Free HCP QUICK FACTS - New Mexico


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The Workers' Compensation Handbook For New Mexico

Annual Safety Inspections
Safety inspection requirement.................................................................................1 Safety assistance from the WCA..............................................................................2 How to Conduct a Safety Inspection........................................................................2
Who may conduct a safety inspection ............................................................................ 2 Alternatives to the required annual safety inspection ....................................................... 3 The Safety Inspection Process ....................................................................................... 3 Safety inspection for travel and remote worksites ........................................................... 6 Safety inspection for businesses using temporary or leased employees ............................. 6

Booklet D1:

Use the Inspection as an Effective Safety Program: Involve Employees ....................6 Follow Up: Implement Your Corrective Action Plan ..................................................7 Common Sources of Workplace Injuries...................................................................9 Safety Inspection Checklist ................................................................................... 10 BASIC SAFETY CHECKLIST ................................................................................... 11 AFFIDAVIT .......................................................................................................... 16
Help from the Workers' Compensation Administration.................................................... 17 Workers' Compensation Handbook List of Booklets........................................................ 18

Published by the New Mexico Workers' Compensation Administration, a state agency. Laws can change. Check for new information by calling 1-866-WORKOMP or 1-866-967-5667 or look on the Internet at www.workerscomp.state.nm.us

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The Workers' Compensation Handbook for New Mexico Booklet D1: Annual Safety Inspections

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2007 Edition page 1

Creating the safest possible workplace is an important goal of the workers' compensation system. When accidents and injuries are eliminated, everyone benefits. A positive attitude towards safety helps to create a positive attitude towards the total work experience and improves employee morale. Safety programs help to reduce the cost of workers' compensation insurance and avoid costly increases in other types of business insurance. Having a workplace without accidents is not just a matter of luck. Most accidents arise from known, identifiable hazards in combination with human error, lack of knowledge or inattention. The way to prevent accidents is to: eliminate the hazards through safety inspection and prevention; and eliminate the human error through employee training.

Safety inspection requirement
The New Mexico workers' compensation law (§52-1-6.2 NMSA) 1 requires many employers to perform or receive an annual safety inspection as the first essential step toward eliminating hazards. Your workplace is required to have an annual safety inspection if: ˇ your insurance premium is $5,000 or more; ˇ you are a self-insured business; or ˇ you pay $5,000 or more as a member of a self-insured group. (Rules of the WCA, 11.4.2.9 NMAC). 2 This booklet explains the safety inspection requirement and provides a method for conducting safety inspections. The method in this booklet satisfies the Workers' Compensation Administration (WCA) minimum standard for conducting a safety inspection (Rules of the WCA, 11.4.2.9 NMAC). Under the Rules, (11.4.2.9 NMAC), employers required to have an annual inspection must submit proof of the inspection to the WCA within 30 days of the completion of the inspection. Notification can be done by one of the following methods:

In this booklet are references to specific paragraphs of the workers' compensation law. These references are in a standard form. §52-1-6.2 NMSA means Chapter 52, Article 1, Paragraph 6.2 of the New Mexico Statutes Annotated (NMSA).
2

1

In this booklet are references to the Rules of the Workers' Compensation Administration. These references are in a standard form based on the numbering system of the New Mexico Administrative Code (NMAC); for example, NMAC 11.4.2.9. This stands for Title 11, Labor and Workers' Compensation; Chapter 4, Workers' Compensation; and then the number of the section and exact paragraph.

Published by the New Mexico Workers' Compensation Administration, a state agency. Laws can change. Check for new information by calling 1-866-WORKOMP or 1-866-967-5667 or look on the Internet at www.workerscomp.state.nm.us

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The Workers' Compensation Handbook for New Mexico Booklet D1: Annual Safety Inspections

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2007 Edition page 2

1. Your insurer or self-insurance program may notify the WCA that it has completed the annual inspection for your business. The notification should include the business name, address, FEIN (federal employer identification number) and date of inspection. 2. If you are visited by a WCA safety consultant, you can show the consultant the results of your completed inspection. 3. You can fill out an Affidavit and mail it to the WCA. The Affidavit must be notarized. The Affidavit form is near the back of this booklet.

Safety assistance from the WCA
WCA safety consultants are on staff at all offices of the WCA. See the list of offices at the back of this booklet. The safety consultants can assist you, free of charge, with your annual safety inspection and other aspects of your company's safety program. See Booklet D2, "How to Develop a Safety Program," for more information about safety.

How to Conduct a Safety Inspection
A safety inspection is a detailed examination of a work environment to identify hazards and make sure that hazards are managed, controlled or eliminated. The guidelines presented here refer to the annual safety inspection required by the New Mexico workers' compensation law. These guidelines set forth the minimum requirements for safety inspections. Many businesses must meet higher standards than this under other laws or requirements. The WCA encourages you to exceed these requirements. You are also encouraged to fulfill the more important purpose of your safety inspection: once you have recognized safety deficiencies, correct them! As you inspect your workplace and train yourself to identify safety hazards, it will become clear to you that good safety practices lead to an orderly workplace, well-maintained tools and equipment and efficient, alert workers. Safety is good for business.

Who may conduct a safety inspection
The safety inspection required by the workers' compensation law may be conducted by: the employer or on-site manager, as self-inspection; a safety consultant or loss control specialist representing the insurance carrier; a professional independent safety consultant;
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Published by the New Mexico Workers' Compensation Administration, a state agency. Laws can change. Check for new information by calling 1-866-WORKOMP or 1-866-967-5667 or look on the Internet at www.workerscomp.state.nm.us

The Workers' Compensation Handbook for New Mexico Booklet D1: Annual Safety Inspections

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2007 Edition page 3

a safety consultant from the WCA. WCA safety consultants perform workplace inspections on request at no charge. Your insurer or self-insurance program is required to provide you with a safety inspection if you request it (§52-1-6.2 (C ) NMSA). The State of New Mexico does not set standards for professional safety consultants. The selection of a professional safety consultant is up to you. You may wish to consider checking the professional insurance coverages of safety consultants, including errors and omissions coverage. The highest level manager of the work site or unit should participate personally, whether by conducting the self-inspection or joining in the walk-through with a safety professional. This task should not be delegated.

Alternatives to the required annual safety inspection
1. Any workplace that is receiving safety inspections from another source, such as OSHA, an industry association or a parent company, does not need additional safety inspections to meet the requirement, provided such safety inspections take place at least once a year and meet the standards set forth in this booklet. Send the Affidavit (see the back of this booklet) to the WCA. Any employer whose annual workers' compensation insurance premium is less than $5,000 is exempt by law from the safety inspection requirement. It is recommended that exempt employers take advantage of a safety inspection program even though they are not required to do so. WCA safety consultants are available, free of charge, to assist these smaller businesses with safety inspections and other services of safety program development.

2.

The Safety Inspection Process
The steps of the inspection are: 1. Design the inspection. 2. Conduct the walk-through. 3. Record your findings and corrective action plan.

1. DESIGN THE INSPECTION.
The purpose of your safety inspection is to identify hazards in your workplace so that you can eliminate or control them. Before you conduct the actual inspection, gather basic information that will guide you so you know what to look for. There are two sources of information, and you should obtain them both. They are the accident history of your own workplace, and an inspection checklist for your industry.
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Published by the New Mexico Workers' Compensation Administration, a state agency. Laws can change. Check for new information by calling 1-866-WORKOMP or 1-866-967-5667 or look on the Internet at www.workerscomp.state.nm.us

The Workers' Compensation Handbook for New Mexico Booklet D1: Annual Safety Inspections

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2007 Edition page 4

Your accident history Compensable injuries: Has your business had any workplace injuries? If so, obtain a list of all workers' compensation claims for your workplace for the last 12 months. Include claims that involved indemnity payments and claims that only involved medical treatment. If the records are available, go back further and include all claims for the last five years. Your accident history will give you a good indication of hazards you should take special precautions to avoid. Make a list of the hazards to check. Note that the "hazard" may involve lack of employee training. If you had any workers' compensation covered injuries during the year, you may have filled out an Employer's First Report of Injury of Illness (E1). You may have filled out other insurance forms for accidents that did not involve injuries. These forms may provide the most convenient record of your accident history. Your insurer or self-insurance program can provide you with a quarterly report of workers' compensation claim activity if you request it. If you need this information to develop an accident history, request it in writing and give the insurer or self-insurance program adequate time to respond before your inspection. (This is also a good time to verify your experience modifier with your insurance carrier. This modifier has an important effect on the cost of your insurance. See Booklet A3 for an explanation of experience modifiers.) Notices of Accident: Notice of Accident forms that may have been submitted by your employees give you a history of major and minor accidents and could provide useful information for safety improvement. Notice of Accident forms may be submitted for minor accidents that do not result in compensable injuries. Compare your Notice of Accident forms with your OSHA Forms 300, 301 and 300A for accuracy (you are required to use these forms if you employer 10 or more workers). The Notice of Accident is a form provided by the Workers' Compensation Administration that employers are required to post so that employees may use them to report accidents. You should have received these forms from your insurer or selfinsurance program along with the Workers' Compensation Act poster. If you do not have these forms or posters, contact the WCA. A detailed explanation of Notice of Accident forms plus information on OSHA forms is in Booklet A2 of this Handbook series, "Setting Up a Workers' Compensation Program." Reports from other sources: Review any other reports of accidents, injuries or hazards at your workplace as part of your preparation for a safety inspection.
Published by the New Mexico Workers' Compensation Administration, a state agency. Laws can change. Check for new information by calling 1-866-WORKOMP or 1-866-967-5667 or look on the Internet at www.workerscomp.state.nm.us
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The Workers' Compensation Handbook for New Mexico Booklet D1: Annual Safety Inspections

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2007 Edition page 5

Helpful hint: Start a Safety Inspection File. Place copies of all accident reports and Notices of Accident in this file so they are handy for your annual safety inspection. A safety inspection checklist for your industry Safety inspection checklists may be available from many sources, including your insurance carrier, your industry association, the American National Standards Institute, the National Safety Council and others. Your trade publications may be a source for safety checklist ideas. The WCA has safety checklists for several common types of business, available free of charge upon request. If your employees drive cars or other motor vehicles as part of their work, include the motor vehicles in your inspection. An annual safety check of your motor vehicles is to ensure that routine safety procedures are being followed and necessary maintenance is being done and documented. The more closely tailored your checklist is to your industry, the more thorough and useful your inspection is likely to be. If you cannot locate an industry-specific checklist, you may use the checklist in this booklet. Add your accident history list to your industry checklist to produce your final inspection checklist. Helpful hint: Some safety checks are specific to certain equipment. File the instruction manuals for these pieces of equipment together with your Safety Inspection File, so you can find the instructions easily when it's time for your inspection. If the manuals are stored elsewhere, place a note in your Safety Inspection File indicating where the manuals can be found.

2. CONDUCT THE WALK-THROUGH.
Walk through your facility, making detailed examinations of all items that appear on your final inspection checklist. Take adequate time and be thorough. Some items on your checklist may involve employee training. For these items it is best to speak directly with the employees to find out whether they have had the necessary training and whether they have learned what they need to know. However, the statutory inspection requirement may be satisfied by checking records to determine whether the training has taken place. Then develop a plan to provide the training. Helpful hint: Many hazards can be corrected during the walk-through itself. For example, if you find boxes blocking a fire exit or electrical cords running across an aisle, you can fix these hazards as you go. Test the batteries in smoke detectors, emergency lights, flashlights and other battery-powered backup equipment. Providing employees with safety instructions can also be done during the walk-through. When
Published by the New Mexico Workers' Compensation Administration, a state agency. Laws can change. Check for new information by calling 1-866-WORKOMP or 1-866-967-5667 or look on the Internet at www.workerscomp.state.nm.us
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The Workers' Compensation Handbook for New Mexico Booklet D1: Annual Safety Inspections

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2007 Edition page 6

your mind is focused on safety, that is a good time to remind employees of basic safety information such as the location of the first-aid kit, fire alarms and extinguishers and the telephone numbers to call in a health or fire emergency. Make sure current, correct emergency telephone numbers are posted, or post them now.

3. RECORD YOUR FINDINGS AND CORRECTIVE ACTION PLAN.
The product of your walk-through should be a record of items that did not meet safety standards and a statement of the action that you will take to correct the defects. Record your findings on your checklist or make a separate list of action items. The safety consultants of the WCA can help you implement your corrective action plan, whether or not they performed the inspection.

Safety inspection for travel and remote worksites
Many types of business involve work by employees away from the primary place of business. In some cases employees perform their jobs without a supervisor present. In such situations the safety inspection should focus on employee training, the safety of the employees' vehicles, safety equipment and emergency procedures. Use an industry-specific checklist to design an effective safety inspection.

Safety inspection for businesses using temporary or leased employees
When employees are engaged through a temporary employment service or an employee leasing arrangement, the client business is responsible for performing the safety inspection. As a business owner or manager, remember that your responsibility for safety extends to everyone on your premises. Temporary employees and contractors should be given the information they need to maintain your high standards of safety.

Use the Inspection as an Effective Safety Program: Involve Employees
The previous section outlined a simple safety inspection that will fulfill the requirement of the workers' compensation law. The real purpose of a safety inspection is not just to comply with the law but to make the workplace safer. Since most workplace injuries are partially caused by human error or inattention, employee involvement is essential to real prevention.

Published by the New Mexico Workers' Compensation Administration, a state agency. Laws can change. Check for new information by calling 1-866-WORKOMP or 1-866-967-5667 or look on the Internet at www.workerscomp.state.nm.us

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The Workers' Compensation Handbook for New Mexico Booklet D1: Annual Safety Inspections

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2007 Edition page 7

Involving your employees in your safety inspection will benefit you in two ways: First, employees may be your best resource in identifying and correcting workplace hazards. Second, the inspection itself is a form of safety awareness training. Some approaches to involving employees in your safety inspection: Before the inspection, ask employees to review and contribute items to your final inspection checklist. Confer with employees at their work stations as you perform your walkthrough. Select employees to participate in the entire walk-through. After your inspection is over, invite employees to help develop statements of corrective actions, and assign employees to implement the corrective actions. Assign employees to perform periodic interim safety inspections and specific safety checks.

Follow Up: Implement Your Corrective Action Plan
Once your safety inspection is complete, you have a list of items that did not meet safety standards and the corrective action that is necessary. You may have implemented some corrective actions during the inspection itself. Follow up by turning your list of corrective actions into a detailed plan, complete with a timetable, a budget and assignment of responsibility to specific individuals or work groups. Find out why safety deficiencies existed, so that your plan can get to the root of the problems. Identify the following four groups of corrective actions:

1. Actions that can be taken immediately
The checklist may show that some corrective actions can be implemented immediately with little or no cost. For example, you can: move any stored objects that are blocking exit doors or aisleways or creating a fire hazard; repair loose floor tiles or other tripping hazards; replace light bulbs in areas where light is a safety concern; put any safety shields or guards that have been removed from equipment back on the equipment; find safety equipment that is not being used and place it where it will be convenient for employees;
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Published by the New Mexico Workers' Compensation Administration, a state agency. Laws can change. Check for new information by calling 1-866-WORKOMP or 1-866-967-5667 or look on the Internet at www.workerscomp.state.nm.us

The Workers' Compensation Handbook for New Mexico Booklet D1: Annual Safety Inspections

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2007 Edition page 8

do quick and easy training tasks, like instructing employees in the location and use of fire extinguishers. You can assign these tasks and get them done during or immediately after your safety inspection.

2. Actions that MUST be taken immediately
The checklist may also reveal that other actions MUST be taken immediately because a serious hazard has been discovered. For example, if you discovered toxic or flammable fumes leaking from a defective container, or defective brakes on a company automobile, that hazard should be remedied immediately.

3. Actions in priority order
Once you have taken care of immediate items, evaluate the remaining items on your list. Common sense should be the guideline as you consider: how serious is the hazard; how probable is an accident resulting from the hazard; how much will it cost to fix the problem; how you can obtain additional positive benefits (such as improved employee morale or productivity) from fixing the hazard. Start with hazards that are the most obvious and easiest to fix, so that you can obtain the maximum value from your time and effort. If you have done a thorough job in your safety inspection, you may have discovered hazards that are minor and involve unlikely accident scenarios as well as more serious and probable hazards. You may also have discovered some hazards that require major expenditures to fix, such as an essential piece of equipment that is not as safe as you would like it to be. It would be unrealistic to expect that you could take care of all the hazards immediately. When a hazard is life-threatening, if you cannot fix it, the next best choice may be to eliminate it by getting rid of the equipment or the process, dismantling the equipment so it cannot be operated, or red tagging the equipment. You may wish to call a WCA safety consultant for help. Establish priorities based on what your company can realistically do. By setting down a budget and timetable and assigning responsibility, you will have taken a decisive step in making your workplace safer.

4. Safety maintenance routines
After your inspection you may find it useful to establish safety maintenance routines. Regular checking of brakes, lights, oil and tire pressure on company vehicles is a good example of a safety maintenance routine.
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Published by the New Mexico Workers' Compensation Administration, a state agency. Laws can change. Check for new information by calling 1-866-WORKOMP or 1-866-967-5667 or look on the Internet at www.workerscomp.state.nm.us

The Workers' Compensation Handbook for New Mexico Booklet D1: Annual Safety Inspections

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2007 Edition page 9

Common Sources of Workplace Injuries
The information in this section is to help you and your employees observe your workplace with injury prevention in mind. By noting the kinds of accidents and injuries that can occur, you will be better able to take appropriate actions to prevent them. You may wish to add items to your final inspection checklist based on the information presented here. Back injuries account for about 30 percent of all workplace injuries and much more than 30 percent of the costs of workers' compensation claims. Back injuries are difficult to diagnose and often difficult to treat. To help prevent back injuries, provide alternatives to manual lifting where appropriate, equip employees with back support belts and train employees in proper lifting techniques and proper use of the belts. Note the lifting activities that provide the most back strain or hazard. Look for ways to rearrange objects in the workplace so that awkward or difficult lifting tasks are easier. Slips, trips and falls are relatively easy to prevent. They often result from a hazard left on the floor. Hazards may be snow, ice, water, grease, electric cords, or any other object unexpectedly placed in a pathway. Identify the slipping hazards in your workplace. Note that some hazards may be built in, such as a slippery floor, and other hazards may result from the weather or another occasional event. Where the hazard can be eliminated by cleaning (such as ice or grease), provide the necessary cleaning materials. You may be able to solve the problem of a slippery floor by providing nonskid mats or coatings. Automobile accidents are a source of work-related injuries that many employers fail to consider, in cases where driving is a minor part of the employee's job. For example, an employee who performs errands for the employer on the way home (such as stopping at the post office) is subject to a work-related auto accident. At the very least, employees should be instructed to drive safely, use seat belts, obey speed limits and make safety a higher priority than speed. Schedule the work to allow for both ontime delivery and safe driving. Company-owned automobiles should be checked to make sure brakes, signal lights and other safety features are working, that tires have adequate tread and are properly inflated and that the vehicle is in good running condition. Repetitive motion injuries, which may be caused when workers do the same body motion over and over for extended periods, can be prevented with stretch breaks, suitable exercises and adjustment of work stations. New employees may benefit from special attention, with training and supervision so they learn how to do their jobs safely.

Published by the New Mexico Workers' Compensation Administration, a state agency. Laws can change. Check for new information by calling 1-866-WORKOMP or 1-866-967-5667 or look on the Internet at www.workerscomp.state.nm.us

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The Workers' Compensation Handbook for New Mexico Booklet D1: Annual Safety Inspections

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2007 Edition page 10

Safety Inspection Checklist
The following pages contain a general safety inspection checklist that can be used for most workplaces. This checklist is provided for your convenience, to help you get started with your safety inspection program. The safety inspection will be more thorough and more valuable to you if you use a more comprehensive checklist that is specific to your industry. Also remember when planning your safety inspection to include safety checks for problem areas that you have identified in reviewing your accident history. Helpful hint: Make a photocopy of the blank checklist. Use the photocopy so that the original in the booklet remains clean for future use. You may wish to use separate copies of the checklist for different areas of your workplace or for areas where different employees will have follow-up responsibility. You can find this checklist online on the WCA web site at www.workerscomp.state.nm.us. It is incorporated into the online version of this booklet.

Published by the New Mexico Workers' Compensation Administration, a state agency. Laws can change. Check for new information by calling 1-866-WORKOMP or 1-866-967-5667 or look on the Internet at www.workerscomp.state.nm.us

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The Workers' Compensation Handbook for New Mexico Booklet D1: Annual Safety Inspections

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2007 Edition Safety Inspection Checklist

BASIC SAFETY CHECKLIST
PHOTOCOPY THIS CHECKLIST BEFORE USING SO YOU CAN REUSE IT. Company name: __________________________________________ Inspection date: ______________________ Site: __________________________________________________ Manager conducting inspection: ______________________________ Title: ____________________________________________________ Safety professional conducting inspection: ______________________ Title: ______________________________________________
Use this checklist for each area of your workplace. When you locate a hazard, check the "needs work" category and note the work needed and the location of the item for the corrective action plan.
Health emergency preparation GOOD
Employees have been trained to respond to health emergencies; or instructions are posted. Emergency telephone numbers (911 or separate numbers for fire, ambulance, etc.) are posted. First aid supplies and instructions are provided; employees know where to find them. First aid supplies are suitable for the type of injuries likely to occur in this workplace. Employees have received "right to know" training on hazardous materials and the use of Material Safety Data Sheets. Employees know where the Material Safety Data Sheets are kept and how to use them.

NEEDS WORK

Housekeeping GOOD
Work areas are clean and orderly to prevent hidden hazards.

NEEDS WORK

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Inspector, initial page when completed: _________________

The Workers' Compensation Handbook for New Mexico Booklet D1: Annual Safety Inspections

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2007 Edition Safety Inspection Checklist

Fire emergency preparation GOOD
Fire extinguishers are easily accessible and have been checked and serviced as necessary. Fire extinguishers are the appropriate type for the predominant fire hazards. Fire exits are accessible and unlocked from the inside. The path to fire exits is clear, free of obstacles. There is access to two fire exits from every point in the building. Emergency escape routes are prominently posted. Smoke detectors are installed. Batteries were tested during this inspection. Sprinkler systems are tested.

NEEDS WORK

Fire prevention GOOD
Flammable materials are safely stored in proper containers away from sources of heat and sparks and clearly labeled. Anything that makes flames or sparks is shielded, and the area is clear of trash, papers and other potential fuel.

NEEDS WORK

Floors, aisles, stairs and entryways GOOD
Floors provide good traction and are free of cracks, bumps and other hazards that could cause trips or falls. Cleanup materials are provided for water, grease or other materials that could create slippery conditions. Employees are trained to clean up spills promptly. Aisles are clear, free of tripping hazards and well lighted. Stairs are in good condition with no loose steps, provided with handrails and well lighted. Areas under stairways are clear and not used for storage.

NEEDS WORK

Ladders GOOD
Ladders are provided where needed, are of standard construction and in good condition.

NEEDS WORK

Storage GOOD
Stored materials, products and supplies are set in stable, balanced piles, to a reachable height. Sturdy stepladders are provided if necessary.
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NEEDS WORK

Inspector, initial page when completed: _________________

The Workers' Compensation Handbook for New Mexico Booklet D1: Annual Safety Inspections

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2007 Edition Safety Inspection Checklist

Machines and equipment GOOD
Machines and equipment are in safe operating condition. Safety guards are in place and in use. Appropriate tools are provided. Employees are trained to use machines only for the tasks for which they are suitable.

NEEDS WORK

Hand and power tools GOOD
Tools are in good condition. Wires, cords and connections are in good condition. Employees are trained to use tools only for jobs for which they are suitable.

NEEDS WORK

Electrical GOOD
Grounds are provided on power tools and extension cords. Equipment is in good operating condition. Wires are in good condition and free of fraying. Wires and extension cords are not routed over metal objects or through doorways or window openings. Circuits are not loaded beyond their capacity.

NEEDS WORK

Lighting GOOD
Light is sufficient for each job. Emergency lighting for power outages is installed. Emergency lights were tested during this inspection.

NEEDS WORK

Personal protective equipment GOOD
Hard hats, gloves, boots, aprons, ear protectors, masks and other protective equipment are provided where appropriate and are in use. Goggles or other eye protection is provided and used for any operation that involves flying particles. Employees are trained in the use of protective equipment.

NEEDS WORK

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Inspector, initial page when completed: _________________

The Workers' Compensation Handbook for New Mexico Booklet D1: Annual Safety Inspections

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2007 Edition Safety Inspection Checklist

Back injury prevention GOOD
All employees who do heavy lifting and moving are trained in back injury prevention and proper use of back support belts. Employees who do heavy lifting and moving stretch and warm up to prevent sudden exertion of cold muscles. Back support belts are used only to lift. All employees who are not physically capable of heavy lifting and moving are instructed to leave these tasks to designated, trained employees.

NEEDS WORK

Repetitive motion injury prevention GOOD
All employees who repeat the same movements throughout the day take stretch and exercise breaks several times a day or when appropriate. When possible, employees are given varied assignments so they can avoid excessive stress on particular body parts while remaining productive.

NEEDS WORK

New employee training GOOD
New employees have been given basic safety training as part of employee orientation.

NEEDS WORK

Automobiles and motor vehicles GOOD
Each motor vehicle is provided with a checklist for routine safety checks by employees assigned to this task and a log for recording routine safety checks by employees. Each automobile and other motor vehicle is provided with a service and maintenance log for recording regular professional servicing, maintenance and repairs. Responsibility for regular inspection and servicing of company-owned automobiles has been assigned to specific employees. Employees are trained to report any safety or mechanical problems to the proper person. Every vehicle receives regular professional servicing every 3,000 miles, or more often if appropriate. Vehicles used in long-distance trips are provided with safety equipment, including flashlight, flares, tools and first aid kit. Spare tire, jack and lug wrench are in place and spare tire is properly inflated.
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NEEDS WORK

Inspector, initial page when completed: _________________

The Workers' Compensation Handbook for New Mexico Booklet D1: Annual Safety Inspections

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2007 Edition Safety Inspection Checklist

Crime/violence prevention GOOD
Outdoor lighting is adequate, including parking lot; lights are in working order (observed at night). Telephones are accessible to all work stations. Building space is arranged so visitors can be observed. Building space is arranged so employees will not be trapped in closed spaces. Security guards, buddy system, or other method is in place for latenight working hours. Employees have received training on response to threats of violence. Employees have received training in handling cash, both in the workplace and in transit. Discreet storage is provided for employee's purses and other personal items.

NEEDS WORK

USE A SEPARATE PAGE FOR INSPECTOR'S COMMENTS.

Use of this safety inspection checklist for an annual safety inspection satisfies the minimum requirement of the safety inspection provision of the New Mexico Workers' Compensation Act, according to the regulations of the Workers' Compensation Administration. A more detailed safety inspection using industry-specific checklists is recommended where possible.

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Inspector, initial page when completed: _________________

The Workers' Compensation Handbook for New Mexico Booklet D1: Annual Safety Inspections

FORMS

2007 Edition page 16

AFFIDAVIT
STATE OF NEW MEXICO ) ss. COUNTY OF ____________________ To: ) )

Safety Program Manager Workers' Compensation Administration Post Office Box 27198 Albuquerque, NM 87125-7198

I, _________________________, after having been duly sworn, state and affirm that: 1. 2. 3. I am the _____________________ (job title) of ______________________ (company name). That the company has completed its statutory requirement for an annual safety inspection. We submit the following information per your request:

Name of business: ___________________________________________________ Federal Employer Identification Number: ________________ Business Address:________________________________________________________ City: ___________________________ State: _____________ Zip Code: ____________ Date of Safety Inspection: ____________________________ Inspection performed by: ____________________________________________ If there are any questions, the WCA should contact ___________________________ at the following phone number ________________________________. ______________________________________ Signature SUBSCRIBED AND SWORN to before me this ________ day of ________________________, 20____ by __________________________________. _______________________________________ Notary public My commission expires: ____________________ Safety Inspection Form Letter and Affidavit, Version 11/07, WCA rules edition 12/29/06 Form WCA-SB-001, Rule 11.4.2.9(A) NMAC

The Workers' Compensation Handbook for New Mexico Booklet D1: Annual Safety Inspections

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2007 Edition page 17

Help from the Workers' Compensation Administration
(See the list of offices and telephone numbers on the back page of this booklet) WCA publications
You can get publications from any office of the WCA. Go to an office or telephone to request publications by mail. This booklet is one booklet of a series called The Workers' Compensation Handbook for New Mexico. Together, these booklets provide comprehensive information about the workers' compensation system in New Mexico. Two of the WCA booklets are specific to safety: Booklet D1, Annual Safety Inspections, Booklet D2, How to Develop a Safety Program The Employer's Guide to New Mexico Workers' Compensation and the Workbook for Injured Workers are written for employers and workers respectively, are simpler and less detailed than the booklets in this series. Some WCA publications are available in Spanish.

Personal contact
The WCA safety consultants provide safety services to all New Mexico businesses and organizations on request. You can ask the WCA safety consultants for any amount of assistance with your safety needs ­ from a simple one-time safety training event to developing a major safety program.

WCA web site

www.workerscomp.state.nm.us

Most publications mentioned above can be downloaded from the WCA web site.

The Workers' Compensation Handbook for New Mexico Booklet D1: Annual Safety Inspections

FORMS

2007 Edition page 18

This list shows new titles and numbering system that will be in effect when the 2007 revision is completed. Some booklets are eliminated and others are renumbered. There are some changes from the pre-2007 editions of the booklets.
To get the information you need: Contact any office of the Workers' Compensation Administration for printed copies OR All booklets can be downloaded from the Workers' Compensation Administration web site at www.workerscomp.state.nm.us

Workers' Compensation Handbook List of Booklets

Booklet Booklet Booklet Booklet Booklet Booklet

A1(E) A1(S) A2 A3 A4 A5

Workers' Compensation Quick Facts- English Compensación A Los Trabajadores Informes Básicos ( Spanish) Setting Up a Workers' Compensation Program The Workers' Compensation Coverage Guide for Employers and Insurance Agents Uninsured Employers' Fund Workers' Compensation Personnel Assessment Fee (WC-1)

Booklet B1 What to Do after an Accident Booklet B2 Benefits for Workers While They Cannot Work Booklet B3 Going Back to Work Booklet B4 Medical Care in Workers' Compensation (B5 and B6 will be discontinued) Booklet B7 Información del sistema compensativo para los empleados (Spanish) Booklet B8 Quick Facts for Health Care Providers Booklet C1 When you need help with a workers' compensation claim Booklet C2 What to Do In Response to "Bad Acts" (C3 through 5 will be discontinued) Booklet D1 Booklet D2 Annual Safety Inspections How to Develop a Safety Program (published by the Advisory Council on Workers' Compensation and Occupational Disease Disablement)

(On the web site, look under Employers)
E3 E4

Guide to Completing and Filing Paper Copy for Employers' First Report of Injury or Illness (Form E1.2) and Notice of Benefit Payment (Form E6.2) EDI Guide to Completing the Employers' First Report of Injury or Illness (Form E1.2) and Notice of Benefit Payment (Form E6.2) -- limited to certified electronic filers

Other publications

Health Care Provider Guide to New Mexico Workers' Compensation Guidebook for Employers in New Mexico (English and Spanish) Workbook for Injured Workers (English and Spanish) The Stay at Work/Return to Work Program Guide
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The Workers' Compensation Handbook for New Mexico Booklet D1: Annual Safety Inspections

FORMS

2007 Edition page 19

NEW MEXICO WORKERS' COMPENSATION ADMINISTRATION
STATE HEADQUARTERS Mailing Address: Workers' Compensation Administration PO Box 27198, Albuquerque NM 87125 Location: 2410 Centre Avenue SE (near Yale-Gibson intersection) In-state toll-free phone: 1-800-255-7965 Local phone 841-6000 REGIONAL OFFICES: Southeastern regional office at Lovington: 100 West Central, Lovington, NM 88260 Telephone: 575-396-3437 In-state toll-free phone: 1-800-934-2450 Southwestern regional office at Las Cruces: 1120 Commerce Drive, Suite B-1, Las Cruces, NM 88011 Telephone: 575-524-6246 In-state toll-free phone: 1-800-870-6826 Northwestern regional office at Farmington: 3535 East 30th Street, Farmington, NM 87401 Telephone: 505-599-9746 In-state toll-free phone: 1-800-568-7310 Northeastern regional office at Las Vegas : 2515-2 Ridge Runner Road, Las Vegas NM 87701 Moving in 2008 to: 32 New Mexico 65, Las Vegas NM 87701 Telephone: 505-454-9251 In-state toll-free phone: 1-800-281-7889 Roswell Office: Penn Plaza Bldg., 400 N. Pennsylvania Ave., Ste. 425, Roswell NM 88201 Telephone: 575-623-3781 In-state toll-free phone: 1-866-311-8587 Santa Fe Office: 810 West San Mateo, Suite A-2, Santa Fe, NM 87505 Telephone: 505-476-7381 Internet web site address: http://www.workerscomp.state.nm.us/ HELP & HOTLINE: 1-866-WORKOMP / 1-866-967-5667

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