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OSHA publishes inspection and enforcement directive on COVID-19 ETS

Photo: Juanmonino/iStockphoto

Washington — OSHA has issued a directive on inspection procedures and enforcement policies for its COVID-19 emergency temporary standard covering health care workers.

The ETS applies to “settings where any employees provide health care or health care support services,” such as hospitals, nursing homes and assisted living facilities. Some exceptions apply, however, including “non-hospital ambulatory care settings” where non-employees are screened for COVID-19 before entering and individuals suspected of having or confirmed to have COVID-19 are not allowed to enter.

OSHA previously has published a flowchart to help employers determine if their workplace is covered by the ETS.

According to a notice published in the June 21 Federal Register, covered employers will need to comply with the ETS – also known as Subpart U – by July 6, except for paragraphs (i), (k) and (n). Those paragraphs cover physical barriers, facility ventilation and training, respectively, and have a compliance date of July 21.

The OSHA directive notes that when health care workers are “embedded” in a non-health care setting, such as a medical clinic in a manufacturing facility or a walk-in clinic in a pharmacy, the ETS applies only to the “embedded” health care setting.

If emergency responders or other licensed providers administer health care services in a non-health care setting, the ETS applies only to those workers.

“For example, if an unvaccinated nurse provides in-home health care while an electrician happens to be working separately in the house, the ETS applies to the nurse’s activities but not those of the electrician,” the directive states.

In “well-defined areas where there is no reasonable expectation that any person with suspected or confirmed COVID-19 will be present,” paragraphs (f) personal protective equipment, (h) physical distancing and (i) physical barriers in the ETS don’t apply to fully vaccinated employees.

Employers, however, must have policies in place to determine the vaccination status of employees.

The standard requires covered facilities to have a COVID-19 plan (in writing if an employer has more than 10 employees) that includes a designated safety coordinator with the “authority to ensure compliance.” Also required: conducting a workplace-specific hazard assessment, monitoring and limiting points of entry in areas where direct patient care is provided, and developing and implementing policies and procedures to limit the transmission of the disease.

OSHA directs its inspectors to request and review that COVID-19 plan.

“If the employer has multiple facilities with substantially similar operations, its COVID-19 plan may be developed by facility type rather than by individual workplace so long as all required site-specific information is included in the plan. Employers may also develop a single comprehensive plan in instances where employees are performing the same task(s) at different facilities as long as any required site-specific information is included,” the directive states.

Workers in facilities covered under the ETS must be supplied with N95 respirators or other personal protective equipment when they’re indoors, in a vehicle with other people for work purposes, or around people who are suspected of having or confirmed to have COVID-19. Their employers also must ensure workers remain 6 feet apart, or erect “cleanable or disposable solid barriers” when that’s not feasible.


Employers will need to follow Centers for Disease Control and Prevention guidelines for cleaning and disinfecting, as well as ensure ventilation systems are used properly, among other steps.

The directive also provides inspection and citation guidance for transmission-based precautions, PPE, patient/non-employee screening and management, training, recordkeeping, aerosol-generating procedures, and employee health screening and medical management.

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