Companies around the country are looking for ways to make the workplace as safe as possible, and the concept of screening employees for possible SARS-CoV-2 has surfaced as a popular strategy. Many organizations - from Amazon to General Motors - have already implemented some kind of screening, whereas others are planning to do so. All of them are grappling with the details of exactly how to implement such screening. If your organization is evaluating screening, here are 5 things you should consider:
This may seem straightforward, but can prove to be a thorny issue.
The first question is whether you will screen all employees, or only those that opt in? Employers who are governed by the Americans with Disabilities Act (ADA) are usually prohibited from requiring “medical examinations” (which would include health screening). However, due to the classification of SARS-CoV-2 as a “direct threat” and “pandemic influenza,” the US Equal Employment Opportunity Commission (EEOC) has confirmed that “employers may measure employees’ body temperature” as well as “ask employees...about their symptoms” if they report feeling ill. This is currently only allowed under a defined “direct threat,” so it would be wise to monitor the EEOC website regarding their assessment of the threat as the SARS-CoV-2 situation evolves.
Many employers, including Amazon, Walmart, and General Motors, have chosen to require employee screening. Optional screening could prove ineffective if large numbers of employees opt out; on the other hand, mandatory screening could be perceived by employees as a lack of trust in their good intent. Kroger appears to only be requiring temperature checks in areas where the local government has mandated it. Boeing has chosen to split the difference, requesting that employees perform self-health checks at home and then performing voluntary temperature screening on-site. Regardless of whether your screening is mandatory or optional, your policy should be objective and non-discriminatory.
Beyond employees, you may be considering screening visitors like contractors, vendors, or customers. This choice depends on the nature of your business - retail stores see many challenges in implementing such policies, but for a typical office building this may be feasible. Some organizations plan to prohibit visitors altogether, or at least limit visitors to only the most essential. If you do choose to screen visitors, give them plenty of notice so they know what to expect before they arrive.
In general, you should clearly communicate your screening policy to any employees and visitors with advance notice. In some jurisdictions (notably, California) you may be required to post a written notice with specific details regarding the collection of personal information (example for California).
There are two major categories of health checks that businesses are exploring: symptom-based screening and diagnostic or serologic testing. Here we cover symptom-based screening as the most prevalent and accessible form of health check, but in a later article we will also cover diagnostic and serologic testing.
In symptom-based screening, employees are evaluated for the presence of SARS-CoV-2 symptoms as described by the CDC, which were updated on May 27 to include not only fever, cough, shortness of breath, chills, shaking with chills, muscle pain, headache, sore throat, and new loss of taste or smell, but also congestion or runny nose, nausea or vomiting, and diarrhea. Screening for these symptoms typically takes the form of temperature checks and/or symptom questionnaires. They are somewhat limited by the fact that many infected individuals do not exhibit symptoms (asymptomatic) or may not yet exhibit symptoms when screened (pre-symptomatic). In a White House briefing, Dr. Anthony Fauci estimated between 25-50% of infected individuals are asymptomatic.
However, many employers favor these approaches because they are broadly accessible, can be implemented immediately, and have been recommended by the CDC for workplaces with “minimal to moderate risk.” According to a recent survey by the Employer Health Innovation Roundtable, “self-reporting of symptoms and thermal screening at worksite entry are the two approaches most commonly cited that will be implemented once worksites are reopened with over half (58%) indicating usage.” Dr. David Hindin, surgeon and Biodesign Innovation Fellow at Stanford University, recommends using both temperature checks and symptom questionnaires together to maximize the efficacy of symptom-based screening.
Temperature checks screen employees based on body temperature and require employees to remain at home if their temperatures register above a certain threshold (the CDC threshold is 100.4 F, but others like Walmart or the State of Delaware have chosen more conservative cutoffs). Organizations have relied on a variety of equipment to accomplish the task - temporal (forehead) non-contact thermometers, thermal cameras, or even oral thermometers. In many cases, equipment availability dictates these choices; even if you are not anticipating returning to work for many weeks, you should begin exploring equipment options early in anticipation of long lead times.
While the FDA usually regulates these devices for clinical or diagnostic use, the agency has temporarily stopped enforcing its requirements for clinical electronic thermometers and thermal imaging equipment. However, be wary of faulty equipment that has surfaced online, and look for devices manufactured by companies who are recognized and respected in their fields. Even for equipment not approved by the FDA, the agency still provides guidance on how to choose a device; for example, the agency recommends that thermal cameras be capable of an accuracy of +/-0.9 F over the temperature range 93.2-102.2 F.
In addition to temperature screening, symptom checks require employees to answer a questionnaire or sign an attestation that they have no SARS-CoV-2 symptoms before reporting to work. If you choose to ask employees about their symptoms, make sure your language is precise and consistent, and reflects the latest understanding of SARS-CoV-2 symptoms from the CDC. You should not ask questions about health unrelated to SARS-CoV-2 symptoms. The Washington State Department of Health has developed a set of five easy Yes/No questions as an example.
On-site screening and screening at home both come with pros and cons – and employers have chosen a variety of approaches.
While some employers have favored on-site testing, it is also possible for employees to perform checks in the privacy of their own homes. For example, Home Depot and Intel have chosen to provide thermometers to their on-site employees and ask them to measure their temperature before coming in to work. Asking employees to self-screen at home eliminates many of the safety and privacy questions associated with on-site screening.
If you are choosing to mandate screening, on-site screening will guarantee compliance, but also comes with other questions. For example, who will conduct the screens? Both Walmart and Amazon (see images here) initiated checks with company employees as screeners. Some Amazon employee screeners admitted this made them feel unsafe, which may have been a factor in Amazon’s decision to switch to thermal cameras (which don’t require interpersonal contact and significantly speed up the process). Alternatively, some legal professionals, such as those at international law firm WilmerHale, recommend the use of health professionals in conducting screens if it’s possible.
Regardless of who performs an on-site screen, make sure you protect your screener(s) with sufficient PPE or possibly even a physical barrier (Amazon initially used plexiglass; see screening guidelines in the CDC FAQs). You will also need to plan the logistics of screening employees efficiently - you don’t want crowds or lines that make social distancing impossible. You may need to stagger employee arrival times to ensure screening stations are not overwhelmed.
Finally, if you have a campus where employees may move between buildings throughout the day, it may be hard to distinguish who has already been screened. You can take a tip from many hospitals in this regard, many of whom are distributing stickers that indicate the date an individual has been screened.
If you are conducting checks on-site or asking employees to self-report information, you will need to decide what information, if any, you will record - the rule of thumb is “less is best.” What information do you truly need to capture? For example, do you need to record all screened employees, or only those who don’t pass? Do you need to capture their precise temperature, or simply that an individual did not meet the threshold? Beyond capturing the result of the screen and the date, you may need personal contact information in order to follow up with them, or a manager’s name. Create an easy template like this one to capture this information consistently.
If you do capture information, it must remain confidential, and “the ADA requires that all medical information about a particular employee be stored separately from the employee’s personnel file.”
If you are asking employees to screen themselves at home, make sure they understand who to contact (e.g., HR) and how to do so if they “fail” the screen. Those contacts across the company should be well-trained in next steps, including the following:
In addition to the steps above, if you are screening individuals on-site you will also need a plan for the on-site logistics of a “failed” screen. Before taking action, you may want to confirm the result by performing the test again, even potentially using a different measurement device with higher accuracy. You will then need a plan for how to discreetly notify the individual that they have “failed” the screen. After being notified, all of the information above will need to be gathered - given the confidential nature of the information, you likely will not want your screener to collect that information. You may simply want to report the employee’s name and contact information to HR and have HR call them immediately afterward.
In the meantime, the employee should leave the area and maintain 6 feet of distance from all others. If he/she has a personal vehicle, they can return to their vehicle and go home; otherwise, you may want to designate a private “waiting room” for employees who will need someone to pick them up.
While these procedures may sound daunting at first, preparing them in advance will help your teams respond to situations in a way that keeps employees as safe and calm as possible. Regardless of how you navigate screening, consult local HR and Legal counsel regarding what you can ask of employees, as well as what information you can record from them and how to properly retain and dispose of personal information. The variations on screening are endless, but if you have answers to these five questions you are well on your way to an effective plan that will support employee safety and respect privacy, all while enabling the smoothest return-to-work possible.
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