Learning topics/objectives: What we know about the virus, spread and impacts Implications for business, health and safety management Basics of infectious agents and routes of transmission Assessing biological and occupational health exposures and risks How to determining targeted, job-specific risk controls Work through an example using a specialized COVID-19 biological risk assessment tool

1. Biological Threats:
Dealing with COVID in
the Workplace
June 2020
Presenter: Doug Kube, EP, CHSC
dougkube@outlook.com

2. Introductions
2
Presenter & Facilitator:
 Doug has worked for 30 years' in safety, occupational and public health.
 He has worked in a variety of sectors including pharmaceutical, food,
aviation/aerospace, courier/mail, chemical and consulting engineering.
 Doug was Senior Director, Health, Safety & Environment at Sanofi Pasteur
Toronto where he was responsible for the biological safety and bio-
containment program at its containment level 2 and 3 vaccine
manufacturing, research and development site.
 He was part Air Canada’s team that led the response to the 2010 H1N1
influenza pandemic and part of Purolator’s 2003 SARS response team.
 He has completed post-graduate courses in High Level Biocontainment for
Healthcare Facilities at University of Nebraska, Epidemics: Dynamics of
Infectious Diseases at Penn State University, Emerging Infectious Diseases
at Johns Hopkins Bloomberg School of Public Health and Epidemiology at
University of Ottawa.
Doug Kube, EP, CHSC
dougkube@outlook.com
Ph. 705-994-7053

3. Presentation Overview
We will cover the following:
 Recognizing threats of COVID-19 and return to work
 Preventing workplace outbreaks, work refusals or
disruptions and assuring compliance
 Benefits of a risk management approach
 Biological safety and risk assessment fundamentals
 COVID-19 Biological Risk Assessment Tool for scenarios
associated with specific workplaces and jobs
3

4. 4

5. 5
COVID-19 Safety Plan
Does your plan include all these controls?
• Work from home
• Postpone projects
• Stop meeting face to face
• Physical distancing of 2 m
• Wear face coverings or masks
• Medical screening of visitors & workers
• Reschedule unnecessary visits
• Train everyone on possible hazards
• Train people on how to keep surface clean
• Limit the # of people working in one space
• Have everyone wash their hands
• Reposition workstations to increase distances
• Control # of people in workplace at one time, who they speak to, what they handle
• Clean and disinfect workplace thoroughly and frequently
• Keep COVID-19 awareness, safety talk, while maintaining a safe physical distance
5

6. Cost of getting it wrong?
• Death (Global 361,270, U.S. 101,706, Cda 6,982)1
• Pain and suffering (Ontario 1,613 intensive care)
• Illness & serious illness (Hospitalized: NY 78,043, ON 8,152)
• Business interruption (40% Canadian retailers closed)
• Reduced morale
• More regulatory scrutiny, non-compliance
• Corporate reputation, employee and customer confidence
• Cost of workers compensation claims
• Divert management attention
• Lost business opportunity
1. COVID-19 Dashboard by the Center for Systems Science and Engineering (CSSE) at Johns Hopkins University (JHU),
https://gisanddata.maps.arcgis.com/apps/opsdashboard/index.html#/bda7594740fd40299423467b48e9ecf6, taken 29May2020

7. Benefits of Risk Management
Approach to COVID-19
 ‘Stress test’ existing COVID-19 safety plans
 Workplace-specific assessment and inventory of:
 Key jobs/positions of concern
 Work locations with greatest risk
 Establish organizational risk profile and risk tolerance
 Enhanced, targeted risk controls to reduce transmission
 Increase organizational capacity to monitor and manage
 Confidence to employees, managers, Union, Boards
 Support existing crisis and business continuity plans
 Ensure compliance and due diligence
7

8. 8
COVID-19 Biological Risk Assessment: Training & Risk Assessment
1. Pandemic
Status
2. Biosafety
Fundamentals
3. Risk
Assessment
Basics
4. Risk
Assessment
Tool
Virtual Risk
Assessment
Workshop
• Routes of transmission
• Decontamination and disinfection
• ISO 31000 standard for risk management,
• Identifying risk treatment and controls
• Using the Excel Tool to analyze and evaluate risk
• Job–specific, targeted risk controls
• Facilitate virtual, online assessment with Tool
• Analyze existing controls and evaluate effectiveness
• Identify additional preventative and protective measures
• Current pandemic situation
• Implications for business

9. 9
Pandemic Status & Update
Case Demographic Distribution
https://ourworldindata.org/mortality-risk-covid, taken 29May2020
Case Fatality Rate by Age
 Case distribution equal in working adults
 Older age, especially > 65 yrs and people
with comorbidities appear more likely to
develop an infection and severe symptoms
and be at risk for death1
 In the U.S., obesity appears to be
emerging as a risk factor, BMI ≥ 30, in
nearly 1/2 of hospitalized patients1
 85% of Canadian cases in Ontario & Quebec
 Community-specific spread (hot spots)
1. Johns Hopkins ABX Guide, Paul G. Auwaerter, M.D., Coronavirus COVID-19 (SARS-CoV-2), Updated: May 23, 2020

10. Severe Acute Respiratory Syndrome
Corona-Virus 2 (SARS-CoV-2)
10
1. Ontario Health, Epidemiologic Summary, Confirmed cases (n=22,957) of COVID-19 by severity: Ontario, January 15, 2020 to May 17, 2020
2. Johns Hopkins ABX Guide, Paul G. Auwaerter, M.D., Coronavirus COVID-19 (SARS-CoV-2), Updated: May 23, 2020
 New strain not previously in humans
 Enveloped, positive-sense single-stranded RNA viruses
 Incubation period (exposure to symptom onset) 4 to 6 days
 Infectious 1 to 3 days before symptoms appear
 Peak viral load in pharynx ~4 days after infected
 Health effects:
 Older and those with underlying medical condition = high risk,
 95% of deaths in group 60+ years of age1
 Many infected have no symptoms (studies suggest up to 50%)2

11. Biological Safety Fundamentals
Routes of Transmission
 Droplets-borne: via droplets from the nose or mouth
spread when infected person sneezes or coughs
 Fomite: Indirect contact via droplet contaminated
surfaces. Touch surface, then eyes, nose or mouth
 Detectable on plastic and steel up to 3 days,
cardboard 1 day, copper 4 hours.
 Virus load reduces over time (half-life 5-6 hours)
 SARS-CoV-2 is an enveloped virus, therefore highly
susceptible to disinfectants
 Aerosol spread could occur, mostly in hospitals1
1. Johns Hopkins ABX Guide, Paul G. Auwaerter, M.D., Coronavirus COVID-19 (SARS-CoV-2), Updated: May 23, 2020

12. Biological Safety Fundamentals
What Increases Transmission Risk?
 Factors that affect risk:
1. People close to one another
2. Many people together (group gatherings)
3. Duration of interaction
 Successful Infection = Exposure to Virus x Time
4. Type of activity
 Talking quietly vs. cheering/shouting at sports event
5. Physical environment
 Layout? Degree of protection? Separation? Air flow
direction and volume? Air purification systems?
Close contact means: a face-to-face conversation for 15 minutes, or being in the same room for 2 hours
(Source: Ontario Self-Assessment website https://covid-19.ontario.ca/self-assessment/, taken 08May2020)

13. Biological Safety Fundamentals
Decontamination & Disinfection
 Enveloped virus = Highly susceptible to disinfectants
 Critical parameters for chemical disinfection: Type,
concentration, contact time and temperature
 Proven chemical disinfectants:
• 0.05% sodium hypochlorite (household bleach), dilute 1:100
• Alcohol (ethanol) at least 70%
• Hydrogen peroxide 0.5%
• Benzalkonium chloride >0.05% (less effective)
 Ultraviolet (UVC) light disinfection (30 mJ/cm2)*
13
* N95 Filtering Facepiece Respirator Ultraviolet Germicidal Irradiation (UVGI) Process for Decontamination and Reuse, University of Nebraska, Version Update 4/10/2020
Refer to manufacturer's specifications and instructions for proper concentration, contact time and temperature.

14. Risk Assessment
Fundamentals
We will cover the following:
 Risk management based on ISO
31000 standard
 Conducting risk assessments
 Assessing biological and
occupational health exposures
 Ascertaining risk tolerance
 Identifying risk treatment and
controls
14

15. Key Definitions
 Hazard - Source with a potential to cause injury and ill health. (ISO45001)
 The SARS-CoV-2 virus is a hazard
 Risk - The effect of uncertainty on objectives (ISO31000)
 Assessment of the consequences (illness) expressed in terms of
probability (likely, unlikely) and severity (mildly sick, death) is the risk.
 Becoming ill is one of the consequences of the hazard
 Risk Management - Coordinated activities to direct and control an
organization with regards to risk (ISO31000)
 The identification, analysis and elimination, and/or mitigation to an
acceptable level of risk
15

16. 16
Risk Management
Why is it Important?
 One way to protect employees and the business
 Key part of H&S Management System
 Helps ensure business continuity
 Enables business to re-open, re-start or sustain operations
 Compliance requirement:
 WorkSafe British Columbia requires a COVID-19 Safety Plan be posted in
the workplace. “Step 1: Assess the risks at your workplace”
 Ontario “The employer is required to take every reasonable precaution
… and do a risk assessment to determine what parts of the jobsite and
what other workers the affected worker would have had contact with.”
 U.S. OSHA: "The employer shall assess the workplace to determine if
hazards are present, or are likely to be present, which necessitate the
use of personal protective equipment (PPE)."

17. Health & Safety Programs
Why do they need risk assessments?
Risk Assessments:
 Create awareness of hazards and risk.
 Identify who may be at risk.
 Prioritize risks and control methods.
 Determine the overall risk management plan an organization should develop.
 Determine if existing mitigation measures are adequate or if additional
measures are needed.
 Determine training needs.
17

18. Team!
 A team approach is needed
 Leader will facilitate the process
 Team needs to include subject matter
participants with knowledge and experience
necessary to assess the activity and risks
 Team provides expertise on the work and work
areas and envision ‘hazardous situations’
 Need more than H&S expertise
 Decisions to accept of residual risk may need
to be escalated to “decision maker”
18

19. 19
Define the risk index and
tolerability
Define the level
of probability
Define the level
of severity
Is the risk index acceptable?
Can the risk be eliminated?
Can the risk be mitigated?
Can the residual risk be
accepted? (if any)
Take action
and continue
the operation
Health & safety concern is perceived
Identify hazards/consequences
and assess risks
NO
NO
NO
Cancel the
operation
YES
Take action
and continue
the operation
YES
Take action
and continue
the operation
YES
YES
Risk
Identification
Risk
Analysis
Risk
Evaluation
Risk
Treatment
(6.5)
RiskAssessment(6.4)
Risk Management as a Process

20. Risk Management
Risk Evaluation & Tolerance
Undesirable
Improvable
Acceptable
Unacceptable
and MUST have
more treatment
or controls
Acceptable with
current controls
but recommend
more treatment.
Acceptable as it
currently
stands, no
further action
As
Low
As
Reasonably
Practicable

21. Risk Treatment & Controls
 Risk Treatment: Process to modify risk
 Control: Measure that maintains or modifies risk
1. avoiding the risk by not to starting or continuing
with the activity that gives rise to the risk (no
face-to-face meetings, use Zoom or MS Teams);
2. removing the risk source (disinfecting surface);
3. changing the likelihood (shop less frequently);
4. changing the consequences (early medical care);
5. sharing the risk (buying insurance); and
6. retaining the risk by informed choice.

22. The Goal & “The Gold”
Risk Controls
Technical (engineering controls & PPE)
 HEPA air filtration of, plastic shields on cashier
stations, one-way aisle, surgical mask
Organizational / Administrative
 Physical distancing, personnel screening,
hygiene (cleaning & disinfection, handwashing)
close areas, work at home, Zoom meetings
Human / Behavioural
 Report when ill, sneeze/cough etiquette, train,
personnel screening, culture (managerial safety
visits, procedure use & adherence)
Technical (Engineering Controls)
Human (Behavioural Controls)
Organizational (Administrative Controls)

23. 5 Step Process & Methodology
Questionnaire
Obtain site-specific
details, job risks,
community/worker
incidence, trends,
plan and
precautions
implemented to
date
Environmental
Scan
Review current
outbreak, known
transmission
dynamics,
geographic
distribution
Interview
Obtain site details,
understand work
environment,
stakeholders, local
guidance issued &
actioned to date
Training
Prepare participants
with knowledge and
understanding to
participate
Identify jobs and
potential hazard
situations and threats
to health, safety,
business continuity
Virtual, online
Risk Assessment
Analyze chosen jobs,
specific to exposure and
vulnerability
Use spreadsheet tool to
evaluate, consider
existing controls
Enable team to identify
targeted, additional
preventative and
protective measures

24. 24
 RISK EVALUATION to support decision making
 GREEN = Acceptable, YELLOW = Improvable, RED = unacceptable,
 Do nothing, maintain existing controls, implement additional controls, stop activity
 Continual improvement: validate or assess the value of additional and new controls
Output
 RISK TREATMENT & CONTROLS: Additional and sustainable actions identified
and documented that can eliminate, reduce or mitigate the risk
 PREVENTION: avoid or reduce likelihood of exposure, and
 REDUCTION: reduce severity or impact, mitigate business losses
 Communication tool for case investigations, contact tracing, refusals, grievances
Severity Exposure
Frequency
Probability of
Scenario
Risk
Score
HSE CONCLUSION COMMENTS ACTION PLAN / ADDITIONAL RISK TREATMENT & CONTROLS
1. First Aid
5. Disabling illness (lost time)
15. Illness with medical treatment;
Minor business impact
25. Illness with hospitalization;
Significant business impact
50. Death; Major business impact
100. Multiple deaths; catastrophic
0.5. Very rarely
1. Rarely (known_
2. Unusual (1/mo-1/yr)
3. Occassional (1/wk-1/mo)
6. Frequently (~1/day)
10. Continuously, many/day
0.1 Practically impossible
0.5 Extremely remote
1. Remotely possible
3. Would be unusual
6. Quite possible (50/50)
10. Expected
Calculated. (Risk Level with
consideration for existing
controls).
Risk < 90 = Acceptable
90 - 270 = Improvable
> 270 = Undesirable/Action!
(Clarify any existing controls and note any relavent
facts or assumtions that may help in identifying risk
treatment or controls.)
(List and describe any additional actions or risk treatment (the process to modify risk) that can be taken to eliminate, reduce or mitigate
the risk. Risk Treatment or controls should consider preventing (avoiding or reducing likelhood of exposure) and reducing the severity.
Ensure you review all Proactive and Preventative Measures (Technical, Organizational and Human) listed in tab enstitled "Scoring Guide
& Measures")
15 3 6 270 Stores are encouraging customers to 'tap'
and signs posted indicating cash
transactions not recommended. Cashiers are
told to disinfect station, belt and ATM every
hour. But, hourly disinfection doesn't address
touching grocery items. May need to
consider accomodating vulnerable or at-risk
workers.
Improvable
1. Document COVID-19 safety plan to comply with provincial requirements.
2. Develop SOP for PPE, require cashiers to wear gloves when touching grocery items.
3. Develop cleaning/disinfection procedures for store and include cash stations.
4. Manager Safety Visits by managers to verify controls are implemented, talk to employees about their concerns,
coach them and provide caring safety culture.
5. Implement written SOP on safe handling/scanning of grocery items and include H&S precautions/controls
included from this risk risk assessment.
6. Implement HuP Tool - Procedure Use & Adherence with managers conducting hourly observations.
7. Implement process for more active personnel monitoring, screening and assessment.
ASSUMPTIONS:
Severity score (25) based on scenario of serious illness requiring hospitalization. NOTE: 4
vulnerable or at-risk employees known to work in area.
Exposure score (2), assuming that although cashier may touch items constantly, having an
infected customer and touching his/her items would be far less frequent or likely.
Probability score (3) assumes its unlikely the scenario would occur that leads to
hospitalization.
 Prioritize and ensure regulatory compliance = Due Diligence

25. THANK YOU!
For more information of assistance:
Doug Kube, EP, CHSC
dougkube@outlook.com
Ph. 705-994-7053