443171.3
INJURY AND ILLNESS
PREVENTION PROGRAM
Updated by the Town of Yountville as of MONTH DAY, YEAR, and replaces the prior IIPP in place. 443171.3 Page 1
Table of Contents
Table of Contents............................................................................................................................................................................................1 SAFETY POLICY STATEMENT ........................................................................................................................................................................2 SECTION 1 – INJURY AND ILLNESS PREVENTION PROGRAM .............................................................................................................3 A. Purpose....................................................................................................................................................................................................3 B. Responsibilities ......................................................................................................................................................................................3
1. Town Manager..................................................................................................................................................................................3
2. Department Directors .....................................................................................................................................................................3
3. Supervisors/Managers ....................................................................................................................................................................3
4. Employees..........................................................................................................................................................................................4
5. Risk Manager.....................................................................................................................................................................................4 SECTION 2 – COMPLIANCE ..........................................................................................................................................................................4 A. Employee Recognition.........................................................................................................................................................................5 B. Disciplinary Action................................................................................................................................................................................5 SECTION 3 – COMMUNICATION.................................................................................................................................................................5 A. Reporting of Safety Concerns ............................................................................................................................................................5 SECTION 4 – HAZARD ASSESSMENT..........................................................................................................................................................6 SECTION 5 – ACCIDENT/EXPOSURE INVESTIGATION ...........................................................................................................................6 A. Work-Incurred Illnesses and Injuries ...............................................................................................................................................6 B. Near Misses.............................................................................................................................................................................................7 C. Accident and Near Miss Investigation .............................................................................................................................................7 D. Reports.....................................................................................................................................................................................................7 SECTION 6 – HAZARD CONTROL PROCEDURES ....................................................................................................................................8 SECTION 7 – TRAINING AND INSTRUCTION ............................................................................................................................................8 SECTION 8 – EMPLOYEE ACCESS TO THE IIPP ........................................................................................................................................9 SECTION 9 – RECORD KEEPING ..................................................................................................................................................................9 SECTION 10 – CODE OF SAFETY PRACTICES...........................................................................................................................................9 EMPLOYEE ACKNOWLEDGMENT............................................................................................................................................................. 11 Also Included In This Document
• Office Inspection Checklist
• Shop/Warehouse Inspection Checklist
• WWTP Safety Inspection Checklist
• Corrective Action Log
443171.3 Page 2
SAFETY POLICY STATEMENT
It is the intention of the Town of Yountville to develop, implement, and administer a comprehensive risk management, safety, and risk control program. The Town of Yountville maintains that our employees and the general public are our most important assets; therefore, public and employee safety is our greatest responsibility.
In all of our assignments, the health and safety of all and the protection of the environment should be of the utmost consideration. Employees at all levels of the workforce are directed to make safety and health a matter of continuing concern, equal in importance to all other operational considerations. This program is established to emphasize that effective risk management, safety, and risk control are integral to management procedures designed to maximize the Town of Yountville’s capital and personnel. Although profit is not the goal of municipal operations, the same efficiency demonstrated in for-profit organizations is desired to ensure that the Town of Yountville can provide services and maximize the use of each available tax dollar.
Within the operational activities of any endeavor, there may be exposure to personal injury, personal illness, or property damage that may be unintentionally hidden. Reviews of operations should consider problems and/or errors that could occur as it relates to the environment, equipment, job procedures, and personnel. Accidents are unplanned events, and most are preventable; proper planning can control accidents. All employees are directed to initiate such pre-planning as is necessary to minimize unsafe acts, contain environmental hazards, and control unsafe conditions.
Continual emphasis on risk management, risk control techniques, the refinement of work procedures, and safer working conditions has been shown to reduce injuries, property damage, and work interruption significantly. Every employee is charged with the responsibility of supporting and cooperating with the risk management policies and risk control programs. As a condition of employment, all employees are expected to adopt the concept that the safer way to perform a task is the most efficient and the only acceptable way to accomplish it. Safety adherence and performance will be an important measure of the Town of Yountville’s supervisory and employee performance evaluations.
_________________________________________________________ Celia King
Administrative Services Director
443171.3 Page 3
SECTION 1 – INJURY AND ILLNESS PREVENTION PROGRAM
A. Purpose
The Town of Yountville strives to maintain a work environment that protects the health of its employees and prevents workplace injuries. The Town has implemented this comprehensive Illness and Injury Prevention Program (IIPP) to achieve this goal. This program is designed to prevent workplace injuries, accidents, and illnesses. The IIPP is a foundational piece of the Town of Yountville’s loss prevention program and complies with the California Code of Regulations, Title 8, Sections 1509 and 3203.
B. Responsibilities
The Town Manager is responsible for ensuring the implementation of an effective health and safety program for the Town of Yountville personnel. The Town recognizes that the responsibility for safety and health is shared, and every person is held accountable for their assigned responsibilities, actions, or inactions.
All managers and supervisors are responsible for implementing and maintaining the IIPP in their work areas and for answering employee questions about the IIPP.
1. Town Manager
It is the responsibility of the Town Manager to provide general oversight and guidance to Department/Division management in promoting accident prevention and holding management accountable for implementing the details of the IIPP.
• Include safety performance as a regular part of discussions held with Department Directors and Division Managers/Supervisors.
• Be observant during Department/Division visits for unsafe work practices and conditions that could cause injury or property damage.
• Review injury data with each Department Director and set goals for safety performance. • Ensure safety rules and safe work practices are being enforced in a consistent manner by Department/Division management.
• Support Department/Division safety promotional campaigns and safety recognition programs.
2. Department Directors
Department Directors are responsible for:
• Developing department-specific safety policies and procedures. • Providing employee IIPP orientation and job-specific safety training prior to the assignment of employees to hazardous duties.
• Posting all health and safety information, such as safety posters and the log of work-related injuries and illnesses (Cal-OSHA Form 300).
• Designating staff responsible for serving on the safety committee as representatives of their department.
• Ensuring that each supervisor adheres to adopted policies and procedures and consistently enforces safety rules and regulations.
• Coordinating discipline with Human Resources for failure to implement and adhere to safe work practices.
3. Supervisors/Managers
Supervisors/Managers are responsible for:
• Enforcing safety policies and procedures.
• Investigating accidents, injuries, and near misses and preparing written documentation. • Evaluating new equipment and procedures and making safety recommendations. 443171.3 Page 4
• Inspecting work areas routinely.
• Correcting or reporting unsafe conditions to their immediate supervisor. • Implement and document the training program to instruct employees in safe work practices and specific job duties.
4. Employees
Employees are responsible for:
• Reporting hazardous conditions and equipment to their supervisor. • Observing all Town safety policies, procedures, and rules. • Using all safety clothing and personal protective equipment (PPE) as required. • Attending all general and tailgate safety meetings.
• Reporting every injury, accident, and near-miss incident to their supervisor.
5. Risk Manager
The Risk Manager, who is appointed by the Town Manager, is responsible for the administration of the Town’s Safety Program, including:
• Coordinating the development and implementation of the IIPP with all departments and divisions.
• Assisting the Department Directors/Division Managers with the implementation of the IIPP. • Maintaining records of employee accidents, injuries, medical records, and baseline biological monitoring.
• Tracking hazard reports and safety concerns through resolution. • Providing technical assistance on occupational health and safety issues to Department Directors/Division Managers.
• Providing statistical reports regarding work-related injuries to Department Directors/Division Managers
• Collecting, printing, and posting Cal-OSHA 300 Illness and Injury Log data. • Investigating and reporting to Cal-OSHA serious injuries resulting in hospitalization or fatality and providing recommendations to prevent recurrence.
SECTION 2 – COMPLIANCE
Department Directors are responsible for ensuring that all safety and health policies and procedures are clearly communicated and understood by all employees. Managers and supervisors are expected to enforce the rules fairly and uniformly.
All employees are responsible for using safe work practices, following all directives, policies, and procedures, and assisting in maintaining a safe work environment.
Our system of ensuring that all employees comply with the rules and maintain a safe work environment includes the following:
• Informing employees of the provisions of our IIPP.
• Evaluating the safety performance of all employees.
• Recognizing employees who perform safe and healthful work practices. • Providing training to employees whose safety performance is deficient. • Disciplining employees for failure to comply with safe work practices. 443171.3 Page 5
A. Employee Recognition
Management should make every effort to recognize employees for following safe work practices. This recognition may include verbal acknowledgment, recognition at meetings, awards, or other recognition deemed appropriate by management.
B. Disciplinary Action
Discipline for safety violations should be administered in a manner that is consistent with the Town of Yountville’s Personnel Rules and Policies. Employees shall be disciplined and/or coached as appropriate for infractions of safety rules and unsafe work practices that are observed, not just those that result in an injury or illness. Failure to follow safety rules and procedures can result in disciplinary action up to and including termination. The Division Manager/Supervisor shall consult with the Department Director and Human Resources when disciplinary action is being considered.
SECTION 3 – COMMUNICATION
The Town of Yountville recognizes that open, two-way communication between management and staff on health and safety issues is essential to an injury-free, productive workplace.
The following system of communication is designed to facilitate a continuous flow of safety and health information between management and staff in a form that is readily understandable and consists of one or more of the following items:
• New employee orientation, including a discussion of safety and health policies and procedures. • Review of our IIPP.
• Workplace safety and health training programs.
• Regularly scheduled safety meetings.
• Tailgate meetings at least every ten (10) working days for those employees who have construction-related activities, to emphasize safety.
• Effective communication of safety and health concerns between employees and supervisors, including translation where appropriate.
• Posted or distributed safety information on bulletin boards, via email, and on the Town of Yountville website and/or intranet.
• A safety committee that meets regularly, reviews results of the periodic scheduled inspections, reviews investigations of accidents and exposures, and makes suggestions to management for the prevention of future incidents, reviews investigations of alleged hazardous conditions, and submits recommendations to assist in the evaluation of employee safety suggestions.
A. Reporting of Safety Concerns
Department Directors and Division Supervisors/Managers should encourage employees to report safety concerns directly to their supervisor without fear of reprisal or punishment. Under California law, it is illegal for any employer to take action against employees who exercise their rights under the law to report unsafe conditions. Department Directors and Division Managers/Supervisors are to encourage employees to report hazards and commend them for their safety awareness.
To encourage employee reporting of unsafe conditions, the Town of Yountville has established a system allowing employees to anonymously notify the Town of Yountville of safety concerns. This is most easily accomplished by clicking this link to access the form: Anonymous Safety Concern Reporting Form Department Directors and Division Supervisors/Managers are encouraged to develop additional means of anonymous reporting that best meet the needs of their departments. 443171.3 Page 6
Safety suggestions will be processed through regular lines of authority (e.g., chain of command). Those suggestions that cannot be approved or disapproved at the department level will be referred to the Risk Manager.
SECTION 4 – HAZARD ASSESSMENT
Periodic inspections to identify and evaluate workplace hazards shall be completed. These periodic inspections aim to identify potential hazards so that they can be corrected before an accident occurs. Regular self-inspections are an essential part of our IIPP. Inspections should include a physical inspection of the premises, as well as identification of unsafe work practices.
Periodic inspections are performed according to the following schedule:
• Quarterly audit of all Town of Yountville facilities. • When the Town initially establishes the IIP Program.
• When new substances, processes, procedures, or equipment that present potential new hazards are introduced into our workplace.
• When new, previously unidentified hazards are recognized. • When occupational injuries and illnesses occur.
• When the Town hires and/or reassigns permanent or intermittent employees to processes, operations, or tasks for which a hazard evaluation has not been previously conducted. • Whenever workplace conditions warrant an inspection.
Periodic inspections can be performed by any of the following:
• Executive Management
• Supervisor/Manager
• Risk Manager
• Safety Committee Members
• Consultants
Periodic inspections consist of identifying and evaluating workplace hazards utilizing the applicable attached Safety Checklist and other effective methods to identify and evaluate workplace hazards.
Departments engaged in hazardous operations are strongly encouraged to schedule more frequent monthly, weekly, or daily inspections, depending on the operation. Inspection recommendations will be made to the Department Director and shared with the Risk Manager.
Supervisors are responsible for the safety of the physical conditions in which their subordinates work. Each supervisor will make frequent work area inspections, and recommendations for correcting unsafe conditions will be made through normal channels of authority and procedures.
SECTION 5 – ACCIDENT/EXPOSURE INVESTIGATION
All work-related injuries, illnesses, near-misses, or property damage instances involving a Town of Yountville employee, equipment, or members of the public on Town property must be reported immediately to a supervisor or the Risk Manager. In addition, all illnesses or injuries occurring in the workplace and resulting in serious injury, hospitalization, or fatality of an employee must be reported immediately to the Risk Manager and Human Resources.
A. Work-Incurred Illnesses and Injuries
• Employees are responsible for:
o Regardless of seriousness, report all work-incurred illnesses, injuries, and near misses to their immediate supervisor before the end of the work shift.
o Securing first aid for minor injuries immediately.
443171.3 Page 7
• Supervisors are responsible for:
o Securing further medical treatment for employees, if required, from a Town’s Designated Medical Facility or the employee’s pre-designated provider.
o Report any work-related death, serious injury, or illness to the Risk Manager and Human Resources immediately, but no later than eight hours after the incident, by phone at (707) 948- 2611/(707)948-2626 or email [email protected].
▪ A serious injury and illness is defined as one involving:
• Inpatient hospitalization, regardless of the length of time, for other than medical observation or diagnostic testing
• Amputation
• Loss of an eye
• Serious degree of permanent disfigurement
o Completing a DWC-1 form for any employee who reports a work-related illness or injury and forwarding it to [email protected] within 24 hours. o Investigate and complete the Accident/Incident Report for any work-related illnesses, injuries, and near misses.
• The Risk Manager is responsible for:
o Immediately report any work-related death, serious injury, or illness (as defined above) within eight (8) hours to Cal/OSHA by calling (707) 649-3700.
▪ American Canyon District Office
3419 Broadway Street, Suite H8
American Canyon, CA 94503
o Working with supervisors to identify measures to prevent illnesses and injuries. o Collecting, printing, and posting Cal-OSHA 300 Illness and Injury Log data.
B. Near Misses
A near miss is defined as an unintended event that has the potential for causing personal injury, illness, property damage, or environmental impairment. Unsafe working conditions, unsafe employee work habits, improper use of equipment, or use of malfunctioning equipment have the potential to cause work-related injuries. It is every employee’s responsibility to report and, where appropriate, correct potential incidents immediately.
C. Accident and Near Miss Investigation
The supervisor must investigate all accidents and near misses to gather information to determine the cause(s) of accidents and near misses to prevent recurrences and future incidents. The Risk Manager or their designee may investigate any accident or near miss involving Town of Yountville employees or property when they deem it appropriate.
Procedures for investigating include, but are not limited to:
• Visiting the accident scene as soon as possible.
• Interviewing injured or involved employees and witnesses. • Examining the workplace for factors associated with the accident/exposure. • Determining the root cause of the accident/exposure.
• Taking corrective action to prevent the accident/exposure from recurring. • Recording the findings and corrective actions taken.
D. Reports
Certain accident investigation reports may be confidential or privileged from disclosure as permitted by law. The Risk Manager or their designee will maintain current accident statistics, which will be available to all department supervisors/managers. Cal-OSHA 300 Logs are available for review near the current labor law posters. Annual summaries of the Cal-OSHA 300 Log are posted as required by state law starting February 1 through April 30 of each year.
443171.3 Page 8
SECTION 6 – HAZARD CONTROL PROCEDURES
Unsafe or unhealthy work conditions, practices, or procedures shall be corrected in a timely manner based on the severity of the hazards.
Hazards shall be corrected according to the following procedures:
• When observed or discovered.
• When an imminent hazard exists that cannot be immediately abated without endangering employee(s) and/or property, the Town will remove all exposed employees from the area except those necessary to correct the existing condition. Employees required to correct the hazardous situation shall be provided with the protection needed.
• All actions taken and the completed dates shall be documented within the Town of Yountville’s Corrective Action Log.
Identified hazardous conditions will be prioritized for correction by considering both the potential consequence (severity) and probability (frequency) of an injury or illness occurring. Corrective action for hazard elimination is the responsibility of the Department Director. The Risk Manager will provide or obtain expert assistance when necessary.
SECTION 7 – TRAINING AND INSTRUCTION
All employees, including managers and supervisors, shall have training and instruction on general and job-specific safety and health practices.
Training and instruction shall be provided as follows:
• When the IIPP is first established.
• To all new employees
• To all employees who are given new job assignments for which training has not been previously provided. • Whenever new substances, processes, procedures, or equipment are introduced to the workplace and represent a new hazard.
• Whenever the Town of Yountville is made aware of a new or previously unrecognized hazard. • To familiarize supervisors with the safety and health hazards to which employees under their immediate direction and control may be exposed.
• To all employees with respect to hazards specific to each employee’s job assignment.
Workplace safety and health practices for all industries include, but are not limited to, the following:
• Explain the Town of Yountville’s IIPP and measures for reporting unsafe conditions, work practices, injuries, and when additional instruction is needed.
• Town of Yountville’s Code of Safety Practices; included at the end of this document. • Use of appropriate clothing, including gloves, footwear, and personal protective equipment (PPE). • Information about chemical hazards to which employees could be exposed and other hazard communication program information.
• Availability of toilet, handwashing, and drinking water facilities. • Provisions for medical services and first aid, including emergency procedures.
In addition, the Town will provide specific instructions to all employees regarding hazards unique to their job assignment, to the extent that such information was not already covered in other training.
The objective of safety training is to develop employee appreciation for safety and accident prevention as well as the required skills and knowledge to reduce the number and severity of illnesses and injuries. All Town of Yountville employees will be provided training on safe work practices applicable to the performance of their work before 443171.3 Page 9
assignment. For employees conducting construction-like tasks, tailgates on appropriate topics will be provided at least every ten (10) working days. Tailgate safety topics and refresher training will also be provided as required to maintain regulatory compliance. (Information on how to conduct a tailgate can be found on the Cal/OSHA Tailgate guide).
Each supervisor receives safety training appropriate to the responsibilities of the supervisory position held. Such training will include the basic techniques of accident prevention, accident investigation, and safety training. If assigned, Department Safety Representatives will receive training in the responsibilities and techniques of their assignments. All training will be documented, and records will be maintained per the Records Retention Policy.
SECTION 8 – EMPLOYEE ACCESS TO THE IIPP
Town of Yountville employees – or their designated representatives, as defined in CCR tit. 8, § 3203 - have the right to examine and receive a copy of the Town of Yountville IIPP.
Ways to access the IIPP include:
• On the Town of Yountville website (available 24/7): Visit www.townofyountville.com/545/Documents and click on the Injury & Illness Prevention Program – IIPP (PDF) hyperlink. This allows an employee unobstructed access to review, print, and email the current version of the Program. • In person: Whenever an employee or designated representative requests a copy of the Program, the Town will provide the requester a printed copy of the Program within five (5) business days of the request. One printed copy of the Program will be provided free of charge. If the employee or designated representative requests additional copies of the Program within one (1) year of the previous request and the Program has not been updated with new information since the prior copy was provided, the Town may charge reasonable, non-discriminatory reproduction costs for the additional copies.
SECTION 9 – RECORD KEEPING
Departments will maintain records of inspections and hazard reports according to the records retention schedule, but at least one year. Records must include the names of those who conducted the inspection, the dates of the inspection, the identified hazards, and any corrective action taken.
Either the Departments or Human Resources will maintain training records per the Town of Yountville’s records retention schedule, but at least one year. Training records must include the names of the employees trained, the topics covered in the training, the duration and date of the training, the core competencies of the training, the trainer’s identity, and the signatures of employees who attended.
Employee records from medical monitoring and exposure evaluations will be preserved and maintained for the duration of employment plus thirty years to the extent required by Title 8, California Code of Regulations section 3204. Employees and their designated representatives have a right to access records in accordance with applicable law.
SECTION 10 – CODE OF SAFETY PRACTICES
Town of Yountville employees shall follow this general code of safety practices:
1. Any employee may stop Town of Yountville work without fear of retaliation if they believe the task is unsafe and must be evaluated by a supervisor or manager to determine necessary safety precautions. Report the condition to your immediate supervisor and/or the Risk Manager.
2. Always keep your work area clean and orderly to prevent slips, trips, or falls. When possible, avoid uneven ground and be aware of the walking surface.
3. No employee shall knowingly be permitted or required to work while the employee's ability or alertness is so 443171.3 Page 10
impaired by fatigue, illness, the influence of drugs or intoxicating substances, or other causes that it might unnecessarily expose the employee or others to injury.
4. Horseplay, scuffling, and other acts which tend to have an adverse influence on the safety or well-being of the employees is prohibited.
5. Do not climb over fences or walls two feet or more in height. When possible, use gates or openings designed for passage. Use steps, stairs, ladders, or ramps to climb up or down work surfaces two feet or more in height or depth.
6. Equipment and Vehicles: Only use equipment for which you have been authorized and trained to operate.
Supervisors are to ensure that employees are trained to operate appropriate tools/equipment. Request an equipment orientation from the manufacturer, dealer, or rental company for all rented equipment unfamiliar to you. Inspect equipment and vehicles for obvious damage and defects before use. When newly operated, leased, or rented for the first time, check critical safety items such as brakes, locks, guards, etc. Request and read the owner’s manual and use any inspection guides included with the manual.
7. Bend your knees and use your legs to lift, push, or pull objects. Use tools to help lift and transport heavy objects.
When mechanical aids are not available, seek the help of others (two-person lift) when lifting objects of heavyweight (more than 50 pounds) and/or awkward size.
8. When possible, use tools instead of hands to lift and remove lids (i.e., meters, vaults, maintenance holes, etc.).
Use tools, the steel-toe of your shoe, or the instep of your foot to slide lids back in place. Avoid pinch points and getting your fingers caught. Ensure that all lids are undamaged, properly seated, and secure before leaving the site.
9. Employees shall not enter manholes, underground vaults, chambers, tanks, silos, or other similar places that receive little ventilation, unless it has been determined that it is safe to enter.
10. Wear all personal protective equipment (PPE) appropriate for the work area, per warning signs, task-specific procedures, or tool/equipment instructions. Use only tools and equipment that are in good working order, with guards in place and free from damage.
11. Use only those hazardous chemicals that you have been trained on and that have appropriate labeling (name and hazard warning). If a new or unfamiliar chemical or substance is encountered, refer to the Safety Data Sheet (SDS). Wear all personal protective equipment (PPE) appropriate for the work, per warning signs, SDS, task-specific procedures, etc. Label all secondary containers immediately after hazardous chemicals are placed inside them or when the original container label has been removed or defaced. Properly dispose of waste chemicals and containers in proper containment.
12. For all minor herbicide/pesticide applications and chemical use, follow all precautions and personal protective equipment requirements described on the herbicide/pesticide/chemical label. Check with your supervisor/manager if a Qualified Applicator Certificate or Qualified Applicator License is required.
13. Wear heavy-duty rubber gloves and boots when working with uncured concrete. Wet Portland cement can cause caustic burns, sometimes referred to as cement burns.
14. Report immediately to your supervisor:
a. On-the-job injuries or illnesses. Report all work-related injuries and illnesses to your supervisor and Human Resources. Supervisors will coordinate a visit to the occupational clinic (address and phone number located below). For off-hours and weekends, it is recommended to call ahead and confirm availability. If immediate medical attention is needed, visit the nearest ER or call 911 to receive transport to a hospital.
i. Kaiser On-The-Job Napa
3285 Claremont Way
Napa, CA 94558
(707) 258-4907
Occupational Health Services | Kaiser Permanente
b. Hazards, unsafe practices, close calls, malfunctioning equipment or tools, defective personal protective equipment, or policies and procedures that you believe could create or result in a dangerous situation: immediately STOP WORK to Recognize, Evaluate, and Control/Correct the Hazard(s). Report to your supervisor any situation that cannot be controlled or corrected.
15. When entering private property, request that the property owners confine their dogs away from you. If an 443171.3 Page 11
unleashed aggressive dog approaches you, do not turn your back. Step back from the dog and use a meter stick or similar item to help keep the dog at a safe distance from you.
16. With the exception of authorized emergency vehicles under California Vehicle Code section 21055, all employees must follow posted speed limits on all public roads. The speed limit inside Town of Yountville facilities, including
plants, roads, maintenance yards, and employee parking lots, is 10 MPH. On private easement and access roads, the speed limit is 15 MPH for unpaved roads and 30 MPH for paved roads. Report all vehicle accidents to your supervisor immediately.
14. Mobile device use while driving is only permitted under state Law when used hands-free or paired to the vehicle. No texting is allowed while driving.
15. If experiencing symptoms of heat illness (fatigue, headache, dizziness, nausea, cramps, hot/dry skin, and rapid pulse), seek shade in an open-air area or an air-conditioned vehicle. If symptoms do not improve immediately or signs of heatstroke are present, call 911.
16. All employees and supervisors who work in environments to which the Town’s Heat Illness Prevention Plan applies shall be knowledgeable of and observe the Town’s Heat Illness Prevention Plan.
17. If a person(s) identifying themselves from Cal/OSHA shows up at a worksite, ask for identification and the purpose of the visit. Contact your supervisor and assigned Town of Yountville representative for direction and assistance. Do not allow permission to enter Town of Yountville sites or provide any documents unless directed by your supervisor or assigned Town of Yountville representative.
EMPLOYEE ACKNOWLEDGMENT
I (print name), hereby acknowledge that I have received, read, and understand the Town of Yountville Injury and Illness Prevention Program (IIPP). I agree to conform to all the Town of Yountville practices, rules, and regulations related to safe work performance. I understand that my failure to follow these safety procedures may result in disciplinary action as outlined in the Personnel Rules & Policies. I further understand that:
• It is my responsibility to report all unsafe conditions or violations of the IIPP or the Code of Safety Practices to my supervisor or other management personnel in order to minimize the potential of injury to myself or my fellow employees.
• I am encouraged to inform my immediate supervisor of any hazards at the worksite without fear of reprisal, and should my assistance create any such action or related intimidation, I am encouraged to contact the Risk Manager and/or Human Resources.
__________________________________________________________________ _______________________________________ (Signature of Employee) (Date)
__________________________________________________________________ _______________________________________ (Signature of Supervisor) (Date)
443171.3
Office Inspection Checklist
Location:____________________________________________________________________________ Frequency:
Quarterly Annual Other:______________________________________ All “No” answers need corrective actions identified and shown on the Corrective Action Log Hazard
Yes
No
NA
Target Date
for
Completion
Date
Completed Corrective Action Needed
1 Are all exits clear and properly marked?
2 Are exit signs illuminated for buildings with occupant load over 50 (§3216)?
3 Are all stairs clear, in good order, and free of debris? 4 Are fire extinguishers in appropriate places and inspected monthly? 5 Are electrical panels closed and properly labeled?
6 Do all electrical outlets have covers and are in good condition? 7 Are all walkways (min. 24”) clear of debris and tripping hazards? 8 Are storage shelves secure to prevent tipping?
9 Is the lighting appropriate for work tasks and regularly maintained? 10 Is there effective ventilation for work tasks?
11 Are electrical ground plugs in place?
12 Is there appropriate security lighting?
13 Is the facility secure and locked to prevent unauthorized entry? 14 Are outside walking surfaces free of trip hazards?
15 Are all required posters displayed?
443171.3
Office Inspection Checklist Continued
Hazard
Yes
No
NA
Target Date
for
Completion
Date
Completed
Corrective Action
Needed
16 Are appropriate “No Trespassing” signs posted as needed? 17 18
19 20
21 22
23 24
25 26
27 28
29 30
Person Conducting Inspection: ________________________________________________________ Date: _____________________________________ 443171.3
Shop/Warehouse Inspection Checklist
Location:____________________________________________________________________________ Frequency:
Quarterly Annual Other:__________________________ All “No” answers need corrective actions identified and shown on the Corrective Action Log Hazard
Yes
No
NA
Target Date
for
Completion
Date
Completed Corrective Action Needed
1 Are all exits clear?
2 Are all stairs clear, in good order, and free of debris? 3 Are fire extinguishers in the appropriate places and in good order? 4 Are electrical panels closed and properly labeled?
5 Do all electrical outlets have covers in good condition? 6 Is the electrical machinery in good condition and properly grounded? 7 All walkways (min. 24”) are clear of debris and tripping hazards? 8 Are storage shelves secure to prevent tipping?
9 Is there appropriate lighting for work tasks, and is it regularly maintained?
10 Is there effective ventilation for work tasks?
11 Are tools properly placed, secured, and maintained?
12 Are electrical ground plugs in place?
13 Is the required personal protective equipment available to employees?
14 Are guards in place and properly secured?
15 Are chemicals stored according to SDS?
443171.3
Shop/Warehouse Inspection Checklist Continued
Hazard
Yes
No
NA
Target Date
for
Completion
Date
Completed Corrective Action Needed
16 Are compressed gas cylinders secured and stored properly? 17 Are chemical containers labeled and legible?
18 Are flammable materials stored in accordance with Cal/OSHA standards §5531 to §5543?
19 Are SDSs available for all chemicals stored in buildings? 20 Is chemical waste properly disposed of?
21 Is there appropriate security lighting?
22 Is the facility secure and locked to prevent unwanted entry? 23 Are outside walking surfaces free of trip hazards?
24 Are appropriate “No Trespassing” signs posted as needed? 25 26
27 28
29 30
Person Conducting Inspection: ________________________________________________________ Date: _____________________________________ 443171.3
WWTP Safety Inspection Checklist
Location:____________________________________________________________________________ Frequency:
Quarterly Annual Other:__________________________ All “No” answers need corrective actions identified and shown on the Corrective Action Log Hazard
Yes
No
NA
Target Date
for
Completion
Date
Completed Corrective Action Needed
1 Are fire extinguishers in appropriate places and in good order? 2 Are electrical panels closed, secure, and properly labeled? 3 Are electrical connections secure, and the conduit free of damage? 4 High Voltage signs posted as needed?
5 Are electrical ground plugs in place?
6 Guards & screens in place?
7 All walkways (min. 24”) are clear of debris and tripping hazards 8 Is there appropriate lighting for work tasks, and is it regularly maintained?
9 Effective ventilation for work tasks?
10 Are the tools properly placed, secured, and maintained? 11 Are storage shelves secure to prevent tipping?
12 Are SDSs available for all chemicals stored on-site? 13 Are chemicals stored according to SDS?
14 Are all chemical containers labeled and legible?
15 Are Compressed Gas Cylinders secured and stored properly? 443171.3
WWTP Safety Inspection Checklist Continued
Hazard
Yes
No
NA
Target Date
for
Completion
Date
Completed Corrective Action Needed
16 Flammable materials stored in accordance with Cal OSHA standards §5531 to §5543?
17 Chemical waste & containers are properly disposed of? 18 Are tanks, pipes, screens, and pumps, and the surrounding area, free of spills or leaks?
19 Gas detectors calibrated, maintained, and functioning per manufacturer specs?
20 Has the ventilation system been tested within the last year? 21 Are the emergency A & B kits properly maintained and stored? 22 Is the respirator equipment properly maintained and stored? 23 Required personal protective equipment available to employees? 24 Appropriate security lighting?
25 Are ladders properly stored?
26 Are life-rings present?
27 Is the facility secure and locked to prevent unauthorized entry? 28 Are appropriate “No Trespassing” signs posted as needed? 29 Outside walking surfaces are free of trip hazards?
30 Are weeds abated to prevent grass fires?
31 Are Contractors and Visitors told about potential hazards and emergency action plans?
Person Conducting Inspection: ________________________________________________________ Date: _____________________________________ 443171.3
Corrective Action Log
Corrective Action Follow-Up
All identified hazards must be corrected according to the severity of the hazard. Imminent dangers must be corrected immediately, and the work area must be secured.
Follow-Up Inspection Date: _________________________________________ Inspector Name & Signature: _______________________________________________________________________________________ Hazard Description &
Location Severity Corrective Action Needed Assigned Individual Target
Date of
Completion
Completion
Date