An organisation where much of the workforce is required to be in the workplace, and where many staff are in public-facing roles, makes a full assessment of whether an asymptomatic Covid-19 testing programme could reduce risk of infection and contribute to improved safety for colleagues and clients. It considers how likely it is that it can reasonably achieve these aims given current pandemic conditions, the available technologies, and its ability to deliver a programme in full.

An organisation identifies all the components that need to be in place for the programme to work well. It makes an assessment of the costs, opportunity costs (e.g. things it can’t do because it is doing the programme), risks and possible unwanted consequences of the programme. It considers the available evidence on testing programmes, current pandemic conditions, its own business needs, its ability to commit resources, and the willingness and ability of the workforce to participate. It is confident that isolation of cases that test positive can be achieved. It concludes that running a testing programme is a justifiable addition to its multi-modal approach to ensuring a safer workplace.

A different organisation, having reviewed the resources required to deliver all elements of a testing programme effectively, determines that it lacks the financial and logistical capabilities to run a sufficiently quality-assured and effective programme. It therefore decides not to proceed with a testing programme.

An organisation that has decided to proceed with a testing programme organisation creates a sound governance structure. It identifies key responsibilities and accountabilities in the programme team, a clear decision-making structure, and a resources plan. The programme team has operational strengths and sound understanding of the science and ethics of testing, and is aware of the public health and legal responsibilities associated with testing. The team designs a holistic, end-to-end programme. The organisation designs and implements appropriate quality assurance mechanisms. It is alert to public health guidance and government policy as it changes over time, and makes appropriate adjustments to its programme.

An organisation running a testing programme models a number of scenarios and puts plans in place to cope with them, for example to address business continuity in situations where large numbers of staff test positive.

An organisation that has decided to run testing programme conceptualises it as a duty of care to staff and clients and as a benefit to staff and the community. It presents the programme to its stakeholders in this way, with the aim of engendering trust, solidarity and a sense of mutual responsibility. The organisation also identifies any factors which might undermine trust (e.g. treating some groups unfairly, communication failures, poor logistics, lack of support for isolation) and takes steps to address these issues.

An organisation defines the goals of its asymptomatic testing programme as improved workplace safety for all colleagues and fulfilling duties of care to client groups. Secondary goals include delivering broader public health benefits and providing reassurance for staff and clients. The organisation is clear about the underlying rationale for why these goals might be achievable: detecting asymptomatic infection enables isolation of positive cases and close contacts, and therefore reduces onward transmission. It also acknowledges the current uncertainties associated with demonstrating whether the programme can deliver on its goals.

An organisation communicates that the wellbeing and safety of staff and clients is the primary motivation for the programme. It clarifies the scope of the programme, explaining that the programme is intended to identify positive cases who can then isolate to disrupt viral transmission. Following feedback from staff, it reaffirms that it is not using negative tests as a way of forcing people to come to the workplace when they could reasonably work from home for the present.

An organisation specifies that it will judge the effectiveness of the programme using criteria relating to: participation rates, positivity rates (percentage of people tested who are positive), outbreaks, cost-effectiveness, and staff satisfaction (measured by surveys). It acknowledges influences outside its own scope of control, such as community prevalence. It monitors effectiveness over time. It keeps its programme under review as conditions, technology, policy, guidance, and scientific understanding, and staff views evolve. It clearly signals any changes to all stakeholders.

An organisation plans regular reviews to check that the purposes being served by the programme are still valid and relevant to need, and to ensure that goal drift has not occurred (such as, for example, using data from the programme as a means of surveillance of productivity or attendance).

An organisation makes a full assessment of the available testing options. It considers validity and reliability, convenience and speed of administration and test result, tolerability of the test for staff, costs, logistical burden and test certification.

An organisation takes steps to ensure that swabbing is done correctly. It reassures staff that there is only mild physical discomfort associated with a nasal swab. It posts a video showing the correct technique for self-swabbing on its website, with voiceovers led by staff themselves, and emphasises that support is available should the test outcome trigger self-isolation. The organisation acknowledges the possibility that some people might experience anxiety about taking the test, about the results of the test, or about the impacts that test results could have for people and their households. It ensures that these concerns are not trivialised. It provides opportunities for staff to talk to people who have already had the test to answer any questions.

One organisation, having reviewed the latest government advice and other sources, selects lateral flow testing (LFT) as its testing approach. It checks that the system has been certified for the purposes for which the organisation is planning to use it. It recognises the limitations of the currently available form of the technology, including the risk that its poor sensitivity could generate high false negative rates (people testing negative for Covid-19 even though they have it). Accordingly, the organisation emphasises in all communications that, for the present, the main goal of the programme is to detect positive cases in asymptomatic individuals. It stresses that the programme does not provide evidence of non-infection, and that negative results should not be used to support relaxation of compliance with social distancing, face coverings, or hygiene rules.

A different organisation also conducts a full assessment of the available testing options. It decides to use PCR testing, and contracts with an external laboratory to provide the facilities needed. It ensures that the lab is certified appropriately for the tests, so it meets the required legal standards.

An organisation reminds its staff of current national guidelines regarding whether it is possible to return to work after close contact with a confirmed case of Covid-19 on the basis of a negative test.

An organisation considers the probability of false positives associated with its chosen testing regime. It notes that in the event of a false positive, a staff member and their close contacts will be erroneously required to isolate. To mitigate this risk, it offers swift confirmatory testing.

An organisation discovers that an unintended consequence of the programme is that those who test negative may engage in more risk-taking behaviour. In response, it explicitly communicates that a negative test result means an individual “has tested negative, but could still be infected with the virus”. It informs staff that the asymptomatic testing program is “one tool in a multi-component risk reduction strategy”. It increases its communication about distancing, face-covering, hygiene, and other infection control measures.

An organisation emphasises to staff that they must self-isolate if they test positive or have had close contact with a positive case. It assesses what is needed to support this. It is aware of worries and concerns staff may have when self-isolating (e.g. anxiety, loneliness, limited access to food shopping and exercise, difficulties related to caring responsibilities, and impact on household members who may also have to isolate as close contacts). The organisation makes sure that isolating staff receive paid leave and practical support where needed. It makes mental health support resources available. Using a clear process, it offers additional financial assistance for staff who might otherwise struggle (e.g. because they or their household members are on zero hours contracts).

An organisation communicates clearly with its staff about what to do if they receive a positive result, what support is available if they must isolate, how they can access it. Communication is intended to address concerns and alleviate anxiety around the possibility of having to isolate; the organisation is attentive to feedback from staff about the experience of isolating, and demonstrates that it is acting on it to reduce the burdens of isolation.

An organisation offers individual staff the choice of whether to participate in the testing programme or not, supported by clear communication surrounding the potential benefits of the programme (including the shared benefits of health protection and community solidarity). Following complaints from some staff about having to share workspace with untested colleagues, and organisation decides to reiterate the principle that participation in testing is voluntary at an individual level, but makes it clear that it strongly encourages staff to participate for the safety of others unless they have good reasons not to participate. It commits to keeping the policy under review if new evidence emergences.

A different organisation makes it clear that its expectation is that all staff will participate in the programme, but it provides a formal process for individuals to apply to be exempted from participation. Its communication focuses on the need for solidarity and collegiality in reducing viral transmission, the shared benefits of reduced risk, and averting unfairness. It reiterates its commitment to equality, diversity and inclusion.

Following consultation with staff representatives, another organisation decides to mandate the programme for all staff who will work on its premises. It assessed that making it voluntary could lead to the programme goals being undermined (reduced ability to disrupt transmission through identification and isolation of positive cases), could potentially lead to unfairness across different staff groups, and could be a source of tension between colleagues. The organisation explains that it will consider carefully any concerns as part of its programme’s governance mechanisms. It provides a formal process through which individuals can apply to be exempted from participation (e.g. medical or religious reasons).

An organisation, following consultation, concludes that offering small incentives (e.g. free coffee for taking part) to encourage participation would be acceptable. It monitors for any unintended consequences, such as the perception that offering either excessively trivial or unduly large rewards could undermine a programme built on community spirit.

An organisation considers the possible benefits and harms of the programme and explicitly considers equity, diversity and inclusion in their distribution. It identifies that those on low incomes or pre-existing mental health conditions may be disproportionately disadvantaged by isolation. It also identifies that some appear to be experiencing stigma and discrimination in relation non-participation in the programme. The organisation puts appropriate measures in place to address these challenges, including reminders that some people have legitimate reasons not to participate, a hardship fund for staff facing particular difficulties, reduced productivity expectations, and paid leave.

An organisation examines costs and benefits of the programme. It considers alternative uses to which the resources might be put, and decides that the programme is a justified expenditure for now because of the potential reduce transmission of COVID-19 for staff, clients and the community, while also facilitating business continuity. The organisation reviews this assessment at key points, for example when costs increase or benefits appear to decrease.

An organisation, through its governance mechanisms, makes clear and explicit the rationale underlying its decisions and acknowledges that not everyone will agree with all of them. It uses consultation where appropriate to engage with diverse views and ensure that they have been taken into account.

A large organisation conducts a data protection impact assessment for its testing programme. It establishes clear workflows for handling data at every stage, and ensuring full compliance with the principles specified in the General Data Protection Regulation. Data is pseudonymised or anonymised where possible. The organisation establishes a secure system where test data are stored in a protected space with access limited to dedicated testing programme managers. It trains individuals handling data, ensuring that they are aware that data concerning health is confidential: it can only be used with the individual’s consent or where it is necessary and proportionate to protect public safety and the health and safety of other people. The organisation issues a privacy notice with information on sharing of personal data.

An organisation develops a clear workflow for notifying public health authorities of confirmed positive tests, making it clear to staff that this will activate contact tracing.

An organisation makes sure test results from the laboratory it has commissioned for its programme is feeding the results through to its country’s established public health channels.

An organisation specifies that those who are deemed close contacts by virtue of sharing the same environment in the workplace will be notified that there has been a positive test, but not the name of the individual who has tested positive. It acknowledges that people may be able to work out who has tested positive, but also says it is taking all possible steps to protect confidentiality so, for example, will not confirm “guesses”.

An organisation seeks the consent of staff for their test results to be used for scientific purposes, and obtains the proper approvals to enable use for research purposes. Those who decline consent for this purpose are reassured that there will be no detriment to them.

An organisation develops a sound communications plan for the programme. It understands that staff need clear information about a range of topics surrounding a testing programme, but is also attentive to the need to avoid information overload. It designs concise brochures, posters, website and emails, using appropriate language and images that are accessibility-compliant and respectful of diversity. It offers clear signposting to more detailed information. It emphasises consistently the importance of isolation in response to a positive test. In all communication, the organisation strongly emphasises the need for all measures for reducing infection risk, stressing that testing is just one of these.

An organisation identifies email is an efficient and acceptable way of communicating with staff about the programme. It supplements email communication with other resources, including a dedicated and regularly updated programme website. Links are provided to brief videos showing how to administer nasal swabs and other advice about the programme, featuring staff from diverse backgrounds.

An organisation becomes aware of the possibility of stigma linked to testing positive (for example owing to a perception that it reflects reckless or selfish behaviour). In an effort to address this, it emphasises someone can test positive even if they have tried their best to follow guidelines.

An organisation regularly releases statements outlining how it has been collecting feedback from stakeholders on the programme, outlining what changes, if any, it has made in response.