iip program for agriculture industry employers with intermittent employees

XYZ Company

Injury and Illness Prevention Program

For

Agriculture Industry EmployersWith

Intermittent Employees

Complies with Provisions of

OSHA 29 CFR Part 1910 – General Industry Standards

OSHA 29 CFR Part 1926 – Construction Industry Standards

Safety Office Depot. All rights reserved.

Injury & Illness Prevention Program(For Agriculture Industry Employers with Intermittent Employees)

Table of Contents

Section Description Page1 Program Policy & Requirement 32 Program Responsibility 4 3 Employee Compliance 5 4 Safety Communication 6 5 Hazard Assessment 76 Accident/Exposure Investigation 87 Hazard Correction 98 Training and Instruction 109 Recordkeeping Policy 1210 Company Required Safety Programs 1511 Company Required Safety Training Courses 1612 Company Required Safety Forms & Checklists 18

Appendices:

Appendix A List of Training Subjects 20 Agriculture Production and Farm Labor and Management Services 21 Preserved Fruits and vegetables Manufacturing and Sugar and Confectionery Products 22

Appendix B Hazard Assessment Checklists 23 General Workplace Checklist 24 Agriculture Production and Farm Labor and Management Services 26 Preserved Fruits and vegetables Manufacturing and Sugar and Confectionery Products 28

Appendix C Hazard Assessment and Correction Record 30

Appendix D Accident/Exposure Investigation Report 32

Appendix E Employee Training and Instruction Record 34

Appendix F Employee Acknowledgement Form 36

Safety Office Depot. All rights reserved. 2


Section 1

Program Policy and Requirement

Program Policy

It is intent of XYZ Company to comply with all laws. To do this, we must constantly be aware of

conditions in all work areas that can produce injuries. No employee is required to work at a job

he/she knows is not safe or healthful. Your cooperation in detecting hazards and, in turn,

controlling them, is a condition of your employment. Inform your supervisor immediately of any

situation beyond your ability or authority to correct.

Program Requirement

This program has been prepared for use by employers in the Agriculture Industry which have

been determined by OSHA to historically utilize intermittent or seasonal workers. Intermittent or

seasonal employment refers to controlling, directing, or directly supervising any worker other than

permanent workers..

Employers in the Agriculture Industry which has been determined by OSHA as historically

utilizing intermittent or seasonal workers and who adopts and implements this program in good

faith shall be deemed in compliance with IIP Program requirements, unless mandated otherwise

by a State law.

Proper use of this program requires the IIP Program administrator to carefully review the

requirements for each of the IIP Program elements found in this program, fill in the appropriate

blank spaces and select those items that are applicable to your workplace. The recordkeeping

section requires that the IIP Program administrator select and implement the category

appropriate for your establishment.

This program must be maintained by the employer in order to be effective.



Section 2

Program Responsibility

Program Administrator

The Injury and Illness Prevention Program (IIPP) administrator, Program Administrator has the

authority and responsibility for implementing the provisions of this program.

è DECISION POINT – Enter a name or position title (recommended)

The Program Administrator for XYZ Company is _______________________________________.

Managers and Supervisors

All managers and supervisors are responsible for implementing and maintaining the IIP Program

in their work areas and for answering worker questions about the IIP Program.

A copy of this IIP Program shall be available from each manager and supervisor upon request.



Section 3

Employee Compliance

XYZ Company management is 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 permanent and intermittent workers, including managers and supervisors, are

responsible for complying with safe and healthful work practices. Our system of

ensuring that all workers comply with these practices includes one or more of the

following selected practices:

è DECISION POINT – Review and select the items that apply and delete those that do not

Our system of ensuring that all workers comply with these practices includes one or more of the

following checked practices:

1. Informing workers of the provisions of our IIP Program;

2. Evaluating the safety performance of all workers;

3. Recognizing workers who perform safe and healthful work practices;

4. Providing training to workers whose safety performance is deficient;

5. Disciplining workers for failure to comply with safe and healthful work practices.



Section 4

Safety Communication

All XYZ Company managers and supervisors are responsible for communicating with all

permanent and intermittent workers about occupational safety and health in a form readily

understandable by all workers. Our communication system encourages all workers to inform

their managers and supervisors about workplace hazards without fear of reprisal.

Upon hiring, management will identify any intermittent workers with special communication

needs. Management will ensure that such a worker understands the safety and health

requirements before being assigned to duties exposing them to workplace hazards.

è DECISION POINT – Review and select the items that apply and delete those that do not

Our communication system includes one or more of the following selected items:

1. New worker orientation including a discussion of safety and health policies and

procedures.

2. Review of our IIP Program.

3. Workplace safety and health training programs.

4. Regularly scheduled safety meetings.

5. Effective communication of safety and health concerns between workers and

supervisors, including translation where appropriate.

6. Posted or distributed safety information.

7. A system for workers to anonymously inform management about workplace hazards.

8. Our establishment has Less Than 10 employees and communicates with and instructs

employees orally about general safe work practices and with respect to hazards unique

to each employee's job assignment.



Section 5

Hazard Assessment

Periodic inspections of XYZ Company facilities, workplaces and sites are performed according to

the following schedule:

1. When we initially established our IIP Program;

2. When new substances, processes, procedures or equipment which present

potential new hazards are introduced into our workplace;

3. When new, previously unidentified hazards are recognized;

4. When occupational injuries and illnesses occur;

5. When we hire and/or reassign permanent or intermittent workers to processes,

operations, or tasks for which a hazard evaluation has not been previously conducted; and

6. Whenever workplace conditions warrant an inspection.

Periodic inspections consist of identification and evaluation of workplace hazards utilizing

applicable sections of the attached Hazard Assessment Checklist and any other effective

methods to identify and evaluate workplace hazards.



Section 6

Accident/Exposure Investigation

XYZ Company procedures for investigating workplace accidents and hazardous substance

exposures include:

1. Interviewing injured workers and witnesses;

2. Examining the workplace for factors associated with the accident/exposure;

3. Determining the cause of the accident/exposure;

4. Taking corrective action to prevent the accident/exposure from reoccurring; and

5. Recording the findings and corrective actions taken.



Section 7

Hazard Correction

Unsafe or unhealthy work conditions, practices or procedures at XYZ Company shall be

corrected in a timely manner based on the severity of the hazards. Hazards shall be corrected

according to the following procedures:

1. When observed or discovered;

2. When an imminent hazard exists which cannot be immediately abated without

endangering employee(s) and/or property, we will remove all exposed workers from the

area except those necessary to correct the existing condition. Workers necessary to correct

the hazardous condition shall be provided with the necessary protection; and



Section 8

Training and Instruction

All XYZ Company permanent and intermittent workers, including managers and supervisors,

shall have training and instruction on general and job-specific safety and health practices.

Training and instruction can be provided through a brief on-site safety meeting. Any training

and instruction shall be provided as follows:

1. When the IIP Program is first established;

2. To all new workers, except for construction workers who are provided training

through a construction industry occupational safety and health training program approved

by Cal/OSHA;

3. To all workers given new job assignments for which training has not previously

provided;

4. Whenever new substances, processes, procedures or equipment are introduced

to the workplace and represent a new hazard;

5. Whenever the employer is made aware of a new or previously unrecognized

hazard;

6. To supervisors to familiarize them with the safety and health hazards to which

workers under their immediate direction and control may be exposed; and

7. To all workers with respect to hazards specific to each worker's job assignment.

Workplace safety and health practices for all industries using intermittent workers include, but

are not limited to, the following:

1. Explanation of the employer's IIP Program, emergency action plan and fire

prevention plan, and measures for reporting any unsafe conditions, work practices, injuries

and when additional instruction is needed.



2. Use of appropriate clothing, including gloves, footwear, and personal protective

equipment.

3. Prevention of musculoskeletal disorders, including proper lifting techniques.

4. Information about chemical hazards to which workers could be exposed and

other hazard communication program information.

5. Availability of toilet, hand-washing and drinking water facilities.

6. Provisions for medical services and first aid including emergency procedures.

In addition, XYZ Company shall train all workers about the selected applicable items found in the

attached List of Training Subjects.



Section 9

Recordkeeping Policy

Every employer has certain mandatory records that they must keep and be prepared to provide

to the appropriate agency when needed. The two primary types of records that must be kept

are Occupational Safety and Health (OSHA) and Internal Revenue Service (IRS) information.

A. Occupational Safety and Health (OSHA) Records

Every employer covered by OSHA who has more than ten (10) employees, except for

employers in certain low-hazard industries such as retail, finance, insurance, real estate, and

some service industries, must maintain OSHA-specified records of job-related injuries and

illnesses. There are two such records, the OSHA Form 300, and the OSHA Form 301.

1. OSHA Form 300

The OSHA Form 300 is an injury/illness log, with a separate line entry for each

recordable injury or illness (essentially those work-related deaths, injuries, and illnesses

other than minor injuries that require only first aid treatment and do not involve

medical treatment, loss of consciousness, restriction of work or motion, or transfer to

another job). A summary section of the OSHA Form 300, which includes the total of the

previous year's injury and illness experience, must be posted in the workplace for the

entire month of February each year.

2. OSHA Form 301

The OSHA Form 301 is an individual incident report that provides added detail about

each individual recordable injury or illness. An equivalent insurance or workers'

compensation form that provides the same details may be substituted for the OSHA

Form 301.

B. Company Recordkeeping Policy

è DECISION POINT – Select one of the four categories below that applies to your company.

Remove the other three categories that do not apply to your company.



The recordkeeping policy for XYZ Company is as follows:

Category 1: XYZ Company has Fewer Than 10 employees in Low Hazard Industries

XYZ Company has fewer than ten (10) workers and will modify our IIP Program as follows:

1. Communications about safety generally do not have to be in writing.

2. Inspection records do not need to be kept after a hazard is corrected.

3. Training records can be a simple log of training provided at hiring or when an employee

is assigned to new duties.

Category 2: XYZ Company has Fewer Than 20 employees in Low Hazard Industries

A. XYZ Company has fewer than twenty (20) workers and will modify our IIP Program if:

1. We are not on a designated high hazard industry list as established by the

Department of Industrial Relations, and the employer has a workers’ compensation

experience modification rate of 1.1 or less; or

2. We are on a designated list of low hazard industries as established by the

Department of Industrial Relations. and have taken the following steps to

implement and maintain our IIP Program:

B. XYZ Company is on a designated list of low hazard industries. As such, our written

recordkeeping documentation may be limited to the following:

1. The identity of the persons with authority and responsibility for implementing the

plan

2. Scheduled periodic inspections to identify and correct workplace hazards and

practices

3. Required training and instruction



Category 3: XYZ Company has More Than 20 employees in Low Hazard Industries

A. Our establishment has twenty (20) or more workers and will modify our IIP Program for

the following reasons:

1. We have a workers' compensation experience modification rate of greater than 1.1;

and

2. We are not on a designated low hazard industry list.

B. XYZ Company has taken the following steps to implement and maintain our IIP Program:

1. Records of hazard assessment inspections, including the person(s) conducting the

inspection, the unsafe conditions and work practices that have been identified and

the action taken to correct the identified unsafe conditions and work practices, are

recorded on a hazard assessment and correction form; and

2. Documentation of safety and health training for each worker, including the worker's

name or other identifier, training dates, type(s) of training, and training provider’s

are recorded on a worker training and instruction form.

Category 4: XYZ is a local government entity

We are a local governmental entity (county, city, district, or and any public or quasi-public

corporation or public agency) and we are not required to keep written records of the steps

taken to implement and maintain our IIP Program.



Section 10

Company Required Safety Programs

Due to the nature of work and operations performed by XYZ Company, it is necessary that the

following regulatory programs are included in our Injury and Illness Prevention Program:

For convenience, programs listed in the table below are alpha sorted.

è DECISION POINT – Review and select those programs that apply or included others not listed

Company Required Safety and Health Plans & Programs

Accident Prevention Program Forklift Safety Program

Asbestos Management Plan Hazard Communication Program

Bloodborne Pathogens Program Hearing Conservation Program

Chemical Hygiene Plan Hot Work Permit Program

Confined Space Entry Program Ladders and Stairways Work Plan

Control of Hazardous Energy Program Laser Safety Program

Cranes and Derricks Safety Program Lead Safety Program

Electrical Safety Program Personal Protective Equipment Plan

Emergency Action Plan Powered Industrial Truck Program

Excavation and Trenching Program Radiation Protection Program

Fall Protection Program Respiratory Protection Program

Fire Prevention Work Plan Scaffolding Safety Program

Flammable Storage / Compressed Gas Welding Safety Program

Table 1


All Safety Plans & Programs are available through Safety Office Depot www.SafetyOfficeDepot.com

http://www.SafetyOfficeDepot.com/


Section 11

Company Required Safety Training Courses


following safety training courses are included in our Injury and Illness Prevention Program:

For convenience, courses listed in the 3 tables below are alpha sorted.

è DECISION POINT – Review and select those courses that apply or included others not listed

Company Required Safety Training Courses – Sorted A-EAccident Investigation Construction Safety Management

Accident Prevention Signs & Tags Crane Safety – Refresher

Asbestos Safety Cranes & Derricks in Construction

Bloodborne Pathogens – Initial/Refresher Electrical Safety

Bloodborne Pathogens – Train-the-Trainer Emergency Exit Routes

Chemical Spills Emergency Response Team

Competent Persons Ergonomics – Basic Human Factors

Compressed Gas Cylinder Ergonomics – Advanced Human Factors

Concrete & Masonry Excavation Safety

Confined Space Entry Eye & Face Protection

Table 2


All Safety Training Courses are available through Safety Office Depot www.SafetyOfficeDepot.com



Company Required Safety Training Courses – Sorted F-LFall Protection Hexavalent Chromium

Portable Fire Extinguisher Hot Work Permit Safety

Flammable & Combustible Liquids Indoor Air Quality

Forklift Safety – Classroom (English) Introduction to OSHA

Forklift Safety – Classroom (Spanish) Job Hazard Analysis

Hand & Power Tools Laser Safety

Hazard Communication Lead Exposure

Hazard Vulnerability Liquid Nitrogen

Hazardous Materials Management Lockout-Tagout

Hearing Protection

Table 3

Company Required Safety Training Courses – Sorted M-WMachine Guarding Safety Representative Training

Material Handling Safety Supervisor Training

Office Safety Awareness Scaffolding

Pandemic Preparedness Slip, Trip & Fall Prevention

Personal Protective Equipment Stairway & Ladder Safety

Powered Industrial Truck TB Respiratory Protection

Radiation Safety Walking & Working Surfaces

Respirator Protection Warehouse Safety

Safe Lifting Awareness – Back Safety Workplace Violence Prevention - Healthcare

Safety Audit Training Workplace Violence Prevention - Retail

Table 4



Section 12

Company Required Safety Forms & Checklists


following safety forms and checklists are included in our Injury and Illness Prevention Program:

For convenience, forms listed below are subject sorted.

è DECISION POINT – Review and select those forms that apply or included others not listed

CONFINED SPACEConfined Space Entry PermitConfined Space – Class A & B PermitConfined Space – Class C Permit List of Authorized EntrantsPermit Required Confined Space – Inventory Log

CONSTRUCTION INDUSTRY - SAFETY MANAGEMENTConstruction Industry Inspection ChecklistJob Start-Up ChecklistContractors Job Site ChecklistContractor Safety Performance ReportConstruction Equipment ChecklistForklift Service ChecklistOperator Performance Evaluation ChecklistSafety Nets Inspection ChecklistBody Harness & Lanyard Inspection ReportCompetent Person Evaluation – Fall Protection

CRANE OPERATIONSCranes, Derricks or Material Handling Devices WorksheetCrane Inspection ChecklistCrane Pre-Lift ChecklistSling (Chain) Inspection ReportMonthly Hoist Rope Inspection ReportMonthly Hoist Hook Inspection Report

EMERGENCY ACTION AND RESPONSECrisis Management Response Team - Contact LogSafety Representatives - Contact LogExternal Resources – Contact LogVulnerability Analysis ChartBomb Threat ChecklistEmployee Evacuation - Accounting LogPhysically Challenged – Employee ListCommand Post Equipment Inventory LogPress Information LogPost Exercise Evaluation Report



EMPLOYEE SAFETY RECORDSEmployee Acknowledgement FormEmployee Orientation Checklist – ConstructionEmployee PPE Assessment FormEmployee PPE Issue FormEmployee Safety Training RecordErgonomic Workstation Analysis FormEmployee Ergonomic Workstation QuestionnaireEmployee Safety Suggestion Form

EXCAVATION OPERATIONSPre-Excavation ChecklistTrenching Design ChecklistTrench Safety – Daily Field ReportCompetent Person Evaluation – Excavation

FIRE PREVENTIONHot Work PermitFire Safety Inspection ChecklistFire Drill Post Response ReportEmergency HAZMAT Inventory LogHazardous Waste Disposal Request Form

GENERAL INDUSTRY – SAFETY MANAGEMENTGeneral Industry Safety Inspection ChecklistOffice Safety Inspection ChecklistJob Safety Analysis Worksheet & InstructionsAccident Prevention Program AnalysisForklift Service ChecklistHearing Conservation Program LogScaffolding Safety ChecklistSite Safety Meeting RecordSupervisors Monthly Meeting RecordReport of Safety Hazard FormProperty Security Survey

INCIDENT REPORTING FORMSOSHA 300 LogEmployee Injury & Illness ReportEmployee Injury Cost Accounting MatrixVehicle Accident & Property Damage ReportCompiling Direct and Indirect Costs

OCCUPATIONAL HEALTH FORMSMedical Evaluation Questionnaire – Respirator UseRespirator Fit Testing RecordHepatitis B Vaccine - Accept/Decline FormBloodborne Pathogens Risk Classification FlowchartBBP Employee Annual Training RecordBBP Source Patient Consent Form

RADIATION PROGRAM FORMSRadioactive Material Use LogPregnancy Declaration FormLaboratory Contamination Survey RecordRadiation Producing Device - Authorization FormTraining Guide for Radiation WorkersTraining Guide for Ancillary Radiation Works

TRAINING RECOGNITION CERTIFICATECertificate of Completion




All Subject Form Groups are available through Safety Office Depot www.SafetyOfficeDepot.com



Appendix A

List of Training Subjects

XYZ Company trains our workers about the following checked training subjects:



AGRICULTURE PRODUCTION AND FARM LABOR AND MANAGEMENT SERVICES

(SIC Codes: 0111-0119, 0131-0139, 0161, 0171-0179, 0191, 0721-0724, 0761-0762)

Safe practices for operating any agricultural equipment, including procedures for cleaning,

repairing, servicing and adjusting.

Electrical hazards.

Heat stress.

Ergonomic hazards, including proper lifting techniques and working on ladders or in a

stooped posture for prolonged periods at one time.

Hazardous chemical exposures.

Other job-specific hazards, such as___________________________

__________________________________________________________

__________________________________________________________



PRESERVED FRUITS AND VEGETABLES MANUFACTURING AND SUGAR AND

CONFECTIONERY PRODUCTS

(SIC Codes: 2032-2038, 2061-2068)

Guarding of belts and pulleys, gears and sprockets, and conveyor nip points.

Machine, machine parts, and prime movers guarding.

Lock-out/tag-out procedures.

Materials handling.

Ergonomic hazards, including proper lifting techniques.

Noise.

Other job-specific hazards, such as ___________________________

__________________________________________________________

__________________________________________________________



Appendix B

Hazard Assessment Checklists

The following checklists contain safety and health hazard assessment items commonly found in

the workplace. It is the employer's responsibility to identify, evaluate and control job-specific

safety and health hazards in the workplace, and to meet all applicable OSHA requirements.

The following checklists are to be used as guides in identifying safety and health hazards in your

workplace. Answer the questions contained in the General Workplace checklist and then

identify and answer the questions contained in the checklist that applies to your specific

industry.



GENERAL WORKPLACE

(SIC Codes: All )

Is the OSHA poster Safety and Health Protection on the Job displayed in a prominent

location where all workers are likely to see it?

Do you have a written, effective Injury and Illness Prevention Program?

Are all work areas properly illuminated?

Are workers instructed in proper first aid and other emergency procedures?

Do you have a fire prevention plan?

Are all worksites clean and orderly?

Are all spilled materials or liquids cleaned up immediately?

Do you have eye wash facilities and a quick drench shower within the work area where

workers are exposed to injurious corrosive materials?

When lunches are eaten on the premises, are they eaten in areas where there is no

exposure to toxic materials or other health hazards?

Are aisles and passageways kept clear?

Are the directions to exits, when not immediately apparent, marked with visible signs?

Are hazardous substances identified which may cause harm by inhalation, ingestion, skin

absorption or contact?

Are workers aware of the hazards involved with the various chemicals they may be

exposed to in their work environment, such as ammonia, chlorine, epoxies, caustics?

Is personal protective equipment provided, used and maintained wherever required?

Are there written standard operating procedures for the selection and use of respirators

where needed?

Are restrooms and washrooms kept clean and sanitary?



Are workers instructed in the proper manner of lifting heavy objects?

Is there a list of hazardous substances used in your workplace?

Is there a written hazard communication program dealing with Material Safety Data Sheets

(MSDS) labeling, and worker training?

Is each container for a hazardous substance (i.e. vats, bottles, storage tanks,) labeled with

product identity and a hazard warning (communication of the specific health hazards and

physical hazards)?

Is there a Material Safety Data Sheet readily available for each hazardous substance used?

Is there a worker training program for hazardous substances?

Can the work be performed without eye strain or glare to the workers?

Does the task require prolonged raising of the arms and does the neck and shoulders have

to be stooped to view the task?

Are there pressure points on any parts of the body (wrists, forearms, back of thighs)?

Are there sufficient rest breaks, in addition to the regular rest breaks, to relieve stress from

repetitive-motion tasks?

Are tools, instruments and machinery shaped, positioned and handled so that tasks can be

performed comfortably?

Are you keeping the required records and documentation?

Have arrangements been made to maintain required records for the legal period of time?



AGRICULTURE PRODUCTION AND FARM LABOR

AND MANAGEMENT SERVICES

(SIC Codes: 0111-0119, 0131-0139, 0161, 0171-0179, 0191, 0721-0724, 0761-0762)

Where workers do not understand English, are safety instructions and warnings presented

in a language the workers understand?

Are adequate first-aid materials are immediately available at the farm headquarters and/or

on worker transportation buses?

At remote locations, are provisions made in advance for prompt medical attention and are

there is there at least 1 worker for every 20 workers trained for the administering of first

aid?

Is all agricultural equipment is properly guarded to prevent accidental contact by workers?

Are safe practices for operating agricultural equipment, including procedures for cleaning,

repairing, servicing and adjusting, being followed?

Is all machinery or equipment capable of movement, required to be de-energized or

disengaged and blocked or locked out during cleaning, servicing, adjusting or setting up

operations, whenever required?

Are safe work practices being followed during operation of self-propelled equipment?

Where mobile farm equipment is towed by a tractor or truck and the tractor or truck driver

cannot see the workers on the towed equipment, is there a positive signaling device

installed on the towed equipment that can stop the towing equipment in case of an

emergency?

Are portable screw conveyors located seven feet or less above the work level substantially

covered or guarded?

Are augers guarded with either grating type guards or solid baffle style covers according to

OSHA requirements?

Are machines, aircraft, or applicators decontaminated in a safe area before they are

overhauled or placed in storage?



Are safety precautions as required by Title 3, Article 23 of the California Code of

Regulations followed when using aircraft for crop dusting and spraying?

Are safe work practices followed when using applicator rigs, tanks, and vessels containing

fertilizer, insecticide, pesticide, and other chemical solutions of a hazardous nature?

Is potable water provided, and access to permitted, at all times, during working hours and

placed in locations readily accessible to all workers?

Is potable water for drinking dispensed in single-use drinking cups or by fountains, and the

water is fresh, pure, and suitably cool?

Are adequate toilet and handwashing facilities available and do they meet OSHA

requirements?

Are all ladders maintained in good condition, and are workers instructed to face the ladder

when ascending or descending and prohibited from using ladders that are broken, missing

steps, rungs, or cleats, broken side rails or other faulty equipment?

Are workers instructed not to use the top 2 steps of ordinary stepladders as a step?

Are workers made aware of the hazards caused by faulty or improperly used hand tools?

Is each van, bus or truck used regularly to transport workers, equipped with an adequate

number of seats, and equipped with the proper safety devices?

Can the work be done without twisting or overly bending the lower back?



Are tools, instruments and machinery shaped, positioned and handled so that tasks can be

performed comfortably?

Are hazardous substances identified which may cause harm by inhalation, ingestion, skin

absorption or contact?


exposed to in their work environment, such as ammonia, chlorine, and caustics?



Is heat stress being evaluated and controlled?

PRESERVED FRUITS AND VEGETABLES MANUFACTURING

AND SUGAR AND CONFECTIONERY PRODUCTS

(SIC Codes: 2032-2038, 2061-2068)

Is sufficient clearance provided around and between machines to allow for safe operations,

set up and servicing, material handling and waste removal and is there a power shut-off

switch within reach of the operator's position at each machine?

Are all pulleys and belts, moving chains and gears and conveyor nip points that are within 7

feet of the floor or working level properly guarded ?

Are revolving drums, barrels and containers required to be guarded by an enclosure that is

interlocked with the drive mechanism, so that revolution cannot occur unless the guard

enclosure is in place, so guarded?

Is all machinery or equipment capable of movement, required to be de-energized or

disengaged and blocked or locked out during cleaning, servicing, adjusting or setting up

operations, whenever required?

Does the lock-out procedure require that stored energy (i.e. mechanical, hydraulic, air,) be

released or blocked before equipment is locked-out for repairs?

Are only authorized and trained personnel permitted to use welding, cutting or brazing

equipment?

Are only trained personnel allowed to operate industrial trucks and does each industrial

truck have a warning horn, whistle, gong, or other device which can be clearly heard above

the normal noise in the area where operated?

Before entering a confined space, are all appropriate tests conducted, precautions

observed, permits obtained, and work practices followed?


exposed to in their work environment?



Can the work be done without twisting or overly bending the lower back?





Are there areas in the workplace where continuous noise levels exceed 85 dBA and if so,

are engineering controls being considered to reduce the noise and/or is a hearing

conservation program in effect?



Appendix C

Hazard Assessment and Correction

Record



Hazard Assessment and Correction

Record

Date of Inspection: ________________________________________

Person Conducting Inspection: _______________________________

Unsafe Condition or Work Practice:

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

Corrective Action Taken:

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________



Appendix D

Accident/Exposure Investigation Report



Accident/Exposure Investigation Report

Date of Accident: _____________________________ Time of Accident: __________________

Location of Accident: ___________________________________________________________

Accident Description:

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

Employees Involved:

______________________________________________________________________________

______________________________________________________________________________

Preventive Action Recommendations:

______________________________________________________________________________

______________________________________________________________________________

Corrective Actions Taken:

______________________________________________________________________________

______________________________________________________________________________

Manager Responsible: ________________________________________

Date Corrective Actions Completed: _____________________________



Appendix E

Worker Training and Instruction Record



Employee Training and Instruction Record

Worker Receiving Training:

(First Name) (Middle Initial) (Last Name)

(Safety Training Topic)

Select one:

Initial Periodic Annual/Refresher Special

This employee has received specific safety & health training in the following subject areas:

Person conducting the training:

(First Name) (Middle Initial) (Last Name)

Trainer’s Signature Date

Qualification or Job Title of Trainer

Trainee’s Signature Date



Appendix F

Employee Acknowledgement Form



Employee Acknowledgement Form

I hereby acknowledge that I have had the opportunity to read, review and ask questions on the

contents of the company’s Injury and Illness Prevention Program. I also acknowledge that the

provisions of this program and company safety and health policies are part of the terms and

conditions of my employment and agree to abide by them.

Furthermore, I understand that failure to comply with any part or parts of this program and any

company safety and health policies may be grounds for termination of my employment.

Additionally, I understand that failure to comply with the company’s Drug-Free Workplace Policy

shall also be grounds for termination of my employment.

Employee - Print Your NameSocial Security Number

Signature of Employee Date

As an employee representative of the company, I hereby attest that the employee named here

was given the opportunity to read, review and ask questions about the company’s Injury and

Illness Prevention Program and company safety and health policies.

Witness – Print Your Name

Duty Title of Witness

Signature of Witness Date



Safety Office Depot Disclaimer Notice

While we have made every attempt to ensure that the information contained in this document is reliable, Safety Office Depot is not responsible for any errors or omissions, or for the results obtained from the use or non-use of this information. All information in this document is provided "as is", with no guarantee of completeness, accuracy, timeliness or of the results obtained from the use or non-use of this information, and without warranty of any kind, express or implied, including, but not limited to warranties of performance, merchantability and fitness for a particular purpose.

In no event will Americana Safety Associates, Safety Office Depot, or the partners, agents or employees thereof be liable to you or anyone else for any decision made or action taken in reliance on the information in this document or for any consequential, special or similar damages, even if advised of the possibility of such damages.

Given the changing nature of laws, rules and regulations, there may be omissions or inaccuracies in information contained in this document. Accordingly, the information in this document is provided with the understanding that the authors and publishers are proving guidance with respect to the information contained herein and that the performance or non-performance of this guidance shall be the responsibility of the user of this information.


iip program for agriculture industry employers with intermittent employees

Documents