At the time of the booking (online or over the phone), clinic visitors will be screened for symptoms and the standard recommendations for self-isolation are followed if the client can be classified as high-risk.

• Recommendations from the CDC can be found here, which outline the global response to COVID-19.

Send notifications via email or text, prior to the clients appointment, of the measures that have been implemented to ensure their comfort during their appointment. This is also be available on your website or social media.

Booking and pre-appointment communications.

• Triage for those with greatest needs

Before arriving to the clinic, all individuals will complete a self screen by answering the questions mentioned here.

• The standard recommendations for self-isolation are followed if the client can be classified as high-risk. For example, such measures will be taken if a client has returned from an international trip less than 14 days prior to their appointment or if they have been in recent contact with someone who has tested positive for COVID-19.

  • Recommendations from the CDC can be found here outlining the global response to COVID-19.

• It is important to note that self-reporting provides limited assurance, as some individuals can be asymptomatic.

Wellness screening at the door

• Provide disposable masks to clients upon entry wherever possible and treatments allow

• Conduct a contactless temperature check

• Provide sanitization wipes and hand sanitizer - this should be located next to the door with clear signage, to ensure that all clinic visitors properly sanitize their hands.

• Screening questions to ask visitors:

  1. Are you feeling sick or experiencing any of the symptoms mentioned here. (Examples include a new cough, headache, weakness, fever, difficulty breathing, etc.)

  2. Have you travelled outside Canada in the past 14 days?

  3. Did you provide care or have close contact with a person with COVID-19 (probable or confirmed) while they were ill?

If possible, online consultations will be provided via video conferencing to assess the required treatment. If there are no urgent appointments, alternative at-home recommendations of exercises will be offered to help mitigate symptoms until an appointment is available.

• Online content can be created to demonstrate steps that clients can follow to help them with exercises. Offering tips for therapies that they can perform themselves is also a good way to help with this transition.

• Live demonstrations can be provided to help give expert advice, without patients having to come into the clinic itself.

• This is a good opportunity to discuss any risks or concerns from the client, as well as put them at ease of steps that have been taken to ensure their comfort when undergoing chiropractic treatments.

Physical distancing measures:

• Create at least 6 feet of distance between each other and within shared areas.

  • Spaces are clearly labelled by visual markings for any areas where clients may be in line.

  • Managing the flow of client arrivals and providing a virtual waiting room are a few suggested solutions.

• Limit the number of occupants in an elevator at the same time (depending on where the 6 foot mark is in the elevator).

• Ensure that employees standing in the designated smoking area must also be at least 6 feet apart.

• Installing plexiglass barriers in front of the receptionist area is an efficient way to achieve proper physical distancing measures. Their material also allows them to be easily sanitized with disinfectant.

Workplace sanitation

• Enforce hand washing guidelines to be posted in all washrooms (See recommended hand washing protocols for further resources).

  • Provide a hand washing or sanitization facility near the entrance of the facility.

• Clear signage near the entrance, washrooms, waiting areas, break rooms and treatment areas regarding hand hygiene, donning and doffing of PPE (Personal Protective Equipment), use of break rooms and where and when food and beverages should be consumed. More info on general guidelines here.

• Thoroughly sanitize all commonly used equipment between each appointment and use. This may include:

  • Gurneys or massage tables

  • Chairs

  • Bottles and other frequently handled equipment

Employee zoned areas and breakout rooms:

• Provide fully-sterilized areas or zones designated for staff only intended for food, beverages and removing any personal protective equipment.

• Provide a hand washing or hand sanitization facility closest to the entrance of this break room.

• Prohibit access to clients and visitors.

• Clear instructions on how to remove and/or discard staff related PPE. See here for more general guidelines.

  • Provide garbage bins at all facility entrance, exits and staff break rooms to properly discard one time use PPE.

• Ensure there is limited sharing of utensils, as well as that any shared utensils are thoroughly cleaned between each use.

Provide PPE to be readily available for all staff to cover nose, mouth and eyes.

• Ensure all staff know how to properly use their PPE.

Provide education, training and awareness to staff. See more details here.

• Hand hygiene

• Donning and doffing of PPE

• Use of break rooms

• Proper handling and cleaning of shared equipment and tools

Group employees in cohorts for all shifts.

• If one employee tests positive for COVID-19, the entire group may need to be tested (depending on your local Public Health Authority).

• Breaks are staggered throughout the day to encourage physical distancing.

Prepare an outbreak management plan including communication protocol in the event that your staff have tested positive for COVID-19. This includes but not be limited to the following:

• Training and certification for IPAC: https://www.publichealthontario.ca/en/education-and-events/online-learning/ipac-courses (Infection Prevention and Control (IPAC) – Online Learning)

• Communication to Public Health (notify accordingly if any of your staff has tested positive).

• Measures taken for increased cleaning.

• Tracing staff exposure by placing employees into cohorts to determine other potential exclusions.

Create policies to be set up to prevent employees from working if they have symptoms or have had symptoms in the last 48 hours (including temperature screening).

• Contactless methods of temperature screening are recommended where possible, with the use of digital thermometers for accuracy. These are available for all employees pre-shift.

• Any new symptoms, including but not limited to: fever, cough, shortness of breath, muscle aches, fatigue, sore throat, conjunctivitis (red eyes), loss of appetite, increased spit up, dizziness, headache, runny nose, chest pain, coughing up blood, diarrhea, nausea/vomiting, abdominal pain, stuffy nose, lost of taste or smell.

• In the case that any unusual or suspicious symptoms are present, employees will refrain from coming into work and follow local public health protocol regarding testing.

• Encourage remote working where possible to reduce in office traffic.

Follow hand washing guidelines posted in all washrooms.

Use PPE provided by employer to cover nose, mouth and eyes (eg. non-surgical masks, plus face shields or safety glasses).*

• If plexiglass face screens are used, these will be sanitized between each appointment.

Self-monitor for symptoms and do not report to work if the symptoms are present.

• If these symptoms are developed at the workplace, employees should inform their employer promptly to be temporarily relieved of their duties.

Enable contactless payment solutions to be the default method of payment to limit any physical contact with the employees and reception area.

Conduct post-treatment consultations over video conferencing and phone tools. These can be scheduled prior to or post-appointment using online booking systems.

Send satisfaction surveys around service and adherence to COVIDsafe measures to the client following the meeting to ensure standards were properly met.

Ensure there is enhanced cleaning of all office areas — this includes high-touch surfaces, resident rooms and washrooms, which should be cleaned at least twice a day.

Establish a separate washroom for staff and clients (recommended)

• Signs are printed to ensure that the toilet lid is closed before flushing the toilet, as COVID has been found in both urine and stool.

Use EPA approved disinfectants for the appropriate length of time (each disinfectant has its own guideline on contact length of time to kill the virus).