This tip sheet is for employers and workers who provide therapeutic health services including massage therapists, chiropractors, physiotherapists, optometrists, midwives, naturopaths, dieticians, occupational therapists, etc. It provides an overview of potential hazards and risks due to COVID-19 and guidance regarding control measures.
COVID-19 is a contagious disease caused by the SARS-CoV-2 coronavirus. Infected individuals can spread the virus through respiratory particles when they cough, sneeze, breathe, etc. People can become infected when they inhale particles that contain the virus or by touching contaminated surfaces and then touching their face with unwashed hands.
Communicate to all workers, clients, and visitors that people who are sick (or may be sick) with COVID-19 should not enter the workplace for any reason.
Consider having a cancellation policy that encourages clients to stay home if they have symptoms (e.g., no fee for cancelling appointments).
Notify visitors and the public that protective measures are necessary for the safety of everyone.
Follow the guidance published by the governing body of your profession (e.g., College of Massage Therapists of Ontario, Nova Scotia College of Physiotherapists, etc.).
Consider installing barriers when physical distancing cannot be maintained (e.g., at reception, service counters, etc.) where it is appropriate and will not interfere with providing therapeutic services.
As workers’ exposure risk increases, adjust control measures as appropriate. Consider modifying procedures and protective equipment requirements (e.g., replacing medical masks with respirators, performing additional cleaning and disinfecting).
Implement measures that promote physical distancing and reduce indoor crowds:
Remind workers to maximize the distance between themselves and others during any interaction with people they do not live with (e.g., training, department meetings, responding to emergencies, etc.).
Reduce the number of people (e.g., administrators, support staff, trainees, etc.) that work in the facility by offering remote work options.
Stagger shift start and end times.
Control access to the facility (e.g., ask clients to come alone if possible, ask clients to minimize their time in waiting rooms, arrive on time, and leave promptly).
Rearrange (or remove) furniture in waiting areas to create more space.
Considerations when providing care that requires close contact:
Screen clients before treatment begins to confirm they are symptom free.
For additional protection, clients and therapists can wear a respirator or medical mask during treatments.
Therapists should frequently wash or sanitize their hands, such as before and after contact with each client, and after handling soiled linens, equipment, etc. that were used for treatment.
If treatment requires close and prolonged face-to-face contact, consider wearing a face shield for additional protection.
If possible open an external window, weather permitting, to provide additional ventilation.
Install an air purifying unit in each treatment room. Make sure to understand their limitations and maintain them in good working order.
If symptoms develop during treatment, consider ending the treatment early and asking the client to leave the clinic as soon as possible.
Allow the room to ventilate for as long as possible between clients, if possible.
If providing treatment in high-risk settings (e.g., long-term care facilities, retirement home) follow their masking and other public health measures.
Considerations for work clothes, uniforms, linens, therapeutic equipment, hot/cold packs:
Require workers to wear clean work clothes or uniforms (e.g., scrubs, lab coat, etc.) each day, and change out of them at the end of each shift. Soiled clothes and uniforms should be washed before they are worn again, either at home or by a laundry service.
Place soiled linens into a lined container (e.g., hamper) with a lid after each treatment, preferably one that is outside the treatment room. Clean and disinfect the container daily.
Transport soiled linens in a sealed container to the washing machine and do not shake them out before adding them to the washing machine.
Keep clean linens, work clothes, and uniforms separate from soiled ones.
If using a third-party laundry service, follow their precautions as well.
If equipment (or any item) is shared between therapists, clients, or others, make sure that it is cleaned and disinfected before and after each use.
Conduct group training and meetings virtually, outdoors, or in well-ventilated indoor spaces (e.g., waiting rooms after hours) with participants spaced out, whenever possible.
Avoid using fans in treatment and waiting rooms, especially if they circulate air from one person to another.
Install sanitizer dispensers in high-traffic areas (e.g., main entrance, break rooms, administration offices, treatment rooms, outside washrooms, etc.).
Consider limiting the use of equipment (e.g., computers, treatment tables, etc.) to one worker, especially when it is difficult to clean and disinfect. Use easy to clean plastic slipcovers, where feasible.
Reduce the amount of paper documentation or other items being exchanged between workers and patients. Consider exchanging documents electronically. If this exchange cannot be avoided, wash or sanitize hands after handling items.
Consider the Risks
The risk of COVID-19 transmission is increased when individuals are exposed to several risks at once, such as:
When person-to-person interactions are longer and more frequent.
In crowded spaces, especially when people cough, sneeze, or exhale forcefully.
In poorly ventilated spaces with other people.
When people have inadequate hand hygiene, respiratory etiquette, or do not have access to cleaning facilities and products.
When shared surfaces and objects are touched frequently.
When community COVID-19 hospitalizations or cases are high or increasing.
When sick individuals are allowed to stay in the workplace.
When individuals are exposed to several risks at once.
When other risks are high and workplace health measures are relaxed (e.g., dropping indoor mask wearing requirements, requiring all workers to return to the workplace, etc.).
Consider all possible COVID-19 exposure scenarios in your setting and perform COVID-19 risk assessments. Develop or use an existing risk assessment form to document and evaluate all work setting characteristics, activities, and job roles. It is good practice to review your assessment on a regular basis to make sure your control methods are effective.
Sample questions to ask during a COVID-19 risk assessment:
Are indoor spaces properly ventilated?
Where do individuals gather?
What activities require interactions, communication, or touching shared objects?
How long, frequent, and physically close are interactions between people?
Are people able to maintain adequate physical distance from each other?
Which workers are at higher risk?
What are the high-touch surfaces and shared objects?
Do individuals normally participate in activities that create respiratory droplets (e.g., singing, shouting, etc.).
Are people expected to stay in an enclosed space for an extended duration?
Meet your legal occupational health and safety obligations by doing everything reasonably possible in the circumstances to protect the workers and ensure the health and safety the workplace.
To provide the highest level of protection to workers, use multiple public health measures and workplace controls in a layered approach. No single measure is completely effective alone. Be careful not to create new hazards or negatively impact existing safety controls. Review and adjust measures as necessary in consultation with the health and safety committee or representative.
Create and implement a written workplace COVID-19 safety plan supported by the risk assessment. A written plan may be legally required by the jurisdiction in which you operate. Refer to local authorities for details on what must be included in the plan, if it needs to be posted, etc.
Implement policies and programs to accommodate workers, particularly those who are at high risk of severe disease or outcomes (i.e., immunocompromised, have chronic medical conditions, or are older) from a COVID-19 infection.
Communication and Training
Communicate new and updated workplace controls and applicable public health measures to all workers in languages they understand. Specific training requirements and recommendations may vary depending on your jurisdiction. Allow workers the opportunity to ask questions and share concerns. Respond to questions and provide feedback within a reasonable time.
Train workers on COVID-19 specific topics such as:
Screening: keeping individuals who may be infected with COVID-19 out of the workplace.
Contact tracing: identifying and notifying people exposed to the virus and offering advice.
Screen individuals who enter the workplace, if required by your local jurisdiction. Consider having a screening program even when it is not required as an additional measure to protect your workers.
Determine which type of screening your worksite requires: passive or active.
Passive screening requires individuals to self-monitor and self-report possible illness or exposure to COVID-19.
Active screening requires individuals to respond to questions about signs or symptoms of infection, recent possible
COVID-19 exposures, or recent travel outside of Canada.
Allow individuals that pass the screening to access the workplace. Deny access to anyone who does not pass the screening.
Have workers who do not pass the screening contact their supervisor. The supervisor should instruct them to return (or stay) home and follow local public health guidance which may include isolation, testing for COVID-19, or contacting their healthcare provider or public health authority.
Determine if you are required to implement contact tracing. If so, maintain a list of all individuals (for which contact tracing applies) entering the workplace, including their names, contact information, and time spent in the workplace. This information should be provided to the local public health authority if requested for the purpose of contact tracing. All information must be safely stored and destroyed as required by privacy legislation.
For additional information on screening and contact tracing, refer to:
Ventilate indoor spaces appropriately according to the number of occupants and types of activities.
Open windows and doors to the outside, if possible.
Maintain ventilation systems and seek advice from a ventilation specialist on possible improvements (e.g., increasing air exchanges per hour, reducing or eliminating recirculated air, or upgrading to air filtration and disinfection).
If possible, run ventilation systems continuously or for two hours before and after buildings are occupied.
Run local exhaust fans that vent to the outside to help remove contaminated air.
Make sure that air circulation or cooling fans do not direct air flow from person to person.
If ventilation cannot be improved, consider using portable air filtration units with high-efficiency particulate (HEPA) filters.
Keep indoor humidity between 30% and 50%.
For additional information on indoor ventilation, refer to:
PPE includes such items as respirators, medical masks, eye protection, gloves, and safety footwear.
Eye protection (safety glasses, goggles, or face shields) may be worn in addition to a mask when in close physical contact with others. Note: face shields do not provide respiratory protection and cannot replace masks.
COVID-19 PPE policies must not interfere when a higher level of protection is needed for a task.
Workers may need PPE for COVID-19 protection if they are:
Performing tasks that require them to be less than 2 metres from another person.
Using cleaning and disinfecting products (refer to the manufacturers’ safe handling instructions).
Follow the mask wearing requirements of your local jurisdiction. If not required, mask wearing should be encouraged as an additional measure when there is a high risk for COVID-19 spread, or when physical distancing is not possible.
Masks should be comfortable, well-constructed and well-fitting, covering the nose, mouth, and chin.
Consider using masks with a transparent window when communicating with people who are deaf or hard of hearing.
Masks should not be worn by anyone who is unable to remove it without assistance (e.g., due to their age, ability, or developmental status).
Allow workers to wear masks, even if not required, based on their discretion (e.g., being at risk of more severe disease, working in crowded setting, etc.).
Immediately have them wear a mask (preferably a respirator or medical mask, or if neither is available, a well-constructed and well-fitting non-medical mask). A respirator used in this way (i.e., as source control) may not need to be fit tested.
Have them leave as soon as possible.
If they cannot immediately leave, have them isolate in a designated area, away from others, until they can leave.
Call 911 for medical assistance if symptoms are life threatening. If it is a worker, notify their emergency contact.
Complete an incident report and begin an investigation.
Refer to guidance from your local public health authority to determine when the worker can return to work.
Consider updating your sick leave policy to provide support to workers who are or may be sick. Support may include paid or unpaid sick leave, long-term disability, and information on government programs, if available.
Note that this guidance is just some of the adjustments organizations can make during a pandemic. Adapt this list by adding your own good practices and policies to meet your organization’s specific needs.
For further information on respiratory infectious diseases, including COVID-19, refer to the Public Health Agency of Canada.
Disclaimer: As public and occupational health and safety information may continue to change, local public health authorities should be consulted for specific, regional guidance. This information is not intended to replace medical advice or legislated health and safety obligations. Although every effort is made to ensure the accuracy, currency, and completeness of the information, CCOHS does not guarantee, warrant, represent or undertake that the information provided is correct, accurate or current. CCOHS is not liable for any loss, claim, or demand arising directly or indirectly from any use or reliance upon the information.