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Prioritizing non-healthcare worksite assessments for Coronavirus Disease 2019 (COVID-19)

Prioritizing non-healthcare worksite assessments for Coronavirus Disease 2019 (COVID-19)
Updated Oct. 18, 2021

This page can assist state, tribal, local, and territorial health departments in making decisions about how to allocate limited resources to respond to non-healthcare worksites that report COVID-19-related concerns, complaints, or clusters. In general, consider worksite COVID-19 clusters high priority in shared housing, detention and correctional facilities, schools, daycares, youth programs, and other providers of services to children. Other worksites may be prioritized based on the potential for extensive transmission of the virus that causes COVID-19 or transmission to people at higher risk for severe illness. These worksites could include high-density critical infrastructure facilities, such as manufacturing facilities, meat and poultry processing facilities, worksites with essential workers, warehouse and distribution centers, construction sites, or service-providing establishments such as salons or restaurants. Federal partners should be consulted regarding assessments of federal worksites. Additional information about identifying and prioritizing COVID-19 outbreaks in non-healthcare worksitespdf iconexternal icon is available from the Council of State and Territorial Epidemiologists (CSTE).

The U.S. Centers for Disease Control and Prevention (CDC) will update this information as needed. Please check the CDC COVID-19 website periodically for updated information.

Definition of a COVID-19 cluster in a non-healthcare worksite

For non-healthcare worksites, a cluster is defined as two or more laboratory-confirmed COVID-19 cases among workers at a worksite with onset of illness or if asymptomatic, a positive test result within a 14-day period, who are epidemiologically linked (have a potential connection in time and place) at the worksite. Employer-provided group housing and employer-provided transportation should be considered when investigating epidemiologic links between cases at the worksite.

Note that in communities with substantial transmission, it might be expected for some worksites to identify two or more cases within a 14-day period that are not connected to the worksite or to employer-provided housing or transportation. This applies especially to large employers. In these circumstances, efforts should be made to determine if there are plausible epidemiologic links among cases in the worksite and to rule out the possibility of exposure outside of the worksite.

Potential worksite clusters might be identified through case investigation, contact tracing, worker complaints, or employer reports to the health department. Depending on the strength of evidence, these potential clusters might warrant worksite assessment even if there are no laboratory confirmed cases yet. The absence of laboratory confirmation alone should not always rule out investigating a potential worksite cluster, particularly when there may be barriers to accessing testing or delayed test results.

Factors for health departments to consider in prioritizing worksite assessments

There is no absolute threshold for deeming a worksite assessment as high priority. The number of cases should not be the sole factor in determining whether a cluster is a priority. If follow-up is not possible for all worksites, the following is a list of factors health departments may consider when identifying and prioritizing facilities for more comprehensive outreach and assistance. Regardless of other response activities, health departments are encouraged to quickly provide information about the Occupational Safety and Health Administrationexternal icon’s (OSHA) guidance on mitigating and preventing the spread of COVID-19 in the workplaceexternal icon as well as other general or industry-specific resources.

Worksites with one or more of the workforce or worksite factors identified below should be prioritized for follow up.

  1. Workforce factors:
    • The proportion of total workers at the site with confirmed or probable SARS-CoV-2 infection, the virus that causes COVID-19, is greater than the proportion of cases in the general public for the local community.
    • Someone with confirmed or probable SARS-CoV-2 infection worked onsite during the 48 hours prior to, or at any time after, symptom onset or specimen collection date if the person was asymptomatic.
    • A large number of potentially exposed workers (for example, five or more) as a result of close contact with someone with confirmed or probable SARS-CoV-2 infection.
    • A substantial proportion of workers (for example, one third or more) who may be at increased risk for severe illness, including
      • Older workers (65 years and older)
      • Workers with underlying medical conditions;
      • Workers who lack healthcare coverage
      • Workers belonging to racial and ethnic minority groups disproportionately affected by COVID-19 because of discrimination, socioeconomic status, barriers to accessing healthcare, and increased exposure to the virus due to occupation
      • Other vulnerable workers (e.g., migrant and seasonal farmworkers)
      • Unvaccinated workers
      • Workers, whether they are vaccinated or unvaccinated, who are exposed to unvaccinated customers or clients
    • A substantial proportion of workers (for example, one third or more) who have barriers to accessing information about worksite procedures and policies for preventing community spread or who may be less likely to comply with these policies. Examples include:
      • Non-English-speaking workers
      • Workers with low literacy levels
      • Workers with practices or beliefs that could impact adoption of prevention guidance
    • A substantial proportion of the workforce (for example, one third or more) is living in high-density housing, multi-generational housing, or in other circumstances that would make it difficult to isolate cases.
    • Evidence of an unexpected number or rate of infections within a worker population with a high vaccination rate.
  2. Worksite factors:
      • A lack of measures in place to protect workers, such as
        • Ensuring all possible ventilation improvements have been implemented.
        • Ensuring at least 6 feet of separation between workers during work and breaks, such as increased distance between workstations or visual cues to maintain separation.
        • Using physical barriers, such as plexiglass, to separate workers from each other and from customers.
        • Following current guidance regarding recommendations or requirements to wear masks at the worksite.
        • Maintaining flexible sick leave policies (e.g., paid sick leave) that encourage vaccination, and discourage sick workers or workers following quarantine recommendations from coming to work.
        • Providing soap and water for handwashing or 60% alcohol-based hand sanitizer.
        • Adopting a vaccination policy that requires workers to be vaccinated or to undergo regular testing in addition to mask wearing and distancing.
        • Offering testing options for non-healthcare worksites when needed.
    • Critical infrastructure workersexternal icon are working in the facility.
    • Group or shared housing is provided to workers by the employer or a contracted supplier, such as camps, dormitories, or apartments.
    • Group transportation is provided by the employer or a contracted supplier, or frequent carpooling occurs among workers.
    • Interaction with customers or clients in close proximity (within 6 feet) is required. Additional considerations may include:
      • A high volume of customers per day (for example, grocery or retail businesses)
      • Extended duration (total of 15 minutes or more) with customers (for example, hair salon)

Collecting information for health departments to consider in prioritizing worksite assessments

When needed, a short questionnairepdf icon can be customized and used to remotely collect this information from the employer’s human resource, occupational health, safety, or other professional at the worksite.