• Policy Statement
• Goals
• Management Commitment
• Assignment of Responsibility
• Supervisors
• All Employees
• Discipline/Enforcement
• Control of Hazards
• Safety Meetings and Objectives

• Safety Committee
• Accident Investigation
• Training and Education
• First Aid / Medical / Emergencies
• Safety Rules and Procedures
• Record Keeping and Hazard Analysis
• Self-Inspection Scope

• Appendix A -- Safety Policy Statement
• Appendix B -- Job Safety Analysis
• Appendix C -- Weekly Safety Meetings
• Appendix D -- Safety Committees
• Appendix E -- Accident Investigation
• Appendix F -- Accident Investigation Reporting
• Appendix G -- Self Inspection Checklists
• Appendix H -- Recommended Vehicle Safety Program
• Appendix I -- Violence in the Workplace

POLICY STATEMENT
This is only a sample.  Each Department should create their own version.

See Appendix A for guidance

I believe our employees are our most important asset and that the preservation of their safety and health must remain a constant consideration in every phase of our activities. It is our intent to provide a work environment as free of hazards as possible.

We are all responsible for working safely and productively, always remaining aware of hazards in our jobs and following recognized safe work practices.

Our safety and health program must be integrated into our daily activities, and managed as we do all other aspects of our duties.

________________________
Department Director

_______________________
Date

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GOALS (For each Department)

Safety begins at the top and goes throughout our Department. Our goal is to provide an injury-free environment for our employees and clients, and to eliminate damage to property and equipment.

To reach our goal of a safe work place, everyone needs to accept responsibility.

Benefits of achieving our goals are:

• The best safety and health conditions possible in the work place.
• No injury accidents.
• No permanent disabilities.
• No loss to property and equipment.
• No fatalities.

*ADD GOALS SPECIFIC TO YOUR DEPARTMENT HERE*

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MANAGEMENT COMMITMENT
(For each Department)

The management of our Department is committed to the State's safety policy, and to provide direction and motivation by:

• Appointing *Title* as our Safety Coordinator.
• Establishing our annual safety goals and objectives.
• Having a written safety and health program and being committed to it.
• Taking part in employee training.
• Establishing and enforcing disciplinary procedures for employees.
• Supporting the safety and health program with people, authority and training.
• Establishing accountability for safety management by including it in employee evaluations.

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ASSIGNMENT OF RESPONSIBILITY (For each Facility)

Safety Officer

We have designated *Title* as our safety and health officer.

It shall be the duty of the *Title* to assist all levels of Management in the initiation and execution of an effective safety program generally, and more specifically, areas such as the following:

• Introduce the safety program to new employees.
• Follow up on recommendations, suggestions, etc., made at safety meetings. All topics of safety concerns shall be documented accordingly.
• Be thoroughly familiar with the Department's safety program and assist personnel in the execution of standard policies.
• Conduct safety inspections on a periodic basis.
• Address all hazards or potential hazards as needed.
• Prepare monthly accident reports and investigations.
• Maintain adequate stock of first aid supplies and other safety equipment to ensure their immediate availability, and make sure there is an adequate number of qualified first aid providers on the job.
• Be thoroughly familiar with the OSHA, local, and state safety codes and regulations.
• Review annually the Safety and Health program and revise, update or change when needed.

*ADD NEEDED ASSIGNMENTS FOR DEPARTMENT HERE*

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SUPERVISORS (For each Facility)

Supervisors will establish an operating atmosphere that ensures that safety and health is managed in the same manner and with the same emphasis as all other aspects of our mission through activities such as:

• Defining the responsibilities for safety and health of all subordinates and holding each person accountable for their actions through the formal appraisal system, and where necessary, disciplinary procedures.
• Regularly emphasizing that accident and health hazard prevention are not only moral responsibilities, but also a condition of employment. Accidents create unnecessary loss, both personal and financial.
• Identifying operating oversights that contribute to accidents which could result in injuries and property damage.
• Participating in safety and health related activities, including routinely attending safety meetings, reviews of the facility and correcting employee behavior that can result in accidents and injuries.
• Spending time with each person hired explaining the safety policies and the hazards of his/her particular work. See that the initial orientation of "new hires" is carried out by the *Title*.
• Never short-cutting safety for expediency, nor allowing workers to do so.
• Enforcing safety rules consistently, and following established discipline/enforcement procedures.
• Continuously monitoring work-site conditions and correcting safety violations.

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ALL EMPLOYEES (For each Facility)

It is the duty of each and every employee to know the safety rules, and conduct their work in compliance. Disregard of the safety and health rules shall be grounds for disciplinary action up to and including termination. It is the duty of each employee to make full use of the safeguards provided for their protection. Every employee will receive an orientation when hired and receive a Department Safety and Health rule book. This is a partial list of these rules:

• Read, understand and follow safety and health rules and procedures.
• Suitable work clothes are required, and will be clearly defined.
• Employees observed working in a manner which might cause injury to either themselves or other workers shall, be warned of the danger and will immediately correct their method of operation.
• Report all injuries, no matter how slight, to their supervisor immediately, and seek treatment promptly.
• Be aware of the location of first aid supplies, fire fighting equipment, and other safety devices.
• Attend all required safety and health meetings.
• Until they are properly trained, employees are not to perform potentially hazardous tasks, or to use any hazardous material. Employees are to follow all procedures when performing those tasks.
• Wear Personal Protection Equipment (PPE) at all times when working in areas where PPE is required.

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DISCIPLINE/ENFORCEMENT (For each Facility)

For a safety program to be successful, all employees must understand and follow the established safety rules. When an employee has been adequately trained in safety rules, but chooses not to follow them, management must take corrective action.

Every facility needs to clearly establish the safety performance expectations for its employees, and be prepared to respond as needed when individuals violate the rules.

Two types or degrees of violation are:

1. Serious Violation - Violation of any Department safety rule or regulation without premeditation. For a serious violation, *Title* can use personal judgment to determine the degree of discipline regarding the number of days off without pay or other actions, as deemed appropriate, up to and including termination.
2. Willful Violation - Violation of any Department rule or regulation with premeditation or forethought. For a willful violation, one to three days off without pay will be assessed. However, the degree of discipline may be extended or increased to termination of employment for willful violations. This decision is to be made by *Title*.

Documentation: Written documentation of violations and subsequent counseling should be maintained.

A sample form is included for your review in Appendix B.

*ENTER YOUR FACILITIES SPECIFIC POLICY HERE*

Note: Make sure that the plan you choose for handling safety violations is compatible with your system for handling other personnel issues.

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CONTROL OF HAZARDS (For each Facility)

Where feasible, workplace hazards are prevented by effective design of the job site or facility. Where it is not feasible to eliminate such hazards, they must be controlled to prevent unsafe and unhealthy exposure. Once a potential hazard is recognized, corrective procedures must be established in a timely manner. These procedures should include measures such as the following:

• Using engineering techniques where feasible and appropriate.
• Providing for regular equipment maintenance to prevent breakdowns that can create hazards.
• Planning for emergencies and performing adequate drills to assure effective implementation under stressful conditions.
• Using administrative controls, such as reducing the duration of exposure.
• Maintaining a periodic site inspection program.
• Assessing the work place to determine the need for a Violence In The Workplace Program. See Appendix I for help.
• Establishing a medical program that includes first aid and emergency medical care to reduce the risk of any injury that occurs.
• Addressing safety hazards with employees whenever they are observed. One of the most effective tools for accomplishing this is called a Job Safety Analysis or JSA. See Appendix C for a sample form and guidance sheet.
• Using appropriate personal protective equipment when engineering and administrative controls do not eliminate the hazard.
• Establishing a Vehicle Safety program, as appropriate for the exposures of each Department. See Appendix H for guidance.

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SAFETY MEETINGS AND OBJECTIVES (For each Facility)

All employees of *Facility Name* will attend and participate in the (weekly-monthly) safety meetings. Attendance and content of the meeting shall be documented. See Appendix A for a sample form.

A minimum of (time frame, i.e. one hour) shall be given each (week/month) to the safety meeting. The meeting shall be conducted by *Title*. Problems that have arisen or that are anticipated, shall be discussed along with any other safety and health topics. To keep the meeting a valuable educational experience, the following is suggested:

• Keep the meeting moving.
• Start and stop on time.
• Use illustrated material and demonstrations to make the point.
• Each topic should be discussed thoroughly.
• Review accidents, injuries.
• Evaluate close calls or near misses for trends, similar causes, and initiate corrective actions.

*ENTER YOUR FACILITY'S PLAN HERE*

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SAFETY COMMITTEE (For each Facility)

The Committee shall consist of representatives from management and employees with *Title* as the chairman. The committee is a forum, created for the purpose of fostering safety and health through communication.

The responsibilities of Safety Committee Members include:

• Discussing safety policies and procedures with management and making recommendations for improvements.
• Serve as liaison between workers and management in safety matters.
• Reviewing and disbursing technical reference materials.
• Working with supervisors to conduct accident investigations of accidents, develop corrective actions, and track those recommend to closure.
• Identify unsafe conditions and practices.

See Appendix E for a sample safety committee structure and suggested procedures.

*ENTER YOUR FACILITY'S SAFETY COMMITTEE POLICY HERE*

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ACCIDENT INVESTIGATION (For each Facility)

In the event of an accident, supervisors shall:

• Provide first aid, call for emergency medical care if required.
• Arrange to have an employee accompany the injured employee to the medical facility if further medical treatment is required.
• Secure area, equipment and personnel from injury or further damage.
• Work with the designated safety committee member(s) to conduct an investigation of the incident. Gather facts, employee and witness statements, pictures and physical measurements of incident site and equipment involved.
• Complete an incident investigation report form within 24 hours whenever possible. See Appendix F for principles of accident investigation and a sample form.
• Insure that a resulting absence is authorized by a physician and that contact is maintained with the employee while he/she remains off work.
• Insure that corrective action to prevent a recurrence is taken.
• Discuss incident, where appropriate, in safety and other employee meetings with the intent of preventing a recurrence. Discuss with other supervisors and other management.
• Monitor status of employee(s) off work, maintain contact with employee and encourage return to work even if restrictions are required by the physician.
• Insure that employee(s) returning to work have "return to work" release form from the physician. Review the release carefully and insure that the employee follows the restrictions indicated by the physician.

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TRAINING AND EDUCATION (For each Facility)

Training is an essential component of an effective safety and health program. It addresses the responsibilities of both management and employees at the site. Training is often most effective when incorporated into other education on performance requirements and job practices.

Training programs should be provided as follows:

• Initially when the plan is developed.
• For all new employees.
• When new equipment, materials, or processes are introduced.
• When procedures have been updated or revised.
• When experiences/operations show that employee performance must be improved.
• Annually in some cases.

Besides the standard training, employees should also be trained in the recognition of hazards. Such as:

Employees trained in the recognition of hazards are less likely to be injured on the job. 

*ENTER YOUR TRAINING POLICY AND PROCEDURES HERE*

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FIRST AID / MEDICAL / EMERGENCIES (For each Facility)

Employees who are expected to respond to medical emergencies as part of their work shall:

• receive first-aid training;
• have hepatitis B vaccination made available to them;
• have appropriate training on procedures to protect them from bloodborne pathogens, including universal precautions;
• have available and understand how to use appropriate personal protective equipment to protect against exposure to bloodborne diseases.

*Facility* has designated *Title* as the person or persons to contact in the event of a medical emergency.

First aid kits are located at the following locations: [*list locations*]

*______________________________________________________*

*______________________________________________________*

*______________________________________________________*

*______________________________________________________*

Every employee shall be trained in emergency procedures in the event of:

• Fire; toxic chemical releases; tornadoes; floods; and others as needed.
• A procedure for each anticipated emergency shall be written.

Example procedures:

Evacuation plan at the maintenance shop for fire, power outage and chemical releases.

1. Employees will evacuate the building immediately in case of fire, power outage or any emergency within the shop.
2. They will gather in the parking lot immediately across the street and wait there to be accounted for and given further instructions.
3. For further information regarding emergency procedures contact *Title*.

Evacuation plan for mobile job sites for fire, power outage and chemical releases.

1. Employees will evacuate the area immediately in case of fire, power outage or any emergency at a job site.
2. They will gather in a location designated by the supervisor and wait there to be accounted for and given further instructions.
3. For further information regarding emergency procedures contact *Title*.

The facility shall have a written evacuation plan consisting of the following:

• Emergency escape procedures and emergency escape route assignments.
• Procedures to be followed by employees who remain to operate critical plant operations before they evacuate.
• Account for all employees after emergency evacuation has been completed.
• Rescue and medical duties for those employees who are to perform them.
• Means of reporting fires and other emergencies.
• Names or regular job titles of department personnel who can be contacted for further information or explanation of duties.

*ENTER ANY SPECIAL PROCEDURES YOUR FACILITY HAS HERE*

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SAFETY RULES AND PROCEDURES (For each Facility)

• No employee is expected to undertake a job with which they are uncomfortable.
• No employee is expected to undertake a job until that person has received adequate training.
• All employees shall be trained on every foreseeable hazard that they could be exposed to and how to protect themselves.
• No employee is required to work under conditions which are unsanitary, or unnecessarily dangerous or hazardous to their health.
• Only qualified, trained personnel are permitted to operate machinery or equipment.
• All injuries must be reported to your supervisor/foreman.
• Manufacturer's specifications, limitations, and/or instructions shall be followed.
• Particular attention should be given to new employees and to employees moving to new jobs or doing non-routine tasks.
• All hand and power tools and similar equipment, whether furnished by the State or the employee, shall be maintained in a safe condition.
• All materials stored in tiers shall be stacked, racked, blocked, interlocked, or otherwise secured to prevent shifting/falling.

*ENTER ADDITIONAL RULES AS APPROPRIATE*

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RECORDKEEPING AND HAZARD ANALYSIS (For each Facility)

All work-related injuries and illnesses must be reported to supervision as soon as possible.

A report shall be maintained for every recordable injury and illness. The entry should be made as soon as it is practical, but no later than six working days after receiving information that a recordable injury or illness has occurred.

A recordable injury or illness would be a fatality, lost work day(s), transfer to another job or termination of employment, an incident requiring medical treatment (other than first aid) or involve loss of consciousness or restriction of work or motion. 

Injury records should be evaluated by the facility to determine trends or patterns in injuries in order to address hazards to which employees are exposed. Each facility shall calculate and trend its Lost Workday Injury Rate or LWDI Rate and its Total Case Incidence Rate or TCI Rate.

Operating permits and records must be kept up-to-date for such items as elevators, air pressure tanks, liquefied petroleum gas tanks, boilers, etc. [*MAY NEED TO ADD OTHERS*]

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SELF-INSPECTION SCOPE (For each Facility)

The scope of your self-inspections should include the following:

Processing, Receiving, Shipping and Storage: equipment, job planning, layout, heights, floor loads, projection of materials, materials-handling and storage methods.

Building and Grounds Conditions: floors, walls, ceilings, exits, stairs, walkways, ramps, platforms, driveways, aisles.

Housekeeping Program: waste disposal, tools, objects, materials, leakage and spillage, cleaning methods, schedules, work areas, remote areas, storage areas.

Electricity: equipment, switches, breakers, fuses, switch-boxes, junctions, special fixtures, circuits, insulation, extensions, tools, motors, grounding, NEC compliance.

Lighting: type, intensity, controls, conditions, diffusion, location.

Heating and Ventilation: type, effectiveness, temperature, humidity, controls, natural and artificial ventilation and exhausting.

Machinery: points of operation, flywheels, gears, shafts, pulleys, key ways, belts, couplings, sprockets, chains, frames, controls, lighting for tools and equipment, brakes, exhausting, feeding, oiling, adjusting, maintenance, lockout-tagout, grounding, work space, location, purchasing standards.

Personnel: training, experience, methods of checking machines before use, type of clothing, personal protective equipment, use of guards, tool storage, work practices, method of cleaning, oiling, or adjusting machinery.

Hand and Power Tools: purchasing standards, inspection, storage, repair, types, maintenance, grounding, use and handling.

Chemicals: storage, handling, transportation, spills, disposal, amounts used, toxicity, warning signs, supervision, training, protective clothing and equipment.

Fire Prevention: extinguisher, alarms, sprinklers, smoking rules, exits, personnel assigned, separation of flammable materials and dangerous operations, explosive proof fixtures in hazardous locations, waste disposal.

Maintenance: regularity, effectiveness, training of personnel, materials and equipment used, records maintained, method of locking out machinery, general methods.

Personal Protective Equipment (PPE): type, size, maintenance, repair, storage, assignment of responsibility, purchasing methods, standards observed, training in care and use, rules of use, method of assignment.

A Self-inspection Check List is included in Appendix G. It can be customized to your facility by simply deleting those items which do not apply.

*ENTER ANY SPECIAL INSPECTION PROCEDURES YOUR FACILITY HAS HERE*

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