BASIC Safety Program
TABLE OF CONTENTS
A. Safety Policy Statement Page(s) 2
B. Safety Policy Assignment of Responsibilities 3
C. Authority and Accountability 3
D. Annual Review Accident Prevention Plan 3-4
E. Injury and Illness Data 4
F. Accident /Injury Anaylsis 4
G. Recordkeeping 4-5
H OSHA Records 5
I. Inspection Reports 5
J. Safety Meetings/Training 5-6
K. Accident Investigation/Reports 6
L. Accident Prevention Plan Health and Safety Training 6
M. Safety Inspection Policy 6
N. Accident Investigation Procedures 7
O. Accident Investigation Guidelines 7-8
P. Disciplinary Policy 8
APPENDICES
Appendix A 9
Appendix B 10
Appendix C 11
Appendix D 12
Appendix E 13
Appendix F 14
Appendix G 15
Relay Delivery, Inc. 11/1/2022
4 E 27th St
NY, NY 10001
DESIGNATED PROGRAM COORDINATOR (TITLE): Director of Operations
SAFETY POLICY STATEMENT
It is the policy of this company to work continually toward improving safety policy as well as safety procedures. The personal safety and health of each employee is of primary importance. To the greatest degree possible, management will provide all mechanical and physical facilities required for personal safety and health in keeping with the highest standards.
We will maintain a safety and health program conforming to the best practices of organizations of this type. To be successful, such a program must embody the proper attitudes toward injury and illness prevention on the part of both on-site supervisors and employees. It also requires cooperation in all safety and health matters, not only between on-site supervisors and the employees, but also between each employee and his or her fellow workers. Only through such a cooperative effort can a safety program in the best interest of all be established and preserved.
Our objective is a safety and health program that will reduce the number of injuries and illnesses to an absolute minimum, not merely in keeping with, but surpassing, the best experience of other operations similar to ours.
We recognize that the responsibilities for safety and health are shared.
The company accepts the responsibility for leadership of the safety and health program, for its effectiveness and improvement, and for providing the guidance and assistance to ensure safe working conditions.
Supervisors are responsible for developing the proper attitudes toward safety and health in themselves and in those they supervise, and for ensuring that all operations are performed with the utmost regard for the safety and health of all personnel involved, including themselves.
Employees are responsible for the wholehearted, genuine cooperation with all aspects of the safety and health program, including compliance with all rules and regulations, and for continuously practicing safety while performing their duties.
Management considers no phase of the operation more important than the health and safety of the employee. Management will continue to be guided and motivated by this policy and, with the cooperation of all supervisors and employees will actively pursue a safer working environment throughout the company.
DATE 11/1/2022 Director of Operations
SAFETY POLICY ASSIGNMENT OF RESPONSIBILITIES
The Designated Program Coordinator is the primary person responsible for the implementation and enforcement of the corporate safety policy.
Managers and supervisors will assume the responsibility for enforcing the program. In addition, the Designated Program Coordinator will be responsible for all documentation and records developed as a result of safety training, meetings, accident investigations, and hazard reports required by this plan.
C. AUTHORITY AND ACCOUNTABILITY
Management accepts responsibility for providing resources and guidance for the development and implementation of the safety and health program.
Managers and supervisors are responsible and will be held accountable for the overall implementation of the working plan.
Supervisors will be responsible for ensuring that all employees follow all safety and health policies, procedures, and rules established by the company.
Managers and supervisors are responsible for administering training and guidance to employees.
Employees will assist the company with commitment to the safety and health program, abiding by the policies, procedures, rules set forth by the program, and becoming actively involved in the program to assist in providing a safe and healthful workplace for all involved.
Contractor managers and supervisors who provide or perform services for our company are responsible to ensure that all employees, and services provided by employees, are performed and delivered in a manner that is consistent with our commitment to safety and health.
Our written safety program will be made available for review by all employees.
ANNUAL REVIEW ACCIDENT PREVENTION PLAN
The Designated Program Coordinator will review the written safety program during the first month of each calendar year and will revise as necessary and appropriate.
This review will be to determine if all areas of exposure are addressed in the written safety program.
Any new hazards identified during the review will be addressed in the written safety program and employees will receive training.
Annual reviews will be documented showing date of review and any new areas of exposure identified.
Documentation will be maintained by the Designated Program Coordinator.
E. INJURY AND ILLNESS DATA
The Designated Program Coordinator will maintain records of all work-related injuries and illnesses.
The following records are applicable only to work-related injuries and illnesses:
• OSHA Form 300 - Record of Occupational Illness and Injuries and associated forms
• Applicable State Workers’ Compensation Form, First Report of Injury
• Record of first aid or other non-recordable incidents
• Insperity Supervisor Accident Investigation Reports (when injuries are involved)
Accident and injury records will be kept by the Designated Program Coordinator for a period of five (5) years as required by OSHA regulation. All data pertaining to injuries or illnesses that did not require medical treatment, or were otherwise not recordable on the above-mentioned documents, will be maintained in written record form (first aid log). This will include first aid treatment of any kind.
F. ACCIDENT/INJURY ANALYSIS
The Designated Program Coordinator will review all accident investigation reports, hazard reports, incident reports, inspection reports, and the OSHA 300 as needed to identify any trends in accidents or hazards that may be developing at our company location(s).
Trend analysis will identify recurring accidents and near miss incidents resulting in, or potentially involving injury, illness, or property damage. The analysis will also recognize repeatedly identified hazards/violations needing corrective action.
Managers, supervisors, and employees will be made aware of developing trends and hazard exposures as they are recognized. The Designated Program Coordinator will recommend corrective actions to be taken to prevent recurrence of similar accidents or hazards. Managers and supervisors will be responsible for implementing corrective actions.
Documentation of these reviews will be retained by for a period of 12 months.
G. RECORDKEEPING
An effective recordkeeping program allows us to identify areas for improvement in our safety program. The recordkeeping element is also essential in tracking the performance of duties and responsibilities under the program (see specific references to required program documents throughout the written safety program).
The Designated Program Coordinator is responsible for maintaining documentation of training, accident reports, OSHA logs, hazard reports, incident reports, and any other documentation incidental to the implementation of this accident prevention plan. Blank forms for all safety-related training and documentation will be available from the Designated Program Coordinator.
OSHA RECORDS
An injury log will be maintained at each location and copied to the central office if applicable. Injuries will be recorded on an OSHA 300 form or equivalent within 24 hours of being reported.
The summary portion of the OSHA 300 form will be posted from February 1 to April 30 each year, in a place where employee notices are normally posted.
Injury records will be retained for a period of five (5) calendar years.
INSPECTION REPORTS
Documentation will include: (1) date of inspection, (2) name of inspector, (3) discrepancies found, (4) person responsible for corrections, and (5) estimated date of correction.
Reports will be maintained until all discrepancies are corrected or at least 12 months, whichever is longer.
J. SAFETY MEETINGS/TRAINING
Employee training records will also be reviewed on a regular basis to ensure an adequate
and effective training program is maintained. Employees will also be interviewed from time to time to establish retention of training and determine when information should be supported or repeated.
Documentation will include: (1) date of training, (2) name of trainer, (3) subject(s) covered, and (4) signed attendance roster.
All training required by OSHA will be conducted on a timely basis and records will be maintained in accordance with OSHA or other directing guidelines.
Specialized training (forklift operator, crane operator, hazard communication, etc.) will be provided and documented before employees are required to perform tasks involving hazards related to the subject matter.
Reports will be filed in a log and maintained for a period of 24 months or as required by law or directives.
ACCIDENT INVESTIGATION REPORTS
A written accident report will be filed with the Designated Program Coordinator where it will be available for review. The investigation will be documented on the company form (Supervisor’s Accident Investigation Report). The report will be retained for a period of 24 months or as required by law or directives.
ACCIDENT PREVENTION PLAN HEALTH AND SAFETY TRAINING
Employees will attend regular safety meetings, which will be conducted by management, a management designee, and/or safety consultant.
Safety training meetings will be documented and records will be maintained by the on-site supervisor and/or department manager. Copies of safety training records will be provided to the Designated Program Coordinator.
Hazard communication training will be given to all new employees before being allowed to work with hazardous materials. Refresher training will be given as needed when new hazardous material is introduced into the workplace. Safety Data Sheets (SDS) formally known as Material Safety Data Sheets (MSDS) will be included in the company hazard communication program and made available to all employees.
SAFETY INSPECTION POLICY
Managers and supervisors will be responsible for conducting and documenting safety inspections within the facility. Records of these inspections will be maintained and a copy provided to the Designated Program Coordinator.
Employees are responsible for inspecting their workstations for possible hazards. Hazards will be reported to the supervisor. The supervisor will take corrective action(s) as necessary to protect employees. Hand and power tools will be inspected daily to identify any hazardous conditions prior to beginning work.
The supervisor will be responsible for conducting daily inspections of the workplace and correcting any identified hazards.
Any vehicles being operated will be inspected thoroughly by the driver before use. Documentation of these inspections will be kept by the foreman for a period of 12 months
ACCIDENT INVESTIGATION PROCEDURES
l. Investigations are required on all accidents including those "near misses" not producing injuries. Near miss investigations will be documented. Near miss investigation reports will be reviewed to determine if a recurring hazard exists. Accidents that do not produce injury have probably produced other job hindrances, such as delays, damaged material, damaged equipment, etc.
2. All accidents are to be investigated by the supervisor or lead person of the employee(s) involved. Investigations will be conducted as soon as possible, but no later than 24 hours after the accident.
3. Employee work related injury and illness events will be reported using the “First Report of Injury” and “Supervisor Accident Investigation Report” (both available on Insperity’s Employee Service Center website), and will be forwarded to Insperity’s Workers’ Compensation Department, who will forward to the safety consultant for review.
All incident reports, hazard reports, accident investigation reports, and inspection checklists will be reviewed by company management to determine if trends are occurring.
4. These are the simple steps involved in producing a thorough and effective investigation:
Understand the need for the investigation.
Prepare for the investigation.
Gather facts about the investigation (who, what, where, why, when, and how).
Take pictures, draw diagrams, and get witness statements (do not rely on memory, accident scenes change).
Analyze the facts.
Develop conclusions.
Analyze conclusions.
Make a report. Be very detailed and don't leave out simple facts.
Correct the situation(s) or recommend corrective actions, depending on your authority.
Follow through on recommendations.
Double check the corrective action(s).
Critique the investigation (assist management in reviewing the investigation report).
5. Each person in the review process is responsible for assuring thorough investigations and following up on corrective action to make sure it is effective.
ACCIDENT INVESTIGATION GUIDELINES
An accident can be defined as any occurrence that interrupts or interferes with the orderly progress of the job and usually occurs suddenly and unexpectedly. Some accidents involve human injury. Accidents arise from a combination of unsafe acts and unsafe conditions.
The intent of an accident investigation should be to determine what basic condition or act caused the accident so corrective measures can be taken to prevent recurrence and not to identify the guilty party.
The person supervising the employee involved will conduct a comprehensive investigation. Supervisors are responsible for getting the most efficient use out of the equipment, material, and people. They are also who management looks to solve operational problems such as unsafe acts or conditions.
An accident should be investigated as soon as possible and at least within the first 24 hours of the occurrence. The sooner the information is gathered, the more accurate the facts will be.
The accident investigation should include the following:
Interview the employee involved (when possible) to evaluate the situation and potential liability.
Photograph the scene (if possible). Do not rely on memory.
Locate, interview, and get statements from any witnesses.
Evaluate any evidence found at the scene and reconstruct events.
Have involved employees step through the sequence of events.
Do not disturb the accident scene until you are satisfied with the investigation.
Before leaving the scene, warn, protect, and/or repair any exposure areas.
Involved employee should complete a written report before leaving for the day. Be sure the report is in sufficient detail.Re‑interview the involved employee if necessary.
Complete all documentation of the event.
DISCIPLINARY POLICY
Managers, supervisors, and employees are required to comply with company safety and health policies, procedures, and practices as a condition of employment.
APPENDIX A
SAMPLE ANNUAL REVIEW ACCIDENT PREVENTION PLAN
DATE OF REVIEW: 9/22/2022
NEW EXPOSURES IDENTIFIED: Bicycles colliding with automobiles
ACTION TAKEN:
REVIEWED BY:
John Smith DATE 9/22/2022
2. DATE
3. DATE
APPENDIX B
SAFETY AWARENESS PROGRAM ATTENDANCE SHEET
DATE HELD:
LOCATION (address):
TRAINER:
The following personnel attended the training held on the above date.
PRINT NAME SIGNATURE SSN LAST 4 DIGITS
TOPICS DISCUSSED
Safety within employee handbook + contractor agreement
APPENDIX C
SAFETY HAZARD REPORT
LOCATION: DATE:
TIME: AREA:
HAZARD CORRECTION:
RECOMMENDATION:
ASSIGNED TO:
CORRECTION DATE:
APPENDIX D
EMPLOYEE SAFETY SUGGESTION
This form is for use by employees who wish to provide a safety suggestion to report an unsafe workplace condition or practice.
Description of unsafe condition or practice:
Causes or other contributing factors:
Employee’s suggestion for improving safety:
Has this matter been reported to the area supervisor? Yes FORMCHECKBOX No FORMCHECKBOX
Employee Name (Optional):
Department: Date:
Use of this form or other reports of unsafe conditions or practices are protected by law. It would be illegal for the employer to take any action against an employee in reprisal for exercising rights to participate in communications involving safety.
APPENDIX E
INDIVIDUAL EMPLOYEE TRAINING DOCUMENTATION AND SAFETY COMMUNICATIONS
Employer:
Name of Trainer:
Name of Employee:
Date of Hire/Assignment:
I have received training as described above in the following areas:
Description of the employer’s workplace safety program.
The potential occupational hazards in the general work area and associated with my job assignment.
The safe work conditions, safe work practices, and personal protective equipment required for my work.
The hazards of any chemicals to which I may be exposed and to my right to information.
My right to ask any questions or provide any information to the employer on safety either anonymously or without any fear of reprisal.
Procedures the employer will use to enforce compliance with safe work practices, including discipline.
Other:
I understand this training and agree to comply with the safe work practices for my job.
Employee Signature Date
APPENDIX F
EMPLOYEE SAFETY ORIENTATION
Name: Date Employed:
Department Assigned:
Job Assignment:
The following items should be discussed during orientation:
Company safety policies and programs – reviewed with and made available to the employee. Safety rules, both general and specific to job assignment.
Safety rule enforcement policy (disciplinary procedures).
Where, when, and how to report injuries.
Where, when, and how to report unsafe conditions.
Review of fire and emergency evacuation plan.
Location and use of fire extinguishers.
Requirement for safe work clothing and footwear.
Importance of housekeeping (spills, etc.).
Special job hazards (chemicals, special precautions, etc.).
Assignment and use of personal protective equipment.
Proper lifting procedures (include demonstration).
Employee is certified in the following:
Additional training requirements: Important: If employee is transferred to another job, a new safety orientation form should be completed.
Signed: Date:
Supervisor
Signed: Date:
Employee
Complete and return to personnel office.
APPENDIX G
SAFETY VIOLATION LOG
Employee Name: Date:
Date of Unsafe Act/Condition: Time:
Hazard or Problem:
Suggestions:
Supervisor: Date:
Action Taken:
Supervisor complete and give to Department Manager and copy to file.
Manager: Date:
Review – Comments:
Signature
This manual contains proprietary material of Insperity and is protected by copyright and other laws respecting proprietary rights. It may not be reproduced, copied, or transmitted in any form without the express written consent of Insperity. Insperity has loaned it to its client company who may not otherwise distribute it to anyone outside of the client company. It shall be returned to Insperity upon request.
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