Illness and Injury Prevention Plan - Ironhouse Sanitary District

Illness and Injury Prevention Plan Rev. 12/27/17

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TABLE OF CONTENTS 1 PLAN REVIEW AND CERTIFICATION ..................................................................................................................................3

2 PURPOSE AND POLICY STATEMENT ..................................................................................................................................3

2.1 PURPOSE: ............................................................................................................................................................................... 3 2.2 POLICY: .................................................................................................................................................................................. 3

3 RESPONSIBILITIES .............................................................................................................................................................3

3.1 THE BOARD OF DIRECTORS IS RESPONSIBLE FOR:............................................................................................................................. 3 3.2 THE GENERAL MANAGER IS RESPONSIBLE FOR: ............................................................................................................................... 3 3.3 SAFETY ADMINISTRATOR ............................................................................................................................................................ 4 3.4 DEPARTMENT HEADS (SUPERINTENDENTS AND PLANT MANAGER) .................................................................................................... 4 3.5 SUPERVISORS AND LEAD PERSONNEL: ........................................................................................................................................... 5 3.6 EMPLOYEES ............................................................................................................................................................................. 6

4 COMPLIANCE ....................................................................................................................................................................7

5 COMMUNICATION ...........................................................................................................................................................7

5.1 NEW EMPLOYEE ORIENTATION ................................................................................................................................................... 7 5.2 SAFETY MEETINGS .................................................................................................................................................................... 8 5.3 DEPARTMENT HEAD MEETINGS .................................................................................................................................................. 8 5.4 DEPARTMENT SAFETY MEETINGS................................................................................................................................................. 8 5.5 TAILGATE SAFETY MEETINGS ...................................................................................................................................................... 8 5.6 REQUIRED SAFETY TRAINING ...................................................................................................................................................... 8 5.7 SAFETY POSTINGS ..................................................................................................................................................................... 8 5.8 SAFETY SUGGESTIONS AND REPORTS OF UNSAFE CONDITIONS OR PRACTICES ....................................................................................... 8

6 HAZARD ASSESSMENT ......................................................................................................................................................9

6.1 PERIODIC AND REQUIRED SAFETY INSPECTIONS .............................................................................................................................. 9 6.2 SAFETY INSPECTIONS, DOCUMENTATION AND TRACKING .................................................................................................................. 9 6.3 JOB HAZARD ANALYSIS .............................................................................................................................................................. 9

7 ACCIDENT, INCIDENT AND NEAR MISS REPORTING & INVESTIGATION .............................................................................9

7.1 OCCUPATIONAL INJURY AND ILLNESS REPORTING .......................................................................................................................... 10 7.2 INVESTIGATIONS ..................................................................................................................................................................... 10 7.3 REPORTING TO CAL/OSHA (PER TITLE 8 SECTION 330(H) AND 342) ............................................................................................... 10

8 HAZARD CORRECTION .................................................................................................................................................... 11

8.1 IMMINENT HAZARD ................................................................................................................................................................ 11 8.2 SERIOUS HAZARD ................................................................................................................................................................... 11 8.3 GENERAL HAZARD .................................................................................................................................................................. 11 8.4 REGULATORY HAZARD ............................................................................................................................................................. 12

9 TRAINING AND INSTRUCTION ........................................................................................................................................ 12

10 RECORD KEEPING ........................................................................................................................................................... 12

Attachments A. Report of Unsafe Condition or Practice B. Program Review and Certification Log C. Incident Investigation Report D. Accident, Incident and Near Miss Investigation and Cal/OSHA Reporting Procedure E. Emergency / Non-Emergency Situation Checklist

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1 PLAN REVIEW AND CERTIFICATION The District’s IIPP will be reviewed and revised as necessary to ensure the program is current. All revisions are documented on the Plan Review and Certification Log, Attachment B.

2 PURPOSE AND POLICY STATEMENT 2.1 Purpose: To establish a Cal/OSHA mandated Employee IIPP in accordance with the California Code of Regulations Title 8 Section 3203. 2.2 Policy: The District believes that the safety of its employees, its contractor’s employees, its guests and the public it serves is a high priority. Consideration of employee safety is as high a priority as the decision to commit funds or complete a task. No function of the District is so critical as to require the compromise of safety. The District is committed to providing a place of employment that is free from health and safety hazards, promotes safe work practices, and complies with all applicable federal, state and District safety requirements.

3 RESPONSIBILITIES 3.1 The Board of Directors is responsible for:

Providing direction for a comprehensive IIPP, Approving funds necessary for implementing a successful IIPP, and Holding personnel accountable for safety and loss control.

3.2 The General Manager is responsible for: Designating a Safety Administrator to manage the District’s IIPP, Ensuring that the IIPP targets losses, exposures to loss, and compliance with

applicable government standards,


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Providing active leadership and participation in the IIPP, Holding Superintendents, Supervisors and Lead Personnel accountable for their

responsibilities under this IIPP, Ensuring adequate funding is made available for the successful implementation

and continuation of this IIPP, Ensuring the District’s IIPP is fully implemented, and Authorizing other safety plans and procedures.

3.3 Safety Administrator The Safety Administrator functions as a liaison to the Board and is responsible for designing and administering the IIPP. Responsibilities also include:

Measuring the effectiveness of the IIPP and making recommendations to reduce risks and eliminate or control unsafe conditions in the workplace,

Confirming all required safety audits and inspections occur in accordance with the IIPP, and all deficiencies and/or hazardous conditions discovered are corrected in a timely manner,

Recognizing employee participation in the IIPP, Periodically review the IIPP for compliance with Cal/OSHA requirements. Providing District-wide support as needed regarding safety-related issues, Communicating safety-related updates, Assisting supervisory personnel with investigation of incidents resulting in injury

when necessary, Review scheduled vs actual safety training and other Cal/OSHA requirements, Confirming IIPP record keeping compliance, Conduct annual review of the IIPP, Designing New Employee Safety Orientation and other safety training as

necessary , and Communicating safety performance to BOD

3.4 Department Heads (Superintendents and Plant Manager) It is a basic requirement that Department Heads make the safety of employees an essential part of their duties. They are responsible for the safety of personnel under their supervision. Department Heads are responsible for the following:

Implementing and maintaining the IIPP, Providing active leadership and participation in the IIPP, Organize and develop a department-specific safety training schedule including

New Employee Orientation and job-specific hazards,


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Ensure that employees are provided the necessary safety equipment and materials (e.g. Personal Protective Equipment, ergonomically designed tools, etc.) to protect them from known work-related hazardous conditions,

Holding Supervisors, Leads, and employees accountable for their safety and loss control responsibilities under the IIPP,

Ensuring all injuries, property damage, near misses, unsafe conditions, and unsafe practices have been documented and reported to the Safety Administrator in accordance with IIPP requirements,

Conducting accident, incident or near miss investigations when required by this IIPP (e.g. involving a direct report),

Reviewing submitted Incident Investigation Reports and Reports of Unsafe Condition or Practice and recommending corrective actions,

Ensuring that required work site safety inspections are conducted and participate in an inspection on a periodic basis,

Ensuring that all identified unsafe conditions and practices are corrected by the expected date of completing corrective measures,

Promote a positive safety attitude by being an example to employees, Understanding and enforcing safety regulations applicable to work performed

within their area of operation, and Ensuring that hazards are corrected within the target date for correction described

in Section 8 – Hazard Correction 3.5 Supervisors and Lead Personnel: Supervisors and Lead Personnel are the foundation of the IIPP. They are responsible for the safety of personnel under their supervision. Supervisors and Lead Personnel shall make the safety of employees an essential part of their duties. This includes the following responsibilities:

Conduct safety training as required, Performing safety inspections as required by the IIPP, Attending safety meetings, Assigning a responsible person to correct unsafe conditions discovered during

any safety inspection, Establishing target dates for correction of unsafe conditions based upon the

severity of the condition as outlined in Section 8 – Hazard Correction, Ensuring all safety hazard reports (Report of Unsafe Condition or Practice -

Attachment A) are submitted and tracked for completion, Providing the proper Personal Protective Equipment (PPE) and training on the

proper use of all PPE issued to employees,


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Ensuring that materials and equipment are maintained in safe operating condition, Understanding and enforcing safety regulations applicable to work performed

within their area of operation, Investigating all reports of near misses and reports of unsafe conditions or

practices, Investigating any accident that causes an injury or illness, Discussing safety concerns and safe job procedures as part of tailgate or

department meeting, Promote a positive safety attitude by being an example to employees, Organizing and documenting safety tailgate meetings, Conduct a Job Hazard Analysis if new substances, job tasks, or equipment

introduce new hazards to their employees, and Ensuring employees receive prompt medical attention for all injuries or illnesses

and proper notifications are made. 3.6 Employees Employees are responsible to follow Code of Safe Work Practices (BO 14-37) and to comply with safety rules and regulations. Employee responsibilities include but are not limited to:

Adhering to District safety programs and procedures, Assisting management in accident prevention, Reporting unsafe conditions and practices immediately, Reporting all injuries to a supervisor as soon as possible, Reporting all incidents and near misses to a supervisor as soon as possible, Wearing and using the proper safety equipment and PPE as required, Operating equipment that they are trained and authorized to use, Maintaining equipment in good condition and using equipment with all safety

guards in place, Actively contributing to the success of the District safety program and this IIPP, Conducting safety inspections of work areas or equipment when requested, Correcting any observed unsafe conditions or practices when and where

appropriate, Maintaining good housekeeping in work areas, Using proper engineering or administrative controls or using PPE when required

or necessary, Advising supervisors when there is a need for job-specific training,


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Coaching fellow employees on safe work practices wherever appropriate, Temporarily suspending any work activity that creates a condition that they believe

is immediately dangerous to life or health, and Employee rights include but are not limited to:

o A safe and healthy working environment, o To receive information and training on general safety and job-specific work

practices, o To refuse work that would violate a health and safety standard or order

where such violation would pose a real and apparent hazard to the employee’s safety or health,

o To contact Cal/OSHA about unsafe or unhealthful working conditions. Such complaints are strictly confidential per Cal/OSHA policy,

o To have an employee representative accompany Cal/OSHA on an inspection and to talk privately to the Cal/OSHA representative during an inspection, and

o To Stop Work IMMEDIATELY, without fear of reprisal, when the employee believes a situation exists which places himself/herself, a coworker(s), or the environment in danger or at risk.

4 COMPLIANCE All employees including Superintendents, Supervisors and Lead Personnel are responsible for complying with safe and healthful work practices. The District’s system of ensuring that all employees comply with these practices may include the following: Informing employees of the provisions of this IIPP, Evaluating the safety performance of all employees, Ensuring that employees are held accountable for performing safe and healthful work

practices, Providing training to employees whose safety performance is deficient, Disciplining employees for failure to comply with safe and healthful work practices.

5 COMMUNICATION The District recognizes that open two-way communication between management and staff on safety and health issues is essential to an injury-free workplace. The following systems of communication are in place to ensure a continuous flow of safety and health information between management and staff in a form that is readily understandable. 5.1 New Employee Orientation New Employee Orientation will be conducted at the time of hire and will include a discussion of this IIPP and other related safety and health program policies and practices.


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5.2 Safety Meetings The purpose of safety meetings are to promote and maintain safe working conditions and environment by developing a safety culture that will identify and correct workplace hazards. The meetings will establish a channel of communication between the department head, supervisors, leads and employees to obtain this purpose. 5.3 Department Head Meetings A review of safety performance issues (positive or negative) shall be discussed at least once a month during a weekly department head meeting. Safety discussions will be documented and retained by the Safety Administrator. 5.4 Department Safety Meetings As appropriate, Superintendents, Supervisors or Lead Personnel will hold safety meetings to review and discuss safety issues arising out of any unusual working conditions such as new job activities, new equipment, onsite contractor activities, or other non-routine working conditions. Department safety meetings shall include, but are not limited to, reviews of all accidents, safety suggestions received from staff, and recent new safety legislation. The outcome of discussions shall be presented during a department head meeting. 5.5 Tailgate Safety Meetings Tailgate Safety Meetings are short duration on-the-job safety meetings that help keep employees alert to upcoming work-related hazards. They are held on an as needed basis, but must be completed whenever a new job activity, work procedure, hazardous substance, or any other unusual working condition exists. These meetings can be held at the job site and/or in a classroom setting. Tailgate Safety Meetings will be documented and kept on file by the Department Head for review and retention. 5.6 Required Safety Training Employees will receive job-specific training in accordance with the tasks they are required to perform, the hazards posed, and regulatory requirements. This training will be provided as part of the new employee orientation, or prior to performing work or being exposed to a new hazard. All training will be documented in the individual’s training record. 5.7 Safety Postings All appropriate and required safety information will be posted on the safety bulletin boards or in other locations that are highly visible and accessible to all employees. 5.8 Safety Suggestions and Reports of Unsafe Conditions or Practices Employees are encouraged to submit safety suggestions. Additionally, if an employee observes or experiences unsafe conditions or practices, they shall report these to their Supervisor, Department Head, or the Safety Administrator. Suggestions, unsafe conditions, or practices are reported using Attachment A: Safety Suggestion / Report of Unsafe Condition or Practice. Forms may be submitted anonymously and without fear of reprisal.


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The District will take appropriate actions to correct hazardous conditions as specified in Section 8.

6 HAZARD ASSESSMENT 6.1 Periodic and Required Safety Inspections The District will conduct periodic and required safety inspections of work sites and job activities in order to identify, evaluate, and correct workplace hazards and unsafe work practices. Periodic inspections are those that can be performed by internal or external sources (e.g. Safety Administrator, Department Head, Consultant, etc.). These inspections assist the District to identify any needs to improve the safety and health program as well as provide an opportunity for management to view employees at the worksite. These types of inspections shall be done as follows:

Periodic inspections shall be done no less than once per year Safety inspections shall be performed as required by Cal/OSHA as well as any

District-specific needs (e.g. facility storage of chemicals, office spaces, etc.) 6.2 Safety Inspections, Documentation and Tracking All safety inspections will be documented as required and reviewed by the department head. If a hazard is recognized, the department head shall use Attachment A (Safety Suggestion / Report of Unsafe Condition or Practice) to document corrective actions. The department head shall prioritize hazards and unsafe conditions for correction according to the classification of hazards detailed in Section 8.0, Hazard Correction. All departments will use a form unique to the area of responsibility. The Safety Administrator or designee will monitor the status of these hazards and unsafe conditions until they have been corrected. 6.3 Job Hazard Analysis The District will conduct Job Hazard Analysis (JHA) to identify the hazards associated with a defined job task in order to determine the appropriate type and level of personal protective equipment (PPE) and other relevant protective measures which must be used to reduce the risk from the hazards. The JHA process is further described in detail in the District’s PPE Plan, however in general a JHA shall be done as follows:

When new substances, processes procedures, or equipment that present potential new hazards are introduced into the workplace

When previously unidentified hazards are recognized

7 ACCIDENT, INCIDENT AND NEAR MISS REPORTING & INVESTIGATION Employees shall report all work-related injuries and illnesses to their immediate Supervisor, without fear of reprisal, in accordance with section 7.1 below. Additional investigation will be performed depending upon the seriousness of the incident and/or injury as outlined in section 7.2 below.


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7.1 Occupational Injury and Illness Reporting

7.1.1 First Aid Injury If the injury or illness requires minor first aid the employee will report the injury or illness to their Supervisor. The Supervisor will follow the District’s Workers’ Compensation claims procedures. Examples of injuries requiring minor first aid include but are not limited to minor cuts, abrasions, or other injuries that only require flushing, cleansing, applying ointments, or require a covering such as a bandage, Band-Aid or gauze pad.

7.1.2 Recordable Injury If the injury requires outside medical attention the employee and Supervisor will follow the District’s Workers’ Compensation claims procedures.

7.2 Investigations The District will perform internal investigations of accidents, incidents, and near misses according to the procedures outlined in Attachment D: Accident, Incident and Near Miss Investigation. The incident shall be documented using Attachment C: Incident Investigation Report. The main objective in conducting an investigation is to identify the root cause(s) of the event and to make any changes necessary to prevent such an event from occurring again. The following accidents and incidents require an investigation, which will be conducted as soon as possible: Fatalities Lost time accidents When outside medical service is necessary If first aid injuries indicate a trend of reoccurring accidents If a near-miss or incident has the potential to cause a serious injury or illness Vehicle accident

7.3 Reporting to Cal/OSHA (per Title 8 Section 330(h) and 342) The District (Safety Administrator or designee) shall immediately report (by phone) any serious injury, illness, or death, of an employee occurring in connection with any employment, to the local Division of Occupational Safety and Health office. Immediately means as soon as possible but not longer than 8 hours after the

District knows or with diligent inquiry would have known of the death or serious injury or illness.

Serious injury or illness means any injury or illness occurring in a place of employment or in connection with any employment which requires in-patient hospitalization for a period of 24 hours for reasons other than medical


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observation, or in which an employee suffers any loss of any member of the body, or suffers any serious degree of permanent disfigurement.

The following information must be given in the report, if available: Time and date of accident, employer’s name address and phone number,

name and job title of person reporting the accident, address of accident site, name of on-site contact, name and address of injured employee(s), nature of injury, location to where injured employee was moved, information regarding any law enforcement entities present at accident site, and description of accident and whether the accident scene or instrumentality has been altered.

8 HAZARD CORRECTION Whenever possible, workplace hazards and unsafe work practices will be corrected as soon as they are identified. A target date for correction will be established according to the following criteria: 8.1 Imminent Hazard Imminent hazards are those conditions or practices that pose an immediate threat to the life or health of employees, the public or others who may be exposed. If not corrected, this activity or condition will likely cause a serious injury, serious illness or fatality. If an imminent hazard is present, employees should stop activity and take immediate corrective action. If employees are unable to take action or are unsure what action to take, they shall notify their Supervisor who will take immediate corrective action if possible. In either case, the employee shall document the condition(s) using Attachment A. If it is necessary for employees to enter the area to correct the hazardous condition, they will be provided with the necessary protection and will be trained to perform these duties. If the imminent hazard cannot be corrected, the hazard area shall be declared off-limits until the hazard can be corrected. 8.2 Serious Hazard Serious hazards are those conditions where there is substantial probability that employees, the public, or others will suffer physical harm. If a serious hazard is present, employees should stop the activity and notify their supervisor. Serious hazards shall be corrected as soon as possible or shall be declared off-limits until the hazard is corrected. The employee shall document the condition(s) using Attachment A. 8.3 General Hazard General hazards are those that may affect the safety and health of employees. These hazards are brought to the attention of the supervisor using Attachment A. General hazards will be corrected as appropriate.


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8.4 Regulatory Hazard Regulatory hazards pertain to permits, postings, record keeping, reporting requirements or procedural deficiencies not directly affecting the safety and health of the employees. These deficiencies are noted on Attachment A for further review by the employee’s Supervisor and/or Department Head for correction as appropriate.

9 TRAINING AND INSTRUCTION All employees, including Department Heads, Supervisors and Lead Personnel shall have training and instruction on general and job-specific safety and health practices. Training and instruction shall be provided as follows and documented. To all new employees To all employees given new job assignments for which training has not been

previously provided When new substances, processes procedures, or equipment that present potential

new hazards are introduced into the workplace When previously unidentified hazards are recognized

10 RECORD KEEPING The following safety records will be kept on file with the District for a minimum of three years and/or as denoted below: Accident and incident investigations Safety inspections Safety training records including the date of training, name of trainer, and description

of training contents Tailgate safety meetings including the names of attendees, the date and any safety

items discussed Unsafe condition or practice reports and corrective actions taken Equipment training records for each employee will be kept for the duration of

employment

Illness and Injury Prevention Plan Attachment A: Safety Suggestion / Report of Unsafe

Condition or Practice Rev. 12/27/17

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Describe below the unsafe working condition, work practice, activity or equipment that you feel may result in injury or illness, workflow interruption or property damage. Send completed reports to your supervisor or Department Head (DH). After review, the supervisor and/or DH forwards this form (report) to Safety Administrator. The DH, supervisor, and reporting party should keep a copy until unsafe condition/practice has been resolved.

CHECK HERE IF YOU BELIEVE IMMEDIATE ACTION IS REQUIRED

Name of Person Submitting This Report:

Date:

Location of Concern: Building/Room:

Description of Unsafe Condition or Practice (If an injury, illness or work-flow interruption has resulted from this, please include details.): Diagram of Situation (if applicable): Suggested Remedial Action:

Received by: Date:

Reviewed by: Date:

Referred to: Date:

Estimated date of completion/correction Date:

Remedial Action Taken:

Completed reports are kept in the District Safety Files by the Safety Administrator

Illness and Injury Prevention Plan Attachment B: IIPP Review and Certification Log

Rev. 12/27/17

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Date Identify the IIPP Sections/Attachments Revised Initial

Illness and Injury Prevention Plan

Attachment C: Incident Investigation Report Rev. 12/27/17

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This report must be completed by a Supervisor within 2 working days of the accident/incident and sent to the Department Head. *If incident involves MAJOR injury or damage, form must be signed by SA, forwarded to GM, and a copy kept w/employee injury file. If the injury is minor in nature and/or damage is not extensive, report will be signed by SA & filed. Check box if MEDICAL

1. Name of injured (involved) employee (last, first) 2. Date of accident/incident 3. Time of accident/incident

4. Injury/Incident location 5. Assigned work location

6. Work Status 7. Job or task performed at time of accident/incident □ Full time o Regular

□ Extra help o Regular

□ Volunteer □ Student intern □ Temporary □ Contractor

8. Object or substance that harmed the employee or caused damage

9. Describe how the accident/incident occurred (if applicable, include crime report #)

10. Initial cause � Struck by/against � Caught in/under/between

� Fall – from elevation � Slip/trip/fall – same level

� Material handling/lifting � Repetitive motion

□ Motor vehicle □ Communicable disease

□ Chemical exposure □ Other_________

11. CONTRIBUTING FACTORS Identify multiple contributing factors involved in the accident or incident

Equipment / PPE Environment / Work Area Policy / Procedure Implementation Individual � Defect or

malfunction � Improper for job � Improper use � Not readily available � Design/ quality

contributed to hazard

� Inadequate layout/space

� Poor housekeeping � Ergonomic hazards � Unauthorized entry � Environmental

conditions

� None available for task � Does not address hazards � Specific responsibilities

not clearly assigned � No method to monitor and

track implementation � Not consistent with best

practices or regulations

� Hazard not identified, or perceived as low risk

� Lack of resources to implement safety policy

� Inadequate training � Poor/inconsistent

implementation of policy � Employee unaware of hazard

� Employee fatigue � Not able to perform work � Difficult to perform task

without help � Aware of hazard and controls

but did not follow safe practice � Other

12. CORRECTIVE ACTIONS Select possible corrective actions for each contributing factor identified.

Equipment / PPE Environment Policy / Procedure Implementation Individual � Develop inspection

procedure � Identify proper

equipment (JHA) � Train employee on

proper EQ use � Evaluate EQ needs

and access � Review EQ design /

quality for task

� Redesign work area � Implement periodic

safety inspections � Conduct ergonomic

evaluation � Develop controls to

prevent entry � Review controls for

environmental conditions

� Develop procedure � Revise to control the

hazards identified � Revise to assign

responsibilities � Develop system to

monitor implementation

� Revise to reflect best practices/regulations

� Establish hazard analysis system

� Review resource allocation for safety

� Revise training plan to ensure job-specific training for supervisors/employees

� Establish method to monitor compliance

� Review training delivery

� Review contributing factors for fatigue

� Review job demands / need for transitional duty

� Assess need for job redesign/assistive devices

� Initiate compliance procedures � Establish corrective actions

appropriate for contributing factor

13. Corrective Action Plan

14. Accident investigation review and approval of corrective actions Supervisor (Print) Supervisor Approval Signature Date Department Head (Print) Department Head Approval Signature Date *Safety Administrator (Print) *Safety Administrator Approval signature Date

*General Manager (Print) ONLY IF MAJOR INJURY *General Manager Approval signature ONLY IF MAJOR INJURY Date

Illness and Injury Prevention Plan Attachment D: Accident/Incident/Near Miss Investigation & Cal/OSHA Reporting

Procedure Rev. 12/27/17

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Supervisor: Completes Accident Investigation Report (AIR) and forwards to the Department Head on the day of injury or day reported

*ACCIDENT – An accident is an undesired event that results in personal injury or property damage. *INCIDENT - An incident is an unplanned, undesired event that adversely affects completion of a task. *NEAR MISS - Near misses describe incidents where no property was damaged and no injury sustained, but where, given a slight shift in time or position, damage and/or injury easily could have occurred. All incidents, whether a near miss or an actual injury-related event, should be investigated. Near miss reporting and investigation allows identification and control of hazards before they cause a more serious incident. Accident/incident investigations are a tool for uncovering hazards that either were missed earlier or have managed to slip out of the planned controls.

Safety Administrator: Reviews the completed AIR with recommendations and if necessary forwards the AIR to the District’s General Manager for review and action

Supervisor: Refer to SUPERVISOR INJURY CHECKLIST –

EMERGENCY SITUATION (Attachment E)

Supervisor: Refer to SUPERVISOR INJURY CHECKLIST –

NON EMERGENCY SITUATION (Attachment E)

Emergency Medical Care

Needed?

Does EE Want Medical

Treatment? *Accident or *Near Miss

EE Reports to Supervisor

Department Head: Schedules incident review meeting with appropriate Supervisor(s) within 10 business days of accident reported; forward results of meeting (AIR) to the Safety Administrator as necessary

Was this a *Near Miss or *Incident that

warrants an investigation?

Supervisor: Offer first aid treatment

Supervisor: Document the incident as minor first aid, reasons why investigation not necessary & forward to Department Head for review

YES

NO

YES

NO

YES

NO

Illness and Injury Prevention Plan Attachment E: Emergency / Non-Emergency Situation Checklist Rev. 12/27/17

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1. Determine if emergency treatment needed:

If emergency treatment is needed: CALL 911 - then administer emergency first aid treatment until professional help arrives (e.g., CPR, apply bandage and pressure to a bleeding wound, etc.)

2. Secure the site of the injury (after employee has proper medical attention)

Protect others from being injured if there is machinery or a potentially hazardous situation involved. Close down any equipment involved in the accident.

Save any broken equipment from further use and preserve for accident investigation/subrogation.

The District must immediately notify CalOSHA of a death or serious injury or illness (as defined in Section 330(h), Title 8, see below). If notification must be made, immediately contact the District General Manager and/or Safety Administrator.

"Serious injury or illness" means any injury or illness occurring in a place of employment or in connection with any employment which requires inpatient hospitalization for a period in excess of 24 hours for other than medical observation or in which an employee suffers a loss of any member of the body or suffers any serious degree of permanent disfigurement, but does not include any injury or illness or death caused by the commission of a Penal Code violation, except the violation of Section 385 of the Penal Code, or an accident on a public street or highway.

If any employees were exposed to another person’s blood or other potentially infectious material as a result of this incident, complete the Bloodborne Exposure Incident Investigation form and Post Exposure Checklist (in the District’s Bloodborne Pathogens Exposure Control Plan)

3. Obtain District Initial Injury Packet:

Conduct a preliminary accident investigation using the ISD Supervisor’s Incident/Accident Report (inside the Initial Injury Packet). Forward to the Safety Administrator as soon as possible but no later than the end of the day the injury/illness was reported.

Ensure that the DWC-1 (Employee Claim for Work-Related Injury Form) is given to the employee w ithin 24 hours. (Assuming there is a hospitalization, a representative from the District normally meets with the injured Employee or his/her family at the hospital. If a personal visit is not appropriate or practical then the form should be mailed via First Class Mail to the employee. Document when the form was mailed. Labor Code 5401 requires that the employer give the DWC-1 claim form to the Employee within one working day of receiving notice or knowledge of an injury) – (Check protocol with Third-Party Administrator).

END

EMERGENCY SITUATION

1. Obtain a District Initial Injury Packet:

2. Ask the employee if they have “pre-designated” a physician; if they are not sure or for some reason cannot answer, contact the Workers’ Compensation Coordinator to determine if the employee has a pre-designated physician

3. Contact the District’s Occupational Health Care Clinic or the employee’s pre-designated physician (whichever will be treating the employee) and alert them to an incoming patient

4. Drive the employee to the clinic

5. Begin Accident Investigation

Conduct a preliminary accident investigation using the ISD Supervisor’s Incident/Accident Report (inside the Initial Injury Packet); send to the Safety Administrator as soon as possible but no later than the end of the day the injury/illness was reported

Ensure that the DWC-1 (Employee Claim for Work-Related Injury Form) is given to the employee w ithin 24 hours (Assuming there is a hospitalization, a representative from the District normally meets with the injured Employee or his/her family at the hospital. If a personal visit is not appropriate or practical then the form should be mailed via First Class Mail to the employee. Document when the form was mailed. Labor Code 5401 requires that the employer give the DWC-1 claim form to the Employee within one working day of receiving notice or knowledge of an injury) – (Check protocol with Third-Party Administrator).

END

NON EMERGENCY SITUATION

Illness and Injury Prevention Plan - Ironhouse Sanitary District

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