Back in Balance Family Chiropractic Corp. Restart Plan
Date: May 18, 2020
Business address: 2325 6th Avenue, Castlegar, BC
At Back in Balance Wellness Centre, the health of our employees and customers are of utmost importance to
us. This document was created for the purpose of outlining plans and action steps to reduce the risk of
COVID-19 transmission and to clarify the actions that Back in Balance Family Chiropractic Corp. will take in
order to ensure the wellbeing of everyone in our place of business and community.
Guidance for this document is informed by recommendations from the BCCDC, the PHO, WorkSafeBC and
the BC Health Regulators. This document reflects the best evidence available at this time and may change as
required to reflect updates released by the above mentioned governing bodies.
This document can be found on site in the office policies and procedures binder and at www.backinbalance.ca
and will regularly be updated by Dr. Brandy Grantham. Should you have any questions, recommendations or
concerns, please contact Brandy Grantham at 250-304-4401 or email@example.com
1. Practitioners, staff and patients must self-assess daily for symptoms and stay home if they are unwell;
should you have symptoms, you must immediately contact Dr. Grantham and 811. You will need to be
tested for COVID-19 and may need to self-isolate for 10 days for any upper respiratory symptoms.
2. We will be using the BC COVID-19 Self Assessment Tool, https://bc.thrive.health/covid...
3. All staff and team members will send Dr. Grantham a screenshot of their “SELF-CHECK” results daily,
which will be stored electronically.
4. Physical distancing. Limit number of patients. No waiting in common areas. No treatment companions,
unless treating a minor.
5. Hand hygiene. Practitioners and staff must have excellent hand washing throughout the day. Stop and
think, should I wash my hands. If in doubt, wash again. Gloves are not necessary if you are washing
regularly and well. Gloves should be worn when dealing with soiled linens.
6. Face Touching Avoidance
7. Enhanced Cleaning - daily checklists will need to be completed and signed. At the beginning of your
shift wipe down all workstation surfaces.
8. Personal Protective Equipment
9. Professional Obligations - Signed Declaration, consent and liability insurance
● Clear guidelines and communication
● Safety protocols
● Ongoing self-assessment
● Each practitioner is required to review their College guidelines and have a written document with the
goal of reducing risk of exposure to the virus; you will need to submit this document to Back in Balance
before re-opening; you are responsible for assuring you will adhere to this document and have it
available for audit
● Honest communication is key between practitioners, staff and patients; to ensure patients feel safe to
return to us for treatment
● This process will be fluid as new information is constantly flowing
● Our key touchpoints for guidance are the BCCDC, the PHO, and WorkSafeBC
1. Pre-screening process; utilize https://bc.thrive.health/covid...
a. All staff and practitioners must self-assess daily using the BC COVID-19 app, and must stay
home if unwell; a screenshot of each workers self-assessment will be sent to Clinic Manager
and stored electronically;
b. This can be done by the patient prior to their arrival at the clinic; patient will need to produce
screenshot with date stamp as proof of daily screening;
c. Alternately the patient can complete this on the clinic iPad upon arrival;
d. Admin or practitioner will have patient review COVID Declaration and Consent documents and
SIGN-IN for their treatment on the Sign-in sheet at reception;
e. Patients must be informed about the new procedures implemented, before or at the time of
booking an appointment;
f. Clear information will be included in all communication tools – website, online booking system,
phone message, and auto-responses to email enquiries;
g. At the outset, it is our responsibility to advise patients that informed consent is required . This
includes ensuring that your patient understands that while you’ve taken measures to minimize
risk of viral transmission, the nature of our work means that physical distancing is not possible
in the treatment room;
h. Advise patient prior to arrival at the practice about provisions you’ve made for personal
protective equipment (PPE, see below), and your rationale. If they have a mask, ask them to
bring it with them and wear it when they arrive;
i. Patients must confirm they have not travelled outside British Columbia in the previous 14 days;
j. One day prior to the patient's appointment, admin will call to connect personally with patient to
ask them to complete the BC COVID-19 Symptom Self-Assessment . Patient will be asked to
stay home if experiencing any symptoms of COVID-19 , including fever, chills, cough, shortness
of breath, sore throat, loss of sense of smell. If patients are experiencing these symptoms and
have not been tested for COVID-19, we recommend that they do so; they start by calling 8-1-1;
k. Our cancellation policy will be relaxed to ensure honesty and compliance with pre-screening
2. Outline physical space, and where able maintain physical distancing -
Back in Balance will ensure the physical distancing of 2 meters (6 feet) where possible for both our
clients and employees inside our business as well as any lines entering our place of business. Should
you have any questions, recommendations or concerns, please contact Brandy Grantham or Sandy
Ewing at 250-304-4401.
a. Clearly-understood distancing protocols – staff, practitioners and patients must maintain 6 feet
of distance in clinic areas other than the treatment room, as best as possible within the practice
b. All clutter, fabric furnishings and decorations that cannot be sanitized after touch have been
c. We will reduce traffic through staggered appointment start- and end- times;
d. Floor/counter/wall markings showing 6 feet of distance, and create one-way traffic flow
e. Patient must arrive unaccompanied, unless the patient is a minor who requires
parent/guardian, or infirm and needs assistance (see recommended protocol, below);
f. Patient is required to wait outside (in their car, or an area suggested by clinic staff) and not in
reception – call or text when it’s time to enter;
g. Greet patient and open the door for them;
h. At end of treatment, accompany patient to the reception and admin to open the door for them
(using a hand towel or other sanitized barrier) on exit;
i. We will make use of alternate entries/exits in the practice environment to assist with distancing.
3. Hand hygiene and Cleaning Protocols -
Back in Balance has developed cleaning protocols to ensure that all common areas are cleaned and
disinfected twice daily, or more often as required (I.e. if soiled).
Health and Safety is a responsibility that belongs to everyone in the workplace.
Should you have any questions, recommendations or concerns, please contact Brandy Grantham or
Sandy Ewing, at 250-304-4401.
a. Back in Balance will ensure that all the necessary supplies such as hot/cold potable running
water, liquid soap, paper towel, and garbage bins, for handwashing; or minimum 60% alcohol
based hand sanitizer ; toilet paper, cleaning and disinfecting supplies and personal protection
equipment (non-medical masks and disposable gloves) are available as appropriate;
b. Back in Balance will ensure that employees are trained on how to clean and disinfect surfaces
and use personal protection equipment if needed;
c. Employees cleaning the workspaces should read and follow manufacturer’s instructions for
safe use of cleaning and disinfection and the direction from these will be used according to the
label directions. Cleaning and disinfecting supplies that clean and disinfect all at once may
require the use of disposable gloves, these should be disposed of appropriately after cleaning.
More information on cleaning and disinfection can be found on the Government of Canada
d. Employees and clients should not be present in the area during the cleaning of the workplace
to allow enough contact time for disinfectants to kill germs based on the product being used;
e. Items such as countertops, chairs (including below the front of the seat), rental/shared tools
and equipment, phones and cell phones, whiteboard markers, cashier equipment, light
switches, public washrooms, doorknobs, cabinet handles, faucet handles, tables, and furniture
need to be disinfected more frequently throughout the day;
f. no spray bottles for tables, use cloth for cleaning and disinfection;
g. sanitation station with 80% alcohol for patients use on arrival and prior to departure,
practitioner/staff to apply;
h. If hands are visibly soiled, patient must use a wipe and/or wash in the bathroom, then
alcohol-based hand rub prior to moving to the treatment room;
i. Practitioners/staff must wash hands upon arrival at the clinic and often throughout the day,
using soap and water for a minimum of 20 seconds each time;
j. Hand-washing protocols are posted visibly in the reception area and at sinks (including
bathroom for patient’s use);
k. If payment occurs in the reception area, a wireless point of sale system with tap feature may be
used or arrange e-transfer for payment. Receipt is emailed to the patient where possible. Cash
is not preferred but may be handled provided that anyone doing so washes their hands
l. Hand washing should occur before and after treatment;
m. Training for therapists and staff in sanitation processes has been completed;
n. Clean visibly soiled surfaces followed by disinfection;
o. Clean and disinfect all high-touch surfaces in between patients, regardless of appearance;
p. Linens (including blankets) must be single use only, then laundered in hot soapy water;
q. Frequently clean and disinfect (at least three times per day, more if possible):
i. handles: doors, cabinets, faucets, fridge, microwave, etc.
ii. electronic device keyboards and mice, phones,
iii. arm rests of chairs,
iv. desk and table surfaces,
v. water cooler;
r. Clean in view of patients so patients see the steps taken for safety;
s. Schedule additional time between patients to thoroughly clean the treatment room;
t. Sanitize the treatment table and table adjustment levers after each treatment;
u. Clean the face cradle (one more time) and armrests (if used) in front of the patient, to maintain
v. Clean equipment and supplies (table levers, lotion bottles, etc.) immediately after each patient;
w. Cease use of thermophores (reconsider all hydrotherapy supplies and discontinue use of
thermal agents that cannot be sanitized);
x. Attach Cleaning and Disinfectants for Clinic Settings poster from the BC Centre for Disease
Control in reception area, washroom for patient use, treatment room;
y. All clinic personnel will clean their cell phones with a Lysol wipe upon arrival, and ensure hands
are cleaned before and after using cell phones while at work.
4. Face Touching
a. Share information about the reason for ‘no face touching’; coronavirus can be spread by touch
if a person has used their hand/s to cover a cough or a sneeze;
b. Suggest patients use a tissue if an itch must be addressed;
c. Tissues must be available for patient’s use in reception, treatment room, washroom;
d. Masks will be made available for patient, practitioner and staff because masks are useful to
avoid touching face;
e. Make use of a hand towel or tissue to touch or scratch face, or to sneeze into.
5. Personal Protective Equipment
a. All staff and contractors must wear a mask on site if physical distancing is not possible
b. RMT should have gloves, protective goggles and other commercially available PPE items
available if the patient requests their use, or if RMT chooses to use PPE.
c. Admin Staff - all admin staff will wear a mask when moving around the office if physical
distancing is not possible; mask can be removed if stationed at reception behind barrier; staff
must don mask, gloves, and gown to handle soiled laundry.
d. Paper or disposable masks should be available for patient use rather than laundered cloth
masks, to instill trust.
6. Staff and Team Education
a. We will have weekly staff meetings to follow up on any concerns around worker safety;
b. Staff members must advise office manager and/or business owner immediately in writing of
any personal concerns with respect to potential illness, exposure at work or elsewhere, or
concerns relating to being exposed to COVID-19 in the workplace and any tasks that workers
feel are unsafe;
c. Immediate action steps will be taken to resolve issues raised;
d. A walk-through of our workplace has been completed on May 15, 2020 by all workers;
e. Tasks with increased risk of exposure have been discussed and concerns raised have been
7. Controls to Eliminate and Minimize Risk of Exposure
a. Physical barriers have been installed at reception;
b. All cloth furniture has been removed;
c. PPE has been provided, including masks, gloves and gowns for higher risk activities;
d. Additional cleaning equipment has been provided and instructions on daily cleaning checklists
have been reviewed;
e. Signage has been placed; hand washing practices, donning and doffing PPE, physical
distancing, safe tap, entry points;
f. Worker safety is ensured by allowing physical distancing where possible, providing soap and
water for regular hand washing, alternately hand sanitizer is available throughout site; and
enhanced cleaning protocols are in place for workers to wipe down high contact items
g. Workers who have new or unusual symptoms will need to contact public health immediately
and self-isolate for 10 days, or until test results are available;
h. Workers who travel internationally will be required to self-isolate for 14 days upon return to
Canada, and will not be allowed on site;
i. Workers who live in the same household as a confirmed or clinical case of COVID-19 and have
been advised by public health to self-isolate, will be required to do so and will not be allowed
j. These measures will be reviewed regularly to ensure they are working as intended;
8. Controlling the Number of People on Site
a. Staff and admin schedules have been revised to minimize number of workers and patients on
site at any given time;
b. Alternate entry and exit points have been established to reduce contact;
c. Office manager will continue to work from home as much as possible;
d. Cleaning protocols and checklists have been established and communicated to all workers;
checklists will need to be initialed and will be reviewed daily to ensure compliance;
e. Work will be prioritized to ensure core work can be done safely and productively;
f. A contact tracing binder has been established to ensure safe record keeping; this will include
admin schedule, practitioner day sheets, daily cleaning checklists and patient sign in sheets.
9. Back in Balance Sick Leave Policy
a. everyone is required to self-isolate at home should they develop new or unusual symptoms
Created May 18,2020
b. notify Sandy of your situation; follow the recommendations of Public Health, call 811, and get
c. you will be required to stay home for 10 days from the onset of symptoms AND until symptoms
resolve, whichever is longer.
d. we will implement a "fit for work with restrictions" policy as outlined by the PHO, for
practitioners provided you only have mild symptoms, feel well enough to work, practice strict
respiratory and hand hygiene protocols, and wear a mask.
10. Back in Balance is committed to clear, concise, honest communication at all times.
11. Back in Balance and all workers will adapt as needs change and new information becomes available.
12. Back in Balance is committed to minimizing risk to all.
Covid-19 Signage in Public Areas
Back in Balance will affix signage on proper hand hygiene, respiratory hygiene, and physical distancing
throughout the facility and outdoor settings as applicable. At a minimum, signage must be placed at any
common entrance and location where people tend to congregate. Should you have any questions,
recommendations or concerns, please contact Brandy Grantham.
The required signage has been affixed in this location in the
Yes No N/A
Public Health Authority Sign
(throughout the facility and outdoor as applicable)
☐✔ ☐ ☐
Physical Distancing Sign
(throughout the facility and outdoor as applicable)
☐✔ ☐ ☐
Customer Screening & Symptoms Sign ☐✔ ☐ ☐
(customer points of entry)
Employee Screening Sign
(if different from customer screening sign, should be at employee
points of entry & common employee spaces if applicable)
☐✔ ☐ ☐
Employee Symptoms Sign
(employee points of entry, employee rooms if applicable)
☐✔ ☐ ☐
How to Wear a Face Mask
(employee points of entry, employee rooms if applicable)
☐✔ ☐ ☐
Hand Washing and Sanitizer Sign
(washrooms, handwashing stations, entries, exists, and other
sanitizing stations if applicable)
☐✔ ☐ ☐
Back in Balance Best Practices Guide for Safety
(manager’s office and/or common employee spaces if applicable)
☐✔ ☐ ☐
Cleaning and Disinfecting Public Spaces
(common employee spaces if applicable)
☐✔ ☐ ☐
Debit/Credit Terminal Sign
(all point-of-sale terminals & customer points of entry)
☐✔ ☐ ☐
A list of important emergency resources
(This would include a list of local public health screening centres,
mental health resources, self-screening links and the contact
information for public health authorities)
☐✔ ☐ ☐
Employee Wellness and Hygiene
Back in Balance will ensure that all employees are informed of the best practices to encourage proper
hygiene etiquette. Additionally, the necessary products and equipment will be available to you in the
workplace to follow these best practices.
Health and Safety is a responsibility that belongs to everyone in the workplace and we encourage you to
review WorkSafe BC resources like COVID-19 Industry Information .
We have also reviewed our sick leave policy & Health and safety policy to ensure employees are not
coming to work unless they are healthy. Should you have any concerns about your wellbeing in the
workplace, please contact Brandy Grantham at firstname.lastname@example.org
The following employee wellness and hygiene procedures are in place at this location:
Each day you are scheduled to work you will be required to complete a Self Assessment on the BC
COVID-19 App, and send a screenshot of your results to the Clinic Manager.
While at work to help stop the spread of germs:
· Avoid touching your eyes, nose or mouth
· Cover your mouth and nose with a tissue when you cough or sneeze and throw the used tissue in the
· If you do not have a tissue, cough or sneeze into your elbow, not in your hands and then wash your
hands immediately afterwards;
· When coming into work and leaving work, please wash/sanitize your hands for 20 seconds
· You are encouraged to clean your cell phone upon arriving at work with a sanitizer wipe (if available);
Created May 18,2020
· Respect the 2-meter physical distancing measures with all your colleagues and clients;
· Handshakes, hugs and direct contact are not permitted;
· Avoid contact with people who are sick
· Indicate your arrival and departure times with the reception desk logbook/timesheet.
· We encourage you to remind your colleagues and clients of the wellness and hygiene measures put
Should you feel unwell (I.e. coughing, sneezing, fever, shortness of breath, runny nose, etc.), think you
have come into contact with someone with COVID-19, or have someone from your household return from
· If you have symptoms or think that you might have COVID-19, please use the Screening
Questionnaire for COVID-19. Please notify Brandy Grantham at email@example.com
· We ask that you do not present yourself at work with COVID-19 symptoms and self-isolate for 14
· To reduce the burden on the health care system and reduce additional exposure to ill individuals, the
company’s sick note policy has been temporarily reviewed to no longer require a medical practitioner’s
note. Please be aware that you will be required to provide a fit-to-work assessment before coming back into
COVID PATIENT SCREENING DECLARATION & CONSENT
The following criteria need to be met in order for you to be seen today:
You HAVE NOT OR ARE NOT EXPERIENCING any symptoms of COVID-19 currently or in the last 14
days. These may include:
● Sore Throat
● New Cough
● Breathing difficulties
● Runny Nose
I acknowledge that I have not experienced any of these symptoms in the last 14 days.
You have, to your knowledge, not been in contact with anyone experiencing the above symptoms
in your household, place of work or with someone who has symptoms or has tested positive for
COVID-19 in the past 14 days. Initial:___________
I acknowledge that I have not traveled outside BC within the last 14 days. Initial:__________
I consent to Back in Balance sharing my information with Public Health should we receive a
request for contact tracing. Initial:___________
I am aware that despite extensive infection control preventative measures being taken by the
clinic, there remains a risk of becoming infected with COVID-19 by proceeding with any in-person
interaction, as physical distancing is not possible for “hands-on” health care services. I agree to
not pursue legal action against Back in Balance Family Chiropractic Corp. or any Independent
Contractors providing service.
Date: _________________ Witness Signature:______________________
COVID-19: Informed Consent
I understand the novel coronavirus, COVID-19, has been declared a worldwide pandemic by the World
Health Organization. I further understand that COVID-19 is extremely contagious and is spread by
person-to-person contact; and, as a result, federal and provincial public health organizations recommend
I recognize that due to the nature of “hands-on” treatment provided at Back in Balance Family Chiropractic
Corp. I will not be able to maintain physical distance (2 metres distance) from my doctor/therapist.
I understand my doctor/therapist and the other staff Back in BalanceWellness Centre will be taking rigorous
preventative measures to reduce the risk of transmitting COVID-19 and other infectious diseases.
These measures include those required by provincial and federal regulatory bodies, as well as those
outlined in the guidelines for “COVID-19: Infection Prevention and Control Guidance for Community-Based
Allied Health Care Providers in Clinic Settings” published by the BCCDC and the Government of BC as part
of the safe return to practice plan.
I am aware that despite these preventative measures, there remains a risk of becoming infected with
COVID-19 by proceeding with any in-person interaction, including in-person chiropractic, physiotherapy,
massage therapy, acupuncture, counseling, kinesiology or reflexology services. This risk includes but is
not limited to the symptoms and complications related to COVID-19.
I accept this risk and would like to proceed with my in-person appointment.
Name (Print): ________________________________
IPAC - Infection Prevention and Control
Infection Prevention Checklist
Declutter, Physical Distance, Pre-entry Screen, Hand Hygiene, Respiratory Etiquette, Point of Care Risk
Assessment, PPE, Cleaning and disinfecting
● 2 wipe process - First pass cleans, rinse cloth, Second pass disinfects, allow 3-5 minute drying time
● Staff wears surgical masks, patients can wear cloth masks; the goal is to create physical distance
just in case with asymptomatic person
● Masks should be taken off with clean hands.
● Masks should be directly disposed of in garbage can with lid when it is wet, dirty or damaged.
● If you need a drink but don’t want to take mask off, use the elastic to remove from one ear, drink
and replace ear elastic.
● No absolute recommendations on when to change it; use your best judgement. Store it in the paper
bag and handle it from the elastic strap. Watch for document from WorkSafeBC on Extended use of
● Patient with allergies that may be coughing or sneezing should keep the mask on;
● Gloves never replace hand hygiene! Gloves are for risk of exposure to blood and body fluids.
Gloves, mask and poncho should be worn when handling soiled linens and laundry basket lids kept
● Admin behind barrier can remove mask, but should wear when moving around clinic
● Staggered start times for front door and one way travel when/where possible. Attention must be
made to others moving around clinic.
● Lynne's patients arrive on the :00 and the :30
● Kelsey's arrive on the :00, :20, :40
● Caroline's arrive on the :05, :35
● Lauren's arrive on the :10, :40
● Jess's arrive on the :15 or :45
● Tammy, Robyn, and Jolene not necessary as they are in the office at less high traffic times
● Back door - BG every 15 minutes, Shail on the 5, 10, 20, 25, 35, 40, 50, 55
● All table linens storage shelves have a plastic curtain installed, ensure this curtain is kept closed at
Created May 18,2020
● Bathroom garbage cans, liner bag to be removed and tied up for disposal
● COVID does not aersolize with coughing or sneezing, it is not AIRBORNE; heavy droplets fall to the
floor within 30-60 seconds
● Cleaners and disinfectants - follow directions on the bottle, use measuring cups to ensure proper
dilution, wash your hands after exposure to cleaners.
I, Brandy Grantham, DC (CEO Back in Balance Family Chiropractic Corp.) am committed to reducing the
risk of exposure to COVID-19 and will adhere to this document in the deliverance of all business activities
and in-person chiropractic care at Back in Balance Wellness Centre.
Dr. Brandy Grantham, DC, CEO
Sandy Ewing, Clinic Manager
Guiding Principles and Prioritization of Patient Care Services
Dr. Brandy Grantham, DC
i. In-person services must only proceed when the anticipated benefits of such services outweigh the risks to
the patient and the health care provided.
ii. As a chiropractor I am alone accountable to determine the need for, urgency and appropriateness of
iii. I must consider if I am the most appropriate health-care provider to address the patient’s needs,
referring patients to other members of the health-care team when in the patient’s interest.
iv. I must not recommend unproven therapies for treating COVID-19.
v. I must not prescribe or offer any COVID-19 treatments or therapies if infectious diseases if not within my
scope of practice.
vi. I am accountable to provide clear, honest, transparent communication regarding our policies and
procedures related to COVID-19.
vii. When determining priority for in-person care, I will reflect upon the following considerations:
- acuity of the patient’s condition
- functional impairment or impact of the condition on health-related quality of life
- the impact of not receiving services (e.g. potential for emergency department visit or acute
care admission, ability to return to/remain at work)
- appropriateness of service provision via virtual care
- necessity of services which can only be provided in-person
- duration of patient wait-times for care
Created May 18,2020