Department of Labor and Industries WISHA Services Division PO Box 44640 RESET Olympia WA 98504-4640 1. 6. 7. Contact Date 2.
ACCIDENT PREVENTION PROGRAM ANALYSIS
I. GENERAL INFORMATION
Ed. Rep I.D. No. 3. Region 4. County 5. Special Emphasis Yes No Follow Up 9. ZIP + 4 13. No. Employed Phone No. Mod Factor
Evaluation for Self-insurance Self-insurance Reevaluation Employer Name
Inspector Referral New Employer Accounts 8. City
Employer Initiated Request Card Employer Account. No. State 12. Sic Title
10. Employer Address 11. Type of Operation 14. Person(s) Contacted
15. Follow Up Due Date
II. ANALYSIS OF PROGRAM ELEMENTS
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RATING SCALE 0. Not Applicable 1. No Evidence of Item Existing 2. Item Unacceptable 3. Item Acceptable 1. Written outline of the Accident Prevention Program is tailored to the needs of the plant or operation and to the type of hazards involved. It is supervised and enforced in a manner which is effective in practice. 2. Safety orientation program describing the employer's Safety Program & including: a How and when to report injuries, including instructions as to the location of first aid facilities. b How to report unsafe conditions and practices. c The use and care of required personal protective equipment (care includes proper maintenance and storage). d The proper actions to take in the event of emergencies, including exit routes from areas during emergencies. e Identification of the hazardous gases, chemicals or materials involved, along with instructions on the safe use and emergency actions following accidental exposure (the hazardous chemical communications program is a part of this requirement, if applicable). f A description of the employer's total safety program. An on-the-job review of the practices necessary to perform the initial job assignments in a safe manner. g
Safety and health committee plan organization and operation including: Safety committee composed of employer and employee elected members. (1) Terms of employee elected members not to exceed one year. (2) Election of new committee members to fill vacancies held prior to the next scheduled meeting.
(3) The number of employer members not to exceed the number of employee elected members. b c d
Chairperson elected by committee. Frequency of meetings to be determined by the committee. (1) Date, hour and location of meeting to be determined by the committee. (2) Length of meeting not to exceed one hour except by majority vote of the committee. Foreman/crew meetings if allowed and used in place of formal committee. (1) Meetings are at least monthly (weekly for construction). (2) Written minutes of meetings on file for one year. (3) Items listed in "f" of this section are addressed. Written minutes of the meetings on file for one year (if less than one year show months records available). Subjects to be addressed by the committee (minimum requirements): ( 1) Safety & health inspection reports to be reviewed for assistance in the correction of identified unsafe conditions or practices. ( 2) Evaluation of accident investigations conducted to determine if causes of unsafe acts or conditions are properly identified and corrected. ( 3) Evaluation of the overall accident prevention program to be made to provide recommendations for improvement where indicated. Safety & health training program to improve the skill and competency of employees are established, supervised and enforced in a manner, which is effective in practice. Accident investigation procedures and documentation Record keeping procedures for occupational injuries and First Aid training and certification including supervisor's certification. First Aid posters and roster.
4. 5. 7. 9. 11.
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6. 8. 10. 12.
Accident reporting procedures. Bulletin board. First Aid kits, aid station, or first aid room. Blood borne pathogens program, if required.
13. Overall evaluation and observation of industrial safety and health; a Personal involvement in the program by management. b The overall accident prevention program activity provides a safe and healthful working environment.
F417-150-000 accident prevention program analysis 11-04