COVID19 Prevention Checklist Industry Guidance

Last updated: Jun 10, 2020

The State of Maine has adopted a staged approach, supported by science, public health expertise, and industry collaboration, to allow Maine businesses to safely open when the time is right. The plan is available at www.maine.gov/covid19/restartingmaine.

This is one of many industry guidance documents the State is preparing for businesses so they can be prepared to meet health guidelines and reopen safely. Please make sure you pair this document with the general guidance document that applies to all industries, which is available on maine.gov/decd.

Please note: This document may be updated as additional information and resources become available. 

Phase 3: Massage Facilities

Staff and clients should be aware of the potential COVID-19 transmission risks of giving and receiving massage therapy treatment. Transmission risk is heightened by close proximity for long durations, particularly in small, poorly ventilated spaces. In addition to the guidance provided here, the Federation of State Massage Therapy Boards has developed Guidelines for Practice with COVID-19 Considerations to help minimize the risk of COVID-19 transmission.

General Guidance

  1. Require all staff, vendors, and clients to maintain 6 feet of physical distance from individuals who are not part of their household group whenever possible.
  2. Require all staff, vendors, and clients to wear a face covering, per CDC recommendations and pertinent Executive Orders from the Office of the Governor.
    1. Information about proper use of face coverings is available from the CDC (see: Use of Cloth Face Coverings to Help Slow the Spread of COVID-19).
  3. The number of individuals that can gather in a shared space must not exceed the limit established by the Governor’s Executive Order, currently set at 50 people.
    1. Maintaining physical distancing of 6 feet and wearing face coverings are the primary tools to avoid transmission of respiratory droplets between individuals. If an indoor space cannot accommodate the gathering limit without complying with the six-foot distancing requirement, attendance must be limited to allow for such compliance.

Employees

  1. “Employees” referred to in this document include anyone providing massage services in an establishment.
  2. Employees should consider whether they can work safely if they have any of these conditions and supervisors should discuss potential risks for individuals with the following:
    1. People 65 or older
    2. People who live in a nursing home or long-term care facility
    3. People of all ages with underlying medical conditions, particularly if not well controlled, including:
      1. People with chronic lung disease or moderate to severe asthma
      2. People who have serious heart conditions
      3. People who are immunocompromised: Many conditions can cause a person to be immunocompromised, including cancer treatment, smoking, bone marrow or organ transplantation, immune deficiencies, poorly controlled HIV or AIDS, and prolonged use of corticosteroids and other immune-weakening medications
      4. People with severe obesity (body mass index [BMI] of 40 or higher)
      5. People with diabetes
      6. People with chronic kidney disease undergoing dialysis
      7. People with liver disease
  3. Workers should stay at home if they are sick. Supervisors should ask all workers to self-screen for COVID-19 symptoms using either of the following approaches:
    1. Use an electronic or app-based self-screening form, such as the Coronavirus Self-Checker available on the federal CDC’s homepage.
    2. Self-screen using the following questions:
      1. Do you feel ill or are you caring for someone who is ill?
      2. In the past two weeks, have you been exposed to anyone who tested positive for COVID-19?
  4. Adjust training practices to limit the number of people involved and allow for 6-foot spacing; use virtual/video/audio training when possible.
  5. Provide employees training on:
    1. hand hygiene
    2. physical distancing guidelines and expectations
    3. monitoring personal health
    4. proper wear, removal, and disposal of personal protective equipment
    5. laundering of face coverings and uniforms: Cleaning and Disinfecting Your Facility, How to Disinfect: Laundry (CDC)
    6. cleaning protocols, including how to safely and effectively use cleaning supplies: Guidance for Cleaning and Disinfecting Public Spaces, Workplaces, Businesses, Schools and Homes (CDC)
  6. Consider employee training in safe de-escalation techniques.

Building Considerations

  1. Take steps to improve ventilation in the building.
    1. Increase the percentage of outdoor air (e.g., using economizer modes of HVAC operations) potentially as high as 100% (first verify compatibility with HVAC system capabilities for both temperature and humidity control as well as compatibility with outdoor/indoor air quality considerations).
    2. Increase total airflow supply to occupied spaces, if possible.
    3. Disable demand-control ventilation (DCV) controls that reduce air supply based on temperature or occupancy.
    4. Consider using natural ventilation (i.e., opening windows if possible and safe to do so) to increase outdoor air dilution of indoor air when environmental conditions and building requirements allow.
  2. Take steps to ensure that all water systems and features (for example, drinking fountains) are safe to use after a prolonged facility shutdown to minimize the risk of Legionnaires’ disease and other diseases associated with water.
    1. Consider restricting the use of water fountains to refill only with instruction for individuals to wash or sanitize hands after use.

Client Services

  1. Ask each client the following questions when they set up their appointment and again when they arrive in order to screen for illness:
    1. Do you feel ill or are you caring for someone who is ill?
    2. In the past two weeks, have you been exposed to anyone who tested positive for COVID-19?
  2. Appointments
    1. Schedule appointments with adequate time in between to reduce the number of clients in the establishment at a single time and to allow time to properly clean and disinfect in between clients.
    2. If multiple massage practitioners work at one facility, stagger session schedules to prevent crowding in reception areas.
    3. Employers should be held accountable for allowing their employees to have enough time to allow for proper disinfection without repercussions. 
  3. Signage
    1. Post a sign that states services will not be offered to or given by anyone who is exhibiting signs of COVID-19 virus. People with these symptoms or combinations of symptoms may have COVID-19:
      1. Cough
      2. Shortness of breath or difficulty breathing
      3. Fever
      4. Chills
      5. Repeated shaking with chills
      6. Muscle pain
      7. Headache
      8. Sore throat
      9. New loss of taste or smell
    2. Symptoms may appear 2-14 days after exposure. Learn more about COVID-19 symptoms.
    3. Place signage at entrances and throughout building (particularly high traffic areas such as reception counters) alerting workers and clients to required occupancy limits, physical distancing requirements, and face covering policies.
  4. Limit people in the establishment.
    1. See clients by appointment only.
    2. Schedule by telephone or online only.
    3. Maintain physical distancing in waiting areas or consider closing them entirely.
    4. Ask clients to wait outside in their vehicle or, if that is not possible, at the entrance of the business with at least 6 feet between clients until their scheduled appointment.
  5. Maintain physical distancing at all times.
    1. Spacing between persons within the establishment should be at least six feet, except when staff are servicing clients.
    2. Consider additional spacing between work stations, divider shields, and/or develop alternate work schedules to accomplish this.
  6. For contact tracing purposes, to the extent practicable, establishments should maintain a record including contact information for visitors and staff who have direct prolonged interaction.
    1. Based on current knowledge, a close contact is someone who was within 6 feet of an infected person for at least 15 minutes starting from 48 hours before illness onset until the time the patient is isolated. Close contacts should stay home, maintain social distancing, and self-monitor until 14 days from the last date of exposure.

Personal Protective Gear, Supplies, and Clothing (all practitioners)

  1. Provide workers with up-to-date COVID-19 information and training on safe donning, doffing, and disposal of personal protective equipment such as gloves and masks.
  2. Face coverings
    1. Establishment employees must wear face coverings at all times.
    2. Require clients to wear face coverings at all times. Consider providing face coverings to clients.
  3. Face Shields
    1. Employees are advised to wear face shields, in addition to face coverings, when servicing clients. If face shields are not available, other eye covering is advised, in order of preference, use goggles, or eyeglasses.
  4. Gloves
    1. Use nitrile or vinyl, unpowdered gloves anytime the potential exists to come into contact with blood or body fluids including when a client has broken skin in an area where massage is provided or when the practitioner has broken skin on the hands or forearms.
    2. Gloves might be worn when handling potentially contaminated laundry, but are not necessary so long as the practitioner practices correct hand hygiene.
  5. Personal Protective Equipment
    1. Clean and disinfect reusable personal protective equipment or discard in a closed container.

Cleaning and Disinfection 

  1. Wash hands with soapy, warm water, for a minimum of 20 seconds between every client service.  
  2. Ensure that soap and paper towels are available at all sinks.
  3. Each establishment shall be thoroughly cleaned and disinfected prior to reopening and then daily. 
  4. Disinfect all surfaces, tools, implements, equipment, and linens, even if cleaning occurred prior to the closing of the establishment.
    1. Clean all surfaces and tools with hot soapy water or cleaning wipes (if using wipes, be sure to cover surface thoroughly) before disinfecting.
    2. Contact time refers to how long the disinfectant is visibly wet on the surface allowing it to destroy the pathogens. Typical contact time for immersion/sprays is 10 minutes, for disinfectant wipes is 2-4 minutes. Observe contact time on label to allow disinfectant to work properly.
    3. Disinfection is for hard non-porous surfaces such as, glass, metal, and plastic
  5. Disinfectant only works on a clean surface, so clean all surfaces and tools with hot soapy water, Ship-shape or cleaning wipes (if using wipes, be sure to cover surface thoroughly) before disinfecting. 
  6. Clean and disinfect all equipment such as cups, stones or rollers between clients.
  7. Porous/soft surfaces cannot be disinfected and must only be used once and then discarded.
  8. Launder all linens, towels drapes, and smocks in hot soapy water and dry completely at the warmest temperature allowed and store in a closed cabinet. Store all used/dirty linens in an airtight container.
  9. Refer to the following documents for guidance on general cleaning and disinfection:
    1. COVID-19 Prevention Checklist General Guidance (State of Maine)
    2. Cleaning and Disinfecting Your Facility (CDC)
    3. Guidance for Cleaning and Disinfecting Public Spaces, Workplaces, Businesses, Schools and Homes (CDC)

Reception area 

  1. Avoid practices such as handshaking or hugging when greeting clients.
  2. Suspend “self-service” food stations.
  3. Remove all unnecessary items such as samples, magazines, newspapers, service menus, any other unnecessary paper products and decor.
  4. Clean and disinfect all seats and tables; since cloth chairs are difficult to properly clean and disinfect, consider plastic covering. 
  5. Clean and disinfect reception desk. Consider discontinuing use of paper appointment books or cards and replace with electronic options. 
  6. Employees should frequently wash their hands after the using the phones, computer, cash register and/or credit card machine. Clean and disinfect these surfaces between each use. Plastic shields on keyboards and other high-touch devices can help with ease of cleaning.
  7. Avoiding the exchange of cash can help greatly in preventing spread of virus, but if this is unavoidable, be sure to wash and sanitize hands well after each transaction. The use of credit/debit transactions is preferred, using touch/swipe/no signature technology. Keep six feet away during transactions and remain masked.
  8. Clean and disinfect all retail areas, daily, including products. Place a sign prohibiting clients from self-serving in the retail area and to ask for assistance. Remove and discard all “Test” products. 
  9. Clean and wipe all door handles and other surfaces that are regularly touched by clients and staff with disinfectant wipes. 
  10. Provide hand sanitizer and tissues for employees and clients and trash bin for disposal.
  11. Consider floor stickers and signage that provide guidance for maintaining 6-foot physical distance. 
  12. Consider using signage to communicate to the client that thorough sanitation procedures are in place.
  13. Consider providing physical barriers to protect clients and staff such as partitions or plexiglass barriers.

Restrooms  

  1. Limit restroom occupancy for group restrooms to incorporate physical distancing and avoid formation of waiting lines outside of restrooms.
  2. Clean and disinfect restrooms on a regular and scheduled basis (see Cleaning and Disinfecting section).
  3. Ensure bathrooms are supplied adequately with soap, water, and drying materials.
  4. Place trashcan by door.
  5. Remove anything that does not have to be in the restrooms. 
  6. Post handwashing signs in the restrooms for both employees and clients.

Work Areas

  1. Limit face-to-face contact with clients.
  2. Work Stations
    1. Between each client session, clean and disinfect any surface the practitioner or client might touch before, during, and/or after sessions (e.g. door handles, massage lubricant bottle).
    2. Cover the massage table or the warmer and padding on the massage table with a heavy-duty plastic sheet or table protector. Disinfect the plastic sheet over the massage table with an EPA-registered disinfectant between clients. If a plastic sheet is not used, clean the massage table with soap and water between clients and wipe it with a massage table specific disinfectant.
    3. Provide a clean face-rest cover for each client.
    4. Prepare the massage table with clean linens. Change drapes and linens between each client.
    5. At the conclusion of a massage session, identify, gather, and remove all soiled linens from the session room.
    6. Do not shake soiled linens as this may disperse contaminated respiratory droplets into the air.
    7. Ventilate the session room between clients by opening doors and windows to circulate fresh air.
    8. Clean and disinfect all reusable tools, implements and items and store in an airtight closed container.
    9. Clean and disinfect all appliances, tools, and any other items used in connection with servicing clients between each client. 
    10. Clean and disinfect all linen hampers and trash containers daily and only use closeable containers with disposable linings. 
    11. Provide hand sanitizer at all work locations for employees and clients. 
    12. Consider installing non-porous physical barriers such as partitions or plexiglass barriers between workstations, if applicable.

Session procedures

  1. Both the practitioner and client must wear a face covering during the session.
  2. To minimize the dispersion of infected respiratory droplets, limit talking in the session room to communication about pressure, warmth, and comfort.
  3. Intra-oral or nasal massage should not be done at this time because of increased risk of exposure.
  4. Because a face covering is worn for the duration of the massage, safe face massage is not possible and therefore discouraged at this time.
  5. Request that client sanitize their hands before they leave the session room and before they pass through common areas of the facility.

Onsite and Outcall Locations

  1. Onsite locations refer to anywhere massage is performed in a massage chair or on a portable massage table at locations where clients are not enclosed in a session room and remain clothed throughout the massage (e.g., an airport chair massage businesses). At onsite settings, massage practitioners are still subject to the same cleanliness and disinfection protocols as other massage business locations, to the proper management of linens, to pertinent client policies and procedures, and to practitioner hygiene requirements as described in this checklist.
  2. Outcall locations refer to mobile massage provided in a client’s home or hotel room. While COVID-19 is present in a community, mobile massage/outcall massage is unsafe and therefore strongly discouraged. Massage practitioners are unable to control the cleanliness or disinfection practices at client homes, exposing the massage practitioner to increased risk of infection.

COVID-19 Prevention Form

In order to open, businesses must commit to complying with requirements of these checklists by filling out this short online form. Please note that religious organizations and licensed health care providers are not required to use this form.

If you have questions, please contact us at business.answers@maine.gov or 1-800-872-3838.