HUMBOLDT STATE UNIVERSITY by TBFUOq

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									                           HUMBOLDT STATE UNIVERSITY

            DEPARTMENTAL INJURY & ILLNESS PREVENTION PLAN


The Department of                                       is committed to maintaining a safe
environment for its students, academic appointees, staff and visitors.

Implementing Authority and Responsible Parties

DEPARTMENT HEAD or CHAIRPERSON:________________________________________

This person has the authority and responsibility to implement the Injury and Illness Prevention
Program. This person is also responsible for designating at least one employee as the department
safety coordinator to assist the department in implementing the mandated health and safety
program.

The following individual(s) will be responsible for implementation of this program at the
departmental level:

   Name:
               (Department Safety Coordinator)

   Title:                                           Phone ext.

   Description of authority and responsibility:



   Name:

   Title:                                           Phone ext.

   Description of authority and responsibility:




       Department Chair      (signature)                    Date



       College Dean          (signature)                    Date

                                              A-1
                      DEPARTMENTAL INJURY & ILLNESS PLAN



                                   SECTION A
                           COMMUNICATING SAFETY ISSUES



The department uses the following methods (indicated by a ) to ensure effective health and
safety communication to employees, and to ensure that employees feel comfortable raising
concerns about safety issues without fear of reprisal.
              Supervisors and managers are provided with training on their roles and
              responsibilities as they pertain to injury and illness prevention, including being
              informed of the hazards to which they may be exposed.
              Information on safe working conditions, work practices, and hazard control is
              included in initial training at the start of employment and all subsequent training.
              Other forms of employer-to-employee communications on health and safety topics
              include:
                 Posters         Meetings         Written procedures             MSDSs
                 Chemical Hygiene Plan            Warning labels         Bulletins
                 other (specify):

               Employees are encouraged to bring to the University’s attention any potential
               health or safety hazard that may exist in the work area. The University provides
               Hazard Identification forms (Appendix D) for this purpose.
               Employees have been advised by the following method
               that adherence to safe work practices and the proper use of required personal
               protective equipment will be monitored and conformance will be reinforced by:
                  Recognition for compliance/good safety record, including:
                          Incentive awards
                          Positive commentary on job performance evaluations
                          Consideration in merit increases in salary
                  Discipline for non-compliance, including:




               Employees have been advised there will be no reprisals or other job
               discrimination for expressing any concern, comment, suggestion or complaint
               about a safety-related matter.


               The following methods are used to ensure that health and safety communications

                                              A-2
              are readily understandable by all affected employees.
                 oral verification
                 written verification
                 supervisor observation/evaluation
                 other:


       Documentation related to Injury & Illness Prevention Program communication is
       maintained by the following:
                department safety coordinator
                individual supervisors
                department chair/manager
                Specialty committees:

                other:


Employees are encouraged to bring to the University's attention any potential health or safety
hazard that may exist in the work area. A mechanism for anonymous employee input, such as a
suggestion box or mail station for safety suggestions, hazard identification, complaints, etc.
which is accessible to all employees will be implemented. The Hazard Identification form (or
equivalent) can be used for this purpose. These forms may also be sent directly to EH&S (ext.
5702) for follow-up.

Supervisors will follow up on all suggestions and investigate the concerns brought up through
these
communication methods, utilizing EH&S assistance if needed. Feedback to the employees is
critical, and must be provided for effective two-way communication.




                                             A-3
                                   SECTION B
                        IDENTIFYING WORK PLACE HAZARDS



The department uses the applicable inspection forms in Appendix C to conduct regularly
scheduled work area inspections as noted below. The specific areas inspected are noted by
building name and room numbers. In addition, inspections are also made in accordance to the
criteria on page 10 of the University IIP Plan.

                        DEPARTMENT INSPECTION SCHEDULE

Inspection schedule codes:   Inspection checklists: C-1 = General/office inspections
                                                    C-2 = Laboratories
                                                    C-3 = Shops
                             Frequency:             A = annual
                                                    SA = semi-annual
                                                    Q = quarterly
                                                    M = monthly



 Building name &             Employee responsible for               Inspection    Frequency
 room numbers                inspection                             Checklist     of
                                                                                  Inspection
 Example: Gist 312, 313      Johnny Slipup                          C-1           SA
          Gist 410           Vinny “Lefty” Khutauff                 C-3           M




       Make additional copies of table as necessary.


                                             A-4
                            Departmental Work Area Hazards

Based upon regularly scheduled inspections and knowledge of specific job tasks, hazards have
been identified and summarized in the following tables.


       Note: For non-laboratory departments which have hazardous substances, the departmental
       IIP written plan must also include Appendix K, Hazard Communication Supplement. For
       departments with laboratories, the Chemical Hygiene Plan will serve as an area-specific
       injury plan including the identification of hazards.



                       Hazard Evaluation Guidelines for Offices

These guidelines contain the most common potential hazards for the specific work area, but are
not inclusive of all the potential hazards in the work area. The inspection and hazard evaluation
of the work area should not be limited to only these hazards.

Date Prepared:        ____________________                        Evaluator: ___________________


                                                                       Preventative Safe Work
  Description of
                       Potential Safety/Health Hazard              Conditions, Safe Work Practices
    Job/Task
                                                                  or Personal Protective Equipment
General Office        Back Strain: Improper Lifting               Provide Training on back care/ proper
                                                                  lifting techniques. Provide hand trucks and
                                                                  carts to transport heavy objects

                      Back Strain, Eyestrain, Repetitive Motion   Ensure that workstation is ergonomically
                      Injury                                      correct. Avoid purchasing office furniture
                                                                  that is not ergonomically correct.

                      Slips, Trips, Falls: Physical Injury        Keep floors clear of debris and liquid spills.
                                                                  Do not string up unprotected electrical
                                                                  cords across aisles. Do not stand on chairs
                                                                  with wheels. Provide general office safety
                                                                  training.

                      Injury Due to Falling Objects               Do not store heavy objects overhead.
                                                                   Do not top load file cabinets, fill them from
                                                                  bottom to top.
                                                                   Do not open more than one file drawer at a
                                                                  time.
                                                                   Brace tall bookcases and file cabinets to
                                                                  walls.


                                                    A-5
        Electrical Fire Hazard           Do not use extension cords in lieu of
                                         permanent wiring.
                                         Ensure that high wattage appliances, e.g.,
                                         space heaters, coffee pots, do not overload
                                         circuits.
                                         Use GFIs in receptacles in wet or
                                         potentially wet areas.
                                         Replace frayed or damaged electrical cords.
                                         Ensure that electrical cords are not
                                         damaged by being wedged against furniture
                                         or pinched by doors



        Health Hazards Due to Chemical   Arrange for proper disposal of unnecessary
        Exposure                         chemicals, e.g., cleaners, solvents, and
                                         adhesives.
                                         Follow manufacturer’s labeling precautions
                                         and instructions for safe use.

Other   ____________________________     _____________________________
                                         _____________________________
                                         _____________________________
                                         _____________________________
                                         _____________________________




                                  A-6
 Hazard Evaluation Guidelines for Receiving Areas, Storerooms, Stockrooms

These guidelines contain the most common potential hazards for the specific work area, but are
not inclusive of all the potential hazards in the work area. The inspection and hazard evaluation
of the work area should not be limited to only these hazards.

 Date Prepared:      __________________________              Evaluator:_____________________


                                                                 Preventative Safe Work
  Description of
                      Potential Safety/Health Hazard         Conditions, Safe Work Practices or
    Job/Task
                                                              Personal Protective Equipment
 General             Back Injury                             Provide training on back care and proper
                                                             lifting techniques.
                                                             Use hand trucks, dollies, fork lifts, and pallet
                                                             jacks to move loads.

                     Foot Injury Due to Heavy Loads, Truck   Wear steel-toed shoes (required at receiving
                     Lift Gates, Drums, etc.                 docks)

                     Chemical Exposure Due to Container      Develop and implement chemical spill
                     Leakage or Spillage                     response plan.
                                                             Provide chemical spill control materials and
                                                             training.
                                                             Provide PPE

                     Injury Due to Falling Objects           Do not store heavy items overhead.
                                                             Ensure that shelves have restraint device or
                                                             lip.
                                                             Ensure that shelf units are seismically
                                                             braced.

 Hazardous           Incompatible Chemicals/Adverse          Segregate incompatible chemicals in storage
 Materials           Reactions                               by distance and/or barrier.
                                                             Minimize the volume of stored materials.
 Storage
 Other               ____________________________            ______________________________
                                                             ______________________________
                                                             ______________________________
                                                             ______________________________
                                                             ______________________________




                                                     A-7
                        Hazard Evaluation Guidelines for Shops

These guidelines contain the most common potential hazards for the specific work area, but are
not inclusive of all the potential hazards in the work area. The inspection and hazard evaluation
of the work area should not be limited to only these hazards.

 Date Prepared:      __________________________               Evaluator:______________________


                                                              Preventative Safe Work Conditions,
  Description of
                     Potential Safety/Health Hazard            Safe Work Practices or Personal
    Job/Task
                                                                    Protective Equipment
 Cleaning and        Getting caught or injured by moving      Ensure machine is turned off and locked out
 Servicing           parts

 Machine/Equip       Getting caught or injured by moving      Ensure guards and safety shields are in place
 ment Operations     parts                                    during operation.

                     Eye injury due to flying metal or wood   Wear safety glasses during and near machine
                     chips                                    operations.

                     Exposure to dust, mist vapor, and fume   Use exhaust ventilation to control airborne
                     inhalation                               hazards.

                     Tripping/Slipping Hazards                Keep aisles and floor areas around machines
                                                              (and other floor surfaces, steps, ladders, etc.)
                                                              free of debris, spilled oil, chemicals or water

                     Harmful Noise Levels                     Ensure EH&S conducts sound level surveys.
                                                              Employ engineering controls to reduce sound
                                                              levels.
                                                              If deemed by EH&S as necessary, wear hearing
                                                              protection.

                     Ingestion of Chemicals                   Allow no food or beverages in machine area.

                     Foot Injury                              Advise or require steel-toes safety shoes

                     Mishandling of Hazardous Materials,      Inventory hazardous materials and ensure
                     Potential Overexposure                   Material Safety Data Sheet information is
                                                              available in work areas.
                                                              Inform/train employees on the hazards of
                                                              materials and according safe handling
                                                              procedures.




                                                   A-8
Other   ___________________________   _______________________________
                                      _______________________________
                                      _______________________________
                                      _______________________________
                                      _______________________________




                            A-9
           Hazard Evaluation Guidelines for Mechanical/Boiler Rooms

These guidelines contain the most common potential hazards for the specific work area, but are
not inclusive of all the potential hazards in the work area. The inspection and hazard evaluation
of the work area should not be limited to only these hazards.

 Date Prepared:      ________________________              Evaluator:______________________


                                                           Preventative Safe Work Conditions,
  Description of
                     Potential Safety/Health Hazard         Safe Work Practices or Personal
    Job/Task
                                                                 Protective Equipment
 Inspection and      Asbestos Inhalation Hazard            Identify asbestos-containing materials in
 Servicing                                                 survey.
                                                           Train employees in asbestos awareness.
                                                           Inform employees of the presence of asbestos.
                                                           Abate asbestos-containing materials posing a
                                                           serious exposure hazard.

                     Thermal Burns                         Label steam lines.
                                                           Maintain insulation.
                                                           Wear gloves, as necessary

                     Heat Stress                           Train employees in special procedures for hot
                                                           environment work.
                                                           Limit work duration to avoid heat stress.

                     Electrical Shock                      Lockout/Tagout equipment prior to servicing.
                                                           Perform work on energized equipment only
                                                           with supervisor approval and according to
                                                           special procedures.

                     Physical Hazard Due to Mechanical     Maintain equipment safeguards during
                     Catch Points                          operation.
                                                           Ensure that employees do not wear loose fitting
                                                           clothing

 Other               ___________________________           _______________________________
                                                           _______________________________
                                                           _______________________________
                                                           _______________________________
                                                           _______________________________




                                                  A - 10
                      Hazard Evaluation Guidelines for Kitchens

These guidelines contain the most common potential hazards for the specific work area, but are
not inclusive of all potential hazards in the work area. The inspection and hazard evaluation of
the work area should not be limited to only these hazards.

 Date Prepared:      __________________________            Evaluator:_____________________


                                                           Preventative Safe Work Conditions,
  Description of
                     Potential Safety/Health Hazard         Safe Work Practices or Personal
    Jab/Task
                                                                 Protective Equipment
 Kitchen/Pantry      Back Strain Due to Improper Lifting   Provide training on back care and proper
 Operations                                                lifting techniques.
                                                           Break down cases of goods into individual
                                                           units.
                                                           Store heavier items at waist level.

 Food                Thermal Burns/Stoves/Hot Oil Fryers   Exercise caution around stoves, ovens, and
 Preparation,                                              fryers.
                                                           Use gloves/mitts to protect hands.
 Other                                                     Use equipment with non-conducting handles.
                                                           Keep floor clear of tripping hazards,
                                                           especially near hot oil fryers; clean up spilled
                                                           oil from floor.

                     Scrapes and Lacerations               Keep knives and equipment blades sharpened.
                                                           Use proper cutting techniques.
                                                           Ensure that equipment guards are maintained
                                                           and in place.
                                                           Wear wire/Kevlar mesh gloves to protect
                                                           hands.

                     Inhalation of Smoke                   Ensure that ventilation hoods are on and
                                                           functioning properly.

 Cleaning/           Thermal Burns Due to Hot Water        Set hot thermostat to no more than 120
 Sanitation                                                degrees Fahrenheit when direct skin contact is
                                                           probable.
                                                           Provide safety closure valves.

 Other               ____________________________          _______________________________
                                                           _______________________________
                                                           _______________________________
                                                           _______________________________
                                                           _______________________________



                                                 A - 11
   Hazard Evaluation Guidelines for Hazardous Waste Accumulation Areas

These guidelines contain the most common potential hazards for the specific work area, but are
not inclusive of all the potential hazards in the work area. The inspection and hazard evaluation
of the work area should not be limited to only these hazards.

 Date Prepared:      ___________________________          Evaluator:______________________


                                                          Preventative Safe Work Conditions,
  Description of
                     Potential Safety/Health Hazard        Safe Work Practices or Personal
    Job/Task
                                                                Protective Equipment
 Laboratory          Breaking of Containers: Chemical     Handle individual containers one at a time.
 Packing/ Solvent    Exposure, Adverse Reaction           Use secondary containment trays to store/move
                                                          containers.
 Pouring
                     Vapor/Dust Exposure                  Use exhaust ventilation to control dust and
                                                          vapors; use respiratory protection as required.

                     Foot Injury                          Wear required steel-toed shoes.
                                                          Use drum dolly to move packed drums.

                     Fire Explosion                       Use exhaust ventilation to avoid build-up of
                                                          flammable vapors.
                                                          Observe that no spark-generating equipment or
                                                          open flames are used in the area when
                                                          flammable liquids are used.
                                                          Bond/ground containers during dispensing.
                                                          Ensure that fire suppression equipment is
                                                          available and maintained.

 Radioactive         Radiation Exposure                   Wear appropriate personal dosimetry.
 Waste Handling                                           Use a well-balanced combination of reduced
                                                          time, increased distance and appropriate
                                                          shielding to reduce exposure

 General             Chemical Exposure/Adverse Health     Ensure containers are securely closed.
                     Effects                              Use gloves to prevent contact.
                                                          Ensure that employees receive required
                                                          HAZWASTE training.

                     Needle Sticks                        Use specialized containers for sharps.
                                                          Institute a needle stick program.

                     Back Injuries                        Teach exercise methods in back care classes.

                     Noise                                Wear appropriate ear protection equipment.




                                                 A - 12
Other   ___________________________   _______________________________
                                      _______________________________
                                      _______________________________
                                      _______________________________
                                      _______________________________




                            A - 13
                                     SECTION C
                         INJURY AND ILLNESS INVESTIGATIONS



All occupationally related injuries are investigated initially by the responsible supervisor who then
completes the Supervisor’s Injury Prevention Report (see Appendix E). Supervisors should visit
the work area where an injury (or near miss) occurred as soon as possible and:
1.                     Interview the injured worker and any witnesses;
2.                     Examine the work area for factors associated with the accident/exposure;
3.                     Take prompt corrective action to prevent incidents from recurring;
4.                     Record the findings and corrective actions taken.
Supervisors may use the optional form on the following page as a guide to conducting an
investigation.

EH&S will provide a secondary review and, as appropriate, a more detailed investigation after the
injury reported is forwarded to EH&S by Human Resources.



                                       SECTION D
                                 CORRECTION OF HAZARDS


Identified hazards must be corrected in a timely manner commensurate with the degree of hazard
and risk of occurrence. Supervisors must initiate corrective action such as removing simple
tripping hazards or initiating a work request for Plant Operations to repair facility related
components which may pose a hazard. Hazards which cannot be promptly abated must be
communicated to employees along with appropriate safe work practices and/or personal protective
equipment requirements.

Supervisors can contact EH&S for additional consultation to identify hazard correction options.




                                               A - 14
                   OCCUPATIONAL INJURY AND ILLNESS INVESTIGATION REPORT

I.                                      Employee                                           Supervisor
Name:
Phone:
Position title:
Department:



                                                   II. Injury/Illness Information
Date:
Location:
Nature of injury/illness:
Activity at time of injury/illness:



                                        III. Analysis and Recommended Preventive Actions
A.        Probable causation factors
1)        hazardous physical
            condition:
2)        inattention to task:
3)        insufficient training:
4)        no/improper protective
            equip.
5)        other:
B.        Preventive Actions/Controls
1)        engineering:
2)        administrative:
3)        personal protective
            equipment:
4)        other:
Comments:


Date of investigation:                                            Investigator:

                                                             A - 15
                                                                                                 c:\wpwin\forms\iipinves.rep




                                            SECTION E
                                   SAFETY AND HEALTH TRAINING


Department supervisors utilize a combination of the following methods to ensure that employees are trained so
that they know:
        1.    What hazards they are potentially exposed to in their work areas;
        2.    What safe work practices, including the proper selection and use of personal protective
              equipment, are to be used; and,
        3.    What to do in case of an emergency.

Department Training Methods:         (check applicable boxes)

                      Supervisor provides direct, hands-on training of tasks
                      Employees are sent to on-campus training sessions provided by EH&S
                      Supervisor arranges for consultant training on campus
                      Employees are sent to off-campus training
                      Employees are shown video training tapes with discussion afterwards
                      Employees are provided written work safety practices/procedures, discussion afterwards
                      Web-based training via EH&S home page link
                      Other:

Training records for department employees are kept:                                                  .
                                                               (specify location)




                                          SECTION F
                               RECORD KEEPING & DOCUMENTATION


Department supervisors have the responsibility to ensure that accurate documentation is retained for employee
training sessions, safety inspections, identified & corrected hazards and other related safety communications
from employees.

Department safety records shall be kept:                                                     .




                                                      A - 16

								
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