HSA Checklists and Templates 

The Health and Safety Authority has published useful checklists and templates to help businesses get 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. 

  

Templates 

 

Return to Work Form 

PDF 

COVID-19 Response Plan 

      PDF 

 

Employer Checklists    

 

Checklist 1: Planning and Preparing 

Word ǀ PDF 

Checklist 2: Control Measures to Prevent Infection 

Word ǀ PDF 

Checklist 3: COVID-19 Induction 

Word ǀ PDF 

Checklist 4: Dealing with a Suspected Case of COVD-19 

Word ǀ PDF 

Checklist 5: Cleaning and Disinfection 

Word ǀ PDF 

Employee Checklist 

 

Checklist 6: Workers 

Word ǀ PDF 

Worker Representative(s) Checklist 

 

Checklist 7: Worker Representative(s) Checklist 

Word ǀ PDF 

  

  

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

  

The Authority has a dedicated section COVID19 section on its homepage at which is regularly updated. 

 

 

  

 

 

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