Sacramento County Airport System

INJURY AND ILLNESS

PREVENTION PROGRAM

AIRPORTS COVERED:

 International

 Executive

 Mather

 Franklin Field

Approved By: ______________________________

(Director of Airport Systems)

Date: September 12, 2005
Contents

PROGRAM OUTLINE

Assignment of Responsibilities...............................................................................1 & 2

Accident Prevention Policy .....................................................................................3

Code of Safe Practices...........................................................................................4 & 5

EMPLOYEE COMPLIANCE AND COMMUNICATION

Employee Compliance............................................................................................6

Safety Communication System ..............................................................................7

Safety Suggestion/Hazard Observation Form ........................................................8

HAZARD EVALUATION AND ABATEMENT

Safety Inspection Procedure ..................................................................................9

Workplace Safety Inspection Guide .......................................................................10 & 11

ACCIDENT INVESTIGATION

Basic Rules for Accident Investigation....................................................................12

Supervisor's Report of Illness or Injury (WC-9) .....................................................13 & 14

SAFETY AND HEALTH TRAINING

Safety & Health Training (Employee and Supervisor) ...........................................15 & 16

Other Programs Requiring Training........................................................................16

Employee Safety Check List...................................................................................17

Supervisor Safety Check List .................................................................................18
Contents

RECORD KEEPING

Safety and Health Record keeping.........................................................................19 & 20

APPENDICES

County of Sacramento, Code of Safe Practices &

General Safety Rules and Work Practices ...................................................Appendix A

Emergency Evacuation Procedures ............................................................Appendix B

Emergency Evacuation Office Floor Plan .....................................................Appendix C

Additional Forms or Information Sheets

Workers’ Compensation Office Work-Related Injuries & Illnesses Supervisor’s Checklist, Benefit

Election Form, Authorization to Release Records, Fact for Injured Workers, Trauma Recovery

Guidelines, Workplace Violence Incident Report Form, and Ergonomic VDT Workstation

Evaluation Form.

Check for updated versions of forms when establishing or updating this policy. Remove all old

versions and replace with the latest version of the form.
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Injury and Illness Prevention Program

The Sacramento County Airport System, hereafter referred to as SCAS, is committed to

preventing occupational injuries and illnesses and providing a safe and healthy workplace.

To achieve this goal, SCAS has adopted an Injury and Illness Prevention Program.

ASSIGNMENT OF RESPONSIBILITIES

Safety Program Administrator

The Safety Program Administrator, G. Hardy Acree, is responsible for ensuring

implementation of the provisions of this program.

SCAS Safety Officer

The Safety Officer, Matt Doyle, is responsible for overall coordination of the Injury and Illness

Prevention Program. He is also responsible for advising the Safety Program Administrator

regarding any safety and health issues that are raised, which may impact the Department.

Additionally, the SCAS Safety Officer will be custodian of the following records:

 Department inspection records

 Department exposure records

 Major accident investigation records

 Overall Department OSHA 300 Log

 Safety & health training records

 Safety suggestion/hazard observation form

On-site Safety Representatives

The On-site Safety Representatives are:

 Andrew Robinson Operations

 Mark Gustavson Maintenance

 Mike Pinkham ARFF

 David Rosado Custodial

 Page Nottingham Executive

 Matt Doyle Administration

 Lee Bost Park Maintenance

 Frank Ayers Design and Development

 Janae Scruggs Planning and Environment
- 2 -

Each On-site Safety Representative is responsible for coordinating the daily administration

of the program and maintaining all site-specific required records, (i.e. safety

suggestion/hazard observation forms, accident investigation reports, training records, OSHA

300 Log), when applicable.

Department Supervisors

Department supervisors are responsible for providing a safe work environment and for

ensuring that the employees they supervise perform their work tasks in a safe manner.

Any occupational safety and health matters that affect employees in the workplace are

appropriately addressed/reported to the Safety Officer. Failure to perform these functions

and responsibilities could result in disciplinary action. Both employee safety recognition

programs and disciplinary action shall be considered to ensure compliance.

The written program will be kept and available for view at the Safety Officer’s work site

located in Human Resources. The program is also available on-line through the SCAS HR

intranet site. Questions regarding the program should be appropriately directed to the

employee's immediate supervisor or the Safety Officer.

Employee

In any working environment, each individual employee must assume responsibility for his or

her actions and the manner in which they conduct themselves. All employees are required

to conduct their work activities in a safe and appropriate manner, set a good example for

others, and aid in the positive orientation of new employees. This shall be achieved by:

 Following the directions of supervisors

 Using the safety equipment provided

 Observing internal policies, procedures, and rules

 Obtaining and implementing training, skills, and knowledge

 Complying with applicable federal, state, and local laws and regulations at all times

 Reporting any unsafe conditions or work practices to the supervisor and/or SCAS

Safety Officer.
- 3 -

Accident Prevention Policy

It is the policy of the Sacramento County Airport System to protect our employees from

occupational injuries and illnesses while on the job.

To carry out this policy, employees are expected to follow the Code of Safe Practices

adopted by the Sacramento County Airport System. A copy of the Code of Safe Practices is

to be posted on the Safety Bulletin Board at each worksite.

Safety is a cooperative undertaking requiring an ever-present safety and health awareness

on the part of every employee.

Prevention of workplace injuries and illnesses is our goal. Therefore, all operations must be

carried out in a safe and healthy manner.

If an employee sustains an occupational injury or illness, positive and prompt action must be

taken to see that the employee receives adequate treatment and any unsafe condition is

reported through the chain of command.
- 4 -

SCAS Code of Safe Practices

1. Report all accidents, injuries, illnesses, or unsafe conditions, immediately to your

supervisor. The supervisor is responsible for reporting this information through the chain

of command and to the Safety Officer.

2. Aisles, hallways and stairways, shall be kept clear of obstructions at all times.

3. Fire extinguishers shall be inspected regularly and access shall be kept clear of

obstructions at all times.

4. Exits shall be kept clear and well lighted.

5. Employees shall not store excessive combustibles (paper products, flammable oils, paint

etc.) near heat generating equipment.

6. Work areas shall be maintained in a neat, orderly manner. Trash and refuse are to be

disposed of in proper waste containers.

7. Files and supplies shall be stored in such a manner as to preclude damage to the

supplies or injury to personnel when they are moved. Heaviest items shall be stored

closest to the floor and lightweight items stored above.

8. Material shall not be stacked precariously on top of file cabinets or other high places.

9. Lower desk or cabinet drawers shall not be left open so as to present a tripping hazard.

Use care when opening and closing drawers to avoid pinching fingers.

10. Do not open more than one upper drawer at a time; particularly the top two drawers on

tall file cabinets.

11. Always use the proper lifting technique. Never attempt to lift or push an object which is

too heavy. Use appropriate material handling equipment and/or ask for help.

12. When carrying material, caution shall be exercised in watching for and avoiding

obstructions, loose material, etc.

13. Equipment such as scissors, staples, etc. shall be used for their intended purposes only

and shall not be misused as hammers, pry bars, screwdrivers etc. Misuse can cause

damage to the equipment and possible injury to the user.

14. Liquid spills shall be wiped up promptly. Chemical spills shall be addressed using

appropriate hazardous material handling procedures.

15. Appliances such as coffee pots and microwaves shall be kept in good working order

and inspected for signs of wearing, heating or fraying of cords.
- 5 -

SCAS Code of Safe Practices

16. Cleaning solvents and flammable liquids shall be stored in appropriate containers.

17. Extension cords and multiplugs are never permitted. Plugging several power strips

together is not permitted.

18. Food waste shall not be disposed of in office waste receptacles. Food waste shall

be disposed of in waste receptacles in the kitchen.

19. Smoking is not permitted inside or within 20 feet of any County leased or owned facility.

20. Employees must consider the effects on others in the work area before using or

displaying items such as: personal fans, pollinating plants or plants that emanate an

offensive odor, strong colognes or perfumes, air fresheners, radios, etc.

21. Employees must not use a chair or table in place of a ladder or step stool to reach high

objects.

22. All coffee pots, coffee cups heaters, radios or other personal electronic devices must be

turned off or unplugged after office hours and must meet minimum safety requirements.

23. Computers, typewriters, calculators and copy machines shall be turned off after normal

hours. Overheating of electrical equipment create a fire hazard.

24. Safety precautions regarding hand tools, machines and mechanical devices shall be

adhered to and training on proper utilization shall be provided.
- 6 -

Employee Compliance

All employees are required to comply with the provisions of this policy and perform their job

responsibilities in a safe and healthy manner, in accordance with the health and safety

training they are provided. Employee safety and health depends upon doing so. Noncompliance to safe and healthful work practices could cause potential harm and injury to coworkers or the public. SCAS staff may conduct unannounced inspections to determine the

degree of compliance with the policy, or any safety-related rule or practice. Any employee

who knowingly violates any provision of this policy may be subject to disciplinary

action.
- 7 -

Safety Communication System

It is SCAS policy to maintain open communication between management and line staff on

matters pertaining to safety and health. SCAS will provide safety and health information

through safety meetings, memorandums, information posted on the safety bulletin board and

the Human Resource intranet site.

Suggestions regarding safety and health are considered important, and employees'

active participation in the Department's safety and health program is encouraged. The

Department desires to have communication relating to safety matters channeled through the

following methods:

 Employees can offer safety suggestions/hazard observations, either verbally or in writing

(via Safety Suggestion/Hazard Observation forms), to their supervisor, On-site Safety

Representative or the Safety Officer. If offered verbally, the initial response may be

verbal. If offered in writing, the response will be in writing. All safety suggestions and

hazard observations will be evaluated and each will receive a response which will be

posted on the safety bulletin board.

 Supervisors who receive safety suggestions or hazard observations shall perform an

initial evaluation to determine if corrective action(s) are necessary. A copy of the

submitted Safety Suggestion/Hazard Observation form, with the supervisor's written

recommended corrective action(s), shall be forwarded to the On-site Safety

Representative who will address it with the SCAS safety committee. If additional

expertise or information is needed, they shall consult appropriate parties.

 The Safety Officer and the On-site Safety Representatives will ensure that all Safety

Suggestions/Hazard Observation forms are considered and any appropriate corrective

action, if necessary, will be taken. A copy of the completed Safety Suggestion/Hazard

Observation Form will then be posted on the applicable safety bulletin board.

 SCAS encourages employees to report, without fear of reprisal, any workplace hazard

they identify. Employees shall report workplace hazards immediately to their direct

supervisor or the On-site Safety Representative. Supervisors, in turn, are required to

either correct the problem in a timely manner, or if they are not able to do so, immediately

report the workplace hazard to the Safety Officer. All safety suggestions and hazard

observations will receive a response, which will be posted on the safety bulletin board.

 Employees are encouraged to utilize the chain of command to address safety issues, but

may choose to remain anonymous. Anyone may mail safety suggestions directly to the

Department Safety Officer, Matt Doyle at 95-001 or email at doylema@saccounty.net.

Anonymous suggestions may also be mailed to your Supervisor or the Director of Airport

Systems.
- 8 -

Sacramento County Airport System

SAFETY SUGGESTION/HAZARD OBSERVATION FORM

To:_________________________________________________Date: _______________________________

From: ________________________________________ Write "Anonymous" if you wish to remain anonymous.

(Optional)

Phone:____________________________

Please describe your SAFETY SUGGESTION or the HAZARDOUS CONDITION/ACT that was observed.

Be specific:

Location:______________________________________________________________________________________

Description: ___________________________________________________________________________________

______________________________________________________________________________________________

RECOMMENDED CORRECTIVE ACTION(S): (To be completed by Employee and/or Supervisor.)

Supervisor: ________________________________________________ Date: ___________________________

Supervisors shall retain the original of this form and forward copies, with recommended corrective action(s) taken,

to the On-site Safety Representative for confirmation of corrective action(s).

CONFIRMATION OF CORRECTIVE ACTION(S): (To be completed by SCAS Safety Officer. List other

corrective action(s) required, if necessary, on the reverse side of this form.)

SCAS Safety Officer: _________________________________________________________________________

Date: ___________________________

A response to each safety suggestion or observation of a hazardous condition/act shall be posted on the Safety

Bulletin Board.
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Safety Inspection Procedure

An effective hazard control system is essential for providing a safe and healthful work

environment and developing safe work practices. Safety inspections provide a method of

identifying, evaluating, and eliminating or controlling existing or potential hazards in the

workplace.

Employees and Supervisors shall continually survey their work areas for unsafe conditions

and/or acts. Any hazards will be reported via the chain of command and corrective

measures for eliminating or controlling identified hazards shall be taken, if necessary.

Safety inspections shall be conducted as follows: Annually and whenever new substances,

processes, procedures or equipment introduce potential new hazards into our workplace;

when new, previously unidentified hazards are recognized; when occupational injuries and

illnesses occur; when we assign and/or reassign permanent or intermittent workers to duties

involving processes, operations, or tasks for which a hazard evaluation has not been

previously conducted; and whenever changing workplace conditions warrant an inspection.

The SCAS Safety Officer shall conduct scheduled inspections of SCAS facilities. These

periodic inspections will be scheduled at least annually or more frequently as necessary, and

will be documented on the Workplace Safety Inspection Guide or Safety Management By

Walking Around (SMBWA) Form. Unsatisfactory conditions shall be noted on the form and

shall be prioritized and corrected based on the severity of the hazard.

Hazard Correction- 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 when observed or

discovered except when an imminent hazard exists which cannot be immediately abated without

endangering employee(s) and/or property, in which case all exposed workers will be removed from

the immediate area.
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WORKPLACE SAFETY INSPECTION

GUIDE

Instructions: Check each item as satisfactory (Yes), unsatisfactory (No), or non-applicable (N/A). Describe any hazardous conditions and unsafe practices

and include recommendations for correcting them. Safety Officer: Initiate corrective action immediately.

Inspector_____________________________________________________________Date_____________________________________

Division/Section _____________________________________________________Location _____________________________________

Satisfactory? Corrective

Yes No N/A Action

Work Areas

1. Lighting around desk/table adequate   

2. File/desk drawers kept closed when not in use   

3. Step stool/ladder (not chairs/boxes) used to reach objects   

4. Heavy materials/glass objects removed from cabinet tops   

5. Offices, cubicles, stockrooms, and copier rooms are orderly   

6. Lunchroom clean and food disposed of properly   

7. Ventilation adequate   

8. Other:   

Computer Equipment

1. Computer monitor set at correct and comfortable height   

2. Keyboard (and mouse) set at correct and comfortable position   

3. Chair has good support and is set at proper height   

4. Glare screen and footrest are available if needed   

5. Other:

Floor Conditions

1. Floor covering in good condition (ie., vinyl tiles, carpet)   

2. Spills immediately cleaned up/wet floor signs used in area   

3. Floors free from objects and clutter   

4. Electrical/telephone cords not across walkways   

5. Other:

First-Aid Kits/Emergency Information/Cal-OSHA

1. First-aid kits are visible and accessible   

2. First-aid supplies are adequate   

3. Floor wardens' names and phone numbers current and posted   

4. Emergency Action Plan updated and accessible   

5. Emergency evacuation route maps posted   

6. Cal-OSHA "Safety & Health Protection on the Job" posted   

7. Cal-OSHA 300 Injury List posted ( February only)   

8. Safety/Hazard Observation forms available to employees   

9. Other:

Egress & Fire Extinguishers

1. Exit doors marked "Exit" and unlocked   

2. Doors that are not exits are clearly marked "Not An Exit"   

3. Exit signs illuminated and easily visible   

4. Aisleways and hallways clear and unobstructed   

5. Fire extinguishers/equipment easily accessible   

6. Other:

Stairs & Stairwells

1. Lighting above steps is adequate   

2. Handrails secure and slip resistant material used on steps   

3. Materials not stored on steps or landings   

4. Other:
- 11 -

Earthquake

1. Bookcases, cabinets, shelves, racks, cages and similar items

over four feet tall are anchored to the wall   

2. Shelves have lip or other seismic restraints   

3. Top-heavy equipment or apparatus bolted down or secured   

4. Large or heavy objects stored on lower shelves   

5. Storage area’s uncluttered-providing clear evacuation routes   

6. Cabinets and lockers containing hazardous materials equipped with

positive latching or sliding door   

8. Other:

Equipment and Machinery

1. Clean and working properly   

2. Electrical cords in good condition with proper grounding   

3. Only extension cords with circuit breakers are used   

4. Sufficient clearances from combustibles (paper, combustible liquids)   

5. Emergency stop mechanisms and dead-man switches identified and

in proper working order   

6. Mechanical safeguards in place and in proper working order   

7. Appropriate Personal Protective Equipment (PPE) available to

employees   

8. Other

Hazardous Materials

1. Original product names or chemical names clearly

identified on container, including secondary containers   

2. No hazardous materials stored next to or above sinks   

3. Incompatible chemicals segregated by class   

4. All chemical containers capped and sealed, except when actively

adding or removing materials from them   

5. MSDS’s and chemical inventory lists are readily accessible   

6. Eye wash locations identified, clean and in good working condition   

7. Other

Work Benches

1. Clear of rubbish   

2. Tools put away when not in use   

3. No sharp edges on work benches   

4. Correct height for worker   

5. Other   

Ergonomics and Manual Handling

1. Controls are well designed and properly positioned   

2. Tools and equipment within east reach   

3. Chairs well designed and adjustable   

4. Sufficient leg room available   

5. Adequate work space available   

6. Working in a fixed position is avoided when possible   

7. Mechanical lifting aids available and used where necessary   

6. Other:
- 12 -

Basic Rules for Accident/Incident

Investigation

The purpose of accident/incident investigation is to find the root cause of an injury/illness and prevent

further occurrences. The purpose is not to assign blame. An unbiased approach is necessary to obtain

objective findings.

The Supervisor, On-site Safety Representative and the SCAS Safety Officer, when appropriate, will

conduct an investigation into SCAS accidents or critical “near misses” utilizing the procedures listed

below:

 Visit the accident scene as soon as possible (when it is safe to do so) -- while facts are

fresh and before witnesses forget important details.

 If possible, interview the injured workers at the scene of the accident and "walk" him or

her through a re-enactment.

 All interviews should be conducted as privately as possible. Interview witnesses one at a

time. Talk with anyone who has knowledge of the accident even if they did not actually

witness it.

 Consider taking signed statements in cases where facts are unclear or there is an element

of controversy.

 Document details graphically. Use sketches, diagrams and photos as needed, and take

measurements when appropriate.

 Focus on causes and hazards. Develop an analysis of what happened, how it happened

and how it could have been prevented. Determine what caused the accident itself, not just

the injury.

 Every investigation should include an action plan. How will you prevent such accidents in

the future?

 If a third party or defective product contributed to the accident, save any evidence. It

could be critical to the recovery of claims costs.

 The law requires that all accidents must be investigated and reported within 48 hours.

Supervisors must give an injured employee a claim form within 24 hours of knowledge of

injury.

 Prepare an accident report, including the recommended actions to prevent a recurrence. Send the

report and if necessary, a Workers Compensation Packet or Drivers Report of Accident (DRA), to

the SCAS Safety Officer at mail code 95-001.
- 13 -

FORM WC-9

COUNTY OF SACRAMENTO

WORKERS’ COMPENSATION OFFICE

SUPERVISOR’S REPORT OF ILLNESS/INJURY

Phone Number: 876-5251 Fax Number: 876-5157

PERSONAL INFORMATION: (Please print or type)

Case number from OSHA Log: If Fatality, Date of Death:

Employee Full Name: _______ _________________________SSN: __ ____________

Address:

Date of Birth: Date of Hire: Sex:

Department/Section: _________________________________ Phone Number(s)__________________

Number of hours worked per week: ____________ Time shift begins: __________ Ends: _________

Normal days off: Su M Tu W Th F Sa Su M Tu W Th F Sa Regular employee? Yes / No

If No, Explain: __________________________________________

Was any informal or formal personnel action considered or taken against the employee within the previous twelve months? Yes

/ No

INJURY/ILLNESS INFORMATION:

Type of Injury / Illness (Check One) ڤ Incident Report / First Aid Only

ڤ Medical Treatment Expected

Date of illness / injury Time: Date Reported:

How was illness / injury reported? ڤ In person ڤ Phone ڤ Other

If other, explain: ____________________________________________________________________

Where did illness/injury occur? (Address and city): _______________________________________

________________________________________________________________________________

Was employee performing usual job duties when injured? Yes / No

Did employee lose time from work after date of injury? Yes / No

If yes, date of anticipated return to work: ________________

Is there any reason to believe this may NOT be a valid claim? Yes / No

If incident was witnessed, provide the name(s), address, and phone number of the witness(s):

Name(s): _______________________Address: _______________________Phone: ____________

Name(s): _______________________Address: _______________________Phone: ____________

Name(s): _______________________Address: _______________________Phone: ____________

If equipment or property was involved, provide the following:

Owner: __________________________________________________Phone: _________________

Address: ________________________________________________________________________

If Motor Vehicle Accident, attach a copy of County accident report or police report.

TREATMENT INFORMATION:

Provided by: ڤ U.S. Healthworks ڤ Kaiser ڤ Emergency Room ڤ Self administered

ڤ Med Clinics ڤ Other, please explain: ______________________________________________

Was employee hospitalized overnight as an in-patient? ڤ Yes ڤ No

Was employee treated in an emergency room? ڤ Yes ڤ No

Name of person providing treatment: ___________________________________________________

Place/Address of treatment: _________________________________________________________________
- 14 -

DESCRIBE HOW THE INJURY OCCURRED: (Example: employee walking down the stairs, tripped & fell injuring

right knee on the cement; employee lifting a box, felt sharp pain in lower back. Include what the employee was

doing just before the incident occurred)

____________________________________________________________________________________

____________________________________________________________________________________

______________________________________________________________________________

BODY PART: Check appropriate box(s) and on the line provided specify the location by indicating LE for Left, RT

for Right, BO for Both, FR for Front, and BA for Back.)

ڤ Head/Skull___ ڤ Arm__ ڤ Leg___ ڤ Heart___ ڤ Back, Upper___

ڤ Nose___ ڤ Elbow___ ڤ Hip___ ڤ Chest___ ڤ Back, Mid___

ڤ Ear___ ڤ Ankle___ ڤ Foot___ ڤ Lung___ ڤ Back, Lower___

___Neck ڤ ___Abdomen ڤ ___Knee ڤ ___Finger ڤ ___Tooth ڤ

___Eye ڤ ___Psyche ڤ ___Toe ڤ ___Wrist ڤ ___Mouth ڤ

__________________________Other ڤ ___Hand ڤ ___Shoulder ڤ

NATURE OF INJURY: (Check appropriate box.)

ڤ Irritation/inflammation ڤ Emotional Stress ڤ Trauma/Contusion

ڤ Sprain/Strain ڤ Heart ڤ Puncture/Laceration

ڤ Repetitive Motion ڤ Bite ڤ Abrasion

ڤ Fracture ڤ Exposure (To what) _______________________

_______________________Other ڤ

CAUSE OF INJURY/ILLNESS: (Check appropriate box.)

ڤ Design of workstation /building ڤ Uneven or slippery surface

ڤ Rules/procedures not followed or inadequate ڤ Horseplay

ڤ Incorrect body position in relation to work ڤ Exposure (chemical, noise, etc.)

ڤ Incorrect tools or mechanical aids used ڤ Vehicle operation

ڤ Equipment operated incorrectly ڤ Congested area (storage)

ڤ Environmental factors (weather, lighting) ڤ Animal or insect

ڤ Action of fellow employee/member of public ڤ Conflict with supervisor

ڤ Protective devices or guards ڤ Inattention or distraction

ڤ Other (Please Explain)

SOURCE OF INJURY: (Check appropriate box.)

ڤ Structure ڤ Equipment/ Tools ڤ Material

Other ڤ Person ڤ Environment ڤ Objects ڤ

PREVENTATIVE MEASURES: (Check one or more actions)

ڤ Provide more complete job instruction ڤ Update or revise procedures

ڤ Enforce work rule ڤ Provide safe equipment

ڤ Provide proper tools, equipment ڤ Reinforce employee training

ڤ Provide personal protective equipment ڤ Modify workstation or building

ڤ Contract third party to effect correction ڤ Other (please explain)

Prepared by______________________________________________________________________________

(Supervisor’s Signature) (Please Print Name)

Phone:_______________________________ Date: ________________________

Please forward this completed form along with your department’s 5020 form, within 24 hours after incident to

Workers’ Compensation Office

PO BOX 276130

Sacramento, CA 95827

Mail Code 58-600
- 15 -

Safety and Health Training

In order to reduce the risk of employee injury, each employee must understand general safe and healthy

work practices, any work hazards specific to the employee's job assignment, and any precautions

necessitated by these hazards. All training will be documented in writing and include: training date(s),

subject(s) covered, instructor's name, and list of attendees.

Training and instruction shall be provided as follows:

 When the IIPP Program is first established;

 To all new workers, except for construction workers who are provided training through a Cal/OSHA

approved construction industry occupational safety and health training program;

 To all workers given new job assignments for which training has not previously provided;

 Whenever new substances, processes, procedures or equipment are introduced to the workplace and

represent a new hazard;

 Whenever the employer is made aware of a new or previously unrecognized hazard;

 To supervisors to familiarize them with the safety and health hazards to which workers under their

immediate direction and control may be exposed;

 To all workers with respect to hazards specific to each employee's job assignment.

Employee Training

Employees shall be trained in the information contained on the Employee Safety Check List (page

17). Each employee needs to know and understand that:

 No employee is expected to undertake a job until he or she has received instructions on how

to do it properly and has been authorized to perform that job.

 No employee shall undertake a job that appears to be unsafe, or use chemicals without

understanding their toxic properties.

 Mechanical safeguards must be in place and remain operational.

 Each employee is expected to report all unsafe conditions encountered during work to their

supervisor and or safety representative.

 Any injury or illness suffered by an employee, regardless of severity, must be reported to a

supervisor at once.
- 16 -

Supervisor Training

Supervisors shall be trained in the information contained in the Supervisor's Safety Checklist (page

18), in order to:

 Familiarize themselves with the safety & health hazards to which employees under their

immediate supervision may be exposed.

 Understand the importance of establishing and maintaining safe and healthful working

conditions.

Other Programs Requiring Training

In addition to the training required above, the County also has specific training as part of other

Cal/OSHA safety programs requiring training. Examples of these programs are as follows:

1. Emergency Procedures Plan, Title 8, CCR, Section 3220

2. Fire Prevention Plan, Title 8, CCR, Section 3221

3. Hazard Communication Program, Title 8, CCR, Section 5194 (Employee Health)

4. Bloodborne Pathogens, Title 8, CCR, Section 5193 (Employee Health)
- 17 -

Employee Safety Checklist

This form is to be completed by the Supervisor and the new employee.

Employee Name (FIRST, LAST) ____________________________________________________________________________________

Employee ID Number_________________________________________________ Date Employed/Assigned__________________

Date Check List Completed_____________________________ Section Assigned ________________________

Job Title ____________________________________________

The following items have been discussed and are understood. Check where appropriate:

1. Department safety policies and programs

2. Code of safe practices

3. Employee compliance with safe and healthful work practices

4. Employee responsibility for accident prevention

5. When and how to report work-related injuries/illnesses

6. Review workers' compensation law as they apply to work-related injuries/illnesses

7. County policy on medical treatment for work-related injuries/illnesses

8. When and how to report unsafe conditions/work practices

9. Review of emergency evacuation and fire procedures

10. Importance of housekeeping

11. Location of hazardous materials and training on Hazmat clean up and Material Safety Data Sheets

12. Special hazards of the job (VDT, Ergonomics, etc.)

13. Personal Protective Equipment (where applicable)

14. Proper lifting procedures (including demonstration and use of specific lifting equipment)

15. Workplace Violence

16. Safe use of County or personal vehicle for County business

17. Employee agrees to fully cooperate with safety efforts of the employer, follow all safety rules and

use good judgment concerning safe work behavior.

Additional comments and notes

_______________________________________________________________________________________________________________________

_______________________________________________________________________________________________________________________________

_______________________________________________________________________________________________________________________________

Signed _______________________________ ______________ ____________________________________ ______________________

SUPERVISOR Date EMPLOYEE Date

Distribution: Original –SCAS Safety Officer Copy - Supervisor Copy - Employee
- 18 -

Supervisor Safety Checklist

Supervisor Name ______________________________ Employee ID Number _______________________________

Hire Date___________________ Department Assigned ___________________________________________

Job Title ____________________________________________

The following items have been discussed and are understood: ____________________________________________________________________

(Date Check List Completed)

 Here

1. Review components of Injury & Illness Prevention Program, including review of:

• Assignment of Responsibilities, page 1

• Accident Prevention Policy, page 3

• Code of Safe Practices, page 4

• Employee Compliance, page 6

• Safety Communication System, page 7

• Safety Inspection Procedure and use of Workplace Safety Inspection Guide, page 9

• Basic Rules for Accident Investigation, page 12

• Safety and Health Training Requirements, page 15

Review of records to be maintained/submitted to the On-site Safety Representative, page 19:

• Inspection Records (1 year retention)

• Accident Investigation Records (open-ended retention/based on severity)

• Training Records (retain 1 year or length of employment)

• OSHA 300 & 300A Summary Log (5 year retention)/Post summary of previous year totals (Feb. 1 through May. 1)

• OSHA Form No. 301, W/C Form 5020 (5 year retention)

Review of other documentation to be maintained, page 20:

• Safety suggestion(s) submitted

• Purchase orders of safety related equipment

• Memos/policies issued regarding safety

• Safety related information distributed to employees

2. Review of other required safety programs:

• Emergency Action Plan • ____________________

• Fire Prevention Plan • ____________________

3. Responsibility of the supervisor to respond to safety & health concerns that arise in the workplace, promptly &

appropriately.

4. Responsibility of the supervisor to communicate safety & health concerns where appropriate to the On-site Safety

Representative and/or Safety Officer.

Additional comments/notes

______________________________________________________________________________________________

____________________________________________________________________________

______________________________________________________________________________________________

____________________________________________________________________________

Signed ___________________________ _______________ __________________________________ ________________

SUPERVISOR Date EMPLOYEE Date

Distribution: Original - SCAS Safety Officer, at mail code 95-001 Copy - Employee
- 19 -

Safety and Health Record Keeping

The injury and illness record keeping requirements under Cal-OSHA require a minimum amount of

paperwork. These records will provide one measure for evaluating the success of safety and health

activities; success would generally mean a lack of, or a reduced number of, employee injuries or

illnesses during a calendar year. The SCAS Safety Officer shall ensure these records are kept at a

central location with all other records. The records must remain accessible to review by applicable

inspectors and other interested parties.

There are four important steps required by the Cal-OSHA record keeping system:

1. Obtain a record of every injury or illness requiring medical treatment. The employee's

supervisor is to prepare a Report of Occupational Injury and Illness (Form 5020).

2. An injured employee must be given the Employee's Claim for Workers' Compensation Benefits,

(DWC-1).

3. Maintain the OSHA Log (Form No. 300) (provided by Workers' Compensation).

4. Every year obtain the summary OSHA Form No. 300A from Workers' Compensation and post it

from February 1 until May 1 on the Safety Bulletin Board.

During the year, the On-site Representatives and SCAS Safety Officer will periodically review these

records to review the frequency of injuries and illnesses and where they have occurred. These

records can help identify hazardous areas in the workplace and pinpoint where immediate corrective

action/training is needed.

Records to be Maintained

 Inspection Records (3 year retention)

 Accident Investigation Records (open-ended retention/based on severity)

 Training Records (length of employment)

 OSHA 300 & 300A Summary Log (5 year retention)

 OSHA Form No. 301, W/C Form 5020 (5 year retention)/(maintained by Workers’

Compensation)

Essential records, including those legally required for workers' compensation, insurance audits and

government inspections, must be maintained for as long as the law requires.

Exposure Records

The injury and illness records may not be the only records the Department will need to maintain.

Certain Cal-OSHA standards that deal with toxic substances and hazardous exposures require

records of employee exposure to these substances and sources, physical examination reports,

employment records, etc. Exposure records shall be maintained for a minimum of 30 years past the

last day of employment.
- 20 -

Safety and Health Record Keeping

Documentation of Activities

In addition to records required by Cal/OSHA, the Safety Officer may also maintain records on other

written safety related activities such as:

 Safety suggestions/hazard observations (submitted and responded to)

 Purchase orders of safety related equipment

 Memos/policies issued regarding safety

 Safety related information distributed to employees
- 21 -

APPENDIX A

County of Sacramento

Code of Safe Practices

General Safety Rules and Work Practices

_____________________________________________________________________

Thousands of employees work for the County of Sacramento in hundreds of different

jobs in many different areas under various conditions. Although some safety rules

may apply only to specific jobs, each employee is expected to comply with general

safety rules and work practices. Therefore, each employee must know and

understand the following:

 No employee shall undertake a job task that appears to be unsafe. If you don't

know the safe way to perform a job task, or if you have any questions, ask your

supervisor first.

 Report all unsafe conditions to your supervisor.

 Immediately report any injury or illness, even a slight one, which you sustain

while at work to your supervisor.

 Read and obey all signs, labels, danger notices, and other warning

devices/indicators.

 Learn and remember where the emergency exits are located. Know alternative

evacuation routes.

 Never handle any hazardous material without specific safety instructions and

authorization from your supervisor. Know and understand the safe use of any

product containing hazardous materials. If you have any doubts, ask your

supervisor.

 Mechanical safeguards, interlocks, or other safety devices must be in place and

remain operational. If they are missing, bypassed or not functioning properly, do

not operate the equipment. Notify your supervisor.

Continued on next page
- 22 -

County of Sacramento

Code of Safe Practices

General Safety Rules and Work Practices (cont.)

________________________________________________

 Use lifting equipment or request assistance to lift loads heavier than what is

comfortable for you. Never attempt to lift or move an object which is too heavy.

Always use proper lifting techniques.

 Drive County or personal vehicles used for County business defensively and

courteously. Be certain to follow all traffic regulations. Your seat belt must be

worn at all times while driving on County business.

 Always make sure that all operating components of County vehicles (i.e. brakes,

lights, horn, tires, steering, windshield wipers, engine) function properly. Report

any defects to General Services -- Automotive Division at 875-5408.

 Keep aisles, floors, hallways, stairs and exits clean and free from obstructions

and hazards at all times.

 Do not operate or use any equipment, machine, tool, furniture, or material that is

broken or damaged or that you have not been trained to operate. Report any

defects to your supervisor immediately.

 Do not operate any material handling equipment, such as cranes or lift trucks,

unless you are a trained and certified operator.

 Never indulge in horseplay, practical jokes, arguments or other behaviors that

take attention away from the primary task. These actions may result in serious

injury.

 Never tempt, assist or fail to report another employee’s violation of a safety rule

or procedure.

APPENDIX B
- 23 -

EMERGENCY EVACUATION PROCEDURES

COUNTY OF SACRAMENTO

Sacramento County Airport System

6900 Airport Blvd

Sacramento, CA 95837

WHEN AN EMERGENCY SOUNDS:

 Remain Calm.

 Listen to and follow instructions from emergency personnel.

 Walk to the nearest stairway exit. Do not use the elevators during an emergency evacuation.

 Once outside, walk to the pre-designated assembly area:

(Nearest corner of Administration employee parking lot.)

 Check in with your Floor Warden at the pre-designated assembly area.

 Stay there until released.

IF YOU DISCOVER A FIRE:

 Warn other people and activate fire alarm. There is a fire alarm located immediately outside of our

two exit doors. (See Evacuation Route Plan.)

 Call 9 - 911 to report the fire (use any phone).

 If you have been properly trained, use the fire extinguisher.

 Never turn your back on an extinguished fire.

 Feel a closed door before opening it. If it feels warm anywhere on its surface, go to another exit.

 Report any missing staff to emergency response personnel. NEVER re-enter a building during

evacuation.

EMERGENCY TELEPHONE NUMBERS:

TO CALL... DIAL...

Emergency 9-911

Communications Center 00

County Operator 5-6900

1

st Floor Warden (Matt Doyle) 4-0708

2

nd Floor Warden (Tim Patterson) 4-0653

Alternate Floor Warden (Randy Lee) 4-0680

PRE-DESIGNATED ASSEMBLY AREA:

Nearest corner of the Administration employee parking lot.
- 24 -

APPENDIX C

INSERT LOCAL EMERGENCY EVACUATION OFFICE FLOOR PLAN