Applicant Eligibility by tyndale


									                         The EH&S Safety Star Program

Program Overview


       Any department can apply for participation in the EH&S Safety Star Program.


       The applicant must assure that:

All employees, including new hires will have the EH&S Safety Star Program explained to them,
as part of a discussion about employee rights under Section 6300 et.seq. of the Labor Code.
Departments may use the Individual Employee Training Documentation Form F-2555
(, included in the campus
Injury and Illness Prevention Program, to document this training.
          All hazards discovered through inspections, accident investigations and employee
            reports will be corrected in a timely manner. A written description of the corrective
            actions is available to affected employees. Departments should utilize the
            inspection, accident investigation and safety information forms found in the campus
            Injury and Illness Prevention Program (
            to document these safety activities.
          If employees are given safety and health duties as part of the applicant's safety and
            health program, the applicant department will assure that those employees will be
            protected from retaliatory action resulting from those duties.
          Employees shall have access to the results of inspections and accident
          The following information will be retained and available for EH&S review:
                o Injury and Illness Prevention Program and all other specific safety and health
                o Copies of first report of injuries forms (F-903)
                o All monitoring and sampling records if applicable
                o Inspection and accident investigation records
                o Records of notifications of unsafe or unhealthful conditions received from
                    employees and action taken, taking into account appropriate privacy interests

       Compliance History

       If the applicant has been inspected in the last three years, the inspection, abatement
       and/or other history of interaction with EH&S and/or Cal OSHA must indicate good faith
       attempts to abate unsafe conditions and to improve safety and health at the worksite.
       The following upheld citations or safety violations for a site in the last three years would
       disqualify the applicant:

          willful citations or safety violations
          serious repeat citations or safety violations
          serious citations directly related to an accident
       Term of Participation

       Once approval is granted the term of participation in the EH&S Safety Star Program
       continues indefinitely, contingent upon continued favorable triennial re-evaluation.

Qualifications for the EH&S Safety Star Program

All of the following elements must be in place for a period of not less than 12 months before

       Injury and Illness Rates

       The average of the lost workday injury/illness incidence rates, and the total injury/illness
       incidence rates for a three-year period must be at or below the most recent specific
       industry rate (at three or four digit SIC code level) published by the California Division of
       Labor Statistics and Research. For most departments this will be the rate associated
       with SIC 822 or 8221.

       Management Commitment

       Each applicant must be able to demonstrate a documented top-level management
       commitment to worker safety and health consisting of the following:

          Authority and responsibility for employee safety and health is integrated into
           management system and overall planning
          Established policies and results-oriented objectives are communicated to all
           employees, managers, supervisors, and safety and health staff
          Authorities and responsibilities are clearly defined and implemented
          Adequate resources are devoted to achieve objectives
          Top management is visibly involved in worker safety and health
          Planning for safety and health must be part of the overall, long-term management
          Management must also clearly commit to meet and maintain the requirements of the
           EH&S Safety Star Program.

       Access to Professional Expertise

       Reasonable site access to Industrial Hygienists and Safety Professionals or Safety
       Engineers, within the Environmental Health & Safety Department or other sources, must
       be available as needed, based on the potential risks of the site.

       Line Accountability

       The department applicant must have a documented system for holding all line managers
       and supervisors accountable for safety and health.

       Contract Workers

       All applicants must be able to demonstrate that all contractors and subcontractors will
       follow Cal/OSHA safety orders and worksite safety and health rules and procedures.

       Worksite Analysis

       For understanding of all hazards and the ability to correct them the following are
   Periodic comprehensive inspections/surveys to identify unsafe conditions and work
    practices. Departments should utilize the Department Safety Coordinator,
    Bloodborne Pathogens, Chemical Safety Program for laboratories or Injury and
    Illness Prevention Program Inspection Forms avail on the EH&S Web Site at
   Pre-use review for new or modified processes, equipment or materials to determine
    potential hazards. Departments should use the Hazard Evaluation Form F-2559
    (, included in
    the campus Injury and Illness Prevention Program, to document these investigations.
   The use of nationally recognized associations that provide guidance for evaluation
    procedures, analysis, sampling and record keeping.
   A reliable system for employees, without fear of reprisal, to notify appropriate
    management personnel of safety and health concerns, in person and/or in writing.
    The system must include the ability to track responses and hazard corrections.
   An accident/incident investigation system which includes written reports of findings
    and hazard correction tracking. Departments should use the Accident and Illness
    Investigation Form F-2553
    (, included in the
    campus Injury and Illness Prevention Program, to document these investigations.
   A routine review of job hazards identified for inclusion in training and hazard control.
   A system for initiating and tracking hazard correction in a timely manner.
   A medical program that includes the availability of physician and first-aid services.
   A system for conducting routine inspections with documentation and tracking of
    hazard correction.

Hazard Prevention and Control

Based on result of worksite analysis, identified hazards must be eliminated or controlled.
The following must be implemented to prevent incidents or control their frequency and/or

   Safety and health rules, including safe and healthful work practices for specific
    operations, appropriate to the potential hazards of the site, written, implemented, and
    updated by management as needed and used by all employees.
   Procedures for disciplinary action or re-orientation of employees and supervisors
    who break or disregard safety rules, safe work practices or emergency procedures.
   Procedures for emergency response requiring personal protective equipment, first
    aid, medical care, and emergency egress.
   Ongoing monitoring and preventive/predictive maintenance of workplace equipment.

Safety and Health Training

Training is necessary to implement management's commitment to prevent exposure to
hazards. Supervisors and employees must know and understand the policies, rules and
procedures established to prevent exposure. Training for safety and health requires
ensuring that:

   Supervisors understand the hazards associated with a job, their potential effects on
    employees, their role in teaching and enforcement ensuring that employees follow
    the rules, procedures and work practices for controlling exposure to the hazards.
   Supervisors must determine the safety training their employees need based on a
    review of the hazards to which the employees are exposed and exist laws.
    Information on required training can be found on the EH&S Web Site at
   Employees are trained in safety and health protection at the same time they are
    taught their job.
   Refresher training is provided as needed.
   Employees at all levels know what to do in emergency situations.

Employee Participation

The department must provide an effective way for employees to participate in safety and
health problem identification and resolution which goes beyond the individual right to
notify appropriate managers of hazardous conditions and practices.

Safety and Health Program Evaluation

The applicant must have a system for annually evaluating the safety and health program
to determine what changes are needed to improve the program effectiveness. The
system must provide for written narrative reports with recommendations for
improvements and documentation of follow-up action.
                                     Application Format

Your application may be in any format convenient for you. It should address each item listed
below. Use the following numbering system below to help speed up the review of your
application. Where existing policies, guidelines, forms, etc., describe your programs, you are
encouraged to enclose them rather than writing new material for this application.


          1.    Department Names and Locations

                  a.    DEPARTMENT NAME:
                        DEPARTMENT CHAIR/HEAD:
                        PHONE NUMBER(S):

                  b.    DEPARTMENT SAFETY COORDINATOR(S):
                        PHONE NUMBER(S):

          2.    Other Site Information (required for each site):

                NUMBER OF EMPLOYEES (faculty, staff, student Assistants, etc.):

                NUMBER OF CONTRACT WORKERS (used routinely):


                INDUSTRY SIC CODE (Typically 8221):

                RATES (All rates shall be for the last three completed calendar years
                and average of all three years combined.):


                    o   All rates shall be for the last three completed calendar years and
                        average of all three years combined.
                    o   Injury/Illness rates are calculated by:
                    o   (N/EH) x 200,000 where:
                    o   N=number of recordable injuries/illnesses in one year
                    o   EH=total number of hours worked by all employees (faculty,
                        staff, student workers, etc) in one year


                    o   All rates shall be for the last three completed calendar years and
                        average of all three years combined.
                    o   Injury/Illness lost workday case rates are calculated with the
                        above formula where:
                 o   N=number of injuries/illnesses resulting in lost workdays or restricted
                     work activity


           Commitment

               a.    Describe your current goals for the safety and health program with the
                     objectives for meeting those goals

           Organization

               a.    Describe how the safety and health function fits into your overall
                     department organization

               b.    Attach the organization chart

           Responsibility. Describe how the department assigns staff safety and health

           Accountability. Describe the accountability system used for managers and
             supervisors. Appropriate examples may include job performance evaluations,
             Management by Objectives. Explain how the system is documented

           Resources. Describe personnel, equipment, budget, and other resources
             devoted to the safety and health program.

           Planning. Indicate how safety and health practices are integrated into
             comprehensive management planning.

           Non-departmental and Contract Workers. Describe the method you use to
             assure safe and healthful working conditions for outside employees who may
             work in your department. This includes maintenance personnel and contract
             employees, i.e., temporary agency employees.

           Employee Notification. Describe how you will notify employees about
             participation in the EH&S Star Program. Departments must notify employees of
             their right to register a complaint with the campus EH&S Department and/or
             Cal/OSHA, their right to obtain inspection and accident investigation results upon
             request. Methods may include one or more of the following: new employee
             orientation, bulletin boards, tool box meetings or work group meetings


        1.   Pre-Use Analysis. Explain how new equipment, materials and processes are
             analyzed for potential hazards prior to use. The Hazard Evaluation Form F-
             2559-00, from the IIPP can be used for this purpose and to document Job
             Hazard Analysis referenced in item 4 below. The form is available on the web at

        2.   Comprehensive Surveys. Indicate how you spot potential safety & health
             hazards at the site. Acceptable surveys include industrial hygiene surveys,
             comprehensive safety reviews and/or project safety reviews at time of design.
       3.   Inspections. Describe your worksite safety and health inspection procedures.
            Include information about inspection schedules and industrial hygiene sampling
            and monitoring. Indicate who performs the inspections and how necessary
            corrections are tracked. (You may attach sample forms and internal time frames
            for correction). Where applicable to health hazards, summarize testing and
            analysis procedures used and qualifications of personnel who conduct them. All
            departments should be conducting quarterly Department Safety Coordinator
            Inspections at a minimum. The Department safety Coordinator Program is
            available on the web at
            inspections may be required to conduct other inspections on a periodic basis,
            depending on the work activities in the department. Some of these other
            inspections are Bloodborne Pathogen and/or Laboratory Safety Inspections.

       4.   Job Hazard Analysis. State how you review jobs, processes, and/or interaction
            of activities to determine safe work procedures (not to be confused with self-
            inspection). Describe the frequency of these analysis and provide supporting
            documentation. Include procedures or guidance techniques used in conducting
            job hazard analysis. In construction, relate phase-planning, and describe how
            results are used in training employees to do their jobs safely. Also, how are
            results used in planning and implementation of your hazard correction and
            control program?

       5.   Employee Notification of Hazards. Describe how employees notify
            management of potential health and safety hazards. What is management's
            procedure for follow-up and tracking correction? (An option providing for written
            notification must be part of the system.)

       6.   Accident Investigations. Explain your department’s accident investigation
            procedures. What training/guidance is given to your investigators? How do you
            determine which accidents warrant investigation? What about near-miss

       7.   Medical Program. Describe both your onsite and offsite medical service or
            physician availability. Indicate the coverage provided by employees trained in
            first aid, CPR, bloodborne pathogens and other para-medical training and
            indicate which training they have received. Give a detailed description of how you
            address specific programs such as hearing conservation, respiratory protection,


       1.   Professional Expertise. Provide details concerning your use of the services of
            the Environmental Health & Safety Department. What industrial hygiene services
            and broad-based safety expertise are available to you?

       2.   Safety and Health Rules. List your department’s safe work practices (safety
            rules), and describe the disciplinary system used in enforcing them

       3.   Personal Protective Equipment. Describe your company's personal protective
            equipment requirements. The University’s Respiratory Protection Program is
            available at
        4.   Emergency Preparedness. Describe your departments emergency planning
             and preparedness program and how it interfaces with the campus plan. Include
             information on emergency and evacuation drills

        5.   Preventive Maintenance. Provide a summary and description of your
             procedures for preventive maintenance of your equipment.


         1. List. List and describe formal and informal safety and health training programs
            for your employees, supervisors and managers.

         2. Procedures for ensuring attendance. Describe how you ensure employees
            attend training.


         1. Description. Describe the ways employees are involved in your safety and
            health program. Provide specific information about decision processes that
            employees impact, such as hazard assessment, work analysis, safety and health
            training or evaluation of the safety and health program.

         2. Committees (if any). For Safety and Health Committees, describe:

               a.    Date of committee inception

               b.    Method of selecting members

               c.    Name, job and length of service of each member

               d.    Average length of service of each member

               e.    Description of the committee role. Frequency and scope of committee
                     inspections/procedures for inspecting entire worksite/role in accident
                     investigation/role in employee hazard notification/other

               f.    Describe your hazard recognition training procedures. If previously
                     covered under Safety Health & Training, indicate "See Training"

               g.    List safety and health information accessible to and used by the


         1. Safety and Health Program Self-Evaluation. Provide a copy of last year's
            comprehensive review/evaluation of your entire safety and health program.
            Assessments of the effectiveness of the areas listed in these application
            guidelines should be included.

         2. Rate Reduction. If injury rates are above industry averages, specify your short
            and long term goals for reducing them to or below industry averages. Include
            specific methods you will use to address this problem.
         3. Other Information. Include any other information you may consider crucial to
            the application.


         1. Management Statement. Please read the statement on the next page carefully
            and either place on your stationery and sign on the line below, or attach a letter
            in your own words that provides the same assurances

             We are committed to complying with the Universities Policy on
             Environmental Health & Safety (Available at
    and doing our best
             to provide outstanding safety and health protection to our employees
             through management systems and employee involvement. We are
             also committed to the achievement and maintenance of the EH&S
             Safety Star Program requirements and to the goals and objectives of
             the Cooperative Self Inspection Programs.

             We agree to provide the information listed below for Environmental
             Health & Safety (EH&S) review onsite. We agree to retain these
             records until EH&S communicates its decision regarding EH&S Safety
             Star participation. We will likewise retain comparable records for the
             period of participation in the program:

                      Injury and Illness Prevention Program (Available at

                      Management statement of commitment to safety and health

                      Line supervisor accountability

                      Injury reports

                      Safety and health manuals (Various manuals are available
                       through the Environmental Health & Safety Web Site at
              ) .

                      Employee notifications of safety and health problems

                      Safety rules, emergency procedures and sample safe work

                      The system for enforcing safety rules

                      Self-inspection procedures, reports and correction tracking

                      Accident investigations

                      Safety Committee minutes

                      Employee orientation and safety training programs and
          attendance records

         Industrial hygiene monitoring records

         Contractors safety & health program

         Prevention maintenance program

         Employees report of safety & health problems and
          documentation of response; and

         Other programs as required such as confined space, lockout
          tagout, hazard communication, bloodborne pathogens and
          laboratory safety

We also agree to correct all hazards identified through self-inspection,
employee reports or accident investigations in a timely manner. We
will provide the results of self-inspections and accident investigations
to our employees upon request. Any employee with safety-related
duties will be protected from discriminatory actions (including unofficial
harassment) resulting from these duties.

We will provide EH&S, each year by February 15th, our annual injury
and illness and lost workday injury and illness rates, hours worked,
and estimated average employment for the past calendar year.

By an agreed upon date, we will provide EH&S the site's safety and
health program evaluation.

[For construction sites only - Injuries of all employees at the site, no
matter who the employer is, will be recorded together. Rates will be
calculated based on information for the site as a whole as long as we
participate in the EH&S Safety Star Program.]

We understand that we may withdraw our participation at any time or
for any reason should we so desire.

Department Manger

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