OCCUPATIONAL HEALTH & SAFETY PROGRAM

Transcription

1 OCCUPATIONAL HEALTH & SAFETY PROGRAM Prepared by Blakeman & Associates Revised Replaces any previously published Occupational Health & Safety Program 2016 Blakeman & Associates

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3 CORPORATE POLICY STATEMENT Foundation Communities Occupational Health & Safety Program The Occupational Safety and Health Act of 1970 clearly states our common goal of safe and healthful working conditions. The safety and health of our employees continue to be the first consideration in the operation of this business. Safety and health in our business must be a part of every operation. Without question, it is every employee s responsibility at all levels. It is the intent of this 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 or 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. The personal safety and health of each employee of this company is of primary importance. The prevention of occupationally induced injuries and illnesses is of such consequence that it will be given precedence over operating productivity whenever necessary. To the greatest degree possible, management will provide all mechanical and physical facilities required for personal safety and health in keeping with the highest standards. We will maintain a safety and health program conforming to the best management practices of organizations of this type. To be successful, such a program must embody the proper attitudes toward injury and illness prevention not only on the part of supervisors and employees, but also between each employee and their co-workers. Only through such a cooperative effort can a safety program in the best interest of all be established and preserved. Our objective is a safety and health program that will reduce the number of injuries and illnesses to an absolute minimum, not merely in keeping with, but surpassing, the best experience of operations similar to ours. Our goal is nothing less than zero accidents and injuries. Executive Director Foundation Communities 2016 Blakeman & Associates Occupational Health & Safety Program

4 TABLE OF CONTENTS RESPONSIBILITY... 1 COMPANY HEALTH & SAFETY PROGRAM GUIDELINES... 1 WRITTEN INDIVIDUAL PROGRAMS... 1 SAFETY COMMITTEE... 2 A. Composition... 2 B. Principal Responsibilities... 2 C. Charter... 3 ROUTINE SAFETY AND HEALTH INSPECTIONS... 3 A. Inspection Team Composition... 4 B. Inspection Intervals... 4 C. Hazard Priority Classification System... 4 D. Inspection Elements... 4 E. Inspection Report... 5 SAFETY MEETINGS... 6 A. Safety Meeting Outlines... 6 B. Safety Meeting Schedules... 6 C. Departmental Staff Meetings... 6 D. Supervisor Meetings... 6 MEDICAL SERVICES FOR WORK-RELATED INJURIES... 6 ACCIDENT INVESTIGATION... 7 A. Immediate Concerns... 7 B. Investigation Team... 7 C. Accident Investigation Form... 7 D. Reviewers... 8 E. Accident Investigation Report... 8 HAZARD REPORTING... 9 GENERAL SAFETY RULES FOR ALL DEPARTMENTS AND PROJECTS... 9 RECORDKEEPING REQUIREMENTS DISCIPLINARY ACTION FOR WILLFUL UNSAFE ACTS A. Forms of Discipline B. Unsafe Act Priority Classification System Blakeman & Associates Occupational Health & Safety Program

5 TABLE OF CONTENTS (cont.) APPENDIX A: HAZARD REPORT APPENDIX B: HAZARD INVESTIGATION REPORT APPENDIX C: NEW EMPLOYEE SAFETY ORIENTATION EMPLOYEE ACKNOWLEDGMENT Blakeman & Associates Occupational Health & Safety Program

6 RESPONSIBILITY All employees must accept responsibility for the safety of themselves and that of their co-workers, as well as for the property and equipment of Foundation Communities. Compliance with all safety rules is mandatory. An employee who violates any of the rules listed may be subject to appropriate disciplinary action, including termination. The Risk and Safety Manager of the company will oversee the enforcement of all health and safety training programs. It is our aim that: Every possible safety hazard be eliminated from all jobs; Every unsafe act or condition be immediately detected, reported, and corrected; A good program of fire prevention and readiness be provided; and Safety consciousness will be instilled in all of our employees so that a perfect safety record can be achieved. There are specific guidelines to follow, but you must remember that no mere set of rules can ever assure safe operations. That assurance can come only from observing safe procedures and practices every minute of every working day. The company Risk and Safety Manager is responsible for all managerial aspects of this program and can make necessary decisions to ensure the success of the program. Safety is also the responsibility of every employee of this company. The Risk and Safety Manager will develop and utilize detailed, written instructions covering each aspects of the basic elements in the company safety program. Any revisions to the program should be recommended by the Risk and Safety Manager for approval by senior management. The company has expressly authorized the Risk and Safety Manager to halt operation of the company or activities of an employee where there is danger of serious personal injury to an employee or to a resident. All employees have the authority and obligation to stop any task or operation where concerns or questions regarding the control of Health, Safety, or Environmental (HSE) risks exist. COMPANY HEALTH & SAFETY PROGRAM GUIDELINES Foundation Communities will review and evaluate this document: On an annual basis; When changes occur to federal regulations that prompt a revision; When changes occur to any related regulatory document that prompts a revision of this document; and/or When facility or project operational changes occur that require a revision of this document. WRITTEN INDIVIDUAL PROGRAMS This company will maintain written individual procedures for the types of hazards/issues that our employees will or could potentially be exposed to. Each program will be reviewed/revised on an annual basis or as required by the respective governing OSHA Standard. Each program insofar as possible will be maintained as an independent program to avoid situations where it is unclear where responsibility for given issues belong. Effective implementation of these programs requires support from all levels of management within this company. Each written program will be communicated to all personnel that are affected by it. Each will encompass the total workplace, regardless of number of workers employed or the number of work shifts Blakeman & Associates 1 Occupational Health & Safety Program

7 They will be designed to establish clear goals and objectives. The following individual safety programs will be maintained. General Industry Programs: Health, Safety, & Environmental Policy Occupational Health & Safety General Safety Practices Hazard Communication Hazardous Energy Control Emergency Response Plan Fire Extinguisher Medical & First Aid Bloodborne Pathogens Working in Hot Conditions OSHA Recordkeeping Accident Investigation & Reporting Office Safety Assured Equipment Grounding Chromium VI Electrical Safety-Related Work Practices Fall Protection Job Hazard Assessment/PPE Machine Guarding Occupational Noise Exposure Permit Required Confined Space Respiratory Protection Stairways & Ladder Safety Stop Work Authority Welding Safety-Related Work Practices SAFETY COMMITTEE A. Composition The company safety committee will be comprised of five (5) members of management/supervision and hourly personnel. The makeup of the committee will consist of the following: Safety Committee Structure Title Co Chair Co Chair s s s Risk and Safety Manager Senior Staff (1) Department Supervisor (1) Department Supervisor (1) Department Supervisor B. Principal Responsibilities The principal responsibilities of the company safety committee will be as follows: 1. Assemble on a QUARTERLY basis to conduct safety meetings. 2. Conduct and oversee departmental safety inspections. 3. Review accident/injury reports and discuss corrective actions. 4. Direct and monitor all employee safety training and safety meetings. 5. Discuss and report on unfinished business from previous meetings. 6. Discuss new business Blakeman & Associates 2 Occupational Health & Safety Program

8 7. Maintain appropriate records of activities. 8. Require lower level supervisors to sit in on the committee meetings whenever deemed necessary. EXAMPLE: If a major hazard exists or operational change is to be considered that is in a specific department, then the Department Supervisor or lower level supervisors should be present. 9. The Risk and Safety Manager will be present to make notations of the meeting and offer advice. He will track open safety items to conclusion. C. Charter The safety committee of Foundation Communities will encourage safety awareness among all employees. It will be established to monitor safety performance, safety inspections, and aid the Risk and Safety Manager in administering the company safety program: To reduce injuries and save lives; To constantly be aware of conditions in all work areas that can produce injuries; To aid the company in complying with all laws pertaining to safety; To ensure that no employee is required to work at a job that is not safe or healthful; To place the personal safety and health of each employee of this company in a position of primary importance; To aid in the prevention of occupationally induced injuries and illnesses; To the greatest degree possible, aid management in providing all mechanical and physical facilities required for personal safety and health in keeping with the highest standards; To maintain a safety and health program conforming to the best management practices of organizations of this type; To establish a program that instills the proper attitudes toward injury and illness prevention not only on the part of supervisors and employees, but also between each employee and their co-workers; and To ultimately achieve a safety program maintained in the best interest of all concerned. ROUTINE SAFETY AND HEALTH INSPECTIONS Routine safety and health inspections of all company facilities will be conducted through specific, methodical auditing, checking, or inspection of procedures, conditions, and work practices that lead to job accidents and industrial illnesses Blakeman & Associates 3 Occupational Health & Safety Program

9 A. Inspection Team Composition The recommended makeup of the team will consist of the following: Safety Inspection Team Structure Title Risk and Safety Manager (1) Department Supervisor (1) Hourly Employee B. Inspection Intervals The Risk and Safety Manager will coordinate inspection dates and times with all assigned inspection team members. The team will conduct inspections on a QUARTERLY basis. C. Hazard Priority Classification System Hazards will be rated according to the following rating system. Where it is unclear where a hazard should be rated the next higher priority classification will be assumed. I. Priority 1 Hazard The most serious type of unsafe condition or unsafe work practice that could cause loss of life, permanent disability, the loss of a body part (amputation or crippling injury), or extensive loss of structure, equipment, or material. II. Priority 2 Hazard Unsafe condition or unsafe work practice that could cause serious injury, industrial illness, or disruptive property damage. III. Priority 3 Hazard Unsafe condition or unsafe work practice that might cause a recordable injury, industrial illness, or non-disruptive property damage. IV. Priority 4 Hazard Minor condition, a housekeeping item, or unsafe work practice infraction with little likelihood of injury or illness other than perhaps a first-aid case. D. Inspection Elements The following inspection elements will be checked during safety inspections. Where an individualized safety program exists, the company standard practice instruction will be used as the basis for development of inspection criteria. Element Floors Aisles Stairs Ladders Lighting Criteria Condition, slip, trip, falls Marking, obstructions Condition, railings, obstructions Condition, Metal in electrical areas Suitable Illumination for work 2016 Blakeman & Associates 4 Occupational Health & Safety Program

10 Exits Ventilation Noise Control Hand Tools Machine Tools Chemicals Compressed Gas Guarding Lockout/Tagout Eye Protection Fire Protection First Aid Waste Disposal Building Exterior Building Interior Yards/Roads Elevators Offices Power Systems Air Compressor Work Practices Power Tools Air Lines Electrical Boxes Eye wash Stations Hoses Bench Grinder Chop Saw Chain Saw Chains Belt Sander Welding Machine Obstructions, locked?, lighted? Adequate, fans guarded?, maintained 85db or less?, hearing protection? Grounded, guarded, pressure switches, condition Guarded, stop buttons, training? SDS's, labels, storage, separated Storage, heat sources, labels, training Installed, over, under, around, between Procedures, training, devices, tags Used, training, Z-87 rated protectors Extinguishers, training, locations Kits, OSHA 300 logs, training, contents Containers, labeled, separated Defective overhangs, lighting Defective overhangs, lighting Obstructions, housekeeping, signs Good repair, load rating, inspected Floors, aisles, exits, ventilation Mechanical, hydraulic, electrical Condition, guard, belt Unsafe work practices observed? (list) Condition, guards, cords Hoses with crimped on fittings Voltage marked on box, obstructions, missing or broken breakers Located where needed, maintenance, condition Condition, hose clamps, permanent type, proper application Proper sign, guards, tool rest, tongue guard, secured Condition, cords, guards Training, blade, guards Condition, proper type Condition, training, guard Lugs covered, cable connected E. Inspection Report The Risk and Safety Manager will develop a safety report based on the inspection items noted during the inspection. The following items will be accomplished. 1. The report will be distributed immediately to maintenance employees responsible for correcting deficiencies noted during the inspection. These personnel will use the hazard classification system to prioritize deficiency correction. 2. The report will be distributed to all supervisors and key management personnel. Supervisors will brief the results to all employees under their control. Any employee requesting to be placed on the distribution list will be accommodated Blakeman & Associates 5 Occupational Health & Safety Program

11 3. The Risk and Safety Manager will develop a statistical analysis of deficiencies noted to determine jobs/areas that have a high incidence of injury potential. These areas will be emphasized during inspections and meetings. SAFETY MEETINGS A well-ordered flow of information is essential to a good safety program. The company, through a program of safety meetings at all levels, intends to accomplish the goals of safety awareness, education, and participation. A. Safety Meeting Outlines The Risk and Safety Manager will maintain outlines serving various topics of importance to the safety of company employees. The outlines will be flexible. They will be intended to be adapted to the widest range of situations and groups. Supervisors can add the level of detail required to make the material completely relevant to their employees. B. Safety Meeting Schedules Employees will be given safety briefings by their respective supervisors on an as needed basis. Safety briefings will also be given immediately: Upon initial job assignment or reassignment; When operational changes to equipment or the job occur; When a co-worker in their department/project is injured; and/or When manufacturers provide safety related information pertaining to defects, use, etc., for equipment used by this company. C. Departmental Staff Meetings Safety will be included in the agenda of all staff meetings. The Risk and Safety Manager will keep Department Supervisors informed of safety performance developments in the area of accident prevention and safety. Department/Project Supervisors may ask the Risk and Safety Manager to provide safety briefings as required. D. Supervisor Meetings Safety will be included in the agenda of all routine supervisor meetings. The Risk and Safety Manager will keep Department Supervisors informed of safety performance developments in the area of accident prevention, and safety. Department Supervisors will ensure the information is transmitted to all employees during safety meetings. Department/Project Supervisors may ask the Risk and Safety Manager to provide safety briefings as required. MEDICAL SERVICES FOR WORK-RELATED INJURIES We want each of you to be safe and injury free at all times, but if an injury happens then do the following things. 1. At once - notify your supervisor of the problem so professional medical care and/or first aid can then be administered. If in the judgment of your supervisor that medical attention is needed, the company requires you to see a medical professional as soon as possible Blakeman & Associates 6 Occupational Health & Safety Program

12 2. Your supervisor will: Arrange for you to be transported to the proper service if professional medical service is required; Call the correct location and tell them you are on the way; and Review the incident to determine if anything can be done to avoid the likelihood of someone else being injured in same manner. 3. Follow the instructions of the doctor completely. 4. As soon as possible, notify your supervisor of your medical condition so your supervisor can be of assistance. 5. As soon as the doctor releases you to return to work, notify your supervisor for instructions. ACCIDENT INVESTIGATION Accident investigation is primarily a fact-finding procedure; the facts revealed are used to prevent recurrences of similar accidents. The focus of accident investigation will be to prevent future accidents and injuries to increase the safety and health of all our employees. A. Immediate Concerns 1. Ensure any injured person receives proper care. 2. Ensure co-workers and personnel working with similar equipment or in similar jobs are aware of the situation. This is to ensure that procedural problems or defects in certain models of equipment do not exist. 3. Start the investigation promptly. B. Investigation Team The accident investigation team will be formed on an as needed basis and will be composed of the following: Accident Investigation Team Title Risk and Safety Manager On Site Supervisor Department Supervisor Immediate Supervisor of Injured Employee C. Accident Investigation Form A standardized investigation form which details specific company requirements for investigation will be developed and used to gather data to determine causes and corrective actions. At a minimum, the form will contain the following areas of concern. 1. Injured Employee's Name 2. Date and Time of Injury 3. Occupation or Task Being Performed When Injured 4. Shift and Department/Project 5. Company ID Number 2016 Blakeman & Associates 7 Occupational Health & Safety Program

13 6. Employee's Address 7. Sex/Age/DOB 8. Social Security Number 9. Length of Service 10. Length of Time at Specific Job 11. Time Shift Started 12. Overtime Length When Injury Occurred 13. Physician's and Hospital Name (if transported) 14. Type of Injury 15. Resulting Fatalities 16. Description and Analysis of Accident 17. Complete Accident Tree 18. Action Taken to Prevent Recurrence and Person 19. Employee's Statement 20. Witnesses' Statement 21. Employer's Statement 22. Person Completing Form and Date 23. Person Reviewing Form and Date D. Reviewers All injury investigation reports will be reviewed by a member of management responsible for the department/project involved to ensure pertinent information is transmitted to all concerned and remedial action taken. Accident Investigation Review Team Title Risk and Safety Manager On Site Supervisor Department Supervisor Immediate Supervisor of Injured Employee E. Accident Investigation Report The final report will be numbered and will include, but is not limited to, the following: 1. Investigation Form and Pertinent Data 2. Photographs/Drawings/Exhibits of Scene 3. Narrative of Accident 4. Sequence of Events 5. Contributing Information 6. Findings and Recommendations, Including Root Cause Analysis 7. Action Items and Completion Dates 8. Responsible Persons 9. Follow-up Procedures to Ensure Completion 10. Distribution List 2016 Blakeman & Associates 8 Occupational Health & Safety Program

14 HAZARD REPORTING The Foundation Communities Hazard Report will be used by all employees to report potential or known hazards. The following procedures apply. 1. The person reporting the hazard should: Notify Department/Project Supervisor of the hazard; Accomplish lockout/tagout if required on machinery or equipment; Fill out required sections of the hazard report; and Forward report immediately to the Risk and Safety Manager. 2. The supervisor should: Notify all affected workers of hazard; Notify maintenance of hazard, if required; Ensure hazard is properly marked and controlled; and Contact the Risk and Safety Manager if needed. GENERAL SAFETY RULES FOR ALL DEPARTMENTS AND PROJECTS The following safety rules are established by this company as general safety rules for all departments and projects. Any infraction of these rules will constitute a safety violation for which disciplinary action will result. 1. Never operate any machine or equipment unless you are authorized and trained to do so. 2. Do not operate defective equipment. Do not use broken hand tools. Report them to your supervisor immediately. 3. Obtain full instructions from your supervisor before operating a machine with which you are not familiar. 4. Never start on any hazardous job without being completely familiar with the safety techniques which apply to it. Check with your supervisor if in doubt. 5. Make sure all safety attachments are in place and properly adjusted before operating any machine. 6. Do not operate any machine or equipment at unsafe speeds. Shut off equipment which is not in use. 7. Wear all protective garments and equipment necessary to be safe on the job. 8. Wear proper shoes; sandals, other open-toed, or thin-soled shoes should not be worn. 9. Do not wear loose, flowing clothing or long hair when operating moving machinery. 10. Never repair or adjust any machine or equipment unless you are specifically authorized to do so by your immediate supervisor. 11. Never oil, clean, repair, or adjust any machine when it is in motion. 12. Never repair or adjust any electrically driven machine without opening and properly tagging the main switch. 13. Put tools and equipment away when they are not in use. 14. Do not lift items which are too bulky or too heavy to be handled by one person. Ask for assistance. 15. Keep all aisles, stairways, and exits clear of skids, boxes, air hoses, equipment, and spillage Blakeman & Associates 9 Occupational Health & Safety Program

15 16. Do not place equipment and materials so as to block emergency exit routes, fireboxes, sprinkler shutoffs, machine or electrical control panels, or fire extinguishers. 17. Stack all materials neatly and make sure piles are stable. 18. Keep your work area, machinery, and all company facilities which you use clean and neat. 19. Do not participate in horseplay, tease, or otherwise distract fellow workers. 20. Do not run on company premises - always walk. 21. Power-truck operators must safeguard other workers at all times; workers must show courtesy to power-truck operators. 22. Filing cabinets, desks, storage cabinets, and other storage devices should have drawers closed when not in use to prevent tripping hazards. 23. Floor mounted extension cords should be placed so that they are flush to the ground at all times. 24. Coffee bar electrical outlets should be properly used. Never overload electrical outlets. 25. Burned out light bulbs should be replaced immediately. 26. Frayed or damaged electrical cords should be replaced. 27. Never take chances. If you're unsure, you re unsafe! 28. Ask for help. Let good common sense be your guide. RECORDKEEPING REQUIREMENTS This employer fully understands that companies with eleven (11) or more employees at any time during the calendar year immediately preceding the current calendar year must comply with the provisions of 29 CFR This section provides for recordkeeping and reporting by Foundation Communities covered under 29 CFR 1904 as necessary or appropriate for developing information regarding the causes and prevention of occupational accidents and illnesses, and for maintaining a program of collection, compilation, and analysis of occupational safety and health statistics both for this company and as part of the national system for analysis of occupational safety and health. Records shall be established on a calendar year basis. 1. This employer will report under 29 CFR concerning fatalities, inpatient hospitalizations, amputations, or loss of an eye accidents. 2. This employer will maintain a log of occupational injuries and illnesses under 29 CFR 1904 as required by the standard. DISCIPLINARY ACTION FOR WILLFUL UNSAFE ACTS Employee safety is paramount at this company. The willful commitment of an unsafe act cannot and will not be condoned. Employees who willfully jeopardize their own or co-workers safety will be disciplined. The type of discipline can range from a verbal warning to dismissal. Supervisory personnel in the administrative chain of any employee may give employees a verbal warning for a known unsafe act, or procedural or operational infraction Blakeman & Associates 10 Occupational Health & Safety Program

16 A. Forms of Discipline I. Verbal Warning Supervisory personnel in the administrative chain of any employee may give employees a verbal warning for a known unsafe act, or procedural or operational infraction. A second verbal warning in the same shift will be grounds for release from the current work shift without pay. The immediate supervisor will be consulted in all cases and will make the determination for release. II. Written Warning A written warning will be issued automatically for a second verbal warning for an unsafe act. The written warning will become part of the employee s permanent personnel record. III. Retraining It must be considered that the possibility exists that lack of proper training may be a cause of the unsafe act. Supervisors will review the need for employee remedial training in their job skill code to enable them to better accomplish their jobs. B. Unsafe Act Priority Classification System Unsafe acts will be rated according to the following rating system. Where it is unclear where an unsafe act should be rated, the next higher priority classification will be assumed. While any unsafe act is serious, this classification system will be used to gage the severity of an unsafe act for use in determining the appropriate level of disciplinary action. I. Priority 1 Unsafe Act The most serious type of unsafe act or unsafe work practice that could cause loss of life, permanent disability, the loss of a body part (amputation or crippling injury), or extensive loss of structure, equipment, or material. II. Priority 2 Unsafe Act Unsafe act or unsafe work practice that could cause serious injury, industrial illness, or disruptive property damage. III. Priority 3 Unsafe Act Unsafe act or unsafe work practice that might cause a recordable injury, industrial illness, or non-disruptive property damage. IV. Priority 4 Unsafe Act Minor unsafe work practice infraction with little likelihood of injury or illness Blakeman & Associates 11 Occupational Health & Safety Program

17 APPENDIX A: HAZARD REPORT HAZARD REPORT DATE: FROM: DEPARTMENT/PROJECT: PHONE: SUPERVISOR NOTIFIED: Yes No Related Operating Procedures Reviewed: Yes No SUPERVISOR ACKNOWLEDGMENT All Affected Employees Notified: Yes No I certify that I have reviewed the information contained in this hazard report and will take the necessary steps to ensure correction. *Further detailed on attachment: Yes No Name: Signature: Title: Date: Time: MACHINE HAZARD: (Narrative) (not to be used for routine maintenance) Has the machine been reported to maintenance? Yes No Date/Time: Has the machine been Locked-out/Tagged-out? Yes No Date/Time: DESCRIPTION OF HAZARD: (other than machine hazard) (Narrative) CORRECTIVE ACTION RECOMMENDATIONS: (other than machine hazard) (Narrative) Do Not Write Below This Line REPORT NUMBER: ESTIMATED COMPLETION DATE: DATE RECEIVED: FORWARDED TO: DATE: PERSON RESPONSIBLE: 2016 Blakeman & Associates 12 Occupational Health & Safety Program

18 APPENDIX B: HAZARD INVESTIGATION REPORT IMMEDIATE ACTION(S) TAKEN HAZARD INVESTIGATION REPORT FOLLOW-UP ACTION(S) TAKEN PERSON CONTACTED: DATE: TIME: REMARKS: NEW ESTIMATED COMPLETION DATE: PERSON CONTACTED: DATE: TIME: REMARKS: SUMMARY OF INVESTIGATION: NEW ESTIMATED COMPLETION DATE: ACKNOWLEDGMENT I certify that I have investigated the hazards reported in this hazard report and will take the necessary steps to ensure correction of safety deficiencies noted. *Further detailed on attachment: Yes No Name: Signature: Title: Date: Time: REPORT FORM RETENTION INFORMATION ATTACHMENTS Permanent Retention File: Location: *Yes No Date Filed: Filed By: *See Following Pages 2016 Blakeman & Associates 13 Occupational Health & Safety Program

19 APPENDIX C: NEW EMPLOYEE SAFETY ORIENTATION NEW EMPLOYEE SAFETY ORIENTATION ANNUAL TRAINING LIST Employee s Name: Date Assigned: Department: Job Title: Supervisor s Name: Date of Review: Signature: Instructions to Supervisor: Check all boxes that apply. Review the duty requirements of the new employee and select the safety topics that the employee must be trained on. SAFETY TOPIC SAFETY TOPIC Accident Reporting Procedures Hazard Markings Back Safety Hazard Signage Bloodborne Pathogens Exposure Hearing Conservation Burn Safety Heat Stress Issues Chemical Safety Awareness Housekeeping Requirements Compressed Gas Safety Job Hazard Analysis Awareness Confined Spaces Awareness Lockout/Tagout Awareness Crane and Sling Safety Machine Guarding Awareness Disciplinary Actions for Unsafe Acts New Products Safety Electrical Safety Awareness OSHA Record keeping Emergency Action Plan Personal Protective Equipment Eye and Face Protection Respiratory Protection Fall Protection Awareness Restricted Areas Fire Extinguisher Slips, Trips, and Falls Safety Fire Prevention Smoking Restrictions Flammable/Combustible Liquids Spill Prevention and Control Food/Beverage Consumption on Duty Violent Acts Forklift Safety Awareness Waste Disposal Procedures Hand & Power Tool Safety Welding Safety Hazard Communication 2016 Blakeman & Associates 14 Occupational Health & Safety Program

20 OCCUPATIONAL HEALTH AND SAFETY EMPLOYEE ACKNOWLEDGMENT ACEPTAMIENTO DEL EMPLEADO Foundation Communities By my signature below, I acknowledge that I have received and will read the Occupational Health and Safety Program. I have been given the opportunity to ask questions, have received clarification, and understand that it is my responsibility to understand the contents of this policy. Con mi firma, acepto que he recibido y leído el Occupational Health and Safety Program. He tenido la oportunidad de hacer preguntas, he recibido clarificación, y entiendo que es mi responsabilidad entender el contenido de esta política. Date Fecha Employee Signature Firma del Empleado Print Name Nombre en Letra de Molde 2016 Blakeman & Associates 15 Occupational Health & Safety Program

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