MODEL INJURY AND ILLNESS PREVENTION PROGRAM
FOR HIGH HAZARD EMPLOYERS

ABOUT THIS MODEL PROGRAM

Every California employer must establish, implement and maintain a written Injury and Illness Prevention (IIP) Program and a copy must be maintained at each workplace or at a central worksite if the employer has non-fixed worksites. The requirements for establishing, implementing and maintaining an effective written injury and illness prevention program are contained in Title 8 of the California Code of Regulations, Section 3203 (T8 CCR 3203) and consist of the following eight elements:

This model program has been prepared for use by employers in industries, which have been determined by Cal/OSHA to be high hazard. You are not required to use this program. This model program was written for a broad spectrum of employers and it may not match your establishment's exact needs. However, it does provide the essential framework required for an Injury and Illness Prevention Program.

Proper use of this model program requires the IIP Program administrator of your establishment to carefully review the requirements for each of the eight IIP Program elements found in this model program, fill in the appropriate blank spaces and check those items that are applicable to your workplace. The recordkeeping section requires that the IIP Program administrator select and implement the category appropriate for your establishment. Sample forms for hazard assessment and correction, accident/exposure investigation, and worker training and instruction are provided with this model program.

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

INJURY AND ILLNESS PREVENTION PROGRAM

RESPONSIBILITY

The Injury and Illness Prevention Program (IIP Program) administrator,

________________________________________________________________________

Program Administrator

has the authority and responsibility for implementing the provisions of this program for

____________________________________________________________.

Establishment Name

All managers and supervisors are responsible for implementing and maintaining the IIP Program in their work areas and for answering worker questions about the IIP Program. A copy of this IIP Program is available from each manager and supervisor.

COMPLIANCE

Management is responsible for ensuring that all safety and health policies and procedures are clearly communicated and understood by all employees. Managers and supervisors are expected to enforce the rules fairly and uniformly.

All employees are responsible for using safe work practices, for following all directives, policies and procedures, and for assisting in maintaining a safe work environment.

Our system of ensuring that all workers comply with the rules and maintain a safe work environment include:

_______________________________________________________________________________

_______________________________________________________________________________

COMMUNICATION

We recognize that open, two-way communication between management and staff on health and safety issues is essential to an injury-free, productive workplace. The following system of communication is designed to facilitate a continuous flow of safety and health information between management and staff in a form that is readily understandable and consists of one or more of the following checked items:

________________________________________________________________________________

________________________________________________________________________________

________________________________________________________________________________

HAZARD ASSESSMENT

Periodic inspections to identify and evaluate workplace hazards shall be performed by the following competent observer(s) in the following areas of our workplace:

Competent Observer  

Area

 

 

 

 

 

 

 

 

 

 

 

 

Periodic inspections are performed according to the following schedule:

Frequency (Daily, weekly, monthly, etc.)

Periodic inspections consist of identification and evaluation of workplace hazards utilizing applicable sections of the attached Hazard Assessment Checklist and any other effective methods to identify and evaluate workplace hazards.

ACCIDENT/EXPOSURE INVESTIGATIONS

Procedures for investigating workplace accidents and hazardous substance exposures include:

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 according to the following procedures:

TRAINING AND INSTRUCTION

All workers, including managers and supervisors, shall have training and instruction on general and job-specific safety and health practices. Training and instruction shall be provided as follows:

Workplace safety and health practices for all industries include, but are not limited to, the following:

In addition, we provide specific instructions to all workers regarding hazards unique to their job assignment, to the extent that such information was not already covered in other training.

RECORDKEEPING

We have checked one of the following categories as our recordkeeping policy.

1. Records of hazard assessment inspections, including the person(s) or persons conducting the inspection, the unsafe conditions and work practices that have been identified and the action taken to correct the identified unsafe conditions and work practices, are recorded on a hazard assessment and correction form; and

2. Documentation of safety and health training for each worker, including the worker's name or other identifier, training dates, type(s) of training, and training providers are recorded on a worker training and instruction form. We also include the records relating to worker training provided by a construction industry occupational safety and health program approved by Cal/OSHA.

Inspection records and training documentation will be maintained according to the following checked schedule:

LIST OF TRAINING SUBJECTS

We train our workers about the following checked training subjects:

_______________________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________

HAZARD ASSESSMENT CHECKLIST

GENERAL WORK ENVIRONMENT

PERSONAL PROTECTIVE EQUIPMENT & CLOTHING

WALKWAYS

FLOOR & WALL OPENINGS

STAIRS & STAIRWAYS

ELEVATED SURFACES

EXITING OR EGRESS

EXIT DOORS

PORTABLE LADDERS

HAND TOOLS & EQUIPMENT

PORTABLE (POWER OPERATED) TOOLS & EQUIPMENT

ABRASIVE WHEEL EQUIPMENT GRINDERS

POWDER ACTUATED TOOLS

MACHINE GUARDING

LOCKOUT BLOCKOUT PROCEDURES

WELDING, CUTTING & BRAZING

COMPRESSORS & COMPRESSED AIR

COMPRESSED AIR RECEIVERS

COMPRESSED GAS & CYLINDERS

HOIST & AUXILIARY EQUIPMENT

INDUSTRIAL TRUCKS - FORKLIFTS

SPRAYING OPERATIONS

ENTERING CONFINED SPACES

ENVIRONMENTAL CONTROLS

FLAMMABLE & COMBUSTIBLE MATERIALS

FIRE PROTECTION

HAZARDOUS CHEMICAL EXPOSURES

HAZARDOUS SUBSTANCES COMMUNICATION

ELECTRICAL

NOISE

FUELING

IDENTIFICATION OF PIPING SYSTEMS

MATERIAL HANDLING

TRANSPORTING EMPLOYEES & MATERIALS

CONTROL OF HARMFUL SUBSTANCES BY VENTILATION

SANITIZING EQUIPMENT & CLOTHING

TIRE INFLATION

EMERGENCY ACTION PLAN

INFECTION CONTROL

ERGONOMICS

VENTILATION FOR INDOOR AIR QUALITY

CRANE CHECKLIST

HAZARD ASSESSMENT AND CORRECTION RECORD

 

 

 

 

 

 

 

 

 

  

 

ACCIDENT/EXPOSURE INVESTIGATION REPORT

 

 

 

 

 

 

 

 

 

 

WORKER TRAINING AND INSTRUCTION RECORD

EMPLOYEE NAME

TRAINING DATES

TYPE OF TRAINING

TRAINERS