noun_Needs-Assessment_4202-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.

They have been drafted based on the Government’s Work Safely Protocol and should be read in conjunction with the Work Safety 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

Note: The templates and checklists below have been revised in line with the Work Safely Protocol which was published on the 20th Nov 2020.  The Protocol sets down the minimum measures required in every place of work to prevent the spread of COVID-19 and to facilitate the re-opening of workplaces following temporary closures and the ongoing safe operation of those workplaces.


updatedLast Updated: 28th September 2021

Checklist PNPTemplates

EnglishUpdatedAs GaeilgeUpdated
Pre-Return to Work FormDownload PDF


Download PDF01/11/21
COVID-19 Response PlanDownload PDF30/09/21Download PDF04/08/21

Employer PNPEmployer Checklists



As GaeilgeUpdated
Checklist 1: Planning and PreparingDownload PDF 28/09/21Download PDF 01/11/21
Checklist 2: Infection Prevention and Control (IPC) MeasuresDownload PDF28/09/21Download PDF 01/11/21
Checklist 3: COVID-19 InductionDownload PDF 28/09/21Download PDF01/11/21
Checklist 4: Dealing with a Suspected Case of COVID-19Download PDF 28/09/21Download PDF01/11/21
Checklist 5: Cleaning and DisinfectionDownload PDF 28/09/21Download PDF 01/11/21
Checklist 8: VentilationDownload PDF 28/09/21Download PDF01/11/21
New DocumentChecklist 9: Returning to the OfficeDownload PDF28/09/21Download PDF01/11/21
New DocumentChecklist 10: Rapid Antigen Diagnostic Tests (RADTs) Download PDF28/09/21Download PDF01/11/21

Worker PNP

Worker Checklists

EnglishUpdatedAs GaeilgeUpdated
Checklist 6: WorkersDownload PDF28/09/21Download PDF01/11/21
New DocumentChecklist 10a: Rapid Antigen Diagnostic Tests (RADTs)Download PDF28/09/21Download PDF01/11/21

LWR1 PNGLead Worker Representative(s) Checklist

EnglishUpdatedAs GaeilgeUpdated
Checklist 7: Lead Worker Representative(s) ChecklistDownload PDF28/09/21Download PDF01/11/21
Lead Worker Representative Poster (A3)Download PDF28/09/21Download PDF22/04/21
Lead Worker Representative Poster (A4)Download PDF28/09/21Download PDF22/04/21

Note: The Work Safely Templates and Checklists 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.