Medical Partners

COVID-19 Protocols For School and Higher Education

The Government of Ontario and Toronto Public Health have implemented guidelines with regards to protecting the health and safety of Ontario's facilities during COVID-19. These are recommendations as well as descriptions of mandatory safety and health standards and are intended to assist administrators in providing a safe and healthy facility or venue.

No Wait Medical Partners focuses on the need to follow appropriate guidelines during work shifts and while at home.


General Responsibilities



Assess the hazards to which your staff, workers, and visitors may be exposed; evaluate the risk of exposure and select, implement, and ensure workers use controls to prevent exposure. Follow local public health for location specific instructions.


1. Implement Basic Infection Prevention and Control (IPAC) Measures



-Hand Hygiene

  • Promote frequent and thorough hand washing, including providing employees and customers with a place to wash their hands. If soap and running water are not immediately available, foam alcohol-based hand rubs containing 60-90% alcohol should be provided. Regular hand washing or using of alcohol-based hand rubs are necessary. Hands should be washed when they are visibly soiled and after removing any Personal Protective Equipment (PPE).


  • Provide resources and environment that promotes personal hygiene, including tissues, no-touch trash cans, hand soap, disinfectants, and disposable towels to clean surfaces. Post hand washing signs in restrooms. Ensure clean toilet and hand washing facilities. Fill hand sanitizer dispensers regularly. Disinfect frequently touched items, including door pulls and toilet seats often.


-Respiratory Etiquette

  • The importance of covering coughs and sneezes with a tissue should be emphasized. Afterwards, throw the tissue away into the trash and perform hand hygiene.


  • Avoid touching the face, especially with unwashed hands.


-Source Control

  • Staff and visitors should wear non-medical masks over their nose and mouth to prevent them from spreading the virus, though it is not PPE.


  • Cloth face coverings should not be placed on children younger than 2 years old, anyone who is incapacitated or otherwise unable to remove the cloth face covering without help, and people who cannot tolerate them based on underlying health and/or behavioral issues.



-Enhanced Sanitation

  • Maintain regular housekeeping practices, including routine cleaning and disinfecting of surfaces, equipment, and other elements of the environment. When cleaning tools and equipment, staff should consult manufacturer recommendations for proper cleaning techniques and restrictions (e.g., concentration, application method and contact time, PPE).



  • Develop a disinfection schedule or routine plan, especially for high contact areas like restrooms. Ensure sufficient stocks of cleaning and disinfecting supplies to accommodate ongoing cleaning and disinfection. High touch areas should be cleaned and disinfected (e.g. doorknobs, display cases, equipment handles) more frequently, at least twice daily and when visibly soiled). Plexiglass barriers should be cleaned routinely (e.g. daily) using a cleaning agent that will not compromise the structural integrity or function of the barrier.

Donation

2. Hazard Controls



-Elimination/Substitution


  • When feasible, replace in person classes with virtual ones to avoid face-to-face interaction. Use implement online synchronous learning.


  • In-person attendance for elementary to secondary students is optional.


-Engineering/System Controls


  • Space out furniture to facilitate physical distancing. In washrooms, close every other stall, sink, or urinal.


  • Install partition barriers such as plexiglass when physical distancing is not an option.


  • Maximize the outdoor air ratio of the heating, venting and air conditioning (HVAC) systems and ensure they are up to American Society of Heating, Refrigerating and Air-Conditioning Engineers (ASHRAE) standards.


-Administrative Controls


  • Provide easily acceptable waste receptacles for used wipes and other disposable protective equipment.


  • Improve circulation inside by opening windows and doors. To prevent blowing droplets onto people and surfaces, limit the use of low ceiling fans and refrain from using pedestal fans.


  • Increase frequency of disinfecting commonly touched surfaces. Remove nonessential frequently touched items (i.e., books, service menus, pens).


  • Manage traffic by designating drop off or pick up locations near the school entrance. Designate or mark whether a door is an entry or exit.


  • Assign items to individuals and label with names to reduce sharing. Disinfect equipment between each use.


-Personal Protective Equipment (PPE)


  • PPE can be used by trained personnel to lower the risk of transmission as a last option if other controls are not sufficient.


3. Screening



  • Everyone regardless of symptoms should wear a cloth face covering until leaving the facility when activities permit.


  • Post screening information on a website, send an email containing screening requirements, or consider mailing by post if the client does not have access to the other methods.


  • Active Screening


    • Facilities should identify individuals with fever or symptoms consistent with COVID-19.


    • Screening stations should be clearly identifiable. The area around the station should have visual markers to facilitate a two metre distance between people waiting to be screened. To avoid long lines, consider organizing students by class and having a designated staff member screen by class before entry. Another option to prevent long lines is having staggered start times.


    • Screeners should be behind an engineering barrier such as a plexiglass screen. If that is not possible, they should maintain a 2 metre distance from the person they are screening and wear droplet/contact precaution PPE such as gloves, gown, surgical mask, and eye protection. Have ABHR, tissues, and a no-touch lined waste basket available.


  • Passive Screening


    • Post signage for passive screening at entry points for people to self-identify if they screen positive.


  • Symptoms/Positive Screen


    • Anyone with symptoms or recent close contact with someone who tested positive should be encouraged to self-isolate and get tested, or call telehealth (1-866-797-0000).


    • Staff or patrons who become unwell in the facility should be instructed to separate themselves from others, leave the facility using private transportation if possible, self-isolate, and get tested at an assessment centre.


  • Contact Tracing


    • Keep names, contact information, dates, times, and location of where the individual was for public health tracing purposes.


4. Testing



More instructions can be found at the COVID-19 Provincial Testing Guidance Update.


  • Symptomatic


    • Whenever symptoms consistent with COVID-19 are present, a test is recommended.


  • Asymptomatic & Risk Based


    • Should be done when the person is in contact with someone who tests positive for COVID-19, is part of an outbreak investigation.


  • Positive Tests


    • Employers must report occupationally acquired infections within 72 hours of receiving notice to the Workplace Safety and Insurance Board. Employers who receive notice that their worker has tested positive due to workplace exposure must give notice to the Ministry of Labour, Training and Skills Development, Workplace's joint health and safety committee (or health and safety representative), and Worker's trade union, if applicable, within four days.


No Wait Medical Partners enables safe and timely triage, antibody testing, monitoring, contact tracking and containment of suspected or confirmed COVID 19 positive employees. No Wait Medical Partners contributes to limiting exposure and risk management and enables contact tracing for suspected COVID-19 positive employees.


5. Mental Health



  • Mental health support should be provided to all employees, including access to an employee (and family) assistance program (EAP/EFAP) if available. Additional comping resources include the Centre for Addiction and Mental Health and Canadian Mental Health Association. Emergency communications plans should be developed, including a forum for answering employees' concerns and internet-based communications, if feasible. Other support factors to consider include parenting, meals, and non-punitive sick policies.


No Wait Medical Partners is available to provide psychological supports, including mental health support, and psychoeducation.


6. Education



  • General Education


    • Post signs covering social distancing, hand hygiene, respiratory hygiene, cough etiquette, and COVID-19 signs and symptoms.


  • Staff Training


    • Ensure information is available in a variety of formats for staff and students with special needs.


    • Staff should be trained on the signs and symptoms of COVID-19 with an explanation of how the disease is potentially spread, including the fact that infected people can spread the virus even if they do not have symptoms.


    • Provide staff with up-to-date education and training on COVID-19 risk factors and protective behaviors (e.g., cough etiquette, proper hygiene practices, and care of PPE). Staff should clearly be instructed on mandatory masking policy, and understand who is exempted, with proof of exemption not being required.


    • Train staff who need to use protecting clothing and equipment, and on how to examine it, put it on, use/wear it, and take it off correctly, within the context of their current and potential duties. Content should emphasize having clean hands before facial contact. Training should be conducted virtually or maintain social distancing.


    • Emphasis should be placed on the need for staff to report any safety and health concerns.


7. Absenteeism



  • Flexible sick leave policies should allow staff to stay at home in the event of sickness, possible exposure, or caring for someone who is sick. Evaluate whether the work duties can be done through telework. Before returning to work, staff should notify their Occupational Health and Safety Department.


  • Administration should inform and encourage staff to self-monitor for signs and symptoms of COVID-19 if they suspect possible exposure.


  • Staff who have symptoms should notify their supervisor and be encouraged to stay home, and a note from their healthcare provider does not need to be provided in order to validate illness, or their ability to return to work. Sick leave policies should be flexible and consistent with public health guidance and with No Wait Medical Partners, and employees should be made aware of these policies. Employees should not return to work until the criteria to discontinue home isolation are met, in consultation with No Wait Medical Partners. Prompt identification and isolation of potentially infectious individuals is a critical step in protecting employees and customers.


  • Staff who are well but who have a sick family member at home with COVID-19 should notify their supervisor and consult with No Wait Medical Partners regarding the mandatory precautions. Policies should permit employees to stay home to care for sick family members, including sick children or children who are in schools or day care centers that have been closed, or who have immunocompromised family members, and are afraid to come to work because of fear of possible exposure.


  • Staff concerns about pay, leave, safety, health, and other issues that may arise during infectious disease outbreaks should be addressed, and employers are encouraged to work with insurance companies (e.g., those providing employee health benefits) and local health agencies to provide information to staff and families about medical care in the event of a COVID-19 outbreak.


No Wait Medical Partners will provide daily follow up on employees who are self-isolating at home, and on what their expected return to work dates will be.


8. Speciality Learning Options



  • Placements


    • Offer virtual co-op placements when feasible.


    • Limit movement between facilities.


    • Record student visits to off-campus facilities.


  • Health and physical education


    • Hold classes outdoors and only use gymnasiums if physical distancing is feasible. Limit capacity in change rooms. Close weight/fitness rooms if the school has them.


    • Items should be disinfected between cohorts. Items that are difficult to disinfect may be quarantined for three days before being used by another cohort.


    • Clean high touch gym surfaces throughout the day. The whole gym and play structures do not need to be cleaned or disinfected.


    • Practice hand hygiene before and after physical activity or using equipment.


    • Plan intense cardiovascular endurance activities outside so masks are not required.


  • Music


    • Consider virtual learning options. If in-person teaching is done, consider ways to lower risk by instructing in a larger space or restricting the type of instrument.


    • Students should not share instruments.


    • Singing and playing wind instruments, both indoors and outdoors, should be cancelled at this time. If these activities continue, singers or players must be separated by an impermeable barrier, and two metres of physical distance maintained for instruction at all times.


    • Non-wind instrument players who do not sing or him while playing may wear a mask and maintain physical distance without an impermeable barrier.


  • Large gatherings


    • Assemblies and other large gatherings should be cancelled.


    • Non-essential student gatherings should be cancelled.


  • Heat alert days


    • Consider cancelling classes during heat alerts due to reduced capability for wearing masks.


Elementary & Secondary Schools



1. Physical Distancing



In addition to administrative controls outlined in the main section, there are classroom specific actions that can be taken to mitigate the risk of transmission.


  • Arrange furniture two metres apart; remove chairs, desks, or other furniture to allow students to physically distance. Mark the locations to make rearranging easier.


  • Increase space between seating or play area for JK/SK classrooms. Mark the locations using tape or other visual markers for floors, tables, seats, and play areas.


  • Physical cues (e.g., tape, stickers, safety cones, painted lines) should be placed in locations such as entrances or washrooms to facilitate a two metre distance between individuals. Design one-way routes and use floor markers to prevent crowding in areas such as entrances, hallways, and classrooms.


  • Designate room(s) for sick individuals. This room should only be used for isolation or wellness purposes. Items and equipment in this room should be minimal and easy to disinfect after each use. These rooms should include a handwashing sink or hand sanitizer with 70% to 90% alcohol concentration.


  • Avoid activities that include sharing objects or those that involve indoor singing, shouting, or speaking loudly.


  • Include hygiene in breaks, recess, between school actives, snack time, and mealtime.


2. Screening



  • Screens may be completed on paper (screener recording answers), electronically, or verbally.


  • Indicate the individual has completed their screening through using smartphone, applications, stickers, or other methods. If children arrive without completing the questionnaire, contact parents to complete the screening.


  • Positive Screens


3. Illness



Students and staff who become ill at school must be isolated to prevent infection. Students should be supervised until pick-up. Ill students should be placed in separate rooms if available, or two metres apart if not.


  • Exposure Risk


    • Always take IPAC measures such as wearing a mask or face covering, practicing respiratory etiquette, and refraining from touching the face.


  • Returning to School


    • Individuals who test positive for COVID-19 must be cleared by public health before returning to school (usually 10 days after symptoms arrive).


    • Individuals who test negative for COVID-19 and are not a close contact of a positive case may return if symptoms are improving for 24 hours.


    • Individuals who do not receive testing and received an alternate diagnosis may return if symptoms are improving for 24 hours.


    • Individuals who do not receive testing or an alternate diagnosis may return to school 10 days after their symptom(s) started if symptoms are improving for 24 hours and they do no have a fever (without taking medication).


  • Siblings


    • Siblings of a symptomatic student must self-isolate unless the symptomatic student has an alternate diagnosis.


    • Siblings of students who test negative for COVID-19 may return to school immediately.


    • Siblings of students who have symptoms and test positive for COVID-19 must self-isolate for 14 days.


    • Siblings of students who have symptoms, do not go for testing, and is NOT a close contact of a positive case must self-isolate for 10 days.


    • Siblings of students who have symptoms, do not go for testing, and is a close contact of a positive case must self-isolate for 14 days. The student must self-isolate for 10 days from when symptoms first appeared.


No Wait Medical Partners enables safe and timely triage, antibody testing, monitoring, contact tracking and containment of suspected or confirmed COVID-19 positive employees. No Wait Medical Partners contributes to limiting exposure and risk management and enables contact tracing for suspected COVID-19 positive employees.


5. Cohorting



Grouping classes into cohorts' limits exposures. Student cohort size should be limited to 50 in elementary and 100 direct or indirect contacts in secondary schools. Encourage students and staff to limit personal items that they bring to school. Ensure items are labelled and stored in a designated area. Disinfect items, spaces, and rooms between cohorts. Play structures must be used by one cohort at a time.


  • Elementary Schools


    • A single cohort with classmates and teacher should remain in one class. Limit contact with other subject teachers. Reduce contact with other cohorts.


    • Students participating in before and after school programs would be part of two cohorts.


    • Older students should maintain physical distancing and practice IPAC measures.


  • Secondary schools


    • At least 50% of instruction days will be in-class. Students should have a maximum of two in-person class cohorts.


    • When different teachers are required, have staff come into the classroom and maintain physical distancing. If supply teachers are required, arrange for them to cover the class for longer absences.


    • Students should maintain physical distancing and practice IPAC measures.


6. Transportation



Review Federal Guidance for School Bus Operations from Transport Canada. Consider Health and Safety Guidance During COVID-19 for Student Transportation Employers.


  • Encourage active forms of travelling (e.g., walking, biking) and private transportation by parents or caregivers.


  • Screening: Complete COVID-19 screening before boarding school transit.


  • Operators: The seat immediately behind the school bus driver should remain empty. Operators should have reduced drivers per vehicle and have a consistent work schedule to limit the number of contacts.


  • Seating: Students should have assigned seating that supports physical distancing. Seating charts and attendance records should be maintained. One student should be assigned per seat unless they are in the same household or cohort. Cohorts may sit in the same area. Consider boarding strategies to limit student interaction.


  • Masking: Bus drivers should wear appropriate PPE (i.e., medical mask). Students are required to wear nonmedical masks when waiting for, boarding, sitting on, and leaving the bus.


7. Food & Water



  • Encourage students to remain seated in classrooms with their cohorts while physically distancing. If possible, have lunch outdoors.


  • Perform hand hygiene before and after eating.


  • Students should not share food. Individual drink bottles should be labeled and not shared.


  • Remove self-service food items. Ensure meals are delivered in a self-contained format. Portion foods in the preparation area, or with minimal handling in the serving area.


  • Water fountains should be disinfected twice daily and as needed. Fill water bottles from the station instead of drinking from the fountain. Post signage indicating measures to take.


8. Masking



Refer to Ontario's face coverings and face masks document for more information.


  • Kindergarten to Grade 3: Wearing non-medical masks is encouraged, but not required indoors, such as in classrooms, and buses.


  • Grade 4 to 12: Wearing non-medical masks is required indoors, such as in classrooms, hallways, and buses.


  • Teachers & Staff: Should be provided appropriate PPE (e.g., medical masks, eye protection, face shields). Staff members must wear masks indoors, with exceptions for medical conditions.


  • Mask Breaks: Consider scheduling mask breaks outdoors or when students are seated and physically distancing.


  • Mask-reuse: If not damp, a nonmedical mask or face covering may be reused in one day. Face coverings should be washed daily. Face coverings should be stored in a container that would not retain moisture if it is to be worn again. Students should keep their labelled containers with them during recess.


Post-Secondary Schools



Individuals who have symptoms may use the COVID-19 Decision Tool for Post-Secondary Institutions to determine next steps to take.


1. Documentation



Daily records must be maintained for case and contact tracing. Records should be kept confidential and disposed of safely. Ensure records are available onsite for contact tracing purposes by public health.


  • Attendance Records


    • Schools must maintain and have available records of staff, student, and visitor names, contact information, time of arrival and departure, areas visited, reason for visit, and if screening was completed.


    • Monitor attendance for trends such as students in one cohort being absent at similar times.


  • Visitors


    • Non-essential visitors are not allowed to enter the campus.


    • Maintain records of essential visitors that have individual's name, company, contact information, date, time in/out, areas visited, and if screening was completed.


  • Reporting laboratory-confirmed cases


    • Students/staff living in university/college dormitories: Email CovidSchools@toronto.ca with


      • Institutional information: name and address of the institution, name and contact information of institutional contact, name and contact information of occupational health & safety contact, if different.


      • Case information: residence involved, including layout and number of students/staff in residence , who reported the case to the school, and any other ill staff or student reports.


      • Personal information: name(s) of ill staff/students, information on ill staff/student (including date of birth), date symptoms started, last day at institution, contact information for staff/students (including a working phone number and address), start date of symptoms, and last day at institution.


    • Students/staff living outside of university/college dormitories: Call TPH Hotline at: 416-338- 7600 (8:30 a.m. to 8:00 p.m.), or 311 after hours, with name and address of the institution, name and contact information of institutional contact, name and contact information of ill staff/student (include phone number, current address, date of birth), start date of symptoms, and last day at institution.


    2. International Students



    Have policies in place to address stigma associated with COVID-19. Ensure appropriate supports and information are available to students.


    • Facilitate international student and staff transportation from the airport. House them in designated rooms with a separate bathroom for each student for the isolation period. Check-in daily and ensure meals and necessities are provided.


    • If faculty arranged private transportation and housing is not available for all international students, instruct students to use private transportation and not go on campus until they complete their isolation period.


2. Campus



  • Amenities


    • Gyms, lounges, and seating areas must comply with relevant provincial and municipal orders, directives, and by-laws.


    • Enhanced IPAC measures should be followed. Common spaces should be rearranged so physical distancing is possible. Create a schedule to use common spaces in shifts.


    • Non-essential visitors and non-essential group activities that require close contact should be cancelled.


  • Clubs


    • Consider implementing virtual meetings instead of in-person attendance. Limit on-site clubs, organizations, and services.


  • Libraries


    • Restrict to only essential on-site library services like contactless book pickup, drop off, and computer access. Limit study spaces to discourage students from remaining on campus.


    • Do not allow patrons to handle shelved books or materials.


    • Leave returned items in a designated waiting area for three days for Toronto facilities or seven days for Ottawa facilities. If they must be moved or used before the quarantine period is over, clean and disinfect the items.


3. Residences



Refer to the Ministry of Health's COVID-19 Guidance: Congregate Living for Vulnerable Populations for on-university/college residences.


  • Restrict shared areas to facilitate physical distancing. Remind students to wear their mask in shared areas.


  • Only permit entry for residents, essential staff, and visitors. Limit student movement between rooms and residences.


  • Support students in quarantine or self-isolation by ensuring services, supports, and essential goods may be delivered. Treat students with respect and focus on dignity and privacy.


Staff Guidelines



  • Employees can protect themselves and their co-workers from COVID-19 by taking IPAC measures. Employees are encouraged to forward any questions or concerns that they may have to No Wait Medical Partners.


Protecting Yourself and Others



-Hand Hygiene


  • Practice good hygiene. Wash your hands frequently with soap and water for at least 20 seconds, or if soap and water are not immediately available, then use an alcohol-based hand sanitizer that contains at least 60% alcohol and rubbing hands until they are dry. Avoid touching your face.
    COVID-19 Guidlines

    Click here


-Respiratory Etiquette


  • Follow the proper guidelines for covering coughs and sneezing (i.e., sneezing or coughing into a tissue or into the upper sleeve). Always wear a face mask while in the workplace, and the mask should cover your nose and mouth. Learn how to properly put on, use/wear, and take off protective clothing and equipment.


  • If possible, wear cloth face coverings protect others in case the wearer is unknowingly infected. Cloth face coverings should not be placed on babies and children younger than 2 years old, anyone who has trouble breathing or is unconscious, or anyone who is incapacitated or otherwise unable to remove the cloth face covering without help.


-Social Distancing


  • Maintain 6-feet of social distancing as work duties permit, and avoid physical contact with others, including other staff, students, or campers.


  • Use alternatives ways to shake hands upon entry, and it is important to not touch your face (i.e., mouth, nose, eyes).


  • Drive to facilities or parking areas individually; when possible, an avoid having passengers or foods.


  • Use gloves to avoid direct bare hand contact with ready-to-eat foods.


  • -Daily-health checks


    • Determine if you have fever, respiratory symptoms (e.g. coughing, shortness of breath) or other symptoms in the past 24 hours. If so, stay at home and notify the COVID-19 point of contact.


    What should I do if I become ill?



    • Notify your supervisor and No Wait Medical Partners immediately, complete the self-assessment (self-checker).


    Resources:

    Below are some resources on government approved guidelines around proper hygiene and cleaning practices, and the use of Personal Protective Equipment (PPE) for COVID-19.


    Environmental Cleaning


    Infection Prevention and Control


    Screening


    Self-Isolation


    Masks


    Signage


    COVID-19 Fact Sheet


    Mental Health Support


    Elementary and Secondary Schools

    Post-Secondary Institutions


    Back to School Confirmation Form (Toronto Public Health guidelines)


    COVID-19: reopening schools (Ontario Government guidelines)


    COVID-19 Decision Tool for School Students (JK-12) (Toronto Public Health guidelines)


    COVID-19 Decision Tool for School Staff (Toronto Public Health guidelines)


    COVID-19 Guidance for Re-Opening Schools JK to Grade 12 (Toronto Public Health guidelines)


    COVID-19 Guidance: Elementary & Secondary Schools (Toronto Public Health guidelines)


    COVID-19 Guidance: Post-Secondary Schools (Toronto Public Health guidelines)