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Speed Architectural Technology Est.

For General Contacting, Trading ‫مؤسسة تقنية المعمار السريع‬


And Marine services ‫للمقاوالت والتجارة‬

SAFETY POLICY & PROCEDURE

SAFETY PROGRAM

Prepared By: Safety Officer


Speed Architectural Technology Est.
For General Contacting, Trading ‫مؤسسة تقنية المعمار السريع‬
And Marine services ‫للمقاوالت والتجارة‬

TABLE OF CONTENTS

Items Sr #
Planning 1
Hot Work Welding 2
Electrical system 3
Industrial Hygiene 4
Elevated work 5
Confined Space entry 6
Ladders 7
Scaffolds 8
Power Tools 9
Hazardous atmosphere 10
Safe Walk Way 11
Structural Work 12
Personal Protective Equipment 13
Work Permit Training 14
Workers Below 15
ventilation 16
Lighting Requirements/Portable 17
Safety Signs and Warning Tapes 18
Hand Tools 19
House keeping 20
Crane 21
Overhead Hazards 22
Material Handling 23
Manual Lifting 24
Vehicles 25
Traffic Signs 26
Coordinator with Department 27
Fall protection 28
Compressed Gases 29
Fire Extinguisher/Blankets 30
Fire Watch 31
Signal Man 32
Sign Boards 33
Illumination ( Night / Roads) 34
Safety Showers / Eye Wash 35
Danger /Caution Tags 36
Gas Testing 37
Machine Guiding 38
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Hearing Protection 39
Respirators 40
Area Assembly Point /Area Alarm Sound 41
Statement of Adherence 42
List of Equipments 43
On site medical 44
Vehicle for transportation 45
Excavation 46
LOTO 47
Spill Management Procedure 48
Accident & Injury Investigation Form 49

1. Planning

To complete the job safely within the targeted time, pre planning is very important hence the
following safety precautions will be followed:-
a. To plan each and every job.
b. To anticipate unexpected events.
c. Use of proper tools for the job.
d. To identify the hazards and minimize or eliminate it.
e. To keep all the needed materials for job in a safe and easily
accessible condition.

2 Hot Works Welding

Electrical Welding Machines shall be properly bonded and grounded in accordance with SABIC
standards.
Welding Cables shall be continuous with in 3 Mtrs of the Electrode Holder
Damaged welding Cables shall be removed from service
Temporary repairs and Taped joints are prohibited.
Proper Welding screens shall be used near other personnel.

3. Electrical System

Potential Hazard

Electrical shock or fire hazard

Recommendations:-

• Fire watch with visible vest shall be deputed.


• Sufficient fire extinguishers and fire blankets provided.
• Welding shields/face shields shall be available at work area.
• Welding cables used should be free from any cut/damage.
• All grinding and cutting machines/wheels shall be protected with guards
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4. Industrial Hygiene

Keeping the working area and surrounding areas hygienic inorder to safely do the work.
Keeping the tools and equipments in Proper way in accordance with the safety Procedures.

5. Elevated Work

While working in elevated area safety harness must be used. Safety harness shall be tied to life
line or handrails, Platforms shall be made with guard rails and toe boards for safe execution of
job. All safety precaution shall be taken so that workers are confident about safety when they
work in elevated area.

6. Confined space entry

Potential Hazard

• Lack of illumination.
• Lack of access and egress.
• Oxygen enriched/deficient atmosphere.
• Hazardous gases may be present.
• Danger of moving objects.
• Slippery Surface.
• Movement of fan blades.

Recommendations:-

• Natural ventilation.
• A spark proof lighting with GFCI 110 V provided.

• Proper access for entry shall be made by scaffolding.

• CS attendant with CSE log book will be available.

• Backup man will be available.

• Inside sludge shall be removed.

• Gas test of CS before entry shall be performed.

• Continues communication between CS attendant and entrant shall be conducted


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7. Ladders

Ladders are the easiest mean of access and egress.


Ladders shall be properly secured to prevent movement. When a ladder is in use and is not
fastened to prevent movement, additional personnel shall continuously stabilize the ladder.
Only one person at a time is permitted to use a ladder and another person have to hold it until it
is secured at top.
Top portion of the ladder shall be approximately beyond 1feet the top support or 3 feet above
the landing platform.

8. Scaffolding

No scaffolding shall be used before any work unless it is inspected and certified as safe and tags
signed and displayed on the scaffolding. Provide hand rails and toe boards on all scaffolding
platforms of more than 2 meter of height. Persons working above a height of 2 meter shall use
safety harness

9. Power Tools

 Only certified Operators shall use power tools.


 Personnel Other than Operators shall be prohibited.
 Operators shall inspect before and after use. Report any deficiency to their
Supervisor.
 Brakes shall be set and the wheels blocked on trailer or Truck being loaded or
unloaded.
 Do not allow any person to stand or walk under elevated forks, whether loaded
or empty
 All material handling equipment designed shall be equipped with them.

10. Hazardous Atmosphere / Energy


 All chemicals or hazardous material containers shall be properly labeled and
stored.
 Drums shall be stored in secondary containment areas or on drum containment
pallets.
 Non- approved electrical/electronic devices shall not be used in the classified
areas unless properly permitted.
 Erect barricades/flagging around hazardous work areas such as holes in decking
and floor surfaces, trenches, road crossings, and over hazardous work.
 Atmospheric testing for O2, explosive and toxic gases should be performed and
recorded immediately.
 All power lines shall be considered energized unless proper measures are taken
for de-energizing them. When Cranes or heavy equipment are used near
energized overhead power lines, no part of the crane, boom. mast, gin poles or
machinery shall be permitted within the distances.
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11. Safe Walk Way

 On all ascending or descending stairways use the handrail and take only one
step at a time.
 Running in work areas is prohibited, except during emergencies.
 Approved safety footwear shall be worn in field operations, Process areas, and
other designated areas.

12. Structural Work

Structural Works should have Proper Supports and should be Properly Clamped to avoid
misshapenness.
Proper Scaffolding at elevated areas.

13. PERSONAL PROTECTIVE EQUIPMENT (P.P.E)

Hard hats, Safety shoes, hand gloves, safety goggles/glasses, are the common PPE. Hearing and
respiratory protection shall also be used in designated areas. Most of the accidents can be
minimized by using them. No one is allowed at job site without proper PPE.

14. Work Permit Training

The work permit is an agreement between issuer and receiver. No one is allowed to execute any
job without a work permit. Following are the different work permits:-

Hot Work Permit


Cold Work Permit
Excavation Permit
Confined Space Permit
Radioactive Permit
All work permits are automatically cancelled when a plant emergency alarm is sounded

15. Workers Below

 Approved hard Hat without defects shall be worn in designated areas. Metallic
hard hats are prohibited.
 Approved safety eye wear with side protection shall be worn where designated.
 Proper hand protection shall be worn when performing tasks that may present a
hand injury risk.
 Be aware of slippery surfaces, newly painted decks, and wetted decks, especially
in rough weather, and decks with oily patches.
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16. Ventilation

Mechanical Ventilation (e.g. Air movers) shall be used to ensure positive ventilation
and remove all hazardous airborne contaminants.
Mechanical Ventilation shall be stopped during atmospheric testing.

17. Lighting Requirements /Portable

Emergency lighting in work condition. Adequate lighting, suitable for work.


Max Voltage for portable electrical hand tools shall not exceed 125 V
Ground fault circuit interrupters or ground isolation system shall be used for all portable
electrical tools, temporary wiring, and in potentially damp areas.

18. Safety Signs and Warning Tapes

All the working area shall be barricaded with warning tapes and safety sign boards shall be
displayed at site to alert the workers and visitors. It gives safe work guidance to the workers
and others

19. Hand Tools

Only proper hand tools for the proper job shall be used, Defective hand tools shall be replaced
immediately. Tools and their uses depend upon the kind of work like hot/cold. There are
specific details for cold/Hot works.

20. House keeping

A good house keeping is a safe habit. It reflects the quality and discipline of work execution.
Protects the workers at site from several minor and major accidents.

House keeping means to keep the working area neat and clean. Keep the materials in a good
working condition. And after completion of job the working site shall be cleaned after
removing all materials and tools.

21. Crane operation

Potential Hazards
• Damage to property and personal

Recommendations
• Only qualified and third party certified crane operator/crane Shall be allowed to
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operate at SABIC premises.


• Crane used should comply to UGP standard .
• Overload/under estimated load shall be avoided.
• Checklist of crane shall be maintained on daily basis.
• Working radius of the crane shall be barricaded and Unauthorized persons
should not be allowed in this area.
• Backlights, indicators, rotary light of crane are must.

• Leakage of hydraulic parts and lifting gear ice-out riggers slings, LMI etc shall
be closely checked.

• Fire extinguishers shall be provided with crane.

22. Overhead Hazards

Approved hard Hat with out defects shall be worn in designated areas.
Metallic hard hats are prohibited.

Climbing or standing on equipment, piping, valves or unstable surfaces to


perform work is prohibited.

Approved fall protection measures shall be used if the working height is


greater than 1.8 meter from floor or operating platform level.
Physical hazards, including falling objects and contact with hot surfaces, shall
be controlled.

23. Material Handling

Material handling is the method by which the material can be safely, quickly and
easily transported from one place to another

24. Manual Lifting

The feet should be placed close to the load and with proper space for the body
balancing . Back shall be as straight as possible and elbows should be as vertical
as possible, knee should be bent until the hand reach the proper place for
gripping the load.

Grasp the load firmly and then straighten the knees for lifting the load.
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25. Vehicles

Vehicle entry for mobilization and demobilization of materials

Potential Hazards

Traffic hazard and road accident

Recommendations

• Drivers HMV/LMV should have Saudi driving license.


• The traffic rules of SABIC shall be strictly followed.
• Any vehicle having any oil leakage shall not be allowed to enter SABIC premises.
• Speed should not exceed 25Kmph.
• Fire extinguishers shall be provided to every vehicle.

26.Trafic Signs

Vehicle operators / Drivers must know the Traffic signs and drive as per SABIC traffic rules

27. Co-ordination with Department

 Ensure that contractor and their employees are trained in safety rules and are competent
in their craft or skill.

 Report injuries, spills, unsafe acts and conditions, near misses and incidents
immediately.

 Holding pre-job meetings and other safety meetings during the job.

 Assist in incident investigations as necessary.

 Co-coordinating with all departments relating to job safety and completion.

28.Fall Protection

By using safety harness we can maximize fall protection.

Working platform shall be clean to avoid accidents. Hand rail or rope life line shall be arranged for
tying up with waist belt
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29. Compressed gases

Lighted torches shall not be left unattended

Compressed type fittings shall be utilized on hose connections

All Connections/equipment shall be checked for leaks before use.

Gas regulators shall be turned off and hoses bled off at the end of shift/task

30.Fire Extinguisher / Blankets

All fire extinguishers and other emergency equipment shall be in good condition, inspected
regularly, and kept clear of any obstruction.

Fire extinguishers tagged with current inspection.

Never operate an extinguisher in such a manner that any part of the body is located directly
above the fill cap.

Only trained personnel shall operate fire extinguishers and equipment

31. Fire Watch

Summon Help / Sound Alarm

Only Trained Personnel shall operate the Fire Extinguisher and Equipment

Isolate all fuel sources and /or threatened facilities and close doors, do not attempt to
extinguish gas fires.

32. Signal Man

The Signal man ensures Proper directions to the Operator to avoid accidents.

33.Sign Boards

The permit and signs and /or barricades shall be posted outside confined spaces to
notify personnel that entry is in progress and to prohibit unauthorized entry.
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34. Illumination ( Night, Roads)

The works carried in the nights shall ensure proper lighting near work area and
caution lights near works at elevated and ground areas that needs attention.
Equipments and vehicles must have indication lights during night operations.

35.Safety Showers /Eye Wash

Approved additional (hazard specific) eye/face protection shall be worn where


foreign objects may injure the eye or face.

36.Danger/Caution Tags

 Tag lines shall be used on all lifts, except when their use may create a
greater hazard.
 All electrical conductors shall be considered energized unless properly
locked, tagged, cleared and tried.
 De-energize all circuits before beginning work. Use safety process Isolation,
lock Out and use of Hold Tags.
 Scaffolding Inspection Tags shall visible ( Red, Green and Yellow) to
indicate the status of the scaffold.
 Hanging of the Caution tags needs attention.

37.Gas Testing

Atmospheric tests for O2 , Explosive gases, Toxic Gases and Vapors shall be performed
and recorded immediately prior to entry, after breaks, or interruptions in the work
procedure and at periodic intervals by certified gas tester. If Other atmospheric hazards,
such as CO and naturally radioactive material are suspected to exist, appropriate air
monitoring shall be conducted by qualified person.
Oxygen concentration shall be 20% minimum, flammables shall be zero and the
concentration of H2S shall not exceed 0 ppm.

38. Machine Guiding

All equipments operators’ should be attentive while guiding the machine for safe
Work operation.
The signaling man shall guide the Crane operator for loading/unloading the
material.
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39. Hearing protection

Approved hearing protection shall be worn in high noise areas i.e., 85 dBA or
higher.

40.Respirators

All required PPE, including respiratory shall be identified and worn during confined
space entries.

41.Area Assembly Point/ Alarm Sound

 In case of any emergency, work shall be stopped at once.


 Equipments should be shutdown as previously designated.
 All personnel shall be evacuated to pre-determined assembly point.
 Roll call shall be taken to ensure that all personnel are accounted for.
 Personnel will not be permitted to return to the work area until all Clear signal is given by
responsible supervisor in charge

42. Statement of Adherence to SABICS Safety Procedures

We hereby confirm that the complete job will be performed as per SABIC Safety procedures and
in case of violation the work will be stopped till due measures are fulfilled in full compliance
with the SABIC Safety requirement.

43. List of All Equipments

SL # Equipment category Quantity


1 Welding machine 1
2 Compressor 1
3 Crane 50 ton 1
4 Threading Machine 1
5 Fork lift 1
6 Oxy acetylene cutting set 2
7 Drilling Machine 8
8 Grinding machine 6
9 Hand Tools 20
10 Boom Truck 1
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44. On Site Medical Requirement:

First Aid box will be arranged at site and standby vehicle will be ready for the medical
treatment of the employees during any emergency.

In case of emergency we will inform SABIC Project in charge and we will utilize SABIC Medical
Facility. Payment will be made as per SABIC rate by us.

45. Vehicles for Transportation

SL # Vehicle Type Door No License Plate QTY

1 PICK UP 2

2 CAR 2

3 Mini Bus 1

46. Excavation

The purpose of these procedures is to ensure that every excavation project is reviewed as
required, that all internal and external permits are in place before work begins, and that all
records are updated once work is completed. These procedures cover operations in which
contact with soil is expected – such as trenching, drilling, and removing soil – that requires any
of the following points:

1. Depth is one foot or more


2. Power tools will be used
3. Utilities are identified
4. Any hazardous condition is likely to be encountered

Potential Hazard

• Lack of adequate protective systems


• Lack of access and egress.
• Failure to make necessary on-site inspections
• No adequate method of access and egress
• Improper placement of soil piles
• Failure to quickly evacuate at-risk employees

Recommendations:-
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• Protective systems to prevent a cave-in


• Inspect the excavation, the surrounding areas, and all protective systems
• Structural ramps used in place of steps
• Placed at least 2 feet back from the excavation to prevent debris falling into the site
• Stand by man will be available
• Barricades and Warnings

47. LOTO

This procedure establishes the minimum requirements for the lockout of energy isolating
devices whenever maintenance or servicing is done on machines or equipment. It shall be used
to ensure that the machine or equipment is stopped, isolated from all potentially hazardous
energy sources and locked out before employees perform any servicing or maintenance because
the unexpected energization or start-up of the machine or equipment or release of stored energy
could cause injury.

PREPARATION FOR LOCKOUT

A survey to locate and identify all isolating devices to be certain which switches, valves or other
isolating devices are of importance to the specific lockout .A copy is included in this program.
Sources of energy and their locations are listed. The Department Head or Lead Mechanic will
be responsible for updating this survey.

LOCKOUT STEPS

General:-

1. NOTIFY all affected employees that a lockout or tagout is going to be used and
reasons why.

2. Authorized employees will know the TYPE AND MAGNITUDE OF ENERGY,


understand the hazards (from survey), and SHUT DOWN the equipment by the
normal operating procedure.

3. Authorized employees will ISOLATE the equipment from its energy source(s), and
dissipate or restrain residual energy.

4. Authorized employees will LOCKOUT the isolating devices.

5. An ATTEMPT TO START the equipment will be made after ensuring that no


personnel are exposed. Return operating controls to off or neutral. THE
EQUIPMENT IS NOW LOCKED OUT.
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SPECIFIC

A specific procedure will be written for each equipment type requiring multiple lockouts.
These completed procedures will be kept in a section of this manual; copies may be kept in
maintenance areas for ready access. The Department Head or Lead Mechanic will be
responsible for ensuring that any new equipment with multiple lockout will have a procedure
developed.

MULTIPLE LOCKS

If more than one individual is required to work on a piece of equipment, each shall place his
own lock on all energy isolate devices. A multiple lockout device may be used.

GENERAL RULES

 All equipment shall be locked out to prevent injury to personnel


 No attempt shall be made to operate any switch, valve, or other energy isolating
device when it is locked or tagged out.

USE OF TAGOUT

When a full positive lockout is not possible, a full tagout must be in place. This requires a tag at
each possible source of energy and start station. All tags must be affixed to ensure that they
cannot be accidentally removed. All lockout requirements must be met and the tags must
remain in place until the job is completed.

Tagout systems have many limitations and are not recognized as having the same degree of
protection as a positive lockout system. Lockout will be the energy control program of choice.
Whenever major replacement, repair, renovation or modification of machines or equipment is
made, and whenever new machines or equipment are installed, energy isolation devices will be
designed to accept lockout devices.

RELEASE FROM LOCKOUT/TAGOUT

Before lockout or tagout devices are removed and energy is restored to the equipment the
following steps will be taken.

1. INSPECT work area to ensure machine components are intact and non-essential
items (tools, etc.) have been removed.
2. Ensure that all EMPLOYEES are OUT OF DANGER, and notify affected employees
of start-up.
3. Each LOCKOUT DEVICE will be REMOVED by the employee who put the locks.
(See Exception Section).
4. START EQUIPMENT to ensure proper operation
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If the machine must be tested and lockout devices temporarily removed, steps 1-3 will be
followed. After testing, all systems must be de-energized and the lockout procedure must be
repeated.

EXCEPTION: When employee who applied the lockout or tagout is not available to remove it,
it may be removed by following the below mentioned procedure.

1. Verify that authorized employee who applied lock is not at the facility.
2. Make all reasonable efforts to contact employee
3. Remove the lockout or tagout device in accordance with the procedure.
4. Continue attempt to contact authorized employee; ensure that he knows the details
before returning to work.

TRAINING AND COMMUNICATION

All authorized (performs lockout) and affected employees (uses equipment) shall be trained in
the purpose and function of the energy control program. Authorized employees will be given
the knowledge and skills required for the safe application, usage, and removal of energy
controls. In addition, all other employees who may be in an area where energy controls are
being used will be instructed on the procedure and about the prohibitions relating to re-starting
or re-energizing locked out or tagged out equipment. When tagout systems are used,
employees will also be trained in the limitations of tags. Records will be kept by the
Department Head or Lead Mechanic. Retraining will be provided when personnel changes,
machine changes, process or energy control procedure changes occur, or if the employer
suspects or the program review indicates inadequacies in employee knowledge or skills.

PROGRAM REVIEW

The effectiveness of the energy control procedure will be determined every 12 months using an
inspection of a lockout by the Department Head or Lead Mechanic. The inspection will include
all the steps of lockout, and will be documented. Appropriate action will be taken when the
results of the inspection are produced.

RECORDKEEPING

All records will be kept in the training and program review section of this manual. A copy of
this Lockout/Tagout Program is located in the Parts Office and is the responsibility of the
Department Head or Lead Mechanic.
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48. Spill Management Procedure

Purpose

The major objective of process safety management (PSM) of highly hazardous chemicals is to
prevent unwanted releases of hazardous chemicals especially into locations that could expose
employees and others to serious hazards. An effective process safety management program
requires a systematic approach to evaluating the whole chemical process. In this approach, the
process design, process technology, process changes, operational and maintenance activities
and procedures, non-routine activities and procedures, emergency preparedness plans and
procedures, training programs, and other elements that affect the process are all considered.

Spill Response and Clean-up Procedures

In the event of a chemical spill, the individual(s) who caused the spill is responsible for prompt
and proper clean-up. It is also their responsibility to have spill control and personal protective
equipment appropriate for the chemicals being handled readily available. See Developing a
Spill Response Plan for more information.

The following are general guidelines to be followed for a chemical spill. More detailed
procedures may be available in your Departmental Chemical Hygiene Plan or Spill Response
Plan.

1. Immediately alert area occupants and supervisor, and evacuate the area, if necessary.
2. If there is a fire or medical attention is needed, contact Safety.
3. Attend to any people who may be affected. Contaminated clothing must be removed
immediately and the skin flushed with water for not less than fifteen minutes. Clothing
must be laundered before reuse. See First Aid for Chemical Exposures for more
information.
4. If a volatile, flammable material is spilled, immediately warn everyone, control sources
of ignition and ventilate the area.
5. Don personal protective equipment, as appropriate to the hazards. Refer to the Material
Safety Data Sheet or other references for information.
6. Consider the need for respiratory protection. The use of a respirator or self-contained
breathing apparatus requires specialized training and medical surveillance. Never enter
a contaminated atmosphere without protection or use a respirator without training. If
respiratory protection is needed and no trained personnel are available, call ERT or
Safety or Shift Supervisor. If respiratory protection is used, be sure there is another
person outside the spill area in communication, in case of an emergency. If no one is
available, contact Safety or ERT or Shift Supervisor.
7. Using the chart below, determine the extent and type of spill. If the spill is large, if there
has been a release to the environment or if there is no one knowledgeable about spill
clean-up available, contact ERT or Safety or Shift Supervisor.
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Category Size Response Treatment Materials


Chemical treatment or Neutralization or absorption
Small Up to 300cc
absorption & call safety spill kit

Medium 300 cc - 5 liters Absorption & call safety Absorption spill kit

More than 5
Large Call safety & ERT Outside help
liters

8. Protect floor drains or other means for environmental release. Spill socks and absorbents
may be placed around drains, as needed.
9. Contain and clean-up the spill according to the table above.
Loose spill control materials should be distributed over the entire spill area, working
from the outside, circling to the inside. This reduces the chance of splash or spread of the
spilled chemical. Bulk absorbents and many spill pillows do not work with hydrofluoric
acid. POWERSORB (by 3M) products and their equivalent will handle hydrofluoric acid.
Specialized hydrofluoric acid kits also are available. Many neutralizers for acids or bases
have a color change indicator to show when neutralization is complete.
10. When spilled materials have been absorbed, use brush and scoop to place materials in
an appropriate container. Polyethylene bags may be used for small spills. Five gallon
pails or 20 gallon drums with polyethylene liners may be appropriate for larger
quantities.
11. Complete a hazardous waste sticker, identifying the material as Spill Debris involving
XYZ Chemical, and affix onto the container. Spill control materials will probably need to
be disposed of as hazardous waste. Contact ERT for advice on storage and packaging for
disposal.
12. Decontaminate the surface where the spill occurred using a mild detergent and water,
when appropriate.
13. Report all spills to your supervisor or the Principal Investigator.

Developing a Spill Response Plan

An effective spill response procedure should consider all of the items listed below. The
complexity and detail of the plan will, of course depend upon the physical characteristics and
volume of materials being handled, their potential toxicity, and the potential for releases to the
environment.

1. Review Material Safety Data Sheets (MSDSs) or other references for recommended spill
cleanup methods and materials, and the need for personal
protective equipment (e.g., respirator, gloves, protective clothing, etc.)
2. Acquire sufficient quantities and types of appropriate spill control materials to contain
any spills that can be reasonably anticipated. The need for equipment to disperse, collect
and contain spill control materials (e.g., brushes, scoops, sealable containers, etc.) should
also be reviewed. See Recommended Spill Control Materials Inventory for more details.
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3. Acquire recommended personal protective equipment and training in its proper use. For
example, if an air purifying respirator or self-contained breathing apparatus are needed,
personnel must be enrolled in the Respiratory Protection Program and attend annual
training and fit-testing.
4. Place spill control materials and protective equipment in a readily accessible location
within or immediately adjacent to the laboratory.
5. Develop a spill response plan that includes:
o Names and telephone numbers of individuals to be contacted in the event of a
spill.
o Evacuation plans for the room or building, as appropriate.
o Instructions for containing the spilled material, including potential releases to the
environment (e.g., protect floor drains).
o Inventory of spill control materials and personal protective equipment.
o Means for proper disposal of cleanup materials (in most cases, as hazardous
waste) including contaminated tools and clothing.
o Decontamination of the area following the cleanup.
6. Discuss the spill response plans with all employees in the area. ERT offers training for
employees who work directly with chemicals (see Chemical Spills and Waste
Procedures) and who are expected to respond outside their work area to assist with spill
cleanup (see Chemical Emergency Response (HAZWOPER) First Responder -
Operations Level Training).

7. Recommended Spill Control Material Inventory

Your laboratory or work area should have access to sufficient quantity of absorbents or other
types of materials to control any spill that can be reasonably anticipated. Vermiculite, lined 5-
gallon pails and limited spill control materials are available at the location. Additional materials
may be found in certain laboratories and the chemical stockrooms.

Personal Protective Equipment

 2 pairs chemical splash goggles


 2 pairs of gloves (recommend Silver Shield or 4H)
 2 pairs of shoe covers
 2 plastic or Tyvek aprons and/or Tyvek suits

Absorption Materials

 4 3M POWERSORB spill pillows (or equivalent)


 1 3M POWERSORB spill sock
 2 DOT pails (5 gallon) with polyethylene liners
 1 filled with loose absorbent, such as vermiculite or clay
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 1 with minimum amount of loose absorbent in the bottom

Neutralizing Materials

Acid Neutralizer
Caustic Neutralizer
 Commercial neutralizers, such as Neutrasorb (for acids) and
Neutracit-2 (for bases) have built in color change to indicate
complete neutralization
Solvent Neutralizer
 Commercial solvent neutralizers, such as Solusorb, act to reduce
vapors and raise the flashpoint of the mixture

Mercury Spills

• Small mercury vacuum to pick up large drops (optional)


• Hg Absorb Sponges - amalgamate mercury residue
• Hg Absorb Powder - amalgamates mercury
• Hg Vapor Absorbent - reduces concentration of vapor in hard to reach areas
• Mercury Indicator - powder identifies presence of mercury

Clean-up Tools

• Polypropylene scoop or dust pan


• Broom or brush with polypropylene bristles
• 2 polypropylene bags
• Sealing tape
• pH test papers
• Waste stickers
• Floor sign - DANGER Chemical Spill - Keep Away

49. Accident & Injury Investigation Form

Employee’s Report of Injury Form

Instructions: Employees shall use this form to report all work related injuries, illnesses, or
“near miss” events (which could have caused an injury or illness) – no matter how minor. This
helps us to identify and correct hazards before they cause serious injuries. This form shall be
completed by employees as soon as possible and given to a supervisor for further action.
I am reporting a work related:  Injury  Illness  Near miss
Your Name:
Job title:
Supervisor:
Have you told your supervisor about this injury/near miss?  Yes  No
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Date of injury/near miss: Time of injury/near miss:

Names of witnesses (if any):

Where, exactly, did it happen?

What were you doing at the time?

Describe step by step what led up to the injury/near miss. (continue on the back if necessary):

What could have been done to prevent this injury/near miss?

What parts of your body were injured? If a near miss, how could you have been hurt?

Did you see a doctor about this injury/illness?  Yes  No


If yes, whom did you see? Doctor’s phone number:

Date: Time:
Has this part of your body been injured before?  Yes  No
If yes, when? Supervisor:
Your signature: Date:

Supervisor’s Accident Investigation Form

Name of Injured Person _________________________________________________


Date of Birth _________________ Telephone Number ____________________
Address ______________________________________________________________
City _____________________________ State_______ Zip _____________
(Circle one) Male Female
What part of the body was injured? Describe in detail. ________________________________________
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_____________________________________________________________________________________
What was the nature of the injury? Describe in detail. _________________________________________
______________________________________________________________________________
______________________________________________________________________________
Describe fully how the accident happened? What was employee doing prior to the event? What
equipment, tools being using?
____________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
Names of all witnesses:
______________________________________ _______________________________________
______________________________________ _______________________________________
Date of Event ______________________ Time of Event
_________________________________
Exact location of event:
_________________________________________________________________
What caused the event?
_________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
Were safety regulations in place and used? If not, what was wrong?
______________________________
_____________________________________________________________________________________
Employee went to doctor/hospital? Doctor’s Name
___________________________________________
Hospital Name
__________________________________________
Recommended preventive action to take in the future to prevent reoccurrence.
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
______________________ ___________
Supervisor Signature Date
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Incident Investigation Report


Instructions: Complete this form as soon as possible after an incident that results in serious injury or
illness. (Optional: Use to investigate a minor injury or near miss that could have resulted in a serious injury
or illness.)

This is a report of a:  Death  Lost Time  Dr. Visit Only  First Aid Only  Near Miss

This report is made by:  Employee  Supervisor  Team 


Date of incident:
Other_________

Step 1: Injured employee (complete this part for each injured employee)

Name: Sex:  Male  Female Age:


Department: Job title at time of incident:
Part of body affected: (shade all that apply) Nature of injury: (most This employee works:
serious one)  Regular full time
 Abrasion, scrapes  Regular part time
 Amputation  Seasonal
 Broken bone  Temporary
 Bruise Months with
 Burn (heat) this employer
 Burn (chemical) Months doing
 Concussion (to the this job:
head)
 Crushing Injury
 Cut, laceration,
puncture
 Hernia
 Illness
 Sprain, strain
 Damage to a body
system:
 Other ___________

Step 2: Describe the incident

Exact location of the incident: Exact time:


What part of employee’s workday?  Entering or leaving work  Doing normal work activities
 During meal period  During break  Working overtime 
Other___________________
Names of witnesses (if any):
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Number of Written witness statements: Photographs: Maps / drawings:


attachments:
What personal protective equipment was being used (if any)?

Describe, step-by-step the events that led up to the injury. Include names of any machines, parts, objects,
tools, materials and other important details.

Description continued on attached sheets: 

Step 3: Why did the incident happen?

Unsafe workplace conditions: (Check all that apply) Unsafe acts by people: (Check all that apply)
 Inadequate guard  Operating without permission
 Unguarded hazard  Operating at unsafe speed
 Safety device is defective  Servicing equipment that has power to it
 Tool or equipment defective  Making a safety device inoperative
 Workstation layout is hazardous  Using defective equipment
 Unsafe lighting  Using equipment in an unapproved way
 Unsafe ventilation  Unsafe lifting
 Lack of needed personal protective equipment  Taking an unsafe position or posture
 Lack of appropriate equipment / tools  Distraction, teasing, horseplay
 Unsafe clothing  Failure to wear personal protective equipment
 No training or insufficient training  Failure to use the available equipment / tools
 Other: _____________________________  Other: __________________________________

Why did the unsafe conditions exist?

Why did the unsafe acts occur?

Is there a reward (such as “the job can be done more quickly”, or “the product is less likely to be damaged”)
that may have encouraged the unsafe conditions or acts?  Yes  No
If yes, describe:
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Were the unsafe acts or conditions reported prior to the incident?  Yes  No

Have there been similar incidents or near misses prior to this one?  Yes  No

Step 4: How can future incidents be prevented?


What changes do you suggest to prevent this incident/near miss from happening again?

 Stop this activity  Guard the hazard  Train the employee(s)  Train the supervisor(s)

 Redesign task steps  Redesign work station  Write a new policy/rule  Enforce existing policy

 Routinely inspect for the hazard  Personal Protective Equipment  Other: ____________________

What should be (or has been) done to carry out the suggestion(s) checked above?

Description continued on attached sheets: 

Step 5: Who completed and reviewed this form? (Please Print)


Written by: Title:

Department: Date:
Names of investigation team members:

Reviewed by: Title:

Date:

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