Professional Documents
Culture Documents
PRACTICES
COMPANY
Address 1
City, State, Zip
Phone Number
Fax Number
Point of Contact
Table of Contents
I Safety and Health Policy Statement...............................................................1
II Management/Employee Leadership Responsibilities....................................2
a. Owner
b. Supervisor
c. Employees
d. Employee Acknowledgement
III Analysis & Review Component.....................................................................5
a. Activities & Documents to Reviews
b. Identified Hazards and Corrective Action
c. Accident Prevention Plan Review
IV Record Keeping.............................................................................................6
a. Injury Records & Logs
b. Inspection Records & Safety Work Order Log
c. Safety Meetings
d. Training
V Policies, Standard & Safe Work Practices.....................................................9
a. Required Documentation & Posters
b. Documentation
VI Disciplinary Program.....................................................................................10
a. Non-Serious Violations
b. Serious Violations
c. Safety Violation Notice
d. Records of Safety Violations
VII Employee Safety Rules & Responsibilities...................................................13
VIII Accident Reporting and Investigation...........................................................15
a. Reporting & Investigation Procedures
b. After An Injury is Reported
c. Investigation Procedures
IX A Return-to-Work Process Makes Sense.......................................................17
a. Put It in Writing
(1) Policy Statement
(2) Procedures for the Return-to-Work Process
(3) Statement of Responsibilities
(4) How to Communicate the Return-to-Work Process to Employees
b. Assess Job Using Job Safety Analysis (JSA)
(1) How to Use the Job Analysis (JSA) Inventory
(2) Job Inventory
(3) How to Use the Physical Demands JSA
(4) Physical Demands JSA Assessment
(5) Principles of Job Redesign
(6) Job Description Guide
c. Identify Modified Duty
(1) How to Identify Modified Duty Work
(2) Sample Modified Duty Work Agreement
i
d. Communicate with the Doctor and Employee
(1) Sample Letters for the Treating Doctor
(2) After-Injury Telephone Report Log
(3) Sample Medical Release of Information
e. Make a Bona Fide Offer of Employment
(1) TDI Rule 129.6 Bona Fide Offer of Employment
(2) Checklist for Making a Bona Fide Offer of Employment
(3) DWC Form 73
X Substance Abuse Policy.................................................................................52
a. Purpose and Scope
b. Disciplinary Action and Prohibited Conduct
c. Testing
d. Miscellaneous Provisions
XI Inspections & Audits......................................................................................55
a. Informal Inspections
b. Formal Inspections
c. Areas to Be Inspected
d. Job Site Hazard Assessments
XII Safety & Health Training...............................................................................57
a. New Employee Orientation
b. Training Topics
c. Safety Meeting
d. Safe Work Practices
e. Forms (Refer to Section XLI in manual)
(1) Safety Meeting
(2) Safety Inspection Checklist
(3) Employee Training Summary
(4) Job Safety Analysis Form (JSA)
XIII Abrasive Blasting...........................................................................................61
XIV Backhoe Operation.........................................................................................62
XV Blood-borne Pathogens Program...................................................................64
XVI Concrete & Masonry......................................................................................67
XVII Confined Space Program...............................................................................68
XVIII Cranes, Rigging & Hoists..............................................................................70
XIX Driving Safety................................................................................................72
XX Electrical Procedures.....................................................................................74
a. General
b. Temporary Wiring
c. Ground Fault Protection
XXI Electrical Hazard Energy Control Program (Lockout/Tagout)......................75
a. Policy
b. Lockout/Tagout Forms
XXII Excavation (Trenching & Shoring Program) ................................................81
a. Policy
b. Definitions
c. General Requirements
ii
d. OSHA Soil Classifications
e. Daily Inspection Form
f. Safety Checklist
XXIII Fall Protection Program...............................................................................87
XXIV Fire Protection & Prevention.......................................................................90
XXV Forklifts……................................................................................................91
XXVI H2S……………………………………………………………………….. 92
XXVII Hazard Communication Program................................................................95
a. Policy
b. Responsibilities
c. Chemical Inventory Lists
d. Material Safety Data Sheets (MSDS)
e. Purchasing
f. Container Labeling
g. Employee Training
h. Personal Protective Equipment (PPE)
i. Hazards of Non-Routine Tasks
j. Emergency Response
k. Informing Other Employees
l. Posting
m. Sample of HAZCOM program
XXVIII Hearing Conservation Program.................................................................103
XXIX Housekeeping............................................................................................106
XXX Manual Lifting Procedures.......................................................................107
XXXI Mechanical Guarding................................................................................108
XXXII Office Safety.............................................................................................109
XXXIII Personal Protective Equipment/Hazard Assessment Program.................111
XXXIV Power & Hand Tool.................................................................................115
XXXV Respiratory Protection Program...............................................................117
XXXVI Scaffold ................................................................................................122
XXXVII Signs & Placards......................................................................................123
XXXVIII Stairways & Ladders...............................................................................124
XXXIX Warehouse Safety………………………………………………………125
XL Welding & Cutting..................................................................................131
XLI Forms
XLII Safety Meeting Records
XLIII Accident / Incident / Illness Records
Legend:
iii
Safety and Health Policy Statement
The safety and health policy of COMPANY (herein after referred
to as COMPANY) is based on the firm conviction that accidents,
which cause personal injury or loss of assets, can and should be
prevented. No area of the company business is of greater
importance than the safety and health of the men and women
working at COMPANY.
_______________________
Owner
1
Management / Employee Leadership
The success of COMPANY’s safety program is dependent on management and
employees accepting their assigned safety responsibilities. The acceptance of these
responsibilities will be the first step in the development of a proactive safety culture.
This company will hold personnel accountable to the following safety responsibilities.
I. Owner
The Owner’s Responsibilities:
A. Understand and support the elements of this Accident Prevention Plan.
B. Issue and support a Safety Policy Statement.
C. Periodically attend Supervisor / Employee safety meetings.
D. Periodically participate in a Supervisor / Employee job site inspection.
E. Monthly, checks the Supervisor’s Safety Work Order Logs (PBS form
110) and verifies that items have been corrected.
F. Each quarter, schedule and facilitate an Owner / Supervisor safety meeting
(PBS form 121).
G. Ensure safety standards, safe work practices, and operating procedures are
understood and implemented.
H. Set example.
I. Participate in Accident Investigations and follow up corrective action.
II. Supervisor
The Supervisor’s Responsibilities:
A. Assist in the development of policies and procedures.
B. Lead by example.
C. Solicit employee input on Accident Prevention Plan activities.
D. Consistently reinforce rules, procedures and safe work practices with
employees, visitors, vendors and contractors.
E. Weekly, schedule and facilitate a Supervisor / Employee safety meeting
(PBS form 120).
F. Monthly, schedule and participate in formal Supervisor / Employee job
site inspection. Record deficiencies on the Safety Work Order Log (PBS
form 110).
G. Verify employees’ job / task knowledge and provide appropriate training
where necessary.
H. Participate in the development of the assigned safe work practice / do’s &
don’ts list.
I. Coordinate work activities to comply with Safe Work Practices.
2
III. Employees
The Employees Responsibilities:
A. Know, understand and comply with the safety policy, rules, procedures
and safe work practices.
B. Assist in the development and review of rules and procedures.
C. Attend, participate, and periodically lead scheduled safety meetings.
D. Maintain good housekeeping
E. Participate in safety inspections and audits.
F. Continually inspect tools and equipment. Repair, tag, or report items in
need of repair.
G. Identify safety and / or operational problems and offer suggestions for
corrective action.
H. Know the chemicals used and comply with the requirements of the
Material Safety Data Sheets.
I. Report all accidents, incidents, and near-misses to the most immediately
available Supervisor.
J. Properly use and maintain required personal protective equipment.
K. Observe and correct unsafe acts of visitors, vendors, contractors and
fellow employees. Safety is your responsibility!
3
Employee Acknowledgement
Every employer is required by law to provide a safe healthful workplace. This company
is committed to fulfilling this requirement. A safe and healthful workplace is one of our
highest priorities.
While we cannot anticipate every workplace hazard, the following general principals
should guide your conduct. In addition you will be given a copy of the Safety Rules.
Our employees have the following obligation:
By signing this acknowledgment, each employee promises to learn and follow safety
policies and rules established by the company. If you don’t understand any policy, please
ask your Supervisor for explanation. Failure to follow safety policies and rules is
punishable under the company’s Discipline Policy, up to and including termination.
______________________________
Employee’s Signature
______________________________
Supervisor’s Signature
______________________________
Date
4
Analysis & Review Component
I. Activities & Documents to Review
The Owner and Supervisor will review, analyze, and develop an action plan using
information generated from the following:
A. Accident / Incident Reports (Owner: as they occur) Inspection Reports
(Supervisor: as they occur / Owner: review weekly).
B. Safety Meeting information (Supervisor: as they occur / Owner: review
monthly)
C. Safe Work Practices (Supervisor: ongoing / Owner: review monthly).
D. Employee orientation, retention, and turnover (Supervisor: regularly /
Owner: review quarterly).
E. OSHA 300 log (Owner and Supervisor - annually)
F. Inspection Reports (Owner - monthly)
G. Insurance loss runs (Owner: review annually).
Any new hazards identified during the review, audits, inspections, safety
meetings, or incident investigations will be communicated to all affected
employees and included in the Accident Prevention Plan.
Annually the Owner, with input from Supervisor, will review the elements of the
Accident Prevention Plan. The review should analyze the effectiveness of the
plan. The plan should be updated to reflect any needed changes identified during
this review.
5
Record Keeping
I. Injury Records & Logs
A. Supervisor’s First Report of Injury and Investigation (PBS form 109)
The Supervisor of the injured employee will be responsible to complete
this report and send it to the PBS Worker’s Compensation Administrator
and COMPANY Office Manager as soon as possible; but no later than 24
hrs after the occurrence.
The law requires a completed copy of the OSHA log be posted between
February 1st and April 30Th of each year in a place where employee
notices are normally kept. A copy of the report should be filed and kept
for a period of 5 years.
6
B. Safety Inspections Checklist (PBS form 111)
The Supervisor will be the one primarily responsible for completion of
this form and gather the appropriate documentation. This is a
comprehensive inspection that covers the work site, power and hand tools,
personal protective equipment, etc. The Supervisor should forward all
inspection documentation to the Office Manager.
The Office Manager will file the checklist in the Supervisor’s safety folder
and distribute copies to the Owner.
The meeting form should be filed in the Supervisor’s manual and a copy sent to
the Office Manager for filing and distribution.
7
IV. Training
A. Documentation
Documentation for training will include:
1. Date of training
2. Name of Trainer
3. Outline of subject(s)
4. Signed attendance roster
B. Responsibilities
The Supervisor will be responsible to complete training documentation per
the guidelines of this manual, any appropriate law, or company policy.
The Supervisor should distribute training documentation to the Office
Manager.
8
Policies, Standards & Safe Work Practices
I. Required Documentation & Posters
II. Posters
• OSHA
• Texas Employment Commission
• Emergency phone numbers
• Texas Workers’ Compensation Commission notice
• Texas Equal Employment Opportunity Commission
_________________________________________________________________
_
_________________________________________________________________
_
_________________________________________________________________
_
_________________________________________________________________
_
_________________________________________________________________
_
III. Documentation
• Safety & Health training
• Hazard Communication Training & MSDS
• Equipment & Job site Inspection Reports
• Maintenance Records
• OSHA 300 log (Posted February 1 to April 30)
• Special Programs
Respiratory Protection
Trenching & Shoring
Fall Protection
Hazard Assessment Program
Lockout / Tagout
Forklift Training
Confined Spaces Training
H2S (and related safety equipment) Training
Personal Protective Equipment (use & maintenance)
Hand / Power Tool Maintenance
Vehicle Maintenance
Any other programs required by law.
_________________________________________
_________________________________________
_________________________________________
_________________________________________
_________________________________________
9
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Disciplinary Program
I. Scope
Employment with PBS is voluntarily entered into, and the employee is free to resign at
will at anytime, with or without cause. Similarly PBS may terminate the employment
relationship at will at any time, with or without notice or cause, so long as there is no
violation of applicable federal or state law. The Disciplinary Program set forth here is not
intended to create a contract, nor is it to be constructed to constitute obligations of any
kind or a contract of employment between PBS and any of its employees.
The following disciplinary program has been implemented to protect the lives and safety
of PBS and COMPANY’s employees, clients, subcontractors and general public. The
purpose is not to punish but to develop better work habits by implementing a formal
corrective action program.
The Owner is responsible for the enforcement of this program. Any verbal or written
warning given an employee should be forwarded to the owner for review and follow-up.
The following constitutes a safety violation. This list is only an example of possible
safety violations. No list could cover every possibility.
1. Not wearing proper PPE
2. Did not follow safety procedures / work practices
3. Horseplay
4. Improper use of equipment / tools
5. Altering safety devices
6. Operating at unsafe speed
7. Other
Types of violations:
1. Serious
2. Non-serious
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The Supervisor and Owner will discuss all violations with the employee. A 30-day
follow-up review will be conducted for serious violations.
Nothing in this policy prohibits the immediate discharge or removal of any employee on
any job site whose conduct constitutes a serious violation of the safety requirements that
could cause serious danger.
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Safety Violation Notice
Company: _______________________________________________________
Explanation
____________________________________________________________
_______________________________________________________________________
_
_______________________________________________________________________
_
_______________________________________________________________________
_
_______________________________________________________________________
_
Note: The portion below is to be completed by the Owner of the company or his / her
representative only.
13
Action Taken: ____ Warning 1st 2nd. 3rd.
____ Suspension ____ Days
____ Discharge
14
Employee Safety Rules & Responsibilities
Each employee is responsible to follow the listed policies, rules & procedures. If for any
reason an employee does not understand or has questions about a particular rule or
situation, THE EMPLOYEE SHOULD STOP and ASK! No employee will be expected
or required to perform a job / task in an unsafe manner or a job / task of which they have
little or no understanding of. If an employee is not comfortable or confident he or she
can perform a specific task safely, they should IMMEDIATELY STOP and contact their
Supervisor. The Supervisor will schedule all required training at the earliest available
opportunity.
The following pages contain rules, procedures and work practices on various topics.
These by no means are all-inclusive and complete but are the minimum requirements.
The employees, supervisors, and Owner must assess each situation and or piece of
equipment to decide the appropriate safe methods and procedures.
Basic Rules
• Employees are required to report any vehicle, tool, piece of equipment and/or
situation that appears to be unsafe.
• Report all injuries; minor as well as major. Report near-miss accidents and/or
equipment damage.
• Personal Protective Equipment appropriate for the job will be required. Additional
protection will be required if recommended on a MSDS, customer policy or company
policy.
• Clothing must be appropriate and not create a potential safety hazard. Loose
clothing, jewelry and bracelets are prohibited for certain jobs.
• All signs and tag warnings or instructions must be adhered too.
• All machine guards must be kept in place.
• Do not leave an electrical tool running and unattended.
• Do not operate any piece of equipment that has a faulty or broken switch, frayed or
taped wires or cord. This includes any equipment that in your opinion is not in a safe
working condition.
• Do not use electrical cords with bare wiring or a plug that is missing a ground plug.
• Return tools and cords to their proper places. Clean up your work area as you go, at
the end of the day, or when work is complete.
• Employees shall obey all company rules, governmental regulations, warning signs
and instructions. Be familiar with those that apply to you. If you do not understand
or know; ask you Supervisor.
• All employees will participate in safety meetings conducted or contracted by the
company and their Supervisor.
• Horseplay, scuffling and other acts which tend to have adverse influence on safety or
well being of other employees are prohibited.
15
• No one shall be permitted to work while the employee’s ability or alertness is or
appears to be so impaired by fatigue, illness or other causes that might expose the
employee or others to injury.
16
Accident Reporting and Investigation
It is the policy of PBS and COMPANY that all injuries / incidents be promptly reported
and investigated. The severity or potential severity and probability of reoccurrence
should determine the depth of the review or investigation. Accident investigations can
and should provide an opportunity to evaluate and correct deficiencies found within the
Accident Prevention Plan.
The “Supervisor’s First Report of Injury and the Investigation” report (PBS form
109) is to be forwarded to the Owner for review.
Supporting Documents:
1. Inspection Reports 4. Hazard Assessment
2. Safe Work Practice’s 5. Training
3. Previous Incident Reports
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III. Investigation Procedures
A. Take pictures and get witness to complete “Witness Statement” (PBS
form 104) and if possible get the injured employee to complete “Employee
Incident Report” (PBS form 103).
B. Gather facts
Who Where
What Why
When How
C. Analyze facts
D. Determine contributing causes
E. Identify which area of the Accident Prevention Plan need revision
(inspections, safe work practices, management commitment and
involvement, etc.).
F. Develop corrective action plan
G. Assign completion dates and responsibilities for implementation of
corrective action plan.
H. Follow up
I. Distribute information to other crews for review and to raise safety
awareness throughout the company.
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A Return-to-Work Process
Makes Sense
Primary Business Systems, Inc. (PBS) and Texas Mutual Insurance Co. (formerly The
Texas Workers’ Compensation Insurance Fund), work hard to help our clients maintain a
safe work place, but we know that no business is immune to on-the-job injuries. When
an employee is injured on the job, your first responsibility is to get him or her prompt
medical care. But don’t stop there.
We know that by helping the injured employee get back on the job, they can actually help
speed his or her recovery. The longer an injured employee stays off work, the less likely
he or she will ever return to productive employment. That’s why we are developing this
return-to-work process. Our insurance carrier rehabilitation specialists are passionate
about the importance of their work, and they can help get our injured employees back on
the job as soon as medically reasonable.
Sections I through III take us through our return-to-work process. We learn how to assess
existing job tasks and identify alternative productive work before it’s actually needed. In
Sections IV and V, we learn how to use the information on Form DWC-73, and how to
communicate with the treating doctor to return the injured employee to work. We provide
a sample of a bona fide offer of employment letter once the treating doctor has cleared
the injured employee to return.
If you suspect fraud, let us know your concerns when reporting the claim or tell the
workers' compensation specialist assigned to the claim about your concerns.
What’s Inside?
19
Section I
Put It in Writing
The goal of the return-to-work process is to provide prompt medical care to injured
employees and return them to work as soon as medically reasonable. Employees who
return to work quickly feel more productive, and they often recover faster. We benefit by
minimizing the cost of lost time.
What can we do to get these results? We can begin by providing a written return-to-work
process and communicating it to employees.
2. The procedures explain the steps that our employees, Supervisor and return-to-work
coordinator will take from the time an employee is injured until after the employee
returns to work.
3. Included, there is a statement that explains the responsibilities of the injured employee,
the company, the health care provider, our return-to-work coordinator, and your insurance
company. Everyone must know what is expected of him or her.
More info
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Policy Statement for the
Return-to-Work Process
PBS and Our Client Companies are committed to providing a safe and healthy workplace
for our employees. Preventing injuries and illnesses is our primary objective.
Our ultimate goal is to return injured employees to their original jobs. If an injured
employee is unable to perform all the tasks of the original job, we will make every effort
to provide alternative productive work that meets the injured employee’s capabilities.
The support and participation of management and all employees are essential for the
success of our return-to-work process.
Rick Matthews
President PBS
Nuestra meta principal es regresar a los empleados lastimados a sus trabajos originales.
Si un empleado es incapaz de realizar todas las tareas de su trabajo original, haremos todo
lo posible por proporcionar un trabajo alternativo que vaya de acuerdo con las
capacidades del empleado lastimado.
Rick Matthews
Presidente PBS
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Procedures for the
Return-to-Work Process
Follow these procedures when an employee is injured on the job.
4. If the injured employee needs medical attention, the client contact or Supervisor should
go with the employee to the doctor or other medical provider. Whenever possible, the
employee or client should provide the doctor with the injured employee’s job description,
essential job elements, and an introductory letter explaining your return-to-work process.
The client can also ask to speak to the doctor after the visit.
5. If the doctor restricts the employee from work, the return-to-work coordinator should
communicate regularly with the employee and treating doctor. The client’s contact
person should talk with the employee on the day of the injury and once a week until the
employee returns to work. The return-to-work coordinator should check with the treating
doctor whenever the employee has a follow-up visit.
6. When the treating doctor releases the employee to modified duty (light duty), the
client, with the assistance of the return to work coordinator, should attempt to develop an
alternative assignment. Every assignment must meet the doctor’s restrictions as specified
on Form DWC-73. (see attached copy.) THE CLIENT SHOULD MAKE EVERY
EFFORT TO DEVELOP ALTERNATIVE PRODUCTIVE WORK.
7. PBS must keep a copy of the DWC-73 each time the doctor completes one, should the
client receive the DWC-73 it should be forwarded to PBS. TDI-DWC requires the doctor
to complete a DWC-73 when the injured workers’ work status changes, or when the
employer’s or carrier’s request, but not more than once every two weeks. The client, with
the assistance of PBS, must give the doctor a copy of the employee’s job description
when requesting a DWC-73.
8. The client contact must follow up with the employee on a regular basis after the
employee returns to work.
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Statement of Responsibilities
Employee responsibilities:
• Make sure you understand your company’s procedure for reporting injuries.
• If you are injured, tell your doctor that alternative work is available to you. Your
Supervisor will ask you to take a letter from work to your doctor. The letter will explain
your company’s return-to-work process.
• If a doctor restricts you from working, call your employer once a week to let them
know how you are doing.
• If a doctor releases you to work, return to work on the next scheduled shift.
• If a doctor gives you medical restrictions for modified duty assignment, follow the
doctor’s orders.
Client’s responsibilities:
• Train employees on proper reporting of incidents and injuries and return-to-work
procedures.
• Go with the injured employee to the doctor. Tell the doctor about your company’s
return-to work process and provide the doctor with an explanatory letter.
• Contact the injured employee once a week and make sure all necessary forms are
completed and returned.
• Express concern for the employee’s health and recovery.
• Provide information to PBS’s return-to-work coordinator.
• Help create modified duty assignments that are meaningful.
• Make sure the injured employee is following the doctor’s restrictions as specified in
Form DWC-73.
• Check the employee’s condition regularly to help get the employee back to his or
her original job.
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Declaración de Responsabilidades
24
How to Communicate the
Return-to-Work Process to Employees
For your return-to-work process to be effective, workers must understand your
procedures and be willing to follow them. Here are ideas for successfully communicating
the process to employees.
1. Put up posters showing your return-to-work policy statement. Make sure employees
have access to return-to-work procedures and the statement of responsibilities.
25
Introduction to
The Return-to-Work Process
EMPLOYEES IN ATTENDANCE:
NAME SIGNATURE
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
26
Section II
You’ll need these analyses to modify duty assignments (described in the next section) for
injured employees who are returning to work. When possible, use JSA and create
modified duty assignments before they are needed.
The reason for taking this proactive approach is simple: You can prevent workplace
injuries by identifying unsafe aspects of a job and modifying them before an employee
gets hurt.
More info
On the following pages, we’ve provided forms that you can use to inventory jobs and
assess physical demands, along with explanations of how to use the forms. We’ve also
provided information on redesigning jobs and writing JSA.
Page
How to Use the Job Safety Analysis (JSA) Inventory .............................................. 26
Job Inventory (blank form to photocopy) .............................................…... See Forms
How to Use the Physical Demands JSA ................................................................... 27
Physical Demands Job Assessment (blank form to photocopy) ................................30
Principles of Job Redesign......................................................................................... 32
Job Description Guide................................................................................................ 34
27
How to Use the Job Safety Analysis (JSA)
The objective of a JSA is to list the steps or activities necessary to perform a job. Most
jobs have multiple steps. This analysis asks you to list each step separately and show the
specific actions or steps required to complete the job
.
Follow these steps for completing the JSA.
Re: Purpose of the JSA. The purpose may be to identify alternative productive
work or to identify areas where safety may be improved.
2. Observe the job and break it down into specific steps. List each step separately, and
then write down the following information about each step.
Percent of time: Determine the percent of time spent on each task during the
entire workday. List the percent of time each step takes. Percentages for the steps listed
must add up to 100 percent.
Job description and steps: Write a short summary (one to two sentences) for each
job. Then observe the job and write down the specific steps (actions or activities) as they
occur from start to finish for each job.
EXAMPLE
You are analyzing the job of a cashier at a fast food restaurant. This job breaks down into
two jobs for the entire shift. The first job description is “takes customer orders for food
and drink.” The second job description is “fixes drinks for customers.” The cashier
spends 55 percent of the time taking orders and 45 percent of the time fixing drinks
(almost every order has a drink).
Each job breaks down into steps. For instance, the steps for the first job (taking orders)
are “greets the customer, answers questions, listens to the order, enters the cost for each
item into the cash register, takes money, gives back change and a receipt, and gives the
order to the cook.” The steps for fixing drinks are “takes a cup out of the cup holder, fills
the cup with ice and a drink, puts a lid on the cup, and hands the drink to the customer.”
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How to Use the
Physical Demands JSA Assessment
There are many types of assessment and analysis tools. This assessment asks you to
describe a job in terms of its physical demands and environmental conditions. Follow
these steps for completing the assessment.
Section 1: Postures
Observe the employee’s postures (standing, sitting, walking, or driving) during the job.
First, circle the number of hours the employee stays in a posture without changing.
Second, circle the total (or cumulative) number of hours that the employee is in a posture
while doing this job throughout the day.
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Climbing Using your legs, arms, hands or feet to move up or down a structure such
as stairs, ladders, scaffolds and ramps.
Example: Climbing a telephone pole to repair wires.
Balancing Moving in a manner that requires you to keep from falling because of
unstable, slippery or moving surfaces, or narrow spaces.
Example: Replacing shingles on a steep roof.
Bending Using your back and legs to bend forward and downward.
Example: Leaning over a car engine to do repairs.
Twisting Rotating your upper body in a different direction than your lower body.
Example: Reaching behind you to pick up parts while you remain seated at a
machine.
Reaching Moving your hands and arms toward an object at arm’s length in any
direction from your body.
Example: Reaching upward to change an overhead light bulb.
Fingering Using your fingers to pinch, pick or manipulate objects, especially small
ones.
Example: Picking up nuts and placing them on bolts.
Feeling Using your hands and fingers to perceive the shape, size, temperature or
other characteristic of an object.
Example: Laying your hand on the hood of a car to check for heat.
Repetitive Using your feet or hands continuously in the same motion or motions.
Example: Typing at a computer or using a foot pedal on a sewing machine.
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Section 4: Equipment
Observe any equipment, tools or machinery the employee uses during the JOB. Describe
the name or type of each tool, piece of equipment or machine. Mark how often it is used:
never, occasionally, frequently or constantly. Note any other information about the
physical demands of operating the equipment
Comments
Write any other information that you observe about the physical demands of the job.
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Physical Demands Job Assessment
Job title: ______________________ Date: ______________
Analyst:___________________
Job duration (hours/day): ______ With breaks: Yes / No Overtime (avg. hours/week):
_____
Description: of Job
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______
1. Postures:
Stand: Hours at one time: 0 1/2 1 2 3 4
______
Total hours per day: 0 1/2 1 2 3 4
______
2. Lifting/carrying
Not present Occasionally Frequently Constantly Height of Distance of
0% 0-33% 34-66% 67-100% Lift Carry
_______________________________________________________________________
1-10 lbs ________ ________
11-20 lbs ________ ________
21-50 lbs ________ ________
51-100 lbs ________ ________
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> 100 lbs ________ ________
33
3. Actions and motions:
Not present Occasionally Frequently Constantly
0% 0-33% 34-66% 67-100% Description
_______________________________________________________________________
_
Pushing
__________________
Pulling
__________________
Climbing
__________________
Balancing
__________________
Bending
__________________
Twisting
__________________
Squatting
__________________
Crawling
__________________
Kneeling
__________________
Reaching
__________________
Handling
__________________
Fingering
__________________
Feeling
__________________
Repetitive:
hand motion
__________________
foot motion
__________________
4. Equipment:
Not present Occasionally Frequently Constantly
0% 0-33% 34-66% 67-100% Description
_______________________________________________________________________
_
Tools
__________________
Machinery
__________________
34
Equipment
__________________
5. Environmental conditions:
Not present Occasionally Frequently Constantly
0% 0-33% 34-66% 67-100% Description
_______________________________________________________________________
_
Vibration
__________________
Noise
__________________
Extreme heat
__________________
Extreme cold
__________________
Wet/humid
__________________
Moving parts
__________________
Chemicals
__________________
Electricity
__________________
Radiation
__________________
Other
__________________
Comments: ______________________________________________________________
35
Principles of Job Redesign
When you identify unsafe aspects of a job, it’s time to redesign the job so you can prevent
injuries or re-injuries. Solutions are often simple and cheap. Here is a list of key
principles to follow when redesigning a job.
36
3. Reduce the hand distance.
• Change the shape of the object.
• Provide grips or handles.
• Provide better access to object.
• Improve layout of the work area.
Reduce carrying
1. Eliminate the need to carry by converting to pushing or pulling.
• Use conveyors, air bearings, ball caster tables, slides, chutes, and similar aids.
• Use lift trucks, two-wheel or four-wheel hand trucks, dollies, and similar aids.
2. Reduce the weight of the object.
• Reduce the size of the object (specify size to suppliers).
• Reduce the capacity of containers.
• Reduce the weight of the container itself.
• Reduce the load in the container.
• Reduce the number of objects lifted or lowered at one time.
3. Reduce the carrying distance.
• Improve the layout of the work area
• Relocate production or storage areas.
37
Job Description Guide
To write a job description, list the information requested for each section using the
guidelines provided.
SECTION GUIDELINES
Job title • Provide the title and the location of the job, if appropriate.
38
Section III
Keep the employee’s doctor informed as you create a modified duty assignment to make
sure it meets with the doctor’s medical restrictions. Fill out a modified duty agreement
form to ensure the injured employee and the client understands the employee’s
capabilities and any medical restrictions.
Texas law now requires PBS and our clients to report whether they offer modified duty
opportunities for injured employees. Upon request, an employer must share this
information with the injured worker, the treating doctor, and the workers’ compensation
insurance carrier.
On the following pages, we’ve provided samples that you can use to identify and assign
modified duty work.
Page
How to Identify Modified Duty Work ..........................................................................36
Sample Modified Duty Work Agreement (English).…………….................................38
Sample Modified Duty Work Agreement (Spanish)…………………………………..39
39
How to Identify
Modified Duty Work
Employers use modified assignments to bring injured employees back to the workplace
as soon as medically reasonable. In most cases, workers won’t be able to return to their
original jobs while recovering from an injury. Bring them back to work by modifying
their duties or developing an entirely new assignment. Here are some helpful tips.
2. Organize information about these jobs. Do a job safety analysis to identify physical
demands and other conditions (helpful information is provided in this kit). If possible,
make a short videotape of the jobs. Keep the job safety analyses and videotapes in an
accessible area.
3. Keep job safety analysis’s up to date and accurate. Write a job safety analysis for
every job at your company. If an employee is injured, you’ll already have the
information you need about the employee’s original job assignment.
2. The doctor must complete Form DWC-73, which lists the employee’s medical
restrictions and current capabilities. The doctor must approve all modified duty
assignments and any changes to the job duties.
3. Have the return-to-work coordinator, the employee, and the client sign a modified duty
work agreement. This agreement describes the new work duties, start and end dates for
the duties, and medical restrictions. The agreement states that the injured employee will
not work or be asked to work outside of medical restrictions.
40
4. Continually monitor the employee’s progress. Talk with the employee regularly and
discuss any concerns. Make sure the doctor agrees to any changes in the modified duty.
5. When the employee reaches the end date for the agreement, discuss the employee’s
medical status and the success of the assignment. If the doctor gives the employee a full
release to work, the employee can go back to the original job. If the doctor continues the
employee’s medical restrictions, evaluate continuing alternative productive work.
Troubleshooting
What if I bring an injured employee back to modified duty and the employee is re-injured
on the job?
There is no guarantee that an employee will not be re-injured. In some circumstances, a
re-injury may be considered a new claim. The treating doctor should always approve
modified duty, which will reduce the risk of re-injury.
What if an injured employee on modified duty is constantly late to work, does not carry
out assigned tasks, and often has unexcused absences?
If you have company rules for all employees, the same rules apply to injured employees.
Follow your existing disciplinary process. However, if the employee has not reached
maximum medical improvement, and you send the employee home without pay, Texas
Mutual Insurance Co. will pay temporary income benefits.
41
Modified Duty Work Agreement
Employee’s name: ______________________ Department: _______________________
My work duties are changed from _______________ (date) until _____________ (date).
I am assigned to modified work duties or limited duties. My new work duties are listed
below.
_______________________________________________________________________
_
_______________________________________________________________________
_
_______________________________________________________________________
_
_______________________________________________________________________
_
The duties above have been described to my doctor. My doctor has signed Form DWC-
73 stating that I may do these activities under the following medical restrictions.
_______________________________________________________________________
_
_______________________________________________________________________
_
_______________________________________________________________________
_
I agree to do the above work duties and follow my doctor’s medical restrictions. If I
ignore my medical restrictions, I understand that my employer may take disciplinary
action.
42
Un Acuerdo
De Trabajo Alternativo
Nombre del empleado: ______________________ Departamento:__________________
Puesto del empleado: ________________________ Fecha: ________________________
Mis deberes de trabajo han cambiado de _________ (fecha) al _______________ (fecha).
Estoy asignado a los deberes de trabajo alternativo o limitado. Mis deberes de trabajo
nuevos están listados en la parte inferior.
_______________________________________________________________________
_
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
___
Los deberes descritos en la parte superior han sido explicados a mi doctor. Mi doctor ha
firmado una Form DWC-73 estableciendo que yo puedo realizar estas actividades bajo
las siguientes restricciones médicas.
_______________________________________________________________________
_
_______________________________________________________________________
_
_______________________________________________________________________
_
Acepto los deberes de trabajo listados en la parte superior y seguir las restricciones del
doctor. Si ignoro mis restricciones médicas, entiendo que la compañía para la que trabajo
puede tomar acciones disciplinarias.
Si un Supervisor o cualquier otra persona me piden que haga tareas o actividades que no
cumplan con mis restricciones médicas, debo reportar la situación inmediatamente a
_______________________________________________ (nombre del coordinador del
regreso al trabajo), quien corregirá la situación.
Si pienso que mis nuevos deberes de trabajo están causando incomodidad o están
empeorando mi condición médica, lo reportaré inmediatamente a
____________________________ (nombre del coordinador del regreso al trabajo).
43
Section IV
Communicate with
the Doctor and Employee
Texas law now requires employers to report whether they offer modified duty
opportunities for injured employees. Upon request, an employer must share this
information with the injured worker, the treating doctor, and the workers’ compensation
insurance carrier.
Communication is vital to the return-to-work process. Maintain regular contact with the
treating doctor and the injured employee. Have the employee’s Supervisor send a letter
to the doctor explaining your company’s return-to-work process. Have the employee sign
a release so the doctor can discuss work-related medical information with your company.
The Supervisor should accompany the injured employee on his or her first visit to the
doctor. If this is not possible, we suggest that you ask the injured employee to take along
a return-to-work folder, and the Supervisor can follow up with a phone call later. A
typical return-to-work folder may contain:
• a letter telling the treating doctor you want to return the employee to work as
soon as medically reasonable,
• a medical release signed by the employee that allows the doctor to provide you
with medical information about how the injury affects the employee’s ability to
work, and
• a copy of Form DWC-73, Work Status Report, so the doctor can make return-to-
work recommendations.
The information in Form DWC-73 will be crucial for assigning modified duty. Always be
sure the doctor agrees with any return-to-work assignments. Keep track of what benefits
the injured employee receives and how long Texas Mutual Insurance Co. pays benefits.
More information
On the following pages, we’ve provided samples for communicating with the doctor,
keeping track of communications with the employee, and understanding benefit
payments.
Page
Troubleshooting………………………………………………………………….41
Sample Letters for the Treating Doctor.................................................................42
After-Injury Telephone Report Log (blank form to photocopy)......………….....44
Sample Medical Release of Information...............................................................46
44
Troubleshooting
If my employee is injured on the job, can I choose the doctor I want the employee to
visit?
You may ask the injured employee to see your company doctor; however, injured
employees have the right to choose their treating doctors in accordance with the Texas
Labor Code and Texas Department of Insurance’s Division of Workers’ Compensation
rules.
45
Sample Letters for the Treating Doctor
Use this letter when asking for the doctor’s recommendations for returning the
employee to regular duties.
Dear Doctor:
This letter provides important information about employees who work for PBS and our
client companies. You may verify insurance coverage by calling Texas Mutual Insurance
Co. at (800) 859-5995. Our policy number is 0001101931.
• Your Recommendations
Please assist us by providing your recommendations for returning this employee to work.
We have attached a job safety analysis and physical demand of the job for this
employee’s regular duties, a medical release form, and a form for your recommendations.
We would appreciate an update after each appointment.
• Scheduling appointments
We can arrange work schedules around diagnostic or treatment appointments.
Please call me at the number below if you have any questions. Thank you in advance for
your assistance.
Sincerely,
46
Use this letter when asking for the doctor’s recommendations for returning the
employee to alternative productive work.
Dear Doctor:
This letter provides important information about employees who work for PBS and our
client companies. We have a return-to-work process designed to return employees to
work as soon as medically reasonable.
Since this employee is unable to return to regular duties, we would like to request your
recommendations on returning the employee to modified duty. We have attached a job
description and job safety analysis for alternative productive work, based on our
knowledge of the employee’s injury.
We have attached a form for your recommendations. We will ensure that this position
meets ALL medical restrictions you prescribe.
Please call me at the number below if you have any questions. Thank you in advance for
your assistance.
Sincerely,
Return to Work Coordinator
PBS
1/888/658-4675
47
After-Injury Telephone Report
Employee’s name: __________________________ Home phone: __________________
Has the employer discussed workers’ compensation benefits with the employee?
Yes _____ No ______
Has the employer discussed the return-to-work process with the employee?
Yes _____ No ______
_______________________________________________________________________
Log of Doctor’s Appointments
Date: ____________________________________ Time: _________________________
Comments:
_______________________________________________________________________
_
_______________________________________________________________________
_
Comments:
_______________________________________________________________________
_
_______________________________________________________________________
_
48
49
After-Injury Telephone Report, cont.
Coordinator’s Telephone Log
Date: ___________________________________ Time: __________________________
Comments:
_______________________________________________________________________
_
_______________________________________________________________________
_
Comments:
_______________________________________________________________________
_
_______________________________________________________________________
_
Comments:
_______________________________________________________________________
_
_______________________________________________________________________
_
50
Sample Medical Release of Information
I, ____________________, hereby release my treating doctor, ___________________ ,
to give my employer, PBS, pertinent information about my current work-related injury
and how that injury may affect my ability to complete the essential functions of my job.
No other confidential information may be released without my written consent. This
release will be valid no longer than 60 days, at which time it will be re-evaluated.
51
Section V
More info
On the following pages, we’ve provided a copy of DWC Rule 129.6 and a checklist for
making an offer of employment. We’ve also provided a sample letter making a bona fide
offer of employment.
Page
Troubleshooting………………………………………………………………………48
DWC Rule 129.6 “Bona Fide Offers of Employment”................................................49
Checklist for Making a Bona Fide Offer of Employment............................................51
DWC Form-73..............................................................................……….......See Forms
52
Troubleshooting
If I offer my injured employee a job, can the employee refuse it?
Injured employees may refuse an offer for alternative productive work, but if the offer of
employment was bona fide (according to DWC Rule 129.6), the insurance company may
discontinue the injured employee’s temporary income benefits. This does not mean the
injured employee is terminated from employment
.
If an injured employee returns to work at a lower pay rate, does the employee receive
workers’ compensation benefits?
Yes. If the injured employee has not reached maximum medical improvement and is not
receiving the average weekly wage that he or she earned before the accident, the
employee will receive income benefits.
53
DWC Rule 129.6
Bona Fide Offers of Employment
(a) An employer or insurance carrier may request the treating doctor provide a Work
Status Report by providing the treating doctor a set of functional job descriptions which
list modified duty positions which the employer has available for the injured employee to
work. The functional job descriptions must include descriptions of the physical and time
requirements of the positions.
(b) An employer may offer an employee a modified duty position which has restricted
duties which are within the employee's work abilities as determined by the employee's
treating doctor. In the absence of a Work Status Report by the treating doctor an offer of
employment may be made based on another doctor's assessment of the employee's work
status provided that the doctor made the assessment based on an actual physical
examination of the employee performed by that doctor and provided that the treating
doctor has not indicated disagreement with the restrictions identified by the other doctor.
(c) An employer's offer of modified duty shall be made to the employee in writing and in
the form and manner prescribed by the Division. A copy of the Work Status Report on
which the offer is being based shall be included with the offer as well as the following
information:
(1) the location at which the employee will be working;
(2) the schedule the employee will be working;
(3) the wages that the employee will be paid;
(4) a description of the physical and time requirements that the position will
entail; and
(5) a statement that the employer will only assign jobs consistent with the
employee's physical abilities, knowledge, and skills and will provide training if
necessary.
(d) A carrier may deem an offer of modified duty to be a bona fide offer of employment
if:
(1) it has written copies of the Work Status Report and the offer; and
(2) the offer:
(A) is for a job at a location which is geographically accessible as
provided in subsection (e) of this section;
(B) is consistent with the doctor's certification of the employee's work
abilities, as provided in subsection (f) of this section; and
(C) Was communicated to the employee in writing, in the form and
manner prescribed by the Division and included all the information
required by subsection (c) of this section.
(e) In evaluating whether a work location is geographically accessible the carrier shall at
minimum consider:
54
(1) The effect that the employee's physical limitations have on the employee's
ability to travel;
(2) The distance that the employee will have to travel;
(3) The availability of transportation; and
(4) Whether the offered work schedule is similar to the employee's work schedule
prior to the injury.
(f) The following is the order of preference that shall be used by carriers evaluating an
offer of employment:
(1) The opinion of a doctor selected by the Division to evaluate the employee's
work status;
(2) The opinion of the treating doctor;
(3) Opinion of a doctor who is providing regular treatment as a referral doctor
based on the treating doctor's referral;
(4) Opinion of a doctor who evaluated the employee as a consulting doctor based
on the treating doctor's request; and
(5) The opinion of any other doctor based on an actual physical examination of
the employee performed by that doctor.
(g) A carrier may deem the wages offered by an employer through a bona fide offer of
employment to be Post-Injury Earnings (PIE), as outlined in §129.2 of this title (relating
to Entitlement to Temporary Income Benefits), on the earlier of the date the employee
rejects the offer or the seventh day after the employee receives the offer of modified duty
unless the employee's treating doctor notifies the carrier that the offer made by the
employer is not consistent with the employee's work restrictions. For the purposes of this
section, if the offer of modified duty was made by mail, an employee is deemed to have
received the offer from the employer five days after it was mailed. The wages the carrier
may deem to be PIE are those that would have been paid on or after the date the carrier is
permitted to deem the offered wages as PIE.
(h) Nothing in this section should be interpreted as limiting the right of an employee or a
carrier to request a benefit review conference relating to an offer of employment. The
Division will find an offer to be bona fide if it is reasonable, geographically accessible,
and meets the requirements of subsections (b) and (c) of this section.
55
Checklist for Making a
Bona Fide Offer of Employment
When the treating doctor releases an injured employee to return to work in any capacity,
you should make a bona fide offer of employment to the employee. To be bona fide
(valid), the offer must meet the requirements of DWC Rule 129.6.
The Texas Department of Insurance established the requirements because a bona fide
offer of employment can affect a worker’s income benefits. When deciding whether an
offer is bona fide, the Division considers the following:
• how long the job is expected to last
• how long the offer was kept open
• the way you made the offer to the employee
• the job’s physical requirements and accommodations compared to the
employee’s physical capabilities
• the distance the employee has to travel to get to work (A job is accessible if it is
within a reasonable distance of where the employee lives, unless the employee
shows through medical evidence that a medical condition won’t allow the
employee to travel that distance.)
To help you make a bona fide offer, we have provided a sample letter on the next page.
Be sure to attach a copy of Form DWC-73 to the letter. Follow this checklist when you
write an offer:
__ State the job title, what the hourly or weekly wage will be, the hours of work, where
the employee will work, and how far the job is from where the employee lives.
__ State how long you will keep the job offer open.
__ Describe the job duties.
__ Describe the maximum physical requirements of the job.
__ Indicate that you understand the employee’s physical limitations and will abide by the
work restrictions sanctioned by the employee’s doctor.
__ If the employee is more fluent in a language other than English, translate the letter into
the appropriate language. We can help you with the translation.
__ Deliver the offer during the time the employee is eligible for workers’ compensation
income benefits.
__ Send the offer by certified mail, return receipt requested, and by regular mail.
__ Send a copy of the letter and mail receipt to your carrier.
If you don’t make an offer in writing, it is difficult to show the Division that you made an
offer.
56
SUBSTANCE ABUSE POLICY
The welfare and success of PBS and COMPANY, depends on the physical and
psychological health of all its employees. While they are committed to maintaining a safe
workplace, it is the responsibility of PBS, COMPANY, and their employees to create and
maintain a safe, healthful and efficient working environment. Therefore, for the
protection of its employees, property, and the general public; PBS and COMPANY have
adopted this Substance Abuse Policy.
1.01 PURPOSE: The purpose of this Policy is to maintain a safe, healthful, and
efficient working environment by eliminating any abuse of legal or illegal drugs, alcohol,
and inhalants at any time while on Company Business or on the Company premises. We
require all employees of the Company to be free from the effects of legal or illegal drugs,
alcohol, inhalants, and any other drug that may impair the employee’s ability to perform
his/her job in a safely manner.
1.02 SCOPE: This Policy applies to all employees of this Company: (a) at all times
while on the Company’s premises, (b) during the course and scope of their employment
regardless of location and (c) during any Company-sponsored activities.
2.01 DISCIPLINARY ACTION: Any employee’s failure to comply with any part of
this policy will result in disciplinary action up to and including termination of
employment.
2.02 PROHIBITED CONDUCT: Any employee will subject to the above measures of
paragraph 2.01 for any of the following:
a.) The manufacture, distribution, possession, use or sale of alcohol, inhalants,
unauthorized or illegal drugs or the misuse of any legal or prescription drugs on
Company’s premises, while on Company business, or during any Company-sponsored
activities.
b.) Being under the influence of any substance described (a) above which impairs
judgment, performance, or behavior while on Company’s premises, while on Company
business, or during any Company-sponsored activities.
c.) Conviction under any criminal statute for the possession, use or sale of drugs or
alcohol or any related activity.
d.) Refusing to submit to a medical evaluation, including drug and alcohol testing
as provided for in section 3 of this policy.
e.) Generating test results, which indicate any drug, alcohol or other substance
abuse.
57
3. TESTING
3.01 DEFINITION: For the purpose of this Policy, “drug” is defined as any alcoholic
beverage, illegal inhalant, illegal drug or other substance, the use, possession,
manufacture, distribution or dispensation of which is prohibited by any state or federal
law or regulation and any drug substance obtained by prescription, over-the-counter or
otherwise.
3.02 APPLICATION OF DRUG TESTING:
a) All persons applying for a position with COMPANY may be required to submit
to a drug test as a condition of employment.
b) All current and future employees must submit to a drug test upon the request of
PBS or COMPANY under the following:
1.) When special safety considerations attendant to certain jobs indicated that
such testing presents a reasonable means to assure a safe working environment.
2.) When employee either sustains an injury in the course and scope of
employment or contributes to or causes another employee to sustain an injury in the
course and scope of employment.
3.) When the employee causes, indirectly or directly, damage to the Company’s
property or to the property of another.
4.) When the employee contributes or causes injury to any third party while the
employee is in the course and scope of employment.
5.) When the employee is convicted under any criminal drug statue for a
violation occurring during the course and scope of employment. If such a conviction
occurs, it is the employee’s responsibility to notify the Company within five (5) days of
the conviction. This requirement includes any finding of guilt, guilty plea, plea of no
contest or imposition of sentence or any other penalty whatsoever by any court of
competent jurisdiction or otherwise in connection with any state or federal criminal
statute involving the manufacture, distribution, dispensation, use or possession of any
controlled substance or drug, including alcohol.
6.) When PBS or the Company, in its sole discretion, determines that it is in
PBS or the Company’s best interest to conduct such a drug test.
4. MISCELLANEOUS PROVISIONS
58
4.04 MEDICAL FACILITY: The Company shall not be responsible for, and makes no
representations or warranties on behalf of the, laboratory or medical facility conducting
the drug test.
59
Inspections and Audits
I. Inspections
It is the intent and policy of COMPANY to provide a workplace free from
recognizable hazards. To accomplish this objective the company has developed a
planned structured process for the maintenance of safe work conditions.
A. Informal Inspections
At the start of each job a visual inspection of tools, equipment, vehicles
and the general work area should be performed.
B. Formal Inspections
Monthly, or as required by law the Supervisor and crew will be
responsible to perform a formal job site and equipment inspection. The
“Inspection Checklist” (PBS form 111) should be completed and
deficiencies noted on the “Safety Work Order Log” (PBS form 110).
Noted deficiencies should be tracked on the safety work order log until
items are corrected.
60
D. Job Site Hazard Assessments
The Supervisor should conduct a hazard assessment for each new job site.
If new equipment or change in activity is introduced additional assessment
or training should be completed.
The Supervisor, along with his/her employees should review the job site
and tasks to be performed. This review should identify areas of potential
exposure or injury to employees. The proper methods and/or Personal
Protective Equipment needed should be reviewed and implemented.
61
Safety & Health Training
It is the policy of COMPANY that employees receive training in the various OSHA
standards, regulations, hazards and safe work practices associated with their assigned
tasks. Completion of training will depend on the complexity of the task and the level of
competency required to perform the task safely and productively.
Training will be completed while on the job and regularly scheduled safety meetings.
The main focus of the training program will consist of the safe work practices related to
the employees’ jobs and tasks. The outline of topics for New and existing employees is
outline below.
B. Documentation:
1. Subject(s) covered
2. Presenter
3. Name & Signature(s) of trainee(s)
4. Date
C. Responsibilities
The Supervisor is primarily responsible for the new employee training
and orientation. The employee is responsible to communicate their level
of knowledge and expertise.
The Owner should periodically audit and review the content and
effectiveness of training.
62
Training should be documented on either the “Supervisor Safety Meeting” (PBS
form 120) or “Safe Work Practice Development” (PBS form 101) and “Job
Safety Analysis Form” (form 107).
A. Documentation should include:
1. Date
2. Presenter
3. Person(s) trained
4. Outline of training topic
B. Training Topics
1. Fire Extinguishers
2. First Aid
3. Back Injury Prevention
4. Electrical (LOTO)
5. Machine Guards
6. Hand & Power Tools
7. Ladders & Scaffolds
8. Housekeeping
9. Heavy Equipment
10. Motor Vehicles
11. Cutting & Welding
12. Safe Work Practices related to tasks (see tasks list)
13. Preventive Maintenance
14. ___________________________
15. ___________________________
16. ___________________________
17. ___________________________
18. ___________________________
These meetings are most effective when they are planned and scheduled in
advance, employees participate (lead part of meeting), and the information is crew
specific, relevant and timely.
A. Documentation
1. Name of Presenter(s)
2. Date
3. Subjects Covered
4. Name and Signatures of attendees
63
Weekly, the Supervisor should schedule and facilitate a “Supervisor
Safety Meeting” (PBS form 120) with his/her crew. The primary focus of
the meeting should be on the safe work practices of the jobs and tasks
performed.
In addition to the development of safe work practices, relevant standards,
recent injuries and/or new MSDS should be discussed.
One meeting per month should be used to develop the assigned safe
work practice. Another meeting should be used to review the previous
month’s master safe work practice.
Several days before the scheduled meeting, the Supervisor should assign
one or more employees various parts of the meeting (MSDS, incident
review and/or assigned work practice).
C. Owner / Supervisor
Quarterly, the Owner is responsible to schedule and facilitate a meeting
(form ASI-121) with the Supervisor. The purpose and content of the
meeting should be as follows:
1. Outline of Meeting
a.) Review injury / incident reports and trends
b.) Review inspections and deficiencies
c.) Review Safe Work Practices and assign new topics
d.) Identify new equipment and/or tasks
e.) Review completion of Accident Prevention Plan activities.
f.) Develop an action plan to address any deficiencies of (a-e
above).
g.) Assign responsibilities and timelines for completion of
action plan.
The purpose of the safe work practice program is to solicit the knowledge and
experience of employees to develop a practical common sense approach to work
place safety. Nobody knows the ins and outs of the jobs and tasks better than the
people who perform them do.
There are four steps to the Safe Work Practice Program
• “Tasks Inventory List” (PBS form 102)
• “Safe Work Practice Development” (PBS form 101)
• “Job Safety Analysis” (PBS form 107)
• Follow Up
64
Tasks Inventory List. This list will be comprised of the various jobs and
tasks performed. This list should be continually revised and updated.
Each month, one of the weekly safety meetings will be used to develop
the crew’s assigned work practice. Two or more employees should be
assigned the job of writing down the dos and don’ts of the task using the
forms “Safe Work Practice Development” (PBS form 101) as a cover
sheet for “Job Safety Analysis Form” (PBS form 107) before this
scheduled meeting. They should lead the discussion and solicit additional
input from other crewmembers in order to complete the JSA.
The Supervisor should bring the crew’s copy of the completed work
practice to the Owner / Supervisor safety meeting.
D. Follow Up
The Supervisor will be responsible to follow up by observation and
review the guidelines developed in the masterwork practice.
The JSA can and should be used for 5-minute tailgate meetings or before
performing a particularly hazardous task.
65
Abrasive Blasting
These requirements only apply to the remote sand blasting operations that are common to
most construction or fabrication sites.
1. A supplied air hood shall be worn when sand blasting is done. This applies to the
person doing the actual blasting and the person attending the pot.
2. Protective clothing shall be worn which protects the arms, legs, hands and feet.
3. Persons working in close proximity of the blaster shall wear eye protection with side
shields and a dust mask to protect against flying dust particles.
4. The compressor and pot shall be grounded with an approved ground and the blast
nozzle bonded to the object being blasted. This will prevent buildup of static
electricity.
5. The air used in the supplied air hood can come from the air blast compressor if proper
filters are used to extract the oil, water and odor.
6. The blast nozzle shall be equipped with a dead man trigger. This allows the nozzle to
shut off if dropped or if the operator falls. A positive switch can be used if it can be
shut off with the movement of one finger.
7. All hoses and connections shall be inspected before each use to prevent rupture
during operation.
8. The supplied air hood shall be cleaned and sanitized after each use to insure the
sanitation of the user.
9. This equipment should be stored in a dry and safe place.
10. The air supply to the hood should be regulated to be compatible with the hood
requirements.
11. All work should be completed down wind from other employee activity.
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Backhoe Operations
1. All operators shall be fully qualified and become thoroughly familiar with the
backhoe before they will be allowed to operate any piece of equipment. Each
operator must thoroughly read and understand the operator’s manual.
2. Each unit shall be equipped with a seat belt and roll bar.
3. The operator should use step plates and handholds when entering the machine. Never
enter from rear.
4. Do not start engine unless seated in the operator’s seat.
5. Controls shall be operated only when the operator is seated.
6. All operators shall wear a seat belt when backhoe is equipped with a rollover bar.
Seat belts should not be worn if the rollover bar has been removed.
7. No riders permitted at any time.
8. Keep bystanders away from backhoe operations. No one is allowed in the excavation
while backhoe is digging or back filling.
9. Locate utility lines and overhead power lines before starting to dig. Do not operate
backhoe within 15’ of overhead power lines.
10. Never attempt to lift loads in excess of backhoe capacity.
11. Never allow anyone to be under bucked when lifted.
12. Never allow anyone to reach through lift arms when bucket is raised.
13. Maintain stability at all times. Operate at slow speeds on rough ground, when
crossing ditches and turning around.
14. To prevent upsets when operating on a slope, avoid using the full reach and swinging
a loaded bucket to the downhill side.
15. Always center and raise the boom before engaging or disengaging the transport.
16. Do not get off the tractor while it is in motion.
17. Do not lubricate or make mechanical adjustments to the unit while it is in motion or
when the engine is running.
18. Never repair or tighten hydraulic hoses for fittings when the system is under pressure,
when the engine is running or when the backhoe cylinders are under a load.
19. Park the unit on level ground when possible. When parking it on an incline, lower the
bucket so that the cutting lip contacts the ground. Apply the parking brake and
securely block the wheels.
20. Use car in attaching towing lines to the backhoe. Pulling from the tractor rear axle or
any point above the axle may cause an accident.
21. Observe good maintenance and repair of all pivot pins, hydraulic cylinders, hoses,
snap rings and main attaching bolts daily.
22. Maintain the brakes in good working order.
23. When loading on haul trailer always use low range and low gear. Keep buckets as
low as possible to maintain low center of gravity on unit.
24. Always set parking brakes on haul truck and chock wheels to keep trailer stable and
in place when loading or unloading.
25. Never load or unload backhoe on haul trucks with buckets loaded with any type of
load.
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26. Double cross chain and boom both front and rear of backhoe on haul trailer with
chains rated for the maximum load (grade 7).
27. If there are no lock pins on rear boom of backhoe then the boom may need to be
chained to trailer to prevent swinging in case of accident.
28. Know how tall the load is when hauling the backhoe down the road.
29. ____________________________________________________________________
_
30. ____________________________________________________________________
_
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Blood-borne Pathogens Program
I. Policy
COMPANY’s policy is to train employees in the basic understanding and awareness of
the potential exposures to deadly diseases that can be contracted through bodily fluids
and tissues. By following the guidelines outlined in this program the chances of
contracting one of these diseases will be greatly reduced.
Since there is no way to recognize an infected individual, the company policy is that all
body fluids could be considered contaminated and handled accordingly.
II. General
Accidental exposures can happen on and off the work site. The company believes that
each employee must have a basic understanding and awareness of the dangers of
contracting a potentially deadly disease. Communicating basic information about these
hazards and methods to minimize the risks is part of the company’s safety and health
program. Therefore, each employee shall be trained in Blood-borne Pathogen
Precautions at the time an employee is assigned to an area where occupational exposure
may take place and at least annually thereafter. Otherwise, employees will be trained
within a reasonable period of time as part of the company’s ongoing training program
concerning affected standards.
Two well-known and deadly diseases can be contracted through infected bodily fluids,
blood and tissue, they are:
• The Hepatitis B Virus (HBV)- this virus is known for causing severe liver disease that
frequently results in death and
• The Human Immunodeficiency Virus (HIV)- this virus causes Acquired Immune
Deficiency Syndrome (AIDS).
2. Blood-borne Pathogens can also be present in feces, urine, vomit and other bodily
excretions. This means someone could be exposed while performing routine cleaning
or housekeeping jobs such as:
• Cleaning toilets or sinks
• Wiping or mopping accidents involving blood, vomit, feces or urine
• Handling laundry that may be soiled with blood, semen or other bodily excretions
• Picking up trash bags that may contain discarded needles, syringes, blades, broken
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glass or other sharps that have been contaminated with blood.
Sexual contact, sharing needles, eyes or nose, cuts and puncture wounds by an object that
is contaminated with infected blood are the most common ways people get contract
blood-borne pathogens.
1. Wear two pairs of protective gloves when doing the clean up (one pair over the
other).
2. Wear a leak proof apron or over-garment to keep contamination form getting on
your regular clothes.
3. Restrict access to the area by keeping other persons out of the area until the clean
up is accomplished.
4. Soak up most of the blood and contamination by using disposable towels.
5. Place all contaminated trash, bandages, towels and other waste in a color-coded or
labeled leak-proof bag. Ensure the bag is labeled reading Regulated Waste.
6. Thoroughly clean the area with a disinfecting solution. Regular chlorine bleach
mixed ¼ cup with a gallon of water.
7. Make sure all mops; buckets and other equipment used in the clean up are
themselves disinfected.
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8. Employees should wash their hands, face or any other potentially contaminated
body part by using an antiseptic hand cleanser.
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Concrete & Masonry
General
1. Re-enforced steel will be covered if it poses a threat to employees.
2. No employees will be allowed to ride concrete buckets.
3. Employees are not to work under overhead concrete buckets.
4. Head and face protection should be used when operating concrete pumping devices.
5. Employees tying re-steel 6 ft. above any surface will be required to wear a lifeline
and safety harness.
6. Concrete trucks must chock wheels when pouring from a sloped surface.
7. Employees should protect themselves from Portland burns. A washing facility will be
provided in close proximity of the job site.
8. Power trowels must be equipped with an automatic shut off switch.
9. Verify proper guarding is on all masonry and concrete saws. Never operate without
guards in place.
10. Face shield and safety glasses are required when working with saws or right angle
grinders.
11. __________________________________________________________________
12. __________________________________________________________________
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Confined Space Program
I. Policy
It is the policy of COMPANY that before any employee is allowed to enter a confined
space that certain precautions and procedures as outlined below be followed and
implemented. No employee will be permitted to enter a confined space without prior
training and approval from a person deemed competent in confined space entry.
Every confined space is unique, therefore, each confined space must be carefully
evaluated and hazards must be eliminated or controlled before entry is permitted.
IV. Confined spaces may include but are not limited to:
•Manholes
•Sewers
•Pipelines
•Culverts
•Underground utility vaults
•Storage tanks
•Tunnels
•Septic Tanks
•Trenches or excavations greater than 4ft.
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1. If the inspection indicates the confined space falls under the guidelines of a permit
required confined space, then a permit shall be followed and filled out according
to the outlined guidelines.
2. Each confined space area will have a competent person qualified in recognition of
a confined space and sufficient knowledge in proper entry and emergency exit.
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Cranes, Rigging & Hoists
I. Cranes
1. Rated load capacities, operating speeds, instructions and special hazard warnings
will be posted on all equipment.
2. The boom angle indicator shall be in good working order.
3. An illustration of hand signals for crane and derrick operators will be posted on
the outside of the crane.
4. A competent person will inspect all machinery and equipment prior to and during
use.
5. A thorough annual inspection will be performed by a competent person or agency
recognized by the U.S. Department of Labor.
6. The Supervisor will keep inspection records.
7. Wire ropes will be taken out of service when any of the following occur:
a. Six randomly distributed broken wires in one lay or three broken in one
lay.
b. Wear of 1/3 the original diameter of outside individual wires.
c. Kinking, bird caging or any other damage resulting in distortion of the
rope structures.
d. Evidence of heat damage.
8. Belts, gears, shafts or other moving parts or equipment will be guarded if such
parts are exposed to employees.
1. Accessible areas, that expose employees to injury, will be barricaded in such a
manner as to prevent an employee form being injured.
2. Windows in cabs will be made of safety glass or equivalent and is free of visible
distortion.
3. Ladder and steps leading to cab roof shall be kept in good working order.
4. Platforms or walkways should have anti-skid surfaces.
5. An accessible, approved fire extinguisher will be provided.
6. A person will be assigned to observe the clearance of equipment when operating
under power lines or other overhead structures.
7. A minimum clearance of 10 ft. will be maintained for all power lines. For lines
over 50 kilovolts or higher the clearance will be 10 ft. plus 5 in. for every kilovolt
over 50.
8. No modifications will be allowed without written approval of the manufacturer.
9. No one is allowed to ride the material being hosted.
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II. Rigging
1. Know the safe working loads of the rigging equipment.
2. Inspect for defects before use.
3. All hooks require safety latches or need to be moused.
4. Only put one eye on a hook.
5. Use shackles if two or more eyes or to be on one hook.
6. Keep hands and fingers from under loads, chokers and slings.
7. Never walk or work under suspended load.
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Driving Safety
I. Speed Limits
All traffic laws are strictly enforced and must be observed by our employees on company
business.
III. Responsibility
Each client company has the responsibility to verify that leased employee’s have valid
driver’s license and adequate liability insurance before driving on company business.
The client company also has the responsible for limiting use of vehicles to properly
authorized personnel. Employees who misuse company vehicles are subject to
disciplinary and financial responsibility for any accident.
All employees driving on company business are responsible for reporting any incident or
accident to their Supervisor by the end of that day’s work or as soon as possible. Failing
to follow the reporting guideline could subject the employee to disciplinary action. If the
employee driving is unable to make a report, another employee who knows the details of
the accident must make the report.
IV. General
1. Wear seat belts
2. Obey speed limit
3. Obey traffic signs and signals
4. Do not tailgate.
5. Stay at least two seconds behind the vehicle in front.
6. Pass on left only.
7. Signal before passing.
8. Yield right of way
9. Do not overload vehicle
10. Do not drink and drive
• slows reactions
• blurs vision
• reduces ability to judge distance
• impairs judgment
11. Be cautious at night
• check headlights
• allow more distance
• stop when tired-take break
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• try not to stop on side of the road
12. Slow down on wet roads
13. Be careful of large puddles
14. Do not brake suddenly
15. Perform an informal vehicle check before operating.
• lights and signals
• tire wear and inflation
• fluid levels
• secure load
16. _________________________________________________________________
_
17. _________________________________________________________________
_
18. _________________________________________________________________
_
19. _________________________________________________________________
_
20. _________________________________________________________________
_
21. _________________________________________________________________
_
22. _________________________________________________________________
_
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Electrical Procedures
I. General
1. Only trained employees will perform electrical work
2. Electric power is to be disconnected before work begins.
3. Connection and junction boxes are to have the proper covers.
4. Label all circuits on panel
5. Light fixtures below 7 ft. must have adequate guarding.
6. All wires should be treated as live wires
7. Turn off power if equipment smokes or sparks
8. _________________________________________________________________
_
9. _________________________________________________________________
_
10. _________________________________________________________________
_
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Electrical Hazardous Energy Control Program
(Lockout / Tag out)
I. Policy
It is the policy of COMPANY to comply and implement the OSHA regulations
regarding the control of hazardous energy and the proper use of lockout / tag out
procedures. This program is designed to establish the requirements for the control
of any source of hazardous energy, electrical, mechanical, hydraulic, chemical
steam, etc.
The intent of the energy control program is to provide a formal procedure for
disabling machines or equipment in order to prevent injury to employees. This is
accomplished by following procedures for attaching lockout/tag out device(s) to
energy isolating devices, which will prevent the unexpected start-up or release of
stored energy.
II. Responsibility
The Owner or designee is responsible for the following:
A. Support and oversee the lockout / tag out program.
B. With Supervisor and employees identify the tasks and equipment that need
to be locked or tagged.
C. Periodically follow up and audit the lockout / tag out program.
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E. Release, disconnect, restrain or otherwise neutralize all stored energy.
F. Verify the machine or piece of equipment is de-energized (operate normal
start-up controls or buttons). Make sure the equipment will not
operate!
G. Return operating controls to off position. The equipment is now ready to
be serviced.
VI. Training
A. The Supervisor or designee is responsible for the following:
B. To train authorized employees prior to their initial involvement in the
lockout/tag out procedures.
C. Train affected employees prior to work assignment.
D. Retrain employees whenever there is a change in job assignment,
equipment or process.
E. Complete all training documentation.
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VIII. Definitions
A. Affected Employee-One whose job requires them to operate or use a
machine or piece of equipment on which service or maintenance is being
performed, or work is being done.
B. Authorized Employee-One who locks or tags out a system, machine or
piece of equipment or service, maintain or otherwise work on it.
C. Energy Isolation Device-A mechanical device that physically prevents
the transmission or release of energy, a disconnect switch, line valve,
blocking device etc. Not a push button or selector switch.
D. Lockout Device-A key or combination type positive locking device to
prevent energizing a machine or piece of equipment.
E. Tag-Out Device-A prominent warning device that is securely fastened to
an energy isolating device indication that the device is not to be operated
until the tag-out is removed.
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Lockout / Tag Out
Inventory List
1._________________________________________________
2. _________________________________________________
3. _________________________________________________
4. _________________________________________________
5. _________________________________________________
6. _________________________________________________
7. _________________________________________________
8. _________________________________________________
9. _________________________________________________
10. ________________________________________________
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Hazardous Energy Control Procedure Form
The following is a step by step procedure for the Lockout / Tag out of
the listed piece of equipment or machinery:
_______________________________
Equipment
1.
____________________________________________________________
2,
____________________________________________________________
3.
____________________________________________________________
4.
____________________________________________________________
5.
____________________________________________________________
The following are the employees that are authorized to perform the
Lockout / Tag out procedure on this piece of equipment.
_____________________________ ______________________________
_____________________________ ______________________________
_____________________________ ______________________________
_____________________________ ______________________________
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Lockout / Tag Out
Inventory List
1._________________________________________________
2. _________________________________________________
3. _________________________________________________
4. _________________________________________________
5. _________________________________________________
6. _________________________________________________
7. _________________________________________________
8. _________________________________________________
9. _________________________________________________
10. ________________________________________________
This form supplied by Primary Business Systems LLC PBS form-TX RM 113
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Excavation (Trenching & Shoring Program)
I. Policy
It is the policy of this company that no employee will enter a trench or excavation until a
competent person determines that the trench is safe for entry. Any trench deeper than 5
ft. must be either sloped shored or the excavation is entirely in stable rock.
II. Definition
•Excavation-is any man-made cut, cavity, trench or depression in the earth’s surface,
formed by earth removal.
•Trench Excavation-is a narrow excavation made below the surface of the ground where
the depth is generally greater than the width. However, the width of a trench as measured
at the bottom is not greater than 15 feet.
•Note: Excavations greater than 20 feet must be designed by a registered professional
engineer and are not covered in this policy.
•Competent Person-is one through experience, testing and/or training is capable of
identifying existing and predictable hazards in the surrounding or working conditions
which could be potentially hazardous to employees. He has the authorization to inspect
and take prompt corrective measures if necessary.
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10. Employees shall not work in excavations where water has accumulated unless
adequate protection has been provided against the hazards posed by the
accumulated water.
11. A competent person shall make daily inspections of the trench, adjacent areas and
protective systems. Inspections will be documented and filed.
• An inspection shall be conducted by the competent person prior to the
start of work and as needed throughout the day.
• After any occurrence that could create a hazard for exposed employees
such as after a rainstorm, the competent person will perform an
inspection.
• If any evidence is discovered that could possibly be a threat to employee’s
health and safety, exposed employees will be removed from the hazardous
area until the necessary precautions have been taken to ensure it is safe to
resume work.
12. Employees are not allowed to work outside the shored areas.
13. Where employees or equipment are required or permitted to cross over
excavations, walkways or bridges with standard guardrails shall be provided.
14. Adequate barrier protection or covers shall be provided after work has been
completed for the day. After completion of the project the trench or excavation
shall be back-filled.
15. The sloping, shield protection and soil classifications will be per the OSHA
standard (CFR 1926.652)
16. The excavation will be cut to a slope of 1 ½ horizontal to 1 vertical or 34 degrees.
A slope of this gradation is considered safe for any type of soil. If the sloping
requirements cannot be met then protection by shoring or trench boxes will be
utilized.
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• Soil that meet s the unconfined compressive strength or cementation requirements for
Type A, but is fissured or subjected to vibration or
• Dry rock that is not stable or
• Material that is part of a sloped, layered system where the layers dip into the
excavation on a slope less steep than four horizontal to one vertical [4H:1V], but only
if the material would otherwise be classified as type B.
3. Type C
• Cohesive soil with an unconfined compressive strength of 0.5 tsf [48kPa] or less or
• Granular soils including gravel, sand and loamy sand or
• Submerged soil or soil from which water is freely seeping or
• Submerged rock that is not stable or material in a sloped, layered system where the
layers dip into the excavation or a slope of four horizontal to one vertical [4H:1V] or
steeper.
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Daily Inspection Form
Date/Time________________________ Location ___________________________
Depth___________________________ Supervisor__________________________
Shoring OK- Timber___ Hydraulic___ Other___ From OSHA Charts___ Eng. Data_______
Shielding OK- Single____ Stacker____ Sloped to 18” below top if necessary _______________
Comments ________________________________________________________________________
__________________________________________________________________________________
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Safety Checklist
Job site Yes No
Prior to starting the job, were utilities notified and
Underground services located? ____ ____
Excavation or Trench
If over 5 ft. deep, is it sloped to maximum allowable
slope, or shored, or is a trench box used? ____ ____
Exits
If trench is 4 ft. or more in depth, is a ladder, ramp or
steps provided? ____ ____
Completion of Job
Is trench back filled as the shoring is dismantled? ____ ____
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Excavation
General
1. Contact local utility companies to locate lines prior to beginning excavation.
2. For trenches 4 ft. or greater a ladder or ramp will be provided and accessible
within a distance of no greater than 25 ft.
3. The atmosphere will be tested in trenches when the potential of a hazardous
atmosphere exists.
4. Barricades and warning devices will be installed to alert equipment operators,
pedestrians and/or other employees of the trench hazard.
5. A competent person will supervise each job site involving trenching.
6. Sloping and benching of trenches will follow the guidelines set forth in OSHA
1926 subpart P.
7. Spoils or loose material will be stacked a minimum of 2 ft. away from the edge of
trench.
8. _________________________________________________________________
_
9. _________________________________________________________________
_
10. _________________________________________________________________
_
11. _________________________________________________________________
_
12. _________________________________________________________________
_
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Fall Protection Program
I. Policy
It is the policy of COMPANY to comply with the OSHA Fall Protection Standard
and to provide safe work practices to prevent falls in the work place. It is our
policy that employees on a walking or working surface with an unprotected side
or edge which is 6 feet or more above a lower elevation shall be protected from
falling by the use of guardrail systems, safety nets or personal fall arrest systems.
Due to the potential consequences of a fall, the company will strictly enforce the
following requirements. If an employee or Supervisor violates these requirements
they shall be subject to disciplinary action up to and including discharge.
II. Responsibilities
The Owner is responsible for ensuring that the fall protection program is
implemented according to these policies and procedures. The Owner with his
staff will be responsible to periodically evaluate and update the program.
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7. If wire rope is used it shall be flagged at no more than 6ft intervals
with high visibility material.
8. All vertical posts should be no more than 8ft apart.
9. When guardrails are used around points of access, they shall have a
gate or be offset so that a person can walk directly into the hole.
10. When guardrails are used at floor openings they shall be guarded
on all four sides.
11. When guardrails are used at hoisting areas, a chain, gate or
removable guardrail section shall be placed across the access
opening between the guardrail sections when hoisting is not in
place.
12. Guardrails used on ramps and runways shall be erected along each
unprotected side or edge.
2. Safety Nets
Safety nets are another form of fall protection but rarely used in our
industry. If the situation would arise a competent person would be hired to
design and install the system.
3. Covers
Covers shall be designed to prevent workers from falling through a hole or
opening.
1. All holes are to be covered if any gap or void exists of 2 or more
inches on a floor, roof or any other working surface.
2. All covers shall be capable of supporting at least twice the weight
of employees, equipment, materials or vehicles to cross cover.
3. All covers shall be secured as to prevent accidental displacement
by wind, equipment or employees.
4. Each cover shall be marked with the Hole or Cover in large easy to
see letters or color-coded to provide warning of the hazard.
2. Lanyards
• They shall be connected to the anchor point and attached to the
full body harness between the employee’s shoulder blades.
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• The lanyard shall not be used for any purpose other than the
personal fall arrest system. Do not use it to hoist or tie
materials of any kind.
• The lanyard shall be inspected each time before use.
• If a lanyard is subjected to impact caused by a fall, it shall be
immediately removed from service.
• Two lanyards shall be in use at all times. Hook the second
lanyard before removing the first.
3. Snap hooks
• Snap hooks shall be double locking and made of smooth
corrosion resistant steel.
• All company employees shall prohibit non-locking snap hooks
for use.
• When using snap hooks, employees shall ensure to only attach
snap hooks to Dee-rings or the anchor point.
• The standard rule is one snap hook per Dee-ring and use
compatible hardware to prevent rollout.
• Snap hooks and Dee-rings are to be the same size and made by
the same manufacturer.
• Employees should always check the connection each time to
ensure everything is in good working order.
4. Anchorage point
• The anchorage point shall be a solid unmovable object that can
support up to 5,000 pounds per employee.
• Anchorage points that must support anything else, like a
platform, scaffold or platform shall never be used.
• Lanyards shall be anchored so that they employee can fall no
more than 6 ft.
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Fire Protection & Prevention
I. Fire Extinguishers
1. Class A Fire-Ordinary combustible fires caused by cloth, paper, trash, wood etc.
(recommended extinguisher-water, soda acid, carbon dioxide)
2. Class B Fire-Flammable liquids, oils, grease etc. (recommended extinguisher-
carbon dioxide, dry chemical and foam)
3. Class C Fire-Electrical type fire- (recommended extinguisher-non conducting
agent such as carbon dioxide and dry chemical)
• Signs need to be posted above fire extinguishers
• Extinguishers should be inspected at least monthly and serviced by a qualified
person annually and/or after use.
• There should be a minimum of a 2A-rated extinguisher for every 3000 square feet of
building space.
• Fire extinguishers should be located within 100 feet of workers
• A minimum of one 2A fire extinguisher at the top of each stairway
• A fire extinguisher not rated less than 10B should be provided within 50 feet
of 5 gallons or more flammable/combustible liquids.
1. ____________________________________________
_____________________
2. ____________________________________________
_____________________
IV. General
1. Familiarize employees with location of fire fighting equipment.
2. The use of open fires is prohibited unless specifically authorized.
3. Only approved solvents should be used for cleaning and degreasing.
4. All flammable liquids must be kept in approved containers.
5. Hot work near a pit, sewer, drain, manhole, trench or any area containing potential
combustibles requires a hot work permit.
6. Outdoors fuel storage area are to be properly graded, curbed or diked and
protected from possible danger of vehicle traffic.
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7. A minimum of a 20B extinguisher is to be located within 75 feet of outside
storage facilities.
8. Emergency Phone numbers are posted in easily accessible areas.
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Forklifts
I. Personnel
1. Only qualified and licensed employees will be allowed to operate.
2. No riders will be allowed.
3. Forks are not to be used as an elevator or work platform.
4. No person shall be allowed to stand or pass under the elevated portion of the fork
truck.
II. Operation
1. Arms and legs must be kept inside while operating.
2. When fork truck is left unattended the forks must be fully lowered, power shut off
and brakes set.
3. A truck is considered unattended when it is out of the operator's view or when
farther than 25 feet away.
4. Trucks should not be used for opening freight doors.
5. A load backrest extension must be used when necessary to prevent the load from
falling rearward.
6. Back downgrades when carrying load.
7. Drivers must slow down and sound horn at intersections and pedestrian crossways
that have obstructed view.
8. Railroad tracks must be crossed diagonally.
9. Secure duckboards or bridge plates before driving over.
10. Verify load does not exceed rated capacity.
11. A safety inspection is to be performed each day or at the beginning of each shift.
12. _________________________________________________________________
_
13. _________________________________________________________________
_
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H2S (Hydrogen Sulfide)
Invisible…Explosive…Flammable…Deadly
H2S smells like rotten eggs at low concentrations, however, don’t trust your sense of
smell to warn you because:
Breathing H2S is the most dangerous route of exposure. But how you are affected
depends on the concentration you’re exposed to and the length of exposure. To help
avoid severe effects, OSHA has established exposure limits:
• Permissible Exposure Limit (PEL) – The PEL for hydrogen sulfide is 10ppm.
This is an amount you can safely breathe, based on an eight-hour day over a five-
day workweek.
• Short-Term Exposure Limit (STEL) – The STEL for hydrogen sulfide is 15ppm.
This is how much you can safely be exposed to averaged over a 15-minute period.
The STEL should be checked four times a day, when your risk is likely to be the
greatest.
Engineering Controls
Engineering controls are another measure OSHA requires your employer to take in
ensuring your safety. The most widely used engineering control is ventilation, either
natural or mechanical.
1. Natural Ventilation comes from normal airflow. If you are relying on natural
ventilation, remain alert for the safest way to escape by noting which way
windsocks, streamers, and flags are blowing. This is called being “wind
conscious”.
2. Mechanical Ventilation is common in confined spaces where only fans and
blowers can move air. But do not become too comfortable knowing fans and
blowers are ventilating your workspace. If you suspect H2S, evacuate the area
immediately.
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Personal Protective Equipment (PPE)
Three types of personal protective equipment (PPE) are used by workers at risk of
exposure to hydrogen sulfide:
1. Escape Units: completely self-contained, equipped with an air cylinder rated for
(5) five minutes, used only to escape from (NOT ENTER) a hazardous area.
2. Air-Line Units: have an air-line or hose that supplies air during normal use,
equipped with a self-contained emergency-escape air cylinder in case the air-line
supply fails.
3. Self-Contained Breathing Apparatus (SCBA): have an air cylinder rated for (15)
fifteen or more minutes, the most flexible because they allow you to move from
area to area, even if you have to disconnect from the air-line supply, equipped
with devices that warn you when approximately (5) minutes of air remain.
Respiratory Program
This program will follow the respiratory standards set by OSHA and the American
National Standards Institute (ANSI). Each year, your employer should train you to use
respiratory protection. This training will include fit testing, proficiency drills,
maintenance programs, and medical surveillance.
• Fit Testing – ensures that your respiratory equipment is properly adjusted, if you
wear glasses, get fitted with a facepiece spectacle kit, which will allow room for
you to wear your glasses under the facepiece (DO NOT WEAR BEAR OR
SIDEBURNS).
• Proficiency Drills – will help you know how to wear and use respiratory
protection and air monitoring equipment properly.
• Maintenance Programs – will help ensure that you know how to take care of your
respiratory and air monitoring equipment.
• Medical Surveillance – will help make sure that you do not have a health
condition that would: be aggravated by exposure, prevent you from wearing your
PPE, or keep you from escaping in an emergency. It should help you recognize
any of the early symptoms caused by exposure on you or your co-workers.
Emergency Procedures
There are four steps to follow if you are in the immediate area of danger:
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Always follow company policies and procedures for escape and rescue. Before
attempting to rescue anyone else: protect yourself first (don’t become another victim), put
on appropriate PPE before attempting rescue, and use the buddy system (don’t attempt to
rescue anyone alone, always proceed in pairs whenever possible). After taking these
precautions, lift or drag the person to an upwind area. Use caution if the victim has
fallen, as the victim may have suffered neck or spinal injuries. Use your portable H2S
monitor to ensure the area is clear before removing your mask. If you are not trained in
first aid, alert supervisory personnel and activate the Emergency Response System.
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Hazard Communication Program
I. Policy
II. Responsibilities
The Program Coordinator, the Owner, or designee, will be responsible for the
administration of the Hazardous Communication Program. He will be responsible
to develop, update and oversee the implementation of the guidelines outlined in
this program.
The first step in the program is to compile and list all hazardous or potentially
hazardous chemicals. This list will be used to gather the associated MSDS sheets.
The list is to be updated as new chemicals are purchased and introduced to the job
sites.
The Supervisor is responsible to include and update the inventory list for any
chemicals brought onto the job site. He should inform the program administrator
of any changes.
The Supervisor is responsible to have the MSDS sheets associated with the
hazardous chemicals used or to be used on each job site. The Supervisor is also
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responsible to verify that each employee understand and comply with the
precautions as outlined on the MSDS.
The employee is responsible to understand and follow the handling and exposure
control guidelines as listed on the MSDS. No employee shall handle any
chemical in which they are unfamiliar!
V. Purchasing
All chemicals should be in their properly labeled containers. The only exception
would be small quantities for immediate use. After use, the product should be
returned to the original container or be properly disposed of. No chemicals will
be left unattended in unmarked containers!
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3. Physical/Chemical Characteristics-This section describes the
physical characteristics of the substance, such as: boiling point,
solubility or ability to mix in water and/or its appearance and odor.
4. Fire and Explosion Hazard Data-This section describes the risk
of fire or explosion, equipment necessary to extinguish a fire, fire
fighting procedures and unusual hazards of the substance.
5. Reactivity Data-This section lists materials to keep away from the
substance and the potential result if the two come in contact with
each other.
6. Health Hazard Data-This section describes exposure limits when
using the product, how long you may work with the substance
without ill effects. It also describes the proper emergency and first
aid procedures if exposed.
7. Precautions for Safe Handling and Use -This section describes
special precautions and appropriate procedures in case of a spill. It
may also describe emergency first aid treatment for injuries caused
by the substance.
8. Control Measures-Proper procedures and equipment will be listed
for the safe handling and storage of the substance. Appropriate
safety equipment will also be recommended.
C. The safe work practices associated with the various substances used on the
job site or office location.
COMPANY will provide the required PPE as listed on the MSDS. It is company
policy that each employee or exposed person follow and adhere to the
requirements as listed.
The Supervisor is responsible to see the required PPE is made available and
properly used when the potential of a hazardous exposure exists.
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X. Emergency Response
B. Personnel should evacuate the area as soon as any danger to health and
safety becomes apparent.
XII. Posting
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COMPANY Has a Written Hazard
Communication Program
(In compliance with OSHA 1926.59 & 1910.1200)
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The Material Safety Data Sheet Collection for
hazardous chemicals at this job site is located at:
____________________________________
____________________________________
____________________________________
____________________________________
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Material Safety Data Sheets Chemical
Inventory List
The following is a list of hazardous chemicals used in this work place. The
corresponding MSDS can be found in the MSDS section of this manual.
Further information on these or other components of the program can be
obtained from the Supervisor and/or Program Administrator.
1. _________________________________
2. _________________________________
3. _____________________________
4. _________________________________
5. _________________________________
6. _________________________________
7. _________________________________
8. _________________________________
9. _________________________________
10. _________________________________
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Employee Hazard Communication Training
Certification
• The safe work practices and required PPE for the specific chemicals
used
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Hearing Conservation Program
I. Policy
It is the policy of this company that all employees be protected from noise exposure
through the following hearing conservation program. Where feasible, administrative or
engineering controls will be used to reduce employees’ exposure to noise at or below an
eight-hour time weighted average of 85 decibels. When administrative and or
engineering controls are not feasible, hearing protection such as earplugs or muffs will be
required.
Employees in the above job positions or those who perform any of the above tasks will be
included in the Hearing Conservation Program.
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III. The objectives of this programs
1. To insure that employees will not be exposed to noise levels at or above 85db
without approved hearing protection.
2. To identify hazardous noise areas and sources through appropriate monitoring
surveys.
3. To educate and train employees in the hazards of noise exposure and how to
properly protect themselves against potential exposure.
IV. Responsibilities
The Owner and Supervisor are responsible to identify high noise exposure areas and
will hold management accountable for the implementation and compliance with
COMPANY hearing conservation program.
The Supervisor is also responsible to provide the proper hearing protection to each
employee under his supervision. Train employees in the proper use and care of the
provided hearing protection. Consistently enforce the requirements of this policy with
all employees.
New employees in the job positions listed above will be tested within the first 90 days of
employment. Exposure to noise will be minimized for 14 hours prior to testing.
If a standard threshold shift (an average shift in either ear of 10 dB or more at 2000,
3000, or 4000 Hz) is identified the following will occur:
• The employee will be notified of the threshold shift within 21 days of testing.
• The employee will be informed of the need for further evaluation if a medical
problem is suspected.
• The use of hearing protection will continue to be enforced.
• The employee will be refitted or retrained in the use of hearing protection.
V. Training
Employees will be trained on an annual basis in at least the following:
1. The importance of a hearing conservation program
2. The effects of noise on hearing
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3. Selection, fitting, use and care of hearing protection equipment.
4. The various types of hearing protection.
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Housekeeping
Housekeeping Requirements
Housekeeping is a priority at this facility. All employees have a duty to keep their
workstations clean and are expected to follow all housekeeping rules.
2. Dispose of trash or scrap materials from job tasks and any other disposable
materials left over immediately upon finishing the task or shift. Leave your workplace
clean and orderly.
4. Return tools and equipment to their storage place immediately after using them.
All tools and equipment will be cleaned and in good condition when stored. Any tools or
equipment in need of repair will be tagged and sent for repairs or replacement as needed.
5. Never use empty food containers for any other purpose. Chemicals should never
be put into food containers under any circumstances. Dispose of empty food containers.
6. All paths to doorways, the doorway itself, and paths leading away from doorways
must be kept free of obstructions. Do not stack equipment or supplies near doorways.
7. Floors must be kept clean and dry to the extent the nature of the work and
environment conditions allow. Where wet processes are used, drainage must be
maintained and false floors, platforms, mats, or other dry standing places should be
provided wherever practical. Mud scrapers and mats should be used to clean shoes from
mud and other debris before entering buildings or entering a place where such debris may
contribute to a slip/trip/fall accident. All spills should be promptly cleaned up and the
clean-up materials should be disposed off properly.
8. Covers used to guard holes and openings must be securely fastened and strong
enough to withstand any load placed upon them. They must be in place when the hole or
opening is not in use.
9. _________________________________________________________________
_
10. _________________________________________________________________
_
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Manual Lifting Procedures
The following are the rules and procedures for proper lifting at COMPANY.
Safe lifting is a critical part of your job and everyday personal activities. Practicing safe
lifting techniques when at work is a condition of employment.
Before you lift anything, think about the load you shall be lifting. Ask yourself; is it too
heavy? Can I lift it alone or do I need help?
• Size up the load-make sure load is stable and balanced.
• Plan the job-plan a route free of tripping and slipping hazards. Think through the lift
and face toward the direction that you plan to go. Use mechanical devices where
possible.
• The base support is Firm Footing with shoulders width feet apart, a staggered stance
and one foot slightly behind the other.
• Bend at the Knees not the waist. Bend down as far as possible using legs and back.
• Get a good grip-use whole hand not just the fingers.
• Keep the load close to your body. The closer it is to the spine the less force it puts on
the back. Ten pounds at arms length is like lifting 100 lbs.
• Lift with the legs not the back.
• Lift smoothly
• Pivot, don’t twist
• Carry the load using short steps with feet far enough apart to maintain good balance.
• Lower slowly by flexing the knees and hips. Do not bend at the waist after releasing
the load; straighten up using the legs.
• When possible push instead of pull. Lean into the object and let the body weight and
thigh muscles do the work.
_______________________________________________________________________
_
_______________________________________________________________________
_
_______________________________________________________________________
_
_______________________________________________________________________
_
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Mechanical Guarding
Purpose and Scope
Mechanical guarding must encompass both the power transmission parts of all
mechanical equipment and the points of operation on production machines.
Guards must be provided where rotational motion, nip points, cutting, shearing, punching
and forming mechanisms can cause injury to personnel or damage to tools and
equipment.
Machine designed for fixed locations must be securely anchored to the floor or bench to
prevent walking or tipping. Employees may operate machinery only when properly
trained and authorized to do so. Proper clothing and personnel protective equipment
must be worn when specified by laws, work rules, Supervisor or shop foreman.
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Office Safety
I. General Hazard
When we hear about “on-the-job” hazards, we usually picture a factory or construction
site. A surprising number of accidents occur every day in the office environment.
II. Goals
Goals of the COMPANY’s Office Safety Program:
•To create an understanding of some of the potential office hazards.
•To equip employees to readily identify and correct those hazards.
•To reduce accident in the office environment.
IV. Furniture
• Check for sharp burrs, splintered edges broken casters and seats.
• Do not use chairs or desks in place of ladders.
VII. General
1. Remove staples with puller.
2. Never overload paper cutters or shredders
3. Keep paper cutters in closed and latched position
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4. Pass scissors handle first
5. Keep razor knife or box cutters in the closed position.
6. Do not keep pointed objects in upright position
7. Never throw broken glass into waste basket
8. Follow label precautions when handling solvents and cleaners
9. Avoid storing heavy objects (paper, manuals etc) above eye level.
10. Do not attempt to make electrical repairs
11. Watch for extension, telephone, computer cords and other tripping hazards.
12. Do not stand or talk in front of closed doorways.
13. Do not attempt to fix, clean or adjust power driven office machines when in
motion.
14. Keep ties and loose clothing or jewelry out of shredders
15. Electric heaters should be turned off before leaving office.
16. Report slippery or wet floor surfaces.
17. Use dollies and similar equipment to move large or heavy items.
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Personal Protective Equipment / Hazard Assessment
Program
I. Policy
It is the company’s goal to protect all employees from workplace injury and illness
through engineering controls and safe work practices. Sometimes, additional protection
may be required in the form of Personal Protective Equipment.
All employees shall follow the published guidelines concerning the requirements of this
program. Failure to use the required personal protective equipment shall result in
disciplinary action. Questions about safety protection should be brought to the Owner’s
attention and resolved before the job is started. If you have any question about the job at
hand STOP and ASK!
B. COMPANY shall verify the hazard assessment has been performed through a written
certification. The certification shall:
• Identify the workplace where the assessment was performed
• Name of the person(s) that performed the assessment
• Date the assessment was performed
• Be written on a hazard assessment form (form ASI-)
C. The company will provide training to each employee who is required to use the
selected PPE. Each employee shall be trained in the following:
• When PPE is necessary
• What PPE is required
• How properly wear the PPE
• Limitations of PPE
• Proper care, maintenance, useful life and proper disposal of PPE
• Each employee shall demonstrate an understanding of the training provided
• Demonstrate the ability to properly use the PPE
• All training will be documented on a safety meeting form or similar type form. The
form should list the date, person trained, topic and trainer.
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D. Retraining will be required when the Owner or Supervisor has reason to believe the
employee does not possess the proper skills required to use the PPE. Retraining will also
be required when:
• There are changes in the workplace that render previous training obsolete
• Changes in PPE that render previous training obsolete
In addition to the written hazard assessments the following is a summary of what types of
PPE is required and when they are to be used.
All head protection shall meet the ANSI specifications Z89-.1-1986 either class A, B, &
C.
Hard hats will be required and used in the following situations and/or locations.
• _________________________________
___________________________________
• _________________________________
___________________________________
• _________________________________
___________________________________
• _________________________________
___________________________________
Contact lenses do not provide eye protection and their use without appropriate eye or face
protection will not be permitted in hazardous environments.
When working with chemicals employees are required to follow the PPE guidelines as
listed on the product’s Material Safety Data Sheet.
Below are some examples of when it will be necessary to wear additional protection.
Job/Task Type Required
• _________________________________
___________________________________
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• _________________________________
___________________________________
• _________________________________
___________________________________
• _________________________________
___________________________________
• _________________________________
___________________________________
• _________________________________
___________________________________
• _________________________________
___________________________________
• _________________________________
___________________________________
• _________________________________
___________________________________
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Job/Tasks Type Required
• _________________________________
___________________________________
• _________________________________
___________________________________
• _________________________________
___________________________________
• _________________________________
___________________________________
• _________________________________
___________________________________
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IX. Respiratory Protection
Job/Tasks Type Required
• _________________________________
___________________________________
• _________________________________
___________________________________
• _________________________________
___________________________________
• _________________________________
___________________________________
• _________________________________
___________________________________
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Power & Hand Tools
I. General
• Tools should be inspected before use
• Tools should be neatly stored when not in use
• Broken or defective tools should be properly tagged
• Use proper tool for job
• Power tools should be unplugged before servicing
• Guards are to remain in place
• No moving parts should be exposed (belts, shafts, gears, pulleys and sprockets)
• Proper PPE is required appropriate for the job
• Chisels and impact tools should be free of mushroomed heads
• Tools with wooden handles are to be kept tight in tool and free from splinters
• Do not carry sharp or pointed objects in pockets
• Never hold work in hand when using screwdriver
• Do not use screwdrivers for chisels or pry bars.
• When using wrenches always pull the wrench toward you.
• Stand to the side when using wrenches above your head.
• Power hand tools are not be hoisted from the cord.
• Adjustments should not be made to power tools while tool is connected.
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• ____________________________________________________________________
_
• ____________________________________________________________________
_
V. General
1. _________________________________________________________________
_
2. _________________________________________________________________
_
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Respiratory Protection Program
I. Policy
Where effective engineering controls are not feasible to control breathing air
contamination such as harmful dusts, fumes, mists, gases or oxygen deficient
atmospheres, respiratory protection equipment shall be used to control exposure.
The purpose of this program is to establish minimum operating procedures governing the
selection and use of respiratory equipment for all employees in tasks where such
protection is required.
This program covers all of the COMPANY employees. A contractor program may be
substituted for the company’s program, provided the contractor’s program is equivalent to
the company’s written Respiratory Protection Program and/or meets or exceeds the
minimum requirements of 29 CFR 1910.134, respiratory Protection Standard for General
Industry.
II. Responsibilities
A. Owner. The Owner is responsible for ensuring that the Respiratory Protection
Program is implemented according to these written policies and procedures.
III. Requirements
For the purpose of this program the Owner and Supervisor shall be trained to identify the
following respiratory hazards. The two basic types of respiratory hazards are oxygen
deficient air and air laden with contaminants.
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A. Oxygen Deficient Air: Current regulations require that the percentage of oxygen in
the workplace not be less than 19.5%. The normal content of oxygen in is 20.9% by
volume at sea level. At low oxygen concentration death can occur within minutes.
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VIII. Supplied-Air respirator (SAR)
Supplied-Air Respirators are designed to provide the worker with clean air to breathe
while the worker is performing a task. Connecting a hose from the full-face mask to a
generator or oxygen cylinder does this.
These systems cannot be used in IDLH conditions and low oxygen atmospheres.
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• Regulations concerning respirator use
Respiratory fit testing shall be completed and documented on each respirator wearer. Fit
testing shall include, positive, negative, and qualitative testing.
XVII. Maintenance
• The Supervisor shall ensure that employees follow maintenance procedures according
to manufacture recommendations.
• Respirators which do not pass inspection shall be replaced or repaired immediately
• Employees may conduct limited repairs to respirators. These repairs shall only be
limited to changing canisters, cartridges, filters, and head straps.
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• The Supervisor or individual experienced and knowledgeable shall perform all other
replacements or repairs with the parts designed for the respirator.
XVIII. Cleaning
Individually assigned respirators shall be cleaned and disinfected as frequently as
necessary to insure that proper protection is provided for the wearer. Respirators not
individually assigned and those for emergency use shall be cleaned and disinfected after
each use.
XIX. Storage
After inspection, cleaning, and necessary repairs, respirators shall be stored to protect
against dust, sunlight, heat extreme hot or cold temperatures, excessive moisture or
damaging chemicals.
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Scaffolds
I. General
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Signs & Placards
General Requirements
1. Signs shall be visible and removed as conditions warrant.
2. Danger signs are to be used in areas of immediate hazards.
3. Caution signs are to be used to warn of potential hazards or unsafe practices.
4. Exit signs should be posted at all exits.
5. Traffic signs should be posted at all points of traffic hazards.
6. Accident Prevention tags are to be used to warn employees of defective tools,
equipment etc.
7. _________________________________________________________________
_
8. _________________________________________________________________
_
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Stairways & Ladders
I. Ladders
1. Used around electrical hazards are to be insulated.
2. May not be spliced.
3. Should be free of oil, mud and grease.
4. Use the belt buckle rule: Keep your belt buckle inside the side rails.
5. Inspect ladder before use. Tag and take out of service defective ladders.
6. Keep both hands free when climbing or descending.
7. Employee should face ladder when climbing.
8. Top of ladder should extend a minimum of 3 ft. above landing surface.
9. Portable ladders should be pitched 1 foot out for every 4 feet of height.
10. The maximum length for single metal extension ladders is 30 ft., two-section
ladders 48 ft., and multi section 60 ft.
11. Ladders should be securely tied off.
12. Do not move or shift while in use.
13. Do not place in front of door, unless door has been locked or secured.
14. Never stand on the top step of any stepladder.
15. Stepladders should be fully open when in use.
16. A stepladder should not be used as a straight ladder.
17. _________________________________________________________________
_
18. _________________________________________________________________
_
II. Stairways
1. All stairways should have at least one handrail and if over 44 inches in width the
standard requires two.
2. Unprotected sides of landing should be protected with a guardrail system with a
top rail 42 inches high and a mid rail and toe board.
3. _________________________________________________________________
_
4. _________________________________________________________________
_
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Warehouse Safety
General
Warehouse – An industrial facility that receives and stocks many types of products; then
transports or ships them to various locations. The warehouse evokes the image of a
simple operation moving materials around with forklifts, powered hand jacks, conveyors,
or by hand. Thanks to this image, warehouse employees often develop a false sense of
security. With no dangerous machines or high-risk operations to consider, many fail to
see the need for a sound safety program. This section offers some practical suggestions
for improving overall warehouse safety.
Statistics indicate that certain areas or operations within a warehouse present greater
hazards than others. The following operations have significantly contributed to significant
numbers of injuries and are considered to be the most hazardous: docks, powered
industrial trucks, conveyors, materials storage, manual lifting/handling, and
charging stations. To improve warehouse safety, employers should focus on these areas
and take steps to improve employee training, enforce safe practices, and implement
appropriate corrective action.
Overview of Hazards
Loading Docks – According to the National Safety Council, injuries that occur at docks
are responsible for 10-25% of all workplace injuries. Employees and visitors can easily
fall off a deck. Due to operator error, a piece of powered equipment (such as a lift truck)
may drive off a dock. If a tractor prematurely pulls out with a trailer, the lift truck and
operator may crash to the dock floor, which could result in serious injury or death. A lift
truck could also skid off the dock as a result of contact with a slippery surface.
Products stored or being moved can easily fall and injure someone if not stacked
properly. In addition, sprinkler heads may be struck by loads being lifted; the resulting
water flow may damage products.
To enhance dock safety, management can take several steps. Paint the dock edge yellow
to provide a better visual perception of the hazard. Require wheel choking at every bay
door. If a trailer creeps or pulls out prematurely, the lift truck may fall between the trailer
and the dock floor, leading to serious injury or death.
Automatic trailer restraints are another alternative. With these devices, the operator
secures the trailer from inside the building by simply pushing a control button. A flashing
green light inside the building indicates that the trailer restraint is engaged, while a
flashing red light outside alerts the tractor-trailer operator that it is not safe to pull away.
Wheel chock signs (with backwards print) may be posted on the outside wall of the dock.
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Verify that ladders from dock surface to dock well meet OSHA specifications. In
addition, management MUST prohibit dock jumping, which can lead to serious ankle,
knee, and back injuries.
Provide proper illumination for exit doors. Such doors should also be equipped with
emergency lighting.
Allow only trained, authorized employees to operate hand trucks or hand jacks (walkies).
Although these devices appear easy to operate, they actually pose hazards similar to those
of forklifts. These units turn in a small radius, which can trap the operator’s hand between
the operating handle and a fixed object (such as storage racks).
Inspect the dock area daily to ensure fire extinguishers are not blocked or damaged. Make
sure the dock plates are designed for the loads and lift trucks that will use them. Attempts
to manually place portable dock plates can lead to back injury. Some portable docks have
built-in handles and can be mechanically lifted using lift trucks. Install dock plates with
non-skid surfaces. Use yellow edging on fixed plates to help operators gain perspective
on distance while driving on them. Color highlighting also helps prevent operators from
driving off the side. When dock plates need repair, rope off the surrounding area and post
appropriate warning signs to prevent accidents.
Clean out dock areas periodically to remove accumulated debris and discarded materials.
Paper, wood, and other combustible materials may fall into holes along the open sides of
dock plates, which pose a fire hazard. Water drainage must also be maintained to prevent
standing water.
Identify overhead pipes and highlight them with color.
Powered industrial trucks – Powered industrial trucks are the key component of the
material handling process in a warehouse. These vehicles are also dangerous. About 100
employees are killed and 95,000 are injured each year while operating powered industrial
trucks. A lift truck has a high center of gravity, turns more sharply than an auto, and may
weight three to four times more than a common car. All this factors contribute to forklift
tipover, which, according to OSHA statistics, is responsible for 24% of all fatal injuries to
operators.
OSHA developed operator guidelines, which states that only trained, authorized
employees will be allowed to operate lift trucks. Training programs must include:
classroom lecture, visual aids, operator testing, hands-on driving skills evaluation,
equipment-specific training and certificates of completion. Install back-up alarms on
trucks, which can prevent many struck-by or caught-between injuries. Flashing lights
may also add to the safety of employees working or moving nearby.
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and falling product at the ends of conveyors. Post signs and install alarms and warning
lights to alert employees when the system starts and stops. Provide proper lighting and
working surfaces in the area surrounding the conveyor. Special floor mats can enhance
employee comfort. Verify that conveyor height is adjustable at both the feeding and
removal end to accommodate employee height. Adjustable pallet stackers further reduce
the need for bending and lifting.
Material Storage – A warehouse provides a building where product and materials are
brought in, stored and later retrieved for shipment to another location. Product
movement and storage pose risk to all present. To improve safety and productivity,
employees should take the following steps.
Visually inspect pallets as they arrive and remove those in poor condition. Loads can fall
from racking or storage if a pallet breaks. Also, lifting a bad pallet that is loaded can
cause product to unexpectedly fall on employees.
Stack loads straight and evenly. Place loads directly on racking. Correct loads that look
out of balance.
Where possible, shrink-wrap loads or place plastic or metal banding around them. A
secure load helps protect lift trucks operators.
Place yellow protective posts or barriers at the ends of racking to prevent damage caused
by lift truck movement.
Space racks so that pallets being handled cannot damage other loads. Spotting a load on
one side of a rack could easily push the adjacent load in the next aisle, perhaps onto
unsuspecting employees.
Provide sufficient space so lift trucks can turn properly and safely, without damaging
storage racks.
Make sure the floor surfaces and aisles are smooth and free of ruts, debris, and slippery
surfaces (e.g. oil, chemicals, fluids, water), which may hinder operator’s ability to stop
powered equipment. In addition, the jarring motion of a forklift operating on a poorly
maintained floor can seriously injure operator’s legs and back.
Store product on shelving, not in aisles or on the floor.
Store low-sales (infrequently handled) product out of the way. Place product that is
regularly handled (manually) on shelves that are knee high and not above shoulder
height.
Manual Lifting and Handling – Manual materials handling can easily produce back and
hand injuries. In fact, back injuries result in the most expensive claims within the
industry. NSC offers several tips for safe manual lifting.
Develop employee’s awareness regarding pinch points. Hand traps can occur while
setting down heavy boxes, working near pulleys in conveyor belts, adjusting lift truck
forks, operating walkies, shutting trailer doors, and manually handling product. Proper-
fitting gloves provide additional protection.
Identify fixed pinch points (e.g. the two horizontal doors that come together on a freight
elevator) with yellow paint or black and yellow striped tape. Post appropriate signs as
well.
Place guards on any moving gears or hazardous rollers to protect hands and other body
parts.
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To ease manual lifting, add handles to containers. Train employees in proper lifting
techniques bend at the knees, keep close to the load, and use the arms and legs to lift.
They should also know how to shift feet not to twist at the waist when turning with a
load.
Fire Safety – Many warehouses are protected by automatic sprinkler systems. As noted,
management must be sure that the product stored can be extinguished by this system
should a fire occur.
Inspect sprinkler system and conduct flow and alarm testing each month. Document
these inspections and tests. Store all flammables according to fire code.
Inspect fire hoses and extinguishers regularly. Remove any obstructions and make sure
these items are readily available. Only employees trained in appropriate firefighting
techniques should handle this equipment.
Perform annual fire drills and practice emergency drills. Post large emergency
evacuation maps throughout the facility.
Develop and emergency plan that assigns specific tasks to specific employees.
Train all employees in basic principle of firefighting, including how to identify fire types
and use extinguishers. Local fire departments can provide on-the-job training.
Maintain fire alarms, smoke detectors, and emergency lighting improper operation
condition.
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Chemical Exposure – Provide MSDS for each chemical in the facility. This is best
achieved by filing MSDS sheets in binders and storing binders in key locations.
Maintain a master chemical inventory. Provide spill clean-up kits in any area where
chemicals are stored. Develop and implement a written spill control plan. Train
employees to clean up spills, protect themselves and properly dispose of used materials.
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Warehouse / Materials Handling Safety Checklist
Aisles have adequate clearance to assure safe movement and handling of materials
Storage levels over 7ft high and loading docks have guard rails along the open edge
Posters and other materials identifying correct lifting and materials handling
techniques are posted
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Welding & Cutting
I. Personal Protective Equipment
1. Use appropriate shaded lens.
2. Use approve leather gloves
3. Wear a long sleeve cotton shirt/not synthetic
4. Never cut or weld in a confined space without the proper testing and permits.
5. Adequate ventilation should be provided for welding, cutting or brazing
6. Set up ventilation so air is blown across face and away from the worker.
7. Do not work directly over top of work.
8. Do not roll up sleeves or cuffs of pants.
9. Pants should overlay tops of shoes.
III. Cutting
1. Always stand to the side when cracking valve(s).
2. Do not crack valve if close to an ignition source.
3. Do not use fuel gas from a cylinder without a pressure regulator.
4. Before removing regulator close cylinder valves and release the pressure from the
regulator.
5. Valve caps should be in place before transporting cylinders.
6. If a cart is not available move cylinders by tilting and rolling.
7. Cylinders should be transported in a vertical position.
8. Cylinders should be stored either 20 feet apart or separated by a 5 foot high, one-
half hour fire rated divider.
9. Keep cylinders isolated from actual welding or cutting operations.
10. Cylinders containing oxygen, acetylene or other fuel gas should not be taken into
a confined space.
11. Cylinders should be placed and stored in a well-ventilated area.
12. Hoses should be periodically checked for damage or leakage.
13. Fuel gas and oxygen hoses shall be properly marked and identified.
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