IIP Program For High-Hazard Industry Employers

XYZ Company
Injury and Illness Prevention Program

For
High-Hazard Industry Employers

As determined by OSHA
Complies with Provisions of OSHA 29 CFR Part 1910 General Industry Standards OSHA 29 CFR Part 1926 Construction Industry Standards
Injury & Illness Prevention Program (For High-Hazard Industry Employers)
Safety Office Depot. All rights reserved.
Table of Contents
Section 1 2 3 4 5 6 7 8 9 10 11 12 13 Description Page Program Policy & Requirement Program Responsibility Employee Compliance and Discipline Safety Communication Safety Committee and Meetings Hazard Identification and Assessment Accident/Exposure Investigation Hazard Prevention and Control Safety Training and Instruction Accident Recordkeeping Company Required Safety Programs Company Required Safety Training Courses Company Required Safety Forms & Checklists 3 4 8 11 13 16 26 33 43 47 50 51 53
Appendices Appendix A List of Training Subjects Appendix B Hazard Assessment Checklists Appendix C Hazard Assessment and Correction Record Appendix D Accident/Exposure Investigation Report Appendix E Employee Training and Instruction Record Appendix F Codes of Safe Practice (General and Construction Industries) Appendix G Employee Acknowledgement Form 55 57 58 60 62 64 75
Section 1
Program Policy & Requirement

Program Policy It is intent of XYZ Company to comply with all laws. To do this, we must constantly be aware of conditions in all work areas that can produce injuries. No employee is required to work at a job he/she knows is not safe or healthful. Your cooperation in detecting hazards and, in turn, controlling them, is a condition of your employment. Inform your supervisor immediately of any situation beyond your ability or authority to correct. Program Requirement This program has been prepared for use by employers in industries which have been determined by OSHA to be HIGH-HAZARD.
Employers in an industry which has been determined by OSHA as High-Hazard and who
adopts and implements this program in good faith shall be deemed in compliance with IIP Program requirements, unless mandated otherwise by a State law. Once this
program has been implemented, a copy must be maintained at each workplace or at a central worksite if the employer has non-fixed worksites.
Proper use of this program requires the IIP Program administrator to carefully review the requirements for each of the eight IIP Program elements found in this program, fill in the appropriate blank spaces and check those items that are applicable to your workplace. The
Injury & Illness Prevention Program (For High-Hazard Industry Employers) recordkeeping section requires that the IIP Program administrator select and implement the category appropriate for your establishment. This program must be maintained by the employer in order to be effective.
Section 2
Program Responsibility
Safety and Health Responsibilities
XYZ Company is responsible for ensuring that all onsite and offsite work activities, equipment, and facilities operated or maintained by XYZ Company our subcontractors or suppliers conform fully with safety and health regulations promulgated by the U.S. Department of Labor in Title 29 CFR 1910 and 1926, Occupational Safety and Health Act of 1970, and provisions of all state approved plans and safety procedures. Compliance shall include the aforementioned regulations, standards and codes and all such regulations, standards and codes as included by reference. These responsibilities include, but are not limited to, the following: A.
Program Administrator
Written Accident Prevention Program administrator, Program Administrator has the authority and responsibility for implementing the provisions of this program.
DECISION POINT Enter a name or position title (recommended)
The Program Administrator for XYZ Company is ____________________________________. B.
Safety Representative Responsibilities
The company safety representative, Safety Representative also has the authority and responsibility for implementing the provisions of this program and may be the same person or title as the Program Administrator.
DECISION POINT Enter a name or position title (recommended)
The Safety Representative for XYZ Company is ___________________________________.

A. The XYZ Company Safety and Health compliance program shall be
Injury & Illness Prevention Program (For High-Hazard Industry Employers) managed and administered by the Safety Representative. B. Ensure the companys compliance with all applicable federal, state, and local safety and health requirements. 1. Ensure that each employee is provided with adequate and appropriate occupational safety and health training and personal protective equipment. 2. Inspect all workplaces, projects, and/or facilities periodically, but not less than once per quarter. 3. Ensure that the safety and health policies are comprehensive and effective. 4. Review each accident and conduct any investigation wherein an accident has resulted in serious occupational injury, illness or property damage. 5. Promote safety and health and serve as a resource to all staff. 6. Review the program on an annual basis. C.
Manager Responsibilities
1. Establish rules and programs designed to promote safety and make known to all employees the established rules and programs. 2. Provide all supervisors with copies of appropriate rules and regulations. 3. Make available training necessary for employees to perform their tasks safely. 4. Provide protective equipment for employees where required. 5. Impress upon all employees, subcontractors and suppliers, the responsibility and accountability of each individual to maintain a safe workplace.
Injury & Illness Prevention Program (For High-Hazard Industry Employers) 6. Record all instances of violations and investigate all accidents. 7. Discipline any employee disregarding safety and loss prevention policies. 8. Require all subcontractors as a matter of contract and all material suppliers through purchase order terms, to follow established safety rules. 9. Require all subcontractors to submit for review their safety programs and encourage them to work safely. 10. Conduct safety inspections, maintain records and continually monitor the program for effectiveness.
Injury & Illness Prevention Program (For High-Hazard Industry Employers) D.
Supervisor Responsibilities
1. Carry out safety programs at the work level.
2. Be aware of all safety requirements and safe working practices. 3. Plan work activities to comply with safe working practices.
4. Instruct new employees, existing employees, and subcontractors performing new tasks on safe working practices. 5. 6. Make sure protective equipment is available and used. Make sure work is performed in a safe manner and no
unsafe conditions or equipment is present. 7. Correct all hazards, including unsafe acts and conditions,
which are within the scope of your position. 8. 9. E. Secure prompt medical attention for any injured employees. Report all injuries and safety violations to management.
Employee Responsibilities
1. Work safely in such a manner as to ensure your own safety as well as that of co-workers and others. 2. Request help when unsure about how to perform any task safely. 3. Correct unsafe acts or conditions within the scope of the immediate work. 4. Report any uncorrected unsafe acts or conditions to the appropriate supervisor. 5. Report for work in good mental and physical condition to safely carry out assigned duties. 6. 7. 8. Use and maintain all safety equipment provided. Maintain and properly use all tools under your control. Follow all safety and project rules.
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Injury & Illness Prevention Program (For High-Hazard Industry Employers) 9. 10. Provide fellow employees help with safety requirements. REPORT ALL WORK RELATED INJURIES OR ACCIDENTS
TO YOUR SUPERVISOR - IMMEDIATELY. F.
All Personnel (without regard to position or assignment):
1. Strive to make all operations safe. 2. Maintain mental and physical health conducive to working safely. 3. Keep all work areas clean and free of debris. 4. Assess result of your actions on the entire work place. Work will not be performed in ways that cause hazards for others. 5. Before leaving work, replace or repair safety precaution signs or barriers that have been removed or altered. Unsafe conditions will not be left to imperil others. 6. Abide by the safety rules and regulations promulgated for this construction project.
DECISION POINT - delete if not applicable
G. 1.
Subcontractors and Suppliers Responsibilities

Abide by safety rules and regulations as promulgated by Federal, State and local authorities including those of XYZ Company and any General Contractor.
2.
Notify all other contractors when their activities could affect the health or safety of other employees in the workplace, project and/or facility.
3.
Check in with XYZ Company site supervision when entering or leaving any job-site.
4.
Inform XYZ Company site Safety Representative of all injuries to workers, immediately.
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Injury & Illness Prevention Program (For High-Hazard Industry Employers) 5. Report to XYZ Company site supervision or safety representatives any unsafe conditions. 6. Provide for review Safety and Hazard Communications Programs. 7. Provide a chemical inventory list and copies of Material Safety Data Sheets (MSDS) for any hazardous materials - prior to bringing materials on-site.
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Section 3
Employee Compliance & Discipline

XYZ Company management is responsible for ensuring that all safety and health policies and procedures are clearly communicated and understood by all employees. Managers and supervisors are expected to enforce the rules fairly and uniformly. All XYZ Company employees are responsible for using safe work practices, for following all directives, policies and procedures, and for assisting in maintaining a safe work environment. A.
Employee Compliance
OSHA requires that you include a system for ensuring that employees comply with safe and healthful work practices. Substantial compliance with this provision includes recognition of employees who follow safe and healthful practices, e.g., incentive programs, training and retraining programs, disciplinary actions, infraction notices; or any other means that ensure employee compliance with safe and healthy work practices. Though sample procedures are provided, you must modify them to suit your requirements. As part of this compliance, you should provide employees with a code of safe practices that reflect your companys specific operations more exactly. The Code of Safe Practices we have provided is a suggested format.
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Injury & Illness Prevention Program (For High-Hazard Industry Employers) B.
Employee Enforcement Procedures and
Systems
The XYZ Company safety rules and work procedures shall be practiced and enforced. We have established a system to ensure that violations of rules are dealt with fairly but firmly, that all employees are aware of the requirements, and that reorientation or retraining may be provided when needed. Incentive programs may be initiated and will be used in conjunction with a good enforcement program. Discipline No safety program can be effective without some form of discipline. There are no rules that must be followed, only guidelines. The first preventable accident or safety rule violation observed should result in a discussion with the employee and the supervisor or manager. This verbal reprimand should be documented, dated, and signed by those involved. A second preventable accident or safety rule violation observed within a 12-month period should result in another discussion with the employee accompanied by a written reprimand. Time off without pay, up to a maximum of 5 days, should be considered. A third preventable accident or safety rule violation observed within a 12-month period should result in another discussion with the employee and a serious evaluation needs to be made. This is probably grounds for termination. Compliance One point must be very clear: discipline has to be administered uniformly and consistently.
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Injury & Illness Prevention Program (For High-Hazard Industry Employers) Violations of safety rules and policies should be addressed in the following manner: a. First Incident: Verbal warning, documented discussion. b. Second Incident: Written reprimand, up to 5 days suspension. c. Third Incident: Written reprimand, grounds for termination. Each XYZ Company supervisor or manager shall be responsible for administering this policy to his/her subordinates. All written reprimands and records of violations shall be held confidential and maintained in the employees personnel files.
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Injury & Illness Prevention Program (For High-Hazard Industry Employers) Accountability Each supervisors efforts and performance will be evaluated relative to reaching XYZ Company safety objectives and assigned responsibilities. This evaluation will be part of the supervisors performance review and will be used in part to determine his or her job assignments, merit increases or promotions.
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Section 4
Safety Communication
Communication between management and employees on matters of safety is of primary importance in order to have an effective Safety Program. The primary means of communicating with employees will include: Safety committee(s); personal safety contacts; group safety meetings; written communications; bulletin boards and posted notices; and a safety suggestion system. A. B.
Safety Committee (See Section 5) Individual Contacts

1. Individual contacts between the supervisor and employee to
instruct or discuss some safety topic related to the employee's work are powerful tools for developing favorable employee behavior toward safety and accident prevention. They are continuing reminders that management is concerned about employee safety 2. Individual contacts with employees on matters of safety and
health should be documented. 3. Important: Keeping a record of personal contacts on safety
rules and job procedures is necessary for a number of reasons. The record is a history of what has been discussed with an employee, on what dates, and by what supervisors. Such information is useful to establish the fact that a person has been properly instructed. Secondly, a record can be a tool to help decide future topics to discuss with the employee. Thirdly, they provide a record of training for statutory compliance
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Injury & Illness Prevention Program (For High-Hazard Industry Employers) requirements. C.
General Safety Meetings
Group safety meetings with all the supervisors employees are another effective training tool and shall be held at least on a monthly basis. 1. Topics should be chosen that are pertinent to the job safety or health of the group. 2. The meeting should include open discussions of the topic to ensure employee understanding. 3. It is also important to obtain suggestions from employees on means for improving their job safety. All XYZ Company group safety meetings are to be documented with the date, department/group designation, topic, employees' names/signatures, name of the supervisor, and name of the presenter if other than the supervisor. Supervisor Safety Meeting Record documentation is again important for purposes of KYOSH compliance. D.
Written Communications
1. XYZ Company written communication of safety and health topics, practices, or matters of interest will be used to convey important new or revised policies and procedures.
2.
All communications should be dated and conform to state policy regarding such communications. E.
Bulletin Boards and Postings
1. At least one company bulletin board shall be made available for posting of required government postings such as the OSHA and Workers' Compensation required notices. They will be used to post
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Injury & Illness Prevention Program (For High-Hazard Industry Employers) safety rules and important policies and procedures. 2. XYZ Company bulletin boards will be conspicuously located. a. The boards are to be properly maintained.. b. One individual will be responsible for maintaining the bulletin board and controlling the notices placed thereon.
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Section 5
Safety Committee and Meetings

DECISION POINT - If you have 25 or more employees, a Safety Committee should be established. If you do not meet this threshold, delete this sub-section. A.
Safety Committee
XYZ Company has formed a safety committee to help employees and management work together to identify safety problems, develop solutions, review incident reports and evaluate the effectiveness of our safety program. The committee is made up of managementdesignated representatives and employee-elected representatives. 1. The committee shall: a. Promote a safe and healthy work environment at all times. b. Encourage communication between employees and management. c. Serve as an oversight committee on all issues relative to safety and health. d. Make recommendations to the Safety Representative. 2. Functions: The committee has four principal functions: a. b. Identify potential hazards; Evaluate these potential hazards;
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Injury & Illness Prevention Program (For High-Hazard Industry Employers) c. d. Recommend corrective action; and Follow up implemented recommendations.
To carry out its functions, the committee is required to hold meetings and carry out regular inspections of the workplace.
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Injury & Illness Prevention Program (For High-Hazard Industry Employers) 3. Membership The make-up of an occupational safety and health committee shall be a cross section of the membership of our organization. Everyone who is a member of this organization should feel that their needs are being adequately and fairly represented through the safety committee. If the XYZ Company employees are represented by a labor organization, the representatives of employees must be selected by the employees and not appointed by the employer. Employee representatives will serve for one year before being reelected or replaced. If there is a vacancy then an election will be held before the next scheduled meeting to fill the balance of the term. In addition to the employee-elected representatives, management will designate no more than three representatives but a minimum of one who will serve until replaced by management. A chairperson will be selected by majority vote of the committee members each year. If there is a vacancy, the same method will be used to select a replacement. In addition to committee responsibilities, duties of safety committee members include:
Perform a monthly self-inspection of the area they
represent;
Communicating with the employees they represent on
safety issues; and
Encourage safe work practices among co-workers.
4. Employer Responsibilities
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Provide support from the top level down to first line
supervisors in terms of time, effort, and money. Resolve scheduling and personnel conflicts. Provide realistic dates for correcting safety and health
concerns. Support training for safety committee members. Provide leadership and direction. Participation in safety committee meetings.
The management commitment/interest/good faith to safety committees must be vocal, visible, and continuous - from the top to the lowest level. 5. Frequency Once established, the XYZ Company safety committee shall meet at least quarterly. An agenda shall be developed by the chairperson and distributed to the members at least 10 workdays prior to the scheduled meeting. Meeting minutes shall be prepared and distributed to the membership within 5 days following the meeting. Meeting minutes shall be posted in a conspicuous location convenient to all employees to view (i.e., lunch room, bulletin board, etc.) B.
Employee Safety Meetings
All trade employees are required to attend a monthly safety meeting. The meeting is to help identify safety problems, develop solutions, review incident reports, provide training and evaluate the effectiveness of our company safety program. Minutes will be kept and kept on file for one year.
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Section 6
Hazard Identification & Assessment

A. Recordkeeping and Review
1. Employees will: Employees will report any injury or work-related illness to their immediate supervisor regardless of how serious. Minor injuries such as cuts and scrapes can be entered on a Minor Injury Log posted in a conspicuous location. The employee must use an Employees Injury/Illness Report Form to report more serious injuries. 2. Supervisors will: DECISION POINT a. Investigate a serious injury or illness using procedures in the Incident Investigation section. b. Complete an Incident Investigation Report form. c. Give the Employees Report and Incident Investigation Report to the company Safety Representative.
B. Hazard Recognition Methods

Hazard recognition is a vital element in the program. It is a system to identify any existing or potential dangers in the workplace, then following through to eliminate or control them. If dangers occur (or reoccur), there is a breakdown in the danger control system, and in turn the safety and health program. The danger control system also serves as the basis for developing safe work procedures and safety
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Injury & Illness Prevention Program (For High-Hazard Industry Employers) and health training. Correcting or controlling dangers can be accomplished in a variety of ways. However, to work properly, a danger control system must have the following components: 1. 2. An initial danger identification survey; A system for danger identification (such as inspections at
regular intervals); 3. An effective system for employees to report conditions
which may be dangerous (such as a safety committee or a safety representative); 4. 5. An equipment and maintenance program; A system for review or investigation of workplace accidents,
injuries and illnesses; 6. A system for initiating and tracking danger corrective
actions; and 7. A system for periodically monitoring the place of
employment.
C. Danger Identification Methods

DECISION POINT - If one has not been done, have it accomplished as soon as possible. If one has been accomplished, so state, and where its maintained. Initial Danger Survey A knowledgeable safety and health person should conduct the initial safety and health survey (audit) to identify existing or potential workplace dangers. DECISION POINT - If one has not been done, have it
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Injury & Illness Prevention Program (For High-Hazard Industry Employers) accomplished as soon as possible. If one has been accomplished, so state, and where its maintained. Periodic Danger Surveys (Monitoring) A Scheduled a walk-through of the XYZ Company workplace is performed at regular intervals to ensure that established work procedures are being followed, and those unsafe conditions or practices are identified and promptly corrected. These inspections are in addition to the everyday safety and health checks that are part of the routine duties of supervisors and managers.
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Injury & Illness Prevention Program (For High-Hazard Industry Employers) The frequency of the inspections depends on the type of operations, the magnitude of the dangers, the proficiency of employees and supervisors, changes in equipment or work processes, and the history of the workplace injuries and illnesses. Someone who, through experience or training, can identify actual and potential dangers and who understands safe work procedures should do an inspection. DECISION POINT - If one has not been done, have it accomplished as soon as possible. If one has been accomplished, so state, and where its maintained. Employee Reports of Danger Perhaps the best source of danger information is the employees. Employees should be trained to recognize danger situations and instructed to bring them to the attention of their supervisors or to a safety committee or a safety and health representative. Prompt attention to identified dangers and positive feedback to employees will reaffirm your personal commitment to workplace safety and health. That will encourage employees to continue to report dangers promptly and assure them that their reporting will not have negative consequences. DECISION POINT - If one has not been done, have it accomplished as soon as possible. If one has been accomplished, so state, and where its maintained.
D. Equipment Monitoring and Maintenance Program

Equipment, particularly all safety controls and safety equipment must be properly maintained. A program must be established to monitor the operation of workplace equipment and make sure that routine preventive maintenance is conducted. That not only makes good safety and health sense, it is good for business. Proper maintenance can prevent costly breakdowns. DECISION POINT - If one has not been done, have it accomplished as soon as possible. If one has been accomplished, so state, and where its maintained.
E. Accident Investigation and Reporting

A system must be established for investigating all workplace accidents, near misses, injuries and illnesses. Someone who can identify the causes and recommend corrective actions should
Safety Office Depot. All rights reserved. 27
Injury & Illness Prevention Program (For High-Hazard Industry Employers) complete the investigation system. It is important to keep records of accident investigations. They can help to determine the types of accidents that occur, where they happen, their causes and any accident trends. Such information is invaluable in preventing future accidents and may also help reveal flaws in operating procedures.
1. Program Introduction At XYZ Company accident investigation is an integral part of our total occupational safety and health program. It is especially important as a means to determine root causes, document facts, provide information on costs, and promote safety. All serious occupational injuries and illnesses shall be thoroughly investigated by the company Safety Representative with the underlying goal of preventing recurrence. If an employee dies while working or is not expected to survive, or when three or more employees are admitted to a hospital as a result of a work-related incident, or when there is property damage exceeding $25,000, (Customize by adding the name or title of person responsible for reporting to L&I) will contact HIOSH within 8 hours after becoming aware of the incident. On Oahu, the telephone number is 586-9102. Toll free numbers are available from the neighbor islands (Kauai 274-3141, Maui 984-2400, Hawaii 974-4000, Molokai/Lanai 1-800-468-4644.) (Add the name or title of the responsible person) must talk with a representative of the department. Fax and answering machine notifications are not acceptable. (Add the name or title of the responsible person) must report: the employer name, location and time of the incident, number of employees
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Injury & Illness Prevention Program (For High-Hazard Industry Employers) involved, the extent of injuries or illness, a brief description of what happened and the name and phone number of a contact person. 2. Accident Investigation Do not disturb the scene except to aid in rescue or make the scene safe. Whenever there is an incident that results in death or serious injuries that have immediate symptoms, a preliminary investigation will be conducted by the immediate supervisor of the injured person(s), a person designated by management, an employee representative of the safety committee, and any other persons whose expertise would help the investigation.
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Injury & Illness Prevention Program (For High-Hazard Industry Employers) The investigation team will take written statements from witnesses, photograph the incident scene and equipment involved. The team will also document as soon as possible after the incident, the condition of equipment and any anything else in the work area that may be relevant. The team will make a written Incident Investigation Report of its findings. The report will include a sequence of events leading up to the incident, conclusions about the incident and any recommendations to prevent a similar incident in the future. The report will be reviewed by the safety committee at its next regularly scheduled meeting. When a supervisor becomes aware of an employee injury where the injury was not serious enough to warrant a team investigation as described above, the supervisor will write an "Incident Investigation Report" to accompany the "Employee's Injury/Illness Report Form" and forward them to (Add the name or title of the responsible person). Whenever there is an incident that did not but could have resulted in serious injury to an employee (a near-miss), the incident will be investigated by the supervisor or a team depending on the seriousness of the injury that would have occurred. The "Incident Investigation Report" form will be used to investigate the nearmiss. The form will be clearly marked to indicate that it was a near miss and that no actual injury occurred. The report will be forwarded to the bookkeeper to record on the incident log. 3. Occupational Injury, Illness Investigation The Supervisor, if initially notified, shall report to the scene of an occupational injury, illness, and property damage and immediately secure and protect the accident scene. Drawings and photographs, if needed, shall be used to record and document
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Injury & Illness Prevention Program (For High-Hazard Industry Employers) where and how the accident occurred and the extent of injuries and damage to property sustained. A preliminary and/or final incident report shall be accomplished and a copy provided to the company Safety Representative. The initial accident report shall become a permanent part of the formal accident investigation.
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Injury & Illness Prevention Program (For High-Hazard Industry Employers) The Safety Representative shall report to and investigate all serious occupational injuries, illnesses and property damage. A formal Incident Investigation Report shall be prepared to determine the cause, document facts and recommend corrective actions to prevent recurrence. 4. Occupational Injury, Illness Reporting Employees shall report all occupational injuries, illnesses and property damage, initially through their supervisor to the XYZ Company Safety Representative. This is the preferred method, which will ensure employees receive medical treatment, if required, because of a serious and/or life threatening occupational injury and/or illness, and damage to property can be documented and repaired. Supervisors will immediately notify the XYZ Company Safety Representative of any serious and/or life threatening occupational injury and/or illness, and property damage. All other minor occupational injuries and/or illnesses, and property damage will also be reported to the Safety Representative the following day. The Safety Representative will ensure the company person responsible for Benefits Administration and/or Workers Compensation claims receives copies of the final report for alloccupational injuries and/or illnesses.
F. Injury and Illness Recordkeeping

In order to establish meaningful goals and objectives for mishap reduction, we must first know where we, as a company, have been in terms of previous mishap experience. For that reason and to comply with federal recordkeeping requirements, the following documentation shall be maintained:
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Injury & Illness Prevention Program (For High-Hazard Industry Employers) 1. The Safety Representative shall maintain for a period of 5 years: a. Safety accident investigation reports for all lost workday
occupational injuries, illnesses or equipment damage; b. Safety accident investigation reports for company
property damage, as a result of accidents; c. Records of formal claims against the company for injury,
illness, personal loss, and/or damage to personal property; and 2. OSHA Form No. 300, Log of Work-Related Injuries and Illnesses, shall be used to record injuries or illnesses that result in fatalities, lost workdays, require medical treatment, involve loss of consciousness, or restrict work or motion. The annual report of this form must be posted by February 1st in a centralized area visible to all employees, and remain there for at least 3 months. 3. OSHA Form No. 301, Injury and Illness Incident Report, shall, when used, be used to give details of each recordable occupational injury and illness. Records must be available for examination by representatives of the U.S. Department of Labor and the Department of Health and Human Services. Note: This record and/or the SF-301are kept for five years. 4. OSHA Form No. 300A, Summary of Work-Related Injuries and Illnesses, provides additional data to make it easier for employers to calculate incidence rates. Employers must review the OSHA 300 Log information before it is summarized on the 300A form. 5. Accident Review: DECISION POINT Following an injury or near miss accident, the incident will be reviewed with the Project Manager and onsite supervision. This
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Injury & Illness Prevention Program (For High-Hazard Industry Employers) review will address the effectiveness of our program, any additional task training that may be needed and measures to prevent recurrence. Once each month the Safety Representative shall report on the effectiveness of XYZ Company safety program to the project or company manager. This report can include data on the number of man-hours worked, the numbers of accidents, injuries and near miss incidents for the month and measures taken to prevent recurrences.
G. Corrective Actions
DECISION POINT - State your method of corrective action here. 1. Timely Correction of Dangers Once remedial measures to control or eliminate dangers have been agreed upon, you should make sure that they are implemented with minimum delay. Interim protection for employees may be necessary until the danger is eliminated or controlled. Keep a record of steps taken to control or eliminate a danger. Records should contain the danger, who reported it and when who is responsible for correction, the correction target date and when it was corrected. Such information will assist in developing safe work practices and training programs. 2. Responsibility for Corrective Action a. Actions necessary to correct or remedy accident causal factors shall rest with the XYZ Company Safety Representative. b. The XYZ Company Safety Representative shall have the broad authority to recommend corrective actions to abate an identified hazard or deficiency to prevent injury or illness to employees, and to prevent property damage or personal loss. DECISION POINT - State how frequently you will accomplish this.
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Injury & Illness Prevention Program (For High-Hazard Industry Employers) 3. Frequency of Monitoring the Place of Employment You have the responsibility of monitoring the workplace regularly the work procedures, equipment and machines to ensure that all dangers to workers are eliminated or controlled or, alternatively, to ensure that the workers are protected from exposure to the dangers.
H. Safety Inspection and Hazard Control Procedures

XYZ Company is committed to aggressively identifying hazardous conditions and practices which are likely to result in injury or illness to employees. We will take prompt action to eliminate any hazards we find. In addition to reviewing injury records and investigating incidents for their causes, management and the safety committee will regularly check the workplace for hazards as described below:
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Injury & Illness Prevention Program (For High-Hazard Industry Employers) 1. Annual Site Survey -- Once a year an inspection team made up of members of the safety committee will do a wall-to-wall walk through inspection of the entire workplace. They will write down any safety hazards or potential hazards they find. The results of this inspection will be used to eliminate or control obvious hazards, target specific work areas for more intensive investigation, assist in revising the checklists used during regular monthly safety inspections and as part of the annual review of the effectiveness of our accident prevention program. 2. Periodic Change Survey -- We will assign a supervisor or form a team to look at any changes we make to identify safety issues. Changes include new equipment, changes to production processes or a change to the building structure. A team is made up of maintenance, production, and safety committee representatives. It examines the changed conditions and makes recommendations to eliminate or control any hazards that were or may be created as a result of the change. 3. Monthly Safety Inspection -- Each month, before the regularly scheduled safety committee meeting, safety committee members will inspect their areas for hazards using the standard safety inspection checklist. They will talk to co-workers about any safety concerns they may have. Committee members will report any hazards or concerns to the whole committee for consideration. The results of the area inspection and any action taken will be posted in the affected area. Occasionally, committee members may agree to inspect each other's area rather than their own. This brings a fresh pair of eyes into the workplace area to look for hazards. 4. Job Hazard Analysis -- As a part of our on-going safety program, we will use a Job Hazard Analysis form to look at each type of job
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Injury & Illness Prevention Program (For High-Hazard Industry Employers) task our employees do. This analysis will be done by the supervisor of that job task or a knowledgeable member of the safety committee. We will change how the job is done as needed to eliminate or control any hazards. We will also check to see if the employee needs to use personal protective equipment (PPE) while doing the job. Employees will be trained in the revised operation and to use any required PPE. The results will be reported to the safety committee. Each job task will be analyzed at least once every two years, or whenever there is a change in how the task is done or if there is a serious injury while doing the task. DECISION POINT Complete the information requested in this table.
Competent Person
Area
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Section 7
Accident/Exposure Investigation
DECISION POINT - If this investigation system is not in place, it must be created.
Accident Investigation and Reporting

A system must be established for investigating all workplace accidents, near misses, injuries and illnesses. Someone who can identify the causes and recommend corrective actions should complete the investigation system. It is important to keep records of accident investigations. They can help to determine the types of accidents that occur, where they happen, their causes and any accident trends. Such information is invaluable in preventing future accidents and may also help reveal flaws in operating procedures.
A. Program Introduction
At XYZ Company accident investigation is an integral part of our total occupational safety and health program. It is especially important as a means to determine root causes, document facts, provide information on costs, and promote safety. All serious occupational injuries and illnesses shall be thoroughly investigated by the Safety Representative with the underlying goal of preventing recurrence. Whenever there is an incident that results in death or serious injuries that have immediate symptoms, a preliminary investigation will be conducted by the immediate supervisor of the injured person(s), a person designated by management, an employee representative of
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Injury & Illness Prevention Program (For High-Hazard Industry Employers) the safety committee, and any other persons whose expertise would help the investigation. The company investigation team will take written statements from witnesses, photograph the incident scene and equipment involved. The team will also document as soon as possible after the incident, the condition of equipment and any anything else in the work area that may be relevant.
The team will make a written Incident Investigation Report of its findings. The report will include a sequence of events leading up to the incident, conclusions about the incident and any recommendations to prevent a similar incident in the future. The report will be reviewed by the safety committee at its next regularly scheduled meeting. When a XYZ Company supervisor becomes aware of an employee injury where the injury was not serious enough to warrant a team investigation as described above, the supervisor will write an "Incident Investigation Report" to accompany the "Employee's Injury/Illness Report Form" and forward them to Program Administrator/Safety Representative. Whenever there is an incident that did not but could have resulted in serious injury to an employee (a near-miss), the incident will be investigated by the supervisor or a team depending on the seriousness of the injury that would have occurred. The "Incident Investigation Report" form will be used to investigate the near-miss. The form will be clearly marked to indicate that it was a near miss and that no actual injury occurred. The report will be forwarded to the bookkeeper to record on the incident log.
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Injury & Illness Prevention Program (For High-Hazard Industry Employers) A Safety Inspection Guide Checklist can be a useful tool to help the supervisor carry out his/her responsibilities as described above.
B. Investigating Occupational Injury, Illness, and Property Damage

1.
The XYZ Company supervisor, if initially notified, shall report to the scene of an occupational injury, illness, and property damage and immediately secure and protect the accident scene. Drawings and photographs, if needed, shall be used to record and document where and how the accident occurred and the extent of injuries and damage to property sustained. A preliminary and/or final incident report shall be accomplished and a copy provided to the company Safety Representative. The initial accident report shall become a permanent part of the formal accident investigation.
2.
The Program Administrator/Safety Representative shall report to and investigate all serious occupational injuries, illnesses and property damage. A formal Incident Investigation Report shall be prepared to determine the cause, document facts and recommend corrective actions to prevent recurrence.
C. Reporting Occupational Injury, Illness and Property Damage

1.
XYZ Company employees shall report all occupational injuries, illnesses and property damage, initially through their supervisor to the Program Administrator/Safety Representative.
2.
This is the preferred method, which will ensure employees receive medical treatment, if required, because of a serious and/or life threatening occupational injury and/or illness, and damage to property can be documented and repaired.
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3.
Supervisors will immediately notify the Program Administrator/Safety Representative of any serious and/or life threatening occupational injury and/or illness, and property damage. All other minor occupational injuries and/or illnesses, and property damage will also be reported to the Program Administrator/Safety Representative the following day.
4.
The Program Administrator/Safety Representative will ensure the company person responsible for Benefits Administration and/or Workers Compensation claims receives copies of the final report for all-occupational injuries and/or illnesses.
D. Injury and Illness Recordkeeping

In order to establish meaningful goals and objectives for mishap reduction, we must first know where we, as a company, have been in terms of previous mishap experience. For that reason and to comply with federal recordkeeping requirements, the following documentation shall be maintained:
1.
The Safety Representative shall maintain for a period of
5 years: a. Safety accident investigation reports for all lost workday
occupational injuries, illnesses or equipment damage; b. Safety accident investigation reports for company
property damage, as a result of accidents; c. Records of formal claims against the company for injury,
illness, personal loss, and/or damage to personal property; and

2.
OSHA Form No. 300, Log of Work-Related Injuries and
Illnesses, shall be used to record injuries or illnesses that result in fatalities, lost workdays, require medical treatment, involve loss of consciousness, or restrict work or motion.
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Injury & Illness Prevention Program (For High-Hazard Industry Employers) The annual report of this form must be posted by February 1st in a centralized area visible to all employees, and remain there for at least 3 months.
3.
OSHA Form No. 301, Injury and Illness Incident
Report, shall, when used, be used to give details of each recordable occupational injury and illness. Records must be available for examination by representatives of the U.S. Department of Labor and the Department of Health and Human Services. Note: This record and/or the SF-301must be kept for five years.
4.
OSHA Form No. 300A, Summary of Work-Related
Injuries and Illnesses, provides additional data to make it easier for employers to calculate incidence rates. Employers must review the OSHA 300 Log information before it is summarized on the 300A form.
5.
Accident Review Following an injury or near miss accident, the incident will be reviewed with the Project Manager and onsite supervision. This review will address the effectiveness of our program, any additional task training that may be needed and measures to prevent recurrence. Each month the company Program Administrator/Safety Representative shall report on the effectiveness of XYZ Company safety program to the project or company manager. This report can include data on the number of man-hours worked, the numbers of accidents, injuries and near miss incidents for the month and measures taken to prevent recurrences.
E. Corrective Actions
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Injury & Illness Prevention Program (For High-Hazard Industry Employers) DECISION POINT - State your method of corrective action here.
1.
Timely Correction of Dangers
Once remedial measures to control or eliminate dangers have been agreed upon, you should make sure that they are implemented with minimum delay. Interim protection for employees may be necessary until the danger is eliminated or controlled. Keep a record of steps taken to control or eliminate a danger. Records should contain the danger, who reported it and when who is responsible for correction, the correction target date and when it was corrected. Such information will assist in developing safe work practices and training programs.
2.
Responsibility for Corrective Action

a. Actions necessary to correct or remedy accident causal
factors shall rest with the XYZ Company Safety Representative.
b. The XYZ Company Safety Representative shall have the

broad authority to recommend corrective actions to abate an identified hazard or deficiency to prevent injury or illness to employees, and to prevent property damage or personal loss.
F. Monitoring the Place of Employment.

You have the responsibility of monitoring the workplace regularly the work procedures, equipment and machines to ensure that all dangers to workers are eliminated or controlled or, alternatively, to ensure that the workers are protected from exposure to the dangers.
G. Safety Inspection and Hazard Control Procedures

XYZ Company is committed to aggressively identifying hazardous conditions and practices which are likely to result in injury or illness to employees. We will take prompt action to eliminate any hazards we find.
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Injury & Illness Prevention Program (For High-Hazard Industry Employers) In addition to the Program Administrator/Safety Representative reviewing injury records and investigating incidents for their causes, area supervisors and the safety committee will regularly check the workplace for hazards in the manner described below:
1.
Annual Site Survey
Once each year an inspection team made up of members of the safety committee will do a wall-to-wall walk through inspection of the entire worksite. They will write down any safety hazards or potential hazards they find. The results of this inspection will be used to eliminate or control obvious hazards, target specific work areas for more intensive investigation, assist in revising the checklists used during regular monthly safety inspections and as part of the annual review of the effectiveness of our accident prevention program. 2. Periodic Change Survey
The Program Administrator/Safety Representative will request a supervisor to form a team to look at any changes we make to identify safety issues. Changes include new equipment, changes to production processes or a change to the building structure. A team is made up of maintenance, production, and safety committee representatives. It examines the changed conditions and makes recommendations to eliminate or control any hazards that were or may be created as a result of the change.
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Injury & Illness Prevention Program (For High-Hazard Industry Employers) 3. Monthly Safety Inspection
Safety committee members will inspect their areas for hazards using the standard safety inspection checklist. They will talk to coworkers about their safety concerns. Committee members will report any hazards or concerns to the whole committee for consideration. The results of the area inspection and any action taken will be posted in the affected area. Occasionally, committee members may agree to inspect each other's area rather than their own. This brings a fresh pair of eyes to look for hazards.
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Injury & Illness Prevention Program (For High-Hazard Industry Employers) 4. Job Hazard Analysis
The Program Administrator/Safety Representative in cooperation with an area supervisor will conduct a Job Hazard Analysis where there has been a recent employee workplace injury that is related to machinery or tool usage or a physical task assignment. The analysis will use the Job Hazard Analysis form as a tool to systematically review a job task. The results of a Job Hazard Analysis will be reported to the safety committee. Each hazardous job task will be analyzed at least once every two years, whenever there is a change in how the task is done or if there is a serious injury while doing the task.
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Section 8
Hazard Prevention and Control

A. Eliminating Workplace Hazards
XYZ Company is committed to eliminating or controlling workplace hazards that could cause injury or illness to our employees. We will meet the requirements of state safety standards where there are specific rules about a hazard or potential hazard in our workplace. Whenever possible we will design our facilities and equipment to eliminate employee exposure to hazards. Where these engineering controls are not possible, we will write work rules that effectively prevent employee exposure to the hazard. When the above methods of control are not possible or are not fully effective we will require employees to use personal protective equipment (PPE) such as safety glasses, hearing protection, foot protection etc.
B. Safety Rules and Work Procedures

1. General Safety Rules The XYZ Company Written Safety and Health Program apply to all employees. The rules may be very simple or extremely complex, depending on the nature of the work processes and the number and kinds of employees involved. Some items that are addressed by general safety rules are: a. Personal protective equipment requirements; b. Clothing appropriate for the work; c. Behavior expected of all employees;
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Injury & Illness Prevention Program (For High-Hazard Industry Employers) d. How to leave the workplace safely, with particular reference to emergency procedures; and e. Danger areas that are: off-limits for employees. As part of our initial safety and health survey, existing rules are always evaluated. New rules may be necessary. All rules will be reviewed and updated periodically to make sure they reflect present conditions. Those no longer applicable will be dropped. 2. Basic Safety Rules The following basic safety rules have been established to help make our company a safe and efficient place to work. These rules are in addition to safety rules that must be followed when doing particular jobs or operating certain equipment. Those rules are listed elsewhere in this program. Failure to comply with these rules will result in disciplinary action. a. Never do anything that is unsafe in order to get the job done. If a job is unsafe, report it to your supervisor or safety committee representative. We will find a safer way to do that job. b. Do not remove or disable any safety device! Keep guards in place at all times on operating machinery. c. Never operate a piece of equipment unless you have been trained and are authorized. d. Use your personal protective equipment whenever it is required. e. Obey all safety warning signs. f. Working under the influence of alcohol or illegal drugs or using them at work is prohibited. g. Do not bring firearms or explosives onto company property. h. Smoking is only permitted outside the building away from any entry or ventilation intake. i. j. Horseplay, running and fighting are prohibited Clean up spills immediately. Replace all tools and supplies after
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Injury & Illness Prevention Program (For High-Hazard Industry Employers) use. Do not allow scraps to accumulate where they will become a hazard. Good housekeeping helps prevent injuries.
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Injury & Illness Prevention Program (For High-Hazard Industry Employers) 3. Standard Work Procedures Effectiveness in safety and health performance results our commitment to establish standard work procedures that fix accountability. These directives or standard work procedures can be oral or written but in all case communicated to each worker, defining specific responsibilities and objectives where safety and health are concerned. It is not uncommon in business operations for individual groups such as quality control, production control, safety and other groups to have their own procedures for doing the same work. The objective is to use results of a work analysis to establish one standard procedure for each job, which is on record and available for reference and continued use. Ideas can often be obtained from equipment and tool manufacturers. It is strongly recommended that those departments consult with employees and use their ideas, particularly those employees who have experience in the work being studied. Standard work procedures provide the tools for teaching how to work consistently with a maximum of efficiency and safety.
C. Company Specific Safety Programs

1. Personal Protective Equipment (PPE) XYZ Company will insure that all employees and subcontractors will use appropriate PPE while on-site. This will include appropriate hard hats, safety glasses, hearing protection, body harnesses and positioning belts and all other necessary equipment as required by site and working conditions. 2. Housekeeping
Injury & Illness Prevention Program (For High-Hazard Industry Employers) XYZ Company will enforce housekeeping requirements daily. This will include: a. Requiring subcontractors to keep their work areas orderly and clean up daily. b. Keeping walkways and access areas clear. c. Run cords and hoses so as not to pose a trip hazard. Do not run cords or hoses through doorways or other openings where they could be pinched and damaged. d. Combustible materials and debris will be properly stored or disposed of daily. Trash will not be permitted to accumulate and will be placed in covered containers or furnished dumpsters. e. Form and scrap lumber will be stored and cleared away from the work area daily. All protruding nails will be hammered in, removed or bent over to prevent injury. f. Spills involving combustible or flammable liquids, oils or grease will be cleaned up immediately. 3. Self-Inspections XYZ Company safety and supervisory personnel will perform daily walk-through inspections. Inspections will be documented and deficiencies noted. Equipment operators will inspect their equipment daily, and a log will be kept in the piece of equipment. All inspection logs will be available for review. a. The XYZ Company Safety Representative is the authority on all company Occupational Health and Safety inspections and safety training, and is responsible for ensuring all required safety inspections are promptly conducted. b. Types and Frequency of Safety Inspections and Surveys. Safety Inspections shall be conducted at periodic intervals of all work locations.
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Injury & Illness Prevention Program (For High-Hazard Industry Employers) c. When established, safety committee members are responsible for conducting self-inspections of their areas and other areas, as assigned by the Safety Representative. d. Supervisors are responsible for conducting self-inspections of their assigned work area(s). 4. Governmental Inspections In the event of a governmental inspection, the compliance officer will be directed to any General Contractors office. If not the General Contractor, XYZ Company will follow the prescribed General Contractor procedures. Outside Agency Inspections. These may include: State Occupational Safety & Health Inspector.

City/County/State Fire Inspector. Insurance Company Loss Control Consultant. Other bonified inspectors with a contractual or legal
interest. a. The Safety Representative shall be immediately notified by any employee who has knowledge of an outside agency inspection, and accompany all inspectors while they are on the property. b. Supervisors shall also be notified and will be encouraged to accompany outside agency inspections of their areas of responsibility. 5. Audits
XYZ Company will cooperate fully with any General Contractor, and the insurance authority with regard to monthly and periodic
52
Injury & Illness Prevention Program (For High-Hazard Industry Employers) safety audits. Additionally, XYZ Company will conduct a monthly audit of all subcontractors under our contract, which are on-site. 6. Planning All project activities will include planning for safety concerns throughout the project. A "Job Hazard Analysis" will be generated with the project superintendent and foremen for all hazardous operations. Subcontractors will be required to provide a documented Job Hazard Analysis for their work prior to commencing operations. 7. Job Hazard Analysis XYZ Company will actively promote and develop a complete Job Hazard Analysis for all construction programs within the scope of our work. a. Those operations, which do not fall in the analysis loop, will be designated as non-hazardous and filed in the appropriate order along with the Job Hazard Analyses. b. Job Hazard Analysis shall be produced by the superintendent and appropriate crew foremen and reviewed by XYZ Company Safety Representative. A copy of each Job Hazard Analysis shal1 be maintained onsite and available for review. Who should participate in a hazard analysis? c. To be fully effective and reliable, it should represent as many different viewpoints as possible. Each person familiar with a process or operation has gained insights concerning problems, faults, and situations that can cause accidents. These insights need to be recorded along with those of the initiator of the hazard analysis, who is the superintendent, appropriate crew foremen, company Safety Representative or a
53
Injury & Illness Prevention Program (For High-Hazard Industry Employers) contract safety professional. What processes, operations, and tasks need to be analyzed? Many processes, operations and tasks in any establishment are good candidates for hazard analysis because they have the potential to cause accidents. Eventually, hazard analyses should be completed for all jobs, but the most potentially threatening should have immediate attention. Those that are making the decisions should consider:

Frequency of accidents Potential for injury Severity of injury
New or altered equipment, processes, equipment, and operations
Excessive material waste or damage to equipment
8. Responsibilities for "Controlling" Workplace Hazards It is the responsibility of all employees to control the possibility of hazards in their work area, which, if left uncorrected, could cause injury to other employees, the public at large and damage to equipment or property.
9. Requirements for "Reporting" Workplace Hazards All workplace hazards, which cannot be immediately controlled (barricaded, placement of warning/danger signs, etc.) or corrected on the spot, shall be immediately reported to the supervisor in charge and the company Safety Representative. 10.Procedures for "Correcting" Identified Workplace Hazards
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Injury & Illness Prevention Program (For High-Hazard Industry Employers) It is the responsibility of each supervisor to ensure that identified workplace hazards are corrected and employees informed. Hazards that have been identified through safety inspections shall be corrected within a reasonable time to make necessary repairs or corrections to abate the hazard.
D. Enforcement Procedures and Systems

At XYZ Company, safety rules and work procedures shall be practiced and enforced. We have established a system to ensure that violations of rules are dealt with fairly but firmly, that all employees are aware of the requirements, and that reorientation or retraining may be provided when needed. Incentive programs may be initiated and will be used in conjunction with a good enforcement program. 1. Discipline No safety program can be effective without some form of discipline. There are no rules that must be followed, only guidelines. The following guidelines have been established by XYZ Company. a. The first preventable accident or safety rule violation observed should result in a discussion with the employee and the supervisor or manager. This verbal reprimand should be documented, dated, and signed by those involved.
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Injury & Illness Prevention Program (For High-Hazard Industry Employers) b. A second preventable accident or safety rule violation observed within a 12-month period should result in another discussion with the employee accompanied by a written reprimand. Time off without pay, up to a maximum of 5 days, should be considered. c. A third preventable accident or safety rule violation observed within a 12-month period should result in another discussion with the employee and a serious evaluation needs to be made. This is probably grounds for termination. Compliance a. One point must be very clear: discipline has to be administered uniformly and consistently. b. Violations of safety rules and policies should be addressed in the following manner:
First Incident: Verbal warning, documented
discussion.
Second Incident: Written reprimand, up to 5 days
suspension.
Third Incident: Written reprimand, grounds for
termination. c. Each supervisor or manager shall be responsible for administering this policy to his/her subordinates. d. All written reprimands and records of violations shall be held confidential and maintained in the employees personnel files. 3. Accountability
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Injury & Illness Prevention Program (For High-Hazard Industry Employers) Each supervisors efforts and performance will be evaluated relative to reaching XYZ Company safety objectives and assigned responsibilities. This evaluation will be part of the supervisors performance review and will be used in part to determine his or her job assignments, merit increases or promotions.
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E. Medical and First Aid

Medical treatment plans. 1. Key XYZ Company personnel should be trained in first aid and CPR. The XYZ Company disaster plan coordinator shall maintain a list of those trained and qualified personnel. Responsibility for monitoring and ensuring initial and recurring training is accomplished, shall be the responsibility of the Safety Representative. 2. All supervisory personnel should be encouraged to enroll in a first aid course and to learn CPR. Those employees who work around high voltage equipment shall be required to be certified annually in CPR. 3. Each XYZ Company construction office shall be equipped with a standard first aid kit suitable for the size of the workforce. Additional first kits may be strategically positioned throughout the workplace and/or jobsite. The location of each kit will be communicated to all employees and shall be clearly marked First Aid. 4. Vehicle size first aid kits shall be maintained in each XYZ Company construction/project-use vehicle. 5. All first aid supplies shall be inspected at least monthly and replenished as required. 6. Accident / Injury reporting: All accidents, near miss incidents and injuries shall be reported to XYZ Company Safety Representative. Following an injury: a. The employees injury will be evaluated and first aid rendered.
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Injury & Illness Prevention Program (For High-Hazard Industry Employers) b. If the injury requires medical attention the employee will be escorted to the onsite clinic. Further evaluation and treatment will be rendered. c. A determination will be made by XYZ Company site supervision and safety representative as to whether or not the injured, and any other involved are to be drug tested. Usually a postaccident drug test is required.
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Injury & Illness Prevention Program (For High-Hazard Industry Employers) d. An Employer's Initial Report of Industrial Injury, Accident and Property Damage form (as directed by your State) will be completed for all injuries requiring medical attention, even if only first aid, when rendered at either an onsite clinic or outside medical facility. e. A supervisor's report or Statement of Injury will be completed by the employees' supervisor. f. An investigation into the incident will be completed by XYZ Company Safety Representative, even if no serious injury occurred. g. A copy of any applicable State document on Employer's Initial Report of Industrial Injury, Accident and Property Damage form, Supervisor's report or Statement of Injury will be submitted to the XYZ Company Safety Representative for the employer provided workers' compensation coverage. h. All first aid cases may be recorded on a First Aid Log maintained by XYZ Company Safety Representative.
F. Disciplinary Policy
XYZ Company employees are expected to use good judgment when doing their work and to follow established safety rules. We have established a disciplinary policy to provide appropriate consequences for failure to follow safety rules. This policy is designed not so much to punish as to bring unacceptable behavior to the employee's attention in a way that the employee will be motivated to make corrections. The following consequences apply to the violation of the same rule or the same unacceptable behavior: 1. First Instance -- verbal warning, notation in employee file, and instruction on proper actions
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Injury & Illness Prevention Program (For High-Hazard Industry Employers) 2. Second Instance -- 1 day suspension, written reprimand, and instruction on proper actions 3. Third Instance -- 1 week suspension, written reprimand, and instruction on proper actions 4. Fourth Instance -- Termination of employment.
Section 9
Safety Training and Instruction

Training at XYZ Company is an essential part of our plan to provide a safe work place. Training Administrator The Injury and Illness Prevention Program training administrator, Training Administrator has the authority and responsibility for implementing the training provisions of this program. DECISION POINT Enter a name or position title (recommended) The Training Administrator for XYZ Company is _______________________________________. The Training Administrator is responsible to verify that each employee has received an initial safety orientation by their supervisor, has received any training needed to do the job safely and that the employee file documents the training. This administrator will make sure that an outline and materials list is available for each training course we provide:
A. New-Hire Employee Orientation
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Injury & Illness Prevention Program (For High-Hazard Industry Employers) 1. All XYZ Company employees will attend the new-hire
employee orientation prior to commencing employment. Newhires shall receive occupational health and safety training in the following subject areas: a. XYZ Company Safety Philosophy and Policy b. Disciplinary procedures for non-compliance c. Employee Danger Reporting System d. Accident Reporting System e. Personal Protective Equipment (when applicable) f. Fall Protection -100% tie-off (when applicable) g. Fire Prevention h. Hazardous Communication Standard, Material Safety Data Sheets, and Environmental Safety i. j. Bloodborne Pathogens Program (if applicable) Workplace housekeeping rules
k. Safety Incentive Program (when established).
B. Supervisor Safety Awareness Training

At XYZ Company, supervisory training is a logical first step since supervisors will help in training the other employees. Supervisors are key figures in the implementation and overall success of the safety and health program. As a minimum, supervisors at XYZ Company shall be trained in the following areas: 1. The need to establish and maintain safe and healthful working conditions;
62
Injury & Illness Prevention Program (For High-Hazard Industry Employers) 2. The dangers associated with a job, the potential effect on employees, and the rules, procedures and work practices for control of these dangers; 3. How to relate this information by example and instruction to employees, to ensure that they understand and follow safe procedures; and 4. How to investigate accidents, and to take corrective and preventive action to prevent recurrence.
C. Employee Safety Training

At XYZ Company, we recognize that employees may create dangers through their own actions if they have not been properly trained. Dangerous situations can be avoided, or made less dangerous, when our employees receive appropriate training and instruction in the following subject areas:
1. Standard work procedures including safe work practices, and how these procedures protect against exposure to dangers. 2. Personal protective equipment: why it is needed, how to use it, and how to keep it in good condition. 3. What to do in case of fire or other emergency that may occur in the workplace. Training is as essential to the overall program as these elements: management commitment; danger assessment and control; and safety planning, rules and work procedures.
D. Required Occupational Safety and Health Programs
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Injury & Illness Prevention Program (For High-Hazard Industry Employers) Hazard Communication Program 1. All XYZ Company employees will receive training in compliance with the OSHA Hazard Communication (HazCom) Standard. This training will be part of the new-hire employee orientation and will cover, at a minimum, the following areas: a. A review of the requirements of the HazCom Standard. b. Chemicals or hazardous materials likely to be found in their workplace; their health effects and means of exposure or routes of entry. c. How to lessen or prevent exposure to hazardous chemicals or materials through the use of control/work practices and Personal Protective Equipment. d. Emergency procedures to follow in the event of an accident or exposure involving hazardous chemicals/materials. 2. Continuous HazCom training will be conducted via weekly toolbox safety meetings when applicable. 3. Personnel regularly expose to hazardous chemicals as part of their job tasks will receive annual refresher training within 30 days of their employment date or by department annual schedule. Note: This annual refresher HazCom training shall be documented.
E. Other Company Required Safety Programs

Section 11)
(See
F. Company Required Safety Training Courses

(See Section 12)
64
G. Company Required Safety Program Forms

Section 13)
(See
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Section 10
Accident Recordkeeping
A. Injury and Illness Recordkeeping
In order to establish meaningful goals and objectives for mishap reduction, we must first know where we, as a company, have been in terms of previous mishap experience. For that reason and to comply with federal recordkeeping requirements, the following documentation shall be maintained: 1. The Safety Representative shall maintain for a period of
5 years: a. Safety accident investigation reports for all lost workday occupational injuries, illnesses or equipment damage; b. Safety accident investigation reports for company property damage, as a result of accidents; c. Records of formal claims against the company for injury, illness, personal loss, and/or damage to personal property; and 2. OSHA Form No. 300, Log of Work-Related Injuries and
Illnesses, shall be used to record injuries or illnesses that result in fatalities, lost workdays, require medical treatment, involve loss of consciousness, or restrict work or motion. The annual report of this form must be posted by February 1st in a centralized area visible to all employees, and remain there for at least 3 months.
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Injury & Illness Prevention Program (For High-Hazard Industry Employers) 3. OSHA Form No. 301, Injury and Illness Incident
Report, shall, when used, be used to give details of each recordable occupational injury and illness. Records must be available for examination by representatives of the U.S. Department of Labor and the Department of Health and Human Services. Note: This record and/or the SF-301 are kept for five years. 4. OSHA Form No. 300A, Summary of Work-Related
Injuries and Illnesses, provides additional data to make it easier for employers to calculate incidence rates. Employers must review the OSHA 300 Log information before it is summarized on the 300A form. 5. Accident Review Following an injury or near miss accident, the incident will be reviewed with the Project Manager and onsite supervision. This review will address the effectiveness of our program, any additional task training that may be needed and measures to prevent recurrence. Each month the company Program Administrator/Safety Representative shall report on the effectiveness of XYZ Company safety program to the project or company manager. This report can include data on the number of man-hours worked, the numbers of accidents, injuries and near miss incidents for the month and measures taken to prevent recurrences.
B. Corrective Actions
DECISION POINT - State your method of corrective action here. 1. Timely Correction of Dangers
Once remedial measures to control or eliminate dangers have
67
Injury & Illness Prevention Program (For High-Hazard Industry Employers) been agreed upon, you should make sure that they are implemented with minimum delay. Interim protection for employees may be necessary until the danger is eliminated or controlled. Keep a record of steps taken to control or eliminate a danger. Records should contain the danger, who reported it and when who is responsible for correction, the correction target date and when it was corrected. Such information will assist in developing safe work practices and training programs.
2.
Responsibility for Corrective Action

a. Actions necessary to correct or remedy accident causal
factors shall rest with the XYZ Company Safety Representative.
b. The XYZ Company Safety Representative shall have the

broad authority to recommend corrective actions to abate an identified hazard or deficiency to prevent injury or illness to employees, and to prevent property damage or personal loss.
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Section 11
Company Required Safety Programs

Due to the nature of work and operations performed by XYZ Company, it is necessary that the following regulatory programs are included in our Injury and Illness Prevention Program: For convenience, programs listed in the table below are alpha sorted. DECISION POINT Review and select those programs that apply or included others not listed
Company Required Safety and Health Plans & Programs

Accident Prevention Program Asbestos Management Plan Bloodborne Pathogens Program Chemical Hygiene Plan Confined Space Entry Program Control of Hazardous Energy Program Cranes and Derricks Safety Program Electrical Safety Program Emergency Action Plan Excavation and Trenching Program Fall Protection Program Fire Prevention Work Plan Flammable Storage / Compressed Gas Forklift Safety Program Hazard Communication Program Hearing Conservation Program Hot Work Permit Program Ladders and Stairways Work Plan Laser Safety Program Lead Safety Program Personal Protective Equipment Plan Powered Industrial Truck Program Radiation Protection Program Respiratory Protection Program Scaffolding Safety Program Welding Safety Program
Table 1 Safety Office Depot. All rights reserved. 69
All Safety Plans & Programs are available through Safety Office Depot www.SafetyOfficeDepot.com
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Section 12
Company Required Safety Training Courses

Due to the nature of work and operations performed by XYZ Company, it is necessary that the following safety training courses are included in our Injury and Illness Prevention Program: For convenience, courses listed in the 3 tables below are alpha sorted. DECISION POINT Review and select those courses that apply or included others not listed
Company Required Safety Training Courses Sorted A-E

Accident Investigation Accident Prevention Signs & Tags Asbestos Safety Bloodborne Pathogens Initial/Refresher Bloodborne Pathogens Train-theTrainer Chemical Spills Competent Persons Compressed Gas Cylinder Concrete & Masonry Confined Space Entry Construction Safety Management Crane Safety Refresher Cranes & Derricks in Construction Electrical Safety Emergency Exit Routes Emergency Response Team Ergonomics Basic Human Factors Ergonomics Advanced Human Factors Excavation Safety Eye & Face Protection
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Table 2
All Safety Training Courses are available through Safety Office Depot www.SafetyOfficeDepot.com
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Company Required Safety Training Courses Sorted F-L

Fall Protection Portable Fire Extinguisher Flammable & Combustible Liquids Forklift Safety Classroom (English) Forklift Safety Classroom (Spanish) Hand & Power Tools Hazard Communication Hazard Vulnerability Hazardous Materials Management Hearing Protection Hexavalent Chromium Hot Work Permit Safety Indoor Air Quality Introduction to OSHA Job Hazard Analysis Laser Safety Lead Exposure Liquid Nitrogen Lockout-Tagout
Table 3
Company Required Safety Training Courses Sorted M-W

Machine Guarding Material Handling Office Safety Awareness Pandemic Preparedness Personal Protective Equipment Powered Industrial Truck Radiation Safety Respirator Protection Safe Lifting Awareness Back Safety Safety Audit Training Safety Representative Training Safety Supervisor Training Scaffolding Slip, Trip & Fall Prevention Stairway & Ladder Safety TB Respiratory Protection Walking & Working Surfaces Warehouse Safety Workplace Violence Prevention Healthcare Workplace Violence Prevention Retail
Table 4
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Section 13
Company Required Safety Forms & Checklists

Due to the nature of work and operations performed by XYZ Company, it is necessary that the following safety forms and checklists are included in our Injury and Illness Prevention Program: For convenience, forms listed below are subject sorted. DECISION POINT Review and select those forms that apply or included others not listed
CONFINED SPACE Confined Space Entry Permit Confined Space Class A & B Permit Confined Space Class C Permit List of Authorized Entrants Permit Required Confined Space Inventory Log CONSTRUCTION INDUSTRY - SAFETY MANAGEMENT Construction Industry Inspection Checklist Job Start-Up Checklist Contractors Job Site Checklist Contractor Safety Performance Report Construction Equipment Checklist Forklift Service Checklist Operator Performance Evaluation Checklist Safety Nets Inspection Checklist Body Harness & Lanyard Inspection Report Competent Person Evaluation Fall Protection CRANE OPERATIONS Cranes, Derricks or Material Handling Devices Worksheet Crane Inspection Checklist Crane Pre-Lift Checklist Sling (Chain) Inspection Report Monthly Hoist Rope Inspection Report Monthly Hoist Hook Inspection Report
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EMERGENCY ACTION AND RESPONSE Crisis Management Response Team - Contact Log Safety Representatives - Contact Log External Resources Contact Log Vulnerability Analysis Chart Bomb Threat Checklist Employee Evacuation - Accounting Log Physically Challenged Employee List Command Post Equipment Inventory Log Press Information Log Post Exercise Evaluation Report
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EMPLOYEE SAFETY RECORDS Employee Acknowledgement Form Employee Orientation Checklist Construction Employee PPE Assessment Form Employee PPE Issue Form Employee Safety Training Record Ergonomic Workstation Analysis Form Employee Ergonomic Workstation Questionnaire Employee Safety Suggestion Form EXCAVATION OPERATIONS Pre-Excavation Checklist Trenching Design Checklist Trench Safety Daily Field Report Competent Person Evaluation Excavation FIRE PREVENTION Hot Work Permit Fire Safety Inspection Checklist Fire Drill Post Response Report Emergency HAZMAT Inventory Log Hazardous Waste Disposal Request Form GENERAL INDUSTRY SAFETY MANAGEMENT General Industry Safety Inspection Checklist Office Safety Inspection Checklist Job Safety Analysis Worksheet & Instructions Accident Prevention Program Analysis Forklift Service Checklist Hearing Conservation Program Log Scaffolding Safety Checklist Site Safety Meeting Record Supervisors Monthly Meeting Record Report of Safety Hazard Form Property Security Survey INCIDENT REPORTING FORMS OSHA 300 Log Employee Injury & Illness Report Employee Injury Cost Accounting Matrix Vehicle Accident & Property Damage Report Compiling Direct and Indirect Costs OCCUPATIONAL HEALTH FORMS Medical Evaluation Questionnaire Respirator Use Respirator Fit Testing Record Hepatitis B Vaccine - Accept/Decline Form Bloodborne Pathogens Risk Classification Flowchart BBP Employee Annual Training Record BBP Source Patient Consent Form RADIATION PROGRAM FORMS Radioactive Material Use Log Pregnancy Declaration Form Laboratory Contamination Survey Record Radiation Producing Device - Authorization Form Training Guide for Radiation Workers Training Guide for Ancillary Radiation Works
TRAINING RECOGNITION CERTIFICATE Certificate of Completion
All Subject Form Groups are available through Safety Office Depot www.SafetyOfficeDepot.com
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Appendix A
List of Training Subjects

DECISION POINT Select applicable training subjects - Strikethrough/delete those that do not XYZ Company trains our workers about the following selected training subjects: 1. The employer's Code of Safe Practices. 2. Confined spaces. 3. Safe practices for operating any agricultural equipment. 4. Good housekeeping, fire prevention, safe practices for operating any construction equipment. 5. Safe procedures for cleaning, repairing, servicing and adjusting equipment and machinery. 6. Safe access to working areas. 7. Protection from falls. 8. Electrical hazards, including working around high voltage lines. 9. Crane operations.
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Injury & Illness Prevention Program (For High-Hazard Industry Employers) 10.Trenching and excavation work. 11.Proper use of powered tools. 12.Guarding of belts and pulleys, gears and sprockets, and conveyor nip points. 13.Machine, machine parts, and prime movers guarding. 14.Lock-out/tag-out procedures. 15.Materials handling. 16.Chainsaw and other power tool operation. 17.Tree falling/bucking procedures and precautions, including procedures for recognizing and working with hazard trees, snags, lodged trees, and unsafe weather conditions. 18.Yarding operations, including skidding, running lines, unstable logs, rigging and communication. 19.Landing and loading areas, including release of rigging, landing layout, moving vehicles and equipment, and log truck locating, loading and wrapping. 20.Fall protection from elevated locations. 21.Use of elevated platforms, including condors and scissor lifts. 22.Safe use of explosives. 23.Driver safety.
Injury & Illness Prevention Program (For High-Hazard Industry Employers) 24.Slips, falls, and back injuries. 25.Ergonomic hazards, including proper lifting techniques and working on ladders or in a stooped posture for prolonged periods at one time. 26.Personal protective equipment. 27.Respiratory Equipment. 28.Hazardous chemical exposures. 29.Hazard communication. 30.Physical hazards, such as heat/cold stress, noise, and ionizing and non-ionizing radiation. 31.Laboratory safety. 32.Bloodborne pathogens and other biological hazards. 33.Other job-specific hazards, such as __________________________________________
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Appendix B
Hazard Assessment Checklist

DECISION POINT Determine which checklists apply to your operation and delete all others XYZ Company has determined the following hazard assessment checklists apply to its operations
1. Abrasive Wheel
Equipment Grinders
12. Ergonomics 13. Exit Doors 14. Exiting or Egress 15. Fire Protection 16. Flammable &
Combustible Materials
2. Compressed Air
Receivers
3. Compressed Gas &

Cylinders
4. Compressors &
Compressed Air
17. Floor & Wall Openings 18. Fueling 19. General Work
Environment
5. Confined Spaces 6. Control of Harmful

Substances by Ventilation
7. Crane Checklist 8. Electrical 9. Elevated Surfaces 10. Emergency Action

Plan
20. Hand Tools &

Equipment
21. Hazardous Chemical

Exposures
22. Hazardous
Substances Communication
11. Environmental
Controls
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Injury & Illness Prevention Program (For High-Hazard Industry Employers) 23. Hoist & Auxiliary
Equipment
33. Portable Ladders 34. Powder Actuated

Tools
24. Identification of Piping

Systems
35. Sanitizing Equipment

& Clothing
25. Industrial Trucks

Forklifts
36. Spraying Operations 37. Stairs and Stairways 38. Tire Inflation 39. Transporting
Employees & Materials
26. Infection Control 27. Lockout-Tagout

Procedures
28. Machine Guarding 29. Material Handling 30. Noise 31. Personal Protective
Equipment & Clothing
40. Ventilation for Indoor

Air Quality
41. Walkways 42. Welding, Cutting &

Brazing
32. Portable (Power

Operated) Tools & Equipment
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Appendix C
Hazard Assessment and Correction Record
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Hazard Assessment and Correction Record
Date of Inspection: ________________________________________ Person Conducting Inspection: _______________________________ Unsafe Condition or Work Practice: _________________________________________________ _____________________________ _________________________________________________ _____________________________ _________________________________________________ _____________________________
Corrective Action Taken: _________________________________________________ _____________________________ _________________________________________________ _____________________________ _________________________________________________ _____________________________
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Appendix D Accident/Exposure Investigation Report
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Accident/Exposure Investigation Report

Date of Accident: _____________________________ Time of Accident: __________________ Location of Accident: _________________________________________________ __________ Accident Description: _________________________________________________ _____________________________ _________________________________________________ _____________________________ _________________________________________________ _____________________________ Employees Involved: _________________________________________________ _____________________________ _________________________________________________ _____________________________ Preventive Action Recommendations: _________________________________________________ _____________________________ _________________________________________________ _____________________________
85
Injury & Illness Prevention Program (For High-Hazard Industry Employers) Corrective Actions Taken: _________________________________________________ _____________________________ _________________________________________________ _____________________________ Manager Responsible: ________________________________________ Date Corrective Actions Completed: _____________________________
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Appendix E Employee Training and Instruction Record
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Employee Training and Instruction Record

Employee Receiving Training:
(First Name) (Last Name)
(Middle Initial)
(Safety Training Topic) Select one: Initial Annual/Refresher Periodic Special
This employee has received specific safety & health training in the following subject areas:
Person conducting the training: (First Name) (Last Name) (Middle Initial)
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Trainers Signature Date Qualification or Job Title of Trainer
Trainees Signature Date
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Appendix F
Codes of Safe Practice

DECISION POINT Determine which of the following Codes of Safety Practices apply to your companys operation, combine or edit them or delete/strikethrough the codes that in your opinion are non-applicable.
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Codes of Safe Practices General Industry

It is our policy that everything possible will be done to protect employees, customers and visitors from injury. Safety is a cooperative undertaking requiring participation by every employee. Failure by any employee to comply with safety rules will be grounds for corrective discipline. Supervisors shall insist that employees observe all applicable Company, State and Federal safety rules and practices and take action as is necessary to obtain compliance. To carry out this policy employees shall follow these safety rules and practices: 1. Report all unsafe conditions and equipment to your supervisor or safety coordinator. 2. Report all incidents, injuries and illnesses to your supervisor or safety coordinator immediately. 3. Anyone known to be under the influence of intoxicating liquor or drugs shall not be allowed on the job while in that condition. 4. Horseplay, scuffling, and other acts which
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Injury & Illness Prevention Program (For High-Hazard Industry Employers) tend to have an adverse influence on the safety or well-being of the employees, are prohibited. 5. Means of egress shall be kept unblocked, well-lighted and unlocked during work hours. 6. In the event of fire, sound alarm and evacuate. 7. Upon hearing fire alarm, stop work and proceed to the nearest clear exit. Gather at the designated location. 8. Only trained workers may attempt to respond to a fire or other emergency. 9. Exit doors must comply with fire safety regulations during business hours. 10. Stairways should be kept clear of items that can be tripped over, and all areas under stairways that are egress routes should not be used to store combustibles. 11. Materials and equipment will not be stored against doors or exits, fire ladders or fire extinguisher stations. 12. 13. Aisles must be kept clear at all times. Work areas should be maintained in a neat, orderly manner. Trash and refuse are to be thrown in proper waste containers.
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Injury & Illness Prevention Program (For High-Hazard Industry Employers) 14. 15. All spills shall be wiped up promptly. Always use the proper lifting technique. Never attempt to lift, push, pull or carry an object that is too heavy. You must contact your supervisor when help is needed to move a heavy object. 16. Never stack material precariously on top of lockers, file cabinets or other relatively high places. 17. When carrying material, caution should be exercised in watching for and avoiding obstructions, loose material, etc. 18. Do not stack material in an unstable manner. 19. Report exposed wiring and cords that are frayed or have deteriorated insulation so that they can be repaired promptly. 20. Never use a metal ladder where it could come in contact with energized parts of equipment, fixtures or circuit conductors. 21. Maintain sufficient access and working space around all electrical equipment to permit ready and safe operations and maintenance. 22. Do not use any portable electrical tools and equipment that are not grounded or double-insulated. 23. All electrical equipment should be plugged
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Injury & Illness Prevention Program (For High-Hazard Industry Employers) into appropriate wall receptacles or into an extension of only one cord of similar size and capacity. Three-pronged plugs should be used to ensure continuity of ground. 24. All cords running into walk areas must be taped down or inserted through rubber protectors to preclude them from becoming tripping hazards. 25. Inspect motorized vehicles and other mechanized equipment daily or prior to use. 26. Shut off engine, set brakes and block wheels prior to loading or unloading vehicles. 27. Inspect pallets and their loads for integrity and stability before loading or moving. 28. Do not use compressed air for cleaning off clothing. 29. Do not store compressed gas cylinders in areas which are exposed to heat sources, electric arcs or high temperature lines. 30. Identify contents of pipelines prior to initiating any work that affects the integrity of the pipe. 31. Wear hearing protection in all areas identified as having high noise exposure. 32. Goggles or face shields must be worn
94
Injury & Illness Prevention Program (For High-Hazard Industry Employers) when grinding. 33. 34. Do not use any faulty or worn hand tools. Guard floor openings by a cover, guardrail, or equivalent. 35. Do not enter into a confined space unless tests for toxic substances, explosive concentrations, and oxygen deficiency have been taken. 36. Always keep flammable or toxic chemicals in closed containers when not in use. 37. Do not eat in areas where hazardous chemicals are present. 38. Be aware of the potential hazards involving various chemicals stored or used in the workplace. 39. Cleaning supplies should be stored away from edible items on kitchen shelves. 40. Cleaning solvents and flammable liquids should be stored in appropriate containers. 41. Solutions that may be poisonous or not intended for consumption should be kept in well-labeled containers. 42. When working with a computer, have all pieces of furniture adjusted, positioned and arranged to minimize strain on all parts of the body.
95
Injury & Illness Prevention Program (For High-Hazard Industry Employers) 43. Never leave lower desk or a cabinet drawer open, which presents a tripping hazard. Use care when opening and closing drawers to avoid pinching fingers. 44. Do not open more than one upper drawer at a time, particularly the top two drawers on tall file cabinets. 45. Individual heaters at work areas should be kept clear of combustible materials, such as drapes, or waste from waste baskets. Newer heaters that are equipped with tip-over switches should be used. 46. Appliances, such as coffee pots and microwaves, should be kept in working order and inspected for signs of wear, heat or fraying of cords. 47. Fans used in work areas should be guarded. Guards must not allow fingers to be inserted through the mesh. Newer fans are equipped with proper guards.
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Codes of Safe Practices Construction Industry

1. All persons shall follow these safe practices rules, render every possible aid to safe operations, and report all unsafe conditions or practices to the supervisor or superintendent. 2. Supervisors or foremen shall insist on employees observing and obeying every applicable Company, State or Federal regulation and order as is necessary to the safe conduct of the work, and shall take such action as is necessary to obtain compliance. 3. All employees shall be given frequent injury and illness prevention instructions. Instructions shall be given at least every 10 working days. 4. Anyone known to be under the influence of drugs or intoxicating substance which impair the employees ability to safely perform the assigned duties shall not be allowed on the job while in that condition. 5. Horseplay, scuffling, and other acts which tend to have an adverse influence on the safety or well-being of
97

the employees, shall be prohibited. 6. Work shall be well planned and supervised to prevent injuries in the handling of materials and in working together with equipment. 7. No one shall knowingly be permitted or required to work while the employees ability or alertness is so impaired by fatigue, illness, or other causes, that they might unnecessarily expose the employee or others to injury. 8. Employees shall not enter manholes, underground vaults, chambers, tanks, silos, or other similar places that receive little ventilation unless it has been determined that it is safe to enter. 9. Employees shall be instructed to ensure that all guards and other protective devices are in proper places and adjusted, and shall report deficiencies promptly to the supervisor or superintendent. 10. Crowding or pushing when boarding or leaving any vehicle or other conveyance shall be prohibited. 11. Workers shall not handle or tamper with any electrical equipment, machinery, or air or water lines in a manner not within the scope of their duties, unless they have received instructions from their superintendent. 12. All injuries shall be reported promptly to the
98

supervisor or superintendent so that arrangements can be made for medical or first aid treatment. 13. When lifting heavy objects, the large muscles of the leg, instead of the smaller muscles of the back, shall be used. 14. Materials, tools, or other objects, shall not be thrown from buildings or structures until proper precautions are taken to protect others from the falling objects. 15. Inappropriate footwear or shoes with thin or badly worn soles must not be worn. 16. Hand protection, such as gloves, shall be worn when there is excessive exposure to cuts, burns, or other materials that could cause injury (except where there is danger of the hand protection becoming entangled in moving machinery). 17. Hard hats shall be worn whenever overhead hazards exist and in all areas designated for hard hat use. 18. Safety glasses, goggles, or other suitable eye protection shall be worn when there is a hazard to unprotected eyes (e.g., when using a grinding wheel, etc.). 19. Employees shall cleanse themselves thoroughly after handling hazardous substances and follow special instructions from authorized sources. 20. Carriers should avoid the use of extension
99

ladders when carrying loads. Such ladders may provide adequate strength, but the rung position and rope arrangement make such climbing difficult and hazardous for this trade. 21. Work shall be so arranged that employees are able to face a ladder and use both hands while climbing. 22. Gasoline shall not be used for cleaning purposes. 23. No burning, welding, or other source of ignition shall be applied to any enclosed tank or vessel, even if there are openings, until it has first been determined that no possibility of explosion exists and authority for the work is obtained from the supervisor or superintendent. 24. Any damage to scaffolds, false work, or other supporting structures shall be immediately reported to the supervisor and repaired before use. 25. Personal fall arrest systems or restraints shall be worn when working over 7 1/2 feet above ground or surface which does not provide protected sides, edges or openings (e.g., no guardrails, etc.).
USE OF TOOLS AND EQUIPMENT 26. All tools and equipment shall be maintained in good condition.
100
Injury & Illness Prevention Program (For High-Hazard Industry Employers) 27. Damaged tools or equipment shall be removed from service and tagged DEFECTIVE. 28. Pipe or Stillson wrenches shall not be used as a substitute for other wrenches. 29. Only appropriate tools shall be used for a specific job. 30. Wrenches shall not be altered by the addition of handle-extensions or cheaters. 31. Files shall be equipped with handles and not used to punch or pry. 32. A screwdriver shall not be used as a chisel. 33. Wheelbarrows shall not be pushed with handles in an upright position. 34. Portable electric tools shall not be lifted or lowered by means of the power cord. Ropes shall be used. 35. Electric cords shall not be exposed to damage from vehicles. 36. In locations where the use of a portable power tool is difficult, the tool shall be supported by means of a rope or similar support of adequate strength.
101
Injury & Illness Prevention Program (For High-Hazard Industry Employers) MACHINERY AND VEHICLES 37. Only authorized persons shall operate machinery or equipment. 38. Loose or frayed clothing, long hair, dangling ties, finger rings, etc., shall not be worn around moving machinery or other areas where they may become entangled. 39. Machinery shall not be serviced, repaired or adjusted while in operation, nor shall oiling of moving parts be attempted, except on equipment that is designed or fitted with safeguards to protect the person performing the work. 40. Where appropriate, lock-out procedures shall be used. 41. Employees shall not work under vehicles supported by jacks or chain hoists without protective blocking that will prevent injury if jacks or hoists should fail. 42. Air hoses shall not be disconnected at compressors until the hose line has been bled. 43. All excavations shall be visually inspected before backfilling to ensure that it is safe to backfill.
102
Injury & Illness Prevention Program (For High-Hazard Industry Employers) 44. Excavating equipment shall not be operated near tops of cuts, banks, or cliffs, if employees are working below. 45. Tractors, bulldozers, scrapers and carryalls shall not operate where there is a possibility of overturning in dangerous areas like edges of deep fills, cut banks, and steep slopes. 46. When loading where there is a probability of dangerous slides or movement of material, the wheels or treads of loading equipment, other than that riding on rails, should be turned in the direction which will facilitate escape in case of danger, except in a situation where this position of the wheels or treads would cause a greater operational hazard. ROOFING OPERATIONS 47. 48. Knotted hand lines should not be used. Roofers tending kettles, or carrying buckets of hot tar, shall wear gloves that fit snugly at the wrists, and longsleeved shirts fastened at the wrists. 49. At no time should a roofer, while handling or exposed to injury from hot tar, work without a shirt or appropriate footwear. 50. Appropriate portable fire extinguishers shall be kept at or near the kettle,
Injury & Illness Prevention Program (For High-Hazard Industry Employers) attached, if practicable, to the tongue of the kettle, away from the danger zone. 51. Kettle covers should be equipped with a handle that projects at least fourteen inches (14") away from the surface of the cover or lid. 52. Kettle covers shall be closed and latched when in transit and the kettle should be slop-proof when cover is closed. 53. When parked, means shall be provided to prevent inadvertent movement of the kettle. 54. Ladders should be used with great caution, and roof gutters should not be depended upon for support. 55. Workers handling buckets of hot tar should not carry anything that will interfere with the safety of this operation. 56. The gallows frame shall be securely anchored before hoisting materials. 57. Only muscular power shall be used to hoist materials by means of a gallows frame. A winch or power hoist shall not be used.
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Injury & Illness Prevention Program (For High-Hazard Industry Employers) BLASTING OPERATIONS 58. Cases that have contained explosives shall be destroyed by burning out-ofdoors. Do not burn in a stove or furnace. 59. Shoes with nails or metal plates shall not be worn in magazines or near explosives. 60. Blasting caps shall only be carried in approved containers. 61. The least amount of proper strength explosive that will do the job effectively shall be used. 62. Detonators and primers shall be separated from the explosives until it is necessary to bring together in preparing for the blast. 63. Holes loaded during a shift should be fired during that shift. 64. The operations of loading and firing should be carried out with as few workers as possible. 65. Drill holes shall be blown out and made ready before explosives are brought to the site. 66. In tamping explosives, steady, even pressure should be used. 67. For electric blasting, the following shall
105
Injury & Illness Prevention Program (For High-Hazard Industry Employers) apply: (a) (b) Tight electrical connections. No short circuits or breaks in the wires. (c) (d) Enough current to fire all shots. A strong, properly-applied force when using a blasting machine operated by physical effort. (e) Care not to damage the insulation
of wires when tamping charges. 68. If misfires occur, the licensed blaster shall be contacted.
106
Appendix G
Employee Acknowledgement Form
107
Employee Acknowledgement Form

I hereby acknowledge that I have had the opportunity to read, review and ask questions on the contents of the companys Injury and Illness Prevention Program. I also acknowledge that the provisions of this program and company safety and health policies are part of the terms and conditions of my employment and agree to abide by them.
Furthermore, I understand that failure to comply with any part or parts of this program and any company safety and health policies may be grounds for termination of my employment. Additionally, I understand that failure to comply with the companys Drug-Free Workplace Policy shall also be grounds for termination of my employment.
Employee - Print Your Name Social Security Number
Signature of Employee Date
As an employee representative of the company, I hereby attest that the employee named here was given the opportunity to read, review and ask questions about the companys Injury and Illness Prevention Program and
108

company safety and health policies.
Witness Print Your Name
Duty Title of Witness
Signature of Witness Date
109
Safety Office Depot Disclaimer Notice
While we have made every attempt to ensure that the information contained in this document is reliable, Safety Office Depot is not responsible for any errors or omissions, or for the results obtained from the use or non-use of this information. All information in this document is provided "as is", with no guarantee of completeness, accuracy, timeliness or of the results obtained from the use or non-use of this information, and without warranty of any kind, express or implied, including, but not limited to warranties of performance, merchantability and fitness for a particular purpose. In no event will Americana Safety Associates, Safety Office Depot, or the partners, agents or employees thereof be liable to you or anyone else for any decision made or action taken in reliance on the information in this document or for any consequential, special or similar damages, even if advised of the possibility of such damages. Given the changing nature of laws, rules and regulations, there may be omissions or inaccuracies in information contained in this document. Accordingly, the information in this document is provided with the understanding that the authors and publishers are proving guidance with respect to the information contained herein and that the performance or non-performance of this guidance shall be the responsibility of the user of this information.
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actions; and 7. A system for periodically monitoring the place of