COMPANY NAME
Safety and Health Manual
Introduction
The purpose of this safety manual is to communicate COMPANY NAME’S (COMPANY NAME SHORT's)
safety policies and special emphasis safety programs through out our organization so that employee injuries and
illnesses can be prevented and compliance with federal, state and local regulations can be achieved.
To accomplish these goals, our company has established a Safety Policy Statement on page 5 stating that
everyone will be held accountable for implementing their assigned safety duties and responsibilities, in this safety
manual, to prevent employee injuries and illnesses.
To ensure that we attain our safety goals, accident data will be periodically analyzed to check on our progress to
attain annual accident reduction goals. In addition, the safety program will be reviewed and signed annually to
determine how the safety program can be improved to attain accident reduction goals and attain compliance with
federal, state and local safety regulations.
This safety manual provides management with a tool to hold others accountable for safety efforts. It provides
supervisors with direction they need to get the job done. And, it provides employees with information (i.e.;
employee safety handbook) to avoid injuries and illnesses. Use it on a daily basis, to prevent employee injuries
and illnesses.
COMPANY NAME
Safety Policy & Procedure Manual
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Table of Contents
SAFETY RESPONSIBILITIES .............................................................................................................. 1
Safety Policy Statement............................................................................................................................................................. 3
Assignment of Responsibility ................................................................................................................................................... 7
CORE SAFETY POLICIES AND PROCEDURES ............................................................................... 11
Employee Safety Orientations ................................................................................................................................................ 13
Personal Protective Equipment .............................................................................................................................................. 17
Safety Training ........................................................................................................................................................................ 25
Safety Inspections .................................................................................................................................................................... 37
Job Safety Analysis.................................................................................................................................................................. 45
Accident Investigation ............................................................................................................................................................. 51
Accident Analysis .................................................................................................................................................................... 55
Safety Meetings ........................................................................................................................................................................ 57
Safety Committee Meeting ..................................................................................................................................................... 59
Central Safety File ................................................................................................................................................................... 61
Program Audit ......................................................................................................................................................................... 65
Machine Guarding .................................................................................................................................................................. 71
Electrical Safety ....................................................................................................................................................................... 77
Hearing Conservation ............................................................................................................................................................. 79
Crane, Hoist and Sling Safety ................................................................................................................................................ 85
SAFETY RULES ................................................................................................................................. 87
General Safety ......................................................................................................................................................................... 89
Fire Protection ......................................................................................................................................................................... 90
Housekeeping ........................................................................................................................................................................... 91
Machinery ................................................................................................................................................................................ 92
Hand Tools ............................................................................................................................................................................... 93
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Safety Policy & Procedure Manual
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Table Of Contents
Personal Protective Equipment .............................................................................................................................................. 94
Electricity ................................................................................................................................................................................. 95
Compressed Gas Cylinders..................................................................................................................................................... 96
Office Safety ............................................................................................................................................................................. 97
Manual Materials Handling ................................................................................................................................................... 98
Ladders, Stairs and Platforms................................................................................................................................................ 99
Welding Safety ....................................................................................................................................................................... 100
SPECIAL EMPHASIS SAFETY PROGRAMS FOR OSHA COMPLIANCE ...................................... 103
Hazard Communication Program ....................................................................................................................................... 105
Hazard Communication Training ....................................................................................................................................... 109
Program Audit .................................................................................................................................................................... 109
Reading A Material Safety Data Sheet ............................................................................................................................... 110
Control of Hazardous Energy Sources ................................................................................................................................ 115
Introduction ........................................................................................................................................................................ 115
Required Equipment ........................................................................................................................................................... 115
Responsibilities................................................................................................................................................................... 116
Energy Control Procedure .................................................................................................................................................. 117
General Lockout Steps........................................................................................................................................................ 118
Group Lockout / Tagout ..................................................................................................................................................... 119
Lockout Removal ............................................................................................................................................................... 119
Shift Changes...................................................................................................................................................................... 119
Removal of Non-energized Tools & Devices ..................................................................................................................... 120
Steps To Re-energize Equipment ....................................................................................................................................... 120
Contractor Requirements .................................................................................................................................................... 120
Training .............................................................................................................................................................................. 121
Periodic Inspection ............................................................................................................................................................. 121
Program Audit .................................................................................................................................................................... 122
Definitions .......................................................................................................................................................................... 122
Bloodborne Pathogens Exposure Control Program ........................................................................................................... 133
Training .............................................................................................................................................................................. 133
Definition............................................................................................................................................................................ 134
Exposure Determination ..................................................................................................................................................... 134
Universal Precautions/Engineering Controls ...................................................................................................................... 134
Hepatitis B Vaccination ...................................................................................................................................................... 136
Facility Emergency Organization ........................................................................................................................................ 143
General Emergency Reporting Procedures ......................................................................................................................... 146
General Emergency Announcing Procedures ..................................................................................................................... 146
Emergency Alarms and Phone Numbers ............................................................................................................................ 146
Fire Prevention Plan ........................................................................................................................................................... 148
Emergency Action Plan for Fire ......................................................................................................................................... 150
Emergency Action Plan for Evacuation.............................................................................................................................. 151
Emergency Action Plan for Tornado and Severe Winds .................................................................................................... 152
Emergency Action Plan for Power Outage ......................................................................................................................... 153
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Safety Policy & Procedure Manual
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Table Of Contents
Emergency Action Plan for Bomb Threat .......................................................................................................................... 154
Emergency Action Plan for Winter Storm .......................................................................................................................... 155
Respiratory Protection Program.......................................................................................................................................... 157
Responsibilities................................................................................................................................................................... 157
Program Evaluation ............................................................................................................................................................ 158
Record Keeping .................................................................................................................................................................. 158
Training and Information.................................................................................................................................................... 158
Selection of Respirators ...................................................................................................................................................... 160
Respiratory Protection Schedule by Job and Working Condition ...................................................................................... 162
Physical and Medical Qualifications .................................................................................................................................. 162
Respirator Fit Testing ......................................................................................................................................................... 164
Respirator Operation and Use ............................................................................................................................................. 165
Cleaning and Disinfecting .................................................................................................................................................. 166
Respirator Inspection .......................................................................................................................................................... 166
Respirator Storage .............................................................................................................................................................. 168
Breathing Air Quality and Use ........................................................................................................................................... 168
COMPANY NAME
Safety Policy & Procedure Manual
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Table Of Contents
Index of Forms, Checklists, and Procedures
Accident Investigation Report Form ____________________________________________________________
Annual Safety Audit ________________________________________________________________________
Authorized Lockout/Tagout Employee List ______________________________________________________
Employee Safety Orientation Checklist__________________________________________________________
Facility Inspection Checklist __________________________________________________________________
General Area Sound Levels ___________________________________________________________________
General Safety Training Matrix ________________________________________________________________
Guide For Entering Injuries & Illnesses In The OSHA 300 Log ______________________________________
Hepatitis B Vaccine Consent Form and Vaccination Record _________________________________________
Hepatitis B Vaccine Declination Form __________________________________________________________
Job Safety Analysis Worksheet ________________________________________________________________
Job Task Risk Assessment ____________________________________________________________________
Lock-Out/Tag-Out Evaluation _________________________________________________________________
Lock-Out/Tag-Out Evaluation Sample __________________________________________________________
Machine Guarding Checklist __________________________________________________________________
Periodic Lock-Out/Tag-Out Inspection Record____________________________________________________
Personal Protective Equipment Needs Assessment Form ____________________________________________
Request for Material Safety Data Sheets _________________________________________________________
Required Personal Protective Equipment ________________________________________________________
Safety Communication Meeting Form __________________________________________________________
Safety Inspections List_______________________________________________________________________
Safety Policy Statement ______________________________________________________________________
Supervisor Safety Skill Training Matrix _________________________________________________________
53
67
125
15
41
83
27
63
139
141
49
47
129
131
75
127
21
113
23
35
39
5
31
Index of Tables
Table 1: Table of required safety inspections. _____________________________________________________ 39
Table 2: Types of emergency alarms. ___________________________________________________________ 146
Table 3: Emergency services and phone numbers. _________________________________________________ 147
COMPANY NAME
Safety Policy & Procedure Manual
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Safety Responsibilities
COMPANY NAME
Safety Policy & Procedure Manual
1
Assignment Of Safety Responsibilities
Safety Policy Statement
Purpose:
The purpose of COMPANY NAME SHORT's Safety Policy Statement on page 5 is to make clear to all
employees that every reasonable effort shall be made to:
a) Identify and control exposures in our operations that can injure people, interrupt production, or damage
property, equipment, and materials.
b) Comply with federal, state and local regulations.
No operation is so important that it must be done in a manner that permits undue hazard to personnel, the public
or property.
Scope:
This policy applies to all COMPANY NAME SHORT's operations, activities and locations.
Administration:
Management is responsible for:
 Requiring supervisors to live up to the spirit of the safety policy.
 Requiring that the Safety Policy Statement be up to date.
Supervisors are responsible for:
 Living up to the spirit of the Safety Policy Statement.
 Reviewing the Safety Policy Statement with employees.
 Requiring employees live up to the spirit of the Safety Policy Statement.
Employees are responsible for:
 Working in a safe manner to avoid injury and illness.
 Obeying all safety rules.
 Immediately reporting an unsafe condition to a supervisor.
Training:
Annually review the Safety Policy Statement with all employees to remind them of their commitment and the
company’s commitment to provide a safe workplace.
COMPANY NAME
Safety Policy & Procedure Manual
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Assignment Of Safety Responsibilities
Timing:
The Safety Policy Statement will be communicated to all employees during their initial employee safety
orientation and annually thereafter.
Action:
1.
2.
3.
Post the safety policy on general bulletin boards.
Review the company's Safety Policy Statement with new employees and annually with all employees.
Review the Safety Policy Statement annually to determine if it needs updating.
Documentation:
The Safety Policy Statement is provided for you on page 5.
Audit:
The Safety Policy Statement will be included in the annual safety program audit. Results of the audit will be
shared with Executive Management.
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Safety Policy & Procedure Manual
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COMPANY NAME
Safety Policy Statement
COMPANY NAME is committed to make every reasonable effort to:
a) Identify and control exposures in our operations that can injure people, interrupt production, or damage
property, equipment, and materials.
b) Comply with federal, state and local regulations.
This policy, put into action through implementation of our safety programs, training programs, and employee
safety rules; is the basis for assuring an efficient, safe and healthful workplace for our employees. No operation is
so important that it must be done in a manner that permits undue hazard to personnel, the public or property.
Management is responsible for developing our loss control policies and has the overall responsibility for requiring
that they be effectively implemented within the company. Employees are responsible for obeying the safety
policies and safety rules to avoid injury and illness.
Safety and loss control policies are the direct responsibility of all management and they are as much a measure of
efficient operations as reaching production and sales goals. Correction of recognized safety hazards and other
potential loss hazards should be assigned top priority by the supervisor in charge. Safety and loss control are
everyone's responsibility. All personnel, supervisory and production alike, must take responsibility for our loss
control programs.
Failure to follow the policies, procedures, safety rules, safe work methods and OSHA regulations can result in
disciplinary actions that can lead to and include termination.
Our objective for these programs is to reduce the number of injuries, illnesses, and property and maintain a safe
and productive work environment.
President
Vice President
Assignment Of Safety Responsibilities
Assignment of Responsibility
Purpose:
The purpose of assigning safety responsibilities is to assure that all employees understand their role in how they
will be held accountable to provide a safe work place.
Scope:
The assignment of responsibilities applies to all levels of the organization.
Administration:
The Executive Management team is responsible for:

Establishing annual accident reduction goals.

Reviewing completed Accident Investigation Report Forms on page 53 and providing feedback to the location
manager and safety committee.

Reviewing the safety committee meeting minutes and providing feedback.

Holding the location manager accountable for attaining accident reduction goals and safety performance
goals.

Requiring that the safety program be audited annually.
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Assignment Of Safety Responsibilities
The Location Manager is responsible for:

Recommending accident reduction goals to Executive Management.

Requiring that hazardous job tasks be evaluated by conducting a Job Safety Analysis and document the
findings on a Job Safety Analysis Worksheet on page 49.

Conducting Employee Safety Orientations and document their activities by using the Employee Safety
Orientation Checklist s on page15.

Requiring the Supervisor to participate in Safety Training as required in the Supervisor Safety Skill Training
Matrix on page 31.

Conducting Safety Training sessions as indicated in the General Safety Training Matrix on page 27 and
documenting them by completing the Safety Communication Meeting Form on page 35.

Conducting monthly Safety Meetings and documenting them by completing the Safety Communication
Meeting Form on page 35.

Requiring Safety Inspections be conducted and documented as indicated in the Safety Inspections List on
page 53.

Conducting an Accident Investigation of an employee injury or illness by the end of the shift and completing
the Accident Investigation Report Form on page 53.

Reviewing completed Safety Communication Meeting Forms on page 35 and providing feedback to the safety
committee and supervisor.

Periodically auditing the quantity and quality of safety documentation in the Central Safety File.

Maintaining an organized Central Safety File of completed safety documentation.

Updating the list of hazardous chemicals and replacing outdated MSDSs in the MSDS binders.

Holding the supervisor accountable for implementing the safety manual and attaining accident reduction
goals.

Interpreting the safety policies, procedures and programs in the safety manual.
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Safety Policy & Procedure Manual
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Assignment Of Safety Responsibilities
The Supervisor is responsible for:

Attaining accident reduction goals by implementing the policies and procedures in the safety manual.

Participate in Safety Training as required in the Supervisor Safety Skill Training Matrix on page 31.

Participate in conducting Job Safety Analysis and completing a Job Safety Analysis Worksheet on page 49.

Requiring employees to wear and maintain Personal Protective Equipment as indicated in the Required
Personal Protective Equipment list on page 53.

Participating in monthly Safety Meetings.

Participate in conducting Safety Inspections as stated in the Safety Inspections List table on page 39.

Correcting unsafe acts and unsafe conditions as soon as they are identified.

Implementing the Special Emphasis Safety Programs For OSHA Compliance beginning on page 103.

Requiring guards to be in place when an employee is operating machinery or equipment.

Participate in conducting an Accident Investigation of an employee injury or illness.

Initiating disciplinary procedures in a uniform and consistent manner.
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Safety Policy & Procedure Manual
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Assignment Of Safety Responsibilities
The Employees are responsible for:

Being responsible for his or her personal safety.

Obeying all safety rules.

Wearing and maintaining personal protective equipment.

Using safe work methods.

Requesting additional training when unclear on how to work safely.

Immediately reporting unsafe acts and unsafe conditions to management.

Submitting safety suggestions.

Reporting all injuries immediately to management.
It is mandatory for employees to work safely at COMPANY NAME. Failure to do so can result in disciplinary
actions being taken against that employee which can include termination.
Training:
Train all employees annually on their assignment of safety responsibilities.
Action:
1.
Train management and employees in their safety duties and responsibilities.
2.
Remind management and employees of their duties and responsibilities during staff meetings and safety
training sessions.
3.
Hold management and employees accountable for performing their safety duties and responsibilities.
Documentation:
Use the Safety Communication Meeting Form on page 35 to document training sessions on safety duties and
responsibilities.
Audit:
The assignment of responsibilities will be included in the annual safety program audit. Results of the audit will
be shared with Executive Management.
COMPANY NAME
Safety Policy & Procedure Manual
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Core Safety Policies and Procedures
COMPANY NAME
Safety Policy & Procedure Manual
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Core Safety Policies And Procedures
Employee Safety Orientations
Purpose:
The purpose of the employee safety orientation policy is to ensure that they understand safe work methods and
how to use machinery, equipment and personal protective equipment (PPE) to avoid injuries and illnesses.
Scope:
This policy applies when an employee is: newly hired, transferred, promoted, or returning to work from an
extended injury or leave of absence.
Administration:
The Location Manager is responsible for:
 Explaining to the trainee the designated topics listed in the Employee Safety Orientation Checklist on page
15.
 Signing and dating the Employee Safety Orientation Checklist when the orientation is completed.
 Filing the completed Employee Safety Orientation Checklist in the employee's personnel/training file.
 Observing the employee working to see if he or she is properly applying the new knowledge.
 Providing feedback to the employee to reinforce safe work behaviors.
The Employee Safety Representatives are responsible for:
 Observing the trainee to provide guidance and instruction on how to work safe.
 Notifying the manager on the status of the trainee’s comprehension of safety knowledge and skills.
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Safety Policy & Procedure Manual
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Core Safety Policies And Procedures
Training:
People conducting employee safety orientations shall be trained at least once every three years on how to conduct
a thorough employee safety orientation.
Timing:
All employees shall be trained on the topics listed in the Employee Safety Orientation Checklist before they begin
to work on job tasks exposing them to those hazards.
Action:
1) Identify employees for safety orientation.
2) The manager will train the employee to the items on the checklist and have the completed Employee Safety
Orientation Checklist filed in the employee's personnel/training file.
3) The manager will assign an employee safety representative to observe the employee work and provide
feedback to the trainee and the manager.
4) The manager will periodically check the quality of the Employee Safety Orientations conducted by observing
the trainee and reviewing the documentation in the employee's personnel file.
Documentation:
The Manager will use the Employee Safety Orientation Checklist on page 15 to document employee orientations.
Copies of these checklists will be kept in the in the employee's personnel file.
Audit:
The New Employee Orientation policy will be included in the annual safety program audit. Results of the audit
will be shared with Executive Management.
COMPANY NAME
Safety Policy & Procedure Manual
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COMPANY NAME
Employee Safety Orientation Checklist
Check “ “
Items Discussed.
Topics
Overview of the company safety program
Review the safety policy statement
Review the employee safety handbook
Explanation of safe work procedures
MSDS binder and HMIS posters
Specific MSDS safety training
Personal protective equipment training
Respirator training (if applicable)
Lock-out & tag-out training
Crane and hoist safety
Safe refuge areas in case of evacuation or tornado
How to report a fire
How to report an injury
Procedure for reporting to a medical clinic for treatment
Policy for return-to-work
Procedure for reporting while recuperating away from work
Reporting absences from work policy
Disciplinary policy
Location of bulletin boards, lunch room, vending machines, restrooms
Introduction to supervisor and safety representatives
My signature below indicates that I understand all items covered in this orientation meeting and that I
agree to follow them. Failure to do so may result in disciplinary actions up to and including
termination.
Employee Signature:
Date:
Training Manager’s Signature:
Date:
KEEP IN THE EMPLOYEE'S PERSONNEL FILE
Core Safety Policies And Procedures
Personal Protective Equipment
Purpose:
The purpose of our personal protective equipment policy is to identify job hazards that require the use of personal
protective equipment, PPE, by employees to protect them from injury and illness. In addition, this section helps
our company be in compliance with mandatory OSHA requirement on personal protective equipment.
Scope:
This program applies to all employees who are required to use PPE.
Administration:
The Manager is responsible for:
 Evaluating job tasks to identify hazards by using the Personal Protective Equipment Needs Assessment Form
on page 21 to determine appropriate PPE.
 Establishing the location's PPE requirements.
 Authorizing purchases of PPE.
 Conducting PPE training annually.
 Holding the supervisor accountable for requiring employees to wear PPE.
The Supervisor is responsible for:
 Observing employees to determine if PPE is being properly utilized.
 Enforcing proper use of PPE.
The Safety Representatives are responsible for:
 Observing employees to determine if PPE is being properly utilized.
 Encouraging employees to properly use and care for PPE.
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Safety Policy & Procedure Manual
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Core Safety Policies And Procedures
Training:
The training will occur prior to the employee engaging in work where PPE is required. Training will cover:
1.
2.
3.
4.
What jobs require PPE to be worn.
Type of PPE that must be worn.
Limitations of PPE.
How to properly inspect, donn, use, doff, clean and store PPE.
Special requirements for safe use of PPE may be established and contained in other sections of this manual.
These special training requirements are included in employee training.
Timing:
The personal protective equipment policy is immediately in effect. All employees shall be trained in PPE before
starting job tasks that require PPE to be worn. The need for personal protective equipment will be reviewed
whenever a job task or operations changes.
Action:
Management will arrange for an initial evaluation of each job task for potential hazards the need for PPE utilizing
the by using the Personal Protective Equipment Needs Assessment Form on page 21. Afterwards, the Manager
will evaluate all subsequent changes in the job tasks and update the Required Personal Protective Equipment list
on page 23. PPE will be provided to all employees in work areas with a hazard index of 1. When the hazard
index is 2, the need for PPE is recommended but the manager will determine if PPE will be used based on past
experience with the operation. When the hazard index is 3, PPE may not be necessary.
Regarding Industrial Hygiene Hazards, the manager must be informed of all job tasks requiring use of respirators
so appropriate testing can be conducted to verify a potential exposure. Respirators must not be provided to an
employee unless a formal respirator program is in place and a qualified medical person who certifies that he/she is
physically capable of wearing it has tested the employee.
The Manager will make final selection of all PPE.
Documentation:
OSHA requires that a hazard assessment be conducted on all job tasks to identify hazards and determine if
personal protective equipment is needed to protect employees from injury and illness. The Personal Protective
Equipment Needs Assessment Form on page 21 must be written and signed by the assessor. The Manager will
keep a file of all completed hazard assessments in the central safety file.
OSHA requires employees attending a PPE training session sign a form indicating that they understood the
information regarding use and maintenance of PPE. The Manager will file all PPE training documentation in the
central safety file.
COMPANY NAME
Safety Policy & Procedure Manual
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Core Safety Policies And Procedures
Audit:
Supervisor and safety representatives will periodically conduct informal observations of employees to determine
if they are properly utilizing personal protective equipment. In addition, the Personal Protective Equipment
policy will be included in the annual safety program audit. Results of the audit will be shared with Executive
Management.
COMPANY NAME
Safety Policy & Procedure Manual
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Personal Protective Equipment Needs Assessment Form
Job Task: _________________________________________ Evaluator: _________________ Date: ____________
Severity
Yes No
Critical Marginal Negligible
Probability
Likely
Probably
May
MSDS
Consulted
Hazard
Yes/
Unlikely Index
No
Eye & Face Protection:
Employees are exposed to
flying particles, molten metal,
liquid chemicals, chemical
gasses or vapors, or potentially
harmful light radiation.
Head Protection:
There is a potential for injury to
the head from a falling object.
There is a potential to contact
exposed electrical conductors
with the head.
A caught on hazard exists for
hair.
Foot Protection:
There is a potential for foot
injury due to falling or rolling
objects.
There is potential for foot
injury due to an object piercing
the sole of the shoe.
The floor surface may create a
slip hazard.
Hand Protection:
There is a potential for hand
injury from: skin absorption of
harmful substances, cuts,
abrasions, punctures, chemical
burns, or harmful temperatures.
Fall Protection:
Employees are working at an
elevated work area where a slip
or fall to a lower level is
possible.
Clothing Protection:
There is exposure to harmful
materials, chemicals,
temperature extremes, sources
of cuts and punctures.
Likely: Occur within a short period of time.
Definitions:
Critical: May cause severe injury.
Probably: _____________________________________Prob
Marginal: May cause minor injury.
May: May occur in time.
Negligible: Probably would not cause first aid injury.
Unlikely: Unlikely to occur.
I certify that a hazard assessment meeting the requirements of CFR 1910.132 was conducted at the job task or work
area indicated above. This assessment was conducted to identify hazards present or likely to be present which
necessitate the use of personal protective equipment.
Signature of Assessor:
Date:
KEEP IN THE CENTRAL SAFETY FILE: PPE NEEDS ASSESSMENTS
Job Hazard Index Matrix
Hazard Probability
Likely
Probably
May
Unlikely
Critical
1
1
1
2
Hazard Severity
Marginal
1
2
2
3
Negligible
2
2
3
3
Core Safety Policies And Procedures
Required Personal Protective Equipment
Job Tasks Reviewed
Welding
Required Personal Protective Equipment
Eye: Welding helmets when welding. Safety glasses with side shields
and top shields under welding helmet. Filter shades ( Select the darkest
filter shade that allows adequate task performance: Electric arc welding
10-14. Gas welding 4-8. Torch soldering 1.5 – 3. Torch brazing 3 –
4. Glare - 1.
Clothing: Dark wool, heavy cotton or leather clothing covering all parts
of the body is recommended to minimize skin burns, spatter, ultraviolet
and infrared ray burns. Rolling up of sleeves or pant cuffs is not
recommended. Flame resistant aprons made of leather shall be
available when additional protection against sparks and radiant energy
is needed.
Head: Skull cap.
Foot: Safety shoes.
Hand: Leather gloves.
Respiratory Protection: Use general air circulation fans to direct fume
plume away from breathable air.
Cutting
Eye: Cutting goggles when torching metal. Safety glasses with side
shields and top shields when not burning. Filter shade 3-6.
Clothing: Dark wool, heavy cotton or leather clothing covering all parts
of the body is recommended to minimize skin burns, and spatter.
Rolling up of sleeves or pant cuffs is not recommended. Flame resistant
aprons made of leather shall be available when additional protection
against sparks and radiant energy is needed.
Head: Skull cap.
Foot: Safety shoes.
Hand: Leather gloves.
Respiratory Protection: Use general air circulation fans to direct fume
plume away from breathable air.
Painting
Eye: Face shield when spray painting. Splash goggles when working
with paints and solvents. Safety glasses with side shields and top shields
when in other areas of the location.
Foot: Safety shoes.
Hand: Nitrile gloves when handling paints and solvents.
Respiratory Protection: Wear respirator with organic cartridges.
Operate the spray paint booth when spray painting and drying painted
objects.
Grinding
Eye: When grinding, face shield with safety glasses with side shields
and top shields. Or, vented safety goggles. Otherwise, safety glasses
with side shields and top shields.
Foot: Safety shoes.
Hand: Leather gloves when handling metal with sharp edges.
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Safety Policy & Procedure Manual
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Core Safety Policies And Procedures
Required Personal Protective Equipment
Foot: Safety shoes.
Woodworker
Eye: Safety glasses with side shields and top shields.
Foot: Safety shoes.
Hand: Tear away gloves when handling and cutting wood.
Date of Evaluation: February 2001
KEEP IN CENTRAL SAFETY FILE: REQUIRED PPE
COMPANY NAME
Safety Policy & Procedure Manual
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Core Safety Policies And Procedures
Safety Training
Purpose:
The purpose of the safety training policy is to ensure compliance with our company's policies and procedures on
employee safety training and OSHA's mandatory regulations on employee safety training. Safety training is a
critical part of any safety program. The main types of safety training include job awareness training, specialized
safety training, and OSHA mandated safety training.
All supervisors shall conduct sufficient employee safety training so they are aware of job hazards and how to
work safely. This training can be conducted during special training sessions, department safety meetings or
during one-on-one employee safety contacts. At a minimum, annual refresher training shall be conducted on
topics listed in the General Safety Training Matrix on page 27. Additional training will be conducted, on an as
needed basis, to close safety skill and knowledge “gaps” and maintain employee awareness of safe working
practices.
Scope:
This section applies to all COMPANY NAME SHORT employees.
Administration:
The Manager is responsible for:
 Recommending annual supervisory and employee training budgets to Executive Management.
 Conducting safety-training sessions on topics listed in the General Safety Training Matrix on page 27.
 Documenting safety-training sessions using the Safety Communication Meeting Form on page 35.
 Requiring supervisor to attend safety skill development sessions on topics listed in the Supervisor Safety Skill
Training Matrix on page 31.
 Filing Safety Communication Meeting Forms in the central safety file under: Year - Safety Training.
 Auditing the completed Safety Communication Meeting Forms in the Central Safety File.
The Supervisor and Safety Representatives are responsible for:
 Observing employees to determine if they are applying their new safety knowledge properly to their work
activities.
 Retraining employees who do not understand safe work methods.
The Safety Committee is responsible for:
 Developing and submitting an annual safety-training schedule to the location manager.
COMPANY NAME
Safety Policy & Procedure Manual
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Core Safety Policies And Procedures
Documentation:
The Safety Communication Meeting Form on page 35 will be used to document employee safety training sessions.
Training:
Training on how to conduct a safety training session is available, upon request, from your workers compensation
insurance insurer and insurance broker.
Timing:


Management shall receive refresher training on topics indicated in the Supervisor Safety Skill Training Matrix
at least once every three years.
All employees shall receive refresher training on topics indicated in the General Safety Training Matrix every
year.
Action:
1.
2.
3.
4.
5.
6.
Review the table titled: General Safety Training Matrix on page 27 to identify what refresher training is
required and how often it is required.
Review the table titled: Supervisor Safety Skill Training Matrix on page 31 to identify what refresher
training is required and how often it is required.
Assign training responsibilities and schedule training.
Establish a system of reporting and following up on scheduled training.
Provide feedback on training sessions.
File training forms in the central safety file.
Audit:
The Training policy will be included in the annual safety program audit. Results of the audit will be shared with
Executive Management.
COMPANY NAME
Safety Policy & Procedure Manual
26
Core Safety Policies And Procedures
General Safety Training Matrix
Safety Program Element
Purpose
Safety Policy Statement
Reinforce:

Assignment of
Responsibility
Safety Rules
Accident Investigation
Safety Inspections
COMPANY NAME
Training Resources
Safety Policy Statement
Awareness of the Safety Policy
Statement.
Reinforce:
 Safety responsibilities and duties
 Safety accountability
 Need to achieve accident reduction
goals
 Need to implement the company safety
program
Reinforce:
 Awareness of the safety rules.
 Disciplinary measures.
Reinforce:
 Accident reporting procedures
 Form of proper notification
 Enforcement of reporting requirements
 Completion of required forms
 Effective and timely accident
investigations
Reinforce:
 OSHA requirements
 Need for inspections
 Who should inspect
 Conducting a thorough inspection
 Proper inspection procedures
 Documentation & follow-up
Executive Management on page 7.
Manager on page 53.
Employees on page 10.
Employee Safety Handbook
Accident Investigation Report Form on page 53
Safety Inspections List on page 39
Safety Policy & Procedure Manual
27
Core Safety Policies And Procedures
General Safety Training Matrix
Safety Program Element
Purpose
Facility Emergency
Organization
Reinforce:
 OSHA requirements
 Roles and responsibilities
 Proper emergency and evacuation
procedures
 Fire prevention & fire extinguishing
 Emergency Action plans
Reinforce:
 OSHA requirements
 Responsibilities and duties
 Employee rights under OSHA
 Labeling system
 How to read MSDS
 Specific hazards
 Safe work methods
 Required PPE
 Proper disposal
 First Aid
Reinforce:
 OSHA requirements
 Nature of bloodborne pathogens
 Universal precautions
 How to protect themselves from
infection
 What to do if they are exposed
 Use of personal protective equipment
 Clean-up procedures
 Waste disposal
 Administrative controls and
documentation
Hazard Communication
Program
Bloodborne Pathogens
Exposure Control
Program
COMPANY NAME
Training Resources
American Red Cross
Facility Emergency Organization on page 143
Online NIOSH Pocket Guide to Hazardous Chemicals
PPE Symbols Used By HMIG
Hazard Communication Program on page 105
Aides –HIV Prevention Information from the CDC
Bloodborne Pathogens Exposure Control Program on page
133
Safety Policy & Procedure Manual
28
Core Safety Policies And Procedures
General Safety Training Matrix
Safety Program Element
Purpose
Personal Protective
Equipment
Reinforce:
 OSHA requirements
 Assessing need for PPE
 Choosing PPE
 PPE limitations
 Inspecting, donning, using, doffing,
cleaning and storing PPE
Reinforce:
 OSHA requirements
 Specific program elements
 Responsibilities
 Right under OSHA
 Documentation and Follow-up
Affected Employees
 Program requirements
 Their responsibilities
Authorized Employees
 Program requirements
 Lockout/Tagout procedures
OSHA Publications
Reinforce:
 OSHA requirements
 Sources of electrical hazards
 Effects of electrical shock on the body
 Safe grounding techniques
 Safe work methods
 Never work on live electricity
OSHA Publications
Control of Hazardous
Energy Sources
Electrical Safety
COMPANY NAME
Training Resources
NIOSH Guidelines for Controlling Hazardous Energy During
Maintenance and Servicing
Safety Policy & Procedure Manual
29
Core Safety Policies And Procedures
Month
COMPANY NAME
Training topic
Safety Policy & Procedure Manual
Core Safety Policies And Procedures
Supervisor Safety Skill Training Matrix
Safety Skill
How To Manage An
Effective Department
Safety Program
How To Conduct An
Effective Training Session
How To Conduct An
Effective New Employee
Orientation
How To Conduct An
Effective Job Observation
and Employee Counseling
Session
COMPANY NAME
Purpose
Reinforce:
 Various types of management style
 Choosing the proper management style
 Managing employees
 Task management
 Documentation & follow-up
Reinforce:
 Need for training
 Types of training
 When to train
 How to train
 Providing feedback
 Documentation & follow-up
Reinforce:
 Need for employee orientations
 Topics to be covered
 How to conduct an orientation meeting
 Checking for learning
 Documentation & follow-up
Reinforce:
 Need for employee observations and
counseling
 Prioritizing employees for observation
 How to conduct an employee
observation
 How to provide feedback
 Documentation & follow-up
Training Resources
PestSure
PestSure
Human Resources
Human Resources
Safety Policy & Procedure Manual
31
Core Safety Policies And Procedures
Supervisor Safety Skill Training Matrix
Safety Skill
How To Conduct An
Effective Safety Meeting
How to Conduct An
Effective Inspection
How to Conduct An
Effective Safety
Committee Meeting
How To Conduct An
Effective Accident
Investigation
COMPANY NAME
Purpose
Reinforce:
 Need for safety meetings
 Obtaining talk topics
 Using safety representatives effectively
 How to conduct a safety meeting
 Checking for learning
 Documentation & follow-up
Reinforce:
 Need for inspections
 Types of required inspections
 How to conduct an inspection
 Documentation & follow-up
Reinforce:
 Need for safety committee meetings
 Who should attend
 Topics to be covered
 How to conduct a safety committee
meeting
 When to use sub-committees
 Documentation & follow-up
Reinforce:
 Need for accident investigations
 Interviewing employees
 How to develop accident prevention
measures
 Communicating accident prevention
measures
 Documentation & follow-up
Training Resources
PestSure
PestSure
PestSure
Safety Policy & Procedure Manual
32
Core Safety Policies And Procedures
Supervisor Safety Skill Training Matrix
Safety Skill
How To Conduct An
Effective Return To Work
Program
COMPANY NAME
Purpose
Reinforce:
 Need for a return to work program
 The company’s RTW program
 Supervisor’s role
 Working with the medical clinic
 Modified duty
 Documentation & follow-up
Training Resources
PestSure
Safety Policy & Procedure Manual
33
COMPANY NAME
Safety Communication Meeting Form
Date: _____________________ Time: _______ Moderator: ____________________________________
Instructor: _____________________________________________________________________________
Topic: ________________________________________________________________________________
 Safety Committee Meeting
 Safety Training Meeting
Print Attendee's Name
 Department Safety Meeting
 Employee Safety Contact
Attendee's Signature
Comments:
KEEP THIS FORM IN THE CENTRAL SAFETY FILE: YEAR - SAFETY COMMUNICATION MEETINGS
Core Safety Policies And Procedures
Safety Inspections
Purpose:
To conduct formal safety inspections that will identify unsafe conditions so that corrective measures can be
implemented to eliminate or reduce the risk for employee injury and illness.
Scope:
This section applies to all office and storage/production (garage, warehouse, office, etc.) areas.
Administration:
The following table illustrates various safety inspections that shall be conducted by various personnel. See the
reference column of the table below to find the section of the manual where the inspection form is located.
The Inspectors are responsible for:
 Conducting a thorough inspection.
 Documenting inspections using the approved inspection form.
 Promptly submitting the completed inspection form.
The Safety Committee is responsible for:
 Conducting a monthly facility safety inspection.
 Providing results of the facility inspection to the safety committee chairman.
The Management is responsible for:
 Requiring that thorough inspections be conducted.
 Requiring that prompt measures be taken to control workplace hazards.
 Reviewing the central safety file to audit the quality and quantity of Safety Inspections List.
 Providing feedback to the inspectors on how they can improve the quality of their inspection.
 Informing Supervisors of safety inspection issues and concerns.
The Supervisor is responsible for:
 Conducting department inspections to identify and reduce workplace hazards.
 Promptly implementing measures to control workplace hazards.
Human Resources is responsible for:
 Filing inspection forms in the Central Safety File.
COMPANY NAME
Safety Policy & Procedure Manual
37
Core Safety Policies And Procedures
Documentation:
All inspections that are mentioned in this section shall be documented using the referenced inspection form(s).
Completed inspections shall be kept in the Central Safety File on page 61.
Training:
Training on how to conduct hazard inspections is available, upon request, from the insurance broker, workers
compensation insurance carrier and outside vendors.
Timing:
See the summary table provided in this section for inspection frequency.
Action:
1.
2.
3.
4.
5.
Select employees that will conduct inspections.
Provide training and assign responsibilities.
Conduct inspections.
Send completed safety inspection forms to the Human Resources for review during the Safety Committee
meetings.
File inspections that have been reviewed by the safety committee in the central safety file.
Audit:
The Inspection policy will be included in the annual safety program audit. Results of the audit will be shared with
Executive Management.
COMPANY NAME
Safety Policy & Procedure Manual
38
Core Safety Policies And Procedures
Safety Inspections List
Form
Facility Inspection
Checklist
Machine Guarding
Checklist
Purpose
To control general
workplace hazards.
To ensure machine &
equipment guards are
appropriate and in place.
Lock-Out/Tag-Out
To ensure machinery and
Evaluation
equipment are being
properly locked and
tagged out of service.
Personal Protective
To ensure the PPE is
Equipment Needs
appropriate for job
Assessment Form
hazards.
Sprinkler System
To ensure safe operating
condition.
Job Task Risk
To prioritize jobs for a job
Assessment
safety analysis
Job Safety Analysis
Analysis of a job task to
Worksheet
identify hazards and safe
work methods
Table 1: Table of required safety inspections.
COMPANY NAME
Responsibility
Safety committee
Frequency
Monthly before
meeting
On new and existing
machinery &
equipment
At least annually
Ref
41
Supervisor
Whenever job hazards
or PPE changes.
21
Outside service
Bi-Annual
Supervisor
All job tasks
N/
A
47
Supervisor
All moderate to high
hazard jobs
Supervisor
Supervisor
Safety Policy & Procedure Manual
75
129
45
39
Facility Inspection Checklist
Building: _____________________________________ Month:
_____________________________________________ Month: ___________________________________
Yes



No



#
1.
2.
3.






4.
5.
6.










7.
8.
9.
10.
11.
























12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
23.










24.
25.
26.
27.
28.


















29.
30.
31.
32.
33.
34.
35.
36.
37.












38.
39.
40.
41.
42.
43.
Category & Item
AISLES & FLOORS
Marked clearly?
Clean, clear and in good
condition?
EXITS
Marked with lighted signs?
Unobstructed inside and outside
areas?
Doors are functional?
Panic hardware operational?
POSTINGS
"No Smoking" signs displayed?
Emergency phone numbers
displayed?
Safety posters displayed?
Evacuation routes displayed?
LADDERS
Are in good condition?
Are stable?
Are appropriate for the job?
Safety feet are in place?
Free of sharp edges and splinters?
RECEIVING AREA
Doors secured?
Housekeeping good inside areas?
Housekeeping good outside
areas?
Driver access restricted?
Floor condition good?
FIRE SAFETY
Paints properly stored?
Fire extinguishers mounted &
charged?
Fire extinguisher access open?
Fire extinguisher signs posted?
Flammable fluid containers used?
FIRST AID KIT
Log being used?
Supplies ample?
Access to supplies restricted?
Blood spill kit available?
Emergency phone numbers
posted?
MAINTENANCE
Gas cylinders chained?
Bench grinder guarded
Tool rest within 1/8" of wheel?
Welding PPE used?
Fire extinguisher available?
Yes



No



#
52.
53.
54.
Category & Item
MACHINE & EQUIPMENT
Point-of-operation guards in place?
Guards not by-passed?






55.
56. Moving parts guarded?
57. Secured to the floor?










58.
59.
60.
61.
62.
Electrically grounded?
Button/controls labeled?
Buttons/controls in good condition?
Nothing stored on or in it?
Warning signs posted?
























63.
64.
65.
66.
67.
68.
69.
70.
71.
72.
73.
74.
Lockout/tagout devices used?
Lockout/tagout procedures followed?
Employees notified of lockout/tagout?
INVENTORY STORAGE
Stable stacking?
Storage 18" below sprinkler heads?
Product/containers in good condition?
Racking in good condition?
Pallets in good condition?
Empty pallets stacked below 6 feet?
Proper lifting observed?
No climbing on racks?










75.
76.
77.
78.
79.
HAND CARTS
Good operating condition?
Safe operation observed?
Wheels operate freely?
Not blocking access?


















80.
81.
82.
83.
84.
85.
86.
87.
88.
SPRINKLERS
Inspections documents?
Valves chained open?
Extra sprinkler heads?
EMERGENCY EQUIPMENT
Battery powered flashlights
Weather band radio
Safe refuge areas posted
PRODUCT STORAGE CAGE












89.
90.
91.
92.
93.
94.
Filters clean?
Ventilation ample?
Respirators stored and clean?
Containers closed?
Smoking controlled?

 44. Welding stick out of jaws?


95. Electrical ignition sources controlled?

 45. Welding curtains used?


96. MSDS book available?

 46. Tool condition good?


97. HMIS poster displayed

 47. HANDTOOLS


98. MISCELLANEOUS

 48. In good condition?


99. Other

 49. Properly used?


100.Other
____________________________________

 50. Gloves worn/appropriate?


101.Other
____________________________________

 51. Properly stored?


102.Other
____________________________________
 "Yes "box is item is acceptable.  "No" box if item is not acceptable and request that a work order be created.
Monthly Facility Inspection Checklist
Work Order #
Inspected By:
Checklist Reference #
Comment
________________________________________ Date:
CENTRAL SAFETY FILE – YEAR, FACILITY SAFETY INSPECTIONS
____________
Core Safety Policies And Procedures
Job Safety Analysis
Purpose:
The purpose of the Job Safety Analysis policy is to develop standard operating procedures and work methods that
will reduce the risk for employee injury and illness.
Scope:
Job Safety Analysis applies to all departments.
Administration:
The Executive management is responsible for:
 Requiring that a Job Safety Analysis Worksheet be conducted on hazardous job tasks.
 Holding the Manager accountable for developing and using Job Safety Analysis Worksheets for training
employees.
The Manager is responsible for:
 Prioritizing job tasks for analysis using the Job Task Risk Assessment form on page 47.
 Conducting a Job Safety Analysis on hazardous job tasks using the Job Safety Analysis Worksheet on page
49.
 Using the Job Safety Analysis Worksheet as a tool for training employees on job hazards and safe work
methods.
 Filing approved Job Safety Analysis Worksheet in the Central Safety File.
The Safety Committee is responsible for:
 Reviewing and approving/rejecting Job Safety Analysis Worksheets.
Training:
The supervisor will be trained on How to Conduct a Job Safety Analysis. Training is available from the worker
compensation insurance carrier, insuring broker, and outside vendors.
COMPANY NAME
Safety Policy & Procedure Manual
45
Core Safety Policies And Procedures
Action:
1.
2.
3.
4.
5.
6.
If necessary, the Supervisor will review their operations and complete the Job Task Risk Assessment form to
identify hazardous job tasks.
Prioritize job tasks for JSA using the Risk Index Matrix. JSA will be completed for all tasks with an index of
4 or less. Tasks with an index of 5 or 6 should be considered for a JSA after the priority tasks are completed.
Conduct the job safety analysis and completed the Job Safety Analysis Worksheet.
Provide the Safety Committee with a copy of the Job Safety Analysis Worksheet for approval.
Train employees in safe work procedures using the Job Safety Analysis Worksheet.
Filing the Job Safety Analysis Worksheet in the central safety file.
Documentation:
A Job Safety Analysis Worksheet will be used to document a job safety analysis.
The Manager will keep all approved Job Task Risk Assessment Forms, the Job Safety Analysis Worksheets
indefinitely in the central safety file.
Audit:
The Job Safety Analysis policy will be included in the annual safety program audit. Results of the audit will be
shared with Executive Management.
Terminology:
Critical:
JHA:
Job:
Likely:
Marginally:
May:
Negligible:
Probably:
Task:
Unlikely:
May cause severe injury or illness.
Job Safety Analysis - a systematic review of tasks to determine hazards and the adequacy steps
taken to mitigate them.
The operations performed by an employee on a regular basis. A job will encompass many tasks.
Likely to occur immediately or within a short period of time.
Make cause minor injury or loss.
May occur in time.
Probably would not affect personnel, cause first aid injury or result in a loss.
Has occurred or probably will occur in time.
The individual steps that make up a job.
Not likely to occur.
Risk Index Matrix
Hazard Probability
Likely
Probably
May
Unlikely
COMPANY NAME
Critical
1
2
3
4
Hazard Severity
Marginal
3
4
5
7
Negligible
5
6
7
7
Safety Policy & Procedure Manual
46
Job Task Risk Assessment
Severity
Job Task
Critical
Marginal
Probability
Negligible
Likely
Probably
CENTRAL SAFETY FILE – JSA’s
May
Unlikely
Hazard
Index
Job Safety Analysis Worksheet
Department: _________________________________________________________________
Job Task: ____________________________________________________________________
Step
Hazards
Developed by: ___________________ Approved by: _ Date: _____________
CENTRAL SAFETY FILE – JSA’s
Controls
Core Safety Policies And Procedures
Accident Investigation
Purpose:
The purpose of an accident investigation is to ensure that accident causes are identified and controlled so that a
similar occurrence can be prevented.
Scope:
This management and supervisory activity applies to all accidents, occupational illnesses, and incidents involving
company property, employees, the public, our products, and our motor vehicles.
Administration:
The Executive Management is responsible for:
 Reviewing Accident Investigation Report Forms completed by the Manager.
 Requiring the Manager to promptly implement corrective measures.
The Manager is responsible for:
 Ensuring prompt medical attention is provided to the injured/ill employee.
 Immediately investigating the accident preserving the accident scene.
 Immediately notifying Executive Management of all accidents requiring professional medical treatment.
 Completing the Accident Investigation Report Form and providing it to Executive Management.
 Promptly implementing accident prevention measures.
 Discussing accidents and accident prevention measures during safety meetings and safety committee
meetings.
 Filing Accident Investigation Report Forms in the employee's personnel file.
 Recording the injury or illness in the OSHA 300 log injury and illness log.
The Safety Committee is responsible for:
 Reviewing Accident Investigation Report Forms.
 Utilizing the safety committee representatives to communicate accident prevention measures company-wide.
COMPANY NAME
Safety Policy & Procedure Manual
51
Core Safety Policies And Procedures
Training:
The Manager and safety committee members will be trained in accident investigation. Training on how to conduct
an accident investigation is available, upon request, from the workers compensation insurance carrier, insurance
broker, and outside vendors.
The Manager will be trained in how to record injuries and illnesses in the OSHA 300 Injury and Illness Summary
Log. Training is available from the insurance carrier and insurance broker.
Timing:
Investigations will be started as soon after notification as possible. In most cases, this will be immediately after
the scene is secured, first aid is provided and action taken to mitigate the damage has been completed. In no case
is the start of the investigation to take more than 24 hours. An initial report should be prepared in the first 24
hours. A final and complete report is due to the Management as soon as practical after the investigation is
completed. Serious accidents shall be immediately reported to the Management.
Action:
1.
2.
3.
4.
5.
6.
7.
8.
Preserve the scene of the accident.
Take photographs.
Interview employees who should work in the area.
Document employee statements and date it.
Interview the injured employee.
Complete the accident investigation form.
Implement corrective measures.
Discuss accident causes and corrective measures during a department safety meeting.
Documentation:
The Accident Investigation Report Form on page 53 will be completed for all accident investigations. The
information on it, along with police reports, medical reports, and fire marshal reports will be used to complete
insurance claim forms and reports required by the government such as OSHA logs. The investigator should feel
free to supplement the basic investigation report as necessary to fully describe what happened, how it happened,
why it happened, and how to prevent a similar occurrence.
All completed accident investigations will be filed in the employee's personnel file kept for five years.
Audit:
The Executive Management will review and approve/reject each investigation report as it is submitted. In
addition, the Safety Committee will discuss them during safety committee meetings. The accident investigation
policy will be included in the annual safety program audit. Results of the audit will be shared with Executive
Management.
COMPANY NAME
Safety Policy & Procedure Manual
52
Accident Investigation Report Form
Name of Injured Employee
Job Title
Accident
Location:
How Long at this Job?
Date of Accident
Time of Accident
When was Accident Reported to Management?
AM/PM
Date
Time
Witness(es)
Nature and Extent of Injuries
(Extent: Superficial, Minor, Serious, Fatal Injury. Type: Burn, Laceration, Sprain, Amputation,
Fracture Body Part: Left Hand, Right Foot, Lower Back, etc.
What First Aid was administered?
Was Physician Seen?
Dr.
At:
Accident Description (Be Specific)
Cause of Accident
Behavioral Causes
Conditional Causes
 Performing without adequate training
 Poor guarding
 Performing without adequate equipment
 Poor housekeeping
 Working beyond physical ability
 Defective equipment tools
 Disregarding policy, procedure, or other
instructions
 Inadequate personal protective equipment
 Disregarding safety equipment
(Other)
 Hazardous workplace arrangement
(Other)
Corrective Action Plan
Consider
 Hiring procedures
 Equipment/tool selection
 Orientation procedures
 Equipment repair/ maintenance
schedule
 Specific job instructions
 Applicable work rules
 Material selection
 Rule enforcement
(discipline)
 Personal protective equipment
 Workplace
arrangement
 Adequacy of staff
 Environmental
conditions
 Guarding adequacy
Which corrections have already taken place?
Location Manager
Employee
Date
Date
Injury Review Process
(Additional Comments/Recommendations of Upper Management of Safety Committee)
Signature
cc:
Date
Follow Up Diary:
Action
Date
CENTRAL SAFETY FILE – YEAR, ACCIDENT INVESTIGATION REPORT
EMPLOYEE PERSONNEL FILE
Core Safety Policies And Procedures
Accident Analysis
Purpose:
Accidents and near-miss incidents need to be analyzed to identify problem accident trends so that corrective
measures can be implemented.
Scope:
This activity applies to all accidents, occupational illnesses, and incidents involving company property,
employees, the public, our products, our services, and our motor vehicles.
Administration:
The Manager is responsible for:
 Requiring that an analysis of accident data be conducted annually to identify causes of problem accident
trends.
 Establishing annual accident reduction goals for problem accident trends.
 Reviewing causes of problem accident trends with employees and developing an action plan for preventing
them.
 Monthly reviewing the status of attaining accident reduction goals during management staff meetings and
during safety committee meetings.
 Holding the Supervisor accountable for implementing the action plan to attain accident reduction goals.
 Filing a copy of the accident analysis and action plan for preventing problem accident trends in the Central
Safety File.
The Supervisor is responsible for:
 Implementing the action plan to attain accident reduction goals.
 Communicating the annual accident reduction goals and action plan for attaining them to employees.
 Monthly discussing the status of attaining accident reduction goals during safety meetings.
 Requiring employees to obey safety rules and safe work methods to attain accident reduction goals.
The Safety Committee is responsible for:
 Reviewing the annual accident reduction goals and action plan for preventing problem accident trends and
providing feedback to enhance it.
 Communicating status of attaining accident reduction goals during department safety meetings.
Training:
No specific training is required.
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Core Safety Policies And Procedures
Timing:
An analysis of the Accident Investigation Report forms, OSHA 300 log entries, and insurance carrier accident
reports will be conducted annually.
Action:
The analysis will be timed to coincide with the receipt of the loss runs from the insurance carrier. The period
analyzed will coincide with the carrier’s loss run. Analysis will cover the current period, year to date, as well as
an historical compilation. At a minimum, the analysis report will consist of a narrative cover memo for the loss
runs.
OSHA Incidence Rates (recordable injuries/year/100 employees) will be computed. These rates will be compared
to the incidence rates published by the Bureau of Labor Statistics for the profit center’s SIC Code. A cost per
man-hour rate also will be computed. These rates will be plotted on control charts. Positive actions are required
whenever the rates exceed the upper control limit.
The losses also will be analyzed for trends in: job title, activity, time of day, day of week, shift, body part
affected, injury type, accident type, Supervisor, cost or any other category that facilitates understanding the loss
situation. . The person doing the analysis is encouraged to look at the data from all perspectives.
Documentation:
There are no specific forms required. The analyst is encouraged to use charts, graphs, or narrative to clearly
communicate the results of the analysis.
Audit:
The accident analysis program will be included in the annual safety program audit. Results of the audit will be
shared with Executive Management.
Terminology:
Incidence rate:
IR = (N)(200,000)/EH where:
N = The number of OSHA recordable injuries and illnesses.
EH= Total hours worked by all employees during the calendar year (or current period).
OSHA Recordable: See OSHA record keeping.
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Core Safety Policies And Procedures
Safety Meetings
Purpose:
The purpose of a safety meeting is to briefly remind employees of important safety aspects and to use them when
working. Generally, a safety meeting is about five to ten minutes long and covers a single topic.
Scope:
Safety meeting(s) shall be conducted monthly for all employees.
Administration:
Manager is responsible for:
 Requiring that monthly safety meetings be conducted.
 Requiring that safety meetings be documented on the Safety Communication Meeting Form on page 35.
 Reviewing completed Safety Communication Meeting Forms.
 Filing completed safety meetings in the Central Safety File under Year - Safety Meeting Minutes.
The Supervisorsare responsible for:
 Attending and participating in safety meetings.
The Safety Committee is responsible for:
 Suggesting topics for discussion during safety meetings.
Training:
Training on how to conduct a safety meeting is available, upon request, from your workers compensation insurer.
No specific training is required.
Topics to be covered during safety meetings are suggested below:
 Safety manual related topics
 Safety related newspaper articles
 Safety rules
 Recent accidents and how they could be avoided
 Results of audits conducted by the Safety Committee, insurance carrier, etc.
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Core Safety Policies And Procedures
Timing:
Effective immediately.
Action:
1.
2.
3.
4.
5.
Schedule and plan monthly safety training sessions.
Obtain safety talk topics.
Conduct monthly safety meetings.
Document the safety meeting.
File documentation in the central safety file.
Audit:
The safety meeting policy will be included in the annual safety program audit. Results of the audit will be shared
with Executive Management.
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Core Safety Policies And Procedures
Safety Committee Meeting
Purpose:
A safety committee is a group of representatives from both management and the workforce that work together to
help administer the company safety program.
Scope:
All of the company’s operations and activities are within the purview of the safety committee.
Administration:
The Executive Management is responsible for:
 Requiring that monthly safety committee meetings be held.
 Requiring that a management representative attend the safety committee meetings on a rotational basis.
 Requiring that the safety committee meeting members select a chairman on a rotational basis.
 Reviewing safety committee meeting minutes and providing feedback to the safety committee.
 Ensuring that the safety committee fulfills its duties and responsibilities.
The Manager is responsible for:
 Bring safety information to the safety committee meeting for the committee's review. Some information may
include, but not limited to:
- Safety Inspections List listed on page 39
- Accident Investigation Report Forms.
- Safety Communication Meeting Forms
- Facility Inspection Checklists
- Personal Protective Equipment Needs Assessment Forms
 Documenting the minutes of the safety committee meeting on the Safety Communication Meeting Form on
page 35.
 Providing a copy of the safety committee meeting minutes to Executive Management.
 Posting safety committee meeting minutes on the company general bulletin board.
 Filing completed safety committee meeting minutes in the central safety file under Year - Safety Committee
Meeting Minutes.
The Safety Committee is responsible for:
 Providing guidance, direction and oversight for the company's safety program.
 Facilitate resolution of safety issues.
 Establishing priorities for operations improvements and safety program development.
 Monitoring safety activities to assure that the overall safety program is being effectively implemented.
 Monitoring employee accidents and property damage incidents to assure that the program is functioning
adequately.
 Acting as a vehicle to communicate employee safety suggestions and concerns to management for action.
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Core Safety Policies And Procedures
Training:
All safety committee members will be trained in how to conduct an effective safety committee meeting.
Action:
1.
2.
3.
4.
5.
6.
Select one employee representative from each primary area to be a safety committee member.
Select one person from management to be a safety committee member.
Conduct monthly safety committee meetings.
Document the safety committee meeting minutes.
Distribute safety committee meeting minutes.
File safety committee meeting minutes for 5-years in the central safety file under Year - Safety Committee
Meeting Minutes.
Documentation:
Minutes of the meeting will be recorded on the Safety Communication Meeting Form on page 35 and distributed
to Executive Management, and posted on the general bulletin board. Hazards shall remain on the safety
committee meeting minutes until their closure is achieved.
Audit:
The safety committee policy will be included in the annual safety program audit. Results of the audit will be
shared with Executive Management.
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Core Safety Policies And Procedures
Central Safety File
Purpose:
The purpose of the central safety filing system policy is to:

Track the implementation of the company's safety policies and procedures.

Comply with OSHA's recordkeeping requirements.

Compile accident data to evaluate the effectiveness of the safety program.
Scope:
This procedure applies to all production departments.
Administration:
The Executive Management is responsible for:
 Requiring that the Manager and Supervisor document their safety activities by using the appropriate
checklists and forms.
The Manager is responsible for:
 Ensuring that safety forms and checklists are completed in compliance with OSHA recordkeeping
requirements.
 Recording injury and illness information in the OSHA 300 log.
 Filing safety forms and checklists in either the central safety file or the employee's personnel file.
Training:
The Manager will be trained in how to properly record injury and illness information into the OSHA 300 log.
Timing:
OSHA 300 log record keeping will be kept current to within six working days. The annual summary will be
completed by February 1st and will be posted in a conspicuous place or places where notices to employees are
customarily posted. The summary will be posted from February 1st until March 1st. Accidents involving
fatalities or the hospitalization of three or more persons must be reported to OSHA within eight hours. Accidents
involving power presses must be reported to OSHA within 30 days.
Executive Management shall be notified immediately of any event requiring OSHA notification as indicated on
the OSHA 300 log.
Action:
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Core Safety Policies And Procedures
The first step in the OSHA recordkeeping process is determining whether or not an injury or illness occurred.
There is nothing to record unless an employee has experienced a work-related injury or illness that is recordable.
The work relationship is established when the injury or illness results from an event or exposure in the work
environment.
The next step is to distinguish between injuries and illnesses. All work-related illnesses must be recorded. Only
those injuries which require medical treatment (other than first aid) or involve loss of consciousness, restriction of
work or motion, or transfer to another job are recordable.
Once the incident is determined to be reportable, the Worker’s Compensation report is completed using the results
of the accident investigation. The form does not need to be completed if the insurance carrier completes it. Next,
the case is logged on the OSHA 300 form.
Documentation:
OSHA Record keeping requires the completion of the OSHA 300 form. The OSHA records must be retained in
each establishment for five calendar years following the end of the year to which they relate. The checklist on the
following page will assist you in determining OSHA recordability.
Audit:
The OSHA Recordkeeping program will be included in the annual safety program audit. Results of the audit will
be shared with Executive Management.
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Guide For Entering Injuries & Illnesses In The OSHA Log
Check Each Treatment Or Condition Which Applies
I. FIRST AID TREATMENT: (Non-Recordable)
_____ Application of ANTISEPTICS during first visit
_____ Treatment of FIRST DEGREE BURN(S)
_____ Application of BANDAGE(S) during any visit
_____ Use of ELASTIC BANDAGE(S) during first visit
_____ Removal of FOREIGN BODIES NOT EMBEDDED IN EYE if only irrigation is required
_____ Removal of FOREIGN BODIES FROM WOUND by tweezers or other simple technique
_____ Use of NONPRESCRIPTION MEDICATIONS AND administration of single dose of
PRESCRIPTION MEDICATION on first visit for minor injury or discomfort
_____ SOAKING THERAPY on initial visit or removal of bandages by SOAKING
_____ Application of hot or cold COMPRESS(ES) during first visit
_____ Application of OINTMENTS to abrasions to prevent drying or cracking
_____ Application of HEAT THERAPY during first visit
_____ Use of WHIRLPOOL BATH THERAPY during first visit
_____ NEGATIVE X-RAY DIAGNOSIS
_____ OBSERVATION of injury during visit
_____ Administration of TETANUS SHOT(S) or BOOSTER(S)
II. MEDICAL TREATMENT AND OTHER CONDITIONS: (RECORDABLE)
_____ Treatment of INFECTION
_____ Application of ANTISEPTICS during second or subsequent visit
_____ Treatment of SECOND OR THIRD DEGREE BURN(S)
_____ Application of SUTURES (stitches)
_____ BUTTERFLY ADHESIVE DRESSING(S) OR STERI STRIP(S) IN LIEU OF STITCHES
_____ Removal of FOREIGN BODIES EMBEDDED IN EYE
_____ Removal of FOREIGN BODIES FROM WOUND: if procedure is COMPLICATED because
of death or embedment, size, or location
_____ Use of PRESCRIPTION MEDICATIONS (except a single dose on first visit)
_____ Use of hot or cold SOAKING THERAPY during second or subsequent visit
_____ Application of hot or cold COMPRESS(ES) during second or subsequent visit
_____ CUTTING AWAY DEAD SKIN (surgical debridement) ___________________________________
_____ Application of HEAT THERAPY during second or subsequent visit
_____ Use of WHIRLPOOL BATH THERAPY during second or subsequent visit
_____ POSITIVE X-RAY DIAGNOSIS (fractures, broken bones, etc.)
_____ ADMISSION TO A HOSPITAL or equivalent medical facility FOR TREATMENT
_____ Loss of consciousness
_____ Transfer to another job
_____ Restriction of work or motion
_____ Lost workday(s)
_____ Occupational illness - result of anything other than an instantaneous event
_____ Chiropractic Manipulations during second or subsequent visit
_____ NEEDLESTICKS if restriction of work or motion, loss of consciousness, job transfer or if medical
treatment is given AFTER injury.
Core Safety Policies And Procedures
Program Audit
Purpose:
A Program Audit is conducted to ensure our company's safety programs, policies and procedures are being
effectively implemented to prevent employee injury and illness, and achieve compliance with OSHA mandated
safety regulations.
Scope:
This section applies to all company locations.
Administration:
The Manager shall require that an annual audit of our company's safety program, policies, and procedures. The
insurance carrier's loss control representative, insurance broker or an outside vendor can conduct this audit.
Training:
Auditors shall be familiar with COMPANY NAME SHORT's safety programs, policies and procedures, and
familiar with OSHA's safety regulations.
Timing:
A Safety Program Audit shall be conducted annually and coincide with the budgeting process to ensure proper
funding for safety related initiatives.
Action:
1.
2.
3.
4.
5.
6.
Finalize all accident data.
Designate an auditor.
Collect completed safety program documentation.
Conduct a safety program audit.
Develop recommendations.
Present an action plan and funding to top management.
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Core Safety Policies And Procedures
Documentation:
A safety and health program audit will be conducted using the Error! Reference source not found. form, or
similar form, provided on page Error! Bookmark not defined.. A report recapping the audit results with
recommendations will be developed and presented to top management for their review and consideration and a
cost / benefit analysis will be developed for recommendations provided in the report. Status of completing the
report's recommendations will be reported to executive management monthly until recommendations have been
completed.
Audit:
Not applicable.
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Annual Safety Audit
Facility: ______________________________________
Written Program Element
Comments
Safety Policy Statement
Written programs
Responsibilities defined
Safety Plan of Action
Safety Rules
Operating Procedures Posted
Administrative procedures
Written Fire Prevention Plan
Written Emergency Plan
Management Responsibility
Sufficient staff & resources
Management commitment
Communication w/ employees
Program Enforcement
Written enforcement policy
Records of disciplinary action
Managers held accountable
Hazard Identification
Department Inspections
Hazard Analysis for each task
Purpose Inspections
Safety reviews for changes
Hygiene Inspections
Hazard control procedures
Hazard Control
All hazards classified
No employee in hazard areas
Correction documentation
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Annual Safety Audit
Facility: ______________________________________
Corrective actions taken
Written Program Element
Comments
Personal Protective Equipment Program
Hazard Analysis Completed
PPE Assessment Completed
Replacement as required
Adequate stocks available
Training completed
Communication
Periodic Safety
Communication
Means For Communication
Employee Participation
Training
Safety Orientation Program
Pre-Assignment Task Training
Annual re-training
Training records maintained
Supervisors training
Specialized training
Accident Investigation and Corrective Action
Supervisors trained
Accident investigation forms
All accidents investigated
Corrective actions identified
Corrective actions taken
Written records
Trends evaluated
First-aid responders trained
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Annual Safety Audit
Facility: ______________________________________
Notes
_____________________________________________ Auditor
__________________________________________ __ Date __________________
CENTRAL SAFETY FILE – Safety Program Audits
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Specific Safety Policies And Procedures
Machine Guarding
Purpose:
The purpose of this section is to ensure that all employees are properly protected from machine hazards that could
result in injury and to assist COMPANY NAME SHORT in being compliant with various OSHA machineguarding regulations.
Scope:
This section applies to all employees that are required to identify machine hazards, develop guards for protecting
employees from injury and employees who rely on machine guards being in place to protect them from injury.
Administration:
Below are the people and their responsibilities for establishing and implementing a machine-guarding program:
The Executive Management is responsible for:
 Ensuring that machines are safeguarded so the risk for employee injury is reduced.
 Requiring the Manager to ensure that machine safeguards are in place.
Maintenance is responsible for:
 Being familiar with OSHA's machine guarding standard.
 Evaluating machinery and equipment using the Machine Guarding Checklist on page 75 to determine if
hazards exist.
 Working with employees to brainstorm guarding solutions.
 Recommending machine safeguards to the Management to reduce machine hazards.
 Maintaining machine safeguards in a proper operating condition.
The Supervisors are responsible for:
 Being familiar with OSHA's machine guarding standard.
 Training employees on potential machine hazards and proper safeguarding.
 Conducting inspections to ensure that proper machine safeguards are in place.
 Reminding employees through safety meetings, on-one-on safety talks, etc. of the dangers of machine hazards
and proper safeguarding.
 Reminding employees of safety rules pertaining to machine guarding.
 Enforcing machine guarding safety rules uniformly and in a consistent manner.
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Specific Safety Policies And Procedures
The Employee is responsible for:
 Inspecting machinery and equipment daily to determine if: all the guards are in place, operational and,
determine safe work methods for working with machine guards.
 Not operating machinery unless machine guards are in place, properly functioning and you know how to work
safely near and with them.
 Immediately reporting to the Supervisor of any machine hazards, defective machine guards or unsafe machine
conditions or by-passed machine guards.
 Obeying all safety rules pertaining to machine guarding.
Training:
Even the most elaborate safeguarding system cannot offer effective protection unless the employee knows how to
use it and why. Specific and detailed training is therefore a crucial part of any effort to provide safeguarding
against machine-related hazards. Thorough operator training should involve instruction and hands-on training in
the following:
1. Proper equipment operation based upon the manufacturer or COMPANY NAME SHORT's safe operating
procedures.
2. A description and identification of the hazards associated with particular machines.
Equipment manufacturer’s guidelines can be used for hazard identification, as well as, the Machine Guarding
Checklist on page 75.
3. The safeguards themselves and how they provide protection, and the hazards for which they are intended.
Describe the enclosures, shields and barrier guards which are intended to prevent employees from coming in
contact with moving parts, sharp objects and points of operation (shears, blades, drill bits, etc.).
4. How to use the safeguards and why.
Describe and show employees how to properly adjust blade guards, shields or other barriers which need to be
adjusted from time to time.
5. How and under what circumstances safeguards can be removed, and by whom (in most cases, repair or
maintenance personnel only).
Explain that machines cannot be operated when guards are not in place.
Removal of a guard necessitates implementation of lockout/tagout procedures. (See Control of Hazardous
Energy Sources program on page 115).
6. What to do (e.g., Contact the Manager) if a safeguard is damaged, missing, or unable to provide adequate
protection.
Damage to any guard or machine control should be immediately reported to the Manager who will make the
decision as to whether the machine can be safely operated.
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Specific Safety Policies And Procedures
Timing:
Before starting any job task, new and transferred employees shall be trained in machine hazards and how to
visually inspect guards to determine if they are in place and are properly functioning. Annual refresher training
shall be conducted for warehouse employees on machine hazards and guarding.
Action:




Provide machine guarding awareness training for maintenance and machine operators.
Require maintenance to conduct an assessment of machinery and equipment to determine if hazards are
properly guarded and make guarding enhancements using the Machine Guarding Checklist on page 75.
Incorporate visual checks of guards into monthly safety inspections to determine if machine guards are in
place.
Evaluate new machinery and equipment to determine if they are properly guarded.
Documentation:
All evaluations of machinery and equipment shall be documented using the Machine Guarding Checklist on page
75. Evaluation of mechanical power press guarding should utilize an outside vendor to conduct a through
assessment due to the complex OSHA guarding requirements. Results of machinery and equipment evaluations
shall be discussed during safety committee meetings and recorded into the minutes to document follow-up.
Audit:
The machine guarding policy will be included in the annual safety program audit. Results of the audit will be
shared with Executive Management.
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Machine Guarding Checklist
Company:
Department:
Review Made With:
Location:
Date:
MACHINE IDENTIFICATION
General Description:
Manufacturer:
Location:
Location #:
References Used*:
Procedures relating to the set-up, start-up, normal operation, "clearing jams", cleaning and maintenance of this
piece of equipment were not evaluated as part of this review.
SPECIFIC GUARDING REQUIREMENTS
YES NO
Points of Operations:
1. Is there a guard or safety device provided for each point-of-operation of the machine?
2. Do these guards allow the operator's hands, arms or other body parts to make contact with
dangerous moving parts by reaching over, under, around or through the guard?
3. Is there evidence that guards have been tampered with or bypassed to make them
ineffective (at the time of this review)?
4. Are guards firmly secured and not easily removed?
5. Are guards interlocked?
*
Power Transmission Apparatus:
1. Are there any unguarded gears, sprockets, pulleys, flywheels, belts or chain drives on the
equipment?
2. Are there any exposed set screws, key ways, collars, etc.?
3. Are guards in good condition and firmly secured?
Operator Controls:
1. Are starting and stopping controls within easy reach of the operator?
2. If there is more than one operator, are separate controls provided where operators can see
the entire operation?
3. Are controls, including foot controls, guarded against accidental activation?
*
4. Are controls labeled to identify their function?
*
5. Are emergency stop controls easily accessible and clearly identified?
*
6. Can the machine be locked out at the main power source, including:
*
Electrical # [ ]
Steam [ ]
______ Hydraulic [ ]
Pneumatic [ ]
Natural Gas [ ] ______ Other [ ]
# Some machine installations involve complex wiring schemes. Unless otherwise indicated,
the consultant has not determined if all circuits can be locked out.
Other Moving Parts:
1. Are guards provided for other hazardous moving parts of the machine, including auxiliary
*
parts?
GENERAL GUARDING REQUIREMENTS
1. Can the machine be oiled without removing any guards?
*
2. Do guards prevent objects from falling into moving parts?
*
3. Do the guards create hazards themselves such as shear or pinch points or sharp edges?
*
NOTE: _______________________________________ Whenever an * has been marked, the
assessor should provide a comment or a recommendation for the item.
COMMENTS/RECOMMENDATIONS
_____________________________________________
_____________________________________________
_____________________________________________
SPECIFIC GUARDING REQUIREMENTS
_____________________________________________
_____________________________________________
_____________________________________________
_____________________________________________
_____________________________________________
_____________________________________________
_____________________________________________
_____________________________________________
_____________________________________________
_____________________________________________
YES
NO
Specific Safety Policies And Procedures
Electrical Safety
Purpose:
The purpose of this section is to:
 Ensure people exposed to electrical energy understand its hazards and how to work safely with electricity.
 Help you comply with OSHA's Electrical Safety Related Work Practices Standard.
Safety-related work practices shall be used to prevent electric shock or other injuries relating from either direct or
indirect electrical contact, when work is performed on or near the following items that are or may be energized:
 power lines,
 electrical equipment,
 electrical circuits.
Specific safety-related work practices shall be consistent with the nature and extent of the associated electrical
hazards.
Scope:
At no time is a COMPANY NAME SHORT employee authorized to work on live electricity. Work on live
electricity must be brought to the attention of the Manager who will make arrangements for this type of work to
be performed by an outside contractor. The Manager shall be notified of any live electrical work.
Administration:
Executive Management is responsible for:
 Requiring that a survey be conducted to identify electrical hazards.
 Requiring maintenance to train employees on how to safely perform repair work on electrical hazards.
The Maintenance is responsible for:
 Conducting a survey to identify electrical hazards.
 Identifying electrical related hazards.
 Identifying employees exposed to them.
 Developing and obeying safe electrical related work practices.
 Obeying lock out and tag out procedures.
The Manager is responsible for:
 Training employees on general electrical hazards and general safe work methods;
 Require employees to follow safe work practices when working near or with electricity;
 Conducting informal observations to ensure that electrical hazards are being controlled and that safe work
procedures are being followed;
 Prohibiting employees from working on or near energized electrical circuits;
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Specific Safety Policies And Procedures
The Supervisors are responsible for:
 Requiring employees to follow safe work practices when working near or with electricity;
 Conducting informal observations to ensure that electrical hazards are being controlled and that safe work
procedures are being followed;
 Prohibiting employees from working on or near energized electrical circuits;
The Employee is responsible for:
 Obeying safe work methods when working on or near machinery and equipment powered by electricity;
 Never working on or near energized electrical circuits;
 Obeying warning signs;
 Wearing the appropriate PPE;
 Following lockout/tagout procedures and warning tags;
 Reporting unsafe conditions and work methods to his or her supervisor for correction.
Training:
OSHA requires employers to provide training for employees who face, or may face, a risk of electric shock. The
OSHA standard requires that these people receive annual training in electrical safety practices that are necessary
for their safety. All employees who face, or may face, a risk of electrical shock shall be trained in related
electrical related safety hazards and control measures shall be trained annually in electrical safety.
Timing:
This policy is immediately in effect.
Action:
1.
2.
3.
4.
5.
6.
Identify all job tasks and employees at risk of electrical shock.
Identify the current safety rules/safe practices, lockout/tagout procedures, available personal protective
equipment and safeguards needed.
Notify the Management of potential job tasks involving work on “live” electricity.
Modify or create safe work practices as necessary.
Train employees on electrical related hazards and safe work methods.
Audit safety related work practices to ensure they are being followed.
Audit:
The electrical policy will be included in the annual safety program audit. Results of the audit will be shared with
Executive Management.
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Specific Safety Policies And Procedures
Hearing Conservation
Purpose:
The purpose of this section is to:
 Establish a policy and procedure for hearing conservation to protect employees from excessive sound levels
by installing engineering controls to reduce noise;
 Provide hearing protection to attenuate noise to safe sound levels, and
 Facilitate compliance with 29 CFR OSHA 1910.95 Occupational Noise Exposure.
Definitions:
A Scale - The setting on a sound level meter that most resembles the way a human ear hears.
Audiogram - A test of an individual’s hearing threshold level as a function of frequency.
Baseline Audiogram - The audiogram against which all future audiograms will be compared.
dBA - Decibel level using the A scale.
Hertz (Hz) - Unit of sound measurement, numerically equal to cycles of sound per second.
Time-Weighted Average Sound Level - Weighted average sound level over a given amount of time usually eight
hours.
Scope:
This section applies to all departments with employees exposed to excessive sound levels (i.e., over an 8-hour
Time Weighted Average (TWA) of 85dB(A) or higher or a sudden impact noise 140dB(A) or higher).
Program Activities:
Hearing Protection Activities





Hearing protection is required in all areas where exposures of noise levels are equal to or greater than 90 dbA
for eight hours.
Employees who are exposed to noise levels at or above 85 dbA for eight hours will be included in a hearing
conservation program.
The hearing conservation program will include baseline and annual audiograms.
The employees will be provided with hearing protection.
Employees will be trained annual on effects of noise and how to protect themselves.
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Specific Safety Policies And Procedures
Sound Level Surveys





Employees will receive audiometric testing when the sound level in an area equals or exceeds an eight hour
time-weighted average of 85 dbA.
A dosimeter will be used to determine individual sound level exposures over an eight hour day.
Sound level surveys will be conducted upon request or as needed.
A sound level survey will be conducted whenever a significant change in the work environment has occurred.
Sound level equipment will be used and calibrated according to manufacturer’s specifications.
Administration:
The Executive Management is responsible for:
 Oversight of the implementation of the Hearing Conservation Program PPE program.
 Requiring employees exposed to excessive sound levels be given initial and annual audiometric exams to
monitor for hearing threshold shifts.
 Requiring employees exposed to excessive sound levels be trained in the effects of exposure to excessive
sound levels and methods of hearing conservation.
 Providing hearing protection and training at no cost to the employees.
The Manager is responsible for:
 Requesting that sound level testing of work areas be conducted to identify employees exposed to excessive
sound levels whenever operations significantly change.
 Implementation of the Hearing Conservation Program PPE program within the facility.
 Informing the executive management of work areas and job tasks suspect of excessive sound levels.
 Maintaining the integrity of engineering interventions.
 Enforcing hearing protection in designated areas.
 Allowing employees exposed to excessive sound levels be given initial and annual audiometric exams to
monitor for hearing threshold shifts.
 Allowing employees exposed to excessive sound levels be trained in the effects of exposure to excessive
sound levels and methods of hearing conservation.
The Employee is responsible for:
 Having his or her hearing tested initially and annually thereafter.
 Wearing hearing protection in designated areas.
 Keeping hearing protection clean.
 Reporting defective or missing noise reduction engineering interventions for repair.
Training:
The hearing conservation training shall occur prior to the employee engaging in work where excessive sound
levels exist and be conducted by the vendor providing employee audiometric testing.
Employee training shall at least cover the following areas:
 Employees will be trained on effects of noise on hearing.
 Employees will be trained on the purpose of hearing protection including the advantages and disadvantages of
various types of hearing protection, and instruction on selection, fitting, use and care of hearing protection.
 Employees will be trained on the purpose of audiometric testing and how they will be administered.
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Specific Safety Policies And Procedures
Audiometric Testing:







Employees who are to receive an audiogram during the workday must wear hearing protection prior to their
test.
Employees will be encouraged to refrain from any noisy non-work related activities fourteen hours prior to
their test.
Each employee’s audiogram will be examined to determine if a standard threshold shift relative to the
baseline has occurred.
If a shift in the employee’s hearing has occurred, the employee will be required to wear hearing protection
while working in high noise areas and will be fitted and trained in their use and care.
Employees already wearing hearing protection will be retrained and/or refitted in their use and provided with
hearing protection offering greater protection if necessary.
The employee will be informed if future audiometric tests indicate that the standard threshold shift is not
permanent.
The employee may discontinue the mandatory wearing of hearing protection if an audiometric test indicates
the threshold shift was temporary.
Timing:
The hearing conservation program is immediately in effect.
Action:
The manager will decide on all engineering interventions and availability of an assortment of hearing protection.
Documentation:




Records of all sound surveys will be maintained for a period of three years. See the following page for a
general sound level survey of the facility.
Complete records of the results of audiometric test for all employees must be kept for employment plus 30yrs.
Use the Hearing Conservation Training Record to keep accurate records of all hearing conservation training
activities, recording all participants and training pertaining to this activity.
Training records must be kept for a minimum of three years.
Audit:
Manager and Supervisors will ensure that employees wear hearing protection and that engineering controls are in
place.
The hearing conservation program will be included in the annual safety program audit.
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Specific Safety Policies And Procedures
SAMPLE
DIAGRAM
SAMPLE
DIAGRAM
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Specific Safety Policies And Procedures
Crane, Hoist and Sling Safety
Purpose:
The purpose of this section is to reduce the risk for employee injury from using cranes, hoists, slings and facilitate
compliance with OSHA standard 29 CFR 1910.179 Overhead and Gantry Cranes and OSHA standard 29 CFR
1910.184 Slings.
Scope:
This section applies to all employees who operate cranes, shop hoists and use slings to rig a load for lifting.
Administration:
The Executive Management is responsible for:
 Requiring that all employees who operate cranes, hoists and rig loads are properly trained.
 Requiring that cranes, hoists and slings be on a preventative maintenance schedule.
 Requiring that cranes and hoist operators inspect his or her equipment for unsafe conditions daily.
The Manager is responsible for:
 Ensuring that all employees who operate cranes, hoists and rig loads properly trained.
 Ensuring that all daily inspections are completed before the equipment is operated.
 Observing people operating cranes, hoists and rig loads for safe work practices.
The Crane and Hoist Operators are responsible for:
 Conducting a daily visual inspection for unsafe conditions and reporting deficiencies to maintenance for
repair.
 Requiring the load to be safely rigged before lifting it.
 Following all safety rules.
Training:
Crane, hoist and rigging training shall be specific to the equipment they will be expected to operate and the loads
they will be expected to lift. Generally, they cover:
 When the equipment shall be inspected.
 Who shall conduct inspections.
 What to look for.
 How daily inspections are conducted and documented.
 How to report unsafe equipment and unsafe conditions for correction.
 Proper crane and hoist operation and proper load rigging procedures.
 Conduct a practical test of his or her knowledge and a test of his or her skills.
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Specific Safety Policies And Procedures
Timing:
This safety procedure is effective immediately.
Action:
1.
2.
3.
4.
5.
Maintenance shall maintain a log of preventative maintenance schedules.
Identify employees required to operate cranes, hoists, and rig loads.
Conduct training.
Document training file.
Supervisor shall conduct periodic observations for compliance.
Documentation:
Cranes, hoist and slings shall be a part of the monthly safety inspection. No other specific form is required.
Audit:
The crane, hoist and sling safety policy will be included in the annual safety program audit. Results of the audit
will be shared with Executive Management.
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Safety Rules
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Safety Rules
General Safety
1. Use of alcohol or illegal drugs is sufficient cause for termination.
2. Ask the Manager a question if you are unsure of how to work in a safe manner.
3. Do not use any hazardous materials for which you have not been trained in safe handling precautions.
4. Work in a safe manner at all times and use good judgment to prevent injury to yourself and to others.
5. Horseplay is not permitted and may be sufficient cause for termination.
6. Immediately inform your supervisor of hazards that could cause an injury or illness.
7. Keep your work area clean.
8. Do not operate powered equipment unless trained and authorized.
9. Do not operate any equipment unless all safeguards and safety devices are in place.
10. Do not by-pass any safeguards, safety devices or lockout/tagout devices.
11. Obey warning signs and signals.
12. Walk within designated pedestrian aisles.
13. Climbing on storage racks is prohibited.
14. Wear personal protective equipment.
15. Wearing loose fitting jewelry is prohibited. "Loose jewelry" includes, but is not limited to, dangling
bracelets, dangling watches, necklaces, dangling earrings, and loose rings.
16. You must wear earplugs whenever working in designated areas or when using noisy equipment.
17. Use proper lifting techniques when lifting.
18. Ask for help when lifting heavy or bulky objects.
19. Immediately report all accidents, regardless of how minor, to your supervisor.
20. Do not self-treat any injury.
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Safety Rules
Fire Protection
1.
Smoking is only allowed in authorized areas.
2.
No open flames shall be permitted in areas where flammable gases or liquids are stored and used.
3.
Flammable liquids, such as gasoline, etc. must be stored in approved safety cans and properly labeled.
4.
Dispense flammable liquids away from open flames and other ignition sources using proper grounding and
bonding.
5.
Open flame heaters, as well as electric heaters, shall be properly guarded and automatically shut-off if
tipped over.
6.
No clothing or other combustible material shall be stored in proximity to any open flame or electric heater
in such a manner as to permit ignition.
7.
Do not operate fire extinguishers unless you are trained and authorized to do so.
8.
Do not attempt to extinguish a fire in a confined space, immediately evacuate the area.
9.
After using a fire extinguisher, turn it in for refilling.
10.
Rags and paper that have come in contact with flammable fluids shall be stored only in approved safety
containers.
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Safety Rules
Housekeeping
1.
Each employee is responsible for good housekeeping of his or her work area.
2.
Debris shall be disposed of in approved waste receptacles.
3.
Aisles, passageways and exits shall be clear and free of debris.
4.
Any liquid substance spilled on the floor shall be immediately cleaned up.
5.
Do not place tools or other devices on any machine.
6.
Empty pallets shall not be stored over 6' high. However, at work areas, empty pallets should not be stacked
more than 10 high.
7.
Pallets shall only be stored in designated areas.
8.
Stairways and fixed ladders shall be kept free of obstructions.
9.
Power cables and air lines should be kept out of walking paths.
10.
Nothing shall not be stored or stacked on electrical power cords and electrical extension cords.
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Safety Rules
Machinery
1. Only operate machinery and equipment that you are trained to operate and authorized to operate.
2. Do not operate unsafe machinery and equipment.
3. Immediately report unsafe machinery & equipment.
4. Loose clothing, neckties, gloves, rings and bracelets, and neck chains shall not be worn when working with
rotating machinery.
5. Long hair shall be secured in a manner so that it cannot get caught.
6. Obey warning signs and alarms.
7. Immediately report a missing warning sign.
8. Keep guards and safety devices in place.
9. Do not try to by-pass guards and safety devices.
10. Lockout and tagout machinery before servicing it.
11. Only remove your lock & tag.
12. Obey lockout and tagout procedures.
13. Do not work on or near exposed energized electrical circuits.
14. Stop, lock and tag machinery before oiling, cleaning and clearing jams.
15. Make shift modifications are prohibited.
16. Use a brush, not a hand or air pressure, for removing chips and debris.
17. Do not distract machine operators while operating machinery.
18. Do not leave machines running and unattended.
19. A clamp shall be used to hold work being drilled on a drill press.
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Safety Rules
Hand Tools
1.
Use the proper tools for the job.
2.
Examine tools for defects before using it.
3.
Tools with mushroomed heads or hammers with split or loose handles shall not be used.
4.
Keep hand tools clean.
5.
Use wrenches of proper size for the job and place them so the pull forces the jaws onto the nut or stud head.
6.
Files shall be used only when equipped with handles.
7.
Sharp and pointed tools shall be carried in sheathes instead of loose in the pocket.
8.
Wear safety glasses when cutting, striking, etc. hardened steel or other brittle material.
9.
Keep hands out of path of sharp tools.
10.
Do not leave tools lying where someone can slip or trip over them.
11.
Do not leave the chuck wrench in the chuck.
12.
Always shut off air at the manifold and bleed the air hose before disconnecting the machine, hand tools or
air hose.
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Safety Rules
Personal Protective Equipment
1.
Employees who are exposed to hazards of flying or falling objects shall wear appropriate protective
clothing and safety devices.
2.
Employees shall wear proper goggles when working in locations where eye hazards due to flying particles,
hazardous substances or injurious light rays are present in the work environment.
3.
Approved goggles or face shields must be worn when handling rough, sharp or hot materials, as well as
chemically active substances.
4.
Respirators or other approved breathing devices shall be worn by trained and authorized employees when
working in areas containing dust, fumes, mist, vapors or gases which if breathed can cause bodily injury.
5.
All employees must wear and use a safety harness and a lanyard on all elevated locations as prescribed by
OSHA.
6.
All production and maintenance personnel must wear approved shoes at all times.
7.
All employees must wear appropriate eye protection when in the production and warehousing areas.
8.
Appropriate hearing protection must be worn when in designated areas when machinery is operating.
9.
Appropriate hand protection will be worn when performing specific hazardous job functions.
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Safety Rules
Electricity
1.
Only authorized and qualified persons shall make repairs to electrical equipment.
2.
All electrical devices shall be grounded.
3.
Never use portable or fixed electrical equipment unless it is properly grounded.
4.
Electrical equipment that is overheated heated or sparking shall be safely shut off and maintenance shall be
immediately called to correct the situation.
5.
Working surfaces shall be kept dry when working with or near electrical apparatus.
6.
All electrical wires must be considered live until proven otherwise.
7.
A switch shall not be closed without full knowledge as to why the circuit is open. Only the person who
tagged the switch open shall remove the tag on a switch.
8.
Do not use any electrical equipment with frayed or otherwise deteriorated insulation. Use the lock-out/tagout procedure to remove it from service until repairs can be made.
9.
Only approved electrical leads and connectors shall be used.
10.
Never work on a live electrical circuit.
11.
Makeshift electrical repairs and connections to cables, cords, connections are prohibited.
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Safety Rules
Compressed Gas Cylinders
1.
Compressed gas cylinder must be visually inspected before use.
2.
Compressed gas cylinders must not be stored in direct sunlight or any area exceeding safe temperature
guidelines.
3.
Employees must not use a cylinder of compressed gas without reducing the pressure through a regulator
attached to the cylinder valve.
4.
Oil or grease shall not be used as a lubricant on valves or attachments on oxygen cylinders.
5.
Cylinders of oxygen, when stored, shall be kept in areas separate from flammable gases by 20 feet or more.
6.
Cylinders must be kept in racks or stands or lashed to prevent their being knocked over.
7.
The valve protector cap must be kept in place whenever cylinders are in storage.
8.
Do not stand in front of gauges when opening the discharge valve.
9.
Handling of cylinders by hoists or similar devices must be done only when the proper racks are used. Rope
or wire slings are forbidden.
10.
Cylinders must never be dropped or treated roughly.
11.
Leaky gas cylinders must be placed outdoors and away from ignition sources immediately upon being
noticed.
12.
Inspect hose lines frequently for leaks.
13.
The welder or burner involved is responsible for fire watch.
14.
Welders must be certain that approved fire-fighting equipment is nearby before starting welding operations
when working in vicinity of flammable or combustible materials.
15.
Do not use hoses with makeshift repairs.
16.
Flame back-flow valves must be in place.
17.
All cylinders must be transported in an upright position.
18.
Cylinder valves must be closed and regulators bled off after use and prior to transporting.
19.
Do not exceed specified pressure settings on gas and oxygen pressure regulators.
20.
The appropriate personal protective equipment must be worn when working with compressed gases.
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Safety Rules
Office Safety
1. Report all defective equipment for repair.
2. Stair rails or wall rails should be used when ascending or descending stairs.
3. Make sure that fingers are on handle of paper cutter before pressing down on blade.
4. Keep fingers away from ejecting slot when loading or testing stapling tools.
5. Do not go into dark places without adequate lighting.
6. Always close scissors when you are through using them.
7. Do not pull open more than one file cabinet drawer at a time.
8. Always close file cabinet drawer when you leave the cabinet.
9. Do not stand on chairs, boxes or crates, use appropriate ladders.
10. All heating appliances such as coffee makers, toasters and space heaters as unauthorized are prohibited.
11. Each employee shall be responsible for keeping his or her working area free of clutter and tripping hazards.
12. No materials or boxes are to be placed in aisles, in front of electrical breaker panels or in areas obstructing
exits.
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Safety Rules
Manual Materials Handling
1. Your first choice shall be to use a mechanical or powered device to lift an object. Your next choice shall be to
obtain assistance in lifting an object. Your last choice shall be to manually lift the object.
2. Use the following procedures when preparing to manually lift a load:
Preparation For Lifting a Load:
a) Examine the load for sharp edges, protruding points or sharp objects, signs of weakness, weight
distribution or other factors likely to cause injury to persons handling objects. Appropriate measure shall
be taken so that the load can be safely lifted.
b) Obtain gloves or other personal protective equipment against minor hand injuries.
c) Walk your travel path and make sure it is clean and clear.
d) Check where you will set your load down to determine if you and the load have enough space.
e) Test the weight and size of the load to determine if it is in your personal lifting capacity and if you
can safely control it.
f) Stretch out the muscles before lifting the load.
2. Use the following Basic Two-Hand Lift Method when appropriate:
Basic Two-Hand Lift Method:
a) Squat down and get your chest close to the load.
b) Pivot at the hips. Do not bend at the waist.
c) Get a firm grasp on the load.
d) Keep you back in a normal "S" shape.
e) Exhale as you lift.
f) Left with your legs.
3. Use the following Two-Hand Lift Method For Two People when appropriate:
Two-Hand Lift Method For Two People:
a) Pick a lifting partner that is approximately the same height as yourself.
b) Establish a mutually agreeable " verbal command" that will initiate the lift.
c) Squat down and get your chest close to the load.
d) Pivot at the hips. Do not bend at the waist.
e) Get a firm grasp on the load.
f) Keep you back in a normal "S" shape.
g) Lift on the "verbal command".
h) Exhale as you lift.
i) Left with your legs.
4. Use the following One-Hand Lift Method when lifting or lowering a load into the bottom third of a sturdy
container:
One-Hand Lift Method:
a) Stand at the container (e.g., 55-gallon drum) with one leg alongside the drum and other leg near its
front.
b) Place one hand on its top edge.
c) Pivot at the hip and bend at the knee while supporting the weight of the upper body with the arm on
the top edge of the container when reaching inside it to lift an object.
d) Simultaneously, use the muscles in the arm and abdomen to stand upright.
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Safety Rules
Ladders, Stairs and Platforms
1.
All ladders shall be checked before using to make certain that rungs and side rails are in good condition and
any ladders in for repair shall be tagged “DANGEROUS, DO NOT USE” or similar wording.
2.
Portable straight ladders shall have safety feet and be firmly placed on a safe surface.
3.
Both hands shall be kept on the ladder when descending or ascending.
4.
Stepladders must be fully opened and in sound condition before being used.
5.
When on a ladder, exercise caution and do not overreach. Keep your chest close to the rails of the ladder.
6.
When it is necessary to place ladders in front of a blind doorway, the door should be locked or guarded by a
co-worker.
7.
Barrels, boxes, chairs or crates shall not be used in place of stepladders or portable steps as working
platforms.
8.
Packages or other materials carried on stairways should be held so that vision is not obscured.
9.
Tools and materials must not be stored on platforms. When practicable, the area beneath overhead
operations should be marked with warning signs and safety cones.
10.
Keep at least 10 feet clear of dangerous or exposed electrical conductors or equipment.
11.
All extension ladders shall be secured at the top to a fixed object.
12.
Check the condition of rubber feet on rolling stairs before using it. Worn feet must be replaced.
13.
Rolling stairs shall be "locked" from movement before ascending the stairs.
14.
Use handrails when ascending or descending stairways.
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Safety Rules
Welding Safety
Electrical Safety
1. Insulate welder form workpiece and ground using a dry rubber mat or dry wood for insulation.
2. Wear dry, hole-free gloves.
3. Do not touch electrically "hot" parts or electrode with bare skin or wet clothing.
4. If wet area and welder cannot be insulated from workpiece with dry insulation, use a semiautomatic, constantvoltage welder or stick welder with voltage reducing device.
5. Keep electrode holder and cable insulation in good condition. Do not use if insulation is damaged or missing.
Respiratory Safety
6. Use ventilation or exhaust to keep air breathing zone clear, comfortable.
7. Use helmet and positioning of head to minimize fume in breathing zone.
8. Read warnings on electrode container and material safety data sheet (MSDS) for electrode.
9. Provide additional ventilation/exhaust where special ventilation requirements exist.
10. Use special care when welding in a confined area.
11. Do not weld unless ventilation is adequate.
Fire and Explosion Safety
12. Do not weld on containers, which have held combustible materials.
13. Remove flammable materials from welding area or shield from sparks, heat.
14. Keep a fire watch in area during and after welding.
15. Keep a fire extinguisher in the welding area.
16. Wear fire retardant clothing and hat. Use earplugs when welding overhead.
Burn Prevention
17. Select a filter lens that is comfortable for you while welding.
18. Always use helmet when welding and tacking.
19. Provide no-flammable shielding to protect others.
20. Wear clothing that protects shin while welding.
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Safety Rules
Welding Safety (continued)
Confined Space Hazards
21. Carefully evaluate adequacy of ventilation especially where electrode requires special ventilation or where
gas may displace breathing air.
22. If basic electric shock precautions cannot be followed to insulate welder from work and electrode, use
semiautomatic, constant-voltage equipment with cold electrode or stick welder with voltage reducing device.
23. Provide welder helper and method of welder retrieval from outside enclosure.
General Work Area Hazards
24. Keep cables, materials, tools neatly organized.
25. Connect work cable as close as possible to area where welding is being performed.
Electrical Equipment
26. Use only double insulated or properly grounded equipment.
27. Always disconnect power to equipment before servicing.
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Special Emphasis Safety Programs For OSHA Compliance
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Hazard Communication Program
Hazard Communication Program
Purpose
The purpose of this program is to assure that COMPANY NAME SHORT is complying with the OSHA Hazard
Communication Standard, Title 29 Code of Federal Regulations 1910.1200, by:
 Compiling a list of hazardous substances.
 Maintaining an effective MSDS system.
 Maintaining an effective labeling system.
 Providing employees with effective and appropriate personal protective equipment.
 Communicating hazards and safe handling methods to all employees.
 Auditing the HAZCOM program to ensure its effectiveness.
This program applies to all work operations in our company where you may be exposed to hazardous substances
under normal working conditions or during an emergency situation.
Responsibilities
The following people have specific responsibilities for implementing an effective HAZCOM program.
The Executive Management's responsibilities is to:
 Require a HAZCOM program to be implemented.
 Hold the Manager accountable for implementing the HAZCOM program.
 Require an annual audit of the program.
The Purchasing Manager's responsibilities are to:
 Require manufacturers to affix a MSDS on a shipment of new hazardous substances.
The Manager's responsibilities are to:
 Conduct annual employee HAZCOM training.
 Prohibit use of new or updated hazardous chemicals until MSDS training is conducted for employees.
 Conduct inspections to ensure hazardous substances are properly labeled.
 Require safe storage and safe handling of hazardous substances and compressed gases.
 Require that emergency equipment to be properly maintained.
 Respond to chemical emergencies.
 Keep the MSDSs binders up to date.
 Keep the master list of MSDSs up to date.
 Keep obsolete MSDSs in a separate binder for 30 years.
 Keep the HAZCOM Program complete in the binder.
 Keep the instructions on How To Read An MSDS in the binder.
 Maintain audit documentation.
The Receiving Clerk's responsibilities are to:
 Check the MSDS affixed to a chemical shipment against the master list of MSDSs to:
- identify new chemical substances,
- a change in hazard rating, or
Hazard Communication Program


- a change in required personal protective equipment.
For chemicals on the master list that have not changed, the Receiving Clerk will:
- complete a HMIS label,
- affix it to the chemical container, and
- notify the supervisor that his chemical shipment has been received and is available for use by trained
employees.
For new chemicals, chemicals that have a change in hazard rating or a change in required personal protective
equipment, the Receiving Clerk will:
- complete a HMIS label.
- affix it to the chemical's container.
- prohibit the chemical from being used by marking it with signs, barrier tape, etc.
- provide the MSDS to the Manager.
- notify the person who ordered the materials that the shipment has been received and that the MSDS can
be obtained from the Manager so that employee MSDS training can be conducted.
The responsibilities of the Employee are to:
 Know where the MSDS binder is located.
 Read and understand container labels and material data safety sheets.
 Use only approved containers for storing hazardous chemicals.
 Keep flammable and explosive materials away from heat sources.
 Follow safe work methods and safety rules.
 Wear personal protective equipment.
 Don't handle sharp objects with your hand. Use a broom and dust pan to pick them up.
 Keep containers closed.
 Use mechanical ventilation to exhaust a mist.
 Ventilate the work area with fresh air.
 Keep chemical areas clean and clean up all chemical spills immediately.
 Dispose of contaminated material properly.
 Wash hands before handling foods.
 Don't smoke, eat, or drink around hazardous substances.
 Know the location of emergency equipment.
 Notify the Supervisor if you find a container without a HMIS and manufacturer's label.
 Notify the Manager if you find materials missing from the MSDS binder.
Under this program, employees will be informed of the contents of the Hazard Communication Standard, the
hazardous properties of chemicals with which they work, safe handling procedures, and measures to take to
protect themselves from these chemicals. They will also be informed of the hazards associated with non-routine
tasks and the hazards associated with chemicals in pipelines.
The Hazardous Chemical Labeling System
COMPANY NAME SHORT will use the HMIS (hazardous material identification system) labeling system to
identify hazardous substances and personal protective equipment that must be worn by employees working with
hazardous chemicals. Poster(s) will be displayed to communicate the HMIS labeling system. HMIS labels will
be used to provide the chemical's name, appropriate hazard warnings, and alphabetic letter for required personal
protective equipment.
The MSDS System
Hazard Communication Program
COMPANY NAME SHORT will rely on the chemical manufacturer's MSDS for communicating chemical
information to employees required to use hazardous substances. The Manager will order chemicals through
Purchasing unless those chemicals are household items and are purchased in household quantities. COMPANY
NAME SHORT will not maintain MSDSs on household type chemicals used and stored in household quantities.
Otherwise, the Purchasing Manager, Manager and the employee receiving the shipment will work together as
described in the Responsibilities section to maintain up to date MSDS binders and labeling on hazardous
chemicals.
No label is required on a portable that is used to immediately transfer a hazardous chemical from a labeled
container to another labeled container.
Non-Routine Tasks
When required to perform non-routine tasks with hazardous chemicals, (e.g., cleaning tasks, entering confined
spaces etc.), a special training session will be conducted by the Manager to inform the employee of the hazardous
chemicals to which he or she might be exposed and the proper precautions to take to reduce or avoid exposure.
Training
Everyone who works with or is potentially exposed to hazardous chemicals will receive initial training on the
Hazard Communication standard and the safe use of those hazardous chemicals by his or her Supervisor.
HAZCOM training materials are provided for this purpose in a separate training guide. Contact the Manager for
HAZCOM training materials. Whenever a new hazardous chemical is introduced, additional training will be
provided before the substance is used.
Hazard Communication Program
The training plan will emphasize these items:
 Summary of the standard and this written program.
 Chemical and physical properties of hazardous materials (e.g., flash point, reactivity) and methods that can be
used to detect the presence of chemicals (including chemicals in unlabeled pipes).
 Physical hazards of chemicals (e.g., potential for fire, explosion, etc.).
 Health hazards, including signs and symptoms of exposure, associated with exposure to chemicals and any
medical condition known to be aggravated by exposure to the chemical.
 Procedures to protect against hazards (e.g., personal protective equipment required, proper use, and
maintenance; work practices or methods to assure proper use and handling of chemicals; and procedures for
emergency response).
 Work procedures to follow, to assure protection when cleaning hazardous chemical spills and leaks.
 Where MSDS’s are located, how to read and interpret the information on both labels and MSDS’s, and how
employees may obtain additional hazard information.
The Manager will review the hazardous chemical list and job tasks to determine who needs HAZCOM training
and advise Executive Management on training or retraining needs. Retraining is required when the hazard
changes or when a new hazard is introduced into the workplace, but it will be company policy to provide training
regularly in safety meetings to ensure the effectiveness of the program; and at least annually. As part of the
assessment of the training program, the Manager will obtain input from employees regarding the training they
have received, and their suggestions for improving it.
Contractor Employers
The Manager will advise outside contractors in person of any chemical hazards that may be encountered in the
normal course of their work on the premises, the labeling system in use, the protective measures to be taken, and
the safe handling procedures to be used. In addition, the Manager will notify these individuals of the location and
availability of MSDS’s. Each contractor bringing chemicals on-site must provide us with the appropriate hazard
information on these substances, including the labels used and the precautionary measures to be taken in working
with these chemicals. The contractor will acknowledge by signature that the hazard communication program has
been reviewed and contractor’s employees are aware of its contents.
Additional Information
All employees can obtain further information on this written program, the hazard communication standard,
applicable MSDSs, and hazardous chemical information lists from the MSDS center, the Manager and the
supervisor.
Hazard Communication Program
Hazard Communication Training
The purpose of hazard communication is to inform people about the physical and health risks of the chemicals
found in their work environments. The potential hazards of any chemical include physical and health risks such
as:




Fire - under what conditions the material burns or contributes to a fire;
Explosion - any conditions that cause the chemical to explode;
Reactivity - the potential of the chemical to combine with other chemicals to result in a fire, explosion, or
evolution of poisonous atmospheres; and
Health risk - the potential to have short-term (acute) or long-term (chronic) effects on people.
Hazard communication information is found on labels and in Material Safety Data Sheets (MSDS).
 Labels are on every container and provide basic information about the chemical’s hazards and simple safety
procedures.
 The MSDS provide additional details such as procedures to follow in case of leak or spill and first aid
instructions.
Please see the Hazard Communication row of the General Safety Training Matrix on page 27 to identify safetytraining materials available on that topic. Training sessions will be documented using the Safety Communication
Meeting Form on page 35.
Program Audit
Annually, the Hazard Communication Program will be audited to determine its effectiveness. To accomplish this
goal, the Error! Reference source not found. on page Error! Bookmark not defined. will be used, at a
minimum, to document the audit.
Hazard Communication Program
Reading A Material Safety Data Sheet
All Material Safety Data Sheets or MSDS contain the same type of information. They may follow different
formats. They generally have similar section headings.
Below is a summary of the basic information typically found under the following general headings within the
MSDS.
Names



The name and address of the manufacturer, importer, or party responsible for preparing the MSDS.
The telephone numbers, both emergency and non-emergency.
The trade names of the materials found on the product label.
Hazardous Ingredients

The chemical will be identified by both its chemical identity and its common name under the following four
conditions:
- Any single chemical substance found to present a physical or health hazard,
- Chemical mixtures tested as a whole and determined as hazardous,
- Chemical mixtures, not tested as a whole, but containing 1% or more of ingredients that present a
physical or health hazard, and
- Mixture ingredients identified as carcinogens or potential carcinogens and comprise 0.1% or greater
of the total mixture.
Physical and Chemical Characteristics


The melting point, boiling point, density, specific gravity, etc. (See Appendix A for definitions of these and
other terms.)
Physical appearance and odor.
Fire and Explosion Hazards

The chemicals’ flashpoint (FP), flammable limits (LEL & UEL), recommended extinguishing media, special
fire fighting procedures, and unusual fire and explosion hazards.
Chemical Stability and Reactivity




Chemical stability - whether the chemical is stable or unstable under reasonably perceivable conditions of
storage, use and misuse.
Incompatible materials and their attendant hazards - chemicals or materials that can initiate a potentially
dangerous reaction when brought into contact with an otherwise stable substance.
Decomposition (the breakdown of a chemical into simpler chemicals) - the causes and whether the
decomposition products are hazardous.
Polymerization (the forming of chemical bonds that results in a long chain molecule called a polymer) - this
reaction can be hazardous if enough heat is released to cause a fire or explosion.
Hazard Communication Program


Whether the chemical reacts readily with air.
Whether the chemical changes its structure when exposed to various combinations of temperature, pressure,
and light conditions.
Health Hazard




Routes of entry - inhalation, ingestion, injection and absorption of the chemical through the skin. Be aware of
all the potential routes of entry based on the parts of the body that are exposed to the chemical.
Acute health hazards (affect the body quickly) versus chronic health hazards (exposure to material over long
periods of time before there are any noticeable effects). Animal testing and reviewing long term human
exposure to the materials identifies these hazards. The signs and symptoms include obvious physical
indications and subjective complaints attributable to the exposure.
Carcinogenicity, signs and symptoms of exposure, medical conditions generally aggravated by exposure.
Emergency and first-aid procedures - immediate steps to take in the event of a medical emergency until a
qualified medical professional can examine the victim.
Safe Handling and the Use of the Chemical




Steps to take in the event that the material is released or spilled.
Appropriate waste disposal methods.
Precautions to take in handling and storing the material.
Other safety precautions.
Reducing Exposure


Engineering controls (the main form of defense against exposure) include:
- Ventilation systems are of two types: local exhaust (captures and removes contaminates at the source)
or general dilution type (reduces contamination levels by circulating fresh air throughout the work
environments);
- Special enclosures; and
- Other mechanical protection systems.
- Personal protective equipment - specific type of protective gloves, safety glasses, goggles, face
shields, aprons, boots, and the exact type of respiratory equipment and materials needed for each
individual chemical. Reminder: Personal protective equipment that is effective for one chemical may
be entirely inappropriate for another.
Appropriate work and hygienic practices.
Exposure Limits
(In some formats this is included under “Hazardous Ingredients”)




All the following measures must be listed:
OSHA permissible exposure limits (PEL) and short-term exposure limit (STEL);
American Conference Governmental Industrial Hygienists (ACGIH) threshold limit values (TLVs); and
Other exposure limits for the hazardous component.
Hazard Communication Program


PELs and TLVs are time-weighted average (TWA) concentrations of the chemical in air, for a normal 8 hour
work day and a 40 hour work week, to which nearly all workers may be repeatedly exposed without adverse
effects.
Units are commonly expressed as parts per million (ppm) or milligrams per cubic meter (mg/m3).
COMPANY NAME
Request for Material Safety Data Sheets
Date: _________________________________________ _________________________________________
_____________________________________________
Manufacturer: __________________________________ _________________________________________
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_____________________________________________
_________________________________________
_________________________________________
_________________________________________
_________________________________________
Request for Material Safety Data Sheets (MSDS - OSHA Form 20)
To Whom It May Concern:
By this letter, we are requesting that you provide us with the Material Safety Data Sheet(s) OSHA Form 20 for the
substances listed below. Our request is made under the provisions set forth by the OSHA-Hazard Communication
Standard 1910-1200.
_____________________________________________
_____________________________________________
_____________________________________________
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_________________________________________
Please forward current MSDS’s to:
d
_____________________________________________ Name: ____________________________________
_____________________________________________ _________________________________________
_____________________________________________ _________________________________________
_____________________________________________
_____________________________________________ Company: _________________________________
_____________________________________________ _________________________________________
_____________________________________________ _________________________________________
_____________________________________________ Address: __________________________________
_____________________________________________ _________________________________________
_____________________________________________ _________________________________________
_____________________________________________ Fax: ______________________________________
_____________________________________________ _________________________________________
_____________________________________________ _________________________________________
_____________________________________________
_____________________________________________ Phone: ____________________________________
_____________________________________________ _________________________________________
_____________________________________________ _________________________________________
_____________________________________________
d
Control of Hazardous Energy Sources
(Lockout / Tagout)
Control of Hazardous Energy Sources
Introduction
The purpose of this program is to assure that COMPANY NAME is complying with the OSHA Control of
Hazardous Energy Source (Lockout / Tagout) Standard, Title 29 Code of Federal Regulations 1910.147, by
establishing practices and procedures required to be followed to disable machinery or equipment and to prevent
the release of potentially hazardous energy while maintenance and servicing activities are being performed and to
train employees affected. This policy requires that lockout devices be utilized for equipment, which is designed
with a lockout capability except when it can be demonstrated that utilization of tag-out provides full employee
protection. For equipment which was not designed to be locked out, the employer may use tag-out.
This program applies to all employees and contractors who perform maintenance, repair, adjustment, set-up,
unjamming, lubrication, installation, or any other type of work on equipment that requires the energy sources to
be locked and tagged out.
Required Equipment
The following equipment is used to properly lockout / tagout energy sources:
1.
Padlocks will be one standard shape, size and color. Each Authorized employee will be assigned his or her
own lock. Locks will have a means to identify the individual lock user, such as a tag or stamp number.
Each lock will have one key held by the individual lock user. No combination locks are to be used.
2.
Lockout hasps will be constructed of material sufficient to prevent unauthorized removal. This measure
helps to guarantee that energy sources will remain locked out until the Authorized employee or contractor
has completed his/her work. Equipment with extension cords does not have to be locked out as long as the
Authorized employee or contractor performing service on this type of equipment maintains exclusive
control of the energy-isolating device.
3.
Danger tags are warning devices that are to be securely attached to an energy isolating or energy
controlling device and indicate that energy may not be turned to the “on” or active position. The
Authorized employee or contractor who is servicing the equipment will have their name clearly identified
on the danger tag as well as the date in which the service is being performed.
4.
Other lockout equipment includes but is not limited to valve covers, ball valve lockouts, chains, plug locks,
power cord locks, wall switch locks, fuse blockouts, lockable emergency stop buttons, and circuit breaker
blackouts and lockout devices.
COMPANY NAME
Safety Policy & Procedure Manual
115
Control of Hazardous Energy Sources
(Lockout / Tagout)
Responsibilities
The Executive Management’s responsibilities are:
 Require that Authorized and Affected employees be annually trained in lockout / tagout safety rules and safe
procedures.
 Hold maintenance and the Manager accountable for implementing an effective lockout / tagout program.
Maintenance's responsibilities are:
 Annually train all employees authorized to service and repair machinery and equipment in the lockout / tagout
program and specific written lockout / tagout procedures.
 Identify all machinery and equipment with potentially hazardous energy sources & employees exposed to
them.
 Require all machinery and equipment are de-energized and locked and tagged out of service before being
serviced and repaired.
 Develop lockout / tagout procedures as required by OSHA.
 Periodically conduct inspections of machinery being serviced and repaired to determine if energy sources are
being de-energized and properly locked out and tagged out of service.
 Hold authorized employees accountable for obeying lockout / tagout procedures.
 Annually evaluate the lockout / tagout program and make enhancements to it.
 Document all lockout / tagout activities in a lockout / tagout compliance file.
 Develop and maintain a list of all employees authorized to lockout / tagout machinery and equipment for
repair.
The Manager’s responsibilities are:
 Conduct lockout / tagout training for new employees and existing employees annually.
 Conduct observations of employees to ensure that lockout / tagout safety rules and safe work procedures are
being obeyed.
 Hold employees accountable for obeying lockout and tagout safety rules and safe work procedures.
 Document all inspections and training activities.
 Provide documentation of lockout / tagout activities.
Employees
The Employees responsibilities are:
 An authorized employee is to lockout / tagout all energy sources including, but not limited to electrical,
mechanical, gravitational, hydraulic, pneumatic, chemical, thermal, or any other type of energy prior to
performing service.
 Affected employees will observe lockout / tagout procedures and not remove lockout / tagout devices or
tamper with equipment or energy controls under lockout / tagout conditions.
 All employees are to participate in lockout / tagout training sessions.
COMPANY NAME
Safety Policy & Procedure Manual
116
Control of Hazardous Energy Sources
(Lockout / Tagout)
Energy Control Procedure
A written energy control procedure is to be developed for each piece of equipment with two or more energy
sources. It provides the proper procedures for an authorized employee to follow when safely shut down and startup machinery and equipment. The Energy Control Procedure form is completed as follows:
1.
List the name, location, and number of the equipment, person completing the energy control procedure, and
date.
2.
Indicate all the energy sources to be locked and tagged out to shut down or start up equipment. Energy
sources include electrical, mechanical, gravitational, hydraulic, pneumatic, chemical, thermal, or any other
type of energy.
3.
Identify all the energy isolating devices and their location that need to be locked and tagged out such as
manually operated circuit breakers, disconnect switches, manually operated switches, slip gates, slip blinds,
line valves, blocks, and any other devices used to block or isolate energy. Push buttons, electrical switch
indicators, and other circuit control type devices are not energy isolating devices, but are considered energy
controlling devices.
4.
Identify the step-by-step control measures and safe work practices necessary to control or eliminate all
hazards or potential hazards associated with locking and tagging out the energy isolating devices listed.
5.
These procedures must be available to all Authorized employees and contractors when they are required to
lockout / tagout the equipment.
6.
These procedures will be re-evaluated and updated on an annual basis or when equipment configuration
changes by Maintenance.
COMPANY NAME
Safety Policy & Procedure Manual
117
Control of Hazardous Energy Sources
(Lockout / Tagout)
General Lockout Steps
1.
Before a piece of equipment can be locked and tagged out, the Authorized employee or contractor who is
responsible for performing the service will inform the equipment operator or any other affected employees
in the immediate work area that service is being performed.
2.
Any Authorized employee or contractor who is required to service equipment will ensure that all energy
sources are properly locked and tagged out in the zero energy state before any work begins. The following
steps are taken to properly lockout / tagout equipment:
3.
4.
a.
Turn the main power disconnect switch, breakers, valves, all other energy isolating devices to the off
or neutral position.
b.
Attach a lockout hasp and padlock to the energy isolating device(s).
c.
Attach a danger tag to the energy-isolating device. This tag identifies the person who is Authorized
to lockout / tagout the equipment, and the date in which the service is being performed.
Before the Authorized employee or contractor can begin work they will:
a.
Ensure that no employees or other persons in the immediate work area are exposed to any hazards.
b.
Test the energy-isolating device to ensure the controls cannot be moved to the on or active position.
c.
Return controls to the “off” or neutral position.
d.
Ensure all potentially hazardous stored or residual energy is relieved, disconnected, or otherwise
restrained to ensure the equipment is in the “zero” energy state. If there is a potential for a release of
stored energy or re-accumulation of energy, blocks or other materials will be used to prevent the
equipment from cycling. These blocks or other materials are of sufficient strength to prevent the
equipment from cycling.
To test or reposition the equipment the following steps will be taken:
a.
Warn all affected employees in the immediate work area the equipment is going to be tested or
repositioned.
b.
Remove all tools, blocks, and other devices from the point of operation before energizing the
equipment.
c.
Each Authorized employee or contractor servicing the equipment will remove their padlock, danger
tag, and lockout hasp.
d.
Test or reposition the equipment.
e.
De-energize all energy sources, and ensure that they are in the “off” or neutral position. Ensure that
each Authorized employee’s or contractor’s lockout hasp, danger tag and padlock are replaced on the
energy isolating device before work resumes.
f.
Re-test the energy-isolating device to ensure that the controls cannot be moved to the “on” or active
position.
COMPANY NAME
Safety Policy & Procedure Manual
118
Control of Hazardous Energy Sources
(Lockout / Tagout)
Group Lockout / Tagout
When group lockout / tagout (more than one person) is required, the following steps will be followed:
1.
An Authorized employee is assigned to coordinate the group lockout / tagout to ensure all energy sources
are identified and all energy control steps are completely and correctly followed.
2.
Each Authorized employee and contractor will attach their lockout hasp, danger tag, and padlock to the
energy isolating device to ensure that no release of energy is possible.
3.
Authorized maintenance electricians and electrical contractors will test all electrical circuits that will be
serviced with a volt meter to ensure that there is no electrical energy present.
4.
The Authorized employee in charge of the project will verify that all the work has been properly performed
before allowing authorized employees to remove their locks. Moreover, the authorized employee in charge
will be the last person to remove his/her lock before following “start-up” procedures.
Lockout Removal
When the authorized employee or contractor who applied the lockout / tagout device is not available to remove it,
the supervisor who is responsible for the authorized employee or contractor is the only person permitted to
remove the employee’s or contractor’s padlock, lockout hasp, and danger tag. Prior to removal of the device, the
following specific procedural steps must be followed:
1.
Verification must be made that the authorized employee or contractor who applied the device is not present.
2.
All reasonable efforts must be made to contact the authorized employee or contractor to inform him/her
that his/her lockout / tagout device has been removed.
3.
The Manager and maintenance must ensure that the authorized employee or contractor has knowledge of
the device removal before he/she resumes work.
4.
Keep a log of all occurrences where authorized employees’ locks have been removed. The dates, name of
authorized employee and circumstances should be recorded and kept by maintenance.
Shift Changes
When service of equipment takes longer than one work shift, the following steps will be followed:
1.
If there is no “authorized” employee on the next shift, the ending shift authorized employee must leave in
place his or her lock(s) & device(s).
2.
If there is an “authorized” employee on the next shift that will continue the repair work, the “authorized”
employee of the ending shift will replace his or her lock(s) and device(s) with “shift change lock(s)”.
3.
All service aspects will be exchanged between the ending shift and beginning shift “authorized” employees.
COMPANY NAME
Safety Policy & Procedure Manual
119
Control of Hazardous Energy Sources
(Lockout / Tagout)
Removal of Non-energized Tools & Devices
In certain situations, tools and devices may not be capable of being locking out of service. An example could be a
damaged sling or a broken hammer handle. In these examples, the equipment is tagged out. The tag identifies the
person who is authorized to tag-out the equipment and the date in which the service is being performed. The tagout steps are as follows:
1.
Attach a danger tag to the tool or device.
2.
Provide it to the individual responsible for repairing or replacing it.
3.
If has decision has been made to replace it, the damaged item must be totally destroyed before it is
disposed. Damaged hand tools are not to be given away.
Steps To Re-energize Equipment
When service is complete and the equipment is ready to be returned to normal production operation, the following
steps are followed:
1.
Warn all affected employees in the immediate work area that the equipment is going to be energized and
returned to normal production operation.
2.
All tools, blocks, and other devices are removed from the point of operation.
3.
Each authorized employee or contractor will remove their padlock, danger tag, and lockout hasp.
4.
Return the main power switches, breakers, valves, or other energy isolating devices to their on or active
position.
5.
Test controls for proper operation.
6.
Resume normal production operations.
Contractor Requirements
All contractors will follow the established lockout / tagout requirements including:
1.
Contractor employees will not perform service on, near, or with live electrical parts of equipment unless
they have been deemed qualified from their employer.
2.
Before servicing the equipment, the Manager or designee responsible for the service will explain all
hazards that may be encountered.
3.
Failure to lockout / tagout equipment or working on live electrical equipment will result in an immediate
stoppage of work. The Manager or designee will inform the contractor of the proper lockout / tagout steps
and safe work practices that will be followed before work can continue on non-energized electrical circuits.
4.
The Manager or designee will periodically inspect the contractor’s work areas to ensure that the lockout /
tagout steps are being correctly and completely followed.
COMPANY NAME
Safety Policy & Procedure Manual
120
Control of Hazardous Energy Sources
(Lockout / Tagout)
Training
1.
The Manager ensures that authorized employees are annually trained on the lockout / tagout program and
requirements of OSHA's Lockout / Tagout Standard. This training includes the following:
a.
Circumstances requiring lockout / tagout and multiple lockout / tagout devices.
b.
Description of the lockout / tagout devices and how they work.
c.
How to identify all energy sources on the equipment they will be servicing and how to properly lock
and tag them out.
d.
Purpose, use and information contained in the shutdown and start-up procedures.
e.
Authorized maintenance electricians are trained in the safe use and operation of a volt meter.
f.
The Manager ensures that affected employees are annually trained on the company's lockout / tagout
program and general requirements of OSHA's Lockout / Tagout Standard.
2. All employees are required to sign a training attendance log to verify they were trained. It is the Manager’s
responsibility to file training documentation in the central safety filing system.
Periodic Inspection
1.
It is the responsibility of the Manager or designee to perform at least semi-annual periodic inspections to
ensure that the lockout / tagout procedures are being followed. The Manager will keep all lockout / tagout
inspection activities documented in the Central Safety File.
2.
The periodic inspection will cover the following:
a.
Ensure that employees servicing equipment are authorized. (See the list of authorized employees.)
b.
Ensure that all lockout / tagout equipment conforms to the specifications in this program.
c.
Ensure that all the energy control procedural steps and safe work practices are followed correctly and
completely.
4. Each time a periodic inspection is performed, the following information will be documented using the
Periodic Lock-Out/Tag-Out Inspection Record on page 127.
a.
Date of inspection.
b.
Person(s) performing the inspection.
d.
Name of authorized employee or contractor performing service.
e.
Department or area where inspection is being performed.
f.
Identification of the equipment that is being locked and tagged out by equipment number and
location.
COMPANY NAME
Safety Policy & Procedure Manual
121
Control of Hazardous Energy Sources
(Lockout / Tagout)
Program Audit
Annually, the lockout/tagout program will be audited to determine its effectiveness. To accomplish this goal, the
Error! Reference source not found. on page Error! Bookmark not defined. will be used, at a minimum, to
document the audit.
Definitions
Affected Employee. An employee whose job requires him/her to operate or use a machine or equipment on
which servicing or maintenance is being performed under Lockout or Tag-Out, or whose job requires him/her to
work in an area in which such servicing or maintenance is being performed.
Authorized Employee. A person who implements a tag-out system procedure on machines or equipment to
perform the servicing or maintenance on it. An authorized employee and affected employee may be the same
person when the affected employee’s duties also include performing maintenance or service on a machine or
equipment that must be locked or a tag-out.
“Capable of being locked out.” An energy-isolating device will be considered to be a capable of being locked
out either if it is designed with a hasp or other attachment or integral part to which, or through which, a lock can
be affixed, or if it has a locking mechanism built into it. Other energy isolating devices will also be considered to
be capable of being locked out, if lockout can be achieved without the need to dismantle, rebuild, or replace the
energy-isolating device or permanently after its energy control capability.
Energized. Connected to an energy source or containing residual or stored energy.
Energy Isolating Device. A mechanical device that physically prevents the transmission or release of energy,
including but not limited to the following: A manually operated electrical circuit breaker; a disconnected switch;
a manually operated switch by which the conductors of a circuit can be disconnected or all ungrounded supply
conductors and, in addition, no pole can be operated independently; a slide gate; a slip blind; a line valve; a block;
and any similar device used to block or isolate energy. The term does not include a push button, selector switch,
and other control circuit type devices.
Energy Source. Any source of electrical, mechanical, hydraulic, pneumatic, chemical, thermal, or other energy
source.
Hot Tap. A procedure used in the repair, maintenance and services activities which involves welding on a piece
of equipment (pipelines, vessels or tanks) under pressure, in order to install connections or appurtenances. It is
commonly used to replace or add sections of pipeline without the interruption of service for air, gas, water, steam,
and petrochemical distribution systems.
Lockout. The placement of a lockout device on an energy isolating device, in accordance with an established
procedure, ensuring that the energy isolating device and the equipment being controlled cannot be operated until
the lockout device is removed.
Lockout Device. A device that utilizes a positive means such as a key lock to hold an energy isolating device in
the safe position and prevent the energizing of a machine or equipment.
COMPANY NAME
Safety Policy & Procedure Manual
122
Control of Hazardous Energy Sources
(Lockout / Tagout)
Normal Production Operations. The utilization of a machine or equipment to perform its intended production
function.
Servicing and/or Maintenance. Workplace activities such as constructing, installing, setting up, adjusting,
inspecting, modifying, and maintaining and/or servicing machines or equipment. These activities include
lubrication, cleaning or unjamming of machines or equipment and making adjustments or tool changes, where the
employee may be exposed to the unexpected energization or startup of the equipment or release of hazardous
energy.
Setting Up. Any work performed to prepare a machine or equipment to perform its normal production operation.
COMPANY NAME
Safety Policy & Procedure Manual
123
COMPANY NAME
Authorized Lockout/Tagout Employee List
Department
Supervisor
Date
Employee Name
Employee Name
KEEP IN THE MAINTENANCE FILE: Lockout/Tagout Audit
COMPANY NAME
Periodic Lockout / Tagout Inspection Record
Date of Inspection: ______________________________ _________________________________________
_____________________________________________ _________________________________________
_____________________________________________ _________________________________________
Name(s) of Person(s) Performing the Inspection: ______ _________________________________________
_____________________________________________ _________________________________________
Authorized Employee(s)/Contractor(s) Performing Service:
_____________________________________________
_____________________________________________
_____________________________________________
_____________________________________________
_____________________________________________
_____________________________________________
_____________________________________________
Department or Area Where Inspection Is Being Performed:
_____________________________________________
_____________________________________________
Equipment Number or Description:
_____________________________________________
_____________________________________________
Equipment Location:
_____________________________________________
_____________________________________________
Comments:
_____________________________________________
_____________________________________________
_____________________________________________
KEEP IN THE MAINTENANCE FILE: Lockout/Tagout Audits
COMPANY NAME
Lock-Out/Tag-Out Evaluation
Machine’s Manufacturer:
Model #:
Department:
Check Energy sources
Serial No./ID#:
Equipped With
Lockout Device
Yes
No
Type Of Lock out Device
Electricity
Gas
Steam
Pneumatic
Hydraulic
Kinetic
Stored
mechanical
Lockout Sequence.
Sequence for notification, removal of lockout devices, and start-up.
Employees authorized to lockout or tagout this Employees affected by lockout/tagout.
equipment.
1.
1.
2.
2.
3.
3.
4.
4.
5.
5.
6.
6.
Developed By:
Date:
Approved By:
Date:
KEEP IN THE MAINTENANCE FILES: Lockout/Tagout Procedures
COMPANY NAME
Lock-Out/Tag-Out Evaluation Sample
Machine’s Manufacturer: Speed Air
Model #: 10 HP Deluxe
Serial No./ID#: 2233-44-5566
Department/Location: Site A
Check Energy Sources
Equipped With
Type Of Lock Out Device & Control
Lockout Device
Yes
No
Electricity
X
X
Hasp on power disconnect/pad lock
Gas
X
Steam
X
Pneumatic
X
X
½” Pipe lock out device / pad lock
Hydraulic
Kinetic
X
Stored
X
X
Air tank bleed valve
mechanical
Lockout Sequence.
1. Notify employees affected by the lockout.
2. Shut off main electrical power disconnect and lock out and tag.
3. Shut off pneumatic valve and lock out and tag out
4. Bleed off air pressure in tank by opening the pressure relief valve.
Sequence for notification, removal of lockout devices, and start-up.
1. Replace all guards.
2. Clear all tools from the compressor.
3. Close the pressure relief valve.
4. Remove the pipe lock and open valve.
5. Remove the lock on the electrical power switch and turn on the power.
6. Test the controls to ensure they function properly.
7. Notify affected associates.
Employees authorized to lockout or tagout this
equipment.
1. John Doe
2.
3.
4.
5.
6.
Developed By:
Approved By:
Employees affected by lockout/tagout.
1. Mary Smith
2. Betty Lou Thomas
3.
4.
5.
6.
Date:
Date:
KEEP IN THE MAINTENANCE FILES: Lockout/Tagout Procedures
Bloodborne Pathogens Exposure Control Program
Bloodborne Pathogens Exposure Control Program
Purpose
The purpose of this policy is to establish procedures to prevent the transmission of bloodborne diseases in the
workplace and to acquaint COMPANY NAME SHORT's employees in management and training positions with
the precautions to be used in situations involving potential bloodborne pathogen exposure. This is an OSHA
compliance requirement.
Scope
This program applies to all COMPANY NAME SHORT's employees with special provisions for employees
whose job responsibilities (i.e. emergency response) may increase their exposure to bloodborne pathogens or who
may be potentially exposed to bloodborne pathogens.
Administration
The Manager is responsible for the Bloodborne Pathogens Control program. The execution of the program may
be delegated to one or more individuals. Only trained personnel shall clean up hazardous bodily fluids and
sanitize the contaminated areas. The following paragraphs describe the safe work procedures to be followed.
All exposure incidents require notification of the Manager.
Training
All employees will be trained on:
 The purpose of the Bloodborne Pathogens program
 Common hazardous bodily fluids
 Routes of transmission for Human Immunodeficiency Virus (HIV) and Hepatitis B Virus (HBV)
 What to do if they should find or be exposed to hazardous bodily fluids.
Employees whose jobs may require them to come in contact with blood or potentially infectious bodily fluids
shall be trained in the areas listed above plus:
1. Use of personal protective equipment
2. Clean up procedures
3. Decontamination procedures
4. Personal hygiene
5. Options for HBV vaccination
Materials for conducting Bloodborne Pathogens training are available in the General Safety Training Matrix on
page 27. All employees will receive refresher Bloodborne Pathogens training on an annual basis. This training
should be documented using the Safety Communication Meeting Form on page 53.
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Definition
Bloodborne pathogens are viruses and/or bacteria found in blood, semen, vaginal secretions, blood-related body
fluids (cerebrospinal fluid, pericardial fluid, synovial fluid, pleural blood, breast milk, and amniotic fluid), and
any body fluid containing visible blood. Bloodborne pathogens are not spread through feces, nasal secretions,
sputum, sweat, tears, and urine unless blood is visibly seen in these body fluids.
Exposure Determination
COMPANY NAME SHORT has determined the following employees could potentially be exposed to bloodborne
pathogens via responding to employee accidents with injuries.
1.
Manager
2.
Supervisor
3.
Employees with first aid responsibilities
4.
Employees with janitorial or maintenance responsibilities
All employees are required to isolate areas where there is blood or potentially infectious bodily fluids and notify
the Manager immediately. The Supervisor should notify the Manager who will determine if trained employees
will clean-up the blood or potentially infectious bodily fluids or if a professional outside service will be contacted
to provide the clean-up services.
Universal Precautions/Engineering Controls
The universal precaution which should be observed at all COMPANY NAME SHORT's locations in order to
prevent contact with blood or potentially infectious materials is that all blood or other potentially infectious
materials will be considered infectious regardless of the perceived status of the source individual. Serious
bloodborne infectious diseases that can be encountered by an employee include HIV and Hepatitis B. Although
the rate of occupational exposure and accidental infection from these diseases is quite low, nationally, several
people have died or become seriously ill from infections contracted through accidental, work-related exposures
where universal precautions have not been used.
Engineering and work practice controls will be used to eliminate or minimize exposure to employees at all
COMPANY NAME SHORT locations during activities such as responding to employee accidents. Where
occupational exposure remains after institution of these controls, personal protective equipment must be used. All
COMPANY NAME SHORT's locations should implement the following controls:
1. Personal Protective Equipment: Protection against bloodborne pathogens is enhanced through the
consistent use of disposable gloves or other disposable personal protective equipment which serves as a
barrier between an individual and potentially infectious materials.
The following precautions must be taken.
1. Intact skin is the most important barrier against infection. If an employee has a rash, skin infection, cuts,
or other breaks in the skin, they should apply a bandage to the affected area. The bandage should be
replaced if it becomes wet or soiled.
2. Touching your own eyes, nose, mouth or non-intact skin with contaminated gloves should be avoided
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3. Disposable gloves must be worn whenever touching blood or other bodily fluids, the eyes, nose, mouth or
non-intact skin of any person, and when touching items or surfaces moist with blood or other bodily
fluids. Hypoallergenic gloves must be accessible to those employees who are allergic to the gloves
normally provided. Gloves should be changed promptly when contaminated with blood or bodily fluids.
4. Disposable personal protective gloves are to be disposed of after use and are not for re-use. Latex gloves
do not protect from needlesticks or other puncture wounds. Always remove latex gloves that are
punctured or torn and promptly replace with new gloves. Remove gloves by grasping the edge along the
wrist and pull the gloves away from the body, turning them inside out.
5. Employees will have available a CPR mask in their first aid kit in the event that a CPR mask is needed.
The CPR mask will assist in the prevention of accidental exposure to a caregiver that is providing CPR to
a victim. No one should attempt to perform CPR or use a CPR mask who has not been specifically
trained in its use.
2. Sharps: OSHA has determined that hypodermic needles, syringes, box knife blades or other sharp items
contaminated with blood or bodily fluids can be considered infectious waste, subject to specific guidelines for
handling and disposal. Contaminated needles and other contaminated sharps will not be bent, re-capped,
removed, sheared or purposely broken. They will be disposed of in a puncture-proof sharps container that is
located near the first aid supplies. The sharps container should be checked monthly, and when 3/4 full, the
container should be closed, sealed, and disposed of according to local city ordinance. This procedure is the
only way of disposing sharp items that may be contaminated.
Since accidental needle sticks represent the most common potentially infectious disease exposure, use the utmost
caution in searching persons and property. You should assume that every person and his or her property may
possess a hypodermic needle, razor blade, knife, or other small sharp object.

First Aid Kits and Supplies: Every full-time manned location should have and be responsible for at
least one approved first aid kit. OSHA requires that a physician approve, by signature, a list of
supplies in the first aid kit. This list shall be kept in the central safety file. Contents of the first aid
kit should be inspected frequently to ensure adequate levels of supplies.
Employees or other personnel should not eat, drink, smoke, apply cosmetics or lip balm, or handle contact lenses
in areas where first aid supplies or application of first aid supplies are located. Do not locate the kit in the
bathroom.
3. Clean-Up: Clean-up kits containing absorbents, disposable gloves, aprons and disposable faceshield should
be available in each facility. Trained personnel shall wear the personal protective equipment and use
approved materials to clean-up bodily fluids. Blood and body fluid clean-up kits should be available near the
first aid supply area. Call your designated service to clean any large area contaminated with blood or bodily
fluids.
Broken glass should not be picked up directly with hands. Broken glass should be swept up with a brush or
broom and dustpan. Broken glass and blades should be placed in a sharps container if there is possible blood or
body fluids contamination.
4. Sterilization: After blood or other potentially infectious material has been cleaned up using paper towels or
materials from the clean-up kit, the surfaces (floor, table, equipment, etc.) should be sterilized by wiping with
a solution of one cup of household bleach per gallon of water or aerosol sterilizers which may be contained in
the clean-up kit. Be sure to use protective gloves and eye protection during the sterilization process.
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5. Hand washing: Hand washing facilities should be available to employees who incur exposure to blood or
other potentially infectious materials. Restrooms are the recommended areas to facilitate hand washing.
Antiseptic towelette should be available in the first aid kits to assist in hand washing. Employees should
wash their hands after the removal of personal protective gloves. Employees should wash hands or other
potentially contaminated skin area with soap and water as soon as feasible using the following methods.
 Remove jewelry. If contaminated, clean separately.
 Wet hands under running hot or warm water.
 Apply soap.
 Scrub hands, keeping hands lower than elbow.
 Use friction to clean between fingers, palms, back of hands, wrists, forearms, and under nails. The
washing should last for at least 15 seconds.
 Rinse under running water with fingers and palms held higher than the wrist.
 Use paper towels to dry hands and skin areas.
6. Waste Disposal: Paper towels should be used to clean up any blood or bodily fluids unless large quantities
require the use of blood and body fluid clean-up kits.
If blood is a small amount, dried and not flaking, it may go into regular garbage. Place all other contaminated
materials in the red biohazard bag which is included the first aid supplies or blood and body fluid clean-up kit. The
red biohazard bag should be disposed of in accordance with Local City ordinance.
Receptacles for personal sanitary items in restrooms should be provided with plastic or wax paper liners for
disposal. As long as these liners can be removed without making contact with the contents, they are not
considered contaminated waste and the normal disposal process is not considered a bloodborne pathogen
exposure incident.
Hepatitis B Vaccination
All employees listed in the “Exposure Determination” section of this document should be offered Hepatitis B
immunization prior to an exposure incident at no cost to the employee. Any employee who has potentially been
exposed to a bloodborne pathogen should be referred to a local physician and the Manager must be notified
immediately. In addition, the vaccine should be offered within ten working days of an employee’s initial
assignment to work, if the assignment may involve the potential for occupational exposure to blood or other
potentially infectious materials, and at no cost to the employee.
A copy of the consent form should be forwarded to the Manager.
The Hepatitis B immunization series consists of three injections:



Initial injection. This injection is also recommended within twenty-four hours of an exposure.
Second injection. One month after initial injection.
Third injection. Six months after second injection.
Employees who decline the Hepatitis B vaccine should complete a waiver that is provided by Manager. Any
employee who initially declines the vaccine may receive the vaccine at a later time if the employee desires to
receive the series of injections. The Hepatitis B Vaccine Consent Form and Vaccination Record on page 139 or
the Hepatitis B Vaccine Declination Form on page 141 should be kept in the employee’s medical file.
A copy of the Declination Form should be forwarded to the Manager.
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Post-exposure Evaluation and Follow-up: Manager should be notified immediately when an employee incurs
an exposure incident. Employees should be offered post-exposure evaluation and follow-up within twenty-four
hours of the exposure, with a doctor of COMPANY NAME SHORT's choice. The doctor should have a copy of
the FEDERAL REGULATION FOR THIS POLICY and the Manager should also give the doctor a copy of our
Post-Exposure Evaluation and Follow-Up and Interaction With Health Care Professionals sections of the
Bloodborne Pathogen Exposure Control Plan.
Manager should be consulted at each step of the follow-up process. The follow-up should include:








Immediate notification of the Executive Management.
Documentation of the route of the reported exposure and the circumstance related to the incident. This
information should be provided to the doctor.
Identification and status of the source individual if possible. This should not be discussed until the
Manager is consulted. The blood of the source individual should be tested after and when consent is
obtained for HIV or Hepatitis B virus infectivity. This information should be provided to the doctor.
Results of the source individual should be made available to the exposed employee with the exposed
employee informed about the applicable laws and regulations concerning disclosure of the identity and
infectivity of the source individual. Locations may need to modify this procedure to be in accordance
with local laws.
The exposed employee should be offered the option of having their blood collected for testing of HIV and
Hepatitis B serological status. The blood sample should be preserved for up to 90 days to allow the
employee to decide if the blood should be tested for HIV serological status. If the exposed employee
should decide that the testing will or will not be conducted, then the appropriate action should be taken
and the blood sample discarded. Results are confidential.
The exposed employee should be offered post-exposure treatment in accordance with the current
recommendations of the U.S. Public Health Service.
The exposed employee should be offered appropriate counseling by a physician concerning precautions to
take during the period after the exposure incident. The exposed employee should also be provided with
information on potential symptoms to be alert for and how to report any symptoms to Manager.
The Manager is designated to ensure that the policy outlined in COMPANY NAME SHORT's
Bloodborne Pathogen Exposure Control Plan is effectively carried out and should maintain all employee's
records related to this plan.
Interaction with Healthcare Professionals: A written opinion should be obtained from the health care
professional who evaluates exposed employees. Written opinions should be obtained (within 15 days after
evaluation) in the following instances:


When an employee obtains a Hepatitis B vaccination.
When an employee visits a health care professional after an exposure incident.
Health care professionals should be advised to limit their opinions to:



Whether Hepatitis B vaccine is indicated and if the employee has received the vaccine, as a result of
evaluation following an exposure incident.
Whether the employee has been informed of the results of the evaluation.
Whether the employee has been informed about any medical conditions resulting from exposure to blood or
other potentially infectious materials.
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The opinion should not reference any personal medical information about the employee.
Training: Training of all employees listed in the Exposure Determination section of this plan should be
conducted. Training should include an explanation of:
1)
2)
3)
4)
The OSHA standard for bloodborne pathogens.
Epidemiology and symptomatology of bloodborne diseases.
Modes of transmission of bloodborne pathogens.
COMPANY NAME SHORT's Bloodborne Pathogen Exposure Control Plan. Points of the plan, lines of
responsibility, how the plan will be implemented, etc.
5) Procedures which might involve exposure to blood or other potentially infectious materials.
6) Control methods that should be utilized to control exposure to blood or other potentially infectious
materials.
7) Personal protective equipment which should be available, and who should be contacted to obtain the
equipment.
8) Post-exposure reporting and follow-up.
9) Signs and labels used for potentially infectious materials.
10) Hepatitis B vaccination program.
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Hepatitis B Vaccine Consent Form and Vaccination Record
The Hepatitis B vaccine is prepared from recombinant yeast culture and is free of association with human blood
or blood products.
If I am allergic to yeast or thimersol, I should not receive this vaccine.
If I have a serious, active infection, I should not receive this vaccine.
If I am on hemodialysis, I should not receive this vaccine without further evaluation.
If I am pregnant, or trying to become pregnant, or breast feeding, I must obtain authorization from my personal
physician before receiving this vaccine.
If I have taken a drug or undergone treatment that affects the body’s resistance to infection, I should not take this
vaccine without further evaluation.
If I have an immune deficiency, I should not take this vaccine without further evaluation.
If I have heart or lung problems, I should not take this vaccine without further evaluation.
If I have a bleeding disorder that prevents me from receiving an intramuscular shot, I should not have this vaccine
without further evaluation.
I have been informed regarding Hepatitis B and Hepatitis B vaccine.
I have been notified of my occupational exposure risk to Hepatitis B and have been made aware of the
consequences to myself, other co-workers, and family, as well as of the fact that my employer strongly urges me
to obtain a Hepatitis B vaccination. I have had a chance to ask questions which were answered to my satisfaction.
Date
______ _________________________________________
______ _________________________________________
______ Employee’s Signature
_____________________________________________
_____________________________________________ ____________________________________
Date
______ Witness
First Dose ____________________________________ _________________________________________
_____________________________________________ _________________________________________
_____________________________________________ Date _____________________________________
_____________________________________________ _________________________________________
Second Dose __________________________________ _________________________________________
_____________________________________________ _________________________________________
_____________________________________________ Date _____________________________________
_____________________________________________ _________________________________________
Third Dose ____________________________________ _________________________________________
_____________________________________________ _________________________________________
_____________________________________________ Date _____________________________________
_____________________________________________ _________________________________________
KEEP IN EMPLOYEE’S PERSONNEL FILE
Hepatitis B Vaccine Declination Form
I understand that, due to my occupational exposure to blood or other potentially infectious materials, I may be at
risk for acquiring the Hepatitis B virus (HBV). I have been given the opportunity to be vaccinated with Hepatitis
B vaccine at no charge to myself. However, I decline Hepatitis B vaccine at this time. I understand that by
declining this vaccine, I continue to be at risk of acquiring Hepatitis B, a serious disease. If in the future I
continue to have occupational exposure to blood or other potentially infectious materials and I want to be
vaccinated with the Hepatitis B vaccine, I can receive the vaccine at no charge to me.
___________________________________________ __ _________________________________________
_____________________________________________ ________________
Employee’s Signature ___________________________ _________________________________________
_____________________________________________ _________________________________________
_____________________________________________ Date
___________________________________________ __ _________________________________________
_____________________________________________ ________________
Witness _______________________________________ _________________________________________
_____________________________________________ _________________________________________
_____________________________________________
_____________________________________________ Date
KEEP IN EMPLOYEE’S PERSONNEL FILE
Facility Emergency Organization Program
Facility Emergency Organization
Purpose:
OSHA's Emergency Action Plan standard, 29 CFR 1910.38(a), requires COMPANY NAME SHORT to have a
written emergency action plan (EAP). This plan applies to all operations in our company where employees may
encounter an emergency situation.
The EAP communicates to employees, policies and procedures to follow in emergencies. This written plan is
available to all employees, their designated representatives, and local, state and federal officials who ask to see it.
Under this plan, our employees will be informed of:
 the plan's purpose
 emergency evacuation procedures and route assignments
 procedures to be followed by employees who remain to control critical location operations before they
evacuate
 procedures to account for all employees after emergency evacuation has been completed
 preferred means of reporting fires and other emergencies
 types of evacuations to be used in various emergency situations
 and the alarm or notification system
The Manager is the overall program coordinator and has overall responsibility for all emergency action plans and
response teams. The Manager will review and update the plan as necessary. At a minimum, the plan will be
updated when there are any personnel changes or significant changes to the operations. Copies of this plan may
be obtained from the Manager.
If after reading this program, you have any questions regarding this plan or your role under this plan, please
contact the Manager. We encourage all suggestions because we are committed to the success of our emergency
action plan. We strive for clear understanding, safe behavior, and involvement in the program from every level of
the company.
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General Emergency Procedures and Assignments:
Our emergency procedures and assignments are designed to respond to many potential emergencies including:
 Evacuation
 Fire
 Tornado and severe winds
 Power outages
In this plan, COMPANY NAME SHORT has developed procedures for fire prevention and responding to various
emergencies. The Fire Protection plan and specific emergency actions are addressed in this document. The
following guidelines apply to all Emergency Action Plans:
1) Employees must know what to do when they:
a) discover an emergency
b) are alerted to a specific emergency
2) Employees must be trained in safe evacuation procedures, and refresher training must be conducted whenever
the employee's responsibilities or designated actions under the plan change, and whenever the plan itself is
changed.
3) Supervisor must review with each employee, upon initial assignment, the parts of the plan that the employee
must know in order to protect the employee in the event of an emergency.
4) Training shall include use of floor plans and/or workplace maps that clearly show the emergency escape
routes and safe refuge areas included in the Emergency Action Plan. Color-coding can aid employees in
determining their route assignments. These floor plans or maps shall be posted at all times in every area of
the facility to provide guidance in an emergency and should be accompanied by the completed Safe Refuge
areas.
5) As a matter of general practice, doorways and stairwells are the primary means for evacuation.
6) No employee is permitted to re-enter the building until advised by the Manager after determination has been
made that such re-entry is safe.
Management
The Manager’s responsibilities are to:
 Implement fire protection and emergency action plans to protect the safety and health of all employees.
 Authorize the notification of employees, via alarm or other means, of an emergency so an Emergency Action
Plan (EAP) is activated.
 Identify those employees who may have a physical handicap or temporary impairment (hearing/mobility) and
develop special procedures (if necessary) to assure their prompt notification and safety evacuation.
 Authorize employees to re-enter the facility only after it has been determined safe to do so.
 Require training (at least annually) for all employees on the contents of the Emergency Response Plan and
how to safely evacuate the facility.
 Require that all members of emergency response teams conduct sufficient drills so they know how to respond
in the event of an emergency.
 Require that there is adequate supervision for emergency response activities.
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Supervisors
The Supervisors’s responsibilities are to:
 Be familiar with the complete workplace layout and the various alternative escape routes
 Be aware of employees with disabilities that may need extra assistance, such as using the buddy system
 Avoid hazardous areas during emergencies
 Determine the type of emergency based on the alarm signal and respond appropriately
 Perform “sweep checks” of assigned areas for any personnel
 Direct personnel to designated safe areas
 Conduct a head count of company personnel and visitors.
 Report the head count to the Manager
 Maintain control of persons at designated safe areas
 Assume role of spokesperson for the designated safe area
 Prevent the employees from leaving the designated safe area until the Manager authorizes them to do so.
Employee
The employee's responsibilities are to:
 Be familiar with the complete workplace layout and the various alternative escape routes
 Be aware of employees with disabilities that may need extra assistance, such as using the buddy system
 Avoid hazardous areas during emergencies
 Determine the type of emergency based on the alarm signal and respond appropriately
 Go to and stay in designated safe refuge areas
 Maintain order in refuge areas and do not leave the area until authorized by the supervisor to do so
The Manager will meet and direct emergency response services (fire/police) and advise the Supervisor.
Rescue Duty Activities
Rescue may be necessary during emergency situations. Circumstances calling for rescue should not be attempted
by COMPANY NAME SHORT personnel. Trained professionals such as the local fire department must perform
this activity. Call the local fire department in the event of any emergency rescue situation.
First Aid Response
Only COMPANY NAME SHORT personnel who are trained in first aide medical treatment and are current in
their certification will provide first aide treatment. First aid response will be turned over to the professional
emergency services upon their arrival at the emergency site.
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General Emergency Reporting Procedures
Upon discovering an emergency, notify the receptionist or alternate and indicate:
1) State the type of emergency.
2) Indicate the location of the emergency.
3) Indicate if any one is injured.
4) Who is injured?
5) The receptionist or alternate will notify the Manager or the President of the emergency.
General Emergency Announcing Procedures
The receptionist or alternate will:
1) On the authorization of the Manager or President, telephone the appropriate professional services, such as,
fire department, police department, etc.
2) Notify the employees of the emergency by using the public address system and say, "There is a (State the type
of emergency) emergency and the emergency action plan for (State the type of emergency) is now in effect.
This is not a drill.”
3) Act as the information coordinator, at the phone switchboard, for the Manager and President until asked to
evacuate the building.
Emergency Alarms and Phone Numbers
The emergency alarms that will be used to notify others of an emergency are listed below (sample). The
following tables should be completed as part of the Emergency Response plan implementation.
Sample Emergency Alarms
Type of
Emergency
Sprinkler
Fire
Winter Storm
Alarm
Operation
Alarm
Systems
Alarm
Device(s)
Types of Alarm
Notice(s)
Water flow
Central Service
Bell
Pull Stations,
Central Service
Public Address
System
Emergency Alert
Broadcast Radio
Public Address
Announcement
Public Address
Announcement
Public Address
Announcement
High pitch bell
with flashing lights
PA
Public Address
System
Public Address
Announcement
Public Address
System
Tornado
Emergency
Alert Broadcast
Radio
Power outage
Emergency
Light Activation
Table 2: Types of emergency alarms.
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The emergency services and phone numbers that will be used to notify others of an emergency are listed below
(sample). The following tables should be completed as part of the Emergency Response plan implementation.
Sample Emergency Services & Phone Numbers
Emergency Service
Contact
Medical
Fire Department
Fire
Fire Department
Police
Police Department
Electrical
Public Works
Water
Village Water Department
Burglar /Fire Alarms
ADT
Table 3: Emergency services and phone numbers.
Phone Number
911
911
911
Local emergency phone numbers shall be readily available by the Receptionist, President, and the Manager.
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Fire Prevention Plan
Scope and Application:
As required by OSHA, the following Fire Prevention Plan has been developed to prevent or minimize the
possibility of a fire emergency.
The following table identifies the emergency equipment that will be visually checking during housekeeping
inspections.
Sample Fire & Emergency Equipment Inspection
Equipment
Location
Fire Extinguishers
Entire Facility
Fire Suppression System
Spray Paint
Booth
Sprinkler System &
extra sprinkler heads
Sprinkler Room
Inspection Items
Properly mounted location identified by signs
Ready for use
System is charged, & tag current, filters in good
condition, over spray contained, flammable fluids
controlled, proper disposal, no smoking.
Valves locked open
Extra heads and wrench in place
Gauges show proper pressure
Housekeeping:
Housekeeping to Control Accumulations of Flammable and Combustible Materials
General housekeeping is an everyday duty. Facility cleanliness is stressed to all employees, whether in the office,
production or storage areas. There may be employees from the maintenance department who have as part of their
duties, the responsibility for maintaining and cleaning equipment. In addition, the Supervisors are responsible for
their respective areas. Trash, scrap, and waste are removed during each shift. Each employee is expected to clean
up his/her area. Waste receptacles are located throughout the facility to dispose of trash.
The safety committee members will include housekeeping and fire safety concerns as a part of their regular
inspections.
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Major Workplace Fire Hazards:
The following is a list of a potential fire hazards (sample) within the location and their property handling and
storage procedures.
Sample Major Workplace Fire Hazards
Area
Major Fire Hazards
Spray booth and flammable
fluid storage areas.
Flammable Fluids
Maintenance
Maintenance
Weld Shop
Production
Flammable Fluids
Welding & Cutting operations
Welding & Cutting operations
Smoking
All areas.
Building heating furnaces
Handling & Storage Procedures
Grounding and bonding practices
followed. NFPA fluid dispensers and
trash containers.
Training and supervision required
Restricted to controlled areas
Restricted to controlled areas
No smoking in flammable fluid storage
areas. Ash trays used for controls.
Serviced by an outside contractor
Fire and Emergency Extinguishing Equipment:
Fire extinguishers are located throughout the facility.
The main building is equipped with a sprinkler system. The alarm for the sprinkler system is connected to the fire
department.
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Emergency Action Plan for Fire
1) Call the receptionist and provide:
a) The exact location of the fire.
b) The nature of the fire. Is it in its early stages or has it spread to machinery or the building’s structure.
c) Closest door for fire department entry.
d) Who may be injured.
e) Extent of injury. Broken bone(s), uncontrolled bleeding.
2) The receptionist should notify the following people/services with the information above:
a) Manager and the president who will authorize the emergency action plan(s) for fire and/or evacuation to
go into effect.
b) Supervisors of a the authorized emergency action plans by:
i) Using the phone/public address system.
ii) Using a bull horn back-up system.
c) Via a phone call, update the Manager and President with new information from the emergency response
team members.
3) Employees who are trained in use of fire extinguishers are responsible for:
a) May attempt to extinguish the fire if it is in its incipient or early stages.
b) If the fire spreads beyond its incipient stage or to the building’s internal structure, the employees
attempting to extinguish the fire must stop fire-extinguishing efforts and evacuate the building to their
designated safe refuge areas.
c) Status of fire extinguishing efforts must be communicated to the receptionist so they can be relayed to the
Manager and president.
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Emergency Action Plan for Evacuation
Supervisors and Area Coordinators
Each department with more than 25 employees will be divided into areas and an area coordinator will be assigned
to a group. If an area does not have more than 25 employees, then the Supervisors will assume the duties of the
Area Coordinator as follows:
The Supervisors’s and / or Area Coordinator's responsibilities are to:
 Be familiar with the complete workplace layout and the various alternative escape routes
 Be aware of employees with disabilities that may need extra assistance, such as using the buddy system
 Avoid hazardous areas during emergencies
 Determine the type of emergency based on the alarm signal
 Check assigned area(s) for any personnel
 Direct personnel to designated safe areas
 Conduct a head count of company personnel and visitors.
 Report the head count to the Manager. Notify the Fire Department of any missing persons.
 Maintain control of persons at designated safe areas
 Assume role of spokesperson for the designated safe area
 Do not allow the employees to leave the designated safe area until the Manager authorizes to do so.
A “check of assigned area(s)” entails moving quickly through an assigned area to check for any persons who, for
any reason, have not begun to evacuate. Bathroom, break room, or any closed office area will be checked. A
“sweep check” will only be performed when the fire or other hazard is not in the vicinity of the assigned area. A
back-up employee should also be assigned to the area and is responsible for knowing when the primary employee
is absent or unable to perform such duty.
The Employees responsibilities are to:
1. Proceed directly to the assigned safe refuge area.
2. Report to Supervisors or area coordinator.
3. Be accounted for in the in the head-count.
4. Stay in the designated safe refuge area until given further instructions.
The Manager’s and President’s responsibilities are to:
1. Assume role of contact with fire and police departments.
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Emergency Action Plan for Tornado and Severe Winds
In The Event of a Tornado or Severe Winds
1.
The receptionist will be provided with a weather broadcast device, at company expense, to monitor for
tornado or severe wind weather conditions that could endanger COMPANY NAME SHORT employees.
2.
The receptionist will notify the Manager of a tornado or severe wind weather conditions that could
endanger COMPANY NAME SHORT employees.
3.
The Manager will authorize when employees need to be notified of the tornado or severe winds emergency
action plan.
4.
In the event of a tornado or severe winds emergency, the Supervisors will be notified:
d) Using the Phone/Public Address system or other means. State "There is a Tornado or Severe Winds
Emergency. The Emergency Action Plan for Tornado and Severe Winds is now in effect. The
announcement should be repeated several times to give people ample opportunity to hear it and respond
according to the plan.
e) Upon the announcement of a tornado emergency, the Supervisors will sweep check assigned area(s) and:
 Locate all personnel in assigned areas
 Direct personnel to designated safe areas
 Conduct a head count of personnel
 Report the head count to the Manager
 Maintain control of persons at designated safe areas
 Assume role of spokesperson for the designated safe area
 Prohibit the employees from leaving the designated safe area until the Manager authorizes them to do
so.
Safe Areas
Safe areas for relocation should be determined ahead of time and designated on all evacuation maps.
Safe areas should be smaller interior rooms away from windows or large wall openings. These are typically
offices, restrooms, locker rooms, interior hallways or break/lunch rooms. Each primary area should be assigned
to specific safe refuge areas within the facility.
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Facility Emergency Organization Program
Emergency Action Plan for Power Outage
1) Supervisors will survey the facility to ensure that emergency lighting is functioning properly and that
employees can safely evacuate the facility.
2) If emergency lights are not functioning and natural light is insufficient for safe travel, employees should be
instructed to stay where they are until the Supervisor arrives with a flashlight to lead them to the designated
safe refuge area.
3) The local utility will be contacted to determine the extent and anticipated duration of the power outage.
4) The Manager will make a decision to dismiss employees or wait for an expected return to the facility.
5) If employees are not at work, a decision (based on information from the local utility) will be made to alert
employees not to report to work. Notification should be through established telephone “trees” and/or through
local news media.
When Power is Restored:
1) Supervisors will survey their areas to ensure that the area is safe for return and report to the Manager.
2) Assigned personnel will evaluate critical equipment for start-up and either activate the equipment or report
problems to the Manager.
3) The Manager will advise employees on when to return to their work activities.
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Facility Emergency Organization Program
Emergency Action Plan for Bomb Threat or other Threat
No one can predict how or why a person may threaten us. Therefore, good judgment should always be used in
deciding how to proceed. These procedures are an outline of possible steps. Keep in mind that we want to protect
the lives and well being of all people in our buildings.
Receiving a Bomb-Threat Call:

Take clear notes regarding the caller’s message and try to record the phone number if you have “caller ID”

Try to get as much information from the caller as possible

Try to remember as much about the caller’s voice as possible:
- Male/Female
- Young/old
- Accent
- Attempts to disguise voice
- Nervousness
- Peculiar use of words, phrases or pronunciation
- Speech impediments
- Pitch of voice -- high/low

Notify the Manager or President.

Upon authorization from the Manager or the President, make an announcement over the public address
system to evacuate the building.

Do not use a two-way radio system during the threat!

Call the Police Department (“911”) and give the caller’s message

Provide the bomb-threat notes to the police department.

Note: No one should attempt to move any item that appears to be suspicious - evacuate employees and
visitors from the area and block off the area to prevent entry.
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Emergency Action Plan for Winter Storm
1.
The Manager will be provided with a weather broadcast device, at company expense, to monitor for
tornado or severe wind weather conditions that could endanger COMPANY NAME SHORT employees.
2.
The Manager will monitor pertinent weather conditions and determine when employees need to be notified
about severe weather conditions and precautions that need to be taken.
3.
In the event of a winter storm emergency, the Supervisors will be notified:
a.
b.
Using the Phone/Public Address system or other means. State "There is a Winter Storm Emergency
in effect. The announcement should be repeated several times to give people ample opportunity to
hear it and respond according to the plan.
Upon the announcement of a winter storm emergency, Supervisors will:
i. Contact the Manager to determine if early dismissal is appropriate.
ii. If early dismissal is appropriate, the supervisor shall inform department employees that they have
the option to be dismissed or stay on premises and take refuge.
iii. If employees elect to take refuge on the premises, they shall be allowed to phone others to ensure
their safety too. The Supervisor shall also ask the employee if he or she needs any special medical
assistance. Any request for medical assistance shall be communicated to the Manager.
iv. No person shall be left alone on premises during a winter storm.
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Respiratory Protection Program
Respiratory Protection Program
General
In the Respiratory Protection program, hazard assessment and selection of proper respiratory PPE is conducted in
the same manner as for other types of PPE. In the control of those occupational diseases caused by breathing air
contaminated with harmful dusts, fogs, fumes, mists, gases, smokes, sprays, or vapors, the primary objective shall
be to prevent atmospheric contamination. This shall be accomplished as far as feasible by accepted engineering
control measures (for example, enclosure or confinement of the operation, general and local ventilation, and
substitution of less toxic materials). When effective engineering controls are not feasible, or while they are being
instituted, appropriate respirators shall be used. References: OSHA Standards Respiratory Protection (29 CFR
1910.134)
Responsibilities
All employees required to wear respirators shall follow the requirements of this respiratory protection program.
Management

Implement the requirements of this program

Provide a selection of respirators as required

Enforce all provisions of this program

Appoint an individual to conduct the respiratory protection program
Program Administrator
 Review sanitation/storage procedures.
 Ensure respirators are properly, stored, inspected and maintained
 Monitor compliance for this program
 Provide training for affected Employees
 Preview compliance and ensure monthly inspection of all respirators
 Provide respirator fit testing
Designated Occupational Health Care Provider
 Conduct medical aspects of program
Program Administrator
The Manager will be the program administrator. He may delegate various aspects of the program to others who
are qualified by appropriate training or experience that is commensurate with the complexity of the program to
administer or oversee the respiratory protection program and conduct the required evaluations of program
effectiveness.
Voluntary Use of Respirators is Prohibited
OSHA requires that voluntary use of respirators, when not required by the company, must be controlled as strictly
as under required circumstances. To prevent violations of the Respiratory Protection Standard Employees are not
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allowed voluntary use of their own or company supplied respirators of any type. Exception: Employees whose
only use of respirators involves the voluntary use of filtering (non-sealing) face pieces (dust masks).
Program Evaluation
Evaluations of the workplace are necessary to ensure that the written respiratory protection program is being
properly implemented, this includes consulting with employees to ensure that they are using the respirators
properly. Evaluations shall be conducted as necessary to ensure that the provisions of the current written program
are being effectively implemented and that it continues to be effective
Program evaluation will include discussions with employees required to use respirators to assess the employees'
views on program effectiveness and to identify any problems. Any problems that are identified during this
assessment shall be corrected. Factors to be assessed include, but are not limited to:
 Respirator fit (including the ability to use the respirator without interfering with effective workplace
performance);
 Appropriate respirator selection for the hazards to which the employee is exposed;
 Proper respirator use under the workplace conditions the employee encounters; and
 Proper respirator maintenance.
Record Keeping
Human Resources will retain written information regarding medical evaluations, fit testing, and the respirator
program in the Central Safety File. This information will facilitate employee involvement in the respirator
program, assist COMPANY NAME SHORT in auditing the adequacy of the program, and provide a record for
compliance determinations by OSHA.
Training and Information
Effective training for employees who are required to use respirators is essential. The training must be
comprehensive, understandable, and recur annually, and more often if necessary. Training will be provided prior
to requiring the employee to use a respirator in the workplace. Please see the Respiratory Protection Training
topic in the General Safety Training Matrix on page 27. The training shall ensure that each employee can
demonstrate knowledge of at least the following:
 Why the respirator is necessary and how improper fit, usage, or maintenance can compromise the protective
effect of the respirator
 Limitations and capabilities of the respirator
 How to use the respirator effectively in emergency situations, including situations in which the respirator
malfunctions
 How to inspect, put on and remove, use, and check the seals of the respirator
 What the procedures are for maintenance and storage of the respirator
 How to recognize medical signs and symptoms that may limit or prevent the effective use of respirators
 The general requirements of this program
Retraining shall be conducted annually and when:
 changes in the workplace or the type of respirator render previous training obsolete
 inadequacies in the employee's knowledge or use of the respirator indicate that the employee has not retained
the requisite understanding or skill
 other situation arises in which retraining appears necessary to ensure safe respirator use
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Instructors certified by the Manager will conduct training. Training is divided into the following sections:
Classroom Instruction
1. Overview of the Company Respiratory Protection Program & OSHA Standard
2. Respiratory Protection Safety Procedures Respirator Selection
3. Respirator Operation and Use
4. Why the respirator is necessary
5. How improper fit, usage, or maintenance can compromise the protective effect.
6. Limitations and capabilities of the respirator.
7. How to use the respirator effectively in emergency situations, including respirator malfunctions
8. How to inspect, put on and remove, use, and check the seals of the respirator.
9. What the procedures are for maintenance and storage of the respirator.
10. How to recognize medical signs and symptoms that may limit or prevent the effective use of
respirators.
11. Change out schedule and procedure for air purifying respirators.
Fit Testing
For each type and model of respirator used
Hands-on respirator Training
12. Respirator Inspection
13. Respirator cleaning and sanitizing
14. Record Keeping
15. Respirator Storage
16. Respirator Fit Check
17. Emergencies
Basic Respiratory Protection Safety Procedures
1. Only authorized and trained Employees may use Respirators. Those Employees may use only the Respirator
that they have been trained on and properly fitted to use.
2. Only Physically Qualified Employees may be trained and authorized to use Respirators. A pre-authorization
and annual certification by a qualified physician will be required and maintained. Any changes in an
Employees health or physical characteristic will be reported to the Manager and will be evaluated by a
qualified physician.
3. Only the properly prescribed respirator or SCBA may be used for the job or work environment. Air cleansing
respirators may be worn in work environments when oxygen levels are between 19.5 percent to 23.5 percent
and when the appropriate air cleansing canister, as determined by the Manufacturer and approved by NIOSH
or MESA, for the known hazardous substance is used. SCBAs will be worn in oxygen deficient and oxygen
rich environments (below 19.5 percent or above 23.5 percent oxygen).
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4. Employees working in environments where a sudden release of a hazardous substance is likely will wear an
appropriate respirator for that hazardous substance (example: Employees working in an ammonia compressor
room will have an ammonia APR respirator on their person.).
5. Only SCBAs will be used in oxygen deficient environments, environments with an unknown hazardous
substance or unknown quantity of a known hazardous substance or any environment that is determined
"Immediately Dangerous to Life or Health" (IDLH).
6. Employees with respirators loaned on "permanent check out" will be responsible for the sanitation, proper
storage and security. Respirators damaged by normal wear will be repaired or replaced by COMPANY NAME
SHORT when returned.
7. The last Employee using a respirator and/or SCBA that are available for general use will be responsible for
proper storage and sanitation. Monthly and after each use, all respirators will be inspected with documentation
to assure its availability for use.
8. All respirators will be located in a clean, convenient and sanitary location.
9. In the event that Employees must enter a confined space, work in environments with hazardous substances that
would be dangerous to life or health should an RPE fail (a SCBA is required in this environment), and/or
conduct a HAZMAT entry, a "buddy system" detail will be used with a Safety Watchman with constant voice,
visual or signal line communication. Employees will follow the established Emergency Response Program
and/or Confined Space Entry Program when applicable.
10. Management will establish and maintain surveillance of jobs and work place conditions and degree of
Employee exposure or stress to maintain the proper procedures and to provide the necessary RPE.
11. Management will establish and maintain safe operation procedures for the safe use of RPE with strict
enforcement and disciplinary action for failure to follow all general and specific safety rules. Standard
Operation Procedures for General RPE use will be maintained as an attachment to the Respiratory Protection
Program and Standard Operation Procedures for RPE use under emergency response situations will be
maintained as an attachment to the Emergency Response Program.
Selection of Respirators
COMPANY NAME SHORT has evaluated the respiratory hazard(s) in each workplace, identified relevant
workplace and user factors and has based respirator selection on these factors. Also included are estimates of
employee exposures to respiratory hazard(s) and an identification of the contaminant's chemical state and physical
form. This selection has included appropriate protective respirators for use in IDLH atmospheres, and has limited
the selection and use of air-purifying respirators. All selected respirators are NIOSH-certified.
Filter Classifications - These classifications are marked on the filter or filter package
N-Series: Not Oil Resistant
 Approved for non-oil particulate contaminants
 Examples: dust, fumes, mists not containing oil
R-Series: Oil Resistant
 Approved for all particulate contaminants, including those containing oil
 Examples: dusts, mists, fumes
 Time restriction of 8 hours when oils are present
P-Series: Oil Proof
 Approved for all particulate contaminants including those containing oil
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

Examples: dust, fumes, mists
See Manufacturer's time use restrictions on packaging
Respirators for IDLH atmospheres.
 The following respirators will be used in IDLH atmospheres:
 A full face piece pressure demand SCBA certified by NIOSH for a minimum service life of thirty minutes, or
 A combination full face piece pressure demand supplied-air respirator (SAR) with auxiliary self-contained air
supply.
 Respirators provided only for escape from IDLH atmospheres shall be NIOSH-certified for escape from the
atmosphere in which they will be used.
Respirators for atmospheres that are not IDLH.
The respirators selected shall be adequate to protect the health of the employee and ensure compliance with all
other OSHA statutory and regulatory requirements, under routine and reasonably foreseeable emergency
situations. The respirator selected shall be appropriate for the chemical state and physical form of the
contaminant.
Identification of Filters & Cartridges
All filters and cartridges shall be labeled and color coded with the NIOSH approval label and that the label is not
removed and remains legible. A change out schedule for filters and canisters has been developed to ensure these
elements of the respirators remain effective.
Respirator Filter & Canister Replacement
An important part of the Respiratory Protection Program includes identifying the useful life of canisters and filters
used on air-purifying respirators. Each filter and canister shall be equipped with an end-of-service-life indicator
(ESLI) certified by NIOSH for the contaminant; or
If there is no ESLI appropriate for conditions a change schedule for canisters and cartridges that is based on
objective information or data that will ensure that canisters and cartridges are changed before the end of their
service life.
Filter & Cartridge Change Schedule
Stock of spare filers and cartridges shall be maintained to allow immediate change when required or desired by
the employee
Cartridges shall be changed based on the most limiting factor below:
 Prior to expiration date
 Manufactures recommendations for the specific use and environment
 After each use
 When requested by employee
 When contaminate odor is detected
 When restriction to air flow has occurred as evidenced by increase effort by user to breathe normally
 Cartridges shall remain in their original sealed packages until needed for immediate use
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Filters shall be changed on the most limiting factor below:
 Prior to expiration date
 Manufactures recommendations for the specific use and environment
 When requested by employee
 When contaminate odor is detected
 When restriction to air flow has occurred as evidenced by increase effort by user to breathe normally
 When discoloring of the filter media is evident
 Filters shall remain in their original sealed package until needed for immediate use.
Respiratory Protection Schedule by Job and Working Condition
The Company maintains a Respiratory Protection Schedule by Job and Working Condition. This schedule is
reviewed with each authorized and trained Employee and is posted where respirators are stored. The Schedule
provides the following information:
Sample Respiratory Protection Schedule by Job and Working Condition
Job/Working
Conditions
Work Loc.
Hazards
Present
Type of
Resp. Prot.
Type of Filter
or Canister
Loc. of
Resp. Prot.
Fiter/Cart.
Change out
schedule.
Spraying
Insulation
Building B
Isocyanate
Air supplied
respirator
N/A
Building B
N/A
The schedule will be reviewed and updated at least annually and whenever any changes are made in the work
environments, machinery, equipment, or processes or if respirator different respirator models are introduced or
existing models are removed.
Permanent respirator schedule assignments are:
People who engage in welding will have their own company provided dust-mist-fume filter APR. This respirator
will be worn during all welding operations when safe levels are exceeded.
Physical and Medical Qualifications
Records of medical evaluations must be retained and made available in accordance with 29 CFR 1910.1020.
Medical evaluation required
Using a respirator may place a physiological burden on employees that varies with the type of respirator worn, the
job and workplace conditions in which the respirator is used, and the medical status of the employee. The
company provides a medical evaluation to determine the employee's ability to use a respirator, before the
employee is fit tested or required to use the respirator in the workplace.
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Medical evaluation procedures
The designated Occupational Health Care Provider will provide the employee a medical questionnaire
Follow-up medical examination
The company shall ensure that a follow-up medical examination is provided for an employee who gives a positive
response to any question among questions in Part B of the questionnaire or whose initial medical examination
demonstrates the need for a follow-up medical examination. The follow-up medical examination shall include any
medical tests, consultations, or diagnostic procedures that the Physician deems necessary to make a final
determination.
Administration of the medical questionnaire and examinations
The medical questionnaire and examinations shall be administered confidentially during the employee's normal
working hours or at a time and place convenient to the employee. The medical questionnaire shall be administered
in a manner that ensures that the employee understands its content. The company shall provide the employee with
an opportunity to discuss the questionnaire and examination results with the Physician.
Supplemental information for the Physician
The following information must be provided to the Physician before the Physician makes a recommendation
concerning an employee's ability to use a respirator
 The type and weight of the respirator to be used by the employee
 The duration and frequency of respirator use (including use for rescue and escape)
 The expected physical work effort
 Additional protective clothing and equipment to be worn
 Temperature and humidity extremes that may be encountered
 Any supplemental information provided previously to the Physician regarding an employee need not be
provided for a subsequent medical evaluation if the information and the Physician remain the same
COMPANY NAME SHORT has provided the Physician with a copy of the written respiratory protection program
and a copy of the OSHA Standard 1910.134
Medical determination
In determining the employee's ability to use a respirator, COMPANY NAME SHORT shall
 Obtain a written recommendation regarding the employee's ability to use the respirator from the Physician.
The recommendation shall provide only the following information
 Any limitations on respirator use related to the medical condition of the employee, or relating to the
workplace conditions in which the respirator will be used, including whether or not the employee is medically
able to use the respirator
 The need, if any, for follow-up medical evaluations
 A statement that the Physician has provided the employee with a copy of the Physician's written
recommendation
 If the respirator is a negative pressure respirator and the Physician finds a medical condition that may place
the employee's health at increased risk if the respirator is used, the Company shall provide a APR if the
Physician's medical evaluation finds that the employee can use such a respirator; if a subsequent medical
evaluation finds that the employee is medically able to use a negative pressure respirator, then the Company is
no longer required to provide a APR
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Additional Medical Evaluations
At a minimum, COMPANY NAME SHORT shall provide additional medical evaluations that comply with the
requirements of this section if:
 An employee reports medical signs or symptoms that are related to ability to use a respirator
 A Physician, supervisor, or the respirator program administrator informs the Company that an employee
needs to be reevaluated
 Information from the respiratory protection program, including observations made during fit testing and
program evaluation, indicates a need for employee reevaluation
 A change occurs in workplace conditions (e.g., physical work effort, protective clothing, temperature) that
may result in a substantial increase in the physiological burden placed on an employee.
Respirator Fit Testing
Before an employee is required to use any respirator with a negative or positive pressure tight-fitting face piece,
the employee must be fit tested with the same make, model, style, and size of respirator that will be used. The
Company shall ensure that an employee using a tight-fitting face piece respirator is fit tested prior to initial use of
the respirator, whenever a different respirator face piece (size, style, model or make) is used, and at least annually
thereafter
COMPANY NAME SHORT has establish a record of the qualitative and quantitative fit tests administered to
employees including:
 The name or identification of the employee tested
 Type of fit test performed
 Specific make, model, style, and size of respirator tested
 Date of test
 The pass/fail results for QLFTs or the fit factor and strip chart recording or other recording of the test results
for QNFTs
Additional fit tests will be conducted whenever the employee reports, or the Company, Physician, supervisor, or
program administrator makes visual observations of, changes in the employee's physical condition that could
affect respirator fit. Such conditions include, but are not limited to, facial scarring, dental changes, cosmetic
surgery, or an obvious change in body weight.
If after passing a QLFT or QNFT, the employee notifies the Company, program administrator, supervisor, or
Physician that the fit of the respirator is unacceptable, the employee shall be given a reasonable opportunity to
select a different respirator face piece and to be retested.
Types of Fit Tests
The fit test shall be administered using an OSHA-accepted QLFT or QNFT protocol. The OSHA-accepted QLFT
and QNFT protocols and procedures are contained in Appendix A of OSHA Standard 1910.134.
 QLFT may only be used to fit test negative pressure air-purifying respirators that must achieve a fit factor of
100 or less.
 If the fit factor, as determined through an OSHA-accepted QNFT protocol, is equal to or greater than 100 for
tight-fitting half face pieces, or equal to or greater than 500 for tight-fitting full face pieces, the QNFT has
been passed with that respirator.
 Fit testing of tight-fitting atmosphere-supplying respirators and tight-fitting powered air-purifying
respirators shall be accomplished by performing quantitative or qualitative fit testing in the negative pressure
mode, regardless of the mode of operation (negative or positive pressure) that is used for respiratory
protection.
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


Qualitative fit testing of these respirators shall be accomplished by temporarily converting the respirator
user's actual face piece into a negative pressure respirator with appropriate filters, or by using an identical
negative pressure air-purifying respirator face piece with the same sealing surfaces as a surrogate for the
atmosphere-supplying or powered air-purifying respirator face piece.
Quantitative fit testing of these respirators shall be accomplished by modifying the face piece to allow
sampling inside the face piece in the breathing zone of the user, midway between the nose and mouth. This
requirement shall be accomplished by installing a permanent sampling probe onto a surrogate face piece, or
by using a sampling adapter designed to temporarily provide a means of sampling air from inside the face
piece.
Any modifications to the respirator face piece for fit testing shall be completely removed, and the face piece
restored to NIOSH approved configuration, before that face piece can be used in the workplace.
Fit test records shall be retained for respirator users until the next fit test is administered. Written materials
required to be retained shall be made available upon request to affected employees.
Respirator Operation and Use
Respirators will only be used following the respiratory protection safety procedures established in this program.
The Operations and Use Manuals for each type of respirator will be maintained by the Program Administrator and
be available to all qualified users.
Surveillance by the direct supervisor shall be maintained of work area conditions and degree of employee
exposure or stress. When there is a change in work area conditions or degree of employee exposure or stress that
may affect respirator effectiveness, the Company shall reevaluate the continued effectiveness of the respirator.
For continued protection of respirator users, the following general use rules apply:
 Users shall not remove respirators while in a hazardous environment
 Respirators are to be stored in sealed containers out of harmful atmospheres
 Store respirators away from heat and moisture
 Store respirators such that the sealing area does not become distorted or warped
 Store respirator such that the face piece is protected

Face piece seal protection
COMPANY NAME SHORT does not permit respirators with tight-fitting face pieces to be worn by employees
who have:
 Facial hair that comes between the sealing surface of the face piece and the face or that interferes with valve
function; or
 Any condition that interferes with the face-to-face piece seal or valve function.
If an employee wears corrective glasses or goggles or other personal protective equipment, COMPANY NAME
SHORT shall ensure that such equipment is worn in a manner that does not interfere with the seal of the face
piece to the face of the user.
Continuing Effectiveness of Respirators
COMPANY NAME SHORT shall ensure the following that employees leave the respirator use area:
 To wash their faces and respirator face pieces as necessary to prevent eye or skin irritation associated with
respirator use
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

If they detect vapor or gas breakthrough, changes in breathing resistance, or leakage of the face piece
To replace the respirator or the filter, cartridge, or canister elements.
If the employee detects vapor or gas breakthrough, changes in breathing resistance, or leakage of the face piece,
the Company will replace or repair the respirator before allowing the employee to return to the work area.
Procedures for IDLH atmospheres
For all IDLH atmospheres, COMPANY NAME SHORT shall ensure that:
 One employee or, when needed, more than one employee is located outside the IDLH atmosphere
 Visual, voice, or signal line communication is maintained between the employee(s) in the IDLH atmosphere
and the employee(s) located outside the IDLH atmosphere
 The employee(s) located outside the IDLH atmosphere are trained and equipped to provide effective
emergency rescue
 COMPANY NAME SHORT or designee is notified before the employee(s) located outside the IDLH
atmosphere enter the IDLH atmosphere to provide emergency rescue
 COMPANY NAME SHORT or designee authorized to do so by the Company, once notified, provides
necessary assistance appropriate to the situation

Employee(s) located outside the IDLH atmospheres will be equipped with:
 Pressure demand or other positive pressure SCBAs, or a pressure demand or other positive pressure suppliedair respirator with auxiliary SCBA; and either
 Appropriate retrieval equipment for removing the employee(s) who enter(s) these hazardous atmospheres
where retrieval equipment would contribute to the rescue of the employee(s) and would not increase the
overall risk resulting from entry; or
 Equivalent means for rescue where retrieval equipment is not required.
Cleaning and Disinfecting
COMPANY NAME SHORT shall provide each respirator user with a respirator that is clean, sanitary, and in
good working order. Our company shall ensure that respirators are cleaned and disinfected using the Standard
Operating Procedure SOP: Cleaning and Disinfecting.
The respirators shall be cleaned and disinfected when:
 Respirators issued for the exclusive use of an employee shall be cleaned and disinfected as often as necessary
to be maintained in a sanitary condition
 Respirators issued to more than one employee shall be cleaned and disinfected before being worn by different
individuals
 Respirators maintained for emergency use shall be cleaned and disinfected after each use
 Respirators used in fit testing and training shall be cleaned and disinfected after each use.
Cleaning and Storage of respirators assigned to specific employees is the responsibility of that Employee.
Respirator Inspection
All respirators/SCBAs, both available for "General Use" and those on "Permanent Check-out", will be inspected
after each use and at least monthly. Should any defects be noted, the respirator/SCBA will be taken to the
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program Administrator. Damaged Respirators will be either repaired or replaced. The inspection of respirators
loaned on "Permanent Check-out" is the responsibility of that trained Employee.
Respirators shall be inspected as follows:
 All respirators used in routine situations shall be inspected before each use and during cleaning
 All respirators maintained for use in emergency situations shall be inspected at least monthly and in
accordance with the manufacturer's recommendations, and shall be checked for proper function before and
after each use
 Emergency escape-only respirators shall be inspected before being carried into the workplace for use

Respirator inspections include the following:
 A check of respirator function, tightness of connections, and the condition of the various parts including, but
not limited to, the face piece, head straps, valves, connecting tube, and cartridges, canisters or filters
 check of elastomeric parts for pliability and signs of deterioration.
 Self-contained breathing apparatus shall be inspected monthly. Air and oxygen cylinders shall be maintained
in a fully charged state and shall be recharged when the pressure falls to 90% of the manufacturer's
recommended pressure level. COMPANY NAME SHORT shall determine that the regulator and warning
devices function properly

For Emergency Use Respirators the additional requirements apply:
 Certify the respirator by documenting the date the inspection was performed, the name (or signature) of the
person who made the inspection, the findings, required remedial action, and a serial number or other means of
identifying the inspected respirator.
 Provide this information on a tag or label that is attached to the storage compartment for the respirator, is kept
with the respirator, or is included in inspection reports stored as paper or electronic files. This information
shall be maintained until replaced following a subsequent certification.
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Respirator Storage
Respirators are to be stored as follows:
 All respirators shall be stored to protect them from damage, contamination, dust, sunlight, extreme
temperatures, excessive moisture, and damaging chemicals, and they shall be packed or stored to prevent
deformation of the face piece and exhalation valve.
 Emergency Respirators shall be:
 Kept accessible to the work area;
 Stored in compartments or in covers that are clearly marked as containing emergency respirators; and
 Stored in accordance with any applicable manufacturer instructions.
Repair of Respirators
Respirators that fail an inspection or are otherwise found to be defective will be removed from service to be
discarded, repaired or adjusted in accordance with the following procedures:
 Repairs or adjustments to respirators are to be made only by persons appropriately trained to perform such
operations and shall use only the respirator manufacturer's NIOSH-approved parts designed for the respirator;
 Repairs shall be made according to the manufacturer's recommendations and specifications for the type and
extent of repairs to be performed; and
 Reducing and admission valves, regulators, and alarms shall be adjusted or repaired only by the manufacturer
or a technician trained by the manufacturer.
Breathing Air Quality and Use
COMPANY NAME SHORT shall ensure that compressed air, compressed oxygen, liquid air, and liquid oxygen
used for respiration accords with the following specifications:
 Compressed and liquid oxygen shall meet the United States Pharmacopoeia requirements for medical or
breathing oxygen; and
 Compressed breathing air shall meet at least the requirements for Grade D breathing air described in
ANSI/Compressed Gas Association Commodity Specification for Air, G-7.1-1989, to include:
 Oxygen content (v/v) of 19.5-23.5%;
 Hydrocarbon (condensed) content of 5 milligrams per cubic meter of air or less;
 Carbon monoxide (CO) content of 10 ppm or less;
 Carbon dioxide content of 1,000 ppm or less; and
 Lack of noticeable odor.
 Compressed oxygen will not be used in atmosphere-supplying respirators that have previously used
compressed air
 Oxygen concentrations greater than 23.5% are used only in equipment designed for oxygen service or
distribution
 Cylinders used to supply breathing air to respirators meet the following requirements
 Cylinders are tested and maintained as prescribed in the Shipping Container Specification Regulations of the
Department of Transportation (49 CFR part 173 and part 178)
 Cylinders of purchased breathing air have a certificate of analysis from the supplier that the breathing air
meets the requirements for Grade D breathing air
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
Moisture content in breathing air cylinders does not exceed a dew point of -50 deg.F (-45.6 deg.C) at 1
atmosphere pressure
Breathing air couplings are incompatible with outlets for non-respirable worksite air or other gas systems. No
asphyxiating substance shall be introduced into breathing air lines.
Breathing gas containers shall be marked in accordance with the NIOSH respirator certification standard, 42
CFR part 84.
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