The EH&S Safety Star Program
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
(http://www.csupomona.edu/~ehs/ftp/IIPPForms/TrainingIndividual.doc), 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 (http://www.csupomona.edu/~ehs/ftp/iipp.doc)
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
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.
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.
The department applicant must have a documented system for holding all line managers
and supervisors accountable for safety and health.
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.
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
(http://www.csupomona.edu/~ehs/ftp/IIPPForms/HazardEvaluation.doc), 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
(http://www.csupomona.edu/~ehs/ftp/IIPPForms/Accident.doc), 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 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
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.
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.
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.
I. GENERAL INFORMATION
1. Department Names and Locations
a. DEPARTMENT NAME:
b. DEPARTMENT SAFETY COORDINATOR(S):
2. Other Site Information (required for each site):
NUMBER OF EMPLOYEES (faculty, staff, student Assistants, etc.):
NUMBER OF CONTRACT WORKERS (used routinely):
TYPE OF WORK PERFORMED AND PRODUCTS PRODUCED:
INDUSTRY SIC CODE (Typically 8221):
RATES (All rates shall be for the last three completed calendar years
and average of all three years combined.):
TOTAL INJURY/ILLNESS INCIDENCE RATE:
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
LOST WORKDAY INJURY/ILLNESS INCIDENCE RATES:
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
II. MANAGEMENT COMMITMENT AND PLANNING
a. Describe your current goals for the safety and health program with the
objectives for meeting those goals
a. Describe how the safety and health function fits into your overall
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
III. WORKSITE ANALYSIS
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
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,
IV. HAZARD PREVENTION AND CONTROL
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 http://www.csupomona.edu/~ehs/ftp/RespiratoryProtection.doc.
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.
V. SAFETY AND HEALTH TRAINING
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
VI. EMPLOYEE INVOLVEMENT
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
VII. PROGRAM EVALUATION
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
VIII. STATEMENT OF COMMITMENT
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
http://www.csupomona.edu/~ehs/PolicyEH&S.pdf) 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
Safety and health manuals (Various manuals are available
through the Environmental Health & Safety Web Site at
http://www.csupomona.edu/~ehs ) .
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
Safety Committee minutes
Employee orientation and safety training programs and
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
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.