Kentucky Written Safety and Health Program
Content
Written Safety and Health Program For
XYZ Company
Required for all Kentucky Construction Companies Incorporates Provisions of Kentucky Revised Statutes 338.031
2013
Americana Safety. All rights reserved. Americana
Kentucky – Kentucky – Written Written Safety and Health Program
Table of Contents Section
Description
Page
1
Management Commitment and Policy
3
2
Assignment of Responsibilities
4
3
Safety Rules and Practices
9
4
Accident Reporting and Investigation
13
5
Accident Recordkeeping and Analysis
16
6
Safety Communication
20
7
Safety Committees and Meetings
22
8
Safety and Health Training
25
9
Hazard Recognition
28
10
Hazard Prevention and Control
37
11
Emergency Planning
47
12
Company Required Safety Programs
56
13
Company Required Safety Training Courses
57
14
Company Required Safety Forms & Checklists
59
Appendix A
List of Training Subjects
69
Appendix B
Hazard Assessment Checklists
71
Appendix C Appendix D
Hazard Assessment and Correction Record Accident/Exposure Investigation Report
72 74
Appendix E
Employee Training and Instruction Record
76
Appendix F
Employee Acknowledgement Form
78
Appendices
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Kentucky – Kentucky – Written Written Safety and Health Program
Section 1
Management Commitment Program Policy Statement
XYZ Company shall comply with all occupational safety and health laws of the State of Kentucky. To accomplish this, we must constantly be aware of unsafe acts and conditions in all work areas that can produce injuries. No employee is required to work at a job they know is not safe or healthful. As employees of XYZ Company, 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 written program is required for all construction companies doing businesses within the State of Kentucky. This program incorporates and complies with Kentucky Revised Statutes 338.031.
Proper use of this program requires the t he Program Administrator to carefully review the re requirements quirements for each of the program sections, appendices and to modify, where necessary, to acc accurately urately reflect specific company requirements as it relates to its operation and workforce. This program must be maintained by the employer in order to be effective.
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Section 2
Assignment of Responsibilities Safety and Health Responsibiliti Responsibilities es 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 CF CFR R 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:
1.
Program Adminis Administrator trator Written Safety and Health Program administrator, Program Administrator has the authority and responsibility for implementing the provisions of this program. Enter a name or position title (recommended) (recommended) DECISION POINT – Enter The Program Administrator for XYZ Company is _______________________ _________________________________ ________________. ______.
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2.
Safety Representativ Representative e Responsibilities Responsibilities The company safety representative, Safety Representative also has the authority and responsibility for implementing the provisions of this program and be the same person or title as the Program Administrator. Enter a name or position title (recommended) (recommended) DECISION POINT – Enter The Safety Representative for XYZ Company is ______________________ _______________________________ _____________. ____. A. The XYZ Company Safety and Health compliance program shall be managed and administered by the Safety Representative. B. Ensure the company’s compliance with all applicable federal, state, and local safety and health requirements. C. Ensure that each employee is provided with adequate a dequate and appropriate occupational safety and health training and personal protective equipment. D. Inspect all workplaces, projects, and/or facilities periodically, but not less than once per quarter. E. Ensure that the safety and health policies are comprehensive and effective. F. Review each accident and conduct any investigation wherein an accident has resulted in serious occupational injury, illness or property damage. G. Promote safety and health and serve as a resource to all staff. H. Review the program on an annual basis.
3.
Manager Responsib Responsibilities ilities A. Establish rules and programs designed designed to promote safety and make make known to all employees the established rules and programs. B. Provide all supervisors with copies of appropriate rules rules and regulations. C. Make availabl available e training necessary for employees to perform their tasks safely. safely. D. Provide pr protective otective equipment equipment for employees where required.
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E. Impress upon all empl employees, oyees, subcontractors and suppliers, suppliers, the responsibility and accountability of each individual to maintain a safe workplace. F.
Record all instances of violations violations and and investigate investigate all accidents.
G. Discipline any employee disregarding safety and loss prevention policies. H. Require all subcontractors as a matter of contract and all material suppliers suppliers through p pururchase order terms, to follow established safety rules. I.
Require all subcontractors to submit submit for review their safety programs and encourage them to work safely.
J.
Conduct saf safety ety inspections, inspections, maintain maintain records and continually continually monitor the program for for effectiveness.
4.
Supervisor Responsibilities A. Carry out safety programs programs at the work level. B. Be aware of all safety requirements and safe safe working practices. C. Plan work activities to comply comply with safe workin working g practices. D. Instruct new emplo employees, yees, existing employees, and subcontractors performing new tasks on safe working practices. E. Make sure protective protective equipment is available and used. F
Make sure work is performed in a safe manner and no unsafe unsafe conditions or equipment is present.
G. Correct all hazards, including including unsafe acts and conditions, conditions, which are within the scope scope of your position.
H. Secure prompt medical attention attention for for any injured employees. employees. 6
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I.
5.
Report all injuries and safety violations to management.
Employee Responsib Responsibilities ilities A. Work safely in such a manner manner as to ensure ensure your own safety safety as well as that of co-workers and others. B
Request h help elp when u unsure nsure about how to perform perform any any task safely.
C. Correct unsafe acts or conditions within the scope of the immediate work. D. Report any un uncorrected corrected unsafe acts acts or conditions conditions to the appropriate supervisor. E. Report for work in good mental and physical condition condition to safely carry out assigned duties. F.
Use and maintain all safety equipment provided.
G. Maintain and and properly use all tools under your control. H. Follow all safety and project rules. I.
Provide fellow employees help with safety requirements.
J.
REPORT ALL WORK RELATED INJURIES OR ACCIDENTS TO YOUR SUPERVISOR IMMEDIATELY.
6.
All Personnel (without regard to position or assignment): A. Strive to make all operations safe. B. Maintain mental and physical health conducive conducive to working safely. C. Keep all work areas clean and and free of debris. D. Assess result of your actions on the entire work place. Work will not be performed in in ways that cause hazards for others. 7
Kentucky – Kentucky – Written Written Safety and Health Program
E. Before leaving work, replace or repair safety precaution signs or barriers tha thatt have been been removed or altered. Unsafe conditions wil willl not be left to iimperil mperil others. F.
Abide by the safety rules and and regulations promulgated for this construction project. project.
DECISION POINT applicable POINT - delete if not applicable
7.
Subcontractors Subcontracto rs and Suppliers Responsibilities A. Abide by saf safety ety rules and regulations regulations as promulgated promulgated by Federal, State and local authorities including those of XYZ Company and any General Contractor. B. Notify all other contractors when their activities could affect the health health or ssafety afety of other employees in the workplace, project and/or facility.
C. Check in with XYZ Company Company site supervision when entering or leaving any job-site. D. Inform XYZ Company site Safety Representative of all injuries to workers, immediately. E. Report to XYZ Company site site supervision or safety representatives representatives any unsafe unsafe conditions. conditions. F. Provide for review Safety and Hazard Communications Programs. G. Provide a chemical inventory list an and d copies of Material Safety Data Sheets (MSDS) for any hazardous materials - prior prior to bringing materials on-site.
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Section 3
Safety Rules and Practices Statistics maintained by Workers' Compensation show that many job injuries are caused by neglecting fundamental safety precautions. The following list of safety rules will help you stay free of injury.
1.
General Safety
Know the job safety requirements.
Know your Agency Safety Representative and Agency Safety Officer. Contact him or her
with all safety problems and/or concerns. If you cannot correct an unsafe condition, report it immediately.
Read thoroughly all safety materials distributed to you.
Be certain that all instructions are clearly understood before starting a task.
Avoid horseplay, and avoid distracting others.
Do not sacrifice safety for the sake of production.
Always use the handrail on stairs.
Drive defensively when operating motor motor vehicles. Observe posted speed limits and and wear seat belts.
Report all injuries to your supervisor, no matter matt er how minor they seem.
Do not report for work under the influence of alcohol or drugs.
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2.
Ergonomics and Workplace Safety
Learn to lift and handle materials safely. Do not hesitate to ask for help in lifting heavy loads. Always push rather than pull a load.
Keep walking surfaces free from tripping tripping hazards. Keep work areas dry, clean and orderly.
Do not leave desk and file cabinet drawers open.
Open one file drawer at a time. Place heavier drawers at the bottom of the cabinet.
The top of the computer monitor should not be higher than the user's eyes for normal vision.
Bifocal and trifocal users may prefer to have their monitor at a lower position.
The screen and document holder should be the same distance from the eye and at the same level to avoid constant changes in focus and close enough e nough together so the operator ccan an look from one to the other without excessive movement of the neck or back.
The preferred viewing distance for monitors ranges between 18 and 24 inches.
The preferred working position for most keyboard operators is with the forearms parallel to the floor and elbows at the sides.
The mouse should be positioned at the operator's side with his or her arm close to the body for support, while maintaining a straight line between the hand and forearm.
Do not use office furniture or other objects instead of a ladder. Inspect ladders before use. Be certain they are in good repair and of the correct height.
3.
Personal Protective Equipment
Use appropriate respirators when working with hazardous materials.
Wear safety glasses, goggles, or face-shields when there is a risk of eye injury.
Never do a task or operate equipment without the required personal protective equipment.
Wear hard hats when there is a hazard from falling objects.
Wear substantial shoes when walking on rough or uneven surfaces. Steel-toed shoes are required when working around heavy loads that could fall on feet.
Wear appropriate gloves to prevent cuts and protect from hazardous materials.
Wear shoes with slip resistant soles that provide maximum m aximum surface traction.
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4.
5.
Emergency Procedures
Know what to do in case of fire or other emergency.
Know the locations of fire extinguishers and how to use them.
Equipment Safety
Operate only equipment for which you are qualified and authorized.
Do not wear jewelry or loose clothing around machinery or equipment.
Do not use defective or unguarded equipment. Report the condition to your supervisor.
Ensure that machine safety guards are always in place when operating equipment.
Maintain hand tools in good repair. Inspect them regularly.
Top heavy equipment should be properly anchored to the floor.
All pedestal/bench grinders should be equipped with properly adjusted tongue guards, tool t ool rests, and peripheral spindle guards.
Shield ventilation and exhaust fan blades with mesh (1/2 inch in diameter or smaller) when fans have been installed within seven feet of the work area floor.
Do not use powered industrial trucks/forklifts that are defective de fective in any manner (horn, brakes, etc.).
6.
Hazardous Materials
Separate compressed gas cylinders by type when storing them, and secure with valve protection caps in place. Separate oxygen cylinders from fuel gases by 20 feet.
Post "NO SMOKING" signs near all flammable liquids.
Report chemical spills to appropriate personnel immediately.
Store flammable liquids such as fuels and solvents (i.e., paint thinner) in approved safety cans. Quantities are also limited limited by KYOSH standard.
Ensure compliance with the KYOSH hazard communication standard. This includes a written program, labeling, material data sheets, and training.
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7.
Electrical Safety
Use portable electric tools outdoors only if they are grounded or double insulated and GFCI protected.
Ground all fixed electrical equipment.
Use extension cords to temporarily furnish furnish power to portable tools or appliances. Cords must be free of defects defect s and without splices.
Always put live electrical parts in proper enclosures and under no condition use exposed electrical parts.
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Section 4
Accident Reporting and Investigation in place, it must be created. POINT - If this investigation system is not in DECISION POINT
Accident Investigation and Reporting A system must be established for investigating investigating all workplace accidents, 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.
1.
Program Introducti Introduction on At XYZ Company accident investigation is an integral part of our total occupational safety and health program. It is especially important important as a means to determine root 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. recurr ence. 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 ex pertise would help the investigation.
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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 possib possible le 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. 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 e mployee 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. Represe ntative. Whenever there is an incident that did not but could have resulted in serious injury to an employee (a near-miss 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. A “Safety Inspection Guide Checklist” can be a useful tool to help the supervisor carry out his/her responsibilities as described above.
2.
Investigating Occupational Occupational Injury, Illness, and Property Damage A. The XYZ Company supervisor, if initially 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 r ecord and document where and how the accident occurred and the extent of injuries and damage to property 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. B. The Program Administrator/Safety Representative Representative shall report to and investigate investigate all serious 14
Kentucky – Kentucky – Written Written Safety and Health Program
occupational injuries, illnesses illnesses and property damage. A formal Incident Investigation R Report eport shall be prepared to determine the cause, document facts and recommend corrective actions to prevent recurrence.
3.
Reporting Occupational Occupational Injury, Illness and Property Damage A. XYZ Company employees shall report all occupational injuries, injuries, illnesses and property damage, initially through their supervisor to the Program Administrator/Safety Representative. This is the preferred method, which will w ill 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 doc umented and repaired. B. Supervisors will immediately notify the Program Administrator/Safety Administrator/Safety Representative of any serious and/or life threatening occupational injury and/or illness, illness, and property damage. All other minor occupational injuries and/or illnesses, and property damage will also be reported to the Program Progr am Administrator/Safety Representative the following day. C. 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 all-occ upational injuries and/or illnesses.
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Section 5
Accident Recordkeeping and Analysis 1.
Injury and Illness Recordkeeping In order to establish meaningful goals and objectives for mishap reduction, re duction, we must first know where we, as a company, have have been in terms of previous previous mishap experience. For that reason and to comply with federal recordkeeping requirements, the following documentation shall be maintained: A. The Safety Representative Representative shall maintain for a period of 5 years: 1) Safety accident investigation reports for all lost workday occupational injuries, illnesses or equipment damage; 2) Safety accident investigation reports for company property damage, as a result of accidents; 3) Records of formal claims against the company for injury, illness, personal loss, and/or damage to personal property; and B. 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 r equire 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 ce centralized ntralized area visible to all employees, and remain there for at least 3 months.
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C. OSHA Form No. 301, Injury and Illness Ill ness Incident Report, shall, when used, be used to give details of each recordable occupational injury and illness. Records must be available 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.
D. OSHA Form No. 300A, Summary of Work-Related Injuries and Illnesses, provides additional data to make it easier for employers employers to calculate incidence rates. Employers must review the OSHA 300 Log information before it is summarized on the 300A form. E. Accident Review Following an injury or near miss accident, the t he 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 o n the effectiveness of XYZ Company safety safety program to the project or company 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.
2.
Corrective Actions DECISION POINT POINT - State your method of corrective action here.
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. 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 assist in developing safe work practices and training programs. programs. 17
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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 o r personal loss. DECISION POINT POINT - State how this will be accomplished.
3.
Monitoring the Place of Employment. You have the responsibility of monitoring the workplace regularly – the the work procedures, equipment and machines – to 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.
4.
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 the Program Administrator/Safety Representative Represe ntative 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: Annual Site Survey
Once each year an inspection team made m ade up of members of the safety ccommittee ommittee will do a wallto-wall walk through inspection of the entire worksite. They will write down any safety hazards or potential hazards they find.
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The results of this inspection will be used to eliminate e liminate 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.
Periodic Change Survey
The Program Administrator/Safety Representative will request a supervisor to form a team to look at any changes we we make to identify safety issues. 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 w ere or may be created as a result of the change. Monthly Safety Inspection
Safety committee members will inspect their areas for hazards using the standard safety inspection checklist. They will talk to co-workers about about their safety concerns. Committee members will report any hazards hazards or concerns to the whole committee for consideration. The results of the area inspection and any action taken t aken 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 pair of eyes to look for for hazards. Job Hazard Analysis
The Program Administrator/Safety Representative in cooperation with an area are a 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 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 6
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.
1.
Safety Committee (See Section 7)
2.
Individual Contacts A. 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 B. Individual contacts with employees on matters of safety and health should be documented. C. 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 discuss with the employee. Thirdly, they provide a record of training for statutory compliance requirements.
3.
General Safety Meetings Group safety meetings with all the supervisor’s employees are another effective training tool and shall be held at least on a monthly basis. a.
Topics should be chosen that are pertinent to the job safety safety or health of the group.
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b. The meeting should include include open di discussions scussions of the topic to ensure employee understanding. c.
It is also also important to obtain suggestions from employees on means for impr improving oving 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.
4.
Written Communications a. 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. b. All communications should be dated and conform to state policy regarding such communications.
5.
Bulletin Boards and Postings a. 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 safety rules and important policies and procedures. b. XYZ Company bulletin boards will be conspicuously located. 1) The boards are to be properly maintained.. 2) One individual will be responsible for maintaining the bulletin board and controlling the notices placed thereon.
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Section 7
Safety Committee and Meetings DECISION POINT - If you have 25 or more employees, a Safety Committee should be established.
1.
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 safety program. The committee is made up of management-designated representatives and employee-elected representatives. A. The committee shall:
1) Promote a safe and healthy work environment e nvironment at all times. 2) Encourage communication between employees and management. 3) Serve as an oversight committee on o n all issues relative to safety and health. 4) Make recommendations to the Safety Representative. B. Functions: The committee has four principal functions:
1) Identify potential hazards; 2) Evaluate these potential hazards; 3) Recommend corrective action; and 4) Follow up implemented recommendations. To carry out its functions, the committee is required to hold meetings and carry out rregular egular inspections of the workplace
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C. 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 t he employees and not appointed by the employer. Employee representatives will serve for one year before being re-elected 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 m inimum of one who will serve until replaced by management. A chairperson will be selected by majority vote of the commi committee ttee 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 safe ty issues; and Encourage safe work practices among co-workers. D. Employer Responsibilities Responsibilities
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. 23
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The management commitment/interest/good faith to safety committees must be vocal, visible, and continuous - from the top to the t he lowest level. E. Frequency
Once established, the XYZ Company safety committee shall meet at leas leastt quarterly. An agenda shall be developed by the chairperson and distributed to the t he members at least 10 workdays prior to the scheduled scheduled meeting. Meeting minutes shall be prepared prepared and distributed to the membership within 5 days following 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.)
2.
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 8
Safety and Health Training Safety and health training at XYZ Company imparts knowledge, generates new ideas, reinforces existing ideas and principles and puts the other three elements of the program into action. The answer to the question, “How do “How do I get new employees into the mainstream and build productivity?” is “Training!” “Training!” On-the-job On-the-job or through formal classroom instruction, training is a necessity for improving performance. As time passes and processes or product lines change, employees must be retrained. Safety and health training implies training on specific job procedures. It can be given separately, but it is better combined with regularly regularly scheduled job-related training. Such training benefits the employee through fewer work-related injuries and illness reduced stress, and worry caused by exposure to dangers. Training must also be provided for supervisors. supervisors.
1.
Supervisor and Employee Safety Training Supervisory Training
XYZ Company supervisory training is a logical first step since supervisors will help in training t raining the other employees. Supervisors are key figures in the implementation and overall success of the safety and health program. As a minimum, our supervisors shall be trained in the following following areas: a. The need to establish and maintain safe and healthful working conditions; b. The dangers associated with a job, the potential effect on employees, and the rules, procedures and work practices for control of these dangers; c. How to relate this information by example and instruction to employees, to ensure that they understand and follow safe procedures; and
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d. How to investigate accidents, and to take t ake corrective and preventive action to prevent recurrence. Employee Training
XYZ Company recognizes 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: a. Standard work procedures including safe work practices, and how these procedures protect against exposure to dangers. b. Personal protective equipment: why it is needed, how to use it, and how to keep it in good condition. c. 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 t hese elements: management commitment; danger assessment and control; and safety planning, rules and work procedures.
2.
New-Hire Employee Orientation All XYZ Company new hires must attend a new-hire new -hire orientation prior to commencing employment. All new-hires shall receive occupational health and safety training in the following subject areas: a. b. c. d. e. b. e. f. g. h.
Company Safety Philosophy and Policy Project Orientation (if applicable) applicable) Disciplinary procedures for non-compliance Employee Danger Reporting System Accident Reporting System Personal Protective Equipment (when applicable) applicable) Fall Protection -100% tie-off (if applicable) applicable) Scaffolding (if applicable) applicable) Fire Prevention Hazardous Communication Standard, Material Safety Data Sheets, and Environmental Safety i. Bloodborne Pathogens Program (if applicable) applicable)
j. Workplace Housekeeping Rules 26
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3.
Mandatory Occupational Safety and Health Programs Hazard Communication Program
All XYZ Company employees will receive training in compliance with the OSHA Hazard Communication (HazCom) Standard, 29 CFR 1926.59. 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; wor kplace; their health effects and means of exposure or routes ro utes 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 ex exposure posure involving hazardous chemicals/materials. Continuous HazCom training will be conducted via weekly toolbox safety meetings when applicable. 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. documented.
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Section 9
Hazard Recognition 1.
Recordkeeping Recordkeepi ng and Review A. 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 “Employee’s Injury/Illness Report Form” to report more serious injuries. injuries. B. Supervisors will:
DECISION POINT POINT
a. Investigate a serious injury or illness using procedures in the “Incident Investigation” section. b. Complete an “Incident Investigation Report” form. form. c. Give the “Employee’s Report” and “Incident Investigation I nvestigation Report” to the company Safety Representative.
2.
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 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 and health training.
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Kentucky – Kentucky – Written Written Safety and Health Program
Correcting or controlling dangers can be accomplished ac complished in a variety of ways. However, to work properly, a danger control system must have the following components: a. An initial danger identification survey; b. A system for danger identification (such as inspections at regular intervals); c. An effective system for employees to report conditions which may be dangerous (such as a safety committee or a safety representative); d. An equipment and maintenance program; e. A system for review or investigation of workplace accidents, injuries and illnesses; f. A system for initiating and tracking danger corrective actions; and g. A system for periodically monitoring the place of employment. em ployment.
3.
Danger Identification Methods POINT - If one has not been DECISION POINT been done, have it accomplished as soon as possible. If one has been accomplished, accomplished, so state, and where it’s maintained.
A. 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. been done, have it accomplished as soon as possible. If DECISION POINT POINT - If one has not been one has been accomplished, accomplished, so state, and where it’s maintained.
B. Periodic Danger Surveys (Monitoring) (Monitoring) A Scheduled a walk-through of the XYZ Company workplace is performed at regular intervals to ensure that established work procedures are ar e being followed, and those unsafe conditions or practices are identified and promptly corrected. These inspections are in ad addition dition to the everyday safety and health checks that are part of the routine duties of supervisors and managers.
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Kentucky – Kentucky – Written Written Safety and Health Program
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 workplace injuries and illnesses. illnesses. Someone who, through experience or training, can identify actual and potential dangers and who understands safe work procedures should do an inspection. been done, have it accomplished as soon as possible. If DECISION POINT POINT - If one has not been one has been accomplished, accomplished, so state, and where it’s maintained.
C. 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 safety and health. That will encourage employees employees to continue to report dangers promptly and assure them that their reporting will not have negative consequences. DECISION POINT POINT - If one has not been been done, have it accomplished as soon as possible. If one has been accomplished, accomplished, so state, and where it’s maintained.
4.
Equipment Monitoring Monitoring and Maintenance Program Equipment, particularly all safety controls and safety equipment must be properly maintained. A program must be established to monitor 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 good for business. Proper maintenance can prevent costly breakdowns.
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Kentucky – Kentucky – Written Written Safety and Health Program
been done, have it accomplished as soon as possible. If one POINT - If one has not been DECISION POINT has been accomplished, so state, and where it’s maintained.
5.
Accident Investigation and Reporting investigating all workplace accidents, A system must be established for investigating 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 reveal flaws in operating procedures. 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 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 Representat ive with the underlying goal of preventing recurrence. recurre nce. B. Accident Investigation 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 re presentative of the safety committee, and any other persons whose expertise e xpertise would help the investigation. The investigation team will take written statements stateme nts from witnesses, photograph the incident scene and equipment involved. The team will also document as soon as possib possible le 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.
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Kentucky – Kentucky – Written Written Safety and Health Program
The report will include a sequence of events leading up to the incident, conclusions about the incident and any recommendations recommendations to prevent a similar iincident ncident in the future. The report will be reviewed by the safety committee at its next regularly scheduled meeting. Determine the person or title (recommended) below. DECISION POINT POINT – Determine When a supervisor becomes aware of o f 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 accompany the "Employee's Injury/Illness Report Form" and forward them to __________________ __________________________ __________________ ___________________ __________________ __________. _. Whenever there is an incident that did not but could have resulted in serious injury to an employee (a near-miss near-miss), ), the incident will be investigated by the supervisor or a team depending on the seriousness seriousness of the injury that would have occurred. The "Incident Investigation Report" form will be used to investigate the 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. C. Occupationa Occupationall Injury, Illness Investigation Investigation The Supervisor, if initially notified, shall report to the scene of an occupational injury, illness, and property damage and immediately immediately secure and protect the accident scene. Drawings and photographs, if needed, shall be used to record re cord and document where and how the accident occurred and the extent exte nt 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. investigation. The Safety Representative shall report to and investigate all serious occupational occupational injuries, illnesses and and property damage. A formal Incident Investigation Report shall be prepared to determine the cause, document facts and recommend corrective actions to prevent recurrence.
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Kentucky – Kentucky – Written Written Safety and Health Program
D. Occupationa Occupationall 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 w ill 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 doc umented and repaired. Supervisors will immediately notify the XYZ Company Safety Representative of o f 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 all-occupational injuries and/or illnesses.
6.
Injury and Illness Recordkeeping In order to establish meaningful goals and objectives for mishap reduction, re duction, we must first know where we, as a company, have have been in terms of previous previous mishap experience. For that reason and to comply with federal recordkeeping requirements, the t he following documentation shall be maintained: A. The Safety Representative Representative shall maintain for a period of 5 years: 1) Safety accident investigation reports for all lost workday occupational injuries, illnesses or equipment damage; 2) Safety accident investigation reports for company property damage, as a result of accidents; 3) Records of formal claims against the company for injury, illness, personal loss, and/or damage to personal property; and
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Kentucky – Kentucky – Written Written Safety and Health Program
B. 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 r equire 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 c entralized area visible to all employees, and remain there for at least 3 months. C. OSHA Form No. 301, Injury and Illness , shall, when used, be used to give Ill ness Incident Report , shall, details of each recordable occupational injury and illness. Records must be available 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. D. OSHA Form No. 300A, Summary of Work-Related Injuries and Illnesses , , provides provides additional data to make it easier for employers employers to calculate incidence rates. Employers must review the OSHA 300 Log information before it is summarized on the 300A form. form. E. Accident Review:
DECISION POINT
Following an injury or near miss accident, the t he incident will be reviewed with the Project Manager and onsite supervision. supervision. This 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 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.
7.
Corrective Actions DECISION POINT - State your method of corrective action here.
A. 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. delay. Interim protection for employees may be necessary until the danger is eliminated or controlled.
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Kentucky – Kentucky – Written Written Safety and Health Program
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 assist in developing safe work practices and training programs. programs.
B. Responsibility for Corrective Action 1) Actions necessary to correct or remedy accident causal factors shall rest with the XYZ Company Safety Representative. 2) 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.
C. Frequency of Monitoring the Place of Employment the work procedures, You have the responsibility of monitoring the workplace regularly – the equipment and machines – to 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.
8.
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 investigatin investigating g incidents for their causes, management and the safety committee will regularly check the workplace for hazards as described below: A. 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.
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Kentucky – Kentucky – Written Written Safety and Health Program
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 t he annual review of the effectiveness of our accident prevention program.
B. Periodic Change Survey - -- We We will assign a supervisor or form a team to look at any changes we make to identify safety issues. Changes include new equipment, equipment, changes to production processes or a change to the building building structure. A team is made up of maintenance, production, and safety committee representatives. It examines the t he changed conditions and makes recommendations to eliminate or control any hazards that were or may be cre created ated as a result of the change. C. 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 an any y safety concerns they may have. Committee members will report any hazards or concerns to the wh whole ole committee for consideration. The results of the area inspection and any action taken will be posted 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. D. Job Hazard Analysis - -- As As a part of our ono n-going going safety program, we will use a “Job “ Job Hazard Analysis” form to form to look at each type of job task our employees do. This analysis will be 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 required PPE. The results will be reported to the safety committee. Each job task will be analyzed 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.
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Kentucky – Kentucky – Written Written Safety and Health Program
Section 10
Hazard Prevention and Control 1.
Eliminating Eliminatin g 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 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 tthat hat effectively prevent employee exposure to the hazard. hazard. When the above methods of control are not possible or are not fully effective we will require employees to use personal protective e equipment quipment (PPE) such as safety glasses, hearing protection, foot protection etc.
2.
Safety Rules and Work Procedures A. General Safety Rules The XYZ Company Written Safety and Health Program P rogram apply to all employees. The rules may be very simple or extremely complex, depending on the nature o off the work processes and the number and kinds of employees involved. Some items that are addressed by general safety rules are: 1)
Personal protective equipment requirements;
2)
Clothing appropriate for the work;
3)
Behavior expected of all employees;
4)
How to leave the workplace safely, with particular reference to emergency procedures; and
5)
Danger areas that are: “off“off-limits” limits” for employees.
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Kentucky – Kentucky – Written Written Safety and Health Program
As part of our initial safety and health survey, existing rules are always evaluated. 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. B. 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 disciplinary action. 1) 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. 2) Do not remove or disable any safety device! Keep guards in place at all times on operating machinery. 3) Never operate a piece of equipment unless you have been trained and are authorized. 4) Use your personal protective equipment whenever it is required. 5) Obey all safety warning signs. 6) Working under the influence of alcohol or illegal drugs or o r using them at work is prohibited. 7) Do not bring firearms or explosives onto company property. 8) Smoking is only permitted outside the building away from any entry or o r ventilation intake. 9) Horseplay, running and fighting are prohibited 10) Clean up spills immediately. Replace all tools and supplies after use. Do not allow scraps to accumulate where they will become a hazard. Good housekeeping helps prevent injuries.
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Kentucky – Kentucky – Written Written Safety and Health Program
C. Standard Work Procedures Effectiveness in safety and health performance results our commitment to establish standard work procedures that fix accountability. These directives or standard st andard work procedures can be oral or written writt en but in all case communicated to eac each h worker, defining specific responsibilities and objectives where safety and health are concerned. c oncerned. 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 stan standard dard procedure for each job, which is on record and available for reference and continued use. use . Ideas can often be obtained from equipment e quipment and tool manufacturers. It is strongly recommended that those departments consult with employees and use their t heir ideas, particularly those employees who have experience in the work being studied. Standard work procedures provide the tools for teaching te aching how to work consistently with a maximum of efficiency and safety.
3.
Company Specific Safety Programs A. 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. B. Housekeeping XYZ Company will enforce housekeeping requirements daily. This will include: 1) Requiring subcontractors to keep their work areas ar eas orderly and clean up daily. 2) Keeping walkways and access areas clear.
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Kentucky – Kentucky – Written Written Safety and Health Program
3) 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. 4) 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. 5) 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. 6) Spills involving combustible or flammable liquids, oils or grease will be cleaned up immediately. C. 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. 1) 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. 2) Types and Frequency of Safety Safety Inspections and Surveys. Safety Inspections shall be conducted at periodic intervals of all work locations. 3) When established, safety committee members are responsible for conducting selfinspections of their areas and other areas, are as, as assigned by the Safety Repre Representative. sentative. 4) Supervisors are responsible for conducting self-inspections of their assigned work area(s). D. Governmenta Governmentall Inspections In the event of a governmental inspection, the compliance officer will be directed to any General Contractor’s office. If not the General Contractor, XYZ Company will follow the prescribed General Contractor procedures.
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Kentucky – Kentucky – Written Written Safety and Health Program
1) Outside Agency Inspections. Inspections. These may include: include:
State Occupational Safety & Health Inspector.
City/County/State Fire Inspector.
Insurance Company Loss Control Consultant.
Other bonified inspectors with a contractual or legal leg al interest.
2) 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. 3) Supervisors shall also be notified and will be encouraged to accompany outside agency inspections of their areas of responsibility. E. Audits XYZ Company will cooperate fully with any General Contractor, and the insurance authority with regard to monthly and periodic safety audits. Additionally, XYZ Company will conduct a monthly audit of all subcontractors under our contract, which are on-site. F. Planning All project activities will include planning for safety concerns throughout the t he project. A "Job Hazard Analysis" will will be generated with the t he project superintendent and foremen for all hazardous operations. Subcontractors will be required to pr provide ovide a documented Job H Hazard azard Analysis for their work prior to commencing operations. oper ations. G. 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. 1) Those operations, which do not fall in the “analysis loop”, will be designated as nonhazardous and filed in the appropriate order along with the Job Hazard Analyses.
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Kentucky – Kentucky – Written Written Safety and Health Program
2) Job Hazard Analysis shall be produced by the superintendent and appropriate crew foremen and reviewed by XYZ Company Safety S afety Representative. 3) A copy of each Job Hazard Analysis shal1 be maintained onsite and available for review. r eview. 4) Who should participate in a hazard analysis? 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 insights concerning problems, faults, and situations that can cause accidents. These insights need to be recorded reco rded along with those of the initiator of the hazard analysis, who is the superintendent, appropriate crew foremen, company Safety Representative or a contract safety professional. 5) 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 they have the potential to cau cause se accidents. Eventually, hazard analyses should be completed for all jobs, but the most potentially threatening should have immediate attention. Those that are making the d decisions ecisions should consider: 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 H. Responsibilities for "Controlling" Workplace Hazards It is the responsibility re sponsibility 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.
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Kentucky – Kentucky – Written Written Safety and Health Program
I. 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. Repre sentative. J. Procedures for "Correcting" Identified Workplace Hazards It is the responsibility re sponsibility 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.
4.
Enforcement Procedures and Systems At XYZ Company, safety rules and work procedures pr ocedures shall be practiced and enforced. We have established a system to ensure that t hat violations of rules are dealt with fairly but firmly, that all employees are aware of the t he requirements, and that reorientation or retraining may be provided when needed. Incentive programs may be initiated and will be used in conjunction conjunction with a good enforcement program. A. Discipline 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 establis established hed by XYZ Company. 1) The first preventable accident or safety rule violation observed should result in a discussion with the employee and the supervisor or manager. manager. This verbal reprimand should be documented, dated, and signed by those involved.
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Kentucky – Kentucky – Written Written Safety and Health Program
2) A second preventable accident or safety rule r ule 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 should be considered. 3) 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 probably grounds for termination. B. Compliance 1) One point must be very clear: discipline has to be administered uniformly uniformly and consistently. 2) 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.
3) Each supervisor or manager shall be responsible for administering this policy to his/her
subordinates. 4) All written reprimands and records of violations shall be held confidential and maintained in
the employees’ personnel files. C. Accountability Each supervisor’s efforts and and performance will be evaluated relative to reaching XYZ Company safety objectives and assigned responsibilities. This evaluation will be part of the supervisor’s performance review and will be used in part to determine his or her job assignments, merit increases or promotions.
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Kentucky – Kentucky – Written Written Safety and Health Program
5.
Medical and First Aid Medical treatment plans.
A. Key XYZ Compan Company y 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 r ecurring training is accomplished, shall be the responsibility of the Safety Representative. B. All supervisory personnel should be encouraged to enroll enroll in a ffirst irst aid course course and to learn learn CPR. Those employees who work around high vol voltage tage equipment shall be required to be certified annually in CPR. C. Each XYZ Compan Company y 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 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.” D. Vehicle size ffirst irst aid kits shall be maintained in each XYZ XYZ Company construction/project-use vehicle. E. All first aid supplies supplies shall be inspected at least monthly and replenished as required. F.
Accident / Injury reporting: All accidents, near miss incidents and injuries shall be reported to XYZ Company Safety Representative. Following an injury: 1) The employee’s injury will be evaluated and first aid rendered. re ndered. 2) If the injury requires medical attention the employee will be escorted to the onsite clinic. Further evaluation and treatment will be rendered. re ndered. 3) 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 post-accident post-accident drug test is required.
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Kentucky – Kentucky – Written Written Safety and Health Program
4) 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 o outside utside medical facility. 5) A supervisor's report or Statement of Injury will be completed by the employees' supervisor. 6) An investigation into the incident will be completed by XYZ Company Safety Representative, even if no serious injury occurred. occ urred. 7) A copy of any applicable State document on Employer's Initial Report Re port of Industrial Injury, Accident and Property Damage form, Supervisor's report or Statement of Injury will be submitted to the XYZ Company Safety Representative Repr esentative for the employer provided workers' compensation coverage. 8) All first aid cases may be recorded recor ded on a First Aid Log maintained by X XYZ YZ Company Safety Representative.
6.
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 provide appropriate consequences for failure to follow safety rules. This policy is designed not so much to punis punish h 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 vi violation olation of the same rule or the same unacceptable behavior: First Instance -- verbal warning, notation in employee file, and instruction on proper actions
ac tions Second Instance -- 1 day suspension, written reprimand, and instruction on proper actions Third Instance -- 1 week suspension, written reprimand, and instruction on proper actions Fourth Instance -- Termination of employment.
An employee may be subject to immediate termination t ermination when a safety violation places the employee or co-workers at risk of o f permanent disability or death.
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Kentucky – Kentucky – Written Written Safety and Health Program
Section 11
Emergency Planning POINT DECISION POINT
1.
Emergency Planning and Procedures Procedures An evacuation map for the building is posted (Customize by adding location, if this applies to your company). It shows the location of exits, fire extinguishers, first aid kits, and where to
assemble outside (Customize by adding meeting location for your location). A copy of the map is attached to this program. All XYZ Company employees will receive training on how to use a portable fire extinguisher as part of their initial orientation. Buildings will display a map that shows the location location of exits, fire extinguishers, first aid kits, and where to assemble outside. At XYZ Company, advance planning and preparation for emergencies is good insurance. Some emergency planning is mandated by regulations, such as for first aid and fire evacuation and for certain situations in specific industries or operations. A list of possible emergencies shall be prepared and procedures established to respond to those emergency situations. Emergency plans shall be reviewed with individuals such as doctors, fire and explosives experts or special consultants where possible, and on an as needed basis. Emergency procedures shall be updated whenever changes are ar e made in materials, equipment or building structures.
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Kentucky – Kentucky – Written Written Safety and Health Program
2.
Emergency Planning No Industrial, Commercial or Mercantile organization is immune immune to disaster. Emergencies can arise at any time and from many causes, but the potential loss is the same - people and property. Advance planning for emergencies is the only way to minimize this potential loss. A. Planning is necessary - it is not a luxury, rather it is good good insurance. Even though professionally trained emergency help and assistance may be available, the need for inhouse emergency planning is still still your first line of defense. A comprehensive management plan is intended to take care of all expected emergencies. This includes both the natural disasters and the common accident situation. Quite often emergency planning is assigned solely to the safety and health professional. This is fine, but there t here is a real need for the corporate management to be fully involved in the many m any decisions that must be made.
B. The safety of our employees, visitors, visitors, and customers must be the fi first rst concern in planning for an emergency. Care for the injured injured must be available available immediately. In some situations situations,, evacuation may be necessary. C. Careful consideration shall be given to protecting the property and the operation. In a new facility, consideration shall be given to arranging and locating certain facilities and operations to provide greater inherent inherent safety to the entire operation. In general, all emergency plans will include cleanup details necessary for the t he situation.
D. Finally, pla planning nning may be concerned with restoring business to normal. In emergencies likely to damage or close a facility or job site, the question of resuming re suming operations under conditions of temporary wiring, lack of heating, or repair r epair and construction work shall always be considered. E. Regardless of the size of the the XYZ Company project project workforce, management will be responsible for developing and operating a program, which is designed to meet these eventualities. An effective plan requires the same good organization and administration as any business undertaking. There is no one emergency plan that will do all things for all organizations. 48
Kentucky – Kentucky – Written Written Safety and Health Program
Therefore, a plan that fits the needs of the workplace, project and/or facility will be developed. F.
Emergency plans involve organizing organizing and training of small groups of people to perform specialized services, such as fire fighting or first aid. Small, well-trained groups can sserve erve as a nucleus to be expanded to any size needed to meet an any y kind of emergency. Even with outside help available, a self-help plan is the best assurance that losses will be kept to a minimum.
G. An organization will will need to develop several plan planss to control different types of emergencies. Although certain basic elements would be common to all plans, the same complete plan could not, for example, be used for a natural disaster, an in-house fire, or the common accident situation.
H. Before an organization initiates an emergency plan, it is is necessary to evaluate the types of emergencies, potential disasters or accidents that could occur, and the potential harm to people and property. I.
C ompany will include: DECISION POINT The basic emergency preparedness plan for XYZ Company 1) A chain of command; 2) An alarm and/or communication system; 3) Medical treatment plans; 4) Shutdown procedures; and 5) Evacuation procedures.
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Kentucky – Kentucky – Written Written Safety and Health Program
3.
Types of Emergencies A. Work Accidents. The "chain reaction" from a so-called "routine" work accident can result in an emergency. For example, a break in a chemical line or toxic vapors from outside the facility entering the ventilation system may create an emergency. Panic caused by a rumor r umor or lack of knowledge can also creates an emergency. Plans for such situations should include establishment of auxiliary areas in the building to be used for medical treatment, a method of notifying employees of the actual situation, a method of quickly taking a head count from shift leaders, and sources of oxygen supplies available on short notice. B. Fire and explosion. Except where fires result from large-scale explosions, the fire emergency usually allows a short time for marshalling of firefighters and organizing an evacuation if necessary. Many conflagrations originate as small fires fires,, that is, fires that could positively be controlled by in-house personnel. Therefore, prompt action by a small, trained group can usually handle the situation. However, plans should include the marshalling of extensive fire fighting forces upon first indication of any fire growing beyond the "small fire" stage. 1) The main point is this; small fires should be checked as soon as they start. The first five minutes are considered the most important. Good housekeeping, prompt action by trained people, proper equipment, and common-sense precautions will prevent a small sm all fire from becoming a disaster. 2) Fire protection equipment, especially sprinkler heads and kitchen overhead grease traps and fans, need to be periodically checked to ensure they are not blocked and in working order 3) Obstructions, such as storage boxes, must remain at least 18 in. from sprinkler heads in order for them to work as designed. Kitchens are the most likely source for fires to originate. Overhead grease traps must be cleaned cleaned at least once daily, or more often in heavy use areas. 4) Non-sparking system cooling fans, used to control the heated trapped grease gre ase particles, must also be checked for operability on a regular basis.
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Kentucky – Kentucky – Written Written Safety and Health Program
C. Shutdowns. Although a shutdown is not an emergency per se, it can result from an unscheduled action, such as a disaster or strike; str ike; hence a fast shutdown procedure should be covered under an emergency plan. This plan should be based on a priority checklist. That is, all of the tasks to be assigned and functions to be performed should be arranged in order of importance so that if time is short, at least the most vital precautions are completed. This "crash" procedure is usually an adaptation of the routine procedure used us ed for scheduled shutdowns, such as for preventive maintenance inspections. 1) During the shutdown, continuous inspection of any maintenance or special operations, such as remodelling, must be maintained. Gas cutting and welding should be carefully car efully supervised. Employees, who remain on duty in the area and construction co nstruction workers involved in any remodelling, should be briefed in effective countermeasures in case a fire breaks out. 2) If there has not been bee n sufficient notice to affect a normal shutdown, it may be necessary to allow personnel into the area to perform necessary functions. D. Hazardous Materials. Because there are many chemical substances being used today, there must be concern with potential usage and handling problems. There are many rules and procedures to be observed, but again one must ask the question, what if a safeguard fails? What if the container cracks and substances leak out? In addition to normal hazards, area there potential chemical reactions with other substances that cause still further dangers to people and property? Any effective emergency plan must also include recognition of the potential for a hazardous chemical spill and its containment.
4.
Plan-of-Action Plan-of-Acti on Consideratio Considerations ns Following the assessment of potential emergencies, the next step is to translate these needs into a plan of action. A. XYZ Company management will be in charge of o f drafting a policy and getting the plan underway. It will usually be necessary that union leaders (if an any) y) be involved in the planning process. The Safety Representative or another member of the safety committee will be appointed emergency planning coordinator. 51
Kentucky – Kentucky – Written Written Safety and Health Program
B. Health and safety, medical, fire, and security personnel will be involved. C. Production and maintenance supervision will be consulted. D. Contacts with local law enforcement and fire departments are necessary. E. The cost and effort involved in giving immediate attention to emergency e mergency planning can be justified by weighing the cost of preparedness against the possibility possibility of yearly losses from accidents, fires and other unplanned events. F. Program considerations. considerations. The preliminary aspects of emergency planning - the need for advance planning and an evaluation of the type of emergencies and their potential harm to people and property have already been discussed. The next logical step is to translate this need into a working plan within the organizational structure. In some cases, this will require working with other agencies to most fully protect the company's operation. 1) Advance planning is the key. It is necessary to develop a written set of plans for action. The plans should be developed locally within the company (and corporate structure) and be in cooperation with other neighboring or similar organizations and with government agencies. It may not always be be possible for them to fully fully cooperate or participate, but through planned action each organization should be aware of certain ce rtain available assistance. The company may need to plan to be largely dependent upon its own resources to provide the internal inter nal safety. 2) A description of the expected disasters with w ith a risk statement. 3) A map of the plant or facility showing equipment, medical and first aid, fire control apparatus, shelters, command center, and evacuation routes. 4) A list (which may also be posted) of cooperating agencies and how to reach them. ---A plant or facility warning system. 5) A central communication center, including home contacts of employees. 6) A shutdown procedure, including internal security procedures.
5.
Chain of Command A XYZ Company disaster plan coordinator should be appointed and an advisory committee, representing various departments, established.
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Kentucky – Kentucky – Written Written Safety and Health Program
A. The disaster plan coordinator should be a member of top management, because he/she will have to be able to delegate authority authority and speak for th the e company. The coordinator's regular duties should be such that the greater part of their time will normally be spent at the workplace he/she is responsible for. B. An alternate disaster plan coordinator will also be named in the plan. The alternate should be a person who has authority and qualifications similar to the primary coordinator and must be trained in their responsibilities. C. Assigned personnel personnel must be trained to carry out their duties in accordance with the overall over all emergency disaster plan. The number of members on each of the teams depends on the size and diversity of the employee work force and normal number of visitors and customers within their area of the facility. D. Training. One of the most important functions of the disaster plan coordinator coordinator and staff, on both the corporate and plant levels is training. Training for each type disaster is essential in developing a disaster-control plan and keeping it functioning. functioning. Employees must realize that an emergency plan is vital and real. The plan cannot be usefully if it remains a remote idea. Training and rehearsals are time consuming, but they keep kee p the program in good working order. Training of key people will be of little value unless it reaches all employees. employees. The better informed and prepared the work force is, the less panic and confusion during the emergency. E. Practice alerts, even in a classroom environment, should be conducted to make sure that the employees know where to report and what their duties are. Even the most carefully developed and prepared plans can develop flaws when put into practice, and only periodic rehearsals can reveal them. If this t his is not done, all the planning effort will have been wasted. F. Management should assure employees that the company is doing everything possible to prevent injury to them, that t hat every employee is an essential and necessary part of the team, and that the disaster-control organization is ready for any any emergency. Such assurance will go a long way toward developing a state of mind that will not panic. panic. Then when disaster does strike, emergency forces snap into action, workers gather visitors and customers and file quietly to their designated safe areas away from the facility. Such planning is further evidence of management's concern for everyone's safety.
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Kentucky – Kentucky – Written Written Safety and Health Program
G. Command headquarters. headquarters. A command headquarters should be planned for any emergency, which may occur. Coordination of the disaster control organization should come from a well-equipped and well-protected control room. The headquarters should be equipped with telephones, sound-powered phones, public address system, maps of the facility, emergency lighting and electric power, and two-way radios for communication locally.
6.
Communications System Good communications are necessary for effective control and flexibility in a disaster situation. Communications include the telephone, radio, messengers, and a facility alarm system. The emergency plan should provide for adequate telephones in an emergency emerg ency headquarters to handle both incoming and outgoing calls. Panic and disintegration of the organization will develop quickly if these calls are not handled with dispatch. The disaster plan must anticipate the possibility of losing normal telephone communications and electric power.
7.
Shutdown Procedures Key department personnel should be knowledgeable of where emergency em ergency shutdown switches and valves are located. Depending on the type of emergency, main electricity to machines and natural gas may need to be shutdown to the t he effected area within the facility.
8.
Evacuation Procedures Safe evacuation routes should be conspicuously posted in internal work areas where direct access to an exterior emergency e mergency exit may not be obvious. An emergency exit e xit notice should also be posted. Newly assigned employees must be briefed on the safest evacuation evacuation route from his or her designated work area.
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Kentucky – Kentucky – Written Written Safety and Health Program
Detailed Emergency Procedures
POINT DECISION POINT
A. XYZ Company employees and subcontractors will abide by the project emergency procedures prescribed by any General Contractor Contrac tor Safety Manager. All employees will receive a review of emergency procedures during the project safety orientation. B. Emergency telephone numbers numbers for any General Contractor safety and security, as well as local emergency services, shall be posted in the jobsite office or in conspicuously designated areas. C. In the event of an evacuation all XYZ Company employees will meet at a designated location. Each foreman will be responsible to verify that his crew c rew has safely evacuated.
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Kentucky – Kentucky – Written Written Safety and Health Program
Section 12
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. Review and select those programs that apply or included others not listed DECISION POINT – Review
Company Required Safety and Health Plans & Programs Accident Prevention Program
Forklift Safety Program
Asbestos Management Plan
Hazard Communication Program
Bloodborne Pathogens Program
Hearing Conservation Program
Chemical Hygiene Plan
Hot Work Permit Program
Confined Space Entry Program
Ladders and Stairways Work Plan
Control of Hazardous Energy Program
Laser Safety Program
Cranes and Derricks Safety Program
Lead Safety Program
Electrical Safety Program
Personal Protective Equipment Plan
Emergency Action Plan
Powered Industrial Truck Program
Excavation and Trenching Program
Radiation Protection Program
Fall Protection Program
Respiratory Protection Program
Fire Prevention Work Plan
Scaffolding Safety Program
Flammable Storage / Compressed Gas
Welding Safety Program
Table 1
All Safety Plans & Programs are available through Americana Safety Supply www.SafetyOfficeDepot.com www.SafetyOfficeDepot.com
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Kentucky – Kentucky – Written Written Safety and Health Program
Section 13
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. Review and select those courses that apply or included others not listed DECISION POINT – Review
A-E Company Required Safety Training Courses – Sorted A-E Accident Investigation
Construction Safety Management
Accident Prevention Signs & Tags
Crane Safety Safety – – Refresher Refresher
Asbestos Safety
Cranes & Derricks in Construction
Bloodborne Pathogens – Pathogens – Initial/Refresher
Electrical Safety
Bloodborne Pathogens – Pathogens – Train-the-Trainer
Emergency Exit Routes
Chemical Spills
Emergency Response Team
Competent Persons
Ergonomics Ergonomics – – Basic Basic Human Factors
Compressed Gas Cylinder
Ergonomics – Ergonomics – Advanced Advanced Human Factors
Concrete & Masonry
Excavation Safety
Confined Space Entry
Eye & Face Protection
Table 2
All Safety Training Courses are available through Americana Safety Supply www.SafetyOfficeDepot.com www.SafetyOfficeDepot.com
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Kentucky – Kentucky – Written Written Safety and Health Program
F-L Company Required Safety Training Courses – Sorted F-L Fall Protection
Hexavalent Chromium
Portable Fire Extinguisher
Hot Work Permit Safety
Flammable & Combustible Liquids
Indoor Air Quality
Forklift Safety – Safety – Classroom (English)
Introduction to OSHA
Forklift Safety – Safety – Classroom (Spanish)
Job Hazard Analysis
Hand & Power Tools
Laser Safety
Hazard Communication
Lead Exposure
Hazard Vulnerability
Liquid Nitrogen
Hazardous Materials Management
Lockout-Tagout
Hearing Protection
Table 3
Company Required Safety Training Courses – Sorted M-W M-W Machine Guarding
Safety Representative Training
Material Handling
Safety Supervisor Training
Office Safety Awareness
Scaffolding
Pandemic Preparedness
Slip, Trip & Fall Prevention
Personal Protective Equipment
Stairway & Ladder Safety
Powered Industrial Truck
TB Respiratory Protection
Radiation Safety
Walking & Working Surfaces
Respirator Protection
Warehouse Safety
Safe Lifting Awareness – Awareness – Back Safety
Workplace Violence Prevention - Healthcare
Safety Audit Training
Workplace Violence Prevention - Retail
Table 4
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Kentucky – Kentucky – Written Written Safety and Health Program
Section 14
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. Review and select those forms that apply or included others not listed DECISION POINT – Review
CONFINED SPACE Confined Space Entry Permit Confined Space – Space – Class Class A & B Permit Confined Space – Space – Class Class C Permit List of Authorized Entrants Permit Required Confined Space – Space – Inventory 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 – Evaluation – Fall Fall Protection CRANE OPERATIONS Cranes, Derricks or Material Handling Devices Worksheet Crane Checklist Crane Inspection Pre-Lift Checklist Sling (Chain) Inspection Report Monthly Hoist Rope Inspection Report Monthly Hoist Hook Inspection Report EMERGENCY ACTION AND RESPONSE Crisis Management Response Team - Contact Log Safety Representatives - Contact Log External Resources – Resources – Contact Contact Log Vulnerability Analysis Chart Bomb Threat Checklist Employee Evacuation - Accounting Log Physically Challenged – Challenged – Employee Employee List Command Post Equipment Inventory Log Press Information Log Post Exercise Evaluation Report
59
Kentucky – Kentucky – Written Written Safety and Health Program All Subject Form Groups are available through Americana Safety
EMPLOYEE SAFETY RECORDS Employee Acknowledgement Form Employee Orientation Checklist – Checklist – Construction 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
www.SafetyOfficeDepot.com Supply www.SafetyOfficeDepot.com
EXCAVATION OPERATIONS Pre-Excavation Checklist Trenching Design Checklist Trench Safety – Safety – Daily Daily Field Report Competent Person Evaluation – Evaluation – Excavation 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 & Instructions Accident Prev Prevention ention Worksheet Program Analy Analysis sis 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 – Questionnaire – Respirator Respirator Use Respirator Fit Testing Record Hepatitis B Vaccine - Accept/Decli Accept/Decline ne 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 W orkers Training Guide for Ancillary Radiation Works
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Kentucky – Kentucky – Written Written Safety and Health Program
Supervisor Safety Meeting Record Department:
Supervisor:
Location: Date of Meeting:
Date of Previous Meeting:
Safety Meeting Topic: Safety Training Presented by: Employee Name
Employee Signature
1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20. 21. 22. 23. 24. 25. 26. 61
Kentucky – Kentucky – Written Written Safety and Health Program
SAFETY ORIENTATION CHECKLIST CHECKLIST Employee's Name Name
Date ____________________________ Date ____________________________
Date Employed Employed
Department ______________________ Department ______________________
Job Title Title
Instructions to be given by Safety Coordinator ITEMS COVERED STATE SAFETY POLICY POLICY
•
INITIALS
ITEMS COVERED
INITIALS
EMERGENCY PROCEDURE
•
PROGRAM PROGRAM SAFETY ORGANIZATION & PROGRAM PROGRAM
Fire Protection
•
Employee Participation in Program
Tornado or windstorm
Safety Performance - Past & Present
Bomb Threat
Employee Safety Awareness Awards
OVERVIEWS OF SPECIAL
•
Program
PROGRAMS PROGRAMS
Off-the-Job Safety Program
Lock-out / Tag-out
Employee Safety Suggestion Program
Confined Space Entry Program
Facility Safety Rules and Regulations
Hot Work Permit Program
MEDICAL FACILITIES AND PROG PROGRAM RAM
•
INTRODUCE DEPARTMENT
•
SUPERVISORS SUPERVISORS Reporting of accidents and any resulting
OTHER: OTHER:
•
injuries or illnesses Location of Dispensary and/or first aid room or stations PERSONAL PROTECTIVE EQUIPMENT
•
PROGRAM PROGRAM HEARING CONSERVATION PROGRAM PROGRAM
•
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Kentucky – Kentucky – Written Written Safety and Health Program
The above items checked were covered during my orientation:
Employee's Signature:
The above items checked were covered during the orientation of the above named.
Safety Coordinator's Signature:
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Kentucky – Kentucky – Written Written Safety and Health Program
SAFETY ORIENTATION CHECKLIST
Page 1 of 2
Employee's Name Name
Date Employed Date Employed
Department ________________________ Department ________________________
Job Title Title
Shift _______________ Shift _______________
Assigned Job and Instructed in Safe Job Procedure on (Date) ___________________________
Instructions to Be Given by Supervisor FOLLOW-UP
DATE & INITIALS ITEMS COVERED
OF SUPERVISOR
ORIENTATION 30 Days
1.
60 Days
HAZARDS THAT EXIST IN DEPARTMENT AND/OR AREA OR JOB
2.
REPORTING OF UNSAFE CONDITIONS NOTED
3.
GENERAL AND DEPARTMENT SAFETY RULES AND REGULATIONS REVIEW
4.
REVIEW EMERGENCY PROGRAM AND PROCEDURES Fire Prevention Rules for department or area Location and use of fire extinguishers Reporting of fires - location of fire alarm Location of emergency exits Evacuation procedures Location of assembly area by department for roll call Tornado or windstorm Bomb threat
5.
REPORTING OF ACCIDENTS, INJURIES, AND AND ILLNESSES
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Kentucky – Kentucky – Written Written Safety and Health Program
FOLLOW-UP
DATE & INITIALS ITEMS COVERED
OF SUPERVISOR
ORIENTATION 30 Days
6.
LOCATION OF FIRST AID STATION AND/OR DISPENSARY
7.
IDENTIFICATION OF FIRST FIRST AID TRAINED
60 Days
PERSONNEL 8.
PERSONAL PROTECTIVE EQUIPMENT PROGRAM
9.
HEARING CONSERVATION PROGRAM PROGRAM
10. LOCK-OUT/TAG-OUT PROGRAM PROGRAM 11. CONFINED SPACE ENTRY PROGRAM PROGRAM 12. MAINTENANCE OF TOOLS AND EQUIPMENT EQUIPMENT 13. MACHINE GUARDING PROGRAM PROGRAM 14. INSTRUCTIO INSTRUCTION N IN PROPER MATERIAL HANDLING HANDLING 15. HOUSEKEEPIN HOUSEKEEPING G AND MATERIAL AND EQUIPMENT STORAGE STORAGE 16. SAFE OPERATION OF MATE MATERIAL RIAL HA HANDLING NDLING EQUIPMENT EQUIPMENT 17. PERSONAL HYGIENE AND CLEANLINESS CLEANLINE SS • Appropriate Apparel & Wearing of Jewelry 18. REVIEW EMPLOYEE PARTICIPATION PARTICIPATIO N IN FACILITY AND DEPARTMENT SAFETY PROGRAMS PROGRAMS 19. HAZARD COMMUNICATION PROGRAM (Chemical Right-To-Know Law) Law) • Labels Practice • Material Safety Data Sheets • Training on Precautions for Specific Hazards 20. OTHER OTHER
The above items have been thoroughly covered, and I understand them.
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Kentucky – Kentucky – Written Written Safety and Health Program
Employee's Signature
Orientation Date
Supervisor's Signature
Employee's Signature
30-Day Follow-Up
Supervisor's Signature
Employee's Signature
60-Day Follow-Up
Supervisor's Signature
Note to the Supervisor: Copies of the completed and signed form are to be returned to the Personnel Department and Safety Department Department after the employee's orientation. orientation. The form will be returned for th the e 30and 60-day follow-up.
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OFFICE SAFETY INSPECTION CHECKLIST Office Name: ____________________________________________ The importance of remedial follow-up, whether it be work practice, detection of hazardous physical condition, or hazardous substance problem, cannot be over-emphasized if the inspection is to be meaningful and effective. Response with an * will require corrective action and follow-up. No
Yes
Aisles/Walkways Are aisles/walkways aisles/walkways obstructe obstructed? d?
*
Exits Are exits easily easily access accessible? ible?
*
Are exits free from from obstructio obstructions? ns?
*
Are exit signs illuminated?
*
Are exit signs clearly vis visible ible from employ employee ee areas?
*
* *
Are they adequately located?
*
Stairways Are there any cracked cracked steps?
*
*
*
*
*
Telephone wiring?
*
Electrical/telephone Electrical/telep hone outlets?
Physical Conditions
Correction Correction Requested
Date Date Completed
Li fe S afet afety y
Emergency Lights Do they function? Do they provide sufficient illumination?
Do steps have a slip-resistant surface? Are there missing missing or loose handrails handrails? ? Is lighting adequate? Walking/Working Surfaces Walking/Working Are employees exposed exposed to slipping/ slipping/tripping tripping hazards fro from: m: Electrical wiring and/or VDT cables?
Congestion in work areas?
Floors/Carpets Are carpets frayed frayed or torn?
*
Are mat edges curled? curled?
*
Are the floors wet wet and/or slippery slippery? ?
*
Are tiles missing missing or broken?
*
*
*
*
*
*
Is the floor cracked or are there holes? Storage Techniques Exposures to injury from falling objects or from lifting heavy h eavy objects: Are heavy boxes boxes stored at wais waistt height? Is heavy, bulky or sharp material stored overhead? Are bookcases/file bookcases/file cabinets a anchored? nchored? Are aisles in storage storage areas congest congested? ed?
*
*
67
Physical Conditions
No
Yes
Office Furniture Are employees exposed exposed to hazards from poorly maint maintained ained or adjusted furniture including: Defective chairs? Inoperable desk drawers? Unstable file cabinets?
* *
*
Overloading file cabinets? Machinery/Equipment Unguarded moving parts? Defective wiring on cords? Sharp edges or burrs on equipment?
*
*
*
*
*
*
*
Parking Lots/Sidewalks Are there potholes? Are there cracks cracks or uneven surfac surfaces? es?
*
*
Is lighting adequate? Are there accumulations accumulations of sn snow ow or ice?
*
*
*
*
*
Lighting Is lighting adequate? Is there glare or excessiv excessive e light? Are there obstructions obstructions creating dark darkness ness or shadow areas?
Work Practices Unsafe practices observed in the office environment: Leaving file or desk drawers open? Standing on chairs? Ignoring liquid spills? Running? Horseplay? Hazard Communicatio Communication n Material safety data sheets on file? Employee right-to-know training provided? Training logs on file? Hazardous substance storage and use Notice posted? Containers properly labeled? Following proper usage and storage procedure?
*
*
*
*
*
*
*
*
Additional comments: comments:
Inspection completed by: by:
Date: Date:
S afety Committee R evi ew Comments:
Committee Chairperson Signature:
Date:
Correction Correction Requested
Date Date Completed
Kentucky – Kentucky – Written Written Safety and Health Program
Appendix A
List of Training Subjects – Select applicable training subjects - Strikethrough/delete those that do not DECISION POINT – XYZ Company trains our workers about the following selected selec ted 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. 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. 69
Kentucky – Kentucky – Written Written Safety and Health Program
17. Tree falling/bucking procedures and precautions, including procedures for recognizing and working with hazard trees, snags, lodged trees, tr ees, 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. 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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Kentucky – Kentucky – Written Written Safety and Health Program
Appendix B
Hazard Assessment Checklist Determine which checklists apply to your operation and delete all others others DECISION POINT – Determine XYZ Company has determined the following hazard assessment checklists apply to its operations oper ations
1. Abrasive Wheel Equipment Grinders
22. Hazardous Substances Communication
2. Compressed Air Receivers
23. Hoist & Auxiliary Equipment
3. Compressed Gas & Cylinders
24. Identification of Piping Systems
4. Compressors & Compressed Air
25. Industrial Trucks – Trucks – Forklifts Forklifts
5. Confined Spaces
26. Infection Control
6. Control of Harmful Substances by
27. Lockout-Tagout Procedures
Ventilation
28. Machine Guarding
7. Crane Checklist
29. Material Handling
8. Electrical
30. Noise
9. Elevated Surfaces
31. Personal Protective Equipment & Clothing
10. Emergency Action Plan
32. Portable (Power Operated) Tools &
11. Environmental Controls
Equipment
12. Ergonomics
33. Portable Ladders
13. Exit Doors
34. Powder Actuated Tools
14. Exiting or Egress
35. Sanitizing Equipment & Clothing
15. Fire Protection
36. Spraying Operations
16. Flammable & Combustible Materials
37. Stairs and Stairways
17. Floor & Wall Openings
38. Tire Inflation
18. Fueling
39. Transporting Employees & Materials
19. General Work Environment
40. Ventilation for Indoor Air Quality
20. Hand Tools & Equipment
41. Walkways
21. Hazardous Chemical Exposures
42. Welding, Cutting & Brazing
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Kentucky - Written Safety and Health Manual
Appendix C Hazard Assessment and Correction Record
72
Kentucky - Written Safety and Health Manual
Hazard Assessment and Correction Record
Date of Inspection: ___________________ ___________________________ _________________ _____________ ____ Person Conducting Inspection: ___________________ _____________________________ ____________ __ Unsafe Condition or Work Practice: __________________ __________ _________________ ___________________ _________________ _________________ ___________________ ___________________ _______________ _____ __________________ __________ _________________ ___________________ ____________________ ____________________ __________________ _________________ _____________ ____
__________________ __________ _________________ ___________________ _________________ _________________ ___________________ ___________________ _______________ _____
Corrective Action Taken: __________________ __________ _________________ ___________________ _________________ _________________ ___________________ ___________________ _______________ _____ __________________ __________ _________________ ____________________ ____________________ ___________________ ___________________ ___________________ ____________ __ __________________ __________ _________________ ___________________ _________________ _________________ ___________________ ___________________ _______________ _____
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Kentucky - Written Safety and Health Manual
Appendix D Accident/Exposure Accident/Exposu re Investigation Report
74
Kentucky - Written Safety and Health Manual
Accident/Exposure Accident/Exposu re Investigation Report Date of Accident: __________________ ____________________________ ___________ _ Time of Accident: A ccident: __________________ __________________ Location of Accident: __________________ __________________________ ___________________ _____________________ ___________________ ____________ ___ Accident Description: __________________ __________ _________________ ___________________ _________________ _________________ ___________________ ___________________ _______________ _____ __________________ __________ __________________ ____________________ ___________________ ___________________ __________________ _________________ _____________ ____ __________________ __________ _________________ ___________________ _________________ _________________ ___________________ ___________________ _______________ _____
Employees Involved: __________________ __________ _________________ ___________________ _________________ _________________ ___________________ ___________________ _______________ _____ __________________ __________ __________________ ___________________ _________________ _________________ __________________ ___________________ _______________ _____ Preventive Action Recommendations: __________________ __________ _________________ ___________________ _________________ _________________ ___________________ ___________________ _______________ _____
__________________ __________ _________________ ___________________ _________________ _________________ ___________________ ______________________ _______________ __ Corrective Actions Taken: __________________ __________ _________________ ___________________ _________________ _________________ ___________________ ___________________ _______________ _____ __________________ __________ _________________ ___________________ _________________ _________________ ___________________ ___________________ _______________ _____ Manager Responsible: ___________________ _____________________________ _____________________ ___________ Date Corrective Actions Completed: ___________________ _____________________________ __________
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Kentucky - Written Safety and Health Manual
Appendix E Employee Training and Instruction Record
76
Kentucky - Written Safety and Health Manual
Employee Training and Instruction Record
Employee Receiving Training:
(First Name)
(Middle Initial)
(Last Name)
(Safety Training Topic) Select one: Initial
Periodic
Annual/Refresher
Special
This employee has received specific safety & health training in the following subject areas:
Person conducting the training:
(First Name)
(Middle Initial)
Trainer’s Signature Trainer’s
(Last Name)
Date
Qualification or Job Title of Trainer
Trainee’s Signature Trainee’s
Date 77
Kentucky - Written Safety and Health Manual
Appendix F Employee Acknowledgement Form
78
Kentucky - Written Safety and Health Manual
Employee Acknowledgement Form I hereby acknowledge that I have had the opportunity to read, review and ask questions on the contents of the company’s Written Safety and Health Program. I also acknow acknowledge ledge 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 th the e company’s Drug-Free Workplace Policy shall also be grounds for termination of my employment.
Employee - Print Your Name
Signature of Employee
Date
As an employee representative of the company, com pany, I hereby attest that the employee em ployee named here was given the opportunity to read, review and ask questions about the company’s Written Safety and Health Program and company safety and health policies.
Witness – Witness – Print Print Your Name
Duty Title of Witness
Signature of Witness
Date
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Kentucky - Written Safety and Health Manual
Americana Safety Disclaimer Notice
While we have made every attempt at tempt to ensure that the information contained in this document is reliable, Americana Safety 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 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 merc hantability and fitness for a particular purpose. In no event will Americana Safety, 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 do doccument 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. document. Accordingly, the information in this d document ocument is provided with the understanding that the authors and publishers are proving guidance with rer espect to the information contained herein and that the performance or non-performance of this guidance shall be the responsibility of the user of this t his information.
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