necessary to comply with any applicable federal, state, or local public
health laws, standards, and guidelines in their COVID-19 plans.
    Under paragraph (c)(2), an employer with more than 10 employees is
required to develop and implement a written COVID-19 plan. While OSHA
has concluded that a COVID-19 plan is necessary for all employers
covered by the ETS, OSHA has determined that only employers with more
than 10 employees need to have a written plan. This cutoff of 10
employees is consistent with OSHA's employer size cutoff for both the
COVID-19 log requirement in this ETS and in the partial exemption from
recordkeeping requirements in 29 CFR 1904.1. In the case of employers
with 10 or fewer employees, the agency does not believe that there is a
high likelihood of misunderstanding when employers communicate their
COVID-19 plans to employees verbally. As a result, OSHA does not
believe the added burden on small employers of establishing a written
plan is necessary, particularly given the need for rapid implementation
of the ETS. However, small employers may opt to create written COVID-19
plans if they find doing so is helpful in developing and implementing
their COVID-19 plans.
    In contrast, the agency is concerned that when employers have more
than 10 employees there is likely sufficient complexity in the
employer's operation that putting the COVID-19 plan in writing is
necessary to establish clear expectations and prevent miscommunication.
For example, employers with more than 10 employees may have employees
working in multiple locations or on multiple shifts, increasing the
likelihood that verbally communicating the employer's COVID-19 plan
will be ineffective. Therefore, OSHA believes that having a written
COVID-19 plan that employees of larger employers can easily access is
essential to ensure those employees are informed about policies,
programs, and protections implemented by their employers to protect
them from COVID-19-associated hazards. This approach is consistent with
OSHA's practice of allowing employers with 10 or fewer employees to
communicate their emergency action plans (29 CFR 1910.38) and fire
prevention plans (29 CFR 1910.39) orally to employees.
    An employer may have already developed and implemented a COVID-19
plan to protect employees from exposure to COVID-19. Existing COVID-19
plans may fulfill some of the requirements in this section. It is not
OSHA's intent for employers to duplicate current effective COVID-19
plans, but each employer with a current COVID-19 plan must evaluate
that plan for completeness to ensure it satisfies all of the
requirements of this section. Employers with existing plans must modify
and/or update their current COVID-19 plans to incorporate any missing
required elements, and provide training on these new updates or
modifications to all employees. Employers with more than 10 employees
must ensure their existing COVID-19 plan is in writing.
    For those employers who do not already have a COVID-19 plan in
place, OSHA will be releasing significant

compliance assistance materials, including a model healthcare-specific
plan to accompany the standard, which will significantly streamline
this step for many businesses. In addition, the Centers for Disease
Control and Prevention (CDC) has developed Guidance for Businesses and
Employers Responding to Coronavirus Disease 2019 (CDC, March 8, 2021)
and Healthcare Facilities: Managing Operations During the COVID-19
Pandemic (CDC, March 17, 2021), that may be helpful to employers in
developing a plan. OSHA has also published key resources for all
businesses, including Protecting Workers: Guidance on Mitigating and
Preventing the Spread of COVID-19 in the Workplace (OSHA, January 29,
2021), Guidance on Returning to Work (OSHA, June 18, 2020) and Guidance
on Preparing Workplaces for COVID-19 (OSHA, March 9, 2020).\131\ (OSHA
and the U.S. Department of Health and Human Services developed the
latter jointly.) The Guidance on Preparing Workplaces for COVID-19
document is based on traditional infection prevention and industrial
hygiene practices, and is meant to help employers and employees
identify risk levels in workplace settings and determine appropriate
control measures to implement. The Guidance on Returning to Work
document complements Guidance on Preparing Workplaces for COVID-19 and
focuses on the need for employers to develop and implement strategies
for hand hygiene, cleaning and disinfection of high-touch surfaces,
physical distancing, identification and isolation of sick employees,
workplace controls and flexibilities, and employee training. The
Protecting Workers: Guidance on Mitigating and Preventing the Spread of
COVID-19 in the Workplace document is intended to help employers and
workers implement a coronavirus prevention program, with several
essential elements, and better identify risks which could lead to
exposure and contraction.
---------------------------------------------------------------------------

    \131\ OSHA's Guidance on Returning to Work (OSHA, June 18,
2020), Guidance on Preparing Workplaces for COVID-19 (OSHA, March 9,
2020), and Protecting Workers: Guidance on Mitigating and Preventing
the Spread of COVID-19 in the Workplace (OSHA, January 29, 2021)
have now been archived. However, the information in these documents
can still be a useful resource for employers as they develop or re-
evaluate their COVID-19 plans.
---------------------------------------------------------------------------

    Additionally, the U.S. Equal Employment Opportunity Commission
(EEOC) has developed guidance regarding What You Should Know About
COVID-19 and the ADA, the Rehabilitation Act, and Other EEO Laws (EEOC,
May 28, 2021). Employers are encouraged to review this guidance as they
develop their COVID-19 plan, including policies and procedures for
health screenings, as well as return to work plans. Additional
information about labor, disability, and employment laws is available
on the Summary of the Major Laws of the Department of Labor web page
(DOL, 2020).
    Paragraph (c)(3) requires the employer to designate one or more
workplace COVID-19 safety coordinators to implement and monitor the
COVID-19 plan. In order to perform these tasks effectively, the safety
coordinator(s) should be able to understand and identify COVID-19
hazards in the workplace. The COVID-19 safety coordinator(s) must be
knowledgeable in infection control principles and practices as they
apply to the workplace and employee job operations. For example, safety
coordinator(s) must be knowledgeable about the CDC's infection control
recommendations, as well as employer policies and procedures
implemented in accordance with the same (e.g., the patient screening
and management strategies implemented pursuant to paragraph (d)(3)).
Additionally, the safety coordinator(s) must have the authority to
ensure compliance with all aspects of the COVID-19 plan so that they
can take prompt corrective measures when hazards are identified. For
employers with more than 10 employees, the name of the safety
coordinator(s) must be documented in the written COVID-19 plan.
    Employers must designate a safety coordinator(s) to implement and
monitor the COVID-19 plan, but the exact responsibilities of a safety
coordinator(s) may vary based on the employer and workplace. Possible
safety coordinator responsibilities may include conducting inspections
of the workplace. Regular inspections would provide a mechanism for
safety coordinator(s) to ensure the COVID-19 plan is being implemented
appropriately and to monitor the ongoing effectiveness of the plan.
During inspections, the safety coordinator(s) could observe employees
to ensure they are physically distancing and using appropriate PPE. At
places like reception or triage counters, where employees would have
encounters with members of the public, the safety coordinator(s) could
conduct inspections to ensure that there are appropriately-sized
physical barriers installed between employees and visitors. If an
employer relies on its safety coordinator to monitor compliance with
the requirements of its COVID-19 plan and this ETS, it must provide the
safety coordinator with adequate training on how to discharge those
duties.
    Paragraph (c)(4)(i) requires the employer to conduct a workplace-
specific hazard assessment to identify potential workplace hazards
related to COVID-19. The hazard assessment process is intended to help
employers identify and understand where COVID-19 hazards potentially
exist and what controls must be implemented in their workplace in order
to minimize the risk of transmission of COVID-19. As part of the hazard
assessment, employers must inspect the entire workplace to find
existing and potential risks of employee exposure to COVID-19. The
hazard assessment must include an evaluation of employees' potential
workplace exposure to all people present at the workplace, including
coworkers, employees of other entities, members of the public,
customers or clients, independent contractors, visitors, and other non-
employees. Places and times where people may congregate or come in
contact with one another must be identified and addressed, regardless
of whether employees are performing an assigned work task or not. For
instance, people may congregate during meetings or training sessions,
as well as in and around entrances, bathrooms, hallways, aisles,
walkways, elevators, breakrooms or eating areas, and waiting areas. All
of these areas must be identified and addressed as part of the hazard
assessment. Employers must consider how employees and other persons
enter, leave, and travel through the workplace, in addition to
addressing potential COVID-19 hazards employees are exposed to at fixed
work locations.
    Employers have flexibility to determine the best approach to
accomplish the overall hazard assessment. For example, the hazard
assessment could be adapted and tailored to specialized clinical
services, the physical characteristics of the workplace, the number of
people in the workplace, or the prevalence of COVID-19 in the
surrounding community. Employers may also want to consult state or
local public health laws, standards, and guidelines in determining how
best to conduct their hazard assessments. While conducting the hazard
assessment, employers must assess each employee's potential COVID-19
exposure but can do so generally. An employer could make a reasonable
assessment based on commonalities of tasks, environmental factors, and
work practices for one shift and prescribe the same protective

controls and work practices to other shifts or exposure groups of
employees with similar hazards and risk. For example, a hospital
employer may not need to conduct an individual hazard assessment for
each receptionist in an emergency room entrance area because the COVID-
19 hazards to which the receptionists are exposed would be the same.
However, if a particular receptionist has additional responsibilities
(e.g., greeting patients, intake for all COVID-19 patients, cleaning of
barriers), those tasks must be taken into consideration as part of the
overall hazard assessment.
    When conducting hazard assessments, employers should document the
following information to assist them in developing and implementing
their COVID-19 plans:

 Specific hazards or risk factors identified
 A plan to abate the identified hazards or risk factors in a
timely manner
 Date(s) the assessment was performed
 The names and titles of the individuals who participated in
the evaluation and contributed to the written plan
 A description of the actions to be taken
 Actions planned to address and prioritize mitigation of
identified hazards or risk factors
 Identification of high-risk area(s), tasks, and occupations
 Communication of the status of planned or completed actions to
employees who may be affected by the identified hazards or risk factors
 The dates by which planned actions are to be completed
 Written documentation of completed actions including:
    [cir] What method(s) of control was/were decided upon
    [cir] Area(s) where control(s) was/were implemented
    [cir] Specific date(s) of completion
    [cir] The names and titles of the individuals who authorized and
managed implementation of control

    When an employer identifies a COVID-19-related exposure hazard
during the hazard assessment, the employer must implement controls to
eliminate or mitigate the hazard, such as physical distancing, physical
barriers where appropriate and when distancing is infeasible, PPE, and
cleaning and disinfection protocols. These hazard controls must be
consistent with the relevant requirements in other paragraphs of this
ETS. The employer must develop a reasonable plan to abate identified
COVID-19 hazards.
    OSHA acknowledges that some of the controls required under other
paragraphs of this ETS may be potentially infeasible in some
situations. However, even in cases where an employer can demonstrate
that a particular control is appropriate but is not feasible, the
employer should still identify and implement alternative measures to
protect employees from COVID-19 exposure(s) to the extent feasible.
This ETS relies on a multi-layered strategy to minimize employee
exposure to COVID-19, and each of the controls provides a layer of
protection for employees. Therefore, when an employer is not
implementing a control that is appropriate but is not feasible, the
employer should take alternative abatement measures to account for the
loss of that protective layer.
    A finding of infeasibility is made on a case-by-case basis and is
highly dependent on the specific circumstances and facts in each
workplace. The concept of an infeasibility defense for non-compliance
with an OSHA standard is well-established under OSHA case law and is
always potentially available to employers. In general, compliance with
an OSHA standard is feasible when it is capable of being done.
Situations where some of the controls required under this ETS may be
infeasible might include where employees cannot maintain 6 feet of
distance from all other people in the workplace and also cannot remain
behind physical barriers while providing services (see the Summary and
Explanation for Physical Distancing for additional discussion about
distancing requirements). In these situations, employers should
consider implementing additional measures to protect their employees.
    An employer might identify other hazards during its hazard
assessment that warrant providing additional PPE to its employees,
beyond what is required by other paragraphs of this ETS. For example,
there may be employees whom the employer would not be required to
provide respirators pursuant to paragraph (f)(2) because the employees
are not exposed to a person with suspected or confirmed COVID-19.
However, those employees may face increased likelihood of COVID-19
exposure because they work in an environment where people with COVID-19
may be present. An employer may also have an employee who has an
underlying medical condition or other risk factors (e.g., chronic
obstructive pulmonary disease, heart condition, pregnancy) that would
place that employee at greater risk for severe illness if they get
COVID-19 (CDC, May 13, 2021). In these situations, employers could
consider upgrading the PPE provided to employees if their health
condition does not prevent it. As explained in paragraph (f)(4)(i), if
an employer provides a respirator in lieu of the required facemask,
then the employer must comply with the requirements under the COVID-19
Emergency Temporary Standard -- Mini Respiratory Protection Program (29
CFR 1910.504, herein referred to as the mini respiratory protection
program section). This ETS reduces the burden on employers and
employees who choose to upgrade to a respirator by allowing them to use
respirators pursuant to the mini respiratory protection program
section. Additional information about the mini respiratory protection
program section can be found in the summary and explanation for that
section.
    Paragraph (c)(4)(ii) requires employers seeking to be exempt from
providing controls under paragraph (a)(4) to include policies and
procedures in their COVID-19 plans to determine employees' vaccination
status. Although this requirement only applies to employers seeking the
exemption under paragraph (a)(4), the following discussion is also
relevant to employers seeking the exemption from the scope of the ETS
under paragraphs (a)(2)(iv) and (a)(2)(v). Employers seeking these
exemptions must determine employees' vaccination status in order to
determine whether the exemption from the ETS applies. In order to make
the determination of which workers are fully vaccinated, employers
could, for example, vaccinate their workforce themselves; review CDC
vaccination cards or similar verification issued by a pharmacy,
healthcare provider, or other vaccinator; if available, review state-
issued passes; or simply ask workers to attest whether they have been
fully vaccinated. If the employer is not able to determine that an
employee is fully vaccinated, the employer must treat that employee as
not fully vaccinated. Additional information about the exemptions in
paragraph (a)(4) can be found in the Summary and Explanation for
paragraph (a) (Scope and application).
    Under paragraph (c)(5), the employer must seek the input and
involvement of non-managerial employees and their representatives, if
any, in the hazard assessment and the development and implementation of
the COVID-19 plan. An employer can seek feedback from employees through
a variety of means, including safety meetings, a safety committee,
conversations between a supervisor and non-managerial employees, a
process negotiated with the exclusive bargaining agent (if any), or any
other similarly interactive

process. Other tools that may be helpful for employers in soliciting
feedback from employees may include employee surveys or a suggestion
box. The method of soliciting employee input is flexible and may vary
based on the employer and the workplace. For example, a large employer
with many employees may find a safety committee with representatives
from various job categories combined with anonymous suggestion boxes to
be more effective than individual conversations between supervisors and
non-managerial employees. In the case of a unionized workplace, a
safety committee established through a collective bargaining agreement
may be the appropriate source for this input based on the definition
and scope of the committee's work. In contrast, a small employer might
determine that an ongoing interactive process between the employer and
employees (e.g., regular safety meetings) is a more effective means of
soliciting employee feedback.
    The employer must monitor each workplace to ensure the ongoing
effectiveness of the COVID-19 plan and update it as needed, as required
in paragraph (c)(6). For example, COVID-19 plans may need to be updated
as more information about COVID-19 becomes available from the CDC, or
state and local agencies. Additionally, the safety coordinator might
learn of a deficiency during an inspection or from another employee.
Any deficiencies identified must be immediately addressed, and re-
training of all affected employees must occur.
    Paragraph (c)(7) requires an employer's COVID-19 plan to address
the hazards identified during the hazard assessment required by
paragraph (c)(4), and to include policies and procedures in accordance
with paragraphs (c)(7)(i) through (c)(7)(iii). Paragraph
(c)(7)(i)requires employers to develop policies and procedures to
minimize the risk of transmission of COVID-19 for each employee, as
required by paragraphs (d) through (n). Information about the
requirements of those paragraphs can be found in the corresponding
sections of the Summary and Explanation. Each of these elements, when
implemented together, provide multiple layers of protection for
employees. As explained in the note to paragraph (c)(7)(i), although
the employer's COVID-19 plan must account for the potential COVID-19
exposures to each employee, the plan can do so generally and need not
address each employee individually. For example, employers could
address unvaccinated employees collectively when pointing to hazards
from exposure to other unvaccinated employees, patients, or visitors
and instructing them what protective actions those employees are
expected to follow for specific situations such as when a visitor
enters without the source control of a face covering.
    The provisions in paragraph (c)(7)(ii) address effective
communication and coordination among employers. Specifically, these
provisions prescribe the information-sharing responsibilities of
employers who share the same physical location. OSHA intends this
requirement to help prevent employees of one employer from creating
hazards for employees of a different employer, and to facilitate
information-sharing between employers when one employer has the
authority to address ventilation, barrier installation, or cleaning in
an area occupied by employees of a different employer. As explained
above, physical location means a site, or an area within a site, where
work or any work-related activity occurs. The full definition for
physical location can be found in paragraph (b). The provisions in
(c)(7)(ii) are necessary to ensure that critical information-sharing
and coordination take place at all workplaces covered by the ETS.
    When employees of different employers share the same physical
location, paragraph (c)(7)(ii)(A) requires that each employer
communicate its COVID-19 plan to all other employers present and
coordinate to ensure that each of its employees is protected.
Additionally, employers must adjust their COVID-19 plans to address any
particular COVID-19 hazards presented by the other employer's employees
who share the physical location.
    Paragraph (c)(7)(ii)(A) does not apply to delivery people,
messengers, and other employees who only enter a workplace briefly to
drop off or pick up items. For example, if an employee of a delivery
company enters a workplace to deliver a package and then immediately
leaves the workplace, the employers regularly present at the physical
location (e.g., the employer receiving the package) and the delivery
company do not need to communicate their COVID-19 plans in accordance
with this paragraph.
    Multiple employers working in the same physical location occurs
regularly. For example, in a hospital setting, an employer might
subcontract nursing or housekeeping tasks to other employers. When this
happens, each employer performing work at the site must communicate
their COVID-19 plans to the other employers and coordinate with them to
ensure all employees are adequately protected from COVID-19 exposure.
If the subcontracted employee is not properly protected and becomes
infected, that employee could pose a transmission risk to other
healthcare staff. In some cases, multiple employers may need to work
collaboratively for either or both employers to become eligible for
exceptions involving vaccinated employees. Paragraph (c)(7)(ii)(B)
contains a notification requirement for employers with one or more
employees working in a physical location controlled by another
employer. Specifically, those employers must notify the controlling
employer when their employees are exposed to conditions at the location
that do not meet the requirements of this section. Examples of
conditions that might not meet the requirements of this section that
would need to be reported could include communal high-touch surfaces
(e.g., elevator buttons or bathroom facilities) that are not being
adequately cleaned, or a physical barrier that has fallen down.
    The communication and coordination provisions in paragraph
(c)(7)(ii) are in addition to, and do not modify, OSHA's existing
multiemployer citation policy, including a controlling employer's
obligation to exercise reasonable care to detect and prevent violations
on the worksite.
    Lastly, paragraph (c)(7)(iii) includes requirements for employers
whose employees enter private residences or other physical locations
controlled by people not covered by the OSH Act (e.g., homeowners, sole
proprietors). These employers must include policies and procedures in
their COVID-19 plans to protect their employees entering those
locations, including procedures for leaving the worksite if protections
prove inadequate. Several methods of protecting employees are discussed
in the technological feasibility section of this document.
References
Centers for Disease Control and Prevention (CDC). (2021, March 8).
Guidance for Businesses and Employers Responding to Coronavirus
Disease 2019 (COVID-19). https://www.cdc.gov/coronavirus/2019-ncov/community/guidance-business-response.html. (CDC, March 8, 2021).
Centers for Disease Control and Prevention (CDC). (2021, March 17).
Healthcare Facilities: Managing Operations During the COVID-19
Pandemic. https://www.cdc.gov/coronavirus/2019-ncov/hcp/guidance-hcf.html. (CDC, March 17, 2021).
Centers for Disease Control and Prevention (CDC). (2021, May 13).
People with Certain Medical Conditions. https://www.cdc.gov/
coronavirus/2019-ncov/need-extra-precautions/people-with-

medical-conditions.html. (CDC, May 13, 2021).
Equal Employment Opportunity Commission (EEOC). (2021, May 28). What
You Should Know About COVID-19 and the ADA, the Rehabilitation Act,
and Other EEO Laws. https://www.eeoc.gov/wysk/what-you-should-know-about-covid-19-and-ada-rehabilitation-act-and-other-eeo-laws. (EEOC,
May 28, 2021).
Occupational Safety and Health Administration (OSHA). (2020, March
9). Guidance on Preparing Workplaces for COVID-19. https://www.osha.gov/Publications/OSHA3990.pdf. (OSHA, March 9, 2020).
Occupational Safety and Health Administration (OSHA). (2020, June
18). Guidance on Returning to Work. https://www.osha.gov/Publications/OSHA4045.pdf. (OSHA, June 18, 2020).
Occupational Safety and Health Administration (OSHA). (2021, January
29). Protecting Workers: Guidance on Mitigating and Preventing the
Spread of COVID-19 in the Workplace. https://www.osha.gov/coronavirus/safework. (OSHA, January 29, 2021).
United States Department of Labor (DOL). (2020). Summary of the
Major Laws of the Department of Labor. https://www.dol.gov/general/aboutdol/majorlaws. (DOL, 2020).

C. Patient Screening/Management

    Patient screening and management strategies aim to identify and
manage those individuals who may have COVID-19 before entering a
facility so that appropriate precautions can be implemented to prevent
transmission to others within the workplace. Therefore, paragraph (d)
includes provisions for screening and management of persons, including
patients, entering settings where direct patient care is provided. The
patient screening and management required under paragraph (d) is in
addition to health screening for employees that is required under
paragraph (l)(1). The additional screening required under paragraph (d)
does not extend to employers covered by the ETS that do not provide
direct patient care.
    Paragraph (d)(1) requires employers in settings where direct
patient care is provided to limit the number of entrances to the
facility, as well as provide a monitoring system for each point of
entry to ensure that persons do not enter the facility without going
through screening. Paragraph (d)(1) does not apply to emergency
responders or other licensed healthcare providers entering a non-
healthcare setting or private residence to provide healthcare services.
For example, this provision would not apply to a paramedic providing
care to a person in their private residence.
    Under paragraph (d)(2), employers must screen all individuals who
enter the facility (e.g., clients, patients, residents, delivery people
and other visitors, and other non-employees). As defined in paragraph
(b), screen means asking questions to determine whether a person is
COVID-19 positive or has symptoms of COVID-19. Although it is not a
perfect tool, screening is an important aspect of a multi-layered
approach to minimizing workplace exposures to COVID-19. Employers must
include their screening and management procedures in their COVID-19
plans, which must be written if the workplace setting has more than 10
employees (see paragraphs (c)(7)(i), (c)(2)). As noted following
paragraph (d), the use of telehealth services, when appropriate and
available, is encouraged. For example, employers may use phone or video
platforms to conduct screening on a patient, client, resident, or other
visitor prior to their arrival at the facility/workplace. Employers
could also schedule patients for telehealth visits, where medically
appropriate. Using telehealth in these ways helps to reduce the number
of individuals entering a facility/workplace as well as reduce employee
exposure, while not compromising the health of the patient.
    OSHA notes that it views asking questions about COVID-19 symptoms
and illness as the minimum requirement for screening. Employers may
choose to employ other methods in addition to the required questions,
such as temperature checks, in the conduct of screening. Screening may
also include confirming that individuals are abiding by the employer's
policies and procedures for wearing face coverings in the facility, in
accordance with paragraph (d)(3), as well as assessing individuals'
recent exposures to COVID-19.
    Under this same provision (paragraph (d)(2)), employers are also
required to establish policies to triage any individual who may be
experiencing COVID-19 symptoms or illness. The screening and triage
process is a tool to identify patients who require specific patient
management practices under paragraph (d)(3) in order to protect both
employees and other patients or visitors. In some cases, visitors who
present with COVID-19 symptoms or illness may be restricted from
entering and referred to a physician or different facility for proper
evaluation. Other triage policies could include: Rescheduling of
surgery, physician visit, or home health visit; referral for treatment
and isolation of the patient to a separate area; or if at a home visit,
leaving the residence and rescheduling the visit. When an in-person
visit is unavoidable, each employer must develop policies and
procedures, including those required by the remaining provisions of the
ETS, to triage those patients who are identified through screening as
having COVID-19 symptoms or illness and ensure employee protection from
COVID-19 transmission. Those patients should either be isolated in a
separate area (e.g., examination room) with the door closed or asked to
wait in their vehicle to be called in for their appointment. The CDC
offers additional guidance on triaging patients (CDC, February 25,
2021).
    Paragraph (d)(3) requires employers to implement other applicable
patient management strategies. OSHA notes that in this context, patient
management strategies must address the management of individuals other
than patients who enter the facility for patient-related reasons, such
as family members or others who accompany patients to ambulatory care
appointments or visit hospitalized patients or nursing home residents.
    The applicable patient management strategies the employer must
implement under paragraph (d)(3) must be in accordance with the ``CDC's
COVID-19 Infection Prevention and Control Recommendations'', which is
incorporated by reference as specified in 29 CFR 1910.509 (CDC,
February 23, 2021). For example, that document provides for patients
and visitors to wear well-fitting source control (cloth masks,
facemasks, or respirators) and for appropriate patient placement to
help reduce the risk of COVID-19 transmission. OSHA expects employers
to comply with these and other patient management strategies in the
``CDC's COVID-19 Infection Prevention and Control Recommendations,'' to
the extent they are applicable.
    As another example of a patient management strategy, patients who
have been admitted may need to be screened daily for new fever onset or
other suspected COVID-19 symptoms, as they may require additional
medical treatment, or may need placement on appropriate Transmission-
Based Precautions (see next section). If the admitted patient develops
a high fever and persistent cough, which may indicate a possible COVID-
19 infection, that patient may need to be isolated in a private room
and placed under Droplet Precautions or Airborne Precautions.
Transmission-Based Precautions are further described in the Summary and
Explanation of Standard and Transmission-Based Precautions.
    Other patient management strategies include posting visual alerts
(e.g., signs,

posters) at the entrance and in other strategic places (e.g., waiting
areas, elevators) relevant to patient management practices that provide
instructions in appropriate languages and education levels about
wearing face coverings, maintaining physical distancing, and performing
timely hand hygiene and proper respiratory etiquette. It may also be
necessary to provide face coverings for patients and visitors, as well
as supplies for hand and respiratory hygiene, including hand sanitizer
(with at least 60% alcohol), tissues, and no-touch waste receptacles at
entrances, in waiting areas, and at patient check-ins.
References
Centers for Disease Control and Prevention (CDC). (2021, February
23). Interim Infection Prevention and Control Recommendations for
Healthcare Personnel During the Coronavirus Disease 2019 (COVID-19)
Pandemic. https://www.cdc.gov/coronavirus/2019-ncov/hcp/infection-control-recommendations.html. (CDC, February 23, 2021).
Centers for Disease Control and Prevention (CDC). (2021, February
25). Standard Operating Procedure (SOP) for Triage of Suspected
COVID-19 Patients in non-U.S. Healthcare Settings: Early
Identification and Prevention of Transmission during Triage. https://www.cdc.gov/coronavirus/2019-ncov/hcp/non-us-settings/sop-triage-prevent-transmission.html. (CDC, February 25, 2021).

D. Standard and Transmission-Based Precautions

    Standard and Transmission-Based Precautions are the cornerstone for
all infection prevention activities to prevent the transmission of
communicable diseases to employees, patients, and other non-employees
in healthcare settings. Under paragraph (e), employers are required to
develop and implement policies and procedures that adhere to Standard
and Transmission-Based Precautions in accordance with ``CDC's
Guidelines for Isolation Precautions'' (incorporated by reference,
Sec.  1910.509) to reduce the transmission of COVID-19. The Standard
and Transmission-Based Precautions required by the ETS only extend to
exposure to SARS-CoV-2 and COVID-19 protection. The agency does not
intend the ETS to apply to other workplace hazards. The ``CDC's
Guidelines for Isolation Precautions'' (Siegel et al., 2007) is an
authoritative standard for infection prevention and control.
    Standard Precautions must be implemented regardless of the presence
of a suspected or confirmed infectious agent, such as COVID-19. The use
of Standard Precautions thus relies on the assumption that every
patient, all potentially-contaminated materials, and all human remains
in healthcare settings are potentially infected or colonized with an
infectious agent. Standard Precautions are similar to, but more
extensive than, ``universal precautions,'' which are required by OSHA's
Bloodborne Pathogens standard (the BBP standard, 29 CFR 1910.1030), to
prevent contact with blood or other potentially infectious materials
(as that term is defined in the BBP standard). Standard Precautions
were developed to integrate principles of universal precautions into
broader principles pertaining to routes of exposure other than the
bloodborne route, such as via the contact, droplet, or airborne routes.
For example, although the BBP standard might not apply, Standard
Precautions would be utilized when employees are exposed to urine,
feces, nasal secretions, sputum, vomit, and other body fluids, and also
when employees are exposed to mucous membranes and non-intact skin
(Siegel et al., 2007). Standard Precautions assume that when there is
exposure to these materials, the materials potentially contain
infectious agents that could be transmitted via the contact, droplet,
or airborne routes.
    The infection prevention and control methods used under Standard
Precautions will likely be similar to, but more extensive than, what
employers should already be implementing to protect employees against
exposures under the BBP standard. Standard Precautions not only include
the infection control methods specified as universal precautions (e.g.,
hand hygiene, the use of certain types of PPE based on anticipated
exposure, safe injection practices, and safe management of contaminated
equipment and other items in the patient environment), but also
include, for example, respiratory and cough etiquette (Siegel et al.,
2007).
    Transmission-Based Precautions are infection control practices that
are used in tandem with Standard Precautions but are based on the way
an infectious agent(s) may be transmitted. Transmission-Based
Precautions are the second tier of basic infection control and are to
be used in addition to Standard Precautions for patients who may be
infected or colonized with certain infectious agents, such as COVID-19,
for which additional precautions are needed to prevent infection
transmission. Unlike Standard Precautions, Transmission-Based
Precautions are only implemented if the presence of an infectious
agent, such as COVID-19, is suspected or confirmed.
    There are three categories of Transmission-Based Precautions:
Contact Precautions, Droplet Precautions, and Airborne Precautions
(Siegel et al., 2007).\132\ For diseases that have multiple routes of
transmission, more than one category of Transmission-Based Precautions
must be used. Whether one category or multiple categories of
Transmission-Based Precautions are used, they are always used in
addition to Standard Precautions. As described in Grave Danger (Section
IV.A. of this preamble), COVID-19 is capable of contact, droplet, and
airborne transmission in healthcare settings. As such, employers must
follow the appropriate precautions specified for these transmission
pathways, as applicable to their workplaces.
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    \132\ Contact Precautions are designed to prevent transmission
of infectious agents spread by direct or indirect physical contact
with an infected or contaminated individual, item, or surface.
Droplet Precautions are designed to prevent transmission of
infectious agents spread by direct respiratory or mucous membrane
contact with infectious droplets. Airborne Precautions are designed
to prevent transmission of infectious agents that remain infectious
over long distances and time when suspended in the air. (Siegel et
al., 2007).
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    An extensive review of current policies and procedures will help
employers ensure that paragraph (e) is met; when necessary, employers
must develop and implement any missing policies and procedures to
adhere to Standard and Transmission-Based Precautions. Additional
details on Standard and Transmission-Based Precautions are also
available in Need for Specific Provisions (Section V of this preamble).
    OSHA notes that the CDC has issued general and COVID-19-specific
recommendations that can inform employers developing and implementing
both Standard and Transmission-Based Precautions in accordance with
``CDC's Guidelines for Isolation Precautions'' (Siegel et al., 2007).
In developing policies and procedures in accordance with paragraph (e),
employers can look to a variety of sources, including Interim Infection
Prevention and Control Recommendations for Healthcare Personnel During
the Coronavirus Disease 2019 (COVID-19) Pandemic (CDC, February 23,
2021); Discontinuation of Transmission-Based Precautions and
Disposition of Patients with COVID-19 in Healthcare Settings (Interim
Guidance) (CDC, February 16, 2021); and Collection and Submission of
Postmortem Specimens from Deceased Persons with Confirmed or Suspected

COVID-19: Postmortem Guidance (CDC, December 2, 2020). As discussed in
Technological Feasibility (Section VI.A. of this preamble), many
employers subject to the ETS have already implemented these guidelines
in their workplaces, and the control practices contained in these
guidelines are technologically feasible.
References
Centers for Disease Control and Prevention (CDC). (2020, December
2). Collection and Submission of Postmortem Specimens from Deceased
Persons with Confirmed or Suspected COVID-19: Postmortem Guidance.
https://www.cdc.gov/coronavirus/2019-ncov/hcp/guidance-postmortem-specimens.html. (CDC, December 2, 2020).
Centers for Disease Control and Prevention (CDC). (2021, February
16). Discontinuation of Transmission-Based Precautions and
Disposition of Patients with COVID-19 in Healthcare Settings
(Interim Guidance). https://www.cdc.gov/coronavirus/2019-ncov/hcp/disposition-hospitalized-patients.html. (CDC, February 16, 2021).
Centers for Disease Control and Prevention (CDC). (2021, February
23). Interim Infection Prevention and Control Recommendations for
Healthcare Personnel During the Coronavirus Disease 2019 (COVID-19)
Pandemic. https://www.cdc.gov/coronavirus/2019-ncov/hcp/infection-control-recommendations.html. (CDC, February 23, 2021).
Siegel, J.D., Rhinehart, E., Jackson, M., Chiarello, L., and the
Healthcare Infection Control Practices Advisory Committee. (2007).
2007 Guideline for Isolation Precautions: Preventing Transmission of
Infectious Agents in Healthcare Settings. Centers for Disease
Control and Prevention. https://www.cdc.gov/infectioncontrol/guidelines/isolation/index.html. (Siegel et al., 2007).

E. Personal Protective Equipment (PPE)

I. Facemasks
    Paragraph (f) contains requirements for personal protective
equipment (PPE). The PPE requirements in paragraph (f) apply to
employees in covered workplaces, with the exception of fully-vaccinated
employees in well-defined areas where there is no reasonable
expectation that any person with suspected or confirmed COVID-19 will
be present (see paragraph (a)(4) and the Summary and Explanation for
paragraph (a)). First, paragraph (f)(1) addresses the use of facemasks.
Facemasks are required by the ETS because they offer both source
control (i.e., reducing the spread of large respiratory droplets to
others by covering an infected person's mouth and nose) and protection
for the wearer. As defined in paragraph (b), facemasks are surgical,
medical procedure, dental, or isolation masks that are FDA-cleared,
authorized by an FDA EUA, or offered or distributed as described in an
FDA enforcement policy. A detailed discussion on the use of facemasks
is in Need for Specific Provisions (Section V of the preamble).
    Paragraph (f)(1)(i) imposes the requirement that employers must
provide, and ensure that employees wear, a facemask that meets the
definition in paragraph (b) of this section. Facemasks provide
protection against exposure to splashes, sprays, and spatter of body
fluids from patients and others. Many employees in healthcare are
exposed to, and therefore need protection from, this hazard. This
requirement is based on CDC recommendations (CDC, February 23, 2021),
and OSHA has previously established that facemasks are essential PPE
for employees in healthcare, under both the general PPE standard (29
CFR 1910.132) and the Bloodborne Pathogens standard (29 CFR 1910.1030).
    Paragraph (f)(1)(ii) requires that employers ensure a facemask is
worn over the nose and mouth when an employee is indoors and when
occupying a vehicle with other people for work purposes. To be worn
properly, facemasks need to completely cover the wearer's mouth and
nose, and fit snugly against the sides of the face without gaps.
Employers must train employees on when and how to properly wear a
facemask in accordance with paragraph (n). Additionally, to ensure
facemasks are worn properly, an employer might appoint a manager or
senior employee to check that each employee is properly wearing a
facemask at the start of and throughout each shift. To serve as
additional reminders for employees, employers may want to display
signs/posters throughout the facility about proper facemask usage.
    Paragraph (f)(1)(ii) further requires employers to provide a
sufficient number of facemasks to each employee as needed to comply
with paragraph (f) and to ensure that each employee changes facemasks
at least one per day, whenever they are soiled or damaged, and more
frequently as necessary (e.g., patient care reasons). Facemasks can
become soiled or dirty by splashes, sprays, or spatters, from contact
with a contaminated surface, or by touching/adjusting it with
contaminated hands. Because facemasks can become soiled after each use
with bacteria and viruses, including the virus that causes COVID-19, it
is important they are replaced as specified in this paragraph,
including when they are soiled or damaged. Thus, employers are required
to provide a sufficient number of facemasks to each employee to ensure
compliance with these provisions. Employers might consider providing
supplemental face shields (further described below) to wear over
facemasks, which would reduce the frequency with which they become
soiled and the rate at which employees would have to change them during
the day.
    Paragraph (f)(1)(iii) contains exceptions to the facemask
requirements imposed in paragraph (f)(1)(ii) of this section. First, as
described in paragraph (f)(1)(iii)(A), when an employee is alone in a
room, they are not required to wear a facemask. However, if the
employee exits the room or another individual enters the room,
facemasks are required.
    Under another exception, paragraph (f)(1)(iii)(B), employees are
not required to wear facemasks while eating or drinking at the
workplace, as long as each employee is at least 6 feet apart or
separated by physical barriers from all other people. Employers may
accomplish this by staggering break times, allowing use of non-
traditional break areas (e.g., conference rooms), or letting employees
eat or drink outside where there may be more space, to ensure each
employee is at least 6 feet apart while eating or drinking. Additional
information on physical distancing and physical barriers is discussed
further in the Summary and Explanation for paragraphs (h) and (i),
respectively.
    The next exception, under paragraph (f)(1)(iii)(C), provides that
facemasks are not required for employees when they are wearing
respiratory protection in accordance with 29 CFR 1910.134 or paragraph
(f) of this section. Employees required to use respiratory protection
in accordance with 29 CFR 1910.134 for certain workplace hazards
unrelated to the COVID-19 pandemic are exempt from the facemask
requirements outlined in paragraph (f)(1) while they are wearing the
respirators. Respirators provide some source control but also more
critical protection to the wearer. Similarly, while employees are
wearing respirators in connection with the COVID-19 hazard, as required
in paragraphs (f)(2)-(f)(3) and (f)(5), they are exempt from the
facemask requirement. Finally, employees using respirators in
compliance with the mini respiratory protection program section of this
standard for voluntary respirator use are also exempt from the facemask
requirement in paragraph (f)(1) while wearing a respirator. This is
discussed in further detail in paragraph (f)(4) on

employee use of respirators when they are not required.
    Paragraph (f)(1)(iii)(D) contains another exception for facemask
use when it is important to see a person's mouth (e.g., communicating
with an individual who is deaf or hard of hearing) and the conditions
do not permit a facemask that is constructed of clear plastic (or
includes a clear plastic window). In such situations, the employer must
ensure that each employee wears an alternative to protect the employee,
such as a face shield, if the conditions permit it.
    Similarly, paragraph (f)(1)(iii)(E) contains an exception for
employees who cannot wear facemasks due to a medical necessity, medical
condition, or disability as defined in the Americans with Disabilities
Act (42 U.S.C. 12101 et seq.), or due to a religious belief. Exceptions
must be provided for a narrow subset of persons with a disability who
cannot wear a facemask or cannot safely wear a facemask, because of the
disability, as defined in the Americans with Disabilities Act (42
U.S.C. 12101 et seq.), including a person who cannot independently
remove the facemask. The remaining portion of the subset who cannot
wear a facemask may be exempted on a case-by-case basis as required by
the Americans with Disabilities Act and other applicable laws. In all
such situations, the employer must ensure that each employee wears a
face shield for the protection of the employee, if their condition or
disability permits it. Accommodations may also need to be made for
religious beliefs consistent with Title VII of the Civil Rights Act.
    Under the final exception, contained in paragraph (f)(1)(iii)(F), a
facemask is not required for an employee if the employer can
demonstrate that the use of a facemask presents a hazard to the
employee of serious injury or death (e.g., arc flash, heat stress,
interfering with safe operation of equipment). This exception ensures
employees remain protected from other potential or known workplace
hazards that could lead to injury. In such situations, the employer
must ensure that each employee wears an alternative to protect the
employee, such as a face shield, if the conditions permit it. OSHA
notes that specialized facemasks, or other specialized equipment that
does not meet the definition of a facemask in paragraph (b), may be
available to protect against the relevant hazard and also allow
effective protection against COVID-19. Any employee not wearing a
facemask under this exception must remain at least 6 feet away from all
other people unless the employer can demonstrate it is not feasible.
Finally, under this exception, the employee must resume wearing a
facemask when not engaged in the activity where the facemask presents a
hazard.
    A note to paragraph (f)(1)(iii)(F) states that, with respect to
paragraphs (f)(1)(iii)(D)-(F), the employer may determine that the use
of a face shield without a facemask, in certain settings, is not
appropriate due to other infection control concerns. These infection
control concerns, along with the rationale for this note, are discussed
in detail in Need for Specific Provisions (Section V of the preamble).
II. Face Shields
    Paragraph (f)(1)(iv) outlines requirements for face shields. As
defined in paragraph (b), face shields are devices, typically made of
clear plastic, that (i) are certified to ANSI/ISEA Z87.1, which is
incorporated by reference in 29 CFR 1910.509; or (ii) cover the
wearer's eyes, nose, and mouth to protect from splashes, sprays, and
spatter of body fluids, wrap around the sides of the wearer's face
(i.e., temple-to-temple), and extend below the wearer's chin. These
specifications are critical design parameters for face shields to
effectively contain respiratory droplets and prevent droplet
transmission.
    Paragraph (f)(1)(iv) first states that when a face shield is
required to comply with paragraph (f), or is otherwise required by the
employer, the employer must ensure that the face shields are cleaned at
least daily and are not damaged. Like facemasks, face shields can
become soiled or dirty by splashes, sprays, or spatters, from contact
with a contaminated surface, or by touching or adjusting the face
shield with contaminated hands. Each time they are worn, face shields
can become contaminated with bacteria and viruses, including the virus
that causes COVID-19, which poses a risk of transmission to employees
upon contact. Additionally, damaged face shields may not fit properly
and thus not meet the required specifications, thereby reducing their
effectiveness. Thus, employers must ensure that face shields are
regularly cleaned and are not used if damaged.
    When an employee provides their own face shield, paragraph
(f)(1)(iv) specifies that such face shield must meet the definition in
paragraph (b) and the employer is not required to reimburse the
employee for that face shield. In order to encourage the voluntary use
of face shields, OSHA is not imposing a separate duty on employers to
inspect or clean employee-provided face shields. Because OSHA
anticipates that employees choosing to voluntarily bring in their own
face shields for extra protection will also wear their face shields
outside of work, employees are expected to continue to care for them
and provide proper cleaning as necessary. The general availability of
cleaning supplies in the workplace, particularly if employer-provided
face shields were also available, would be sufficient to allow workers
to clean their own personal face shields as appropriate. More
significantly, while employer-provided face shields must be thoroughly
cleaned and disinfected because they might be shared between employees,
this particular reason for cleaning would not apply to personal face
shields, which would not be shared. Inspection is not required for
employee-provided face shields because the most likely damage to a face
shield (e.g., failure of the head harness or strap, or cracks in the
face shield) would render the face shield unusable or be blatantly
obvious and employees could revert to an employer-provided face shield,
if required.
III. Respirators and Other PPE
    Paragraphs (f)(2) through (f)(5) contain requirements addressing
the provision and use of respirators and other PPE. Information on why
OSHA is requiring the provision and use of respirators is discussed in
greater detail in Need for Specific Provisions (Section V of this
preamble).
    As defined in paragraph (b), a respirator is a type of PPE that is
certified by NIOSH under 42 CFR part 84 or is authorized under an EUA
by the FDA. These specifications are intended to ensure some consistent
level of testing, approval, and protection and to prevent the use of
counterfeit respirators that will not offer adequate protection, which
is important because respirators are intended to protect the wearer
when directly exposed to hazards. Respirators protect against airborne
hazards by removing specific air contaminants from the ambient
(surrounding) air or by supplying breathable air from a safe source.
Common types of respirators include filtering facepiece respirators
(FFRs), elastomeric respirators, and powered air-purifying respirators
(PAPRs). Face coverings, facemasks, and face shields are not
respirators.
    Paragraph (b) also contains definitions for the types of
respirators referred to in the definition of respirator. A filtering
facepiece respirator (FFR) is a negative-pressure particulate
respirator with a non-replaceable filter as an integral part of the
facepiece or with the entire facepiece composed of the non-

replaceable filtering medium. N95 FFRs are the most common type of FFR
and are the type of respirator most often used to control exposures to
infections transmitted via the airborne route. When properly worn, N95
FFRs filter at least 95% of airborne particles (CDC, January 11, 2021).
An elastomeric respirator, also defined in paragraph (b), is a tight-
fitting respirator with a facepiece that is made of synthetic or rubber
material that permits it to be disinfected, cleaned, and reused
according to the manufacturer's instructions. Elastomeric respirators
are equipped with replaceable cartridges, canisters, or filters.
Lastly, a powered air-purifying respirator (PAPR) is an air-purifying
respirator that uses a blower to force the ambient air through air-
purifying elements to the inlet covering. In general, an employer may
provide and ensure the use of any of these respirator types to comply
with the requirements in paragraphs (f)(2) through (f)(5).
    Paragraph (f)(2) addresses the provision and use of respirators and
other PPE for exposure to a person with suspected or confirmed COVID-
19. A detailed discussion of OSHA's rationale for requiring employers
to provide and ensure the use of respirators and other PPE for exposure
to a person with suspected or confirmed COVID-19 is in the Need for
Specific Provisions (Section V of the preamble).
    Paragraph (f)(2) requires two types of PPE whenever employees have
``exposure'' to a person with suspected or confirmed COVID-19. In this
context, exposure refers to close proximity, which includes being
within 6 feet or in the same room. As part of their COVID-19 hazard
assessments, employers must assess their facilities and practices and
identify areas where employees are reasonably anticipated to be exposed
to a person with suspected or confirmed COVID-19. This understanding of
exposure is consistent with the process employers are expected to
follow under OSHA's Bloodborne Pathogens standard, 29 CFR 1910.1030.
    Employers should always anticipate that personnel involved in
direct patient care will have exposure whenever they are treating
patients who are suspected or confirmed to have COVID-19. For example,
when the patient or client is suspected or confirmed to have COVID-19,
exposure should be anticipated in the following types of situations:
     Medical examinations, regardless of where they are
conducted;
     Medical assistant performing a nasal swab on a patient at
a COVID-19 testing location;
     Home healthcare aide bathing a patient in the patient's
home;
     A dental hygienist setting plates in a patient's mouth for
x-rays of a patient in a dental office.
    In other cases, whether an employer should reasonably anticipate
exposure to persons with suspected or confirmed COVID-19 depends on the
employee's location and job duties. Thus, for example, employers should
anticipate that an employee conducting screening and triage of patients
in an emergency room would have exposure to persons with suspected or
confirmed COVID-19, as their job involves determining whether patients
have symptoms that are consistent with a COVID-19 diagnosis. Likewise,
a security guard stationed at the entrance of an emergency room or
COVID-19 testing location should anticipate some exposure to visitors
with COVID-19. On the other hand, exposure would not normally be
anticipated for a security guard stationed at an employee-only entrance
where the employees are regularly screened for COVID-19 symptoms. A few
other examples of employees whose anticipation of exposure would vary
by job task or locations include the following:
     Housekeeping or other healthcare support personnel whose
duties involve entry into a room (or enclosed space, such as a
partitioned patient area in an emergency room) of a suspected or
confirmed COVID-19 patient to exchange laundry, clean, or remove trash.
     A maintenance person who enters the room of a patient with
suspected or confirmed COVID-19 or changes a light in a hallway while
such patients are nearby.
     A nutritionist entering the room of a resident with
suspected or confirmed COVID-19 in a nursing home to discuss dietary
requirements.
    As part of the COVID-19 plan development, employers must take steps
to minimize avoidable exposure of employees like janitors and
housekeeping personnel to persons with suspected or confirmed COVID-19.
For example, employers can implement administrative controls to
restrict visitors who are suspected to have COVID-19 to specific areas
and away from as many staff as possible. Employers can also designate a
limited group of janitors, food service, or maintenance staff to handle
all entries into rooms of suspected or confirmed COVID-19 patients and
defer maintenance or other services until after the patient has left
the room and there is an opportunity for an air exchange. Employers can
implement policies restricting the movement of patients who are
suspected or confirmed to have COVID-19, keep the doors to their rooms
closed, and locate them in specific areas of the facility where there
is less likelihood of unexpected interaction with staff.
    The types of PPE necessary to reduce employee risks from these
exposures are specified in paragraphs (f)(2)(i) and (f)(2)(ii). First,
under paragraph (f)(2)(i), the employer must provide a respirator to
each employee and ensure that it is provided and used in accordance
with OSHA's Respiratory Protection standard (29 CFR 1910.134). Second,
under paragraph (f)(2)(ii), the employer must provide gloves, an
isolation gown or protective clothing, and eye protection to each
employee and ensure that the PPE is used in accordance with OSHA's PPE
standard, 29 CFR part 1910, subpart I. The Respiratory Protection
standard requires, among other things, that the employer develop and
implement a written respiratory protection program with required
worksite-specific procedures and elements for required respirator use.
The program must include several elements, such as procedures for fit
testing and medical evaluations of employees. In any setting covered
under the ETS where employees are exposed to persons with known or
suspected COVID-19, employers are required to provide and ensure the
use of N95 FFRs or higher-level respirators and follow all requirements
under 29 CFR 1910.134.
    The COVID-19 pandemic has had an unprecedented impact on the
availability of FFRs, particularly N95 FFRs. While earlier in the
pandemic there were shortages and supply chain disruptions, more
recently the CDC acknowledged that the supply and availability of
NIOSH-approved respirators have increased significantly over the last
several months (CDC, April 9, 2021). Nonetheless, there may be times
when individual employers experience limitations or disruptions to the
supply of FFRs. Thus, a note to paragraph (f)(2) provides that, when
there is a limited supply of FFRs, OSHA will permit employers to follow
the CDC's ``Strategies for Optimizing the Supply of N95 Respirators''
(CDC, April 9, 2021). OSHA will examine whether there is a limited
supply of FFRs on a case-by-case basis, and intends this note to apply
only for the limited time when there is a limited supply of FFRs. For
example, where respirators or associated supplies and services are
readily available, this note will not apply. The note to paragraph
(f)(2) also encourages employers to select elastomeric respirators or
PAPRs instead of FFRs to

prevent shortages and supply chain disruption, where possible. Since
elastomeric respirators and PAPRs are reusable, they offer the
advantage of repeated use by employees, both during and beyond the
pandemic. It should be noted that elastomeric respirators and PAPRs
have specific use limitations and restrictions that need to be
understood when determining whether they are appropriate for specific
applications (CDC, October 13, 2020). Therefore, employers should
evaluate and determine whether elastomeric respirators or PAPRs are
suitable for particular tasks prior to using them as alternatives to
FFRs. For example, an elastomeric respirator with an exhalation valve
should not be used during surgical procedures due to concerns that air
coming out of the valve may contaminate the sterile field (CDC, October
13, 2020).\133\ Additionally, PAPRs should not be used in surgical
settings due to concerns that the blower exhaust and exhaled air may
contaminate the sterile field (CDC, April 9, 2021).
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    \133\ There are some newly designed NIOSH-approved half-mask
elastomeric respirators that can not only protect the wearer, but
also provide adequate source control by filtering the wearer's
exhaled air that may contain harmful viruses or bacteria (NIOSH,
March 1, 2021).
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    Paragraph (f)(3) addresses the provision and use of respirators and
other PPE during aerosol-generating procedures (AGPs) performed on
persons with suspected or confirmed COVID-19, which, under this
paragraph, includes AGPs performed on suspected or confirmed COVID-19
cases during autopsies. As defined in paragraph (b), an AGP is a
medical procedure that generates aerosols that can be infectious and
are of respirable size. The definition lists a number of types of
procedures that are considered to be AGPs for purposes of the ETS (see
below for additional discussion of the listed procedures). AGPs
performed on persons with suspected or confirmed COVID-19 are more
likely to generate higher concentrations of potentially infectious
respiratory aerosols than coughing, sneezing, talking, or breathing;
therefore, employees performing or assisting in the conduct of AGPs
performed on persons with suspected or confirmed COVID-19 are at an
increased risk for COVID-19 exposure and infection (CDC, March 4,
2021). Given the risks associated with AGPs performed on persons with
suspected or confirmed COVID-19, the ETS requires the provision and use
of respirators and other PPE when AGPs are performed on such persons. A
detailed discussion of OSHA's rationale for requiring employers to
provide and ensure the use of respirators and other PPE in these
circumstances is in the Need for Specific Provisions (Section V of the
preamble).
    Development of a comprehensive list of AGPs for healthcare settings
has not been possible due to limitations in available data on which
procedures may generate potentially infectious aerosols and the
challenges in determining if reported transmissions during AGPs are due
to aerosols or other exposures (CDC, March 4, 2021). Furthermore, there
is neither expert consensus, nor sufficient supporting data, to create
a definitive and comprehensive list of AGPs for this ETS (CDC, March 4,
2021). For example, based on limited available data, it is uncertain
whether aerosols generated from some procedures, such as nebulizer
administration and high-flow oxygen delivery, may be infectious. More
specifically, aerosols generated by nebulizers are derived from
medication in the nebulizer, and it is uncertain whether potential
associations between performing this common procedure and increased
risk of infection might be due to aerosols generated by the procedure
or due to increased contact between those administering the nebulized
medication and infected patients (CDC, March 4, 2021).
    Therefore, the only medical procedures that are considered AGPs for
the purposes of this ETS are: Open suctioning of airways; sputum
induction; cardiopulmonary resuscitation; endotracheal intubation and
extubation; non-invasive ventilation (e.g., BiPAP, CPAP); bronchoscopy;
manual ventilation; medical/surgical/postmortem procedures using
oscillating bone saws; and dental procedures involving ultrasonic
scalers, high-speed dental handpieces, air/water syringes, air
polishing, and air abrasion. Examples of procedures that are considered
AGPs under the ETS are a dentist or dental hygienist using an
ultrasonic scaler on a patient; a nurse intubating a patient; an
emergency medical technician (EMT) performing cardiopulmonary
resuscitation on a patient; and a coroner or medical examiner using an
oscillating bone saw during an autopsy. These and the other commonly
performed procedures listed above are considered AGPs because they
create uncontrolled respiratory secretions. They are also consistent
with those identified by the CDC as the most common AGPs in healthcare
settings (CDC, March 4, 2021; CDC, December 4, 2020; CDC, December 2,
2020).
    Paragraph (f)(3) requires that for AGPs performed on a person with
suspected or confirmed COVID-19, the employer must provide: (i) A
respirator to each employee and ensure that it is provided and used in
accordance with the Respiratory Protection Standard (29 CFR 1910.134);
and (ii) gloves, an isolation gown or protective clothing, and eye
protection to each employee and ensure that the PPE is used in
accordance with the PPE standard (29 CFR part 1910, subpart I). These
requirements are similar to those in paragraph (f)(2), discussed above.
    There are two notes to paragraph (f)(3). The first note provides
that, for AGPs performed on a person with suspected or confirmed COVID-
19, employers are encouraged to select elastomeric respirators or PAPRs
instead of FFRs. OSHA included this note in the regulatory text because
of the high risk associated with AGPs conducted on persons with
suspected or confirmed COVID-19. One published article explained why
filters certified as 99, 100, or HEPA (high-efficiency particulate
air), but not N95s, are appropriate for AGPs. Howard (May 12, 2020)
concluded that the correct selection of respirators for AGPs is ``of
the utmost importance in the current COVID-19 pandemic'' because
``high-risk aerosol-generating procedures may create aerosolization of
high viral loads that represent increased risk to healthcare workers.''
    PAPRs provide a higher level of respiratory protection than N95
FFRs. PAPRs reduce the aerosol concentration inhaled by the wearer to
at least 1/25th of that in the air, compared to a 1/10th reduction for
FFRs (CDC, November 3, 2020). Because they provide higher-level
respiratory protection than N95 FFRs, the CDC encourages the use of
PAPRs during AGPs regardless of the pathogen (i.e., not just for
protection against COVID-19) (CDC, November 3, 2020). Furthermore, the
CDC encourages the use of PAPRs during autopsy procedures on deceased
persons who had COVID-19 due to the likelihood of generation of
contagious aerosols during various autopsy procedures (CDC, December 2,
2020).
    Elastomeric respirators provide at least the level of respiratory
protection as N95 FFRs. Half-mask elastomeric respirators offer the
same level of protection as N95 FFRs (i.e., both N95 FFRs and half-mask
elastomeric respirators reduce the aerosol concentration inhaled by the
wearer to 1/10th of that in the air).\134\ Full-face

elastomeric respirators provide greater protection because of better
sealing characteristics and less face-seal leakage (and also provide
protection to more of the face including the eyes) (CDC, October 13,
2020). Full-face elastomeric respirators reduce the aerosol
concentration inhaled by the wearer to at least 1/50th of that in the
air (CDC, October 13, 2020).
---------------------------------------------------------------------------

    \134\ For more information on the minimum level of protection
that can be expected from any class of respirator (e.g., FFR, PAPR,
half-mask elastomeric respirator) when the respirator is properly
selected and used, see NIOSH/OSHA's (May 2015) Hospital Respiratory
Protection Program Toolkit at https://www.osha.gov/sites/default/files/publications/OSHA3767.pdf.
---------------------------------------------------------------------------

    The second note to paragraph (f)(3) is a reminder that additional
requirements, besides respirator requirements, specific to AGPs on
people with suspected or confirmed COVID-19 are contained in paragraph
(g). Additional information on paragraph (g) is discussed later in the
Summary and Explanation.
    Paragraph (f)(4) addresses the optional use of respirators by
employees when not required by the ETS. OSHA recognizes that there will
be cases where either an employer or an employee believes that
protection is needed beyond the facemask required by paragraph (f)(1).
Therefore, under paragraph (f)(4)(i), the employer may upgrade an
employee's protection by providing a respirator to the employee when
only a facemask is required by paragraph (f)(1). For example, an
employer that operates a hospital may choose to provide, or an employee
may choose to wear, a respirator instead of a facemask where an
employee is performing administrative work in an area of the hospital
where there is no reasonable anticipation of exposure to persons with
suspected or confirmed COVID-19. Per paragraph (f)(4)(ii), where the
employer provides the employee with a facemask as required by paragraph
(f)(1) of the section, the employer must permit the employee to wear
their own respirator instead of a facemask. In both circumstances, the
employer must comply with the mini respiratory protection program
section of the ETS (29 CFR 1910.504). OSHA intends this flexibility,
combined with lowered administrative requirements, to encourage more
respirator use because properly worn respirators will provide
significantly improved protection from COVID-19. Again, for a detailed
discussion of the mini respiratory protection program section, please
see the relevant discussion in this Summary and Explanation and Need
for Specific Provisions (Section V of the preamble).
    Paragraph (f)(5) addresses the provision and use of respirators and
other PPE based on Standard and Transmission-Based Precautions. Under
this paragraph, the employer must provide PPE (e.g., respirators,
gloves, gowns, goggles, face shields) to each employee in accordance
with Standard and Transmission-Based Precautions in healthcare settings
in accordance with CDC's ``Guidelines for Isolation Precautions,''
which is incorporated by reference into the ETS. The employer must also
ensure that the PPE is used in accordance with OSHA's PPE Standard, 29
CFR part 1910, subpart I. OSHA provides a more in-depth explanation and
discussion of Standard and Transmission-Based Precautions in the
relevant section of this Summary and Explanation, as well as Need for
Specific Provisions (Section V of the preamble).
References
Centers for Disease Control and Prevention (CDC). (2020, October
13). Elastomeric Respirators: Strategies During Conventional and
Surge Demand Situations. https://www.cdc.gov/coronavirus/2019-ncov/hcp/elastomeric-respirators-strategy/index.html. (CDC, October 13,
2020).
Centers for Disease Control and Prevention (CDC). (2020, November
3). Considerations for Optimizing the Supply of Powered Air-
Purifying Respirators (PAPRs). https://www.cdc.gov/coronavirus/2019-ncov/hcp/ppe-strategy/powered-air-purifying-respirators-strategy.html. (CDC, November 3, 2020).
Centers for Disease Control and Prevention (CDC). (2020, December
2). Collection and Submission of Postmortem Specimens from Deceased
Persons with Confirmed or Suspected COVID-19: Postmortem Guidance.
https://www.cdc.gov/coronavirus/2019-ncov/hcp/guidance-postmortem-specimens.html. (CDC, December 2, 2020).
Centers for Disease Control and Prevention (CDC). (2020, December
4). Guidance for Dental Settings: Interim Infection Prevention and
Control Guidance for Dental Settings During the Coronavirus Disease
2019 (COVID-19) Pandemic. https://www.cdc.gov/coronavirus/2019-ncov/hcp/dental-settings.html. (CDC, December 4, 2020).
Centers for Disease Control and Prevention (CDC). (2021, January
11). NIOSH-Approved N95 Particulate Filtering Facepiece Respirators.
https://www.cdc.gov/niosh/npptl/topics/respirators/disp_part/n95list1.html. (CDC, January 11, 2021).
Centers for Disease Control and Prevention (CDC). (2021, February
23). Interim infection prevention and control recommendations for
healthcare personnel during the coronavirus disease 2019 (COVID-19)
pandemic. https://www.cdc.gov/coronavirus/2019-ncov/hcp/infection-control-recommendations.html. (CDC, February 23, 2021).
Centers for Disease Control and Prevention (CDC). (2021, March 4).
Clinical questions about COVID-19: questions and answers. Which
procedures are considered aerosol generating procedures in
healthcare settings? https://www.cdc.gov/coronavirus/2019-ncov/hcp/faq.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fcoronavirus%2F2019
-ncov%2Fhcp%2Finfection-control-faq.html. (CDC, March 4, 2021).
Centers for Disease Control and Prevention (CDC). (2021, April 9).
Strategies for Optimizing the Supply of N95 Respirators. https://www.cdc.gov/coronavirus/2019-ncov/hcp/respirators-strategy/index.html. (CDC, April 9, 2021).
Howard, BE. (2020, May 12). High-Risk Aerosol-Generating Procedures
in COVID-19: Respiratory Protective Equipment Considerations.
Otolaryngol Head Neck Surg 163(1): 98-103. (Howard, May 12, 2020).
National Institute for Occupational Safety and Health (NIOSH).
(2021, March 1). Advancements in Elastomeric Respirator Technology
for Use as Source Control. https://blogs.cdc.gov/niosh-science-blog/2021/03/01/elastomeric_source-control/. (NIOSH, March 1, 2021).
National Institute for Occupational Safety and Health (NIOSH)/
Occupational Safety and Health Administration (OSHA). (2015, May).
Hospital Respiratory Protection Program Toolkit at https://www.osha.gov/sites/default/files/publications/OSHA3767.pdf. (NIOSH
and OSHA, May 2015).

F. Aerosol-Generating Procedures on Suspected or Confirmed COVID-19
Patients

    As discussed in Need for Specific Provisions (Section V of this
preamble), aerosol-generating procedures (AGPs) are well-known to be
high-risk activities for exposure to respiratory infections. As such,
paragraph (g) addresses policies and procedures that employers must
implement to protect employees who perform AGPs on persons with
suspected or confirmed COVID-19. This includes aerosol-generating
postmortem procedures (e.g., autopsies) because human remains can still
produce infectious droplets and particles (i.e., ``person'' includes
``human remains'' for the purpose of paragraph (g)).
    As defined in paragraph (b), AGPs are medical procedures that
generate aerosols that can be infectious and are of respirable size.
For the purposes of the ETS, only the following medical procedures are
considered AGPs: Open suctioning of airways; sputum induction;
cardiopulmonary resuscitation; endotracheal intubation and extubation;
non-invasive ventilation (e.g., BiPAP, CPAP); bronchoscopy; manual
ventilation; medical/surgical/postmortem procedures using oscillating
bone saws; and dental procedures involving ultrasonic scalers,

high-speed dental handpieces, air/water syringes, air polishing, and
air abrasion. For further information on why these procedures are
considered AGPs under the ETS, please see Need for Specific Provisions
(Section V of this preamble).\135\
---------------------------------------------------------------------------

    \135\ CDC guidelines recommend avoiding AGPs during postmortem
activities if possible. The guidelines also provide that, if aerosol
generation is likely and unavoidable (e.g., when using an
oscillating saw), appropriate engineering controls and PPE should be
used, and that these precautions, combined with the use of Standard
Precautions, will help prevent direct contact with infectious
material, percutaneous injury, and other hazards related to moving
human remains and handling embalming chemicals (CDC, December 2,
2020).
---------------------------------------------------------------------------

    If an AGP is performed on a person with suspected or confirmed
COVID-19, per paragraph (g)(1), the employer must limit the number of
employees present during the procedure to only those essential for
patient care and procedure support. This will ensure that as few
employees as possible are exposed to infectious aerosols.
    As noted in Grave Danger (Section IV.A. of this preamble), COVID-19
may spread through airborne transmission during AGPs. To this end,
paragraph (g)(2) requires that when an AGP is performed on a person
with suspected or confirmed COVID-19, the employer must ensure it is
performed in an existing airborne infection isolation room (AIIR), if
available. An AIIR, under paragraph (b), is defined as a dedicated
negative-pressure patient-care room, with special air handling
capability, which is used to isolate persons with a suspected or
confirmed airborne-transmissible infectious disease. AIIRs include both
permanent rooms and temporary structures (e.g., a booth, tent or other
enclosure designed to operate under negative pressure). For further
discussion on the need for adequate ventilation and AIIRs during AGPs,
please see Need for Specific Provisions (Section V of this preamble)
and the Summary and Explanation for ventilation (paragraph (k)(2)).
    There are a limited number of AIIRs available across the United
States, and the COVID-19 pandemic has created added demand for AIIRs
(Wilson, April 16, 2020). Based on this, OSHA concludes that the use of
AIIRs needs to be prioritized for those persons that present the
greatest exposure risk to employees (which, for the purposes of the
ETS, means those persons with suspected or confirmed COVID-19). OSHA's
decision to require the use of AIIRs only when AGPs are performed on
persons with suspected or confirmed COVID-19 is consistent with the
CDC's guidance on the use of AIIRs during AGPs (CDC, February 23,
2021).
    If an AIIR is not available for an AGP on a person with suspected
or confirmed COVID-19 (because, for example, the facility does not have
an AIIR), the employer may transfer the patient to a facility with an
available AIIR, if feasible. Employers may also consider the use of a
ventilated headboard with a canopy if an AIIR is not available.
However, if the procedure must be performed in the facility that does
not have an available AIIR, the employer should still isolate the
person to the extent feasible and distance that person from others when
isolation is not feasible. For example, the employer could ensure that
the procedure is performed in an isolated area of the facility.
Moreover, the employer will need to comply with other provisions of the
ETS, as well as all other applicable OSHA standards, during the conduct
of the procedure (e.g., providing employees with and ensuring they use
respirators and other PPE in accordance with paragraph (f), and
complying with requirements for ventilation in paragraph (k)).
    Paragraph (g)(3) requires that, after an AGP is performed on a
person with suspected or confirmed COVID-19, the employer must clean
and disinfect the surfaces and equipment in the room or area where the
AGP was performed. The employer must also develop and implement
policies and procedures in accordance with paragraphs (c) and (j) to
ensure prompt, proper cleaning and disinfection of the surfaces and
equipment in the room or area.
    Finally, a note to paragraph (g) provides that respirator and other
PPE requirements for use during AGPs are contained in paragraph (f)(3).
This note serves as a cross-reference.
References
Centers for Disease Control and Prevention (CDC). (2020, December
2). Collection and Submission of Postmortem Specimens from Deceased
Persons with Confirmed or Suspected COVID-19. https://www.cdc.gov/coronavirus/2019-ncov/hcp/guidance-postmortem-specimens.html. (CDC,
December 2, 2020).
Centers for Disease Control and Prevention (CDC). (2021, February
23). Interim Infection Prevention and Control Recommendations for
Healthcare Personnel During the Coronavirus Disease 2019 (COVID-19)
Pandemic. https://www.cdc.gov/coronavirus/2019-ncov/hcp/infection-control-recommendations.html. (CDC, February 23, 2021).
Wilson, M. (2020, April 16). Negative pressure rooms save lives. Why
aren't there more of them? Fast Company. https://www.fastcompany.com/90491094/negative-pressure-rooms-save-lives-why-arent-there-more-of-them. (Wilson, April 16, 2020).

G. Physical Distancing

    The virus that causes COVID-19 spreads mainly through droplet
transmission between people who are in physical proximity to each
other. Adequate physical distancing to prevent droplet transmission of
infectious diseases is generally considered to be at least 6 feet, as
addressed under Need for Specific Provisions (Section V of the
preamble). Therefore, paragraph (h)(1) requires employers to ensure
that each employee is separated from all other people by at least 6
feet when indoors. In cases where the employer can demonstrate that
maintaining 6 feet of physical distance is not feasible for a specific
activity, paragraph (h)(2) requires the employer to ensure that each
employee is as far apart as feasible from all other people in the
workplace. The requirements of paragraph (h) do not apply to momentary
exposure while people are in movement, such as when coworkers pass each
other in a hallway. However, this exception has important limits, as
discussed further below.
    Paragraph (a)(4) provides one notable exception to the physical
distancing requirements of paragraph (h) for employees who are fully
vaccinated when those employees are in well-defined areas where there
is no reasonable expectation that any person with suspected or
confirmed COVID-19 will be present. When those conditions are
satisfied, the fully vaccinated employees are not required to maintain
6 feet of distance from any other people. By operation of this
exception, employees who are not fully vaccinated are not required to
maintain 6 feet of distance from any fully vaccinated employee;
however, they must continue to follow distancing requirements as to all
other persons because employers may not be able to confidently
ascertain the vaccination status of non-employees. This exception might
arise, for example, if an employer provides a training or holds a
conference for its employees in a conference room where no patients or
persons with suspected or confirmed COVID-19 will be present. In that
example, the employer is not required to keep vaccinated employees
separate from any other people by 6 feet; however, if employees in
attendance are not fully vaccinated, the employer would be required to
ensure that the unvaccinated employees maintain sufficient physical
distance from all people other than the fully vaccinated employees,
such as other non-employee attendees, trainers, or conference
presenters. In another example, where

there is an employee breakroom, any employee who is fully vaccinated
would not be required to maintain physical distancing from any other
persons while using the breakroom. Again, however, any employee who is
not fully vaccinated would still be required to maintain at least 6
feet of distance from any persons other than their fully vaccinated co-
workers who might enter the space. In order for fully vaccinated
employees to be exempt from the requirement for physical distancing in
accordance with paragraph (a)(4), paragraph (c)(4)(ii) of the standard
requires the employer's COVID-19 plan to include policies and
procedures for determining employees' vaccinations status. For further
explanation of the exception for fully vaccinated employees from some
requirements of the ETS, see the Summary and Explanation discussion of
paragraph (a)(4), above.
    Employers must rely on the results of the hazard assessment
performed under paragraph (c)(4) to determine when and where physical
distancing is necessary in the workplace. The hazard assessment
requires employers to evaluate their workplaces to determine potential
workplace hazards related to COVID-19. This evaluation will involve
determining when, where, and under what circumstances employees come
within 6 feet of other people during the course of their workdays or
work shifts. After identifying where this is occurring, employers must
then implement, per their COVID-19 plans, policies and procedures to
comply with the physical distancing requirements in paragraph (h).
    To comply with the physical distancing requirements of the ETS,
employers must ensure there is at least a full 6 feet of distance
between each employee and any other person, such that neither person's
body intrudes into that 6 feet of space. The employer must evaluate
situations where employees are expected to come close to any other
individuals, including coworkers, patients or residents, visitors,
delivery or repair persons, and any other people present at the
workplace. Employers must also consider all areas accessed by employees
when determining how to implement the physical distancing requirements.
To be in compliance, an employer must ensure that 6 feet of distance
can be maintained when employees are: At their workstations, whether
they are fixed or mobile; arriving at and leaving a worksite; traveling
within a worksite to their designated workstations; using locker rooms
to change in and out of work clothing or PPE; using restroom facilities
and break areas; and otherwise performing their work duties and
activities incidental to those duties. (OSHA notes, however, the
exception for fully vaccinated employees in certain well-defined areas,
discussed above.)
    The note to paragraph (h) describes several ways employers can
implement physical distancing that would be in compliance with this
standard. OSHA recognizes that the provided list of examples is not
exhaustive and that some options may be infeasible in some workplace
settings. The agency also recognizes that physical distancing policies
will need to be specific for each workplace. The note to the physical
distancing provision is simply meant to provide a brief list of some of
the primary options for physical distancing that employers are expected
to consider in determining how to comply. For example, if an employee's
job activities can be completed entirely remotely, then physical
distancing could be easily maintained through telework or other remote
work arrangements. Employers should maximize their reliance on telework
or remote work whenever possible.
    When employees have job activities that must be done on-site or on-
location, other physical distancing approaches will be required. To
comply with physical distancing requirements, employers may need to
reconfigure workstations. Workstations could be spread out or relocated
to more spacious areas to ensure that employees at the workstations are
at least 6 feet away from each other. Workstations near high-traffic
areas may need to be moved to places with less foot traffic if physical
distance cannot be maintained.
    Shared workstations (e.g., security checkpoints, nursing stations)
may also need to be reconfigured to ensure physical distancing can be
maintained. However, for shared workstations that require extended use
over the course of a workday, it may be useful to schedule when
employees can use those stations by adjusting the timing of their use
or providing alternative locations. In settings where security
checkpoints are used, stations can be spread farther apart or
additional, unused desks can be utilized. Similarly, individual
workspaces at nursing stations can be spread farther apart, and visual
cues can be used to ensure nurses and other healthcare employees remain
6 feet apart when communicating.
    For workplaces that utilize shift work, minimal-contact shift
changes, in which employees maintain at least 6 feet of distancing
during shift turnover, can be considered. For these shift transitions,
detailed notes, virtual communications, and virtual oversight could be
substituted for in-person contact to help ensure important information
is not overlooked. Shift changes at healthcare facilities that involve
a large number of people may be particularly challenging in terms of
physical distancing. At these times, many employees may be entering or
leaving through a limited number of doors or using the same equipment
to clock in or clock out. It may also be foreseeable that weather
conditions (e.g., rain, heat, cold) could result in employees
congregating at facility entrances and exits. In these situations,
employers can consider permitting employees to utilize additional entry
or exit points, installing additional time clock equipment, or
staggering arrival and departure times to limit employee interactions.
Visual cues, such as signs or floor markings, can be utilized in
parking lots, sidewalks, lobbies, and other walking areas to designate
clear entry and exit routes and to remind employees and non-employees
to remain physically distant, especially during high-traffic times of
the day.
    Employers can also consider adjusting work processes to achieve
physical distancing. If workstations and work processes cannot be
physically rearranged in a way that allows 6 feet of distance at all
times, employers must consider additional measures, such as reducing
capacity and occupancy limits or altering work procedures. The
following measures could help ensure compliance with paragraph (h):
Limiting the types of services provided; limiting occupancy in the
establishment; installing visual cues (e.g., signs and floor markers)
to remind employees and others to maintain 6 feet between individuals;
enforcing one-way traffic flow; and using verbal public service
announcements to remind employees and non-employees to practice
physical distancing.
    Changing work procedures and utilizing available technologies can
also minimize or eliminate the necessity for close physical proximity
between employees and other people. For example, employers may
implement contactless transaction methods through mobile devices for
payments, signing documents, and pick-up and/or delivery confirmations.
Similarly, employers can consider adopting policies for booking
appointments by phone or online, curbside pickup, and drive-through
options to reduce the need for contact with customers or patients.
Phones or other visual recording and streaming devices may also be
useful in some facilities to perform physically-distanced equipment and
safety

inspections. Employers could maximize the use of telehealth to consult
with patients and clients through phone or video visits, where
appropriate.
    Subject to the exception for fully vaccinated employees in well-
defined areas where there is no reasonable expectation that any person
with suspected or confirmed COVID-19 will be present, employers must
also ensure that employees maintain physical distancing during
meetings, trainings, and conferences. This could be achieved through
the use of additional rooms to decrease group sizes or by scheduling
these activities to occur virtually. When on-site or hands-on training,
such as specialized equipment training, is necessary, employers could
consider holding one-on-one sessions instead of large group sessions to
minimize exposure risk. An employer could also consider offering
activities at multiple times to decrease the number of attendees in
each session.
    If ensuring physical distancing in compliance with paragraph (h)(1)
is not feasible given how work is currently scheduled, employers can
consider staggering work shifts. This would result in fewer people in
the workplace at a time, which should facilitate physical distancing.
Employers can also consider scheduling employees for fewer, longer
shifts instead of shorter, more-frequent shifts to minimize employee
turnover within the facility.
    Unless the exception for fully vaccinated employees in certain
well-defined areas applies, employers must also pay attention to
physical distancing during break times and within common areas where
employees normally congregate (e.g., nursing stations, locker rooms).
To maintain physical distance, employers may decide to replace or add
to existing break areas by using training or conference rooms that
provide more space for employees to spread out. Also, tables and chairs
may be spaced out, removed, or blocked off to limit occupancy and
create distanced seating arrangements. Chairs could be placed 6 feet
apart and only on one side of a table to ensure employees are not
facing each other while eating. An employer could also stagger break
times to reduce the number of employees using those spaces at any one
time.
    Also, where the exception in paragraph (a)(4) does not apply,
physical distancing must be implemented in workplace restrooms and
locker rooms. Some sinks, urinals, and stalls may need to be closed or
blocked off to ensure adequate space is maintained. There may be
certain times, such as during breaks, when the number of users
outnumbers the facilities available given the imposition of the
distancing requirement. Employers may find that additional restrooms or
queues outside of restrooms are needed to ensure that an appropriate
number of individuals are inside each restroom and that physical
distance is maintained outside of those spaces. If queues are needed,
visual floor markers may be useful to reinforce physical distancing
requirements. If restrooms have lounge areas, removing lounge furniture
can prevent people from congregating. In small facilities, employers
may have to limit access to a small restroom to only one person at a
time to maintain physical distancing.
    As stated in paragraph (h)(1), physical distancing is not required
for momentary exposures while people are in movement. As discussed
further in the Need for Specific Provisions (Section V of the
preamble), an employee generally needs to be both close enough to an
infectious person and near them long enough to get an infectious dose
of COVID-19. The time of exposure is cumulative; multiple short
exposures over the course of a day can add up to a long enough period
of time to receive an infectious dose of the virus. Therefore, OSHA
interprets this exception for momentary exposures as applying only in
situations where the momentary exposures happen on an infrequent or
occasional basis. If an employee quickly passes another person in a
hallway or aisle a few times a day, the distancing requirement of
paragraph (h)(1) would not apply. On the other hand, physical
distancing requirements would be required for short conversations in a
hallway or at a work station, as well as in other situations involving
frequent, brief contact.
    Similarly, the exception for momentary exposures in paragraph
(h)(1) does not apply to two employees in a workplace who repeatedly
pass by each other to perform their tasks. For example, physical
distancing (from employees and non-employees alike) is required where
employees are regularly moving around to check on patients. If
employees must pass each other repeatedly during a shift, the employer
must ensure employees maintain a physical distance of 6 feet in
accordance with the standard.
    Paragraph (h)(2) applies if an employer can demonstrate that it is
not feasible to maintain 6 feet of physical distance for a certain
activity. In such cases, paragraph (h)(2) requires employers to ensure
that the employee is as far apart from all other people as feasible.
The requirement in paragraph (h)(2) recognizes that, even where 6 feet
of distance cannot be maintained, keeping as much distance between
people as possible can help lower the possibility of transmission of
COVID-19, especially when combined with the other protections required
by the ETS.
    Paragraph (h)(2) acknowledges that there will be situations in some
workplaces in which maintaining 6 feet of distance at all times is not
possible. For example, there may be situations where a room or other
workspace is less than 6 feet in length and width and two employees
must be in it at one time. This could include spaces in vehicles, such
as emergency responders in an ambulance. If the employer can
demonstrate that the space cannot be expanded, and that both employees
must be in that space at the same time (i.e., that there are no other
feasible alternatives that would permit 6 feet of physical distancing),
the employer satisfies its burden under paragraph (h)(1) to demonstrate
infeasibility. The employer would then be required, pursuant to
paragraph (h)(2), to ensure that as much distance as possible is
maintained between the two employees in that space. The ETS also
generally requires the employer to ensure the use of physical barriers
at fixed work locations outside of direct patient care areas where each
employee is not separated from all other people by at least 6 feet (see
paragraph (i)) and the use of facemasks or respirators (see paragraph
(f)).
    Maintaining physical distance between a healthcare provider and
patient is not always feasible when conducting an in-person exam or
providing medical treatment, particularly within a small exam room.
However, it is more likely that physical distance of 6 feet can be
maintained when healthcare providers are asking patients questions
about their medical history or problems they are experiencing. Again,
the agency requires employers to ensure 6 feet whenever possible.
However, employees who provide medical care will also be protected by
other aspects of the ETS, including the use of facemasks or respirators
and other PPE, depending on the circumstances, and cleaning and
disinfection requirements (see paragraphs (f) and (j), respectively).
    Other job duties that may require employees to be within 6 feet of
others include patient transport, operations security, multi-person
maintenance tasks, and confined space work. Physical distancing of 6
feet may be difficult to maintain at all times in constricted areas,
even after the employer has reallocated work tasks or redesigned
workflow to maximize distancing. In all cases, the burden is on

the employer to demonstrate that it is infeasible to comply with the
required physical distancing for a specific activity. And in such
cases, employers must ensure that employees maintain as much physical
distance as feasible under paragraph (h)(2) and that physical
distancing is layered with the other means of protection required by
this standard (e.g., facemask use, cleaning and disinfection,
installation of physical barriers).
    Physical distancing may also be challenging to maintain at a shared
worksite or shared facility. In such a case, coordination with other
employers will be critical to determining when and where employees
should perform their tasks at the site. Also, as noted previously with
reference to emergency responders in an ambulance, when employees
operate or ride in work vehicles with other people in them (e.g.,
ambulances, shuttle buses), it might not always be possible to maintain
6 feet of distancing. Employers must first consider reducing capacity
in the vehicle to allow for 6 feet of physical distancing under
paragraph (h)(1). When that is not feasible, employers must ensure that
employees maintain as much distance as possible while in the vehicle
(paragraph (h)(2)).
    Although paragraph (h)(1) requires employers to ensure physical
distancing of at least 6 feet, respiratory droplets may at times be
capable of traveling across longer distances, as discussed further in
Grave Danger (Section IV.A. of the preamble). However, as explained in
the Need for Specific Provisions (Section V of the preamble), COVID-19
infections require exposure to a certain quantity of viral particles,
and exposures beyond 6 feet involve exposure to fewer particles.
Therefore, OSHA has concluded that a distance of 6 feet sufficiently
minimizes viral transmission in conjunction with the other aspects of
the layered infection control approach required under this ETS. While
the agency requires that employers, at a minimum, ensure 6 feet of
distance between people in the workplace, the agency also recommends
that employers implement physical distancing of more than 6 feet
whenever possible.

H. Physical Barriers

    Physical barriers intercept respiratory droplets, which can contain
COVID-19, and prevent them from being transmitted from person to
person. As such, physical barriers are an important component of this
ETS when workers cannot be separated from all other people by at least
6 feet. Paragraph (i) requires barriers to be installed at each fixed
work location outside of direct patient care areas where each employee
is not separated from all other people by at least 6 feet of distance,
except where the employer can demonstrate it is not feasible to install
the barrier.
    Paragraph (a)(4) provides an exception to the physical barrier
requirements of paragraph (i) for employees who are fully vaccinated
when those employees are in well-defined areas where there is no
reasonable expectation that any person with suspected or confirmed
COVID-19 will be present. When those conditions are satisfied, barriers
are not required to separate fully vaccinated employees from those who
are not fully vaccinated. Barriers must be provided in accordance with
paragraph (i) to separate employees who are not fully vaccinated from
other employees who are not fully vaccinated and all non-employees
because employers will not be able to confidently ascertain the
vaccination status of non-employees. In order for fully vaccinated
employees to be exempt from the requirement for physical barriers in
accordance with paragraph (a)(4), paragraph (c)(4)(ii) of the standard
requires the employer's COVID-19 plan to include policies and
procedures for determining employees' vaccinations status. For further
explanation of the exception for fully vaccinated employees from some
requirements of the ETS, see the Summary and Explanation discussion of
paragraph (a)(4), above.
    In paragraph (i), the barriers must be sized (e.g., height, width)
and located so that they block face-to-face pathways between the
employee and other individuals, based on where each person would
normally stand or sit. If necessary, barriers may have a pass-through
space at the bottom to be used to pass items from one side of the
barrier to the other. In healthcare and healthcare support services,
physical barriers are not required in patient care areas or resident
rooms, as stated in the note to paragraph (i).
    Fixed locations where barriers may be required under paragraph (i)
include entryways, lobbies, check-in desks, admission desks, screening
sites, intake and triage areas, hospital pharmacy windows, security
guard stations, and bill-payment counters; again, barriers would only
be required for these work locations where physical distancing cannot
be achieved. For example, a barrier may be required at a bill-payment
counter if employees or visitors are not able to maintain 6 feet of
physical distancing while at the counter.
    As noted following paragraph (i), physical barriers are not
required in direct patient care areas, such as treatment rooms,
examination rooms, and resident rooms in hospitals, long-term care
facilities, rehabilitation facilities, hospice facilities, or other in-
patient healthcare facilities. Direct patient care, as defined in
paragraph (b), is hands-on, face-to-face contact with patients for the
purpose of diagnosis, treatment, and monitoring. The CDC does not
recommend the installation of barriers between healthcare professionals
and their patients during direct patient care, so OSHA is not requiring
them, even when they might be feasible. Employers in healthcare may
consider installing barriers in direct patient care areas if
appropriate. However, in areas where direct patient care is not
provided, barriers are required when individuals cannot maintain at
least 6 feet of physical distancing under this provision.
    As part of the hazard assessment under paragraph (c)(4), employers
need to determine which job activities and fixed work locations require
physical barriers. This involves a determination, for each fixed work
location, of whether the employee(s) at that work location can be
separated from other people by at least 6 feet of distance. The
implementation of physical barriers in the workplace, including how
many are needed, where they are needed, and how they should be
installed, may vary with the size and type of the workplace, along with
the work activities performed there. As such, the provision that
requires physical barriers is presented in a manner that gives the
employer flexibility to adapt the design, location, size, and materials
of physical barriers to specific workplace conditions, policies,
procedures, tasks, and layouts, as well as state and local legal
requirements such as zoning and fire codes. Despite this performance
language, employers must ensure that the barriers are installed when
and where they are required, in accordance with paragraph (i), and that
the barriers meet the other criteria in the provision, including those
for material, location, and size.
    Physical barriers are only required for fixed work locations
outside of direct patient care areas when an employee is not separated
from all other people by at least 6 feet of distance. A fixed work
location is a workstation where an employee is assigned to work for
significant periods of time, or at which the employee spends much of
their workday or shift, even if they leave that workstation
intermittently as part of their work. Although the employee may

be required to move away from that fixed location to perform their job,
in many cases they would be required to return to the fixed location
throughout the day. Under paragraph (i), physical barriers are not
required at non-fixed workstations. In healthcare settings, examples of
non-fixed workstations may include when employees must move from
patient-to-patient within a waiting room or check-in area to complete
screening procedures. However, if these employees return to a central
desk to complete the check-in process or to enter information into a
computer for multiple patients, that desk would be considered a fixed
work location and would require a barrier. Barriers are also not
required in common areas where employees would pass each other, such as
hallways or break areas, as these are not fixed workstations.
    To be effective, barriers must prevent droplets from passing
through them. Therefore, paragraph (i) requires barriers to be solid,
meaning they must be impermeable to the droplets that are expelled when
an individual is sneezing, coughing, breathing, talking, or yelling.
The employer must immediately repair or replace a barrier if it becomes
damaged. Examples of solid physical barriers include clear plastic or
acrylic partitions and sneeze guards, as well as temporary or permanent
walls. In some situations, flexible, transparent plastic sheeting can
qualify as a solid physical barrier, but only if it remains in place
and blocks face-to-face pathways of air between the users on either
side. It is critical that barriers block face-to-face pathways and that
they do not flap or otherwise move out of position when they are being
used. For example, if flexible plastic sheeting is installed between
employees, but the sheeting could easily be swept out of the way in the
course of an employee's work tasks or by ventilation, it would not
comply with this provision. However, employers may use flexible plastic
sheeting if it is installed in a manner such that it remains stationary
and is unlikely to be disturbed during use enough to allow droplets to
pass through that area (e.g., plastic sheeting hung between employees
and anchored--directly or via taut tethers or other devices--to a
surface to prevent movement), or the sheeting is weighted or affixed to
the ceiling and floor (or other fixture) to prevent its movement and
improve stability.
    In accordance with paragraph (i), barriers must be made from
materials that can be easily cleaned and disinfected. Replacement is
also acceptable in lieu of cleaning. Since these barriers are
intercepting respiratory droplets that may contain COVID-19, it is
important to clean them frequently. Impermeable materials like plastic
or acrylic are easy to clean and disinfect. Cleaning and disinfection
of physical barriers should occur in accordance with requirements in
paragraph (j). This includes cleaning physical barriers at least once a
day, as well as disinfecting physical barriers if there has been a
COVID-19 positive person present in the workplace. Cleaning and
disinfecting products should be chosen to be compatible with the
barrier material used. If the cleaning and disinfecting products
selected are not compatible with the barrier material, the barrier may
become damaged and would then need to be replaced.
    Where appropriate, barriers may be made of easily replaceable
materials, such as flexible, clear plastic sheeting. Using replaceable
materials would allow an employer to dispose of and replace barriers
between uses, instead of cleaning and disinfecting more permanent
barriers. Barriers constructed out of materials like cloth fabric or
mesh would not comply with paragraph (i); these materials are not
impermeable and would allow respiratory droplets to pass through them.
    Employers must design and install physical barriers in a manner
that ensures that, given their positioning, height, and width, the
barriers can effectively prevent droplet transmission. Essentially, the
barriers must be designed and installed such that any person cannot
cough, talk, or breathe on an employee when the employee is in their
normal sitting or standing location relative to the workstation.
Therefore, the effective design and implementation of physical barriers
will differ between workplaces based on job tasks, work processes, and
even potential users.
    As noted above, paragraph (i) requires barriers to be sized and
located so that they block face-to-face pathways between individuals
effectively, based on where each person would normally sit or stand.
When the individuals on both sides of the barrier will be sitting, the
barrier must be high enough, and extend far enough, to block face-to-
face pathways between those seated individuals effectively. To ensure
compliance with the size and location requirements, employers must
account for where the breathing zones of the users on both sides of the
barrier will likely be, as a barrier is only effective at reducing an
employee's exposure to COVID-19 if it keeps respiratory droplets out of
the employee's breathing zone. As described in the Need for Specific
Provisions (Section V of this preamble), OSHA defines the breathing
zone as the area from which a person draws air when they breathe; it
extends 10 inches beyond a person's nose and mouth. The location of
that breathing zone is critical to designing compliant barriers because
of the requirement that barriers block face-to-face pathways between
the individuals on both sides of the barriers.
    The height of employees and other individuals separated by barriers
impacts where their breathing zones will be located, as does whether
those individuals will be sitting or standing when at the fixed work
location. These factors must, therefore, be taken into account when
determining the size and location of each barrier in order to comply
with paragraph (i). If employers are certain that only specific
employees will be at a particular fixed workstation and will not be
exposed to other people (e.g., visitors) of varying heights, then the
barrier can be tailored to those factors (i.e., employers can tailor
the barrier height to the height of the employees that use that
particular workstation). However, in the vast majority of cases, the
heights of employees and visitors will vary and, and employers must
construct their barriers to at least address average heights. The
average height of adults in the US is 63.6 inches for women and 69
inches for men (CDC, May 20, 2020). Employers should consider the
height of typical users and their breathing zones to design and install
barriers in a way that ensures face-to-face pathways are effectively
blocked. Note that OSHA is not mandating a specific barrier height and
enforcement will focus on whether the barrier blocks the breathing
pathway.\136\ For example, for employers who do not know the heights of
the people who are likely to be separated by a barrier, OSHA will
accept as compliant a barrier that extends to at least 6 and a half
feet above the surface on which both people are standing, as this would
block face-to-face transmission at the average heights for both females
and males while also accounting for their breathing zones. Depending on
the job tasks, workstation design, and typical user height, barriers
may be able to be shorter (e.g., if both users are sitting) or may need
to be taller (e.g., a person is standing on an elevated surface) to
ensure that they block face-to-face pathways between users.
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    \136\ In the absence of observable interactions at the barriers,
or evidence that the barrier is only used to separate specific
persons of known heights, OSHA's enforcement will focus on whether
the employer has installed the barriers for the average heights.

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    If the barrier is installed on a table, desk, countertop, or other
surface above floor height, the height of those items would be included
in the barrier height. If one user may be sitting and the other may be
standing, barriers should be high enough to reflect the height of the
standing user as well as the sitting user. The average sitting height
of users will vary based on chair height and type, and employers should
consider the workstation design when implementing physical barriers. If
employees utilize sit-and-stand workstations, barriers would need to be
designed to block face-to-face pathways of employees in both sitting
and standing positions. If that is not possible, employers should
consider suspending the use of sit-and-stand workstations during the
pandemic.
    To meet the requirement for the barrier to be sized (e.g., height
and width) and located to block face-to-face pathways based on where
individuals would normally stand or sit, the physical barrier must
extend far enough along the workstation to fully contain respiratory
droplets that are expelled during sneezing, coughing, breathing,
talking, or yelling. In addition to being sufficiently tall, barriers
need to be wide enough to protect users on either side during the
entire interaction. To ensure compliance, employers also need to
consider predictable behaviors and movements of employees and non-
employees when designing and installing barriers. The part of paragraph
(i) that refers to where each person would normally stand or sit is
meant to ensure employees are protected in the event users behave in a
way that would reduce the effectiveness of the physical barriers, such
as moving to the side of, around, or above the barrier. If such
behaviors are predictable, and are not taken into account when
designing the barrier, the barrier would not be compliant.
    For example, at a service counter, the barrier must be wide enough
to block the face-to-face pathway between an employee and a visitor
when the employee and visitor are positioned directly across from each
other. In situations where the employee and the visitor are positioned
diagonally across from each other but still within 6 feet, the barrier
must still extend to block those diagonal face-to-face pathways.
    Barriers do not need to block all of the face-to-face pathways
while employees are briefly moving between the fixed workstations. For
healthcare check in areas, a barrier would likely be necessary to
separate employees from non-employees at reception desks or other in-
take stations where payments are required. Barriers must extend far
enough to cover the area where credit card machines are located to
ensure that both users' breathing zones are behind the barrier during
the entire transaction and to avoid users moving around the barrier at
any point during the transaction. If the visitor has to move away from
that barrier to access a credit card machine in a manner that would
result in a face-to-face pathway between the customer and cashier, the
barrier must extend to block those pathways. Employers should also
consider visual reminders, like floor markings or signs, to remind
employees and non-employees not to step around or move to the side of
or above the barrier when interacting with an employee. Additionally,
when designing barrier placement and implementation, employers should
consider if and how the barrier could alter communication between
users. If a barrier is required, but may interfere with effective
communication between individuals (e.g., when working with individuals
who are hard-of-hearing, when working in an environment with
significant background noise), electronic communication devices could
be installed. Slotted speaking grates should not be installed in the
barrier, as this would allow droplets to pass through the barrier.
    Paragraph (i) allows the barrier to have a pass-through space at
the bottom for objects. This limited exception to the requirement for
the barrier to be solid applies when employees or others need to pass
items to someone on the other side of a barrier. For example, when
health screening is utilized at a healthcare facility, to screen either
employees or non-employees before entry, a barrier could be installed
to separate the employee conducting the screening from other
individuals. A small pass-through space could be used to facilitate the
passing of items between users, such as medical screening
questionnaires or COVID-19 testing materials. Such openings should be
as small as possible for the given job tasks and activities, and
openings should not be placed in front of the breathing zone of any
user.
    The employer needs to consider the positioning of the individuals
on both sides of the barrier before determining where the pass-through
space should be located. For example, if a standing user is required to
pass items to a seated user on the other side, the pass-through space
must not be placed in front of either user's breathing zone. Instead,
the opening could be installed to the side of the seated individual. In
situations where the barrier extends to the floor, the pass-through
space may be located in the middle of the barrier, as long as it is
below or to the side of the breathing zones of both users and still
effectively blocks face-to-face pathways.
    In some cases, when the items being transferred are large, a
sliding door may be installed to ensure the effectiveness of the
barrier. If a sliding door is used, it must be kept closed except when
necessary to transfer an item. As an alternative, work processes can be
established to take turns placing and picking up large items from a
location to the side of a barrier in order for users on either side of
the barrier to maintain 6 feet of physical distance. In addition,
employers must ensure that this high-touch surface is cleaned
frequently, in accordance with paragraph (j).
    Physical barriers are typically mounted on hard surfaces or
designed to be free-standing. However, there may be circumstances where
an employer may decide to utilize a hanging barrier, depending on the
surface below or the work tasks being completed. Barriers may be hung
from above, such as from the ceiling or other fixture, as long as they
remain stationary and are unlikely to be disturbed during use. Barriers
that sway back and forth or do not fully block face-to-face pathways,
whether attached from below or hung from overhead, would not comply
with this provision. Hanging barriers may also be appropriate in
situations where pets or children may be present, such that alternate
barrier installations present safety hazards or risks related to
barriers falling down. Where hanging barriers are used above a counter
or other surface that is raised above the floor, they should extend
down as close to that surface as possible, allowing a space for passing
items where necessary. If barriers are hung from the ceiling but do not
fully extend to the floor or counter, policies should be developed to
ensure employees are not placing personal items (e.g., backpacks,
umbrellas, cellphones) on the floor or counter below the barrier where
they could be contaminated by droplets that land under the barrier. For
the same reason, employers must ensure that the surface below the
barrier is frequently cleaned in accordance with the cleaning and
disinfection provisions in paragraph (j).
    While barriers provide protection to employees from COVID-19, their
design and installation must also consider employee safety. In the
event of an emergency, employees must be able to quickly leave their
work area, with their entry and exit not hindered by a physical
barrier. Building and fire safety should be considered when installing

barriers. Barriers must not block safety features, such as smoke
detectors, sprinklers, carbon monoxide detectors, fire extinguishers,
or fire alarms. Employers must properly secure large barriers that
could fall and injure an employee. Depending on the size and placement
of the barrier, temporary adhesive may be necessary to keep the barrier
securely in place. If barriers are mounted on floors, employers should
ensure barriers do not present trip-or-fall hazards to employees.
Ventilation should also be considered to ensure that the air in one
workspace is not funneled around a barrier and directly into another
person's workspace.
    Barriers serve as a particularly important control when employees
are exposed to many different people, each a potential carrier of
COVID-19, and the barriers must be provided at fixed workstations even
if the employee also has tasks that cannot be performed behind the
barrier. The barrier can still reduce the duration of exposure and
potentially also the number of sources of exposure the employee faces
in the workplace. During these scenarios, barriers are not required
when the employee moves away from their fixed workstation, but the
other controls required by this standard, such as face masks, physical
distancing, and cleaning shared equipment play a vital role in reducing
employee exposure. Further, in these types of circumstances, employers
must also consider additional controls, such as rearranging work flow
to minimize the time an employee has to spend outside of the barrier,
or reducing the number of employees at non-fixed workstations at a
time, to ensure that the other protections required by the ETS are
implemented to the extent feasible.