Docstoc

Trident-Sample-Municipal-Safety-Manual-2011.doc - Argo Group

Document Sample
Trident-Sample-Municipal-Safety-Manual-2011.doc - Argo Group Powered By Docstoc
					                                                                                                                                          Formatted: Font: (Default) Arial
                                   SAMPLE DRAFT PROGRAM

TO:       ALL STAFF MEMBERS                                                                                                               Formatted: Font: (Default) Arial, 10 pt




FROM:



We are committed to maintaining a safe and healthful environment for all. The personal safety and health
of each staff member and visitor is of primary importance. The prevention of property losses, injuries, and
illnesses is of such importance that it will be given precedence over everyday operations to the greatest
degree possible.

We are committed to establishing and maintaining a safety and health program conforming to the best
practices for organizations of our type. To be successful, such a program must embody the proper
attitudes toward property conservation, injury, and illness prevention on the part of all of members of our
organization.

To accomplish our objective, every reasonable effort will be made in the interest of loss prevention, fire
prevention and health preservation. Developing good safety habits to a maximum, and reducing hazards
to a minimum, must be everyone's goal in each phase of our operation. Every team member of our
organization must play a part in creating a safe and healthy place to work and provide services our
citizens.

Our goal is to reduce property losses, injuries and illness to a minimum and work to control exposures
with the potential to cause loss to both people and property. We must make every attempt to minimize
injury or loss. Only through proper coordination and team effort can a program such as ours be
successful.



Signature ___________________                 Date: ____________




                                                                                                                                          Formatted: Font: (Default) Arial
Trident Insurance Services provides this Manual as part of its efforts to reduce the risk of insurance loss and claims. This          1
Manual is advisory only and not intended to address every potential hazard or any insured specifically. Trident does not
warrant that all loss and/or claims will be avoided if the Manual is used. Trident further in no way intends to relieve the insured
of its own duties and obligations, nor is Trident undertaking on behalf of or for the benefit of the insured any duty or obligation
to ensure that the insured’s property and operations are safe, healthful and in compliance with any law, rule, or regulation.
Insureds remain responsible for their own efforts to reduce risks and should consult their own legal counsel for appropriate
guidance.
                                                                                                                                          Formatted: Font: (Default) Arial
                                   SAMPLE DRAFT PROGRAM


SAFETY PROGRAM ORGANIZATION AND RESPONSIBILITIES

We have established safety and health requirements designed to provide appropriate guidelines and
policies for all visitors and personnel. Our program strives to provide a safe environment for all citizens
who may use or work within our facilities. We have based our program on recognized guidelines for safe
operations established by federal and state agencies. Some of these agencies may not, at this time,
directly apply to our facilities. We however recognize that current standards are what we will be held to in
the event of a loss. We further recognize that these standards could be legislated to apply to us in the
near future.

We should:

          1.        Provide each staff member, visitor, or student a place free from recognized hazards that
                    have the potential to cause injury or loss.

          2.        Provide safe operational conditions as required by local, state and federal regulations and
                    standards.

          3.        Recognize that injuries and illnesses seriously impact the personal lives of those affected
                    and their families, and that these losses have an adverse effect on attitudes toward us
                    within our community.

Authority for the time, activity and financial resources for accident prevention begins with top
management. Within each facility, the authority and responsibility must begin with local management and
extend to all levels of the organization.

Since operating management has the authority and resources to control and correct situations and
conditions from which losses result, the prevention of accidents and injuries and illnesses will be the
responsibility of both administrative and facility management personnel.

Success of the loss prevention program depends upon the degree to which safety consciousness is
instilled within each staff member. Management, at all levels, must consider itself largely responsible for
the development of this mental attitude. Loss prevention starts at the top; it is essential that facility
management take the initiative. Members of management in all facility locations must demonstrate, by
their behavior and actions, that their interest is sincere and that they are determined to get results.




                                                                                                                                          Formatted: Font: (Default) Arial
Trident Insurance Services provides this Manual as part of its efforts to reduce the risk of insurance loss and claims. This          2
Manual is advisory only and not intended to address every potential hazard or any insured specifically. Trident does not
warrant that all loss and/or claims will be avoided if the Manual is used. Trident further in no way intends to relieve the insured
of its own duties and obligations, nor is Trident undertaking on behalf of or for the benefit of the insured any duty or obligation
to ensure that the insured’s property and operations are safe, healthful and in compliance with any law, rule, or regulation.
Insureds remain responsible for their own efforts to reduce risks and should consult their own legal counsel for appropriate
guidance.
                                                                                                                                          Formatted: Font: (Default) Arial
                                   SAMPLE DRAFT PROGRAM


Safety Responsibilities

All staff will be held accountable for meeting safety responsibilities. Failure to do so may result in
disciplinary action, up to and including termination.

The following describes the primary safety responsibilities of all levels of staff at each facility.

Administrative Management Responsibilities

Management's support for the safety program should involve the following:

1.        Knowledge of the total cost of accidents to include both direct and indirect cost.

2.        Total commitment toward the prevention of accidents.

3.        Assignment of responsibilities to qualified individuals.

4.        Budget reasonable funds to sustain the safe operation of the overall program.

5.        Establish expected results.

6.        Motivate all facility managers to pursue the overall safety effort.

Safety Coordinator's Responsibilities

1.        Develop the "tools" necessary to establish a safety policy:

          a.        Accident prevention procedures.
          b.        Useful accident analysis.
          c.        Self-inspection procedure.

2.        Develop necessary controls to include:

          a.        Adequate staff procedures.
          b.        Equipment maintenance procedures.
          c.        Staff training.
          d.        Safety enforcement.




                                                                                                                                          Formatted: Font: (Default) Arial
Trident Insurance Services provides this Manual as part of its efforts to reduce the risk of insurance loss and claims. This          3
Manual is advisory only and not intended to address every potential hazard or any insured specifically. Trident does not
warrant that all loss and/or claims will be avoided if the Manual is used. Trident further in no way intends to relieve the insured
of its own duties and obligations, nor is Trident undertaking on behalf of or for the benefit of the insured any duty or obligation
to ensure that the insured’s property and operations are safe, healthful and in compliance with any law, rule, or regulation.
Insureds remain responsible for their own efforts to reduce risks and should consult their own legal counsel for appropriate
guidance.
                                                                                                                                      Formatted: Font: (Default) Arial
                                   SAMPLE DRAFT PROGRAM


3.        Maintain awareness and participation in safety through:

          a.        Systematic follow-up program on safety problems and priorities.
          b.        Eliminating hazards.
          c.        Staff training.
          d.        Staff support and motivation.
          e.        Communication with staff and management.
          f.        Staff feedback and suggestions.

Facility Management's Responsibilities

1.        Understand and communicate to staff, both management's and individual's interest in the
          prevention of accidents.

2.        Plan all operations to prevent injuries and property damage.

3.        Assure that personal protective equipment is issued and worn by all employees and that safety
          barricades and crowd control is used where required.

4.        Assure that equipment is provided with adequate guards, and the guards are properly in place.

5.        Inspect tools, materials and equipment for unsafe conditions.

6.        Comply with established safety standards and procedures.

7.        Promote program interest through:

          a.        Prompt investigation of accidents to determine cause.
          b.        Take necessary corrective action.
          c.        Provide safety training and retraining to all employees.
          d.        Regularly schedule safety meetings.
          e.        Motivate employees to work safely.

Staff Responsibilities

1.        Understand and support management's interest in the prevention of accidents.

2.        Bring to the attention of management, any conditions which could lead to an accident.

3.        Follow the safety rules and procedures established for the prevention of accidents.                                         Formatted: Indent: Left: 0", Hanging: 0.5"

4.        Use personal protective equipment and crowd control barricades as required.

5.        Report all injuries immediately to management.

6.        Submit any and all safety suggestions to management.

7.        Motivate co-workers to work safely.

We will comply with federal, state and local safety and health regulations when establishing a safety
program. The following regulatory agencies and codes have established minimum guidelines for effective
safety and health programs, although all may not be directly applicable to our organization:                                          Formatted: Font: (Default) Arial
Trident Insurance Services provides this Manual as part of its efforts to reduce the risk of insurance loss and claims. This 4
Manual is advisory only and not intended to address every potential hazard or any insured specifically. Trident does not
warrant that all loss and/or claims will be avoided if the Manual is used. Trident further in no way intends to relieve the insured
of its own duties and obligations, nor is Trident undertaking on behalf of or for the benefit of the insured any duty or obligation
to ensure that the insured’s property and operations are safe, healthful and in compliance with any law, rule, or regulation.
Insureds remain responsible for their own efforts to reduce risks and should consult their own legal counsel for appropriate
guidance.
                                                                                                                                          Formatted: Font: (Default) Arial
                                   SAMPLE DRAFT PROGRAM


          1.        OSHA - Occupational Safety and Health Administration
          2.        NIOSH - National Institute of Occupational Safety and Health
          3.        National Fire Prevention Code
          4.        National Electric Code, and
          5.        All state, county and municipal codes which may be applicable.
          6.        EPA - Environmental Protection Agency.

This manual contains general safety rules for all personnel to follow. These general rules apply to
organization personnel, visitors, and contractors in all of our facilities. Additional rules may apply to
different or special situations, but the following are intended to illustrate our general expectation for safety
and hazard compliance. Personnel are expected to observe specific rules of conduct in all facilities. Any
violations of these rules can result in immediate corrective action, up to and including termination of
employment.

The following safety rules are general in nature and should not be considered as the only safety rules to
be followed. They are an example of rules that can be used to establish guidelines for personnel operating
within your facilities. These guidelines should be placed on organization letter head and should always
include a sign off section for an employee to acknowledge that they read and received a copy of the rules
that they must follow.




                                                                                                                                          Formatted: Font: (Default) Arial
Trident Insurance Services provides this Manual as part of its efforts to reduce the risk of insurance loss and claims. This          5
Manual is advisory only and not intended to address every potential hazard or any insured specifically. Trident does not
warrant that all loss and/or claims will be avoided if the Manual is used. Trident further in no way intends to relieve the insured
of its own duties and obligations, nor is Trident undertaking on behalf of or for the benefit of the insured any duty or obligation
to ensure that the insured’s property and operations are safe, healthful and in compliance with any law, rule, or regulation.
Insureds remain responsible for their own efforts to reduce risks and should consult their own legal counsel for appropriate
guidance.
                                                                                                                                          Formatted: Font: (Default) Arial
                                   SAMPLE DRAFT PROGRAM

                                                 GENERAL SAFETY RULES

1.        Staff isare required to know and observe all safety rules applicable to their work environment. .                               Formatted: Font: 10 pt
                                                                                                                                          Formatted: Font: (Default) Arial, 10 pt
2.        Any injury or accident, no matter how slight and including exposure to hazardous fumes and
          contact with hazardous chemicals, must be promptly reported to management. If the injury is
          serious enough, an accident report must be completed.

3.        The following are strictly prohibited and will not be allowed: horseplay, practical jokes, fighting,
          throwing of objects, running except in extreme emergencies, alcohol, unauthorized use of drugs,
          firearms, tampering with equipment, use of equipment without authorization or proper training.

4.        Equipment will not be operated unless all guards and safety devices are in place. Guards should
          never be removed or altered in any manner. They are there for everyone’s protection and anyone
          found tampering with an equipment guard or rendering it inoperable in any manner will be subject
          to immediate disciplinary action up to and including termination from employment.

5.        Smoking is allowed in designated areas only.

6.        All personal protective equipment must be worn when and where required, including safety
          glasses, hard hats, shoes, gloves, etc. NOTE: All personnel, including office, when entering
          areas where such footwear is required, must wear shoes that completely cover their feet. Steel
          toe shoes or boots where required in all appropriate areas. Staff violating the use of personal
          protective equipment policy will be subject to immediate disciplinary action up to and including
          termination from employment.

7.        Lock out and tag out procedures must be followed at all times on all pieces of equipment.                                       Formatted: Indent: Left: 0", Hanging: 0.5"

8.        Flammable and/or corrosive liquids (materials) must be contained and transported in approved
          containers. All such liquids and/or materials should be stored only in locations designated for this
          purpose.

9.        The driver of a forklift is responsible for its safe operation. Forklifts may be driven only by trained,
          qualified, and authorized forklift drivers. Forklifts must be driven at a slow, safe speed (maximum
          5 MPH) and heavy loads carried low to the ground.

10.       Emergency equipment or exits are not to be blocked for any reason.

11.       Good housekeeping practices must be maintained at all times. Staff must leave their places of
          work orderly and clean in the interest of safety. There are many days when the floors of our
          facility could be slippery due to weather change. Staff should therefore be extremely careful when
          walking at all times. Any spills should be cleaned immediately with proper equipment (mop and
          bucket, wet       vacuum, absorbent pads, etc.).




                                                                                                                                          Formatted: Font: (Default) Arial
Trident Insurance Services provides this Manual as part of its efforts to reduce the risk of insurance loss and claims. This          6
Manual is advisory only and not intended to address every potential hazard or any insured specifically. Trident does not
warrant that all loss and/or claims will be avoided if the Manual is used. Trident further in no way intends to relieve the insured
of its own duties and obligations, nor is Trident undertaking on behalf of or for the benefit of the insured any duty or obligation
to ensure that the insured’s property and operations are safe, healthful and in compliance with any law, rule, or regulation.
Insureds remain responsible for their own efforts to reduce risks and should consult their own legal counsel for appropriate
guidance.
                                                                                                                                          Formatted: Font: (Default) Arial
                                   SAMPLE DRAFT PROGRAM


12.       All unsafe acts and conditions must promptly be corrected promptly and reported to management.

13.       All containers of material must be clearly identified with the name of the material and NFPA
          chemical label. Do not use unidentified material.

14.       Established safety procedures must be followed at all times.

15.       Incidents that may have weakened or damaged equipment must be reported to management at
          once.

16.       Only authorized, qualified personnel may perform maintenance or repair work.

17.       Any person present in, or passing an area, must observe the rules of that area.

18.               Escape routes must be known by all personnel and rehearsed during emergency                                             Formatted: Indent: Left: 0", Hanging: 0.5"
          evacuation drill.

19.       Jewelry, such as rings and bracelets, necklaces and loose clothing, are not to be worn when
          working around electrical equipment or moving machinery.

20.       Broken or defective hand tools are required to be removed immediately from service and reported
          to management.

21.       The use of personal type radios or other devices, which have the potential to reduce hearing, will
          not be allowed within staff work areas unless prior approval is obtained from management.

22.       Staff is not allowed to wear loose clothing, such as neckties, loose dresses or loose shirts when
          working around machinery. Appropriate attire as definied by management should be worn at all
          times.

23.       All staff and shop students with long hair must have their hair in a hair net or tied up so as not to
          fall below the nape of the neck when working with powered equipment.

24.       Learn the proper and safe way to do a job; if any unsafe conditions exist, they are required to be
          brought to the management's attention.

25.       Any operator of a piece of equipment must be at least 18 years old or under the direct supervision
          of an instructor.

26.       Always turn off and unplug any equipment when cleaning. (Follow proper lock out procedure for
          exposure to unprotected energy sources.)

27.       All safety devices such as interlocks, barriers, gate locks, or other locking or restricting entry type,
          are for your protection and anyone removing or altering any safety device will be subject to
          immediate disciplinary action up to and including termination from employment.

28.       Approved type protective goggles of proper shade (color) must be worn when welding or working
          close to a welding operation.

29.       Keep hand tools in proper condition. If worn out or damaged, repair or replace them immediately.

                                                                                                                                          Formatted: Font: (Default) Arial
Trident Insurance Services provides this Manual as part of its efforts to reduce the risk of insurance loss and claims. This          7
Manual is advisory only and not intended to address every potential hazard or any insured specifically. Trident does not
warrant that all loss and/or claims will be avoided if the Manual is used. Trident further in no way intends to relieve the insured
of its own duties and obligations, nor is Trident undertaking on behalf of or for the benefit of the insured any duty or obligation
to ensure that the insured’s property and operations are safe, healthful and in compliance with any law, rule, or regulation.
Insureds remain responsible for their own efforts to reduce risks and should consult their own legal counsel for appropriate
guidance.
                                                                                                                                          Formatted: Font: (Default) Arial
                                   SAMPLE DRAFT PROGRAM

30.       No staff member may operate any piece of equipment unless authorized.

31.       Do not use compressed air to clean yourself or your clothing.

32.       Anyone making repairs on a motor driven machine or other power activated equipment must
          make sure that switches, valves and starting devices are turned off, locked and tagged out.

33.       Any and all safeguards removed during repairs or maintenance must be properly replaced before
          the machine is put back into operation.

34.       Oily rags or open cans of flammable liquids must not be left at work stations.

35.       Know where fire extinguishers are located and how to use them. Tampering with fire extinguishers
          is cause for immediate disciplinary action up to and including termination from employment.

36.       Do not look into any welding area when welding is being done; serious eye damage will result.                                   Formatted: Indent: Left: 0", Hanging: 0.5"

37.       When lifting heavy loads use the strength of your legs and not your back.

38.       Never use any power equipment unless there is a ground plug. Report any loose wiring to
          management immediately.

39.       Drive at a slow, safe speed in the parking lot. Maximum speed - 5 MPH.

40.       Keep objects away from electrical switch boxes; the areas in front of them must remain clear in
          case an emergency shut-off is required. Never block fire extinguishers, fire hose, aisles or exits
          with material or other objects.

41.       REMEMBER: Most accidents on machines are caused by human error. Don't allow yourself or
          others to daydream and be seriously hurt.

42.       Marked aisles must be kept clear at all times.

43.       Ladders must be in good condition and equipped with safety feet. Assistance must be obtained
          prior to using when a slipping potential exists. Do not use any “makeshift” scaffolding, rigging or
          staging.

44.       No one is allowed to operate a lift truck or pallet jack unless trained, qualified and authorized.                              Formatted: Indent: Left: 0", Hanging: 0.5"

45.       Do not lift personnel on forks or makeshift platform. Use only a secured, safety                         platform.

46.       Make sure area is clear and no one is in the vicinity of a load or lift truck while the operator is
          lifting, lowering or repositioning a load.

47.       Only approved dock plates, which are strong enough to carry the load imposed on them, secured
          in place, proper handholds on plates and secure all transport vehicles by means of wheel chocks
          are to be used.

48.       Staff must ensure that all areas are properly illuminated prior to start of work.

49.       Staff must ensure that all areas of work have adequate means of egress and that all exit aisle
          ways, are adequate to assure safe passage.
                                                                                                                                          Formatted: Font: (Default) Arial
Trident Insurance Services provides this Manual as part of its efforts to reduce the risk of insurance loss and claims. This          8
Manual is advisory only and not intended to address every potential hazard or any insured specifically. Trident does not
warrant that all loss and/or claims will be avoided if the Manual is used. Trident further in no way intends to relieve the insured
of its own duties and obligations, nor is Trident undertaking on behalf of or for the benefit of the insured any duty or obligation
to ensure that the insured’s property and operations are safe, healthful and in compliance with any law, rule, or regulation.
Insureds remain responsible for their own efforts to reduce risks and should consult their own legal counsel for appropriate
guidance.
                                                                                                                                          Formatted: Font: (Default) Arial
                                    SAMPLE DRAFT PROGRAM

50.       Designated trained employees must be familiar with the location of fire equipment and the use of
          fire equipment.


------------------------------------------------------------
Safety Rules Received by:


                                          Signed: _________________________________________

                                          Date: ___________________________________________

                                          Verified: ________________________________________




                                                                                                                                          Formatted: Font: (Default) Arial
Trident Insurance Services provides this Manual as part of its efforts to reduce the risk of insurance loss and claims. This          9
Manual is advisory only and not intended to address every potential hazard or any insured specifically. Trident does not
warrant that all loss and/or claims will be avoided if the Manual is used. Trident further in no way intends to relieve the insured
of its own duties and obligations, nor is Trident undertaking on behalf of or for the benefit of the insured any duty or obligation
to ensure that the insured’s property and operations are safe, healthful and in compliance with any law, rule, or regulation.
Insureds remain responsible for their own efforts to reduce risks and should consult their own legal counsel for appropriate
guidance.
                                                                                                                                           Formatted: Font: (Default) Arial
                                   SAMPLE DRAFT PROGRAM

                                                        Safety Meetings

Safety meetings must be recorded and maintained on file at all locations. Staff should discuss:

          1.        Non-routine work, new procedures, hazardous conditions.

          2.        Normal expected hazards from work scheduled in the near future.

          3.        Causes of any accidents that may have occurred since the last meeting.

          4.        Priorities and follow up on safety improvement projects.

All staff are required to report any condition that could contribute to a loss. All accidents or incidents
should be reported immediately regardless of how small the injury or property damage may seem.

Management or designated staff should investigate all incidents to determine the cause and corrective
measures to ensure the accident or incident is not repeated. Accident and incident reports must be in a
written format, reviewed by the Safety Committee or Safety Coordinator and maintained as a permanent
document.

Accident summary reports will be completed at each facility location and distributed. OSHA 200 logs or
other acceptable forms should also be maintained at each location for reporting of staff injuries.

NOTE: IN ANY LOCATIONS WHERE SAFETY MEETINGS ARE NOT FEASIBLE OR IN LOCATIONS
WHERE STAFF IS LIMITED IN NUMBER, THE INDIVIDUAL IN CHARGE WILL BE REQUIRED TO
INSPECT HIS/HER AREAS OF RESPONSIBILITY AND PROVIDE FINDINGS TO MANAGEMENT FOR
REVIEW.

We recognize that safe operations are spearheaded by our management team. Enforcement of safety is
one key to a successful safety effort. Facility management is responsible for enforcing safety rules.

Management has the authority to enforce safety rules in their facility. If they see an unsafe act or
condition in another facility, management must either correct or stop the unsafe situation and then tell or
properly notify the appropriate personnel of the situation immediately. Facility management not enforcing
safety rules may be subject to disciplinary action up to and including termination from employment.

Safety discipline is the same procedure as discipline for any other operational procedure which is broken.
If management observes a staff member violating a safety rule, they should follow these steps:

          A.        Stop the employee from doing the unsafe act or working with unsafe equipment.

          B.        Turn off the equipment, lock it out and call maintenance if they cannot correct the
                    situation.

          C.        Tell and show the employee what is unsafe.

          D.        Show and/or tell the employee how to do the job safely.

          E.        Take disciplinary action BUT do it correctly. Is a simple verbal warning enough? Is a
                    written warning called for? Is the situation or action serious enough to discuss with your
                    manager?

                                                                                                                                           Formatted: Font: (Default) Arial
Trident Insurance Services provides this Manual as part of its efforts to reduce the risk of insurance loss and claims. This          10
Manual is advisory only and not intended to address every potential hazard or any insured specifically. Trident does not
warrant that all loss and/or claims will be avoided if the Manual is used. Trident further in no way intends to relieve the insured
of its own duties and obligations, nor is Trident undertaking on behalf of or for the benefit of the insured any duty or obligation
to ensure that the insured’s property and operations are safe, healthful and in compliance with any law, rule, or regulation.
Insureds remain responsible for their own efforts to reduce risks and should consult their own legal counsel for appropriate
guidance.
                                                                                                                                           Formatted: Font: (Default) Arial
                                   SAMPLE DRAFT PROGRAM

          F.        If a manager is not sure of the disciplinary action tell the employee to wait until you can
                    discuss it with your manager. Then follow up!

          G.        Be prepared to refer the staff member to Human Resources or top management if
                    necessary.

          H.        Documentation of all disciplinary action is mandatory, even if it is a simple note kept in a
                    file. Names, date , a brief description of the incident, and the corrective action taken
                    should be recorded.

          I.        When disciplining a staff member, management must be firm, positive, control emotions
                    and be consistent. Do not yell, threaten or abuse the staff member in any away.

          J.        If the staff member becomes insubordinate, ask them to accompany you to Human
                    Resources or to top management. Do not allow situation to escalate to a physical or
                    threatening confrontation.

          K.        Management must set the example and follow all safety rules.

          L.        A sample Employee Warning Record form is provided. This or a similar document
                    should be used to document any disciplinary action. Remember the old adage that if it is
                    not written down, it did not happen.




                                                                                                                                           Formatted: Font: (Default) Arial
Trident Insurance Services provides this Manual as part of its efforts to reduce the risk of insurance loss and claims. This          11
Manual is advisory only and not intended to address every potential hazard or any insured specifically. Trident does not
warrant that all loss and/or claims will be avoided if the Manual is used. Trident further in no way intends to relieve the insured
of its own duties and obligations, nor is Trident undertaking on behalf of or for the benefit of the insured any duty or obligation
to ensure that the insured’s property and operations are safe, healthful and in compliance with any law, rule, or regulation.
Insureds remain responsible for their own efforts to reduce risks and should consult their own legal counsel for appropriate
guidance.
                                                                                                                                           Formatted: Font: (Default) Arial
                                   SAMPLE DRAFT PROGRAM

                                              STAFF DISCIPLINARY NOTICE

EMPLOYEE NAME:

DEPARTMENT:

LOCATION:


VERBAL WARNING



WRITTEN WARNING



SUSPENSION FROM                                 TO

YOU HAVE RECEIVED THE DISCIPLINE LISTED ABOVE, BECAUSE:
(PLEASE DESCRIBE CONDUCT RULE INFRACTION OR ACTION REQUIRING DISCIPLINE).




THIS NOTICE WILL BECOME A PERMANENT PART OF YOUR PERSONNEL FILE. THIS IS A
SERIOUS MATTER. YOU SHOULD TAKE CORRECTIVE ACTION IMMEDIATELY. FUTURE
DISCIPLINE FOR THE SAME OR UNRELATED REASONS MAY LEAD TO FURTHER ACTION
INCLUDING TERMINATION FROM EMPLOYMENT.


STAFF SIGNATURE: ____________________________ DATE: _______________________


MANAGEMENT SIGNATURE:____________________ DATE:________________________




                                                                                                                                           Formatted: Font: (Default) Arial
Trident Insurance Services provides this Manual as part of its efforts to reduce the risk of insurance loss and claims. This          12
Manual is advisory only and not intended to address every potential hazard or any insured specifically. Trident does not
warrant that all loss and/or claims will be avoided if the Manual is used. Trident further in no way intends to relieve the insured
of its own duties and obligations, nor is Trident undertaking on behalf of or for the benefit of the insured any duty or obligation
to ensure that the insured’s property and operations are safe, healthful and in compliance with any law, rule, or regulation.
Insureds remain responsible for their own efforts to reduce risks and should consult their own legal counsel for appropriate
guidance.
                                                                                                                                           Formatted: Font: (Default) Arial
                                   SAMPLE DRAFT PROGRAM


                                                         Safety Training

Safety regulations and good management practice dictate that staff receive training that provides them
with the knowledge necessary to complete any job or task completely and safely. The purpose of this
section, and the requirements it contains, is to ensure that management presents safety training in a
consistent and timely manner.

This section describes basic safety training topics and training programs for all facility locations. Local
training needs, inherent to some but not all locations, will need to be determined by facility management
and addressed.

A training guide containing guidelines and methods for conducting acceptable staff safety training and
maintaining documentation of such training is attached at the end of this section.

Safety training not only serves to prepare our staff to work safely, but it also to be more effective and
increase their overall knowledge of their job. In simple terms, a more knowledgeable staff member is
more effective, capable and interested.

New Staff Members

Newly hired staff must receive specific safety indoctrination. The attached "Safety Orientation Checklist"
includes each topic to be covered and provides a form to be used for documenting such training.

Unless otherwise required, the standardized form should be used. Regardless, orientation must be
completed on the first day of work and documented. Orientation can be performed by designated
personnel. Documentation needs to be maintained in the employee's personnel file.

Many of the topics listed on the checklist may already exist at each facility. We are responsible for the
development of any missing information, revising attachments to meet local needs or adding new topics to
this list as necessary.

Refresher Safety Training

Selected topics are required to be presented on an annual or more frequent basis, depending upon local
codes and operational aspects of each location.

The following safety topics may require annual or more frequent safety training:

          1.        Hazard communication.

          2.        Forklift operator certification.

          3.        Confined space entry (selected staff members).

          4.        Employee emergency plan/fire protection.

          5.        Vehicle driver training (advanced driver performance).

          6.        Lock and tag out program (selected staff members).

          7.        Welding/cutting/brazing (selected staff members).
                                                                                                                                           Formatted: Font: (Default) Arial
Trident Insurance Services provides this Manual as part of its efforts to reduce the risk of insurance loss and claims. This          13
Manual is advisory only and not intended to address every potential hazard or any insured specifically. Trident does not
warrant that all loss and/or claims will be avoided if the Manual is used. Trident further in no way intends to relieve the insured
of its own duties and obligations, nor is Trident undertaking on behalf of or for the benefit of the insured any duty or obligation
to ensure that the insured’s property and operations are safe, healthful and in compliance with any law, rule, or regulation.
Insureds remain responsible for their own efforts to reduce risks and should consult their own legal counsel for appropriate
guidance.
                                                                                                                                           Formatted: Font: (Default) Arial
                                   SAMPLE DRAFT PROGRAM

          8.        Respirator training (selected employees).

          9.        Hearing conservation program (selected employees).

          10.       First aid/CPR (selected staff members).

          11.       When new job tasks, new equipment or new hazardous materials are introduced.

          12.       Changes in code or regulatory requirements.

          13.       Storm water discharge protection.

Training Documentation

All training, no matter the topic, duration or number of staff involved, must be documented. The actual
topic should be outlined in writing and the outline kept on file. The date(s) of the training, topic involved
and names of employees who received the training should be included in any documentation.

Trainer Capability

Trainers must be qualified with technical knowledge, speaking ability and dedication to teaching. The
trainer needs to be prepared and should include demonstrations, films, handouts or other visual aids.

Managers and safety coordinators should coordinate the scheduling of employees for attendance at safety
training. Alternate training dates should be established as soon as possible for absentees.




                                                                                                                                           Formatted: Font: (Default) Arial
Trident Insurance Services provides this Manual as part of its efforts to reduce the risk of insurance loss and claims. This          14
Manual is advisory only and not intended to address every potential hazard or any insured specifically. Trident does not
warrant that all loss and/or claims will be avoided if the Manual is used. Trident further in no way intends to relieve the insured
of its own duties and obligations, nor is Trident undertaking on behalf of or for the benefit of the insured any duty or obligation
to ensure that the insured’s property and operations are safe, healthful and in compliance with any law, rule, or regulation.
Insureds remain responsible for their own efforts to reduce risks and should consult their own legal counsel for appropriate
guidance.
                                                                                                                                           Formatted: Font: (Default) Arial
                                   SAMPLE DRAFT PROGRAM


Machine Operators

The exposure to injury is considered one of greatest concerns in regards to safety for machine operators.
Due to this concern, all machine operators must have sufficient on-the-job training prior to being permitted
to operate assigned equipment.

FEDERAL MANDATED SUBJECT & STANDARD NUMBER

Employee Emergency Plans and Fire Prevention Plans
1910.38(a)(5)(i), (ii) and (111)

1910.38(4)(i) and (ii)

TRAINING REQUIREMENT

(i)       Before implementing the emergency action plan, the employer shall designate and train a
          sufficient number of persons to assist in the safe and orderly emergency evacuation of
          employees.

(ii)      The employer shall review the plan with each employee covered by the plan at the following times:

          (a)       Initially when the plan is developed,

          (b)       Whenever the employee's responsibilities or designated actions under the plan change,
                    and

          (c)       Whenever the plan is changed.

(iii)     The employer shall review with each employee upon initial assignment those parts of the plan the
          employee must know to protect the employee in the event of an emergency. The written plan
          shall be kept at the workplace and made available for employee review. For those employees
          with 10 or fewer employees, the plan may be communicated orally to employees and the
          employer need not maintain a written plan.

(i)       The employer shall apprise employees of the fire hazards of the materials and processes to which
          they are exposed.

(ii)      The employer shall review with each employee upon initial assignment those parts of the fire
          prevention plan the employee must know to protect the employee in the event of an emergency.
          The written plan shall be kept in the workplace and made available for employee review. For
          those employers with 10 or fewer employees, the plan may be communicated orally to employees
          and the employer need not maintain a written plan.



Occupational Noise Exposure
1910.95(k) and (l)

(k) Training program.


                                                                                                                                           Formatted: Font: (Default) Arial
Trident Insurance Services provides this Manual as part of its efforts to reduce the risk of insurance loss and claims. This          15
Manual is advisory only and not intended to address every potential hazard or any insured specifically. Trident does not
warrant that all loss and/or claims will be avoided if the Manual is used. Trident further in no way intends to relieve the insured
of its own duties and obligations, nor is Trident undertaking on behalf of or for the benefit of the insured any duty or obligation
to ensure that the insured’s property and operations are safe, healthful and in compliance with any law, rule, or regulation.
Insureds remain responsible for their own efforts to reduce risks and should consult their own legal counsel for appropriate
guidance.
                                                                                                                                           Formatted: Font: (Default) Arial
                                   SAMPLE DRAFT PROGRAM

(1)       The employer shall institute a training program for all employees who are exposed to noise at or
          above an 8-hour time-weighted average of 85 decibels, and shall ensure employee participation in
          such program.

(2)       The training program shall be repeated annually for each employee included in the hearing
          conservation program. Information provided in the training program shall be updated to be
          consistent with changes in protective equipment and work processes.

(3)       The employer shall ensure that each employee is informed of the following:

          (i)       The effects of noise on hearing;

          (ii)      The purpose of hearing protectors, the advantages, disadvantages, and attenuation of
                    various types, and instructions on selection, fitting, use and care; and

          (iii)     The purpose of audiometric testing, and an explanation of the test procedures.

(l)       Access to information and training materials.

(1)       The employer shall make available to affected employees or their representatives copies of this
          standard and shall also post a copy in the workplace.

(2)       The employer shall provide the affected employees any informational materials pertaining to the
          standard that are supplied to the employer by the Assistant Secretary.

(3)       The employer shall provide, upon request, all materials related to the employer's training and
          education program pertaining to this standard to the Assistant Secretary and the Director.

Respiratory Protection
1910.134(a)(3)
1910.134(b)(3)
1910.134(e)(2), (3), (4)


(1)       The employee shall use the provided respiratory protection in accordance with instructions and
          training received.

(2)       The user shall be instructed and trained in the proper use of respirators and their limitations.                                 Formatted: Indent: Left: 0", Hanging: 0.5"



(3)       The correct respirator shall be specified for each job. The respirator type is usually specified in
          the work procedures by a qualified individual supervising the respiratory protective program. The
          individual issuing them shall be adequately instructed to insure that the correct respirator is used.
          Each respirator permanently assigned to an individual should be durable marked to indicate to
          whom it was assigned. This mark shall not affect the respirator performance in any way. The
          date of issuance should be recorded.

(4)       Written procedures shall be prepared covering safe use of respirators in dangerous atmospheres
          that might be encountered in normal operations or in emergencies. Human Resources shall be
          familiar with these procedures and the available respirators.


                                                                                                                                           Formatted: Font: (Default) Arial
Trident Insurance Services provides this Manual as part of its efforts to reduce the risk of insurance loss and claims. This          16
Manual is advisory only and not intended to address every potential hazard or any insured specifically. Trident does not
warrant that all loss and/or claims will be avoided if the Manual is used. Trident further in no way intends to relieve the insured
of its own duties and obligations, nor is Trident undertaking on behalf of or for the benefit of the insured any duty or obligation
to ensure that the insured’s property and operations are safe, healthful and in compliance with any law, rule, or regulation.
Insureds remain responsible for their own efforts to reduce risks and should consult their own legal counsel for appropriate
guidance.
                                                                                                                                           Formatted: Font: (Default) Arial
                                   SAMPLE DRAFT PROGRAM

(5)       Respiratory protection is no better than the respirator in use, even though it is worn
          conscientiously. Frequent random inspections shall be conducted by a qualified individual to
          assure that respirators are properly selected, used, cleaned and maintained.

(6)       For safe use of any respirator, it is essential that the user be properly instructed in its selection,
          use and maintenance. Both supervisors and workers shall be so instructed by competent
          persons. Training shall provide the men an opportunity to handle the respirator, have it fitted
          properly, test its face-piece-to-face seal, wear it in normal air for a long familiarity period, and,
          finally, to wear it in a test atmosphere.

(i)       Every respirator wearer shall receive fitting instructions including demonstrations and practice in
          how the respirator should be worn, how to adjust it, and how to determine if it fits properly.
          Respirators shall not be worn when conditions prevent a good face seal. Such conditions may be
          a growth of beard, sideburns, a skill cap that projects under the face piece or temple pieces on
          glasses. Also, the absence of one or both dentures can seriously affect the fit of a face piece.
          The worker's diligence in observing these factors shall be evaluated by periodic check. To assure
          proper protection, the face piece fit shall be checked by the wearer each time he puts on the
          respirator. This may be done by following the manufacturer's face piece fitting instructions.

Specifications for Accident Prevention
Signs and Tags
1910.145(d)(1)(ii), (2)(ii) and (3)

Medical Services and First Aid
1910.151(a) and (b)

Portable Fire Extinguishers
1910.157(g)

Fixed Extinguishing Systems
1910.160(b)(10)

Fire Detecting Systems
1910.164(c)(4)

(1)(ii)   All employees shall be instructed that danger signs indicate immediate danger and that special
          cautions are necessary.

(2)(ii)   All employees shall be instructed that caution signs indicate a possible hazard against which
          proper precautions should be taken.

(3)       Safety instruction signs. Safety Instruction signs shall be used where there is a need for general
          instructions and suggestions relative to safety measures.

(a)       The employer shall insure the ready availability of medical personnel for advice and consultation
          on matters of plant health.

(g) Training and Education.

(1)       Where the employer has provided portable fire extinguishers for employee use in the workplace,
          the employer shall also provide an educational program to familiarize employees with the general
          principles of fire extinguisher use and the hazards involved with incipient stage fire fighting.
                                                                                                                                           Formatted: Font: (Default) Arial
Trident Insurance Services provides this Manual as part of its efforts to reduce the risk of insurance loss and claims. This          17
Manual is advisory only and not intended to address every potential hazard or any insured specifically. Trident does not
warrant that all loss and/or claims will be avoided if the Manual is used. Trident further in no way intends to relieve the insured
of its own duties and obligations, nor is Trident undertaking on behalf of or for the benefit of the insured any duty or obligation
to ensure that the insured’s property and operations are safe, healthful and in compliance with any law, rule, or regulation.
Insureds remain responsible for their own efforts to reduce risks and should consult their own legal counsel for appropriate
guidance.
                                                                                                                                           Formatted: Font: (Default) Arial
                                   SAMPLE DRAFT PROGRAM


(2)       The employer shall provide the education required in paragraph (g) (1) of this section upon initial
          employment and at least annually thereafter.

(3)       The employer shall provide employees who have been designated to use fire fighting equipment
          as part of an emergency action plan with training in the use of the appropriate equipment.

(4)       The employer shall provide the training required in paragraph (g) (3) of this section upon initial
          assignment to the designate group of employees and at least annually thereafter.

(10)      The employer shall train employees designated to inspect, maintain, operate or repair fixed
          extinguishing systems and annually review their training to keep them up-to-date in the functions
          they are to perform.

(4)       The employer shall assure that the servicing, maintenance and testing of fire detection systems,
          including cleaning and necessary sensitivity adjustments, are performed by a trained person
          knowledgeable in the operations and functions of the system.

Piece rim wheels

1910.177(c) (1) (2) and (3), (Includes single piece wheels per Federal Register of February 3, 1984
(pp.4338-4352) but not automobile or truck tires marked "L.T.")

(c) Employee training

(1)       The employer shall provide a training program to train and instruct all employees who service
          multi-piece rim wheels in the hazards involved in servicing multi-piece rim wheels and the safety
          procedures to be followed.

(i)       The employer shall assure that no employee services any multi-piece rim wheel unless the
          employee has been trained and instructed in correct procedures of mounting, demounting and all
          related services, activities and correct safety precautions for the rim type being services, and the
          safe operating procedures described in paragraph (f) of this section.

(ii)      Information to be used in the training program shall include at a minimum, the data contained on
          the charts and the contents of this standard.

(iii)     Where an employer knows or has reason to believe that any of his employees is unable to read
          and understand the charts or rim manual, the employer shall assure that the employee is
          instructed concerning the contents of the charts and rim manual in a manner which the employee
          is able to understand.

(2)       The employer shall assure that each employee demonstrates and maintains his ability to service
          multi-piece rim wheels safely, including performance of the following tasks:

          (i)       Demounting of tires (including deflation);

          (ii)      Inspection of wheel components;

          (iii)     Mounting of tires (including inflation within a restraining device);

          (iv)      Use of the restraining device;
                                                                                                                                           Formatted: Font: (Default) Arial
Trident Insurance Services provides this Manual as part of its efforts to reduce the risk of insurance loss and claims. This          18
Manual is advisory only and not intended to address every potential hazard or any insured specifically. Trident does not
warrant that all loss and/or claims will be avoided if the Manual is used. Trident further in no way intends to relieve the insured
of its own duties and obligations, nor is Trident undertaking on behalf of or for the benefit of the insured any duty or obligation
to ensure that the insured’s property and operations are safe, healthful and in compliance with any law, rule, or regulation.
Insureds remain responsible for their own efforts to reduce risks and should consult their own legal counsel for appropriate
guidance.
                                                                                                                                      Formatted: Font: (Default) Arial
                                   SAMPLE DRAFT PROGRAM

          (v)       Handling of wheels;

          (vi)      Inflation of tires when a wheel is mounted on the vehicle; and

          (vii)     Installation and removal of wheels.

(3)       The employer shall evaluate each employee's ability to perform these tasks and to service multi-
          piece rim wheels safely and shall provide additional training as necessary to assure that each
          employee maintains his proficiency.

Powered Industrial Truck
1910.178(1)

Welding, Cutting and Brazing
1910.252(b)(1)(iii)

1910.252(b)(4)(i) and (ix) (a)

1910.252(c)(10)(i) and (iii)

1910.252(c)(6)

1910.252(d)(2)(iii)(b)

1910.252(d)(2)(xiii)(c)

1910.252(f)(13)

(1)       Operating training. Only trained and authorized operators shall be permitted to operate a powered
          industrial truck. Method shall be devised to train operators in the safe operation of powered
          industrial trucks.

          (iii)     Instruction. Workmen designated to operate arc welding equipment shall have been
                    properly instructed and qualified to operate such equipment as specified in subparagraph
                    (4) of this paragraph.

          (i)       General. Workmen assigned to operate or maintain arc welding equipment shall be
                    acquainted with the requirements of subparagraphs (b), (d), (e) and (f) of this section; if
                    doing gas-shielded arc welding, see also Recommended Safe Practices for Gas-Shielded
                    Arc Welding, A6.1966, American Welding Society.

          (a)       The operator shall report any equipment defect or safety hazard to his supervisor and the
                    use of the equipment shall be discontinued until its safety has been assured. Repairs
                    shall be made only by qualified personnel.

          (i)       Installation. All equipment shall be installed by a qualified electrician in conformance with
                    Subpart S of this part...

          (iii)     Personnel Workmen designated to operate resistance welding equipment shall be
                    properly instructed and judged competent to operate such equipment.

(6)       Maintenance. Periodic inspection shall be made by qualified maintenance personnel, and records
          of the same maintained. The operator shall be instructed to report any equipment defects to his                             Formatted: Font: (Default) Arial
Trident Insurance Services provides this Manual as part of its efforts to reduce the risk of insurance loss and claims. This 19
Manual is advisory only and not intended to address every potential hazard or any insured specifically. Trident does not
warrant that all loss and/or claims will be avoided if the Manual is used. Trident further in no way intends to relieve the insured
of its own duties and obligations, nor is Trident undertaking on behalf of or for the benefit of the insured any duty or obligation
to ensure that the insured’s property and operations are safe, healthful and in compliance with any law, rule, or regulation.
Insureds remain responsible for their own efforts to reduce risks and should consult their own legal counsel for appropriate
guidance.
                                                                                                                                           Formatted: Font: (Default) Arial
                                   SAMPLE DRAFT PROGRAM

          supervisor and the use of the equipment shall be discontinued until safety repairs have been
          completed.

          (b)       Fire watchers shall have fire extinguishing equipment readily available and be trained in
                    its use...

          (c)       Insist that cutters or welders and their supervisors are suitably trained in the safe
                    operation of their equipment and the safe use of the process.

(13)      First-aid Equipment. First-aid equipment shall be available at all times. On every shift of                        welding
          operations there should be present employees trained to render first aid.




Asbestos
1910.100(j)(5)

(5)       Employee information and training.

          (i)       The employer shall institute a training program for all employees who are exposed to
                    airborne concentrations of asbestos, tremolite, anthophylite, actinolite or a combination of
                    these minerals at or above the action level ensure their participation in the program.

          (ii)      Training shall be provided prior to or at the time of initial assignment and at least annually
                    thereafter.

          (iii)     The training program shall be conducted in a manner which the employee is able to
                    understand. The employer shall ensure that each employee is informed of the following:

                    (A)        The health effects associated with asbestos, tremolite, anthophylite or actinolite
                               exposure;

                    (B)        The relationship between smoking and exposure to asbestos, tremolite,
                               anthophylite and actinolite in producing lung cancer;

                    (C)        The quantity, location, manner of use, release and storage of asbestos, tremolite,
                               anthophylite or actinolite, and the specific nature of operations which could result
                               in exposure to asbestos, tremolite, anthophylite or actinolite;

                    (D)        The engineering controls and work practices associated with the employee's job
                               assignment;

                    (E)        The specific procedures implemented to protect employees from exposure to
                               asbestos, tremolite, anthophylite or actinolite, such as appropriate work practices,
                               emergency and clean-up procedures and personal protective equipment to be
                               used;

                                                                                                                                           Formatted: Font: (Default) Arial
Trident Insurance Services provides this Manual as part of its efforts to reduce the risk of insurance loss and claims. This          20
Manual is advisory only and not intended to address every potential hazard or any insured specifically. Trident does not
warrant that all loss and/or claims will be avoided if the Manual is used. Trident further in no way intends to relieve the insured
of its own duties and obligations, nor is Trident undertaking on behalf of or for the benefit of the insured any duty or obligation
to ensure that the insured’s property and operations are safe, healthful and in compliance with any law, rule, or regulation.
Insureds remain responsible for their own efforts to reduce risks and should consult their own legal counsel for appropriate
guidance.
                                                                                                                                           Formatted: Font: (Default) Arial
                                   SAMPLE DRAFT PROGRAM

                    (F)        The purpose, proper use and limitations of respirators and protective clothing;                             Formatted: Indent: Left: 0", Hanging: 1.5"

                    (G)        The purpose and a description of the medical surveillance program required by
                               paragraph (1) of this section;

                    (H)        A review of this standard, including appendices.

          (iv)      Access to information and training materials.

                    (A)        The employer shall make a copy of this standard and its appendices readily
                               available without cost to all affected employees.

                    (B)        The employer shall provide, upon request, all materials relating to the employee
                               information and training program to the Assistant Secretary and the training
                               program to the Assistant Secretary and the Director.


Hazard Communication
1910.1200(h)(2)

(2)       Training. Employee training shall include at least:

          (i)       Methods and observations that may be used to detect the presence or release of a
                    hazardous chemical in the work area (such as monitoring conducted by the employer,
                    continuous monitoring devices, visual appearance or odor of hazardous chemicals when
                    being released, etc.)

          (ii)      The physical and health hazards of the chemicals in the work area;

          (iii)     The measures employees can take to protect themselves from these hazards, including
                    specific procedures the employer has implemented to protect employees from exposure
                    to hazardous chemicals, such as appropriate work practices, emergency procedures and
                    personal protective equipment to be used.

          (iv)      The details of the hazard communication program developed by the employer, and how
                    employees can obtain and use the appropriate hazard information.




                                                                                                                                           Formatted: Font: (Default) Arial
Trident Insurance Services provides this Manual as part of its efforts to reduce the risk of insurance loss and claims. This          21
Manual is advisory only and not intended to address every potential hazard or any insured specifically. Trident does not
warrant that all loss and/or claims will be avoided if the Manual is used. Trident further in no way intends to relieve the insured
of its own duties and obligations, nor is Trident undertaking on behalf of or for the benefit of the insured any duty or obligation
to ensure that the insured’s property and operations are safe, healthful and in compliance with any law, rule, or regulation.
Insureds remain responsible for their own efforts to reduce risks and should consult their own legal counsel for appropriate
guidance.
                                                                                                                                           Formatted: Font: (Default) Arial
                                   SAMPLE DRAFT PROGRAM


                                           SAFETY ORIENTATION CHECKLIST



TOPIC: ____________ LECTURER: ___________________ DATE & TIME _____________

PLACE OF MEETING___________________________________________________________

ATTENDEES




Introduction

Loss Prevention

Organization and Committees

Supervisor's Responsibility in Loss Prevention

Inspection and Control Procedures

Removing the Hazard from the Job

Loss Prevention Training

Employees for Safe Performance

Maintaining Awareness in Loss Prevention and Motivating Employees to Work Safely

Publicizing Loss Prevention

Accident Record and Injury Rates

Accident Investigation, Analysis and Costs

Results of Accidents
(nature/causes), How to Prevent Basic Types

Worker's Compensation Insurance




                                                                                                                                           Formatted: Font: (Default) Arial
Trident Insurance Services provides this Manual as part of its efforts to reduce the risk of insurance loss and claims. This          22
Manual is advisory only and not intended to address every potential hazard or any insured specifically. Trident does not
warrant that all loss and/or claims will be avoided if the Manual is used. Trident further in no way intends to relieve the insured
of its own duties and obligations, nor is Trident undertaking on behalf of or for the benefit of the insured any duty or obligation
to ensure that the insured’s property and operations are safe, healthful and in compliance with any law, rule, or regulation.
Insureds remain responsible for their own efforts to reduce risks and should consult their own legal counsel for appropriate
guidance.
                                                                                                                                           Formatted: Font: (Default) Arial
                                   SAMPLE DRAFT PROGRAM


                                      SAFETY ORIENTATION CHECKLIST (Cont.)


Sources of Help (How to Find Answers to Loss Prevention)

Layout of Buildings

Building Construction and Maintenance

Boilers and Unfired Pressure Vessels

Principles of Material Handling and Storage

Powered Industrial Trucks

Ropes, Chains and Slings

Principles of Guarding and Transmission Guards

Machine Tools

Woodworking Machinery

Hot Working of Metals

Local Exhaust Systems

Welding and Cutting

Hand and Portable Power Tools

Preventing fall, Overexertion and Exposure Accidents

Electrical Hazards

Scaffolding, Ladders and Platforms

Flammable and Combustible Liquids

Fire Loss Control

Fire Extinguisher and Control (Proper Use of Fire Extinguishers, etc.)

Planning for Emergencies




                                                                                                                                           Formatted: Font: (Default) Arial
Trident Insurance Services provides this Manual as part of its efforts to reduce the risk of insurance loss and claims. This          23
Manual is advisory only and not intended to address every potential hazard or any insured specifically. Trident does not
warrant that all loss and/or claims will be avoided if the Manual is used. Trident further in no way intends to relieve the insured
of its own duties and obligations, nor is Trident undertaking on behalf of or for the benefit of the insured any duty or obligation
to ensure that the insured’s property and operations are safe, healthful and in compliance with any law, rule, or regulation.
Insureds remain responsible for their own efforts to reduce risks and should consult their own legal counsel for appropriate
guidance.
                                                                                                                                           Formatted: Font: (Default) Arial
                                   SAMPLE DRAFT PROGRAM

                                      SAFETY ORIENTATION CHECKLIST (Cont.)


Personal Protective Equipment (Eye Protection, Etc.)

Industrial Sanitation and Personnel Facilities

Industrial Hygiene

Elements of Toxicology

Industrial Noise

Motorized Equipment

Job Loss Prevention Analysis




                                                                                                                                           Formatted: Font: (Default) Arial
Trident Insurance Services provides this Manual as part of its efforts to reduce the risk of insurance loss and claims. This          24
Manual is advisory only and not intended to address every potential hazard or any insured specifically. Trident does not
warrant that all loss and/or claims will be avoided if the Manual is used. Trident further in no way intends to relieve the insured
of its own duties and obligations, nor is Trident undertaking on behalf of or for the benefit of the insured any duty or obligation
to ensure that the insured’s property and operations are safe, healthful and in compliance with any law, rule, or regulation.
Insureds remain responsible for their own efforts to reduce risks and should consult their own legal counsel for appropriate
guidance.
                                                                                                                                           Formatted: Font: (Default) Arial
                                   SAMPLE DRAFT PROGRAM


Handling Loss Prevention: Employees

To establish an action plan for the systematic recognition and control of workplace hazards (unsafe acts
and conditions).

1.        Eliminate or control unsafe acts and conditions before they result in accidents or exposures that
          have the potential to produce injury and/or damage.

2.        Stimulate regular employee hazard detection and control activity.

3.        Provide a mechanism for employees to formally report physical hazards and to make safety
          recommendations.

A.        DEFINITIONS

1.        Hazard - an unsafe act or condition that may cause an exposure or accident.

2.        Unsafe Act - what the employee did or failed to do that has or could have resulted in an exposure
          or accident. (There are mental, emotional, physical, attitudinal, knowledge and skill factors which
          influence the employee to act unsafely.)

3.        Unsafe Condition - what part of employee's physical surroundings that has or could have resulted
          in an exposure or accident (factors such as deterioration of equipment, poor design, inadequate
          maintenance and the actions of employees are the source of unsafe conditions).

B.        PHILOSOPHY

A planned systematic approach to hazard detection and control is more effective than random
observations by supervisor. Thoughtful preparation for hazard detection produces a greater likelihood of
identifying critical (high risk) hazards.

It is generally the more obscure high risk hazard that produces the severe injuries and illnesses. The
supervisor of the employee performing the work is in the best position to detect and control high risk,
unsafe acts. Top management is responsible for directing and coordinating the efforts of line supervision
in the hazard recognition and control process.

C.        HAZARD RECOGNITION AND CONTROL

1.        Supervisory actions are as follows:

          a.        Schedule a planned observation of employee performing a job/task, record any unsafe
                    acts and take any required hazard control action.

          b.        Identify unsafe practices as a result of an unplanned or incidental observation and take
                    any required hazard control action.

          c.        Make a planned inspection of tools, machines, equipment or work areas and take any
                    required hazard control action.

          d.        Identify unsafe conditions noted during any unplanned or incidental observation and take
                    any required hazard control action.
                                                                                                                                           Formatted: Font: (Default) Arial
Trident Insurance Services provides this Manual as part of its efforts to reduce the risk of insurance loss and claims. This          25
Manual is advisory only and not intended to address every potential hazard or any insured specifically. Trident does not
warrant that all loss and/or claims will be avoided if the Manual is used. Trident further in no way intends to relieve the insured
of its own duties and obligations, nor is Trident undertaking on behalf of or for the benefit of the insured any duty or obligation
to ensure that the insured’s property and operations are safe, healthful and in compliance with any law, rule, or regulation.
Insureds remain responsible for their own efforts to reduce risks and should consult their own legal counsel for appropriate
guidance.
                                                                                                                                           Formatted: Font: (Default) Arial
                                   SAMPLE DRAFT PROGRAM

          e.        Record and act on any unsafe acts or unsafe conditions brought to the supervisor's
                    attention by others.

          f.        Eliminate or control the detected hazard. There must be a system for following up for
                    those hazards that cannot be controlled within 24 hours. Always take immediate
                    temporary control action.

          g.        Schedule for correction those hazards requiring more than 24 hours for control and
                    provide protection against the hazards until they are corrected.

          h.        Pass to management all hazards that require control assistance due to responsibility or
                    authority limitations. Retain the responsibility for follow-up and protective action until the
                    hazard is corrected.

D.        STAFF PARTICIPATION

Facility management must encourage staff to bring hazards to their attention. When staff advises the
supervisor of a hazard, the supervisor must immediately record the hazard and note the staff member’s
name. The supervisor should discuss the significance or urgency of the hazard in question to avoid
misconceptions concerning control timing. After the supervisor has evaluated and/or controlled the
hazard, the supervisor should personally advise the employee as to what action was taken. In the event
the supervisor and staff differ regarding the existence of a hazard and, in the supervisor's best judgment,
no action is necessary; the following steps should be taken:

          1.        Avoid any rejection comment during the initial contact.

          2.        Provide impersonal, objective reasons for the rejection after review.

          3.        If the employee persists, recommend processing a formal, written recommendation to
                    management or other alternative avenues for addressing the disputed situation.




                                                                                                                                           Formatted: Font: (Default) Arial
Trident Insurance Services provides this Manual as part of its efforts to reduce the risk of insurance loss and claims. This          26
Manual is advisory only and not intended to address every potential hazard or any insured specifically. Trident does not
warrant that all loss and/or claims will be avoided if the Manual is used. Trident further in no way intends to relieve the insured
of its own duties and obligations, nor is Trident undertaking on behalf of or for the benefit of the insured any duty or obligation
to ensure that the insured’s property and operations are safe, healthful and in compliance with any law, rule, or regulation.
Insureds remain responsible for their own efforts to reduce risks and should consult their own legal counsel for appropriate
guidance.
                                                                                                                                           Formatted: Font: (Default) Arial
                                   SAMPLE DRAFT PROGRAM

E.        STAFF SAFETY/HEALTH RECOMMENDATIONS

1.        Employee requests or recommendations are to be used for formally reporting hazards not
          handled directly by first line supervision or for presenting suggestions to improve safety/health in
          general.

2.        This procedure is designed to ensure that feedback is provided to the individual on a timely basis,
          regardless of whether positive or negative.

F.        MANAGEMENT CONTROLS

1.        The Hazard Recognition and Control Program is primarily a tool for facility management and those
          who directly supervise the staff or others performing tasks. However, the program will not be
          successful unless higher supervision participates and manages the total effort.

2.        Department heads or their equivalent should review activities at least monthly to ensure its proper
          functioning and to counsel personnel as necessary. They should direct the program by doing the
          following:

          a.        Designate the specific jobs to be reviewed.

          b.        Designate the specific staff functions or tasks they want to check..

          c.        Designate specific physical areas they want to check.

When designating one of the above, management should take into consideration any increases in
accidents; his/her own observations of unsafe acts; near-misses of a serious nature; or observations of
unsafe conditions. In other words, give direction to the program for a reason.

3.        Department heads or their equivalent must ensure that:

          a)        the same unsafe conditions do not continually appear;

          b)        individuals who frequently commit unsafe acts are counseled/disciplined.

          c)        when unsafe conditions and/or unsafe acts continue to reappear, the necessary corrective
                    action is taken.

4.        Periodic survey - A formal hazard survey/inspection of tools, personal protective equipment
          compliance, machinery, or work areas, etc. should be made monthly. It is more effective if the
          inspection is directed at a specific target, rather than general conditions. The inspection
          committee or management member should record their findings for follow-up action and
          documentation of activity.

5.        Goals and Objectives - Tangible results can be achieved only when objectives and specific goals
          are defined. The goals should be established by or with those responsible for achieving them and
          should be scheduled and stated in clear, measurable terms.

6.        Evaluation - The ability of a manager to detect, evaluate and control hazards is crucial to the
          success of the program. The program should provide:

          a.        A system of quality evaluation and feed back on the supervisor's log book activity.
                                                                                                                                           Formatted: Font: (Default) Arial
Trident Insurance Services provides this Manual as part of its efforts to reduce the risk of insurance loss and claims. This          27
Manual is advisory only and not intended to address every potential hazard or any insured specifically. Trident does not
warrant that all loss and/or claims will be avoided if the Manual is used. Trident further in no way intends to relieve the insured
of its own duties and obligations, nor is Trident undertaking on behalf of or for the benefit of the insured any duty or obligation
to ensure that the insured’s property and operations are safe, healthful and in compliance with any law, rule, or regulation.
Insureds remain responsible for their own efforts to reduce risks and should consult their own legal counsel for appropriate
guidance.
                                                                                                                                      Formatted: Font: (Default) Arial
                                   SAMPLE DRAFT PROGRAM

          b.        Feedback regarding the facility progress in reducing the frequency and severity level of all
                    detectable unsafe acts/conditions.

G.        STAFF MOTIVATION AND TRAINING

1.        Training- Periodic training in hazard detection and control principles, procedures and systems
          should occur in order to produce and maintain an informed group of participating personnel.

2.        Interest-Motivation- Interest promoting and motivational activities should be developed and utilized
          to enhance progress toward stated program objectives.

H.        HAZARD RECOGNITION ACTIVITIES

The following information is attached for use by individual locations. Where applicable, forms and other
information should be photocopied and provided to the persons assigned safety responsibilities:

          1.        Four basic steps to conducting a hazard recognition (safety) inspection.

          2.        Facility Inspection Checklist which makes the inspection process consistent as well as
                    providing suitable documentation.

                    (1)        Inspect - You must make your own personal inspection of the facility and not
                               delegate the responsibility to anyone else. A large amount of time need not be
                               devoted to an inspection. A complete tour should not be attempted. Since you
                               are not a professional safety observer, a safety inspection should not be tied to
                               other reasons for visiting the facility. Take notes on things you see.

                               Eliminate unsafe acts by observing them, taking immediate corrective action, and
                               following up to prevent recurrence. Develop a questioning attitude to determine
                               what injuries or losses might occur if the unexpected happens and how we can
                               act more safely. Be alert to injury exposure caused by overexertion in lifting,
                               pulling, pushing, and chemical exposure. Stop as you enter a shop area and
                               observe reactions to your presence; staff may correct unsafe practices when you
                               enter. You must recognize these unsafe acts to prevent a recurrence.

                    (2)        React - You must react to benefit from your inspection. The manner in which you
                               react will be the strongest single element in establishing the safety climate at your
                               facility. With the philosophy that all injuries can be prevented, goals must be set
                               high. You must display confidence that your facility can achieve high standards of
                               safety and housekeeping.

                               Each time you inspect an area, ask yourself a question and make a decision. Are
                               all aspects of safety and housekeeping acceptable? If the how the facility
                               deviates from your standard.

                    (3)        Communicate - The reaction that you write down should be communicated to
                               your subordinates. You should talk with the person who reports directly for the
                               area you reviewed.

                             In order for the contact to be productive, your staff member must understand that
                             you did review the area and that your are pleased or displeased with what you
                             saw. In addition, he/she must understand that you expect him/her to correct any
                             unsafe conditions or more thoroughly instruct his/her subordinates who were                              Formatted: Font: (Default) Arial
Trident Insurance Services provides this Manual as part of its efforts to reduce the risk of insurance loss and claims. This 28
Manual is advisory only and not intended to address every potential hazard or any insured specifically. Trident does not
warrant that all loss and/or claims will be avoided if the Manual is used. Trident further in no way intends to relieve the insured
of its own duties and obligations, nor is Trident undertaking on behalf of or for the benefit of the insured any duty or obligation
to ensure that the insured’s property and operations are safe, healthful and in compliance with any law, rule, or regulation.
Insureds remain responsible for their own efforts to reduce risks and should consult their own legal counsel for appropriate
guidance.
                                                                                                                                           Formatted: Font: (Default) Arial
                                   SAMPLE DRAFT PROGRAM

                               observed performing unsafe acts. In addition, advise that you will inspect the area
                               again (set a date) and expect to see improvements. A one-on-one audit can be
                               conducted with the person responsible for the area, as an alternative to an audit
                               alone. Remember that if your reaction was favorable, this reaction should be                                Formatted: Font: (Default) Arial, 10 pt
                               communicated to the staff member as well.                                                                   Formatted: Font: (Default) Arial, 10 pt

                               Your staff member must clearly understand the reasons and the implications of
                               your inspection. If you indicate that you expect them to correct certain conditions,
                               the member must have the authority, manpower, supplies and equipment to do
                               the job. Do not expect results if you have not provided the proper tools.

                    (4)        Follow-up - If you fail to effectively follow up the communications you have had
                               with your staff members, your efforts will be wasted. Subordinates will view this
                               as another management "kick" which will subside. Failure to follow up will
                               demonstrate that high standards of safety are not one of your important
                               objectives.

                               If your subordinates have not acted on your comments, than you are obligated to
                               let them know in very clear terms that you are not satisfied and that their
                               performance is not satisfactory. Knowing that you mean business will inspire your
                               staff to take the initiative in safety management for their facility.

b.        Good Results from Consistency

        By consistently following the above four steps, you will see steady improvements in the
appearance, housekeeping, orderliness and safety of your facilities. When you have raised conditions in
your facility to meet your personal standards, you can start to give attention to the unsafe acts that
account for 80-90 percent of the disabling injuries, losses, and property damage.

        Each location should prepare a facilities plan of each overall plant or building, plus detailed plans
for each area. The overall plan will let all personnel see at a glance the arrangement of aisles, exits,
storage areas, etc. The facilities plan can help management/safety coordinators determine the best
locations for first aid material, fire extinguishers, emergency exits and recommended routes of travel
should an emergency arise. The plan should also designate the locations of power and utility shut-off
switches or valves.

         Additionally, when providing periodically self-inspect programs, the plan will allow each facility to
be divided into into "inspection sections." For such instances, individual area plans can be prepared in
advance with different area plans used by the inspecting personnel in conducting the inspections. Those
involved should point out certain problem areas or hazards scheduled for survey. The "inspecting
employee" can then use the plan to make notations of any problem or hazard found during the inspection.
The following list are suggestions for the items to include on your facilities plan:

Areas to consider:

1.        Aisles, hallways, and passageways.

2.        Access and egress locations.

3.        Traffic flow plans for evacuation.

4.        Fire extinguisher locations.
                                                                                                                                           Formatted: Font: (Default) Arial
Trident Insurance Services provides this Manual as part of its efforts to reduce the risk of insurance loss and claims. This          29
Manual is advisory only and not intended to address every potential hazard or any insured specifically. Trident does not
warrant that all loss and/or claims will be avoided if the Manual is used. Trident further in no way intends to relieve the insured
of its own duties and obligations, nor is Trident undertaking on behalf of or for the benefit of the insured any duty or obligation
to ensure that the insured’s property and operations are safe, healthful and in compliance with any law, rule, or regulation.
Insureds remain responsible for their own efforts to reduce risks and should consult their own legal counsel for appropriate
guidance.
                                                                                                                                           Formatted: Font: (Default) Arial
                                   SAMPLE DRAFT PROGRAM

5.        Hazardous areas - PPE required.

6.        Areas requiring machine guarding.

7.        Areas requiring special safety devices.

8.        Storage areas requiring segregation of key material.

9.        Areas requiring ventilation and atmospheric controls.

10.       Location of emergency supplies, equipment, first aid material.

11.       Emergency treatment locations.

12.       Emergency alarm locations.

13.       Location of master switches, valves, controls.

Use the Facilities Plan sheets for:

1.        Maintenance and inspection scheduling - indicate route to be followed, key points to be covered.                                 Formatted: Indent: Left: 0", Hanging: 0.5"

2.        Hazard analysis to seek out any loss-contributing conditions that may exist;

3.        Illumination survey.

4.        Industrial hygiene, surveys - indoor air quality, noise, ventilation, sampling, etc.

5.        Assignment of sectors and duties for emergency situations.

A member of management should periodically inspect all facilities to see that individual safety
requirements are being met. Checklists are provided on the following pages to be used during this self-
inspection.

Through the inspection process of physical hazards found, a number of violations have been found to be
prevalent. Those most noted federal violations are listed below:

1(1) 1910.1200(e)(1) Written hazard communication program

2(3) 1904.2(a) OSHA 200 Log

3(2) 1910.1200(h) Hazardous chemicals - information

4(4) 1903.2(a)(1) Posting of notice, availability of the Act

5(5) 1910.1200(g)(1) Material safety data sheets

6(6) 1910.147(c)(1) Compulsory lock out/tag out program

7(7) 1910.212(a)(1) Types of machine guarding

8(10)1910.215(b)(9) Abrasive wheel adjustment
                                                                                                                                           Formatted: Font: (Default) Arial
Trident Insurance Services provides this Manual as part of its efforts to reduce the risk of insurance loss and claims. This          30
Manual is advisory only and not intended to address every potential hazard or any insured specifically. Trident does not
warrant that all loss and/or claims will be avoided if the Manual is used. Trident further in no way intends to relieve the insured
of its own duties and obligations, nor is Trident undertaking on behalf of or for the benefit of the insured any duty or obligation
to ensure that the insured’s property and operations are safe, healthful and in compliance with any law, rule, or regulation.
Insureds remain responsible for their own efforts to reduce risks and should consult their own legal counsel for appropriate
guidance.
                                                                                                                                           Formatted: Font: (Default) Arial
                                   SAMPLE DRAFT PROGRAM

9(8) 1910.1200(f)(5)(i) Hazardous chemicals - identity

10(9)1910.1200(f)(5)(ii) Hazardous chemicals - hazard warnings

11(12)1910.151(c) Medical services ad first aid - corrosives

12(13)1910.219(d)(1) Pulleys - guarding

In addition to the most frequent federal violations, the following items are the safety issues most often
found to lead to injury or facility damage

Electrical

1.        Ungrounded equipment (shop tools, drinking fountains, vending machines, etc.).

2.        Broken ground leads on electrical leads, open switch and junction boxes, frayed and spliced
          cords.

3.        Lack of dead man switches on hand and portable power tools and other hand-held equipment.




                                                                                                                                           Formatted: Font: (Default) Arial
Trident Insurance Services provides this Manual as part of its efforts to reduce the risk of insurance loss and claims. This          31
Manual is advisory only and not intended to address every potential hazard or any insured specifically. Trident does not
warrant that all loss and/or claims will be avoided if the Manual is used. Trident further in no way intends to relieve the insured
of its own duties and obligations, nor is Trident undertaking on behalf of or for the benefit of the insured any duty or obligation
to ensure that the insured’s property and operations are safe, healthful and in compliance with any law, rule, or regulation.
Insureds remain responsible for their own efforts to reduce risks and should consult their own legal counsel for appropriate
guidance.
                                                                                                                                           Formatted: Font: (Default) Arial
                                   SAMPLE DRAFT PROGRAM

Fire Protection

1.        Fire extinguishers of improper type, often not tagged or properly marked.

2.        Too few fire extinguishers per square foot of space.

3.        Lack of automatic sprinklers in storage areas.

Housekeeping

1.        Floors not painted to identify aisles and exits in maintenance areas.

2.        Work areas and aisles cluttered.

Means of Egress

1.        Exits not clearly marked.

2.        Number of exits not adequate.

3.        Exits blocked by desks, chairs or other furniture.

Machine Guarding

1.        Controls (hand, foot, light)

2.        Guards (pulleys, drive shafts, openings)

3.        Lock out/Tag out

Security

1.        Entry ways not fully controlled

2.        Access doors to controlled areas unlocked (equipment rooms, exercise facilities, etc.)




                                                                                                                                           Formatted: Font: (Default) Arial
Trident Insurance Services provides this Manual as part of its efforts to reduce the risk of insurance loss and claims. This          32
Manual is advisory only and not intended to address every potential hazard or any insured specifically. Trident does not
warrant that all loss and/or claims will be avoided if the Manual is used. Trident further in no way intends to relieve the insured
of its own duties and obligations, nor is Trident undertaking on behalf of or for the benefit of the insured any duty or obligation
to ensure that the insured’s property and operations are safe, healthful and in compliance with any law, rule, or regulation.
Insureds remain responsible for their own efforts to reduce risks and should consult their own legal counsel for appropriate
guidance.
                                                                                                                                           Formatted: Font: (Default) Arial
                                     SAMPLE DRAFT PROGRAM


                                         FACILITY INSPECTION

Inspection Date: _____________________________________________________________
Inspected by: ________________________________________________________________
Reviewed by: ________________________________________________________________

Maintenance Work Orders Attached                   YES             NO

Follow-up Needed               YES                  NO       Date:__________

Distributed                    YES                  NO

Check One

 YES                NO

  O                 O          1.        Machine Guarding.

  O                 O          2.        Space arrangement, Housekeeping.

  O                 O          3.        Work Surfaces, floors.

  O                 O          4.        Proper clothing, gloves, aprons, footwear.

  O                 O          5.        Hygiene, hair nets.

  O                 O          6.        Refuse collection cleanliness.

  O                 O          7.        Personal protective equipment.

  O                 O          8.        Electrical systems.

  O                 O          9.        Forklift, pallet jack operation.

  O                 O          10.       Stairs, floor surfaces.

  O                 O          11.       Exits, evacuation plans.

  O                 O          12.       Fire Extinguishers.




                                                                                                                                           Formatted: Font: (Default) Arial
Trident Insurance Services provides this Manual as part of its efforts to reduce the risk of insurance loss and claims. This          33
Manual is advisory only and not intended to address every potential hazard or any insured specifically. Trident does not
warrant that all loss and/or claims will be avoided if the Manual is used. Trident further in no way intends to relieve the insured
of its own duties and obligations, nor is Trident undertaking on behalf of or for the benefit of the insured any duty or obligation
to ensure that the insured’s property and operations are safe, healthful and in compliance with any law, rule, or regulation.
Insureds remain responsible for their own efforts to reduce risks and should consult their own legal counsel for appropriate
guidance.
                                                                                                                                           Formatted: Font: (Default) Arial
                                     SAMPLE DRAFT PROGRAM


Check One                                WAREHOUSE

  YES               NO

  O                 O          1.        Forklift/Pallet Jack Op.

  O                 O          2.        Battery charging proper.

  O                 O          3.        Rack condition, use.

  O                 O          4.        Pallet condition, use.

  O                 O          5.        Evacuation plans posted.

  O                 O          6.        Electrical panels clear.

  O                 O          7.        Fire sprinklers/piping clear.

  O                 O          8.        Floor condition, aisles clear.

  O                 O          9.        Exits clear, marked.

  O                 O          10.       Stairs, ladders, railings.

  O                 O          11.       Lighting, regular and emergency.

  O                 O          12.       Housekeeping, cleanliness.

  O                 O          13.       Fire extinguishers present/available.




Check One                                           LOADING AREAS

YES                NO

  O                 O          1.        Procedures posted.
                                                                                                                                           Formatted: Font: (Default) Arial
Trident Insurance Services provides this Manual as part of its efforts to reduce the risk of insurance loss and claims. This          34
Manual is advisory only and not intended to address every potential hazard or any insured specifically. Trident does not
warrant that all loss and/or claims will be avoided if the Manual is used. Trident further in no way intends to relieve the insured
of its own duties and obligations, nor is Trident undertaking on behalf of or for the benefit of the insured any duty or obligation
to ensure that the insured’s property and operations are safe, healthful and in compliance with any law, rule, or regulation.
Insureds remain responsible for their own efforts to reduce risks and should consult their own legal counsel for appropriate
guidance.
                                                                                                                                           Formatted: Font: (Default) Arial
                                     SAMPLE DRAFT PROGRAM


  O                 O          2.        Chocks provided.

  O                 O          3.        Adequate lighting.

  O                 O          4.        Fire extinguishers present/available.

  O                 O          5.        Dock plates adequate.

   O                O          6.        Ladders safe.

   O                O          7.        Derailer present (rail spur).

   O                O          8.        Dock edges painted.

   O                O          9.        Hand Railings adequate.

   O                O          10.       Housekeeping, aisles.

   O                O          11.       Traffic patterns established.

   O                O          12.       Forklifts operated safely.

   O                O          13.       Unauthorized personnel controlled.

   O                O          14.       Overhead door works OK.

   O                O          15.       Outlets, wiring, lights OK.

   O                O          16.       Freight stacked OK in vehicle.

   O                O          17.       Vehicle doors in good repair.

   O                O          18.       Dock plate available or anchored and in good repair.

   O                O          19.       Smoking rules obeyed.

   O                O          20.       Dock bumpers secure -in good condition.

   O                O          21.       Ladders secure - in good condition.

   O                O          22 .      Wheel chocks in position, no defects.




                                                                                                                                           Formatted: Font: (Default) Arial
Trident Insurance Services provides this Manual as part of its efforts to reduce the risk of insurance loss and claims. This          35
Manual is advisory only and not intended to address every potential hazard or any insured specifically. Trident does not
warrant that all loss and/or claims will be avoided if the Manual is used. Trident further in no way intends to relieve the insured
of its own duties and obligations, nor is Trident undertaking on behalf of or for the benefit of the insured any duty or obligation
to ensure that the insured’s property and operations are safe, healthful and in compliance with any law, rule, or regulation.
Insureds remain responsible for their own efforts to reduce risks and should consult their own legal counsel for appropriate
guidance.
                                                                                                                                           Formatted: Font: (Default) Arial
                                     SAMPLE DRAFT PROGRAM

Check One                      LOADING AREAS (Continued)

YES                 NO

  O                 O          23.       Trailer stands in position, no defects.

   O                O          24.       Free of trash and debris.

  O                 O          25.       Trash containers sufficient in number and no overflow.




                                                                                                                                           Formatted: Font: (Default) Arial
Trident Insurance Services provides this Manual as part of its efforts to reduce the risk of insurance loss and claims. This          36
Manual is advisory only and not intended to address every potential hazard or any insured specifically. Trident does not
warrant that all loss and/or claims will be avoided if the Manual is used. Trident further in no way intends to relieve the insured
of its own duties and obligations, nor is Trident undertaking on behalf of or for the benefit of the insured any duty or obligation
to ensure that the insured’s property and operations are safe, healthful and in compliance with any law, rule, or regulation.
Insureds remain responsible for their own efforts to reduce risks and should consult their own legal counsel for appropriate
guidance.
                                                                                                                                           Formatted: Font: (Default) Arial
                                    SAMPLE DRAFT PROGRAM

Check One
                                                STORAGE AND EQUIPMENT
YES                 NO

  O                 O          1.        Permanent aisles defined and clear.

  O                 O          2.        Freight stacked properly.

  O                 O          3.        Loading of carts, OK.

  O                 O          4.        Equipment used properly. Staff adhere to safe work practices.

  O                 O          5.        Dunnage/pallets stored OK.

  O                 O          6.        Tools, equipment stored OK.

  O                 O          7.        Material properly stored.

  O                 O          8.        Equipment in good repair.

  O                 O          9.        Ladders in good condition.




                                                                                                                                           Formatted: Font: (Default) Arial
Trident Insurance Services provides this Manual as part of its efforts to reduce the risk of insurance loss and claims. This          37
Manual is advisory only and not intended to address every potential hazard or any insured specifically. Trident does not
warrant that all loss and/or claims will be avoided if the Manual is used. Trident further in no way intends to relieve the insured
of its own duties and obligations, nor is Trident undertaking on behalf of or for the benefit of the insured any duty or obligation
to ensure that the insured’s property and operations are safe, healthful and in compliance with any law, rule, or regulation.
Insureds remain responsible for their own efforts to reduce risks and should consult their own legal counsel for appropriate
guidance.
                                                                                                                                           Formatted: Font: (Default) Arial
                                     SAMPLE DRAFT PROGRAM

Check One                                           SAFE PRACTICES (EXTERIOR)

 YES                NO

  O                 O          1.        Pedestrian traffic obeys safety rules.

  O                 O          2.        Only authorized persons walking in around facility.

  O                 O          3.        Drivers obey speed limits, signs, patterns in parking lots.

  O                 O          4.        Only authorized drivers/vehicles in controlled facility areas.

  O                 O          5.        Driver visibility unimpaired by shrubbery.

  O                 O          6.        Drivers use seat belts.

  O                 O          7.        Drivers use hand and footholds properly to get on and off.

  O                 O          8.        Proper procedures followed in hookups, unhooking and parking of
                                         vehicles.

  O                 O          9.        Fuel pumps attended when in operation (if applicable).

  O                 O          10.       Fuel island kept clean of trash-spills (if applicable).


Check One                                ELECTRICAL

  YES               NO

  O                 O          1.        Permanent wiring, boxes, switches, outlets, lights, secure, free of defects.

  O                 O          2.        Lines and outlets not overloaded.

  O                 O          3.        Machines, tools, vending and water machines grounded, in good repair.

  O                 O          4.        Wiring for extension cords, portable lights and tools free of cuts, kinks,
                                         wear, used properly.

  O                 O          5.        Lighting (portable and fixed) provides adequate lighting, free of glare and
                                         defects.




                                                                                                                                           Formatted: Font: (Default) Arial
Trident Insurance Services provides this Manual as part of its efforts to reduce the risk of insurance loss and claims. This          38
Manual is advisory only and not intended to address every potential hazard or any insured specifically. Trident does not
warrant that all loss and/or claims will be avoided if the Manual is used. Trident further in no way intends to relieve the insured
of its own duties and obligations, nor is Trident undertaking on behalf of or for the benefit of the insured any duty or obligation
to ensure that the insured’s property and operations are safe, healthful and in compliance with any law, rule, or regulation.
Insureds remain responsible for their own efforts to reduce risks and should consult their own legal counsel for appropriate
guidance.
                                                                                                                                           Formatted: Font: (Default) Arial
                                     SAMPLE DRAFT PROGRAM

Check One                                FORKLIFT TRUCKS

  YES               NO

  O                 O          1.        Horn, handbrake operate OK.

  O                 O          2.        Operated in safe manner.

  O                 O          3.        Operated by authorized persons.

  O                 O          4.        Parked with brakes set, forks lowered, mast forward, controls neutralized,
                                         engine off.

  O                 O          5.        No excess fumes, in good repair.

  O                 O          6.        Refueling area in good order.

  O                 O          7.        Smoking rules obeyed.


Check One                                HOIST

  YES               NO

  O                 O          1.        Listing of all electrical/mechanical hoisting equipment available/ utilized.

  O                 O          2.        Inspections maintained as required by OSHA standards.

  O                 O          3.        Employees knowledgeable as to use of support equipment, i.e. slings,
                                         chockers, etc.

  O                 O          4.        Only authorized personnel allowed to use hoist.

  O                 O          5.        Safety equipment required, i.e., gloves, hardhat, safety glasses and
                                         shoes.

  O                 O          6.        Load capacity rating available, visible to all users.

  O                 O          7.        Condition of slings, chains, wire rope, hooks, chockers, etc. checked
                                         prior to use.

  O                 O          8.        Use of "mouse" safety clip required for all hook assemblies.

  O                 O          9.        Only authorized personnel allowed in hoisting area.


Check one                                HOIST(Continued)

 YES                NO

  O                 O          10.       Prior to making lift all rigging, overhead supports, blocking, etc.
                                         inspected.
                                                                                                                                           Formatted: Font: (Default) Arial
Trident Insurance Services provides this Manual as part of its efforts to reduce the risk of insurance loss and claims. This          39
Manual is advisory only and not intended to address every potential hazard or any insured specifically. Trident does not
warrant that all loss and/or claims will be avoided if the Manual is used. Trident further in no way intends to relieve the insured
of its own duties and obligations, nor is Trident undertaking on behalf of or for the benefit of the insured any duty or obligation
to ensure that the insured’s property and operations are safe, healthful and in compliance with any law, rule, or regulation.
Insureds remain responsible for their own efforts to reduce risks and should consult their own legal counsel for appropriate
guidance.
                                                                                                                                           Formatted: Font: (Default) Arial
                                     SAMPLE DRAFT PROGRAM


   O                O          11.       Hoist is lined up proper to insure load is not restricted.

  O                 O          12.       Hoist located in areas where operator will be clear of load at all times.

  O                 O          13.       Hoist with brake capability checked for proper braking.

  O                 O          14.       Hooks are inspected for spread.

  O                 O          15.       Only rated hooks are used (matches hoist rating).

  O                 O          16.       Maintenance records maintained/current.

  O                 O          17.       Hoist rated greater than load requires.

  O                 O          18.       Proper hand signals used and taught in operation of hoist (where
                                         required).

  O                 O          19.       Conductive "Tag" lines not used on electric hoist (metallic).

  O                 O          20.       Staff trained in proper rigging techniques.


Check One                                FIRE CONTROL

 YES                NO

  O                 O          1.        Fire doors kept closed (if applicable).

  O                 O          2.        Exits marked and not locked.

  O                 O          3.        Fire instructions posted.

  O                 O          4.        No smoking areas designated and posted with signs.

  O                 O          5.        Fire extinguishers at proper height.

  O                 O          6.        Extinguishers visible and accessible.




                                                                                                                                           Formatted: Font: (Default) Arial
Trident Insurance Services provides this Manual as part of its efforts to reduce the risk of insurance loss and claims. This          40
Manual is advisory only and not intended to address every potential hazard or any insured specifically. Trident does not
warrant that all loss and/or claims will be avoided if the Manual is used. Trident further in no way intends to relieve the insured
of its own duties and obligations, nor is Trident undertaking on behalf of or for the benefit of the insured any duty or obligation
to ensure that the insured’s property and operations are safe, healthful and in compliance with any law, rule, or regulation.
Insureds remain responsible for their own efforts to reduce risks and should consult their own legal counsel for appropriate
guidance.
                                                                                                                                           Formatted: Font: (Default) Arial
                                     SAMPLE DRAFT PROGRAM


Check One                                FIRE CONTROL (Continued)

 YES                NO

  O                 O          7.        Extinguishers marked for type of use and have inspection- maintenance
                                         tag.

  O                 O          8.        Flammables-hazardous materials properly stored.

  O                 O          9.        Machines free of dirt-grease.

  O                 O          10.       Heaters and fuel properly stored.


Check One                                EMERGENCY PLANS

 YES                NO

  O                 O          1.        Fire emergency action plan exists.

  O                 O          2.        Employees and Supervisors assigned tasks in case of fire emergency.

  O                 O          3.        Snow removal plan exists and is practical (if applicable).


Check One                                           HEALTH AND SANITATION

 YES                NO

  O                 O          1.        Restrooms clean and equipped.

  O                 O          2.        Food area or areas clean and equipped.

  O                 O          3.        Personal protective equipment properly stored, available, clean, in good
                                         condition.

  O                 O          4.        Ventilation good on dock and in vehicles.

  O                 O          5.        Noise levels OK.

  O                 O          6.        Dust, fumes controlled.




                                                                                                                                           Formatted: Font: (Default) Arial
Trident Insurance Services provides this Manual as part of its efforts to reduce the risk of insurance loss and claims. This          41
Manual is advisory only and not intended to address every potential hazard or any insured specifically. Trident does not
warrant that all loss and/or claims will be avoided if the Manual is used. Trident further in no way intends to relieve the insured
of its own duties and obligations, nor is Trident undertaking on behalf of or for the benefit of the insured any duty or obligation
to ensure that the insured’s property and operations are safe, healthful and in compliance with any law, rule, or regulation.
Insureds remain responsible for their own efforts to reduce risks and should consult their own legal counsel for appropriate
guidance.
                                                                                                                                           Formatted: Font: (Default) Arial
                                    SAMPLE DRAFT PROGRAM


Check One                                HOUSEKEEPING (EXTERIOR)

  YES               NO

  O                 O          1.        No trash accumulation, extra-pallets-material neatly stacked or stored.

  O                 O          2.        Trash containers adequate, convenient, and kept from overflowing.

  O                 O          3.        Yards surface free of holes and breaks.

  O                 O          4.        Yard drainage good, no water accumulation.

  O                 O          5.        Traffic signs and pavement markings OK.

  O                 O          6.        Cleaning equipment available.


Check One                                MISCELLANEOUS (MAINTENANCE, SHOP, OFFICES)

 YES                NO

  O                 O          1.        Exits marked, clear.

  O                 O          2.        Fire extinguishers marked, available.

  O                 O          3.        Aisles clear.

  O                 O          4.        Equipment guarded.

  O                 O          5.        Warning signs posted.

  O                 O          6.        Proper use of equipment.

  O                 O          7.        Employees trained.

  O                 O          8.        Housekeeping, storage practices.


Check One                                SECURITY (EXTERIOR)

 YES                NO

  O                 O          1.        Proper signage denoting "No Trespassing" in place.

  O                 O          2.        Areas well lit, adequate, dark areas.

Check One                                SECUTITY (EXTERIOR CONTINUED)

  YES                NO

  O                 O          3.         Lights secure and burning - no defects.
                                                                                                                                           Formatted: Font: (Default) Arial
Trident Insurance Services provides this Manual as part of its efforts to reduce the risk of insurance loss and claims. This          42
Manual is advisory only and not intended to address every potential hazard or any insured specifically. Trident does not
warrant that all loss and/or claims will be avoided if the Manual is used. Trident further in no way intends to relieve the insured
of its own duties and obligations, nor is Trident undertaking on behalf of or for the benefit of the insured any duty or obligation
to ensure that the insured’s property and operations are safe, healthful and in compliance with any law, rule, or regulation.
Insureds remain responsible for their own efforts to reduce risks and should consult their own legal counsel for appropriate
guidance.
                                                                                                                                           Formatted: Font: (Default) Arial
                                    SAMPLE DRAFT PROGRAM


   O                O          4.        Fences in good condition, no overgrown areas, free of shadows.

   O                O          5.        Gates in good repair. Unused gates locked.


Check One                                FUEL AREA (IF APPLICABLE)

  YES                NO

   O                O          1.        Fuel area clean, trash containers available and no overflow. No spills.

   O                O          2.        Lighting adequate - no defects.

   O                O          3.        No smoking sign and extinguisher at fuel island.

   O                O          4.        Extinguisher marked and tagged - securely mounted.

   O                O          5.        Pumps protected from damage.

   O                O          6.        Emergency shutoff marked and accessible.




                                                                                                                                           Formatted: Font: (Default) Arial
Trident Insurance Services provides this Manual as part of its efforts to reduce the risk of insurance loss and claims. This          43
Manual is advisory only and not intended to address every potential hazard or any insured specifically. Trident does not
warrant that all loss and/or claims will be avoided if the Manual is used. Trident further in no way intends to relieve the insured
of its own duties and obligations, nor is Trident undertaking on behalf of or for the benefit of the insured any duty or obligation
to ensure that the insured’s property and operations are safe, healthful and in compliance with any law, rule, or regulation.
Insureds remain responsible for their own efforts to reduce risks and should consult their own legal counsel for appropriate
guidance.
                                                                                                                                           Formatted: Font: (Default) Arial
                                    SAMPLE DRAFT PROGRAM


                              RISK CONTROL / PROPERTY MANAGEMENT REPORT

Inspection Date: _______________________                          Inspected by: _________________________

Location: ____________________________                            Reviewed by: ________________________

Maintenance Work Orders Attached                   YES             NO

Follow-up Needed YES                     NO                 Date Distributed _________________________


Check One                                SAFETY MANAGEMENT/ADMINISTRATION

  YES               NO

  O                 O          1.        Safety rules are posted.

  O                 O          2.        Staff provided with initial safety indoctrination.

  O                 O          3.        Written safety policy/program - known by management and available for
                                         release.

  O                 O          4.        Current staff procedures such as application, interviewing, reference
                                         checks and pre-employment exams are being followed.

  O                 O          5.        Part-time, casual or seasonal help is employed.

  O                 O          6.        High degree of staff turnover.

  O                 O          7.        Safety coordinator appointed.

  O                 O          8.        Bulletin boards have information posted (i.e. OSHA logs, posters, EEO,
                                         safety bulletins, etc.).




                                                                                                                                           Formatted: Font: (Default) Arial
Trident Insurance Services provides this Manual as part of its efforts to reduce the risk of insurance loss and claims. This          44
Manual is advisory only and not intended to address every potential hazard or any insured specifically. Trident does not
warrant that all loss and/or claims will be avoided if the Manual is used. Trident further in no way intends to relieve the insured
of its own duties and obligations, nor is Trident undertaking on behalf of or for the benefit of the insured any duty or obligation
to ensure that the insured’s property and operations are safe, healthful and in compliance with any law, rule, or regulation.
Insureds remain responsible for their own efforts to reduce risks and should consult their own legal counsel for appropriate
guidance.
                                                                                                                                           Formatted: Font: (Default) Arial
                                    SAMPLE DRAFT PROGRAM


Check One                                EDUCATION/TRAINING

  YES               NO

  O                 O          1.        Formal orientation program in effect for all new or transferred employees.

  O                 O          2.        Safety training and/or meetings held and documented.

  O                 O          3.        Rosters and records kept on all training conducted with employee
                                         signatures.

  O                 O          4.        Supervisors participate in employee training.

  O                 O          5.        OSHA training sufficient to determine if qualified and competent -
                                         documentation required.

  O                 O          6.        DOT requirements complied with including: inquiry into previous
                                         employment, motor vehicle record checks, road test, written test, physical
                                         examination, annual review of driving record (fleet).


Check One                                PERSONAL PROTECTIVE EQUIPMENT

  YES               NO

  O                 O          1.        PPE provided to and used by staff and visitors/students (i.e. goggles, foot
                                         protection, hearing protection, etc.).

  O                 O          2.        Staff aware of consequences involved when not using PPE (disciplinary
                                         action up to and including termination).

  O                 O          3.        Supervisors aware of PPE requirements.

Check One                                ENVIRONMENTAL

  YES               NO

  O                 O          1.        Routine environmental inspection conducted.

  O                 O          2.        Training and retraining completed.




                                                                                                                                           Formatted: Font: (Default) Arial
Trident Insurance Services provides this Manual as part of its efforts to reduce the risk of insurance loss and claims. This          45
Manual is advisory only and not intended to address every potential hazard or any insured specifically. Trident does not
warrant that all loss and/or claims will be avoided if the Manual is used. Trident further in no way intends to relieve the insured
of its own duties and obligations, nor is Trident undertaking on behalf of or for the benefit of the insured any duty or obligation
to ensure that the insured’s property and operations are safe, healthful and in compliance with any law, rule, or regulation.
Insureds remain responsible for their own efforts to reduce risks and should consult their own legal counsel for appropriate
guidance.
                                                                                                                                           Formatted: Font: (Default) Arial
                                     SAMPLE DRAFT PROGRAM


                                         INDUSTRIAL HYGIENE

NOTE: Industrial hygiene surveys are performed only on an individual need and/or scheduling. This area
of specialty must be performed by a qualified individual , who is then responsible for reporting findings and
observations. Supervisors are required to check off industrial hygiene service when performed in their
area of responsibilities.

Check One                                TESTING

YES                 NO

  O                 O          1.        Verbally describe area(s) where testing was performed

Check One                                           HOUSEKEEPING

  YES               NO

  O                 O          1.        Buildings/facilities do not have a build-up of trash or debris.

  O                 O          2.        Lighting is good; spills are cleaned up immediately; dust control is good.

  O                 O          3.        Accumulations of scrap material and trash are emptied or removed.

  O                 O          4.        Storing or stacking of material is not too high where visibility will be
                                         affected.

  O                 O          5.        Sanitation available/clean; potable water available.

  O                 O          6.        Procedures for proper disposal of waste oils established.

  O                 O          7.        Appearance of building-facilities does not have a build-up of trash or
                                         debris.

 O                  O          8.        Wood/forms-nails bent, no splinters or breaks.

 O                  O          9.        Lighting is good; spills are cleaned up immediately; dust control is good.

 O                  O          10.       Storing or stacking of material is not too high where visibility will be
                                         affected.




                                                                                                                                           Formatted: Font: (Default) Arial
Trident Insurance Services provides this Manual as part of its efforts to reduce the risk of insurance loss and claims. This          46
Manual is advisory only and not intended to address every potential hazard or any insured specifically. Trident does not
warrant that all loss and/or claims will be avoided if the Manual is used. Trident further in no way intends to relieve the insured
of its own duties and obligations, nor is Trident undertaking on behalf of or for the benefit of the insured any duty or obligation
to ensure that the insured’s property and operations are safe, healthful and in compliance with any law, rule, or regulation.
Insureds remain responsible for their own efforts to reduce risks and should consult their own legal counsel for appropriate
guidance.
                                                                                                                                           Formatted: Font: (Default) Arial
                                    SAMPLE DRAFT PROGRAM


Check One                                HAZARD COMMUNICATION

YES                 NO

  O                 O          1.        All material labels legible and not defaced.

  O                 O          2.        Staff trained to properly use of MSDS.

  O                 O          3.        Procedures established to ensure MSDS received on products used on
                                         site, updated as necessary and employees familiar with location of
                                         binder.

  O                 O          4.        MSDS on used products distributed where applicable.


Check One                                LOCK OUT AND TAG OUT

  YES               NO

  O                 O          1.        Training of staff completed.

  O                 O          2.        Equipment lock out requirements posted by department.

  O                 O          3.        Lock out and tag out checklist completed and maintained on file.


Check One                                INDUSTRIAL HYGIENE/FIRST AID

  YES               NO

 O                  O          1.        Medical Programs established as dictated by possible exposures.

 O                  O          2.        First aid kits available, stocked and maintained.

 O                  O          3.        Persons trained in first aid and CPR; certificates in personnel files.

 O                  O          4.        Emergency telephone numbers and locations posted on bulletin boards.




                                                                                                                                           Formatted: Font: (Default) Arial
Trident Insurance Services provides this Manual as part of its efforts to reduce the risk of insurance loss and claims. This          47
Manual is advisory only and not intended to address every potential hazard or any insured specifically. Trident does not
warrant that all loss and/or claims will be avoided if the Manual is used. Trident further in no way intends to relieve the insured
of its own duties and obligations, nor is Trident undertaking on behalf of or for the benefit of the insured any duty or obligation
to ensure that the insured’s property and operations are safe, healthful and in compliance with any law, rule, or regulation.
Insureds remain responsible for their own efforts to reduce risks and should consult their own legal counsel for appropriate
guidance.
                                                                                                                                           Formatted: Font: (Default) Arial
                                    SAMPLE DRAFT PROGRAM


Check One                                           BLOOD BORNE PATHOGENS

  YES               NO

  O                 O          1.        Training of employees completed and documented.

  O                 O          2.        Blood borne pathogens cleanup kits available.

  O                 O          3.        Necessary personal protection equipment being used.

  O                 O          4.        Proper disposal of bio-hazardous waste.


Check One                                           INSPECTIONS/ACCIDENT INVESTIGATION

  YES               NO

  O                 O          1.        Job site inspections are made of active work areas by the supervisor and
                                         are documented.

  O                 O          2.        Employees report all accidents, including near misses immediately.

  O                 O          3.        Managers are trained in accident investigation techniques and complete
                                         reports on all accidents to determine basic cause.

 O                  O          4.        Management reviews all accidents and follow-up system to ensure
                                         appropriate corrective action taken.

Check One                                           NOISE EXPOSURE

  YES               NO

  O                 O          1.        When sound levels exceed maximum decibel level, protection against the
                                         effects of such noise exposure provided.

  O                 O          2.        Monitoring program developed and implemented when any staff
                                         exposure may equal or exceed an 8-hour time weighted average(TWA)
                                         of 85 decibels.

  O                 O          3.        Audiometric testing program established and maintained by making such
                                         testing available to all staff whose exposures equal or exceed an 8-hour
                                         TWA of 85 decibels.

  O                 O          4.        Staff exposed at or above an 8-hour TWA decibels notified of the results
                                         of the monitoring.




                                                                                                                                           Formatted: Font: (Default) Arial
Trident Insurance Services provides this Manual as part of its efforts to reduce the risk of insurance loss and claims. This          48
Manual is advisory only and not intended to address every potential hazard or any insured specifically. Trident does not
warrant that all loss and/or claims will be avoided if the Manual is used. Trident further in no way intends to relieve the insured
of its own duties and obligations, nor is Trident undertaking on behalf of or for the benefit of the insured any duty or obligation
to ensure that the insured’s property and operations are safe, healthful and in compliance with any law, rule, or regulation.
Insureds remain responsible for their own efforts to reduce risks and should consult their own legal counsel for appropriate
guidance.
                                                                                                                                           Formatted: Font: (Default) Arial
                                    SAMPLE DRAFT PROGRAM


Check One                                WELDING/CUTTING

YES                 NO

  O                 O          1.        Oxygen cylinders in storage separated from fuel gas cylinders or
                                         combustible materials a minimum distance of 20 feet or by a non-
                                         combustible barrier at least 5 feet high having a fire resistive rating of at
                                         least 1/2 hour.

  O                 O          2.        Storage of fuel-gas inside a building limited to a total gas capacity of
                                         2,000 cubic feet or 300 pounds of liquefied petroleum gas, except for
                                         cylinders actually in use or attached ready for use.

   O                O          3.        Valve protection caps, where cylinders are designed to accept a cap,
                                         always kept in place, except when cylinders are in use or connected for
                                         use.

   O                O          4.        Splices or repaired insulation within ten feet of the holder.

   O                O          5.        Reverse flow check valve between the torch and regulator.

                                         MACHINE GUARDING

  O                 O          1.        One or more methods of machine guarding provided to the operator and
                                         other employees in the machine area from hazards such as those
                                         created by point of operation, in-going nip points, rotating parts, flying
                                         chips and sparks.

  O                 O          2.        Guards affixed to the machine where possible or secured elsewhere if
                                         attachment to the machine not possible.

  O                 O          3.        Guard designed not to create an accident hazard in itself.

  O                 O          4.        Point of operation guarded on machines whose operations expose an
                                         employee to injury.




                                                                                                                                           Formatted: Font: (Default) Arial
Trident Insurance Services provides this Manual as part of its efforts to reduce the risk of insurance loss and claims. This          49
Manual is advisory only and not intended to address every potential hazard or any insured specifically. Trident does not
warrant that all loss and/or claims will be avoided if the Manual is used. Trident further in no way intends to relieve the insured
of its own duties and obligations, nor is Trident undertaking on behalf of or for the benefit of the insured any duty or obligation
to ensure that the insured’s property and operations are safe, healthful and in compliance with any law, rule, or regulation.
Insureds remain responsible for their own efforts to reduce risks and should consult their own legal counsel for appropriate
guidance.
                                                                                                                                           Formatted: Font: (Default) Arial
                                    SAMPLE DRAFT PROGRAM

Check One                                MACHINE GUARDING

YES                 NO

  O                 O          5.        All machines designed for a fixed location securely anchored to prevent
                                         walking or moving.

  O                 O          6.        Special hand tools provided for placing and removing material.

                                         GENERAL

Do any of the following exist, if so are they properly controlled and operated?

Check One

  YES               NO

  O                 O          1.        Boilers or pressure vessels.

  O                 O          2.        Fire or explosion hazards (use of flammable liquids, welding, etc.).

  O                 O          3.        Use of mechanical material handling equipment(cranes, elevators, hoists,
                                         etc.)

  O                 O          4.        Operations that could release hazardous materials into the environment.

 O                  O          5.        Temperature extremes.

  O                 O          6.        Unsafe acts by employees.

COMMENTS:
____________________________________________________________________________________
____________________________________________________________________________________

Are there any unusual hazards or deficiencies regarding the following?

  O                 O          1.        Building conditions.

  O                 O          2.        Fire protection facilities.

  O                 O          3.        Electrical hazards.

  O                 O          4.        Exterior condition: yards, walks, stairs, parking, etc.

  O                 O          5.        Interior condition: exits, floors, stairs, lighting, etc.

Comments:___________________________________________________________________________
         ___________________________________________________________________________

Check One                                FIRE PROTECTION

  YES               NO
                                                                                                                                           Formatted: Font: (Default) Arial
Trident Insurance Services provides this Manual as part of its efforts to reduce the risk of insurance loss and claims. This          50
Manual is advisory only and not intended to address every potential hazard or any insured specifically. Trident does not
warrant that all loss and/or claims will be avoided if the Manual is used. Trident further in no way intends to relieve the insured
of its own duties and obligations, nor is Trident undertaking on behalf of or for the benefit of the insured any duty or obligation
to ensure that the insured’s property and operations are safe, healthful and in compliance with any law, rule, or regulation.
Insureds remain responsible for their own efforts to reduce risks and should consult their own legal counsel for appropriate
guidance.
                                                                                                                                           Formatted: Font: (Default) Arial
                                     SAMPLE DRAFT PROGRAM


  O                 O          1.        Extinguishers serviced, tagged and in good condition and properly
                                         located.

  O                 O          2.        Flammable liquids properly stored and handled.

  O                 O          3.        Drip pans provided under flammable liquids.

  O                 O          4.        Liquids properly signed for, labeled and disposed of.

  O                 O          5.        Proper containers and procedures used in dispensing or transferring
                                         flammable, combustible material (bonding, grounding).

  O                 O          6.        Three wire plugs or double insulated tools used.

  O                 O          7.        Insulation and plugs broken on electrical tools.

  O                 O          8.        Automatic sprinkler system in building operational.

  O                 O          9.        Standpipes/hose system in building operational.

  O                 O          10.       Fire detection/alarm system present operational.

  O                 O          11.       Watchman service provided.

  O                 O          12.       Fire hydrants located near buildings. Number of hydrants within 500 feet
                                         of building.____




                                                                                                                                           Formatted: Font: (Default) Arial
Trident Insurance Services provides this Manual as part of its efforts to reduce the risk of insurance loss and claims. This          51
Manual is advisory only and not intended to address every potential hazard or any insured specifically. Trident does not
warrant that all loss and/or claims will be avoided if the Manual is used. Trident further in no way intends to relieve the insured
of its own duties and obligations, nor is Trident undertaking on behalf of or for the benefit of the insured any duty or obligation
to ensure that the insured’s property and operations are safe, healthful and in compliance with any law, rule, or regulation.
Insureds remain responsible for their own efforts to reduce risks and should consult their own legal counsel for appropriate
guidance.
                                                                                                                                           Formatted: Font: (Default) Arial
                                     SAMPLE DRAFT PROGRAM


Check One                                PROPERTY - CONSTRUCTION

Yes                 No
                                         PROPERTY - COMMON HAZARDS

  O                 O          1.        Approved type of heating equipment used.

  O                 O          2.        Approved type of fuel used.

  O                 O          3.        Unit cut off by fire partition walls.

  O                 O          4.        Heating/AC service/maintenance contract.

  O                 O          5.        Approved wiring (conduit, romex, etc.).

  O                 O          6.        Wiring in good condition.

  O                 O          7.        System properly fused.

  O                 O          8.        Temporary wiring used.

  O                 O          9.        Excessive use of extension cords.

  O                 O          10.       Electrical appliance hazards noted.

  O                 O          11.       Other electrical hazards noted.

                                     SPECIAL HAZARDS - FLAMMABLE LIQUIDS

  O                 O          1.        Approved storage cabinets provided.

  O                 O          2.        Flammables used during operations limited to one shift.

  O                 O          3.        Approved storage room.

  O                 O          4.        Automatic fire protection in storage room.

  O                 O          5.        Outside storage of flammables.

  O                 O          6.        Unsafe conditions noted.

  O                 O          7.        Materials used - name, class, amount stored.




                                                                                                                                           Formatted: Font: (Default) Arial
Trident Insurance Services provides this Manual as part of its efforts to reduce the risk of insurance loss and claims. This          52
Manual is advisory only and not intended to address every potential hazard or any insured specifically. Trident does not
warrant that all loss and/or claims will be avoided if the Manual is used. Trident further in no way intends to relieve the insured
of its own duties and obligations, nor is Trident undertaking on behalf of or for the benefit of the insured any duty or obligation
to ensure that the insured’s property and operations are safe, healthful and in compliance with any law, rule, or regulation.
Insureds remain responsible for their own efforts to reduce risks and should consult their own legal counsel for appropriate
guidance.
                                                                                                                                           Formatted: Font: (Default) Arial
                                    SAMPLE DRAFT PROGRAM

Check One                                SPECIAL HAZARDS - SPRAYING

YES                 NO

 O                  O          1.        Spray areas free from heavy accumulation of combustible residue.

  O                 O          2.        Automatic fire protection in spray booth; filters clean and removable.

  O                 O          4.        Finishes and solvents used - name, class, amount stored.

  O                 O          5.        Spray booths utilized.

 O                  O          6.        Total gallons used 8 hours a day.

                                               SPECIAL HAZARDS - DIPPING

  O                 O          1.        Floors non-combustible, curbed drained.

  O                 O          2.        Automatic fire protection for tanks and drain boards.

  O                 O          3.        Finishes and solvents used - name, class, amount stored.

  O                 O          4.        Number tanks used and total tank capacity.

  O                 O          5.        Are tanks non-combustible.


                                      SPECIAL HAZARDS - BASIC SAFEGUARDS

  O                 O          1.        Electric wiring and equipment within 20 feet of operations explosion-
                                         proof.

  O                 O          2.        Operations isolated from all combustibles.

  O                 O          3.        Operations at least 20 feet away from ignition sources.

  O                 O          4.        No smoking rules strictly enforced.

  O                 O          5.        Self-inspection program in effect.




                                                                                                                                           Formatted: Font: (Default) Arial
Trident Insurance Services provides this Manual as part of its efforts to reduce the risk of insurance loss and claims. This          53
Manual is advisory only and not intended to address every potential hazard or any insured specifically. Trident does not
warrant that all loss and/or claims will be avoided if the Manual is used. Trident further in no way intends to relieve the insured
of its own duties and obligations, nor is Trident undertaking on behalf of or for the benefit of the insured any duty or obligation
to ensure that the insured’s property and operations are safe, healthful and in compliance with any law, rule, or regulation.
Insureds remain responsible for their own efforts to reduce risks and should consult their own legal counsel for appropriate
guidance.
                                                                                                                                           Formatted: Font: (Default) Arial
                                   SAMPLE DRAFT PROGRAM


                                         SPECIAL HAZARDS - EXPOSURES

                    DISTANCE                        HEIGHT               CONSTRUCTION                   OCCUPANCY
North
South
East
West

Unsatisfactory Items
Number Description             Date to be Completed


1.        Were any unsafe acts or unsafe conditions not covered in the above observed during your
          survey?


2.        What has been the accident experience at this site? What are predominant cause of accidents
          and injuries?


3.        What is the greatest potential for loss? What is the biggest safety problem?


Additional Comments:


Maintenance Work Orders Attached                    YES                            NO
                                                                                                                                           Formatted: Font: (Default) Arial




                                                                                                                                           Formatted: Font: (Default) Arial
Trident Insurance Services provides this Manual as part of its efforts to reduce the risk of insurance loss and claims. This          54
Manual is advisory only and not intended to address every potential hazard or any insured specifically. Trident does not
warrant that all loss and/or claims will be avoided if the Manual is used. Trident further in no way intends to relieve the insured
of its own duties and obligations, nor is Trident undertaking on behalf of or for the benefit of the insured any duty or obligation
to ensure that the insured’s property and operations are safe, healthful and in compliance with any law, rule, or regulation.
Insureds remain responsible for their own efforts to reduce risks and should consult their own legal counsel for appropriate
guidance.
                                                                                                                                           Formatted: Font: (Default) Arial
                                   SAMPLE DRAFT PROGRAM

                                                                                                                                           Formatted: Font: (Default) Arial, 10 pt
                               HAZARD RECOGNITION/SAFETY INSPECTION REPORT

Inspection Date:_____________________________

Inspected by: _______________________________

Location:___________________________________

                                                MAINTENANCE AREA/SHOP

A.        AREAWIDE OBSERVATIONS

          1.        Housekeeping:

                    a.         Suitable trash containers available.
                    b.         Covered containers in use for greasy towels and flammables.
                    c.         Floors clean and dry.
                    d.         Halls and pathways clear (walkways to be min. of 24" wide).

          2.        Overhead lighting:

                    a.         Portable lights used safely.
                    b.         Vapor-proof covers on any pit lights.

          3.        Shop and paint areas well ventilated.

          4.        Exit signs at each exit to outside (if not obviously an exit).

                    a.         Adequately illuminated for visibility.
                    b.         Lettering 6" or more in height.

          5.        Doors that do not lead outside are marked "NOT AN EXIT" or identified.

          6.        Electrical:

                    a.         Outlets grounded.
                    b.         Outlet and junction boxes covered.
                    c.         Permanent wiring (not flexible cords) to stationary items(excepting bench
                               grinder).
                    d.         Switches and controls identified.
                    e.         Drop cords, trouble lights are 3-wire type.
                    f.         Access to electrical panels is unobstructed (30" clear in front).




                                                                                                                                           Formatted: Font: (Default) Arial
Trident Insurance Services provides this Manual as part of its efforts to reduce the risk of insurance loss and claims. This          55
Manual is advisory only and not intended to address every potential hazard or any insured specifically. Trident does not
warrant that all loss and/or claims will be avoided if the Manual is used. Trident further in no way intends to relieve the insured
of its own duties and obligations, nor is Trident undertaking on behalf of or for the benefit of the insured any duty or obligation
to ensure that the insured’s property and operations are safe, healthful and in compliance with any law, rule, or regulation.
Insureds remain responsible for their own efforts to reduce risks and should consult their own legal counsel for appropriate
guidance.
                                                                                                                                           Formatted: Font: (Default) Arial
                                   SAMPLE DRAFT PROGRAM


          7.        “NO SMOKING” signs at any gas pump, parts cleaner, battery charging area.

          8.        Fire extinguisher:

                    a.         Mounting secure at proper height (3’ max. if over 40%, 5' max. for under 40#).
                    b.         Location visible or identified with visible marking.
                    c.         Marked for intended use.
                    d.         Tagged with dates of maintenance, seal in place.

          9.        Work benches sturdy and in good repair.

B.        STOCKROOM STORAGE AREAS

          1.     Housekeeping good.
          2.     Aisles maintained clear (24" MIN.).
          3.     Materials stacked, placed safely.
          4.     Tops of cabinets clear of falling objects (items stored on top are restrained by railing or lip
                 on cabinet).
          5.     Flammable liquids and aerosol containers stored in closed metal cabinet properly
          marked.
          6.     Tires properly stored.
          7.     Lab materials storage neat, safe.
          8.     Where storage is on a 2nd floor mezzanine, etc., floor load limits are posted.
          9.     Flammable liquids stored away from heat.

                    a.         Parts cleaning tanks have self-closing covers with fuse link.
                    b.         Safety cans have spring closing lids, flame arresters and contents identified by
                               stenciled yellow letters (i.e. Gasoline) on red cans.

C.        MANUAL EQUIPMENT

          1.        Shop tools in good repair.
          2.        Jacks, hoists and stands in good repair.

                    a.         Marked for load rating.
                    b.         Adequately lubricated.

          3.        Tire inflation safety devices available (safety cage; whip hose with clip-on chuck).




                                                                                                                                           Formatted: Font: (Default) Arial
Trident Insurance Services provides this Manual as part of its efforts to reduce the risk of insurance loss and claims. This          56
Manual is advisory only and not intended to address every potential hazard or any insured specifically. Trident does not
warrant that all loss and/or claims will be avoided if the Manual is used. Trident further in no way intends to relieve the insured
of its own duties and obligations, nor is Trident undertaking on behalf of or for the benefit of the insured any duty or obligation
to ensure that the insured’s property and operations are safe, healthful and in compliance with any law, rule, or regulation.
Insureds remain responsible for their own efforts to reduce risks and should consult their own legal counsel for appropriate
guidance.
                                                                                                                                           Formatted: Font: (Default) Arial
                                   SAMPLE DRAFT PROGRAM


D.        POWER EQUIPMENT, MOTORS, COMPRESSORS

          1.        In good repair.
          2.        Adequately grounded.
          3.        Wiring and switches in good repair (permanently installed-not drop cords).
          4.        Guards installed (drive pulleys; V-belt and chain drive pinch points).

E.        COMPRESSED AIR SYSTEM

          1.        Hoses/connections not leaking.
          2.        30 psi max. pressure for blow guns.
          3.        Tank protected against overcharge.
          4.        Safety valves operating properly.
          5.        Water trap drained manually regularly to eliminate water or verify proper operation of
                    automatic drain.

F.        WELDING EQUIPMENT

          1.        Cylinders stored out of travel paths.
          2.        Cylinders stored away from heat.
          3.        Cylinders marked for content.
          4.        Spare tanks of oxygen and acetylene segregated from each other (20' apart or by firewall.
          5.        Valves closed (full and empty cylinders).
          6.        Hoses/connections in good repair.
          7.        Fire extinguishers on welding cart w/current inspection tag.

G.        SANITATION

          1.        Restrooms neat, sanitary and equipped (both hot and cold water available).
          2.        Area used for meal/break neat and orderly (covered containers used for food waste).

H.        SCAFFOLDING

          1.        In good repair, equipped with outrigger.
          2.        Capable of support (marked with capacity rating).
          3.        Toeboards installed (if over 7' off floor).
          4.        Guardrails installed when over 7' above ground (42'ht. above platform).
          5.        Stencilled - Not for use near electrical equipment.




                                                                                                                                           Formatted: Font: (Default) Arial
Trident Insurance Services provides this Manual as part of its efforts to reduce the risk of insurance loss and claims. This          57
Manual is advisory only and not intended to address every potential hazard or any insured specifically. Trident does not
warrant that all loss and/or claims will be avoided if the Manual is used. Trident further in no way intends to relieve the insured
of its own duties and obligations, nor is Trident undertaking on behalf of or for the benefit of the insured any duty or obligation
to ensure that the insured’s property and operations are safe, healthful and in compliance with any law, rule, or regulation.
Insureds remain responsible for their own efforts to reduce risks and should consult their own legal counsel for appropriate
guidance.
                                                                                                                                           Formatted: Font: (Default) Arial
                                   SAMPLE DRAFT PROGRAM


I.        BATTERY AREA

          1         Well ventilated so that explosive fumes do not accumulate.
          2.        Source of running water nearby.
          3.        Eye wash provided near batteries (eye wash sign posted).
          4.        Smoking prohibited (sign posted).

J.        MACHINE GUARDING (Comment on all exceptions)

          1.        Machines, V-belts and power trains all properly guarded (including grinders, saws,
                    jointers, planers, drill presses, etc.).
          2.        Ventilating fans guarded if within 7' floor.

K.        BENCH GRINDERS

          1.        Properly grounded.
          2.        Properly guarded (tool rest not more than 1/8" from wheel/adjustable).
          3.        Eye protection provided and worn (goggles and face shields).
          4.        Wheels properly mounted and dressed.

L.        CRANES AND HOISTING EQUIPMENT

          1.        Cable condition good (not worn).
          2.        Shop and lube hoists have nameplates with:
                    a.     Name of manufacturer.
                    b.     Capacity of hoist.
                    c.     Date of installation.

M.        LADDERS

          1.        Conform to standards (i.e. 12' centers on rungs).
          2.        Used safely and adequate.
          3.        Inspected frequently (monthly).
          4.        Removed from the premises if unsafe, tagged "Do Not Use".
          5.        Portable rug ladders have safety feet.
          6.        Wood ladders stored in shelter or out of elements.




                                                                                                                                           Formatted: Font: (Default) Arial
Trident Insurance Services provides this Manual as part of its efforts to reduce the risk of insurance loss and claims. This          58
Manual is advisory only and not intended to address every potential hazard or any insured specifically. Trident does not
warrant that all loss and/or claims will be avoided if the Manual is used. Trident further in no way intends to relieve the insured
of its own duties and obligations, nor is Trident undertaking on behalf of or for the benefit of the insured any duty or obligation
to ensure that the insured’s property and operations are safe, healthful and in compliance with any law, rule, or regulation.
Insureds remain responsible for their own efforts to reduce risks and should consult their own legal counsel for appropriate
guidance.
                                                                                                                                           Formatted: Font: (Default) Arial
                                   SAMPLE DRAFT PROGRAM


N.        YARD AREA (assigned to Garage)

          1.        Yard lights functional.
          2.        Yard lights adequate.
          3.        Traffic patterns observed.
                    a.       Speed limit observed.
                    b.       Equipment parked in proper areas.
          4.        Yard free of trash accumulations.

O.        FUELING FACILITIES (if applicable)

          1.        Lights function.
          2.        Lighting adequate.
          3.        Fuel pumps clean.
          4.        Fuel area free of spills.
          5.        No smoking sign posted.
          6.        Fire extinguisher readily accessible,
                    a.       Mounting secure, at proper height.
                    b.       Marked for intended use.
                    c.       Tagged with dates of maintenance.
          7.        Gasoline pumps protected with barriers or inside building alcove,
          8.        Emergency turn-off switch labeled.
          9.        Gas buggy/truck equipment with grounding device for use when being filled.

P.        PROTECTIVE EQUIPMENT (if applicable)

          1.        Cage used to inflate tires.
          2.        Safety glasses, goggles or shields provided where needed.
          3.        The following provided and used where necessary:
                    a.       Gloves           d.     Hard hats                g. Goggles/Face Shields
                    b.       Aprons           e.     Ear plugs
                    c.       Boots?           f.     Safety belts
          4.        Safety stands used when jack in use.
          5.        Flash shield used around arc welder.
          6.        Tire mounting instructions posted near tire changer (rules observed).




                                                                                                                                           Formatted: Font: (Default) Arial
Trident Insurance Services provides this Manual as part of its efforts to reduce the risk of insurance loss and claims. This          59
Manual is advisory only and not intended to address every potential hazard or any insured specifically. Trident does not
warrant that all loss and/or claims will be avoided if the Manual is used. Trident further in no way intends to relieve the insured
of its own duties and obligations, nor is Trident undertaking on behalf of or for the benefit of the insured any duty or obligation
to ensure that the insured’s property and operations are safe, healthful and in compliance with any law, rule, or regulation.
Insureds remain responsible for their own efforts to reduce risks and should consult their own legal counsel for appropriate
guidance.
                                                                                                                                           Formatted: Font: (Default) Arial
                                   SAMPLE DRAFT PROGRAM


                                         General Liability

By the very nature of our operations, we have daily contact with the public. If we do not evaluate our
operations and procedures with this in mind ,we establish a mind set with our staff that safety is a
secondary feature of what we do. We should always consider how to perform safely and effectively the
services we provide and evaluate new services for problems and needed controls. Through this review
process, we can establish a risk management attitude for all that we do. The result will be a reduction in
the potential for injury to staff and the general public.

We must remember that any public property we manage is just that, public property. Members of the
general populace will continuously use this property. Special attention should be paid to maintain this
property in a safe condition. Life Safety should be considered in all property changes or configurations.
Existing property should be evaluated to determine how well it meets the current NFPA Life Safety Code
(NFPA 101).

Walking surfaces are very important. Slips and falls may not appear a major consideration, but the
frequency of a claim can be a red flag that a problem area exists. Current claims may not be serious, but
a fall by one of our senior citizens may result in a very serious claim for a broken limb or hip. This can be
costly in terms of money spent to settle the claim and make the individual wel,l and in how we as an
organization are perceived. Our function, both in actuality and perception, is to provide a safe place for
citizens to conduct their business with us.

Public entity operations, such as street and road maintenance, repair, utility operations and law
enforcement, effect all members of the general public every day.

Pro-active controls such as the establishment of policies, procedures, self inspections, and operational
guidelines provide us with a frame work for our safe, day to day, operations.


As part of our operations, we should make sure that the following criteria are met:

    Facility grounds inspected for hazards on a regular basis.

    Fencing properly maintained and adequate to secure premises.

    Exterior signs clearly visible and road signs meet with Federal Uniform Traffic requirements.

    Windows and glass doors in satisfactory condition.

    Exits unobstructed and appropriately marked.

    Emergency lighting available and adequate for each building per the Life Safety Code.

    Fire alarms operational.

    Fire drills conducted on a regular basis in each facility.

    Floor surfaces non-slippery and free from tripping hazards.

    Stairs and treads in good condition.
                                                                                                                                           Formatted: Font: (Default) Arial
Trident Insurance Services provides this Manual as part of its efforts to reduce the risk of insurance loss and claims. This          60
Manual is advisory only and not intended to address every potential hazard or any insured specifically. Trident does not
warrant that all loss and/or claims will be avoided if the Manual is used. Trident further in no way intends to relieve the insured
of its own duties and obligations, nor is Trident undertaking on behalf of or for the benefit of the insured any duty or obligation
to ensure that the insured’s property and operations are safe, healthful and in compliance with any law, rule, or regulation.
Insureds remain responsible for their own efforts to reduce risks and should consult their own legal counsel for appropriate
guidance.
                                                                                                                                           Formatted: Font: (Default) Arial
                                   SAMPLE DRAFT PROGRAM

    Handrails in good condition and firmly fixed to upright supports.

    Public use equipment in good condition and regularly inspected.

    Elevators meet current codes and inspected on a regular basis.

    Emergency plans in place and emergency exit routes posted in all facilities.

    All playground equipment evaluated and meets current Consumer Product Safety Commission
     standards for safety.




                                                                                                                                           Formatted: Font: (Default) Arial
Trident Insurance Services provides this Manual as part of its efforts to reduce the risk of insurance loss and claims. This          61
Manual is advisory only and not intended to address every potential hazard or any insured specifically. Trident does not
warrant that all loss and/or claims will be avoided if the Manual is used. Trident further in no way intends to relieve the insured
of its own duties and obligations, nor is Trident undertaking on behalf of or for the benefit of the insured any duty or obligation
to ensure that the insured’s property and operations are safe, healthful and in compliance with any law, rule, or regulation.
Insureds remain responsible for their own efforts to reduce risks and should consult their own legal counsel for appropriate
guidance.
                                                                                                                                           Formatted: Font: (Default) Arial
                                   SAMPLE DRAFT PROGRAM

                                              ACCIDENT/INCIDENT REPORT
Check One

          O         PROPERTY INCIDENT

          O         HUMAN SAFETY

          O         ENVIRONMENTAL SAFETY

          O         EPA

          O         GENERAL LIABILITY


Location:                                           Date:_____________                        Time: ____________________


Reported by: _________________                      Report Date: _________________                      Time: _________


INCIDENT DESCRIPTION:

FOLLOW UP


Report By:________________________ Date: ____________




                                                                                                                                           Formatted: Font: (Default) Arial
Trident Insurance Services provides this Manual as part of its efforts to reduce the risk of insurance loss and claims. This          62
Manual is advisory only and not intended to address every potential hazard or any insured specifically. Trident does not
warrant that all loss and/or claims will be avoided if the Manual is used. Trident further in no way intends to relieve the insured
of its own duties and obligations, nor is Trident undertaking on behalf of or for the benefit of the insured any duty or obligation
to ensure that the insured’s property and operations are safe, healthful and in compliance with any law, rule, or regulation.
Insureds remain responsible for their own efforts to reduce risks and should consult their own legal counsel for appropriate
guidance.
                                                                                                                                           Formatted: Font: (Default) Arial
                                   SAMPLE DRAFT PROGRAM


ACCIDENT INVESTIGATION

One of the principal purposes of accident/incident investigation is to obtain information that will assist in
the prevention of future losses. Nearly every accident/incident offers the possibility of preventing another
loss sometime in the future. To this end, it is necessary to examine each accident/incident for the cause
and to correct the situation as soon as possible. It is not the purpose of accident/incident investigation to
find blame or fix fault.

It is well established that losses, unsafe acts and unsafe conditions are only symptoms of weakness or
malfunctions of the management system. Identifying losses and the basic causes (the unsafe acts and/or
unsafe conditions) are only the starting points in learning why the unsafe acts and/or unsafe conditions
(primary causes) were allowed to exist. Identifying the primary causes of a loss will assist you in
determining where the weaknesses and/or malfunctions exist in your management system and allow you
to make the appropriate changes and corrections and reduce the possibility of recurrence.

All losses are important regardless of whether they resulted in injury and/or property damage. As a result,
all incidents, no matter how minor, should be investigated.

Loss investigations should begin the moment it is known that a loss has occurred. The passage of time
tends to erase and color the facts surrounding a loss and key witnesses may leave the scene. A delay of
only a few hours may permit evidence to be removed, destroyed, or forgotten.

The supervisor and/or manager for the area involved should be responsible for conducting the accident
investigation.

How we approach people in our investigation will often determine the amount of information we receive
and the success or failure of the investigation. Fault finding , trying to fix blame , or giving this impression
will accomplish little toward obtaining the required information for a thorough investigation. Although many
accident investigation report forms are available, it is important that you review these forms to make
certain that they do not restrict the investigation, and that the required facts (the accident, basic and
primary cause(s) and the corrective action) are covered.

One of the most important and over-used words in the fact finding process is the word "Why". Thoroughly
determining the answer to "why" an unsafe act or an unsafe condition occurred, and "why" it was permitted
to exist in the first place will assist you in your analysis. Asking this question will help you pinpoint areas
where weaknesses exist and where efforts should be concentrated to reduce those exposures.

In short, the benefits of loss investigation are numerous. Chief among them are the development of
actions to correct the unsafe act or condition and to strengthen your management system. Completed
loss investigation reports should be routed to a person in the organization who has the authority and
responsibility to see that the necessary changes are made. Accountability will then be built into your loss
investigation program.




                                                                                                                                           Formatted: Font: (Default) Arial
Trident Insurance Services provides this Manual as part of its efforts to reduce the risk of insurance loss and claims. This          63
Manual is advisory only and not intended to address every potential hazard or any insured specifically. Trident does not
warrant that all loss and/or claims will be avoided if the Manual is used. Trident further in no way intends to relieve the insured
of its own duties and obligations, nor is Trident undertaking on behalf of or for the benefit of the insured any duty or obligation
to ensure that the insured’s property and operations are safe, healthful and in compliance with any law, rule, or regulation.
Insureds remain responsible for their own efforts to reduce risks and should consult their own legal counsel for appropriate
guidance.
                                                                                                                                           Formatted: Font: (Default) Arial
                                   SAMPLE DRAFT PROGRAM

1.        PROCEDURES

1.1.      Written loss reporting notification, response, investigation, and training requirements should
          exist and define what accidents are to be investigated, by whom, when, and how thoroughly.

1.2.      Procedure Requires:

          1.2.1.    Reporting and investigation of all accidents involving personal injury or near miss
                    accidents that have the potential for personal injury.

          1.2.2.    Implementation of pre-established emergency response procedures to care for the
                    injured, minimize the risk of further losses, and preserve and gather evidence for
                    investigation.

          1.2.3.    Factual documentation of the accident, investigation; recommendations and actions taken
                    to prevent similar occurrences.

          1.2.4.    Completion of an accident investigation report by the appropriate Supervisor for all OSHA
                    recordable injuries and those near-miss accidents involving the potential for significant
                    loss.

                    1.2.4.1. Department managers should review all accident investigation reports for clarity,
                             timeliness and appropriate corrective measures to eliminate similar accident/near
                             miss occurrences.

                    1.2.4.2. Facility manager should review all lost time cases with the department
                             manager.

                    1.2.4.3. Safety Coordinator should conduct a special review meeting with the Facility
                             Manager for all work related injuries/illnesses involving fatalities.

2.        REPORTING REQUIREMENTS

2.1.      Immediate Reporting of Work Related Serious Accidents

          We are always concerned about serious accidents that cause suffering or death to our
          employees. Serious accidents are to be reported immediately under both corporate and OSHA
          requirements. If the accident involves a fatality or serious injuries involving three or more
          employees and require hospitalization, then the accident must be reported to OSHA verbally
          within 8 hours of its occurrence.

2.2.      Routine Reporting

          2.2.1.    All accidents are to be investigated and documented using the Accident Investigation
                    Report.

                    2.2.1.1. A copy of each accident investigation report is to be forwarded to the safety
                             coordinator upon completion.

          2.2.2.    All workers' compensation injuries are to be investigated, documented and reported in
                    compliance with each location's state workers’compensation requirements.

3.        TRAINING/RESOURCES                                                                                                               Formatted: Font: (Default) Arial
Trident Insurance Services provides this Manual as part of its efforts to reduce the risk of insurance loss and claims. This          64
Manual is advisory only and not intended to address every potential hazard or any insured specifically. Trident does not
warrant that all loss and/or claims will be avoided if the Manual is used. Trident further in no way intends to relieve the insured
of its own duties and obligations, nor is Trident undertaking on behalf of or for the benefit of the insured any duty or obligation
to ensure that the insured’s property and operations are safe, healthful and in compliance with any law, rule, or regulation.
Insureds remain responsible for their own efforts to reduce risks and should consult their own legal counsel for appropriate
guidance.
                                                                                                                                           Formatted: Font: (Default) Arial
                                   SAMPLE DRAFT PROGRAM


3.1.      The plant manager is accountable for assuring that line and staff personnel are trained on
          how to conduct effective accident investigations.

3.2.      A safety coordinator should be available and involved in the investigation of serious or potentially
          serious accidents.

4.        ADMINISTRATION

4.1.      Supervisor's Accountability

          4.1.1.    Initiates the accident investigation.

          4.1.2.    Identifies accident causative factors.

          4.1.3.    Takes corrective action.

                    4.1.3.1. Corrective action should be permanent so as to prevent recurrence.

                    4.1.3.2. Temporary corrective measures are appropriate if the corrective action requires
                             capital funds approval, ordering of materials, outside services and/or the
                             exposure is low.

                    4.1.3.3. Exposures that have a high potential for an accident occurrence and continue to
                             be a high exposure as a result of the inability to initiate temporary corrective
                             action should be reviewed and discussed with the Facility Manager.

          4.1.4.    Counsels employee(s) on safe operating procedures as required by the safety program.

          4.1.5.    Conducts daily inspection of department to reinforce/monitor corrective action taken.

4.2.      Facility Manager Immediate Supervisor - Accountability

          4.2.1.    Review completed accident investigation report for:

                    4.2.1.1. Clarity in describing the accident causative factors.

                    4.2.1.2. Appropriateness of corrective action taken.

                    4.2.1.3. Timeliness of corrective action activities.

          4.2.2.    Provide feedback to supervisory personnel on strengths/weaknesses in meeting the
                    accident investigation program objectives.

          4.2.3.    Accident investigation should be addressed in supervisory performance reviews.

4.3.      Facility Manager - Accountability

          4.3.1.    Hold subordinates accountable for the accident investigation program and address in any
                    performance reviews.

          4.3.2.    Implement program changes as initiated through the safety coordinator.
                                                                                                                                           Formatted: Font: (Default) Arial
Trident Insurance Services provides this Manual as part of its efforts to reduce the risk of insurance loss and claims. This          65
Manual is advisory only and not intended to address every potential hazard or any insured specifically. Trident does not
warrant that all loss and/or claims will be avoided if the Manual is used. Trident further in no way intends to relieve the insured
of its own duties and obligations, nor is Trident undertaking on behalf of or for the benefit of the insured any duty or obligation
to ensure that the insured’s property and operations are safe, healthful and in compliance with any law, rule, or regulation.
Insureds remain responsible for their own efforts to reduce risks and should consult their own legal counsel for appropriate
guidance.
                                                                                                                                           Formatted: Font: (Default) Arial
                                   SAMPLE DRAFT PROGRAM

5.        REPORTING FORMS

5.1.      Management/Safety Coordinators are to utilize the following reporting forms:

          5.1.1.    Accident Investigation Report (Attached)

          5.1.2.    Accident Investigation Report Employee Description (Attached)

          5.1.3.    Physician's Report (Attached)




                                                                                                                                           Formatted: Font: (Default) Arial
Trident Insurance Services provides this Manual as part of its efforts to reduce the risk of insurance loss and claims. This          66
Manual is advisory only and not intended to address every potential hazard or any insured specifically. Trident does not
warrant that all loss and/or claims will be avoided if the Manual is used. Trident further in no way intends to relieve the insured
of its own duties and obligations, nor is Trident undertaking on behalf of or for the benefit of the insured any duty or obligation
to ensure that the insured’s property and operations are safe, healthful and in compliance with any law, rule, or regulation.
Insureds remain responsible for their own efforts to reduce risks and should consult their own legal counsel for appropriate
guidance.
                                                                                                                                           Formatted: Font: (Default) Arial
                                   SAMPLE DRAFT PROGRAM

                               Emergency Response Plans

The following Emergency Response Plan describes the designated actions management and staff must
take to ensure safety during emergencies ranging from such natural disasters as tornadoes, hurricanes,
earthquakes and floods, to fire, chemical spills and other potential hazardous conditions.

Because emergency conditions may arise at any time and from many different causes, planning is
necessary to minimize employee injury and property damage. Some of the obvious benefits from being
prepared are reduced injuries and diminished property loss. Indirect benefits may include lower insurance
costs, higher morale, and reduced worker's compensation costs.

Eachfacility should develop their own action plan using the following outline:

1.        Emergency First Responder Team
          a.    Qualifications
          b.    Duties

2.        Emergency First Responder Team
          a.    Recruitment
          b.    Training
          c.    Duties

3.        Emergency Equipment and Supplies
          a.    Alarms
          b.    Communications
          c.    First Aid

5.        Map Indicating:
          a.     Escape Routes
          b.     Emergency Assembly Areas

6.        Shutdown Procedures

7.        Method to Account for all employees

8.        Security Measures

9.        Elements

10.       Timing

11.       Drills

The responsibility for creating and implementing a emergency response action plan at each individual
location rests with local management who can decide which program best fits the individual location needs
and budgetary constraints. However, management should seek input and support from all employees in
developing an emergency response action plan.

The emergency response action plan should be clear and made available to all personnel in manual form.
Also, the plan should be reviewed and updated as required to reflect changes in personnel and the
workplace.

Risk Assessment                                                                                                                            Formatted: Font: (Default) Arial
Trident Insurance Services provides this Manual as part of its efforts to reduce the risk of insurance loss and claims. This          67
Manual is advisory only and not intended to address every potential hazard or any insured specifically. Trident does not
warrant that all loss and/or claims will be avoided if the Manual is used. Trident further in no way intends to relieve the insured
of its own duties and obligations, nor is Trident undertaking on behalf of or for the benefit of the insured any duty or obligation
to ensure that the insured’s property and operations are safe, healthful and in compliance with any law, rule, or regulation.
Insureds remain responsible for their own efforts to reduce risks and should consult their own legal counsel for appropriate
guidance.
                                                                                                                                           Formatted: Font: (Default) Arial
                                   SAMPLE DRAFT PROGRAM


The emergency response action plan should address all potential risks and the related emergency
situations that may arise in each location. Effective risk assessment recognizes dangerous conditions and
builds a first line of defense against them. Local management should therefore identify the specific types
of disasters that pose the greatest threat to the individual location. Some of the exposures that should be
considered are:

          1.        Fire
          2.        Major gas and water main breaks
          3.        Flood
          4.        Earthquake
          5.        Snow and ice buildup
          6.        High winds
          7.        Tornado
          8.        Hurricanes (Obtain Coregis Hurricane Material)

This analysis, conducted after the potential disasters are identified, helps to develop realistic response
plans based on concrete disaster data.

Alarms

Since alarms alert staff and others to evacuate or take other action, alarms currently being used should be
evaluated to determine whether they are capable of being seen or heard by all persons in the facility.
Police and fire departments should be called in to evaluate the current number and configuration of alarms
in individual locations. (If system is installed and functional as an central MPS station.)

Communications Equipment

When alarms are activated, staff should be given evacuation instructions through the public address
system or intercom. During a disaster, communications equipment such as portable radio units and
battery operated P.A. systems are needed to determine outside conditions and communicate to
employees.

Emergency Evacuation Procedures

Floor plans or work area maps clearly showing escape routes should be posted in key areas where
employees can readily see them. These plans and/or maps should indicate the nearest shelter areas and
the best routes for escape.

Specific personnel should also be designated as responsible for accounting all staff after evacuation and
informing the Response Team of any missing staff members.

Shutdown Procedures

Before evacuation, staff should turn off appropriate critical facility systems such as electric, gas, etc. They
must complete these procedures before evacuating the facility.

Emergency and First Aid Supplies

Designated individuals should bring emergency supplies to their designated shelter area. These supplies
should to be stored in the immediate area, packaged in a kit-like form, kept fully stocked and used for
emergency purposes only. Supplies should be checked monthly to ensure their reliability and availability.
                                                                                                                                           Formatted: Font: (Default) Arial
Trident Insurance Services provides this Manual as part of its efforts to reduce the risk of insurance loss and claims. This          68
Manual is advisory only and not intended to address every potential hazard or any insured specifically. Trident does not
warrant that all loss and/or claims will be avoided if the Manual is used. Trident further in no way intends to relieve the insured
of its own duties and obligations, nor is Trident undertaking on behalf of or for the benefit of the insured any duty or obligation
to ensure that the insured’s property and operations are safe, healthful and in compliance with any law, rule, or regulation.
Insureds remain responsible for their own efforts to reduce risks and should consult their own legal counsel for appropriate
guidance.
                                                                                                                                           Formatted: Font: (Default) Arial
                                   SAMPLE DRAFT PROGRAM

At a minimum, the following items must be included: portable radio with spare batteries and flashlights
with spare batteries.

Also, designated individuals with a medical background or training should be in charge of bringing first-aid
supplies to their assigned shelter area. As with emergency supplies, first aid supplies should be stored in
the immediate area, packaged in a kit and checked on a monthly basis to ensure that all items are present
and in good working order. The following items may be included: bandages, antiseptics, special
medicines, blankets and a first-aid handbook.

Security Measures

An Emergency First Responder Team member with knowledge or experience in security should be
appointed to handle security issues after an emergency. This individual should compile a list of security
problems that can take place after a disaster, including looting of inventory, theft of records and
documents, and prevention of further accidents to onlookers and personnel in unsafe areas. Security
efforts should be coordinated with community law enforcement personnel.

Emergency First Responder Team Coordinator

An effective method for implementing the Emergency Response Plan is to assign that responsibility to an
Emergency First Responder Team (ERT) with an appointed leader and members including personnel
trained in emergency procedures.

A responsible, cool and quick-thinking individual should be designated Emergency First Responder Team
Coordinator. This individual should be able to withstand the arduous duties required in an emergency.

The duties of an Emergency First Responder Team Coordinator include:

          1.        Assessing the situation and determining whether the emergency requires the activation of
                    the Emergency Response Plan.

          2.        Directing the implementation of the Emergency Response Plan, including the evacuation
                    of personnel and the minimization of property loss.

          3.        Activating required security procedures.

An alternate Emergency First Responder Team Coordinator, with qualifications and authority similar to the
Emergency First Responder Team Coordinator, should be appointed and trained.

Personnel should be recruited who are physically capable of performing duties assigned to them by the
Emergency First Responder Team Coordinator. Ideal team members should already have training and
experience in responding to emergencies, such as volunteers on local fire, rescue and first-aid squads.

Emergency First Responder Teams should be trained in the following emergency procedures:

          1.        Firefighting

          2.        First aid and cardiopulmonary resuscitation (CPR).

          3.        Shutdown procedures.

          4.        Disaster evacuation procedures (tornado, flood, explosion, etc.)
                                                                                                                                           Formatted: Font: (Default) Arial
Trident Insurance Services provides this Manual as part of its efforts to reduce the risk of insurance loss and claims. This          69
Manual is advisory only and not intended to address every potential hazard or any insured specifically. Trident does not
warrant that all loss and/or claims will be avoided if the Manual is used. Trident further in no way intends to relieve the insured
of its own duties and obligations, nor is Trident undertaking on behalf of or for the benefit of the insured any duty or obligation
to ensure that the insured’s property and operations are safe, healthful and in compliance with any law, rule, or regulation.
Insureds remain responsible for their own efforts to reduce risks and should consult their own legal counsel for appropriate
guidance.
                                                                                                                                           Formatted: Font: (Default) Arial
                                   SAMPLE DRAFT PROGRAM

          5.        Chemical spill control procedures (not all locations).

          6.        Use of personal protective equipment, including respirators (not all locations).

          7.        Search and rescue procedures.

All team members should be informed about any special hazards such as flammable materials.




                                                                                                                                           Formatted: Font: (Default) Arial
Trident Insurance Services provides this Manual as part of its efforts to reduce the risk of insurance loss and claims. This          70
Manual is advisory only and not intended to address every potential hazard or any insured specifically. Trident does not
warrant that all loss and/or claims will be avoided if the Manual is used. Trident further in no way intends to relieve the insured
of its own duties and obligations, nor is Trident undertaking on behalf of or for the benefit of the insured any duty or obligation
to ensure that the insured’s property and operations are safe, healthful and in compliance with any law, rule, or regulation.
Insureds remain responsible for their own efforts to reduce risks and should consult their own legal counsel for appropriate
guidance.
                                                                                                                                           Formatted: Font: (Default) Arial
                                   SAMPLE DRAFT PROGRAM

Intentionally left Blank for Insertion of Foreign and Domestic Terrorism section.)




                                                                                                                                           Formatted: Font: (Default) Arial
Trident Insurance Services provides this Manual as part of its efforts to reduce the risk of insurance loss and claims. This          71
Manual is advisory only and not intended to address every potential hazard or any insured specifically. Trident does not
warrant that all loss and/or claims will be avoided if the Manual is used. Trident further in no way intends to relieve the insured
of its own duties and obligations, nor is Trident undertaking on behalf of or for the benefit of the insured any duty or obligation
to ensure that the insured’s property and operations are safe, healthful and in compliance with any law, rule, or regulation.
Insureds remain responsible for their own efforts to reduce risks and should consult their own legal counsel for appropriate
guidance.
                                                                                                                                           Formatted: Font: (Default) Arial
                                   SAMPLE DRAFT PROGRAM


Local Offsite Emergency Responders

A survey of the location and services provided by local offsite emergency responders should be
conducted. Information that should be provided to each of these agencies includes:

          1.        Fire Department

                    a.         The location, construction and arrangement of all buildings.
                    b.         Accurate floor plans of each building.
                    c.         Knowledge and acquaintance with all special hazards such as flammable gases,
                               liquids and materials.
                    d.         On-site fire equipment: type, location
                    e.         Access routes in and around the property.

          2.        Police Department

                    a.         The location, construction and arrangement of all buildings.
                    b.         Accurate floor plans of each building.
                    c.         Traffic patterns in and around the property.
                    d.         Potential security problems.

          3.        Ambulance Service(s)

                    a.         The location, construction and arrangement of all buildings.
                    b.         Accurate floor plans of each building.
                    c.         Access routes in and around the facilities.
                    d.         Hospital locations.

          4.        Staff Training

                    Staff should be trained in procedures to follow for each type of emergency, as proper
                    training reduces the possibility of panic and confusion. Any training should address the
                    following:

                    a.         Types of potential emergencies.
                    b.         Evacuation plans.
                    c.         Alarm systems.
                    d.         Reporting procedures.
                    e.         Operating equipment shutdown procedures.
                    f.         Response action.

One of the most important aspect of training is practice drills, which ensure that personnel know where to
report and what their duties are in an emergency. Drills should be held at random intervals, but at a
minimum of two times per year.

Staff should be evaluated as to their drill performance. Evidence of ineffective emergency response
procedures should be noted and investigated by management, with follow-up drills scheduled to determine
if past problems have been corrected.

Because fires are the most common and devastating hazard to which a entity will be exposed, special
attention should be directed to fire protection and prevention. In particular, a plan should be developed for
                                                                                                                                           Formatted: Font: (Default) Arial
Trident Insurance Services provides this Manual as part of its efforts to reduce the risk of insurance loss and claims. This          72
Manual is advisory only and not intended to address every potential hazard or any insured specifically. Trident does not
warrant that all loss and/or claims will be avoided if the Manual is used. Trident further in no way intends to relieve the insured
of its own duties and obligations, nor is Trident undertaking on behalf of or for the benefit of the insured any duty or obligation
to ensure that the insured’s property and operations are safe, healthful and in compliance with any law, rule, or regulation.
Insureds remain responsible for their own efforts to reduce risks and should consult their own legal counsel for appropriate
guidance.
                                                                                                                                           Formatted: Font: (Default) Arial
                                   SAMPLE DRAFT PROGRAM

response to a fire, including all elements of the emergency response plans previously described. In
addition, general approaches for fire protection and prevention should be evaluated.

Physical Fire Protection

Physical fire protection takes two forms: active and passive. Active protection helps to control and
extinguish a fire with automatic or manual equipment. Sprinklers constitute automatic equipment, while
fire extinguishers and small hoses constitute manual equipment. Passive protection contains a fire
through the use of fire walls, fire doors, and building construction.

Components of Automatic Fire Protection

The automatic sprinkler system is the most effective line of defense against a fire. Adequate sprinkler
protection means that sprinklers are provided where needed, none are missing, plugged, or blocked, and
the system design matches the fire challenge.

Advantages of automatic sprinklers are:

          1.        Always "on guard": sprinklers active 24 hours per day.

          2.        Prompt action: sprinklers operate while the fire is controllable.

          3.        Sends an alarm: locally or to a constantly attended location.

          4.        Operates only over the fire area: sprinklers away from the fire area do not discharge
                    water.

          5.        Pre-wets nearby combustibles: keeps them from igniting.

          6.        Less water, less water damage: sprinklers discharge less water, a lower pressure than
                    the hoses used to control fire in an unprotected building.




                                                                                                                                           Formatted: Font: (Default) Arial
Trident Insurance Services provides this Manual as part of its efforts to reduce the risk of insurance loss and claims. This          73
Manual is advisory only and not intended to address every potential hazard or any insured specifically. Trident does not
warrant that all loss and/or claims will be avoided if the Manual is used. Trident further in no way intends to relieve the insured
of its own duties and obligations, nor is Trident undertaking on behalf of or for the benefit of the insured any duty or obligation
to ensure that the insured’s property and operations are safe, healthful and in compliance with any law, rule, or regulation.
Insureds remain responsible for their own efforts to reduce risks and should consult their own legal counsel for appropriate
guidance.
                                                                                                                                           Formatted: Font: (Default) Arial
                                   SAMPLE DRAFT PROGRAM


Components of Manual Fire Protection

Fire extinguishers and small hoses are active forms of fire protection; however, unlike sprinklers, their
operation is manual and not automatic. Since most fires can be put out by employees using extinguishers
and small hoses, employees must be properly trained in their use. Extinguishers should be immediately
accessible and conspicuously located. In a small, unattended area, locate extinguishers where they can
be reached quickly, such as entrances. In a large area, place fire extinguishers 100 to 200 feet apart. All
extinguishers should be clearly marked with signs directing attention to their location.

In comparison to extinguishers, small hoses provide an "unlimited" supply of water and cover a greater
range. Small hoses should be located so that all areas of the facility can be reached with hose length at
each station not exceeding 100 feet.

Because both of these protection methods are used in the early stages of a fire, maintaining them is
critical.

Housekeeping

Housekeeping has an important role in loss control. Paper and debris can act as an ignition source or fuel
for a fire. Storage areas, aisles or spaces in between racks should be regularly cleared of trash. Storage
in the aisles, or storage too close to sprinkler heads, should be eliminated and prohibited.

Sprinkler Control Valve Supervision

Sprinkler control valves regulate the water flow to the automatic sprinklers and should be locked in the
open position to ensure adequate flow. Valves should be visually inspected weekly and physically tested
monthly.

Fire Protection Equipment

Automatic and manual fire fighting equipment should also be checked regularly. Portable fire
extinguishers should be examined to see that they are full, adequately charged, and that the seal pin and
hose are present and in good condition. Extinguishers should be of proper size and classification.

Fire doors (if installed) should be inspected for proper closure, and doorways should be visually inspected
for potential obstructions that may prevent proper closing. Check door mechanisms and guides to ensure
they have not been damaged. Consider installing barriers to protect door mechanisms from physical
damage caused by warehouse traffic.




                                                                                                                                           Formatted: Font: (Default) Arial
Trident Insurance Services provides this Manual as part of its efforts to reduce the risk of insurance loss and claims. This          74
Manual is advisory only and not intended to address every potential hazard or any insured specifically. Trident does not
warrant that all loss and/or claims will be avoided if the Manual is used. Trident further in no way intends to relieve the insured
of its own duties and obligations, nor is Trident undertaking on behalf of or for the benefit of the insured any duty or obligation
to ensure that the insured’s property and operations are safe, healthful and in compliance with any law, rule, or regulation.
Insureds remain responsible for their own efforts to reduce risks and should consult their own legal counsel for appropriate
guidance.
                                                                                                                                           Formatted: Font: (Default) Arial
                                   SAMPLE DRAFT PROGRAM


Building safety requires a swift response to any fire situation. Employees must be well-trained in the
details of handling the fire emergency.

The duties described below should be assigned to employees who will respond to a fire:

          1.        Notify Public Fire Department and Police Department of emergency.

          2.        Contact all Emergency Response Team members.

          3.        Maintain current phone list.

          4.        Manage the emergency until the Fire Department arrives.

          5.        Staff and train members of the emergency organization.

          6.        Cut off potential fuel supply to the fire (flammable liquids, gases) and any systems that
                    may interfere with firefighting (steam, coolants).

          7.        Manually "try" valve for automatice sprinkler system to make sure that it is open.

          8.        Cut off any power that can contribute to an emergency.

          9.        Control ventilation system to:
                    a.      Limit air to the fire.
                    b.      Stop fire's spread through ventilation ducts.
                    c.      Limit smoke damage.

          10.       Install temporary light/power system after loss.

          11.       Check operation of emergency lighting.

                                              Confined Space Entry Program

A confined space/vessel is defined as "any space confined or semi-confined not intended for human
occupancy which is either open/closed and in which toxic or flammable vapors could accumulate or a
deficiency of oxygen could occur". Such spaces would include but are not limited to tanks, silos, vats,
bins, hoppers, boilers, sewers, manholes, tunnels, chimneys and scale pits.

Oxygen deficiency is an atmosphere containing oxygen at a concentration of less than 19.5% by volume.

Oxygen danger occurs in atmosphere containing less than 19.5% or more than 23.5% by volume oxygen.




                                                                                                                                           Formatted: Font: (Default) Arial
Trident Insurance Services provides this Manual as part of its efforts to reduce the risk of insurance loss and claims. This          75
Manual is advisory only and not intended to address every potential hazard or any insured specifically. Trident does not
warrant that all loss and/or claims will be avoided if the Manual is used. Trident further in no way intends to relieve the insured
of its own duties and obligations, nor is Trident undertaking on behalf of or for the benefit of the insured any duty or obligation
to ensure that the insured’s property and operations are safe, healthful and in compliance with any law, rule, or regulation.
Insureds remain responsible for their own efforts to reduce risks and should consult their own legal counsel for appropriate
guidance.
                                                                                                                                           Formatted: Font: (Default) Arial
                                   SAMPLE DRAFT PROGRAM


Dangerous air contamination is an atmosphere presenting a threat of causing death, injury, acute illness
or disablement due to the presence of flammable and/or explosive toxic or otherwise injurious or
incapacitating substances. The following should be prepared:

          1.        A published Confined Space Entry Procedure and Permit System personalized for each
                    facility
.
          2.        A current list of confined spaces requiring entry, the reason for entry and frequency of
                    entry.

The following information should be provided on the permit prior to the start of each confined space entry.

Staff Assigned:

          1. Description of equipment and work to be performed.

          2. Preparations required to ensure safe working conditions.

          3. Precautionary measures and required safety and rescue equipment.

          4. Testing requirements.

                    1.         Complete and post the Confined Entry Space Permit.

                    2.         Isolate the confined space.

                    3.         Drain and Purge the confined space.

                    4.         Ventilate the confined space.

                    5.         Test the atmosphere inside the confined space (PEL of materials common to
                               task).

                    6.         Select and use the correct protective gear.

                    7.         Prepare for emergencies: Entry supervisor who has an staff member enter a
                               confined space should be capable of effecting a rescue, have rescue equipment
                               immediately available, be equipped with a self-contained breathing apparatus,
                               and trained in its use.

                    8.         A pre-job discussion by management and staff involved in specific work activity.

                    9.         Enter the vessel.

No employee should, under any circumstances, enter a confined space without the written permission of
the entry supervisor or manager in charge of the operation where the confined space is located. The
written permit should be issued only after the supervisor or manager is satisfied personally with the
confined space preparation, precaution to be taken, personal protective equipment to be used, and the
procedures to be followed.

All staff having exposure to confined space environment should be trained in accordance with current
OSHA standards program: Confined Spaces: A Training Program for Employees.                                                                 Formatted: Font: (Default) Arial
Trident Insurance Services provides this Manual as part of its efforts to reduce the risk of insurance loss and claims. This          76
Manual is advisory only and not intended to address every potential hazard or any insured specifically. Trident does not
warrant that all loss and/or claims will be avoided if the Manual is used. Trident further in no way intends to relieve the insured
of its own duties and obligations, nor is Trident undertaking on behalf of or for the benefit of the insured any duty or obligation
to ensure that the insured’s property and operations are safe, healthful and in compliance with any law, rule, or regulation.
Insureds remain responsible for their own efforts to reduce risks and should consult their own legal counsel for appropriate
guidance.
                                                                                                                                           Formatted: Font: (Default) Arial
                                   SAMPLE DRAFT PROGRAM


                                                    (LOCK OUT/TAG OUT)

Controlling hazardous energy sources (lock out/tag out) involves servicing and maintaining machines and
equipment that can unexpectedly start up or release stored energy and cause injury to persons or
property. Typical injuries to operating personnel include fractures, lacerations, contusions, amputations
and puncture wounds, with an average lost time of 24 days.

Please note that the generation, transmission and distribution of electric power by utilities and work on
electric conductors and equipment are not covered below because lock out/tag out procedures for these
specific industries are addressed in separate standards under development.

Generally, energy sources for equipment should be turned off or disconnected, and the power or operation
switch either locked or labeled with a warning tag. Facility managers should also ensure that the following
steps are taken:

          1.        Develop an energy control program.

          2.        Use locks when equipment can be locked out.

          3.        Ensure that new equipment or overhauled equipment can accommodate locks.

          4.        Employ additional means to ensure safety when tags rather than locks are used by using
                    an effective tag out program.

          5.        Identify and implement specific procedures (generally in writing) for the control of
                    hazardous energy, including preparation for shutdown, shutdown, equipment isolation,
                    lock out/tag out application, release of stored energy, and verification of isolation.

          6.        Institute procedures for release of lock out/tag out, including machine inspection,
                    notification and safe positioning of employees and removal of the lock out/tag out device.

          7.        Obtain standardized locks and tags the indicate the identity of the employee using them
                    and are of sufficient quality and durability to ensure their effectiveness.

          8.        Require inspections of energy control procedures at least annually.

          9.        Train staff in the specific energy control procedures with training reminders as part of the
                    annual inspections of the control procedures at least annually.

          10.       Adopt procedures to ensure safety when equipment must be tested during servicing,
                    when outside contractors are working at the site, when a multiple lock out is needed for a
                    crew servicing equipment and when shifts or personnel change.




                                                                                                                                           Formatted: Font: (Default) Arial
Trident Insurance Services provides this Manual as part of its efforts to reduce the risk of insurance loss and claims. This          77
Manual is advisory only and not intended to address every potential hazard or any insured specifically. Trident does not
warrant that all loss and/or claims will be avoided if the Manual is used. Trident further in no way intends to relieve the insured
of its own duties and obligations, nor is Trident undertaking on behalf of or for the benefit of the insured any duty or obligation
to ensure that the insured’s property and operations are safe, healthful and in compliance with any law, rule, or regulation.
Insureds remain responsible for their own efforts to reduce risks and should consult their own legal counsel for appropriate
guidance.
                                                                                                                                           Formatted: Font: (Default) Arial
                                   SAMPLE DRAFT PROGRAM

Excluded from the Act is:

          1.        Normal production operations including repetitive, routine minor adjustments and
                    maintenance which would be covered under OSHA's machine guarding standards.

          2.        Work only on cord and plug connected electric equipment when it is unplugged and when
                    employee working on the equipment has complete control over the plug.

          3.        Hot tap operators involving gas, steam, water or petroleum products when the employer
                    shows that continuity of service is essential, shutdown is impractical and documented
                    procedures are followed to provide proven effective protection for staff.

The final rule on Lock outs was published in the Federal Register September 1, 1989 with implementation
effective October 31, 1989.

A lock out procedure is a system ensuring that equipment has been de-energized and cannot operate.
Effective lock out procedures will prevent unexpected operation of machines and, thereby, eliminate a
prime source of injury to maintenance personnel.

Lock out procedures are needed for these and other operations:

          1.        Electrical lubrication of moving machine parts.

          2.        Routine lubrication of moving machine parts.

          3.        Sanitation or cleaning of machinery.

          4.        De-jamming.

          5.        Maintenance of high pressure, high temperature or hazardous substance pipelines.

Whenever maintenance is done on potentially hazardous equipment, there should be a lock out
procedure. To be effective, the procedure should incorporate provisions for adequate hardware,
employee training, documentation, and enforcement.

Common hardware used for lock outs consists of multiple lock out devices, padlocks and notification tags.




                                                                                                                                           Formatted: Font: (Default) Arial
Trident Insurance Services provides this Manual as part of its efforts to reduce the risk of insurance loss and claims. This          78
Manual is advisory only and not intended to address every potential hazard or any insured specifically. Trident does not
warrant that all loss and/or claims will be avoided if the Manual is used. Trident further in no way intends to relieve the insured
of its own duties and obligations, nor is Trident undertaking on behalf of or for the benefit of the insured any duty or obligation
to ensure that the insured’s property and operations are safe, healthful and in compliance with any law, rule, or regulation.
Insureds remain responsible for their own efforts to reduce risks and should consult their own legal counsel for appropriate
guidance.
                                                                                                                                           Formatted: Font: (Default) Arial
                                   SAMPLE DRAFT PROGRAM


Multiple Lock out Devices

A multiple lock out device is an interlocking hasp with several holes. The device is placed on the
equipment lock out hasp or adaptor. Each maintenance staff member places his or her padlock shackle
through the holes and secures the lock. By using this device, several employees may lock out and work
on the same equipment. The equipment cannot be operated until the device and last padlock is removed.

Padlocks

Key operated padlocks should be issued to each person who will use the lock out procedure.

Only one key should be issued to the lock holder. The supervisor or manager may have a duplicate or
master key, but for maximum safety only one key per lock is best. If a lock must be removed and the key
has been lost or there is an emergency, the lock can be cut.

Each lock should be identified by the user's name and department. This information can be stamped or
engraved on the lock case. Locks should never be loaned.

Tags

Notification tags are four-by-six inch sturdy paper or plastic signs that are placed on the machine being
maintained or repaired. Captions state "Machine Under Repair" or words to that effect. The tags are a
useful adjunct to the lock out procedure and should be used only in conjunction with lock out hardware.

A carefully sequenced procedure should be developed for the lock out of each potentially hazardous
machine and pipeline and for all electrical controls. The procedure should be written and kept on file. As
new equipment is purchased or existing equipment modified, these procedures should be reviewed and
appropriately revised.

All maintenance personnel should be thoroughly trained in lock out procedures. The specific hazards
involved with equipment maintenance should be emphasized to all employees. Periodic review training is
essential to maintain an effective lock out procedure. Once the procedure has been documented and
employees trained, the lock out procedure must also be enforced.

The following is a basic lock out procedure that can be adapted for individual needs:

          1.        Notify the department head, maintenance supervisor, or facility management before
                    beginning any work.

          2.        Turn off point of operation equipment controls.

          3.        In the case of electrical equipment, turn off or disconnect the main power switches.

          4.        After switches or valves have been turned off, place padlocks through the lock on the
                    control or through the multiple lock out device. Notification tags also should be placed at
                    the control indicating that the equipment is being repaired.

          5.        Try the disconnect or switch to verify that it cannot be moved.

          6.        Test equipment rams, shears, augers, blades and other parts to ensure moving parts
                    cannot cycle during the repair or maintenance work.
                                                                                                                                           Formatted: Font: (Default) Arial
Trident Insurance Services provides this Manual as part of its efforts to reduce the risk of insurance loss and claims. This          79
Manual is advisory only and not intended to address every potential hazard or any insured specifically. Trident does not
warrant that all loss and/or claims will be avoided if the Manual is used. Trident further in no way intends to relieve the insured
of its own duties and obligations, nor is Trident undertaking on behalf of or for the benefit of the insured any duty or obligation
to ensure that the insured’s property and operations are safe, healthful and in compliance with any law, rule, or regulation.
Insureds remain responsible for their own efforts to reduce risks and should consult their own legal counsel for appropriate
guidance.
                                                                                                                                           Formatted: Font: (Default) Arial
                                   SAMPLE DRAFT PROGRAM

          7.        When the work is completed, remove padlocks and tags and notify department manager
                    of completed work.

GENERAL:

Lock out is the preferred method of isolating machines/equipment from energy sources. The following
procedure meets the requirements of Occupational Safety and Health Standards 29 CFR Part 1910.147,
and is provided for use in developing a lock out program. This procedure may be used when there are
limited number or types of machines/equipment or there is a single power source. For more complex
systems, a more comprehensive procedure will need to be developed, documented, and utilized. Lock out
procedures are to be followed anytime an staff member or other individual may be exposed to an
unexpected energizing or startup of the equipment, release of hazardous energy, bypassing a guard, or
placing part of body into working area or danger zone during servicing and maintenance.

PURPOSE:

This procedure establishes the minimum requirements for the lock out of energy-isolating devices,
including circuit breakers, switches, disconnects, valves, blocks, etc. This procedure may be used to
ensure that the machine or equipment is isolated from all potentially hazardous energy, and locked out
with a keyed padlock before anyone performs servicing or maintenance. This procedure addresses
hazards that may arise from electrical, mechanical, hydraulic, pneumatic, chemical, thermal, or other
energy sources.

RESPONSIBILITY:

The Program Coordinator, with the assistance of the Human Resources Department, should schedule all
staff for mandatory training. Annually, the Coordinator should review the Lock out Training Program and
Procedures to update and modify as needed. The Program Coordinator should also annually conduct a
plant inspection of the energy control procedure to ensure that the procedure and the requirements of the
lock out standard are being followed. This inspection should encompass a review between the
Coordinator and each “Authorized Employee” responsible for the energy control procedures. The Program
Coordinator along with any maintenance supervisors should be responsible for enforcing lock out
procedures, maintaining lock out equipment, filing Lock out Checklist forms, and controling emergency
spare lock out keys. All authorized and trained staff should will be required to follow the mandatory lock
out procedures as outlined. A safety committee may also be established to evaluate the effectiveness of
the lock out program.




                                                                                                                                           Formatted: Font: (Default) Arial
Trident Insurance Services provides this Manual as part of its efforts to reduce the risk of insurance loss and claims. This          80
Manual is advisory only and not intended to address every potential hazard or any insured specifically. Trident does not
warrant that all loss and/or claims will be avoided if the Manual is used. Trident further in no way intends to relieve the insured
of its own duties and obligations, nor is Trident undertaking on behalf of or for the benefit of the insured any duty or obligation
to ensure that the insured’s property and operations are safe, healthful and in compliance with any law, rule, or regulation.
Insureds remain responsible for their own efforts to reduce risks and should consult their own legal counsel for appropriate
guidance.
                                                                                                                                           Formatted: Font: (Default) Arial
                                   SAMPLE DRAFT PROGRAM

LOCK OUT SURVEY:

A Lock out Survey locates and identifies all isolating devices to ensure that the appropriate switches,
valves, or other energy isolating devices are locked out. More than one energy source (electrical,
hydraulic, mechanical, pneumatic, thermal, etc.) may be involved and may require multiple lock outs.

TRAINING:

Authorized maintenance and safety personnel should be trained annually and when initially hired in the
recognition of applicable hazardous energy sources, the type and magnitude of the energy available in the
workplace, and the method and means necessary for energy isolation and control. All other staff should be
trained as “affected employees” annually and when initially hired in the purpose and use of the energy
control procedure and about the consequences for attempts to restart or re-energizelocked out machines
or equipment . Retraining should be provided whenever there is a change in job assignments, in
machines, equipment, or processes that present a new hazard, or in the energy control procedures.

CERTIFICATION:

All authorized maintenance and safety personnel should date and sign the Lock out Training Form for
“authorized employees” after completing training. All other staff should date and sign the Lock out
Training Form for “affected employees” after completing a separate training program. The Human
Resources Department should maintain all signed forms in the individual personnel files.

SEQUENCE OF LOCK OUT PROCEDURES:

1.        “Authorized Employees” should know before beginning lock out procedures the type, magnitude,
          and hazards of energy that the machine or equipment utilizes.

2.        Notify all “Affected Employees” when, where, and why a lock out system will be utilized.

3.        Post lock out sign in a visible position on the machine or equipment to be locked out.

4.        If the machine or equipment is operating, shut it down by the normal stopping procedure (depress
          stop button, open toggle switch, etc.).

5.        Operate the switch, valve, unplug, quick disconnect, or other energy isolating devices so that the
          equipment is isolated from its energy sources. Stored energy such as springs, elevated machine
          members, rotating flywheels, hydraulic systems, air, gas, steam, or water pressure, etc. must be
          dissipated or restrained by methods such as reposition, blocking, bleeding, etc.

6.        Lock out the energy isolating devices with the specially assigned red individual locks. Use yellow
          cylinder boxes to lock out plugs, quick disconnects, or remote witches. Sign, date, and attach
          Lock out Identification Tag through the lock pin.

7.        After ensuring that no “affected employees” are exposed, and as a check for proper disconnection
          of the energy sources, operate the push button or other normal operating controls to make certain
          that the equipment will not operate. Return operating controls to off or neutral position after test.

8.        The equipment is now locked out, and maintenance and servicing can begin.


                               TESTING/POSITIONING OF MACHINES/EQUIPMENT:
                                                                                                                                           Formatted: Font: (Default) Arial
Trident Insurance Services provides this Manual as part of its efforts to reduce the risk of insurance loss and claims. This          81
Manual is advisory only and not intended to address every potential hazard or any insured specifically. Trident does not
warrant that all loss and/or claims will be avoided if the Manual is used. Trident further in no way intends to relieve the insured
of its own duties and obligations, nor is Trident undertaking on behalf of or for the benefit of the insured any duty or obligation
to ensure that the insured’s property and operations are safe, healthful and in compliance with any law, rule, or regulation.
Insureds remain responsible for their own efforts to reduce risks and should consult their own legal counsel for appropriate
guidance.
                                                                                                                                           Formatted: Font: (Default) Arial
                                   SAMPLE DRAFT PROGRAM


1.        Inspect the work area to ensure that nonessential tools and material have been removed and that
          the machine/equipment components are operationally intact.

2.        Notify and remove employees from the machine/equipment area.

3.        Remove the lock out devices applied by the Authorized Employee.

4.        Energize and proceed with testing/positioning.

5.        De-energize all systems and reapply energy control measures as outlined in Sequence of Lock
          out Procedures.

RESTORING TO NORMAL OPERATION:

1.        After the servicing and maintenance is completd, and the equipment is ready for normal
          production operations, check the area around the machines or equipment to ensure that no one is
          exposed to danger.

2.        After all tools have been removed from the machine or equipment, guards have been reinstalled
          and employees are in the clear, the individual applying the lock out device should remove all lock
          out devices, identification tags, and signs, and operate the energy isolating devices to restore
          energy to the machine or equipment.

PROCEDURE INVOLVING MORE THAN ONE PERSON:

1.        In the preceding steps, if more than one individual is required to lock out equipment, each
          individual should place their own personal lock out device on the energy isolating devices.

2.        When an energy isolating device cannot accept multiple locks, a special red multiple lock out hasp
          should be used.

EMERGENCY LOCK OUT REMOVAL:

1.        The Maintenance Supervisor and Plant Manager should first verify that the Authorized Employee
          who applied the device is not at the facility.

2.        The Plant Manager should be present at the machine/equipment before the Maintenance
          Supervisor uses the emergency spare key or other means to remove lock out device.

3.        All reasonable effort must be made to contact and inform the “Authorized Employee” of the
          removal of the lock out device.

4.        The Authorized Employee should be informed before resuming work at the facility that the lock out
          device was removed.

LOCK OUT CHECKLIST:

1.        The Lock out Checklist should be followed and completed during all lock out and restoring of
          machines/equipment.


                                                                                                                                           Formatted: Font: (Default) Arial
Trident Insurance Services provides this Manual as part of its efforts to reduce the risk of insurance loss and claims. This          82
Manual is advisory only and not intended to address every potential hazard or any insured specifically. Trident does not
warrant that all loss and/or claims will be avoided if the Manual is used. Trident further in no way intends to relieve the insured
of its own duties and obligations, nor is Trident undertaking on behalf of or for the benefit of the insured any duty or obligation
to ensure that the insured’s property and operations are safe, healthful and in compliance with any law, rule, or regulation.
Insureds remain responsible for their own efforts to reduce risks and should consult their own legal counsel for appropriate
guidance.
                                                                                                                                           Formatted: Font: (Default) Arial
                                   SAMPLE DRAFT PROGRAM

2.        All completed Lock out Checklists should to be turned in to the Maintenance Supervisor for 1 year
          recordkeeping after the job is finished.

3.        The Safety Committee and Program Coordinator should periodically review the Lock out Checklist
          File.

BASIC RULES FOR LOCK OUT PROCEDURE:

1.        All machines/equipment should be locked out to protect against accidental or inadvertent
          operation when such operation could cause injury to an individual.

2.        No switch, valve, circuit breaker, or other energy isolating device should be operated when it is
          locked out.

CONTRACTOR:

Whenever outside servicing personnel are to be engaged in activities covered by this Lock out Program,
the Facility Manager/Maintenance Supervisor, as well asthe outside employer, should inform each other of
their respective Lock out Procedures.




                                                                                                                                           Formatted: Font: (Default) Arial
Trident Insurance Services provides this Manual as part of its efforts to reduce the risk of insurance loss and claims. This          83
Manual is advisory only and not intended to address every potential hazard or any insured specifically. Trident does not
warrant that all loss and/or claims will be avoided if the Manual is used. Trident further in no way intends to relieve the insured
of its own duties and obligations, nor is Trident undertaking on behalf of or for the benefit of the insured any duty or obligation
to ensure that the insured’s property and operations are safe, healthful and in compliance with any law, rule, or regulation.
Insureds remain responsible for their own efforts to reduce risks and should consult their own legal counsel for appropriate
guidance.
                                                                                                                                           Formatted: Font: (Default) Arial
                                   SAMPLE DRAFT PROGRAM

                                                      FORKLIFT TRUCKS

(SAMPLE)            POWERED INDUSTRIAL TRUCK OPERATOR'S PERMIT


NAME: ____________________________________

SOCIAL SECURITY NO.: ______/_______/______
LICENSE NO.:______________________________

ISSUED BY:________________________________
POSITION: ________________________________

IS QUALIFIED TO OPERATE:

O LIFT TRUCK O TOWING TRACTOR                                 O OTHER

RESTRICTIONS:                  O NONE               O CORRECTIVE LENSES



OPERATOR'S SIGNATURE:_______________________________EXPIRES:__/__/__

A SAFE OPERATOR

          NEVER drives a vehicle until filling out the operator's check list.
          NEVER drives a vehicle without brakes or horn.
          NEVER exceeds the load limit of a vehicle.
          NEVER rides the clutch.
          NEVER goes down a ramp load first.
          NEVER smokes while re-fueling the engine.

AN OPERATORS LICENSE MUST BE CARRIED ON YOUR PERSON AT ALL
TIMES WHILE OPERATING A VEHICLE ON OUR BEHALF.

All drivers should be completely safe and accident free.

          1.        Safer drivers are more professional.
          2.        Cause less product damage.
          3.        Lower maintenance costs.
          4.        Increase efficiency.
          5.        Since 1971 OSHA requires certification of forklift drivers every two years. If the driver has
                    no accidents the first year, the certification is extended for the second year.
          6.        The money saved from avoiding accidents will benefit employees and the Conference.




                                                                                                                                           Formatted: Font: (Default) Arial
Trident Insurance Services provides this Manual as part of its efforts to reduce the risk of insurance loss and claims. This          84
Manual is advisory only and not intended to address every potential hazard or any insured specifically. Trident does not
warrant that all loss and/or claims will be avoided if the Manual is used. Trident further in no way intends to relieve the insured
of its own duties and obligations, nor is Trident undertaking on behalf of or for the benefit of the insured any duty or obligation
to ensure that the insured’s property and operations are safe, healthful and in compliance with any law, rule, or regulation.
Insureds remain responsible for their own efforts to reduce risks and should consult their own legal counsel for appropriate
guidance.
                                                                                                                                           Formatted: Font: (Default) Arial
                                   SAMPLE DRAFT PROGRAM

The types of forklifts available are:

          1.        Electric
          2.        Diesel
          3.        LPG
          4.        Gas

Facility traffic rules are the same as for cars in many situations.

1.        Safe habits are more important than speed. Conditions dictate forklift driving speed.
          a.     Beware of people walking or distracting you.
          b.     Truck or other traffic outside of the plant must always be observed.
          c.     Recognize that surface conditions may change and affect your driving.
2.        Always use your horn for blind corners and backing.
3.        Always have the load on upside of incline whether going up or coming down ramp or hill that is ten
          degrees or more, turning on hills can unbalance a load.

Train new drivers to use safe driving habits and remind experienced drivers to:

          1.        Watch out for bad habits.
          2.        Reduce accidents and improve efficiency.
          3.        Recall where and why accidents or near accidents occurred.
          4.        Take better care of the forklifts.

Some violations of operating principles are:

          1.        Speeding or careless driving.
          2.        Not looking in the direction that the forklift is moving.
          3.        Any form of stunt driving.
          4.        Carrying more than one person without a personnel carrier.
          5.        Jeopardizing the safety of employees or product due to carelessness.

There is a nameplate on each forklift that provides information concerning:

          1.        Load limit - the greatest weight that the forklift can carry.
          2.        Load center: - the location of the center of the weight.
          3.        Lift height - load should not be overextended as it affects forklift stability and mast
                    strength. For every six inches that you extend the load center, you must lower the weight
                    limit by 500 pounds.
          4.        When elevating the load, use one smooth movement, then lower the load gently to the
                    location where you want to set it. Jumpy movements strain the battery and hydraulics.
          5.        Loads should not be placed closer than 18 inches from ceiling, sprinkler heads, lights,
                    pipes, etc.
          6.        With any incline of 10 degrees or more, drive with the load uphill. .
                    a.       Do not turn around on the ramp.
                    b.       Be careful of loads shifting on inclines.




                                                                                                                                           Formatted: Font: (Default) Arial
Trident Insurance Services provides this Manual as part of its efforts to reduce the risk of insurance loss and claims. This          85
Manual is advisory only and not intended to address every potential hazard or any insured specifically. Trident does not
warrant that all loss and/or claims will be avoided if the Manual is used. Trident further in no way intends to relieve the insured
of its own duties and obligations, nor is Trident undertaking on behalf of or for the benefit of the insured any duty or obligation
to ensure that the insured’s property and operations are safe, healthful and in compliance with any law, rule, or regulation.
Insureds remain responsible for their own efforts to reduce risks and should consult their own legal counsel for appropriate
guidance.
                                                                                                                                           Formatted: Font: (Default) Arial
                                   SAMPLE DRAFT PROGRAM

                    c.         It is easier to unbalance a truck on the ramp.
                    d.         Ramps require increased stopping distances.

Driving characteristics of a forklift:

          1.        The truck weight is used to counterbalance the load weight.
          2.        The load weight always needs to be considered.
          3.        Moving parts horizontally and vertically.
          4.        No springs or shock absorbers.
          5.        Rear wheel steering.

Stability Triangle of a Format:

          1.        Three point suspension.
          2.        Center of gravity shift.
          3.        Heaviest weight should be put near the truck.
          4.        Seesaw principle.

Load Placement on the Forks:

          1.        Balanced loads.
          2.        Load weight vs. load center.
          3.        Effects of tilting the mast.
                    a.      When elevating.
                    b.      When traveling.

Review of basic operating principles

          1.        Know the limits of the forklift (you will find these on the nameplate of your truck).

          2.        Do not overload.
                    a.      Avoid excess weight.
                    b.      Avoid unstable loads.
                    c.      Make sure that the weight is distributed properly.

          3.        Stability triangle.

          4.        Seesaw principle.

          5.        Balanced loads.
                    a.     Balanced pallet.
                    b.     Strong enough, not broken pallet.
                    c.     Heavier end toward the mast.
                    d.     Tilting the mast alters the load center.
                    e.     Ramps can cause even balanced loads to change weight center.

          6.        Smooth operation is essential.

Inspect forklift before each use

          1.        Brakes most important.
          2.        Steering.
          3.        Abnormal leaks or sounds.                                                                                              Formatted: Font: (Default) Arial
Trident Insurance Services provides this Manual as part of its efforts to reduce the risk of insurance loss and claims. This          86
Manual is advisory only and not intended to address every potential hazard or any insured specifically. Trident does not
warrant that all loss and/or claims will be avoided if the Manual is used. Trident further in no way intends to relieve the insured
of its own duties and obligations, nor is Trident undertaking on behalf of or for the benefit of the insured any duty or obligation
to ensure that the insured’s property and operations are safe, healthful and in compliance with any law, rule, or regulation.
Insureds remain responsible for their own efforts to reduce risks and should consult their own legal counsel for appropriate
guidance.
                                                                                                                                           Formatted: Font: (Default) Arial
                                   SAMPLE DRAFT PROGRAM

          4.        Check for any unsafe conditions.

Inspect the area that you work in for:

          1.        Obstructions on the floor.
          2.        Loose dock plates.
          3.        Weak storage racks.
          4.        Wet areas or cracks on floors.
          5.        Weak floors on trucks.
          6.        People who are not paying attention to the forklift.

Safe, smooth movements help maintain forklifts in good working order

          1. Be alert to all driving and load conditions.
          2. Keep the forklift clean and check it daily for problems.

Do not do unauthorized maintenance work yourself.

Do not reach through the mast.

Do not work on lift mechanism that is not functioning.

Additional comments, suggestions or rules:

          1.        Use the same traffic rules as highway driving.
          2.        Keep to the right of the aisle, if possible.
          3.        Obey speed limit or reduce speed for hazardous conditions.
          4.        Do not tailgate.
          5.        Keep a space cushion around truck.
          6.        Slow down at intersections.
          7.        Sound horn at blind corners.
          8.        Give pedestrians the "Right of Way".

What are the problem locations at the facility?

          1.        People pulling parts and long pieces of extrusion out and into the aisles.
          2.        Outside traffic near the shipping area.
          3.        It is difficult for your eyes to adjust from the bright sun to indoor lighting.




                                                                                                                                           Formatted: Font: (Default) Arial
Trident Insurance Services provides this Manual as part of its efforts to reduce the risk of insurance loss and claims. This          87
Manual is advisory only and not intended to address every potential hazard or any insured specifically. Trident does not
warrant that all loss and/or claims will be avoided if the Manual is used. Trident further in no way intends to relieve the insured
of its own duties and obligations, nor is Trident undertaking on behalf of or for the benefit of the insured any duty or obligation
to ensure that the insured’s property and operations are safe, healthful and in compliance with any law, rule, or regulation.
Insureds remain responsible for their own efforts to reduce risks and should consult their own legal counsel for appropriate
guidance.
                                                                                                                                           Formatted: Font: (Default) Arial
                                   SAMPLE DRAFT PROGRAM

Be aware of save stopping distances.

          1.        Make sure that the brakes work each time that you get on the forklift.
          2.        Keep three forklift truck distances between yourself and another vehicle.
          3.        Be careful of blind corners.

Handling unsafe loads.

          1.        Broken pallets.
          2.        Damaged pallets, crushed cartons and bags.
          3.        If a load is too large so that you cannot see in front of it, drive in reverse looking in the
                    direction of movement.
          4.        Broken strapping.

Safe operating practices.

          1.        Dry hands and shoes avoid slipping.
          2.        Look around to make sure no person or thing is in the way of the forklift before you move
                    the truck.
          3.        Always know the position of fork tips.
                    a.       When parked, the tips should be on the ground.
                    b.       When driving over level ground, the forks should be no more than six inches
                             above the ground.
                    c.       Do not drive with forks elevated.
          4.        Fork trucks are not tow trucks and are not to pull loads.
          5.        Make sure aisles and doorways are clear.
          6.        Make sure that you will not hit overhead obstructions with a load.

Driving on ramps.

          1.        Trucks can become unstable on ramps.
          2.        The weight centers of loads change on ramps.
          3.        Loads can shift more easily on ramps.
          4.        Be careful of the sides of the ramp.
          5.        Ramps require increased stopping distance.

Driving on loading docks.

          1.        Do not drive too close to the edge.
          2.        The rear-end swing of the truck can cause problems on the loading dock.
          3.        Wet surfaces can cause a worse problem since the dock area is small and any error
                    appears worse.
          4.        Changing light conditions between the sunlight and indoor lighting may make it difficult
                    to see.




                                                                                                                                           Formatted: Font: (Default) Arial
Trident Insurance Services provides this Manual as part of its efforts to reduce the risk of insurance loss and claims. This          88
Manual is advisory only and not intended to address every potential hazard or any insured specifically. Trident does not
warrant that all loss and/or claims will be avoided if the Manual is used. Trident further in no way intends to relieve the insured
of its own duties and obligations, nor is Trident undertaking on behalf of or for the benefit of the insured any duty or obligation
to ensure that the insured’s property and operations are safe, healthful and in compliance with any law, rule, or regulation.
Insureds remain responsible for their own efforts to reduce risks and should consult their own legal counsel for appropriate
guidance.
                                                                                                                                           Formatted: Font: (Default) Arial
                                   SAMPLE DRAFT PROGRAM

Loading trailers.

          1.        It's the forklift operator's responsibility to see that the trailer's
                    a.        Wheels are chocked.
                    b.        Brakes are set.
                    c.        Floor is safe.
                    d.        Dockplate is safe.
          2.        It is important to know the condition of the floor - check for:
                    a.        Cracks, bumps and holes.
                    b.        Wet conditions, oil or floor dry type absorbents.
                    c.        Small garbage, move it instead of driving through it.

Parking forklifts.

          1.        Forks are to be on the ground.
          2.        Leave the controls in neutral.
          3.        Set the brakes.
          4.        Leave key unless instructed not to leave it.
          5.        Shut off engine when leaving forklift unattended.

Make sure that the load is stable.

Clearance for the load.

          1.        Check aisles
          2.        Doorways
          3.        Overhead obstructions
                    a.     Sprinklers - the top of the load should be no more than 18 inches from the
                           sprinkler heads.
                    b.     Electrical controls - never block them.
                    c.     Pipes - maintain a safe distance from them.
                    d.     Ceiling - be aware of the top of the load.
                    e.     Door frames - be especially careful of turns near doorways.

Know the floor weight capacity of the floor that the forklift is and the floor weight capacity of where you are
moving the product.

Refueling must be done in:

          1.        Designated areas.
          2.        According to safety policy.
          3.        Spills should be avoided.

ALWAYS BE AWARE OF YOUR SURROUNDINGS, DRIVE SAFELY AND USE COMMON SENSE.




                                                                                                                                           Formatted: Font: (Default) Arial
Trident Insurance Services provides this Manual as part of its efforts to reduce the risk of insurance loss and claims. This          89
Manual is advisory only and not intended to address every potential hazard or any insured specifically. Trident does not
warrant that all loss and/or claims will be avoided if the Manual is used. Trident further in no way intends to relieve the insured
of its own duties and obligations, nor is Trident undertaking on behalf of or for the benefit of the insured any duty or obligation
to ensure that the insured’s property and operations are safe, healthful and in compliance with any law, rule, or regulation.
Insureds remain responsible for their own efforts to reduce risks and should consult their own legal counsel for appropriate
guidance.
                                                                                                                                      Formatted: Font: (Default) Arial
                                   SAMPLE DRAFT PROGRAM

                                                  FIRST AID PROCEDURES

The following guidelines may be followed in establishing First Aid Procedures:

1.        First aid supplies should be approved by the locally designated safety coordinator.

2.        A qualified individual should be in charge of the first aid supplies. The person designated should
          have first aid training.

3.        A first aid station should be available to all employees.

4.        A notice of emergency numbers should be posted throughout the premises, especially at the first
          aid stations.

5.        A check of first aid supplies should be made every 30 days by the safety committee and recorded
          in writing on a Safety Inspection Report.

First Aid supplies should be located in the following areas:

Individuals trained in First Aid include:

All supervisory personnel.



The Person in Charge of First Aid Supplies is:


The following guidelines are suggested to help establish CPR procedures:

1. The coordinator is responsible to insure that an adequate number of employees are trained in CPR.

Individuals trained in CPR include:

          All Supervisory Personnel




                                               BLOOD-BORNE PATHOGENS

INTRODUCTION                                                                                                                          Formatted: Font: 10 pt
                                                                                                                                      Formatted: Font: (Default) Arial, 10 pt
On December 6, 1991, the Occupational Safety and Health Administration (OSHA) issued a standard
covering Occupational Exposures to Blood-borne Pathogens. In issuing this standard, OSHA determined                                   Formatted: Font: (Default) Arial
Trident Insurance Services provides this Manual as part of its efforts to reduce the risk of insurance loss and claims. This 90
Manual is advisory only and not intended to address every potential hazard or any insured specifically. Trident does not
warrant that all loss and/or claims will be avoided if the Manual is used. Trident further in no way intends to relieve the insured
of its own duties and obligations, nor is Trident undertaking on behalf of or for the benefit of the insured any duty or obligation
to ensure that the insured’s property and operations are safe, healthful and in compliance with any law, rule, or regulation.
Insureds remain responsible for their own efforts to reduce risks and should consult their own legal counsel for appropriate
guidance.
                                                                                                                                           Formatted: Font: (Default) Arial
                                   SAMPLE DRAFT PROGRAM

that certain personnel face significant health risk as a result of exposure to human blood or other
potentially infectious material. This includes Hepatitis B Virus (HBV) and Human Immunodeficiency Virus
(HIV). Under OSHA’s standard, organizations are required to:

A.        Develop an exposure control plan that identifies departments, job tasks and staff with
          occupational exposures.

B.        Establish universal precautions to prevent staff contact with blood or other potentially infectious
          material.

C.        Implement engineering and work practice controls to eliminate or reduce staff exposures.

D.        Provide personal protective equipment for staff use when exposures cannot be eliminated by
          engineering controls.

E.        Educate staff in the occupational risks of Blood-borne Pathogens and the methods being used to
          reduce or control the risk.

F.        Provide sanitation facilities or effective alternatives.

G.        Establish decontamination, contaminated laundry handling and regulated waste disposal
          procedures.

H         Provide for voluntary staff vaccination (Hepatitis B), and post exposure medical evaluation.

I.        Maintain documentation of staff training and medical evaluations.

The Blood-borne Pathogen standard allows organizations the flexibility of developing a program that is
unique to their individual requirements for staff protection. The following plan addresses the identified
requirements of facilities and operations.

PURPOSE

The purpose of the exposure control plan is to reduce the potential for transmission of Blood-borne
Pathogens and to provide a safe environment for all staff, students, and visitors. This will be
accomplished through the application of OSHA standard 29 CFR 1910.1030, outlined as follows:

A.        Identify all personnel who may be at risk of exposure to HIV and HBV or other infectious diseases.

B.        Establish policies and implement procedures for controlling this exposure to body fluids or tissue
          considered to be sources of HIV or HBV infection or other infectious diseases.

C.        Establish procedures for the evaluation of circumstances surrounding exposure incidents.

D.        Make Hepatitis B Vaccine available to all staff at risk in accordance with standard medical
          practice.

E.        Provide appropriate treatment and counseling should a staff or others be exposed to infectious
          diseases.

F.        Establish an infectious disease training program for all staff members.

G.        Provide exposure and training record keeping.                                                                                    Formatted: Font: (Default) Arial
Trident Insurance Services provides this Manual as part of its efforts to reduce the risk of insurance loss and claims. This          91
Manual is advisory only and not intended to address every potential hazard or any insured specifically. Trident does not
warrant that all loss and/or claims will be avoided if the Manual is used. Trident further in no way intends to relieve the insured
of its own duties and obligations, nor is Trident undertaking on behalf of or for the benefit of the insured any duty or obligation
to ensure that the insured’s property and operations are safe, healthful and in compliance with any law, rule, or regulation.
Insureds remain responsible for their own efforts to reduce risks and should consult their own legal counsel for appropriate
guidance.
                                                                                                                                      Formatted: Font: (Default) Arial
                                   SAMPLE DRAFT PROGRAM


PROGRAM MANAGEMENT

Effective implementation of the Blood-borne Pathogens exposure control plan requires the establishment
of assigned responsibility for program management. The responsibility for program implementation within
all facilities will involve several individuals within our organization. These are outlined as follows:

1.        The Administration will have overall responsibility for program implementation and will provide
          guidance and support to effected departments as necessary.

2.        A Safety Coordinator will serve as the "designated infection control officer" for each facility and
          will have the following responsibilities for implementing the Blood-borne Pathogen Exposure
          Plan.

          a.        Develop and implement an HBV immunization program in conjunction with a qualified
                    physician and healthcare facility.

          b.        Develop and implement a post-exposure program in conjunction with a qualified physician
                    and healthcare facility.

          c.        Provide support and assistance to others involved in implementing the Exposure Control
                    program.

          d.        Maintain the confidentiality of all medical and exposure records.

Managers and Supervisors

Management and Supervisors are also responsible for infection control in their respective areas. They
should work together to ensure that proper infection control procedures are followed.

The individuals or job classifications considered primarily at risk are identified under the exposure
determination section of the manual.
Department Personnel

As with all operations, staff have the most important role for implementing this infectious disease control
compliance program. The ultimate execution of much of the Infection Control Plan rests in your hands. In
this role, staff must:

          a.        Know what tasks may have occupational exposure.

          b.        Attend the Blood-borne Pathogens training sessions.

          c.        Know and follow the work practice controls outlined in the Plan.

          d.        Plan and conduct all operations in accordance with the work practice controls.

          e.        Develop good personal hygiene habits.

          f.        Report any suspected occupational exposure to infectious disease to their immediate
                    supervisor.

          g.       Report any diagnosis of infectious disease (occupational or non occupational) to medical
                   services coordinator.                                                                                              Formatted: Font: (Default) Arial
Trident Insurance Services provides this Manual as part of its efforts to reduce the risk of insurance loss and claims. This 92
Manual is advisory only and not intended to address every potential hazard or any insured specifically. Trident does not
warrant that all loss and/or claims will be avoided if the Manual is used. Trident further in no way intends to relieve the insured
of its own duties and obligations, nor is Trident undertaking on behalf of or for the benefit of the insured any duty or obligation
to ensure that the insured’s property and operations are safe, healthful and in compliance with any law, rule, or regulation.
Insureds remain responsible for their own efforts to reduce risks and should consult their own legal counsel for appropriate
guidance.
                                                                                                                                           Formatted: Font: (Default) Arial
                                   SAMPLE DRAFT PROGRAM


Medical Providers (who provide service for ________________ facility location).

a.        Physician

Name:

Address:

Telephone:

b.        Healthcare Facility

Name:

Address:

Telephone:

                                                                                                                                           Formatted: Font: 10 pt




                                                                                                                                           Formatted: Font: (Default) Arial
Trident Insurance Services provides this Manual as part of its efforts to reduce the risk of insurance loss and claims. This          93
Manual is advisory only and not intended to address every potential hazard or any insured specifically. Trident does not
warrant that all loss and/or claims will be avoided if the Manual is used. Trident further in no way intends to relieve the insured
of its own duties and obligations, nor is Trident undertaking on behalf of or for the benefit of the insured any duty or obligation
to ensure that the insured’s property and operations are safe, healthful and in compliance with any law, rule, or regulation.
Insureds remain responsible for their own efforts to reduce risks and should consult their own legal counsel for appropriate
guidance.
                                                                                                                                           Formatted: Font: (Default) Arial
                                   SAMPLE DRAFT PROGRAM

EXPOSURE DETERMINATION
                                                                                                                                           Formatted: Font: (Default) Arial, 10 pt
A key element in implementing the exposure control plan is to determine departments, job classifications
and exposure situations personnel may encounter. The following list has been developed to address this
element; however, all department operations should be constantly evaluated for the potential of employee
exposure to Blood-borne Pathogens or other infectious material.

Emergency and/or First Aid Response Team Members

Employees serving in this capacity may be exposed to blood or Other Potentially Infectious Materials
(OPIM) if and when responding to an accident at the plant involving a traumatic injury.

This involves the following individuals at the ___________________ facility:

1.        All Management (required)
2.
3.
4.
5.
6.
7.
8.
9.
10.

Attach supplemental page(s) as necessary.

A. Availability of the Exposure Control Plan to staff.

The Exposure Control Plan should be available to all personnel at any time. Personnel should be advised
of the Plan’s availability during education/training sessions. Copies of the Exposure Control Plan should
also be maintained at the following locations:

          Management Offices

          Safety Coordinator's Office

          Individual Facilities - Maintained as part of Safety and Health Plan

Personal copies should be obtained through individual facility Human Resources departments or the Risk
Management office.

B. Review and Update Program

We recognize that it is important to keep the Exposure Control Plan up-to-date. To ensure this, the plan
should be reviewed and updated under the following circumstances:

          Annually

          Whenever new or modified tasks and procedures are implemented that may affect the exposure
          of personnel.

                                                                                                                                           Formatted: Font: (Default) Arial
Trident Insurance Services provides this Manual as part of its efforts to reduce the risk of insurance loss and claims. This          94
Manual is advisory only and not intended to address every potential hazard or any insured specifically. Trident does not
warrant that all loss and/or claims will be avoided if the Manual is used. Trident further in no way intends to relieve the insured
of its own duties and obligations, nor is Trident undertaking on behalf of or for the benefit of the insured any duty or obligation
to ensure that the insured’s property and operations are safe, healthful and in compliance with any law, rule, or regulation.
Insureds remain responsible for their own efforts to reduce risks and should consult their own legal counsel for appropriate
guidance.
                                                                                                                                           Formatted: Font: (Default) Arial
                                   SAMPLE DRAFT PROGRAM

The concept of universal precautions, as developed by the Center for Disease Control is that all human
blood, body fluid and tissue be treated as if known to be infected with HIV, HBV and other blood borne
pathogens or infectious diseases.

As the potential for exposure is present within all operations, staff awareness and education in the risks
associated with blood borne pathogens should be an initial step in controlling the spread of infectious
disease. Bulletins, posters and handout material should be used, and the focus of this effort should be
staff education and the need to:

          Avoid unnecessary contact with human blood or other potentially infectious material.

          Practice good personal hygiene through washing and disinfecting hands or other skin surfaces
          immediately should exposure occur.

          Report any exposure incidents to appropriate personnel.

Operations in which all or specific staff job classifications have an anticipated exposure should implement
the universal precautions previously listed as well as the following infection control measures:

Methods of Compliance

1. Personal Protective Equipment

Appropriate Personal Protective Equipment should be used by all identified personnel except under rare
and extraordinary circumstances where in the staff’s judgment , its use would have prevented the
performance of assigned job duties or would have posed an increased hazard to the safety of others. If
exceptions are taken to the use of Personal Protective Equipment, they should be documented on an
Exposure Report.

All procedures involving blood, or other bodily fluids, should be performed to minimize splashing, spraying,
splattering, and generation of droplets of these substances.

          a.        Follow Universal Precautions (UP) at all times to prevent contact with blood or other
                    bodily fluids.

          b.        Provide appropriate Personal Protective Equipment (PPE) such as disposable gloves,
                    disposable gown, goggles, and pocket mouth-to-mouth devices at no cost to staff and
                    store in readily accessible designated areas.

          c.        Ensure that staff members use appropriate PPE unless the staff member declines to use
                    PPE under extraordinary circumstances such as increased hazard to them. Investigate
                    and document these incidences to prevent future occurrences.

          d.        Use appropriate gloves whenever hand contact with blood, mucous membranes, non-
                    intact skin, and/or touching contaminated items or surfaces is expected.

          e.        Use disposable gowns, masks, eye shields, or goggles if at risk from splash or spray with
                    body fluids.

          f.        Remove all PPE prior to leaving work area and place PPE in designated area or container
                    for storage, washing, decontamination, or disposal.

                                                                                                                                           Formatted: Font: (Default) Arial
Trident Insurance Services provides this Manual as part of its efforts to reduce the risk of insurance loss and claims. This          95
Manual is advisory only and not intended to address every potential hazard or any insured specifically. Trident does not
warrant that all loss and/or claims will be avoided if the Manual is used. Trident further in no way intends to relieve the insured
of its own duties and obligations, nor is Trident undertaking on behalf of or for the benefit of the insured any duty or obligation
to ensure that the insured’s property and operations are safe, healthful and in compliance with any law, rule, or regulation.
Insureds remain responsible for their own efforts to reduce risks and should consult their own legal counsel for appropriate
guidance.
                                                                                                                                           Formatted: Font: (Default) Arial
                                   SAMPLE DRAFT PROGRAM

At this facility the _____________________ is responsible for maintenance of PPE. The PPE is stored in
the ______________________. The date for compliance is__________________.

2. Personal Hygiene Facilities

          a.        Hand-washing facilities must be readily accessible to employees.

          b.        Staff must wash hands immediately after removal of gloves or other PPE and following
                    contact with blood or other bodily fluids.

          c.        Antiseptic hand cleaners or towelettes can be used if hand washing facility is not
                    accessible. Wash hands with soap and running water as soon as possible after using
                    towelette.

3. Hepatitis B Vaccination

          a.        Hepatitis B Vaccine (Recombivax HB) will be made available to all staff identified in the
                    exposure determination and to all employees who have an Exposure Incident (EI).

          b.        As required by OSHA, the vaccine will be available at no cost to employees and given
                    under the supervision of a licensed healthcare professional. If routine immunization
                    boosters are recommended at a future date by the U.S. Public Health Service, free
                    vaccine will again be made available to all staff.

          c.        Provide Health Care Professional with copy of Blood borne Pathogens Regulation.

          d.        Staff may initially decline immunization by signing a statement form and can choose to
                    accept the immunization at a later date.

Hepatitis B vaccine will be offered to all affected staff by ______________.




                                                                                                                                           Formatted: Font: (Default) Arial
Trident Insurance Services provides this Manual as part of its efforts to reduce the risk of insurance loss and claims. This          96
Manual is advisory only and not intended to address every potential hazard or any insured specifically. Trident does not
warrant that all loss and/or claims will be avoided if the Manual is used. Trident further in no way intends to relieve the insured
of its own duties and obligations, nor is Trident undertaking on behalf of or for the benefit of the insured any duty or obligation
to ensure that the insured’s property and operations are safe, healthful and in compliance with any law, rule, or regulation.
Insureds remain responsible for their own efforts to reduce risks and should consult their own legal counsel for appropriate
guidance.
                                                                                                                                           Formatted: Font: (Default) Arial
                                   SAMPLE DRAFT PROGRAM

4. Storage and Disposal of Contaminated Materials

a. First Aid and Medical Personnel

1) Eating, drinking, smoking, handling of contact lenses, etc., are prohibited in work areas where there is a
likelihood of exposure to contaminated materials.

2) Place all Regulated Waste (RW) in containers which are:

- Closeable

- Leak-proof for handling, storage, transport, and shipping

- Labeled (Biohazard and color-coded red)

3) Call local medical waste disposal company to dispose of all Regulated Waste. CHECK WITH AND
ADHERE TO APPLICABLE LOCAL, STATE, AND FEDERAL LAWS AND REGULATIONS.

5. Housekeeping

a. First Aid and Janitorial Personnel

1) Clean with hot soapy water and decontaminate all equipment, environmental areas and work surfaces
immediately after contact with blood or other bodily fluids.

2) Use a chemical germicide or household bleach, 1:10 or 1:100 solution for decontamination. (i.e., 1 part
Clorox to 100 parts of water - approximately 1/4 cup bleach per gallon of tap water.) Dispose of these
materials as indicated for Regulated Waste.

6. Training

a. Initial training for all staff potentially exposed to blood or other bodily fluids at the following facilities
should be completed by _______________. New staff assigned to a position involving potential exposure
during the performance of assigned duties (e.g., Nurses, First Aid Team Members) should be trained
initially upon assignment. All potentially exposed staff should receive refresher training annually.

At each facility, management remains responsible for the administration of the blood borne pathogens
training program.

b. Training at each facility should be performed by a person or persons qualified through education and/or
experience in the area of blood borne pathogens. Material appropriate in content and vocabulary to
educational level, literacy, and language of employees should be used.

The training program should, as a minimum, cover all of the following topics:

1) Review of the OSHA Blood-borne Pathogens Standard and its appendix. Each participant will be
provided with a copy of the full text of the standard and the appendix.

2) Discussion of blood-borne diseases and their transmission.

3) Review of the Exposure Control Plan for location, with each participant receiving a copy of the
Exposure Control Plan.
                                                                                                                                           Formatted: Font: (Default) Arial
Trident Insurance Services provides this Manual as part of its efforts to reduce the risk of insurance loss and claims. This          97
Manual is advisory only and not intended to address every potential hazard or any insured specifically. Trident does not
warrant that all loss and/or claims will be avoided if the Manual is used. Trident further in no way intends to relieve the insured
of its own duties and obligations, nor is Trident undertaking on behalf of or for the benefit of the insured any duty or obligation
to ensure that the insured’s property and operations are safe, healthful and in compliance with any law, rule, or regulation.
Insureds remain responsible for their own efforts to reduce risks and should consult their own legal counsel for appropriate
guidance.
                                                                                                                                           Formatted: Font: (Default) Arial
                                   SAMPLE DRAFT PROGRAM

4) Instruction on the location and appropriate use of Personal Protective Equipment available at the
location.

5) Instruction on appropriate methods for recognizing tasks and other activities that may involve exposure
to blood and OPIM.

6) Review of any engineering controls (if applicable) and the work practice controls instituted at this
location.

7) Review of the need for Hepatitis B vaccine and the procedure for receiving the vaccine at this location.

8) Detailed instructions on how to respond to an Exposure Incident.

9) Develop detailed procedure on how to handle an Exposure Incident (e.g., who to notify, what action
should be taken, etc.).

10) Review of the post-exposure evaluation and follow-up program.

11) Instructions on the meaning of and appropriate use of signs, labels, red bags and color coding.


7. Recordkeeping

a. Training Records

Records of training should be maintained for a minimum of 3 years. Training records should include the
following:

- Names of the Instructor(s)

- Qualifications of the Instructor(s)

- Date of training

- Summary or Outline of the specific topics covered

- Names and Job titles of staff attending the training

Training records will be provided upon written request for examination and copying to staff, staff
representatives and OSHA.

b. Medical Records

Medical Records for all staff exposed to blood or other bodily fluids at our facilities should be kept for the
duration of employment plus 30 years. These records must be kept confidential and MAY NOT be
disclosed to anyone except as expressly set forth in the next paragraph.

These records may include the following information.

- Name and Job title of staff member

- Employee Social Security Number
                                                                                                                                           Formatted: Font: (Default) Arial
Trident Insurance Services provides this Manual as part of its efforts to reduce the risk of insurance loss and claims. This          98
Manual is advisory only and not intended to address every potential hazard or any insured specifically. Trident does not
warrant that all loss and/or claims will be avoided if the Manual is used. Trident further in no way intends to relieve the insured
of its own duties and obligations, nor is Trident undertaking on behalf of or for the benefit of the insured any duty or obligation
to ensure that the insured’s property and operations are safe, healthful and in compliance with any law, rule, or regulation.
Insureds remain responsible for their own efforts to reduce risks and should consult their own legal counsel for appropriate
guidance.
                                                                                                                                           Formatted: Font: (Default) Arial
                                   SAMPLE DRAFT PROGRAM

- Hepatitis B vaccination status with date

- Results of any examination(s)

- Medical testing and follow-up procedures if staff member was exposed

- A copy of the health care provider’s written opinion, if applicable

- A copy of the information provided to the health care provider, if applicable

Staff medical records may not be disclosed or reported without the staff's expressed written consent to
any person within or outside the workplace, except as required by the regulation or by law.

At our facilities __________________ is responsible for maintaining medical records. In the event of a
facility closing, _______________________ will be responsible for notifying OSHA at least 3 months prior
to the disposal of any records required by this plan.

All aspects of this record keeping plan will be in effect on or before ___________________.

8. Post Exposure Evaluation & Follow-up                                                                                                    Formatted: Font: 10 pt
                                                                                                                                           Formatted: Font: (Default) Arial, 10 pt
a. When there is a significant Exposure Incident, the exposed employee shouldhave a confidential
medical evaluation and follow-up to include:

1) Completion of the Significant Exposure Incident Report Form including site and route of exposure.

2) Identification and documentation of the Source Individual, unless prohibited by state or local law.

3) Test the Source Individual's (SI) blood as soon as consent is obtained (if legally required) to determine
HBV and HIV status. If consent is not obtained, document. When the SI's consent is not required by law,
test the SI's blood (if available) and document the results. When the SI is already known to be HIV or
HBV positive, testing is not necessary. This information may also be communicated to potentially
exposed staff, if permitted by state and local law or with consent of the SI.

4) Inform the exposed employees of SI's test results. Inform employese of laws and regulations
concerning confidentiality and disclosure of the identity and infectious status of SI.

5) Test exposed staff members’ blood for HBV and HIV as soon as written consent is obtained. If consent
is given for HBV testing but not for HIV testing, the exposed staff member's blood specimen may be
maintained for 90 days (Stored at external Clinical Laboratory Site). Then, if the staff member decides to
have a baseline test done within the 90 day period, it can be completed.

6) Provide post-exposure treatment when medically indicated and as recommended by the U. S. Public
Health Service.

7) Provide the exposed staff member with counseling and evaluation of reported illnesses.

8) After obtaining consent from involved staff member(s), provide the Health Care Professional evaluating
the staff member(s) after a significant Exposure Incident with the following information:

- a copy of the regulation (29 CFR S1910.1030)

- a Significant Exposure Incident Report Form*                                                                                             Formatted: Font: (Default) Arial
Trident Insurance Services provides this Manual as part of its efforts to reduce the risk of insurance loss and claims. This          99
Manual is advisory only and not intended to address every potential hazard or any insured specifically. Trident does not
warrant that all loss and/or claims will be avoided if the Manual is used. Trident further in no way intends to relieve the insured
of its own duties and obligations, nor is Trident undertaking on behalf of or for the benefit of the insured any duty or obligation
to ensure that the insured’s property and operations are safe, healthful and in compliance with any law, rule, or regulation.
Insureds remain responsible for their own efforts to reduce risks and should consult their own legal counsel for appropriate
guidance.
                                                                                                                                      Formatted: Font: (Default) Arial
                                  SAMPLE DRAFT PROGRAM


- Source Individual's test results*

- Medical records relevant to appropriate treatment of exposed employee

9) The Healthcare Professional responsible for the medical evaluation should furnish a written opinion
within 15 days of completion of the evaluation, which should be limited to:

- Whether Hepatitis B vaccine is recommended and if immunization has begun

- That the staff member has been informed of the evaluation results and of any medical conditions
resulting from exposure

- All other findings shall be held confidential and shall not be included in the report

At this location _____________________ will be responsible for the Post Exposure Evaluation and
Follow-up.

* Unless prohibited by state or local law with respect to Source Individual's identity and/or test results.




                                                                                                                                      Formatted: Font: (Default) Arial
Trident Insurance Services provides this Manual as part of its efforts to reduce the risk of insurance loss and claims. This 100
Manual is advisory only and not intended to address every potential hazard or any insured specifically. Trident does not
warrant that all loss and/or claims will be avoided if the Manual is used. Trident further in no way intends to relieve the insured
of its own duties and obligations, nor is Trident undertaking on behalf of or for the benefit of the insured any duty or obligation
to ensure that the insured’s property and operations are safe, healthful and in compliance with any law, rule, or regulation.
Insureds remain responsible for their own efforts to reduce risks and should consult their own legal counsel for appropriate
guidance.
                                                                                                                                      Formatted: Font: (Default) Arial
                                  SAMPLE DRAFT PROGRAM

                                                      Fleet Guidelines

As a public entity, we have a large fleet to manage that includes passenger cars, police vehicles, highway
maintenance trucks, fire trucks, ambulances, and emergency equipment. Even with all of these types of
vehicles, there are common safety factors that can help minimize the potential for accidents and minimize
the exposure to loss causing situations.

The following is a basic management guide in an outline form:

A) A fleet safety coordinator will be appointed for each department.

B) An operator’s manual should be distributed to each vehicle operator and should include:

1) Vehicle maintenance schedule
2) Authorized use of vehicle
3) Safe driving rules

C) Vehicles should be inspected on a time and mileage basis as part of a preventative maintenance
program. At a minimum, the schedule should follow recommended manufacturer specifications. All work
shouled be documented and records maintained for the service life of the vehicle. Remember: “If it is not
documented it did not happen”.

D) Operators should be trained properly concerning use, care, and daily safety inspection of their vehicles.

E) Proper accident investigation procedures should be established and include:

          1) What operator information gathering is needed in the event of an accident.

          2) Who should be called in the event of an accident.

          3) Who internally will investigate an accident.

          4) Corrective measures for accidents found to be chargeable

          Trends in accidents should also be reported to all other departments for their review and inclusion
in training if needed.




                                                                                                                                      Formatted: Font: (Default) Arial
Trident Insurance Services provides this Manual as part of its efforts to reduce the risk of insurance loss and claims. This 101
Manual is advisory only and not intended to address every potential hazard or any insured specifically. Trident does not
warrant that all loss and/or claims will be avoided if the Manual is used. Trident further in no way intends to relieve the insured
of its own duties and obligations, nor is Trident undertaking on behalf of or for the benefit of the insured any duty or obligation
to ensure that the insured’s property and operations are safe, healthful and in compliance with any law, rule, or regulation.
Insureds remain responsible for their own efforts to reduce risks and should consult their own legal counsel for appropriate
guidance.
                                                                                                                                      Formatted: Font: (Default) Arial
                                  SAMPLE DRAFT PROGRAM

SUGGESTED TRAINING TOPIC: Defensive Driving Principles

Defensive driving simply means that the ability to defend oneself from all the other drivers' mistakes or
bad driving habits. The key is to develop the ability to anticipate accidents before they actually happen.
By doing so, defensive measures can be taken and accidents avoided.

Because preventing accidents is such an important part of defensive driving , we rate accidents as either
preventable or non preventable. Preventability, however, has nothing to do with legality. A driver can be
legally right and still become involved in a preventable accident.

Defensive driving revolves around the IPDE principle:

                              I = Identify
                              P = Predict
                              D = Decide
                              E = Execute

Identification - It is essential to identify hazards encountered while driving. To identify hazards, drivers
should constantly scan the area ahead. This requires a 12 to 15 second scanning distance looking from
side to side and checking mirrors. Many people assume that having a side view mirror on both sides of the
vehicle eliminates blind spots. This is simply not true. No matter how many mirrors installed on your
vehicle, a driver cannot eliminate a blind spot; it is simply a physical impossibility. It is therefore essential
that drivers constantly check and scan mirrors and look over their shoulders when passing or changing
lanes.

Predict - Once a hazard has been recognized, drivers should predict what to do and anticipate the
outcome of their decision. Drivers should not only predict their own actions, but also those of drivers
around them. It is not enough to think only of oneself; drivers always must think about other drivers,
particularly in merging situations on expressways. It is not only the responsibility of the driver merging to
enter traffic smoothly; it is the responsibility of those on the highway to allow that driver access to the
roadway.

Decide - Once the outcome is predicted and the benefits weighed, drivers must decide on what course of
action should be taken to avoid the hazard. This may mean becoming involved in an accident. In that
case, drivers should prioritize their values in the following order:

1. Human life is the number one priority.

2. Injury to yourself and other people involved is of secondary priority.

3. Damage to vehicles and other property should be the last concern.

Execute - Once a driver has identified, predicted, and decided on a course of action, the driver must
execute the chosen defensive driving maneuver. If that means swerving off the road or glancing off a fixed
object, so be it. However, drivers must commit themselves to a course and do whatever is necessary to
avoid an accident or minimize its consequences.


SUGGESTED TRAINING TOPICS: Following Distance Procedure

The best way to avoid collisions is to allow time to look for danger, set defenses, and avoid the accident.

                                                                                                                                      Formatted: Font: (Default) Arial
Trident Insurance Services provides this Manual as part of its efforts to reduce the risk of insurance loss and claims. This 102
Manual is advisory only and not intended to address every potential hazard or any insured specifically. Trident does not
warrant that all loss and/or claims will be avoided if the Manual is used. Trident further in no way intends to relieve the insured
of its own duties and obligations, nor is Trident undertaking on behalf of or for the benefit of the insured any duty or obligation
to ensure that the insured’s property and operations are safe, healthful and in compliance with any law, rule, or regulation.
Insureds remain responsible for their own efforts to reduce risks and should consult their own legal counsel for appropriate
guidance.
                                                                                                                                      Formatted: Font: (Default) Arial
                                   SAMPLE DRAFT PROGRAM

When danger is observed, a driver should make one of three decisions: blow the horn, turn the steering
wheel, or apply the brakes. In the average healthy adult, this process takes about three-quarters of a
second and is called "Reaction Time".

During a driver’s reaction time, the vehicle is still moving. How far it moves depends on the speed the
vehicle is moving. On average, a vehicle will move 11 feet for each 10 miles per hour. This means that
at 50 miles per hour, a vehicle will travel 55 feet while the driver moves from the accelerator to the brake
pedal. This does not include the time it takes to bring the vehicle to a complete stop in order to avoid a
collision.

All drivers also may experience rain, sleet, hail, snow, ice, or other adverse driving conditions. These all
affect the way a driver perceives the surrounding environment and handles the vehicle. When any adverse
driving condition develops, drivers should reduce their speed and increase the following distance between
them and the vehicle in front.

Normal reaction time and the vehicle braking distances make it imperative that an adequate following
distance maintained. The following procedure should provide for that distance:

          1. Allow one second of elapse time for each 10 feet of vehicle length as follows:

                    20 feet - sedans, wagons, pick-ups, and panels

                    30 feet - route and stake trucks

                    40 feet - stake truck and trailer

                    50 feet - semi-tractor and trailer

          2. Select a stationary marker as close to the road as possible.

          3. When the rear bumper of the vehicle in front crosses the marker, start counting seconds.

          4. Count seconds by saying "One thousand and one, one thousand and two, one thousand and
          three", et cetera.

          5. If the full count can be completed before the front bumper of the vehicle crosses the marker,
          then there is an adequate following distance.

The above formula is based on time, speed, and distance traveled factors. One mile per hour equals one
and one-half feet per second. At 30 miles an hour, a vehicle is traveling at 45 feet per second. In a
highway department dump truck, the driver would be three seconds, or 135 feet, behind the previous
vehicle at 30 miles an hour. As speed increases, so would the distance by a three-second count. This
formula allows 1.5 vehicle lengths for each 10 miles per hour, which is vital for today's traffic and driving
conditions.

SUGGESTED TRAINING TOPICS: Physical Vehicle Differences

Just as there is a difference between an experienced driver and a safe driver, there are differences
between a family car, truck, bus, and a van. Knowing that difference can help a driver better handle the
vehicle and plan for the actions of others. Obviously, trucks are much larger. The family car is designed to
carry about six adults and a few suitcases... just enough for a vacation. The truck may be designed to
carry tons of material and a maximum of two people. A bus is designed for maximum safe transportation
of passengers over short and long distances.                                                                                          Formatted: Font: (Default) Arial
Trident Insurance Services provides this Manual as part of its efforts to reduce the risk of insurance loss and claims. This 103
Manual is advisory only and not intended to address every potential hazard or any insured specifically. Trident does not
warrant that all loss and/or claims will be avoided if the Manual is used. Trident further in no way intends to relieve the insured
of its own duties and obligations, nor is Trident undertaking on behalf of or for the benefit of the insured any duty or obligation
to ensure that the insured’s property and operations are safe, healthful and in compliance with any law, rule, or regulation.
Insureds remain responsible for their own efforts to reduce risks and should consult their own legal counsel for appropriate
guidance.
                                                                                                                                      Formatted: Font: (Default) Arial
                                  SAMPLE DRAFT PROGRAM


Trucks and busses are also taller... trees, awnings, low clearance bridges that a car goes under without
difficulty have a whole new meaning in these vehicles. All drivers should know the height of their vehicle!
Tree limbs, overhangs, and low bridges are not targets. A low hanging branch that a driver can ignore in a
car could shatter a truck or bus windshield, damage the roof, or injure persons inside the vehicle.

Trucks and busses are wider... wide enough that without constant alertness the driver could drift out of a
lane and into a parked car, or worse, an oncoming car. And they are longer ... maneuvering is no longer
the simple job that it was in a personal vehicle. If drivers try to make a turn too tightly in either vehicle, they
may run over a curb... or a fire hydrant... or a telephone pole... or a pedestrian.

Over time and with experience, drivers will become aware of their vehicle and its size. Until then, however,
drivers must be very careful. These vehicles can be very dangerous even for the best drivers.
Consider these statistics:

          Traffic accidents are the number one cause of death of people between the ages of 1 and 44
          years.

          80% of all accidents happen at speeds of less than 30 mph.

          70% of all accidents happen with 25 miles of home.

          85% of all accidents are caused by driver error or indecision; only 15% are caused by mechanical
          failure.

These statistics are not intended to frighten but to cause drivers to become more cautious. Each vehicle
must be respected. Familiarity, it is often said, breeds contempt. If a driver does not respect what a
motorized piece of equipment can do, accidents can occur. Remember that no vehicle can think, that is
the driver’s responsibility.




                                                                                                                                      Formatted: Font: (Default) Arial
Trident Insurance Services provides this Manual as part of its efforts to reduce the risk of insurance loss and claims. This 104
Manual is advisory only and not intended to address every potential hazard or any insured specifically. Trident does not
warrant that all loss and/or claims will be avoided if the Manual is used. Trident further in no way intends to relieve the insured
of its own duties and obligations, nor is Trident undertaking on behalf of or for the benefit of the insured any duty or obligation
to ensure that the insured’s property and operations are safe, healthful and in compliance with any law, rule, or regulation.
Insureds remain responsible for their own efforts to reduce risks and should consult their own legal counsel for appropriate
guidance.
                                                                                                                                      Formatted: Font: (Default) Arial
                                   SAMPLE DRAFT PROGRAM

SUGGESTED TRAINING TOPIC: Weight Distribution and Loading

There is a huge weight difference between a car and a truck or bus. Fully loaded, they weigh many, many
tons.

It will take longer to stop these vehicles than your family car just because they weigh more. And they will
not accelerate as rapidly because of the added weight. That means you must make allowances for the
capabilities of your vehicle.

The extra height and weight of large vehicles creates another problem called the center of gravity. Since
the weight of a car is generally low to the ground, it is easy to handle because it "hugs" the road. The
center of gravity is much higher on a truck or bus. That means if you turn too sharply, too fast, or hit a
bump just right, you could tip your vehicle.

This is a new problem for most new drivers of heavy vehicles. You must learn to "feel" the motion of your
vehicle and be alert for this hazard. It is also important to note that the center of gravity may change during
the course of the day. As you unload or load material or people, the center of gravity drops lower or rises
and the potential for a tip-over decreases or increases.

IT IS IMPORTANT TO UNLOAD TRUCK MATERIAL EVENLY OR YOU WILL INCREASE THE HAZARD
OF A TIP-OVER. If you unload only from one side, the weight becomes unbalanced toward the loaded
side. A truck that has been loaded or unloaded incorrectly is even easier to tip over. Keep your load
balanced from side to side.

BUS OPERATORS MUST KEEP PASSENGERS SEATED UNLESS STOPPED AND DISEMBARKING
FROM THE VEHICLE. MOVEMENT NOT ONLY UPSETS THE BALANCE OF THE VEHICLE BUT IT IS
DISTRACTING TO THE DRIVER.

As the center of gravity of a vehicle drops lower, the potential for tip-over decreases. Always bear in mind
the current weight of your vehicle. The weight variations will cause you to make slight adaptations when
turning, accelerating, braking, and negotiating a curve in the road.

The load placed in or on your truck should be evenly distributed and secure. Personal injury and property
damage could result if you stop suddenly and objects come loose from their proper place. No objects
should be placed in rear window decks. They become projectiles when you stop suddenly.

SUGGESTED TRAINING TOPIC: Seatbelts

Studies by the National Safety Council and other institutions support the premise that safety belts can
prevent 50% of all traffic fatalities and 65% of serious injuries in traffic accidents.

Many people do not wear their seatbelts because they do not understand their operation. This is a brief
review of how a seatbelt works:

During normal driving the shoulder restraint can be moved forward and backward as needed. However,
when the car suddenly decelerates in a collision or sudden stop, a pendulum mechanism is forced forward
causing a safety bar to engage and lock the shoulder restraint. This locks the shoulder restraint and you in
place. During a crash, the shoulder belt keeps your head and chest from striking the steering wheel,
dashboard, and windshield. The lap belt is used to keep you from being thrown forward.

Many people think it is better to be thrown clear during a collision. If you are thrown clear, the force of the
collision can hurl the car in the same direction you will be going in. Where you land, the car would mostly
likely follow, and could land on top of you. Seatbelts help you stay in your vehicle and maintain control                             Formatted: Font: (Default) Arial
Trident Insurance Services provides this Manual as part of its efforts to reduce the risk of insurance loss and claims. This 105
Manual is advisory only and not intended to address every potential hazard or any insured specifically. Trident does not
warrant that all loss and/or claims will be avoided if the Manual is used. Trident further in no way intends to relieve the insured
of its own duties and obligations, nor is Trident undertaking on behalf of or for the benefit of the insured any duty or obligation
to ensure that the insured’s property and operations are safe, healthful and in compliance with any law, rule, or regulation.
Insureds remain responsible for their own efforts to reduce risks and should consult their own legal counsel for appropriate
guidance.
                                                                                                                                      Formatted: Font: (Default) Arial
                                   SAMPLE DRAFT PROGRAM

during sharp turns or on uneven terrain. Seatbelts should also be used to secure objects which must be
transported on vehicle seats.

Currently standard equipment for busses does not include seatbelts. Few states require that seatbelts be
placed in busses. Studies have been done on seatbelt restraints within busses. Currently there are more
studies that say seatbelts are more of a hazard on a bus based upon the current bus construction
standards.

SUGGESTED TRAINING TOPIC: Courteous Driving

The professional driver knows that courteous driving is also safe driving. A professional driver does not
tailgate or bully other drivers, and is ready to yield the right-of-way and use signals to warn other drivers.

A professional driver knows how to control his or her temper. When you are angry, your muscles tighten
and that slows your reflexes. An angry driver does not think clearly. Tempers are for amateurs. A
professional never "takes out" their anger on his or her vehicle or on others. They never lose their temper
behind the wheel. The best drivers are well rested. They know that lack of sleep slows their timing and can
cause an accident... or even kill them.

They respect themselves and act like the professional drivers they are. When operating any organization
vehicle, the operation of that vehicle is your full-time job and you should approach it in a professional,
courteous manner.

An important element of defensive driving is preventing accidents from happening. This is why we rate
accidents as either preventable or non preventable. It is important to remember that preventability has
nothing to do with legality. You can be legally right and still become involved in a preventable accident.

We use the four "Cs" to help remember the important parts of becoming a good driving expert. Let's
review them one at a time:

Courtesy

Did you know that 75% of our vehicle code simply forces drivers to be courteous to each other? If all
drivers simply practice good, old-fashioned courtesy, we could eliminate 75% of the accidents and
fatalities.

What is courtesy? A good way to remember it is this: Driving with courtesy is treating all other drivers
exactly like they were your very best and dearest friends or relatives. It means you will go out of your way
to ensure that nothing you do would interfere with or endanger them in any way while they are driving their
vehicles.

Courtesy is also being willing to offer the other person the right-of-way or precedence at a signal or stop
sign. In plain words, a courteous driver is one who has good manners and uses them at all times.

Consideration

Consideration is a close kin of courtesy. While there is only a slight difference, it is an important one.

A considerate driver would never weave in and out of traffic because they would know this endangers all
the other drivers on the road.

A considerate driver will permit opposing drivers to complete their turns when it is safe to do so because
this way, the chance of a collision is greatly reduced.                                                                               Formatted: Font: (Default) Arial
Trident Insurance Services provides this Manual as part of its efforts to reduce the risk of insurance loss and claims. This 106
Manual is advisory only and not intended to address every potential hazard or any insured specifically. Trident does not
warrant that all loss and/or claims will be avoided if the Manual is used. Trident further in no way intends to relieve the insured
of its own duties and obligations, nor is Trident undertaking on behalf of or for the benefit of the insured any duty or obligation
to ensure that the insured’s property and operations are safe, healthful and in compliance with any law, rule, or regulation.
Insureds remain responsible for their own efforts to reduce risks and should consult their own legal counsel for appropriate
guidance.
                                                                                                                                      Formatted: Font: (Default) Arial
                                  SAMPLE DRAFT PROGRAM


A considerate driver will always dim their headlights when approaching opposing traffic at night, because
this way they will not blind the other drivers and risk a collision.

Again, having consideration is simply having and using good manners while you are driving.

Concentration

Driving requires all of your attention at all times. By consciously trying to safely drive your vehicle, you can
do a better job of preventing accidents.

Concentration means you are devoting your attention to the task of looking for danger, recognizing it, and
avoiding it to prevent a collision.

A driver who concentrates on driving never takes their eyes off the road or their mirrors. They use their
eyes like radar to search their entire field of vision; right, ahead, left, ahead, right rear, ahead, left rear,
ahead, et cetera. They know that this routine will help defeat highway hypnosis and keep them alert and
razor-sharp.

A good driver also concentrates on their instruments to make sure the vehicle is operating properly so that
abuse and damage are held to the absolute minimum.

In summary, concentration is the process of always devoting your full attention to driving and in being alert
for anything which could represent a hazard to you or your vehicle.

Control

State vehicle codes are consistently based upon the premise that a driver must keep their vehicle under
control at all times. Part of keeping a vehicle under control is to learn to drive at speeds that are legal and
safe under existing conditions.

An additional way of maintaining control of the vehicle is to keep an adequate following distance for the
speed at which you are traveling. The best way to do this is to remember the principles of the "Following
Procedure" and allow one second for each ten feet of vehicle length. This should give you the time to see
danger and attempt to do something to prevent a collision.

In summary, maintaining control over your vehicle at all times is the best way to stay out of trouble and to
prevent collisions. This can best be done by learning to recognize danger and then avoid the collision by
setting up adequate defenses.

Summary

The four "Cs" of good driving are:

          Courtesy
          Consideration
          Concentration
          Control

Notice how they seem to pair off in a logical manner.

Courtesy and Consideration are the good manners to be used while operating a motor vehicle.
                                                                                                                                      Formatted: Font: (Default) Arial
Trident Insurance Services provides this Manual as part of its efforts to reduce the risk of insurance loss and claims. This 107
Manual is advisory only and not intended to address every potential hazard or any insured specifically. Trident does not
warrant that all loss and/or claims will be avoided if the Manual is used. Trident further in no way intends to relieve the insured
of its own duties and obligations, nor is Trident undertaking on behalf of or for the benefit of the insured any duty or obligation
to ensure that the insured’s property and operations are safe, healthful and in compliance with any law, rule, or regulation.
Insureds remain responsible for their own efforts to reduce risks and should consult their own legal counsel for appropriate
guidance.
                                                                                                                                      Formatted: Font: (Default) Arial
                                  SAMPLE DRAFT PROGRAM

Concentration and Control are essential skills to be used in avoiding danger and collisions while operating
a motor vehicle.

All together they are just a different way of restating the Golden Rule, "Do unto others as you would have
them do unto you."

SUGGESTED TRAINING TOPIC: Backing, Skidding, and Car Telephones

Here are some important rules for backing:

1. WHENEVER POSSIBLE, PARK SO THAT YOU WILL NOT NEED TO BACK!

2. If you must back, always personally check the area behind your vehicle. Approach your vehicle from
   the direction you will travel.

3. Measure the distance available for you to use with reference points you can see from inside the
     Vehicle... just a simple visual check should be enough.

4. After you have checked the area available, don't delay! A car, a pedestrian, a motorcycle, shopping
     cart, or anything can move behind you in one short inattentive moment!

5. Avoid backing into an intersection ... it is very dangerous, and in some areas, illegal.

6. Avoid backing out of a driveway or alley. The best way to avoid this hazard is to back INTO the alley or
   driveway. That way, when you prepare to leave, you have full vision.

7. Whenever possible, use a helper but ensure you have your signals straight beforehand. Notice that
     immediately in front of large vehicles there is a "dead" area. That area is just big enough to hide a
     child. You cannot see behind the vehicle either. The side view mirrors offer only a limited view of the
     rear area. You must learn to adapt and compensate for this difference in your visibility. Be aware of
     your visibility limitations.

Skidding

Skids create a number of different problems for different types of vehicles. Many vehicles today are front-
wheel drive and do not skid as often as rear-wheel drive vehicles. Nonetheless, the principles which apply
to rear-wheel drive vehicles apply to front-wheel drive as well.

If you feel your vehicle going into a skid, you should immediately steer in the direction you want to go. This
should straighten out the rear-end of your vehicle and bring it back under control. If it does not happen the
first time, you may overcorrect and come into a second skid and have to repeat the procedure. Steer in
the direction you wish to go when in a skid.

Radios and Car Telephones

To avoid distraction and keep both hands on the wheel, you should try to use communication equipment
only while stopped. If this is not possible and you have a partner with you, ask him/her to use the
equipment. This will allow you to concentrate on driving.

SUGGESTED TRAINING TOPIC: Vehicle Abuse


                                                                                                                                      Formatted: Font: (Default) Arial
Trident Insurance Services provides this Manual as part of its efforts to reduce the risk of insurance loss and claims. This 108
Manual is advisory only and not intended to address every potential hazard or any insured specifically. Trident does not
warrant that all loss and/or claims will be avoided if the Manual is used. Trident further in no way intends to relieve the insured
of its own duties and obligations, nor is Trident undertaking on behalf of or for the benefit of the insured any duty or obligation
to ensure that the insured’s property and operations are safe, healthful and in compliance with any law, rule, or regulation.
Insureds remain responsible for their own efforts to reduce risks and should consult their own legal counsel for appropriate
guidance.
                                                                                                                                      Formatted: Font: (Default) Arial
                                  SAMPLE DRAFT PROGRAM

About 10 to 25 percent of annual fleet maintenance costs are due to faulty operation or abuse of the
vehicle by the driver which, in turn, stems from carelessness, lack of training, or inadequate supervisory
control.

Not only can excessive repair bills be an index to substandard driving performance, but they are directly
related to the number of accidents experienced. A "rough" driver has a high accident potential; a "smooth"
driver is usually more alert, avoids accident hazards, and is ready for emergencies.

Rough operation, including fast starts, delayed braking, and sudden stops, can indicate a poor driving
attitude that may produce an accident. It may also indicate driver inexperience. Lack of training as a
cause of rough operation can be corrected.

Freedom to abuse an expensive vehicle is not a fringe benefit. Drivers are expected to act as stewards of
company property by showing respect for the equipment placed in their charge.

Following is a list of driving abuses that lead to undue wear of the vehicle. These abuses should be
avoided:

Engine (Motor) Abuse

    Excessive acceleration of a cold engine
    Stopping engine suddenly after a long run
    Operating overheated engine
    Operating engine with low oil level
    Racing engine
    Failure to keep checking instrument panel gauges

Clutching Errors

    Riding the clutch
    Snapping the clutch

Errors in Shifting Gears

    Starting out in wrong gear
    Rapid acceleration from stops
    Scraping and jerking the gears
    Shifting gears into neutral and coasting down hill
    Failure to double clutch if necessary when changing gears
    Operating in improper gear

Errors in Use of Brakes

    Failure to fully release hand brake when moving
    Abrupt stops
    Delayed braking
    Excessive brake applications

Errors in Tire Care

    Operating with flat or under-inflated tires
                                                                                                                                      Formatted: Font: (Default) Arial
Trident Insurance Services provides this Manual as part of its efforts to reduce the risk of insurance loss and claims. This 109
Manual is advisory only and not intended to address every potential hazard or any insured specifically. Trident does not
warrant that all loss and/or claims will be avoided if the Manual is used. Trident further in no way intends to relieve the insured
of its own duties and obligations, nor is Trident undertaking on behalf of or for the benefit of the insured any duty or obligation
to ensure that the insured’s property and operations are safe, healthful and in compliance with any law, rule, or regulation.
Insureds remain responsible for their own efforts to reduce risks and should consult their own legal counsel for appropriate
guidance.
                                                                                                                                      Formatted: Font: (Default) Arial
                                  SAMPLE DRAFT PROGRAM

    Driving over curbs or objects and into potholes
    Rubbing tires against curbs while parking
    Letting air out of tires "for better traction"
    Unnecessary spinning of tires

Lack of Maintenance Responsibility

    Driving unit even though it needs repairs
    Failure to write up defects and needed repairs
    Failure to inspect equipment properly before each trip




                                                                                                                                      Formatted: Font: (Default) Arial
Trident Insurance Services provides this Manual as part of its efforts to reduce the risk of insurance loss and claims. This 110
Manual is advisory only and not intended to address every potential hazard or any insured specifically. Trident does not
warrant that all loss and/or claims will be avoided if the Manual is used. Trident further in no way intends to relieve the insured
of its own duties and obligations, nor is Trident undertaking on behalf of or for the benefit of the insured any duty or obligation
to ensure that the insured’s property and operations are safe, healthful and in compliance with any law, rule, or regulation.
Insureds remain responsible for their own efforts to reduce risks and should consult their own legal counsel for appropriate
guidance.
                                                                                                                                      Formatted: Font: (Default) Arial
                                  SAMPLE DRAFT PROGRAM

SUGGESTED TRAINING TOPIC: Rural Driving

As you leave the city or towns and enter the country, there are a whole new set of driving habits you
should develop.

The rural environment has additional sources of danger. Slow moving farm vehicles and oversized farm
equipment may be present on country roads. Watch for them and be ready to give them extra room.
Remember that if you are traveling at 50 mph and they are moving at 10 mph, you will overtake them very
quickly. If you are not alert, you can run out of maneuvering room too soon.

Be alert for animals. Horses, cows, chickens, deer, dogs, and cats all live in the country. There are
pedestrians, too. Hunters are often dressed so they will blend into the background. Watch for them during
hunting season. Farmers also have a tendency to blend into their surroundings so extra care is needed in
farming communities to avoid potential incidents.

Be especially careful of hills and curves. You cannot know what is around the curve or over the hill. There
could be a piece of farm equipment blocking the road or a person riding a horse... and you are blind until it
is too late. Prepare for the unexpected and be prepared to react. Keep your speed down in unfamiliar
areas.

In the country the roads tend to be a little narrower. There may be poor or no shoulders to the road. If you
drift off of the road, the shoulder could cause you to swerve into a ditch. If you do leave the road and move
onto the shoulder, do not attempt to get back onto the road right away. Maintain your position until you
feel you have good surface traction and road position. Once this is established you can safely bring your
vehicle back onto the pavement.




                                                                                                                                      Formatted: Font: (Default) Arial
Trident Insurance Services provides this Manual as part of its efforts to reduce the risk of insurance loss and claims. This 111
Manual is advisory only and not intended to address every potential hazard or any insured specifically. Trident does not
warrant that all loss and/or claims will be avoided if the Manual is used. Trident further in no way intends to relieve the insured
of its own duties and obligations, nor is Trident undertaking on behalf of or for the benefit of the insured any duty or obligation
to ensure that the insured’s property and operations are safe, healthful and in compliance with any law, rule, or regulation.
Insureds remain responsible for their own efforts to reduce risks and should consult their own legal counsel for appropriate
guidance.
                                                                                                                                      Formatted: Font: (Default) Arial
                                  SAMPLE DRAFT PROGRAM

                                                Law Enforcement Liability

Our officers are a well trained professional force dedicated to protecting our citizens and serving our
community. Law enforcement, by its very nature, is a high risk operation both for officers and for the
department as a whole. With that it mind, it is imperative that written procedures be in place with
guidelines established to assist officers with their every day decisions.

We feel that important departmental policies should be developed along guidelines established either by
the courts or other “authorities having jurisdiction”.

Departmental policies that should be in force and updated on a regular basis include:

          1)        Past employment records should be obtained and reviewed based on the position in light
                    of the position applied for.

          2)        Sworn officers should be graduates of a certified police academy before given arrest
                    powers or armed. Only sworn officers should be provided with weapons.

          3)        Continuing education requirements should be established for all police personnel. These
                    policies should be part of the criteria for the officers keeping their positions.

          4)        On the job training should include:

                    a)        Constitutional issues involving arrest and detainment of a citizen.

                    b)        Proper procedures for instituting a stop - legal requirements vs. what has always
                              been done.

                    c)        Review of “Use of Force” procedures

                    d)        Review “Hot Pursuit” policy based upon latest court rulings.

                    e)        Review jail/holding cell/lock-up procedures.

                    f)        Psychological training

                    g)        Domestic interdiction sensitivity training

          5)        Sworn officers should be required to re-qualify at a minimum annually with approved
                    firearms.

          6)        Written procedures should be established and provided to each officer on the following
                    issues:

                    a)        Use of deadly force

                    b)        Use of non-deadly force

                    c)        Hot pursuit procedures and controls

                    d)        Domestic violence

                    e)        Sexual assault investigation and victim sensitivity training                                            Formatted: Font: (Default) Arial
Trident Insurance Services provides this Manual as part of its efforts to reduce the risk of insurance loss and claims. This 112
Manual is advisory only and not intended to address every potential hazard or any insured specifically. Trident does not
warrant that all loss and/or claims will be avoided if the Manual is used. Trident further in no way intends to relieve the insured
of its own duties and obligations, nor is Trident undertaking on behalf of or for the benefit of the insured any duty or obligation
to ensure that the insured’s property and operations are safe, healthful and in compliance with any law, rule, or regulation.
Insureds remain responsible for their own efforts to reduce risks and should consult their own legal counsel for appropriate
guidance.
                                                                                                                                      Formatted: Font: (Default) Arial
                                  SAMPLE DRAFT PROGRAM


                    f)        The handling of alcohol or drug impaired individuals

          7)        Any complaints should be documented and kept in a log.

          8)        An investigative procedure should be established by the department to handle all
                    complaints against officers.

          9)        Detainees should be checked at least every 30 minutes. If there is a suspicion that
                    detainees may harm themselves, they should be transported to a healthcare facility that
                    can provide appropriate car. Until transported, they should be placed on suicide watch.

          10)       Outside employment of officers should be restricted and require prior approval by the
                    sheriff/chief/mayor, etc.




                                                                                                                                      Formatted: Font: (Default) Arial
Trident Insurance Services provides this Manual as part of its efforts to reduce the risk of insurance loss and claims. This 113
Manual is advisory only and not intended to address every potential hazard or any insured specifically. Trident does not
warrant that all loss and/or claims will be avoided if the Manual is used. Trident further in no way intends to relieve the insured
of its own duties and obligations, nor is Trident undertaking on behalf of or for the benefit of the insured any duty or obligation
to ensure that the insured’s property and operations are safe, healthful and in compliance with any law, rule, or regulation.
Insureds remain responsible for their own efforts to reduce risks and should consult their own legal counsel for appropriate
guidance.
                                                                                                                                      Formatted: Font: (Default) Arial
                                  SAMPLE DRAFT PROGRAM

                                       HEARING CONSERVATION PROGRAM

Continuing, effective hearing conservation should be administered to all employees exposed to noise
equal to or exceeding an 8-hour time weighted average sound level of 85 DBA.

Each facility manager should be responsible to have noise exposures monitored every two years or when
changes alter the noise level. This is to determine which employees may be exposed at or above a sound
level of 85 DBA. Detailed monitoring requirements allow an area monitoring or personal monitoring
approach. Some state regulations may also require annual monitoring.

1.        Observation of Monitoring

2.        Affected employees or their representative may observe exposure measurements.

          a.        Audiometric testing should be required for all employees whose exposures exceed a
                    sound level of 85 DBA.

          b.        This testing should be provided at no cost to the employees.

3.        A licensed or certified audiologist, an otolaryngologist or qualified physician, or a technician who is
          certified by the Council of Accreditation in Occupational Hearing conservation should conduct all
          audiometric tests.

          a.        A baseline audiogram shall be given to all exposed employees within 120 days of
                    employment.

          b.        Hearing protection may be used to satisfy the 14-hour quiet rule for baseline tests.

          c.        .The company will accept baseline audiograms that were taken prior to this Amendment
                      using hearing protectors as a substitute for the 14-hour quiet rule. OSHA is prepared to
                      be flexible in accepting old baseline audiograms.

4.
          1.        A audiogram should be obtained at least annually and performed at any time during the
                    work shift provided a 14-hour quiet rule is enforced.

          2.        All employees exposed to 85 DBA or more should wear hearing protectors before both
                    baseline and annual tests.

          3.        Part time employees that work less than four months per year may be excluded from
                    audiometric testing.

5.

          1.        Each audiogram should be compared to the results of the latest test as well as the
                    baseline audiogram to determine if the audiogram is valid and if a significant threshold
                    shift has occurred.

          2.        The audiograms should be reviewed to determine whether there is need for further
                    evaluation. Problem audiograms should be reviewed by an audiologist, otolaryngologist
                    or qualified physician who can submit the test results, comments and recommendations
                    to the facility management for dissemination to the affected employees.
                                                                                                                                      Formatted: Font: (Default) Arial
Trident Insurance Services provides this Manual as part of its efforts to reduce the risk of insurance loss and claims. This 114
Manual is advisory only and not intended to address every potential hazard or any insured specifically. Trident does not
warrant that all loss and/or claims will be avoided if the Manual is used. Trident further in no way intends to relieve the insured
of its own duties and obligations, nor is Trident undertaking on behalf of or for the benefit of the insured any duty or obligation
to ensure that the insured’s property and operations are safe, healthful and in compliance with any law, rule, or regulation.
Insureds remain responsible for their own efforts to reduce risks and should consult their own legal counsel for appropriate
guidance.
                                                                                                                                      Formatted: Font: (Default) Arial
                                  SAMPLE DRAFT PROGRAM

6.

          For enforcement purposes, OSHA considers a significant threshold shift as a shift of 20 dB at
          any frequency.

          1.        The company identifies two types of threshold shifts:

                    A change in hearing most likely medically related.

                    A change in hearing most likely due to noise exposure.

          2.        Our organization does not distinguish between temporary threshold shift (TTS) or
                    permanent threshold shift (PTS). Both TTS and PTS are treated alike, as they could
                    occur only due to loud noise. Whether a shift is temporary or permanent is not the
                    important issue. What is important is that the staff member is not being adequately
                    protected from noise levels which may cause permanent hearing loss.

          3.        Our organization defines a significant threshold shift as the level that gives employees the
                    earliest indication of a possible shift due to noise on or off the job.

                    Medically related shift = change of 10 dB at the average of 500, 1,000, or 2,000 Hz.

                    Possible high frequency threshold shift is defined as a change of 20 dB at 3,000 or 4,000
                    Hz.

          4.        Follow-up Procedures

                    Once a significant threshold shift is determined, the following steps should be taken:

                    a.        Staff not wearing hearing protectors should be fitted with such and trained in
                              their use and care.

                    b.        Staff already using protective devices should be refitted and retrained in their use
                              and provided with protectors offering greater attenuation if necessary.

                    2.1.      Within twenty-one days of management receiving the test results indicating a
                              threshold shift, staff should be informed in writing.

                    2.2.      Those staff members with a shift shall be referred for audiological or otological
                              evaluation to determine the cause of the shift or if a medical problem is
                              suspected.

                              2.3.     The cause of a high frequency threshold shift would most likely be due to
                              noise exposure; therefore, nothing would be gained by audiological or otological
                              follow-up. The most important steps are to check the staff member’s hearing
                              protection for adequacy and fit, and for staff to wear hearing protection on and off
                              the job whenever exposed to loud noise.

                    2.4.      Staff should be informed that the hearing test does not by itself provide sufficient
                              information on which to base any final conclusion.


                                                                                                                                      Formatted: Font: (Default) Arial
Trident Insurance Services provides this Manual as part of its efforts to reduce the risk of insurance loss and claims. This 115
Manual is advisory only and not intended to address every potential hazard or any insured specifically. Trident does not
warrant that all loss and/or claims will be avoided if the Manual is used. Trident further in no way intends to relieve the insured
of its own duties and obligations, nor is Trident undertaking on behalf of or for the benefit of the insured any duty or obligation
to ensure that the insured’s property and operations are safe, healthful and in compliance with any law, rule, or regulation.
Insureds remain responsible for their own efforts to reduce risks and should consult their own legal counsel for appropriate
guidance.
                                                                                                                                      Formatted: Font: (Default) Arial
                                  SAMPLE DRAFT PROGRAM

                    2.5.      When medical follow-up is recommended, it should done as a service to staff and
                              in the employee's best personal interest. Medical services should be directed
                              through the Dial Corporation Group Insurance Plan.
7.

          1.        Audiometric tests should be pure tone, air conduction with test frequencies including as a
                    minimum 500, 1,000, 2,000, 3,000, 4,000 and 6,000 Hz. (8,000 Hz is required in some
                    states.)

          2.        The audiometric equipment used for testing is to meet the specifications of and is to be
                    maintained according to the ANSI standard S3.6-1969.

          3.        Audiometric Test Room or Booth

          3.1.      Audiometric testing should be administered in a quiet room or sound booth meeting the
                    following requirements:

                    Frequency/Max. allowable sound pressure levels (dB) Hz/dB .5K/40 - 1k/40 - 2k/47 -
                    4k/52 - 8k/62

          3.2.      Our organization’s facilities are to conform with the test room sound pressure level
                    requirement.

8.

          1.        Functional operation should be checked before each day's use.

          2.        Biological calibration should be performed daily.

          3.        Acoustic calibration should be performed annually.

          4.        Exhaustive calibration should be performed every two years.

          5.        Calibration, maintenance and repair of all equipment should be performed by a certified
                    technician.




                                                                                                                                      Formatted: Font: (Default) Arial
Trident Insurance Services provides this Manual as part of its efforts to reduce the risk of insurance loss and claims. This 116
Manual is advisory only and not intended to address every potential hazard or any insured specifically. Trident does not
warrant that all loss and/or claims will be avoided if the Manual is used. Trident further in no way intends to relieve the insured
of its own duties and obligations, nor is Trident undertaking on behalf of or for the benefit of the insured any duty or obligation
to ensure that the insured’s property and operations are safe, healthful and in compliance with any law, rule, or regulation.
Insureds remain responsible for their own efforts to reduce risks and should consult their own legal counsel for appropriate
guidance.
                                                                                                                                      Formatted: Font: (Default) Arial
                                  SAMPLE DRAFT PROGRAM

9.        Facility management should:

          a.        Ensure that hearing protectors are worn by all employees exposed to a sound level of 85
                    DBA or greater.

          b.        Make hearing protectors available to all staff exposed to a sound level of 85 DBA or
                    greater at no cost to the employees.

          c.        Give staff a choice of hearing protectors (usually muffs, inserts and/or plugs).

          d.        Ensure adequate fitting of hearing protectors.

          e.        Provide training in use and care of all hearing protectors.

          f.        Supervise the correct use of all hearing protection.

          g.        Replace hearing protection as necessary.

          h.        Outline to all staff members the enforcement procedure.

          i.        Document training and disciplinary action taken.

10.       Hearing Protections

          1.        A Safety Consultant should recommend hearing protection for specific noise
                    environments in which the protectors will be used.

          2.        Hearing protectors should attenuate staff exposure to less than the allowable level based
                    on the time period of exposure.

          3.        The adequacy of hearing protector attenuation should be reevaluated whenever staff
                    noise exposures increase to the point that the hearing protectors may no longer provide
                    adequate attenuation. Facility management should then provide more effective hearing
                    protectors as necessary.

11.       Training -

          1.        Because staff education and motivation is an essential part of effective hearing
                    conservation program, annual training should be instituted for each staff member included
                    in hearing conservation program

          2.        During training, staff members should be informed of the following:

                    a.        The effects of noise on hearing.

                    b.        The purpose of hearing protectors - the advantages, disadvantages, attenuation
                              of various types, and clear instructions on the selection, fitting, use and care of
                              protectors.

                    c.        The purpose of the audiometric testing and an explanation of test procedures.

                    d.        The disciplinary action for failure to comply with this hearing conservation
                              standard.                                                                                               Formatted: Font: (Default) Arial
Trident Insurance Services provides this Manual as part of its efforts to reduce the risk of insurance loss and claims. This 117
Manual is advisory only and not intended to address every potential hazard or any insured specifically. Trident does not
warrant that all loss and/or claims will be avoided if the Manual is used. Trident further in no way intends to relieve the insured
of its own duties and obligations, nor is Trident undertaking on behalf of or for the benefit of the insured any duty or obligation
to ensure that the insured’s property and operations are safe, healthful and in compliance with any law, rule, or regulation.
Insureds remain responsible for their own efforts to reduce risks and should consult their own legal counsel for appropriate
guidance.
                                                                                                                                      Formatted: Font: (Default) Arial
                                  SAMPLE DRAFT PROGRAM


12.       A copy of this standard should be made available to affected staff member’s.

13.

          1.        Exposure Measurements

                    Location management should maintain an accurate record of all employee exposure
                    measurements for a period of two years.

          2.        Audiometric Tests

                    Location management should retain all audiometric tests for the duration of employment
                    plus five years.

          3.        Audiometric Test Rooms

                    Location management should maintain accurate records of the measurements of the
                    background sound pressure levels in the audiometric test rooms.

          4.        Access to Records

                    All records should be provided, upon written request, to staff and former staff members.


OSHA Standards require that each location comply with standards regarding personal protective
equipment. Thsee standards require the following:

          1.        An assessment of hazards in the workplace that may require the use of personal
                    protective equipment and a certification that such an assessment has been completed;

          2.        Training of staff members on identifying when such equipment is necessary, how to use
                    the gear, and on the proper care and maintenance of such equipment;

          3.        Verification that the equipment is not damaged or defective; and

          4.        Retraining of staff members as necessary.




                                                                                                                                      Formatted: Font: (Default) Arial
Trident Insurance Services provides this Manual as part of its efforts to reduce the risk of insurance loss and claims. This 118
Manual is advisory only and not intended to address every potential hazard or any insured specifically. Trident does not
warrant that all loss and/or claims will be avoided if the Manual is used. Trident further in no way intends to relieve the insured
of its own duties and obligations, nor is Trident undertaking on behalf of or for the benefit of the insured any duty or obligation
to ensure that the insured’s property and operations are safe, healthful and in compliance with any law, rule, or regulation.
Insureds remain responsible for their own efforts to reduce risks and should consult their own legal counsel for appropriate
guidance.
                                                                                                                                      Formatted: Font: (Default) Arial
                                   SAMPLE DRAFT PROGRAM


                                     OCCUPATIONAL SAFETY and HEALTH ACT

What is OSHA? OSHA is the Occupational Safety and Health Act of 1970. This Federal law, which took
effect April 28, 1971, requires mandatory compliance by every employer and employee in the nation (with
few exceptions), and is designed to assure safe and healthful working conditions for every worker in the
nation.

DOES THIS LAW APPLY TO YOU?

"AS STATED"

Sec. 4 "THE ACT"

Sec. 4 (a) This act shall apply with respect to employment performed in a workplace in a State, the District
of Columbia, the Commonwealth of Puerto Rico, the Virgin Islands, American Samoa, Guam, The Trust
Territory of the Pacific Islands, Wake Island, Outer Continental Shelf lands defined in the Outer
Continental Shelf Lands Act, Johnston Island and the Canal Zone. The Secretary of the Interior shall, by
regulation, provide for judicial enforcement of this Act by the courts established for areas in which there
are no United States district courts having jurisdiction.

The following lists some of the requirements set forth by OSHAin regard to safety and health. These
provisions apply to shop areas or any place where a company carries on its business. The following items
are meant only to give you an idea of some of the requirements and are in no way a substitute for
reviewing the Federal Register, entitled, "Safety and Health Regulations.”

1.        No employee should be required to work in surroundings or under conditions that are unsanitary,
          hazardous or dangerous to his health and safety.

2.        Regular inspections should be made of facilities and records kept as to the results of the
          inspections. Unsafe materials, tool or machinery should be prohibited and removed from use or
          made inoperable until corrected.

3.        Some type of first-aid station should exist at all locations, and someone who is qualified to
          administer first-aid should be in attendance.

4.        Housekeeping should a priority. No location should be allowed to accumulate scrap and debris.

5.        Safety glasses should be required if there is any danger of employees sustaining injury to their
          eyes due in the performance of their work.

6.        A vehicle should be maintained on site for transportation of any injured person to a physician or
          hospital.

7.        Telephone number of doctors, hospital and ambulance should be conspicuously posted.

8.        All electrical tools should be grounded, unless double insulated.

9.        Anyone blowing down a steam line, or working on ductwork, or any other act in which loud noises
          are prevalent should wear approved hearing protection.

10.       Fire protection should be provided in any area where people are working, and evacuation plans
          posted.                                                                                                                     Formatted: Font: (Default) Arial
Trident Insurance Services provides this Manual as part of its efforts to reduce the risk of insurance loss and claims. This 119
Manual is advisory only and not intended to address every potential hazard or any insured specifically. Trident does not
warrant that all loss and/or claims will be avoided if the Manual is used. Trident further in no way intends to relieve the insured
of its own duties and obligations, nor is Trident undertaking on behalf of or for the benefit of the insured any duty or obligation
to ensure that the insured’s property and operations are safe, healthful and in compliance with any law, rule, or regulation.
Insureds remain responsible for their own efforts to reduce risks and should consult their own legal counsel for appropriate
guidance.
                                                                                                                                      Formatted: Font: (Default) Arial
                                   SAMPLE DRAFT PROGRAM


11.       Impact tools, such as drift pens, wedges and chisels should be free of mushroom heads. Any
          power actuated tool, such as ramset gun, should be tested daily to determine if in good working
          order.

12.       Any extension cord used with portable electric tools and appliances should be of the three-wire
          type.

13.       Temporary lighting should be equipped with guards to prevent accidental contact with the bulb,
          and the cords must be of heavy duty type. Temporary lights cannot be suspended from the
          electrical cords, as is a common practice of temporary lighting.

14.       Any flexible cord that is used as an extension cord should be used only in continuous lengths,
          without a splice.

15.       Ground fault circuit interrupter (FGI) protection should be provided for each circuit that any
          extension cord, power tools, or electrical power supply is fed from.

16.       Guard rails and toe boards should be installed on all open sides and ends of all open floors, on
          platforms and runways more than 6 feet above the ground, or adjacent flooring.

17.       All boards used for scaffolds should be free of knots and of a particular type of wood, such as
          Douglas Fir.

18.       All hoisting equipment should be inspected periodically, and inspection records.

19.       All vehicles with cabs should be equipped with windshields and powered wipers.


OSHA RESPONSIBILITY

Both our organization and our staff have responsibilities for facility safety. Workers should discuss
problems with their manager or supervisor. OSHA provides that:

          Individual Facilities:

          “Shall furnish to each employee, employment and a place of employment which are free from
          recognized hazards that are causing or likely to cause death or serious physical harm to
          employees.

          Shall comply with the occupational safety and health standards promulgated under this Act.”

          Employees:

          Each employee shall comply with occupational safety and health standards and all rules,
          regulation and orders issued pursuant to this Act that are applicable to his/her own action and
          conduct.

Therefore, it is the responsibility of both management and the employee to comply with OSHA.


FAILURE TO ABIDE BY OUR SAFETY POLICY WILL BE GROUNDS FOR DISCIPLINARY ACTION UP
TO AND INCLUDING TERMINATION FROM EMPLOYMENT.                                                                                         Formatted: Font: (Default) Arial
Trident Insurance Services provides this Manual as part of its efforts to reduce the risk of insurance loss and claims. This 120
Manual is advisory only and not intended to address every potential hazard or any insured specifically. Trident does not
warrant that all loss and/or claims will be avoided if the Manual is used. Trident further in no way intends to relieve the insured
of its own duties and obligations, nor is Trident undertaking on behalf of or for the benefit of the insured any duty or obligation
to ensure that the insured’s property and operations are safe, healthful and in compliance with any law, rule, or regulation.
Insureds remain responsible for their own efforts to reduce risks and should consult their own legal counsel for appropriate
guidance.
                                                                                                                                      Formatted: Font: (Default) Arial
                                  SAMPLE DRAFT PROGRAM


In the event that an OSHA inspector presents himself or herself on the job, the person in charge should
follow the procedure outlined below:

1.        Politely greet the compliance officer, and indicate "good faith" as this may reduce any penalty
          proposed.

2.        Carefully examine his credentials.

3.        Ask the compliance officer the purpose of his visit.

4.        Ask the compliance officer if you might have a minute to call your Safety Coordinator or corporate
          office to be made available to provide assistance or instructions before starting the inspection.

5.        Immediately return to the officer. Answer all of his questions, but do not volunteer any information
          not requested. If you do not know the answer, or if it's a tricky question, inform the officer that you
          will find the answer and provide it later. Take complete notes of any defects or deficiencies he
          points out. If possible, have someone correct items that can be quickly remedied. Explain items
          that he may not understand or misinterpret, but do not argue with him.

6.        Explain to the inspector that, in order to protect trade secrets , only pictures related to the purpose
          of the visit may be taken. Take photographs of everything that the OSHA inspector photographs,
          and take additional photographs from other angles. Determine every employee interviewed or
          questioned by the OSHA inspector. (and what? write it down)

7.        Machinery or equipment not meeting the standards should be immediately shut down.

8.        All records requested should be readily available for the compliance officer's inspection.

          Remember it is our intention to abide by the regulations to the best of our ability, therefore, your
          cooperation is greatly needed.

9.        Always personally escort compliance officers for their personal safety, and to defuse any
          misconceptions before unjustifiable allegations are established. Try to confine inspection to the
          area stated as purpose of visit.

The following is a summary of what to expect, how to act and what you should do during and after a safety
inspection by OSHA.

This section deals with:

1.        Inspections
2.        Citations
3.        Variances - How to Apply
4.        Recordkeeping Requirements

What to do when the compliance officer (Inspector) arrives at your location:

1.        Be polite, respectful and cooperative

You should not be hostile or negative, for such attitudes will only interfere with the investigation and result
in a loss of rapport, while possibly receiving the maximum penalties and fines for violations.
                                                                                                                                      Formatted: Font: (Default) Arial
Trident Insurance Services provides this Manual as part of its efforts to reduce the risk of insurance loss and claims. This 121
Manual is advisory only and not intended to address every potential hazard or any insured specifically. Trident does not
warrant that all loss and/or claims will be avoided if the Manual is used. Trident further in no way intends to relieve the insured
of its own duties and obligations, nor is Trident undertaking on behalf of or for the benefit of the insured any duty or obligation
to ensure that the insured’s property and operations are safe, healthful and in compliance with any law, rule, or regulation.
Insureds remain responsible for their own efforts to reduce risks and should consult their own legal counsel for appropriate
guidance.
                                                                                                                                      Formatted: Font: (Default) Arial
                                   SAMPLE DRAFT PROGRAM

2.        See Credentials and request purpose of visit.

The inspector should present his credentials. The inspector should be allowed to enter the workplace
without delay; however, the inspector may be asked to wait several minutes while the highest ranking
manager is located.

3.        Outside parties NOT with the department of labor require corporate approval prior to visit.

If the inspector brings another person, who is neither a compliance officer nor an authorized employee's
representative, to participate in the inspection, you should carefully question this person to determine why
he is present.

The best rule to follow is one of reasonableness and common sense. If the person is an equipment
expert, and he is otherwise a disinterested party to the investigation, let him participate. If, on the other
hand, you feel the person's presence will be of questionable value concerning matters of health and safety
in the workplace, then you may politely ask the outside party to wait until a corporate officer can be
consulted. However, in no event should the compliance officer who has presented proper credentials be
unduly delayed in his entry to the facility.

4.        Get his card and copies of complaint

The facility may want to contest an alleged violation, so record all pertinent information. If the investigation
is the result of a written complaint, get a copy and keep it. The names, business affiliation and addresses
of all persons present should be written down. You should ask:

          a.        If the party filing the complaint requested that his/her name be withheld. If he/she made
                    no such request, then the disclosures of the party initiating the complaint would not be
                    contrary to the Act.

          b.        Was the complaint filed by a present or past employee, by an employee of a customer,
                    subcontractor, or material supplier or by a person not directly employed around the
                    workplace involved? The answers to these questions may be extremely important.

5.        Pre-Inspection

The inspector should explain the nature and purpose of his inspection, the general scope and the outline
of the records he wants to review, and the employees he wishes to question.

Your Right to a Reasonable Inspection

1.        Reasonableness is a Right

OSHA repeatedly guarantees employers the right to a reasonable, orderly and fair inspection. Under the
Act, an inspector’s entry must be:

          a.        At a reasonable time.
          b.        Inspected within reasonable limits.
          c.        And in a reasonable manner.
          d.        And to question a reasonable number of employees.

After preliminary investigation, if you believe that a request is unreasonable, you should use careful
judgment and good faith in handling the situation. You can discuss the matter with the Compliance Officer
and explain why you think his request is unreasonable. If the Officer insists on the request, then you may                            Formatted: Font: (Default) Arial
Trident Insurance Services provides this Manual as part of its efforts to reduce the risk of insurance loss and claims. This 122
Manual is advisory only and not intended to address every potential hazard or any insured specifically. Trident does not
warrant that all loss and/or claims will be avoided if the Manual is used. Trident further in no way intends to relieve the insured
of its own duties and obligations, nor is Trident undertaking on behalf of or for the benefit of the insured any duty or obligation
to ensure that the insured’s property and operations are safe, healthful and in compliance with any law, rule, or regulation.
Insureds remain responsible for their own efforts to reduce risks and should consult their own legal counsel for appropriate
guidance.
                                                                                                                                      Formatted: Font: (Default) Arial
                                  SAMPLE DRAFT PROGRAM

either give in or ask the Inspector to wait until top management can be consulted. If you have strong
convictions that the request is unreasonable and unnecessary, you should consult with a corporate officer
before proceeding. Consider allowing the Compliance Officer to inspect other non-disputed areras while a
decision is being made by management.

2.        Avoidance of Disruption

The Department of Labor's proposed regulations direct the Compliance Officer to conduct his
investigations in a manner that avoids any undue and unnecessary disruption of the normal operations of
the employer. You should inform the Inspector of that day's schedule, and assist him in conducting the
investigation so as to least disrupt the work.

What to do During the Actual Inspection

1.        Accompany the Inspector

This is an employer's right and a most important one, since in most cases you may be the only
spokesman present during the inspection as well as the “eyes and ears” of management for any contest
proceedings later. Remember that OSHA gives the Compliance Officer authority to interview employees,
privately, if he wishes and to examine machinery or equipment. He is empowered to take pictures and
samples and to employ other reasonable techniques.

2.Take Notes

It is imperative that you take as complete a set of notes as possible, identifying:

          a. Areas visited.
          b. Machinery, equipment and materials examined.
          c. Employees interviewed.
          d. Others interviewed or involved in the inspection.

There is nothing improper about taking notes during the inspection. A full written report should be
prepared including the above items and relevant comments made by the Inspector, or information
acquired during the pre-inspection and the informal conference at the completion of the investigation.

3.Representatives Authorized by Employer

The Act provides a right for a representative authorized by the employer to accompany the Compliance
Officer. But it further provides, in the absence of an authorized representative, the Compliance Officer
"shall consult with a reasonable number of employees concerning matters of health and safety in the
workplace.”.

Post-Inspection Actions

1.Post-Inspection

Upon completion of the inspection, the Compliance Officer will confer with management, or you the
representative, and informally advise of apparent violations. The closing conference is important. After an
OSHA Inspector completes his inspection, he will conduct a closing conference with the employer's
representative. It is during this step of the inspection process that you can negotiate. The Inspector may
tell you that he doesn't know if you will be cited for "such and such" condition, but that these same
conditions should be corrected in a certain amount of time. Agreeing to have the alleged unsafe
                                                                                                                                      Formatted: Font: (Default) Arial
Trident Insurance Services provides this Manual as part of its efforts to reduce the risk of insurance loss and claims. This 123
Manual is advisory only and not intended to address every potential hazard or any insured specifically. Trident does not
warrant that all loss and/or claims will be avoided if the Manual is used. Trident further in no way intends to relieve the insured
of its own duties and obligations, nor is Trident undertaking on behalf of or for the benefit of the insured any duty or obligation
to ensure that the insured’s property and operations are safe, healthful and in compliance with any law, rule, or regulation.
Insureds remain responsible for their own efforts to reduce risks and should consult their own legal counsel for appropriate
guidance.
                                                                                                                                      Formatted: Font: (Default) Arial
                                  SAMPLE DRAFT PROGRAM

conditions corrected with a designated time period becomes your abatement period (assuming you
receive a citation - and you will).

The employer has a say in deciding on an abatement date. It is NOT set by the Inspector alone. The
Inspector should ask, "When can you have it corrected?" It is up to the employer to insist on an adequate
abatement period. If the condition to be corrected is a very minor one and is not a problem to correct, and
if you recognize that it is an unsafe condition, then agree to an early abatement period, i.e., immediate or
one day after receipt of citation. If, on the other hand, you question the Inspector's reasoning and you feel
you are, in fact, in compliance or you ascertain that a certain amount of time would be necessary to
correct the alleged unsafe condition, then insist on the longer abatement date- 15 to 20 days. Remember,
the abatement date becomes effective upon receipt of the Safety Order (Citation) from OSHA. Even with
immediate abatement, you have one day after the receipt of the Safety Order in which to correct the
alleged unsafe condition.


Employers generally receive a Safety Order (Citation) about seven days after an inspection. It takes this
long for an Inspector to write up his report, send it in, and have it go through all the administrative
channels. So, until you actually receive the Safety Order, you cannot be positive that you will be cited on a
particular item. However, if you wait to see what you will be cited on and you agreed to an immediate or
one day abatement, then you may not have time to make the correction, subjecting you to a penalty of
$1,000 a day for failure to abate if you should be reinspected. On the other hand, to spend money to
correct an alleged unsafe condition before you actually receive the Safety Order may prove to be a waste
if, in fact, you are not cited on that particular condition. Consider this: If it is going to cost you money
and/or you question the alleged unsafe condition - insist on a "long" abatement period - to allow enough
time to be able to assess whether you want to contest before you spend the money and/or ample time to
order equipment and install it or to correct the unsafe condition. The closing conference presents the
employer the opportunity to help itself. The employer can't blame OSHA for inadequate time in which to
abate, it has a voice - use it.

After the inspection process is over and you have been cited, make sure you follow up; reinspections are
becoming more prevalent due to federal pressures and failure to abate can cost you $1,000 per day.

2.Imminent Danger

If the Compliance Officer concludes that conditions or practices exist that could reasonably be expected to
cause death or serious harm before the danger can be eliminated, he will inform management, or you as
representative, and attempt to schedule the conference to voluntarily abate the danger. When the danger
can be immediately abated without great expense of shutting down the job, you should do so immediately.
However, the Compliance Officer has no authority to shut down the job without a court order. Such an
order, however, can be sexured in a matter of hours. If you decide that you cannot abate the danger
without a court order, a Compliance Officer can only leave and report to his office that he is
recommending a civil action to restrain or remove the condition.

If you estimate wrong on whether the danger is a violation of the Act, and an employee is killed before a
court order can remove the danger, we will likely be subjected to criminal penalties of a $50,000 fine
and/or one year imprisonment.

3.Items to specifically point out to the Compliance Officer are:

          a .Copies of minutes of safety meetings.
          b. Copies of "Safety Talks" or other employee training material.
          c. Copies of "Safety Warnings to Individuals.”.
          d. Any other material that would help to establish "good faith compliance efforts.”.                                        Formatted: Font: (Default) Arial
Trident Insurance Services provides this Manual as part of its efforts to reduce the risk of insurance loss and claims. This 124
Manual is advisory only and not intended to address every potential hazard or any insured specifically. Trident does not
warrant that all loss and/or claims will be avoided if the Manual is used. Trident further in no way intends to relieve the insured
of its own duties and obligations, nor is Trident undertaking on behalf of or for the benefit of the insured any duty or obligation
to ensure that the insured’s property and operations are safe, healthful and in compliance with any law, rule, or regulation.
Insureds remain responsible for their own efforts to reduce risks and should consult their own legal counsel for appropriate
guidance.
                                                                                                                                      Formatted: Font: (Default) Arial
                                   SAMPLE DRAFT PROGRAM

          e. If the location is cited for alleged violations you should follow these procedures:

4.Make a written record to Safety Coordinator immediately following the closing conference. This report
should provide as much detail as possible, such as:

          a. Location of alleged violation.
          b. What actually was occurring at the time of inspection relating to the alleged violation?
          c. What sort of investigation techniques or documentation was used by the Inspector?

5.If the facility is cited for alleged violation, the following items should be noted:

a. You may receive, by mail, a Safety Citation or Safety Order with a cover letter stating posting
requirements. If these are sent to the office, the Safety Coordinator will see that the company complies
with the requirements for all citations. If, however, it is determined after review with all concerned that you
should contest, the Safety Coordinator will take the correct steps to do so.

b. If the Safety Order or Citation is sent to the facility, it should be forwarded to the Safety Coordinator at
the appropriate location for appropriate handling.

c. All payments of penalties should be made through the Safety Coordinator's office.

After OSHA has inspected the facility, you may receive a Safety Order with a cover letter. OSHA requires
that a copy of the enclosed Citations be prominently posted in a conspicuous place at or near each place
of violation referred to in the Citation. The Citations must remain posted until the alleged violation is
corrected or for at least three days.

1.A Citation for an infraction of a standard is either deemed serious or non-serious. If it is non-serious, no
penalty is assessed unless 10 or more citations were charged. In the event penalties for serious citations
begin at $1,000 for each violation, they can be reduced, based on company size, past history, good faith,
etc.

Read the Safety Order carefully. Note, especially the date by which alleged violations are to be corrected.
If you have not contested a particular citation, it must be corrected by the date so indicated. Failure to
correct puts you in a position of "Failure to Abate," which carries a $500 per day fine for up to ten days and
a maximum of $5,000.

2.Contesting Citations

From the day you receive a Safety Order at the facility involved, you have 15 working days in which to
contest a citation(s) assessed against the facility. After 15 working days have elapsed and no contest has
been made by you, the Safety Order becomes final and binding, and you must then pay any assessed
penalties, correct the penalties, and correct all alleged violations.

Effective January 1, 1978, employers have two OSHA recordkeeping forms to fill out:

1.Form 101 - Accident or Illness Report for each incident

2.Form 200 - Summary of All Accident and/or Illnesses (which is merely a compilation of the 101 Form).
This form is required to be posted at each facility for the month of February.

The following section provides information about the written records that must be maintained to comply
with OSHA. The trend has been toward a lighter paperwork burden for companies, and many industries
have been exempted from keeping certain OSHA records. However, it is very important to keep those                                     Formatted: Font: (Default) Arial
Trident Insurance Services provides this Manual as part of its efforts to reduce the risk of insurance loss and claims. This 125
Manual is advisory only and not intended to address every potential hazard or any insured specifically. Trident does not
warrant that all loss and/or claims will be avoided if the Manual is used. Trident further in no way intends to relieve the insured
of its own duties and obligations, nor is Trident undertaking on behalf of or for the benefit of the insured any duty or obligation
to ensure that the insured’s property and operations are safe, healthful and in compliance with any law, rule, or regulation.
Insureds remain responsible for their own efforts to reduce risks and should consult their own legal counsel for appropriate
guidance.
                                                                                                                                      Formatted: Font: (Default) Arial
                                  SAMPLE DRAFT PROGRAM

records for which you are responsible, since OSHA reviews records first during any inspection and uses
the findings to decide whether further inspection is necessary. Although OSHA's major interest lies in
abatement, if an employer knowingly falsifies records and OSHA can prove it, the employer can face a
fine of up to $50,000 and a six-month jail term.

NOTE: It is very important to remember that OSHA recordkeeping requirements are independent of any
workers’ compensation laws or rulings of any state. Also, OSHA requires federal reporting that is different
from any state law or regulation.

In the case of occupational injury and illness records, certain prescribed formats should be used. These
forms are available on request and can be obtained from your nearest OSHA office, Bureau of Labor
Statistics Office, or from a state agency. Where no specific form is required, the record can be of your
own design as long as it contains all require data .

Anyone who wishes to maintain records by a different procedure than outlined in the OSHA regulations
must petition OSHA for an exception ruling. For more information on petitioning for a recordkeeping
variance, contact the nearest OSHA area office.

By far the most important records kept are those of employee injuries and illnesses in the workplace.
These records are designed to help compliance officers when they visit a worksite for an inspection, but
can be of even greater help to the employer in identifying "trouble spots" and hazards in the workplace.

The OSHA Form #200 is the combination log and summary form that all employers subject to
recordkeeping requirements should use. If an alternative form is used, it must be as readable and
comprehensible to a person not familiar with it as the OSHA Form #200. Computerized recordkeeping is
allowed, but two requirements must be met: (1) sufficient information must be available at the computer
location to complete the log within six work days after receipt of information that a recordable case has
occurred; and (2) a copy of the log updated to within 45 calendar days must be present at all times at the
establishment.

The required data can be recorded with "log" entries on the left and cumulative "summary" entries on the
right. Instructions for filling out the log and summary can be found below. The summary portion of the
form (the right-hand side) is the cumulative record to be posted at the end of the calendar year (no later
than February 1 of the year immediately following) and remain posted until March 1.

Columns A through F

Column A
       Enter case or file number.

Column B
       Enter date of injury or onset of illness:

For injuries, enter date of work accident resulting in injury; for occupational illness enter date of initial
diagnosis, or, if absence from work occurred before diagnosis, enter first day of absence attributable to
the illness.

Column C
       Enter employee's name (first name or initial, middle initial, last name).

Column D
       Enter occupation (job title or duties of employee).
                                                                                                                                      Formatted: Font: (Default) Arial
Trident Insurance Services provides this Manual as part of its efforts to reduce the risk of insurance loss and claims. This 126
Manual is advisory only and not intended to address every potential hazard or any insured specifically. Trident does not
warrant that all loss and/or claims will be avoided if the Manual is used. Trident further in no way intends to relieve the insured
of its own duties and obligations, nor is Trident undertaking on behalf of or for the benefit of the insured any duty or obligation
to ensure that the insured’s property and operations are safe, healthful and in compliance with any law, rule, or regulation.
Insureds remain responsible for their own efforts to reduce risks and should consult their own legal counsel for appropriate
guidance.
                                                                                                                                      Formatted: Font: (Default) Arial
                                  SAMPLE DRAFT PROGRAM

Column E
       Enter department or workplace in which employee is regularly employed or assigned.

Column F
       Enter description of injury or illness briefly stated. Indicate part or parts of body affected.

Columns 1 through 13

Injury-Related Entries: Columns 1 through 6

Column 1
       Enter date(s) of any injury-related fatalities.

Column 2
       Enter a check if injury resulted in lost workdays or days of restricted activity.

Column 3
       Enter a check if injury resulted in days away from work.

Column 4
        Enter the number of workdays (consecutive or not) on which the employee would have worked but
could not because of the injury. Do not include the day of the injury or days on which the employee would
not have worked even if able.

In instances where the employee does not have a regularly scheduled shift (is a part-time employee,
casual laborer, etc.), it may be necessary to estimate the number of lost workdays based on prior work
history of the employee AND comparison with days worked by other employees in the same department
and/or occupation as the ill or injured employee.

Column 5
       Enter number of workdays (consecutive or not) on which, because of the injury, the employee
       was:

          1. assigned to another job on a temporary basis;
          2. working at a permanent job less than full time; or
          3. worked at a permanently assigned job but could not perform all duties normally connected
             with it.

NOTE: The number of lost workdays should not include the day of injury or any days on which the
employee would not have worked even if able to work.

Column 6
       Enter check if recordable injury did not involve lost workdays.

Illness-Related Entries: Columns 7 through 13

Column 7 (a through g)
       Enter a check in only one column for each illness.
       If the illness resulted in termination of employment or permanent transfer, place an asterisk to
       the right of the checkmarked entry.

Column 8
       Enter the date of any illness-related fatality.                                                                                Formatted: Font: (Default) Arial
Trident Insurance Services provides this Manual as part of its efforts to reduce the risk of insurance loss and claims. This 127
Manual is advisory only and not intended to address every potential hazard or any insured specifically. Trident does not
warrant that all loss and/or claims will be avoided if the Manual is used. Trident further in no way intends to relieve the insured
of its own duties and obligations, nor is Trident undertaking on behalf of or for the benefit of the insured any duty or obligation
to ensure that the insured’s property and operations are safe, healthful and in compliance with any law, rule, or regulation.
Insureds remain responsible for their own efforts to reduce risks and should consult their own legal counsel for appropriate
guidance.
                                                                                                                                      Formatted: Font: (Default) Arial
                                  SAMPLE DRAFT PROGRAM


Column 9
       Enter check if illness resulted in lost workdays or days of restricted activity.

Column 10
       Enter check if illness resulted in days away from work.

Column 11
       Enter the number of days away from work (consecutive or not) due to illness. Do not include the
       day of the illness or days on which the employee would not have worked even if able.

In instances where employee does not have a regularly scheduled shift (is a part-time employee, casual
laborer, etc.), it may be necessary to estimate the number of lost workdays based on prior work history of
the employee AND compare with days worked by other employees in the same department and/or
occupation as the ill or injured employee.

Column 12
       Enter number of workdays (consecutive or not) on which, because of the injury, the employee
       was:

          1. assigned to another job on a temporary basis;
          2. working at a permanent job less than full time; or
          3. worked at a permanently assigned job but could not perform all duties normally connected
             with it.

NOTE: The number of lost workdays should not include the day of injury or any days on which the
employee would not have worked even if able to work.

Column 13
       Enter a check if recordable injury did not involve lost workdays.

If, during the five-year period the log must be retained, there is a change in the outcome of an injury or
illness for which an entry was made in Columns 1, 2, 6, 8, 9 or 12, the first entry should be lined out and a
new entry made. For example:

If an employee who had been injured required only medical treatment, it would be recorded in Column 6.
If the injury later resulted in lost workdays away from work, the checkmark in Column 6 should be lined out
and checks entered in Columns 2 and 3, and the number of lost workdays entered in Column 4.

If an employee with an occupational illness lost workdays, returned to work, and then died of the illness,
entries in Columns 9 and 10 should be lined out and the date of death entered in Column 8.

Entries for injuries or illness later determined to be nonrecordable (see Charts 1 and 2) should be lined
out. Examples:

An injury or illness is determined to be non work-related. An injury initially thought to involve medical
treatment is later determined to have only involved first aid.

TOTALS

Enter totals at bottom of each column and then in the upper section of columns on the next page (previous
page totals).
                                                                                                                                      Formatted: Font: (Default) Arial
Trident Insurance Services provides this Manual as part of its efforts to reduce the risk of insurance loss and claims. This 128
Manual is advisory only and not intended to address every potential hazard or any insured specifically. Trident does not
warrant that all loss and/or claims will be avoided if the Manual is used. Trident further in no way intends to relieve the insured
of its own duties and obligations, nor is Trident undertaking on behalf of or for the benefit of the insured any duty or obligation
to ensure that the insured’s property and operations are safe, healthful and in compliance with any law, rule, or regulation.
Insureds remain responsible for their own efforts to reduce risks and should consult their own legal counsel for appropriate
guidance.
                                                                                                                                      Formatted: Font: (Default) Arial
                                  SAMPLE DRAFT PROGRAM

Columns 1 and 8: Add total number of fatalities.
Columns 2, 3, 6, 7, 9, 10 and 13: Add total number of checks in each column.
Columns 4, 5, 11 and 12: Add the number of days entered in each column.

Totals should be generated for each column at the end of each page and at the end of each year. ONLY
the yearly totals are required for posting.

If an employee's loss of workdays is continuing at the time the totals are summarized, estimate the
number of future workdays the employee will lose and add that estimate to the workdays already entered
as lost workdays and include this figure in the annual totals. No further entries should be made with
respect to such cases in the next year's log and summary.

In addition to the OSHA Form #200, each employer must have available for inspection at each
establishment a supplementary record for each recordable occupational injury or illness. The record must
be completed in detail and be available within six working days after receiving information that a
recordable case has occurred. Workers’ compensation, insurance or other reports are acceptable if they
contain the required information, which appears below. Any missing items may be added on another form
or an attachment.

The supplementary record must contain the following:

1. The employer's name, mail address and location, if different from mail address.

2. Injured or ill employee's name, social security number, home address, age, sex, occupation and
   department.

3. Accident or exposure details - place of the accident or exposure, whether it was on the employer's
   premises, what the employee was doing when injured, and how the accident occurred.

4. Occupational injury or illness details: description of the injury or illness, part or parts of body affected,
   name of the object or substance that directly injured the employee, and date of injury or diagnosis of
   illness.

5. Name and address of physician; if hospitalized, name and address of hospital.

6. Date of report, and name and position of person preparing the report.

An annual summary of occupational injuries and illnesses must be posted for each establishment no later
than February 1 of the year immediately following, and remain posted until at least March 1. The
summary must include the year's totals from the OSHA Form #200 and calendar year covered, company
name, establishment name and address, certification signature, title and date. If no injuries or illnesses
occurred, the form must still be posted with zeroes filled in for the totals. Whomever supervises the
preparation of the log and summary must certify (by signature) that the annual summary is true and
complete. Employers must present or mail a copy of the summary to those employees who do not
regularly report to the single establishment.

All records must remain in the establishment for five years after the year to which they relate. If an
establishment changes ownership, the new employer must preserve the records for the remainder of the
five-year period.

Records must be maintained at each establishment (workplace). If an employer has more than one
establishment, a different set of records must be maintained at each one.
                                                                                                                                      Formatted: Font: (Default) Arial
Trident Insurance Services provides this Manual as part of its efforts to reduce the risk of insurance loss and claims. This 129
Manual is advisory only and not intended to address every potential hazard or any insured specifically. Trident does not
warrant that all loss and/or claims will be avoided if the Manual is used. Trident further in no way intends to relieve the insured
of its own duties and obligations, nor is Trident undertaking on behalf of or for the benefit of the insured any duty or obligation
to ensure that the insured’s property and operations are safe, healthful and in compliance with any law, rule, or regulation.
Insureds remain responsible for their own efforts to reduce risks and should consult their own legal counsel for appropriate
guidance.
                                                                                                                                      Formatted: Font: (Default) Arial
                                   SAMPLE DRAFT PROGRAM

Dispersed Work Locations - Companies engaged in activities that are physically dispersed, such as
agriculture, construction and transportation, are to maintain records of injuries and illnesses at the place
where employees report each day. Records for employees, such as traveling salespeople and
technicians, must be maintained either at the base from which they operate or at the place from which
they are paid.

Required records must be kept current and be available for inspection and copying at any reasonable time
by authorized federal or state government representatives. This includes representatives of the
Department of Labor, the Department of Health and Human Services ,and states with jurisdiction. The log
and summary must also be made available to any employee, former employee, and employee
representatives (union officials) for examination and copying.

When an occupational accident results in a fatality or the hospitalization of three or more employees, the
employer must notify the nearest OSHA area office (either by telephone or in person) within 8 hours. The
report must relate the accident circumstances, number of fatalities, and extent of injuries. More detailed
reports also may be required. OSHA Toll Free Hot Line, 800-321-OSHA.

Additional accident reporting and recordkeeping requirements include:

1. Employer's First Report of Injury

Employers are required to file the “First Report of Injury” within two working days of being notified of the
injury occurring or being reported. For this reason, it is imperative that accurate, prompt reporting be
accomplished.

We do not admit or accept responsibility for an injury/illness by reporting the case. Therefore, all injuries or
illnesses related to the job, either directly or indirectly, must be reported to the individual facility location.

2. Report Completion

The Safety office is responsible for sending completed records. The report can be prepared either by
management or the Safety Officer, depending upon local need and the circumstances of the injury.

Because various states have different reporting requirements, it is the responsibility of each location to be
knowledgeable of the requirements within their respective states.

Information and instructions for completing the First Report of Injury can be obtained from the individual
facility location.

3. Report Files

A copy of each “First Report of Injury” should have its own separate file and maintained in the Safety
Department. These reports are not to be filed in the employee's personnel file.

4. Report Attachments

A copy of an Accident Investigation Report should be provided with the First Report of Injury. Any other
pertinent data, such as job descriptions, witness statements, medical information, police reports, etc.,
should also be provided.

The attending physician completes this report and sends the original to the State and a copy to the
individual facility location. This report states the diagnosis, initial treatment and other pertinent information
needed.                                                                                                                               Formatted: Font: (Default) Arial
Trident Insurance Services provides this Manual as part of its efforts to reduce the risk of insurance loss and claims. This 130
Manual is advisory only and not intended to address every potential hazard or any insured specifically. Trident does not
warrant that all loss and/or claims will be avoided if the Manual is used. Trident further in no way intends to relieve the insured
of its own duties and obligations, nor is Trident undertaking on behalf of or for the benefit of the insured any duty or obligation
to ensure that the insured’s property and operations are safe, healthful and in compliance with any law, rule, or regulation.
Insureds remain responsible for their own efforts to reduce risks and should consult their own legal counsel for appropriate
guidance.
                                                                                                                                      Formatted: Font: (Default) Arial
                                  SAMPLE DRAFT PROGRAM


Our copy of this report should be kept with the incident file. The report should also be reviewed to insure
that the report content matches what was stated as to the loss cause and nature of loss or complaint.
Dates and times should also be compared with initial information. If the review shows a discrepancy, the
doctor's office should be notified in writing immediately and allowed to make any necessary changes.

When an injured staff member becomes represented by an attorney, the attorney may file with the court
an "Adjudication of Claim." This basically notifies the carrier and the court system that the case is not
litigated. The attorney should send the employer a copy of this adjudication form.

Often the first notification that an injury has occurred is receipt of the Adjudication of Claim form. When
this occurs, the Safety Officer should complete the employer's First Report of Injury as best as possible
and forward it to the individual facility location.

When the "adjudication" is received on a known claim, it should be placed in the injury file. The affected
employee should not be questioned or contacted regarding his right to seek and retain legal counsel. The
individual facility will handle all future correspondence with the employee.

1. Reporting requirements

All employees should be required to report a work-related injury or illness to management immediately.
This is an established safety rule and should be consistently enforced.

2. Management Responsibility

When an employee reports an occupational injury or illness, the following steps should be taken:

a. Provide medical attention immediately.

b. Conduct an accident investigation (unless it is a "first aid" case) to determine cause, not fault.

c.   Provide the investigation report and other information so that the First Report of Injury can be sent to
     the individual facility location.

d. Determine if the employee can return to his normal job, requires light duty or will not report for work
   until released by the doctor (lost time).

3. Late Reporting of Injuries

If an employee does not report an injury, or reports it after he has had medical treatment, the Human
REsources Department should be consulted and, where applicable, disciplinary action taken for not
reporting promptly. The employee should NOT to be disciplined for having an injury!

4. Medical Reports

Copies of all medical reports should be sent to the individual facility location office. One copy should be
retained in the accident file for that particular injury and another maintained in the Human Resources
Department.

5. Return to Work/Doctor Release


                                                                                                                                      Formatted: Font: (Default) Arial
Trident Insurance Services provides this Manual as part of its efforts to reduce the risk of insurance loss and claims. This 131
Manual is advisory only and not intended to address every potential hazard or any insured specifically. Trident does not
warrant that all loss and/or claims will be avoided if the Manual is used. Trident further in no way intends to relieve the insured
of its own duties and obligations, nor is Trident undertaking on behalf of or for the benefit of the insured any duty or obligation
to ensure that the insured’s property and operations are safe, healthful and in compliance with any law, rule, or regulation.
Insureds remain responsible for their own efforts to reduce risks and should consult their own legal counsel for appropriate
guidance.
                                                                                                                                      Formatted: Font: (Default) Arial
                                  SAMPLE DRAFT PROGRAM

An employee with an on-the-job injury requiring treatment by a doctor, clinic or emergency room facility
must obtain a written release from medical personnel BEFORE returning to work.

The release should include the following information:

a. Employee's name.

b. Date of accident and/or treatment.

c.     Date of authorized return to work.

d. Any limitations set by the doctor (i.e., restricted to light duty, no lifting, etc.).

Releases should be sent to the Human Resources or Safety Department and individual facility location as
soon as possible after their receipt.

This standard establishes minimum management requirements for reporting safety and regulatory
incidents. All company facilities are required to communicate all Safety and/or Regulatory Incidents as
defined below within 24 hours of their occurrence. (Exception - A fatality or hospitalization required by 3 or                        Formatted: Font: (Default) Arial, 10 pt
more employees. This must be reported within 8 hours to OSHA and corporate - See Section 1.2.4.)

To effect compliance with the reporting requirements and to facilitate appropriate follow-up actions, all
facilities should adhere to the following procedures.

1.

1.1. Regulatory Incident

1.1.1 Any visit (formal or informal) to a company facility by an officer or employee of a regulatory agency,
such as OSHA, State or Local Health Department, etc.

1.1.2 Any communication (written or verbal) to a facility or office by a regulatory agency during which
information relating to the firm is exchanged or passed.

1.1.3 The acquisition of knowledge of an outside incident that might secondarily affect the facility.
Examples of this would be information about regulatory actions at a supplier's facility or at a facility in
which our products are held.

1.2.     Personal Safety Incidents

1.2.1 Property damage or liability where the loss is expected to exceed $2,500.

1.2.2 Any fire involving the facility or its equipment -- one that exceeds the waste basket variety.

1.2.3 Any impairment to or discharge of the fire protection system due to damaged pipe, broken heads,
         closed sprinkler valves, faulty alarms, booster pump removed from service and the like.

1.2.4      Death or serious injury/illness of an employee at work.

           Serious injury/illness is defined such as: amputations, head injuries requiring hospitalization,
           severe eye injuries, severe burns, fractures and injuries requiring hospitalization and questionable
           cases exceeding $25,000 initial incurred cost estimates by our third-party claims administrator.
                                                                                                                                      Formatted: Font: (Default) Arial
Trident Insurance Services provides this Manual as part of its efforts to reduce the risk of insurance loss and claims. This 132
Manual is advisory only and not intended to address every potential hazard or any insured specifically. Trident does not
warrant that all loss and/or claims will be avoided if the Manual is used. Trident further in no way intends to relieve the insured
of its own duties and obligations, nor is Trident undertaking on behalf of or for the benefit of the insured any duty or obligation
to ensure that the insured’s property and operations are safe, healthful and in compliance with any law, rule, or regulation.
Insureds remain responsible for their own efforts to reduce risks and should consult their own legal counsel for appropriate
guidance.
                                                                                                                                      Formatted: Font: (Default) Arial
                                  SAMPLE DRAFT PROGRAM


When an occupational accident results in a fatality or the hospitalization of three or more employees, the
employer must notify the nearest OSHA area office (either by telephone or in person) within 8 hours. The
report must relate the accident circumstances, number of fatalities and extent of injuries. More detailed
reports also may be required. OSHA Toll Free Hot Line, 800-321-OSHA.

1.2.5     Any lost time injuries/illnesses.

1.2.6     Any injury that occurs on our premises to a non-employee (salesman, serviceman, tourist, delivery
          personnel etc.).

1.2.7     Employee exposure to an excessive amount of hazardous or toxic substances released into the
          environment without adequate safeguards for human safety (accidental overexposure to chlorine,
          ammonia, pesticides, carbon monoxide, carbon dioxide, etc.).

2.

2.1 Regulatory Incidents

2.1.1 All visits and contact by Regulatory Agencies as defined, must be reported immediately (by phone)
        to the responsible employee.

2.1.2 The information reported will be communicated to the appropriate headquarters personnel utilizing
        the Incident Report Form (Attached).

2.1.3 The responsible safety coordinator will coordinate all subsequent activities related to the incident
        and serve as a clearing-house for all communications and information.

2.2     Personal Safety Incidents

2.2.1 Each personal safety incident is to be reported immediately by the facility manager to the
        responsible employee.

2.2.2 The Safety Coordinator will coordinate the facility actions and reporting as is required.




                                                                                                                                      Formatted: Font: (Default) Arial
Trident Insurance Services provides this Manual as part of its efforts to reduce the risk of insurance loss and claims. This 133
Manual is advisory only and not intended to address every potential hazard or any insured specifically. Trident does not
warrant that all loss and/or claims will be avoided if the Manual is used. Trident further in no way intends to relieve the insured
of its own duties and obligations, nor is Trident undertaking on behalf of or for the benefit of the insured any duty or obligation
to ensure that the insured’s property and operations are safe, healthful and in compliance with any law, rule, or regulation.
Insureds remain responsible for their own efforts to reduce risks and should consult their own legal counsel for appropriate
guidance.

				
DOCUMENT INFO
Shared By:
Categories:
Tags:
Stats:
views:1
posted:11/14/2012
language:Latin
pages:133