iip program for low-hazard industry employers

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XYZ Company

Injury and Illness Prevention

Program

For

Non High-Hazard Employers

As determined by OSHA

Complies with Provisions of

OSHA 29 CFR Part 1910 – General Industry Standards

OSHA 29 CFR Part 1926 – Construction Industry Standards



Injury and Illness Prevention Program(For Non High-Hazard Employers)

©Safety Office Depot. All rights reserved.

©Safety Office Depot. All rights reserved. 2




Table of Contents

Section Description Page

1 Program Policy & Requirement 3

2 Program Responsibility 4

3 Employee Compliance 5

4 Safety Communication 6

5 Hazard Assessment 7

6 Accident/Exposure Investigation 9

7 Hazard Correction 10

8 Safety Training and Instruction 11

9 Recordkeeping Policy 13

10 Company Required Safety Programs 16

11 Company Required Safety Training Courses 17

12 Company Required Safety Forms & Checklists 19

Appendices

Appendix A List of Training Subjects 21

Appendix B Hazard Assessment Checklists 23

Appendix C Hazard Assessment and Correction Record 24

Appendix D Accident/Exposure Investigation Report 26

Appendix E Employee Training and Instruction Record 28

Appendix F Codes of Safe Practice (General and ConstructionIndustries) 30

Appendix G Employee Acknowledgement Form 41





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 yoursupervisor 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 NON-HIGH-HAZARD.

Employers in an industry which has been determined by OSHA as Non 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

recordkeeping section requires that the IIP Program administrator select

and implement the category appropriate for your establishment.





This program must be maintained by the employer in order to be

effective.





Section 2

Program Responsibility

Program Administrator

The Injury and Illness Prevention Program (IIPP) administrator, Program

Administrator has the authority and responsibility for implementing the

provisions of this program.

è DECISION POINT – Enter a name or position title (recommended)

The Program Administrator for XYZ Company is

_______________________________________.

Managers and Supervisors

All managers and supervisors are responsible for implementing and

maintaining the IIP Program in their work areas and for answering worker

questions about the IIP Program.

A copy of this IIP Program shall be available from each manager and

supervisor upon request.





Section 3

Employee Compliance

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 workers, including managers and supervisors, are responsible for

complying with safe and healthful work practices.

è DECISION POINT – Review and select the items that apply and

delete those that do not

Our systems of ensuring that all workers comply with these practices include one or more of

the following selected practices:

1. Informing workers of the provisions of our IIP Program;

2. Evaluating the safety performance of all workers;

3. Recognizing employees who perform safe and healthful work

practices;

4. Providing training to workers whose safety performance is

deficient;

5. Disciplining workers for failure to comply with safe and healthful

work practices.





Section 4

Communication

XYZ Company managers and supervisors are responsible for communicating with all

workers about occupational safety and health in a form readily understandable by all

workers. Our communication system encourages all workers to inform their managers and

supervisors about workplace hazards without fear of reprisal.

è DECISION POINT – Review and select the items that apply and

delete those that do not

Our communication system includes one or more of the following selected items:

1. New worker orientation including a discussion of safety and health

policies and procedures.

2. Review of our IIP Program.

3. Workplace safety and health training programs.

4. Regularly scheduled safety meetings.

5. Effective communication of safety and health concerns between

workers and supervisors, including translation where appropriate.

6. Posted or distributed safety information.

7. A system for workers to anonymously inform management about

workplace hazards.

8. Our establishment has less than ten employees and

communicates with and instructs employees orally about generalsafe work practices and with respect to hazards unique to each

employee's job assignment.





Section 5

Hazard Assessment

Periodic inspections of XYZ Company facilities, workplaces and sites to

identify and evaluate workplace hazards shall be performed by the

following Competent Person(s) in the following areas of our workplace:

è DECISION POINT – Complete the information requested in this table.

Competent Person Area

Periodic inspections are performed according to the following schedule:

è DECISION POINT - State the frequency of inspections below (Daily,

weekly, monthly, etc.)

1. ________________________________;





2. When we initially established our IIP Program;

3. When new substances, processes, procedures or equipment which

present potential new hazards are introduced into our workplace;

4. When new, previously unidentified hazards are recognized;

5. When occupational injuries and illnesses occur; and

6. Whenever workplace conditions warrant an inspection.





Section 6

Accident/Exposure

Investigation

XYZ Company procedures for investigating workplace accidents and

hazardous substance exposures include:

1. Interviewing injured workers and witnesses;

2. Examining the workplace for factors associated with the

accident/exposure;

3. Determining the cause of the accident/exposure;

4. Taking corrective action to prevent the accident/exposure from

reoccurring; and

5. Recording the findings and corrective actions taken.





Section 7

Hazard Correction

Unsafe or unhealthy work conditions, practices or procedures at XYZ

Company shall be corrected in a timely manner based on the severity of

the hazards. Hazards shall be corrected according to the following

procedures:

1. When observed or discovered;

2. When an imminent hazard exists which cannot be immediately

abated without endangering employee(s) and/or property, we willremove all exposed workers from the area except those necessary

to correct the existing condition.

3. Workers necessary to correct the hazardous condition shall be

provided with the appropriate personal protective equipment for

the hazardous condition.





Section 8

Safety Training and

Instruction

All XYZ Company workers, including managers and supervisors, shall

have safety training and instruction on general and job-specific safety

and health practices.

A. Safety training and instruction shall be provided as

follows:

1. When the IIP Program is first established;

2. To all new hires;

3. To all workers given new job assignments for which training has

not previously provided;

4. Whenever new substances, processes, procedures or equipment

are introduced to the workplace and represent a new hazard;

5. Whenever the employer is made aware of a new or previously

unrecognized hazard;

6. To supervisors to familiarize them with the safety and health

hazards to which workers under their immediate direction and

control may be exposed; and

7. To all workers with respect to hazards specific to each employee's

job assignment.

B. General workplace safety and health practices include, but are not limited to:

1. Implementation and maintenance of the IIP Program.

2. Emergency action and fire prevention plan.





3. Provisions for medical services and first aid including emergency procedures.

4. Prevention of musculoskeletal disorders, including proper lifting techniques.

5. Proper housekeeping, such as keeping stairways and aisles clear, work areas neat

and orderly, and promptly cleaning up spills.

6. Prohibiting horseplay, scuffling, or other acts that tend to adversely influence safety.

7. Proper storage to prevent stacking goods in an unstable manner and storing goods

against doors, exits, fire extinguishing equipment and electrical panels.

8. Proper reporting of hazards and accidents to supervisors.

9. Hazard communication, including worker awareness of potential chemical hazards,

and proper labeling of containers.

10. Proper storage and handling of toxic and hazardous substances including

prohibiting eating or storing food and beverages in areas where they can become

contaminated.





Section 9

Recordkeeping Policy

Every employer has certain mandatory records that they must keep and

be prepared to provide to the appropriate agency when needed. The two

primary types of records that must be kept are Occupational Safety and

Health (OSHA) and Internal Revenue Service (IRS) information.

Occupational Safety and Health (OSHA) Records

Every employer covered by OSHA who has more than ten (10)

employees, except for employers in certain low-hazard industries such as

retail, finance, insurance, real estate, and some service industries, must

maintain OSHA-specified records of job-related injuries and illnesses.

There are two such records, the OSHA Form 300, and the OSHA Form

301.

OSHA Form 300

The OSHA Form 300 is an injury/illness log, with a separate line entry

for each recordable injury or illness (essentially those work-related

deaths, injuries, and illnesses other than minor injuries that require

only first aid treatment and do not involve medical treatment, loss of

consciousness, restriction of work or motion, or transfer to another

job). A summary section of the OSHA Form 300, which includes the

total of the previous year's injury and illness experience, must be

posted in the workplace for the entire month of February each year.

OSHA Form 301

The OSHA Form 301 is an individual incident report that provides

added detail about each individual recordable injury or illness. An

equivalent insurance or workers' compensation form that provides the





same details may be substituted for the OSHA Form 301.

Company Recordkeeping Policy

è DECISION POINT – Select one of the four categories below that

applies to your company. Remove the other three categories that do not

apply to your company.

The recordkeeping policy for XYZ Company is as follows:

Category 1: XYZ Company has Fewer Than 10 Employees in Low Hazard

Industries

XYZ Company has fewer than ten (10) workers and will modify our IIP

Program as follows:

• Communications about safety generally do not have to be in writing.

• Inspection records do not need to be kept after a hazard is

corrected.

• Training records can be a simple log of training provided at hiring or

when an employee is assigned to new duties.

Category 2: XYZ Company has Fewer Than 20 Employees in Low Hazard

Industries

A. XYZ Company has fewer than twenty (20) workers and will

modify our IIP Program if:

1. We are not on a designated high hazard industry list as

established by the Department of Industrial Relations, and the

employer has a workers’ compensation experience modification

rate of 1.1 or less; or

2. We are on a designated list of low hazard industries as

established by the Department of Industrial Relations. and have

taken the following steps to implement and maintain our IIP





Program:

B. XYZ Company is on a designated list of low hazard industries. As

such, our written recordkeeping documentation may be limited to the

following:

• The identity of the persons with authority and responsibility for

implementing the plan

• Scheduled periodic inspections to identify and correct workplace

hazards and practices

• Required training and instruction





Category 3: XYZ Company has More Than 20 Employees in Low Hazard

Industries

A. Our establishment has twenty (20) or more workers and will

modify our IIP Program for the following reasons:

1. We have a workers' compensation experience modification rate of

greater than 1.1; and

2. We are not on a designated low hazard industry list.

B. XYZ Company has taken the following steps to implement and

maintain our IIP Program:

• Records of hazard assessment inspections, including the person(s)

conducting the inspection, the unsafe conditions and work

practices that have been identified and the action taken to correct

the identified unsafe conditions and work practices, are recorded

on a hazard assessment and correction form; and

• Documentation of safety and health training for each worker,

including the worker's name or other identifier, training dates,

type(s) of training, and training provider’s are recorded on aworker training and instruction form.

Category 4: XYZ is a Local government entity

We are a local governmental entity (county, city, district, or and any

public or quasi-public corporation or public agency) and we are not

required to keep written records of the steps taken to implement and

maintain our IIP Program.





Section 10

Company Required Safety

Programs

Due to the nature of work and operations performed by XYZ Company, it

is necessary that the following regulatory programs are included in our

Injury and Illness Prevention Program:

For convenience, programs listed in the table below are alpha sorted.

è DECISION POINT – Review and select those programs that apply or

included others not listed

Company Required Safety and Health Plans &

ProgramsAccident Prevention Program Forklift Safety Program

Asbestos Management Plan Hazard Communication Program

Bloodborne Pathogens Program Hearing Conservation Program

Chemical Hygiene Plan Hot Work Permit Program

Confined Space Entry Program Ladders and Stairways Work PlanControl of Hazardous Energy

Program Laser Safety Program

Cranes and Derricks Safety Program Lead Safety Program

Electrical Safety Program Personal Protective Equipment Plan

Emergency Action Plan Powered Industrial Truck Program

Excavation and Trenching Program Radiation Protection Program

Fall Protection Program Respiratory Protection Program

Fire Prevention Work Plan Scaffolding Safety ProgramFlammable Storage / Compressed

Gas Welding Safety Program

Table 1


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Section 11

Company Required Safety Training

Courses


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


Company Required Safety Training Courses – Sorted

A-EAccident Investigation Construction Safety Management

Accident Prevention Signs & Tags Crane Safety – Refresher

Asbestos Safety Cranes & Derricks in ConstructionBloodborne Pathogens –

Initial/Refresher Electrical SafetyBloodborne Pathogens – Train-the-

Trainer Emergency Exit Routes

Chemical Spills Emergency Response Team

Competent Persons Ergonomics – Basic Human Factors

Compressed Gas Cylinder

Ergonomics – Advanced Human

Factors

Concrete & Masonry Excavation Safety

Confined Space Entry Eye & Face Protection

Table 2


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F-LFall Protection Hexavalent Chromium

Portable Fire Extinguisher Hot Work Permit SafetyFlammable & Combustible Liquids Indoor Air Quality

Forklift Safety – Classroom (English) Introduction to OSHAForklift Safety – Classroom

(Spanish) Job Hazard Analysis

Hand & Power Tools Laser Safety

Hazard Communication Lead Exposure

Hazard Vulnerability Liquid Nitrogen

Hazardous Materials Management Lockout-Tagout

Hearing Protection

Table 3


M-WMachine Guarding Safety Representative Training

Material Handling Safety Supervisor Training

Office Safety Awareness Scaffolding

Pandemic Preparedness Slip, Trip & Fall Prevention

Personal Protective Equipment Stairway & Ladder Safety

Powered Industrial Truck TB Respiratory Protection

Radiation Safety Walking & Working Surfaces

Respirator Protection Warehouse SafetySafe Lifting Awareness – Back

Safety

Workplace Violence Prevention -

Healthcare

Safety Audit Training

Workplace Violence Prevention -

Retail

Table 4





Section 12

Company Required

Safety Forms & Checklists


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


CONFINED SPACEConfined Space Entry PermitConfined Space – Class A & B PermitConfined Space – Class C PermitList of Authorized EntrantsPermit Required Confined Space – Inventory Log

CONSTRUCTION INDUSTRY - SAFETY MANAGEMENTConstruction 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

EMERGENCY ACTION AND RESPONSECrisis Management Response Team - Contact LogSafety Representatives - Contact LogExternal Resources – Contact LogVulnerability Analysis ChartBomb Threat ChecklistEmployee Evacuation - Accounting LogPhysically Challenged – Employee List





Command Post Equipment Inventory LogPress Information LogPost Exercise Evaluation Report





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 Form

EXCAVATION OPERATIONSPre-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 MANAGEMENT

General 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 Costs

OCCUPATIONAL HEALTH FORMSMedical 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 Form

Training Guide for Radiation WorkersTraining Guide for Ancillary Radiation Works

TRAINING RECOGNITION CERTIFICATECertificate of Completion


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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.

10.Trenching and excavation work.

11.Proper use of powered tools.

12.Guarding of belts and pulleys, gears and sprockets, and conveyor

nip points.

13.Machine, machine parts, and prime movers guarding.





14.Lock-out/tag-out procedures.

15.Materials handling.

16.Chainsaw and other power tool operation.

17.Tree falling/bucking procedures and precautions, including

procedures for recognizing and working with hazard trees, snags,

lodged trees, and unsafe weather conditions.

18.Yarding operations, including skidding, running lines, unstable

logs, rigging and communication.

19.Landing and loading areas, including release of rigging, landing

layout, moving vehicles and equipment, and log truck locating,loading and wrapping.

20.Fall protection from elevated locations.

21.Use of elevated platforms, including condors and scissor lifts.

22.Safe use of explosives.

23.Driver safety.

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

__________________________________________





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 assessmentchecklists apply to its operations

1. Abrasive Wheel

Equipment Grinders

2. Compressed Air

Receivers

3. Compressed Gas &

Cylinders

4. 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 Materials

17.Floor & Wall Openings

18.Fueling

19.General Work

Environment

20.Hand Tools &

Equipment

21.Hazardous Chemical

Exposures

22.Hazardous

Substances

Communication

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

& Clothing

36.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

Appendix C

Hazard Assessmentand

Correction Record





Hazard Assessment and

Correction Record

Date of Inspection:

________________________________________

Person Conducting Inspection:

_______________________________

Unsafe Condition or Work Practice:

____________________________________________________

__________________________

____________________________________________________

__________________________

____________________________________________________

__________________________

Corrective Action Taken:

____________________________________________________

__________________________

____________________________________________________

__________________________

____________________________________________________

__________________________





Appendix D

Accident/Exposure

Investigation Report





Accident/Exposure

Investigation Report

Date of Accident: _____________________________

Time of Accident: __________________

Location of Accident:

____________________________________________________

_______

Accident Description:

____________________________________________________

__________________________

____________________________________________________

__________________________

____________________________________________________

__________________________

Employees Involved:

____________________________________________________

__________________________

____________________________________________________

__________________________

Preventive Action Recommendations:

____________________________________________________

__________________________

____________________________________________________

__________________________





Corrective Actions Taken:

____________________________________________________

__________________________

____________________________________________________

__________________________

Manager Responsible:

________________________________________

Date Corrective Actions Completed:

_____________________________





Appendix E

Employee Training and

Instruction Record





Employee Training and

Instruction Record

Employee Receiving Training:

(First Name) (Middle Initial)(Last Name)

(Safety Training Topic)

Select one:

Initial Periodic Annual/Refresher Special

This employee has received specific safety & health training inthe following subject areas:

Person conducting the training:

(First Name) (Middle Initial)(Last Name)





Trainer’s SignatureDate

Qualification or Job Title of Trainer

Trainee’s SignatureDate





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.





Codes of Safe

Practices

General Industry

It is our policy that everything possible will be done

to protect employees, customers and visitors from

injury. Safety is a cooperative undertaking

requiring participation by every employee. Failure

by any employee to comply with safety rules will be

grounds for corrective discipline.

Supervisors shall insist that employees observe all

applicable Company, State and Federal safety rules

and practices and take action as is necessary to

obtain compliance. To carry out this policy

employees shall follow these safety rules and

practices:

1. Report all unsafe conditions and equipment

to your supervisor or safety coordinator.

2. Report all incidents, injuries and illnesses to

your supervisor or safety coordinator

immediately.

3. Anyone known to be under the influence of

intoxicating liquor or drugs shall not be

allowed on the job while in that condition.

4. Horseplay, scuffling, and other acts which

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 a neat,

orderly manner. Trash and refuse are to be

thrown in proper waste containers.

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 beexercised in watching for and avoiding

obstructions, loose material, etc.

18. Do not stack material in an unstable manner.

19. Report exposed wiring and cords that are

frayed or have deteriorated insulation so

that they can be repaired promptly.

20. Never use a metal ladder where it could

come in contact with energized parts of

equipment, fixtures or circuit conductors.

21. Maintain sufficient access and working space





around all electrical equipment to permit

ready and safe operations and maintenance.

22. Do not use any portable electrical tools and

equipment that are not grounded or double-insulated.

23. All electrical equipment should be plugged

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 betaped 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 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.

43. Never leave lower desk or a cabinet

drawer open, which presents a trippinghazard. 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 shouldbe 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.





Codes of Safe

Practices

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 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 littleventilation unless it has been determined

that it is safe to enter.

9. Employees shall be instructed to ensure that all

guards and other protective devices are in proper

places and adjusted, and shall report deficiencies

promptly to the supervisor or superintendent.

10. Crowding or pushing when boarding or

leaving any vehicle or other conveyance

shall be prohibited.

11. Workers shall not handle or tamper with

any electrical equipment, machinery, or air

or water lines in a manner not within the

scope of their duties, unless they have

received instructions from their

superintendent.

12. All injuries shall be reported promptly to the

supervisor or superintendent so that

arrangements can be made for medical or first

aid treatment.





13. When lifting heavy objects, the large muscles of

the leg, instead of the smaller muscles of the

back, shall be used.

14. Materials, tools, or other objects, shall not be

thrown from buildings or structures until proper

precautions are taken to protect others from the

falling objects.

15. Inappropriate footwear or shoes with thin or

badly worn soles must not be worn.

16. Hand protection, such as gloves, shall be worn

when there is excessive exposure to cuts, burns,

or other materials that could cause injury (except

where there is danger of the hand protection

becoming entangled in moving machinery).

17. Hard hats shall be worn whenever overhead

hazards exist and in all areas designated for hard

hat use.

18. Safety glasses, goggles, or other suitable eye

protection shall be worn when there is a hazard

to unprotected eyes (e.g., when using a grinding

wheel, etc.).

19. Employees shall cleanse themselves thoroughly

after handling hazardous substances and follow

special instructions from authorized sources.

20. Carriers should avoid the use of extension

ladders when carrying loads. Such ladders mayprovide 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.

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 similar

support of adequate strength.

MACHINERY AND VEHICLES

37. Only authorized persons shall operate

machinery or equipment.

38. Loose or frayed clothing, long hair, dangling

ties, finger rings, etc., shall not be worn

around moving machinery or other areas

where they may become entangled.

39. Machinery shall not be serviced, repaired or

adjusted while in operation, nor shall oiling





of moving parts be attempted, except on

equipment that is designed or fitted with

safeguards to protect the person performing

the work.

40. Where appropriate, lock-out procedures shall

be used.

41. Employees shall not work under vehicles

supported by jacks or chain hoists without

protective blocking that will prevent injury if

jacks or hoists should fail.

42. Air hoses shall not be disconnected atcompressors until the hose line has been

bled.

43. All excavations shall be visually inspected

before backfilling to ensure that it is safe to

backfill.

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,

attached, if practicable, to the tongue of

the kettle, away from the danger zone.

51. Kettle covers should be equipped with a

handle that projects at least fourteen

inches (14") away from the surface of the

cover or lid.

52. Kettle covers shall be closed and latched

when in transit and the kettle should be

slop-proof when cover is closed.

53. When parked, means shall be provided to

prevent inadvertent movement of the

kettle.

54. Ladders should be used with great

caution, and roof gutters should not be





depended upon for support.

55. Workers handling buckets of hot tar

should not carry anything that will

interfere with the safety of this operation.

56. The gallows frame shall be securely

anchored before hoisting materials.

57. Only muscular power shall be used to

hoist materials by means of a gallows

frame. A winch or power hoist shall not

be used.

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

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.





Appendix G

Employee

Acknowledgement

Form





Employee

Acknowledgement Form

I hereby acknowledge that I have had the opportunity to read,

review and ask questions on the contents of the company’s

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 company safety and health

policies.

Witness – Print Your Name

Duty Title of Witness

Signature of WitnessDate





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While we have made every attempt to ensurethat the information contained in thisdocument is reliable, Safety Office Depot is notresponsible for any errors or omissions, or forthe results obtained from the use or non-use of this information. All information in thisdocument is provided "as is", with no

guarantee of completeness, accuracy,timeliness or of the results obtained from theuse or non-use of this information, and withoutwarranty of any kind, express or implied,including, but not limited to warranties of performance, merchantability and fitness for aparticular purpose.

In no event will Americana Safety Associates,Safety Office Depot, or the partners, agents oremployees thereof be liable to you or anyoneelse for any decision made or action taken inreliance on the information in this document or

for any consequential, special or similardamages, even if advised of the possibility of such damages.

Given the changing nature of laws, rules andregulations, there may be omissions orinaccuracies in information contained in thisdocument. Accordingly, the information in thisdocument is provided with the understandingthat the authors and publishers are provingguidance with respect to the informationcontained herein and that the performance ornon-performance of this guidance shall be theresponsibility of the user of this information.




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