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.


Checklist PNPTemplates

EnglishUpdatedAs GaeilgeUpdated
Pre-Return to Work FormPDFpdf_icon21/05/21PDFpdf_icon21/05/21
COVID-19 Response PlanPDFpdf_icon21/05/21PDFpdf_icon21/05/21

Employer PNPEmployer Checklists

EnglishUpdatedAs GaeilgeUpdated
Checklist 1: Planning and PreparingPDF pdf_icon21/05/21PDF pdf_icon21/05/21
Checklist 2: Infection Prevention and Control (IPC) MeasuresPDFpdf_icon21/05/21PDF pdf_icon21/05/21
Checklist 3: COVID-19 InductionPDF pdf_icon21/05/21PDFpdf_icon21/05/21
Checklist 4: Dealing with a Suspected Case of COVID-19PDF pdf_icon21/05/21PDFpdf_icon21/05/21
Checklist 5: Cleaning and DisinfectionPDF pdf_icon21/05/21PDF pdf_icon21/05/21

Worker PNPEmployee Checklist

EnglishUpdatedAs GaeilgeUpdated
Checklist 6: WorkersPDFpdf_icon21/05/21PDFpdf_icon21/05/21

LWR1 PNGLead Worker Representative(s) Checklist

EnglishUpdatedAs GaeilgeUpdated
Checklist 7: Lead Worker Representative(s) ChecklistPDFpdf_icon21/05/21PDFpdf_icon21/05/21
Lead Worker Representative Poster (A3)PDFpdf_icon10/03/21PDFpdf_icon22/04/21
Lead Worker Representative Poster (A4)PDFpdf_icon10/03/21PDFpdf_icon22/04/21

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.