ML20272A110

DNFSB-20-A-08-Audit of the Dnfsb COVID-19 RE-Entry Plan Dated September 25, 2020

ML20272A110
Person / Time
Issue date:	09/25/2020
From:	Baker B NRC/OIG/AIGA
To:	Sklar G Defense Nuclear Facilities Safety Board
References
DNFSB-20-A-08
Download: ML20272A110 (20)

Text

Audit of the DNFSB COVID-19 Re-Entry Plan DNFSB-20-A-08 September 25, 2020 All publicly available OIG reports (including this report) are accessible through NRCs website at http://www.nrc.gov/reading-rm/doc-collections/insp-gen

DEFENSE NUCLEAR FACILITIES SAFETY BOARD WASHINGTON, D.C. 20004-2901 OFFICE OF THE INSPECTOR GENERAL September 25, 2020 MEMORANDUM TO:

Glenn Sklar General Manager FROM:

Dr. Brett M. Baker /RA/

Assistant Inspector General for Audits

SUBJECT:

AUDIT OF THE DNFSB COVID-19 RE-ENTRY PLAN (DNFSB-20-A-08)

Attached is the Office of the Inspector Generals (OIG) audit report titled Audit of the DNFSB COVID-19 Re-Entry Plan.

The report presents the results of the subject audit. Following the September 14, 2020, exit conference, the DNFSB staff indicated that they had no formal comments for inclusion in this report.

Please provide information on actions taken or planned on the recommendation within 30 days of the date of this memorandum.

We appreciate the cooperation extended to us by members of your staff during the audit. If you have any questions or comments about our report, please contact me at (301) 415-5915 or Vicki Foster, Team Leader, at (301) 415-5909.

Attachment:

As stated cc:

R. Howard, DNFSB

Office of the Inspector General U.S. Nuclear Regulatory Commission Defense Nuclear Facilities Safety Board Results in Brief Audit of the DNFSB COVID-19 Re-Entry Plan What We Found The OIG found that the DNFSBs plan for returning employees to work was not prepared in full accordance with government-wide guidance and agreed-upon best practices for safe, healthy, and effective office re-openings.

Federal guidance requires agencies to develop plans to protect the health and safety of employees and support a phased return to normal work operations. However, the DNFSB re-entry email communications and the DNFSB COOP for COVID-19 Pandemic Response do not sufficiently address 11 of 16 federal government-wide guidance and agreed-upon best practices for re-entry plans.

This occurred because the Board did not approve the Request for Board Action by a Board Member to draft a re-entry plan. Without a re-entry plan that complies with federal guidance, the DNFSB may not be able to adequately ensure the safety, health, and well-being of its employees.

What We Recommend This report makes one recommendation to develop and implement an employee re-entry plan that is in accordance with federal guidance and best practices.

During an exit conference on September 14, 2020, agency management indicated their general agreement with the finding and recommendation in this report. Subsequently, the DNFSB provided the OIG with UC-2020-025, DNFSB Pandemic Response and Recovery Plan, Revision 0, September 14, 2020.

Why We Did This Review Coronavirus Disease-2019 (COVID-

19) is a highly contagious respiratory disease caused by the SARS-CoV-2 virus that results in illness levels ranging from mild to severe and, in some cases, can be fatal. Symptoms of COVID-19 typically include fever, cough, and shortness of breath. The United States (U.S.) Department of Health and Human Services declared a Public Health Emergency on January 31, 2020, in response to the rising number of COVID-19 cases. On March 11, 2020, the COVID-19 outbreak was characterized as a pandemic by the World Health Organization. The U.S. Defense Nuclear Facilities Safety Board (DNFSB), as did the federal government, subsequently took steps to contain the spread of COVID-19 among its workforce.

On June 15th, 2020, the Inspector General for the DNFSB and the Nuclear Regulatory Commission (NRC) received a letter from the Chairman of the Subcommittee on Government Operations, House Government Oversight and Reform Committee that requested the examination of the plans and procedures for returning employees to federal offices in the wake of the coronavirus pandemic.

Thus, the audit objective was to determine if the DNFSBs plan for returning employees to government facilities was prepared in accordance with government-wide guidance and agreed-upon best practices for safe, healthy, and effective office re-openings.

OIG-20-A-08 September 25, 2020

Audit of the DNFSB COVID-19 Re-Entry Plan ABBREVIATIONS AND ACRONYMS.......................................................... i I. BACKGROUND................................................................................ 1 II. OBJECTIVE...................................................................................... 3 III. FINDING.......................................................................................... 3 The DNFSBs Plan Did Not Fully Address Guidance and Best Practices....................................................................... 3 Recommendation....................................................................... 8 IV. AGENCY COMMENTS..................................................................... 9 APPENDICES A. OBJECTIVE, SCOPE, AND METHODOLOGY............................... 10 B. CROSSWALK BETWEEN REQUIREMENTS AND THE DNFSBS ACTIONS....................................................... 12 TO REPORT FRAUD, WASTE, OR ABUSE............................................. 15 COMMENTS AND SUGGESTIONS.......................................................... 15 TABLE OF CONTENTS

Audit of the DNFSB COVID-19 Re-Entry Plan i

CDC Centers for Disease Control and Prevention COVID-19 Coronavirus Disease-2019 DNFSB Defense Nuclear Facilities Safety Board DNFSB COOP DNFSB Continuity of Operations Plan NATIONAL GUIDELINES National Guidelines for Opening Up America Again NRC Nuclear Regulatory Commission OIG Office of the Inspector General OMB Office of Management and Budget OPM Office of Personnel Management OSHA Occupational Safety and Health Administration UC Unanimous Consent U.S.

United States ABBREVIATIONS AND ACRONYMS

Audit of the DNFSB COVID-19 Re-Entry Plan 1

The U.S. DNFSB continues to fulfill its mission1 as it deals with a pandemic that has affected millions of people worldwide. COVID-19 is a highly contagious respiratory disease caused by the SARS-CoV-2 virus that results in illness levels ranging from mild to severe and, in some cases, can be fatal. Symptoms of COVID-19 typically include fever, cough, and shortness of breath. The U.S. Department of Health and Human Services declared a Public Health Emergency on January 31, 2020, in response to the rising number of COVID-19 cases. On March 11, 2020, the COVID-19 outbreak was characterized as a pandemic by the World Health Organization. The DNFSB, as did the federal government, subsequently took steps to contain the spread of COVID-19 among its workforce including implementation of maximum telework, workplace flexibilities, and provision of disinfecting wipes, masks and gloves to employees at the office.

The DNFSB headquarters building is located in Washington, D.C. where over 11,427 residents have tested positive for COVID-19 and tragically 580 residents have lost their lives due to COVID-19.2 The DNFSB headquarters is in a multi-tenant building leased through the U.S. General Services Administration. The other tenants include the U.S. Department of Justice Daycare, the United States Court of Appeals for Veterans Claims, and the Office of the Federal Public Defender.

On July 22, 2020, the Mayor of Washington D.C. signed an Order to consolidate, clarify, and extend requirements related to wearing masks indoors and outdoors in Washington D.C. and provided additional mechanisms for re-opening buildings located in Washington D.C.

1 The DNFSB mission is to provide independent analysis, advice, and recommendations to the Secretary of Energy to inform the Secretary in his/her role as operator and regulator of the defense nuclear facilities of the Department of Energy. These recommendations aide the Secretary in providing adequate protection of public health and safety at such defense nuclear facilities, including with respect to the health and safety of employees and contractors at such facilities.

2 As of July 22, 2020.

I. BACKGROUND

Audit of the DNFSB COVID-19 Re-Entry Plan 2

The DNFSB consists of approximately 100 employees. The decision-making body of the Board is legislated to be composed of five Members appointed by the President and confirmed by the Senate. As of August 17, 2020, the DNFSB organizational structure was comprised of four Board Members, including the Chairman, in addition to the General Counsel, the Technical Director, and the General Manager. In September 2020, a newly-appointed Board Member became the Acting Chairman.

On March 13, 2020, the DNFSB activated the DNFSB Continuity of Operations Plan (DNFSB COOP), dated February 2019. The DNFSB COOP designates to the DNFSB Chairman the responsibility for providing overall decision authority and ordering the implementation of the DNFSB COOP.

The former DNFSB Chairman updated the DNFSB employees weekly from March 13, 2020 to August 4, 2020 through email communication and attached the DNFSB COOP for COVID-19 Pandemic Response, as revised per the Chairman. The former DNFSB Chairmans initial email communications and the DNFSB COOP for COVID-19 Pandemic Response encouraged the DNFSB employees to telework during core duty hours, with the exception of essential staff, including information technology, front desk staff, and the leadership team. The resident inspectors were directed by the former Chairman to follow U.S.

Department of Energy guidance for their assigned sites.3 Subsequently, in the communications for the weeks of June 15 and June 29, 2020, the former Chairman directed Office Directors, Deputy Directors, Associate Directors, the leadership team, and a small support staff to return to work at the DNFSB headquarters building two days per week.

On June 15th, 2020, the Inspector General for the DNFSB and the NRC received a letter from the Chairman of the Subcommittee on Government Operations, House Government Oversight and Reform Committee that requested the examination of the plans and procedures for returning employees to federal offices in the wake of the coronavirus pandemic.

3 The DNFSB resident inspectors relocate to the Department of Energy sites with defense nuclear facilities and perform direct oversight of the safety of operations and advise on the overall safety conditions at defense nuclear facilities.

Audit of the DNFSB COVID-19 Re-Entry Plan 3

The audit objective was to determine if the DNFSBs plan for returning employees to government facilities was prepared in accordance with government-wide guidance and agreed-upon best practices for safe, healthy, and effective office re-openings. The report appendix contains information on the audit scope and methodology.

The OIG found that the DNFSBs plan for returning employees to work was not prepared in full accordance with government-wide guidance and agreed-upon best practices for safe, healthy, and effective office re-openings.

The DNFSBs Plan Did Not Fully Address Guidance and Best Practices Federal guidance requires agencies to develop plans to protect the health and safety of employees and support a phased return to normal work operations. However, the DNFSB re-entry email communications and the DNFSB COOP for COVID-19 Pandemic Response do not sufficiently address 11 of 16 federal government-wide guidance and agreed-upon best practices for re-entry plans. This occurred because the Board did not approve the Request for Board Action by a Board Member to draft a re-entry plan. Without a re-entry plan that complies with federal guidance, the DNFSB may not be able to adequately ensure the safety, health, and well-being of its employees.

II. OBJECTIVE III. FINDING

Audit of the DNFSB COVID-19 Re-Entry Plan 4

Federal Requirements and Guidance Federal guidance requires agencies to develop plans to protect the health and safety of employees and support a phased return to normal work operations. These requirements are stipulated in the following documents:

White House--National Guidelines for Opening up America Again On April 16, 2020, the President of the United States issued the National Guidelines for Opening Up America Again (hereafter, National Guidelines) describing the data-driven gating criteria to be met before a region or state proceeds to a phased approach for gradually resuming operations. In addition, the National Guidelines offer guidance based on U.S. Centers for Disease Control and Prevention (CDC) information and the advice of public health experts on topics such as the need for individuals to maintain social distancing.

The Office of Management and Budget (OMB)/The Office of Personnel Management (OPM)--Memorandum M-20-23, Aligning Federal Agency Operations with the National Guidelines for Opening Up America Again The OMB/OPM Memorandum M-20-23, Aligning Federal Agency Operations with the National Guidelines for Opening Up America Again establishes near-to mid-term processes to align federal agency operations to the National Guidelines. The OMB/OPM Memorandum M-20-23 parallels the National Guidelines by supporting the transition of federal government operations back to a normal state. The memorandum also supports maintaining practices which have proven successful in fighting the virus and calibrates a return to normal operations to the phase of the state, county, region, or metropolitan area.

The OMB/OPM Memorandum M-20-23 indicates that when developing new policies and processes, agencies should review the CDC and Department of Labor guidance and other appropriate resources.

What Is Required

Audit of the DNFSB COVID-19 Re-Entry Plan 5

Occupational Safety and Health Administration (OSHA) -- Guidance on Returning to Work In June 2020, U.S. Occupational Safety and Health Administration (OSHA) 4045-06, Guidance on Returning to Work provided supplemental information that focuses on the need for employers to develop and implement strategies for basic hygiene (e.g., hand hygiene, cleaning and disinfection), social distancing, and identification and isolation of sick employees. The OSHA re-entry guidance also identifies engineering and administrative controls, work process flexibilities, assessment of occupational job hazards, and employee training.

The DNFSBs Plan for Returning Employees to Government Facilities Did Not Fully Address Federal Guidelines and Best Practices The DNFSB re-entry email communications and the DNFSB COOP for COVID-19 Pandemic Response, Rev. 14, August 4, 2020, do not sufficiently address 11 of 16 federal government-wide guidance and agreed-upon best practices for employee re-entry to federal facilities.

Specifically, the National Guidelines for Opening up America Again, the OMB/OPM Memorandum M-20-23, and the OSHA Guidance on Returning to Work.

White House--National Guidelines for Opening up America Again As required in National Guidelines, the Board has not:

• Established policies in accordance with federal, state, and local regulations and guidance, and informed by best practices, regarding social distancing and protective equipment; temperature checks; testing, isolating and contact tracing; sanitation; use and disinfection of common and high-traffic areas; and business travel. Staff indicated that policy is non-existent.

• Implemented measures to monitor the workforce for indicative symptoms. For example, the DNFSB does not have a screening What We Found

Audit of the DNFSB COVID-19 Re-Entry Plan 6

process for identifying symptomatic employees before they enter the building.

• Implemented procedures for workforce contact tracing, following employee COVID positive tests. The former Chairman indicated staff are not aware of the contact tracing procedures and staff will be informed of contact tracing procedures when necessary.

The OMB/OPM Memorandum M-20-23 As required in the OMB/OPM Memorandum M-20-23, the Board has not:

• Established gating criteria for phases for re-entry. For example, the DNFSB re-entry email communications and the DNFSB COOP for COVID-19 Pandemic Response do not specify the gating criteria for moving between phases in the geographic areas where the DNFSB operates.

• Established two-way communication to address staff concerns that would have more effectively communicated management decision making to the staff. For example, the Board has not fully addressed concerns staff raised about returning to the workplace, such as optional mask wearing and building ventilation.

• Established entry screening policies and procedures as required by federal guidelines and best practices. For example, the DNFSB does not have a screening policy and procedure for entering the building.

• Adhered to the CDC guidelines for cleaning protocols. For example, the CDC guidelines for cleaning work areas following a confirmed or suspected case are not reflected in the DNFSB re-entry email communications and the DNFSB COOP for COVID-19 Pandemic Response.

The OSHA Guidance on Returning to Work As required in the OSHAs guidance, the Board has not:

• Assessed job exposure through hazard assessments.

Audit of the DNFSB COVID-19 Re-Entry Plan 7

• Developed protocols for staff who are returning to work after they have tested positive or have been exposed to COVID-19.

• Developed training for the staff to understand their risk of exposure and how to properly use personal protective equipment (PPE).

• Developed policies for anti-retaliation so staff understand their rights to a safe and healthy work environment.

Appendix B contains a crosswalk between the requirements in the guidance and the DNFSBs actions.

The Board Did Not Approve the Development of a Re-Entry Plan The DNFSB re-entry email communications and the DNFSB COOP for COVID-19 Pandemic Response do not fully address federal guidelines and best practices because the Board did not approve the Request for Board Action by a Board Member to draft a re-entry plan. On June 24, 2020, a Board Member initiated a request for Board action for Office Directors to develop plans to protect the health and safety of employees and to support a phased return to normal work operations. However, the Board action to draft a re-entry plan was null and void because the former Chairman abstained from voting and a quorum was not achieved. Three members of the Board would constitute a quorum, which is the minimum number of members that must be present to make a proceeding valid.

The former Chairman believed a re-entry plan was already in place with the COOP and that emergency operations, such as the pandemic, require unity of command as opposed to command by committee.

Safe, Healthy, and Effective Office Reopening The DNFSB cannot adequately ensure the safety, health, and well-being of its employees without a re-entry plan that complies with federal Why This Occurred Why This Is Important

Audit of the DNFSB COVID-19 Re-Entry Plan 8

guidance. Without established procedures that would be included in an activated re-entry plan, management and staff do not have a clear understanding of the process for returning to the office, including gating criteria and cleaning protocols to limit the risk of COVID-19 infection.

Recommendation The OIG recommends that the Board

1.

Develop and implement an employee re-entry plan that is in accordance with federal guidance and best practices.

Audit of the DNFSB COVID-19 Re-Entry Plan 9

An exit conference was held with the agency on September 14, 2020.

Agency management stated their general agreement with the finding and recommendation in this report and opted not to submit formal comments.

Subsequently, the DNFSB provided the OIG with UC-2020-025, DNFSB Pandemic Response and Recovery Plan, Revision 0, September 14, 2020.

IV. AGENCY COMMENTS

Audit of the DNFSB COVID-19 Re-Entry Plan 10 Appendix A Objective The audit objective was to determine if the DNFSBs plan for returning employees to government facilities was prepared in accordance with government-wide guidance and agreed-upon best practices for safe, healthy, and effective office re-openings.

Scope This audit focused on determining if the DNFSBs plan for returning employees to government facilities was prepared in accordance with government-wide guidance and agreed-upon best practices for safe, healthy, and effective office re-openings. We conducted this performance audit at the DNFSB and the NRC OIG offices (Rockville, Maryland), from July 2020 through August 2020. For the purpose of this audit, information was requested from February 28, 2020 through August 4, 2020. Internal controls related to the audit objective were reviewed and analyzed.

Methodology The OIG reviewed relevant criteria such as the National Guidelines for Opening Up America Again, the OMB/OPM Memorandum M-20-23, Aligning Federal Agency Operations with the National Guidelines for Opening Up America Again, and the OSHA Guidance on Returning to Work. The OIG reviewed internal DNFSB guidance documents relevant to its re-entry plans including the DNFSB COOP, the DNFSB COOP for COVID-19 Pandemic Response, the DNFSB Board Notational Vote 2020-300-025 Request for Board Action, the DNFSBs Telework Program, and agency announcements.

The OIG conducted interviews with the DNFSB managers and staff to gain an understanding of roles, responsibilities, and processes related to the DNFSBs re-entry plan. The OIG interviewed the Board Members and staff from the Office of the General Manager, the Office of the Technical Director, and the Office of the General Counsel. Further, the OIG OBJECTIVE, SCOPE, AND METHODOLOGY

Audit of the DNFSB COVID-19 Re-Entry Plan 11 analyzed the DNFSB surveys sent to the staff regarding parking spaces and the staffs concerns and desire to return to the office. In addition, the OIG requested and reviewed invoices and pictures of the COVID-19 supplies at the DNFSB.

We conducted this performance audit in accordance with generally accepted government auditing standards. Those standards require that we plan and perform the audit to obtain sufficient, appropriate evidence to provide a reasonable basis for our finding and conclusion based on our audit objective. We believe that the evidence obtained provides a reasonable basis for our finding and conclusion based on our audit objective.

Throughout the audit, auditors considered the possibility of fraud, waste, and abuse in the program.

The audit was conducted by Vicki Foster, Team Leader; Jimmy Wong, Audit Manager; George Gusack, Senior Auditor; Megan Tate, Management Analyst; Bobbie Castillo, Student Intern; and Kathryn Cates, Student Intern.

Audit of the DNFSB COVID-19 Re-Entry Plan 12 Appendix B White House National Guidelines for Opening Up America Again Guidance/ Best Practice The DNFSB Actions Sufficiently Addressed (Yes/No/Partial)

1. Develop and implement appropriate policies Weekly Chairman agency announcements COOP for COVID-19 Pandemic Response, Rev. 14, August 4, 2020 No

2. Monitor workforce for indicative symptoms Staff self-assessment of symptoms No

3. Develop and implement policies and procedures for workforce contact tracing Do not have policies and procedures in place for contact tracing No Source: OIG Generated CROSSWALK BETWEEN REQUIREMENTS AND THE DNFSBS ACTIONS

Audit of the DNFSB COVID-19 Re-Entry Plan 13 Appendix B Source: OIG Generated OMB/OPM M-20-23 Memorandum Guidance/ Best Practice The DNFSB Actions Sufficiently Addressed (Yes/No/Partial)

4. Establish gating criteria for phases for re-entry No defined criteria for phases for re-entry No

5. Effective communication to all stakeholders Weekly Chairman agency announcements No

6. Maximum telework, schedule, and workplace flexibilities Telework policy updated as of June 24, 2020 Weekly Chairman agency announcements COOP for COVID-19 Pandemic Response, Rev. 14, August 4, 2020 Yes

7. Entry screening policies and procedures No policy and procedure Stop sign poster No

8. Implement social distancing procedures Use social distancing where possible Consider wearing mask, especially when social distancing is challenged Two persons to an elevator Partial

9. Adhere to CDC guidelines for cleaning protocols No policy and procedure defined No

Audit of the DNFSB COVID-19 Re-Entry Plan 14 Appendix B OSHA Guidance on Returning to Work Guidance/ Best Practice The DNFSB Actions Sufficiently Addressed (Yes/No/Partial)

10. Controls - engineering, administrative, personal protective equipment Provide masks but leave it optional to staff Partial

11. Hazard assessment Self-assessment No

12. Basic and Industrial Hygiene Sanitizer, wipes, soap, water and paper towels provided upon request Yes

13. Identification and isolation Self-assessment Partial

14. Return to work after illness/exposure No protocol in place No

15. Training No training available No

16. Anti-retaliation No protocol in place No Source: OIG Generated

Audit of the DNFSB COVID-19 Re-Entry Plan 15 Please

Contact:

Email:

Online Form Telephone:

1-800-233-3497 TDD 7-1-1, or 1-800-201-7165 Address:

U.S. Nuclear Regulatory Commission Office of the Inspector General Hotline Program Mail Stop O5-E13 11555 Rockville Pike Rockville, MD 20852 If you wish to provide comments on this report, please email the OIG using this link.

In addition, if you have suggestions for future OIG audits, please provide them using this link.

TO REPORT FRAUD, WASTE, OR ABUSE COMMENTS AND SUGGESTIONS