osha - hcprocontent.hcpro.com/manuals/meu/13c_dental_doublepdf.pdf · 2013. 3. 11. · university...

About the AuthorSheila Dunn, DA, MT (ASCP), holds a doctoral degree in clinical laboratory science from the Catholic

University of America in Washington, DC. She has helped thousands of outpatient medical facilities comply

with federal regulations such as CLIA and OSHA through her presentations at a nationwide seminar series.

She has written more than 150 articles about regulatory issues and healthcare delivery systems and serves

as an advisor to numerous companies.

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©2005–2013. HCPro, Inc. All rights reserved, including right of reproduction. The author(s) and their agent(s) have made every reasonable effort in the preparation of this publication to ensure the accuracy of the information. However, the information in this book is sold without warranty, either expressed or implied. The authors, the editors, their agents, and the publishers will not be liable for any damages caused or alleged to be caused directly, indirectly, incidentally, or consequentially by the information in this publication. This publication cannot and does not provide specific information for a user’s exact situation. Users of this publication should exercise their own judgment and, where appropriate, seek the assistance of legal counsel regarding their particular situation.

HCPro, Inc.75 Sylvan Street, Suite A-101

Danvers, MA 01923Tel: 800/650-6787Fax: 800/639-8511

www.hcmarketplace.com

OSHAPROGRAMMANUALfor Dental Facilities

OSHA Program Manual for Dental Facilities is published by HCPro, Inc.

Copyright © 2013 HCPro, Inc.

All rights reserved. Printed in the United States of America. 5 4 3 2 1

ISBN: 978-1-60146-744-7

No part of this publication may be reproduced, in any form or by any means, without prior written consent of HCPro, Inc., or the Copyright Clearance Center (978/750-8400). Please notify us immediately if you have received an unauthorized copy.

HCPro, Inc., provides information resources for the healthcare industry.

HCPro, Inc., is not affiliated in any way with The Joint Commission, which owns the JCAHO and Joint Commission trademarks.

Sheila Dunn, DA, MT (ASCP), AuthorJaclyn Beck Zagami, Associate DirectorJay Kumar, Senior Managing EditorMarge McFarlane, PhD, CHSP, CHFM, HEM, MEP, CHEP, ReviewerMike Mirabello, Senior Graphic ArtistMatt Sharpe, Senior Manager of ProductionJean St. Pierre, Vice President, Operations and Customer Relations

Advice given is general. Readers should consult professional counsel for specific legal, ethical, or clinical questions.

Arrangements can be made for quantity discounts. For more information, contact:

HCPro, Inc.75 Sylvan Street, Suite A-101Danvers, MA 01923Telephone: 800/650-6787 or 781/639-1872Fax: 800/639-8511E-mail: [email protected]

Visit HCPro online at: www.hcpro.com and www.hcmarketplace.com

03/201322012

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IntroductionImportant Information About the Use of This Program ............................. iHow to Customize this Program .................................................................. iiWhat Is Included in This Program ............................................................... vi

TAB 1: OSHA Jurisdictions & InspectionsA Quick Look at OSHA .................................................................................. 1-1

States with OSHA-Approved Plans ......................................................................................1-1OSHA Consultative Services Division ..................................................................................1-2OSHA’s Jurisdiction ..............................................................................................................1-2OSHA’s General Duty Clause ..............................................................................................1-2

Employee or Employer? ............................................................................... 1-3Employer Responsibilities Under OSHA ..............................................................................1-4

Overview of OSHA Standards ...................................................................... 1-4OSHA Inspections ......................................................................................... 1-5

Employee Complaints ..........................................................................................................1-5If an On-site OSHA Inspection Occurs .................................................................................1-6During the Inspection ...........................................................................................................1-7What OSHA Inspectors May Ask Employees .......................................................................1-7The Typical OSHA Inspection ...............................................................................................1-8The Closing Conference .......................................................................................................1-8

OSHA Sanctions ............................................................................................ 1-10Whistleblower Protection ............................................................................. 1-11Students and Volunteers .............................................................................. 1-13

OSHA PROGRAM MANUAL

Contents

Front Pocket OSHA Poster 3165: IT’S THE LAW! Laminated Eyewash Station Sign 4 Sample Biohazard Self-Adhesive Labels CD-ROM (MS Word for Windows 2000) with Master Record Forms (Tab 8) from this Manual

for Customization.

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Contents

TAB 2: Injury & Illness Prevention ProgramKey Contacts for the OSHA Safety Program ........................................................................2-2Location of the OSHA Safety Program .................................................................................2-2

Duties of the OSHA Safety Officer ............................................................... 2-2Accident/Incident Investigation & Reporting Procedure ........................... 2-3

Definition of an Accident and/or Incident ..............................................................................2-4When to Investigate an Accident/Incident ............................................................................2-4How to Document an Accident/Incident................................................................................2-4Recording Accidents or Injuries for OSHA............................................................................2-4Correcting Unsafe Conditions ..............................................................................................2-4

Recordkeeping Requirements ..................................................................... 2-5Equipment & Facility Records ..............................................................................................2-5Bloodborne Pathogens Records ..........................................................................................2-5Hazard Communication Records .........................................................................................2-5TB Records ..........................................................................................................................2-5Employee Medical Records ..................................................................................................2-6Evaluating Exposure Incidents .............................................................................................2-6

Workplace Hazard Analysis ......................................................................... 2-7Employee Training ........................................................................................ 2-8

Checklist for an Effective Safety Training Session ...............................................................2-8Interactive Safety Training Exercises ...................................................................................2-9

General Safety .............................................................................................................2-9Fire Safety ....................................................................................................................2-9Bloodborne Pathogens Safety .....................................................................................2-10Chemical Safety ...........................................................................................................2-10TB Safety .....................................................................................................................2-10

Annual Employee Retraining ....................................................................... 2-10Bloodborne Pathogens Annual Training Contents................................................................2-11Respiratory Protection Annual Training Contents.................................................................2-12Hazard Communication Annual Training Contents...............................................................2-12

New Employee Orientation ........................................................................... 2-12Documenting Employee Training ................................................................ 2-12

OSHA Yearly Retraining .......................................................................................................2-13

Practical Ideas for Administering the OSHA Safety Program ................... 2-17Organizing OSHA Compliance Duties ......................................................... 2-17

Weekly Facility Review Checklist .........................................................................................2-19Monthly Facility Review Checklist ........................................................................................2-20Annual Facility Review Checklist ..........................................................................................2-21Annual OSHA Safety Program (Exposure Control Plan) Review Form ...............................2-24

TAB 1: OSHA JURISDICTIONS & INSPECTIONS

Contents

A Quick Look at OSHA ..................................................................................... 1-1States with OSHA-Approved Plans ........................................................................................1-1OSHA Consultative Services Division .....................................................................................1-2OSHA’s Jurisdiction ................................................................................................................1-2OSHA’s General Duty Clause .................................................................................................1-2

Employee or Employer? .................................................................................. 1-3Employer Responsibilities Under OSHA .................................................................................1-4

Overview of OSHA Standards ......................................................................... 1-4OSHA Inspections ............................................................................................ 1-5

Employee Complaints .............................................................................................................1-5If an On-site OSHA Inspection Occurs ...................................................................................1-6During the Inspection ..............................................................................................................1-7What OSHA Inspectors May Ask Employees .........................................................................1-7The Typical OSHA Inspection .................................................................................................1-8The Closing Conference .........................................................................................................1-8

OSHA Sanctions ............................................................................................... 1-10Whistleblower Protection ................................................................................ 1-11Students and Volunteers ................................................................................. 1-13

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OSHA Program Manual for Dental Facilities

TAB 1: OSHA JURISDICTIONS & INSPECTIONS

A Quick Look at OSHA

OSHA is the Occupational Safety and Health Administration, part of the U.S. Department of Labor. President Richard M. Nixon signed the Occupational Safety and Health (OSH) Act on December 29, 1970, which is responsible for ensuring workplace safety and health protection.

There are currently 27 states and territories with their own OSHA plan. Of these 27 states and territories, 22 have jurisdiction over private and public (state and local government) sector employees. Connecticut, Illinois, New Jersey, New York, and the Virgin Islands plans cover public employees only. In all remaining states, federal OSHA assumes jurisdiction for public and private sector employers.

States with OSHA-Approved PlansAlaska Arizona California Connecticut*Hawaii Illinois* Indiana Iowa Kentucky Maryland Michigan Minnesota Nevada New Jersey* New Mexico New York* North Carolina Oregon Puerto Rico South Carolina Tennessee Utah Vermont Virginia Virgin Islands* Washington Wyoming*State plan applies to public employees only.

Most states with their own OSHA plans are identical to the federal OSHA standards for dental offices, but if you are operating under an OSHA state plan (see list above), contact the state to determine how its requirements differ from federal OSHA’s. Telephone numbers for OSHA state offices are provided behind Tab 9: OSHA Regulations & Key Contacts. For additional information, go to www.osha.gov/dcsp/index.html

OSHA regulations are published in the Federal Register. It is impractical for a typical dental practice to obtain and read the Federal Register on a daily basis. For this reason, HCPro keeps dental facilities abreast of OSHA’s latest requirements via Medical Environment Update newsletter updates.

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OSHA Consultative Services DivisionThe OSHA Consultative Services Division office is staffed with OSHA consultants who have received the same training as OSHA inspectors, but who give practical advice about OSHA regulations. They do not issue citations or penalties and do not share information with OSHA’s federal inspectors. OSHA’s consultants can often answer telephone compliance questions, but be sure to ask for a consultant whose expertise is dental. Occasionally, OSHA consultants will agree to perform a mock inspection, upon request. This service is free, but any corrective actions recommended during a mock inspection must be implemented, or penalties will be assessed. A list of OSHA Consultative Services Divisions is located behind Tab 9: OSHA Regulations & Key Contacts. For additional information go to www.osha.gov/dcsp/smallbusiness/consult_directory.html.

OSHA’s JurisdictionOSHA regulates virtually every workplace ranging from hospitals to construction sites. Federal OSHA does not have jurisdiction over facilities where the Federal Aviation Administration, Department of Energy, Department of Transportation, or Federal Rail-way Administration assumes responsibility and enforces worker safety and health regula-tions. In all other workplaces, federal OSHA regulates workplace safety and health.

OSHA’s General Duty ClauseOSHA has issued workplace guidelines, often derived from government agencies such as the CDC, NIOSH, and the American National Standards Institute (ANSI), that specifically address safety in the healthcare industry. Although these guidelines do not carry the force of OSHA regulations under which employers may be cited, employers who fail to provide a safe and healthy workplace may be cited under OSHA’s general duty clause or sued under a variety of common law tort theories. These recommenda-tions, where applicable, are provided in this OSHA Program Manual.

OSHA’s general duty clause imposes a duty on the employer to:

“… furnish to each of his employees a place of employment which is free from recognized hazards that are causing or are likely to cause death or serious physical harm to his employees.”

To establish a violation of the OSH Act’s general duty clause, OSHA must prove that all of the following conditions existed:

� The employer failed to render the workplace free of a hazard. � The employer or industry had knowledge that the condition or practice was

hazard ous and that the condition existed, or potentially exists, at the employer’s workplace.

� The hazard was causing or was likely to cause death or serious physical harm. � The employer could have eliminated or materially reduced the alleged hazardous

condition or practice by feasible methods.

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A 2011 revision of the Field Operations Manual (FOM) has broadened the criteria for determining the second item listed above, recognizing that a condition or practice was hazardous and existed in the workplace, making it easier to establish this requirement of the general duty clause.

According to the FOM, OSHA compliance safety and health officers (CSHO) may establish recognition by:

� Actual recognition by the employer. This includes written or oral statements made by the employer or executive or managerial staff members during and inspection; company memos, minutes of safety meetings, operation manuals, or policies and procedures; formal employee complaints or grievances; ineffective corrective action.

� Industry recognition. Employers are responsible for knowing about hazards recognized as part of their industry that could be present in the workplace. Examples include statements and reports by safety experts; industry abatement methods; industry, government or insurance studies; national consensus stan-dards of organizations such as ANSI and the National Fire Protection Association.

� Common sense. If a hazard is “so obvious that any reasonable person would have recognized it,” it meets the FOM definition of a recognized hazard. The FOM cautions that this method of recognition should be reserved only for “flagrant or obvious cases.”

Using these recognition criteria, OSHA says that employers are responsible not only for hazards they outright recognize, but also for hazards they should have recognized.

Employee or Employer?

Since OSHA’s concern is the health and safety of employees, it is the employer’s responsibility to provide a safe workplace. When applying OSHA’s standards to dental practices, the status of dentists is important.

Dentists may be employees or employers. Dentists who are unincorporated sole proprietors or partners in a bona fide partnership are employers for OSHA purposes. They can be cited if they employ at least one employee. Such dentist employers may also be cited if they create or control bloodborne pathogens hazards that expose employees at sites where they have staff privileges, such as a hospital.

In general, professional corporations are the employers of their dentist members. In this case, dentists are considered employees and are required to abide by OSHA standards.Part-time, temporary, and per diem workers are also covered by OSHA regulations. Temporary workers from an employment agency are typically on the payroll of the agency, but the dental facility exercises day-to-day supervision over them and would technically be considered their employer for OSHA purposes.

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Before temporary workers are placed in situations that involve potential exposure to bloodborne pathogens, they must receive a facility-specific safety orientation. Inde-pendent contractors who provide a service to a dental facility that involves potential exposure to bloodborne pathogens fall under these same guidelines.

Employer Responsibilities Under OSHAEmployers covered by OSHA must:

� Meet the general duty of providing a workplace free from recognized hazards. � Comply with the OSHA regulations. � Report to OSHA within eight hours of any accident that results in a fatality or

hospitalization of three or more employees. � Maintain a sharps injury log for all percutaneous injuries from contaminated sharps. � Display the OSHA poster, which advises employees of their legal rights and

responsibilities. � Not discriminate against employees who properly exercise their rights under OSHA. � Post any OSHA citations in the workplace. � Correct any cited violations that have become a final order within the prescribed

time period.

Employers have the right to: � Seek free advice and off-site assistance from OSHA. � Request and receive proper identification from any OSHA compliance officer

requesting access to your facility. � Be advised by the compliance officer of the reason for the inspection. � Request a search warrant for OSHA to enter your premises. � Have an opening and closing conference with the compliance officer to discuss

your rights and his or her findings. � Accompany the compliance officer on the inspection. � Be assured of protection of any trade secrets. � Request an informal hearing and settlement from the OSHA area director. � File a notice of contest to dispute any citations and penalties. � Submit comments to OSHA on any rulemaking procedure.

Overview of OSHA Standards

All industries, including healthcare, are covered by general industry standards, 29 CFR 1910. The following standards are most applicable to the dental setting:

� general duty clause (OSH Act of 1970; SEC. 5. Duties) � bloodborne pathogens (1910.1030)

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� compressed gases (1910.101) � electrical safety (1910.303) � emergency action plans (1910.38) � portable fire extinguishers (1910.157) � medical services and first aid (1910.151) � personal protective equipment (1910.132) � respiratory protection (1910.134) � hazard communication (1910.1200) � occupational exposure to hazardous chemicals in laboratories (1910.1450) � ionizing radiation (1910.1096)

OSHA Inspections

OSHA is authorized by law to conduct workplace inspections to enforce health and safety standards. OSHA does not have enough inspectors to oversee all workplaces under its jurisdiction, so the agency sets priorities:

1. Notices of imminent danger.2. Fatalities and catastrophes.3. Serious signed employee complaints.4. Referrals from other government entities alleging serious hazards. 5. Complaints that are not from current employees, are not signed, or do not allege a

serious hazard.6. Follow-up inspections.7. Programmed general inspections of high-hazard workplaces.

Employee ComplaintsThird in priority are employee safety complaints, which, depending on the nature of the allegation, will lead to a complaint inspection or a complaint investigation. An investigation may be conducted by phone, fax, or letter.

When an anonymous employee complaint is filed via phone or letter, OSHA will contact the employer in writing, citing the allegations and requesting a written response within two weeks. The employer must respond to OSHA in writing; OSHA then provides a copy of the written response to the original complainant. Take these investigations seriously because an inadequate response will trigger an on-site inspection.

When an employee files a written, signed complaint, OSHA conducts an on-site inspection without advance notice during working hours. Smaller dental facilities are usually only inspected in response to a complaint from an employee or patient.

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If an On-site OSHA Inspection OccursWhen the OSHA CSHO arrives, ask him or her to display a photo identification. Verify that the person is actually an employee of the OSHA division of the U.S. Department of Labor.

The employer should: � Ask the purpose for the inspection, its scope, and its anticipated length. � Determine which documents the OSHA CSHO wishes to inspect and under what

regulatory authority. If possible, determine which employees the CSHO intends to interview and what areas of the workplace he or she wants to inspect.

� If the inspection is based on a complaint, ask to see a copy the written complaint. Although OSHA will block out the identity of the complainant, the information will be helpful.

Employers may request a civil warrant be obtained before the inspection proceeds further. This is a 4th Amendment constitutional right, but OSHA’s right to inspect is clear, and OSHA often takes a dim view of an employer’s resistance. In the end, it is your decision whether to require a warrant or voluntarily consent to an inspection. In most cases, requiring the CSHO to obtain a warrant may help you delay an inspection, but it will not help you avoid one.

If the inspector has a warrant, records that are not specified on the warrant do not have to be provided. Be careful about providing OSHA with company documents, and don’t volunteer information! You are not required to bear the cost of making copies or allowing use of your copying equipment. Technically, if the inspector wants to copy information by hand, he may do so (29 CFR 1903.3[a]).

During the tour of your facility, the areas to be examined are specified by the inspector. If the OSHA inspector wants to see a specific area, take him or her directly there. The inspector may talk with employees, take notes, make instrument readings, take photos, and/or use a video camera.

OSHA inspectors are legally entitled to review: � Bloodborne pathogens exposure control plan. � Hazard communication policy/material safety data sheets (MSDS) or safety data

sheets (SDSs). � Posters and logs (e.g., #3165 and accident/sharps injury logs). � Hepatitis B vaccination records. � Annual OSHA training records. � General industry standards records (e.g., fire extinguisher inspections and

evacuation plan).

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Each OSHA CSHO will focus on different aspects of a dental office depending on his or her expertise. The inspector may conduct a wall-to-wall inspection or simply focus on one specific matter.

During the InspectionOnce the OSHA inspector is past the reception area, do not let him or her out of your sight.

Your facility’s OSHA safety officer need not be able to answer every question asked by the OSHA inspector and should not try. The OSHA safety officer must be able to, for example, show the OSHA CSHO the location of the Hazard Communication Plan but does not need to know all the details, such as the antidote for a particular hazardous chemical. The OSHA safety officer should not guess about an answer. Instead, write down the question and later speak with others who know the answer.

What you say can and will be used against you, so think before you speak and don’t say more than necessary. Even an innocent comment may be perceived as an admission of a specific violation. When you answer a question, be precise. Never give estimates if you do not have accurate information. You could be providing OSHA with false information, which is a criminal offense. If at any time you have difficulty responding to a question, call for a time-out and get help. You may then go to a telephone and call for advice from your corporate attorney or trusted, knowledgeable source.

Employees are usually interviewed as part of the inspection. If the employer refuses such interviews, the OSHA CSHO will contact the employee at home. Staff members must answer all questions honestly but should not volunteer information. The inspector may consult with employees as long as it does not interfere with work operations and the employee does not object. He or she may also meet with an employee in private if the employee does not object (29 CFR 1903.7[b]).

What OSHA Inspectors May Ask EmployeesOSHA inspectors will determine whether employees:

� Are familiar with your facility’s safety policies and procedures. � Have complied with these policies and procedures. � Can verbalize actions to take in the event of an emergency. � Are aware of the hazards of the products with which he or she works.

OSHA will not permit an employer representative, such as the OSHA safety officer, to be present during interviews of frontline nonsupervisory employees, but the employer has a right to have a representative attend interviews of supervisors.

During the inspection, the CSHO may point out any unsafe working conditions and suggest possible corrective measures. Do not agree that they are violations, or you

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could be cited and fined. If you are able to correct obvious violations on the spot, do so, but you may still receive a citation and penalty.

If the CSHO takes notes or measurements or uses a camera, you should do likewise. Record everything that happens, including the time and date. Get a person to help with notes and someone to help with a camera, if needed. Have the notes typed (keep originals) and add who said what, the inspector’s name, date, times, measuring techniques, equipment used, calibration dates and procedures, and who was present.

The Typical OSHA Inspection1. Opening conference (usually one hour):

� Purpose for the visit is explained. � Records are examined:

– Exposure control plan and overall safety program are checked to see whether they are complete and being followed.

– Hazard Communication Program is checked for provisions for labeling, MSDSs (SDSs), employee training and a list of hazardous chemicals.

2. Tour of the facility: � Employees may be interviewed. � Safety practices are observed. � Photos, videos, instrument readings, or notes may be taken by the inspector.

3. Closing conference: � Employer is advised of the conditions observed in the facility. � OSHA officer may obtain further information. � Any possible citing that may be issued is revealed, along with your right to

appeal and time limits to do so. � Your questions are answered.

The Closing Conference At the completion of an inspection, the OSHA compliance officer will conduct a closing conference with the employer and employee representatives. At this time he or she will:

� Advise the employer of the conditions observed in the facility. � Obtain further information. � Relate any possible citations that may be issued. � Explain your right to appeal alleged violations and provide information on

time limits. � Answer your questions.

After the inspection, the CSHO will inform the employer or the OSHA safety officer of any apparent violations for which a citation may be issued or recommended. The CSHO does not, however, indicate proposed penalties.

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At this time, it is important to ask questions and get as much information as possible about the facts of alleged violations and the specific standards (and language of those standards) that the compliance officer believes to have been violated. Find out about the degree of seriousness of the alleged violations, the potential penalties, and the recommended abatement methods.

Under its reinvention efforts, OSHA allows the opportunity for an employer to correct minor violations on the spot. But be sure that the inspector states—before he or she leaves the premises and with a witness present—that the violations have been abated, with date, time, and place.

Not every potential citation discussed at the closing conference will be included in the final written citation. The inspector’s supervisors will review the proposed citations and decide whether to revise or even drop them. Rarely will citations be added that were not discussed at closing.

To establish a violation under the OSH Act, OSHA must prove all four of the following elements:

1. The standard applies to the working conditions cited.2. The standard’s requirements were not met.3. Employees had access to the hazardous conditions. 4. The employer knew of the hazardous conditions or could have known through the

exercise of reasonable diligence.

The OSH Act’s general duty clause may serve as the basis for a citation when a specific standard does not apply. Generally, OSHA prefers citations under a specific standard to those under the general duty clause because proving a violation of the latter is much more difficult.

Begin to prepare a response to any expected citation immediately after the inspection. The U.S. Department of Labor area director determines penalties after the full inspection report has been reviewed. The area director will notify you in writing, by certified mail, of any citations or penalties that OSHA has placed on your organization.

Immediately after a citation is issued, request an informal conference with the OSHA area director to obtain additional information and to explore the possibility of a settlement. Schedule the conference early in the 15-day response period so there will be enough time to file a notice of contest if the matter is not settled during the conference.

You have 15 working days to pay the penalties or to contest the citation, the penalties, or both. Failure to contest the citation confirms the penalty as final. Contacting legal assistance is advised at this point.

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File a notice of contest before the expiration of 15 working days if you believe that any part of the inspection or citation process was defective or if you want to contest the amount of time OSHA allows for correcting a hazard. The contested issues will be decided by the Occupational Safety and Health Review Commission. The Review Commission is an independent agency and not part of the U.S. Department of Labor.

OSHA Sanctions

The OSHA area director determines what citations, if any, will be issued and what penalties, if any, will be proposed. Citations and penalties will be sent to the employer by certified mail up to six months after the inspection. Citations indicate which regulations have been violated and the time frame allowed for their correction. The employer must post each citation for three days, at or near the place a violation occurred or until the violation is corrected, whichever is longer.

If violations are classified as “other than serious” or “serious,” employers are required to use a simple one-page form to certify to OSHA that the hazardous condition has been abated. For cases involving more serious violations, such as willful, repeat, or high-gravity serious violations, additional verification documents must be submitted along with the abatement certification letter. Examples of acceptable documentation are invoices for equipment purchases, bills from repair services, photographs or video evidence, and reports by safety professionals describing the actions taken for abatement.

For more serious violations that take 90 days or more to abate, OSHA may specify that the employer submit an abatement plan that identifies the violations, the steps to be taken to abate them, an achievement schedule, and the interim measures taken to protect employees from immediate hazards. Abatement plans must be submitted to OSHA within 25 days of the date of the final order in the case.

If a facility fails to take corrective action in response to a cited condition, it is subject to an additional citation for failure to abate. If, after citation, an employer anticipates difficulty abating the condition in the manner or time frame that OSHA expects, the employer should notify OSHA rather than risk re-inspection and a failure-to-abate citation.

OSHA may seek a federal injunction to restrain conditions and practices that could reasonably be expected to immediately cause death or serious physical harm, or before OSHA can force corrective action.

Penalties can range from $50 to $7,000 for each violation; $1,000 is the customary base amount levied. An employer’s good faith, history of previous violations, and size of business will reflect in the amount levied.

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Fines depend on four factors: � Gravity of the violation � Size of the company � Good faith � History

Penalties will usually be reduced an additional 10% if a workplace has not been cited for a serious, willful, or repeat violation within the previous three years.

A willful violation is the most serious, occurring when an employer intentionally and knowingly commits a violation. In this case, OSHA believes that the employer has specific knowledge of a hazardous condition in the workplace and shows an intentional disregard for the requirements of the act or plain indifference to employee safety. Penalties can reach $70,000 per violation, with a minimum of $5,000 per violation. If an employee is killed on a job resulting from a willful violation, the employer, if convicted, could face enormous fines and possibly imprisonment. Willful violations account for less than 1% of all violations.

Repeat violations are assessed when a violation has not been corrected. To establish a repeat violation, OSHA must show that the employer was previously cited within the three years following the prior citation. Repeat violations can result in a $70,000 fine, plus $7,000 per day until corrected.

Other-than-serious citations are given for violations that may cause an accident or illness, but not death or serious physical harm (e.g., a refrigerator not labeled for biohazard storage; or exposure to substances at the worksite that might result in contact dermatitis, but is not likely to result in serious physical harm). Fines for non-serious citations can go up to $7,000, depending on previous violations and good-faith efforts of the employer.

Serious violations are given when death or serious physical harm could result, and the employer knew or should have known about the hazard (e.g., not providing an appropriate eyewash in an area where hazardous chemicals are used). Fines are up to $7,000 for each violation. Fines may be decreased through negotiations or good faith on the part of the employer.

Whistleblower Protection

In addition to workplace safety and health matters, OSHA enforces whistleblower protection for employees covered under Section 11(c) the OSH Act and 20 other federal whistleblower statutes, and on September 21, 2011 OSHA updated the Whistleblower Investigations Manual.

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Employees’ rights under the OSH Act include:

� Filing a complaint with OSHA � Seeking an OSHA inspection � Participating in an OSHA inspection � Participating or testifying in any procedure related to an OSHA inspection

These are employees’ legal rights, and the employer cannot interfere with the exercising of them.

If you receive notice of a complaint from OSHA, do not attempt to identify who made the complaint. Do not try to assign blame to anyone concerning the complaint. Ignorance is bliss in this case, because if you do not know the identity of the complaining employee, it will be difficult to prove retaliation on the employer’s part.

In order for OSHA to bring a whistleblower suit, four conditions must be met:

1. Protected Activity. The evidence must establish that the complainant engaged in activity protected by the specific statute(s) under which the complaint was filed.

2. Employer Knowledge. The investigation must show that a person involved in the decision to take the adverse action was aware, or suspected, that the complainant engaged in protected activity.

3. Adverse Action. The evidence must demonstrate that the complainant suffered some form of adverse action initiated by the employer.

4. Nexus. A causal link between the protected activity and the adverse action must be established by a preponderance of the evidence

Some examples of adverse actions identified in the updated investigation manual include, but are not limited to:

� Discharge � Demotion � Reprimand � Harassment, including slurs, graffiti, offensive or derogatory comments, or other

verbal or physical conduct. � Hostile work environment, including separate adverse actions that occur over a

period of time � Lay-off � Failure to hire � Failure to promote � Blacklisting � Failure to recall

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� Transfer to different job � Change in duties or responsibilities � Denial of overtime � Making a threat � Intimidation � Constructive discharge, where the employer deliberately created working

conditions that were so difficult or unpleasant that a reasonable person in similar circumstances would have felt compelled to resign

Remedies that a court could require from the employer include:

� Reinstatement and front pay � Back pay � Compensatory damages � Punitive damages � Attorney’s fees � Interest on back pay and other damages � Expungement of warnings, reprimands, and derogatory references resulting � Providing the complainant a neutral reference for potential employers

For more information on whistleblower protection, see the OSHA web page at www.osha.gov/dep/oia/whistleblower.

Students and Volunteers Many healthcare facilities use the services of students and volunteers, and the question of OSHA coverage often arises for this category of staff member.

Students and volunteers are not usually covered under OSHA as the agency defines the employer-employee relationship to include work for pay or compensation. For an explanation, search for the OSHA letter of interpretation, 03/05/1999 – OSHA coverage does not extend to unpaid students, at www.osha.gov.

That is not to say that students and volunteers should not be afforded protection. It’s just that the regulatory oversight is usually not by OSHA. Policies should address hazards that students or volunteers could encounter—especially in area bloodborne pathogens and infection control—and what specific training or education they should receive.

Also, for students from accredited education programs who are coming to gain experi-ence in your facility, it is common to insist that they provide proof of the necessary

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vaccinations and bloodborne pathogens and infection control training for their protection and the protection of other staff and patients. Make this proof or other accommodations part of the agreement with the of the education program.

Limiting liability, maintaining the integrity of your infection control plan, and exercising common sense are good reasons for your organization to verify or provide training and protection for students and volunteers to the same extent as employees.

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ALABAMA Safe State ProgramUniversity of Alabama432 Martha Parham WestP.O. Box 870388Tuscaloosa, Alabama 35487(205) 348-8975(205) 348-9878 FAX ALASKAConsultation Section, ADOL/AKOSH3301 Eagle Street, Suite 305Anchorage, Alaska 99503-4149(907) 269-4957(907) 269-3723 FAX ARIZONA Consultation & TrainingIndustrial Commission of ArizonaDivision of Occupational Safety & Health800 West Washington StreetPhoenix, Arizona 85007-2922(602) 542-5795(602) 542-1614 FAX ARKANSAS OSHA ConsultationArkansas Department of Labor10421 West MarkhamLittle Rock, Arkansas 72205(501) 682-4522(501) 682-4532 FAX CALIFORNIA CAL/OSHA Consultation ServiceDivision of Occupational Safety and Health2000 East McFadden Ave, Room 214Santa Anna, CA 92705(714)558-4411(714)558-4431 FAX

COLORADO Colorado State UniversityDepartment of Environmental and Radiological Health Services1681 Campus DeliveryFort Collins, Colorado 80523(970) 491-6151(970) 491-7778 FAX CONNECTICUT Connecticut Department of LaborDivision of Occupational Safety and Health38 Wolcott Hill RoadWethersfield, Connecticut 06109(860) 566-4550(860) 566-6916 FAX

DELAWARE Delaware Department of LaborDivision of Industrial AffairsOccupational Safety and Health4425 North Market StreetWilmington, Delaware 19802(302) 761-8217(302) 761-6602 FAX DISTRICT OF COLUMBIA DC Department of Employment ServicesOffice of Occupational Safety and Health64 New York Avenue, NE-Room 2106Washington, D.C. 20002(202) 671-1800(202) 673-2380 FAX FLORIDASafety Florida Consultation ProgramUniversity of South Florida 13201 Bruce B. Downs Boulevard MDC 56Tampa, Florida 33612 (866) 273-1105(813) 974-8270 FAX

GEORGIA Georgia Institute of Technology21(d) Onsite Consultation Program430 10th Street, N.E.North BuildingAtlanta, Georgia 30332-0837(404) 407-8276(404) 894-8275 FAX HAWAIIConsultation and Training BranchDepartment of Labor and Ind. Relations830 Punchbowl Street, Room #425Honolulu, Hawaii 96813(808) 586-9083(808) 586-9099 FAX IDAHOIdaho OSHA Consultation ProgramBoise State University1910 University Drive, M.S. 1825Boise, Idaho 83725-1825(208) 426-3283(208) 426-4411 FAX ILLINOISIllinois Onsite ConsultationIllinois Department of Labor900 South Spring StreetSpringfield, IL 62704(217) 782-1442(217) 785-8776 FAX

INDIANAIndiana SafeIndiana Department of Labor402 West Washington, W195Indianapolis, Indiana 46204(317) 234-4792(317) 233-1868 FAX IOWAIowa Workforce Devel. & Labor SrvcesBureau of Consultation and Education1000 East Grand AvenueDes Moines, Iowa 50319(515) 281-7629(515) 281-5522 FAX

KANSASKansas Department of Human ResourcesDivision of Industrial Safety and Health417 SW Jackson StreetTopeka, Kansas 66603-3327(785) 296-4386(785) 296-1775 FAX KENTUCKYKentucky Labor CabinetDivision of Education and TrainingKentucky OSH Program1047 U.S. Highway 127 So., Suite 4Frankfort, Kentucky 40601(502) 564-3070(502) 564-4769 FAX

LOUISIANA21(d) Consultation ProgramLouisiana Department of LaborOSHA Consultation, Office of Worker’s CompP.O. Box 94040Baton Rouge, LA 70804-9094(225) 342-0720(225) 342-6756 FAX MAINEMaine Bureau of Labor StandardsWorkplace Safety and Health DivisionState House Station #45Augusta, Maine 04333-0045(207) 623-7900(207) 623-7938 FAX MARYLANDMOSH Consultation Services Dept. of Labor, Licensing & Regulations10946 Golden W. Drive, Suite 160Hunt Valley, MD 21031(410) 527-4472(410) 527-5678 FAX

OSHA Consultative Services State DirectoryState OSHA consultants give practical advice on job safety and health problems. While these consultants have received the same training as the federal inspection staff, they cannot issue citations or penalties. They also do not routinely provide information about workplace conditions to the federal inspection staff. To keep your State OSHA Consultative Services Directory current, go to www.osha.gov/dcsp/smallbusiness/consult_directory.html.

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MASSACHUSETTSDepartment of Labor StandardsExecutive Office of Labor and Workforce Development375 Shattuck StreetLawrence, MA 01843(978) 242-1351(978) 688-0352 FAX MICHIGANConsultation Education and Training DivisionMichigan Occupational Safety and Health AdministrationLabor and Economic Growth7150 Harris DriveP.O. Box 30643Lansing, Michigan 48909-8413(517) 322-1809(517) 322-1374 FAX MINNESOTADepartment of Labor and IndustryConsultation Division443 LaFayette RoadSaint Paul, Minnesota 55155(651) 284-5060(651) 284-5739 FAX MISSISSIPPIMississippi State UniversityCenter for Safety and Health2151 Highway 18, Suite BBrandon, Mississippi 39042 (601) 825-0783(601) 825-6609 FAX MISSOURIOnsite Consultation ProgramDivision of Labor StandardsDepartment of Labor and Ind. Relations3315 West Truman BoulevardP.O. Box 449Jefferson City, Missouri 65109(573) 751-3403(573) 751-3721 FAX

MONTANAMT Bureau of SafetyPO Box 17281625 11th AvenueHelena, Montana 59624(406) 444-6418(406) 444-9396 FAX NEBRASKANebraska Workforce DevelopmentOffice of Safety and Labor Standards550 S. 16th StreetP.O. Box 94600Lincoln, Nebraska 68509- 4600(402) 471-4717(402) 471-5039 FAX

NEVADASafety Consultation and Training SectionDivision of Industrial RelationsDepartment of Business and Industry1301 Green Valley Parkway, #200Henderson, Nevada 89074(702) 486-9147(702) 990-0326 FAX NEW HAMPSHIREOccupational Health and Safety Consultation ServicesWorkwise NH, Keene State College175 Ammon Drive, Suite 101Manchester, NH 03103(603) 271-2024(603) 271-2667 FAX NEW JERSEYNew Jersey Department of Labor and Workforce Development1 John Fitch PlazaP.O. Box 386Trenton, New Jersey 08625-0386(609) 292-0404(609) 292-4409 FAX NEW MEXICONM Environment DepartmentOccupational Health and Safety Bureau525 Marquez PlazaSanta Fe, New Mexico 87502(505) 827-4230(505) 827-4422 FAXToll Free: 877-610-6742 NEW YORKDivision of Safety and HealthState Office Building CampusBuilding 12, Room 168Albany, New York 12240(518) 457-2238(518) 457-3454 FAX NORTH CAROLINABureau of Consultative ServicesNC Department of Labor—OSHA Division1101 Mail Service CenterRaleigh, North Carolina 27699-1101(919) 807-2905(919) 807-2902 FAX NORTH DAKOTANorth Dakota Occupational Safety and Health Consultation— Bismarck ST CollegeCorporate and Continuing Education1815 Shafer StreetP.O. Box 5587Bismarck, North Dakota 58506(701) 224-5778(701) 224-5763 FAX

OHIOOhio Bureau of Workers CompensationDivision of Safety and HygieneOSHA On-Site Consultation 13430 Yarmouth DrivePickerington, OH 431471-800-282-1425 (614) 644-3133 FAX OKLAHOMAOklahoma Department of LaborOSHA Consultation Division3017 N. Stiles, Suite 100Oklahoma City, OK 73105-5212(405) 521-6100 (405) 557-1214 FAX OREGONOregon OSHA Consultation/ServiceDepartment of Consumer and Business Services350 Winter Street, N.E., Room 430Salem, Oregon 97301-3882(503) 947-7434(503) 947-7462 FAX PENNSYLVANIAIndiana University PennsylvaniaRoom 210 Walsh Hall302 East WalkIndiana, Pennsylvania 15705-1087(800) 382-1241(724) 357-2396(724) 357-2385 FAX RHODE ISLANDOSH Consultation ProgramDivision of Occupational Health and Radiation ControlRhode Island Department of Health3 Capital Hill Cannon Building, Room 206Providence, Rhode Island 02908(401) 222-7745(401) 222-2456 FAX SOUTH CAROLINASouth Carolina Department of Labor, Licensing and Regulation110 Centerview DriveP.O. Box 11329Columbia, South Carolina 29211-1329(803) 896-7744(803) 896-7750 FAX SOUTH DAKOTASouth Dakota State UniversityEngineering Extension—OSHA ConsultationSHH 201, Box 2220Brookings, SD 57007-0597(605) 688-4101(605) 688-6290 FAX

OSHA Consultative Services State DirectoryFor the latest contact information, go to www.osha.gov/dcsp/smallbusiness/consult_directory.html,

as information changes frequently

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TENNESSEEOSHA Consultation Services DivisionTennessee Department of Labor220 French Landing DriveNashville, Tennessee 37243 (800) 325-9901(615) 532-2997 FAX TEXASWorkers’ Health and Safety Division— MS 22Texas Workers’ Compensation Comm7551 Metro Center DriveAustin, Texas 78744-1609(512) 804-4693(512) 804-4641 FAXOSHCON Request Line: 800-687-7080 UTAHUtah OSHA Consultation Program 160 East 300 South, Third FloorSalt Lake City, Utah 84114-6650(801) 530-6868 (801) 530-7606 FAX(801) 530-6901 TDY(800) 530-5090 VERMONTVT Department of Labor and IndustryWorkers Compensation & Safety DivisionP.O. Box 4885 Green Mountain DriveMontpellier, VT 05601-0488(802) 888-0620(802) 888-2598 FAX

VIRGINIAVA Department of Labor and IndustryOccupational Safety and HealthTraining and Consultation13 South 13th StreetRichmond, Virginia 23219(804) 786-6613(804) 786-8418 FAX WASHINGTONWISHA Services DivisionP.O. Box 4648Olympia, WA 98504-4648(360) 902-5554(360) 902-5438 FAX WEST VIRGINIAWest Virginia Department of LaborCapitol Complex Building #61800 E Washington Street, Room B-749Charleston, West Virginia 25305(304) 558-7890(304) 558-2415 FAX

WISCONSINUniversity of WI State Lab of Hygiene2601 Agriculture DriveP.O. Box 7996Madison, WI 53707-7996(608) 266-5240(608) 266-5249 FAX(800) 947-0553 WYOMINGWyoming Department of EmploymentWorkers’ Safety and Compensation DivisionWyoming Worker’s Safety1510 East Pershing BoulevardCheyenne, Wyoming 82002(307) 777-7786(307) 777-3646 FAX

OSHA Consultative Services State DirectoryFor the latest contact information, go to www.osha.gov/dcsp/smallbusiness/consult_directory.html,

as information changes frequently

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Alaska Department of Labor and Workforce Development P.O. Box 1111491111 W. 8th Street, Room 304 Juneau, Alaska 99801-1149(907) 465-2700 Fax: (907) 465-2784

Industrial Commission of Arizona 800 W. Washington Phoenix, Arizona 85007(602) 542-4411 Fax: (602) 542-7889

California Department of Industrial Relations 1515 Clay Street, 17th FloorOakland, CA 94612(510) 622-3965Fax: (510) 286-7037

Connecticut Department of Labor 200 Folly Brook Boulevard Wethersfield, Connecticut 06109 (860) 263-6505Fax: (860) 263-6529Conn-OSHA (860) 263-6900Fax: (860) 263-6940

Hawaii Department of Labor and Industrial Relations 830 Punchbowl Street Honolulu, Hawaii 96813 (808) 586-8844 Fax: (808) 586-9099

Illinois Department of Labor900 South Spring StreetSpringfield, IL 62702(217) 782-6206FAX (217) 782-0596

Indiana Department of Labor State Office Building 402 W. Washington Street, Room W195 Indianapolis, IN 46204-2751 (317) 232-2378 Fax: (317) 233-3790

Iowa Division of Labor 1000 E. Grand Avenue Des Moines, Iowa 50319-0209 (515) 281- 3447 Fax: (515) 281- 5631

Kentucky Labor Cabinet 1047 U.S. Highway 127 So., Suite 4 Frankfort, Kentucky 40601 (502) 564-3070 Fax: (502) 564-5387

Maryland Division of Labor and Industry Department of Labor, Licensing and Regulation 1100 No. Eutaw Street, Room 606Baltimore, MD 21201-2206 (410) 767-2241 Fax: (410) 767-2986

Michigan Department of Labor and Economic Growth Michigan Occupational Safety and Health AdministrationP.O. Box 30643 Lansing, MI 48909-8143 (517) 322-1817 Fax: (517) 322-1775

Minnesota Department of Labor and Industry 443 Lafayette Road St. Paul, Minnesota 55155 (651) 284-5010 Fax: (651) 284-5741OSHA Management Team (877) 470-6742Fax: (651) 284-5741

Nevada Division of Industrial Relations 400 West King Street, Suite 400 Carson City, Nevada 89703 (775) 684-7260 Fax: (775) 687-6305 Occupational Safety & Health Enforcement Section (OSHES) (702) 486-9020 Fax: (702) 990-0358

New Jersey Dept. of Labor and Workforce Development Office of Public Employees Occupational Safety and Health (PEOSH)1 John Fitch PlazaP.O. Box 386Trenton, NJ 08625-0386(609) 292-2975 Fax: (609) 292-4409

New Mexico Environment Department 525 Camino del los MarquezSuite 3, Box 5469Santa Fe, New Mexico 87502 (505) 827-2855 Fax: (505) 827-2836

New York Department of Labor NY Public Employee Safety and Health Program ST Off Campus Building 12, Room 158 Albany, New York 12240 (518) 457-2746 Fax: (518) 457-5545

North Carolina Department of Labor 1101 Mail Service CenterRaleigh, NC 27699-1101(919) 733-0359 Fax: (919) 733-6197 OSH (919) 807-2861 Fax: (919) 807-2855

Oregon Occupational Safety and Health Division Department of Consumer and Bus. Services 350 Winter Street, NE, Room 430 P.O. Box 14480Salem, Oregon 97309-0405(503) 378-3272 Fax: (503) 947-7461

Puerto Rico Department of Labor Prudencio Rivera Martínez Building505 Muñoz Rivera Avenue Hato Rey, Puerto Rico 00918 (787) 754-5824 Fax: (787) 753-9550

South Carolina Department of Labor, Licensing, and Regulation Synergy Business Park, Kingstree Building110 Centerview Drive P.O. Box 11329 Columbia, South Carolina 29211 (803) 896-4300 Fax: (803) 896-4393

Tennessee Department of Labor 220 French Landing DriveNashville, TN 37243(615) 741-2582 Fax: (615) 741-5078

Utah Labor Commission 160 East 300 South, 3rd Floor P.O. Box 146600Salt Lake City, Utah 84114-6600 (801) 530-6901Fax: (801) 530-7606

Vermont Department of Labor and Industry 5 Green Mountain DriveP.O. Box 488Montpelier, VT 05601-0488(802) 828-2765 Fax: (802) 828- 0408

Virgin Islands Department of Labor 3012 Golden Rock Christiansted, St. Croix, Virgin Islands 00840(340) 773-1994 Fax: (340) 773-0094

Directory of States with Approved OSHA PlansTo keep your States with Approved OSHA Plans Directory current, go to www.osha.gov/dcsp/osp/states.html.

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Virginia Department of Labor and Industry Main Street Centre600 East Main StreetRichmond, Virginia 23219 (804) 786-2377 Fax: (804) 371-6524

Washington Department of Labor and Industries General Administration BuildingP.O. Box 44001 Olympia, WA 98504-4001 (360) 902-4200 Fax: (360) 902-4202

Wyoming Department of Employment Workers’ Safety and Compensation Division 1510 East Pershing Boulevard West WingCheyenne, Wyoming 82002 (307) 777-7672 Fax: (307) 777-5805

Directory of States with Approved OSHA PlansTo keep your States with Approved OSHA Plans Directory current, go to www.osha.gov/dcsp/osp/states.html.

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Acronyms used in the OSHA Program Manual

ACGIH American Conference on Governmental Industrial HygienistsACLS Advanced cardiac life supportADA American Dental AssociationADA Americans with Disabilities Act AED Automated external defibrillatorsALARA As low as reasonably achievable ALT Alanine aminotransferaseANSI American National Standards InstituteBCG Bacille Calmette-GuérinBSC Biological safety cabinet CD Cytotoxic drugsCDC Centers for Disease Control and PreventionCESQG Conditionally exempt small quantity generators CFR Code of Federal RegulationsCPL Compliance (used as prefix in OSHA compliance directive documents)CPR Cardiopulmonary resuscitationCSHO Compliance safety and health officer CTS Carpal tunnel syndrome CVS Computer vision syndrome DEA Drug Enforcement Administration DOL Department of LaborDOT Department of TransportationEAP Employee Assistance ProgramECP Exposure control planEPA Environmental Protection AgencyEtO Ethylene oxide FDA Food and Drug AdministrationFIFRA Federal Insecticide, Fungicide, and Rodenticide Act FOM Field Operations Manual GHS Globally Harmonized SystemHAVl Hepatitis A virus HazCom Hazard CommunicationHBIG Hepatitis B immune globulinHBV Hepatitis B virusHCV Hepatitis C virus

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