NY Forward Safety Plan
Each business or entity, including those that have been designated as essential under Empire State Development’s Essential Business Guidance, must develop a written Safety Plan outlining how its workplace will prevent the spread of COVID-19. A business may fill out this template to fulfill the requirement, or may develop its own Safety Plan. This plan does not need to be submitted to a state agency for approval but must be retained on the premises of the business and must made available to the New York State Department of Health (DOH) or local health or safety authorities in the event of an inspection.

Business owners should refer to the State’s industry-specific guidance for more information on how to safely operate. For a list of regions and sectors that are authorized to re-open, as well as detailed guidance for each sector, please visit: forward.ny.gov. If your industry is not included in the posted guidance but your businesses has been operating as essential, please refer to ESD’s Essential Business Guidance and adhere to the guidelines within this Safety Plan. Please continue to regularly check the New York Forward site for guidance that is applicable to your business or certain parts of your business functions, and consult the state and federal resources listed below.

COVID-19 Reopening Safety Plan

Name of Business:

Pineview Commons LLC


Assisted Living


201 South Melcher Street

Contact Information:

Kara Vollmer

Owner/Manager of Business:

Kara Vollmer

Human Resources Representative and Contact Information, if applicable:

Kara Vollmer


A. Physical Distancing. To ensure employees comply with physical distancing requirements, you agree that you will do the following:

Ensure 6 ft. distance between personnel, unless safety or core function of the work activity requires a shorter distance. Any time personnel are less than 6 ft. apart one another, personnel must wear acceptable face coverings.
Tightly confined spaces will be occupied by only one individual at a time, unless all occupants are wearing face coverings. If occupied by more than one person, will keep occupancy under 50% of maximum capacity.
Post social distancing markers using tape or signs that denote 6 ft. of spacing in commonly used and other applicable areas on the site (e.g. clock in/out stations, health screening stations).
Limit in-person gatherings as much as possible and use tele- or video-conferencing whenever possible. Essential in-person gatherings (e.g. meetings) should be held in open, well-ventilated spaces with appropriate social distancing among participants.
Establish designated areas for pick-ups and deliveries, limiting contact to the extent possible.

List common situations that may not allow for 6 ft. of distance between individuals. What measures will you implement to ensure the safety of your employees in such situations?

During personal care assistance tasks and the serving of wih meals to the residents we serve all employees are required to wear surgical masks at all times. Staff is required to wear the masks at all times during all care and tasks while on duty.

How you will manage engagement with customers and visitors on these requirements (as applicable)?

Visiting will be limited to outside visiting only at this time. All visitors will be screened including a series of questions and temperature check prior to having access to resident. No visitors allowed inside facility or in resident living quarters.

How you will manage industry-specific physical social distancing (e.g., shift changes, luch breaks) (as applicable)?

Staff have been required to wear masks at all times while on duty and on premises since 3/13/20. Staff wear masks when they are in the facility, not only when they are closer than 6 feet from ech other or another resident of the facility.


A. Protective Equipment. To ensure employees comply with protective equipment requirements, you agree that you will do the following:

Employers must provide employees with an acceptable face covering at no-cost to the employee and have an adequate supply of coverings in case of replacement.

What quantity of face coverings - and any other PPE - will you need to procure to ensure that you always have sufficient supply on hand for employees and visitors? How will you procure these supplies?

We have been procuring supplies since March. We continue to order to keep a supply of all PPE in the facility at all times. When necessary we have reached out to Office of Emergency Management for supplies. We have expanded the number of vendors we use to continue to procure supplies. At this time we will be allowing visitors at various schedules times during the day Monday – Friday. Policy will indicate that family members who do not arrive with an appropriate face cover on will be provided with one. We anticipate that if we had to provide face coverings for visitors for all visits this would be an increase of 480-500 face coverings per month the facility will have to procure for visitors. Our policy will include that a cloth face mask will be given to visitors as needed and they are being asked to keep the mask, wash between visits and bring with them for the next visit. Residents will be provided with masks with an additional increase of 360 – 400 face coverings per month for visitors. Staff and others have been making cloth face masks for the residents.
Face coverings must be cleaned or replaced after use or when damaged or soiled, may not be shared, and should be properly stored or discarded.

What policy will you implement to ensure that PPE is appropriately cleaned, stored, and/or discarded?

Facemasks are not cleaned, they are discarded in receptacles provided after use. They are stored until they are used and discarded at the minimum of at the end of each employee’s shift. When a N-95 needs to be used it will be stored in a brown paper bag in staff members’s locker for use on next shift but discarded in receptacle provided when soiled.
Limit the sharing of objects and discourage touching of shared surfaces; or, when in contact with shared objects or frequently touched areas, wear gloves (trade-appropriate or medical); or, sanitize or wash hands before and after contact.

List common objects that are likely to be shared between employees. What measures will you implement to ensure the safety of your employees when using these objects?

Thermometers are wiped down with alcohol after each use. Staff members have their own cleaning supplies, writing utensils. Personal care items such as hair dryers are wiped down with alcohol after each use if being used by more than one staff member. Housekeeping each has their own vacuum.

B. Hygiene and Cleaning. To ensure employees comply with hygiene and cleaning requirements, you agree that you will do the following:

Adhere to hygiene and sanitation requirements from the Centers for Disease Control and Prevention (CDC) and Department of Health (DOH) and maintain cleaning logs on site that document date, time, and scope of cleaning.

Who will be responsible for maintaining a cleaning log? Where will the log kept?

The facility has a housekeeping and maintenance staff that general duties always include sanitizing high touch areas such as handrails, elevator buttons, doorknobs, tables, faucets, toilet flush knobs, etc. This is completed with daily tasks. Tables and chairs are clean between each meal seating. Policy on cleaning in place. In regards to cleaning logs, they will be kept by the staff member in charge supervising the outdoor visits who will be responsible for sanitizing outdoor visiting tables and chairs. Cleaning logs will be kept in a binder in the Administrative offices for review and safe keeping.
Provide and maintain hand hygiene stations for personnel, including handwashing with soap, water, and paper towels, or an alcohol-based hand sanitizer containing 60% or more alcohol for areas where handwashing is not feasible.

Where on the work location will you provide employees with access to the appropriate hand hygiene and/or sanitizing products and how will you promote good hand hygiene?

Hand sanitizing products are provided to each individual staff member as well as sanitizing products at each nurse’s station, outside dining room areas and throughout the facility. Staff have always been required to wash hands with soap and water before and after each task with residents.
Conduct regular cleaning and disinfection at least after every shift, daily, or more frequently as needed, and frequent cleaning and disinfection of shared objects (e.g. tools, machinery) and surfaces, as well as high transit areas, such as restrooms and common areas, must be completed.

What policies will you implement to ensure regular cleaning and disinfection of your wowrksite and any shared objects or materials, using products identified as effective against COVID-19?

The facility has a housekeeping and maintenance staff that general duties always include sanitizing high touch areas such as handrails, elevator buttons, doorknobs, tables, faucets, toilet flush knobs, etc. This is completed with daily tasks. Tables and chairs are clean between each meal seating. All bedrooms, sitting areas, and bathrooms are cleaned by housekeeping staff daily and sitting areas and bathrooms are also cleaned in the evening by other staff. Disinfectant cleaners are purchased through our vendors and labels reviewed.

C. Communication. To ensure the business and its employees comply with communication requirements, you agree that you will do the following:

Post signage throughout the site to remind personnel to adhere to proper hygiene, social distancing rules, appropriate use of PPE, and cleaning and disinfecting protocols.
Establish a communication plan for employees, visitors, and customers with a consistent means to provide updated information.
Maintain a continuous log of every person, including workers and visitors, who may have close contact with other individuals at the work site or area; excluding deliveries that are performed with appropriate PPE of through contactless means; excluding customers, who may be encouraged to provide contact information to be logged but are not mandated to do so.

Which employee(s) will be in charge of maintaining a log of each person that enters the site (excluding customers and deliveries that are performed with appropriate PPE or through contactless means), and where will the log be kept?

A sign in including screening questionnaire and temperature check has been in use since March 2020. All staff and/or medical personnel entering the facility are screened including a temperature check. No one is permitted into facility if temperature is above 100.0 degrees or if they are showing any signs/symptoms of COVID-19. No one is permitted anywhere in the facility without a mask in place covering their mouth and nose. These have been the policies since 3/13/20. Unless it is an employee or medical personnel who are all tested weekly for COVID-19 no one is permitted to enter the facility. Visitors will be limited to outdoor visits only and the same screening and temperature policies will apply including a minimum of 6 foot social distancing and mask in place for all visitors and those residents receiving visitors outside. Activities Director and the Coordinator of Resident and Family Services will be responsible for the screening of each visitor prior to the start of every visit. The log will be completed at the time of the visit and visitors log will be returned to Administrative offices at the end of daily visits for review. Log will be kept in Administrative offices when visits are not occurring for review and safe keeping.
If a worker tests positive for COVID-19, employer must immediately notify state and local health departments and cooperate with contact tracing efforts, including notification of potential contacts, such as workers or visitors who had close contact with the individual, while maintaining confidentiality required by state and federal law and regulations.

If a worker tests positive for COVID-19, which employee(s) will be responsible for notifying state and local health departments?

The Administrator


A. Screening. To ensure the business and its employees comply with protective equipment requirements, you agree that you will do the following:

Implement mandatory health screening assessment (e.g. questionnaire, temperature check) before employees begin work each day and for essential visitors, asking about (1) COVID-19 symptoms in past 14 days, (2) positive COVID-19 test in past 14 days, and/or (3) close contact with confirmed or suspected COVID-19 case in past 14 days. Assessment responses must be reviewed every day and such review must be documented.

What type(s) of daily health and screening practices will you implement? Will the screening be done before employee gets to work or onsite? Who will be responsible for performing them, and how will those individuals be trained?

Above screening has been in place since March 2020. All employees are screened when they arrive to work. Series of questions asked regarding signs/symptoms. Temperature taken. A no touch or temporal thermometer is used by staff trained on proper use. Any signs/symptoms or temp at or above 100.0 degrees the employee is sent home until further notice. All staff are being tested for COVID-19 once per week per Executive Order of Governor Cuomo. Screening of staff is conducted by the Medication Aides and/or nursing staff. The screening of visitors will be completed by the Activities Staff and the Coordinator of Resident and Family Services. If a screening of a visitor leads to the visit not being able to be held as planned the Administrator will be notified.

If screening onsite, how much PPE will be required for the responsible parties carrying out the screening practices? How will you supply this PPE?

Staff all wear masks when inside the facility and during screening. Facility provides.

B. Contact tracing and disinfection of contaminated areas. To ensure the business and its employees comply with contact tracing and disinfection requirements, you agree that you will do the following:

Have a plan for cleaning, disinfection, and contact tracing in the event of a positive case.

In the case of an employee testing positive for COVID-19, how will you clean the applicable contaminated areas? What products identified as effective against COVID-19 will you need and how will you acquire them?

We have a company that we use for sanitation and general cleaning of facility on an as needed basis. They are prepared to complete cleaning/sanitation/disinfecting of entire facility shall the end present. If an employee tests positive for COVID-19 they will be contacted by local Public Health for questioning. The administrator would also contact the employee to go through list of people they may have come into contact with. The staffing schedule would be reviewed and any staff members would be tested at that time as opposed to waiting for scheduled weekly testing date. Residents providers would be made aware that their patient has been in recent contact with a person that has tested positive for COVID-19. Resident testing would be arranged per provider order. Resident would be monitored for signs and symptoms of COVID-19 including increasing daily health check to once per shift health checks.

In the case of an employee testing positive for COVID-19, how will you trace close contracts in the workplace? How will you inform close contacts that they may have been exposed to COVID-19?

If an employee were to test positive the local county public health department is contacted who completes the contract tracing. Employees would be made aware that a staff member has tested positive and all staff would continue to be tested once per week. Adult care facility employees are essential employees and guidance provided by the department of health regarding positive tests are already in place and are being followed.


Please use this space to provide additional details about your business's Safety Plan, including anything to address specific industry guidance.

We receive guidance from NYS Department of Health on a regular basis and policies implemented and/or revised as needed. Staff will be informed that our adult care facility will begin to allow our residents to receive visitors outside only. No visitors will be allowed inside at this time. Visitors will be required to wear a mask at all times and a minimum of 6 foot social distancing from all residents will be required. Residents will also wear a mask during the visits. Visits will be schedules and supervised by staff. Visiting area will be sanitized and disinfected prior to the start of daily visits and after each visit. Visitors will be screened and screening will include a questionnaire and temperature check. Visiting logs will be maintained by staff. All guidelines received by NYS Department of Health regarding the restricted visiting will be followed.

Staying up to date on industry-specific guidance:

To ensure that you stay up to date on the guidance that is being issued by the State, you will:


Consult the NY Forward website at forward.ny.gov and applicable Executive Orders at governor.ny.gov/executiveorders on a periodic basis or whenever notified of the availability of new guidance.

State and Federal Resources for Businesses and Entities

As these resources are frequently updated, please stay current on state and federal guidance issues in response to COVID-19

Visit Plan Addendum

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