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Accident Prevention Plan

(Sami Almalki)

TECH 462 –Industrial Safety Engineering

March 18, 2013

Table of Contents

Introduction

Purpose & Intentions Page 5

Company Presidents Statement Page 6

Management Responsibilities

Manager Responsibilities Page 8

Supervisors Responsibilities Page 8-9

Employee Orientation

How and When Page 11

Emergency Action Plan Page 12-24

Emergency Shutdown Procedures Page 25

Injury and Illness Procedures

Procedures Page 27

Record Keeping Page 27

Supervisor Responsibilities Page 28

Report Form Page 29

Incident/Accident Investigation Procedures

Procedure Steps Page 31

Worksheet Form Page 32

Incident/accident Table Page 33

Safety Guidelines

General Guidelines Page 35-36

Equipment Specific Page 37

Individual Specific Page 38

Safety Disciplinary Policy

Safety Disciplinary Policy Page 40

Safety Awareness Program

Safety Committee Page 42

Safety Meetings Page 43

Safety Training Forms Page 43-44

Safety Award Program Page 45

Appendix A: Material Safety Data Sheet

(ACETOPHENONE) MSDS Page 47

(CALCIUM CARBONATE) MSDS Page 48

Appendix B: State and Federal Posters

(Job and Safety It’s the Law) Page 50

(In Case of Injury At Work) Page 51

(Fire Safety) Page 52

(Health and Safety at Work) Page 53

(Speak Up For Safety) Page 54

(Please Use Your Safety Gear) Page 55

Appendix C: OSHA Forms and Instructions

OSHA Form Instructions Page 57

OSHA Form 300 Page 58

OSHA Form 300A Page 59

OSHA Form 301 Page 60

ADDITIONAL FORMS Page 61-73

Introduction

SAFETY AND HEALTH POLICY FOR XYZ COMPANY

XYZ COMPANY places a high value on the safety of its employees. XYZ COMPANY is committed to providing a safe workplace for all employees and has developed this program for injury prevention to involve management, supervisors, and employees in identifying and eliminating hazards that may develop during our work process.

It is the basic safety policy of this company that no task is so important that an employee must violate a safety rule or take a risk of injury or illness in order to get the job done. The time during which employees are participating in training and education activities shall be considered as hours worked for purposes of wages, benefits, and other terms and conditions of employment. The training and education shall be provided at no cost to the employees. Members of the Safety/Health Committee will be allowed reasonable time to exercise the rights of the committee without any loss of pay or benefits.

Employees are required to comply with all company safety rules and are encouraged to actively participate in identifying ways to make our company a safer place to work. Supervisors are responsible for the safety of their employees and as a part of their daily duties must check the workplace for unsafe conditions, watch employees for unsafe actions and take prompt action to eliminate any hazards.

Management will do its part by devoting the resources necessary to form a safety committee composed of management and elected employees. We will develop a system for identifying and correcting hazards. We will plan for foreseeable emergencies. We will provide initial and ongoing training for employees and supervisors. And, we will establish a disciplinary policy to insure that company safety policies are followed.

Letter From The President

The purpose of this policy is to create a high criterion of safety all the way through operations of XYZ Company, and to make certain that no employee is expected to work under any conditions, which are risky or unhygienic.

We know that each employee has the right to obtain personal satisfaction from their job and the prevention of occupational injury and illness is of such significance to this belief that it will be given top priority at all times.

It is our goal here at ZYX Company to begin and maintain complete accident prevention and safety training programs. Each distinct individual from upper management to the working person is accountable for the safety and health of those persons that are in charge and their coworkers around them, our employee’s.

Signed,

The Company President

Management Responsibilities

Responsibilities for safety and health include the establishment and maintenance of an effective communication system among workers, supervisors and management officials. To this end, all personnel are responsible to assure that their messages are received and understood by the intended receiver. Specific safety and health responsibilities for company personnel are as follows:

1. Management Officials

Active participation in and support of safety and health programs is essential. Management officials will display their interest in safety and health matters at every opportunity. At least one manager (as designated) will participate in the safety and health committee meetings, incident investigations and inspections. Each manager will establish realistic goals for implementing instructions for meeting the goals. Goals and implementing instructions shall be within the framework established by this document. Incentives will be included as part of the instructions.

1. Supervisors

The safety and health of the employees they supervise is a primary responsibility of the supervisors. To accomplish this obligation, supervisors will:

1.	Assure that all safety and health rules, regulations, policies and procedures are understood and observed.
2.	Require the proper care and use of all required personal protective equipment.
3.	Identify and eliminate job hazards quickly through job safety analysis procedures. (See the sample Job Safety Analysis form attached to this document.)
4.	Inform and train employees on the hazardous chemicals and/or procedures they MAY encounter under normal working conditions or during an emergency situation. (See the sample hazard communication program.)
5.	Receive and take initial action on employee suggestions, awards or disciplinary measures.
6.	Train employees (new and experienced) in the safe and efficient methods of accomplishing each job or task as necessary.
7.	Review injury trends and establish prevention measures.
8.	Participate in incident investigations and inspections.
9.	Promote employee participation in the safety and health program.
10.	Actively follow the progress of injured workers and display an interest in their rapid recovery and return to work.

Employee Orientation

How and When

Safety is everyone's job at Small Business Notes. Small Business Notes provides a clean, hazard free, healthy, safe environment in which to work in accordance with the Occupational Safety and Health Act of 1970. As an employee, you are expected to take an active part in maintaining this environment. You should observe all posted safety rules, adhere to all safety instructions provided by your supervisor and use safety equipment where required. Your workspace should be kept neat, clean and orderly.

EMERGENCY ACTION PLAN for: XYZ COMPANY

Facility Name: ____________________

Facility Address: ___________________

DATE PREPARED: ___/_____/______

EMERGENCY PERSONNEL NAMES AND PHONE NUMBERS

DESIGNATED RESPONSIBLE OFFICIAL (Highest Ranking Manager at

_____________site, such as __________, ___________, or ____________):

Name: Phone: (________________)

EMERGENCY COORDINATOR:

Name: Phone: (______________)

AREA/FLOOR MONITORS (If applicable):

Area/Floor: Name: Phone: (_______________)

Area/Floor: Name: Phone: (_______________)

ASSISTANTS TO PHYSICALLY CHALLENGED (If applicable):

Name: Phone: (_______________)

Name: Phone: (________________)

Date ____/____/____

EVACUATION ROUTES

• Evacuation route maps have been posted in each work area. The

following information is marked on evacuation maps:

1. Emergency exits

2. Primary and secondary evacuation routes

3. Locations of fire extinguishers

4. Fire alarm pull stations’ location

a. Assembly points

• Site personnel should know at least two evacuation routes.

EMERGENCY PHONE NUMBERS

FIRE DEPARTMENT: ________________

PARAMEDICS: _______________

AMBULANCE: _______________

POLICE: ________________

FEDERAL PROTECTIVE SERVICE: ________________

SECURITY (If applicable): _________________

BUILDING MANAGER (If applicable): ________________

UTILITY COMPANY EMERGENCY CONTACTS

(Specify name of the company, phone number and point of contact)

ELECTRIC: _____________________

WATER: _______________________

GAS (if applicable): __________________________

TELEPHONE COMPANY: _______________________

Date: ___/____/_____

EMERGENCY REPORTING AND EVACUATION PROCEDURES

Types of emergencies to be reported by site personnel are:

• MEDICAL

• FIRE

• SEVERE WEATHER

• BOMB THREAT

• CHEMICAL SPILL

• STRUCTURE CLIMBING/DESCENDING

• EXTENDED POWER LOSS

• OTHER (specify)___________________________________

MEDICAL EMERGENCY

• Call medical emergency phone number (check applicable):

􀂆 Paramedics

􀂆 Ambulance

􀂆 Fire Department

􀂆 Other

Provide the following information:

a. Nature of medical emergency,

b. Location of the emergency (address, building, room number),

and

c. Your name and phone number from which you are calling.

• Do not move victim unless absolutely necessary.

• Call the following personnel trained in CPR and First Aid to provide the

required assistance prior to the arrival of the professional medical help:

Name: Phone:_______________________

Name: Phone: ________________________

• If personnel trained in First Aid are not available, as a minimum, attempt to

provide the following assistance:

1. Stop the bleeding with firm pressure on the wounds (note: avoid

contact with blood or other bodily fluids).

2. Clear the air passages using the Heimlich Maneuver in case of

choking.

• In case of rendering assistance to personnel exposed to hazardous materials,

consult the Material Safety Data Sheet (MSDS) and wear the appropriate personal

protective equipment. Attempt first aid ONLY if trained and qualified.

Date___/___/___

FIRE EMERGENCY

When fire is discovered:

• Activate the nearest fire alarm (if installed)

• Notify the local Fire Department by calling .

• If the fire alarm is not available, notify the site personnel about the fire

emergency by the following means (check applicable):

􀂆 Voice

Communication

􀂆 Phone Paging

􀂆 Radio

􀂆 Other (specify)

Fight the fire ONLY if:

• The Fire Department has been notified.

• The fire is small and is not spreading to other areas.

• Escaping the area is possible by backing up to the nearest exit.

• The fire extinguisher is in working condition and personnel are trained to

use it.

Upon being notified about the fire emergency, occupants must:

• Leave the building using the designated escape routes.

• Assemble in the designated area (specify location):

• Remain outside until the competent authority (Designated Official or

designee) announces that it is safe to reenter.

Designated Official, Emergency Coordinator or supervisors must (underline one):

• Disconnect utilities and equipment unless doing so jeopardizes his/her

safety.

• Coordinate an orderly evacuation of personnel.

• Perform an accurate head count of personnel reported to the designated

area.

• Determine a rescue method to locate missing personnel.

• Provide the Fire Department personnel with the necessary information

about the facility.

• Perform assessment and coordinate weather forecast office emergency

closing procedures

Area/Floor Monitors must:

• Ensure that all employees have evacuated the area/floor.

• Report any problems to the Emergency Coordinator at the assembly area.

Assistants to Physically Challenged should:

• Assist all physically challenged employees in emergency evacuation.

Date___/___/___

EXTENDED POWER LOSS

In the event of extended power loss to a facility certain precautionary measures should

be taken depending on the geographical location and environment of the facility:

• Unnecessary electrical equipment and appliances should be turned off in

the event that power restoration would surge causing damage to

electronics and effecting sensitive equipment.

• Facilities with freezing temperatures should turn off and drain the following

lines in the event of a long term power loss.

· Fire sprinkler system

· Standpipes

· Potable water lines

· Toilets

• Add propylene-glycol to drains to prevent traps from freezing

• Equipment that contain fluids that may freeze due to long term exposure

to freezing temperatures should be moved to heated areas, drained of

liquids, or provided with auxiliary heat sources.

Upon Restoration of heat and power:

• Electronic equipment should be brought up to ambient temperatures

before energizing to prevent condensate from forming on circuitry.

• Fire and potable water piping should be checked for leaks from freeze

damage after the heat has been restored to the facility and water turned

back on.

CHEMICAL SPILL

The following are the locations of:

Spill Containment and Security Equipment: ___________________________

Personal Protective Equipment (PPE):

MSDS:_____________________________________________________

When a Large Chemical Spill has occurred:

• Immediately notify the designated official and Emergency Coordinator.

• Contain the spill with available equipment (e.g., pads, booms, absorbent

powder, etc.).

• Secure the area and alert other site personnel.

• Do not attempt to clean the spill unless trained to do so.

• Attend to injured personnel and call the medical emergency number, if

required.

• Call a local spill cleanup company or the Fire Department (if arrangement

has been made) to perform a large chemical (e.g., mercury) spill cleanup.

Name of Spill Cleanup Company:_______________________________

Phone Number:_____________________________________________

• Evacuate building as necessary

When a Small Chemical Spill has occurred:

• Notify the Emergency Coordinator and/or supervisor (select one).

• If toxic fumes are present, secure the area (with caution tapes or cones) to

prevent other personnel from entering.

• Deal with the spill in accordance with the instructions described in the

MSDS.

• Small spills must be handled in a safe manner, while wearing the proper

PPE.

• Review the general spill cleanup procedures.

SEVERE WEATHER AND NATURAL DISASTERS

Tornado:

• When a warning is issued by sirens or other means, seek inside shelter.

Consider the following:

- Small interior rooms on the lowest floor and without windows,

- Hallways on the lowest floor away from doors and windows, and

- Rooms constructed with reinforced concrete, brick, or block with no

windows.

• Stay away from outside walls and windows.

• Use arms to protect head and neck.

• Remain sheltered until the tornado threat is announced to be over.

Earthquake:

• Stay calm and await instructions from the Emergency Coordinator or the

designated official.

• Keep away from overhead fixtures, windows, filing cabinets, and electrical

power.

• Assist people with disabilities in finding a safe place.

• Evacuate as instructed by the Emergency Coordinator and/or the

designated official.

Flood:

If indoors:

• Be ready to evacuate as directed by the Emergency Coordinator and/or

the designated official.

• Follow the recommended primary or secondary evacuation routes.

If outdoors:

• Climb to high ground and stay there.

• Avoid walking or driving through flood water.

• If car stalls, abandon it immediately and climb to a higher ground.

Hurricane :

• The nature of a hurricane provides for more warning than other natural

and weather disasters. A hurricane watch issued when a hurricane

becomes a threat to a coastal area. A hurricane warning is issued when

hurricane winds of 74 mph or higher, or a combination of dangerously high

water and rough seas, are expected in the area within 24 hours.

Once a hurricane watch has been issued:

• Stay calm and await instructions from the Emergency Coordinator or the

designated official.

• Moor any boats securely, or move to a safe place if time allows.

• Continue to monitor local TV and radio stations for instructions.

• Move early out of low-lying areas or from the coast, at the request of

officials.

• If you are on high ground, away from the coast and plan to stay, secure

the building, moving all loose items indoors and boarding up windows and

openings.

• Collect drinking water in appropriate containers.

Once a hurricane warning has been issued:

• Be ready to evacuate as directed by the Emergency Coordinator and/or

the designated official.

• Leave areas that might be affected by storm tide or stream flooding.

During a hurricane:

• Remain indoors and consider the following:

- Small interior rooms on the lowest floor and without windows,

- Hallways on the lowest floor away from doors and windows, and

- Rooms constructed with reinforced concrete, brick, or block with no

windows.

Blizzard:

If indoors:

• Stay calm and await instructions from the Emergency Coordinator or the

designated official.

• Stay indoors!

• If there is no heat:

- Close off unneeded rooms or areas.

- Stuff towels or rags in cracks under doors.

- Cover windows at night.

• Eat and drink. Food provides the body with energy and heat. Fluids

prevent dehydration.

• Wear layers of loose-fitting, light-weight, warm clothing, if available.

If outdoors:

• Find a dry shelter. Cover all exposed parts of the body.

• If shelter is not available:

- Prepare a lean-to, wind break, or snow cave for protection from the

wind.

- Build a fire for heat and to attract attention. Place rocks around the

fire to absorb and reflect heat.

- Do not eat snow. It will lower your body temperature. Melt it first.

If stranded in a car or truck:

• Stay in the vehicle!

• Run the motor about ten minutes each hour. Open the windows a little for

fresh air to avoid carbon monoxide poisoning. Make

sure the exhaust pipe is not blocked.

• Make yourself visible to rescuers.

- Turn on the dome light at night when running the engine.

- Tie a colored cloth to your antenna or door.

- Raise the hood after the snow stops falling.

• Exercise to keep blood circulating and to keep warm.

CRITICAL OPERATIONS

During some emergency situations, it will be necessary for some specially

assigned personnel to remain at the work areas to perform critical operations.

Assignments:

Work Area Name Job Title Description of Assignment

• Personnel involved in critical operations may remain on the site upon the

permission of the site designated official or Emergency Coordinator.

• In case emergency situation will not permit any of the personnel to remain

at the facility, the designated official or other assigned personnel shall

notify the appropriate _______________ offices to initiate backups. This

information can be obtained from the Emergency Evacuation Procedures

included in the ___________________ Manual.

The following offices should be contacted:

Name/Location:________________________________

Telephone Number:_____________________________

Name/Location:________________________________

Telephone Number:_____________________________

Name/Location:________________________________

Telephone Number:_____________________________

TRAINING

The following personnel have been trained to ensure a safe and orderly

emergency evacuation of other employees:

Facility:

Name Title Responsibility Date

Emergency Shutdown Procedures

What is the first step in an emergency shutdown?

A.	Place pressure on switch to NO. 1 located in break room and release.

B.	Notify all personnel to evacuate the building.

C.	Pull fire control handle.

D.	Run to the outside warehouse.

Injury & Illness Procedures

Procedures

This document contains guidance for safety procedures to be followed and forms to be used. Supervisors are expected to integrate the procedures into the appropriate work activity and employees are expected to apply them on the job. The sample forms are to be used if they apply to the job concerned.

Record Keeping

1. Minor injuries – requiring doctor or outpatient care: After the emergency actions following an injury, an investigation of the incident will be conducted by the immediate supervisor and any witness to determine the causes. The findings must be documented on our investigation form.

1. Major injuries – fatality or one or more hospitalizations: Top management must see that the Department of Labor and Industries is notified as soon as possible, but at least within 8 hours of the incident. Call or contact in person the nearest office of the Department or call the OSHA toll free central number (1-800-321-6742). Top management will then assist the Department in the investigation.

1. The findings must be documented on our incident investigation report form and recorded on the OSHA 300 log, if applicable.

Supervisor’s Responsibilities

1. Supervise and administer first aid as you wish (Good Samaritan Law applies).

1. Arrange for transportation (ambulance, helicopter, company vehicle, etc.), depending on the seriousness of the injury. Protect the injured person from further injury.

1. Notify owner or top management, if not already present.

1. Do not move anything unless necessary, pending investigation of the incident.

1. Accompany or take injured person(s) to doctor, hospital, home etc. (depending on the extent of injuries).

1. Take injured person to family doctor, if available.

1. Remain with the injured person until relieved by other authorized persons (manager, EMT, doctor, etc.).

1. When the injured person’s immediately family is known, the owner or supervisor should properly notify family members, preferable in person, or have an appropriate person do so.

Report Form

Incident/Accident

Investigation Procedures

Procedure Steps

Observe the items of responsibility established in this document as well as job safety rules which may apply to specific task assignments.

1 Follow safety rules described in this program, OSHA safety standards and training or receive.

2. Report unsafe conditions or actions to your supervisor or safety committee representative

right away.

3. Report all injuries to your supervisor promptly regardless of how serious.

4. Report all near-miss incidents to your supervisor promptly.

5. Always use personal protective equipment (PPE) in good working condition where it is required.

6. Do not remove or defeat any safety device or safeguard provided for employee protection.

7. Encourage co-workers by your words and example to use safe work practices on the job.

8. Make suggestions to your supervisor, safety committee representative or management about changes you believe will improve employee safety.

Worksheet Form

Incident/Accident Table

Safety Guidelines

General Guidlines

Learn ways store materials in a safe manner. Tie down or support piles if necessary to prevent falling, rolling, or shifting.

1. Shavings, dust scraps, oil or grease should not be allowed to accumulate. Good housekeeping is a part of the job.

1. Trash piles must be removed as soon as possible. Trash is a safety and fire hazard.

1. Remove or bend over the nails in lumber that has been used or removed from a structure.

1. Immediately remove all loose materials from stairs, walkways, ramps, platforms, etc.

1. Do not block aisles, traffic lanes, fire exits, gangways, or stairs.

1. Avoid shortcuts – use ramps, stairs, walkways, ladders, etc.

1. Standard guardrails must be erected around all floor openings and excavations must be barricaded. Contact your supervisor for the correct specifications.

1. Do not remove, deface or destroy any warning, danger sign, or barricade, or interfere with any form of protective device or practice provided for your use or that is being used by other workers.

1. Get help with heavy or bulky materials to avoid injury to yourself or damage to material.

1. Keep all tools away from the edges of scaffolding, platforms, shaft openings, etc.

1. Do not use tools with split, broken, or loose handles, or burred or mushroomed heads. Keep cutting tools sharp and carry all tools in a container.

1. Know the correct use of hand and power tools. Use the right tool for the job.

1. Know the location and use of fire extinguishing equipment and the procedure for sounding a fire alarm.

Equipment Specific

The following equipment will be operated, and will require training beforehand:

Specific equipment in factory:

Air compressor

Conveyors

Electric forklift

Hoists

Metal punch presses

Metal bending and cutting machines

Plastic injection molding machines

Plastic sheet forming equipment

Shearing machine for sheet plastic

Individual Specific

Processes at factory include:

Circuit board assembly

Circuit board production

Metal case production

Plastic forming processes

Plastic pellet storage and transport to machines

Shipping/receiving

Safety Disciplinary Policy

Safety Disciplinary Policy

XYZ COMPANY believes that a safety and health Accident Prevention Program is unenforceable without some type of disciplinary policy. Our company believes that in order to maintain a safe and healthful workplace, the employees must be cognizant and aware of all company, State, and Federal safety and health regulations as they apply to the specific job duties required. The following disciplinary policy is in effect and will be applied to all safety and health violations.

The following steps will be followed unless the seriousness of the violation would dictate going directly to Step 2 or Step 3.

1. A first time violation will be discussed orally between company supervision and the employee. This will be done as soon as possible.

1. A second time offense will be followed up in written form and a copy of this written documentation will be entered into the employee’s personnel folder.

1. A third time violation will result in time off or possible termination, depending on the seriousness of the violation.

Safety Awareness Program

Safety Committee

We believe that hard work and perseverance are required for the prevention of injuries, with an active safety committee being the key to a successful result. The committee is made up of management-designated representatives and employee-elected representatives. Employees in each division will elect a representative from among themselves to be on the committee. At no time will there be more management-designated representatives than employee-elected representatives.

A. Purpose: To assist in the detection and elimination of unsafe conditions and work procedures.

B. Procedures:

The following guidelines will be followed:

0. The committee will elect a chairperson by majority vote.

0. The attendance and subjects discussed shall be documented and maintained on file for one year.

0. Copies of the minutes should be made available to the employees by posting or other means.

Safety Meetings

The regularly scheduled meeting time is at 12:50 pm on the first Tuesday of every third

month, at the break room. This may be changed by vote of the committee.

Safety Training Form

1.	Explain the company safety program, including:
		Orientation	______	______
		On-the-job training	______	______
		Safety meetings	______	______
		Incident investigation	______	______
		Disciplinary action	______	______
2.	Use and care of personal protective equipment (Hard hat, fall protection, eye protection, etc.)	______	______
3.	Line of communication and responsibility for immediately reporting injuries.
	A.	When to report an injury	______	______
	B.	How to report an injury	______	______
	C.	Who to report an injury to	______	______
	D.	Filling out incident report forms	______	______
4.	General overview of operation, procedures, methods and hazards as they relate to the specific job	______	______
5.	Pertinent safety rules of the company and WISHA	______	______
6.	First aid supplies, equipment and training
	A.	Obtaining treatment	______	______
	B.	Location of Facilities	______	______
	C.	Location and names of First-aid trained personnel	______	______
7.	Emergency plan
	A.	Exit location and evacuation routes	______	______
	B.	Use of fire fighting equipment (extinguishers, hose)	______	______
	C.	Specific procedures (medical, chemical, etc.)	______	______
8.	Vehicle safety	______	______
9.	Personal work habits
	A.	Serious consequences of horseplay	______	______
	B.	Fighting	______	______
	C.	Inattention	______	______
	D.	Smoking policy	______	______
	E.	Good housekeeping practices	______	______
	F.	Proper lifting techniques	______	______

Safety Award Program

Appendix A:

Material Safety Data Sheet

Appendix B:

State and Federal Posters

Appendix C:

OSHA Forms and Instructions

OSHA Form Instructions

OSHA Form 300

OSHA Form 300A

OSHA Form 301

Safety and Health Inspection Check List

Job site: _____________________________________ Date: _________________________

This format is intended only as a reminder to look for unsafe practices, potential and/or near miss incidents.

(S) indicates Satisfactory (U) indicates Unsatisfactory

Date of inspection/walk around

Machinery

Point of operation guard

Belts, pulleys, gears, shafts, etc.

Oiling, cleaning, and adjusting

Maintenance and oil leaks

Pressure equipment

Steam equipment

Air Receivers and Compressors

Gas cylinders and hoses

Unsafe Practices

Excessive speed of vehicles

Improper lifting

Smoking in dangerous places

Horseplay

Running in aisles or on stairs

Improper use of air hoses

Removing machine guards

Job site: _____________________________________ Date: _________________________

This format is intended only as a reminder to look for unsafe practices, potential and/or near miss incidents.

(S) indicates Satisfactory (U) indicates Unsatisfactory

Date of inspection/walk around

Machinery

Point of operation guard

Belts, pulleys, gears, shafts, etc.

Oiling, cleaning, and adjusting

Maintenance and oil leaks

Pressure equipment

Steam equipment

Air Receivers and Compressors

Gas cylinders and hoses

Unsafe Practices

Excessive speed of vehicles

Improper lifting

Smoking in dangerous places

Horseplay

Running in aisles or on stairs

Improper use of air hoses

Removing machine guards

Working under suspended loads

Working on machines in motion

First aid

First aid kits

Stretchers and fire blankets

Emergency showers

Eyewash stations

All injuries and illnesses reported

Hazard Communications

Acids and caustics

Solvents

Dusts, vapors, or fumes

Radiation

Safety and Health Inspection Check List – continued

Job site: _____________________________________ Date: _________________________

(S) indicates Satisfactory (U) indicates Unsatisfactory

Date of inspection/walk around

Tools

Power tools, wiring and grounding

Hand tools (condition)

Use and storage of tools

Personal protective equipment

Goggles or face shield

Substantial footwear

Working under suspended loads

Working on machines in motion

First aid

First aid kits

Stretchers and fire blankets

Emergency showers

Eyewash stations

All injuries and illnesses reported

Hazard Communications

Acids and caustics

Solvents

Dusts, vapors, or fumes

Radiation

Safety and Health Inspection Check List – continued

Job site: _____________________________________ Date: _________________________

(S) indicates Satisfactory (U) indicates Unsatisfactory

Date of inspection/walk around

Tools

Power tools, wiring and grounding

Hand tools (condition)

Use and storage of tools

Personal protective equipment

Goggles or face shield

Substantial footwear

Hard hats

Gloves

Respirators

Fall protection equipment

Other protective clothing

Fire protection

Extinguishing equipment

Exits, stairs, and signs

Storage of flammable materials

Material Handling Equipment

Power trucks and hand trucks

Elevators

Cranes and hoists

Conveyors

Cables, ropes, chains, slings

Housekeeping

Aisles, stairs and floors

Storage and piling of materials

Wash and locker rooms

Light and ventilation

Disposal of water

Yards and parking lots

Bulletin boards

Only safety and health materials posted

Neat and attractive

Display regularly changed

Well-illuminated

Equipment Safety Inspection Checklist

Date: __________________________________________

Project: _________________________________________

Equipment: ______________________________________

All guards and fenders	_____	OK	_____	Needs Repair
Brakes	_____	OK	_____	Needs Repair
Lights – front, rear, side, dash	_____	OK	_____	Needs Repair
Back-up alarm – horn	_____	OK	_____	Needs Repair
Ladders, stairs, hand holds	_____	OK	_____	Needs Repair
ROPS (Roll-over protection)	_____	OK	_____	Needs Repair
Seat belts	_____	OK	_____	Needs Repair
Fire extinguisher	_____	OK	_____	Needs Repair
Glass	_____	OK	_____	Needs Repair
Tires	_____	OK	_____	Needs Repair
Electrical cords	_____	OK	_____	Needs Repair
Ground fault circuit interrupters	_____	OK	_____	Needs Repair
Electrical hand tools	_____	OK	_____	Needs Repair
Powder actuated tools	_____	OK	_____	Needs Repair
Pneumatic condition of all hand tools	_____	OK	_____	Needs Repair

Other Items Checked:

Oil level and leaks	___	OK	___	Needs Repair	___	Add	___	Change
Hydraulic oil level and leaks	___	OK	___	Needs Repair	___	Add	___	Change
Anti-freeze level and leaks	___	OK	___	Needs Repair	___	Add	___	Change
Fuel level and leaks	___	OK	___	Needs Repair	___	Add	___	Change
First aid kit	___	OK	___	Needs Repair	___	Add	___	Change

Repaired by: _________________________________________

Checked by: __________________________________________

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JOB SAFETY ANALYSIS WORKSHEET

TITLE OF JOB OPERATION: _______________________________	Date: ______________
Title of person who does job: _____________________________________________________
Employee observed: _________________________	Location: ________________________
Analysis made by: ___________________________	Analysis approved by: ______________

Sequence of basic job steps	Potential injuries or hazards	Recommended safe job procedures

Hazardous Substances

Employee Orientation Checklist

Employee Name: (Add Name of Employee here)

Title: (Add title of employee here) Date hired: (Add Date Hired here)

Trainer Name: (Add name of person conducting training here)

This checklist is to inform employees of (Add company name here) of its Hazard Communication Program. Place a check in each box to indicate that the subject has been covered.

The supervisor has reviewed the following information with the employee:

1. The purpose of the hazard communication standard is to require chemical manufacturers or importers to assess the hazards of chemicals they produce or import. All employers must provide information to their employees about the hazardous chemicals to which they may be exposed.

Employees must be informed about the hazard communication program, labels and other forms of warning, and material safety data sheets, and they must have training on the hazardous substances they may encounter.

2. The supervisor has reviewed the hazardous chemical list with the employee.

3. The supervisor has shown the employee the following:

Location of hazardous chemicals within the employee’s work site.

Location of the written Hazard Communication Program.

Location of the material safety data sheets for all hazardous chemicals in the employee’s assigned work area.

Location of the list of person(s) trained and authorized to handle the hazardous chemicals.

The signature below documents that the appropriate elements have been talked over to the satisfaction of both parties and that both the supervisor and employee accept responsibility for maintaining a safe and healthful work environment.

Date: (Enter date of orientation) Supervisor’s signature: _______________________

Date: (Enter date of orientation) Employee’s signature: ________________________

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