Nevada Written Safety and Health Program

1
Written Safety and Health Program

For

XYZ Company

Required for all Nevada Businesses with 10 or More Employees
Incorporates Provisions of Nevada Revised Statutes 618.383

2013 Americana Safety. All rights reserved.
Nevada - Written Safety and Health Program
2013 Americana Safety. All rights reserved. 2

Table of Contents

Section Description Page
1 Policy Statement 3
2 Assignment of Responsibilities 4
3 Safety Orientation and Training 9
4 Inspections and Hazard Control 12
5 General Safety Requirements 22
6 Accident Investigation and Reporting 26
7 Safety Committee and Meetings 33
8 Employee Compliance and Discipline 36
9 Medical, First Aid 39
10 Emergency Planning and Procedures 41
11 Company Required Safety Programs 51
12 Company Required Safety Training Courses 52
13 Company Required Safety Forms & Checklists 54

Appendices
Appendix A List of Training Subjects 56
Appendix B Hazard Assessment Checklists 58
Appendix C Hazard Assessment and Correction Record 59
Appendix D Accident/Exposure Investigation Report 61
Appendix E Employee Training and Instruction Record 63
Appendix F Code of Safe Practices 65
Appendix G Employee Acknowledgement Form 77


Section 1
Policy Statement

Program Policy Statement
XYZ Company shall comply with all occupational safety and health laws of the State of Nevada.
To accomplish this, we must constantly be aware of unsafe acts and conditions in all work areas
that can produce injuries. No employee is required to work at a job they know is not safe or
healthful.
As employees of XYZ Company, your cooperation in detecting hazards and, in turn, controlling
them, is a condition of your employment. Inform your supervisor immediately of any situation
beyond your ability or authority to correct.
Program Requirement
In the State of Nevada, the law requires you to develop and implement this Written Safety and
Health Program if your company manufactures explosives or has 11 or more employees.
This program incorporates and complies with Nevada Revised Statutes 618.383.
Proper use of this program requires the Program Administrator to carefully review the
requirements for each of the program sections, appendices and to modify, where necessary, to
accurately reflect specific company requirements as it relates to its operation and workforce.
This program must be maintained by the employer in order to be effective.


Section 2
Assignment of Responsibilities

Safety and Health Responsibilities
XYZ Company is responsible for ensuring that all onsite and offsite work activities, equipment,
and facilities operated or maintained by XYZ Company our subcontractors or suppliers conform
fully with safety and health regulations promulgated by the U.S. Department of Labor in Title 29
CFR 1910 and 1926, Occupational Safety and Health Act of 1970, and provisions of all state
approved plans and safety procedures. Compliance shall include the aforementioned
regulations, standards and codes and all such regulations, standards and codes as included by
reference. These responsibilities include, but are not limited to, the following:
1. Program Administrator
Written Safety and Health Program administrator, Program Administrator has the authority
and responsibility for implementing the provisions of this program.
DECISION POINT Enter a name or position title (recommended)
The Program Administrator for XYZ Company is ____________________________________.
2. Safety Representative Responsibilities
The company safety representative, Safety Representative also has the authority and
responsibility for implementing the provisions of this program and be the same person or
title as the Program Administrator.
DECISION POINT Enter a name or position title (recommended)
The Safety Representative for XYZ Company is ___________________________________.
A. The XYZ Company Safety and Health compliance program shall be managed and
administered by the Safety Representative.

B. Ensure the companys compliance with all applicable federal, state, and local safety and
health requirements.
C. Ensure that each employee is provided with adequate and appropriate occupational
safety and health training and personal protective equipment.
D. Inspect all workplaces, projects, and/or facilities periodically, but not less than once per
quarter.
E. Ensure that the safety and health policies are comprehensive and effective.
F. Review each accident and conduct any investigation wherein an accident has resulted in
serious occupational injury, illness or property damage.
G. Promote safety and health and serve as a resource to all staff.
H. Review the program on an annual basis.
3. Manager Responsibilities
A. Establish rules and programs designed to promote safety and make known to all
employees the established rules and programs.
B. Provide all supervisors with copies of appropriate rules and regulations.
C. Make available training necessary for employees to perform their tasks safely.
D. Provide protective equipment for employees where required.
E. Impress upon all employees, subcontractors and suppliers, the responsibility and
accountability of each individual to maintain a safe workplace.
F. Record all instances of violations and investigate all accidents.
G. Discipline any employee disregarding safety and loss prevention policies.
H. Require all subcontractors as a matter of contract and all material suppliers through
purchase order terms, to follow established safety rules.

I. Require all subcontractors to submit for review their safety programs and encourage
them to work safely.
J. Conduct safety inspections, maintain records and continually monitor the program for
effectiveness.
4. Supervisor Responsibilities
A. Carry out safety programs at the work level.
B. Be aware of all safety requirements and safe working practices.
C. Plan work activities to comply with safe working practices.
D. Instruct new employees, existing employees, and subcontractors performing new tasks
on safe working practices.
E. Make sure protective equipment is available and used.
F Make sure work is performed in a safe manner and no unsafe conditions or equipment
is present.
G. Correct all hazards, including unsafe acts and conditions, which are within the scope of
your position.
H. Secure prompt medical attention for any injured employees.
I. Report all injuries and safety violations to management.
5. Employee Responsibilities
A. Work safely in such a manner as to ensure your own safety as well as that of co-workers
and others.
B Request help when unsure about how to perform any task safely.
C. Correct unsafe acts or conditions within the scope of the immediate work.
D. Report any uncorrected unsafe acts or conditions to the appropriate supervisor.

E. Report for work in good mental and physical condition to safely carry out assigned
duties.
F. Use and maintain all safety equipment provided.
G. Maintain and properly use all tools under your control.
H. Follow all safety and project rules.
I. Provide fellow employees help with safety requirements.
J. REPORT ALL WORK RELATED INJURIES OR ACCIDENTS TO YOUR SUPERVISOR -
IMMEDIATELY.
6. All Personnel (without regard to position or assignment):
A. Strive to make all operations safe.
B. Maintain mental and physical health conducive to working safely.
C. Keep all work areas clean and free of debris.
D. Assess result of your actions on the entire work place. Work will not be performed in
ways that cause hazards for others.
E. Before leaving work, replace or repair safety precaution signs or barriers that have been
removed or altered. Unsafe conditions will not be left to imperil others.
F. Abide by the safety rules and regulations promulgated for this construction project.
DECISION POINT - delete if not applicable
7. Subcontractors and Suppliers Responsibilities
A. Abide by safety rules and regulations as promulgated by Federal, State and local
authorities including those of XYZ Company and any General Contractor.
B. Notify all other contractors when their activities could affect the health or safety of
other employees in the workplace, project and/or facility.

C. Check in with XYZ Company site supervision when entering or leaving any job-site.
D. Inform XYZ Company site Safety Representative of all injuries to workers, immediately.
E. Report to XYZ Company site supervision or safety representatives any unsafe conditions.
F. Provide for review Safety and Hazard Communications Programs.
G. Provide a chemical inventory list and copies of Material Safety Data Sheets (MSDS) for
any hazardous materials - prior to bringing materials on-site.

Section 3
Safety Orientation and Training

Safety and health training at XYZ Company imparts knowledge, generates new ideas, reinforces
existing ideas and principles and puts the other three elements of the program into action.
The answer to the question, How do I get new employees into the mainstream and build
productivity? is Training! On-the-job or through formal classroom instruction, training is a
necessity for improving performance. As time passes and processes or product lines change,
employees must be retrained.
Safety and health training implies training on specific job procedures. It can be given separately,
but it is better combined with regularly scheduled job-related training. Such training benefits
the employee through fewer work-related injuries and illness reduced stress, and worry caused
by exposure to dangers. Training must also be provided for supervisors.
1. Supervisor and Employee Safety Training
Supervisory Training
XYZ Company supervisory training is a logical first step since supervisors will help in training
the other employees. Supervisors are key figures in the implementation and overall success
of the safety and health program. As a minimum, our supervisors shall be trained in the
following areas:
a. The need to establish and maintain safe and healthful working conditions;
b. The dangers associated with a job, the potential effect on employees, and the rules,
procedures and work practices for control of these dangers;
c. How to relate this information by example and instruction to employees, to ensure
that they understand and follow safe procedures; and

d. How to investigate accidents, and to take corrective and preventive action to
prevent recurrence.
Employee Training
XYZ Company recognizes that employees may create dangers through their own actions if
they have not been properly trained. Dangerous situations can be avoided, or made less
dangerous, when our employees receive appropriate training and instruction in the
following subject areas:
a. Standard work procedures including safe work practices, and how these procedures
protect against exposure to dangers.
b. Personal protective equipment: why it is needed, how to use it, and how to keep it
in good condition.
c. What to do in case of fire or other emergency that may occur in the workplace.
Training is as essential to the overall program as these elements: management
commitment; danger assessment and control; and safety planning, rules and work
procedures.
2. New-Hire Employee Orientation
All XYZ Company new hires must attend a new-hire orientation prior to commencing
employment.
All new-hires shall receive occupational health and safety training in the following subject
areas:
a. Company Safety Philosophy and Policy
b. Project Orientation (if applicable)
c. Disciplinary procedures for non-compliance
d. Employee Danger Reporting System
e. Accident Reporting System
b. Personal Protective Equipment (when applicable)

e. Fall Protection -100% tie-off (if applicable)
f. Scaffolding (if applicable)
g. Fire Prevention
h. Hazardous Communication Standard, Material Safety Data Sheets, and
Environmental Safety
i. Bloodborne Pathogens Program (if applicable)
j. Workplace Housekeeping Rules
3. Mandatory Occupational Safety and Health Programs
Hazard Communication Program
All XYZ Company employees will receive training in compliance with the OSHA Hazard
Communication (HazCom) Standard, 29 CFR 1926.59. This training will be part of the new-
hire employee orientation and will cover, at a minimum, the following areas:
a. A review of the requirements of the HazCom Standard.
b. Chemicals or hazardous materials likely to be found in their workplace; their health
effects and means of exposure or routes of entry.
c. How to lessen or prevent exposure to hazardous chemicals or materials through the
use of control/work practices and Personal Protective Equipment.
d. Emergency procedures to follow in the event of an accident or exposure involving
hazardous chemicals/materials.
Continuous HazCom training will be conducted via weekly toolbox safety meetings when
applicable.
Personnel regularly expose to hazardous chemicals as part of their job tasks will receive
annual refresher training within 30 days of their employment date or by department annual
schedule. Note: This annual refresher HazCom training shall be documented.


Section 4
Inspection and Hazard Control

1. Eliminating Workplace Hazards
XYZ Company is committed to eliminating or controlling workplace hazards that could cause
injury or illness to our employees. We will meet the requirements of state safety standards
where there are specific rules about a hazard or potential hazard in our workplace.
Whenever possible we will design our facilities and equipment to eliminate employee
exposure to hazards. Where these engineering controls are not possible, we will write work
rules that effectively prevent employee exposure to the hazard. When the above methods
of control are not possible or are not fully effective we will require employees to use
personal protective equipment (PPE) such as safety glasses, hearing protection, foot
protection etc.
2. Safety Rules and Work Procedures
A. General Safety Rules
The XYZ Company Written Safety and Health Program apply to all employees.
The rules may be very simple or extremely complex, depending on the nature of the
work processes and the number and kinds of employees involved. Some items that are
addressed by general safety rules are:
1) Personal protective equipment requirements;
2) Clothing appropriate for the work;
3) Behavior expected of all employees;
4) How to leave the workplace safely, with particular reference to emergency
procedures; and

5) Danger areas that are: off-limits for employees.
As part of our initial safety and health survey, existing rules are always evaluated. New
rules may be necessary. All rules will be reviewed and updated periodically to make sure
they reflect present conditions. Those no longer applicable will be dropped.
B. Basic Safety Rules
The following basic safety rules have been established to help make our company a safe
and efficient place to work. These rules are in addition to safety rules that must be
followed when doing particular jobs or operating certain equipment. Those rules are
listed elsewhere in this program. Failure to comply with these rules will result in
disciplinary action.
1) Never do anything that is unsafe in order to get the job done. If a job is unsafe,
report it to your supervisor or safety committee representative. We will find a safer
way to do that job.
2) Do not remove or disable any safety device! Keep guards in place at all times on
operating machinery.
3) Never operate a piece of equipment unless you have been trained and are
authorized.
4) Use your personal protective equipment whenever it is required.
5) Obey all safety warning signs.
6) Working under the influence of alcohol or illegal drugs or using them at work is
prohibited.
7) Do not bring firearms or explosives onto company property.
8) Smoking is only permitted outside the building away from any entry or ventilation
intake.
9) Horseplay, running and fighting are prohibited

10) Clean up spills immediately. Replace all tools and supplies after use. Do not allow
scraps to accumulate where they will become a hazard. Good housekeeping helps
prevent injuries.
C. Standard Work Procedures
Effectiveness in safety and health performance results our commitment to establish
standard work procedures that fix accountability. These directives or standard work
procedures can be oral or written but in all case communicated to each worker, defining
specific responsibilities and objectives where safety and health are concerned.
It is not uncommon in business operations for individual groups such as quality control,
production control, safety and other groups to have their own procedures for doing the
same work. The objective is to use results of a work analysis to establish one standard
procedure for each job, which is on record and available for reference and continued
use.
Ideas can often be obtained from equipment and tool manufacturers. It is strongly
recommended that those departments consult with employees and use their ideas,
particularly those employees who have experience in the work being studied.
Standard work procedures provide the tools for teaching how to work consistently with
a maximum of efficiency and safety.
3. Company Specific Safety Programs
A. Personal Protective Equipment (PPE)
XYZ Company will insure that all employees and subcontractors will use appropriate PPE
while on-site. This will include appropriate hard hats, safety glasses, hearing protection,
body harnesses and positioning belts and all other necessary equipment as required by
site and working conditions.

B. Housekeeping
XYZ Company will enforce housekeeping requirements daily. This will include:
1) Requiring subcontractors to keep their work areas orderly and clean up daily.
2) Keeping walkways and access areas clear.
3) Run cords and hoses so as not to pose a trip hazard. Do not run cords or hoses
through doorways or other openings where they could be pinched and damaged.
4) Combustible materials and debris will be properly stored or disposed of daily. Trash
will not be permitted to accumulate and will be placed in covered containers or
furnished dumpsters.
5) Form and scrap lumber will be stored and cleared away from the work area daily. All
protruding nails will be hammered in, removed or bent over to prevent injury.
6) Spills involving combustible or flammable liquids, oils or grease will be cleaned up
immediately.
C. Self-Inspections
XYZ Company safety and supervisory personnel will perform daily walk-through
inspections. Inspections will be documented and deficiencies noted. Equipment
operators will inspect their equipment daily, and a log will be kept in the piece of
equipment. All inspection logs will be available for review.
1) The XYZ Company Safety Representative is the authority on all company
Occupational Health and Safety inspections and safety training, and is responsible
for ensuring all required safety inspections are promptly conducted.
2) Types and Frequency of Safety Inspections and Surveys. Safety Inspections shall be
conducted at periodic intervals of all work locations.
3) When established, safety committee members are responsible for conducting self-
inspections of their areas and other areas, as assigned by the Safety Representative.

4) Supervisors are responsible for conducting self-inspections of their assigned work
area(s).
D. Governmental Inspections
In the event of a governmental inspection, the compliance officer will be directed to any
General Contractors office. If not the General Contractor, XYZ Company will follow the
prescribed General Contractor procedures.
1) Outside Agency Inspections. These may include:
State Occupational Safety & Health Inspector.
City/County/State Fire Inspector.
Insurance Company Loss Control Consultant.
Other bonified inspectors with a contractual or legal interest.
2) The Safety Representative shall be immediately notified by any employee who has
knowledge of an outside agency inspection, and accompany all inspectors while
they are on the property.
3) Supervisors shall also be notified and will be encouraged to accompany outside
agency inspections of their areas of responsibility.
E. Audits
XYZ Company will cooperate fully with any General Contractor, and the insurance
authority with regard to monthly and periodic safety audits. Additionally, XYZ Company
will conduct a monthly audit of all subcontractors under our contract, which are on-site.
F. Planning
All project activities will include planning for safety concerns throughout the project. A
"Job Hazard Analysis" will be generated with the project superintendent and foremen
for all hazardous operations. Subcontractors will be required to provide a documented
Job Hazard Analysis for their work prior to commencing operations.

G. Job Hazard Analysis
XYZ Company will actively promote and develop a complete Job Hazard Analysis for all
construction programs within the scope of our work.
1) Those operations, which do not fall in the analysis loop, will be designated as non-
hazardous and filed in the appropriate order along with the Job Hazard Analyses.
2) Job Hazard Analysis shall be produced by the superintendent and appropriate crew
foremen and reviewed by XYZ Company Safety Representative.
3) A copy of each Job Hazard Analysis shall be maintained onsite and available for
review.
4) Who should participate in a hazard analysis?
To be fully effective and reliable, it should represent as many different viewpoints as
possible. Each person familiar with a process or operation has gained insights
concerning problems, faults, and situations that can cause accidents.
These insights need to be recorded along with those of the initiator of the hazard
analysis, who is the superintendent, appropriate crew foremen, company Safety
Representative or a contract safety professional.
5) What processes, operations, and tasks need to be analyzed?
Many processes, operations and tasks in any establishment are good candidates for
hazard analysis because they have the potential to cause accidents. Eventually,
hazard analyses should be completed for all jobs, but the most potentially
threatening should have immediate attention. Those that are making the decisions
should consider:
Frequency of accidents
Potential for injury
Severity of injury
New or altered equipment, processes, equipment, and operations

Excessive material waste or damage to equipment
H. Responsibilities for "Controlling" Workplace Hazards
It is the responsibility of all employees to control the possibility of hazards in their work
area, which, if left uncorrected, could cause injury to other employees, the public at
large and damage to equipment or property.
I. Requirements for "Reporting" Workplace Hazards
All workplace hazards, which cannot be immediately controlled (barricaded, placement
of warning/danger signs, etc.) or corrected on the spot, shall be immediately reported
to the supervisor in charge and the company Safety Representative.
J. Procedures for "Correcting" Identified Workplace Hazards
It is the responsibility of each supervisor to ensure that identified workplace hazards are
corrected and employees informed. Hazards that have been identified through safety
inspections shall be corrected within a reasonable time to make necessary repairs or
corrections to abate the hazard.
4. Enforcement Procedures and Systems
At XYZ Company, safety rules and work procedures shall be practiced and enforced.
We have established a system to ensure that violations of rules are dealt with fairly but
firmly, that all employees are aware of the requirements, and that reorientation or
retraining may be provided when needed. Incentive programs may be initiated and will be
used in conjunction with a good enforcement program.
A. Discipline
No safety program can be effective without some form of discipline. There are no rules
that must be followed, only guidelines. The following guidelines have been established
by XYZ Company.

1) The first preventable accident or safety rule violation observed should result in a
discussion with the employee and the supervisor or manager. This verbal reprimand
should be documented, dated, and signed by those involved.
2) A second preventable accident or safety rule violation observed within a 12-month
period should result in another discussion with the employee accompanied by a
written reprimand. Time off without pay, up to a maximum of 5 days, should be
considered.
3) A third preventable accident or safety rule violation observed within a 12-month
period should result in another discussion with the employee and a serious
evaluation needs to be made. This is probably grounds for termination.
B. Compliance
1) One point must be very clear: discipline has to be administered uniformly and
consistently.
2) Violations of safety rules and policies should be addressed in the following manner:
First Incident: Verbal warning, documented discussion.
Second Incident: Written reprimand, up to 5 days suspension.
Third Incident: Written reprimand, grounds for termination.
3) Each supervisor or manager shall be responsible for administering this policy to
his/her subordinates.
4) All written reprimands and records of violations shall be held confidential and
maintained in the employees personnel files.
C. Accountability
Each supervisors efforts and performance will be evaluated relative to reaching XYZ
Company safety objectives and assigned responsibilities. This evaluation will be part of
the supervisors performance review and will be used in part to determine his or her job
assignments, merit increases or promotions.

5. Medical and First Aid
Medical treatment plans.
A. Key XYZ Company personnel should be trained in first aid and CPR. The XYZ Company
disaster plan coordinator shall maintain a list of those trained and qualified personnel.
Responsibility for monitoring and ensuring initial and recurring training is accomplished,
shall be the responsibility of the Safety Representative.
B. All supervisory personnel should be encouraged to enroll in a first aid course and to
learn CPR. Those employees who work around high voltage equipment shall be
required to be certified annually in CPR.
C. Each XYZ Company construction office shall be equipped with a standard first aid kit
suitable for the size of the workforce. Additional first kits may be strategically
positioned throughout the workplace and/or jobsite. The location of each kit will be
communicated to all employees and shall be clearly marked First Aid.
D. Vehicle size first aid kits shall be maintained in each XYZ Company construction/project-
use vehicle.
E. All first aid supplies shall be inspected at least monthly and replenished as required.
F. Accident / Injury reporting: All accidents, near miss incidents and injuries shall be
reported to XYZ Company Safety Representative. Following an injury:
1) The employees injury will be evaluated and first aid rendered.
2) If the injury requires medical attention the employee will be escorted to the onsite
clinic. Further evaluation and treatment will be rendered.
3) A determination will be made by XYZ Company site supervision and safety
representative as to whether or not the injured, and any other involved are to be
drug tested. Usually a post-accident drug test is required.

4) An Employer's Initial Report of Industrial Injury, Accident and Property Damage form
(as directed by Nevada) will be completed for all injuries requiring medical
attention, even if only first aid, when rendered at either an onsite clinic or outside
medical facility.
5) A supervisor's report or Statement of Injury will be completed by the employees'
supervisor.
6) An investigation into the incident will be completed by XYZ Company Safety
Representative, even if no serious injury occurred.
7) A copy of any applicable State document on Employer's Initial Report of Industrial
Injury, Accident and Property Damage form, Supervisor's report or Statement of
Injury will be submitted to the XYZ Company Safety Representative for the employer
provided workers' compensation coverage.
8) All first aid cases may be recorded on a First Aid Log maintained by XYZ Company
Safety Representative.
6. Disciplinary Policy
XYZ Company employees are expected to use good judgment when doing their work and to
follow established safety rules. We have established a disciplinary policy to provide
appropriate consequences for failure to follow safety rules. This policy is designed not so
much to punish as to bring unacceptable behavior to the employee's attention in a way that
the employee will be motivated to make corrections. The following consequences apply to
the violation of the same rule or the same unacceptable behavior:
First Instance -- verbal warning, notation in employee file, and instruction on proper actions
Second Instance -- 1 day suspension, written reprimand, and instruction on proper actions
Third Instance -- 1 week suspension, written reprimand, and instruction on proper actions
Fourth Instance -- Termination of employment.


Section 5
General Safety Requirements

Statistics maintained by Workers' Compensation show that many job injuries are caused by
neglecting fundamental safety precautions. The following list of safety rules will help you stay
free of injury. Read and practice them.
1. General Safety
Know the job safety requirements.
Know your Agency Safety Representative and Agency Safety Officer. Contact him or her
with all safety problems and/or concerns.
If you cannot correct an unsafe condition, report it immediately.
Read thoroughly all safety materials distributed to you.
Be certain that all instructions are clearly understood before starting a task.
Avoid horseplay, and avoid distracting others.
Do not sacrifice safety for the sake of production.
Always use the handrail on stairs.
Drive defensively when operating motor vehicles. Observe posted speed limits and
wear seat belts.
Report all injuries to your supervisor, no matter how minor they seem.
Do not report for work under the influence of alcohol or drugs.


2. Ergonomics and Workplace Safety
Learn to lift and handle materials safely. Do not hesitate to ask for help in lifting heavy
loads. Always push rather than pull a load.
Keep walking surfaces free from tripping hazards. Keep work areas dry, clean and
orderly.
Do not leave desk and file cabinet drawers open.
Open one file drawer at a time. Place heavier drawers at the bottom of the cabinet.
The top of the computer monitor should not be higher than the user's eyes for normal
vision.
Bifocal and trifocal users may prefer to have their monitor at a lower position.
The screen and document holder should be the same distance from the eye and at the
same level to avoid constant changes in focus and close enough together so the
operator can look from one to the other without excessive movement of the neck or
back.
The preferred viewing distance for monitors ranges between 18 and 24 inches.
The preferred working position for most keyboard operators is with the forearms
parallel to the floor and elbows at the sides.
The mouse should be positioned at the operator's side with his or her arm close to the
body for support, while maintaining a straight line between the hand and forearm.
Do not use office furniture or other objects instead of a ladder. Inspect ladders before
use. Be certain they are in good repair and of the correct height.

3. Personal Protective Equipment
Use appropriate respirators when working with hazardous materials.
Wear safety glasses, goggles, or face-shields when there is a risk of eye injury.
Never do a task or operate equipment without the required personal protective
equipment.
Wear hard hats when there is a hazard from falling objects.
Wear substantial shoes when walking on rough or uneven surfaces. Steel-toed shoes are
required when working around heavy loads that could fall on feet.
Wear appropriate gloves to prevent cuts and protect from hazardous materials.
Wear shoes with slip resistant soles that provide maximum surface traction.
4. Emergency Procedures
Know what to do in case of fire or other emergency.
Know the locations of fire extinguishers and how to use them.
5. Equipment Safety
Operate only equipment for which you are qualified and authorized.
Do not wear jewelry or loose clothing around machinery or equipment.
Do not use defective or unguarded equipment. Report the condition to your supervisor.
Ensure that machine safety guards are always in place when operating equipment.
Maintain hand tools in good repair. Inspect them regularly.
Top heavy equipment should be properly anchored to the floor.
All pedestal/bench grinders should be equipped with properly adjusted tongue guards,
tool rests, and peripheral spindle guards.

Shield ventilation and exhaust fan blades with mesh (1/2 inch in diameter or smaller)
when fans have been installed within seven feet of the work area floor.
Do not use powered industrial trucks/forklifts that are defective in any manner (horn,
brakes, etc.).
6. Hazardous Materials
Separate compressed gas cylinders by type when storing them, and secure with valve
protection caps in place. Separate oxygen cylinders from fuel gases by 20 feet.
Post "NO SMOKING" signs near all flammable liquids.
Report chemical spills to appropriate personnel immediately.
Store flammable liquids such as fuels and solvents (i.e., paint thinner) in approved safety
cans. Quantities are also limited by OSH standards.
Ensure compliance with the OSH hazard communication standard. This includes a
written program, labeling, material data sheets, and training.
7. Electrical Safety
Use portable electric tools outdoors only if they are grounded or double insulated and
GFCI protected.
Ground all fixed electrical equipment.
Use extension cords to temporarily furnish power to portable tools or appliances. Cords
must be free of defects and without splices.
Always put live electrical parts in proper enclosures and under no condition use exposed
electrical parts.


Section 6
Accident Investigation and Reporting

DECISION POINT - If this investigation system is not in place, it must be created.
Accident Investigation and Reporting
A system must be established for investigating all workplace accidents, near misses, injuries and
illnesses. Someone who can identify the causes and recommend corrective actions should
complete the investigation system. It is important to keep records of accident investigations.
They can help to determine the types of accidents that occur, where they happen, their causes
and any accident trends. Such information is invaluable in preventing future accidents and may
also help reveal flaws in operating procedures.
1. Program Introduction
At XYZ Company accident investigation is an integral part of our total occupational safety
and health program. It is especially important as a means to determine root causes,
document facts, provide information on costs, and promote safety.
All serious occupational injuries and illnesses shall be thoroughly investigated by the Safety
Representative with the underlying goal of preventing recurrence.
Whenever there is an incident that results in death or serious injuries that have immediate
symptoms, a preliminary investigation will be conducted by the immediate supervisor of the
injured person(s), a person designated by management, an employee representative of the
safety committee, and any other persons whose expertise would help the investigation.
The company investigation team will take written statements from witnesses, photograph
the incident scene and equipment involved. The team will also document as soon as
possible after the incident, the condition of equipment and any anything else in the work
area that may be relevant.
The team will make a written Incident Investigation Report of its findings. The report will

include a sequence of events leading up to the incident, conclusions about the incident and
any recommendations to prevent a similar incident in the future. The report will be
reviewed by the safety committee at its next regularly scheduled meeting.
When a XYZ Company supervisor becomes aware of an employee injury where the injury
was not serious enough to warrant a team investigation as described above, the supervisor
will write an "Incident Investigation Report" to accompany the "Employee's Injury/Illness
Report Form" and forward them to Program Administrator/Safety Representative.
Whenever there is an incident that did not but could have resulted in serious injury to an
employee (a near-miss), the incident will be investigated by the supervisor or a team
depending on the seriousness of the injury that would have occurred. The "Incident
Investigation Report" form will be used to investigate the near-miss. The form will be clearly
marked to indicate that it was a near miss and that no actual injury occurred. The report
will be forwarded to the bookkeeper to record on the incident log.
A Safety Inspection Guide Checklist can be a useful tool to help the supervisor carry out
his/her responsibilities as described above.
2. Investigating Occupational Injury, Illness, and Property Damage
A. The XYZ Company supervisor, if initially notified, shall report to the scene of an
occupational injury, illness, and property damage and immediately secure and protect
the accident scene. Drawings and photographs, if needed, shall be used to record and
document where and how the accident occurred and the extent of injuries and damage
to property sustained. A preliminary and/or final incident report shall be accomplished
and a copy provided to the company Safety Representative. The initial accident report
shall become a permanent part of the formal accident investigation.
B. The Program Administrator/Safety Representative shall report to and investigate all
serious occupational injuries, illnesses and property damage. A formal Incident
Investigation Report shall be prepared to determine the cause, document facts and
recommend corrective actions to prevent recurrence.
3. Reporting Occupational Injury, Illness and Property Damage

A. XYZ Company employees shall report all occupational injuries, illnesses and property
damage, initially through their supervisor to the Program Administrator/Safety
Representative.
This is the preferred method, which will ensure employees receive medical treatment, if
required, because of a serious and/or life threatening occupational injury and/or illness,
and damage to property can be documented and repaired.
B. Supervisors will immediately notify the Program Administrator/Safety Representative of
any serious and/or life threatening occupational injury and/or illness, and property
damage. All other minor occupational injuries and/or illnesses, and property damage
will also be reported to the Program Administrator/Safety Representative the following
day.
C. The Program Administrator/Safety Representative will ensure the company person
responsible for Benefits Administration and/or Workers Compensation claims receives
copies of the final report for all-occupational injuries and/or illnesses.
4. Injury and Illness Recordkeeping
In order to establish meaningful goals and objectives for mishap reduction, we must first
know where we, as a company, have been in terms of previous mishap experience. For that
reason and to comply with federal recordkeeping requirements, the following
documentation shall be maintained:

A. The Safety Representative shall maintain for a period of 5 years:
1) Safety accident investigation reports for all lost workday occupational injuries,
illnesses or equipment damage;
2) Safety accident investigation reports for company property damage, as a result of
accidents;
3) Records of formal claims against the company for injury, illness, personal loss,
and/or damage to personal property; and
B. OSHA Form No. 300, Log of Work-Related Injuries and Illnesses, shall be used to record
injuries or illnesses that result in fatalities, lost workdays, require medical treatment,
involve loss of consciousness, or restrict work or motion.
The annual report of this form must be posted by February 1st in a centralized area
visible to all employees, and remain there for at least 3 months.
C. OSHA Form No. 301, Injury and Illness Incident Report, shall, when used, be used to
give details of each recordable occupational injury and illness. Records must be
available for examination by representatives of the U.S. Department of Labor and the
Department of Health and Human Services. Note: This record and/or the SF-301must be
kept for five years.
D. OSHA Form No. 300A, Summary of Work-Related Injuries and Illnesses, provides
additional data to make it easier for employers to calculate incidence rates. Employers
must review the OSHA 300 Log information before it is summarized on the 300A form.
E. Accident Review
Following an injury or near miss accident, the incident will be reviewed with the Project
Manager and onsite supervision. This review will address the effectiveness of our
program, any additional task training that may be needed and measures to prevent
recurrence.
Each month the company Program Administrator/Safety Representative shall report on
the effectiveness of XYZ Company safety program to the project or company manager.

This report can include data on the number of man-hours worked, the numbers of
accidents, injuries and near miss incidents for the month and measures taken to prevent
recurrences.
5. Corrective Actions
DECISION POINT - State your method of corrective action here.
Timely Correction of Dangers
Once remedial measures to control or eliminate dangers have been agreed upon, you should
make sure that they are implemented with minimum delay. Interim protection for
employees may be necessary until the danger is eliminated or controlled.
Keep a record of steps taken to control or eliminate a danger. Records should contain the
danger, who reported it and when who is responsible for correction, the correction target
date and when it was corrected. Such information will assist in developing safe work
practices and training programs.
Responsibility for Corrective Action
A. Actions necessary to correct or remedy accident causal factors shall rest with the XYZ
Company Safety Representative.
B. The XYZ Company Safety Representative shall have the broad authority to recommend
corrective actions to abate an identified hazard or deficiency to prevent injury or illness
to employees, and to prevent property damage or personal loss.
DECISION POINT - State how this will be accomplished.
6. Monitoring the Place of Employment.
You have the responsibility of monitoring the workplace regularly the work procedures,
equipment and machines to ensure that all dangers to workers are eliminated or controlled
or, alternatively, to ensure that the workers are protected from exposure to the dangers.

7. Safety Inspection and Hazard Control Procedures
XYZ Company is committed to aggressively identifying hazardous conditions and practices
which are likely to result in injury or illness to employees. We will take prompt action to
eliminate any hazards we find.
In addition to the Program Administrator/Safety Representative reviewing injury records
and investigating incidents for their causes, area supervisors and the safety committee will
regularly check the workplace for hazards in the manner described below:
Annual Site Survey
Once each year an inspection team made up of members of the safety committee will do a
wall-to-wall walk through inspection of the entire worksite. They will write down any safety
hazards or potential hazards they find.
The results of this inspection will be used to eliminate or control obvious hazards, target
specific work areas for more intensive investigation, assist in revising the checklists used
during regular monthly safety inspections and as part of the annual review of the
effectiveness of our accident prevention program.
Periodic Change Survey
The Program Administrator/Safety Representative will request a supervisor to form a team
to look at any changes we make to identify safety issues. Changes include new equipment,
changes to production processes or a change to the building structure. A team is made up
of maintenance, production, and safety committee representatives. It examines the
changed conditions and makes recommendations to eliminate or control any hazards that
were or may be created as a result of the change.

Monthly Safety Inspection
Safety committee members will inspect their areas for hazards using the standard safety
inspection checklist. They will talk to co-workers about their safety concerns. Committee
members will report any hazards or concerns to the whole committee for consideration.
The results of the area inspection and any action taken will be posted in the affected area.
Occasionally, committee members may agree to inspect each other's area rather than their
own. This brings a fresh pair of eyes to look for hazards.
Job Hazard Analysis
The Program Administrator/Safety Representative in cooperation with an area supervisor
will conduct a Job Hazard Analysis where there has been a recent employee workplace
injury that is related to machinery or tool usage or a physical task assignment. The analysis
will use the Job Hazard Analysis form as a tool to systematically review a job task. The
results of a Job Hazard Analysis will be reported to the safety committee. Each hazardous
job task will be analyzed at least once every two years, whenever there is a change in how
the task is done or if there is a serious injury while doing the task.


Section 7
Safety Committee and Meetings

DECISION POINT - If a Safety Committee is not established state reason.
1. Safety Committee
XYZ Company has formed a safety committee to help employees and management work
together to identify safety problems, develop solutions, review incident reports and evaluate
the effectiveness of our safety program. The committee is made up of management-designated
representatives and employee-elected representatives.
A. The committee shall:
1) Promote a safe and healthy work environment at all times.
2) Encourage communication between employees and management.
3) Serve as an oversight committee on all issues relative to safety and health.
4) Make recommendations to the Safety Representative.
B. Functions: The committee has four principal functions:
1) Identify potential hazards;
2) Evaluate these potential hazards;
3) Recommend corrective action; and
4) Follow up implemented recommendations.
To carry out its functions, the committee is required to hold meetings and carry out
regular inspections of the workplace

C. Membership
The make-up of an occupational safety and health committee shall be a cross section of
the membership of our organization. Everyone who is a member of this organization
should feel that their needs are being adequately and fairly represented through the
safety committee. If the XYZ Company employees are represented by a labor
organization, the representatives of employees must be selected by the employees and
not appointed by the employer.
Employee representatives will serve for one year before being re-elected or replaced. If
there is a vacancy then an election will be held before the next scheduled meeting to fill
the balance of the term.
In addition to the employee-elected representatives, management will designate no
more than three representatives but a minimum of one who will serve until replaced by
management.
A chairperson will be selected by majority vote of the committee members each year. If
there is a vacancy, the same method will be used to select a replacement.
In addition to committee responsibilities, duties of safety committee members include:
Perform a monthly self-inspection of the area they represent;
Communicating with the employees they represent on safety issues; and
Encourage safe work practices among co-workers.
A. Employer Responsibilities
Provide support from the top level down to first line supervisors in terms of
time, effort, and money.
Resolve scheduling and personnel conflicts.
Provide realistic dates for correcting safety and health concerns.
Support training for safety committee members.

Provide leadership and direction.
Participation in safety committee meetings.
The management commitment/interest/good faith to safety committees must be
vocal, visible, and continuous - from the top to the lowest level.
B. Frequency
Once established, the XYZ Company safety committee shall meet at least quarterly.
An agenda shall be developed by the chairperson and distributed to the members at
least 10 workdays prior to the scheduled meeting. Meeting minutes shall be
prepared and distributed to the membership within 5 days following the meeting.
Meeting minutes shall be posted in a conspicuous location convenient to all
employees to view (i.e., lunch room, bulletin board, etc.)
2. Employee Safety Meetings
All trade employees are required to attend a monthly safety meeting. The meeting is to
help identify safety problems, develop solutions, review incident reports, provide training
and evaluate the effectiveness of our company safety program. Minutes will be kept and
kept on file for one year.


Section 8
Employee Compliance & Discipline

1. Employee Compliance
OSHA requires that you include a system for ensuring that employees comply with safe and
healthful work practices.
Substantial compliance with this provision includes recognition of employees who follow
safe and healthful practices, e.g., incentive programs, training and retraining programs,
disciplinary actions, infraction notices; or any other means that ensure employee
compliance with safe and healthy work practices. Though sample procedures are provided,
you must modify them to suit your requirements.
As part of this compliance, you should provide employees with a code of safe practices that
reflect your companys specific operations more exactly. The Code of Safe Practices we
have provided is a suggested format.
2. Employee Enforcement Procedures and Systems
The XYZ Company safety rules and work procedures shall be practiced and enforced.
We have established a system to ensure that violations of rules are dealt with fairly but
firmly, that all employees are aware of the requirements, and that reorientation or
retraining may be provided when needed. Incentive programs may be initiated and will be
used in conjunction with a good enforcement program.
Discipline
No safety program can be effective without some form of discipline. There are no rules that
must be followed, only guidelines.

The first preventable accident or safety rule violation observed should result in a discussion
with the employee and the supervisor or manager. This verbal reprimand should be
documented, dated, and signed by those involved.
A second preventable accident or safety rule violation observed within a 12-month period
should result in another discussion with the employee accompanied by a written reprimand.
Time off without pay, up to a maximum of 5 days, should be considered.
A third preventable accident or safety rule violation observed within a 12-month period
should result in another discussion with the employee and a serious evaluation needs to be
made. This is probably grounds for termination.
Compliance
One point must be very clear: discipline has to be administered uniformly and consistently.
Violations of safety rules and policies should be addressed in the following manner:
a. First Incident: Verbal warning, documented discussion.
b. Second Incident: Written reprimand, up to 5 days suspension.
c. Third Incident: Written reprimand, grounds for termination.
Each XYZ Company supervisor or manager shall be responsible for administering this policy
to his/her subordinates.
All written reprimands and records of violations shall be held confidential and maintained in
the employees personnel files.
Accountability
Each supervisors efforts and performance will be evaluated relative to reaching XYZ
Company safety objectives and assigned responsibilities. This evaluation will be part of the
supervisors performance review and will be used in part to determine his or her job
assignments, merit increases or promotions.

DECISION POINT Determine which Code of Safety Practices apply to your companys
operation, combine or edit them or delete/strikethrough the codes that in your opinion are
non-applicable.
Code of Safe Practices for General Industry (See Appendix F)
Code of Safe Practices for Construction Industry (See Appendix F)


Section 9
Medical and First Aid

Medical and First Aid
1. Each XYZ Company construction office shall be equipped with a standard first aid kit suitable
for the size of the workforce. Additional first kits may be strategically positioned throughout
the workplace and/or jobsite. The location of each kit will be communicated to all
employees and shall be clearly marked First Aid.
2. Vehicle size first aid kits shall be maintained in each XYZ Company construction/project-use
vehicle.
3. All first aid supplies shall be inspected at least monthly and replenished as required.
4. Accident / Injury reporting: All accidents, near miss incidents and injuries shall be reported
to XYZ Company Safety Representative. Following an injury:
A. The employees injury will be evaluated and first aid rendered.
B. If the injury requires medical attention the employee will be escorted to the onsite
clinic. Further evaluation and treatment will be rendered.
Note: In the event of a life threatening emergency contact 911 for emergency medical
assistance.
C. A determination will be made by XYZ Company site supervision and safety
representative as to whether or not the injured, and any other involved are to be drug
tested. Usually a post-accident drug test is required.
D. An Employer's Initial Report of Industrial Injury, Accident and Property Damage form (as
directed by your State) will be completed for all injuries requiring medical attention,
even if only first aid, when rendered at either an onsite clinic or outside medical facility.

E. A supervisor's report or Statement of Injury will be completed by the employees'
supervisor.
F. An investigation into the incident will be completed by XYZ Company Safety
Representative, even if no serious injury occurred.
G. A copy of any applicable State document on Employer's Initial Report of Industrial Injury,
Accident and Property Damage form, Supervisor's report or Statement of Injury will be
submitted to the XYZ Company Safety Representative for the employer provided
workers' compensation coverage.
H. All first aid cases may be recorded on a First Aid Log maintained by XYZ Company Safety
Representative.
5. Accident Review
Following an injury or near miss accident, the incident will be reviewed with the Project
Manager and onsite supervision. This review will address the effectiveness of our program,
any additional task training that may be needed and measures to prevent recurrence.
6. Once each month the Safety Representative shall report on the effectiveness of XYZ
Company safety program to the project or company manager. This report can include data
on the number of man-hours worked, the numbers of accidents, injuries and near miss
incidents for the month and measures taken to prevent recurrences.


Section 10
Emergency Planning and
Procedures

DECISION POINT
1. Emergency Planning and Procedures
An evacuation map for the building is posted (Customize by adding location, if this applies
to your company). It shows the location of exits, fire extinguishers, first aid kits, and where
to assemble outside (Customize by adding meeting location for your location). A copy of
the map is attached to this program.
All XYZ Company employees will receive training on how to use a portable fire extinguisher
as part of their initial orientation. Buildings will display a map that shows the location of
exits, fire extinguishers, first aid kits, and where to assemble outside.
At XYZ Company, advance planning and preparation for emergencies is good insurance.
Some emergency planning is mandated by regulations, such as for first aid and fire
evacuation and for certain situations in specific industries or operations.
A list of possible emergencies shall be prepared and procedures established to respond to
those emergency situations.
Emergency plans shall be reviewed with individuals such as doctors, fire and explosives
experts or special consultants where possible, and on an as needed basis.
Emergency procedures shall be updated whenever changes are made in materials,
equipment or building structures.

2. Emergency Planning
No Industrial, Commercial or Mercantile organization is immune to disaster. Emergencies
can arise at any time and from many causes, but the potential loss is the same - people and
property. Advance planning for emergencies is the only way to minimize this potential loss.
A. Planning is necessary - it is not a luxury, rather it is good insurance. Even though
professionally trained emergency help and assistance may be available, the need for in-
house emergency planning is still your first line of defense. A comprehensive
management plan is intended to take care of all expected emergencies. This includes
both the natural disasters and the common accident situation. Quite often emergency
planning is assigned solely to the safety and health professional. This is fine, but there is
a real need for the corporate management to be fully involved in the many decisions
that must be made.
B. The safety of our employees, visitors, and customers must be the first concern in
planning for an emergency. Care for the injured must be available immediately. In
some situations, evacuation may be necessary.
C. Careful consideration shall be given to protecting the property and the operation. In a
new facility, consideration shall be given to arranging and locating certain facilities and
operations to provide greater inherent safety to the entire operation. In general, all
emergency plans will include cleanup details necessary for the situation.
D. Finally, planning may be concerned with restoring business to normal. In emergencies
likely to damage or close a facility or job site, the question of resuming operations under
conditions of temporary wiring, lack of heating, or repair and construction work shall
always be considered.
E. Regardless of the size of the XYZ Company project workforce, management will be
responsible for developing and operating a program, which is designed to meet these
eventualities.

An effective plan requires the same good organization and administration as any
business undertaking. There is no one emergency plan that will do all things for all
organizations. Therefore, a plan that fits the needs of the workplace, project and/or
facility will be developed.
F. Emergency plans involve organizing and training of small groups of people to perform
specialized services, such as fire fighting or first aid. Small, well-trained groups can
serve as a nucleus to be expanded to any size needed to meet any kind of emergency.
Even with outside help available, a self-help plan is the best assurance that losses will be
kept to a minimum.
G. An organization will need to develop several plans to control different types of
emergencies. Although certain basic elements would be common to all plans, the same
complete plan could not, for example, be used for a natural disaster, an in-house fire, or
the common accident situation.
H. Before an organization initiates an emergency plan, it is necessary to evaluate the types
of emergencies, potential disasters or accidents that could occur, and the potential
harm to people and property.
DECISION POINT
I. The basic emergency preparedness plan for XYZ Company will include:
1) A chain of command;
2) An alarm and/or communication system;
3) Medical treatment plans;
4) Shutdown procedures; and
5) Evacuation procedures.

3. Types of Emergencies
A. Work Accidents. The "chain reaction" from a so-called "routine" work accident can
result in an emergency. For example, a break in a chemical line or toxic vapors from
outside the facility entering the ventilation system may create an emergency. Panic
caused by a rumor or lack of knowledge can also creates an emergency. Plans for such
situations should include establishment of auxiliary areas in the building to be used for
medical treatment, a method of notifying employees of the actual situation, a method
of quickly taking a head count from shift leaders, and sources of oxygen supplies
available on short notice.
B. Fire and explosion. Except where fires result from large-scale explosions, the fire
emergency usually allows a short time for marshalling of firefighters and organizing an
evacuation if necessary. Many conflagrations originate as small fires, that is, fires that
could positively be controlled by in-house personnel. Therefore, prompt action by a
small, trained group can usually handle the situation. However, plans should include the
marshalling of extensive fire fighting forces upon first indication of any fire growing
beyond the "small fire" stage.
1) The main point is this; small fires should be checked as soon as they start. The first
five minutes are considered the most important. Good housekeeping, prompt action
by trained people, proper equipment, and common-sense precautions will prevent a
small fire from becoming a disaster.
2) Fire protection equipment, especially sprinkler heads and kitchen overhead grease
traps and fans, need to be periodically checked to ensure they are not blocked and
in working order
3) Obstructions, such as storage boxes, must remain at least 18 in. from sprinkler
heads in order for them to work as designed. Kitchens are the most likely source for
fires to originate. Overhead grease traps must be cleaned at least once daily, or
more often in heavy use areas.
4) Non-sparking system cooling fans, used to control the heated trapped grease
particles, must also be checked for operability on a regular basis.

C. Shutdowns. Although a shutdown is not an emergency per se, it can result from an
unscheduled action, such as a disaster or strike; hence a fast shutdown procedure
should be covered under an emergency plan. This plan should be based on a priority
checklist. That is, all of the tasks to be assigned and functions to be performed should be
arranged in order of importance so that if time is short, at least the most vital
precautions are completed. This "crash" procedure is usually an adaptation of the
routine procedure used for scheduled shutdowns, such as for preventive maintenance
inspections.
1) During the shutdown, continuous inspection of any maintenance or special
operations, such as remodelling, must be maintained. Gas cutting and welding
should be carefully supervised. Employees, who remain on duty in the area and
construction workers involved in any remodelling, should be briefed in effective
countermeasures in case a fire breaks out.
2) If there has not been sufficient notice to affect a normal shutdown, it may be
necessary to allow personnel into the area to perform necessary functions.
D. Hazardous Materials. Because there are many chemical substances being used today,
there must be concern with potential usage and handling problems. There are many
rules and procedures to be observed, but again one must ask the question, what if a
safeguard fails? What if the container cracks and substances leak out? In addition to
normal hazards, area there potential chemical reactions with other substances that
cause still further dangers to people and property? Any effective emergency plan must
also include recognition of the potential for a hazardous chemical spill and its
containment.

4. Plan-of-Action Considerations
Following the assessment of potential emergencies, the next step is to translate these needs
into a plan of action.
A. XYZ Company management will be in charge of drafting a policy and getting the plan
underway. It will usually be necessary that union leaders (if any) be involved in the
planning process. The Safety Representative or another member of the safety
committee will be appointed emergency planning coordinator.
B. Health and safety, medical, fire, and security personnel will be involved.
C. Production and maintenance supervision will be consulted.
D. Contacts with local law enforcement and fire departments are necessary.
E. The cost and effort involved in giving immediate attention to emergency planning can
be justified by weighing the cost of preparedness against the possibility of yearly losses
from accidents, fires and other unplanned events.
F. Program considerations. The preliminary aspects of emergency planning - the need for
advance planning and an evaluation of the type of emergencies and their potential harm
to people and property have already been discussed. The next logical step is to
translate this need into a working plan within the organizational structure. In some
cases, this will require working with other agencies to most fully protect the company's
operation.
1) Advance planning is the key. It is necessary to develop a written set of plans for
action. The plans should be developed locally within the company (and corporate
structure) and be in cooperation with other neighboring or similar organizations and
with government agencies. It may not always be possible for them to fully
cooperate or participate, but through planned action each organization should be
aware of certain available assistance. The company may need to plan to be largely
dependent upon its own resources to provide the internal safety.
2) A description of the expected disasters with a risk statement.

3) A map of the plant or facility showing equipment, medical and first aid, fire control
apparatus, shelters, command center, and evacuation routes.
4) A list (which may also be posted) of cooperating agencies and how to reach them. ---
A plant or facility warning system.
5) A central communication center, including home contacts of employees.
6) A shutdown procedure, including internal security procedures.
5. Chain of Command
A XYZ Company disaster plan coordinator should be appointed and an advisory committee,
representing various departments, established.
A. The disaster plan coordinator should be a member of top management, because he/she
will have to be able to delegate authority and speak for the company. The coordinator's
regular duties should be such that the greater part of their time will normally be spent
at the workplace he/she is responsible for.
B. An alternate disaster plan coordinator will also be named in the plan. The alternate
should be a person who has authority and qualifications similar to the primary
coordinator and must be trained in their responsibilities.
C. Assigned personnel must be trained to carry out their duties in accordance with the
overall emergency disaster plan. The number of members on each of the teams
depends on the size and diversity of the employee work force and normal number of
visitors and customers within their area of the facility
D. Training. One of the most important functions of the disaster plan coordinator and
staff, on both the corporate and plant levels is training. Training for each type disaster is
essential in developing a disaster-control plan and keeping it functioning. Employees
must realize that an emergency plan is vital and real.

The plan cannot be usefully if it remains a remote idea. Training and rehearsals are time
consuming, but they keep the program in good working order. Training of key people
will be of little value unless it reaches all employees. The better informed and prepared
the work force is, the less panic and confusion during the emergency.
E. Practice alerts, even in a classroom environment, should be conducted to make sure
that the employees know where to report and what their duties are. Even the most
carefully developed and prepared plans can develop flaws when put into practice, and
only periodic rehearsals can reveal them. If this is not done, all the planning effort will
have been wasted.
F. Management should assure employees that the company is doing everything possible to
prevent injury to them, that every employee is an essential and necessary part of the
team, and that the disaster-control organization is ready for any emergency. Such
assurance will go a long way toward developing a state of mind that will not panic. Then
when disaster does strike, emergency forces snap into action, workers gather visitors
and customers and file quietly to their designated safe areas away from the facility.
Such planning is further evidence of management's concern for everyone's safety.
G. Command headquarters. A command headquarters should be planned for any
emergency, which may occur. Coordination of the disaster control organization should
come from a well-equipped and well-protected control room. The headquarters should
be equipped with telephones, sound-powered phones, public address system, maps of
the facility, emergency lighting and electric power, and two-way radios for
communication locally.
6. Communications System
Good communications are necessary for effective control and flexibility in a disaster
situation. Communications include the telephone, radio, messengers, and a facility alarm
system.

DECISION POINT
7. Medical Treatment Plans
A. Key personnel should be trained in first aid and CPR. The XYZ Company disaster plan
coordinator shall maintain a list of those trained and qualified personnel. Responsibility
for monitoring and ensuring initial and recurring training is accomplished, shall be the
responsibility of the Safety Representative.
B. All supervisory personnel should be encouraged to enroll in a first aid course and to
learn CPR. Those employees who work around high voltage equipment shall be
required to be certified annually in CPR.
8. Shutdown Procedures
Key department personnel should be knowledgeable of where emergency shutdown
switches and valves are located. Depending on the type of emergency, main electricity to
machines and natural gas may need to be shutdown to the effected area within the facility.
9. Evacuation Procedures
Safe evacuation routes should be conspicuously posted in internal work areas where direct
access to an exterior emergency exit may not be obvious. An emergency exit notice should
also be posted. Newly assigned employees must be briefed on the safest evacuation route
from his or her designated work area.
DECISION POINT
10. Detailed Emergency Procedures
A. XYZ Company employees and subcontractors will abide by the project emergency
procedures prescribed by any General Contractor Safety Manager. All employees will
receive a review of emergency procedures during the project safety orientation.

B. Emergency telephone numbers for any General Contractor safety and security, as well
as local emergency services, shall be posted in the jobsite office or in conspicuously
designated areas.
C. In the event of an evacuation all XYZ Company employees will meet at a designated
location. Each foreman will be responsible to verify that his crew has safely evacuated.
No XYZ Company employee is to return to the jobsite until the project superintendent
gives an all clear.


Section 11
Company Required Safety Programs

Due to the nature of work and operations performed by XYZ Company, it is necessary that the
following regulatory programs are included in our Injury and Illness Prevention Program:

For convenience, programs listed in the table below are alpha sorted.
DECISION POINT Review and select those programs that apply or included others not listed

Company Required Safety and Health Plans & Programs
Accident Prevention Program Forklift Safety Program
Asbestos Management Plan Hazard Communication Program
Bloodborne Pathogens Program Hearing Conservation Program
Chemical Hygiene Plan Hot Work Permit Program
Confined Space Entry Program Ladders and Stairways Work Plan
Control of Hazardous Energy Program Laser Safety Program
Cranes and Derricks Safety Program Lead Safety Program
Electrical Safety Program Personal Protective Equipment Plan
Emergency Action Plan Powered Industrial Truck Program
Excavation and Trenching Program Radiation Protection Program
Fall Protection Program Respiratory Protection Program
Fire Prevention Work Plan Scaffolding Safety Program
Flammable Storage / Compressed Gas Welding Safety Program

Table 1

All Safety Plans & Programs are available through Safety Office Depot
www.SafetyOfficeDepot.com


Section 12
Company Required
Safety Training Courses

following safety training courses are included in our Injury and Illness Prevention Program:

For convenience, courses listed in the 3 tables below are alpha sorted.
DECISION POINT Review and select those courses that apply or included others not listed

Company Required Safety Training Courses Sorted A-E
Accident Investigation Construction Safety Management
Accident Prevention Signs & Tags Crane Safety Refresher
Asbestos Safety Cranes & Derricks in Construction
Bloodborne Pathogens Initial/Refresher Electrical Safety
Bloodborne 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

All Safety Training Courses are available through Safety Office Depot


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

Table 3

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

Table 4

Section 13
Company Required
Safety Forms & Checklists

following safety forms and checklists are included in our Injury and Illness Prevention Program:
For convenience, forms listed below are subject sorted.
DECISION POINT Review and select those forms that apply or included others not listed

CONFINED SPACE
Confined Space Entry Permit
Confined Space Class A & B Permit
Confined Space Class C Permit
List of Authorized Entrants
Permit Required Confined Space Inventory Log
CONSTRUCTION INDUSTRY - SAFETY MANAGEMENT
Construction Industry Inspection Checklist
Job Start-Up Checklist
Contractors Job Site Checklist
Contractor Safety Performance Report
Construction Equipment Checklist
Forklift Service Checklist
Operator Performance Evaluation Checklist
Safety Nets Inspection Checklist
Body Harness & Lanyard Inspection Report
Competent Person Evaluation Fall Protection
CRANE OPERATIONS
Cranes, Derricks or Material Handling Devices Worksheet
Crane Inspection Checklist
Crane Pre-Lift Checklist
Sling (Chain) Inspection Report
Monthly Hoist Rope Inspection Report
Monthly Hoist Hook Inspection Report
EMERGENCY ACTION AND RESPONSE
Crisis Management Response Team - Contact Log
Safety Representatives - Contact Log
External Resources Contact Log
Vulnerability Analysis Chart
Bomb Threat Checklist
Employee Evacuation - Accounting Log
Physically Challenged Employee List
Command Post Equipment Inventory Log
Press Information Log
Post Exercise Evaluation Report

EMPLOYEE SAFETY RECORDS
Employee Acknowledgement Form
Employee Orientation Checklist Construction
Employee PPE Assessment Form
Employee PPE Issue Form
Employee Safety Training Record
Ergonomic Workstation Analysis Form
Employee Ergonomic Workstation Questionnaire
Employee Safety Suggestion Form

EXCAVATION OPERATIONS
Pre-Excavation Checklist
Trenching Design Checklist
Trench Safety Daily Field Report
Competent Person Evaluation Excavation
FIRE PREVENTION
Hot Work Permit
Fire Safety Inspection Checklist
Fire Drill Post Response Report
Emergency HAZMAT Inventory Log
Hazardous Waste Disposal Request Form
GENERAL INDUSTRY SAFETY MANAGEMENT
General Industry Safety Inspection Checklist
Office Safety Inspection Checklist
Job Safety Analysis Worksheet & Instructions
Accident Prevention Program Analysis
Forklift Service Checklist
Hearing Conservation Program Log
Scaffolding Safety Checklist
Site Safety Meeting Record
Supervisors Monthly Meeting Record
Report of Safety Hazard Form
Property Security Survey
INCIDENT REPORTING FORMS
OSHA 300 Log
Employee Injury & Illness Report
Employee Injury Cost Accounting Matrix
Vehicle Accident & Property Damage Report
Compiling Direct and Indirect Costs

OCCUPATIONAL HEALTH FORMS
Medical Evaluation Questionnaire Respirator Use
Respirator Fit Testing Record
Hepatitis B Vaccine - Accept/Decline Form
Bloodborne Pathogens Risk Classification Flowchart
BBP Employee Annual Training Record
BBP Source Patient Consent Form

RADIATION PROGRAM FORMS
Radioactive Material Use Log
Pregnancy Declaration Form
Laboratory Contamination Survey Record
Radiation Producing Device - Authorization Form
Training Guide for Radiation Workers
Training Guide for Ancillary Radiation Works

TRAINING RECOGNITION CERTIFICATE
Certificate of Completion
All Subject Form Groups are available through Safety Office Depot


Appendix A
List of Training Subjects

DECISION POINT Select applicable training subjects - Strikethrough/delete those that do not
XYZ Company trains our workers about the following selected training subjects:

1. The employer's Code of Safe Practices.
2. Confined spaces.
3. Safe practices for operating any agricultural equipment.
4. Good housekeeping, fire prevention, safe practices for operating any construction
equipment.
5. Safe procedures for cleaning, repairing, servicing and adjusting equipment and
machinery.
6. Safe access to working areas.
7. Protection from falls.
8. Electrical hazards, including working around high voltage lines.
9. Crane operations.
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

DECISION POINT Determine which checklists apply to your operation and delete all others
XYZ Company has determined the following hazard assessment checklists apply to its operations

1. Abrasive Wheel Equipment Grinders
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

59

Appendix C
Hazard Assessment and Correction Record

Nevada - Written Workplace Safety Program
60

Hazard Assessment and Correction Record

Date of Inspection: ________________________________________
Person Conducting Inspection: _______________________________
Unsafe Condition or Work Practice:
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________

Corrective Action Taken:
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________

61

Appendix D
Accident/Exposure Investigation Report
62

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: _____________________________

63

Appendix E
Employee Training and Instruction Record
64

Employee Training and Instruction Record

Employee Receiving Training:

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

(Safety Training Topic)

Select one:

Initial Periodic Annual/Refresher Special

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

Person conducting the training:

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

Trainers Signature Date

Qualification or Job Title of Trainer

Trainees Signature Date

65

Appendix F
Codes of Safe Practice

DECISION POINT Determine which of the following Codes of Safety Practices apply to your
companys operation, combine or edit them or delete/strikethrough the codes that in your
opinion are non-applicable.
66

Appendix F
Codes of Safe Practice

DECISION POINT Determine which of the following Codes of Safety Practices apply to your
companys operation, combine or edit them or delete/strikethrough the codes that in your
opinion are non-applicable to your business.
67

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
68

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 be exercised in watching for and avoiding
obstructions, loose material, etc.
18. Do not stack material in an unstable manner.
19. Report exposed wiring and cords that are frayed or have deteriorated insulation so that
they can be repaired promptly.
20. Never use a metal ladder where it could come in contact with energized parts of
equipment, fixtures or circuit conductors.
21. Maintain sufficient access and working space around all electrical equipment to permit
ready and safe operations and maintenance.
22. Do not use any portable electrical tools and equipment that are not grounded or
double-insulated.
69

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 be taped down or inserted through rubber
protectors to preclude them from becoming tripping hazards.
25. Inspect motorized vehicles and other mechanized equipment daily or prior to use.
26. Shut off engine, set brakes and block wheels prior to loading or unloading vehicles.
27. Inspect pallets and their loads for integrity and stability before loading or moving.
28. Do not use compressed air for cleaning off clothing.
29. Do not store compressed gas cylinders in areas which are exposed to heat sources,
electric arcs or high temperature lines.
30. Identify contents of pipelines prior to initiating any work that affects the integrity of the
pipe.
31. Wear hearing protection in all areas identified as having high noise exposure.
32. Goggles or face shields must be worn 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.
70

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 tripping
hazard. Use care when opening and closing drawers to avoid pinching fingers.
44. Do not open more than one upper drawer at a time, particularly the top two
drawers on tall file cabinets.
45. Individual heaters at work areas should be kept clear of combustible materials,
such as drapes, or waste from waste baskets. Newer heaters that are equipped
with tip-over switches should be used.
46. Appliances, such as coffee pots and microwaves, should be kept in working order
and inspected for signs of wear, heat or fraying of cords.
47. Fans used in work areas should be guarded. Guards must not allow fingers to be
inserted through the mesh. Newer fans are equipped with proper guards.
71

Codes of Safe Practices
Construction Industry

1. All persons shall follow these safe practices rules, render every possible aid to
safe operations, and report all unsafe conditions or practices to the supervisor
or superintendent.
2. Supervisors or foremen shall insist on employees observing and obeying
every applicable Company, State or Federal regulation and order as is
necessary to the safe conduct of the work, and shall take such action as
is necessary to obtain compliance.
3. All employees shall be given frequent injury and illness prevention
instructions. Instructions shall be given at least every 10 working days.
4. Anyone known to be under the influence of drugs or intoxicating
substance which impair the employees ability to safely perform the
assigned duties shall not be allowed on the job while in that condition.
5. Horseplay, scuffling, and other acts which tend to have an adverse
influence on the safety or well-being of the employees, shall be
prohibited.
6. Work shall be well planned and supervised to prevent injuries in the handling
of materials and in working together with equipment.
7. No one shall knowingly be permitted or required to work while the
employees ability or alertness is so impaired by fatigue, illness, or
other causes, that they might unnecessarily expose the employee or
others to injury.
8. Employees shall not enter manholes, underground vaults, chambers,
tanks, silos, or other similar places that receive little ventilation unless it
has been determined that it is safe to enter.
72

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.
73

20. Carriers should avoid the use of extension ladders when carrying loads. Such
ladders may provide adequate strength, but the rung position and rope
arrangement make such climbing difficult and hazardous for this trade.
21. Work shall be so arranged that employees are able to face a ladder and use
both hands while climbing.
22. Gasoline shall not be used for cleaning purposes.
23. No burning, welding, or other source of ignition shall be applied to any
enclosed tank or vessel, even if there are openings, until it has first been
determined that no possibility of explosion exists and authority for the work is
obtained from the supervisor or superintendent.
24. Any damage to scaffolds, false work, or other supporting structures shall be
immediately reported to the supervisor and repaired before use.
25. Personal fall arrest systems or restraints shall be worn when working over 7
1/2 feet above ground or surface which does not provide protected sides,
edges or openings (e.g., no guardrails, etc.).
USE OF TOOLS AND EQUIPMENT
26. All tools and equipment shall be maintained in good condition.
27. Damaged tools or equipment shall be removed from service and tagged DEFECTIVE.
28. Pipe or Stillson wrenches shall not be used as a substitute for other wrenches.
29. Only appropriate tools shall be used for a specific job.
30. Wrenches shall not be altered by the addition of handle-extensions or cheaters.
31. Files shall be equipped with handles and not used to punch or pry.
32. A screwdriver shall not be used as a chisel.
33. Wheelbarrows shall not be pushed with handles in an upright position.
34. Portable electric tools shall not be lifted or lowered by means of the power cord. Ropes
shall be used.
74

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 at compressors until the hose line has been bled.
43. All excavations shall be visually inspected before backfilling to ensure that it is safe to
backfill.
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.
75

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.
76

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.

77

Appendix G
78


I hereby acknowledge that I have had the opportunity to read, review and ask questions on the
contents of the companys Injury and Illness Prevention Program. I also acknowledge that the
provisions of this program and company safety and health policies are part of the terms and
conditions of my employment and agree to abide by them.

Furthermore, I understand that failure to comply with any part or parts of this program and any
company safety and health policies may be grounds for termination of my employment.
Additionally, I understand that failure to comply with the companys Drug-Free Workplace Policy
shall also be grounds for termination of my employment.

Employee - Print Your Name Social Security Number

Signature of Employee Date

As an employee representative of the company, I hereby attest that the employee named here
was given the opportunity to read, review and ask questions about the companys Injury and
Illness Prevention Program and company safety and health policies.

Witness Print Your Name

Duty Title of Witness

Signature of Witness Date

79

Americana Safety Disclaimer Notice

While we have made every attempt to ensure that the information contained in this document
is reliable, Americana Safety is not responsible for any errors or omissions, or for the results
obtained from the use or non-use of this information. All information in this document is
provided "as is", with no guarantee of completeness, accuracy, timeliness or of the results
obtained from the use or non-use of this information, and without warranty of any kind, express
or implied, including, but not limited to warranties of performance, merchantability and fitness
for a particular purpose.

In no event will Americana Safety, or the partners, agents or employees thereof be liable to you
or anyone else for any decision made or action taken in reliance on the information in this
document or for any consequential, special or similar damages, even if advised of the possibility
of such damages.

Given the changing nature of laws, rules and regulations, there may be omissions or inaccuracies
in information contained in this document. Accordingly, the information in this document is
provided with the understanding that the authors and publishers are proving guidance with
respect to the information contained herein and that the performance or non-performance of
this guidance shall be the responsibility of the user of this information.

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