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XYZ Company
Injury and Illness Prevention
Program
For
High-Hazard Industry EmployersAs determined by OSHA
Complies with Provisions of
OSHA 29 CFR Part 1910 – General Industry StandardsOSHA 29 CFR Part 1926 – Construction Industry Standards
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Injury & Illness Prevention Program(For High-Hazard Industry Employers)
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Injury & Illness Prevention Program(For High-Hazard Industry Employers)
Table of Contents
Section DescriptionPage
1 Program Policy & Requirement 3
2 Program Responsibility 4
3 Employee Compliance and Discipline 8
4 Safety Communication 11
5 Safety Committee and Meetings 13
6 Hazard Identification and Assessment 16
7 Accident/Exposure Investigation 26
8 Hazard Prevention and Control 33
9 Safety Training and Instruction 43
10 Accident Recordkeeping 47
11 Company Required Safety Programs 50
12 Company Required Safety Training Courses 51
13 Company Required Safety Forms & Checklists 53
Appendices
Appendix A List of Training Subjects 55
Appendix B Hazard Assessment Checklists 57
Appendix C Hazard Assessment and Correction Record 58
Appendix D Accident/Exposure Investigation Report 60
Appendix E Employee Training and Instruction Record 62
Appendix F Codes of Safe Practice (General and ConstructionIndustries) 64
Appendix G Employee Acknowledgement Form 75
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Injury & Illness Prevention Program(For High-Hazard Industry Employers)
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Injury & Illness Prevention Program(For High-Hazard Industry Employers)
Section 1
Program Policy &
Requirement
Program Policy
It is intent of XYZ Company to comply with all laws. To do this, we must
constantly be aware of conditions in all work areas that can produce
injuries. No employee is required to work at a job he/she knows is not
safe or healthful. Your cooperation in detecting hazards and, in turn,
controlling them, is a condition of your employment. Inform your
supervisor immediately of any situation beyond your ability or authority
to correct.
Program Requirement
This program has been prepared for use by employers in industries
which have been determined by OSHA to be HIGH-HAZARD .
Employers in an industry which has been determined by OSHA as High-Hazard and who
adopts and implements this program in good faith shall be deemed in compliance with IIP
Program requirements, unless mandated otherwise by a State law . Once this
program has been implemented, a copy must be maintained at each
workplace or at a central worksite if the employer has non-fixed
worksites.
Proper use of this program requires the IIP Program administrator to
carefully review the requirements for each of the eight IIP Program
elements found in this program, fill in the appropriate blank spaces and
check those items that are applicable to your workplace. The
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Injury & Illness Prevention Program(For High-Hazard Industry Employers)
recordkeeping section requires that the IIP Program administrator select
and implement the category appropriate for your establishment.
This program must be maintained by the employer in order to be
effective.
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Injury & Illness Prevention Program(For High-Hazard Industry Employers)
Section 2
Program Responsibili ty
Safety and Health Responsibilities
XYZ Company is responsible for ensuring that all onsite and offsite work
activities, equipment, and facilities operated or maintained by XYZ
Company our subcontractors or suppliers conform fully with safety and
health regulations promulgated by the U.S. Department of Labor in Title
29 CFR 1910 and 1926, Occupational Safety and Health Act of 1970, and
provisions of all state approved plans and safety procedures. Complianceshall include the aforementioned regulations, standards and codes and
all such regulations, standards and codes as included by reference.
These responsibilities include, but are not limited to, the following:
A. Program Administrator
Written Accident Prevention Program administrator, ProgramAdministrator has the authority and responsibility for implementingthe provisions of this program.
è DECISION POINT – Enter a name or position title (recommended)
The Program Administrator for XYZ Company is ____________________________________.
B. Safety Representative Responsibilities
The company safety representative, Safety Representative also hasthe authority and responsibility for implementing the provisions of this program and may be the same person or title as the ProgramAdministrator.
è DECISION POINT – Enter a name or position title (recommended)
The Safety Representative for XYZ Company is ___________________________________.
A. The XYZ Company Safety and Health compliance program shall be
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Injury & Illness Prevention Program(For High-Hazard Industry Employers)
managed and administered by the Safety Representative.
B. Ensure the company’s compliance with all applicable federal,
state, and local safety and health requirements.
1. Ensure that each employee is provided with adequate and
appropriate occupational safety and health training and personal
protective equipment.
2. Inspect all workplaces, projects, and/or facilities periodically, but
not less than once per quarter.
3. Ensure that the safety and health policies are comprehensive and
effective.
4. Review each accident and conduct any investigation wherein an
accident has resulted in serious occupational injury, illness or
property damage.
5. Promote safety and health and serve as a resource to all staff.
6. Review the program on an annual basis.
C. Manager Responsibilities
1. Establish rules and programs designed to promote safetyand make known to all employees the established rules andprograms.
2. Provide all supervisors with copies of appropriate rules andregulations.
3. Make available training necessary for employees to performtheir tasks safely.
4. Provide protective equipment for employees whererequired.
5. Impress upon all employees, subcontractors and suppliers,the responsibility and accountability of each individual to maintaina safe workplace.
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Injury & Illness Prevention Program(For High-Hazard Industry Employers)
6. Record all instances of violations and investigate allaccidents.
7. Discipline any employee disregarding safety and lossprevention policies.
8. Require all subcontractors as a matter of contract and allmaterial suppliers through purchase order terms, to followestablished safety rules.
9. Require all subcontractors to submit for review their safetyprograms and encourage them to work safely.
10. Conduct safety inspections, maintain records andcontinually monitor the program for effectiveness.
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Injury & Illness Prevention Program(For High-Hazard Industry Employers)
D. Supervisor Responsibilities
1. Carry out safety programs at the work level.
2. Be aware of all safety requirements and safe workingpractices.
3. Plan work activities to comply with safe working practices.
4. Instruct new employees, existing employees, andsubcontractors performing new tasks on safe working practices.
5. Make sure protective equipment is available and used.
6. Make sure work is performed in a safe manner and no
unsafe conditions or equipment is present.
7. Correct all hazards, including unsafe acts and conditions,
which are within the scope of your position.
8. Secure prompt medical attention for any injured employees.
9. Report all injuries and safety violations to management.
E. Employee Responsibilities
1. Work safely in such a manner as to ensure your own safetyas well as that of co-workers and others.
2. Request help when unsure about how to perform any tasksafely.
3. Correct unsafe acts or conditions within the scope of theimmediate work.
4. Report any uncorrected unsafe acts or conditions to theappropriate supervisor.
5. Report for work in good mental and physical condition to
safely carry out assigned duties.6. Use and maintain all safety equipment provided.
7. Maintain and properly use all tools under your control.
8. Follow all safety and project rules.
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Injury & Illness Prevention Program(For High-Hazard Industry Employers)
9. Provide fellow employees help with safety requirements.
10. REPORT ALL WORK RELATED INJURIES OR ACCIDENTS
TO YOUR SUPERVISOR - IMMEDIATELY.
F. All Personnel (without regard to position or assignment) :
1. Strive to make all operations safe.
2. Maintain mental and physical health conducive to working safely.
3. Keep all work areas clean and free of debris.
4. Assess result of your actions on the entire work place. Work willnot be performed in ways that cause hazards for others.
5. Before leaving work, replace or repair safety precaution signs or
barriers that have been removed or altered. Unsafe conditions will
not be left to imperil others.
6. Abide by the safety rules and regulations promulgated for this
construction project.
è DECISION POINT - delete if not applicable
G. Subcontractors and Suppliers Responsibilities
1. Abide by safety rules and regulations as promulgated by Federal,
State and local authorities including those of XYZ Company and
any General Contractor.
2. Notify all other contractors when their activities could affect the
health or safety of other employees in the workplace, project
and/or facility.
3. Check in with XYZ Company site supervision when entering orleaving any job-site.
4. Inform XYZ Company site Safety Representative of all injuries to
workers, immediately.
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Injury & Illness Prevention Program(For High-Hazard Industry Employers)
5. Report to XYZ Company site supervision or safety representatives
any unsafe conditions.
6. Provide for review Safety and Hazard Communications Programs.
7. Provide a chemical inventory list and copies of MaterialSafety Data Sheets (MSDS) for any hazardous materials - prior tobringing materials on-site.
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Injury & Illness Prevention Program(For High-Hazard Industry Employers)
Section 3
Employee Compliance &
Discipline
XYZ Company management is responsible for ensuring that all safety
and health policies and procedures are clearly communicated and
understood by all employees. Managers and supervisors are expected to
enforce the rules fairly and uniformly.
All XYZ Company employees are responsible for using safe work
practices, for following all directives, policies and procedures, and for
assisting in maintaining a safe work environment.
A. Employee Compliance
OSHA requires that you include a system for ensuring that employees
comply with safe and healthful work practices.
Substantial compliance with this provision includes recognition of
employees who follow safe and healthful practices, e.g., incentive
programs, training and retraining programs, disciplinary actions,
infraction notices; or any other means that ensure employee
compliance with safe and healthy work practices. Though sample
procedures are provided, you must modify them to suit your
requirements.
As part of this compliance, you should provide employees with a codeof safe practices that reflect your company’s specific operations more
exactly. The Code of Safe Practices we have provided is a suggested
format.
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Injury & Illness Prevention Program(For High-Hazard Industry Employers)
B. Employee Enforcement Procedures and
Systems
The XYZ Company safety rules and work procedures shall be
practiced and enforced.
We have established a system to ensure that violations of rules are
dealt with fairly but firmly, that all employees are aware of the
requirements, and that reorientation or retraining may be provided
when needed. Incentive programs may be initiated and will be used
in conjunction with a good enforcement program.
Discipline
No safety program can be effective without some form of discipline.
There are no rules that must be followed, only guidelines.
The first preventable accident or safety rule violation observed
should result in a discussion with the employee and the supervisor or
manager. This verbal reprimand should be documented, dated, and
signed by those involved.
A second preventable accident or safety rule violation observedwithin a 12-month period should result in another discussion with the
employee accompanied by a written reprimand. Time off without
pay, up to a maximum of 5 days, should be considered.
A third preventable accident or safety rule violation observed within
a 12-month period should result in another discussion with the
employee and a serious evaluation needs to be made. This is
probably grounds for termination.
Compliance
One point must be very clear: discipline has to be administered
uniformly and consistently.
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Injury & Illness Prevention Program(For High-Hazard Industry Employers)
Violations of safety rules and policies should be addressed in the
following manner:
a. First Incident: Verbal warning, documented discussion.
b. Second Incident: Written reprimand, up to 5 days suspension.
c. Third Incident: Written reprimand, grounds for termination.
Each XYZ Company supervisor or manager shall be responsible for
administering this policy to his/her subordinates.
All written reprimands and records of violations shall be held
confidential and maintained in the employees’ personnel files.
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Injury & Illness Prevention Program(For High-Hazard Industry Employers)
Accountability
Each supervisor’s efforts and performance will be evaluated relative
to reaching XYZ Company safety objectives and assigned
responsibilities. This evaluation will be part of the supervisor’sperformance review and will be used in part to determine his or her
job assignments, merit increases or promotions.
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Injury & Illness Prevention Program(For High-Hazard Industry Employers)
Section 4
Safety Communication
Communication between management and employees on matters of
safety is of primary importance in order to have an effective Safety
Program. The primary means of communicating with employees will
include: Safety committee(s); personal safety contacts; group safety
meetings; written communications; bulletin boards and posted notices;
and a safety suggestion system.
A. Safety Committee (See Section 5)
B. Individual Contacts
1. Individual contacts between the supervisor and employee to
instruct or discuss some safety topic related to the employee's
work are powerful tools for developing favorable employee
behavior toward safety and accident prevention. They are
continuing reminders that management is concerned about
employee safety
2. Individual contacts with employees on matters of safety and
health should be documented.
3. Important : Keeping a record of personal contacts on safety
rules and job procedures is necessary for a number of reasons.
The record is a history of what has been discussed with an
employee, on what dates, and by what supervisors. Such
information is useful to establish the fact that a person has been
properly instructed. Secondly, a record can be a tool to help
decide future topics to discuss with the employee. Thirdly, they
provide a record of training for statutory compliance
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Injury & Illness Prevention Program(For High-Hazard Industry Employers)
safety rules and important policies and procedures.
2. XYZ Company bulletin boards will be conspicuously located.
a. The boards are to be properly maintained..
b. One individual will be responsible for maintaining the bulletin
board and controlling the notices placed thereon.
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Injury & Illness Prevention Program(For High-Hazard Industry Employers)
Section 5
Safety Committee and
Meetings
è DECISION POINT - If you have 25 or more employees, a Safety Committee should be established. If you do not meet this threshold,delete this sub-section.
A. Safety Committee
XYZ Company has formed a safety committee to help employees and
management work together to identify safety problems, develop
solutions, review incident reports and evaluate the effectiveness of
our safety program. The committee is made up of management-
designated representatives and employee-elected representatives.
1. The committee shall:
a. Promote a safe and healthy work environment at all times.
b. Encourage communication between employees and
management.
c. Serve as an oversight committee on all issues relative to
safety and health.
d. Make recommendations to the Safety Representative.
2. Functions: The committee has four principal functions:
a. Identify potential hazards;
b. Evaluate these potential hazards;
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Injury & Illness Prevention Program(For High-Hazard Industry Employers)
c. Recommend corrective action; and
d. Follow up implemented recommendations.
To carry out its functions, the committee is required to hold meetings
and carry out regular inspections of the workplace.
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Injury & Illness Prevention Program(For High-Hazard Industry Employers)
3. Membership
The make-up of an occupational safety and health committee shall
be a cross section of the membership of our organization.
Everyone who is a member of this organization should feel thattheir needs are being adequately and fairly represented through
the safety committee. If the XYZ Company employees are
represented by a labor organization, the representatives of
employees must be selected by the employees and not appointed
by the employer.
Employee representatives will serve for one year before being 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
of one who will serve until replaced by management.
A chairperson will be selected by majority vote of the committee
members each year. If there is a vacancy, the same method will
be used to select a replacement.
In addition to committee responsibilities, duties of safety
committee members include:
Perform a monthly self-inspection of the area they
represent;
Communicating with the employees they represent on
safety issues; and
Encourage safe work practices among co-workers.
4. Employer Responsibilities
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Injury & Illness Prevention Program(For High-Hazard Industry Employers)
Provide support from the top level down to first line
supervisors in terms of time, effort, and money.
Resolve scheduling and personnel conflicts.
Provide realistic dates for correcting safety and health
concerns.
Support training for safety committee members.
Provide leadership and direction.
Participation in safety committee meetings.
The management commitment/interest/good faith to safety
committees must be vocal, visible, and continuous - from the top
to the lowest level.
5. Frequency
Once established, the XYZ Company safety committee shall meet
at least quarterly. An agenda shall be developed by the
chairperson and distributed to the members at least 10 workdays
prior to the scheduled meeting. Meeting minutes shall be
prepared and distributed to the membership within 5 days
following the meeting. Meeting minutes shall be posted in a
conspicuous location convenient to all employees to view (i.e.,
lunch room, bulletin board, etc.)
B. Employee Safety Meetings
All trade employees are required to attend a monthly safety meeting.
The meeting is to help identify safety problems, develop solutions,
review incident reports, provide training and evaluate the
effectiveness of our company safety program. Minutes will be keptand kept on file for one year.
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Injury & Illness Prevention Program(For High-Hazard Industry Employers)
Section 6
Hazard Identification &
Assessment
A. Recordkeeping and Review
1. Employees will:
Employees will report any injury or work-related illness to their
immediate supervisor regardless of how serious. Minor injuries
such as cuts and scrapes can be entered on a “Minor Injury Log”posted in a conspicuous location. The employee must use an
“Employee’s Injury/Illness Report Form” to report more serious
injuries.
2. Supervisors will: è DECISION POINT
a. Investigate a serious injury or illness using procedures in
the “Incident Investigation” section.
b. Complete an “Incident Investigation Report” form.
c. Give the “Employee’s Report” and “Incident Investigation
Report” to the company Safety Representative.
B. Hazard Recognition Methods
Hazard recognition is a vital element in the program. It is a system to
identify any existing or potential dangers in the workplace, then
following through to eliminate or control them. If dangers occur (or
reoccur), there is a breakdown in the danger control system, and in
turn the safety and health program. The danger control system also
serves as the basis for developing safe work procedures and safety
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Injury & Illness Prevention Program(For High-Hazard Industry Employers)
and health training.
Correcting or controlling dangers can be accomplished in a variety of
ways. However, to work properly, a danger control system must have
the following components:
1. An initial danger identification survey;
2. A system for danger identification (such as inspections at
regular intervals);
3. An effective system for employees to report conditions
which may be dangerous (such as a safety committee or a safety
representative);
4. An equipment and maintenance program;
5. A system for review or investigation of workplace accidents,
injuries and illnesses;
6. A system for initiating and tracking danger corrective
actions; and
7. A system for periodically monitoring the place of
employment.
C. Danger Identification Methods
è DECISION POINT - If one has not been done, have it accomplished as soon as possible. If one has been accomplished, sostate, and where it’s maintained.
Initial Danger Survey
A knowledgeable safety and health person should conduct the initialsafety and health survey (audit) to identify existing or potential
workplace dangers.
è DECISION POINT - If one has not been done, have it
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Injury & Illness Prevention Program(For High-Hazard Industry Employers)
accomplished as soon as possible. If one has been accomplished, sostate, and where it’s maintained.
Periodic Danger Surveys (Monitoring)
A Scheduled a walk-through of the XYZ Company workplace is
performed at regular intervals to ensure that established work
procedures are being followed, and those unsafe conditions or
practices are identified and promptly corrected. These inspections
are in addition to the everyday safety and health checks that are part
of the routine duties of supervisors and managers.
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Injury & Illness Prevention Program(For High-Hazard Industry Employers)
The frequency of the inspections depends on the type of operations,the magnitude of the dangers, the proficiency of employees and supervisors, changes in equipment or work processes, and the history of the workplace injuries and illnesses. Someone who, throughexperience or training, can identify actual and potential dangers and
who understands safe work procedures should do an inspection.è DECISION POINT - If one has not been done, have it accomplished as soon as possible. If one has been accomplished, sostate, and where it’s maintained.
Employee Reports of Danger
Perhaps the best source of danger information is the employees.Employees should be trained to recognize danger situations and instructed to bring them to the attention of their supervisors or to asafety committee or a safety and health representative.
Prompt attention to identified dangers and positive feedback toemployees will reaffirm your personal commitment to workplacesafety and health. That will encourage employees to continue toreport dangers promptly and assure them that their reporting will not have negative consequences.
è DECISION POINT - If one has not been done, have it accomplished as soon as possible. If one has been accomplished, so state, and whereit’s maintained.
D. Equipment Monitoring and Maintenance
Program
Equipment, particularly all safety controls and safety equipment must be properly maintained. A program must be established to monitor the operation of workplace equipment and make sure that routine
preventive maintenance is conducted. That not only makes good safety and health sense, it is good for business. Proper maintenancecan prevent costly breakdowns.
è DECISION POINT - If one has not been done, have it accomplished as soon as possible. If one has been accomplished, so state, and where
it’s maintained.E. Accident Investigation and Reporting
A system must be established for investigating all workplaceaccidents, near misses, injuries and illnesses. Someone who canidentify the causes and recommend corrective actions should
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Injury & Illness Prevention Program(For High-Hazard Industry Employers)
involved, the extent of injuries or illness, a brief description of
what happened and the name and phone number of a contact
person.
2. Accident Investigation
Do not disturb the scene except to aid in rescue or make the
scene safe.
Whenever there is an incident that results in death or serious
injuries that have immediate symptoms, a preliminary
investigation will be conducted by the immediate supervisor of the
injured person(s), a person designated by management, an
employee representative of the safety committee, and any otherpersons whose expertise would help the investigation.
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Injury & Illness Prevention Program(For High-Hazard Industry Employers)
The investigation team will take written statements from
witnesses, photograph the incident scene and equipment involved.
The team will also document as soon as possible after the
incident, the condition of equipment and any anything else in the
work area that may be relevant. The team will make a written
“Incident Investigation Report” of its findings. The report will
include a sequence of events leading up to the incident,
conclusions about the incident and any recommendations to
prevent a similar incident in the future. The report will be
reviewed by the safety committee at its next regularly scheduled
meeting.
When a supervisor becomes aware of an employee injury wherethe injury was not serious enough to warrant a team investigation
as described above, the supervisor will write an "Incident
Investigation Report" to accompany the "Employee's Injury/Illness
Report Form" and forward them to (Add the name or title of
the responsible person) .
Whenever there is an incident that did not but could have resulted
in serious injury to an employee (a near-miss ), the incident will be
investigated by the supervisor or a team depending on the
seriousness of the injury that would have occurred. The "Incident
Investigation Report" form will be used to investigate the 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.
3. Occupational Injury, Illness Investigation
The Supervisor, if initially notified, shall report to the scene of an
occupational injury, illness, and property damage and immediately
secure and protect the accident scene. Drawings and
photographs, if needed, shall be used to record and document
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Injury & Illness Prevention Program(For High-Hazard Industry Employers)
where and how the accident occurred and the extent of injuries
and damage to property sustained. A preliminary and/or final
incident report shall be accomplished and a copy provided to the
company Safety Representative. The initial accident report shall
become a permanent part of the formal accident investigation.
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Injury & Illness Prevention Program(For High-Hazard Industry Employers)
The Safety Representative shall report to and investigate all
serious occupational injuries, illnesses and property damage. A
formal Incident Investigation Report shall be prepared to
determine the cause, document facts and recommend corrective
actions to prevent recurrence.
4. Occupational Injury, Illness Reporting
Employees shall report all occupational injuries, illnesses and
property damage, initially through their supervisor to the XYZ
Company Safety Representative.
This is the preferred method, which will ensure employees receive
medical treatment, if required, because of a serious and/or lifethreatening occupational injury and/or illness, and damage to
property can be documented and repaired.
Supervisors will immediately notify the XYZ Company Safety
Representative of any serious and/or life threatening occupational
injury and/or illness, and property damage. All other minor
occupational injuries and/or illnesses, and property damage will
also be reported to the Safety Representative the following day.
The Safety Representative will ensure the company person
responsible for Benefits Administration and/or Workers’
Compensation claims receives copies of the final report for all-
occupational injuries and/or illnesses.
F. Injury and Illness Recordkeeping
In order to establish meaningful goals and objectives for mishap
reduction, we must first know where we, as a company, have been in
terms of previous mishap experience. For that reason and to comply
with federal recordkeeping requirements, the following
documentation shall be maintained:
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Injury & Illness Prevention Program(For High-Hazard Industry Employers)
1. The Safety Representative shall maintain for a period of 5
years:
a. Safety accident investigation reports for all lost workday
occupational injuries, illnesses or equipment damage;
b. Safety accident investigation reports for company
property damage, as a result of accidents;
c. Records of formal claims against the company for injury,
illness, personal loss, and/or damage to personal property; and
2. OSHA Form No. 300, Log of Work-Related Injuries and
Illnesses , shall be used to record injuries or illnesses that result in
fatalities, lost workdays, require medical treatment, involve loss of
consciousness, or restrict work or motion. The annual report of
this form must be posted by February 1st in a centralized area
visible to all employees, and remain there for at least 3 months.
3. OSHA Form No. 301, Injury and Illness Incident Report ,
shall, when used, be used to give details of each recordable
occupational injury and illness. Records must be available for
examination by representatives of the U.S. Department of Laborand the Department of Health and Human Services. Note: This
record and/or the SF-301are kept for five years.
4. OSHA Form No. 300A, Summary of Work-Related Injuries
and Illnesses , provides additional data to make it easier for
employers to calculate incidence rates. Employers must review
the OSHA 300 Log information before it is summarized on the
300A form.
5. Accident Review: è DECISION POINT
Following an injury or near miss accident, the incident will be
reviewed with the Project Manager and onsite supervision . This
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Injury & Illness Prevention Program(For High-Hazard Industry Employers)
review will address the effectiveness of our program, any
additional task training that may be needed and measures to
prevent recurrence.
Once each month the Safety Representative shall report on the
effectiveness of XYZ Company safety program to the project or
company manager. This report can include data on the number of
man-hours worked, the numbers of accidents, injuries and near
miss incidents for the month and measures taken to prevent
recurrences.
G. Corrective Actions
è DECISION POINT - State your method of corrective action here.
1. Timely Correction of Dangers
Once remedial measures to control or eliminate dangers havebeen agreed upon, you should make sure that they areimplemented with minimum delay. Interim protection for employees may be necessary until the danger is eliminated or controlled.
Keep a record of steps taken to control or eliminate a danger.
Records should contain the danger, who reported it and when whois responsible for correction, the correction target date and whenit was corrected. Such information will assist in developing safework practices and training programs.
2. Responsibility for Corrective Action
a. Actions necessary to correct or remedy accident causal
factors shall rest with the XYZ Company Safety Representative.
b. The XYZ Company Safety Representative shall have the
broad authority to recommend corrective actions to abate anidentified hazard or deficiency to prevent injury or illness to
employees, and to prevent property damage or personal loss.
è DECISION POINT - State how frequently you will accomplish this.
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Injury & Illness Prevention Program(For High-Hazard Industry Employers)
1. Annual Site Survey -- Once a year an inspection team made up
of members of the safety committee will do a wall-to-wall walk
through inspection of the entire workplace. They will write down
any safety hazards or potential hazards they find. The results of
this inspection will be used to eliminate or control obvious
hazards, target specific work areas for more intensive
investigation, assist in revising the checklists used during regular
monthly safety inspections and as part of the annual review of the
effectiveness of our accident prevention program.
2. Periodic Change Survey -- We will assign a supervisor or form a
team to look at any changes we make to identify safety issues.
Changes include new equipment, changes to production processesor a change to the building structure. A team is made up of
maintenance, production, and safety committee representatives. It
examines the changed conditions and makes recommendations to
eliminate or control any hazards that were or may be created as a
result of the change.
3. Monthly Safety Inspection -- Each month, before the regularly
scheduled safety committee meeting, safety committee members
will inspect their areas for hazards using the standard safety
inspection checklist. They will talk to co-workers about any safety
concerns they may have. Committee members will report any
hazards or concerns to the whole committee for consideration.
The results of the area inspection and any action taken will be
posted in the affected area. Occasionally, committee members
may agree to inspect each other's area rather than their own. This
brings a fresh pair of eyes into the workplace area to look for
hazards.
4. Job Hazard Analysis -- As a part of our on-going safety program,
we will use a “Job Hazard Analysis” form to look at each type of job
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Injury & Illness Prevention Program(For High-Hazard Industry Employers)
A “Safety Inspection Guide Checklist” can be a useful tool to help the
supervisor carry out his/her responsibilities as described above.
B. Investigating Occupational Injury, Illness, and
Property Damage
1. The XYZ Company supervisor, if initially notified, shall report to the
scene of an occupational injury, illness, and property damage and
immediately secure and protect the accident scene. Drawings and
photographs, if needed, shall be used to record and document
where and how the accident occurred and the extent of injuries
and damage to property sustained. A preliminary and/or final
incident report shall be accomplished and a copy provided to thecompany Safety Representative. The initial accident report shall
become a permanent part of the formal accident investigation.
2. The Program Administrator/Safety Representative shall report to
and investigate all serious occupational injuries, illnesses and
property damage. A formal Incident Investigation Report shall be
prepared to determine the cause, document facts and recommend
corrective actions to prevent recurrence.
C. Reporting Occupational Injury, Illness and
Property Damage
1. XYZ Company employees shall report all occupational injuries,
illnesses and property damage, initially through their supervisor to
the Program Administrator/Safety Representative.
2. This is the preferred method, which will ensure employees receive
medical treatment, if required, because of a serious and/or life
threatening occupational injury and/or illness, and damage to
property can be documented and repaired.
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Injury & Illness Prevention Program(For High-Hazard Industry Employers)
The annual report of this form must be posted by February 1st in a
centralized area visible to all employees, and remain there for at
least 3 months.
3. OSHA Form No. 301, Injury and Illness Incident
Report , shall, when used, be used to give details of each
recordable occupational injury and illness. Records must be
available for examination by representatives of the U.S.
Department of Labor and the Department of Health and Human
Services. Note: This record and/or the SF-301must be kept for five
years.
4. OSHA Form No. 300A, Summary of Work-Related
Injuries and Illnesses , provides additional data to make it easier
for employers to calculate incidence rates. Employers must
review the OSHA 300 Log information before it is summarized on
the 300A form.
5. Accident Review
Following an injury or near miss accident, the incident will be
reviewed with the Project Manager and onsite supervision. This
review will address the effectiveness of our program, any
additional task training that may be needed and measures to
prevent recurrence.
Each month the company Program Administrator/Safety
Representative shall report on the effectiveness of XYZ Company
safety program to the project or company manager. This report
can include data on the number of man-hours worked, the
numbers of accidents, injuries and near miss incidents for themonth and measures taken to prevent recurrences.
E. Corrective Actions
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Injury & Illness Prevention Program(For High-Hazard Industry Employers)
è DECISION POINT - State your method of corrective action here.
1. Timely Correction of Dangers
Once remedial measures to control or eliminate dangers have been
agreed upon, you should make sure that they are implemented withminimum 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 isresponsible for correction, the correction target date and when it wascorrected. Such information will assist in developing safe work
practices and training programs.
2. Responsibility for Corrective Action
a. Actions necessary to correct or remedy accident causalfactors shall rest with the XYZ Company Safety Representative.
b. The XYZ Company Safety Representative shall have the
broad authority to recommend corrective actions to abate an
identified hazard or deficiency to prevent injury or illness to
employees, and to prevent property damage or personal loss.
F. Monitoring the Place of Employment .
You have the responsibility of monitoring the workplace regularly –the work procedures, equipment and machines – to ensure that alldangers to workers are eliminated or controlled or, alternatively, toensure that the workers are protected from exposure to the dangers.
G. Safety Inspection and Hazard Control
Procedures
XYZ Company is committed to aggressively identifying hazardous
conditions and practices which are likely to result in injury or illness toemployees. We will take prompt action to eliminate any hazards we
find.
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Injury & Illness Prevention Program(For High-Hazard Industry Employers)
In addition to the Program Administrator/Safety Representative
reviewing injury records and investigating incidents for their causes,
area supervisors and the safety committee will regularly check the
workplace for hazards in the manner described below:
1. Annual Site Survey
Once each year an inspection team made up of members of the
safety committee will do a wall-to-wall walk through inspection of
the entire worksite. They will write down any safety hazards or
potential hazards they find.
The results of this inspection will be used to eliminate or control
obvious hazards, target specific work areas for more intensive
investigation, assist in revising the checklists used during regular
monthly safety inspections and as part of the annual review of the
effectiveness of our accident prevention program.
2. Periodic Change Survey
The Program Administrator/Safety Representative will request a
supervisor to form a team to look at any changes we make to
identify safety issues. Changes include new equipment, changes
to production processes or a change to the building structure. A
team is made up of maintenance, production, and safety
committee representatives.
It examines the changed conditions and makes recommendations
to eliminate or control any hazards that were or may be created as
a result of the change.
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Injury & Illness Prevention Program(For High-Hazard Industry Employers)
3. Monthly Safety Inspection
Safety committee members will inspect their areas for hazards
using the standard safety inspection checklist. They will talk to co-
workers about their safety concerns. Committee members will
report any hazards or concerns to the whole committee for
consideration. The results of the area inspection and any action
taken will be posted in the affected area. Occasionally, committee
members may agree to inspect each other's area rather than their
own. This brings a fresh pair of eyes to look for hazards.
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Injury & Illness Prevention Program(For High-Hazard Industry Employers)
Section 8
Hazard Prevention and
ControlA. Eliminating Workplace Hazards
XYZ Company is committed to eliminating or controlling workplace
hazards that could cause injury or illness to our employees. We will
meet the requirements of state safety standards where there are
specific rules about a hazard or potential hazard in our workplace.
Whenever possible we will design our facilities and equipment to
eliminate employee exposure to hazards. Where these engineering
controls are not possible, we will write work rules that effectively
prevent employee exposure to the hazard. When the above methods
of control are not possible or are not fully effective we will require
employees to use personal protective equipment (PPE) such as safety
glasses, hearing protection, foot protection etc.
B. Safety Rules and Work Procedures
1. General Safety Rules
The XYZ Company Written Safety and Health Program apply to all
employees.
The rules may be very simple or extremely complex, depending on
the nature of the work processes and the number and kinds of
employees involved. Some items that are addressed by general
safety rules are:
a. Personal protective equipment requirements;
b. Clothing appropriate for the work;
c. Behavior expected of all employees;
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Injury & Illness Prevention Program(For High-Hazard Industry Employers)
d. How to leave the workplace safely, with particular reference toemergency procedures; and
e. Danger areas that are: “off-limits” for employees.
As part of our initial safety and health survey, existing rules are
always evaluated. New rules may be necessary. All rules will be
reviewed and updated periodically to make sure they reflect
present conditions. Those no longer applicable will be dropped.
2. Basic Safety Rules
The following basic safety rules have been established to help
make our company a safe and efficient place to work. These rules
are in addition to safety rules that must be followed when doing
particular jobs or operating certain equipment. Those rules are
listed elsewhere in this program. Failure to comply with these
rules will result in disciplinary action.
a. Never do anything that is unsafe in order to get the job done.If a job is unsafe, report it to your supervisor or safetycommittee representative. We will find a safer way to do that
job.
b. Do not remove or disable any safety device! Keep guards inplace at all times on operating machinery.
c. Never operate a piece of equipment unless you have beentrained and are authorized.
d. Use your personal protective equipment whenever it isrequired.
e. Obey all safety warning signs.
f. Working under the influence of alcohol or illegal drugs or usingthem at work is prohibited.
g. Do not bring firearms or explosives onto company property.
h. Smoking is only permitted outside the building away from anyentry or ventilation intake.
i. Horseplay, running and fighting are prohibited
j. Clean up spills immediately. Replace all tools and supplies after
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Injury & Illness Prevention Program(For High-Hazard Industry Employers)
use. Do not allow scraps to accumulate where they willbecome a hazard. Good housekeeping helps prevent injuries.
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Injury & Illness Prevention Program(For High-Hazard Industry Employers)
3. Standard Work Procedures
Effectiveness in safety and health performance results our
commitment to establish standard work procedures that fix
accountability. These directives or standard work procedures canbe oral or written but in all case communicated to each worker,
defining specific responsibilities and objectives where safety and
health are concerned.
It is not uncommon in business operations for individual groups
such as quality control, production control, safety and other
groups to have their own procedures for doing the same work.
The objective is to use results of a work analysis to establish one
standard procedure for each job, which is on record and available
for reference and continued use.
Ideas can often be obtained from equipment and tool
manufacturers. It is strongly recommended that those
departments consult with employees and use their ideas,
particularly those employees who have experience in the work
being studied.
Standard work procedures provide the tools for teaching how to
work consistently with a maximum of efficiency and safety.
C. Company Specific Safety Programs
1. Personal Protective Equipment (PPE)
XYZ Company will insure that all employees and subcontractors
will use appropriate PPE while on-site. This will include appropriate
hard hats, safety glasses, hearing protection, body harnesses and
positioning belts and all other necessary equipment as required by
site and working conditions.
2. Housekeeping
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Injury & Illness Prevention Program(For High-Hazard Industry Employers)
XYZ Company will enforce housekeeping requirements daily. This
will include:
a. Requiring subcontractors to keep their work areas orderly andclean up daily.
b. Keeping walkways and access areas clear.
c. Run cords and hoses so as not to pose a trip hazard. Do notrun cords or hoses through doorways or other openings wherethey could be pinched and damaged.
d. Combustible materials and debris will be properly stored ordisposed of daily. Trash will not be permitted to accumulateand will be placed in covered containers or furnisheddumpsters.
e. Form and scrap lumber will be stored and cleared awayfrom the work area daily. All protruding nails will be hammeredin, removed or bent over to prevent injury.
f. Spills involving combustible or flammable liquids, oils orgrease will be cleaned up immediately.
3. Self-Inspections
XYZ Company safety and supervisory personnel will perform daily
walk-through inspections. Inspections will be documented and
deficiencies noted. Equipment operators will inspect their
equipment daily, and a log will be kept in the piece of equipment.
All inspection logs will be available for review.
a. The XYZ Company Safety Representative is the authority on
all company Occupational Health and Safety inspections and
safety training, and is responsible for ensuring all required
safety inspections are promptly conducted.
b. Types and Frequency of Safety Inspections and Surveys.
Safety Inspections shall be conducted at periodic intervals of all
work locations.
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Injury & Illness Prevention Program(For High-Hazard Industry Employers)
c. When established, safety committee members are responsible for
conducting self-inspections of their areas and other areas, as
assigned by the Safety Representative.
d. Supervisors are responsible for conducting self-inspections
of their assigned work area(s).
4. Governmental Inspections
In the event of a governmental inspection, the compliance officer
will be directed to any General Contractor’s office . If not the
General Contractor, XYZ Company will follow the prescribed
General Contractor procedures.
Outside Agency Inspections. These may include:
State Occupational Safety & Health Inspector.
City/County/State Fire Inspector.
Insurance Company Loss Control Consultant.
Other bonified inspectors with a contractual or legal
interest.
a. The Safety Representative shall be immediately notified by
any employee who has knowledge of an outside agency
inspection, and accompany all inspectors while they are on the
property.
b. Supervisors shall also be notified and will be encouraged to
accompany outside agency inspections of their areas of
responsibility.
5. Audits
XYZ Company will cooperate fully with any General Contractor,
and the insurance authority with regard to monthly and periodic
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Injury & Illness Prevention Program(For High-Hazard Industry Employers)
safety audits. Additionally, XYZ Company will conduct a monthly
audit of all subcontractors under our contract, which are on-site.
6. Planning
All project activities will include planning for safety concerns
throughout the project. A "Job Hazard Analysis" will be generated
with the project superintendent and foremen for all hazardous
operations. Subcontractors will be required to provide a
documented Job Hazard Analysis for their work prior to
commencing operations.
7. Job Hazard Analysis
XYZ Company will actively promote and develop a complete Job
Hazard Analysis for all construction programs within the scope of
our work.
a. Those operations, which do not fall in the “analysis loop”,
will be designated as non-hazardous and filed in the
appropriate order along with the Job Hazard Analyses.
b. Job Hazard Analysis shall be produced by the
superintendent and appropriate crew foremen and reviewed by
XYZ Company Safety Representative. A copy of each Job
Hazard Analysis shal1 be maintained onsite and available for
review. Who should participate in a hazard analysis?
c. To be fully effective and reliable, it should represent as
many different viewpoints as possible. Each person familiar
with a process or operation has gained insights concerning
problems, faults, and situations that can cause accidents.
These insights need to be recorded along with those of the
initiator of the hazard analysis, who is the superintendent,
appropriate crew foremen, company Safety Representative or a
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Injury & Illness Prevention Program(For High-Hazard Industry Employers)
contract safety professional.
What processes, operations, and tasks need to be analyzed?
Many processes, operations and tasks in any establishment are
good candidates for hazard analysis because they have the
potential to cause accidents. Eventually, hazard analyses
should be completed for all jobs, but the most potentially
threatening should have immediate attention. Those that are
making the decisions should consider:
Frequency of accidents
Potential for injury
Severity of injury
New or altered equipment, processes, equipment,and operations
Excessive material waste or damage to equipment
8. Responsibilities for "Controlling" Workplace Hazards
It is the responsibility of all employees to control the possibility of
hazards in their work area, which, if left uncorrected, could cause
injury to other employees, the public at large and damage toequipment or property .
9. Requirements for "Reporting" Workplace Hazards
All workplace hazards, which cannot be immediately controlled
(barricaded, placement of warning/danger signs, etc.) or correctedon the spot, shall be immediately reported to the supervisor in
charge and the company Safety Representative.
10. Procedures for "Correcting" Identified Workplace Hazards
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Injury & Illness Prevention Program(For High-Hazard Industry Employers)
It is the responsibility of each supervisor to ensure that identified
workplace hazards are corrected and employees informed.
Hazards that have been identified through safety inspections shall
be corrected within a reasonable time to make necessary repairs
or corrections to abate the hazard.
D. Enforcement Procedures and Systems
At XYZ Company, safety rules and work procedures shall be practiced
and enforced.
We have established a system to ensure that violations of rules are
dealt with fairly but firmly, that all employees are aware of the
requirements, and that reorientation or retraining may be providedwhen needed. Incentive programs may be initiated and will be used
in conjunction with a good enforcement program.
1. Discipline
No safety program can be effective without some form of
discipline. There are no rules that must be followed, only
guidelines. The following guidelines have been established by XYZ
Company.
a. The first preventable accident or safety rule violation
observed should result in a discussion with the employee and
the supervisor or manager. This verbal reprimand should be
documented, dated, and signed by those involved.
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Injury & Illness Prevention Program(For High-Hazard Industry Employers)
b. A second preventable accident or safety rule violation
observed within a 12-month period should result in another
discussion with the employee accompanied by a written
reprimand. Time off without pay, up to a maximum of 5 days,
should be considered.
c. A third preventable accident or safety rule violation
observed within a 12-month period should result in another
discussion with the employee and a serious evaluation needs to
be made. This is probably grounds for termination.
Compliance
a. One point must be very clear: discipline has to beadministered uniformly and consistently.
b. Violations of safety rules and policies should be addressed in
the following manner:
First Incident: Verbal warning, documented
discussion.
Second Incident: Written reprimand, up to 5 days
suspension.
Third Incident: Written reprimand, grounds for
termination.
c. Each supervisor or manager shall be responsible for
administering this policy to his/her subordinates.
d. All written reprimands and records of violations shall be held
confidential and maintained in the employees’ personnel files.
3. Accountability
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Injury & Illness Prevention Program(For High-Hazard Industry Employers)
Each supervisor’s efforts 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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Injury & Illness Prevention Program(For High-Hazard Industry Employers)
E. Medical and First Aid
Medical treatment plans.
1. Key XYZ Company personnel should be trained in first aid andCPR. The XYZ Company disaster plan coordinator shall maintain a
list of those trained and qualified personnel. Responsibility for
monitoring and ensuring initial and recurring training is
accomplished, shall be the responsibility of the Safety
Representative.
2. All supervisory personnel should be encouraged to enroll in a first
aid course and to learn CPR. Those employees who work around
high voltage equipment shall be required to be certified annually
in CPR.
3. Each XYZ Company construction office shall be equipped with a
standard first aid kit suitable for the size of the workforce.
Additional first kits may be strategically positioned throughout the
workplace and/or jobsite. The location of each kit will be
communicated to all employees and shall be clearly marked “First
Aid.”
4. Vehicle size first aid kits shall be maintained in each XYZ Company
construction/project-use vehicle.
5. All first aid supplies shall be inspected at least monthly and
replenished as required.
6. Accident / Injury reporting: All accidents, near miss incidents and
injuries shall be reported to XYZ Company Safety Representative.
Following an injury:
a. The employee’s injury will be evaluated and first aid
rendered.
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Injury & Illness Prevention Program(For High-Hazard Industry Employers)
b. If the injury requires medical attention the employee will be
escorted to the onsite clinic. Further evaluation and treatment
will be rendered.
c. A determination will be made by XYZ Company site supervision
and safety representative as to whether or not the injured, and
any other involved are to be drug tested. Usually a post-
accident drug test is required.
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Injury & Illness Prevention Program(For High-Hazard Industry Employers)
d. An Employer's Initial Report of Industrial Injury, Accident
and Property Damage form (as directed by your State) will be
completed for all injuries requiring medical attention, even if
only first aid, when rendered at either an onsite clinic or
outside medical facility.
e. A supervisor's report or Statement of Injury will be
completed by the employees' supervisor.
f. An investigation into the incident will be completed by XYZ
Company Safety Representative, even if no serious injury
occurred.
g. A copy of any applicable State document on Employer'sInitial Report of Industrial Injury, Accident and Property
Damage form, Supervisor's report or Statement of Injury will be
submitted to the XYZ Company Safety Representative for the
employer provided workers' compensation coverage.
h. All first aid cases may be recorded on a First Aid Log
maintained by XYZ Company Safety Representative.
F. Disciplinary Policy
XYZ Company e mployees are expected to use good judgment when
doing their work and to follow established safety rules. We have
established a disciplinary policy to provide appropriate consequences
for failure to follow safety rules. This policy is designed not so much
to punish as to bring unacceptable behavior to the employee's
attention in a way that the employee will be motivated to make
corrections. The following consequences apply to the violation of thesame rule or the same unacceptable behavior:
1. First Instance -- verbal warning, notation in employee file,and instruction on proper actions
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Injury & Illness Prevention Program(For High-Hazard Industry Employers)
2. Second Instance -- 1 day suspension, written reprimand,and instruction on proper actions
3. Third Instance -- 1 week suspension, written reprimand,and instruction on proper actions
4. Fourth Instance -- Termination of employment.
Section 9
Safety Training and
Instruction
Training at XYZ Company is an essential part of our plan to provide a
safe work place.
Training Administrator
The Injury and Illness Prevention Program training administrator,
Training Administrator has the authority and responsibility for
implementing the training provisions of this program.
è DECISION POINT – Enter a name or position title (recommended)
The Training Administrator for XYZ Company is
_______________________________________.
The Training Administrator is responsible to verify that each employee
has received an initial safety orientation by their supervisor, has received
any training needed to do the job safely and that the employee file
documents the training. This administrator will make sure that an
outline and materials list is available for each training course we provide:
A. New-Hire Employee Orientation
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Injury & Illness Prevention Program(For High-Hazard Industry Employers)
1. All XYZ Company employees will attend the new-hire
employee orientation prior to commencing employment. New-
hires shall receive occupational health and safety training in the
following subject areas:
a. XYZ Company Safety Philosophy and Policy
b. Disciplinary procedures for non-compliance
c. Employee Danger Reporting System
d. Accident Reporting System
e. Personal Protective Equipment (when applicable)
f. Fall Protection -100% tie-off (when applicable)
g. Fire Prevention
h. Hazardous Communication Standard, Material Safety Data
Sheets, and Environmental Safety
i. Bloodborne Pathogens Program (if applicable)
j. Workplace housekeeping rules
k. Safety Incentive Program (when established).
B. Supervisor Safety Awareness Training
At XYZ Company, supervisory training is a logical first step since
supervisors will help in training the other employees. Supervisors are
key figures in the implementation and overall success of the safety
and health program. As a minimum, supervisors at XYZ Company
shall be trained in the following areas:
1. The need to establish and maintain safe and healthful working
conditions;
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Injury & Illness Prevention Program(For High-Hazard Industry Employers)
2. The dangers associated with a job, the potential effect on
employees, and the rules, procedures and work practices for
control of these dangers;
3. How to relate this information by example and instruction to
employees, to ensure that they understand and follow safe
procedures; and
4. How to investigate accidents, and to take corrective and
preventive action to prevent recurrence.
C. Employee Safety Training
At XYZ Company, we recognize that employees may create dangers
through their own actions if they have not been properly trained.
Dangerous situations can be avoided, or made less dangerous, when
our employees receive appropriate training and instruction in the
following subject areas:
1. Standard work procedures including safe work practices, and how
these procedures protect against exposure to dangers.
2. Personal protective equipment: why it is needed, how to use it,
and how to keep it in good condition.
3. What to do in case of fire or other emergency that may occur in
the workplace.
Training is as essential to the overall program as these elements:
management commitment; danger assessment and control; and safety
planning, rules and work procedures.
D. Required Occupational Safety and Health
Programs
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Injury & Illness Prevention Program(For High-Hazard Industry Employers)
Hazard Communication Program
1. All XYZ Company employees will receive training in compliance
with the OSHA Hazard Communication (HazCom) Standard. This
training will be part of the new-hire employee orientation and will
cover, at a minimum, the following areas:
a. A review of the requirements of the HazCom Standard.
b. Chemicals or hazardous materials likely to be found in their
workplace; their health effects and means of exposure or
routes of entry.
c. How to lessen or prevent exposure to hazardous chemicals
or materials through the use of control/work practices and
Personal Protective Equipment.
d. Emergency procedures to follow in the event of an accident
or exposure involving hazardous chemicals/materials.
2. Continuous HazCom training will be conducted via weekly toolbox
safety meetings when applicable.
3. Personnel regularly expose to hazardous chemicals as part of their job tasks will receive annual refresher training within 30 days of
their employment date or by department annual schedule. Note:
This annual refresher HazCom training shall be documented.
E. Other Company Required Safety Programs (See
Section 11)
F. Company Required Safety Training Courses(See Section 12)
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Injury & Illness Prevention Program(For High-Hazard Industry Employers)
G. Company Required Safety Program Forms (See
Section 13)
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Injury & Illness Prevention Program(For High-Hazard Industry Employers)
Section 10
Accident Recordkeeping
A. Injury and Illness Recordkeeping
In order to establish meaningful goals and objectives for mishap
reduction, we must first know where we, as a company, have been in
terms of previous mishap experience. For that reason and to comply
with federal recordkeeping requirements, the following
documentation shall be maintained:
1. The Safety Representative shall maintain for a period of
5 years:
a. Safety accident investigation reports for all lost workday
occupational injuries, illnesses or equipment damage;
b. Safety accident investigation reports for company property
damage, as a result of accidents;
c. Records of formal claims against the company for injury,
illness, personal loss, and/or damage to personal property; and
2. OSHA Form No. 300, Log of Work-Related Injuries and
Illnesses , shall be used to record injuries or illnesses that result in
fatalities, lost workdays, require medical treatment, involve loss of
consciousness, or restrict work or motion.
The annual report of this form must be posted by February 1st in a
centralized area visible to all employees, and remain there for at
least 3 months.
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Injury & Illness Prevention Program(For High-Hazard Industry Employers)
3. OSHA Form No. 301, Injury and Illness Incident
Report , shall, when used, be used to give details of each
recordable occupational injury and illness. Records must be
available for examination by representatives of the U.S.
Department of Labor and the Department of Health and HumanServices. Note: This record and/or the SF-301 are kept for five
years.
4. OSHA Form No. 300A, Summary of Work-Related
Injuries and Illnesses , provides additional data to make it easier
for employers to calculate incidence rates. Employers must
review the OSHA 300 Log information before it is summarized on
the 300A form.
5. Accident Review
Following an injury or near miss accident, the incident will be
reviewed with the Project Manager and onsite supervision. This
review will address the effectiveness of our program, any
additional task training that may be needed and measures to
prevent recurrence.
Each month the company Program Administrator/Safety
Representative shall report on the effectiveness of XYZ Company
safety program to the project or company manager. This report
can include data on the number of man-hours worked, the
numbers of accidents, injuries and near miss incidents for the
month and measures taken to prevent recurrences.
B. Corrective Actions
è DECISION POINT - State your method of corrective action here.
1. Timely Correction of Dangers
Once remedial measures to control or eliminate dangers have
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Injury & Illness Prevention Program(For High-Hazard Industry Employers)
been agreed upon, you should make sure that they areimplemented with minimum delay. Interim protection for employees may be necessary until the danger is eliminated or controlled.
Keep a record of steps taken to control or eliminate a danger.
Records should contain the danger, who reported it and when whois responsible for correction, the correction target date and whenit was corrected. Such information will assist in developing safework practices and training programs.
2. Responsibility for Corrective Action
a. Actions necessary to correct or remedy accident causal
factors shall rest with the XYZ Company Safety Representative.
b. The XYZ Company Safety Representative shall have the
broad authority to recommend corrective actions to abate an
identified hazard or deficiency to prevent injury or illness to
employees, and to prevent property damage or personal loss.
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Injury & Illness Prevention Program(For High-Hazard Industry Employers)
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Injury & Illness Prevention Program(For High-Hazard Industry Employers)
Section 12
Company Required
Safety TrainingCourses
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.
è DECISION POINT – Review and select those
courses that apply or included others not listed
Company Required Safety Training Courses – Sorte d
A-EAccident Investigation Construction Safety ManagementAccident Prevention Signs & Tags Crane Safety – RefresherAsbestos Safety Cranes & Derricks in ConstructionBloodborne Pathogens –
Initial/Refresher Electrical SafetyBloodborne Pathogens – Train-the-
Trainer Emergency Exit RoutesChemical Spills Emergency Response TeamCompetent Persons Ergonomics – Basic Human Factors
Compressed Gas CylinderErgonomics – Advanced HumanFactors
Concrete & Masonry Excavation SafetyConfined Space Entry Eye & Face Protection
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Injury & Illness Prevention Program(For High-Hazard Industry Employers)
Table 2
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Injury & Illness Prevention Program(For High-Hazard Industry Employers)
Company Required Safety Training Courses – Sorted
F-LFall Protection Hexavalent Chromium
Portable Fire Extinguisher Hot Work Permit SafetyFlammable & Combustible Liquids Indoor Air QualityForklift Safety – Classroom (English) Introduction to OSHAForklift Safety – Classroom
(Spanish) Job Hazard AnalysisHand & Power Tools Laser SafetyHazard Communication Lead ExposureHazard Vulnerability Liquid NitrogenHazardous Materials Management Lockout-TagoutHearing Protection
Table 3
Company Required Safety Training Courses – Sorted
M-WMachine Guarding Safety Representative TrainingMaterial Handling Safety Supervisor TrainingOffice Safety Awareness ScaffoldingPandemic Preparedness Slip, Trip & Fall PreventionPersonal Protective Equipment Stairway & Ladder SafetyPowered Industrial Truck TB Respiratory ProtectionRadiation Safety Walking & Working SurfacesRespirator Protection Warehouse SafetySafe Lifting Awareness – Back
Safety
Workplace Violence Prevention -
Healthcare
Safety Audit Training
Workplace Violence Prevention -
Retail
Table 4
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Injury & Illness Prevention Program(For High-Hazard Industry Employers)
Section 13
Company Required
Safety Forms &Checklists
Due to the nature of work and operations
performed by XYZ Company, it is necessary that
the following safety forms and checklists are
included in our Injury and Illness Prevention
Program :
For convenience, forms listed below are subject
sorted.
è DECISION POINT – Review and select those
forms that apply or included others not listed
CONFINED SPACE
Confined Space Entry PermitConfined Space – Class A & B PermitConfined Space – Class C PermitList of Authorized Entrants
Permit Required Confined Space – Inventory LogCONSTRUCTION INDUSTRY - SAFETY MANAGEMENT
Construction Industry Inspection ChecklistJob Start-Up ChecklistContractors Job Site ChecklistContractor Safety Performance ReportConstruction Equipment ChecklistForklift Service ChecklistOperator Performance Evaluation ChecklistSafety Nets Inspection ChecklistBody Harness & Lanyard Inspection ReportCompetent Person Evaluation – Fall Protection
CRANE OPERATIONSCranes, Derricks or Material Handling Devices WorksheetCrane Inspection ChecklistCrane Pre-Lift ChecklistSling (Chain) Inspection ReportMonthly Hoist Rope Inspection ReportMonthly Hoist Hook Inspection Report
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Injury & Illness Prevention Program(For High-Hazard Industry Employers)
EMERGENCY ACTION AND RESPONSECrisis Management Response Team - Contact LogSafety Representatives - Contact LogExternal Resources – Contact LogVulnerability Analysis ChartBomb Threat ChecklistEmployee Evacuation - Accounting Log
Physically Challenged – Employee ListCommand Post Equipment Inventory LogPress Information LogPost Exercise Evaluation Report
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Injury & Illness Prevention Program(For High-Hazard Industry Employers)
EMPLOYEE SAFETY RECORDSEmployee Acknowledgement FormEmployee Orientation Checklist – ConstructionEmployee PPE Assessment FormEmployee PPE Issue FormEmployee Safety Training RecordErgonomic Workstation Analysis Form
Employee Ergonomic Workstation QuestionnaireEmployee Safety Suggestion FormEXCAVATION OPERATIONS
Pre-Excavation ChecklistTrenching Design ChecklistTrench Safety – Daily Field ReportCompetent Person Evaluation – Excavation
FIRE PREVENTIONHot Work PermitFire Safety Inspection ChecklistFire Drill Post Response ReportEmergency HAZMAT Inventory LogHazardous Waste Disposal Request Form
GENERAL INDUSTRY – SAFETY MANAGEMENTGeneral Industry Safety Inspection ChecklistOffice Safety Inspection ChecklistJob Safety Analysis Worksheet & InstructionsAccident Prevention Program AnalysisForklift Service ChecklistHearing Conservation Program LogScaffolding Safety ChecklistSite Safety Meeting RecordSupervisors Monthly Meeting RecordReport of Safety Hazard FormProperty Security Survey
INCIDENT REPORTING FORMSOSHA 300 LogEmployee Injury & Illness ReportEmployee Injury Cost Accounting Matrix
Vehicle Accident & Property Damage ReportCompiling Direct and Indirect CostsOCCUPATIONAL HEALTH FORMS
Medical Evaluation Questionnaire – Respirator UseRespirator Fit Testing RecordHepatitis B Vaccine - Accept/Decline FormBloodborne Pathogens Risk Classification FlowchartBBP Employee Annual Training RecordBBP Source Patient Consent Form
RADIATION PROGRAM FORMSRadioactive Material Use LogPregnancy Declaration FormLaboratory Contamination Survey RecordRadiation Producing Device - Authorization FormTraining Guide for Radiation WorkersTraining Guide for Ancillary Radiation Works
TRAINING RECOGNITION CERTIFICATECertificate of Completion
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Injury & Illness Prevention Program(For High-Hazard Industry Employers)
Appendix A
List of Training
Subjects
è DECISION POINT – Select applicable training
subjects - Strikethrough/delete those that do not
XYZ Company trains our workers about the
following selected training subjects:
1. The employer's Code of Safe Practices.
2. Confined spaces.
3. Safe practices for operating any
agricultural equipment.
4. Good housekeeping, fire prevention, safe
practices for operating any construction
equipment.
5. Safe procedures for cleaning, repairing,
servicing and adjusting equipment and
machinery.
6. Safe access to working areas.
7. Protection from falls.
8. Electrical hazards, including working
around high voltage lines.
9. Crane operations.
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Injury & Illness Prevention Program(For High-Hazard Industry Employers)
10.Trenching and excavation work.
11.Proper use of powered tools.
12.Guarding of belts and pulleys, gears and
sprockets, and conveyor nip points.
13.Machine, machine parts, and prime
movers guarding.
14.Lock-out/tag-out procedures.
15.Materials handling.
16.Chainsaw and other power tool operation.
17.Tree falling/bucking procedures and
precautions, including procedures for
recognizing and working with hazard trees,
snags, lodged trees, and unsafe weather
conditions.
18.Yarding operations, including skidding,
running lines, unstable logs, rigging and
communication.
19.Landing and loading areas, including
release of rigging, landing layout, moving
vehicles and equipment, and log truck
locating, loading and wrapping.
20.Fall protection from elevated locations.
21.Use of elevated platforms, includingcondors and scissor lifts.
22.Safe use of explosives.
23.Driver safety.
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Injury & Illness Prevention Program(For High-Hazard Industry Employers)
24.Slips, falls, and back injuries.
25.Ergonomic hazards, including proper lifting
techniques and working on ladders or in a
stooped posture for prolonged periods at
one time.
26.Personal protective equipment.
27.Respiratory Equipment.
28.Hazardous chemical exposures.
29.Hazard communication.
30.Physical hazards, such as heat/cold stress,
noise, and ionizing and non-ionizing
radiation.
31.Laboratory safety.
32.Bloodborne pathogens and other biological
hazards.
33.Other job-specific hazards, such as __________________________________________
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Injury & Illness Prevention Program(For High-Hazard Industry Employers)
Appendix B
Hazard Assessment
Checklist
è DECISION POINT – Determine which
checklists apply to your operation and delete all
others
XYZ Company has determined the following
hazard assessment checklists apply to itsoperations
1. Abrasive Wheel
Equipment Grinders
2. Compressed Air
Receivers
3. Compressed Gas &
Cylinders4. Compressors &
Compressed Air
5. Confined Spaces
6. Control of Harmful
Substances by Ventilation
7. Crane Checklist
8. Electrical
9. Elevated Surfaces
10. Emergency Action
Plan
11. Environmental
Controls
12. Ergonomics
13. Exit Doors
14. Exiting or Egress
15. Fire Protection
16. Flammable &
Combustible Materials17. Floor & Wall Openings
18. Fueling
19. General Work
Environment
20. Hand Tools &
Equipment
21. Hazardous Chemical
Exposures
22. Hazardous
Substances
Communication
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Injury & Illness Prevention Program(For High-Hazard Industry Employers)
23. Hoist & Auxiliary
Equipment
24. Identification of Piping
Systems
25. Industrial Trucks –Forklifts
26. Infection Control
27. Lockout-Tagout
Procedures
28. Machine Guarding
29. Material Handling
30. Noise
31. Personal Protective
Equipment & Clothing
32. Portable (Power
Operated) Tools &
Equipment
33. Portable Ladders
34. Powder Actuated
Tools
35. Sanitizing Equipment
& Clothing36. Spraying Operations
37. Stairs and Stairways
38. Tire Inflation
39. Transporting
Employees & Materials
40. Ventilation for Indoor
Air Quality
41. Walkways
42. Welding, Cutting &
Brazing
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Injury & Illness Prevention Program(For High-Hazard Industry Employers)
Appendix C
Hazard Assessment
andCorrection Record
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Injury & Illness Prevention Program(For High-Hazard Industry Employers)
Hazard Assessment and
Correction Record
Date of Inspection:
________________________________________
Person Conducting Inspection:
_______________________________
Unsafe Condition or Work Practice:
_________________________________________________
_____________________________
_________________________________________________
_____________________________
_________________________________________________
_____________________________
Corrective Action Taken:
_________________________________________________
_____________________________
_________________________________________________
_____________________________
_________________________________________________
_____________________________
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Injury & Illness Prevention Program(For High-Hazard Industry Employers)
Appendix D
Accident/Exposure
Investigation Report
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Injury & Illness Prevention Program(For High-Hazard Industry Employers)
Accident/Exposure
Investigation Report
Date of Accident: _____________________________
Time of Accident: __________________
Location of Accident:
_________________________________________________
__________
Accident Description:
_________________________________________________
_____________________________
_________________________________________________
_____________________________
_________________________________________________
_____________________________
Employees Involved:
_________________________________________________
_____________________________
_________________________________________________
_____________________________
Preventive Action Recommendations:
_________________________________________________
_____________________________
_________________________________________________
_____________________________
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Injury & Illness Prevention Program(For High-Hazard Industry Employers)
Corrective Actions Taken:
_________________________________________________
_____________________________
_________________________________________________
_____________________________
Manager Responsible:
________________________________________
Date Corrective Actions Completed:
_____________________________
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Injury & Illness Prevention Program(For High-Hazard Industry Employers)
Appendix E
Employee Training and
Instruction Record
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Injury & Illness Prevention Program(For High-Hazard Industry Employers)
Employee Training and
Instruction Record
Employee Receiving Training:
(First Name) (Middle Initial)(Last Name)
(Safety Training Topic)
Select one:
Initial PeriodicAnnual/Refresher Special
This employee has received specific safety & health trainingin the following subject areas:
Person conducting the training:
(First Name) (Middle Initial)(Last Name)
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Injury & Illness Prevention Program(For High-Hazard Industry Employers)
Trainer’s SignatureDate
Qualification or Job Title of Trainer
Trainee’s SignatureDate
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Injury & Illness Prevention Program(For High-Hazard Industry Employers)
Appendix F
Codes of Safe
Practice
è DECISION POINT – Determine which of the
following Codes of Safety Practices apply to your
company’s operation, combine or edit them or
delete/strikethrough the codes that in your
opinion are non-applicable.
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Injury & Illness Prevention Program(For High-Hazard Industry Employers)
Codes of SafePractices
General Industry
It is our policy that everything possible will be
done to protect employees, customers and
visitors from injury. Safety is a cooperative
undertaking requiring participation by every
employee. Failure by any employee to comply
with safety rules will be grounds for corrective
discipline.
Supervisors shall insist that employees observe
all applicable Company, State and Federal safety
rules and practices and take action as is
necessary to obtain compliance. To carry out this
policy employees shall follow these safety rules
and practices:
1. Report all unsafe conditions and
equipment to your supervisor or safety
coordinator.
2. Report all incidents, injuries and illnesses
to your supervisor or safety coordinator
immediately.
3. Anyone known to be under the influence of
intoxicating liquor or drugs shall not be
allowed on the job while in that condition.
4. Horseplay, scuffling, and other acts which
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Injury & Illness Prevention Program(For High-Hazard Industry Employers)
tend to have an adverse influence on the
safety or well-being of the employees, are
prohibited.
5. Means of egress shall be kept unblocked,
well-lighted and unlocked during work
hours.
6. In the event of fire, sound alarm and
evacuate.
7. Upon hearing fire alarm, stop work and
proceed to the nearest clear exit. Gather
at the designated location.
8. Only trained workers may attempt to
respond to a fire or other emergency.
9. Exit doors must comply with fire safety
regulations during business hours.
10. Stairways should be kept clear of items
that can be tripped over, and all areas
under stairways that are egress routes
should not be used to store combustibles.
11. Materials and equipment will not be stored
against doors or exits, fire ladders or fire
extinguisher stations.
12. Aisles must be kept clear at all times.
13. Work areas should be maintained in aneat, orderly manner. Trash and refuse
are to be thrown in proper waste
containers.
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Injury & Illness Prevention Program(For High-Hazard Industry Employers)
14. All spills shall be wiped up promptly.
15. Always use the proper lifting technique.
Never attempt to lift, push, pull or carry
an object that is too heavy. You must
contact your supervisor when help is
needed to move a heavy object.
16. Never stack material precariously on top
of lockers, file cabinets or other relatively
high places.
17. When carrying material, caution should be
exercised in watching for and avoidingobstructions, loose material, etc.
18. Do not stack material in an unstable
manner.
19. Report exposed wiring and cords that are
frayed or have deteriorated insulation so
that they can be repaired promptly.
20. Never use a metal ladder where it could
come in contact with energized parts of
equipment, fixtures or circuit conductors.
21. Maintain sufficient access and working
space around all electrical equipment to
permit ready and safe operations and
maintenance.
22. Do not use any portable electrical tools
and equipment that are not grounded or
double-insulated.
23. All electrical equipment should be plugged
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Injury & Illness Prevention Program(For High-Hazard Industry Employers)
into appropriate wall receptacles or into
an extension of only one cord of similar
size and capacity. Three-pronged plugs
should be used to ensure continuity of
ground.
24. All cords running into walk areas must be
taped down or inserted through rubber
protectors to preclude them from
becoming tripping hazards.
25. Inspect motorized vehicles and other
mechanized equipment daily or prior to
use.
26. Shut off engine, set brakes and block
wheels prior to loading or unloading
vehicles.
27. Inspect pallets and their loads for integrity
and stability before loading or moving.
28. Do not use compressed air for cleaning off clothing.
29. Do not store compressed gas cylinders in
areas which are exposed to heat sources,
electric arcs or high temperature lines.
30. Identify contents of pipelines prior to
initiating any work that affects the
integrity of the pipe.
31. Wear hearing protection in all areas
identified as having high noise exposure.
32. Goggles or face shields must be worn
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Injury & Illness Prevention Program(For High-Hazard Industry Employers)
when grinding.
33. Do not use any faulty or worn hand tools.
34. Guard floor openings by a cover, guardrail,
or equivalent.
35. Do not enter into a confined space unless
tests for toxic substances, explosive
concentrations, and oxygen deficiency
have been taken.
36. Always keep flammable or toxic chemicals
in closed containers when not in use.
37. Do not eat in areas where hazardous
chemicals are present.
38. Be aware of the potential hazards
involving various chemicals stored or
used in the workplace.
39. Cleaning supplies should be stored away
from edible items on kitchen shelves.
40. Cleaning solvents and flammable liquids
should be stored in appropriate
containers.
41. Solutions that may be poisonous or not
intended for consumption should be kept
in well-labeled containers.
42. When working with a computer, have all
pieces of furniture adjusted, positioned
and arranged to minimize strain on all
parts of the body.
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Injury & Illness Prevention Program(For High-Hazard Industry Employers)
43. Never leave lower desk or a cabinet
drawer open, which presents a
tripping hazard. Use care when
opening and closing drawers to avoid
pinching fingers.
44. Do not open more than one upper
drawer at a time, particularly the top
two drawers on tall file cabinets.
45. Individual heaters at work areas
should be kept clear of combustible
materials, such as drapes, or waste
from waste baskets. Newer heaters
that are equipped with tip-over
switches should be used.
46. Appliances, such as coffee pots and
microwaves, should be kept in working
order and inspected for signs of wear,
heat or fraying of cords.
47. Fans used in work areas should be
guarded. Guards must not allow fingers to
be inserted through the mesh. Newer
fans are equipped with proper guards.
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Injury & Illness Prevention Program(For High-Hazard Industry Employers)
Codes of SafePractices
ConstructionIndustry
1. All persons shall follow these safe practices
rules, render every possible aid to safe
operations, and report all unsafe conditions or
practices to the supervisor or superintendent.
2. Supervisors or foremen shall insist on
employees observing and obeying every
applicable Company, State or Federal
regulation and order as is necessary to
the safe conduct of the work, and shall
take such action as is necessary to obtain
compliance.
3. All employees shall be given frequent injury
and illness prevention instructions.
Instructions shall be given at least every 10
working days.
4. Anyone known to be under the influence of
drugs or intoxicating substance which
impair the employee’s ability to safely
perform the assigned duties shall not be
allowed on the job while in that condition.
5. Horseplay, scuffling, and other acts
which tend to have an adverse
influence on the safety or well-being of
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Injury & Illness Prevention Program(For High-Hazard Industry Employers)
the employees, shall be prohibited.
6. Work shall be well planned and supervised to
prevent injuries in the handling of materials
and in working together with equipment.
7. No one shall knowingly be permitted or
required to work while the employee’s
ability or alertness is so impaired by
fatigue, illness, or other causes, that
they might unnecessarily expose the
employee or others to injury.
8. Employees shall not enter manholes,
underground vaults, chambers, tanks,
silos, or other similar places that receive
little ventilation unless it has been
determined that it is safe to enter.
9. Employees shall be instructed to ensure that
all guards and other protective devices are in
proper places and adjusted, and shall report
deficiencies promptly to the supervisor or
superintendent.
10. Crowding or pushing when boarding or
leaving any vehicle or other conveyance
shall be prohibited.
11. Workers shall not handle or tamper with
any electrical equipment, machinery, or
air or water lines in a manner not within
the scope of their duties, unless theyhave received instructions from their
superintendent.
12. All injuries shall be reported promptly to the
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Injury & Illness Prevention Program(For High-Hazard Industry Employers)
supervisor or superintendent so that
arrangements can be made for medical or first
aid treatment.
13. When lifting heavy objects, the large muscles
of the leg, instead of the smaller muscles of
the back, shall be used.
14. Materials, tools, or other objects, shall not be
thrown from buildings or structures until
proper precautions are taken to protect others
from the falling objects.
15. Inappropriate footwear or shoes with thin or
badly worn soles must not be worn.
16. Hand protection, such as gloves, shall be worn
when there is excessive exposure to cuts,
burns, or other materials that could cause
injury (except where there is danger of the
hand protection becoming entangled in
moving machinery).
17. Hard hats shall be worn whenever overheadhazards exist and in all areas designated for
hard hat use.
18. Safety glasses, goggles, or other suitable eye
protection shall be worn when there is a
hazard to unprotected eyes (e.g., when using
a grinding wheel, etc.).
19. Employees shall cleanse themselves
thoroughly after handling hazardous
substances and follow special instructions
from authorized sources.
20. Carriers should avoid the use of extension
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Injury & Illness Prevention Program(For High-Hazard Industry Employers)
ladders when carrying loads. Such ladders
may provide adequate strength, but the rung
position and rope arrangement make such
climbing difficult and hazardous for this trade.
21. Work shall be so arranged that employees are
able to face a ladder and use both hands while
climbing.
22. Gasoline shall not be used for cleaning
purposes.
23. No burning, welding, or other source of
ignition shall be applied to any enclosed tank
or vessel, even if there are openings, until it
has first been determined that no possibility of
explosion exists and authority for the work is
obtained from the supervisor or
superintendent.
24. Any damage to scaffolds, false work, or other
supporting structures shall be immediately
reported to the supervisor and repaired before
use.
25. Personal fall arrest systems or restraints shall
be worn when working over 7 1/2 feet above
ground or surface which does not provide
protected sides, edges or openings (e.g., no
guardrails, etc.).
USE OF TOOLS AND EQUIPMENT
26. All tools and equipment shall be
maintained in good condition.
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Injury & Illness Prevention Program(For High-Hazard Industry Employers)
27. Damaged tools or equipment shall be
removed from service and tagged
“DEFECTIVE.”
28. Pipe or Stillson wrenches shall not be used
as a substitute for other wrenches.
29. Only appropriate tools shall be used for a
specific job.
30. Wrenches shall not be altered by the
addition of handle-extensions or
“cheaters”.
31. Files shall be equipped with handles and
not used to punch or pry.
32. A screwdriver shall not be used as a
chisel.
33. Wheelbarrows shall not be pushed with
handles in an upright position.
34. Portable electric tools shall not be lifted orlowered by means of the power cord.
Ropes shall be used.
35. Electric cords shall not be exposed to
damage from vehicles.
36. In locations where the use of a portable
power tool is difficult, the tool shall be
supported by means of a rope or similarsupport of adequate strength.
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Injury & Illness Prevention Program(For High-Hazard Industry Employers)
MACHINERY AND VEHICLES
37. Only authorized persons shall operate
machinery or equipment.
38. Loose or frayed clothing, long hair,
dangling ties, finger rings, etc., shall not
be worn around moving machinery or
other areas where they may become
entangled.
39. Machinery shall not be serviced, repaired
or adjusted while in operation, nor shall
oiling of moving parts be attempted,except on equipment that is designed or
fitted with safeguards to protect the
person performing the work.
40. Where appropriate, lock-out procedures
shall be used.
41. Employees shall not work under vehicles
supported by jacks or chain hoists withoutprotective blocking that will prevent injury
if jacks or hoists should fail.
42. Air hoses shall not be disconnected at
compressors until the hose line has been
bled.
43. All excavations shall be visually inspected
before backfilling to ensure that it is safeto backfill.
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Injury & Illness Prevention Program(For High-Hazard Industry Employers)
44. Excavating equipment shall not be
operated near tops of cuts, banks, or cliffs,
if employees are working below.
45. Tractors, bulldozers, scrapers and
carryalls shall not operate where there is a
possibility of overturning in dangerous
areas like edges of deep fills, cut banks,
and steep slopes.
46. When loading where there is a probability
of dangerous slides or movement of
material, the wheels or treads of loading
equipment, other than that riding on rails,
should be turned in the direction which
will facilitate escape in case of danger,
except in a situation where this position of
the wheels or treads would cause a
greater operational hazard.
ROOFING OPERATIONS
47. Knotted hand lines should not be used.
48. Roofers tending kettles, or carrying
buckets of hot tar, shall wear gloves
that fit snugly at the wrists, and long-
sleeved shirts fastened at the wrists.
49. At no time should a roofer, while
handling or exposed to injury from hot
tar, work without a shirt or appropriate
footwear.
50. Appropriate portable fire extinguishers
shall be kept at or near the kettle,
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Injury & Illness Prevention Program(For High-Hazard Industry Employers)
attached, if practicable, to the tongue
of the kettle, away from the danger
zone.
51. Kettle covers should be equipped with
a handle that projects at least fourteen
inches (14") away from the surface of
the cover or lid.
52. Kettle covers shall be closed and
latched when in transit and the kettle
should be slop-proof when cover is
closed.
53. When parked, means shall be provided
to prevent inadvertent movement of
the kettle.
54. Ladders should be used with great
caution, and roof gutters should not be
depended upon for support.
55. Workers handling buckets of hot tarshould not carry anything that will
interfere with the safety of this
operation.
56. The gallows frame shall be securely
anchored before hoisting materials.
57. Only muscular power shall be used to
hoist materials by means of a gallowsframe. A winch or power hoist shall
not be used.
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Injury & Illness Prevention Program(For High-Hazard Industry Employers)
BLASTING OPERATIONS
58. Cases that have contained explosives
shall be destroyed by burning out-of-
doors. Do not burn in a stove or
furnace.
59. Shoes with nails or metal plates shall not
be worn in magazines or near explosives.
60. Blasting caps shall only be carried in
approved containers.
61. The least amount of proper strength
explosive that will do the job
effectively shall be used.
62. Detonators and primers shall be
separated from the explosives until it
is necessary to bring together in
preparing for the blast.
63. Holes loaded during a shift should be fired
during that shift.
64. The operations of loading and firing should
be carried out with as few workers as
possible.
65. Drill holes shall be blown out and
made ready before explosives are
brought to the site.
66. In tamping explosives, steady, even
pressure should be used.
67. For electric blasting, the following shall
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Injury & Illness Prevention Program(For High-Hazard Industry Employers)
apply:
(a) Tight electrical connections.
(b) No short circuits or breaks in the
wires.
(c) Enough current to fire all shots.
(d) A strong, properly-applied force
when using a blasting machine
operated by physical effort.
(e) Care not to damage the insulation
of wires when tamping charges.
68. If misfires occur, the licensed blaster shall
be contacted.
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Injury & Illness Prevention Program(For High-Hazard Industry Employers)
Appendix G
Employee
Acknowledgement
Form
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Injury & Illness Prevention Program(For High-Hazard Industry Employers)
EmployeeAcknowledgement Form
I hereby acknowledge that I have had the opportunity to read,
review and ask questions on the contents of the company’s
Injury and Illness Prevention Program. I also acknowledge
that the provisions of this program and company safety and
health policies are part of the terms and conditions of my
employment and agree to abide by them.
Furthermore, I understand that failure to comply with any part
or parts of this program and any company safety and health
policies may be grounds for termination of my employment.
Additionally, I understand that failure to comply with the
company’s Drug-Free Workplace Policy shall also be grounds
for termination of my employment.
Employee - Print Your NameSocial Security Number
Signature of EmployeeDate
As an employee representative of the company, I hereby
attest that the employee named here was given the
opportunity to read, review and ask questions about the
company’s Injury and Illness Prevention Program and
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Injury & Illness Prevention Program(For High-Hazard Industry Employers)
company safety and health policies.
Witness – Print Your Name
Duty Title of Witness
Signature of WitnessDate
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Injury & Illness Prevention Program(For High-Hazard Industry Employers)
Safety Office Depot Disclaimer Notice
While we have made every attempt toensure that the information contained in thisdocument is reliable, Safety Office Depot isnot responsible for any errors or omissions,or for the results obtained from the use ornon-use of this information. All informationin this document is provided "as is", with no
guarantee of completeness, accuracy,timeliness or of the results obtained from theuse or non-use of this information, andwithout warranty of any kind, express orimplied, including, but not limited towarranties of performance, merchantabilityand fitness for a particular purpose.
In no event will Americana Safety Associates,Safety Office Depot, or the partners, agentsor employees thereof be liable to you oranyone else for any decision made or actiontaken in reliance on the information in this
document or for any consequential, specialor similar damages, even if advised of thepossibility of such damages.
Given the changing nature of laws, rules andregulations, there may be omissions or