FINAL INTERNATIONAL ISO/FDIS

DRAFT
STANDARD 45006

ISO/TC 283
Secretariat: BSI Occupational health and safety
Voting begins on:
management — Guidelines for
2023-09-18 organizations on preventing and
Voting terminates on: managing infectious diseases
2023-11-13
Management de la santé et de la sécurité au travail — Lignes
directrices sur la prévention et la prise en charge des maladies
iTeh STANDARD PREVIEW infectieuses destinées aux organismes

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 ISO/FDIS 45006:2023(E)

Contents Page

Foreword...........................................................................................................................................................................................................................................v
Introduction............................................................................................................................................................................................................................... vi
1 Scope.................................................................................................................................................................................................................................. 1
2 Normative references...................................................................................................................................................................................... 1
3 Terms and definitions..................................................................................................................................................................................... 1
4 Context of the organization....................................................................................................................................................................... 4
4.1 General............................................................................................................................................................................................................ 4
4.2 External issues........................................................................................................................................................................................ 4
4.3 Internal issues.......................................................................................................................................................................................... 5
4.3.1 General......................................................................................................................................................................................... 5
4.3.2 Diversity of workers and other relevant interested parties........................................................ 5
5 Characteristics of infectious diseases........................................................................................................................................... 6
6 ​Leadership and worker participation............................................................................................................................................ 7
6.1 ​Leadership................................................................................................................................................................................................... 7
6.2 Consultation and participation of workers.................................................................................................................... 7
6.3 Roles, responsibilities and competence............................................................................................................................ 8
7 Communication...................................................................................................................................................................................................... 8
7.1
7.2 iTeh STANDARD PREVIEW
General............................................................................................................................................................................................................ 8
Methods of communication.......................................................................................................................................................... 9
7.3 Communication with and reporting to external interested parties..................................... 9
8
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Hazards, risks and controls ...................................................................................................................................................................... 9
8.1 Identification of hazards................................................................................................................................................................. 9
8.2 ​Assessment of risks..........................................................................................................................................................................
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Determination of controls.......................................................................................................................................................... 11
8.3.1 Selection of7d84b012a923/iso-fdis-45006
controls...................................................................................................................................................... 11
8.3.2 Hierarchy of controls.................................................................................................................................................... 11
8.3.3 Additional considerations for controls......................................................................................................... 12
8.4 ​Planification of changes to controls.................................................................................................................................. 12
9 Psychological health and well-being............................................................................................................................................13
9.1 Psychosocial hazards and risks............................................................................................................................................. 13
9.2 Controls to manage psychosocial risks.......................................................................................................................... 13
10 Resources................................................................................................................................................................................................................... 14
11 Implementation of controls for infectious diseases..................................................................................................... 15
11.1 General......................................................................................................................................................................................................... 15
11.2 Personal hygiene................................................................................................................................................................................. 15
11.3 Work-related travel.......................................................................................................................................................................... 16
12 Implementation of controls for contagious diseases.................................................................................................. 16
12.1 General......................................................................................................................................................................................................... 16
12.2 Workplaces under the control of the organization.............................................................................................. 17
12.2.1 General workplace infection controls........................................................................................................... 17
12.2.2 Use of common areas.................................................................................................................................................... 18
12.2.3 Meetings and visits to workplaces................................................................................................................... 19
12.2.4 Deliveries................................................................................................................................................................................ 19
12.3 Working from home......................................................................................................................................................................... 20
12.4 Working in other people’s homes......................................................................................................................................... 20
12.5 Working in multiple locations................................................................................................................................................. 21
12.6 Working with the public............................................................................................................................................................... 22
13 Implementation of controls for non-contagious infectious diseases........................................................ 22

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14 Implementation of controls for endemic diseases......................................................................................................... 23

15 Use of personal protective equipment and face coverings................................................................................... 23
15.1 General......................................................................................................................................................................................................... 23
15.2 Selection of appropriate protection................................................................................................................................... 24
15.2.1 General...................................................................................................................................................................................... 24
15.2.2 Protective gloves.............................................................................................................................................................. 24
15.2.3 Face and respiratory protection......................................................................................................................... 25
16 Emergency preparedness and response.................................................................................................................................. 26
17 Management of suspected or confirmed cases of a relevant infectious disease........................... 27
17.1 General......................................................................................................................................................................................................... 27
17.2 Managing illness in a workplace........................................................................................................................................... 27
17.2.1 General...................................................................................................................................................................................... 27
17.2.2 Occurrence of contagious disease.................................................................................................................... 28
17.3 Screening, testing, contact tracing, quarantine and vaccination............................................................ 28
18 ​Performance evaluation............................................................................................................................................................................ 29
18.1 General......................................................................................................................................................................................................... 29
18.2 ​Monitoring and measurement................................................................................................................................................ 29
18.3 Analysis and evaluation............................................................................................................................................................... 30
18.4 ​Management review........................................................................................................................................................................ 30
19 Improvement.......................................................................................................................................................................................................... 31
Annex A (informative) Examples of risk tables.................................................................................................................................... 32
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Bibliography..............................................................................................................................................................................................................................34

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Foreword
ISO (the International Organization for Standardization) is a worldwide federation of national standards
bodies (ISO member bodies). The work of preparing International Standards is normally carried out
through ISO technical committees. Each member body interested in a subject for which a technical
committee has been established has the right to be represented on that committee. International
organizations, governmental and non-governmental, in liaison with ISO, also take part in the work.
ISO collaborates closely with the International Electrotechnical Commission (IEC) on all matters of
electrotechnical standardization.
The procedures used to develop this document and those intended for its further maintenance are
described in the ISO/IEC Directives, Part 1. In particular, the different approval criteria needed for the
different types of ISO document should be noted. This document was drafted in accordance with the
editorial rules of the ISO/IEC Directives, Part 2 (see www.iso.org/directives).
ISO draws attention to the possibility that the implementation of this document may involve the use
of (a) patent(s). ISO takes no position concerning the evidence, validity or applicability of any claimed
patent rights in respect thereof. As of the date of publication of this document, ISO had not received
notice of (a) patent(s) which may be required to implement this document. However, implementers are
cautioned that this may not represent the latest information, which may be obtained from the patent
database available at www.iso.org/patents. ISO shall not be held responsible for identifying any or all
such patent rights.
Any trade name used in this document is information given for the convenience of users and does not
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constitute an endorsement.

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For an explanation of the voluntary nature of standards, the meaning of ISO specific terms and
expressions related to conformity assessment, as well as information about ISO's adherence to
the World Trade Organization (WTO) principles in the Technical Barriers to Trade (TBT), see
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This document was prepared by Technical Committee ISO/TC 283, Occupational health and safety
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Any feedback or questions on this document should be directed to the user’s national standards body. A
complete listing of these bodies can be found at www.iso.org/members.html.

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ISO/FDIS 45006:2023(E)

Introduction
Infectious diseases are increasingly recognized as major challenges to health, safety and well-being.
Decisions and activities relating to the prevention and management of infectious diseases affect workers
within the organization and other people who visit a workplace, come into contact with workers, or can
be affected by the organization’s activities. This document is a response to the risks that infectious
diseases present to workers and other relevant interested parties (e.g. customers, the public, suppliers,
workers from other organizations, family members and other personal contacts).
There is a broad range of infectious diseases with potential impacts on health, safety and well-being,
which can vary from very mild to very serious depending on the nature of the infectious disease. Key
characteristics of infectious diseases (see Clause 5) are a major factor in the risk posed to workers and
other relevant interested parties.
Some infectious diseases are non-contagious and infect only the individual who contracts the disease
and do not usually transmit from human to human (e.g. legionellosis or malaria), while others are
contagious and have the potential to spread from a single individual to infect others (e.g. influenza,
COVID-19, smallpox, hepatitis, salmonellosis, tuberculosis, Ebola and HIV/AIDS), up to and including a
pandemic spread of the disease.
The impact in terms of severity of infectious diseases can vary from person to person depending on
underlying health conditions (e.g. asthma, diabetes, obesity, strength of immune system) and factors
such as age, sex, and socio-economic situation. Impacts can be more severe where one or more such
circumstances exist.
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This document provides guidelines to prevent or reduce exposure to, and transmission of, infectious
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agents and to manage risks to workers and other relevant interested parties from infectious diseases. It
supports the principle that workers should not be required to work in settings without implementation
of appropriate prevention and controls.
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The guidance is generic and applicable to organizations regardless of the nature of business, service
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provision, size or complexity. It recognizes that many smaller organizations do not have dedicated
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departments or functions such as occupational health and safety (OH&S), facilities management, human
resources or infectious disease specialists. More detailed information for specific functions is available
from professional bodies and a wide range of national and international standards.
Organizations using ISO 45001 can use this document to improve OH&S management by relating the
relevant clauses to the PDCA cycle:
— Plan: plan what needs to be done for the organization to work safely;
— Do: do what the organization has planned to do;
— Check: see how well it is working;
— Act: take actions to improve or change controls that are not effective.
Taking a systems approach facilitates the coordination of resources and efforts and will enable
organizations to better manage the risk from infectious diseases, by ensuring they are included in to
existing OH&S processes.
This document is not intended to be a single step-by-step set of recommendations. It provides guidelines
to enable ongoing continual improvement and to ensure the organization responds to incidents of
infectious diseases, including epidemics and pandemics.
This document is designed to complement ISO 45001 by providing guidelines that align with the
requirements of ISO 45001. This document can be used independently, by any organization, to improve
OH&S performance.

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FINAL DRAFT INTERNATIONAL STANDARD ISO/FDIS 45006:2023(E)

Occupational health and safety management — Guidelines

for organizations on preventing and managing infectious
diseases

1 Scope
This document gives guidelines for organizations on how to prevent or control exposure to infectious
agents at the workplace and manage the risks associated with infectious diseases that:
— present a risk of severe ill health or death and can impact the health, safety and well-being of workers
and other relevant interested parties;
— present a lower risk to health yet have a significant impact on the organization, its workers and
other relevant interested parties.
This document is applicable to organizations of all sizes and sectors.
NOTE This document does not provide comprehensive guidance to those parts of an organization that
implement mandated infection controls such as hospitals and medical or biological laboratories because there
is an inherent potential for exposure to infectious diseases. Applicable legislation and guidance is provided by
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government, regulators and health authorities for specific infection controls for the protection of workers in
such settings and for work activities on or with pathogenic microorganisms.
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2 Normative references
The following documents are referredISO/FDIS 45006
to in the text in such a way that some or all of their content
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constitutes requirements of this document. For dated references, only the edition cited applies. For
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undated references, the latest edition of the referenced document (including any amendments) applies.
ISO 45001:2018, Occupational health and safety management systems — Requirements with guidance for
use

3 Terms and definitions

For the purposes of this document, the terms and definitions given in ISO 45001 and the following apply.
ISO and IEC maintain terminology databases for use in standardization at the following addresses:
— ISO Online browsing platform: available at https://​w ww​.iso​.org/​obp
— IEC Electropedia: available at https://​w ww​.electropedia​.org/​
— IEC Electropedia: available at https://​w ww​.electropedia​.org/​
3.1
workplace
place where a person needs to be or to go for work purposes
Note 1 to entry: The organization’s responsibilities for the workplace depend on the degree of control over the
workplace.

Note 2 to entry: Workplaces can be inside or outside and include the worker’s own home, other people’s homes,
personal vehicles, vehicles provided by the organization, other organizations’ facilities and public spaces.

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[SOURCE: ISO 45001:2018, 3.6, modified — “under the control of the organization” has been deleted
from the definition, “under the OH&S management system” has been deleted from Note 1 to entry and
Note 2 to entry has been added.]
3.2
legal requirements and other requirements
legal requirements that an organization has to comply with and other requirements that an organization
has to or chooses to comply with
[SOURCE: ISO 45001:2018, 3.9, modified — Notes 1, 2 and 3 to entry have been deleted.]
3.3
top management
person or group of people who directs and controls an organization at the highest level
[SOURCE: ISO 45001:2018, 3.12, modified — Notes 1, 2 and 3 to entry have been deleted.]
3.4
incident
occurrence arising out of, or in the course of, work that could or does result in injury and ill health
Note 1 to entry: In this document, “injury and ill health” refers to contracting an infectious disease (3.8) or any
identifiable, adverse physical or psychological condition arising from or associated with an infectious disease.

[SOURCE: ISO 45001:2018, modified — Note 1 to entry has been replaced, and Notes 2 and 3 to entry
have been deleted.]
3.5
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personal protective equipment
PPE
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device or appliance designed to be worn by an individual for their protection against one or more health
and safety hazards ISO/FDIS 45006
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Note 1 to entry: PPE includes, but is not limited to, gowns, gloves, respirators, safety glasses, helmets and goggles.
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Note 2 to entry: While generally not considered PPE, masks, and other face coverings (3.6) can provide a level of
protection for the user in addition to their primary purpose as a public health measure to control the spread of
transmission and infection.

Note 3 to entry: In many countries, PPE is required to conform to national regulations.

[SOURCE: ISO 15384:2018, 3.12, modified — “or held” have been deleted after “worn” and “their” has
been added before “protection” in the definition, and Notes 1, 2 and 3 to entry have been added.]
3.6
face covering
facepiece that covers the mouth, nose and chin
EXAMPLE ‘community masks’, ‘hygiene masks’, ‘barrier masks’, and ‘comfort masks’ are all examples of face
coverings.

Note 1 to entry: Face coverings in the context of this document are not considered to be personal protective
equipment (PPE) (3.5) or a medical device.

3.7
well-being
fulfilment of the physical, mental and cognitive needs and expectations of a worker related to their
work
Note 1 to entry: Well-being can also contribute to the quality of life outside of work.

Note 2 to entry: Well-being relates to all aspects of working life, including work organization, social factors at
work, work environment, equipment and hazardous tasks.

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[SOURCE: ISO 45003:2021, 3.2, modified — “at work” has been deleted after “well-being” from the term
and Notes 1 and 2 to entry have been added.]
3.8
common area
space and amenity provided for the use of more than one person
EXAMPLE Canteens, lifts/elevators, stairs, reception areas, meeting rooms, areas of worship, toilets,
gardens, fire escapes, kitchens, fitness facilities, store rooms, laundry facilities.

Note 1 to entry: Common areas can include spaces and amenities used by more than one organization.

Note 2 to entry: Common areas can include spaces and amenities where people are working.

[SOURCE: ISO/PAS 45005:2020, 3.11, modified — the term "common areas" has been changed to
"common area", "spaces and amenities" has been changed to "space and amenity" in the definition, and
Notes 1 and 2 to entry have been added.]
3.9
infectious disease
condition caused by agents such as bacteria, viruses, prion, parasites or fungi that can spread, directly
or indirectly, and that can result in ill-health
Note 1 to entry: In this document, “infectious disease” refers to a disease that:

— presents a risk of severe ill health or death and can impact the health, safety and well-being (3.7) of workers
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and other relevant interested parties;

— presents a lower risk to health yet have a significant impact on the organization, its workers and other
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relevant interested parties.

3.10
contagious disease ISO/FDIS 45006
infectious disease (3.9) that can be transmitted from person to person
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EXAMPLE 7d84b012a923/iso-fdis-45006
Influenza, Ebola, hepatitis.

3.11
outbreak
increase in cases of an infectious disease (3.9) in excess of what is normally expected in a particular
location, community or geographical region in a specified time period
Note 1 to entry: An outbreak can affect a small and localized group or multiple groups and places and can result
in an epidemic (3.12) or pandemic (3.13).

Note 2 to entry: Two linked cases of an infectious disease can be sufficient to constitute an outbreak.

3.12
epidemic
large number of cases of a particular infectious disease (3.9), occurring at the same time in a community
or geographic region
[SOURCE: ISO 28901:2011, 3.6 modified — “infectious” has been added before “disease”, “usually
infectious” has been deleted, “particular community” has been replaced with “community or geographic
region” in the definition.]
3.13
pandemic
worldwide spread of an infectious disease (3.9)
Note 1 to entry: A pandemic is declared by the World Health Organization (WHO).

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ISO/FDIS 45006:2023(E)

[SOURCE: ISO/PAS 45005:2020, 3.5, modified — “infectious” added before “disease” and Note 1 to entry
has been added.]
3.14
endemic infectious disease
infectious disease (3.9) either constantly present or usually prevalent in a particular geographic region

4 Context of the organization

4.1 General
The organization should acquire and maintain awareness of known and emerging infectious diseases
that can, or are likely to, significantly affect the organization or its activities.
The organization should determine external and internal issues and consider:
a) the specific hazards and related risks from infectious diseases to workers and other interested
parties who can be affected by the organization’s activities (e.g. visitors, customers, clients, service
users, the public) (see 8.1, 8.2 and 8.3);
b) if changes should be made to its operations to address the risks (see 8.4);
c) how workers can be supported to work safely (see Clauses 11 to 17).
NOTE 1
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Infectious diseases can vary in occurrence, impact and severity depending on country or region.

NOTE 2 Appropriate controls can vary depending on country or region.

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4.2 External issues
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When determining external issues, the organization 45006
should consider:
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a) emergence and/or prevalence of infectious disease within the local community (including in other
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organizations and other workplaces);
b) local, regional, national and international circumstances and related legal requirements and other
requirements, and guidance (e.g. likelihood of infectious diseases being transmitted through
people, products or services moving from one place to another);
c) availability of clinical services, testing, treatments and vaccines;
d) availability of health, safety and other supplies (e.g. PPE, face coverings, hand sanitizers,
thermometers, cleaning and disinfection materials);
e) potential changes or problems in the supply chain;
f) the modes of transport workers use to travel to and from work (e.g. public transport, car, bicycle,
walking, shared transport);
g) workers travelling into regions with an endemic infectious disease or an outbreak of an infectious
disease;
h) workers' access to childcare and schooling for their children;
i) suitability of worker’s home for remote working;
j) workers’ domestic situations (e.g. living with someone who is at higher risk of contracting or
getting severely ill from infectious diseases);
k) continuity of essential services (e.g. food provision, domestic infrastructure, utilities);

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l) changes in the needs and expectations, or behaviours of relevant interested parties;

m) local culture and cultural behaviours (e.g. kissing, hugging, shaking hands);
n) increased or decreased demand for the organization’s products/services.

4.3 Internal issues

4.3.1 General

When determining internal issues, the organization should consider:

a) prevalence or likelihood of an infectious disease in the organization;
b) sources of infectious agents in the workplace that can result in an infectious disease
c) ability of the organization to gain up-to-date knowledge about infectious diseases;
d) type of organization and related activities (e.g. primary production, processing, manufacturing,
services, retail, social care, training or other education, delivery or distribution);
e) number, locations and types of workplaces potentially affected (e.g. offices, factories, workshops,
warehouses, water treatment plants, vehicles, retail outlets, workers’ own homes or other people’s
homes);
f)
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how work is organized (e.g. changed work demands, pace of work, time pressure, shift work, travel
requirements) and how this impacts workers’ health, safety and well-being;
g) (standards.iteh.ai)
resource availability (e.g. operational, health and safety, hygiene);
h) cultural values within the organization that can affect risk controls;
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i) the relationship between workers and the organization (e.g. employed, contractors, volunteers,
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freelance, part-time, shift workers, remote workers);
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j) specific needs of workers considered to be at higher risk for contracting or getting severely ill from
an infectious disease (e.g. workers with underlying health conditions);
k) specific needs of diverse workers (see 4.3.2);
l) language barriers and communication issues;
m) the extent to which it is possible to implement specific infection controls in a workplace or in
relation to work activities or ways of working;
n) increased worker absence (e.g. due to illness, self-isolation or quarantine requirements,
bereavement).

4.3.2 Diversity of workers and other relevant interested parties

The organization should take into account the full diversity of its workers and other relevant interested
parties when determining internal issues (see 4.3.1) relating to preventing and managing infectious
diseases. The organization should consider that individual workers and other relevant interested
parties have different needs, based on their characteristics and personal circumstances, such as:
a) gender-specific needs, including those of women;
b) pregnancy, or recently given birth;
c) those caring for, or living with vulnerable individuals (e.g. infants, immunocompromised family
members);

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d) age, taking into account both older and younger workers;

e) disabilities;
f) ethnicity, culture and faith;
g) those with underlying health conditions (e.g. immunocompromised, asthmatics).
NOTE 1 Disabilities can affect the suitability of controls for infectious diseases, including accessibility to
buildings, facilities, equipment or services. Disabilities include physical and mental impairment. People with a
disability can include wheelchair users, those with mobility, hearing or sight impairment, or with a condition or
illness that has an impact on their mental capacity.

NOTE 2 Many people have disabilities or vulnerabilities to infectious diseases, or specific needs which are not
immediately apparent (e.g. people with diabetes, respiratory conditions, heart conditions, hearing impairment).

5 Characteristics of infectious diseases

As part of the assessment of risks, the organization should take into account the characteristics of
infectious diseases that are likely to impact workers and other interested parties, so that suitable
controls can be determined (see Clause 8). Characteristics of an infectious disease include:
a) virulence of the infectious agent causing the disease;
b) likelihood of transmission;
c) incubation period;iTeh STANDARD PREVIEW
d) time frame during which people(standards.iteh.ai)
can transmit a contagious disease;
e) length of time an infectious agent remains infectious on contaminated objects or materials;
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symptoms related to the infectious disease;
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g) potential severity of illnesses (see Table A.1);
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h) sources and modes of transmission, including:
1) an infectious agent carried by another person that is spread through skin-to-skin contact,
biological waste, or exchange of bodily fluids (e.g. personal care hazards, sexual interaction);
2) animals or insects that are infected with or carry an infectious agent (e.g. through touch,
stings, or bites);
3) contaminated environmental sources (e.g. through water or air);
4) inhalation (e.g. mould spores, inhalation of bodily fluids from coughing);
5) ingestion (e.g. through eating contaminated food);
6) skin puncture (e.g. injections, wounds);
7) contact with a contaminated surface or object (e.g. used needles, door handles).
The organization should seek advice from:
— trusted bodies (e.g. public health authorities, disease control centres, the World Health Organization,
the International Labour Organization);
— specialists (e.g. epidemiologists, infectious disease physicians, occupational health specialists and
hygienists, public health practitioners, other infectious disease experts).

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The organization should be aware that information about emerging diseases changes over time.
NOTE Some people who are infected do not show symptoms but can transmit the disease.

6 ​Leadership and worker participation

6.1 ​Leadership
Top management, and managers at all levels should demonstrate leadership to effectively manage risks
to workers and other relevant interested parties arising from infectious diseases that are, or can be, in
the workplace.
Top management should communicate to workers and other interested parties:
— how concerns about, or incidences of, infectious diseases should be reported;
— the organization’s commitment to transparency when managing infectious diseases;
— actions to take if a person has, or suspects they have, contracted an infectious disease;
— actions the organization will take to support workers and other relevant interested parties when
there is an outbreak of an infectious disease or an infectious disease incident;
— support for workers to remove themselves from work situations believed to present an imminent or

iTeh STANDARD PREVIEW

serious risk to life or health.
When an infectious disease is known to be, or can be, an issue, top management should:
a) (standards.iteh.ai)
provide adequate resources (see Clause 10) and make them available in a timely and effective
manner;
ISO/FDISof45006
b) consult with, and encourage, participation workers and worker representatives, where they
https://standards.iteh.ai/catalog/standards/sist/8f9d6b66-2eba-4e21-bf7d-
exist, in making decisions that affect work-related health, safety and well-being (see 6.2);
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c) provide appropriate support for workers unable to work, including provision of appropriate
leave from work, paid if possible (so that concerns about pay do not lead to workers coming to a
workplace when they are unwell or potentially contagious);
d) protect workers from reprisals when reporting potential cases of illness or incidents;
e) coordinate across all parts of the organization when implementing measures to manage the risks
to workers and other relevant interested parties related to infectious diseases;
f) ensure the health and safety of workers in workplaces not under the control of the organization
(e.g. at home, in other people’s homes, workers in a mobile role, other locations) are taken into
account;
g) seek advice and information from competent and trusted bodies, specialists and sources on
managing risks to workers and other relevant interested parties, when necessary;
h) implement processes for returning to work and rehabilitation.
Managers at all levels should ensure workers have been instructed on what to do in relation to exposure
to an infectious agent (e.g. seeking medical or psychological advice) and support workers to take
appropriate actions.

6.2 Consultation and participation of workers

The organization should consult workers and encourage their participation as appropriate to facilitate
better understanding of infectious agents that can impact the organization as well as other hazards and
risks related to infectious diseases and health outcomes.

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