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World Health Organization: Whole-of-Society Pandemic Readiness


WHO guidelines for pandemic preparedness and response in the non-health sectors (Geneva, May 2009)

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May 2009


This guidance is a complement document supporting Pandemic Influenza Prepared and
Response: a WHO guidance document published in April 20091. This document provides
detailed information on the whole of society approach to pandemic preparedness.
This document was produced by the Non-health sector preparedness taskforce of the
Pandemic influenza preparedness and response guidance revision working group at WHO
headquarters. A WHO consultation was convened on 05-09 May 2008 in Geneva,
Switzerland to review draft document prepared by taskforces and working group, to receive
additional input. All taskforce members and participants to the consultations have signed a
declaration of interest statement in accordance with WHO policy. A small number of
participants indicated a conflict of interest. However it was deemed by the working group that
these declarations were not sufficient in conflict with the recommendations, to exclude them
from the guidance development process. The declarations of interest are available upon

The Global Influenza Programme in the Health Security and Environment Cluster of the
World Health Organization will revise this guidance in 2014, or sooner in the event of
significant developments which impact pandemic preparedness and response planning.
WHO wishes to acknowledge the contributions of taskforce members and consultation

Taskforce members: N Bakirci (Turkey), M Bökkerink (Netherlands), M Fawzi (Egypt), M
Jacobs (New Zealand), R Kirby (UK), A Marx (OCHA), M Mosselmans (OCHA), A Nicoll
(ECDC), E Perez (France), G Ramirez-Prada (Peru), G Saour (France), P Scott-Bowden
(WFP), S Strickland (UK), L Vedrasco (OCHA),

Consultation participants: L Ahadzie (Ghana), D Bell (USA), F Binam (Cameroon), D
Boakye (Ghana), JS Bresee (USA), D Camus (France), O Carlino (Argentina), M Cetron
(USA), S Chunsuttiwat (Thailand), V Davidyants (Armenia), B Duncan (ECDC), R El-Aouad
(Morroco), U Go (Republic of Korea), MM Gouya (Iran), W Haas (Germany), J Hall
(Australia), P Imnadze (Georgia), O Kiselev (Russia), P Kreidl (ECDC), H-S Lee (Republic of
Korea), W Lum (Panama), Z Memish (Saudi Arabia), J Moran (Kazakhstan), J Newstead
(UK), J Nguyen van Tam (UK), H Oshitani (Japan), J Paget (Netherlands), N Phin (UK), S
Redd (USA), C Schuyler (NATO), J Sciberras (Canada), P Seukap (Cameroon), H Shirley-
Quirk (UK), Y Shu (China), R Snacken (Belgium), N Sunderland (USA), K Taniguchi (Japan),
M Tashiro (Japan), B Toussaint (EC), P Tull (Sweden), M Vanderford (USA), S Vong
(Cambodia), H Yu (China), S Zaidi (Pakistan).

The following WHO staff were involved in the development and review of this document and
their contribution is gratefully acknowledged:

T Curtin-Niemi, K Fukuda, H Harmanci, J Kanokporn Coninx, S Kirori, R Lee, K Park, E
Pluut, A Reis, C Vivas, S Wilburn.

1 Pandemic influenza preparedness and response: a WHO guidance document, World Health
Organization. 2009


1. AIM 6


Why do pandemic planning beyond health? 6


A Whole-of-Society Approach 8

Preparedness at all levels 8

Critical interdependencies 8

A scenario-based response 8

Legal and ethical considerations 9


Planning assumptions 9

Core preparedness actions for all sectors 9

Interoperability of pandemic preparedness plans 10


Major critical interdependencies among essential services 10

Key healthcare sector interdependencies 11




Ethical aspects 13

Legal aspects 14

Annex A: Whole-of-society pandemic readiness checklist for central governments 15
Institutional arrangements 15

Harmonization of national plans and roles of different agencies and organizations 15
Coordination and communication 16

Annex B: Pandemic influenza business continuity management checklist for
businesses and government organizations 17

Plan for impact on your organization 17

Establish policies to be implemented during a pandemic 17

Allocate resources to protect employees and customers 18

Communicate with and educate employees 18

1. AIM

1.1 These guidelines address the need to prepare the whole of society, beyond the
health sector, for pandemic influenza. The primary aim of this document is to support
integrated planning and preparations for pandemic influenza across all sectors of society,
including public and private sector organizations and essential services. These guidelines
focus on non-health sector mitigation actions and aim to help WHO member states in the
process of revising their existing national pandemic preparedness plans to better include all
sectors of society.


Why do pandemic planning beyond health?

2.1 Given that a severe (or even moderate) pandemic will have significant consequences
for the whole of society, it is essential that all organizations, both private and public, plan for
the potential disruption that a pandemic will cause, including the impact of staff absenteeism.
While many countries have made substantial efforts to prepare for the health consequences
of pandemics, not all countries have yet given sufficient attention to preparing for the
economic, humanitarian and societal consequences.

2.2 In the absence of early and effective planning, countries are likely to face wider social
and economic disruption, significant threats to the continuity of essential services, lower
production levels, distribution difficulties, and shortages of supplies. Individual organizations
will suffer from the pandemic’s impact on business and services. For example, if the
electricity and/or water sectors are not able to maintain services, this will have grave
implications for the ability of the health sector to function and will result in severe
humanitarian consequences for vulnerable populations. The failure of businesses to sustain
operations would add to the economic consequences of a pandemic. Some business sectors
will be especially vulnerable (e.g. those dependent on tourism and travel) and certain groups
in society are likely to suffer more than others.

2.3 Given the ever increasing levels of global migration, transport and communication, a
pandemic virus may spread rapidly, leaving little time to prepare.

2.4 Developing robust preparedness plans now is essential to ensure continuity of
operations during a pandemic and mitigate significantly the likely economic and social

2.5 Preparing for the next influenza pandemic will have additional benefits as it will
strengthen the resilience of communities to withstand other future threats to their health,
security, and wellbeing.


3.1 A severe (or even moderate) influenza pandemic will test the limits of resilience of
nations, companies, and communities. No single agency or organization can prepare for a
pandemic on its own. Inadequate or uncoordinated preparedness of interdependent public
and private organizations will reduce the ability of the health sector to respond during a
pandemic. A comprehensive approach to pandemic preparedness is required.

3.2 The ‘Readiness Framework’ is one approach that emphasizes the interdependence
of all sectors of society. The framework suggests five key principles: (1) a whole-ofsociety
approach, (2) preparedness at all levels, (3) attention to critical
interdependencies, (4) a scenario-based response, and (5) respect for ethical norms.
The diagram below seeks to illustrate the whole-of-society approach. It is represented by
the three circles in the middle of the diagram: government, civil society, and business. The
pyramids inside each of the circles represent the levels within each sector (including subnational,
local government, and community). The nine circles around the disaster
management continuum of readiness, response, and recovery represent nine key essential

A whole-of-society approach

3.3 The economic and social consequences of a pandemic will be greater if
governments, businesses, and civil society have not developed plans as to how they can
continue to deliver key services in a pandemic. That is why all sectors of society should be
involved in pandemic preparedness.

3.4 It will require a concerted and collaborative effort by different Government Ministries,
businesses, and civil society to sustain essential infrastructure and mitigate impacts on the
economy and the functioning of society. The Government should help other agencies and
organizations by providing guidance on measures that should be taken, making appropriate
modifications to the law or regulations to facilitate pandemic response, and making
appropriate modifications to monetary policy to mitigate the economic impact of a pandemic.

Preparedness at all levels

3.5 All levels (local, national, regional, and global) should prepare for a pandemic. The
global and national levels should provide leadership and the local level should prepare to
take specific actions. Pandemic preparedness should be integrated into national, local, and
regional disaster management plans, processes, and structures. Planning should be
based around three crisis management stages (readiness, response, and recovery).
Individual organizations should incorporate pandemic preparedness into existing crisis and
continuity management systems.

3.6 As the impact and duration of pandemic waves is unpredictable and the
characteristics of all previous influenza pandemics were different, local communities should
develop flexible plans to support the full spectrum of their needs over the course of a few
months. Governments should provide clear guidance to local communities on the planning
that is needed, including standard planning assumptions.

Critical interdependencies

3.7 Widespread illness is likely to result in sudden and significant shortages of personnel
to provide essential services. The effect of influenza on individual communities could be
prolonged, as it is possible that the next influenza pandemic may have more than one wave.
Staffing is the critical element in business continuity plans.

3.8 Providers of essential services (e.g. water and energy) depend on critical goods and
services to maintain their operations. These goods and services are supplied by other
providers that in turn depend on others to operate.

3.9 Each of the providers needs to map out these critical interdependencies and plan to
address possible disruptions in the supply of critical goods and services.

A scenario-based response

3.10 We do not know how severe the next pandemic will be. It is therefore appropriate
to develop and plan for different scenarios that may arise, using clearly defined planning
assumptions. Plans should consider what actions would be implemented in the event of
these different scenarios. It is important to be clear what actions will be taken should the
worst case scenario materialize. It is prudent to plan for the worst, while hoping for the best.

Legal and ethical considerations

3.11 Pandemic influenza preparedness and response should be based on and consistent
with ethical norms and reflect fundamental human rights considerations. Governments
should identify and protect vulnerable groups who tend to be overlooked, (such as refugees,
migrants, the disabled, prison populations, etc.) and incorporate their interests in planning.


4.1 Business continuity plans are at the heart of preparing the whole of society for
pandemic. Business continuity management focuses on the analysis of risks and the
potential effects of such risks on an organization. Business continuity management looks at
an organization’s departments, processes and functions, including inputs and outputs.
Business continuity management processes are documented in business continuity plans.
These can be used to manage business interruptions, including loss of staff or disruption of
supplies. The objective of a plan is to make an organization less vulnerable to and reduce
the impact of shocks. Pandemic preparedness should be an integral part of any
organization’s business continuity management. Plans should be subjected to regular
review, as planning is a continuous rather than a static process.

4.2 Thorough plans look at vital components outside the organization (e.g. transport,
water, and the resilience of suppliers of these services).

Planning assumptions

4.3 Business continuity plans should be based on explicit assumptions that characterize
the parameters of the emergency and its expected impacts. These vary from country to
country based on the levels of preparedness and available medical counter-measures.
Public health authorities should communicate planning assumptions and guidance to other
sectors of society. In general the assumptions should cover the following:

  • Attack and fatality rates
  • Population susceptibility
  • Worker absenteeism levels
  • Duration of the pandemic
  • Possible multiple waves of illness.

Core preparedness actions for all sectors

4.4 Employers need to take responsibility for ensuring that their business continuity
plans address the following areas:

  • Identify the critical functions that will need to be sustained and those that can be stopped for a period.
  • Identify the personnel, supplies, and equipment vital to maintain essential functions.
  • Consider how to deal with the anticipated level of staff absenteeism and minimize its impact on activities,
  • Provide clear command structures, delegations of authority, and orders of succession for workers.
  • Assess the need to stockpile strategic reserves of supplies, material, and equipment, including those that will be necessary to protect the health of employees.
  • Identify who is going to do what, when, and how.
  • Identify units, departments, or services that could be downsized or closed to reallocate human and material resources.
  • Assign and train alternates for critical posts.
  • Establish guidelines for priority of access to essential services.
  • Plan for security risks to operations and supply chain.
  • Train staff on infection control and communicate essential safety messages.
  • Consider whether there are ways of reducing social mixing (e.g. telecommuting or working from home and reducing meetings and travel) and test these.
  • Consider the need for family and childcare support for essential workers.
  • Consider the need for psychosocial support services to help workers to remain effective.
  • Consider and plan for the recovery phase.

Interoperability of pandemic preparedness plans

4.5 It is desirable to share business continuity plans with key partners to ensure
consistency and interoperability. Local government plans should be aligned with the central
government strategic directives. National plans should be shared with neighbouring
countries. Particular attention should be paid to plans in neighbouring border areas.


Major critical interdependencies among essential services

5.1 While the specific set of essential services varies from country to country, there is a
core set of essential services present in many settings: water and sanitation, fuel and
energy, food, healthcare, telecommunication, finance, law and order, education, and
transport. The failure of one or more of these services can have major economic and social
consequences, as well as impacting other essential services.

5.2 Public and private providers of essential services are interdependent and rely on the
goods and services of other sectors in order to sustain their operations. For example, the
water sector remains indispensable to all citizens living in urban and many rural settings; it is
also indispensable to most other services. The water sector relies on other sectors for many
critical functions, including the energy sector to power its equipment, the chemical sector to
provide materials to treat water, the transport sector to deliver supplies, and the food and
healthcare sectors to protect the health of its workforce. In whatever way the sectors define
themselves; these critical interdependencies constitute complex vulnerabilities.

5.3 Interdependencies need to be identified by each of the essential service providers.
Issues that need to be clarified in the process of identifying interdependencies include:

  • Critical goods and services required in order for the organization to provide its essential services.
  • Key interdependencies for each critical good or service.
  • The impact of the loss or reduction of any of the critical goods and services to the customers/beneficiaries.
  • Critical employee groups.
  • The impact of the loss or reduced availability of critical employee groups.
  • Likely points of failure.

5.4 Pandemic plans should take into account potential failures generated by
interdependencies. These include failures of individual businesses or small numbers of
businesses representing the sole providers of an essential good or service.

Key healthcare sector interdependencies

5.5 The healthcare sector always faces especially severe challenges during a pandemic.
In the pandemic plans of some countries, the relationship between the healthcare sector and
other sectors has not yet been fully considered and the complexity and interdependency of
systems on which healthcare settings rely has not yet been fully taken into account.

5.6 Healthcare institutions depend on goods and services that are delivered by the
following sectors:

  • Transport for the movement of supplies, personnel, and patients;
  • Telecommunications to support patient care, provide teletriage, and maintain business processing;
  • Energy to power facility, clinical, and security systems;
  • Water for healthcare facilities, pharmaceutical operations, and sanitation services;
  • Pharmaceuticals, including consumables, for treatment of patients; and
  • Finance to ensure the supply chain.


6.1 Central Governments should provide the information and framework for the planning
which must take place across all sectors of society. While all sectors of society are involved
in pandemic preparedness and response, central governments are responsible for
leadership, communication, and coordination. National inter-ministerial pandemic
preparedness committees should map out the central governments’ roles, responsibilities,
and chain of command and designate lead agencies. Governments should actively
promote the preparedness of the private sector. Plans should build on existing national
disaster management approaches and institutions and be regularly revised as circumstances
change and new information becomes available.

6.2 Central governments should define, oversee, and coordinate key preparedness
actions. Standard operating procedures (SOPs) are helpful in generating common
understanding and coordinated implementation. National governments should advise local
governments on best practices in pandemic preparedness planning and implement a quality
control system to regularly monitor and evaluate the operability and quality of local and
regional plans.

6.3 Governments should develop a detailed communication strategy, including a view to
stimulating appropriate pandemic responses from key relevant agencies and organizations.

6.4 Key line ministries need to develop business continuity plans to limit disruption. For
some ministries, these plans should be both inward-looking (to ensure the ministries
themselves can deliver their key functions) and outward-looking (ensuring that planning is
taking place across their sector). Ministries of Defence should consider what military assets
should be brought to bear in the event of a pandemic and how to mobilize them. Ministries of
Transport should minimize infection risks and staff absences in vital transport, air, and sea
ports and loading and unloading facilities, to enable continued supply of medicines and food.
Ministries of Finance should plan to maintain essential cash, credit, banking, payment,
international funds transfers, salary, pension, and regulation services in the face of
significant absenteeism and conduct testing of systemic resilience to pandemic risk.
Ministries of Justice should consider what legal processes could be suspended during the
pandemic and make alternative plans to operate courts during pandemic. They should also
consider measures to minimize the spread of infection in prisons and other institutions under
their authority.

6.5 Table-top and simulation exercises and drills at all levels are the best way to test,
validate, and improve pandemic preparedness plans.

6.6 Critical transborder issues should be identified and addressed at a bilateral or
regional level. Interoperability of plans across borders should be considered. Plans should
be developed to cope with possible external and internal displacement of people during the
pandemic and to address the needs of displaced populations. Governments should
coordinate activities in border areas and be ready to explain differences in mitigation actions
between neighbouring countries.


7.1 It is essential that all institutions prepare for a pandemic in order to mitigate its
economic and societal impact. This requires a shift in thinking for some entities.
Governments should provide guidance on how to accomplish this planning. The private
sector should develop sound business continuity plans, because the survival of the private
sector is essential to a society’s economy and provides many goods and services which are
critical to the welfare of many vulnerable people and the functioning of key infrastructure.
Many private sector companies already have business continuity plans and should
incorporate pandemic specific measures into their plans.

7.2 In many countries, national and international civil society and community-based
organizations will have a key role in meeting the basic needs of vulnerable populations. It is
therefore critical that these organizations have in place plans regarding how they will
continue their essential services during pandemic. Governments should involve civil society
and local communities in developing pandemic preparedness plans and should work with
local and international humanitarian agencies and organizations to develop plans as to who
has the capacity where to meet which basic needs of vulnerable populations (food, health,
shelter, water, and sanitation) in a pandemic. Doing so clarifies responsibilities, identifies
gaps, and avoids duplications in planning and implementation.

7.3 Community-based organizations represent large networks that can translate
scientific and government messages and recommendations, which otherwise may be met
with mistrust or scepticism by parts of populations. Community leaders can build public
confidence, disseminate information, and identify people at risk. Such organizations can also
provide community-based services to meet the needs of the vulnerable during a pandemic.

7.4 It is important that planning extends to a local level, including local government.
Central authorities should provide advice to local authorities. Local governments should
coordinate with non-governmental agencies and organizations. Local authorities and
community groups should plan how to cope with large numbers of deaths. Coordination
committees that bring together all local agencies and organizations can provide a central
focus for cross-agency cooperation to deal with disruptive challenges. They can coordinate
decision-making across departments at the local level.

7.5 Employers in the public and private sector have an important role to play both in
providing appropriate information to staff to protect staff health and safety and reduce the
spread of infection in the workplace and during travel to work, and in maintaining business
continuity through contingency planning. Labour unions are important participants in making
sure that employers honour their obligations toward staff health and safety and in making
sure that staff receives the information and advice that they need.


Ethical aspects

8.1 Pandemic influenza planning and response should be based on sound scientific
and public health principles, and should respect ethical and human rights norms. As far
as is practical, equitable access to health and other vital services should be ensured. In
particular, the needs and rights of the vulnerable should be considered, and they should be
included in planning processes through which their preferences and interests can be
articulated and incorporated. Vulnerable groups should be specifically identified based on
local circumstances and include refugees, internally displaced persons, migrants, ethnic
minorities, the poor, the elderly, the physically and mentally disabled, people confined to
prisons, the homeless and visiting foreign nationals.

8.2 Governments, intergovernmental and non-governmental organizations should take
account of the interests of vulnerable groups in pandemic influenza planning and response:

  • All people should have ready access to accurate, up-to-date and easily understood information about human pandemic influenza, public policy responses, and appropriate local and individual actions.
  • Communications should be tailored to overcome obstacles that vulnerable groups face in accessing such information.
  • Public health strategies should foster wide engagement in planning for and responding to the pandemic influenza threat.
  • Civil society, community-based organizations and the private sector should be involved in helping to overcome barriers to effective engagement by disadvantaged groups.
  • The impact and effectiveness of interventions and policies need to be evaluated and monitored, especially with respect to prospects for providing fair benefits to, and avoiding undue burdens on, disadvantaged groups, so that corrective adjustments can be made in a timely manner.
  • Governments should ensure access to the best available scientific and socioeconomic data and analyses to inform pandemic influenza planning and response, including information on the particular burdens and secondary harms that pandemic and pandemic responses may inflict on vulnerable groups.

8.3 Public health measures, such as quarantine, school and business closures might
place serious burdens on society and individual liberties, in particular if implemented on a
wide scale. Governments should carefully weigh the risks and benefits of far-reaching
restrictions of movement, and implement these measures in a way that respect individual

8.4 Health care and other essential workers have a moral obligation to provide essential
services to society. Employers have a reciprocal obligation to protect the health of their staff
and their families, in particular in high-risk work areas2. A careful balance needs to be struck
between the safety of staff and delivery of services to vulnerable beneficiaries.

Legal aspects

8.5 In a pandemic situation, Governments may need to take regulatory measures in
three main areas:

  • health policy and organization,
  • public order and individual liberties, and
  • labour and economic issues.

8.6 It is recommended that Governments should lead a cross-sectoral process to identify
the legal issues related to a pandemic and should mobilize relevant participants to undertake four sets of actions:

  • Identify the relevant existing measures and regulations and how they need to be modified for a pandemic.
  • Identify the gaps in the existing legal system with regard to coping with a pandemic or other similar major crisis.
  • Prepare in advance necessary legal texts, with a view to either implementing them in advance or to having them ready for when a pandemic starts. Plans
  • should be made for when such new regulations would need to be ratified and implemented.
  • Develop the mechanisms to be able to implement and comply with the

International Health Regulations.

2 More information can be found in the WHO guidance document “Ethical considerations in developing a public
health response to pandemic influenza” WHO, Geneva, 2007. Available at:

Annex A: Whole-of-society pandemic readiness checklist
for central governments

Yes No

Institutional arrangements

1. Establish a cross-government committee or task force to coordinate
national planning and response.
2. Establish a forum involving civil society and the private sector.
3. Assign one agency, department or ministry to lead coordination of the
various multi-sectoral agencies or organizations engaged in preparedness.
4. Integrate pandemic preparedness into national disaster management
processes, plans, and committees.
5. Develop explicit legal and ethical frameworks to govern policy
implementation during pandemic.
6. Develop clear pandemic plans, including chain of command and what
human, material, and financial resources are required and where they will
come from.
7. Establish the locations, structures, and standard operating procedures of
crisis command and control centres.
8. Differentiate the actions that will be taken at different phases
and in different pandemic scenarios.
9. Align the pandemic plans with the neighbouring countries. They should be
consistent and as similar as possible.

Harmonization of national plans and roles of different agencies and

10. Promote the preparedness of the private sector.
11. Share the pandemic preparedness plans in order to facilitate public
understanding and cross-border consistency.
12. Consult with neighbouring countries about aspects of their pandemic
preparedness plan that have regional or cross-border implications. These
may include meetings, workshops, and joint simulation exercises.
13. Identify which groups in society are likely to be most vulnerable and
most severely affected and establish measures to protect them.
14. Determine what agencies and organizations will deliver services
most appropriate to each vulnerable population in all targeted locations.

Yes No

Coordination and communication

15. Stipulate which level of government (national, regional, local,
and community levels) is responsible for each preparedness actions.
16. Provide advice to local authorities on preparedness planning and
conduct necessary training for effective dissemination at all levels.
17. Involve national and international organizations and designate a
coordination body.
18. Conduct drills, simulations, or table-top exercises at least annually
to test the robustness of the established plan, identify gaps, and revise the
plan accordingly.
19. Involve the private sector, civil society and international organizations
in simulation exercises.
20. Prepare to evaluate the lessons learned from a pandemic.

Annex B: Pandemic influenza business continuity
management checklist for businesses and government


Yes No

Plan for impact on your organization

1. Identify a pandemic coordinator for preparedness and response planning.
2. Identify the critical activities and functions that must to continue during
a pandemic, as well as resources needed.
3. Assess the need to stockpile strategic reserves of supplies, and
4. Establish clear command structures, delegations of authority, and orders
of succession for workers and identify who is going to do what, when, and
5. Assign and train alternate personnel for critical posts.
6. Identify units or services that need to be downsized or closed to
reallocate human and material resources.
7. Develop standard operating procedures (SOPs), and identify when they
should be implemented and suspended.
8. Determine financial risks in the event of an influenza pandemic.
9. Identify customer needs during a pandemic and review business model.
10. Determine the ability of the organization to continue operations if critical
infrastructure services become unavailable.
11. Determine the financial consequences of fluctuations in the supply
and demand of the products and/or services during a pandemic.
12. Plan for security risks to operations and supply chains.
13. Conduct an exercise to test your plan and update periodically.

Establish policies to be implemented during a pandemic

14. Establish a personnel policy, addressing sickness, absenteeism, and
when to return to work.
15. Assess a need for continued face-to-face contact with other employees /
customers / suppliers and modify as needed.
16. Develop social distancing protocols that may be used during a

Yes No

17. Establish guidelines for priority of access to essential services.

Allocate resources to protect employees and customers

18. Implement hand hygiene in the workplace.
19. Procure adequate infection control supplies.
20. Develop a plan for family and childcare support for critical workers.
21. Develop a plan for psychosocial support services to help workers.

Communicate with and educate employees

22. Develop a system of communication with employees, customers,
and suppliers in the event of a pandemic.
23. Ensure that information on measures that your business is implementing
during a pandemic is available to employees.
24. Train staff on infection control and communicate essential safety

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