OSHA’s COVID-19 Healthcare Emergency Temporary Standard (Pt. 2)

From: COVID-19

OSHA’s COVID-19 Healthcare Emergency Temporary Standard (Pt. 2)

Medical Removal from the Workplace

Employers are required to remove employees from the workplace when employers know that the employees:

  • Are COVID-19 positive, meaning that they were confirmed positive for, or were diagnosed by a licensed healthcare provider with, COVID-19;
  • Have been told by a healthcare provider that they are suspected to have COVID-19;
  • Are experiencing recent loss of taste or smell, with no other explanation;
  • Are experiencing both fever (≥100.4° F) and a new unexplained cough associated with shortness of breath; or
  • Are required to be notified by the employer of close contact in the workplace to a person who is COVID-19 positive, UNLESS the employee has been fully vaccinated against COVID-19 (i.e., two weeks or more have passed following the final dose), or had COVID-19 and recovered within the past three months, AND the employee does not experience the symptoms listed above.

Employers must remove these employees from the workplace and keep these employees removed until the employees meet return-to-work criteria based on guidance from a licensed health care provider or applicable guidance from the CDC, unless state or local public health authorities specify a longer period of removal.

For cases when employee infection is not confirmed or diagnosed, employers may allow employees to return to work immediately after a negative COVID-19 polymerase chain reaction (PCR) test. The PCR test must be provided at no cost to the employees.

Employers may choose to go beyond the minimum requirements of the ETS. For example, they may choose to remove employees who (1) are experiencing symptoms other than recent loss of taste and/or smell or fever coupled with new unexplained cough and shortness of breath, (2) were exposed to a COVID-19-positive person outside of the workplace, or (3) were notified by a state or local public health authority to quarantine or isolate. Although the ETS does not require removal in those situations, the state or local public health authority may impose separate obligations or the employer might choose to remove employees in those circumstances, above and beyond what is required by this ETS.

Medical Removal Protection Benefits

The ETS creates medical removal protection (MRP) benefits for employees who are required to quarantine because of COVID-19. MRP benefits require employers to continue paying removed employees the same regular pay and benefits the employee would have received had the employee not been removed. The benefits must continue until employees meet the return-to-work criteria or the medical removal expires.

Obligations to pay the removed employee depend on the size of the employer: 

  • Employers with 10 or fewer employees on the date that the ETS becomes effective are not required to maintain pay for removed employees.
  • Employers with fewer than 500 employees must pay the employee’s regular pay, up to $1400 per week, for the first two weeks that the employee is removed. Beginning in the third week, if the employee’s removal continues that long, the employer must pay two-thirds of the same regular pay the employee would have received if working, up to $200 a day (equivalent to $1000 per week in most cases).
  • Employers with 500 or more employees must pay the employee’s salary up to $1400 per week during the entire period of removal, until the employee meets the return-to-work criteria described below.
  • Employers with more than 10 employees must also continue to provide the benefits to which the employee is normally entitled (e.g., employer-sponsored health insurance) during the removal period.

In each scenario, the employer is not required to provide overtime pay, even if the employee had regularly worked overtime hours in recent weeks. In addition, if the employee receives compensation for lost earnings from any other source, such as employer-paid sick leave, administrative leave or a publicly funded compensation program, then the employer may reduce the amount paid to the removed employee by however much the employee receives from the outside source. 

In addition, the obligation to pay MRP benefits ceases when the employee meets the ETS return criteria, even when employers choose to require a longer removal period.

Please note that businesses with fewer than 500 employees may be eligible for refundable tax credits under the American Rescue Plan (ARP) if they provide paid time off for sick and family leave to their employees due to COVID-19-related reasons. The ARP tax credits are available to eligible employers that pay sick and family leave for qualified leave from April 1, 2021, through Sept. 30, 2021. More information is available from the IRS.

Return to Work

Employers must make return-to-work decisions in accordance with guidance from a licensed healthcare provider or applicable guidance from the CDC, which is incorporated by reference in the ETS, unless state or local public health authorities specify a longer period of removal.  

However, OSHA recognizes that the CDC’s Strategies to Mitigate Healthcare Personnel Staffing Shortages allows elimination of quarantine for certain health care workers, but only as a last resort, if the workers’ absence would mean there are no longer enough staff to provide safe patient care, specific other amelioration strategies have already been tried, patients have been notified and workers are utilizing additional PPE at all times.


Employers must support COVID-19 vaccinations for each employee by providing reasonable time and paid leave (for example, paid sick leave, administrative leave) to each employee for vaccination and any side effects experienced following vaccination.


Employers must ensure that each employee receives training, in a language and at a literacy level the employee understands, so the employee comprehends at least the following:

  • How the COVID-19 disease is transmitted (including pre-symptomatic and asymptomatic transmission), the importance of hand hygiene to reduce the risk of spreading COVID-19 infections, ways to reduce the risk of spreading COVID-19 through the proper covering of the nose and mouth, the signs and symptoms of the disease, risk factors for severe illness and when to seek medical attention;
  • Employer-specific policies and procedures on patient screening and management;
  • Tasks and situations in the workplace that could result in COVID-19 infection;
  • Workplace-specific policies and procedures to prevent the spread of COVID-19 that are applicable to the employee’s duties (for example, policies on Standard and Transmission-Based Precautions, physical distancing, physical barriers, ventilation, aerosol-generating procedures);
  • Employer-specific multi-employer workplace agreements related to infection control policies and procedures, the use of common areas, and the use of shared equipment that affect employees at the workplace;
  • Employer-specific policies and procedures for PPE worn to protect against COVID-19, including when PPE is required; limitations of PPE for protection; how to properly put on, wear, take off, care for, store, clean, maintain and dispose of PPE, and any modifications to donning, doffing and cleaning;
  • Storage, maintenance and disposal procedures needed to address COVID-19 when PPE is worn, to address workplace hazards other than COVID-19;
  • Workplace-specific policies and procedures for cleaning and disinfection;
  • Employer-specific policies and procedures on health screening and medical management;
  • Available sick leave policies, any COVID-19-related benefits to which the employee may be entitled under applicable federal, state, or local laws, and other supportive policies and practices (for example, telework, flexible hours);
  • The identity of the safety coordinators specified in the COVID-19 plan;
  • How the employee can obtain copies of this section and any employer-specific policies and procedures developed under this section, including the employer’s written COVID-19 plan, if required.

Employers can rely on training that has been completed prior to the effective date of the ETS as long as it meets the relevant training requirements. Employees must receive additional training whenever changes occur that affect an employee’s risk of contracting COVID-19 at work (for example, new job tasks), policies and procedures are changed or there is an indication that the employee has not retained the necessary understanding or skill.

Employers must ensure that the training is overseen or conducted by a person knowledgeable in the covered subject matter as it relates to the employee’s job duties. The training provided must provide an opportunity for interactive questions and answers with a person knowledgeable in the covered subject matter as it relates to the employer’s job duties.


Employers must inform each employee that they have a right to the protections required by the ETS and that employers are prohibited from discharging or in any manner discriminating against any employee for exercising their right to the protections required by this section. Employers must not discharge or in any way discriminate against any employee for exercising their right to the protections required by the ETS or for engaging in actions that are required by the ETS.

In addition, section 11(c) of the OSH Act also prohibits employers from discriminating against an employee for exercising rights under, or as a result of actions that are required by, this section. That provision of the Act also protects the employee who files a safety and health complaint, or otherwise exercises any rights afforded by the OSH Act.

Recordkeeping and Reporting

Employers with ten or more employees on the effective date of the ETS must:

  • Retain all versions of the COVID-19 plan implemented to comply with this section while this section remains in effect.
  • Establish and maintain a COVID-19 log to record each instance identified by the employer in which an employee is COVID-19 positive, regardless of whether the instance is connected to exposure to COVID-19 at work.

The COVID-19 log must contain, for each instance:

  • The employee’s name;
  • The employee’s contact information;
  • The employee’s occupation;
  • The location where the employee worked;
  • The date of the employee’s last day at the workplace;
  • The date of the positive test for, or diagnosis of, COVID-19; and
  • The date the employee first had one or more COVID-19 symptoms, if any were experienced.

The information in the COVID-19 log must be recorded within 24 hours of the employer learning that the employee is COVID-19 positive and must be maintained as though it is a confidential medical record and must not be disclosed except as required by the ETS or other federal law. The COVID-19 log must be maintained and preserved while this section remains in effect. The COVID-19 log is intended to assist employers with tracking and evaluating instances of employees who are COVID-19 positive without regard to whether those employees were infected at work. The tracking will help evaluate potential workplace exposure to other employees.

Availability of Records

By the end of the next business day after a request, employers must provide, for examination and copying:

  • All versions of the written COVID-19 plan to any employees, their personal representatives, and their authorized representatives.
  • The individual COVID-19 log entry for a particular employee to that employee and to anyone having written authorized consent of that employee.
  • A version of the COVID-19 log that removes the names of employees, contact information, and occupation, and only includes, for each employee in the COVID-19 log, the location where the employee worked, the last day that the employee was at the workplace before removal, the date of that employee’s positive test for, or diagnosis of, COVID-19, and the date the employee first had one or more COVID-19 symptoms, if any were experienced, to any employees, their personal representatives, and their authorized representatives.
  • All records required to be maintained by this section to the Assistant Secretary of OSHA.

Employers with 10 or fewer employees on the effective date of this section are not required to comply with these requirements.

Employers must continue to record all work-related confirmed cases of COVID-19 on their OSHA Forms 300, 300A and 301, or the equivalent forms, if required to do so under OSHA’s recordkeeping requirements.

Reporting COVID-19 Fatalities and Hospitalizations

Employers must report to OSHA each work-related COVID-19 fatality within eight hours of the employer learning about the fatality. Each work-related COVID-19 inpatient hospitalization must be reported to OSHA within 24 hours of the employer learning about the inpatient hospitalization.

When reporting COVID-19 fatalities and inpatient hospitalizations to OSHA in accordance with this section, the employer must follow the requirements in 1904.39, except for 29 CFR part 1904.39(a)(1) and (2) and (b)(6).

Mini Respiratory Protection Program

The mini respiratory protection program (29 CFR 1910.504) is a section of the COVID-19 ETS. It applies only in certain circumstances specified under the ETS, generally when workers are not exposed to suspected or confirmed sources of COVID-19 but where respirator use could offer enhanced worker protection. The mini respiratory protection program provides a limited set of requirements for the safe use of respirators.

OSHA’s normal respiratory protection standard (29 CFR 1910.134) still applies to:

  • Circumstances under the ETS when workers are exposed to suspected or confirmed sources of COVID-19
  • Any other workplace hazards that might require respiratory protection (e.g., respirable crystalline silica, asbestos or airborne infectious agents such as Mycobacterium tuberculosis)

Where employees provide and use their own respirator, the employer must provide each employee with the following notice:

Respirators can be an effective method of protection against COVID-19 hazards when properly selected and worn. Respirator use is encouraged to provide an additional level of comfort and protection for workers even in circumstances that do not require a respirator to be used. However, if a respirator is used improperly or not kept clean, the respirator itself can become a hazard to the worker. If your employer allows you to provide and use your own respirator, you need to take certain precautions to be sure that the respirator itself does not present a hazard. You should do the following:

  • Read and follow all instructions provided by the manufacturer on use, maintenance, cleaning and care, and warnings regarding the respirator’s limitations.
  • Keep track of your respirator so that you do not mistakenly use someone else’s respirator.
  • Do not wear your respirator where other workplace hazards (for example, chemical exposures) require use of a respirator. In such cases, your employer must provide you with a respirator that is used in accordance with OSHA’s respiratory protection standard (29 CFR part 1910.134).

Employer-provided Respirators

When employers provide employees with respirators, employers must ensure that each employee wearing a respirator receives training prior to first use and if they change the type of respirator, in a language and at a literacy level the employee understands. Employers must make sure their employees at a minimum comprehend the following:

  • Training on how to inspect, put on, remove and use a respirator;
  • The limitations and capabilities of the respirator, particularly when the respirator has not been fit tested;
  • Procedures and schedules for storing, maintaining and inspecting respirators;
  • How to perform a user seal check under the mini respiratory protection program; and
  • How to recognize medical signs and symptoms that may limit or prevent the effective use of respirators and what to do if the employee experiences signs and symptoms.

Employers must ensure that each employee who uses a tight-fitting respirator performs a user seal check to ensure that the respirator is properly sealed to the face each time the respirator is put on. Acceptable methods of user seal checks include:

  • Positive pressure user seal check by trying to blow air out.
  • Negative pressure user seal check by sucking air in.

Employers must ensure that each employee corrects any problems discovered during the user seal check. In the case of either type of user seal check (positive or negative), if air leaks around the nose, the employee should use both hands to readjust how the respirator sits on their face or adjust the nosepiece, if applicable. The employee should readjust the straps along the sides of their head until a proper seal is achieved.

When employees are required to wear a respirator and a problem with the seal check arises due to interference with the seal by an employee’s facial hair, employers may provide a different type of respirator to accommodate employees who cannot trim or cut facial hair due to religious belief.

Employers must ensure that a filtering facepiece respirator used by a particular employee is only reused by that employee, and only when:

  • The respirator is not visibly soiled or damaged;
  • The respirator has been stored in a breathable storage container for at least five calendar days between use and has been kept away from water or moisture;
  • The employee does a visual check in adequate lighting for damage to the respirator’s fabric or seal;
  • The employee successfully completes a user seal check;
  • The employee uses proper hand hygiene before putting the respirator on and conducting the user seal check; and
  • The respirator has not been worn more than five days total.

The reuse of single-use respirators is discouraged. Employers must ensure that an elastomeric respirator or power air-purifying respirator (PAPR) is only reused when:

  • The respirator is not damaged;
  • The respirator is cleaned and disinfected as often as necessary to be maintained in a sanitary condition in accordance with the respiratory protection program (29 CFR 1910.134) and appendix B-2; and
  • A change schedule is implemented for cartridges, canisters or filters.

Employers must require employees to discontinue use of a respirator when either the employee or a supervisor reports medical signs or symptoms (for example, shortness of breath, coughing, wheezing, chest pain, any other symptoms related to lung problems, cardiovascular symptoms) that are related to ability to use a respirator. Any employee who previously had a medical evaluation and was determined to not be medically fit to wear a respirator must not be provided with a respirator under this standard unless they are reevaluated and medically cleared to use a respirator.

The mini respiratory protection program is effective as of the date the ETS is published in the Federal Register.