IIP Program For Low-Hazard Industry Employers

XYZ Company
Injury and Illness Prevention Program

For
Non High-Hazard Employers

As determined by OSHA
Complies with Provisions of OSHA 29 CFR Part 1910 General Industry Standards OSHA 29 CFR Part 1926 Construction Industry Standards
Injury and Illness Prevention Program (For Non High-Hazard Employers)
Safety Office Depot. All rights reserved.
Table of Contents
Section 1 2 3 4 5 6 7 8 9 10 11 12 Description Program Policy & Requirement Program Responsibility Employee Compliance Safety Communication Hazard Assessment Accident/Exposure Investigation Hazard Correction Safety Training and Instruction Recordkeeping Policy Company Required Safety Programs Company Required Safety Training Courses Company Required Safety Forms & Checklists Page 3 4 5 6 7 9 10 11 13 16 17 19
Appendices Appendix A List of Training Subjects Appendix B Hazard Assessment Checklists Appendix C Hazard Assessment and Correction Record Appendix D Accident/Exposure Investigation Report Appendix E Employee Training and Instruction Record Appendix F Codes of Safe Practice (General and Construction Industries) Appendix G Employee Acknowledgement Form 21 23 24 26 28 30 41
Section 1
Program Policy & Requirement

Program Policy It is intent of XYZ Company to comply with all laws. To do this, we must constantly be aware of conditions in all work areas that can produce injuries. No employee is required to work at a job he/she knows is not safe or healthful. Your cooperation in detecting hazards and, in turn, controlling them, is a condition of your employment. Inform your supervisor immediately of any situation beyond your ability or authority to correct. Program Requirement This program has been prepared for use by employers in industries which have been determined by OSHA to be NON-HIGH-HAZARD. Employers in an industry which has been determined by OSHA as Non High-Hazard and
who adopts and implements this program in good faith shall be deemed in compliance with IIP Program requirements, unless mandated otherwise by a State law. Once this
program has been implemented, a copy must be maintained at each workplace or at a central worksite if the employer has non-fixed worksites. Proper use of this program requires the IIP Program administrator to carefully review the requirements for each of the eight IIP Program elements found in this program, fill in the appropriate blank spaces and check those items that are applicable to your workplace. The recordkeeping section requires that the IIP Program administrator select and implement the category appropriate for your establishment.
Injury and Illness Prevention Program (For Non High-Hazard Employers) This program must be maintained by the employer in order to be effective.
Section 2
Program Responsibility
Program Administrator The Injury and Illness Prevention Program (IIPP) administrator, Program Administrator has the authority and responsibility for implementing the provisions of this program. DECISION POINT Enter a name or position title (recommended) The Program Administrator for XYZ Company is _______________________________________. Managers and Supervisors All managers and supervisors are responsible for implementing and maintaining the IIP Program in their work areas and for answering worker questions about the IIP Program. A copy of this IIP Program shall be available from each manager and supervisor upon request.
Section 3
Employee Compliance
XYZ Company management is responsible for ensuring that all safety and health policies and procedures are clearly communicated and understood by all employees. Managers and supervisors are expected to enforce the rules fairly and uniformly. All XYZ Company workers, including managers and supervisors, are responsible for
complying with safe and healthful work practices.
DECISION POINT Review and select the items that apply and delete those that do not
Our systems of ensuring that all workers comply with these practices include one or more of the following selected practices: 1. Informing workers of the provisions of our IIP Program; 2. Evaluating the safety performance of all workers; 3. Recognizing employees who perform safe and healthful work
practices;
4. Providing training to workers whose safety performance is
deficient;
5. Disciplining workers for failure to comply with safe and healthful
work practices.
Section 4
Communication
XYZ Company managers and supervisors are responsible for communicating with all
workers about occupational safety and health in a form readily understandable by all workers. Our communication system encourages all workers to inform their managers and supervisors about workplace hazards without fear of reprisal.
DECISION POINT Review and select the items that apply and delete those that do not
Our communication system includes one or more of the following selected items: 1. New worker orientation including a discussion of safety and health
policies and procedures.

2. Review of our IIP Program. 3. Workplace safety and health training programs. 4. Regularly scheduled safety meetings. 5. Effective communication of safety and health concerns between
workers and supervisors, including translation where appropriate.

6. Posted or distributed safety information. 7. A system for workers to anonymously inform management about
workplace hazards.
8. Our establishment has less than ten employees and
communicates with and instructs employees orally about general safe work practices and with respect to hazards unique to each employee's job assignment.
Section 5
Hazard Assessment
Periodic inspections of XYZ Company facilities, workplaces and sites to identify and evaluate workplace hazards shall be performed by the following Competent Person(s) in the following areas of our workplace: DECISION POINT Complete the information requested in this table.
Competent Person
Area
Periodic inspections are performed according to the following schedule: DECISION POINT - State the frequency of inspections below (Daily, weekly, monthly, etc.)
1. ________________________________;

2. When we initially established our IIP Program; 3. When new substances, processes, procedures or equipment which
present potential new hazards are introduced into our workplace;

4. When new, previously unidentified hazards are recognized; 5. When occupational injuries and illnesses occur; and 6. Whenever workplace conditions warrant an inspection.
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Section 6
Accident/Exposure Investigation
XYZ Company procedures for investigating workplace accidents and hazardous substance exposures include: 1. Interviewing injured workers and witnesses; 2. Examining the workplace for factors associated with the accident/exposure; 3. Determining the cause of the accident/exposure; 4. Taking corrective action to prevent the accident/exposure from reoccurring; and 5. Recording the findings and corrective actions taken.
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Section 7
Hazard Correction
Unsafe or unhealthy work conditions, practices or procedures at XYZ Company shall be corrected in a timely manner based on the severity of the hazards. Hazards shall be corrected according to the following procedures: 1. When observed or discovered; 2. When an imminent hazard exists which cannot be immediately abated without endangering employee(s) and/or property, we will remove all exposed workers from the area except those necessary to correct the existing condition. 3. Workers necessary to correct the hazardous condition shall be provided with the appropriate personal protective equipment for the hazardous condition.
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Section 8
Safety Training and Instruction

All XYZ Company workers, including managers and supervisors, shall have safety training and instruction on general and job-specific safety and health practices. A. Safety training and instruction shall be provided as follows: 1. When the IIP Program is first established; 2. To all new hires; 3. To all workers given new job assignments for which training has not previously provided; 4. Whenever new substances, processes, procedures or equipment are introduced to the workplace and represent a new hazard; 5. Whenever the employer is made aware of a new or previously unrecognized hazard; 6. To supervisors to familiarize them with the safety and health hazards to which workers under their immediate direction and control may be exposed; and 7. To all workers with respect to hazards specific to each employee's job assignment. B. General workplace safety and health practices include, but are not limited to:
1. Implementation and maintenance of the IIP Program. 2. Emergency action and fire prevention plan. Safety Office Depot. All rights reserved.
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3. Provisions for medical services and first aid including emergency procedures. 4. Prevention of musculoskeletal disorders, including proper lifting techniques. 5. Proper housekeeping, such as keeping stairways and aisles clear, work areas neat and orderly, and promptly cleaning up spills. 6. Prohibiting horseplay, scuffling, or other acts that tend to adversely influence safety. 7. Proper storage to prevent stacking goods in an unstable manner and storing goods against doors, exits, fire extinguishing equipment and electrical panels. 8. Proper reporting of hazards and accidents to supervisors. 9. Hazard communication, including worker awareness of potential chemical hazards, and proper labeling of containers. 10. Proper storage and handling of toxic and hazardous substances including prohibiting eating or storing food and beverages in areas where they can become contaminated.
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Section 9
Recordkeeping Policy
Every employer has certain mandatory records that they must keep and be prepared to provide to the appropriate agency when needed. The two primary types of records that must be kept are Occupational Safety and Health (OSHA) and Internal Revenue Service (IRS) information.
Occupational Safety and Health (OSHA) Records

Every employer covered by OSHA who has more than ten (10) employees, except for employers in certain low-hazard industries such as retail, finance, insurance, real estate, and some service industries, must maintain OSHA-specified records of job-related injuries and illnesses. There are two such records, the OSHA Form 300, and the OSHA Form 301. OSHA Form 300 The OSHA Form 300 is an injury/illness log, with a separate line entry for each recordable injury or illness (essentially those work-related deaths, injuries, and illnesses other than minor injuries that require only first aid treatment and do not involve medical treatment, loss of consciousness, restriction of work or motion, or transfer to another job). A summary section of the OSHA Form 300, which includes the total of the previous year's injury and illness experience, must be posted in the workplace for the entire month of February each year. OSHA Form 301 The OSHA Form 301 is an individual incident report that provides added detail about each individual recordable injury or illness. An equivalent insurance or workers' compensation form that provides the
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Injury and Illness Prevention Program (For Non High-Hazard Employers) same details may be substituted for the OSHA Form 301.
Company Recordkeeping Policy

DECISION POINT Select one of the four categories below that applies to your company. Remove the other three categories that do not apply to your company. The recordkeeping policy for XYZ Company is as follows: Category 1: XYZ Company has Fewer Than 10 Employees in Low Hazard Industries XYZ Company has fewer than ten (10) workers and will modify our IIP Program as follows: Communications about safety generally do not have to be in writing. Inspection records do not need to be kept after a hazard is
corrected. Training records can be a simple log of training provided at hiring or when an employee is assigned to new duties. Category 2: XYZ Company has Fewer Than 20 Employees in Low Hazard Industries A. XYZ Company has fewer than twenty (20) workers and will modify our IIP Program if:
1. We are not on a designated high hazard industry list as
established by the Department of Industrial Relations, and the employer has a workers compensation experience modification rate of 1.1 or less; or
2.
We are on a designated list of low hazard industries as established by the Department of Industrial Relations. and have taken the following steps to implement and maintain our IIP
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Injury and Illness Prevention Program (For Non High-Hazard Employers) Program: B. XYZ Company is on a designated list of low hazard industries. As such, our written recordkeeping documentation may be limited to the following: The identity of the persons with authority and responsibility for implementing the plan Scheduled periodic inspections to identify and correct workplace hazards and practices Required training and instruction
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Injury and Illness Prevention Program (For Non High-Hazard Employers) Category 3: XYZ Company has More Than 20 Employees in Low Hazard Industries A. Our establishment has twenty (20) or more workers and will modify our IIP Program for the following reasons:
1. We have a workers' compensation experience modification rate of
greater than 1.1; and

2. We are not on a designated low hazard industry list.
B. XYZ Company has taken the following steps to implement and maintain our IIP Program: Records of hazard assessment inspections, including the person(s) conducting the inspection, the unsafe conditions and work practices that have been identified and the action taken to correct the identified unsafe conditions and work practices, are recorded on a hazard assessment and correction form; and Documentation of safety and health training for each worker, including the worker's name or other identifier, training dates, type(s) of training, and training providers are recorded on a worker training and instruction form. Category 4: XYZ is a Local government entity We are a local governmental entity (county, city, district, or and any public or quasi-public corporation or public agency) and we are not required to keep written records of the steps taken to implement and maintain our IIP Program.
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Section 10
Company Required Safety Programs

Due to the nature of work and operations performed by XYZ Company, it is necessary that the following regulatory programs are included in our Injury and Illness Prevention Program: For convenience, programs listed in the table below are alpha sorted. DECISION POINT Review and select those programs that apply or included others not listed
Company Required Safety and Health Plans & Programs

Accident Prevention Program Asbestos Management Plan Bloodborne Pathogens Program Chemical Hygiene Plan Confined Space Entry Program Control of Hazardous Energy Program Cranes and Derricks Safety Program Electrical Safety Program Emergency Action Plan Excavation and Trenching Program Fall Protection Program Fire Prevention Work Plan Flammable Storage / Compressed Gas Forklift Safety Program Hazard Communication Program Hearing Conservation Program Hot Work Permit Program Ladders and Stairways Work Plan Laser Safety Program Lead Safety Program Personal Protective Equipment Plan Powered Industrial Truck Program Radiation Protection Program Respiratory Protection Program Scaffolding Safety Program Welding Safety Program
Table 1
All Safety Plans & Programs are available through Safety Office Depot www.SafetyOfficeDepot.com
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Section 11 Company Required Safety Training Courses

Due to the nature of work and operations performed by XYZ Company, it is necessary that the following safety training courses are included in our Injury and Illness Prevention Program: For convenience, courses listed in the 3 tables below are alpha sorted. DECISION POINT Review and select those courses that apply or included others not listed
Company Required Safety Training Courses Sorted A-E

Accident Investigation Accident Prevention Signs & Tags Asbestos Safety Bloodborne Pathogens Initial/Refresher Bloodborne Pathogens Train-theTrainer Chemical Spills Competent Persons Compressed Gas Cylinder Concrete & Masonry Confined Space Entry Construction Safety Management Crane Safety Refresher Cranes & Derricks in Construction Electrical Safety Emergency Exit Routes Emergency Response Team Ergonomics Basic Human Factors Ergonomics Advanced Human Factors Excavation Safety Eye & Face Protection
Table 2
All Safety Training Courses are available through Safety Office Depot www.SafetyOfficeDepot.com
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Company Required Safety Training Courses Sorted F-L

Fall Protection Portable Fire Extinguisher Flammable & Combustible Liquids Forklift Safety Classroom (English) Forklift Safety Classroom (Spanish) Hand & Power Tools Hazard Communication Hazard Vulnerability Hazardous Materials Management Hearing Protection Hexavalent Chromium Hot Work Permit Safety Indoor Air Quality Introduction to OSHA Job Hazard Analysis Laser Safety Lead Exposure Liquid Nitrogen Lockout-Tagout
Table 3
Company Required Safety Training Courses Sorted M-W

Machine Guarding Material Handling Office Safety Awareness Pandemic Preparedness Personal Protective Equipment Powered Industrial Truck Radiation Safety Respirator Protection Safe Lifting Awareness Back Safety Safety Audit Training Safety Representative Training Safety Supervisor Training Scaffolding Slip, Trip & Fall Prevention Stairway & Ladder Safety TB Respiratory Protection Walking & Working Surfaces Warehouse Safety Workplace Violence Prevention Healthcare Workplace Violence Prevention Retail
Table 4
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Section 12
Company Required Safety Forms & Checklists

Due to the nature of work and operations performed by XYZ Company, it is necessary that the following safety forms and checklists are included in our Injury and Illness Prevention Program: For convenience, forms listed below are subject sorted. DECISION POINT Review and select those forms that apply or included others not listed
CONFINED SPACE Confined Space Entry Permit Confined Space Class A & B Permit Confined Space Class C Permit List of Authorized Entrants Permit Required Confined Space Inventory Log CONSTRUCTION INDUSTRY - SAFETY MANAGEMENT Construction Industry Inspection Checklist Job Start-Up Checklist Contractors Job Site Checklist Contractor Safety Performance Report Construction Equipment Checklist Forklift Service Checklist Operator Performance Evaluation Checklist Safety Nets Inspection Checklist Body Harness & Lanyard Inspection Report Competent Person Evaluation Fall Protection CRANE OPERATIONS Cranes, Derricks or Material Handling Devices Worksheet Crane Inspection Checklist Crane Pre-Lift Checklist Sling (Chain) Inspection Report Monthly Hoist Rope Inspection Report Monthly Hoist Hook Inspection Report EMERGENCY ACTION AND RESPONSE Crisis Management Response Team - Contact Log Safety Representatives - Contact Log External Resources Contact Log Vulnerability Analysis Chart Bomb Threat Checklist Employee Evacuation - Accounting Log Physically Challenged Employee List
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Command Post Equipment Inventory Log Press Information Log Post Exercise Evaluation Report
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EMPLOYEE SAFETY RECORDS Employee Acknowledgement Form Employee Orientation Checklist Construction Employee PPE Assessment Form Employee PPE Issue Form Employee Safety Training Record Ergonomic Workstation Analysis Form Employee Ergonomic Workstation Questionnaire Employee Safety Suggestion Form EXCAVATION OPERATIONS Pre-Excavation Checklist Trenching Design Checklist Trench Safety Daily Field Report Competent Person Evaluation Excavation FIRE PREVENTION Hot Work Permit Fire Safety Inspection Checklist Fire Drill Post Response Report Emergency HAZMAT Inventory Log Hazardous Waste Disposal Request Form GENERAL INDUSTRY SAFETY MANAGEMENT General Industry Safety Inspection Checklist Office Safety Inspection Checklist Job Safety Analysis Worksheet & Instructions Accident Prevention Program Analysis Forklift Service Checklist Hearing Conservation Program Log Scaffolding Safety Checklist Site Safety Meeting Record Supervisors Monthly Meeting Record Report of Safety Hazard Form Property Security Survey INCIDENT REPORTING FORMS OSHA 300 Log Employee Injury & Illness Report Employee Injury Cost Accounting Matrix Vehicle Accident & Property Damage Report Compiling Direct and Indirect Costs OCCUPATIONAL HEALTH FORMS Medical Evaluation Questionnaire Respirator Use Respirator Fit Testing Record Hepatitis B Vaccine - Accept/Decline Form Bloodborne Pathogens Risk Classification Flowchart BBP Employee Annual Training Record BBP Source Patient Consent Form RADIATION PROGRAM FORMS Radioactive Material Use Log Pregnancy Declaration Form Laboratory Contamination Survey Record Radiation Producing Device - Authorization Form Training Guide for Radiation Workers Training Guide for Ancillary Radiation Works
TRAINING RECOGNITION CERTIFICATE Certificate of Completion
All Subject Form Groups are available through Safety Office Depot www.SafetyOfficeDepot.com
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Appendix A
List of Training Subjects

DECISION POINT Select applicable training subjects Strikethrough/delete those that do not XYZ Company trains our workers about the following selected training subjects: 1. The employer's Code of Safe Practices. 2. Confined spaces. 3. Safe practices for operating any agricultural equipment. 4. Good housekeeping, fire prevention, safe practices for operating any construction equipment. 5. Safe procedures for cleaning, repairing, servicing and adjusting equipment and machinery. 6. Safe access to working areas. 7. Protection from falls. 8. Electrical hazards, including working around high voltage lines. 9. Crane operations. 10.Trenching and excavation work. 11.Proper use of powered tools. 12.Guarding of belts and pulleys, gears and sprockets, and conveyor nip points. 13.Machine, machine parts, and prime movers guarding.
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Injury and Illness Prevention Program (For Non High-Hazard Employers) 14.Lock-out/tag-out procedures. 15.Materials handling. 16.Chainsaw and other power tool operation. 17.Tree falling/bucking procedures and precautions, including procedures for recognizing and working with hazard trees, snags, lodged trees, and unsafe weather conditions. 18.Yarding operations, including skidding, running lines, unstable logs, rigging and communication. 19.Landing and loading areas, including release of rigging, landing layout, moving vehicles and equipment, and log truck locating, loading and wrapping. 20.Fall protection from elevated locations. 21.Use of elevated platforms, including condors and scissor lifts. 22.Safe use of explosives. 23.Driver safety. 24.Slips, falls, and back injuries. 25.Ergonomic hazards, including proper lifting techniques and working on ladders or in a stooped posture for prolonged periods at one time. 26.Personal protective equipment. 27.Respiratory Equipment. 28.Hazardous chemical exposures. 29.Hazard communication.
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Injury and Illness Prevention Program (For Non High-Hazard Employers) 30.Physical hazards, such as heat/cold stress, noise, and ionizing and non-ionizing radiation. 31.Laboratory safety. 32.Bloodborne pathogens and other biological hazards. 33.Other job-specific hazards, such as __________________________________________
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Appendix B
Hazard Assessment Checklist

DECISION POINT Determine which checklists apply to your operation and delete all others XYZ Company has determined the following hazard assessment checklists apply to its operations
1. Abrasive Wheel
Equipment Grinders
15. Fire Protection 16. Flammable &

Combustible Materials
2. Compressed Air
Receivers
17. Floor & Wall Openings 18. Fueling 19. General Work
Environment
3. Compressed Gas &

Cylinders
4. Compressors &
Compressed Air
20. Hand Tools &

Equipment
5. Confined Spaces 6. Control of Harmful

Substances by Ventilation
21. Hazardous Chemical

Exposures
7. Crane Checklist 8. Electrical 9. Elevated Surfaces 10. Emergency Action

Plan
22. Hazardous
Substances Communication
23. Hoist & Auxiliary

Equipment
11. Environmental
Controls
24. Identification of Piping

Systems
12. Ergonomics 13. Exit Doors 14. Exiting or Egress

25. Industrial Trucks

Forklifts
26. Infection Control
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Injury and Illness Prevention Program (For Non High-Hazard Employers) 27. Lockout-Tagout
Procedures
35. Sanitizing Equipment

& Clothing
28. Machine Guarding 29. Material Handling 30. Noise 31. Personal Protective
Equipment & Clothing
36. Spraying Operations 37. Stairs and Stairways 38. Tire Inflation 39. Transporting
Employees & Materials
32. Portable (Power

Operated) Tools & Equipment
40. Ventilation for Indoor

Air Quality
41. Walkways 42. Welding, Cutting &

Brazing
33. Portable Ladders 34. Powder Actuated

Tools
Appendix C
Hazard Assessment and Correction Record
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Hazard Assessment and Correction Record
Date of Inspection: ________________________________________ Person Conducting Inspection: _______________________________ Unsafe Condition or Work Practice: ____________________________________________________ __________________________ ____________________________________________________ __________________________ ____________________________________________________ __________________________
Corrective Action Taken: ____________________________________________________ __________________________ ____________________________________________________ __________________________ ____________________________________________________ __________________________
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Appendix D Accident/Exposure Investigation Report
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Accident/Exposure Investigation Report

Date of Accident: _____________________________ Time of Accident: __________________ Location of Accident: ____________________________________________________ _______ Accident Description: ____________________________________________________ __________________________ ____________________________________________________ __________________________ ____________________________________________________ __________________________ Employees Involved: ____________________________________________________ __________________________ ____________________________________________________ __________________________ Preventive Action Recommendations: ____________________________________________________ __________________________ ____________________________________________________ __________________________
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Injury and Illness Prevention Program (For Non High-Hazard Employers) Corrective Actions Taken: ____________________________________________________ __________________________ ____________________________________________________ __________________________ Manager Responsible: ________________________________________ Date Corrective Actions Completed: _____________________________
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Appendix E Employee Training and Instruction Record
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Employee Training and Instruction Record

Employee Receiving Training:
(First Name) (Last Name)
(Middle Initial)
(Safety Training Topic) Select one: Initial Periodic Special Annual/Refresher
This employee has received specific safety & health training in the following subject areas:
Person conducting the training: (First Name) (Last Name) (Middle Initial)
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Trainers Signature Date Qualification or Job Title of Trainer Trainees Signature Date
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Appendix F
Codes of Safe Practice

DECISION POINT Determine which of the following Codes of Safety Practices apply to your companys operation, combine or edit them or delete/strikethrough the codes that in your opinion are non-applicable.
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Codes of Safe Practices General Industry

It is our policy that everything possible will be done to protect employees, customers and visitors from injury. Safety is a cooperative undertaking requiring participation by every employee. Failure by any employee to comply with safety rules will be grounds for corrective discipline. Supervisors shall insist that employees observe all applicable Company, State and Federal safety rules and practices and take action as is necessary to obtain compliance. To carry out this policy employees shall follow these safety rules and practices: 1. Report all unsafe conditions and equipment to your supervisor or safety coordinator. 2. Report all incidents, injuries and illnesses to your supervisor or safety coordinator immediately. 3. Anyone known to be under the influence of intoxicating liquor or drugs shall not be allowed on the job while in that condition. 4. Horseplay, scuffling, and other acts which tend to have an adverse influence on the safety or well-being of the employees, are prohibited.
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Injury and Illness Prevention Program (For Non High-Hazard Employers) 5. Means of egress shall be kept unblocked, well-lighted and unlocked during work hours. 6. In the event of fire, sound alarm and evacuate. 7. Upon hearing fire alarm, stop work and proceed to the nearest clear exit. Gather at the designated location. 8. Only trained workers may attempt to respond to a fire or other emergency. 9. Exit doors must comply with fire safety regulations during business hours. 10. Stairways should be kept clear of items that can be tripped over, and all areas under stairways that are egress routes should not be used to store combustibles.
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Injury and Illness Prevention Program (For Non High-Hazard Employers) 11. Materials and equipment will not be stored against doors or exits, fire ladders or fire extinguisher stations. 12. 13. Aisles must be kept clear at all times. Work areas should be maintained in a neat, orderly manner. Trash and refuse are to be thrown in proper waste containers. 14. 15. All spills shall be wiped up promptly. Always use the proper lifting technique. Never attempt to lift, push, pull or carry an object that is too heavy. You must contact your supervisor when help is needed to move a heavy object. 16. Never stack material precariously on top of lockers, file cabinets or other relatively high places. 17. When carrying material, caution should be exercised in watching for and avoiding obstructions, loose material, etc. 18. 19. Do not stack material in an unstable manner. Report exposed wiring and cords that are frayed or have deteriorated insulation so that they can be repaired promptly. 20. Never use a metal ladder where it could come in contact with energized parts of equipment, fixtures or circuit conductors. 21. Maintain sufficient access and working space
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Injury and Illness Prevention Program (For Non High-Hazard Employers) around all electrical equipment to permit ready and safe operations and maintenance. 22. Do not use any portable electrical tools and equipment that are not grounded or doubleinsulated. 23. All electrical equipment should be plugged into appropriate wall receptacles or into an extension of only one cord of similar size and capacity. Three-pronged plugs should be used to ensure continuity of ground. 24. All cords running into walk areas must be taped down or inserted through rubber protectors to preclude them from becoming tripping hazards. 25. Inspect motorized vehicles and other mechanized equipment daily or prior to use. 26. Shut off engine, set brakes and block wheels prior to loading or unloading vehicles. 27. Inspect pallets and their loads for integrity and stability before loading or moving. 28. Do not use compressed air for cleaning off clothing. 29. Do not store compressed gas cylinders in areas which are exposed to heat sources, electric arcs or high temperature lines. 30. Identify contents of pipelines prior to initiating any work that affects the integrity of the pipe.
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Injury and Illness Prevention Program (For Non High-Hazard Employers) 31. Wear hearing protection in all areas identified as having high noise exposure. 32. Goggles or face shields must be worn when grinding. 33. 34. Do not use any faulty or worn hand tools. Guard floor openings by a cover, guardrail, or equivalent. 35. Do not enter into a confined space unless tests for toxic substances, explosive concentrations, and oxygen deficiency have been taken. 36. Always keep flammable or toxic chemicals in closed containers when not in use. 37. Do not eat in areas where hazardous chemicals are present. 38. Be aware of the potential hazards involving various chemicals stored or used in the workplace. 39. Cleaning supplies should be stored away from edible items on kitchen shelves. 40. Cleaning solvents and flammable liquids should be stored in appropriate containers. 41. Solutions that may be poisonous or not intended for consumption should be kept in well-labeled containers. 42. When working with a computer, have all pieces of furniture adjusted, positioned and
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Injury and Illness Prevention Program (For Non High-Hazard Employers) arranged to minimize strain on all parts of the body. 43. Never leave lower desk or a cabinet drawer open, which presents a tripping hazard. Use care when opening and closing drawers to avoid pinching fingers. 44. Do not open more than one upper drawer at a time, particularly the top two drawers on tall file cabinets. 45. Individual heaters at work areas should be kept clear of combustible materials, such as drapes, or waste from waste baskets. Newer heaters that are equipped with tip-over switches should be used. 46. Appliances, such as coffee pots and microwaves, should be kept in working order and inspected for signs of wear, heat or fraying of cords. 47. Fans used in work areas should be guarded. Guards must not allow fingers to be inserted through the mesh. Newer fans are equipped with proper guards.
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Codes of Safe Practices Construction Industry

1. All persons shall follow these safe practices rules, render every possible aid to safe operations, and report all unsafe conditions or practices to the supervisor or superintendent. 2. Supervisors or foremen shall insist on employees observing and obeying every applicable Company, State or Federal regulation and order as is necessary to the safe conduct of the work, and shall take such action as is necessary to obtain compliance. 3. All employees shall be given frequent injury and illness prevention instructions. Instructions shall be given at least every 10 working days. 4. Anyone known to be under the influence of drugs or intoxicating substance which impair the employees ability to safely perform the assigned duties shall not be allowed on the job while in that condition. 5. Horseplay, scuffling, and other acts which tend to have an adverse influence on the safety or well-being of the employees, shall be prohibited.
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6. Work shall be well planned and supervised to prevent injuries in the handling of materials and in working together with equipment. 7. No one shall knowingly be permitted or required to work while the employees ability or alertness is so impaired by fatigue, illness, or other causes, that they might unnecessarily expose the employee or others to injury. 8. Employees shall not enter manholes, underground vaults, chambers, tanks, silos, or other similar places that receive little ventilation unless it has been determined that it is safe to enter. 9. Employees shall be instructed to ensure that all guards and other protective devices are in proper places and adjusted, and shall report deficiencies promptly to the supervisor or superintendent. 10. Crowding or pushing when boarding or leaving any vehicle or other conveyance shall be prohibited. 11. Workers shall not handle or tamper with any electrical equipment, machinery, or air or water lines in a manner not within the scope of their duties, unless they have received instructions from their superintendent. 12. All injuries shall be reported promptly to the supervisor or superintendent so that arrangements can be made for medical or first aid treatment.
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13. When lifting heavy objects, the large muscles of the leg, instead of the smaller muscles of the back, shall be used. 14. Materials, tools, or other objects, shall not be thrown from buildings or structures until proper precautions are taken to protect others from the falling objects. 15. Inappropriate footwear or shoes with thin or badly worn soles must not be worn. 16. Hand protection, such as gloves, shall be worn when there is excessive exposure to cuts, burns, or other materials that could cause injury (except where there is danger of the hand protection becoming entangled in moving machinery). 17. Hard hats shall be worn whenever overhead hazards exist and in all areas designated for hard hat use. 18. Safety glasses, goggles, or other suitable eye protection shall be worn when there is a hazard to unprotected eyes (e.g., when using a grinding wheel, etc.). 19. Employees shall cleanse themselves thoroughly after handling hazardous substances and follow special instructions from authorized sources. 20. Carriers should avoid the use of extension ladders when carrying loads. Such ladders may provide adequate strength, but the rung position and rope arrangement make such climbing difficult and hazardous for this trade.
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21. Work shall be so arranged that employees are able to face a ladder and use both hands while climbing. 22. 23. Gasoline shall not be used for cleaning purposes. No burning, welding, or other source of ignition shall be applied to any enclosed tank or vessel, even if there are openings, until it has first been determined that no possibility of explosion exists and authority for the work is obtained from the supervisor or superintendent. 24. Any damage to scaffolds, false work, or other supporting structures shall be immediately reported to the supervisor and repaired before use. 25. Personal fall arrest systems or restraints shall be worn when working over 7 1/2 feet above ground or surface which does not provide protected sides, edges or openings (e.g., no guardrails, etc.).
USE OF TOOLS AND EQUIPMENT 26. All tools and equipment shall be maintained in good condition. 27. Damaged tools or equipment shall be removed from service and tagged DEFECTIVE. 28. Pipe or Stillson wrenches shall not be used as a substitute for other wrenches.
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Injury and Illness Prevention Program (For Non High-Hazard Employers) 29. Only appropriate tools shall be used for a specific job. 30. Wrenches shall not be altered by the addition of handle-extensions or cheaters. 31. Files shall be equipped with handles and not used to punch or pry. 32. 33. A screwdriver shall not be used as a chisel. Wheelbarrows shall not be pushed with handles in an upright position. 34. Portable electric tools shall not be lifted or lowered by means of the power cord. Ropes shall be used. 35. Electric cords shall not be exposed to damage from vehicles. 36. In locations where the use of a portable power tool is difficult, the tool shall be supported by means of a rope or similar support of adequate strength. MACHINERY AND VEHICLES 37. Only authorized persons shall operate machinery or equipment. 38. Loose or frayed clothing, long hair, dangling ties, finger rings, etc., shall not be worn around moving machinery or other areas where they may become entangled. 39. Machinery shall not be serviced, repaired or adjusted while in operation, nor shall oiling
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Injury and Illness Prevention Program (For Non High-Hazard Employers) of moving parts be attempted, except on equipment that is designed or fitted with safeguards to protect the person performing the work. 40. Where appropriate, lock-out procedures shall be used. 41. Employees shall not work under vehicles supported by jacks or chain hoists without protective blocking that will prevent injury if jacks or hoists should fail. 42. Air hoses shall not be disconnected at compressors until the hose line has been bled. 43. All excavations shall be visually inspected before backfilling to ensure that it is safe to backfill. 44. Excavating equipment shall not be operated near tops of cuts, banks, or cliffs, if employees are working below. 45. Tractors, bulldozers, scrapers and carryalls shall not operate where there is a possibility of overturning in dangerous areas like edges of deep fills, cut banks, and steep slopes. 46. When loading where there is a probability of dangerous slides or movement of material, the wheels or treads of loading equipment, other than that riding on rails, should be turned in the direction which will facilitate escape in case of danger, except in a
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Injury and Illness Prevention Program (For Non High-Hazard Employers) situation where this position of the wheels or treads would cause a greater operational hazard. ROOFING OPERATIONS 47. 48. Knotted hand lines should not be used. Roofers tending kettles, or carrying buckets of hot tar, shall wear gloves that fit snugly at the wrists, and long-sleeved shirts fastened at the wrists. 49. At no time should a roofer, while handling or exposed to injury from hot tar, work without a shirt or appropriate footwear. 50. Appropriate portable fire extinguishers shall be kept at or near the kettle, attached, if practicable, to the tongue of the kettle, away from the danger zone. 51. Kettle covers should be equipped with a handle that projects at least fourteen inches (14") away from the surface of the cover or lid. 52. Kettle covers shall be closed and latched when in transit and the kettle should be slop-proof when cover is closed. 53. When parked, means shall be provided to prevent inadvertent movement of the kettle. 54. Ladders should be used with great caution, and roof gutters should not be
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Injury and Illness Prevention Program (For Non High-Hazard Employers) depended upon for support. 55. Workers handling buckets of hot tar should not carry anything that will interfere with the safety of this operation. 56. The gallows frame shall be securely anchored before hoisting materials. 57. Only muscular power shall be used to hoist materials by means of a gallows frame. A winch or power hoist shall not be used. BLASTING OPERATIONS 58. Cases that have contained explosives shall be destroyed by burning out-ofdoors. Do not burn in a stove or furnace. 59. Shoes with nails or metal plates shall not be worn in magazines or near explosives. 60. Blasting caps shall only be carried in approved containers. 61. The least amount of proper strength explosive that will do the job effectively shall be used. 62. Detonators and primers shall be separated from the explosives until it is necessary to bring together in preparing for the blast. 63. Holes loaded during a shift should be fired
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Injury and Illness Prevention Program (For Non High-Hazard Employers) during that shift. 64. The operations of loading and firing should be carried out with as few workers as possible. 65. Drill holes shall be blown out and made ready before explosives are brought to the site. 66. In tamping explosives, steady, even pressure should be used. 67. For electric blasting, the following shall apply: (a) (b) (c) (d) Tight electrical connections. No short circuits or breaks in the wires. Enough current to fire all shots. A strong, properly-applied force when using a blasting machine operated by physical effort. (e) Care not to damage the insulation of
wires when tamping charges. 68. If misfires occur, the licensed blaster shall be contacted.
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Appendix G
Employee Acknowledgement Form
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Employee Acknowledgement Form

I hereby acknowledge that I have had the opportunity to read, review and ask questions on the contents of the companys Injury and Illness Prevention Program. I also acknowledge that the provisions of this program and company safety and health policies are part of the terms and conditions of my employment and agree to abide by them. Furthermore, I understand that failure to comply with any part or parts of this program and any company safety and health policies may be grounds for termination of my employment. Additionally, I understand that failure to comply with the companys Drug-Free Workplace Policy shall also be grounds for termination of my employment.
Employee - Print Your Name Social Security Number Signature of Employee Date
As an employee representative of the company, I hereby attest that the employee named here was given the opportunity to read, review and ask questions about the companys Injury and Illness Prevention Program and company safety and health policies.
Witness Print Your Name
Duty Title of Witness
Signature of Witness Date
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Safety Office Depot Disclaimer Notice
While we have made every attempt to ensure that the information contained in this document is reliable, Safety Office Depot is not responsible for any errors or omissions, or for the results obtained from the use or non-use of this information. All information in this document is provided "as is", with no guarantee of completeness, accuracy, timeliness or of the results obtained from the use or non-use of this information, and without warranty of any kind, express or implied, including, but not limited to warranties of performance, merchantability and fitness for a particular purpose. In no event will Americana Safety Associates, Safety Office Depot, or the partners, agents or employees thereof be liable to you or anyone else for any decision made or action taken in reliance on the information in this document or for any consequential, special or similar damages, even if advised of the possibility of such damages. Given the changing nature of laws, rules and regulations, there may be omissions or inaccuracies in information contained in this document. Accordingly, the information in this document is provided with the understanding that the authors and publishers are proving guidance with respect to the information contained herein and that the performance or non-performance of this guidance shall be the responsibility of the user of this information.
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Injury and Illness Prevention Program

Non High-Hazard Employers

Injury and Illness Prevention Program (For Non High-Hazard Employers)

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Program Policy & Requirement

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policies and procedures.

workers and supervisors, including translation where appropriate.

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Injury and Illness Prevention Program (For Non High-Hazard Employers)

present potential new hazards are introduced into our workplace;

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Safety Training and Instruction

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Occupational Safety and Health (OSHA) Records

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Company Recordkeeping Policy

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greater than 1.1; and

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Injury and Illness Prevention Program (For Non High-Hazard Employers)

Company Required Safety Programs

Company Required Safety and Health Plans & Programs

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Section 11 Company Required Safety Training Courses

Company Required Safety Training Courses Sorted A-E

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Company Required Safety Training Courses Sorted F-L

Company Required Safety Training Courses Sorted M-W

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Company Required Safety Forms & Checklists

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TRAINING RECOGNITION CERTIFICATE Certificate of Completion

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List of Training Subjects

Corrective Action Taken: ______________________