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Highest Risk Settings

Highest risk settings include:

  • Acute care settings such as hospitals, including complex continuing care facilities
  • Congregate living settings with medically and socially vulnerable individuals, including but not limited to long-term care homes, retirement homes, First Nation elder care lodges, group homes, shelters, hospices, correctional institutions, and hospital schools
  • Employer-provided living settings of International Agricultural Workers


The aforementioned highest-risk settings should notify their local PHU when they have a suspected or confirmed outbreak, as defined by relevant MOH guidance for their sector. Highest risk settings that are institutions or public hospitals must report suspect and confirmed outbreaks to their local PHU as per the Health Protection and Promotion Act.


Note: Long-Term Care, retirement homes, and congregate living settings should contact their HNHU investigator with any questions or concerns regarding COVID-19 or other infectious diseases by calling 519-426-6170 or emailing [email protected]

Provincial Guidance Documents
Important Memos and Resources from HNHU for Highest Risk Settings
COVID-19 Line List Templates



Managing COVID-19 in Highest Risk Settings


Who is eligible for PCR testing in highest-risk settings?


  • Symptomatic staff, volunteers, residents/inpatients, essential care providers, and visitors in highest-risk settings 
  • Symptomatic household members of workers in highest-risk settings 
  • People in the context of confirmed or suspected outbreaks in highest-risk settings as directed by the local public health unit. 
  • Asymptomatic testing in hospitals, long-term care, retirement homes and other congregate living settings and institutions will also be available as per provincial guidance and/or Directives, or as directed by Haldimand Norfolk Health Unit. 


Visit HNHU’s testing webpage here

I work/volunteer in a highest-risk setting and have symptoms. What should I do?


  • For routine operations, COVID-19-positive cases that work in highest-risk settings may return to work if they have no fever and other symptoms have been improving for 24 hours (or 48 hours if vomiting/diarrhea) AND meet at least one of the following criteria:


  1.  10 days after symptom onset or date of specimen collection (whichever is earlier) OR
  2. After a single negative molecular test any time prior to 10 days from the date of specimen collection or symptom onset (whichever is earlier) OR
  3. After two consecutive negative rapid antigen tests that are collected at least 24 hours apart any time prior to 10 days from the date of specimen collection or symptom onset (whichever is earlier).


NOTE: Testing for clearance is NOT recommended. For settings that are using testing to support a return to work, staff may routinely return to work earlier than day 10 if criteria 2 or 3 are met.


For Critical Staffing Shortages — COVID-19 Positive staff may return to work earlier with adherence to Workplace Measures for Reducing Risk of Exposure in place, and making organizational decisions with the following principles for reducing the risk of spread:


  1. Staff must be afebrile and their symptoms have been improving for 24 hours (48 hours if vomiting/diarrhea).
  2. While there is no specific minimum time prior to returning to work, staff who are closer to day 10 from their symptom onset date/specimen collection date should be prioritized for early return to work ahead of staff closer to their symptom onset/specimen collection date (for staff who do not meet test-based criteria in Section 9.1).
  3. Staff who have never had symptoms should be prioritized ahead of staff who have been symptomatic.
  4. Assignment of staff on early return to work should be prioritized to caring for COVID-19-positive/recovered patients/residents, if possible. With appropriate IPAC oversight, staff on early return to work may be assigned to care for all patients/residents (including COVID-19 negative patients/residents), with strict adherence to workplace measures for reducing risk of transmission, and avoiding caring for patients/residents at highest risk of severe COVID-19 infection, where possible.


I work in a highest-risk setting and my household member tested positive/has symptoms OR I work in a highest-risk setting and I am a close contact with someone (not in my household). What should I do?



  • You should self-monitor for symptoms for a total of 10 days after the last exposure to the COVID-19 positive case or individual with COVID-19 symptoms.
  • You may attend the highest risk setting right away following the guidance below.
  • Where feasible, additional workplace measures may include:
    • obtaining an immediate PCR or rapid molecular test, and re-testing at day 5 from initial exposure if initial test was negative if in an ongoing exposure
    • For an isolated (one-time) high-risk exposure obtain PCR or rapid molecular testing at day 5 from initial exposure
  • Testing with rapid antigen testing for 10 days may be recommended (as an alternative to PCR/molecular testing and/or in addition to PCR/molecular testing) based on setting specific IPAC and/or Occupational Health direction.
  • Where testing is recommended, individuals may continue to attend the highest risk setting even if test results are pending or if testing was not obtained, unless otherwise directed by their IPAC/Occupational health lead.
  • Actively screen for symptoms ahead of each shift.
  • Do not remove your mask when in the presence of other staff to reduce exposure to co-workers (i.e., not eating meals/drinking in a shared space such as conference room or lunch room).
  • Work in only one facility, where possible. · Ensure well-fitting source control masks to reduce the risk of transmission (e.g., a well-fitting medical mask or fit or non-fit tested N95 respirator or KN95).
  • If you develop symptoms of COVID-19 you should self-isolate immediately and seek testing if eligible.


I work in a highest-risk setting and I tested positive for COVID-19. What should I do?


  • After a positive result with a PCR test, you will receive a text message from HNHU.  
  • Inform your employer.   
  • You may return to work 10 days after symptom onset or the date of specimen collection (whichever is earlier) 
  • You must not have a fever and other symptoms that have been improving for 24 hours (or 48 hours if gastrointestinal symptoms) before leaving isolation. 




Last updated 05/30/2023