Worker risk of occupational exposure to COVID-19 during an outbreak may vary from very high to high, medium or lower (caution) risk. The level of risk depends in part on the employee's job, their need for contact within six feet of people known to be, or suspected of being, infected with COVID-19, or requirement for repeated or extended contact with those people.
To help employers determine appropriate precautions, job tasks have been divided into four risk exposure levels: very high, high, medium and lower risk. The Occupational Risk Pyramid shows the four exposure risk levels to represent probable distribution of risk. Most American workers will likely fall in the lower exposure risk (caution) or medium exposure risk levels.
Occupational Risk Pyramid for COVID-19
Very High Exposure Risk
Very high exposure risk jobs are those with high potential for exposure to known or suspected sources of COVID-19 during specific medical, postmortem or laboratory procedures. Workers in this category include:
- Health care workers (e.g., doctors, nurses, dentists, paramedics, emergency medical technicians) performing aerosol-generating procedures (e.g., intubation, cough induction procedures, bronchoscopies, some dental procedures and exams or invasive specimen collection) on known or suspected COVID-19 patients.
- Health care or laboratory personnel collecting or handling specimens from known or suspected COVID-19 patients (e.g., manipulating cultures from known or suspected COVID-19 patients).
- Morgue workers performing autopsies, which generally involve aerosol-generating procedures, on the bodies of people who are known to have, or suspected of having, COVID-19 at the time of their death.
High Exposure Risk
High exposure risk jobs are those with high potential for exposure to known or suspected sources of COVID-19. Workers in this category include:
- Health care delivery and support staff (e.g., doctors, nurses, and other hospital staff who must enter patients' rooms) exposed to known or suspected COVID-19 patients. (Note: when such workers perform aerosol-generating procedures, their exposure risk level becomes very high.)
- Medical transport workers (e.g., ambulance vehicle operators) moving known or suspected COVID-19 patients in enclosed vehicles.
- Mortuary workers involved in preparing (e.g., for burial or cremation) the bodies of people who are known to have, or suspected of having, COVID-19 at the time of their death.
Medium Exposure Risk
Medium exposure risk jobs include those that require frequent and/or close contact with (i.e., within six feet of) people who may be infected with COVID-19, but who are not known or suspected COVID-19 patients. In areas without ongoing community transmission, workers in this risk group may have frequent contact with travelers who may return from international locations with widespread COVID-19 transmission. Jails and law enforcement operations could come in contact with transient population groups who could have traveled from unknown areas where widespread COVID-19 transmission is occurring. In areas where there is ongoing community transmission, workers in this category may have contact with the general public (e.g., government and social services offices, in schools, high-population-density work environments and some high-volume retail settings).
Lower Exposure Risk (Caution)
Lower exposure risk (caution) jobs are those that do not require contact with people known to be, or suspected of being, infected with COVID-19 nor require frequent close contact with (i.e., within six feet of) the general public. Workers in this category have minimal occupational contact with the public and other coworkers.
- Lower Exposure Risk (Caution): What to Do to Protect Workers
For workers who do not have frequent contact with the general public, employers should follow the guidance provided and implement control measures described in this section.
Engineering Controls
Additional engineering controls are not recommended for workers in the lower exposure risk group. Employers should ensure that engineering controls, if any, used to protect workers from other job hazards continue to function as intended.
- Medium Exposure Risk: What to Do to Protect Workers
In workplaces where workers have medium exposure risk, employers should follow the guidance provided and implement control measures described in this section.
Engineering Controls
- Install physical barriers, such as clear plastic sneeze guards, where feasible.
Administrative Controls
- Consider offering face masks to ill employees and other individuals in the workplace to contain respiratory secretions until they are able leave the workplace (i.e., for medical evaluation/care or to return home). In the event of a shortage of masks, a reusable face shield that can be decontaminated may be an acceptable method of protecting against droplet transmission. See Centers for Disease Control/National Institute for Occupational Safety and Health guidance for optimizing respirator supplies, which discusses the use of surgical masks.
- Inform any visitors to your facilities about symptoms of COVID-19 and ask these individuals to minimize contact with staff until healthy again by posting signs about COVID-19 in areas where they may congregate (e.g., receptionist, common areas, holding spaces, break or dining rooms) Ensure that law enforcement staff take proper precautions with individuals they may encounter while performing their job functions. Update intake checklists and institute procedures that require jail staff to ensure proper screening for individuals that may need possible COVID-19 medical evaluation and/or isolation.
- Where appropriate, limit the public's access to the worksite, or restrict access to only certain workplace areas.
- Consider strategies to minimize face-to-face contact (e.g., drive-through windows, phone-based communication, telecommuting for jobs that can be performed remotely).
- Communicate the availability of medical screening or other worker health resources (e.g., on-site nurse, telemedicine services).
Personal Protective Equipment (PPE)
When selecting PPE, consider factors such as function, fit, decontamination ability, disposal and cost. Sometimes, when PPE will have to be used repeatedly for a long period of time, a more expensive and durable type of PPE may be less expensive overall than disposable PPE. Each employer should select the combination of PPE that protects workers specific to their workplace.
Workers with medium exposure risk may need to wear some combination of gloves, a gown, a face mask and/or a face shield or goggles. PPE ensembles for workers in the medium exposure risk category will vary by work task, the results of the employer's hazard assessment, and the types of exposures workers have on the job.
High exposure risk jobs are those with high potential for exposure to known or suspected sources of COVID-19.
Very high exposure risk jobs are those with high potential for exposure to known or suspected sources of COVID-19 during specific medical, postmortem, or laboratory procedures that involve aerosol generation or specimen collection/handling.
In rare situations that would require workers in this risk category to use respirators, please refer to the PPE section in the "Workplace Controls to Protect Employees" document. For the most up-to-date information, visit OSHA's COVID-19 webpage: www.osha.gov/covid-19.
- High or Very High Exposure Risk: What to Do to Protect Workers
In workplaces where workers have high or very high exposure risk, employers should follow the guidance provided and implement control measures described in this section.
Engineering Controls
- Ensure appropriate air-handling systems are installed and maintained in health care facilities. See "Guidelines for Environmental Infection Control in Healthcare Facilities" for more recommendations on air handling systems.
- CDC recommends that patients with known or suspected COVID-19 (i.e., person under investigation) should be placed in an airborne infection isolation room (AIIR), if available.
- Use isolation rooms when available for performing aerosol-generating procedures on patients with known or suspected COVID-19. For postmortem activities, use autopsy suites or other similar isolation facilities when performing aerosol-generating procedures on the bodies of people who are known to have, or suspected of having, COVID-19 at the time of their death. See the CDC postmortem guidance. OSHA also provides guidance for postmortem activities on its COVID-19 webpage: www.osha.gov/covid-19.
- Use special precautions associated with Biosafety Level 3 when handling specimens from known or suspected COVID-19 patients. For more information about biosafety levels, consult the U.S. Department of Health and Human Services (HHS) "Biosafety in Microbiological and Biomedical Laboratories".
Administrative Controls
If working in a health care facility, follow existing guidelines and facility standards of practice for identifying and isolating infected individuals and for protecting workers.
- Develop and implement policies that reduce exposure, such as cohorting (i.e., grouping) COVID-19 patients when single rooms are not available.
- Post signs requesting patients and family members to immediately report symptoms of respiratory illness on arrival at the health care facility and use disposable face masks.
- Consider offering enhanced medical monitoring of workers during COVID-19 outbreaks.
- Provide all workers with job-specific education and training on preventing transmission of COVID-19, including initial and routine/refresher training.
- Ensure that psychological and behavioral support is available to address employee stress.
Safe Work Practices
- Provide emergency responders and other essential personnel who may be exposed while working away from fixed facilities with alcohol-based hand rubs containing at least 60% alcohol for decontamination in the field.
Personal Protective Equipment (PPE)
Most workers at high or very high exposure risk likely need to wear gloves, a gown, a face shield or goggles, and either a face mask or a respirator, depending on their job tasks and exposure risks.
Those who work closely with (either in contact with or within six feet of) patients known to be, or suspected of being, infected with COVID-19, the virus that causes COVID-19, should wear respirators. In these instances, please refer to the PPE section in the "Workplace Controls to Protect Employees" document, which provides more details about respirators. For the most up-to-date information, also visit OSHA's COVID-19 webpage.
PPE ensembles may vary, especially for workers in laboratories or morgue/mortuary facilities who may need additional protection against blood, body fluids, chemicals and other materials to which they may be exposed. Additional PPE may include medical/surgical gowns, fluid-resistant coveralls, aprons, or other disposable or reusable protective clothing. Gowns should be large enough to cover the areas requiring protection. OSHA may also provide updated guidance for PPE use on its website.
NOTE: Workers who dispose of PPE and other infectious waste must also be trained and provided with appropriate PPE.
The CDC webpage "Healthcare-associated Infections" provides additional information on infection control in health care facilities.
This document was prepared using information obtained from OSHA Publication 3990-03 2020 – "Guidance on Preparing Workplaces for COVID-19."