ensure
screeners and employees waiting to be screened are protected, an
employer must continue to maintain compliance with all
requirements of this standard for physical distancing, physical
barriers, and facemask or other source control use. Screening
33
personnel may use touchless digital thermometers. Note that
during the course of their work shift, employees have to wear at a
minimum facemasks in accordance with 29 CFR §
1910.502(f)(1)(i), or respiratory protection as dictated by the type
of patient care they are engaged in.
• If the employer requires a COVID-19 test, it must be provided at
no cost to the employee. In such cases, CSHOs should verify that
the employer does not require employees to pay for screening tests.
• Records of test results are medical records and must be handled in
accordance with 29 CFR § 1910.1020. Screening records, such as
temperature readings or responses to symptom screening questions,
that are made or maintained by a physician, nurse, other healthcare
personnel, or a technician are also considered to be employee
medical records, as defined 29 CFR § 1910.1020. CSHOs should
verify that such records are being retained in accordance with 29
CFR § 1910.1020(d)(1)(i) (i.e., records must generally be
preserved and maintained for at least the duration of the workers’
employment, plus 30 years).
b. Notification of symptoms: In accordance with 29 CFR §
1910.502(l)(2)(i)-(iv), the employer must require employees to
promptly notify the employer of a confirmed positive COVID-19
test, a diagnosis or reported suspicion of COVID-19 infection by a
licensed healthcare provider, or serious symptoms such as loss of
taste, loss of smell, or when experiencing high fever (≥100.4° F)
combined with an unexplained cough. Prompt notification to the
employer means as soon as possible after the employee became
aware that they were experiencing one or more of the reportable
conditions.
In accordance with 29 CFR § 1910.502(l)(3)(i)(A)-(C), the
employer must notify all employees within 24 hours of becoming
aware of COVID-19 exposures in the workplace. Employers must
notify affected employers and employees who were not wearing a
respirator of their close contacts with a COVID-19 positive person
and must include the date(s) that the contact occurred and location
where the infected person was in the workplace. The notifications
are not required by the presence of a COVID-19 positive patient
where services are normally provided to suspected or confirmed
COVID-19 patients.
• The employer has flexibility in the methods employees use to
notify them and mechanisms and procedures they implement to
notify employees. As long as the requisite notifications are made,
the employer has satisfied the requirement. Some suggested
acceptable forms of notification of symptoms to the employer
include verbal, e-mail/text, voice mail, written letter from the
34
employee, a family member, and/or physician or other licensed
health care provider.
CSHOs should determine through management and employee
interviews whether the employers have implemented procedures
that required and encouraged employees to notify them of COVID-
19 diagnoses, suspected infections or symptoms.
• CSHOs should determine through a combination of interviews and
document reviews whether employees were notified of workplace
exposures to COVID-19 positive individuals within 24 hours after
the employer was notified that a person at its workplace(s)
(including vendors, contractors, customers, visitors or other non-
employees) is COVID-19 positive. CSHOs should also determine
if the notifications included the required dates and locations and
did not include any employee’s name, contact information or
occupation of the person who is COVID-19 positive.
2. Citation Guidance for Screening and Notification of symptoms:
a. Paragraph 29 CFR § 1910.502(l)(i) should be cited if the employer
failed to screen each employee in person or ask each employee to
self-monitor before each workday and each shift.
• Paragraph 29 CFR § 1910.502(l)(1)(ii) should be cited if the
employer required COVID-19 screening test(s) and failed to
provide it at no cost to employees.
b. If the employer failed to require employees to notify the employer
of COVID-19 illness, suspected infections or symptoms, then the
applicable paragraph of 29 CFR § 1910.502(l)(2) should be cited.
• If the employer has a policy requiring symptom notification, but
employees fail to notify the employer of COVID-19 illness or
symptoms, CSHOs should determine whether employees received
training on employer-specific policies and procedures for making
such notifications. If it is determined that the employee(s) did not
receive training, the Area Office may cite 29 CFR §
1910.502(n)(1)(ix) which can be grouped with employee
notification violations.
• If the employer failed to notify employees or employers of other
exposed employees, or failed to make a timely notification (i.e.,
within 24 hours of becoming aware of a notifiable exposure), the
Area Office may issue a citation of the specific applicable
paragraph of 29 CFR § 1910.502(l)(3)(i)(A)-(C).
• If the employer made timely notifications (i.e., within 24 hours)
but failed to communicate all requisite information (e.g., missing
exposure locations and/or dates), then the Area Office may issue
an other-than-serious citation of the specific applicable paragraph
35
of 29 CFR § 1910.502(l)(3)(i)(A)-(C). If evidence indicates that
the omission of exposure locations and/or dates contributed to a
serious condition, such as additional cases of COVID-19
infections, then a serious citation may be warranted and grouped
with other relevant paragraphs of this section.
• Employers shall not disclose confidential information in their
notification to other employees. If the notifications included name,
contact information, or occupation of infected employees, then
paragraph 29 CFR § 1910.502(l)(3)(ii) may be cited.
3. Inspection Guidance for Medical Removal.
29 CFR § 1910.502(l)(4)(i)-(iv) describe the steps the employer must take
for removing and keeping employees removed from the workplace if the
employer knows the employee(s) meet one of the notification criterion
described in paragraphs 29 CFR § 1910.502(l)(2)(i)-(iv).
a. CSHOs should determine employer knowledge of employees’
COVID-19 status by interviewing managers and employees and
reviewing documents such as the OSHA 300 log, the COVID-19
log, employee and employer notification records (e.g., e-mails
and/or letters) and any existing screening forms.
• The employer is considered to have knowledge of an employee’s
COVID-19 status if: 1) the employee notified the employer as
required in notification requirements sections; 2) the employer
was notified by close contacts or contact tracers; 3) the employer
notified close contacts; or 4) the employer notified employers of
other employees working in the facility. Employer knowledge
may also be established if the employee was visibly displaying
symptoms of COVID-19 during daily screenings.
b. Employees must be immediately removed from the workplace if
the employer knows they are COVID-19 positive, have been told
by a licensed healthcare provider that they are suspected to have
COVID-19, are experiencing the symptoms specified in 29 CFR §
1910.502(l)(2)(iii) and (iv), or were in close contact in the
workplace to a person who was found to be COVID-19 positive.
CSHOs should determine whether the employer is adhering to the
requirement to remove workers who have been COVID-19
positive, had a COVID-19 diagnosis, suspected infection or
reported symptoms as provided by paragraphs 29 CFR §
1910.502(l)(2)(iii)-(iv).
NOTE: Employers may choose to use a more comprehensive list of
COVID-19 symptoms provided by CDC in deciding whether to
remove or test employees who report additional symptoms that are
not included in the OSHA standard.
c. Employees who are medically removed must remain away from
36
the workplace until the return to work criteria in 29 CFR §
1910.502(l)(6) are met, or kept removed until the employer
provides a polymerase chain reaction (PCR) test at no cost to the
employee.
• The employer may require the employee(s) who were subject to
medical removal to work remotely or in isolation if suitable work
is available. Suitable work means any work that can be done with
no contact with others. If an employee is too ill to work, remote
work should not be required; and sick leave or other leave should
be made available as consistent with the employer’s general
policies and any applicable laws.
• CSHOs should determine through interviews and document
reviews what procedures were implemented for removal (i.e.,
whether employees were given the opportunity to work remotely
or in isolation if suitable work was available.)
d. Employers are not required to remove any employee who has been
fully vaccinated (i.e., 2 weeks or more following the final dose); or
who recovered from COVID-19 within the past 3 months, if the
employee is not COVID-19 positive and does not experience
symptoms.
4. Citation Guidance for Medical Removal.
a. If the employer failed to remove employees who are suspected of
being infected or showing symptoms, are positive for COVID-19,
or were notified by the employer as a close contact, then the
appropriate paragraph of 29 CFR § 1910.502(l)(4)(i)-(iii) should
be cited. Consider the facts of each case, such as whether the
employee who had a close contact was previously vaccinated,
when determining whether an employer’s failure to remove the
worker is citable.
b. Citations of relevant sections should be considered on a case-by-
case basis where employers removed workers but failed to fully
observe the requisite follow up procedure (e.g., testing) and/or
timeframes for returning employees to work (e.g., requiring
employees to return before the return to work period has ended).
5. Inspection Guidance: Medical Removal Protection Benefits and Return to
Work.
Paragraphs 29 CFR § 1910.502(l)(5)(i)-(v) require the employer to
continue to provide regular pay and benefits to employees when they are
removed or working remotely or in isolation due to a condition in
paragraph 29 CFR § 1910.502(l)(4).
a. Employers are required to reimburse medically removed workers
up to $1,400 per week. These requirements are modified after the
37
second week based on the size of company. Employers with fewer
than 500 employees are required to pay medically removed
employees for only two thirds of the regular pay, up to $200 per
day ($1,000 per week in most cases) after the second week.
Further, the employer’s payment obligation is reduced by the
amount of compensation the employee received from any other
source.
b. CSHOs should request any documentation (e.g. emails, meeting
minutes, chat discussions, memos, policy statements, medical
records) that would help verify that an employee who was
removed, working remotely, in isolation, or not working, was on
medical removal as provided by this section.
c. CSHOs should determine through interviews and document
reviews whether employees who were removed, working remotely
or in isolation due to conditions in paragraph 29 CFR §
1910.502(l)(4) received the regular pay and benefits mandated per
paragraphs 29 CFR § 1910.502(l)(5)(i-iv) of this section.
d. CSHOs should determine whether the employer is appropriately
compensating employees who are medically removed due to
COVID-19. The determination regarding compensation for
medical removal may depend on various factors including the size
of the company, other sources of compensation to the employee,
and payroll records.
• If the size of the company nationwide is ten employees or less at
the effective date of this section, paragraphs 29 CFR §
1910.502(l)(5)(iii) – (l)(5)(iv) do not apply.
e. Paragraph 29 CFR § 1910.502(l)(6) requires that the employer
follow guidance from a licensed healthcare provider or CDC’s
“Isolation Guidance” (incorporated by reference, 29 CFR §
1910.509); and CDC’s “Return to Work Healthcare Guidance”
(incorporated by reference in 29 CFR § 1910.509) when making
employee’s return to work decisions.
• CSHOs should determine through interviews and document
reviews if an employee’s return to work after a COVID-19 related
workplace removal followed appropriate CDC or licensed health
care provider guidance.
f. The paragraph also provides that employees must not experience
adverse action when they return to work. See paragraph 29 CFR §
1910.502(l)(5)(v) for specific guidance.
• If CSHOs determine that an employee (or former employee, if they
were fired) experienced adverse action or threat of averse action as
a result of medical removal, then a referral should be made to the
Whistleblower Protection Program. CSHOs will follow the steps
38
outlined in the anti-retaliation section of this directive.
6. Citation Guidance for Medical Removal Protection Benefits and Return to
Work. See also Appendix D.
a. The employers with ten employees or less nationwide, are
encouraged but not required to abide by 29 CFR §
1910.502(l)(5)(iii) – (l)(5)(iv).
b. If the employer did not pay the employee their regular rate of pay
when working remotely or in isolation as part of medical removal,
the Area Office may issue a citation for 29 CFR §
1910.502(l)(5)(ii). The citation will be classified as serious due to
the potential for discouraging reporting COVID-19 and exposing
other employees to the disease.
c. If an employee was returned to work prior to the CDC or health
care providers guidance, then the Area Office may cite 29 CFR §
1910.502(l)(6) .
N. Vaccination.
29 CFR § 1910.502(m) requires employers to support COVID-19 vaccination for
each employee through reasonable time off during work hours and paid leave
(e.g., paid sick leave, administrative leave, etc.) for the full vaccination series
(i.e., each required dose) and any side effects experienced following vaccination.
Generally, OSHA presumes that, if an employer makes available up to four hours
of paid leave for each dose of the vaccine, as well as up to 16 additional hours of
leave for any side effects of the dose(s) (or 8 hours per dose), the employer would
be in compliance with this requirement. OSHA understands that employers may
be able to provide much less than four hours if employees do not need to travel
for vaccinations, for example, if they are provided onsite, and that side effects will
generally last less than two days, but may in some cases last longer.
a. CSHOs should determine through interviews and document review
that employers support vaccination efforts by providing reasonable
time off and paid leave. CSHOs should determine through
interviews whether the employer actively discourages or hinders
employees from getting vaccinated.
• Reasonable time off may include, but would not be limited to, time
spent during work hours related to the vaccination appointment(s),
such as registering, completing required paperwork, all time spent
at the vaccination site (e.g., receiving the vaccination dose, post-
vaccination monitoring by vaccine provider), and time spent
traveling to and from the location for vaccination (including travel
to an off-site location (e.g., a pharmacy). Reasonable time also
may include situations in which an employee working remotely
(e.g., telework) or in an alternate location must travel to the
39
workplace to receive the vaccine.
• Employers are not obligated to reimburse employees for
transportation costs (e.g., gas money, train/bus fare, etc.) incurred
to receive the vaccination, such as the costs of travel to an off-site
vaccination location, or travel from an alternate work location to
the workplace to receive a vaccination dose.
b. CSHOs should determine when vaccination or travel for
vaccination took place to confirm whether the activities took place
during work hours.
• If an employee chooses to receive the vaccine outside of work
hours, employers are not required to grant time and paid leave for
the time that the employee spent receiving the vaccine during non-
work hours. However, employers must still afford them
reasonable time and paid leave to recover from any side effects
that they experience during scheduled work time.
NOTE: Nothing in the ETS precludes an employer from taking steps
beyond the requirements of this standard to encourage employees to get
vaccinated, as appropriate under applicable laws and/or labor management
contracts. The EEOC provides guidance on COVID-19 vaccination as it
relates to equal employment opportunity laws. See EEOC, December 16,
2020, www.eeoc.gov/newsroom/eeoc-issues-updated-covid-19-technical-
assistance-publication-3.
Employees may decline vaccination for a number of reasons, including
underlying medical conditions or conscience-based objections (moral or
religious). There is no requirement that employees who decline the
vaccination sign a declination form.
a. If employees incurred costs such as loss of pay or were required to
take unpaid leave for the vaccination or adverse effects from the
vaccination, Area Offices should consider citing 29 CFR §
1910.502(m).
O. Training.
29 CFR § 1910.502(n) requires employers to provide training in an actionable
manner that accommodates employee language and literacy levels. The following
guidance applies:
1. Standard Guidance.
a. 29 CFR § 1910.502(n)(1)(i)-(xii): Employers must provide
training, including reasonable accommodation as required by the
Americans with Disabilities Act if needed by an employee with a
disability, at no cost to the employee. The employee must be paid
for time spent receiving training. If the employee must travel away
from the workplace to receive training, the employer is required to
40
pay for the cost of travel, and the employee must be paid for travel
time.
b. 29 CFR § 1910.502(n)(3): An employer must ensure training is
overseen or conducted by a person knowledgeable in the covered
subject matter as it relates to the duties required of employees.
c. 29 CFR § 1910.502(n)(4): An employer could utilize a virtual or
online training, but will need to ensure that the training method
allows for employees to ask questions and receive answers
promptly. Video- or computer -based trainings may require the
employer to make available a qualified trainer to address questions
after the training, or to offer a telephone hotline where employees
can ask questions.
a. Review employer-provided training materials (e.g., presentation
slides, signs, posters, handouts) to determine if the company
provided materials that are written in languages and literacy levels
that employees understand, speak and read.
b. When the employer provided training, CSHOs should pay
particular attention to the times trainings were conducted.
Establish whether employees were offered training during
scheduled work times and at no cost to the employee.
c. Employees play a particularly important role in reducing exposures
because appropriate application of work practices and controls
limit exposure levels. Employees therefore need to be informed of
the grave danger of COVID-19, as well as the workplace measures
included in their employers’ COVID-19 plans because those
measures are necessary to reduce risk and provide protection to
employees. Employees must know what specific protective
measures are being utilized and be trained in their use so that those
measures can be effectively implemented.
d. The CSHO should determine, through a number of interviews,
whether employees can demonstrate knowledge and
comprehension of training materials and items denoted in the
respective standard.
• Document whether training was provided in a language and
manner the employee could understand.
• Determine whether employees can describe tasks and situations
where exposure could occur.
• Determine whether employees can describe PPE donning/doffing,
cleaning, disinfecting, and storage procedures.
• Determine whether employees can describe available sick leave
41
policies.
• Ask if employees can identify the designated Safety Coordinator
for the COVID-19 Plan
• Ask if employees were offered an opportunity to ask questions and
receive answers; and
• Ask whether employees can describe any changes that have
occurred that would require retraining such as changes in the
workplace that would increase risk to COVID-19 transmission.
a. 29 CFR § 1910.502(n) does not require the employer to maintain
training records. In the event that the employer cannot provide
training records, the CSHO will note accordingly and continue to
gather evidence sufficient to establish any trend (e.g., material
review, observations, and employee interviews) establishing a
violative condition.
b. When employees received inadequate information or training (e.g.,
training was insufficient for a significant number of employees to
be able to demonstrate knowledge of the required information or
employees’ inability to practice safety measures), cite the
applicable paragraph(s).
c. Consider grouping violations for deficient training with a related
paragraph. For example, 29 CFR § 1910.502(n)(1)(vii) requires
employers to train each employee on workplace-specific policies
and procedures for cleaning and disinfection. This training must
be consistent with the cleaning and disinfection requirements in
paragraph (j). Training must include instruction on the proper and
safe use of cleaning and disinfection supplies provided by the
employer. Therefore, the employer must train an employee who is
tasked to clean their work area, tools or equipment on the supplies
to use, as well as how to properly and safely use those supplies.
d. The Area Office may issue a serious violation when an employer
fails to educate and train their employees.
P. Anti-Retaliation.
29 CFR § 1910.502(o) requires the employer to inform each employee of their
right to the protections required by this section. It also prohibits employers from
discharging or in any manner discriminating against any employee for exercising
their right to the protections required by this section, or for engaging in actions
that are required by this section. 
a. Employers have flexibility regarding how they will inform
employees of their rights and the prohibition on retaliation.
42
Employers are able to choose any method of informing employees,
so long as each employee is apprised of the information specified
in the standard. Employees can be informed in writing, verbally
during a staff meeting, or using other methods. This information
can be provided along with other training required under the
standard, or it can be provided separately.
b. Through management and a sufficient number of private employee
interviews, CSHOs should determine if employees have been
told of their rights to protection under this section.
c. In accordance with paragraph 29 CFR § 1910.502(o)(2), employers
are prohibited from discharging or discriminating against any
employee for exercising their right to protections required by this
section or for engaging in actions required by this section. CSHOs
should gather information regarding alleged discrimination against
employees for exercising their right to protections required by this
section or for engaging in actions required by this section.
d. In general, allegations of retaliation potentially violating this
section will be handled on a case-by-case-basis as this section
overlaps with section 11(c) of the OSH Act. However, some
employees may not have the time or knowledge necessary to file a
timely section 11(c) complaint or may fear additional retaliation
from their employer if they file a complaint.
• Investigations of allegations for a violation of this standard and
section 11(c) should involve close collaboration between the
Compliance Safety and Health Officer, Assistant Area Directors,
and the Area Director in the Area Office and the Whistleblower
Investigator, the Regional Supervisory Investigator, and Assistant
Regional Administrators in the WPP Section.
e. The standard allows OSHA to issue citations to employers for
retaliating against employees, and require abatement including
back pay and reinstatement, even if no employee has filed a section
11(c) complaint within 30 days of the retaliation. Also, this
section of the standard allows OSHA to issue a single citation
addressing retaliation against multiple employees.
• However, an employee who wishes to file a complaint under
section 11(c) may do so within the statutory 30-day period
regardless of whether OSHA is investigating an alleged violation
of the standard involving the same underlying conduct.
a. If employees have not been informed of their rights to protections
required by this standard, the Area Office may issue a citation for
29 CFR § 1910.502(o)(1).
43
b. If an investigation establishes evidence where the employer either
discharged, or otherwise discriminated against, an employee for
exercising their right to protections under this section, a
determination will be made (in consultation with the complainant,
where appropriate) whether to pursue a remedy under section 11(c)
or through a citation under 29 CFR § 1910.502(o)(2), but not both.
The Regional Administrator has the discretion to determine under
which avenue the resulting remedy is ultimately pursued.
Q. Requirements at No Cost.
29 CFR § 1910.502(p) requires that the employer meet all elements of the
respective standard without shifting the cost to employee(s). This provision makes
clear that the employer is responsible for all costs associated with implementation
of the standard.
a. OSHA considers costs to include not only direct monetary
expenses to the employee, but also the time and other expenses
necessary to perform required tasks.
b. The term “no cost” means, among other things, no out of pocket
expense(s) to the employee. The preamble recognizes that
required training is provided at no cost to employees. Examples of
violative conditions may include, but are not limited to, an
employer requiring employees to:
• Purchase COVID-19-related protective equipment and devices;
• Purchase COVID-19-related cleaning and/or disinfectant materials;
and
• Purchase COVID-19-related training and/or training materials.
c. CSHOs should determine through interviews and document
reviews if employees incurred any monetary cost(s) during the
review of the respective standards. Documentation may include
purchase receipts, or medical bills from the employee.
a. 29 CFR § 1910.502(p) will usually be cited as an other-than-
serious violation when/if employees incur monetary costs
associated with this section.
b. Based on specific circumstances of a case, if the Area Office
determines that it is appropriate to achieve the necessary deterrent
effect, the unadjusted penalty may be up to the maximum penalty
allowed for an other-than-serious violation.
c. Violations under this paragraph may be grouped with other
relevant sections (e.g., 29 CFR § 1910.502(m) for costs incurred
44
by the employee to obtain the COVID-19 vaccination).
R. Recordkeeping.
Paragraph 29 CFR § 1910.502(q) requires the retention and availability of all
versions (not drafts) of the COVID-19 plan and the establishment and
maintenance of a COVID-19 log for at least as long as the ETS stays in effect.
This record retention does not apply to employers with 10 or fewer employees
nationwide on the effective date of this section.
a. CSHOs should verify that the employer is maintaining all versions
(not drafts) of its COVID-19 plan.
b. CSHOs should determine whether the employer had more than 10
employees at the time of the effective date of this section.
Interviews with management, employee representatives, and
review of payroll records may be necessary to determine whether
the employer meets the threshold for maintaining a COVID-19 log.
c. Where logs are required, CSHOs should review the employer’s
COVID-19 log and verify that all required information is recorded.
The CSHO should interview the person responsible for
maintaining the log, management, and a sufficient number of
employees to determine if the logs are correct.
• CSHOs should examine the log and ensure that employers
recorded each instance identified in which an employee is COVID-
19 positive (according to the definition in the standard) regardless
if it is work-related. It is important for an employer to examine
COVID-19 cases among workers and respond appropriately to
protect workers, regardless of whether a case is ultimately
determined to be work-related. CSHOs should inquire if the
employer utilized the log to aid in identifying trends of the hazard
in the workplace.
• However, the COVID-19 log should not record incidences for
employees who work exclusively from home and thus could not
expose others in the workplace.
d. The CSHO shall review the employer's injury and illness records
to identify recordable illnesses or symptoms among employees
with exposure(s) to patients with suspected or confirmed COVID-
19. The review of the OSHA 300 log can aid in pinpointing any
inconsistencies on the COVID-19 log and can provide insight on
personnel who should be interviewed.
• CSHOs shall examine additional injury and illness logs and ensure
that employers who are required to maintain injury/illness records
under 29 CFR part 1904 continue to record all work-related
confirmed cases of COVID-19 on their OSHA Forms 300, 300A,
45
and 301, or the equivalent forms. Note: The partial exemption for
some NAICS codes in 29 CFR § 1904.2 does not apply to the
recordkeeping requirements in paragraph 29 CFR § 1910.502(q) –
all employers covered by this section must maintain a COVID-19
log. CSHOs must ensure the OSHA 300 log is not used as a
substitute for the COVID-19 log required by this section. Note: So
as not to discourage vaccination, employers are not required to
record instances of adverse reactions to vaccinations on the OSHA
300 log effective through May 2022.
e. CSHOs should verify that, at a minimum, each instance recorded
on the COVID-19 log contains the following information: the
employee’s name; contact information; occupation; location where
the employee worked; the date of the employee’s last day at the
workplace; the date of the positive test for, or diagnosis of,
COVID-19; and, the date the employee first had one or more
COVID-19 symptoms, if any were experienced, and that entries
were made within 24 hours of the employer learning that an
employee is COVID-19 positive.
• The log may be kept in any manner that the employer chooses as
long as the information required to be on the log is present and
understandable and can be obtained and shared within the
timeframes mentioned in the standard. The log must be
maintained as a confidential medical record. The disclosure of
personal information entered on the COVID-19 log is limited to
the access provisions set forth in paragraph 29 CFR §
1910.502(q)(3). There is no requirement for the log to be kept at
the establishment as long as the timeframes for availability can be
met.
f. CSHOs should verify through interviews and/or document reviews
that the employer provides access to the COVID-19 log to
employees and their representatives.
g. CSHOs should also interview others not on the COVID-19 log to
determine if there are any cases that should have been recorded but
were not placed on the log.
• Through interviews and document review, CSHOs should
determine if employees, former employees, and their
representatives have access rights to all versions (not drafts) of the
written COVID-19 plan at any workplace where the employee or
former employee has worked. Employees or former employees
also have access to the COVID-19 log entry pertaining to their
own illness(es) and to a version of the COVID-19 log that
maintains employee privacy by removing personally identifiable
information (e.g., names, contact information and occupation) of
other employees. The location where the employee worked, the
46
date of the employee’s last day at the workplace, the date of the
positive test for, or diagnosis of, COVID-19, and the date the
employee first had COVID-19 symptoms must be included in the
privacy-protected log.
• CSHOs should document where employers fail to provide OSHA
with access to the records required to be created and maintained by
this section when requested.
• The employer must provide these records (one free copy of each
requested record) upon request for examination and copying not
later than by the end of the next business day after the request was
made.
• If an inspection reveals that a business changed ownership while
the ETS is in effect, the CSHO shall inquire to determine if the
employer (i.e., the predecessor) transferred information on the
COVID-19 log to the new owner (i.e., the successor).
a. Where the employer fails to maintain all versions (not drafts) of
their COVID-19 plan, the employer may be cited for a violation of
29 CFR § 1910.502(q)(2)(i).
b. Where the employer fails to establish or maintain the COVID-19
log or fails to record entries on the COVID-19 log, the employer
may be cited for a violation of 29 CFR § 1910.502(q)(2)(ii).
• If there are no known COVID-19 positive cases at the
establishment, the employer shall not be cited for not having a
COVID-19 log.
• The employer shall not be cited for recording any additional
information not mandated by the standard on the COVID-19 log.
c. When the employer fails to have all of the information required for
an entry on the COVID-19 log, the deficiency should be
documented and the employer may be cited for a violation of 29
CFR § 1910.502(q)(2)(ii)(A).
d. Where the employer has not maintained the log to ensure employee
privacy and confidentiality, the employer may be cited for a
violation of 29 CFR § 1910.502(q)(2)(ii)(B).
e. When the employer does not maintain the COVID-19 log for the
time that the standard exists, the employer may be cited for a
violation of 29 CFR § 1910.502(q)(2)(ii)(C).
g. A citation against the previous employer may be issued if the
previous employer did not transfer all of the information entered
on the COVID-19 log to the new owner. This is applicable if six
months has not passed since the change of ownership and if the
47
predecessor is still in business. The current employer may be cited
if they did not retain the log if the CSHO can show that they did
receive the log from the previous employer.
h. If a work-related COVID-19 illness was not entered into the 300
log and the COVID-19 log, both standards would be cited.
i. OSHA shall not cite for failure to comply with § 29 CFR 1904.5
and § 29 CFR 1904.7 mandates requiring employers to record
worker side effects from a COVID-19 vaccination through May
2022.
j. Where citations are issued, penalties will be proposed only in the
following cases:
• Where OSHA can document that the employer was previously
informed of the requirements to keep records; or,
• Where the employer's deliberate decision to deviate from the
recordkeeping requirements, or the employer's plain indifference to
the requirements, can be documented.
S. Reporting to OSHA.
29 CFR § 1910.502(r)(i) requires the employer to report work-related COVID-19
fatalities to OSHA within 8 hours of learning about the fatality. 29 CFR §
1910.502(r)(ii) requires the employer to report each work-related COVID-19 in-
patient hospitalization within 24 hours of learning about the in-patient
hospitalization. The criteria in 29 CFR § 1904.5 must be used to determine work-
relatedness.
a. CSHOs should gather information through employer and employee
interviews, and CSHOs should review documents such as the
COVID-19 log and the OSHA 300 log when documenting
apparent deficiencies in the reporting requirements.
b. CSHOs and Area Offices shall evaluate that when reporting work-
related COVID-19-related fatalities or hospitalizations to
OSHA, the employer followed the requirements in 29 CFR §
1904.39 except for 29 CFR § 1904.39(a)(1) and (2) and (b)(6) at
https://www.osha.gov/laws-
regs/regulations/standardnumber/1904/1904.39, in accordance with
29 CFR § 1910.502(r)(2).
• Note: An employer may “learn” of a work-related COVID-19
fatality or inpatient hospitalization when a family member or
medical professional reports it to the employer or through another
employee at the company. It is the employer’s responsibility to
ensure that appropriate instructions and procedures are in place so
that managers, supervisors, company medical personnel, as well as
48
other employees or agents of the company, who learn of an
employee’s death or in-patient hospitalization due to work-related
COVID-19 have been instructed that the company must make a
report to OSHA.
c. Note: Employers must give OSHA the following information for
each fatality or in-patient hospitalization: the establishment name,
the location of the work-related incident, the time of the work-
related incident, the type of reportable event (i.e., fatality or in-
patient hospitalization), the number of employees who died or
were hospitalized, the names of the deceased or hospitalized
employees, the employer’s contact person and his/her phone
number, and a brief description of the work-related incident.
d. Note: If an employer makes a report to OSHA concerning a
COVID-19 in-patient hospitalization within the 24-hour period and
that employee subsequently dies from the illness, the employer
does not need to make an additional fatality report to OSHA, but
must still record the fatality.
e. Note: OSHA defines in-patient hospitalization as a formal
admission to the in-patient services of a hospital or clinic for care
or treatment (see 29 CFR § 1904.39(b)(9) and (b)(10)). The
determination as to whether an employee is formally admitted into
the in-patient service is made by the hospital or clinic. Treatment
in an Emergency Room only is not reportable.
a. When an employer fails to report within 8 hours of learning of the
death of an employee resulting from a work related exposure to
COVID-19, the employer may be cited for a violation of 29 CFR §
1910.502(r)(1)(i).
b. When an employer fails to report within 24 hours of learning of a
work related exposure to COVID-19 hospitalization, the employer
may be cited for a violation of 29 CFR § 1910.502(r)(1)(ii).
c. If the Area Office becomes aware of an incident required to be
reported through some means other than an employer report, prior
to the lapse of the 8-hour or 24-hour reporting period and an
inspection of the incident is made, a citation for failure to report
will normally not be issued.
Due to the COVID-19 pandemic, an OSHA Area Office may be temporarily
closed to the public. If an Area Office is closed for any reason, per 1904.39(b)(1)
an employer must use the OSHA 24-hour hotline at 1-800-321-6742 (OSHA) or
complete and submit a Serious Event Reporting Online Form at the OSHA
website, and must not make the report to OSHA by fax, email, or by leaving an
Area Office voice mail.
49
X. Mini Respiratory Protection Program.
29 CFR § 1910.504 applies to respiratory use when such use is not required, in
accordance with 29 CFR § 1910.502(f)(4)(i) and (ii), namely, when the employer either
optionally provides respirators or allows employees to use their own respirators for use in
lieu of required facemasks. In the first situation, employers must provide training on the
use of respirators, on conducting user seal checks on tight-fitting respirators, on the reuse
of respirators and instruction on when to discontinue the use of respiratory protection. In
the second situation, employers must provide a notice to employees using text from 29
CFR § 1910.504(c).
The “Respiratory Protection Guidance by Activity and Standard” table in Appendix B of
this directive contains a breakdown of respiratory protection usage and requirements,
including a listing of the specific requirements applicable to common, foreseeable
situations. Note that 29 CFR § 1910.504 only requires a user seal check and training,
while medical and fit testing requirements are only performed if the employer is required
to follow the Respiratory Protection Standard, 29 CFR § 1910.134.
a. CSHOs shall determine through workplace observations and
interviews whether respirators are required by 29 CFR §
1910.502(f)(2), (f)(3), or (f)(5).
b. If respirators are not required under 1910.502(f)(2), (f)(3), or
(f)(5), the CSHO shall determine whether the employer provides a
respirator to an employee instead of the required facemask under
29 CFR § 1910.501(f)(4)(i). The CSHO shall determine whether
the employer provided the training required by 29 CFR § 1910.504
to each employee wearing a respirator under 29 CFR §
1910.502(f)(4)(i).
• CSHOS shall determine through interviews and document review
that when the employer provides employees with respirators for
use in lieu of required facemasks, the employer must provide
training as described in 29 CFR § 1910.504(d)(1)(i)-(v). Note:
Training is particularly important since fit testing and medical
evaluation provisions are not included in 29 CFR § 1910.504.
c. If respirators are not required under 1910.502(f)(2), (f)(3), or
(f)(5), the CSHO shall determine whether the employer permits an
employee who is required to wear a facemask to wear their own
respirator instead of the required facemasks, under 29 CFR §
1910.502(f)(4)(ii). The CSHO shall determine whether the
employer has provided to the employee a notice containing the
standardized text from 29 CFR § 1910.504(c).
d. The CSHO shall determine if employees wearing elastomeric
respirators have previously been medically evaluated and found
medically unable to wear a respirator, CSHOs should advise the
employer of the hazard and to discontinue the practice until a new
50
medical evaluation is performed as required by 29 CFR §
1910.504.
e. CSHOs should determine whether such employees using tight-
fitting respirators perform user seal checks to ensure the respirator
is properly sealed to the face. CSHOs should evaluate by asking
employees to describe (or demonstrate) the procedures, focusing
on whether the employees recognize the signs that leakage is
occurring.
f. CSHOs should ensure that employers correct any problems
discovered by employees during User Seal Check procedures. If
employee(s) report that a user seal check fails, CSHOs should
make a determination whether the employer provided alternate
models or sizes of respirators.
NOTE: In circumstances where an employer requires respirator usage in
an effort to offer a higher degree of protection to workers not otherwise
required to wear respirators, the employer must comply with the
requirements of 29 CFR § 1910.134. Please refer to CPL 02-00-158,
Inspection Procedures for the Respiratory Protection Standard, dated
June 26, 2014, for agency interpretations and enforcement policies.
g. CSHOs should determine whether respirators used in accordance
with 29 CFR § 1910.504 are being reused by healthcare
employees. Employers must ensure that FFRs used by a particular
employee is only reused by that employee. Note: Reuse is
discouraged unless the employer is experiencing a shortage.
h. If reuse is observed, CSHOs should verify that FFRs are only
reused by the original wearer and that previously used FFRs are
not shared among multiple employees.
• Reuse of FFRs is only allowed for healthcare associated industries
during times of shortages in the respirator supply chain.
i. In the unexpected situation that an employer is asserting a shortage
of respirators, CSHOs should request evidence of this claim by
obtaining a daily inventory of respirators and the “burn rate”
calculations along with applicable invoices and purchase orders.
NOTE: The employer may only use CDC strategies for N95 FFR
shortages for a limited period of time and must take immediate steps to
purchase and use other NIOSH-approved respirators, such as elastomeric
respirators and PAPRs. CDC’s Strategies for Optimizing the Supply of
N95 Respirators are found on the following webpage:
https://www.cdc.gov/coronavirus/2019-ncov/hcp/respirators-
strategy/index.html.
j. CSHOs should verify that re-used respirators are not visibly soiled
or damaged; and determine how the end-user verifies the integrity
51
of respirator (i.e., fabric, straps, seal, nose bridge); whether the
employee hygienically handles the respirator and successfully
completes a user seal check on the re-used respirator; and whether
the respirator has been used more than five (5) days in total.
k. CSHOs should verify the storage conditions of the respirators. Re-
usable respirators must be stored in a breathable container (e.g.
paper bag), away from water or moisture for at least five (5)
calendar days prior to re-use. In practice, this means that an
employer must provide at least five (5) FFRs to be used on
different days.
NOTE: For FFRs, the exhalation process combined with environmental
factors (i.e., increased temperature and/or humidity) may lead to higher
moisture content in the fabric of the respirator and may promote the
growth of pathogens. Respirators that are soiled or grossly contaminated
with blood, respiratory secretions, or other bodily fluids, shall not be
stored for later re-use.
a. If the employer did not provide affected employees who provide

and use their own respirators with the notice listed at 29 CFR §
1910.504(c), the Area Office may consider issuing an other-than-
serious citation.
b. If the employer failed to provide training in accordance with the
requirements of 29 CFR § 1910.504(d)(1), the Area Office may
consider issuing citation(s) for any documented deficiencies listed
in paragraphs 1910.504(d)(1)(i) through (v) of this section.
Violations of multiple training provisions under 29 CFR §
1910.504(d)(1) should normally be grouped in a single citation.
c. If the employer has not ensured employees are conducting user
seal checks as outlined in 29 CFR § 1910.504(d)(2), the Area
Office may consider issuing citation(s) for any deficiencies as
listed in paragraphs 1910.504(d)(2)(i)(A) and (B). If the employer
fails to correct any problems with the user seal check process, a
citation for 29 CFR § 1910.504(d)(2)(ii) may be considered.
d. If the reuse of respirators was not compliant with the requirements
of 29 CFR § 1910.504(d)(3)(i), the Area Office may consider
issuing citation(s) for any documented deficiencies listed in
paragraphs 1910.504(d)(3)(i)(A) through (F) of this section.
Violations of multiple reuse provisions under 29 CFR §
1910.504(d)(3)(i) should normally be grouped in a single citation.
Deficiencies associated with the reuse of elastomeric respirators or
PAPRs may be cited under 29 CFR § 1910.504(d)(3)(ii).
e. If the employer does not require employees to discontinue use of
respirators when employees report or experience signs and
52
symptoms that are related to their ability to use a respirator, a
citation for 29 CFR § 1910.504(d)(4) should be cited. If
employees are allowed to wear respirators and have previously had
a medical evaluation that determined they were not medically fit to
wear a respirator, a citation for 29 CFR § 1910.504(d)(4) should be
cited.
XI. Drafting OSHA Citations for COVID-19 Violations.
A. CSHOs should follow the general procedures for writing OSHA citations in the
FOM, CPL 02-00-164, and any specific procedures in this directive. The
recommended classification of violations shall be as per the current version of the
FOM, Violations, Chapter 4, and guidance set forth herein.
B. The general procedures for classifying and grouping violations in the FOM should
be followed. This document also contains some specific instructions for grouping
violations of provisions in the COVID-19 ETS and other OSHA standards.
C. Cases initiated before the effective date of the ETS should be carefully evaluated
to determine whether case-specific findings and supporting employer knowledge
warrant a violation under the ETS. For ongoing inspections, where the opening
conference date precedes the effective date of the ETS, the Area Office may
consider citations under the ETS for well-known SARS-CoV-2 control measures
that should have been implemented before the issuance of the ETS, such as, but
not limited to, physical distancing, barriers and hand hygiene. Where violations
are subsequently found, while the inspection is still open, of unique requirements
of the ETS, such as but not limited to, maintaining a COVID-19 plan, maintaining
a COVID-19 log, and notifications to employees, citations should be treated on a
case-by-case basis, in consultation with the Regional Office.
D. The Area Director discretion for Gravity Based Penalty (GBP) should account for
additional considerations including, but not limited to:
1. Suspected or confirmed COVID-19 status of the affected employee(s),
patients and residents in the facility or specific work area;
2. COVID-19 vaccination status of the affected employee(s);
3. Use and implementation of barriers in the workspace;
4. Use and implementation of physical distancing by the affected workforce;
5. Other environmental controls such as area ventilation (either forced
mechanical ventilation / HVAC, or natural ventilation through the opening
of doors or windows);
6. Other engineering controls such as the use of Airborne Infection Isolation
Rooms (AIIRs);
7. Other administrative controls such as telehealth; telework or other remote
work arrangements; reducing the number of people, including non-
employees, in an area at one time; staggered arrival, departure, work, and
break times.
53
8. Any updated CDC COVID-19 guidance that may impact on worker
exposures.
XII. Training for OSHA Personnel.
A. For all inspections or on-site visits where COVID-19 exposures are expected,
CSHOs and OSHA consultation staff are expected to be knowledgeable of:
1. Potential hazards which may be encountered at the site, including the
potential hazards of COVID-19.
2. Contents of the COVID-19 standard and this Direction.
3. Knowledge of CDC guidance incorporated by reference in 29 CFR §
1910.509 and on OSHA’s web page at www.osha.gov/coronavirus/ets/ibr.
4. Appropriate PPE is to be worn. Each CSHO/OSHA consultation staff
who will be expected to use PPE shall be trained in the proper care, use,
and limitations of the PPE. Use of respiratory protection by CSHOs and
other Agency personnel is addressed in OSHA Instruction, CPL 02-02-
054, Respiratory Protection Program Guidelines, July 14, 2000.
Additional respiratory protection instruction may be available to OSHA
personnel in the form of interim enforcement guidance such as in the most
recent OSHA Memorandum, Updated Interim Enforcement Response
Plan. According to this guidance, the minimum levels of respiratory
protection for CSHOs are a fit-tested half-mask elastomeric respirator with
at least an N95-rated filter or a fit-tested, NIOSH-approved, disposable,
FFR, such as an N95, since they have an assigned protection factor (APF)
of 10. A fit-tested half-mask elastomeric respirator with at least an N95-
rated filter is preferred as minimum protection for use in healthcare
settings. Note that the CDC may regularly update its public health
guidance to account for vaccinations against COVID-19, and therefore
OSHA may also update its enforcement guidance.
5. In addition to on-the-job training, CSHOs should be trained through
available course work, such as offered by the OSHA Training Institute
(OTI), (e.g., OSHA #2341 – Biohazards; OSHA #3360 – Healthcare), and
archived webinars related to COVID-19 (e.g., OTI #0158 – Interim
Enforcement Response Plan; OTI #0161 – SHMS CSHO Safety:
Inspections During the Pandemic; OTI #0162 – NIOSH: COVID-19 and
Protecting Workers; OTI #0169 - COVID-19 National Emphasis Program
(NEP); OTI #0173 - COVID-19 Emergency Temporary Standard for
Healthcare).
XIII. Medical Examinations for OSHA Personnel.
A. Many of the hazards CSHOs may encounter are specifically addressed by the
medical surveillance requirements in OSHA standards. In accordance with
OSHA personnel policy in OSHA Instruction, PER 04-00-005, OSHA Medical
Examination Program, Aug. 22, 2009, Regional Administrators and Area
Directors (AD) are responsible for implementing a medical examination program
for CSHOs.
54
B. OSHA Instruction, CPL 02-02-054, Respiratory Protection Program Guidelines,
July 14, 2000, includes medical evaluation requirements for OSHA personnel
required to wear respiratory protection. The Instruction requires that CSHOs be
medically evaluated and found eligible to wear the respirator selected for their use
prior to fit testing and first-time use of the respirator in the workplace. CSHOs
who are required to wear any respiratory protection shall be medically cleared via
the CSHO Medical Examination procedures and ensure they are up to date.
XIV. Protection of OSHA Personnel.
A. The Area Director will ensure that CSHOs evaluate potential sources of exposure
and minimize transmission risk during on-site inspections. CSHOs should
conduct a risk-level assessment per OSHA’s most recent Updated Interim
Enforcement Response Plan for Coronavirus Disease 2019 (COVID-19), with
available industry, company, and any known task-related information. The Area
Director will ensure that a site-specific risk assessment is complete and available
for review prior to opening the inspection. The site-specific risk assessment will
include an exposure control plan, job-hazard analysis, and PPE hazard
assessment.
1. To protect the Federal workforce and individuals interacting with the
Federal workforce, and to ensure the continuity of Government services
and activities, all on-duty or on-site Federal employees, on-site Federal
contractors, and other individuals in Federal buildings and on Federal
lands who are not fully vaccinated are required to wear a face covering
(i.e., cloth face coverings or surgical masks) and maintain physical
distance; but all mentioned above must adhere to other public health
measures, as provided in CDC guidelines. This is in accordance with
Presidential Executive Order 13991 on Protecting the Federal Workforce
and Requiring Mask-Wearing, January 20, 2021, and the OMB
memorandum M-21-15, June 10, 2021, which gives OSHA the ability to
provide exceptions consistent with CDC guidelines.
2. OSHA will continue to implement the U.S. Department of Labor’s
(DOL) COVID-19 Workplace Safety Plan to reduce the risk of COVID-19
transmission to OSHA CSHOs during inspections.
3. CSHOs will take all appropriate precautions as described in OSHA’s
Updated Interim Enforcement Response Plan for Coronavirus Disease
2019 (COVID-19). Supervisors shall ensure all staff comply with all
COVID-19-related requirements developed as part of the ADM 04-00-
003: OSHA Safety and Health Management System.
B. All personnel engaged in on-site inspection-related activities in healthcare must
wear appropriate respiratory protection, or use face coverings at a minimum.
While respirators including FFRs are recommended in most settings, this
Direction permits the voluntary use of fit-tested FFRs by OSHA staff during
inspection-related activities. For voluntary use of filtering facepiece respirators,
OSHA staff must be provided a copy of Appendix D of the OSHA Respiratory
Protection standard, 29 CFR § 1910.134
55
Respirators shall be selected and used in accordance with the respirator selection
procedures in CPL 02-02-054, Respiratory Protection Program Guidelines, and
all requirements of the OSHA Respiratory Protection standard (i.e., medically
evaluated, fit-tested) shall be followed.
C. Additional Personal Protective Equipment (PPE).
CSHOs must use personal protective equipment as necessary to protect
themselves against all non-COVID-19 hazards during an inspection.
1. Regional Administrators and Area Directors shall ensure that appropriate

PPE is available for CSHOs.
2. In addition to respiratory protection, mentioned above, CSHOs will
maintain at a minimum, goggles or face shield, disposable gloves, and
disposable gowns or coveralls of appropriate size.
3. CSHOs should determine the appropriate PPE donning, doffing, and
decontamination locations, where appropriate.
4. CSHOs should inquire and adhere to any facility-imposed PPE
requirements.
See FOM Chapter 3, Section II.C, Safety and Health Issues Relating to CSHOs.
See also ADM 04-00-003, OSHA Safety and Health Management System.
D. Additional CSHO precautionary guidance and inspection tools are provided in
Appendix C and Appendix D of the most recent COVID-19 NEP, including but
not limited to:
1. Leave unnecessary equipment in the vehicle and retrieve only if necessary;
2. Place inspection equipment and materials in plastic bags when possible to
prevent contamination;
3. Ensure hand sanitizer, disinfecting wipes, and bags to dispose of
contaminated PPE and used materials are available in the vehicle;
4. Maximize the use of physical distancing at all times;
5. Avoid interviewing multiple employees in the same area at the same time;
6. Wash hands with soap and water or use hand sanitizers with at least 60%
alcohol prior to leaving the site;
7. Practice contamination reduction techniques (i.e., limit surface touching
and subsequent hand-to-face touching); and
8. Avoid areas in the facility where acute patient care operations are
underway, as necessary. If all alternative measures are exhausted and the
CSHO must enter a high-risk area, they shall immediately stop the
inspection activities and contact their Area Director/Assistant Area
Director for further guidance.
E. In some instances, CSHOs may find that an employer’s exposure assessment is
56
inadequate, has not been performed at all, the employer has not fully and properly
implemented hazard controls, or a COVID-19 outbreak has occurred. In such
cases, use professional judgment in anticipating exposure during a brief entry into
a very high-risk work area, such as a COVID-19 patient room or area for
inspection. CSHOs shall comply with the Regional or Area Office’s respiratory
protection program.
XV. Dates.
Effective dates: The rule is effective June 21, 2021. The incorporation by reference of
certain publications listed in the rule is approved by the Director of the Federal Register
as of June 21, 2021.
Compliance dates: Compliance dates for specific provisions are in 29 CFR § 1910.502(s).
Employers must comply with all requirements of this section, except for requirements in
paragraphs (i), (k), and (n) by July 6, 2021. Employers must comply with the
requirements in paragraphs (i), (k), and (n) by July 21, 2021.
XVI. OSHA Information System (OIS) Coding Instructions.

All COVID-19-related enforcement activities (i.e., inspections, complaints, and
referrals, etc.) and compliance assistance interventions conducted shall be coded as
“COVID-19” under the NEP Code field, as specified in the COVID-19 NEP. Area
Offices and State Plans following the NEP no longer use the previous “N-16-
COVID-19” in the Additional Code field of OIS. The NEP code must be applied
even if the establishment was not among the targeted NAICS listed in the
appendices, as long as COVID-19-related hazardous conditions were investigated.
However, State Plans not implementing the NEP are requested to continue using the
previous N-16-COVID-19 code in the OIS for nationwide tracking purposes.
Additionally, all COVID-19-related inspections are to be coded under Inspection
Category as a “Health” inspection, unless the inspection was initiated as an
unprogrammed safety inspection where no COVID-19 related hazards were initially
alleged, but were later found during the course of the inspection. In such a case, the
inspection should be coded under Inspection Category as a “Safety” inspection.
CSHOs should also identify in OIS any COVID-19 violations or HALs using the
Related Event Code (REC) field under the Additional Information Section in the
violation screen. CSHOs should select “COVID-19” in the REC section. If
applicable, other RECs should also be selected to relate the violation or HAL to the
fatality, complaint, referral, etc. The COVID-19 Related Event Code is in addition to
the other COVID-19 coding required.
NOTE: Until further notice, the agency will continue to track inspections conducted
entirely remotely for COVID-19-related complaints, referrals, or fatalities. When an
inspection is conducted entirely remotely, CSHOs shall enter the code “N-10-
COVID-19 REMOTE” under the Additional Codes section in OIS for all COVID-19
related inspections that are conducted completely offsite, in addition to the code,
COVID-19, for the NEP. In addition, Regions must retroactively code (if not
previously done) all COVID-19-related remote inspections conducted since February
57
1, 2020. State Plans are strongly encouraged to begin or continue using the N-10-
COVID-19 REMOTE code as well, so that data can be gathered on a nationwide
basis.
Table 1, below, provides a summary of all COVID-19-related OIS codes.
Table 1. List of OIS codes for COVID-19-related inspections/activities
OIS Field OIS Codes Activity Type
All enforcement and compliance assistance

NEP COVID-19 activities conducted under the NEP (complaints,
fatalities, referrals, inspections, etc.)
Additional N-16-COVID-19 Code will only continue to be used by those State

Code Plans that did not implement OSHA’s NEP
Additional N-10-COVID-19 Code used for COVID-19-related inspections that

Code REMOTE are conducted completely off site
Inspections of establishments where there were

hazards that would normally have been cited, but
Additional N-10-ABATEMENT
enforcement discretion was used to defer issuance
Code DEFERRED
of violation for COVID-19-related hazards (refer
to Section XII.C.2. of the NEP for further
guidance)
Related Event
COVID-19 All COVID-19-related violations and HALs
Code (REC)
58
Appendix A
Additional Specifications for AIIRs and Ventilation References
See also: OSHA Directive, CPL 02-02-078, Enforcement Procedures and Scheduling for
Occupational Exposure to Tuberculosis, June 30, 2015, Appendix B, Testing Methods for
Airborne Infection Isolation Rooms, www.osha.gov/enforcement/directives/cpl-02-02-078.
An AIIR is a single-occupancy negative pressure patient care room or enclosure (See
definition of AIIR in Section IX. B. this Direction). Environmental factors are controlled in
AIIRs to minimize the transmission of infectious agents that are usually spread from person
to person by droplet nuclei associated with coughing or aerosolization of contaminated
fluids. AIIRs should be maintained under negative pressure (so that air flows under the door
gap into the room). AIIRs should have an air change rate of ≥ 6 mechanical air changes per
hour (ACH). Whenever feasible, the airflow rate should be raised to ≥ 12 mechanical ACH
by adjusting or modifying the ventilation system or supplementing with air cleaning
technologies. Achieving a total air change rate of ≥ 12 mechanical ACH should be a goal
when designing new AIIRs or renovating existing AIIRs.
There should be direct exhaust of air from the room to the outside of the building or
recirculation of air through a high-efficiency particulate air (HEPA) filter. The air from an
AIIR should be exhausted directly to the outside of the building or, if recirculation of that air
is unavoidable, passed through a HEPA filter. A HEPA filter is a filter that is at least 99.97%
efficient in removing monodisperse particles of 0.3 micrometers in diameter. HEPA filters
should be installed in the duct system exiting the room to remove infectious organisms from
the air before the air returns to the general ventilation system. The employer should
implement a scheduled maintenance program for HEPA filters that includes procedures for
installing, removing, and disposing of filter elements
Maintenance on HEPA filters should be performed only by adequately trained and protected
personnel, and only while the ventilation system or room-air recirculation unit is off.
Employees performing maintenance and replacing filters on ventilation systems that are
potentially contaminated with COVID-19 should wear appropriate respiratory protection in
addition to eye and hand protection. When feasible, HEPA filters can be disinfected in a
10% bleach solution or in another appropriate bactericide before removal. In addition, filter
housing should be labeled with appropriate warnings. Filters and other potentially
contaminated materials should be disposed of in accordance with applicable local or state
regulations. Pre-filters should be handled and disposed in the same manner as HEPA filters.
In circumstances where air from an AIIR must be recirculated back into the room (e.g.,
where there is no general ventilation system), recirculation may be achieved by either fixed
or portable room-air recirculation systems. Fixed recirculation systems are preferred to
portable (freestanding) units because they can be installed with a higher degree of reliability
and can have a higher airflow capacity than portable systems. Also, fixed systems reduce the
potential for the short-circuiting of air as the distance between the air intake and exhaust is
greater. AIIRs should be kept under negative pressure to induce airflow into the room or
enclosure from all surrounding areas. Negative pressure must be monitored to ensure that air
A-1
is always flowing from the corridor (or surrounding area) into the AIIR. The negative
pressure should be ≥ 0.01 inches of water gauge.
Negative pressure can be monitored using nonirritating smoke trails or other indicators to
demonstrate that the direction of airflow is from the corridor or adjacent area into the AIIR.
Pressure indicating equipment, such as continuous positive and negative pressure monitors,
air velocity indicators, and alarms can be installed on an AIIR to verify proper room
pressure.
Booths, tents, or hoods that discharge exhaust air into the room they are located in should
incorporate HEPA filters at the discharge duct; the exhaust fan should be on the discharge
side of the filter. If the device does not incorporate a HEPA filter, the exhaust should be
exhausted directly to the outside and not recirculated.
Provisions should be made for emergency power to prevent interruptions in the performance
of critical controls during a power outage. If there is no emergency power, the system should
have dampers installed to isolate the AIIR or treatment room in the event of a power failure
to prevent the backflow of contaminated air. If dampers are not automated, the facility
should have a written procedure to initiate the timely closure of dampers if a power failure is
detected.
CDC:
Guidelines for Preventing the Transmission of Mycobacterium tuberculosis in Health-

Care Settings, 2005, December 30, 2005/Vol. 54/No. RR-17.
www.cdc.gov/infectioncontrol/guidelines/environmental/appendix/air
American Society of Heating, Refrigerating and Air-Conditioning Engineers (ASHRAE):
Negative Pressure Rooms
www.ashe.org/negative-pressure-rooms
American Industrial Hygiene Association:
Reducing the Risk of COVID-19 Using Engineering Controls (September 9, 2020)
aiha-assets.sfo2.digitaloceanspaces.com/AIHA/resources/Guidance-
Documents/Reducing-the-Risk-of-COVID-19-using-Engineering-Controls-Guidance-
Document.pdf
A-2
Appendix B - Respiratory Protection Guidance by Activity and Standard1
Patient Status User
Exposure Risk Written Medical
for COVID-19 Respirator Use Fit Testing Training Seal Re-use Discontinuation Notice
Examples Program Evaluations
(if applicable) Check
positive / Employer provided.
Aerosol Generating suspected or Required by 29 CFR § Required to comply with 29 CFR § 1910.134
Procedures
unknown2 1910.502(f)(3)(i)
positive / Employer provided.
Patient Care / suspected or Required by 29 CFR § Required to comply with 29 CFR § 1910.134
All other employees
unknown2 1910.502(f)(2)(i)
Employer provided in lieu of required
Part of COVID-19
facemask per 29 CFR § N/A 29 CFR § 1910.504(d)(1) - (d)(4) N/A
Plan
negative / not 1910.502(f)(4)(i)
Patient Care
suspected Employee use their own in lieu of
Part of COVID-19
required facemask N/A N/A 29 CFR § 1910.504(c)
Plan
See 29 CFR § 1910.502(f)(4)(ii)
Required use for protection against
Patient Care / All
negative / not other (non-COVID) hazards/infectious
other required Required to comply with 29 CFR § 1910.134
suspected agents (TB, varicella, cauterization or
respirator use
amputation procedures, etc.).
Facemasks required Part of COVID-19
All employees - Facemasks required N/A N/A N/A
See 29 CFR § 1910.502(f)(1)(i) Plan
Employer provided Part of COVID-19
N/A 29 CFR § 1910.504(d)(1) – (d)(4) N/A
All employees – Respirators optionally See 29 CFR § 1910.502(f)(4)(i) Plan
used in lieu of required facemasks Employee provides their own Part of COVID-19 29 CFR § 1910.504(c)
N/A N/A
See 29 CFR § 1910.502(f)(4)(ii) Plan
All other industries for required or Required Required to comply with 29 CFR § 1910.134
voluntary respirator use for protection Voluntary use of FFR 29 CFR § 1910.134 Appendix D
against any respiratory hazard. Voluntary use of Elastomeric or PAPR See 29 CFR § 1910.134(c)(2)(ii)
Footnotes:
1. See CPL 02-00-158 for enforcement of 29 CFR § 1910.134, and refer to this directive for enforcement of the ETS for COVID-19.
2. See sections on “Syndromic and Empiric Applications of Transmission-Based Precautions,” “Airborne Precautions,” and Table 2 in CDC’s Guideline for Isolation Precautions:
Preventing Transmission of Infectious Agents in Healthcare Settings (2007) document, which is incorporated by reference in 29 CFR § 1910.509.
B-1
Appendix C
Additional Guidance for Determining Medical Removal Benefits
Citations for not providing medical removal benefits shall not identify the employee other than
by job title or department unless, due the size of the establishment, that would identify the
employee. Any cost that will continue to accrue until payment, such as back wages, insurance
premiums, and the like should be stated as formulas—that is, amounts per unit of time, so that
the proper amount to be paid the complainant is calculable as of the date of payment. For
example, “The employer did not pay the surgical technician’s regular rate of pay in the amount
of $15.90 per hour, for 40 hours per week, from July 7, 2021, through the date of payment, less
the customary deductions when the employee was working remotely due to COVID-19
exposure.”
In order to determine the employee’s regular rate of pay, the CSHO should request copies of the
employee’s payroll records and prior year’s W-2 form from the employer and copies of pay stubs
and any other relevant documentation from the employee. (The employer and the employee may
redact the employee’s social security number from the copied document and if they do not, the
CSHO shall keep the record confidential unless it is needed for court.) It is important to realize
that circumstances have changed many employees’ incomes since the pandemic began and the
CSHO needs to take extra care to determine current wages. Employees with similar job titles
and seniority (if possible) should be interviewed regarding their wages to determine actual
current income.
CSHOs should cite 29 CFR § 1910.502(l)(5)(ii) where the employer has failed to provide
medical removal benefits. The CSHO may consult with a whistleblower protection investigator
if needed to help determine how to calculate the amount owed by the employer. If the employee
would have received a bonus during this time period or a medical plan, this would be factored
into the regular rate of pay. Punitive damages are not to be assessed as part of this section but
may fall under Section 11(c). If the employee would have left the job for any other reason than
for medical removal under this section, then the counting period for the regular rate of pay will
stop at the day of separation.
If the employee experienced adverse action or threat of averse action as a result of medical
removal, then a referral should be made to the Whistleblower Protection Program.
C-1

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U.S.

DEPARTMENT OF LABOR Occupational Safety and Health Administration

Purpose: This Direction establishes inspection procedures and enforcement

Scope: This Direction applies OSHA-wide.

References: Presidential Executive Order on Protecting Worker Health and Safety,

Federal Register, 86 FR 32376, 29 CFR § 1910, Emergency

OSHA Instruction, CPL 02-00-164, Field Operations Manual (FOM),

OSHA Instruction, CPL 02-00-158, Inspection Procedures for the

OSHA Direction, DIR 2021-01 (CPL-03), National Emphasis

(See Section III for additional references.)

Originating Office: Directorate of Enforcement Programs

By and Under the Authority of

Appendix A: Additional Specifications for AIIRs and Ventilation References

B. Federal Register, 86 FR at 32376, 29 CFR § 1910, Emergency Temporary

D. OSHA Instruction, CPL 02-00-158, Inspection Procedures for the Respiratory

E. OSHA Instruction, CPL 02-02-078, Enforcement Procedures and Scheduling for

F. OSHA Direction, DIR 2021-01 (CPL-03), National Emphasis Program –

G. OSHA Instruction, CPL 02-02-072, Rules of agency practice and procedure

H. OSHA Instruction, ADM 04-00-003, Safety and Health Management System,

I. CDC, Hospital Preparedness Checklist, ww.cdc.gov/coronavirus/2019-

K. CDC, How to Wash Masks, www.cdc.gov/coronavirus/2019-ncov/prevent-

L. CDC, Cleaning and Disinfecting Your Facility, www.cdc.gov/coronavirus/2019-

M. CDC, Symptoms of COVID-19, www.cdc.gov/coronavirus/2019-ncov/symptoms-

N. CDC, Healthcare Facilities: Managing Operations During the COVID-19

O. CDC, Burn Rate Calculator, www.cdc.gov/coronavirus/2019-ncov/hcp/ppe-

Q. FDA, Umbrella EUA for Surgical Masks, www.fda.gov/medical-

T. CDC, NIOSH-Approved Particulate Filtering Facepiece Respirators,

U. CDC, Counterfeit Respirators / Misrepresentation of NIOSH-Approval,

V. See 29 CFR § 1910.509 for additional guidelines and standards incorporated by

VI. Federal Program Change.

VIII. Significant Changes.

IX. Inspection Procedures.

With some exceptions, the Healthcare COVID-19 ETS, 29 CFR § 1910.502,

2. Inspection Scheduling. In most cases, in accordance with the FOM, the

a. Expansion of inspections to areas involving occupational

3. Opening Conference. CSHOs shall request to speak to the employer’s

4. CSHO Safety. Inspections shall be conducted in a manner that ensures the

a. Determine whether the employer has a written COVID-19 plan (or

COVID-19 plan is a part of another emergency preparedness plan,

b. Review evidence or documentation that a hazard assessment was

c. Determine whether the employer has established administrative

d. Review information such as medical records related to worker

e. For assistance with accessing medical records, CSHOs are

f. Review the respiratory protection program and any modified

g. Review employee training records, including any records or

h. Review any documented efforts made by the employer to obtain

i. Review documentation of maintenance and use of engineering

j. Where appropriate, determine if the facility has airborne infection

a. If the employer did not provide affected employees who provide

1. Regional Administrators and Area Directors shall ensure that appropriate

XVI. OSHA Information System (OIS) Coding Instructions.

OIS Field OIS Codes Activity Type

All enforcement and compliance assistance

Additional N-16-COVID-19 Code will only continue to be used by those State

Additional N-10-COVID-19 Code used for COVID-19-related inspections that

Inspections of establishments where there were

Guidelines for Preventing the Transmission of Mycobacterium tuberculosis in Health-

American Society of Heating, Refrigerating and Air-Conditioning Engineers (ASHRAE):

Negative Pressure Rooms

American Industrial Hygiene Association:

Reducing the Risk of COVID-19 Using Engineering Controls (September 9, 2020)

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