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San Jose City - SSCP Self Assessment Form

The document outlines requirements for maintaining health protocols in enclosed areas to prevent the spread of COVID-19, including social distancing measures, air exchange, disinfection protocols, and personal protective equipment usage. It also emphasizes the need for designated personnel to monitor compliance and manage health-related issues. A certification statement is included to affirm the accuracy of the information provided.

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acongapalaciireal2703
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13 views1 page

San Jose City - SSCP Self Assessment Form

The document outlines requirements for maintaining health protocols in enclosed areas to prevent the spread of COVID-19, including social distancing measures, air exchange, disinfection protocols, and personal protective equipment usage. It also emphasizes the need for designated personnel to monitor compliance and manage health-related issues. A certification statement is included to affirm the accuracy of the information provided.

Uploaded by

acongapalaciireal2703
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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REQUIREMENTS YES NO NA

9 Installed physical barriers in enclosed areas to maintain


social distancing (blocking off chairs, markers, stickers on
the floor for spacing)
10 Availability of personnel in charge for monitoring and
maintaining social distancing, and ensuring the compliance
of clients/visitors/employees to health protocols and areas
in the establishment where people gather (e.g. queue)
11 Availability of windows for adequate air exchange in
enclosed (indoor) areas as cited in DOLE Department
Order No. 224-21 or the Guidelines on Ventilation for
Workplaces and Public Transport to Prevent and Control
the Spread of COVID-19.
12 Compliance to the disinfection protocol in accordance with
DOH Department Memorandum No. 2020-157 and 0157-A
or the Guidelines on Cleaning and Disinfection in Various
Settings as an Infection Prevention and Control Measure
Against COVID-19
13 Conducts regular (at least twice a week) cleaning and
disinfection in the establishment in compliance to the
Cleaning and Disinfection of Environmental Surfaces in the
Context of COVID-19 by the World Health Organization
14 Personnel, employees, clients, and visitors always wear
facemasks and face shields especially in enclosed places
15 Presence of designated Safety Officer with the following
functions: a) coordinate with the appropriate bodies for
support and referral to community-based isolation facilities
for confirmed cases with mild symptoms, and to health
facilities for severe and critical care; b) undertake contact
tracing or coordinate the conduct thereof; and c) monitor
status of employees quarantined or isolated; and d)
implement return to work policies
16 Availability of storage facility for proper collection,
treatment, and disposal of used facemasks and other
infectious wastes

I hereby certify that the facts stated herein are true and correct of my own personal
knowledge and any misrepresentation subjects me to criminal or administrative
liability.

Prepared by:

_____________________________
Signature over printed name

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