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

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

COVID-19 Reopening Safety Plan

Name of Business:

Island Nursing & Rehab Center


Skilled Nursing Facility


5537 Expressway Drive North
Holtsville, NY 11742

Contact Information:

Audrey Marchand/Administrator 631-930-7403

Owner/Manager of Business:

Not for Profit Facility

Human Resources Representative and Contact Information, if applicable:

Evelyn Rodriguez, Human Resource Supervisor 631-930-744


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

[X] Ensure 6 ft. distance between personnel, unless safety or core function of the work activity requires a shorter distance. Any time personnel are less than 6 ft. apart from one another, personnel must wear acceptable face coverings

[X] Tightly confined spaces will be occupied by only one individual at a time, unless all occupants are wearing face coverings. If occupied by more than one person, will keep occupancy under 50% of maximum capacity

[X] Post social distancing markers using tape or signs that denote 6ft. of spacing in commonly used and other applicable areas on the site (e.g. clock in/out stations, health screening stations)

[X] Limit in-person gatherings as much as possible and use tele- or video-conferencing whenever possible. Essential in-person gatherings (e.g. meetings) should be held in open, well-ventilated spaces with appropriate social distancing among participants.

[X] Establish designated areas for pick-ups and deliveries, limiting contact to the extent possible.

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

Smaller offices and employee dining rooms on the unit. Employees will practice social distancing, wear masks and other PPE when applicable. Signage will be posted throughout the building and elevators, stairwells and locker rooms. Residents will be encouraged to wear masks as tolerated.


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

Signage will be posted throughout visitor area, e.g. restrooms and lobby. The facility will use the outside courtyard weather permitting or indoor visitation when visitation is allowed. No more than 10% of the residents shall have visitors at one time. Each visitation will only accommodate a maximum of 5 residents and guests. Only 2 visitors per resident will be allowed at each visit.

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

Employee break rooms: Signage is posted, marking on floors noting appropriate seat placement which is 6 feet, break times on units are staggered as applicable.

Hair salon has been closed.

Common areas will have signage and social distancing markers.

Fountains have been shut off.


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

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

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

Facility is maintaining a minimum of 60 days of PPE supply in locked storage area.

The facility utilizes a PPE burn calculator to identify use.

HERDS report is completed as per regulations to identify facility PPE amounts and needs.

[X] Face coverings must be cleaned or replaced after use or when damaged or soiled, may not be shared, and should be properly stored or discarded.

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

COVID-19 Infection policy will include proper use and storage of PPE. Said policy will be reviewed, revised and updated according to the NYS DOH and CDC guidelines. ***Policy for use of PPE and reuse has been developed.*** Staff compliance of use of PPE will be audited and the results will be discussed at QAPI meetings.

[X] Limit the sharing of objects and discourage touching of shared surfaces; or, when in contact with shared objects or frequently touched areas, wear gloves (trade-appropriate or medical); or, sanitize or wash hands before and after contact.

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

Computers/keypads, kiosks, telephones, desktops are wiped between use and at the beginning of the shift with EPA-approved disinfectant wipes. Blood pressure machines, medication carts, housekeeping carts, accucheck machines and nurses stations. Staff will be in-serviced to use alcohol sanitizers.

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

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

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

The Director of Environmental Services will be responsible for maintaining cleaning logs.  All cleaning log documents are located in the Housekeeping office.

[X] Provide and maintain hand hygiene stations for personnel, including handwashing with soap, water, and paper towels, or an alcohol-based hand sanitizer containing 60% or more alcohol for areas where hand washing is not feasible.

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

Alcohol-based touchless hand sanitizer dispensers are located throughout the facility at the following locations: each nursing unit hallway, all entrances /exits, rehab gyms, outside dining areas, lobby areas, and at time clocks. Hand washing sinks are located in all the resident dining rooms, at the nursing stations, medication rooms, resident rooms. Hand sanitizers are located in dining rooms on medication carts and in all personal offices.

The facility will ensure the bathrooms and other hand washing areas are well stocked with hand soap and paper towels.

[X] Conduct regular cleaning and disinfection at least after every shift, daily, or more frequently as needed, and frequent cleaning and disinfection of shared objects (e.g. tools, machinery) and surfaces, as well as high transit areas, such as restrooms and common areas, must be completed.

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

The Director of Environmental Services/Material Management will procure all products for cleaning. They will review the EPA list prior to procurement of any disinfectant to ensure the product has been identified as effective against COVID-19.

EPA-approved cleaning wipes are available in all departments and on nursing units for cleaning shared items.

Employees will wipe down their assigned workspace, telephones, and computers prior to use with disinfectant wipes.

The Director of Environmental Services will present random audit findings to the QAPI Committee for review and evaluation.

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

[X] Post signage throughout the site to remind personnel to adhere to proper hygiene, social distancing rules, appropriate use of PPE, and cleaning and disinfecting protocols.

[X] Establish a communication plan for employees and visitors with a consistent means to provide updated information.

[X] Maintain a continuous log of every person, including workers and visitors, who may have close contact with other individuals at the work site or area; excluding deliveries that are performed with appropriate PPE or through contactless means.

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

Front desk receptionist will compile logs for both employees and visitors/vendors. All logs will be given to the ADON daily or on next business day.

[ X  ] If a worker tests positive for COVID-19, employer must immediately notify state and local health departments and cooperate with contact tracing  efforts, including notification of potential contacts, such as workers or visitors  who had close contact with the individual, while  maintaining confidentiality required by state and federal law and regulations.

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

The Associate Director of Nursing/Assistant Director of Nursing will be responsible for notifying NYSDOH via HERDS daily reporting. Human Resources will update DON/ADON and staffing on employee status.


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

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

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

All employees are screened upon entrance into the building. ***Receptionist/Front Desk employees screen employees. RN Supervisor will be made aware of any response indicating ***

The facility has only one entrance open for employees, vendors, contract personnel, and essential visitors.  The entrance screening table is located at the entrance of the facility; no persons (employees, vendors, contract personnel, essential visitors) can go pass the screening area unless they have completed the mandatory health screening.

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

All screeners wear surgical masks, gloves, and eye shields/goggles.  The PPE for this function is provided by the facility and included in the established par levels. The eye protection is cleaned after each session by the employee

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

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

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

The ICP/Designee will notify the Department Head of any employee who tests positive for COVID-19.  The Department head will notify the Housekeeping Department to complete a thorough cleaning of the employee’s office space as applicable.

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

Employees schedule will be checked for assignment prior to diagnosis and the staff and residents will be monitored for signs and symptoms of COVID-19, for example, cough, temperature, or any sign/symptom of respiratory distress. Designated reps will be made aware of any employee testing positive and all precautions are in place. The Human Resource Department will notify the ICP/Designee of any employee that tested positive for COVID-19.  The ICP/Designee will contact that employee to establish if the employee is symptomatic/asymptomatic.  This information and testing date will be utilized by the ICP to establish an appropriate timeline for contact tracing. The ICP/Designee will also interview the employee to establish any significant contacts amongst staff/residents. All residents and their designated representatives identified will be notified of a possible exposure to a COVID -19 positive employee.  Any employee identified that had significant close contact with the confirmed positive employee will be notified by the appropriate Department Head/ICP/Designee

Staying up to date on industry-specific guidance:

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

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

State and Federal Resources for Businesses and Entities

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

General Information

New York State Department of Health (DOH) Novel Coronavirus (COVID-19) Website Centers  for Disease  Control and Prevention (CDC) Coronavirus (COVID-19) Website Occupational Safety and Health  Administration (OSHA) COVID-19 Website

Workplace Guidance

CDC Guidance for Businesses and Employers to Plan, Prepare and Respond to Coronavirus

Disease 2019

OSHA Guidance on Preparing Workplaces for COVID-19

Personal Protective Equipment Guidance

DOH Interim Guidance on Executive Order 202.16 Requiring Face Coverings for Public and

Private Employees

OSHA Personal Protective Equipment

Cleaning and Disinfecting Guidance

New York State Department of Environmental Conservation (DEC) Registered Disinfectants of COVID-19

DOH Interim Guidance for Cleaning and Disinfection of Public and Private Facilities for COVID-19

CDC Cleaning and Disinfecting Facilities

Screening and Testing Guidance

DOH COVID-19 Testing

CDC COVID-19 Symptoms