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 631-930-7447

  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)?

Conditions of entry into the facility for any customer and visitor are displayed: Including wearing a mask upon entrance to the facility, maintaining social distancing, and proper and frequent hand washing is required.

The facility will post the facility visitation policy and safety plan requirements on this website.  While taking a person-centered approach and adhering to the core principals of COVID-19 infection prevention, outdoor visitation will be preferred even when the resident and visitor are fully vaccinated against COVID-19.

The core principles of COVID-19 Infection Prevention will be followed which include; screening of all who enter the facility for signs and symptoms of COVID-19 which includes completing questions and observation of symptoms.  Visitors will be required to complete a health screening  prior to entry and have their temperature checked.  Visitors will be denied entry if they have signs of symptoms of COVID-19, have temperature of 100.0F or greater, or had close contact with known COVID-19 person.

The facility will use the outside courtyard weather permitting.

Each scheduled outdoor visitation session will accommodate a maximum of 14 residents and guests. Only 2 visitors per resident will be allowed at each scheduled visit.

Indoor visitation will be allowed except for a few circumstances when it may be limited due to high risk of COVID-19 transmission such as:  unvaccinated residents if the COVID-19 county positivity rate is > 10% AND < 70% of residents are fully vaccinated, residents with confirmed COVID-19 infection, and residents in quarantine whether vaccinated or unvaccinated, until they have met the criteria to release from quarantine.

Indoor visitation may occur in closed section of dining area on Memory Care Unit, family rooms, and vacated dining rooms when residents share a room.  In-room visits may occur when the resident’s health status prevents leaving the room.

Visitors will be encouraged to be tested within 2-3 days of their visit.  Visitors will also be encouraged to be vaccinated.

Visitor guidance forms are available at the front desk. Visitors will be requested to complete hand hygiene with alcohol based hand sanitizer (ABHS) at the screening table and throughout their stay.

Educational resources will be available to all visitors on COVID-19 symptoms, testing, and measures to prevent transmission.  Signage is posted throughout the facility

Signage will be posted at screening areas of potential for COVID-19 exposure in the facility (e.g., signage regarding current outbreaks), and adherence to the core principals of COVID-19 infection prevention, including effective hand hygiene and use of face-coverings. Signage will be noted above ABS for hand hygiene.

The visitors will be directed to proceed immediately to designated outdoor visitation area, designated indoor area, or resident room for visit.

Occupancy limits will be posted on outdoor patios to comply with social distancing.

All tables/chairs will be disinfected after every visit by staff using EPA-approved disinfectant.

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.

Tables and chairs in the employee dining area have been rearranged to allow for 6 foot distancing between staff.

All large meetings, resident council, and staff education will be held via zoom or conference call as practical.

All facility water fountains have been shut off.

All meeting rooms have decreased the capacity by 50% with social distancing signage in those areas posted

  1. PLACE
  1. 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.

The facility has established prime vendors for PPE procurement.  Weekly deliveries are received and reconciled based upon requested orders. When par levels cannot be met by prime vendors the facility has identified alternate/3rd party vendors.  Bulk orders of PPE are placed thru these vendors.

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?

Island has a policy for use of PPE to address both disposable and reusable PPE items within the facility.

Staff are inserviced ongoing on the appropriate usage of PPE as well as the infection control procedures for appropriately cleaning and storing PPE for multiple uses and disposable of one time use PPE items.  Competency evaluations on PPE  use are done on facility staff ongoing.

Surgical Masks in individual plastic bags are distributed to all employees, vendors, contract staff, and essential visitors upon entrance to the facility. Plastic bags are used by staff to store their mask when on breaks.  Masks are to be removed when soiled or moist.

There is a training video for donning and doffing PPE on the facility intranet in the policy section for reference for employees.

Signage is on all units on PPE donning and doffing procedure.

Surveillance on compliance with PPE use, cleaning, and storage is being done ongoing and reported to the QAPI committee.

[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?

EPA approved disinfectant wipes are located on all units, office areas, and shared spaces for staff to use when equipment/materials are shared between residents/employees.

Touchless Alcohol based hand sanitizer dispensers are located adjacent to time clocks.

Computers, kiosk, telephones, desk tops are wiped between use and at the beginning of the shift with EPA approved disinfectant wipes.

Disposable equipment is utilized whenever possible.

  1. 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, meeting areas, and gyms. Hand sanitizers are located in dining rooms, gyms, on medication carts and in all personal offices.

The facility promotes good hand hygiene through education and signage throughout the facility including the employee rest rooms, and at the entrance.

The facility intranet has a hand hygiene video for all staff for review.

Hand hygiene competencies are completed by all departments and reported to the QAPI Committee.

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 Chief Housekeeping Officer/Designee and Interim Director of Purchasing will procure all products for cleaning. The Chief Housekeeping Officer/Designee and Interim Director of Purchasing 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, gyms, 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 Chief Housekeeping Officer/Designee completes random audits to inspect and validate the cleaning process on resident rooms, common areas, equipment, and high touch surfaces. Audit findings are presented to the QAPI Committee for review and evaluation.

  1. 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?

The facility uses the entrance screening log to document every person that enters the facility.  The screening logs are maintained by the Infection Control Preventionist/Designee.

[ 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/Designee will be responsible for notifying state and local health departments when a worker tests positive for COVID-19.


  1. 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?

The facility has only one entrance open for employees, vendors, contract personnel, and visitors.  There is a screening table located at the entrance of the facility and 4 kiosks for all persons entering the facility to complete the screening questionnaire and perform temperature checks.

All visitors and staff will be screened daily prior to entering the facility.  The assessment is completed on the kiosk and the assessment is electronically gathered and maintained.  The information can be accessed at any time by the Director of Engineering/ICP. In the event that the kiosk is not used the screeners will maintain a log of the visitors/staff including notation that the individual was cleared and time of entry. This log will be maintained in electronic format.

No person (employees, vendors, contract personnel, or visitor) can go past the screening area unless they have completed the mandatory assessment questions and have a temperature check. In the event that the kiosk is unable to be used the screener will document the assessment responses on the screening log.   The Infection Control Preventionist/Designee reviews the screening logs daily.


All screeners are trained by the Executive Assistant/Designee on the screening procedure.  The screening policies are updated as regulations change.  Signage is posted at the screening table with questions to be asked by the screeners specific to travel history, COVID symptoms, testing,   and contact with confirmed or suspected COVID cases in the past 14 days.  HR maintains COVID testing results for all employees, contract staff, and vendors.

Human Resources maintain the name and telephone number for all staff for COVID-19 tracing.

Audits are done by the ICP/Designee to ensure compliance with the screening process and presented to the QAPI Committee for review and evaluation.

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.

  1. 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?

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