DEPARTMENT OF HEALTH & HUMAN SERVICES Centers for Disease Control and Prevention (CDC) Date: June 9, 2020 From: Mark Methner, PhD, CIH, CDC National Institute for Occupational Safety and Health Jorge Alvarez, MD, MPH, CDC Team Lead To: Andrew Boyles, Plant Manager, Tyson Foods Poultry Plant, New Holland, PA Copy: Dr. Jeffrey Miller, Pennsylvania Department of State Health Services Region 1 Dr. Betsy Schroeder, Pennsylvania Public Health Veterinarian Subject: Strategies to reduce transmission of SARs-Cov-2, the virus that causes COVID-19, among workers at the Tyson Foods Poultry Plant, New Holland, Pennsylvania Background On May 8, 2020, the Pennsylvania Department of Health (PA DOH) requested technical assistance from the Centers for Disease Control and Prevention (CDC) for an assessment of strategies to help mitigate transmission of SARs-Cov-2, the virus that causes COVID-19, among workers in six food processing and distribution facilities in northcentral, southcentral, and southeast Pennsylvania. On May 13, 2020, a CDC field team traveled to Harrisburg, Pennsylvania. On May 14, 2020, the CDC team met with staff from PA DOH and the Pennsylvania Department of Agriculture (PDA) to gain a better understanding of the current epidemiological data and results of a previous site assessment performed by PDA The CDC team worked with PA DOH staff to determine the deployment objectives. On May 22, 2020, the team visited the Tyson Foods Poultry Plant in New Holland, PA to evaluate existing health and safety controls implemented to prevent transmission of SARs-Cov-2, the virus that causes COVID-19,and provide recommendations to help mitigate the spread of COVID-19 between workers. The team included a physician, an industrial hygienist who specializes in occupational safety and health, an epidemiologist, an environmental health officer, and a community health behavior and education specialist/epidemiologist. The observations provided in this report are based on this site visit and conversations with the plant managers, human resources, occupational health, and food safety staff. The recommendations are steps this Tyson Foods Poultry Plant should implement to address issues identified at the plant, but also may be helpful in developing strategies for other Tyson Foods facilities. Setting and Facility Description The Tyson Foods Poultry Plant is approximately 200,000 square feet and began operating in 1946 as Weaver Foods, which was subsequently purchased and renamed as Tyson in 1989. There are an estimated 1,000 Tyson workers, including 750 production staff, that work at this plant. At the time of our visit, the Tyson Foods Poultry Plant was running four shifts with staggered start times per day as well as an overnight shift focused on sanitation. The sanitation shift is contracted, with about 125 staff working overnight to clean and disinfect the plant. Management reported there were 38 positive cases of COVID19 but no hospitalizations or deaths associated with these cases. Approximately four U.S. Department of Agriculture, Food Safety Inspection Service (USDA/FSIS) staff are assigned to this plant. Approximately 60% of workers are of Hispanic origin with English and Spanish spoken as primary languages; additional languages make up less than 10% of all languages spoken and include French Creole, Nepali, Burmese, and Arabic. This plant is not unionized and does not have any ongoing OSHA investigations. During the site visit, the team observed the fresh harvest and processing departments, which were operating at a normal production rate of approximately 125,000 birds processed per day. The fresh harvest area is where animals are stunned, eviscerated, and processed. The processing area seasons, breads, and cooks the chicken into final products that are boxed for shipment. The team also toured areas outside of processing, focusing on locations where workers might congregate, including the building entry, locker rooms, cafeterias, and smoking areas. We discussed issues related to worker screening, communications, sick leave policies, worker and supervisor training, and managing workers who are determined to be symptomatic or exposed. The Tyson Foods Poultry Plant is designed so workers from the fresh harvest and processing sides do not need to use the same entrances or common areas. There are separate locker rooms for fresh harvest and processing workers, and the restrooms are located within the locker rooms. Observations and Discussion This report is not intended to document every observation and intervention that occurred at the plant. It is a summary of the plant’s implementation of the CDC Interim Guidance: Meat and Poultry Processing Workers and Employers: Interim Guidance from CDC and the Occupational Safety and Health Administration (OSHA). We observed that the plant had implemented many recommended changes prior to our site visit. We discussed preliminary recommendations with plant managers while onsite to facilitate their timely implementation. We also discussed the observations and recommendations with state public health partners prior to issuing this report. Visitor Entry Screening At the visitor’s entrance, screening is conducted by contract medical staff who measure the temperature of each person entering the building using a handheld temporal thermometer, which was sanitized with a disinfection wipe prior to use on subsequent people. The screener is outfitted with a disposable facemask, face shield, nitrile gloves and a disposable gown. All visitors are asked if they currently have any of the following COVID-19 symptoms: cough, headache, shortness of breath, sore throat, muscle or body aches, chills, and recent loss of taste or smell. Visitors are also asked about recent travel and potential close contacts with people who have tested positive for COVID-19. Worker Screening Workers arrive to the plant by personal vehicle or carpool. Carpooling has been generally discouraged by management. When workers arrive onsite, they walk down a footpath toward the worker screening area at their designated plant. We observed most workers arriving onsite wearing either a cloth face covering Page 2 of 13 or disposable facemask. Large posters that describe COVID-19 symptoms, written in 16 languages, are located at the entry to the screening area. To maintain social distancing, we observed visual markers on the outside walkway leading to the entrance and on the floor inside the entrance of the screening area. To begin the screening process, a staff member monitors individual worker temperatures using a thermal imaging camera connected to a computer screen. Following the temperature screening, another staff member asks workers about any symptoms they may have and hands out a disposable facemask. The worker conducting the body temperature scanner reported to us that they have been trained on how to use and calibrate the device. Both staff members conducting the screening were observed wearing the following personal protective equipment (PPE): disposable facemask, face shield, nitrile gloves, and a disposable gown. If a worker reports any symptoms or has a body temperature of 100.4°F or higher, they are escorted from the body temperature screening area and placed inside a nearby isolation room or outside for secondary screening. The isolation room has been designed to enhance privacy of workers that are undergoing secondary screening. The staff monitoring thermal imaging temperatures calls the plant nursing staff to come and conduct the secondary screening which consists of a temperature check using a handheld temporal thermometer and a symptom check. The nurse reportedly wears a disposable facemask, nitrile gloves, a face shield and a disposable gown during secondary screening. If workers are referred to seek further medical evaluation based on the secondary screening, they are instructed to visit their doctor or contact medical services contractors (Matrix Medical or Axion), who will instruct them on how to get testing. Occupational Health and Worker Benefits The plant has onsite occupational safety and health services, including 24-hour coverage using an on-call nurse. If any worker is absent from work due to quarantine or COVID-19 symptoms, they are paid up to 90% of their pay for 14 days. If a worker tests positive for COVID-19, the company requires a full 14-day quarantine, a note from a physician followed by a medical assessment by the nurse at the plant before the worker can return to work. At the time of our visit, any worker that chooses not to work due to fear of COVID-19 can take non-paid personal leave with no penalty. Management indicates that they are typically informed of positive cases by infected workers or contact tracing. When there is a confirmed case, contract tracing is performed by a team consisting of staff from human resources, management, and occupational health. They ask the affected worker about close work contacts, carpool contacts, and household members who also work at the plant. Management reported that during contact tracing they try to not disclose the case’s identity to other workers in accordance with the Americans with Disabilities Act (ADA). At the time of our visit, management informed us they are calling workers for wellness checks while they are out on quarantine. Workers who are a close contact to a confirmed case are subject to an additional temperature and symptom check during the work shift. Increasing Distance Between Workers During Work and Breaks The cafeteria in the fresh harvest area had visual cues on the floor to remind workers to maintain social distancing. They also erected barriers made of plastic sheeting attached to frames constructed with plastic pipe and installed seat markers on tables. Microwave ovens had been relocated throughout the room to prevent workers from congregating. There were multiple storage racks in the cafeteria where workers stored lunch boxes. In the processing plant cafeteria, round tables with four seats were located throughout. A four-way plexiglass divider was installed on each table along with “table tents” (an informational card Page 3 of 13 intended to remind workers about social distancing). Some cafeteria tables were observed to be closer than 6 feet apart. We observed some workers were leaning back from the barriers and talking around them. In the fresh harvest and processing areas, plexiglass barriers or plastic sheeting have been installed, where feasible, because social distancing was not possible. In some other areas, automation of certain processes has decreased the number of workers necessary to operate the production line. In areas without barriers, workers are provided face shields which reportedly tend to fog and partially obscure vision. Supplementary Infection Control Measures Touchless hand sanitizer dispensers were present throughout the plant. Management shared that they have been trying to ensure hand sanitizer stations are present in high-touch areas and at the ends of hallways or stairwells. Worker handwashing stations within the plant were touchless and had wall-mounted air hand dryer units. However, sinks were clustered together and were not marked off at 6-foot increments. At this plant, entry doors to locker rooms were removed to eliminate the potential for creating a high contact surface (e.g., doorknob or handle). The lockers are randomly assigned with some being full-length, and others being double stacked vertically. Management shared with us that not many workers utilize the company provided lockers. Overall, there was a lack of COVID-19 related signage in the locker rooms. Staff are cleaning and sanitizing commonly touched surfaces such as handrails, doors and door handles, lockers, vending machines, and lunch tables more frequently (e.g., every 1-2 hours). The products used to clean these surfaces were peracetic acid, water/chlorine solution, and/or quaternary ammonium. Use of Face Shields and Face Coverings Face shields are being provided to workers in job positions where no barriers are present or where it is required by the Occupational Safety and Health Administration (OSHA) regulations. Most workers we observed were not wearing their face shields appropriately (keeping the shield in a vertical position). Workers reported they tipped the shield up because of fogging issues. Workers are responsible for disinfecting their face shields with soap and water at handwashing stations within the plant. We observed this process and noted they also used the air hand dryer to drive water off the shield so they could use it again immediately. Workers are always required to wear disposable facemasks inside the plant, except for when they are eating or drinking. Disposable masks are provided daily by the plant upon arrival and are replaced if they become soiled. During our visit, we observed most workers wearing their disposable facemasks correctly. Educating Workers on COVID-19 Risks, Prevention, and Company Policies Informational flyers with pictures representing COVID-19 symptoms, social distancing, and hand hygiene were placed on walls throughout the plant and/or displayed on television monitors placed throughout the plant. Visual markers were installed on the floor every 6 feet in the entry screening areas to maintain social distancing. There were opportunities for more signage in some common areas, such as locker rooms. There were also opportunities for increased messaging on the television monitors in the cafeteria. Signage encouraging disposable facemask wear and discouraging carpooling were also observed. Management showed us their educational messaging system. We learned that COVID-19 messaging has been provided on several platforms such text messaging, mailings, videos, table tents, posters, and verbally via group meetings. Management and supervisory staff have also been trained on subjects such as social distancing and use of cloth face coverings and disposable facemasks. They are responsible for ensuring Page 4 of 13 compliance with COVID-19 policies. Management also reported that they have instituted peer-to-peer enforcement via social distance ambassadors. The plant also provides workers with messaging and printed materials in both English and Spanish. For other languages, interpreters are used for assistance in developing written materials or verbal communications. Pending Activities Reportedly Planned by the Company 1. Planning to install plexiglass dividers in the grinding department of the fresh harvest area. 2. Continuing to target COVID-19 prevention messaging to workers. Conclusions The company has implemented many controls at the plant to help mitigate the spread of SARs-Cov-2, the virus that causes COVID-19, among workers in the plant. In addition, implementation of additional controls is progressing. Additional recommendations are provided below to help management, workers, PA DOH, PDA, and strategic community partners to potentially limit virus transmission among workers in the plant. The company should consult with USDA/FSIS staff at the plant to determine if proposed controls or other efforts are acceptable with respect to food safety and sanitation. Recommendations The following actions are recommended to reduce the spread of COVID-19 between workers. With ongoing community transmission, COVID-19 cases among staff will continue to be identified. However, a combination of control measures with ongoing education and training could help reduce transmission in the workplace. Interim recommendations for meat and poultry processing industries are available (CDC Interim Guidance Meat and Poultry Processing Workers and Employers) and should be considered in developing or refining plant COVID-19 response plans. The recommendations in this report are specific to the Tyson Foods Poultry Plant. Plant management, PA DOH, PDA, the local health department and community partners should continue to work together to implement recommendations and plans at the facility and among its workers to further reduce the spread of COVID-19. Hierarchy of Controls The following recommendations should be implemented according to the hierarchy of controls. Hierarchy of controls is an approach to hazard intervention which ranks the controls perceived to be most effective first, followed by those considered least effective. In most cases, the preferred approach is to eliminate a hazard or exposures, install engineering controls, and implement appropriate sanitation and cleaning to reduce worker exposure. Until such controls are in place, or if they are not adequately effective or feasible, administrative measures, personal protective equipment (PPE), and source controls may be needed. Entry Screening Screening workers for COVID-19 symptoms is a strategy to help ensure that symptomatic workers or visitors do not enter the facility. Screening policies and procedures should be developed in consultation Page 5 of 13 with state and local health officials and occupational medicine professionals. Actions to improve existing screening policies and processes include: 1. Continue to screen all individuals entering the plant (e.g., workers, management, contractors, USDA/Food Safety and Inspection Service (FSIS) inspectors, package and poultry delivery drivers). a. Continue to exclude all non-essential visitors from entering the premises. For essential services, like package and poultry delivery, limit drivers’ access to the building. b. Continue to screen essential visitors. Those who screen positive for fever or other COVID19 symptoms should be denied entry to the plant. 2. Continue to provide screening prior to entry into the facility. a. Consider using engineering controls, such as physical barriers or walkway dividers, to maintain at least 6 feet of distance between screeners and workers being screened. Also continue to use management or other staff to reinforce social distancing behaviors in this area. b. Continue to provide screeners with appropriate PPE (face shield, respiratory protection, nitrile gloves, disposable surgical gown). c. Offer disposable facemasks to workers before they enter the temperature screening area rather than after they have had their body temperature taken. 3. Continue to check temperatures of workers at the start of each shift to identify anyone with a temperature reading equal to or greater than 100.4℉. a. If continuing to use thermal imaging systems, use FDA-approved system(s) and use in accordance with the manufacturer specifications, including frequent, scheduled calibrations and screening workers one-by-one. If an FDA-approved system cannot be procured, use the thermal imaging system in accordance with all manufacturer specifications and FDA guidance. If feasible. ensure that it is set up in such a way to accommodate the height variation of individuals being screened. 4. In addition to measuring temperature, continue providing verbal screening in appropriate language(s) to determine whether workers have experienced symptoms of COVID-19 in the past 24 hours. Including large pictograms in the screening process can increase effectiveness of nonverbal communication if language or literacy challenges exist. a. At this facility, workers were not always explicitly asked questions, but rather indicated to the screener yes or no for all questions at once. Consider modifying this practice to ensure that workers are asked and must respond to each individual question. If someone declares symptoms, they should be taken to the isolation room before they reach the temperature check area. b. Consider limiting the languages on the rotating screen to the ones known to be spoken by workers, while keeping all other languages visible using posters. 5. Workers who screen positive for fever or other COVID-19 symptoms should be sent home and Page 6 of 13 instructed to seek a medical evaluation from a healthcare provider. 6. Workers who are ill before they report for work should stay home and not be allowed in the workplace until they are screened and tested for COVID-19. 7. Continue educating workers to report to supervisors if they get sick during work. a. Ensure that supervisors know protocols for dealing with workers who report being ill at work. b. Continue sending workers home immediately if they become ill during work. c. Surfaces and tools in their workspace should be cleaned and disinfected immediately upon learning that a worker became ill and left the workplace. 8. Workers who are sent home either from secondary screening or throughout the workday should be provided with written materials including information on how to self-isolate at home, how to contact a healthcare provider, the facility’s return-to-work policy, and worker benefits for workers with COVID-19. a. Translate this information into other languages commonly spoken in the plant to improve communication with workers. b. Consider adding CDC guidance: “What to do if you are sick” to the information provided to workers being sent home after screening or during the workday. This guidance is available in multiple languages on the CDC website. 9. Continue to work with state and local public health authorities in using CDC guidance to identify and follow up with contacts of ill persons. Contact Tracing Contact tracing is important for identifying workers who have been exposed to a person with COVID-19, so they can be excluded from the workplace and monitored for symptom onset. Policies and procedures for contact tracing should be developed in consultation with state and local health officials and conducted under the supervision of your occupational health program. Actions to improve existing policies and procedures include: 1. Continue to conduct a contact investigation for each COVID-19 case by identifying close contacts of the case while at work during the time the worker had symptoms and 2 days prior to symptom onset, as defined by the CDC Interim Guidance for Implementing Safety Practices for Critical Infrastructure Workers Who May Have Had Exposure to a Person with suspected or Confirmed COVID-19. These might include co-workers who work in the same area of the plant, take breaks together, ride to work together, or live in the same household. 2. Workers determined to be a close contact of a confirmed case may be permitted to continue working (current company policy), provided they remain asymptomatic and undergo additional temperature and symptom screening checks for 14 days after their last exposure. 3. Consider posting or sharing the cumulative number of cases within the facility by date with workers to increase transparency and awareness among workers. Page 7 of 13 Sick Leave Policies Review leave and incentive policies to ensure that workers who are sick with COVID-19 do not come to work. Consider the following actions to improve the existing sick leave policies and practices: 1. Continue to analyze sick leave and short-term disability policies and consider modifying them to ensure that ill workers are not in the workplace. Ensure that workers are aware of and understand these policies, particularly how they might differ from usual policies. 2. Continue to analyze any incentive programs and consider modifying them, if warranted, so that workers are not penalized for taking sick leave or short-term disability if they have COVID-19. 3. Explore the possibility of deactivating or collecting the badges of quarantined workers to ensure that they are not coming to work. Social Distancing In addition to everyday steps to prevent COVID-19, keeping space between individuals (social distancing) is one of the best strategies to avoid being exposed to the virus and slowing its spread. In addition to work areas, social distancing should be emphasized in all areas where workers congregate, such as break rooms, parking lots, hallways and corridors, entrance/exit areas, and locker rooms. Barriers are one method to physically separate workers in areas of the plant where social distancing is not possible. Physical barriers should not be used as a replacement for social distancing and should only be used when distancing is not possible, due to work design or task to be completed (e.g., two people needing to work together on a single carcass or trimming tasks that need to be done next to one another). Consider the following actions to improve the existing social distancing procedures in common areas: 1. Continue employing social distancing “champions” to reinforce proper social distancing and disposable facemask use in parking lots, throughout screening, in hallways, locker rooms, cafeteria and break areas, and any other spaces in the plant where workers congregate. This is especially important in areas like the locker rooms where social distancing is more difficult given the limited physical space. 2. Empower workers to provide corrective guidance to other workers about improper social distancing and disposable facemask use. 3. Add more visual cues at 6-foot intervals (e.g., floor markings, wall markings, signs, traffic cones) in the building entries, screening areas, cafeterias, locker rooms, and other areas where lines or groups may form. 4. Increase the distance between tables in the cafeterias. Remove some tables to facilitate more space between workers. This action may reduce the potential for exposure because we observed workers sitting at adjacent tables within 6 feet of each other while eating and talking without a physical barrier between them. 5. Consider setting up break and lunch areas outdoors to reduce the density of workers in existing cafeterias and encourage workers to spend their breaks in locations with air movement and space for social distancing. For example, temporary shelters could be set up and have the capability of being heated or cooled to encourage use of the outdoor space in inclement weather. Other facilities Page 8 of 13 have implemented similar controls and are incentivizing outdoor breaks and lunches. Consider including portable or temporary restroom and handwashing facilities as a part of this setup. Consider the following actions to improve the existing social distancing procedures in production areas: 1. Consider staggering workers along line workstations so that workers are not working directly across from each other to maintain appropriate distancing among workers. a. Consider adding floor markings to remind workers of the adequate distance necessary for social distancing in areas with no barriers. 2. Continue to alter workstations to minimize close contact among workers by adding plexiglass, stainless steel, or durable polycarbonate barriers between workstations. Barriers should be used in combination with (and not replace) other social distancing, hand hygiene, and PPE efforts outlined in these recommendations, wherever feasible given the task being conducted in that area. 3. Continue staggering shifts, start times, and break times as much as feasible to decrease the number of workers in locker rooms, break areas, and cafeterias at one time. If feasible, strictly prescribe the time that the next shift is allowed to come into the plant so that these workers are not congregating in the locker rooms and cafeteria for long periods of time before their shifts start. 4. Consider turning off every other faucet at handwashing stations and marking them with caution tape to limit the number of people in that area and maintain social distancing. Face coverings (cloth face coverings and disposable facemasks) Source control is a term used to describe measures intended to prevent infected individuals from spreading disease. Evidence suggests that COVID-19 transmission may be spread by workers who are not showing symptoms or asymptomatic individuals prior to being diagnosed. In the context of this COVID-19 pandemic, source control refers to the practice of wearing a mask to reduce the likelihood of transmitting the virus. Cloth face coverings or disposable facemasks are generally recommended as an addition to social distancing for source control, as they help keep the person wearing the cloth face covering or disposable mask from spreading respiratory droplets when talking, sneezing, or coughing. Cloth face coverings and disposable facemasks are meant to protect other people in case workers are infected but not symptomatic. Face shields also can serve as a second level of source control when worn with cloth face coverings and disposable facemasks. Consider the following actions to improve source control: 1. Continue to enforce the policy of issuing disposable facemasks to all workers and visitors. Continue to ensure cloth face covering use meets CDC guidelines. a. Cloth face coverings and disposable facemasks should allow for breathing without restriction, should not be touched after being put on to prevent transferring infected materials, and should be discarded and replaced when dirty or wet. b. Continue to have replacement disposable facemasks available in case a worker’s facemask becomes wet or soiled. This will be important in areas where the work is wet, dirty, or hot. c. Educate workers to avoid touching their faces, including their eyes, noses, and mouths, particularly until after they have thoroughly washed their hands upon completing work and/or removing PPE. This includes adjusting their disposable facemasks once they have Page 9 of 13 been donned. d. Instruct workers to talk with their supervisor if their disposable facemask needs to be adjusted frequently or if it interferes with their job-specific PPE. Supervisors should work to address these issues. 2. Continue reinforcing proper cloth face covering and disposable facemask use and social distancing in parking lots, throughout screening, in hallways, locker rooms, cafeteria and break areas, and any other spaces in your plant where workers congregate. 3. Continue requiring all workers and visitors to wear disposable facemasks properly covering their nose and mouth in all areas of the plant (including break areas and locker rooms, except when removing briefly to eat or drink). 4. Continue with the plan that all workers wear a disposable facemask and a face shield anytime they are at work, if their job task prevents the use of barriers. The face shield is being used in this plant to supplement the use of the disposable facemasks, not to replace them. a. Consider developing a facility-managed process for decontaminating face shields during and after each shift. Workers should not use air dryers to dry off freshly cleaned face shields. 5. Continue to train management and supervisors to educate and encourage workers to follow these guidelines. 6. Distribute disposable facemasks in a contactless manner while allowing for control of the number of disposable facemasks distributed. For example, consider placing disposable facemasks on a table and having workers step forward one at a time while another worker oversees the process. a. The worker distributing disposable facemasks should follow appropriate social distancing and wear appropriate PPE (gloves) and a cloth face covering or disposable facemask. 7. Work with USDA/FSIS partners to communicate any new COVID-19 policies and practices being rolled out in the plant. 8. Face shields are not acceptable substitutions for eye protection (such as safety glasses) that are used for impact protection. If needed and feasible, face shields should be used in addition to the eye protection, not as a replacement for jobs requiring eye protection, as identified by the plant’s OSHA PPE hazard assessment (29 CFR 1910.132). Hand Hygiene and Sanitation Hand hygiene and sanitation (infection prevention and control) are important tools to avoid being exposed to the virus and slowing its spread. Follow and frequently monitor the CDC recommendations for cleaning and disinfection during the COVID-19 response for updates. Cleaning and disinfection of surfaces and objects that are frequently touched, especially in common areas, several times per day is an important component to control the spread of SARS-CoV-2. Consider the following actions to improve hand hygiene and sanitation: 1. Continue to encourage frequent handwashing with soap and water for at least 20 seconds. Use Page 10 of 13 hand sanitizer with at least 60% alcohol if soap and water are not available. a. Consider adding hand washing technique signage over all sinks. 2. Install additional touchless hand sanitizer stations in the cafeteria, outside of locker rooms, and before and after high touch areas (e.g., handrails). a. Consider providing hand sanitizing wipes in the cafeteria so that workers can sanitize their hands after they remove their cloth face coverings and disposable facemasks at their lunch cubicles. 3. Educate workers on proper alcohol-based hand sanitizer use. a. Additional information on proper hand sanitizer use can be found at: https://www.cdc.gov/handwashing/hand-sanitizer-use.html. b. Consider the use of videos such as these videos from YouTube: https://www.youtube.com/watch?v=Qe5bvXjEmkY or https://www.youtube.com/watch?v=ZnSjFr6J9HI. You can also find videos in languages other than English. 4. Install touchless soap dispensers, sanitizer dispensers, paper towel dispensers, (preferred over hand dryers) and touchless trash cans wherever possible, including administrative/office areas of the plant. 5. Emphasize proper hand hygiene after gloves are removed and before and after facial coverings are donned or doffed. Continue to frequently disinfect high-touch areas in food production areas with products meeting and approved under the facility’s sanitation standard operating procedures. a. If EPA-registered disinfectants are not available, diluted household bleach solutions (final concentration at least 1000 ppm sodium hypochlorite), or alcohol solutions with at least 70% alcohol, can be used. Additional guidance on cleaning and disinfecting non-food production areas of your facility can be found on the CDC website. 6. Continue to conduct targeted and more frequent cleaning of high-touch surfaces of common areas (e.g., time clocks, bathroom fixtures, break room tables and chairs, locker doors, vending machines, railings, door handles, etc.). Follow CDC guidance for disinfection. Training and Communication When developing training and communication materials, the plant should use current, correct messaging from a trusted source. Training should be reinforced using signage (preferably infographics or simple signs with a single, clear message) placed in strategic locations. Graphics and suggested messages are available from CDC for use on social media profiles and web pages. Print resources and communication guidance also are available from CDC and are available in multiple languages. Videos are also available for use. Use definitions and examples to explain technical terminology and concepts used in training or communications to help improve understanding. CDC’s Interim Guidance for Businesses and Employers to Plan and Respond to COVID - 19 also provides a thorough list of topics for educating workers about how they can reduce the spread of COVID-19. CDC has also developed a communications plan along with state and local public health that we will share with you as soon as it is completed. Consider the following actions to improve your training and communication efforts: Page 11 of 13 1. Continue to provide COVID-19 informational signage throughout the plant. 2. Add additional signage in areas where workers might congregate to remind workers about hand hygiene, social distancing, and cloth face covering and disposable facemask use. 3. Enlarge and simplify COVID-19 signage. 4. Remove as much outdated signage as possible. “Refreshing” messages by putting up new signs (even if they have a similar message) helps make the signs stand out to workers. 5. Do not post signs in spaces that are already congested with other signs or postings as they are hard to pick out in these settings. 6. Use more pictures/pictograms in relevant languages to increase the percentage of the workforce that engages with signs and messaging. 7. Ensure signage is at eye level and can be easily seen by the workers. Consider hanging signs from the ceiling so that workers do not have to look to the side to see all messaging. 8. Install additional video monitors for displaying messaging to workers throughout the day. Simple, eye catching messages that refresh frequently can be a simple way to provide information to more workers. As with signs, use pictures/pictograms and relevant languages to increase the percentage of the workforce that engages with this messaging. Consider developing videos in relevant languages using plant workers who speak those languages. 9. Continue to engage in group communication used by workers, such as texting, Viber, and WhatsApp. Engage with workers and community organizations to understand which apps and methods are most used by plant workers. 10. Increase the number of signs, ensuring use of relevant languages, regarding proper hand hygiene near hand washing stations. 11. Consider developing closed (private) worker-only Facebook or other social media pages and invite workers to follow the page. Post guidance and information on the page in relevant languages to ensure maximum reach. 12. Continue to provide existing training and messaging (in relevant languages) for social distancing, hand hygiene, donning and doffing, cough and sneeze etiquette (even when wearing disposable facemask), and sanitizing PPE and source controls, and messaging about what to do if you are sick. If workers carpool, consider training in relevant languages on the risks related to carpooling and how to mitigate them. 13. Consider alternatives to traditional in-person trainings for delivery of this information (e.g., videos, phone applications). a. Develop a method to verify worker understanding and participation. b. Partner with community organizations and the local health department to distribute messaging to workers. 14. Provide training to workers, supervisors, and management whenever changes are implemented in the workplace. Refresher trainings should be provided on a regular basis. 15. Share all training and messaging materials with contract staff. 16. Consider targeting additional training and education to production areas or shifts in which you are seeing positive COVID-19 cases. Updated information and Guidance Check back frequently on the CDC COVID-19 webpage for updated information and guidance on preventing and mitigating the spread of COVID-19 among your workers while they are at work. The company should consult with USDA/FSIS to determine if proposed controls are acceptable with regards Page 12 of 13 to food safety and sanitation. Continue communicating and working with PA DOH, PDA and strategic community partners. End of Memo Page 13 of 13