Additional comments:

In the requirements for very high or high exposure risk section, subsection C4 should read: "An employer shall post signs requesting patients and family members to immediately report signs or symptoms of respiratory illness on arrival at the healthcare facility and use disposable face coverings."

In the same section, subsection C9 should read: "Provide face coverings to non-employees suspected to be infected with SARS-CoV-2 virus to contain respiratory secretions until the non-employees are able to leave the site (i.e., for medical evaluation and care or to return home)."

In the same section, subsection D5 should read: "Unless contraindicated by a hazard assessment and equipment selection requirements in subdivision 1 of this subsection, employees classified as very high or high exposure risk shall be provided with and wear gloves, a gown, a face shield or goggles, and a respirator when in contact with or inside six feet of patients or other persons known to be or suspected of being infected with SARS-CoV-2. Where indicated by the hazard assessment and equipment selection requirements in subsection D of this section, such employees shall also be provided with and wear a surgical/medical procedure mask. Gowns shall be the correct size to assure protection." Further, the italicized part is confusing for several reason: 1. It makes reference to subsection D, but it is subsection D.  2. The prior sentence already stipulates the provision of a respirator – requiring providing/wearing of a surgical/medical procedure mask is confusing. Perhaps what is meant is that the PATIENT should be wearing such a mask for source control – but that should not be required when not medically tolerated.

As mentioned in a previous comment, the requirements for hazards or job tasks classified as medium exposure risk section should be rewritten for simplification for employers due to the similarity of requirements in this section to the requirements for very high/high risk settings.

Subsection C1b of the requirements for medium exposure risk settings should read: "Provide face coverings to non-employees suspected to be infected with SARS-CoV-2 to contain respiratory secretions until the non-employees are able to leave the site (i.e., for medical evaluation and care or to return home)."

In the infectious disease preparedness and response plan section, subsection C3aii reads "Known or suspected to be infected with the SARS-CoV-2 virus persons or those at particularly high risk of COVID-19 infection (e.g., local, state, national, and international travelers who have visited locations with ongoing COVID-19 community transmission..." VDH and CDC are now emphasizing the activities that one participates in as much as the locations one travels to. This should be addressed in this section. (Reference: https://www.vdh.virginia.gov/coronavirus/coronavirus/travel-to-areas-with-widespread-ongoing-community-spread/ and https://www.cdc.gov/coronavirus/2019-ncov/travelers/index.html). 

In the same section, subsection C3b should read (in part): "To the extent permitted by law, including HIPAA, employees’ individual risk factors for severe disease. For example, people of any age with one or more of the following conditions are at increased risk of severe illness from COVID-19:...obesity (body mass index or BMI of 30 or higher)..." The BMI value has been changed from 40 to 30, and this should be reflected in the standard. (Reference: https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/people-with-medical-conditions.html). Additionally, this subsection should end with the sentence "The risk for severe illness from COVID-19 also increases with age." (Reference: https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/older-adults.html). It's essential that the ETS includes this, particularly with the advancing age of many workers.

In the same section, subsection 5 should read (in part): "Identify infection prevention measures to be implemented." Subsection 6 should read: "Provide for the prompt identification and isolation of known or suspected to be infected with the SARS-CoV-2 virus employees away from work, including procedures for employees to report when they are experiencing signs and/or symptoms of COVID-19."

In the training section, subsection B5 should read: "Risk factors of severe COVID-19 illness with underlying health conditions and advancing age;". Subsection 7 should read "Safe and healthy work practices, including but not limited to, physical distancing, wearing of face coverings, disinfection procedures, disinfecting frequency, ventilation, noncontact methods of greeting, etc.;". The following language should be added to subsection 8: "Strategies to extend PPE supplies during limited capacity."

Subsection C makes reference to "the trained employee's physical or electronic signature." VDH recognizes that obtaining a physical or electronic signature on a document can be difficult in a telework environment. VDH suggests revising this language to indicate a physical or electronic signature is not necessary if other documentation of training completion (e.g., electronic certification through a training system) can be provided.

Subsection E4 of the training section should be added and should read: "Changes in public health’s (CDC and VDH) understanding of SARS-CoV-2’s transmission and impact on public health."

Subsection G3 of the training section should read: "The signs and symptoms of the COVID-19 disease". Subsection G5 should read: "Safe and healthy work practices and control measures, including but not limited to, physical distancing, wearing of face masks, sanitation and disinfection practices." Subsection G6 should be added and should read: "Requirements of any applicable Virginia executive order or order of public health emergency related to the SARS-CoV-2 virus or COVID-19 disease; and the current subsection G6 should be moved to G7. 

In the discrimination against an employee for exercising rights section, subsection B should read: "No person shall discharge or in any way discriminate against an employee who voluntarily provides and wears the employee's own personal protective equipment, including but not limited to a respirator, face shield, gowns or gloves provided that the PPE does not create a greater hazard to the employee or create a serious hazard for other employees. No person shall discharge or in any way discriminate against an employee who voluntarily provides and wears the employee's own face covering." As previously written, it included face covering as PPE (face coverings are not PPE) and it indicated “if provided by the employer” for PPE, when  the employer MUST provide PPE. 

In regard to subsection D of this section, language should be rewritten to be clearer. Employees may read and interpret that they can refuse to work, even if appropriate safeguards can be put into place, but this was clarified to mean that employees cannot refuse to work – this becomes a performance issue – if appropriate safeguards are implemented. It is important to assure that there is a whistleblower clause but, as written, this will create considerable consternation for employers-employees.