Hyde County Risk Control Manual by sdfgsg234

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									Hyde County Risk Control

Implemented: December, 2005

State of North Carolina
County of Hyde


The County of Hyde hereby establishes a Safety & Risk Management Program, as required by the
North Carolina Association of County Commissioners Risk Management Pool, as well as various
standards, laws, and regulations.

The County adopts the NCACC Risk Management Manual as the basis for its safety program.
Additional documents referenced include the NCACC Fleet Management Program and the NCACC
Return to Work Program.

The County adopts the Hyde County Risk Control Manual (RCM) draft, dated December, 2005 and
authorizes the Hyde County Safety Committee (defined within) to make needed changes and
editions going forward. This RCM applies to all Hyde County employees, facilities, vehicles, and
employees of related agencies that operate in our facilities.

The County authorizes adding a County Employee benefit of Returning to Work, after an outside
injury, in a modified duty status as further outlined, described, and allowed.

The County authorizes the County Manager and the Safety Coordinator to take any necessary
action to limit dangers to life and safety, including the authority to make emergency expenditures
and repairs. All emergency expenditures must be immediately reported to the Finance Director.

The County will fully support safety measures and expenditures as a priority in all operations.

The County creates the following deadlines for implementation of this program:

         Initial Review of Draft RCM                  Department Heads                 December 14, 2005
         Obtain Copies of RCM for employees           Safety Coordinator               January 5, 2006
         Annual Employee Training Completed           Safety Coordinator               February 1, 2006
         Self Inspections Process                     Everyone                         February 1, 2006
         New Employee Orientation Program             Department Heads                 March 1, 2006
         Emergency Action Plans                       Department Heads                 March 1, 2006
         Safety Program Filing System                 EM Administrative Assistant      March 1, 2006
         Vehicle Maintenance & Operation Logs         Safety Coordinator/ Finance Dir. April 1, 2006
         Departmental Safety Training Program         Department Heads                 April 1, 2006
         New Employee Safety Training                 Safety Coordinator               May 1, 2006
         Hazardous Communication Training             Safety Coordinator               May 1, 2006
         Detailed, Compliant Job Descriptions         County Manager                   May 1, 2006
         Full Compliance                              Everyone                         June 30, 2006

Every County Department is directed to fully comply with the RCM, or be subject to resulting
financial penalties incurred from the NCACC Risk Management Pool and disciplinary action.

_________________________________________                    ___________________
Chairperson, Hyde County Board of Commissioners              Date

                                                                         Safety Policy
December, 2005


TO:            All Department Heads, Supervisors and Employees

FROM:          Kevin Howard, County Manager

RE:            Safety Policy

It is the objective of Hyde County to conduct all operations as safely and efficiently as possible.
Hyde County believes every employee is important and is a valuable resource to furthering the
objectives of our organization.

To accomplish this, we are assigning the responsibility, authority, and accountability for safety to all
department heads and supervisory personnel within their individual area of operations.

We are also appointing the Director of Emergency Management as our Safety Coordinator. All
employees and managers are responsible for active participation in the safety program activities;
the Coordinator’s role is to support and coordinate this participation to ensure the program functions

Other specific appointments are:

        Claims Processor                       County Manager’s Assistant
        Return to Work Coordinator             Finance Director
        OSHA Log Coordinator                   Finance Director
        Department Safety Officers             Department Heads

All employees will have the responsibility of performing their own work in a safe and efficient
manner and to report unsafe conditions to their department head or supervisor for prompt
correction. All employees are also to report all work-related injuries to their supervisor in a timely

We will make every effort to prevent on the job injuries and illnesses. Should an employee be
injured on the job, we will make every reasonable effort to provide suitable transitional work
opportunities for the employee if he or she is unable to perform his/her regular job duties. This may
include modifying the employee’s regular job or, if available, providing temporary alternate work
depending on the employee’s physical abilities. As an added benefit to our employees, the county
will offer employees, injured outside of work, the opportunity to Return to Work under this program,
when possible and feasible, and not detrimental to county operations..

Kevin Howard
County Manager

                       Hyde County Risk Control Manual

Tab 1    Management Support and Direction
         • Introduction and Assignment of Responsibility
         • Policy Statement
         • Basic Safety Rules
         • Safety Committee

Tab 2    Safety Orientation and Training
         • Safety Orientation of New Employees
         • On-going Safety Training

Tab 3    Control of Hazards
         • Self Inspection Activity
         • Follow Through on Concerns Identified

Tab 4    Emergency Procedures
         • Basic Emergency Evacuations
         • Plans for Special or Unusual Risks

Tab 5    Claims Management
         • Accident Reporting and Investigation
         • Basic Claims Management

Tab 6    Protective Clothing and Equipment
Tab 7    Housekeeping
Tab 8    Materials Handling and Lifting
Tab 9    First Aid
Tab 10   Bloodbourne Pathogens
Tab 11   Fire Prevention
Tab 12   Hazard Communication
Tab 13   Emergency Medical Services – Lifting/Handling Patients
Tab 14   Motor Vehicle Safety
Tab 15   Office Safety
Tab 16   Ladders and Scaffolding
Tab 17   Hand Tools and Power Tools
Tab 18   Working in Confined Spaces
Tab 19   Refuse Collection and Disposal / Utility Equipment
Tab 20   Construction Safety
Tab 21   Cell Phone Policy
Tab 22   Disciplinary Policy
Tab 23   Return to Work Program

         NCACC Workers’ Compensation Risk Management Pool

Management Support and Direction
   •   Basic Safety Rules Established
   •   Responsibilities assigned
   •   Appropriate safety organization established

Safety Orientation and Training
   •   Basic safety orientation training of new employees
   •   Appropriate on-going safety training

Control of Hazards
   •   Self inspection activity
   •   Follow through on concerns identified

Emergency Procedures
   •   Appropriate evacuation procedures
   •   Plans for special or unusual risks

Claims Management
   •   Accident reporting and investigation procedures
   •   At least minimal return to work program

We are sincerely concerned with the safety and welfare of our employees and the public they serve.
We acknowledge an obligation as an employer to provide the safest possible working conditions for
employees and a safe environment for the public who use our services. It is the fingers, limbs,
eyes, and lives of our employees that we are concerned about. They are irreplaceable. Livelihoods
are diminished, or at worst destroyed, when employees are disabled. Employees and their families
suffer the most when an accident occurs.

The primary purpose of this manual is to acquaint employees with the County's general safety rules
and policies. It reflects the efforts of many people to establish reasonable, practical, safe work
practices to prevent accidents. Our approach to accident prevention cannot be simple or basic; it is
complicated by differences in tasks performed and differences in work environments. Departmental
supervisors will explain rules and policies regarding departmental operations.

We can and must perform the tasks of government operations and public services without
accidents. It is the responsibility of all employees to contribute to that goal. The attitudes that shall
guide our efforts are as follows:

   •   Accidents are caused and can be prevented.
   •   Safety is a mark of skill and good common sense.
   •   We are sincerely interested in safety and are willing to put forth the effort to prevent
   •   Safety is a personal responsibility.
   •   No job is so important and no service is so urgent that we cannot take time to perform our
       work safely.
   •   We have a moral obligation to each other to do everything possible to prevent accidents.
   •   Work areas and equipment will be kept as safe as possible. As hazards are discovered,
       corrective measures will be taken.
   •   Employees shall report all unsafe conditions encountered in their work.
   •   No job shall be undertaken until it has been mastered by the employee and has been
       authorized by the supervisor.
   •   All injuries must be reported immediately.
   •   Compliance with safety rules is a condition of employment.
   •   We will achieve a good, mediocre, or poor occupational safety record in direct proportion to
       the amount of effort that is exerted. Wishful thinking or discussions concerning safety will
       not produce the desired results. Only when our actions meet our desires will we achieve the

Safe work practices benefit the employee, the family, fellow employees, the entity, and society as a

These guidelines are issued to inform our employees and contractors about the policies that are the
basis for our occupational safety program, and to establish uniform safety policies and procedures.

A successful Risk Control Program requires active participation by every employee and every level
of management. As such, everyone needs to be familiar with the policies and procedures outlined
in this manual, with active participation by employees and managers at all levels:

   Department heads and other managers are directed to make safety a matter of continuing
   concern, equal in importance to all other operational considerations. Department Managers
   must develop and administer active departmental safety programs. This manual helps define
   what some of those programs may be.

   All supervisors are required to study these program guidelines. Supervisors will also be
   responsible for conveying the information contained herein to all personnel under their direct

   All employees are charged with the responsibility for cooperating with, and supporting, the
   safety program and its objectives. Every employee is expected, as a condition of employment,
   to be concerned with personal safety, safety of fellow workers, and safety of the general public.
   This means willing acceptance and active support of approved safety rules or safety
   procedures. It is important that employees be constantly alert to potential hazards which are not
   referred to in any written practices, but which may result in injuries or property damage. Where
   potential hazards are thought to exist, employees will use all known precautionary measures.
   When in doubt as to the procedure to follow, employees will consult their supervisor before
   proceeding with the job.

Safety is a way of life. Most people endorse it, many talk of it frequently, but all of us fail in varying
degrees to live up to the commitment we preach. Failures in accident prevention occur when we
overlook or disregard safety to concentrate on a mechanical skill or problem; when we fail to
recognize a hazard; or when we feel pressured to finish the job and decide to take unnecessary

Experienced professionals in any occupation recognize that they cannot afford to ignore safety.
Accidents are too costly. They cost our employees physical pain, possible disability, and potential
loss of future income. Workers' Compensation, no matter how generous, will never equal the cost
of injuries to employees. The monetary benefits are certainly small consolation to the spouse and
children of an employee who suffers fatal or severely disabling injuries. Accident costs to
employers are high also. Premiums for Workers' Compensation insurance, medical treatment,
repair of damaged equipment, and many indirect costs that are not so easily measured are an
unnecessary burden. Accident prevention is just plain common sense. Safe operating procedures
demonstrate job skill. Safe performance is efficient performance.

An Accident Is Any Unplanned Event That Results In Personal Injury or
Property Damage

Accidents do not just happen. They are caused. They are caused because someone acted in an
unsafe or failed to act in a responsible, safe manner. Human failures can be controlled through
effective supervision. By demanding safe performance and enforcing approved safety procedures,

supervisors demonstrate concern for the welfare of all employees. Accident prevention can be the
most important employment benefit any of us have.

What does all this add up to? Here is a positive side of Safety:

       •   Safety is a matter of COMMON SENSE. It is acceptance of procedures developed
           through experience for self-protection.

       •   The SAFE WAY to do a job is the most efficient way to do it. Shortcuts that ignore safety
           ultimately cost you more and negate any monetary savings.

       •   A good safety record is a mark of JOB SKILL.

Employee training is the single most important activity in any organization. Thorough training
provides employees with the most efficient and safest methods to perform their jobs. Therefore, it
is essential that all supervisors develop a plan to ensure that employees are properly trained in all
aspects of their jobs. An effective training program includes:

       •   Development of job work procedures.

       •   Communication of these procedures to the employee.

       •   Monitoring the employee's work to evaluate adherence to established procedures.

       •   Reinforcement of proper work methods and correction of improper methods.


County Manager

The County Manager is ultimately responsible for the occupational safety performance of the Entity.
They must establish employee safety as the first priority. To achieve this, safety policies should be
established that set goals for all departments and then holds the departments accountable for
achieving these goals.

Department Heads

The Department Head may, and usually does, delegate authority and assign responsibilities.
However, the Department Head is ultimately responsible for the safety performance of the
department. Safety performance is based on the "quality of effort" involved with performing safety
activities such as employee training, accident investigation, work site inspections, etc. The
Department Heads must make employee safety a priority.


Supervisors are at "the point of implementation" for most safety activities. Therefore, supervisors
will assume the responsibility of thoroughly instructing their personnel in safe practices to be
followed in their work situations. They will consistently enforce safety standards and requirements
to the utmost of their ability and authority. Supervisors will act positively to eliminate any potential
hazards concerning activities under their jurisdiction, and they will set an example of good safety


All employees are responsible for compliance with safety procedures, standards, and rules
established by management. This is essential to prevent injury to themselves, other persons, or
damage to equipment and property. They should also be responsible for promptly reporting to their
supervisor any hazardous conditions or procedures that affect themselves, their fellow workers, or
the general public.

Safety Coordinator

The Safety Coordinator should be responsible for the organization, coordination, and
implementation of the safety programs. The Safety Coordinator should advise the County
Manager, Department Heads and supervisory personnel on problem areas and assist in developing
programs to correct these problems. However, the Safety Coordinator is not expected to solely
assume the responsibility of performing safety activities. The Safety Coordinator is a "resource" for
the management staff to utilize in developing their safety programs.

Should a department be required by statute, law, or regulation to have a more stringent safety
procedure, the procedure shall apply in lieu of these general requirements. Should any policy found
to be in conflict, the Safety Committee will determine applicability of each.

                                                   Safety Responsibility
County Manager

For the Risk Control program to function effectively, it must have the support and guidance of the
top officials. The County Manager is responsible for setting up and supporting policies and
procedures to include:

   •   An active Safety Committee meeting on a scheduled basis.
   •   A thorough and effective Accident Investigation process to include reporting and recording
       procedures, and a written report on actions taken to prevent recurrence of accidents,
       including action taken against individual violators of safety rules and practices.
   •   A training program for employees and supervisory personnel directly related to avoiding a
       possible injury or illness in the area of assigned operations.
   •   A periodic audit of all premises, equipment, and materials so that unsafe conditions and
       actions can be identified and corrected.
   •   A communications system established and maintained to ensure that all personnel are
       contacted regularly about the importance safety in all operations.
   •   Specific goals established for the Risk Control program, with progress toward those goals
       measured on a monthly basis.

The County Manager is directly responsible for all safety efforts in the organization. Enthusiasm
and faith in the safety program must be such as to maintain the interest and support of all
Department Heads and Supervisors. This attitude is reflected down through the Department Heads
and Supervisors to the individual workers. The specific accident prevention duties include the

   •   Active participation and direction in the planning of details for accident prevention which will
       bring the best results for all employees. Expansion and adaptation of programs and
       procedures to all departments within the organization.
   •   Demonstrated support of the program through personal participation and through approval
       of necessary expenditures for such items as personal protective equipment, mechanical
       guards, good lighting, good ventilation, and other physical improvements to the working
       environment, as well as expenditures for safety training materials, awards and incentives,
   •   Continuing review of the effectiveness of accident prevention efforts in various sections and
       departments, with necessary follow-up and bolstering of efforts when required.

Safety Coordinator Responsibility
Implement and administer the Risk Control program.

   •   Maintain records as necessary to comply with laws and objectives of the safety program.
       These records should include:

          •   Copy of Report of Injury, Illness or Accident
          •   Supervisor's Accident Investigation Reports
          •   Minutes of all Safety Meetings
          •   Safety Program status reports
   •   Submit status reports to Safety Committee.
   •   Make periodic visits to all buildings/operations to assist and consult in developing safe work
       methods, accident investigations, training, and other technical assistance.
   •   Analyze accident reports and investigations.
   •   Act as Chairperson of the Safety Committee.
   •   Promote "safety awareness" in all employees through stimulating educational and training
   •   Promote compliance with all Federal, state and local laws, and established safety standards
   •   Maintain contact with available sources of topical safety information such as the following:
       American Society of Safety Engineers (ASSE), National Safety Council (NSC), Department
       of Environment, Health, & Natural Resources (DEHNR), North Carolina Association of Local
       Government Employee Safety Officials (NCALGESO), North Carolina Department of Labor
       (NCDOL), North Carolina Occupational Safety & Health Administration (NCOSHA) and
       North Carolina Industrial Commission (NCIC).

   •   Provide/arrange training programs or assist departments as necessary.
   •   Represent management in the implementation of the Safety Policy.
   •   Recommend immediate corrective action in cases of hazardous operations.

Department Head and Supervisor Responsibility

Management will demonstrate support for the Risk Control program through every visible means,

   •   Providing a safe and healthful work place.
   •   Providing personal protective equipment as well as machine guards and safety devices
       commensurate with the state of the art.
   •   Reviewing accident records and accomplishments of the safety program with the Safety
   •   Evaluating effectiveness of the safety program and recommending changes.
   •   Participating directly and/or indirectly in safety activities as may be required to maintain the
       enthusiasm and interest of all concerned.
   •   Abiding by safety rules and regulations when exposed to conditions governed by the rules.
   •   Directing that any flagrant disregard of safety rules and regulations by employees be
       grounds for dismissal as outlined in Personnel Policy.

Because of the close relationship with the employees and intimate knowledge of operating
procedures, Supervisors are the key persons in the scheme of loss control.

Supervisors of each department are charged with the responsibilities of quality and quantity of
production within that department, and therefore are responsible for the work conduct of same.
Supervisors should be afforded the necessary knowledge to carry out their duties with efficiency
and safety. Supervisors must:

   •   Have a thorough knowledge of the safety policy.
   •   Provide instruction and training to workers so that they may fulfill their job in a safe manner.
       (See section on Training New Employees.)
   •   Make daily inspection of the department to ensure that no unsafe conditions or unsafe
       practices exist.
   •   Initiate immediate corrective action where unsafe conditions or practices are found. When a
       capital expenditure is required to make necessary corrections, a written report shall be
       submitted to the County Manager and the Safety Coordinator.
   •   Properly complete accident reports and investigate all accidents to determine what must be
       done to prevent recurrence of a similar accident.
   •   Be familiar with procedures that must be followed in the event of an emergency.
   •   Enforce safety rules and regulations of the organization.
   •   Provide good example by safe work habits.


To assist the employees in developing a keen "safety awareness", the following responsibilities are

   •   To abide by the safety rules and regulations of the organization.
   •   To regard the safety of fellow workers at all times.
   •   To report any unsafe condition to the Supervisor.
   •   To contribute ideas and suggestions for improving the safety of conditions or procedures to
       the Supervisor.
   •   To use individual knowledge and influence to prevent accidents.
   •   To attend safety training sessions.
   •   To report all accidents and injuries immediately.

Finance Director

The Finance Director will serve as the OSHA log coordinator and the Return to Work Coordinator.
Assistance, if necessary, will be provided by the Safety Coordinator.

County Manager’s Assistant

The Manager’s Assistant will serve as the primary processor for claims management. Assistance, if
necessary, will be provided by the Finance Director.

Health Director

The Health Director will serve as the Bloodborne Pathogens Coordinator for any department not
having a more specific plan to the contrary.

                                                                       General Rules
General Safety Procedures

Every employee is required to abide by safety rules, act in a safe manner, and be knowledgeable of
potential hazards related to their job. Lists of job specific safety procedures must be developed
locally. The following general safety rules apply to all locations and are to be enforced through the
disciplinary policy:

•   Report all personal injuries, no matter how minor, to your immediate supervisor as soon as
    possible. This must be done whether the injury resulted in lost time from work or required
    medical attention or not. Prompt reporting of injuries is a requirement under the Workers'
    Compensation Law.
•   Do not take any unnecessary chances or work under hazardous conditions. Learn the right way
    to do your job. That will be the safe way. If you do not thoroughly understand the job or task
    ask your supervisor for further instructions.
•   Avoid horseplay and practical jokes on the job. Any employee participating in such activities will
    be subject to disciplinary action.
•   Drinking of alcoholic beverages or use of illegal drugs on the job, or during working hours, is
    prohibited. Any employee reporting to work under the influence of alcoholic beverages or
    illegal drugs shall be subject to disciplinary action, up to and including termination, as outlined in
    personnel policy.
•   Observe and obey all safety rules, signs, warnings, and instructions.
•   Work at a speed consistent with Safety. "Foolish Hurry" such as running in passageways or on
    stairs is dangerous. Running on the job is prohibited, except in obvious extreme emergencies.
•   Use the handrails on stairs or on elevated places.
•   Use an appropriate ladder or other climbing device to reach elevated work. Jumping down from
    an elevation such as a ladder, bench, or platform can result in injury. "DON'T DO IT".
•   Always inspect tools and equipment before use. Report defects to supervisors and other
    potential users. Do not use tools and equipment that are defective.
•   Work clear of suspended loads; if a load is moved above where you are working, stand aside
    until it has passed by.
•   Operate only the machinery or equipment you have been authorized and trained to operate
•   Remove jewelry such as rings, identification bracelets, etc., in work involving climbing, materials
    handling, or operating mechanical equipment.
•   Never reach over moving parts of machinery or equipment.
•   Never operate machinery or equipment with guards removed.
•   Report to work in appropriate clothing suitable for the type of work you perform. This includes
    footwear designed to protect your feet and to avoid slipping. Avoid wearing loose-fitting clothing
    or jewelry near machinery or equipment with moving parts. Loose hair longer than shoulder
    length must be tied back behind the shoulders when working around moving machinery.
•   Always use all safety equipment and personal protective equipment provided for your job.

•   Good housekeeping is always necessary in order to prevent accidents. Do not allow
    waste to accumulate in your work area. Dispose of waste materials properly.
•   Report any unsafe conditions or unsafe acts to your supervisor immediately.
•   Common sense, along with health and sanitation rules, must be observed for the welfare and
    consideration of other employees.
Repeat violators of safety rules and procedures may be subject to disciplinary action.

                                                       Safety Committees
A Safety Committee provides the important function of improving employee participation in the
safety program by tying the knowledge of employees with the experience of supervisors. A
committee provides a channel for action on suggestions and ideas submitted by the employees. It
encourages a closer relationship between management and employees, improving attitudes toward
safety and understanding of problems.

The Safety Committee is an excellent means for maintaining good employee and public relations
and for keeping morale on a high plane.

By its observation, thinking and discussions, the Committee provides the stimulation and
suggestions necessary to maintain safe conditions and safe workers.

1. Hyde County Safety Committee membership consists of:

       •   Emergency Management Director /Safety Coordinator
       •   County Manager / Safety Director
       •   Finance Director
       •   EMS Director
       •   Health Director
       •   Water System Director
       •   Maintenance Director
       •   Sheriff
       •   Board of Elections Director

2. The Hyde County Accident Review Board consists of:

       •   Emergency Management Director / Safety Coordinator
       •   County Manager / Safety Director
       •   Water System Director
       •   Chief Deputy Sheriff
       •   County Manager’s Administrative Assistant
       •   Health Department Administrative Assistant
       •   Finance Director

3. Special meetings of the Accident Review Board will be called by the Safety Coordinator within
   two weeks of any serious accident.

4. The Safety Committee will meet on the 2nd Wednesday at 10AM in months 3, 6, 9, and 12. The
   Committee’s primary purpose should be to assist the Safety Coordinator in the formulation and
   implementation of the safety program. To accomplish this, the Committee should:

       •   Draft safety rules and regulations and recommend approval for adoption by
       •   Devise methods of promoting safety among all employees.
       •   Review accident records to identify trends and to gauge effectiveness of the safety

       •   Discuss difficult accident problems and make suggestions for preventive measures.
       •   Maintain minutes of all Committee meetings and recommendations, signed by the Safety

Effective Committee Meetings
Good safety meetings require planning and effort. Notices of
meetings, preferably accompanied by an agenda, should be
sent to each member of the Committee.

The frequency of meetings varies, depending upon the type of
committee and the program. Where possible, the meeting
place should be comfortable and cheerful. Each person
attending the meeting should be provided with a seat and be in a position to see and hear the

Meetings should be conducted according to the generally accepted rules of order. Formality should
not be allowed to overwhelm the meeting and inhibit free and frank discussions.

The following is presented as a suggested order of business that may be adopted for Safety
Committee meetings in general:
      •    Call to Order. The meeting should be called to order promptly at the appointed time.
      •    Roll Call by the Secretary. Names of members and others present should be recorded.
           Members who cannot attend should notify the Secretary in advance, and the reasons for
           absence should be noted. Visitors should be recognized.
      •    Approval of previous meeting minutes and discussion of unfinished business. All matters
           on which definite decisions have not been made are brought up for reconsideration.
      •    Review of Accidents and Statistics. Classification by cause should be determined and
           approved. Responsible conditions should be determined for every accident and
           preventive measures should be discussed. Where appropriate, recommendations for
           preventive measures should be formulated and included in minutes.

•   Inspections and Recommendations. An inspection of the facility should be made on a
    scheduled basis. A record of the inspection time, territory covered, unsafe conditions
    found, and recommendations made should be included in the minutes. Definite action,
    not necessarily favorable, should be taken on recommendations and reported to the
•   Posters. The Chairperson should question members as to the condition of bulletin
    boards in the jurisdiction of the Committee.
•   New Business. The Chairperson should appoint subcommittees to arrange for:
       ▸   Speakers from outside the organization
       ▸   Accident statistics
       ▸   Revision of safety rules and shop practices
•   Adjournment. Reports (meeting minutes) should be taken, prepared and circulated by
    the Secretary, after approval by the Chairperson. The reports are of great importance
    since they are often sent to others in addition to Committee members, especially top
    management. The reports must record accurately all decisions made and actions taken
    or recommended, since they serve as a means of keeping management informed of the
    group's work and as a follow-up. It is important that reports be completed promptly.

________    Arrange for Meeting Place
________    Notify Members of Meeting
________    Arrange Program
________    Make Time Schedule for Meeting
________    Arrange for Seating All Members
________    Review Previous Reports and Materials for Meeting

________    Prepare Reports of Meetings
________    Distribute Minutes
________    Report Status of Recommendations

________    Report Unsafe Acts & Conditions
________    Attend All Safety Meetings
________    Report All Accidents or Near-Accidents (Near-Misses)
________    Investigate All Lost Time Accidents, Including Specific Causes of the Accident and
            Specific Recommendation to Prevent Recurrence
________    Contribute Ideas and Suggestions for Improvement of Safety
________    Work Safely
________    Influence Others to Work Safely
________    Make Inspections

                          SAFETY COMMITTEE MEETING

                             DATE ___________, 19___

A.    Attendance:

B.    Review                 of                 Previous                   Minutes:

C.    Review      of     Suggestions        Received   at    Prior     Meetings:

D.    New                          Suggestions                        Submitted:
E.    Special                          Topics                           Covered:

Copies to: ____________________________   Submitted by: ____

                           Employee Orientation / Training
When a new employee comes to work, they immediately begin to learn things and form attitudes
about their workplace, job, boss, and fellow employees. They do so whether or not the employer
makes an effort to train them. So that new employees may form good attitudes, it is desirable for
the employer to give them the right kind of start.

At the beginning of employment, there are many administrative, procedural, and regulatory matters
to address. Each new employee should know the public entity’s safety policies, but the amount
learned during the introduction procedure is limited. Unfamiliarity with surroundings, interest in
many matters of seemingly more immediate concern, the detailed procedure of getting on the
payroll – all make it difficult for the employee to absorb and retain much safety instruction. It is
necessary, therefore, to consider what safety information must be first and the best way to present
it. Keep in mind the necessity of covering critical safety issues before an employee is put on the job
and allowed to work.

On-the-job training is the most effective method of setting efficient and safe work patterns for
employees to follow. The importance of job training cannot be overemphasized, as too often it is
done inadequately. Supervisory performance is directly related to the degree to which knowledge
and skill has been acquired by the people who work for a supervisor, permitting them to work with
the best possible effectiveness and the least disturbance in work activity. If training is ineffective or
incomplete or if instruction is improper, results will show in poor work and accidents. To be
effective, job training will include safe procedures – the recognition of and how to avoid hazards –
as an integral part of work methods.

Safety must be an integral part of the new employee orientation training program. The goal of the
orientation safety training is to give the employee the knowledge necessary to be able to work
without injury to self or to others. Orientation Safety Training will consist of the following:
   •   Initial orientation
   •   Basic safety training
   •   Job Safety Training and OJT
   •   Supervisory observations
   •   Performance review.

Initial Orientation
During initial orientation new employees receive information concerning basic safety and health
policies and procedures. Initial orientation will take place in the three days of employment and prior
to hazardous duties. Initial orientation will be conducted by the Supervisor and Department Head.
Items to be covered are shown on the checklist at the end of this section.

Basic Safety Training
Basic safety training is a continuation of initial safety orientation. This training may repeat / review
some of the materials covered in the initial orientation. Basic safety training begins the process of
job specific training. HR, the employee’s department head, and the employee’s immediate
supervisor may share responsibilities for this training. Items to be covered are shown on the
checklist at the end of this section. Basic Safety Training will be conducted by the Safety
Coordinator for new employees monthly as necessary.

Job Safety Training
In job safety training, the new employee receives the job specific information he or she needs to do
the job safely. The employee’s immediate supervisor is typically responsible for this type of
training, and often this training is part of the on-the-job instruction. Where orientation to this point is
more focused on general policies, procedures, and safety rules, job safety training informs the new
employee of the specific hazards related to his or her job, and what actions are necessary to avoid
those hazards.
This phase of safety training is on going. It starts when the new employee enters his or her new
department (before any work is performed); it should continue through the employee’s entire
employment history.

Job Safety Training Techniques
Supervisors should be well versed in and apply the following methods of job instruction for all

Get ready before job instruction is started.
•   Break down the job into the important steps of operations stressing the key points, one of which
    is safety.
•   Have proper tools, materials and supplies available.
•   Arrange the workplace the way the worker is expected to keep it.

Prepare the employee to learn.
•   Put the employee at ease.
•   Create interesting training procedures.
•   Find out what the employee already knows about the job.
•   Put the employee in the best position to see and to learn.

Present the operation.
•   Demonstrate with tools or equipment on the job, giving complete explanation of each step.
•   Take important steps or operations one at a time.
•   Explain, clearly and completely, and actually show the how and the why of each step or
•   Emphasize the hazards and how to avoid accidents.
•   Repeat the demonstration as often as necessary.

Let the employee try.
•   Have the employee do the operation and correct any errors immediately.

•   Have the employee repeat the operation and explain the what or why of each step.
•   Question the employee on the hazards of the job and be sure they are understood.
•   Have the employee repeat the operation until you are completely satisfied.

•   Check back to see if employees need further instruction and encourage them to ask questions.
•   Gradually lessen close observation, but let employees know help is available at any time.
•   Each employee should completely understand the following in order to have a good foundation
    in safety training:
    1. Management is sincerely interested in preventing accidents.
    2. Accidents may occur, but it is possible to prevent them.
    3. Safeguarding equipment and the workplace has to be thoroughly done, and management is
       willing to go further as needs and methods are discovered.
    4. Each employee is expected to report any unsafe conditions that are encountered in the
       workplace to the supervisor.
    5. The supervisor will provide job instructions. No employee is expected to undertake any job
       until authorized to do so by the supervisor.
    6. If an employee suffers an injury, even a slight one, it must be reported to the supervisor

    In addition to these points, any safety rules that are conditions of employment, such as wearing
    of eye protection or safety hats, etc., should be understood and enforced at once. They should
    also be told that any flagrant violations of safety rules would result in immediate disciplinary
    action up to and including discharge.

Supervisory Observations
Supervisors must be alert to the actions of new employees. Supervisors are required to regularly
observe the job procedures followed by new employees to be certain they are working safely and
that they know required safe job procedures. Planned observations will allow the supervisor to
regular communicate with the new employee, and will help establish good safety habits early on.

Each observation should be discussed with the employee. If the employee is doing the job correctly
and following safe job procedures, he or she should be complimented and thanked for doing a good
job. If the employee is not working safely, the supervisor should use the observation as a
opportunity to provide additional safety training.

Supervisors should keep records of these observations/discussions for follow up in performance

Performance Review

Department heads and/or supervisors are required to meet with each new employee at 30, 60, and
90 days to discuss their performance and to give them the opportunity to ask questions and state
concerns. Safety should be an important element in these reviews. A brief written record of each
review should be maintained in the employee’s personnel file.
All employees are required to attend six (6) hours of formal safety training each year, either within
their department, or as provided by the Safety Coordinator. Training should be during normal
working hours and all attendees fully excused from normal duties. Any person failing to attend the
full session will not receive credit, including emergency response personnel.

Nothing shall prohibit departments with similar needs from working together for single or multiple
training events. In the case of departmental training, records of all training, including dates, times,
subject, and attendees must be maintained by the Department Head and forwarded to the Safety

The Safety Coordinator may also assist with topics and materials as possible.

All county employees shall attend annual refresher training conducted by the Safety Coordinator.
Training topics will include general safety policies and procedures that are non specific to a
department. Sessions may be combined with other requirements and these sessions will generally
be held in January.

                               SAFETY ORIENTATION TRAINING CHECKLIST

EMPLOYEE NAME: _________________________________________                       JOB:

INITIAL                INITIAL                     DATE              TOPIC COVERED
Initial Orientation
________         ________         ________         Management policy re: Safety and Health
________         ________         ________         Employee’s responsibility to work safely
________         ________         ________         Dress Code and safe dress
________         ________         ________         Accident reporting procedures
________         ________         ________         How to make safety suggestions
________         ________         ________         Return to Work policy and program

Basic Safety Training
________         ________         ________         "Employee Safety Instructions" from handbook
________         ________         ________         Basic Safety Rules
________         ________         ________         How to report unsafe conditions
________         ________         ________         Housekeeping requirements
________         ________         ________         Smoking regulations
________         ________         ________         Safety Committee structure and activities
________         ________         ________         Accident reporting procedures
________         ________         ________         Medical treatment authorization procedures
________         ________         ________         General Hazard Communication Training
________         ________         ________         Applicable emergency and evacuation procedures

Job Safety Training
________         ________         ________         Personal Protective Equipment requirements/how to use
________         ________         ________         Emergency procedures
________         ________         ________         Authorization to use machinery/equipment
________         ________         ________         Safety procedures / hazard controls for the specific job
________         ________         ________         Job specific Hazard Communication Training (MSDS’s)
________         ________         ________         How to make safety suggestions
________         ________         ________         Safe Lifting training

Other specialized training (lift truck licensing, electrical safety, ergonomics, workstation adjustment, etc.):
________         ________         ________         ____________________________________________
________         ________         ________         ____________________________________________
________    ________     ________

    Maintenance of Safe Working Conditions

A vital factor in accident prevention is the detection and correction of hazards before an accident is
caused. The findings of an inspection, when combined with an analysis of past accidents, are a
sound basis on which to base necessary corrective action.

Inspections are made by various individuals and agencies with the same common interest of
accident prevention, but with different secondary interests. Some of the various agencies and
procedures involved are as follows:


      •   Employees will inspect their work area daily for safety violations or concerns. Situations
          not within the employee’s authority to correct shall be immediately reported to the
          appropriate Supervisor.

      •   Supervisors will inspect their assigned work areas weekly for safety violations or
          concerns. Situations not within the Supervisor’s authority to correct shall be immediately
          reported to the appropriate Department Head in writing.

      •   Each Department Head will inspect their assigned work areas monthly for safety
          violations or concerns. Situations not within the Department Head’s authority to correct
          shall be immediately reported to the County Manager in writing. Copies shall be
          maintained by the Department Head.

      •   Safety Committees and will make periodic inspections as deemed necessary.

      •   The Hyde County Building Inspector will be responsible for inspecting all areas of every
          county facility annually for safety violations and concerns. Reports will be provided to the
          County Manager, appropriate Department Heads and the Safety Committee.

      •   The Hyde County Fire Marshal will be responsible for inspecting all areas of every county
          facility annually for safety violations and concerns. Reports will be provided to the
          County Manager, appropriate Department Heads and the Safety Committee.

      •   The Hyde County Maintenance Director will be responsible for inspecting all areas of
          every county facility annually for safety violations and concerns. Reports will be provided
          to the County Manager, appropriate Department Heads and the Safety Committee.

      •   The Hyde County Environmental Health Inspector will be responsible for inspecting all
          areas of every county facility annually for safety violations and concerns. Reports will be
          provided to the County Manager, appropriate Department Heads and the Safety

      •   The Safety Coordinator and the County Manager should make periodic inspections of the
          facilities and work sites to identify hazards, to assess exposures, and to determine level
          of compliance with regulatory and/or other requirements.

Departmental Safety Inspections
Planning & Conducting Inspections

Departmental safety inspections are an important part of any organized effort to control accident
exposures and prevent personal injuries. They should be a routine with every supervisor.
Here are some tips on how to plan for inspections and what to look for:
      •   Look at the record. Before the inspection, analyze past accidents to determine specific
          causes and high hazard areas or operations. Give special attention to these during the
      •   Unsafe conditions and unsafe acts. Both unsafe conditions and unsafe acts are
          contributing factors in most accidents. An unsafe condition, in addition to being a direct
          cause of accidents itself, often requires, or at least suggests, an unsafe act.

Check for the Following Unsafe Conditions

      •   Floors and floor openings

          1.   Are floors in good condition, free of broken and pitted surfaces?
          2.   Are floor coverings, such as carpets and mats, in good condition?
          3.   Are floor openings properly protected?
          4.   Are stairways equipped with appropriate handrails, guardrails?
          5.   Check floors for slippery conditions - a major cause of falls.

      •   Aisles and passageways

          1. Are aisles and passageways kept clear?
          2. Are they free of tripping hazards?

      •   Machines

          1. Are belts, pulleys, gears, chains and sprockets guarded?
          2. Are effective point of operation guards in use?
          3. Is additional guarding needed?

      •   Electrical

          1.   Are extension cords used appropriately, i.e., not in place of permanent wiring?
          2.   Are electrical cords stretched across the floor without appropriate floor covers?
          3.   Are electrical cords free from damage (exposed wires, missing grounding pins)?
          4.   Are electrical equipment, wiring and fusing up to standards?
          5.   Are portable electrical tools grounded?

      •   Hand Tools
          1. Are the right tools for the job used?
          2. Are tools in good condition?

         3. Are cutting edges sharp?
         4. Watch for mushroomed heads, split handles and other defects.

     •   Housekeeping
         1. Is the department clean and orderly?
         2. Are materials properly stored out of walkways or paths to exits?

     •   Storage of materials
         1. Are materials and supplies properly stacked - within recommended heights?
         2. Are flammable materials properly handled and stored?
         3. Are all chemical containers appropriately labeled?

     •   Lighting
         1. Is lighting in work and storage areas, passageways and stairways satisfactory?
         2. Check for burned out bulbs.
         3. Check light guarding and reflectors.

     •   Ventilation
         1. Is there good general ventilation?
         2. Is there adequate local ventilation to control possible health hazards?

     •   Ladders
         1. Are portable ladders of standard construction and in good condition?
         2. Are fixed ladders of standard construction and securely fastened?

     •   Fire Extinguishers
         1.   Are enough fire extinguishers of the right type available and easily accessible?
         2.   Is all fire suppressant equipment in proper working order?
         3.   Are fire extinguishers properly mounted?
         4.   Are fire extinguishers inspected on a monthly & annual basis per OSHA

     •   Exits
         1. Are emergency exits adequate in number and location and properly identified?
         2. Are any exits blocked or locked, preventing escape to the outside?
         3. Are emergency lighting and exit lights properly maintained?

Watch for the Following Unsafe Acts of Employees

     •   Using equipment without authority or training.
     •   Unstable or disorderly stacking or arranging of material.
     •   Operating equipment at unsafe speed.
     •   Using defective tools or equipment.
     •   Unsafe loading of trucks, skids, racks, conveyors, etc.
     •   Lifting improperly or handling loads that are too heavy.
      •   Using improper tools or equipment.
      •   Using tools or equipment improperly.
      •   Making guards or safety devices inoperable.
      •   Failure to use personal protective equipment.
      •   Repairing or adjusting machinery in motion or equipment that is under pressure or
      •   Horseplay.

Additional Inspection Procedures

Well-planned safety inspections help in detecting hazards before an accident occurs. Approached
properly, they help to convince employees of your concern for their welfare and are an indication
that with you, safety is not an off-again-on-again proposition.

Removing hazards increases operating efficiency because safety and efficiency go hand in hand.

A record should be kept of periodic inspections required by state and local laws. This usually
applies to elevators, boilers, unfired pressure vessels and possibly some other equipment.
Supplementary inspections should be scheduled and made by qualified personnel of the

A schedule of periodic inspections by qualified personnel should also be established for hoisting
equipment, automatic devices, conveyors, pumps, power trucks and other equipment which
requires specialized knowledge for complete inspections to be completed.

Follow Through
Most safety inspection activity will generate recommendations or a list of things that need to be
done. Be sure to set up documentation and follow up procedures to be certain corrective actions
are taken. Failure to do so may result in needless injuries – it will also damage the credibility of
your program.

Insurance Inspection

      •   Insurance Company or Broker representatives may make periodic inspections to look at
          risk control exposures. They may focus of employee injuries, injuries to the public,
          vehicle accidents, or issues involving property, such as fire protection.

      •   Representatives should be required to make an appointment through the County
          Manager/Agency Administrator or the Safety Coordinator prior to any inspection visits.

      •   The Safety Coordinator and Department Representative should accompany the
          representative during the inspection.

      •   The representative should be invited to summarize their findings with the County
          Manager/Agency Administrator or the Safety Coordinator prior to departure.

Governmental Agency Inspections

•   State and Federal agencies

    •   The County Manager and the Safety Coordinator should be made aware of any
        inspector on the premises.
    •   A department representative will accompany the inspector at all times.

•   OSHA Compliance Officer:

    •   To carry out the purposes of the Occupational Safety and Health Act (OSHA), a
        Compliance Officer, upon presenting proper credentials, will be turned over to the
        County Manager/Agency Administrator and the Safety Coordinator. Under no
        circumstances will an inspection begin without these representatives being present.
        1. The Compliance Officer is authorized to enter without excessive delay and at
           reasonable times any establishment, work place, or environment where work is
           performed by an employee of the employer. This is not applicable to the
           Consultative Officers.
        2. The Compliance Officer is authorized to inspect and investigate during regular
           hours and at other reasonable times, and within reasonable limits and in a
           reasonable manner, any such place of employment. He may observe any
           conditions, structures, machines, apparatus, devices, equipment and materials.
           He can question privately any employer, owner, operator, agent or employee.
        3. The Compliance Officer can make a formal request that a representative of the
           employees be permitted to participate in the inspection, such formal request must
           be complied with by the individual in charge. The Safety Coordinator and
           appropriate department representative will accompany the Compliance Officer at
           all times while s/he is on the premises.
        4. In the exit interview, the Compliance Officer will discuss the findings with
           management and will indicate what violations may be cited. The citations and
           penalties will be forwarded by mail.

Emergency Action Plans

A.    Each department will develop a written action plan for emergencies. Multiple
      Departments sharing facilities will work together in planning.

      1.     The plan will include, as a minimum, actions to be taken in the event of:
             a.     Fire
             b.     Bomb threat
             c.     Power failure
             d.     Medical emergencies, such as a heart attack or choking
             e.     Chemical spills
             f.     Severe wind storm, hurricane or tornado
             g.     Acts of terrorism

      2.     The following elements, at a minimum, shall be included in the plan:
             a.     Emergency escape procedures and emergency escape route
             b.     Procedures to be followed by employees who remain to operate critical
                    plant operations before they evacuate
             c.     Procedures to account for all employees after emergency evacuation
                    has been completed
             d.     Rescue and medical duties for those employees who are to perform
             e.     The preferred means of reporting fires and other emergencies
             f.     Names or regular job titles of persons or departments who can be
                    contacted for further information or explanation of duties under the

      3.     All emergency plans must include appropriate emergency phone numbers.
             Emergency phone numbers must be posted at the switchboard and at other
             phones, as appropriate.

      4.     Employees designated to assist in the evacuation must be trained in their
             duties. In addition, Department Heads must review with all employees
             covered by the plan annually.

B.    Each location will work to ensure that trained first-aid is available during operating
      hours. At least 1/3 of each department’s employees should be trained annually.
      Plans should contemplate coverage for facilities with small employee populations.
C.    Emergency posters describing actions to be taken in the event of cuts, heart attacks
      and choking should be posted as appropriate.

D.    Plans must be submitted to the Safety Coordinator for review prior to approval and as

Sample Emergency Action Plan

This information is advisory and is designed solely to assist the NCACC RMP members in developing their own
Emergency Action Plan, and it is not intended to replace the Association members own efforts in developing a
comprehensive Program for their employees. Please refer to OSHA 29 CFR 1910.38 for specific requirements.


These are basic concerns noted from the NCACC manual – more specific requirements should be included for
Hurricane Preparation.

To call 9-1-1 from the County’s phone system, remember to dial 9, 9-1-1.

To be included in plans: The Safety Coordinator should be immediately notified of any emergency occurring in
any county facility or with any county employee. Emergency Contact can be made via the 9-1-1 center.


This Emergency Action Plan is intended to provide guidelines on general evacuation and means of
egress along with inclement weather procedures that will help provide protection against injury to
our employees and customers, damage to property, and disruption of business operations. All
employees are to become familiar with the provisions of this plan in an effort to make their
responses automatic in the event of a possible fire or other emergency requiring evacuation.


Fire and Emergency Evacuation
The first employee aware of a fire in the building is to alert other occupants by activating the fire
alarm system. The alarm consists of _______________________________.

If you are in the vicinity of the fire when it is discovered, do not attempt to extinguish it unless you
have been trained in the proper use of a portable fire extinguisher, the fire is very small in size, and
it can be easily controlled without placing yourself or other building occupants in danger.
Remember, the purpose is not the loss of property but the safety of our employees and customers.

In the event of a fire or emergency that requires evacuation of the building, each employee is to
immediately leave the building by the nearest available exit. If time permits and without placing an
employee in danger, a call to the fire department should be made by ______________ before
evacuating the building. If time does not permit a call from the building, it is to be made outside from
an available car phone, cellular phone, or neighboring business, by ____________ immediately
after evacuating the building.

The ______________ is assigned to act as a fire warden to ensure all employees have evacuated
the building.

Dial 911 for fire department or other emergency services.

Once outside the building, all employees are to assemble in the _________________ where an
accounting is to be made by each department head to ensure all assigned employees have safely
exited the building.

Employee Training
Provisions of the Emergency Action Plan will be reviewed with all assigned employees:
      •   when the plan is developed,
      •   upon initial employee hire or assignment,
      •   when an employee's designated actions per the plan change, or
      •   when the plan is updated or changed.

Records of this training should be maintained showing the review date, employee name, and
person conducting the review.

A copy of the written plan is kept in the ________________ and available for review.

Inclement Weather Procedures

When the weather is severe, all efforts will be made to listen for weather reports regarding the
changing weather conditions in our area. If a tornado warning is issued, all employees will be
informed immediately through the intercom system and/or verbally within each department.
Employees will be instructed to take shelter, when deemed appropriate, in low-lying areas
(basements), bathrooms, closets, and/or hallways away from windows. Employees will be
instructed to stay in their sheltered area until they are notified that it is clear.

If an injury has occurred, emergency response will be addressed immediately by dialing 911. If
property damage has been sustained, appropriate safety measures will be addressed by
____________________ to ensure that other employees are not injured due to debris (glass,
metal) or other potential hazards (electrical shorts, flooding).

If required, restoration procedures will be addressed immediately by the ______________ to start
the recovery process. This may include recovery of critical documents, computer backup tapes, and
insurance policies; setting up a temporary location; identifying temporary payroll procedures; clean
up of building; along with other key recovery procedures deemed necessary.

Hurricanes/High Winds/Flooding
Preparations for the hazard are to be made within each department to protect employees from
injury and to safeguard building & property. Depending on the hazard, preparations may include:
backing up computers, storing critical documents, removing equipment/paper from areas known to
flood, boarding up windows, and sending employees home before the weather becomes too

Once the emergency passes, employees will be notified of procedures to follow for returning to
work. This will be conducted via the telephone and/or radio. If the building sustains damage,
restoration procedures will be addressed by the _____________________.

Chemical Spills
If a large spill occurs that requires evacuation, follow the procedures identified by emergency
personnel (Emergency Management, Fire Department, Sheriff’s Department). Be aware that prior to
evacuation, special procedures may need to be followed. This may include turning off electrical
power to the building. Once the spill has been cleaned-up, employees will be notified of procedures
to follow for returning to work. This will be conducted via the telephone and/or radio. If the building
sustains damage, restoration procedures will be addressed by the
___________________________ and Department Heads.

            Accident Reporting and Investigation
There are specific claims reporting procedures for NCACC RMP members or for entities in insured
programs, and the claims manual should be consulted for pertinent information on filing claims.
The following information is intended to provide guidance for maintaining recordkeeping and for
investigating accidents so that appropriate actions can be taken to prevent recurrence of accidents
and injuries.

No employee shall be disciplined or discouraged from reporting safety violations though their
supervisors. Employees are strongly encouraged to report violations in a manner not to reflect
poorly upon their supervisors or the County of Hyde.

Accident Recordkeeping
The purpose of recordkeeping is to discover patterns and trends of occurring accidents to direct risk
control efforts in the right direction. Effectiveness of the Risk Control Program can be gauged by
keeping accurate statistics.

The following recordkeeping procedures will be used in the Safety Program:

Accident Report

      •   All injuries, no matter how slight, must be reported immediately to the injured employee’s
      •   All employees will complete an Incident Report for any hazardous incident, including
          “close calls”. Generally, close calls will not be assigned points under the Disciplinary
          Policy and will be used for training purposes.
      •   Supervisors are responsible for investigating all accidents immediately to determine what
          corrective action should be taken to prevent future similar accidents.
      •   Supervisors are to report accidents to the Claims Processor and the Safety Coordinator
      •   Accident & Incident Reports will be reviewed by the appropriate supervisor for accuracy
          and approval. Appeals may be made at each level of supervision. The Safety
          Committee is the last level of appeal above the County Manager.

OSHA Recordkeeping

      •   The OSHA Log Coordinator will maintain the OSHA Form 300, Log of Occupational
          Injuries and Illnesses. OSHA requires that each recordable case be entered on the log
          no later than six (6) days after the incident.
      •   The OSHA Log Coordinator will post the completed OSHA 300A Summary Form for the
          period Feb 1 to April 30 each year. The Summary Form must be posted in a visible
          location so that employees are aware of injuries and illnesses occurring in their
       • The Claims Processor will maintain a record of the Form 19, “First Report of Injury” (NCIC
         Form) for all incidents which are entered on the OSHA Form 300. The Form 19 is

          generally used in lieu of the OSHA Form 301 and kept with the OSHA 300 Log. These
          forms should be immediately made available to the OSHA Log Coordinator and the
          Safety Coordinator. All personal information shall be treated as confidential and not
          shared outside the assigned parties.

Accident Summary and Analysis

      •   The Safety Coordinator shall prepare summary and analysis of all accidents and/or
          incidents. The analysis is to be presented to Advisory Groups and the Safety Committee,
          and should be included in Safety Committee meeting minutes.

Procedure for Medical Treatment

      •   Employee reports the accident to the Supervisor.
      •   Supervisor, depending upon the extent of injury, arranges to:
              ▸   Have temporary first aid treatment administered followed with treatment by a
                  physician or at a hospital.
              ▸ Direct employee to authorized physician or hospital.
      •   Within 12 hours of the incident, the supervisor investigates the incident and completes
          the Supervisor's Incident Investigation Report to show the cause(s) of the accident and
          specific recommendations to prevent recurrence. The supervisor forwards the report to
          the Safety Coordinator and/or designated Claims Personnel for review and Workers'
          Compensation insurance purposes.
      •   Safety Coordinator and/or Claims Personnel reports claims to the Claims Administrator
          by completing the State Workers' Compensation form (Form 19) or by using telephonic or
              Telephonic Reporting:                        1-877-NCACC RM (622-2276)
              Internet Reporting:                          WWW.NCACC.ORG

Procedure for Disability (Lost Time) Accidents

      •   Employee reports accident to supervisor.
      •   Depending on extent of injury, employee is administered first aid and/or transported to a
          physician or hospital for treatment.
      •   Supervisor completes Supervisor's Accident Investigation Report that investigates cause
          of accident with specific recommendations to prevent recurrence and forwards it to the
          proper authority for review and Workers' Compensation insurance purposes.
      •   Safety Coordinator and/or Claims Personnel reports claims to the Claims Administrator
          by completing the State Workers' Compensation form (Form 19) or by using telephonic or
              Telephonic Reporting:                        1-877-NCACC RM (622-2276)
              Internet Reporting:                          WWW.NCACC.ORG

All accidents must be reviewed at Accident Review Board and presented to Safety Committee
meetings. Specific recommendations must be made and entered into the reports of meeting.

NOTE: For serious injury cases the local claims coordinator should follow up to make sure
the injured employee has been contacted by the claims adjustor and case manager.

If an employee is absent for a few days due to a seemingly minor injury, call the employee as
a kind of "friendly reminder" to show we are interested in their well being and to urge them
to return to work as soon as possible. If you are concerned that an employee is trying to take
advantage of the system, discuss your concerns with the adjustor.

Tips on Accident Investigations

When Should Accidents be Investigated?
Every accidental injury should be investigated and documented as soon as possible. The longer
you wait, the harder it is to get the facts. As time passes, evidence is lost and important details are
quickly forgotten. Prompt investigation and documentation assures more complete and useful

Why Should They be Made?
Accidents do not just happen - they are caused. One of the purposes of accident investigations is
to find out what causes them. Once this has been determined, action to eliminate or control the
cause can be taken.

Even minor injuries and near misses should be investigated, for the seriousness of an accident is
frequently a matter of luck. Eliminating the cause of a minor injury today may prevent a serious
accident tomorrow. If it happened once - it could happen again.

Who Should Make Them?
The Supervisor should conduct an investigation. While others will probably also want to look into
the situation, here are three good reasons why the Supervisor should personally get the facts:
•   Employees under supervision are basically the Supervisor's responsibility. This includes
    responsibility for their safety and welfare.
•   Supervisors know the employees and the jobs better than anyone else. They are in the best
    position to get the facts and find a practical solution to the problem or recognize those problems
    needing the attention of technical personnel.
•   Supervisor's investigation of the accident can help to promote better relations with employees
    by demonstrating concern for their safety and proving that management is sold on accident
Investigating incidents is one of the supervisor’s most important roles in the safety program.
Supervisors should be trained in these skills. Training is available through many sources, including
your NCACC Risk Consultants. Also, see the Incident Investigation Sequence on for details
concerning how to investigate an accident.

The Department Head must be promptly notified of any emergency situation involving any facility or

The Safety Coordinator must be immediately notified of any emergency situation involving any
county facility or county employee.


If someone from the Public is injured on premises, assist in seeing that appropriate medical care is

Public incidents are to be treated with utmost care. Console, comfort and show sympathy but do
not admit liability or commit to medical expense. Apologize if appropriate and explain you will
submit the proper report to management. Avoid discussion of insurance.

Take the person's name and get the names and telephone numbers of any witnesses.

Notify your Claims Processor immediately so the incident can be reported.

Complete the required Accident Investigation Report. This report must be completed within 24
hours of the incident.

If an attorney or other representative calls or comes to your location:

     •   Be courteous but refuse any request to look around or take photographs
     •   Do not discuss facts or provide details concerning a claim
     •   Do not allow individuals to interview employees
     •   Do not discuss insurance coverage or limits
     •   Refer the attorney or representative to the County Manager or the SCMS claims supervisor.

If an attorney or other representative claiming to represent the NCACC or an insurance company
calls or comes by your location:

     •   Ask for proper identification. Do not hesitate to refuse admittance or refrain from giving
         information until you are sure of their identity.
     •   Once properly identified, cooperate fully by providing as much information as possible.
     •   Refer requests for any documents to the County Manager.
     •   If in doubt, or if assistance is required, call the County Manager.

The following is provided as a simple step-by-step guide for completing an incident investigation. It
is intended primarily to serve as a guide to investigating work-related incidents, though it can serve
for other types of cases.

1.       Take note pad and a blank investigation form to the scene of the incident. Remember:
         simply filling out a report is not an investigation. An investigation is an in-depth look at an
         incident to determine exactly what happened, what factors caused it to happen, and, from
         an accident prevention standpoint, what changes and improvements can be made to keep it
         from happening again. The completed report is simply a written summary of the findings of
         this investigation.
2.       At the scene of the incident, ask questions to determine who, what, where, when and how
         the incident occurred. A thorough incident investigation involves exploring:

A. Basic accident facts
   • Incident agency or source of the incident -- tool, material or equipment involved
   • Type of incident -- fall, struck by object, caught in moving machinery, etc.
   • Part of body affected -- identify part(s) of body injured
   • Exactly what employee was doing at the time of the injury
B. Unsafe practices or procedures
   • Departure from accepted, normal or correct procedure
   • Established procedures that are not safe
   • Lack of established procedures
C. Behavioral factors
   • Lack of knowledge
   • Disregard of instructions
   • Inadequate training
   • Emotional upset
   • Excessive haste
D. Unsafe conditions
   • Physical defects
   • Errors in design
   • Inadequate maintenance
   • Poor housekeeping practices
   • Faulty planning or layout
   • Omission in recognizing safety requirements

     E. Environmental factors
        • Noise
        • Chemical or dust emissions
        • Lighting
        • Temperature extremes
        • Vibration
     F. Ergonomic factors – the relationship between the employee and the workplace
        • “Fit” between employee and equipment or tools
        • Repetitive motions
        • Materials handling requirements involving excessive forces or reaching or twisting
     G. Safety Programs -- contributing factors that could be corrected by:
        • Safety policies, procedures, or programs
        • Inspection and/or testing procedures
        • Authorization procedures
        • Safety rules

3.   If they are available for questioning, interview the injured employee and any witnesses.
     Emphasize prevention as your goal and not faultfinding. If the injured person is not
     available, do not wait for their return to complete your investigation.
4.   Some information may have to be investigated away from the scene of the incident (extent
     of an employee's training, maintenance records on a piece of equipment, etc.) Investigate
     elsewhere as necessary.
5.   Review all questions and blanks on the investigation report form and obtain additional
     information as necessary.
6.   Review all of your notes and facts found during the investigation. Begin recording the
     results of your investigation on the "Incident Investigation Report". Start by answering all
     questions on the top half of the report.
7.   List incident causes in the other sections of the form (Job Procedures, Behavioral Factors,
     Physical Conditions, Ergonomic Factors, and Safety Programs/Policies/Rules). Usually,
     there are 3 or more causes or contributing factors. Try to list at least 3. Always consider
     these questions in determining incident causes:
     A. Was there an unsafe physical condition (water on floor, uneven pavement, unguarded
        machine, defective equipment, etc.)? If so, what are the underlying causes which
        allowed the unsafe condition to exist?
     B. For employee injuries, is there an established safe procedure for completing the task?
        Did the employee know the procedure (was employee adequately trained)? Is the
        procedure usually enforced? Was the procedure being followed at the time of the injury?
        Is a safer procedure needed?
     C. Did an unsafe action by the injured person contribute to the incident?
     D. Was the employee properly trained? Is additional training needed? Does the injured
         employee need additional training? Other employees?
8.   Complete other sections on back of the form. Corrective actions are the most important
     area of the form. It is essential that positive corrective action be taken for each cause or
     contributing factor identified. Also, more than one type of corrective action may be needed.
     Remember, making an engineering or other physical change to eliminate a hazard is more
     effective than training or warning to avoid the hazard.

9.   Sign and date the report and send it to your Department Head and Safety Coordinator who
     will review the report and forward it through proper channels for corrective action, comments,
     and management review.

                                    INCIDENT INVESTIGATION REPORT

INJURED EMPLOYEE: _______________________________ DEPARTMENT:
LENGTH OF SERVICE - With County: _______________ On This Job: _________________ AGE: ____
DATE & TIME -- Of Incident: ___________ Reported: ___________ Investigated: ____________ This Report:
Explain if all dates are not the same:
__________INCIDENT DESCRIPTION: Describe exactly what happened, including exactly what the employee was
doing and any extenuating


JOB PROCEDURES: Describe job procedure issues which may have contributed to the incident. Are there
established procedures? Did the employee follow prescribed procedure? Were unsafe acts involved? Was EE trained
in safe procedures?
BEHAVIORAL FACTORS: Are there behavioral issues, such as lack of knowledge, disregard of instructions,
inadequate training, emotional upset, or excessive haste, which may have contributed to the incident?

PHYSICAL CONDITIONS: At the incident scene, look at equipment, materials and the environment. Describe the
conditions reviewed here or by checking boxes in the list below. Be sure to list any conditions needing corrective action.


Lighting                        Goo      Deficient -- Action Needed:
                            d          _______________________________________________________________________
Walking, working                Goo      Deficient -- Action Needed:
surfaces                    d          _______________________________________________________________________
Housekeeping,                   Goo      Deficient -- Action Needed:
congestion                  d          _______________________________________________________________________
Machinery &                     Goo      Deficient -- Action Needed:
equipment                   d          _______________________________________________________________________
Layout                          Goo      Deficient -- Action Needed:
                            d          _______________________________________________________________________
Maintenance                     Goo      Deficient -- Action Needed:
                            d          _______________________________________________________________________
Noise                           Goo      Deficient -- Action Needed:
                            d          _______________________________________________________________________
Safety guards &                 Goo      Deficient -- Action Needed:
equipment                   d          _______________________________________________________________________
Other:                          Goo      Deficient -- Action Needed:
________________            d          _______________________________________________________________________

ERGONOMIC FACTORS AND MATERIALS HANDLING: Investigate any ergonomic or materials handling risks
associated with the incident. Describe what you looked at and what you found:
“Fit” between employee and workstation, equipment, tools:
Excessive reaching (distance;              Goo      Deficient -- Action Needed:
repetition)                            d          ____________________________________________________________
Awkward postures                           Goo      Deficient -- Action Needed:
                                       d          ____________________________________________________________
Work surface (too high, too low,           Goo      Deficient -- Action Needed:
etc.)                                  d          ____________________________________________________________
Tool design                                Goo      Deficient -- Action Needed:
                                       d          ____________________________________________________________
Chair design                               Goo      Deficient -- Action Needed:
                                       d          ____________________________________________________________
Lighting / glare                           Goo      Deficient -- Action Needed:
                                       d          ____________________________________________________________
Equipment design                           Goo      Deficient -- Action Needed:
                                       d          ____________________________________________________________
Other:                                     Goo      Deficient -- Action Needed:
__________________________             d          ____________________________________________________________

Repetitive motions:
Lifting, lowering               Repetitions/hr: _______ or /shift:         Contributed to incident
Grasping                        Repetitions/hr: _______ or /shift:         Contributed to incident
Pinching                        Repetitions/hr: _______ or /shift:         Contributed to incident
Reaching above shoulder         Repetitions/hr: _______ or /shift:         Contributed to incident
height                          ________
Other reaching                  Repetitions/hr: _______ or /shift:         Contributed to incident
Bending, twisting               Repetitions/hr: _______ or /shift:         Contributed to incident
Other:                          Repetitions/hr: _______ or /shift:         Contributed to incident
____________________            ________

Materials Handling / Overexertion

Lifting,            Object:                         Weight: _________ Distance:              Repetitions:    Contributed to
lowering            ______________________          ____________                             _______        incident
Lifting,            Object:                         Weight: _________ Distance:              Repetitions:    Contributed to
lowering            ______________________          ____________                             _______        incident
Carrying            Object:                         Weight: _________ Distance:              Repetitions:    Contributed to
                    ______________________          ____________                             _______        incident

Pushing /        Object:                      Weight: _________ Distance:          Repetitions:            Contributed to
pulling          ______________________       ____________                         _______                incident
Other:           Object:                      Weight: _________ Distance:          Repetitions:            Contributed to
_________        ______________________       ____________                         _______                incident

SAFETY PROGRAMS/POLICIES/RULES: Are there contributing factors that safety policy, inspection, testing,
training, authorization, rules, etc. could correct if implemented?

CORRECTIVE ACTIONS: Number each and state exactly what is to be done. Include responsibility
assignment and expected completion date; when complete, check off and fill in completion date.
Rec.N     Recommended Action                                                     Who will          By            Completed /
o.                                                                               complete?         When?         Date

Report By:                                                    Manager:
___________________________________ Date: ____________        ___________________________________ Date: ____________


  COUNTY OR ENTITY                                        DEPARTMENT

  EXACT LOCATION                              DATE OF OCCURENCE        TIME           DATE REPORTED

  INJURED’S NAME                              NAME OF WITNESS (ES)

                                                    PROPERTY DAMAGE
  PROPERTY DAMAGED                                        VEHICLE DAMAGED



























Accident causation factors. Check all that apply.

                         1   Road surface wet or     2    Failure to yield       3   Unnecessary haste       4   Failure to follow
                             icy                          right of way                                           standard operating
                         5   Poor road conditions    6    Failure to secure      7   Influence of alcohol    8   Following too close
                                                          doors or cargo             or drugs
  A   VEHICLE            9   Unsafe condition of    10    Failure to use seat   11   Physical limitation    12   Failure to observe
      OPERATIONS             vehicle                      belt or shoulder           or mental attitude          traffic signals/signs
  N                     13   Congested              14    Operating vehicle     15   Unaware of             16   Failure to control
                             roadways                     without authority          hazards                     vehicle
  A                     17   Adverse visibility     18    Lack of skill or      19   Unsafe act of other    20   Other

  L                     21   Unsafe floors,         22    Inadequate fire       23   Inadequate             24   Blocked exits and
                             ramps, stairways             extinguishers              illumination                hallways
  Y   BUILDING &        25   Improper supply        26    Fire or explosion     27   Inadequate             28   Unmarked exits
      GROUNDS                storage                      hazards                    ventilation
  S                     29   Inadequate warning     30    Poor                  31   Tripping hazard        32   Other
                             system                       housekeeping

  I                     33   Inadequate hiring      34    Inadequate            35   Inadequate             36   Inadequate
                             standards                    supervision                preventive                  policies/procedures
  S   BASIC             37   Lack of proper job     38    Inadequate            39   Improper layout or     40   Inadequate job
      CAUSES                 procedures                   vehicle inspection         design of work area         planning
                        41   Inadequate             42    Inadequate driver     43   Other:
                             enforcement of work          training

                                            MOTOR VEHICLE DIAGRAM

For accidents involving motor vehicles, complete the following diagram showing direction & positions of
vehicles involved, designating clearly point of contact.


                  Protective Equipment and Clothing
Working Around Machines
Employees within a public entity perform a variety of work operations that involve many industrial
hazards. The tasks performed range from custodial services to heavy truck repair. Over time,
research is conducted to develop measures that protect employees from accidental injury during
various tasks. When measures can be developed that protect the employee, this is referred to it as
having "engineered out" the hazard. This can be seen by the use of guards on various types of

When working with machinery, there are several rules that must be followed without exception:

•   Never operate machinery unless you are trained and authorized by your supervisor to do so,
    and you are knowledgeable of the safety aspects of its operation. If in doubt, ask.
•   Wear prescribed personal protective equipment (PPE), such as safety glasses or hearing
    protection. Your supervisor can tell you what is required for a specific job.
•   Keep all machine guards and other safety devices in place while machinery is in operation.
    Tampering with or removing machine guards or other safety devices is prohibited.
•   Guards must sometimes be removed for machinery repair. Removal of guards on powered
    machinery requires that the power source be disconnected and locked out. All guards are to be
    properly replaced after the repair work has been completed. At no time will equipment be
    operated without the guard(s) in place.

General Clothing
To work safely, you must start by coming to work appropriately dressed. Follow the dress code as
explained by your supervisor and Human Resources Department. For your safety and comfort,
invest in work clothes that are sturdy, fit well, and are washable. If the public entity issues you a
work uniform, wear what has been issued. Always follow these safety rules:

•   The wearing of loose clothing on or near moving machinery or equipment is prohibited. Shirt-
    tails need to be kept tucked in.
•   Pant legs should be kept to slightly below ankle length and ensure hems are sewn up. Rolled
    up cuffs are discouraged as they collect dirt and are likely to come down and cause you to fall.
•   Wear steel toed safety shoes on all jobs involving handling or moving heavy material.
    Otherwise wear sturdy, comfortable work shoes. Excessively high healed shoes or shoes with
    hard, slick soles can cause you to fall.
•   Lightweight canvas tennis shoes are not allowed on many jobs. Their soft soles do not afford
    protection from puncture wounds, and their thin uppers offer little protection from dropped
•   Shoes with run down heels or torn soles are hard on the feet and can cause falls. Keep your
    shoes in good repair.

•   Avoid wearing rings, medals, identification bracelets, and other jewelry around moving
    machinery. Jewelry increases the danger of electric shock and can cause fingers to be badly
•   Wash work clothes frequently as a safe guard against skin infections and irritations.
•   For outdoor work in winter weather, it is best to wear loose, warm, fairly lightweight clothing.
    Wear layers of clothing so you can peel it off for inside work and put it back on when you have
    to go outdoors.
•   Oil soaked clothes are a serious fire hazard. Keep your clothes free from oil.

Protective Equipment
When it is impractical or impossible to place a guard over the source of the hazard, then it becomes
necessary to place the guard on the worker. This is done by wearing approved personal protective
equipment (PPE) such as hard hats, safety belts, safety goggles, face shields, gloves, aprons, toe
guards, respirators, etc. Supervisors should insure that all their employees are properly protected.
Local dress codes may be established within a particular department, or work area, and each
employee is expected to know and follow these codes where applicable.

Every possible effort will be made by management to select protective clothing and equipment that
is acceptable for comfort, appearance and utility and still afford the desired protection. At times
protective equipment is less comfortable to wear than ordinary dress, but do not be tempted to lay it
aside when the "boss isn't around". If you do, you may become a gambler who is betting his life,
eyesight, or physical well being, by thinking, "it won't happen to me". Losing that bet becomes more
uncomfortable for a lifetime than wearing the equipment for the duration of the job. Safety, in this
instance, is knowledge of the hazards, knowledge of the protection available, and a frame of mind
that makes use of available protection a safe work habit.

PPE Hazard Assessments and Equipment Selection

Each facility should complete an assessment of hazards in the workplace that may require the use
of personal protective equipment. Forms at the end of this section can be used as a guideline for
evaluating the need for eye, face, head, foot and hand protection. Where hazards are identified
which require the use of personal protective equipment, management must:
1. Select appropriate types of personal protective equipment to protect the employees from the
   hazards identified in the hazard assessment. See the OSHA PPE Standard (29 CFR 1910 -
   Subpart I) and contact reputable safety equipment vendors for assistance.
2. Communicate selection decisions to each affected employee.
3. Select personal protective equipment that properly fits each affected employee.
4. Require each affected employee to wear the personal protective equipment selected.

PPE Training

Each employee who is required to use personal protective equipment must be trained to know at
least the following:
   ▸   What personal protective equipment is necessary
   ▸   When the personal protective equipment is necessary
   ▸   How to properly don, doff, adjust and wear the personal protective equipment
   ▸   The limitations of the personal protective equipment
   ▸   The proper care, maintenance, useful life and disposal of the personal protective equipment

As part of the training, each employee must demonstrate an understanding of the items
specified above and the ability to use the equipment properly, before being allowed to
perform work requiring the use of personal protective equipment.

Retraining is necessary whenever the required PPE changes, or when the employee demonstrates
lack of knowledge concerning use of the equipment.

Face and Eye Protection
The loss of one or both eyes has extremely serious consequences to an employee. Yet individuals
often vigorously resist wearing this vital eye and face protection with no better excuse than slight
discomfort or false pride. This is probably one of the most important protective features of any
safety program, yet one of the most difficult to sell.

Hazards involving the possibility of injuries to the face and eyes exist in both indoor and outdoor
tasks. They range from dust blown into eyes on a windy day, to particles of steel, sand, rust, etc.,
propelled into eyes with considerable force by power tools and machinery, or splashes of corrosive
dust and liquid chemicals. There are many types of safety glasses, goggles, shields, etc., made of
impact resistant glass or plastic to protect the worker from these hazards. New designs offer both
comfort and attractive appearance.

Face and eye protection is to be provided for any task where there is any probability that an injury
may occur without such protection. Employees assigned to perform tasks that require eye
protection are to wear the protection provided.

Safety glasses, goggles, and other eye protection equipment offer a vital protection. If sufficient
care is not exercised to maintain them properly, dirty or scratched lenses may provide another
hazard from reduced visibility.

The following safety procedures apply:

      •   Safety goggles or safety glasses with temple shields are to be worn when:

          •   Grinding, cutting, milling or drilling with power tools
          •   Using impact wrenches and compressed air tools
          •   Chipping, scrapping, or scaling paint, rust, carbon or other materials
          •   Using punches, chisels, or other impact tools
          •   Cutting rivets
          •   Cutting or breaking glass
          •   Using paint remover
          •   Soldering
          •   Cleaning dust or dirt from vehicles, machinery, etc.
          •   Sand blasting or air cleaning operations
          •   Using metal cutting lathes, shapers, drill press, power hack-saw and other metal
              working tools
          •   Steam cleaning
          •   Washing vehicle parts with soaps or solvents
          •   Working under vehicles
          •   Using mowers, string trimmers, shredders, power blowers, etc.

      •   A full face shield and safety goggles are to be worn when handling acids, caustics, and
          other harmful dusts, liquids, or gases.

      •   A face shield with the proper filter lens, or welders lens, or welder’s goggles, is to be worn
          in all welding and cutting operations.

      •   For electric arc welding, a welder's helmet with proper filter lenses is to be worn. During
          gas welding or cutting operations, welder’s goggles with proper filter lenses should be
      •   Portable welding screens are to be used to protect the eyes of others in the vicinity
          whenever potential exposure to others exists.
      •   Helpers and observers are to wear safety glasses, goggles, or hand held shields with the
          proper filter lenses.

Your supervisor may also require eye protection on other jobs not listed. But most
importantly -- You have but one pair of eyes -- They cannot be replaced -- Protect them!

Hearing Protection
In a public entity, there are some machines or equipment that may produce sound levels in the
frequencies which cause hearing loss. When employees are subjected to excessive sound levels,
attempts will be made to use engineering controls. If the sound level cannot be reduced within a
tolerable range, then personal protective equipment (PPE) will be provided and is to be worn by
exposed employees.

Ear protection may consist of earmuffs or earplugs (referred to as hearing protective devices –
HPDs). When hearing protection is required due to the noise levels, a choice of hearing protection
will be provided at no cost to employees. Hearing protection will be selected to ensure that it will
provide a sufficient reduction to noise exposure. Cotton balls will not be used as earplugs since
cotton does not offer any protection.

Foot Protection
Many tasks involve manual lifting or handling of heavy tools and materials. Foot injuries frequently
occur when heavy objects are dropped, resulting in bruises, dislocations, fractures or crushes.
Shoes and boots, reinforced with steel toes or soles, can help prevent foot injuries from the impact
of falling objects, stepping on sharp objects, or exposure to blades of power tools. Protective
footwear is available in a variety of attractive styles, and is as comfortable as any pair of properly
fitted shoes.

The wearing of sandals or canvas sneakers (tennis shoes) in shop work areas (where the chances
of foot injuries are greatest) is prohibited.

Foot protection is a sound investment for any employee -- not only for work activities, but for many
off the job tasks as well.

Finger, Palm, and Hand Protection
One of the most dangerous pieces of jewelry to wear in occupational or industrial work is a ring.
Rings need to be removed or not worn to work if there is the slightest chance of getting the ring
caught in any hook, tool, or piece of machinery. Rings can cause the loss of a finger or painful
lacerations. In some cases, rings have to be cut off of a finger if they have been bent in such a
manner as to cut off circulation.

Gloves with leather palms are to be worn when handling rough edges or abrasive material, or when
the work subjects your hands to possible cuts or burns. Rubber gloves may be needed when
handling chemicals such as paints, solvents, degreasers, or other irritating products. Latex gloves
offer minimal protection from chemicals and should be used cautiously. Before using any type of
PPE, refer to the packaging information regarding use, maintenance and cautionary measures.

 Washing with soap and water and not gasoline can prevent skin irritation. Good hygiene is
important in controlling dermatitis and skin rashes.

Respiratory Protection
There are many tasks involving exposure to fumes, gases, mists, and dusts that are harmful to the
human respiratory system. For certain tasks, such as painting or doing bodywork, employees may
be required to wear a respirator.

The first step in implementing a respiratory protection program is evaluation of the exposure.
Hazardous substances that may become airborne, or that may give off respirable fumes or vapors,
must be specifically identified. Testing by a qualified individual is then needed to determine the
extent of the exposure. Only after appropriate identification of the exposure can the respirator that
will provide adequate protection be determined. Such exposure identification is the basis for
choosing the appropriate respirator.

Several types of respirators can be used in public entity operations, but whatever respirator is used
must be NIOSH-approved (National Institute for Occupational Safety & Health). In selecting
respirators for a specific exposure, be sure the respirator is NIOSH-approved and is the correct one
for the exposure. If you are not sure, work with the respirator vendor to determine what respirators
are appropriate for the exposure.

Dust masks may be used during some operations, such as sanding and buffing operations. Such
masks provide protection from airborne dust particles, but provide no protection against chemical
vapors. Never wear a dust mask to protect against exposure to chemical vapors such as
those given off by solvents and spray paints.

Where painting and priming are performed, you may be given a cartridge style respirator, or a
supplied air respirator. The type of respirator being used depends on the health hazards of the
products in use. If you are not sure which respirator to use, be sure to ask your supervisor for
instruction and training so that you will be protected.

•   Regardless of which respirator you are provided, you need to be fit tested. You should also be
    shown how to put on the respirator, adjust it, and wear it correctly.
•   Know how to clean and inspect the respirators in your work area. Respirators are to be cleaned
    and inspected frequently. Your cleaning schedule will depend on how often you use this
    equipment. Your respirator can be cleaned with soap and water, then sanitized with a dilute
    bleach solution. (2 tablespoons bleach to a gallon of water.) Rinse thoroughly and allow your
    respirator to dry.
•   Store your respirator in a clean, sanitary and convenient location. Many people use a sealable
    plastic bag for this purpose, and then place the respirator in a locker or on a shelf. Proper
    storage keeps your respirator clean, and can minimize the chance of contaminants getting on
    the face piece.
•   Most dust masks are disposable. If you have these respirators available when sanding and
    buffing, be sure both straps are used and that you replace the dust mask routinely. Dispose of
    used masks properly – do not leave them laying around.

Respirators are used in shops because in many cases, the spray booths or ventilation cannot
remove the airborne paint mist or other chemicals effectively. Because of the health hazards
present, you may be instructed to wear respirators in this area. This is for your protection, and you
must follow the rules and instructions you have received in your public entity regarding respirator

               Guideline for Evaluating Need for Personal Protective Equipment

Survey: Conduct a walk-through survey of the entire facility. The purpose of the survey is to
identify sources of hazards to employees.

Injury/Accident Data: Previous accident, injury, and occupational illness data should also be
reviewed to identify any problem areas.

A.     During the walk-through survey, consideration should be given to the basic hazard
          1.   Impact
          2.   Penetration
          3.   Compression (roll-over)
          4.   Chemical
          5.   Heat
          6.   Harmful Dust
          7.   Light (optical) radiation

B.     During the walk-through survey observe for these potential hazards:
          1. Sources of motion such as machinery where movement of tools, machine elements
              or particles could exist
          2. Movement of personnel or body parts which could result in collision with objects
          3. Sources of contact with temperature extremes or flash burns
          4. Types of chemical exposures
          5. Sources of harmful dust
          6. Sources of light radiation, i.e., welding, brazing, cutting, furnaces, heat treating, high
              intensity lights, etc.
          7. Sources of falling objects or potential for dropping objects
          8. Sources of sharp objects which might pierce the feet or cut the hands
          9. Sources of rolling or pinching objects which could crush the feet
          10. Layout of workplace and location of co-workers
          11. Electrical hazards

C.    Observe for these types of exposures to the eyes and face:
         1. Flying particles, chips or other small objects
         2. Molten metal
         3. Liquid chemicals, acids or caustics
         4. Chemical gases or vapors
         5. Light radiation
D.    Observe for these types of exposures to the feet:
          1.   Potential for falling or dropped objects
          2.   Rolling objects
          3.   Sharp objects which might be stepped on
          4.   Electrical hazards

E.    Observe for these types of hazards to the hands:
           1.   Potential skin absorption of harmful substances
           2.   Sharp objects, tools or machines
           3.   Chemical contact exposures
           4.   Temperature extreme contact exposures

Organize Data: Following the walk-through survey, it is necessary to organize the data and
information for use in the assessment of hazards and the selection of personal protective
equipment. The following exhibit can be used to organize the data by job classification or by area.

              Area or Department Personal Protective Equipment Hazard Assessment

LOCATION:                   DEPARTMENT:                    DATE/REVISION DATE:


    Assessment By: __________________________________________     Date: _____________

Housekeeping is an important element of every safety and health program. Most safety experts will
agree that they can tell a lot about a facility’s accident and injury experience simply by looking at the
housekeeping. Facilities with poor housekeeping generally have poor safety results, while facilities
with superior housekeeping typically have very few injuries.

Many painful and sometimes disabling injuries are caused when employees are struck by falling
objects or by striking against or tripping over objects they did not see. Many injuries and property
damage losses stem from fires caused by poor housekeeping practices and improper storage of
flammable materials. The best protection against these hazards is good housekeeping.

When materials are stored properly with adequate space to move through the storage area, or with
adequate clearance to work within the storage area, accidents can be avoided. With some pre-
planning, tripping hazards can be avoided and many other sprains, fractures, and bruises that result
from falls can be prevented.

Aside from the accident prevention benefits, good housekeeping means efficient performance.
When materials, tools, and equipment all have a place for orderly storage, and are returned to the
proper place after use, they are easier to find and easier to inspect for damage and wear.

The following housekeeping safety procedures apply:

•   Keep work areas and storage facilities clean, neat and orderly.
•   Keep all aisles, stairways, passageways, exits and access ways to
    buildings free from obstructions at all times. Remove all grease
    and water spills from traffic areas immediately.
•   It is everyone’s responsibility to pick up and clean up.
•   Do not place supplies on top of lockers, hampers, boxes, or other
    moveable containers at a height where they are not visible from
    the floor.
•   When piling materials for storage, make sure the base is firm and level. Cross tie each layer.
    Keep piles level and do not stack piles too high. Keep aisles clear and maintain adequate
    space to work in them.
•   When storing materials suspended from racks or hooks, secure them from falling and route
    walkways a safe distance from the surface beneath.
•   When storing materials overhead on balconies or mezzanines, provide adequate toe boards to
    keep objects from rolling over the edge.
•   Do not let materials and supplies that are no longer needed accumulate. IF IT IS NOT
•   Tools, equipment, machinery and work areas are to be maintained in a clean and safe manner.
    Defects and unsafe conditions must be reported to your supervisor.
•   Return tools and equipment to their proper place when not in use.
•   Lay out extension cords, air hoses, water hoses, ladders, pipes, tools, etc., in such a way as to
    minimize tripping hazards or obstructions to traffic.

•   Clean up spills immediately to avoid hazards. In the event the removal cannot be done
    immediately, the area must be appropriately guarded, signed or roped off.
•   Nail points, ends of loop or tie wires, etc., must not be left exposed when packing and
    unpacking boxes, crates, barrels, etc. Nails are to be removed as soon as lumber is
•   Store sharp or pointed articles to keep co-workers from coming in contact with the sharp edges
    or points.
•   Dispose of all packing materials properly to reduce the chance of fires.
•   Empty wastebaskets daily into approved containers.
•   Put oily and greasy rags in a metal container for that purpose and dispose of properly and
•   Maintain adequate lighting in obscure areas for the protection of both employees and the public.
    Keep landscaping well manicured to minimize hiding places.
•   Employees are not to handle food, tobacco, etc., with residue from any lead-based product
    (such as leaded gasoline) on their hands. Consumption of food and beverages is prohibited in
    areas where hazardous substances are stored or used.
•   Employees whose hands are cut or scratched are not to handle any lead-based products.
•   All switches or drives on machinery must be shut down and locked out before cleaning,
    greasing, oiling, or making adjustments or repairs.
•   Circuit breaker boxes and fuse boxes should be kept closed at all times. It is a requirement to
    maintain a minimum clearance of 36 inches in front of them.
•   Flammables (kerosene, gasoline) and combustible materials (coats, rags, cleaning supplies)
    should not be stored in mechanical rooms or around electrical boxes.
•   Extension cords should not be run across aisles or through oil or water. Inspect cords for kinks,
    worn insulation, and exposed strands of wire before use.
•   When fuses blow continually it is an indication of an overload or short. Report this condition to
    your supervisor immediately.
•   Keep electrical equipment properly maintained and free of grease and dirt.
•   To prevent static sparks, keep drive belts dressed. Also check belts for proper tension to
    prevent overloading motors.
•   Maintain fire inspections and other fire prevention measures.

                                                                    Material Handling
Manual Handling
For the Counties and other public entities covered by the NCACC Workers’ Compensation RMP,
about one-third of the injuries are related to overexertion/strains/sprains, mostly due to handling
materials. A study of the more serious cases over a recent 2 ½ year period revealed the following:

                                         Loss Cause Analysis

                                                                       Number            % of
   Materials Handling and Overexertion Injury Causes:                  of Cases       All Cases
    Lifting/Handling a person -- Client or Patient (member services)        90             12%

    Lifting – Not Otherwise Classified                                      60             8%
    Repetitive Motion (Cumulative Trauma Disorders)                         39             5%

    Pushing/Pulling - Not Otherwise Classified                              18             2%
    Overexertion -- Not Otherwise Classified                                18             2%
    Lifting / Overexertion – Moving office equipment or furniture            6             1%

    Overexertion – Bend/Reach/Twist                                          9             1%

                                  TOTAL                                    240             32%

These injuries resulted in over $6 million dollars of medical bills, compensation, etc. -- a figure that
does not include the financial losses to employees and the pain and discomfort they had to endure.
Injuries of this nature can be avoided by taking a little time to plan ahead, by using mechanical
equipment whenever possible, by thinking about the proper way to do the task, and by using the
proper tools.

Safe Lifting
The single and most important preventative safety measure an employee should keep in mind is the
four step lifting process. This process applies whether you are lifting a small box, a heavy
computer, an invalid patient, or a file drawer:

1. Get Ready ... Size up the load. If it is too heavy or bulky, play it smart -- get help. Check the
   load for hazards: protruding nails, splinters, sharp edges, oil, grease or moisture on a case can
   cause injuries or cause you to lose your grip. If the surface is rough--wear gloves. Wear
   protective footwear to help prevent foot injuries. Know where the load is going and where you
   are going to put it down. Be sure the path you take is clear of obstacles.
2. Pick It Up ... Get a firm footing and good balance; have your feet about shoulder width apart. If
   the load is below waist level, bend your knees to get into position. Keep your back as straight
   as possible. Grip the load firmly. Lift the object to carrying position, keeping it close to your
   body. Let the leg and arm muscles do the work.
3. Carry It Carefully ... Be sure you can see where you are going. When changing directions, be
   careful not to twist your body. Turn your body with changes of the position of your feet. Use
   extra caution in tight places so as not to smash your fingers or hands.

4. Put It Down ... If the receiving surface is about waist high, use the edge to take part of the load.
   Then push it forward. If you lower the load to the floor, bend your knees, keep your back as
   straight as possible and the load close to your body.

Using Hand Trucks
Proper use of appropriate mechanical aids, such as hand trucks and dollies, can greatly reduce the
exposure to overexertion types of injuries. If mechanical aids are provided, and we expect
employees to use them, we must ensure the aids are readily available and in good operating
condition. Employees should follow these established materials handling safety rules in using
mechanical aids:

•   Four-wheel hand trucks with swivel axles and tongue are to be pulled; all other trucks are to be
•   Use the correct type of hand truck for the materials you are handling. If there is a special truck,
    for example a drum or drawbar truck, it should be used.
•   Watch where you are going when pushing or pulling a hand truck, and slow down at corners.
•   When pushing a truck, use truck handles and keep your hands within the running lines of the
    truck so you will not be caught between the truck and a fixed object.
•   Use caution and get help in moving hand trucks up or down inclines. Never try to move a truck
    on an incline where you are not fully in control of the load.
•   When using hand trucks, stop at all blind intersections before passing the area.
•   Always park hand trucks at a spot where people will not stumble over them; leave handles in a
    vertical position.
•   Report hand trucks with broken wheels or other damage to your supervisor so repairs can be
    made promptly.
•   All hand truck operators should wear protective footwear, generally steel-toed safety shoes.
•   When using hand trucks, be sure to watch the floor ahead to avoid bumps, cracks, uneven
    surfaces, etc. that can jerk the truck and cause an accident or injury.
•   Pile loads evenly. An unbalanced load may shift causing the hand truck to overturn.

Moving Patients or Other Persons (ALSO SEE TAB 13 – Emergency
Medical Services)
Potential risk factors for ergonomic injuries in patient handling include:
• Overexertion; trying to stop a patient from falling or picking patient up from floor or bed.
• Multiple lifts per shift (more than 20; ref. OSHA Framework Document).
• Lifting alone/no available staff to help.
• Patient weight.
• Lifting un-cooperative, confused patients or patients that cannot support their own weight.
• Expecting employees to perform work beyond their physical capabilities.
• Distance to be moved, and the distance the patient is from the employee, (it is more stressful to
   reach away from the body to lift or pull a patient).
• Awkward postures required by the activity.
• Ineffective training of employees in body mechanics and proper lifting techniques

Transferring patients. Patient transfers are particularly hazardous and are not often covered in
general publications on preventing back injury. The following special points should be emphasized
to prevent back injuries during transfers:
• Communicate the plan of action to the patient and other workers to ensure that the transfer will
    be smooth and without sudden, unexpected moves
• Position equipment and furniture effectively (for example, move a wheelchair next to the bed)
    and remove obstacles
• Ensure good footing for the staff and patient (patients should wear slippers that provide good
• Maintain eye contact and communication with patient: be alert for trouble signs
• If help is needed, request that a co-worker stand by before attempting the transfer
• Record any problems on the patient’s chart so co-workers will know how to cope with difficult
    transfers; note the need for any special equipment, such as a lift.

Aids for patient handling: In special situations it may be necessary to buy or rent special
equipment, such as:
• Gait, transfer, or walking belt - a wide belt placed around patient's waist to allow staff member a
   handhold on patient during transfer operations or walking.
• Hoyer Lift - mechanical lift assist device used to lift heavy or dependent patients. Many
   manufacturers currently make similar devices.
• Sliding board - a slick board used under patient to reduce the friction during transfers of patient
   from bed to chair or changing position in bed.
• Geri chair - geriactic chair is a recliner chair used for dependent patients
• Trapeze lift - a bar device suspended above bed which allows patients with upper muscle
   strength to reposition themselves.

Powered Lift Trucks
•   Only trained and authorized employees are to operate a powered lift truck - or forklift.
•   If you have been trained to operate the forklift, be sure that all nameplates
    and markings are in legible condition. If nameplates or markings are
    illegible or missing, notify your supervisor immediately.
•   Never attempt to use the lift truck to move loads that exceed the rated
    capacity (as indicated on the tag on front of truck). This endangers you as
    well as your co-workers.
•   Pedestrians always have the right of way -- watch for them at all times.
•   When operating a forklift, look in the direction of travel and keep a clear view of the path of
    travel. If the load blocks your vision, travel with the load trailing.
•   Only lift stable and safely arranged loads. When moving a load, the forks must be lowered and
    tilted back.
•   Powered lift trucks should not travel with loads above six inches from the floor. Loads should
    never be lifted or lowered while traveling.
•   Never carry passengers on the forklift.
•   Never allow a co-worker to pass under the elevated portion of the lift truck, whether loaded or
•   When a truck is unattended, the forks must be fully lowered, the brakes set, the power shut off,
    and the controls in neutral position. A truck is considered unattended when either the operator
    is 25 or more feet away, or when the operator is not in view of the truck.
•   When operating a lift truck at cross aisles and other locations where your vision is obstructed,
    slow down and sound the horn.
•   A forklift should not be used to lift people except in special cases. If employees are going to be
    lifted, then a special safety platform securely fastened to the lifting carriage or forks must be
    used. The safety platform must be approved for use with your lift truck. Home or shop- made
    lifts are not permissible unless certified by a Registered Professional Engineer and permitted by
    the manufacturer.
•   If you must move co-workers on a safety platform, the brakes must be set and the operator
    must remain in the truck. Do not move the truck horizontally with employees on the platform or
    while the platform is elevated.
•   Avoid driving in areas where the floors may be oily or wet. If these areas cannot be avoided,
    slow down. Report hazardous floor conditions to your supervisor.
•   If you use the public entity's forklift to unload deliveries from a tractor-trailer, be aware of safe
    loading and unloading procedures. The brakes of a highway truck or trailer should be set and
    the rear wheels chocked before the forklift enters the trailer. It is your responsibility as the
    forklift operator to ensure that the wheels have been chocked, or that a dock lock is secured.
•   If the trailer is not coupled to a tractor, then fixed jacks must be used to support the semi-trailer.
    Wheel chocks or dock locks are still required when fixed jacks are used.
•   Before you enter, check the floor of the trailer to ensure that it is not damaged, then secure
    dockboards and bridgeplates before you drive the forklift into the trailer.
•   Refueling can only be performed with the engine off. Also, do not refuel in a location that has
    flame sources. Do not smoke when refueling a forklift.

•   All battery changing or charging areas must be equipped with fire extinguishers and emergency
    eyewash stations. No smoking is allowed in battery changing or charging areas.
•   Examine the lift truck to ensure that it is in proper working condition at the beginning of each
    shift. If at any time a truck is found to be in need of repair, or unsafe in any way, contact your
    supervisor immediately and take the lift truck out of service until it can be repaired by an
    authorized repair person.
•   Last, but not least, never stunt drive or be involved with horseplay when operating a forklift.

Hoisting Equipment
•   All hoists are to have a rated load capacity posted on the exterior of the hoist. Employees are
    not to exceed the specified limit.
•   Hoisting equipment must undergo periodic inspection and testing, and must be properly
    maintained. Users should inspect the hoisting equipment before each use, and report any
    defects to supervision. Maintenance personnel should inspect hoisting equipment monthly, and
    there should be an annual maintenance agreement including an annual inspection by a qualified
    technician. Defective equipment should be removed from service and tagged “Do Not Use”.
    Repairs must be made promptly when deficiencies are identified. Documentation of
    inspections, repairs and maintenance should be kept on file.
•   When operating a hoist, controls should be moved smoothly and gradually to avoid abrupt jerky
•   Do not lift or move a load if anyone is in a position to be injured. Never carry a load over
    people. If people are in the path of travel, stop and clear the area.
•   Never raise a load before the chains are secured and everyone's hands are free and clear of
    the load. As a load is picked up, pinch points are created which could cause a severe hand
    injury if proper precautions are not taken. Always let others in the area know when you are
    ready to move the load.
•   When raising or lowering a load, proceed slowly and make sure the load is under control. Stand
    far enough away from the load so that if it swings, slips, or spills, you will not be injured.
•   When unhooking material, always clear the hooks and chains well away from the load.
•   If at any time the hoisting equipment is not operating properly, or other unsafe conditions are
    found - report this to your supervisor immediately.

Warehouse - Material Storage
Another issue in the warehouse is material handling and proper storage. By following some good
housekeeping principles, you can reduce hazards that could possibly cause you or a co-worker to
be injured.

•   Be sure that goods are stored neatly on shelving, or are stacked in the designated area.
    Objects that are laying in aisles and walkways create a tripping hazard for the employees who
    work in the warehouse. Clear access aisles must be maintained.
•   Exit doors and the pathways to reach them must be kept clear. Never store materials in front of
    an emergency exit door, even temporarily.
•   Keep heavy materials stored low to the floor. This will make it easier to move and lift these
    objects safely. If heavy materials are stored too high, it can increase the chance for a back
    injury, since you may have to lift the object with your arms extended.
•   Be sure that stored supplies do not block electrical breaker boxes. Electrical panels and
    disconnects should be labeled and must be accessible at all times should an electrical
    emergency arise.
•   Breaker boxes should be closed or covered to minimize that chance of a spark starting a fire.
•   Keep a step stool or stepladder in the area to reach supplies. Do not use a chair, or climb on
    shelving to reach objects. This increases your chance of falling and being injured.

Piling Materials
•   Have a safe base. That means a solid, smooth, and level surface. If the floor or ground is not
    level, use dunnage, bearing strips, or timber to make sure that the pile will not shift. Barrels and
    other materials that may roll or slide should be chocked at the base.
•   Do not exceed a safe height. The pile must not be so high as to be unstable, the floor load limit
    must not be exceeded, and clearances must be maintained for fire protection systems
    (minimum 18 inches clearance between the pile and sprinkler heads), electrical equipment, etc.
•   Lock the material by cross-tying the layers so there are no unsteady stacks within the pile. Piles
    should also be stepped back to insure stability.
•   Maintain aisle space for workers and fire equipment. Materials should not protrude beyond the
    face of the pile.

Storing and Handling Gas Cylinders
•   The protective cap over the valve should be kept on when the cylinder is not in use.
•   Never let grease or oil be on your hands or gloves. Keep grease away from the oxygen cylinder
•   Lifting cylinders is always a job for two persons. If available, move cylinders with a cylinder
•   Keep cylinders on end and strap or chain them securely so that they cannot fall.
•   Store cylinders away from salt, acid, film, or other corrosive substances.
•   Cylinders should be kept away from radiators and other sources of heat.
•   Oxygen cylinders in storage should be separated from fuel-gas cylinders or combustible
    materials (especially oil or grease), a minimum distance of 20 feet, or by a noncombustible
    barrier at least 5 feet high having a fire resistance rating of at least one-half hour.

                                                                                  First Aid
While emphasis is placed on the prevention of accidents and injuries, accidents do occur. Prompt,
knowledgeable treatment of injured employees will, in many cases, prevent minor injuries from
becoming major ones.

The following first aid rules should be established:

•   In the absence of an infirmary, clinic, or hospital in near proximity
    to the workplace and used for the treatment of injured
    employees, a person or persons must be adequately trained to
    render first aid. It is recommended that each department head
    and supervisor receive American Red Cross first aid and CPR
    training (See Tab 4 – Emergency Procedures).
•   Adequate first aid supplies must be readily available. First aid
    cabinets or kits should be maintained in all buildings. First aid
    kits should also be carried on all vehicles.
•   First aid supplies are to be checked on a periodic basis.
•   Minor medical treatment for cuts, scratches, etc., should be given by the supervisor or other
    trained first-aider. Always be sure that open wounds are thoroughly cleansed with soap and
    water to prevent infection. Follow universal precautions as outlined in Tab 10 – Bloodborne
    pathogens, and in first-aid training.
•   There may be cases when injured employees who need professional medical attention can be
    transported to the hospital by car. There may be other cases, however, when injured
    employees should be transferred by ambulance to a hospital or medical center. If there is any
    doubt about the mode of transportation, an ambulance should be called. For example, the
    following conditions would definitely indicate ambulance service:
       •   Employee is unconscious or in shock.
       •   Hemorrhaging.
       •   Severe abdominal cramps and/or vomiting.
       •   Any apparent fracture.
       •   Other symptoms of internal injury.
•   If the need for the Emergency Medical Services or rescue squad should arise, personnel in
    vehicles equipped with two-way radios may use them to call for assistance.
•   All animal bites, because of the possibility of rabies, should receive prompt medical attention by
    a physician. If someone is bitten, every attempt should be made to confine the animal.
•   All injuries, no matter how minor, are to be reported. The supervisor should complete an
    accident investigation report form as soon as possible after the incident.

                                         BLOODBORNE PATHOGENS
                                         EXPOSURE CONTROL PLAN

     The purpose of this exposure control plan is to:

     1.     Eliminate or minimize employee occupational exposure to blood or certain other
            body fluids;

     2.     Comply with the OSHA Bloodborne Pathogens Standard, 29 CFR 1910.1030 and
            the Needlestick Safety and Prevention Act (the Act) (Pub. L. 106-430).


     An exposure determination of each department has been completed to identify which
     employees may incur occupational exposure to blood or other potentially infectious
     materials (OPIM). The exposure determination is made without regard to the use of
     personal protective equipment (PPE) since employees are considered to be exposed even if
     they wear personal protective equipment.

     This document includes a listing of job classifications in this department or establishment in
     which all employees within the identified job classification may be expected to incur such
     occupational exposure, regardless of frequency.

     In addition, it also includes a separate listing of job classifications within this
     department/establishment in which some employees may have occupational exposure.
     Since not all the employees in these categories would be expected to incur exposure to
     blood or other potentially infectious materials, task or procedures that would cause these
     employees to have occupational exposures are also to be listed in order to clearly
     understand which employees in these categories are considered to have occupational


     1.     Compliance Methods:

            Universal precautions will be observed at this facility in order to prevent contact with
            blood or other potentially infectious materials. All blood or other potentially infectious
            material will be considered infectious regardless of the perceived status of the source

            Engineering and work practice controls will be utilized to eliminate or minimize
            exposure to employees at this facility. Engineering controls are the primary means of
            eliminating or minimizing employee exposure and include the use of safer medical
            devices, such as needle-less devices, shielded needle devices, and plastic capillary
            tubes. Medical devices with engineered sharps injury protections and needle-less
            systems constitute an effective engineering control and must be used where feasible.

           Where occupational exposure remains after institution of these controls, personal
           protective equipment shall also be utilized. These controls will be examined and
           maintained on a regular schedule. Appendix (B) includes the schedule for reviewing
           the effectiveness of the control for this department/establishment.

           Handwashing facilities shall be made available to the employees who incur exposure
           to blood or other potentially infectious materials. These facilities are to be readily
           accessible after incurring exposure. If there is a case where a hand washing facility
           is not accessible, an antiseptic cleanser in conjunction with clean cloth/paper towels
           or antiseptic towelettes is to be provided. If this alternative is used, then the
           employee is to wash their hands with soap and running water as soon as possible
           after the occupational exposure. The location(s) of the nearest hand washing facility
           should be readily available to employees that are using the alternative method.

           Supervisors shall ensure that after the removal of personal protective
           gloves, employees shall wash hands and any other potentially
           contaminated skin area immediately or as soon as feasible with soap and

           Supervisors shall ensure that if employees incur exposure to their skin or
           mucous membranes then those areas shall be washed or flushed with
           water as soon as feasible following contact.

   2.      Annual Review Exposure Control Plan

           An annual review and update will be conducted to reflect changes in technology that
           eliminate or reduce exposure to bloodborne pathogens. Medical devices with
           engineered sharps injury protections and needle-less systems constitute an effective
           engineering control and will be considered during our review. These devices will be
           used where feasible to ensure employee safety. Refer to Appendix (E).

           This review will:
           •   take into account innovations in medical procedure and technological
               developments that reduce the risk of exposure (e.g., newly available medical
               devices designed to reduce needlesticks); and
           •   document consideration and use of appropriate, commercially-available, and
               effective safer devices (e.g., describe the devices identified as candidates for
               use, the method(s) used to evaluate those devices, and justification for the
               eventual selection).

Since no one medical device is considered appropriate or effective for all circumstances, we will
select devices that, based on reasonable judgment:
           •   will not jeopardize client or employee safety or be medically inadvisable; and
           •   will make an exposure incident involving a contaminated sharp less likely to

           (During your annual review of devices, you must inquire about new or
           prospective safer options and document this fact in your written Exposure
           Control Plan. This would include, but would not be limited to, newly available
           medical devices designed to reduce the risk of percutaneous exposure to

bloodborne pathogens. Consideration and implementation of safer medical
devices could be documented in the Exposure Control Plan by describing the
safer devices identified as candidates for adoption; the method or methods
used to evaluate devices and the results of evaluations; and justification for
selection decisions. This information must be updated at least annually.

The revised Exposure Control Plan requirements make clear that employers
must implement the safer medical devices that are appropriate, commercially
available, and effective. No one medical device is appropriate in all
circumstances of use. For purposes of this standard, an "appropriate" safer
medical device includes only devices whose use, based on reasonable
judgment in individual cases, will not jeopardize patient or employee safety or
be medically contraindicated.

Although new devices are being continually introduced, OSHA recognizes that
a safer device may not be available for every situation. If a safer device is not
available in the marketplace, the employer is not required to develop any such
device. Furthermore, the revised requirements are limited to the safer medical
devices that are considered to be "effective."

For purposes of this standard, an "effective" safer medical device is a device
that, based on reasonable judgment, will make an exposure incident involving
a contaminated sharp less likely to occur in the application in which it is used.

If no engineering control is available, work practice controls shall be used and,
if occupational exposure still remains, personal protective equipment must
also be used.)

Employee Input

Input will be solicited from non-managerial employees responsible for direct patient
care regarding the identification, evaluation, and selection of effective engineering
controls, including safer medical devices.

The employees providing input will represent the range of exposure situations
encountered in the workplace, such as those in the health department, substance
abuse, or EMS, along with others involved in direct care of patients.

(OSHA will check for compliance with this provision during inspections by

questioning a representative number of employees to determine if and how

their input was requested.

No specific procedures for obtaining employee input are prescribed. This
provides the employer with flexibility to solicit employee input in any manner
appropriate to the circumstances of the workplace. A dental office employing
two hygienists, for example, may choose to conduct periodic conversations to
discuss identification, evaluation, and selection of controls. A large hospital,

     on the other hand, would likely find that an effective process for soliciting
     employee input requires the implementation of more formal procedures. The
     solicitation of input required by the standard requires employers to take
     reasonable steps to obtain employee input in the identification, evaluation, and
     selection of controls. Methods for soliciting employee input may include
     involvement in informal problem-solving groups; participation in safety audits,
     worksite inspections, or exposure incident investigations; participation in
     analysis of exposure incident data or in job or process hazard analysis;
     participation in the evaluation of devices through pilot testing.)

     Documentation of Employee Input

     Employers are required to document, in the Exposure Control Plan, how they
     received input from employees. This obligation will be met by:
     •   Listing the employees involved and describing the process by which input was
         requested; or
     •   Presenting other documentation, including references to the minutes of meetings,
         copies of documents used to request employee participation, or records of
         responses received from employees.

3.   Engineered Sharps & Needle-less Systems

     Sharps with Engineered Sharps Injury Protections

     Non-needle sharps or needle devices containing built-in safety features that are used
     for collecting fluids or administering medications or other fluids, or other procedures
     involving the risk of sharps injury will be used where feasible. During our annual
     review, these devices will be discussed, reviewed as to their effectiveness with our
     procedures, and used where feasible. This covers a broad array of devices,
         •   syringes with a sliding sheath that shields the attached needle after use;
         •   needles that retract into a syringe after use;
         •   shielded or retracting catheters
         •   intravenous medication (IV) delivery systems that use a catheter port with a
             needle housed in a protective covering.

     (Safety equipment must be available at all times. If for some reason an
     engineering control is not available (due to supply shortages, back orders,
     shipping delays, etc.), this must be documented in your Exposure Control
     Plan. You would then be responsible to implement the chosen control(s) as
     soon as it becomes available and adjust your exposure control plan to
     illustrate such. In the meantime, work practice controls must be used and, if
     occupational exposure still remains, personal protective equipment must also
     be used.)

     Needleless Systems

     Needle-less systems is defined as devices which provide an alternative to needles
     for various procedures to reduce the risk of injury involving contaminated sharps.
     During our annual review, these devices will be discussed, reviewed as to their

     effectiveness with our procedures, and used where feasible. Types of needle-less
     systems include:
        •   IV medication systems which administer medication or fluids through a
            catheter port using non-needle connections; and
        •   jet injection systems which deliver liquid medication beneath the skin or
            through a muscle.

     (A key element in choosing a safer medical device, other than its
     appropriateness to the procedure and effectiveness, is its availability on the
     market. If there is no safer option for a particular medical device used where
     there is exposure to blood or OPIM, you are not required to use something
     other than the device that is normally used. )

4.   Needles

     Contaminated needles and other contaminated sharps will not be bent, recapped,
     removed, sheared, or purposely broken. An exception to this is allowed if the
     procedure would require that the contaminated needle be recapped or removed and
     no alternative is feasible and the action is required by the medical procedure. If such
     action is required, then the recapping or removal of the needle must be done by the
     use of a mechanical device or a one-handed technique. Appendix (B) includes a list
     of procedures at this facility where recapping or removal is permitted.

5.   Containers for REUSABLE Sharps

     Contaminated sharps that are reusable are to be placed immediately, or as soon as
     possible, after use into appropriate sharps containers. At this facility, the sharps
     containers are to be puncture resistant, labeled with a biohazard label, and are to be
     leak resistant. Appendix (B) lists where reusable sharps containers are located at
     this facility as well as who has responsibility for removing sharps from containers and
     how often the containers will be checked to remove the sharps.

6.   Work Area Restrictions

     In work areas where there is a reasonable likelihood of exposure to blood or other
     potentially infectious materials, employees are not to eat, drink, apply cosmetics or
     lip balm, smoke, or handle contact lenses. Food and beverages are not to be kept in
     refrigerators, freezers, shelves, cabinets, or on counter tops or bench tops where
     blood or other potentially infectious materials are present.

     Mouth pipetting/suctioning of blood or other potentially infectious materials is

     All procedures will be conducted in a manner which will minimize splashing,
     spraying, splattering, and generation of droplets of blood or other potentially
     infectious materials. Appendix (B) includes methods which will be employed at this
     facility to accomplish this goal.

     Any specimens which could puncture a primary container will be placed within a
     secondary container which is puncture resistant.

     If outside contamination of the primary container occurs, the primary container shall
     be placed within a secondary container which prevents leakage during the handling,
     processing, storage, transport, or shipping of the specimen.

7.   Contaminated Equipment

     Supervisors are responsible for ensuring that equipment that has become
     contaminated with blood or other potentially infectious materials be examined prior to
     servicing or shipping and be decontaminated as necessary unless the
     decontamination of the equipment is not feasible.

8.   Personal Protective Equipment

     PPE Provision:

     Supervisors are responsible for ensuring that required PPE is available within their
     respective work sites.

     All personal protective equipment used at this facility will be provided without cost to

     Personal protective equipment will be chosen based on the anticipated exposure to
     blood or other potentially infectious materials.

     The protective equipment will be considered appropriate only if it does not permit
     blood or other potentially infectious materials to pass through or reach the
     employees' clothing, skin, eyes, mouth, or other mucous membranes under normal
     conditions of use and for the duration of time that the protective equipment will be

     PPE Use:

     Supervisors shall ensure and enforce employee use of appropriate PPE unless the
     supervisor shows that the employee temporarily and briefly declined to use PPE
     when under rare and extraordinary circumstances, it was the employee's
     professional judgment that in the specific instance its use would have prevented the
     delivery of healthcare or posed an increased hazard to the safety of the worker or co-
     worker. When the employee makes this judgment, the circumstances shall be
     investigated and documented in order to determine whether changes can be
     instituted to prevent such occurrences in the future.

     PPE Accessibility:

     Supervisors shall ensure that appropriate PPE in the appropriate sizes is readily
     accessible at the work site or is issued without cost to employees. Hypoallergenic
     gloves, glove liners, powderless gloves, or other similar alternatives shall be readily
     accessible to those employees who are allergic to the gloves normally provided.

     PPE Cleaning, Laundering and Disposal:

     All personal protective equipment will be cleaned, laundered, or disposed of by the
     employer at no cost to the employees. All repairs and replacements are made by the
     employer with no cost to employees.

      All garments that are penetrated by blood shall be removed immediately or as soon
      as feasible. All PPE will be removed prior to leaving the work area.

      When PPE is removed, it shall be placed in a appropriately designated area or
      container for storage, washing, decontamination, or disposal.


      Gloves shall be worn where it is reasonably anticipated that employees will have
      hand contact with blood, other potentially infectious materials, non-intact skin, and
      mucous membranes; when performing vascular access procedures and when
      handling or touching contaminated items or surfaces.

      Disposable gloves used at this facility are not to be washed or decontaminated for
      re-use and are to be replaced as soon as practical when they become contaminated
      or as soon as feasible if they are torn, punctured, or when their ability to function as a
      barrier is compromised.

      Eye and Face Protection:

      Masks in combination with eye protection devices, such as goggles or glasses with
      solid side shield, or chin length face shields, are required to be worn whenever
      splashes, spray, splatter, or droplets of blood or other potentially infectious materials
      may be generated and eye, nose, or mouth contamination can reasonably be

      Additional PPE Protection:

      Additional protective clothing (such as lab coats, gowns, aprons, clinic jackets, or
      similar outer garments) shall be worn in instances when gross contamination can
      reasonably be anticipated (such as autopsies and orthopedic surgery).

9.    Housekeeping

      This facility will be cleaned and decontaminated according to the schedule and
      method listed in Appendix (B).

      All contaminated work surfaces will be decontaminated after completion of
      procedures and immediately or as soon as feasible after any spill of blood or other
      potentially infectious materials, as well as at the end of the work shift if the surface
      may have become contaminated since the last cleaning.

      All bins, pails, and similar receptacles shall be inspected and decontaminated on a
      regular scheduled basis.

      Any broken glassware that may be contaminated will not be picked up directly with
      the hands. Dustpans and hand-brooms or forceps/tongues are to be used.

      Reusable sharps that are contaminated with blood or other potentially infectious
      materials shall not be stored or processed in a manner that requires employees to
      reach by hand into the containers where these sharps have been placed.

10.   Regulated Waste Disposal

      Disposable Sharps:

      Contaminated sharps shall be discarded immediately or as soon as feasible in
      containers that are closable, puncture resistant, leak proof on sides and bottom, and
      labeled or color-coded.

      During use, containers for contaminated sharps shall be easily accessible to
      personnel and located as close as feasible to the immediate area where sharps are
      used or can be reasonably anticipated to be found (e.g., laundries)

      The containers shall be maintained upright throughout use and replaced routinely
      and not be allowed to overfill.

      When moving containers of contaminated sharps from the area of use, the
      containers shall be closed immediately prior to removal or replacement to prevent
      spillage or protrusion of contents during handling, storage, transport, or shipping.

      The container shall be placed in a secondary container if leakage of the primary
      container is possible. The second container shall be closable, constructed to contain
      all contents and prevent leakage during handling, storage, transport or shipping. The
      second container shall be labeled or color-coded to identify its contents.

      Reusable containers shall not be opened, emptied, or cleaned manually or in any
      other manner which would expose employees to the risk of percutaneous injury.

      Other Regulated Waste:

      Other regulated waste shall be placed in containers which are closable, constructed
      to contain all contents and prevent leakage of fluids during handling, storage,
      transportation, or shipping.

      The waste must be labeled or color-coded and closed prior to removal to prevent
      spillage or protrusion of contents during handling, storage, transport, or shipping.

      Disposal of all regulated waste shall be in accordance with applicable United States,
      state, and local regulations.

11.   Laundry Procedures

      Laundry contaminated with blood or other potentially infectious materials will be
      handled as little as possible. Such laundry will be placed in appropriately marked
      (biohazard labeled, or color-coded red) bags at the location where it was used. Such
      laundry will not be sorted or rinsed in the area of use.

      Whenever Body Substance Isolation or Universal Precautions are used in the
      handling of all soiled laundry (i.e. all laundry is assumed to be contaminated), no
      labeling or color-coding is necessary as long as all employees recognize the hazards
      associated with the handling of this material.

      Contaminated laundry will be disposed of or professionally cleaned at an approved
      commercial facility.

      Whenever contaminated laundry is shipped off-site to a second facility which does
      not utilize Universal Precautions in the handling of all laundry, contaminated laundry
must be placed in bags or containers which are labeled or color-coded. One
possible solution would be to include a requirement in the laundry facility contract
requiring the laundry to utilize the equivalent of Universal Precautions.

12.   Hepatitis B Vaccine and Post-Exposure Evaluation and Follow Up


      The County will make available the Hepatitis B vaccine and vaccination series to all
      employees who have occupational exposure, and post exposure follow-up to
      employees who have had an exposure incident.

      The County will ensure that all medical evaluations and procedures, including the
      Hepatitis B vaccine and vaccination series and post exposure follow-up (including
      prophylaxis), are:
      a.      Made available at no cost to employee;
      b.      Made available to the employee at a reasonable time and place;
      c.      Performed by or under the supervision of a licensed physician or by or under
              the supervision of another licensed healthcare professional; and
      d.      Provided according to the recommendations of the U.S. Public Health

      All laboratory tests shall be conducted by an accredited laboratory at no cost to the

      Hepatitis B Vaccination:

      The Bloodborne Pathogens Coordinator is in charge of the Hepatitis B vaccination
      program. Vaccinations will be administered by the County Health Department or
      other identified facility.

      Hepatitis B vaccination will be made available after the employee has received the
      training in occupational exposure (see information and training) and within 10
      working days of initial assignment to all employees who have occupational exposure
      unless the employee has previously received the complete Hepatitis B vaccination
      series, antibody testing has revealed that the employee is immune, or the vaccine is
      contraindicated for medical reasons.

      Participation in a pre-screening program is not a prerequisite for receiving Hepatitis B

      If the employee initially declines Hepatitis B vaccination but at a later date, while still
      covered under the standard, decides to accept the vaccination, the vaccination shall
      then be made available.

      Each employee who declines the Hepatitis B vaccination offered shall sign a waiver
      indicating their refusal. The included OSHA declination statement to be used for this

      If a routine booster dose of Hepatitis B vaccine is recommended by the U.S. Public
      Health Service at a future date, such booster doses shall be made available by the
      County/Entity/Entity at no cost the employee.

      Post-Exposure Evaluation and Follow-Up:

All exposure incidents shall be reported, investigated, and documented. When the
employee incurs an exposure incident, it shall be reported to the Bloodborne
Pathogens Coordinator for investigation.

Following a report of an exposure incident, the exposed employee shall immediately
receive a confidential medical evaluation and follow-up, including at least the
following elements:

a.     Documentation of the route of exposure, and the circumstances under which
       the exposure incident occurred;

b.     Identification and documentation of the source individual, unless it can be
       established that identification is infeasible or prohibited by state of local law.

c.     The source individual's blood shall be tested as soon as feasible and after
       consent is obtained in order to determine HBV and HIV infectivity. If consent
       is not obtained, the Bloodborne Pathogens Coordinator, shall establish that
       legally required consent cannot be obtained. When the source individual's
       consent is not required by law, the source individual's blood, if available, shall
       be tested and the results documented.

d.     When the source individual is already known to be infected with HBV or HIV,
       testing for the source individual's known HBV or HIV status need not be

e.     Results of the source individual's testing shall be made available to the
       exposed employee, and the employee shall be informed of applicable laws
       and regulations concerning disclosure of the identity and infectious status of
       the source individual.

Collection and testing of blood for HBV and HIV serological status will comply with
the following:

a.     The exposed employee's blood shall be collected as soon as feasible and
       tested after consent is obtained;

b.     The employee will be offered the option of having their blood collected for
       testing of the employee's HIV/HBV serological status. The blood sample will
       be preserved for up to 90 days to allow the employee to decide if the blood
       should be tested for HIV serological status.

Each employee who incurs an exposure incident will be offered post-exposure
evaluation and follow-up in accordance with the OSHA standard. All post exposure
follow-up will be performed by the County Health Department or other identified
healthcare provider.

Information Provided To The Healthcare Professional

The County Bloodborne Pathogens Coordinator shall ensure that the healthcare
professional responsible for the employee's Hepatitis B vaccination is provided with
the following:

a.     A copy of the OSHA Bloodborne Pathogens Standard, 29 CFR 1910.1030;
       (While the standard outlines the confidentiality requirements of the healthcare
             professional, the County/Entity Bloodborne Pathogens Coordinator is to
             remind the healthcare professional of these requirements)

      b.     A written description of the exposed employee's duties as they relate to the
             exposure incident;

      c.     Written documentation of the route of exposure and circumstances under
             which exposure occurred;

      d.     Results of the source individual's blood testing, if available; and

      e.     All medical records relevant to the appropriate treatment of the employee
             including vaccination status.

      Healthcare Professional's Written Opinion:

      The County Bloodborne Pathogens Coordinator shall obtain and provide the
      employee with a copy of the evaluating healthcare professional's written opinion
      within 15 days of the completion of the evaluation.

      The healthcare professional's written opinion for HBV vaccination shall be limited to
      whether HBV vaccination is indicated for an employee, and if the employee has
      received such vaccination.

      The healthcare professional's written opinion for post exposure follow-up shall be
      limited to the following information:

      a.     A statement that the employee has been informed of the results of the
             evaluation; and

      b.     A statement that the employee has been told about any medical conditions
             resulting from exposure to blood or other potentially infectious materials
             which require further evaluation or treatment.

      NOTE: All other findings or diagnosis shall remain confidential and shall not
      be included in the written report.

13.   Labels and Signs

      Supervisors shall ensure that biohazard labels are affixed to containers of regulated
      waste, refrigerators and freezers containing blood or other potentially infectious
      materials, and other containers used to store, transport, or ship blood or other
      potentially infectious materials.

      The universal biohazard symbol shall be used. The label shall be fluorescent orange
      or orange-red.

      Red bags or containers may be substituted for labels. However, regulated wastes
      must be handled in accordance with the rules and regulations of the organization
      having jurisdiction.

      Blood products that have been released for transfusion or other clinical use are
      exempted from these labeling requirements.
14.   Information and Training

      The Department Head shall ensure that training is provided to each employee at the
      time of initial assignment to tasks where occupational exposure may occur, and that
      it shall be repeated within twelve months of the previous training. Training shall be
      tailored to the education and language level of the employee, and offered during the
      normal work shift.

      The training will be interactive and cover the following:
      a.     A copy of the standard and an explanation of it's contents.
      b.     A discussion of the epidemiology and symptoms of bloodborne diseases;
      c.     An explanation of the modes of transmission of bloodborne pathogens.
      d.     An explanation of the Bloodborne Pathogen Exposure Control Plan (this
             program), and a method for obtaining a copy.
      e.     The recognition of tasks that may involve exposure.
      f.     An explanation of the use and limitations of methods to reduce exposure. (i.e.
             engineering controls, work practices and personal protective equipment)
      g.     Information on the types, use, location, removal, handling, decontamination,
             and disposal of PPE.
      h.     An explanation of the basis of selection of PPE.
      i.     Information on the Hepatitis B vaccination, including efficacy, safety, method
             of administration, benefits, and that it will be offered free of charge.
      j.     Information on the appropriate actions to take and persons to contact in an
             emergency involving blood or other potentially infectious materials.
      k.     An explanation of the procedures to follow if an exposure incident occurs,
             including the method of reporting and medical follow up.
      l.     Information on the evaluation and follow up required after an employee
             exposure incident.
      m.     An explanation of the signs, labels, and color coding systems.

      The person conducting the training shall be knowledgeable in the subject matter.

      Additional training shall be provided to employees when there are any changes of
      tasks or procedures affecting the employee's occupational exposure.

      Employees who have received bloodborne pathogens training within the twelve
      months preceding the effective date of this policy shall only receive training in
      provisions of the policy that have not already been covered.

15.   Recordkeeping

      Medical Record:

      The County’s Bloodborne Coordinator is responsible for maintaining medical records
      as indicated below.

Medical records shall be maintained in accordance with OSHA Standard 29 CFR
1910.1020. These records shall be kept confidential, and must be maintained for at
least the duration of employment plus 30 years. The records shall include the

a.       The name and social security number of the employee.

b.       A copy of the employee's HBV vaccination status, including the dates of

c.       A copy of all results of examinations, medical testing, and follow-up

d.       A copy of the information provided to the healthcare professional, including a
         description of the employee's duties as they relate to the exposure incident,
         and documentation of the routes of exposure and circumstances of the

NOTE: For OSHA Log Recordkeeping purposes, an occupational bloodborne
pathogens exposure incident shall be classified as an injury since it is usually
the result of an instantaneous event or exposure. It shall be recorded if it
meets the recordability requirements.

Training Records:

The County Bloodborne Pathogens Coordinator is responsible for maintaining
training records. These records will be kept at the Human Resources/Personnel
Department or other secure location.

Training records shall be maintained for three years from the date of training. The
following information shall be documented:
a.       The dates of the training sessions.
b.       An outline describing the material presented.
c.       The names and qualifications of persons conducting the training.
d.       The names and job titles of all personnel attending the training sessions.

Sharps Injury Log

The Sharps Injury Log will be maintained in a manner that protects the privacy of our
employees. Every sharps injury will be noted on the Sharps Injury Log ASAP after
the injury has been reported. The sharps injury log must be maintained for the period
required by 29 CFR 1904 (5 years). Refer to Appendix (D).

All sharps injuries will be investigated by the supervisor for accident cause(s) and
corrective action. The corrective action will be noted on a Supervisor’s Accident
Investigation Report form or other tracking methods. At a minimum, the log will
contain the following:

     •   the type and brand of device involved in the incident;

         •   location of the incident (e.g., department or work area);

         •   description of the incident

      (The format of the sharps injury log is not specified. The employer is permitted
      to determine the format in which the log is maintained (e.g., paper or
      electronic), and may include information in addition to that required by the
      standard, so long as the privacy of injured workers is protected. The Agency
      recognizes that many employers already compile reports of percutaneous
      exposure incidents in a variety of ways. Existing mechanisms for collecting
      these reports will be considered sufficient to meet the requirements of the
      standard for maintaining a sharps injury log, provided that the information
      gathered meets the minimum requirements specified in the standard, and the
      confidentiality of the injured employee is protected.

      Under newly published revisions to OSHA's Recordkeeping rule (29 CFR 1904),
      employers are required to record sharps injuries involving contaminated
      objects on the OSHA 300 Log of Work-Related Injuries and Illnesses and the
      OSHA 301 Injury and Illness Incident Report (the new forms replace the current
      200 and 101 forms). When the revisions become effective, employers may elect
      to use the OSHA 300 and 301 forms to meet the sharps injury log
      requirements, provided two conditions are met. First, the employer must enter
      the type and brand of the device on either the 300 or 301 form. Second, the
      employer must maintain the records in a way that segregates sharps injuries
      from other types of work-related injuries and illnesses, or allows sharps
      injuries to be easily separated.

      For example, if OSHA 300 and 301 records are maintained on a computer, the
      employer must ensure that the computer is able to produce a record of sharps
      injuries that does not include other types of work-related injuries and illnesses
      (i.e., through using a program that allows for sorting of entries by injury type).
      If records are kept on paper forms, the employer would need to use a separate
      page of the 300 Log for sharps injuries.)

      Availability of Records:

      All employee records shall be made available to the employee in accordance with 29
      CFR 1910.1020

      All employee records shall be made available to the Assistant Secretary of Labor for
      the Occupational Safety and Health Administration (OSHA) and the Director of the
      National Institute for Occupational Safety and Health (NIOSH) upon request.

      Transfer of Records:

      If this facility is closed or there is no successor employer to receive and retain the
      records for the prescribed period, the Director of NIOSH shall be contacted for final

16.   Evaluation and Review

      The Department Head is responsible for annually reviewing this program and its
      effectiveness, and for updating the written program as needed.

17.   Dates

      All provisions required by this standard will be implemented immediately upon
      approval and implementation of the written program.

18.   Outside Contractors

      While the written exposure control plan does not have to address information
      obtained from and provided to outside contractors, written standard operating
      procedures are to be established for situations involving the use of outside
      contractors by this facility. A copy of these standard operating procedures is to be
      attached to this document.

Hyde County
December, 2005

OSHA requires employers to perform an exposure determination concerning which employees may
incur occupational exposure to blood or other potentially infectious materials. The exposure
determination is made without regard to the use of personal protective equipment (i.e. employees
are considered to be exposed even if they wear personal protective equipment). This exposure
determination is required to list all job classifications in which all employees may be expected to
incur such occupational exposure, regardless of frequency. The following job classifications are in
this category:

Emergency Medical Technicians
Sheriff & Deputies
Emergency Management
Fire Marshal
Health Nurses
Health Aides
Health Department Staff

In addition, OSHA requires a listing of job classifications in which some employees may have
occupational exposure. Since not all the employees in these categories would be expected to incur
exposure to blood or other potentially infectious materials, task or procedures that would cause
these employees to have occupational exposure are also required to be listed in order to clearly
understand which employees in these categories are considered to have occupational exposure.
The job classifications for this category are as follows:

Solid Waste


I understand that due to my occupational exposure to blood or other potentially infectious materials
I may be at risk of acquiring hepatitis B virus (HBV) infection. I have been given the opportunity to
be vaccinated with hepatitis B vaccine, at no charge to my self. However, I decline hepatitis B
vaccination at this time. I understand that by declining this vaccine, I continue to be at risk of
acquiring hepatitis B, a serious disease. If in the future I continue to have occupational exposure to
blood or other potentially infectious materials and I want to be vaccinated with hepatitis B vaccine, I
can receive the vaccination series.



                                                                    Fire Prevention
One of the most fearsome and damaging disasters that can occur is a fire. Due to the various
activities performed in public entity facilities, the potential fire hazards that exist must be recognized
and addressed. Fires can be prevented through planning, sensible arrangement of fire or spark-
producing activities in relation to combustible materials, good housekeeping, and observance of
practical work practice controls (no smoking) when flammable substances are present.

Most facilities that contain potential fire hazards should have a fire plan to combat a fire if it occurs.
The plan should include:

•      Adequate warning measures for alerting all people in the area of the existence of a fire.
•      Rapid reporting to the Fire Department.
                                            •   Evacuation of personnel from areas involved or
                                                threatened by the fire.
                                            •   Procedures for containing the fire in so far as it is safe
                                                to do so and, particularly only to the extent that it is
                                                possible to maintain safe exit for personnel so
                                            •   Employee training for those who regularly work in the
                                                area, and their duties, if any, in a fire situation.
                                            •   Adequate fire extinguishing equipment that is
                                                regularly inspected by a responsible authority.
                                            •   An emergency evacuation plan for each building.

The following basic fire prevention procedures should be observed:
•   Maintain good housekeeping. Storage areas should be clean and orderly. Combustibles must
    not be stored around electrical panels or heat producing appliances.
•   Fire extinguishing equipment is to be prominently displayed, labeled for usage, and kept clear
    for easy access at all times. Equipment must be appropriately inspected and maintained.
•   Know the location of fire extinguishers and how to use them. After using an extinguisher, report
    the use immediately to your supervisor so a replacement may be obtained or the extinguisher
•   Do not use water-type extinguishers on electrical fires because of the danger of electrocution
    and damage to equipment. Water-type extinguishers are intended for use on Class "A" fires
    only (combustibles such as wood, paper, rags, etc.).
•   Keep oily rags and other flammable wastes in covered metal containers. Such debris must be
    removed from the maintenance shop building as soon as possible and, in no case, should it be
    left unattended in a building overnight.
•   Keep cleaning solutions that have flammable properties (a flash point below 140o F) in UL
    Listed or Factory Mutual Approved safety containers having spring-lift caps. Each container
    must also be labeled as to its contents. Use of gasoline is prohibited for cleaning purposes.

•   Gasoline used in small quantities in shops for fueling engines being repaired, tested, adjusted,
    etc., must be handled and dispensed in the smaller (one gallon) approved safety containers,
    having a spring-lift cap. Containers must be labeled as to contents.
•   The fueling of any type of motorized equipment while the engine is running is prohibited. Many
    injuries occur when gasoline is spilled on or around a hot exhaust system. Fill lawn mowers and
    other equipment before starting. If refueling is necessary after the engine has run, shut the
    engine off and allow it to cool before refueling.
•   When transferring flammable liquids, make sure the filler nozzle touches the equipment or can
    to be filled in order to guard against the build-up of static electrical charge.
•   Never overfill a tank but rather, under-fill it to allow room for expansion of the liquid.
•   No artificial light, except UL Listed electric flashlights will be used near escaping gasoline or
    other flammable vapors. Do not enter any enclosure suspected of containing gas or other
    flammable vapors. Stay out of the area completely and call the Fire Department.
•   Compressed gas cylinders must be stored upright and secured in place with a chain or belt.
    Caps must be in place when cylinders are not in use. Oxygen and fuel cylinders must be
    appropriately separated.
•   Do not enter dark places, basements or cellars without proper light.
    The use of matches for lighting is strictly forbidden.
•   Do not use fuel oil or kerosene for starting fires in stoves. Under no
    circumstances will gasoline be used for starting fires.
•   A "No Smoking" rule will be enforced in all areas where hazardous
    substances are stored or used and in all other areas where "No
    Smoking" signs are posted.
•   Exits are not to be locked (chained or otherwise) from the inside.
•   All motorized equipment will have an appropriate fire extinguisher.
•   Have heating equipment cleaned and serviced periodically by competent technicians.
•   The use of portable heaters should be discouraged, particularly in office areas. Many office
    fires have occurred because of unattended heaters accidentally left on over night.
•   Areas around buildings and yard storage areas must be kept free of dry grass and weeds and
    outside waste storage should be kept at least 20’ from buildings.

                         HAZARD COMMUNICATION PROGRAM
                                  29 CFR 1910.1200

This information is advisory and is designed solely to assist the Association members in developing their own
Hazard Communication Program, and it is not intended to replace the Association members own efforts in
developing a comprehensive Hazard Communication Program for their employees. Please refer to OSHA Hazard
Communication Standard 1910:1200 for specific requirements.


The provided information and guidelines to a Hazard Communication Program are designed for use
by a typical county with typical county chemical operations and exposures. A county may have the
following chemical hazards:
1.    Solvents, grease, lubricants, and chlorinated based materials used in repair work for vehicle
      engine maintenance.
2.    Handling of sulfuric acids, caustics, chlorine gases, and other strong irritants at water and
      wastewater treatment facilities and laboratories.
3.    Use of pesticides, herbicides, fungicides, and other fumigants by maintenance ground crews
      for insect and rodent control.
4.    Solvents, lubricants, and oils used to clean firearms by Sheriff Deputies and other personnel.
5.    Inks, dyes, toner, and other materials associated with copying machine and printing
6.    Transferring small quantities of fuels, such as kerosene, gasoline, diesel fuels for vehicle use,
      belting units, etc. at landfill operations.
7.    Diverse groups of organic solvents and chemicals such as ammonia, ethers, alcohols used
      and stored in health unit laboratories.
8.    Soaps, detergents, waxes, window cleaners, ammonia-based products, and other agents
      used in providing janitorial services to county buildings.
9.    Paints, and paint thinner solvents used throughout county operations.
10.   A wide variety of chemicals/substances used by Emergency Medical First Response units
      such as compressed gases, anesthetics, acids, caustics, etc.

A meeting should be held with all departments to determine if other non-routine jobs create
hazardous chemical/substance exposures that management has not previously identified.


A.   Scope and Application
     The Hazard Communication Standard applies to all employers and employees. Employers in
     the public and private sectors must establish a written hazard communication program for
     their employees. Suppliers of hazardous chemicals are required to transmit hazard
     information to their customers.

B.   Exemptions
     The rule does not cover potentially hazardous chemicals that are brought into the work place
     for the personal use of employees such as foods, prescription drugs, cosmetics, or tobacco
     products. The rule also does not apply to:
     1.   Tobacco and tobacco products.
     2.   Articles (finished products).
     3.   Hazardous Waste.
     4.   Alcoholic Beverages.
     5.   Food, Drugs, and Cosmetics (intended for personal use).
     6.   Consumer Products or Hazardous Substances (where use and exposure is the same as
          for a consumer).
     7.   Medicine (in final form such as pills or tablets).
     8.   Wood or wood products.

     These are generally regulated or covered under other acts.

C.   Definitions
     The Standard contains many definitions. These are listed in Section (c) of the Hazard
     Communication Standard. [29 CFR 1910.1200(c)]

D.   Specific Requirements
     1.   Hazard Determination
          Chemical manufacturers are required to evaluate chemicals produced or used in their
          work places to determine if they are hazardous. Chemical manufacturers or employers
          evaluating chemicals shall identify and consider all available scientific evidence in
          making this determination. Any written procedures used by us to determine the hazards
          of chemicals are available to you upon request.

     2.   Written Hazard Communication Program
          Employers must develop and implement a written hazard communication program for
          their work places, describing how the requirements for labels and other forms of
          warning, Material Safety Data Sheets, and employee information and training will be

3.   Labels and Other Forms of Warning
     The chemical manufacturers shall ensure that each container of hazardous material is
     labeled, tagged, or marked with the following information:
          •    Identity of the hazardous chemical/material.
          •    Appropriate hazard warning.
          •    Name and address of the chemical manufacturer, importer, or other responsible
     An employer must meet the first two requirements, if it has not already been done by
     the manufacturer. An employer may use signs, placards, process sheets, etc., instead
     of affixing labels to individual stationery process containers, as long as the method
     identifies the containers accurately. An employer is not required to label portable
     containers into which hazardous chemicals are transferred and which are intended only
     for immediate use by the individual making the transfer.

4.   Material Safety Data Sheets (MSDS's)
     Chemical manufacturers and users must obtain or develop a Material Safety Data Sheet
     (MSDS) for each hazardous chemical used. The MSDS must be provided with the first
     shipment, and the employer must maintain MSDS’s for all materials used by
     employees. The MSDS’s must be readily available for critical information and must be
     readily accessible to employees in every job area/location. Specific information on how
     to read an MSDS is contained in Section IV of this program.

5.   Employee Information and Training
     You have a right to information and training on hazardous materials you use. This basic
     information includes:
      •       Physical and health hazards of chemicals in any operation in your work area.
      •       The location and availability of the:
                 - written hazard communication program
                 - required list of hazardous chemicals
                 - MSDS
      •       Methods, observations, and monitoring data that are used to detect and measure
              the presence or release of hazardous chemicals.
      •       Measures you can take to protect yourself from chemical hazards, including
              personal protective equipment, work practices, and emergency procedures.
      •       Details of the Hazard Communication Program, including labeling, MSDS, etc.
      •       In general, you should feel confident and knowledgeable about the materials and
              processes with which you work.

Questions can be answered by contacting your Hazard Communication Coordinator.

                                             Hyde County

This program has been established to meet the OSHA requirements for Hazard Communication
Standard (29 CFR 1910.1200). The purpose of this program and standard is to ensure that
employees are made aware of the hazards of chemicals found in their work environment. This
information is to be transmitted by means of a written hazard communication program, container
labeling and other forms of warning, material safety data sheets, and employee education and
training programs. A copy of this written program will be available in the (Location)   for review
by any interested employee.

A survey will be conducted to identify all known hazardous chemicals used by employees. A list of
these chemicals and the department in which they are used, as well as copies of the material safety
data sheets for each, appear later in this report. The list of hazardous chemicals and material
safety data sheets will also be available for employee review in each department.

The Department Head will be responsible for obtaining and maintaining the data sheet system.
This individual will review incoming data sheets for new and significant health/safety information.
He/she will see that any new information is passed on to the affected employees.

(If alternatives to actual data sheets are used, provide a description of the system.)

MSDS's will be available to all employees in their work area for review during each work shift. If
MSDS's are not available or new chemicals in use do not have MSDS's, immediately contact the
Department Head or the Safety Coordinator.

Employees and Supervisors will verify that all containers received for use are:
   • Clearly labeled as to their contents;
   • Note the appropriate hazard warning; and
   • Listing the name and address of the manufacturer.

Employees and Supervisors in each department will ensure that all secondary containers are
labeled with either an extra copy of the original manufacturer's label or a generic label noting
chemical identity and appropriate hazard warnings. For help with labeling of in-plant containers,
please contact the Department Head or the Safety Coordinator.

Stationary process containers will use signs, placards, process sheets, batch tickets, operating
procedures or other written materials in place of labels as long as the chemical content is identified
and appropriate hazard noted. In these cases, copies of the original label or MSDS will be
immediately available to employees throughout the work shift, either by being posted or maintained
by the immediate Supervisor.

(If alternate labeling techniques are used, a written description of the technique should be included.)

The Department Head is responsible for the employee training program. He/she will ensure that all
elements specified below are carried out.

Each new employee of Hyde County will attend a health and safety orientation and will receive
information and training on the following:
      -    An overview of the requirements contained in the Hazard Communication Standard;
      -    Chemicals present in their workplace operations;
      -    Location and availability of our written hazard program;
      -    Physical and health effects of the hazardous chemicals;
      -    Methods and observation techniques used to determine the presence or release of
           hazardous chemicals in the work area;
      -    How to lessen or prevent exposure to the hazardous chemicals through usage of
           control/work practices, personal protective equipment, and good personal hygiene
      -    Steps the county/entity has taken to lessen or prevent exposure to these chemicals;
      -    Emergency procedures to follow if they are exposed to these chemicals or if there is a
           chemical spill;
      -    How to read labels and review MSDS's to obtain appropriate hazard information; and
      -    Location of MSDS file and location of hazardous chemical list.

After attending the training class, each employee will sign a form to verify that they attended the
training, received our written materials, and understood this county's policies on hazard
communication (sample form is attached).

Prior to a new chemical hazard being introduced into any department of this county, each employee
of that department will be given information as outlined above. The Department Head and
Supervisors are responsible for ensuring that MSDS on the new chemical(s) are available.


Periodically, employees are required to perform hazardous non-routine tasks. Prior to starting work
on such projects, each affected employee will be given information by their supervisor about
hazardous chemicals to which they may be exposed during such activity.

This information will include:
      -    Specific chemical hazards;
      -    Protective/safety measures the employee will take to prevent over-exposures; and
      -    Measures the county/entity has taken to lessen the hazards including ventilation,
           respirators, presence of another employee, and emergency procedures.

Employees will be informed of the hazards of chemicals in unlabeled pipes in their work area. In
areas where chemicals in unlabeled pipes may pose a risk, employees will be informed of
procedures should a leak or rupture occur. The Supervisor in each area should be contacted if
questions arise regarding any unlabeled pipes within their area.

It is the responsibility of the appropriate Supervisor to provide contractors (and their employees)
with the following information:
      -    Hazardous chemicals to which they may be exposed while on the job site, and
      -    Precautions the employees may take to lessen the possibility of exposure by usage of
           appropriate protective measures.

Supervisors will also ensure that the contractors have provided the county with the same
      -    Hazardous chemicals to which our employees may be exposed while the contractor is
           on the job, and
      -    Precautions our employees may take to lessen the possibility of exposure by usage of
           appropriate protective equipment.

Supervisors will also ensure that contractors have provided the necessary training to their
employees, and that employees understand the labeling systems used in the facility.

Supervisors will be responsible for contacting each contractor before work is started in the
county/entity to gather and disseminate any information concerning chemical hazards that the
contractor is bringing to our workplace.

Supervisors will be responsible for notifying each contractor regarding material safety data sheets
for the products which will be brought on site. Either copies will be made available or the MSDS will
be kept in a central location for the duration of time the contractor is on site.

                             HAZARD COMMUNICATION TRAINING

The Hazard Communications workshop included information on the following subjects:


       A.   Workplace safety and health hazards.
       B.   Hazardous chemicals/materials list.

       A.   Sheets are available on hazardous chemicals
       B.   Location of MSDS’s or whom to contact
       C.   Information on the data sheets
            1. Name of product
            2. Hazardous ingredients and primary entry into body
            3. Physical data
            4. Fire and explosion data
            5. Health hazards
            6. Reactivity
            7. Spill or leak procedure
            8. Special protection information
            9. Special precautions


       A.   Information on labels such as identity, appropriate hazard warning.
       B.   Name and address of manufacturer.
       C.   Other warnings may also be used such as symbols or number rating systems.
       D.   Labels not required on portable containers only for transfer or immediate use.
       E.   Labels shall not be removed or defaced on incoming containers.
       F.   Labels must be readable at all times.

I have received basic information on the above subjects.

       Employee ___________________________________________              Date ____________

I verify that the employee has been instructed on the above subjects.

       Instructor ____________________________________________             Date ___________

                                        MSDS GLOSSARY
The following glossary presents brief explanations of acronyms and common terms frequently used by chemical
manufacturers in their MSDS's.

ACGIH American Conference of Governmental Industrial Hygienists is an organization of
professional personnel in governmental agencies or educational institutions engaged in
occupational safety and health programs. ACGIH establishes recommended occupational
exposure limits for chemical substances and physical agents. See TLV.
Acid Any chemical that undergoes dissociation in water with the formation of hydrogen ions. Acids
have a sour taste and may cause severe skin burns. Acids turn litmus paper red and have pH
values of 0 to 6.
Acute Effect Adverse effect on a human or animal that has severe symptoms developing rapidly
and coming quickly to a crisis.
Acute Toxicity Acute effects resulting from a single dose of, or exposure to, a substance.
Ordinarily used to denote effects in experimental animals.
Adenocarcinoma A tumor with glandular (secreting) elements.
Adenosis Any disease of a gland.
Adhesion A union of two surfaces that are normally separate.
Aerosol A fine aerial suspension of particles sufficiently small in size to confer some degree of
stability from sedimentation (e.g., smoke or fog).
Air-line Respirator A respirator that is connected to a compressed breathable air source by a
hose of small inside diameter. The air is delivered continuously or intermittently in a sufficient
volume to meet the wearer's breathing requirements.
Air-purifying Respirator A respirator that uses chemicals to remove specific gases and vapors
from the air or that uses a mechanical filter to remove particulate matter. An air-purifying respirator
must only be used when there is sufficient oxygen to sustain life and the air contaminant level is
below the concentration limits of the device.
Alkali Any chemical substance that forms soluble soaps with fatty acids. Alkalis are also referred
to as bases. They may cause severe burns to the skin. Alkalis turn litmus paper blue and have pH
values from 8 to 14.
Allergic Reaction An abnormal physiological response to chemical or physical stimuli.
Amenorrhea Absence of menstruation.
Anesthetic A chemical that causes a total or partial loss of sensation. Overexposure to
anesthetics can cause impaired judgment, dizziness, drowsiness, headache, unconsciousness, and
even death. Examples include alcohol, paint remover, and degreasers.
ANSI American National Standards Institute is a privately funded, voluntary membership
organization that identifies industrial and public needs for national consensus standards and
coordinates development of such standards.
Antidote A remedy to relieve, prevent, or counteract the effects of a poison.
API American Petroleum Institute is a organization of the petroleum industry.
Appearance A description of a substance at normal room temperature and normal atmospheric
conditions. Appearance includes the color, size, and consistency of a material.
Aquatic Toxicity The adverse effects to marine life that result from being exposed to a toxic

Asphyxiant A vapor or gas that can cause unconsciousness or death by suffocation (lack of
oxygen). Most simple asphyxiants are harmful to the body only when they become so concentrated
that they reduce oxygen in the air (normally about 21 percent) to dangerous levels (18 percent or
lower). Asphyxiation is one of the principal potential hazards of working in confined and enclosed
ASTM American Society for Testing and Materials is the world's largest source of voluntary
consensus standards for materials, products, systems, and services. ASTM is a resource for
sampling and testing methods, health and safety aspects of materials, safe performance guidelines,
effects of physical and biological agents and chemicals.
Asymptomatic Showing no symptoms.
Atm Atmosphere, a unit of pressure equal to 760 mm Hg (mercury) at sea level.
Atmosphere-supplying Respirator A respirator that provides breathable air from a source
independent of the surrounding atmosphere. There are two types: air-line and self-contained
breathing apparatus.
Auto-ignition Temperature The temperature to which a closed, or nearly closed container must
be heated in order that the flammable liquid, when introduced into the container, will ignite
spontaneously or burn.
BAL British Anti-Lewisite - A name for the drug dimercaprol - a treatment for toxic inhalations.
Base A substance that (1) liberates hydroxide (OH) ions when dissolved in water, (2) receives
hydrogen ions from a strong acid to form a weaker acid, and (3) neutralizes an acid. Bases react
with acids to form salts and water. Bases have a pH greater than 7 and turn litmus paper blue.
See Alkali.
BCM Blood-clotting mechanism effects.
Benign Not recurrent or not tending to progress. Not cancerous.
Biodegradable Capable of being broken down into innocuous products by the action of living
Biopsy Removal and examination of tissue from the living body.
BLD Blood effects.
Boiling Point - BP The temperature at which a liquid changes to a vapor state at a given pressure.
The boiling point usually expressed in degrees Fahrenheit at sea level pressure (760 mm Hg, or
one atmosphere). For mixtures, the initial boiling point or the boiling range may be given.
Flammable materials with low boiling points generally present special fire hazards. Some
approximate boiling points:
       Propane                       -44 F
       Anhydrous Ammonia             -28 F
       Butane                         31 F
       Gasoline                      100 F
       Allyl Chloride                113 F
       Ethylene Glycol               387 F
BOM, or BuMines Bureau of Mines, U.S. Department of Interior.
Bonding The interconnecting of two objects by means of a clamp and bare wire. Its purpose is to
equalize the electrical potential between the objects to prevent a static discharge when transferring
a flammable liquid from one container to another. The conductive path is provided by clamps that
make contact with the charged object and a low resistance flexible cable which allows the charge to
equalize. See Grounding.

Bulk Density Mass of powdered or granulated solid material per unit of volume.
C Centigrade, a unit of temperature.
Ceiling Limit (PEL or TLV) The maximum allowable human exposure limit for an airborne
substance which is not to be exceeded even momentarily. Also see PEL and TLV.
ca Approximately.
CAA Clean Air Act was enacted to regulate/reduce air pollution. CAA is administered by U.S.
Environmental Protection Agency.
Carcinogen A substance or agent capable of causing or producing cancer in mammals, including
humans. A chemical is considered to be a carcinogen if
       (a) It has been evaluated by the International Agency for Research On Cancer (IARC) and
       found to be a carcinogen or potential carcinogen; or
       (b) It is listed as a carcinogen or potential carcinogen in the Annual Report on Carcinogens
       published by the National Toxicology Program (NTP) (latest edition); or
       (c) It is regulated by OSHA as a carcinogen.
Carcinogenicity The ability to produce cancer.
Carcinoma A malignant tumor. A form of cancer.
CAS Chemical Abstracts Service is an organization under the American Chemical Society. CAS
abstracts and indexes chemical literature from all over the world in "Chemical Abstracts." "CAS
Numbers" are used to identify specific chemicals or mixtures.
Caustic See Alkali.
cc Cubic centimeter is a volume measurement in the metric system that is equal in capacity to one
milliliter (ml). One quart is about 946 cubic centimeters.
Central Nervous System The brain and spinal cord. These organs supervise and coordinate the
activity of the entire nervous system. Sensory impulses are transmitted into the central nervous
system, and motor impulses are transmitted out.
CERCLA Comprehensive Environmental Response, Compensation, and Liability Act of 1980./
The Act requires that the Coast Guard National Response Center be notified in the event of a
hazardous substance release. The Act also provides for a fund (the Superfund) to be used for the
cleanup of abandoned hazardous waste disposal sites.
CFR Code of Federal Regulations. A collection of the regulations that have been promulgated
under United States Law.
Chemical An element (e.g., chlorine) or a compound (e.g., sodium bicarbonate) produced by
chemical reaction.
Chemical Cartridge Respirator A respirator that uses various chemical substances to purify
inhaled air of certain gases and vapors. This type respirator is effective for concentrations no more
than ten times the TLV of the contaminant, if the contaminant has warning properties (odor or
irritation) below the TLV.
Chemical Family A group of single elements or compounds with a common general name.
Example: acetone, methyl ethyl ketone (MEK), and methyl isobutyl ketone (MIBK) are of the
"Ketone" family; acrolein, furfural, and acetaldehyde are of the "aldehyde" family.
Chemical Name The name given to a chemical in the nomenclature system developed by the
International Union of Pure and Applied Chemistry (IUPAC) or the Chemical Abstract Service
(CAS). The scientific designation of a chemical or a name that will clearly identify the chemical for
hazard evaluation purposes.

Chemical Pneumonitis Inflammation of the lungs caused by accumulation of fluids due to
chemical irritation.
CHEMTREC Chemical Transportation Emergency Center is a national center established by the
Chemical Manufacturers Association (CMA) to relay pertinent emergency information concerning
specific chemicals on requests from individuals. CHEMTREC has a 24 hour toll-free telephone
number (800-424-9300) to help respond to chemical transportation emergencies.
Chronic Effect An adverse effect on a human or animal body, with symptoms that develop slowly
over a long period of time or that recur frequently. Also see Acute.
Chronic Exposure Long-term contact with a substance.
Chronic Toxicity Adverse (chronic) effects resulting from repeated doses of or exposures to a
substance over a relatively prolonged period of time. Ordinarily used to denote effects in
experimental animals.
Clean Air Act See CAA.
Clean Water Act Federal law enacted to regulate/reduce water pollution. CWA is administered by
CMA Chemical Manufacturers Association. See CHEMTREC.
CO Carbon monoxide is a colorless, odorless, flammable, and very toxic gas produced by the
incomplete combustion of carbon. It is also a byproduct of many chemical processes. A chemical
asphyxiant; it reduces the blood's ability to carry oxygen. Hemoglobin absorbs CO two hundred
times more readily than it does oxygen.
CO2 Carbon dioxide is a heavy, colorless gas that is produced by the combustion and
decomposition of organic substances and as a byproduct of many chemical process. CO2 will not
burn and is relatively nontoxic (although high concentrations, especially in confined spaces, can
create hazardous oxygen-deficient environments).
COC Cleveland Open cup is a flash point test method.
Combustible A term used by NFPA, DOT, and others to classify certain liquids that will burn, on
the basis of flash points. Both NFPA and DOT generally define "combustible liquids" as having a
flash point of 100F (37.8C) or higher but below 200F (93.3C ). Also see "flammable." Non-liquid
substances such as wood and paper are classified as "ordinary combustibles" by NFPA.
Combustible Liquid Any liquid having a flashpoint at or above 100F (37.8C), but below 200F
(03.3C), except any mixture having components with flashpoints of 200F (93.3C) or higher, the total
volume of which makes up ninety-nine (99) percent or more of the total volume of the mixture.
Common Name Any means used to identify a chemical other than its chemical name (e.g., code
name, code number, trade name, brand name, or generic name). See Generic.
Compressed Gas:
(a)    A gas or mixture of gases having, in a container, an absolute pressure exceeding 40 pounds
       per square-inch (psi) at 70F (21.1C); or
(b)    A gas or mixture of gases having, in a container, an absolute pressure exceeding 104 psi at
       130F (54.4C) regardless of the pressure at 70F (21.1C); or
(c)    A liquid having a vapor pressure exceeding 40 psi at 100F (37.8C) as determined by ASTM
Conc See Concentration.
Concentration The relative amount of a substance when combined or mixed with other
substances. Examples: 2 ppm hydrogen sulfide in air, or a 50 percent caustic solution.

Conditions to Avoid Conditions encountered during handling or storage that could cause a
substance to become unstable.
Confined Space Any area that has limited openings for entry and exit that would make escape
difficult in an emergency, has a lack of ventilation, contains known and potential hazards, and is not
intended nor designed for continuous human occupancy.
Conjunctivitis Inflammation of the conjunctiva, the delicate membrane that lines the eyelids and
covers the eyeballs.
Container Any bag, barrel, bottle, box , can, cylinder, drum, reaction vessel, storage tank, or the
like that contains a hazardous chemical. For purposes of MSDS or HCS, pipes or piping systems
are not considered to be containers.
Corrosive A chemical that causes visible destruction of, or irreversible alterations in, living tissue
by chemical action at the site of contact. For example, a chemical is considered to be corrosive if,
when tested on the intact skin of albino rabbits by the method described by the DOT in appendix A
to 49 CFR Part 173, it destroys or changes irreversibly the structure of the tissue at the site of
contact following an exposure period of 4 hours. This term shall not refer to action on inanimate
CPSC Consumer Products Safety Commission has responsibility for regulating hazardous
materials when they appear in consumer goods. For CPSC purposes, hazards are defined in the
Hazardous Substances Act and the Poison Prevention Packaging Act of 1970.
Curettage Cleansing of a diseased surface.
Cutaneous Toxicity See Dermal Toxicity.
CWA Clean Water Act -- enacted to regulate/reduce water pollution; administered by EPA.
Cyst A sac containing a liquid. Most cysts are harmless.
Cytology The scientific study of cells.
Decomposition Breakdown of a material or substance (by heat, chemical reaction, electrolysis,
decay, or other processes) into parts or elements or simpler compounds.
Density The mass (weight) per unit volume of a substance. For example, lead is much more
dense than aluminum.
Depressant A substance that reduces a bodily functional activity or an instinctive desire, such as
Dermal Relating to the skin.
Dermal Toxicity Adverse effects resulting from skin exposure to a substance. Ordinarily used to
denote effects in experimental animals.
DHHS U.S. Department of Health and Human Services (replaced U.S. Department of Health,
Education and Welfare). NIOSH and the Public Health Service (PHS) are part of DHHS.
Dike A barrier constructed to control or confine hazardous substances and prevent them from
entering sewers, ditches, streams, or other flowing waters.
Dilution Ventilation Air flow designed to dilute contaminants to acceptable levels. Also see
general ventilation or exhaust.
DOL U.S. Department of Labor. OSHA and MSHA are part of DOl.
DOT U.S. Department of Transportation regulates transportation of chemicals and other
Dry Chemical A powdered fire-extinguishing agent usually composed of sodium bicarbonate,
potassium bicarbonate, etc.
Dysmenorrhea Painful menstruation.
Dysplasia An abnormality of development.
Dyspnea A sense of difficulty in breathing, shortness of breath.
Ectopic pregnancy The fertilized ovum becomes implanted outside of the uterus.
Edema An abnormal accumulation of clear watery fluid in the tissues.
Endocrine glands Glands that regulate body activity by secreting hormones.
Endometrium the mucous membrane lining the uterus.
Environmental Toxicity Information obtained as a result of conducting environmental testing
designed to study the effects on aquatic and plant life.
EPA U.S. Environmental Protection Agency
Epidemiology Science concerned with the study of disease in a general population.
Determination of the incidence (rate of occurrence) and distribution of a particular disease (as by
age, sex, or occupation) which may provide information about the cause of the disease.
Epithelium The covering of internal and external surfaces of the body.
Estrogen Principal female sex hormone.
Evaporation Rate The rate at which a material will vaporize (evaporate) when compared to the
known rate of vaporization of a standard material. The evaporation rate can be useful in evaluating
the health and fire hazards of a material. The designated standard materials is usually normal butyl
acetate (NBUAC or n-BuAc), with a vaporization rate designated as 1.0. Vaporization rates of other
solvents or materials are then classified as:
       -FAST evaporating if greater than 3.0. Examples: Methyl Ethyl Ketone = 3.8, Acetone = 5.6,
       Hexane = 8.3
       -MEDIUM evaporating if 0.8 to 3.0 Examples: 190 proof (95%) Ethyl Alcohol = 1.4, VM&P
       Naphtha = 1.4, MIBK = 1.6
       -SLOW evaporating if less than 0.8. Examples: Xylene = 0.6, Isobutyl Alcohol = 0.6, Normal
       Butyl Alcohol = 0.4, Water = 0.3, Mineral Spirits = 0.1.
Explosive A chemical that causes a sudden, almost instantaneous release of pressure, gas, and
heat when subjected to sudden shock, pressure, or high temperature.
Exposure of Exposed State of being open and vulnerable to a hazardous chemical by inhalation,
ingestion, skin contact, absorption, or any other course; includes potential (accidental or possible)
Extinguishing Media The firefighting substance to be used to control a material in the event of a
fire. It is usually identified by its generic name, such as fog, foam, water, etc.
Eye Protection Recommended safety glasses, chemical splash goggles,
F Fahrenheit is a scale for measuring temperature. On the Fahrenheit scale, water boils at 212F
and freezes at 32F.
f/cc Fibers per cubic centimeter of air.
FDA U.S. Food and Drug Administration.
Fetal Pertaining to the fetus.
Fibrosis An abnormal thickening of fibrous connective tissue, usually in the lungs.

FIFRA Federal Insecticide, Fungicide, and Rodenticide Act requires that certain useful poisons,
such as chemical pesticides, sold to the public contain labels that carry health hazard warnings to
protect users. It is administered by EPA.
First Aid Emergency measures to be taken when a person is suffering from overexposure to a
hazardous material, before regular medical help can be obtained.
Flammable A chemical that includes one of the following categories:
   a. "Aerosol, flammable." An aerosol that, when tested by the method described in 16 CFR
      1500.45, yields a flame projection exceeding 18 inches at full valve opening, or a flashback
      (a flame extending back to the valve) at any degree of valve opening;
   b. "Gas, flammable." (1) A gas that, at ambient temperature and pressure, forms a flammable
      mixture with air at a concentration of 13 percent by volume or less; or (2) A gas that, at
      ambient temperature and pressure, forms a range of flammable mixtures with air wider than
      12 percent by volume, regardless of the lower limit;
   c. "Liquid, flammable." Any liquid having a flashpoint below 100F (37.8C), except any mixture
      having components with flashpoints of 100F (37.8C) or higher, the total of which make up 99
      percent or more of the total volume of mixture.
   d. "Solid, flammable." A solid, other than a blasting agent or explosive as defined in
      1910.109(a), that is liable to cause fire through friction, absorption of moisture, spontaneous
      chemical change, or retained heat from manufacturing or processing, or which can be
      ignited readily and when ignited burns so vigorously and persistently as to create a serious
      hazard. A solid is a flammable solid if, when tested by the method described in 16 CFR
      1500.44, it ignites and burns with a self-sustained flame at a rate greater than one-tenth of
      an inch per second along its major axis.
Flashback Occurs when flame from a torch burns back into the tip, the torch, or the hose. It is
often accompanied by a hissing or squealing sound with a smoky or sharp-pointed flame.
Flashpoint The minimum temperature at which a liquid gives off a vapor in sufficient concentration
to ignite when tested by the following methods:
   a. Tagliabue Closed Tester (see American Nation Standard Method of Test for Flash Point by
      Tag Closed Tester, Z11,24 1979 [ASTM D5-79]).
   b. Pensky-Martens Closed Tester (see American National Standard Method of Test for Flash
      Point by Pensky-Martens Closed Tester, Z11.7-1979 [ASTM D33-79]).
   c. Setaflash Closed Tester (see American National Standard Method of Test for Flash Point by
      Setaflash Closed Tester [ASTM D3278-78]).
Foreseeable Emergency Any potential occurrence such as, but not limited to, equipment failure,
rupture of containers, or failure of control equipment which could result in an uncontrolled release of
a hazardous chemical into the workplace.
Formula The scientific expression of the chemical composition of a material (e.g., water is H2O,
sulfuric acid is H2SO4, sulfur dioxide is SO2).
Fume A solid condensation particle of extremely small diameter, commonly generated from molten
metal as metal fume.
g Gram is a metric unit of weight. One ounce U.S. (avoirdupois) is about 28.4 grams.
General Exhaust A system for exhausting air containing contaminants from a general work area.
Also see Local Exhaust.
Generic Name A designation or identification used to identify a chemical by other than its chemical
name (e.g., code name, code number, trade name, and brand name.)

Genetic Pertaining to or carried by genes.
Gestation The development of the fetus in the uterus from conception to birth; pregnancy.
g/kg Grams per kilogram is an expression of dose used in oral and dermal toxicology testing to
denote grams of a substance dosed per kilogram of animal body weight. Also see "kg" (kilogram).
Grounding The procedure used to carry an electrical charge to ground through a conductive path.
A typical ground may be connected directly to a conductive water pipe or to a grounding bus and
ground rod. See Bonding.
Gynecology The study of the reproductive organs of women.
Hand Protection Specific type of gloves or other hand protection required to prevent harmful
exposure to hazardous materials.
Hazardous Chemical Any chemical whose presence or use is a physical hazard or a health
Hazardous Warning Words, pictures, symbols, or combination thereof presented on a label or
other appropriate form to inform of the presence of various materials.
HCS Hazard Communication Standard is an OSHA regulation issued under 29 CFR Part
Health Hazard A chemical for which there is significant evidence, based on at least one study
conducted in accordance with established scientific principles, that acute or chronic health effects
may occur in exposed employees. The term "health hazard" includes chemicals that are
carcinogens, toxic, or highly toxic agents, reproductive toxins, irritants, corrosives, sensitizers,
hepatotoxins, nephrotoxins, neurotoxins, agents that act on the hematopoietic system, and agents
that damage the lungs, skin, eyes, or mucous membranes.
Hemoglobin An iron-containing conjugated protein or respiratory pigment occurring in the red
blood cells of vertebrates.
Hematoma A blood clot under the surface of the skin.
Hematopoietic System The blood-forming mechanism of the human body.
Hematuria The presence of blood in the urine.
Hepatotoxin A substance that causes injury to the liver.
Highly toxic A chemical in any of the following categories:
   a. A chemical with a median lethal dose (LD50) of 50 milligrams or less per kilogram of body
      weight when administered orally to albino rats weighing between 200 and 300 grams each.
   b. A chemical with a median lethal dose (LD50) of 200 milligrams or less per kilogram of body
      weight when administered by continuous contact for 24 hours ( or less if death occurs within
      24 hours) with the bare skin of albino rabbits weighing between 2 and 3 kilograms each.
   c. A chemical that has a median lethal concentration (LC50) in air of 200 parts per million by
      volume or less of gas or vapor, or 2 milligrams per liter or less of mist, fume, or dust, when
      administered by continuous inhalation for 1 hour (or less if death occurs within 1 hour) to
      albino rats weighing between 200 and 300 grams each.
Hormones Act as chemical messengers to body organs.
Hyperplasia Increase in volume of a tissue or organ caused by the growth of new cells.
IARC International Agency for Research on Cancer.
Ignitable Capable of being set afire.

Impervious A material that does not allow another substance to pass through or penetrate it.
Incompatible Materials that could cause dangerous reactions by direct contact with one another.
Ingestion Taking in by the mouth.
Inhal See inhalation.
Inhalation Breathing in of a substance in the form of a gas, vapor, fume, mist, or dust.
Inhibitor A chemical added to another substance to prevent an unwanted chemical change.
Insol See insoluble.
Insoluble Incapable of being dissolved in a liquid.
Intrauterine Within the uterus.
Irritant A chemical, which is not corrosive, that causes a reversible inflammatory effect on living
tissue by chemical action at the site of contact. A chemical is a skin irritant if, when tested on the
intact skin of albino rabbits by the methods of 16 CFR 1550.41 for 4 hours exposure or by other
appropriate techniques, it results in an empirical score of 5 or more. A chemical is an eye irritant if
so determined under the procedure listed in 16 CFR 1500.42 or other appropriate techniques.
Irritating As defined by DOT, a property of a liquid or solid substance which, upon contact with fire
or when exposed to air, gives off dangerous or intensely irritating fumes ( not including poisonous
materials). See Poison, Class A and Poison, Class B.
kg Kilogram is a metric unit of weight, about 2.2 U.S. pounds. Also see "g/kg," "g," and "mg."
L Liter is a metric unit of capacity. A U.S. quart is about 9/10 if a liter.
Lacrimation Secretion and discharge of tears.
Label Notice attached to a container, bearing information concerning its contents.
Lactation The secretion of milk by the breasts.
LC Lethal concentration is the concentration of a substance being tested that will kill.
LCL Lethal concentration, low, lowest concentration of a gas of vapor capable of killing a specified
species over a specified time.
LC50 The concentration of a material in air that will kill 50 percent of a group of test animals with a
single exposure (usually 1 to 4 hours). The LC50 is expressed as parts of material per million parts
of air, by volume (ppm) for gases and vapors, or as micrograms of material per liter of air (g/l) or
milligrams of material per cubic meter of air (mg/m3) for dusts and mists, as well as for gases and
LD Lethal dose is the quantity of a substance being tested that will kill.
LDL Lethal dose low, lowest administered dose of a material capable of killing a specified test
LD50 A single dose of a material expected to kill 50 percent of a group of test animals. The LD50
dose is usually expressed as milligrams or grams of material per kilogram of animal body weight
(mg/kg or g/kg). The material may be administered by mouth or applied to the skin.
LEL, or LFL Lower explosive limit, or lower flammable limit, of a vapor or gas; the lowest
concentration (lowest percentage of the substance in air) that will produce a flash of fire when an
ignition source (heat, arc, or flame) is present. At concentrations lower than the LEL, the mixture is
too "lean" to burn. Also see "UEL."
Lesion Any damage to a tissue.

Lfm Linear feet per minute, a unit of air velocity.
Local Exhaust A system for capturing and exhausting contaminants from the air at the point where
the contaminants are produced (welding, grinding, sanding, other processes or operations). Also
see General Exhaust.
M Meter is a unit of length in the metric system. One meter is about 39 inches.
m3 Cubic meter is a metric measure of volume, approximately 35.3 cubic feet or 1.3 cubic yards.
Malaise A feeling of general discomfort, distress, or uneasiness, an out-of-sorts feeling.
Malignant Tending to become progressively worse and to result in death.
Mammary Pertaining to the breast.
Mechanical Exhaust A powered device, such as a motor-driven fan or air steam venturi tube, for
exhausting contaminants from a workplace, vessel, or enclosure.
Mechanical Filter Respirator A respirator used to protect against airborne particulate matter like
dusts, mists, metal fume, and smoke. Mechanical filter respirators do not provide protection against
gases, vapors, or oxygen deficient atmospheres.
Melting Point The temperature at which a solid substance changes to a liquid state.
Menorrhagia Excessive menstruation.
Menstruation Periodic discharge of blood from the vagina of a nonpregnant uterus.
Metabolism Physical and chemical processes taking place among the ions, atoms, and molecules
of the body.
Metastasis The transfer of disease from one organ or part to another not directly connected with it.
Meter A unit of length; equivalent to 39.37 inches.
mg Milligram is a metric unit of weight that is one-thousandth of a gram.
mg/kg Milligrams of a substance per kilogram of body weight is an expression of toxicological
mg/m3 Milligrams per cubic meter is a unit for expressing concentrations of dusts, gases, or mists
in air.
Micron (Micrometer) A unit of length equal to one-millionth of a meter; approximately 0.000039 of
an inch.
Mist Suspended liquid droplets generated by condensation from the gaseous to the liquid state, or
by breaking up a liquid into a dispersed state, such as splashing, foaming, or atomizing. Mist is
formed when a finely divided liquid is suspended in air.
Mixture Any combination of two or more chemicals if the combination is not, in whole or part, the
result of a chemical reaction.
Mld Mild
ml Milliliter is a metric unit of capacity, equal in volume to 1 cubic centimeter (cc), or approximately
one-sixteenth of a cubic inch. One-thousandth of a liter.
mmHg Millimeters (mm) of mercury (Hg) is a unit of measurement for low pressures or partial
Molecular Weight Weight (mass) of a molecule based on the sum of the atomic weights of the
atoms that make up the molecule.

mppcf Million particles per cubic foot is a unit for expressing concentration of particles of a
substance suspended in air. Exposure limits for mineral dusts (silica, graphite, Portland cement,
nuisance dusts, and others), formerly expressed as mppcf, are now more commonly expressed in
MSDS Material Safety Data Sheet.
MSHA Mine Safety and Health Administration, U.S. Department of Labor.
Mutagen A substance or agent capable of altering the genetic material in a living cell.
MW See molecular weight.
N2 Nitrogen is a colorless, odorless, and tasteless gas that will not burn and will not support
combustion. The earth's atmosphere (air) is about 78 percent nitrogen. At higher concentrations,
nitrogen can displace oxygen and become a lethal asphyxiant. See Asphyxiant.
Narcosis A state of stupor, unconsciousness, or arrested activity produced by the influence of
narcotics or other chemicals.
Nausea Tendency to vomit, feeling of sickness at the stomach.
NCI National Cancer Institute is that part of the National Institutes of Health that studies cancer
causes and prevention as well as diagnosis, treatment, and rehabilitation of cancer patients.
NFPA National Fire Protection Association is an international membership organization which
promotes/improves fire protection and prevention and establishes safeguards against loss of life
and property by fire. Best known on the industrial scene for the National Fire Codes - 16 volumes
of codes, standards, recommended practices and manuals developed (and periodically updated) by
NFPA technical committees. Among these is NFPA 704M, the code for showing hazards of
materials as they might be encountered under fire or related emergency conditions, using the
familiar diamond-shape label or placard with appropriate numbers or symbols.
Neo See neoplasia.
Neonatal The first 4 weeks after birth.
Neoplasia A condition characterized by the presence of new growths (tumors).
Nephrotoxin A substance that causes injury to the kidneys.
Neurotoxin A material that affects the nerve cells and may produce emotional or behavioral
Neutralize To eliminate potential hazards by inactivating strong acids, caustics, and oxidizers. For
example, acids can be neutralized by adding an appropriate amount of caustic substance to the
ng nanogram, one-billionth of a gram.
NIOSH National Institute for Occupational Safety and Health, U.S. Department of Health and
Human Services (DHHS), among other activities, tests and certifies respiratory protective devices
and air sampling detector tubes, recommends occupational exposure limits for various substances,
and assists OSHA and MSHA in occupational safety and health investigations and research.
Nonflammable Not easily ignited, or if ignited, not burning rapidly.
Non-Sparking Tools Tools made from beryllium-copper or aluminum-bronze greatly reduce the
possibility of igniting dusts, gases, or flammable vapors. Although these tools may emit some
sparks when striking metal, the sparks have a low heat content and are not likely to ignite most
flammable liquids.

NOx Oxides of nitrogen which are undesirable air pollutants. NO emissions are regulated by EPA
under the Clean Air Act.
NPIRS National Pesticide Information Retrieval System is an automated data base operated by
Purdue University containing information on EPA registered pesticides, including reference file
NRC National Response Center is a notification center that must be called when significant oil or
chemical spills or other environment-related accidents occur. The toll-free telephone number is 1-
NTP National Toxicology Program. The NTP publishes an Annual Report on Carcinogens.
Odor A description of the smell of the substance.
Odor Threshold The lowest concentration of a substance's vapor, in air, that can be smelled.
Olfactory Relating to the sense of smell.
Oral Used in or taken into the body through the mouth.
Oral Toxicity Adverse effects resulting from taking a substance into the body by mouth. Ordinarily
used to denote effects in experimental animals.
Organic Peroxide An organic compound that contains the bivalent -O-O structure and may be
considered a structural derivative of hydrogen peroxide where one or both of the hydrogen atoms
has been replaced by an organic radical.
Organogenesis The formation of organs during development.
OSHA Occupational Safety and Health Administration, U.S. Department of Labor.
Ovary The female sex gland in which ova are formed.
Overexposure Exposure to a hazardous material beyond the allowable exposure limits.
Oxidation In a literal sense, oxidation is a reaction in which a substance combines with oxygen
provided by an oxidizer or oxidizing agent. See Oxidizing Agent.
Oxidizer A chemical other than a blasting agent or explosive that initiates or promotes combustion
in other materials, causing fire either by itself or through the release of oxygen or other gases.
Oxidizing Agent A chemical or substance that brings about an oxidation reaction. The agent may
(1) provide the oxygen to the substance being oxidized (in which case the agent has to be oxygen
or contain oxygen), or (2) it may receive electrons being transferred from the substance undergoing
oxidation (chlorine is a good oxidizing agent for electron-transfer purposes, even though it contains
no oxygen).
Pathologic Pertaining to or caused by disease.
Pathology Scientific study of alterations produced by disease.
PEL Permissible Exposure Limit is an occupational exposure limit established by OSHA's
regulatory authority. It may be a time-weighted average (TWA) limit or a maximum concentration
exposure limit.
Percent Volatile Percent volatile by volume is the percentage of a liquid or solid (by volume) that
will evaporate at an ambient temperature of 70F (unless some other temperature is specified).
Examples: butane, gasoline, and paint thinner (mineral spirits) are 100 percent volatile; their
individual evaporation rates vary, but in time, each will evaporate completely.
pH The symbol relating the hydrogen ion (H+) concentration to that of a given standard solution. A
Ph of 7 is neutral. Numbers increasing from 7 to 14 indicate greater alkalinity. Numbers
decreasing from 7 to 0 indicate greater acidity.

Physical Hazard Means a chemical for which there is scientifically valid evidence that it is a
combustible liquid, a compressed gas, explosive, flammable, an organic peroxide, and oxidizer,
pyrophoric, unstable (reactive) or water-reactive.
Placenta A structure that grows on the wall of the uterus during pregnancy, through which the
fetus is nourished.
PMCC Pensky-Martens Closed Cup. See Flashpoint.
Pneumoconiosis A condition of the lung in which there is permanent deposition of particulate
matter and the tissue reaction to its presence. It may range from relatively harmless forms of iron
oxide deposition to destructive forms of silicosis.
Poison, Class A A DOT term for extremely dangerous poisons-poisonous gases or liquids that, in
very small amounts, either as gas or as vapor of the liquid, mixed with air, are dangerous to life.
Examples: phosgene, cyanogen, hydrocyanic acid, nitrogen peroxide.
Poison, Class B A DOT term for liquid, solid, paste or semisolid substances-other than Class A
poisons or irritating materials-that are known (or presumed on the basis of animal tests) to be so
toxic to humans that they are a hazard to health during transportation.
Polymerization A chemical reaction in which one or more small molecules combine to form larger
molecules. A hazardous polymerization is such a reaction that takes place at a rate that releases
large amounts of energy. If hazardous polymerization can occur with a given material, the MSDS
usually will list conditions that could start the reaction and - since the material usually contains a
polymerization inhibitor-the length of time during which the inhibitor will be effective.
ppb Parts per billion is the concentration of a gas or vapor in air--parts (by volume) of the gas or
vapor in a billion parts of air. Usually used to express extremely low concentrations of unusually
toxic gases or vapors; also the concentration of a particular substance in a liquid or solid.
ppm Parts per million is the concentration of a gas or vapor in air--parts (by volume) of the gas or
vapor in a million parts of air; also the concentration of a particulate in a liquid or solid.
Prenatal Preceding birth.
psi Pounds per square inch (for MSDS purposes) is the pressure a material exerts on the walls of
a confining vessel or enclosure. For technical accuracy, pressure must be expressed as psig
(pounds per square inch gauge) or psia (pounds per square inch absolute; that is, gauge pressure
plus sea level atmospheric pressure, or psig plus approximately 14.7 pounds per square inch).
Also see mmHg.
Pul See pulmonary.
Pulmonary Relating to, or associated with, the lungs.
Pulmonary Edema Fluid in the lungs.
Pyrophoric A chemical that will ignite spontaneously in air at a temperature of 13F (54.4C) or
Reaction A chemical transformation or change. The interaction of two or more substances to form
new substances.
Reactive See Unstable.
Reactivity Chemical reaction with the release of energy. Undesirable effects-such as pressure
buildup, temperature increase, formation of noxious, toxic or corrosive byproducts- may occur
because of the reactivity of a substance to heating, burning, direct contact with other materials, or
other conditions in use or in storage.

Reducing Agent In a reduction reaction (which always occurs simultaneously with an oxidation
reaction) the reducing agent is the chemical or substance which (1) combines with oxygen or (2)
loses electrons to the reaction. See Oxidation.
REL The NIOSH REL (Recommended Exposure Limit) is the highest allowable airborne
concentration which is not expected to injure the workers. It may be expressed as a ceiling limit or
as a time-weighted average (TWA).
Reproductive Toxin Substances that affect either male or female reproductive systems and may
impair the ability to have children.
Respiratory Protection Devices that will protect the wearer's respiratory system from
overexposure by inhalation to airborne contaminants. Respiratory protection is used when a worker
must work in an area where he/she might be exposed to concentration in excess of the allowable
exposure limit.
Respiratory System The breathing system that includes the lungs and the air passages (trachea
or "windpipe," larynx, mouth, and nose) to the air outside the body, plus the associated nervous and
circulatory supply.
Routes of Entry The means by which material may gain access to the body, for example,
inhalation, ingestion, and skin contact.
RCRA Resource Conservation and Recovery Act is environmental legislation aimed at controlling
the generation, treating, storage, transportation and disposal of hazardous wastes. It is
administered by EPA.
Sarcoma A tumor that is often malignant.
Self-Contained Breathing Apparatus A respiratory protection device that consists of a supply or
a means of respirable air, oxygen, or oxygen-generating material, carried by the wearer.
Sensitizer A chemical that causes a substantial proportion of exposed people or animals to
develop an allergic reaction in normal tissue after repeated exposure to the chemical.
SETA Setaflash Closed Tester. See Flashpoint.
Silicosis A disease of the lungs (fibrosis) caused by the inhalation of silica dust.
Skn Skin.
"Skin" A notation (sometimes used with PEL or TLV exposure data) that indicates that the stated
substance may be absorbed by the skin, mucous membranes, and eyes-either airborne or by direct
contact-and that this additional exposure must be considered part of the total exposure to avoid
exceeding the PEL or TLV for that substance.
Skin Absorption Ability of some hazardous chemicals to pass directly through the skin and enter
the bloodstream.
Skin Sensitizer See Sensitizer.
Skin Toxicity See Dermal Toxicity.
Solubility in Water A term expressing the percentage of a material (by weight) that will dissolve in
water at ambient temperature. Solubility information can be useful in determining spill cleanup
methods and reextinguishing agents and methods for a material.
Solvent A substance, usually a liquid, in which other substances are dissolved. The most common
solvent is water.
SOx Oxides of sulfur.
Species On the MSDS's, species refers to the test animals- usually rats, mice, or rabbits- used to
obtain the toxicity test data reported.

Specific Chemical Identity The chemical name, Chemical Abstract Service (CAS) Registry
Number, or any precise chemical designation of a substance.
Specific Gravity The weight of a material compared to the weight of an equal volume of water is
an expression of the density (or heaviness) of a material. Insoluble materials with specific gravity of
less than 1.0 will float in (or on) water. Insoluble materials with specific gravity greater than 1.0 will
sink in water. Most (but not all) flammable liquids have specific gravity less than 1.0 and , if not
soluble, will float on water-an important consideration for fire suppression.
Spill or Leak Procedures The methods, equipment, and precautions that should be used to
control or clan up a leak or spill.
Splash-Proof Goggles Eye protection made of a noncorrosive material that fits snugly against the
face, and has indirect ventilation ports.
Spontaneously Combustible A material that ignites as a result of retained heat from processing,
or that will oxidize to generate heat and ignite, or that absorbs moisture to generate heat and ignite.
Squamous Scaly or platelike.
Stability The ability of a material to remain unchanged. For MSDS purposes, a material is stable if
it remains in the same form under expected and reasonable conditions of storage or use.
Conditions that may cause instability (dangerous change) are stated; for example. temperatures
above 150F; shock from dropping.
STEL Short-Term Exposure Limit (ACGIH terminology). See TLV.
Stenosis Narrowing of a body passage or opening.
Steroid A complex molecule among which are the male and female sex hormones.
Subcutaneous Beneath the layers of the skin.
Supplied-Air Respirators Air line respirators of self-contained breathing apparatus.
Sys System or systemic.
Systemic Poison A poison that spreads throughout the body, affecting all body systems and
organs. Its adverse effect is not localized in one spot or area.
Systemic Toxicity Adverse effects caused by a substance that affects the body in a general rather
than local manner.
Synonym Another name or names by which a material is known. Methyl alcohol, for example, is
known as methanol or wood alcohol.
Target Organ Effects The following is a target organ categorization of effects that may occur,
including examples of signs and symptoms and chemicals that have been found to cause such
effects. These examples are presented to illustrate the range and diversity of effects and hazards
found in the workplace, and the broad scope employers must consider in this area, but they are not
intended to be all inclusive.
   (a)   Hepatotoxins - Chemicals that produce liver damage.
         Signs and symptoms - Jaundice; liver enlargement.
         Chemicals - Carbon tetrachloride; nitrosamines.
   (b)   Nephrotoxins - Chemicals that produce kidney damage.
         Signs and symptoms - Edema; proteinuria.
         Chemicals - Halogenated hydrocarbons; uranium.
   (c)   Neurotoxins - Chemicals that produce their primary toxic effects on the nervous system.
         Signs and symptoms - Narcosis; behavioral changes; decrease in motor functions.
         Chemicals - Mercury, carbon disulfide.

   (d)   Agents that act on blood hematopoietic system - Decrease hemoglobin function; deprive
         the body tissues of oxygen.
         Signs and symptoms - Cyanosis; loss of consciousness.
         Chemicals - Carbon monoxide; cyanides.
   (e)   Agents that damage the lung - Chemicals that irritate or damage pulmonary tissue.
         Signs and symptoms - Cough, tightness in chest, shortness of breath.
         Chemicals - Silica, asbestos.
   (f)   Reproductive toxins - Chemicals that adversely affect the reproductive capabilities
         including chromosomal damage (mutations) and effects on fetuses (teratogenesis).
         Signs and symptoms - Birth defects; sterility.
         Chemicals - Lead; DBCP.
   (g)   Cutaneous hazards - Chemicals that affect the dermal layer of the body.
         Signs and symptoms - Defatting of the skin; rashes; irritation.
         Chemicals - Ketones; chlorinated compounds.
   (h)   Eye hazards - Chemicals that affect the eye or visual capacity.
         Signs and symptoms - Conjunctivitis; corneal damage.
         Chemicals - Organic solvents; acids.
Target Organ Toxin A toxic substance that attacks a specific organ of the body. For example,
overexposure to carbon tetrachloride can cause liver damage.
TCC Tag (Tagliabue) Closed Cup. See Flashpoint.
TCL Toxic concentration low, the lowest concentration of a gas or vapor capable of producing a
defined toxic effect in a specified test species over a specified time.
TDL Toxic dose low, lowest administered dose of a material capable of producing a defined toxic
effect in a specified test species.
Temp Temperature.
Ter See Teratogen.
Teratogen A substance or agent, exposure to which by a pregnant female can result in
malformations in the fetus.
Tfx Toxic effect(s).
TLV Threshold Limit Value is a term used by ACGIH to express the airborne concentration of
material to which nearly all persons can be exposed to day after day without adverse effects.
ACGIH expresses TLV's in three ways:
   TLV-TWA: The allowable Time-Weighted Average concentration for a normal 8-hour workday or
   80-hour workweek.
   TLV-STEL: The Short-Term Exposure Limit, or maximum concentration for a continuous 15-
   minute exposure period (maximum of four such periods per day, with at least 60 minutes
   between exposure periods, and provided the daily TLV-TWA is not exceeded).
   TLV-C: The ceiling exposure limit - the concentration that should not be exceeded even
TOC Tag Open Cup. See Flashpoint.
Torr A unit of pressure, equal to 1/760 atmosphere.
Toxic A chemical falling within any of the following categories:

   (a) A chemical that has a median lethal dose (LD50) of more than 50 milligrams per kilogram
       but not more than 500 milligrams per kilogram of body weight when administered orally to
       albino rats weighing between 200 and 300 grams each.
   (b) A chemical that has a median lethal dose (LD50) of more than 200 milligrams per kilogram
       but not more than 1,000 milligrams per kilogram of body weight when administered by
       continuous contact for 24 hours (or less if death occurs within 24 hours) with the bare skin of
       albino rabbits weighing between two and three kilograms each.
   (c) A chemical that has a median lethal concentration (LC50) in air of more than 200 parts per
       million but not more than 2,000 parts per million by volume of gas or vapor, or more than
       two milligrams per liter but not more than 20 milligrams per liter of mist, fume, or dust, when
       administered by continuous inhalation for one hour (or less if death occurs within 1 hour) to
       albino rats weighing between 200 and 300 grams each.
Toxic Substance Any substance that can cause acute or chronic injury to the human body, or
which is suspected of being able to cause diseases or injury under some conditions.
Toxicity The sum of adverse effects resulting from exposure to a material , generally, by the
mouth, skin, or respiratory tract.
Trade Name The trademark name or commercial trade name for a material or product.
Transplacental An agent that causes physical defects in the developing embryo.
TSCA Toxic Substances Control Act (Federal Environmental Legislation administered by EPA)
regulates the manufacture, handling, and use of materials classified as "toxic substances."
TWA Time-Weighted Average exposure is the airborne concentration of a material to which a
person is exposed, averaged over the total exposure time- generally the total workday (8 to 12
hours). Also see TLV.
UEL, or UFL Upper explosive limit or upper flammable limit of a vapor or gas; the highest
concentration (highest percentage of the substance in air) that will produce a flash or fire when an
ignition source (heat, arc, or flame) is present. At higher concentrations, the mixture is too "rich" to
burn. Also see LEL.
ug Microgram, one-millionth of a gram.
Unstable Tending toward decomposition or other unwanted chemical change during normal
handling or storage.
Unstable Reactive A chemical that, in the pure state, or as produced or transported, will
vigorously polymerize, decompose, condense, or become self-reactive under conditions of shocks,
pressure, or temperature.
USDA U.S. Department of Agriculture.
Vapor The gaseous form of a solid or liquid substance as it evaporates.
Vapor density The weight of a vapor or gas compared to the weight of an equal volume of air is an
expression of the density of the vapor or gas. Materials lighter than air have vapor densities less
than 1.0 (examples: acetylene, methane, hydrogen). Materials heavier than air (examples:
propane, hydrogen sulfide, ethane, butane, chlorine, sulfur dioxide) have vapor densities greater
than 1.0. All vapors and gases will mix with air, but the lighter materials will tend to rise and
dissipate (unless confined). Heavier vapors and gases are likely to concentrate in low places -
along or under floors, in sumps, sewers, and manholes, in trenches and ditches - where they may
create fire or health hazards.
Vapor pressure The pressure exerted by a saturated vapor above its own liquid in a closed
container. When quality control tests are performed on products, the test temperature is usually

100F, and the vapor pressure is expressed as pounds per square inch (psig or psia), but vapor
pressures reported on MSDS's are in millimeters of mercury (mmHg) at 68F (20C), unless stated
otherwise. Three facts are important to remember:
   1. Vapor pressure of a substance at 100F will always be higher than the vapor pressure of the
      substance at 68F (20C).
   2. Vapor pressures reported on MSDS's in mmHg are usually very low pressures; 760 mmHg
      is equivalent to 14.7 pounds per square inch.
   3. The lower the boiling point of a substance, the higher its vapor pressure.
Ventilation See General Exhaust, Local Exhaust, and Mechanical Exhaust.
Vermiculite An expanded mica (hydrated magnesium-aluminum-iron silicate) used as sorbent for
spill control and cleanup.
Viscosity The tendency of a fluid to resist internal flow without regard to its density.
Volatility A measure of how quickly a substance forms a vapor at ordinary temperatures.
Water Disposal Methods Proper disposal methods for contaminated material, recovered liquids or
solids, and their containers.
Water-Reactive A chemical that reacts with water to release a gas that is either flammable or
presents a health hazard.
Work Area A room or defined space in a workplace where hazardous chemicals are produced or
used, and where employees are present.
Workplace An establishment at one geographical location containing one or more work areas.
Zinc Fume Fever A condition brought on by inhalation of zinc oxide fume characterized by flulike
symptoms with a metallic taste in the mouth, coughing, weakness, fatigue, muscular pain, and
nausea, followed by fever and chills. The onset of symptoms occurs four to twelve hours after

                                 Emergency Medical Service -
                                    Lifting/Handling Patients
Behind every good EMS employee is a badly abused back.

Many occupations demand harder, more prolonged physical exertion from their practitioners, but
few fields of endeavor require the frequent, sudden bursts of maximal effort during uncontrollable
circumstances which are so common to emergency medical service workers. And the back, being
out of sight, is not often on the mind.

As a result, most EMS employees have known colleagues who have left the street, perhaps the
industry, with crippling back injuries. What can you do to make your rewarding profession a safer
one? EMS employees and the agencies they serve can take several measures.

Understand the Mechanics
Learn how your body is designed to carry weight. Basically, remember to use your back to bear
weight rather than to lift it. The human vertebral column is structurally similar in design to a pyramid
- the strongest weight bearing design known to architecture. The cervical vertebrae are delicate,
and designed to offer great range of motion. The lower vertebrae become more and more massive,
less mobile, but capable of bearing more and more weight. At the same time, however, this
cushioned, sturdy weight bearer is a pushover when it comes to lifting things. Its system of
muscular leverages is simply not designed for the job.

With this in mind, support your patient as close to your body as you can, with your back as straight
as you can keep it. Generally, in lifting, if it feels right, it probably is right. Conversely, when you
begin a lift that just does not feel right, stop lifting and get some help. The body has a way of telling
us when something is wrong. One very important aspect of patient handling is, “Do not
overestimate your own strength or your partner’s strength.”

In addition, advise your patients in advance of what you are doing to avoid surprising them. This
will help keep them from being startled and making sudden moves while you are trying to balance
their weight.

Any time you have made your job as easy on yourself as possible, and you realize that your
attempts to move a patient may result in injury to yourself, your partner, or your patient, call for help.
If you or your partner gets hurt, you will do the patient no good.

Consider, of course, the possibility of using bystanders. Harness this source of energy, making
sure to let them know beyond a doubt that you are in complete control. However, if for any reason
whatever the available resources do not suit your needs, do not take chances. Call your
communications center for help; no one in your outfit will blame you.

Lifting and Carrying
Spare your body. Use your equipment. Never before have we had the opportunity to be so safe.
Members of our ranks have invented a plethora of equipment which is designed to make lifting and
carrying safer and easier for us - equipment for getting patients off of floors, out of cars, into
ambulances, and even into and out of beds and bathtubs. Learn about each new piece of
equipment you see. There can never be equipment for every situation, but EMS employees today
have more opportunities for adaptation than they ever have.

If a patient must be carried at all, most often the best means is lying supine. Most equipment that
has been designed for use in ambulances was designed for this position. Carrying a patient supine,
you have everything under your control. You are not depending on the patient. You are working
with equipment that you know you can trust. More than that, regardless of what is wrong with the
patient; you know that your lifting methods will not worsen the condition.

Of course, there are exceptions, and we will deal with them.

When lifting and carrying patients in the supine position, try to make the move in the easiest way
possible. This will protect both you and your patient.

Get the ambulance as close to the patient as possible. Next, get the gurney as close to the patient
as you can. If you find it necessary to use an accessory stretcher such as a supine board or
canvas stretcher, get that as close as you can. This minimizes the amount of lifting and carrying for
you, and your back.

Before you decide how to lift a patient, consider the chief complaint and secondary complaints as
well. Where is the pain? How is the pain being caused? What does the pain probably mean?
What kind of motion or positioning increases the pain or relieves it? Weigh this information against
your knowledge of anatomy and physiology and against the urgency of each overall situation.

Often a patient will be resting in the position that is most comfortable. Consider this position and try
to maintain it. Before lifting, learn everything you can about a patient's signs and symptoms. This
pertains especially to patients with possible spinal injuries. A great man once said, "Listen to your
patient, and he will tell you what is wrong with him."

When lifting any patient, especially a heavy patient, balance means more than strength. If in doubt,
call for assistance.
Moving the Sitting Patient
The patient found in a sitting position can be moved in this position, but it is not as safe as moving
in the supine position. There are several ways to make a sitting move. You may be familiar with
most of them. Remember, however, that they are all in some way awkward. For that reason, they
are all in one way or another dangerous, both to your patient and to you. Further, most of them
necessitate the patient's being physically sound, and not too heavy. These two conditions you will
not always find.

Sometimes the sitting position is mandatory. This is, for instance, the case when you must move
your patient through hallways with sharp corners - especially if these involve stairways.

Sometimes you can put the patient in a chair, and carry the chair and the patient to the location of
the gurney. If you find this is necessary, be sure that the chair is structurally sound.

 If a chair is to be used, or the sitting position is to be used for any reason, use it only so far as you
have to. Patients should be fastened to chairs by tying a sheet around their hips. Also, if you find
yourself in a tight stairway situation, it may be a good idea for you to suggest that your agency
invest in stair chairs. One bad injury may equal the cost of equipping a fair sized fleet.

Moving the Recumbent Patient
Often we encounter the patient who must be moved from a recumbent position, i.e., a couch, bed,
ground, or floor. This problem can be solved in many ways, but the most harmful to the crew is to
bend down and attempt to pick the patient up, without any body support equipment. This type of lift
can lead to serious injury to both the crew and the patient. The following should be considered as
alternative methods:

   •   Use a scoop stretcher. Folding scoop stretchers may be the most preferable means of
       moving patients from low surfaces, because they are comfortable enough to leave under
       patients until their arrival at a hospital. In cold weather situations or other dangerous
       environments, these devices can be used to quickly get a patient into the ambulance, even
       prior to a secondary survey of injuries. They are also useful in cases of cardiac arrest, as
       they do not necessitate interruption of compressions, can be assembled under a patient by
       one technician without disturbing the others, and are contoured to prevent slippage of even
       a bleeding or diaphoretic patient.
   •   Logroll the patient onto a breakdown, or flat stretcher of the canvas type. Either the scoop
       or a breakdown will enable two crew persons to lift even an obese patient from ground level
       to a gurney without risk. One suggestion: the gurney mattress may be placed on top of a
       breakdown prior to placing the patient on your stretcher or bench; this will make the patient
       more comfortable.
   •   Often we must load two or more patients into one ambulance, say, at the scene of a multiple
       injury auto accident. Breakdowns are used to handle the least critically injured patients in
       ambulances that will carry three or four patients. Usually, it is a good idea to avoid the
       practice of carrying patients suspended from the ceiling. If it is possible, send them with
       additional ambulances instead.
   •   You can prevent serious back injuries to rescuers by not loading these patients directly into
       the ambulance. It is safer to prioritize the patients you plan to carry. Place the least
       critically injured on breakdowns and load them, one at a time, onto the gurney. These
       patients can then be rolled into the ambulance and the gurney secured into its latches. Now
       lift the patients on their stretchers from the gurney into their respective ceiling locations and
       latch them into place.
   •   The second-to-most-critical patient should be loaded onto the gurney next in the same way,
       and placed on the bench or on the floor next to the gurney location, depending on what kind
       of ambulance you are using.
   •   The most critically injured patient should be placed on the gurney last, and left there. This
       patient will be the first into the hospital, because he will be the easiest one to offload. Finally,
       the gurney is used to offload the bench patient, and then the suspended patients.
   •   This may seem like an involved and time-consuming process. In fact, it works very smoothly
       and eliminates what used to be a glaring safety problem from the prospect of loading
       several patients into an ambulance.
   •   Logroll, or slide the patient lengthwise (depending on room) onto a long spine board. This
       method is preferable in all cases except for the scoop stretcher if a patient has potential
       cervical damage and is on the ground or floor, but it is the least comfortable means for a
       patient. It is also the most dangerous device you can use if a patient must be carried for any
       distance, because it is slippery, especially if the patient is wet. A spine board is also the
       most difficult for a crew to pick up, once the patient's weight is involved. A board is usually
       the best means of removing patients from confined spaces such as automobiles, especially
       after trauma, and especially if an extrication device is not available.

   •   Logroll the patient onto a rug or sturdy blanket, roll the edges to form handgrips, and use as
       many bystanders or assisting crews as necessary to lift the patient - blanket and all - onto a
   •   This may be preferable to other means when the patient is found in a confined area, or
       when the patient must be moved in a position other than supine. Once again, have the
       gurney in a proper position and as handy as you can prior to lifting the patient. If you are
       unable to get enough help into a small room, you may elect to drag the patient, on the
       blanket, toward the gurney. Note that when getting a patient onto any accessory stretcher, it
       is usually better to logroll the patient rather than to lift part of his body. If the patient must be
       moved lengthwise onto an accessory stretcher, he should be pulled, not pushed, in case
       there are any fractures.
   •   If the patient is on a couch or be and you can get the gurney alongside it, you can slide the
       patient onto the gurney. If you choose to slide, be absolutely certain that neither the gurney
       nor the bed can move away from one another during the move. In addition, you can use the
       patient's bed sheets to do a sheetdraw. Either way, it is a good idea to have the gurney
       slightly lower than the surface on which the patient is found; this lessens any friction on the
       patient and minimizes the need for any lifting force by you or your partner.
   •   Sometimes it becomes necessary to lift a patient without an accessory stretcher. An
       example would be the patient who is found in bed but to whom you are unable to bring the
       gurney or accessory stretcher due to narrow doors or hallway corners. This patient can be
       cradled in the arms of two or three rescuers, depending on the patient's weight. This is one
       of the most unsafe moves you could choose to make; it should be used only when you have
       no other choice.
   •   Regardless of the type of accessory stretcher which you select to move a patient, it is a
       good idea for you to carry it as short a distance as possible, or not at all. Rescuers can lift
       the accessory stretcher, stand, and instruct a bystander to roll the gurney (pre-adjusted for
       height and with railings lowered) under the stretcher.
   •   When you adjust the gurney height, set it so it roughly corresponds to the height of your
       hands when you are standing in a relaxed position. This way you will be lifting the stretcher,
       with patient, to a comfortable position and setting it on the gurney without bending your
       knees to lower it. If, on the other hand, you are not using an accessory stretcher to flat lift a
       patient, adjust the gurney to its maximum height before making the move, so you will be
       bending down as little as possible to lower the patient onto the gurney.

Moving Via Stairways
Very often the only route from your patient's location to the ambulance will include a stairway. This
is a complication, but it can be overcome.

 In lifting anything, we try to distribute ourselves as evenly as we can about an object's center of
mass, or balance point. In making a stable move, we try to keep the center or mass as low as
possible to minimize the effort involved. The center of mass of a supine patient is in the area of the

 Remembering the center of mass, it is easy to understand the most desirable position for a patient
who is being carried up or down a flight of stairs. This move should usually be made using a
gurney, with the patient's head elevated and closest to the downward end of the stairway. The
gurney should be lowered to its minimum height so the rescuers can keep it as low as clearances
will allow. (With the patient's head at the upward end of the stairway, the center of mass is about
thirty (30) percent higher, so the gurney is much more unstable and more difficult to control.)

The patient should be securely belted in and advised in advance of what to expect. If the EMS
employee carrying the top end of the gurney should slip or begin to lose control of the gurney
entirely, it may bounce down the stairs. However, it will not topple, end over end, which could
cause serious injury to both the patient and the EMS employee at the bottom end of the gurney.

Most calls involve the process of traversing at least one curb with a loaded gurney. In general, we
try to avoid even single steps when we can use a ramp or driveway instead. Steps are dangerous
because they involve movement of the hips and lumbar spine while they are under load and
because of the danger of slippage. We can eliminate much of this danger by taking the load off of
the spine while the hips are in motion. Instead of carrying the gurney over a curb, it is better to
cantilever it.

Removing Your Patient From Danger
Often you will be faced with the patient whom you consider to be in immediate danger from his
environment. Some examples are:

      •   Patient exposed to moving traffic;
      •   Patient in auto, with odor of gasoline present;
      •   Patient in auto afire on your arrival;
      •   Patient in building afire on your arrival;
      •   Patient in area of violent crime prior to arrival of support from law enforcement.

Certainly you could name other such situations. It is important to realize that, if a situation such as
these cannot be corrected immediately, the patient should be removed quickly before treatment,
assessment, or even immobilization.

These situations are just as dangerous to rescuers as they are to victims. In fact, fire and medical
rescuers should not knowingly enter such an area until law enforcement personnel arrive. There is
no call more unfortunate than one involving unnecessary injuries to one of your colleagues because
somebody "jumped in" on something they did not suspect. In patient assessment, we "Assume
Nothing and Suspect Everything." Perhaps this little saying applies to the safeguarding of
ourselves as well as our patients.

A similar situation involving a patient in danger from the surroundings is the patient requiring pre-
transport care who is found in a bathroom or other small area. On your way into a building, as part
of your assessment of the overall scene you should pay attention to the largest room you can find.
When you locate the patient and determine that working room will be needed (e.g. - cardiac arrest),
drag the patient immediately into the largest room you have found, then proceed with appropriate

Not only will you be better able to perform effective CPR or establish the IV, but also when it
becomes time to move you will have the room you need for good body mechanics and the right

Personal Considerations

Just as it is important for agencies to express a proper attitude toward safety, this is a prerequisite
for workers as well. Safety in everyday activities, both on and off duty, should be a way of life
rather than something to memorize on command out of textbooks.

Though taken for granted daily, bodies are delicate, magnificent treasures. In order for them to
meet the demands that emergency medical service work places on them, they must be carefully

Be aware of your health, especially if you have extremely high call loads or extremely low ones. A
strong, well nourished body with a good circulatory system and rested nerves is a basic need for
one who must repeatedly meet the instant and uncompromising demands of the critically ill and
injured. Try to remember that your body is one of the tools of your trade.

From the standpoint of lifting, proper footgear is also important.

Remember that in bearing the weight of a 200-pound patient, each ankle has to handle the bearer's
own weight as well as half the patient's weight. (During walking, we spend much more time on one
foot that we do on two.) Heavy-duty lace-type boots with padded ankle protection and non-slip
soles and heels are well worth the investment.

            Motor Vehicles and Mobile Equipment
Conducting public entity business requires that employees operate county-owned or leased vehicles (cars,
vans, pickups, emergency vehicles, etc.) and/or use their personally owned vehicles on county business.
From a safety standpoint, motor vehicle use creates some of the greatest risks for serious injury and property
damage. Motor vehicles accidents are a leading cause of loss for the NCACC Risk Management Pools –
accidents result in injuries to employees, injuries to the public, and extensive property damage.

About 15% of the workers’ compensation claims for the NCACC Workers’ Compensation RMP are the result
of injuries related to motor vehicle accidents (MVA). The cost of these cases shows the injuries tend to be
serious – the cases make up a disproportionate share of the RMP monetary losses with 20% of the total. For
County Members in 2003 and 2004, MVA caused 8% of the claims, but 23% of the incurred losses.

Further, motor vehicle accidents cause injuries to the public and extensive property damage. For a recent
three-year period, auto liability losses incurred by members of the NCACC Liability & Property RMP exceeded
$7 million. Of this amount, $4.7 million was related to 382 cases involving Sheriff and law enforcement
There are many considerations in controlling the risks associated with the operation of motor
vehicles. While public entities have many specialized fleet exposures (such as emergency
vehicles, law enforcement vehicles, and sanitary landfill trucks), the same basic principals are
fundamental to safety of any motor vehicle operations:
     •   Vehicle maintenance
     •   Driver selection
     •   Driver training and knowledge
     •   Safe driving habits / safe vehicle operation

                                       MOTOR VEHICLE POLICY

Employees will be responsible for ensuring safe operation, maintenance, and when required, inspection of the
vehicle as detailed in this policy. Employees must not operate an unsafe vehicle or operate a vehicle in an
unsafe manner.

Motor Vehicle Policy -- Maintenance

A.       All vehicles must be properly maintained in conformity with the vehicle manufacturer's
         suggested schedule. No employee is to operate a vehicle that is not in safe operating
         condition. For assigned automobiles, the assignee is responsible for proper maintenance.
         For other vehicles, the Department Head will designate someone to be responsible for
         maintenance of each individual vehicle. The person(s) responsible will see that the
         maintenance schedule is followed, see that other needed repairs are made in a timely
         manner, and keep a file documenting all maintenance and repair records.

Motor Vehicle Policy – Driver Selection

         PERSONNEL. Spouses are allowed to drive county vehicles only in the event of an
         emergency. County vehicles ARE NOT TO BE OPERATED BY OTHER NON-

B.       No employee is allowed to operate a county vehicle unless properly licensed to do so.

      Operating a county vehicle with an expired or revoked driver's license is grounds for

C.    The Department Heads will annually review and photocopy the driver's license of every
      employee who is authorized to operate a county vehicle. Photocopies will be forwarded to
      the Safety Coordinator collectively and will be given to the Finance Director for inclusion in
      personnel files. A license review check sheet is included at the end of this section. Any
      problems identified are to be passed on to the County Manager for review.

D.    Periodically, the Safety Coordinator may obtain state Motor Vehicle Record checks (MVR's)
      on all employees at the location who are authorized to operate a county vehicle. The Safety
      Coordinator will review these records carefully and advise the County Manager of any
      record showing a poor driving record. As a minimum, the County Manager is to be advised
      of any record showing:
          1. Suspension, revocation or expiration of license
          2. 2 or more moving violations, 2 or more chargeable accidents, or a combination of 2
             or more moving violations and chargeable accidents over a 24 month period
          3. Driving while intoxicated (DWI), reckless driving, leaving the scene of an accident, hit
             and run, vehicular homicide or assault, participating in an unlawful speed contest, or
             eluding or attempting to elude a police officer violations
          4. Any other violation or accident indicating careless disregard for public or personal
             safety, or the abuse of a county/entity vehicle.
E.    The County Manager will review any record showing driving problems to decide whether or
      not to allow the employee to continue to operate a County vehicle.

F.    Careful driver selection is the key to overall fleet safety. No new employee is to be allowed
      to drive a County vehicle until the employee has completed the normal application
      procedure, references have been checked, possession of a valid driver's license has been
      verified (photocopy in personnel file), and a motor vehicle record (MVR) has been obtained
      and reviewed. No applicant is to be hired and allowed to operate a County vehicle whose
      driving record shows, during the preceding 24 months:
          _   Two or more moving violation convictions
          _   Two or more chargeable accidents
          _   A combination of three or more moving violations and chargeable accidents
          -- DWI, reckless driving, leaving the scene of an accident, hit and run, vehicular
             homicide or assault, participating in an unlawful speed contest, or eluding or
             attempting to elude a police officer violations

Motor Vehicle Policy – Vehicle Use

A.    Careful driving habits will reduce the chances of an accident more than any other factor.
      Drivers are to abide by all traffic regulations, laws and ordinances while driving for the
      County. The Safety Coordinator or Department Head may periodically provide appropriate
      fleet safety information to County vehicle drivers.
B.    Seat belts shall be worn when driving or riding in any vehicle on County business. All
      occupants of a County-owned vehicle shall wear seat belts while it is in operation
C.    The employee and the Department Head are responsible for maintaining the following
      information in the glove box of each county-owned vehicle:

            1.   Vehicle accident report form
            2.   Witness information request cards (3)
            3.   Insurance Policy Card
            4.   Vehicle registration information
D.       Drivers will not drive after having consumed alcohol and/or drugs when reasonably expected
         to impair their ability to operate a motor vehicle.
E.       Family members and other passengers can be carried in an assigned County vehicle when
         the vehicle is being used for business use.
F.       County-owned vehicles are not to be used for personal errands and local travel outside of
         working hours. Employees on official business may only deviate slightly from the most
         direct routes to accomplish any personal tasks which are not detrimental to Hyde County.
         Any abuse will result in additional restrictions by the Department Head or the Manger.
G.       For those employees who operate County vehicles, fleet safety must be included in their
         performance appraisals. Fleet safety must also be addressed in the performance appraisals
         of all management personnel who supervise employees who drive County vehicles. Good
         or poor performance in fleet safety is to be rewarded or penalized in salary, bonus and/or
         stock programs as appropriate.

H.       Vehicle operation and maintenance must be reported on forms prescribed by the Safety
         Coordinator or the Safety Committee. Monthly reports must be approved by the Supervisor
         and submitted to the Safety Coordinator within 10 business days.

Motor Vehicle Policy – General Safety Rules

The following safety procedures apply to operation of all county vehicles:

     •   Employees are required to complete a visual evaluation EACH DAY on any vehicle they are
         assigned to drive.

     •   Employees are required to complete safety checks weekly on each vehicle. (Emergency
         Vehicles should be checked prior to any new shift or switch in operators.) Safety checks
         should be documented on a form prescribed by the Safety Coordinator. Vehicle safety
         checks include:

                 •   windshield washers and wipers
                 •   directional signals
                 •   power steering
                 •   fluid reservoir
                 •   brakes and brake fluid
                 •   hydraulic systems
                 •   clutch
                 •   lights
                 •   tires
                 •   horn
                 •   motor oil

     •   Adjust the seat, inside and outside mirrors, and steering wheel tilt for safe driving before
         putting the vehicle into gear.

•   Emergency vehicles: All operators of Emergency Vehicles should be trained on
    Emergency Vehicle Operations. The fact that an employee is operating an emergency
    vehicle does not absolve him or her from civil or criminal liability for the consequences of
    wantonly reckless driving. The driver must be in the position to satisfy a jury that reasonable
    care and prudence was used in operating emergency vehicles. Even though emergency
    equipment has warning devices, the drivers are expected to PROCEED WITH ALL
•   Remember that drugs, illness, or extreme fatigue may affect your ability to judge distance,
    speed, and driving conditions.
•   Supervisors are responsible for insuring that all of their employees are utilizing the installed
    seat belts.
•   Not more than three persons are permitted to ride in the front seat of any vehicle. Persons
    may not be transported in any vehicle unless safe and secure seating is provided for each
•   Parking vehicles:
       -   Except when working conditions require otherwise, parked vehicles must have the
           motor stopped, key removed and emergency brakes set, and be left in gear or in
           park - depending on the type of transmission.
       -   Vehicles are not to be parked on the wrong side of the street facing traffic except in
           case of emergency.
       -   When trucks or vehicles must be stopped on streets or highways, warning signals
           must be used. All emergency vehicles and utility service vehicles must be equipped
           with supplemental warning lights of significant configuration and candlepower to be
           very conspicuous. Manufacturer’s emergency flashers are not sufficient warning.
       -   Use a flagman if traffic warrants.
       -   Before pulling away from the curb look to see that no vehicles are approaching from
           either direction, and signal your intention.
       -   When backing a vehicle, be sure the way is clear. Get out of the vehicle when
           necessary and inspect the area you will be backing into. Back up slowly. Larger or
           specialty vehicles should sound the horn before backing. For larger or specialty
           vehicles, another employee should direct the backing if possible.
•   Vehicles, except Emergency Vehicles on incidents or a Sheriff’s K-9 vehicle, are not to be
    left unattended with the vehicle running. Always remove the keys from the ignition.

•   Drivers must be particularly alert while driving near children.

•   Drive within posted speed limits. Slow down when conditions warrant.

•   Do not assume the right-of-way. Use defensive driving, and yield when necessary, even if
    you legally have the right of way. "Don't Be Pushy - Yield or Stop".
•   Keep a safe distance behind other vehicles and avoid tailgating. Do not allow others to
    tailgate. Slow down, pull over to the side, and let the tailgater pass.
•   Signal intentions at least 100 feet in advance, including change in lanes, and turns. Avoid
    sudden braking.

   •   Turn on low beam headlights during dark periods of the day, such as rainstorms or fog.
       Turn headlights on 1/2 hour before sunset until 1/2 hour after sunrise when driving at night.
       Parking lights designate a vehicle is parked – do not drive with only parking lights.
   •   Filling Tanks:
           -   Shut off the engine.
           -   Do not smoke or use radio / phone devices near fuel pumps.
           -   Keep the nozzle against the edge of the filler pipe.
           -   To avoid spillage, do not fill the tank too fast or too full.

Motor Vehicle Policy – Accident / Crash Reporting

In the event of an accident involving county owned vehicles, the following procedures apply:
   •   Drivers are to report any incident involving a county vehicle or any incident involving use of
       their personal vehicle for business to their Supervisor and the Safety Coordinator
       immediately. Any incident involving the use of a car or other vehicle while working, whether
       or not it results in any injury to any person or damage to any vehicle or property, and
       regardless of who is at fault, must be reported.
   •   Render first aid, if qualified to do so, and arrange for medical help if necessary.
   •   Notify Law Enforcement Officials immediately. Unless it is necessary, the vehicle should not
       be moved until authorized by the investigating officer.
   •   Obtain names and addresses of any witnesses to the accident. Offer no information
       regarding the responsibility for the accident or what should have been done to avoid the
   •   Emergency Vehicles involved in a multi-vehicle crashes should remain on the scene and
       additional units dispatched to the emergency. An exception may be made for ambulances
       transporting a patient, IF remaining on scene is reasonably expected to jeopardize life
       safety. In all cases, vehicles must stop and assess potential damage and injuries.

                                                                        Office Safety
Office work can be more hazardous than is commonly thought since many accidents occur during
ordinary office routines. Following are some best practices that can help make your office areas
safe. An Office Safety Checklist is included at the end of this section.

•   Every employee should see that his or her desk and work area is clean and orderly. Pick up
    items such as pencils or paper clips and wipe up any spilled liquids. Good housekeeping is the
    key to a safe office environment.
•   Slips, trips, and falls are some of the most common causes of injuries to office workers. Keep
    an eye open for loose or rough floor covering, loose tiles, or carpeting that can create a tripping
    hazard. Clean up spills immediately, or put up wet floor signs until help can be summoned.
•   Be extra cautious when you come up to a door that can be pushed toward you. Take it easy
    when pushing one open. Also, slow down when coming to a blind corner.
•   Haste when walking between desks can result in bruises and falls. Watch out for electrical
    cords and keep them out of aisle-ways. If a cord needs to be run through the walkways, ensure
    that a cord cover is used.
•   Never run electrical cords through doorways as it creates a pinch point that can break the
    integrity of the cord.
•   All file, desk, and table drawers should be kept closed when not in use. If you leave them, close
    them. Never open more than one file drawer at a time.
•   Overloading the top drawers of unsecured file cabinets can cause injuries and damage to the
    file cabinet if they tip over. Cabinets should be loaded evenly and should be secured to
    adjacent cabinets or to walls so they cannot fall over. File cabinets should have an interlocking
    device that allows only one drawer to be opened at a time, and drawers should have stops so
    they cannot inadvertently be pulled all the way out of the cabinet.
•   Furniture such as tables, desks, and chairs must be maintained in good condition and free from
    sharp corners, projecting edges, wobbly legs, etc.
•   Tilted chairs can be a hazard when improperly used. Take care to assure that they are in good
    condition. Learn the limits.
•   Never use chairs, desks or other office furniture as a makeshift ladder. Use a stepladder or step
    stool and don't over-reach.
•   Keep the blades of a paper cutter closed when not in use. All paper cutters should be guarded.
•   Pencils are safest when carried point down in shirt pockets.
•   Scissors, paper cutters, glass, and razor blades can cause painful injuries. Report and treat
    such injuries at once to protect yourself from infection.
•   Paper can cut and it hurts. Use a sponge or other wetting device for envelopes instead of your
    tongue. Use rubber finger guards when working with stacks of paper.
•   Keep paper clips, thumb tacks, and pins in a place where they can't bite. Even a little scratch
    can get infected.
•   Be sure all electric office equipment is grounded and that the cord is in good condition. If a
    machine gives you an electric shock or starts smoking, unplug it and report it.

•   For computers, use surge protectors to protect your equipment from electrical power surges.
    Outlet strips may also allow more electrical equipment to be plugged in safely at one
    outlet/location, but look at the rating of the device and do not overload the circuit.
•   Store heavy office supplies at a height between your knees and shoulders. Use proper lifting
    techniques for moving paper supplies to copy machines or printers.


With the increased use of computers in every line of work, it is important to review your computer
workstation setup. If you spend the majority of your time in front of a computer, then you should be
aware of some basic ergonomic principles that will help improve your comfort and minimize stress
caused from repetitive motion and poor posture.

Computer Workstations

Ergonomics is the science of designing your workstation to
fit you better.

•   Start by adjusting the chair height and keyboard to achieve a
    neutral wrist position, with the forearms roughly parallel to
    the floor, with your keyboard or other work within a range of
    2” above or below your seated elbow height. If a non-
    adjustable work surface must be used, adjust the chair
    height to achieve a neutral wrist position and use a footrest,
    if needed, to make the workstation more comfortable.
•   Select a sturdy chair with a firm padded back, adjustable arms, and with a back that adjusts
    vertically and horizontally. By adjusting the backrest to support your lumbar curve (lower back),
    you can help support and improve your posture, which will ultimately improve your comfort. You
    may need to lock the tilt feature to use the backrest when keying.
•   Locate the computer monitor so the screen is 18 to 30 inches away. The top of the screen
    should be at seated eye level or below to help prevent head and neck strain. If you wear
    bifocals, you may want to have the monitor below eye level.
•   Organize your desk or worktable to accommodate the materials and equipment you need.
    Place the things you need regularly (such as a telephone or calculator) within easy reach. Use
    a chair that swivels to avoid unnecessary twisting and reaching. The base should have five legs
    for greater stability.
•   Sit up straight! Poor posture can increase problems with your back, neck and shoulders and
    increase the strain you feel in these areas.
•   If you use a mouse or other screen-pointing device, locate it next to the keyboard on the side of
    your dominant hand.
•   If you enter data into your computer from hard copies, use a document holder positioned next to
    your VDT screen. This helps keep your eyes focused at the same distance and reduces
    eyestrain associated with moving your eyes from the document to the computer.
•   Work surfaces should have rounded edges so you do not bump or rest your wrists against sharp
    surfaces. Use a cushioned pad or wrist rest to support your wrists when working at a computer

    workstation. This support can reduce the pressure on your wrists and reduce strain as well. Try
    to work with your wrists in a straight (neutral) position.
•   Glare can produce eyestrain. If overhead lights or windows create glare on your screen, glare
    screens can be placed over the front of your monitor. You can also reduce glare on your screen
    by tilting the front of the VDT screen down.
•   If you spend significant time on the telephone, use a telephone headset to reduce neck and
    shoulder strain.
•   Be sure to blink every so often as your eyes will get dry if focusing on an object for long periods
    of time. It is also helpful to glance away from the monitor regularly to focus on a distant object.
•   While ergonomics can help improve your comfort and productivity, remember that micro-breaks
    can also be beneficial. During a micro-break, you might perform other job tasks that allow you
    to get up and move around. Filing, making copies, or performing other functions can provide
    that micro-break which allows you to increase your circulation, relieve tension and improve your
    mental attitude. Try stretching while you are taking a micro-break to get your limbs working
    freely again.

Instructions: Check each area covered in the inspection form. For every "No" box checked, describe the situation
and needed corrective action at the end of the checklist or on a separate sheet of paper.

        Are all areas kept clean and orderly?
        Are areas where people walk free of boxes, wastebaskets, chairs and other obstacles that impede
        Are floors, aisles, and passageways kept clean and dry and all spills cleaned up immediately?
        Are floors and carpets in good repair?
        Are floor elevation changes (step up at door, edge of ramp, etc.) clearly marked?
        Is lighting adequate?
        Are restrooms kept clean with dry floors?
        Are employee parking lots clean, free of tripping hazards, well lighted?
        Are procedures established for snow and ice removal? Tools and supplies available?

        Are desk or file drawers left open?
        Are file cabinets bolted to each other and/or the wall?
        Are file cabinet interlocks preventing more than one drawer at a time from being open provided,
        Are file cabinets loaded evenly to avoid top-heaviness?

        Are shelving units and racks strong, stable, free from damage?
        Are shelving units and racks loaded within the limits of their capacity?
        Is storage neat, stable?
        Are heavy, bulky items stored in low and middle shelves; frequently handled items in shelves
        between knuckle height and shoulder height?
        Where needed, are appropriate ladders readily available for access to higher shelves?
        Have all employees been instructed in safe lifting techniques?
        Are employees prohibited from climbing on racks, shelves? (Shelves show no evidence of being
        climbed on?)
        Where light bulbs are subject to contact or damage, are protective sleeves or other guarding

        Are stairway handrails, treads and risers in good condition?
        Are all stairs free of litter, spills, other tripping, slipping hazards?
        Are all stairways adequately lighted?
        Are step risers on stairs uniform from top to bottom?
        Are there standard stair rails (34") on all stairways of more than four stairs (On all open sides or,
        where there are walls, on both sides, or at least the right side, descending)?

     Are ladders in good condition (no cracked side rails or rungs; no loose, missing or damaged
     hardware; no unauthorized repairs; etc.)?
     Have defective ladders been removed from service for repair or destruction and tagged as
     "Dangerous Do Not Use"?
     Is it prohibited to stand on the top 2 steps of an ordinary stepladder?
     Are all rolling ladders maintained in good condition (no bent casters, locking mechanism operating,
     frame not bent, etc.)?

     Are transparent glass doors marked (decals, etc.) so they will be seen?
     Are closing mechanisms on doors properly adjusted?
     Are all exits marked with an exit sign and illuminated by a reliable light source?
     Are all exits always kept free of obstructions?
     Is the direction of exits, when not immediately apparent, marked with visible signs?
     Are evacuation route maps posted at main traffic points?
     Are doors or other passageways, that are neither exits nor access to an exit, and located where they
     may be mistaken for exits, marked "Not An Exit", "Storeroom", etc.?

     Are non-hazardous chemicals substituted for hazardous ones whenever possible?
     Are flammable liquids properly stored in safety cans?
     Are all flammable aerosols stored in closed cabinets or storage rooms?
     Is there a formal, written Hazard Communication program?
     Is there an inventory of all hazardous chemicals used (photocopy supplies, cleaning solutions, etc.)?
     Is there an up-to-date Material Safety Data Sheet (MSDS) for every chemical on the inventory?
     Have all employees exposed to hazardous chemicals been trained per Hazard Communication
     program requirements?

     In the absence of a nearby clinic or hospital, is there always at least one employee on duty currently
     qualified to render first aid?
     Are approved first-aid supplies readily available, inspected, and replenished?
     Are emergency phone numbers (ambulance, doctor, fire department, etc.) posted?

     Are fire extinguishers fully charged and mounted in designated places?
     Are extinguishers located along normal paths of travel?
     Are extinguishers free from obstruction or blockage?
     Are extinguishers not mounted too high? If less than 40 lbs., the top must be below 5' above floor -
     greater than 40 lbs., the top must be below 3 1/2' above floor.
     Are all extinguishers checked monthly to see if they are in place and ready for use?
     Are fire drills conducted at least annually?
     Are combustible materials stored away from machinery, appliances, heating equipment, and electrical
     Are doors to enclosed stairwells kept closed at all times?
     Are "No Smoking" rules enforced?
     Are areas where smoking is permitted designated and appropriate ashtrays provided?
     Are areas where smoking is permitted located away from combustible storage, waste bins, etc.?

     Is all power transmission equipment on machinery properly guarded (e.g. belts and pulleys, chains
     and sprockets, rotating shafts, gears, etc.)?
     Is all equipment with an electric motor or any electrical connection effectively grounded?
     Is machinery turned off when not in use?
     Are all fan blades 7' or less from the floor guarded in such a manner that there exist no openings
     greater than 1/2"?


     Is electrical equipment accessible and in good repair?
     Are exposed wires, frayed cords, deteriorated insulation repaired or replaced promptly?
     Are covers in place on all electrical boxes, outlets, switches, etc.?
     Are computers, other electronic equipment protected by appropriate surge protection?
     Are all cord-connected electrical appliances, tools and equipment (such as vacuums, polishers,
     vending machines, drills, etc.) effectively grounded (3-wire cord & 3-prong plug) or of the approved
     double-insulated type?
     Are electrical cords arranged so as not to create a tripping hazard?
     Are all disconnects and circuit breakers labeled to indicate their use or equipment served?
     Are adequate numbers of receptacles provided, in the correct locations, to provide power for cord-
     connected equipment?

     Is employee Job Safety and Health Protection poster (OSHA or equivalent state poster) prominently
     Have occupational injuries and illnesses, except minor injuries requiring only first aid, been recorded
     on the OSHA 300 log?
     Is appropriate back-up documentation available for each case recorded on the OSHA 300 log?
     Is the summary of occupational injuries and illnesses posted from Feb 1 to April 30 each year?
     Have all OSHA records been retained for a period of five full years following the year to which they

            Office Ergonomics: Trouble Shooting
This checklist presents a few of the more common potential ergonomic problems that might be
observed in VDT workers. The list is only a guideline and is not a substitute for a thorough
understanding of ergonomic issues. All possible interventions are tentative. Many possible
conditions and interventions are not shown. Also, be aware that some interventions may cause
other problems.

                                                       Possible Interventions,
                                                    Depending on Further Analysis
Things to Look for
                                                    4   Telephone headset
Prolonged hunched or elevated shoulder while
                                                    4   Habit training
holding the phone
                                                    4   Lower work surface
Elbows splayed out (shoulder abduction)
                                                    4   Lower chair armrest or remove
                                                    4   Bring chair armrests in closer
                                                    4   Habit or tension training
Elevated or tensed shoulders
                                                    4   Lower work surface or keyboard
                                                    4   Lower chair armrests or remove
                                                    4   Raise chair (keep floor alignment)
                                                    4   Document holder
Twisting the head to the side
                                                    4   Bring viewed item closer of centerline of view
                                                    4   Telephone headset
Elbow flexed or shoulder raised for long periods
                                                    4   Habit training
using the telephone
                                                    4   Pad or round surfaces, corners and armrests
Elbow or forearm resting for long periods on hard
                                                    4   Telephone headset
or sharp work surface, chair armrests
                                                    4   Remove armrests
                                                    4   Habit training
                                                    4   Habit training
Wrists bent to the sides when using side keys
                                                    4   Shift keyboard L/R toward dominant hand
                                                    4   Different keyboard with more accessible
                                                        keys or split keyboard design
                                                    4   Habit training
Wrists bent up to the sides when using side keys
                                                    4   Shift keyboard L/R toward dominant hand
                                                    4   Different keyboard with more accessible
                                                        keys or split keyboard design
                                                    4   Habit training
Wrists bent up (extended), down (flexed ≥ 1½ “)     4   Wrist rest/Palm rest
for prolonged periods                               4   Change keyboard or mouse design
                                                    4   Lower, raise or change slope of keyboard,
                                                        work surface or chair
                                                    4   Habit training
Wrists or palms resting for long periods on hard
                                                    4   Wrist rest
or sharp keyboard or work surfaces
                                                    4   Padded or rounded surfaces, corners
                                                    4   Habit training
Hands held actively over the keyboard during
                                                    4   Wrist rest
keying pauses
                                                    4   Greater work variety
Rapid, sustained or prolonged keying
                                                    4   Aggressive break schedule, microbreaks
                                                    4   Reduce overtime
                                                    4   Flexing exercises
                                                    4   Habit training
Forceful keying, key pounding
                                                    4   Light-touch keyboard

                                                  4   Mechanical aids (e.g., electric stapler or
Significant amounts of hand stapling, punching,
lifting or other forceful exertions, especially
                                                  4   Reduce size of lifted loads
combined with awkward postures
                                                  4   Bring heavy loads close to the body, at a
                                                      medium height
                                                  4   Substitute sliding (across work surface) or
                                                      wheeling (across floor)
                                                  4   Sharpen letter openers
                                                  4   Cushion contact surfaces
                                                  4   Mouse close to body, same level at
Prolonged mouse use
                                                  4   Keyboard tray extension
                                                  4   Greater work variety
                                                  4   Aggressive break schedule
                                                  4   Alternate hands
                                                  4   Alternative pointer devices
                                                  4   Arm support
                                                  4   Change mouse type
                                                  4   Greater work variety
Prolonged sitting, especially in one posture
                                                  4   Aggressive break schedule; microbreaks
                                                  4   Char that supports posture change, through
                                                      movement, size or easy adjustability
                                                  4   Habit training
                                                  4   Check chair fit
                                                  4   Monitor swivel in-out
                                                  4   Sit-stand work surface
                                                  4   Backrest separately adjusted from seat
Lumbar back area not supported
                                                  4   Lumbar cushion
                                                  4   Backrest height and tilt
                                                  4   Habit training
                                                  4   Avoid sitting in middle of chair
                                                  4   Check chair fit
                                                  4   Change chair
Feet dangling, not well-supported, or a posture
                                                  4   Lower chair
that seems to put pressure on the backs of the
                                                  4   Lower work surface
                                                  4   Habit training
                                                  4   Footrest (last resort)
                                                  4   Check workload and organization
Chair backrest not used for long periods
                                                  4   Check chair fit
                                                  4   Habit training
                                                  4   Frequently-used items within easy reach
Twisted torso
                                                  4   Rearrange work
                                                  4   Provide more knee space
                                                  4   U-shaped work surface
                                                  4   Swivel chair
                                                  4   Rearrange work
Frequent or prolonged leaning or reaching
                                                  4   Mouse pad armrest
                                                  4   Bring mouse closer to keyboard
                                                  4   Bring keyboard closer to body
Abducting the shoulder to reach mouse or
                                                  4   Mouse pad/armrest
                                                  4   Bring mouse closer to keyboard
                                                  4   Shield light sources
Light sources that can be seen by the work
                                                  4   Rearrange work area
(direct glare)
                                                  4   Shield light sources
Reflected glare on the screen or off desk and
                                                  4   Shade screen
wall surfaces
                                                  4   Adjust screen angle
                                                  4   Rearrange work area
                                                  4   Lower light levels

                                                    4   Move light sources
                                                    4   Matte finish on desk
                                                    4   Pastel color on wall
                                                    4   Change fluorescent filter to grid type
                                                    4   Lower ambient light levels
Too much contract between screen and
                                                    4   Turn off or dim task lights
surroundings or document; worker feels relief
                                                    4   Remove visual clutter behind screen
when bright areas are shielded
                                                    4   Change color scheme on walls or screen
                                                    4   Use task lighting and lower ambient light
Very bright ambient lighting (above 500 lux or 50
                                                        levels to 200-500 lux (20-50fc)
fc) or shadowed areas caused by over-
                                                    4 Habit training
Monitor closer than approximately 40 cm (16
                                                    4 Push monitor back
                                                    4 Increase desk area
                                                    4 Computer glasses
                                                    4 Bring keyboard forward, possibly with a
                                                      keyboard tray
                                                    4 Use document stand or other equalize
Different viewed objects (screen, documents) at
                                                      distances between to within 10 cm (4 inches)
different distances from the eyes
                                                    4   Change monitor and/or document stand
Screen or documents not oriented perpendicular
to the line of sight
                                                    4 Habit training
Prolonged near-focusing throughout the day with
                                                    4 Rearrange space to provide view
few far-focusing opportunities
                                                    4 Eye fatigue reduction exercises
                                                    4 Adjust monitor
Monitor image dim, fuzzy, flickery, small or
                                                    4 Upgrade monitor
otherwise difficult to read
                                                    4 Use software to enlarge image
                                                    4 Adjust monitor
Shiny, low-contrast or small print documents
                                                    4 Use magnifier for documents
                                                    4 Improve lighting on document if documents
                                                      cannot be changed
                                                    4 Check for monitor image quality problems,
Forward position of the head (peering) or
                                                      monitor distance or lighting
                                                    4   Check environment – temperature, humidity,
Eyestrain complaints
                                                    4   Habit training
                                                    4   Eye fatigue reduction exercises
                                                    4   Check all aspects of visual environment
                                                    4   Check monitor adjustments
                                                    4   Suggest consultation with vision specialist
                                                    4   Adjust chair
Neck extended backwards, head tilted back,
                                                    4   Lower monitor
even slightly
                                                    4   Remove CPU
                                                    4   Check for bifocals and suggest full-frame
                                                        “computer glasses” prescription
                                                    4   Raised document or monitor to a
Neck flexed (downward)
                                                        comfortable height
                                                    4   Adjust chair or work surface
                                                    4   Adjust posture
                                                    4   Habit training
                                                    4   Check glasses

                                             Ladders and Scaffolding
Electrocution and falls are the two most critical types of injuries resulting from work on ladders and
scaffolding. Other hazards include splinters, slivers, and slips resulting in sprains, strains, bruises,
and abrasions.

The following safety procedures will aid in the prevention of accidents and possible injuries:

       •   Choose the right ladder for the job. The ladder should be the correct type, length, and
           capacity for the job.
       •   Inspect the ladder before you use it. Never climb a ladder that has broken, bent or loose
           rungs, cracks, exposed screws or other missing parts. Remove defective ladders from
       •   Do not use metal ladders or wet wood ladders in the vicinity of electrical circuits.
       •   Periodically inspect wooden ladders. Wooden ladders shrink over time causing steps or
           back bar members to become loose. Hold the rods beneath the steps with pliers and
           tighten the nut at the end with a wrench to maintain strength and steadiness. If rungs or
           other parts are broken or missing, the ladder should not be used. Remove it from service
           and mark it so others do not use it.
       •   Wooden ladders or scaffold planks should not be painted as defects may be covered up
           by paint. Use a good grade of spar varnish, or a mixture of linseed oil and turpentine to
           preserve the wood.
       •   Nonskid feet should be used on all straight and extension ladders.
       •   Straight ladders form a triangle when placed against walls or objects for climbing. Follow
           the 4-to-1 Rule for a stable ladder – for every 4 feet of ladder height, position the base 1
           ft. away from the vertical surface (i.e. if the ladder is leaning eight (8) feet high against a
           wall, the feet should be set two (2) feet from the wall). Ladders should never be placed
           against window sashes or doors.
       •   When ladders are used to access a roof or other landing, the side rails must extend at
           least three feet above the landing. If this is not possible, then the ladder must be
           secured, and a grab rail or other device should be used to help workers get on and off the
           ladder safely.
       •   Secure the ladder in position by using hooks, ropes, spikes, cleats, or other anti-slip
           devices, or by stationing an employee at the base of the ladder to hold it in position.
           Check the ladder stability before taking your first step.
       •   As you climb or descend always face the ladder and keep a 3 point contact with the
           ladder; that is, two hands hold while one leg moves, or one hand moves to the next rung
           while both feet maintain a solid base.
       •   Never stand on the top 2 steps of a stepladder or the top 3 rungs of an extension ladder.
       •   Avoid overreaching. Never lean the center of your body out past the side rails. “Keep
           your belt buckle between the rails”.
       •   Only one person should be on a ladder at a time.

      •   Do not carry tools or materials by hand while climbing ladders. Use a hand line to raise
          and lower tools and materials, or carry them in a tool belt. Hands must be kept free to
          grasp the ladder while climbing.
      •   Don’t use chairs, tables, boxes, etc. as makeshift ladders.
      •   Clean muddy or slippery shoes before climbing.
      •   Keep rungs clean and free from grease and oil.
      •   If it is necessary to place a ladder near a door or where there is potential traffic, set up
          warning signs and use any other precautionary measures needed to ensure that the
          ladder will not be struck by anyone or anything.

Scaffolding is often used to access work areas, and if assembled properly, can be a safe working
platform. However, for any scaffold to be safe, certain safety precautions and policies should be

      •   Supervision is required while employees are erecting scaffolding. Do not attempt to erect
          scaffolding if you are not technically qualified to do so.
      •   Scaffolds should meet all safety requirements before any worker climbs it. If the scaffold
          is damaged or deteriorated, it may be unsafe, and should not be used.
      •   Scaffolds should be plumb, square, and rigid. This will ensure the most secure and
          stable work platform. When erecting scaffolding, do not force braces to fit. Adjust and
          level the scaffolding until the braces fit easily.
      •   All braces should be fastened securely. Use the proper pins - bent wire or welding rods
          are not adequate. If additional pins are needed, contact your supervisor.
      •   Planks and other materials used to build scaffolding must be sound and free from knots.
          Walk boards should be scaffold grade lumber or manufactured walk boards. Planks
          should be kept in good condition with a spar varnish. DO NOT paint the planks.
      •   Planks should be adequately cleated. Scaffolding should have toe boards, mid-rails, and
          handrails at any level where employees are working. Allow enough overlap in walk
          boards to ensure they will not slip off. Unsupported ends of walk boards should not
          extend more than 18 inches beyond the end of the scaffolding.
      •   Tools on top of the scaffolding are apt to fall and injure someone. Tools should be kept in
          a bucket or box that has been strapped to the scaffolding. In addition, anyone working
          below or surrounding the scaffold should wear a hard hat while in the job area.

                                                                            Hand Tools
Disabling injuries, such as metal chips from mushroomed chisel heads flying in an eye, do happen.
Injuries to fingers and hands are a common occurrence. Often the injuries occur because the
wrong tool was used for the job.

Employees should follow these safety rules when using hand tools:

•   Select the right tool for the job - it’s safer and easier. Do not use a wrench as a hammer or use
    the wrong size wrench for a job.

•   Keep all cutting tools sharp. Always carry cutting tools with the cutting edge

•   Smooth sand the wooden handles of a shovel, rake, maul, etc., thus
    preventing splinters and burns.

•   Check the handle of each tool for tightness.

•   Check the head of each tool, such as hammers, chisels, punches, mauls, and have the tool
    dressed if it is mushroomed (includes burns and chipped edges). All tools, whether public entity
    property or personally owned, should be maintained in first class condition.

•   Wear shatterproof clear goggles or protective eyewear when using hammers, chisels, punches,
    wedges, grinders, drills, wire brushes, etc. Be sure no one is in the area before using such a

•   Gloves save many knuckles from scrapes and scratches. Wear work gloves to protect your
    hands, particularly when working in tight quarters. Gloves are also good for preventing blisters
    and scratches when using rakes, brooms, and garden tools.

•   Never work on energized electrical circuits or equipment unless you are qualified and authorized
    to do so. Use only properly insulated tools (screwdrivers, wire cutters, etc.) when working
    around energized electrical circuits or equipment. A void using metal measuring tapes, fabric
    tapes containing woven metal strands, rope with wire cord, or other tools and equipment that
    have conductive properties.

•   Remember good housekeeping and store your tools in a toolbox or on a workbench. Return
    tools to their proper place so that they do not fall from a ledge or are tripped over, and so they
    will be readily available the next time they are needed.

•   Do not leave your tools in aisles or walkways. If you use a mobile tool cabinet, use the wheel
    brakes so that the cabinet will not be moved carelessly into a work area.

                                                                         Power Tools
Electrical Equipment
Power tools substantially increase the number and types of hazards an employee must be aware of
to operate the equipment safely. Because of the extreme mobility of power tools, they can come in
contact with fingers, hands, and other body parts. Hazards can also include electrical shock due to
a short circuit, or being struck by chips, shavings, and other debris during operation.

•   All electrical tools used must be grounded by connecting a three-wire cord with a polarized
    three-prong plug to a properly grounded three-hole receptacle. In some cases, you may also
    encounter double insulated tools that also provide reliable shock protection, even though they
    have a two-prong plug. Double insulated tools are permanently marked either by label or
•   If extension cords are used, they must be of the three-conductor type with matching plug and
    receptacle. This will help ensure proper grounding for those tools that are not double insulated.
•   Visually inspect each electrical tool or machine for damage to cords and ground connections
    prior to use. The most common defects occur at the points where the cord is attached to the
    tool or where the cord is attached to the plug.
•   Where electrical equipment is used in a wet location, use only low voltage equipment and wear
    rubber boots and rubber gloves.
•   OSHA has ground-fault protection rules and regulations for construction sites. It is the
    employer’s responsibility to provide either: (a) ground fault circuit interrupters (GFCIs) for
    receptacle outlets in use and not part of the permanent wiring of the building or structure; or (b)
    a scheduled and recorded assured equipment grounding conductor program, covering all cord
    sets, receptacles which are not part of the permanent wiring of the building or structure, and
    equipment connected by cord and plug which are available for use or used by employees.

    The employer is required to provide approved GFCIs for all l20-volt, single-phase, 15- and 20-
    ampere receptacle outlets on construction sites that are not a part of the permanent wiring of
    the building or structure and that are in use by employees. If a receptacle or receptacles are
    installed as part of the permanent wiring of the building or structure and they are used for
    temporary electric power, GFCI protection must be provided. Receptacles on the ends of
    extension cords are not part of the permanent wiring and, therefore the cord’s receptacle must
    be of the GFCI type, whether or not the extension cord is plugged into permanent wiring. This
    protection is required in addition to, not as a substitute for, the grounding requirements of OSHA
    safety and health rules and regulations, 29 CFR 1926.

Powered Machines, Tools, and Equipment - General
•   One or more methods of machine guarding must be provided to protect 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. Examples of guarding methods are-
    barrier guards, two-hand tripping devices, electronic safety devices, etc.
•   Never operate power tools or equipment unless you are trained and authorized to do so.
•   Always use the guards provided. If guards are damaged or missing, tell your supervisor and do
    not use the equipment until guards are replaced or repaired. Guards must be in place and
    properly adjusted.
•   Always wear required personal protective equipment. If you are not sure what is required, ask
    your supervisor.
•   Never make adjustments to a machine while it is running.
•   Disconnect electrical power when changing blades, bits, etc. or anytime an injury could occur if
    the machine is accidentally turned on. Generally this requires that powered hand tools be
    unplugged or the circuit breaker turned to the off position. Fixed equipment should have the
    disconnect moved to the off position. Lockout/Tagout program requirements must always be
•   Tools such as shop drill presses and floor stand grinders that are used in a fixed location must
    be bolted to the floor to prevent movement or ”walking” during use.
•   Practice good housekeeping. Do not use tools, machinery, or equipment in crowded or
    congested areas, or where objects can fall into moving parts. Keep work benches and shop
    areas clean.

•   Only those employees who are familiar with the mounting of grinding wheels are permitted to do
    so. A ring test on each new grinding wheel should be completed before installation. (A ring test
    is made by supporting the wheel freely on a rod and tapping it lightly with a wooden object. A
    clear, metallic ring indicates an absence of cracks).
•   The abrasive wheel must fit easily onto the spindle. Too loose or too tight is dangerous.
•   When the wheel is mounted, stand out of danger at one side while you allow it to develop full
    operating speed for at least one minute. Keep co-workers out of the area while the wheel is
    being tested.
•   Apply work gradually to a cold wheel at the beginning of each grinding task since cold wheels
    are most subject to breakage.
•   Never store a grinding wheel on damp or concrete surfaces, nor put oily rags on the wheel.
•   Every grinding tool must be securely fastened to the shaft before commencing work.
•   The maximum rated operating speed by the wheel manufacturer is on the wheel label; wheels
    are not to be operated in excess of these speeds. The speed of the grinder (as shown on a
    plate on front of the grinder) must never exceed the speed rating of the wheel.
•   Appropriate guarding should be in place on stationary grinders to enclose unused portions of
    the wheel and the spindle end. A peripheral or tongue guard should be in place to block chips
    for being thrown out toward the operator should the wheel break. This tongue guard should be
    adjusted to ¼” of the grinding wheel.

•   The work rest must be securely adjusted on all stationary grinders to within 1/8 inch of the
•   Avoid using the side of a wheel for grinding, unless it is especially designed for side grinding.
    Side grinding weakens the ordinary wheel and may cause it to burst.
•   Use the cutting surface of a grinding wheel uniformly, as a grooved wheel has been
    dangerously weakened.
•   Grinder bearings must be kept properly oiled and adjusted. This will help to prevent hot
    bearings and spindles, which are sometimes responsible for melted bushings.
•   Do not abuse the wheel by applying excess pressure.
•   Be particularly careful when grinding narrow tools or other objects because they can catch
    between the work rest and the wheel.
•   The operator's eyes must be protected with goggles at all times when the machine is in use.

Drill Press
•   Adjust the table so that you have plenty of room for the jib and keep your hands away from the
    revolving drill. Never run the point of the drill into the table.
•   Be sure that both the chuck and the drill are tight on the spindle, and that any circular tables are
    tightened before beginning to drill.
•   Do not wear loose clothing, gloves, rings, watches, or bracelets while working with a drill press.
•   Never leave the key in the chuck after tightening the drill. If setscrews protrude, report it to your
•   Materials being drilled must be clamped or fastened to the drill press bed, never held by hand.
    Many serious hand injuries occur when a hand held piece is rotated by the drill.
•   A sluggish drill is probably the result of incorrect grinding. Be sure the drills are sharpened
    properly for the particular material, so that the cut may be the right size.
•   Reduce the pressure if there is any backlash in the spindle. Listen carefully for the distinctive
    noise made when the drill comes through work so that you can ease off the pressure.
•   Never run a drill faster than the rated speed. This may result in broken drills, damaged material
    and serious injury.
•   It is dangerous to attempt the removal of broken drill pieces with a center punch and hammer.
•   Lower the spindle close to the table before removing the chuck, so that it may not cause any
    injury or damage to the material as it falls.
•   The safety stop must be set to keep the over arm of a radial drill from swinging out where it may
    cause an injury.

Lathe Operations
•   Ground lathe tools - so that the chips will break off instead of curl. Only lathe dogs equipped
    with setscrews are to be used.
•   Make sure that all gear and belt guards are in place. This includes backgears and ingears,

•   Whenever chucks or faceplates are changed, they must be started on the spindle by hand
    power. Keep hands off chuck rims when lathe is in motion.
•   After adjusting a chuck, be sure to remove the chuck wrench immediately. See that the tailstock
    tool-holder and material are properly clamped before turning on power.
•   For external work, never set the lathe tools below the center of the work being turned.
•   Use a brush to remove chips. Do not use compressed air.
•   Wear only short sleeves when filing on a lathe. When near the chuck end or head stock, file
    with right hand over the lathe stock instead of the left hand, holding file in such a position that in
    case it is forced back, the hand will not be forced against the body.
•   The operator's eyes must be protected with goggles at all times when the machine is in use.

Compressed Air
Do not use compressed air for cleaning purposes except where reduced to less than 30 P.S.I. dead
end pressure and then only with effective chip guarding and personal protective equipment.
Compressed air is not to be used for personal blow-off at any time.

Woodworking Machinery
•   Always use the guards provided. If guards are damaged or missing, tell your supervisor and do
    not use the equipment until guards are replaced or repaired.
•   Never tie back or otherwise defeat a guard or other safety device.
•   Machine guards are to be permanently attached.
•   If you are running short or narrow stock, protect your fingers by using a push block.
•   If a saw binds in a cut, the saw must be shut off before attempting to dislodge the lumber.
•   Do not use a rip saw for cross-cutting, or a cross-cut saw for ripping. A spreader and kickback
    fingers are required when using a rip saw. A spreader is required when using a cross-cut saw.
•   Learn to stand out of the line of a possible "kick-back" and to avoid the danger of being struck
    by the small pieces that are frequently thrown from a circular saw.
•   Never reach over any machine to get finished materials from the opposite side, to remove dust
    or wood particles from the saw table, or to oil the machine while it is in operation.
•   When using a jointer, never allow either hand to pass over the knife. Use both hands, one on
    each side of the material, using particular care at the start and finish.

Gas Welding
•   Keep all gas welding equipment and connections free from gas and oil.
    (Oxygen will explode upon contact with oil or grease). Oily and greasy
    gloves may bring about the same effect, besides making it difficult to
    handle the cylinders.

•   Wear appropriate personal protective equipment when welding. Wear proper goggles and
    gloves. Employee should wear steel-toed shoes.
•   Never roll tanks on the floor, nor attempt to carry them by hand or hoist unless properly slung.
    Cylinders must be securely chained at all times.
•   Securely fasten acetylene and oxygen tanks in an upright position with a chain and store them
    where there is no danger of their falling or being bumped. All cylinders in storage should be
•   Never lay acetylene cylinders on their side.
•   Use a standard green oxygen hose with right hand couplings, together with a red acetylene
    hose with left-hand thread.
•   Blow out the tank valve before attaching the regulator. Never use compressed air for blowing
    out equipment since air may contain some oil and moisture. Use oxygen to blow out the oxygen
    hose and acetylene to blow out the acetylene hose.
•   Do not use damaged equipment. Check hoses and replace if damaged.
•   Use welding curtains where appropriate to protect other employees and to prevent spreading
    sparks and starting a fire.
•   Always have a properly charged fire extinguisher readily available where you are welding.
•   Turn off valves when welding rig is not in use.
•   When changing empty tanks for full ones:
       -   Shut off valve on empty tanks
       -   Release thumb screw on regulator
       -   Disconnect regulator, blow out tank valve and connect on full tank.
       -   Stand on opposite side of tank, point the acetylene valve outlet away from the oxygen
           tank and face away from the gauge while operating the tank valve.
       -   Adjust thumb-screw on regulator to proper pressure, making sure that you do not have
           excess oxygen, which only causes unnecessary sparks in operation.
•   Be sure that the end of your torch is cleaned before attempting to light it. Use only friction
•   Do not put the materials in such a position as to permit sparks, hot metal, or the severed section
    of metal to fall on the gas supply hose or the feet of an employee.
•   At the completion of the work, the welder is to inspect the job site to insure that hot articles have
    not been left smoldering which might later develop into a serious fire.

Electric Arc Welding
•   Whenever possible, welding operations should be carried on inside a regular welding booth. If
    work must be performed outside a booth, the arc is to be effectively screened to prevent injury
    to eyes and others.
•   Before entering the welding area, give an effective warning, such as a shout, so that the
    operator will be aware of your presence and help you to avoid a sudden flash or other injury.
•   Like the welding operator, any person entering the welding area is required to wear eye

•   The welding of galvanized material requires the operator to be protected with a specially
    designed airline respirator that fits under the helmet.
•   Deposit short ends of welding rods in containers made for that purpose to prevent burning holes
    in your shoes or starting fires.
•   When not in use, place the electric holder where it cannot cause an arc.
•   Avoid an injury to yourself from short circuits by using welding cables that are in good condition.
•   Only properly authorized operators may use welding equipment. Never attempt to repair
    welding equipment yourself.
•   Use helmets and shields with all electrical welding. Do not remove your helmet while bending
    over a hot weld.

Lawn Mowers

•   Refuel the lawn mower before you start, while the motor is cold. Start and refuel mowers
    outdoors, not in a garage or shed.
•   Keep all safety devices, switches, guards, and shields in place and working. Shut the engine off
    before servicing.
•   Do not leave power mowers unattended with the motor running.
•   Inspect the area to be mowed for foreign objects. Remove wire, stones, bottle caps, sticks,
    etc., before mowing.
•   The operator should warn bystanders about the danger of flying objects. Extreme precaution
    must also be taken when there are children in the immediate area.
•   Always keep your hands and feet away from the undercarriage of the mower. Never reach
    near the undercarriage to remove jammed materials, sticks, or objects blocking the mower
•   For proper traction, mow when the grass is dry. Avoid sudden stops or starts.
•   With riding equipment on hillsides, mow up and down the slope -- not across. With non-riding
    equipment, mow across the slope--not up and down -- there is less possibility of slipping into
    the mower or having the mower slide over the feet.
•   After mowing is completed, remove dirt, grass, etc., from the top of the mower; and place
    mower in dry location under cover.
•   Operators of power mowers are to wear steel-toed shoes.
•   Power lawn mowers must not be lifted or tilted off the ground while the motor is running.
•   When refueling the mower, turn off the mower and allow the engine to cool. Never smoke
    during refueling operations.

                                  Working in Confined Spaces
Some employees may frequently required to work in confined spaces. OSHA defines a confined
space as those work spaces which are adequate in size and configuration to allow employee entry
but which are not designed for continuous human occupancy and which have limited or restricted
means of entry or exit. Examples are closed storage tanks, storage bins, ductwork, sewers,
tunnels, vaults, manholes, valve chambers and even open pits where heavier than air gases may

Employees may be tempted to adopt an indifferent attitude in regards to the hazards of confined
spaces. It is often particularly difficult to convey the hazards of a potentially deadly atmosphere
when an atmospheric hazard cannot be seen or detected by our senses. The records are full of
stories about people trapped in confined spaces and overcome by gases, vapors, lack of oxygen,
etc. Many of these tragedies were compounded when other workers or emergency personnel
entered the confined space in an attempt to perform a rescue and were themselves overcome.

The hazards of confined spaces include flammable or explosive gases or vapors, toxic gases or
vapors, and not enough oxygen to support life. They can kill with frightening efficiency and lightning
speed. Some gases and vapors are colorless, odorless, and tasteless. With some, a very small
amount can be dangerous.

When employees enter manholes for sewer repair, cleaning, checking electrical circuits, etc., there
may be hazardous gases, or a lack of oxygen present. These hazards may be caused by natural
sewer gas decomposition, spills of chemical compounds, or seepage through the ground.

The protection against these hazards involves adequate precautionary measures. Pre-planning,
education, and established confined space entry procedures must be established to protect
employees from the hazards that can be encountered in a confined space. Air monitoring
equipment must be available to detect oxygen concentration and the presence of explosive gases
or vapors, or other toxic gases. If tests indicate danger, the area should be purged of dangerous
atmospheres whenever possible. Whenever it is necessary for a worker to enter a space that is
potentially hazardous, appropriate work practices must be followed.

OSHA has developed a regulation on confined spaces that requires established entry procedures
(29 CFR 1910.146). The OSHA regulation is a good reference for developing a program.
Appendices in the regulation show sample written programs, sample entry permits, etc. All
departments that encounter confined spaces shall develop a permit system and entry procedures to
meet OSHA requirements and that these guidelines be strictly followed.

The following safety procedures should be established:
      •   All supervisors, designated stand-by personnel, and entry personnel should be fully
          trained on the hazards of confined spaces. Everyone involved should understand each
          and every entry procedure, and why that procedure is important to their safety. Before an
          entry occurs, refresher training may be appropriate, and if special hazards or unusual
          conditions are present - this training session will provide an opportunity to address all
          safety requirements.
      •   Before entering confined spaces, know your permit entry requirements and perform tests
          to determine oxygen concentration and whether explosive or toxic gases or vapors are
      •   Venting of hazardous atmospheres shall be accomplished before entering whenever
      •   Maintain adequate ventilation while working.

      •   When using portable blowers to ventilate, make sure the air intake will not pick up carbon
          monoxide from the engine. Never use gasoline blowers near confined spaces containing
          flammable gases unless adequate separation is maintained between confined space and
      •   Appropriate respiratory equipment (SCBA or airline respirator with escape bottle) should
          be available for use as necessary. Any employee required to enter a confined space
          must be instructed about the nature of the hazards involved, the necessary precautions
          to take, use and care of personal protective equipment, and use of emergency equipment
      •   No employee should enter a manhole, sewer, tank, or other underground confined space
          without a safety belt or harness and attached lifeline that is tended by another employee
          at the point of entry.
      •   Smoking or open flames should be prohibited in any underground operation and in any
          confined space.
      •   When opening manholes in streets, use barricades and warning signs with lights at night
          to protect pedestrian traffic and to alert vehicular traffic to the hazard.
      •   Never allow exits to be blocked.
      •   Ladders should be used when entering manholes if there is any question about the safety
          of manhole steps.
      •   Only explosion-proof lights and equipment, approved and provided by the Entity, should
          be used in manholes and sewers.
      •   No gasoline or diesel motor should be operated in any enclosed place or confined space
          unless the exhaust is connected to the proper outlet.

The above information outlines basic facts you should be aware of if you perform confined space
entry. If you have any questions about other confined space entry requirements or need additional
details, you should contact your supervisor. OSHA's Permit Required Confined Space Standard,
1910.146, outlines minimum safety standards for entry. The requirements of this standard should
be met, and exceeded if possible, to ensure employee safety when performing any type of confined
space entry work.

                           Refuse Collection and Disposal
                                        Utility Equipment
Garbage trucks and other utility equipment operate under a wide range of conditions that affect
safety. Conditions such as weather, road surfaces, traffic, types of refuse handled, etc., demand
skill, alertness, and judgment by employees performing collection tasks. Exposure to traffic hazards
is a daily experience. Skilled driving techniques are essential. Awareness of traffic is essential to
the safety of employees who are physically in the street while collecting and loading refuse.

Perhaps of greatest concern is the process of compaction. Compaction in a refuse packer unit is
powerful enough to crush a telephone pole. Imagine what would happen to an employee who was
trapped or pulled into the unit. Refuse collection employees should never push an item into the
hopper, or try to retrieve an item from the hopper after the packet plate has been activated. The
risk is too great.

Refuse collection / hydraulic operations have identified the following hazards in collection tasks:

      •   Amputations, fractures, bruises, and dislocations caused by employees who have been
          caught in a pinch point created by packer mechanisms, mechanically loaded trash bins,
          or raised portions of the truck body when they are loaded.
      •   Sprains, strains, and hernias caused by improper handling of containers and/or improper
          lifting procedures.
      •   Sprains and strains caused by losing one's balance, and slips/falls while carrying
          containers over slippery or uneven surfaces.
      •   Being struck by particles thrown from the hopper during compaction cycles.
      •   Being struck by tailgate assembly after the compaction cycle started when the clamps on
          each side were not secured.
      •   Sprains and strains caused by inattentive employees dismounting the truck and/or
          employees who deliberately jump off of, or onto, the riding steps while the truck is in
      •   Being thrown from the rear step by unnecessary rough operation of the vehicle.

      •   Employees should be mentally alert and in good physical condition to perform refuse
          collection tasks. Adequate rest is required. Overindulgence in alcoholic beverages while
          off duty could affect the next duty period.
      •   Employees who are taking medicines or drugs that could affect their ability to perform
          refuse collection tasks in a safe manner should notify their supervisor.
      •   Employees should take pride in their equipment. Trucks should be washed and cleaned
          on a regular basis.
      •   Drivers should be alert to the safety of other employees, bystanders, and particularly
          children when the refuse compaction equipment is in operation.

Inspection of Equipment
    •   Make sure that the turn signals and brake lights on trucks and equipment are clean.
        They should be checked regularly to prevent them from becoming covered by dirt,
        grease, ice or snow, etc. This protection is for you and other motorists, especially during
        inclement weather.
    •   Make sure that the brake pedal is not worn down to the metal. A smooth brake pedal,
        especially during inclement weather could cause the driver's foot to slip and create the
        potential for an accident.
    •   Trucks and equipment should be inspected at the beginning of each route or activity.
        Particular attention should be paid to hydraulic lines. If visual inspection indicates a
        possible leakage, do not use the equipment until it has been examined and released by a
    •   Read and implement all inspection safety rules in the "Motor Vehicles and Mobile
        Equipment" section.
    •   The hopper or cargo space should not be entered for inspection or maintenance until
        proper action has been taken to lock out the power source and tag it.
    •   Any parts that could move or fall due to a loss of hydraulic pressure should be locked in
        place so that an employee can not be crushed or caught by these moving parts.

Mounting and Dismounting
    •   Employees should never mount or dismount from either the cab or the riding steps while
        the truck or equipment is moving; employees should wait until the truck or equipment has
        completely stopped.
    •   The "Material Handling" section should be carefully studied as it relates to proper lifting
        techniques. Supervisors shall be responsible for advising employees of proper lifting
    •   When streets are zoned for two-way traffic, refuse collection shall be operated only to the
        right of the centerline of the street. Employees are not to cross the centerline to pick up
    •   Refuse collection procedures on one way streets that normally contain heavy traffic may
        require vehicles to operate on one side only. The supervisor shall make this decision.

Manual Materials Handling
    •   Plastic bags may contain sharp, pointed objects that can puncture the bag and inflict
        injury to unsuspecting employees. Carefully feel plastic bags to check for sharp objects
        before picking them up. Employees are required to wear gloves.
    •   The handles on metal refuse containers should be carefully inspected. If they are rusty
        or appear to be weak, employees should not use them to lift the container.

Compaction Operators and Vehicle Drivers

    •   When two or more employees are loading refuse into the hopper of a refuse packer unit,
        one should be designated to operate the compaction controls. No other member of the
        crew should operate the controls.
    •   The power take-off should be engaged only when requested by the refuse collector
        working at the rear of the truck.
    •   Employees should not place any part of their body into the hopper area while the power
        source (truck engine or auxiliary engine) is running.
    •   Position boards, sticks, glass tubes, etc., in the hopper so that no portion extends beyond
        the sill. Objects that extend beyond the sill could be snapped and thrown in any direction
        with considerable force.
    •   Employees should be extremely careful when operating trucks with hoppers that are not
        equipped with safety doors. Flying objects may be propelled out of the hopper during the
        compaction cycle. Whenever possible, hazardous items such as those listed below
        should be covered with other soft or loose refuse before cycling to absorb flying particles.
        Particular concern for items such as:
            -   Cathode ray tubes or fluorescent light tubes.
            -   Glass containers with residues of corrosive, toxic, or otherwise harmful agents.
    •   Avoid overloading the hopper to the extent that the packer plate or sweep panel cannot
        contain all the refuse being cycled.
    •   The employee that is designated to activate the compaction cycle controls, shall be
        prepared to stop and/or reverse the cycle immediately if such action is required to
        prevent injury to employees or equipment.
    •   Employees should not push refuse into the hopper or place any part of their body in the
        path of compaction machinery once it has been activated.
    •   Employees should not attempt to manipulate any article of refuse that extends into the
        hopper once the compaction machinery has been activated.
    •   The packer unit should not be cycled while the truck is in motion.
    •   Always place the transmission in "neutral" before starting the engine.
    •   Employees should not back up the truck except in cases of emergency.
    •   If it is necessary to back the truck, do so only after all employees are clear of the area.
        One employee should assist the driver with hand signals. If the driver is alone, he should
        dismount and inspect the area behind the vehicle before backing.
    •   If it should be necessary to park the truck on the street for any length of time, park at the
        curb so that all traffic lanes are free. Do Not Block Driveways.
    •   Equipment operators should be aware of all overhead wires, structures, streets, etc., to
        ensure adequate clearance when driving vehicles under them.
    •   Vehicles should be operated in a smooth, even manner, to avoid violent jolts and shocks
        to employees riding on the rear steps. Sudden starts and sudden stops should not be

Unloading Mobile Packer Units
    •   Upon arrival at the designated disposal point, all refuse must be unloaded.

    •   Directions of disposal site attendants should be followed unless they would result in
        personal injury or damage to the vehicle.
    •   Employees should watch for sharp objects that could puncture or cut the tires, or wires,
        etc., that could become tangled in the drive train.
    •   Employees should wait until the truck has come to a complete stop and is in the proper
        unloading position before unfastening turn buckles or latches to unload.
    •   Make sure all employees or other persons are clear before raising the tailgate.
    •   Make sure all employees or other persons are standing clear of the vehicle before the
        dumping controls are activated to discharge the load.
    •   The cargo body should be raised in a smooth and even manner.
    •   Employees should not walk, stand, or sit under the raised tailgate nor should they allow
        anyone else to do so.
    •   Drivers of refuse trucks should visually inspect their vehicles for cracks, broken welds,
        leaking hydraulic lines, etc., while unloading at the disposal site. The helper should be
        required to stay clear of the vehicle. The operator should not walk, stand, or sit under
        any raised portion of the vehicle while making the inspection.
    •   When the tractor trailer type refuse container units are dumping, never operate bulldozers
        beside them or close enough to them to be struck by the container, should the unit tip
        over while it is raised in the dumping position.

Safety and Health
    •   Employees in collection and disposal operations should wear high visibility vests.
    •   All employees should wear steel-toed safety shoes.
    •   Safety glasses should be worn. Safety glasses should be clean and free of scratches.
    •   Personal articles, except for personal protective equipment, should not be stored or left in
        the cab of refuse trucks. Empty soda pop bottles and other miscellaneous articles under
        the seat have resulted in injury to mechanics that have been struck by falling items when
        the cab was tilted.
    •   Refuse handled by employees frequently includes the disposal of garbage that contains
        infectious bacteria. It is important that refuse employees wash frequently with soap to
        avoid infection should they have any open cuts, bruises, etc.
    •   A first aid kit should be kept in each supervisor's vehicle. Its contents are to be inspected
        periodically and items replaced as they are used.

                                                        Construction Safety
Above Ground and Underground Work

Employees are often involved in tasks related to the construction industry. Construction work can
be dangerous and it is important that employees involved in these projects understand dangers and
be trained and equipped to work safely. Workers must be properly dressed for the job, and
supplied with the proper protective equipment, such as hard hats and steel-toe safety boots.

Heavy machinery is employed for special projects, creating potential hazards to inexperienced or
untrained workers. Operators of construction machinery often do not have sufficient visibility to
detect danger to nearby workers, or the ability to avoid an accident by quickly reversing the
controls. This machinery is designed to handle extremely heavy work. Being struck by, or caught
in or between such machinery and its loads, inflicts severe injuries. No bi-directional equipment
should be operated without a reverse direction (backup) alarm.

Public Utilities
Public utilities are often installed in or near the work site of projects to be completed. Contact with,
or damage to utilities may effect the safety of the workers on the job, safety of the general public, or
interruption of essential utility services. The following list includes most of the utilities that
employees must consider:

      •   Electric Company
      •   Water works
      •   Gas Company
      •   Storm drains
      •   Telephone Company
      •   Traffic signals
      •   Sewer
      •   Cable TV
      •   Street lighting

Daily familiarity with these services may cause even experienced employees to treat them too
lightly until a gas explosion, an electrocution, a cave-in, or a loss in vital communication service
occurs. Frequent work in a particular area may lead employees to think they are aware of all
services in the area. However, the rapidly changing demands by today’s society leaves no room for
such confidence. Recent changes may have been made. This attitude must be avoided at all
times. Safety precautions must be a part of job planning. Overhead lines constitute a hazard that
must be considered when operating machinery beneath them. Underground services constitute
many hazards when damaged by digging.
The most immediate dangers to workers lie in their contact with electricity and ruptures in gas
service. Advance planning can minimize such accidents. Utilities should be located and marked
before any digging begins. However, should a digging accident occur, prompt reporting to the utility
company is of prime importance. Escaping natural gas constitutes an explosion potential and
trained personnel must stop the leak as soon as possible. Contact with a primary electrical circuit
constitutes a shock hazard. If rescuers are attempting to remove an injured employee who is still at
the point of contact, the reactivation of the circuit poses additional hazards. Prompt reporting to the
utility company will reduce the potential of compounding the hazard.
Some of the principal hazards affecting employees and/or the public safety are:
      •       Digging that results in gas explosion, electrocution, flash burns, etc.
      •       Rupture of gas, water, and sewer facilities from using mechanical compaction, boring, or
              digging equipment.
      •       Electrocution resulting from contact with overhead electrical wires.
      •       Interruption of electrical service or communication lines from digging, pole collapse, etc.
      •       Fractures, contusions, crushes, etc., caused by being struck by or caught in materials
              and/or machinery.
      •       Suffocation, fractures, strains, dislocations, etc., from trench cave-ins.
      •       Strains from lifting and material handling tasks.
      •       Eye injuries from dust and debris propelled by machinery and/or tools.

Construction accidents can be prevented by planning necessary safety precautions into every job,
determining the locations of all utilities near the job site, instructing workers regarding the hazards
involved in each job, use of approved personal protective clothing and equipment, and adherence
to approved safe job procedures.

Safety Procedures
The following safety procedures should be established for every job site:
      •       Check plans to see which public utility services are located at or near the work area.
      •       Contact all public utilities having services in the work area to secure assistance in
              locating, marking, and protecting all underground or overhead services that may be
      •       Make an inspection of the work area to identify what signs, post markers, overhead
              electrical lines, etc., may be visible and provide this information to all workers.
       •      Obtain the service and repair telephone numbers of all utilities in the job site area so that
              if accidental contact should occur it can be reported immediately.
       •      All crew members should be informed of locations and depths of buried pipelines.
       •      Consult the local gas utility of closely paralleling or crossing buried pipelines.
       •      Specifically instruct equipment operators to avoid contact with buried lines. Hand dig
              when in close proximity to buried pipelines.
       •      Be aware of proper compaction procedures when using mechanical compaction
              equipment after back filling over buried pipelines.
       •      Do not use drop weight type concrete or frost breakers over buried pipelines.

      If A Gas Pipeline Is Damaged

          •   Immediately call the gas utility service and repair office to report the damage.
          •   Shut off all motors in the area.
          •   Remove all flares or lanterns.
          •   Enforce "No Smoking" in the area.

     •   Do not cover up a damaged pipeline.
     •   Do not operate gas valves.
     •   Check buildings in the immediate area for gas odors.
     •   Request occupants to leave the area if gas odors are detected.
     •   Reroute traffic from the immediate area and notify Law Enforcement Officials.
     •   Stay near the area until relieved by Law Enforcement Officers or gas company officials.

Electrical Transmission Service
    •    Contact the local electrical power utility if work is to be done near electrical service to
         locate any buried service.
    •    If excavating near poles or guy wires where the possibility of damage to cables or
         collapse of a pole line exists, consult the power company.
    •    If excavating beneath buried conduit or cables, arrangements shall be made in advance
         with the power company concerning maintenance of electrical services, proper support of
         exposed conduit, and suitable compacting of backfill.
    •    All wires and conduit shall be considered energized and dangerous.

    Booms and protruding parts of construction machinery shall not be operated closer than
    10 feet from overhead electrical lines. When construction machinery is operated in close
    enough proximity to energized lines that a full traverse of the moving parts could result in
    contact, a signalman shall be provided to direct the operator. Signalmen in those
    circumstances shall be especially watchful to prevent movement of the machinery any closer
    than the 10 feet minimum clearance prescribed above.

    Workers on the ground handling suspended loads, slings, cables, or in contact with the
    machine, are in the most hazardous position if contact with energized electrical lines occurs.
    Ground crews shall be trained and repeatedly warned of the hazard and especially watchful
    to prevent such contact.
    If Machines Contact Energized Wires

         •   Immediately contact the power company service and repair office.
         •   The operator should attempt to swing the boom clear.
         •   Persons on the rig are usually safe. If it is necessary to leave the rig, jump entirely
             free, being careful that no part of the body is in contact with the machine and the
             ground at the same time.
         •   When jumping clear of energized equipment, aim for dry ground.
         •   Once clear of energized equipment, stay clear. Keep all persons, employees or
             public, away from energized equipment.
         •   If wires are down, post guards to help prevent anyone from touching them.

Telephone Service
    •    While telephone circuits operate on low voltage and are not an electrical hazard in
         themselves, they may be energized with higher voltages when crossed with power lines
         accidentally at points far removed from the job site. You should consider ALL lines as
         being hazardous.

      •   Do not cut or disturb guy wires. Sudden release of tension may cause an entire pole line
          to collapse.
      •   Observe the precautions listed for electrical power lines.
      •   Underground telephone cable is generally buried with a minimum cover of 24 inches.
          Subsequent grading may have reduced this minimum. Pipe pushers, trenchers, boring
          tools, air hammers, pins for paving, and curb forms, etc., should not be used until has
          been determined the depth and location of buried telephone cables and conduit.

Digging and Trenching Operations
Digging and trenching operations can be some of the most dangerous jobs involving county
employees. It is critical that these jobs be under the supervision of those with the technical
expertise, training, and qualifications to know how to complete the work safely. The following
provides general guidance for employees involved on these jobs; it is not intended to take the place
of the technical expertise needed at the job site.
      •   Approved guards such as cribbing, barricades, warning signals, or flagmen should be in
          place when workers are engaged in any street excavation or street repair work, or when
          removing or replacing manhole covers. Warning devices should be placed a sufficient
          distance ahead of the work to permit vehicles a reasonable stopping distance with due
          regard for visibility, speed, and volume of traffic. Open manholes should be properly
          guarded with approved warning devices.
      •   A signalman should be posted on the surface to assist the machine operator. He should
          station himself where he can be seen by the operator, outside the range of movement or
          hazardous area from loads, and warn the operator of the presence of others who may
          enter that area.
      •   Manhole covers not provided with lifting devices shall be raised slightly on one edge and
          slid off the hole. To replace the cover, reverse the procedure.
      •   All tools, materials, and equipment should be kept at least two (2) feet from the edge of
          trenches, curbs, or embankments.
      •   Shoring or sloping of trenches must commence at a depth of 5 feet. Earth banks more
          than 5 feet in depth, when not shored or braced, should be sloped to a safe angle.
          Excavation work should be under the supervision of someone with the necessary
          experience and authority to modify the shoring and method of excavating as necessary to
          ensure safety. Excavations less than 5 feet should also be guarded when hazardous
          ground movement may be expected.
      •   Workers in an excavation that is properly sloped or shored should not be in danger of
          being buried by a cave-in. An adequate means of exit, such as ladders or steps, shall be
          provided and located so as to require no more than twenty-five (25) feet of lateral travel.
      •   Prevention is the best insurance. Watch the texture of the earth as it is removed. If it is
          unstable (sand, loose fill, etc.) warn workers to stay away from the edge until the shoring
          is installed. Workers must not enter the excavation until sloping or shoring is competed.
      •   Hard hats should be worn at all times by workers in or around excavations, trenches,
          tunnels, sewers, or other subsurface operations.
      •   When chains, ropes, cables, slings, etc., are placed under tension, workers and
          observers should be warned to stay beyond the range of whipping strands in case they
          should separate due to tension.
      •   The public should be directed away from hazardous areas and material piles.

Materials Handling Machinery

      •   When moving heavy objects with a crane, use proper slings and grips to secure the load.
      •   When guiding a suspended load into position, always use nonconductive ropes or nylon
          tag lines to permit maintenance of a safe distance from the drop zone in case the load
          should fall or come into contact with an electrical service.
      •   Do not crawl under mobile construction machinery at any time.
      •   Avoid moving a suspended load above persons on the ground, or above persons working
          in an excavation.

Aerial Platforms and Baskets
A public entity may use several types of vehicles equipped with platforms or baskets designed to
raise employees who have to work in areas that cannot be reached from the ground. This
equipment is used by linemen, tree trimmers, and in various public service maintenance tasks.

The hazards involved are:

      •   Contact with electrically charged overhead wires.
      •   Falls.
      •   Dropping tools and other objects on employees who are working below.
      •   Being trapped in, on, or between equipment parts.

Extreme care must be exercised while operating this equipment near overhead lines. Aerial
platforms or baskets should not be positioned closer than ten (10) feet to overhead lines.

Falls can be prevented by use of adequate and appropriate safety equipment. A raised platform or
basket becomes highly unstable when jarred by a collision with the base vehicle, jerky operation, or
failure of mechanical controls. A safety line (strong enough to support the weight of the employee)
that is secured to the employee and to the boom or platform, will aid in preventing falls.

The equipment used by crews has controls at various locations on the basic machine to operate the
outriggers, booms, power takeoffs, etc. There is little standardization, even on equipment of the
same general type. Operators should make sure that all persons in the vicinity of this equipment
are clear of any moving part before power is applied. The supervisor or lead man in charge of the
crew is responsible for ensuring that this precaution is taken and that appropriate warning is given.

The following safety procedures should be established:

      •   Always lower outriggers before raising the basket. (Most equipment now in use is
          equipped with an interlock that prevents raising the basket until outriggers are down.)
      •   Give verbal warning to persons near the vehicle when lowering outriggers if an automatic
          audible signal is not operative.
      •   When working aloft in aerial baskets or platforms, a safety line shall be connected to a
          fitting or harness secured to the platform, basket, or boom, and to a harness worn by the

Working in Public Rights-Of-Way
Employees are often required to work in or alongside right-of-ways normally used for vehicle or
pedestrian traffic to repair utility services, or perform tree trimming or landscaping tasks, and other
maintenance activities. It is desirable that, whenever possible, some continued flow of traffic be
maintained with the least possible interference with normal traffic patterns. There are two safety
considerations involved:
       •   Protecting employees from being struck by vehicular traffic.
       •   Protecting the public from hazardous obstructions, excavations, etc., that interrupts the
           flow of both vehicle and pedestrian traffic.

When road surfaces are being repaired, manholes opened, or excavations dug, it is necessary to
post adequate warnings of the hazard; to block off a minimum amount of the right-of-way,
consistent with safety requirements; and to efficiently re-route traffic.

If repair work obstructs a traffic lane in a street and thus compresses multiple lanes of traffic into
fewer lanes, warning signs and barricades must be set up for motorists, well in advance of the
obstruction. If manhole openings and excavations constitute a hazard to pedestrians, adequate
barricades must be provided and walkways must be re-routed.

Maintenance activities may include minor interference such as tree trimming, curb site planting,
street sweeper operations, trash pick ups, light fixture cleaning, traffic signal repair, etc. Stationary
or slow moving vehicles and equipment, as well as work in the normal right-of-way could interfere
with normal traffic. For minor construction or maintenance operations requiring fifteen (15) minutes
or less, simultaneous flashing of all turn signal lights should be required, augmented by oscillating
or rotating lights, or flashing arrow signs mounted on the vehicles. These vehicles should also be
equipped with brightly colored markings or reflective markings.

                                                              Cell Phone Policy

To provide information to our employees on precautionary measures to follow when driving and
using a cell phone. This policy is written to help ensure the safety of employees and the public.


This policy applies to all of our drivers when a cell phone is utilized while driving.


Driving can be difficult enough even when you concentrate completely on the road. But driving while
you dial a phone or balance it to your ear can be distracting and potentially dangerous. Cell phones
may be convenient for those who own them but, if not used properly, drivers with cell phones are a
danger to themselves and everyone on the road.

The New England Journal of Medicine has released a study that reports that cell phone usage while
driving increases the potential of accidents 400%, or about the same as driving while intoxicated.
With this in mind, we have developed the following lists of precautionary measures that should
always be followed by our drivers when using a cell phone:


1. Get to know your cell phone’s features such as speed-dial and redial. Use these features to
   avoid the distraction of dialing numbers while driving.
2. Use hands-free devices whenever possible. All county employees who are reasonably
   expected to operate cellular phones while driving will be provided hands-free devices.
   Supervisors will ensure devices are available and utilized.
3. Position the cell phone within easy reach. The phone should be installed as near as possible to
   the driver’s line of vision so eyes are diverted from the road for the least amount of time.
4. If possible, place the calls when you are not moving or before pulling into traffic. If you have
   passengers, let them dial numbers for you.
5. Assess the traffic situation before placing or receiving calls, making sure you are fully aware of
   road and vehicle distractions. Emergency Vehicle operators will refrain from cell phone usage
   unless absolutely necessary while in response mode.
6. Make it clear to the person you are speaking with that you are driving and may need to interrupt
   the call to respond to traffic situations. Hang up or to discontinue the telephone conversation
   without warning in precarious traffic situations. You can always explain later why you
7. Suspend cell phone use during hazardous driving situations, including congested traffic or bad

8. Never take notes or look up information while driving. If necessary, find a rest area or other
   safe place to pull off the road and focus on your call.
9. Do not engage in stressful or emotional conversations that may divert your attention from the
10. Keep any necessary conversations brief.
11. Develop ways to get free of long-winded conversations that may divert your attention from the
12. Don’t use the cell phone for social visiting while you drive.
13. Refrain from placing or receiving unnecessary calls. Allow voice mail to handle your calls and
    return them when it is safe and convenient.
14. Remember! Safe driving is the top priority. Actively compensate for the potential distraction
    created by cellular phone use, move to slower travel lanes, increase your following distance,
    and frequently check your mirrors to assess the immediate driving situation.

                                                                              Safety Compliance
Compliance with safety procedures is not optional. The following provisions are hereby established for lack
of compliance based upon a point value system. These points are assigned by the Accident Review Board for
“at fault” incidents, and not for situations beyond the employee’s control.

        1 Point                 Minor Injuries – No Lost Time
                                Vehicle or Equipment Crash – Damage < $2,000
                                Noted Safety Violations
        2 Points                Significant Injuries – Medical Attention Required
                                Vehicle or Equipment Crash – Damage > $2000
                                Failure to attend required training
        3 Points                Major Injury or Permanent Disability – Lost Time > 1 week
        4 Points                Failure to report accidents
        5 Points                Incidents involving Death

Two points may be removed from the record by the employee taking an approved course, in the subject area
of one of their violations, if approved by the Safety Committee. The course may be taken on county time
with use of a county vehicle (if assigned), but otherwise at the employee’s expense.

Employees who receive cumulative points within any five year period are subject to the following actions:

        2 Points        Consultation with Department Head
        3 Points        Written Warning
        4 Points        Day off without pay – not eligible for vacation, sick, or other pay
        5 Points        Week off without pay – not eligible for vacation, sick, or other pay
        7 Points        Automatic Dismissal

                                         Hyde County Return To Work Program

Early return to work following an injury helps control costs directly related to the injury and reduces
the potential impact of the injury on the employer as well as on the injured worker’s life.
Studies show that injured workers who are allowed to return to productive work as early as possible
following an injury heal faster and better than those injured workers who remain off work. Injured
workers who return to work during their healing period tend to require fewer medical treatments and
incur less medical expense related to the injury. Work becomes part of medical treatment and
rehabilitation and allows the injured worker to take an active role in his or her recovery.
Samples included in this guide are intended for use as reference documents.
For this program, “modified duty” refers to the following types of transitional assignments:

•   Modified Regular Duty
    The primary goal of early return to work is to return an injured worker to his or her original
    job as soon as possible. If an injured worker cannot return to regular work at full capacity,
    temporary modifications to his or her regular job such as schedule changes, reduced hours,
    reduced capacities, or sharing parts of the work with others are effective accommodations.
•   Alternate Assignments
    If an injured worker cannot perform regular duties, temporary alternate assignments can be
    the bridge back to regular employment. Injured workers who take an active role in the
    decision making process to determine their own return to work assignments are more likely
    to have a successful return to work.
    Alternate assignments must be meaningful and productive. Demeaning or “make-work”
    assignments will defeat the purpose and may be seen as punishment. Assignments must
    be within the injured worker’s capabilities. When determining alternate assignments,
    consider jobs or tasks that need to be done but are rarely done due to lack of time.
    Consider the injured worker’s past work experience and skills. Alternate work assignments
    are generally short term in nature. Temporary transfer to another regular position that meets
    the injured worker’s medical restrictions is another choice.

 Successful return to work is time sensitive. There is a point in time for most injured or ill
 workers when an appropriate temporary assignment will expedite recovery both physically and
 Managing employees with work related injuries or illnesses requires an understanding of the
 behavioral forces that motivate an employee to be a productive participant in the workforce.
 Normally, an employee who is satisfied with his or her job and employment situation, and who
 suffers an injury or illness that results in absence from work, is self-motivated to return as
 quickly as possible. However, even the most dedicated employee’s attitude and outlook may
 diminish if the person remains out of the workforce for an extended period. The longer an
 employee is unable to work, the more difficult it becomes to return to full duty employment. By
 providing appropriate productive return to work opportunities, employers can significantly reduce
 injury related lost time.
 Non-medical factors often present barriers to return to work. Issues such as personal fears and
 anxieties, decline in self-esteem, depletion of personal financial resources, family problems,
 potential loss of position or status at work, and fear of re-injury can lengthen lost time.
 The stage is often set for extended lost time long before any injury has occurred. Supervisors
 and managers who communicate sensitively and treat employees fairly and with respect can
 greatly reduce the possibility of unnecessary lost time. Relationships that are adversarial
 between supervisors and employees tend to interfere with or delay return to work. Provide
 training for your supervisors to help them acquire or develop these skills.

 Incorporating these basic elements can maximize the opportunity for a successful early return to
 work program.
 •   Commitment to the program by all managers, department heads, and supervisors
 •   Prompt medical care following an injury and timely reporting of all WC claims
 •   Frequent communication with the injured worker while he or she is away from work
 •   Monitoring the injured worker’s progress following return to work and throughout the
     transition back to regular work
 •   Education and dissemination of information about the return to work program before injuries
 •   Development of job descriptions that clearly explain essential job functions and physical job
 •   Development of information to help doctors understand the employee’s regular job, the
     return to work program, and available alternative assignments
 •   Designation of one person to coordinate the early return to work program, to coordinate and
     monitor assignments, and to facilitate communications with the treating doctor and injured
 •   Compliance with ADA, FMLA, and NC Workers’ Compensation legal requirements

 Successful implementation of a Return To Work Program will involve these steps:

     1. Obtain management commitment

     2. Designate a Return To Work Coordinator

     3. Develop policies and procedures for the program and put them in writing

     4. Develop a written policy statement to show continuing management support for
        the program

     5. Train and educate all employees and managers in the purpose, goals, and
        procedures of the program

     6. Establish communications lines to keep the program going

 The program will not succeed if it is not supported by management. This written
 document will give much of the information needed to implement the program.

 Part of the commitment from management needs to be the appointment of a Return To
 Work Coordinator. Frequently the person responsible for handling claims is appointed
 as Coordinator. The Coordinator’s role is to facilitate the program and the early return to
 work of injured employees by:
 •   Communicating with the injured employee and their supervisor
 •   Communicating directly, or facilitating communication, with the medical community
 •   Working with the claims adjustor, and providing pertinent information for handling the
 •   Coordinating modified duty job assignments with department managers and, if
     necessary, across department lines
 •   Educating managers, supervisors, and employees regarding the RTW program and
 •   Creating a “bank” of available modified jobs or job duties to facilitate ease of
     placement when an injury occurs


 A written policy statement reinforces the public entity’s commitment to the program and
 helps make the expectation of early return to work an integrated part of the work culture.
 Write, adopt, and post a policy statement that is brief and broadly written so that it does
 not require frequent revision. Post the policy statement in an easily accessible place as
 a constant reminder and encouragement of early return to work following a work-related
 illness or injury. Add the policy statement to the materials covered during the orientation
 of new employees.
 The policy statement should include wording that does the following:
     •   Confirms the public entity’s commitment to the early return to work program
     •   Explains the public entity’s return to work philosophy
     •   Stresses the importance of safe operations and prevention of injury

 Our goal is to return employees suffering injuries or illnesses to their job as soon as they
 are medically able to return. To do so is in the best interest of the employee and the
 public entity. To the extent feasible, we will return workers to their regular job. Where
 the employee faces temporary medical restrictions, we will, if feasible, modify their
 regular job or, if necessary, place them on another productive job. It is our goal to work
 with employees to get them back to work in their regular job as quickly as possible.
 A determination will be made by the Return To Work Coordinator and Department Head
 as to whether or not a modified duty work assignment can be provided which will be
 consistent with the treating physician's work release.
 •   All work provided will be consistent with and not exceed the limitations set by the
     treating physician. The employee agrees not to work beyond his/her physical
     limitations and will immediately bring any such assignment to the attention of the
     Return To Work Coordinator.
 •   While in the Modified Duty Program, the employee will dress in the appropriate attire
     to the modified duty work environment.
 When feasible, every effort will be made to accommodate the needs of the employee by
 modifying his/her present work setting; however, work availability may make it necessary
 to transfer employees from one job function to another. Pay will be at the rate of the
 employee's appointed position classification. It is the option of the employer to change
 regular days off and work hours while in the Modified Duty Program. If a modified duty
 position is offered, but the employee for personal reasons is unable to work the new
 shift, or refuses the position, the Supervisor & Human Resources must meet with and
 discuss the options with the employee.
 •   If an employee is unable to report to work for personal reasons, he/she must call and
     report to the RTW Coordinator who will notify the Department Head and supervisor
     of the employee's status.
 •   If the employee's medical status changes, it must be reported immediately to the
     RTW Coordinator. All changes in medical status must be reviewed by the
     Coordinator for assessment of restrictions.

  When an injured/ill employee is released to participate in the modified duty program,
  he/she does not have the option to substitute paid sick leave because he/she does not
  personally feel ready to perform modified duty.
  When employees are released to their regular job duties, the information will be provided
  to the Coordinator for distribution, and to facilitate placement of the vacant modified duty

  The following procedures are to be followed in the event of a job-related injury or illness
  that results in time away from work for the injured/ill employee. These procedures are
  supplemental to the procedures outlined in the NCACC Claims Manual.
  1. An employee who is injured at work must immediately report the incident to their
  2. The supervisor is required to:
     •   Obtain immediate medical attention for the injured worker
     •   Follow the requirements for reporting job-related injuries and illnesses
     •   Complete an incident investigation report
  3. When an injured employee is unable to return to work on the day following the injury,
     the supervisor is responsible for notifying their department head and the RTW
     Coordinator. The RTW Coordinator will review information about the case with the
     supervisor including information received from the doctor. The Coordinator,
     supervisor, and department head will decide jointly if appropriate work is available
     that meets the injured employee’s medical restrictions.
  4. If modified duty work is not available in the injured employee’s department, the RTW
     Coordinator will determine if appropriate work meeting the employee’s medical
     restrictions is available in other departments. The Coordinator is responsible for
     facilitating discussions among managers to assure placement of injured workers in
     modified positions to the extent feasible.
  5. The injured worker is responsible for following medical instructions on and off the job.
  6. Following an injured worker’s return to work, the supervisor and the RTW
     Coordinator will monitor the injured worker’s progress to assure that restrictions are
     carefully followed and assist to resolve any difficulties. The injured worker must
     immediately report any difficulties with performing assigned work. The supervisor
     and RTW Coordinator will work with the injured employee and the medical
     community to determine the appropriate course of action in resolving the problem.
  7. No permanent jobs will be created to accommodate a disability from a work related
  8. Modified Duty Program assignments will be for no longer than two weeks without
     medical review. Modified duty can extend up to ninety days. Extensions up to an
     additional ninety days will be allowed only with physician recommendation and
     monitoring on a fifteen to twenty day cycle.
  9. While in the Modified Duty Program, a status review involving management and the
     employee will be performed at two-week intervals or as deemed necessary by the

      RTW Coordinator. The status review will take into account the employee’s medical
      condition and restrictions, the availability of suitable work, and any other pertinent
      information, in determining whether the modified duty assignment will be continued
      for another two-week period.
  10. The RTW Coordinator is responsible for scheduling and tracking management and
      medical reviews.
  11. Employees may be required to move from one modified duty assignment to another
      if their health status changes or they complete an assignment prior to recovery.
  12. All employees will abide by the work/safety rules at the location of their modified duty

  Consider these guidelines in determining appropriate duties/tasks:
  •   Transitional employment should always have an end date.
  •   Before assigning transitional employment, physicians should affirm injured workers’
      ability to perform the tasks involved.
  •   Eliminate misunderstandings by making certain the entire work unit understands the
      transitional work approach and specific assignments. Emphasize to co-workers that
      injured workers are not receiving special treatment but complying with the return-to-
      work process.
  •   Look for work that is valuable to the team, department, and other employees.
  •   Look for work that is meaningful to injured workers.
  •   Focus on what injured employees can do, not what they cannot do.
  •   Focus on tasks rather than jobs.
  •   Avoid busy work. Instead, be creative in finding work that accommodates limitations.
  •   Look for tasks that are not being done or are only occasionally being done. Or look
      for tasks that, if assigned to injured workers, would free other employees to do
      different work. This may mean tasks in other departments or areas of the workplace.

  Prior to the initiation of an early return to work program, provide information to all
  employees, including supervisors and department managers, about the human and
  financial costs of workplace injuries, the benefits of an early return to work program, and
  their roles and responsibilities.
  All employees, including supervisors and managers, must agree that every effort will be
  made to return any injured worker to work as soon as possible following an on the job
  injury and understand why that is important. Supervisors and managers should be held
  accountable for supporting the program and for assisting to provide return to work
  opportunities as often as possible.

  Continuous reminders about the program reinforce the public entity’s commitment to
  employees and to successful return to work.

  Poor communication or lack of communication is the primary barrier to a successful
  return to work program. Maintaining regular communication with the injured worker and
  with the treating doctor is vital to the return to work process.

Maintaining the Employer-Employee Connection
  It is easy for an injured worker who cannot immediately return to work to become
  disconnected from his or her employer. The longer an injured worker remains off work,
  the more probable it is that this detrimental separation will occur. Maintaining the
  employer-employee relationship with regular communication will help reduce the
  probability of lengthy lost time.
  The RTW Coordinator is responsible for encouraging and tracking communication
  between the supervisor or other designated representative and the injured employee
  during lost time. Expressions of sincere regard for the injured worker’s quick recovery
  help the injured worker feel valued and missed.
  The RTW Coordinator should also call the injured worker to determine if there are any
  questions or if assistance is needed. Telephone calls provide an opportunity to show
  concern for an injured worker, to encourage the injured worker to follow the doctor’s
  instructions while at home, and to provide information and encourage return to work.
  See the forms and samples in the attachments for ideas.

Communicating with the Treating Doctor
  Usually, doctors only know what they are told about the employee’s worksite and job
  requirements. Without a detailed job description of the injured worker’s regular job, the
  treating doctor must base return to work decisions only on the subjective assessment of
  the job, usually provided by the injured worker.
  It is not the job of the treating doctor to make employment decisions. The doctor is
  responsible for providing information regarding the abilities of the injured worker so that
  his or her employer can make informed return to work determinations. After reviewing
  the medical restrictions stated by the doctor, the employer can determine if there is
  suitable work available that accommodates the employee’s restrictions.
  Having an information packet to provide to an injured worker and the treating doctor at
  the time of the initial visit can make the difference between a medical only claim and a
  lost time claim. Providing the information as soon as possible helps ensure that correct
  information is communicated in a timely manner.
  Although it is not required, some employers find it helpful to obtain a medical release at
  the time of a work related injury pertinent only to the injury. With a signed release, the
  doctor may be more inclined to discuss medical information with the employer.
  The prepared packet could include information such as the following:

   •   A letter to the treating doctor explaining the return to work program, providing
       insurance information and identifying an employer contact
   •   Description of the injured workers’ regular job, including a description of physical
       requirements and information about alternate assignments
   •   A signed release of medical information
   •   Information about the workers’ compensation system and workers’ compensation

See samples of these types of documents in the attachments.

Job Descriptions
Review accident and injury history to identify the jobs that are most likely to have an injury and
identify the typical types of injuries that have occurred related to those jobs. Write detailed
functional job descriptions for these and most other jobs using information from the task
analysis. Keep job descriptions up to date and accurate. If an employee is injured, the
information is readily available saving time and providing vital information to the treating doctor
so that timely and appropriate return to work determinations can be made.
See the forms and samples in the attachments for ideas.


When an employee is hurt or becomes ill on the job, the checklist provides a systematic process
that should be taken by the County/Entity Claims Administrator immediately. You may modify
the form to meet criteria already established by your organization.
If you have any questions on the severity of an injury/illness when filling out the form, contact Sedgwick CMS for
Attachment B - Lost Time Case Management & RTW/MDS Checklist
If the employee cannot return to work immediately, refer to the Lost Time Case Management & RTW/MDS
Checklist for procedures to follow.

Attachment C - Workers’ Compensation Lost Time Injuries – Telephone Follow-up Form

Attachment C-1 - Modified Duty Status Weekly Meeting Topics
If there is a lost time injury, use the Management Telephone Follow-up Form to track your calls
during the first week. This is an important step in your claims management process. Use
Attachment C-1 as your guide for topics of conversation when calling the employee.

Attachment D - Modified Duty Employee/Physician Contact Log – WC Diary Entry
When the lost time injury goes over a week, use the WC Diary Entry log to record ALL phone
calls, messages or correspondence regarding the employee. This is extremely important for
serious claims.
Attachment E - Workers’ Compensation Information for Injured Employee
Provide this form regarding WC to employee upon injury. It provides them with some basic
information regarding worker’s compensation coverage.

Attachment E-1- North Carolina Workers’ Compensation Law – Questions & Answers
This information is to be provided with Attachment E.
Attachment F - Attending Physician’s Report
Send Attending Physician’s Report form on the initial visit with the injured employee. The
form should be returned to you within 24 hours if possible. If needed, follow-up with a phone
Review restrictions noted to determine what modified duty positions might be suitable.
Remember to check on the employee’s abilities in addition to their limitations.
(Please note: you can use either Attachment F or Attachment G and G-1 for this step)
Attachment G - Letter to Physician: Return-to-Work/Modified Duty Status Program
Attachment G-1 – Job Function Abilities Form
Send the RTW/MDS Program letter to the physician along with a copy of the job function
abilities form for them to complete. Once you receive the form(s) back, you may move on to
the next step.

Risk Management Pools
North Carolina Association of County Commissioners
   •   Review restrictions noted to determine what modified duty positions might be
       suitable. Remember to check on the employee’s abilities in addition to their

Risk Management Pools
North Carolina Association of County Commissioners
Attachment H - Physician’s Work Release
Attachment H-1 - Job Requirements vs. Worker Capabilities
Once the physician responds back with either Attachment F or G-1, use either Attachment
H-1 to set up a modified job description based on the restrictions provided by the physician.
You may also want to include a job description (see examples).
   •   Once you have modified jobs available, send Attachment H (Physician’s Work
       Release letter) with the description of the modified jobs that you have available
       (Attachment H-1).
   •   Once you get approval from the Physician for one of the modified jobs, go to the next
   •   If physician will not return injured employee for modified duty right away, continue to
       request early Return-to-Work/Modified Duty Status clearance on a weekly basis,
       because the employee’s injury should be gradually improving and may get to a point
       where modified duty is possible.

Attachment I - Return-to-Work/Modified Duty Status Letter to the Employee
Once you receive approval from the Physician on a modified job, send the letter with a copy
of the job description to the employee for their acceptance. If the employee refuses the
modified duty, check with Sedgwick Claims Management Services and/or the NCIC for your
Attachment J - Modified Duty Status Report
Once the employee is back to work, the supervisor should complete this form noting status of
employee’s return to work. This should be completed after the first day and after the first week
on modified duty. If long term, monthly status reports should be conducted using this form.
Attachment K - Job Requirements vs. Worker Capabilities Examples
The following are examples of job descriptions and the Job Requirements vs. Worker
Capabilities form. Three jobs are included:
   •   Deputy Sheriff
   •   EMT/Paramedic
   •   Nurse
Attachment L - NC Industrial Commission Bulletin
June 15, 2004 NC Industrial Commission Bulletin – Information about the NC Workers’
Compensation Act

Risk Management Pools
North Carolina Association of County Commissioners
Attachment A

Case Management Checklist

                                    CASE MANAGEMENT & RTW/MDS CHECKLIST

Name of Employee:                                            Date of Injury/Illness:

Department:                                                  Supervisor:

                                                                                         Completion Date

1. Provide for appropriate medical care. Get the best medical care
   you can for the ill or injured worker. Prompt medical referral is
   a major factor in quick recovery from an illness or injury.              _____________________________________

2. Submit an Employer’s First Report of Injury or Illness (Form
   19) – within 24 hours, if possible.                                      _____________________________________

   Call Sedgwick Claims Management Services (1-877-622-2276)
   immediately with any case involving:                                     _____________________________________

   A.    Head Trauma
   B.    Spinal Cord Injury and/or Any Paralysis
   C.    Vascular Conditions
         (1) Cardiovascular Accident (Stroke)
         (2) Myocardial Infarction (Heart Attack)
         (3) Aneurysm – Any Vessel (a swelling or an artery)
         (4) Fatal Arrhythmia (irregular heartbeats)
   D.    Burns – 3rd Degree (deep tissue) over 25% of the body
   E.    Amputation
   F.    Severe Fracture(s)
   G.    Hospitalization

3. Save all evidence associated with the injury/illness.                    _____________________________________

4. Give employee a brief explanation of benefits including
   pamphlet spelling out benefits to which he/she may be entitled.          _____________________________________

5. Contact the physician regarding Modified Duty. Consult with
   the physician the day of the injury on the type of Modified Duty
   that is available as the employee may be allowed to Return-to-
   Work/Modified Duty Status that day or shortly thereafter.
6. Take corrective action to avoid another incident.                        _____________________________________

Attachment B

Loss Time Case Management & RTW/MDS Checklist


Risk Management Pools
North Carolina Association of County Commissioners
 Name of Employee:                                             Supervisor:
                                                               This log should be used when an employee cannot immediately Return-to-
 Department:                                                   Work/Modified Duty Status after an occupational illness or injury.


 Action Steps                                                    Date            3rd Day           1 Week Post-      2 Weeks or More
                                                                                 Post-Injury       Injury            Post-Injury
 A. Submit Employer’s First Report of Injury/Illness
    immediately.                                                     _______
 B. Contact Sedgwick CMS on all Lost Time Cases and
    on all serious cases as listed under item #2 of the Case
    Management & RTW/MDS Checklist.                                  _______
 C. Discuss benefits with employee and ask about
    satisfaction with medical care.                                  _______          _______           _______           _______
 D. Keep track of medical treatment. Next medical exam
    scheduled for:                                                   _______          _______           _______           _______
 E. Tell employee they are missed by the County/Entity
    and fellow employees.                                            _______          _______           _______           _______

 F. Ask about any special needs or problems.                         _______          _______           _______           _______
 G. Call employee as scheduled (refer to Management
    Telephone Follow-Up form)                                        _______          _______           _______           _______

                                                                     _______          _______           _______
 H. Discuss case with physician.                                                                                          _______
      Discuss modified duty positions available.                                                                          _______
      Discuss return-to-work status date.                                                                                 _______

 I.   Have supervisor call/send note to employee.                                                                         _______

 J.   Personal visit to employee. Scheduled for _____________
      Note: Stagger the time of day and day of week you call the employee so your contacts do not appear to be a routine automatic task,
      but a sincere spontaneous concern.

 K. Contact Sedgwick CMS when there is a significant change in the employee’s medical status, (i.e., Return-to-Work/Modified Duty
    Status, modified work, or medical condition) and continue to stay in close contact with Sedgwick regarding progress of the injured/ill

 L. If the injured/ill employee has not returned to work after the 2-week period, continue to monitor progress using the format in the last

Attachment C

      Workers’ Compensation Lost Time Injuries – Phone Follow-up Form

                                     MANAGEMENT TELEPHONE FOLLOW-UP FORM

I.    Personnel Section
 Risk Management Pools
 North Carolina Association of County Commissioners
Name ____________________ Occupation ________________ Home Telephone ___________________
Address ______________________________________________________________________________
Hire Date __________ First Day of Lost Time ________________________________________________
Date Injured_______________________ Work Area ___________________________________________
Nature of Injury ________________________________________________________________________
How Did Accident Occur _________________________________________________________________

II.     Supervisor/Manager (Contact employee on 3rd day of lost time)

Keep in mind, the purpose of your telephone call to this employee is to demonstrate an interest in the injured
employee’s welfare and to determine if the County/Entity can be of assistance to the employee or family.
Questions to ask include:

   • How are you feeling?
   • Is there anything we can do at this time to help you or your family?
   • Do you have any idea when you will be able to Return-to-Work/Modified Duty Status?
   • What did the (your) doctor tell you about your benefits?
   • Do you have any question about your condition?
   • What could we have done to avoid your injury?
   • What can we do to assist you back to work?

Contact Person’s Signature: _____________________________Date:_______________

III.    Contact employee after the first week of lost time (1 week post-injury)

Go through similar questions as above, and express the company’s interest in the individual’s recovery.

Notes: ___________________________________________________________________________________

Contact Person’s Signature: ____________________________Date:________________


       Risk Management Pools
       North Carolina Association of County Commissioners
Attachment C-1

  Modified Duty Status Weekly Meeting Topics

  1. How are you feeling? (Express concern)

  2. Are you feeling better? How much better? (20%, 50%, etc.?)

  3. When do you think you will be able to return to full duty?

  4. When does the doctor think you will be able to full duty?

  5. When is your next doctor’s appointment? (If this appointment is in the distant future, suggest that you
     call the doctor to schedule one sooner).

  6. Are you satisfied with the quality of the medical care you are receiving? (Reiterate company’s
     commitment to do whatever is necessary to facilitate the employee’s full recovery and return to regular
     work assignment.)

  7. Has your doctor recommended that you do any exercise?

  8. Do you take any medication(s) for your condition?

  9. Do you feel you are continuing to recover or are you leveling off? Getting worse?

  10. If you consider the pain you experienced on the day after your accident (10 on the scale), how would
      you describe how you are feeling now (0=best, fully recovered with no pain – 10 worst, as painful as the
      day after the accident).

  11. What types of activities are you currently doing? Do you get bored?

     Watch TV? How long? _________________________________________________
     Are you able to drive? How long? ________________________________________
     Are you able to walk? How long? _________________________________________
     Do you shop? How long? _______________________________________________
     Do you run errands? How long? __________________________________________
     Do you do laundry? ____________________________________________________

  12. What activities do you do in the evening?

  13. What do you spend your free time doing?

  14. What can we do to help you get better?

  15. Conclude with plan for that week, including medical appointments scheduled, transportation arranged,
      disability nurse involvement, etc. Schedule the next weekly meeting for one week from today.

  Risk Management Pools
  North Carolina Association of County Commissioners
Risk Management Pools
North Carolina Association of County Commissioners
Attachment D

   Modified Duty Employee/Physician Contact Log – Diary Entry

                                                WC DIARY ENTRY


   Risk Management Pools
   North Carolina Association of County Commissioners
Attachment E

      Workers’ Compensation Information for Injured Employee

                                           WORKERS’ COMPENSATION INFORMATION

TO:                                               _____DATE:_ / /__
FROM:                                             _____
                      (Claims Coordinator)

I am sorry to hear about your recent injury and would like to assist in your speedy recovery. I would also like to alleviate any concerns
you may have regarding the circumstances of the incident or the logistics of the workers’ compensation system.

The attached information “North Carolina Workers’ Compensation Law – Questions and Answers” will address some of the questions
you may have about your work-related injury. Also, in order for us to assist you, please communicate your physician’s instructions to
your supervisor after each appointment; keep us informed of your progress and let us know if we can help. Additionally, Sedgwick
CMS, our third party claims administrator, will be in contact with you regarding the injury.

Please be informed that North Carolina Law includes the following benefits:

      •   All medical care including medicines, lab fees, etc. is paid by the employer
      •   Payment for lost wages (Temporary Disability): You will receive payments until the doctor says you are
          able to work.

      → No compensation is due for the first seven (7) days of lost time unless the disability exceeds 21 days.
        Therefore, the first check will not include payment for days 1-7. Payment for those days will be made
        should the disability continue beyond 21 days.
      → Benefits are calculated at 66 2/3 percent of your average weekly wage – not to exceed a maximum
        amount set by law.
      → Payments are tax-free. There are no deductions for state or federal taxes or Social Security.
      → Permanent Disability Payments: Payment will be made after you are able to work if there is permanent
        handicap. These payments are determined by the amount of disability the doctors indicate. The
        payment is determined based on what part of the body was injured and the degree of disability.
      → Contrary to advertisement, lawyers will not benefit you in workers’ compensation cases because the
        system was set up over 50 years ago to guarantee fair, prompt, and automatic benefits to workers
        injured on the job. A lawyer will, however, take approximately 25% of the award given to you for
        payment; thereby reducing the amount you receive.

It is County/Entity’s policy to assist your recovery through our Return-to-Work/Modified Duty Status Program.

Your doctor will be informed of alternative productive work available and will assess your abilities in relation to

those functions. If you are able to participate in our Return-to-Work/Modified Duty Status program, your work

duties will be coordinated with your doctor and such duties will comply with him/her stated restrictions and

abilities pertaining to your health and recovery process.

If you have any additional questions concerning workers’ compensation benefits or if I can assist your recovery
process, please call me at __________________.

      Risk Management Pools
      North Carolina Association of County Commissioners
  Attachment E-1

NC WC Law – Q & A


     1. Who is required to provide workers' compensation coverage?
         Any employer who employs three or more employees.
         NOTE: Every executive officer selected or appointed and empowered in accordance with the charter
         and bylaws of a corporation is considered an employee of such corporation. For example, a
         corporation with two officers and one employee would be required to provide workers' compensation
         coverage. Any employer in which one or more employees are employed in activities which involve
         the use of or presence of radiation is required to have coverage.
     2. What must an employee do when an injury occurs?
         Report the injury to the employer, orally and in writing, immediately and in any event within 30 days.
     3. What should be done if the employer fails or refuses to report an injury?
         Employee should file a claim (Form 18 or 18B) within two years of the accident with the Industrial
     4. Who provides and directs medical treatment?
         The employer or its insurance company, subject to any Commission orders, provides and directs
         medical treatment. The Commission may permit the employee to change physicians or approve a
         physician of employee's selection when good grounds are shown. However, payment by the
         employer or carrier is not guaranteed unless written permission to change physicians is obtained
         from the employer, carrier, or Commission before the treatment is rendered.
     5. Chiropractic Rules:
         If the employer grants permission to seek medical treatment from a chiropractor, the employee is
         entitled to 20 visits if medically necessary. If additional visits are needed, the chiropractor should
         request this authorization from the employer.
     6. When can reimbursement for sick travel be collected?
         Employees are entitled to collect for mileage for medical treatment in workers' compensation cases
         at the rate of 25 cents a mile for travel prior to June 1, 2000 and at the rate of 31 cents a mile for
         travel on or after June 1, 2000, provided they travel 20 miles or more round trip. Special
         consideration will be given to employees who are totally disabled.
         NOTE: The Industrial Commission has given the self-insurers and insurance carriers permission to
         pay drug and travel expenses directly to the employee without approval from the Commission.
     7. What happens if in an emergency the employer fails or refuses to provide medical treatment?
         The employee may obtain the necessary treatment from a physician or hospital of his own choice,
         but must promptly request the Commission's approval.
     8. When do I become eligible for lost wage compensation?
         No compensation is due for the first seven (7) days of lost time unless the disability exceeds 21
         days. Therefore, the first check will not include payment for days 1-7. Payment for those days will be
         made should the disability continue beyond 21 days.

  Risk Management Pools
  North Carolina Association of County Commissioners
  Attachment E-1

NC WC Law – Q & A (cont.)


     9. How often are compensation payments made?
     10. At what rate of pay?
         66 2/3% of the average weekly wage, not to exceed $688.00* (2004 maximum) per week.
                       * The maximum weekly benefit is adjusted annually.
     11. How long is the employee eligible to receive lost-time weekly benefits?
         Until the employee is able to return to work.
     12. What is permanent partial disability?
         Total loss or partial loss of use of a member of the body or inability to earn the same wages in any
         employment as earned at the time of injury.
     13. Who determines permanent partial disability?
         The Commission, based on the impairment ratings of physicians or evidence of consideration of
         wage earning capacity.
     14. What happens when the employer refuses to acknowledge the claim?
         When liability for payment of compensation is denied, the Commission, claimant, his or her attorney,
         if any, and all known providers of health care shall be promptly notified of the reason for such denial.
         The denial Form 61 shall not be worded in general terms, but must detail the exact reason for the
         denial of liability.
         a) If a claim is denied by the insurance company or self-insurer, the employee may request a
            hearing before the Industrial Commission by submitting a Form 33, Request for Hearing.
         b)    Medical providers may bill the employee only after it has finally been determined that it is not a
              compensable workers' compensation claim.

  Risk Management Pools
  North Carolina Association of County Commissioners
Attachment F

   Letter to Attending Physician w/ Restriction Request



Physician's Name _____________________________________________ Appointment Date ________________

Name of Employee _____________________________________________ Date of Injury ____________________

Description of Injury ____________________________________________________________________________

Dear Dr. ________________________________

It is our understanding that you are currently or will be treating an employee of ours (named above) for an accident that occurred at our
location. It is our desire to have our injured employees enter our Return-to-Work/Modified Duty Program in an appropriate capacity as
soon as possible.

We have a number of modified duty opportunities that are designed to assist our injured employees in their return to full employment. With

your assistance, we would like to utilize our Return-to-Work/Modified Duty Program and return our injured employee to work under your


Please complete the section below to assist us in finding an appropriate modified duty position for our employee. At the bottom please
indicate if the employee has reached a medical endpoint, or if restrictions are still temporary. If temporary, I would appreciate it if you
would estimate their duration.

I would be happy to answer any questions you might have concerning our modified duty program. I will be following-up with you in a few
days to discuss the modified jobs that we have available based on your recommendations.


Name ___________________________________ Position ___________________________ Phone ___________

Address ________________________________________ City/State/Zip _________________________________
 WORK                        LIFTING:                             CARRYING LIMITED TO:            PUSHING/PULLING LIMITED TO:
    Regular Work             _____lbs.        From Floor              Up to 5 lbs                    Up to 5 lbs
       Modified Duty         _____lbs.        From Waist                 Up to 25 lbs                      Up to 25 lbs
       No Work               _____lbs.        From Shoulders             Up to 40 lbs                      Up to 40 lbs

 ENDURANCE LIMITATION:                                      POSITION LIMITATION:
 Standing    ______min/hr ______hrs/day                     No Reaching:
                                                              above shoulder                No Climbing
 Sitting           ______min/hr ______hrs/day                 below knees                   No twisting spine
 Walking           ______min/hr ______hrs/day
 Driving           ______min/hr ______hrs/day               Wrist bending:               Wrist twisting:
                                                              left hand                    left hand
 Keyboard Entry ______min/hr ______hrs/day                    right hand                   right hand

Comments (Please Print):

Status of restrictions: ____________________________________ Duration of Current Restrictions: __________________________

Next Appointment: ______________________________________________

_____________________________________________                  _______________________           _______________
(Physician's Signature)                                            (Please Print Name)               (Date)
       Risk Management Pools
       North Carolina Association of County Commissioners
  Attachment G

Letter to Attending Physician


  Street Address
  City, State Zip Code

  Dear Dr. ________________________________

  It is our understanding that you are currently or will be treating an employee of ours for an accident that

  occurred at our location. It is our desire to have any of our injured employees Return-to-Work/Modified Duty

  Program in an appropriate capacity, as soon as possible.

        We have a number of modified duty opportunities that are designed to assist our injured employees in

        their return to full employment. With your assistance, we would like to utilize our Return-to-

        Work/Modified Duty Program and return our injured employee to work under your supervision.

  I request that you complete the attached Job Function Abilities Form and send it to my attention at the
  address below. This will assist us in identifying a modified job that would meet your recommended
  restrictions for our employee. Once we have the completed form, we will review the jobs that meet the
  criteria and will send them to you for your review and approval.

  Please let me know if you have any questions regarding our Return-to-Work/Modified Duty Program, please

  feel free to contact me.


  Risk Management Pools
  North Carolina Association of County Commissioners
Attachment G-1

Job Function Abilities Form
                                                 Functional Abilities Form
Employee                                                                                                         SSN:

   To be completed by the Health Professional
Examination Date                                                             Area of Injury

Treatment Required?                   No                    Yes Type of treatment

Date of Next Appointment

Is the employee capable of returning to work immediately without restrictions?                            Yes                No

  To be completed if response to previous question was No
Capabilities                                                                                  General Comments/Specific Limitations
Walking:                  short distance only               other (e.g. uneven
Standing:           less than 15 min               less than 30 min           other

Sitting:            less than 30 min               less than 1 hour           other

Lifting floor to waist:        less than 10 kg          less than 25 kg          other

Lifting waist to shoulder:         less than 10 kg       less than 25 kg             other

Stair climbing:             none           2-3 steps only             short flight

Ladder climbing:          none             2-3 steps only             4-6 steps only

Limitations                                                                                   General Comments/Specific Limitations
Limited ability to use hand to:        hold objects         grip      type      write

    Bending or twisting of:

    Repetitive movement of:

    Chemical exposure to:

    Environmental exposure to:

    Operating motorized equipment

    Above shoulder activity                             Below shoulder activity

    Restrictions related to medications (specify):

    Exposure to vibration:             high frequency              low frequency

    Limit physical exertion to:             mild         moderate            heavy

   Risk Management Pools
   North Carolina Association of County Commissioners
Recommended Work Hours                      Complete Recovery Expected?           Estimated Duration of Limitations
  Full time hours      Modified hours
             Graduated Hours                        Yes       No

Health Professional’s Name                                                Health Profession

Full Address                                                                    City                      Postal Code

Signature                                                                    Telephone                         Date

   Attachment H

Physician’s Work Release Letter


   Street Address
   City, State Zip Code


   Dear Dr.                             :

   We are dedicated to working with you to return                              to productive employment at the
   earliest date. To this end, I wish to assure you that ANY restriction you may feel medically necessary will be

   We have previously identified job functions that may be suitable for early Return-to-Work/Modified Duty
   Status situations. Based on my knowledge of                                        ‘s injury, I feel the
   attached positions may be appropriate. Please review this document and return the copy to us with your

   Let me reinforce our commitment to our employee and you. We are committed to working with you to
   reintroduce                                 into our workplace safely. If this position cannot be modified
   appropriately, we may be able to create a position to allow                _____ to Return-to-Work/Modified
   Duty Status.

   Please feel free to contact me directly if you would like any further information on our Return-to-
   Work/Modified Duty Status Program, or on the proposed position.


   Cc:         employee
               Claims Administrator
   Risk Management Pools
   North Carolina Association of County Commissioners
Risk Management Pools
North Carolina Association of County Commissioners
Attachment H-1

 Job Requirements vs. Worker Capabilities

                            Job Requirements vs. Worker Capabilities

                                                                                                                               Working Potential
Employee Name _____________________________ Date _____________
                                                                                                                    Modified Duties Req’d ______
Job Title: ________________________ Work Location _______________
Describe                                                                                                                       U&C        U&C           If Mod
Essential Job Functions: ________________________________________                                                              Req’d      Part Tm         Wrk
____________________________________________________________                                                  Hrs/Day:         ______     ______        ______
____________________________________________________________                                                  Days/Wk:         ______     ______        ______

0 hours.                       Never
0 - 3 hours.                   Occasionally
3 - 6 hours                    Frequent
6 - 8+ hours.                  Constant                                        Activity Frequency (Hours per Day)

                                                         To be filled out by EMPLOYER:           To be filled out by PHYSICIAN:
                                                                                                                                            Rest/Stretch Break
                                                                      Job Requires                  Worker Abilities                        How often/long?
                                                               0      0-3    3-6     6-8+       0    0-3    3-6      6-8+
Sitting ...................................................... ____   ____ ____      ____       ____ ____ ____ ____                         _____       _____
Walking ................................................... ____      ____   ____    ____       ____   ____   ____      ____                _____       _____
Standing ................................................... ____     ____   ____    ____       ____   ____   ____      ____                _____       _____
Bending (neck) ......................................... ____         ____   ____    ____       ____   ____   ____      ____                _____       _____
Bending (waist) ........................................ ____         ____   ____    ____       ____   ____   ____      ____                _____       _____
Squatting.................................................. ____      ____   ____    ____       ____   ____   ____      ____                _____       _____
Climbing.................................................. ____       ____   ____    ____       ____   ____   ____      ____                _____       _____
Kneeling................................................... ____      ____   ____    ____       ____   ____   ____      ____                _____       _____
Crawling. ................................................. ____      ____   ____    ____       ____   ____   ____      ____                _____       _____
Twisting (neck)........................................ ____          ____   ____    ____       ____   ____   ____      ____                _____       _____
Twisting (waist). ...................................... ____         ____   ____    ____       ____   ____   ____      ____                _____       _____
Stooping................................................... ____      ____   ____    ____       ____   ____   ____      ____                _____       _____

                                                                               Hand Use (Hours per Day)
                                                                      Job Requires                  Worker Abilities
                                                   0                  0-3    3-6   6-8+        0      0-3   3-6      6-8+            Dominant Hand
Simple Grasping - Right .......................... ____               ____ ____ ____           ____ ____ ____ ____                 Right ____ Left ____
Simple Grasping - Left ............................ ____              ____   ____    ____       ____   ____   ____      ____
Power Grasping - Right .......................... ____                ____   ____    ____       ____   ____   ____      ____       Repetitive Hand Use
Power Grasping - Left. ............................ ____              ____   ____    ____       ____   ____   ____      ____       Required? Yes__ No__
Fine Manipulation - Right ...................... ____                 ____   ____    ____       ____   ____   ____      ____       Right ____ Left ____
Fine Manipulation - Left ........................ ____                ____   ____    ____       ____   ____   ____      ____
Pushing & Pulling - Right ...................... ____                 ____   ____    ____       ____   ____   ____      ____            Dominant Foot
Pushing & Pulling - Left.......................... ____               ____   ____    ____       ____   ____   ____      ____       Right ____ Left ____
Reach (Above Right Shoulder)................ ____                     ____   ____    ____       ____   ____   ____      ____
Reach (Above Left Shoulder) .................. ____                   ____   ____    ____       ____   ____   ____      ____       Repetitive Foot Use
Reach (Below Right Shoulder) ................ ____                    ____   ____    ____       ____   ____   ____      ____       Required? Yes__ No__
Reach (Below Left Shoulder)................... ____                   ____   ____    ____       ____   ____   ____      ____       Right ____ Left ____

Doctors Comments: ____________________________________________________________________

       Risk Management Pools
       North Carolina Association of County Commissioners

   Risk Management Pools
   North Carolina Association of County Commissioners

                                                                           Daily Requirements for:                                  Limitations
                                                                                                                                    ___ Visual
                                                                                Lifting (Hours)                                     ___ Hearing
                                            Job Requires                                            Worker Abilities                ___ Balance
                                     0   0-3 3-6 6-8+                   Height                  0   0-3 3-6 6-8+ Height
Up to 10 lbs ....................... ___ ___ ___ ___                    _____                   ___ ___ ___ ___      _____          If Yes, Describe: _______
Up to 25 lbs ....................... ___ ___ ___ ___                    _____                   ___ ___ ___ ___          _____      _____________________
Up to 50 lbs ....................... ___ ___ ___ ___                     _____                  ___ ___ ___ ___          _____
Up to 99 lbs ....................... ___ ___ ___ ___                    _____                   ___ ___ ___ ___          _____      Protective Equipment
100 + lbs ........................... ___ ___ ___ ___                    _____                  ___ ___ ___ ___          _____      Yes ___ No ___
Describe heaviest item carried and required distance:                                           Capable of lbs per lift ____
__________________________________________                                                      Lifts per hour ____                 Hearing
__________________________________________                                                                                          ___ Headset
                                                                                                                                    ___ Earplugs

                                                                                                                                    ___ Shield
                                                                           Carrying (Hours)                                         ___ Safety Glasses
                                            Job Requires                                  Work Abilities                            ___ goggles
                                     0   0-3 3-6 6-8+                   Height        0   0-3 3-6 6-8+                   Height
Up to 10 lbs ....................... ___ ___ ___ ___                    _____         ___ ___ ___ ___                    _____      Respiratory
Up to 25 lbs ....................... ___ ___ ___ ___                    _____                   ___ ___ ___ ___          _____      ___ supplied air respirator
Up to 50 lbs ....................... ___ ___ ___ ___                    _____                   ___ ___ ___ ___          _____      ___ cartridge
Up to 75 lbs ....................... ___ ___ ___ ___                     _____                  ___ ___ ___ ___          _____
Up to 99 lbs ....................... ___ ___ ___ ___                    _____                   ___ ___ ___ ___          _____      Miscellaneous
100 + lbs............................ ___ ___ ___ ___                    _____                  ___ ___ ___ ___          _____      ___ Hardhat
                                                                                                                                    ___ Safety shoes

                                                                                Environmental & Other Factors

                                                                                    Yes                     If Yes, Describe                         Restrict
Driving cars, trucks, forklifts & other equipment...................................___                     ________________________________        __ _
Working around equipment and machinery. .........................................___                        ________________________________        _    __
Walking on uneven surface. .....................................................................___         ________________________________        __   _
Exposure to excessive noise. ....................................................................___        ________________________________        __   _
Exposure to extremes in temp, humidity or wetness. .............................___                         ________________________________        _    __
Exposure to dust, gas, fumes or chemicals. ..............................................___                ________________________________        _     _
Working at heights. ..................................................................................___   ________________________________        _    __
Operation of foot controls or repetitive foot movement........................___                           ________________________________        __   _
Use special visual or auditory protective equipment...............................___                       ________________________________        _    __

Employee Comments:


Employer Comments: ___________________________________________________________________


       Risk Management Pools
       North Carolina Association of County Commissioners
Attachment I

 Return-to-Work/Modified Duty Status Letter to the Employee


(Employee Name)
Address 1
Address 2

Dear _______________________:

Dr. _________ has told us that, while he thinks you should not return to your former job right now at full
capacity, he strongly encourages that you return to work on a modified duty status with certain restrictions.
Those restrictions are attached to this letter. Our desire is that, under strict medical supervision, we will do
everything possible to help you when you return to work.

We have a number of positions and functions available, which fit within the restrictions cited by the Doctor.
We would like you to come in on Wednesday at 9:00 A.M. to begin work within the Doctor’s medical
restrictions. Your modified duty job will be working as a _____________. For the first week, you will work
only (example: three hours each day). We will review your medical progress each week during our Weekly
Progress Meetings to determine whether you can decrease your medical restrictions.

Your rate of pay and your employment status will remain the same in this modified duty job. We have been
advised that your returning to work in a modified duty status will help speed your recovery so that you will be
able to return to your regular job as soon as possible.

Please indicate below whether you accept or reject the offer of modified duty work described herein and
return it to me in the enclosed self-addressed stamped envelope.

We look forward to seeing you on _____________ (example: mid-week is a good time to bring someone
back to work). If you have any questions, please call me collect at 1-999-081-3333.


Personnel Manager

Acceptance: ______________________________________

I reject this job: ___________________________________

If you reject this job, please explain your reason:

 Risk Management Pools
 North Carolina Association of County Commissioners
Attachment J

Modified Duty Status Report

Important: to be completed by the Supervisor or Department Head and returned to RTW Coordinator
after the first day/week of modified duty.

Today’s Date:

Start Date of Modified Duty _______________ Date of Last Medical Check____________________

Projected Date of Return
to Regular Duties _________________________ Date of Next Medical Check_________________

Treating Physician ________________________Phone #__________________________________



Is the Employee having any specific problems? yes ____ no ____

If yes, explain:

(Signature) ________________________________________________________________________


Are you having any specific problems? yes ____ no ____

If yes, explain:

Risk Management Pools
North Carolina Association of County Commissioners


                               Summary Job Description: Deputy Sheriff

Under general supervision; performs law enforcement work of moderate difficulty in enforcing laws,
maintaining order, protecting life and property and investigating and assisting in the prevention of crime;
and performs related work as required. Work may be required on weekends and holidays according to
assigned shift and duties may be assigned in any geographical or functional unit of the department. The
following duties required but are not limited to:

A. Enforcing federal and state laws and local ordinances

B. Responding to emergency scenes and calls for service to provide assistance and maintain law and

C. Recovering lost or stolen property.

D. Investigating emergent and non-emergent complaints of crimes and conducting follow-up

       II. Appearing in court to testify in legal proceedings.

       III. Serving civil and criminal process papers.

All of the above includes:
    • Patrolling assigned area for the prevention of crime and enforcement of laws and ordinances.
    • Arresting violators of laws and ordinances, and insuring violators are booked on charges; Escorts
         prisoners to jail and court.
    • Enforcing traffic laws, directing traffic and providing information concerning the location of streets,
         routes and buildings.
    • Investigating and preparing detailed reports of collisions.
    • Investigating suspicious conditions, activities, or persons.
    • Investigating and checking for wanted or missing persons and stolen property.

Risk Management Pools
North Carolina Association of County Commissioners
                           Job Requirements vs. Worker Capabilities

                                                                                                                               Working Potential
Employee Name _____________________________ Date _____________
                                                                                                                    Modified Duties Req’d ______
Job Title: __Deputy Sheriff____________Work Location _______________
Describe                                                                                                                       U&C        U&C           If Mod
Essential Job Functions: _Under general supervision, performs law enforcement                                                  Req’d      Part Tm         Wrk
_work, maintaining order, protecting life and property, and investigating and                                 Hrs/Day:         ______     ______        ______
_assisting in the prevention of crime. Performs related work as required.___                                  Days/Wk:         ______     ______        ______

0 hours.                       Never
0 - 3 hours.                   Occasionally
3 - 6 hours                    Frequent
6 - 8+ hours.                  Constant                                        Activity Frequency (Hours per Day)

                                                        To be filled out by EMPLOYER:           To be filled out by PHYSICIAN:
                                                                                                                                            Rest/Stretch Break
                                                                      Job Requires                  Worker Abilities                        How often/long?
                                                               0      0-3    3-6     6-8+       0    0-3    3-6      6-8+
Sitting ...................................................... ____   ____ ____      _x_        ____ ____ ____ ____                         _____       _____
Walking ................................................... ____      ____   _x__    ____       ____   ____   ____      ____                _____       _____
Standing ................................................... ____     ____   ____    _x_        ____   ____   ____      ____                _____       _____
Bending (neck) ......................................... ____         ____   _x_     ____       ____   ____   ____      ____                _____       _____
Bending (waist) ........................................ ____         ____   _x__    ____       ____   ____   ____      ____                _____       _____
Squatting.................................................. ____      ____   _x__    ____       ____   ____   ____      ____                _____       _____
Climbing.................................................. ____       _x__   ____    ____       ____   ____   ____      ____                _____       _____
Kneeling................................................... ____      ____   _x__    ____       ____   ____   ____      ____                _____       _____
Crawling. ................................................. ____      _x__   ____    ____       ____   ____   ____      ____                _____       _____
Twisting (neck)........................................ ____          _x__   ____    ____       ____   ____   ____      ____                _____       _____
Twisting (waist). ...................................... ____         _x__   ____    ____       ____   ____   ____      ____                _____       _____
Stooping................................................... ____      _x__   ____    ____       ____   ____   ____      ____                _____       _____

                                                                               Hand Use (Hours per Day)
                                                                      Job Requires                  Worker Abilities
                                                   0                  0-3    3-6   6-8+        0      0-3   3-6      6-8+            Dominant Hand
Simple Grasping - Right .......................... ____               ____ _x__ ____           ____ ____ ____ ____                 Right ____ Left ____
Simple Grasping - Left ............................ ____              _x__   ____    ____       ____   ____   ____      ____
Power Grasping - Right .......................... ____                ____   _x__    ____       ____   ____   ____      ____       Repetitive Hand Use
Power Grasping - Left. ............................ ____              _x__   ____    ____       ____   ____   ____      ____       Required? Yes__ No__
Fine Manipulation - Right ...................... ____                 _x__   ____    ____       ____   ____   ____      ____       Right ____ Left ____
Fine Manipulation - Left ........................ ____                _x__   ____    ____       ____   ____   ____      ____
Pushing & Pulling - Right ...................... ____                 _x _   ____    ____       ____   ____   ____      ____            Dominant Foot
Pushing & Pulling - Left.......................... ____               _x _   ____    ____       ____   ____   ____      ____       Right ____ Left ____
Reach (Above Right Shoulder)................ ____                     _x _   ____    ____       ____   ____   ____      ____
Reach (Above Left Shoulder) .................. ____                   _x _   ____    ____       ____   ____   ____      ____       Repetitive Foot Use
Reach (Below Right Shoulder) ................ ____                    _x _   ____    ____       ____   ____   ____      ____       Required? Yes__ No__
Reach (Below Left Shoulder)................... ____                   _x _   ____    ____       ____   ____   ____      ____       Right ____ Left ____

Doctors Comments: ____________________________________________________________________

       Risk Management Pools
       North Carolina Association of County Commissioners

   Risk Management Pools
   North Carolina Association of County Commissioners

                                                                              Daily Requirements for:                                       Limitations
                                                                                                                                            ___ Visual
                                                                                   Lifting (Hours)                                          ___ Hearing
                                            Job Requires                                               Worker Abilities                     ___ Balance
                                     0   0-3 3-6 6-8+                      Height                  0   0-3 3-6 6-8+ Height
Up to 10 lbs ....................... ___ ___ ___ ___                       _____                   ___ ___ ___ ___      _____               If Yes, Describe: _______
Up to 25 lbs ....................... ___ ___ ___ ___                       _____                   ___ ___ ___ ___          _____           _____________________
Up to 50 lbs ....................... ___ _x_ ___ ___                       _____                   ___ ___ ___ ___          _____
Up to 99 lbs ....................... ___ ___ ___ ___                       _____                   ___ ___ ___ ___          _____           Protective Equipment
100 + lbs ........................... ___ _x_ ___ ___                      _____                   ___ ___ ___ ___          _____           Yes ___ No ___
Describe heaviest item carried and required distance:                                              Capable of lbs per lift ____
__________________________________________                                                          Lifts per hour ____                     Hearing
__________________________________________                                                                                                  ___ Headset
                                                                                                                                            ___ Earplugs

                                                                                                                                            ___ Shield
                                                                              Carrying (Hours)                                              ___ Safety Glasses
                                            Job Requires                                     Work Abilities                                 ___ goggles
                                     0   0-3 3-6 6-8+                      Height        0   0-3 3-6 6-8+                   Height
Up to 10 lbs ....................... ___ ___ ___ ___                       _____         ___ ___ ___ ___                    _____           Respiratory
Up to 25 lbs ....................... ___ ___ ___ ___                       _____                   ___ ___ ___ ___          _____           ___ supplied air respirator
Up to 50 lbs ....................... ___ ___ ___ ___                       _____                   ___ ___ ___ ___          _____           ___ cartridge
Up to 75 lbs ....................... ___ _x_ ___ ___                       _____                   ___ ___ ___ ___          _____
Up to 99 lbs ....................... ___ ___ ___ ___                       _____                   ___ ___ ___ ___          _____           Miscellaneous
100 + lbs............................ ___ _x_ ___ ___                      _____                   ___ ___ ___ ___          _____           ___ Hardhat
                                                                                                                                            ___ Safety shoes

                                                                           Environmental & Other Factors

                                                                                    Yes                         If Yes, Describe                                 Restrict
Driving cars, trucks, forklifts & other equipment..................................._x_                         ____Sheriff Car___________________               __ _
Working around equipment and machinery. .........................................___                            ________________________________               __       _
Walking on uneven surface. ....................................................................._x_             ____Terrain, location_______________             __         _
Exposure to excessive noise. ...................................................................._x_            ____Sirens, environmental conditions__             __       _
Exposure to extremes in temp, humidity or wetness. ............................._x_                             ____Environmental conditions_______              _      __
Exposure to dust, gas, fumes or chemicals. .............................................._x_                    ____On occasion__________________              _       __
Working at heights. .................................................................................._x_       ____Surveillance, etc._______________            __     _
Operation of foot controls or repetitive foot movement........................_x_                               ____Driving______________________              __       _
Use special visual or auditory protective equipment..............................._x_                           ____On occasion, sunglasses, environmental         _    __
        .....................................................................................................       protective wear

Employee Comments:


Employer Comments: ___________________________________________________________________

       Risk Management Pools
       North Carolina Association of County Commissioners

                              Summary Job Description: EMT

  Under general supervision, provides basic to advanced emergency rescue and
  paramedical care to the ill and injured. Receives call from dispatcher, responds verbally
  to emergency calls, reads maps, may drive ambulance to emergency site, uses most
  expeditious route, and observes traffic ordinances and regulations. Guides and supports
  EMT Intermediate and/or EMT Basic techs and/or students in the application of
  appropriate EMS techniques, as required. Typically works on an on-call basis as per
  schedule or as otherwise required.

  The following duties are required but are not limited to:

     •   Determines nature and extent of illness or injury
     •   Takes pulse, blood pressure, visually observes changes in skin color
     •   Makes determination regarding patient status, establishes priority for emergency
         care, renders appropriate emergency care (based on competency level)
     •   May administer intravenous drugs or fluid replacement as directed by physician.
     •   May use equipment (based on competency level) such as but not limited to,
         defibrillator, electrocardiograph
     •   Performs endotracheal intubation to open airways and ventilate patient, inflates
         pneumatic anti-shock garment to improve patient's blood circulation.
     •   Participates in a continuous training program to maintain certification and
         improve competence in medical technical work and in ambulance service and
         operation; studies street and road patterns and networks of the county in order
         that future runs may be made with minimum difficulty and delay.
     •   Maintains accurate records and reports.
     •   Performs daily inspection and cleaning of ambulance and base.

  Risk Management Pools
  North Carolina Association of County Commissioners

                           Job Requirements vs. Worker Capabilities

                                                                                                                                 Working Potential
Employee Name _____________________________ Date _____________
                                                                                                                     Modified Duties Req’d ______
Job Title: _Emergency Medical Technician (EMT)____Work Location _______________
Describe                                                                                                                         U&C        U&C           If Mod
Essential Job Functions: _Perform non-invasive and invasive procedures                                                           Req’d      Part Tm         Wrk
_consistent with State, County and Departmental policies and regulations                                           Hrs/Day:      ______     ______        ______
_regarding training and certification.                                                 ___                         Days/Wk:      ______     ______        ______

0 hours.                        Never
0 - 3 hours.                    Occasionally
3 - 6 hours                     Frequent
6 - 8+ hours.                   Constant                                      Activity Frequency (Hours per Day)

                                                       To be filled out by EMPLOYER:            To be filled out by PHYSICIAN:
                                                                                                                                              Rest/Stretch Break
                                                                       Job Requires                    Worker Abilities                       How often/long?
                                                                0      0-3    3-6     6-8+         0    0-3     3-6       6-8+
Sitting ....................................................... ____   ____ _x_       _ _          ____ ____ ____         ____                _____       _____
Walking ..................................................... ____     ____    _ __   _x_          ____   ____     ____   ____                _____       _____
Standing..................................................... ____     ____    ____   _x_          ____   ____     ____   ____                _____       _____
Bending (neck) .......................................... ____         ____    __     _x_          ____   ____     ____   ____                _____       _____
Bending (waist) ......................................... ____         ____    _ __   _x_          ____   ____     ____   ____                _____       _____
Squatting.................................................... ____     ____    _ __   _x_          ____   ____     ____   ____                _____       _____
Climbing.................................................... ____      _ __    _x_    ____         ____   ____     ____   ____                _____       _____
Kneeling. ................................................... ____     ____    _ __   _x_          ____   ____     ____   ____                _____       _____
Crawling. ................................................... ____     _ __    _x_    ____         ____   ____     ____   ____                _____       _____
Twisting (neck). ........................................ ____         __ _    _x_    ____         ____   ____     ____   ____                _____       _____
Twisting (waist)......................................... ____         __ _    _x_    ____         ____   ____     ____   ____                _____       _____
Stooping..................................................... ____     _ __    _ _    _x_          ____   ____     ____   ____                _____       _____

                                                                                 Hand Use (Hours per Day)
                                                                       Job Requires                   Worker Abilities
                                                    0                  0-3    3-6    6-8+        0       0-3   3-6        6-8+          Dominant Hand
Simple Grasping - Right............................ ____               ____ _x__ ____            ____ ____ ____           ____        Right ____ Left ____
Simple Grasping - Left ............................. ____              __ _    _x__   ____         ____   ____     ____   ____
Power Grasping - Right ............................ ____               _ __    _x__   ____         ____   ____     ____   ____        Repetitive Hand Use
Power Grasping - Left............................... ____              __ _    _x__   ____         ____   ____     ____   ____        Required? Yes__ No__
Fine Manipulation - Right ........................ ____                __ _    _x__   ____         ____   ____     ____   ____        Right ____ Left ____
Fine Manipulation - Left .......................... ____               _ __    _x__   ____         ____   ____     ____   ____
Pushing & Pulling - Right ........................ ____                _ _     _x__   ____         ____   ____     ____   ____            Dominant Foot
Pushing & Pulling - Left. .......................... ____              _ _     _x__   ____         ____   ____     ____   ____        Right ____ Left ____
Reach (Above Right Shoulder) ................. ____                    _x _    ____   ____         ____   ____     ____   ____
Reach (Above Left Shoulder) ................... ____                   _x _    ____   ____         ____   ____     ____   ____        Repetitive Foot Use
Reach (Below Right Shoulder) ................. ____                    _ _     _x__   ____         ____   ____     ____   ____        Required? Yes__ No__
Reach (Below Left Shoulder) ................... ____                   _ _     _x__   ____         ____   ____     ____   ____        Right ____ Left ____

Doctors Comments:


        Risk Management Pools
        North Carolina Association of County Commissioners



                                                                              Daily Requirements for:                                         Limitations
                                                                                                                                              ___ Visual
                                                                                  Lifting (Hours)                                             ___ Hearing
                                             Job Requires                                              Worker Abilities                       ___ Balance
                                      0   0-3 3-6 6-8+                     Height                  0   0-3 3-6 6-8+           Height
Up to 10 lbs ........................ ___ ___ ___ ___                      _____                   ___ ___ ___ ___            _____           If Yes, Describe: _______
Up to 25 lbs ........................ ___ ___ ___ ___                      _____                   ___ ___ ___ ___            _____           _____________________
Up to 50 lbs ........................ ___ _ _          _x_ ___             _____                   ___ ___ ___ ___            _____
Up to 99 lbs ........................ ___ ___ _x_ ___                      _____                   ___ ___ ___ ___            _____           Protective Equipment
100 + lbs ............................ ___ _ _         _x_ ___             _____                   ___ ___ ___ ___            _____           Yes ___ No ___
Describe heaviest item carried and required distance:                                              Capable of lbs per lift ____
_Objects or persons at distances of more than 20 feet.                                              Lifts per hour ____                       Hearing
__________________________________________                                                                                                    ___ Headset
                                                                                                                                              ___ Earplugs

                                                                                                                                              ___ Shield
                                                                              Carrying (Hours)                                                ___ Safety Glasses
                                             Job Requires                                     Work Abilities                                  ___ goggles
                                      0   0-3 3-6 6-8+                     Height        0    0-3 3-6 6-8+                    Height
Up to 10 lbs ........................ ___ ___ ___ ___                      _____         ___ ___ ___ ___                      _____           Respiratory
Up to 25 lbs ........................ ___ ___ ___ ___                      _____                   ___ ___ ___ ___            _____           ___ supplied air respirator
Up to 50 lbs ........................ ___ ___ ___ ___                      _____                   ___ ___ ___ ___            _____            ___ cartridge
Up to 75 lbs ........................ ___ _ _          _x_ ___             _____                   ___ ___ ___ ___            _____
Up to 99 lbs ........................ ___ ___ ___ ___                      _____                   ___ ___ ___ ___            _____           Miscellaneous
100 + lbs ............................. ___ _ _        _x_ ___             _____                   ___ ___ ___ ___            _____           ___ Hardhat
                                                                                                                                              ___ Safety shoes

                                                                           Environmental & Other Factors

                                                                                         Yes                    If Yes, Describe                                 Restrict
Driving cars, trucks, forklifts & other equipment....................................... _x_                    ____Ambulance___________________                 __ _
Working around equipment and machinery. .............................................. _x_                      ____Medical Equipment____________                __ _
Walking on uneven surface......................................................................... _x_          ____Terrain, location_______________             __     _
Exposure to excessive noise. ...................................................................... _x_         ____Sirens, environmental conditions__            __       _
Exposure to extremes in temp, humidity or wetness. ................................. _x_                        ____Environmental conditions_______              _ __
Exposure to dust, gas, fumes or chemicals. ................................................ _x_                 ____On occasion__________________                _     __
Working at heights. ..................................................................................... _x_   ____10+ feet______________            _          __    _
Operation of foot controls or repetitive foot movement............................. _x_                         ____Walking, running______________               __     _
Use special visual or auditory protective equipment. ................................. _x_                      ____Protection from bacteria, bodily fluids.     _     __

Employee Comments: ___________________________________________________________________


Employer Comments:


       Risk Management Pools
       North Carolina Association of County Commissioners


                    Summary Job Description: Home Healthcare Nurse

   Contracts independently to render nursing care, usually to one patient, in hospital or
   private home: Administers medications, treatments, dressings, and other nursing
   services, according to physician's instructions and condition of patient. Observes,
   evaluates, and records symptoms. Applies independent emergency measures to
   counteract adverse developments and notifies physician of patient's condition. Directs
   patient in good health habits and gives information to family in treatment of patient and
   maintenance of healthful environment. May specialize in one field of nursing, such as
   obstetrics, psychiatry, or tuberculosis.

   Job functions may require but are not limited to:
      • Maintains equipment and supplies.
      • Cooperates with community agencies furnishing assistance to patient.
      • May supervise diet when employed in private home.
      • Serving as an interface with the authorizing personnel of personal care programs
          to coordinate the balance between the medical work model and the social work
          model of care.
      • Recommending changes to service plan, when indicated, to the case manager
          and gives feedback on quality of care provided.
      • Provides training to the care provider on-site, or directs further formal training for
          the provider as necessary.
      • Refers to appropriate health care providers as necessary to assure appropriate
          care and medical service delivery based on client need.
      • Enters case notes into computer system in a timely manner

  Risk Management Pools
  North Carolina Association of County Commissioners

                           Job Requirements vs. Worker Capabilities

                                                                                                                                 Working Potential
Employee Name _____________________________ Date _____________
                                                                                                                     Modified Duties Req’d ______
Job Title: Home Healthcare Nurse ___Work Location _______________
Describe                                                                                                                         U&C        U&C           If Mod
Essential Job Functions: _Manage both expected and unexpected emergency                                                          Req’d      Part Tm         Wrk
_situations that are commonly seen for the assigned patient.                                                       Hrs/Day:      __8___     ______        ______
_                                                                  ___                                             Days/Wk:      __5___     ______        ______

0 hours.                        Never
0 - 3 hours.                    Occasionally
3 - 6 hours                     Frequent
6 - 8+ hours.                   Constant                                      Activity Frequency (Hours per Day)

                                                       To be filled out by EMPLOYER:            To be filled out by PHYSICIAN:
                                                                                                                                              Rest/Stretch Break
                                                                       Job Requires                    Worker Abilities                       How often/long?
                                                                0      0-3    3-6     6-8+         0    0-3     3-6       6-8+
Sitting ....................................................... ____   _x_    _ _     _ _          ____ ____ ____         ____                _____       _____
Walking ..................................................... ____     ____    _x _   _ _          ____   ____     ____   ____                _____       _____
Standing..................................................... ____     ____    ____   _x_          ____   ____     ____   ____                _____       _____
Bending (neck) .......................................... ____         ____    _x_    _ _          ____   ____     ____   ____                _____       _____
Bending (waist) ......................................... ____         ____    _x _   _ _          ____   ____     ____   ____                _____       _____
Squatting.................................................... ____     _x_     _ __   _ _          ____   ____     ____   ____                _____       _____
Climbing.................................................... ____      _x      __     ____         ____   ____     ____   ____                _____       _____
Kneeling. ................................................... ____     _x_     _ __   _ _          ____   ____     ____   ____                _____       _____
Crawling. ................................................... ____     _x      _ _    ____         ____   ____     ____   ____                _____       _____
Twisting (neck). ........................................ ____         __ _    _x_    ____         ____   ____     ____   ____                _____       _____
Twisting (waist)......................................... ____         __ _    _x_    ____         ____   ____     ____   ____                _____       _____
Stooping..................................................... ____     _x      _ _    _            ____   ____     ____   ____                _____       _____

                                                                                 Hand Use (Hours per Day)
                                                                       Job Requires                   Worker Abilities
                                                    0                  0-3    3-6    6-8+        0       0-3   3-6        6-8+          Dominant Hand
Simple Grasping - Right............................ ____               ____ _x__ ____            ____ ____ ____           ____        Right ____ Left ____
Simple Grasping - Left ............................. ____              __ _    _x__   ____         ____   ____     ____   ____
Power Grasping - Right ............................ ____               _ __    _x__   ____         ____   ____     ____   ____        Repetitive Hand Use
Power Grasping - Left............................... ____              __ _    _x__   ____         ____   ____     ____   ____        Required? Yes__ No__
Fine Manipulation - Right ........................ ____                __ _    _ _    _x__         ____   ____     ____   ____        Right ____ Left ____
Fine Manipulation - Left .......................... ____               _ __    __ _   _x__         ____   ____     ____   ____
Pushing & Pulling - Right ........................ ____                _ _     _x__   ____         ____   ____     ____   ____            Dominant Foot
Pushing & Pulling - Left. .......................... ____              _ _     _x__   ____         ____   ____     ____   ____        Right ____ Left ____
Reach (Above Right Shoulder) ................. ____                    _x _    ____   ____         ____   ____     ____   ____
Reach (Above Left Shoulder) ................... ____                   _x _    ____   ____         ____   ____     ____   ____        Repetitive Foot Use
Reach (Below Right Shoulder) ................. ____                    _ _     _x__   ____         ____   ____     ____   ____        Required? Yes__ No__
Reach (Below Left Shoulder) ................... ____                   _ _     _x__   ____         ____   ____     ____   ____        Right ____ Left ____

Doctors Comments: ____________________________________________________________________


        Risk Management Pools
        North Carolina Association of County Commissioners


                                                                              Daily Requirements for:                                         Limitations
                                                                                                                                              ___ Visual
                                                                                  Lifting (Hours)                                             ___ Hearing
                                             Job Requires                                              Worker Abilities                       ___ Balance
                                      0   0-3 3-6 6-8+                     Height                  0   0-3 3-6 6-8+           Height
Up to 10 lbs ........................ ___ ___ ___ ___                      _____                   ___ ___ ___ ___            _____           If Yes, Describe: _______
Up to 25 lbs ........................ ___ ___ ___ ___                      _____                   ___ ___ ___ ___            _____           _____________________
Up to 50 lbs ........................ ___ _ _          _x_ ___             _____                   ___ ___ ___ ___            _____
Up to 99 lbs ........................ ___ ___ _x_ ___                      _____                   ___ ___ ___ ___            _____           Protective Equipment
100 + lbs ............................ ___ _ _         _x_ ___             _____                   ___ ___ ___ ___            _____           Yes ___ No ___
Describe heaviest item carried and required distance:                                              Capable of lbs per lift ____
_Objects or persons from floor level to 36 inches.                                                   Lifts per hour ____                      Hearing
__________________________________________                                                                                                    ___ Headset
                                                                                                                                              ___ Earplugs

                                                                                                                                              ___ Shield
                                                                              Carrying (Hours)                                                ___ Safety Glasses
                                             Job Requires                                     Work Abilities                                  ___ goggles
                                      0   0-3 3-6 6-8+                     Height        0    0-3 3-6 6-8+                    Height
Up to 10 lbs ........................ ___ ___ ___ ___                      _____         ___ ___ ___ ___                      _____           Respiratory
Up to 25 lbs ........................ ___ ___ ___ ___                      _____                   ___ ___ ___ ___            _____           ___ supplied air respirator
Up to 50 lbs ........................ ___ ___ ___ ___                      _____                   ___ ___ ___ ___            _____            ___ cartridge
Up to 75 lbs ........................ ___ _ _          _x_ ___             _____                   ___ ___ ___ ___            _____
Up to 99 lbs ........................ ___ ___ _x_ ___                      _____                   ___ ___ ___ ___            _____           Miscellaneous
100 + lbs ............................. ___ _ _        _x_ ___             _____                   ___ ___ ___ ___            _____           ___ Hardhat
                                                                                                                                              ___ Safety shoes

                                                                           Environmental & Other Factors

                                                                                         Yes                    If Yes, Describe                                 Restrict
Driving cars, trucks, forklifts & other equipment....................................... _x_                    ____Transport patient______________              __ _
Working around equipment and machinery. .............................................. _x_                      ____Medical Equipment____________                __ _
Walking on uneven surface......................................................................... _ _          ____                   _______________           __    _
Exposure to excessive noise. ...................................................................... _ _         ___                                 __           __    _
Exposure to extremes in temp, humidity or wetness. ................................. _x_                        ____Environmental conditions_______              _ __
Exposure to dust, gas, fumes or chemicals. ................................................ _x_                 ____On occasion__________________                _    __
Working at heights. ..................................................................................... _ _   ____          ______________          _          __    _
Operation of foot controls or repetitive foot movement............................. _x_                         ____Walking             _____________            __    _
Use special visual or auditory protective equipment. ................................. _x_                      ____Protection from bacteria, bodily fluids.      _   __

Employee Comments: ___________________________________________________________________


Employer Comments: ___________________________________________________________________


       Risk Management Pools
       North Carolina Association of County Commissioners
NC Industrial Commission Bulletin

   North Carolina Industrial Commission
          Administering the Workers’ Compensation Act
                      STREET ADDRESS
           Dobbs Building · 430 North Salisbury Street
              Raleigh, North Carolina 27603-5937
                      MAILING ADDRESS
                    4340 Mail Service Center
              Raleigh, North Carolina 27699-4340
                     Internet Address: http://www.comp.state.nc.us/

                             JUNE 15, 2004 UPDATE

                      Information About
                     The North Carolina
                  Workers’ Compensation Act
       North Carolina Industrial Commission
                         Michael F. Easley, Governor
                          Buck Lattimore, Chairman
Bernadine S. Ballance, Commissioner                  Christopher Scott, Commissioner
Thomas J. Bolch, Commissioner                        Dianne C. Sellers, Commissioner
Laura K. Mavretic, Commissioner                       Pamela T. Young, Commissioner

                              Barbara Levine, Administrator

                          Tracey Weaver, Executive Secretary

Risk Management Pools
North Carolina Association of County Commissioners
NC Industrial Commission Bulletin
                    Ombudsmen: (800) 688-8349, (919) 807-2501

Risk Management Pools
North Carolina Association of County Commissioners
NC Industrial Commission Bulletin
                                         Fax: (919) 715-0282
Claims Section:                     (919) 807-2502    Mediation Section:              (888) 242-5757,
                                                                                       (919) 807-2586
Commissioners:                      (919) 807-2500    Medical Billing Section:        (919) 807-2503
Computer Support:                   (919) 807-2591    Occupational Disease Section:   (919) 807-2502
Deputy Commissioners:               (919) 807-2500    Ombudsman Section:              (800) 688-8349,
                                                                                       (919) 807-2501
Docket Section:                     (919) 807-2504    Safety Section:                 (919) 807-2603

Executive Secretary:                (919) 807-2575    Statistics Section:             (919) 807-2506
Fraud Investigations:               (888) 891-4895,   Workers’ Compensation Nurses:   (919) 807-2616
                                     (919) 807-2570

                        FOR ANSWERS TO QUESTIONS…

                  About:                                             Telephone:
General questions and disputes
                                           Ombudsmen: (800) 688-8349, (919) 807-2501
in cases; coverage information
Filing and case status                     Docket Section: (919) 807-2504
Application of the Act,
Settlement Agreements, and                 Executive Secretary: (919) 807-2575
change of physicians
Appeals, Rules, and Policies               Commissioners: (919) 807-2500
Medical Bill Approvals                     Medical Billing Section: (919) 807-2503
Medical Fee Schedule                       http://www.comp.state.nc.us/ncic/pages/feesched.asp
Rehabilitation Assistance                  Workers' Compensation Nurses: (919) 807-2616
Workplace Safety Programs                  Safety Section: (919) 807-2603
Hearings in Contested Cases                Docket Section: (919) 807-2504
Pending Occupational Disease
                                           Occupational Disease Section: (919) 807-2502
Publications and Forms                     Main Number: (919) 807-2527
Form Agreements, Attorney
                                           Claims Section: (919) 807-2502
Personnel and Contracts                    Administrator: (919) 807-2500
Workers' Compensation Fraud                Fraud Section: (888) 891-4895, (919) 807-2570
Mediation of Claims                        Mediation Section: (888) 242-5757, (919) 807-

Risk Management Pools
North Carolina Association of County Commissioners
NC Industrial Commission Bulletin
                                      Please Note…
This bulletin is designed to give general information only. It is not a law book. Further
information may be obtained by writing a letter to the Executive Secretary or Ombudsmen,
North Carolina Industrial Commission, or by consulting with an attorney of your choice which
may be at your expense. If you need assistance locating an attorney in your community who is
familiar with workers' compensation law, you may contact the N.C. Bar Association's nonprofit
Lawyer Referral Service. Just telephone toll free in North Carolina to (800) 662-7660—or dial
(919) 677-8574 from out of state or (919) 677-8574 from the Raleigh/Durham/Chapel Hill
area—to obtain the name of an attorney willing to discuss your question for a nominal fee or no
fee. Mention workers' compensation when requesting a referral. When writing or calling the
Commission about a specific case, always give the name of the injured employee, the I.C. file
number for the claim or the employee's social security number, and, if available, the name of the
employer and date of injury.

                               Publications and Forms
Publications and forms may be obtained by contacting the N.C. Industrial Commission, 4340
Mail Service Center, Raleigh, NC 27699-4340, calling (919) 807-2527, or e-mailing Carolyn
Wall at wallc@ind.commerce.state.nc.us. Orders require prepayment. Please call or e-mail to
obtain current prices and to confirm quantities available.

See http://www.comp.state.nc.us/ncic/pages/feesched.asp to view portions the Commission's
Medical Fee Schedule online. To buy the complete North Carolina Workers’ Compensation
Medical Fee Schedule in electronic format, call Emmy Walsh of Ingenix, Inc. at (800) 765-6088,
ext. 23483.

               MAINTAIN COVERAGE
Businesses covered by the Workers' Compensation Act are required by law to obtain insurance
or qualify as self-insureds for possible compensation liability to their employees. All businesses
employing three (3) or more employees on a regular basis are covered, except that agricultural
employments with fewer than ten (10) regular employees, certain sawmill and logging operators,
and all domestic employees are exempt. Businesses with any employee whose work involves the
use of or presence of radiation are required to have coverage. Corporate officers, partners, and
owners who are employed in the business may be exempted from coverage. However, corporate
officer/employees are counted in determining whether the business has three or more employees.
Sole proprietors and partnerships who have three (3) or more employees must purchase coverage
for these employees and may elect to include coverage for themselves.

        How to Obtain Workers' Compensation Insurance

Risk Management Pools
North Carolina Association of County Commissioners
NC Industrial Commission Bulletin
If you are subject to the Act, you are required to carry workers' compensation insurance. In
order to obtain workers' compensation insurance, contact your independent agent about your
coverage needs and the types of coverage available to you.

               Types of Workers' Compensation Coverage
There are three (3) types of workers' compensation coverage:

   1.   An independent agent can write coverage solely for your business.
   2.   You can become a member of or contributor to a Self-Insured Fund. A Self-Insured Fund is a "blanket
        coverage" of workers' compensation insurance in which you pay into a large fund which provides the
        coverage for your business and all those who pay into that fund. Your contribution to the fund is based on
        coverage for your business and all those who pay into that fund. Your contribution to the fund is based on
        your number of employees, the rate assigned to them by the North Carolina Rate Bureau, and your payroll.

        EXAMPLE: You are a General Contractor who is subject to the Act. A Builders
        Association offers a Self-Insured Fund program. You become a member of the Builders
        Association and thus pay into their fund for coverage on your business.

   3.   You can become Self-Insured. In order to be Self-Insured, you must come to the Department of Insurance
        and post bond showing that you have the financial means to provide coverage for your employees.

        NOTE: There is a difference between being Self-Insured and being part of a Self-
        Insured Fund. Many people mistakenly think they are Self-Insured and actually have
        coverage through a Self-Insured Fund.

   How Your Workers' Compensation Insurance Premiums
                       Are Set
The North Carolina Rate Bureau ((919) 783-9790) sets rates for specific types of employment,
and bases premiums on $100.00 of payroll. Policies are written annually, and premiums increase
if there is an injury and decrease if there is not one. Premiums also increase or decrease based
upon the number of employees and the payroll. (In the Self-Insured Fund situation, if there is an
injury of an employee of one of the other contributors to the fund, their contribution to the fund
increases, but the other members' contributions do not increase unless they have an injury.)

                                  INJURIES COVERED
Employees are entitled to benefits if, while carrying out activities for the benefit of their
employer, they suffer an injury by accident, a "specific traumatic incident," resulting in a hernia
or back injury, or an "occupational disease." An "accident" is an interruption of the regular work
routine and the introduction of unusual circumstances, such as a slip, trip, fall, or other unusual
activity, likely to result in unexpected consequences. A "specific traumatic incident," as defined
by our courts, includes "injuries that occur during normal work activities." The claimant need not
show "an instantaneous occurrence" or "an external cause or unusual conditions." However,
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"injuries that occur gradually, over long periods of time, are not specific traumatic incidents." If
the work-relatedness of a hernia is disputed, an employee must show that the hernia appeared
suddenly following an accident and did not exist prior to the accident or incident. All injuries
must "arise out of and in the course and scope of" the covered employment to be compensated.

Businesses complying with the Act and their employees may not be sued in the Courts by
employees for work-related injuries, except for intentional assaults and conditions so grossly
unsafe as to make injury substantially certain. Businesses may obtain the benefits and protections
of the Workers' Compensation Act by purchasing compensation insurance, by being self-insured,
or by joining a self-insurance pool.

                         OCCUPATIONAL DISEASE
Generally, an employee is entitled to benefits for disability due to a condition to which the
employment significantly contributed, or if the employment was a significant factor in causing
the disease's development, and if the employment exposed the worker to a greater risk of
contracting the disease than the public generally. Where an employee is exposed to the same
injurious agent at the place of business of more than one employer, the claim should be filed with
the employer on whose premises he was last injuriously exposed.

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To obtain benefits, an employee or his representative must give the employer written notice of
the accident within 30 days, or in instances of occupational disease (excepting asbestosis,
silicosis, or lead poisoning) within 30 days of being advised by competent medical authority that
the employee has the occupational disease, unless reasonable excuse is made for not giving
notice and no prejudice results to the employer/carrier. NOTICE should be given by providing a
completed copy of the Commission's Form 18 to the employer and the Commission. SUBJECT
HAS AN OCCUPATIONALLY RELATED DISEASE, whichever last occurs; provided, that if
the injury is due to exposure to radiation, the two (2) year period runs from the time the
employee suffered incapacity and knew or should have known that the disease or condition was
caused by his employment. A CLAIM should be filed by sending to the Commission a statement
of claim, preferably on the Commission's Form 18. COPIES should be sent to the employer or
its insurance carrier. Claimants using informal statements will be asked to complete forms
requiring information necessary to process the case.

                 REPORT INJURIES
All work-related injuries requiring medical attention (other than first aid at the work place)
should be reported by the employer to its insurance company or administrator, who will report
the injury to the Industrial Commission on I.C. Form 19 if the injury results in more than
$2000.00 in medical expenses or more than one day's lost time from work. A COPY OF THE

                   Wage Replacement and Cash Benefits
Temporary Total Disability: If the employee remains unable to earn wages after the first seven
(7) days of disability, he or she is entitled to weekly benefits equal to two-thirds (2/3) of his or
her average weekly wage up to the maximum compensation rate (see below). After disability has
continued more than twenty-one (21) days, the employee is entitled to receive compensation for
the first seven days of disability. The days counted do not have to be consecutive. Weekend
days, holidays, and any workday in which the injured employee does not earn a full day's wages
because of the injury are counted as a day of disability, even though the employee may earn
some wages.

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Temporary Partial Disability: If upon obtaining post-injury employment, the employee is
unable to earn wages as great as those earned pre-injury, the employee is entitled to
compensation equal to two-thirds (2/3) of the difference between the post-injury and pre-injury
average weekly wages, so long as the amount does not exceed the statutory maximum weekly
benefit. Temporary partial disability benefits may not continue beyond three hundred (300)
weeks from the date of injury, and any number of weeks wherein temporary total disability
benefits were paid will be deducted from the 300 week maximum.

Permanent Partial Disability: If, at the end of the healing period, there is a permanent
impairment to one of the parts of the body listed below, the employee may receive a set period of
benefits without regard to his ability to earn wages. Total loss of use of the part entitles the
employee to two-thirds (2/3) of his average weekly wage, times the number of weeks shown
following the body part below. Benefits for less than total loss are figured on a percentage basis.
For example, twenty percent (20%) of 45 weeks' compensation is nine (9) weeks. Alternatively,
in cases where the employee has a permanent impairment to one of the parts of the body listed
below and is unable to earn wages as great as before the injury, the employee may choose to
receive benefits for two-thirds (2/3) of the wage difference for a period not to exceed 300 weeks
from the date of injury rather than receiving benefits for a set period based on the permanent
impairment. The 300-week period, however, will be reduced by the number of weeks Temporary
Total Disability compensation was paid.

                 Thumb                    75 weeks     Arm                   240 weeks
                 First or index finger    45 weeks     Foot                  144 weeks
                 Second or middle finger 40 weeks      Leg                   200 weeks
                 Third or ring finger     25 weeks     Eye                   120 weeks
                 Fourth or little finger  20 weeks     Hearing (one ear)      70 weeks
                 Great toe                35 weeks     Hearing (both ears)   150 weeks
                 Any other toe            10 weeks     Back                  300 weeks
                 Hand                    200 weeks

The percentage of disability is determined based on physicians' ratings of the percentage of
physical impairment. If there is a dispute between physicians regarding ratings, the Commission
will determine the percentage of disability. If either party is dissatisfied with the treating
physician's rating, it may obtain the "second opinion" of another doctor. The employee, upon
approval by the Commission, is entitled to a single second opinion rating by a doctor of his or
her choice at the employer's expense. To obtain the Commission's Rating Guide, see
"Publications and Forms" above. If, however, the employee is unable to earn any wages in any
employment, he or she may elect to receive either the carrier's offer for the rating or for his
ongoing disability, whichever remedy provides the most reimbursement.

Total and Permanent Disability: The loss of both hands, both arms, both feet, both legs, or
both eyes, or any two thereof, constitutes total and permanent disability, and entitles the worker
to weekly benefits and medical compensation during his or her lifetime.

Disfigurement and Damage to Other Organs: If the injury leaves facial or head scars which
seriously disfigure the person, or causes the loss or permanent injury to an important organ of the
body, the employee may be awarded additional compensation not to exceed $20,000.00. The
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maximum payable for serious bodily disfigurement is $10,000.00. No compensation is allowed
for scars where the employee is paid for loss or partial loss of use of the same member. The
employee is also entitled to payment for disfigurement due to the loss or crowning of permanent

Figuring the Compensation Rate: The weekly rate of compensation cannot be less than $30.00
nor more than $688.00 for injuries occurring after January 1, 2004. The maximum weekly
benefit is adjusted annually to equal approximately 110% of the average North Carolina wage.
This rate of compensation remains the same during the life of the claim. (The maximum weekly
compensation rate for 1996 was $492.00, for 1997 it was $512.00, for 1998 it was $532.00, for
1999 it was $560.00, for 2000 it was $588.00, for 2001 it was $620.00, for 2002 it was $654.00,
and for 2003 it was $674.00.) The average weekly wage is usually computed by averaging all
wages earned by the employee in the employment in which he or she was injured (including
overtime, paid holidays, special allowance for board, lodging, etc.), during the 52 weeks prior to
the injury. If the employee has lost more than seven (7) consecutive calendar days at one or more
times, these days are excluded from the calculation. If the employee has worked only a short
time in the employment in which injured, or for other reasons this formula does not fairly reflect
earnings, the Industrial Commission will compute a fair average weekly wage for him as
provided by the Act. If the employee is under eighteen (18) years of age, a different rate may
apply (see "Minors and Incompetents" below). The Commission's Claims Section can calculate
the average weekly wage from information submitted on the Commission's Form 22. [To view
or print this Form 22 and other PDF versions of NCIC forms, you must first download and
install a FREE Adobe® Acrobat® Reader.]

                               Medical Compensation
Employers must provide, and injured employees must accept, all reasonable medical, surgical,
hospital, nursing, and rehabilitative services, and medicines, sick travel, and other treatment,
including medical and surgical supplies, as may reasonably be required to effect a cure or give
relief, and tend to lessen the period of disability, and any artificial members as may reasonably
be necessary at the end of the healing period, which are needed due to the compensable injury.
The costs of medical compensation are in addition to cash benefits, and do not offset or reduce
them. If the employer denies liability or fails to provide treatment, or in the case of an
emergency, the employee may select the physician or hospital but must promptly request
Industrial Commission approval.* The employer or its insurance carrier may select the treating
physician and other providers of medical compensation, subject to contrary orders of the
Commission. If the employee is dissatisfied with the services rendered by providers selected by
the employer, the employee may request the Commission order a change of treatment, or
approve treatment by providers of employee’s selection.* Such request should state reasonable
cause, be submitted with any medical opinions or records which support the request, and a copy
of the request should be simultaneously sent to the employer or its insurance company. If an
employee fails to cooperate with a provider selected by the employer after being ordered to do so
by the Commission, compensation may be suspended while such refusal continues.

As a final note, rules governing rehabilitative services in workers' compensation cases have been
adopted and may be obtained through the Industrial Commission if needed.

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*Requests for Industrial Commission approval must be made in writing and should be directed to
                              the Executive Secretary's Office.

                                     Death Benefits
Death benefits are payable when an employee dies due to an occupational disease, due to an
accident if the death occurs within six (6) years thereafter, or within two (2) years of the final
determination of disability, whichever is later. THE CLAIM MUST BE FILED WITHIN TWO
DECEASED. Death is compensated by payment of two-thirds (2/3) of the decedent employee's
average weekly wage, or the maximum compensation rate for a minimum period of 400 weeks;
$3,500.00 for actual funeral expenses, payable to the person or firm actually entitled to it; and
any medical expenses incurred due to the mortal injury or disease. A minor child or disabled
spouse may receive more than 400 weeks of benefits.

                             Minors and Incompetents
An employee under the age of 18 is entitled to receive the same benefits as other employees if
injured. For the purposes of calculating compensation for a minor's permanent disability, death,
or temporary total disability for a period exceeding 52 weeks, the minor's average weekly wage
shall be considered to be the same paid to adult employees employed by the same employer at
the time of the accident in a similar or like class of work to which the injured minor employee
would probably have been promoted to if not injured.

No time limitation under the Workers' Compensation Act runs against a minor or incompetent
until a guardian or trustee has been appointed to represent their interests. The Commission may
appoint a guardian ad litem, for the purpose of pursuing the claim on behalf of the minor in
litigation before the Commission. However, a guardian ad litem may not receive cash
compensation on behalf of a minor or incompetent. Compensation may be received by a general
guardian or guardian of the estate of a minor or incompetent appointed by the Clerk of Superior
Court of the county in which the employee resides; by the trustee or committee having powers
over the employee's financial affairs; by the Clerk, if small sums are due an incompetent; and,
when both a surviving spouse and minor children are entitled to receive compensation due to the
death or injury of a deceased employee, the surviving spouse may receive the compensation for
the use of both himself/herself and the minor children. In certain circumstances, a minor
employee may sign agreements and receipts for payments of compensation although the
Commission may require the signature of a parent or person standing in place of a parent.

                               DENIAL OF A CLAIM
An employee who submits a written claim (I.C. Form 18, or its equivalent), in a case where no
compensation has been initiated by the employer to the employee, is entitled to a detailed
statement from the employer or insurance carrier of grounds for denying the claim within 14
days of receipt, unless time is extended by the Commission's Executive Secretary's Office. The
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employee desiring a hearing on the claim before the Industrial Commission must make the
request on the I.C. Form 33. A statement making a claim or requesting a hearing must be
received by the Commission within two years of the date of injury to preserve the employee's
right to pursue the claim. If the claim or request for hearing is not made on the Commission's
official forms (Form 18, Form 33R, or Form 33, respectively), claimant will be asked to
complete those forms.

All agreements to pay compensation must be approved by the Commission. The most common
forms of agreements are the I.C. Form 21 for the initial period of disability, the I.C. Form 26 for
subsequent periods of disability, and the Compromise Settlement Agreement (or "clincher")
under which the employee receives a lump sum of money and payment of any remaining medical
compensation bills in return for terminating the claim and any right to reopen it.

(In cases of direct pay or pay without prejudice, a Form 60, Employer's Admission of Employee's
Right to Compensation, or a Form 63, Notice To Employee of Payment Without Prejudice,
should be submitted as soon as the employee becomes entitled to compensation. A copy should
be sent to the employee, and the original of the form should be sent to the Industrial

A Form 21, Agreement for Temporary Total Disability or Temporary Partial Disability, should
state that the compensation is payable for the "necessary" period unless for some reason the
period of temporary total disability or temporary partial disability is actually known (such as
having already ended). The agreement may be submitted subject to future correction of the
compensation rate used. Unless the employee successfully returns to work, dies, or enters into
another agreement, the employer or carrier must apply to the Commission to terminate the
compensation on the Commission's Form 24 or request a hearing once the Form 21 has been

A Form 21 or 26 agreement may be entered into after the end of the healing period to provide for
payment of temporary partial disability benefits or permanent partial disability benefits based
upon a doctor's evaluation, or "rating," of any remaining physical impairment. The employee is
entitled to a single second opinion by a physician of his or her choice at the employer or carrier's
expense when the physician approved by the employer or carrier has rated and/or released the
employee. The employee retains the right to reopen the case for further benefits within two years
of the last payment of compensation if the employee can show that there has been a substantial
change in the condition that resulted from the compensable injury.

The Compromise Settlement Agreement, or "clincher," provides for payment of all cash benefits
and medical compensation due, and an additional sum in return for the employee's giving up his
or her right to reopen the case based upon change of condition.

                        MEDICAL AND LEGAL FEES
                                     Attorney's Fees
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It is unlawful for any attorney or other person to accept a fee, gift, or any remuneration for any
services rendered in connection with the claim of a worker seeking compensation unless such fee
or other consideration has been approved by the Industrial Commission.

                        Fees for Medical Compensation
Subject to the provisions of N.C. Gen. Stat. §97-25.3, Preauthorization, the Industrial
Commission shall adopt and publish a Fee Schedule, pursuant to the provisions of N.C. Gen.
Stat. §97-26(a), fixing maximum fees, except for hospital fees pursuant to N.C. Gen. Stat. §97-
26(b), which may be charged for medical, surgical, nursing, dental, and rehabilitative services,
and medicines, sick travel, and other treatment, including medical and surgical supplies, original
artificial members as may reasonably be necessary at the end of the healing period and the
replacement of such artificial members when reasonably necessitated by ordinary use or medical
circumstances. The fees prescribed in the applicable published Fee Schedule shall govern and
apply in all cases. However, in special hardship cases where sufficient reason is demonstrated to
the Industrial Commission, fees in excess of those so published may be allowed. Persons who
disagree with the allowance of such fees in any case may make application for and obtain a full
review of the matter before the Industrial Commission as in all other cases provided. Copies of
this published Fee Schedule may be obtained from Medicode at (800) 765-6023.

A provider of medical compensation shall submit its statement for services within seventy-five
(75) days of the rendition of the service or if treatment is longer, within thirty (30) days after the
end of the month during which multiple treatments were provided, or within such other
reasonable period of time as allowed by the Industrial Commission. However, in cases where
liability is initially denied but subsequently admitted or determined by the Industrial
Commission, the time for submission of medical bills shall run from the time the health care
provider received notice of the admission or determination of liability. Within thirty (30) days of
the receipt of the statement, the employer, or carrier, or managed care organization, or
administrator on its behalf, shall pay or submit the statement to the Industrial Commission for
approval or send the provider written objections to the statement. If an employer,
carrier/administrator, or managed care organization disputes a portion of the provider's bill, it
shall pay the uncontested portion of the bill and shall resolve disputes regarding the balance of
the charges through its contractual arrangement or through the Industrial Commission. If any bill
for medical compensation services is not paid within sixty (60) days after it has been approved
by the Industrial Commission and returned to the responsible party, or when the employee is
receiving treatment through a managed care organization, within sixty (60) days after the bill has
been properly submitted to an insurer or managed care organization, there shall be added to such
unpaid bill an amount equal to ten percent (10%), which shall be paid at the same time as, but in
addition to, such bill, unless late payment is excused by the Industrial Commission. When the ten
percent (10%) addition to the bill is contested, any party may request a hearing by the Industrial
Commission pursuant to N.C. Gen. Stat. §97-83 and N.C. Gen. Stat. §97-84.

When the responsible party seeks an audit of hospital charges, and has paid the hospital charges
in full, the payee hospital, upon request, shall provide all reasonable access and copies of
appropriate records, without charge or fee, to the person(s) chosen by the payor to review and
audit the records.

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The responsible employer or carrier/administrator shall pay the statements of medical
compensation providers to whom the employee has been referred by the authorized treating
physician, unless said physician has been requested to obtain authorization for referrals or tests,
provided that compliance with such request does not unreasonably delay the treatment or service
to be rendered to the employee.

A health care provider may not pursue a private claim against an employee for all or part of the
costs of medical treatment which have been provided to that employee unless (1) the employee's
claim for treatment is finally adjudicated to be non-compensable or (2) the employee fails to
request a hearing following a denial of liability by the employer. Subsequent to an unanswered
denial of liability or an adjudication that the treatment is non-compensable, the insurer (or self-
insured employer) is liable to any medical care providers whose services had previously been
authorized by the insurer or employer.

   1.   Who is required to provide workers' compensation coverage?

        Any employer who employs three or more employees.

        NOTE: Every executive officer selected or appointed and empowered in accordance with
        the charter and bylaws of a corporation is considered an employee of such corporation.
        For example, a corporation with two officers and one employee would be required to
        provide workers' compensation coverage. Any employer in which one or more employees
        are employed in activities which involve the use of or presence of radiation is required to
        have coverage.

   2.   What must an employee do when an injury occurs?

        Report the injury to the employer, orally and in writing, immediately and in any event
        within 30 days.

   3.   What should be done if the employer fails or refuses to report an injury?

        Employee should file a claim (Form 18 or 18B) within two years of the accident with the
        Industrial Commission.

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   4. Who provides and directs medical treatment?

        The employer or its insurance company, subject to any Commission orders, provides and
        directs medical treatment. The Commission may permit the employee to change
        physicians or approve a physician of employee's selection when good grounds are shown.
        However, payment by the employer or carrier is not guaranteed unless written permission
        to change physicians is obtained from the employer, carrier, or Commission before the
        treatment is rendered.

   5.   Chiropractic Rules:

        If the employer grants permission to seek medical treatment from a chiropractor, the
        employee is entitled to 20 visits if medically necessary. If additional visits are needed, the
        chiropractor should request this authorization from the employer.

   6.   When can reimbursement for sick travel be collected?

        Employees are entitled to collect for mileage for medical treatment in workers'
        compensation cases at the rate of 25 cents a mile for travel prior to June 1, 2000 and at
        the rate of 31 cents a mile for travel on or after June 1, 2000, provided they travel 20
        miles or more round trip. Special consideration will be given to employees who are
        totally disabled.

        NOTE: The Industrial Commission has given the self-insurers and insurance carriers
        permission to pay drug and travel expenses directly to the employee without approval
        from the Commission.

   7.   What happens if in an emergency the employer fails or refuses to provide medical treatment?

        The employee may obtain the necessary treatment from a physician or hospital of his own
        choice, but must promptly request the Commission's approval.

   8.   When do I become eligible for lost wage compensation?

        No compensation is due for the first seven (7) days of lost time unless the disability
        exceeds 21 days. Therefore, the first check will not include payment for days 1-7.
        Payment for those days will be made should the disability continue beyond 21 days.

   9.   How often are compensation payments made?


   10. At what rate of pay?

        66 2/3% of the average weekly wage, not to exceed $688.00* (2004 maximum) per week.

                              * The maximum weekly benefit is adjusted annually.

   11. How long is the employee eligible to receive lost-time weekly benefits?
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       Until the employee is able to return to work.

   12. What is permanent partial disability?

       Total loss or partial loss of use of a member of the body or inability to earn the same
       wages in any employment as earned at the time of injury.

   13. Who determines permanent partial disability?

       The Commission, based on the impairment ratings of physicians or evidence of
       consideration of wage earning capacity.

   14. What happens when the employer refuses to acknowledge the claim?

       When liability for payment of compensation is denied, the Commission, claimant, his or
       her attorney, if any, and all known providers of health care shall be promptly notified of
       the reason for such denial. The denial Form 61 shall not be worded in general terms, but
       must detail the exact reason for the denial of liability.

           a.   If a claim is denied by the insurance company or self-insurer, the employee may request a hearing
                before the Industrial Commission by submitting a Form 33, Request for Hearing.

           b.   Medical providers may bill the employee only after it has finally been determined that it is not a
                compensable workers' compensation claim.


                           For further information, contact:

                           North Carolina Industrial Commission
                           4340 Mail Service Center
                           Raleigh, North Carolina 27699-4340

Need Workers' Compensation Information? Need Help with
                     a Claim?
For information, help with a claim, or workers' compensation inquiries, call:

                     Ombudsmen: (800) 688-8349,
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                                             (919) 807-2501
                    Fax:                     (919) 715-0282
Ombudsmen assist unrepresented claimants, employers, and other parties to enable them to
protect their rights. In addition, the Ombudsmen serve as the information source for the North
Carolina Industrial Commission and answer questions pertaining to all aspects of workers'

              N.C. Industrial Commission · 4340 Mail Service Center · Raleigh, NC 27699-4340
                            Main Telephone: (919) 807-2500 · Fax: (919) 715-0282
                               NCIC Home Page: http://www.comp.state.nc.us/

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