COVID-19 Templates, Checklists and Posters

These checklists and templates have been prepared to help employers, business owners and managers to get their business up and running again and to inform workers about what they need to do to help prevent the spread of Covid-19 in the workplace.  
Note: The templates and checklists below are currently being revised in line with the Work Safely Protocol COVID-19 National Protocol for Employers and Workers which was published on the 20th Nov 2020.

They have been drafted based on the Government’s Work Safely Protocol and should be read in conjunction with the Work Safely Protocol. Employers and workers must work together to keep workplaces safe.  These checklists will help you to do that.  

Further information can be found at,, and  



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Return to Work FormPDFpdf_icon PDF pdf_icon
COVID-19 Response PlanPDFpdf_iconPDF pdf_icon

Employer Checklists   

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Checklist 1: Planning and PreparingPDF pdf_iconPDF pdf_icon
Checklist 2: Control Measures to Prevent InfectionPDFpdf_iconPDFpdf_icon
Checklist 3: COVID-19 Induction PDF pdf_iconPDFpdf_icon
Checklist 4: Dealing with a Suspected Case of COVD-19PDF pdf_icon PDFpdf_icon
Checklist 5: Cleaning and DisinfectionPDF pdf_iconPDFpdf_icon

Employee Checklist

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Checklist 6: WorkersPDF pdf_iconPDFpdf_icon

Lead Worker Representative(s) Checklist

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Checklist 7: Lead Worker Representative(s) ChecklistPDF pdf_iconPDFpdf_icon
Lead Worker Representative Poster (A3)PDFpdf_iconPDF pdf_icon
Lead Worker Representative Poster (A4)PDFpdf_iconPDF pdf_icon

Note: The Return to Work checklists and plan are now interactive fillable forms designed using Adobe Acrobat. It is recommended that users use the Adobe Acrobat Reader DC to open and edit the fillable forms.

If you are using an Android or Apple device we recommend you download the Adobe Acrobat Reader from the Google Play or Apple App Store to view and edit the fillable forms.